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<s>[INST] context: Ethambutol (E): Ethambutol is selectively tuberculostatic and clinically as active as S. Fast multiplying bacilli are more susceptible as are many atypical mycobacteria. Added to the triple drug regimen of RHZ it has been found to hasten the rate of sputum conversion and to prevent development of resistance. About 3 / 4 of an oral dose of E is absorbed. It is distributed widely but penetrates meninges incompletely and is temporarily stored in RBCs Less than 1/2 of E is metabolized. It is excreted in urine by glomerular filtration and tubular secretion; plasma half life is 4 hrs. Caution is required in its use in patients with renal disease. Patient acceptability of E is very good and side effects are few. Pyrazinamide (Z): Chemically similar to INH It is more lethal to intracellularly located bacilli and to those at sites showing an inflammatory response (pH is acidic at both these locations). It is highly effective during the first 2 months of therapy when inflammatory changes are present Hepatotoxicity is the most impoant doserelated adverse effect. R ifampin (Rifampicin, R): Adverse effects: The incidence of adverse effects is similar to INH. Hepatitis, a major adverse effect, generally occurs in patients with preexisting liver disease INH: Hepatitis, a major adverse effect of iNH, is rare in children, but more common in older people and in alcoholics. It is due to dose-related damage to liver cells and is reversible on stopping the drug. Other side effects are rashes, fever, acne and ahralgia ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:741,742 [/INST] question: Which of the following antitubercular drugs is safe in hepatitis? | options: A: Isoniazid B: Rifampicin C: Pyrazinamide D: Ethambutol | answer: D </s>
<s>[INST] context: There are 115 distinct species of pine trees with 35 native to North America. Pines are defined as evergreens with long, needle-like leaves and are only native to the northern hemisphere. Pine trees are an adaptable and tough species that can survive in many conditions where other plants cannot. The average pine is 45 to 60 feet tall, but some are nearly twice as high. Western White Pine The western white pine grows the tallest of any pine tree, reaching up to 110 feet in height. They have blue-green needles arranged in bundles of five and produce a long cone . Bristlecone Pine The bristlecone pine grows slowly, reading about 20 feet tall. It is one of the oldest species of pine. Mexican Pine The Mexican pine can grow to 50 feet tall, with long, slender needles that drape off it like a weeping willow . Often nicknamed the "willow pine", it is native to Mexico. Its leaves can droop up to 12 inches long. Sugar Pine The sugar pine is another of the large pine species, such as the bull pine, but it also has the largest cones of any pine species, at 10 to 20 inches long. It grows from Oregon to California and is often used for construction. Jack Pine The jack pine is one of the smallest species of pine with rare leaves. Compared with the pines mentioned above, it doesn't seem to belong to the family. It is considered a member of the scrub-pine family; it prefers sandy soil. [/INST] question: Which of the following pines is often used as a building material? | options: A: The Mexican pine B: The bristlecone pine C: The sugar pine D: The jack pine | answer: C </s>
<s>[INST] context: In the computer age, most of us take a broadband Internet connection for granted. Whether cable or mobile broadband, today's connections are many times faster than those in the early days. Videos play smoothly, complex websites load quickly, and files download much faster than ten years ago. And the files are much bigger too. There's _ , of course: You have to live near enough to a major city to get broadband Internet. If you don't, it's slow dial-up access for you. And for those living really far out, there may be no Internet access at all. Technology experts often talk about the "last mile" problem, which refers to the difficulty of bringing Internet access to remote locations. In cities and suburbs, it's relatively easy to provide access for everyone. It is much more difficult to deliver access to those living far from cities, especially in developing countries. Internet service providers, for their part, have been reluctant to provide access to sparsely populated areas. The handful of Internet users they would reach wouldn't cover the expense. But every year, technological advancements allow of more and more Internet users. Most broadband connections today run over existing cable TV and telephone lines although these technologies aren't available everywhere. Some companies have delivered the Internet over standard power lines. Advancements in cheaper, more efficient fiber optics cables promise to bring extremely fast Internet connections to more users. Still, the "last mile" problem remains hard to deal with. There will always be somewhere that doesn't have an affordable broadband connection. But someday that might not matter. If the rapid progress in cell phone technology is any indication , it may not be too long before an Internet connection simply follows you wherever you go. [/INST] question: What may eventually settle the "last mile" problem? | options: A: The broadband connection's getting faster B: More and more Internet users C: more and more Internet connections D: The rapid progress in cell phone technology | answer: D </s>
<s>[INST] context: A story tells that a senior villager led some other villagers carrying salt day and night to a town in order to trade rice as food the winter.One night they camped in a wilderness with a starry sky above.The senior villager,obeying the tradition passed down from forefathers,took out three blocks of salt and threw them into the campfire,probably to predict the changes of weather in the mountains. All eagerly waited for the old man's"weather report":if the salt in the fire produced crackling sound,they would have good weather in store;if no sound was produced,it then meant the good weather would soon end and a storm would come at any moment. The senior villager looked serious.The salt in the campfire made no sound at all.Convinced by this bad sign,he urged the whole team to set out immediately after daybreak.A young man in the group,however,insisted that they should not start in such a hurry,considering it superstitious to"forecast weather by using salt. It was not until the next afternoon that the young man caught up on the wisdom of the old man when the weather suddenly changed,with cold winds blowing and a snowstorm raging.In fact,the method used by the clan head could be well explained by modem science:whether or not salt produces sound in campfire depends on air humidity .That is to say,when a storm approaches,due to high humidity,the dampened salt blocks will not produce any sound in fire. [/INST] question: The senior villager predicted the changes of the weather _ while camping in a wilderness that night. | options: A: by taking out salt B: by burning salt in fire C: in a superstitious way D: depending on his wisdom | answer: B </s>
<s>[INST] context: Can 13-year-olds do something to change the world? Cris Kesz Valdez, 13, from the Philippines believes so. At the age of 7, Valdez set up an organization to give homeless kids things like slippers and toothbrushes. So far he has helped more than 10,000 children improve their lives in his hometown. Valdez won the 2012 International Children's Peace Prize on September 19, 2012. "My motto is 'we can change the world one heart at a time,' " Valdez said at the award ceremony. In fact, Valdez is a homeless kid himself. He looked for food from trash, lived on the streets and slept in a public cemetery for most of his childhood. His parents didn't care about him and often beat him. Valdez said he felt he was living in " _ " at that time. But this "darkness" didn't turn him into a dark person. Valdez got help from community workers. On his first birthday party, at the age of 7, Valdez decided what he wanted most was to help other children who were still living on the streets. "I didn't have a lot of money, but I had a lot of love to give," Valdez explained. That day was the birth of the organization, Championing Community Children. Since then, Valdez and his friends visit homeless children and hand out bags with slippers, toys and even candy. They nurse their wounds, teach them about their rights and offer them hope. "I want children on the streets to get the same chance as I have," he said. [/INST] question: Cris Kesz Valdez helped homeless kids in _ . | options: A: China B: America C: the Philippines D: Japan | answer: C </s>
<s>[INST] context: The diagnostic evaluation of an infertile couple should be thorough and completed as rapidly as possible. The primary diagnostic steps in the workup of the infertile couple include (1) documentation of ovulation by measurement of basal body temperature (BBT) or mid-luteal phase serum progesterone; (2) semen analysis; (3) postcoital test; (4) hysterosalpingogram; and (5) endometrial biopsy. Women should record their BBT for evidence of ovulation. In addition, serial serum progesterone levels may be helpful to confirm ovulation. Serum progesterone values should be obtained 7 days after ovulation and may also be helpful in evaluating inadequate luteal phase. An endometrial biopsy may also provide valuable information regarding the status of the luteal phase. The biopsy is obtained 12 days after the thermogenic shift, or 2 to 3 days before the expected onset of menses, on about day 26 of a 28-day cycle. A postcoital test is an in vivo test that evaluates the interaction of sperm and cervical mucus. It is performed during the periovulatory period up to 12 h after coitus. The cervical mucus is obtained, and its quantity and quality as well as its interaction with the sperm are evaluated. The hysterosalpingogram is performed in the mid follicular phase in order to evaluate the fallopian tubes and the contour of the uterine cavity; it should not be done while the patient is menstruating or after ovulation has occurred. Although gonadotropin levels are not routinely evaluated, they should be obtained in the early follicular phase when testing is indicated, e.g., in cases where there is a history of oligoovulation. [/INST] question: "Determination of serum progesterone level to document ovulation" For the evaluation, select the most appropriate day of a normal 28-day menstrual cycle for a woman with 5-day menstrual periods. (SELECT 1 DAY) | options: A: Day 3 B: Day 8 C: Day 14 D: Day 21 | answer: D </s>
<s>[INST] context: When Elizabeth Kenny was a little girl, she fell off a horse and hurt her arm. Mrs. Kenny took her to a doctor in Toowoomba, Queensland. In the doctor's, Elizabeth saw many bottles of medicine standing in a row. Since then, she wanted to be a nurse. As soon as she was old enough, Elizabeth was trained in a hospital. After working for some time, she made a surprising discovery. Among her patients were some children who had lost the use of their legs because of polio ( ) . Kenny tried putting hot cloth on their legs and washing them in a special way. The results were great. The children were able to use their legs again. Most doctors would not believe that children could get well in such a simple way. Gradually, however, she became famous. From 1993 on people from many parts of the world brought their children to Australia to receive treatment by this wonderful nurse. She was invited to America where her methods were used in many hospitals. Money was collected to build Kenny foundations which were for polio patients. Kenny died in 1952, but she will long be remembered for her fight against polio. [/INST] question: Toowoomba is the name of _ . | options: A: a famous doctor B: a kind of disease C: an Australian city D: an Australian school | answer: C </s>
<s>[INST] context: The "Thumbs-Up" While Western culture has become used to the thumbs-up as a positive signal (probably coming from World War II pilots using the signal to communicate that they were "good to go" with ground crews), there are cultures where a thumbs-up may land you in trouble. In West Africa, as well as Greece, Italy and Middle East, the thumbs-up is pretty much the biggest insult . Rather more charming is a thumbs-up in Germany and in parts of Japan --they just see it as the hand signal for the number one. The "A-OK" This sign is mainly used by divers to mean "OK"(to prevent being confused with the thumbs-up sign, which means "rise"). Basically the meaning comes out as "great", or "completely fine". However, in a few countries in Europe, people may think you're telling them that you think they're a 'zero'. The "V Sign" The sign comes in two formats: one with the palm faced outwards, and one with the palm inwards. In America they mean the same thing --"victory". However, if the outside of your hand is facing your target, you're giving somebody a long-established insult in Great Britain and many English-speaking countries such as Australia, Ireland and New Zealand. Winston Churchill famously used the "incorrect" version of the V sign during the early years of the war, turning the outside inside later. The V sign is also considered rude in Italy. The "Corna" The corna hand gesture has most recently been adopted by fans of rock and heavy metal music.Nowadays many Americans use the gesture simply to mean "rock on", or in support of the University of Texas in Austin (known as the "Hook'em Horns"). Today it is still popular in Spain, Brazil and Slovakia . Historically, however, the symbol possibly dates back to Ancient Greece. [/INST] question: Which of the following signs doesn't have an insulting meaning? | options: A: The "Thumbs-Up" B: The "A-OK" C: The "V Sign" D: The "Corna" | answer: D </s>
<s>[INST] context: This afternoon, I spoke with Governor Daniel Malloy and FBI Director Mueller. I offered Governor Malloy my condolences on behalf of the nation, and made it clear he will have every single resource that he needs to investigate this horrible crime, care for the victims and their families. The majority of those who died today were children--beautiful little kids between the ages of 5 and 10 years old. They had their entire lives ahead of them--birthdays, graduations, weddings, kids of their own. Among the fallen were also teachers--men and women who devoted their lives to helping our children fulfill their dreams. So our hearts are broken today--for the parents and grandparents, sisters and brothers of these little children, and for the families of the adults who were lost. Our hearts are broken for the parents of the survivors as well, for as blessed as they are to have their children home tonight, they know that their children's innocence has been torn away from them too early, and there are no words that will ease their pain. As a country, we have been through this too many times. Whether it's an elementary school in Newtown, or a shopping mall in Oregon, or a temple in Wisconsin, or a movie theater in Aurora, or a street corner in Chicago--these neighborhoods are our neighborhoods, and these children are our children. And we're going to have to come together and take meaningful action to prevent more tragedies like this, regardless of the politics. This evening, Michelle and I will do what I know every parent in America will do, which is hug our children a little tighter and we'll tell them that we love them, and we'll remind each other how deeply we love one another. But there are families in Connecticut who cannot do that tonight. And they need all of us right now. In the hard days to come, that community needs us to be at our best as Americans. And I will do everything in my power to help. Because while nothing can fill the space of a lost child or loved one, all of us can extend a hand to those in need--to remind them that we are there for them, that we are praying for them, that the love they felt for those they lost endures not just in their memories but also in ours. [/INST] question: Who is the speaker likely to be? | options: A: A victim parent B: The US president C: A US police officer D: The Connecticut governor | answer: B </s>
<s>[INST] context: Ever since Stephanie's 13th birthday we have been receiving comments from other adults expressing their sympathies because our daughter is now a teenager.We've heard everything from,"Sure she's a good kid,but just wait,now that she's teenager..."to the ever inspiring,"Well,all kids are rotten when they are teenagers,just try to go through it the best way you can."What's more upsetting is that many of these insensitive adults feel the need to share their negative predictions well within the hearing of both our daughters. I know that teenagers can be moody and difficult at times,but I'm 38 and I can also be difficult and moody.We worry about the future and want today's kids to know that we care for them and that there are opportunities that wait for them.However, at the very point they set out on that journey toward adulthood we stand there watching them disapprovingly ,just waiting for them to make mistakes."just like we knew they would."We tell them to respect themselves and to say no to drugs,yet we fail to set a positive example by treating them with kindness and consideration,demonstrating our respect for them. I have,at times been guilty of this behavior but am now realizing that the more I see each person as a person,the more I am pleasantly surprised in some way or another. For example,a few weeks ago my husband and I were having dinner at our favorite restaurant and two teenage boys came in and sat down right beside us.I must admit that my first thought was,"perfect,there goes our quiet, peaceful dinner."I was so wrong! These young men were well behaved.quiet and left a nice tip for the waitress.Once I looked beyond the jeans so loose they were practically falling off and the multi-colored hair, I saw what fine people these kids were. Many of the people who,perhaps unknowingly, treat teens with disrespect are unhappy about the fact that pop singers and sports stars are our children's heroes. I feel that unless we give them something better to go after, we really shouldn't complain. [/INST] question: When their children reach their teens,parents usually expect _ . | options: A: trouble B: sympathy C: congratulations D: inspiring comments | answer: A </s>
<s>[INST] context: Source: style="font-family: Times New Roman, Times, serif"> What is pregnancy-induced hypertension (PIH)?Pregnancy-induced hypertension (PIH) is a form of high blood pressure in pregnancy. It occurs in about 7 to 10 percent of all pregnancies. Another type of high blood pressure is chronic hypertension - high blood pressure that is present before pregnancy begins.Pregnancy-induced hypertension is also called toxemia or preeclampsia. It occurs most often in young women with a first pregnancy. It is more common in twin pregnancies, and in women who had PIH in a previous pregnancy.Usually, there are three primary characteristics of this condition, including the following:high blood pressure (a blood pressure reading higher than 140/90 mm Hg or a significant increase in one or both pressures)protein in the urineedema (swelling)Eclampsia is a severe form of pregnancy-induced hypertension. Women with eclampsia have seizures resulting from the condition. Eclampsia occurs in about one in 1,600 pregnancies and develops near the end of pregnancy, in most cases.HELLP syndrome is a complication of severe preeclampsia or eclampsia. HELLP syndrome is a group of physical changes including the breakdown of red blood cells, changes in the liver, and low platelets (cells found in the blood that are needed to help the blood to clot in order to control bleeding).What causes pregnancy-induced hypertension (PIH)?The cause of PIH is unknown. Some conditions may increase the risk of developing PIH, including the following:pre-existing hypertension (high blood pressure)kidney diseasediabetesPIH with a previous pregnancymother's age younger than 20 or older than 40multiple fetuses (twins, triplets)Why is pregnancy-induced hypertension a concern?With high blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta.There are other problems that may develop as a result of PIH. Placental abruption (premature detachment of the placenta from the uterus) may occur in some pregnancies. PIH can also lead to fetal problems including intrauterine growth restriction (poor fetal growth) and stillbirth.If untreated, severe PIH may cause dangerous seizures and even death in the mother and fetus. Because of these risks, it may be necessary for the baby to be delivered early, before 37 weeks gestation.What are the symptoms of pregnancy-induced hypertension?The following are the most common symptoms of high blood pressure in pregnancy. However, each woman may experience symptoms differently. Symptoms may include:increased blood pressureprotein in the urineedema (swelling)sudden weight gainvisual changes such as blurred or double visionnausea, vomitingright-sided upper abdominal pain or pain around the stomachurinating small amountschanges in liver or kidney function testsHow is pregnancy-induced hypertension diagnosed?Diagnosis is often based on the increase in blood pressure levels, but other symptoms may help establish PIH as the diagnosis. Tests for pregnancy-induced hypertension may include the following:blood pressure measurementurine testingassessment of edemafrequent weight measurementseye examination to check for retinal changesliver and kidney function testsblood clotting testsTreatment for pregnancy-induced hypertension:Specific treatment for pregnancy-induced hypertension will be determined by your physician based on:your pregnancy, overall health and medical historyextent of the diseaseyour tolerance for specific medications, procedures, or therapiesexpectations for the course of the diseaseyour opinion or preferenceThe goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other complications. Treatment for pregnancy-induced hypertension (PIH) may include:bedrest (either at home or in the hospital may be recommended).hospitalization (as specialized personnel and equipment may be necessary).magnesium sulfate (or other antihypertensive medications for PIH).fetal monitoring (to check the health of the fetus when the mother has PIH) may include:fetal movement counting - keeping track of fetal kicks and movements. A change in the number or frequency may mean the fetus is under stress.nonstress testing - a test that measures the fetal heart rate in response to the fetus' movements.biophysical profile - a test that combines nonstress test with ultrasound to observe the fetus.Doppler flow studies - type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel.continued laboratory testing of urine and blood (for changes that may signal worsening of PIH).medications, called corticosteroids, that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies).delivery of the baby (if treatments do not control PIH or if the fetus or mother is in danger). Cesarean delivery may be recommended, in some cases.Prevention of pregnancy-induced hypertension:Early identification of women at risk for pregnancy-induced hypertension may help prevent some complications of the disease. Education about the warning symptoms is also important because early recognition may help women receive treatment and prevent worsening of the disease. [/INST] question: Earliest sign of Pregnancy induced Hypertension is-(JIPMER 98) | options: A: Rapid gain in weight B: High BP C: Albuminuria D: Edema | answer: B </s>
<s>[INST] context: Laura Brent is a manager in an important company. She has three children--the eldest is 10, and youngest is three. "My job was only possible because my husband David was prepared to take my place and become a house husband," she says. More and more couples are finding this arrangement suits them better in today's world, where women are rising to the top of their careers faster and more easily than they did in the past. Many men, on the other hand, like the idea of staying at home and looking after the children. "My children see a lot more of me than I saw of my father when I was young, and I think it's better for them, especially for the boys," says David. "It works just as well for Laura." "Now I can come home from a hard day at work, and immediately relax with the children, instead of having to do the housework and the cooking," she says. Is there anything David misses about going out to work? "Not really. I suppose the worst thing about looking after children and doing the housework is not having a lunch break! It's a lot harder than most men think." [/INST] question: How many people are there in Laura's family? | options: A: 2 B: 3 C: 4 D: 5 | answer: D </s>
<s>[INST] context: An elderly couple lived far away from their children. They noticed that they were beginning to forget many little things around the house. They were afraid that this could be perilous, as one of them might forget to turn off the stove and thus cause a fire. They were so worried that they decided to see their doctor to get some help. Their doctor told them that it was unnecessary to take medicine and that many people of their age found it useful to write themselves little notes as reminders. The elderly couple thought this wonderful, and left the doctor's office very pleased with the advice. When they got home, the wife said, "Dear, will you please go to the kitchen and get me a dish of ice cream? And why don't you write that down so you won't forget?" "Don't be silly," said the husband. "I can remember a dish of ice cream!" "Well," said the wife, "I'd also like some strawberries on it. You should write that down, because I know you'll forget." "Come on, my memory's not that bad," replied the husband. "A dish of ice cream and some strawberries. I can remember that!" And with that, the husband shut the kitchen door behind him. The wife could hear him getting out pots and pans, and making some noise, preparing the dish. He came out of the kitchen about 15 minutes later. Walking over to his wife, he presented her with a plate of fried eggs. The wife took a look at the plate, glanced up at her husband and said, "Hey, where's the toast?" [/INST] question: The couple was worried about _ . | options: A: their bad health B: their lonely life C: their dangerous stove D: their poor memory | answer: D </s>
<s>[INST] context: CLASSIFICATION 1.4-Aminoquinolines: Chloroquine, Amodiaquine, Piperaquine. 2.Quinoline-methanol :Mefloquine. 3.Cinchona alkaloid :Quinine, Quinidine 4.Biguanides :Proguanil (Chloroguanide) Chlorproguanil 5. Diaminopyrimidines Pyrimethamine 6. 8-Aminoquinoline :Primaquine, Bulaquine 7.Sulfonamides and sulfone: Sulfadoxine Sulfamethopyrazine Dapsone 8. Tetracyclines:Tetracycline, Doxycycline 9. Sesquiterpine lactones:Aesunate, Aemether, Aeether 1 0. Amino alcohols:Halofantrine, Lumefantrine 1 1 . Mannich base:Pyronaridine 1 2. Naphthoquinone:Atovaquone 1. Aesunate-sulfadoxine + pyrimethamine (AS/5/P) This ACT has been adopted as the first line drug for falciparum malaria in chloroquineresistant areas under the &;National antimalaria drug policy&; of India, and has replaced chloroquine in 73 districts. However, this does not imply that it is the most effective/best ACT, because it is not effective against multidrugresistant strains which are nonresponsive to S/P. Moreover, no comparative evaluation of this regimen against AS/MQ or aemether/ lumefantrine, etc. has been done to establish the relative efficacy /tolerability. 2. Aesunate-mefloquine (AS/MQ) It has been extensively used in Thailand, Myanmar and several other countries; found to be highly effective, well tolerated and is now the first line treatment for uncomplicated falciparum malaria in Southeast Asia. Many areas in the far East already have mefloquine-resistant P. falciparum. By combining with aesunate, fuher spread of mefloquine-resistance has been prevented ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:781,795 [/INST] question: Most effective treatment for severe malaria is: | options: A: Aesunate B: Chloroquine C: Quinine D: Primaquine | answer: A </s>
<s>[INST] context: Teachers say the digital age has had a good and a not-so-good influence on the American teenagers. More than 2,000 high school teachers took an online survey. 75 percent of the teachers said the Internet and digital search tools have had a "mostly good" use for their students' research habits and skills, But 87 percent agreed that these technologies "make the students not have enough attention." And 64 percent said the technologies "do little to help them in courses." Judy Buchanan is a director of the National Writing Project. Ms. Buchanan says digital research tools are helping students learn more, and learn faster. Teachers really like these tools, because they are ways to make some of learning exciting. Young people enjoy using these tools. And the goal is to help them become creative students of meaningful work, and not just that kind of copyist. But one problem the survey found is that many students don't have a good understanding of how to use the digital knowledge well. In other words, they trust too much of the information. Judy Buchanan says these students have not developed the skills they need to tell whether the online information is good or bad. Another problem the survey found is something that might not seem like a problem, at all, being-able to quickly find information online. Teachers say the ability of their students to work hard to find answers is becoming weaker. They say students depend too much on search engines and do not make enough use, of printed books or research, librarians. Besides, many teachers are also worried about the problem that the Internet makes it easy for students to copy work done by others, instead of using their own abilities. [/INST] question: _ of the teachers agreed technologies may stop students from having enough attention. | options: A: 50% B: 64% C: 75% D: 87% | answer: D </s>
<s>[INST] context: Carl studied in our middle school three years ago. Last August his father found a job in another city and his family moved there. He began to study in the new school and we often write to each other. He often tells me something about the city where he lives now and his studies in the school. So I can know what happens to him. Last Friday Carl came to our city again. He hoped to accompany his old grandpa during the summer holiday. He was taller and stronger than before. We swam in the river outside the city together and had a picnic on the island. It surprised me that he had learnt to cook when we were traveling in the wild forest. He told me his parents were both busy and sometimes he stayed at home and he had to look after himself. "How do you like your school?" I asked. "Wonderful," said the young man." It has a tall building and there 're two chemistry labs, two biology labs and three physics ones. And its library is big and there're plenty of books in it." "I can see you are satisfied with it." "Yes," he answered. "But our geography teacher often says it himself in class." "So does our new history teacher." I said. "But he doesn't notice it. He often talks on and on in a flow of the eloquence , but none of us listens to him." [/INST] question: I can know what happens to Carl because _ . | options: A: he lives near to me B: he often calls me C: I often visit him D: he often writes to me | answer: D </s>
<s>[INST] context: Edema and effusion Disorders that disturb cardiovascular, renal, or hepatic function are often marked by the accumulation of fluid in tissues (edema) or body cavities (effusions). Elevated hydrostatic pressure or diminished colloid osmotic pressure disrupts this balance and results in increased movement of fluid out of vessels. Within tissues the result is edema, and if a serosal surface is involved, fluid may accumulate within the adjacent body cavity as an effusion. Increased Hydrostatic pressure Impaired Venous Return Congestive venous Return Constrictive pericarditis Ascites (liver cirrhosis) Venous obstruction or compression Thrombosis External pressure (e.g. mass) Lower extremity inactivity with prolonged dependency Aeriolar Dilation Heat Neurohumoral dysregulation Reduced plasma osmotic pressure (Hypoproteinemia) Protein- losing glomerulopathies (nephrotic syndrome) Liver cirrhosis (ascites) Malnutrition Protein - losing gastroenteropathy Lymphatic obstruction Inflammatory Neoplastic Postsurgical Postirradiation Sodium Retention Excessive salt intake with renal insufficiency Increased tubular reabsorption of sodium Renal hypoperfusion Increased renin-angiotensin-aldosterone secretion Inflammation Acute inflammation Chronic inflammation Angiogenesis [/INST] question: Oedema can be caused by: | options: A: decreased hydrostatic pressure B: sodium retention C: hyperproteinaemia D: polycythaemia | answer: B </s>
<s>[INST] context: If you live in the United States, the law says you can't have a full-time job until you are 16 years old. At 14 or 15, you can work part-time after school or on weekends, and during summer holidays you can work 40 hours each week. Does all that mean that if you are younger than 14, you can't earn your own money? Of course not ! Kids who are between the ages of 10 and 13 can earn money by doing lots of things. Valerie, 11, told us that she made money by cleaning up other people's yards. Susan, 12, said she had started taking art classes and showing her work to people. People ask her to draw pictures for them and they pay her for them. Jasmine, 13, writes articles for different magazines! Earning is learning. By working to earn your own money, you are learning the skills you will need to succeed in life. When you make your own money ,you don't have to depend on someone else. The five dollars that you earn will probably make you feel a lot better in your hand than the twenty dollars you ask for. [/INST] question: Kids can have full-time jobs at the age of _ in the USA. | options: A: 16 B: 14 C: 13 D: 10 | answer: A </s>
<s>[INST] context: Not only a popular singer was Yao Beina, but also she was an energetic and warm-hearted angel. She had her corneas donated to two men who needed them, which helped them see the world clearly again. Yao was born in a music family on Sept. 26, 1981 in Wuhan. She started to learn the piano at the age of 4, and she sang her first song on the stage when she was 9 years old. Yao did quite well in singing, so she took part in the thirteenth Youth Singing Competition and won the first prize. She became well-known to the public after making a series of songs for the hit TV drama "The Legend of Zhenhuan" in 2012, and the mandarin version of "Let It Go" from Disney's "Frozen". In July 2013, she competed in The Voice of China II and finally got the second place in Na Ying's team. She had won a lot of music awards before she was famous. Yao Beina was unfortunate to be diagnosed with breast cancer and had a successful operation in 2011. Since then, she has fought against the disease for about four years while keeping singing, but sadly she failed. She originally thought of donating all of her organs to save others' lives, but failed to do it because of her serious illness. She's gone, even though she had never stopped struggling with cancer. Heaven just got another beautiful angel, with her beautiful voice and kindness. [/INST] question: Yao Beina had her _ donated to save others. | options: A: two corneas B: all organs C: heart D: kidney | answer: A </s>
<s>[INST] context: A tall figure appeared from the dark door of the tent. It was a smoking young man about twenty three or four. He had an almost black face, though smooth. His moustache was black with curled points. There was an unusual force in his face, and in his daring rolling eyes. cef Rebecca still stood hesitating like a swimmer about to make his dive, hardly knowing whether to return or move forward. "Hi, my beauty, what can I do for you?" said he, approaching. Realizing that she was quite at a loss, the man spoke in a gentle voice, "Never mind. I am Mr. Thackeray. Have you come to see me or my mother?" This scene differed greatly from what Rebecca had expected. She had dreamed of an aged and dignified face. She told herself to be calm and answered "I came to see your mother, sir." "I am afraid you cannot see her-she is ill in bed," replied the representative of the house; for this was Mr. Alee Thackeray, the only son of the noble family. "What is the business you wish to see her about?" "It isn't business-it is-I can hardly say what!" "Pleasure?" "Oh no. Why, sir, if I tell you, it will seem..." Rebecca's sense of a certain ridicule(,) was now so obvious and strong that, despite her general discomfort at being here, her rosy lips curved towards a smile, much to the attraction of the young man. "It is so foolish", she murmured. "I fear I can't tell you!" "Never mind; I like foolish things. Try again, my dear," said he kindly. "Mother told me to come," Rebecca continued; "and, indeed, I was in the mind to do so myself. But I did not expect it would turn out like this. I came...sir, I came to tell you that we are of the same family as you." "Ho Ho! Poor relations?" "Yes." "Rossetti?" "No. Thackeray." "Ay, ay; I mean Thackeray." "Our names are worn away to Durbeyfield; but we have several proofs that we are Thackeray. The local scholars hold the view that we are, and...and we have an old seal and a silver spoon marked with the same castle as yours. So mother said we ought to make ourselves known to you, as we've lost our horse by a bad accident. We can hardly make a living." "It's very kind of your mother, I'm sure." Alec looked at Rebecca as he spoke, in a way that made her uneasy. "And so, my pretty girl, you've come on a friendly visit to us, as relations?" "I suppose I have," looking less confident and uncomfortable again. "Well, there's no harm in it. I mean it doesn't hurt to come and make yourself known to me. Where do you live? What are you?" ... [/INST] question: While meeting with Alec, Rebecca feels _ during the whole course. | options: A: nervous and uneasy B: excited and hopeful C: amazed and comfortable D: pleased but embarrassed | answer: A </s>
<s>[INST] context: It has taken 90 years since she was born in a poor house in County Limerick for a woman considered America's oldest illegal immigrant to get her Irish passport.It will be a few more months before Josephine Stout will finally be declared a US citizen, entitling(...) her to a pension and other benefits. Despite having lived in America for most of her life since she arrived in 1923, the great-grandmother was declared an undocumented alien in 1999, when she tried to claim state aid to help raise her seven grandchildren, who were left orphaned when her daughter was killed by a robber over$20. Even though she has never considered herself Irish, noting "I don't even have an accent," she didn't officially exist as an American when officials in Chicago insisted that she prove her citizenship in order to qualify for benefits. But she had no birth certificate or passport when she arrived on an immigrant ship from Ireland from Ireland with her parents, who had 12 other children. She never gave the matter much thought until 1999, when she was in her late 70s and needed assistance to raise her grandchildren. For 12 years, Mrs. Stout managed to support the family by doing various jobs. But her life was hard and marked by tragedy. Her husband died in 1996, and her son Thomas died in a car accident with his girlfriend in 1985. Her only surviving child, Rosemary, died of cancer in 2009. A Catholic charity referred her case to Chicago Irish Immigrant Support(CIIS), which alerted the Irish Consulate . Through them, they tracked down her birth certificate, the website irishcentral.com reported. The document, in turn, allowed her to receive her Irish passport, and eventually her American green card in September 2011, which was dated back to November 1, 1923. [/INST] question: What will happen to a person if he has no green card in the US? | options: A: he cannot get any chance to get education B: he can't have a pension and other benefits C: his citizenship will be taken away D: he has to take illegal part-time job | answer: B </s>
<s>[INST] context: Nathan Sawaya's childhood was a lot of fun. He drew cartoons, wrote stories, and played with plastic toy bricks . His grandparents bought his first set of toy bricks when he was five years old and he's been building with toy bricks ever since. He even took his building bricks to college with him! Instead of books and a computer, he had a model of Greenwich Village made of bricks on his desk. Nathan started as a lawyer but gave up His highly-paid job to become an artist that uses toys in his art. He uses toy bricks to build everything from the Statue of Liberty to Superman! He has more than 1.5 million colored bricks in his working room in New York which he uses to make pieces of art. He started by building small models but then decided to do something big and created a self-portrait . It took him two days just to build the eyes. Nathan's work has appeared in museums around the world. Children love his art because it is made out of the same toys that they play with at home and adults love his work because it is fascinating. Since it began in2007, Nathan's exhibition "The Art of the Brick" has been very popular with museum visitors everywhere. "I'm proud that I took a dream I had as a child, to become an artist, and I have actually made a job out of it," says Nathan. "To do what you love in life is the most important thing." [/INST] question: What did Nathan put on his desk at college? | options: A: The Statue of Liberty B: Superman C: His serf-portrait D: A Greenwich Village modal | answer: D </s>
<s>[INST] context: About ten men in every hundred suffer from colour blindness in some way. Women are luckier. Only about one in two hundred is affected in this matter. So some people say it is safer to be driven by women. There are different forms of colour blindness. In some cases a man may not be able to see deep red. He may think that red, orange and yellow are all shades of green. Sometimes a person cannot tell the difference between blue and green. In rare cases an unlucky man may see everything in shades of green--a strange world indeed. Colour blindness in humans is a strange thing to explain. In our eyes there are millions of very small things called "cones". These help us to see in a bright light and to tell differences between colours. There are also millions of "rods", but these are used for seeing when it is nearly dark. They show us shapes but no colour. Some insects have favourite colours. Mosquitoes like blue but do not like yellow. A red light will not attract insects, but a blue lamp will. In a similar way humans also have favourite colours. Yet we are lucky. With the aid of the cones in our eyes we can see many beautiful colours by day, and with the aid of the rods we can see shapes at night. One day we may even learn more about the invisible colours around us. [/INST] question: With the help of the cones, we can _ | options: A: see in a weak light B: tell different shapes C: kill mosquitoes D: tell orange from yellow | answer: D </s>
<s>[INST] context: The story of the day I lost my best friend to a car accident. The day a precious life was taken from us way too soon. It was a bright and Sunny day in November. Thanksgiving had been celebrated only two days before. Since it was a holiday weekend I had been on the phone with Greg the night before many times. His dad didn't want him to come over because of the holiday. I guess he finally wore him down and he called and said, "I can stay". So, my mom, brother, and I went to pick him up. He was always smiling. The complete opposite of my shy self, Greg was always the life of the party. We got two large pizzas that Friday night. I've never known anyone in my entire life who loved to eat more than Greg. That's the way he was though. He was just enjoying life. And if it meant gaining weight or whatever, so be it. He would sit back and put his hands on his belly and just laugh. We (Greg, David, and I) did so many funny things together and had such great times. Things we should have done and things we shouldn't have done, I'll "Never" forget. On Saturday morning Dad took us out for breakfast. We all finished eating and followed my Dad up to the cashier. Greg asked Dad if he could have a candy bar. I looked at Greg shaking my head. He just laughed. After breakfast, Father took us to my Mom's house. When we got out at Mom's house there was no one home. So, one of us grabbed a big wheel and rode it down the steep driveway into the street. Just boys being boys. Greg and I did it several times until the last time. The car hit him on the head, knocking him around 75-- 100 yards. My brother and I both ran screaming just yelling for help and crying. One of the neighbors called 911. I was in shock. That day was forever etched into our memories. It still hurts to think about it. Wishing we could have grown old together. Wondering how it would have been. I'm sure It WOULD HAVE BEEN GREAT. [/INST] question: We can describe Greg as _ . | options: A: impolite and greedy B: easy-going and optimistic C: shy and unconfident D: friendly and brave | answer: B </s>
<s>[INST] context: Governments and health officials around the world continued to take steps Tuesday against the outbreak of swine flu that has killed scores of people in Mexico and spread to the U.S., Europe and possibly Asia. By early Tuesday, the swine flu outbreak in Mexico had caused in 152 deaths and more than 1,600 illnesses. So far, at least 113 cases have been proved worldwide, including 64 in the United States; six in Canada; 11 in New Zealand and two each in Spain the United Kingdom and Israel. None has yet resulted in death. The World Health Organization on Monday raised its alert level from three to four on its six-level scale. The move means the U.N. agency has determined that the virus can transmit from human to human. "In this age of global travel, where people move around in airplanes so quickly, there is no region to which this virus could not spread," said Fukuda, assistant director-general of the WHO. Governments around the world struggled to prevent further outbreak. Some, like China and Russia, banned pork imports from the United States and Mexico. U.S. President Barack Obama said the outbreak was a cause for concern, not for alarm. The government urged travelers to avoid non-essential travel to Mexico. The latest WHO report listed only seven proved swine flu deaths in Mexico but it was not clear why there was the discrepency. Mexico City has closed all schools until at least May 6 to help curb(control) the spread of swine flu and ordered 35,00 public venues to close or serve only takeaway meals. In addition, bars, clubs, movie theaters, pool halls, gyms, sport centers and convention halls have been told to close until May 5. Armed police officers are also guarding hospitals in Mexico City while roads and schools in the city of 20 million people are deserted. Officials also have talked about shutting down the bus and subway systems. [/INST] question: How many people were found catching swine flu in Spain? | options: A: 2 B: 11 C: 6 D: 64 | answer: A </s>
<s>[INST] context: These x-rays show a marked degree of hyperinflation depicted radiographically by increased lung volume with flattened diaphragm and widened interspaces. Attenuation of the pulmonary vasculature in the peripheral lung zones, especially in the lower zones, is seen.These x-ray are consistent with severe emphysema. The lower lobe accentuation of hyperinflation is consistent with a1 antitrypsin deficiency causing panacinar emphysema. The physical signs and CXR suggest emphysema. This is confirmed by an obstructive ventilatory impairment with hyperinflation, air trapping, and reduced diffusion. In bronchial asthma, there would typically be marked bronchodilator response, and the patient with chronic bronchitis would present with chronic sputum production. Tuberous sclerosis presents radiographically as hyperinflation and lower zone infiltrates, but clinically is a systemic disease with a clinical triad of mental retardation, seizure disorder, and dermal angiofibromas called adenoma sebaceum. Pulmonary disease is rare (it is seen in less than 1% of cases) and presents with pneumothoraces and hemoptysis. Pulmonary emphysema is a chronic condition characterized by irreversible enlargement of airspaces distal to the terminal bronchioles with destruction of the alveolar walls and intraalveolar septa. It results in a loss of lung elastic recoil causing airflow obstruction, air trapping, and hyperinflation. Pulmonary function tests reveal an obstructive pattern with elevated total lung capacity, increased residual volume, and decreased diffusion capacity. Chest x-ray reveals all signs of hyperinflation as illustrated above. CT scan is the most sensitive imaging modality to reliably detect emphysema. Although pulmonary aery enlargement and mild pulmonary aerial hypeension are common in advanced emphysema, radiographic evaluation of pulmonary aery size is a poor indicator of PA pressures. Other concomitant pulmonary disease processes such as pneumonia or pulmonary edema may present in an atypical fashion in a patient with emphysema. Forms of emphysema include the following: 1. Centrilobular emphysema is the most common form, found predominantly in cigarette smokers. The destructive process begins with involvement of the center of the secondary lobule and extends into the lung parenchyma. The upper lobes are more frequently involved. 2. Panacinar emphysema begins with the involvement of the entire secondary lobule with diffuse, widespread lung destruction. It is seen in a1 antitrypsin deficiency and has lower zone predominance. 3. Paraseptal emphysema refers to peripheral lung destruction adjacent to the visceral pleura and interlobular septa. Progressive dyspnea associated with increasing paraseptal emphysema forming bullae refers to the "vanishing lung syndrome" 4. Congenital emphysema is seen in the first few months of life and refers to a large hyperlucent lobe associated with compressive and mass effect on the adjacent structures. 5. Compensatory emphysema refers to hyperlucent and hyperinflated airspaces adjacent to areas of deformity, atelectasis, or resection of lung and represents overexpansion without actual lung destruction. 6. Scar emphysema is associated with conditions of fibrosis and scarring and associated honeycombing as in stage 4 sarcoidosis or chronic inflammatory conditions. [/INST] question: A 50-year-old male smoker is evaluated for chronic shoness of breath. On physical examination his vital signs are: pulse 110 bpm; temperature normal; respirations 30/min with use of accessory muscles and pursed-lip breathing; blood pressure 110/78 mm Hg. Other peinent findings are: hea exam: apex beat (impulse) is medial to the midclavicular line with generalized decreased breath sounds on lung exam; ABGs (FiO2 0.21): pH 7.38; PCO2 47 mm Hg; PO2 67 mm Hg. PFTs/spirometry: FVC 2.80 L (67% of predicted); FEV1 1.56 (50% of predicted); FEV1/FVC% 56%; TLC 134% of predicted; RV 170% of predicted; DLCO 43% of predicted. There is no reversibility with bronchodilators. Chest radiograph are shown below.What is the most likely diagnosis? | options: A: Bronchial asthma with status asthmaticus B: Emphysema C: Chronic bronchitis D: Tuberous sclerosis | answer: B </s>
<s>[INST] context: Until she was six, Oprah Winfrey lived on a farm with her grandmother. She remembers, "One day, my grandmother was boiling clothes because at that time we didn't have a washing machine. I was four years old, and I remember thinking, 'My life won't be like this. It will be better.' " It is better-- much better. Winfrey is a billionaire, and "the Oprah Winfrey Show", which is watched by over 20 million people every day, has won many awards. As a little girl, Winfrey was always different. She learned to read when she was three. She read the Bible in church and was famous for being the little girl who talked a lot. Since then, talking has been the most important part of her life. She got her first big chance while at Tennessee State University. At age 17, she was offered a job at a radio station. Next, she hosted a talk show, " People Are Talking" , which soon became very popular. People felt comfortable telling her about their lives, and people liked her warm interviewing style. After a year, the show was renamed " The Oprah Winfrey Show" , and she was a star. Winfrey's real dream, though , was to be an actor. Finally, she achieved this when she starred in " The Color Purpose" in 1985. Her performance won her an Oscar nomination . She now has her own production company. Harpo Productions ("Harpo" is "Oprah" spelled backward).Winfrey says her greatest lesson in her life is " not living my life to please other people, but doing what my heart says". [/INST] question: When did Oprah Winfrey make up her mind that her life would be better? | options: A: At the age of 3 B: At the age of 4 C: At the age of 6 D: At the age of 17 | answer: B </s>
<s>[INST] context: President Barack Obama set out his plans for the nation on January 27. At the top of his to-do list: his jobs for Americans, health care and education. "Although we have our difficulties, our union is strong. We do not give up. We do not stop," President Barack Obama told American in his State of the Union speech on January 27. Guests and government officials filled the hall of the House of Representatives . Obama looked back on his first year in office and explained his plan for the future. He dealt with important matters, including health care, the nation' s high unemployment, national security and education. Many times during the 70-minute speech, people in the hall clapped their hands happily. The U.S. law system requires the President to report regularly to government officials. Presidents see the speech as an opportunity to set their goals and encourage the nation. The President devoted much of his speech to the _ of unemployed Americans. "Jobs must be our Number 1 focus in 2010," he said. "People are out of work. They are hurting." Obama also stressed the value of education. "The best way for people to lead a better life is a first-class education." he told the nation. Following the President's speech, the other party always gets the chance to speak. Bob McDonnell, the new governor of Virginia, spoke for Republicans . He agreed with many of Obama's goals, but pointed out policy difference. He tried to persuade both parties to work together. The President had made the same point earlier in the evening. He promised to hold monthly meetings with members of both parties. "Let's show the American people," he said, "that we can do it together." [/INST] question: Which of the following things does Obama consider the most important in 2010? | options: A: Health care B: Jobs C: Education D: National security | answer: B </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 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 PAKTY. 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 9am and 5pm weekdays. (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 6pm at 555-9834. [/INST] question: How many of the seven ads are placed by people who want to hire someone for a certain job? | options: A: Four B: Three C: Two D: Five | answer: B </s>
<s>[INST] context: Contraindications Even if the tooth is indicated for removal, the presence of certain factors makes the tooth contraindicated for extraction. They may be relative or absolute contraindications. They can be considered relative, if the contraindication is provided with additional care, one can overcome the complication. In other words, given the situation, the patient is made fit to undergo extraction, once the underlying condition is treated. On the contrary, there are a few conditions which are absolute contraindications. These factors will be the impediments for extraction, even if care is taken. If extraction is carried out in the presence of such absolute contraindications, the outcome may be even fatal. Hence, it is essential to differentiate between these two types of contraindications. To avoid legal consequences, it is preferable to avoid extraction, if the contraindication is absolute. The contraindications may also be classified as systemic or local factors. The presence of absolute systemic contraindications indicates that this group of diseases exists in an uncontrolled state. No attempt should be made by the dental surgeon to thrust extraction on such patients. By doing so the clinician will be inviting disaster, e.g. metabolic disorders like uncontrolled diabetes, uncontrolled cardiac problems, leukemia, renal failure and liver disorders like cirrhosis of liver. Local contraindications: The most common local contraindication is an ongoing acute inflammatory or infectious process. The acute infection/inflammation should first be treated before proceeding with the extraction, depending on the location of the acute process. Extraction of a third lower molar during an ongoing acute pericoronitis could lead to a lifethreatening postoperative infection. However, there are also situations where an acute abscess is best drained by extraction of the tooth even in an acute phase. An acute infectious process caused by pulpal disease is resolved most quickly by extraction of the tooth. Therefore an acute infectious and inflammatory process should not be considered as an absolute contraindication for extraction [/INST] question: Which of the following is not an absolute contraindication for extraction of teeth is | options: A: Uncontrolled diabetes B: Uncontrolled hypertension C: Leukemia D: Acute abscess with tooth | answer: D </s>
<s>[INST] context: Alzheimer's disease Coical atrophy Deposition of amyloid b plaque & tangles Cerebellar amyloid angiopathy Association with chromosome 14 and chr.1 Premature Alzheimer's - mutation in App gene (amyloid precursor protein)-on chr.21 3 copies of chr.21 -more amyloid precursor protein?premature Alzheimer's Downs syndrome patients have high risk of Alzheimer's disease Abnormal folding of Ab peptides causes aggregation within neurons and apoptosis Some degenerative diseases of the CNS are associated with neuronal intracytoplasmic inclusions, such as neurofibrillary tangles of Alzheimer disease and Lewy bodies of Parkinson disease Cerebral amyloid angiopathy (CAA) is the risk factor most commonly associated with lobar hemorrhages. In CAA, amyloidogenic peptides, usually the same ones found in Alzheimer disease are deposited in the walls of medium and small caliber meningeal and coical vessels. This deposition can weaken the vessel wall and lead to hemorrhage. Many individuals with CAA have evidence of numerous small hemorrhages within the brain ("microbleeds"), which can be visualized by various imaging methods. As with Alzheimer disease, in which there is a relationship between a polymorphism in the gene that encodes apolipoprotein E (ApoE) and risk of disease,there is an effect of the ApoE genotype on the risk of recurrence of hemorrhage from sporadic CAA. The presence of either an e2 or e4 allele increases the risk of repeat bleeding. While some mutations in the precursor protein for the Ab peptide (amyloid precursor protein, APP) cause familial Alzheimer disease, others result in autosomal dominant forms of CAA. [/INST] question: Which of the pathognomic feature of Alzheimer's disease? | options: A: Lewy body B: Plaques and tangles C: Pick bodies D: Red neuronal degeneration | answer: B </s>
<s>[INST] context: This question has been answered wrongly by most of the guides. Please remember few basic things about adjustment disorder and depression. Adjustment disorder is always seen after a stressful event, which is usually a negative life event. The symptoms of adjustment disorder are quite similar to depression and include depressed mood, anxiety, worry, a feeling of inability to cope and some degree of disturbance in individuals daily functioning. Now, a negative life event can also precipitate the depressive episode. So, the presence of a stressor cannot be used to differentiate between adjustment disorder and depression. If a patient has the symptoms severe enough to qualify the diagnosis of depression, depression would always be diagnosed ahead of adjustment disorder, irrespective of whether there was a stressor or not. In this case patient has the symptoms such as loss of interest, ideas of hopelessness (patient is convinced that she won't be able to work again) and most impoantly suicide attempt, all of which are highly suggestive of depression. Hence, the diagnosis would be depressive disorder. [/INST] question: A 27 year old nurse had extracurricular interests in trekking and painting. She broke up relationship with her boyfriend. Two months later she lost interest in her hobbies and was convinced that she would not be able to work again. She thought life was not woh living and consumed 60 tablets of phenobarbitone to end her life. She is most likely suffering from: | options: A: Adjustment disorder B: Acute stress disorder C: Depressive disorder D: Post traumatic stress disorder | answer: C </s>
<s>[INST] context: Ladybirds didn't have black spots on their backs at first. Then a storm broke out, and their famous guide, Caius Insectus, disappeared into the flood , and the few ladybirds who survived had to choose a new leader to guide them out of trouble. They decided that their new leader would be the first ladybird to successfully travel south to the Great Lake and return to describe it. Many young ladybirds moved off immediately into this adventure. One by one they returned and told of how beautiful the southern lake was at that time of year, with its clear waters and flowers. However, the last of the ladybirds was late in getting back. He hadn't managed to reach the lake. Everyone criticized him, and they prepared to continue their journey the next day. Following their new guide, they spent a morning walking northwards until they reached some tall thick grassland, where they stopped. There were no clear waters or flowers in front of them. The heavy rain had turned the place into a huge green puddle . Everyone understood what had happened. When the ladybirds had gone out looking for the lake, they had gone in the wrong direction. Now they could see that, except that one late ladybird, they had lied in order to get what they wanted. And so, the late little ladybird was made the Great Guide. They also decided that every time one of them was discovered lying they would paint a black spot on that ladybird's back. From then on, when a ladybird looks at another's back, it can tell whether that ladybird can be trusted. [/INST] question: Why did the ladybirds decide to choose a new guide? | options: A: They lost their way in the storm B: They weren't satisfied with Caius Insectus C: They needed someone to lead them out of danger D: They needed someone to help prepare for the storm | answer: C </s>
<s>[INST] context: At age 11, Ghulam was married off to 40-year-old Jaiz in a rural Afghan village, making her only one of more than 10 million young girls who are being forced to wed men old enough to be their fathers of grandfather every year. In an effort to start a global conversation about the devastating effects of early marriages, which are currently practiced in more than 50 developing countries, the United Nations designed October 11 as International Day of the Girl Child this year. Although child marriage is against the law in many countries, and international treaties forbid the practice, it is estimated that about 51 million girls below age 18 are currently married, often under the cover of darkness and in secret. In Afghanistan alone, it is believed that approximately 57 percent of girls wed before the legal age of 16. Various factors drive parents of child bridges to marry off their daughters, from the community's pressure to confirm to age-old cultural customs to economic considerations. In poor, developing nations, it is not uncommon for families to settle debts by offering their daughters as payment. Experts agree that early marriage denies the girl education and robs them of their childhood because most young wives, burdened by grownup responsibilities, do not get a chance to interact with their peers or carry on friendships outside the household. In many cases, the girls are lorded over by their husbands and in-laws, leaving them vulnerable to domestic violence as well as physical, sexual and verbal abuse. Underage wives who are lucky enough to escape from their husbands end up living in poverty, or worse. Most girls who enter early marriages are expected to get pregnant right away, which often leads to tragedy for both the mothers, who are still children themselves, and their babies. Unless international organizations take steps to reverse the troubling trend, it is estimated that over the next decade, 100 million more girls--or about 25,000 girls a day ---will marry before they turn 18. To learn more about campaign to end the practice of early marriages, please click: Too Young To Wed. [/INST] question: The UN made October 11 as International Day of the Girl Child in order to _ | options: A: urge parents to treat girls equally as boy B: call on people to pay more attention to girls' education C: call on people to pay more attention to girls in poor countries or areas D: start a global campaign against early marriages | answer: D </s>
<s>[INST] context: PITYRIASIS The term pityriasis is used to describe skin condition in which the scale appears similar to bran. So, any skin disease with pityriasis in its name will be scaly. Differential diagnosis of different Pitriasis Pityriasis rosea Children and young adults Erythmatous annular plaque → Mother patch (Herald patch) Mainly involves Trunk. Christmas tree or Fir tree configration Collarette scales (cigar paper scale) Self limiting course Pityriasis rubra pilaris Two peaks → 5-10 years and 40-60 years Elythmatous (orange to pink), follicular, scaly plaques Characteristic presence of distinct island of normal skin Involvement of trunk with cranio caudal distribution Nutmeg papules on knuckles Thickening of palms (Palmer thickening) & soles (keratoden-nic sandals) Pityriasis lichenoides 1)   Pityriasis lichenoides et variolifermis acuta Constitutional symptoms; fever, arthralgia Multiple erythmatous & edematous papules often surmounted by vesicles Lesions heal with hyperpigmented scar  Trunk and flexures of arm 2) Pityriasis lichenoides chronica Successive crops of red-brown papules which are surmounted by a central adherent mica like scales Lesions heal with hypopigmentation Trunk and proximal part of extremities Pityriasis alba Children (6-12 years) Hypopigmented macule on face Presence of fine scales Pityriasis versicolor Young adults Hypopigmented macule Fine scales → Furfuraceous or rice powder like scales Involvement of Trunk and shoulder (chest & backs) Note - Pityriasis Rosea, Pityriasis rubra pilaris and pityriasis lichenoides are papulosquamous lesions, whereas pityriasis versicolor and pityriasis alba are not papulosquamous lesions. [/INST] question: Multiple erythematous annular lesions with peripheral collorette of scales arranged predominantly on trunk are seen in – | options: A: Pityriasis vesicular B: Pytiriasis rubra pilaris C: Pityriasis rosea D: Pityriasis lichennoides chronica | answer: C </s>
<s>[INST] context: Hanukkah Hanukkah is a Jewish festival. It is celebrated on the 25th day of the Jewish month of Kislev , which is usually sometime in December. It is often called the festival of lights. The festival celebrates the time, over 2,000 years ago, when the Jewish people fought against an emperor who would not let them follow their own traditions and religion. When the Jewish people won back their temple in Jerusalem, they found there was only enough holy oil to keep the sacred light burning for one day. However, to their surprise, this small amount of oil kept the light burning for eight days and nights, until the people had time to make more oil. At the center of the Hanukkah celebrations is a candlestick (called a Menorah) that holds nine candles. On the first night of Hanukkah the first candle is lit, and each day this candle is used to light another candle, until on the eighth day, the last day, all the candles are lit. During Hanukkah, people go to the synagogue to pray and to remember the miracle of the holy oil. Hanukkah is a time for family and friends to come together. People exchange gifts and greeting cards, and children go to parties. Parents often give their children money at Hanukkah. Potato cakes, called latkes, are a traditional Hanukkah food. [/INST] question: For how many days does Hanukkah last? | options: A: 7 B: 10 C: 9 D: 8 | answer: D </s>
<s>[INST] context: Researchers in over 80 nations are taking part in a project to conduct a decade-long census of sea life. Scientists presented some of their findings at a recent conference as the project neared its completion. In deep icy waters under Antarctica, scientists found bulbous tunicates, an underground animal, and many newly-discovered creatures believed to be related to starfish and other marine creatures. Elsewhere in the world's oceans, they have recently discovered many kinds of underwater life forms new to science. It is all part of a research effort called the Census of Marine Life. "There are about 2,000 scientists worldwide involved," said Bob Gagosian, President, CEO of the Consortium for Ocean Leadership. Gagosian helps manage the project. "Everywhere they've gone they've found new things," he says. "The ocean basically is unexplored from the point of view of marine living things." Researchers have placed small markers on hundreds of fish and marine animals to track by satellite their migration routes and to discover places where sea life gathers. According to Ron O'Dor, a senior scientist with the Census of Marine Life, knowledge of life on the ocean floor is especially limited. "90% of all the information we have is from the top hundred meters of the ocean," O'Dor states. And he says the sea floor is, on average, at a depth of 4, 000 meters. And so, as some machines dive far below what people have previously seen, scientists are discovering new species of plants, animals and living things. Since the census project began, more than 5,300 new marine animals have been found. Ocean researchers say they hope to catalogue 230,000 species during the census --which some say is only a small part of all the creatures living in the sea. [/INST] question: Why do the researchers place small markers on many marine creatures? | options: A: To catch them B: To research them C: To kill them D: To protect them | answer: B </s>
<s>[INST] context: The British coloney of Bermude is a top summertime escape. Yet, even through October, Bermuda isn't ready to stop for the winter. During this month, world-class festivals on teh island keep things lively and the weather remains comfortable enough for Bermuda shorts and bathing suits. In October, Bermuda hosts two major festivals--the Bermuda Music Festival and the Bermuda Culinary Arts Festival. The 10thanniversary Bermuda Music Festival begins October 5 and features three days of performances at the Royal Naval Dockyard on Bermuda's West End. Featured main stage performers include Joss Stone, Pattie Labelle, and Al Green, and a second stage spotlights local Bermudian artists. General admission tickets start at $60 for on e day or $160 for a three-day pass. Starting October 21, the Culinary Arts Festival brings some of North America's top chefs to the island for four days of food and wine tastings, conferences and cooking competitions. Participating chefs include Todd English and Michael Lomonaco, among others. Three-day festival passes start at $649 per person, but you can also buy separate tickets for individual events. Even if you don't attend one of the festivals, there's still plenty to do. With mostly sunny days and temperatures averaging aroung 79 degrees, the weather is just right for participating in Bermuda's two favorite pastimes--golf and tennis. With fewer visitors on the island than during the summer, you may have an easier time getting the best times or a spot on the courts. It's also still warm enough to enjoy the island's pink sand beaches and go swimming, because the water keeps the summer's heat longer than the air. Of course, you can always shop in the city of Hamilton's upscale small goods arts and crafts shops. [/INST] question: The Culinary Arts Festival lasts _ . | options: A: from October 5 to 7 B: from October 5 to 8 C: from October 21 to 24 D: from October 21 to 25 | answer: C </s>
<s>[INST] context: T. verrucosum is a zoophilic species . The dermatophytes on the basis of their natural habitat and host preferences can be classified into following groups: (i) Anthropophilic species: These dermatophytes are typically adapted to live on human host. They are transmitted from human to human through fallen hairs, desquamated epithelium, combs, hair brushes, towels, etc. Examples: T. rubrum, T. mentagrophytes ,T. schoenleinii, T. tonsurans and T. violaceum, M. audouinii ,E. floccosum. (ii) Zoophilic species: These are the dermatophytes that live on animals and often cause infection in their animal host. These zoophilic species are transmitted from infected animals to humans by direct and indirect contacts with domestic animals (e.g., cat and dog) and occasionally wild animals. Examples: T. equinum T. verrucosum M. canis, M. equinum. (iii) Geophilic species: These are saprophytic fungi found in soil or in dead organic substances. They occasionally cause infection in humans and animals. Examples are Microsporum gypseum, E. stockdaleae and Trichophyton ajelloi. [/INST] question: Which of the following is spread from animals to man - | options: A: T. rubrum B: T. tonsurans C: T. floccosum D: T. verrucosum | answer: D </s>
<s>[INST] context: Renal colic The main pharmacological action of Nitrates Nitroglycerine relaxes all types of smooth muscle irrespective of the state of the preexisting muscle tone. The most prominent action is exeed on the vascular smooth muscle. - Apa .from vascular smooth muscle nitrates also cause relaxation of the smooth muscles of the bronchi, gastrointestinal tract (including biliary system) and genitourinary tract. Nitrates are rapidly denitrated in the smooth muscle to release nitric oxide which activates cytosolic guanyl cyclase which in turn increases CGMP that leads to vasodilation Effect of nitrate on cardiovascular system Enzymes activates Nitrates --4 NO --> Gyanylcyclase 1' CGMP Vasodilation Nitrates cause relaxation of all the components of vascular system from large aeries to veins, aerioles and capillaries. Veins respond at the lowest concentrations and aeries at slightly higher one (Veins express greater amount of the enzyme that generates NO )from organic nitrates). The primary direct result of an effective dose of nitroglycerine is marked relaxation of veins with increased venous capacitance and decreased ventricular preload. This leads to reduction in pulmonary vascular pressure and hea size. Effect of nitrates on coronary circulation '* In normal subjects without coronary disease - Nitroglycerine can induce a significant if transient increase in total coronary blood flow. In patients with angina due to atherosclerosis - There is no evidence that total coronary .flow is increased in patients with angina due to atherosclerotic obstructive coronary aery disease. However, in these patients - Nitrates cause redistribution of coronary blood flow from normal to ischemic regions which may play role in therapeutic effect. There are two types of vessels in coronary circulation :Larger conducting aeries They run epicardially and send perforating branches to deeper tissue. Smaller resistance vessels These are the perforating branches of larger conducting aeries. These aerioles supply blood to endocardium. If there is ischemia in any region of endocardium the perforating vessels of those region are dilated due to autoregulation (hypoxia causes vasodilation). Nitrates preferentially dilates larger conducting vessels. This pattern of action ours more blood flow towards the ischaemic zone as the smaller endocardial vessels are already dilated as a result of hypoxia / ischaemia. Nitrates in hea failure Nitrates afford relief by causing venous pooling of blood. - Nitrates reduce venous return (preload) decreases end diastolic volume -4 improvement in left ventricular function by Laplace law regression of pulmonary congestion. Nitrates are used in cyanide poisoning Cyanide poisoning results from complexing of cytochrome iron by the CV ion. - Methemoglobin has a very affinity for CN ion. - Methemoglobin combines with CN to form cyamnethemoglobin which is rapidly excreted by the body. It is a well known fact that Nitrates generate generate Methemoglobin when they combine with Hb. - Thus administration of nitrates will generate large amount of methemoglobin. - Due to its high offinity.for cyanide, methemoglobin combines with cyanide .forming cyanmethemoglobin. - This will regenerate active cytochrome. - However this may again dissociate to release cyanide. - The cynamethemoglobin can be fuher detoxified by the intravenous administration of sodium thiosulfate. This results in formation of thiocyanate ion a less toxic ion that is readily excreted. Biliary colic Esophageal spasm Sublingual GIN promptly relieves pain. Nitrates taken before a meal facilitate feeding in esophageal achalasia by reducing esophageal tone. Also remember these impoant propeies of Nitrates. Oral availability of Nitrates is low The liver contains a high capacity organic nitrate reductase that removes nitrate groups in a stepwise _fashion from the parent molecule and ultimately inactivates the drug. Therefore oral bioavailability of the traditional organic nitrates e.g. nitroglycerine and isosorbidedinitrate is very low. For this reason sublingual route is preferred for nitrates. Nitroglycerine and isosorbide dintrate are both absorbed effectively by this route and reach therapeutic blood levels within a few minutes. Nitrates develop tolerance With continued exposure smooth muscles develop tolerance to nitrates. The mechanism by which tolerance develops are not completely understood. As noted above diminished release of nitric oxide resulting from depletion of tissue thiol compounds may be paly responsible ,for tolerance to nitrates. Some student argue that cyanide poisoning should be the answer because nitrites not nitrates are used in cyanide poisoning but we are not convinced. All the standard books group them together and do not differentiate between nitrates or nitrites. More so Nitrates have'nt found wide clinical use in Renal colic - None of the standard text books mention use of nitrates in renal colic. - Both Goodman Gilman and KDT says that unlike its consistent effect on muscles of biliary tract, the action of nitrates on ureteric muscles is variable therefore it has not found application in renal colic. - None of the studies and research papers convincingly state that nitrates should be used in renal colic. Nitrates have been anecdotally used only in uruguay to treat renal colic. A trial was conducted based on this but it did'nt come out with conclusive results. - It states that large trials and studies should be undeaken before nitrates before nitrates use is begun clinically. [/INST] question: Nitrates are not used in | options: A: CCF B: Esophageal spasm C: Renal Colic D: Cyanide poisoning | answer: C </s>
<s>[INST] context: Prader-Willi syndrome (PWS) is a genetic disorder due to loss of function of specific genes. In newborns symptoms include weak muscles, poor feeding, and slow development. In childhood the person becomes constantly hungry which often leads to obesity and type 2 diabetes. There is also typically mild to moderate intellectual impairment and behavioral problems. Often the forehead is narrow, hands and feet small, height sho, skin light in color, and they are unable to have children. About 70% of cases occur when pa of the father's chromosome 15 is deleted. In another 25% of cases the person has two copies of chromosome 15 from their mother and none from their father. As pas of the chromosome from the mother are turned off they end up with no working copies of ceain genes. PWS is not generally inherited but instead the genetic changes happen during the formation of the egg, sperm, or in early development. There are no known risk factors. Those who have one child with PWS have less than a 1% chance of the next child being affected.] A similar mechanism occurs in Angelman syndrome except there is a defective chromosome 15 from the mother or two copies from the father. Prader-Willi syndrome has no cure. Treatment, however, may improve outcomes, especially if carried out early. In newborns feeding difficulties may be suppoed with feeding tubes. Strict food supervision is typically required staing around the age of three in combination with an exercise program. Growth hormone therapy also improves outcomes. [/INST] question: Paternal 15 chromosome deletion is seen in - | options: A: Angelman syndrome B: Prader Willi syndrome C: Down syndrome D: Turner syndrome | answer: B </s>
<s>[INST] context: Cities need to put efforts to deal with pollution and clear the air. Chinese cities will need to put efforts to clear up the sky when a new department to improve regional air quality is set up by 2015, according to the latest plan released by the State Council. Besides the existing pollution control program for SO2, regional emission caps for other certain chemicals will be established in the three key air polluting areas-- the Yangtze River Delta, Pearl River Delta and the Beijing-Tianjin-Hebei region. Coal-consumption caps will also be tried out in some areas, according to the plan. "The plan is aimed at dealing with regional air pollution--such as acid rain and smog--which have become increasingly obvious in China in recent years and caused a severe threat to people's health," Zhang Lijun, vice-minister of environmental protection, said in an interview on Monday. "The air quality in a city affects the regions nearby because pollutants Can travel through the atmosphere," said Chai Fahe, vice-director of Chinese Research Academy of Environmental Sciences. "So efforts to reduce air pollution in a single city, targeting a certain pollutant will not be enough," Chai said. Zhang said, "The country's major industrial districts--the Yangtze River Delta, Pearl River Delta and the Beijing-Tianjin-Hebei region--have recorded more than 100 misty days annually in recent years." These three regions, home to at least 200 million people, occupy only 6. 3 percent of the country's area but consume 40 percent of the country's coal and produce half of its steel, according to official figures. Studies also show that the visibility in eastern regions of China has dropped by 7 to 15 km compared to that in the early 1960s, as a result of air pollution. Liaoning province, the Shandong Peninsula, Wuhan in Hubei province and its surrounding area, the Changsha-Zhuzhou-Xiangtan region in Hunan province, the Chengdu-Chongqing region, and the western coast of the Taiwan Straits are also listed as areas to carry out such regional air pollution control programs, according to the plan. The new plan also requires an improved air quality system, which will measure the pollution levels. "The current system, which only measures some major pollutants, cannot reflect ." said Chai. [/INST] question: It will not be enough to reduce air pollution in a single city because _ . | options: A: air pollution has been becoming more and more serious in recent years B: air pollution like acid rain and smog is threatening people's health C: air pollutants in a city can travel in the sky and affect nearby areas D: air pollutants stay in fixed places over the cities | answer: C </s>
<s>[INST] context: During the outbreak of 2009-2010 H1N1 or "swine flu", the same virus that caused mild coughing and sneezing in some patients proved deadly for others. It highlighted a medical mystery: why are some people more fit to handle the flu than others? British and American researchers think they have a clue. Reporting on Sunday in the journal Nature, researchers say they've found a gene that influences our ability to fight against flu illness. The gene, called IFITM3, is the "important first line of defense" against the flu, researcher Paul Kellam of Britain's Sanger Institute told Reuters. The IFITM3 protein prevents flu viruses from reproducing in cells. So, if you have a high amount of IFITM3, you're in luck, since it weakens the spread of the virus; a low amount can lead to more rapid viral reproduction, causing severe flu symptoms, according to Kellam. Scientists first found in gene studies that IFITM3 played a role in resistance to flu and other viruses. In experiments in mice, they showed that when mice were raised to lack the IFITM3 gene and then infected with influenza, the animals developed more severe lung infection from flu, compared with mice that had the gene. To figure out the role of IFTTM3 in humans, researchers then studied the IFITM3 genes of 53 patients with the flu in 2009-2010. They found that these patients were more likely to have a variant of the IFITM3 gene -- which makes people more vulnerable to flu -- compared with the general population. According to evidence from large genetic databases, about 1 in 400 people carries this IFITM3 variant, the BBC reports. "Our research is important for people who have this variant as we predict their immune defenses could be weakened to some virus infections," said Kellam. The Findings also suggest that a drug that functions as IFITM3 could help increase resistance to flu and other viruses, including deadly ones like H5N1 flu. [/INST] question: You are less likely to get infected with H1N1 if _ | options: A: a variant of EFIM3 is produced B: the immune system is weakened C: protein doesn't function in your cells D: you have a high amounts of IFITM3 | answer: D </s>
<s>[INST] context: Traveling by train is usually not easy in China. It can be hard to get a ticket. When you're traveling to the railway station, you look at your watch, for you are afraid you will miss your train. But there is good news for people traveling between Beijing and Shanghai. Construction on the express railway between the two cities started just before the Spring Festival of 2008. When it is finished by 2013, taking a train will be as easy as taking a bus. "There will be trains every several minutes. Buying a ticket, getting through the checkpoint and taking your seat, will take just 10 minutes," said an engineer. There may be high-speed trains running at 350 kilometers an hour. The travel time between the two cities will _ from 10 to about 5 hours. The trains will carry twice the present number of passengers. The new line will be 1,318 kilometers long and go across specially built bridges. It will run along side the present line. There will be 21 stations in Hebei, Tianjin, Shandong, Anhui and Jiangsu. "The cost of traveling by the express railway may be around 800 yuan. That will be more expensive than an ordinary train, but cheaper than by air." Said Zhang Xiaoling, a Jiangsu government official. According to Zhang, the higher price is caused by the large cost of the railway project. At about 200 billion yuan, the project may be even more expensive than the Three Gorges Project . [/INST] question: The express railway between Beijing and Shanghai will be finished _ . | options: A: at the end of this year B: before the Spring Festival of 2008 C: by 2013 D: in about 5 years | answer: C </s>
<s>[INST] context: Do you ever fight with your little brother or sister? How would you like to travel around the world with them in a musical group? Sisters Johanna and Klara Soderburg are doing just that in their band, First Aid Kit! The two sisters are sweeping the world with a perfect mix of pop and folk music. The Soderburg sisters come from Sweden. Their music sounds like music from the 1960s. They both play several instruments. And, since they are sisters, their voices fit together perfectly! Like many other teen stars before them, the two girls got their start on the website, YouTube. Their singing caught the attention of a Swedish musician. It wasn't long before people all over the world discovered their music! The sisters don't just sing or play instruments; they also write their own music and design all of their album art!They have worked very hard, and they _ four new songs at the beginning of 2011! If you want to hear the songs, check out their music in YouTube for yourself! Listen to see why First Aid Kit is your new favorite band! [/INST] question: Johanna and Klara Soderburg are famous for _ . | options: A: touring the world B: their musical group C: a perfect mix of music D: cleaning the world | answer: C </s>
<s>[INST] context: During the week days, they are luckily busy office people; but on weekends, they are just a brood of stay-home animals. A recent survey shows that office workers in China prefer quiet and easy ways to spend their weekends. In the survey, conducted by job seeking and offering website Zhaopin.com, 32.8 percent of the 6,000 respondents choose to stay home at weekends and have a good rest, the Beijing Morning Post reported. Twenty percent use their days-off to do housework. And only 19.3 percent are willing to have fun during the break time from work. Their first choice of fun is shopping. Other choices, though practiced by few, include meeting friends, accompanying the children, trips to the suburbs, and lessons for more skills. When they. go shopping, 54.5 percent of the white-collars actually shop in supermarkets, while 27.9. percent attend other stores, especially when discounts are offered. These activities don't seem to cost much, as 60 percent spend average less than 200 yuan (US$26) during weekends, and 30 percent no more than 500 yuan. When asked whom they would spend the weekends with, about 40 percent mention their partners, and 30 percent prefer a weekend all by themselves. Less than 20 percent hang out with friends. Only 5.8 percent would kill the time with their colleagues. This is because we tend to avoid too many personal contacts with our co-workers when we don't have to work with them, according to some experts. [/INST] question: How many of the office workers who are the respondents do the housework at weekends? | options: A: 1,968 B: 1,158 C: 1,200 D: 1,674 | answer: C </s>
<s>[INST] context: X Ray Findings - Chest Heart & Blood Vessels * Flask-shaped / Pear-shaped / Leathe- bottle / Money-bag shaped heart - Pericardial effusion * Boot-shaped heart / Coer-en-sabot - Fallot's tetralogy * Box shaped appearance - Tricuspid atresia * Jug Handle appearance - Primary pulmonary artery hypertension * "3" like appearance - Coarctation of Aorta * Egg on side appearance - Transposition of great vessels * Egg in cup appearance - Constrictive pericarditis * Snow-man heart - TAPVC (total anomalous pulmonary venous connection) * Figure of '8' - TAPVC (total anomalous pulmonary venous connection) * Cottage Leaf appearance - TAPVC * Pericardial calcification - Constrictive pericarditis * Calcification in heart wall - is seen in - Carcinoid syndrome * Calfication of ascending aorta - Atherosclerosis, Syphilis * Hilar dance on fluoroscopy - Atrial Septal Defect * Xray finding in Ebstein's anomaly - Pulmonary oligemia * Posterior displacement of trachea - seen in - aneurysm of aorta * Obliteration of left border of heart (PA view of chest) is - suggestive of - Lingular pathology (left lung) * Bat's wings appearance - Pulmonary oedema * Pruned tree appearance (of pulmonary circulation) - Pulmonary artery hypertension Lungs * Ground glass appearance - Hyaline membrane disease * Solitary pulmonary mass lesion > 4cms - is most commonly due to - Bronchial adenoma * Honey Comb appearance - o SarcoidosisQ o Histiocytosis XQ o Interstitial lung diseaseQ o TuberculosisQ o Collagen disordersQ o PneumoconiosisQ o Drugs - bleomycin, busulphan, melphalan, cyclophosphamide * Meniscus sign / Crescent sign (mobile mass in pulmonary cavity) is most commonly seen in - Aspergilloma (fungal ball lesion) * Egg-Shell calcification - SilicosisQ , SarcoidosisQ , Coal miner's pneumoconiosisQ, Lymphoma following radiotherapyQ * Pop-corn calcification / Craggy pop-corn calcification - Pulmonary Hamartoma * Pleural calcification - commonest cause is - Tuberculosis (Asbestosis) * Diaphragmatic Pleura calcification - is due to - Asbestosis * Calcification in a pulmonary metastasis - is most commomly due to - Osteosarcoma * Coin shadow in the lung (single), with calcification in the centre - Epidermoid carcinoma * For radiologically evident pleural effusion - the minimal amount of pleural fluid that should be present is - 250 ml * Plethoric lung fields - seen in - L-R shunts ( VSD, PDA, ASD) * Oligemic lung fields - Pulmonary atreisa, Stenosis; Ebstein's anomaly * Perihilar fluffy opacities - seen in - Pulmonary venous hypertension Ribs * Superior surface notch of ribs - seen in - Hyperparathyroidsm, Neurofibromatosis, Connective tissue disorders * Inferior surface notch of ribs - seen in - Coarctation of Aorta, SVC obstruction, Chest wall AV fistula, Aortic Thrombosis, * Unilateral notching of ribs - Coarctation of Left subclavian artery, Subclavian artery block, Blalock-Taussig Operation Others * Displacement of tracheal shadow - most common cause is - Thyroid swelling * Water Lily sign - Ruptured hydatid cyst [/INST] question: Perihilar fluffy opacities on chest X-ray is seen in(Jipmer 92) | options: A: Pulmonary embolism B: Pericardial effusion C: Pulmonary arterial hypertension D: Pulmonary venous hypertension | answer: D </s>
<s>[INST] context: Reading is very important. World Book Day falls on April 23 every year. It encourages people, especially teenagers, to discover the pleasure of reading. It is also the day to honor great writers. Many countries celebrate World Book Day. On that day, millions of school children can buy books at a much lower price than usual in any bookstore in England. It has been done every year since 1998. World Book Day is also celebrated in China. Wen Jiabao, Premier of China, is an avid reader. He does lots of reading every day though he is very busy. On World Book Day 2009, he called on people to do more reading. Wen suggested that young people should spend more time reading. "Books can not change the world, but people can change the world by changing themselves through reading," he said. Reading helps us become more knowledgeable and smarter. Reading helps us to follow the latest developments of science and technology . Reading gives us information about other cultures and places in the world. Reading is also one of the most important ways to learn a foreign language like English. We all know that it is difficult to learn everything in the classroom, for example, the ways English people are living and working today can be learnt by reading. Books, magazines, newspapers and other kinds of reading materials can help us to know more about the outside world. Therefore, it is necessary for us to spend time reading every day. [/INST] question: When is World Book Day? | options: A: August 8 every year B: March 12 every year C: April 23 every year D: June 6 every year | answer: C </s>
<s>[INST] context: The scleroderma spectrum of disorders are a group of connective tissue diseases inclusive of localized scleroderma (affects skin only), Raynaud's (vasospastic involvement of the fingers) and systemic sclerosis which is itself divided into diffuse cutaneous systemic sclerosis (DCSS) and limited cutaneous systemic sclerosis (also known as CREST syndrome). The two conditions vary in their symptom pattern and onset, but both involve the internal organ systems, including the renal tract and lungs (causing failure and pulmonary fibrosis). Skin involvement in DCSS is severe and widespread, but organ involvement is maximal at around 3 years and then typically improves. In CREST skin involvement is confined to the face and extremities; however, organ involvement tends to be progressive and more severe. CREST syndrome is typified by the following features: Calcinosis, Raynaud's, esophageal disorders, sclerodactyly and telangiectasia. Diagnosis is clinical and backed by identification of ceain auto-antibodies. Anti-nuclear antibodies are usually present, anti-Scl-70 is positive in 40% of scleroderma, the presence of anti-centromere antibody occurs in 80%-90% of CREST and is suggestive of the diagnosis. However, auto-antibody testing is non-specific, and either antibody or both antibodies may occur in both conditions. [/INST] question: CREST syndrome is an autoimmune condition which is associated with atrophy and fibrosis of the oesophageal musculature resulting in dysphagia and reflux-type symptoms. Which of the following is not a feature of CREST syndrome? | options: A: Raynaud's phenomenon B: Erythematous malar rash C: Sclerodactyly D: Soft tissue calcification | answer: B </s>
<s>[INST] context: Students are leaving the junior high school . What are they taking with them ? A lot of things for sure , but the most important thing is friends . We asked some teachers to give us one last lesson . The lesson is proverbs(, ) about friends . Proverbs teach people about life . Older people often teach proverbs to younger people . Every culture has proverbs . They are short and easy to remember . Mrs Minelli says , " It is important to remember this Sicilian proverb , ' Only your real friends will tell you when your face is dirty .' It means that only good friends tell you when you are making a mistake ." Mr Tulga says , " I have a favorite proverb about friends , ' Friendship is a plant we must water .' It is German . It means that everyone needs to take care of friendship like we take care of a garden ." Mr Tulga says , "My grandfather in Turkey told me , 'Nobody is so rich that he can throw away a friend .' It means that everyone needs friends . Be good to them ." The good news is :there is no test for this lesson ,. The bad news is :We will miss you . Goodbye , friends ! Don't forget us ! [/INST] question: As the proverb says , _ will tell you when you are making mistakes . | options: A: real friends B: older people C: some teachers D: younger people | answer: A </s>
<s>[INST] context: (Braunwald, 15/e, pp 1984-1986.) Carpal tunnel syndrome results from median nerve entrapment and is usually due to excessive use of the wrist. The process has been associated with thickening of connective tissue as in acromegaly, or with deposition of amyloid. It also occurs in hypothyroidism, rheumatoid ahritis, and diabetes mellitus. As in this patient, numbness occurs in the distribution of the median nerve. Later in the process, atrophy of the abductor pollicis brevis becomes apparent. The Tinel sign (parasthesia induced in the median nerve distribution by a reflex hammer hitting on the volar aspect of the wrist) is very characteristic. De Quervain's tenosynovitis causes focal wrist pain on the radial aspect of the hand and is due to inflammation of the tendon sheath of the abductor pollicis longus. It should not produce a postive Tinel sign. Amylotrophic lateral sclerosis may present with distal muscle weakness that is diffuse and not focal. Diffuse atrophy and muscle fasiculations would be prominent. Rheumatoid ahritis would not produce these symptoms unless inflammation of the wrist was causing median nerve entrapment in the carpal tunnel. [/INST] question: A 35-year-old construction worker presents with complaints of nocturnal parasthesias of the thumb and the index and middle fingers. There is some atrophy of the thenar eminence. Tinel sign is positive. The most likely diagnosis is | options: A: Carpal tunnel syndrome B: De Quervain's tenosynovitis C: Amyotrophic lateral sclerosis D: Rheumatoid ahritis of the wrist joint | answer: A </s>
<s>[INST] context: "Choking and coughing episodes accompanied by wheezing are highly suggestive of airway foreign body" - Nelson "Foreign body aspiration should always be considered as a potential cause of stridor and airway obstruction in children".  --- O.P. Ghai Foreign body aspiration Infants and toddlers use their mouths to explore their surroundings. So, they are very prone to aspirate a foreign body. The most common age group is 6 months to 4 years. Most common foreign body aspirated is nuts (peanuts). Most airway foreign bodies lodge in a bronchus (right more than left). Clinical manifestions Three stages of symptoms may results : - Stage I - Initial event → Violent paroxysm of coughing (a most common symptom), choking, gagging and wheeze immediately after aspiration. If the obstruction is complete, child may be unable to vocalize (aphonia) and there may be cyanosis. If the obstruction is incomplete drooling and stridor may occur. Stage II Asymptomatic → The foreign body becomes lodged, reflex fatigue and immediate irritating symptoms subside. This stage is most treacherous and account for a large percentage of delayed diagnosis and overlooked foreign bodies. Stage III - Complications → Obstruction, erosions or infection can cause fever, hemoptysis, pneumonia and atelectasis. The most serious complication of foreign body aspiration is complete airway obstruction. [/INST] question: Acute onset of a cough, stridor and dyspnea in a child is mostly due to – | options: A: Foreign body B: Acute Asthma C: Aspiration pneumonitis D: Primary complex | answer: A </s>
<s>[INST] context: What does it mean to cry over a book? "I'm a reader who did not weep," Ruth Graham, a well-known critic, wrote. "Does this make me heartless? Or does it make me a grown-up?" Tears have played a surprisingly important part in the history of the novel. Readers have always asked about the role that emotion plays in reading: What does it mean to be deeply moved by a book? Which books are worthy objects of our feelings? In different times, people answered those questions in different ways. In the early eighteenth century, when the novel was still a new form, crying was a sign of readers' virtue. "Sentimental" novels, full of touching scenes, gave readers an occasion to exercise their "finer feelings." Your tear proved that you were likely to feel the suffering of others. At that time, sentimental novels were hugely popular, but also easy to attack. Tears, after all, had no necessary connection to actual virtue, and they could be not true As the critic John Mullan points out, by the end of the eighteenth century, the word "sentimental" had acquired a new meaning -- "addicted to low emotion" -- bringing it closer to the meaning that it has for us today. In the nineteenth century, the meaning of tears evolved in two different directions. Some writers sought to waken "higher" feelings in their readers: Victorian sentimentalists wrote touching scenes in an effort to inspire social and political reform. However, the "sensation" novel, a different type of Victorian best-seller, showed that tears could be enjoyable in themselves. Sensation novels were the leaders of the modern thriller and mystery. Heavy on secrets, and madness, they were known for creating physical "sensations" in their readers -- trembling, a fast beating heart, and tears. But these were tears without moral purpose or effect. Today's debate about crying while reading looks back on all of this history. The debate, in fact, is about why books matter to us, and what reading is "for." Talking about what makes us cry is a way of talking about ourselves. [/INST] question: What was people's attitude towards crying over novels in the early 18th century? | options: A: Doubtful B: Positive C: Uncaring D: Worried | answer: B </s>
<s>[INST] context: Nowadays, the food that you buy comes from many different countries.Have a look in your fridge, cupboard, and fruit bowl and check the origins of the food.Perhaps there are apples from California, lamb from New Zealand, or potatoes from Egypt? You will probably be surprised how far food travels to get to your plate.This journey, from "field to plate", is called "food miles". A food mile is the distance that food travels from the farmer's field to the person who buys the food.Nowadays, food often travels thousands of miles to get to the consumer .Why is this, and what are the effects of these long distances? Traditionally, farmers sold their food in the local market so the food didn't have to travel very far.The consumers also did not travel very far, because they went to their local market to buy the food.This was a good system for farmers and consumers.However, there were some disadvantages.For example, consumers could only buy food that farmers produced locally.In addition, they could only get food that was in season.Now, because of modern technology, food comes from all over the world.We do not have to wait for spring or summer to buy strawberries or tomatoes.They are _ in winter if we want. Some countries have to import most of their food.This is because they have difficult climates.The United Arab Emirates(UAE), for example, gets 85% of its food from other countries.Even food made in the UAE often uses imported materials. What's wrong with "food miles"? Is this not a good way of increasing international trade? I believe these miles are worrying for a number of reasons.First of all, because food travels such long distances.we need more planes, lorries, and ships to move the food.This means we use more oil or petrol, so there is more pollution and more global warming.In addition, food that travels a long way is not fresh and usually not very tasty.Tomatoes, for example, are picked early and stored for their long journey.For this reason, they are usually tasteless when they get to the consumer.Local food has a better taste, and it also reduces the amount of global pollution.We need to buy more local food. [/INST] question: Some countries like the United Arab Emirates have to import most of their food because of _ . | options: A: long distances B: modern technology C: fresh and tasty food D: difficult climates | answer: D </s>
<s>[INST] context: Niclosamide Niclosamide is a highly effective drug against cestodes infesting man-Taenia saginata, T. solium, Diphyllobothrium latum and Hymenolepis nana, as well as threadworm. The drug appears to act by inhibiting oxidative phosphorylation in mitochondria and interfering with anaerobic generation of ATP by the tapeworm. Niclosamide is available as 0.5 g tab (NICLOSAN). After a light breakfast, 2 tablets are to be chewed and swallowed with water, followed by another 2 tablets after 1 hr (total 2 g); total dose for children 2-6 years is 1 g. A saline purge is given 2 hours after the later dose to wash off the worm.The scolex should be searched in the stools to be sure that the worm will not grow again. Cure rate of 85-95% has been obtained by one day treatment. A thorough purge is essential in the cases of T. solium so that all segments are passed out and cysticercosis does not occur. Because praziquantel does not lead to digestion of the worm and kills encysted larvae as weU, it is the drug of choice for T. solium ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:814 [/INST] question: What is the dose of niclosamide used in treatment of Taenia saginata infection in children? | options: A: 40 mg\/kg single dose B: 40 mg \/ kg\/ day for 3 days C: 40 mg\/kg\/day for 7 days D: 40 mg \/kg \/day for 21 days | answer: D </s>
<s>[INST] context: The infant in question has: Recurrent episodes of abdominal pain Passing of altered stools after episodes of pain No vomiting or bleeding per rectum. Most common presentation of rectal polyps and Meckel's diverticulum is painless rectal bleeding (option a & c are ruled out) Necrotizing enterocolitis is seen in premature infants and is manifested in neonatal period. Symptoms progress from abdominal distension, vomiting, lethargy, poor feeding to passage of grossly bloody stool and features of shock (option d is excluded) Now we are left with intussusception. Most common presentation is recurrent abdominal pain (Paroxysmal clock pain offer severe). The absence of history of bleeding per rectum is creating some confusion here. However, the altered stool should raise the suspicion of intussusception because intussusception typically presents with "currant jelly- stool" (altered stool) representing a mixture of blood, mucus and stool. So, amongst the given options, best answer is intussusception. [/INST] question: A previously healthy infant presents with a recurrent episode of abdominal pain. The mother says that the child has been passing an altered stool after episodes of pain, but gives no history of vomiting or bleeding per diagnosis -rectum. Which of the following is the most likely diagnosis – | options: A: Rectal Polys B: Intussuception C: Meckel's Diverticulum D: Necrotizing Enterocolitis | answer: B </s>
<s>[INST] context: East Hampton Fine Arts Festival Date: July 4-6, 2010 Time: 10:00 am-6:00 pm East Hampton Fine Arts Festival features (...)America's top artists and is one of the highest quality juried show on Long Island. Learn about their inspiration and skills. The Festival offers a full range of arts, including painting, photography, glass, and more. $9.00 Adults / $7.00 Seniors / $4.00 Students / Free for museum members and children under six Where: Montauk Highway (Rt.27), Amagansett, NY 631-421-1590 Winzy Instant Winner Sweepstakes Winzy is a search engine where you can win free prizes -- every search on Winzy is a chance to win immediately! Just use Winzy to search the Web and you will be reminded if you have won an instant prize. Prize: Prizes vary each month -- For example, current prizes include: Apple iPod Nano, Apple iPod Shuffle, $25 Gift Certificate for Amazon.com, $10 Gift Certificate for Amazon.com Female Babysitter Wanted Location: Johannesburg Female babysitter wanted for one child aged 11 years for the following position: Mon-Fri: Fetch child from school (Benmore, Sandton) at 3:30 pm, drop off at my work or drop off at home (Florida Hills) and wait for me to come home at about 5 pm; Babysit for 3-6 hours every alternative week / weekend (Florida Hills)--must be flexible. Must have a driver's license. Coastlife Adventures Learn to surf on soft surfboards on the NSW South Coast. Surf lessons from beginners to advanced with qualified surf instructors and lifesavers. A variety of surf packages are available to suit everyone. Coastlife is famous for its new instructional method and high quality equipment. Surf classes operate daily on beaches between Tathra, Pambula and Merimbula. The beaches we teach on are rated as the safest in the area by Surf Lifesaving Australia. Tel: 02-6494-1122 [/INST] question: If your grandparents take you and your sister aged 5 to the arts show after school, you should pay _ . | options: A: $29 B: $22 C: $20 D: $18 | answer: D </s>
<s>[INST] context: Most American teenagers can't wait to get rid of their "mental mouth" nickname . They count down the days they can finally take their braces off. However, trendy teenagers in Indonesia, Malaysia and Thailand can't wait to get them on, even if they don't need them. Braces are the latest teenage fashion trend in Southeast Asia. Having a mouthful of metal has become so popular with Asian teens that there have been reports of many teens wearing fake braces. Many Asian beauty shops are now offering to put in cheap fake braces. There are even cheaper do-it-yourself braces such as " Hello Kitty," Mickey Mouse" or others for a price of around $100. Braces are considered a sign of wealth in Southeast Asia. A real set of braces in Bangkok, the capital city of Thailand, for example, will cost around $ 1,200, which is a large amount for the country with a GDP of $345 billion ( a billion is 1,000 million), compared to the US which had a GDP of $1,506 Trillion ( a Trillion is 1,000 billion) last year. While Asian teens may think that their colorful fake braces are cool, experts say that these trendy fashion braces can cause illness and can even lead to death. According to the New York Daily News, fake fashion braces have already been linked to the deaths of two teens in Thailand.A 17-year-old in the northeast city of Khon Kaen died from heart failure caused by a thyroid infection from a pair of fake fashion braces. Police also linked the death of another 14-year-old girl in Chonburi to a pair of fashion braces she had brought from an illegal shop. Although the government is giving warnings about fake braces, the trend has been going strong for at least four years. What's worse, the trend for fake braces shows no sign of slowing down. [/INST] question: In general, US teens consider braces _ . | options: A: Comfortable B: interesting C: useless D: ugly | answer: D </s>
<s>[INST] context: One of its worst ever mass shootings in America occurred on Friday when 20 children and six adults were shot dead by a gunman who opened fire at an elementary school in Connecticut. The gunshot at Sandy Hook elementary school in Newtown, about 65 miles north-east of New York, is understood to have been carried out by a gunman, who was later found dead at the scene. State policeman Paul Vance said 18 children died at the scene and two more died in hospital Six adults were found dead at the school, Vance said.The bodies of the victims remain inside the school. In an emotional press conference at the White House, Barack Obama suggested that he may take action.Fighting back tears, he said: "We've tolerate too many of these tragedies in the past few years.And each time ] learn the news I react not as a president, but as anybody else would as a parent.And that was especially true today.I know there's not a parent in America who isn't in the same overwhelming sorrow that I am." Referring to a number of major shootings this year alone, Obama continued: "Whether it's an elementary school in Newtown, or a shopping mall in Oregon, or a temple in Wisconsin, or a movie theater in Aurora, or a street comer in Chicago - these neighborhoods are our neighborhoods, and these children are our children.And we're going to have to come together and take meaningful action to prevent more tragedies like this, regardless of the politics." [/INST] question: How many people died on the spot ? | options: A: 18 B: 20 C: 24 D: 26 | answer: C </s>
<s>[INST] context: A soap opera called "Tiger Mother and Cat Father" is popular in China now. The tiger mother is pretty strict with her daughter and the little girl is not allowed to watch TV or play computer games. On the other hand, she makes all efforts to buy the expensive house near the key school, in order to let her daughter have a better education. However, the cat father has an opposite _ of how to raise their child. He gives her daughter more independence and doesn't make many rules for her. Which one is better, " Tiger Mother"or "Cat Father"? In China, it seems that in each family, there is tiger mother and a cat father, even worse, some families have two tigers. Children can't decide anything for themselves. What's worse, Chinese mothers believe key school will bring a better future to their children. This soap opera fully shows us a common problem in China. And maybe it is the real reason why such kind of TV shows can get popular. Whether the tiger mother or the cat father, respecting children and growing together are the keys to family education. Confidence, kindness, honesty and independence are the most important qualities to develop a child, not the grades. Just like a poem said, "Educating children is like walking with a snail , and the steps are gentle and slow." [/INST] question: In the soap opera, the little girl isn't allowed to _ . | options: A: eat vegetables B: get good grades C: go to the key school D: watch TV or play computer games | answer: D </s>
<s>[INST] context: Anganwadi worker will guide ASHA in performing following activities:  Organizing Health Day once/twice a month. On health day, the women, adolescent girls and children from the village will be mobilized for orientation on health-related issues such as the importance of nutritious food, personal hygiene, care during pregnancy, the importance of antenatal check-up and institutional delivery, home remedies for minor ailment and importance of immunization, etc. AWWs will inform ANM to participate and guide organizing the Health Days at Anganwadi centre. AWWs and ANMs will act as resource persons for the training of ASHA. IEC activity through the display of posters, folk dances, etc. on these days can be undertaken to sensitize the beneficiaries on health related issues. Anganwadi worker will be depot holder for drug kits and will be issuing it to ASHA. The replacement of the consumed drugs can also be done through AWW. AWW will update the list of eligible couples and also the children less than one year of age in the village with the help of ASHA. ASHA will support the AWW in mobilizing pregnant and lactating women and infants for nutrition supplements. She would also take initiative for bringing the beneficiaries from the village on specific days of immunization, health check-ups/health days, etc. to Anganwadi centres. lt is involved in the integrated child development program of WHO. [/INST] question: The personnel involved in the integrated child development program of WHO is: | options: A: Dhai B: Anganwadi workers C: Village health workers D: School health teacher | answer: B </s>
<s>[INST] context: We use passwords to keep our personal information secret and safe, but some passwords we use may not be as reliable as we think. Splash Data, a computer security company, recently released a list of the 25 worst passwords of 2011.This list is based on the research of _ files containing stolen passwords. According to the list, "password" is the worst and most common password. Many others on the list are numbers in order either forward (for example,1234) or backward. Letters on the keyboard in order, such as "qwerty" are also common, as well as some first names and animals. "Hackers can easily break into many accounts just by trying common passwords again and again, " said Morgan Slain, CEO of Splash Data. How can you make a strong password? It should be eight characters or more, with a mix of letters, numbers and symbols. One way to create a long and easy-to-remember password is to separate short words with spaces or numbers. Having safe passwords is necessary for surfing the Internet safely. But it's not the only thing you must do to keep safety online. Here are some other web safety tips: *Never give out information that will allow someone to find you offline. That includes your full name, address and phone number. *Don't include your real name as part of your online screen name. *Never meet people you met on the Internet in person. If you insist on breaking this rule, meet in a very public place and consider taking an adult with you. Top 10 worst passwords: 1.password 2. 123456 3. 12345678 4. qwerty 5. abc123 6. monkey 7. 1234567 8. letmein 9.trustno1 10. dragon [/INST] question: What is "Splash Data"? | options: A: A company B: A TV station C: A scientist D: An American | answer: A </s>
<s>[INST] context: When parents talk about school safety these days, they're usually referring to the increase in violence at schools. But research shows that school-age children are actually nine times more likely to suffer an injury while doing sports than to be the victim of violence while at school. Accidents can be prevented if parents are on the lookout for potential dangers. To help you keep your kids free from harm, here are some safety tips: a. Teach your child never to talk to strangers or accept rides or gifts from strangers. Remember, a stranger is anyone you or your child doesn't know well or trust. b. Be sure that your child walks to and from school with a _ , friend or neighbor. c. Teach your kid, whether walking, biking or riding a bus to school, to obey all traffic signals, signs and traffic officers. Remind him to be extra careful in bad weather. d. When driving your kid, deliver and pick them up as close to the school as possible. Don't leave until they are in the schoolyard or building. e. If your child rides a bike to school, make sure he wears a standard helmet . Research shows that a helmet can reduce the risk of head injury by 85%. f. Teach your kid to arrive at the bus stop earlier, stay off the street, and wait for the bus to come to a complete stop. g. Be sure that your kid knows his or her home phone number and address, your work number, the number of another trusted adult and how to call 911 for emergencies . [/INST] question: If your kid walks to school, tell him or her to _ . | options: A: wear a helmet B: go alone every day C: walk as fast as possible D: be more careful in bad weather | answer: D </s>
<s>[INST] context: Some families live quite far in the UK.Visiting them can either be an adventure or a chore .It depends on how much family members like each other. If all goes well,kids have an exciting time.Your relatives will plan different fun activities and make you happy.Taking you to visit relatives gives your parents a chance to rest.It gives older relatives a good chance to _ when they had young kids.If they do not have children of their own,they get to play parent for a while. I remember that Blackpool Pleasure Beach was the place I liked to go with my grandparents It is an amusement park on the northwest coast.It is packed with roller coasters and candy stalls .You could race small boats on a lake or scare yourself into death riding the ghost train.I had good memories of my time there. As you get older,you suddenly become the one who must help your relatives with their kids.I have four COUSINS aged between one and eleven.They are fantastic and I really enjoy seeing them.However,it is very tiring,as they get so excited and energetic .I fall asleep hoping they will remember our good times when they get older. [/INST] question: If all goes well,visiting relatives far away can be _ for kids. | options: A: dangerous B: exciting C: boring D: hard | answer: B </s>
<s>[INST] context: Basketball is still a young game. It's over a hundred years old . In the winter of 1891, a certain college was having some trouble with its boy students. The weather was bad and the students had to stay indoors . As they couldn't play outdoors , they were unhappy ,and some even got into fights from time to time . Some of the teachers at the college asked Dr Naismith to invent a game so that the students might have something to play with. It was ont easy to invent such a game, because it had to played indoors , and the court was not very large. Dr.Naismith thought for a few days and invented a kind of ball game .It is a wonderful game with much moving and passing of the ball .It was played between two teams .To make a score, the ball had to be thrown into the basket ten feet above the floor on the wall. At each end of the court there was such a basket .At first, Dr.Naismith wanted to throw the ball into a box, As he could not find boxes of the right size, he had to use fruit baskets instead. That is how the game got its name . [/INST] question: How long is it since basketball was invented? | options: A: 1000years B: Less than 100years C: 1100years D: More than 100years | answer: D </s>
<s>[INST] context: Today Chinese people can enjoy longer and more holidays, such as the two"Gold Week Holidays" -- the Spring Festival, National Day and Mid-autumn Festival and so on. They have more time to travel. Rising incomes also make it possible for ordinary Chinese people to travel abroad . Zhang Haitao, a middle school student in Shanghai will go to Japan with his parents during the Spring Festival. "Overseas touring has always been a dream of mine ,"Zhang Haitao said. " How will you go to Japan, by air or by ship?" I asked him. "By ship. Traveling by ship is more enjoyable than a rushed trip by air.""But a plane is much faster than a ship. ""Yes. but you can't see much during the flight while a sea trip will make you happier, because you can see waves, islands and even big fish." "Will you travel at your own expense ?" "Certainly. Though my father's job is to recycle rubbish, I'm very proud of him. He has saved lots of money in the last three years. What's more, he has made a contribution to protecting our environment." [/INST] question: Now it is possible for the Chinese people to travel abroad because of _ | options: A: less time B: more money C: shorter holiday D: more work | answer: B </s>
<s>[INST] context: It is well-known that it will take travelers only 48 hours by train to go from Beijing to Lhasa, the capital of west China's Tibet on July 1 this year. Travelers can enjoy the beautiful views during the 48 hour train ride. The new railway line will be controlled by the Beijing' s West Railway Station from July 1, 2006. The most important part of the line, the Qinghai-Tibet Railway, has been completed. The Qinghai-Tibet part of the railway is the world's highest railway. About 960 kilometers of the train tracks are 4,000 meters above sea level. The highest parts reach 5,072 meters. The railway is the world' s longest plateau railroad which is 1,956 kilometers long, from Qinghai's capital Xining to Lhasa in Tibet. The Golmud-Lhasa part is 1,142 kilometers long and goes across the Kunlun and Tanggula mountain ranges. The trains running on the Qinghai-Tibet Railway have very good conditions. If the passengers feel hard to breathe, they will be provided with oxygen masks, because all of the trains have oxygen supplying equipments. [/INST] question: It will take people 48 hours by train to go to Lhasa from Beijing _ . | options: A: from now on B: next July 1 C: from July 1,2006 D: from July 1, 2005 | answer: C </s>
<s>[INST] context: Cerebral toxoplasmosis must be differentiated from other oppounistic infections or tumors in the CNS of AIDS patients. The differential diagnosis includes herpes simplex encephalitis, cryptococcal meningitis, progressive multifocal leukoencephalopathy, and primary CNS lymphoma. Toxoplasmosis - Noncontrast CT scans show multiple low-density areas. The differential diagnosis ors toxoplasmosis if there is associated hemorrhage, whereas the presence of subependymal extension with contrast enhancement of the ventricular walls ors lymphoma. In toxoplasmosis, Contrast CT scans may show no enhancement, nodular enhancement, or ringlike enhancement . MRI studies are more sensitive in detecting the Toxoplasma lesions than contrast-enhanced CT scans. They exhibit hypointensity on TI-weighted images and variable intensity on T2-weighted images. Gadolinium-enhanced MRI studies show enhancing patterns similar to those seen on contrast- enhanced CT scans.On PET imaging, increased tracer activity is seen in lymphoma as a result of hypermetabolic activity, but it is not seen in toxoplasmosis. On SPECT imaging, thallium 201 uptake also reflects hypermetabolism. On MRS, increased lipid and lactate peaks with a decrease in other metabolites are characteristic for toxoplasmosis. Lymphoma shows a large increase in choline peak with only a mild increase in lipid and lactate peaks. Primary CNS lymphoma - generally presents with focal neurologic deficits, including cranial nerve findings, headaches, and/or seizures. MRI or CT generally reveals a limited number (one to three) of 3 to 5 cm lesions. The lesions often show ring enhancement on contrast administration and may occur in any location. Contrast enhancement is usually less pronounced than that seen with toxoplasmosis. Differential diagnosis of ring-enhancing lesion include - metastasis, tuberculoma, neurocysticercosis, abscess, toxoplasmosis, CNS lymphoma, GBM. [/INST] question: A 37-year-old man with AIDS presents with confusion, lethargy and memory loss. CT of the brain demonstrates multiple supratentorial enhancing masses. Which imaging feature ours a diagnosis of toxoplasmosis rather than primary CNS lymphoma? | options: A: Subependymal Distribution B: Lesions Hyperdense On Unenhanced CT C: Lesion Size >3 Cm D: Lesions without increased tracer activity on FDG-18 PET imaging | answer: D </s>
<s>[INST] context: Woodland High School is an international sch ool. We have students from all around the world. As an international student you can get first-class facilities with trained teachers to help. For further information: [email protected] Subjects We offer a wide choice of subjects for international students, which includes: Arts, IT, French, English, Spanish and other languages. Communication Studies, Social Sciences, etc. For further information: [email protected] Tuition Fees Tuition fees are different from subject to subject, from PS5,000 to PS6,000 a year. For further information: [email protected] Accommodation You can have a room in a 4-bedroom flat, which will cost about PS100 a month with other regular living costs of about PS150 a month for one person. For further information: [email protected] Health The Student Health Service provides excellent medical services for students. The Medical Centre is open five days a week, including student holidays with four doctors and nurses to meet your me dical needs. For further information: [email protected] Sports The Centre is a great place to have sports activities. Trained exercise teachers can help you work out a training plan and keep you active. The sports hall has volleyball, b asketball and indoor football counts and a swimming pool as well. There are also a large number of sports clubs at Woodland High School. For further information: [email protected] [/INST] question: If you want to get more information about arts, you can write to _ . | options: A: [email protected] B: [email protected] C: [email protected] D: [email protected] | answer: A </s>
<s>[INST] context: A person who has gross haematuria should be suspected of having infection with S. haematobium regardless of what other diagnoses may need to be enteained by the rest of the history. Infected humans inevitably excrete S. haematobium eggs in their urine, which finds its way into the water. Once thus excreted, these eggs develop into a very motile form called a miracidium that "homes in" on the intermediate host, which is a snail. In the snail, the fluke metamorphoses into a form called a cercaria, which swims freely in the water, waiting to penetrate the intact skin of a person who may be swimming or wading in this water. Once in the human, S. haematobium develops into adults, which migrate to the veins of the vesical plexus around the bladder. The female lays eggs, which create an inflammatory response that leads to bleeding, which is perceived by the infected individual as gross haematuria. The passage of these eggs, in urine, into water inhabited by the correct species of snail, completes the life cycle. The arrow points towards a terminal spine and when obtained from urinary bladder, is characteristic of S. hematobium species. TREATMENT INFECTION DRUG OF CHOICE S. haematobium, S. mansoni, S. intercalatum Praziquantel S. mekongi, S. japonicum Praziquantel C. sinensis, O. viverreni Praziquantel F. hepatica, F. gigantica Triclabendazole Echinostoma spp. Praziquantel F. buski Praziquantel P. westermani, P. kellicotti Praziquantel, Triclabendazole [/INST] question: A 35-year-old male presented with gross haematuria with similar episodes occurring in the past 6 months. No H/O of fever, pain, or burning on urination weight loss or increased sense of urgency to void. There was no history of exposure to toxins either at work or during recreational activities. The patient underwent fibreoptic cystoscopy. A mass was noted in the fundus of the bladder, biopsy of which is shown in Figure. What is the drug of choice of the likely cause? | options: A: Albendazole B: Mebendazole C: Praziquantel D: Triclabendazole | answer: C </s>
<s>[INST] context: The International School for Earth Studies It's a private,interdisciplinary institution specializing in earth-based studies.The Programs encourage students to explore the seeds of greatness,with a view to developing tomorrow's environmentally sensitive spokespersons and leaders. The principle goal is to help students develop responsibility inspired through appreciation and love for natural places and the greater environment. Program Location(s):Newfoundland,Canada Phone:819--647--3226 Email:[email protected] Expedition Education Institute Do you want to be an ecological leader,to become deeply rooted in the natural world and in your own power to make change and create a better,more resilient world? Organized as the equivalent to a semester abroad,Expedition Education Institute offers a unique opportunity for gap year participants to be personally transformed and academically challenged and supported to become better and more self-directed life-long learners. Program Location(s):USA Phone:207--322--2973 Email:Info@expedition educatlon.org The Experiment in International Living It provides summer abroad programs for high school students who want to connect deeply and engage meaningfully with the richness and complexities of another country. Programs are designed to equip participants not only with essential cultural skills and,in many cases,language skills,but also with a deeper awareness of and sensitivity to critical global issues shaping the diverse communities and regions we visit. Program Location(s):Europe,the Americas,Africa,south of the Sahara Phone:800--345--2929 Email:[email protected] Visitoz It's the Only organization in Australia that guarantees jobs for young people coming to our country on a Work and Holiday Visa. For young Americans this is a huge chance to get away from home and stand on their own two feet to make their own decisions. Program Location(s):Australia Phone:4168--6106 Email:[email protected] [/INST] question: If you want to learn to be independent,what phone number will you dial? | options: A: 819--l647--3226 B: 207--322--2973 C: 800345--2929 D: 4168--6106 | answer: D </s>
<s>[INST] context: Urticaria is characterized by large, irregularly shaped pruritic, erythematous wheels Special forms of urticaria have special features (Dermographism, cholinergic urticaria, solar urticaria, or cold uritcaria) Most incidents are acute and self-limited over a period of 1-2 weeks Chronic urticaria (episodes lasting> 6 weeks) may have an autoimmune basis The most common immunologic mechanism is hypersensitivity mediated by IgE, seen for most patients with acute urticaria The morphology of the lesions may vary over a period of minutes to hours, resulting in geographic or bizarre, pattern, true urticaria last less than 24 hours and often only 2-4 hours. The most common cause of acute urticaria are foods, viral infections and medications Diagnosis - In vivo allergy skin testing and in vitro RAST testing Determination of serum tryptase (Increased in anaphylaxis, systemic mastocytosis, non IgE mediated disease ("anaphylactoid reaction") ACE inhibitors and Angiotensin II receptors antagonist therapy is contraindicated. Urticaria pigmentosa (mastocytosis) - consists of multiple irregularly shaped hyperpigmented macule which may present on the trunk and extremities. Stroking the skin through the lesion with a blunt instrument elicits the classical "triple response of Lewis" called Darier's sign Treatment - Avoides taking drugs of Aspirin, NSAID', drugs, morphine, codeine, procaine, thiamine, polymyxin B and alcohol.                . The main stay of treatment is initially includes HI antihistamines (Hydroxyzine, cyproheptadine, Loratadine Doxepin (TCA) - very effective in chronic urticaria. Urticarial vasculitis may be seen as part of serum sickness, associated with fever and arthralgia. [/INST] question: A 5 year old male child has multiple hyper pigmented macules over the trunk, on rubbing the lesion with the rounded end of a pen. He developed urticarial wheal, confined to the border of the lesion. The most likely diagnosis is | options: A: Fixed drug eruption B: Licken planus C: Urticaria pigmentosa D: Urticarial vasculitis | answer: C </s>
<s>[INST] context: Thousands of hungry birds left the countryside of Britain in the bitter winter to find food and warmth in urban gardens. The move included species such as the redwing and the fieldfare, almost unknown outside rural areas The hard situation of farmland birds has been revealed in the latest survey of bird populations from the Royal Society for the Protection of Birds released today. The redwing has an obvious stripe over the eye and a red flash on the flanks , while the fieldfare has a grey head, a peach underbelly, and a distinctive dark band on the tail. Graham Madge, the society's spokesman, says, "For many urban birdwatchers the sight of these striking species is a real treat. Many people have never imagined there being such an amazing chance." "Frozen ground prevented them from getting food in the countryside and they have been saved from starvation in towns," he added. He says the unusual sight this year somewhat _ the frustration felt at the suffering of small garden birds such as robins and wrens. These birds are sensitive to cold and must eat almost continuously to stay alive. Data from people who took part in the society's Big Garden Birdwatch recorded sightings in 280,000 gardens during the last weekend of January, with the goldcrest down 75 percent, the longtailed tit down 27 percent, and the coal tit down 20 percent. The study highlighted the need for food to be left out for birds during winter. The redwing and the fieldfare are relatively unknown outside the eastern part of the country. The research shows, however, that they moved to the other side of the country where the climate is generally mild in winter and that many for the first time have reached Cornwall and Isles of Scilly. The number of redwing sightings was up 185 percent, those of the fieldfare 73, and of the yellowhammer 68. Another surprise garden "guest" this year was the blackcap. This robinsized, silvergrey bird was rare in Britain 50 years ago, but increasing numbers now arrive each year from Germany and Austria. [/INST] question: How did the urban birdwatchers probably feel when seeing the hungry birds? | options: A: Excited B: Worried C: Annoyed D: Motivated | answer: A </s>
<s>[INST] context: Royal palace and fortress for over 900 years , scene of mystery , murder and home to the Crown Jewels . KENSINGTON PALACE Birthplace of Queen Victoria , this royal retreat is home to magnificent State Apartments and the stunning Royal Ceremonial Dress Collection , which includes dresses worn by HM Queen Elizabeth II and Diana , Princess of Wales . HISTORIC ROYAL PALACES Hampton Court Palace is part of Historic Royal Palaces , a registered charity (N 1068852 ) that receives no public funding . We rely on the income from admission tickets to the palaces to pay for vital protection work, necessary for the preservation of these national monuments and collections for future generations . Please ask at the ticket office for more information or visit www.hrp.org.uk . VISITOR INFORMATION CARRIAGE RIDES Take a trip around Home Park in a horse-drawn carriage. Rides begin and end in Home Park at the entrance by the East Front Gardens. Available all day. 20 minute duration . PS10.00 per carriage . Subject to weather and ground conditions . ENQUIRIES For details of admission charges , group rates , the Friends of Hampton Court Palace and facilities for disabled visitors , call 0870 752 7777 or visit www. Hampton-court- palace.org.uk RESTAURANTS &SHOPS Choose from the Tiltyard Tea-rooms or the Privy Kitchen Coffee Shop. There are also a number of ice-cream kiosks open in the summer . The palace shops offer a wide range of gifts and souvenirs . AUDIO GUIDES Audio guides are included in the palace ticket and are available in English , French , German , Italian , Spanish and Japanese . [/INST] question: Where can visitors see the dresses worn by some royal members ? | options: A: Kensington Palace B: The Tower of London C: Hampton Court Palace D: Historic Royal Palaces | answer: A </s>
<s>[INST] context: Pyrrolizidine Repeat from Nov 06 Endemic ascites is caused by a hepatotoxin - pyrrolizidine alkaloid found in weed seeds of Crotolaria (Jhunjhunia). These weed seeds of Jhunjhunia contaminate the millet seeds Panicum milare (locally k/a Gondhli) Endemic ascites presented in Sarguja district of Madhya Pradesh during 1973 & 1976 as outbreak of rapidly developing ascites and jaundice with high moality. Preventive measures - educating the people - deweeding of Jhunjhunia plants which grow along with the staple food-millet. - sieving to separate out the Jhunjhunia seeds from millet seeds. Other food toxicant diseases: Neurolathyrism - caused by toxin Beta oxalyl amino alanine (BOAA) found in seeds of pulse Lathyrus sativum (Khersari dal) Epidemic dropsy - caused by toxic alkaloid Sanguinarine found in argemone mexicana seeds. Argemone oil contaminates mustard oil. Aflatoxicosis is due to ingestion of aflatoxins produced by ceain fungi, Aspergillus flavus and A. parasiticus. Aflatoxins are hepatotoxins & also carcinogenic. [/INST] question: Endemic ascitis is associated with the following aEUR' | options: A: Pyrrolizidine B: Aflatoxin C: Sanguinarine D: Beta oxalylamino alanine (BOAA) | answer: A </s>
<s>[INST] context: To the Editor, Re Why a Fallen Angel Is a Centerfold (Sunday Review, Nov. 6): I first met Lindsay Lohan in 1997 when she was 11 and I was the casting director of the film The Parent Trap. I was struck by her talent, fresh charm and innocence the moment I caught sight of her. She was, and remains, a gifted actress and a good human being. It is not for me to judge Ms Lohan's choices, or whether fame has been less than kind to her, but I have been greatly saddened by the way the media have chosen, with all gloves off and seemingly going with what could please them, to record her efforts and failures. She is a sentient human being, not a thing, not a product, not anything else to be sold. Charles McGrath makes several attractive points in his news analysis about the public demand which is impossible to satisfy, in a 24/7 news cycle forever changed by the Internet, to gossip about, and give nearly complete access to, celebrity or famous persons' lives. Perhaps people do feel better knowing that wealth and fame do not lead to a perfect life for everyone. Perhaps we admire famous people only to reject them without any pity or mercy when their behavior disappoints us. I find it ironic that Ms Lohan's decision to pose for Playboy for a monetary reward is considered to be morally questionable, while journalists and photographers gain profit by writing about and capturing images of her and other famous people. Perhaps when reporting on and reading about famous people who have lost their way, we will remember that those people are also very human people who, like us, make mistakes, endure misfortune and have a chance--in spite of media coverage--to begin a completely new life tomorrow. ILENE STARGER Brooklyn [/INST] question: This letter was written mainly to tell the editor that _ . | options: A: the public should bear famous people's mistakes B: the public should be especially strict with famous people C: the media shouldn't only satisfy the public's demands D: nobody can get both wealth and fame at the same time | answer: A </s>
<s>[INST] context: Indications for breast conserving surgery : 1. Patient's desire for breast conservation 2. Tumor less than 4 cm in size (T1 or T2) 3. Good Breast vs. tumor volume ratio 4. Availability of radiotherapy and mammographic facilities 5. Patients with N0 or N1 axillary nodes 6. Non-pendulous breast to allow a uniform radiation dosage distribution Contraindications for BCS: 1. Multicentric breast cancer 2. Diffuse malignant looking micro calcifications on mammogram 3. Matted (N2) axillary lymph nodes 4. Recurrence in a previously conserved breast 5. Collagen vascular disease 6. Early pregnancy 7. H/o previous irradiation to chest wall 8. Positive surgical margins Relative Contraindications for BCS: 1. Tumor size >5cm. (T3) 2. High risk of residual tumor or surgical margin positivity on resection 3. Large tumor in a small breast 4. Poor histological differentiation 5. Extensive intraductal component (>25% of tumor is DCIS) Advantages : Breast conserving surgery over Mastectomy Improved body image and higher treatment satisfaction No greater fear of recurrence compared with Mastectomy Lower rates of major depression, anxiety and Insomnia [/INST] question: Breast conservation surgery for breast cancer is indicated in which one of the following conditions? | options: A: T1 breast tumor B: Multicentric tumor C: Extensive in situ cancer D: T4b breast tumor | answer: A </s>
<s>[INST] context: It was the day when the UPSR results would be released. Sleepless nights, pounding hearts... Pupils were laughing with their peers or talking non-stop as their eyes searched for their parents. They looked pale, as if someone had squeezed the air from their lungs. Now I was among the anxious parents. I sat behind my daughter. She looked back, saw me and waved. I nodded. As the teachers walked in, the noise subsided. The year's results were read out. Then came the moment of truth. Pupils who had scored 5As were called out one by one and each of them stepped up on stage. When my daughter went up, I felt fine, but she was crying. I wondered why; maybe she didn't expect to score 5As. Anyway, I said a thankful prayer quietly. After the last name was called, what I saw made an impact on me. One mother just dashed from the back, crying. I thought she was the parent of the last pupil, but I was wrong. She hugged her daughter seated in the front row, saying it was all right that she hadn't scored all As. Her kid was crying. This morn kissed her daughter's forehead and walked straight to the back of the hall, wiping her tears as she walked. She didn't care about the other parents looking at her. How much pressure do we put on these 12-year-olds? All they did was studying and doing endless homework and countless practice questions. Where was the joy that they rightfully needed? As a parent, I think scoring top marks is not the main thing in life. Survival skills are more important than just chewing school texts and regurgitating them in an exam. So let your kids be kids. Let them play, cycle and climb trees. They will be children only once in their lifetime, so don't rob them of their childhood. Let's teach our kids how to be human, how to interact with others, how to help others and recognize "bad people". Teach them how to survive in this cruel world! [/INST] question: How did most parents feel when waiting for the UPSR results? | options: A: Hopeful B: Excited C: Anxious D: Disappointed | answer: C </s>
<s>[INST] context: I learned a long time ago that hair has meanings--plenty of meanings. Growing up in the 1960s, my friends and I struggled without parents' control over the length and style of our hair. At the time, hair represented our need to break free from adults in our lives. Long hair represented our freed inner selves. My clients are often surprised when I asked them questions about their hairstyle--why they choose it, how else they've worn their hair, how they feel about it, and so on. However, while it may seem to be a simple topic, even today our hairstyles still have many psychological and emotional meanings. Understanding some of those meanings can lead to understanding of many different aspects of a person's mind. How we view our hair, for example, can show something about how we view ourselves. Our hair can show physical and emotional wellbeing, desirability, and even social and financial status. When it becomes dull or fragile, it can communicate emotional and physical diseases. But hair can also show unrecognized and often unspoken daydreams about oneself and one's world. One woman--a successful professional--wore her long hair in a thick bun . But one day she showed me that tangled hair was kept in the bun. She said that she never brushed out the tangles because the hair showed her secret image of herself as a helpless, disturbed woman, like Ophelia in the play Hamlet. Another woman came to therapy in a huge shirt and huge pants that she believed they could hide the weight she had put on since the birth of her child. She talked about how much she hated her body and how helpless she felt about doing anything about it. But her hair was always beautifully coloured and decorated. When I pointed out that she seemed to have a different relationship with her hair from she did with her body, she said that her hair had been thinning and that she was trying to make it look as good as she could. I pointed out that what she was doing with her hair and her body was kind of contradictory, and wondered if she had any thoughts about that. She was surprised. But as we talked about her contradictory attitudes towards different parts of her physical self, we began to open up all sorts of other thoughts and ideas about her inner self. And interestingly, as we continued opening those internal doors, changes started to happen. She started eating differently and exercising regularly. One day some months later, she appeared in my office in skinny jeans and a tight sweater, and her hair was pulled back in a ponytail. "I decided to see what would happen if I stopped trying to hide myself, " she said with a big smile. "And...? " I asked. "People keep smiling at me in the street. My husband hugged me this morning for the first time in ages. And I feel good! " Besides, selfrespect in both men and women can be damaged by thinning hair;they may feel alone even though they are really not. Given our cultural focus on physical appearance, youth, and health, hair loss can be unpleasant for both men and women. The market is filled with hairenhancing treatments, but there are those who have decided to be against the system and change to the "bald is beautiful" position. But it is much harder for women to take the "bald is beautiful" approach to hair loss. We tend to try to hide it in one way or another. But no matter what approach you use, it is important to remember that the thickness of your hair has nothing to do with your value in the world. Remember that you have nothing to be ashamed of if you have thinning hair. Thinning hair may not be something you can change, but it doesn't have to control how you represent the person who lives underneath it. [/INST] question: In the 1960s, long hair represented _ . | options: A: fashion B: honesty C: peace D: freedom | answer: D </s>
<s>[INST] context: Welcome to this Website on the British Isles. Over the coming months it will be expanded to allow you to find information on all aspects of life in the British Isles. The British Isles is visited by millions of people each year, many returning time and again. Wales: Wales is full of fascinating places to visit and stay. The castles of Beaumaris, Conwy, Harlech and Caernarfon are officially listed as world heritage sites and provide an insight into the troubled past of this great land. The national park of Snowdonia is stunning and provides walkers and climbers with many opportunities to challenge their limits. South Wales also has interesting places to visit: Pembrokeshire is especially inviting for tourists. England: We all know about the attractions lf London but England has a lot more to offer outside of the city. The "English Riviers", Torquay, is blessed with good weather and is a major tourist attraction. This is a great place to stay and explore the local seaside resorts. Windsor castle is a great place to visit and the town and surrounding areas are beautiful. Warwick castle in the centre of England is world famous and holds regular evens to show how life was like in the time it was built. Scotland: A great place to visit, Scotland still has many places that are relatively uninhabited and are great for getting away from it all. Ben Nevis is the highest mountain in the British Isles and the numerous lakes provide great fishing. In parts you can still hear Gaelic spoken and we all know about the Scottish expertise in making Whisky! You can also visit the ski resorts of Aviemore in the Cairngorms. Glasgow, the capital is now recognized as a centre of culture as well as being a great shopping centre. [/INST] question: The highest mountain in the British Isles is in _ . | options: A: Wales B: England C: Scotland D: Chester | answer: C </s>
<s>[INST] context: Tour Inside a Volcano in Iceland Operation dates: From June 15th -July 31st Departure times: 8:00 AM / 10:00 AM /12:00 PM / 14:00 PM. Duration: 5-6 hours (up to 1 hour inside the volcano) Fitness level needed: Average. No knowledge of hiking or climbing is needed. Distance Walked: About 2.5 km (1.7 miles) each way. Age limit: 12 years Included: Pick-up at your hotel in Reykjavik All safety equipment Soup, coffee/tea and perhaps some sweets as well Transfer back to Reykjavik Bring with you: Good shoes. Sneakers will work, but we don't recommend them. Water. The walk over the lava field is a good workout! Outdoor clothing. Dress according to weather for the walk. A warm sweater or a jacket would be useful. About the tour: This volcano tour takes you inside a volcano, through the top crater and down to the bottom of its magma chamber . The Thrihnukagigur volcano has not erupted for 4,000 years and shows no signs of coming to life again anytime soon. Hence, you are safe! You depart from Reykjavik and drive to the area of Blafjoll mountains (About 30 minutes' drive). From there, an easy 35- to 40-minute walk awaits you, in order to get to the volcano. Using a system normally used to carry window cleaners outside skyscrapers, you will go down 120 metres in an open elevator, a basket lift that is supported by cable wires. The group is split into smaller parties of four to five persons. The trip takes about 10 minutes and the first ones to go down will be the first ones to go up. After exploring the volcano on the inside, you will walk back over the lava field where the coach awaits and transfers you back to Reykjavik. [/INST] question: How long does it take to get to the volcano from Reykjavik? | options: A: About thirty minutes B: More than one hour C: Nearly two hours D: Just thirty-five or forty minutes | answer: B </s>
<s>[INST] context: In today's congratulatory phone call to the team behind NASA's Mars Curiosity rover , President Barack Obama made sure that if the mission discovers Martians, he'll be one of the first to know. "If in fact you do make contact with Martians, please let me know right away," Obama said during the call, "I've got a lot of things on my plate, but I expect that that will go to the top of the list. Even if they're just microbes , it will be pretty exciting." Obama also said he was impressed by the attention that's been paid to flight director Bobak Ferdowsi, the "Mohawk Guy" whose star-spangled haircut and warmhearted behavior during Curiosity's Aug. 5 landing won him Internet fame. "I, in the past, thought about getting a Mohawk myself," Obama joked. "But my team keeps on discouraging me. And now that he's received marriage proposals and thousands of new Twitter followers, I think I'm going to go back to my team and see if it makes sense." The congratulatory phone call is a tradition for the White House. But it was clear that Obama particularly enjoyed congratulating the scientists and engineers behind the amazingly successful landing of NASA's newest Mars exploration. He also said the achievement reflected the American spirit, and he gave his personal promise to protect these critical investments in science and technology. "This is the kind of thing that inspires kids across the country," he said. "They're telling their moms and dads they want to be part of a Mars mission, maybe even the first person to walk on Mars. And that kind of inspiration is the byproduct of work of the sort that you guys have done." The Curiosity rover's $2.5 billion mission focuses on studying billions of years' worth of geology on Mars and determining whether the planet was ever potentially suitable for people to live in. The mission is not specifically designed to explore life, even on the range of microbes, but it could point the way for future life-exploration experiments. [/INST] question: Obama phoned the team behind NASA's Mars Curiosity rover in order to _ . | options: A: congratulate them on finding Martians B: praise the flight director C: congratulate on the rover's landing D: encourage them to contact with Martians | answer: C </s>
<s>[INST] context: The baby elephant, Sheila, was moved out of Belfast Zoo because of fears she might be hit by bombers during the Belfast Blitz of 1941. She was one of the lucky ones. A lot of the animals were killed because of fears they might escape during the bombing and attack people. They included a tiger, a black bear, a wolf, a penguin, and two polar bears. But Sheila was walked down the road by zoo-keepers to a nearby house where a woman took her in and kept her in her backyard for several months until the bombing was over. The woman has never been identified and the zoo knows her only as "the elephant angel". As the zoo celebrates its 75thbirthday, people have decided to try to find the elephant's saver. Mark Challis is the manager of Belfast Zoo. He explained a bit more about Sheila's story. "Well, we know that Sheila, the elephant that was in the zoo at that time spent some time living with a lady relatively near to the zoo and we have one sweet photo, you can see it on our zoo website." "In the photo you can see the elephant with the lady in her back garden and that's almost all we know. So we're just trying to find a little bit more information and we are not even sure if the lady is alive today, but maybe her relatives or somebody will recognize the back of that house and we can fill in some detail on this story." Once the bombing was over, Sheila went back to the zoo and lived for another quarter of a century. She died of a skin disease in 1966. [/INST] question: How many years has the zoo been open? | options: A: For 25 years B: For 75 years C: For half a century D: For several months | answer: B </s>
<s>[INST] context: Do you like somewhere a little bit different to the usual types of places you find on the high street? I do,so I'm glad to see new ones popping up everywhere in London. The so called pop-up shop is a temporary arrangement.In the aftermath of the financial crisis of 2008,many businesses had to shut down.Shops,warehouses and offices were left vacant when they stopped trading.Pop-up enterprisers occupied some of them quickly. For them the appeal of this temporary shopping concept is clear:they can start a business with much 1ower risk.The temporary nature of a pop-up shop gives the opportunity to test a product and develop a customer base,without being tied in to a long-term renting contract. Being small makes it much easier for pop-ups to expand if they are successful* Pop-up shops first appeared in the UK in the early 2000s,with the economy booming. They were originally a way for small companies to rent retail space in great locations. This was while landlords who owned these spaces looked for permanent renters. Pop-up shops can take a number of different forms.They might be temporary shops in the high street or a shopping centre.They might be simple market stalls . They could be based in some kind of transport,like a food truck.Or they could be run by people who visit different establishments,like travelling chefs who take over pub and restaurant kitchens temporarily. According to a report by the Centre of Economic and Business Research,the pop-up industry was worthPS2.1bn and is expected to grow by 8.4%this year.Almost anything that can be on a high street can also be a pop-up.There have been pop-up shops,art galleries,theatres and restaurants among others.In an age of fast-changing habits,the pop-up idea might be here to stay. [/INST] question: What nature of the pop-up shops appeals many small companies? | options: A: Long-terra benefits B: Lower prices C: Quick service D: Temporary shopping concept | answer: D </s>
<s>[INST] context: Diabetes insipidus is characterized by the excretion of abnormally large volumes of dilute urine (polyuria) with a commensurate increase in fluid intake (polydipsia). The most common type is due to inadequate secretion of antidiuretic hormone (also called vasopressin) and is usually referred to as "neurogenic" diabetes insipidus. This condition rarely causes severe problems as long as the person has plenty of water to drink. Placing the patient on overnight water restriction caused severe dehydration and a greatly elevated plasma sodium concentration. The possibility of diabetes mellitus, which can also be associated with polyuria and polydipsia, is easily excluded by the lack of glucosuria. Addison's disease results from failure of the adrenal coices to produce adrenocoical hormones. The lack of aldosterone leads to decreases in sodium reabsorption allowing large amounts of sodium to be lost into the urine. Polyuria and polydipsia are not characteristic of Addison's disease. Fanconi's syndrome is associated with multiple transpo defects in the proximal tubule. Large amounts of glucose (as well as other substances normally reabsorbed in the proximal tubule) are usually present in the urine. [/INST] question: A 64-year-old man has severe polyuria and polydipsia, drinking 3 to 4 glasses of water and producing over 0.5 liters of urine each hour. Rajesh a new medicine resident places the patient on overnight water restriction for fuher analysis. The test results shown below were obtained the following morning. Plasma sodium concentration: 155 mEq/L Urine osmolarity: 90 mOsmol/L Urine glucose concentration: 0 mg/dL Which of the following is the most likely diagnosis? | options: A: Addison's disease B: Fanconi syndrome C: Diabetes insipidus D: Diabetes mellitus | answer: C </s>
<s>[INST] context: The sudden onset of tachycardia and hypotension indicates an acute process. Since the patient is being mechanically ventilated with positive pressure, he is at increased risk of a bullous rupture from barotrauma, leading to a pneumothorax.Cardiac arrhythmia could lead to tachycardia and hypotension. Ventricular tachycardia and atrial fibrillation with a rapid ventricular response may cause this from decreased ventricular filling. An ECG would aid in this diagnosis. In the setting of mechanical ventilation, however, a pneumothorax must be excluded first. Bronchial secretions usually have a progressively worsening presentation. Fuhermore, the patient would exhibit desaturation, but not necessarily hypotension. Myocardial infarction may lead to cardiogenic shock from failure. However, this would most likely be a bit more progressive and less acute. Infarction must remain high on the differential diagnosis, and the patient may require vasopressors because of the shock. In the immediate setting, the pneumothorax is more likely, given the acuity of onset. Pulmonary embolus is on the differential diagnosis of electromechanical dissociation. This patient&;s risk of an embolus is increased because of prolonged immobilization. However, the subcutaneous heparin should be adequate prophylaxis against an embolism. [/INST] question: A 56-year-old man has been admitted to the ICU in respiratory distress. An endotracheal tube is placed for mechanical ventilation at a tidal volume of 900 mL, a rate of 12 breaths/min, and FiO2 50%. PEEP is 10 cm of water. Medications include subcutaneous heparin and aspirin. He now develops tachycardia and a blood pressure of 70/palpation mm Hg. Cardiac examination reveals multiple premature contractions. His aerial blood gas reveals a PO2 of 40 mm Hg. Most likely cause of this condition is? | options: A: Cardiac arrhythmia B: Bronchial secretions C: Myocardial infarction D: Pneumothorax | answer: D </s>
<s>[INST] context: Doppler ultrasonography (duplex) has become the best initial test for screening patients with carotid disease. It has become a highly accurate test, often obviating the need for carotid arteriography prior to carotid endarterectomy. Carotid arteriography remains the "gold standard" when quantifying the degree of carotid stenosis, but it is usually performed after noninvasive testing suggests significant stenosis. Spiral CT angiography is a new noninvasive modality that has been used to evaluate many segments of the vascular tree, but as yet its accuracy does not approach that of standard arteriography and it would certainly not be used in the initial evaluation of a patient with an asymptomatic bruit. Magnetic resonance arteriography (MRA) is also a relatively new modality that has enjoyed moderate success in the investigation of carotid disease. Although not quite as accurate as standard arteriography, it has been used in conjunction with the duplex as a complementary study. Once again, because of its cost, MRA would not be used as the primary screening modality. Transcranial Doppler studies are used to assess the intracranial vasculature. [/INST] question: A 75-year-old man is found by his internist to have an asymptomatic carotid bruit. The best initial diagnostic examination would be | options: A: Transcranial Doppler studies B: Doppler ultrasonography (duplex) C: Spiral CT angiography D: Arch aortogram with selective carotid artery injections | answer: B </s>
<s>[INST] context: Although there is an increased risk of spontaneous abortion, and a small risk of infection, an intrauterine pregnancy can occur and continue successfully to term with an IUD in place. However, if the patient wishes to keep the pregnancy and if the string is visible, the IUD should be removed in an attempt to reduce the risk of infection, abortion, or both. Although the incidence of ectopic pregnancies with an IUD was at one time thought to be increased, it is now recognized that in fact the overall incidence is unchanged. The apparent increase is the result of the dramatic decrease in intrauterine implantation without affecting ectopic implantation. Thus, while the overall probability of pregnancy is dramatically decreased, when a pregnancy does occur with an IUD in place, there is a higher probability that it will be an ectopic one. With this in mind, in the absence of signs and symptoms suggestive of an ectopic pregnancy, especially after ultrasound documentation of an intrauterine pregnancy, laparoscopy is not indicated. The incidence of heterotopic pregnancy, in which intrauterine and extrauterine implantation occur, is no higher than approximately 1 in 2500 pregnancies. [/INST] question: An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30-year-old gravida 5, para 4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to be continued. On examination, the string of the IUD is noted to be protruding from the cervical os. The most appropriate course of action is to | options: A: Leave the IUD in place without any other treatment B: Leave the IUD in place and continue prophylactic antibiotics throughout pregnancy C: Remove the IUD immediately D: Terminate the pregnancy because of the high risk of infection | answer: C </s>
<s>[INST] context: METRONIDAZOLE It is the prototype nitroimidazole introduced in 1959 for trichomoniasis and later found to be a highly active amoebicide. It has broad-spectrum cidal activity against protozoa, including Giardia Iamblia in addition to the above two. Many anaerobic bacteria, such as Bact. fragilis, Fusobacterium, Clostridium perfringens, Cl. difficile, Helicobacter pylori, Campylobacter, peptococci, spirochetes and anaerobic Streptococci are sensitive. Though, it does not directly inhibit the helminth Dracunculus medinensis, extraction of the worm from under the skin is facilitated. Metronidazole does not affect aerobic bacteria. Clinically significant resistance has not developed among E. histolytica, but decreased responsiveness of T. vaginalis has been observed in some areas. Anaerobic bacteria and G. Iamblia also can develop metronidazole resistance, but this is a clinical problem only in the case of H. pylori. Uses 1 . Amoebiasis: Metronidazole is a first line drug for all forms of amoebic infection. Many dosageregimens have been tried; the current recommendations are: For invasive dysentery and liver abscess-800 mg TDS (children 30- 50 mg/kg/day) for 7- 10 days. In serious cases of liver abscess 1 g may be infused i.v. slowly followed by 0.5 g every 8-12 hr till oral therapy is instituted. For mild intestinal diseas [/INST] question: Drug of choice for antibiotic associated pseudomembranous colitis is? | options: A: Oral vancomycin B: Metronidazole C: Clindamycin D: Penicillin G | answer: B </s>
<s>[INST] context: Pulsed dye laser (PDL) therapy is considered the standard of care for the treatment of capillary malformations. It is based on the concept of selective photothermolysis.. The beam is selectively absorbed by red- pigmented material such as hemoglobin in the blood vessels of the lesion. This produces selective heat destruction of capillary vessel walls with minimal damage to the overlying epidermis, which leads to the lightening of the port wine stain without scarring. "The best treatment to date for early and intermediate port wine stains is with the pulsed dye laser. The method of treatment is termed selective photothermolysis. The beam is selectively absorbed by red- pigmented material such as haemoglobin in the blood vessels of the lesion. This produces selective heat destruction of these structures, and the treated area becomes whiter."- CSDT 13/e Capillary malformations (port wine stains or nevus flammeus) Capillary malformations (port wine stains or nevus flammeus) are low-flow vascular malformations of dermal capillaries and postcapillary venules. They are present at birth as blanchable pink to red patches. They may be located anywhere on the body, most commonly on the face, typically with a unilateral or segmental distribution that respects the midline. On the face, they tend to follow the distribution of the trigeminal nerve branches (segments V1 , V2 , and V3 ) Capillary malformations do not regress, but grow in proportion to the child's growth and become thicker and darker in colour during adulthood. [/INST] question: The best cosmetic results for large capillary (port wine) hemangiomas are achieved by - | options: A: Excision and split-thickness skin B: Laser ablation C: Cryosurgery D: Tattooing | answer: B </s>
<s>[INST] context: (CMV) (1154, 1158- CMDT-08) (1180-CMDT-09)Relationship of CD4 count to development of opportunistic infections || 500 - Bacterial infections TuberculosisH. simplex, Zoster, Hairy leukoplakia Kaposis* sarcoma ||| |||||||||||||||||| 200 -Pneumocytosis Toxoplasmosis Cryptococcosis Coccidiodomycosis Cryptosporidiosis ||| |||||||||| 50 - Disseminated. Mycoavium complex- Histoplasmosis- CMV retinitis- CNS- Lymphoma ||**Cotton wool spots - seen in CMV retinitis** White fluffy exudates is the most common retinal infection in AIDS*Hypogonadism is probably the most common endocrine abnormalities in HIV infected man*Toxoplasmosis is the most common space- occupying lesion in HIV infected patients**Pneumocystis jivoveci pneumonia is the most common opportunistic infection associated with AIDS* Definitive diagnosis can be obtained in 50- 80% of cases by Wright- Giemsa stain or Direct fluorescence antibody (DFA) test of induced sputum* Community acquired pneumonia is the most common cause of pulmonary disease in HIV infected persons [/INST] question: In AIDS patients, CD4 count >75 lymphocyte count, cotton wool spots in eye examination reveales infection of | options: A: CMV B: Toxoplasma C: Cryptococcus D: Acanthamoeba | answer: A </s>
<s>[INST] context: Fifty people died, over 11,000 were injured, and 100,000 houses were heavily damaged or destroyed in an earthquake that struck North China's Hebei Province. The quake, measuring 6. 2 on the Richter scale (6 .2) , hit the area 220km northwest of Beijing at 11: 50 a. m. on January 10, 1998. Scientists made a report of the recent quake. They said that the area of northwestern Beijing, the joint of Shanxi and Hebei Provinces and the Inner Mongolia were most easily attacked by earthquakes measuring 6 to a bit over 7 on the Richter scale. However, scientists did not see the recent earthquake earlier. Clouds covered a large area in the northern part of North China before the earthquake and experts say that this prevented satellites from correctly watching the temperature at the correct altitude . Experts say that in the last ten years, about 305 earthquakes have taken place in China with 9 measuring over 7 on the Richter scale, 60 measuring over 6, and 236 measuring over 5. Tens of thousands of people died or were injured. Loss valued over 10 billion yuan. [/INST] question: When the earthquake attacked the area, most people there were unlikely to _ . | options: A: sleep in bed B: work in the fields C: walk in the streets D: stay at home | answer: A </s>
<s>[INST] context: Frank Smithson woke up and leaned over to turn off the alarm clock. "Oh,no!"he thought to himself."Another day at that office;a boss who shouts at me all the time." As Frank went downstairs his eyes fell on a large brown envelope by the door. He was overjoyed when he opened it and read the letter inside. "Bigwoods Football Pools would like to congratulate you. You have won half a million pounds." Frank suddenly came to life. The cigarette fell from his lips as he let out a shout that could be heard halfway down the street. At 11:30 Frank arrived at work."Please explain why you're so late,"his boss said." _ ," replied Frank. "I've just come into a little money so this is goodbye.Find yourself someone else to shout at." That evening Frank was smoking a very expensive Havana cigar when a knock was heard on the door. He rushed to the door. Outside were two men,neatly dressed in grey suits. "Mr Smithson," one of them said,"We're from Bigwoods Football Pools. I'm afraid there's been a terrible mistake......" [/INST] question: What do we know about Frank? _ . | options: A: He was a lazy man B: He was a lucky person C: He made a lot of money D: He didn't get on well with his boss | answer: D </s>
<s>[INST] context: There are some strange driving laws in different countries. Vietnam: If you're in Vietnam without a Vietnamese driver's license, you risk a prison sentence of up to 3years. Russia: In Moscow, if your car is dirty enough to draw dust art, you will be fined about 2,000 rubles. Worse yet, it's not legal to wash your car by hand in public places--forcing you to take it to one of the few car wash facilities. Thailand: Drivers--males or females--can't drive shirtless, whether it's a car, a bus or a tuk-tuk. France: France requires its drivers to carry a potable breathalyzer all the time when driving a car. The one-time breathalyzer cost around US $ 5, and if you don't have one, you will be fined US $ 15. Cyprus: Raising your hands in the car can get you fined of US $ 35. The law states a driver can be fined if the person is not in a regular position inside the car or raises his hands from the steering wheel unnecessarily. Japan: Politeness isn't just the culture in Japan; it's part of driving laws. Splashing a person by driving through a puddle with your car will cost you over US $ 60. The country is also strict with its DUI laws---riding with or lending your car to a driver who gets caught drinking can lead to a fine costing thousands of dollars. [/INST] question: Where should you go to wash your car when you are in Moscow? | options: A: The car wash facilities B: Any public place C: Your home D: The forest | answer: A </s>
<s>[INST] context: Post coital test (Sims or Huhner's test) is a test for evaluation of the potential role of Cervical factor in infertility. It is designed to assess: The quality of cervical mucus. Presence and number of motile sperms in the female reproductive tract. after coitus. Interaction between cervical mucus and sperms. It gives an approximate idea of sperm count: (normally 10 - 50 motile sperms are seen per high power field in cervical mucus, if count is < 10 sperms/HPF it indicates the need for complete semen analysis). Post coital test gives a very rough idea about sperm count, motility and morphology. As far as fallopian tube block is concerned postcoital test has no relation. Time of test: It should be performed 1 or 2 days before the anticipated time of ovulation ,when maximum estrogen secretion is present. For patients with irregular cycles, patients urinary LH surge may be helpful in scheduling the test. Prerequisites for the test: - Abstinence of 2 days. Intercourse to be performed 2 -12 hours before the test. No use of lubricant. [/INST] question: Post coital test (PCT) is done for: | options: A: Cervical receptivity B: Sperm motility C: Absolute sperm count D: Viable sperm count e. Endometrial function | answer: A </s>
<s>[INST] context: Flash light pumped dye laser "Non blanching bosselated lesion on right side of the face suggests po wine stain" Po wine stain (PWS), also called nevus fiammeus, is a congenital, cutaneous vascular malformation involving post-capillary venules which produce a light pink to red to dark-red- violet discoloration of human skin. PWS occurs in an estimated 3 children per 1,000 live bihs, affecting males and females and all racial groups equally. There appears to be no hereditary predilection for PWS within families. There are no known risk factors or ways to prevent PWS. The most likely hypothesis for the development of PWS is the deficiency or absence of surrounding neurons regulating blood .flow through the ectatic post-capillary venules. - As a result, the blood vessels are unable to constrict normally and remain permanently dilated. - They are "non, blanching". PWS is a progressive vascular malformation of the skin -PWS remain throughout life; there is no involution. PWS are well demarcated and .1lat and grow propoionately in surface area with the child. In infants and young children, PWS are flat red macules. However, the lesions tend to darken progressively to purple and, by adult age. often become raised as a result of the development of vascular papules bosselated or nodules. These changes in color and contour are attributed to progressive ectasia of the abnornull dermal vascular plexus. - If left untreated, PWS often become incompatible with normal life due to the development of vascular nodules on the skin surface which can often bleed spontaneously with incidental trauma. For all of the above reasons, it is essential to begin treatment of PWS as early as possible. The treatment of PWS early will prevent the development of hyperophic component of the lession. - "The pulsed dye laser in conjunction with cryogen spray cooling ("dynamic cooling device" or "DCD") is now the treatment of choice for PWS". Yellow light produced by the pulsed dye laser penetrates up to 2 mm into the skin and is preferentially absorbed by hemoglobin within the dilated PWS blood vessels. The heat adsorbed within the vessel lumen causes blood vessel damage which is evidenced by intense purpura ("bruised" appearance of the skin). The purpura heals, later on and the lesion is cured. Several treatment sessions spaced at 4-8 week intervals are required for maximum efficacy. The number of treatments required .for maximum PWS fading can he variable and unpredictable. Treatment side effects are mainly limited to post-operative swelling and purpura, which generally resolves within 2 weeks. With the addition of cryogen spray cooling. the risks of scarring or changes in the normal skin pigmentation are minimal after pulsed dye laser therapy performed l an experienced physician. Multiple pulsed dye laser devices are now available for PWS treatment, each with its own unique wavelength and pulse duration. Changing the wavelength or pulse duration of the laser can result in substantial PWS fading not previously observed with single device therapy. Moreover, several devices are sometimes used during an extended treatment protocol in order to destroy vessels of different sizes. [/INST] question: Child with erythematous non blanching bosselated lesion on right side of face, Rx is aEUR' | options: A: >Erbium laser B: Nd-YAG laser C: >Flash light pumped dye laser D: >Q ruby laser | answer: C </s>
<s>[INST] context: Each year, we celebrate many holidays here in America. On January 1, we welcome the coming of a new year like many people in other countries. And we have another four holidays on the first day of a month: April Fool's Day, May Day, Friendship Day (Aug.1) and Grandparents Day (Sep. 1). The most important holiday for the young people comes in February. It is Valentine's Day. Lots of boys give red roses to girls as a present. People celebrate some holidays for their family members. We say thanks to our mother in May and celebrate Father's Day in the following month. In November many people return home for Thanksgiving Day, so the whole family can stay together. There are also some interesting holidays for children. For example, Halloween comes at the end of October. Children often play with pumpkin lanterns and put on all kinds of masks. Of course, the most important festival is Christmas. After a year of work and study, people can enjoy a long holiday, eat big meals, and visit family and friends. [/INST] question: How many holidays do you know on the first day of a month in America? | options: A: Four B: Five C: Seven D: Ten | answer: B </s>
<s>[INST] context: Founded in 1764 by French traders, St. Louis today is the fifteenth largest urban area in the United States. There are many attractive destinations for touists. American Kennel Club Museum of the Dog Dog lovers who visit St. Louis won't want to miss this 14,000-square-foot museum. Inside are over 500 paintings,prints, watercolors,and a variety of other dog art objects. The Museum is open year round,Tuesday through Saturday 10 AM to 4 PM, and Sunday 1 PM to 5 PM. Admission is $5 for adults,$2.50 for seniors, and $1 for children up to 14. Anheuser Busch Brewery The Anheuser Buxch Brewery tour is not just for beer lovers.The tour includes the historic Brew House.Then the tour continues to the modern Bevo Packaging Plant. The best will be the Budweiser Clydesdale stables. The tours are always free. Gateway Arch Designed by Eero Sarinen and Hannskari Bandel, it took over two years and 900 tons of stainless steel to build. It is the tallest of the country's National Monuments. The Arch is part of the Jefferson National Expansion Memorial. About one milion people per year come to the top of the Arch, where there is an observation platform providing a great view of the city. The St. Louis Zoo First version of the St. Louis Zoo opened in 1904 at the St. Louis World's Fair, but in the century since it has grown into one of the chief zoos in the world. The passenger train takes visitors around the Zoo,which contains over 9,000 animals of over 800 species. The Zoo is open every day but Christmas and New Year,with summer hours of 8 AM to 7 PM,and hours the rest of the year of 9 AM to 5 PM.Admission to the Zoo is free. [/INST] question: If a senior high school student plans to visit American Kennel Club Museum of the Dog with his parents and his five-year-old brother,he has to pay _ . | options: A: $8.5 B: $12 C: $13.5 D: $16 | answer: C </s>
<s>[INST] context: Once in a village, the villagers built a new church building and people came from far and wide to see it. They admired its beauty! They said it was the most beautiful building in the world. Up on the roof, a little nail heard the people praising everything about the lovely structure - except the nail! No one even knew he was there, and he became very angry and sad. "If I am not important, nobody will miss me if I quit!" So the nail then released its hold, got down from the roof, and fell into the mud. That night it rained and rained. Soon, the board that had no nail was blown away, and the roof began to leak . The water flowed down along the walls and over the beautiful pictures on the walls. The plaster began to fall, the floor was ruined, and the Biblewas also ruined by water. All this was because a little nail decided to quit! But what of the nail? While holding the board, it was not known by others but it was useful. Buried in the mud now, it was useless and would soon be eaten up by rust! What the story wants to say is that every member is important to a whole group! You may, like the nail, feel not important at times, but just like the nail, your absence is felt. A big building might fall to pieces. You are important to a group even if you are small. [/INST] question: Why did the nail decide to quit? | options: A: Because he was not able to hold on any longer B: Because he was angry and sad without people's praising him C: Because he knew a big nail would replace him D: Because he had finished his task successfully | answer: B </s>
<s>[INST] context: (Contra-lateral renal function is scertain)Nephrectomy is a possibility so it is important to establish that the contralateral kidney is functioning (1291- Bally & Love 25th)Injury to the Kideny * Haematuria is a cardinal sign of a damaged kidney *** Meterorism - abdominal distension comes on about 24-48 hours after the accident (retroperitoneal haematoma implicating splanchnic nerves)* An Intravenous urogram (IVP) should be obtained urgently to show that the other kidney is normal. A leak of urine on the damaged side is often demonstrated* Before proceeding to surgical procedure for bleeding a renal arteriogram should be performed if possible. If the bleeding vessel is visualized it may be embolised with small starch microspheres to stop bleeding* Should the necessity for a urgent operation arise and facilities for urography not be available, the presence of a functioning kidney on the contralateral side can often be confirmed by chromo- cystoscopyTREATMENT1. Nephrectomy - Kidney is found to rupture in several places or kidney pedicle is damaged2. Small tear can be sutured over oxycel or a piece of detached muscle3. Nephrostomy - Larger single rents in the middle of the kidney4. Partial Nephrectomy - laceration is confined to one pole of the kidney [/INST] question: During renal rupture the nephrectomy is NOT attempted until | options: A: Fluid replacement B: Antibiotics covers C: Contralateral renal function is ascertain D: Renal angiogram | answer: C </s>