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[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What medical therapy is used to treat chronic myelogenous leukemia?", "role": "user" }, { "content": "Stem cell transplant may be offered for CML in the chronic phase. It is sometimes used as a primary treatment option for younger people who have an HLA -matched donor. It is a treatment option for some people who do not achieve a complete response or develop resistance to or relapse with imatinib.\r\nAllogeneic hematopoietic cell transplantation (HCT) is a curative treatment option that comes at the cost of increased toxicity.\r\nA reduced intensity transplant may be an option for older people who may not tolerate a standard transplant. The chemotherapy or radiation used to prepare for a stem cell transplant is less intense than that used for a standard allogeneic transplant.\r\nOutcomes with HCT and tyrosine kinase inhibitors have not been directly compared in a well-designed trial. However, based on historical comparisons, HCT is associated with increased morbidity and mortality, despite the possibility of cure. Thus, allogeneic HCT is currently not offered as initial therapy, except in rare circumstances.\r\nWith HCT, the probability of survival can be predicted with reasonable accuracy using a scoring system devised by the European Group for Blood and Marrow Transplantation. The five-year overall survival rates for patients in the best risk groups ranged from 60 to 80 percent. As an example, a prospective trial of HCT in patients in first chronic phase, most of whom had failed to respond to initial treatment with imatinib, reported a transplant-related mortality rate of 8 percent. \r\nThe aim of initial therapy with a tyrosine kinase inhibitor is to achieve the milestones, which are optimal responses proposed by the European LeukemiaNet. At three months, BCR/ABL 1 ≤10 % on the International Scale and/or Ph+ metaphase cells ≤35% At six months, BCR/ABL 1 <1 % and/or Ph+ 0 At 12 months, BCR/ABL 1 ≤0.1 %\r\nFailure to achieve these milestones should be confirmed with repeat studies before changes in therapy are initiated. A decision to change therapy must also take into consideration the trends in these values over time. Discontinuation of a TKI would be an option for only the approximately 15 to 20 percent of patients who achieve sustained non-detectable levels of BCR/ABL1 for at least two years; successful long-term discontinuation of therapy would be expected in less than 10 to 15 percent of newly diagnosed patients. \r\nFor individuals who have had a deep molecular remission, about half will have evidence of molecular recurrence and progression within one year after discontinuing TKI therapy, since viable CML stem cells can remain in a quiescent state in the marrow. . In general, the patients who are most likely to maintain a long treatment-free remission are those who have had the longest period of TKI treatment and have had undetectable transcript levels for years.\r\nBiological therapy may be offered for chronic stage CML. Biological therapy can be used alone or in combination with chemotherapy. The most common biological therapy used is interferon alfa (Intron A, Roferon A). Interferon alfa may be used for people who cannot tolerate, or whose CML is resistant to, imatinib.\r\nChemotherapy\r\nChemotherapy may be offered for CML in the chronic phase. The types of chemotherapy used are: Hydroxyurea (Hydrea, Apo-hydroxyurea, Gen-hydroxyurea) Cytarabine (Cytosar) May be used in combination with interferon alfa Busulfan (Myleran oral, Busulfex intravenous)", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What factors increase the risk of developing hepatocellular carcinoma?", "role": "user" }, { "content": "Less common risk factors that may increase the risk of developing hepatocellular carcinoma are: \r\nAnabolic steroids Alpha1-antitrypsin deficiency Arsenic Alcohol Obesity Diabetes Mellitus Food infected with Aspergillus flavus (especially peanuts and corns stored during prolonged wet seasons), which produces aflatoxin. Glycogen storage diseases Hemochromatosis Inherited metabolic diseases such as: Porphyria cutanea tarda Smoking Tyrosinemia Vinyl chloride and thorium dioxide Wilson disease", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What classification scheme is utilized in the ACC: AHA guidelines?", "role": "user" }, { "content": "The Class designation is used to indicate whether a therapy is recommended or not and the certainty surrounding that recommendation.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What are the causes of confusion during a physical examination?", "role": "user" }, { "content": "In cases of confusion, a physical examination helps in localizing the lesion if the cause is from the brain. It also gives clues to the underlying cause of the disease. A complete neurological examination may not be done due to a limitation of the patient's condition.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What diagnostic study is typically used to evaluate chest pain?", "role": "user" }, { "content": "Chest pain or chest pain equivalent may be referred as chest pain. The diagnosis of nontraumatic chest pain is a frequent challenge for clinicians in emergency department. Initial evaluation for work-up of chest pain is considered for life-threatening conditions such as ACS, aortic dissection, and pulmonary embolism, as well as nonvascular syndromes (eg, esophageal rupture, tension pneumothorax). Therapy for those with less critical illnesses is reasonable. Although there are several life-threatening causes, chest pain usually reflects a more benign condition. The initial ECG is important to the evaluation, but history, physical examination, biomarkers, and other tests are necessary. There is no direct association between the intensity of symptoms and seriousness of disease and general similarity of symptoms among different causes of chest pain. A comprehensive history that collects all the characteristics of chest pain including:\r\nNature Onset and duration Location and radiation Precipitating factors Relieving factors Associated symptoms", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the underlying biological mechanism of dermatofibroma?", "role": "user" }, { "content": "Microscopically dermatofibroma is characterized by: \r\nLocalized nodular proliferation of spindle -shaped fibrous cells in a mixture of histocytoid cells inside the dermis Spiculated margin of cells “Storiform” pattern which defines as whorls of elongated nuclei Collagen bundles that usually seen inside and between the fascicles of spindled fibrous cells \"Grenz zone\" which is an unaffected layer that separates the overlying epidermis from the dermis Epidermal hyperplasia", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is melena and what are its causes?", "role": "user" }, { "content": "The most common cause of melena is peptic ulcer disease. Any other cause of bleeding from the upper gastro-intestinal tract, or even the ascending colon, can also cause melena. Melena may also be a sign of drug overdose if a patient is taking anti-coagulants, such as warfarin. A less serious, self-limiting case of melena can occur in newborns two to three days after delivery, due to swallowed maternal blood.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does intraventricular conduction delay mean?", "role": "user" }, { "content": "Intraventricular conduction delay involves a variety of disturbances of the His-Purkinje/ventricular conduction system that affects the electrocardiogram (ECG) in distinctive ways and may or may not lead to a wide QRS complex and/or axis deviation.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the explanation for Normoblast and the additional images?", "role": "user" }, { "content": "Blood cell lineage Hematopoiesis Blood: Schistocytes: Micro blood film shows an excellent example with normoblast.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does the term \"fundus of the uterus\" refer to?", "role": "user" }, { "content": "The fundus of the uterus is the top portion, opposite from the cervix.\r\nFundal height, measured from the top of the pubic bone, is routinely measured in pregnancy to determine growth rates.\r\nIf the measurement is smaller or larger than what would be expected for gestational age, it can be a crude indicator of an abnormality (for example, a breech or sideways presentation, twins, or a placental issue), requiring further tests such as ultrasound to determine the exact nature of the problem, if any.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does a physical examination for glaucoma entail?", "role": "user" }, { "content": "External adnexae\r\nUseful in determining the presence of a variety of conditions associated with secondary glaucomas as well as external ocular manifestations of glaucoma therapy.\r\nPupils\r\nPupillary responses are one measure of compliance in patients who are on miotic therapy. Corectopia, ectropion uveae and pupillary abnormalities may be observed in some forms of glaucoma. Testing for a RAPD may detect asymmetric optic nerve damage in glaucoma.\r\nConjunctiva\r\nconjunctival injection can lead to acutely elevated IOP during chronic use of sympathomimetic drops massive episcleral venous dilation can cause chronically elevated IOP black adrenochrome deposits due to chronic use of epinephrine derivative drops use of topical antiglaucoma medication may lead to decreased tear production, allergic reactions, foreshortening of the conjunctival fornices, scarring. to measure size, height, degree of vascularization, integrity of a filtering bleb if present\r\nEpisclera and sclera\r\ndilation of the episcleral vessels can cause elevated episcleral venous pressure. sentinel vessels in case of an intraocular tumor thinning or staphylomatous areas\r\nCornea\r\nenlargement of the cornea, breaks in Descemet’s membrane (Haab’s striae) can lead to developmental glaucoma punctate epithelial defects (especially in the inferonasal interpalpebral region) secondary to medication toxicity microcystic epithelial edema → acute elevated IOP endothelial abnormalities → underlying associated secondary glaucoma Krukenberg spindle in pigmentary glaucoma deposition of exfoliation material in exfoliation syndrome keratic precipitates in uveitic glaucoma guttae in Fuchs endothelial dystrophy irregular and vesicular lesions in posterior polymorphous dystrophy ‘beaten bronze’ appearance in the iridocorneal endothelial syndrome anteriorly displaced Schwalbe’s line → Axenfeld-Rieger syndrome traumatic or surgical corneal scars, corneal thickness\r\nAnterior chamber\r\nwidth of the chamber angle → van Herick method (A narrow slit beam is directed at an angle of 60˚ onto the cornea just anterior to the limbus. If the distance from the anterior iris surface to the posterior surface of the cornea is less than one fourth the thickness of the cornea, the angle may be narrow) uniformity of depth of the anterior chamber (iris bombe, iris masses) inflammatory cells, red cells, ghost cells, fibrin, vitreous\r\nIris\r\nheterochromia, iris atrophy, transillumination defects, ectropion uveae, corectopia, nevi, nodules, exfoliative material early stages of neovascularization of the anterior segment → fine tufts around the pupillary margin, fine network of vessels on the surface of the iris. evidence of trauma (sphincter tear, iridodonesis), iris pigmentation \\\r\nLens\r\nexfoliative material, phacodonesis, subluxation, dislocation lens size, shape and clarity posterior subcapsular cataract → chronic corticosteroid use presence, type and position of an IOL\r\nFundus\r\ncareful assessment of the optic disc hemorrhage, effusion, masses, inflammatory lesion, retinovascular occlusion, diabetic retinopathy, retinal detachment\r\nUnder normal conditions the anterior chamber angle cannot be vieweddirectly through the cornea, because light coming from the angle undergoes total internal reflection at the tear film-air interface. Because the index of refraction of glass or plastic is similar to that of thecornea and tears, gonioscopy eliminates this interface and replaces it with anew lens-air interface set at a different angle to the emerging rays. Types of goniolenses Indirect goniolens: Goldmann-type, Zeiss-type Direct goniolens: Koeppe, Barkan, Wurst, Richardson. Angle landmarks: Schwalbe’s line and scleral spur → inferior portion The width of the angle is determined by: the site of insertion of the iris on the ciliary face the convexity of the iris the prominence of the peripheral iris roll The best method for describing the angle is a description or drawing of theiris contour, the location of the iris insertion, and the angle between the iris and the trabecular meshwork. Gonioscopic grading systems Shaffer system→ describes the angle between the iris and the surface of the trabecular meshwork Grade IV 45° Grade III 20-45° Grade II 20° Angle closure possible Grade I 10° Angle closure probable in time Slit <10° Angle closure very likely O (the iris is against the trabecular meshwork; angle closure is present) Spaeth system → describes the peripheral iris contour, the insertion of their is root, and the effects of indentation gonioscopy on the angle configuration. Ordinarily, Schlemm’s canal is invisible by gonioscopy. Occasionally during gonioscopy in normal eyes, blood refluxes into Schlemm’s canal where it is seen as a faint red line in the posterior portion of the trabecular meshwork. Blood enters Schlemm’s canal when episcleral venous pressure exceeds IOP, most commonly because of compression of the episcleral veins by the lip of the goniolens. Pathological causes include hypotony and elevated episcleral venous pressure (e.g. carotid-cavernous fistula, Sturge-Weber syndrome). Normal blood vessels in the angle include: radial iris vessels, portions of the arterial circle of the ciliary body vertical branches of the anterior ciliary arteries → oriented either radially along the iris or circumferentially (in a serpentine\r\nmanner) in the ciliary body face Fuchs heterochromic iridocyclitis → fine, branching, unsheathed, meandering Neovascular glaucoma → trunklike vessels crossing the ciliary body and scleral spur and arborizing over the trabecular meshwork. • Gonioscopic examination Posterior cornea pigmentation, guttata Schwalbe’s line thickening, anterior displacement Trabecular meshwork pigmentation, PAS, inflammatory or neovascular membranes, keratic precipitates Scleral spur iris processes Ciliary body band width, regularity, cyclodialysis cleft Iris contour, rubeosis, atrophy, cysts, iridodonesis Pupil, lens exfoliation syndrome, posterior synechiae, position and regularity, sphincter rupture, ectropion uveae Zonular fibers pigmentation, rupture • Iris processes → follow the normal curve of the angle; the angle structures are visible in the open spaces between the processes\r\n0.5 to 0.9 cup-to- disc ratio. Increase seen with open angle glaucoma. Glaucoma A normal range of vision. Courtesy NIH National Eye Institute The same view with advanced vision loss from glaucoma.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "How do you classify conjunctivitis in individuals who have allergies?", "role": "user" }, { "content": "Seasonal conjunctivitis (SAC) Perennial conjunctivitis ((PAC)\r\nVernal Keratoconjunctivitis (VKC) Atopic Keratoconjunctivitis (AKC)\r\nContact lens induced papilloconjunctivitis Giant papillary conjunctivitis", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Could you please explain what carcinoid syndrome means?", "role": "user" }, { "content": "Carcinoid syndrome must be differentiated from systemic mastocytosis, medullary thyroid carcinoma, irritable bowel syndrome, malignant neoplasms of the small intestine, benign cutaneous flushing, and recurrent idiopathic anaphylaxis.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What information is there about Disopyramide?", "role": "user" }, { "content": "Disopyramide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:\r\ndizziness or lightheadedness difficult urination dry mouth constipation blurred vision stomach pain or bloating headache\r\nIf you experience any of the following symptoms, call your doctor immediately:\r\nchest pain swelling of the feet or hands unusual weight gain irregular heartbeat shortness of breath fever, chills, or sore throat skin rash or yellowing of the skin\r\nIf you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online at http://www.fda.gov/MedWatch/report.htm or by phone 1-800-332-1088.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does Aortic stenosis mean?", "role": "user" }, { "content": "If there are no symptoms or symptoms are mild, you may only need to be monitored by a health care provider. Patients with aortic stenosis may be told not to play competitive sports, even if they don't have symptoms. If symptoms do occur, strenuous activity must be limited.\r\nIn adults, treatments include:\r\nMedication: Medications are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated. Lifestyle changes: Stop smoking and be treated for high cholesterol. See a cardiologist every 3 to 6 months. Surgery: Surgery to repair or replace the aortic valve is the preferred treatment for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery. People with no symptoms but worrisome results on diagnostic tests may also require surgery. Valvuloplasty: Some high-risk patients may be poor candidates for heart valve surgery. A less invasive procedure called balloon valvuloplasty may be done in adults or children instead. This is a procedure in which a balloon is placed into an artery in the groin, advanced to the heart, placed across the valve, and inflated. This may relieve the obstruction caused by the narrowed valve. Percutaneous Aortic Valve Replacement: Percutaneous aortic valvular replacement (PAVR) is a new less invasive procedure that does not require open heart surgery. In this procedure, a new replacement or prosthetic valve is implanted into the heart. The device is inserted through a small hole in the artery that runs to the leg . It is a relatively new procedure and is currently under study. It has the benefits of not requiring general anesthesia, causing less pain, less blood loss, and a lower risk of infection. There is also a faster recovery after PAVR than with traditional open heart surgery to replace the aortic valve.\r\nIn children, treatments include:\r\nPhysically activity limits: Children with mild aortic stenosis may be able to participate in most activities and sports. As the illness progresses, sports such as golf and baseball may be permitted, but not more physically demanding activities. Surgery: Valvuloplasty is often the first-choice for surgery in children. Some children may require aortic valve repair or replacement. If possible, the pulmonary valve may be used to replace the aortic valve, called a Ross procedure.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What are the history and symptoms associated with pleural effusion?", "role": "user" }, { "content": "Pleural effusion is typically diagnosed on the basis of a family history and a physical exam, and it is confirmed by a chest X-ray.\r\nPleural effusion can often be asymptomatic, however the most common symptoms are as follows: \r\nChest pain, usually a sharp pain that is worse with cough or deep breaths Cough Fever Hiccups Rapid breathing Shortness of breath Dyspnea Orthopnea Diaphragmatic breathing Anorexia", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the verbal information regarding Carteolol?", "role": "user" }, { "content": "Cartrol®", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "\"What is the medical treatment for hypertrophic cardiomyopathy?\" is already proper English.", "role": "user" }, { "content": "These patients should avoid volume depletion and dehydration which reduces Left ventricular volume and thereby exacerbates left ventricular outflow tract obstruction.\r\nStrenuous activity has been associated with sudden cardiac death in these patients and for this reason these patients are counseled to avoid engaging in competitive sports.\r\nThis autosomal dominant disease has a high degree of penetrance and first degree relatives should be screened.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Could you explain the meaning of \"Polymorphous light eruption\"?", "role": "user" }, { "content": "Polymorphous light eruption (PLE), or polymorphic light eruption, is a skin complaint caused by sunlight. Symptoms include skin irritations, which may be itchy or painful, and are sometimes confused with hives. These irritations appear upon exposure to sunlight—sometimes as little as 15 minutes of exposure to the sun can bring onset of the condition—and may last from 1 to 7 days. Generally, PLE resolves without treatment; also, PLE irritations generally leave no scar. The cases of this condition are most common between the spring and autumn months in the northern hemisphere.\r\nTypically, 10-20% of the population are affected. It is more common in females than in males. The condition can affect all ethnic groups and research suggests that 20% of patients have a family history of the complaint. Those suffering from PMLE usually do so by age 30.\r\nThe cause of PLE is not yet understood. It is thought to be due to a type IV delayed-type hypersensitivity reaction.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is thromboembolism and what does an overview of it involve?", "role": "user" }, { "content": "Thromboembolism is a general term describing both thrombosis and its main complication which is embolism.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What are the important pieces of information to know regarding infants born to mothers with diabetes?", "role": "user" }, { "content": "All infants who are born to mothers with diabetes should be tested for low blood sugar (hypoglycemia), even if they have no symptoms.\r\nIf an infant had one episode of low blood sugar, tests to check blood sugar levels will be done over several days. This will continue until the infant's blood sugar remains stable with normal feedings.\r\nEarly feeding may prevent low blood sugar in mild cases. Persistent low blood sugar is treated with sugar (glucose) given through a vein.\r\nRarely, the infant may need breathing support or medications to treat other effects of diabetes.\r\nHigh bilirubin levels are treated with light therapy (phototherapy), or rarely, by replacing the baby's blood with blood from a donor (exchange transfusion).", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What are the historical background and symptoms of Amyotrophic lateral sclerosis?", "role": "user" }, { "content": "ALS is a neurodegenerative disease that ultimately leads to paralysis. Patients may have a positive history of:\r\nWeakness start proximally/ distally in upper or lower limbs. Twitching Cramping Gradually Stiffness also develop in affected muscles Difficulty swallowing/ speech. Drooling\r\nCommon symptoms of ALS include:\r\nMuscle weakness Muscle stiffness Gait disturbances Dysarthria/ dysphagia with bulbar-onset ALS. Respiratory difficulties", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What are the history and symptoms of Acanthocytosis?", "role": "user" }, { "content": "Patients with acanthocytosis may have a history of chronic diarrhea with pale, foul-smelling, and bulky stools; loss of appetite and vomiting; and slow weight gain and decreased growth, possibly including a bleeding tendency. Patients may report symptoms of ataxia, tremors, and visual abnormalities or jaundice, abdominal pain, pallor, dark urine, and recurrent infections. Adolescents and adults may report dyskinesias, specifically orolingual, and cognitive deterioration.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Could you please provide me the statement that needs to be rephrased?", "role": "user" }, { "content": "Screening for pneumomediastinum is not recommended.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "How is anticipation linked to genetics?", "role": "user" }, { "content": "Since the early 90’s, a new class of molecular disease has been characterized based upon the presence of unstable and abnormal expansions of DNA-triplets (trinucleotides). The first triplet disease to be identified was fragile X syndrome that has since been mapped to the long arm of the X chromosome. At this point, there are from 230 to 4000 CGG repeats in the gene that causes fragile X syndrome in these patients, as compared with 60 to 230 repeats in carriers and 5 to 54 repeats in normal persons. The chromosomal instability resulting from this trinucleotide expansion presents clinically as mental retardation, distinctive facial features, and macroorchidism in males. The second, related DNA-triplet repeat disease, fragile X-E syndrome, was also identified on the X chromosome, but was found to be the result of an expanded GCC repeat. Identifying trinucleotide repeats as the basis of disease has brought clarity to our understanding of a complex set of inherited neurological diseases.\r\nAs more repeat expansion diseases have been discovered, several categories have been established to group them based upon similar characteristics. Category I includes Huntington’s disease (HD) and the spinocerebellar ataxias that are caused by a CAG repeat expansion in protein-coding portions of specific genes. Category II expansions tend to be more phenotypically diverse with heterogeneous expansions that are generally small in magnitude, but also found in the exons of genes. Category III includes fragile X syndrome, myotonic dystrophy, two of the spinocerebellar ataxias, juvenile myoclonic epilepsy, and Friedreich ataxia. These diseases are characterized by typically much larger repeat expansions than the first two groups, and the repeats are located outside of the protein-coding regions of the genes.\r\nCurrently, ten neurologic disorders are known to be caused by an increased number of CAG repeats, typically in coding regions of otherwise unrelated proteins. During protein synthesis, the expanded CAG repeats are translated into a series of uninterrupted glutamine residues forming what is known as a polyglutamine tract. Such polyglutamine tracts may be subject to increased aggregation.\r\nRecent results suggest that the CAG repeats need not always be translated in order to cause toxicity. Researchers at the University of Pennsylvania demonstrated that in fruit flies, a protein previously known to bind CUG repeats (muscleblind, or mbl) is also capable of binding CAG repeats. Furthermore, when the CAG repeat was changed to a repeating series of CAACAG (which also translates to polyQ), toxicity was dramatically reduced.</ref> The human homolog of mbl, MBNL1, which was originally identified as binding CUG repeats in RNA , has since been shown to bind CAG (and CCG ) repeats as well.\r\nThese disorders are characterized by autosomal dominant mode of inheritance (with the exception of spino-bulbar muscular atrophy which shows X-linked inheritance), midlife onset, a progressive course, and a correlation of the number of CAG repeats with the severity of disease and the age at onset. Family studies have also suggested that these diseases are associated with anticipation, the tendency for progressively earlier or more severe expression of the disease in successive generations. Although the causative genes are widely expressed in all of the known polyglutamine diseases, each disease displays an extremely selective pattern of neurodegeneration.\r\nClick on section title for internal link to a thorough list\r\nAutosomal Dominant Several spinal cerebellar atrophies Huntington's Disease - CAG Myotonic Dystrophy - CTG\r\nAutosomal Recessive Friedreich Ataxia - GAA\r\nX-Linked Fragile X syndrome - CGG", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What exactly is a Lisch nodule?", "role": "user" }, { "content": "The incidence of Lisch nodules is approximately 1 in 2600 to 3000 individuals worldwide. Approximately one-half of the cases are familial (inherited). The remainder are the result of de novo (sporadic) mutations.\r\nThe prevalence of Lisch nodules is approximately 1 in 3500 individuals worldwide. \r\nLisch nodules are predominantly visible in children usually after the age of six years. \r\nLisch Nodule incidence in NF1 increases with age and their prevalence raises by about 10% per year of life, up to age 9. Lisch nodules are found in 93% of adults with NF-1 but have not been described in NF-2. Lisch Nodules may be found in a very limited number of individuals without NF. The de novo mutations occur primarily in paternally derived chromosomes, and the likelihood of de novo NF1 increases with advanced paternal age.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the historical background or perspective on maturity-onset diabetes of the young?", "role": "user" }, { "content": "The term MODY dates back to 1964, when diabetes mellitus was considered to have two main forms: juvenile-onset and maturity-onset, which roughly corresponded to what we now call type 1 and type 2. MODY was originally applied to any child or young adult who had persistent, asymptomatic hyperglycemia without progression to diabetic ketoacidosis or ketoacidosis. In retrospect we can now recognize that this category covered a heterogeneous collection of disorders which included cases of dominantly inherited diabetes (the topic of this article, still called MODY today), as well as cases of what we would now call type 2 diabetes occurring in childhood or adolescence, and a few even rarer types of hyperglycemia (e.g., mitochondrial diabetes or mutant insulin). Many of these patients were treated with sulfonylureas with varying degrees of success.\r\nBy the 1990s, as the understanding of the pathophysiology of diabetes has improved, the concept and usage of \"MODY\" have become refined and narrower. It is now used as a synonym for dominantly inherited, monogenic defects of insulin secretion occurring at any age, and no longer includes any forms of type 2 diabetes.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the primary method of preventing esophageal stricture?", "role": "user" }, { "content": "Effective measures for the primary prevention of esophageal stricture include:\r\nTreatment of gastroesophageal reflux disease with proton pump inhibitors or H2 antagonists as a most important cause of esophageal stricture Life style modification for gastroesophageal reflux disease such as avoiding: Spicy foods Tobacco Alcohol Peppermint Chocolate Food before bedtime Take pills with a full glass of water in an upright position in order to prevent pill-induced esophagitis as a cause of esophageal stricture. Store all corrosive chemicals out of the reach of children.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What diagnostic approach is used for deep vein thrombosis?", "role": "user" }, { "content": "Shown below is the diagnostic approach to suspected recurrent DVT. The recommended initial test is either proximal ultrasound (US) or highly sensitive D-dimer tetsing rather than venography, CT venography or MR imagining. Initial D-dimer testing is recommended over proximal US in case there is no prior ultrasound for comparison. Note the following definitions:\r\nNegative US: Normal US, or Increase in residual diameter of less than 2 mman, or Area of prior noncompressibility with a decreased or stable residual diameter Nondiagnostic US: Ultrasound that is technically limited, or Area of prior noncompressibility with an increment in residual venous diameter of < 4 mm yet ≥ 2 mm, or Area of prior noncompressibility in the absence of a previous measurement of the residual diameter Positive US: New noncompressible segment, or Area of prior noncompressibility with an increment in residual venous diameter of ≥ 4 mm", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What medical therapy is utilized for HIV and AIDS?", "role": "user" }, { "content": "1. Antiretroviral regimen options for treatment-naive patients \r\n1.1. Integrase strand transfer inhibitor-based regimens Preferred regimen (1): Dolutegravir 50 mg PO qd AND Abacavir 600 mg- Lamivudine 300 mg PO qd in patients who are HLA-B*5701-negative Preferred regimen (2): Dolutegravir 50 mg PO qd AND Tenofovir 300 mg- Emtricitabine 200 mg PO qd Preferred regimen (3): Elvitegravir 150 mg- Cobicistat 150 mg- Tenofovir 300 mg- Emtricitabine 200 mg PO qd in patients with estimated CrCl ≥ 70 mL/min/1.73 Preferred regimen (4): Raltegravir 400 mg PO bid AND Tenofovir 300 mg- Emtricitabine 200 mg PO qd Alternative regimen (1): Efavirenz 600 mg PO qd OR Tenofovir 300 mg- Emtricitabine 200 mg PO qd Alternative regimen (2): Rilpivirine 25 mg PO qd AND (Tenofovir 300 mg PO qd OR Emtricitabine 200 mg PO qd) for patients with CD4 count >200 cells/microL Alternative regimen (3): Raltegravir 400 mg PO bid AND (Abacavir 600 mg PO qd OR Lamivudine 300 mg PO qd) in patients who are HLA-B*5701-negative\r\n1.2. Protease inhibitor-based regimen Preferred regimen: Darunavir 800 mg- Ritonavir 100 mg PO qd AND Tenofovir 300 mg- Emtricitabine 200 mg PO qd Alternative regimen (1): Atazanavir 300 mg- Cobicistat 150 mg PO qd AND Tenofovir disoproxil fumarate 300 mg- Emtricitabine 200 mg PO qd only for patients with pre-treatment estimated CrCl ≥70 mL/min Alternative regimen (2): Atazanavir 300 mg- Ritonavir 100 mg PO qd AND Tenofovir 300 mg- Emtricitabine 200 mg PO qd Alternative regimen (3): (Darunavir 800 mg- Cobicistat 150 mg PO qd OR Darunavir 800 mg- Ritonavir 100 mg PO qd) AND Abacavir 600 mg- Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative Alternative regimen (4): Darunavir 800 mg- Cobicistat 150 mg PO qd AND Tenofovir disoproxil fumarate 300 mg- Emtricitabine 200 mg PO qd only for patients with pre-treatment estimated CrCl ≥70 mL/min Alternative regimen (5): Atazanavir 300 mg- Ritonavir 100 mg PO qd AND Abacavir 600 mg- Lamivudine 300 mg PO qd in patients who are HLA-B*5701-negative and with pre-treatment HIV RNA <100,000 copies/mL Alternative regimen (6): Lopinavir 400 mg- Ritonavir 100 mg PO qd or bid AND Abacavir 600 mg- Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative Alternative regimen (7): Lopinavir 400 mg- Ritonavir 100 mg PO qd or bid AND Tenofovir disoproxil fumarate 300 mg- Emtricitabine 200 mg PO qd\r\n1.3. A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen Alternative regimen (1): Efavirenz 600 mg- Tenofovir 300 mg- Emtricitabine 200 mg PO qd Alternative regimen (2): Rilpivirine 25 mg- Tenofovir 300 mg- Emtricitabine 200 mg PO qd\r\n1.4. Other regimen options 1.4.1. A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen Preferred regimen (1): Efavirenz 600 mg PO qd AND Abacavir 600 mg- Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative and with pre-treatment HIV RNA <100,000 copies/mL. 1.4.2. Other regimens when tenofovir or abacavir cannot be used Preferred regimen (1): Darunavir 800 mg- Ritonavir 100 mg PO qd AND Raltegravir 400 mg PO qd only for patients with pre-treatment HIV RNA <100,000 copies/mL and CD4 cell count >200 cells/mm3. Preferred regimen (2): Lopinavir 400 mg- Ritonavir 100 mg PO bid AND Lamivudine 300 mg PO bid\r\n1.5. Pediatric doses Abacavir 300 mg PO bid Lamivudine 4 mg/kg/dose PO bid; maximum 150 mg PO bid Stavudine 1 mg/kg/dose PO bid Tenofovir 8 mg/kg/dose PO bid Zidovudine 180-240 mg/m 2 /dose PO bid or 160 mg/m 2 /dose PO tid (range 90 mg/m 2 /dose-180 mg/m 2 /dose) Lopinavir 400 mg PO bid Nelfinavir 50 mg/kg/dose PO bid Raltegravir 300 mg PO bid Didanosine 20 to < 25 kg: 200 mg PO qd 25 to < 60 kg: 250 mg PO qd ≥60 kg: 400 mg PO qd Efavirenz 10 to < 15 kg: 200 mg PO qd 15 to <20 kg: 250 mg PO qd 20 to < 25 kg: 300 mg PO qd 25 to < 32.5 kg: 350 mg PO qd 32.5 to <40 kg: 400 mg PO qd ≥ 40 kg: 600 mg PO qd Nevirapine maximum 200 mg per dose Between 1 day and 8 years: 200 mg/m 2 /dose PO qd for 14 days, then 200 mg/m 2 /dose PO bid 8 years and above: 120-150 mg/m 2 /dose PO qd for 14 days, then 120-150 mg/m 2 /dose PO bid Note (1): Anti retroviral therapy for treatment naive patients is a life long therapy. Note (2): Tenofovir disoproxil fumarate should be avoided in patients with a creatinine clearance <50 mL/min. Note (3): Rilpivirine should be used in patients with a CD4 cell count >200 copies/mL and should not be used with proton pump inhibitors. Note (4): Efavirenz should not be used in pregnant women.\r\n2. Pre-exposure prophylaxis (PrEP)\r\nPreferred regimen: Tenofovir disoproxil fumarate 300 mg- Emtricitabine 200 mg PO qd for ≤90-days Note (1): People with high risk behavior such as men who have sex with men, intravenous drug abusers, HIV-positive sexual partner, recent bacterial STI, high number of sex partners, history of inconsistent or no condom use, commercial sex work, people in high-prevalence area or network are advised to take pre-exposure prophylaxis of drugs. Note (2): Follow-up visits at least every 3 months to provide the following: HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STI symptom assessment, pregnancy testing. Note (3): At 3 months and every 6 months thereafter, assess renal function. Note (4): Every 6 months, test for bacterial STIs.\r\n3. Post- exposure prophylaxis\r\nPreferred regimen: Raltegravir 400 mg PO bid AND Tenofovir disoproxil fumarate 300 mg- Emtricitabine 200 mg PO qd Preferred basic regimen for low-risk exposures (Eg: mucus membrane): Zidovudine 100 mg PO qd AND Lamivudine 300 mg PO qd Zidovudine 100 mg PO qd AND Emtricitabine 200 mg PO qd Tenofovir 300 mg PO qd AND Lamivudine 300 mg PO qd Tenofovir 300 mg PO qd AND Emtricitabine 200 mg PO qd Preferred expanded regimen for high-risk exposure (Eg: percutaneous needle stick) Zidovudine 100 mg PO qd AND Lamivudine 300 mg PO qd AND Lopinavir 400 mg- Ritonavir 100 mg PO qd Zidovudine 100 mg PO qd AND Emtricitabine 200 mg PO qd AND Lopinavir 400 mg- Ritonavir 100 mg PO qd Tenofovir 300 mg PO qd AND Lamivudine 300 mg PO qd AND Lopinavir 400 mg- Ritonavir 100 mg PO qd Tenofovir 300 mg PO qd AND Emtricitabine 200 mg PO qd AND Lopinavir 400 mg- Ritonavir 100 mg PO qd Note: Ideally therapy should be started within hours of exposure and continued for 28 days.\r\n4. Perinatal antiretroviral regimen\r\n4.1. Antepartum 4.1.1. Protease inhibitor-based regimen Preferred regimen: (Tenofovir 300 mg- Emtricitabine 200 mg PO qd (fixed dose combination) OR Tenofovir 300 mg- Lamivudine 300 mg PO qd OR Abacavir 600 mg- Lamivudine 300 mg PO qd OR Zidovudine 100 mg- Lamivudine 300 mg PO qd) AND (Atazanavir 300 mg- Ritonavir 100 mg PO qd OR Lopinavir 400 mg- Ritonavir 100 mg PO qd) 4.1.2. A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen: Preferred regimen (1): Efavirenz 600 mg- Tenofovir 300 mg- Emtricitabine 200 mg (fixed dose combination) PO qd Preferred regimen (2): Efavirenz 600 mg- Tenofovir 300 mg- Lamivudine 300 mg PO qd Alternative regimen: (Abacavir 600 mg- Lamivudine 300 mg PO qd OR Zidovudine 100 mg- Lamivudine 300 mg PO qd) AND Efavirenz 600 mg PO qd\r\n4.2. Intrapartum Note (1): HIV RNA <1000 copies/mL and good adherance-Continue the regimen during delivery or cessarean section. Note (2): HIV RNA >1000 copies/mL near delivery, possible poor adherence, or unknown HIV RNA levels- Intravenous Zidovudine 2 mg/kg IV over 1 hr should be given three hours before cesarean section or delivery and then 1 mg/kg/hr IV continuous infusion until umbilical cord clamping.\r\n4.3. Postpartum Note: Initiate anti retroviral therapy (ART) and continue after delivery and cessation of breastfeeding.\r\n5. Infant antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV\r\n5.1 Prophylaxis for HIV-exposed infants of women who received antepartum antiretroviral prophylaxis Preferred regimen: Zidovudine (ZDV) 100 mg PO given at birth and continued till six weeks Note (1): Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery. Note (2): ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours. Note (3): ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days. Note (4): <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks. 5.2. Prophylaxis for HIV-exposed infants of women who received no antepartum antiretroviral prophylaxis Nevirapine Dose based on birth weight, initiated as soon after birth as possible. Birth weight 1.5 to 2 kg: 8 mg/dose orally. Birth weight >2 kg: 12 mg/dose orally. AND Zidovudine (ZDV) Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery. ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours. ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days. <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks. Note (1): Three doses in the first week of life. Note (2): First dose within 48 hours of birth (birth to 48 hrs). Note (3): Second dose 48 hours after first. Note (4): Third dose 96 hours after second.\r\nIndications: CD4 count <200 cells/mm3 or thrush Drugs used: Trimethoprim–sulfamethoxazole one double-strength tablet (160 mg of trimethoprim and 800 mg of sulfamethoxazole) daily or 3 times/week Dapsone 100 mg, orally once daily Pentamidine 300 mg, aerosolized through nebulizer monthly Atovaquone 1500 mg, orally (liquid suspension) daily\r\nIndications: CD4 count <100 cells/mm3 and positive serum cryptococcal antigen Drug used: fluconazole 200 mg, orally once daily\r\nIndications: CD4 count <150 cells/mm3 in areas where histoplasmosis is endemic\r\nDrug used: itraconazole 200 mg, orally once daily\r\nIt is no longer recommended in patient with rapid initiation of ART\r\nThe 2021 CDC STD guidelines recommend the following steps to be taken with every patient diagnosed with HIV: \r\nLink persons with HIV infection to care and start them on ART as soon as possible. Report cases (in accordance with local requirements) to public health and initiate partner services. Provide prevention counseling to persons with diagnosed HIV infection. Ensure all persons with HIV infection are informed that if they achieve and maintain a suppressed viral load, they have effectively no risk for transmitting HIV. Stress that a suppressed viral load is not a substitute for condoms and behavioral modifications because ART does not protect persons with HIV against other STIs. Provide additional counseling, either on-site or through referral, about the psychosocial and medical implications of having HIV infection. Assess the need for immediate medical care and psychosocial support. Link persons with diagnosed HIV infection to services provided by health care personnel experienced in managing HIV infection. Additional services that might be needed include substance misuse counseling and treatment, treatment for mental health disorders or emotional distress, reproductive counseling, risk-reduction counseling, and case management. Providers should follow up to ensure that patients have received services for any identified needs. Persons with HIV infection should be educated about the importance of ongoing medical care and what to expect from these services.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What information pertains to boiling?", "role": "user" }, { "content": "Boils may heal on their own after a period of itching and mild pain. More often, they increase in discomfort as pus collects.\r\nBoils usually must open and drain before they will heal. This usually occurs in less than 2 weeks.\r\nWarm, moist compresses help boils drain, which speeds healing. Gently soak the area with a warm, moist cloth several times each day. Never squeeze a boil or try to cut it open at home. This can spread the infection and make it worse. When the boil finally does burst and drain, continue to put warm, wet compresses on the area.\r\nDeep or large boils may need to be drained with surgery by a health care provider. Treatment by a health care provider is needed if:\r\nA boil lasts longer than 2 weeks A boil comes back The boil is on the spine or the middle of the face The boil occurs with a fever or other symptoms, because the infection may spread and cause complications\r\nCareful hygiene is important:\r\nClean draining boils often. Wash your hands very well after touching a boil. Do not re-use or share washcloths or towels. Wash clothing, washcloths, towels, and sheets or other items that contact infected areas in very hot (preferably boiling) water. Change dressings often and throw them out with the drainage, such as by placing them in a bag that can be closed tightly before throwing it out.\r\nAntibacterial soaps and antibiotics placed on the skin are of little help once a boil has formed. Antibiotics taken by mouth or given as a shot may help a more severe infection or if the boil returns.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the surgical procedure for treating blue rubber bleb nevus syndrome?", "role": "user" }, { "content": "Surgery is not the first-line treatment option for patients with blue rubber bleb nevus syndrome (BRBNS). Surgery is usually reserved for patients with either repeated or severe bleeding or cosmetic purposes", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can you provide an overview of Hemolytic anemia?", "role": "user" }, { "content": "The pathophysiology of most hemolytic anemia involves complement -activated autoantibodies or non- complement -activated autoantibodies, which result in destruction of red blood cells. The underlying mechanisms is based on immune dysregulation between self and non-self. Numerous drugs including novel anti-cancer therapeutics, can result in immune-mediated hemolysis. On the other hand, the pathophysiology of non-immune-mediated hemolysis relates to structural factors, such as red blood cell membrane and enzyme defects which confer fragility towards red blood cells. In the setting of defects of red blood cell membranes or anti-oxidant enzymes, there is increased risk for red blood cell destruction.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does the term \"Allen's test\" refer to?", "role": "user" }, { "content": "In medicine, Allen's test, is used to test blood supply to the hand. It is performed prior to radial arterial blood sampling or cannulation.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the primary prevention method for palpitations?", "role": "user" }, { "content": "There are no established measures for the primary prevention of palpitations. Effective measures for the primary prevention of palpitations include: Medication compliance Avoidance of triggers such as caffeine intake, alcohol abuse. Cessation of substance abuse (cocaine, amphetamines, alcohol, MDMA)", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the surgical procedure for treating osteoma?", "role": "user" }, { "content": "Treatment for an osteoma that is causing symptoms is surgery. The types of surgery that may be used are: Medial maxillectomy with a lateral rhinotomy incision: removal of part of the upper jaw bone through an incision along the side of the nose. Craniofacial resection: rebuilding the bones of the face and skull. Endoscopic resection: removal of the osteoma through a thin tube inserted into the sinus area Surgery and an endoscopic resection may be used together to try to completely remove the tumor.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the definition of polydipsia and what is its underlying pathophysiology?", "role": "user" }, { "content": "Polydipsia in Psychiatric patients", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What other imaging findings are associated with aortitis?", "role": "user" }, { "content": "Other diagnostic studies for aortitis include PET scan, which demonstrates uptake of Fluorine-18-fluorodeoxyglucose in the aorta and periaortic activity. The uptake of Fluorine-18-fluorodeoxyglucose in vascular structures is considered abnormal.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What are the historical and symptomatic aspects of Cryptosporidiosis?", "role": "user" }, { "content": "The symptoms of cryptosporidiosis are seen 2-10 days after infection. The common manifestations include watery diarrhea, abdominal pain, nausea, vomiting and fever.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Could you explain what Junctional bradycardia is?", "role": "user" }, { "content": "Junctional bradycardia or junctional escape rhythm need to be differentiated from other bradycardia conditions which has the bundle of His or the ventricles as their pacemaker compensating for the failed SA node.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does Hemophilia C mean?", "role": "user" }, { "content": "Treatment is usually not necessary, except in relation to operations, leading to many of those having the condition not being aware of it. In these cases, fresh frozen plasma or recombinant factor XI may be used, but only if necessary.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the definition of chronic obstructive pulmonary disease?", "role": "user" }, { "content": "The Global Burden of Disease Study reports a prevalence of 251 million cases of COPD globally in 2016. According to WHO estimates, 65 million people have moderate to severe chronic obstructive pulmonary disease (COPD) worldwide. COPD occurs in 34 out of 1000 greater than 65 years old. In England, an estimated 842,100 of 50 million people have a diagnosis of COPD; translating into approximately one person in 59 receiving a diagnosis of COPD at some point in their lives. In the most socioeconomically deprived parts of the country, one in 32 people were diagnosed with COPD, compared with one in 98 in the most affluent areas. In the United States, the age adjusted prevalence of COPD is approximately 6.4%, totalling approximately 15.7 million people in USA, or possibly approximately 25 million people if undiagnosed cases are included. COPD is the third cause of death among adult population in the United States.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the physiological process that causes menopause?", "role": "user" }, { "content": "The most important Conditions associated with Menopause include:\r\nCardiovascular disease: during menopause, estrogen deficiency causes vasoconstriction of the vessel wall. menopause is linked to the increased risk of cardiovascular disease.\r\nOsteoporosis is a disease of the bones that causes bones to become weak and break easily. During menopause, estrogen deficiency increases osteoclastic activity.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "\"What does the term 'intolerance' in relation to exercise refer to?\"", "role": "user" }, { "content": "Exercise intolerance is primarily found in organic brain diseases, mitochondrial disease and neuromuscular disease.\r\nMany diseases have exercise intolerance as one of the only symptoms, as in the case of some of the less severe metabolic myopathies. Nonspecific fatigue or pain syndromes such as chronic fatigue syndrome, fibromyalgia and Overtraining Syndrome are all collections of symptoms, one of likely to be exercise intolerance.\r\nHeart block Junctional bradycardia\r\nExercise intolerance can also be caused by specific health conditions, such as heart conditions or conditions that cause back pain. Several heart conditions, such as a cardiac arrhythmia (abnormal heart rate or rhythm) or an aortic valve insufficiency, if severe enough can cause activity problems such as shortness of breath and/or exercise intolerance. People with acute back pain from an injury or chronic back pain (e.g., from a degenerative condition) may also experience exercise limitations due to muscle spasms or limited range of spinal motion. Exercise is key for many heart and back patients, and a variety of specific exercise techniques are available for both groups. Some exercise specialists (e.g., physical therapists, athletic trainers) are trained in modifications specific to these patients.\r\nCertain conditions in particular exist where exercise, particularly rehabilitation, may be contraindicated, including:\r\ndecompensated heart failure recent MI hypertrophic cardiomyopathy or cardiomyopathy from recent myocarditis active or suspected myocarditis or pericarditis low left ventricular ejection fraction severe aortic stenosis unstable ischemia unstable arrhythmia irregular or resting pulse greater than 100 bpm resting systolic blood pressure >200 mm Hg or resting diastolic blood pressure >110 mm Hg severe pulmonary hypertension suspected or known dissecting aneurysm recent systemic or pulmonary embolus pneumothorax and haemoptysis thrombophlebitis\r\nOther conditions may also preclude exercising under certain conditions. Passive physiotherapy can in some instances be an alternative for some patients unable to safely self-power.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is an overview of Orbital Cellulitis?", "role": "user" }, { "content": "A positive history of fever, proptosis, eyelid edema and erythema, and painful or restricted ocular movements is suggestive of orbital cellulitis. Additionally, patients with orbital cellulitis often have a recent history of rhinosinusitis, upper respiratory tract infection, facial insect bite, orbital surgery or trauma, tooth abscess, or otitis media. \r\nPatients with orbital cellulitis usually appear ill. Physical examination of patients with orbital cellulitis is usually remarkable for fever, proptosis, ophthalmoplegia, and impaired visual acuity. Patients should undergo a complete physical examination, paying particular attention to general appearance, vital signs, visual acuity, visual field, orbital positioning, ocular movmements, oropharynx, and nasopharynx examinations. \r\nThere are no diagnostic lab findings associated with orbital cellulitis. Some patients with orbital cellulitis may have elevated ESR, CRP, and white blood cells with a left shift. These are non-specific findings associated with infections, inflammatory conditions and some neoplasia. Blood and nasal mucosal cultures are often ordered to help guide medical therapy, though they have low positive and negative predictive values, and thus do not contribute to diagnosis of orbital cellulitis.\r\nThere are no diagnostic x ray findings associated with orbital cellulitis. In cases where CT scan is contraindicated, plain radiograph (x ray) is indicated prior to MRI in patients with a suspected history of metallic object ocular trauma. \r\nComputed tomography of the orbit is the imaging modality of choice for patients with orbital cellulitis. On CT scan of the head, orbital cellulitis is characterized by hyperdensity within low density periorbital fat and generalized elevation of the periobital space. CT is also diagnostic of subperiosteal and orbital abscesses associated with orbital cellulitis. \r\nMRI has demonstrated equivalence to CT in diagnosing orbital disease and is also accepted as a gold standard diagnostic imaging modality. On MRI scan of the head, orbital cellulitis is characterized by hypointense signal on T1 -weighted fat-suppressed images, and hyperintense signal on T2-weighted fat-suppressed images. Although an MRI scan is safer in children since there is no risk of radiation exposure, the long acquisition time and the need for prolonged sedation make CT scan the imaging modality of choice. \r\nThere are no ultrasound findings specifically associated with orbital cellulitis. Ultrasound can detect an abscess in the anterior orbit or medial orbital wall with high sensitivity. On orbital ultrasound, orbital abscess may show an anechoic mass with low internal reflectivity. \r\nThere are no other diagnostic imaging findings associated with orbital cellulitis.\r\nThere are no other diagnostic studies associated with orbital cellulitis.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does \"toxic megacolon surgery\" mean?", "role": "user" }, { "content": "The mainstay of treatment for toxic megacolon is medical therapy. Surgery is usually reserved for patients with either failed medical therapy, progressive toxicity or dilation and signs of perforation.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the importance of an x-ray in diagnosing chronic cholecystitis?", "role": "user" }, { "content": "Abdominal X-Ray does not aid diagnosis of chronic cholecystitis. It is performed as an initial evaluation to diagnose the complicated gallbladder disease.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is Pylephlebitis and what is its overview?", "role": "user" }, { "content": "Pylephlebitis (also called infective suppurative thrombosis of the portal vein) is an inflammation of the portal vein or any of its branches. It is usually a complication of intraabdominal sepsis, most often following diverticulitis or appendicitis. It has a poor prognosis.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "How is Acromegaly related to radiation therapy?", "role": "user" }, { "content": "No single treatment is effective for acromegaly. Treatment should be individualized depending on patient characteristics, such as age and tumor size. The first choice in the treatment of acromegaly is pharmacotherapy. If the tumor has not yet invaded surrounding brain tissues, removal of the pituitary adenoma by surgery is preferred. Radiation therapy is generally reserved for patients who do not respond adequately to surgery and medication. Radiation therapy has been used both as a primary treatment and combined with surgery or drugs. It is usually reserved for patients who have tumor remaining after surgery. Radiation therapy is given in divided doses over four to six weeks. This treatment lowers GH levels by about 50 percent over 2 to 5 years. Patients monitored for more than 5 years show significant further improvement.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can you explain what a semicircular canal is?", "role": "user" }, { "content": "The semicircular canals are three half-circular, interconnected tubes located inside each ear that are the equivalent of three gyroscopes located in three orthogonal planes. The vertical canals are positioned at an angle of about 100 degrees relative to one another, while the horizontal canal makes an angle of about 95 degrees with the posterior canal and an angle of about 110 degrees with the anterior canal. Deviations up to 10-15 degrees between individuals are normal. Because the angles between the canals are not perpendicular, movements of the head stimulate horizontal and vertical canals simultaneously.\r\nThe three canals are:\r\nSuperior semicircular canal Posterior semicircular canal Horizontal semicircular canal\r\nEach canal is filled with a fluid called endolymph and contains a motion sensor with little hairs (cilia) whose ends are embedded in a gelatinous structure called the cupula.\r\nThe Semicircular canals are a component of the Labyrinth.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Which trials are considered landmarks in relation to AIDS?", "role": "user" }, { "content": "HIV drug resistance database", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is cardiac valve disease and how is it acquired?", "role": "user" }, { "content": "The content on this page was first contributed by: C. Michael Gibson M.S., M.D\r\nList of contributors:\r\nTemplate:Disambiguation\r\n\r\nv t e Cardiovascular disease (heart) Ischaemic Coronary disease Coronary artery disease (CAD) Coronary artery aneurysm Spontaneous coronary artery dissection (SCAD) Coronary thrombosis Coronary vasospasm Myocardial bridge Active ischemia Angina pectoris Prinzmetal's angina Stable angina Acute coronary syndrome Myocardial infarction Unstable angina Sequelae hours Hibernating myocardium Myocardial stunning days Myocardial rupture weeks Aneurysm of heart / Ventricular aneurysm Dressler syndrome Layers Pericardium Pericarditis Acute Chronic / Constrictive Pericardial effusion Cardiac tamponade Hemopericardium Myocardium Myocarditis Chagas disease Cardiomyopathy Dilated Alcoholic Hypertrophic Tachycardia-induced Restrictive Loeffler endocarditis Cardiac amyloidosis Endocardial fibroelastosis Arrhythmogenic right ventricular dysplasia Endocardium / valves Endocarditis infective endocarditis Subacute bacterial endocarditis non-infective endocarditis Libman–Sacks endocarditis Nonbacterial thrombotic endocarditis Valves mitral regurgitation prolapse stenosis aortic stenosis insufficiency tricuspid stenosis insufficiency pulmonary stenosis insufficiency Conduction / arrhythmia Bradycardia Sinus bradycardia Sick sinus syndrome Heart block: Sinoatrial AV 1° 2° 3° Intraventricular Bundle branch block Right Left Left anterior fascicle Left posterior fascicle Bifascicular Trifascicular Adams–Stokes syndrome Tachycardia (paroxysmal and sinus) Supraventricular Atrial Multifocal Junctional AV nodal reentrant Junctional ectopic Ventricular Accelerated idioventricular rhythm Catecholaminergic polymorphic Torsades de pointes Premature contraction Atrial Junctional Ventricular Pre-excitation syndrome Lown–Ganong–Levine Wolff–Parkinson–White Flutter / fibrillation Atrial flutter Ventricular flutter Atrial fibrillation Familial Ventricular fibrillation Pacemaker Ectopic pacemaker / Ectopic beat Multifocal atrial tachycardia Pacemaker syndrome Parasystole Wandering atrial pacemaker Long QT syndrome Andersen–Tawil Jervell and Lange-Nielsen Romano–Ward Cardiac arrest Sudden cardiac death Asystole Pulseless electrical activity Sinoatrial arrest Other / ungrouped hexaxial reference system Right axis deviation Left axis deviation QT Short QT syndrome T T wave alternans ST Osborn wave ST elevation ST depression Strain pattern Cardiomegaly Ventricular hypertrophy Left Right / Cor pulmonale Atrial enlargement Left Right Athletic heart syndrome Other Cardiac fibrosis Heart failure Diastolic heart failure Cardiac asthma Rheumatic fever\r\nTemplate:WikiDoc Sources CME Category::Cardiology", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can you provide a summary of B-cell prolymphocytic leukemia?", "role": "user" }, { "content": "Screening for B-cell prolymphocytic leukemia is not recommended.\r\nScreening for B-cell prolymphocytic leukemia is not recommended.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can you provide a summary or explanation of primary biliary cirrhosis?", "role": "user" }, { "content": "The female:male ratio is at least 9:1. In some areas of the US and UK the prevalence is estimated to be as high as 1 in 4000. This is much more common than in South America or Africa, which may be due to better recognition in the US and UK. First-degree relatives may have as much as a 500 times increase in prevalence, but there is debate if this risk is greater in the same generation relatives or the one that follows.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can you provide a brief summary of Chagas disease?", "role": "user" }, { "content": "Chagas disease is a human tropical parasitic disease usually caused by Trypanosoma cruzi, a flagellate protozoa.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the overview or summary of primary biliary cirrhosis?", "role": "user" }, { "content": "Primary biliary cirrhosis also known as primary biliary cholangitis is an autoimmune cholestatic disease. The disease is chronic and slowly progressive. The exact pathogenesis of primary biliary cirrhosis is not fully understood. It is postulated that primary biliary cirrhosis is the result of antimitochondrial antibodies (AMAs), directed to the E2 component of the pyruvate dehydrogenase complex (PDC-E2). Overexpression of Bcl-2 in small apoptotic biliary epithelial cells and cell lineage-specific lack of glutathione prevents loss of immunogenicity of the PDC-E2 component after apoptosis of biliary epithelial cells which finally results in autoimmunity. Primary biliary cirrhosis may be familial and is related to factors inherited maternally. Primary biliary cirrhosis is strongly associated with a variety of rheumatologic conditions, most commonly Sjogren's syndrome. On gross pathology, characteristic findings of primary biliary cirrhosis include hepatomegaly, splenomegaly, and cirrhosis (in late stage). On microscopic histopathological analysis, asymmetric destruction of the intralobular bile ducts within portal triads is characteristic findings of primary biliary cirrhosis. It is important to differentiate PBC from other disease that may cause cholestasis including autoimmune hepatitis, common bile duct stone, hepatitis A (choelstatic type), EBV or CMV hepatitis, primary sclerosing cholangitis, pre-ampullary cancers, AIDS cholangiopathy, parasites induced cholestasis, and intrahepatic cholestasis of pregnancy.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is sexual dysfunction caused by SSRI?", "role": "user" }, { "content": "One or more of the following sexual symptoms persist or begin after the discontinuation of SSRIs.\r\nDecreased or absent libido Impotence or reduced vaginal lubrication Difficulty initiating or maintaining an erection or becoming aroused Persistent sexual arousal syndrome despite absence of desire Muted, delayed or absent orgasm (anorgasmia) Reduced or no experience of pleasure during orgasm (ejaculatory anhedonia) Premature ejaculation Weakened penile, vaginal or clitoral sensitivity Genital anesthesia Loss or decreased response to sexual stimuli Reduced semen volume Priapism", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "How are electrocardiogram readings related to type 1 diabetes mellitus?", "role": "user" }, { "content": "There are no ECG findings associated with diabetes mellitus type 1.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Could you explain the meaning of neonatal jaundice?", "role": "user" }, { "content": "According to the American Academy of Pediatrics, screening tests recommended for neonatal jaundice include blood typing, clinical assessment of jaundice in the newborns, assessment of the total serum bilirubin level, measuring the level of G6PD enzyme. Also, it is recommended for all hospitals to provide information to the parents on jaundice and its consequences.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Could you please provide the original statement that needs to be rephrased?", "role": "user" }, { "content": "Cryptococcosis may be classified based on the site of infection. The clinical syndrome can be classified as pulmonary, CNS, or disseminated cryptococcosis. Another approach to the classification is based upon the variety of species of the Cryptococcus causative organism, including Cryptococcus neoformans, Cryptococcus gattii, and other, rarer species.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the medical condition that defines AIDS?", "role": "user" }, { "content": "AIDS is defined as an the presence of either of the following in a patient with HIV infection: a CD4+ T-cell count below 200 cells/µl, a CD4+ T-cell percentage of total lymphocytes of less than 15%, any of the 27 specified AIDS-defining illnesses.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can surgery be considered as a treatment option for prostatitis?", "role": "user" }, { "content": "Surgery is usually not required for prostatitis. In certain scenarios surgery can be helpful e.g when draining an abscess. Extracorporeal shock wave therapy has also proved to be helpful in chronic abacterial prostatitis.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can you provide a summary of mantle cell lymphoma?", "role": "user" }, { "content": "The mainstay of treatment for mantle cell lymphoma is chemotherapy. However, immunotherapy, radioimmunotherapy, targeted therapy using newer biologic agents and stem cell transplantation are also used along with chemotherapy to treat the disease. Mantle cell lymphoma shows a heterogeneous clinical behavior, with some patients having indolent disease whereas a vast majority show aggressive presentation. Most of the patients eventually relapse and have disease progression after treatment. Hence, mantle cell lymphoma is still considered an incurable disease and there is no consensus among oncologists about its optimal treatment. It is therefore recommended that mantle cell lymphoma patients are seen by physicians having extensive experience in dealing with mantle cell lymphoma and they are also encouraged to participate in clinical trials to get the latest treatments.\r\nThe mainstay of treatment for mantle cell lymphoma is medical therapy.\r\nThe mainstay of treatment for mantle cell lymphoma is medical therapy. However, surgical therapy has proven curative in a case of MCL with a single protruding lesion presenting as intussusception.\r\nThere are no established measures for the primary prevention of mantle cell lymphoma.\r\nThere are no established measures for the secondary prevention of mantle cell lymphoma.\r\nRecent advances in the understanding of the pathogenesis of mantle cell lymphoma have led to the development of targeted therapies which have shown potential promise as effective therapeutic approaches in the future. In addition to the ongoing assessment of new monoclonal antibody-based therapies, the continued development of targeted molecular signaling inhibitors based on the underlying biology of MCL is an approach that will potentially yield fruitful results in this disease. Some of the current therapies under clinical investigation are the BCL-2 inhibitor venetoclax (ABT-199), the phosphatydilinosytol 3-kinase δ (PI3K δ) inhibitor idelalisib, chimeric antigen receptor T-cell (CAR-T) therapy in relapsed MCL, androgen receptor (AR) blockers like enzalutamide as means of decreasing MCL cell proliferation and a few next-generation proteasome inhibitors (carfilzomib, oprozomib, ixazomib) in bortezomib -resistant MCL patients.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What information is currently available regarding Eclampsia?", "role": "user" }, { "content": "If you have preeclampsia your health care provider should carefully monitor you for signs of worsening and potential eclampsia.\r\nDelivery is the treatment of choice for severe preeclampsia in an attempt to prevent eclampsia. Delivering the baby relieves the condition. Prolonging the pregnancy can be dangerous to both you and your infant.\r\nWith careful monitoring, the goal is to manage severe cases until 32 - 34 weeks into the pregnancy, and mild cases until 36 - 37 weeks have passed. This helps reduce complications from premature delivery.\r\nYou may be given medicine to prevent seizures (anticonvulsant). Magnesium sulfate is a safe drug for both you and your baby.\r\nYour doctor may prescribe medication to lower high blood pressure, but you may have to deliver if your blood pressure stays high, even with medication.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can you provide a definition and explanation of Glabrousness and Glabrous skin?", "role": "user" }, { "content": "On the human body, glabrous skin is skin that is hairless. It is found on fingers, palmar surfaces of hands, soles of feet, lips, and penises.\r\nTinea corporis is a mycosis that targets glaborous skin. \r\nThere are four main types of mechanoreceptors in the glabrous skin of humans; Pacinian corpuscles, Meissner's corpuscles, Merkel's discs, and Ruffini corpuscles.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What information is available on a dislocated patella?", "role": "user" }, { "content": "Depending on how severe the conditions of your dislocation is, your treatment options may range from a knee immobilizer and crutches for a week to surgery with a long term recovery coupled with physical therapy. Every person's knees are a little different so treatment options do vary.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What other imaging findings are associated with myeloproliferative neoplasms?", "role": "user" }, { "content": "Other imaging studies for myeloproliferative neoplasm include positron emission tomography (PET) scan, which helps to detect metastasis in bone marrow and to follow up medical treatment.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is Carney's definition of the word \"complex\"?", "role": "user" }, { "content": "The spotty skin pigmentation and lentigines occur most commonly on the face, especially on the lips, eyelids, conjunctiva, and oral mucosa (McCarthy et al, 1986). Cardiac myxomas may lead to embolic strokes and heart failure (Reynen, 1995) and may present with fever, joint pain, shortness of breath, diastolic rumble, and tumor plop. Myxomas may also occur outside the heart, usually in the skin and breast. Endocrine tumors may manifest as disorders such as Cushing syndrome.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What information does a CT scan provide about medullary thyroid cancer?", "role": "user" }, { "content": "CT scan may be helpful in the diagnosis of medullary thyroid cancer.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the cause of metabolic syndrome?", "role": "user" }, { "content": "Common causes of metabolic syndrome include:\r\nInsulin resistance / hyperinsulinemia Hypertension Hypertriglyceridemia Obesity", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the explanation for the relationship between barbiturates and cardiotoxicity?", "role": "user" }, { "content": "Bradycardia\r\nMyocarditis Myopericarditis Pericardial effusion Cardiac tamponade Congestive heart failure Supraventricular arrhythmias Ventricular arrhythmias", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does a mass physical examination for the liver entail?", "role": "user" }, { "content": "The following physical examination findings may be present among patients with liver mass: \r\nPatients could be well appeared. However, some of them, based on the etiology and stage might be: Lethargic Cachectic Confused\r\nHigh-grade or low grade fever Tachycardia Tachypnea Decreased SPO2\r\nInspection\r\nChest alopecia Rapid rate of breathing\r\nAuscultation\r\nDecreased/absent breath sounds\r\nPercussion\r\nDull percussion Reduced chest expansion\r\nInspection\r\nCaput medusae Appearance of distended and engorged superficial epigastric veins\r\nAuscultation\r\nPerform the liver scratch test Useful for liver size determination Cruveilhier-Baumgarten murmur Described as a venous hum in patients with portal hypertension Present in patients with cirrhosis\r\nPercussion\r\nDull percussion\r\nPalpation\r\nAbdominal distention Tenderness in right upper quadrant Hepatomegaly Splenomegaly\r\nPeripheral edema Muscle rigidity Hypertrophic osteoarthropathy\r\nInspection\r\nPallor Jaundice Plantar and palmar erythema Dermatographic urticaria, or \"scratching marks\" Nail changes\r\nMuehrcke nails Terry nails, or \" leukonychia \"\r\nLymphadenopathy\r\nConfusion Asterixis\r\nClubbing of fingers Swelling of hands and feet Weakness Absent pulse", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What medical treatment is available for Polycystic Ovary Syndrome?", "role": "user" }, { "content": "Preferred regimen (1): Clomiphene, alone or in combination with glucocorticoids, is the first-choice treatment. Preferred regimen (2): Follicle-stimulating hormone may be administered in conjunction with timed human chorionic gonadotropin for ovulation induction. Preferred regimen (3): Metformin", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the function of cardiac catheterization in the diagnosis of mitral stenosis?", "role": "user" }, { "content": "While echocardiography remains the diagnostic imaging modality of choice, cardiac catheterization is useful to evaluate mitral stenosis when the results of the non-invasive testing are insufficient. Simultaneous left and right heart catheterization demonstrate a pressure gradient such that the pulmonary capillary wedge pressure (a surrogate of the left atrial pressure) exceeds the left ventricular end diastolic pressure.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the medical treatment for a boil?", "role": "user" }, { "content": "The mainstay of therapy for mild furuncles is incision and drainage only. Antimicrobial therapies are indicated in moderate and severe furuncles. Empiric antimicrobial therapies for furuncle include either TMP-SMX or Doxycycline for moderate furuncles, and either Vancomycin, Daptomycin, Linezolid, Telavancin, or Ceftaroline for severe furuncles.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is catatonia and how is it associated with another mental disorder?", "role": "user" }, { "content": "Bipolar disorders Depressive disorders Schizophrenia \r\nPoor prognostic factors include:\r\nBipolar disorder Depressive disorder Mental disorder Metabolic conditions Infectious conditions Psychotic disorder \r\n“ Catatonia associated with another mental disorder (catatonia specifier) may be used when criteria are met for catatonia during the course of a neurodevelopmental, psychotic, bipolar, depressive, or other mental disorder. A. The clinical picture is dominated by three (or more) of the following symptoms: Stupor (i.e., no psychomotor activity; not actively relating to environment). Catalepsy (i.e., passive induction of a posture held against gravity). Waxy flexibility (i.e., slight, even resistance to positioning by examiner). Mutism (i.e., no, or very little, verbal response Note: not applicable if there is an established aphasia). Negativism (i.e., opposition or no response to instructions or external stimuli). Posturing (i.e., spontaneous and active maintenance of a posture against gravity). Mannerism (i.e., odd, circumstantial caricature of normal actions). Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements). Agitation, not influenced by external stimuli. Grimacing. Echolalia (i.e., mimicking another’s speech). Echopraxia (i.e., mimicking another’s movements). ”", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is Oligodendroglioma, and what are its Epidemiology and Demographics?", "role": "user" }, { "content": "Oligodendroglioma, although rare, is the third most common glioma. In adults, it constitutes about 9.4% of all primary brain and central nervous system tumors and 5%–18% of all glial neoplasms. The incidence of oligodendroglioma and anaplastic oligodendroglioma is estimated to be 0.32 and 0.17 cases per 100,000 individuals in the United States, respectively. Oligodendroglioma tends to affect the middle-aged adult population, most commonly occurring in the 4th and 5th decade of life. Median age at the time of diagnosis of oligodendroglioma is 35-47 years. Males are more commonly affected with oligodendroglioma than females with male to female ratio being approximately 1.3:1. Oligodendroglioma usually affects individuals of the Caucasian race. African American, Latin American, and Asian individuals are less likely to develop oligodendroglioma.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the procedure or protocol for assessing a returned traveler for Ebola?", "role": "user" }, { "content": "Shown below is the Centers for Disease Control and Prevention (CDC) algorithm for the evaluation of the returned traveler developed by the CDC. Click here to access the PDF version of the CDC algorithm and print it.\r\nIs there a FEVER (subjective or ≥101.5°F or 38.6°C) or compatible EVD symptoms (headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage) in a patient who has traveled to an Ebola-affected area in the 21 days before illness onset? Yes No 1. Isolate patient in single room with a private bathroom and with the door to hallway closed 2. Implement standard, contact, and droplet precautions (gown, facemask, eye protection, and gloves) 3.Notify the hospital Infection Control Program and other appropriate staff 4. Evaluate for any risk exposures for EVD 5. IMMEDIATELY report to the health department Report asymptomatic patients with high- or low-risk exposures in the past 21 days to the health department Determine the risk of exposure HIGH-RISK EXPOSURE LOW-RISK EXPOSURE NO KNOWN EXPOSURE Percutaneous (e.g., needle stick) or mucous membrane contact with blood or body fluids from an EVD patient OR Direct skin contact with, or exposure to blood or body fluids of, an EVD patient OR Processing blood or body fluids from an EVD patient without appropriate personal protective equipment (PPE) or biosafety precautions OR Direct contact with a dead body (including during funeral rites) in an Ebola affected area without appropriate PPE Household members of an EVD patient and others who had brief direct contact (e.g., shaking hands) with an EVD patient without appropriate PPE OR Healthcare personnel in facilities with confirmed or probable EVD patients who have been in the care area for a prolonged period of time while not wearing recommended PPE Residence in or travel to affected areas without HIGH- or LOW-risk exposure Review case with Health Department including: • Severity of illness • Laboratory findings (e.g., platelet counts) • Alternative diagnoses Is EVD suspected? Yes No TESTING IS INDICATED • The health department will arrange specimen transport and testing at a Public Health Laboratory and CDC. • The health department, in consultation with CDC, will provide guidance to the hospital on all aspects of patient care and management TESTING IS NOT INDICATED If patient requires in-hospital management: • Decisions regarding infection control precautions should be based on the patient’s clinical situation and in consultation with hospital infection control and the health department • If patient’s symptoms progress or change, re-assess need for testing with the health department If patient does not require in-hospital management • Alert the health department before discharge to arrange appropriate discharge instructions and to determine if the patient should self-monitor for illness • Self-monitoring includes taking their temperature twice a day for 21 days after their last exposure to an Ebola patient\r\nAlgorithm adapted from the Centers for Disease Control and Prevention: Algorithm for Evaluation of the Returned Traveler.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the medical treatment for cysticercosis?", "role": "user" }, { "content": "Neurocysticercosis most often presents as headaches and acute onset seizures, thus the immediate mainstay of therapy is anticonvulsant medications. *Once the seizures have been brought under control, antihelminthic treatments may be undertaken. The decision to treat with antihelminthic therapy is complex and based on the stage and number of cysts present, their location, and the patient's specific clinical presentation. Antihelminthic therapy should be given in combination with corticosteroids and anticonvulsants to reduce inflammation surrounding the cysts and lower the risk of seizures. Albendazole is generally preferable over praziquantel due to its lower cost and fewer drug interactions. Asymptomatic cysts, such as those discovered incidentally on neuroimaging done for another reason, may never lead to symptomatic disease and in many cases do not require therapy. Calcified cysts have already died and involuted. Further antihelminthic therapy will be of no benefit.\r\nIn ophthalmic disease, surgical removal is necessary for cysts within the eye itself. Cysts outside the globe can be treated with antihelminthic drugs alone.\r\nIn general, the subcutaneous disease does not need specific therapy. Painful or bothersome cysts can be surgically excised. Treatment recommendations for subcutaneous cysticercosis includes surgery, praziquantel and albendazole.\r\nNeurocysticercosis treatment 1. Parenchymal neurocysticercosis 1.1 Single lesions Preferred regimen: Albendazole 15 mg/kg/day PO bid for 3-8 days AND Prednisone 1 mg/kg/day PO qid for 8-10 days followed by a taper 1.2 Multiple cysts Preferred regimen: Albendazole 15 mg/kg/day PO bid for 8-15 days and high-dose steroids Preferred regimen: Praziquantel 50 mg/kg/day PO tid AND Albendazole 15 mg/kg/day PO bid 1.3 Cysticercal encephalitis Cysticercal encephalitis (diffuse cerebral edema associated with multiple inflamed cysticerci) is a contraindication for antiparasitic therapy, since enhanced parasite killing can exacerbate host inflammatory response and lead to diffuse cerebral edema and potential transtentorial herniation. Most cases of cysticercal encephalitis improve with corticosteroid therapy 1.4 Calcified cysts Radiographic evidence of parenchymal calcifications is a significant risk factor for recurrent seizure activity; these lesions are present in about 10 percent of individuals in regions where neurocysticercosis is endemic. Seizures in these patients should be treated with antiepileptic therapy. 2. Extraparenchymal NCC 2.1 Subarachnoid cysts Preferred regimen: Albendazole 15 mg/kg/day PO bid for 28 days AND (Prednisone up to 60 mg/day PO OR Dexamethasone (up to 24 mg/day)) along with the antiparasitic therapy. The dose can often be tapered after a few weeks. However, in cases for which more prolonged steroid therapy is required, methotrexate can be used as a steroid-sparing agent 2.2 Giant cysts Giant cysticerci are usually accompanied by cerebral edema and mass effect, which should be managed with high-dose corticosteroids (with or without mannitol). 2.3 Intraventricular cysts Emergent management with CSF diversion via a ventriculostomy or placement of a ventriculo-peritoneal shunt Treatment of residual hydrocephalus may be managed with endoscopic foraminotomy and endoscopic third ventriculostomy; this approach may also allow debulking of cisternal cysticerci 2.4 Ocular cysticercosis Surgical excision is warranted in the setting of intraocular cysts Cysticercal involvement of the extraocular muscles should be managed with albendazole and corticosteroids. 2.5 Spinal cysticercosis Medical therapy with corticosteroids and antiparasitic drugs\r\nOcular cysticercosis is considered an absolute contraindication to the use of the following medications:\r\nPraziquantel", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does an MRI for aortic stenosis involve?", "role": "user" }, { "content": "Cardiac MRI may be helpful in the diagnosis of aortic stenosis. Findings on MRI suggestive of/diagnostic of aortic stenosis include: \r\nThickening of the aortic valve cusps Diminished aortic valve area Stenotic jets (low signal intensity) Poststenotic dilatation of the ascending aorta Myocardial thickening Delayed myocardial enhancement\r\nCardiac magnetic resonance (CMR) can be used in cases where echocardiographic results are inconclusive. CMR can assist in measuring heart volumes, blood flow and ventricular wall thickness. Magnetic Resonance Angiography (MRA) assists in visualizing the heart vasculature. Phase velocity mapping helps in measuring the ratio of pulmonary to systemic blood flow (Qp:Qs). CMR is a useful tool in the diagnosis and evaluation of a bicuspid aortic valve. Differentiation may be made between an anatomically bicuspid valve, and an anatomically trileaflet valve with fused comissures (\"functionally-bicuspid valve\"). CMR is invaluable in defining anatomic aortic valve area, in quantitating aortic regurgitation, and in the diagnosis of concomitant cardiovascular abnormalities, such as thoracic aortic dilatation/aneurysm and mitral valve abnormalities.\r\nThe scan times are longer than most other imaging modalities. The MRI environment itself is often uncomfortable for the patient (loud noises, confined area, patients are required to remain motionless for long periods of time). The MRI environment can potentially be dangerous, if specific safety measures are not strigently followed. Patients should be screened for any surgically implanted device that may not be MRI compatiable before entering the MRI department. The MRI environment must be kept free of any ferro magnetic material, which may otherwise be drawn into the magnet with sufficent force to injure, or kill patients, family and or staff in the area. Small metallic objects such as paper clips or hairpins which may not have significant mass to cause serious injury to a person, may be drawn into the magnet, and distort the magnetic field until removed. The removal of these items is very costly, and may result in downtime of several days for the imaging system. In the event that a serious (potentally life threatening) accident occurs in the MRI scan room, an emergency quench of the magnets' cryogens is performed. In such an instance (very rare) the scan room may be suddenly filled with helium gas, there is the potential for suffocation, cryogen burns, ruptured eardrums. An emergency quench of the magnet is very expensive (the magnet may be ruined) and is considered to be a option of last resort. In the event of medical emergencies in the MRI environment, the general rule of thumb, is to remove the patient from the scan room prior to the arrival of emergency support personnel. Safety of patients, family members, and staff are always the first priority in any MRI facility. For a successful MRI procedure, breath holding is required, which is sometimes difficult to achieve with small kids. Due to this, the procedure is sometime performed under general anesthesia in children.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What kind of information is available regarding astrocytoma?", "role": "user" }, { "content": "When patients present with signs and symptoms of subependymal giant cell astrocytoma, along with a thorough history and physical examination, a magnetic resonance imaging (MRI) and computed tomography (CT) scan of the head are used in the diagnosis of subependymal giant cell astrocytoma.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What factors lead to confusion when it comes to information?", "role": "user" }, { "content": "Don't drink too much alcohol Eat a balanced diet with plenty of vitamins and minerals Get enough sleep Keep careful control of your blood sugar if you have diabetes Quit smoking, which puts you at greater risk for lung diseases Take your medications as prescribed", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Could you please provide me with the original sentence that needs to be rephrased? This seems like a complete and grammatically correct question.", "role": "user" }, { "content": "Bernard-Soulier syndrome must be differentiated from Wiskott-Aldrich syndrome (small platelets) X-linked thrombocytopenia (small platelets) May-Hegglin syndrome (giant platelets) Sebastian syndrome (giant platelets) Fechtner syndrome (giant platelets) Epstein syndrome (giant platelets) Idiopathic thrombocytopenic purpura (ITP)- most commonly misdiagnosed BSS as ITP", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Is anticoagulant commonly utilized in the treatment of Lupus?", "role": "user" }, { "content": "The presence of prolonged clotting times on a routine blood test often triggers functional testing of the blood clotting function, as well as serological testing to identify common autoantibodies such as antiphospholipid antibodies. These antibodies tend to delay in-vitro coagulation in phospholipid-dependent laboratory tests such as the partial thromboplastin time.\r\nThe initial workup of a prolonged PTT is a mixing test whereby the patient's blood is mixed with normal blood and the clotting is re-assessed. If a clotting inhibitor such as a lupus anticoagulant is present, the inhibitor will interact with the normal blood and the clotting time will remain abnormal. However, if the clotting time of the mixed blood corrects towards normal, the diagnosis of an inhibitor such as the lupus anticoagulant is excluded; the diagnosis is a deficient clotting factor that is replenished by the normal blood.\r\nIf the mixing test indicates an inhibitor, diagnosis of a lupus anticoagulant is then confirmed with phospholipid -sensitive functional clotting testing, such as the dilute Russell's viper venom time, or the Kaolin clotting time. Excess phospholipid will eventually correct the prolongation of these prolonged clotting tests (conceptually known as \"phospholipid neutralization\" in the clinical coagulation laboratory), confirming the diagnosis of a lupus anticoagulant.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the underlying cause or mechanism of orbital cellulitis?", "role": "user" }, { "content": "The following conditions are associated with orbital cellulitis: \r\nChronic sinusitis Upper respiratory tract infection Subperiosteal abscess", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Could you define hay fever, please?", "role": "user" }, { "content": "NIH site on Allergic Rhinitis\r\nTemplate:Respiratory pathology\r\nv t e Health science - Medicine - Allergic conditions Respiratory system Allergic rhinitis · Asthma · Hypersensitivity pneumonitis · Eosinophilic pneumonia · Churg-Strauss syndrome · Allergic bronchopulmonary aspergillosis · Farmer's lung Skin Angioedema · Urticaria · Atopic dermatitis · Allergic contact dermatitis · Hypersensitivity vasculitis Blood and immune system Serum sickness Circulatory system Anaphylaxis Digestive system Coeliac disease · Eosinophilic gastroenteritis · Food allergy · Milk intolerance Nervous system Eosinophilic meningitis Genitourinary system Acute interstitial nephritis Other conditions Drug allergy · Allergic conjunctivitis\r\nTemplate:WH Template:WS\r\nca:Rinitis al·lèrgica cs:Alergická rýma cy:Clefyd y gwair de:Allergische Rhinitis it:Raffreddore allergico lt:Šienligė nl:Hooikoorts no:Pollenallergi sv:Pollenallergi", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can you provide a summary or explanation of percutaneous coronary intervention?", "role": "user" }, { "content": "Status of tobacco use should be asked about at every visit (Level of Evidence: B). Every tobacco user and family members who smoke should be advised to quit at every visit. (Level of Evidence: B). The tobacco user should be assisted by counseling and developing a plan for quitting. (Level of Evidence: B)\". Follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement and pharmacological treatment) should be arranged. (Level of Evidence: B) \". Blood pressure goal is less than 140/90 mm Hg or less than 130/80 mm Hg if patient has diabetes or chronic kidney disease. Starting dietary therapy is recommended. Reduce intake of saturated fats (to less than 7% of total calories), trans fatty acids, and cholesterol (to less than 200 mg per day) (Level of Evidence: B) \". LDL-C should be less than 100 mg per dL. (Level of Evidence: B). If triglycerides are greater than or equal to 150 mg per dL or HDL-C is less than 40 mg per dL, weight management, physical activity, and smoking cessation should be emphasized. (Level of Evidence: B). Adding plant stanol / sterols (2 g per day) and/or viscous fiber (greater than 10 g per day) is reasonable to further lower LDL-C. (Level of Evidence: A) \". A fasting lipid profile should be assessed in all patients and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiation of lipid-lowering medication is indicated. It may be reasonable to encourage increased consumption of omega-3 fatty acids in the form of fish or in capsules (1 g per day) for risk reduction. For treatment of elevated triglycerides, higher doses are usually necessary for risk reduction. (Level of Evidence: B) \". Physical activity goal is 30 minutes 5 days per week; optimal daily. Advising medically supervised programs (cardiac rehabilitation) for high-risk patients (e.g., recent acute coronary syndrome or revascularization, heart failure) is recommended. (Level of Evidence: B) \". For all patients, it is recommended that risk be assessed with a physical activity history and/or an exercise test to guide prescription. (Level of Evidence: B) \". For all patients, encouraging 30 to 60 minutes of moderate-intensity aerobic activity is recommended, such as brisk walking on most—preferably all—days of the week, supplemented by an increase in daily lifestyle activities (e.g., walking breaks at work, gardening, and household work). (Level of Evidence: B) \"", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What are the risk factors that are linked to Seminoma?", "role": "user" }, { "content": "Common risk factors in testicular seminoma include: \r\nCaucasian race Undescended testicle Family history of testicular cancer Personal history of testicular cancer (previous tumor in contralateral testis) Klinefelter syndrome Impaired spermatogenesis Hypospadias Testicular microlithiasis Testicular dysgenesis\r\nTesticular feminization Klinefelter syndrome\r\nInfections such as HIV, orchitis History of trauma Organ transplant immunosuppression Canabis exposure", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What information is available on secondary hyperparathyroidism?", "role": "user" }, { "content": "Secondary hyperparathyroidism is an endocrine disorder that the parathyroid glands produce too much parathyroid hormone (PTH). The most important cause of secondary hyperparathyroidism is chronic renal failure. Other causes include rickets, malnutrition or malabsorption, and certain types of cancer. Signs and symptoms include symptoms of diseases above, such as weakness, poor growth, bowed limbs and swollen joints in children, bone pain, osteomalacia, osteoporosis, fractures, even symptoms of certain cancer. Blood tests of parathyroid hormone and biochemistry, and imaging tests may help the diagnosis of secondary hyperparathyroidism. Treatments and prognosis of secondary hyperparathyroidism depend on the underlying cause.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the definition of mucositis and what treatments are currently available for it?", "role": "user" }, { "content": "Treatment of mucositis is mainly supportive. Oral hygiene is the mainstay of treatment; patients are encouraged to clean their mouth every four hours and at bedtime, more often if the mucositis becomes worse. Water-soluble jellies can be used to lubricate the mouth. Salt mouthwash can soothe the pain and keep food particles clear so as to avoid infection. Patients are also encouraged to drink plenty of liquids, at least three liters a day, and avoid alcohol. Citrus fruits, alcohol, and foods that are hot are all known to aggravate mucositis lesions. Medicinal mouthwashes may be used such as Chlorhexidine gluconate and viscous Lidocain for relief of pain. Palifermin, brand name \"Kepivance\", is a human KGF (keratinocyte growth factor) that has shown to enhance epithelial cell proliferation, differentiation, and migration. Experimental therapies have been reported, including the use of cytokines and other modifiers of inflammation (eg, IL-1, IL-11, TGF-beta3), amino acid supplementation (eg, glutamine), vitamins, colony-stimulating factors, cryotherapy, and laser therapy.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does screening for colorectal cancer involve?", "role": "user" }, { "content": "Advanced adenomas are defined as being ≥10 mm, having villous histology, or having high grade dysplasia. Advanced neoplasia is defined as cancer or advanced adenoma .", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What information is available about cradle cap?", "role": "user" }, { "content": "Seborrheic dermatitis is a common, inflammatory skin condition that causes flaky, white to yellowish scales to form on oily areas such as the scalp or inside the ear. It can occur with or without reddened skin.\r\nCradle cap is the term used when seborrheic dermatitis affects the scalp of infants.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the general overview of T-cell prolymphocytic leukemia?", "role": "user" }, { "content": "There are no identified risk factors of T-cell prolymphocytic leukemia.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is the medical treatment for myocarditis?", "role": "user" }, { "content": "Arrhythmias or conduction abnormalities can occur in patients with myocarditis. Treatment should be initiated only if arrhythmias are symptomatic or sustained. Caution should be observed while using antiarrhythmics as majority of these agents have negative inotropic property which may worsen heart failure. Regular monitoring with ECG is important as it enables early detection and treatment of asymptomatic yet life threatening arrhythmias. Supraventricular tachycardia (SVT) can aggravate heart failure. Symptomatic and sustained SVT should be immediately converted electrically. While, patients with recurrent sustained SVT should be treated with antiarrhythmics and rate controlling agents. Implantation of ICD should be considered in patients with recurrent ventricular arrhythmia refractory to medical therapy. Myocarditis patients presenting with conduction abnormalities, particularly Mobitz type II and complete heart block require temporary pacemaker usually during the acute phase. Implantation of permanent pacemaker or ICD may be necessary in few patients.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What does the term tracheoesophageal fistula mean?", "role": "user" }, { "content": "Congenital TEF can arise due to failed fusion of the tracheoesophageal ridges during the third week of embryological development.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "\"What are the possible diagnoses to consider for measles?\"", "role": "user" }, { "content": "The following table summarizes the most commonly confused conditions with measles:\r\nThe following table is a list of differential diagnosis oral lesions presenting similar to measles:\r\nDisease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture Coxsackie virus Fever Sores in the mouth Rash with blisters Aches Pregnancy immunodeficiency History and Physical exam Throat swabs Swabs from the lesion Tzanck test Oral cavity Skin Symptomatic treatment Chicken pox Conjunctival symptoms Catarrhal symptoms Characteristic spots on the trunk appearing in two or three waves Itching Pregnancy Premature infants born to susceptible mothers All infants born at less than 28 weeks gestation or who weigh ≤1000 grams Immunocompromised History and physical exam PCR to detect VZV in skin lesions (vesicles, scabs, maculopapular lesions) Oral cavity Skin Sodium bicarbonate in baths or antihistamines for itching Paracetamol (acetaminophen) for fever Prednisolone is contraindicated Measles Fever Rash Cough Coryza (runny nose) Conjunctivitis (pink eye) Malaise Koplick spots in mouth Unvaccinated individuals Crowded and/or unsanitary conditions Traveling to less developed and developing countries Immunocompromized Winter and spring seasons Born after 1956 and never fully vaccinated Health care workers History and examination PCR for Measles -specific IgM antibody PCR for Measles RNA Oral cavity Skin Respiratory tract Eyes Throat Caused by Morbillivirus Primary site of infection is the respiratory epithelium of the nasopharynx Transmitted in respiratory secretions, via aerosol droplets containing virus particles Herpangina Sudden fever Sore throat and dysphagia - These can occur several hours(up to 24 hours), before the appearance of the enanthem. Vomiting Abdominal pain Myalgia Headache Pharyngeal lesions Attendance at a kindergarten/child care center Contact with herpangina cases Residence in rural areas Overcrowding Poor hygiene Low socioeconomic status Clincial diagnosis Pharyngeal viral and bacterial cultures can be taken to exclude HSV infection and streptococcal pharyngitis. Skin Oral Cavity Characteristic enanthem- Punctate macule which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate. The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the soft palate and uvula. The lesions can also be seen on the tonsils, posterior pharyngeal wall and the buccal mucosa. Primary herpetic gingivoestomatitis Pin-head vesicles rupture to form painful irregular ulcerations covered by yellow-grey membrane Severe pain Submandibular lymphadenopathy Halitosis It involves buccal mucosa, tongue, posterior pharynx, and gingival and palatal mucosa Direct contact HIV infection Tzanck test demonstrates multinucleated epithelial giant cells Viral culture is the gold standard for diagnosis Direct immunofluorescence Oral cavity Mucous membranes Ulcers are common on lips, gums, throat, front of tongue, inside of the cheeks and roof of the mouth Treatment is with antiviral agents such as Valacyclovir and Famciclovir Koplik spots must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection. Disease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture Diseases predominantly affecting the oral cavity Oral Candidiasis Dysphagia or odynophagia White patches on the mouth and tongue Newborn babies Denture users Poorly controlled diabetes As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for the treatment of lung conditions (e.g, asthma or COPD) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication. People with poor nutrition, specifically vitamin A, iron and folate deficiencies. People with an immune deficiency (e.g. as a result of AIDS / HIV or chemotherapy treatment). Women undergoing hormonal changes, like pregnancy or those on birth control pills. Organ transplantation patients Clinical diagnosis Confirmatory tests rarely needed Localized candidiasis Oral and esophageal candidasis Candida vulvovaginitis Chronic mucocutaneous candidiasis Invasive candidasis Candidaemia Candida endocarditis Candida osteoarticular disease Oral candidiaisis is a benign self limiting disease unless accompanied by immunosuppression. Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg Herpes simplex oral lesions Fever Sore throat Painful ulcers Stress Recent URTI Female sex Physical examination Viral culture Tzanck smear Orofacial Infection Anogenital Infection Ocular Infection Herpes Encephalitis Neonatal Herpes Herpetic Whitlow Herpes Gladiatorum The symptoms of primary HSV infection generally resolve within two weeks Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg Aphthous ulcers Painful, red spot or bump that develops into an open ulcer Being a female Between the ages of 10-40 Family history of aphthous ulcers Physical examination Diagnosis of exclusion Oral cavity Self-limiting, Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358 Squamous cell carcinoma Non healing ulcer, nodule, indurated plaque or mass May involve skin, lips, inside the mouth, throat or esophagus Chronic sun or UV exposure Fair skin Elderly age (>45 yrs) Male sex Smoking Physical exam Biopsy Oral Cavity Floor of mouth Lateral tongue Throat Esophagus Malignant Can spread to TMJ Some times associated with leukoplakia Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632 Leukoplakia White leathery spots on the mucous membranes of the tongue and inside of the mouth Lateral borders of tongue Atypical Tobacco use Chronic irritation Immunodeficiency Bloodroot (sanguinaria) Physical exam Diagnosis of exclusion Biopsy Vulvar lesions occur independent of oral lesions Associated with HIV Persistant white spots Benign but can progress to carcinoma after almost 10 years Oral proliferative verrucous leukoplakia is an aggressive sub type with multiple lesions and higher conversion to warts or carcinoma Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087 Melanoma A lesion with ABCD Asymmetry Border irregularity Color variation Diameter changes Bleeding from the lesion UV radiations Genetic predisposition Old age Male gender Family or personal history of melanoma Multiple benign or atypical nevi ABCD characteristics Bleeding or ulceration may show malignancy Serum LDH may be elevated in case of malignancy Biopsy Can metastasize All UV radiation or sun exposed areas can be effected independently 1-2 to hundreds of granules Neural crest cell derivative Development begins with disruption of nevus growth control Progression involves MAPK/ERK pathway N-RAS or BRAF oncogene also involved Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), , CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811 Fordyce spots Rice-like granules or spots Small, painless, raised, pale, red or white 1 to 3 mm in diameter Greasy skin types Some rheumatic disorders Hereditary nonpolyposis colorectal cancer Lower gingiva (gums) Vestibular mucosa Physical exam Small keratin -filled pseudocysts May be seen on incidental mucosal biopsy Biopsy not done for them primarily Oral cavity Vermilion border of the lips Oral mucosa of the upper lip Buccal mucosa in the commissural region often bilaterally Genitals Benign neoplasms with sebaceous features Visible sebaceous glands No surrounding mucosal change Several adjacent glands may coalesce into a larger cauliflower-like cluster Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899 Burning mouth syndrome Burning or tingling on the lips, tongue, or entire mouth Nutritional deficiencies Chronic anxiety or depression Diabetes type 2 Menopause Oral thrush or dry mouth, or damaged nerves transmitting taste Female gender Menopause Presentation Physical exam Oral cavity Pain typically is low in the morning and builds up over the day Low dosages of benzodiazepines, tricyclic antidepressants or anticonvulsants may be effective Torus palatinus Bony growth on midline of the hard palate Nodular mass covered with normal mucosa Genetic predisposition Autosomal dominant Physical exam Types Flat tori Spindle tori Nodular tori Lobular tori Hard palate More common in Asian and Inuit populations Twice more common in females Repeated trauma can cause bleeding Surgery may be required in symptomatic Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591 Diseases involving oral cavity and other organ systems Behcet's disease Painful mouth sores Acne like skin lesions Headache, fever, poor balance, disorientation Abdominal pain, diarrhea or bleeding Uveitis Joint swelling and joint pain Genital sores wit pain and scaring Aneurysms Over active immune system Physical examination Mouth Genitals GIT Eye Joints Skin Vascular system Brain Outbreaks of exaggerated inflammation Affects smaller blood vessels Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021 Crohn's disease Chronic, episodic diarrhea or constipation Abdominal pain Vomiting Weight loss or weight gain Smoking Whites and European Jews Hormonal contraception Diets high in microparticles, sweet, fatty or refined foods Industrialized country Typical history and symptoms Skip lesions on biopsy Anti-Saccharomyces cerevisiae antibodies (ASCA) Anti-neutrophil cytoplasmic antibodies (ANCA) Eyes Joints Skin May lead to Obstructions Abscesses Free perforation Hemorrhage Agranulocytosis Fever or chills Frequent infections Unusual redness, pain, or swelling around a wound Mouth ulcers Abdominal pain Burning sensation when urinating Sore throat Medications Cytotoxic chemotherapy Hematologic malignancies Autoimmune disorders Neutropenia <100 cells per micro litre Eosinopenia Basopenia Oral cavity Skin GIT Urinary system Conjunctiva Immunocompromization Types Drug-induced Malignant Autoimmune Syphilis Chancre Regional lymphadenopathy Multiple sexual partners Illicit drug use Unprotected sex Men who have sex with men Residence in highly prevalent areas HIV infection Presence of other STIs Previous history of STIs Intravenous drug use Darkfield microscopy Non treponemal tests like VDRL and RPR test) Treponemal tests FTA-ABS tests, (TP-PA) assay, enzyme immunoassays, and chemiluminescence immunoassays) Oral cavity Penis Cervix Labia Anal canal Rectum CNS CVS Primary syphilis Chancre Secondary syphilis Condylomata lata Latent syphilis Asymptomatic Tertiary syphilis Gummas Neurosyphilis oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349 Coxsackie virus Fever Sores in the mouth Rash with blisters Aches Pregnancy immunodeficiency History and Physical exam Throat swabs Swabs from the lesion Tzanck test Oral cavity Skin Symptomatic treatment Coxsackie virus stomatitis - Adapted from Dermatology Atlas. Chicken pox Conjunctival symptoms Catarrhal symptoms Characteristic spots on the trunk appearing in two or three waves Itching Pregnancy Premature infants born to susceptible mothers All infants born at less than 28 weeks gestation or who weigh ≤1000 grams Immunocompromised History and physical exam PCR to detect VZV in skin lesions (vesicles, scabs, maculopapular lesions) Oral cavity Skin Sodium bicarbonate in baths or antihistamines for itching Paracetamol (acetaminophen) for fever Prednisolone is contraindicated Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565 Measles Fever Rash Cough Coryza (runny nose) Conjunctivitis (pink eye) Malaise Koplick spots in mouth Unvaccinated individuals Crowded and/or unsanitary conditions Traveling to less developed and developing countries Immunocompromized Winter and spring seasons Born after 1956 and never fully vaccinated Health care workers History and examination PCR for Measles -specific IgM antibody PCR for Measles RNA Oral cavity Skin Respiratory tract Eyes Throat Caused by Morbillivirus Primary site of infection is the respiratory epithelium of the nasopharynx Transmitted in respiratory secretions, via aerosol droplets containing virus particles Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483 References ↑ \"Epidemiology and Prevention of Vaccine-Preventable Diseases\". ↑ 2.0 2.1 Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE (2000). \"Individual and community risks of measles and pertussis associated with personal exemptions to immunization\". JAMA. 284 (24): 3145–50. PMID 11135778. CS1 maint: Multiple names: authors list (link) ↑ 3.0 3.1 Ratnam S, West R, Gadag V, Williams B, Oates E (1996). \"Immunity against measles in school-aged children: implications for measles revaccination strategies\". Can J Public Health. 87 (6): 407–10. PMID 9009400. CS1 maint: Multiple names: authors list (link) ↑ Kolokotronis, A.; Doumas, S. (2006). \"Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis\". Clinical Microbiology and Infection. 12 (3): 202–211. doi: 10.1111/j.1469-0691.2005.01336.x. ISSN 1198-743X. ↑ Chauvin PJ, Ajar AH (2002). \"Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management\". J Can Dent Assoc. 68 (4): 247–51. PMID 12626280. ↑ Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). \"Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!\". Advances in anatomic pathology. 20 (6): 416–423. doi: 10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter |month= ignored (help) CS1 maint: Multiple names: authors list (link) ↑ Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). \"Idiosyncratic drug-induced agranulocytosis: Update of an old disorder\". Eur J Intern Med. 17 (8): 529–35. Text \"pmid 17142169\" ignored (help) CS1 maint: Multiple names: authors list (link) ↑ title=\"By Internet Archive Book Images No restrictions, via Wikimedia Commons\" href=\" https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg \" ↑ \"Dermatology Atlas\". Template:WikiDoc Sources", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "Can gastroparesis be diagnosed by ultrasound?", "role": "user" }, { "content": "To rule out gallbladder disease and pancreatitis as sources of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What is dysthymia and what information can you offer regarding this condition?", "role": "user" }, { "content": "http://www.nlm.nih.gov/medlineplus/ency/article/000918.htm\r\nTemplate:WH Template:WS", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What observations can be made on a chest x-ray regarding cardiac tumors?", "role": "user" }, { "content": "Chest X-Rays do not have a diagnostic value until late in disease or presence of features like heart failure. They are usually done as a part of preliminary investigations.", "role": "assistant" } ]

[ { "content": "Answer the question truthfully, you are a medical professional.", "role": "system" }, { "content": "What information is available regarding cancer of the small intestine?", "role": "user" }, { "content": "Patients with small intestine cancer have many treatment options. The selection depends on the the size and location of the tumor, whether it has spread to distance, whether there are any other serious medical conditions. The options are surgery, radiation therapy, chemotherapy, or a combination of methods and palliative treatment. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.\r\nSurgery\r\nSmall intestine resection: In this operation, surgeon removes the piece of intestine that has the tumor and some of the normal tissue on each side of the tumor. Palliative operation: If small intestine cancer has spread too far in the abdomen, the surgeon will do a palliative operation. The goal of this type of surgery is to decrease symptoms such as abdominal pain and abdominal distension.\r\nChemotherapy\r\nThe treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Some general chemotherapy drugs used include: 5-fluorouracil (5FU), leucovorin, oxaliplatin, and irinotecan.\r\nRadiation therapy:\r\nThis is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.", "role": "assistant" } ]