Words of Wisdom

Even a slight touch in right time , in right place and in right direction scores not only in football but also in every sphere of life while due to a slight delay you do not only miss a train but it spoils the whole labour and beauty not only of the game but it changes the colour and prospect of life .

Words of wisdom

Life is just like classical music.

In classical music the tone and tune 

changes every moment

 and 

in life thought and situations 

also change like classical music.

The tones and tunes sometimes go very high 

and 

sometimes very low and depressed, 

this adds to the beauty of classical music,

likewise in life, 

sometimes happiness and sometimes sorrow 

which adds to the beauty of life

 and 

mixture of these two is actually makes 

the sense of life.

Words of wisdom

Please don't take Indian dogs as fools , they are very cleaver and cunning they are well- born and brought-up ,well -red and well -fed. Their personalities are also grand and gracious to look at but the only misfortune lies with them is that they  do not bark at thieves because they are commonly met -with and look more friendly and homely not only that they are the persons who come forward with all means in time of needs . But when they happen to come across an honest and simple man, not only one dog but a pack of hounds with their puppies not only bark at him but try to bounce on him . The poor fellow has nothing but to save his life as he knows that some dogs are rabid and their bite may cause hydrophobia . He also knows that hydrophobia is one disease in which mortality rate is  hundred percent and his sound of the soul is kept aside,engraved in cardiac muscles , unspoken and undone. When alone he is forced to think that it is really too bad to be too good .

Spot the diagnosis -100

(1) A  patient has come with a sinus on the ramus of mandible . There is watery discharge from the sinus at the time of meals .
(2) A patient says that his checks and Parotid region of right side of face becomes painful at the time of shaving and beads of perspiration appear during meals .
(3) A patient had mixed Parotid tumour for long years . Now he has developed  facial palsy that side .
(4) A patient has come with a cystic swelling on the scalp . There is baldness over the cyst .
 
Answers.
(2) Auriculotemporal (Freys) syndrome .
(4) Sebaceous cyst.
(3) Malignant transformation in mixed Parotid tumour .
(1) Parotid fistula.

Spot the diagnosis -99

(1) A patient has come with a sinus on the lower jaw with proud flesh . 
(2) One patient has come with multiple sinuses on the lower jaw  with yellowish discharge.
(3) A patient of forty five has come with a big boil on the posterior side of neck with multiple sieve like openings.
(4) A young lady has come with haemangioma of the face on her right check . She also complains of occasional fits .
 
Answers .
(3) Carbuncle .
(2) Actinomycosis .
(4)Sturge- weber - syndrome.
(1) Osteomylitis of mandible .

Words of wisdom.

(1) The person who does not bother for himself ,for his caste, religion etc but always thinks for the welfare and the betterment of the whole mankind of the whole universe is nothing less than a great saint ,a great mahatma .

(2) Doctors ,Engineers, Lawyers, Administrators ,Politicians, and men in any field if they are not honest and sincere they are bound to be doomed one day.

Spot the diagnosis -98

(1) You have been told about a child patient of thirteen years old that he was admitted in a big hospital  for tumour of femur . The tumour disappeared completely after radiotherapy . Spot the diagnosis ?

(2) A laprotomy for vague abdominal pain was done . Everything is normal except an enlarged and inflammed lymph node is found in the calot's triangle which is formed by cystic duct ,cystic artery and common hepatic duct.

(3) A middle aged woman has come with pain ,tenderness and a nodule on the radial styloid process . Finkelstein's test is positive. Spot the diagnosis ?

(4) An x-ray plate of a patient was shown to you . There are multiple punched out areas of bone destruction in the size of pea in the x-ray plate. Spot the diagnosis ?

Answers

(2) Chronic cholecystitis .

(3) De Quervon's disease .

(1) Ewing's tumour .

(4) Multiple myeloma .

Spot the diagnosis -97

(1) A chain smoker has developed dry gangrene of his big toe of his right foot .

(2) A diabetic patient has developed wet gangrene of the toes.

(3) An old patient has developed gangrene of his toes . He is neither a smoker nor a diabetic .

(4) A young Lady has come with elevation of the skin on the upper chest which is butterfly shaped and pinkish.

Answers

(2) Diabetic gangrene .

(3) Senile gangrene .

(1) Buerger's disease .

(4) Keloid .

Spot the Diagnosis- 96

(1) A patient has come with gangrene of fingers of one hand . His heart is normal . Spot the diagnosis?

(2) A patient of gangrene of fingers of one hand has come   . His radiological views of cervical vertebra is normal . Spot the diagnosis ?

(3) A patient has come with painless whitlow . Spot the diagnosis ?

(4) A lady patient has come with superficial gangrene of fingers of both the  hands excluding both the thumbs .

Answers

(2) Embolic gangrene .

(3)Morvon's disease .

(1) Cervical rib .

(4) Raynaud's disease .

Spot the diagnosis- 95

(1) A patient aged about fifty has come with bilateral renal swellings . Spot the diagnosis?
 

(2) A patient has been admitted for fever,rigor and profuse sweating . He has brawny endurance in the loin . Spot the diagnosis?
 

( 3) A patient of recurrent renal calculi has been admitted . His urine contains huge amount of calcium. Spot the diagnosis?
 

(4) An emaciated patient with vague abdominal pain has been admitted . His urine is acidic , contains pus cells and on ordinary culture urine is found to be sterile .
 

Answers
(4) Renal tuberculosis .
(3) Parathyroid disease .
(2) Perinephric abscess.
(1)Polycystic kidney .

Spot the diagnosis- 94

(1) In a radiological view of a patient of forty years of age  has an ulcer on the lesser curvature of stomach is more than one inch in length   . Spot the diagnosis ?
(2) A patient has come whose radiological finding is an ulcer on the greater curvature about half an  inch in length . Spot the diagnosis ?
(3) A child patient of four years of age  was brought to S.O.P.D . He has painless and gross enlargement of kidney without haematuria . Spot the diagnosis ?
(4) An adult male of  forty five has come with painless and gross enlargement of kidney . Spot the diagnosis ?

Answers
(3) Wilms tumour .
(2) All ulcers on the greater curvature of the stomach is thought to be malignant .
(4) Hypernephroma .
(1) Ulcers on the lesser curvature of stomach more than one inch is thought to be malignant.

Spot the diagnosis- 93

(1) A senior police officer complains of pain in his left arm.

(2) A fatty woman of forty  complains of pain in her right shoulder .

(3) A busy clerck complains of pain on the posterior side of his neck .

(4) A patient has come with persistent fever,cardiac murmurs and palpable spleen .

Answers .
(2) Cholelithiasis .
(3) Refractory errors .
(4) Subacute bacterial endocarditis 
(1) Ischemic heart

Spot the diagnosis -92

(1) A smuggler was caught and thrashed thoroughly by the police . He was brought to Supaul hospital where he was treated for a week and then referred to sadar hospital Saharsa where all the doctors  examined him and failed to diagnose the case and referred to P.M.C.H as he was very poor he could not leave for P.M.C.H . One of my doctors friend Dr Choudhary M.D requested me to see the case and do the needful  . I operated the case in my clinic with great success . He had  a big cystic lump in the abdomen which appeared  after trauma . Can you spot the diagnosis ?

(2) A lady patient of forty has come with pain in right hypochondrium  . On examination nothing abnormal was found except tenderness on the eighth right costal cartilage . Spot the diagnosis ?

(3) A widow having five children complains of pain in right hypochondrium . Spot the diagnosis ?

(4) A man of weak health complains of pain in left iliac fossa . His stool contains mucus.

Answers
(3) Chronic cholecystitis .
(2) Cholecystitis .
(1) Pseudopancreatic-cyst.
(4) Chronic amoebic cholitis .

Spot the diagnosis-91

(1) A patient of forty has come with urinary troubles . He says that pressure during micturation increases the flow of urine .

(2) A patient of fifty five has come with urinary troubles . He says that pressure during micturation stops the flow of urine  .

(3) A lady patient came with swelling of her body . Her B.P was found to be high and on  examination of her urine there was microscopic haematuria .

(4) A young patient of twenty four was in the habit of taking drugs and alcohol . One day he was admitted to the hospital for severe pain in the epigastrium and was treated and released . Some weeks after he was brought to you with a lump in the epigastrium which was firm . Can you spot the diagnosis?


Answers
(2)Benign enlargement of prostate .
(1) Stricture of urethra .
(3) Subacute glomerulonephritis.
(4) Subacute peptic ulcer perforation .

Spot the diagnosis -90

(1) A patient of fifty has developed loss of appetite with distaste for meat . Can you spot the diagnosis?
(2) A lady patient of forty has developed distaste for fat . Can you spot the diagnosis ?
(3) A patient says that he feels pain on the tip of penis and haematuria at the end of micturation .
(4) A patient is suffering from abdominal colic . The doctor gives him injections  to relieve  his pain but no relief  at all .
(5) A patient complains of scalding pain during micturation.

Answers
(2) Chronic cholecystitis .
(3) Stone in urinary bladder.
(4) Renal stones .
(1) Carcinoma stomach .
(5) Acute urethritis

Spot the diagnosis- 89

(1) A patient has come with anasarca with full neck vein .
(2) Anasarca with massive proteinuria .
(3) A patient has come whose liver is palpable but absence of protein in the urine .
(4) A patient has come whose urine contains protein but liver is not enlarged .
(5)  A child was brought with his father . His father says that child screams with lower abdominal pain and pulls at his prepuce .

Answers
(4) Kidney disease.
(1) Conjestive heart failure .
(2) Nephrotic syndrome .
(3) Hepatic disease .
(5) Stone in the urinary bladder .

Spot the diagnosis -88

(1) A patient has come whose  spleen is palpable and there is spider naevi on the chest and abdomen . Spot the diagnosis ?

(2) A patient has come with a huge and hard splenic enlargement with sternal tenderness

(3) A patient has come with  splenic enlargement and  moderate lymphadenopathy .

(4)  A patient of jaundice has come ,his spleen is enlarged and his reticulocyte count is very much  high .

Answer
(2) Chronic myeloid leukaemia
(4) Hemolytic jaundice 
(1) Cirrhosis of liver
(3) Lymphatic leukaemia

Spot the diagnosis -87

(1) A rural ,febrile  patient says that the fever comes daily by evening train . On examination his spleen is enlarged .

(2) A febrile patient has come with palpable spleen . There is relative bradycardia .

(3) A febrile patient of months together has come . Only one thing is known that his total W.B.C count is  2000.

(4) A patient of low grade fever has come with palpable spleen and his lymph glands are big and rubbery in feel .

(5) A febrile patient has come with palpable spleen with cardiac murmurs .


Answers
(3) Kalazar
 (1) Maleria
 (4)Hodgekin's disease
 (2) Typhoid fever
(5)Sub-acute bacterial endocarditis .

Spot the diagnosis 86

(1) A patient of amoebic dysentry has come in S.O.P.D with a lump in right iliac fossa . Can you spot the diagnosis ?
 Ans Amoebic typhlitis . 

(2) A young patient has come with the complaints of pain in his right hip joint . On examination his extension of right hip joint is restricted and on x -ray there is haziness in the Babescock's triangle . Spot the diagnosis ?
 Ans Tuberculosis of right hip joint . 

(3)A patient has come whose urine is acidic ,contains pus cell and sterile on ordinary culture Can you spot the diagnosis ? 
Ans Renal tuberculosis . 

(4) A lady of forty five has come with sub-cutaneous haemorraghe and splenic enlargement . The only thing is known that her platelet count is low . Can you spot the diagnosis ?
 Ans essential thrombocytopenic purpura haemorrhagica .

Spot the diagnosis 85

(1) A patient has come with ascites and loss of subcutaneous fat on his nose and face and there are many small red swellings on the thorax which blanches on pressure by the tip of a match-stick .
Ans Cirrhosis of liver

(2)An already diagnosed case of cirrhosis liver has come for check-up . Now he has developed anorexia and evening rise of temperature . Spot the diagnosis ?
Ans cirrhotic patient are very sensitive to catch tuberculosis .

(3) A poor ,undiagnosed and untreated patient of ascites died of  severe haemetemesis . Can you spot the diagnosis ?
Ans Cirrhosis of liver .

(4) A patient of forty five has come in the S.O.P.D with the complaints of alternate diarrhoea and constipation  for months together . On palpation of his abdomen the doctor finds a hard and irregular lump in his right iliac fossa . Spot the diagnosis ?
Ans Carcinoma caecum.

(5)  A young and neglected patient has come with a hard and irregular lump in right iliac fossa with multiple sinuses over it with yellowish discharge . Spot the diagnosis ?
Ans Actinomycosis .

Spot the diagnosis 84

(1) A patient of injury has come with swelling and tenderness of his anatomical snuff - box of right hand . Spot the diagnosis?
Ans Fracture of the scaphoid bone of right hand .

(2a)What is the name of the nodule which is hard and subcutaneous and found near the umbilicus .
Ans Sister Joseph 's nodule

(2b) What are the conditions in which these nodules are found ?
Ans Carcinoma stomach ,colon ,ovary and breast .

(C) Who discovered this nodule?
Ans Sister Joseph who was working with  Dr William mayo in his  clinic as surgical assistant .

(D) Why this name was imparted and by whom ?
Ans Because she was the first lady who observed these nodules for the first time in more than three patients in the ward and that's why Dr William mayo named this nodule on her name .

Words of wisdom

 It is not at all a bad habit  to mimic a great man if you want to be great like him .

Spot the diagnosis - 83

(1) A patient of Bihar was suffering from fever for months together . His total  W.B.C  count was only 2000 . Can you spot the diagnosis ?
Ans Kalazar

(2) A patient of Jacksonian epilepsy had tremors in her right hand for long . Now she has developed severe pain on the top of her right shoulder . Her ultrasound of abdomen was found to be normal . Can you spot the diagnosis.
Ans Jacksonian march .

(3) A patient of abdominal injury has come in the emergency . He is pale and there is tachycardia . His medial end of left clavicle is very tender on the pressure of fingers tip in between the sternomastoid and  scalenus medius . Spot the diagnosis ?
Ans Splenic rupture .

(4) A patient has come with acute abdomen, there is hyperesthecia in the sherren's triangle .
Ans Acute appendicitis.

 ( 5) A patient feels suffocation in cinema hall. He visits a clinician. The clinician finds nothing abnormal except bilateral basal crepts in the lungs .
Ans Acute left ventricular failure .

Spot the Diagnosis -82

(1) One patient has come with enlarged and soft liver . There is intercostal tenderness . Spot the diagnosis ?
Ans Amoebic liver abscess .

(2) A diagnosed patient of acute appendicitis has developed pain in the left iliac fossa .
Ans He has developed peritonitis.

(3) A patient has pain in the left iliac fossa at manson bar's amoebic point (same point like macburny's point  in the left side)
Ans chronic amoebic colitis

(4) A lady of fifty has pain on the tip of right shoulder and there is hyperesthecia below right scapula on the back .
Ans Cholecystitis .

(5) A patient of abdominal injury has pain on the  tip of the left shoulder and rigidity in the left side of the epigastrium .
Ans Spleenic rupture

Spot the diagnosis -81

 (1)A patient of acute abdomen has come in the emergency in which nothing abnormal was detected except on per rectal exam there is bulging of anterior rectal wall with tenderness. Can you spot the diagnosis ?
Ans Pelvic abscess .

(2) What dermoid cyst is the commonest ?
Ans External angular dermoid cyst .

(3) Earlier appearance of rigidity in the cases of acute intestinal obstruction indicates what condition?
Ans Internal strangulation.

(4) Late peritonitis with the features of toxaemia without muscular rigidity name the conditions .
Ans Typhoid perforation and post operative peritonitis.

(5) A patient was seized with sudden and severe pain in the epigastrium  after some times the pain has subsided automatically and there is slight  rigidity in the epigastrium and on P.R exam there  is tenderness in the rectovesical pouch .
Ans Perforation of peptic ulcer.

Words of wisdom

 A good clinician should better listen patiently to the presenting complaints and history of the patients and then go for thorough clinical examination and  should make first a clinical and provisional diagnosis than giving him  a list of unnecessary test which at times may deviate his diagnosis and bring unnecessary financial and physical troubles to the poor patients .
                                                                                                              The patient who soever he may be are the poorest and helpless creatures and for then the treating doctor is the only help and a real  god on earth .
                 A good doctor should prescribe only the desired test only to confirm his provisional diagnosis and prescribe only the desired drugs which must be affective ,safe and economical too .
                  

Everybody is born on earth with only one motive to earn more and more money even by wrong and illegal means . It is only a real doctor who are born only to serve his patients.
 

Please don't be a commoner , a professional. Be a real doctor ,a real god on earth . It is certain that you will not be given another chance to be a doctor in your next birth,and it is more than certain that you will take nothing with you when your heart stops for ever then why to cry after excess money .

Words of wisdom.

(1) A brainy surgeon operates more by his brain than  by his hands and surgical knives .

(2) A seasoned physician treats his patients more by his words than by medicine if he has a grip not only over his diagnosis but also over the  psychology of his patients .

Spot the diagnosis

 (1)A huge and hard enlargement of  liver and spleen without sternal tenderness .
Ans Post Kalazar  syndrome .

(2) A patient with palsatile liver with ascites .
Ans Tricuspid regurgitation

(3) A firm liver suggests .
Ans Cirrhosis of liver .

(4) Hard and nodular liver suggest .
Ans Secondary carcinoma

Spot the diagnosis- 79

(1) Which tuberculous arthritis finally ends in bony- ankylosis unlike other tuberculous arthritis?
 Ans Pott's disease.

(2) Abdominal pain which radiates to the sacral region ,flank or genitalia is a signal of the possibility  of which condition ?
Ans Rupturing of abdominal aorotic aneurysm
 ( lower portion)

(3) A patient has come with a fixed mass in abdomen not descending with respiration .
Ans Retroperitonel tumour.

Spot the diagnosis -78

(1) A young lady has come with the complaints of occasional   tremors and  twitching in the right forearm muscles and in all the  fingers of right hand .          On clinical exam nothing abnormal was  detected except an irregular protuberance on right side at the junction of parietal and occipital region due to very old fracture of skull .
Ans Jacksonian epilepsy due to previous head injury.

(2) A patient has come with palpably enlarged spleen with ascites  .
Ans Cirrhosis liver

(3) A patient has come with throbbing pain in the pelvis .
Ans Pelvic abscess

Spot the diagnosis

(1) A young lady of twenty three has come for occasional shooting pain, burning sensation, pallor , blanching and numbness in both arms and fingers ( Both the thumbs are escaping). Nothing abnormal  detected in x ray of the cervical region .
Ans: Reynaud's disease

(2) Huge and soft enlargement of liver with intercostal tenderness .
Ans :Amoebic liver abscess

(3) Huge and hard liver without splenic enlargement.
Ans :Metastatic cancer of liver .

(4) Huge and hard enlargement of spleen with sternal tenderness
Ans Chronic myeloid leukemia .

(5)  Posterior vertebral protusion (Gibbus ) with local bony tenderness .
Ans: Pott's disease .

Spot the diagnosis.

(1) Froth coming out of the mouth of a young -adult- male- patient was rushed to the hospital . The patient had died before he reached the hospital. Immediately,post mortem was done and nothing abnormal was detected except his heart was found to be enlarged .
Ans - It may be a case of acute left ventricular failure

Test your clinical acumen

(1) What does it suggest - pitting oedema on pressure with brawny induration .
(2) What is the difference between phlegmasia alba dolens and phlegmasia cerulia  dolens .
(3) In which disease the epitrochlear and occipital lymph nodes are involved and palpably enlarged
(4) What are the drainage areas of Virchow's gland (left  supraclavicular lymph gland)
(5) What comes first in your mind when a lymph gland is found to be hard ,irregular and fixed to the skin

Test your clinical acumen
(1) What is the name of the dermoid cyst which contains no hair ?

Words of wisdom
(1) The most characteristic and the most  peculiar feature of the Indian frog is that it never allows other frog to jump out of the bucket , it pulls down by the legs with  all its vigour  and strength so that the frog who wants to jump out of the bucket to go ahead may not escape alone to show the outer world its quality of thoughts , capacity of moral courage ,the secrecy and power of peace.

Words of wisdom .
(1) Always appreciate your child, he will do much better in life .
(2) Always appreciate your enemy, he will turn into a better friend .
(3) Always appreciate your P.M ,Narendra Modi , he can do miracles and lead the whole world What to talk of India alone .

Test your clinical acumen
(1) A lady of forty has come with a lump in breast , the lump is variable in consistency , somewhere hard somewhere soft . Spot the diagnosis ?

Test your clinical acumen

(1) A patient of rheumatoid arthritis has come with palpable spleen, extreme leucopaenia and ulcer on legs . Spot the diagnosis ?

(2) A child of three years has voracious appetite, losses weight,  has chronic cough and passes bulky offensive stool . Spot the diagnosis?

Test your clinical acumen

1).A patient has prolonged and persistent fever, cardiac murmur and palpable spleen. Spot the diagnosis.
2).A patient has anasarca, hypertension and microscopic haematuria. Spot the diagnosis.

Test your clinical acumen.

(1) A patient has come with a huge,hard and irregular liver and there is spleenomegaly with ascities and deep and protracted jaundice . Spot the diagnosis?

Test your clinical acumen.

One patient has come with only one clinical finding that his liver is enlarged and there is intercostal tenderness . Spot the diagnosis ?

Words of wisdom

 Our honourable P.M should give only one slogan and act  seriously and sternly ,
"Corruption ,leave India".
If corruption is eradicated completely and thoroughly which is rampant and in a epidemic form, India will be a much better country than the America and our honourable P.M will find a much higher place in Indian history than mahatma Gandhi who gave the slogan ,"The English ,leave India" .
Our P.M alone can save India from this viral disease of corruption which is more lethal and more dreaded than E-bola viral epidemic in west Africa .

Test your clinical acumen

 A patient has a large and soft liver and there is no spleenomagaly and his J.V.P is not seen . Spot the the diagnosis ?

Words of wisdom

 A good doctor without the grip over the psychology  is as good as a flower without scent .

Test your clinical acumen

(1) A patient of anasarca has come ,he has hypertension and microscopic haematuria .

Words of wisdom

(1) A man cannot be a true surgeon without the knowledge of medicine .

(2) A man cannot be a true physician without the knowledge of every discipline of medical science.

( Sushruta, father of modern surgery .)

Test your clinical acumen

(1) A patient having cardiac murmurs and has prolonged fever sweating and spleenomegaly.

Words of wisdom

(1) Major time in life is wasted .
(2) Major money and property earned in life is wasted .
(3) Major education taken in life is wasted .
(4) Major work done in life is wasted .
Then why to worry and to use corrupt means for earning money. Make merry and always be cheerful with what you have.

Please remember the lines from a great man of English literature.

"They also serve the almighty who only wait and watch."

Test your Clinical acumen

(1) A robust gentleman of fifty five feels suffocated whenever he visits cinema in a cinema hall.  He consulted one clinician . The clinician finds nothing abnormal except bilateral  basal crepts . Can you spot the diagnosis ?

Test your clinical acumen .
(1) A patient of irregular fever for months together with total  leucocyte count two thousand only . Can you spot the diagnosis ?
(M.R.C.P viva question)

Words of wisdom
(1) To bat more than a century in life ,it is more than essential that you must not earn fat on your body and never earn fat of finance and property by legal or illegal means or it is more than certain that you will be bowled out in the way much before time.

Test your clinical acumen

(1) A patient has come with the complaints of flushing and sweating of one side of his face and cheeks during meals . He gives the history of Parotid abscess which was incised and drained earlier in a big hospital .
(2) A patient has come with symmetrical enlargement of all the salivary glands ,narrowing of both the palpebral fissures due to enlargement of lacrimal glands and parchment like dryness of the mouth .

Words of wisdom

While taking tea ,all of a sudden ,an idea comes to your brain or you remember some very small work ,you should stop taking tea then and there and start doing that pretty work otherwise you may forget it the very next Moment as nothing dies so fast as a new idea in a fast brain and the very next moment is as uncertain as life itself .

Test your clinical acumen

(1) A patient of rheumatoid arthritis has come with dry eyes and dry mouth . What is this syndrome known as ?

(2) A patient has come with dry eyes and dry mouth only . What is this syndrome known as ?

(3) A child patient of polyarticular rheumatoid arthritis has developed spleenomegaly and enlargement of lymph glands .

Test your clinical acumen

 Two pyelograms of two different patients have been shown to you .

(1a) A patient of forty has spider leg deformity  with clubbing and cupping of terminal calyces of both the kidneys .
(1b) A patient of fifty five has spider leg deformity with clubbing and cupping of renal calyces of only one kidney .

(2) A patient of ten has been advised pyelography . In his pyelogram there is inward direction of the calyces .

(3) A lady patient of twenty has been advised pyelography. Her pyelogram shows irregular dilatation of the calyces  and cavity formation .

worlds of wisdom

A prestige loving man prefers taking troubles for himself to taking minor obligations.