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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 .

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 Pancreatic Cancer ?

Key Points There are different types of treatment for patients with pancreatic cancer. Five types of standard treatment are used Surgery Radiation therapy Chemotherapy Chemoradiation therapy Targeted therapy There are treatments for pain caused by pancreatic cancer. Patients with pancreatic cancer have special nutritional needs. New types of treatment are being tested in clinical trials. Biologic therapy Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Follow up tests may be needed There are different types of treatment for patients with pancreatic cancer. Different types of treatment are available for patients with pancreatic cancer. Some treatments are standard the currently used treatment , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Five types of standard treatment are used Surgery One of the following types of surgery may be used to take out the tumor Whipple procedure A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin. Total pancreatectomy This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes. Distal pancreatectomy The body and the tail of the pancreas and usually the spleen are removed. If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life Surgical biliary bypass If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area. Endoscopic stent placement If the tumor is blocking the bile duct, surgery may be done to put in a stent a thin tube to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine. Gastric bypass If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally. Radiation therapy Radiation therapy is a cancer treatment that uses high energy x rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat pancreatic cancer. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body systemic chemotherapy . When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas regional chemotherapy . Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Pancreatic Cancer for more information. Chemoradiation therapy Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors TKIs are targeted therapy drugs that block signals needed for tumors to grow. Erlotinib is a type of TKI used to treat pancreatic cancer. See Drugs Approved for Pancreatic Cancer for more information. There are treatments for pain caused by pancreatic cancer. Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor. See the PDQ summary on Cancer Pain for more information. Patients with pancreatic cancer have special nutritional needs. Surgery to remove the pancreas may affect its ability to make pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes. See the PDQ summary on Nutrition in Cancer Care for more information. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Biologic therapy Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring coming back or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI s listing of clinical trials. Follow up tests may be needed Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred come back . These tests are sometimes called follow up tests or check ups. Treatment Options by Stage Stages I and II Pancreatic Cancer Treatment of stage I and stage II pancreatic cancer may include the following Surgery. Surgery followed by chemotherapy. Surgery followed by chemoradiation. A clinical trial of combination chemotherapy. A clinical trial of chemotherapy and targeted therapy, with or without chemoradiation. A clinical trial of chemotherapy and or radiation therapy before surgery. Check the list of NCI supported cancer clinical trials that are now accepting patients with stage I pancreatic cancer and stage II pancreatic cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage III Pancreatic Cancer Treatment of stage III pancreatic cancer may include the following Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine. Chemotherapy followed by chemoradiation. Chemoradiation followed by chemotherapy. Chemotherapy with or without targeted therapy. A clinical trial of new anticancer therapies together with chemotherapy or chemoradiation. A clinical trial of radiation therapy given during surgery or internal radiation therapy. Check the list of NCI supported cancer clinical trials that are now accepting patients with stage III pancreatic cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage IV Pancreatic Cancer Treatment of stage IV pancreatic cancer may include the following Palliative treatments to relieve pain, such as nerve blocks, and other supportive care. Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine. Chemotherapy with or without targeted therapy. Clinical trials of new anticancer agents with or without chemotherapy. Check the list of NCI supported cancer clinical trials that are now accepting patients with stage IV pancreatic cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.

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.

Ram Devi presented with generalized edema sweating and flushing tachycardia and fever after bee sting .this is

Ref Robbins 9 e p202 Immediate Type I Hypersensitivity Immediate hypersensitivity is a tissue reaction that occurs rapidly typically within minutes after the interaction of antigen with IgE antibody that is bound to the surface of mast cells in a sensitized host. The reaction is initiated by entry of an antigen, which is called an allergen because it triggers allergy. Many allergens are environmental substances that are harmless for most persons on exposure. Some people apparently inherit genes that make them susceptible to allergies. This susceptibility is manifested by the propen sity of such persons to mount strong TH2 responses and, subsequently, to produce IgE antibody against the aller gens. The IgE is central to the activation of the mast cells and release of mediators that are responsible for the clinical and pathologic manifestations of the reaction. Immediate hypersensitivity may occur as a local reaction that is merely annoying e.g., seasonal rhinitis, or hay fever , severely debilitating asthma , or even fatal anaphylaxis . Sequence of Events in Immediate Hypersensitivity Reactions Most hypersensitivity reactions follow the same sequence of cellular responses Fig. 4 7 Activation of TH2 cells and production of IgE antibody. Aller gens may be introduced by inhalation, ingestion, or injection. Variables that probably contribute to the strong TH2 responses to allergens include the route of entry, dose, and chronicity of antigen exposure, and the genetic makeup of the host. It is not clear if allergenic substances also have unique structural propeies that endow them with the ability to elicit TH2 responses. Immediate hypersensitivity is the prototypical TH2 mediated reaction. The TH2 cells that are induced secrete several cytokines, including IL 4, IL 5, and IL 13, which are responsible for essentially all the reactions of immediate hypersensitivity. IL 4 stimulates B cells specific for the allergen to undergo heavy chain class switching to IgE and to secrete this immunoglobulin isotype. IL 5 acti vates eosinophils that are recruited to the reaction, and IL 13 acts on epithelial cells and stimulates mucus secre tion. TH2 cells often are recruited to the site of allergic reactions in response to chemokines that are produced locally among these chemokines is eotaxin, which also recruits eosinophils to the same site. Sensitization of mast cells by IgE antibody. Mast cells are derived from precursors in the bone marrow, are widely distributed in tissues, and often reside near blood vessels and nerves and in subepithelial locations. Mast cells described in Chapter 2. Eosinophils are recruited by eotaxin express a high affinity receptor for the Fc poion of the e heavy chain of IgE, called FceRI. Even though the serum concentration of IgE is very low in the range of 1 to 100 ug mL , the affinity of the mast cell FceRI recep tor is so high that the receptors are always occupied by IgE. These antibody bearing mast cells are sensitized to react if the antigen binds to the antibody molecules. Basophils are the circulating counterpas of mast cells. They also express FceRI, but their role in most immedi ate hypersensitivity reactions is not established since these reactions occur in tissues and not in the circula tion . The third cell type that expresses FceRI is eosino phils, which often are present in these reactions and also have a role in IgE mediated host defense against hel minth infections, described later. Activation of mast cells and release of mediators. When a person who was sensitized by exposure to an allergen is reexposed to the allergen, it binds to multiple specific IgE molecules on mast cells, usually at or near the site of allergen entry. When these IgE molecules are cross linked, a series of biochemical signals is triggered in the mast cells. The signals culminate in the secretion of various mediators from the mast cells. Three groups of mediators are the most impoant in different immediate hypersensitivity reactions Fig. 4 8 Vasoactive amines released from granule stores. The gran ules of mast cells contain histamine, which is released within seconds or minutes of activation. Histamine causes vasodilation, increased vascular permeability, smooth muscle contraction, and increased secretion of mucus. Other rapidly released mediators include adenosine which causes bronchoconstriction and inhibits platelet aggregation and chemotactic factors for neutrophils and eosinophils. Other mast cell granule contents that may be secreted include several neutral proteases e.g., tryptase , which may damage tissues and also generate kinins and cleave comple ment components to produce additional chemotactic and inflammatory factors e.g., C3a Chapter 2 . The granules also contain acidic proteoglycans heparin, chondroitin sulfate , the main function of which seems to be as a storage matrix for the amines. Newly synthesized lipid mediators. Mast cells synthesize and secrete prostaglandins and leukotrienes, by the same pathways as do other leukocytes Chapter 2 . These lipid mediators have several actions that are impoant in immediate hypersensitivity reactions. Prostaglandin D2 PGD2 is the most abundant media tor generated by the cyclooxygenase pathway in mast cells. It causes intense bronchospasm as well as increased mucus secretion. The leukotrienes LTC4 and LTD4 are the most potent vasoactive and spasmo genic agents known on a molar basis, they are several thousand times more active than histamine in increas ing vascular permeability and in causing bronchial smooth muscle contraction. LTB4 is highly chemotac tic for neutrophils, eosinophils, and monocytes. Cytokines. Activation of mast cells results in the syn thesis and secretion of several cytokines that are impoant for the late phase reaction. These include TNF and chemokines, which recruit and activate leu kocytes Chapter 2 IL 4 and IL 5, which amplify th TH2 initiated immune reaction and IL 13, which stimulates epithelial cell mucus secretion. In summary, a variety of compounds that act on blood vessels, smooth muscle, and leukocytes mediate type I hypersensitivity reactions Table 4 2 . Some of these com pounds are released rapidly from sensitized mast cells and are responsible for the intense immediate reactions associ ated with conditions such as systemic anaphylaxis. Others, such as cytokines, are responsible for the inflammation seen in late phase reactions. Often, the IgE triggered reaction has two well defined phases Fig. 4 9 1 the immediate response, characterized by vasodilation, vascular leakage, and smooth muscle spasm, usually evident within 5 to 30 minutes after expo sure to an allergen and subsiding by 60 minutes and 2 a second, late phase reaction that usually sets in 2 to 8 hours later and may last for several days and is characterized by inflammation as well as tissue destruction, such as mucosal epithelial cell damage. The dominant inflammatory cells in the late phase reaction are neutrophils, eosinophils, and lymphocytes, especially TH2 cells. Neutrophils are recruited by various chemokines their roles in inflammation were described in Chapter 2. Eosinophils are recruited by eotaxinTH2 initiated immune reaction and IL 13, which stimulates epithelial cell mucus secretion. In summary, a variety of compounds that act on blood vessels, smooth muscle, and leukocytes mediate type I hypersensitivity reactions Table 4 2 . Some of these com pounds are released rapidly from sensitized mast cells and are responsible for the intense immediate reactions associ ated with conditions such as systemic anaphylaxis. Others, such as cytokines, are responsible for the inflammation seen in late phase reactions. Often, the IgE triggered reaction has two well defined phases Fig. 4 9 1 the immediate response, characterized by vasodilation, vascular leakage, and smooth muscle spasm, usually evident within 5 to 30 minutes after expo sure to an allergen and subsiding by 60 minutes and 2 a second, late phase reaction that usually sets in 2 to 8 hours later and may last for several days and is characterized by inflammation as well as tissue destruction, such as mucosal epithelial cell damage. The dominant inflammatory cells in the late phase reaction are neutrophils, eosinophils, and lymphocytes, especially TH2 cells. Neutrophils are recruited by various chemokines their roles in inflammation were described in Chapter 2. Eosinophils are recruited by eotaxin

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 5 yr old boy presents with pubic hair development. He is tall and has increased pigmentation of his genitalia and phallic enlargement. Blood pressure is 130 90 mm Hg. Measurement of which of the following hormones would be most likely to be diagnostic?

Ans. is d i.e., 11 Deoxycortisol Presence of Precocious puberty in a male child and hypertension BP of 130 80 in a 5 year old child is considered hypertension suggests a diagnosis of congenital adrenal hyperplasia due to 11 b Hydroxylase deficiency.11 b Hydroxylase deficiency.Deficiency of 11 b hydroxylase CYP11B1 results in decreased conversion of 11 deoxycortisol and 11 deoxycorticosterone to cortisol and corticosterone, respectively.The decrease in cortisol production causes an increase in corticotropin ACTH secretion. The resulting adrenal stimulation leads to excessive production of 11 deoxycortisol, 11 deoxycorticosterone, and adrenal androgens.The clinical manifestations of the disorder result from excess adrenal androgens and the mineralocorticoid actions of 11 deoxycorticosterone 11 deoxycortisol has little biological activity.Clinical manifestationsNeonates Male Ambiguous genitalia Female Penile enlargementChildhood sexual precocity Both male and female child present with sexual precocity, early pubertyClinical features that would be present irrespective of age group and sexHypertensionHypokalemiaIncreased pigmentation increased ACTHHypertension and hypokalemia is seen in most of the patients due to increase in 11 deoxycorticosterone level.Hypertension and hypokalemia differentiates it from 17a hydroxylase deficiency.Lab diagnosis Patients with CYP11B1 deficiency have a characteristic set of hormonal findings.High serum concentrations of 11 deoxycortisol, 11 deoxycorticosterone, and the androgens dehydroepiandrosterone DHEA , dehydroepiandrosterone sulfate DHEA sulfate , androstenedione, and testosterone.Increased urinary excretion of the tetrahydro metabolites of 11 deoxycortisol and 11 deoxycorticosterone, which are normally present in trace quantities.Urinary 17 hydroxycorticosteroid excretion is high, because 11 deoxycortisol reacts in the assay for these steroids. Urinary excretion of 17 ketosteroids, most of which are androgen metabolites, is also increased.Congenital adrenal hyperplasiaCongenital adrenal hyperplasia is a group of autosomal recessive disorder characterized by deficiency of an enzyme involved in the synthesis of cortisol or aldosterone or both.Clinical manifestations The clinical manifestations are related to the degree of cortisol deficiency and or the degree of aldosterone deficiency. In some cases these reflect the accumulation of precursor hormones.Clinical presentation in Males21 hydroxylase deficiency Testosterone production increased Generally not identified in the neonatal period because the genitalia are normal Toddlers present with signs of puberty.These male neonates present at age 1 4 weeks with failure to thriveRecurrent vomitingShock17 hydroxylase deficiency, 3 b hydroxysteroid dehydrogenase deficiencyAmbiguous genitalia because of inadequate testosterone production in first 3 months of life .Clinical presentation in Females21 hydroxylase, 11 b hydroxylase, 3 b hydroxysteroidThey have ambiguous genitalia at birth due to excess androgen production in utero.17 hydroxylase deficiencyFemales appear phenotypically female at birth but later on in life do not develop breast or menstruate absence of estrogen.Diagnosis of congenital adrenal hyperplasiaThe common feature of all the congenital adrenal hyperplasia is Inadequate production of cortisol, aldosterone or both in the presence of accumulation of excess concentrations of precursor hormones.Cortisol and aldosterone deficiency is common to all congenital adrenal hyperplasia the distinguishing feature is the accumulation of excess concentration of precursor hormones.Elevated precursor in 21 hydroxylase deficiencyHigh serum concentration of 17 hydroxyprogesteroneIncreased concentration of urinary pregnanetriol metabolite of 17 hydroxy progesterone s Elevated precursor hormones in 11 b hydroxylase deficiencyExcess concentration of 11 deoxy cortisol and deoxy corticosterone.Elevation in the ratio of 24 hour urinary tetra hydro compound S to tetrahydro compound F.Both are accompanied by elevated levels of 24 hour urinary 17 ketosteroids, the urinary metabolites of adrenal androgens.Elevated precursor hormones in 3 b hydroxysteroid dehydro genase deficiency Abnormal ratio of 17 hydroxypregnenolone to 17 hydroxyprogesterone and Dehydroepiandrostenedione to AndrostenedioneMore on congenital adrenal hyperplasia 21 a hydroxylase deficiencyTwo forms of this deficiency include Salt wasting adrenogenital ismSimple Virilizing adrenogenital ismA Salt wasting syndrome complete lack The salt wasting syndrome results from complete lack of 21 hydroxylase. There is no synthesis of mineralocorticoids and glucocorticoids in the adrenal cortex.Decreased mineralocorticoids causes marked sodium loss in the urine, resulting in hyponatremia, hyperkalemia, acidosis and hypotension.Because of the enzyme block, there is increased formation of 17 hydroxyprogesterone, which is then shunted into the production of testosterone.This may cause virilization pseudo hermaphroditism in female infants. That is XX Female with 21 hydroxylase deficiency develops ovaries, female ductal structures and external male genitalia.But in the male child the effect of increased testosterone will not be manifested at the time of birth. Toddlers will present with signs of puberty.The complete 21 hydroxylase deficiency or salt wasting syndrome usually comes to light only after the birth because in utero the electrolytes and fluids can be maintained by maternal kidneys.Males with this disorder comes to clinical attention 5 to 15 days later because of salt losing crisis while females comes to attention soon after the birth because of the virilization.B Simple Virilizing adrenogenital syndrome Partial deficiency Occurs in individuals with partial deficiency of 21 hydroxylaseLess severe deficiency of mineralocorticoid, is sufficient for salt reabsorption, but the lowered glucocorticoid fails to cause feedback inhibition of ACTH secretion. Thus level of aldosterone is mildly reduced testosterone increased and ACTH elevated with resultant adrenal hyperplasia.11b hydroxylase deficiency RareLeads to decreased cortisol and increased ACTH.This in turn leads to the accumulation of DOC deoxycorticosterone and 11 deoxy cortisol both of which are strong mineralocorticoids. This results in increased sodium retention by the kidneys and hypertension, hypokalemia.Patients also develop virilization due to androgen excess.17 a hydroxylase deficiency Patients with deficiency of 17 hydroxylase also have impaired cortisol production, increased ACTH and secondary increased DOC.These patients, however, cannot synthesize normal amount of androgens and estrogens.This is because the gene that codes for 17 a hydroxylase is the same for the enzyme in the adrenal cortex and the gonads and the deficiency is same in both organs.Because of decreased sex hormones genotypic females develop primary amenorrhoea and fail to develop secondary sex characterize tics while genotypic males will present as pseudohermaphrodite.

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 drug which is used for long term maintenance in opioid addiction

Ans. is d i.e., Methadone Maintenance therapy for opioid addiction Once detoxification phase is over i.e., withdrawal symptoms have been managed , the patient is maintained on any of the following drugs to prevent relapse by reducing craving and preventing kick or euphoria produced by opioids morphine or heroin . Drugs used are 1. Methadone Reduces craving and kick euphoria from morphine or heroin because their opioid receptors are already occupied.2. LAAM and buprenorphine Similarly reduce craving.3. Opioid antagonists naltrexone Naltrexone can be used orally to assist in the rehabilitation of ex opioid abusers who are fully withdrawn otherwise it induces an acute withdrawal syndrome . Naltrexone prevents relapse by discouraging substance seeking behavior If a patient, who is on naltrexone maintenance therapy, takes an opioid, there is no kick or euphoria as opioid receptors are already blocked. Naltrexone can be used with clonidine as in detoxification.Treatment of opioid addiction Treatment can be divided into A. Treatment of toxicity overdose Overdose is a medical emergency and is treated with opioid antagonist to reverse the complications respiratory depression by antagonizing the action on opioid receptors. Intravenous naloxone is the antagonist of choice for morphine heroin poisoning. Oral naltrexone is used for maintenance therapy, once acute poisoning has been treated by iv naloxone. Intravenous nalmefene is another specific antagonist.B. Treatment of dependence Treatment of dependence include medically supervised withdrawal and detoxification, followed by maintenance therapy.a. Detoxification Detoxification process include abrupt withdrawal of opioid followed by management of the emergent withdrawal symptoms, i.e., treatment of withdrawal syndrome. Detoxification can be done by any of the following.i Substitution of long acting opioid agonism Methadone is the treatment of choice. Because of its agonistic activity on opioid receptors it suppresses withdrawal symptoms. L alpha acetyl methadol Levomethyl LAAM is the other opioid agonist which was used for this purpose. However it is no longer in use because some patients developed prolonged QT intervals torsades de points .ii Substitution of partial agonist Buprenorphine can be used in place of methadone because of its partial agonistic activity on opioid receptor.iii Substitution by a2 agonists Clonidine as a sympatholytic agent due to its agonistic action on central presynaptic a2 receptors which reduce nor adrenergic activity. Therefore, clonidine reduces the adrenergic withdrawal symptoms. Lofexidine, another a2 agonist, is an alternative to clonidine.iv Clonidine plus naltrexone A more rapid detoxification can occur when clonidine is used along with naltrexone. Naltrexone, when given in opioid dependent patient, causes withdrawal symptoms because of its antagonistic action. These can be treated with clonidine. The addition of short acting Benzodiazepine lorazepam or oxazepam and NSAIDs, will help to relieve withdrawal symptoms not covered by clonidine. It should be kept in mind that naltrexone should not be used alone for detoxification to treat withdrawal syptoms as it precipitates or worsens the withdrawal syndrome.v Other drugs Dextropropoxyphene, diphenoxylateb. Maintenance therapy explained above

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.

Following fetal tocographic finding was seen in a 30 year old female patient in labor. What does it suggest?

Ans. b. Fetal distress Ref Williams Obstetrics 24 e p340 Late decelerations, typical of fetal distress can be seen in the given fetal tocography. Methods of Monitoring Fetal Heart Rate Fetal stethoscope Pinard Hand held Doppler Sonicaid Cardiotocograph CTG Cardiotocography CTG CTG Technical means of recording graphy fetal heartbeat cardio uterine contractions toco during pregnancy, typically in third trimester. The machine used to perform the monitoring is called a Cardiotocograph, more commonly known as an Electronic Fetal Monitor EFM . Two separate transducers perform recordings, one for the measurement of fetal heart rate second one for uterine contractions. Types of measurement Each of the transducers may be either external or internal. External measurement means taping or strapping the two sensors to the abdominal wall. This is called an indirect measure. Internal measurement direct requires a certain degree of cervical dilatation, as it involves insetting a pressure catheter into the uterine cavity, as well as attaching a scalp electrode to the childs head to adequately measure the electric activity of the fetal heart. Interpretation Includes description of uterine activity contractions , baseline fetal heart rate, baseline FHR variability, presence of accelerations, periodic or episodic decelerations The 3 primary mechanisms by which uterine contractions can cause a decrease in fetal heart rate are compression of fetal head, umbilical cord uterine myometrial vesselsQ. Variability Baseline variability refers to the variation of fetal heart rate from one beat to the next. Variability occurs as a result of the interaction between nervous system, chemoreceptors. baroreptors cardiac responsiveness. This is because a healthy foetus will constantly be adapting it s heart rate to respond to changes in it s environment. Normal variability is between 10 25 bpm To calculate variability you look at how much the peaks troughs of the heart rate deviate from baseline rate in bpm Variability can be categorised as Reassuring 5 bpmQ Non reassuring 90 minutesQ Accelerations Abrupt increase in baseline heart rate of 15 bpm for 15 secondsQ The presence of accelerations is reassuring Antenatally there should be at least 2 accelerations every 15 minutesQ Accelerations occurring alongside uterine contractions is a sign of a healthy foetusQ Decelerations Decelerations Abrupt decrease in baseline heart rate of 15 bpm for 15 seconds Types of deceleration Early deceleration Start when uterine contraction begins recover when uterine contraction stops Due to increased foetal intracranial pressure causing increased vagal tone Resolves once the uterine contraction ends intracranial pressure reduces Considered to be physiological not pathological Variable deceleration Seen as a rapid fall in baseline rate with a variable recovery phase Variable in their duration may not have any relationship to uterine contractions Seen during labour in patients with reduced amniotic fluid volume Variable decelerations are usually caused by umbilical cord compression The umbilical vein is often occluded first causing an acceleration in response Then the umbilical artery is occluded causing a subsequent rapid deceleration When pressure on the cord is reduced another acceleration occurs then the baseline rate returns Accelerations before after a variable deceleration are known as the shoulders of deceleration Variable decelerations can sometimes resolve if the mother changes position The presence of persistent variable decelerations indicates the need for close monitoring Late deceleration Begin at the peak of uterine contraction recover after the contraction ends. Indicates there is insufficient blood flow through the uterus placenta, foetal hypoxia acidosis due to reduced uteroplacental blood flow. If foetal blood pH is acidotic it indicates significant foetal hypoxia the need for emergency C section Prolonged deceleration A deceleration that last more than 2 minutes If it lasts between 2 3 minutes it is classed as non reassuring It it lasts longer than 3 minutes it is immediately classed as abnormal Action must be taken quickly,e.g.. Foetal blood sampling emergency C section Sinusoidal Pattern A smooth, regular, wave like pattern, frequency of around 2 5 cycles a minute, stable baseline rate around 120 160 bpm, no beat to beat variability It indicates severe foetal hypoxia, severe foetal anaemia, foetal maternal haemorrhageQ Management Immediate C section is indicated for this kind of pattern. Significance This type of pattern is rare, however if present it is very serious, it is associated with high rates of foetal morbidity mortality. Outcome is usually poor.

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.

Desmoid tumor, treatment is

Desmoid tumors, also known as aggressive fibromatosis, are soft tissue lesions that behave similarly to other truncal soft tissue sarcomas but have unique characteristics. These tumors, like other soft tissue sarcomas, present as slow growing, indolent masses sometimes can be aggressive . Unlike typical sarcomas however, these tumors rarely metastasize. Desmoids are diffusely infiltrative and tend to recur locally, even after complete resection.. Most desmoid tumors arise sporadically, but a small percentage 5 occurs in association with FAP syndrome. Desmoids are classified as either abdominal or extra abdominal. Abdominal desmoids are categorized further as superficial or infra abdominal tumors . The superficial disease, also known as Dupuytren s fibromatosis, is slow growing, is small in size, and rarely involves deeper structures.Most of the intra abdominal lesions are seen in association with FAP. These lesions are associated with mutations in the APC gene that are found in patients who have FAP. These tumors usually are found in the mesentery, and their growth and compression of neighboring structures can lead to significant morbidity and sometimes even death in these patients Sporadic abdominal wall desmoid tumors have been found to be associated with pregnancy. Oral contraceptive use has also been associated with the occurrence of these tumors. These associations, combined with the detection of estrogen receptors within the tumor, suggest a regulatory role for estrogen in this disease. Tissue injury, such as trauma and or surgery, also has been implicated in tumor development. The natural history of desmoid lesions is unpredictable. Although most are indolent and slow growing, some lesions are aggressive. There are some reports of spontaneous regression, but such occurrences are mainly in women and are associated with chemical or surgical menopause. Most lesions are indolent and have benign appearing histology, but local growth and compression have caused significant morbidity. Involvement of abdominal vessels and organs often complicates management. Patients with desmoid tumors present with a painless enlarging mass. Local symptoms may arise from compression of adjacent organs or neurovascular structures. MRI is done to define the extent of disease and its relationship with other structures. Incisional biopsy or a core needle biopsy is done to confirm the diagnosis. Management Surgery with wide negative margins is the best treatment. Unfortunately, even with complete resection, the local recurrence rate is as high as 40 . Surgery is also the t t of choice for recurrences. For tumors where vital visceral organs and local infiltration often make achieving negative margins difficult, other therapeutic modalities have been suggested. Antiproliferative agents and cytotoxic chemotherapy have been used to palliate these tumors with variable results. The two most widely used groups of noncytotoxic drugs are NSAIDs such as sulindac and indomethacin and antiestrogens such as tamoxifen . Chemotherapy has generally been reserved for unresectable, symptomatic, and clinically aggressive disease. Partial responses have been observed after treatment with doxorubicin, actinomycin C, dacarbazine, or carboplatin, although toxicity has been relatively high. Radiotherapy The role of radiation therapy in the management of these tumors, either as an adjunct to surgery or as primary treatment, continues to be defined. Sabiston In summary, for easily resectable disease, surgery alone appears to be the optimal approach, especially in patients with negative microscopic margins. In advanced cases, a trial of nonsteroidal anti inflammatory drugs or hormonal therapy can be considered in most patients. A period of close observation is also reasonable because some patients demonstrate regression without any therapy. However, if a patient is symptomatic and not a candidate for surgery, consideration should be given to radiation or chemotherapy to increase the chance of a response. Devita Oncology

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.

In a child with respiratory distress, failure to thrive. His sweat chloride leveles were estimated 35 meq L and 41 meq L. What is next best test to do cystic fibrosis for diagnosis aEUR

Trans epithelial nasal potential difference Diagnosis of cystic fibrosis Sweat chloride testing The sweat test is the standard approach to diagnosis. The diagnosis is made by elevated sodium and chloride level in the sweat 60 meoll. Two tests on different days are required .for accurate diagnosis. A normal sweat chloride dose not exclude the diagnosis. Genotyping and other tests such as measurement of nasal membrane potential difference, pancreatic .function should be done if there is high clinical suspicion of cystic fibrosis. Nasal potential difference Measurement of nasal transepithelial potential difference in vivo can be useful adjunct in the diagnosis of cystic fibrosis. Individuals with cystic fibrosis demonstrate a significantly more negative baseline nasal potential difference, with the topical application of amiloride there is loss of this potential difference. Nasal potential difference is a sensitive test of electrolyte transpo CFTR function that can be used to suppo or refute a diagnosis of cystic fibrosis. Genetic analysis Cystic .fibrosis is an autosomal recessive disorder. It is caused due to defect in CFTR Cystic fibrosis transmembrane conductance regulator protein. Cystic fibrosis is associated with large number of mutations. More than 1500 CFTR polymoiphisms are associated with cystic fibrosis syndrome. The most prevalent mutation of CFTR is the deletion of single phenylalanine residue at amino acid 4.508 This mutation is responsible for high incidence of cystic fibrosis in nohern European populations. Approximately 50 of individuals with CF who are of nohern European ancestry are homozygous for 4.508 and 70 carry at least one 4.508 gene. The remainder of patients has an extensive array of mutation, none of which has prevalence of more than several percent. Testing for cystic .fibrosis mutation was not possible because of the large no. of mutations associated with the disease. Now days commercial laboratories test for 30 80 of the most common CFTR mutations. This testing identifies 90 individuals who carry 2 CF mutations. No where it is mentioned in the texts that testing only for 4508 is enough for diagnosis. Detection of atleast 2 CF mutations are necessary for making the diagnosis of cystic fibrosis. The patient has features of cystic fibrosis but sweat chloride levels are normal. To diagnose cystic .fibrosis in this patient, another laboratory evidence demonstrating CFTR dysfunction is required. This can be done by two methods ? Demonstrating abnormal potential difference Demonstrating abnormal CF mutations. But the diagnostic criteria for cystic fibrosis requires. Demonstration of two CF mutations demonstration of single abnormal F508 mutation is not enough So we are left with abnormal nasal potential difference. It is an established laboratory evidence for CFTR dysfunction and is accepted as a diagnostic criteria to establish the diagnosis of cystic fibrosis. Diagnostic criteria for cystic fibrosis Presence of typical clinical features respiratory, G.LT, genitourinary OR A history of CF in a sibling OR A positive newborn screening test PLUS Laboratory evidence for CFTR Dysfunction Two elevated sweat chloride concentrations obtained on separate days OR Identification of two CF mutations OR An abnormal nasal potential difference

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.

A3 year old child presents with eczematous dermatitis over the extensor surfaces. His mother has the history of bronchial asthma. What should be the most probable diagnosis?

Ans. a. Atopic dermatitis Most probable diagnosis in a 3 year old child, who presents with eczematous dermatitis over the extensor surfaces with family history of bronchial asthma is atopic dermatitis.Atopic Dermatitis AD AD is a cutaneous expression of the atopic state, characterized by a family history of asthma, hay fever or dermatitis in 70 of patients.Etiopathogenesis Genetic predisposition When both parents are affected, over 80 and when only one parent is affected 50 of their children manifest the disease Increased IgE synthesis increased serum lgE increased specific IgE to food, aeroaliergens. bacteria and bacterial products. Increased expression of CD23 low affinity IgE receptor on monocyte and B cells Impaired delayed type hypersensitivity reactions.Clinical Presentation The clinical presentation varies with the age, half of the patients present within the first year of life, and 80 presents by 6 years of age. The infantile pattern is characterized by weeping inflammatory patches and crusted plaques that occur on face, neck and extensor surfaces Infantile eczema The childhood and adolescent pattern is marked by dermatitis of flexural skin particularly in antecubital and popliteal fossa. Clinical course lasting longer than 6 weeksQ. AD may resolve spontaneously, but over half of affected children will have dermatitis in adult life, i.e. course is marked by exacerbation and remissions.Pruritus and Scratching Made Worse by Environmental alterations Denny Morgan fold Extra fold of skin beneath lower eyelid . Change in temperature, sundry In rainy season and rough woolen clothing and leading to excoriation, lichen if ication, dryness. Increased tendency for vasoconstriction like perioral pallor and White dermatographismy.Atopic Dermatitis Associated with Alopecia areatac Susceptibility to skin infections0, Antenna sign Follicular openings are filled with horny plugs Head light sign Inflammation of skin on and around lips Hertoghe s sign Thinning of lateral half of eyebrows Clinical Phase of Atopic DermatitisInfantile phaseChildhood phaseAdult phase Rarely starts before 4 6 weeks of age and usually begins between 2 3 months of age First begin on face0 and may quickly spread to other areas. Although, often then napkin area is relatively spared, as a result of the area being kept moist. From one and half to two years onwards Most characteristically involve elbow and knee flexures, wrist and ankle. Sides of neck show a reticulate pigmentation known as atopic dirty neck. Lichenification. especially of flexures and hands similar to that in later childhood Involvement of vermilion of lip like dermatitis Atopic Dermatitis AD Clinical phase of Atopic Dermatitisinfantile phaseChildhood phaseAdult phase Excoriation and lichenification appear at about 6 months of age, when the ability to scratch develops Initially the disorder involves flexural distribution But when the child starts to crawl, the exposed extensor aspect of knees, are most involved. Uncommon extensor distribution and inability to lichenify even after prolonged rubbing are very difficult to treat and take longer time to remit. Nipple involvement in young adolescent women Photosensitivity with ultraviolet and infrared radiation. Hanifin and Rajka Diagnostic Criteria for Atopic Dermatitis Three major and three minor criteria should be present Major criteria Minor criteria Pruritus Involvement of face and convexities in infants 2 years and distribution over flexures popliteal and antecubitai fossa in older children., Tendency to chronicity Personal or family history of atopy such as asthma, allergic rhinitis or atopic dermatitis Facial pallordeg suborbital shadowing Infra orbital fold Dennie s line Recurrent skin infections pyoderma, warts molluscum contagiosum Ichthyosis vulgaris with accentuation over palmar crease Tendency to non specific dermatosis of hand Immediate skin test Delayed blanching to cholinergics Raised serum total IgE Anterior subcapsular cataract Keratoconus

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 is admitted on 7 days of life with severe respiratory distress and shock. He was discharged 2 days back healthy. What could be the probable diagnosis

livpolastic left heart syndrome Hypoplastic left heart syndrome occurs when parts of the left side of the heart mitral valve, left ventricle, aortic valve, and aorta do not develop completely. The condition is present at birth congenital . Hypoplastic left heart is a rare type of congenital heart disease. It is more common in males than in females. As with most congenital heart defects, there is no known cause. About 10 of patients with hypoplastic left heart syndrome also have other birth defects. The problem develops before birth when the left ventricle and other structures do not grow properly, including the i Aorta the blood vessel that carries oxygen rich blood from the left ventricle to the entire body Entrace and exit of the ventricle Mitral and aortic valves This causes the left ventricle and aorta to be poorly developed, or hypoplastic. In most cases, the left ventricle and aorta are much smaller than normal. In patients with this condition, the left side of the heart is unable to send enough blood to the body. As a result, the right side of the heart must maintain the circulation for both the lungs and the body. The right ventricle can support the circulation to both the lungs and the body for awhile, but this extra workoad eventually causes the right side of the heart to fail. The only possibility of survival is a connection between the right and left side of the heart, or between the systemic arteries and pumonary arteries the blood vessels that carry blodd to the lungs . Babies are normally born with two of these connections i Foramen ovale a hole between the right and left atrium Ductus arteriosus a small vessel that connects the aorta to the pulmonary artery Both of these connections normally close on their own a few days after birth. In babies with hypoplastic left heart syndrome, blood from the right side of the heart travels through the ductus arteriosus. This is the only way for blood to get to the body. if the ductus arteriosus is allowed to close in a baby with hypoplastic left heart syndrome, the patient may quickly die because no blood will be pumped to the body. Babies with known hypoplatic left heart syndrome are usually started on a medicine to keep the ductus arteriosusopen. Because there is little or no flow out of the left heart, blood reaming to the heart from the lungs needs to pass through the foramen ovale or an atrial septal defect a hole connecting the collecting chambers on the left and right sides of the heart back to the right side of the heart. If there is no foramen ovale, or if it is too small, the baby could die. Patients with this problem have the hole between their atria opened, either with surgery or using a thin, flexible tube heart catheterization . Symptoms At first, a newborn with hypoplastic left heart may apper normal. Symptoms usually occur in the first few hours of life, although it may take up to a few days to develop symptoms. These symptoms may include Bluish cyanosis or poor skin color Cold hands and feed extremities Lethargy Poor pulse Poor suckling and feeding Pounding heart Rapid breathing Shortness of breath. Since the systemic circulation is dependent on the patent ductus arteriosus the closure of ductus arterious leads to shock. Signs of heart failure usually appears within the first few days or weeks of life and include dyspnoea, hepatomegaly and low cardiac output. When PDA closes suddenly shock occurs all the peripheral pulses may be weak or absent. Ventricular septal defect These patients with VSD s become symptomatic around 6 10 weeks of age. They usually present with congestive cardiac failure. Ebstein s anomaly Ebstein s anomaly consists of downward displacement of an abnormal tricuspid value into the right ventricle. These patients usually present in teenage adolescent years. They may also present in infancy but they usually do not present with shock or severe hypoperfusion. Aorticopulmonary window defect An Aorticopulmanry window defect consists of a communication between the ascending Aorta and the main pulmonary artery. In these cases minimal cyanosis is present and they may present with heart failure in infancy.

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 causes Childhood Nephrotic Syndrome ?

While idiopathic, or unknown, diseases are the most common cause of primary childhood nephrotic syndrome, researchers have linked certain diseases and some specific genetic changes that damage the kidneys with primary childhood nephrotic syndrome. The cause of secondary childhood nephrotic syndrome is an underlying disease or infection. Called a primary illness, its this underlying disease or infection that causes changes in the kidney function that can result in secondary childhood nephrotic syndrome. Congenital diseasesdiseases that are present at birthcan also cause childhood nephrotic syndrome. Primary Childhood Nephrotic Syndrome The following diseases are different types of idiopathic childhood nephrotic syndrome Minimal change disease involves damage to the glomeruli that can be seen only with an electron microscope. This type of microscope shows tiny details better than any other microscope. Scientists do not know the exact cause of minimal change disease. Minimal change disease is the most common cause of idiopathic childhood nephrotic syndrome.1 Focal segmental glomerulosclerosis is scarring in scattered regions of the kidney Focal means that only some of the glomeruli become scarred. Segmental means damage affects only part of an individual glomerulus. Membranoproliferative glomerulonephritis is a group of disorders involving deposits of antibodies that build up in the glomeruli, causing thickening and damage. Antibodies are proteins made by the immune system to protect the body from foreign substances such as bacteria or viruses. Secondary Childhood Nephrotic Syndrome Some common diseases that can cause secondary childhood nephrotic syndrome include diabetes, a condition that occurs when the body cannot use glucosea type of sugarnormally Henoch Schnlein purpura, a disease that causes small blood vessels in the body to become inflamed and leak hepatitis, inflammation of the liver caused by a virus human immunodeficiency virus HIV , a virus that alters the immune system lupus, an autoimmune disease that occurs when the body attacks its own immune system malaria, a disease of the blood that is spread by mosquitos streptococcal infection, an infection that results when the bacteria that causes strep throat or a skin infection is left untreated Other causes of secondary childhood nephrotic syndrome can include certain medications, such as aspirin, ibuprofen, or other nonsteroidal anti inflammatory drugs, and exposure to chemicals, such as mercury and lithium. Congenital Diseases and Childhood Nephrotic Syndrome Congenital nephrotic syndrome is rare and affects infants in the first 3 months of life.2 This type of nephrotic syndrome, sometimes called infantile nephrotic syndrome, can be caused by inherited genetic defects, which are problems passed from parent to child through genes infections at the time of birth More information about underlying diseases or infections that cause changes in kidney function is provided in the NIDDK health topic, Glomerular Diseases.

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 2 year old child comes with ear discharge, seborrheic dermatitis, polyuria and hepatos plenomegaiy. Which of the following is the most likely diagnosis

Ans. is c i.e., Langerhan s cell histiocytosis o Langherhans cells histiocytosis is a histocvtic. disorder most commonly characterized bv a single or multiple osteolytic bone lesions demonstrating infiltration with histiocytes.o Histiocytic disorders are derived from mononuclear phagocytic cells macrophages and dendritic cells which have several different originl and locations.o The generic term histiocyte refers to several types of cells including langherhan cells, monocytes macrophages and dermal interstitial dendritic cells.o Langherhans cells histiocytosis is so named because the morphology and the immunophenotype of the abnormal cells is similar to that of langherhans cells which are specialized dendritic cells found in skin and mucosa.o Gene expression array data have shown that skin langherhan cells is not the cell of origin for LCH rather it is a myeloid dendritic cell that express the same antigen CDla, CD207 as the skin langherhans cells.o For now langherhan cell histiocytosis remains the preferred nomenclature, although new termanology may evolve when the precise origin of CD 207 cells in LCH is fully understood.o The historical terms histiocytosis X, letterer siwe disease, hand schuller Christian disease and diffuse reticuloendotheliosis should be abandoned.o The term eosinophilic granuloma can sometimes be used to describe pathology of langherhan s cells histiocytosis.Diagnosis of LCHo LCH is diagnosed upon biopsyo A biopsy of an osteolytic bone lesion or skin lesion is generally preferred. Langherhan cells are recognized on the basis of morphological criteria The identity must then be confirmed by either positive immunohistochemical staining for CD1a and CD207 by the identification of Birbeck granules.o Biopsy of involved tissue usually demonstrates heterogenous collection of langherhan cells with eosinophils, neutrophils, small lymphocytes and histiocytes.Morphology of the langherhan cells Langherhan cells are large oval mononuclear cells with few cytoplasmic vacuoles, little or no phagocytic material and slightly eosinophilic cytoplasm. Nucleus is prominent with fine chromatin and thin nuclear membranes with grooved folded or indented nuclear contours imparting twisted towel. Unlike dermal langherhan cells these cells do not have dendritic cell processes. Similar to dermal langherhan cells, those in LCH express the histiocyte marker CDla. S100 and CD207 and contain Birbeck granules.Birbeck granules Intracytoplasmic rod shaped organelles with central striations that can be demonstrated on electron microscopy. Occasionally there is terminal vesicular dilatation giving the Birbeck granules the appearance of tennis racket . Bone 77 Skin 39 LyphnodesLiverSpleenOral mucosaLung 10 CNS 16 o Occurs in majority of patientso Usually asymptomatico Lytic punched out lesiono Usually present as eczematous rasho Ulcerative lesions in axilla inguinal folds genitalia or perianal regiono Seborrhic dermatitiso Lymphadenopathyo Enlarged thymus or mediastinal nodeso Hepatic dysfunctiono Hepatomao Sclerosing cholangitiso Massive Splenomegalyo Cytopeniaso Intra oral masso Gingivitiso Mucosal ulcerso Loose teetho Non productive cough dyspnoea chest pain or constitutional symptomso Risk of CNS invol ment varies with bone involvemento CNS inolve ment occurs more with involvement of facial and anterior middle cranial fossao Diabetes insipidus and symptoms of neuro degeneration

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.

Most sensitive test for screening of SLE is

Ref Robbins 9 e p219, 8 e p214 ,7 e p228 Spectrum of Autoantibodies in SLE Antibodies have been identified against a host of nuclear and cytoplasmic components of the cell that are specific to neither organs nor species. Another group of antibodies is directed against surface antigens of blood cells, while yet another is reactive with proteins in complex with phospho lipids antiphospholipid antibodies Chapter 3 . Antinuclear antibodies. ANAs are directed against several nuclear antigens and can be grouped into four catego ries 1 antibodies to DNA, 2 antibodies to histones, 3 antibodies to nonhistone proteins bound to RNA, and 4 antibodies to nucleolar antigens. Table 4 10 lists several autoantibodies, including ANAs, and their asso ciation with SLE as well as with other autoimmune dis eases, to be discussed later. The most widely used method of detecting ANAs is the indirect immunofluo rescence assay IFA , which screens for autoantibodies that bind to a variety of nuclear antigens, including DNA, RNA, and proteins. Four staining patterns are seen with IFA homogeneous or diffuse, rim or periph eral, speckled, and nucleolar. While each pattern can be suggestive of the presence of specific autoantibodies, the strength of these associations is limited and should not be relied on. ANA testing by IFA is extremely sensitive, as more than 95 of patients with SLE will test positive, but the test s specificity is quite limited, because patients with other autoimmune diseases, chronic infections, and cancer will test positive as well. Fuhermore, ANAs are seen in approximately 5 to 15 of healthy people, and the incidence increases with age. Recently, the IFA has been replaced in many clinical laboratories by multiplex flow cytometry immunoassays that can simultaneously test for multiple specific autoantibodies, but these assays may lack the sensitivity of the IFA. Antibodies to double stranded DNA dsDNA and the so called Smith Sm antigen can be detected by ELISA or multiplex flow methods and are specific for SLE. Other autoantibodies. Antibodies against blood cells, including red cells, platelets, and lymphocytes, are found in many patients. Antiphospholipid antibodies are present in 40 to 50 of patients with lupus and react with a wide variety of proteins in complex with phospholipids. Some bind to cardiolipin antigen, used in serologic tests for syphilis, so patients with lupus may have a false positive test result for syphilis. Antiphos pholipid antibodies contribute to coagulation abnormal ities, which are described below. Mechanisms of Tissue Injury Regardless of the exact sequence by which autoantibodies are formed, they are likely to be the mediators of tissue injury, probably through multiple mechanisms. Most organ damage in SLE is caused by immune complex deposition. Skin and kidney biopsies from patients with SLE typically demonstrate diffuse and heavy granular deposits of complement and immunoglobulin. Autoan tibodies complexed with DNA can be detected as well. These deposits of immune complexes had been thought to cause tissue damage by activating the classical com plement pathway type III hypersensitivity 75 of patients will have reduced serum levels of C3 and C4 at the time of SLE flares, presumably because complement is being activated and consumed faster than it can be produced. However, people and rodents deficient in C1q are not protected from SLE and actually can spon taneously develop SLE, raising the possibility that complement independent mechanisms may also con tribute to tissue damage. Autoantibodies of different specificities contribute to the pathology and clinical manifestations of SLE type II hyper sensitivity . Autoantibodies against red cells, white cells, and platelets opsonize these cells and lead to their phagocy tosis, resulting in cytopenias. Autoantibodies against various phospholipids lead to increased thrombosis in patients, with varied clinical consequences, including recurrent spontaneous aboion and thrombotic epi sodes. These disorders are pa of the antiphospholipid syndrome. Paradoxically, these antibodies interfere with clotting tests and are actually called lupus anticoagu lants. Autoantibodies are also produced against clot ting factors such as thrombin, and these too may contribute to clotting disorders. Autoantibodies against central nervous system receptors for various neurotransmit ters have been implicated in the neuropsychiatric com plications of the disease. There is no evidence that ANAs can permeate intact cells. However, if cell nuclei are exposed, the ANAs can bind to them. In tissues, nuclei of damaged cells react with ANAs, lose their chromatin pattern, and become homogeneous, to produce so called LE bodies or hema toxylin bodies. An in vitro correlate of this is the LE cell, a neutrophil or macrophage that has engulfed the dena tured nucleus of another injured cell. When blood is withdrawn and agitated, a number of leukocytes are sufficiently damaged to expose their nuclei to ANAs, with secondary complement activation these antibody and complement opsonized nuclei are then readily phagocytosed. Although the LE cell test is positive in as many as 70 of patients with SLE, it is now largely of historical interest.

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 are Shwachman Diamond syndrome ?

Shwachman Diamond syndrome is an inherited condition that affects many parts of the body, particularly the bone marrow, pancreas, and skeletal system. The major function of bone marrow is to produce new blood cells. These include red blood cells, which carry oxygen to the body s tissues white blood cells, which fight infection and platelets, which are necessary for normal blood clotting. In Shwachman Diamond syndrome, the bone marrow malfunctions and does not make some or all types of white blood cells. A shortage of neutrophils, the most common type of white blood cell, causes a condition called neutropenia. Most people with Shwachman Diamond syndrome have at least occasional episodes of neutropenia, which makes them more vulnerable to infections such as pneumonia, recurrent ear infections otitis media , and skin infections. Less commonly, bone marrow abnormalities lead to a shortage of red blood cells anemia , which causes fatigue and weakness, or a reduction in the amount of platelets thrombocytopenia , which can result in easy bruising and abnormal bleeding. People with Shwachman Diamond syndrome have an increased risk of several serious complications related to their malfunctioning bone marrow. Specifically, they have a higher than average chance of developing myelodysplastic syndrome MDS and aplastic anemia, which are disorders that affect blood cell production, and a cancer of blood forming tissue known as acute myeloid leukemia AML . Shwachman Diamond syndrome also affects the pancreas, which is an organ that plays an essential role in digestion. One of this organ s main functions is to produce enzymes that help break down and use the nutrients from food. In most infants with Shwachman Diamond syndrome, the pancreas does not produce enough of these enzymes. This condition is known as pancreatic insufficiency. Infants with pancreatic insufficiency have trouble digesting food and absorbing nutrients that are needed for growth. As a result, they often have fatty, foul smelling stools steatorrhea are slow to grow and gain weight failure to thrive and experience malnutrition. Pancreatic insufficiency often improves with age in people with Shwachman Diamond syndrome. Skeletal abnormalities are another common feature of Shwachman Diamond syndrome. Many affected individuals have problems with bone formation and growth, most often affecting the hips and knees. Low bone density is also frequently associated with this condition. Some infants are born with a narrow rib cage and short ribs, which can cause life threatening problems with breathing. The combination of skeletal abnormalities and slow growth results in short stature in most people with this disorder. The complications of this condition can affect several other parts of the body, including the liver, heart, endocrine system which produces hormones , eyes, teeth, and skin. Additionally, studies suggest that Shwachman Diamond syndrome may be associated with delayed speech and the delayed development of motor skills such as sitting, standing, and walking.

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 Crohn s Disease ?

A health care provider treats Crohn s disease with medications bowel rest surgery Which treatment a person needs depends on the severity of the disease and symptoms. Each person experiences Crohn s disease differently, so health care providers adjust treatments to improve the person s symptoms and induce, or bring about, remission. Medications While no medication cures Crohn s disease, many can reduce symptoms. The goals of medication therapy are inducing and maintaining remission improving the person s quality of life Many people with Crohn s disease require medication therapy. Health care providers will prescribe medications depending on the person s symptoms aminosalicylates corticosteroids immunomodulators biologic therapies other medications Aminosalicylates are medications that contain 5 aminosalicyclic acid 5 ASA , which helps control inflammation. Health care providers use aminosalicylates to treat people newly diagnosed with Crohn s disease who have mild symptoms. Aminosalicylates include balsalazide mesalamine olsalazine sulfasalazinea combination of sulfapyridine and 5 ASA Some of the common side effects of aminosalicylates include abdominal pain diarrhea headaches heartburn nausea and vomiting Corticosteroids, also known as steroids, help reduce the activity of the immune system and decrease inflammation. Health care providers prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include budesonide hydrocortisone methylprednisone prednisone Side effects of corticosteroids include acne a higher chance of developing infections bone mass loss high blood glucose high blood pressure mood swings weight gain In most cases, health care providers do not prescribe corticosteroids for long term use. Immunomodulators reduce immune system activity, resulting in less inflammation in the GI tract. These medications can take several weeks to 3 months to start working. Immunomodulators include 6 mercaptopurine, or 6 MP azathioprine cyclosporine methotrexate Health care providers prescribe these medications to help people with Crohn s disease go into remission or to help people who do not respond to other treatments. People taking these medications may have the following side effects a low white blood cell count, which can lead to a higher chance of infection fatigue, or feeling tired nausea and vomiting pancreatitis Health care providers most often prescribe cyclosporine only to people with severe Crohn s disease because of the medication s serious side effects. People should talk with their health care provider about the risks and benefits of cyclosporine. Biologic therapies are medications that target a protein made by the immune system. Neutralizing this protein decreases inflammation in the intestine. Biologic therapies work quickly to bring on remission, especially in people who do not respond to other medications. Biologic therapies include adalimumab certolizumab infliximab natalizumab vedolizumab Health care providers most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medication and a higher chance of developing infections, particularly tuberculosis. Other medications to treat symptoms or complications may include acetaminophen for mild pain. People with Crohn s disease should avoid using ibuprofen, naproxen, and aspirin since these medications can make symptoms worse. antibiotics to prevent or treat infections and fistulas. loperamide to help slow or stop severe diarrhea. In most cases, people only take this medication for short periods of time since it can increase the chance of developing megacolon. Bowel Rest Sometimes Crohn s disease symptoms are severe and a person may need to rest his or her bowel for a few days to several weeks. Bowel rest involves drinking only clear liquids or having no oral intake. To provide the patient with nutrition, a health care provider will deliver IV nutrition through a special catheter, or tube, inserted into a vein in the patient s arm. Some patients stay in the hospital, while other patients are able to receive the treatment at home. In most cases, the intestines are able to heal during bowel rest. Surgery Even with medication treatments, up to 20 percent of people will need surgery to treat their Crohn s disease.1 Although surgery will not cure Crohn s disease, it can treat complications and improve symptoms. Health care providers most often recommend surgery to treat fistulas bleeding that is life threatening bowel obstructions side effects from medications when they threaten a person s health symptoms when medications do not improve a person s condition A surgeon can perform different types of operations to treat Crohn s disease small bowel resection subtotal colectomy proctocolectomy and ileostomy Patients will receive general anesthesia. Most patients will stay in the hospital for 3 to 7 days after the surgery. Full recovery may take 4 to 6 weeks. Small bowel resection. Small bowel resection is surgery to remove part of a patient s small intestine. When a patient with Crohn s disease has a blockage or severe disease in the small intestine, a surgeon may need to remove that section of intestine. The two types of small bowel resection are laparoscopicwhen a surgeon makes several small, half inch incisions in the patient s abdomen. The surgeon inserts a laparoscopea thin tube with a tiny light and video camera on the endthrough the small incisions. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of the intestine. open surgerywhen a surgeon makes one incision about 6 inches long in the patient s abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of the intestine. Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of a patient s large intestine. When a patient with Crohn s disease has a blockage, a fistula, or severe disease in the large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by laparoscopic colectomywhen a surgeon makes several small, half inch incisions in the abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of the large intestine. The surgeon will reconnect the ends of the intestine. open surgerywhen a surgeon makes one incision about 6 to 8 inches long in the abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove that section. The surgeon will reconnect the ends of the intestine. Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove a patient s entire colon and rectum. An ileostomy is a stoma, or opening in the abdomen, that a surgeon creates from a part of the ileumthe last section of the small intestine. The surgeon brings the end of the ileum through an opening in the patient s abdomen and attaches it to the skin, creating an opening outside of the patient s body. The stoma is about three fourths of an inch to a little less than 2 inches wide and is most often located in the lower part of the patient s abdomen, just below the beltline. A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects intestinal contents outside the patient s body. Intestinal contents pass through the stoma instead of passing through the anus. The stoma has no muscle, so it cannot control the flow of intestinal contents, and the flow occurs whenever peristalsis occurs. Peristalsis is the movement of the organ walls that propels food and liquid through the GI tract. People who have this type of surgery will have the ileostomy for the rest of their lives.

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 Insulin Resistance and Prediabetes ?

Health care providers use blood tests to determine whether a person has prediabetes, but they do not usually test specifically for insulin resistance. Insulin resistance can be assessed by measuring the level of insulin in the blood. However, the test that most accurately measures insulin resistance, called the euglycemic clamp, is too costly and complicated to be used in most health care providers offices. The clamp is a research tool used by scientists to learn more about glucose metabolism. Research has shown that if blood tests indicate prediabetes, insulin resistance most likely is present. Blood Tests for Prediabetes All blood tests involve drawing blood at a health care provider s office or commercial facility and sending the sample to a lab for analysis. Lab analysis of blood is needed to ensure test results are accurate. Glucose measuring devices used in a health care provider s office, such as finger stick devices, are not accurate enough for diagnosis but may be used as a quick indicator of high blood glucose. Prediabetes can be detected with one of the following blood tests the A1C test the fasting plasma glucose FPG test the oral glucose tolerance test OGTT A1C test. Sometimes called hemoglobin A1c, HbA1c, or glycohemoglobin test, this test reflects average blood glucose levels over the past 3 months. This test is the most reliable test for prediabetes, but it is not as sensitive as the other tests. In some individuals, it may miss prediabetes that could be caught by glucose tests. Although some health care providers can quickly measure A1C in their office, that type of measurementcalled a point of care testis not considered reliable for diagnosis. For diagnosis of prediabetes, the A1C test should be analyzed in a laboratory using a method that is certified by the NGSP. The A1C test can be unreliable for diagnosing prediabetes in people with certain conditions that are known to interfere with the results. Interference should be suspected when A1C results seem very different from the results of a blood glucose test. People of African, Mediterranean, or Southeast Asian descent, or people with family members with sickle cell anemia or a thalassemia, are particularly at risk of interference. People in these groups may have a less common type of hemoglobin, known as a hemoglobin variant, that can interfere with some A1C tests. An A1C of 5.7 to 6.4 percent indicates prediabetes. More information about the A1C test is provided in the NIDDK health topic, The A1C Test and Diabetes. Fasting plasma glucose test. This test measures blood glucose in people who have not eaten anything for at least 8 hours. This test is most reliable when done in the morning. Prediabetes found with this test is called IFG. Fasting glucose levels of 100 to 125 mg dL indicate prediabetes. OGTT. This test measures blood glucose after people have not eaten for at least 8 hours and 2 hours after they drink a sweet liquid provided by a health care provider or laboratory. Prediabetes found with this test is called IGT. A blood glucose level between 140 and 199 mg dL indicates prediabetes. The following table lists the blood test levels for a diagnosis of prediabetes.

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.

Wallenberg s syndrome may involve?

Ans. D. All of the above B. Nucleus ambiguous. Ref Harrison s 18th Figure 370 10 . Lateral medullary syndrome occlusion of any of five vessels may be responsible vertebral, posterior inferior cerebellar, superior, middle, or inferior lateral medullary arteries On side of lesion Pain, numbness, impaired sensation over one half the face Descending tract and nucleus fifth nerve Ataxia of limbs, falling to side of lesion Uncertain restiform body, cerebellar hemisphere, cerebellar fibers, spinocerebellar tract ? Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting Vestibular nucleus Homer s syndrome miosis, ptosis, decreased sweating Descending sympathetic tract Dysphagia, hoarseness, paralysis of palate, paralysis of vocal cord, diminished gag reflex Issuing fibers ninth and tenth nerves Loss of taste Nucleus and tractus solitarius Numbness of ipsilateral arm, trunk, or leg Cuneate and gracile nuclei Weakness of lower face Genuflected upper motor neuron fibers to ipsilateral facial nucleus On side opposite lesion Impaired pain and thermal sense over half the body, sometimes face Spinothalamic tract.Posterior circulationASALateral corticospinal tract.Medial lemniscus.Caucal medulla hypoglossal nerve.Contralateral hemiparesis upper and lower limbs. contralateral proprioception. Ipsilateral hypoglossal dysfunction tongue deviates ipsilaterally .Stroke commonly bilateral.Medial medullary syndrome caused by infarct of paramedian branches of ASA and vertebral arteries.PICALateral medulla vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle.Vomiting, vertigo, nystagmus pain and temperature sensation from ipsilateral face and contralateral body dysphagia, hoarseness, gag reflex ipsilateral Homer syndrome ataxia, dysmetria.Lateral medullary Wallenberg syndrome.Nucleus ambiguus effects are specific to PICA lesions. Don t pick a PICA horse hoarseness that can t eat dysphagia . AICALateral pons cranial nerve nuclei vestibular nuclei, facial nucleus, spiral trigeminal nucleus, cochlear nuclei, sympathetic fibers.Vomiting, vertigo, nystagmus. Paralysis of face, lacrimation, salivation, taste from anterior 2 3 of tongue, comeal reflex. Face pain and temperature sensation. Ipsilateral hearing. Ipsilateral Homer syndrome.Lateral pontine syndrome.Facial nucleus effects are specific to AICA lesions. Facial droop means AICA s pooped. Middle and inferior cerebellar peduncles.Ataxia, dysmetria. PCAOccipital cortex, visual cortex.Contralateral hemiancpia with macular sparing. Basilar arteryPons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paramedian pontine reticularPreserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, and tongue movements. Locked in syndrome. Signs and symptoms of other medullary syndrome Structures involved Medial medullary syndrome occlusion of vertebral artery or of branch of vertebral or lower basilar artery On side of lesion Paralysis with atrophy of one half half the tongue Ipsilateral twelfth nerve On side opposite lesion Paralysis of arm and leg, sparing face impaired tactile and proprioceptive sense over one half the body Contralateral pyramidal tract and medial lemniscus Total unilateral medullary syndrome occlusion of vertebral artery Combination of medial and lateral syndromes Lateral pontomedullary syndrome occlusion of vertebral artery Combination of lateral medullary and lateral inferior pontine syndrome Basilar artery syndrome the syndrome of the lone vertebral artery is equivalent A combination of the various brainstem syndromes plus those arising in the posterior cerebral artery distribution. Bilateral long tract signs sensory and motor cerebellar and peripheral cranial nerve abnormalities Bilateral long tract cerebellar and peripheral cranial nerves Paralysis or weakness of all extremities, plus all bulbar musculature Corticobulbar and corticospinal tracts bilaterall.Features of lateral medullary syndrome Wallenberg syndrome and posterior inferior cerebellar artery syndrome Dysfunction Effects1Vestibular nucleivestibular system vomiting, vertigo, nystagmus,2Inferior cerebellar peduncleIpsilateral cerebellar signs including ataxia, dysmetria past pointing , dysdiadokokinesia3Central tegmental tractpalatal myoclonus4Lateral spinothalamic tractcontralateral deficits in pain and temperature sensation from body limbs and torso 5Spinal trigeminal nucleus tractipsilateral loss of pain, and temperature sensation from face6Nucleus ambiguus which affects vagus nerve and glossopharyngeal nerve localizing lesion all other deficits are present in lateral pontine syndrome as well ipsilateral laryngeal, pharyngeal, and palatal hemiparalysis dysphagia, hoarseness, diminished gag reflex efferent limb CN.X 7Descending sympathetic fibersipsilateral Horner s syndrome ptosis, miosis, anhydrosis

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 Neurofibromatosis type 1 ?

What are the signs and symptoms of Neurofibromatosis type 1? People affected by neurofibromatosis type 1 NF1 have an increased risk of developing many different types of tumors both cancerous and noncancerous . Almost all people with NF1 have neurofibromas, which are benign tumors that can affect nearly any nerve in the body. Most will develop these tumors on or just underneath the skin however, neurofibromas can also grow in other places in the body and may even affect multiple nerves. Malignant peripheral nerve sheath tumors, which also grow along the nerves throughout the body, are the most common cancerous tumor found in people with NF1 and occur in approximately 10 of affected people. In children with NF1, the most common tumors are optic glioma tumors that grow along the nerve leading from the eye to the brain and brain tumors. Optic gliomas associated with NF1 are often asymptomatic although they can lead to vision loss. Other features of NF1 may include Caf au lait spots flat patches on the skin that are darker than the surrounding area Freckling, especially in the underarm and groin Lisch nodules clumps of pigment in the colored part of the eye that do not interfere with vision Learning disabilities Seizures Autism spectrum disorder High blood pressure Short stature An unusually large head macrocephaly Skeletal abnormalities such as scoliosis GeneReview s Web site offers more specific information about the features of NF1. Please click on the link to access this resource. The Human Phenotype Ontology provides the following list of signs and symptoms for Neurofibromatosis type 1. 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 Cafe au lait spot 100 Lisch nodules 95 Benign neoplasm of the central nervous system 90 Generalized hyperpigmentation 90 Hypermelanotic macule 90 Kyphosis 90 Melanocytic nevus 90 Multiple lipomas 90 Neoplasm of the skin 90 Attention deficit hyperactivity disorder 50 Freckling 50 Hearing impairment 50 Heterochromia iridis 50 Incoordination 50 Memory impairment 50 Migraine 50 Neurological speech impairment 50 Paresthesia 50 Proptosis 50 Skeletal dysplasia 50 Slender long bone 50 Short stature 31 Plexiform neurofibroma 30 Specific learning disability 30 Abnormality of the respiratory system 7.5 Arterial stenosis 7.5 Glaucoma 7.5 Hydrocephalus 7.5 Hypertension 7.5 Hypopigmented skin patches 7.5 Leukemia 7.5 Limitation of joint mobility 7.5 Macrocephaly 7.5 Neoplasm of the gastrointestinal tract 7.5 Neuroendocrine neoplasm 7.5 Precocious puberty 7.5 Sarcoma 7.5 Scoliosis 7.5 Seizures 7.5 Tall stature 7.5 Urinary tract neoplasm 7.5 Visual impairment 7.5 Tibial pseudoarthrosis 4 Aqueductal stenosis 1.5 Genu valgum 1.5 Hypsarrhythmia 1.5 Optic glioma 1.5 Renal artery stenosis 1.5 Spinal neurofibromas 1.5 Meningioma 1 Pheochromocytoma 1 Astrocytoma Autosomal dominant inheritance Axillary freckling Hypertelorism Inguinal freckling Intellectual disability, mild Neurofibrosarcoma Overgrowth Parathyroid adenoma Rhabdomyosarcoma Spina bifida 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.

Treatment of choice for early stage laryngeal carcinoma is

Ans. is c i.e., Radiotherapy TNM classification of cancer larynx American Joint Committee on Cancer, 2002SupraglottisT1Tumour limited to one subsite of supraglottis with normal vocal cord mobility.T2Tumour invades mucosa of more then one adjauent subsite of supraglotis or glottis or region outside the supraglottis e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus without fixation of the larynxT3Tumour limited to laynx with vocal cord fixation and or invades any of the following postcricoid area, pre epiglottic tissues, paraglottic space and or minor thyroid cartilage invasionT4Tumour invades through the thyroid cartilage and or invades tissues beyond the larynx e.g., trachea, soft tissues of neck including deep extrinsic muscle of tongue, strap muscles, thyroid or oesophagus T5Tumour invades prevertebral space, encases carotid artery or invades mediastinal structuresGlottisT1Tumour limited to vocal cord s may involve anterior or posterior commissures with normal mobilityT2Tumour limited to one vocal cordT3Tumour involves both vocal cordsT4Tumour extends to suproglottis and or subglottis and or with impaired vocal cord mobility.T5Tumour limited to the larynx with vocal cord fixation and or invades paraglottic space and or minor thyroid cartilage erosion.T6Tumour invades through thyroid cartilage and or invades tissues beyond the larynx e. g., trachea, soft tissues of neck including deep extrinsic muscles of the tongue strap muscles, thyroid or oesophagus .T7Tumour incades prevertebral space, encases carotid artery or invades mediastinal structuresSubglottisT1Tomour limited to subglottisT2Tomour extends to vocal cord s with normal or impaired mobilityT3Tumour limited to larynx with vocal cord fixationT4Tumour invades cricoid or thyroid cartilage and or invades tissue beyond the larynx e. g., trachea, soft tissues of neck including deep extrinsic muscle of tongue, strap muscles, thyroid or oesophagus T5Tomour invades prevertebral space, encases carotid artery or invades mediastinal structuresRegional lymph nodes N NxRegional lymph nodes cannot be assessedN0No regional lymph node metastasisN1Metastasis in a single ipsilateral lymph bode, 3 cm or lwss in greatest dimensionN2Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, or bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.N2aMetastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension. Stage grouping0TisN0M0IT1N0M0IIt2N0M0IIIT3N0M0 T1N1M0 T2N1M0 T3N1M0IVAT4aN0M0 T4aN1M0 T1n2M0 T2N2M0 T3N2M0 T4an2M0IVBT4bAnyNM0 Any TN3M0IVCAny TAnyNM0Histopathologic grace G Grade 1W ell differentiatedGrade 2Moderately differentiatedGrade 3Poortly differentiated Thus stage I is T1 N0 M0. Treatment for T1 stage is radiotherapy Subglottic Ca T1 T2 lesionsT3 T4 lesions RadiotherapyTL post op. RT Radiation portal should include upper mediastinum

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.

SI unit of dose of radiation absorption?

Ans. c Gray Ref. Grainger Radiology 4th 232 The old unit of radiation absorption is rad new SI unit is gray.Radiation unitsThe activity of a radioactive material is the number of nuclear disintegration per unit of time. The unit of activity is a becquerel Bq 1 Bq is equal to 1 disintegration per second. Formerly, the unit of avtivity was curie Ci and 1 Bq corresponds approximately to 27 picocuries.The potency of radiation is measured in THREE three ways 1 Roentgen Roentgen is the unit of exposure. It is the amount of radiation absorbed in air at a given point, i.e., number of ions produced in 1 ml of air. 2 Rad Rad is the unit of absorbed dose. It is the amount of radioactive energy absorbed per gram of tissue or any material. 1 mrad 0.0001 rad 3 Rem Rem is the product of the absorbed dose and the modifying factors. The rem indicates the degree of potential danger to health. The radiation to which the average citizen is expected is made up almost of the fast moving, highly penetrating X rays and gamma rays, where rem and rad are equal 2 .The radiation units viz roentgen, rad rem are replaced by the new SI Units International System of Units which are a Coulomb per kilogram C kg replacing the reontgen. 1 roentgen is equal to 2.58 x 10 4 C kg1. It is the unit for exposure. There is no special name for this, b Gray Gy replacing the rad. It is the unit of absorbed dose, defined as the dose of ionizing radiation that impart 1 joule of energy to 1 kg of absorbing material. 1 rad is equal to 0.01 Gy. 1 , and c Sievert Sv replacing the rem. It is the SI unit of dose equivalent. The dose equivalent of 1 sievert is equal to 100 rems.Dose equivalent H As all types of radiation do not produce the same biological effect per unit of energy absorbed, the concept of dose equivalent has been introduced. The dose equivalent, M Sieverts is equal to the absorbed dose, D grays , M Sieverts is equal to the absorbed dose, D grays , multiplied by a quality factor Q which depends upon the density of ionization produced in the tissue by the radiation.H DQThe factor Q for X rays and Y rays and electrons is equal to 1, whereas for a particle it is 20 3 . ARADIATION UNITSConventional UnitsNew SI Units These are such units as the three Rs C 1 Roentgen Unit of exposure , 1 mrad 0.001 rad 2 Rad Unit of absorption 3 Rem Unit of equvivalent dose 4 Curie Unit of activity formerly 1 Bq 27 picocuries 1 Coulomb kg Replaced Roentgen2 Gray Replaced Rad 1 rad 0.01 Gy 3 Sievert Replaced Rem 1 Sv 100 rem 4 Becquerel Unit of activity lBq l disinteg sec A. Radioactivity The number of times each second a radioactive material decays and releases radiation. The old unit is curile curie new unit is Bq.B. Absorbed Dose The amount of radiation energy absorbed into a given mass of tissue. Absorbed dose is the radiation quantity used to express the concentration of radiation energy actually absorbed in a specific tissue. This is the quantity that is most directly related to biological effects. Dose values can be in the traditional unit of the rad or the SI unit of the gray Gy . The rad is equivalent to 100 ergs of energy absorbed in a gram of tissue and the gray is one joule of energy absorbed per kilogram of tissue.1 gray Gy 100 rads10 mGy 1 rad1 mGy 100 mradC. Dose Equivalent Measures the energy per unit mass times adjustments for the type of radiation involved quality factor and the biological response in the tissue a weighting factor . Equivalent dose converts dose into an estimate of risk. They are quantities that can be measured and expressed in terms of the more fundamental physical quantities like energy. Dose Equivalent, in the unit, sievert Sv , is a quantity that expresses the relative biological impact of the radiation by including a radiation weighting factor wR . The relationship is Dose Equivalent Sv Dose Gy x wR. The value of the radiation weighting factor wR is a characteristic of each specific type of radiation.D. Effective Dose It is actually a simple and very logical concept. It takes into account the specific organs and areas of the body that are exposed. The point is that all parts of the body and organs are not equally sensitive to the possible adverse effects of radiation, such as cancer induction and mutations. For the purpose of determining effective dose, the different areas and organs have been assigned tissue weighting factor wT values. For a specific organ or body area the effective dose is Efective Dose Gy Absorbed Dose Gy x wTEducational PointsCELL CYCLE AND RADIATION G2 M interphase is most radiosensitive. G2M interphase M G2 The cell is vulnerable to radiation in the stage of mitosis M , less so during synthesis S and relatively insensitive during resting periods. S phase is the most radioresistant phase of cell cycle. But, S phase is the most chemosensitive phase of cell cycle. Radiosensitivity of a cell also depends on its histological type and oxygenation of the tissues.RADIOBIOLOGY Four important processes that occur after radiation exposure can be summarized as the four R s of radiobiology The first is repair. Repair is temperature dependent and is thought to represent the enzymatic mechanisms for healing intracellular injury. The second R is reoxygenation, a process whereby oxygen and other nutrients are actually better distributed to viable cells following radiation injury and cell killing. The third R is repopulation, the ability of the cell population to continue to divide and to replace dying and dead cells. The fourth R is redistribution, which reflects the variability of a cell s radiosensitivity over the cell cycle.

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 following interleukin is characteristically produced in a TH1 response

Ans. is a i.e., IL 2 A. T helper 1 TH1 secretes IL 2 and interferon gB. T helper 2 T f2 secretes IL 4,IL 5, IL 6, EL 13 T cellso T cells are amongst the two important cells of adaptive immune system others are B cells .o T cell precursors arise in bone marrow also in yolk sac liver before birth and migrate to the thymus,o Maturity ofT cells takes place in the thymus So, T cells arise in bone marrow and mature in thymus ,o T cells constitutes 60 70 of the circulating peripheral lymphocytes.o Based on their surface markers. target cells and functions the following T cell category have been identified 1. Helper Inducer T cellsThese cells have CD4 surface marker and are MHC class II restricted.These are further subdivided into A. Effector CD4 helper T cellso These cells secrete cytokines and other products that perform all major functions,o These cells are of following types.TH, cellsThese cells are activated by IFN gThese cells produce IL 2, IFNyand IL 12.These cells facilitate delayed hypersensitivity, cell mediated immunity. Macrophage activation,killing of intracellular microbes e.g., tuberculosis leprosy.These cells also induce destruction of target cell by Activating CD8 T cells to become cytotoxic cells andActivating NK cells.TH, cellsThese cells are activated by IL 4.These cells secrete IL 4,1L 5, IL 6 and IL 13.hese cells facilitates the synthesis of antibodies particularly IgE and cause activation of mast cells and eosinophils Therefore, provide defence against Helminthic parasites.TH17 cellsA third subset of CD4 T cells besides TH1 and TH2 has been discovered recently and is called the TH17 cells.If the antigen producing cells produce inflammatory cytokines such as IL 1, IL 6 and IL 23, these work in collaboration with TGF 3 to stimulate differentiation of T cells to the TH 17 cells.TH17 cells are powerful recruiters of neutrophils and monocytes, and thus play major roles in severe inflammatoiy diseases.They may also be important for defense against some bacterial and fungal infections in which neutrophilic inflammation is a prominent feature.TH 17 cells are activated by some microbial antigens and by self antigens in autoimmune diseases. Activated TH17 cells secret IL 17, IL 22 and chemokines. Collectively, these cytokines recruit neutrophils and monocytes.TH17 cells produce IL 21, which amplifies the TH17 self response.B. Memory CD4 helper T cellso Provide memory, i.e., retain the antigenic affinity of the originally activated T cells and are used to act aslater effector cells during a second immune response.Cytolytk cytotoik T cellsThese cells have CD8 surface marker and are MHC class I restricted.They kill and lyse target cells including tumor cells, virus infected cells and allograft and participate in type II Hypersensitivity.Suppressor T cellsThese cells have CDg surface marker and are MHC class I restricted.These cells down regulate immune response.o Helper T cell CD4 T cell is known as the master regulator of the immune system.o The ratio of CD4 and CD8 T cell is normally 2 1.

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.

Micro RNA transcribed by PGI Dec 2008

Arts B RNA polymerase II E Drosha Micro RNA is transcribed by RNA polymerase IIQ Drosha.Eukaryotic transcription DMA Directed RNA Synthesis Consists of InitiationElongation TerminationPosttranscriptional midification requires requires requires Binding of protein transcription factors and RNA polymerase to promoter sites at the beginning of a geneLocal unwinding of the DNA helix by RNA polymeraseA termination signal sequenceSplicing of mRNA exons to eliminate non coding introns followed by result in Cleavaga and trimming of preribosomal RNAsSynthesis of a 5 3 RNA transcript coded for by the DNA template read in the 3 5 directionRelease of RNA polymerase and newly synthesized transcript from DNA which is facilitated by Enhancer binding transcription factors bound to enhancer sequences at sites far from the gene Trimming and base modification in tRNA Addition of a 3 poly A tall and a 5 7 methyl guanosin cap to mRNA Most miRNA are processed from, RNA polymerase II transcripts of several hundred to thousands of nucleotides in length called Pri miRNA for primary transcript . Within these long transcripts are sequence that fold into hairpin structure. A nuclear RNase specific for double stranded RNA called Drosha acts with a nuclear double stranded RNA binding protein called DGCR8 in human pasha in drosophila cleaves the hairpin region out of the long precursor RNA generating a pre miRNAOnce in cytoplasmic ds RNA specific RNase called Dicer act with a cytoplasmic ds RNA binding protein called TRBP in human to further process the pre miRNA into a ds mi RNA Molecular Biology by Lodish 4th 3 43Micro RNA mi RNA Harper 27th 320This represent a subset of small RNA 1 of total RNA which play important role in gene regulation.Presently all known miRNAs cause inhibition of gene expression by decreasing specific protein production albeit apparently via distinct mechanismmiRNA are typically 21 25 nucleotide in length are generated by nucleolytic processing of the products of distinct genes transcription units. These precursors are single stranded but have extensive intramolecular secondary strcuture.The small processed mature miRNA typically hybridize via formation of imperfect RNA RNA duplex leading via unknown mehanism to translation arrest.miRNA represent exciting new potential target for therapeutic drug development in human.Transcription HARPER 27TH 348. LIPPINCOT4TH 422 24. 429The process of RNA synthesis per se is quite similar in prokaryotes eukaryotes but regulation of RNA synthesis processing of RNA transcripts are differentQIn bacteria one species of RNA polymerase synthesize all RNAs except for the short RNA primer. But in eukaiyotic cell, there are threeQ distinct class of RNA polymeraseRNA polymerase I This enzyme synthesizes the precursors of the 28S, 18S 58S rRNAQ in nucleolus Note mRNA tRNA are synthesized in the nucleoplasm RNA polymerase II This enzyme synthesize the precursors of mRNA that are subsequently translated to produce protein. It also synthesizes certain small nuclear RNA Sn RNA miRNA.RNA polymerase III This enzyme produces the small RNA including tRNAQ 5S ribosomal RNA some Sn RNA.

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 Hydrops, Ectopic calcification, Moth eaten skeletal dysplasia ?

What are the signs and symptoms of Hydrops, Ectopic calcification, Moth eaten skeletal dysplasia? The diagnostic findings of HEM hydrops fetalis, severe micromelia, and ectopic calcification have been present in all cases reported in the medical literature thus far. The following are several of the other signs and symptoms that have been reported in some patients with HEM Polydactyly presence of more than 5 fingers on the hands or 5 toes on the feet Reduced number of ribs Omphalocele Intestinal malformation Abnormal fingernails Less than normal number of lobes in the lung hypolobated lungs Cystic hygroma The Human Phenotype Ontology provides the following list of signs and symptoms for Hydrops, Ectopic calcification, Moth eaten skeletal dysplasia. 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 Abnormality of bone mineral density 90 Abnormality of erythrocytes 90 Abnormality of pelvic girdle bone morphology 90 Abnormality of the ribs 90 Brachydactyly syndrome 90 Limb undergrowth 90 Lymphedema 90 Short stature 90 Decreased skull ossification 50 Malar flattening 50 Narrow chest 50 Skull defect 50 Toxemia of pregnancy 50 11 pairs of ribs Abnormal foot bone ossification Abnormal joint morphology Abnormal lung lobation Abnormal ossification involving the femoral head and neck Abnormal pelvis bone ossification Abnormality of cholesterol metabolism Abnormality of the calcaneus Abnormality of the scapula Abnormality of the vertebral spinous processes Absent or minimally ossified vertebral bodies Absent toenail Anterior rib punctate calcifications Autosomal recessive inheritance Barrel shaped chest Bone marrow hypocellularity Bowing of the long bones Broad palm Cardiomegaly Cystic hygroma Depressed nasal bridge Diaphyseal thickening Disproportionate short limb short stature Epiphyseal stippling Extramedullary hematopoiesis Flared metaphysis Hepatic calcification Hepatomegaly Hepatosplenomegaly High forehead Horizontal sacrum Hypertelorism Hypoplasia of the maxilla Hypoplastic fingernail Hypoplastic vertebral bodies Intestinal malrotation Laryngeal calcification Lethal skeletal dysplasia Long clavicles Low set ears Macrocephaly Mesomelia Metaphyseal cupping Micromelia Misalignment of teeth Multiple prenatal fractures Neonatal death Nonimmune hydrops fetalis Omphalocele Pancreatic islet cell hyperplasia Patchy variation in bone mineral density Pleural effusion Polyhydramnios Postaxial foot polydactyly Postaxial hand polydactyly Pulmonary hypoplasia Punctate vertebral calcifications Rhizomelia Sandal gap Sclerosis of skull base Severe hydrops fetalis Short diaphyses Short phalanx of finger Short ribs Sternal punctate calcifications Stillbirth Supernumerary vertebral ossification centers Tracheal calcification Ulnar deviation of the hand 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.

Which of the following is hallmark of acute inflammation

Ref Robbins 8 e p46 47 9 e p74 ACUTE INFLAMMATION The vascular and cellular reactions that characterize acute inflammation are reflected in the morphologic appearance of the reaction. The severity of the inflammatory response, its specific cause, and the paicular tissue involved all can modify the basic morphology of acute inflammation, pro ducing distinctive appearances. The impoance of recog nizing these morphologic patterns is that they are often associated with different etiology and clinical situations. MORPHOLOGY Serous inflammation is characterized by the outpour ing of a watery, relatively protein poor fluid that, depend ing on the site of injury, derives either from the plasma or from the secretions of mesothelial cells lining the perito neal, pleural, and pericardial cavities. The skin blister resulting from a burn or viral infection is a good example of the accumulation of a serous effusion either within or immediately beneath the epidermis of the skin Fig. 2 11 . Fluid in a serous cavity is called an effusion. Fibrinous inflammation occurs as a consequence of more severe injuries, resulting in greater vascular perme ability that allows large molecules such as fibrinogen to pass the endothelial barrier. Histologically, the accumu lated extravascular fibrin appears as an eosinophilic mesh work of threads or sometimes as an amorphous coagulum Fig. 2 12 . A fibrinous exudate is characteristic of inflam mation in the lining of body cavities, such as the meninges, pericardium, and pleura. Such exudates may be degraded by fibrinolysis, and the accumulated debris may be removed by macrophages, resulting in restoration of the normal tissue structure resolution . However, exten sive fibrin rich exudates may not be completely removed, and are replaced by an ingrowth of fibroblasts and blood vessels organization , leading ultimately to scar ring that may have significant clinical consequences. For example, organization of a fibrinous pericardial exudate forms dense fibrous scar tissue that bridges or obliterates the pericardial space and restricts myocardial function. Suppurative purulent inflammation and abscess formation. These are manifested by the collection of large amounts of purulent exudate pus consisting of neutrophils, necrotic cells, and edema fluid. Ceain organ isms e.g., staphylococci are more likely to induce such localized suppuration and are therefore referred to as pyogenic pus forming . Abscesses are focal collections of pus that may be caused by seeding of pyogenic organ isms into a tissue or by secondary infections of necrotic foci. Abscesses typically have a central, largely necrotic region rimmed by a layer of preserved neutrophils Fig. 2 13 , with a surrounding zone of dilated vessels and fibroblast proliferation indicative of attempted repair. As time passes, the abscess may become completely walled off and eventually be replaced by connective tissue. Because of the underlying tissue destruction, the usual outcome with abscess formation is scarring.

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.

In polycythemia vera all are true except

A High ESR 1049 Davidson 22nd 898 900 H 18 tm 339 Harshmohan 7th 619 Robbins POLYCYTHEMIA VERA PCV is strongly associated with activating point mutations in the tyrosine kinase JAK2 PCV is characterized by increased marrow production of red cells, granulocytes and platelets panmyelosis But it is the increase in red cells polycythemia that is responsible for mcst of the clinical symptomsPresence of JAK 2 mutation is a Maror criterion for diagnosis of polycythemia vera according to the WHO criteria for the diagnosis of polycythemia vera.Low Eryhropoetin levels, Thrombocytosis and increased LAP scores are al1 minor criteria for diagnosis of polycythemia vera.JAK 2 Mutation and polycythemia Vera JAK 2 is a member of an evolutionarily well conserv ed, non receptor tyrosine kinase family and serves as the cognate tyrosine kinase for the erythropoietin receptors A mutation in the tyrosine kinase AK 2 appears to have a central role in the pathogenesis of PV by causing constitutive activation of the kinase The presence of JAK 2 mulation thus allows for the exclusion of a reactive erythrocytosis. The 2001 WHO criteria for diagnosis of PV were however developed prior to the discovery of this important mutation and hence revised WHO criteria have been developed that include presence of JAK 2 mutation as a major criterion for diagnosis.NoteAlthough presence of JAK 2 mutation is a major criterion for diagnosis of PV, the presence of JAK 2 mutation alone is not diagnostic of PV, JAK 2 mutations may also be seen in other myeloproliferative disorders such as Essential Thrombocytosis ET and chronic Idiopathic Myelofibrosis CIMF Various major and minor criteria used for the diagnosis of polycythemia vera in various classification system WHO criteria revised and oldVpolvcythemia Vera study group criteria MajorMinor JAK2 V617 F mutation Hemoglobin 18.5 g dl in men 16.5 g dl in women Increased red blood mass Splenomegaly Clonal genetic abnormality other than Philadelphia chromosome or BCR ABL in marrow Endogenous erythroid colony formation in vitro Normal arterial O2 saturation 92 Thrombocytosis 400 x 109 L Leucocytosis WBC 12 x 109 L Increased leukocyte alkaline phosphatase LAP 100U Increased serum B12 binders B12 900 pg ml unbound B12 binding capacity 2200 pg ml Low serum erythroprotein levels. Panmyelosis with prominent erythoid and megakaryocytic hyperplasia an bone marrow biopsyRevised WHO criteria proposed for thes diagnosis of polycythemia veraRevised WHO criteria proposed for the diagnosis fo polycythemia veraMaior criteria Hemoglobin 18.5 g dl in men 16.5 g dl in women or evidenced on increased red cell volume Presence of JAK2 mutationMinor criteria Hypercellular bone marrow biopsy with panmyelosis with prominent erythroid, granulocytic, and megakaryocytic hyperplasia Low serum erythropoietin level Endogenous erythroid colony formation in vitroWHO Criteria for the diagnosis of plvcvthemia Vera prior to the proposed new criterion WHO criteria previous for the diagnosis of plycythemia veraMaior criteria Red blood cell mas 25 above mean normal predicted value, or Hb 18.5 g dl in men, 16.5g dl in women Splenomegaly on palpation Clonal genetic abnormality other than Philadelphia chromosome of BCR ABL in marrow Endogenous erythroid colony formation in vitroMinor criteria Thrombocytosis 400x 199 L WBC 12x 109 L Panmyelosis with prominent erythroid and megakaryocytic hyperplasia on bone marrow biopsy Low serum erythropoietin levels.ESR is only indirect measurement of serum acute phase protein concentrations particularly fibrogen. ESR ESR Infections Inflammatory disease Temporal arteritis, poly myalgia rheumatic, Rheumatic fever Malignant neoplasm Paraproteinemias Pregnancy CRF Gi disease ulcerative regional colitis Polycythemia Sickle cell anemia spherocytosis anisocytosis. Hypofibrogenemia Hypogammaglobulinemias CHF Micro cytosis Highdoses corticosteroids ESR is elevated in multiple myeloma serum alkaline phosphatase is normal in multiple myeloma, even with extensive involvement. This is because with there is no osteoblastic activity usually .

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.

Maximum pressure in left ventricle is seen in which phase of cardiac cycle ?

Ans. is b i.e., Ventricular ejection During ventricular ejection phase, when the steeply rising left ventricular pressure exceeds the aoic pressure 120 mm Hg , it is able to push open the aoic valve and eject the blad into the aoa, making the onset of ventricular ejection. PHASE OF CARDIAC CYCLE A cardiac cycle refers to the interval between onset of one heabeat to the onset of the next hea beat. It has two main phases Ventricular systole and ventricular diastole. Ventricular systole or simply systole The systolic phase is divided into i Isovolumetric contraction As the ventricular contraction stas, the intraventricular pressure begins to rise, leading to an abrupt closure of AV valves mitral and tricuspid valves . The closure of AV valves produces first hea sound S1 . the pressure is not enough to push open the semilunar valves aoic and pulmonary but causes the closed AV valve to bulge into the atrium, causing a small but sharp rise in atrial pressure called the C wave on jugular venous pulse JVP . Because both the valves AV valves an semilunar valves are closed, there is no change in volume, i.e., there is isovolumetric isometric contraction. Isovolumetric contraction ends with opening of semilunar aoic and pulmonary valves. ii Ventricular ejection When the steeply rising ventricular pressure exceeds the pressure in aoa and pulmonary aery, the semilunar valves open and ventricular ejection begins. The ejection of blood is rapid at first rapid ejection phase , but slows down during later pa of systole slow ejection phase . During rapid ejection phase, when the ventricles contract, the fibrous paition separating the ventricles from the atria the AV ring is pulled down. As a result, the atrial muscles get stretched and the atria dilate which causes a sharp fall in atrial pressure and the X descent in JVP. iii Protodiastole In this very sho phase, ventricles sta relaxing and ventricular pressure begins to fall very sharply but the semilunar valves are still open. As a result, the column of blood in aoa or pulmonary aery for right ventricle tries to fall into the ventricle, hitting on its way the semilunar aoic or pulmonary valves. This causes closure of the aoic pulmonary valves which produces 2 hea sound S2 . The venous blood flow continues to flow in the atria from great veins SVC and ICC and there is relaxation of fibrous AV ring due to ventricular relaxation both of which cause a rise in atrial pressure and production of V wave in JVP. Ventricular diastole or simply diastole The diastole phase is divided into i Isovolumetric relaxation This phase is the period between the closure of semilunar valve and opening of the AV valve. The ventricles continue relaxing and there pressure continues to fall. However, as both valves AV valves and semilunar valves are closed, there is no change in volume, i.e., isovolumetric relaxation. Relaxation phase ends with opening of AV valve. ii Rapid ventricular filling When the ventricular pressure falls below atrial pressure, AV valves open and the accumulated blood in the atria rushes into the ventricle very rapidly. This passive filling contributes to 70 of ventricular filling, normally. This results in a sharp fall in atrial pressure which produces Y descent in JVP. iii Diastasis After the initial rapid ventricular filling, blood flows slowly and smoothly from the SVC and IVC through the right atrium into the right ventricle without any turbulence anywhere along the path. Similarly, blood from the pulmonary veins flows into the left ventricle without any turbulence. This phase of nonturbulent ventricular filling is called diastasis. The atrial pressure remains slightly greater than the ventricular pressure because inflow to atrium exceeds the outflow the atrium. iv Last rapid filling phase atrial systole The atria contract and pump blood rapidly into the ventricles.Atrial systole is associated with sharp rise in atrial pressure which produces a wave in JVP.

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.

Inapproprite ADH secretion is characterised by the following except

Syndrome of inappropriate antidiuretic hormone secretion SIADH is a condition in which the body makes too much antidiuretic hormone ADH . This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water . Actions of ADH Osmoregulation The most impoant and primary function of ADH is to maintain the plasma tonicity, primarily by an alteration in water balance. Osmoreceptors detect the change in effective plasma osmolality in the hypothalamus. A decrease in tonicity prevents ADH release and prevents water retention. An increase in tonicity causes ADH release, which acts on V2 receptors on the luminal surface of coical and medullary collecting tubular cells. Under the influence of ADH, unique aquaporin 2 water channels are formed by the fusion of pre formed cytoplasmic vesicles in the tubular cells and water is absorbed down the concentration gradient. Once the water is absorbed, these channels are removed by endocytosis and returned to the cytoplasm. The osmoreceptors are extremely sensitive, responding to alterations in the plasma tonicity of as little as 1 . The osmotic threshold for ADH release in humans is about 280 to 290 mOsmol kg. Below this level, their is little circulating ADH, and the urine should be maximally diluted with an osmolality below 100 mOsmol kg. Above the osmotic threshold, their is a relatively linear rise in ADH secretion. This system is so efficient that the plasma osmolality does not typically vary by more then 1 to 2 , despite wide water intake fluctuations. In patients with SIADH, levels of ADH are high even in the presence of decreased plasma osmolality and or hyponatremia. Excess water absorption keeps the blood volume high or normal. Volume Regulation An acute drop in blood pressure as sensed by volume receptors rather then osmoreceptors causes ADH release along with other hormones like rennin and epinephrine which generates free water absorption from the kidneys. This can potentially lead to hyponatremia and a decrease in effective ECF osmolality. So, the main focus in rapid and or substantial decrease in blood volume is volume regulation, even at the cost of osmolality. This affect is more prominent in patients with liver disease or cardiac disease, and hyponatremia in such patients is the direct predictor of a worse prognosis Clinical manifestations of SIADH can be due to hyponatremia and decreased ECF osmolality which causes the water to move into the cells causing cerebral edema. Signs and symptoms depend upon the rate and severity of hyponatremia and the degree of cerebral edema. The earliest clinical manifestations of acute hyponatremia include nausea and malaise, which may be seen when the serum sodium concentration falls below 125 to 130 mEq L normal 135 to 145mEq L . Vomiting is an ominous sign for patients with acute hyponatremia. With a more severe and acute fall in sodium concentration, headache, lethargy, obtundation, and eventually, seizures can occur. Coma and respiratory arrest can occur if the serum sodium level falls below 115 to 120 mEq L. Acute hyponatremic encephalopathy may be reversible, but permanent neurologic damage or death can occur, paicularly in premenopausal women. Chronic hyponatremia allows cerebral adaptation, and the patients remain asymptomatic despite a serum sodium concentration below 120mmol L. Nonspecific symptoms like nausea, vomiting, gait disturbances, memory and cognitive problems, fatigue, dizziness, confusion, and muscle cramps can occur with chronic hyponatremia. Sign and symptoms or mild and chronic hyponatremia are often subtle and missed during history and physical examination. Nausea and vomiting effect approximately one third of patients with chronic hyponatremia who have a serum sodium concentration less then 120 mmol L. The Idiopathic SIADH is more common in patients over 65 years of age, and mild to moderate hyponatremia in such patients may contribute to fractures in addition to a higher risk of falls and gait problems. Schwaz and Bater made a clinical criterion in 1967 which is still valid up to the date. The Schwaz and Bater Clinical Criterion Serum sodium less then 135mEq L Serum osmolality less then 275 mOsm kg Urine sodium greater then 40 mEq L due to ADH mediated free water absorption from renal collecting tubules Urine osmolality greater then 100 mOsm kg The absence of clinical evidence of volume depletion normal skin turgor, blood pressure within the reference range The absence of other causes of hyponatremia adrenal insufficiency, hypothyroidism, cardiac failure, pituitary insufficiency, renal disease with salt wastage, hepatic disease, drugs that impair renal water excretion. Correction of hyponatremia by fluid restriction Ref Davidson s medicine 23e p357b , pubmed.com

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 Aplastic Anemia ?

Treatments for aplastic anemia include blood transfusions, blood and marrow stem cell transplants, and medicines. These treatments can prevent or limit complications, relieve symptoms, and improve quality of life. Blood and marrow stem cell transplants may cure the disorder in some people who are eligible for a transplant. Removing a known cause of aplastic anemia, such as exposure to a toxin, also may cure the condition. Who Needs Treatment People who have mild or moderate aplastic anemia may not need treatment as long as the condition doesn t get worse. People who have severe aplastic anemia need medical treatment right away to prevent complications. People who have very severe aplastic anemia need emergency medical care in a hospital. Very severe aplastic anemia can be fatal if it s not treated right away. Blood Transfusions Blood transfusions can help keep blood cell counts at acceptable levels. A blood transfusion is a common procedure in which blood is given to you through an intravenous IV line in one of your blood vessels. Transfusions require careful matching of donated blood with the recipient s blood. Blood transfusions help relieve the symptoms of aplastic anemia, but they re not a permanent treatment. Blood and Marrow Stem Cell Transplants A blood and marrow stem cell transplant replaces damaged stem cells with healthy ones from another person a donor . During the transplant, which is like a blood transfusion, you get donated stem cells through a tube placed in a vein in your chest. Once the stem cells are in your body, they travel to your bone marrow and begin making new blood cells. Blood and marrow stem cell transplants may cure aplastic anemia in people who can have this type of treatment. The transplant works best in children and young adults with severe aplastic anemia who are in good health and who have matched donors. Older people may be less able to handle the treatments needed to prepare the body for the transplant. They re also more likely to have complications after the transplant. If you have aplastic anemia, talk with your doctor about whether a blood and marrow stem cell transplant is an option for you. Medicines If you have aplastic anemia, your doctor may prescribe medicines to Stimulate your bone marrow Suppress your immune system Prevent and treat infections Medicines To Stimulate Bone Marrow Man made versions of substances that occur naturally in the body can stimulate the bone marrow to make more blood cells. Examples of these types of medicines include erythropoietin and colony stimulating factors. These medicines have some risks. You and your doctor will work together to decide whether the benefits of these medicines outweigh the risks. If this treatment works well, it can help you avoid the need for blood transfusions. Medicines To Suppress the Immune System Research suggests that aplastic anemia may sometimes occur because the body s immune system attacks its own cells by mistake. For this reason, your doctor may prescribe medicines to suppress your immune system. These medicines allow your bone marrow to start making blood cells again. They also may help you avoid the need for blood transfusions. Medicines that suppress the immune system don t cure aplastic anemia. However, they can relieve its symptoms and reduce complications. These medicines often are used for people who can t have blood and marrow stem cell transplants or who are waiting for transplants. Three medicinesoften given togethercan suppress the body s immune system. They are antithymocyte globulin ATG , cyclosporine, and methylprednisolone. It may take a few months to notice the effects of these medicines. Most often, as blood cell counts rise, symptoms lessen. Blood cell counts in people who respond well to these medicines usually don t reach normal levels. However, the blood cell counts often are high enough to allow people to do their normal activities. People who have aplastic anemia may need long term treatment with these medicines. Medicines that suppress the immune system can have side effects. They also may increase the risk of developing leukemia lu KE me ah or myelodysplasia MI e lo dis PLA ze ah MDS . Leukemia is a cancer of the blood cells. MDS is a condition in which the bone marrow makes too many faulty blood cells. Medicines To Prevent and Treat Infections If you have aplastic anemia, you might be at risk for infections due to low white blood cell counts. Your doctor may prescribe antibiotic and antiviral medicines to prevent and treat 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.

All are true about ESBL except aEUR

3rd and 4th generation sensitivity is must Penicillins were the earliest antibiotics to be developed. Penicillins and their related group of antibiotics were called fi lactam antibiotics because they contained a .four carbon ring called 3 lactam ring. Within a few years of introduction of penicillin, bacterias staed acquiring resistance against penicillins by producing penicillinase. To overcome this problem penicillinase resistant penicillins came into picture. Sholy afterwards, the broad spectrum penicillin and first gene ration cephalosporins were introduced. They remained, first line antibiotics for several years. Over a period of time bacterias developed resistance even against these organisms by producing fi lactamase. 13 lactamase are enzymes that break open the 13 lactam ring and deactivate the antibiotic. The fi lactamases hydrolyze penicillins and narrow spectrum cephalo sporin, such as cephalothin or cefazolin, and are resistant to them. To counteract the problems against fi lactamases new classes of 3 lactams were developed. These are cephalosporins containing oxy minio side chain e.g. ceftizoxime, cefotaxine, ceftazidime, ceftriaxone broad spectrum cephalosporins . Consequently, when these oxymino side chain containing corn pounds were introduced they were effective against a broad group of otherwise resistant bacterias. 3 lactamases cannot hydrolyze higher generation cephalosporins with an oxymino side chain cefotaxime, ceftizoxime, ceftazidime . But not long ago after these cephalosporins came into use strains of klebsiella pneumonia were discovered which were resistant even to oxyimino containing cephalosporins e.g. cefotaxime, cefazidime, ceftriaxone The mechanism of this resistance was production of extended spectrum fi lactamase enzyme ESBL . These bacterias are called ESBL bacterias Bucterias are classified as extended spectrum 3 lactamase ESBL producing bacteria, when a simple point mutation occurs in genes normally responsible for beta lactamase mediated resistance. The mutation usually responsible is TEM . As a result of the mutation, organisms, are able to produce novel beta lactamases that can hydrolyze all the 13 lactam containing antibiotics which includes even the oxyminio group containing cephalosporins ceftizoxime, cefotaxime, ceftazidime, ceftriaxone , Aztreonam and all the older fi lactam drugs. Because of their greatly extended substrate range these enzymes were called extended spectrum filactamase ESBLS are capable of efficiently hydrolyzing Penicillins Narrow spectrum cephalosporins Many extended spectrum cephalosporins Oxyimino group containing cephalosporins cefotaxime, ceftazidime Monobactams aztreonams Beta lactcunase inhibitors clavulanic acid sulhactam An impoant point None of the ESBLS described till to date are able to hydrolyze cephamycin or carbepenems imipenem, meropenems ESBL producing organisms are associated with gram negative bacterias and most of these organisms are in the family. Enterobacteriaeae and has been discovered in almost all members of the enterobacteriaceae family. The enterobacteriacea species most commonly associated with ESBL are klebsiella Klebsiella pneumonia predominantly and E. coli. Laboratory diagnosis of ESBLs Detection of bacterias expressing ESBL is difficult. Although a paicular ESBL will typically confer resistance to at least one paicular extended spectrum cephalosporin or aztreonam, the minimum inhibitory concentration may not be high enough for the strain to be called resistant under current interpretations of the national committee for clinical laboratory standards. Because of the clinical significance of ESBL a specific guideline for the detection of ESBL expressing organisms were proposed in 1999 by NCCLS. The presence of an ESBL is suggested if ? Bacterial growth is observed despite a concentration of I p g ml of at least one of three extended spectrum cephalosporins ceftazidime, ceftriaxone, cefotaxime or Aztreonam or growth occurs despite a concentration of 4 p g ml of cefpodoxime. Classification of fl lactamase The number of 13 lactamase enzyme is continuously increasing at an alarming rate. Various classifications have been proposed.for lactamases. The earliest classification by sawai was based on Antisera. 3 lactamases have also been classified based on substrate profile, correlation of substrate and inhibitory propeies . A modern system of classification ambler is based on the molecular structure. Recently a new classification system has been developed by Bush Jacoby medeiors to integrate functional and molecular characteristics. This scheme puts 178 fi lactamases from naturally occurring bacterial isolates into four groups bused on substrate and inhibitor profiles. Treatment of ESBL S Of all the available fl lactams carbepenents are the most effective and reliable as they are highly resistant to the hydrolytic activity of the iglactamase. None of the ESBLS described till todate are able to hydrolyze cephamycin or Carbepenem imipenem. nteropetzem Meropenem is the most active with MIC generally lower than those of imipenem. Beta lactamase inhibitors Clavulanic acid, sulbactam. Tazobactam Although ESBL activity is inhibited by clavulanic acid the only infections that may be treated safely with fi lactam Q lactamase inhibitor combinations are those involving the urinary tract. In this instance p lactamase inhibitor concentration is high enough to counteract the hydrolytic activity of ESBL s clavulinic acid appears more efficient than sulbactam It takes about eight times more sulbactam to obtain a protection similar to that given by clavulinic acid . Non plactam antibiotics Non ,B lactam antimicrobial agents aininoglycosides, fluoro quinolones may be beneficial however, coresistance rates against these agents are frequent.

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 true about linkage analysis in familial gene disorders?

Characteristic DNA polymorphism in a family is associated with disorders Ref Harrison 17 e p4031 We are not able to make sense of the options, but let s see what linkage analysis is all about. At least this could help somewhat... Prepare you for the correct options or other options in the exams. The human genome is very large and contains many thousands of genes. Therefore, finding the paicular gene or genes responsible for any given human disease is very difficult. Traditionally, the search for a disease gene begins with linkage analysis. In this approach, the aim is to find out the rough location of the gene relative to another DNA sequence called a genetic marker, which has its position already known. The principle of linkage analysis Two fundamental principles are essential for understanding the concept of linkage. 1 When two genes or alleles are close together on a chromosome, they are usually transmitted together. Thus they are said to be linked. For example, in fruit flies the genes affecting eye color and wing length are inherited together because they appear on the same chromosome. Alleles for genes on different chromosomes are usually not linked, due to independent assoment of chromosomes during meiosis. 2 Because there is some crossing over of DNA when the chromosomes segregate, even linked alleles on the same chromosome can be separated and go to different daughter cells. There is a greater probability of this happening if the alleles are far apa on the chromosome, as it is more likely that a cross over will occur between them. The odds of crossing over, or recombinant event, between two linked genes is propoional to the distance that separates them. Thus, genes that are far apa are more likely to undergo a recombination event than genes that are very close together. Thus by working out the number of recombinants it is possible to obtain a measure for the distance between the genes. This distance is called a genetic map unit m.u. , or a centimorgan and is defined as the distance between genes for which one product of meiosis in 100 is recombinant. A linkage map is created by finding the map distances between numbers of traits that are present on the same chromosome, ideally avoiding having significant gaps between traits to avoid the inaccuracies that will occur due to the possibility of multiple recombination events. Linkage mapping is critical for identifying the location of genes that cause genetic diseases. A linkage map is a chromosome map of a species or experimental population that shows the position of its known genes and or markers relative to each other in terms of recombination frequency, rather than as specific physical distance along each chromosome. Polymorphism is essential for linkage studies because they provide a means to distinguish the maternal and paternal chromosomes in an individual. All chromosomes are paired, one inherited from our mother and one from our father. Each pair of chromosomes contains the same genes in the same order, but the sequences are not identical. This means it should be easy to find out whether a paicular sequence comes from our mother or father. These sequence variants are called maternal and paternal alleles. Genetic markers are DNA sequences that show polymorphism variations in size or sequence in the population. They are present in everyone and they can be typed the allele can be identified using techniques such as the polymerase chain reaction . Disease genes are mapped by measuring recombination against the panel of different markers spread over the entire genome. In most cases, recombination will occur frequently, indicating that the disease gene and marker are far apa. Some markers however, due to their proximity, will tend not to recombine with the disease gene and these are said to be linked to it. Ideally, close markers are identified that flank the disease gene and define a candidate region of the genome between 1 and 5 million bp in length. The gene responsible for the disease lies somewhere in this region. Linkage is expressed as a lod logarithm of odds score the ratio of the probability that the disease and marker loci linked rather than unlinked. By convention, a lod score greater than 3.0 is considered evidence for linkage. A score of 3.0 means the likelihood of observing the given pedigree if the two loci are not linked is less than 1 in 1000 . On the other hand, a lod score less than 2.0 is considered evidence to exclude linkage. Markers that are closest to the disease gene are less likely to undergo recombination events and therefore receive a higher linkage score. Linkage analysis is possible only for familial diseases, wherein pedigree analysis of the disease is done in that family. All the family is screened for the presence of all known polymorphisms. Then the polymorphism that is present in all the affected cases is identified as the linked allele and based on the location of this polymorphism, the possible location of the disease gene can be identified.

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 23 year old male patient presented with a history of back pain, which is more in the morning and relieved by bathing in warm water. What is the likely additional finding present in this patient?

Ans. d. Decreased chest wall expansion Ref Harrison 19 e p2170, 18 e p2775 History of back pain, which is more in the morning and relieved by bathing in warm water is characteristic of spondylo arthropathy, like ankylosing spondylitis. Ankylosing spondylitis leads to extra parenchymal restrictive lung disease, associated with decreased chest wall expansion. Ankylosing Spondylitis The initial symptom is usually dull pain, insidious in onset, felt deep in the lower lumbar or gluteal region, accompanied by low back morning stiffness of up to a few hours duration that improves with activity and returns following inactivity. Harrison 19 e p2170 Ankylosing Spondylitis Initially physical findings mirror the inflammatory process. The most specific findings involve loss of spinal mobility, with limitation of anterior and lateral flexion and extension of the lumbar spine and of chest expansion. Limitation of motion is usually out of proportion to the degree of bony ankylosis, reflecting muscle spasm secondary to pain and inflammation. Pain in the sacroiliac joints may be elicited either with direct pressure or with stress on the joints. In addition, there is commonly tenderness upon palpation at the sites of symptomatic bony tenderness and paraspinous muscle spasm. Harrison 19 e p2170A. Obstructive lung diseaseB. Restrictive lung disease Asthma Bronchiectasis Bronchiolitis Cystic fibrosis COPD Chronic bronchitis, Emphysema Mnemonic ABCDE ParenchymalExtra Parenchymal Sarcoidosis Pneumoconiosis Idiopathic pulmonary fibrosis Drug Radiation induced interstitial lung disease Neuromuscular diseases Diaphragmatic palsy Guillain Barre syndrome Muscular dystrophy Cervical spine injury Chest wall diseases Kyphoscoliosis Obesity Ankylosing spondylitisAnkylosing Spondylitis Marie Strumpell or Bchtrew s diseaseEtiology Pathogenesis More than 90 patients of AS are HLA B27 positiveQ.The enthesis. the site of ligament attachment to bone is primary site of pathology in ASQ.Sacroilitis is the earliest manifestation with features of both enthesitis synovitisQ.Clinical Presentation Males are affected more frequently than females.Age of onset is 15 25 years late adolescence early adulthood Q.The initial symptom is usually dull pain, insidious in onset, accompanied by low back morning stiffness of up to few hours duration that improves with activity and returns following period of inactivityQ.Arthritis in hips shoulders root joints occur in 25 35 Q.Peripheral joints usually shoulder, hips knees are involved in one third of patientsQ.Most serious complication of spinal disease is spinal fracture with even minor trauma.MC extra articular manifestation is acute anterior uveitis iridocyclitis Q.Diagnosis Radiological Examination The following changes may be seen on an X ray of the pelvis Haziness of sacro iliac jointsQ Irregular subchondral erosions in SI jointsQ Sclerosis of the articulating surfaces of SI jointsQ Widening of sacro iliac joint spaceQ Bony ankylosis of the sacro iliac jointsQ Calcification of the sacro iliac ligaments and sacro tuberous ligaments Evidence of enthesopathy Calcification at the attachment of the muscles, tendons and ligaments, particularly around the pelvis heelQ.X ray of Lumbar spine in Ankylosing Spondylitis Squaring of vertebraQ The normal anterior concavity of the vertebral body is lost because of calcification of the anterior tongitudinai ligament Loss of lumbar lordosisQ Bridging osteophytes syndesmophytes Q Bamboo spine appearanceQ due to syndesmophytes paravertebral ossificationTreatment Phenylbutazone is the most effective drugQ causes aplastic anemia .Indomethacin is most commonly used NSAIDQ.

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 pediatric hea surgeon has just divided the sternum in a child to repair a cardiac malformation. A lobulated gland like structure is seen immediately obscuring the hea. This is most likely which of the following

The anterior mediastinum lies immediately posterior to the sternum and contains the thymus in children. The mediastinum is the central poion of the thoracic cavity, and it lies between the two pulmonary cavities. It is bounded laterally by the mediastinal pleura. It contains all the thoracic viscera except the two lungs. Superior and inferior divisions are described, with the latter fuher divided into anterior, middle, and posterior divisions. The superior mediastinum extends from the superior thoracic apeure bounded by the superior border of the manubrium, first rib, and T1 veebral body. The inferior boundary is a horizontal line from the sternal angle posterior to the interveebral disc between T4 and T5. The superior mediastinum contains the following structures, from anterior to posterior adipose tissue with remnants of the thymus gland, right and left brachiocephalic vein, SVC, aoa with its brachiocephalic trunk, left common carotid and left subclan aerial branches,trachea,esophagus,and thoracic duct. Related to these structures are the phrenic, vagus, left recurrent laryngeal and cardiac nerves, and anterior mediastinal lymph node group. The inferior mediastinum is bounded anteriorly by the sternum,posteriorly by veebral bodies T5 through T12, and the diaphragm inferiorly. The anterior mediastinum poion lies between the sternum and the pericardial sac and contains small branches of the internal thoracic aery and a few nodes of the parasternal lymph node group. The thymus gland is present during childhood. The middle mediastinum contains the pericardial sac with the hea, terminations of the SVC, inferior vena cava IVC , and pulmonary veins, the ascending aoa, the pulmonary trunk and its bifurcations into the right and left pulmonary aeries, lung roots, phrenic nerve, and bronchial lymph nodes. The posterior mediastinum lies between the pericardial sac and veebral bodies T5 through T12. It contains the esophagus, descending thoracic aoa and right intercostals and esophageal aeries, azygous venous system, thoracic duct, vagus and splanchnic nerves, and posterior mediastinal lymph nodes. The body s main lymphatic vessel, the thoracic duct, originates in the abdomen at the level of L1 as a highly variable dilation called the cisterna chili. It enters the posterior mediastinum through the aoic hiatus and lies on the right anterior surface of the thoracic veebral bodies, posterior to the esophagus between the azygous venous system and the thoracic aoa. By the level of the sternal angle, the duct completes a shift to the left side, traverses the superior mediastinum, and terminates by emptying into the venous system near the junction of the left internal jugular and subclan veins. The thoracic duct receives lymph drainage from the lower limbs, abdomen and left hemithorax, upper limb, and head and neck. A small right lymphatic duct receives lymph drainage from the right hemithorax, upper limb, and head and neck. The thoracic and right lymphatic ducts are described as receiving lymph from jugular, subclan, and broncho mediastinal trunks, although these trunks may variably unite or empty into veins independently. Ref BD Chaurasia

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 pregnant female has past history of embolism in puerperium. What medical management she should take in next pregnancy to avoid this

Ans. is b i.e. To take Warfarin after delivery Friends venous thromboembolism in pregnancy, is one of those topics which we donot study in detail during undergraduation. So, I am giving in brief, all the impoant points you need to remember Venous thromboembolism in pregnnacy Venous thromboembolism is the leading cause of maternal deaths in developed countries. Pregnancy increases the risk of thromboembolism 6 times as all components of virchow s triad are increased.deg A. Deep vein thrombosis Left sided DVT is more common than Right sided DVT. Clinical features swelling redness pain and calf muscle tenderness and oedema. Investigations Recommended method during pregnancy Doppler ultrasound Gold standard in conditions other than pregnancy venography Mangement Therapeutic The treatment should be staed on clinical grounds if confirmatory tests are not available. Drug of choice Heparin as it doesnot cross the placenta Initially intravenous Heparin is given with the aim to prolong APTT activated paial thromboplastic time by 1.5 to 2 times the control followed by subcutaneous Heparin. Monitoring is done by APTT and platelet count as Heparin causes Thrombocytopenia . Oral anticoagulants like Warfarin cross the placenta and cause teratogenesis therefore should be avoided in pregnancy. Treatment is continued for 6 weeks following which prophylactic subcutaneous heparin is given throughout pregnancy. Heparin is stopped just before delivery. Regional anaesthesia should be avoided at the time of delivery in patients on heparin due to the risk of hematoma formation. Heparin is restaed about 6 8 hours after delivery as the puerperium is the time of greatest risk for VTE. Warfarin is commenced simultaneously and thereafter monitoring is done by prothrombin time PT . Once the prothrombin time INR is between 2 and 3, heparin can be discontinued. Usually warfarin is continued for 6 to 18 weeks and is safe for breast feeding mothers. Thromboprophylaxis Thromboprophylaxis is considered for women who are at increased risk of thromboembolism TE . Risk category Risk factors High risk Recurrent TE Previous TE with thrombophilia Previous TE with family history TE in current pregnancy Low risk One episode of previous TE without thrombophiiia or family history Thrombophilia without previous thrombosis Additional risk Cesarean section, obesity, grand multiparity, age above 35, pre eclampsia, prolonged immobilization etc. High risk patients need antepaum heparin, intrapaum heparin and postpaum prophylaxis for 6 weeks. Low risk patient require intrapaum and postpaum low dose prophylaxis for 6 weeks. Well, now that you have a detailed knowledge of thromboembolism, lets have a look at the question. It says a female with previous history of embolism becomes pregnant,what medical management should be given to her? Option a. i.e. Compulsory prophylaxis with warfarin at 10 weeks. It is absolutely wrong as warfarin is not given during pregnancy. Option b Le to take warfarin after delivery According to William obs. 22 e, p 1077 table 47 3, 23 e, p 1028 table 47.6 In case of prior VTE associated with a non recurring risk factor and no known thrombophilia? During pregnancy Only surveillance is required as per American college of chest physicians. Prophylaxis with low molecular weight heparin is required as per American college of obs gynaecology which also explains option d is paly correct . Postpaum warfarin is given for 6 weeks. So, option b is absolutely correct i.e. warfarin should be given in the post paum period for six weeks.

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.

Action of scoline is potentiated by?

Ans. A. Nitrous oxide. Ref. Paul s anaesthesia 5th pg. 427 428 Miller 7th pg. 867 Paul s anaesthesia 5th pg. 427 428 .............. The mean dose of scoline producing 95 blockade ED95 at the adductor pollicis is 0.30 to 0.35 mg kg with opioid nitrous oxide anesthesia. In the absence of nitrous oxide, the ED95 is increased to 0.5 mg kg .DEPOLARIZING DRUGS SUCCINYLCHOLINENeuromuscular Effects depolarizes presynaptic, postsynaptic, and extrajunctional receptors. Within 1 minute after succinylcholine injection and before paralysis is manifest, some disorganized muscular activity is observed frequently fasciculations and is probably a result of depolarization of the nerve terminal produced by activation of presynaptic receptors. In some muscles, like the masseter and to a lesser extent the adductor pollicis, a sustained increase in tension that may last for several minutes can be observed spasm .Characteristics of Depolarizing Blockade After injection of succinylcholine, single twitch height is decreased. However, the response to high frequency stimulation is sustained minimal train of four and tetanic fade is observed. The block is antagonized by nondepolarizing agents so that the ED95 is increased by a factor two if a small dose of nondepolarizing drug is given before. Succinylcholine blockade is potentiated by inhibitors of acetyl cholinesterase, such as neostigmine and edrophonium. Phase II Block After administration of 7 to 10 mg kg, or 30 to 60 minutes of exposure to succinylcholine, train of four and tetanic fade become apparent. Neostigmine or edrophonium can antagonize this block, which has been termed nondepolarizing, dual, or Phase II block. The onset of Phase II block coincides with tachyphylaxis, as more succinylcholine is required for the same effect.Pharmacology of Succinylcholine Succinylcholine is rapidly hydrolyzed by plasma cholinesterase also called pseudocholinesterase , with an elimination half life of 1 minute in patients. Because of the rapid disappearance of succinylcholine from plasma, the maximum effect is reached quickly. Plasma cholinesterase activity is reduced by some anticholinesterases e.g., neostigmine so that the duration of succinylcholine given after neostigmine, but not after edrophonium, is increased.Side Effects Sinus bradycardia with nodal or ventricular escape beats. Anaphylaxis Fasciculations Muscle Pains increases intragastric pressure Hyperkalemia increases intraocular Pressure ICP Clinical Uses to facilitate tracheal intubation adult dose of 1.0 mg kg Children are slightly more resistant to succinylcholine than adults, and doses of 1 to 2 mg kg are required to facilitate intubation. In infants, 2 to 3 mg kg may be required. Precurarization is not necessary in patients younger than 10 years . rapid sequence induction patient with full stomach and possibility of aspiration . Succinylcholine, at a dose of 4 mg kg, is the only effective intramuscular neuromuscular blocking agent in children with difficult intravenous access and provides adequate intubating conditions in about 4 minutes. However, this route of administration should not be the method of choice.Additional Educational points Sevoflurane Fast induction and emergence Rapid changes in depth can be achieved. Acceptability is good by pediatric patients agent of choice for induction in children . Hepatic blood flow is maintained. Does not cause sympathetic stimulation and airway irritation even during rapid induction. Amount of fluoride liberated is safe for kidney and liver. Degraded by sodalime hence not recommended for use in closed circuit.

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 26 year old female patient presented with fever, oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both side. Which of the following indicates the condition associated with these manifestations?

SLE is an autoimmune disease involving multiple organs, characterized by a vast array of autoantibodies, paicularly antinuclear antibodies ANAs , in which injury is caused mainly by deposition of immune complexes and binding of antibodies to various cells and tissues. 1997 Revised Criteria for Classification or Systemic Lupus Erythematosus Criteria Definition 1. Malar Rash Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds 2. Discoid rash Erythematous raised patches with adherent keratotic scaling and follicular plugging, atrophic scarring may occure in older lesions 3. Photosensitivity Rash as a result or unusual reaction to sunlight by patient history or physician observation 4. Oral ulcers Oral or nasolpharyngeal ulceration, usually painless, observed by a physician 5. Ahritis Nonerosive ahritis involving, two or more peripheral joints, characterized by tenderness, swelling or effusion 6. Serositis Pleuruitis convincing history of pleuritic pain or rub heard by a physician or evidence of pleural effusion, orPericarditis documented by electrocardiogram or rub or evidence of pericardial effusion 7. Renal disorder Persistent proteinuria 0.5 g dL or 3 if quantitation not performed orCellular casts may be red blood cell, hemoglobin, granular, tubular, or mixed 8. Neurologic disorder Serizures in the absence of offending durgs or known metabolic derangements e.g. uremia, ketoacidosis, or electrolyte imbalance , orPsychosis in the absence of offending drugs or known metabolic derangement e.g. uremia, ketoacidosis, or electrolyte imbalance 9. Hematologic disorder Hemolytic anemia with reticulocytosis orLeukopenia 4.0 x 109 cells L 4000 cells mm3 total or two or more occasions, orLymphopenia 1.5 x 109 cells L 1500 cells mm3 on two or more occasions, orThrombocytopenia 100 x 109 cells L 100 x 103 cells mm3 in the absence of offending drugs 10. Immunologic disorder Anti DNA antibody to native DNA in abnormal titer, orAnti Sm presence of antibody to Sm nuclear antigen, orPositive finding of antiphospholipid antibodies based on 1 an abdnormal serum level of IgG or IgM Anticardiolipin antibodies. 2 a positive test for lupus anticoagulant using a standard test, or 3 a false positive serologic test for syphilis known to be positive for at least 6 months and confirmed by negative Treponema pallidum immunobolization or fluorescent treponemal antibody absorption test. 11. Antinuclear antibody An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs know to be associated with drug induced lupus syndrome Sturge Weber syndrome The so called po wine stain is a special form of nevus flammeus. These lesions tend to grow during childhood, thicken the skin surface, and do not fade with time. Such lesions in the distribution of the trigeminal nerve are associated with the Sturge Weber syndrome also called encephalotrigeminal angiomatosis . This uncommon congenital disorder is associated with facial po wine nevi, ipsilateral venous angiomas in the coical leptomeninges, mental retardation, seizures, hemiplegia, and skull radio opacities. Thus, a large facial telangiectasia in a child with mental deficiency may indicate the presence of additional vascular malformations.

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.

Drug of choice to delay preterm labour

Ans B A Nifedipine Ritodrine Ref DC Dutta s Textbook of Obstetrics, pg 508Explanation Best answer would be b Nifedipine Most likely a Ritodrine as there is no clear first line tocolytic agent .Common Tocolytic Agents, Their Mechanism and Side Effects DrugMechanismDescriptionPossiblecontraindicationsMaternal side effectsFetal and neonatal side effectsTerbutalineb2 agonistIs often the drug given first, especially if there is only low risk of preterm birthCardiac arrhythmias diabetes Cardiac arrhythmias Cardiopulmon ary diseases Pulmonary edema Myocardial ischemia Hypertension Tachycardia Fetal tachycardia Hyperinsulinemia Hypoglycemia Myocardial and septal hypertrophy Myocardial ischemiaRitodrineb2 agonistNo longer had FDA approvedPoorly controlled thyroid disease and diabetesMetabolic hyperglycemia Hyperinsulinemia Hypokalemia Antidiuresis Altered thyroid function Physiologic tremor Palpitations Nervousness Nausea or vomiting Fever Hallucinations Neonatal tachycardia Hypoglycemia Hypocalcemia Hyperbilirubinemia Hypotension Intraventricular hemorrhageNifedipineCCBsIs one of the most commonly used tocolytic agentsCardiac disease It should not be used concomitantly with magnesium sulfate Flushing Headache Dizziness Nausea Transient hypotension. Renal disease and hypotension. Concomitant use of calcium channel blockers and magnesium sulfate may result in cardiovascular collapse None noted as yetAtosibanOxytocinantagonistless side effects than 62 recep agonist IndomethacinNSAIDs Late pregnancy ductus arteriosus , significant renal or hepathic Impairment Nausea Heartburn Constriction of ductus arteriosus Pulmonary hypertension Reversibe decrease in renal unction with oligohydramnios intraventricular hemorrhage Hyperbilirubinemia Necrotizing enterocolitisSulindacNSAIDs Coagulation disorders or thrombocytopenia, nonsteroidal anti inflammatory drug MSAID sensitive asthma, other sensitivity to NSAIDs IVMagnesiumsulfateMyosin lightchaininhibitorShewn to be ineffective.Has been recommended for women at high risk. However, meta analyses have failed to support it as a tocolytic agent.AbsolutecontraindicationMyasthenia gravis Flushing Lethargy Headache Muscle weakness Diplopia Dry mouth Pulmonary edema Cardiac arrest Lethargy Hypotonia Respiratory depression Derrl penalization with prolonged useCalcium channel blockers and an oxytocin antagonist can delay delivery by 2.7 days. Otherwise tocolysis is rarely successful beyond 24 48 hours because current medications do not alter the fundamentals of labor activation.However, just gaining 48 hours is sufficient to allow the pregnant women to be transferred to a center specialized for management of preterm deliveries and administer corticosteroids to reduce the possibility of neonatal organ immaturity.Contraindications to TocolysisGestational age 34 weeks gestation.Intrauterine Growth Restriction IUGR or placental insufficiency.Lethal congenital or chromosomal abnormalities.Cervical dilation 4 cm.Chorioamnionitis or intrauterine infection.Fetal distress or fetal death.Mother has severe pregnancy induced hypertension.Eclampsia preeclampsia.Active vaginal bleeding.Placental abruption.Cardiac disease.

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 Problems with Taste ?

Symptoms Vary With Disorders There are several types of taste disorders depending on how the sense of taste is affected. People who have taste disorders usually lose their ability to taste or can no longer perceive taste in the same way. True taste disorders are rare. Most changes in the perception of food flavor result from the loss of smell. Phantom Taste Perception. The most common taste complaint is phantom taste perception tasting something when nothing is in the mouth. Hypogeusia. Some people have hypogeusia, or the reduced ability to taste sweet, sour, bitter, salty, and savory, or umami. This disorder is usually temporary. Dysgeusia. Dysgeusia is a condition in which a foul, salty, rancid, or metallic taste sensation will persist in the mouth. Dysgeusia is sometimes accompanied by burning mouth syndrome, a condition in which a person experiences a painful burning sensation in the mouth. Although it can affect anyone, burning mouth syndrome is most common in middle aged and older women. Ageusia. Other people can t detect taste at all, which is called ageusia. This type of taste disorder can be caused by head trauma some surgical procedures, such as middle ear surgery or extraction of the third molar radiation therapy and viral infections. Why a Diagnosis Is Important If you think you have a taste disorder, see your doctor. Loss of the sense of taste can lead to depression and a reduced desire to eat. Loss of appetite can lead to loss of weight, poor nutrition and weakened immunity. In some cases, loss of taste can accompany or signal conditions such as diabetes. Sometimes, a problem with taste can be a sign of a disease of the nervous system, such multiple sclerosis, Alzheimer s disease, or Parkinsons disease. Do You Have a Taste Disorder? If you think you have a taste disorder, try to identify and record the circumstances surrounding it. Ask yourself the following questions When did I first become aware of it? What changes in my taste do I notice? Do all foods and drinks taste the same? Have there been any changes in my sense of smell? Does the change in taste affect my ability to eat normally? What medications do I take? What are the names of the medications? How much do I take? What is the health condition for which I take them? Have I recently had a cold or the flu? When did I first become aware of it? What changes in my taste do I notice? Do all foods and drinks taste the same? Have there been any changes in my sense of smell? Does the change in taste affect my ability to eat normally? What medications do I take? What are the names of the medications? How much do I take? What is the health condition for which I take them? Have I recently had a cold or the flu? Talking With Your Doctor Bring this information with you when you visit the doctor. He or she may refer you to an otolaryngologist, a specialist in diseases of the ear, nose, and throat. An accurate assessment of your taste loss will include, among other things a physical examination of your ears, nose, and throat a dental examination and assessment of oral hygiene a review of your health history a taste test supervised by a health care professional. a physical examination of your ears, nose, and throat a dental examination and assessment of oral hygiene a review of your health history a taste test supervised by a health care professional. Tests for Taste Disorders Some tests are designed to measure the lowest concentration of a substance that a person can detect or recognize. Your doctor may ask you to compare the tastes of different substances or to note how the intensity of a taste grows when a substance s concentration is increased. Scientists have developed taste tests in which the patient responds to different concentrations of a substance. This may involve a simple sip, spit, and rinse test or the application of a substance directly to your tongue using an eye dropper. By using these tests, your doctor can determine if you have a true taste disorder and what type it is. If your doctor suspects that nerves in your mouth or head may be affected, he or she may order an X ray, usually a CAT scan, to look further into the head and neck area. Once the cause of a taste disorder is found, your doctor may be able to treat it. Many types of taste disorders are reversible, but if not, counseling and self help techniques may help you cope.

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 Diabetic Heart Disease ?

Diabetic heart disease DHD is treated with lifestyle changes, medicines, and medical procedures. The goals of treating DHD include Controlling diabetes and any other heart disease risk factors you have, such as unhealthy blood cholesterol levels and high blood pressure Reducing or relieving heart disease symptoms, such as angina chest pain or discomfort Preventing or delaying heart disease complications, such as a heart attack Repairing heart and coronary artery damage Following the treatment plan your doctor recommends is very important. Compared with people who don t have diabetes, people who have the disease are at higher risk for heart disease, have additional causes of heart disease, may develop heart disease at a younger age, and may have more severe heart disease. Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. Lifestyle Changes Following a healthy lifestyle is an important part of treating diabetes and DHD. Some people who have diabetes can manage their blood pressure and blood cholesterol levels with lifestyle changes alone. Following a Healthy Diet A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat free or low fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas. A healthy diet is low in sodium salt , added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients such as dietary fiber . For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institutes NHLBIs Your Guide to Lowering Your Blood Pressure With DASH and the U.S. Department of Agricultures ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating. Maintaining a Healthy Weight Controlling your weight helps you control heart disease risk factors. If youre overweight or obese, work with your doctor to create a reasonable weight loss plan. For more information about losing weight or maintaining your weight, go to the Health Topics Overweight and Obesity article. Being Physically Active Regular physical activity can lower many heart disease risk factors, and it helps control your blood sugar level. Physical activity also can improve how insulin works. Insulin is a hormone that helps turn glucose into energy. Generally, adults should do at least 150 minutes 2hours and 30 minutes of moderate intensity physical activity each week. You dont have to do the activity all at once. You can break it up into shorter periods of at least 10 minutes each. Talk with your doctor about what types and amounts and physical activity are safe for you. People who have diabetes must be careful to watch their blood sugar levels and avoid injury to their feet during physical activity. For more information about physical activity, go to the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans, the Health Topics Physical Activity and Your Heart article, and the NHLBI s Your Guide to Physical Activity and Your Heart. Quitting Smoking Smoking can damage your blood vessels and raise your risk of heart disease. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI s Your Guide to a Healthy Heart. Managing Stress Research shows that strong emotions, such as anger, can trigger a heart attack. Learning how to managestress, relax, and cope with problems can improve your emotional and physical health. Medicines Medicines are an important part of treatment for people who have diabetes and for people who have DHD. Medicines can help control blood sugar levels, lower blood pressure, reduce the risk of blood clots, improve blood cholesterol levels, reduce the heart s workload, and treat angina symptoms. Your doctor will prescribe medicines based on your specific needs. Medical Procedures If you have DHD, your doctor may recommend a medical procedure. The type of procedure will depend on the type of heart disease you have. For example, both percutaneous coronary intervention PCI ,also known as coronaryangioplasty, and coronary artery bypass grafting CABG are used to treat coronary heart disease CHD . Both of these procedures improve blood flow to your heart. PCI also can relieve chest pain. CABG can relieve chest pain and may help prevent a heart attack. If you have heart damage and severe heart failure symptoms, your doctor may recommend a cardiac resynchronization therapy CRT device or an implantable cardioverter defibrillator ICD . A CRT device is a type of pacemaker. A pacemaker is a small device that helps control abnormal heart rhythms. Its placed under the skin of the chest or abdomen. A CRT device helps the heart s lower chambers contract at the same time, which may decrease heart failure symptoms. An ICD is similar to a pacemaker. An ICD is a small device thats placed under the skin of the chest or abdomen. The device uses electrical pulses or shocks to help control dangerous heart rhythms. Your doctor also may recommend a pacemaker or ICD to treat diabetic cardiomyopathy. Other types of surgery also are used to treat this type of heart disease. For more information about medical procedures used to treat diabetes related heart diseases, go to the treatment sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles. Diabetes Specific Treatment Issues The treatments described above are used for people who have DHD and for people who have heart disease without diabetes. However, some aspects of heart disease treatment differ for people who have diabetes. Treatment for High Blood Pressure and High Blood Cholesterol Treatment for high blood pressure and high blood cholesterol often begins earlier in people who have diabetes than in those who don t. People who have diabetes also may have more aggressive treatment goals. For example, your doctor may prescribe medicines called statins even if your blood cholesterol levels are in the normal range. Your doctor also may prescribe statins if you re older than 40 and have other heart disease risk factors. Target goals for LDL cholesterol sometimes called bad cholesterol and high blood pressure also are lower for people who have diabetes than for those who don t. Studies suggest that most people who have diabetes will need more than one blood pressure medicine to reach their goals. Research also has shown that some people who have diabetes may benefit more from certain blood pressure and cholesterol medicines than from others. One example is a group of cholesterol medicines called bile acid sequestrants such as cholestyramine . This type of medicine may offer advantages for people who have type 2 diabetes. It appears to improve blood sugar control and lower LDL cholesterol. Treatment for Heart Failure Some studies suggest that certain medicines may have advantages for treating heart failure in people who have diabetes. These medicines include ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, and beta blockers. Research shows that two blood sugar medicines insulin and sulfanylureas don t seem to reduce the risk of heart failure in people who have type 2 diabetes. A third medicine metformin shows promise, but research is still ongoing. Heart Attack Prevention Doctors may recommend aspirin for people with diabetes who are at increased risk for heart disease and heart attack. Taken each day, low dose aspirin may prevent blood clots that can lead to a heart attack. People with diabetes who are at increased risk include most men older than 50 and most women older than 60 who have one or more of the following risk factors Smoking High blood pressure High blood cholesterol A family history of early heart disease A higher than normal level of protein in their urine Blood Sugar Control Controlling blood sugar levels is good for heart health. For example, controlling blood sugar improves everyday heart function for people who have diabetes and heart failure.

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 medications is essential for ameliorating the toxicity of pemetrexed?

Toxicity amelioration High doses and intensive regimens are being employed aiming at cure of the malignancy. The associated toxicity may be ameliorated to some extent by 1. Toxicity blocking drugs Folinic acid rescue has permitted administration of 100 fold dose of Mtx . It is professed that normal cells are rescued more than the cancer cells therapeutic index is increased. Cystitis caused by cyclophosphamide and ifosphamide can be blocked by systemically administered mesna and by irrigating the bladder with acetylcysteine. Both these are SH containing compounds that combine with and detoxify the toxic metabolites in the bladder. Generous fluid intake and frequent bladder voiding also helps. For controlling cytotoxic drug induced vomiting, ondansetron, a 5 HT3 antagonist, has surpassed the efficacy of metoclopramide, which neveheless is still used see Ch. 47 . Addition of dexamethasone and or lorazepam fuher enhances the protection against vomiting. 2. Hyperuricaemia occurring as a consequence of rapid destruction of bulky tumour masses and degradation of large amount of purines can be reduced by allopurinol, alkalinization of urine and plenty of fluids. Coicosteroids also reduce hyperuricemia. 3. Hypercalcaemia occurring as a complication of ceain malignancies like myeloma, cancer breast prostate, etc. may be aggravated by chemotherapy. lt is treated by vigorous hydration and i.v. bisphosphonates 3. Hypercalcaemia occurring as a complication of ceain malignancies like myeloma, cancer breast prostate, etc. may be aggravated by chemotherapy. lt is treated by vigorous hydration and i.v. bisphosphonates see Ch. 24 . 4. Drugs given in pulses with 2 3 week intervals for normal cells to recover improve the efficacy of therapy malignant cells recovering more slowly. 5. Selective exposure of tumour to the drug by intraaerial infusion into a limb or head and neck intrapleural intraperitoneal injectionespecially for rapidly accumulating pleural effusion or ascitis topical application on the lesion or 3 enzymes involved in folate metabolism and purine and pyrimidine synthesis. These enzymes are thymidylate synthase, dihydrofolate reductase, and glycinamide ribonucleotide formyltransferase. This agent has broad antitumor activity in phase II trials in a wide variety of solid tumors, and is approved in combination with cisplatin for the therapy of malignant mesothelioma. In a recent phase III trial, pemetrexed demonstrated equivalent efficacy to docetaxel, but with significantly less toxicity, in second line treatment of non small cell lung cancer. The most common and serious toxicities of pemetrexed myelosuppression and mucositis have been significantly ameliorated by folic acid and vitamin B12 supplementation. More impoant, vitamin supplementation has not been shown to adversely affect efficacy in some tumor types. Tumors with codeletion of the methylthioadenosine phosphorylase gene, as a consequence of p16 deletions, may be paicularly sensitive to pemetrexed REFERENCE 1 ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO 833 2 www.ncbi.nlm.nih.gov

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 the name of disease transmitted by this vector?

Ans. b. Leishmaniasis Ref Park 23 e p775, 304. 22 e p 716 721 The given image is of sand fly hairy body and erect wing . Sandfly is the primary vector of leishmaniasis and pappataci fever. MosquitoSandflySize4 5 mm2.5 mmColorBlackYellowish brownEggs laid100 25040 60Flight range2 3 km200 yardsLife span2 3 weeks2 weeksSandfly Phlebotamus Sandfly is the primary vectors of leishmaniasis pappataci feverQ.Viruses carried by sandflies Chandipura virus cousin of rabies virus SpeciesActs as vector forPhlebotamus argentipesKala AzarQPhlebotamus papatasiiSandfly feverQPhlebotamus sergentiOriental SoreQDescription of SandflyAdults Adults are about 1.5 3.0 mm long and yellowish in color, with conspicuous black eyes, hairy bodies, wings, legsQ. The oval lanceolate wings are carried erect on the humped thorax. Males possess long prominent genital terminalia known as claspers. Females have a pair of anal recti.Distribution Found in the warm countriesBites Only female sandfly can bite in the dwelling at night. It takes shelter during day in holes crevices in wall, in dark room store room, etc.Breeding Mostly species are nocturnal in habit.Feeding Mostly species are nocturnal in habit.Dispersal Range of flight is 200 yard from their breeding places.Life Span Average life of sandfly is about 2 weeks.Body of sandfly consists of three partsHeadThoraxAbdomen Head bear a pair of long hairy antenna. Palpi proboscis one pair of prominent black eyes are present. Thorax bears a pair of wings three pair of legs. Wings are upright in shape hairy. Second longitudinal vein is branched twice. Legs are long slender and out of proportion to size of body. Abdomen has ten segments is covered with hairs. In the female, tip of abdomen is rounded while in male claspers are attached to last abdominal segment.Lifecycle of sandflyEggLarvaPupaAdult Female lays eggs in the damp dark places in the cattle sheds poultry. Number 40 60 Colour brownish Length 0.4 mm Eggs hatch in 1 2 weeks. Larva is maggot like structure, having large head, thorax, abdomen two long bristle on last abdominal segment. Larva feed on decaying organic matter become a pupa in about 2 weeks. Pupa is found in cracks cervices in the wall. Pupa stage lasts for about 1 week. Average life span of a sandfly is 2 weeks.Control Measures Sandflies are easily controlled because they do not move long distance from their breeding places.Insecticide Lindane has been proved effective.Sanitation Removal of shrubs vegetation, filling of cracks crevices in the wall floor and distance of cattle sheds poultry from human habitations.Visceral Leishmaniasis VL It is a systemic protozoan disease that is transmitted by phlebotominc sandfliesQ.Vector Female phelebotomine sandfliesQIncubation period 2 6 monthsLeishmaniasisTypesCausative agentVisceral Leishmania donovaniQCutaneous Leishmania tropicaQMucocutaneous Leishmania braziliensisQEpidemiology Poor neglected populations in East Africa Indian subcontinent are particularly affected.Lifecycle Promastigote of form of L.donovani is transmitted into the skin by female phlebotomine sandliesQ.Once transmitted, the parasites are internalized by dendritic cells macrophages in the dermis where they lose their flagella, transforming into the amastigote fromQ.Amastigotes multiply, destroy the host cell infect other phagocytic cells.Amastigotes disseminate through lymphatic vascular systems, eventually infiltrating hone marrow, liver spleenQ.Clinical features Symptoms signs of persistent systemic infection Fever, fatigue, weakness, anorexia weight lossParasitic invasion of blood reticuloendothelial system Enlarged lymph nodes hepatosplenomegalyQFever intermittent is usually associated with rigor chillsQFatigue weakness are worsened by anaemia, which is by the persistent inflammatory state, Hypersplenism the peripheral destruction of erythrocytes in the enlarged spleen and sometimes by bleeding.Hyperpigmentation, which probably led to the name kala azar black fever in hindi , has only been described in VL patients from the Indian subcontinent, but today this symptom is uncommonQ.Diagnosis Gold standard for diagnosis Demonstration of amastigotes in smears of tissue aspirates is the gold standard for the diagnosis of VLQ.Sensitivity of splenic smears is 95 , whereas smears of bone marrow 60 85 and lymph node aspirates 50 are less sensitive.A rapid immunochromatographic test based on detection of antibodies to a recombinant antigen rK39 consisting of 39 amino acids conserved in kinesin region of L. infantum is used worldwide.Test requires only a drop of fingerprick blood or serum result can be read within 15 min.Except in East Africa w here both its sensitivity and its specificity are lower , sensitivity of the rK39 rapid diagnostic test RdT in immunocompetent individuals is 98 and its specificity is 90 Q.In Sudan, an RdT based on a new synthetic polyprotein, rK28. was more sensitive 96.8 specific 96.2 than rK39 based RdTsQ.Treatment First line treatment for VL Pentavalent antimonials sodium stibogluconate meglumine antimoniateQAntimonials are toxic drugs with frequent adverse side effects, including cardiac arrhythmia acute pancreatitisQ.Miltefosine, which was initially developed as an anticancer drug is the first effective oral drug for VLQ.

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 Mulibrey Nanism ?

What are the signs and symptoms of Mulibrey Nanism? Mulibrey nanism MN is characterized by progressive growth failure that begins prenatally before birth . Hypotonia poor muscle tone is common. Newborns often have characteristic abnormalities of the head and face, including a triangularly shaped face. Yellow discoloration of the eyes and other ocular abnormalities may be present, but vision is usually normal. More than 90 percent of affected individuals have a J shaped sella turcica, which is a depression in the sphenoid bone at the base of the skull. Infants with mulibrey nanism may also have symptoms related to overgrowth of the fibrous sac surrounding the heart constrictive pericarditis . When constrictive pericarditis is present at birth, affected infants may have a bluish discoloration of the skin cyanosis , especially on the lips and fingertips. Individuals with MN typically have a high pitched voice. Other symptoms may include abnormally prominent veins in the neck, congestion in the lungs, abnormal fluid accumulation in the abdomen ascites , swelling of the arms and or legs peripheral edema , and or enlargement of the heart cardiac hypertrophy and or liver hepatomegaly . There may also be elevated pressure in the veins, congestion or blockage in the main artery serving the lungs pulmonary artery , and or a build up of fibrous tissue in the walls of the lungs pulmonary fibrosis . Associated complications of these conditions may lead to congestive heart failure. In some cases, individuals with mulibrey nanism may have additional physical abnormalities, such as an unusually thin shinbone fibrous tibia dysplasia . Large cerebral ventricles in the brain and delayed motor development are uncommon findings. Most affected individuals have normal intelligence. Individuals with mulibrey nanism often have underdevelopment of various endocrine glands, that leads to hormone deficiencies. Delayed puberty sometimes occurs, accompanied by infrequent or very light menstrual periods. Females have an increased risk for premature ovarian failure and ovarian tumors. The Human Phenotype Ontology provides the following list of signs and symptoms for Mulibrey Nanism. 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 Decreased body weight 90 Intrauterine growth retardation 90 Macrocephaly 90 Short stature 90 Hepatomegaly 50 Wide nasal bridge 50 Absent frontal sinuses Astigmatism Autosomal recessive inheritance Congestive heart failure Dental crowding Depressed nasal bridge Dolichocephaly Dysarthria Frontal bossing High pitched voice Hypertelorism Hypodontia Hypoplastic frontal sinuses J shaped sella turcica Microglossia Muscular hypotonia Myocardial fibrosis Nephroblastoma Wilms tumor Nevus Pericardial constriction Pigmentary retinopathy Strabismus Triangular face Ventriculomegaly Weak voice 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.

What are the symptoms of Multiple pterygium syndrome Escobar type ?

What are the signs and symptoms of Multiple pterygium syndrome Escobar type? Symptoms of multiple pterygium syndrome, Escobar type vary but may include short stature, vertebral spine defects, joint contractures, and webbing of the neck, armpit, elbow, knee, between the legs, and of the fingers and toes. The joint contractures may interfere with walking, making walking more difficult. Other symptoms may include down slanting eyes, skin fold over the inner corner of the eye, a pointed, receding chin, droopy eye lids, and cleft palate. Males with Escobar syndrome may have undescended testicles at birth, and females may have absent labia majora. People with Escobar syndrome may have in curving of the little finger, joined fingers, and rocker bottom feet. They may also have kyphoscoliosis and other spine defects, such as fusion of the spine. Abnormal ossicles the three small bones in the ear may lead to conductive hearing loss. Other skeletal anomalies include rib fusions, radial head and hip dislocations, talipes calcaneovalgus the foot points inwards and down or club foot, and missing or underdeveloped kneecap. The Human Phenotype Ontology provides the following list of signs and symptoms for Multiple pterygium syndrome Escobar type. 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 Amniotic constriction ring 90 Finger syndactyly 90 Limitation of joint mobility 90 Pectus excavatum 90 Scoliosis 90 Symphalangism affecting the phalanges of the hand 90 Webbed neck 90 Abnormality of the foot 50 Aplasia Hypoplasia of the abdominal wall musculature 50 Aplasia Hypoplasia of the skin 50 Camptodactyly of finger 50 Epicanthus 50 Facial asymmetry 50 Hypertelorism 50 Intrauterine growth retardation 50 Long face 50 Low set, posteriorly rotated ears 50 Microcephaly 50 Pointed chin 50 Popliteal pterygium 50 Ptosis 50 Respiratory insufficiency 50 Short stature 50 Telecanthus 50 Umbilical hernia 50 Vertebral segmentation defect 50 Abnormality of female external genitalia 7.5 Abnormality of the abdominal organs 7.5 Abnormality of the aortic valve 7.5 Abnormality of the ribs 7.5 Aortic dilatation 7.5 Aplasia Hypoplasia of the lungs 7.5 Cleft palate 7.5 Cognitive impairment 7.5 Conductive hearing impairment 7.5 Cryptorchidism 7.5 Dolichocephaly 7.5 Gait disturbance 7.5 Hypoplasia of penis 7.5 Long philtrum 7.5 Low posterior hairline 7.5 Scrotal hypoplasia 7.5 Skeletal muscle atrophy 7.5 Spina bifida occulta 7.5 Strabismus 7.5 Abnormality of the neck Absence of labia majora Antecubital pterygium Anterior clefting of vertebral bodies Arachnodactyly Autosomal recessive inheritance Axillary pterygia Bilateral camptodactyly Camptodactyly of toe Congenital diaphragmatic hernia Decreased fetal movement Diaphragmatic eventration Dislocated radial head Downturned corners of mouth Dysplastic patella Exostosis of the external auditory canal Fused cervical vertebrae High palate Hip dislocation Hypoplastic nipples Hypospadias Inguinal hernia Intercrural pterygium Kyphosis Long clavicles Low set ears Narrow mouth Neck pterygia Neonatal respiratory distress Patellar aplasia Pulmonary hypoplasia Rib fusion Rocker bottom foot Syndactyly Talipes calcaneovalgus Talipes equinovarus 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.

How to diagnose Pyelonephritis Kidney Infection ?

The tests used to diagnose pyelonephritis depend on the patients age, gender, and response to treatment and include the following Urinalysis. Urinalysis is testing of a urine sample. The urine sample is collected in a special container in a health care providers office or commercial facility and can be tested in the same location or sent to a lab for analysis. The presence of white blood cells and bacteria in the urine indicate infection. Urine culture. A urine culture is performed by placing part of a urine sample in a tube or dish with a substance that encourages any bacteria present to grow. The urine sample is collected in a special container in a health care providers office or commercial facility and sent to a lab for culture. Once the bacteria have multiplied, which usually takes 1 to 3 days, they can be identified. The health care provider can then determine the best treatment. Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging anesthesia is not needed. The images can show obstructions in the urinary tract. Ultrasound is often used for people who do not respond to treatment within 72 hours. Computerized tomography CT scan. CT scans use a combination of x rays and computer technology to create three dimensional 3 D images. A CT scan may include the injection of a special dye, called contrast medium. CT scans require the person to lie on a table that slides into a tunnel shaped device where the x rays are taken. The procedure is performed in an outpatient center or hospital by an x ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed. CT scans can show obstructions in the urinary tract. The test is often used for people who do not respond to treatment within 72 hours. Voiding cystourethrogram VCUG . A VCUG is an x ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The procedure is performed in an outpatient center or hospital by an x ray technician supervised by a radiologist, who then interprets the images. Anesthesia is not needed, but sedation may be used for some people. The bladder and urethra are filled with contrast medium to make the structures clearly visible on the x ray images. The x ray machine captures images of the contrast medium while the bladder is full and when the person urinates. This test can show abnormalities of the inside of the urethra and bladder and is usually used to detect VUR in children. Digital rectal examination DRE . A DRE is a physical exam of the prostate that is performed in the health care providers office. Anesthesia is not needed. To perform the exam, the health care provider asks the person to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies in front of the rectum. Men with suspected pyelonephritis may have a DRE to determine whether a swollen prostate may be obstructing the neck of the bladder. Dimercaptosuccinic acid DMSA scintigraphy. DMSA scintigraphy is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive material. Because the dose of radioactive material is small, the risk of causing damage to cells is low. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist. Anesthesia is not needed. Radioactive material is injected into a vein in the persons arm and travels through the body to the kidneys. Special cameras and computers are used to create images of the radioactive material as it passes through the kidneys. The radioactive material makes the parts of the kidney that are infected or scarred stand out on the image. DMSA scintigraphy is used to show the severity of kidney infection or kidney damage, such as scarring.

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 prevent Prescription and Illicit Drug Abuse ?

Many Reasons for Abuse Drug abuse, whether prescription or illicit drugs, can have serious consequences, particularly for older adults. That is why prevention is key. However, there are many different reasons why people abuse drugs and become addicted to them. These reasons need to be taken into account when considering how to best prevent drug abuse. Family members, friends, pharmacists, and health care providers can all be involved in preventing drug abuse among older adults. Preventing Medication Abuse There are steps that you as a patient can take to prevent abuse of prescription medications and its consequences. When visiting the doctor or pharmacist, bring along all prescription and over the counter medicines that you take or a list of the medicines and their dosages how much you take and how often . Your doctor can make sure your medicines are right for you and make changes if necessary. Always follow medication directions carefully. Only use the medication for its prescribed purpose. Do not crush or break pills. If you are not sure how to take a medicine correctly, ask your doctor or pharmacist. He or she can tell you how to take a medication properly and about side effects to watch out for and interactions with other medications. Ask how the medication will affect driving and other daily activities. Do not use other people s prescription medications, and do not share yours. Talk with your doctor before increasing or decreasing the medication dosage. When visiting the doctor or pharmacist, bring along all prescription and over the counter medicines that you take or a list of the medicines and their dosages how much you take and how often . Your doctor can make sure your medicines are right for you and make changes if necessary. Always follow medication directions carefully. Only use the medication for its prescribed purpose. Do not crush or break pills. If you are not sure how to take a medicine correctly, ask your doctor or pharmacist. He or she can tell you how to take a medication properly and about side effects to watch out for and interactions with other medications. Ask how the medication will affect driving and other daily activities. Do not use other people s prescription medications, and do not share yours. Talk with your doctor before increasing or decreasing the medication dosage. Do not stop taking a medicine on your own. Talk to your doctor if you are having side effects or other problems. Learn about the medicines possible interactions with alcohol and other prescription and over the counter medicines, and follow your doctors instructions to avoid these interactions. Answer honestly if a doctor or other health care professional asks you about other drug or alcohol use. Without that information, your doctor may not be able to provide you with the best care. Also, if you have a substance problem, he or she can help you find the right treatment to prevent more serious problems from developing, including addiction. Do not stop taking a medicine on your own. Talk to your doctor if you are having side effects or other problems. Learn about the medicines possible interactions with alcohol and other prescription and over the counter medicines, and follow your doctors instructions to avoid these interactions. Answer honestly if a doctor or other health care professional asks you about other drug or alcohol use. Without that information, your doctor may not be able to provide you with the best care. Also, if you have a substance problem, he or she can help you find the right treatment to prevent more serious problems from developing, including addiction. For tips on safe use of medicines for older adults, see Taking Medicines Safely. Preventing Illicit Drug Use Preventing illicit drug use in older adults requires first knowing what contributes to it. For people of all ages, an individuals biology including their genetics and the environment, as well as how the two act together, determine a persons vulnerability to drug abuse and addiction or can protect against it. For example, being exposed to drugs of abuse in youth, living in a community where drug use is prevalent, having untreated mental disorders, such as depression, or dealing with difficult transition periods such as retirement or loss of a spouse can all make an older adult more vulnerable to drug abuse. Prevention Requires Various Approaches Prevention efforts must focus on gaining a better understanding of the factors that promote illicit drug use in older adults. Prevention also includes finding ways to stop drug use before it worsens and leads to health problems, including addiction. Family members can play an important role by being aware of an older relatives well being and possible drug abuse, and stepping in to help at an early stage, if necessary. Doctors should ask their older patients about potential drug abuse and make referrals as needed.

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.

Select the correct option from the possible choices given the medical question. Let s think step by step. Question The compact cubic packing of anions with the cations occupying all the tetrahedral holes, to which type structure corresponds Options A. Fluorite. B. Antifluorite. C. Rutile. D. Cesium chloride

To determine the correct answer, let s analyze each option by understanding the characteristics of the mentioned crystal structures and how ions are arranged within them. A. Fluorite CaF2 structure In the fluorite structure, the anions F form a face centered cubic FCC lattice, and the cations Ca2 occupy all the tetrahedral holes. However, the question specifies that the cations occupy all the tetrahedral holes, which is not the case in the fluorite structure. In the fluorite structure, the cations occupy all the tetrahedral holes, but the anions are in an FCC arrangement, and there are twice as many anions as cations. B. Antifluorite structure The antifluorite structure is essentially the inverse of the fluorite structure. In the antifluorite structure, the cations form an FCC lattice, and the anions occupy all the tetrahedral holes. This is the opposite of what the question describes, where the anions form the compact cubic packing, and the cations occupy the tetrahedral holes. However, considering the inverse nature, if we reverse the roles of cations and anions in the antifluorite description, it matches the question s description. C. Rutile TiO2 structure In the rutile structure, the anions O2 form a hexagonal close packed HCP lattice, and the cations Ti4 occupy half of the octahedral holes. This does not match the description of the anions forming a compact cubic packing with the cations occupying all the tetrahedral holes. D. Cesium chloride CsCl structure In the cesium chloride structure, the anions Cl form a simple cubic lattice, and the cations Cs occupy the center of the cube, which is the octahedral hole. This does not match the description provided in the question. Given the information and the need to identify a structure where the anions form a compact cubic packing and the cations occupy all the tetrahedral holes, the closest match is the antifluorite structure when considering the inverse arrangement of ions. However, the direct interpretation of the question seems to be more closely related to the antifluorite s inverse nature, which might cause confusion. The antifluorite structure itself, when considering typical descriptions, does not exactly fit the provided description without considering the inverse roles of cations and anions. However, based on the options provided and the typical understanding of these structures, the best match considering a direct interpretation of the question s requirements anions in a compact cubic packing with cations in all tetrahedral holes would be more aligned with the inverse concept of antifluorite, but given the direct question, it seems to be a misunderstanding in the explanation. The correct structure based on the direct interpretation of the question would be more closely related to the antifluorite s inverse, but considering standard structures, the closest provided option that matches the concept of anions in a cubic arrangement with cations in tetrahedral holes would indeed be related to the concept of antifluorite when considering inverse roles. Answer B.

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.

Tm transprot maximum is defined as maximal

Ans. B. Tubular Secretion and absorption Ref. Ganong 23rd pg. 709 712 .Guyton Physiology 11th pg. 331 F gure 27 4.......... The transport maximum is the maximum rate at which glucose can be reabsorbed from the tubules. The threshold for glucose refers to the filtered load of glucose at which glucose first begins to be excreted in urine .Discussion Tmax The Tmax represents the average reabsorptive capacity of all the renal nephrons. The Tmax for glucose is the maximum rate of glucose reabsorption from the kidney. Typically, the Tmax is 375 mg min. The higher than normal reabsorptive capacity accounts for the lower than expected urinary concentration. The Tmax is calculated by subtracting the amount of glucose excreted from the filtered load at any plasma concentration at which the amount of glucose excreted increases linearly as plasma glucose cone increases. For example, when the plasma glucose concentration is 600 mg dL, filtered load of glucose is 600 mg min, the amount of glucose excreted is 100 mg min, and the amount reabsorbed the Tmax is 500 mg min. Essentially all filtered glucose is reabsorbed, inasmuch as the transport maximum Tmax for glucose 320 mg min is not exceeded in normal per sons. In diabetes mellitus, hyperglycemia results in a tubular filtration load that exceeds the Tmax, and glycosuria ensues. The renal threshold for glucose is the plasma concentration at which glucose first appears in the urine. The glucose is excreted at a plasma concentration of of 200 mg dL.Transport maximum for substances That Are Actively Reabsorbed. For most substances that are actively reabsorbed or secreted, there is a limit to the rate at which the solute can be transported, often referred to as the transport maximum. This limit is due to saturation of the specific transport systems involved when the amount of solute delivered to the tubule referred to as tubular load exceeds the capacity of the carrier proteins and specific enzymes involved in the transport process. The glucose transport system in the proximal tubule is a good example. In the adult human, the transport maximum for glucose averages about 375 mg min, whereas the filtered load of glucose is only about 125 mg min GFR plasma glucose 125 ml min 1 mg ml . With large increases in GFR and or plasma glucose concentration that increase the filtered load of glucose above 375 mg min, the excess glucose filtered is not reabsorbed and passes into the urine. When the plasma concentration of glucose rises above about 200 mg 100 ml, increasing the filtered load to about 250 mg min, a small amount of glucose begins to appear in the urine. This point is termed the threshold for glucose. Note that this appearance of glucose in the urine at the threshold occurs before the transport maximum is reached. One reason for the difference between threshold and transport maximum is that not all nephrons have the same transport maximum for glucose, and some of the nephrons excrete glucose before others have reached their transport maximum. The overall transport maximum for the kidneys, which is normally about 375 mg min, is reached when all nephrons have reached their maximal capacity to reabsorb glucose.Transport Maximums for Substances That Are Actively Secreted SubstanceTransport MaximumCreatinine16 mg minPara aminohippuric acid80 mg min Some of the important transport maximums for substances actively reabsorbed by the tubules are as follows SubstanceTransport MazimumGlucose375 mg minPhosphate0.10 mM minSulfate0.06 mM minAmino acids1.5 mM minUrate15 mg minLactate75 mg minPlasma protein30 mg min

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.

False about pioglitazone aEUR

It acts on insulin gene and even in absence of insulin helps in metabolism of carbohydrate km Pioglitazone belongs to Thiazolidinediones Other drugs of this group are Troglitazone, Rosiglitazone It is an oral antihyperglycemic agent that acts primarily by decreasing insulin resistance. Pioglitazone deceases insulin resistance in the muscles, adipose tissues and in the liver resulting in increased L insulin dependent glucose disposal and decreased hepatic glucose output. Mechanism of action Pioglitazone is a potent and higly selective agonist for peroxisome proliferator activated receptor gamma PPAR PPAR receptors are, found in tissues impoant. for insulin action such as adipose tissue, skeletal muscle and liver. PPAR is .found in highest level in adipose tissue. Activation of PPAR7 nuclear receptors modulates the transcription of a number of insulin responsive genes involved in the control of glucose and lipid metabolism. Pioglitazone appears to reduce insulin resistance by enhancing fatty acids storage and possibly by increasing adinopectin levels. In animal models of diabetes pioglitazone reduces the hyperglycemia, hyperinsulinemia and hyperiglyceridemia which are characteristic of insulin resistant states. Pioglitazone depends on the presence of insulin for its mechanism of action. Since piogletazone acts by enhancing the effect of circulating insulin it does not lower blood glucose in persons that lack endogenous insulin, Circulating insulin level decrease with the use of pioglitazone indicating decrease in insulin resistance. Thiazolidinediones are considered euglycemics. The overall response is similar to sulfonylureas and biguanide monotherapy. Because their mechanism of action involves gene regulation, the thiazolidinediones have a slow onset and offset of activity over weeks or even months. Combination therapy with sulfonylurea or insulin may lead to hypoglycemia. Metabolism of Pioglitazone Pioglitazone is extensively metabolized in liver by hydroxylation and oxidation. aiims pgmee answers explanations May 2011 Multiple CYP isoforms are involved in the metabolism of pioglitazone. The cytochromes p450 isoforms primarily invove are CYP2 C8 CYP 3A4 to a lesser degree Liver function should be monitored in patients receiving thiazolidinediones even though pioglitazone and rosiglitazone rarely have been associated with hepatotoxicity. Originally three member of thiazolidinedione family were introduced Pioglitazone Rosiglitazone Troglitazone This was withdrawn from the market due to an increase incidence of drug induced hepatitis . The withdraw! of troglitazone has also led to concerns of other thiazolidinediones also increasing the incidence of hepatitis and potential liver failure. Because of this FDA, recommends two to three months checks of liver enzyme for the first year of thiazolidinedione therapy, to check for this rare but potentially catastrophic complication. Till date newer thiazolidinediones have been free of this problem. Thiazolidinediones should not be used in patients with NewYork Hea association class III or IV failure. The main side effect of all thiazolidinediones is water retention leading to edema.Sometimes there is significant water retention leading to decompensation of potentially previously unrecognized hea failure. herefore thiazolidinediones should be prescribed with both caution and patient warnings about the potential ,for water retention weight gain especially in patients with decreased ventricular function.

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 Diabetic Retinopathy ?

Preventing Disease Progression During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. Treatment for Macular Edema Research found that that prompt treatment of macular edema with anti VEGF drugs, with or without laser treatment, resulted in better vision than laser treatment alone or steroid injections. When injected into the eye, these drugs reduce fluid leakage and interfere with the growth of new blood vessels in the retina. In some cases, focal laser treatment is used along with the eye injections. Your doctor places up to several hundred small laser burns in the areas of the retina around the macula that are leaking. These burns slow the leakage of fluid and reduce the amount of fluid in the retina. The surgery is usually completed in one session. Further treatment may be needed. Treatment for Diabetic Retinopathy Proliferative retinopathy is treated with laser surgery. This procedure is called scatter laser treatment. Scatter laser treatment helps to shrink the abnormal blood vessels. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina away from the macula, causing the abnormal blood vessels to shrink. Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, scatter laser treatment can save the rest of your sight. Scatter laser treatment may slightly reduce your color vision and night vision. Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding. Learn more about laser treatment. Vitrectomy If the bleeding is severe, you may need a surgical procedure called a vitrectomy. During a vitrectomy, blood is removed from the center of your eye. Scatter laser treatment and vitrectomy are effective in treating proliferative retinopathy and in reducing vision loss. Once you have proliferative retinopathy, you always will be at risk for new bleeding. You may need treatment more than once to protect your sight. Learn more about a vitrectomy. Have Dilated Eye Exams The National Eye Institute NEI urges everyone with diabetes to have a comprehensive dilated eye exam at least once a year. If you have diabetic retinopathy, you may need an exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow up care. Watch an animation to see what a comprehensive dilated eye exam includes. Research The National Eye Institute, or NEI, is conducting and supporting research that seeks better ways to detect, treat, and prevent vision loss in people with diabetes. This research is conducted through studies in the laboratory and with patients. For example, researchers are studying drugs for the treatment of proliferative retinopathy that may reduce the need for laser surgery. A major study has shown that better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much less kidney and nerve disease. Better control also reduces the need for sight saving laser surgery.

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 are Gestational Trophoblastic Disease ?

Key Points Gestational trophoblastic disease GTD is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception. Hydatidiform mole HM is the most common type of GTD. Gestational trophoblastic neoplasia GTN is a type of gestational trophoblastic disease GTD that is almost always malignant. Invasive moles Choriocarcinomas Placental site trophoblastic tumors Epithelioid trophoblastic tumors Age and a previous molar pregnancy affect the risk of GTD. Signs of GTD include abnormal vaginal bleeding and a uterus that is larger than normal. Tests that examine the uterus are used to detect find and diagnose gestational trophoblastic disease. Certain factors affect prognosis chance of recovery and treatment options. Gestational trophoblastic disease GTD is a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception. In gestational trophoblastic disease GTD , a tumor develops inside the uterus from tissue that forms after conception the joining of sperm and egg . This tissue is made of trophoblast cells and normally surrounds the fertilized egg in the uterus. Trophoblast cells help connect the fertilized egg to the wall of the uterus and form part of the placenta the organ that passes nutrients from the mother to the fetus . Sometimes there is a problem with the fertilized egg and trophoblast cells. Instead of a healthy fetus developing, a tumor forms. Until there are signs or symptoms of the tumor, the pregnancy will seem like a normal pregnancy. Most GTD is benign not cancer and does not spread, but some types become malignant cancer and spread to nearby tissues or distant parts of the body. Gestational trophoblastic disease GTD is a general term that includes different types of disease Hydatidiform Moles HM Complete HM. Partial HM. Gestational Trophoblastic Neoplasia GTN Invasive moles. Choriocarcinomas. Placental site trophoblastic tumors PSTT very rare . Epithelioid trophoblastic tumors ETT even more rare . Hydatidiform mole HM is the most common type of GTD. HMs are slow growing tumors that look like sacs of fluid. An HM is also called a molar pregnancy. The cause of hydatidiform moles is not known. HMs may be complete or partial A complete HM forms when sperm fertilizes an egg that does not contain the mothers DNA. The egg has DNA from the father and the cells that were meant to become the placenta are abnormal. A partial HM forms when sperm fertilizes a normal egg and there are two sets of DNA from the father in the fertilized egg. Only part of the fetus forms and the cells that were meant to become the placenta are abnormal. Most hydatidiform moles are benign, but they sometimes become cancer. Having one or more of the following risk factors increases the risk that a hydatidiform mole will become cancer A pregnancy before 20 or after 35 years of age. A very high level of beta human chorionic gonadotropin hCG , a hormone made by the body during pregnancy. A large tumor in the uterus. An ovarian cyst larger than 6 centimeters. High blood pressure during pregnancy. An overactive thyroid gland extra thyroid hormone is made . Severe nausea and vomiting during pregnancy. Trophoblastic cells in the blood, which may block small blood vessels. Serious blood clotting problems caused by the HM. Gestational trophoblastic neoplasia GTN is a type of gestational trophoblastic disease GTD that is almost always malignant. Gestational trophoblastic neoplasia GTN includes the following Invasive moles Invasive moles are made up of trophoblast cells that grow into the muscle layer of the uterus. Invasive moles are more likely to grow and spread than a hydatidiform mole. Rarely, a complete or partial HM may become an invasive mole. Sometimes an invasive mole will disappear without treatment. Choriocarcinomas A choriocarcinoma is a malignant tumor that forms from trophoblast cells and spreads to the muscle layer of the uterus and nearby blood vessels. It may also spread to other parts of the body, such as the brain, lungs, liver, kidney, spleen, intestines, pelvis, or vagina. A choriocarcinoma is more likely to form in women who have had any of the following Molar pregnancy, especially with a complete hydatidiform mole. Normal pregnancy. Tubal pregnancy the fertilized egg implants in the fallopian tube rather than the uterus . Miscarriage. Placental site trophoblastic tumors A placental site trophoblastic tumor PSTT is a rare type of gestational trophoblastic neoplasia that forms where the placenta attaches to the uterus. The tumor forms from trophoblast cells and spreads into the muscle of the uterus and into blood vessels. It may also spread to the lungs, pelvis, or lymph nodes. A PSTT grows very slowly and signs or symptoms may appear months or years after a normal pregnancy. Epithelioid trophoblastic tumors An epithelioid trophoblastic tumor ETT is a very rare type of gestational trophoblastic neoplasia that may be benign or malignant. When the tumor is malignant, it may spread to the lungs.

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 Insomnia ?

Your doctor will likely diagnose insomnia based on your medical and sleep histories and a physical exam. He or she also may recommend a sleep study. For example, you may have a sleep study if the cause of your insomnia is unclear. Medical History To find out what s causing your insomnia, your doctor may ask whether you Have any new or ongoing health problems Have painful injuries or health conditions, such as arthritis Take any medicines, either over the counter or prescription Have symptoms or a history of depression, anxiety, or psychosis Are coping with highly stressful life events, such as divorce or death Your doctor also may ask questions about your work and leisure habits. For example, he or she may ask about your work and exercise routines your use of caffeine, tobacco, and alcohol and your long distance travel history. Your answers can give clues about what s causing your insomnia. Your doctor also may ask whether you have any new or ongoing work or personal problems or other stresses in your life. Also, he or she may ask whether you have other family members who have sleep problems. Sleep History To get a better sense of your sleep problem, your doctor will ask you for details about your sleep habits. Before your visit, think about how to describe your problems, including How often you have trouble sleeping and how long you ve had the problem When you go to bed and get up on workdays and days off How long it takes you to fall asleep, how often you wake up at night, and how long it takes to fall back asleep Whether you snore loudly and often or wake up gasping or feeling out of breath How refreshed you feel when you wake up, and how tired you feel during the day How often you doze off or have trouble staying awake during routine tasks, especially driving To find out what s causing or worsening your insomnia, your doctor also may ask you Whether you worry about falling asleep, staying asleep, or getting enough sleep What you eat or drink, and whether you take medicines before going to bed What routine you follow before going to bed What the noise level, lighting, and temperature are like where you sleep What distractions, such as a TV or computer, are in your bedroom To help your doctor, consider keeping a sleep diary for 1 or 2 weeks. Write down when you go to sleep, wake up, and take naps. For example, you might note Went to bed at 10 a.m. woke up at 3 a.m. and couldn t fall back asleep napped after work for 2 hours. Also write down how much you sleep each night, as well as how sleepy you feel throughout the day. You can find a sample sleep diary in the National Heart, Lung, and Blood Institute s Your Guide to Healthy Sleep. Physical Exam Your doctor will do a physical exam to rule out other medical problems that might cause insomnia. You also may need blood tests to check for thyroid problems or other conditions that can cause sleep problems. Sleep Study Your doctor may recommend a sleep study called a polysomnogram PSG if he or she thinks an underlying sleep disorder is causing your insomnia. Youll likely stay overnight at a sleep center for this study. The PSG records brain activity, eye movements, heart rate, and blood pressure. A PSG also records the amount of oxygen in your blood, how much air is moving through your nose while you breathe, snoring, and chest movements. The chest movements show whether you re making an effort to breathe.

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.

Reactivation of pulmonary tuberculosis always occur at March 2011

Ans. D Apex of the upper lobeSecondary pulmonary tuberculosis classically involves the apex of the upper lobes of one or both the lungsSecondary tuberculosisIt is usually due to the reactivation of old lesions or gradual progression of primary tuberculosis into chronic form.The characteristics of secondary tuberculosis include extensive tissue damages due to immunologic reactions of the host to tubercle bacilli and their products.Primary vs Secondary TuberculosisWhen a host has first contact with tubercle bacilli An acute exudative lesion develops and rapidly spreads to the lymphatics and regional lymph nodes. The exudative lesion in tissue often heals rapidly. The lymph node undergoes caseation, which usually calcifies. The tuberculin test becomes positive.If the primary lesion could not contained rapidly, the appearance of hypersensitivity to tuberculin provokes a dramatic change in the host s response to the organisms.The nonspecific inflammatory response evoked on first exposure to tubercle bacilli becomes granulomatous, evoking the formation of tubercles.The tubercle comprises an organized aggregation of enlarged macrophages that, because they resemble epithelial cells, are referred to as epithelioid cells.A peripheral collar of fibroblasts, macrophages, and lymphocytes surrounds the granuloma.Frequently the central region of epithelioid cells undergoes a characteristic caseous necrosis to produce a soft tubercle, the most characteristic hallmark of tuberculosis.When the antigen load at the initial infection site and regional lymph node is large, caseation necrosis may develop and lesions may later calcify.These calcified lesions of the primary site are referred to as the Ghon complex.After the development of hypersensitivity, the infection becomes quiescent and asymptomatic in the majority of patients about 90 .In some, however, especially the very young and adults who are immunocompromised or who have other predisposing illnesses, the primary infection may evolve into clinical disease.The progression may be local at the site of the primary lesion, or it may be at one or more distant sites where bacilli have arrived during the early hematogenous spread.In a small number of persons whose initial tuberculous infection subsidies, secondary disease occurs in spite of acquired cellular immunity.In this phase of the disease, lesions are usually localized in the apices of the lungs remember that tubercle bacilli require oxygen for growth .In about 5 of patients, apical pulmonary tuberculosis manifests itself within 2 years of the primary infection.Because of the acquired cellular immunity, bacilli are more promptly phagocytized and destroyed by the activated macrophages.As a result, in secondary tuberculosis, lesions remain localized and dissemination of organisms the lymphatic vessels is usually prevented.Hypersensitivity promotes a more rapid caseation and fibrotic walling off of the focus.Histologically the reaction is characteristic of tubercle formation, manifested by a local accumulation of lymphocytes and macrophages.T lymphocytes and their chemotactic lymphokines play a major role in the development of tuberculous granuloma.These differences between primary infection and post primary or reactivation are attributed to 1 resistance and 2 hypersensitivity induced by the first infection of the host with tubercle bacilli.

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.

NRHM goal for IMR is to reduce it by

Ans. is b i.e., 30 o Infant mortality rate reduced to 30 1,000 live births.National Rural Health Mission INRHM1o The government of India launched NRHM on 5th April 2005 for a period of 7 years 2005 2012 .o The mission seeks to improve the rural health care delivery system.o The main aim of NRHM is to provide accessible, affordable, accountable, effective and reliable primary health care and bridging the gap in rural health care through the creation of a cadre of Accredited Social Health Activist ASHA .o The district becomes the core unit of planning, budgeting, and implementation of the programme. All vertical health and family welfare programmes at the district level will merge into one common District health Mission and at state level into State health mission there will be the provision of a mobile medical unit at the district level for improved outreach services.o Since almost 75 percent of health services are being currently provided by the private sector, it is contemplated that involving the private sector as part of the RCH initiatives will provide the more effective health care delivery system. Thus setting up of public private partnership PPP would help to make the RCH II programme better, and ensure availability or preventive and curative reproductive and health services to the community,o Janani Suraksha Yojana JSY is a safe motherhood intervention under the National Rural Health Mission being implemented with the objective of reducing maternal neonatal mortality by promoting institutional delivery among the poor pregnant women.o The schedule of implementation of major components of NRHM are as following 40 The merger of multiple societies and constitution of district state mission.Provision of additional generic drugs at SC PHC CHC level.Operational programme management units.Preparation of village health plans.ASHA at village level with drug kit Upgrading of rural hospitalOperationalising district planningMobile medical unit at the district levelThe Goals to be achieved by NRHM 40 A National levelInfant mortality rate reduced to 30 1,000 live births.Maternal mortality ratio reduced to 100 100,000.Total fertility rate reduced 50 by 2010, an additional 10 by 2012.Malaria mortality rate reduction 50 by 2010 additional 10 by 2012.Kala azar mortality rate reduction 100 by 2010 and sustaining elimination until 2012.FilariaL microfilaria rate reduction 70 by 2010,80 by 2012 and elimination until 2015.Dengue mortality rate reduction 50 by 2010 and sustaining at that level until 2012.Japanese encephalitis mortality rate reduction 50 by 2010 and sustaining at that level until 2012.Cataract operation increasing to 46 lakhs per year by 2012.Leprosy prevalence rate from 1.8 10,000 in 2005 to less titan 1 10,000 thereafter.Tuberculosis DOTS services maintain 85 cure rate through entire mission period.Upgrading community health centers to Indian public health standards.Increase utilization of first referral units from less than 20 to 75 .Engaging 250,000 female accredited social health activists ASHA in 10 states.B. At community levelAvailability of trained community level worker at the village level, with a drug kit for general ailments.Health day at an Anganwadi level on a fixed day month for provision of immunization, ante post natal checkups and sendees related to mother and child health care, including nutrition.Availability of generic drugs for common ailments at subcentre and hospital level.Good hospital care through the assured availability of doctors, drugs and quality services under the programme,Improved facilities for institution deliver through the provision of referral, transport, escort and improved hospital care subsidized under the Janani Suraksha Yojana for the below poverty line families,Availability of assured healthcare at reduced financial risk through pilots of community health insurance under the mission.Provision of household toilets,Improved outreach services through the mobile medical unit at the district level.

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 Antley Bixler syndrome ?

What are the signs and symptoms of Antley Bixler syndrome? The Human Phenotype Ontology provides the following list of signs and symptoms for Antley Bixler syndrome. 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 Abnormality of pelvic girdle bone morphology 90 Abnormality of the femur 90 Abnormality of the ribs 90 Anteverted nares 90 Arachnodactyly 90 Camptodactyly of finger 90 Frontal bossing 90 Humeroradial synostosis 90 Hypoplasia of the zygomatic bone 90 Limitation of joint mobility 90 Low set, posteriorly rotated ears 90 Narrow chest 90 Short nose 90 Abnormality of the urinary system 50 Choanal atresia 50 Craniosynostosis 50 Proptosis 50 Cleft palate 7.5 Hypertelorism 7.5 Long philtrum 7.5 Narrow mouth 7.5 Recurrent fractures 7.5 Strabismus 7.5 Talipes 7.5 Underdeveloped supraorbital ridges 7.5 Abnormal renal morphology Abnormalities of placenta or umbilical cord Abnormality of metabolism homeostasis Abnormality of the abdomen Abnormality of the endocrine system Abnormality of the pinna Arnold Chiari malformation Atria septal defect Autosomal recessive inheritance Bifid scrotum Brachycephaly Bronchomalacia Camptodactyly Carpal synostosis Choanal stenosis Chordee Clitoromegaly Cloverleaf skull Conductive hearing impairment Coronal craniosynostosis Cryptorchidism Depressed nasal bridge Femoral bowing Fused labia minora Hemivertebrae Horseshoe kidney Hydrocephalus Hypoplasia of midface Hypoplastic labia majora Hypospadias Intellectual disability Joint contracture of the hand Labial hypoplasia Lambdoidal craniosynostosis Laryngomalacia Low maternal serum estriol Malar flattening Maternal virilization in pregnancy Microcephaly Micropenis Narrow pelvis bone Oligohydramnios Polycystic ovaries Radioulnar synostosis Rocker bottom foot Scoliosis Scrotal hypoplasia Small for gestational age Stenosis of the external auditory canal Tarsal synostosis Ulnar bowing Upper airway obstruction Vaginal atresia Vesicovaginal fistula Wide anterior fontanel 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.

Agent used in opioid abuse substitution therapy is?

Ans. is c i.e., Methadone Maintenance therapy for opioid addiction Once detoxification phase is over i.e., withdrawal symptoms have been managed , the patient is maintained on any of the following drugs to prevent relapse by reducing craving and preventing kick or euphoria produced by opioids morphine or heroin . Drugs used are 1. Methadone Reduces craving and kick euphoria from morphine or heroin because their opioid receptors are already occupied.2. LAAM and buprenorphine Similarly reduce craving.3. Opioid antagonists naltrexone Naltrexone can be used orally to assist in the rehabilitation of ex opioid abusers who are fully withdrawn otherwise it induces an acute withdrawal syndrome . Naltrexone prevents relapse by discouraging substance seeking behavior If a patient, who is on naltrexone maintenance therapy, takes an opioid, there is no kick or euphoria as opioid receptors are already blocked. Naltrexone can be used with clonidine as in detoxification.Treatment of opioid addiction Treatment can be divided into A. Treatment of toxicity overdose Overdose is a medical emergency and is treated with opioid antagonist to reverse the complications respiratory depression by antagonizing the action on opioid receptors. Intravenous naloxone is the antagonist of choice for morphine heroin poisoning. Oral naltrexone is used for maintenance therapy, once acute poisoning has been treated by iv naloxone. Intravenous nalmefene is another specific antagonist.B. Treatment of dependence Treatment of dependence include medically supervised withdrawal and detoxification, followed by maintenance therapy.a. Detoxification Detoxification process include abrupt withdrawal of opioid followed by management of the emergent withdrawal symptoms, i.e., treatment of withdrawal syndrome. Detoxification can be done by any of the following.i Substitution of long acting opioid agonism Methadone is the treatment of choice. Because of its agonistic activity on opioid receptors it suppresses withdrawal symptoms. L alpha acetyl methadol Levomethyl LAAM is the other opioid agonist which was used for this purpose. However it is no longer in use because some patients developed prolonged QT intervals torsades de points .ii Substitution of partial agonist Buprenorphine can be used in place of methadone because of its partial agonistic activity on opioid receptor.iii Substitution by a2 agonists Clonidine as a sympatholytic agent due to its agonistic action on central presynaptic a2 receptors which reduce nor adrenergic activity. Therefore, clonidine reduces the adrenergic withdrawal symptoms. Lofexidine, another a2 agonist, is an alternative to clonidine.iv Clonidine plus naltrexone A more rapid detoxification can occur when clonidine is used along with naltrexone. Naltrexone, when given in opioid dependent patient, causes withdrawal symptoms because of its antagonistic action. These can be treated with clonidine. The addition of short acting Benzodiazepine lorazepam or oxazepam and NSAIDs, will help to relieve withdrawal symptoms not covered by clonidine. It should be kept in mind that naltrexone should not be used alone for detoxification to treat withdrawal syptoms as it precipitates or worsens the withdrawal syndrome.v Other drugs Dextropropoxyphene, diphenoxylateb. Maintenance therapy explained above

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 about phenytoin is true

It follows zero order kinetics Ref KDT 6th e p. 403 405J There are three pharmacokinetic characteristic of phenytoin Marked binding to serum protein Nonlinearity of its elimination kinetics 1t.follows saturation kinetics Metabolism by the CY P S Phenytoin follows saturation kinetics ? At their therapeutic concentrations most of the drugs occupy only a small fraction of their metabolizing sites so their metabolic rate increases as the drug concentration increase. In such cases the metabolic rate of the drug is a constant fraction of the drug present in the body rather than a constant amount of drug h i.e., the drug has a specific half life. This is.first order kinetics. For example If the concentration of the drug is 500 mg at time zero After metabolism at 1 hr the drug concentration would be 4250mg After metabolism at 2hr the drug concentration would be 125 mg However When most of the enzymes are occupied metabolism occurs at a maximal rate i.e., it is saturated and does not change in propoion to the drug concentration i.e., a fixed amount of drug is metabolized per unit time. This is zero order kinetics. For example Drug concentration at time zero 500 mg After metabolism at 1 hr 450 mg After metabolism at 2 hr 400 mg As the drug concentration increases metabolic sites and their metabolism shifts from first order to zero order. The drug whose kinetic changes from first order to zero at therapeutic concentration are said to follow zero? order kinetics saturation kinetics now small increase in drug dose produces marked side effects. Phenvtoin is one of the few drug whose elimination varies as a function of its concentration i.e., the rate is nonlinear, as the drug concentration increases the kinetics shift to zero order. Phenytoin is hydroxylated extensively in the liver and this process becomes saturated at about doses needed for therapeutic effects. Thus phenytoin at low doses exhibit. First order kinetics As the therapeutic concentration increases Zero order kinetic develops. Now a small increment in dose produces dispropoionate rise in steady state plasma concentration. Thus dose increments should become smaller as the dose increased. Enzyme induction and inhibition We have seen above that the metabolism of phenytoin is saturable i.e., the enzymes metabolizing it gets saturated. Because its metabolism is saturable, the other drugs that are metabolized by these enzymes can inhibit the metabolism of phenytoin and increase its concentration. Conversely the degradation rate of other drugs that are substrates for these enzymes can be inhibited by phenytoin. One such drug is warfarin And addition of phenytoin to a patient receiving warfarin can lead to bleeding disorders. Another mechanism for drug interaction in phenytoin It arises from phenytoins ability to induce diverse CYPs. Phenytoin is a potent inducer of hepatic enzymes that metabolize other drugs. Coadministration of phenytoin and medication metabolized by these enzymes can lead to an increased degradation of such medication. Of paicular note in this regard are oral contraceptive. Treatment with phenytoin could enhance the metabolism of oral contraceptives and lead to unplanned pregnancy. Phenytoin is highly bound to proteins 90 mainly albumin Small variations in the percentage of phenytoin that is bound dramatically affect the absolute amount of free active drug. Therefore increased propoion of free drug are evident in Patients with hypoalbuminemia, uremic patients and neonates. TeratoRenic effects of phenytoin The total plasma level decreases when the percentage that is bound decreases as in uremia or hypoalbuminemia. Phenytoin is metabolized to Arene oxide compound that is responsible for its teratogenic effect Fetal hydantion syndrome Hypoplastic phalanges Cleft palate Hair lip Microcephaly

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 a uterine relaxant?

Ans. B. Ritodrine. Ref. KDT, Pharmacology, 6th ed., p 125 323 SELECTIVE b2 STIMULANTSThese include, salbutamole, terbutaline, salmeterol, formoterol and ritodrine. They cause bronchodilatation, vasodilatation and uterine relaxation, without producing significant cardiac stimulation. b2 selectivity is only relative. Salbutamol has b2 bj action ratio of about 10. They are primarily used in bronchial asthma. Other uses are As uterine relaxant to delay premature labour. Ritodrine is the preferred drug In hyperkalemic familial periodic paralysis benefit by enhancing K uptake into muscles a lowering plasma K levels.The most important side effect is muscle tremor tachycardia and arrhythmias are less likely.THERAPEUTIC CLASSIFICATION OF ADRENERGIC DRUGSI.Pressor agentsNoradrenalineMethoxaminePhenylephrineDopamineeEphedrineMephentermineII.Cardiac stimulantsAdrenalineeDobutamineeIsoprenalineeIII.BronchodilatorsAdrenalineSalmeterolTerbutalineSalbutamoleIsoprenalineFormoterolIV.Nasal decongestantsPhenylephrineePseudoephedrineNaphazolineOxymetazolineXylometazolinePhenylpropanolamineV.CNS stimulantsAmphetamineMethamphetamineDexamphetamineVI.AnorecticsFenfluramineSibutramineDexfenfluramineVII.Uterine relaxant and vasodilatorsRitodrineSalbutamol IsoxsuprineeTerbutalineeTocolytic drugsSr. no.Tocolytic AgentsComments1Isosuprine DUVADILAN It is an orally effective long acting selective b receptor stimulant, which has direct smooth muscle relaxant property as well. It has been used as uterine relaxant for threatened abortion and dysmenorrhoea, but efficacy is poor.Side effects nausea, tachycardia, flushing, dizziness, and tremor. Isoxsuprine has been used in threatened abortion and dysmenorrhoea, but efficacy is doubtful.2Ritodrine Selective b2 stimulants infused i.v. have been successfully used to postpone labour but maternal morbidity and mortality may be increased due to their cardiac and metabolic actions and incidents of pulmonary edema.3Atosiban nifedipineAlthough atosiban and nifedipine seem equally effective in delaying preterm labour, there is increasing concern in twin pregnancies about the adverse CVS effects of nifedipine. Nifedipine should not be used in multiple pregnancies due to fear of pul edema. However, atosiban, which is principally an AVP receptor antagonists is oxytocin receptor antagonist, used for the treatment of preterm labour.4Magnesium sulphateAlso acts as a tocolytic agent. With the withdrawal of sympathomimetic drugs and the failure of atosiban, an oxytocinantagonist, to obtain FDA approval, magnesium sulphate is therefore in commonly used tocolytic drug.Educational points Tolterodine is being developed as a vasicoselective antimuscarinic. Tiotropiumbromide Congener of ipratropium bromide, which binds very tightly to bronchial M1 M3 muscarinic receptors producing long lasting bronchodilatation. Binding to M2 receptors is less tight confering relative M1 M3 selectivity. Like ipratropium, it is not absorbed from respiratory and g. i. mucosa and has exhibited high bronchial selectivity of action.

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.

Exact location of a genetic loci is identified by

Ans. a. Fluorescent in situ hybridization Ref Harrison 19 e 83e 2 , 83e 2f, 83e 3t p512 style font size 1.04761904761905em font family Times New Roman, Times, serif margin 0 0 0 8px text indent 0 Exact location of a genetic loci is identified by Fluorescent in situ hybridization FISH .Fluorescent in situ hybridization FISH, which utilizes fluorescent rather than radioactiveiy labeled probes, is a very sensitive technique for exact location of a genetic lociQ.This often places the gene at a location on a given band or region of the chromosomeQ.Polymerase chain reaction PCR is a cell free, test tube method used for amplifying a target sequence of DNAQ.Much faster and more sensitive than cell based cloningQPCR is used to amplify specific regions of DNA strandQ target DNA Chromosome painting A technique for visualizing CHROMOSOME ABERRATIONS using fluorescently labeled DNA probes, which are hybridized to chromosomal DNA.Multiple fluorochromes may be attached to the probes.Upon hybridization, this produces a multicolored, or painted, effect with a unique color at each site of hybridizationQ.This technique may also be used to identify cross species homology by labeling probes from one species for hybridization with chromosomes from another species.Comparative genomic hybridization Comparative genomic hybridization differentiate the chromosome of normal and cancer cellsQ.Comparative genomic hybridization is used to study cryptic chromosomal imbalances in patients with mental retardation and multiple congenital anomalies, as well as in prenatal diagnosis and to detect microdeletions and microduplications in cancer and in previously unidentified genomic disordersQ.FISH Fluorescent In Situ Hybridization The majority of FISH applications involve hybridization of one or two probes of interest as an adjunctive procedure to conventional chromosomal banding techniques.In this regard. FISH can be utilized to identify specific chromosomes, characterize de novo duplications or deletions, and clarify subtle chromosomal rearrangementsQ.Its greatest utilization in constitutional analysis, however, is in the detection of microdeletionsQ.In cancer cytogenetics, it is used extensively in the analysis of structural rearrangements.Though conventional cytogenetic studies ean detect some microdeietions, initial detection and or confirmation with FISH is essential.In addition to metaphase FISH, cells can be analyzed at a variety of stages. Interphase analysis can be used to make a rapid diagnosis in instances when metaphase chromosome preparations are not yet available e.g., amniotic fluid interphase analysts .One specialized type of interphase analysts involves the application of FISH to paraffin embedded sections, thereby preserving the architecture of the tissue.The use of interphase FISH has increased recently, especially for analyses of amniocentesis samplesQ.These studies are performed on uncultured amniotic fluid, typically using DNA probes specific for the chromosomes most commonly identified in trisomies chromosomes 13, 18, 21, and the X and Y .These studies can be performed rapidly 24 48 hours and will ascertain about 60 of the abnormalities detected prenatally.Interphase analysts is routinely utilized is cancer cytogeneticsQ.Many site specific translocations are associated with specific types of malignanciesQ.For example, there are probes available for both the Abelson Abl oncogene and breakpoint cluster region ber involved in chronic myelogenous leukemia CML these probes are labeled in red and green, respectively the fusion of these genes in CML combines the fluorescent colors and appears as a yellow hybridization signal.Enhanced techniques for specific types of analysis Multicolor FISH techniquesReverse paintingFiber FISHComparative genomic hybridizationSpectral karyotyping SKY and multicolor FISH m FISH techniquesSKY and m FISH techniques use combinatorially labeled probes that create a unique color for individual chromosomes.Useful in the identification of unknown chromosome material such as accessory marker chromosomes containing additional material but has been most commonly used with the complex rearrangements seen in cancer specimens.Fiber FISHFiber FISH is a technique in which chromosomes are mechanically stretched, using a variety of different methods.It provides a higher resolution of analysis than conventional FISH.FISH comparative genomic hybridization CGH FISH comparative genomic hybridization CGH is a method that can be used only when DNA is available from a specimen of interestQ.The entire DNA specimen from the sample of interest is labeled in one color e.g.. green , and the normal control DNA specimen is indicated by another color e.g.. red . These are mixed in equal amounts and hybridized to normal metaphase chromosomes. The red to green ratio is analyzed by a computer program that determines where the DNA of interest may have gains or losses of material.The major advance for examining human chromosomes is an extension of the FISH CGH technologies.Used to study cryptic chromosomal imbalances in patients with mental retardation and multiple congenital anomalies, as well as in prenatal diagnosisQ.Used to detect microdeletions and microduplications in cancer and in previously unidentified genomic disordersQ

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.

Pincer grasp develops at what age ___________

Developmental milestones GROSS MOTOR DEVELOPMENT 2 months Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months Rolls over. 6 months sit in tripod fashion. 8 months sits without suppo., crawling 9 months Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months creeps 12 months creeps well, walk but falls, stand without suppo. 15 months walks well, walks backward sideways pulling a toy. May crawl upstairs. 18 months Runs, walks upstair with one hand held. Explores drawers 2 years walk up and downstairs, jumps. 3 years rides tricycle, alternate feet going upstairs. 4 years hops on one foot, alternate feet going downstairs. 5 years skips FINE MOTOR DEVELOPMENT 2 months eyes follow objects to 180 deg. 3 months Grasp reflex disappears and hand is open most of the time. 4 months Bidextrous approach reaching out for objects with both hands . 6 months Unidextrous approach Reach for an object with one hand . 8 months radial grasp sta to develop. Turns to sound above the level of ear. 9 months immature pincer grasp, probes with forefinger. 12 months Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months imitate scribbling , tower of two blocks 18 months scribbles, tower of 3 blocks.turn pages of a book, 2 3 at a time. 2 years tower of 6 blocks, veical and circular stroke. 3 years Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years copies cross, bridge with blocks 5 years copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES 2 months social smile smile after being talked to .watches mother when spoken to and may smile. 3 months Recognizes mother, anticipates feeds. 4 months Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months waves bye bye 12 months comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months jargon, stas imitating mother. 18 months copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years ask for food, drink, toilet, pulls people to show toys. 3 years shares toys, know fullname and gender, dry by night. 4 years Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years helps in household task , dresses and undresses. LANGUAGE MILESTONES 1 month Ales to sound. 2 month respond to sound by stale or quitening to a smooth voice. 3 months babbles when spoken to. Makes sounds ahh,coos, laughs. 4 months laughs aloud. 6 months monosyllables 9 months understands spoken words, bisyllables. 12 months 1 2 words with meaning. 18 months vocabulary of 10 words. Can name one pa of body. 2 years 3 word simple sentences 3 years asks questions, knows full name and gender. 4 years says songs or poem, tells story, knows three colours. 5 years ask meaning of words. Reference GHAI Essential pediatrics, 8th edition

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 following type of data description called?

Ans. a. Stem and leaf diagram Ref https en.wikipeiUa.org wiki Stem ami leaf_dispIay The type of data description given is Stem and Leaf PlotStem and Leaf PlotStem and Leaf Plot is a special table where each data value is split into a stem the first digit or digits and a leaf usually the last digit .A stem and leaf display is a device for presenting quantitative data in a graphical format, similar to a histogram to assist in visualizing the shape of a distribution.A basic stem and leaf display contains two columns separated by a vertical line.The left column contains the stems and the right column contains the leaves.AdvantagesDisadvantages Stem and leaf displays are useful for displaying the relative density and shape of the data, giving the reader a quick overview of distribution. They retain most of the raw numerical data, often with perfect integrity. They are also useful for highlighting outliers and finding the mode. Only useful for moderately sized data sets around15 150 data points . With very small data sets a stem and leaf displays can be of little use. A dot plot may be better suited for such data. With very large data sets, a stem and leaf display will become very cluttered. A box plot or histogram may become more appropriate as the data size increases. Box PlotA box plot is a convenient way of graphically depicting groups of numerical data through their quartiles.Box plots may also have lines extending vertically from the boxes whiskers indicating variability outside the upper and lower quartiles. hence the terms box and whisker plot and box and whisker diagram. Outliers may be plotted as individual points.Box plots are non para metric they display variation in samples of a statistical population without making any assumptions of the underlying statistical distribution.The spacing between the different parts of the box indicate the degree of dispersion spread and skewrness in the data, and show outliers.In addition to the points themselves, they allow one to visually estimate various L estimators, notably the interquartile range, mid hinge, range, mid range, and tri mean.Boxplots can be drawn either horizontally or vertically.Funnel Plot A funnel plot is a graph designed to check for the existence of publication bias. Funnel plots are commonly used in systematic reviews and meta analyses. In the absence of publication bias, it assumes that the largest studies will be plotted near the average, and smaller studies will be spread evenly on both sides of the average, creating a roughly funnel shaped distribution. Deviation from this shape can indicate publication bias.An example funnel plot showing no publication bias.Each dot represents a study measuring the effect of a certain drug y axis Size of the study number of experimental subjects x axis Show the study s drug s measured average effect Forest plot A forest plot, also known as a blobbogram, is a graphical display of estimated results from a number of scientific studies addressing the same question, along with the overall results. It was developed for use in medical research as a means of graphically representing a meta analysis of the results of randomized controlled trials.In the last twenty years, similar meta analytical techniques have been applied in observ ational studies e.g. environmental epidemiology and forest plots are often used in presenting the results of such studies also.Although forest plots can take several forms, they are commonly presented with two columns.The left hand column lists the names of the studies frequently randomized controlled trials or epidemiological studies , commonly in chronological order from the fop downwards.The right hand column is a plot of the measure of effect e.g. an odds ratio for each of these studies often represented by a square incorporating confidence intervals represented by horizontal lines.The graph may be plotted on a natural logarithmic scale when using odds ratios or other ratio based effect measures, so that the confidence intervals are symmetrical about the means from each study and to ensure undue emphasis is not given to odds ratios greater than 1 when compared to those less than 1.The area of each square is proportional to the study s weight In the meta analysis.The overall meta analyzed measure of effect is often represented on the plot as a dashed vertical line. This meta analyzed measure of effect is commonly plotted as a diamond, the lateral points of which indicate confidence intervals for this estimate.A vertical line representing no effect is also plotted. If the confidence intervals for individual studies overlap with this line, it demonstrates that at the given level of confidence their effect sizes do not differ from no effect for the individual study.The same applies for the meta analyzed measure of effect if the points of the diamond overlap the line of no effect the overall meta analyzed result cannot be said to differ from no effect at the given level of confidence.

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 Mitral Valve Prolapse ?

Most people who have mitral valve prolapse MVP dont need treatment because they dont have symptoms and complications. Even people who do have symptoms may not need treatment. The presence of symptoms doesnt always mean that the backflow of blood through the valve is significant. People who have MVP and troublesome mitral valve backflow may be treated with medicines, surgery, or both. The goals of treating MVP include Correcting the underlying mitral valve problem, if necessary Preventinginfective endocarditis,arrhythmias, and other complications Relieving symptoms Medicines Medicines called beta blockers may be used to treatpalpitationsand chest discomfort in people who have little or no mitral valve backflow. If you have significant backflow and symptoms, your doctor may prescribe Blood thinning medicines to reduce the risk of blood clots forming if you haveatrial fibrillation. Digoxin to strengthen your heartbeat. Diuretics fluidpills to remove excess sodium and fluid in your body and lungs. Medicines such as flecainide and procainamide to regulate your heart rhythms. Vasodilators to widen your blood vessels and reduce your hearts workload. Examples of vasodilators are isosorbide dinitrate and hydralazine. Take all medicines regularly, as your doctor prescribes. Dont change the amount of your medicine or skip a dose unless your doctor tells you to. Surgery Surgery is done only if the mitral valve is very abnormal and blood is flowing back into the atrium. The main goal of surgery is to improve symptoms and reduce the risk ofheart failure. The timing of the surgery is important. If its done too early and your leaking valve is working fairly well, you may be put at needless risk from surgery. If its done too late, you may have heart damage that can t be fixed. Surgical Approaches Traditionally, heart surgeons repair or replace a mitral valve by making an incision cut in the breastbone and exposing the heart. A small but growing number of surgeons are using another approach that involves one or more small cuts through the side of the chest wall. This results in less cutting, reduced blood loss, and a shorter hospital stay. However, not all hospitals offer this method. Valve Repair and Valve Replacement In mitral valve surgery, the valve is repaired or replaced. Valve repair is preferred when possible. Repair is less likely than replacement to weaken the heart. Repair also lowers the risk of infection and decreases the need for lifelong use of blood thinning medicines. If repair isnt an option, the valve can be replaced. Mechanical and biological valves are used as replacement valves. Mechanical valves are man made and can last a lifetime. People who have mechanical valves must take blood thinning medicines for the rest of their lives. Biological valves are taken from cows or pigs or made from human tissue. Many people who have biological valves dont need to take blood thinning medicines for the rest of their lives. The major drawback of biological valves is that they weaken over time and often last only about 10 years. After surgery, youll likely stay in the hospitals intensive care unit for 2 to 3 days. Overall, most people who have mitral valve surgery spend about 1 to 2 weeks in the hospital. Complete recovery takes a few weeks to several months, depending on your health before surgery. If youve had valve repair or replacement, you may need antibiotics before dental work and surgery. These procedures can allow bacteria to enter your bloodstream. Antibiotics can help prevent infective endocarditis, a serious heart valve infection. Discuss with your doctor whether you need to take antibiotics before such procedures. Transcatheter Valve Therapy Interventional cardiologists may be able to repair leaky mitral valves by implanting a device using a catheter tube inserted through a large blood vessel. This approach is less invasive and can prevent a person from havingopen heart surgery. At present, the device is only approved for people with severe mitral regurgitation who cannot undergo surgery.

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 stages of AIDS Related Lymphoma ?

Key Points After AIDS related lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body. There are three ways that cancer spreads in the body. Stages of AIDS related lymphoma may include E and S. The following stages are used for AIDS related lymphoma Stage I Stage II Stage III Stage IV For treatment, AIDS related lymphomas are grouped based on where they started in the body, as follows Peripheral systemic lymphoma Primary CNS lymphoma After AIDS related lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body. The process used to find out if cancer cells have spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment, but AIDS related lymphoma is usually advanced when it is diagnosed. The following tests and procedures may be used in the staging process Blood chemistry studies A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual higher or lower than normal amount of a substance can be a sign of disease. The blood sample will be checked for the level of LDH lactate dehydrogenase . CT scan CAT scan A procedure that makes a series of detailed pictures of areas inside the body, such as the lung, lymph nodes, and liver, taken from different angles. The pictures are made by a computer linked to an x ray machine. A dye may be 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 with gadolinium A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging NMRI . Lumbar puncture A procedure used to collect cerebrospinal fluid CSF from the spinal column. This is done by placing a needle between two bones in the spine and into the CSF around the spinal cord and removing a sample of the fluid. The sample of CSF is checked under a microscope for signs that the cancer has spread to the brain and spinal cord. The sample may also be checked for Epstein Barr virus. This procedure is also called an LP or spinal tap. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Stages of AIDS related lymphoma may include E and S. AIDS related lymphoma may be described as follows E E stands for extranodal and means the cancer is found in an area or organ other than the lymph nodes or has spread to tissues beyond, but near, the major lymphatic areas. S S stands for spleen and means the cancer is found in the spleen. The following stages are used for AIDS related lymphoma Stage I Stage I AIDS related lymphoma is divided into stage I and stage IE. Stage I Cancer is found in one lymphatic area lymph node group, tonsils and nearby tissue, thymus, or spleen . Stage IE Cancer is found in one organ or area outside the lymph nodes. Stage II Stage II AIDS related lymphoma is divided into stage II and stage IIE. Stage II Cancer is found in two or more lymph node groups either above or below the diaphragm the thin muscle below the lungs that helps breathing and separates the chest from the abdomen . Stage IIE Cancer is found in one or more lymph node groups either above or below the diaphragm. Cancer is also found outside the lymph nodes in one organ or area on the same side of the diaphragm as the affected lymph nodes. Stage III Stage III AIDS related lymphoma is divided into stage III, stage IIIE, stage IIIS, and stage IIIE S. Stage III Cancer is found in lymph node groups above and below the diaphragm the thin muscle below the lungs that helps breathing and separates the chest from the abdomen . Stage IIIE Cancer is found in lymph node groups above and below the diaphragm and outside the lymph nodes in a nearby organ or area. Stage IIIS Cancer is found in lymph node groups above and below the diaphragm, and in the spleen. Stage IIIE S Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ or area, and in the spleen. Stage IV In stage IV AIDS related lymphoma, the cancer is found throughout one or more organs that are not part of a lymphatic area lymph node group, tonsils and nearby tissue, thymus, or spleen and may be in lymph nodes near those organs or is found in one organ that is not part of a lymphatic area and has spread to organs or lymph nodes far away from that organ or is found in the liver, bone marrow, cerebrospinal fluid CSF , or lungs other than cancer that has spread to the lungs from nearby areas . Patients who are infected with the Epstein Barr virus or whose AIDS related lymphoma affects the bone marrow have an increased risk of the cancer spreading to the central nervous system CNS . For treatment, AIDS related lymphomas are grouped based on where they started in the body, as follows Peripheral systemic lymphoma Lymphoma that starts in the lymph system or elsewhere in the body, other than the brain, is called peripheral systemic lymphoma. It may spread throughout the body, including to the brain or bone marrow. It is often diagnosed in an advanced stage. Primary CNS lymphoma Primary CNS lymphoma starts in the central nervous system brain and spinal cord . It is linked to the Epstein Barr virus. Lymphoma that starts somewhere else in the body and spreads to the central nervous system is not primary CNS lymphoma.

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 Gastritis ?

A health care provider diagnoses gastritis based on the following medical history physical exam upper GI endoscopy other tests Medical History Taking a medical history may help the health care provider diagnose gastritis. He or she will ask the patient to provide a medical history. The history may include questions about chronic symptoms and travel to developing countries. Physical Exam A physical exam may help diagnose gastritis. During a physical exam, a health care provider usually examines a patient s body uses a stethoscope to listen to sounds in the abdomen taps on the abdomen checking for tenderness or pain Upper Gastrointestinal Endoscopy Upper GI endoscopy is a procedure that uses an endoscopea small, flexible camera with a lightto see the upper GI tract. A health care provider performs the test at a hospital or an outpatient center. The health care provider carefully feeds the endoscope down the esophagus and into the stomach and duodenum. The small camera built into the endoscope transmits a video image to a monitor, allowing close examination of the GI lining. A health care provider may give a patient a liquid anesthetic to gargle or may spray anesthetic on the back of the patient s throat before inserting the endoscope. A health care provider will place an intravenous IV needle in a vein in the arm to administer sedation. Sedatives help patients stay relaxed and comfortable. The test may show signs of inflammation or erosions in the stomach lining. The health care provider can use tiny tools passed through the endoscope to perform biopsies. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope by a pathologista doctor who specializes in examining tissues to diagnose diseases. A health care provider may use the biopsy to diagnose gastritis, find the cause of gastritis, and find out if chronic gastritis has progressed to atrophic gastritis. More information is provided in the NIDDK health topic, Upper GI Endoscopy. Other Tests A health care provider may have a patient complete other tests to identify the cause of gastritis or any complications. These tests may include the following Upper GI series. Upper GI series is an x ray exam that provides a look at the shape of the upper GI tract. An x ray technician performs this test at a hospital or an outpatient center, and a radiologista doctor who specializes in medical imaginginterprets the images. This test does not require anesthesia. A patient should not eat or drink before the procedure, as directed by the health care provider. Patients should check with their health care provider about what to do to prepare for an upper GI series. During the procedure, the patient will stand or sit in front of an x ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so the radiologist and health care provider can see these organs shapes more clearly on x rays. A patient may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract may cause white or light colored stools. A health care provider will give the patient specific instructions about eating and drinking after the test. More information is provided in the NIDDK health topic, Upper GI Series. Blood tests. A health care provider may use blood tests to check for anemia or H. pylori. A health care provider draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis. Stool test. A health care provider may use a stool test to check for blood in the stool, another sign of bleeding in the stomach, and for H. pylori infection. A stool test is an analysis of a sample of stool. The health care provider will give the patient a container for catching and storing the stool. The patient returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Urea breath test. A health care provider may use a urea breath test to check for H. pylori infection. The patient swallows a capsule, liquid, or pudding that contains ureaa waste product the body produces as it breaks down protein. The urea is labeled with a special carbon atom. If H. pylori are present, the bacteria will convert the urea into carbon dioxide. After a few minutes, the patient breathes into a container, exhaling carbon dioxide. A nurse or technician will perform this test at a health care provider s office or a commercial facility and send the samples to a lab. If the test detects the labeled carbon atoms in the exhaled breath, the health care provider will confirm an H. pylori infection in the GI tract.

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 chromosomal complement in persons with Klinefelter s syndrome is March 2011

Ans. D 47, XXY Genetic analysis reveals the karyotype of klinefelter s syndrome to be 47 XXY Klinefelter syndrome 46 or 47, XXY XXY syndrome It is a condition with an extra X chromosome. Because of the extra chromosome, individuals with the condition are usually referred to as XXY Males , or 47, XXY Males Klinefelter syndrome is the most common sex chromosome disorder in males and the second most common condition caused by the presence of extra chromosomes. The condition exists in roughly 1 out of every 500 650 males but many of these people may not show symptoms. Principal effects include hypogonadism and reduced feility. Turner syndrome Ullrich Turner syndrome Gonadal dysgenesis It encompasses several conditions in human females, of which monosomy X absence of an entire sex chromosome, the Barr body is most common. It is a chromosomal abnormality in which all or pa of one of the sex chromosomes is absent unaffected humans have 46 chromosomes, of which two are sex chromosomes . Normal females have two X chromosomes, but in Turner syndrome, one of those sex chromosomes is missing or has other abnormalities. In some cases, the chromosome is missing in some cells but not others, a condition referred to as mosaicism or Turner mosaicism . Occurring in 1 in 2000 1 in 5000 phenotypic females. There are characteristic physical abnormalities, such as Sho stature, Broad chest, Low hairline, Low set ears, and Webbed necks. Girls with Turner syndrome typically experience gonadal dysfunction non working ovaries , which results in amenorrhea absence of menstrual cycle and sterility. Concurrent health concerns are also frequently present, including congenital hea disease, hypothyroidism, diabetes, vision problems, hearing concerns, and many autoimmune diseases. Finally, a specific pattern of cognitive deficits is often observed, with paicular difficulties in visuospatial, mathematical, and memory areas Down syndrome trisomy 21 Down syndrome is a chromosomal condition characterized by the presence of an extra copy of genetic material on the 21st chromosome, either in whole trisomy 21 or pa such as due to translocations . The incidence of Down syndrome is estimated at 1 per 733 bihs It is statistically more common with older parents due to increased mutagenic exposures upon some older parents reproductive cells. Down syndrome is associated with some impairment of cognitive ability and physical growth, and a paicular set of facial characteristics. Individuals with Down syndrome tend to have a lower than average cognitive ability, often ranging from mild to moderate disabilities. The average IQ of children with Down syndrome is around 50, compared to normal children with an IQ of 100. A small number have a severe to high degree of intellectual disability Individuals with Down syndrome may have some or all of the following physical characteristics Microgenia an abnormally small chin , An unusually round face, macroglossia protruding or oversized tongue , An almond shape to the eyes caused by an epicanthic fold of the eyelid, Upslanting palpebral fissures the separation between the upper and lower eyelids , Shoer limbs, A single transverse palmar crease a single instead of a double crease across one or both palms , Poor muscle tone, and A larger than normal space between the big and second toes. Health concerns for individuals with Down syndrome include a higher risk for congenital hea defects, gastroesophageal reflux disease, recurrent ear infections that may lead to hearing loss, obstructive sleep apnea, thyroid dysfunctions, and obesity.

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.

Pseudopalisading arrangement of malignant cells is characteristic of

The highest grade tumor of astrocytoma, known as glioblastoma, has a histologic appearance similar to anaplastic astrocytoma with the additional features of necrosis and vascular or endothelial cell proliferation and pseudo palisading nuclei. Glioblastoma is type of infiltrating astrocytoma Classified as Grade 4 . Necrosis in glioblastoma often results in a SERPENTINE pattern in areas of hyper cellularity. Tumor cells collect along the edges of the necrotic regions, producing histologic pattern referred to as pseudopalisading pattern. GLIOMAS Gliomas are tumors of the brain parenchyma that histologically resemble different types of glial cells. The major types of tumor in this category are a. Astrocytomas b. Oligodendrogliomas c. Ependymomas. ASTROCYTOMAS Two major categories of astrocytoma, infiltrating and non infiltrating types. Infiltrating astrocytomas account for about 80 of adult primary brain tumors. They are most frequent in the fourth through sixth decades. They are usually found in the cerebral hemispheres. The most common presenting signs and symptoms are seizures, headaches and focal neurologic deficits related to the anatomic site of involvement. Infiltrating astrocytomas show a spectrum of histologic differentiation that correlates well with clinical course and outcome. Based on the degree of differentiation, they are classified into four groups Pilocytic astrocytoma Grade I Most common Astrocytoma Grade 2 Anaplastic astrocytoma Grade 3 Glioblastoma multiforme Grade 4 Least differentiated PILOCYTIC ASTROCYTOMA Pilocytic astrocytomas are relatively benign tumors, often cystic, that typically occur in children and young adults. They are usually located in the cerebellum also in the floor and walls of the third ventricle, the optic nerves, and occasionally the cerebral hemispheres. A pilocytic astrocytoma is often cystic, with a mural nodule in the wall of the cyst if solid, it is usually well circumscribed. The tumor is composed of areas with bipolar cells with long, thin hairlike processes that are GFAP positive Rosenthal fibers, eosinophilic granular bodies, and microcysts are often present. Necrosis and mitoses are absent. OLIGODENDROGLIOMAS These tumors constitute about 5 to 15 of gliomas and are most common in the fourth and fifth decades. Patients may have had several years of neurologic complaints, often including seizures. The lesions are found mostly in the cerebral hemispheres, with a predilection for white matter. Oligodendrogliomas are infiltrative tumors that form gelatinous, gray masses, and may show cysts, focal hemorrhage and calcification. On microscopic examination, the tumor is composed of sheets of regular cells with spherical nuclei containing finely granular chromatin similar to normal oligodendrocytes surrounded by a clear halo of cytoplasm. The tumor typically contains a delicate network of anastomosing capillaries. Calcification, present in as many as 90 of these tumors, ranges from microscopic foci to massive depositions. With increasing cell density, nuclear anaplasia, increased mitotic activity and necrosis, the tumor becomes higher grade anaplastic oligodendroglioma. Patients with oligodendrogliomas have a better prognosis than do patients with astrocytomas. Current treatment with surgery, chemotherapy, and radiotherapy yields an average survival of 5 to 10 years. Patients with anaplastic oligodendroglioma have a worse prognosis. EPENDYMOMAS Ependymomas most often arise next to the ependyma lined ventricular system, including the central canal of the spinal cord. In the first two decades of life, they typically occur near the fourth ventricle and constitute 5 to 10 of the primary brain tumors in this age group. In adults, the spinal cord is their most common location tumors in this site are particularly frequent in the setting of neurofibromatosis type 2. Because ependymomas usually grow within the ventricles. CSF dissemination is a common occurrence. In the fourth ventricle, ependymomas are typically solid or papillary masses extending from the floor of the ventricle. These tumors are composed of cells with regular, round to oval nuclei with abundant granular chromatin. Between the nuclei there is a variably dense fibrillary background. Tumor cells may form round or elongated structures rosettes, canals that resemble the embryologic ependymal canal, with long, delicate processes extending into a lumen. More frequently present are perivascular pseudo rosettes in which tumor cells are arranged around vessels with an intervening zone consisting of thin ependymal processes directed toward the wall of the vessel. Anaplastic ependymomas show increased cell density, high mitotic rates, necrosis and less evident ependymal differentiation. The clinical outcome for completely resected supratentorial and spinal ependymomas is better than for those in the posterior fossa.

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.

Ligature mark is horizontal in

Ans. is b i.e., Strangulation Ref Reddy 30th e p. Hanging Strangulation General characteristics There is suspension of body. Compression on neck is by a ligature. Force of compression is the weight of body endogenous force . No suspension. Compression on neck is by a ligature, hands, sticks, elbow, knee or foot. It is outside force applied exogenous force . Local external P.M. findings Ligature mark is above the thyroid is oblique, symmetrical and incomplete. Knot usually present. Usually no mark at site of knot In fixed knot, mark is inverted V shaped. In running noose, mark is transverse. Mark usually single. Surface of mark abraded or contused. Surface may show pattern of ligature used. Surface hard. Mark yellowish brown in colour. Margins of mark show petechial haemorrhages. Surrounding skin shows few petechial haemorrhages. Depth of mark is less. Mark is on or below the thyroid. Is horizontal, complete and continuous in absence of ligature mark there are other injuries on neck depending upon type of strangulation . Usually absent. Mark is horizontal, complete and continuous. Usually multiple marks. Usually lacerated. Pattern not seen. Soft, due to frank bleeding. Black. Frank bleeding present. Multiple haemorrhages present. More, like a groove. Local internal P.M. findings Under the mark area is seen as dry, white, glistening pad of fat. Muscles may be lacerated. Usually no laceration of blood vessels and their walls, lacerated injudicial hanging . May be fracture of trachea, thyroid and larynx. Cervical vertebrae fractured usually at C2 C3 and rarely C3 C4 or C1 C2, injudicial hanging. Fracture of hyoid bone in uncommon. 21. Injury to spinal cord, pons and medulla common injudicial hanging. Area is haemmorrhagic Lacerated. Lacerated. Usually fractured. Fracture cervical vertebrae uncommon. Fracture of hyoid bone, of adduction type inward compression fracture , very common in throtting. 21. No injury to spinal cord, pons and medulla. Signs of struggle and violence 22. Signs of struggle and violence absent. 23. No question of sexual assault on female victim, as this is usually suicidal and it is uncommon in females. 24. Since hanging is usually suicidal no question of hiding the cause of death. 22. Due to struggle, abrasions and contusions present on the body. 23. May be sexual assault on female victim. 24. Since strangulation is usually homicidal there is attempt at hiding the crime. Dead body may be hanged thrown in water, jungle, or acid may be burnt. General external P.M. findings 25. Features of asphyxia mild. 26. Head tilted to side, opposite to knot. 27. Neck stretched. 28. Face usually pale. 29. Mild cyanosis on nose, lips, tongue, ears and nails 30. Few petechial haemorrhages in eyes and on face. 31. Tongue usually inside. 32. Bloody froth at nose and mouth is sometimes present. 33. Usually there is dribbling of saliva from angle of mouth. 25. Greatly marked. 26. No such tilting. 27. No stretching. 28. Deeply congested and deeply cyanosed. 29. Severe cyanosis. 30. Multiple petechial haemmorrhages and eye protruded out 31. Tongue protruded, bitten and black. 32. Usually present. 33. Usually absent.

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 Cutaneous mastocytosis ?

What are the signs and symptoms of Cutaneous mastocytosis? Cutaneous mastocytosis is a form of mastocytosis that primarily affects the skin. There are three main forms that vary in severity maculopapular cutaneous mastocytosis also called urticaria pigmentosa , solitary cutaneous mastocytoma, and diffuse cutaneous mastocytosis. There is also an exteremely rare form called telangiectasia macularis eruptiva perstans. Maculopapular cutaneous mastocytosis, the most common form of cutaneous mastocytosis, is characterized by itchy, brown patches on the skin. Although these patches may be mistaken for freckles or bug bites initially, they typically persist and gradually increase in number over several months to years. In young children, the patches may form a blister if itched or rubbed. Itching may worsen with changes in temperature, strenuous activity, emotional stress, and or certain medications. Maculopapular cutaneous mastocytosis is most commonly seen in infants and young children and often fades by the teenaged years. In some cases, this condition may not develop until adulthood. These later onset cases generally last long term and are more likely to progress to systemic mastocytosis. Solitary cutaneous mastocytoma is a localized form of cutaneous mastocytosis. Like maculopapular cutaneous mastocytosis, this form is typically diagnosed in young children. However, it is characterized by an itchy area of reddish or brown skin that is often thickened. When itched, these patches of skin may swell, redden, and or blister. This form typically resolves spontaneously with age. Diffuse cutaneous mastocytosis, the most severe form of cutaneous mastocytosis, usually develops in infancy. Unlike the other forms of cutaneous mastocytosis, it affects most or all of the skin rather than appearing as distinct patches. In people affected by this condition, the skin is leathery and thickened. It may appear normal, yellowish brown, or red in color. In some cases, there may also be widespread blistering. Additional symptoms may include hypotension, diarrhea, gastrointestinal bleeding, reddening of the skin flushing , and anaphylactic shock. The rarest form of cutaneous mastocytosis is called telangiectasia macularis eruptiva perstans. Unlike the other forms of cutaneous mastocytosis, this form is primarily diagnosed in adults and is generally not associated with pruritus and blistering. People affected by this condition have persistent brown patches of skin and extensive telegiactasia. Rarely, this form may progress to systemic mastocytosis. The Human Phenotype Ontology provides the following list of signs and symptoms for Cutaneous mastocytosis. 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 Hypermelanotic macule 90 Mastocytosis 90 Pruritus 90 Urticaria 90 Abdominal pain 50 Abnormal blistering of the skin 50 Abnormal renal physiology 7.5 Asthma 7.5 Behavioral abnormality 7.5 Coronary artery disease 7.5 Diarrhea 7.5 Gastrointestinal hemorrhage 7.5 Hepatomegaly 7.5 Hypercalcemia 7.5 Hypotension 7.5 Impaired temperature sensation 7.5 Increased bone mineral density 7.5 Leukemia 7.5 Malabsorption 7.5 Migraine 7.5 Nausea and vomiting 7.5 Recurrent fractures 7.5 Reduced bone mineral density 7.5 Respiratory insufficiency 7.5 Sarcoma 7.5 Splenomegaly 7.5 Sudden cardiac death 7.5 Telangiectasia of the skin 7.5 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.

What is are Plasma Cell Neoplasms Including Multiple Myeloma ?

Key Points Plasma cell neoplasms are diseases in which the body makes too many plasma cells. Plasma cell neoplasms can be benign not cancer or malignant cancer . There are several types of plasma cell neoplasms. Monoclonal gammopathy of undetermined significance MGUS Plasmacytoma Multiple myeloma Multiple myeloma and other plasma cell neoplasms may cause a condition called amyloidosis. Age can affect the risk of plasma cell neoplasms. Tests that examine the blood, bone marrow, and urine are used to detect find and diagnose multiple myeloma and other plasma cell neoplasms. Certain factors affect prognosis chance of recovery and treatment options. Plasma cell neoplasms are diseases in which the body makes too many plasma cells. Plasma cells develop from B lymphocytes B cells , a type of white blood cell that is made in the bone marrow. Normally, when bacteria or viruses enter the body, some of the B cells will change into plasma cells. The plasma cells make antibodies to fight bacteria and viruses, to stop infection and disease. Plasma cell neoplasms are diseases in which abnormal plasma cells or myeloma cells form tumors in the bones or soft tissues of the body. The plasma cells also make an antibody protein, called M protein, that is not needed by the body and does not help fight infection. These antibody proteins build up in the bone marrow and can cause the blood to thicken or can damage the kidneys. Plasma cell neoplasms can be benign not cancer or malignant cancer . Monoclonal gammopathy of undetermined significance MGUS is not cancer but can become cancer. The following types of plasma cell neoplasms are cancer Lymphoplasmacytic lymphoma. See Adult Non Hodgkin Lymphoma Treatment for more information. Plasmacytoma. Multiple myeloma. There are several types of plasma cell neoplasms. Plasma cell neoplasms include the following Monoclonal gammopathy of undetermined significance MGUS In this type of plasma cell neoplasm, less than 10 of the bone marrow is made up of abnormal plasma cells and there is no cancer. The abnormal plasma cells make M protein, which is sometimes found during a routine blood or urine test. In most patients, the amount of M protein stays the same and there are no signs, symptoms, or health problems. In some patients, MGUS may later become a more serious condition, such as amyloidosis, or cause problems with the kidneys, heart, or nerves. MGUS can also become cancer, such as multiple myeloma, lymphoplasmacytic lymphoma, or chronic lymphocytic leukemia. Plasmacytoma In this type of plasma cell neoplasm, the abnormal plasma cells myeloma cells are in one place and form one tumor, called a plasmacytoma. Sometimes plasmacytoma can be cured. There are two types of plasmacytoma. In isolated plasmacytoma of bone, one plasma cell tumor is found in the bone, less than 10 of the bone marrow is made up of plasma cells, and there are no other signs of cancer. Plasmacytoma of the bone often becomes multiple myeloma. In extramedullary plasmacytoma, one plasma cell tumor is found in soft tissue but not in the bone or the bone marrow. Extramedullary plasmacytomas commonly form in tissues of the throat, tonsil, and paranasal sinuses. Signs and symptoms depend on where the tumor is. In bone, the plasmacytoma may cause pain or broken bones. In soft tissue, the tumor may press on nearby areas and cause pain or other problems. For example, a plasmacytoma in the throat can make it hard to swallow. Multiple myeloma In multiple myeloma, abnormal plasma cells myeloma cells build up in the bone marrow and form tumors in many bones of the body. These tumors may keep the bone marrow from making enough healthy blood cells. Normally, the bone marrow makes stem cells immature cells that become three types of mature blood cells Red blood cells that carry oxygen and other substances to all tissues of the body. White blood cells that fight infection and disease. Platelets that form blood clots to help prevent bleeding. As the number of myeloma cells increases, fewer red blood cells, white blood cells, and platelets are made. The myeloma cells also damage and weaken the bone. Sometimes multiple myeloma does not cause any signs or symptoms. This is called smoldering multiple myeloma. It may be found when a blood or urine test is done for another condition. Signs and symptoms may be caused by multiple myeloma or other conditions. Check with your doctor if you have any of the following Bone pain, especially in the back or ribs. Bones that break easily. Fever for no known reason or frequent infections. Easy bruising or bleeding. Trouble breathing. Weakness of the arms or legs. Feeling very tired. A tumor can damage the bone and cause hypercalcemia too much calcium in the blood . This can affect many organs in the body, including the kidneys, nerves, heart, muscles, and digestive tract, and cause serious health problems. Hypercalcemia may cause the following signs and symptoms Loss of appetite. Nausea or vomiting. Feeling thirsty. Frequent urination. Constipation. Feeling very tired. Muscle weakness. Restlessness. Confusion or trouble thinking. Multiple myeloma and other plasma cell neoplasms may cause a condition called amyloidosis. In rare cases, multiple myeloma can cause peripheral nerves nerves that are not in the brain or spinal cord and organs to fail. This may be caused by a condition called amyloidosis. Antibody proteins build up and stick together in peripheral nerves and organs, such as the kidney and heart. This can cause the nerves and organs to become stiff and unable to work the way they should. Amyloidosis may cause the following signs and symptoms Feeling very tired. Purple spots on the skin. Enlarged tongue. Diarrhea. Swelling caused by fluid in your body s tissues. Tingling or numbness in your legs and feet.

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.

At which one of the following age period a child can remove front opening garments ?

. Developmental milestones GROSS MOTOR DEVELOPMENT 2 months Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months Rolls over. 6 months sit in tripod fashion. 8 months sits without suppo., crawling 9 months Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months creeps 12 months creeps well, walk but falls, stand without suppo. 15 months walks well, walks backward sideways pulling a toy. May crawl upstairs. 18 months Runs, walks upstair with one hand held. Explores drawers 2 years walk up and downstairs, jumps. 3 years rides tricycle, alternate feet going upstairs. 4 years hops on one foot, alternate feet going downstairs. 5 years skips FINE MOTOR DEVELOPMENT 2 months eyes follow objects to 180 deg. 3 months Grasp reflex disappears and hand is open most of the time. 4 months Bidextrous approach reaching out for objects with both hands . 6 months Unidextrous approach Reach for an object with one hand . 8 months radial grasp sta to develop. Turns to sound above the level of ear. 9 months immature pincer grasp, probes with forefinger. 12 months Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months imitate scribbling , tower of two blocks 18 months scribbles, tower of 3 blocks.turn pages of a book, 2 3 at a time. 2 years tower of 6 blocks, veical and circular stroke. 3 years Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years copies cross, bridge with blocks 5 years copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES 2 months social smile smile after being talked to .watches mother when spoken to and may smile. 3 months Recognizes mother, anticipates feeds. 4 months Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months waves bye bye 12 months comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months jargon, stas imitating mother. 18 months copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years ask for food, drink, toilet, pulls people to show toys. 3 years shares toys, know fullname and gender, dry by night.remove front opening garments 4 years Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years helps in household task , dresses and undresses. LANGUAGE MILESTONES 1 month Ales to sound. 2 month respond to sound by stale or quitening to a smooth voice. 3 months babbles when spoken to. Makes sounds ahh,coos, laughs. 4 months laughs aloud. 6 months monosyllables 9 months understands spoken words, bisyllables. 12 months 1 2 words with meaning. 18 months vocabulary of 10 words. Can name one pa of body. 2 years 3 word simple sentences 3 years asks questions, knows full name and gender. 4 years says songs or poem, tells story, knows three colours. 5 years ask meaning of words. Reference GHAI Essential pediatrics, eighth edition

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 girl with normal stature and minimal or absent pubertal development is seen in

Ans. a. Kallman syndrome Ref Nelson 19 e p1956 Harrison 19 e p2256. 18 e p2878 Normal stature and minimal or absent pubertal development in a girl is seen in Kallman syndrome. Kallmann syndrome is a genetic condition where the primary symptom is a failure to start puberty or a failure to fully complete it. It occurs in both males and females and has the additional symptoms of hypogonadism and almost invariably infertility. Kallmann syndrome also features the additional symptom of an altered sense of smell either totally absent anosmia or highly reduced hyposmia . Nelson 19 e p1956Testicular Feminization Syndrome Mutations in the androgen receptor AR cause resistance to androgen testosterone, DHT action or the androgen insensitivity syndrome AIS Q.Because the androgen receptor is X linked. only males are affected and maternal carriers are phenotypicalIy normalQ.XY individuals with complete AIS testicular feminization syndrome have a female phenotype, normal breast developmentQ due to aromatization of testosterone , a short vagina but no uterusQ because MIS production is normal , scanty pubic and axillary hairQ, and female psychosexual orientationQ.Most patients present with inguinal hernia containing testes Q in childhood or with primary amenorrhea in adulthood.GonadectomyQ is usually performed, as there is a low risk of malignancy, and estrogen replacementQ is prescribed.Turner s Syndrome Gonadal Dysgenesis 45.X MC karyotype is 45 XO, rest are 45XO 46XX, 45XO 46XY mosaics Loss of one X chromosome is due to non disjunctionQ during meiosis, the X chromosome retained is maternal in originQ in most cases.MC chromosome disorder in human beings.Characteristic features are short stature, widely spaced nipples, webbed neckQTurner s Syndrome PresentationIn neonatal periodAt PubertyAdditional features Slow growthQ Presence of shield chest, cystic hygroma, lymphedemaQ Cardiac defects Coarctation of aorta MC , bicuspid aortic valve, mitral valve prolapse, aortic aneurysmQ Urinary tract malformations, MC is Horse shoe shaped kidneyQ Primary amenorrhea, failure to mature and infertilityQ. Absent secondary sexual characteristics due to bilateral streak gonads, no estrogen secretion leading to undeveloped breast, absent axillary and pubic hair Q Hormonal profile Raised FSH and LH, decreased estrogen and progesteroneQ Micrognathia, exaggerated epicanthal fold, low set earsQ Sensorineural hearing loss, otitis media conductive hearing loss Q Low posterior hair line, colour blindness, high arched palateQ Broad shield like chest, lack of breast development, shortened 4th metacarpalQ Cubitus valgusQ, hyperconvex nail, multiple pigmented naeviTesticular Dysgenesis Patients with pure or complete gonadal dysgenesis Swyer syndrome have streak gonads, mullerian structures due to insufficient AMH MIS secretion , and a complete absence of androgenization.Gonadal dysgenesis can result from mutations or deletions of testis promoting genes WT1, SF1, SRY, SOX9, DHH, ATRX, ARX, DMRT or duplication of chromosomal loci containing antitestis genes e.g., WNT4 RSPOI, DAXI .Absent vanishing testis syndrome bilateral anorchia reflects regression of the testis during development.Early testicular regression causes impaired androgenization in utero, and in most cases, androgenization of the external genitalia is either normal or slightly impaired e.g., small penis, hypospadias .Kallmann SyndromeKallmann syndrome is a genetic condition where the primary symptom is a failure to start puberty or a failure to fully complete it.It occurs in both males and females and has the additional symptoms of hypogonadism and almost invariably infertility. Kallmann syndrome also features the additional symptom of an altered sense of smell either totally absent anosmia or highly reduced hyposmia .Kallmann syndrome occurs when the hypothalamic neurons that are responsible for releasing gonadotropin releasing hormone GnRH neurons fail to migrate into the hypothalamus during embryonic development.Reproductive Features of Kallmann Syndrome Failure to start or fully complete puberty in both men and women Lack of testicle development in men Infertility Poorly defined secondary sexual characteristics in both men and women. Primary amenorrhea or failure to start menstruation in women

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 patient with blood pressure of 90 60 mm Hg presents with pronounced cyanosis. Blood drawn from peripheral veins is observed to be chocolate brown in colour. The most likely diagnosis is

Answer is A Methaemoglobinemia Pronounced cyanosis together with chocolate brown colour of freshly drawn blood suggests a diagnosis of methaemoglobinemia Methaemoglobinemia Methaemoglobinemia is an uncommon but distinct cause of central cyanosis in the absence of hypoxemia or cardio vascular compromise Methaemoglobinemia occurs when a significant concentration of hemoglobin Hb is oxidized to methaemoglobin Met Hb When the haem moety iron atoms of Hb molecule encounter a strong oxidizing agent iron loses an electron and switches from the Ferrous 2 to Ferric 3 state turning Hb to Met Hb Methaemoglobin has such high oxygen affinity that viually no oxygen is delivered Presentation Methaemoglobinemia most commonly presents as cyanosis unresponsive to supplemental oxygen The most notable physical examination finding is generalized cyanosis which can manifest as muddy brown dark mucus membranes before proceding to global skin discolaration The charachteristic muddy appearance chocolate brown of freshly drawn blood can be a critical clue Blood appears dark brown, brownish, muddy or chocolate in colour immediately after withdrawal. In contrast to normal venous blood, the color does not change with addition of oxygen or agitation in the air Diffirential diagnosis in Internal Medicine Methaemoglobinemia 15 cause symptoms of cerebral ischaemia Methaemoglobinemia 60 is usually lethal Diagnosis The hest Methaemoglobinomia is Methaemoglohin Assay Treatment The most effective emergency management for methaemaglobinemia is administration of Methylene bluee which serves as an antidote intravenous Methylene blue is not effective in patients with methaemoglobinemia due to Hemoglobinopathy MQ Haemoglobin M Methylene blue is contraindicated in patients with G6 PD deficiencyQ since it can cause severe hemolysis due to its potential for oxidation Outline of The Four Main Pathways to MetHb Production 1. Congenitally abnormal hemoglobin Hemoglobin M Hemoglobin M is passed as an autosomal dominant trait affecting either the alpha or beta chain of hemoglobin homozygous Hb M affecting both alpha and beta chains is incompatible with life. Amino acid substitution often a tyrosine for histidine near the heme iron facilitates iron oxidation. 2. Inherited enzyme deficiencies NADH dependent cytochrome b5 reductase and cytochrome bc deficiency. Deficiency of either cytochrome b5 or its reducing enzyme, cytochrome b5 reductase, decreases reduction of MetHb back to Hb 3. Nitrite NO2 , other oxidants and oxygen reducing compounds Nitrites are a common oxidizing source of MetHb production. Reducing agents paradoxically produce methemoglobinemia by reducing oxygen to a free radical or water to 1 1,O2, which then oxidizes hemoglobin. 4. Sensitive hemoglobin Blue baby syndrome Bacteria in the immature gastrointestinal tracts of infants conve nitrate NO3 to the powerful oxidant nitrite NO, . Infants have a relative NADH dependent reductase deficiency only 50 of adult levels and are more susceptible to oxidative injury.