Datasets:

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Euanyu

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medmcqa-processed-dataset

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[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: Which of the following is a manifestation of 22q11 mutation syndrome?\n###Options:\nA. Hypercalcemia\nB. Conotruncal abnormalities\nC. Thymic hyperplasia\nD. Dysmorphogenesis of the 1st and 2nd pharyngeal pouches\n", "role": "user" }, { "content": "###Rationale: Chromosome 22q11.2 deletion syndrome encompasses a spectrum of disorders that result from a small deletion of band q11.2 on the long arm of chromosome 22. It is also called as Velocardiofacial syndrome or DiGeorge syndrome It is characterized by Dysmorphogenesis of the 3rd and 4th pharyngeal pouches resulting in following features: C: Cardiac anomaly/cono-truncal anomaly A:Abnormal facies T: Thymic hypoplasia/T cell abnormality C: Cleft palate H: Hypocalcemia 22: Chromosome 22\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your role as a doctor requires you to answer the medical questions taking into account the patient's description.\nAnalyze the question and answer with the best option.###Question: All of the following are true about medulloblastoma except?\n###Options:\nA. It is the most common primary malignant brain tumor in childhood\nB. Isochrome 17q indicates poor prognosis\nC. Most common site is brainstem (medulla)\nD. Tumor is highly radio sensitive\n", "role": "user" }, { "content": "###Rationale: Medulloblastoma occurs exclusively in the cerebellum.\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: A 40-year-old man complains of nausea, vomiting, diarrhea, and cramping abdominal pain. His temperature is 38degC , blood pressure 90/60 mm Hg, and pulse rate 90/minute. On physical examination, the patient appears dehydrated, with sunken eyeballs, dry tongue, and poor skin turgor. Hyperpigmentation is noted in the palmar creases and the gingival margins. Laboratory results include fasting serum glucose of 62 mg/dL, BUN of 27 mg/dL, Na of 122 mEq/L, and K of 6.5 mEq/L. Which of the following is the most likely cause of this patient's symptoms?\n###Options:\nA. Amyloidosis\nB. Autoimmunity\nC. Metastatic cancer\nD. Sarcoidosis\n", "role": "user" }, { "content": "###Rationale: - Given clinical features suggests the diagnosis of Primary chronic adrenal insufficiency (Addison disease). - MCC of addison disease in developed countries - Autoimmunity - MCC of addison disease in developing countries like India - Tuberculosis - It is fatal wasting disorder caused by failure of adrenal glands to produce glucocoicoids, mineralocoicoids & androgens. - If untreated, Addison disease is characterized by weakness, weight loss, gastrointestinal symptoms, hypotension, electrolyte disturbances & hyperpigmentation.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Considering your role as a medical practitioner, please use the patient's description to answer the medical questions.\nAnalyze the question and answer with the best option.###Question: Internucleosomal cleavage of DNA is characteristic of:\n###Options:\nA. Reversible cell injury\nB. Irreversible cell injury\nC. Necrosis\nD. Apoptosis\n", "role": "user" }, { "content": "###Rationale: . Apoptosis\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your role as a doctor requires you to answer the medical questions taking into account the patient's description.\nAnalyze the question and answer with the best option.###Question: An 8-year-old child has had abdominal pain and dark urine for 10 days. Physical examination shows blotchy purple skin lesions on the trunk and extremities. Urinalysis shows hematuria and proteinuria. Serologic test results are negative for MPO-ANCA (P-ANCA) and PR3-ANCA (C-ANCA). A skin biopsy specimen shows necrotizing vasculitis of small dermal vessels. A renal biopsy specimen shows immune complex deposition in glomeruli, with some IgA-rich immune complexes. Which of the following is the most likely diagnosis?\n###Options:\nA. Giant cell arteritis\nB. Henoch-Schonlein purpura\nC. Polyarteritis nodosa\nD. Takayasu arteritis\n", "role": "user" }, { "content": "###Rationale: In children, Henoch-Schonlein purpura is the multisystemic counterpart of the IgA nephropathy seen in adults. The immune complexes formed with IgA produce the vasculitis that affects mainly arterioles, capillaries, and venules in the skin, gastrointestinal tract, and kidney. In older adults, giant cell arteritis is seen in external carotid branches, principally the temporal artery unilaterally. Polyarteritis nodosa is seen most often in small muscular arteries and sometimes veins, with necrosis and microaneurysm formation followed by scarring and vascular occlusion. This occurs mainly in the kidney, gastrointestinal tract, and skin of young to middle-aged adults. Takayasu arteritis is seen mainly in children and involves the aorta (particularly the arch) and branches such as coronary and renal arteries, with granulomatous inflammation, aneurysm formation, and dissection. Telangiectasias are small vascular arborizations seen on the skin or mucosal surfaces.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: A 55-year-old woman presents to the clinic for evaluation of several weeks of fever, abdominal pain, weight loss, and lack of energy. Three days prior to the assessment, she developed a left foot drop. Her blood pressure is 160/90 mm Hg, pulse 80/min, and the physical examination confirms left peroneal nerve damage and a bilateral sensory neuropathy in both legs. There are no skin rashes. Laboratory evaluation reveals an ESR of 105 mm/h, WBC of 14,000/mL, and negative serologic tests for antineutrophil cytoplasmic antibody (ANCA) and ANA. The eosinophil count is normal, and urinalysis is negative for casts, protein, and red cells. A clinical diagnosis of polyarteritis nodosa is made. Which of the following is the most likely mechanism for renal injury in this condition?\n###Options:\nA. nephrotic syndrome\nB. diffuse glomerulonephritis\nC. granuloma formation\nD. necrotizing vasculitis of vessels\n", "role": "user" }, { "content": "###Rationale: This patient has polyarteritis nodosa (PAN) and in classic PAN, unlike microscopic polyangiitis, both small and medium vessels are involved. The renal lesions are ischemic secondary to fibrinoid necrosis of the vessels. In microscopic polyangiitis, a diffuse glomerulonephritis is frequently present. The most common organ systems involved are the kidneys, musculoskeletal system, and peripheral nervous system.\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Most common type of renal stone is: March 2013 (d)\n###Options:\nA. Calcium phosphate\nB. Magnesium ammonium phosphate\nC. Cystine\nD. Uric acid\n", "role": "user" }, { "content": "###Rationale: Ans. A i.e. Calcium Phosphate\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnswer with the best option directly.###Question: A 14 year old female patient complains of decayed teeth. Intra-oral examination reveals restoration of occlusal caries with composite restoration. Which of the following lasers is used for curing of this restorative material?\n###Options:\nA. Argon\nB. CO2\nC. Nd:YAG\nD. Excimers\n", "role": "user" }, { "content": "###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: Drug of choice in amoebic liver abscess is\n###Options:\nA. Metronidazole\nB. Ciprofloxacin\nC. Emetine\nD. Chloroquine\n", "role": "user" }, { "content": "###Rationale: (A) Metronidazole # Metronidazole acts directly on the trophozoites of E. histolytica. Because of high concentration in liver extensively small amounts of drug (800 mg, TDS X 5-10 days) effective in Amoebic Liver Abscess.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: WHO immunization evaluation coverage survey is normally done in what age group?\n###Options:\nA. 0-12 months\nB. 6-12 months\nC. 12-23 months\nD. 9-12 months\n", "role": "user" }, { "content": "###Rationale: Ans. is 'c' i.e., 12-23 months WHO used 30 x 7 technique (total = 210 children) for cluster sampling in which there are 30 clusters, each containing 7 childrenwho are 12 - 23 months old and are completely immunized for primary immunization (till measles vaccine at 9 month).\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnalyze the question and answer with the best option.###Question: Pseudokidney sign' on USG is seen in\n###Options:\nA. Trichobezoar\nB. CA stomach\nC. CA kidney\nD. Polycystic kidney\n", "role": "user" }, { "content": "###Rationale: Ans. CA stomach\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Robe Koch assistant advised him to use agar instead of gelatin for solidifying culture media for cultivation of bacteria because\n###Options:\nA. Agar has more nutrients\nB. Gelatin melts at 37oC\nC. Gelatin is not easily available\nD. Agar is cheaper\n", "role": "user" }, { "content": "###Rationale: Gelatin was the substance originally used to gel culture media. However, gelatin is liquid at 35oC., the optimum temperature for many bacteria. In addition, some bacteria are capable of liquifying the gelatin, making it an unsuitable solidifying agent. Agar has neither of these drawbacks. Agar is preferred over gelatin, as it is bacteriologically ine, melts at 98degC and usually solidifies at 42degC.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Super imposition technique is used in :\n###Options:\nA. Skull\nB. Pelvis\nC. Femur\nD. Ribs\n", "role": "user" }, { "content": "###Rationale: A i.e. Skull\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnalyze the question and answer with the best option.###Question: True about citrate in ORS\n###Options:\nA. Cheaper\nB. Nutritious\nC. Increases shelf\nD. Tastier\n", "role": "user" }, { "content": "###Rationale: In WHO ORS, sodium bicarbonate has been replaced by trisodium citrate: –\nMakes the product more stable –\nResults in less stool output (especially in high-output diarrhoea like cholera) as it increases intestinalabsorption of sodium and water\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnswer with the best option directly.###Question: All the drugs given below can be used to protect gastric ulcer except\n###Options:\nA. Colloidal bismuth salt\nB. Magnesium hydroxide\nC. Misoprostal\nD. Sucralfate\n", "role": "user" }, { "content": "###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Isolation period should be -\n###Options:\nA. Minimum incubation period\nB. Maximum incubation period\nC. Period interval\nD. Generation time\n", "role": "user" }, { "content": "###Rationale: Isolation is defined as the period of communicability of infected person or animals from others in such places and such strict conditions as to prevent or limit the indirect transmission of the infectious agent from those infected to those who are susceptible or who may spread the agent to others (refer pgno:120 park 23 rd edition)\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnalyze the question and answer with the best option.###Question: Dangerous area of eye:\n###Options:\nA. Ciliary body\nB. Optic nerve\nC. Sclera\nD. Choroid\n", "role": "user" }, { "content": "###Rationale: A i.e. Ciliary body\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Hummingbird sign in brain MRI is seen in ?\n###Options:\nA. Multiple sclerosis\nB. Progressive supranuclear palsy\nC. Parkinson's disease\nD. Alzheimer disease\n", "role": "user" }, { "content": "###Rationale: Ans. is 'b' i.e., Progressive supranuclear palsyHummingbird sign on brain MRI is a radiological sign of progressive supranuclear palsy.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnswer with the best option directly.###Question: The commonest site of lytic lesion in multiple myeloma is -\n###Options:\nA. Vertebral column\nB. Femur\nC. Clavicle\nD. Pelvis\n", "role": "user" }, { "content": "###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Earliest radiological change in RHEUMATOID AHRITIS is ?\n###Options:\nA. Decreased joint space\nB. Aicular erosion\nC. Periaicular osteopenia\nD. Subchondral cyst\n", "role": "user" }, { "content": "###Rationale: REF : MAHESWARI 9TH ED\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Hypopigmented patches are seen in\n###Options:\nA. Nevus ota\nB. Nevus Ito\nC. Nevus anemicus\nD. Becker nevus\n", "role": "user" }, { "content": "###Rationale: Nevus anemicus presents as a single or multiple patches of hypopigmentation with ill-defined margins merging into normal skin present at bih or thereafter. Nevus anemicus presents as congenital hypopigmented patches with a well-defined border. They are asymptomatic and typically seen on the upper trunk, although they have also repoed on the face and extremities. The distribution of hair, formation of sweat, and skin sensation are unaffected by nevus anemicus (Ref: harrison.20th edition pg 1267\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: A premature infant is more likely than a full-term infant to –\n###Options:\nA. Suffer from jaundice of hepatic origin\nB. Maintain in normal body temperature in a cold environment\nC. Excrete urine with a uniform specific gravity\nD. Suffer from anaemia\n", "role": "user" }, { "content": "###Rationale: The liver of premature (preterm) neonate is functionally immature that leads to hypoglycemia, hyperbilirubinemia (jaundice) and poor detoxification of drugs.\n\nProblems of preterm Premature babies\n\nBirth asphyxia                                           \nHypothermia                                                                                           \nFeeding difficulties                                             \nInfections                                                                    \nRespiratory distress      \nARDS (Hyaline membrane dis)     \nHyperbilirubinemia     \nApenia   \nIntraventricular haemorrhage    \nHypocalcemia \nNecrotising enterocolitis  \nMetabolic acidosis\nHypoglycemia\nHypoproteinemia\n\nNote - Problems of preterm small for date babies include problems of both i.e. problems of preterm and problems of small for date.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: Least post translational modification occurs in\n###Options:\nA. t-RNA\nB. Prokaryotic r- RNA\nC. Eukaryotic r - RNA\nD. Prokaryotic mRNA\n", "role": "user" }, { "content": "###Rationale: D i.e. Prokaryotic mRNA\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: In myasthenia gravis, antibodies are present against:September 2012\n###Options:\nA. Muscarinic receptor proteins\nB. Nicotinic receptor proteins\nC. Protein actin\nD. Protein myosin\n", "role": "user" }, { "content": "###Rationale: Ans. B i.e. Nicotinic receptor proteinsMyasthenia gravisIt is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability.It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the excitatory effects of the neurotransmitter acetylcholine on nicotinic receptors throughout neuromuscular junctions.Myasthenia is treated medically with acetylcholinesterase inhibitors or immunosuppressants, and, in selected cases,thymectomy.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Mineral oils are used in mosquito control measure as -\n###Options:\nA. A personal protection method\nB. Larvicide\nC. Adulticide\nD. Space spray\n", "role": "user" }, { "content": "###Rationale: Mineral oils are used as chemical control against mosquito larvae. The mineral oil application to water is the oldest method to control mosquito. oils used are diesel oil, fuel oil, kerosene oil, and crude oils. Special mosquito larvicidal oils are also available. Oil kills larvae and pupae within a sho time after application. When applied on water oil spreads and forms a thin film, which cuts off the air supply to mosquito larvae and pupae. Since the life cycle of a mosquito is about 8 days, its customary to apply oil once in a week on all breeding places. Other anti-larval measures include source reduction, using Paris green, and synthetic insecticides. Biological control with larvivorous fishes like Gambusia and Lebister. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 832\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: A patient with congenital nephrotic syndrome requires which of the following procedures?\n###Options:\nA. Live attenuated vaccines\nB. Renal biopsy\nC. Steroids in high doses\nD. Low protein diet\n", "role": "user" }, { "content": "###Rationale: Congenital nephrotic syndrome is a very rare form of nephrotic syndrome. It occurs predominantly in families of Finnish origin and manifests sholy after bih. It is an inherited disorder. The condition is caused by a defect in the protein nephrin. Requires renal biopsy for diagnosis.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: A woman presents with a thick curdy -- white vaginal discharge. The best treatment for her is :\n###Options:\nA. Miconazole\nB. Metronidazole\nC. Nystatin\nD. Doxycyclin\n", "role": "user" }, { "content": "###Rationale: Miconazole\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Considering your role as a medical practitioner, please use the patient's description to answer the medical questions.\nAnalyze the question and answer with the best option.###Question: Iodised salt is given in an area endemic to Goiter. Type of prevention:\n###Options:\nA. Health promotion\nB. Specific protection\nC. Primordial prevention\nD. Treatment\n", "role": "user" }, { "content": "###Rationale: Ans. (b) Specific protectionRef : K. Park 23rd ed. / 41, 370-73* Iodised salt is given in an area which has risk of developing goiter. This is a primary level of prevention done by specific protection.* Primordial prevention is done before the emergence of risk factor.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your role as a doctor requires you to answer the medical questions taking into account the patient's description.\nAnswer with the best option directly.###Question: Consider the following statements; giant cells are a\ncharacteristic histopathologic finding in\n###Options:\nA. Apthous ulcers\nB. Keratocyst\nC. Brown tumor of hyper parathyroidism\nD. Dentigerous cyst\n", "role": "user" }, { "content": "###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Modified Ziehl-neelsen staining is used for:\n###Options:\nA. Mycobacterium tuberculosis\nB. Mycobacterium bovis\nC. Nocardia\nD. All of the above\n", "role": "user" }, { "content": "###Rationale: Ans. is. 'd' i. e., All of the above\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Type of Collagen in Hyaline Cartilage is\n###Options:\nA. Type I\nB. Type II\nC. Type III\nD. Type IV\n", "role": "user" }, { "content": "###Rationale: Types of Collagen in different tissues\nType I - Bone, skin\nType II - Hyaline and elastic Cartilage\nType III - Skin, ligament, blood vessels\nType IV - Basement membrane in various tissue\nType V - Blood vessel wall, Synovium, corneal stroma\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a medical professional, your responsibility is to address the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Flaying is seen in which type of laceration -\n###Options:\nA. Tear\nB. Avulsion\nC. Split\nD. Stretch\n", "role": "user" }, { "content": "###Rationale: The synopsis of forensic medicine & toxicology ; Dr k.s.narayan reddy ;28th edition ; Pg.no. 110 & 111 . Flaying comes under avulsion .The shearing & grinding force by a weight ,such as lorry wheel passing over a limb ,may produce seperation of skin from underlying tissue (avulsion ) over a relatively large area .This is called \"FLAYING\" .The underlying muscles are crushed and the bones are fractured .\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: Site of action of vecuronium is -\n###Options:\nA. Cerebrum\nB. Reticular formation\nC. Motor neurone\nD. Myoneural junction\n", "role": "user" }, { "content": "###Rationale: Ans. is 'd' i.e., Myoneural junction Vecuronium is a nondepolarizing (competitive) neuromuscular blocker. The site of action is the end plate of skeletal muscles (End plate is thickened poion of muscle membrane at neuromuscular junction).\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: FALSE about Leprosy eradication programme is ?\n###Options:\nA. Early detection of cases\nB. Disability limitation\nC. Long term multi drug therapy\nD. Health education\n", "role": "user" }, { "content": "###Rationale: Ans. is 'c' i.e., Long term multidrug therapy o In leprosy eradication programme the multidrug therapy is not long term but sho term therapy. o Shoer therapy has added advantage of patient compliance, cost-effectiveness and decreased work load.\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: The intermediate syndrome in organophosphorus poisoning refers to the occurence of which of the following?\n###Options:\nA. Cholinergic syndrome with hypersecretion\nB. Organophosphate induced polyneuropathy\nC. Organophosphate induced delayed neuropathy\nD. Motor cranial nerve palsies\n", "role": "user" }, { "content": "###Rationale: Intermediate Syndrome: This has been repoed in some patients and is characterized by weakness of the upper extremities and neck musculature, cranial nerve palsies and secondary respiratory arrest. It may occur between 24 and 96 hours after ingestion.Delayed Neuropathy: May sometimes occur 1-4 weeks after exposure. The symptoms occur distally and progress proximally. The neuropathy is usually mixed with the patients complaining paraesthesias and motor weakness.Krishan Vij textbook of forensic medicine and toxicology 5e pg:533\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnswer with the best option directly.###Question: The main pathway for \"De - Novo\" synthesis of fatty acids occurs in\n###Options:\nA. Mitochondria\nB. Nucleus\nC. Cytosol\nD. None of the above\n", "role": "user" }, { "content": "###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnswer with the best option directly.###Question: Primary lesion in lichen planus is:\n###Options:\nA. Macule\nB. Papule\nC. Vesicle\nD. Bulk\n", "role": "user" }, { "content": "###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Considering your role as a medical practitioner, please use the patient's description to answer the medical questions.\nAnalyze the question and answer with the best option.###Question: Which of the following inhalational agents has the maximum blood gas solubility coefficient?\n###Options:\nA. Isoflurane\nB. Sevoflurane\nC. Desflurane\nD. Nitrous oxide\n", "role": "user" }, { "content": "###Rationale: Blood-gas paition coefficient, also known as Ostwald coefficient for blood-gas, is a term used in pharmacology to describe the solubility of inhaled general anesthetics in blood. The coefficient is defined as the ratio of the concentration in blood to the concentration in gas that is in contact with that blood when the paial pressure in both compaments is equal. It is inversely propoional to the induction rate. It determines the onset of induction and recovery. anesthetic blood gas solubility Nitrous oxide 0.47 Halothane 2.4 Isoflurane 1.4 Sevoflurane 0.65 Desflurane 0.45 Methoxyflurane 12 Enflurane 1.9\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Blood form of folic acid is -\n###Options:\nA. Folinic acid\nB. Pteroglutamate\nC. Methyl THE\nD. None\n", "role": "user" }, { "content": "###Rationale: Ans. is 'c' i.e., Methyl THE Folic acid is absorbed in the jejunum. Following absorption, folic acid is transpoed in blood by two (3-globulins. The major circulating form is methyltetrahydrofolate and the normal concentration range is 5-15 ng/ml. Once it arrives in the liver, the methyl derivates are taken up by hepatocytes where various coenzyme are produced. o Folic acid is not stored in the body. Remembers Major circulating form of folic acid --0 methyl THE Major point of entery for 1 carbon transfer by substitued folate -4 methylene THE\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnswer with the best option directly.###Question: Changes in the gingiva during pregnancy are attributed to\n###Options:\nA. Changes in the hormonal level\nB. Altered microorganisms\nC. Altered immunological responses level\nD. All the above\n", "role": "user" }, { "content": "###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: A female comes with normal breast development but scanty pubic hair. What is the most likely diagnosis ?\n###Options:\nA. Turner's syndrome\nB. Testicular feminizing syndrome\nC. Mullerian agenesis\nD. Gonadal dysgenesis\n", "role": "user" }, { "content": "###Rationale: Androgen insensitivity syndrome (AIS), formerly known as testicular feminization, is an X-linked recessive condition resulting in a failure of normal masculinization of the external genitalia in chromosomally male individuals. Adolescent patients have no pubic and axillary hair, with otherwise scanty body hair, and lack acne, although breasts are normal as a result of conversion of testosterone to estradiol. Mullerian agenesis is characterized by a failure of the mullerian ducts to develop, resulting in a missing uterus and fallopian tubes and variable malformations of the upper poion of the vagina. An individual with this condition is hormonally normal; that is, they will enter pubey with development of secondary sexual characteristics including thelarche and adrenarche (pubic hair). Gonadal dysgenesis is characterized by a progressive loss ofprimordial germ cells on the developing gonads of an embryo.The accompanying hormonal failure also prevents the development of secondary sex characteristicsin either sex, resulting in a sexually infantile female appearance and infeility. Failure to develop secondary sex characteristics (sexual infantilism) is typical in Turner's syndrome.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: A patient came with dyspnea, elevated JVP and edema in the feet. Lungs are clear. There is a parasternal heave and S2 is palpable in the pulmonary area. Which one of the following is LEAST helpful in determining etiology?\n###Options:\nA. Echo for mitral stenosis\nB. Anti-endomysial antibody estimation\nC. ELISA for HIV\nD. Urine/stool examination for Schistosoma ova\n", "role": "user" }, { "content": "###Rationale: * The findings of dyspnea, elevated JVP and pedal oedema are suggestive of right sided CHF * Parasternal heave and palpable S2 indicates pulmonary aery hypeension * This also explains why lungs are clear since pulmonary oedema is absent in PAH * Reduced RV compliance in RVH leads to elevated JVP and oedema in feet * The reason for dyspnea is less pulmonary flow due to PAH. Echo for mitral stenosis Useful for diagnosis as PAH is seen in long standing MS ELISA For HIV Useful for diagnosis of Group 1 PAH Urine and stool for Schistosoma Useful for diagnosis of Group 1 PAH WHO classification of PAH Group 1 Idiopathic PAH HIV Poal Hypeension (Schistosomiasis) Drugs Connective tissue disorders Pulmonary veno-occlusive disease Group 2 Pulmonary aery hypeension due to left hea disease Group 3 PAH due to lung disease like COPD, interstitial lung disease Group 4 PAH due to secondary thromboembolism with occlusion of proximal or distal pulmonary aeries Group 5 PAH due to Hematological disorders: Myeloproliferative disorders Systemic disorders: Sarcoidosis, Langerhans cell histiocytosis Metabolic disorders: glycogen storage disorders Miscellaneous: Tumor embolization\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: Which of the following clotting factors helps in bridging the fibrin in a clot and stabilizes the clot?\n###Options:\nA. Factor III\nB. Factor V\nC. Factor VIII\nD. Factor XIII\n", "role": "user" }, { "content": "###Rationale: Factor XIII is also called as fibrin stabilizing factor. It is activated by thrombin. Activated factor XIII strengthens the fibrin reticulum. The fibrin monomer molecules are initially held together by weak non covalent hydrogen bonding, and the newly formed fibers are not cross linked with each other. Therefore as a result, the clot is weak and can be broken apa easily. The activated factor XIII acts as an enzyme to cause covalent bonds between more and more fibrin monomer molecules as well as multiple cross-linkages between adjacent fibrin fibers, adding strength to the fibrin mesh work. Ref: Competition Science Vision, Feb 2003, Pages 1628-9 ; Text Book of Medical Physiology By Guyton and Hall, 10th Edition, Page 422\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Mature defence mechanism is-\n###Options:\nA. Sublimation\nB. Denial\nC. Projection\nD. Distortion\n", "role": "user" }, { "content": "###Rationale: Ans. is 'a' i.e., Sublimation Defence mechanismo Narcissistic (Psychotic) :- Denial, disortion, projection.o Immature :- Blocking, introjection, passive-aggressive behavior, acting out, hypochondriasis, regression, schizoid fantasy, somatization.o Neurotic :- Controlling, Displacement, inhibition, extemalization, intellectualization, isolation, rationalization, dissociation, reaction formation, repression, sexualization, conversion, undoing, inhibition,o Mature :- Asceticism, suppression, altruism, sublimation, humor, anticipation.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: Best screening test for pheochromocytoma?\n###Options:\nA. Urinary VMA estimation\nB. Serum catecholamine estimation\nC. Clonidine suppression test\nD. Urinarymetanephrine\n", "role": "user" }, { "content": "###Rationale: Ans: a (Urinary VMA estimation)Ref: Vasudevan & Sreekumari, 6th edi., Pg. 207Vanillyl mandelic acid (VMA) in urineVMA is the main urinary metabolite of the norepinephrine pathway. Metanephrine is acted upon by mono amine oxidase to form(VMA). Normal level of excretion of VMA is 2-6 mg/24 hr.lt is increased in pheochromocytoma and in neuroblastoma.Patient is asked to refrain from intake of chocolate, coffee, banana, vanilla ice creams, citrus fruits (lime & orange). These items contain vanillin, which produces very high value of VMA in urine. Patient should not take aspirin or drugs containing phenol ring.Homovanillic acid (HVA) in urine: HVA is the main urinary metabolite of dopa and dopamine pathway It is increased in neuroblastoma, malignant pheochromocytoma and ganglioneuroma.It is useful to predict prognosis of neuroblastoma. Drugs increasing the value are -L-dopa, disulfiram and reserpine.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Oral medication used in the treatment of scabies.\n###Options:\nA. Albendazole\nB. Metronidazole\nC. Ketoconazole\nD. Ivermectin\n", "role": "user" }, { "content": "###Rationale: Gama benzene hexachloride 1%lindane 12 -24 hrs a day/2hrs in children .used in caution in infants and children. Permethrin 5%cream -8-12 hrs at night. It act on the nerve cell membrane and disrupt sodium channel current . Used to treat scabies in pregnancy,lctation and infants more than 2 months of age. Benzoyl benzoate 25%emulsion left on body for 48hrs or 3 consecutive nights Crotamiton 10%lotion every night for 2days Malathion 0.5% liquid 6%precipitated sulphur daily night application for 3 days Oral Ivermectin 200ug/kg two doses at 10day interval GABA agonist and chloride channel opener. IADVL textbook of dermatology page 429\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: A 68-year-old male patient in the cardiology ward complains at each mealtime of difficulty in swallowing (dysphagia). Radiographic studies reveal significant cardiac hypertrophy. A barium swallow, followed by radiographic examination of the thorax, reveals esophageal constriction directly posterior to the heart. Which of the following is the most likely cause of the patient's dysphagia?\n###Options:\nA. Mitral valve stenosis\nB. Pulmonary valve stenosis\nC. Regurgitation of the aorta\nD. Occlusion of the anterior interventricular artery\n", "role": "user" }, { "content": "###Rationale: Mitral stenosis leads to left atrial dilation, which can exert a compressive effect on the esophagus. The pulmonary valve is located between the outflow tract of the right ventricle and the pulmonary trunk. The aortic valve is located between the left ventricle and the aorta. Anterior interventricular (left anterior descending) and posterior interventricular (posterior descending) arterial occlusions can cause a myocardial infarction, but not dysphagia. In the normal position of the heart the left atrium lies most posteriorly. Therefore, a stenosis of the mitral valve (atrioventricular valve between left atrium and left ventricle) would lead to enlargement of the left atrium, which would in turn impinge upon the esophagus. A stenosis of the pulmonary valve would have no effect upon the esophagus because of the anterior position of the pulmonary trunk in the thorax. Regurgitation through any valve will ultimately decrease systemic blood flow. An occlusion of a coronary artery will lead to ischemia and possibly myocardial infarction.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: True about delusions is all except:\n###Options:\nA. They are false belief, but firm.\nB. It is primarily a disorder of perception\nC. Not associated with intellectual background\nD. It remains despite of contrary evidence\n", "role": "user" }, { "content": "###Rationale: DELUSION: Delusion is a false belief in something which is not a fact It persists even after its falsity has been clearly demonstrated. A normal person can have a delusion, but is capable of correcting it by his reasoning power, by his past experience and by being convinced by others. It is primarily a disorder of thought\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: Aggrecan in\n###Options:\nA. Receptor over platelets\nB. A molecule present in osteoid tissue\nC. Granules in leukocytes\nD. Important component of cartilage\n", "role": "user" }, { "content": "###Rationale: Aggrecan is the major proteoglycan component of cartilage. It is composed of several glycosaminoglycans (hyaluronic acid, chondroitin sulfate and keratin sulfate) and both link and core proteins.\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Anterior mesentery gives origin to\n###Options:\nA. Greater omentum\nB. Faciform ligament\nC. Linorenal ligament\nD. None of the above\n", "role": "user" }, { "content": "###Rationale: The pa of the ventral mesentery that attaches to the stomach is known as the ventral mesogastrium. The lesser omentum is formed, by a thinning of the mesoderm or ventral mesogastrium, which attaches the stomach and duodenum to the anterior abdominal wall. The lower pa is dorsal mesentery. ref - BDC 6e vol2 pg235\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: \"Iris bombe\" occurs due to\n###Options:\nA. Adherent Glaucoma\nB. Anterior Synechiae\nC. Posterior Synechiae\nD. Ring synechiae\n", "role": "user" }, { "content": "###Rationale: Posterior synechiae extending for 360 degrees around the pupil (seclusio pupillae), prevent the passage of aqueous from the posterior to the anterior chamber. This gives rise to forward bowing of the peripheral iris causing an 'iris bombe'. This may lead to elevation of IOP due to secondary angle closure by the peripheral iris.\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Neisseria infection are associated with ?\n###Options:\nA. Deficiency of early complements\nB. Deficiency of late complements\nC. There is no such association\nD. Any deficiency can be associated\n", "role": "user" }, { "content": "###Rationale: Ans. is `b' i.e., Deficiency of late complements\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: Signs of graft rejection are all except\n###Options:\nA. Krachmer spots\nB. Khodadoust line\nC. Oedema\nD. Foster spot\n", "role": "user" }, { "content": "###Rationale: D i.e. Foster spot Foster-Fuchs spot, lacquer cracksQ, temporal crescent, lattice degeneration and peripapillary, macular & diffuse chorioretinal atrophy are seen in myopic chorioretinal degeneration.\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Considering your role as a medical practitioner, please use the patient's description to answer the medical questions.\nAnswer with the best option directly.###Question: All the following are true about bronchopulmonary aspergillosis except -\n###Options:\nA. Central bronchiectasis\nB. Pleural effusion\nC. Asthma\nD. Eosinophilia\n", "role": "user" }, { "content": "###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a medical professional, your responsibility is to address the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Exceptions for informed consent are the following, except\n###Options:\nA. Therapeutic privilege\nB. Emergency doctrine\nC. Therapeutic waiver\nD. Therapeutic misadventure\n", "role": "user" }, { "content": "###Rationale: Exceptions for informed consent: Therapeutic privilege Emergency doctrine Therapeutic waiver Loco parentis Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 385\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: Septic arthritis in a 2-year-old child is often caused by –\n###Options:\nA. Hemophilous influenzae\nB. Staphylococcus aureus\nC. Gonococi\nD. Pneumococci\n", "role": "user" }, { "content": "###Rationale: Bacteria are the most common pathogens in acute skeletal infections.\nThe microbial spectrum is diverse in suppurative arthritis, but Staphylococcus aureus infection is most common.\nSalmonella is the most common cause of osteomyelitis in children with sickle cell anemia.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: Cell lining of small intestine -\n###Options:\nA. Simple squamous\nB. Stratified squamous\nC. Simple columnar\nD. Stratified columnar\n", "role": "user" }, { "content": "###Rationale: Explainatin 2: The intestinal epithelium is the layer of cells that forms the luminal surface or lining of both the small and large intestine (colon) of the gastrointestinal tract. It is composed of simple columnar epithelium. It has two important functions: absorbing helpful substances and providing a barrier against harmful substances. Explainatin 1:Ans. is 'c' i.e., Simple columnar o Simple columnar epithelium : It is made up of tall columnar cells. Simple columnar cells may be :Simple columnar epithelium (without cilia and microvilli) : Lining of stomach, large intestine, collecting duct and cervical canal.Columnar epithelium with striated border (regularly arranged microvilli) : Lining of small intestine.Columnar epithelium with brush border (irregularly placed microvilli) : Lining of gall bladder.Ciliated columnar epithelium (presence of cilia) : Lining of uterus, fallopion tube, eustachian tube, tympanic cavity and central canal of spinal cord and ventricles.o Linining of gall-bladder is columnar epithelium with brush border (irregularly placed microvilli).Type of epitheliumTissue or organSimple squamousLung alveoliMesothelium lining serous surfacesEndocardium and endotheliumLoop of henle in nephronKeratinized stratified squamousEpidermis of skinDuct of sebaceous glandNon keratinized stratified squamousTongue, tonsil, pharynx, esophagusCorneaVaginaSimple columnar epithelium(without cilia and microvilli)Lining of stomach and large intestineCervical canalColumnar epithelium with striated border(regularly arranged microvilli)Lining of small intestineColumnar epithelium with brush border(Irregularly placed microvilli)Gall bladderCiliated columnar epithelium(cilia on surface for propulsion of fluid)Uterus and fallopian tubesEustachian tubeCentral canal of spinal cord and ventricles of brainRespiratory epitheliumSecretory columnar epithelium (with goblet cells)Stomach and intestinesTrachea and bronchiPseudostratified columnar epitheliumOlfactory epitheliumTracheaEustachian tubeVas + deferensUrethraCuboidal epitheliumDucts of glandsThyroid folliclesOvarian surface epitheliumTransitional epithelium (Crothelium)Renal pelvis, calyces, ureter, urinary bladder and part of urethra\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Patient with 37 week AOG, centrally located placenta previa presented with bleeding per vaginum. Management:\n###Options:\nA. Caesarean section\nB. Abortion\nC. Vaccum delivery\nD. Foreceps delivery\n", "role": "user" }, { "content": "###Rationale: Ans. (a) Caesarean sectionRef : D.C. Dutta 8th ed. / 290-92; William's 23rd ed. Chapter 35.* Placenta previa-placenta located at LUS.* One of the most commoncause of APH.* In case of centrally located placenta previa -mode of delivery is always CS.Management of placenta previa depends on its type- 4 typesIndication for termination(by vaginal/CS)Indication for conservative management* POG-37 weeks or beyond* Pt continuosly bleeding* Fetal distress* Hemodynamically unstable mother* Pt is active labour* IUD* Congenital malformation of baby which are incompatible with lifeDone in patient who do not obey previous 7 ruleTermination by vaginal delivery or CS (depending on type of PPMa caffe's protocol for conservative mxBed restMonitor vitals-mother and babyBlood transfusion (if needed) Type 1(low lying-vaginal deliveryType 2 (marginal vaginal if placenta anterior, CS-if posteriorType 3 (incomplete/partial)- always CSType 4 (complete/central)- always CSIf POG<34 weeks-give betamethsone 12 mg IM 2 dose, 24 hrs apartm, for lung maturityMark CS as management option for placenta previa if any of following points give in Q-* Mother unstable* Fetal distress* Major degree of PP-type3 (incomplete/partial), type4 (complete/central)\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: Which of the following techniques in the best for differentiating recurrence of brain tumour from radiation therapy induced necrosis?\n###Options:\nA. MRI\nB. Contrast enhanced MRI\nC. PET scan\nD. CT scan\n", "role": "user" }, { "content": "###Rationale: Ans. is 'c' ie PET scan (Ref: Harrison, 16/e, p2460).\"MRI or CT scans are often unable to distinguish radiation necrosis from recurrent tumor, but PET or SPECT scans may demonstrate that glucose metabolism is increased in tumor tissue but decreased in radiation necrosis.\" - Harrison.\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: A 27 yr old boy has itchy, excoriated papules on the forehead and exposed pas of the arms and legs for 3 years. The disease was most severe in the rainy season and improved completely in winter. What is the most likely diagnosis?\n###Options:\nA. Scabies\nB. Uicaria\nC. Insect bite hypersensitivity\nD. Atopic dermatitis\n", "role": "user" }, { "content": "###Rationale: In this case, diagnosis can be made by excluding each option. This patient is least likely to have scabies, as it does not produce lesions on the face in adults. Atopic dermatitis is unlikely since he is giving a history of similar lesions only since 3 years. In atopic dermatitis lesions first appears in infancy and then continues into childhood and adulthood. By this time lesions become more and more lichenified. Uicaria is characterised by the presence of evanescent wheals due to edema of dermis, and it last only for 24- 48 hours. So the most appropriate diagnosis would be insect bite hypersensitivity. In this condition the characteristic lesions are itchy persistent papules with a central punctum, seen mainly on exposed pas of the body and aggrevated during rainy season.\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your role as a doctor requires you to answer the medical questions taking into account the patient's description.\nAnswer with the best option directly.###Question: Jean Piaget put forth the theory of\n###Options:\nA. Psychoanalytic theory of psychosexual development\nB. Social learning\nC. Cognitive development\nD. Cultural adaptation\n", "role": "user" }, { "content": "###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your role as a doctor requires you to answer the medical questions taking into account the patient's description.\nAnalyze the question and answer with the best option.###Question: Most important layer of a slow sand filter is -\n###Options:\nA. Vital layer\nB. Sand bed\nC. Filter system\nD. Raw water\n", "role": "user" }, { "content": "###Rationale: This is confusing one because of the following statements of Park.\n\t\"The most important part of the filter is the sand bed\" - Park\n\t\"The vital layer is the heart of the slow sand filter\" - Park\nFollowing statement may help in choosing the answer : -\n\n\"Vital layer is the layer that provides the effective purification in potable water treatment, the underlying sand layer providing the support medium for this biological treatment layer\"  - Water & Health 3rd/e 733.\n\nRead the mechanism of action of slow sand filter and there will be no confusion.\nMechanism of action of slow sand filter\nSlow sand filter work through the, formation of a gelatinous layer called vital layer or hypogeal layer or Schmutzdecke in the top few cm of sand layer.\nThis layer is formed in the first 10-20 days of operation.\nThe formation of vital layer is known as \"Ripening of the filter\".\nThis vital layer consists of bacteria, fungi, Protozoa, and a range of aquatic insect larvae.\nAs waste passes through vital layer, particles of foreign matter are trapped in the mucilaginous matrix and dissolved organic material is absorbed and metabolized by bacterial, fungi and protozoa → Vital layer has mechanical (physical) as well as biological action.\nSo, the vital layer acts as the heart of slow sand filter.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: A rickshaw is run over legs of a child making markings of tyre on the legs. Which type of injury is this?\n###Options:\nA. Patterned abrasion\nB. Imprint abrasion\nC. Pressure bruise\nD. Split lacerations\n", "role": "user" }, { "content": "###Rationale: Patterned abrasion. Patterning of abrasions The patterning of abrasions is clearer than that of bruises because abrasions frequently take a fairly detailed impression of the shape of the object causing them and, once inflicted, do not extend or gravitate; therefore, they indicate precisely the area of application of force. An abrasion (or a graze) is a superficial injury involving only the outer layers of the skin and not penetrating the full thickness of the epidermis. Patterned Abrasions: Patterned abrasions occur when the force is applied at or around right angle to the surface of skin. The classical example of this is seen in traffic accidents when tyre of a motor car passes over the skin leaving the pattern when the skin has been squeezed into the grooves of the rubber tread. Pressure Abrasions (Imprint Abrasions): When the impact is veical to the skin surface, the epidermis gets crushed and pressure type of abrasions result and the imprint of the impacting object may be produced. These may be seen in manual strangulation (abrasions produced by fingernails) and in hanging, where the weave of the ligature material may be reproduced.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnalyze the question and answer with the best option.###Question: Asher man n syndrome is secondary to -\n###Options:\nA. Tuberculosis\nB. Endometrial carcinoma\nC. Endometriosis\nD. Submucosal fibroid\n", "role": "user" }, { "content": "###Rationale: Ans. is 'a' i.e., Tuberculosis Asherman's syndrome (AS) or Fritsch syndromeo It is a condition characterized by adhesions and/or fibrosis of the endometrium most often associated with dilation and curettage of the intrauterine cavity:o Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis,o The adhesions may cause amenorrhea (lack of menstrual periods). repeated miscarriages, and infertility:o Pain during menstruation and ovulation is also sometimes experiencedo The history of a pregnancy event followed by a D&C leading to secondary amenorrhea or hypomenorrhea is typicalo Hysteroscopy is ihe gold standard for diagnosis.o Imaging by sonohysterography or hysterosalpingography will reveal the extent of the scar formation.o Treatment involves surgery to cut and remove the adhesions or scar tissue (adhesiolysis). This can usually be done with hysteroscopy:o Progesterone challenge test is negative.Sites of genital TB% involvementTubes90-100%Uterus50-60%Ovaries20-30%Vagina & vulva1-2%o Menstrual problems occurring in TB patients:-Hypomenorrhea/Amenorrhea due to Asherman s syndrome.Polym enorrhea/Menorrhagia\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your role as a doctor requires you to answer the medical questions taking into account the patient's description.\nAnalyze the question and answer with the best option.###Question: What is the age of tendon transfer in post polio residual paralysis -\n###Options:\nA. <6 months\nB. 1 year\nC. 2 years\nD. >5 years\n", "role": "user" }, { "content": "###Rationale: Ans. is 'd' i.e., > 5 years * The available musclepower is redistributed either to equalize an unbalanced paralysis, or to use the motorpower for a more useful function.* It is not done before 5 years of age, asthe child has to be manageable enough tobe taught proper exercises.* More commonlyperformed tendon transfers are as follows:i) Transfer of extensor hallucis longus (EHL)from the distal phalanx of great toe tothe neck of the first metatarsal (modifiedjones operation). This is done to correctfirst metatarsal drop in case of tibialisanterior muscle weakness.ii) Transfer of peronius tertious and brevismuscles (evertors of the foot) to thedorsum of the foot. The transfer isrequired in a foot with dorsiflexor weakness.Evertors can be spared for moreuseful function of dorsiflexion of the foot.iii) Hamstring (knee flexors) transfer to thequadriceps muscle to support a weak knee extensor.\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Considering your role as a medical practitioner, please use the patient's description to answer the medical questions.\nAnalyze the question and answer with the best option.###Question: Alosetron is\n###Options:\nA. 5HT1 receptor antagonist\nB. 5HT2 receptor antagonist\nC. 5HT3 receptor antagonist\nD. Analogues of somatostatin\n", "role": "user" }, { "content": "###Rationale: .\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Vitamin A prophylaxis is given to children every:September 2007\n###Options:\nA. 3 months\nB. 6 months\nC. 12 months\nD. 18 months\n", "role": "user" }, { "content": "###Rationale: Ans. B: 6 monthsNational programme for prevention of nutritional blindness focuses onPromoting consumption of vitamin A rich foods by pregnant and lactating women and by children under 5 years of age.Administration of massive doses of vitamin A up to 5 years. First dose of 100,000 IU with measles vaccination at 9 months and subsequent doses of 200,000 IU each, every 6 months up to the age of 5 years should be given.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: In comparison to hyperplasia, hyperophy involves?\n###Options:\nA. Increase in cell size and number\nB. Increase in cell size without increase in number\nC. Increase in cell number without increasing in size\nD. Increase in cell size and decrease in number\n", "role": "user" }, { "content": "###Rationale: Ans. is 'b' i.e., Increase in cell size without increase in number Hyperplasia Increase in cell number without increasing in size o Occurs due to proliferation of cells Occurs only in cell capable of division DNA content in nuclei is same as normal cells o Example of tissues --> Breast, endometrium, liver, kidney Hyperophy Increase in cell size without increase in number Occurs due to increased synthesis of structural proteins Can occur both in cells with limited capacity of division as well as cells capable of division. DNA content is more than normal cells. Examples of tissues Myocardium, skeletal muscles, Breast, endometium, liver, kidney. Why do some tissues undergo hyperophy, while others undergo hyperplasia ? o The cells that have limited capacity of proliferation (e.g., myocardial cells & skeletal muscle cells) can not increase their number, So they are not able to undergo hyperplasia. But these cells can increase in size in response to increased demand, So they can undergo hyperophy. o The cells capable of division (hepatocytes, renal tubular epithelial cells, smooth muscles of uterus) have both the propeies, i.e., to increase the number as well as the size. So, tissues containing these cells can undergo hyperophy or hyperplasia or both. o For example, both hyperplasia and hyperophy occur in endometrium of pregnant uterus.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your role as a doctor requires you to answer the medical questions taking into account the patient's description.\nAnalyze the question and answer with the best option.###Question: This milestone is achieved by _________\n###Options:\nA. 10 months\nB. 12 months\nC. 16 months\nD. 18 months\n", "role": "user" }, { "content": "###Rationale: At 10 months Sits up alone and indefinitely without suppo Pulls to a standing position Walks holding furniture Grabs objects with thumb and forefinger Pokes at things with forefingers Uncovers hidden toy Mama, dada sounds (repetitive consonant sounds) Responds to the sound of a name Plays Peek-a-boo Waves bye-bye Ref : Nelson 20th edition pg no : 67\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Considering your role as a medical practitioner, please use the patient's description to answer the medical questions.\nAnalyze the question and answer with the best option.###Question: Which of the following is used for initial screening of auditory function in a neonate?\n###Options:\nA. Otoacoustic emission (OAE)\nB. Auditory brainstem response (ABR)\nC. Pure tone audiometry (PTA)\nD. Free field audiometry\n", "role": "user" }, { "content": "###Rationale: Most screening programmes for newborn hearing ability uses otoacoustic emission as the initial test. It this test fails then auditory brainstem response is used for screening. Otoacoustic emissions are low level sound emitted spontaneously by the cochlea on presentation of an auditory stimulus. Persons with normal hearing produce oatoacoustic emissions whereas those who have hearing loss of 30-40db HL or greater do not produce OAE. Auditory brainstem response testing is used with babies between the ages of bih and 5 months. It is the electrophysiological response to an acoustic stimulus and originates from the eight cranial nerve and auditory brain stem. It can be used to determine the degree of hearing loss at different audiometric frequencies.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: The recommended oral dose of vitamin A in pregnant females is:\n###Options:\nA. 50,000 U\nB. 1,00,000 U\nC. 2,00,000 U\nD. 3,00,000 U\n", "role": "user" }, { "content": "###Rationale: Ans. c. 2,00,000 U style=\"font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif; margin: 0 0 0 8px; text-indent: 0\">'There was a previous recommendation by WHO on giving 2 lacs IU of Vitamin A to pregnant women immediately after delivery, which was withdrawn in 2011.'\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnswer with the best option directly.###Question: Contraceptive efficacy expressed as -\n###Options:\nA. 100 women months\nB. 1000 women years\nC. 100 women years\nD. 10 women years\n", "role": "user" }, { "content": "###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Not true regarding Sudden infant death syndrome\n###Options:\nA. Also known as cot/crib death\nB. Threefold increase in twins\nC. Incidence common in females\nD. Cigarette smoking by pregnant mothers increase the risk\n", "role": "user" }, { "content": "###Rationale: SIDS / COT DEATH / CRIB DEATH :- It is sudden & unexpected death of seemingly healthy infant whose death remains unexplained even after comp. autopsy. Factors associated with SIDS :- Age = 2 month to 2 years Sex = Male Time = early morning Twins Mother = smoking during pregnancy\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Which vitamin is given in type 2B familial hyperlipidemia?\n###Options:\nA. Thiamine\nB. Riboflavin\nC. Nicotinic acid\nD. Panthothenic acid\n", "role": "user" }, { "content": "###Rationale: Niacin or nicotinic acid is vitamin. Niacin is conveed to its coenzyme forms NAD and NADPTreatment of hyperlipidemia:Niacin (at doses of 1.5 g/day or 100 times the Recommended Dietary Allowance or RDA) strongly inhibits lipolysis in adipose tissue--the primary producer of circulating free fatty acids. The liver normally uses these circulating fatty acids as a major precursor for triacylglycerol synthesis. Thus, niacin causes a decrease in liver triacylglycerol synthesis, which is required for very-low-density lipoprotein (VLDL, see p.231) production. Low-density lipoprotein (LDL, the cholesterolrich lipoprotein) is derived from VLDL in the plasma. Thus, both plasma tri acylglycerol (in VLDL) and cholesterol (in VLDL and LDL) are lowered. Therefore, niacin is paicularly useful in the treatment of Type IIb hyperlipoproteinemia, in which both VLDL and LDL are elevated. Ref: Lippincott, 5th edition, page no: 380\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: Doxylamine used in management of nausea and vomiting is marketed with which vitamin ?\n###Options:\nA. Thiamine\nB. Riboflavin\nC. Niacin\nD. Pyridoxine\n", "role": "user" }, { "content": "###Rationale: Ans. is'd'i.e., PyridoxineDoxylamineSedative H1 antihistamine with prominent anticholinergic activity. Marketed in combination with pyridoxine, it is specifically promoted in India for 'morning sickness' (vomiting of early pregnancy), although such use is not made in the UK and many other countries.\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Maximum tensile strength is recovered in wound area during what period after an injury?\n###Options:\nA. 1 to 2 weeks\nB. 3 to 4 weeks\nC. 6 months\nD. 1 year\n", "role": "user" }, { "content": "###Rationale: Net collagen accumulation, however, depends not only on increased collagen synthesis but also on decreased degradation. When sutures are removed from an incisional surgical wound, usually at the end of the first week, wound strength is approximately 10% that of unwounded skin. Wound strength increases rapidly over the next 4 weeks, slows down at approximately the third month after the original incision, and reaches a plateau at about 70% to 80% of the tensile strength of unwounded skin. Lower tensile strength in the healed wound area may persist for life. Ref: Robbins 8th edition Chapter 3.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: Characteristic of acute inflammation is\n###Options:\nA. Vasodilation and increase permeability\nB. Vasoconstriction\nC. Platelet aggregation\nD. Infiltration by neutrophil\n", "role": "user" }, { "content": "###Rationale: Ref Robbins 8/e p 45 ,9/e p74 The acute inflammatory response rapidly delivers leuko- cytes and plasma proteins to sites of injury. Once there, leukocytes clear the invaders and begin the process of digesting and getting rid of necrotic tissues. Acute inflammation has two major components (Fig. 2-2): * Vascular changes: alterations in vessel caliber resulting in increased blood flow (vasodilation) and changes in the vessel wall that permit plasma proteins to leave the cir- culation (increased vascular permeability). In addition, endothelial cells are activated, resulting in increased adhesion of leukocytes and migration of the leukocytes through the vessel wall. * Cellular events: emigration of the leukocytes from the circulation and accumulation in the focus of injury (cel- lular recruitment), followed by activation of the leuko- cytes, enabling them to eliminate the offending agent. The principal leukocytes in acute inflammation are neu- trophils (polymorphonuclear leukocytes). Stimuli for Acute Inflammation Acute inflammatory reactions may be triggered by a variety of stimuli: * Infections (bacterial, viral, fungal, parasitic) are among the most common and medically impoant causes of inflammation. * Trauma (blunt and penetrating) and various physical and chemical agents (e.g., thermal injury, such as burns or frostbite; irradiation; toxicity from ceain environ- mental chemicals) injure host cells and elicit inflamma- tory reactions. * Tissue necrosis (from any cause), including ischemia (as in a myocardial infarct) and physical and chemical injury * Foreign bodies (splinters, di, sutures, crystal deposits * Immune reactions (also called hypersensitivity reactions) against environmental substances or against \"self\" tissues. Because the stimuli for these inflammatory responses often cannot be eliminated or avoided, such reactions tend to persist, with features of chronic inflam- mation. The term \"immune-mediated inflammatory disease\" is sometimes used to refer to this group of disorders. Although each of these stimuli may induce reactions with some distinctive characteristics, in general, all inflamma- tory reactions have the same basic features. In this section, we describe first how inflammatory stimuli are recognized by the host, then the typical reac- tions of acute inflammation and its morphologic features, and finally the chemical mediators responsible for these reactions.\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnswer with the best option directly.###Question: A 45-year-old female is diagnosed as a case of pneumococcal meningitis. Her blood sample were sent for culture sensitivity. In the mean time best drug to start as an empirical treatment is -\n###Options:\nA. Penicillin G\nB. Doxycycline\nC. Streptomycin\nD. Vancomyin + Ceftriaxone\n", "role": "user" }, { "content": "###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: All are components of GCS EXCEPT:\n###Options:\nA. Eye opening\nB. Respiration\nC. Conversation\nD. Motor response\n", "role": "user" }, { "content": "###Rationale: ANSWER: (B) RespirationREF: Harrison 18t ed table 267-1GLASGOW COMA SCALE 123456EyesDoes not open eyesOpens eyes in response to painful stimuliOpens eyes in response to voiceOpens eyes spontaneouslyN/AN/AVerbalMakes no soundsIncomprehensiblesoundsUttersinappropriatewordsConfused,disorientedOriented,conversesnormallyN/AMotorMakes no movementsExtension to painful stimuli (decerebrate response)Abnormal flexion to painful stimuli (decorticate response)Flexion/ Withdrawal to painful stimuliLocalizespainfulstimuliObeyscommandsThe scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnswer with the best option directly.###Question: The prognosis of rapidly proliferating glomerulonephritis (Crescentric GN) depends upon -\n###Options:\nA. Number of crescents\nB. Size of crescents\nC. Shape of crescents\nD. Cellularity of crescents\n", "role": "user" }, { "content": "###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: Deficiency of the 'intrinsic factor of Castle' causes:\n###Options:\nA. Microcytic anemia\nB. Pernicious anemia\nC. Cooley's anemia\nD. Aplastic anemia\n", "role": "user" }, { "content": "###Rationale: Answer is B (Pernicious Anemia) Deficiency of Intrinsic factor leads to a specific form of vitamin B12 deficiency megaloblastic anemia called `Pernicious Anemia'. Pernicious Anemia also known as Addison's Anemia is a megaloblastic anemia due to deficiency of intrinsic factor (secreted by parietal cells of gastric mucosa) that is essential for vitamic B12 absorption. Note: 'Intrinsic factor' was first described by castle & coworkers and hence intrinsic factor is also called Intrinsic factor of Castle.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Urinary incontinence results from all except -\n###Options:\nA. Neurogenic bladder\nB. Vesico vaginal fistula\nC. Ectopic ureter\nD. Rectovesical fistula\n", "role": "user" }, { "content": "###Rationale: Rectovesical fistula doesn’t cause urinary incontinence, as the level of fistula is above the sphincter mechanism.\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: Morbid jealousy is most often seen in patients taking\n###Options:\nA. Alcohol\nB. Amphetamine\nC. LSD\nD. Cannabis\n", "role": "user" }, { "content": "###Rationale: Some Complications of Alcohol Dependence Medical Complications Central Nervous System: i. Peripheral neuropathy ii. Delirium tremens iii. Rum fits (Alcohol withdrawal seizures) iv. Alcoholic hallucinosis v. Alcoholic jealousy vi. Wernicke-Korsakoff psychosis vii. Marchiaa-Bignami disease viii. Alcoholic dementia ix. Suicide x. Cerebellar degeneration xi. Central pontine myelinosis xii. Head injury and fractures. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 39\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: Most common subtype of thyroid cancer is?\n###Options:\nA. Medullary carcinoma\nB. Papillary carcinoma\nC. Follicular carcinoma\nD. Anaplastic carcinoma\n", "role": "user" }, { "content": "###Rationale: ANSWER: (B) Papillary carcinomaREF: Sabiston 18th ed chapter 36, Schwartz 9th ed chapter 38Papillary carcinoma is the most common of the thyroid neoplasms and is usually associated with an excellent prognosis, particularly in female patients younger than 40 years. About 70% to 80% of patients in the United States in whom thyroid carcinoma is newly diagnosed have papillary carcinoma.Thyroid malignancy PapillarycarcinomaFollicularcarcinomaHurthle cell carcinomaMedullarycarcinomaAnaplasticcarcinomaLymphomaPrevalence80%10%3%5%1%<1%Cell typeFollicularFollicularFollicular,oxyphiliccellsParathyroid C cellswide variety of cell typesNon Hodgkin's B cell type\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: A 35 yr old P 3+0 is observed to have CIN grade III on colposcopic biopsy. Best treatment will be\n###Options:\nA. Cryosurgery\nB. Conization\nC. LEEP\nD. Hysterectomy\n", "role": "user" }, { "content": "###Rationale: LEEP Repeat All India 2009 \"Although CIN can be treated with a variety of techniques, the preferred treatment for CIN 2 and 3 has become LEE?\" - Novak's Gynecology p582 Though the patient is 35 yrs old and has completed her family, still hysterectomy won't be treatment of choice as-\"Hysterectomy is currently considered too radical .for treatment of CIN\"Novak's Gynecology p.585 Following are some situations in which hysterectomy remains a valid and appropriate method of treatment for CIN Microinvasion CIN 3 at limits of conizution specimen in selected patients Poor compliance with follow-up Other gynecologic problems requiring hysterectomy, such as fibroids, prolapse, endometriosis, and pelvic inflammatory disease Cervical intraepithelial neoplasia(CIN) Invasive squamous cell cervical cancers are preceded by a long phase of preinvasive disease, collectively referred to as cervical intraepithelial neoplasia (CIN). Histopathologically a pa or the full thickness of cervical squamous epithelium is replaced by cells showing varying degree of dysplasia, with intact basement membrane. CIN may be suspected through cytological examination using the Pap smear test or through colposcopic examination. Cervical cytology is the most efficacious and cost-effective method for cancer screening. Final diagnosis of CIN is established by the histopathological examination of a cervical punch biopsy or excision specimen. Additionally, human papilloma virus (HPV) testing can be performed in order to better triage women with early cytologic changes. Cervical Cytology Screening (American College of Obstetricians and Gynecologists Guideline) Initial screening Age 21 or 3 y after vaginal sex Interval Every year Every 2-3 y after age 30 with 3 consecutive normals Discontinue No upper limit of age Comparison of Cytology Classification Systems (in simplified form) Bathesda CIN llysplasia Limit of histologic changes *LSIL CIN 1 Mild Basal 1/3rd of sq. epithelium HSIL ON 2 Moderate Basal 1/2 to 2/3rd CIN3 Severe Whole thickness except one or two superficial layers CIS Whole thickness LSIL - Low grade squamous intraepithelial lesion HSIL - High grade squamous intraepithelial lesion CIS - Carcinoma in situ *LSIL incorporates HPV changes (koilocytotic atypia) along with CIN I. Role of HPV HPV infection is found in approx. 90% cases of intraepithelial neoplasia. Type H&18 are most commonly associated. HPV-18 is more specific than HPV-16 for invasive tumors. In most women, the HPV infection clears in 9 to 15 months. Only a minority of women exposed to HPV develop persistent infection that may progress to CIN. Type-16 is the most common HPV type found in women with normal cytology. Treatment CIN 1 Spontaneous regression of CIN 1 is seen in 60% to 85% of cases, typically within 2yrs. So patients who have biopsy diagnoses of C1N 1 are kept under observation with: Pap testing performed at 6 and 12 months Or HPV DNA testing at 12 months After two negative test results or a single negative HPV DNA test, annual screening may be resumed. Women with persistent CIN 1 after 24 months should be treated with a local ablative method. CIN 2 and3 CIN 2&3 carries a much higher probability of progressing to invasive cancer. All CIN 2 and 3 lesions require t reatment. LEEP ( loop electrosurgical excision procedure) is the preferred treatment for CIN 2 and 3. Because all therapeutic modalities carry an inherent recurrence rate of upto 10%. cytologic follow-up at about 3-month intervals for 1 year is necessary. Cryotherapy Considered acceptable therapy when the following criteria are met: - Cervical intraepithelial neoplasia, grade 1 to 2 - Small lesion Ectocervical location only - Negative endocervical sample - No endocervical gland involvement on biopsy Laser Ablation It has been used effectively for the treatment of CIN .But because of the expense of the equipment as well as necessity for special training, laser ablation has fallen out of or. Laser has been widely replaced by LEEP. Laser Excisional Conization Rather than using laser for vaporization leading to ablation, it can be used to excise a conization specimen. The ease of LEEP conization has significantly reduced the indications of laser conization. Loop electrosurgical excision( LEEP) LEEP, variably known as simply loop excision or LLETZ (large loop excision of the transformation zone), is a valuable tool for the diagnosis and treatment of CIN. It uses low-voltage, high-frequency, thin wire loop electrodes to perform a targeted removal of a cervical lesion, an excision of the transformation zone, or a cervical conization. This technique can be used in the outpatient setting Cold knife conization (scalpel) Conization is both a diagnostic and therapeutic procedure and has the advantage over ablative therapies of providing tissue for fuher evaluation to rule out invasive cancer. Conization is indicated for CIN 2&3 in following conditions: - Limits of the lesion cannot be visualized with colposcopy. - The squat-no-columnar junction (SCE) is not seen at colposcopy. - Endocervical curettage (ECC) histologic findings are positive for CIN 2 or CIN 3. - There is a substantial lack of correlation between cytology, biopsy, and colposcopy results. - Microinvasion is suspected based on biopsy, colposcopy, or cytology results. - The colposcopist is unable to rule out invasive cancer.\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnalyze the question and answer with the best option.###Question: Lipschutz inclusion bodies are seen in infects caused by-\n###Options:\nA. Herpes virus\nB. Vaccinia virus\nC. Hepatitis-A virus\nD. Hanta virus\n", "role": "user" }, { "content": "###Rationale: Herpes Simplex Viruses Infection Laboratory Diagnosis 1. Light Microscopy - cells from the base of the lesion, or wiped from a mucous surface, or biopsy material, may reveal intranuclear inclusions (Lipschutz inclusion bodies). Infected cells may show ballooning and fusion. 2. Electron Microscopy - Electron microscopy is not a sensitive tool for the detection of HSV, except in the case of vesicle fluids which often contain 108 or more paicles per milliliter. However, like light microscopy, electron microscopy cannot distinguish between the different viruses. 3. Direct examination by antigen detection - cells from specimens is treated in ice-cold acetone. FITC is generally used for staining of fixed material. It is more sensitive and specific than light and electron microscopy (90% sensitive, 90% specific), but cannot match virus culture. In terms of cost and technical expeise, it is very much more demanding. Cytopathic effect of HSV in cell culture, note the ballooning of cells (Couesy of Linda Stannard, University of Cape Town, S.A.) and positive immunofluorescence test for HSV antigen in the epithelial cell (Virology Laboratory, Yale-New Haven Hospital) Ref: mayo clinic\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnalyze the question and answer with the best option.###Question: Which of the following antibodies is the most specific for the diagnosis of rheumatoid arthritis?\n###Options:\nA. IgA\nB. IgG\nC. IgM\nD. Anti-CCP\n", "role": "user" }, { "content": "###Rationale: Ans. d. Anti-CCP (Ref: Harrison 19/e p2136, 18/e p2745; CMDT 09/727)Anti-CCP antibodies are the most specific blood test for the diagnosis of rheumatoid arthritis.\"Anti CCP antibodies are the most specific blood test for rheumatoid arthritis (specificity ~95%).\"- CMDT 09/727\"Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis,with high specificity, presence early in the disease process, and ability to identify patients who are likely to have severe disease and irreversible damage. Anti-CCP antibodies have not been found at a significant frequency in other diseases to date, and are more specific than rheumatoid factor for detecting rheumatoid arthritis.\"- Oxford Journal of Medicine\\Rheumatoid ArthritisIt is a chronic systemic inflammatory disease of unknown cause characterized by persistent involvement of synovial membrane of multiple joints and variety of systemic manifestations.More common in femalesQRA is best diagnosed by Anti-CCP antibodiesQ.Pathology:Pathology is not limited to articular cartilage alone and arthritis is typically 'erosive'QThe potential of the synovia! inflammation to cause cartilage damage and bone erosions and subsequent changes in joint integrity is the hallmark of the diseaseQ.RA is most strongly associated with the Class IIQ MHC allele HLA DR4Qand related alleles.Characteristic Features:RA most often causes symmetric arthritis with characteristic involvement of certain specific joints such as the proximal interphalangeal and metacarpophalangeal jointsQ.DIP joints are typically sparedQAxial skeleton involvement is usually limited to upper cervical spineQExtra articular manifestations are seen in up to 40% of patientsQRheumatoid nodules are seen in approximately 20% of patientsQTypically the pleural fluid contains very low levels of glucoseQRA is associated with nurmocytic normochromic anemia of chronic diseaseQAnti CCP antibodies arc the most specific blood test for RA (specificity ~95%)Felty's syndrome is seen in association with RAFelty's syndrome consists of chronic rheumatoid arthritisQ, splenomegalyQ and neutropeniaQDiagnostic criteria for Rheumatoid arthritisMorning stiffness* Stiffness in and around joints lasting 1 hour before maximal improvement.* Constitutional features indicative of the inflammatory nature of disease such as morning stiffness \"support the diagnosis\"Arthritis* SymmetricalQ, involving same joint areas on both sides of body simultaneously* MultipleQ: It commonly involves three or more joint areas, predominantly of the joint areas in hand (peripheral)* * Typical picture of bilateral symmetrical inflammatory polyarthritis involving small and large joints in both upper and lower extremity with sparing of axial skeleton except the cervical spineQRheumatoid nodulesQ* Demonstration of subcutaneous nodules is helpful diagnostic featureSerum Rheumatoid factorQ* An IgM antibody directed against the Fc fragment of IgG is present in sera of >75% of patientsQ.RadiographicchangesQ* Juxta articular osteoporosisQ* Joint erosion with narrowing of joint spacesQ.Rheumatoid Factor and Rheumatoid Arthritis:Rheumatoid factor in RA belongs to the igM class0 (directed against Fc fragment of IgG)QIgM Rheumatoid factor is positive in about 75-80% of patients with RAPresence of RA factor is not specific for RAQPresence of Rheumatoid factor does not establish the diagnosis of RAQRheumatoid factor is only of prognostic significance because patients with high titers tend to have more severe and progressive disease with extra-articular manifestationsQ.Causes of False Positive Rheumatoid factor* SLE (Associated with a positive Coomb's test)* Sjogren syndrome* Chronic liver disease* Sarcoidosis* Interstitial pulmonary fibrosis* Infectious mononucleosis* Hepatitis B (Associated with HbsAg)* Tuberculosis* Leprosy* Syphilis (Associated with a positive VDRL)* Subacute bacterial endocarditis* Visceral Leishmaniasis* Schistosomiasis* MalariaTreatment:DMARD's include agents that appear to have the capacity to alter the course of Rheumatoid Arthritis.Methotrexate is the DMARD of choice.DMARDs (Disease Modifying Anti-Rheumatoid Drugs)1. MethotrexateQ2. Gold compoundsQ3. D-PenicillamineQ1. Anti-malarials e.g. ChloroquinesQ2. SulfasalazineQ\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your profession as a doctor, please provide responses to the medical questions using the patient's description.\nAnalyze the question and answer with the best option.###Question: Glomus tumour invading the veical pa of the carotid canal. It is\n###Options:\nA. Type B\nB. Type C1\nC. Type C2\nD. Type C3\n", "role": "user" }, { "content": "###Rationale: FISCH classification is used for glomus tumours based on the extension into surrounding anatomic structures. Type A tumour - Tumour limited to the middle ear cleft (glomus tympanicum) Type B tumour - Tumour limited to the tympanomastoid area with no infralabyrinthine compament involvement Type C tumour - Tumour involving the infralabyrinthine compament of the temporal bone and extending into the petrous apex; Type C1 tumour - Tumor with limited involvement of the veical poion of the carotid canal; Type C2 tumour - Tumour invading the veical poion of the carotid canal; Type C3 tumour - Tumour invasion of the horizontal poion of the carotid canal Type D1 tumour - Tumour with an intracranial extension less than 2 cm in diameter; Type D2 tumour - Tumour with an intracranial extension greater than 2 cm in diameter\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnswer with the best option directly.###Question: Na channel mediated TTXN resistant caused is d\nto involvement of the following:\n###Options:\nA. Nav 1.1\nB. Nav 1.8\nC. TRPI\nD. NMD4\n", "role": "user" }, { "content": "###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnswer with the best option directly.###Question: Dobutamine is preferred over dopamine in cardiogenic shock because of its effect related to:\n###Options:\nA. Better cardiac stimulation\nB. Less peripheral vasoconstriction\nC. Lower risk of cardiac arrhythmias\nD. More CNS stimulation\n", "role": "user" }, { "content": "###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: An elective surgery is to be done in a patient taking heavy doses of Aspirin. Management consists of :\n###Options:\nA. Proceed with surgery\nB. Stopping aspirin for 7 days and then do surgery\nC. Preoperative platelet transfusion\nD. Intra operative platelet transfusion\n", "role": "user" }, { "content": "###Rationale: Ans. is 'b' i.e., Stop aspirin for 7 days and then do surgery \"Aspirin should be stopped 1 week before elective surgery.\" - KDT Aspirin, even in small doses, irreversibly inhibits Thrombooxane A2 (TXA2) synthesis by platelets. Thus it interferes with platelet aggregation and increase the bleeding time. This effect lasts for a week, the turnover time of platelets.\n\n###Answer: OPTION B IS CORRECT.", "role": "assistant" } ]

[ { "content": "In your capacity as a doctor, it is expected that you answer the medical questions relying on the patient's description.\nAnalyze the question and answer with the best option.###Question: A point that falls on horopter excites:\n###Options:\nA. Corresponding retinal points\nB. Crossed diplopia\nC. Confusion\nD. Stereopsis\n", "role": "user" }, { "content": "###Rationale: Ans. Corresponding retinal points\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Being a doctor, your task is to answer the medical questions based on the patient's description.\nAnalyze the question and answer with the best option.###Question: Xerophthalmia is considered a problem in a community if:-\n###Options:\nA. Night blindness >1%\nB. Bitot spots >1%\nC. Corneal ulceration > 0.05%\nD. Corneal ulcer >0.5%\n", "role": "user" }, { "content": "###Rationale: Prevalence criteria for determining the Xerophthalmia problem in a community: Criteria Prevalence Night blindness >1.0% Bitot's spots >0.5% Corneal xerosis / corneal ulceration / keratomalacia >0.01% Corneal ulcer >0.05% Serum retinol >5.0%\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "As a healthcare professional, please evaluate the patient's description and offer your expertise in answering the medical questions.\nAnswer with the best option directly.###Question: The predominant immunoglobulin in saliva is\n###Options:\nA. IgA\nB. IgD\nC. IgE\nD. IgG\n", "role": "user" }, { "content": "###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your role as a doctor requires you to answer the medical questions taking into account the patient's description.\nAnalyze the question and answer with the best option.###Question: Nerve supplying Gemellus inferior\n###Options:\nA. Nerve to Obturator internus\nB. Superior gluteal nerve\nC. Inferior gluteal nerve\nD. Nerve to Quadratus femoris\n", "role": "user" }, { "content": "###Rationale: Nerve to Obturator internus supplies obturator internus and Gemellus superior.\nNerve to Quadratus femoris supplies Quadratus femoris and Gemellus inferior\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnalyze the question and answer with the best option.###Question: Ca-wheel appearance of tympanic membrane in ASOM is due to\n###Options:\nA. Perforation of tympanic membrane\nB. Edema of tympanic membrane\nC. Congested blood vessels along malleus\nD. Granulation tissue on tympanic membrane\n", "role": "user" }, { "content": "###Rationale: In the stage of presuppuration of ASOM, there is congestion of pars tensa. A leash of blood vessels appears along the handle of malleus and at the periphery of tympanic membrane impaing it a ca-wheel appearance. (Ref: Textbook of diseases of ENT, Dhingra 7th edition; pg no 67)\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Your identity is a doctor, kindly provide answers to the medical questions with consideration of the patient's description.\nAnswer with the best option directly.###Question: A patient on treatment for leukemia, develops chest pain, pulmonary infiltrates and pleural effusion. The likely cause is :\n###Options:\nA. Daunorubicin\nB. Hydroxyurea\nC. Cytarabine\nD. Tretinoin\n", "role": "user" }, { "content": "###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]

[ { "content": "You're a doctor, kindly address the medical queries according to the patient's account.\nAnalyze the question and answer with the best option.###Question: Regarding Case Control Study true is\n###Options:\nA. Useful for rare diseases\nB. Incidence can be calculated\nC. Takes longer time\nD. Relative risk can be calculated\n", "role": "user" }, { "content": "###Rationale: (A) Useful for rare diseases # CASE-CONTROL STUDY: Both exposure & outcome have occurred before the start of the study the study proceeds backwards from effect to cause; & it uses a control or comparison group to support or refute an inference.ADVANTAGES AND DISADVANTAGES OF CASE CONTROL STUDIESADVANTAGESDISADVANTAGES1. Relatively easy to carry out1. Problems of bias relies on memory or past records, the accuracy of wh'ch may be uncertain; validation of information obtained is difficult or sometimes impossible2. Rapid and inexpensive (compared with cohort studies)2. Selection of an appropriate control group may be difficult3. Require comparatively few subjects3. We cannot measure incidence, and can only estimate the relative risk4. Particularly suitable to investigate rare diseases or diseases about which little is known. But a disease which is rare in the general population (e.g., leukaemia in adolescents) may not be rare in special exposure group (e.g. prenatal X-rays).4. Do not distinguish between causes and associated factors5. No risk to subjects5. Not suited to the evaluation of therapy or prophylaxis of disease6. Allows the study of several different aetioiogical factors (e.g., smoking, physical activity and personality characteristics in myocardial infarction)6. Another major concern is the representativeness of cases and controls7. Risk factors can be identified. Rational prevention and control programmes can be established 8. No attrition problems, because case control studies do not require follow-up of individuals into the future9. Ethical problems minimal\n\n###Answer: OPTION A IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnalyze the question and answer with the best option.###Question: Laboratory evaluation for the differential diagnosis of chronic myeloproliferative disorders includes all the following evcepr :\n###Options:\nA. Chromosomal evaluation\nB. Bone marrow aspiration\nC. Flow-cytometric analysis\nD. Determination of red blood cell mass\n", "role": "user" }, { "content": "###Rationale: Answer is C (Flow cytometry) respective myeloproliferative disorde Myeloproliferative disorder Useful tests Polycythemia vera Elevated Red cell mass / with normal erythropoetin levels Chronic myeloid leukemia Chromosomal demonstration of Philadelphia chromosome or bcr /abl translocation Chronic idiopathic Myelofibrosis Dry tap on bone marrow aspiration alongwith characteristic peripheral blood picture Essential thrombocytosis Elevated Platelet count with cytogenetic evaluation to rule out CML or other myelodysplastic disorder\n\n###Answer: OPTION C IS CORRECT.", "role": "assistant" } ]

[ { "content": "Given your background as a doctor, please provide your insight in addressing the medical questions based on the patient's account.\nAnalyze the question and answer with the best option.###Question: Scabies, an infection of the skin caused by Sarcoptes scabiet, is an example of:\n###Options:\nA. Water borne disease\nB. Water washed disease\nC. Water based disease\nD. Water related disease\n", "role": "user" }, { "content": "###Rationale: D i.e. Water related disease Scabies is water washed (category II) water related disease.\n\n###Answer: OPTION D IS CORRECT.", "role": "assistant" } ]