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<s>[INST] context: Pityriasis rosea (pityriasis - fine scale, rosea-red) Acute self limiting papulo- squamous disorder mainly occurring in children and young adults. Etiology: Infection - HHV6/7 Drugs causing PR- arsenic, bismuth, gold, omeprazole, metronidazole,isotretinoin,barbiturates, clonidine, captopril, imatinib , ketotifen Others- Hepatitis B, BCG vaccination. Characteristic features of PR indicating infective etiology 1: history of preceeding ui 2: primary lesion followed after an interval with widespread rash 3: self limiting course 4: recurrence is rare Clinical features: 1. Age - 10-35 years 2. First manifestation -HERALD patch or mother patch- seen in 50% of patients. Erythematous well defined oval lesion 2-10 cm diameter with typical colarette of scale at margin 3. After 5-15 days wide spread rash in crops. Oval round erythematous scaly plaques 0.5-1.5cm with colate of fine scales at margin. Free edge of scale points to center. 4. Distribution - CHRISTMAS tree or FIR tree pattern- long axis of lesions along skin tension lines running parallel to ribs 5. Spontaneous resolution in 3-6weeks Treatment: Reassurance, self liming disease Symptomatic rx- calamine emollients, antihistamines, topical steroids Erythromycin , acyclovir,NBUVB can be given at acute stages IADVL textbook of dermatology,page 375 Pityriasis rosea (pityriasis - fine scale, rosea-red) Acute self limiting papulo- squamous disorder mainly occurring in children and young adults. Etiology: Infection - HHV6/7 Drugs causing PR- arsenic, bismuth, gold, omeprazole, metronidazole,isotretinoin,barbiturates, clonidine, captopril, imatinib , ketotifen Others- Hepatitis B, BCG vaccination. Characteristic features of PR indicating infective etiology 1: history of preceeding ui 2: primary lesion followed after an interval with widespread rash 3: self limiting course 4: recurrence is rare Clinical features: 1. Age - 10-35 years 2. First manifestation -HERALD patch or mother patch- seen in 50% of patients. Erythematous well defined oval lesion 2-10 cm diameter with typical colarette of scale at margin 3. After 5-15 days wide spread rash in crops. Oval round erythematous scaly plaques 0.5-1.5cm with colate of fine scales at margin. Free edge of scale points to center. 4. Distribution - CHRISTMAS tree or FIR tree pattern- long axis of lesions along skin tension lines running parallel to ribs 5. Spontaneous resolution in 3-6weeks Treatment: Reassurance, self liming disease Symptomatic rx- calamine emollients, antihistamines, topical steroids Erythromycin , acyclovir,NBUVB can be given at acute stages IADVL textbook of dermatology,page 375 [/INST] question: Annular herald patch is seen in - | options: A: Psoriasis B: P. alba C: P. rosea D: Nocardiasis | answer: C </s> |
<s>[INST] context: Management of VVF is surgical management:
The timing of surgery -
Small urinary fistulas sometimes heal spontaneously during the first few weeks.
However, in a case of established fistula - it is better to wait for about 3 months° for all tissue inflammation to subside. If one attempt fails to heal fistula, the second attempt is done after 3 months.°
In fistulas following surgery, waiting period is 3-6 months.
In fistulas following radiation: 6 months - 2 years time can be taken before inflammation subsides.
Techniques of Repair -
Layer technique
Latzko procedure (for fistulas following hysterectomy)
Chassar Moir technique.
Post-operative Management -
Continuous bladder drainage for 14 days.
Antibiotic coverage.
No vaginal examination, P/S, intercourse x 3 months.
Avoid pregnancy for 2 years.
In pregnancy after repair of vaginal fistula - elective cesarean is done.
Extra Edge:
This question is an old one so here answer will be 3 months but if this question is repeated now remember the following lines from Williams Gynae. 1st /ed 575-576:
"Timing of repair: Traditional teaching recommends delayed repair of fistulas at 3 - 6 months after injury. However, this old dictum is probably no longer applicable. Most agree that unless there is a severe infection or acute signs of inflammation, waiting is not necessary. Early surgical intervention of uncomplicated fistulas does not affect closure rates, yet appears to reduce social and psychological patient distress (Balivas, 1995). Fistulas identified within the first 24 - 48 hours postoperatively can be safely repaired immediately with success rates of 90 - 100%." [/INST] question: Postpartum VVF is best repaired after: | options: A: 6 weeks B: 8 weeks C: 3 months D: 6 months | answer: C </s> |
<s>[INST] context: Oxytocin is a nonapeptide,
It is secreted by posterior pituitary along with vasopressin (ADH).
Both oxytocin and ADH are synthesized within the nerve cell bodies in supraoptic and paraventricular nuclei of the hypothalamus; are transported down the axon and stored in the nerve endings within the neurohypophysis.
They are stored in separate neurones as complexes with their specific binding proteins (Neurophysin).
Actions
Uterus It increases the force and frequency of uterine contraction. Estrogens sensitize the uterus to oxytocin, while progestins decrease the sensitivity. The increased contractility is restricted to the fundus and body„ lower segment is not contracted, may even be relaxed at term.
Breast Oxytocin contracts myoepithelium of mammary alveoli and forces milk into bigger sinusoids - Milk ejection or milk letdown reflex.
CVS Higher doses cause vasodilation → Brief fall in BP, reflex tachycardia and flushing. The umbilical vessels are constricted oxytocin may help their clossure at birth.
Kidney Oxytocin in high doses exerts ADH like action —» water retention can occur. [/INST] question: Main hormone acting upon uterus to initiate labour | options: A: Oxytocin B: Estrogen C: Progesterone D: Cortisole | answer: A </s> |
<s>[INST] context: Clothes are very important in our life. Different people wear different clothes. Now let's listen to some people in France talking about clothes.
Hello, I'm Betty. I started working this year, so I'm able to get new clothes more often than before. I think what I look like is really important to me, so I spent much money on clothes. I like to wear bright colors and always dress up when I go to parties. I often buy all kinds of clothes and try to follow the latest fashion.
Hi, I'm Jack. I don't have much to say about clothes. _ aren't the thing I'm interested in. I know little about the way of dressing. In summer, I always wear a T-shirt or something else.
My name is Alice. I would like to say that clothes must be comfortable and feel easy to put on. Sometimes I buy clothes in some small street markets -- they are cheap there. I change the look of my clothes quite often -- put some flowers on them or use different buttons, just for a change. They'll look good all the time. I go shopping for clothes about once a month. I see something comfortable and fashionable and it fits me well, I would go for it and then... [/INST] question: How many people are talking about clothes? | options: A: Three B: Five C: Four D: Two | answer: A </s> |
<s>[INST] context: The world moves so quickly nowadays. With so many daily responsibilities, some of us can hardly keep our heads above water. Should we make time for studying or appreciating the arts? Many people would say the arts are nice, but not necessary .In school, students should focus on languages ,math and science. Painting, drama and music are _ After graduation, listening to Mozart won't lead you to a better-paying job.
In truth, spending time learning to appreciate the arts may be more worthwhile than you think. A recent British study examined the salaries and jobs of people who spent time enjoying the arts when growing up. The researchers found those who enjoyed the arts from an early age had better jobs and higher salaries than those who didn't. What's the link? How could visiting a museum, enjoying a symphony, or honing painting skills lead to career success? It turns out that the arts help us develop many useful skills.
Other students have found students studying the arts exercise their reasoning ability. The skill helps with problem-solving. Creative and critical-thinking abilities are also developed through art study. Moreover, those who enjoy the arts have more motivation to achieve .Students who practice an art experience the rewards that come from persistence and goal-setting. These benefits also extend to those who make time to appreciate the arts beyond their school years. The best kind of art stirs our imagination and makes us think. Paintings aren't just pretty pictures. They tell stories about the lives of the subjects or about the experience of the painter. See Michelangelo's art and you'll taste the power of his faith in God. Look at the world from Picasso's point of view, and you see everyday life in new ways. Those who appreciate the arts also gain a broader perspective on the world. The arts reveal and explain the world beyond our own personal knowledge which can help us better communicate and cooperate with other people.
If you want to better yourself, go and enjoy the arts. Check out an art gallery or a museum. Take in a play. You won't regret it and it will do you more good than you can imagine. [/INST] question: The benefits of enjoying arts are all of the following EXCEPT _ . | options: A: communicating skills B: high positions C: problem-solving abilities D: creation and imagination | answer: B </s> |
<s>[INST] context: Hysterectomy when performed in molar pregnancy significantly decreases the chances of developing choriocarcinoma (by 5 fold times) but does not make it nil and hence follow up is required (so both options a and b are incorrect)
This is supported by following lines from Dutta-
“It should be remembered that following hysterectomy, persistent GTD is observed in 3–5% cases. As such, it does not eliminate the necessity of follow up.The enlarged ovaries (theca lutein cysts) found during operation should be left undisturbed as they will regress following removal of mole. But, if complication arises, like torsion, rupture or infarction, they should be removed.”
Dutta 7/e, p 195
Thus from above lines it is also clear that ovaries even if they are enlarged should not be removed during hysterectomy for h mole.
As far as pulmonary embolisation in concerned -acute pulmonary insufficiency due to pulmonary embolization of trophoblastic cells, is a complication seen with suction evaculation and not hysterectomy. [/INST] question: The advantages of hysterectomy in molar pregnancy are: | options: A: Chance of choriocarcinoma becomes nil B: Follow up is not required C: Enlarged ovaries can be removed during operation D: Chance of pulmonary embolisation is minimal | answer: D </s> |
<s>[INST] context: Where do the turtles go?
Every summer, thousands of endangered green sea turtles climb onto beaches around the world. Each mother sea turtle produces 100 or more eggs in a hole, and covers the hole with sand before she swims away.
Two months later, the eggs hatch , and the baby turtles climb out of the sand and swim into the ocean. They don't reappear until they have grown as large as dinner plates. Until now, no one knows where the baby turtles go or what they do.
"if we don't know where these little turtles are, we can't protect them," says Kim Reich, who helps solve part of the mystery.
Her teacher, Karen Bjorndal, has studied green sea turtles for more than 30 years. Every year, Bjorndal goes to the Bahamas Islands. Many young sea turtles come here to live and eat at the end of their childhood.
These turtles are the only sea turtles that live as plant eaters. In fact, their name may be a result of what they eat. The turtles don't look green but they do have green fat. Scientists learned that the turtles eat green sea plants, which may turn their fat green.
Between 2002 and 2004, Bjorndal caught 44 green sea turtles in the Bahamas. After testing them, she found something to support the 20-year-old idea: baby green sea turtles eat meat before they turn to a diet of plants. In fact, they eat animals that live in the open ocean.
Scientists still need to find where exactly green sea turtles grow. We now know that baby green sea turtles are out in the open ocean, but the open ocean is a big place.
" _ is really a problem," says Bjorndal. The discovery may help us do a better job of protecting this sea animal. [/INST] question: Kim Reich does research on where baby turtles go because she wants to _ . | options: A: help her teacher B: prove an idea C: protect turtles D: become a scientist | answer: C </s> |
<s>[INST] context: Transcribe Sheng Qi
Born in Anhui province, Sheng Qi worked in Italy from 1989 to 1992. His work deals with the ever-popular subject of the cultural gap between East and West. The artist combines calligraphy with other more western media in an attempt to bridge this gap.
Where: Red Gate Gallery, Dongbianmen, Watchtower
When: Till February 6, daily 10 a.m. to 5 p.m.
Admission: free
Tel: 6525 1005
Wan Qingli Traditional Chinese Painting
Professor at the Hong Kong Chinese Language University and graduate of the Central Academy of Fine Arts, Wan Qingli, is well known as an art theorist. His landscape paintings are now on display at his alma mater.
Where: Central Academy of Fine Arts Gallery, Shuaifuyuaj, Wangfujing, 5 Xiaowei Hutong
When: Till January 26, Tuesday to Sunday, 9:30 a.m. to 4 p.m.
Admission: 5 yuan
Tel: 6527 7991
Music
Xie Tingfeng (Nicholas Tse)
Nicholas Tse is one of the hottest young stars in Hong Kong and a top-selling singer. Having decided to pursue a career in show business, he left school at 16 and spent a year in Tokyo studying various aspects of music and performance. On his return to Hong Kong, he released his debut CD, My Attitude, which quickly became a hit and propelled him to stardom .
Where: Capital Gymnasium, 54 Baishiqiao Lu
When: January 25, 7:30 p.m.
Admission: 80 to 900 yuan
Tel: 6833 5552
Movies
Yige Dou Buneng Shao (Not One Less)
Rural China in the 1990s was a far cry from its city counterparts. A young girl is made teacher of the local primary school and finds herself tracking down a student who left the school for work in the city. Director Zhang Yimou cast non-professionals for this film. Mandarin with English subtitles.
Where: B2M Bar, Dongpingfang Apartment Block (inside the easternmost gate), next to the Dong River, Andingmenwai
When: February 6, 7:00 p.m.
Admission: free
Tel: 6426 1091 [/INST] question: You can go to see _ for free in February. | options: A: two exhibitions B: a concert and a movie C: a movie and an exhibition D: an exhibition and a concert | answer: C </s> |
<s>[INST] context: We all love festivals. But since culture develops differently in many places, some festivals are, to us, very strange. Let's take a look at some unique festivals around the world.
Cheese Rolling Festival (England)
The festival started in the 15thcentury in May. When a round cheese is rolled, competitors run down the hill and try to catch it before it reaches the bottom. As the cheese can reach speeds of up to 112 km/h, it's rare that someone catches the cheese. First to the bottom wins the cheese. But running down a very steep hill behind a cheese can be dangerous. Eight people were injured in 1992.
Roswell UFO festival (New Mexico, US)
The Roswell UFO festival celebrates the anniversary of the "Roswell Incident", when a UFO was said to have crashed nearby. Every year in July, experts, authors, researches and lecturers come to discuss the incident. The celebration also includes an alien parade, an alien costume contest, and an alien hot air balloon ride.
Hemingway Days (Florida, US)
This festival has normal stuff (,) like short-story readings and exhibits about the author. But the highlight of the festival is definitely the Hemingway look alike contest.
Imagine walking into a bar and being greeted by 20 middle-aged men who all look alike: stocky with thick white beards. The festival takes place in mid-July every year. [/INST] question: Which festival takes place in mid-July every year? | options: A: Cheese Rolling Festival B: Roswell UFO festival C: Hemingway Days D: All of the above | answer: C </s> |
<s>[INST] context: Anaesthesia face mask FEATURES These facemasks have a cuff that allows for a complete seal to be achieved between the mask and the patient's face. Anesthetic facemasks can therefore be used to deliver non-invasive ventilation (NIV). In order to ventilate with an anesthetic facemask you'll need a pressurized gas source (anesthesia gas supplies)such as a cylinder or gas wall supply. If no pressurized gas source is available, a self-inflating bag will allow for positive pressure-ventilation through an anesthetic facemask. The cuff volume can typically be adjusted through a valve. A somewhat under-inflated cuff usually achieves a better seal than a fully inflated one. Most manufacturers supply these masks with a detachable hook ring, which allows for the mask to be held in place with a head strap for delivering NIV. USES Anaesthetic facemasks are generally used in two different settings/ scenarios: 1. For bag-mask ventilation (BMV) in the OR or resuscitation setting. 2. To provide non-invasive ventilation (NIV) or respiratory suppo, most commonly as either continuous or biphasisc positive airway pressure (CPAP or BIPAP) in patients with respiratory compromise. [/INST] question: Which one of the following can provide 100 % oxygen? | options: A: Ventimask B: Simple oxygen mask C: Oxygen catheter D: Anesthetic face mask | answer: D </s> |
<s>[INST] context: Centre for Early Childhood Development & Research (CECDR)
Jamia Millia Islamia, New Delhi
June 20, 2014
The CECDR has been given permission for an ICSSR research project entitled "The Uttarakhand Disaster and Lives of Young Children & Pregnant & Lactating Mothers: An Exploratory Study of Impact, Coping & Interventions". The CECDR requires a Research Officer for the same.
No of Posts - Research Officer: 1 (One)
Duration - Two years (24 months)
Salary - Rs. 20,000/- pm (fixed)
Essential Qualifications - Post-Graduate Degree in Psychology / Social Work / Sociology / Anthropology / Child Development / Education with a Good Academic Record.
Desirable:
a) Previous research experience including of leading a research team
b) Familiarity in working with MS Office and Statistical software
c) Good conversational skills (Hindi and English, knowledge of languages spoken in Uttarakhand would be an added advantage)
d) Willingness to Travel at least 15 days in a month in Uttarakhand
Candidates fulfilling the above required qualifications may apply on plain paper along with their latest CV. The applications should reach "The Director, Centre for Early Childhood Development and Research" latest by July 20, 2014 either in person or by post to: Director, Centre for Early Childhood Development and Research, 1st Floor, Child Development Centre, Schools Complex, Jamia Millia Islamia, New Delhi- 10025.
Prof Zubair Meenai
Director
Centre for Early Childhood Development and Research
Advertisement for the post of Project Assistant
Applications are invited on plain paper for the post of Project Assistant (One), Rs. 14,000/- per month in an Indian National Science Academy (INSA) sponsored project entitled, "Role of small G-protein in Leishmania donovani infection", at Deptt of Biotechnology, Jamia Millia Islamia, New Delhi-110025 under the guidance of Dr. Abdur Rub (Principle Investigator). The post is purely temporary and will continue till the continuation of the project (3 yrs).
Essential qualifications: The candidates must be possessing Master Degree in Biotechnology /Biochemistry /Bioinformatics with at least 60 % aggregate.
Desirable: Research experience in the field of Leishmania infection/ cell signaling/drug development etc.
How to apply: Applications along with updated CV and self attested copies of the relevant documents in support of educational qualification and experiences must reach to Dr. Abdur Rub (Principle Investigator), Room No. 418, Fourth Floor, Deptt of Biotechnology, Srinivasa Ramanujan Block, Jamia Millia Islamia (A Central University), New Delhi-110025 by post/personally latest by 5th July 2014. [/INST] question: How much can you get in the first year if you are employed as the research officer? | options: A: Rs. 20,000 B: Rs. 140,000 C: Rs. 240,000 D: Rs. 480,000 | answer: C </s> |
<s>[INST] context: Inorganic iron is transported into the mucosal cell by a proton-linked divalent metal ion transporter, and accumulated intracellularly by binding to ferritin. Iron leaves the mucosal cell via a transport protein ferroportin, but only if there is free transferrin in plasma to bind to. Once transferrin is saturated with iron, any that has accumulated in the mucosal cells is lost when the cells are shed. Expression of the ferroportin gene (and possibly also that for the divalent metal ion transporter) is downregulated by hepcidin, a peptide secreted by the liver when body iron reserves are adequate.
In response to hypoxia, anemia, or hemorrhage, the synthesis of hepcidin is reduced, leading to increased synthesis of ferroportin and increased iron absorption. As a result of this mucosal barrier, only ∼10% of dietary iron is absorbed, and only 1% to 5% from many plant foods.
Hemosiderosis is an iron overload condition and further iron absorption is not required.
HARPERS ILLUSTRATED BIOCHEMISTRY30th ed. page no.541 [/INST] question: In which of the following conditions is the synthesis of hepcidin not reduced ? | options: A: Hypoxia B: Anemia C: Hemorrhage D: Hemosiderosis | answer: D </s> |
<s>[INST] context: "My dream has come true. I have always wanted to be a Grand Slam champion." These are the words of Chinese tennis player Li Na after she became the first Asian woman to win a Grand Slam final in the French Open on June 4, 2011.
"People were saying I'm getting old. So this is a great success for such an old woman," the 29-year-old girl joked.
Miss Li has a tattoo . She has _ her hair many different colors. And, at the 2008 Beijing Olympics, she told her fans to "shut up" when they got too noisy in their support.
Li Na was born in Wuhan, she started to play tennis at the age of 6. She once recalled: "As a child, I felt sad because every day I had to wake up early to practice. After school I had to practice more. I didn't have time to play."
Luckily, the strong girl didn't give up, thus making history for Chinese tennis time after time.
Now the new champion is already thinking about winning another Grand Slam title. "When you have one title, surely you will think about another," she says, not hiding her ambition .
"Chinese people are so lacking in confidence on the tennis court. If there is a person like me who can prove we Chinese can do it, the other young players in China will feel the same," she said.
,. [/INST] question: When she began to play tennis, Li Na was _ . | options: A: happy B: sad C: excited D: bored | answer: C </s> |
<s>[INST] context: I am in my father's house in Connecticut, sitting at a crowded table with my brother, my two sisiters and all our partners, talking about a tree.
"He doesn't want it cut down." My sister says when my father has gone to bed and none of us speaks of the tree in his presence. "He says he usef to climb it when he was a boy."
When I was last here, a year and a half ago, for my father's 90th birthday, Hurricane Irene drove seawater into the roads. The large tree that hangs over the houses swayed alarmingly, but it stayed up.
Last October, Hurricane Sandy acused a great deal of damage. Six months on, many of the surrounding houses are on sale, but the tree that hangs over the house still stands.
"That tree," my brother says, "has survived the two worst storms of the last 100 years."
Though my brother thinks highly of the amazing staying power of the tree, my sister says that the tree should never have been planted: it stops light from reaching the house. My other sister's partner says that all trees fall down eventually. There is plenty of evidence for what he says: throughout the neighborhood, the ramains of similarly sized trees lie on their sides, with their roots in the air. During this discussion, I offer to pay a quarter of whatever is required to remove the tree.
"A guy I talked to," my brother says, "told me it could cost us$10,000."
As night wears on, the discussion becomes increaslingly meaningless. There is no point in reaching any kind of agreement, since the decision is not for us to make. It's my father's tree, and he has refused to cut down the only thing in the neighborhood older than him. [/INST] question: When does the discussion take place? | options: A: After lunch B: After supper C: At the weekend D: Before their father's 90th birthday | answer: B </s> |
<s>[INST] context: It is well known that Albert Einstein was one of the greatest scientists of all time and he was also a really great person. Here are some interesting things about him.
When Einstein started to work in America, someone asked him what he needed. He said he needed a desk, some paper and a pencil. He also asked for a big waste-paper basket to hold all of his mistakes. This shows that he knew even the cleverest man in the world can only learn by making mistakes.
Einstein regarded time as very important. He never wore socks and he thought putting on socks was a waste of time as people already wore shoes. He also thought it was a waste of time remembering things that could quickly be found in a book. That's why he never remembered his own phone number, which was in the phone book. He knew what was worth remembering. It is true that if we are going to do great things in our lives, we can not waste our time.
Einstein liked to joke too. Once in an exam a student asked him why all the questions were the same as last year's. Einstein replied the questions were the same but the answers were different!
,A, B, C, D,,. [/INST] question: When Einstein began his work in America, he asked for some things except _ . | options: A: a desk B: some paper C: a book D: a waste-paper basket | answer: C </s> |
<s>[INST] context: Just put your special clothes on in the morning and you could jump 3 meters into the air and even carry more than 60 kilograms without getting tired. The walk to school would be very, very easy. Such _ clothing is one of the products that could be created using "wearable robotics" technology.
Designed to improve a person's senses and skills, the device could be as simple as a hearing aid. Or it could be a full-body suit that senses what you're going to do, then helps you do it better.
"A superman suit would be the final result in wearable robot i cs ",s a id Francois Pin, head of robotics and energy systems at the Oak Ridge National Laboratory , US. While these suits are at least ten years away, in some areas the technology is already in use.
Researchers are developing artificial- arms and legs that allow old,disabled or injured people to move freely. Thus US Army is interested in using wearable robot legs to help soldiers run faster, carry more equipment and be stronger in battle. Jobs that involve lifting heavy loads or saving lives from the rubble of an earthquake could also become much easier.
A robot is a device that responds to a command. You're probably with simple robots, such as toy cars or airplanes that respond to buttons you push on a remote control.
Wearable robotics goes further. Instead of just receiving information through a wire or remotecontrol- the robotic device can send information back to its controller.
Suppose you wore a sleeve that has sensors where your joints are. Every time you move your arm, the sleeve senses your movements and sends the information to a robot, which then moves its arm just as you did. When the robot hits or touches something, it sends a signal back to the sleeve and you sense the action.
In this way,scientists are working to wrap the robot around the person. Their goal is to make the sleeve, shoe or suit help you do what you want to do. [/INST] question: Products resulting from this wearable robotics technology do not include _ . | options: A: remote controls B: hearing aids C: wearable robot legs D: superman suits | answer: B </s> |
<s>[INST] context: The earth is the only planet that scientists are certain has life .What does the earth have that the other planets don't ? For one thing , the earth has just the right temperature . As _ from the sun , the earth seems to be just the right distance away . The planets that are closer to the sun are so hot that their surfaces bake in the sun . The farthest planets are cold balls .
When the earth developed-- which scientists believe may have happened about billions of years ago , many gases covered the earth . The gases caused the earth to be hot . But something wonderful happened . The temperature was just right for thick clouds to form . It rained very hard for a very long time . This gave the earth its oceans . Water made it possible for plants to grow . The plants created oxygen in the atmosphere . Oxygen is the gas that humans and animals breathe .
Only one other planet in the solar system seems to be something like the earth . That planet is Mars . Mars is smaller than the earth , and it is quite a bit cooler . But it is not too cold for humans . On some days , the temperatures are as cold as a winter day in the northern United States . If you wore a special spacesuit , you could walk around on Mars . You would have to bring your own air to breathe , though . The air on Mars is too thin to breathe . Mars has the largest volcano in the solar system . It is sixteen miles high . The highest volcano on the earth is five miles high . The most unexpected sight on Mars is dried-up river beds . Scientists believe that Mars was once much wetter that it is now . Does this mean there could have been living things on Mars ? Scientists are not sure , but there has been no sign so far . [/INST] question: It is the _ on the earth that makes life possible . | options: A: temperature B: water C: oxygen D: temperature , water and oxygen | answer: D </s> |
<s>[INST] context: Crane was traveling from the United States to Cuba as a newspaper reporter. One night, his ship hit a rock. It sank m the Atlantic Ocean, off the coast of Florida. Most of the people on board got into lifeboats. Crane was among the last to leave. There were three others with him: the ship's captain, the cook, and a sailor.
These four men climbed into the only remaining lifeboat. The boat was so small that no one believed it could stay afloat for very long. None of the four men thought he would ever reach the shore. But the men fought the seas bravely, with all their strength. For two days, the four men had been struggling to reach land, but there was no land to be seen. All the men saw were violent waves which rose and came fiercely down on them. Hours passed. Then, as the boat was carried to the top of a great wave, the captain looked across the water. He said that he saw the lighthouse at Mosquito Inlet. The cook also said he saw it.
The lighthouse had been slowly growing larger. At last, from the top of each wave the men in the boat could see the land. Slowly, the land seemed to rise from the sea. Soon, the men could see two lines, one black and one white. They knew that the black line was formed by trees, and the white line was the sand. At last, the captain saw a house on the shore. And the lighthouse became even larger. Slowly and beautifully, the land rose from the sea. The wind came again. Finally, the men heard a new sound -- the sound of waves breaking and crashing on the shore. The men watched the shore grow larger. They became hopeful. In an hour, perhaps, they would be on land. The men struggled to keep the boat from turning over. They were used to balancing in the boat.
The reporter thought he was now wet to the skin. But he felt in the top pocket of his coat and found eight cigars. Four were wet, but four were still dry. One of the men found some dry matches. Each man lit a cigar. The four men sailed in their boat with the belief of a rescue shining in their eyes. [/INST] question: What did the men think of their fate after climbing into the lifeboat"? | options: A: Promising B: Miserable C: Optimistic D: Hopeless | answer: D </s> |
<s>[INST] context: Empathy lets us feel another person's pain and drives us to help. Do any other animals feel empathy? Scientists recently found that rats do, too.
Most people don't like rats. In many people's eyes, rats are only bad. But Jean Decety and his partners at the University of Chicago did an experiment. It showed that rats are kind, warm-hearted animals. They can feel each other's pain.
Scientists placed pairs of rats in plastic cages for two weeks. During this time they got to know each other. Then they put one of the rats from each pair into a small container in the cages. The small container had a door. It was so designed as to fall to the side when the free rat touched it. Many of the trapped rats squeaked to show their discomfort. The other rats of the pairs could see their suffering friends clearly.
In most pairs, the free rats would become very worried about their friends. They kept trying to save their friends again and again throughout the month. Scientists put the rats' favorite chocolate in the cages, but the rats didn't eat it until they had saved their friends successfully. Scientists also found that female rats seemed to act more empathetic than male rats.
"The results are the first to show that rats take action in response to another's trouble," Decety said. "Monkeys and chimpanzees have similar behavior. But unlike those animals, rats can be ready used in laboratory studies. They will help us to learn which parts of the brain lead to empathy and helping behavior and whether empathy is natural." [/INST] question: A person with empathy is often _ . | options: A: kind-hearted B: clever C: active D: strong | answer: A </s> |
<s>[INST] context: Increased Euchromatin formation Histone acetylation promotes Euchromatin formation (transcriptionally active DNA). Deacetylation and methylation promotes Heterochromatin formation (transcriptionally inactive DNA). There are five classes of histones, designated HI, H2A, H2B, H3, and H4. These small proteins are positively charged at physiologic pH as a result of their high content of lysine and arginine. Because of their positive charge, they form ionic bonds with negatively charged DNA. Histones help in condensation of DNA into chromosomes. Two molecules each of H2A, H2B, H3, and H4 form the structural core of the individual nucleosome "beads." Around which a segment of the DNA double helix is wound nearly twice. (Histone HI, is not found in the nucleosome core, but instead binds to the linker DNA chain between the nucleosome beads.). Nucleosomes are fuher arranged into increasingly more complex structures that organize and condense the long DNA molecules into chromosomes. These histone proteins can undergo reversible modifications at their N-terminal end (like acetylation, methylation or phosphorylation). These modifications help in regulation of gene expression. Acetylation of the lysine residues at the N terminus of histone proteins removes positive charge on the lysine and thereby decreases the interaction of the histone with the negatively charged DNA. As a result, the condensed chromatin is transformed into a more relaxed structure allowing transcription factors to access specific regions on the DNA. Deacetylation restores the positive charge, causing stronger interactions between histones and DNA. Thus histone acetylation enhances transcription while histone deacetylation represses transcription. Relaxed, transcriptionally active DNA is referred to as euchromatin. More condensed, inactive DNA is referred to as heterochromatin. Histone acetylation is catalyzed by histone acetyltransferases (HATS) and histone deacetylation is catalyzed by histone deacetylases (denoted by HDs or HDACs). Another difference noted between transcriptionally active and inactive chromatin is the extent of methylation of cytosine bases in CG-rich regions (CG islands) of many genes. It has been observed that transcriptionally active genes are less methylated (hypomethylated) than their inactive counterpas. Thus formation of euchromatin is promoted by acetylationand formation of heterochromatin is promoted by deacetylation and methylation. The action of methylation is indirect and has no effect upon charge. [/INST] question: Histone acetylation causes? | options: A: >Increased Heterochromatin formation B: >Increased Euchromatin formation C: >Methylation of cystine D: >DNA replication | answer: B </s> |
<s>[INST] context: As a boy, Sanders was much influenced by books about the sea, but by the age of fifteen he had decided to become a doctor rather than a sailor. His father was a doctor. So he was often with the doctors and got along very well with them. When he was fourteen, he was already hanging around the hospital where he was supposed to be helping to clean the medicine bottles, but was actually trying to listen to the doctors' conversations with patients in the next room.
During the war Sanders served in the army as a surgeon . "That was the happiest time of my life. I was dealing with real sufferers and on the whole making a success of my job." In Rhodes he taught the country people simple facts about medicine. He saw himself as a life-saver. He had proved his skill to himself and had a firm belief that he could serve those who lived simply, and were dependent upon him. Thus, while in a position to tell them what to do he could feel he was serving them.
After the war, he married and set up a practice deep in the English countryside, working under an old doctor who hated the sight of blood. This gave the younger man plenty of opportunity to go on working as a life-saver. [/INST] question: When he was a small boy, books about the sea had made Sanders want to be _ . | options: A: a surgeon B: an army man C: a sailor D: a life-saver | answer: C </s> |
<s>[INST] context: With RBC microcytosis, iron deficiency anemia must be considered. It could be a nutritional deficiency in children and pregnant women, but more likely is due to chronic blood loss in adults. The ferritin concentration is a measure of storage iron because it is derived from the total body storage pool in the liver, spleen, and marrow. About 80% of functional body iron is contained in hemoglobin; the remainder is in muscle myoglobin. Individuals with severe liver disease can have an elevated serum ferritin level because of its release from liver stores. A bone marrow biopsy specimen provides a good indication of iron stores because the iron stain of the marrow shows hemosiderin in macrophages, but such a biopsy is an expensive procedure. Some patients with hemoglobinopathies, such as b-thalassemia, also can have microcytic anemia, but this is far less common than iron deficiency. The serum haptoglobin level is decreased with intravascular hemolysis, but the anemia is normocytic because the iron can be recycled. The serum iron concentration or transferrin level by itself gives no indication of iron stores because, in anemia of chronic disease, the patient's iron level can be normal to low, and the transferrin levels also can be normal to low, but iron stores are increased. Transferrin, a serum transport protein for iron, usually has about 33% iron saturation. [/INST] question: A 54-year-old, previously healthy man has experienced minor fatigue on exertion for the past 9 months. On physical examination, there are no remarkable findings. Laboratory studies show hemoglobin of 11.7 g/dL, hematocrit of 34.8%, MCV of 73 mm3, platelet count of 315,000/ mm3, and WBC count of 8035/ mm3. Which of the following is the most sensitive and cost-effective test that the physician should order to help to determine the cause of these findings? | options: A: Bone marrow biopsy B: Hemoglobin electrophoresis C: Serum ferritin D: Serum haptoglobin | answer: C </s> |
<s>[INST] context: Three kids have been learning chemistry for only a few months. But they have already begun to challenge a world famous scientist!
Li Weichi, Huang Runling, and Xiao Yan are from Zhongshan Huaqiao Middle School in Guangdong. They have just found a red cabbage that could be a new kind of acid-base indicator . They want it to take the place of litmus paper.
"We've learnt to think of and ask questions about life by ourselves," said Li, "We work well with each other."
British scientist Robert Boyle discovered the use of litmus paper over 300 years ago. Now it is used widely in experiments all over the world.
But when the kids did some experiments in class last winter, they saw that the litmus paper didn't turn very blue with base matter. It's hard to get a clear result.
Will there be a better indicator than litmus paper? The three kids decided to try and find out!
How? They went to collect over 40 plants in parks, gardens and markets. Then they ground leaves, flowers and stems to get the pigments from them.
The kids mixed pigments with acid and base. They spent months watching carefully to see which paper showed the best colour change. They decided it was the litmus paper!
"It's our first scientific journey, Huang said, "But it makes me want to try harder." [/INST] question: Whom did the three kids want to challenge? | options: A: Their chemistry teacher B: Their headmaster C: Robert Boyle D: Thomas Edison | answer: C </s> |
<s>[INST] context: Last year The Voice of China, the most popular TV talent show became a popular topic in people's chatting and media information from both home and abroad. It began on July 13, 2012 and ended on September 30, 2012. Liang Bo, a handsome boy from Changchun, Jilin was the champion of The Voice of China in 2012. Before the competition Liang Bo was just an ordinary college student studying music. He captured the hearts of audience with his passionate rock'n'roll performance at the show.
Fans described Liang's voice as "natural, clear and touching''. Although he seemed cool on stage, he could quickly turn on the power once he started singing. "His performances make you imagine things. When I listen to his singing, I see pictures and think of stories." said Na Ying, one of the four judges on the show. She was also Liang's tutor for the competition.
Liang Bo, like many young Chinese, he fell in love with music through playing the guitar. Liang got his first guitar as a birthday gift when he was in middle school. He would spend days and nights practicing. " I can't live without my guitar." he said.
" I don't like talking much but I carry great passion inside me," Liang said. " There is no better way to let it out than through music like rock'n'roll. Many people compare Liang to famous Chinese rockers including Xu Wei, Wang Feng and Zheng Jun. But the young man doesn't want to stand in others' shadow. " I respect those rockers, but I'm not going to copy them. I will be who I am," he said. [/INST] question: Which was the most popular TV show last summer? | options: A: The Voice of China B: Sports News C: Football D: Animal World | answer: A </s> |
<s>[INST] context: While many women are busy with planning their bridal showers , a baby shower usually comes as a complete surprise. A baby shower is a party where a pregnant woman is "showered" with gifts and good wishes. A baby shower is usually given by a close female friend or a relative of the mother-to-be. Sometimes co-workers of a pregnant person will also hold a baby shower for her.
The baby shower is usually given when the mother-to-be is between 6 and 9 months pregnant. _ the date of a baby's birth isn't always exact. Sometimes a baby shower can also happen after the baby is born. A baby shower can be held in someone's home or outside, like in a restaurant or a catering hall. Traditionally only women are invited to a baby shower. However, more and more baby showers are also including the father-to-be.
Like a bridal shower, a mother-to-be will register a wish list of things she wants at one or several stores. This list usually includes things the mother wants for her baby like clothes, diapers and even furniture. This way friends and family members can go to the stores and buy something from the list. Registering helps make sure that there aren't repeat items, like 30 bottles when a new mom only needed 15.
At a baby shower, people can give cards with wishes for the new baby and mom. Most of these cards also include money or gift cards to help the mom-to-be buy whatever else she needs for the baby. Sometimes there are games as well. In one game everyone guesses the date of the baby. Another game lets people taste baby food and guess the flavor. [/INST] question: Who was only invited to a baby shower traditionally? | options: A: Men B: Children C: Women D: Pregnant women | answer: C </s> |
<s>[INST] context: Sam "Fingers" had been in trouble all his life. He'd started stealing things when he was only a kid. He used to walk through the street market near his home and "pick up" a few things--an apple, or a hairbrush perhaps. But things got worse as Sam got older. By the time he was twenty-five, he was spending a lot of time stealing and then he got caught. While he was in prison he decided that he'd never steal again. He really had to stop.
On his first day out of prison, Sam went for a walk along the High Street. It was so nice to walk along in the crowds and looked at the shops. Oh, the shops!
"I'll just go into this jeweler's and have a look around," Sam said to himself. "There's nothing to worry about. No more stealing for me." Then Sam saw the diamond ring. He'd always wanted to give one to his girlfriend. And nobody was looking. In a minute the ring was in his pocket and Sam was walking out of the shop. But as he went towards the door he felt a hand on his shoulder, "I shall have to call the police."
"I'll pay for it. Yes, I'll pay for it," said Sam.
With a smile, the manager handed him the bill: 500!
"Err, um, well..." said Sam. "I really didn't want to spend that much. Would you please show me something a little cheaper?" [/INST] question: People called him "Fingers" because he was a _ . | options: A: prisoner B: piano-player C: thief D: small boy | answer: C </s> |
<s>[INST] context: long ago people made fires from lightning . But they had to keep the fire burning, for they couldn't start it again if there was no lightning. Later, they found out hitting two piece of stone together could make a spark . The spark could fire dry leaves. In this way they could make the fire again if it went out. Then people also learned to make a fire by rubbing. They made a hole on a big piece of wood and put a smaller stick into the hole. They turned the stick again and again. After a few minutes they got a fire.
As years went by, people learned other ways to make a fire. Sometimes they used the heat from sun. they held a piece of glass in the right way and made a piece of paper on fire.
About two centuries ago, people began to make matches . Matches brought people a quick and easy way to make fire. Today matches are still being used, but people have more new ways to make fires. One of them is to use an electric fire starter. Of course an electric fire starter is much more expensive than a box of matches. But it is more useful. [/INST] question: A spark can _ . | options: A: fire any leaves B: burn anything C: burn dry leaves D: keep fires burning | answer: C </s> |
<s>[INST] context: Former South African President Nelson Mandela who was treated for a recurring lung infection, dies on Dec. 5th, 2013, at the age of 95.
People around the world are mourning the loss of the country's first black president. He was often called humble, charming, loyal person and a man who cared about others.
"He seemed to have that special charismatic personality," said Herman Cohen, U.S. assistant secretary of state for Africa from 1989 to 1993. "He became the symbol in the fight against _ ."
Mandela was born on July 18, 1918. As a young man he became active in the anti-apartheid movement and joined the African National Congress, or ANC, in the 1940s.
The white-led government banned the ANC in 1960, but the group continued to operate secretly. Mandela became head of the group's new military wing, coordinating a sabotage campaign against South African military and government targets.
In 1962, he was arrested and put on trial for his actions and sentenced to life in prison on Robben Island off the coast of Cape Town. He spent 18 years there, refusing a government offer to release him if he would renounce the ANC's armed struggle. But he was freed in 1990 after South African President Frederik de Klerk legalized all political parties and discharged most political prisoners.
Shortly after his release, Mandela was elected president of the African National Congress. And in 1994, when the ANC won South Africa's first all-race elections, he was inaugurated as the county's first black president at age 75.
"Never, never and never again shall it be that this beautiful land will again experience the oppression of one by another," he said.
President Mandela said he would stay for only one five-year term. Cohen says Mandela earned international respect for South Africa's national reconciliation.
"Mandela devoted himself mainly to rallying the Africans to this new era to work on economic development, having good education, also he was very much of a spokesman on the international scene." he said.
In 1993, Mandela shared the Nobel Peace Prize with his once bitter enemy F.W. de Klerk for their contribution to the peace process in South Africa. After receiving the award, Mandela praised the South African people.
"All have created a society which recognizes that all people are born equal," he said. In a country torn apart by years of racial conflict, Nelson Mandela is considered a remarkable leader -- a man who turned South Africa away from violence and hatred into a country of greater peace and understanding. [/INST] question: How long was Nelson Mandela sent to prison? | options: A: 18 years B: 28 years C: 6 years D: 19 years | answer: B </s> |
<s>[INST] context: One Tuesday morning, Harry saw an ad in a window. It said, "Wanted. The Best Salesman in the World Top Pay." Harry thought he was a great salesman and went to ask for the job." I am the best salesman in the world," he said to the manager, "Give me the job."
"You must prove you're the best," the manager said.
"OK, I will!" Harry answered.
"Good!" The manager took a box of sweets out of his desk." Last week I bought a thousand boxes of sweets. If you can sell them all before the end of the week, you can have the job," said the manager.
"That's easy." Harry said. He took the boxes of sweets and left the office.
Every day and all day, he went from shop to shop, trying to sell the boxes of sweets. He couldn't sell one. The sweets were too bad for him to sell. At the end of the week he went back to the manager. "I'm sorry, sir." He said. "I was wrong about myself. I'm not the best salesman in the world, but I know who is."
"Oh," said the manager. "Who?" "The person who sold you a thousand boxes of these sweets." Harry said. [/INST] question: Harry went to ask for the job because he was _ himself at first. | options: A: afraid of B: wrong with C: sure of D: worried about | answer: C </s> |
<s>[INST] context: Testicular feminization syndrome - complete androgen resistance, presents as phenotypic young woman without sexual hair but with normal breast development and primary amenorrhoea Complete testicular feminization is a common form of male pseudohermaphroditism. It is the 3rd most common cause of primary amenorrhea after gonadal dysgenesis and congenital absence of the vagina. The features are characteristic. Namely, a ''woman" is asceained either because of inguinal hernia (prepubeal) or primary amenorrhea (postpubeal). The development of the breasts, the habitus, and the distribution of body fat are female in character so that most have a ''truly" feminine appearance. Axillary and pubic hairs are absent or scanty, but some vulval hairs are usually present. Scalp hairs are that of a normal woman, and facial hairs are absent. The external genitalia are unambiguously female, and the clitoris is normal. The vagina is sho and blind-ending and may be absent or rudimentary. All internal genitalia are absent except for testes that contain normal Leydig cells and seminiferous tubules without spermatogenesis. The testes may be located in the abdomen, along the course of the inguinal canal, or in the labia majora. [/INST] question: A young girl presents with primary amenorrhoea, grade V thelarche, grade II pubarche and no axillary hair. The most probable diagnosis is | options: A: Testicular feminization B: Mullerian agenesis C: Turner syndrome D: Gonadal dysgenesis | answer: A </s> |
<s>[INST] context: When light is shone to one (e.g. left) eye, left optic nerve carries afferent impulse to brain and from brain efferent impulse to ipsiplateral (left) eye comes through ipsilateral (left) occulomotor nerve (for direct light reflex) and efferent for contralatcral (right) eye comes through contralateral (right) occulmotor nerve for consensual light reflex. When light is shone to other (right) eye, right optic nerve carries afferent impulse to brain and from brain, efferent impulse to right eye (for direct light reflex) comes through right occulmotor nerve and efferent for left eye (for consensual light reflex) comes through left occulomotor nerve. So :-
Optic nerve is responsible for direct light reflex in ipsilateral eye and consensual light reflex for contralateral eye. (In above example, afferent for right sided direct and left sided.consensual light reflex is through right optic nerve; and afferent for left sided direct and right sided consensual light reflex is through left optic nerve).
Occulomotor nerve is responsible for direct and consensual light reflex in the same eye. (In above example, efferent for right sided direct as well as consensual light reflex is through right occulmotor nerve and efferent for left sided direct as well as consensual light reflex is through left occulomotor nerve).
In complete optic nerve lesion of one side (Amaurosis light reflex or total afferent pupillary defect)
The ipsilateral direct reflex is lost
The ipsilateral consensual reflex is intact
The contralateral direct reflex is intact
The contralateral consensual reflex is lost
In occulomotor nerve lesion of one side (efferent pupillary defect
The ipsilateral direct reflex is lost
The ipsilateral consensual reflex is lost
The cool ralateral direct reflex is intact
The contralateral consensual reflex is intact [/INST] question: A patient presented with normal eyesight and absence of direct and consensual light reflexes. Which of the following cranial nerves is suspected to be lesioned? | options: A: Occulomotor B: Trochlear C: Optic D: Abducent | answer: A </s> |
<s>[INST] context: In many countries, unusual names for children are becoming more popular, especially when more and more stars give their children special names. In Britain, you can call a child almost anything you like except dirty words.
Some parents choose names which come from popular culture. Because of the film the Lord of the Rings , six boys were named Gandalf. Names about sport are very common, too. Since 1984, 36 children have been called Arsenal after the football team.
Other parents like to make up names, or combine two names to make a special one. A mother in Britain invented the name Tiaamii for her daughter. She combined the names Thea and Amy (the two grandmothers).
In China, there are some rules about names --- you can't use foreign letters or symbols in a Chinese name. For example, parents are not allowed to name their baby @. In New Zealand, a name beginning with a number is not allowed. Other countries have stricter rules about calling children. For example, Japan, Denmark, Spain, Germany and Argentina have a list of names. Parents must choose the names in the lists for their children.
In Britain, some old-fashioned names have become popular again, such as Maisie or Ella for a girl, and Alfie or Noah for a boy. But the most popular names are not the strange ones. The top names are very traditional--Jack and Thomas for boys, or Grace and Jessica f6r girls.
,,. (5,2,l0) [/INST] question: In Britain, people can't use _ words in their children's names. | options: A: strange B: popular C: old-fashioned D: dirty | answer: D </s> |
<s>[INST] context: Foul smelling discharge and perforation in the Pars flaccida suggest CSOM of the unsafe type (Atticoantral type) This type of CSOM is often associated with a bone eroding process such as cholesteatoma, granulations or osteitis. Risk of complications is high Surgery is the mainstay of treatment. The primary aim is to remove the disease process by tympano-mastoid exploration and render the ear safe. Tympano-mastiod exploration can be done through various procedures. 1. Canal wall down procedures - Atticotomy, modified radical mastoidectomy and rarely radical mastoidectomy. 2. Canal wall up procedures Tympanoplasty is a surgical procedure that repairs or reconstructs the hearing mechanism. 'Type I Defect is perforation of tympanic membrane which is repaired with a graft. It is also called myringoplasty. -Type II Defect is perforation of tympanic membrane with erosion of malleus. Graft is placed on the incus or remnant of malleus. 'Type III Malleus and incus are absent. Graft is placed directly on the stapes head. It is also myringostapediopexy or columella tympanoplasty. -Type IV Only the footplate of stapes is present. It is exposed to the external ear, and graft is placed between the oval and round windows. A narrow middle ear (cavum minor) is thus created, to have an air pocket around the round window. A mucosa-lined space extends from the eustachian tube to the round window. Sound waves in this case act directly on the footplate while the round window has been shielded. *Type V Stapes footplate is fixed but round window is functioning. In such cases, another window is created on horizontal semicircular canal and covered with a graft. Also called fenestration operation. [/INST] question: A child presents with left ear hearing loss of three month duration. On examination, foul smelling purulent discharge is seen with perforation in pars flaccida. What is the most appropriate management? | options: A: Topical antibiotics and decongestants for 4 weeks B: Aural toileting C: Tympano-mastoid exploration D: Type I tympanoplasty | answer: C </s> |
<s>[INST] context: Henry found work in a bookstore after he finished middle school. He wouldn't do anything but wanted to get rich. Mr. King thought he was too lazy and was going to send him away. Henry was afraid and had to work hard.
It was a cold morning. It was snowing and there was thin ice on the streets. Few people went to buy the books and the young man had nothing to do. He hated to read, so he watched the traffic. Suddenly he saw a bag fall off a truck and it landed by the other side of the street.
"It must be full of expensive things," Henry said to himself. "I have to get it, or others will take it away. "
He went out of the shop and ran across the street. A driver saw him and began to whistle , but he didn't hear it and went on running. The man drove aside, hit a big tree and was hurt in the accident. Two weeks later Henry was taken to court . A judge asked if he heard the whistle when he was running across the street. He said that something was wrong with his ears and he could hear nothing.
"But you've heard me this time." said the judge.
"Oh, I'm sorry. Now I can hear with one ear."
"Cover the ear with your hand and listen to me with your deaf one. Well, can you hear me? "
"No, I can't, Sir." [/INST] question: What was Mr. King? | options: A: a driver B: a doctor C: a policeman D: a shopkeeper | answer: D </s> |
<s>[INST] context: Production of ketone bodies by the livera. As glucagon levels rise, adipose tissue breaks down its triacylglycerol stores into fatty acids and glycerol, which are released into the blood.b. Through the process of b-oxidation, the liver converts the fatty acids to acetyl coenzyme A (acetyl CoA).c. Acetyl CoA is used by the liver for the synthesis of the ketone bodies, acetoacetate and b-hydroxybutyrate. The liver cannot oxidize ketone bodies and hence releases them into the blood.Blood glucose is the major fuel for the brain, except when, after 3 to 5 days of fasting, ketone bodies in the blood reach a concentration at which the brain can begin to utilize them. Even at this point the nervous system still obtains 60% of its energy from glucose. The brain does not take up, to an appreciable extent, fatty acids, and fatty acid oxidation does not provide much energy for the brain. The brain's glycogen stores are very small, and alanine is not used as an energy source under any conditions by the nervous system. [/INST] question: Choose the major fuel that is being used by the brain after 1 day of fasting. | options: A: Ketone bodies B: Blood glucose C: Fatty acids D: Glycogen | answer: B </s> |
<s>[INST] context: Would you eat a ready meal from the fridge rather than cook by yourself? Have you been doing Internet shopping rather than going to the stores? What can't you be bothered to do?
A study into how lazy British people are has found more than half of the adults are so idle that they'd catch the lift rather than climb two flights of stairs.
Just over 2,000 people were quizzed by independent researchers at Nuffield Health, Britain's largest health center. The results were extremely surprising.
About one in six people questioned said if their remote control was broken, they would continue watching the same channel rather than get up.
More than one third of those questioned said they would not run to catch a bus. Worryingly, of the 654 respondents with children, 64% said they were often too tired to play with them.
This led the report to conclude that it's no wonder that one in six children in the UK are classified as obese (very fat) before they start school.
Dr Sarah Dauncey, medical director of Nuffield Health, said, "People need to get fitter, not just for their own sake, but for the sake of their families, friends and evidently (;) their pets too."
"If we don't start to take control of this problem, a whole generation will become too unfit to perform even the most fundamental tasks."
And Scotland's largest city, Glasgow, was shamed as the most idle city in the UK, with 75% questioned admitting they do not get enough exercise, followed closely by Birmingham and Southampton, both with 67%.
The results bring serious challenges for the National Health Service, where obesity-related illnesses such as heart disease and cancer have been on a steady increase for the past 40 years and are costing billions of pounds every year. [/INST] question: How many people questioned don't play with their children? | options: A: 1280 B: More than 333 C: 654 D: About 420 | answer: D </s> |
<s>[INST] context: (1)Secretary. Part time. 20 hours a week. Busy doctor's office. Experience preferred. Good typing. Call 555-2438.
(2)BABY SITTER. 3 to 6 weekday afternoons. I will take you home. $5.00 an hour. Call 555-5593.
(3)Guitar lessons. Your home or mine. Experienced musician. Master's degree in music. Call Louise 555-6131.
(4)TENTH STREET BLOCK PARTY. Sunday, July 15. Noon to 8. Food, games, prizes, live band, Tenth Street between Main and North,
(5)APARTMENT FOR RENT. 3 sunny rooms on high floor, great view. Separate kitchen. Wall-to-wall carpeting. The living room can be used as dining room. Email: [email protected].
(6)TAXI DRIVER WANTED. Full or part time. Experience necessary. A good knowledge of the city is required. Call 555-8860 between 9 a.m. and 5 p.m. weekday.
(7)A stereo system for sale, It has two speakers. The system has an AM/FM radio. It also has a tape deck and turntable. It is in good condition. The stereo was owned for only one year. The price is $200 including the speakers. The owner will also take the highest price offered if the asking price is not met. Call Bill after 6 p.m., at 555-9834. [/INST] question: How many of the seven ads are placed by people who want to hire someone for certain job? | options: A: 4 B: 3 C: 2 D: 5 | answer: B </s> |
<s>[INST] context: In respiratoy alkalosis, there is an increase in extracellular fluid pH and a decrease in H+ concentration. The cause of the alkalosis is a decrease in plasma pCO2, caused by hyperventilation. The reduction in pCO2, then leads to a decrease in the rate of H+ secretion by the renal tubules. The decrease in H+ secretion reduces the amount of H+ in the renal tubular fluid. Consequently, there is not enough H+ to react with all the HCO3- that is filtered. Therefore, the HCO3- that cannot react with H+ is not reabsorbed and is exreted in the urine. This results in a decrease in plasma HCO3- concentration and correction of the alkalosis. Therefore, the compensatory response to a primary reduction in pCO2 in respiratory alkalosis is a reduction in plasma HCO3- concentration, caused by increased renal exretion of HCO3-
Changes in plasma hydrogen ion concentration can influence the degree of calcium binding to plasma proteins. With acidosis, less calcium is bound to the plasma proteins. Conversely, in alkalosis, a greater amount of calcium is bound to the plasma proteins. Therefore, patients with alkalosis are more susceptible to hypocalcemic tetany. [/INST] question: After hyperventilating for sometime, holding the breath is dangerous, since: | options: A: It can lead to CO2 necrosis B: Due to lack of stimulation by CO2 anoxia can go into dangerous levels C: Decreased CO2 shift the oxygen dissociation curve to the left D: Alkalosis can lead to tetany | answer: D </s> |
<s>[INST] context: Immunopathological studies suggest that the target of immune attack is different in the subtypes of Guillain-Barre syndrome (GBS). In acute motor axonal neuropathy (AMAN), the attack appears directed against the axolemma and nodes of Ranvier. In acute inflammatory demyelinating polyneuropathy (AIDP), the attack appears directed against a component of the Schwann cell. However, the nature of the antigenic targets is still not clear. We prospectively studied 138 Chinese GBS patients and found that IgG anti-GD1a antibodies were closely associated with AMAN but not AIDP. With a cutoff titer of greater than 1:100, 60% of AMAN versus 4% of AIDP patients had IgG anti-GD1a antibodies; with a cutoff titer of greater than 1:1,000, 24% of AMAN patients and none of the AIDP patients had IgG anti-GD1a antibodies. In contrast, low levels of IgG anti-GM1 antibodies (> 1:100) were detected in both the AMAN and the AIDP forms (57% vs 35%, NS). High titers of IgG anti-GM1 (>1:1,000) were more common in the AMAN form (24% vs 8%, NS). Serological evidence of recent Campylobacter infection was detected in 81% of AMAN and 50% of AIDP patients, and anti-ganglioside antibodies were common in both Campylobacter-infected and noninfected patients. Our results suggest that IgG anti-GD1a antibodies may be involved in the pathogenesis of AMAN. [/INST] question: Anti GDla | options: A: AIDP B: ASMAN C: AMAN D: Fisher syndrome | answer: B </s> |
<s>[INST] context: A fractional excretion of sodium (FENa) is calculated as (urine sodium x serum creatinine) / (serum sodium x urinary creatinine) x 100. A FENa less than 1% suppos a prerenal etiology for the patient's oliguria. When oliguria occurs postoperatively, it is impoant to differentiate between low output caused by the physiologic response to intravascular hypovolemia and that caused by acute tubular necrosis. A FENa of less than 1% in an oliguric setting indicates aggressive sodium reclamation in the tubules. Values above this suggest a tubular injury such that Na cannot be appropriately reclaimed. In the setting of postoperative hypovolemia, all findings would reflect the kidney's effos to retain volume: the urine sodium would be below 20 mEq/L, the urine chloride would not be helpful except in the metabolically alkalotic patient, the urine osmolality would be over 500 mOsm/kg, the urine/serum creatinine ratio would be above 20, and the blood urea nitrogen (BUN)/creatinine ratio would be above 20. [/INST] question: Following surgery a patient develops oliguria. You believe the oliguria is due to hypovolemia, but you seek corroborative data before increasing intravenous fluids. Which of the following values suppos the diagnosis of hypovolemia? | options: A: Urine sodium of 28 mEq/L B: Urine chloride of 15 mEq/L C: Fractional excretion of sodium less than 1 D: Urine/serum creatinine ratio of 20 | answer: C </s> |
<s>[INST] context: Lupus nephritis is one manifestation of systemic problems related to immune complex deposition, including fever, arthralgias, myalgias, pancytopenia, and serositis with pericarditis and pleuritis, which are characteristic of systemic lupus erythematosus (SLE). Renal disease is common in SLE, and a renal biopsy helps to determine the severity of involvement and the appropriate therapy. Anti-centromere antibody is most specific for limited scleroderma (formerly CREST syndrome), which is unlikely to have renal involvement. Anti-DNA topoisomerase I antibody is more specific for diffuse scleroderma, which does have renal involvement, although usually, this manifests as vascular disease and not as glomerulonephritis. The anti-glomerular basement membrane antibody is characteristic of Goodpasture syndrome, in which the IgG antibody is deposited in a linear fashion along glomerular capillary basement membranes. Anti-histone antibody may be present in drug-induced lupus. ANCAs can be seen in some forms of vasculitis, such as ANCA-associated granulomatous vasculitis or microscopic polyangiitis. Antiribonucleoprotein is present in mixed connective tissue disease, which has some features of SLE but usually does not include severe renal involvement. [/INST] question: A 33-year-old woman has had fever and increasing fatigue for the past 2 months. Over the past year, she has noticed the soreness of her muscles and joints and has had a 4-kg weight loss. On physical examination, her temperature is 37.5degC, pulse is 80/min, respirations are 15/min, and blood pressure is 145/95 mm Hg. She has pain on deep inspiration, and a friction rub is heard on auscultation of the chest. Laboratory findings show glucose, 73 mg/dL; total protein, 5.2 g/dL; albumin, 2.9 g/dL; and creatinine, 2.4 mg/dL. Serum complement levels are decreased. CBC shows hemoglobin of 9.7 g /dL, platelet count of 85,000/mm3, and WBC count of 3560/mm3. A renal biopsy specimen shows diffuse proliferative glomerulonephritis with extensive granular immune deposits of IgG and C1q in capillary loops and mesangium. After being treated with immunosuppressive therapy consisting of prednisone and cyclophosphamide, her condition improves. Which of the following serologic studies is most likely to be positive in this patient? | options: A: Anti centromere antibody B: Anti-DNA topoisomerase I antibody C: Anti-double-stranded DNA antibody D: Anti-glomerular basement membrane antibody | answer: C </s> |
<s>[INST] context: We know that many animals do not stay in one place.Birds,fish and other animals move from one place to another at a certain time.They move for different reasons:most of them move to find food more easily,but others move to get away from places that are too crowded.
When cold weather comes,many birds move to warmer places to find food.Some fishes give birth in warm water and move to cold water to feed.The most famous migration is probably the migration of fish,which is called "Salmon".This fish is born in fresh water but it travels many miles to salt water.There it spends its life.When it is old,it returns to its birthplace in fresh water.Then it gives birth and dies there.In northern Europe,there is a kind of mouse.They leave their mountain homes when they become too crowded.They move down to the low land.Sometimes they move all the way to the seaside,and many of them are killed when they fall into the sea.
Recently,scientists have studied the migration of a kind of lobster .Every year,when the season of bad weather arrives,the lobsters get into a long time and start to walk across the floor of the ocean.Nobody knows why they do this,and nobody knows where they go.
So,sometimes we know why humans and animals move from one place to another,but at other times we don't.Maybe living things just like to travel. [/INST] question: Most animals move from one place to another at a certain time to _ . | options: A: give birth B: enjoy warmer water C: find food more easily D: find beautiful places | answer: C </s> |
<s>[INST] context: This Friday is TombSweeping Day, one of the three traditional festivals that are included as the Chinese mainland's public holidays starting this year. Together with the Dragon Boat Festival in June and MidAutumn Festival in September, the authorities say observing these days is aimed at protecting folk culture and customs.
Chinese nationwide should thank Chen Jing, a 68yearold folk artist and professor from Nanjing University for the move. "It is certainly a favorable gesture for the promotion and preservation of folk culture and customs," Chen said. In 2006, Chen proposed to the authorities to make TombSweeping Day, also known as Qingming Festival, a public holiday. His suggestion received wide support from other folk artists. "TombSweeping Day means a lot to the Chinese," Chen said. It is a day for people to honour their ancestors.
Two years ago, on his trip to honour his ancestor in Taizhou, Jiangsu province, he found the train full of people, most of whom were the elderly. From the conversation with them, he found the elderly thought it necessary to include young family members in the festival's activities, while working people also wanted the chance to honor their ancestors. Among those he spoke to was an elderly man from Hongkong, who told Chen TombSweeping Day is a holiday in Hongkong for paying tribute to ancestors. Chen was inspired by the experience and insight from these people and put forward the suggestion for the holiday during an interview by mainstream media.
"If we do not take immediate action, our traditional folk customs will be forgotten by the younger generation," he said. His idea soon spread all over the country and was echoed by many scholars and experts. [/INST] question: Why do the elderly think it is important to make TombSweeping Day a public holiday? | options: A: Because they want to honor their ancestors B: Because it can make young people and working people be included in the festival's activities C: Because it can make people have a chance to honor their ancestors D: Because they think it is an important traditional folk custom | answer: B </s> |
<s>[INST] context: When Mrs.Joseph Groeger died recently in Vienna,Austria,people asked the obvious question,"Why did she live to be 107?" .Answers were provided by a survey conducted among 148 Viennese men and women who had reached the age of 100.Somewhat surprising was the fact that the majority had lived most of their lives in cities.In spite of the city's image as an unhealthy place,city living often provides benefits that country living can lack.One factor seems to be important to the longevity of those interviewed.
This factor is exercise.In the cities it is often faster to walk short distances than to wait for a bus.Even taking public transportation often requires some walking.Smaller apartment houses have no elevators ,and so people must climb stairs.City people can usually walk to local supermarkets. Since parking spaces are hard to find,there is often no alternative to walking.
On the other hand,those who live in the country and suburbs do not have to walk every day.In fact,the opposite is often true.To go to school,work,or almost anywhere else,they must ride in cars. [/INST] question: The Vienna survey may help to explain _ | options: A: the complaints of people in apartment houses B: the cause of Mrs Groeger's death C: the longevity of people like Mrs.Groeger D: the image of cities in general | answer: C </s> |
<s>[INST] context: We all know about this famous Kitty. She has no mouth,and she wasn't born out of a TV show or a video game. So how did this cute character become popular? How did she change the world?
Hello Kitty was created in Japan in 1974.Sanrio,a company in Japan,was working for a new character to put on their new purse. The first picture of Hello Kitty was introduced on November 1.She was so cute that it became popular soon in Japan and all over the world.
Hello Kitty is only a character,but she has a story of her own. Her full name is Kitty White,and she's even not a Japanese. She lives in the countryside outside London with her family--George White,Mary White and her twin sister Mimmy. Hello Kitty wears a red bow on her left ear while Mimmy wears a yellow bow on her right ear.
Kitty loves goldfish and baking cookies,but her favourite thing is to eat her mum's apple pie! She also loves stars and candies too.She is in the 3rd grade and she weighs as much as three apples but is five apples tall.She even had a blood (.) type,which is A.
Hello Kitty's appearance hasn't changed much,though she turned 40 on November 1,2014. [/INST] question: Hello Kitty became popular because of _ . | options: A: a Japanese story B: a video game C: her picture on a purse D: a TV show | answer: C </s> |
<s>[INST] context: Strasberg classification Class A: Bile leak from the cystic duct or an accessory duct showing continuity with the common bile duct Class B: Section/injury of an accessory duct/sectorial ducts aberrant right hepatic duct with no continuity with the common bile duct with occlusion Class C: Leak/open drainage from a sectorial duct/aberrant right hepatic duct with no continuity with the common bile duct Class D: Paial section/lateral injury of an extrahepatric duct bile duct with no complete loss of continuity with the rest of the bile duct system Class E: Complete section/circumferential injury of the bile duct with subtypes according to the length of the stump at various levels - E1- Stricture/injury at more than 2 cm distal to bifurcation. - E2 - Stricture/injury less than 2 cm distal to bifurcation. - E3 - Stricture/injury at bifurcation - E4 - Stricture/injury involving right and left hepatic ducts - E5 - Complete obstruction of entire bile duct Note: Only right and left paial injuries are not included in this classification SRB's Manual of Surgery, 4th Edition, pg. no. 708 [/INST] question: According to the Bismuth/Strasberg classification &; Cystic blow out&; is classified as | options: A: TYPE A B: TYPE B C: TYPE C D: TYPE D | answer: A </s> |
<s>[INST] context: Angelina Jolie is an American actress. She has received an Academy Award and three Golden Globe Awards. Jolie is keen on charity, and is noted for her work with refugees as a Goodwill Ambassador for the United Nations High Commissioner for Refugees (UNHCR). She has been recognized as one of the world's most attractive people, as well as the world's "sexiest" and "most beautiful" woman.
Born in Los Angels, California, Jolie is the daughter of actors Jon Voight and Marcheline Bertrand. After her parents' separation in 1976, Jolie and her brother were raised by their mother, who abandoned her acting ambitions and moved with them to Palisades, New York. As a child, Jolie regularly saw movies with her mother and later explained that this has inspired her interest in acting.
Jolie achieved wider fame after her performance of video games heroine Lara Croft in Lara Croft: Tomb Raider, and since then she has established herself as one of the best-known and highest-paid actress in Hollywood. Jolie has had her biggest commercial successes with the action-comedy Mr.&Mrs.Smith.
After divorcing her second ex-husband, Jolie lives with actor Brad Pitt, in a relationship that has attracted world-wide media attention. Jolie and Pitt have three adopted children, Maddox, Pax, and Zahara, and three biological children, Shiloh, Knox, and Vivienne.ks#5u
It's reported recently that Jolie and Brad Pitt have finally decided to legally become husband and wife, and the wedding ceremony will take place in September in their France castle. The couple will leave Hollywood, choosing to _ to southern France. They will also leave the U.S. to move to Europe. It seems that Jolie and Pitt will do this for their six children, who greatly desire this. [/INST] question: What do you think is the reason for Jolie's interest in acting when she was a child? | options: A: People around her thought that she would be a good actress B: Her family was poor and they couldn't send her to school C: Her mother often took her to cinema D: She was good at acting when she was just a child | answer: C </s> |
<s>[INST] context: Zhang Lili, a 29-year-old middle school teacher at the No 19 middle school in the city of Jiamusi in Northeast China's Heilongjiang province was crossing the road just outside the school's gate when a school bus suddenly came rushing toward nearby students at 8:38 pm on May 8, 2012.
"There were three buses at the school gate ready to pick up students, but the one in the back suddenly crashed into the second bus and pushed it into the first one. There were several students standing between the first and the second buses and they were about to be crushed," said Liu Ye, a student of No. 19 middle school.
"We were waiting to board the bus when suddenly _ began moving toward the teachers and students. Zhang Lili immediately pushed the students out of the way, but unfortunately she didn't escape. The bus crushed her legs. " added Liu.
Zhang Lili was sent to hospital at about 9 pm and she was critically injured and her blood pressure was low. The situation was quite serious when rushed to hospital.
After consulting specialists, the doctors decided that the only way to save her life was cut off both of her legs.
Upon learning about the accident, the deputy mayor of the city, Sun Zhe, asked the hospital to "save the young teacher regardless of the cost"
"If necessary, we will invite more specialists from the capital city, even from whole nation," said Sun.
Fortunately, after 58 hours of emergency medical attention after being transferred to the First Affiliated Hospital of Harbin Medical University, Zhang finally regained consciousness on May 15.
" _ , and the doctors are still working full out to save the heroic teacher," said Zhao Mingyan, ICU director at the hospital, where Zhang is now receiving treatment.
"Her courage moved all of our staff, and we will try our best to help the brave teacher in her future life. " said Wang Jianwei, the director of center.
The Ministry of Education has also named her "National Outstanding Teacher" and called on the country's educators to learn from her. [/INST] question: What can be inferred from the remark of the deputy Mayor Sun Zhe? | options: A: Every possible means is being carried out to save the brave teacher B: It's increasingly difficult to save the brave teacher C: The only way to save the brave teacher is to cut off her legs D: No more medical experts will be needed in the operation to save the brave teacher | answer: A </s> |
<s>[INST] context: Signs and Tests
Adson's test : for thoracic outlet syndrome
Allen's test : for testing patency of radial and ulnar arteries
Alli's test : for CDH
Anvil test : for testing tenderness of the spine
Ape thumb : for median nerve injury
Apley's grinding test :for a meniscus injury
Apprehension test : for recurrent dislocation of the shoulder
Barlow's test : for CDH
Blue sclera : Osteogenesis imperfecta
Bryant's test : for anterior dislocation of the shoulder
Callways' test : for anterior dislocation of the shoulder
Chovstek's sign : for tetany
Claw hand : for ulnar nerve injury
Coin test : for dorso lumbar tuberculosis of spine
Cozen's test : for tennis elbow
Drawer test : for ACL and PCL injuries
Anterior : for ACL injury
Posterior : for ACL injury
Finkelstein's test : for de Quervain's tenovaginitis
Foot drop : for common peroneal nerve injury
Froment's sign : for ulnar nerve injury
Gaenslen's test: for SI joint involvement
Galleazzi sign : for CDH
Gower's sign : for muscular dystrophy
Hamilton ruler test : for anterior dislocation of the shoulder
Kanavel's sign : for infection in ulnar bursa
Lasegue's test: for disc prolapse
Lachmann test : for ACL injury
Ludloffs sign: for avulsion of lesser trochanter
McMurray's test : for meniscus injury
Nagffziger test : for disc prolapse
Ober's test : for tight ilio- tibial band (e.g., in polio)
O' Donoghue triad: traid of MCL, ACL & medial meniscus injuries occurring together
Ortolani's test : for CDH
Pivot shift test : for ACL injury
Policeman tip : for Erb's palsy
Runner's knee : Patellar tendinitis
Sulcus sign: for inferior dislocation of the shoulder
Thomas' test : for hip flexion deformity
Trendelenburg's test: for unstable hip due to any reason (e.g., CDH)
Tinel's sign: for detecting improving nerve injury
Volkmann's sign : for ischemic contracture of forearm muscles
Wrist drop : for radial nerve injury [/INST] question: Test for the tight iliotibial band is - | options: A: Ober's test B: Osber's test C: Sirru-nand's test D: Charnley's test | answer: A </s> |
<s>[INST] context: Many people take it for granted that black is a color of bad things while white should always mean something good. This may be because, in their opinion, black is related to darkness and white to purity. However, that is not always the case. Did you know that the same one color may mean something differently in different places of the world?
In the English-speaking world, black is the color of mourning--people wear black at the funeral. Red is concerned with danger or bloodshed . Yellow is the word for fear. If you are afraid, you are yellow. Yet none of these sayings is true outside the English-speaking world. In China and Korea white is the color of mourning. In Russia, China and some other countries, red stands for beauty, life and excellence. In Italy and Germany, you are yellow with anger, not with fear.
Even within the English-speaking area, it is not difficult to find color contradictions .A redcap in the United States is a porter in a railway station. In Britain, however, a redcap is a military policeman. Both names are logical, because both men wear red caps. Similarly, the British term for an American white-collar worker is sometimes called a black-coated worker.
One does not have to cross an area to find color differences. Would you rather be red-blooded or a blue-blooded? If we go back to the origin, we find that both terms are logical as both names suggest. The expression "blueblood" comes from Spain, where some noble families proudly told the world that they had "blue blood". Actually they meant that they had no Moorish or Jewish blood. But then why "blue" blood? Because they were fair-skinned, and it is only natural that their blood vessels stood out appearing blue. [/INST] question: Yellow is concerned with anger in _ . | options: A: India B: Britain C: China D: Italy | answer: D </s> |
<s>[INST] context: Some people are pessimistic when they think about the future. They say that a hundred years from now, we will have used most of the earth's resources. We will have polluted our seas badly, and be unable to eat fish from them. We will have made the air so dirty that we will need to wear masks. The world's population will have doubled, and we will have used all the countryside for housing; there will be no farmland left.
Other people believe that Man adapts very easily. They have a different idea of the future. How, in their views, will people be living in a hundred years' time?
One architect believes that Man will move off the land. He suggests that the city of the future will be a huge, pyramid-shaped building, which will be floating on the surface of the sea. About 5,000 families will be living there, and the building will contain shops and schools as well as homes. By living on the sea, we will give the farmers more land to grow crops.
As for oil, people will no longer need it: we will be heating our homes with power from the sun. And we will not be short of minerals, because there are plenty under our oceans. At the moment, we do not have the technology to get them out. But, in a hundred years' time, the optimists say, the new sea cities will be using these resources.
What will be in the shops in the year 3000? What will people be wearing? How will people be traveling?
Scientists who make predictions about the future suggest that, by the year 3000, shops will no longer exist. Computers will have replaced them, and people will order goods from home.
People will be wearing very light, thin clothes. By this time, scientists will have invented a fabric that keeps us cool in hot weather and warm in cold weather.
As for travel, the experts say that most people will be using public transport. Electric cars will be traveling through the streets day and night. Anybody will be able to stop one and use it.
An interesting picture. Unfortunately, we will not be there to see if these predictions come true. [/INST] question: Pessimists believe that in the future _ . | options: A: the seas and oceans will be full of houses B: we'll have used up all the resources C: we will not have enough fish to eat from the seas D: we'll have polluted the air so badly that it'll be impossible for us to breathe without masks | answer: D </s> |
<s>[INST] context: Autoimmune hemolytic anemia > Thalassemia intermedia It is a close diagnosis between autoimmune hemolytic anemia and thalassemia intermedia. 1 am more in our of autoimmune hemolytic anemia. Factors which our Autoimmune hemolytic anemia Age and sex of the patient - AIHA is mare common in adult females Severity of anemia - In many cases of AMA, anemia is severe with Hb < 6 ing/d1. Factors which goes against Autoimmune hemolytic anemia Adequate response with blood transfusion only - Patients with AIHA are managed by glucocoicoid therapy not by blood transfusion. - Severe anemia in AIHA requires immediate blood transfusion but the patient will not remain asymptomatic in the absence of glucocoicoid therapy, other immunosuppressant or splenectomy is definitely needed to kees the patient asymptomatic. So adequate response to blood transfusion without any other therapy strongly ours thalassemia intermediate. Features which goes against thalassemia intermediate Severe anemia (1-lb < 5) - Patients with thalassemia intermedia presents with moderate degree of anemia (10g/dl) - Even in severe cases of thalassemia the Hb level rarely go below 7g/d1. More on t/t of Autoimmune hemolytic anemia Autoimmune hemolytic anemia .Mild . Watch . Moderate --> . Begin with glucocoicoids . If no response, splenectomy / iinmunosuppresants .Severe ---> . Either glucocoicoid or splenectomy [/INST] question: A 21 year old male presents with anemia and mild hepatosplenomegaly. His hemoglobin is 5 gni/dL history of single blood transfusion is present till date. Most probable diagnosis is : | options: A: Thalassemia major B: Thalassemia minor C: Thalassemia intermedia D: Autoimmune hemolytic anemia | answer: D </s> |
<s>[INST] context: Pyrimidine antagonists Pyrimidine analogues have varied applications as antineoplastic, antifungal and antipsoriatic agents. Cytarabine It is phosphorylated in the body to the corresponding nucleotide which inhibits DNA synthesis. The triphosphate of cytarabine is an inhibitor of DNA polymerase and blocks generation of cytidilic acid. However, it is now believed that its incorporation into DNA is more impoant for the expression of cellular toxicity. It also interferes with DNA repair. Cytarabine is cell cycle specific and acts primarily during S phase. Its main use is to induce remission in acute leukaemia in children, also in adults. Other uses are-Hodgkin&;s disease and non-Hodgkin lymphoma. Both 5-FU and cytarabine exe primary toxicity on bone marrow and g.i.t. Genetic deficiency of dihydropyrimidine dehydrogenase (DPD) predisposes to severe 5-FU toxicity. High-dose therapy (2,000-3,000 mg/m2) has been associated with severe and potentially fatal toxicities which differ from those seen with usual low doses. Ocular toxicities may include vision loss, reversible corneal toxicity (keratitis), and hemorrhagic conjunctivitis (<80%).2,3,6 Ocular toxicities have been repoed 1-2 weeks after initiating therapy.Symptoms may include tearing, eye pain, foreign body sensation, photophobia, and blurred vision. Conjunctivitis may occur with rash. Toxicity can be minimized by prophylactic use of ophthalmic coicosteroids.2Use prednisolone 0.12% - 1% or dexamethasone 0.1%, 2 drops in each eye every 4 hours, beginning before the first dose of cytarabine and continuing until 48 hours after the last one. NS may also help relieve symptoms. Neurotoxicity (8-10%) typically occurs 3-8 days after initiating therapy. Cerebellar dysfunction is characterized by difficulty with speech, trouble standing or walking, and tremors. Cerebral dysfunction may be seen concomitantly and is characterized by somnolence, confusion, personality changes, cognitive dysfunction, memory loss, psychosis, or seizures. Seizures are usually self-limited. In most patients, neurologic dysfunction resolves in 5-10 days. There is a high incidence (~60%) of recurrent cerebellar toxicity in patients who have already experienced toxicity. It is not conclusively known if cytarabine therapy should be discontinued if neurological toxicity develops. ESSENTIALS OF MEDICAL PHARMACOLOGY, bccancer.bc.ca K.D.TRIPATHI SIXTH EDITION PAGE NO:824 [/INST] question: Cerebellar toxicity is seen with: | options: A: Cisplatin B: Cytarabine C: Bleomycin D: Actionmycin D | answer: B </s> |
<s>[INST] context: * Transposons, also called jumping genes, are pieces of DNA that move readily from one site to another.* They move either within or between the DNAs of bacteria, plasmids and bacteriophages in a manner, that plasmid genes can become part of the chromosomal complement of genes.* Interestingly, when transposons transfer to a new site, it is usually a copy of the transposon that moves, while the original remains in situ (like photocopying).* Transposons can code for metabolic or drug resistance enzymes and toxins. They may also cause mutations in the gene into which they insert or alter the expression of nearby genes.* In contrast to plasmids or bacterial viruses, transposons cannot replicate independently of the recipient DNA. More than one transposon can be located in the DNA for example, resistance genes. Thus, transposons can jump from:# The host genomic DNA to a plasmid# One plasmid to another# A plasmid to genomic DNA.* An insertion sequence is a short DNA sequence that acts as a simple transposable element. Insertion sequences have two major characteristics: they are small relative to other transposable elements (generally around 700 to 2500bp in length) and only code for proteins implicated in the transposition activity (they are thus different from other transposons, which also carry accessory genes such as antibiotic resistance genes. [/INST] question: Jumping gene is known as? | options: A: Transposon B: Retroposon C: Insertion sequence D: Integron | answer: A </s> |
<s>[INST] context: Welcome to Cambridge Dictionaries Online!
Cambridge University Press publishes a range of dictionaries for learners of English all around the world. You can search our dictionaries using the search box at the top of the page. New for elementary learners
We've added two new choices to Cambridge Dictionaries Online-Essential British English and Essential American English. Both are for elementary, and lower intermediate learners of English, and are specially written to make the definitions and examples easy to understand.
They cover all of the vocabulary that elementary and lower intermediate students need to make progress, and help students to arrange their learning by showing the words that should be known at Al, A2, and B1 levels. You can look up the dictionaries from the dropdown box at the top of the page.
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Don't forget to visit our New Words, which keeps you up to date with those words and meanings that are just starting to be used in English. There's also About Words, our fascinating blog about how the English language behaves. You can give your opinion on new expressions or blog posts by voting or leaving comments, so get involved!
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Cambridge University Press [/INST] question: The new-added Cambridge Dictionaries online are probably most suitable for _ . | options: A: college students B: English teachers C: adult English learners D: middle school students | answer: D </s> |
<s>[INST] context: A little stream flowed down from a high mountain far, far away through many villages and forests, until it reached a desert. The stream then thought, "I've been through countless obstacles. I should have no problem crossing this desert!" But when she decided to start her journey, she found herself gradually disappearing into the mud and sand. After numerous tries, she found it was all in vain and was very upset. "Maybe it's my destiny ! I'm not destined to reach the vast ocean in the legend, " she murmured sadly to herself.
At this time, a deep voice came, saying, "If a breeze can cross the desert, so can a river."
It was the voice of the desert. Unconvinced, the little stream replied, "That's because a breeze can fly, but I can't."
"That's because you stick to what you are. If you're willing to give it up, and let yourself evaporate into the breeze, it can take you across, and you can reach your destination," said the desert in its deep voice.
The little stream had never heard of such a thing. "Give up what I am now and disappear into the breeze? No! No!" She could not accept this idea. After all, she had never experienced anything like it before. Wouldn't it be self-destruction to give up what she was now?
"How do I know if this is true?" asked the little stream.
"The breeze can carry the vapor across the desert and release it as rain at an appropriate site. The rain will form a river again to continue its course," answered the desert very patiently.
"Will I still be what I am now?" asked the little stream.
"Yes, and no. Whether you're a river or invisible vapor, your inner nature never changes. You stick to the fact that you're a river because you don't know your inner nature," answered the desert.
Deep down, the stream vaguely remembered that before she became a river, it was perhaps also the breeze that carried her halfway up a high mountain, where she turned into rain and fell onto the ground and became what she was now. Finally the little stream gathered her courage and rushed into the open arms of the breeze, which carried her to the next stage of her life.
Perhaps you can try asking yourself these questions: What is my inner nature? What is it that I cling to? And what is it that I really want? [/INST] question: When reaching the desert at first, the little stream was _ to cross it. | options: A: upset B: confident C: pessimistic D: hesitant | answer: B </s> |
<s>[INST] context: No one can believe that the over 6 300-kilometer long Great Wall might disappear some day.Believe it or not,the Great Wall is being destroyed by people.Less than 20 percent of the Great Wall built in the Ming Dynasty is still perfect,but about 80 percent is in danger.The Great Wall can be called "great" mostly because of its amazing length.But we should realize that the length was made up of one brick at a time.If we do nothing to save the Great Wall,it will become a series of separate wasteland rather than a historic site.
The Great Wall is actually a series of walls built and rebuilt by different dynasties over the past 2 000 years.It began in the rule of China's first emperor,Qin Shihuang of the Qin Dynasty (221 BC~206 BC),and lasted into the Ming Dynasty.The parts built before the Ming Dynasty have nearly disappeared.People are familiar with sections such as Badaling in Beijing and Jiayuguan Pass in Gansu because they have been open to tourists for many years.But those sections far away from the public eyes have been almost forgotten.
Few local people knew the 3-meter-high walls made of earth and stones beside them are part of the Great Wall.The lack of knowledge is considered as one of the main reasons behind human.
The bricks on the Great Wall are carried off by countryside people to build their houses,sheep corral and pigsties .Some were taken away to build roads.Bricks carved with people's names are put away as remembrance.Rubbish is spread over the battlements .The bricks can be sold for 15 yuan per tractor load.Those who destroyed and are destroying the Great Wall know its name,but are not clear about its cultural meaning.It will take a long time to let them know this.The local farmers not only carried off the body of the Wall but dug out the entire base.
It is necessary to protect the Great Wall.First of all,the officials should be aware of theimportance of the Great Wall.Young Chinese should know more about the nation's great civilization and learn to love it. [/INST] question: The main reason for which the Great Wall can be called"great"is _ . | options: A: it was made by brick B: it was very wide C: it was very long D: it had a long history | answer: C </s> |
<s>[INST] context: Refer robbins 8/e p406 Lead poisoning is a type of metal poisoningcaused by lead in the body. The brain is the most sensitive. Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, inability to have children, and tingling in the hands and feet. It causes almost 10% of intellectual disability of otherwise unknown cause and can result in behavioral problems. Some of the effects are permanent. In severe cases anemia, seizures, coma, or death may occur Associated conditionsEdit Thalassemia (b-thalassemia Minor (i.e Trait) & Major, and a-thalassemia, only when 3 gene loci defective: (--/-a)) Severe megaloblastic anemia Hemolytic anemia Sickle-cell anemia Pyrimidine 5' nucleotidase deficiency Alcoholism Myelodysplastic syndromes Sideroblastic anemia Congenital dyserythropoietic anemia Primary myelofibrosis Leukemia Erythroleukemia Hemorrhage, e.g. from gastrointestinal tract CPD-choline phosphotransferase deficiency Unstable hemoglobins Altered hemoglobin biosynthesis Heavy metal poisoning Lead poisoning Zinc Arsenic Silver Mercury [/INST] question: Bosophillic stippling is seen in | options: A: Cadmium Poisoning B: Lead Poisoning C: Chromium poisoning D: Iron poisoning | answer: B </s> |
<s>[INST] context: Six chimps were introduced to a slot machine called the Chimp- O- Mat, which would give out one grape when a white coin was insert into the slot. When Dr Wolf showed a young chimp named Moos how he could win himself a grape by inserting a coin, Moos immediately picked up another coin, pushed it into the slot, then stuck out his paw and waited for a grape to drop out..
Besides white coins, the chimps were given yellow coins to insert into the slot, but nothing came out because they were worthless. The chimps soon learned this fact. When a handful of white and yellow coins were thrown into the cage housing, Bula, Bimba and Alpha, the three chimps rushed for the white coins and never touched the yellow ones.
Now the chimps were madly in love with money. Would the six chimps value money enough to work for it? To find the answer, Dr Wolfe designed a work machine. The chimps were shown that when a large handle was lifted, they could pick one grape. When they had learned the skill of lifting the handle to get the grape, Dr Wolf made a change to the machines so that instead of the grape they would find a white coin. This coin would still buy them one grape at the Chimp- O- Mat.
Thus the complexity of getting a grape was not only doubled, but also the money to buy the grape could be achieved only by honest work. The handle they had to lift to get the coin weighed eighty pounds. Great effort is needed for a young chimp to raise that weight, yet the formerly lazy chimps not only quickly mastered the new operation, but also showed great eagerness to work for money. [/INST] question: The purpose of the Chimp- O- Mat experiment was to discover whether chimps would learn to _ . | options: A: enjoy themselves B: work together C: use coins D: operate a machine | answer: C </s> |
<s>[INST] context: Anti-endomysial antibody The clinical features are suggestive of celiac sprue0. The typical symptoms of celiac sprue are weight loss, chronic diarrhoea, abdominal distension, growth retardation anemia. Raised liver enzymes is not mentioned in many text books including Harrison. But according to C.M.D.T. 'Mild elevation of aminotransferases are seen in upto 40% of patientsdeg " Impoant points about the diagnosis of celiac sprue Small intestinal biopsy in celiac sprue demonstrates characteristic features but it is not specific for the diagnosis of celiac sprue. It can be seen in tropical sprue also. Serological tests helpful in the diagnosis of celiac sprue are - Anti endomysial antibody (Anti EMA) - Anti tissue (t) transglutaminase antibody Anti (t) TGA A negative test excludes the diagnosis of celiac sprueQ The diagnosis of celiac sprue still rests upon - Clinical demonstration of malabsotptioni2 - Demonstration of intestinal lesion by small bowel biopsyo - Unequivocal improvement in both symptoms and mensal histology on gluten with drawl from the diets'. Antimitochondrial antibody Antimitochondrial antibody testing is done for primary biliary cirrhosis. The points against the diagnosis of primary biliary cirrhosis. - It typically presents in middle aged females. - initial clinical manifestations of the disease are - Pruritus -Fatigue - Characteristic elevation of alkaline phosphatase Antismooth muscle antibody Antismooth muscle antibody testing is done for autoiminune hepatitis Antoimmune hepatitis is common in young women. The usual presentation is an acute attack of hepatitis. [/INST] question: 30 year male with chronic diarrhoea, anemia, raised liver enzymes. Most likely associated with | options: A: Antimitochondrial antibody B: Anti-endomysial antibody C: Anti-smooth muscle antibody D: Antinuclear antibody | answer: B </s> |
<s>[INST] context: Studying abroad will shape you in various ways. You will learn things you never would have if you had stayed home. When you are young and unattached, you should travel. Besides, you just might save a large sum of money. College is expensive in the United States. It's cheap or free in other countries even for foreigners, so why not get out of here and come back smarter?
More and more American students are currently studying at German colleges. That number has increased 20% over the last three years. Living costs are about $7,000 a year, which is even lower than in other European countries. Germany encourages international students. They create a multicultural landscape that benefits German students as well. According to a new report, Germany is home to six of the world's 100 best universities. These schools offer around 900 degrees completely in English and many German students speak the language.
You could be part of Finland's excellent education system. The Finns charge no tuition and offer a number of courses purely in English. They would be happy for you to add flavor to their school scene. Cost of living there is high. Be prepared for frosty winters that far north, but you will get that sweet midnight sun in the summer.
Many other European nations offer cheap or free college for foreign students, but if South America is more your thing, try Brazil. Most of the education will take place in Portuguese, so if that is in your plan you can study near beautiful beaches and jungles. The University of Sao Paulo and State University of Campinas are both highly ranked internationally. Your money will go a long way there, too.
Many of the lessons you will learn will be outside the classroom. Living on the economy in a foreign country will keep you on your toes. You will learn new customs, how to bargain, stay safe, budget and become more flexible with people. There is no better way to learn a language than by immersing yourself in it. At first, it will be the toughest thing you have ever done. Eventually, it will become second nature. [/INST] question: German universities are popular among US students mainly because _ . | options: A: they offer a multicultural landscape B: they belong to the world's best ones C: the cost of living there is reasonable D: the students can get their degrees easily | answer: A </s> |
<s>[INST] context: Introduction
Blenheim Palace is one of the Europe's largest and greatest palaces. It was built between 1705 and 1722 as a reward of the British government to John Churchill, 1stDuke of Marlborough, for defeating King Louis XIV's army at Blenheim, a small Bavarian village on the Danube River.
The palace was designed by Sir John Vanbrugh, which displayed strength and arm glory. It is the largest non-royal building in England and is now listed by the UNESCO as a World Heritage Site.
Winston Churchill
In 1874, the palace was the birthplace of the duke's most famous _ . Winston Churchill, who was to become the UK's Prime Minister (some would say Britain's greatest 20th-century politician ) and Nobel prize winner for literature. It is also in Blenheim that Winston got married to Clementine Hozier in 1908.
A lasting exhibition is devoted to the man's life, work and writings. Winston and his wife are buried in Bladon Church within the palace.
Opening Hours & Admission
Blenheim is still the home of the 11th Duke of Marlborough and is therefore not open all year round (although the park is). The palace opens its doors to visitors from 12 February to 11 December. Entry to the palace, park and gardens cost PS11.50 during the low season and PS13 during the peak season (Easter weekend and from 28 May to 11 September), or PS6/PS8 for the park and gardens only.
The park is open all-year round from 9am to 4:45pm (last entry). Admission is PS2.50 for adults and PS1.50 for children.
Note that numerous discounts exist for seniors, students, children and groups. Please refer to the official website for more details. [/INST] question: What can be learned, about Blenheim Palace? | options: A: It is the Europe's largest and greatest palaces B: It is the largest royal building in England C: It is now one of the world's heritage sites D: It was built in honor of Prime Minister Winston Churchill | answer: C </s> |
<s>[INST] context: In this age of media technology where the Internet is playing a more and more important role in our lives,how do you usually get information? For many students and office workers,their first Interact stop is the search engine Google:For any information they want,they's imply type in a keyword, click "enter",and within seconds relevant web pages appear out.
So are people still reading books? The answer is surely yes.It's simply not realistic to use acomputer to read a novel But reading habits in China,and other countries,are changing.Mr Li,a businessman,says his purpose in reading is to get practical knowledge."I like stories of successful people and books that give advice on how people become successful.Besides,I read books with basic knowledge,"said Li.
"I like funny books,especially Japanese funny books,"said Xing Mingyan,a junior student,who reads purely for entertainment.
"I like to read cook books,"said Miss Zhang,an office worker,who usually reads magazines.
"And I usually buy fashion magazines."
It seems that the purposes of reading have changed a lot.People don't tend to read for entertainment as much.They usually read to learn.Books that teach people how to be more successful,wealthier or more beautiful stay on the best--seller charts for a long time.People are also interested in buying funny books and magazines.Just remember how the funny novels of Jimmy Liao took China and other countries by storm.
But educators say reading is important to teach people and also to develop their imaginations and language skills.No matter what you like to read,why not turn off the computer and television and read a good book,make yourself comfortable and open the door to another world? [/INST] question: Which of the following is Tree? | options: A: Educators say reading is useful in improving people's language skills B: Xing Mingyan,a senior student,especially likes Japanese funny books C: Jimmy Liao's serious stories made him well-known in China and other countries D: Miss Zhang likes reading funny magazines and fashion magazines | answer: A </s> |
<s>[INST] context: . A total thyroidectomy with bilateral neck dissection is the gold standard for treating medullary thyroid cancer, and is the most definitive means of achieving a cure in patients without distant metastases or extensive nodal involvement. Due to the extreme level of difficulty in successfully performing the neck dissection without extensive morbidity, it is very impoant for patients to seek care under an experienced surgeon at a Center of Excellence who operates on MTC patients at least several times a year. Risks of surgery include loss of vocal control, irreparable nerve damage, death or the need for second operation to clean out residual diseased lymph nodes left behind if the sentinel node biopsy was positive for cancerous spread. Extensive surgery can be effective when the condition is detected early, but a risk for recurrence remains, paicularly in patients with multiple positive lymph nodes or extracapsular invasion. About half of patients have metastasis to regional lymph nodes at the time of diagnosis. [/INST] question: Treatment of Medullary Carcinoma thyroid | options: A: Surgery and radiotherapy B: Radiotherapy and chemotherapy C: Surgery only D: Radioiodine ablation | answer: C </s> |
<s>[INST] context: Have you ever noticed the colour of the water in a river or stream after a heavy rainfall? What do you think caused this change in colour? It is soil that has been washed into the river from the riverbank or from the nearby fields.
Components of Soil
Soil is made up of a number of layers, each having its own distinctive colour and texture. The upper layer is known as the litter. It acts like a blanket,limiting temperature changes and reducing water loss. The topsoil layer is made up of small particles of rock mixed with rotten plant and animal matter called humus , which is black and gives the topsoil its dark colour. This layer is usually rich in nutrients, oxygen, and water. Below the topsoil is the subsoil, a layer that contains more stones mixed with only small amounts of organic matter. This layer is lighter in colour because of the lack of humus. Beneath the soil lies a layer of bedrock.
Soil forms from the bottom up. Over time bedrock is attacked by rain, wind, frost, and snow. It is gradually broken down into smaller particles in a process called weathering. Plants begin to grow,and rotten materials enrich the topsoil. Most of the soil in Eastern Canada ,for example ,was formed from weathered rock that was exposed when the ice disappeared 12,000 years ago.
Water Beneath the Soil
Surface water collects and flows above the ground in lakes ,ponds, and rivers. Once in the soil or rock, it is called groundwater. Gravity pulls groundwater through the soil in a process called percolation . Eventually the water reaches a layer called the water table. Under this is bedrock through which water cannot percolate.
As water percolates downward, it _ organic matter and minerals from the soil and carries them to deeper layers.This causes a serious problem because plants require these nutrients for growth.
Soil pH
Soil can be acidic, neutral, or basic. The pH of the soil is determined by the nature of the rock from which it was formed,and by the nature of the plants that grow and rot in it.
The acidity of rain and snow can lower the pH of the groundwater that enters the soil. By burning fossil fuels such as coal ,oil and gasoline,humans have been contributing to higher levels of acidity in many soils. When fossil fuels are burned,gases are released into the air and then fall back to earth as acid rain. Acid soil increases the problem of carrying nutrients to lower soil levels. As nutrients are removed,soil is less fertile. Plants grow more slowly in acidic soil,and also become easily attacked by diseases. [/INST] question: The layer of soil that provides necessary nutrients for plant growth is called _ . | options: A: litter B: subsoil C: humus D: topsoil | answer: D </s> |
<s>[INST] context: Gastric ulcers have been classified as type I (incisura or most inferior portion of lesser curvature), type II (gastric and duodenal), type III (pyloric and prepyloric), and type IV (juxtacortical). Indications for surgery are intractability, perforation, obstruction, and bleeding. A patient with an intractable type I ulcer can be treated with an antrectomy alone or with a proximal gastric vagotomy. If done properly, antrectomy offers slightly lower recurrence rates and a higher incidence of postoperative sequelae as compared with proximal gastric vagotomy. However, significant scarring along the lesser curvature makes a proximal gastric vagotomy technically unfeasible.Gastric outlet obstruction and severe inflammation around the pylorus and duodenum make resection a difficult and dangerous option. Similarly, pyloroplasty is often not adequate in the setting of gastric outlet obstruction to provide adequate drainage. Vagotomy and gastrojejunostomy, although associated with the highest recurrence rate, offers the best choice in the described setting.In an elderly patient with a bleeding duodenal ulcer, recurrence rates are less of a consideration and thus the simplest and most expedient operation offers the best surgical outcome. Vagotomy and pyloroplasty with oversewing of the ulcer is the best choice in this setting. Finally, in a young patient with intractable type III ulcers, antrectomy with vagotomy offers the best long-term outcome. Recurrence rates following this procedure are about 2-3%, as compared with 7.4% for vagotomy and drainage and 10-31% in patients receiving a proximal gastric vagotomy only. [/INST] question: A 72-year-old patient with an intractable type I ulcer along the incisura with a significant amount of scarring along the entire length of the lesser curvature. Select the appropriate surgical procedure for the patient. (SELECT 1 PROCEDURE) | options: A: Vagotomy and antrectomy B: Antrectomy alone C: Vagotomy and pyloroplasty D: Vagotomy and gastrojejunostomy | answer: B </s> |
<s>[INST] context: Rosettes
Rosettes are pathological findings characterized by a halo or spoke wheel arrangement of cells surrounding a central core or hub.
Type of Rosette
1. Flexner - Wintersteiner Rosettes
A halo of cells surrounds a largely empty central hub but small cytoplasmic extension from cells project into the lumen.
It is characteristic of retinoblastoma.
May also be seen in → Medulloblastoma, Primitive neuroectodermal tumor, Pineoblastoma.
2. Homer Wright rosettes
A halo of cells surrounds a central hub that contains a meshwork of fibres (neutrophil rich centre).
Homer-Wright rosettes are characteristic of neuroblastomas and medulloblastomas.
May also be seen in → Primitive neuroectodermal tumors (PNET), Pineoblastomas, Retinoblastomas.
3. True ependymal Rosette
A halo of cells surrounds an empty lumen.
It is characteristic of ependymomas.
4. Perivascular pseudorosettes
A halo of cells surrounds a blood vessel.
The term pseudo is used because the central structure is not formed from the tumor itself, and represents a nonneoplastic element.
May be seen in
Ependymonas
Glioblastomas
Medulloblastomas
Retinoblastoma
Primitive neuroectodermal tumors
Monimorphous pilimyxoid astrocytoma
Central neurocytoma [/INST] question: Homer wright rossette are seen in-a) Neuroblastomab) Astrocytomac) Meningiomad) Pinealoma | options: A: ad B: c C: ac D: ab | answer: A </s> |
<s>[INST] context: Many children would start school hungry without breakfast clubs, teachers have claimed. A new survey suggests these clubs are the only way many students can get a meal before lessons.
About 54% of the 552 school staff questioned by the Association of Teachers and Lecturers(ATL)said their school provides a breakfast club for pupils. The biggest reason for them to attend these clubs is that their parents or carer goes to work early, cited by 76.8% of those questioned.
About 22.6% said children attended due to lack of money at home because parents or carers are unemployed and 15.2% said lack of money at home due to changes or cuts to benefits.
About 17.6% said pupils mainly attend breakfast clubs to socialize.
The survey found that teachers believe that offering breakfast to pupils often helps improve their concentration and ability to learn. One primary school teacher said: "Although there is a charge for our breakfast club, we have accessed funding for those pupils on free school meals and the breakfast club had an effect on their attendance, concentration and being in school for the start of lessons.
ATL general secretary Dr Roper said a nutritious meal at the start of the day has a huge impact on pupils' ability to learn. "Many schools do everything they can to ensure children eat well during school term-time. But there are many children living in poverty, who we fear won't be getting a decent meal a day in the holidays and this is something the government needs to address," she said.
A Department for Education spokesman said: "We know how important it is for children to
have a good breakfast. We want schools and local authorities to use their budgets to best meet the needs of their children. Many provide breakfast clubs which offer a free meal to children from poorer families. The Pupil Premium, which will double to PS 2.5 billion in 2014-2015, targets extra money to help schools to provide support such as this to the most disadvantaged children. The free school meal scheme also ensures that these children have access to a nutritious lunch every day. [/INST] question: How many factors are mentioned which can account for the popularity of breakfast clubs? | options: A: Two B: Three C: Four D: Five | answer: B </s> |
<s>[INST] context: Blood bag along with laboratory cultures, specimens of micro-organisms and live and attenuated vaccine are dicarded in YELLOW bag. Blood bags are Pre-treated to sterilize with non-chlorinated chemicals on-site as per National AIDS Control Organisation or World Health Organisation guidelines Microbiology, biotechnology and other clinical laboratory waste:Blood bags. Laboratory cultures, stocks or specimens of micro-organisms, live or attenuated vaccines. Cat. Type of Bag/ container used Type of waste Treatment/ Disposal options Yellow Non-chlorinated plastic bags Separate collection system leading to effluent treatment system a)Human Anatomical Waste b)Animal Anatomical Waste c)Solid Waste d)Expired or Discarded Medicines e)Chemical Waste f)Micro, Bio-t and other clinical lab waste g)Chemical Liquid waste Incineration or Plasma pyrolysis or deep burial* Red Non-chlorinated plastic bags or containers Contaminated Waste (Recyclable)tubing, bottles, intravenous tubes and sets, catheters, urine bags, syringes (without needles and gloves) Autoclaving, microwaving/ Hydroclaving and then sent for recycling not be sent to landfill White (Translucent) Puncture, Leak, tamper proof containers Waste sharps including Metals Auto or Dry Heat Sterilization followed by shredding or mutiation or encapsulation Blue Cardboard boxes with blue colored marking Glassware Disinfection or autoclaving, microwaving, hydroclaving and then sent for recycling [/INST] question: Blood bag is discarded in: | options: A: Red bag B: White bag C: Blue bag D: Yellow bag | answer: D </s> |
<s>[INST] context: Our planet is home to about seven billion people. Since the 1990s, population experts have predicted the number would grow to nine billion before it begins to slow down and possibly decrease.
But a new report predicts the world's population is likely to increase to almost 11 billion by 2100. Based on the most modern statistical tools, the new report makes use of government records and considers expert predictions, including death rates, birthrates and international migration, or people moving across borders. The report says during the rest of this century, Africa's population will grow from about 3.5 billion to 5.1 billion over the next 85 years
John is director of the United Nations Population Division. He says that in the past, researchers thought population growth in Africa would be similar to that of other areas. They expected slower growth rates as birth control use became more widespread. But he says those ideas were wrong.
"The level of contraception use has continued to increase but slowly -- more slowly than expected, and birthrate therefore has been falling less rapidly than expected, and the population therefore continues to grow somewhat more rapidly than we expected.The new findings are based on a joint research project of the United Nations and the University of Washington.
The researchers believe the population of Asia will reach five billion by 2050. That is up from the current 4.4 billion. And then begin to decline. The researchers also believe that North America, Europe, Latin America and the Caribbean area will have a total population of below one billion.
John says the pressure of feeding the rising population is likely to be less than that might be expected.
"The relatively good news is that the world has been winning the race between population growth and food production. If you look back historically over the last 50 years, certainly for the world as a whole and for many, most individual countries and regions, the increase in food production has outpaced the increase of population.||" [/INST] question: Which area will experience the largest increase in population at the end of the century? | options: A: Asia B: Africa C: Europe D: North America | answer: B </s> |
<s>[INST] context: paneth cellThe small intestine contains large finger-like projections (villi). A one-cell thick epithelium overlies each villus. The epithelium regenerates itself thorughout life, and serves not only as the initial site for processing nutrients absorbed from the lumen, but also acts as a barrier to prevent microbes in the lumen from crossing into the body. The base of intestinal villi extends into the crypts of Lieberkiihn . Within the crypts multipotent crypt stern cells divide through life, giving rise to the epithelial lineages. Cells differentiate as they leave the crypt for the villus surface. Migration continues until cells are lost from the tip of a villus into the intestinal lumen. The exceptions are the intestinal Paneth cells which instead of migrating towards the tip migrates towards the base. It reside at the base of the crypts.Paneth cells are specialised secretory cells. They foify the small intestine's defenses against bacteria by secreting lysozyme, an antibacterial enzyme. [/INST] question: Cell which does not migrate from the base of the crypt to ends of villi is | options: A: enterocyte B: endocrine cell C: paneth cell D: goblet cell | answer: C </s> |
<s>[INST] context: Laboratory Tests FSH (Follicle Stimulating Hormone), will be normal or low with PCOS LH (Lutenizing Hormone), will be elevated LH/FSH ratio. This ratio is normally about 1:1 in mensturating women, but with PCOS a ratio of greater than 2:1 or 3:1 may be considered diagnostic Testosterone, total and/or free, usually elevated DHEAS (may be done to rule out a virilizing adrenal tumor in women with rapidly advancing hirsutism), frequently mildly elevated with PCOS Estrogens, may be normal or elevated, reversal of E1:E2 ratio Sex hormone binding globulin, may be reduced Androstenedione, may be elevated Lipid profile (low HDL, high LDL, and cholesterol, elevated triglycerides) Glucose, fasting and/or a glucose tolerance test, may be elevated Insulin, often elevated Fasting Glucose: fasting insulin ratio < 4.5 Non-Laboratory Tests With PCOS, the ovaries may be 1.5 to 3 times larger than normal and characteristically have more than 12 follicles per ovary, with each follicle less than 10 mm (2-9 mm) in diameter. Ovarian volume is usually > 10 cc. Often the cysts are lined just under the surface the ovaries, forming the appearance of a "pearl necklace." These ultrasound findings are not diagnostic as they are present in more than 90% of women with PCOS, but they are also found in up to 15-25% of women without PCOS. Hyperinsulinemia can present as a cluster syndrome called metabolic syndrome or dysmetabolic syndrome X. This is a risk factor for cardiovascular disease The presence of three of the following five criteria confirm the diagnosis of metabolic syndrome, and an insulin lowering agent and/or other interventions may be warranted Metabolic Syndrome Diagnostic Criteria Female waist >35 inches Triglycerides >150 mg/dL HDL <50 mg/dL Blood pressure >130/85 mmHg Fasting glucose: 110-126 mg/dL Two-hour glucose (75 gm OGTT): 140-199 mg/dL [/INST] question: The following hormone is raised in polycystic ovarian syndrome: | options: A: 17-OH progesterone B: Follicular stimulating hormone C: Luteinizing hormone D: Thyroid stimulating hormone | answer: C </s> |
<s>[INST] context: In Subarachnoid Hemorrhage-BNP | -Natriuresis-Salt loss, | H2O-Hypovolemic Hyponatremic. The degree to which hyponatremia might occur primarily as a result of primary natriuresis is controversial. Cerebral salt wastingsyndrome (CSWS) was proposed by Peters and associates in 1950 as an explanation for the natriuresis and hyponatremiathat sometimes accompanies intracranial disease, paicularly subarachnoid hemorrhage in which up to one-third of patients oftendevelop hyponatremia. A recent study of 100 consecutive adult patients with acute nontraumatic aneurysmal subarachnoid hemorrhage found that thecause of the hyponatremia was attributable to SIAD in 71.4% and acute glucocoicoid deficiency in 8.2%, with the remaining cases caused by incorrect intravenous fluid administration or hypovolemia. Most significantly, no cases were found that methistorically accepted criteria for a diagnosis of CSWS. This suggests that CSWS is an exceedingly rare cause of the hyponatremiawith intracranial disorders. [/INST] question: Which of the following is found in patients with cerebral salt wasting syndrome? | options: A: Elevated serum coisol B: Hypernatremia C: Hypovolemia D: Low urine sodium excretion | answer: C </s> |
<s>[INST] context: " In women with hereditary breast - ovarian cancer, two susceptibility loci have been identified:
BRCA -1 → located on chromosome 17 and
BRCA - 2 → located on chromosome 13
"About 25% of familial cancers (or around 3% of all breast cancer) can be attributed to two highly penetrant autosomal dominant genes BRCA1 and BRCA2"
Coming to the question
This woman is suffering from familial breast carcinoma as (family history positive for ovarian cancer)
The most common gene associated with familial breast cancer is BRCA-1 (52%) followed by BRCA-2 (32% of all familial cancers).
BRAC-1 and BRAC-2 are associated with ovarian cancer, so a family history of ovarian carcinoma may be positive.
Remember
The most common gene involved in famiilial breast cancer → BRCA-1
The most common gene involved in sporadic breast cancer → p53
Most common gene involved overall (Hereditary plus sporadic) → p53
The maximum increase in susceptibility to breast cancer is seen with → p53 mutation (>90%) whether it is sporadic or Hereditary. [/INST] question: A female patient presented with a firm mass of 2 x 2 ems in the upper outer quadrant of the breast. She gives a family history of ovarian carcinoma. The investigation that needs to be done to assess for mutation is - | options: A: p53 B: BRCA-2 C: Her 2/Neu gene D: C-myc gene | answer: B </s> |
<s>[INST] context: The mainstay of treatment for LUTS due to BPH is a1-adrenergic receptor blockers.a-adrenergic receptors are the most common adrenergic receptors in the bladder, and a1 is the most common subtype in the lower urinary system, prostate, and urethra. The action of a1 blockers is to relax the smooth muscle in the bladder neck and prostate and to reduce outflow resistance. (Prazosin)This class of drugs has become progressively more selective to the a1 subtypes, and many now target the a1asubtype receptor specifically. (Tamsulosin, Alfuzosin)The most common side effects of these drugs are dizziness related to ohostasis, retrograde ejaculation, and rhinitis.The second category of pharmacologic therapy is the 5a-reductase inhibitors that target the glandular component of the prostate. These drugs block the conversion of testosterone to dihydrotestosterone in the prostate and subsequently reduce the prostate volume, thereby reducing outflow resistance. (Finasteride, Dutasteride)Sabiston 20e pg: 2108 [/INST] question: Tamsulosin belongs to | options: A: 5a-reductase inhibitors B: a1a receptor blockers C: a1a receptor agonist D: 5a-transferase inhibitors | answer: B </s> |
<s>[INST] context: Once Dr. Mellinkoff invited me to join him at the hospital to discuss interesting cases(, ) with his students.The case at hand was a Guatemalan man, aged 34, who had a fever and many other medical problems.His condition was not improving, and there was not much hope he would live.
Dr.: Mellinkoff asked to see the patient.He introduced himself in Spanish and, in a very gentle voice, asked how he felt.The patient smiled and said everything was all right.Then the doctor asked if he was able to eat.The patient said that he had no desire to eat.
"Are you getting food you like?"
The patient said nothing.
"Do you get the kind of food you have at home?"
The answer was no.
The doctor put his hand on the man's shoulder and his voice was very soft.
"If you had food that you liked, would you eat it?"
"Yes, yes," the patient said.
The change in the patient's appearance couldn't have been more obvious.Nothing was said, but it was easy to tell that a message had been sent and had also been received.
Later, the doctor asked why the Guatemalan man wasn't getting food he could eat.One of the students said, "We all know how difficult it is to get the kitchen to make special meals."
"Suppose," the doctor replied, "you felt a certain medicine was absolutely necessary but that our hospital didn't carry it, would you accept defeat or would you insist the hospital meet your request?"
"I would probably insist," the student said.
"Very well," the doctor said."You might want to try the same method in the kitchen.It won't be-easy, but I can help you.Meanwhile, let's get some food inside this man as fast as possible, and stay with it.Or he'll be killed by hunger.By the way, there must be someone among you who can speak Spanish.If we want to make real progress, we need to be able to talk with him."
Three weeks later.Doctor Mellinkoff told me that the Guatemalan man had left the hospital under his own power.It takes more than medicine to help sick people; you also have to talk to them and make them comfortable. [/INST] question: The patient had no desire to eat because _ . | options: A: he was not hungry B: he was seriously ill C: he was given special meals D: he was not satisfied with the food | answer: D </s> |
<s>[INST] context: The Lego Group had a very low beginning in the workshop of Ole Kirk Christiansen,a carpenter from Denmark.Christiansen began creating wooden toys in 1932.Two years later, he came upon the Lego name by putting together the first two letters of the Danish words Leg and Godt,which mean "play well."The name could be interpreted as "I put together" in Latin;it is also similar to the Greek verb meaning "gather" or "pick up".
In 1947,the company enlarged to making plastic toys.At first,the use of plastic for toy production was not highly regarded by salesmen and consumers of the time.Many of the Lego Group's shipments were returned,following poor sales.However, Christiansen's son,Godtfred Kirk Christiansen,saw the great potential in Lego bricks to become a system for creative play-As the junior managing director of the Lego Group,he spent years trying to improve the "locking" ability of the bricks and made the bricks more versatile .In 1958, the modem interlocking brick design was finally developed and patented .
Today Lego is sold in more than 1 30 countries.Every minute 33,824 Lego bricks are made,and kids around the world spend 5 billion hours a year playing with Lego.There will be more than 400 million people playing with Lego bricks this year.On average,every person in the world owns 62 Lego bricks,and about seven Lego sets are sold every second.
This year Lego fans all over the world are celebrating the 50th anniversary of the tiny building blocks.Though already 50 years old,Lego is still the same product it was in the 1950s.
Bricks bought then are still compatible with present bricks and that is probably the reason the toy has never fallen out of favor. [/INST] question: Which of the following is true about the name Lego? | options: A: It is a combination of Greek and Latin words B: It was created by Ole Kirk Christiansen's son C: It was created in 1947 for naming the plastic toys D: It came from Danish words meaning "play" and "well | answer: D </s> |
<s>[INST] context: Six Americans are working on a new highway. But this highway won't have any traffic.It's an "ice highway" to the South Pole.
The team has just finished a second year of work on the 1,020-mile highway. "The road is the greatest single footprint of activity we've seen in the Antarctic ," said Alan Hemmings, an Australian environmentalist.
The highway will provide a new way for supplies to be trekked (, ) across the earth on tractor-pulled sleds . This method will use a lot less fuel than an aircraft, the current way that scientists and supplies reach the Amundsen-Scott Base, a U.S. research station in the South Pole. The highway will also allow for equipment that is too big for planes to carry to be brought to Antarctica.Even with these benefits, there is one disadvantage--a round trip on the road will be 30 days, compared to a few hours by plane.
Making this 20-foot-wide road isn't easy, and it takes a lot of time. The crew has been working on the road for two summers, when it's warmer and easier to work with the ice. It probably won't be completed until 2006.
Crevasses , or cracks, in the land often make the construction difficult. Crevasses are kind of like pot holes that form when surface ice is stretched.This can be very dangerous, especially when the crevasses are hidden under a layer of snow and can't be seen.
"Last year it took us three months to go three miles across a crevasse field, full of dangerous, hidden crevasses," said the project's manager, John Wright. Each year, more crevasses appear and they have to be filled with snow and ice so the road is safe for travel. The road will also be lined with green flags so travelers know where the safe surface is. [/INST] question: It will probably take _ years to complete the ice highway. | options: A: 2 B: 4 C: 6 D: 8 | answer: B </s> |
<s>[INST] context: We know that Ringer's lactate is the preferred agent during initial 24 hrs.
Nasogastric intubation is done to decrease the risk of emesis and possible aspiration (as parlytic ileus develops in a pt. with significant burn)
Dextran is a colloid and can be used in 2nd 24 hrs., however albumin is the preferred and most widely used colloid.
Blood has also role in burn patient.
The need for Blood replacement is significant in extensive burns. Besides injury to red blood cells and their decreased half-life resulting in their early destruction, many patients may be anaemic. Hence, repeated and frequent transmission to maintain a hematocrit around 35% is necessary.
Schwartz 9/e p201 writes- "The role of blood transfusion in burns has undergone a re-evaluation in recent years. A large multicenter study found that increased numbers of transfusions were associated with
increased infections and a higher mortality rate in burn patients, even when correcting for burn severity. A follow-up study implanting a restrictive transfusion policy in burned children showed that a hemoglobin threshold of 7 g/dL had no more adverse outcomes versus a traditional transfusion trigger of 10 g/dL.
These data, in concert with other reported complications such as transfusion-related lung injury, have led to recommendations that blood transfusions be used only when there is an apparent physiologic need." [/INST] question: In excessive burns, least useful is - | options: A: Blood B: Dextran C: Ringer lactate D: Nasogastric intubation | answer: A </s> |
<s>[INST] context: Here is some information about several famous local bakeries in Indiana, the US. They serve as a social gathering place for locals.
Maple Lane Bakery
At 8260 S. State Rd. Claypool, IN. (574) 566-2917, it offers a variety of cooked pies, cookies, and bread. With 20 years' experience Maple Lane Bakery has specialized in the making of pies. The menu includes peach pie $7.19, berry pie $ 7.70, apple pie $7.19 and banana pie $6.99. Feel free to place an order at least 24 hours in advance.
Betty's cakes & Candy Shop
At 816 E. Winona Avenue Warsaw, IN. (574) 269-1231, it specializes in cakes and offers cookies and candies. The chocolate cookies are sold at $ 8.99 a dozen. Betty's cakes & Candy Shop, started half a century ago, specializes in wedding cakes and birthday cakes. Buying a cake from Betty's will not disappoint you as they are always excellent.
Crepes' Quality Bakery
At 217S. Cavin Street Ligonier, IN.(260) 894-3024, this third generation bakery is located downtown Ligonier. It offers cookies and cupcakes, and specializes in rolls and bread. If you plan to buy cookies for the office or work area, you had better get there early as the building workers arrive just before 5:00 am waiting for the doors to open.
Olympia Candy Kitchen
At 136N. Main Street Goshen, IN. (574) 533-5040, it has been welcoming visitors for almost a century in its unchanged location in downtown Goshen, Indiana. Its tradition began in 1912 when Greek Nicholas began making his own chocolates. Today this family-owned operation offers all kinds of candies and boxed candies. If you need an order, you should call ahead of time to see if they can meet your request. [/INST] question: Which of the following pies is the most expensive? | options: A: Berry pie B: Banana pie C: Apple pie D: Peach pie | answer: A </s> |
<s>[INST] context: It seems that everywhere around the world, people are spending more time at work and less time with their families and friends.People are busier than ever before.
In the past in many countries,the father worked and the mother stayed at home, took care of the children, and did the food shopping,cooking,and cleaning.At present in most of the families,parents need to work on weekends,so they both have to do the shopping,cooking,and cleaning in their free time.Parents don't have much time with their children,however,they often had time in the past.There are also many single parent families.In these families,the single parent has to do everything.
These days,many children come home from school to an empty apartment or house.A lot of children spend many hours each day in front of the television.Even when families are together,it is common for family members to do things by themselves.For example,they watch programs on their own TVs in different rooms,they use the Internet,they talk with friends on the telephone,and they do other things by themselves.
Isn't it strange?Thanks to technology,people are able to communicate so easily with people far away,but sometimes they don't communicate with people in their own homes. [/INST] question: Everywhere around the world people are _ than the past. | options: A: happier B: lazier C: busier D: healthier | answer: B </s> |
<s>[INST] context: ANS. BClassification of diarrhea based on severity in children and management.SignsClassify asIdentify treatment(Urgent pre-referral treatment are in bold print)Two of the following signs:* Lethargic or unconscious* Sunken eyes* Not able to drink or drinking poorly* Skin pinch goes back very slowlySevere dehydration* If child has no other severe classificationGive fluid of severe dehydration (Plan C)ORIf child also has another severe classificationRefer urgently to hospital with mother giving frequent sips of ORS on the way. Advise the mother to continue breastfeeding* If child is 2 years or older, and there is cholera in your area, give antibiotic for cholera.Two of the following signs:* Restless, irritable* Sunken eyes* Drinks eagerly, thirsty* Skin pinch goes back slowly.Some dehydration* Give fluid, zinc supplements and food for some dehydration (Plan B)* If child also has a severe classification:Refer urgently to hospital with mother giving frequent sips of ORS on the way. Advise the mother to continue breastfeeding* Advise mother when to return immediately* Follow-up in 5 days if not improving* If confirmed/symptomatic HIV, follow-up in 2 days if not improving* Not enough signs to classify as some or severe dehydrationNo dehydration* Give fluid, zinc supplements and food to treat diarrhea at home (Plan A)* Advise mother when to return immediately* Follow-up in 5 days if not improving* If confirmed/symptomatic HIV, follow-up in 2 days if not improving [/INST] question: You and your friend goes for a picnic to a hilly area. He has 5 to 6 episodes of loose stools. There is no fever, tachycardia or no other signs of dehydration. What should you do next? | options: A: Start a course of oral ofloxacin and onidazole B: Give ORS solution with water C: Take him to a nearby hospital D: Start intravenous (IV) fluids | answer: B </s> |
<s>[INST] context: It's become part of the restaurant table setting: knife, fork, napkin and cell phone.
Distracted dining is the new concern with customers constantly texting friends, uploading a Weibo photo of the meal they're about to chew down or emailing the boss. For many smart-phone users, it's hard just to focus on the meal and company at hand.
Now, one restaurant in Los Angeles is giving diners a reason to turn off the digital world, by offering customers willing to check their phones at the door a 5-percent discount on their bill. Owner and chef Mark Gold of Eva Restaurant, located on Beverly Boulevard near N. Gardner Street, hopes this gives customers a way to truly sit back and relax, enjoy their meal and actually talk with friends and family in person.
"For us, it's really not about people disturbing other guests. Eva is home, and we want to create that environment of home, and we want people to connect again," he explained. "It's about two people sitting together and just connecting, without the distraction of a phone, and we're trying to create an atmosphere where you come in and really enjoy the experience and the food and the company."
Gold said applying the suggestion reminds him to avoid cell phone usage, too. "I'm guilty of it as well. When my wife and I go to dinner it seems like the cell phone is part of the table setting now. Every table you look at, it's a wine glass, the silverware and the cell phone," he joked.
The husband and wife team runs Eva, a 40-person space with European flair. Gold said a little less than half take advantage of the deal, and no one has gotten upset about it.
"I think once the server approaches the table and they're presented with the offer, they like the idea of actually talking to each other again," he said. [/INST] question: When having meal in Eva Restaurant, we are not offered _ on the table.[, | options: A: forks B: cellphones C: napkins D: knives | answer: B </s> |
<s>[INST] context: Freda Bright says, _ ." It's true.You really can't love somebody to death.I've known people to die from no love, but I've never known anyone to be loved to death.We just can't love one another enough.
A heart-warming story tells of a woman who finally decided to ask her boss for a raise in salary.All day she felt nervous and late in the afternoon she summoned the courage to approach her employer.To her delight, the boss agreed to a raise.
The woman arrived home that evening to a beautiful table set with their best dishes.Candles were softly glowing.Her husband had come home early and prepared a festive meal.She wondered if someone from the office had tipped him off, or...did he just somehow know that she would not get turned down?
She found him in the kitchen and told him the good news.They embraced and kissed, then sat down to the wonderful meal.Next to her plate the woman found a beautifully lettered note.It read: "Congratulations, darling! I knew you'd get the raise! These things will tell you how much I love you."
Following the supper, her husband went into the kitchen to clean up.She noticed that a second card had fallen from his pocket.Picking it off the floor, she read: "Don't worry about not getting the raise! You deserve it anyway! These things will tell you how much I love you."
Someone has said that the measure of love is when you love without measure.What this man feels for his wife is total acceptance and love, whether she succeeds or fails.His love celebrates her victories and soothes her wounds.He stands with her, no matter what life throws in their direction.
Upon receiving the Nobel Peace Prize, Mother Teresa said: "What can you do to promote world peace? Go home and love your family." And love your friends.Love them without measure. [/INST] question: That the husband prepared her a second letter about her raise suggests that _ . | options: A: he loves her because he believes that she is sure to receive a raise B: he has a great way to promote his wife's love towards him C: he had a false love for people even if the person is his wife D: he loves his family members truly, whether they are in good conditions or not | answer: D </s> |
<s>[INST] context: Read the following interview with Dr John Bass, an international shark specialist who has spent many years studying sharks:
First of all, doctor, are all sharks dangerous?
No, they aren't. There are about 250 different kinds of sharks, but fewer than 30 of them are dangerous to humans. Certain sharks are very aggressive and we should fear them, but the danger of shark attacks is much lower than most people think.
So which sharks are dangerous?
The Great White shark is the most dangerous. Then there is the Tiger shark, which other sharks are afraid of, and the Blue shark. Both of them are very fast and dangerous.
Which are the biggest and smallest sharks?
The Whale shark is the biggest shark in the world. It grows up to 15 m in length and weighs as much as six large cars. The smallest shark, which is found near prefix = st1 /Japan, could fit into the palm of your hand because it is only 15-20 cm long.
Do all sharks have teeth ?
Yes, they do. Most sharks have hundreds, sometimes even thousands, of sharp teeth. These are arranged in rows of four or more. They fit quite loosely in the jaw. When the front ones break off or fall out, spare teeth move forwards from the rows behind: Sharks get a new set of teeth every two weeks. In 10 years, a Tiger may lose as many as 24,000 teeth!
That's lots of teeth! What kind of food do sharks eat?
Most sharks feed on small fish, and they keep the oceans healthy by eating sick and injured fish. However, hungry sharks will eat almost anything, including smaller sharks and even rubbish. Inside one Tiger shark which was found, there was a tin can, a bicycle tyre , a leather wallet and an alarm clock!
And how do sharks find their food, doctor?
A shark's sense of smell is excellent. It will follow the smell of blood across thousands of metres of ocean. They also see well, and they have good hearing. Sharks can feel movement in water very easily too, and it is possible for them to feel a fish moving as far as 30 m away. [/INST] question: Most types of sharks are _ . | options: A: dangerous killers B: not dangerous C: afraid of people D: found inJapan | answer: B </s> |
<s>[INST] context: In China, parents often tell their kids not to waste food. However, it's reported that a lot of food is wasted in restaurants every day.
Many people say when they eat out, they usually order a lot of dishes and they can't eat them up. One person in Chengdu, Sichuan Province says he takes away the _ . "Usually we'll have some leftovers after meals, because when I invite friends to eat out, I don't know how much they can eat, so I order lots of dishes to make sure everybody has enough food."
While another person in Fuzhou, Fujian Province says she never packs what is left on the dining table. "What I usually experience during eating out is a big meal. I seldom take away the leftovers because we often have other activities after the meals, and it's not convenient to take the leftovers. And when no one suggests taking away leftovers, I won't do so."
Some people say they only take away leftovers when they eat out with family, but not if they eat with friends or colleagues .
Food waste means washing money as well as wasting precious resources . When food is thrown away, it becomes rubbish and can be harmful to the environment.
We should realize how important it is to save food. It's wise to order proper food for our meals. If there're leftovers, it's better to take home. To save food, we should start with ourselves and start from now. [/INST] question: _ food is wasted in the restaurants of our country every day. | options: A: Little B: Many C: Few D: Much | answer: D </s> |
<s>[INST] context: Pelvi-ureteral junction (PUS)/ureteropelvic IUPJ)
UPJ obstruction is the most common obstructive lesion in childhood and is the most common cause of hydronephrosis found on prenatal and early postnatal ultrasonography. •
It is most commonly caused by intrinsic stenosis of a segment of ureter which is usually localized to the region of pelviureteric junction. Other causes include ureteric folds & extrinsic obstruction by crossing lower pole vessels.
Presentation
Hydronephrois revealed by maternal USG (Dilated renal pelvis but normal ureter).
Palpable renal mass in new horns or infants.
Abdominal flank or back pain typically exacerbated by drinking large volumes of liquid.
UTUHaemanuia after minimal trauma.
Epidemiology
Left side more commonly involved than right (Bilateral = 10%).
Male more commonly involved than females (M : F = 2 : 1).
Initial iagnosis by Ultrasonography
Hydronephrosis with dilated renal pelvis.
Ureter if visualized is of normal caliber (not dilated).
Renal Differential function
Nuclear Renography is used to determine Renal Differential function
A differential function of < 40% is considered significant and often an indication for surgical management. Management
Management depends on the differential renal function and AP diameter of PUJ :-
Differential renal function > 40% especially when AP diameter ofPILI <30 min -3 Conservative treatment.
Differential renal function < 40% especially when AP diameter of PUI > 30 MM —4 Surgical treatment is indicated. Pyeloplasty is the surgical procedure of choice. Other surgical procedures used are external drainage (nephrostomy), endopyelotomy and nephrectomy.
Differential function of < 10% is often considered as an arbitary cut off for nephrectomy. [/INST] question: A child presented with intermittent episodes of left sided flank pain. Ultrasonography reveals large hydronephrosis with dilated renal pelvis and cortical thinning with a normal ureter. Kidney differential function was observed to he 19% which of the following is the best management – | options: A: Nephrectomy B: Pyeloplasty C: External drainage D: Endopylostomy | answer: B </s> |
<s>[INST] context: Longitudinal Middle cranial Fossa is involved in 60%-80% of fracture of skull base. Types of Temporal bone fracture include Longitudinal, Transverse. Mixed, Oblique and Unusual. a. Longitudinal : * The longitudinal is one where fracture line runs parallel to the Petrous ridge, that is longitudinal axis of the bone. it constitutes 85% of all the Temporal Bone . 23% are bilateral. Fracture begins in Squamous Temporal Bone & continues towards the Petrous apex, coursing around the dense Otic capsule bone. Hearing loss is common after the injury; it is usually mixed hearing loss. * These invariably results in laceration of the roof of the External Auditory Canal and often the tympanic membrane blood from the middle ear appears in the of External Auditory Canal, leading to a-dictum, that bloody Otorhea after head injury usually represents a longitudinal temporal bone until proved otherwise. If the Dura is disrupte CSF may leak through a disrupted Tegmen Tympani, resulting in CSF Otorrhea. * Spontaneous Nystagmus is Rare. * Facial N. is usually spared * Most extends along the Fallopian Canal rather than across it. Facial weakness after this is usually incomplete and is most often delayed, secondary. to the edema rather than disruption of the nerve. b. Transverse : * This runs right angle to the longitudinal axis of the Petrous bone. * Caused by: - Blow on the Occipul or less commonly a direct frontal blow. Transverse has a higher moality than longitudinal and greater force is required to generate them. * The "Classical' Transverse begins in Posterior Cranial Fossa, usually in the region of Foramen Lacerum or Foramen Spinosum. * The hearing loss in transverse is usually Sensorineural, caused by disruption of the integrity of the labrynth or the neurovascular bundle in the internal auditory canal. Veigo with spontaneous Nystagmus & post traumatic common after it.Facial n. paresis is also common (50%), it is immediate and greater intensity than longitudinal . Mixed : Involves a combination of several of the routes, described. Oblique : a recent study (not confirmed) shows that these types of are actually the most common (75%). Other of temporal Bone: of anterior wall of External Auditory Canal can occur in conjugation with injuries to the Mandible. [/INST] question: A 22 year old young man was brought in emergency room after scuffle in which he was punched over his face by a hooligan road side. The patient was conscious and blood was trickling from right ear. The bleeding was controlled at that time. Next day the Audiometry of the patient showed conductive type of hearing loss. The type of temporal bone fracture the patient has? | options: A: Longitudinal B: Transverse C: Oblique D: Mixed | answer: A </s> |
<s>[INST] context: A young man was getting ready for graduation. He always wanted a beautiful sports car, and he told his father this. On the morning of his graduation, his father called him into his study. His father told him how proud he was to have such a fine son, and told him how much he loved him. He handed his son a beautiful box. The young man was disappointed when he opened the box and found a book. He shouted angrily,"With all your money you give me a book?"and rushed out of the house.
Many years passed and the young man was very successful in business. He had a beautiful home and a wonderful family, but he realized his father was very old and thought he should go to see him. Before he made a visit, he got a call telling him his father had passed away .He was also told his father had given all his _ to him. When he arrived at his father's house, sadness filled his heart.
He began to see his father's important papers and saw the still new book. With tears, he opened the book and began to turn the pages. As he read the words, a car key dropped from an envelope in the book. It was the key to a sports car. [/INST] question: The young man wanted his father to buy him a _ . | options: A: book B: sports T-shirt C: sports car D: cellphone | answer: C </s> |
<s>[INST] context: Brief Introduction
(Adeline) Virginia Woolf (nee Stephen; 25 January 1882 - 28 March 1941) was an English novelist and essayist, regarded as one of the foremost modernist literary figures of the twentieth century.During the interwar period, Woolf was a significant figure in London literary society and a member of the Bloomsbury Group. Her most famous works include the novels Mrs Dalloway (1925), To the Lighthouse (1927) and Orlando (1928), and the book-length essay A Room of One's Own (1929), with its famous dictum, "a woman must have money and a room of her own if she is to write fiction."Main body
My dear,
'Dearest, I feel certain I am going mad again. I feel we can't go through another of those terrible times. And I shan't recover this time. I begin to hear voices, and I can't concentrate. So I am doing what seems the best thing to do. You have given me the greatest possible happiness. You have been in every way all that anyone could be. I don't think two people could have been happier till this terrible disease came. I can't fight any longer. I know that I am spoiling your life, that without me you could work. And you will I know. You see I can't even write this properly. I can't read. What I want to say is I owe all the happiness of my life to you. You have been entirely patient with me and incredibly good. I want to say that - everybody knows it. If anybody could have saved me it would have been you. Everything has gone from me but the certainty of your goodness. I can't go on spoiling your life any longer.
I don't think two people could have been happier than we have been
...........................form the last letter of virginia woolf [/INST] question: what is form of The main body? | options: A: letter of resignation B: Letter of condolence C: Letter of suicide D: Letters of Apologies ; | answer: C </s> |
<s>[INST] context: Cast your mind back to the past twenty years and hardly did anyone have their own email account. The Internet had just taken off in 1991 and people were only using office and PCbased email exchanges.
In the mid 1990s external email providers appeared. The most famous of these was Hotmail, the first free email provider and webbased email service. Sabeer Bhatia and Jack Smith launched Hotmail on July 4, 1996. And Microsoft took note of and bought Hotmail for $400 million on December 30, 1997, a nice birthday present for Bhatia who turned 29 that day. It was relaunched as MSN Hotmail and in 2007 was relaunched again as Windows Live Hotmail.
Fast forward the present day and most of us have at least a personal webbased email account. It seems impossible to live without them. One of the biggest advantages of email is the fact that communication has become so much easier, especially with those across different time zones. Email takes seconds to send a message whereas letters, as we used to communicate by, could take weeks. Of course there was the fax, that beeping invention from the 1980s, but it wasn't as secure as email and you never knew if the person on the other end had picked up your fax or if it had got lost somewhere in the office.
In conclusion, one of the best inventions from the 1990s has to be email. But sometimes people are too closely connected to their email and have a _ to check it several times a day. At work, people have become lazy and instead of going to speak to the person sitting next to them, they send an email,causing an in box to pile up with more time spent reading email and responding rather than working. Clearly, an invention that saved time because of its quick and speedy connection can now also cause us to waste a lot of time. [/INST] question: The earliest web-based email came into being probably _ . | options: A: in 1991 B: in 1996 C: in 1997 D: in 2007 | answer: B </s> |
<s>[INST] context: Dear Dr. Smith,
My mom always keeps asking me, "What's going on?" If I want to go to a concert, she asks who I will go with. I think that's my own business . Sometimes it looks like she doesn't trust me. It makes me very sad. How can I get her to stop?
Dear Katie,
Many young people have the same problem as you. If you don't talk much with your parents, they might feel they need to ask you questions to know about your life. It seems to you that your mom is getting into your business, but I think she's just trying to keep a close relationship with you. In fact, some experts often tell parents to stay close to their kids by asking them about what's going on in their life.
Some parents do this better than others, of course. But, unluckily, some parents ask questions because they don't trust their kids. So start by trying to trust your mom. She is probably just trying to stay close to you because she loves and cares about you. You can have a talk with her about it.
Of course, that doesn't make the questions less boring. If you're tired of so many questions, tell your mom about your feelings the day before she asks. If you _ more information, conversations with your mom won't seem like she's just asking you too many questions!
If you do this, I'm sure you can get on well with your mom.
Dr. Smith [/INST] question: Katie's problem is that _ . | options: A: she is sad about the person at the concert B: she doesn't like or care about her mother C: her mother always asks her lots of questions D: her mother doesn't want her to make new friends | answer: C </s> |
<s>[INST] context: A woman planning "Harry Potter night" at a supper club she runs at home has been forced to change their name after a warning from film studio Warner Bros .
The evenings in Kiburn, north London, were due to include food and other elements from the Harry Potter books. However, Warner Bros, maker of the Harry Potter films, wrote to the club's organizer "Ms Marmite Lover" warning that the parties would infringe its rights.
The club will now hold two "Genetic Wizard nights" for Halloween. On her blog,Ms Marmite Lover explains that she researched and developed her menu with her Harry Potter-obsessed teenage daughter and a food writer.
Guests would have to enter the venue, called the Underground Restaurant, through "Diagon Alley" and by giving a password--while a "Sorting Hat" would decide the seating plan.
After Warner Bros learned about the event, he wrote to Ms Marmite Lover saying: "While we are delighted that you are such a fun of the Harry Potter series, unfortunately your proposed use of the Harry Potter Properties without our permission would amount to an infringement of Wamer's rights."
The letter added: "Warner does not, of course, object to you holding a generic wizard/Halloween night at the Underground Restaurant."
Ms Marmite Lover suggested in her blog: "JK Rowling herself, having at one time been a struggling single parent, and having donated to the National Council for one Patent Families, would probably approve of a single mother being entrepreneurial and creative".
The Underground Restaurant usually charges diners about 20-30 each, except alcohol. Warner Bros says it has guidelines to help Harry Potter fans run non-profit and charitable events true to the spirit of the stories.
The vast majority of non-commercial events are able to go ahead with the studio's support, it says. [/INST] question: Mr. Marmite Lover had to change their name because _ . | options: A: the sold tickets to whoever attends the supper club B: JK Rowling didn't approve of their doing so C: the Underground Restaurant charged too much D: the use of the name infringed Warner's rights | answer: D </s> |
<s>[INST] context: The physical finding of facial asymmetry is suggestive of an abnormality involving the facial nerve (CN VII). The facial nucleus, which is located within the pons, is divided in half, the upper neurons innervate the upper muscles of the face, while the lower neurons innervate the lower poion of the face. It is impoant to realize that each half receives input from the contralateral motor coex, while only the upper half receives input from the ipsilateral motor coex. Therefore an upper motor neuron (UMN) lesion will produce a defect involving only the contralateral lower half of the face. Causes of UMN lesions involving the facial nerve includes strokes that involve the coex or the internal capsule. In contrast, lesions that affect the facial nerve from the facial nucleus to the remaining length of the nerve result in LMN lesions. Patients present with facial asymmetry involving the ipsilateral upper and lower quadrants. Lesions to the facial nerve within the facial canal (frequently due to cold weather) cause Bell's palsy. Patients present with paralysis of all muscles of facial expression. Bell's phenomenon refers to the finding of the affected eye looking up and out when patients try to close their eyes. Because the lacrimal punctum in the lower eyelid moves away from the surface of the eye, lacrimal fluid does not drain into the nasolacrimal duct. This produces "crocodile tears." ref - pubmed.com [/INST] question: An upper motor neuron (UMN) lesion involving cranial nerve VII would most likely produce | options: A: Contralateral weakness of the lower half of the face with sparing of the upper half of the face B: Decreased gag (pharyngeal) reflex with decreased taste sensation from the posterior one-third of the tongue C: Hemianesthesia of the face with flaccid paralysis of the muscles of mastication D: Ipsilateral anosmia with primary amenorrhea in females | answer: A </s> |
<s>[INST] context: Dear Grandma,
How are you? I hope you are feeling well and your leg is improving. Can you walk a bit now? Is your neighbour, Mrs Lu, bringing you enough books to read? I hope so. You'd love our school library, Grandma. There are so many books on all kinds of subjects. The other day I found a book about engineering. I couldn't really understand it but I hope to learn more about this topic sometime. This term I have three new subject classes, so I think I'll tell you about them.
I study biology. It is a very interesting subject. I'm learning all about the human body, where everything is and what it does. Did you know that we have a kissing muscle? It's called 'orbicularis' and it's a circle muscle that closes your mouth and moves your lips forward. I love biology. It's so interesting! Another new subject is religion . I didn't think I would like this one, but actually it is very interesting to hear how different people worship . We are learning about lots of religions from all over the world, not only Asia. My other new subject is Spanish. It's really difficult to learn a new language but I know it will be useful for me in the future, if I want to travel around the world. Spanish is one of the official languages of the European Union and the United Nations. I've learnt that Spanish is not only spoken in Europe but in South America too. Countries like Peru, Bolivia, Chile, and Mexico also speak Spanish. You know I've always wanted to go to Mexico, so if I can speak Spanish it would be really useful.
Did you study these subjects when you were at school? I suppose subject choice changes over time, doesn't it? I'll come to visit you again in the next holiday, which I think is in eight weeks' time. I'll bring you some of my new books if you like. I hope you can write back soon and tell me all the village news. I miss you very much.
Lots of love,
Sara [/INST] question: From the letter we can know that Grandma's leg was _ . | options: A: improving B: lost C: getting worse D: hurt | answer: D </s> |
<s>[INST] context: (Theodor kocher) (Internet)Theodor kocher was the first Nobel prize winner in the surgical speciality in 1909 for this work in surgery of the thyroid glandWillian Stewart Halsted* In 1882 Halsted was researching breast cancer a disorder that was becoming better understood by the time. He decided that the best way to prevent the spread of the cancerous cells was to simply remove them surgically known as radical mastectomy*** Between 1883 and 1886 Halsted published many papers on* Usuage of blood transfusion during surgery* Injection of a saline solution in to the blood to dilute it can treat shock* In 1884 a physician named Karl Koller demonstrated the use of cocaine for LA* Rubber gloves for medical purposes & its importance** in preventing infection and the spread of pathogene* Method for repair of inguinal hernia that had a lower mortality rate than other previous methods* The noble prize in physiology or medicine for 2007 was jointly awarded to Mario R. capecchi, Martin J. Evans J and Oliver Smithies for their discoveries of - Principles for introducing specific gene modification in mice by the use of embryonic stem cells** [/INST] question: Noble laurate among the following | options: A: Banker's B: Willium halsted C: Turek D: Theodor kocher | answer: D </s> |
<s>[INST] context: PV: an impoant cause of benign was, cervical cancer, and oropharyngeal cancer # Oncogenic types of HPV encode two viral oncoproteins, E6 and E7, that bind to Rb and p53, respectively, with high affinity and neutralize their function. # Development of cancer is associated with integration of HPV into the host genome and additional mutations needed for acquisition of cancer hallmarks. # HPV cancers can be prevented by vaccination against high-risk HPV types. EBV: ubiquitous herpesvirus implicated in the pathogenesis of Burkitt lymphomas, B-cell lymphomas in patients with T-cell immunosuppression (HIV infection, transplant recipients), and several other cancers # The EBV genome harbors several genes encoding proteins that trigger B cell signaling pathways; in conce, these signals are potent inducers of B cell growth and transformation. # In the absence of T-cell immunity, EBV-infected B cells can rapidly "grow out" as aggressive B-cell tumors. # In the presence of normal T-cell immunity, a small fraction of infected patients develop EBV-positive B-cell tumors (Burkitt lymphoma, Hodgkin lymphoma) or carcinomas (nasopharyngeal, gastric carcinoma) Hepatitis B virus and hepatitis C virus: cause of between 70% and 85% of hepatocellular carcinomas worldwide # Oncogenic effects are multifactorial; dominant effect seems to be immunologically mediated chronic inflamma- tion, hepatocellular injury, [/INST] question: Which of the following is not a carcinogenic virus | options: A: Hepatitis B B: Hepatitis C C: Molluscum contagiosum D: HPV | answer: C </s> |
<s>[INST] context: Systemic lupus erythematosus (SLE), also known simply as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many pas of the body. Symptoms vary between people and may be mild to severe. Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is most commonly on the face. Often there are periods of illness, called flares, and periods of remission when there are few symptoms.In diagnostic pathology, a hematoxylin body, or LE body, is a dense, homogeneous, basophilic paicle, easily stainable with hematoxylin. It consists of degraded nuclear material from an injured cell, along with autoantibodies and a limited amount of cytoplasm. Hematoxylin bodies occur in systemic lupus erythematosus. The hematoxylin body may be green, blue, or purple with the Papanicolaou stain and magenta with Romanowsky stains.] The material has a positive Feulgen stain reaction, which is typical of DNA. The material may be extracellular or may be ingested by leukocytes, which are then known as LE cells. [/INST] question: Hemotoxylin bodies are seen in ? | options: A: SLE B: PAN C: RA D: Wegners granulomatosis | answer: A </s> |
<s>[INST] context: Hemorrhagic pericardial effusion most commonly is caused by either tumor or tuberculosis. The most common neoplasm involving the heart is metastatic cancer because primary cardiac neoplasms are rare. The most common primary sites are nearby-lung, breast, and esophagus. The skin lesion in this patient is likely to be a malignant melanoma, which tends to metastasize widely, including to the heart. Most cardiac metastases involve the epicardium/pericardium. (By convention, even though epicardial surfaces are often involved most severely, the term pericardial effusion is typically used when fluid is present, or pericarditis is used when inflammation is present.) A large effusion can cause tamponade, which interferes with cardiac motion. Calcific aortic stenosis leads to left-sided congestive heart failure, with pulmonary edema as a key finding. Coronary atherosclerosis may lead to myocardial infarction, which can be complicated by ventricular rupture and hemopericardium, but the level of troponin I, in this case, suggests that infarction did not occur. Rheumatic heart disease mainly affects the cardiac valves, but acute rheumatic fever can produce fibrinous pericarditis. Tuberculosis is unlikely in this case because no pulmonary lesions were seen on the radiograph. [/INST] question: A 73-year-old woman has had episodes of chest pain during the past week. She is afebrile. Her pulse is 80/min, respirations are 16/min, and blood pressure is 110/70 mm Hg. On auscultation of the chest, heart sounds seem distant, but the lung fields are clear. Neck veins are distended to the angle of the jaw, even while sitting. There is a darkly pigmented, irregular, 1.2-cm skin lesion on the right shoulder. A chest radiograph shows prominent borders on the left and right sides of the heart. Pericardiocentesis yields bloody fluid. Laboratory findings include a serum troponin I level of 0.3 ng/mL. Which of the following lesions is the most likely cause of these findings? | options: A: Calcific aortic stenosis B: Coronary atherosclerosis C: Epicardial metastases D: Mitral valvulitis | answer: C </s> |
<s>[INST] context: Urban citizens can enjoy a more colorful life than rural citizens.Townspeople are wellinformed because they have the easier access to news,while country people are uniformed because these districts are hard to get to.Urban traffic is so welldeveloped that the residents there often visit exhibitions and parks which are only a short bus ride away. For country people this is a major operation which involves considerable planning.Shopping,a necessary activity in everyday life is more convenient in the city than in the countryside. Townspeople can buy what they want at any time of a day.But rural residents go to town at most once a week.So after shopping they always stagger home loaded with heavy purchases. As for as meals and clothes concerned,townspeople are wellfed and welldressed as there is an adequate supply of goods.But rural residents are too busy to pay particular attention to them.It is for these reasons that more and more people are moving into the city and looking for a rest there.
On the contrary,some people are attracted by the rural area.Air pollution,noise and overcrowding which are the biggest problems confronting townspeople seem strange for rural residents.Medical studies have proved that rural residents can live longer than urban residents, because they are free from a polluted environment. In addition,the crime rate in the city is several times higher than in the countryside.As is known to all,the life in any city is much more expensive than in the countryside.So the safe, quiet and cheap life in the country appeals to(......)many city residents.
Either an urban or a rural area gives pleasure and trouble.But,I believe,the suburban area has the excellencies of both and is superior to both.As the automobile industry develops,more and more people will make their homes in suburban areas. [/INST] question: When visiting an exhibition in town,country people have to _ . | options: A: listen to local news B: take a bus C: make a careful plan D: ask friends for help | answer: C </s> |
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