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You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| How to diagnose Thrombocytopenia ? | Your doctor will diagnose thrombocytopenia based on your medical history, a physical exam, and test results. A hematologist also may be involved in your care. This is a doctor who specializes in diagnosing and treating blood diseases and conditions. Once thrombocytopenia is diagnosed, your doctor will begin looking for its cause. Medical History Your doctor may ask about factors that can affect your platelets, such as The medicines you take, including over the counter medicines and herbal remedies, and whether you drink beverages that contain quinine. Quinine is a substance often found in tonic water and nutritional health products. Your general eating habits, including the amount of alcohol you normally drink. Your risk for AIDS, including questions about blood transfusions, sexual partners, intravenous IV drugs, and exposure to infectious blood or bodily fluids at work. Any family history of low platelet counts. Physical Exam Your doctor will do a physical exam to look for signs and symptoms of bleeding, such as bruises or spots on the skin. He or she will check your abdomen for signs of an enlarged spleen or liver. You also will be checked for signs of infection, such as a fever. Diagnostic Tests Your doctor may recommend one or more of the following tests to help diagnose a low platelet count. For more information about blood tests, go to the Health Topics Blood Tests article. Complete Blood Count A complete blood count CBC measures the levels of red blood cells, white blood cells, and platelets in your blood. For this test, a small amount of blood is drawn from a blood vessel, usually in your arm. If you have thrombocytopenia, the results of this test will show that your platelet count is low. Blood Smear A blood smear is used to check the appearance of your platelets under a microscope. For this test, a small amount of blood is drawn from a blood vessel, usually in your arm. Bone Marrow Tests Bone marrow tests check whether your bone marrow is healthy. Blood cells, including platelets, are made in your bone marrow. The two bone marrow tests are aspiration as pih RA shun and biopsy. Bone marrow aspiration might be done to find out why your bone marrow isn t making enough blood cells. For this test, your doctor removes a sample of fluid bone marrow through a needle. He or she examines the sample under a microscope to check for faulty cells. A bone marrow biopsy often is done right after an aspiration. For this test, your doctor removes a sample of bone marrow tissue through a needle. He or she examines the tissue to check the number and types of cells in the bone marrow. Other Tests If a bleeding problem is suspected, you may need other blood tests as well. For example, your doctor may recommend PT and PTT tests to see whether your blood is clotting properly. Your doctor also may suggest an ultrasound to check your spleen. An ultrasound uses sound waves to create pictures of your spleen. This will allow your doctor to see whether your spleen is enlarged. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| What are the symptoms of Wilson disease ? | What are the signs and symptoms of Wilson disease? Wilson disease can affect many different systems of the body. Affected people often develop signs and symptoms of chronic liver disease in their teenaged years or early twenties. These features may include jaundice abnormal fluid retention which can lead to swelling of the legs and or abdomen weight loss nausea and vomiting and or fatigue. Unfortunately, some people may not experience any signs until they suddenly develop acute liver failure. Affected people often experience a variety of neurologic central nervous system related signs and symptoms, as well. Neurologic features often develop after the liver has retained a significant amount of copper however, they have been seen in people with little to no liver damage. These symptoms may include tremors muscle stiffness and problems with speech, swallowing and or physical coordination. Almost all people with neurologic symptoms have Kayser Fleisher rings a rusty brown ring around the cornea of the eye that can best be viewed using an ophthalmologist s slit lamp. About a third of those with Wilson disease will also experience psychiatric mental health related symptoms such as abrupt personality changes, depression accompanied by suicidal thoughts, anxiety, and or psychosis. Other signs and symptoms may include Menstrual period irregularities, increased risk of miscarriage and infertility in women Anemia Easy bruising and prolonged bleeding Kidney stones Early onset arthritis Osteoporosis The Human Phenotype Ontology provides the following list of signs and symptoms for Wilson disease. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients when available Kayser Fleischer ring 90 Polyneuropathy 5 Aminoaciduria Atypical or prolonged hepatitis Autosomal recessive inheritance Chondrocalcinosis Cirrhosis Coma Dementia Drooling Dysarthria Dysphagia Dystonia Esophageal varix Glycosuria Hemolytic anemia Hepatic failure Hepatomegaly High nonceruloplasmin bound serum copper Hypercalciuria Hyperphosphaturia Hypoparathyroidism Joint hypermobility Mixed demyelinating and axonal polyneuropathy Nephrolithiasis Osteoarthritis Osteomalacia Osteoporosis Personality changes Poor motor coordination Proteinuria Renal tubular dysfunction Tremor The Human Phenotype Ontology HPO has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25 25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| For Rx of ventricular fibrillation in an adult, DC shock of what joules should be started with? | Ans. A 200 J . Ref. Harrison, Medicine, 18th Ch. 233 fibg 233 11 . Ref Sustained polymorphic VT, ventricular flutter, and VF all lead to immediate hemodynamic collapse. Emergency asynchronous defibrillation is required with at least 200 J monophasic 100 J biphasic shock VENTRICULAR FLUTTER AND VENTRICULAR FIBRILLATION VF These arrhythmias occur most often in patients with ischaemic heart disease. Episodes of cardiac arrest recorded during Holter monitoring reveal that approximately three fourths of the sudden deaths are due to VT or VF. Types Ventricular flutter usually appears as a sine wave with a rate between 150 and 300 beats min. VF is recognized by grossly irregular undulations of varying amplitudes, contours, and rates. VT originates below the bundle of His at a rate 100 beats per minute most VT patients have rates 120 beats per minute. Sustained VT at rates 140 ms for RBBB type V1 morphology V1 160 ms for LBBB type V1 morphology Frontal plane axis 90Adeg to 180Adeg Delayed activation during initial phase of the QRS complex LBBB pattem R wave in V1, V2 40 ms RBBB pattern onset of R wave to nadir of S 100 ms Bizarre QRS pattern that does not mimic typical RBBB or LBBB QRS complex Concordance of QRS complex in all precordial leads RS or dominant S in V6 for RBBB VT Q wave in V6 with LBBB QRS pattern Monophasic R or biphasic QR or R S in V1 with RBBB pattern TREATMENT VENTRICULAR TACHY C ARDIA FEBRILL ATION Sustained polymorphic VT, ventricular flutter, and VF all lead to immediate hemodynamic collapse. Emergency asyn chronous defibrillation is therefore required, with at least 200 J monophasic or 100 J biphasic shock. The shock should be delivered asynchronously to avoid delays related to sensing of the QRS complex. If the arrhythmia persists, repeated shocks with the maximum energy output of the defibrillator are essential to optimize the chance of successful resuscitation. Intravenous lidocaine and or amiodarone should be administered but should not delay repeated attempts at defibrillation. For any monomorphic wide complex rhythm that results in hemodynamic compromise, a prompt R wave synchronous shock is required. Pharmacologic treatment to terminate monomorphic VT is not typically successful 30 . Intravenous procainamide, lidocaine, or amiodarone can be utilized. Idiopathic LV septal VT appears to respond uniquely to IV verapamil administration. VT in patients with structural heart disease is now almost always treated with the implantation of an ICD to manage anticipated VT recurrence. The ICD can provide rapid pacing and shock therapy to treat most VTs effectively Several recent secondary prevention trials have demonstrated superior survival 3 years in patients treated with ICDs versus amiodarone ALGORITHM VF Assess ABC Give pericardial thump and begin CPR till defibrillator is ready Defibrillation with 200 J 2 J kg in children and repeat with 300 and 360 j 4 J kg in children Rhythm after first 3 shocks Asystole Normal rhythm VF still persists Intubate at once, obtain IV access and give adrenaline 1 mg IV and defibrillate with 360 J. If not aborted, repeat adrenaline in high dose and defibrillate with 360 J. If not aborted, give lignocaine bretyl ium MgSO4 NaHCO3 with D 360 J. If no response, terminate efforts. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Treatment of Simple rib fracture includes following EXCEPT | Ans. d. Strapping of chest Ref Bailey and Love 25th 343 Localised rib fracture due to direct trauma. A simple rib fracture may be serious in elderly people or in those with chronic lung disease who have little pulmonary reserve. Uncomplicated fractures require sufficient analgesia to encourage a normal respiratory pattern and effective coughing. Oral analgesia may suffice but intercostal nerve blockade with local anesthesia may be very helpful. Chest strapping or bed rest is no longer advised and early ambulation with vigorous physiotherapy and oral antibiotics if necessary is encouraged. A chest radiograph is always taken to exclude an underlying pneumothorax. It is useful to confirm the skeletal injuries but routine chest radiography may miss rib fractures. However, once a pneumothorax and major skeletal injuries are excluded, the management is the same the local control of chest pain.THE COMPONENTS OF CHEST INJURY IN BLUNT TRAUMAMajor chest wall traumaa. Flail chest This occurs when several adjacent ribs are fractured in two places either on one side of the chest or either side of the sternum. The flail segment moves paradoxically, that is, inwards during inspiration and outwards during expiration, thereby reducing effective gas exchange. The net result is poor oxygenation from injury to the underlying lung parenchyma and paradoxical movement of the flail segment. This creates a right to left shunt and prevents full saturation of arterial blood. In the absence of any other injuries and, if the segment is small and not embarrassing respiration, the patient may be nursed on a high dependency unit with regular blood gas analysis and good analgesia until the flail segment stabilises. In the more severe case, endotracheal intubation is required with positive pressure ventilation for up to 3 weeks, until the fractures become less mobile. Thoracotomy with fracture fixation is occasionally appropriate if there is an underlying lung injury to be treated at the same time. An anterior flail segment with the sternum moving paradoxically with respiration can be stabilised by internal fixation but operative management is not usual for either.b. First rib fracturec. Fractures of the sternum.d. Vertebraee. Pleuraf. Traumatic pneumothoraxg. Continuing blood loss in excess of 200 mL hour may require urgent thoracotomy within the first few hours.h. Lung contusion.It is important to prevent infection of the underlying lung by early mobilisation if the patient s condition permits , prophylactic antibiotics, suction drainage and physiotherapy.MANAGEMENT OF BLUNT CHEST TRAUMAMost chest injuries where the heart is not injured are managed conservatively with underwater seal drainage if necessary, and oxygen and physiotherapy to help the patient to expectorate while the underlying lung parenchyma heals. In about 10 per cent of cases a thoracotomy is required. The indications for thoracotomy following blunt thoracic trauma are the following 50 1000 mL of blood at the time of initial drainage is common and may need no further action, but greater volumes, especially if the blood is fresh, require intervention continued brisk bleeding 100 mL 15 minutes from the intercostal drains indicates a serious breach of the lung parenchyma and urgent exploration is required continued bleeding of 200 mL hour for 3 or more hours may require thoracotomy under controlled conditions rupture of the bronchus, aorta, esophagus or diaphragm cardiac tamponade if needle aspiration is unsuccessful .All explorations following trauma should have double lumen tube endotracheal intubation to facilitate surgery on the injured side and to protect the undamaged lung. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Not true about experimental study | Ans. is b i.e., Unethical to use in animal Experimental epidemiology Epidemiological Experiments Experimental epidemiology is also called trial. Broadly speaking, a trial refers to putting something to a test. This allows the term to be used in reference to a test of a treatment for the sick or a test of a preventive measure intended to ave illness, injury or disease. Therefore, the defining feature of an experimental study is its ability to allocate or assign interventions or treatment to experiment unit. In simple words, the study of a treatment Drugs, surgical intervention or preventive measure e.g. vaccination on living subjects is known as experimental study or trial. Assignment of treatments may be based on i Randomization In randomized controlled trials ii Non randmization trails There are following types of experimental trials 1. Clinical trials Used to evaluate treatment for people who are ill e.g. a clinical trial of a chemotherapeutic agent 2. Field trails Used to evaluate interventions to prevent disease in healthy people e.g. a field trial of a vaccine . 3. Community trial Used to evaluate community wide intervention e.g. a community trail of the effects of fluoridation of public water supply . 4. Animal Study When clincial trails are done on animals instead of human is called animal study. In an experimental study, the investigator assign individuals in experimental group and reference group and then follows the two groups for the outcome of interests. Therefore, experimental study is prospective study. Before staing any experimental study the approval of ethics committee is required. The poocol of study is submitted to ethics committee and ethics committee gives approval to the studies which are ethical. So, all experimental studies are considered ethical after taking approval of ethics committee . There are fewer ethical restrains on experimental study in animals than in human. Blinding in experimental study Blinding is a procedure to avoid bias i In single blinding, study subjects are not aware of the treatment they are receiving whether of experimental group treatment or reference group treatment . ii In double blinding, study subjects as well as investigator are not aware of the treatment study subject are receiving. iii In Triple blinding, study subjects, investigator as well as analyzer are not aware of the treatment study subjects are receiving. It is not always possible to do blinding. For example in a trial of surgical intervention, the surgeon and the patient will always know about the surgical procedure as it is necessary to explain the patient to take consent for surgery. Of course, in animal study, the animals do not have awareness or expectancies about their assignment to experimental or reference group. So, we do not use terms single blinding and double blinding. In animal study, when the investigator is not aware of which subjects are in which experiments group, it is simply called a blind study. Interim analysis An interim analysis is the assessment of data during follow up stages of a study for the purpose of assessing the performance of the study. If there is convincing enough evidence to say that there is a significance large treatment difference, study can be stopped at a point earlier than the planned end point. Therefore, interim analysis is also known as data dependent stopping or early stopping There are two main reasons for early stopping of study interim analysis 1. Ethical We want to make sure that the maximum number of patients receive the most effective treatment at the earliest stage. So, if we have convincing evidence that the treatment of study has significant treatment difference, study is closed early and the treatment can be approved so that other patients in outside world can receive effective treatment early. 2. Economic We do not want to spend extra money if we already have enough evidence in interim analysis to stop study early. Since clinical trials are expensive, interim analysis can reduce the expenditure by shoening of follow up time needed to make a conclusion. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| A child was admitted to the hospital with H. influenza meningitis. Cefotaxime is preferred over ampicillin because | Ans. d. Cefotaxime is more active against beta lactamase Ref Ananthanarayan 9 e p327, 8 e p331 Harrison 19 e p1011, 18 e p1228 Nelson 19 e p941,942 Cefotaxime or ceftazidime is the drug of choice for the treatment of Hemophilus meningitis. Ampicillin and cotrimoxazole were popular for respiratory infections, but as plasmid borne resistance to these drugs is now common, thus amoxicillin clavulanate or clarithromycin is more effective. Plasmid for beta lactamase production makes them resistant. Ananthanarayan 9 e p327 Antibiotic Resistance Most H, influenzae isolates are susceptible to ampicillin amoxicillin, but about a third produce a beta lactamase and are therefore resistant beta Lactamase negative ampicillin resistant BLNAR isolates have been identified that manifest resistance by production of a beta lactam insensitive cell wall synthesis enzyme called PBP3. Amoxicillin clavulanate is uniformly active against H. influenzae clinical isolates except for the rare BLNAR isolates. Among macrolides azithromycin is active against about 99 of H. influenza isolates in contrast, the activity of erythromycin and clarithromycin against H. influenzae clinical isolates is poor. H. influenzae resistance to 3rd generation cephalosporins has not been documented. Resistance to trimethoprim sulfamethoxazole is infrequent ? 10 and resistance to quinolones is believed to be rare. Initial therapy for meningitis due to Hib should consist of a cephalosporin such as ceftriaxone or cefotaxime. Administration of glucocorticoids to patients with Hib meningitis reduces the incidence of neurologic sequelae. Many infections caused by non typable strains of H. influenzae, such as otitis media, sinusitis, and exacerbations of CO PD, can be treated with oral antimicrobial agents. Approximately 20 35 of non typable strains produce B lactamase with the exact proportion depending on geographic location , and these strains are resistant to ampicillin. Several agents have excellent activity against non typable H. influenzae, including amoxiciltin clavulanic acid, various extended spectrum cephalosporins, and the macrolides, azithromycin and clarithromycin. In addition to B lactamase production, alteration of penicillin binding proteins a second mechanism of ampicillin resistance has been detected in isolates of H. influenzae. Harrison 19 e p 1011 Clinically meningitis caused by H. influenzae type b cannot be differentiated from meningitis caused by Neisseria meningitidis or Streptococcus pneumoniae. Antimicrobial therapy should be administered intravenously for 7 14 days for uncomplicated cases. Cefotaxime, ceftriaxone, and ampicillin cross the blood brain barrier during acute inflammation in concentrations adequate to treat H. influenzae meningitis. Intramuscular therapy with ceftriaxone is an alternative in patients with normal organ perfusion. Nelson 19 e p941Hemophilus influenzae Pfeiffer s bacillus Morphology Non motile, non sporing, oxidase positive, gram negative bacilliQCapsulated coccobacilli shows pleomorphismQStained by Loeffler s methylene blueQ or Dilute carbol fuschinQDivided into 8 biotypes on the basis of indole production, urease and ornithine decarboxyalse activityQCulture Fildes agar is the best for primary isolationQOn Levinthal s mediumQ, capsulated strains show distinctive iridesecenceRequires both X factor heat stable hemin and V factor heat labile coenzyme present in RBC , so heated or boiled blood agar is superior to plain agarQShows Satellitisre dependence on V factor when S. aureus is streaked across the blood agarAntigenic properties Hemophilus influenzae is the first free living organism whose complete genome is sequencedQThere are three major surface antigen the capsular polysaccharide, the outer membrane protein, and Iipo oligosaccharideQMajor antigenic determinant is capsular polysaccharideQ based on which, it is typed into six capsular typesMost isolates from acute invasive infections belong to type bQType b capsule has unique structure containing pentose sugar ribose and ribitol in the form of polyribosyl ribitol phosphate PRP Q instead of hexose and hexosaminesTypes of Hemophilus influenzaeInvasiveNon invasive Bacillus acts as a primary pathogen, causing acute invasive infectionsQ. Bacilli spread through blood, being protected from phagocytes by their capsuleQ. Meningitis is the most important infection in this group. Others Laryngoepiglottits, conjunctivitis, bacteremia, pneumonia, arthritis, endocarditis and pericarditis. Usually seen in children Caused by the capsulated strains, type b accounting for most cases. Bacillus spreads by local invasion along mucosal surfacesQ Causes secondary or superadded infections, usually of the respiratory tractQ. These include otitis media, sinusitis and exacerbations of chronic bronchitis and bronchiectasisQ. Usually seen in adultsQ Caused by non capsulated strainsQClinical Features Meningitis respiratory tract infection are the most common presentationQ.MeningitisMost frequently caused by biotype 1QOccur in childrenQ due to absence of PRP antibodiesSubdural effusionQ is the MC complicationDOC is ceftriaxone or cefotaximeQHemophilus influenzae is called Pfeiffer s bacillus but Pfleffer s phenomenon bacteriolysis in vivo is associated with V. choleraQ cholera vibrios were lysed when injected intraperitoneally into specifically immunized guinea pigs OrganismDrug of Choice Streptococcus pneumoniae. S. viridans. Hemolytic streptococci group A, B, C, G Staphylococcus non penicillinase producing Actinomyces, Bacillus cereus, Clostridium Neisseria meningitidis Treponema pallidum, T. pertenuePenicillin GQ MRSA, Coagulase negative Staphylococcus Enterococcus faeciumVancomycinQ Enterococcus faecalis. ListeriaAmpicillinQ Bacillus anthracis Borrelia burgdorferi, B. recurrentis Chlamydia RickettsiaeDoxycyclineQ CorynebacteriumErythromycinQ Hemophilus ducreyi MycoplasmaAzithromycinQ NocardiaCotrimoxazoleQ E. coli, Klebsiella, Proteus SalmonellaCeftriaxoneQ Serratia, Enterobacter, AcinetobacterCarbapenemsQ SEA BacteroidesMetronidazoleQ |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Gene involved in Cowden syndrome is | B PTENo Phosphatase and Tensin homolog PTEN protein in humans encoded by the PTEN gene. Gene mutations promotes development of cancers. ? Cowden s disease Multiple Hamartoma Syndrome Part of PTEN hamartoma tumor syndrome An autosomal dominant syndrome Trichilemmomas Numerous tumors of hair follicles in face Multiple hamartomatous polyps in GI tract, Lipomas, Granulomas Very high risk of breast, Follicular endometrail carcinoma thyroid carcinomaoTreatment Bilateral mastectomies recommended Contraindicated are mammography other radiation exposure of breast tissue. Mean age at presentation 10 years Very high risk of breast, follicular carcinoma of thyroid Endometrial carcinomaoPTEN phosphatase and tensin homologue is a membrane associated phosphatase encoded by a gene on chromosome 10q23 that is mutated in Cowden syndrome, an autosomal dominant disorder marked by frequent benign growths, such as skin appendage tumors, and an increased incidence of epithelial cancers, particularly of the breast, endometrium, and thyroid.oPTEN acts as a tumor suppressor by serving as a brake on the PI3K AKT arm of the receptor tyrosine kinase pathway.oPTEN gene function is lost in many cancers through deletion, deleterious point mutations, or epigenetic silencing.SELECTED TUMOR SUPPRESSOR GENES ASSOCIATED FAMILIAL SYNDROMES CANCERS, SORTED BY CANCER HALLMARKS Gene Protein Familial SyndromesAssociated CancersInhibitors of Mitogenic Signaling PathwaysAPC Adenomatous polyposis coli protein Familial colonic polyps and carcinomasCarcinomas of stomach, colon, pancreas melanoma . NF1 Neurofibromin 1 Neurofibromatosis type 1 neurofibromas and malignant peripheral nerve sheath tumors Neuroblastoma, juvenile myeloid leukemia . NF2 Merlin Neurofibromatosis type 2 acoustic schwannoma and meningioma Schwannoma, meningioma . PTCH Patched Gorlin syndrome basal cell carcinoma, medulloblastoma, several benign tumors Basal cell carcinoma, medulloblastoma . PTEN Phosphatase and tension homologue Cowden syndrome variety of benign skin, GI, and CNS growths breast, endometrial, and thyroid carcinoma Diverse cancers, particularly carcinomas and lymphoid tumors . SMAD2, SMAD4 SMAD2, SMAD4 Juvenile polyposisFrequently mutated along with other components of TGFb signaling pathway in colonic pancreatic CaInhibitors of Ceil Cycle Progression . RB Retinoblastoma RB proteinFamilial retinoblastoma syndrome retinoblastoma, osteosarcoma, other sarcomas Retinoblastoma osteosarcoma carcinomas of breast, colon, lung . CDKN2A p16 INK4a pU ARFFamilial melanomaPancreatic, breast, and esophageal carcinoma, melanoma, certain leukemiasInhibitors of Pro growth Programs of Metabolism and Angiogenesis . VHL Von Hippel Lindau VHL protein Von Hippel Lindau syndrome cerebellar hemangioblastoma, retinal angioma, renal cell carcinoma Renal cell carcinoma . STK11 Liver kinase B1 LKB1 or STK11 Peutz Jeghers syndrome GI polyps, GI cancers, pancreatic carcinoma and other carcinomas Diverse carcinomas 5 20 of cases, depending on type . SDHB, SDHD Succinate dehydrogenase complex subunits B D Familial paraganglioma, familial pheochromocytomaParaganglioma |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| How to diagnose Von Willebrand Disease ? | Early diagnosis of von Willebrand disease VWD is important to make sure that you re treated and can live a normal, active life. Sometimes VWD is hard to diagnose. People who have type 1 or type 2 VWD may not have major bleeding problems. Thus, they may not be diagnosed unless they have heavy bleeding after surgery or some other trauma. On the other hand, type 3 VWD can cause major bleeding problems during infancy and childhood. So, children who have type 3 VWD usually are diagnosed during their first year of life. To find out whether you have VWD, your doctor will review your medical history and the results from a physical exam and tests. Medical History Your doctor will likely ask questions about your medical history and your family s medical history. He or she may ask about Any bleeding from a small wound that lasted more than 15 minutes or started up again within the first 7 days following the injury. Any prolonged, heavy, or repeated bleeding that required medical care after surgery or dental extractions. Any bruising with little or no apparent trauma, especially if you could feel a lump under the bruise. Any nosebleeds that occurred for no known reason and lasted more than 10 minutes despite pressure on the nose, or any nosebleeds that needed medical attention. Any blood in your stools for no known reason. Any heavy menstrual bleeding for women . This bleeding usually involves clots or lasts longer than 7 to 10 days. Any history of muscle or joint bleeding. Any medicines you ve taken that might cause bleeding or increase the risk of bleeding. Examples include aspirin and other nonsteroidal anti inflammatory drugs NSAIDs , clopidogrel, warfarin, or heparin. Any history of liver or kidney disease, blood or bone marrow disease, or high or low blood platelet counts. Physical Exam Your doctor will do a physical exam to look for unusual bruising or other signs of recent bleeding. He or she also will look for signs of liver disease or anemia a low red blood cell count . Diagnostic Tests No single test can diagnose VWD. Your doctor may recommend one or more blood tests to diagnose the disorder. These tests may include Von Willebrand factor antigen. This test measures the amount of von Willebrand factor in your blood. Von Willebrand factor ristocetin ris to SEE tin cofactor activity. This test shows how well your von Willebrand factor works. Factor VIII clotting activity. This test checks the clotting activity of factor VIII. Some people who have VWD have low levels of factor VIII activity, while others have normal levels. Von Willebrand factor multimers. This test is done if one or more of the first three tests are abnormal. It shows the structure of your von Willebrand factor. The test helps your doctor diagnose what type of VWD you have. Platelet function test. This test measures how well your platelets are working. You may have these tests more than once to confirm a diagnosis. Your doctor also may refer you to a hematologist to confirm the diagnosis and for followup care. A hematologist is a doctor who specializes in diagnosing and treating blood disorders. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| A male patient of bipolar disorder with history of 5 episodes of mania and 1 episode of depression in last 8 years, under control by mood stabilizer, and manic symptoms appear as he tapered down the drugs. Which of the following intervention should be carried out to improve drug compliance? | Ans. a. Psychoeducation Ref Niraj Ahuja 7 e p67 68 In the question patient symptoms of bipolar disorder are well controlled by medication, which implies pharmacotherapy is efficient and added psychotherapy is necessary only to keep the patient compliant to the medication. In such a case, psychoeducation of the patient about adherence to strict treatment is most crucial psychotherapy modality in preventing relapse.PsychoeducationPsychoeducation refers to the education offered to individuals with a mental health condition their families to help empower them deal with their condition in an optimal way.Frequently psychoeducational training involves individuals with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as w ell as patient training courses in context of the treatment of physical illnesses.Family members are also included.A goal is for the consumer to understand and be better able to deal with the presented illness.Also, the patient s own capabilities, resources coping skills are strengthened used to contribute to their own health well being on a long term basis.Since it is often difficult for the patient and their family members to accept the patient s diagnosis, psychoeducation also has the function of contributing to the destigmatization of psychological disturbances and to diminish barriers to treatment.The relapse risk is in this way lowered patients family members, who are more well informed about the disease, feel less helplessQ.Important elements in psychoeducation are Information transfer symptomatology of the disturbance, causes, treatment concepts, etc. Emotional discharge understanding to promote, exchange of experiences with others concerning, contacts, etc. Support of a medication or psychotherapeutic treatment, as cooperation is promoted between the mental health professional and patient compliance, adherence .Assistance to self help e.g. training, as crisis situations are promptly recognized and what steps should be taken to be able to help the patient .Supportive PsychotherapyIt is a psychotherapeutic approach that integrates psychodynamic, cognitive behavioral, interpersonal conceptual models techniques.The objective of the therapist is to reinforce the patient s healthy adaptive patterns of thought behaviors in order to reduce the intrapsychic conflicts that produce symptoms of mental disorders.Unlike in psychoanalysis, in which the analyst works to maintain a neutral demeanor as a blank canvas for transference, in supportive therapy, the therapist engages in a fully emotional, encouraging, and supportive relationship with the patient as a method of furthering healthy defense mechanisms, especially in the context of interpersonal relationships.This therapy has been used for patients suffering from severe cases of addiction as well as bulimia nervosa, stress and other mental illnesses.Supportive psychotherapy is used as an initial therapy, to be reduced and not to be prolonged, in situations or periods where there is a lack of means for a systematic approach or behaviorism. Examples of such situations include Critical negotiationsVolatile but unavoidable everyday life or decisive situationsCompromises to introduce at least minimal operational, efficient relationship conditions in long term, engaged relationships, based on lasting agreementsInsight oriented PsychotherapyIt relies on conversation between the therapist client.It helps people through understanding expressing feelings, motivations, beliefs, fears and desires.As insight oriented psychotherapy is a client centered therapy, it is assumed that the client is healthy his her problem is a result of faulty thinking.During the therapy, the patient talks about what is on his her mind and the therapist looks for patterns in situations in which the patient might feel stress or anxiety.Patients typically wish to explore their anxiety more deeply because of a belief that deeper exploration will lead to change.Insight oriented psychotherapy can refer to Psychoanalysis, a method of treatment of mental disorders by using talk therapy to discover and process unconscious thoughts and desires.Psychodynamic psychotherapy, a more brief less intensive type of talk therapy that uses psychoanalytic theory methods. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Who is at risk for Urinary Tract Infection In Adults? ? | Although everyone has some risk, some people are more prone to getting UTIs than others. People with spinal cord injuries or other nerve damage around the bladder have difficulty emptying their bladder completely, allowing bacteria to grow in the urine that stays in the bladder. Anyone with an abnormality of the urinary tract that obstructs the flow of urinea kidney stone or enlarged prostate, for exampleis at risk for a UTI. People with diabetes or problems with the bodys natural defense system are more likely to get UTIs. Sexual activity can move microbes from the bowel or vaginal cavity to the urethral opening. If these microbes have special characteristics that allow them to live in the urinary tract, it is harder for the body to remove them quickly enough to prevent infection. Following sexual intercourse, most women have a significant number of bacteria in their urine, but the body normally clears them within 24 hours. However, some forms of birth control increase the risk of UTI. In some women, certain spermicides may irritate the skin, increasing the risk of bacteria invading surrounding tissues. Using a diaphragm may slow urinary flow and allow bacteria to multiply. Condom use is also associated with increased risk of UTIs, possibly because of the increased trauma that occurs to the vagina during sexual activity. Using spermicides with diaphragms and condoms can increase risk even further. Another common source of infection is catheters, or tubes, placed in the urethra and bladder. Catheters interfere with the bodys ability to clear microbes from the urinary tract. Bacteria travel through or around the catheter and establish a place where they can thrive within the bladder. A person who cannot urinate in the normal way or who is unconscious or critically ill often needs a catheter for more than a few days. The Infectious Diseases Society of America recommends using catheters for the shortest time possible to reduce the risk of a UTI.3 Recurrent Infections Many women suffer from frequent UTIs. About 20 percent of young women with a first UTI will have a recurrent infection.4 With each UTI, the risk that a woman will continue having recurrent UTIs increases.5 Some women have three or more UTIs a year. However, very few women will have frequent infections throughout their lives. More typically, a woman will have a period of 1 or 2 years with frequent infections, after which recurring infections cease. Men are less likely than women to have a first UTI. But once a man has a UTI, he is likely to have another because bacteria can hide deep inside prostate tissue. Anyone who has diabetes or a problem that makes it hard to urinate may have repeat infections. Research funded by the National Institutes of Health NIH suggests that one factor behind recurrent UTIs may be the ability of bacteria to attach to cells lining the urinary tract. One NIH funded study found that bacteria formed a protective film on the inner lining of the bladder in mice.6 If a similar process can be demonstrated in humans, the discovery may lead to new treatments to prevent recurrent UTIs. Another line of research has indicated that women who are nonsecretors of certain blood group antigens may be more prone to recurrent UTIs because the cells lining the vagina and urethra may allow bacteria to attach more easily. A nonsecretor is a person with an A, B, or AB blood type who does not secrete the normal antigens for that blood type in bodily fluids, such as fluids that line the bladder wall.7 Infections during Pregnancy Pregnant women seem no more prone to UTIs than other women. However, when a UTI does occur in a pregnant woman, it is more likely to travel to the kidneys. According to some reports, about 4 to 5 percent of pregnant women develop a UTI.8 Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys and cause infection. For this reason, health care providers routinely screen pregnant women for bacteria in the urine during the first 3 months of pregnancy. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Major criteria for rheumatic fever includes All except | Ans B Increased ESR CRP Ref The famous Jones criteria for diagnosis of Acure Rhemaric Fever are recently revised in 2015 by AHA with emphasis on doppler echocardiogarphy for involvement of heart. It is the first substantial revision to the Jones Criteria by the American Heart Association since 1992. It is technology driven ECHO and focuses on epidemiological differences in high risk and low risk populations. This is a effort to summarize important points for Pediatric post graduates exams. link to article Here For any discrepancy refer original Article Epidemiological Background 1. During the 20th century, the incidence of ARF and the prevalence of RHD declined substantially in Europe, North America, and developed nations. 2. Attributed to improved hygiene, improved access to antibiotic drugs and medical care, reduced household crowding, and other social and economic changes. 3. However, in developing countries the incidence remains high. In summary, the global distribution of ARF RHD is clearly disproportionate. As per epidemiological data, cases are divided into Low risk should be defined as having an ARF incidence 2 per 100 000 school aged children usually 5 14 years old per year. Or an allege prevalence of RHD of 1 per 1000 population per year. Children not clearly from a low risk population are at moderate to high risk depending on their reference population. Revised Jones Criteria A. Diagnosis For all patient populations with evidence of preceding GAS infection initial ARF 2 Major or 1 major plus 2 minor recurrent ARF 2 Major or 1 major and 2 minor or 3 minor B. What are Major criteria ? C. What are the Minor criteria Evidence of Preceding Streptococcal Infection Laboratory evidence of antecedent group A streptococcal infection is needed whenever possible, and the diagnosis is in doubt when such evidence is not available Exceptions include chorea, chronic, indolent rheumatic carditis with insidious onset and slow progression. This latter problem refers to patients without an identifiable history of ARF who have had subclinical carditis that was not detected previously. Interpretation of streptococcal serology results can be difficult in populations with endemic skin or upper respiratory group A streptococcal infections. In these settings, a negative streptococcal antibody test helps to exclude a recent infection, but a positive test does not necessarily indicate an infection in the past few months. Any 1 of the following can serve as evidence of preceding infection, per a recent AHA statement 1. Increased or rising anti streptolysin O titer or other streptococcal antibodies anti DNASE B . A rise in titer is better evidence than a single titer result. 2. A positive throat culture for group A b hemolytic streptococci. 3. A positive rapid group A streptococcal carbohydrate antigen test in a child whose clinical presentation suggests a high pretest probability of streptococcal pharyngItis. Clinical Manifestations of ARF 1. Generally, the clinical profile of ARF in low and middle income countries closely resembles that of high income countries. 2. Most common major manifestations during the first episode of ARF remain carditis 50 70 and arthritis 35 66 . 3. These are followed in frequency by chorea 10 30 , which has been demonstrated to have a female predominance, and then subcutaneous nodules 0 10 and erythema marginatum 6 , which remain much less common but highly specific manifestations of ARF. However in very high risk populations, such as the indigenous Australian population, variability in typical Jones criteria manifestations has been described. As discussed below, these include presentations with 1. aseptic monoarthritis 2. polyarthralgia and 3. low grade as opposed to traditionally considered high grade fevers. 1. Carditis 1. As per 1992 AHA revised Jones criteria statement, carditis as a major manifestation of ARF was mostly a clinical diagnosis based on the auscultation of typical murmurs that indicate MR or AR, at either or both valves. Valvulitis is by far the most consistent feature of ARF, and isolated pericarditis or myocarditis should rarely, if ever, be considered rheumatic in origin. 2. With declining auscultatory skills and widespread use of ECHO, the concept of subclinical carditis has become incorporated into other guidelines and consensus statements as a valid rheumatic fever major manifestation. 3. Subclinical carditis refers exclusively to the circumstance in which classic auscultatory findings of valvar dysfunction either are not present or are not recognized by the diagnosing clinician but Doppler studies reveal mitral or aortic valvulitis. 4. Specific Doppler Findings in Rheumatic Valvullitis and Morphological Findings on Echocardiogram in Rheumatic Valvulitis both acute and chronic are distinctly defined in the guidelines. Additional recommendations include 1. Echocardiography with Doppler should be performed in all cases of confirmed and suspected ARF. 2. Reasonable to consider performing serial echocardiography Doppler studies in any patient with diagnosed or suspected ARF even if documented carditis is not present on diagnosis. 3. Echocardiography Doppler testing should be performed strictly fulfilling the findings defined to assess whether carditis is present in the absence of auscultatory findings, particularly in moderate to high risk populations and when ARF is considered likely. 4. Echocardiography Doppler findings not consistent with carditis should exclude that diagnosis in patients with a heart murmur otherwise thought to indicate rheumatic carditis. 2. Arthritis 1. Migratory polyarthritis 2. Most frequently involved are larger ones, including knees, ankles, elbows, and wrists. Involvement of small joints of the hands and feet and the spine is much less common in ARF than in other arthritic illnesses. 3. Rapid improvement with salicylates or nonsteroidal anti inflammatory drugs is characteristic. 4. Self limited course, even without therapy, lasting ? 4 weeks. 5. No long term joint deformity. Aseptic Monoarthritis Studies from India, Australia, and Fiji have indicated that aseptic monoarthritis may be important as a clinical manifestation of ARF in selected high risk populations. Polyarthralgia Polyarthralgia is a very common, highly nonspecific manifestation of a number of rheumatologic disorders. No compelling evidence to amend this conclusion in low risk. But Children with polyarthralgia are more likely to have ARF if they come from a population with a high incidence population. Therefore, it is minor criteria for low risk, major for high risk! Chorea Sydenham Chorea 1. Purposeless, involuntary, nonstereotypical movements of the trunk or extremities. 2. Associated with muscle weakness and emotional lability. Skin Findings 1.Erythema marginatum. a. Unique, evanescent, pink rash seen with pale centers and rounded or serpiginous margins. b. Usually is present on the trunk and proximal extremities and is not facial. Heat can induce its appearance, and it blanches with pressure. Harder to detect in dark skinned individuals. 2. Subcutaneous nodules 1. Firm, painless protuberances found on extensor surfaces at specific joints, including the knees, elbows, and wrists, and occiput and along the spinous processes vertebrae. Common in those who also have carditis, and as with erythema marginatum, subcutaneous nodules almost never occur as the sole major manifestation of ARF. Rheumatic Fever Recurrences As stated in the 1992 guidelines, patients who have a history of ARF or RHD are at high risk for recurrent attacks if reinfected with group A streptococci. Possible Rheumatic Fever A given clinical presentation may not fulfill these updated Jones criteria, but the clinician may still have good reason to suspect that ARF is the diagnosis. This may occur in high incidence settings. In such situations, clinicians should use their discretion and clinical acumen to make the diagnosis that they consider most likely and manage the patient accordingly. AHA recommendations for management of possible rheumatic fever are 1. In genuine uncertainty, 12 months of secondary prophylaxis followed by reevaluation including careful history and physical examination with repeat echo. 2. In recurrent symptoms particularly involving the joints who has been adherent to prophylaxis recommendations but lacks serological evidence of group A streptococcal infection and lacks echo evidence of valvulitis, it is reasonable to conclude that the recurrent symptoms are not likely related to ARF, and discontinuation of antibiotic prophylaxis may be appropriate. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Minimum duration of developing coal miner pneumoconiosis March 2011 | Ans. D More than 10 years Simple pneumoconiosis first phase of anthracosis requires 12 years of exposure Coal workers pneumoconiosis CWP Black lung disease It is caused by long exposure to coal dust. It is a common affliction of coal miners and others who work with coal, similar to both silicosis from inhaling silica dust, and to the long term effects of tobacco smoking. Inhaled coal dust progressively builds up in the lungs and is unable to be removed by the body that leads to inflammation, fibrosis, and in worse cases, necrosis. Coal workers pneumoconiosis, severe state, develops after the initial, milder form of the disease known as anthracosis anthrac coal, carbon . This is often asymptomatic and is found to at least some extent in all urban dwellers due to air pollution. Prolonged exposure to large amounts of coal dust can result in more serious forms of the disease, simple coal workers pneumoconiosis and complicated coal workers pneumoconiosis or Progressive massive fibrosis, or PMF . More commonly, workers exposed to coal dust develop industrial bronchitis, clinically defined as chronic bronchitis i.e. productive cough for 3 months per year for at least 2 years associated with workplace dust exposure. Coal dust is not as fibrogenic as is silica dust. Coal dust that enters the lungs can neither be destroyed nor removed by the body. The paicles are engulfed by resident alveolar or interstitial macrophages and remain in the lungs, residing in the connective tissue or pulmonary lymph nodes. Coal dust provides a sufficient stimulus for the macrophage to release various products, including enzymes, cytokines, oxygen radicals, and fibroblast growth factors, which are impoant in the inflammation and fibrosis of CWP. Aggregations of carbon laden macrophages can be visualised under a microscope as granular, black areas. In serious cases, the lung may grossly appear black. These aggregations can cause inflammation and fibrosis, as well as the formation of nodular lesions within the lungs. Simple CWP is marked by the presence of 1 2mm nodular aggregations of anthracotic macrophages, suppoed by a fine collagen network, within the lungs. Those 1 2mm in diameter are known as coal macules, with larger aggregations known as coal nodules. These structures occur most frequently around the initial site of coal dust accumulation the upper regions of the lungs around respiratory bronchioles. The coal macule is the basic pathological feature of CWP, and has a surrounding area of enlargement of the airspace, known as focal emphysema. Continued exposure to coal dust following the development of simple CWP may progress to complicated CWP with progressive massive fibrosis PMF , wherein large masses of dense fibrosis develop, usually in the upper lung zones, measuring greater than 1 cm in diameter, with accompanying decreased lung function. These cases generally require a number of years to develop. Grossly, the lung itself appears blackened. Pathologically, these consist of fibrosis with haphazardly arranged collagen and many pigment laden macrophages and abundant free pigment. Radiographically, CWP can appear strikingly similar to silicosis. In simple CWP, small rounded nodules predominate, tending to first appear in the upper lung zones. The nodules may coalesce and form large opacities 1 cm , characterizing complicated CWP, or PMF There are three basic criteria for the diagnosis of CWP Chest radiography consistent with CWP An exposure history to coal dust typically underground coal mining of sufficient amount and latency Exclusion of alternative diagnoses mimics of CWP Symptoms and pulmonary function testing relate to the degree of respiratory impairment, but are not pa of the diagnostic criteria. Chest X ray appearance for CWP can be viually indistinguishable from silicosis. Chest CT, paicularly high resolution scanning HRCT , are more sensitive than plain X ray for detecting the small round opacities. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Two month old baby presented with non bilious vomiting and a palpable epigastric lump. which among the following will be investigation of choice | Ans a USG abdomen Ref Nelson 18th ed pi555Above clinical scenario is about the classical presentation of hypertrophic pyloric stenosis.Ultrasound examination confirms the diagnosis in the majority of cases and allots an earlier diagnosis in infants with suspected disease but no pyloric mass on physical examination.Criteria for diagnosis include pyloric thickness 4 mm or an overall pyloric length 14 mm Ultrasonography has a sensitivity of ?95 When contrast studies are performed, they demonstrate an elon gated pyloric channel, a bulge of the pyloric muscle into the antrum shoul der sign , and parallel streaks of barium seen in the narrowed channel, producing a double tract sign Hypertrophic pyloric stenosisHypertrophic pyloric stenosis occurs in 1 3 1,000 infants in the United States. Males, especially first borns are affected approximately four times as often as females. The offspring of a mother and. to a lesser extent, the father who had pyloric stenosis are at higher risk for pyloric stenosis. Pyloric stenosis develops in approximately 20 of the male and 10 of the female descendants of a mother who had pyloric stenosis. The inci dence of pyloric stenosis is increased in infants with type B and O blood groups. Pyloric stenosis is associated with other congenital defects, in cluding tracheoesophageal fistula and hypoplasia or agenesis of the infe rior labial frenulum.ETIOLOGY.The cause of pyloric stenosis is unknown, but many factors have been implicated. Pyloric stenosis is usually not present at birth and is more concordant in monozygotic than dizygotic twins. Pyloric stenosis has been associated with eosinophilic gastroenteritis, Apert syndrome, Zellweger syndrome, trisomy 18, Smith Lemli Opitz syndrome, and Cornelia de Lange syndrome. A variable association has been found with the use of erythromycin in neonates when administered for pertussis postexposure prophy laxis. Reduced levels of pyloric nitric oxide synthase have been found with altered expression of the neuronal nitric oxide synthase nNOS exon lc regulatory region, which influences the expression of the nNOS gene. Reduced nitric oxide may contribute to the pathogenesis of pyloric stenosisCLINICAL MANIFESTATIONSNonbilious vomiting is the initial symptom of pyloric stenosis. The vomiting may or may not be projectile initially but is usually progressive, occurring immediately after a feeding. The vomiting usually starts after 3 wk of age, but symptoms may develop as early as the 1 st wk of life and as late as the 5th mo. As vomiting continues, a progressive loss of fluid, hydrogen ion, and chloride leads to hypochloremic metabolic alkalosis. Serum potassium levels are usually maintained, but there may be a total body potassium deficit. Jaundice associated with a decreased level of glucuronyl trans ferase is seen in ?5 of affected infants. The indirect hyperbiliru binemia usually resolves promptly after relief of the obstruction.The diagnosis has traditionally been established by palpating the pyloric mass. The mass is firm, movable, ?2 cm in length, olive shaped, hard, best palpated from the left side, and located above and to the right of the umbilicus in the mid epigastrium beneath the liver edge. In healthy infants, feeding can be an aid to the diagnosis. After feeding, there may be a visible gastric peristaltic wave that progresses across the abdomen. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| What are the symptoms of Langerhans Cell Histiocytosis ? | These and other signs and symptoms may be caused by LCH or by other conditions. Check with your doctor if you or your child have any of the following Skin and nails LCH in infants may affect the skin only. In some cases, skin only LCH may get worse over weeks or months and become a form called high risk multisystem LCH. In infants, signs or symptoms of LCH that affects the skin may include Flaking of the scalp that may look like cradle cap. Raised, brown or purple skin rash anywhere on the body. In children and adults, signs or symptoms of LCH that affects the skin and nails may include Flaking of the scalp that may look like dandruff. Raised, red or brown, crusted rash in the groin area, abdomen, back, or chest, that may be itchy. Bumps or ulcers on the scalp. Ulcers behind the ears, under the breasts, or in the groin area. Fingernails that fall off or have discolored grooves that run the length of the nail. Mouth Signs or symptoms of LCH that affects the mouth may include Swollen gums. Sores on the roof of the mouth, inside the cheeks, or on the tongue or lips. Teeth that become uneven. Tooth loss. Bone Signs or symptoms of LCH that affects the bone may include Swelling or a lump over a bone, such as the skull, ribs, spine, thigh bone, upper arm bone, elbow, eye socket, or bones around the ear. Pain where there is swelling or a lump over a bone. Children with LCH lesions in bones around the ears or eyes have a high risk for diabetes insipidus and other central nervous system disease. Lymph nodes and thymus Signs or symptoms of LCH that affects the lymph nodes or thymus may include Swollen lymph nodes. Trouble breathing. Superior vena cava syndrome. This can cause coughing, trouble breathing, and swelling of the face, neck, and upper arms. Endocrine system Signs or symptoms of LCH that affects the pituitary gland may include Diabetes insipidus. This can cause a strong thirst and frequent urination. Slow growth. Early or late puberty. Being very overweight. Signs or symptoms of LCH that affects the thyroid may include Swollen thyroid gland. Hypothyroidism. This can cause tiredness, lack of energy, being sensitive to cold, constipation, dry skin, thinning hair, memory problems, trouble concentrating, and depression. In infants, this can also cause a loss of appetite and choking on food. In children and adolescents, this can also cause behavior problems, weight gain, slow growth, and late puberty. Trouble breathing. Central nervous system CNS Signs or symptoms of LCH that affects the CNS brain and spinal cord may include Loss of balance, uncoordinated body movements, and trouble walking. Trouble speaking. Trouble seeing. Headaches. Changes in behavior or personality. Memory problems. These signs and symptoms may be caused by lesions in the CNS or by CNS neurodegenerative syndrome. Liver and spleen Signs or symptoms of LCH that affects the liver or spleen may include Swelling in the abdomen caused by a buildup of extra fluid. Trouble breathing. Yellowing of the skin and whites of the eyes. Itching. Easy bruising or bleeding. Feeling very tired. Lung Signs or symptoms of LCH that affects the lung may include Collapsed lung. This condition can cause chest pain or tightness, trouble breathing, feeling tired, and a bluish color to the skin. Trouble breathing, especially in adults who smoke. Dry cough. Chest pain. Bone marrow Signs or symptoms of LCH that affects the bone marrow may include Easy bruising or bleeding. Fever. Frequent infections. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| How to diagnose Oropharyngeal Cancer ? | Tests that examine the mouth and throat are used to help detect find , diagnose, and stage oropharyngeal cancer. The following tests and procedures may be used Physical exam and history An exam of the body to check general signs of health, including checking for signs of disease, such as swollen lymph nodes in the neck or anything else that seems unusual. The medical doctor or dentist does a complete exam of the mouth and neck and looks under the tongue and down the throat with a small, long handled mirror to check for abnormal areas. An exam of the eyes may be done to check for vision problems that are caused by nerves in the head and neck. A history of the patients health habits and past illnesses and treatments will also be taken. PET CT scan A procedure that combines the pictures from a positron emission tomography PET scan and a computed tomography CT scan. The PET and CT scans are done at the same time with the same machine. The combined scans give more detailed pictures of areas inside the body than either scan gives by itself. A PET CT scan may be used to help diagnose disease, such as cancer, plan treatment, or find out how well treatment is working. CT scan CAT scan A procedure that makes a series of detailed pictures of areas inside the body, such as the head and neck, taken from different angles. The pictures are made by a computer linked to an x ray machine. A dye is injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. PET scan positron emission tomography scan A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose sugar is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. MRI magnetic resonance imaging A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging NMRI . Biopsy The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A fine needle biopsy is usually done to remove a sample of tissue using a thin needle. The following procedures may be used to remove samples of cells or tissue Endoscopy A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision cut in the skin or opening in the body, such as the mouth or nose. An endoscope is a thin, tube like instrument with a light and a lens for viewing. It may also have a tool to remove abnormal tissue or lymph node samples, which are checked under a microscope for signs of disease. The nose, throat, back of the tongue, esophagus, stomach, larynx, windpipe, and large airways will be checked. The type of endoscopy is named for the part of the body that is being examined. For example, pharyngoscopy is an exam to check the pharynx. Laryngoscopy A procedure in which the doctor checks the larynx with a mirror or with a laryngoscope. A laryngoscope is a thin, tube like instrument with a light and a lens for viewing. It may also have a tool to remove abnormal tissue or lymph node samples, which are checked under a microscope for signs of disease. If cancer is found, the following test may be done to study the cancer cells HPV test human papillomavirus test A laboratory test used to check the sample of tissue for certain types of HPV infection. This test is done because oropharyngeal cancer can be caused by HPV. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| How to diagnose Fanconi Anemia ? | People who have Fanconi anemia FA are born with the disorder. They may or may not show signs or symptoms of it at birth. For this reason, FA isn t always diagnosed when a person is born. In fact, most people who have the disorder are diagnosed between the ages of 2 and 15 years. The tests used to diagnose FA depend on a person s age and symptoms. In all cases, medical and family histories are an important part of diagnosing FA. However, because FA has many of the same signs and symptoms as other diseases, only genetic testing can confirm its diagnosis. Specialists Involved A geneticist is a doctor or scientist who studies how genes work and how diseases and traits are passed from parents to children through genes. Geneticists do genetic testing for FA. They also can provide counseling about how FA is inherited and the types of prenatal before birth testing used to diagnose it. An obstetrician may detect birth defects linked to FA before your child is born. An obstetrician is a doctor who specializes in providing care for pregnant women. After your child is born, a pediatrician also can help find out whether your child has FA. A pediatrician is a doctor who specializes in treating children and teens. A hematologist blood disease specialist also may help diagnose FA. Family and Medical Histories FA is an inherited disease. Some parents are aware that their family has a medical history of FA, even if they don t have the disease. Other parents, especially if they re FA carriers, may not be aware of a family history of FA. Many parents may not know that FA can be passed from parents to children. Knowing your family medical history can help your doctor diagnose whether you or your child has FA or another condition with similar symptoms. If your doctor thinks that you, your siblings, or your children have FA, he or she may ask you detailed questions about Any personal or family history of anemia Any surgeries youve had related to the digestive system Any personal or family history of immune disorders Your appetite, eating habits, and any medicines you take If you know your family has a history of FA, or if your answers to your doctor s questions suggest a possible diagnosis of FA, your doctor will recommend further testing. Diagnostic Tests and Procedures The signs and symptoms of FA aren t unique to the disease. They re also linked to many other diseases and conditions, such as aplastic anemia. For this reason, genetic testing is needed to confirm a diagnosis of FA. Genetic tests for FA include the following. Chromosome Breakage Test This is the most common test for FA. It s available only in special laboratories labs . It shows whether your chromosomes long chains of genes break more easily than normal. Skin cells sometimes are used for the test. Usually, though, a small amount of blood is taken from a vein in your arm using a needle. A technician combines some of the blood cells with certain chemicals. If you have FA, the chromosomes in your blood sample break and rearrange when mixed with the test chemicals. This doesn t happen in the cells of people who don t have FA. Cytometric Flow Analysis Cytometric flow analysis, or CFA, is done in a lab. This test examines how chemicals affect your chromosomes as your cells grow and divide. Skin cells are used for this test. A technician mixes the skin cells with chemicals that can cause the chromosomes in the cells to act abnormally. If you have FA, your cells are much more sensitive to these chemicals. The chromosomes in your skin cells will break at a high rate during the test. This doesn t happen in the cells of people who don t have FA. Mutation Screening A mutation is an abnormal change in a gene or genes. Geneticists and other specialists can examine your genes, usually using a sample of your skin cells. With special equipment and lab processes, they can look for gene mutations that are linked to FA. Diagnosing Different Age Groups Before Birth Prenatal If your family has a history of FA and you get pregnant, your doctor may want to test you or your fetus for FA. Two tests can be used to diagnose FA in a developing fetus amniocentesis AM ne o sen TE sis and chorionic villus ko re ON ik VIL us sampling CVS . Both tests are done in a doctor s office or hospital. Amniocentesis is done 15 to 18 weeks after a pregnant woman s last period. A doctor uses a needle to remove a small amount of fluid from the sac around the fetus. A technician tests chromosomes chains of genes from the fluid sample to see whether they have faulty genes associated with FA. CVS is done 10 to 12 weeks after a pregnant woman s last period. A doctor inserts a thin tube through the vagina and cervix to the placenta the temporary organ that connects the fetus to the mother . The doctor removes a tissue sample from the placenta using gentle suction. The tissue sample is sent to a lab to be tested for genetic defects associated with FA. At Birth Three out of four people who inherit FA are born with birth defects. If your baby is born with certain birth defects, your doctor may recommend genetic testing to confirm a diagnosis of FA. For more information about these defects, go to What Are the Signs and Symptoms of Fanconi Anemia? Childhood and Later Some people who have FA are not born with birth defects. Doctors may not diagnose them with the disorder until signs of bone marrow failure or cancer occur. This usually happens within the first 10 years of life. Signs of bone marrow failure most often begin between the ages of 3 and 12 years, with 7 to 8 years as the most common ages. However, 10 percent of children who have FA aren t diagnosed until after 16 years of age. If your bone marrow is failing, you may have signs of aplastic anemia. FA is one type of aplastic anemia. In aplastic anemia, your bone marrow stops making or doesn t make enough of all three types of blood cells red blood cells, white blood cells, and platelets. Aplastic anemia can be inherited or acquired after birth through exposure to chemicals, radiation, or medicines. Doctors diagnose aplastic anemia using Family and medical histories and a physical exam. A complete blood count CBC to check the number, size, and condition of your red blood cells. The CBC also checks numbers of white blood cells and platelets. A reticulocyte re TIK u lo site count. This test counts the number of new red blood cells in your blood to see whether your bone marrow is making red blood cells at the proper rate. Bone marrow tests. For a bone marrow aspiration, a small amount of liquid bone marrow is removed and tested to see whether it s making enough blood cells. For a bone marrow biopsy, a small amount of bone marrow tissue is removed and tested to see whether it s making enough blood cells. If you or your child is diagnosed with aplastic anemia, your doctor will want to find the cause. If your doctor suspects you have FA, he or she may recommend genetic testing. For more information, go to the Health Topics Aplastic Anemia article. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Two groups are tested for anemia. Which test should be used ? | Ans. is c i.e., Chi square test Observations in the given question are in the form of qualitative data anemia present or not . Thus Chi square test should be used. Chi square test Is used when the observation are in the form of propoions for qualitative data The outcome are in clear cut answers yes or no. As in the example the HBsAg is either present or not present. In contrast when the observation is normally distributed in the population e.g blood pressure, blood sugar student test is used. In the example comparing the occurence of hepatitis B surface antigen in medical and dental students, use of chi square analysis is appropriate because the outcome variables are dichomatous. Students are classified by the presence or absence of HBsAg. Student t test is used when the outcome variable is normally distributed in population for quantitative data e.g blood pressure, blood glucose. In the example student t test is used to assess the difference between mean systolic pressure of pregnant and non pregnant women to know the effect of pregnancy on mean systolic blood pressure because mean systolic blood pressure is normally distributed in the population. Every single lady has a mean systolic blood pressure. It may be low or high , but she has a value of mean systolic blood pressure. Students t test may be following types Unpaired t test Independent t test It compares the mean of two small samples The data is unpaired from two independent sample. for example, blood sugar concentration is measured in two different group A group of 10 patients and other group of 8 patient . To test the significance of difference between the means of the two groups, unpaired t test is used. Paired t test It compares the mean in paired data, before and after the intervention from same sample. For example, Blood sugar level in a sample of 10 patients is measure before giving and after giving the oral hypoglycemic. In this condition paired t test is used. Chi square test Vs Student t test In the example student t test is used to assess the difference between mean systolic pressure of pregnant and non pregnant women to know the effect of pregnancy on mean systolic blood pressure because mean systolic blood pressure is normally distributed in the population. Every single lady has a mean systolic blood pressure. It may be low or high , but she has a value of mean systolic blood pressure. But suppose we change the example in a way that we make a clear cut definition of hypeension such as mean systolic blood pressure over 140 mm of Hg will be taken to be hypeension and then look for hypeension among pregnant and non pregnant women. The test now used to analyse the outcome will be chi square test since the outcomes are now in the form of dichomatous data i.e yes or no a woman is either hypeensive or not hypeensive. This is in contrast to mean systolic blood pressure which was normally distributed among ladies every lady had one value of mean systolic blood pressure . Analysis of Variance ANOVA F test F ratio ANOVA is considered as an extension of the student t test for the significance of the difference between two sample means. The student t test can be used only for making just one comparison between two sample means , or between a sample mean and hypothesized population mean. ANOVA is used when more than one comparison is to be made When means of more than two groups are being compared . For example, BP is measured in more than two groups of men married, unmarried, widowed, separated and divorced . In this situation ANOVA test is best. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| True regarding fluorosis are all except ? | Ans. is a i.e. Fluorosis is the most common cause of dental caries in children endemic Fluorosis o Endemic fluorosis occurs when drinking water contains increased amounts of fluorine 3 5 mg L o Various toxic manifestations of endemic fluorosis are a. Dental fluorosis Fluoride is deposited in the enamel of teeth when excess fluoride is ingested during the years of tooth calcification i.e. during the first 7 yrs of life q Earliest signs of dental fluorosis is molting of dental enamel. The teeth loose their shine and chalk white patches develop. Later the white patches turn yellow or sometimes brown or black. In severe cases, loss of enamel gives the teeth a corroded appearance. Mottling is best seen on the upper incisors. Mottling is almost entirely confined to the permanent teeth and develops only during the period of formation. b. Skeletal fluorosis Chronic ingestion of excessive amount of fluorine 3.0 to 6.0 mg L or more results in skeletal fluorosis. There is a heavy fluoride deposition in the skeleton. Fluoride deposition leads to Osteosclerosis calcification of the ligaments. In the early clinical stage of skeletal fluorosis, symptoms include pains in the bones and joints sensations of burning. pricking. and tingling in the limbs muscle weakness chronic fatigue and gastrointestinal disorders and reduced appetite. In the next clinical stage, pain in the bones become constant and some of the ligaments begin to calcify. Osteoporosis may occur in the long bones, and early symptoms of osteosclerosis are present. Stiffness In the back occurs, especially in the lumbar region, followed by dorsal and cervical spines. Restriction of the spine movements is the earliest clinical sign of fluorosis. The stiffness increases steadily until the entire spine becomes one continuous column of bone manifesting a condition referred to as poker hack . The stiffness that first appears in the spine soon spreads to various joints in the limbs owing to the involvement of the joint capsules, the related ligaments, and the tendinous attachments to the bones. The involvement of the ribs gradually reduces the movement of the chest during breathing. which finally becomes mainly abdominal. When that happens the chest assumes a barrel shape. With the increasing immobilization of the joints due to contractures, flexion deformities may develop at hips, knees and other joints, which make the patient bedridden. Despite the fact that the entire bone structure has become affected, the mental faculties remain unimpaired till the last stage is reached. la The stage at which skeletal fluorosis becomes crippling usually occurs between 30 and 50 years of age in the endemic regions c. Genu valgum In recent years, a new form of fluorosis characterised by genu valgum and osteoporosis of the lower limbs has been repoed from some districts of Andhra Pradesh and Tamil Nadu. This form of fluorosis was observed in people whose staple diet was Sorghum jov ar . It was found that diets based on sorghum promoted a higher retention of ingested fluoride than do diets based on rice. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Which of the following is not true about Myositis ossificans? | A i.e. Associated with muscle tendon rupture Myositis Ossificans M.O Hetrotropic Ossification It is hetrotropic calcification and ossification in muscle tissue. The name is misnomer as there is no myositis inflammation of muscle and rarely ossification in the muscle because the mineral phase differs from that in bone and no true bone matrix is formed . Etiology Injury trauma is an impoant factor and m.o. associated with trauma is better k a post traumatic ossification it is seen in Elbow hipQ are commonly involved joints. Trauma around elbowQ eg. fracture supracondylar humerus, dislocation or surgery. Surgical trauma specially total hip replacement, Massage to the elbow and vigorous passive stretchine to restore movements is aggravating factor. Repeated micro trauma and overuse injuries. This type usually involve soleus muscle in ballerians. It occurs in muscles which are vulnerable to tear under heavy loads, such as quadriceps, adductors, brachicilisQ, biceps, and deltoid. M. 0. not associated with traumatic injury is termed as Pseudomalignant mysitis ossificans. And it is seen in Neurological disorders eg.G.B syndrome, AIDS encephalopathy, closed head injury, hypoxic brain injury burns. Pathogenesis Bone formation in muscle represents metaplasia of fibroblast at the site of injury. Paial rupture avulsion of muscle , ligament joint capsule from bone usually cause periosteal elevation with the formation of subperiosteal hematoma and the wide exposure of cells with osteogenic potential. It inevitably lit subperiosteal ossification. It has four microscopic zones Ackerman Zonation with centre most zone of undifferentiated, highly active mitotic cells and the outermost zone of well oriented hone encapsulated by fibrous tissue. It must be distinguished from extaskeletal osteosarcoma. The latter usually occur in elderly, lacks zonationQ, and the most peripheral regions of osteosarcoma are most cellular primitive, which is reverse of m.o. It is distinguished from calcinosis, which is a metabolic disorder, often associated with collagen diseases scleroderma dermatomyositis. It is distinguished from ectopic calcification, which occurs in the capsule of joints, commonly the shoulder and is caused by inflammatory reaction around deposits of hydroxy appetite crystals. And it is seen in CRF, hypo hyper Clinical feature Mostly asymptoma tic but may present with tenderness, palpable swelling, pain on range of motion, stiffness, and increased warmth. Imaging Radiographs initially are normal, but by 10 days to 4 weeks fine calcification dotted veil cotton wool appearance is seen. There is peripheral ossification and central lucencyQ of the mass. The mass is usually seperated from underlying bone by at least a thin lineQ lesion are usually located in the diaphysis. If the lesion is in continuity with the bone it is not myositis ossificans and the possibility of tumor or infection arises. Calcification may first be noted on USG focal hypoechoic mass located with in the muscle . CT is better than x ray Biopsy before 4 weeks is usually in accurate. Treatment of Myositis Ossificans Treatment is normally by watchful inactivity . It must be emphasised that it is a passive stretching and not active exercise that is responsible for stimulating new growth formation. The worst treatment is to attack an injured and stiffish elbow with vigorous mucle stretching exercises this is liable to precipitate or aggrevate the condition. So any physical therapy should be discontinuedQ. Relative rest of the affected extremity is helpfulQ, with motion activity gradually resumed as the acute phase subsides. In acute phase the treatment consist of limiting motion icing the extremity while avoiding heat or massage Low dose irradiation indomethacin may prevent hetrotopic ossification, but the radiation should be avoided in children. Surgical excision in toto is not done until a year or 2 after the acute phase of disease, at a time when radiograph reveal that the bone is fully mature and bone scan show either a return to normal uptake or decreasing activity in the lesion. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| What to do for Growth Failure in Children with Chronic Kidney Disease ? | Children with CKD may lose their appetite or lack the energy to eat. To treat growth failure in children, a health care provider may recommend dietary changes, such as adding calcium. Children with CKD should get the recommended level of calcium for their age from their diet or from calcium supplements. monitoring liquids. Balancing the childs liquid intake based on his or her kidney disease is important. Some children will need to increase liquid intake, while other children will need to restrict liquid intake. limiting phosphorus. Children with CKD may need to limit phosphorus intake if they have mineral and bone disorder. monitoring protein. Children with CKD should eat enough protein for growth however, they should avoid high protein intake, which can put an extra burden on the kidneys. monitoring sodium. The amount of sodium children with CKD need depends on the stage of their kidney disease, their age, and sometimes other factors. The health care provider may recommend either limiting or adding sodium, often from salt, to the childs diet. adding vitamin D. Children who do not get enough vitamin D through diet may need to take vitamin D supplements. To help ensure coordinated and safe care, parents and caregivers should discuss the use of complementary and alternative medical practices, including the use of dietary supplements, with the childs health care provider. Read more at www.nccam.nih.gov. Some children will use a feeding tube to receive all their nutrition. A feeding tube is a small, soft plastic tube placed through the nose or mouth into the stomach. The child will receive supplements through the tube to provide a full supply of fluid and nutrients to help him or her grow and develop. Feeding tubes are most often used in infants however, sometimes older children and adolescents benefit from them as well. Encouraging children to develop healthy eating habits can help prevent poor nutrition and promote healthy growing. The health care team will work with parents or caretakers to develop a healthy diet tailored to meet the needs of their child. More information about diet and kidney disease is provided in the NIDDK health topic, Nutrition for Chronic Kidney Disease in Children. Medications A health care provider may prescribe medications that can help correct the underlying problems causing growth failure. A health care provider may prescribe phosphate binders when phosphorus levels in the blood rise and interfere with bone formation and normal growth. In the intestine, the medications bind, or attach, to some of the phosphorus found in food, causing the phosphorus to move through the intestine without being absorbed and exit the body in the stool. This process can decrease blood phosphorus levels and increase blood calcium levels. Phosphate binders come as chewable tablets, liquids, capsules, and pills. A health care provider may prescribe alkaline agents such as sodium bicarbonate to restore the acid base balance in a child with acidosis. Synthetic erythropoietin is a man made form of erythropoietin given by injection to treat anemia. Growth Hormone Therapy When a health care provider diagnoses a child with CKD and the child begins to show signs of growth failure, the health care provider may prescribe daily human growth hormone injections. The injections are a man made growth hormone that mimics the natural hormone found in the body. Researchers have shown that using growth hormone therapy is effective in helping children reach normal adult height. More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| What are the treatments for Indigestion ? | Some people may experience relief from symptoms of indigestion by eating several small, low fat meals throughout the day at a slow pace refraining from smoking abstaining from consuming coffee, carbonated beverages, and alcohol stopping use of medications that may irritate the stomach liningsuch as aspirin or anti inflammatory drugs getting enough rest finding ways to decrease emotional and physical stress, such as relaxation therapy or yoga The doctor may recommend over the counter antacids or medications that reduce acid production or help the stomach move food more quickly into the small intestine. Many of these medications can be purchased without a prescription. Nonprescription medications should only be used at the dose and for the length of time recommended on the label unless advised differently by a doctor. Informing the doctor when starting a new medication is important. Antacids, such as Alka Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve symptoms of indigestion. Many brands on the market use different combinations of three basic saltsmagnesium, calcium, and aluminumwith hydroxide or bicarbonate ions to neutralize the acid in the stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects. Calcium carbonate antacids, such as Tums, Titralac, and Alka 2, can also be a supplemental source of calcium, though they may cause constipation. H2 receptor antagonists H2RAs include ranitidine Zantac , cimetidine Tagamet , famotidine Pepcid , and nizatidine Axid and are available both by prescription and over the counter. H2RAs treat symptoms of indigestion by reducing stomach acid. They work longer than but not as quickly as antacids. Side effects of H2RAs may include headache, nausea, vomiting, constipation, diarrhea, and unusual bleeding or bruising. Proton pump inhibitors PPIs include omeprazole Prilosec, Zegerid , lansoprazole Prevacid , pantoprazole Protonix , rabeprazole Aciphex , and esomeprazole Nexium and are available by prescription. Prilosec is also available in over the counter strength. PPIs, which are stronger than H2RAs, also treat indigestion symptoms by reducing stomach acid. PPIs are most effective in treating symptoms of indigestion in people who also have GERD. Side effects of PPIs may include back pain, aching, cough, headache, dizziness, abdominal pain, gas, nausea, vomiting, constipation, and diarrhea. Prokinetics such as metoclopramide Reglan may be helpful for people who have a problem with the stomach emptying too slowly. Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness, including fatigue, sleepiness, depression, anxiety, and involuntary muscle spasms or movements. If testing shows the type of bacteria that causes peptic ulcer disease, the doctor may prescribe antibiotics to treat the condition. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| About Randomized Controlled trial all are trueexcept | Dropouts are excluded from the study Ref Epidemiology and health services By Haroutune K. Annenian, Sum Shapiro p63 http www3. interscience. wiley. corn journa1 8901 1300 abstract ?CRETRY 1 SRETRY 0 Park 20 e p1 Repeat from Nov 08 Randomised controlled trials RCT , are experimental studies where the effect of an intervention is assessed by collecting data before and after an intervention has taken place. RCT are used to compare an intervention with one or more other interventions or with no intervention. In RCT, an intervention is investigated by comparing one group of people who receive the intervention with a control group or control arm who do not. The control group receives the usual or no treatment and their outcome measure, or the change in measure from the staing point or baseline, is compared with that of the intervention group. RCT are designed to minimize bias Subject variation or Performance bias there may be bias on the pa of the paicipants, who may subjectively feel better or repo improvement if they may subjectively feel better or repo improvement if they knew they were receiving a new form of treatment. Observer bias the investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the paicular procedure of therapy to which the patient has been subjected. Bias in evaluation the investigator may subconsciously give a orable repo of the outcome of the trial, if he has beforehand knowledge of the group getting treatment. Randomization cannot guard against these sos of bias, nor the size of the sample. In order to reduce these problems, blinding is adopted. Park Blinding can be done in three ways Single blinding here the paicipants are not aware whether they belong to the study group or the control group. b. Double blinding here neither the doctor nor the paicipant are aware of the group allocation and the treatment received. Triple blinding here the paicipants, the investigator or person analyzing the data are all blind . Ideally triple blinding should be used, but double blinding is the most common method used. Allocation bias Allocation bias occurs when the measured treatment effect differs from the true treatment effect because of how paicipants were selected into the intervention or control groups. In RCT, once the paicipants are entered into the study, they are randomised to either an intervention group or the control group. Randomisation ensures that characteristics that might affect the relationship between intervention and outcome measures will be roughly equal across all arms of the study, minimising potential bias. Random allocation of patients is preferable to other methods of allocation because only randomization has the ability to create truly comparable groups. All factors related to prognosis, whether or not they are known before the study takes place or have been measured, tend to be equally distributed in the comparison groups. Patients in one group are, on the average, as likely to possess a given characteristic as patients in another. In the long run, with a large number of patients in the trial, randomization usually works as described above. However, random allocation does not guarantee that the groups will be similar. Dissimilarities between groups can arise by chance alone, paicularly when the number of patients randomized is small. To assess whether this kind of bad luck has occurred, authors of randomized controlled trials often present a table comparing the frequency of a variety of characteristics in the treated and control groups, especially those known to be related to outcome. These are called baseline characteristics because they are present before randomization and so should be equally distributed in the treatment groups. Attrition bias Attrition bias also call loss to follow up bias occurs when patients drop out of the study from one or other of the study groups preferentially. For example, if halfway through a study the treatment has been successful paicipants may drop out, and information about the success of the treatment is then lost. Conversely, paicipants in the control group may be unhappy with their lack of progress and may drop out of the study in order to seek alternative help. Sample size The size of the sample required when carrying out RCT is dependent upon the power of the test and what size of intervention impact is considered meaningful. It also depends on the type of hypothesis the RCT is testing. The smaller the magnitude of difference between groups that is to be detected and the greater the variability in outcomes, the larger the sample size that will be required. Randomised controlled trials are the most rigorous way of determining whether a cause effect relation exists between treatment and outcome, however they are generally more costly and time consuming than other studies. Now lets come to the last option that s our answer Dropouts are excluded from the study. Though it sounds absurd but the truth is that the Dropouts are not excluded from the study. This is known as Intention to treat. The dropouts are included in the study. The aphorism is Once randomized, always analyzed Intention to treat ITT analysis sometimes also called Intent to Treat is an analysis based on the initial treatment intent, not on the treatment eventually administered. For example, if people who have a more refractory or serious problem tend to drop out at a higher rate, even a completely ineffective treatment may appear to be providing benefits if one merely compares those who finish the treatment with those who were enrolled in it. For the purposes of ITT analysis, everyone who begins the treatment is considered to be pa of the trial, whether they finish it or not. Rationale Intention to treat analyses are done to avoid the effects of crossover and drop out, which may break the randomization to the treatment groups in a study. Intention to treat analysis provides information about the potential effects of treatment policy rather than on the potential effects of specific treatment. If dropouts and noonadherent subjects are ignored, there is the possibility that bias will be introduced. For example consider two weight loss diets. one of which is effective while the other isn t. People on the effective diet lose weight and stay in the study. On the ineffective diet Some will lose weight regardless and will stay in the study. Those who fail to lose weight are more likely to drop out, if only to try something else. This will make the ineffective diet look better than it really is and, by comparison, the effective diet looks worse than it really is because the only subjects who remain in the study following the ineffective diet are those losing weight! A popular phrase used to describe ITT analyses is Analyze as randomized! Once subjects are randomized, their data must be used for the ITT analysis! |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Mildly elevated bilirubin, normal liver enzy mes are seen in | Ans. is d i.e., AH of above o Mildly elevated bilirubin especially indirect and normal liver enzyme seen in hemolytic anemia,o In above question all causes hemolytic anemiao In severe hemolysis or hemolysis which cause liver damage may derange LFT.o Other causes of hemolysisHemolytic Anemias and Their TreatmentDIAGNOSISDEFECTL ABORATORY TESTSTREATMENTCELLULAR DEFECT SMembrane Defects HereditaryspherocytosisCytoskeletal protein defectsSpherocytes on blood filmIfHb lOg dL and reticulocyte count age 6 yr, but earlier if necessaryFolic acid, 1 mg qdG6PD deficiencyA type age labile enzymeMediterranean type no enzyme activity in circulating RBCsG6PDAvoid oxidant stress to RBCsTransfusion if acute anemia is symptomaticHemoglobin Abnormalities For discussion of hemoglobinopathies, see sections on these topics EXTRACELLULAR DEFECTS AutoimmuneAutoimmune hemolytic anemiaAlteration in membrane surface antigen Rh or abnormal response of B lymphocytes, causing autoantibody formationSpherocytes on blood filmIf Hb 10 nonePositive direct Coombs test to IgG warm antibody antibody directed aeainst RBCsSevere anemia may require transfusion Warm antibody Prednisone, 2 mg kg 24 hrPositive indirect Coombs test and antibody detectable in plasmaIVIGDanazolThermal amplitude 35 40degC Some complement C3b may be detected on RBCsSplenectomyImmunosuppressivesTests for underlying diseaseFolic acid, 1 mg. 24 hr if chronic Cold antibody Cold or IgM autoantibody directed against I i antigen systemAgglutination or rouleaux on blood filmIfHb 10g dLand reticulocyte count 10 none Positive direct Coombs test to complement C3b Severe anemia may require transfusionTests for underlying diseaseAvoid exposure to coldSerology for infectious mononucleosis anti i presentIf severe immunosuppressives and plasmapheresisSerology for Mycoplasma pneumoniae anti I presentPrednisone is less effective Splenectomy is not useful Folic acid, 1 mg 24 hr if chronicFragmentationHemolysis DIC, TTP, HUSDirect damage to RBC membraneFragments on blood filmTreat underlying condition Transfusion, but transfused cells also will have shortened life spanExtracorporealDirect damage to RBCFragmentsSupportivemembraneoxygenationmembraneon blood filmTransfusion until ECMO is discontinuedProsthetic heart valveDirect damage to RBC membraneFragments on blood filmFolic acid, 1 mg 24 hr Iron for secondary iron deficiencyBurns thermal injuryDirect damage to RBC membraneSpherocytes on blood filmSupportive TransfusionHypersplenism Effects of sequestration, i pH. lipases and other enzymes, and macrophages on RBCsThrombocytopenia and neutropeniaTreat underlying condition cytopenias alt usually mild Splenectomy if complicating other anemia e.g., thalassemia major Folic acid, 1 mg 24 hrPlasma Factors Liver diseaseAlteration in plasma cholesterol and phospholipidsTarget cells or speculated RBCs on blood filmTreat underlying condition Abnormal liver function testsTransfusion, but transfused cells also will have shortened life span Folic acid, 1 mg 24 hrAbetalipoproteinemiaAbsence of apo lipoprotein bAcanthocytes on blood filmVitamin E A, K, and D Vitamin E deficiency and heightened sensitivity to oxidative damageAbsent chylomicrons, VLDL, and LDLFolic acid, 1 mg 24 hrDietary restriction of triglyceridesInfectionsToxic effects on RBCsAssociated symptoms and signsAntibiotics CulturesSupportiveWilson DiseaseEffect of copper on RBC membrane, usually self limitedSpherocytes on blood filmPenicillamineCopper, ceruloplasminSupportive Penicillamine challenge and urine copper excretionTransfusion if acute anemia is symptomatic |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| A lesion 3cms away from gastroesophageal junction contain columnar epithelium ,such a type of lesion is | Ref Robbins 8 e p10,265, 9 e p271 Metastasis Metastases are secondary implants of a tumor that are dis continuous with the primary tumor and located in remote tissues Fig. 5 11 . More than any other attribute, the propey of metastasis identifies a neoplasm as malignant. Not all cancers have equivalent ability to metastasize, however. At one extreme are basal cell carcinomas of the skin and most primary tumors of the central nervous system, which are highly invasive locally but rarely metastasize. At the other extreme are osteogenic bone sarcomas, which usually have metastasized to the lungs at the time of initial discovery. Approximately 30 of patients with newly diagnosed solid tumors excluding skin cancers other than melano mas present with clinically evident metastases. An additional 20 have occult hidden metastases at the time of diagnosis. In general, the more anaplastic and the larger the primary neoplasm, the more likely is metastatic spread, but as with most rules, there are exceptions. Extremely small cancers have been known to metastasize conversely, some large and ominous looking lesions may not. Dissemination strongly prejudices, and may preclude, the possibility of curing the disease, so obviously, sho of prevention of cancer, no achievement would confer greater benefit on patients than the prevention of metastases. Malignant neoplasms disseminate by one of three path ways 1 seeding within body cavities, 2 lymphatic spread, or 3 hematogenous spread. Spread by seeding occurs when neoplasms invade a natural body cavity. This mode of dissemination is paicularly characteristic of cancers of the ovary, which often cover the peritoneal sur faces widely. The implants literally may glaze all peritoneal surfaces and yet not invade the underlying tissues. Here is an instance of the ability to reimplant elsewhere that seems to be separable from the capacity to invade. Neoplasms of the central nervous system, such as a medulloblastoma or ependymoma, may penetrate the cerebral ventricles and be carried by the cerebrospinal fluid to reimplant on the men ingeal surfaces, either within the brain or in the spinal cord. Lymphatic spread is more typical of carcinomas, whereas hematogenous spread is ored by sarcomas. There are numerous interconnections, however, between the lym phatic and vascular systems, so all forms of cancer may disseminate through either or both systems. The pattern of lymph node involvement depends principally on the site of the primary neoplasm and the natural pathways of local lymphatic drainage. Lung carcinomas arising in the respi ratory passages metastasize first to the regional bronchial lymph nodes and then to the tracheobronchial and hilar nodes. Carcinoma of the breast usually arises in the upper outer quadrant and first spreads to the axillary nodes. However, medial breast lesions may drain through the chest wall to the nodes along the internal mammary aery. Thereafter, in both instances, the supraclavicular and infra clavicular nodes may be seeded. In some cases, the cancer cells seem to traverse the lymphatic channels within the immediately proximate nodes to be trapped in subsequent lymph nodes, producing so called skip metastases. The cells may traverse all of the lymph nodes ultimately to reach the vascular compament by way of the thoracic duct. A sentinel lymph node is the first regional lymph node that receives lymph flow from a primary tumor. It can be identified by injection of blue dyes or radiolabeled tracers near the primary tumor. Biopsy of sentinel lymph nodes allows determination of the extent of spread of tumor and can be used to plan treatment. Of note, although enlargement of nodes near a primary neoplasm should arouse concern for metastatic spread, it does not always imply cancerous involvement. The necrotic products of the neoplasm and tumor antigens often evoke immunologic responses in the nodes, such as hyperplasia of the follicles lymphadenitis and proliferation of macro phages in the subcapsular sinuses sinus histiocytosis . Thus, histopathologic verification of tumor within an enlarged lymph node is required. Hematogenous spread is the ored pathway for sarco mas, but carcinomas use it as well. As might be expected, aeries are penetrated less readily than are veins. With venous invasion, the blood borne cells follow the venous flow draining the site of the neoplasm, with tumor cells often stopping in the first capillary bed they encounter. Since all poal area drainage flows to the liver, and all caval blood flows to the lungs, the liver and lungs are the most frequently involved secondary sites in hematogenous dissemina tion. Cancers arising near the veebral column often em bolize through the paraveebral plexus this pathway probably is involved in the frequent veebral metastases of carcinomas of the thyroid and prostate. Ceain carcinomas have a propensity to grow within veins. Renal cell carcinoma often invades the renal vein to grow in a snakelike fashion up the inferior vena cava, sometimes reaching the right side of the hea. Hepatocel lular carcinomas often penetrate poal and hepatic radicles to grow within them into the main venous channels. Remarkably, such intravenous growth may not be accom panied by widespread dissemination. Many observations suggest that the anatomic localiza tion of a neoplasm and its venous drainage cannot wholly explain the systemic distributions of metastases. For example, prostatic carcinoma preferentially spreads to bone, bronchogenic carcinomas tend to involve the adre nals and the brain, and neuroblastomas spread to the liver and bones. Conversely, skeletal muscles, although rich in capillaries, are rarely the site of secondary deposits. The molecular basis of such tissue specific homing of tumor cells is discussed later on. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Which of the following parasite can cause duodenal stricture ? | Ans. b Strongyloides stercoralis Ref. H 16th ed., p 1235, 1258 Table 192 2 Table 201 1 The Strongyloides stercoralis larvae inhabit duodenum of humans, attaching themselves to mucous membrane, causing inflammation, and eventually duodenal stricture results.SpeciesDisease OrgansForm TransmissionDiagnosisTreatmentNecator americanus New World hookworm Hookworm infectionLung migration pneumonitisBloodsucking anemiaFilariform larva penetrates intact skin of bare feetFecal larvae up to 13 mm and ova oval, transparent with 2 8 cell stage visible insideFecal occult blood may be presentMebendazole and iron therapyAncyclostoma brazilienseAncylostoma canium dog and cat hookworms Cutaneous larva migrans intense skin itchingFilariform larva penetrates intact skin but cannot mature in humansUsually a presumptive diagnosis, exposureThiabendazoleStrongyloides stercoralisThreadworm strongyloidiasis Early pneumonitis, abdominal pain, diarrheaLater malabsorption, ulcers, bloody stoolsFilariform larva penetrates intact skin, autoinfection leads to indefinite infections unless treatedLarvae in stool, serologyThiabendazoleTrichinella spiralisTrichinosis larvae encyst in muscle painViable encysted larvae in meat are consumed wildgame meatMuscle biopsy clinical findings fever, myalgia, splinter hemorrhages, eosinophiliaSteroids for severe symptoms and mebendazoleSTRONGYLOIDIASIS S. stercoralis is distinguished by its ability unusual among helminths to replicate in the human host. This capacity permits ongoing cycles of autoinfection as infective larvae are internally produced. Life cycle Humans acquire strongyloidiasis when filariform larvae in fecally contaminated soil penetrate the skin or mucous membranes.0 The larvae then travel through the bloodstream to the lungs, where they break into the alveolar spaces, ascend the bronchial tree, are swallowed, and thereby reach the small intestine. Clinical Features Recurrent urticaria, often involving the buttocks and wrists, is the most common cutaneous manifestation. Migrating larvae can elicit a pathognomonic serpiginous eruption, larva currens running larva a pruritic, raised, erythematous lesion that advances as rapidly as 10 cm h along the course of larval migration. Adult parasites burrow into the duodenojejunal mucosa and can cause abdominal pain, which resembles peptic ulcer pain except that it is aggravated by food ingestion.0 It causes duodenal stricture. Eosinophilia is common, with levels fluctuating over time. Abrogation of host immunity glucocorticoid therapy immunosuppressive agents , leads to hyperinfection, with the generation of large numbers of filariform larvae. Strongyloidiasis is a frequent complication of infection with human T cell lvmphotropic virus type I. but disseminated strongyloidiasis is not common among patients infected with HIV. Diagnosis In uncomplicated strongyloidiasis, the finding of rhabditiform larvae in feces is diagnostic. The eggs are almost never detectable because they hatch in the intestine. If stool examinations are negative, Strongyloides can be assayed by sampling of the duodenojejunal contents by aspiration or biopsy.6 ELISA for antibodies to excretory secretory or somatic antigens of Strongyloides is a sensitive method. Treatment Even in the asymptomatic state, strongyloidiasis must be treated due to the potential for fatal hyperinfection. Ivermectin Single 0.2 mg kg dose yields highest cure rates is more effective than albendazole 400 mg x3 days,repeated at 2 wks . For disseminated strongyloidiasis, treatment with ivermectin should be extended for at least 5 to 7 days.Additional Educational Points STRING TEST to sample duodenal contents is sometimes necessary to detect Giardia lamblia, Cryptosporidium, and Strongyloides larvae. Alternative tests for detection of Strongyloides larvae include duodenal aspirate or jejunal biopsy serology sputum or lung biopsy for filariform larvae in disseminated disease. Some species, including Strongyloides stercoralis and Enterobius vermicularis, can be transmitted directly from person to person, while others, such as Ascaris lumbricoides, Necator americanus, and Ancylostoma duodenale, require a soil phase for development. Strongyloides stercoralis is a gastrointestinal parasitic infection that has a pattern of endemic distribution similar to that of HTLV I. Ivermectin is active at low doses against a wide range of helminths and ectoparasites. It is the drug of choice for the treatment of onchocerciasis, strongyloidiasis, cutaneous larva migrans, and scabies.PARASITIC NEMATODESFeatureAscaris lumbricoides Roundworm Necator americanus, Ancylostoma duodenale Hookworm Strongyloides stercoralisTrichuris trichuria whipworm pinworm Enterobius vermicularisGlobal prevelance in humans millions 1273127750902300Endemic areasWorld wideHot, humid regionsHot, humid regionsworldwideWorldwideInfective stageEggFilariform larvaFilariform larvaEggEggRoute of infectionOralPercutaneousPercuteneous or auto infectionOralOralGastrointestinal location of wormsJejunal lumenJejunal mucosaSmall bowel mucosaCecum, colonic mucosaCecum, appendixAdult worm size15 40 cm7 12 mm2 mm30 50 mm8 13 mm female Pulmonary passage of larvaeYesYesYesNoNoIncubation period days 60 7540 10017 2870 9035 45Longevity1yN.americanus 2 5 yA. duodenale 6 8 yDecades owing to autoinfection 5y2 monthsFecundity eggs day worm 240,000N.americanus 4000 10,000A.duodenale 50005000 10,0003000 70002000Principal symptomsRarely gastro intestinal or biliary obstructionIron deficiency anemia in heavy infectionGastrointestinal symptoms malabsorption or sepsis in hyperinfectionGastrointestinal symptoms, anemiaPerianal pruritusDiagnostic stageEgg in stoolEgg in fresh stool, larva in old stoolLarvae in stool or duodenal aspirate sputum in hyperinfectionEgg in stoolEggs from perianal skin on cellulose acetate tapeTreatmentMebendazoleAlbendazolePyrantel pamoateMebendazolePyrantel pamoateAlbendazole1. Ivermectin2. Albendazole3. ThiabendazoleMebendazoleAlbendazoleMebendazolePyrantel pamoateAlbendazole |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Substance that is used for veebroplasty is | A i.e. Polymethyl methacrylate Veebroplast or kyphoplasty is percutaneous injection of bone cement PMMA polymethy methacrylate into veebral bodyQ. It can be used for osteolytic spinal metastes, multiple myleoma, aggressive hemangiomas, osteoporotic veebral compression fractures. Its use has been recommended for patients with sho life expectancy or in salvage cases. It is contraindicated in infection eg TB, osteomyelitis, discitis etcQ. Veebroplasty Kyphoplasty Veebroplasty is percutaneous placement of large spinal needles into the fractured compressed veebral body through a channel made in the pedicle and injecting bone cement into th fractured bone. It requires high pressure injection b o structure of the trabeculae and the high viscosity of the bone cement as it hardens. Veebroplasty was designed to decrease pain and strengthen the bone to prevent fuher collapse of a wedge compression fracture that result from failure of anterior column by forward flexion forces . It does not restore veebral body height or prevent spinal deformity. Balloon Kyphoplasty is the next step in treatment of veebral compression fractures. This percutaneous minimally invasive procedure involves reduction fixation performed through small instruments inseed into the veebral body through the pedicle. A small balloon is inflated to restore the height of collapsed veebral body and create a cavity inside. The balloon is deflated withdrawn, and the remaining cavity is filled under low pressur with the surgeon s choice of material. This procedure restores veebral height spinal alignment , which is impoant in preventing long term morbidity moality that ariss from veebral compression fractures spinal deformity d t cardio respiatory compromise . It stabilities veebrae internally, facilitates pain relief and restores function rapidly. Polymethyl methacrylate PMMA bone cement is controlled injected in paste like consistency with fluoroscopic monitoring. 5g of barium sulfate and 2g of tungeston powder is mixed with each kit of PMMA cement to make it radiopaque enough to be visualized adqquately. Potential complications include extrusion of cement into the spinal canal, resulting in neurological compromise, infection, hematoma, pulmonary embolus, failure to relieve pain, and incomplete deformity correction. Pulmonary embolism was correlated with paraveebral venous cement leak, but not with the number of veebral bodies treated or the type of procedure vetebroplasty or kyphoplasty . Indications Painful veebral metastasis, multiple myeloma with or without adjuvant or surgery Painful veebral hemangioma, osteonecosis Osteoporotic veebral compression fracturesQ 2 weeks old in cervical, thoracic and lumbar spine causing pain which is non responsive to medical management. Absolute Contraindications Infection eg tuberculosisQ, discitis, osteomyelitis, sepsis 2 weeks old in cervical, thoracic and lumbar spine causing pain which is non responsive to medical management. v shapes _x0000_s1026 Untreated coagulopathy Osteoporotic veebral fracture which is completely healed or is clearly responding to medical management Relative Contraindications 80 90 collapse of veebral body Significant compromise of spinal canal by retropulsed bone fragment or tumor 1 year old fracture |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Acute contact dermatitis is best treated with | Ref Rook s Dermatology. Essentials in Dermatology, 2nd editionExplanation Acute contact dermatitis is best treated by moist compresses. No creams or ointment would stay on the skin at this stage hence would be wasted if used . Once. the skin is relatively drier and the eczema has entered into subacute stage, topical corticosteroids in creams or lotion preparations with without topical antibiotics are prescribed. Moisturizers can start to be used in subacute stage. In chronic stage, owing to the lichen died skin, topical corticosteroids in ointment with external occlusion are preferred. Ref Rook s Dermatology Eczemas and contact dermatitis generally go through three stages Acute stage Characterized by erythema, edema, oozing accompanied by itching.Subacute stage The affected area in relatively dry compared to the acute stage. In this stage, scaling and crusting predominate.Chronic Stage Unresolved eczema persisting for a long time evolve into chronic stage characterized lichenification of the skin. Lichenification refers to thickening of skin, increased skin markings and pigmentation of the skin.Acute contact dermatitis is best treated by moist compresses. No creams or ointment would stay on the skin at this stage hence would be wasted if used .Once, the skin is relatively drier and the eczema has entered into subacute stage, topical corticosteroids in creams or lotion preparations are used.Moisturizers can be started in subacute stage.In chronic stage, owing to the lichenified skin, topical corticosteroids in ointment with external occlusion are preferred.For hyperkeratosis, salicylic acid is added to topical corticosteroids in general 6 salicylic acid is added to 3 topical corticosteroids .High potency topical corticosteroids are used for chronic eczemas.Topical calcineurin inhibitors Tacrolimus and pimecrolimus are indicated in childhood eczemas like atopic dermatitis.When therapy is prolonged, topical corticosteroids used for long time can produce a lot of side effects like atrophy, hypo or depigmentation, telangiectasia.Topical calcineurin inhibitors are safer in this regard, for areas with thin skin like the face.Oral corticosteroids, cyclosporine are used in special circumstances like extensive acute eczemas, erythroderma due to eczema, acute flare of atopic dermatitis.Stages of eczemaClinical featureTopical treatment of choiceAcuteErythema, edema, oozingMoist compressesSubacuteCrusting and scalingCreams and moisturizersChronicLichenificationOintments with without occlusion TRE ATMENT OF CONTACT DERMATITISGeneral PrinciplesAvoid further contact w ith the allergen known identified.Short course of oral corticosteroids for severe dermatitis.Topical corticosteroids Creams for subacute stage and ointment for chronic stage. Occlusion is warranted for lichenified lesions. Salicylic acid is usually added with topical corticosteroids for hyperkeratotic lesions.Liberal use of bland moisturizers Total restoration of integrity of the epidermis may require months of moisturizers use.In cumulative irritant dermatitis produced by prolonged contact with detegents. onlymoisturizers are needed along with measures for avoiding contact with the detergents. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| What is a good chicken salad sandwich recipe for people with diabetes? | Low fat milk or soy milk for your cereal or as a beverage Part skim milk cheese added to your omelet Low fat or nonfat yogurt with fruit or cereal, or in a smoothie Healthy Eating With Diabetes Your Menu Plan Sample Daily Menu Options continued... Smart fats Avocado added to your omelet Nuts for cereals or a yogurt parfait Extra virgin olive oil used in omelet Canola oil used in whole grain muffins, pancakes, or waffles Lunch A sandwich or wrap with whole grain bread or tortilla and a lean protein such as Roasted turkey, skinless chicken, or lean beef or pork Part skim milk cheese or soy cheese Water packed tuna dressed in vinaigrette, yogurt, or light mayo A bean based lunch such as Bean burrito with whole grain tortilla Hummus with whole grain bread or vegetable dippers Vegetarian or lean meat chili or bean stew Main course salad made with Dark green lettuce Lots of vegetables Lean meat, fish, beans, or cheese plus avocado and nuts, if desired Dressing made with extra virgin olive oil, canola oil, or yogurt Dinner High fiber carb choices Cooked grains like brown rice, quinoa, barley, bulgur, or amaranth Whole wheat bread, tortilla, pita bread, or buns Colorful vegetables on the side or in the main course Dark green lettuce for a side or dinner salad Fresh fruit on the side or with the entrà e Lean protein low in saturated fat Grilled or baked fish, by itself or in a mixed dish such as tacos Skinless poultry grilled, baked, or stir fried Lean beef or pork sirloin, tenderloin with no visible fat Part skim milk cheese in entrees, such as eggplant parmesan, vegetarian pizza on whole wheat crust, vegetable lasagna, or enchiladas Smart fats A sensible amount of extra virgin olive oil or canola oil used for cooking Nuts added to entrà e or side dishes Avocado or olives with entrà e or side dishes Sample Recipes Homemade Napa Almond Chicken Salad Sandwich To add a couple of servings of higher fiber and nutrient rich whole grains, serve this chicken salad on 2 slices of 100 whole grain bread or in a whole wheat pita pocket. Or make a wrap sandwich with a whole wheat flour tortilla. Makes 4 or more servings. 3 cups shredded roasted or rotisserie chicken, skin removed 1 cup red grapes, cut in half 2 3 cup finely chopped celery 1 3 cup sliced almonds, honey roasted or plain roasted Healthy Eating With Diabetes Your Menu Plan Sample Recipes continued... Dressing 1 2 cup low fat or light mayonnaise or nonfat plain Greek yogurt 2 tablespoons honey 2 tablespoons Dijon mustard 1 4 teaspoon black pepper Garnish optional 8 leaves romaine lettuce 8 slices of tomato In a medium bowl, combine shredded chicken, grapes, celery, and almonds. In a small bowl, combine dressing ingredients with whisk or spoon until smooth and blended. Drizzle dressing over the chicken and grape mixture and stir to blend. Spoon chicken mixture onto bread to make 4 or more sandwiches. Garnish with lettuce and tomato, if desired. Per serving, including bread if 4 per recipe 500 calories, 42 g protein, 51 g carbohydrate, 14 g fat, 2.6 g saturated fat, 6 g monounsaturated fat, 5 g polyunsaturated fat, 96 mg cholesterol, 7 g fiber, 764 mg sodium. Calories from fat 25 . Omega 3 fatty acids 0.4 gram, omega 6 fatty acids 4.5 grams. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Antimicrobial agent effective against ESBL producing microorgansims is | A Beta lactam plus beta lactamase inhibitorAntimicrobial Agents that must not be reported as susceptibleOrganismESBL producing K. pneumoniae, K oxytoca, E. coli P mirabilis1st 2nd generation cephalosporins, cephamycins aminoglycosidesSalmonell spp., Shegella spp.Penicillins, beta lactam beta lactamase inhibitor combinations, cephems carbapenemsOxacillin resistant Staphylococcus spp.Aminoglycosides except high concentrations , cephalosporins, Clindamycin trimethoprim sulfamethoxazoleEnterococcus spp. Important resistance mechanisms to beta lactam antibiotics Beta lactamase Resistance Many bacteria produce enzymes that are capable of destroying the beta lactam ring of penicillin, these enzymes are referred to as penicillinases or beta lactamases and they make the bacteria that possess them resistant to many penicillins.Clavulanic acid is inhibits beta lactamase enzymes, thereby increasing the longevity of beta lactam antibiotics in the presence of penicillinase producing bacteria.Clavamox is a combination of amoxicillin and clavulanate.Combination of the beta lactamase inhibitor tazobactam and piperacillin.Summary of beta lactam beta lactamase inhibitor on treatment of ESBL producing organisms Limited clinical information Class A ESBLs are susceptible to clavulanate tazobactam in vitro, nevertheless many producers are resistant to beta lactamase inhibitor due to Hyperproduction of the ESBLs overwhelm inhibitor. Co production of inhibitor resistant penicillinases E.g., OXA 1 or AmpC enzyme. Relative impermeability of the host strain.Beta lactam beta lactamase inhibitor should not be used not be used to treat serious infections with ESBL producing organisms.Beta lactamase inhibitors Almost all have weak antibacterial activitiy.Important in combination with penicillins sensitive to beta lactamase degradation.Clavulanic acid is the first one of this class.Natural product from streptomyces.Has a powerful irreversible inhibition of beta lactamase enzymes because it will covalently bind to two positions in the active site.Normally used in combination with amoxicillin other beta lactamase sensitive penicillins.Extended Spectrum Beta Lactamase ESBL Enzymes that are produced by Gram negative bacteria.Confer resistance to Cephalosporins, Penicillins Monobactam Aztreonam by opening the beta lactam ring inactivating the antibiotic.Cannot attack Cephamycins cefoxitin, cefotetan or the carbapenems imipenem, meropenem, ertapenem, doripe nem .Generally susceptible to beta lactamase inhibitors Tazobactam Plasmid mediated TEM, SHV, CTX M beta lactamases are the most common.Therapy for ESBL producing gram negative rods Carbapenems Imipenem, Macropenem, Doripenem, ErtapenemPiperacillin Tazobactam Tazobactam blocks beta lactamase action.Beta lactam beta lactamase inhibitor on treatment of ESBL producing organisms Most ESBLs are susceptible to clavulanate tazobactam in vitro.Nevertheless some ESBL producers are resistant to beta lactamase inhibitor due to Hyperproduction of the ESBLs overwhelm inhibitor.Co production of inhibitor resistent penicillinases or AmpC enzyme.Relative impermeability of the host strain.Beta lactam beta lactamase inhibitor should not be used to treat serious infections with ESBL producing organisms |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| The Fc piece of which Immunoglobulin fixes C1? | Ans. C. IgM. Ref. H 17th Table 308 11 pg. 708 IgM IgG Immunoglobulin isotypes Mature B lymphocytes express IgM and IgD on their surfaces. They may differentiate in germinal centers of lymph nodes by isotype switching gene rearrangement mediated by cytokines and CD40 ligand into plasma cells that secrete IgA, IgE, or IgG. IgG Main antibody in 2deg delayed response to an antigen. Most abundant isotype in serum. Fixes complement, crosses the placenta provides infants with passive immunity , opsonizes bacteria, neutralizes bacterial toxins and viruses. IgA Prevents attachment of bacteria and viruses to mucous membranes does not fix complement. Monomer in circulation or dimer when secreted . Crosses epithelial cells by transcytosis. Most produced antibody overall, but released into secretions tears, saliva, mucus and early breast milk known as colostrum . Picks up secretory component from epithelial cells before secretion. IgM Produced in the 1deg immediate response to an antigen. Fixes complement but does not cross the placenta. Antigen receptor on the surface of B cells. Monomer on B cell or pen tamer when secreted. Shape of pentamer allows it to efficiently trap free antigens out of tissue while humoral response evolves. IgD Unclear function. Found on the surface of many B cells and in serum. IgE Binds mast cells and basophils cross links when exposed to allergen, mediating immediate type I hypersensitivity through release of inflammatory mediators such as histamine. Mediates immunity to worms by activating eosinophils. Lowest concentration in serum. Antibody structure and function Variable part of L and H chains recognizes antigens. Fc portion of IgM and IgG fixes complement. Heavy chain contributes to Fc and Fab fractions. Light chain contributes only to Fab fraction. Fab wAntigen binding fragment f Determines idiotype unique antigen binding pocket only 1 antigenic specificity expressed per B cell Fc f Constant f Carboxy terminal f Complement binding f Carbohydrate side chains f Determines isotype IgM, IgD, etc. Antibody diversity is generated by f Random recombination of VJ light chain or V D J heavy chain genes Random combination of heavy chains with light chains Somatic hypermutation following antigen stimulation Addition of nucleotides to DNA during recombination by terminal deoxynucleotidyl transferase. PHYSICAL, CHEMICAL, AND BIOLOGIC PROPERTIES OF HUMAN IMMUNOGLOBULINS Property IgG IgA IgM IgD IgE Usual molecular form Monomer Monomer, dimer Pentamer, hexamer Monomer Monomer Other chains None J chain, SC J chain None None Subclasses Gl, G2, G3, G4 Al, A2 None None None Heavy chain allotypes Gm 30 No Al, A2m 2 None None None Molecular mass, kDa 150 160, 400 950, 1150 175 190 Sedimentation constant, Sw20 6.6S 7S, US 19S 7S 8S Carbohydrate content, 3 7 10 9 13 Serum level in adult, mg mL 9.512.5 1.5 2.6 0.7 1.7 0.04 0.0003 Percentage of total serum Ig 75 85 7 15 5 10 0.3 0.019 Serum half life, days 23 6 5 3 2.5 Synthesis rate, mg kg per day 33 65 7 0.4 0.016 Antibody valence 2 2,4 10, 12 2 2 Classical complement activation G1, 2?, 3 Alternate complement activation G4 Binding cells via Fc Macrophages, neutrophils, large granular lymphocytes Lymphocytes Lymphocytes None Mast cells, basophils, B cells Biologic properties Placental transfer, secondary Ab for most antipathogen responses Secretory immunoglobulin Primary Ab responses. Phylogenitically oldest Ig is IgM and it is the one to appear earliest in fetus at 20 wks of gestation. Marker for mature B cells Allergy, antiparasite responses. Homocytotropism is vital property. |
You are a highly skilled and analytical medical assistant trained to solve complex medical problems, answer questions, and provide detailed, step-by-step reasoning. Your primary objective is to approach each medical question methodically, ensuring accuracy, clarity, and logical consistency in your responses.
When given a question or scenario with multiple options, follow this structured process:
1. **Understand and Summarize the Question**: Begin by identifying the main topic or focus of the question. Briefly summarize what the question is about to ensure clarity and context.
2. **Analyze Each Option Individually**: Evaluate every option carefully. Discuss the merits and limitations of each choice based on the context, medical guidelines, and relevant principles.
3. **Use Step-by-Step Reasoning**: Apply clinical reasoning, medical knowledge, and logic to systematically eliminate incorrect options while narrowing down to the most appropriate answer.
4. **Conclude with the Correct Answer**: Clearly state the final option you have selected as the correct answer. Provide a concise summary explaining why this choice is the most suitable based on the question.
Throughout this process, maintain a professional tone and ensure your response is supported by evidence-based knowledge. If additional background information is relevant to the question, provide it succinctly to enhance understanding. Avoid making assumptions not supported by the context, and focus on delivering precise and thoughtful conclusions.
Your goal is to assist users in understanding complex medical scenarios and help them arrive at the correct answers through logical, step-by-step guidance while upholding high standards of professionalism and accuracy.
| Job functions of Health Assitant males are ? | Ans. is b i.e. Collect Smear from any fever case ORS distribution is function of Health Worker Mule Female Park Collection of sputum smear from having person prolonged cought is function ofHealth Worker mule Health Assistants Male and Female J Under the multipurpose v orker s scheme the health assistant male and female are expected to cover a population of 30,000 20,000 in tribal and hilly areas . Health Assistants male and female will supervise 6 health workers each, of the corresponding category. The job functions of these health assistants male and female regarding a administration h maintaing human relations skill c methods of supervision are similar. But in the technical aspects, their super isory functions are different. Common Job Functions for The Health Assistant Male and Female o The HA will Supervise and guide the health workers in the delivery of health care services to the community Strengthen the knowledge and skills of the health workers in their different areas Help the health worker in improving their human relations skill Help and guide the health workers in planning and organizing their programmes Promote team work among the health workers Coordinates the activities with other workers and agencies Visit each worker periodcially observe and guide the health workers in the day to day activities Arrange group meetings with leaders and involve them in spreading the maintenance of various health programmes Scrutinize the maintenance of records of the health workers to guide them in their proper maintenance 10. Conduct regular staff meetings for the health workers 11 Attend staff meetings at PHC Block. Assess the progress of work of the health workers periodically and submit their assessment repos to M.O. PHC Assist the medical officers of the PHC in the organisation of the di flerent health services in the area Paicipate in mass camps and campaigns in health programmes. Indent, procure and supply material to health workers Prepare, maintain and utilize prescribed records and repos Review, consolidate and submit periodical repos to M.O., PHC Attend to cases refered by the workers and refer cases beyond her his competency to the PHC hospital Collect and compile the weekly repos of bihs and deaths occuring in their areas and submit them to the MO PHC and educate the community regarding the need for registration of vital events. Specific Job Function for the Health Assistant Male I. Malaria Supervise the work of Health Worker Male during concurrent visits. Check minimum of 10 of the houses in a village. Collect thick and thin smears from any fever case he come across and will administer, presumptive treatment of prescribed dosage of antimalarial drugs. Administer radical treatment to positive cases in his area. Supervise the spraying of insecticides during local spraying along with the Health Worker Male . II. Communicable diseases Be ale to the sudden outbreak of epidemics of diseases such as diarrhoea dysentery, fever with rash. jaundice, enecephalitis, diphtheria, whooping cough or tetanus, acute eye infections and take all possible remedial measures. Take the necessary control measures when any notifiable disease is repoed to him. Carry out the destruction of stray dogs with the help of the Health Worker Male. IL Leprosy Ensure that all cases of Leprosy take regular and completed treatment and inform the Medical Officer PHC about any defaulters to treatment. IV. Tuberculosis Ensure that all cases of tuberculosis are taking regular and complete treatment and inform the Medical Officer PHC about any defaulter to treatment. V. Environment sanitation Help the community in the construction of a Safe water source b Soakage pits c Kitchen garden d manure pits e composit pits f sanitary latrines g smokeless chulhas and superivsc their construction. Supervise the chlorination of water source including wells. VL Expanded programmen on Immunization I. Conduct immunization of all school going children with the help of the health worker male. Supervise the immunization of all children from one to five years. VII. Family planning Personally motivate resistant cases for family planning. Guide the Health Worker Male in establishing male depot holders with the assistance of the Health Worker Male and supervise the functioning. Assist medical officer PI IC in organization of Family Planning camps and drives_ Provide information on the availability of services for medical termination of pregnancy and refer suitable cases to the approved institutions. Ensure follow of all cases of vasectomy, tuhectomy, IUD and other Family Planning acceptors. VIII. Nutrition I. Ensure that all cases of malnutrition among infants and young children 0 5 years arc given the necessary treatment and advice and refer serious cases to the PHC. 2 Ensure that Iron and Folic Acid and Vitamin A are distributed to the benficiaries as prescribed. IX. Control of blindness All cases of blindness including suspected cases of cataract be referred to Medical Officer of Primary health Centre. Specific Job Function for the Health Assistant Female The health Assistant female will Carry out supervisory house visiting Guide the health worker female in establishing women depot holders for distribution of conventional contraceptives Conduct MCH and family planning clinics and carry out educatinal activities. Organize and conduct training for dais and women leaders with the help of health workers Visit each of the 4 sub centres at least once a week on fixed day Respond to urgent calls from the health workers and trained dais and render necessary help Organize and utilize the Mahila Mandals, teachers etc., in the family welfare programmes Personally motivate resistant cases for family planning Provide information on the availability of serives for medical termination of pregnancy and refer suitable cases to the approved institutions and Supervise the immunization of all pregnant women and children zero to five years . |
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