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<s>[INST] context: When he stopped his car at a traffic light in Basra, Bassam Rady noticed the motorbike with two riders on it passed by him slowly. Suddenly the bike turned round and Mr. Rady, feeling dangerous, tried to drive off. Before he could, a man on the back of the bike took out a gun from his jacket and fired. The bullet went through the windscreen and just missed him. As he sped away another shot was fired, but missed the car.
Mr. Rady was an interpreter for British army in Iraq. As such, his life is in danger from the militia that once controlled the Iraqi city and is now returning.
More than a year ago Iraqi soldiers, backed by US, brought peace and stability to Basra by driving militants over the Iranian border in an operation called Charge of the Knights.
According to local estimates, however, about half have returned. Although they have not become as active as before, the militants are trying to shoot Iraqi citizens who worked with British. Most in danger are translators such as Mr. Rady.
The 31-year-old father worked with soldiers on dangerous missions but was refused resettlement in Britain at the end of his employment. He worked with nine translators. Seven of them have been killed.
"I'm like a cancer patient -- now that the militia is back, my family is just waiting for me to die," Mr. Rady said. "I see reports in the media that Basra is safe but it's not true. I know these militia people. I went to school with some of them. I didn't see them for a year but now they are around again. They have told me, 'Your day will come soon'." He takes security precautions and never follows a routine. This means that he cannot work because that would give the militants a better chance of success.
Militiamen belonging to the alMahdi Army took control of Basra between 2004 and 2007 with other Shia fighters. They enforced strict Islamic rules at the same time as running criminal rackets. British army was unable or unwilling to fight back and eventually went back to their base at the airport. [/INST] question: Mr. Bassam Rady was_. | options: A: a motorbike rider B: a car driver C: an Iraqi D: a British soldier | answer: C </s> |
<s>[INST] context: GIANT CELL AERITIS Headache, scalp tenderness, visual symptoms, jaw claudication, or throat pain The temporal aery is usually normal on physical examination but may be nodular, enlarged, tender, or pulseless Blindness Results from occlusive aeritis of the posterior ciliary branch of the ophthalmic aery Ischemic optic neuropathy may produce no funduscopic findings for the first 24-48 hours after the onset of blindness Asymmetry of pulses in the arms, a murmur of aoic regurgitation, or bruits heard near the clavicle resulting from subclan aery stenoses identify an affected aoa or its major branches Foy percent of patients with giant cell aeritis have nonclassic symptoms at presentation, primarily respiratory tract problems (most frequently dry cough), mononeuritis multiplex (most frequently with painful paralysis of a shoulder), or fever of unknown origin The fever can be as high as 40degC and is frequently associated with rigors and sweats Unexplained head or neck pain in an older patient may signal the presence of giant cell aeritis Diagnosis An elevated ESR, with a median result of about 65 mm/h, occurs in more than 90% of patients with polymyalgia rheumatica or giant cell aeritis Magnetic resonance angiography or CT angiography establishes the diagnosis by demonstrating long stretches of narrowing of the subclan and axillary aeries Imaging of the temporal aery with ultrasound, MRI, or CT angiography can sometimes obte the need for biopsy Temporal aery biopsy -Diagnostic findings of giant cell aeritis may still be present 2 weeks (or even considerably longer) after staing coicosteroids . TREATMENT The urgency of early diagnosis and treatment in giant cell aeritis relates to the prevention of blindness When a patient has symptoms and findings suggestive of temporal aeritis, therapy with prednisone, 60 mg daily orally, is initiated immediately Prednisone should be continued in a dosage of 60 mg/day for 1-2 months before tapering Intravenous pulse methylprednisolone (eg, 1 g/day for 3 days) may help patients with visual loss and may increase chance of remission; however, data suppoing this recommendation are preliminary Low-dose aspirin (~81 mg/day orally) may reduce the risk of visual loss or stroke and should be added to prednisone Tocilizumab, an anti-interleukin-6 receptor monoclonal antibody Phase 2 clinical trials have shown that patients initially treated withtocilizumaband prednisone were able to be tapered off prednisone faster than those who were treated with prednisone alone After 1 year of treatment,tocilizumabachieves coicosteroid-free remission in approximately 50% of patients [/INST] question: A 65 year old lady underwent mastectomy for Carcinoma breast. Later she developed frontal headache, pain in temple region and around eye. Her ESR is 55 mm/hour. What is the most probable diagnosis? | options: A: Cavernous sinus thrombosis B: Meningeal metastasis C: Frontal sinusitis D: Giant cell aeritis | answer: D </s> |
<s>[INST] context: The sacrococcygeal symphysis is an amphiahrodial (slightly mobile) joint, formed between the oval surface at the apex of the sacrum, and the base of the coccyx.The movements which take place between the sacrum and coccyx, and between the different pieces of the latter bone, are forward and backward; they are very limited. Their extent increases during pregnancy.A zygapophyseal joint (or facet joint) is a veebral joint between the superior aicular process of one veebra and the inferior aicular process of the one adjacent. It is of plane synol variety. In fact, all the joints of veebra are plane synol Except the median one- which is a symphysis (as expected *).*All midline joints tend to be symphysis, only very few Exceptions are there. E.g., spheno-occipital joint, which is a synchondrosisInterveebral discs (or interveebral fibrocailage) lie between adjacent veebrae in the spine. Each disc forms a secondary cailaginous (symphysis) joint to allow slight movement of the veebrae, and acts as a ligament to hold the veebrae together.Discs consist of an outer annulus fibrosus, which surrounds the inner nucleus pulposus. The annulus fibrosus consists of several layers of fibrocailage. The strong annular fibers contain the nucleus pulposus and distribute pressure evenly across the disc. The nucleus pulposus contains loose fibers suspended in a mucoprotein gel the consistency of jelly. The nucleus of the disc acts as a shock absorber, absorbing the impact of the body&;s daily activities and keeping the two veebrae separated.The disc can be likened to a doughnut: whereby the annulus fibrosis is similar to the dough and the nucleus pulposis is the jelly. If one presses down on the front of the doughnut the jelly moves posteriorly or to the back. When one develops a prolapsed disc the jelly/ nucleus pulposis is forced out of the doughnut/ disc and may put pressure on the nerve located near the disc. This will give one the symptoms of sciatica if the disc herniation is at lumbosacral region.There is one disc between each pair of veebrae, Except for the first cervical segment, the atlas. There are a total of twenty-three discs in the spine.When the annulus fibrosus tears due to an injury or the aging process, the nucleus pulposus can begin to extrude through the tear, most commonly postero-lateral. This is called disc herniation. Near the posterior side of each disc, all along the spine, major spinal nerves extend out to different organs, tissues, extremities etc. It is very common for the herniated disc to press against these nerves (pinched nerve) causing radiating pain, numbness, tingling, and diminished strength and/or range of motion. In addition, the contact of the inner nuclear gel, which contains inflammatory proteins, with a nerve can also cause significant pain and muscle spasm. Nerve-related pain is called radicular pain. [/INST] question: The type of joint between the sacrum and the coccyx is a | options: A: Symphysis B: Synostosis C: Synchondrosis D: Syndesmosis | answer: A </s> |
<s>[INST] context: Alan Tong was the worst driver in town. He had an accident of some kind almost every week.
Alan lived with his mother. His mother was always worried about him. Every day she worried that police would turn up to arrest him. This wasn't a foolish worry because they usually called on the Tong household about once a week to deliver a speeding ticket or to serve him notice to appear in court.
Most of his accidents were caused by his carelessness. He drove through red lights. He turned right without signaling. He drove at night without proper lights. He overtook other cars on hills and sharp curve. In short there wasn't a traffic regulation Alan had not broken, and he had had so many accidents that it was a miracle he was still alive. But luckily for Alan, he had never hurt anyone in his accidents or even gone to the hospital.
Although Alan wasn't popular with the police, he was very popular with his lawyer. Alan's lawyer, Mr.Tsui, had earned a lot of money from Alan's cases and always rubbed his hands expectantly when he saw Alan coming into his office.
One day Alan was working in the garage spraying painting his car when his mother walked in. "What are you doing?" his mother asked.
"Painting my car," Alan replied.
"I can see that," his mother said, "but why are you painting one side of the car red and the other side blue?" "Because every time I have to go to court for a traffic offense, there are always two witnesses . "What color1 was the car?" the prosecutor always asks, and the two witnesses always give the same answer. Well, in the future, one witness will say it was blue. Mr. Tsui will then say to the judge, "Your honor, the witnesses cannot even agree on the color1 of the car involved in the accident." And the judge will have to dismiss the case against me. [/INST] question: Alan's mother's worries were _ . | options: A: unbelievable B: quite reasonable C: silly D: unrelated to his bad driving | answer: B </s> |
<s>[INST] context: Billie Holiday was an American jazz singer and songwriter. Nicknamed Lady Day by her loyal friend and musical partner, Lester Young, Holiday was a great influence on jazz and pop singing. Her voiced style, strongly inspired by jazz instrumentalists, pioneered a new way of controlling tempo . Above all, she was admired for her deeply personal and direct approach to singing.
Billie Holiday was born Eleanora Fagan on April 7, 1915, in Philadelphia, Pennsylvania. Her father, Clarence Halliday (Holiday), a musician, did not marry or live with her mother. Her mother had moved to Philadelphia when thirteen, after being driven away from her parents' home in Sandtown-Winchester, Baltimore for becoming pregnant. With no support from her own parents, Holiday's mother arranged for the young Holiday to stay with her older married half sister, Eva Miller, who lived in Baltimore.
During her final period of separation from her mother, Holiday began to perform the songs she learned while working in the brothel . By early 1929, Holiday joined her mother in Harlem. Their landlady was a sharply dressed woman named Florence Williams, who ran a brothel at 151 West 140th Street. In order to live, Holiday and her mother had to work there. Holiday had not yet turned fourteen at that time. On May 2, 1929, the house was raided , and Holiday and her mother were sent to prison. After spending some time in a workhouse, her mother was released in July, followed by Holiday in October, at the age of 14.
She co-wrote a few songs, and several of them have become jazz standards, notably God Bless the Child, Don't Explain, and Lady Sings the Blues. She also became famous for singing jazz standards written by others, including Easy Living and Strange Fruit.
Her early career is hard to track down exactly. But, she later gained work singing in local jazz clubs before being spotted by a talent scout , John Hammond, in 1933, aged 18.
Her voice and recordings are loved for the depth of emotion and intensity she could bring to classic standards. Her range of voice was not the greatest, but, her extraordinary gravelly voice was soon to become very famous and influential.
She was an important icon of the jazz era and influential in the development of jazz singing. In the late 1930s she began singing a civil rights song called Strange Fruit--a song which told the tale of a lynching of a black man in the deep south. It was very controversial for that period and it was not played on radios. It was recorded for Commodore records and she performed it many times over the next 20 years.
In early 1959 she found out that she had cirrhosis of the liver. The doctor told her to stop drinking, which she did for a short time, but soon returned to heavy drinking. By May she had lost twenty pounds, friends Leonard Feather, Joe Glaser, and Allan Morrison tried to get her to check into to a hospital, she put them off.
On May 31, 1959, Holiday was taken to Metropolitan Hospital in New York suffering from liver and heart disease. She was arrested for drug possession as she lay dying, and her hospital room was raided by authorities. Police officers were stationed at the door to her room. Holiday remained under police guard at the hospital until she died from cirrhosis of the liver on July 17, 1959.Billie Holiday had difficult life experiences which influenced her attitude towards life. She experienced many violent relationships. She also became increasingly dependent on various drugs which contributed to her early death in 1959, aged just 44. [/INST] question: What made Holiday develop a new way of controlling tempo? | options: A: Her musical partner B: Her voiced style C: Jazz instrumentalists D: Her way of singing | answer: B </s> |
<s>[INST] context: No budget for your vacation? Try home exchanges ---- swapping houses with strangers. Agree to use each other's cars, and you can save dollars on car rentals , too.
Home exchanges are not new. At least one group, Intervac, has been facilitating such an arrangement since 1953. But trading online is gaining popularity these days, with several sites in operation, including Home Exchanges. Founded in 1992, with some 28,000 listings, this company bills itself as the world's largest home exchange club, reporting that membership has increased 30% this year.
The annual fee is usually less than US$100. Members can access thousands of listings for apartments, villas, suburban homes and farms around the world. Initial contact is made via e-mail, with subsequent communication usually by phone. Before a match is made, potential swappers tend to discuss a lot.
However, the concept may sound risky to some people. What about theft? Damage? These are reasonable causes for concern, but equally unlikely. As one swapper puts it, "Nobody is going to fly across the ocean or drive 600 miles to come steal your TV. Besides, at the same time they're staying in your home, you are staying in their home."
Exchange sites recommend that swappers discuss such matters ahead of time. They may fill out an agreement spelling out who shoulders which responsibilities if a problem arises. It does not matter if the agreement would hold up in court, but it does give the exchangers a little satisfaction.
Generally, the biggest complaint among home exchangers has to do with different standards of cleanliness. Swappers are supposed to make sure their home is in order before they depart, but one person's idea of "clean" may be more forgiving than another's. Some owners say if they come back to a less-than-sparkling kitchen, it may be inconvenient but would not sour them on future exchanges. [/INST] question: How do home exchangers normally begin their communication? | options: A: By phone B: Via a matchmaker C: By e-mail D: Via a face-to-face meeting | answer: C </s> |
<s>[INST] context: New York is the biggest city of the USA. A long time ago, it was called Lenapehoking. In 1626, Dutch people bought the land for only $24! They called it New Amsterdam. Then in 1664, the British took it over and changed the name to New York.
New York had an excellent harbour . Many people from all over the world came by sea and landed in New York. These people wanted a better life. New York seemed to give them that. By 1835, New York became the largest city in the United States. New York City used to have five smaller towns but now they are all part of the same city. They are Manhattan, Brooklyn, Queens, the Bronx and Staten Island.
Today, New York is home to millions of people from all over the world. These different cultures make New York an exciting place to visit. There's much to do in New York. You can take a helicopter riding through the city, ride horses in Central Park, see a movie in the afternoon and watch the sunset over the Brooklyn Bridge. Don't worry if you get hungry. Some restaurants are open 24 hours a day! [/INST] question: In the year 1626, New York was called _ . | options: A: Lenapehoking B: New Amsterdam C: New York D: Manhattan | answer: B </s> |
<s>[INST] context: TCA / Krebs cycle Characteristics of TCA cycleuSite of occurrence - Mitochondria u20 ATPs are produced in one cycleuAmphibolic pathway (Anabolic + Catabolic pathway)uAnaplerotic reaction of TCA cycle - Pyruvate to Oxaloacetate by Pyruvate carboxylase Inhibitors Enzyme Inhibitor Aconitase Fluoroacetate Alpha ketoglutarate Arsenite Succinate dehydrogenase Malonate Irreversible reactions Reactions Enzyme Oxaloacetate - Citrate Citrate synthase Alpha ketoglutarate - Succinyl Co-AAlpha ketoglutarate dehydrogenase Oxidative / Substrate level phosphorylation Reactions Enzyme Succinyl Co-A - Succinate Succinate thiokinase Energetics 20 ATPVitamins in TCA cycle Riboflavin Niacin Thiamine Pantothenic acid FAD as cofactor NAD as cofactor Thiamine diphosphate as cofactor Coenzyme A as cofactor Alpha ketoglutarate dehydrogenase;Succinate dehydrogenase Isocitrate dehydrogenase;Alpha ketoglutarate dehydrogenase; Malate dehydrogenase Alpha ketoglutarate dehydrogenaseAcetyl CoA; Succinyl CoAHarper's illustrated Biochemistry , 30th ed , page 164 [/INST] question: Source of energy in Kreb cycle is | options: A: NAD B: NADP C: NADPH D: NADH | answer: D </s> |
<s>[INST] context: If you had the chance to leave the life you have now, what would you do?
Students from Fair-grounds Middle School, New Hampshire, US, chose to lead a special life for a week. They left the city and lived a different life by working on a farm. They handed over their cell phones and lived like any farmer's children. And they enjoyed it!
"I didn't know what would happen when we got there," said Tyler Swift, 14, "but there were so many fun things. So much hard work, too. It was a _ ."
"Getting up at 6 every morning, the students milked cows, spread hay , and washed hundreds of sticky buckets . The hardest part was cleaning up piles of poop in the animal houses. It smelled bad, but it was lots of fun!
None of the students said no to the work. "With the farmers' help, they did the work better and better. And they learned a lot more than just farming work." said Rick Brown, a science teacher at Fair-grounds.
"You get to know who can do what and learn to work with different people. The children all showed great team work." said Nick Quadros. [/INST] question: How long did the children work on the farm? | options: A: For a week B: For about half a month C: For a month D: For ten days | answer: A </s> |
<s>[INST] context: Wide fixed splitting of S2 in association with ejection systolic murmur suggests the diagnosis of Atrial septal defect.
Ideally, with hypertrophy of the right side of the heart, right axis deviation should be present, but sometimes left axis deviation is also seen in A.S.D.
The explanation for the presence of left axis deviation in A.S.D
Atrial septal defects are of two types
Ostium primum atrial septal defect
Ostium secundum atrial septal defect
This division depends upon the development of interatrial septum and related structures.
Ostiutn secundum type atrial septal defect is the classical atrial septum defect.
Presence of interatrial septum is the only developmental anomaly in ostium secundum type and associated with right axis deviation.
In contrast, the ostium primum defects are characterized by the presence of certain other developmental abnormalities, besides the interatrial septum.
Once such abnormality is the malformation or lack of development of the anterosuperior division of the left bundle branch.
Maldevelopment of antero superior division of the left bundle branch is responsible for abnormal left axis deviation. [/INST] question: A young female presents with a history of dyspnoea on exertion. On examination, she has wide, fixed split S2 with ejection systolic murmur (III/VI) in left second intercostal space. Her ECG shows left axis deviation. The most probable diagnosis is – | options: A: Total anomalous pulmonary venous drainge B: Tricuspid atresia C: Ostium primum atrial septal defect D: Ventricular septal defect with pulmonary arterial hypertension | answer: C </s> |
<s>[INST] context: Systemic lupus erythematosus (SLE), also known simply as lupus, is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many pas of the body. Symptoms vary between people and may be mild to severe. Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is most commonly on the face. Often there are periods of illness, called flares, and periods of remission when there are few symptoms. Treatments may include NSAIDs, coicosteroids, immunosuppressants, hydroxychloroquine, and methotrexate. Alternative medicine has not been shown to affect the disease. Life expectancy is lower among people with SLE. SLE significantly increases the risk of cardiovascular disease with this being the most common cause of death. With modern treatment about 80% of those affected survive more than 15 years. Women with lupus have pregnancies that are higher risk but are mostly successful. [/INST] question: In which of following ahritis erosions are not seen - | options: A: Rheumatoid ahritis B: Systemic lupus ehematosus (SLE) C: Psoriasis D: Gout | answer: B </s> |
<s>[INST] context: You may have noticed that you feel hungry a lot. This is natural----during teens, a person's body needs more nutrients to grow. Snacks are a great way to satisfy that hunger and get all the vitamins and nutrients your body needs.
But you need to pay attention to what you eat. Filling your stomach with a lot of fries after class may give you a short-time help, but a snack high in fat and calories will only slow you down in the long time.
To keep energy levels going---and avoid gain weight---keep away from foods like candy or soda. Look for foods like bread and grains and combine them with some food like peanut butter or low-fat milk or cheese.
Choosing healthy snacks means shopping smart. Be careful of the health instructions on food bags. Here are some things to watch out for.
That something is "all natural " doesn't necessarily mean that it's nutrients. For example, "all natural" juice drinks or sodas can be filled with sugar (which means they'll be high in calories and give you little nutrition.)
A granola bar is a good example of a snack that people think is healthy. Although granola bars can be a good source of certain vitamins and nutrients, may also contain a great deal of fat, including a particularly harmful type of fat called trans fat. Check the Nutrition Facts instructions on the bag to be sure. [/INST] question: We need snacks to _ . | options: A: reduce energy B: gain weight C: help grow D: keep healthy | answer: C </s> |
<s>[INST] context: Zygoma fracture is also known as tripod fracture. Clinical features of zygoma fracture Considerable swelling over zygomatic arch is common and makes clinical diagnosis more difficult. Flattening of malar prominence. Step-deformity of infraorbital margin. Anaesthesia in the distribution of infraorbital nerve. Trismus, due to depression of zygoma on the underlying coronoid process. Oblique palpebral fissure, due to the displacement of lateral palpebral ligament. Restricted ocular movement, due to entrapment of inferior rectus muscle. It may cause diplopia. Periorbital emphysema, due to escape of air from the maxillary sinus on nose-blowing. The mucosa of the maxillary sinus may be lacerated and cause epistaxis on that side. Fracture of the zygoma may or may not be painful to palpation and running a finger along the zygomatic arch may give a feel of a depressed fracture or a small dimple. The cheek may appear flattened compared to symmetry with the opposite side. This may be obvious immediately following trauma or several days later once swelling has subsided. [/INST] question: Tripod fracture is the name given for | options: A: Zygomatic fracture B: Maxillary fracture C: Mandibular fracture D: Temporal fracture | answer: A </s> |
<s>[INST] context: Sweetest Day in America is always the third Saturday in October. This holiday is much more important in some regions than in others (Detroit, Cleveland and Buffalo being the biggest Sweetest Day cities). It is a holiday that is gaining in popularity every year throughout the country.
Sweetest Day is celebrated on the third Saturday in October as a day to make someone happy. It is an occasion which offers all of us an opportunity to remember not only the sick, aged, and orphaned, but also friends, relatives and associates whose helpfulness and kindness we have enjoyed.
Over 60 years ago, a man in Cleveland, believing that the city's orphans and shutins too often felt forgotten and neglected, thought of the idea of showing them that they were remembered. He did this through the distribution of small gifts. With the help of his friends and neighbors, he distributed these small remembrances on a Saturday in October. During the years that followed, other Clevelanders began to participate in the celebration ceremony, which came to be called "Sweetest Day". In time, the Sweetest Day idea of spreading cheer to the underprivileged was broadened to include everyone, and became an occasion for remembering others with a kind act or a small remembrance. And soon the idea spread to other cities all over the country.
Sweetest Day is not based on any single group's religious affection or on a family relationship. It is a reminder that a thoughtful word or deed enriches life and gives it meaning.
Because for many people remembering takes the form of giftgiving, Sweetest Day offers us the opportunity to show others that we care, in a practical way. [/INST] question: Sweetest Day was intended to remember _ . | options: A: the young and disabled B: friends and relatives C: orphans and shutins D: the sick and aged | answer: C </s> |
<s>[INST] context: Mark Twain left school when he was twelve. Though he had little school education, he became the most famous writer of his time. He made millions of dollars by writing. His real name was Samuel Langhorne Clements, but he is better known all over the world as Mark Twain, his penname.
Mark Twain was born in 1835 and he was not a healthy baby. In fact, he was not expected to live through the first winter. But with his mother's tender care, he managed to survive. As a boy, he caused much trouble to his parents. He used to play jokes on all his friends and neighbors. He didn't like to go to school, and he ran away from home from time to time. He always went in the direction of the nearby Mississippi. He was nearly drowned nine times.
After his father's death in 1847, Mark Twain began to work for a printer, who only provided him with food and clothing. Then, he worked as a river-boat pilot and later joined the army. But shortly after that he became a miner, during this period, he started to write short stories. Afterwards he became a full-time writer.
In 1870, Mark Twain got married. In the years that followed he wrote many books including
in 1876, and
in 1884, which made him famous, and brought him a great fortune .Unfortunately, Mark Twain got into debts in bad investments and he had to write large numbers of stories to pay these debts. In 1904, his wife died and then three of their children passed away.
He died on April 21, 1910 at the age of 70. [/INST] question: Mark Twain was _ in his childhood. | options: A: a naughty boy B: a good student C: a handsome boy D: a strong boy | answer: A </s> |
<s>[INST] context: Familial glucocoicoid deficiency Familial glucocoicoid deficiency is a rare autosomal recessive condition. It is characterized by adrenal insufficiency. The pathological examination of the adrenal gland reveals that:- This causes low coisol concentration because the zona fasciculata is primarily responsible for glucocoicoid production. Because the zona glomerulosa is well preserved mineralocoicoid action is usually unaffected. Low circulating serum coisol results in lack of feedback inhibition to the hypothalamus which results in increased ACTH secretion from pituitary. Clinical features Zona glomerulosa --> well preserved Zona fasciculata atrophied Zona reticularis --> atrophied Patients with familial glucocoicoid deficiency generally presents with signs and symptoms of "adrenal insufficiency" with the impoant distinction that mineralocoicoid production is always normal. The most common initial presenting sign is "deep hyperpigmentation" of the skin, mucous membrane or both as a result of the action of adrenocoicotrophic hormone (ACTH) on cutaneous melanocyte stimulating hormone (MSH) receptors. The symptoms are compatible with glucocoicoid deficiency. Many patients presents with recurrent hypoglycemia or severe infections. - In the neonatal period, frequent presenting signs include - feeding problems, failure to thrive, regurgitation and hypoglycemia manifesting as seizures [/INST] question: A previously healthy 6 week old female infant is found unresponsive in her crib. In the emergency depament, she is noted to be well developed and well nourished with normal blood pressure and appearance of the genitalia but with increased pigmentation of her skin. Blood glucose level is 30 mg/dL. The most likely diagnosis is aEUR' | options: A: CAH due to 21 alpha hydroxylase deficiency B: Familial glucocoicoid deficiency C: Cushing syndrome D: Insulinoma | answer: B </s> |
<s>[INST] context: Copenhagen is a city full of fairy tales . If you want to _ it, you have to spend a long time and walk slower to enjoy yourself. Copenhagen was the first city to have a street for walkers only. The city has less traffic noise and pollution than any other European capital.
Walking along the river banks, you'll see the Amalienborg Palace first. The king's family is living there.
Churches and castles show us the original city. Copenhagen became the capital of Denmark in 1445. But fires in 1728 and 1795 completely destroyed the old wooden buildings. Much of what we see today dates back to the 19th and early 20th centuries.
Keep going, and you'll see the Christiansborg Palace. The town of Copenhagen began there. The you'll see Nyhavn ,a waterway, which was dug in 1673. When you see it, you'll understand why Hans Christian Andersen made this beautiful waterway his home. Nyhavn is a peaceful and wonderful place. You'll usually see some rich people walk along here.
If you walk there, you can enjoy the old trees, the colorful lights and the beautiful gardens. You might feel as if you were in a fairy tale. [/INST] question: Which of the following European capital cities has the least traffic noise and pollution? | options: A: London B: Rome C: Paris D: Copenhagen | answer: D </s> |
<s>[INST] context: Writer: Ralph Ellison Novel : Invisible Man
Invisible Man is Ellison's best known work, most likely because it was the only novel he ever published during his lifetime and because it won him the National Book Award in 1953. Ellison, originally from Oklahoma worked hard to match his earlier success but felt that he could not make any progress on his next novel that eventually came to include well over 2000 pages. It was not until Ellison's death that this novel was condensed ,edited and published under the title Juneteenth.
Writer: Margaret Mitchell Novel: Gone with the wind
Margaret Mitchell, born in Georgia, never wanted to seek out literary success and wrote this expansive work in secret, only sending to publishers after she was mocked by a colleague who didn't believe she was capable of writing a novel. She turned out to be more than capable, and the book won a Pulitzer Prize and was adapted into one of the best-known and loved films of all time. Mitchell would not get a chance to write another novel, as she was struck and killed by a car on her way to the cinema at only 49 years of age.
Writer: Anna Sewell Novel: Black Beauty
Sewell didn't start off her life intending to be a novelist, she didn't begin writing Black Beauty until she was 51 years old, motivated by the need to create a work that encouraged people to treat horses ( and humans) humanely and it took her six years to complete it. Upon publication it was an immediate bestseller, rocketing Sewell into success. Unfortunately, she would not live to enjoy but a little of it as she died of hepatitis five months after her book was released. [/INST] question: Which novel has been adapted into one of the most successful films? | options: A: Invisible Man B: Gone with the Wind C: Black Beauty D: Juneteeth | answer: B </s> |
<s>[INST] context: More soluble in plasma Diffusion of gases through the tissues or respiratory membrane depends on the solubility of the gas in lipids; but since all the gases of respiratory impoance are all highly soluble in lipids the diffusion through the tissues would depend on diffusion of gases in tissue water. The diffusion of gases through fluid depends on multiple factors (1. the solubility of the gas in the fluid, 2. the cross-sectional area of the fluid, 3. the distance through which the gas must diffuse, 4.the molecular weight of the gas, and 5. the temperature of the fluid.] of which the two which are characterstics of the gas itself are - Solubility in fluid & - Molecular weight. The diffusion coefficient of the gas is directly propoional to the solubility and inversely propoional to the square root of the molecular weight. Diffusion coefficient = Solubility/ Molecular weight Diffusion coeffiecient of: Oxygen ---- 1.0 Carbon dioxide ---- 20.3 Carbon dioxide despite having higher molecular weight than Oxygen, has a very high diffusion coefficient because of its very high solubility in plasma (about 22 times). [/INST] question: CO2 diffuses more easily through the respiratory membrane than 02 because it is: | options: A: Less dense B: More soluble in plasma C: Less molecular weight D: Less PCO2 in the alveoli | answer: B </s> |
<s>[INST] context: It was already dark when an old man came to a small town. He found an inn and wanted to stay there for the night. After he had gone to his room, the owner said to his wife, "Look at his bag, dear. I'm sure there are lots of valuable things in it. I want to steal it when he is asleep."
"No, no," said the woman. "He must look for his bag tomorrow morning. Then he'll take you before the judge." They thought and at last the woman had an idea. "We have forgetful grass," said the woman, "Why not put some into his food? If he has the food, he will forget to take his bag away." "How clever you are!" said the owner, "Don't forget it when you prepare supper for him."
The old man had the food with the forgetful grass and went to bed. The next morning, when the owner got up, he found the door was open and the old man had left with his bag. He woke his wife up and said angrily, "What a fool! Your forgetful grass isn't useful at all." "No, no," said the woman. "I don't think so. He must forget something." "Oh, I've remembered!" The owner cried out suddenly, "He forgot..." [/INST] question: The old man came to the inn _ . | options: A: in the morning B: in the afternoon C: in the evening D: at night | answer: C </s> |
<s>[INST] context: Functions of Female health worker
1. Maternal and child health.
Ensure at least 3 antenatal checkups for pregnant women.
Test urine of pregnant women for albumin, and estimate hemoglobin level.
Conduct deliveries in her area when called for.
Supervise deliveries conducted by dais and assist them whenever called.
Make at least two post-natal visits for each delivery.
7th of each month, will submit accounts of the previous month of beneficiaries under janani Suraksha yojana (JSY).
Refer cases of abnormal pregnancy and cases with medical and gynecological problems to PHC.
2. Family planning
Responsible for maintaining eligible couple registers and updating at all times.
Distribute conventional contraceptives and oral contraceptives to couples.
3. Medical termination of pregnancy
i) Refer the related case to nearest approved institution.
4. Nutrition
Distribute iron & folic acid tablets to pregnant women.
Administer vitamin A solution to children.
5. Universal programme of immunization
Immune pregnant women with TT.
Administer DPT, OPV, measles, vaccine & BCG to all infants & children.
6. Dai training
List dais in her area
Help the health assistant in training programme of Dais.
7. Communicable diseases
Give ORS to all cases of diarrhea, dysentery/vomiting.
Helps identification & treatment of filariasis, where it is endemic.
8. Vital events
i) Record & Report vital events (birth, death).
9. Records keeping
i) Register : -
Pregnant women from 3 months onward.
Infants (0-1 year)
Women aged 15 to 44 year.
10. Treatment of minor ailments
11. Team activities
i) Meet the health assistant each week and seek her advice and guidance whenever necessary.
Note : About option `e' → FHW tests urine for albumin. [/INST] question: Function of Health worker female – a) Perform 50% of deliveriesb) Trains daisc) Enlist dais of the subcentred) Chlorination of watere) Collectors of urine samples | options: A: a B: c C: ac D: bc | answer: D </s> |
<s>[INST] context: Close your eyes for a minute and imagine what life would be like if you couldn't see. Imagine having to read this page, not with your eyes but with your fingers. How do you feel, then?
With medical knowledge and skills today, two-thirds of the world's 42 million blind people should not have to suffer. Unluckily, rich countries have this knowledge, but developing countries do not.
ORBIS is an international charitable organization. Its goal is to help fight blindness all over the world. Inside a DC-8 airplane, there is a teaching hospital with television room and classroom. Doctors are taught the latest technology of helping the blind get sight again here. ORBIS is always trying to keep a closer relation among countries.
ORBIS helps those developing countries by providing sight-saving training. It has taught over 35,000 doctors and nurses. They continue to treat thousands of blind people every year. They have traveled around the earth 3 times, visited 76 countries and treated over 20,000 blind people. They need your help to continue their work and free people from blindness.
For just $ 38, you can help one person see; for $ 380 10 people can see; $ 1,300 helps train a doctor new skills; and for $ 13,000 you can provide a training program for a group of doctors who can make thousands of blind people see again. Your love can help them open their eyes to the world. [/INST] question: How many blind people should not have to suffer with medical knowledge and skills today? | options: A: 14 million B: 42 million C: 28 million D: 200 million | answer: C </s> |
<s>[INST] context: Does your pet have a slim figure? According to the Association of Pet Obesity Prevention (APOP), about half of all dogs and nearly 60% of all indoor cats are overweight. Larry Kornegay, president of the American Veterinary Medical Association, says he sees an overweight pet nearly every day, and unusually the owner is overweight. So talking about the topic can be _ . "I talk about their pet's health. Still, some clients take it personally."
Here are some tips for pet weight loss:
See the vet . Have your vet put together a plan and treat any existing medical problems. Pain relief and diet changes may be required for arthritic pets, which will allow for exercise to at least begin.
Skip the crash diet (an attempt to lose weight quickly by strictly limiting the diet). A special weight-loss diet may be suggested. For example, look for the supplement which burns fat and builds muscle mass in foods. Never place any pet on a crash diet, especially cats, which can suffer a potentially fatal liver disease as a result. There's a safe weight-loss drug for dogs you can ask your vet about.
Dine alone. "Cut out treats and resist temptation by keeping pets out of the room you're dining in," says Chicago vet Sheldon Rubin. You can buy low-calorie treats for dogs and cats. Rubin also recommends mini carrots, small apple slices or blueberries for dogs. What's important is finding other ways, aside from food, to show your love. Play with your cat using an interactive toy, and take your dog for walks. Walks are great for bonding, and good for you. Studies show people are actually more willing to lose weight themselves if it also will help their pet.
Feed pets at special times. Pre-measure food carefully--don't give them a larger meal than ever--and leave it in various places, so pets sniff it out and use the stairs. It's fun, and it's good exercise. [/INST] question: Which of the following methods is healthy for your pets? | options: A: Providing them with mini carrots or blueberries B: Keeping them with you when you're dining C: Supplying them with larger meals or drinks D: Leaving the food in a fixed place for your pets | answer: A </s> |
<s>[INST] context: Reid index is used to assess the increase in the size of the submucous gland in chronic bronchitis.
Chronic bronchitis
Chronic bronchitis is defined as a persistent cough with sputum production for at least 3 months in at least 2 consecutive years, in the absence of any other identifiable cause.
It is strongly associated with smoking.
Morphological changes in chronic bronchitis
The earliest feature of chronic bronchitis is hypersecretion of mucus in the larger airways, associated with hypertrophy of submucosal gland of trachea and bronchi.
Although the numbers of glands increase slightly, the major increase is in the size of mucous glands.
This increase can be assessed by Reid index which is the ratio of between the thickness of the submucosal glands to that of the bronchial wall. The Reid index (normal 0.4) is increased in chronic bronchitis.
Later, small airways (small bronchi and bronchioles) are also involved and show goblet cell hyperplasia, and intraluminal and peribronchial fibrosis.
In most severe cases, there may be obliteration of lumen due to fibrosis → Bronchiolitis obliterans.
The bronchial epithelium may undergo squamous metaplasia and dysplasia. [/INST] question: Reid index is useful in - | options: A: Glomerulonephritis B: Chronic bronchitis C: Cirrhosis D: MI | answer: B </s> |
<s>[INST] context: How to be Prepared
Electricity, water, gas and telephone may not be working after an earthquake. The police and fire department are likely to be tied up. You should be prepared to take care of yourself for at least three days, preferably for a week.
This list can also be applied to other disasters, such as floods or wildfires.
1. food and water (a gallon a day per person)
2. a first aid kit
3. a fire extinguisher suitable for all types of fires
4. flashlights, a portable radio extra batteries
5. blankets, clothes, shoes and money (ATMs may not work)
6. baby and pet food
It's also a good idea to decide beforehand how and where your family will reunite if separated during a quake and to conduct in-home practice drills.
During an Earthquake
If you are indoors, stay there. Get under and hold onto a desk or table, or stand against an interior wall. Stay away from exterior walls, glass, heavy furniture, and stay away from windows and outside walls and do not use the elevator.
If you are outside, get into the open, stay into the open, stay away from buildings, power lines or anything else that could fall on you.
If you are driving, move the car out of traffic and stop, avoid parking under or on bridges or overpasses, Try to get clear of trees, light posts, signs and power lines.
If you are in a crowded public place, avoid panicking and do not rush for the exit. Stay low and cover your head and neck with your hands and arms.
After an Earthquake
If the phone is working, only use it in case of emergency. Likewise, avoid driving if possible to keep the streets clear for emergency vehicles.
Be aware that items may fall out of cupboards or closets when the door is opened, and also that chimneys can be weakened and fall with touch. Check for cracks and damage to the roof and foundation of your home.
Listen to the radio for important information and instructions. Remember that _ , sometimes large enough to cause damage in their own right, generally follow large quakes.
If you leave home, leave a message telling friends and family your location. [/INST] question: Which of the following items is unnecessary to prepare before an earthquake? | options: A: Batteries B: Cash C: Medicine D: Creditcard | answer: D </s> |
<s>[INST] context: Tri methylaminuria Fish odour syndrome (autosomal recessive) is a rare metabolic disorder in which enzyme defect is Flavin containing mono-oxygenase-3 (FMO3). This enzyme uses riboflavin as a co-factor. In this syndrome, Affected individuals have a reduced capacity to metabolize trimethylamine into trimethylamine N-oxide (odourless). Trimethylamine is volatile compound, which gives off a strong fishy smell in urine, sweat, and expired air. Treatment Restriction of foods rich in trimethyl amine (fish, egg, liver, nuts, grains) Riboflavin supplement Extra Information: Various diseases and their odor is an impoant question being asked frequently these days: Inborn Error of Metabolism Urine Odour Phenylketonuria (PKU) Mousy/ Musty Maple Syrup Urine Disease (MSUD) Maple Syrup/ Burnt Sugar Isovaleric Acidemia Sweaty feet/ Cheesy Hawkinsinuria Swimming Pool Glutaric Acidemia Sweaty Feet 3-Hydroxy-3-Methyl Glutaric Aciduria Cat Urine Multiple Carboxylase Deficiency Tomcat Urine Hypermethioninemia Boiled Cabbage Tyrosinemia Boiled Cabbage, Rancid Butter Trimethylaminuria Rotten fish Diabetic Ketoacidosis Fruity Urinary Tract Infections Foul smell [/INST] question: An infant unable to feed properly, weak, and not gaining proper weight. His mother comes to OPD with complaints of multiple episodes of urination and baby cries each time he passes urine. She also tells that the baby often smells of rotten fish in his urine and his sweat. Which of the following would you test in the urine of the infant? | options: A: Vinyl mandalic acid B: Isovaleric acid C: Trimethylamine D: Oxoisocaproic acid | answer: C </s> |
<s>[INST] context: Prognosis depends most impoantly upon staging but there are multiple factors affecting the prognosis After going through the survival rates of these tumours and confirming our answer with a paediatric oncologist we found the Wilm's tumor to have the best prognosis among the given options. If you have time, go through the below given tables for your own satisfaction and conclusions. Wilm's tumour: CSDT 11/e n 1345 Stage 4 year Survival % Favurable histology Unourable istology Limited to kidney 97 89 Extends beyond kidney 94 68 Residual tumor confined to abdomen 88 68 Distant metastasis 82 55 Bilateral renal involvement 84 16 Rhabdom degsarcoma : CPDT 15/c' p 812 3 year disease free survival Predominant Pathologic subtype Head & Neck Embryonal Orbit 93% Parameningeal 71% Other 69% Genitourinary Embryonal (botryoid variant in bladder and vagina) Bladder and prostate 64-80% Vagina and uterus 60-80% Paratesticular 60-80% Extremities 56% Alveolar (50%) undifferentiated Trunk 57% Alveolar undifferentiated Neuroblastoma : CSDT 11/e o 1343 Staging and survival of Neuroblastoma Survival I. Tumor confined to site of origin 100% Ha. Unilateral tumour completely excised. Nodes Negative 80% IIb. Unilateral tumour, complete or incomplete excision nodes positive 70% III. Tumor infiltrating across the midline, or a unilateral tumor with contralateral nodes positive 40% IV. Remote disease in bone, soft tissue, distant nodes 15% V. Infants with stage I or stage II primary and spread to Liver skin or bone marrow. 85% Primitive neuroectodermal tumours PETS include -Medulloepithelioma - Medulloblastoma (known as PET-MB) - Primary cerebral neuroblastoma - Pineoblastoma - Ependymoblastoma Prognosis : 5 year survival rate is near about 75% after total tumor removal. [/INST] question: Which of the following malignant disease of children has the best prognosis - | options: A: Wilm' s tumor B: Neuroblastoma C: Rhabdomyosarcoma D: Primitive neuroectodermal tumor | answer: A </s> |
<s>[INST] context: Shanghai Faces Aging Problem
The population of citizens aged above sixty in Shanghai City in east China has reached 2.46 million, accounting for nearly 18.6 percent of its total population, a local official said today.
Shen Zhenxin, deputy director of Shanghai Civil Affairs Bureau, says that the figure mainly shows a social problem brought by the increase in the numbers of elderly people, according to Tuesday's China Daily.
Shanghai was the first city in the country to have an aging society-with 10.07 percent of the population of pensionable age in 1979. It is predicted(told in advance)that the rise in the city's elderly population will reach its top between 2025 to 2030, the newspaper reports.
A recent survey(study)also shows that the population above the age of 60 in China has amounted to(reached)some 132 million so far, and the figure is increasing by 3.2 percent each year.
"Yet fewer children have been born these years, so the social security system should be improved as soon as possible," said Shen.
Shanghai has chosen some communities as pilot neighborhoods to carry out a help-each-other program in an attempt to solve the problem. People can help take care of the elderly people, and they in turn will be looked after by others when they get old, according to China Daily. [/INST] question: Which of the following is the correct way to calculate Shanghai's population? | options: A: 132,000,000x0.1007 B: 2.460,000/0.186 C: 132,000,000x0.032 D: 2.460,000x0.186 | answer: B </s> |
<s>[INST] context: Knott's Berry Farm is the nation's oldest, and first, theme park and draws around five million visitors each year. Knott's Berry Farm hardly had a very good start. Arriving in Southern California in the 1920s, the Knott Family farmed about 20 acres of land and finally started a restaurant called Mrs. Knott' s Chicken Dinner Restaurant. Mrs. Knott's food became well known and her husband Walter built a Ghost Town as a way of entertaining waiting customers. Today Knott's Berry Farm has 165 rides, shows, attractions and restaurants. For more than 80 years, Knott's Berry Farm has been entertaining families and visitors from around the world.
There are six different themed areas with rides and attractions in Knott's Berry Farm. Fiesta Village throws attention to California's Spanish heritage . Indian Trails is similar to Fiesta Village but with an accent on Native American legends, crafts, music and dancing. The heart and soul of Knott's, Ghost Town is an 1880s California Boom Town with cowboys, gunfights, and a real steam train. The Boardwalk makes people think of Southern California beach. Wild Water Wilderness is an 1800s-style park with water rapids and a magical journey into Native North America. For Peanuts fans, Camp Snoopy is a six-acre children's wonderland with 30 rides and attractions. Knott's Berry Farm is in Buena Vista, Orange County, California. It is about half an hour from downtown Los Angeles and 10 minutes from Disneyland. Knott's Berry Farm is open from 10 a.m. to 6 p.m. during the week. The park is open on Saturdays from 10 a. m. to 10 p.m. and from 10 a. m. to 7 p.m. on Sundays. During the summer months, the park is open later. The theme park is closed on Christmas Day. [/INST] question: Besides Indian Trails, you can also experience Native American culture in _ . | options: A: Fiesta Village B: the Boardwalk C: Wild Water Wilderness D: Camp Snoopy | answer: C </s> |
<s>[INST] context: Birthday Traditions in Different Countrles[
England
Certain symbolic objects are mixed into the birthday cake as it's being prepared. If your piece of cake has a coin in it,then you will be rich. Also, when it's your birthday,your friends give you the"bumps".They lift you in the air by your hands and feet and raise you up and down to the floor;one for each year you lived,then another one or two for luck.
Denmark
A flag is flown outside a window to show that someone who lives in that house is having a birthday. Presents are placed around the child's bed while he/she is sleeping,so he/she will see them at once upon awakening.
Holland
Special year birthdays such as 5,10,15,20,21 are called"crown"years.The birthday child receives an especially large gift on a crown year birthday.The family also decorates the birthday child's chair at the dining room table with flowers,paper streamers and balloons.
Canada
The birthday child's nose is greased with butter for good luck.The greased nose makes the child too slippery for bad luck to catch him/her.In some parts of Canada,the birthday person even receives a punch for each year he/she is alive and then one for good luck.
Brazil
The birthday child receives a pull on the ear for each year he/she has been alive.The birthday person also gives the first plece of cake to his/her most special friend or relative,usually mom or dad.
Korea
There is a big family party on the first birthday.The table is set with food,and four items:a pencil,a ruler,thread,and money. The item that the baby chooses is said to forecast his/her future:excellent student,good with hands,long life or riches.
South Africa
On the twenty-first birthday,a key made of anything from paper to silver to gold is presented by the parents as a sign that the child is ready to unlock the door to their future. [/INST] question: If a British friend is raised up and down to the floor 18 yimes on his birthday,he is most likely to be _ . | options: A: 17 B: 18 C: 19 D: 20 | answer: A </s> |
<s>[INST] context: His talent and charm have made him the No.1Chinese classical artist in the world. And he played in the grand Beijing Olympic opening ceremony in 2008, watched by a TV audience of 5 billion.
Lang Lang, 26, is the first Chinese pianist to play with the world's top orchestras ,making his first appearance at the Carnegie Hall in New York at 18, while still a student.
Lang's charm and fondness make him a natural fit to represent China's new international image. According to the British newspaper the Times, "The Lang Lang effect" drives 36 million Chinese children to learn the piano.
Now in China, children are learning Chopin and Western orchestras are playing sold-out tours across Chinese cities. But can China ever introduce its own music to the West? Lang is trying. His cooperation with the London Symphony Orchestra this month includes a performance of Dragon Songs, an album of traditional Chinese classics.
Behind the success , however, is a surprising story of a gifted child. Lang grew up with his father's own musical ambition and high expectations. It is not hard to imagine how boring it must be to practice the piano every day. Lang said that he once hated his hands and the piano. He got his right hand hurt six years ago and had to rest. "That was the best month," he says. [/INST] question: What is the main reason why Lang Lang is the No.1 Chinese classical artist in the world? | options: A: He played in the Beijing Olympic opening ceremony in 2008 B: He usually plays with the world's top orchestras C: He tries to introduce Chinese music to Western countries D: He plays the piano so well and has a good international image | answer: D </s> |
<s>[INST] context: Acute interstitial nephritis is due to a hypersensitivity reaction usually caused by a drug. Drugs implicated in the pathogenesis of acute interstitial nephritis include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and indomethacin; beta-lactam antibiotics, such as cephalothin and methicillin; sulfonamides; diuretics, such as furosemide and thiazides; and drugs like phenytoin, cimetidine, and methyldopa. The typical presentation for acute interstitial nephritis is the development of acute renal failure, fever, a maculopapular rash, and eosinophilia. The patient's periorbital edema and wheezing are also consistent with acute interstitial nephritis. Ibuprofen is the most likely causative agent for the development of the patient's signs and symptoms. Although the exact mechanism by which NSAIDs cause this disorder is not fully understood, it is believed to be related to their ability to decrease prostaglandin formation, which leads to a reduction in renal blood flow. None of the other medications are associated with the development of acute interstitial nephritis. Acarbose is an antidiabetic agent that delays the absorption of glucose from the intestinal tract. Clonidine is a centrally-acting antihypeensive agent used in the treatment of hypeension and prophylaxis of migraines. It has been shown to be efficacious in ameliorating symptoms of alcohol, tobacco, opiate, and benzodiazepine withdrawal. It is also used in the treatment of attention deficit disorder with hyperactivity. Metformin is an antidiabetic agent that increases the binding of insulin to its receptor. One impoant side effect of metformin is the development of lactic acidosis. [/INST] question: A 72-year-old female is brought to the emergency room after the development of periorbital edema, a maculopapular rash on her chest, and a fever of 101degF (38.3degC). Laboratory examination reveals a blood urea of 77 mg/dL and a serum creatinine of 3.1 mg/dL. Urinalysis shows mild proteinuria and eosinophils, but is negative for glucose and ketones. The patient's past medical history is significant for hypeension, diabetes, and osteoahritis. Which of the following medications most likely caused the appearance of her signs and symptoms? | options: A: Acarbose B: Clonidine C: Ibuprofen D: Metformin | answer: C </s> |
<s>[INST] context: The isoenzyme of lactate dehydrogenase(LDH). active muscle tissue becomes anaerobic and produces pyruvate from glucose glycolysis, it needs LDH to regenerate NAD+ from NADH so that glycolysis can continue. the lactate produced is released into the blood. the musclesLDH isozyme(A4) works best in the NAD+ regenerating direction. hea tissue is aerobic and uses lactate as a fuel. conveing it into pyruvate too fule the citric acid cycle to obtain energy. the hea LDH isoenzyme(B$) is inhibited by excess pyruvate so that the fuel won&;t be wasted.Lactate dehydrogenase (LDH or LD) is an enzyme found in nearly all living cells (animals, plants, and prokaryotes). LDH catalyzes the conversion of lactate to pyruvic acid and back, as it conves NAD+ to NADH and back. A dehydrogenase is an enzyme that transfers a hydride from one molecule to another.LDH exists in four distinct enzyme classes. This aicle is specifically about the NAD(P)-dependent L-lactate dehydrogenase. Other LDHs act on D-lactate and/or are dependent on cytochrome c: D-lactate dehydrogenase (cytochrome)) and L-lactate (L-lactate dehydrogenase (cytochrome)).LDH is expressed extensively in body tissues, such as blood cells and hea muscle. Because it is released during tissue damage, it is a marker of common injuries and disease such as hea failure. [/INST] question: Which is predominant in normal healthy human? | options: A: LDH1 B: LDH2 C: LDH3 D: LDH4 | answer: B </s> |
<s>[INST] context: Benjamin Franklin only studied in school for two years. But he liked to read and write very much. Once he discussed a question with his friend in letters. His father found the letters and read them. He felt Ben did not express himself well. Nor did Ben make his meaning clear. He agreed that his father was right, From then on, he paid more attention to the style of his writing so that he could write better.
About that time he bought a copy of the British periodical called The Spectator (<<>> ). He read it over and over. He thought the writing excellent, and wished, if possible, to write in the same style.
With this in mind, he studied some of the stories and made a note of the thought in each sentence. Then, a few days later, without looking at the magazine, he tried to write the stories. He tried to express each thought as fully as it had been expressed before. Then he compared his writing with the magazine. He found some of his faults in the compositions.
In this way he discovered he needed to know many more words. He felt that writing poetry would help him since that needed to use many different words which had the same meaning. So he turned some of the stories into poems; and after a time, he wrote them as stories again. He insisted on doing this for a long time.
He learned much from his efforts and went on to practise his writing. Then he became the first famous writer in American history. [/INST] question: Benjamin liked _ very much when he was _ . | options: A: languages; young B: writing; young C: writing; old enough D: languages; old enough | answer: B </s> |
<s>[INST] context: Some amino acids (isoleucine, tryptophan, phenylalanine, and tyrosine) are both glucogenic and ketogenic because their degradation pathway forms multiple products.a. Amino acids that are converted to pyruvate (see Figure I).(1). The amino acids that are synthesized from the intermediates of glycolysis (serine, glycine, cysteine, and alanine) are degraded to form pyruvate.(a). Serine is converted to 2-phosphoglycerate, an intermediate of glycolysis, or directly to pyruvate and NH4+ by serine dehydratase, an enzyme that requires PLP.(b). Glycine, in a reversal of the reaction utilized for its synthesis, reacts with methylene-FH4 to form serine.1. Glycine also reacts with FH4 and NAD+ to produce CO2 and NH4+ (glycine cleavage enzyme).2. Glycine can be converted to glyoxylate, which can be oxidized to CO2 and H2 O or converted to oxalate.(c). Cysteine forms pyruvate. Its sulfur, which was derived from methionine, is converted to H2 SO4 , which is excreted by the kidneys.(d). Alanine can be transaminated to pyruvate.b. Amino acids that are converted to intermediates of the TCA cycle (see Figure II).(1). The carbons from the four groups of amino acids form the TCA cycle intermediates: a-ketoglutarate, succinyl-CoA, fumarate, and oxaloacetate.(a). Amino acids that form a-ketoglutarate (see Figure III).1. Glutamate can be deaminated by glutamate dehydrogenase or transaminated to form a- ketoglutarate.2. Glutamine is converted by glutaminase to glutamate with the release of its amide nitrogen as NH4+ 3. Proline is oxidized so that its ring opens, forming glutamate semialdehyde, which is oxidized to glutamate.4. Arginine is cleaved by arginase in the liver to form urea and ornithine. Ornithine is transaminated to glutamate semialdehyde, which is oxidized to glutamate.5. Histidine is converted to formiminoglutamate (FIGLU). The formimino group is transferred to FH4, and the remaining five carbons form glutamate.(b). Amino acids that form succinyl-CoA (see Figure IV)1. Four amino acids are converted to propionyl-CoA, which is carboxylated in a biotin requiring reaction to form methylmalonyl-CoA, which is rearranged to form succinyl-CoA in a reaction that requires vitamin B12 (seen previously in the metabolism of odd-chain number fatty acids).a). Threonine is converted by a dehydratase to NH4+ and a-ketobutyrate, which is oxidatively decarboxylated to propionyl-CoA.In a different set of reactions, threonine is converted to glycine and acetyl-CoA.b). Methionine provides methyl groups for the synthesis of various compounds; its sulfur is incorporated into cysteine; and the remaining carbons form succinyl-CoA.i. Methionine and ATP form S-adenosylmethionine (SAM), which donates a methyl group and forms homocysteine.ii. Homocysteine is reconverted to methionine by accepting a methyl group from the FH4 pool via vitamin B12 .iii. Homocysteine can also react with serine to form cystathionine. The cleavage of cystathionine produces cysteine, NH4+ , and a-ketobutyrate, which is converted to propionyl-CoA.c). Valine and isoleucine, two of the three branched-chain amino acids, form succinyl-CoA (see Figure IV).i. The degradation of all the three branched-chain amino acids begins with a transamination followed by an oxidative decarboxylation catalyzed by the branched-chain a-keto acid dehydrogenase complex (Figure V). This enzyme, like pyruvate dehydrogenase and a-ketoglutarate dehydrogenase, requires thiamine pyrophosphate, lipoic acid, CoA, flavin adenine dinucleotide (FAD), and NAD+.ii. Valine is eventually converted to succinyl-CoA via propionyl-CoA and methylmalonyl-CoA.iii. Isoleucine also forms succinyl-CoA after two of its carbons are released as acetyl-CoA.(c). Amino acids that form fumarate1. Three amino acids (phenylalanine, tyrosine, and aspartate) are converted to fumarate (see Figure II).a). Phenylalanine is converted to tyrosine by phenylalanine hydroxylase in a reaction requiring tetrahydrobiopterin and O2 (Figure VI).b). Tyrosine, obtained from the diet or by hydroxylation of phenylalanine, is converted to homogentisic acid. The aromatic ring is opened and cleaved, forming fumarate and acetoacetate.c). Aspartate is converted to fumarate via reactions of the urea cycle and the purine nucleotide cycle.d). Aspartate reacts with IMP to form AMP and fumarate in the purine nucleotide cycle.(d). Amino acids that form oxaloacetate (see Figure II)1. Aspartate is transaminated to form oxaloacetate.2. Asparagine loses its amide nitrogen as NH4+ , forming aspartate in a reaction catalyzed by asparaginase.c. Amino acids that are converted to acetyl-CoA or acetoacetate (see Figure VI).(1). Four amino acids (lysine, threonine, isoleucine, and tryptophan) can form acetyl-CoA, and phenylalanine and tyrosine form acetoacetate. Leucine is degraded to form both acetyl-CoA and acetoacetate.In maple syrup urine disease, the a-keto acid dehydrogenase involved in metabolism of the branched-chain amino acids (valine, isoleucine, and leucine) is defective. McArdle disease is caused by a defective muscle glycogen phosphorylase, such that the muscle cannot generate glucose from glycogen, leading to exercise intolerance. Glycogen accumulates in the muscle because of this enzyme deficiency (McArdle disease is one of the glycogen storage disease). A defect in the synthesis or processing of collagen will lead to a variety of diseases, of which Ehlers-Danlos syndrome is one (osteogenesis imperfecta is another). Parkinson disease is caused by low levels of dopamine in the nervous system. In the initial stages of Parkinson disease, giving DOPA can reduce the severity of the symptoms because DOPA can be decarboxylated to form dopamine. DOPA can easily enter the brain, whereas dopamine cannot. Tay-Sachs disease results from an inability to degrade GM2, a ganglioside (it is also a sphingolipid). The enzyme missing is b-hexosaminidase.I. Amino acids derived from the intermediates of glycolysis. These amino acids can be synthesized from glucose and can be reconverted to glucose in the liver.II. The degradation of amino acids. A. Amino acids that produce pyruvate or the intermediates of the TCA cycle. These amino acids are considered glucogenic because their carbons can produce glucose in the liver. B. Amino acids that produce acetyl-CoA or ketone bodies. These amino acids are considered ketogenic. CoA, coenzyme A; HMG-CoA, hydroxymethylglutaryl-CoA; TCA, tricarboxylic acid.III. Amino acids related through glutamate. These amino acids contain carbons that can be converted to glutamate, which can be converted to glucose in the liver. All of these amino acids except histidine can be synthesized from glucose.IV. Amino acids that can be converted to succinyl-CoA. The amino acids methionine, threonine, isoleucine, and valine, which form succinyl-CoA via methyl malonyl-CoA, are all essential. Because succinyl-CoA can form glucose, these amino acids are glucogenic. The carbons of serine are converted to cysteine and do not form succinyl-CoA by this pathway. A defect in cystathionine synthase causes homocystinuria. A defect in cystathionase causes cystathioninuria. B12-CH3, methyl cobalamin; N5-CH3-FH4, N 5- methyl tetrahydrofolate; PLP, pyridoxal phosphate; SAM, S-adenosylmethionine; TCA, tricarboxylic acid.V. The degradation of the branched-chain amino acids. Valine forms propionyl-CoA. Isoleucine forms propionyl-CoA and acetyl-CoA. Leucine forms acetoacetate and acetyl-CoA. CoA, coenzyme A; FAD, flavin adenine dinucleotide; HMG-CoA, hydroxymethylglutaryl-CoA.VI. A. Ketogenic amino acids. Some of these amino acids (tryptophan, phenylalanine, and tyrosine) also contain carbons that can form glucose. Leucine and lysine are strictly ketogenic; they do not form glucose. B. A deficiency in various steps leads to the diseases indicated. CoA, coenzyme A; NAD, nicotinamide adenine dinucleotide; NADP, nicotinamide adenine dinucleotide phosphate; PKU, phenylketonuria; PLP, pyridoxal phosphate; TCA, tricarboxylic acid cycle. [/INST] question: Maple syrup urine disease can be caused by a problem with the metabolism of which particular compound. | options: A: Glycogen B: Collagen C: Dopamine D: Valine | answer: D </s> |
<s>[INST] context: Japanese sailor Kenichi Horie has finished a 110-day solo voyage across the Pacific Ocean in a boat pushed by sea waves to win another world first.
Weak waves and ocean water movements made his arrival late, which was going to be in late May.
"When waves were weak, the boat slowed down. That's a problem that needs to be solved," the adventure told reporters from his boat in western Japan. His 9.5-meter-long boat can move like a dolphin's tail, and it rises or falls with the waves.
Horie reached his destination in the channel between the main Japanese islands just before midnight after covering about 7,000 kilometers from Hawaii.
Horie first made world record in 1962 when, at the age of 23, he became the first person to sail alone across the Pacific. He made the three-month voyage from his hometown in spite of breaking Japanese law, which did not allow his citizens to sail on their own out of the country, and without a passport or money.
He was arrested upon arrival in San Francisco but the city mayor freed him, gave him a 30-day visa and made him an honorary citizen. News of his achievement made him a hero back home in Japan and his book of the voyage In the Pacific was made into a film. Since then, he has completed many sailing trips across the Pacific and around the world.
After his latest adventure with an environmentally friendly theme, Horie planned to return to his hometown on Sunday. He said, "Throughout history, mankind has used wind for power, but no one has appeared to be serious about wave power." Horie told the reporter, "I think I'm a lucky boy as this wave power system has remained untouched in fact." [/INST] question: Horie's boat was mainly powered by _ . | options: A: sea waves B: sea winds C: his strength D: petrol | answer: A </s> |
<s>[INST] context: In London, everyone is busy in the early morning. Some are running to the stations, buses and cars. Some are stopping only to drink a cup of coffee. They usually have no time for breakfast. At about eight thirty, one after another, the shops open for business .Taxis and buses are running in the streets. People work busily all day.
At six o'clock in the evening, people go home quickly from work. Most of the shops closed , but some are still open. Many people work at night in a big city. In newspaper offices, reporters work hard. Doctors and nurses work in the hospital. Taxis and buses take people around the city all night. Some people are going to the movies. Some people are going to watch the plays. You can hear people talking, laughing and singing. You can listen to music, too. Every night, there are many people on the sidewalks . Some stop to look at shop windows, but they never buy clothes. Others are waiting for buses and taxis.
Day and night you can find people working and playing in London. A big city never sleeps. [/INST] question: In the morning, some people in London are really busy, they don't _ . | options: A: have a drink B: have breakfast C: drive cars D: wait for buses | answer: B </s> |
<s>[INST] context: Put 2 February in your diary! It is World Wetlands Day! It marks the date that the
Convention on Wetlands was signed in1971.This special day was first celebrated in 1997 and it is celebrated every year.
The celebration is a call for action. It is a way to show people how important and
useful the wetlands are for people. On World Wetlands Day, people around the world take
part in many wetlands activities. People take trips to the local wetlands. There are talks
about how important the wetlands are. People get together to clean up their local wetlands
Children draw pictures to advertise the day. People also compete in boat races.
The World Wetlands Day is important! If there are no wetlands, there will be no water for anyone in the future. Wetlands help protect nature and resources like fresh water. Already, more than 10000 million people in the world do not have fresh water.
Many people do not know how important the wetlands are. They can understand why an
elephant or a tiger is important because they are big, beautiful animals. It is much harder for
them to understand how important the animals in the wetlands are. These small animals,
such as frogs and snails, play a very important part in keeping the balance of nature.
All plants and animals are part of the food chain .If the small wetlands animals
die, some animals in the food chain will have nothing to eat. They will also die. People
need the wetlands to keep the balance of nature in the world. If we do not protect nature
today,it will be gone tomorrow. [/INST] question: What should you put in your diary? | options: A: Some frogs B: The date of World Wetlands Day C: 1971 D: Any special day | answer: B </s> |
<s>[INST] context: "Get out of the plane!" Justin shouted.Teddy and he dropped to the ground,...
When Kathy and Victor reached the edge of the meadow flames of the fire were shooting more than five meters into the air.
Kathy couldn't believe what she was seeing.One glance told her they needed medical attention immediately.She questioned Victor, "Are you able to find someone nearby for help?"
"There are no farmers, nor villagers nearby," he replied.
"I'm a distance runner, and I'll go for help." Looking at the seriously injured men, Kathy said to Victor, "It may take me several hours to get out." She started out.
When she was 23, Kathy set a women's record in a Marathon of 42 kilometers. _ She had nearly 30 kilometers of hard wilderness to cover to get help.
Kathy had been running for two hours.This was far back into the wilderness.The country path was growing vague .She stopped to take a quick compass reading.Yes, she had run almost for more than 20 kilometers.Her heart fell, her muscle aching.And finally she saw her car in the distance.
She jumped into the car and sped away.She reached a holiday house and called the police.
During the wait, she walked around, relaxing her legs and drinking water.It took almost two hours for a police helicopter to reach her at the trail end.They needed her for one more task. [/INST] question: Who actually had the airplane accident? | options: A: Justin himself B: Kathy and Victor C: Justin and Teddy D: Kathy herself | answer: C </s> |
<s>[INST] context: UGG boots have been a winterweather fashion for several years now, combining function, comfort, warmth and even some style. What many UGGenthusiasts don't know is that their boots are a breeding ground for bacteria and cause foot problems.
Doctors believe the boots, which are particularly popular among young teenage girls, are leading to a rise in the number of people suffering pains in their feet and knees.
Dr. Ian Drysdale, head of the British College of Osteopathic Medicine, believes because the foot does not get the proper support on the inside, it will lead to more ankle, knee, hip and back problems. "These boots are not designed for outside wear. Just because something becomes a trend or fashionable doesn't mean it's good or right," he said. "The particular problem with this type of footwear is that it is unsupported. It's a slipper. You wouldn't normally expect to be doing outdoor activities from something that's indoor. If you decide to wear your pajamas outside all the time, someone will come up and say it's not a good idea." Dr. Drysdale explained that the feet issues become a particular problem among young teenage girls, whose bones are "plastic" and developing when they are growing. "If that structure is developing in an inappropriate way," he said,"then the ultimate structure will be _ ."
Mike O'Neill, a consultant surgeon, said,"As the foot slides around, you get wear and tear on the joints on the inside of the foot. The ankle is in the wrong position, the thigh bone also changes position, and you get an abnormal movement in the pelvis, which leads to back problems."
UGG Australia, who makes the designer version of the boots, told The Daily Wirror that their boots are "comfort" rather than "performance" footwear and consumers should be aware of "knockoffs " which lack reinforced heels in their boots. [/INST] question: Teenage girls prefer to wear UGG boots because of the following EXCEPT _ . | options: A: design B: comfort C: quality D: warmth | answer: C </s> |
<s>[INST] context: Many French academics,teachers and parents complain because they feel that intellectual levels are falling rapidly!The figures prove it:young people visit museums less,spend their lives chatting on the Internet,read nothing but Stephen King,while watching American soaps such as Friends or reality shows like Star Academy on television,music player glued to their cars,and the games console handy.
It is,however,easy to see these habits in a positive light.Music is the favorite leisure activity:86% of 14-to18-year-olds put it at the top of their activities,above the cinema(71%),clubbing(68%),sport(56%) and television(48%).For 90% of young people aged 14to 18,radio is also very popular:they listen to it every day without exception.International popular music has a strong showing,but songs in French are still in the majority(60%).
Young people do,of course,watch a lot of television,but less than their elders,and if they tend to choose mostly soaps and reality TV shows,that is because these are the programs people talk about,which encourages social interaction.Do young people read less than they used to?Maybe,but that's also true of the elders.Young people still read more than their elders.When asked,"Do you like reading?",94% of 14-to-18-year-olds say they do,and 81% are convinced that computers will never replace books.
Contrary to popular belief,reading continues to occupy an extremely important place in leisure-time activities,but the reading matter young people choose has changed considerably:there is a greater variety of media(computers and new technologies) and young people admit to taste they would perhaps have been ashamed of in the past.For example,comic strips,Stenphen King or other authors not recognized by mainstream culture,such as Betty Mahmoody (Not Without My Daughter),Mary Higgins Clark or Jostein Gaader (Sophie's World).As Beatrice Toulon,Editor in Chief of the magazine Phosphore,see it,"They don't read the same things as their parents did,but they are not afraid to admit it.They have their own culture,which they flaunt openly!" [/INST] question: Which activity is the most popular with young French people? | options: A: Music B: Sport C: Cinema D: TV | answer: A </s> |
<s>[INST] context: Newtonian viscosity: An “ideal” fluid produces shear stress proportional to the strain rate. That is, the greater the force applied, the faster the fluid flows and the plot is a straight line.
Pseudoplastic viscosity: The viscosity of many dental materials decreases with increasing strain rate until it reaches a nearly constant value.
That is, the faster they are stirred, forced through a syringe, or squeezed, the less viscous and more fluid they become.
Liquids that show the opposite behavior are dilatant and become more rigid as the rate of deformation (shear strain rate) increases. That is, the faster they are stirred, the more viscous and resistant to flow they become.
Finally, some classes of materials behave like a rigid body until some minimum value of shear stress is reached. This is represented by the offset along the shear-stress axis. These fluids, which exhibit rigid behaviour initially and then attain constant viscosity, are referred to as plastic.
The viscosity of most fluids decreases rapidly with increasing temperature. Viscosity may also depend on the previous deformation of the liquid. Such fluids become less viscous and more flowable upon repeated applications of pressure and are termed thixotropic.
Key concept [/INST] question: Which of the following represents the rheological behaviour of dilatant liquids? | options: A: A B: B C: C D: D | answer: B </s> |
<s>[INST] context: Nobody likes an old poop . Developing a sense of humor is part of becoming a mature, emotionally healthy individual. Laughter is good for the soul, builds friendships and relieves stress. It serves as the glue for social situations and as an ice-breaker for sadness and boredom. If you've ever been told to "lighten up" or "chill out", you should save the blue attitude for serious situations and develop your sense of humor.
Forgive the accidental. A sudden fall is humorous not because we like to see people fall, but because it surprises. From a spilled water glass in a meeting to Aunt Rae's teeth coming off in the Thanksgiving turkey, the embarrassment of accidents can be relieved by humor and a helping hand. After making sure that nobody's hurt, forgive accidents with a chuckle rather than a scolding.
Look for the unexpected. The kid who used to look at you with his eyes closed during a test had the idea. Parents who serve green eggs and ham to their children on graduation day get the idea. Unexpected actions lighten an atmosphere and relax people.
Learn to laugh with your kids. Most of what children say and do is funny. Help them learn that accidents are sometimes funny and sometimes occasions for joining in and helping another human being. By sharing laughs and attempting to explain humor, you develop your sense of humor, as well as help kids develop their own sense of humor. [/INST] question: If you've ever been told to "lighten up" or "chill out", it means _ . | options: A: you are humorous B: you are blue C: you lack humor D: you are funny | answer: C </s> |
<s>[INST] context: Your friends' lives may look more exciting than yours on Facebook,but new research shows that is because they are faking it.
A recent survey has found around twothirds of people on social media post images to their personal information to make their lives seem more adventurous.And more than three quarters of those asked said they judged their peers based on what they saw on their Instagram,Snapchat or Facebook pages.
The British survey,by smartphone maker HTC,found that,in order to make our own pages and lives appear more exciting,six percent also said they had borrowed items to include in the images in order to pass them off as their own. More than half of those surveyed said they posted images of items and places purely to show off,causing _ among friends and family.
Behavioural psychologist Hemmings said the trend was unsurprising due to the rise of social media."We're living in a world of instant communication."she said."Fashion and style used to live and die in magazines;now people are in search of authentic ,peertopeer recommendations as well,making social media an equal power house to magazines and newspapers."
"With images being shared in an instant we desire to know what our friends are wearing,or what super stars are buying, as soon as they have got them." Such is the influence of social media sites like Instagram,76 percent of those asked also said seeing items on social media influences them to buy them,with men more likely to take style advice and buy what they see. [/INST] question: How do some people make their lives appear more exciting? | options: A: By buying pictures B: By posting images C: By making up stories D: By risking their lives | answer: B </s> |
<s>[INST] context: • MC indication for surgery is symptoms interfering with quality of life (bothersome symptoms and symptoms of BOO).
• TURP (Gold standard) :
−− Cystoscopic removal of strips of prostatic tissue using diathermy loop. Two techniques; NESBIT technique (preferred maver mayer technique)
−− Best irrigant fluid is 1.5% glycine (Electrolyte solutions like NaCl are not compatible with electrocautery, so not used).
−− Glycine is composed of glycolic acid and ammonium, which can cause CNS (visual) toxicity.
TURIS: TUR in saline using bipolar cautery
• Verumontanum is the single most important anatomical landmark in TURP.
• Verumontanum lies immediately proximal to external sphincter and serve as the distal landmark for prostate resection to prevent injury to the external sphincter.
• Verumontanum: Distal landmark for prostate resection.
• Verumontanum: Landmark for proximal limit of external sphincter.
−− Risks of TURP: Retrograde ejaculation (75%)Q, impotence (5–10%) and incontinence (< 1%).
−− Complications: Bleeding, urethral stricture or bladder neck contracture, perforation of the prostate capsule with extravasation, and if severe, TUR syndrome.
TUR syndrome (Dilutional hyponatremia or water intoxication)
• TUR syndrome (Dilutional hyponatremia or water intoxication) resulting from a hypervolemic, hyponatremic state due to absorption of the hypotonic irrigating solution.
• Clinical Features: Nausea, vomiting, confusion, hypertension, bradycardia, and visual disturbances.
• The risk increases with resection times > 90 minutes or gland size > 75 gm.
• Treatment includes diuresis (furosemide) and in severe cases, hypertonic saline (3%) administration.
Late Complications of TURP
• Bladder neck stenosis (4%) > Urethral stricture (3.6%)
• Bladder neck stenosis is seen more often with small (< 30 gm) fibrotic prostates.
• Transurethral incision of the prostate (TUIP):
−− For posterior commissure hyperplasia (elevated bladder neck), involves two incisions using the Collins knife at the 5- and 7-o’clock positions.
−− The incisions are started just distal to the ureteral orifices and are extended outward to the verumontanum.
• TUIP lowers the incidence of bladder neck contracture when compared to TURP, so TUIP should be strongly considered in patients with smaller gland in place of TURP.
• TUIP is used for smaller (20 gm) prostate, young patients.
• Decreased incidence of retrograde ejaculation as compared to TURP.
• Open simple prostatectomy: Glands > 75 gm, concomitant bladder diverticulum or a bladder stone or if dorsal lithotomy positioning is not possible.
−− Suprapubic prostatectomy: Performed transvesically (Frayer’s) and operation of choice in dealing with concomitant bladder pathology (Bladder stones or diverticulum).
−− Retropubic prostatectomy (Millin’s): Transverse incision is made in surgical capsule of prostate and enucleation is done.
−− Perineal prostatectomy (Youngs): Abandoned now
• Carcinoma prostate originates in peripheral zone of prostate, so prostatectomy for BPH confers no protection for subsequent cancer. [/INST] question: Grade I benign prostate with outflow obstruction is best treated with - | options: A: Retropubic prostatectomy B: Transurethral resection C: Transvesical prostatectomy D: Androgen therapy | answer: B </s> |
<s>[INST] context: Our planet was born some billions of years ago. Ever since this planet has developed, it has surprised us human beings. No matter how much we human beings have developed technologically, we cannot ever create this kind of natural planet. The human race can only discover some amazing facts about it. Let us find out what some of them are.
On September 13, 1922 El Azizia, a place in Libya, recorded a temperature of 136 degrees Fahrenheit. This was the highest temperature ever measured on the planet Earth. The highest waterfall in the world is Angel Falls in Venezuela, which drops from an amazing height of 3,212 feet. The waterfall drops over the edge of Auyantepui in the Canaima National Park. The gravitational pull of the Earth can be escaped if someone moves at a speed of 6.95 miles per second. At such a speed, one could travel from New York to Philadelphia in just 20 seconds. If the entire water in the world's oceans evaporated, the salt we got from these oceans could cover the entire planet with a 500-foot deep layer of salt. The deepest lake on Earth is Lake Baikal in Russia. Lake Baikal is the largest freshwater lake in the world, containing about 20% of the world's unfrozen surface fresh water. The Andes in South America spreads over 4,525 miles. This is the longest mountain range in the world.
Did you know that the biggest valley in the world is the Grand Valley in Mesa County, Colorado and Grand County, Utah? It is about 30 miles (48 km) long and 5 miles (8 km) wide, along the Colorado River. The amazing facts about the earth are too many to be told completely above. [/INST] question: Where is the longest mountain range in the world? | options: A: In Russia B: In Libya C: In South America D: At the Oregon-Idaho border | answer: C </s> |
<s>[INST] context: Revised National Tuberculosis Control Programme
The Government of India, WHO and World Bank together reviewed the NTP in the year 1992. Based on the findings a revised strategy for NTP was evolved. The salient features of this strategy are : -
Achievement of at least 85 percent cure rate of infectious cases through supervised Short Course Chemotherapy involving peripheral health functionaries.
Augmentation of case finding activities through quality sputum microscopy to detect at least 70 percent estimated cases; and
Involvement of NGOs; Information, Education and communication and improved operational research.
Following information has been added in 22nd /e of Park
For a "TB -free India" following objectives have been proposed :
i) To achieve 90% notification rate
ii) To achieve 90% success rate for all new cases and 85% for retreatment cases
iii) To significantly improve the successful outcomes of treatment of drug resistant TB cases
iv) To decrease morbidity and mortality of HIV associated TB
v) To improve outcomes of TB care in the private sector [/INST] question: Which of the following is a novel feature of RNTCP ( Revised National Tuberculosis Control Programme) – | options: A: Achieving 80% BCG coverage B: Achieving 85% detection rate C: Achieving 70% cure rate D: Involvement of NGOs | answer: D </s> |
<s>[INST] context: Read the suggestions for making an English speech.
a. Looking at and talking to one person in the audience helps keep you natural, but it feels foolish talking to only one person. Speak to that person as long as 15 seconds and then change another one.
b. The audience have a hard time understanding what they hear. They need your help. Slow down, pause and guide the audience through your talk. Remember that you should help the audience understand what you are saying.
c. Make your voice a little lower than normal. Listeners like to listen to a relatively deep voice.
d. When you talk, try to be as natural as possible. Don't try to memorize your words and read or recite them to your audience. You can use short notes to help you remember the important points.
e. You should know you and most of the people you talk to are different in many ways. Some of them may not know what you are talking about. Then speak to them on their terms and in their languages.
f. Concentrate on what you want to say. If you are always paying attention to gestures ,you will feel uncomfortable.
g. It's true that there are some differences between American English and British English, but they'll not cause much difficulty for listeners, so just speak the way you're used to.
Choose a suggestion for each of the following students according to their problems. [/INST] question: Paul: I don't think I can talk fluently because it's difficult for me to remember all the words. | options: A: a B: b C: c D: d | answer: D </s> |
<s>[INST] context: BBFHI: Description: To improve care throughout the childbearing continuum in order to save lives, prevent illness and harm from the overuse of obstetric technologies, and promote health for mothers and babies around the world Launched: 1996, USA
10 Steps of MFCI:
Step 1: Treat every woman with respect and dignity, providing her right to informed consent and refusal
Step 2: Possess and routinely apply midwifery knowledge and skills related to normal physiology
Step 3: Inform the mother of the benefits of continuous support during labour and birth,
Step 4: Provide drug-free comfort and pain-relief methods during labour
Step 5: Provide specific evidence-based practices proven to be beneficial
Step 6: Avoid potentially harmful procedures and practices that have no scientific support
Step 7: Implement measures that enhance wellness and prevent emergencies, illness, and death of Mother and Baby
Step 8: Provide access to evidence-based skilled emergency treatment for life-threatening complications
Step 9: Provide a continuum of collaborative maternal and newborn care with all relevant health care providers, institutions and organizations
Step 10: Strive to achieve the 10 Steps to Successful Breastfeeding (WHO/UNICEF Baby-friendly Hospital Initiative BFHI) [/INST] question: Mother friendly childbirth initiative was launched in | options: A: USA B: Britain C: Australia D: India | answer: A </s> |
<s>[INST] context: Photography has been my interest ever since I was old enough to pick up a camera, but today I want to share with you the 15 most treasured photos of mine, and I didn't take any of them. There were no art directors, no stylists, no chance for reshoots, not even any regard for lighting. In fact, most of them were taken by random tourists.
My story begins when I was in New York City for a speech, and my wife took a picture of me holding my daughter on her first birthday. We're on the corner of the 57thand 5thavenue. We happened to be back in New York exactly a year later, so we decided to take the same picture.
Well you can see where this is going. Approaching my daughter's third birthday, my wife said, "Hey, why don't you take Sabina back to New York and make it a father-daughter trip, and continue the ceremony?" This is when we started asking passing tourists to take the picture.
So these photos are far more than representatives for a single moment, or even a specific trip. They're also ways for us to freeze time for one week in October and reflect on our times and how we change from year to year, and nor just physically, but in every way. Because while we take the same photo, our viewpoints change, and she reaches new milestones and I get to see life through her eyes, and how she communicates with and sees everything. This very focused time we get to spend together is something we value and expect the entire year. [/INST] question: Who came up with the idea of having a father-daughter trip when Sabina was 3 years old? | options: A: Her mother B: Her father C: Sabina herself D: An unknown tourist | answer: A </s> |
<s>[INST] context: Have you ever heard of Weifang, Shangdong Province? What is it known for? There is an international kite festival every April in Weifang that is a modern city with many traditions. People from all over the world compete in the kite flying. There are also competitions for the best kites. The kites in the competition are all made by hand.
Most people have flown a kite. It makes people happy. It's easy to make it. It's made of bamboo and paper. But not so many people know that kites were first made in China thousands of years ago. The ancient Chinese made and flew kites even before they could write.
A long time ago, the Chinese made kites to use in wars. They would fly these war kites in the dark. The kites were fixed and they made strange sounds in wind. Men who were at war against them would hear these sounds and run away. They thought those strange sounds were made by gods in the sky.
The ancient Chinese also flew kites to bring good luck and to make their crops grow rich and tall. Sometimes they tied long strings and hooks to their kites. Then they would fly the kites over water, letting the hooks hang down to catch fish.
The Chinese use sticks, string and paper for their kites. Some of these kites look like animals or trees and others look like houses. [/INST] question: Chinese made and flew kites _ . | options: A: two thousand years ago B: before they could write C: after they write D: three thousand years ago | answer: B </s> |
<s>[INST] context: A recent study of ancient and modern elephants has come up with the unexpected conclusion that the African elephant is divided into two distinct species.
The discovery was made by researchers at York and Harvard Universities when they were examining the genetic relationship between the ancient woolly mammoth and mastodon to modern elephants -- the Asian elephant, African forest elephant, and African savanna elephant.
Once they obtained DNA sequences from two fossils , mammoths,and mastodons the team compared them with DNA from modern elephants. They found to their amazement that modern forest and savanna elephants are as distinct from each other as Asian elephants and mammoths.
The scientists used detailed genetic analysis to prove that the African savanna elephant and the African forest elephant have been distinct species for several million years. The divergence of the two species took place around the time of the divergence of Asian elephants and woolly mammoths. This result amazed all the scientists. There has long been debate in the scientific community that the two might be separate species, but this is the most convincing scientific evidence so far that they are indeed different species.
Previously, many naturalists believed that African savanna elephants and African forest elephants were two populations of the same species, despite the elephants' significant size differences. The savanna elephant has an average shoulder height of 3.5 metres while the forest elephant has an average shoulder height of 2.5 metres. The savanna elephant weighs between six and seven tons, roughly double the weight of the forest elephant. But the fact that they look so different does not necessarily mean they are different species. However the proof lay in the analysis of the DNA.
Alfred Roca, assistant professor in the Department of Animal Sciences at the University of Illinois, said, "We now have to treat the forest and savanna elephants as two different units for conservation purposes. Since 1950,all African elephants have been conserved as one species. Now that we know the forest and savanna elephants are two very distinctive animals, the forest elephant should become a bigger priority for conservation purposes." [/INST] question: One of the fossils studied by the researchers is that of _ . | options: A: the Asian elephant B: the forest elephant C: the savanna elephant D: the mastodon elephant | answer: D </s> |
<s>[INST] context: Future Life Pets
By DogTown Media, LLC Open iTunes to buy and download apps.
*Price: $2.99
*Category: Lifestyle
*Updated: Jan 07, 2012
*Version: 1.1
*Size: 36.3 MB
*Language: English
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Description
DISCOVER FUTURE LIFETIMES WITH YOUR PETS
You can be transported into the future to be reunited with your pet in another place and time.
As an internationally recognized psychic and best-selling author, Anne Jirsch will be your guide in this fascinating meditation game.
Future Life Pets will take you into a state of deep relaxation to help you understand this special condition. With expert hypnosis you can discover how your paths will cross in your future lifetime.
WHAT PEOPLE ARE SAYING
"I immediately saw I was riding a tall black and white horse and you've guessed it --it was my dog and this time he was bigger than ever." --Mike from Kansas City.
"Seeing both my cats in the future lifetime has given me so much joy. They are both cats again next time around, only a lot bigger and smoother. I clearly saw them both lie by my feet just as they do right now." --Felicity from Manchester, UK.
The regular buyers of Anne's products include heads of industry, politicians, and celebrities of all kinds. She is a world famous psychic and author of three books Instant Intuition, The Future is Yours, and Cosmic Energy.
More than a billion people in the world believe in the truth of meditation, through which we'll gain a greater understanding of our pets and ourselves.
Prepare for the experience as the results are astonishing. [/INST] question: If we want to use the app of Future Life Pets, what kind of language should we know? | options: A: English B: Chinese C: French D: Japanese | answer: A </s> |
<s>[INST] context: Cardinal symptoms of Meniere's disease are: Episodic veigo, fluctuating hearing loss, tinnitus and sense of fullness or pressure in the involved ear Meniere's disease "Classic Meniere's" is considered to have the following symptoms: Attacks of rotational veigo that can be severe, incapacitating, unpredictable, and last anywhere from minutes to hours, but generally no longer than 24 hours. This combines with an increase in volume of tinnitus and temporary, albeit significant, hearing loss. Hearing may improve after an attack, but often becomes progressively worse. Nausea, vomiting, and sweating sometimes accompany veigo, but are symptoms of veigo, and not of Meniere's. Fluctuating, progressive, unilateral or bilateral hearing loss, usually in lower frequencies. For some, sounds can appear tinny or distoed, and patients can experience unusual sensitivity to noises. Unilateral or bilateral tinnitus. A sensation of fullness or pressure in one or both ears. Some may have parasitic symptoms, which aren't necessarily symptoms of Meniere's, but rather side effects from other symptoms. Veigo may induce nystagmus, or uncontrollable rhythmical and jerky eye movements, usually in the horizontal plane, reflecting the essential role of non-visual balance in coordinating eye movements. Sudden, severe attacks of dizziness or veigo, known informally as "drop attacks," can cause someone who is standing to suddenly fall Meniere's disease is idiopathic, but it is believed to be linked to endolymphatic hydrops, an excess of fluid in the inner ear. Edolymphatic fluid bursts from its normal channels in the ear and flows into other areas, causing damage. This is called "hydrops." The membranous labyrinth, a system of membranes in the ear, contains a fluid called endolymph. The membranes can become dilated like a balloon when pressure increases and drainage is blocked. This may be related to swelling of the endolymphatic sac or other tissues in the vestibular system of the inner ear, which is responsible for the body's sense of balance. Endolymphatic duct may be obstructed by scar tissue, or may be narrow from bih. In some cases there may be too much fluid secreted by the stria vascularis. The symptoms may occur in the presence of a middle ear infection, head trauma, or an upper respiratory tract infection, or by using aspirin, smoking cigarettes, or drinking alcohol. A detailed otolaryngological examination, audiometry and head MRI scan should be performed to exclude a vestibular schwan.noma or superior canal dehiscence which would cause similar symptoms. There is no definitive test for Meniere's, it is only diagnosed when all other causes have been ruled out. [/INST] question: Which is not seen in Meniere's disease: | options: A: Tinnitus B: Hearing loss C: Loss of consciousness D: Veigo | answer: C </s> |
<s>[INST] context: Many people think heroes need to be handsome, rich, or very smart. But as for me, a hero is a person who always helps others. My hero is Uncle Bill. He is the oldest son of a worker, and he grew up in a poor family with four younger brothers and two little sisters.
He was good at neither writing nor math. In fact, he never did well in school. so he had to give up school at a very young age. He worked and gave all his money to help his parents. When he was getting older, he found that he was very interested in fixing things. he collected broken things which people threw away and fixed them into good ones. He could fix almost everything that did not work. He worked hard never gave up. Finally, he opened his own repair shop. It took him about 20 years to become a successful shopkeeper .
Now, he is very rich and has four shops. But he never forgets the days when he had nothing. He gives money to poor families, helps poor kids buy books and offers them free lunch. He also encourages people to reuse things. He always says :Make good use of what you have because we just have one earth.
I am proud of Uncle Bill. He is really a hero. [/INST] question: How many people were there in Uncle Bill's family when he was a child | options: A: 7 B: 8 C: 9 D: 10 | answer: C </s> |
<s>[INST] context: positron emission tomography (PET) scanning has enhanced the detection of localized infections and of occult neoplasms and lymphomasPET scanning appears to be superior to other forms of nuclear imaging. The FDG used in PET scans accumulates in tumors and at sites of inflammation and has even been shown to accumulate reliably at sites of vasculitis. Where available, FDG PET scanning should therefore be chosen over 67 Ga scanning in the diagnosis of FUO.PET scans using fluorodopa demonstrate diminished striatal dopamine formation and storage. In addition to hypometabolism in the putamen, severe caudate involvement on PET scanning distinguishes PSP from Parkinson's disease .PET scanning attempts to identify sites of malignancy based on glucose metabolism by measuring the uptake of fluorodeoxyglucose F18. Rapidly dividing cells, presumably in the lung tumors, will preferentially take up 18 F-FDG and appear as a "hot spot." To date, PET has been used for staging and detection of metastases in lung cancer and in the detection of nodules >15 mm in diameter. Combined 18 F-FDG PET-CT imaging has been shown to improve the accuracy of staging in NSCLC compared to visual correlation of PET and CT or either study alone. ref:harrison&;s principles of internal medicine,ed 18,pg no 1150 [/INST] question: Which test is not useful in a patient with history of syncopal attack | options: A: Electrophyciological test B: Table tilt test C: PET scan D: Holter monitoring | answer: C </s> |
<s>[INST] context: For my grandmother's 70th birthday, my family and I visited South Korea. While there, I was attentive to Korean high schools and students.
I was surprised by how different Korea's public high schools are from America's. Korean high schools can be all-girls, all-boys or co-ed unlike our standard co-ed high schools. There are three grades: "go 1" (10th), "go 2" (11th) and "go 3" (12th). ''Go" is the first syllable of the word "go-deung-hakkyo", which, simply translated, is "high school".
In America, unless you want to go to a private school, you don't have to take an entrance exam. In Korea, however, students must take a test to get in because of the many choices of schools.
Another difference I couldn't help but notice was the students' appearance. With very few exceptions, all wear uniforms. A name tag with the student's name, grade and homeroom number must also be worn. Girl's skirts can't be above the upper part of the knee, and it is forbidden to dye your hair or wear accessories except small earrings. There are strict regulations for appearance to achieve neatness, and it seems the only freedom students have is with their choices of hair style, socks and shoes.
The final difference was the _ of the classes. There may be 40 students in a classroom, but the number can be less or even more, depending on the population of the town or city. Although there are many students per classroom, they are very close, which I think is a result of not changing classrooms for different subjects. There are no levels in the subjects and the teachers are the ones who switch classrooms. They just have ten-minute breaks between subjects. In each class, students are ranked by their grades. This causes strict competition, and Korean students do a lot of studying. To help them, all schools have extra study classes after school. One other fact that helped me appreciate living in America is that Koreans have school on Saturdays. Although it's only a half day, I think I speak for most Americans when I say we could never imagine ourselves in school on a Saturday.
Korea's public high schools are clearly different from America's. I had imagined them to be just like our schools, but now I have a clear picture of how different they are. [/INST] question: How many main differences are mentioned between Korea's public high school and America's? | options: A: 3 B: 4 C: 5 D: 6 | answer: B </s> |
<s>[INST] context: Cytochromes in complex III receive electrons from the reduced form of CoQ.a. Each cytochrome consists of a heme group (see Figure below) associated with a protein.b. The iron of the heme group is reduced when the cytochrome accepts an electron.Fe3+=Fe2+An iron-deficiency anemia is characterized by small, pale RBCs. The lack of iron reduces the synthesis of heme, so the red cells cannot carry as much oxygen (which gives them the pale color). The cells are small in order to maximize the concentration of hemoglobin present in the cells. A megaloblastic anemia is caused by deficiencies in either vitamin B12 or folic acid (a lack of intrinsic factor will lead to a B12 deficiency named pernicious anemia). These cells are large because the vitamin deficiency interferes with DNA synthesis, and the cells double in size without being able to replicate their DNA. Once the anemia begins, the large blast cells are released by the marrow in an attempt to control the anemia. Hemolytic anemia occurs when the red cell membrane fragments, which can occur with pyruvate kinase deficiencies or a lack of glucose-6-phosphate dehydrogenase activity (which results in reduced NADPH levels). Sickle cell anemia is caused by a point mutation in the b-globin gene, substituting a valine for a glutamic acid.The general structure of the heme group, which is present in hemoglobin, myoglobin, and the cytochromes b, c, and c1. Each cytochrome has a heme with a different modification of the side chains (indicated with the dashed lines), resulting in a slightly different reduction potential and, consequently, a different position in the sequence of electron transfer. [/INST] question: A deficiency of substance iron can result in an anemia. Choose the type of anemia that would occur if the substance were deficient. | options: A: Megaloblastic anemia B: Hypochromic, microcytic anemia C: Hemolytic anemia D: Sickle cell anemia | answer: B </s> |
<s>[INST] context: Gut hormones (for a full listing, see Table I below)a. Gastrin from the gastric antrum and the duodenum stimulates gastric acid and pepsin secretion.b. Cholecystokinin from the duodenum and jejunum stimulates the contraction of the gallbladder and the secretion of pancreatic enzymes.c. Secretin from the duodenum and jejunum stimulates the secretion of bicarbonate by the pancreas.d. Ghrelin from the central nervous system, stomach, small intestine, and colon stimulates GH release under fasting conditions.e. Gastric inhibitory polypeptide (GIP) from the small bowel enhances insulin release and inhibits the secretion of gastric acid.f. Glucagon-like peptide 1 (GLP-1) from the neuroendocrine cells in the ileum, colon, and central nervous system enhances glucose disposal after meals by inhibiting glucagon secretion and stimulating insulin secretion. The actions of GIP and GLP-1 relevant to glucose control are summarized in Table II and Figure below.g. Vasoactive intestinal polypeptide from the pancreas relaxes smooth muscles and stimulates bicarbonate secretion by the pancreas.h. Somatostatin from the central nervous system, pancreatic d cells, and enteroendocrine d cells inhibits the secretion of insulin and glucagon from the pancreas; inhibits the release of gastrin, secretin, and GLP-1 from the gut; and reduces carbohydrate absorption from the gut lumen.Somatostatin, produced by the hypothalamus, inhibits growth hormone production and secretion by the anterior pituitary. Somatostatin will also reduce the secretion of TSH, insulin, and glucagon.Table I: Gastrointestinal-Derived Hormones That Affect Fuel Metabolism DirectlyHormonePrimary Cell/Tissue of OriginActionsSecretary Stimuli {and Inhibitors)AmylinPancreatic b cell, endocrine cells of stomach and small intestine1. Inhibits arginine-stimulated and postprandial glucagon secretion2. Inhibits insulin secretionCosecreted with insulin in response to oral nutrientsCalcitonin gene-related peptideEnteric neurons and enteroendocrine cells of the rectumInhibits insulin secretionOral glucose intake and gastric acid secretionGalaninNervous system, pituitary, neurons of gut, pancreas, thyroid, and adrenal glandInhibits the secretion of insulin, somatostatin, enteroglucagon, pancreatic polypeptide, and othersIntestinal distensionGastric inhibitory polypeptide/glucase-dependent Insulinatroprc polypeptide (GIP)Neuroendocrine K cells of duodenum and proximal jejunum1. Increases insulin release via an "incretin" effect2. Regulates glucose and lipid metabolismOral nutrient ingestion, especially long-chain fatty acidsGastrin-releasing peptide (GRP)Enteric nervous system and pancreasStimulates the release of cholecystokinin; GIP, gastrin, glucagon, GLP-I, GLP-2, and somatostatin GhrelinCentral nervous system, stomach, small intestine, and colonStimulates GH releaseFastingGlucagonPancreatic a cell, central nervous systemPrimary counterregulatory hormone that restores glucose levels in hypoglycemic state (increases glycogenolysis and gluconeogenesis as well as protein-lipid flux in liver and muscle)Neural and humoral factors released in response tohypoglycemiaGlucagon-like peptide 1 (GLP-1)Enteroendocrine L cells in ileum, colon, and central nervous system1. Enhances glucose disposal after meals by inhibiting glucagon secretion and stimulating insulin secretion2. Acts through second messengers in b cells to increase the sensitivity of these cells to glucose (an incretin)1. Oral nutrient ingestion2. Vagus nerve3. GRP and GIP4. Somatostatin inhibits secretionGlucagon-like peptide 2 (GLP-2)Same as for GLP-1Stimulates intestinal hexose transportSame as GLP-1Neuropeptide YCentral and peripheral nervous system, pancreatic islet cellsInhibits glucose-stimulated insulin secretionOral nutrient ingestion and activation of sympathetic nervous systemNeurotensin (NT)Small intestine N cells (especially ileum), enteric nervous system, adrenal gland, pancreasIn brain, modulates dopamine neurotransmission and anterior pituitary secretions1. Luminal lipid nutrients2. GRP3. Somatostatin inhibits secretionPituitary adenylate cyclase-activating peptide (PACAP)Brain, lung, and enteric nervous systemStimulates insulin and catecholamine releaseActivation of central nervous systemSomatostatinCentral nervous system, pancreatic d cells, and enteroendocrine 5 cells1. Inhibits secretion of insulin, glucagon and PP (islets), and gastrin, secretin, GLP-1, and GLP-2 (in gut)2. Reduces carbohydrate absorption from gut lumen1. Luminal nutrients2. GLP-33. GIP4. PACAP5. VIP6. b-Adrenergic stimulationVasoactive intestinal peptide (VIP)Widely expressed in the central and peripheral nervous systemsMay regulate the release of Insulin and pancreatic glucagon1. Mechanical stimulation of gut2. Activation of central and peripheral nervous systemsTable II: Actions of GLP-1 and GIP Relevant to Glucose Control GLP-1GIPPancreasStimulates glucose-dependent insulin release++Increase insulin biosynthesis++Inhibits glucagon secretion+-Stimulates somatostatin secretion+-Induces b-cell proliferation++Inhibits p-cell apoptosis++Gastrointestinal tractInhibits gastric emptying+-Inhibits gastric acid secretion++Central nervous systemInhibits food and water intake+-Promotes satiety and weight loss+-Cardiovascular systemImproves cardiovascular function after ischemia+-Adipose tissueInsulin-like lipogenic actions-+Lipid storage-+ The actions of selected peptides on vital tissues involved in glucose homeostasis. Both GLP-1 and GIP increase insulin secretion and b-cell survival. GLP-1 has additional actions related to glucose metabolism. In contrast, gastrin and CCK do not acutely regulate plasma glucose levels, but appear to increase b-cell proliferation. CCK, cholecystokinin; GIP, gastric inhibitory polypeptide; GLP-1, glucagon-like peptide 1. [/INST] question: Elevated levels of somatostatin is a pathologic condition associated with which of the blood hormone levels. | options: A: High prolactin (PRL) B: High TSH C: High cortisol D: Low growth hormone (GH) | answer: D </s> |
<s>[INST] context: This patient developed enteritis-associated arthritis affecting the lumbar and sacroiliac joints several weeks after Shigella dysentery. He subsequently developed conjunctivitis and, most likely, uveitis. This symptom complex is a classic representation of a cluster of related disorders called seronegative spondyloarthropathies. This cluster includes ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis (as in this case). A common feature is a very strong association with the HLA-B27 genotype. Despite some similarities with rheumatoid arthritis, these patients invariably have a negative test result for rheumatoid factor. Urethritis caused by Chlamydia trachomatis can trigger reactive arthritis, another form of seronegative spondyloarthropathy. Such infection precedes the onset of arthritis, however. There is no relationship between infection with Borrelia burgdorferi, the causative agent of Lyme disease, and reactive arthritis in individuals testing positive for HLA-B27. Similarly, Epstein-Barr virus infection is not a trigger for these disorders. [/INST] question: A 30-year-old man has had cramping abdominal pain and bloody diarrhea for the past 4 days. On physical examination, there is diffuse tenderness on palpation of the abdomen. Bowel sounds are present. There are no masses and no organomegaly. A stool culture is positive for Shigella flexneri. The episode resolves spontaneously within 1 week after onset. Six weeks later, he has increasingly severe lower back pain. Physical examination now shows stiffness of the lumbar spine and tenderness of the sacroiliac joints. He is treated with nonsteroidal anti-inflammatory agents. Two months later, the back pain recurs, and he complains of redness of the right eye and blurred vision. Serologic testing for which of the following is most likely to be positive in this patient? | options: A: Borrelia burgdorferi B: Chlamydia trachomatis C: Epstein-Barr virus D: HLA-B27 | answer: D </s> |
<s>[INST] context: DERM ATOM MYOSITIS:
DM is a distinctive entity identified by a characteristic rash accompanying, or more often preceding muscle weakness.
√ Heliotrope rash: The rash may consist of a blue-purple discolouration on the upper eyelids with edema
√ Gottron's sign: A flat red rash on the face and upper trunk and erythema of the knuckles with a raised violaceous scaly eruption.
√ Gottron's papules: Discrete erythematous papules overlying the metacarpal and interphalangeal joint
√ The erythematous rash can also occur on other body surfaces, including the knees, elbows, malleoli, neck and anterior chest (often in a V sign), or back and shoulders (shawl sign), and may worsen after sun exposure.
√ In some patients, the rash is pruritic, especially on the scalp, chest, and back. √ Dilated capillary loops at the base of the fingernails are also characteristic. The cuticles may be irregular, thickened, and distorted, and the lateral and palmar areas of the fingers may become rough and cracked, with irregular, "dirty" horizontal lines, resembling mechanics hands. [/INST] question: Gottron’s papules Seen in? | options: A: SLE B: MTCD C: Dermatomyositis D: Rheumatoid arthritis | answer: C </s> |
<s>[INST] context: It is said that a person has about 6,000 thoughts every day, Yet, of the 6,000 thoughts you have today, ninety percent of these are the same as the 6,000 you had yesterday and the day before, leaving little room for new thoughts. No wonder life can seem _ at times. Unless you start to think differently, you are to continue to create and repeat the same old reality every day. Is it not time to change your thoughts, enliven your dreams and let reality catch up?
Most of our thoughts and actions are habits, and we go thought the same motions each day, with little change in our behaviors or outlook. What would happen if you challenged these habits or customs? What if you were to step out of your comfort zone and explore new ideas or new ways or doing things? Would your life not change as a result?
Thought is a form of energy. Does this energy keep you forward or hold you back? You have a choice about the thoughts you think. How many times in the past have you chosen to disregard your positive thoughts and focus on your negative thoughts? At this moment, if you were to be at ease and to focus on your positive thoughts while discounting your negative thoughts, how would your life change?
To realize your dreams, pay attention to what is happening around you. Be curious. Notice how your thoughts about yourself, your thoughts about others and your thoughts about what others may be thinking of you influence and what you are able to achieve. Start to think, see and experience things, people, places and events in new ways. Recognize what happens when you begin to think differently about yourself and what you are capable of achieving. [/INST] question: _ thoughts per minute you had are the same as yesterday and the day before. | options: A: About 40 B: Over 5,400 C: About 4 D: Over 100 | answer: C </s> |
<s>[INST] context: On November 15th, 2014, children aged 8 to 12 got together in five cities around the world to participate in the first Global Children's Designation. The event that was organized by a Dutch company called Unexpect, challenged kids to come up with solutions for some of the world's most pressing problems in a day!
The day began with the kids listening to the various challenges that were related to their particular cities and towns. The teams were then asked to brainstorm about which problem they were going to handle and how. There were so many amazing ideas produced on that day.
While some of the ideas were far from perfect, there were many that could be practical like the smart cars which can ease traffic pressure by telling traffic lights of its arrival and also guiding the drivers to the best possible route .
Emer Beamer, the founder of Unexpect, says the purpose of the project is to introduce children to skills they probably never learn in class. She says that for most part, schools focus on teaching things that they will most likely never need to know again. She believes that for kids to be successful in the world, they should be learning how to be creative, handle new technologies and deal with unexpected situations.
Though the first global design challenge was relatively small, involving only a few hundred of the two billion youngsters that are bursting with ideas, the next one will be much bigger. That's because in 2015, Unexpect plans to distribute free tool kits to any school that is interested in hosting their own Children's Designation Challenge. We can't wait to see what ideas kids will come up with next. [/INST] question: What does the project of Unexpect aim to do? | options: A: To improve school education B: To share achievements of technologies C: To develop children's creativity D: To predict some unexpected situations | answer: C </s> |
<s>[INST] context: When someone says extinct animals, you may think about dinosaurs . But now many other animals are becoming less and less in number. These animals might disappear from the earth very soon. Take a look at the following animals. They are all in danger.
The African Elephant
The African elephant is a clever animal. It has a very good memory. But people kill it for its tusks . Half of the African elephants have disappeared.
The African Lion
The African lions have nowhere to live because of wars in Southern Africa. Besides, hunters and farmers often kill them.
The Tortoise
George is a tortoise. It is the last Pinta Island giant tortoise. It was found in 1971. Now it lives in a research station. It can still live for another 200 years. But it is the last one of this species of tortoise.
The Tadpole Shrimp
Maybe you've never seen a tadpole shrimp. This is one of the oldest species on the earth. People have found them in fresh water pools on four continents . A tadpole shrimp can only live for two months or less. [/INST] question: When someone says extinct animals, you may think about _ ? | options: A: monkeys B: dinosaurs C: pandas D: tigers | answer: B </s> |
<s>[INST] context: Hi! My name is Robert and I live in Chicago. My school is called Parkside Elementary. It is Jake and Elizabeth's school too. Michael and Trevor's school is called Lincoln Middle School. In the USA many students go to elementary school between the ages of 5-10, then middle school between the ages of 11-13, and then a four year high school, and last but not least, many people go to college or vocational school. Our elementary school starts at 8:30 am and ends at 3:20 pm. We go to school on Monday through Fridays and have the weekends off.
Some of the favorite sports here in America are basketball, baseball, football, soccer, hockey, and more. But, my favorite sport is football. My favorite player in the NFL (National Football League) is Brian Urlacher of the Chicago Bears ( the Bears are my favorite team too).
Americans wear jeans, a shirt, socks, shoes, and sometimes a hat. I usually wear a baseball hat, my favorite pants, and my favorite shirt. My pants have 4 pockets on it, and my shirt has red and black stripes on it.
There is no common agreement in the west about the best method of education. Many _ can be found among parents, teachers, and students.
http://library.thinkquest.org/CR02www.qzjyzx.com2/italy.html
http://www.cfl.cqu.edu.cn/jpkc/kj/xb/xb2/2-1/culturalnotes.htm [/INST] question: Students in elementary school stay at school for about _ days. | options: A: four B: five C: six D: seven | answer: B </s> |
<s>[INST] context: I had managed to sell all my papers and was coming home in the snow. It was that strange hour in New York when the workers were walking towards home in the evening. I recognized my father near Cooper Union, a frozen figure in an old overcoat standing by a banana cart . He looked so lonely; tears came to my eyes. Then he saw me, and his face lit with his sad, beautiful smile.
"Arch," he said, "so you have sold your papers! Come and eat a banana."
He offered me one, but I refused it. I felt it important that my father sell his bananas, not give them away. He thought I was shy, and joked with me, and made me eat the banana. It smelled of wet snow.
"You haven't sold many bananas today, Dad," I said.
"What can I do? No one seems to want them," Dad said.
It was true. The crowds pushed home; the sky darkened over the New York buildings; the tall street lamps were lit; street cars and bikes went by. Nobody and nothing in the great city stopped for my father's bananas.
"I ought to yell ," said my father sadly. "I ought to make a big noise like other peddlers , but it makes my throat sore. Anyway, I'm ashamed of yelling; it makes me feel like a fool."
I had eaten one of his bananas. A voice deep down told me that I ought to pay for it somehow. I must remain here and help my father.
"I'll yell for you, Dad," I volunteered.
"Arch, no," he said, "go home; you have worked enough today. Just tell momma I'll be late."
But I yelled and yelled. My father, standing by, spoke words of praise, and said I was a wonderful yeller. However, nobody else paid attention; nobody listened and came to buy our bananas.
My father tried to stop me at last. He said, "That was wonderful yelling, Arch. But it's just we are unlucky today! Let's go home."
I insisted on keeping up my yells. But at last my father persuaded me to leave with him. [/INST] question: Which of the following can NOT be used to describe the son? | options: A: Hard-working B: Kind C: Shy D: Determined | answer: C </s> |
<s>[INST] context: Which color do you like best? Everyone has his own favorite color, but how do people feel about colors? It depends on their cultures. The same color sometimes has different meanings in different countries.
In England, the right color for a bride to wear is white. But in China and other eastern countries, brides often wear red. Why? It is because the red color is a sign of good luck.
Red is used as a sign of danger in England. Road signs are often in red. In eastern countries, red does not mean you have to be careful.
In England and other western countries, black is the color of death. But in many eastern countries, most people think white is the color of death.
In England, green is used in traffic lights to tell people that it is safe to go. Green is often seen as a lucky color, but wearing green at a wedding is unlucky.
Many people like the color orange because it is bright and exciting. But some _ will not use orange in their ads because they believe it suggests that their products are cheap and perhaps not of high quality.
As is known to all, red is the most popular color in China while in England it is blue. [/INST] question: Most Chinese people like red because they think _ . | options: A: it is safe to go B: it can bring good luck C: it is bright and exciting D: it has different meanings | answer: B </s> |
<s>[INST] context: Management of open fracture
Open fracture need immediate surgery to clean the area of the injury.
Because of the break in the skin, debris and infection can travel to the fracture location, and lead to a high rate of infection in the bone.
Once an infection is established, it can be a difficult problem to solve.
Treatment of established bone infections often requires multiple surgeries, prolonged antibiotic treatment and long-term problems.
Therefore, every effort is made to prevent this potential problem with early surgery.
All open fractures, no matter how trivial they are must be assumed to be contaminated.
The four essential principles of treatment for management of open fractures are : -
Antibiotic prophylaxis
Urgent wound and fracture debridement.
Stabilization of fracture (fracture fixation)
Early definitive wound cover
Debridement
Patient is taken immediately to surgery and debridement is done by removal of contaminated and devitalized tissue, copious irrigation by sterile solution (usually saline).
As a general rule it is best to leave cut nerves and tendons alone, though if the wound is absolutely clean and no dissection is require, and provided the necessary expertise is available, they can be sutured.
Wound closure
A small, uncontaminated wound in a Grade I or II fracture may (after debridement) be sutured, provided this can be done without tension.
In the more severe grades of injury, immediate fracture stabilization and wound cover using split-skin grafts, local or distant flaps is ideal, provided both orthopaedic and plastic surgeons are satisfied that a clean, viable wound has been achieved after debridement.
In the absence of this combined approach at the time of debridement, the fracture is stabilized and the wound is left open and dressed with impervious dressing.
Return to surgery for a 'second look' should have definitive fracture cover as an objective. It should be done by 48-72 hours, and not later than 5 days.
Stabilizing the fracture
Stabilizing the fracture is important in reducing the likelihood of infection and assisting recovery of the soft tissues.
The method of fixation depends on the degree of contamination, length of time from injury to operation and amount of soft tissue damage.
If there is no obvious contamination and definitive wound cover can be achieved at the time of debridement, open fractures of all grades can be treated as for a closed injury. Internal fixation or external fixation depends on the individual characteristic of fracture.
If wound is contaminated and clean wound cannot be obtained by debridement or if wound cover is delayed, then external fixation by a fixator is safer.
Coming back to question
Debridement, Internal fixation and external fixation all are used in the treatment of open fracture.
For one answer go ahead with debridement because debridement is the most important step and is done in all open fractures.
On the other hand, whether to stabilize the fracture either by internal fixation or external fixation, depends upon specific situations. [/INST] question: Open fracture is treated by -a) Tourniquetb) Internal fixationc) Debridementd) External fixation | options: A: bcd B: acd C: ac D: bd | answer: A </s> |
<s>[INST] context: If you experience great stress in your life on a frequent basis, you're not alone. Nowadays, stress is almost a given fact of life. Actually, a certain degree of stress can have positive effects on us. But if stress continues over a long period of time, the effects on the body can be harmful, resulting in health problems and stress-related illness, including heart attack and stroke.
Stress is a normal reaction by the body to what it perceives as a threatening situation or environment. Short-term reactions may include an increase in heart rate as well as a rise in blood pressure. A person under short-term stress may feel nervous, anxious and even experience shortness of breath. Other reactions can include a dry mouth, quick heartbeat, sweating, stomach upset and diarrhea.
When stress is long-term and becomes more chronic in nature, it can cause more serious health-related problems, including regular headaches, back pain, weight changes, sleep difficulties, changes in mood and so on. Chronic stress can also result in memory problems, including difficulty remembering new information and the inability to quickly deal with old information.
No matter how your body reacts to stress, ignoring the problem can have serious health results. Not surprisingly, more women than men openly seek the help of their family doctors or other health care experts when they are experiencing stress or stress-related illness. Men are more likely to refuse to admit the problem or attempt to self-treat it, which may contribute to higher rate of drug and alcohol addiction seen in men exposed to chronic stress.
There's no doubt that stress is a fact of life and is likely to remain a part of our fast-paced society. Although stress can't be completely _ , methods of dealing with stress-related issues, in my view, can be developed so that the effects of stress on the body are avoided, so people won't be so easy to suffer stress-related illness. [/INST] question: Which of the following is not the reaction of short-term stress? | options: A: A dry mouth B: Stomach upset C: Weight changes D: A rise in blood pressure | answer: C </s> |
<s>[INST] context: As the price of a college degree continues to rise, there's growing evidence that the monetary payoff isn't quite as big as often advertised. The best estimate now is that a college degree is worth about $300,000 in today's dollars--nowhere near the million figure that is often quoted.
"That million number has driven me crazy!" says Sandy Baum, a Skidmore economist who studied the value of a college degree for the College Board last year.
Baum's research showed that college graduates earn, on average, about $20,000 a year more than those who finished their educations at high school. Add that up over a 40-year working life and the total differential is about $800,000, she figures. But since much of that bonus is earned many years from now, taking away the impact of inflation means that$800,000 in future dollars is worth only about $450,000 in today's dollars.
Then, if you remove the cost of a college degree--about ,$30,000 in tuition and books for students who get no aid and attend public in-state universities--and the money a student could have earned at a job instead of attending school, the real net value in today's dollars is somewhere in the $300,000 range, a number confirmed by other studies.
But, especially these days, that still makes a college degree one of the most _ investments a person can make, Baum notes.
Better yet, college graduates can go on to earn advanced degrees, which return even bigger payoffs. The average holder of a bachelor's degree earns about$51,000 a year, Baum calculates. But those who've gone on to earn MBAs, law degrees, or other professional degrees earn about $100,000 a year.
In addition, Baum found that there are plenty of other rewards for a degree. The quality of the jobs college graduates get is far better, for example. College graduates are more likely to get jobs with health insurance. And it is easier for them to find and hold jobs. The unemployment rate for college graduates was just 2.2 percent last year, half the unemployment level of those with only high school diplomas.
There are lots of other nonmonetary benefits as well. College graduates are healthier, contribute more to their communities, and raise kids who are better prepared academically, studies show.
Other researchers have found that the payoff of a degree is especially lucrative for students from low-income families, since the education and degrees give them a chance to break out of low-paying careers. [/INST] question: What can be inferred from Para 1 ? | options: A: The payoff of a college degree is still big enough to match the advertised B: It's more and more difficult to get a college degree C: The return of a college degree is less than often quoted D: A college degree is worth about one million dollars | answer: C </s> |
<s>[INST] context: The quality of drinking water in Shanghai will meet European Union standard by 2010 and, a decade later, citizens in Shanghai will drink the best water in the world.
These were the goals set out by the Shanghai Water Authority. With the city's population expected to increase only slightly and the economy to boom by 2020, Chen Yin, an official in the water authority, said Shanghai's water consumption will not increase from its present amount.
Zhang Yue, director of the Urban Construction Division under the Ministry of Construction, said, "Shanghai is the first city in the country to publicize these ambitions. They will not be easy to achieve." He said water saving will help keep the sustainable development of China's economy.
Saving one cubic meter of water means saving the city's infrastructure costs by 10,000 Yuan. Last year, Shanghai saved 300 million cubic meters of water either from readjustment of industrial structure or the employment of new technology.
"The aim is to arouse public awareness of the seriousness of water shortages," Chen said. "The abundant surface water and amount of rain of the city are so misleading that they result in improper use of water."
Shanghai lacks drinkable water. The Huangpu River, which supplies 80 percent of the city's drinkable water, is nearing exhaustion. The city, therefore, has been exploring new sources from the Yangtze River and growing forests along it to conserve quality water.
Besides penning regulations, the authority is popularizing technology among the public to efficiently cut the amount of water used.
At present, the city has 600,000 family toilets, each using 13 liters of water per flush. These are to be renovated to use only 9 liters of water per flush. The authority is renovating the first 200 toilets for households - at a cost of Yuan each. In three years, all the toilets will be renovated, which saves the city nearly 15 million Yuan every year in water conservation.
Another task the city is engaged in is the treatment of sewage to improve the water environment. At present the city can only treat 44 percent of its daily 5.04 million tons of waste water. To meet the total demand, 27 more sewage treatment factories are to be established with an estimated investment of 18 billion Yuan. [/INST] question: People in Shanghai get their daily water mainly from _ now. | options: A: the underground B: the Huangpu River C: the rain D: the Yangtze River | answer: B </s> |
<s>[INST] context: WASHINGTON--US President Barack Obama said Thursday that he had known about NBA star Jeremy Lin's talent long before the"Linsanity"phenomenon swept the sport.
"I knew about Jeremy before you did because Arne Duncan, my secretary of education, was captain of the Harvard team,"Obama told the famous US sportswriter Bill Simmons in an interview.
"When Arne and I were playing, he said,'I'm telling you, we've got this terrific guard named Jeremy Lin at Harvard.'And then when one of my best friends, whose son is a freshman at Harvard, went for a recruiting trip he saw Lin in action, so I've been on the Jeremy Lin bandwagon for a while,"said the president, who is a Harvard Law graduate.
Lin, the New York Knicks' point guard, though he was cut twice in December 2011, had had a sudden rise in the past month to high points scoring stardom in Madison Square Garden, the world's biggest basketball stage.
He is the first Chinese-American player in the NBA. He has already developed a devoted following among many Asian-Americans and in China, Taiwan, the Philippines and other countries.
Clicks to the NYKnicks. Com website _ as basketball fans from around the world search for Lin's news and highlights.
"He seems like a wonderful young man. It elevates this great sport all round the world,"said Obama, a Chicago Bulls fan."And what's been encouraging is to see how fast the sport has bounced back recently."But he sounded a note of caution on how much basketball costs to watch.
"It's really important for professional athletes and sports owners to just remember you got a whole bunch of folks out here, all across the country, who invest so much in their teams. All they ask is not to be so selfish that you're not looking out for your fans,"Obama said. [/INST] question: President Obama learned about Jeremy long before through _ . | options: A: news reports B: a friend C: Bill Simmons D: Arne Duncan | answer: D </s> |
<s>[INST] context: Sales Executive
Pindan Labor Solutions is expanding and we require a sales executive. Working hours from Monday to Friday,12 months a year. However,some weekend work may be required. You will be assisting our team of consultants with business development. You can get a monthly income of $5,200.Essential requirements include previous sales experience,strong communication skills,high level of computer competency ,WA driver's license.
For more information,please email [email protected] or phone 0452 236 541.
Martial Arts Trainer
GoKanRyu Karate has a number of positions available for people who have an interest in the martial arts. The position will involve training new students on working days. An expected first year income of $45,000.Excellent people skills and previous experience are essential. Own car and license required.
Please contact Tim Hort on 0285 371 464 or [email protected] for further information.
Workshop Manager
Located in Wongan Hills WA,Beckman Machinery wants a service/workshop manager to join our successful team. Your role will be to provide the best possible service to customers,Monday to Friday. You must have trade certificate,excellent communication and computer skills. Knowledge of agricultural products is essential. You can get at least $50,000 in your first year.
Please call Stuart 0427 777 105 or email [email protected] if any further information is needed.
Farmhand
A general farmhand is required to work on a farm located 40kms from Condobolin.A driver's license is essential. Duties include:sheep,cattle work;cropping & irrigation .Weekends off,except during sowing and harvest periods.$39,000 a year.
If you are interested in farm work,please email [email protected] or call 0167 327 047 for detailed information. [/INST] question: Of the four positions,which offers the top yearly income? | options: A: A sales executive B: A martial arts trainer C: A workshop manager D: A farmhand | answer: A </s> |
<s>[INST] context: How was your Children's Day? What kind of gifts did you get?
Eight third graders in some poor places in Hebei Province got new schoolbags as Children's Day gifts. They were very happy. There were pencils, pens, exercise books and many other school supplies in the schoolbags.
These schoolbags are from students in Beijing Zhongguancun Fourth Primary School. They are in Class 5, Grade 3. They raised money by themselves. They printed out their writings. Their head teacher Mrs Hou helped them to make books. They sold the books at their school to make 800 yuan.
Chen Hongsheng, 9 years old, is one of the students. "We use 800 yuan to buy eight schoolbags at the post office. The post office workers give us a list of the kids. These kids live in poor places. We can choose eight kids by ourselves and post these schoolbags to them," she said very proudly. "These schoolbags are gifts of our class. This summer vacation, I'll send out a schoolbag by myself. I hope the kid with my schoolbag can go to school happily like us in the new term." [/INST] question: How many kids got new schoolbags in Hebei Province? | options: A: Three B: Five C: Eight D: Nine | answer: C </s> |
<s>[INST] context: Thousands of puffins live in Maine and on islands in the Gulf of Maine. But the puffins may be in danger. Last summer, the percentage of laid eggs that successfully produced baby puffins took a dive. Scientists also found a decline in the average body weight of the adult and baby puffins on Machias Seal Island, home to the area's largest colony. Over the winter, dozens of the seabirds from the region were found dead, likely from starvation.
What's causing the puffin trouble? Scientists think it may be a shortage of food. With ocean temperatures rising, fish populations have moved around. Normally, puffins' primary food source is herring, a type of fish. A lack of herring in the area could be causing the problem.
Butterfish from the south have become more abundant in the Gulf of Maine and could be a new food source for birds. But Steve Kress says butterfish may be too big and round for baby puffins to swallow.
Puffins spend most of their lives at sea. They come ashore to breed each spring and return to the ocean in August. The chicks swim to sea about 40 days after hatching. Puffin populations stretch across the North Atlantic, from Maine to northern Russia.
Maine's puffin population has been at risk in the past. In the 1800s, they were hunted for their food, eggs and feathers. By 1901, only one pair of puffins remained in the state. Thanks to the help of local lighthouse keepers and seabird restoration programs, the state's puffin population has been restored to more than 2,000 birds.
Scientists aren't sure what will happen to the Gulf of Maine's puffins. The birds may move further north. Kress says he hopes the Gulf population will sustain itself and then he continued. "You never know what climate change will bring," Kress said. "Historically fish could move out and more southerly fish could move in, and puffins may adapt to the new fish. Only they will know how the story will unfold." [/INST] question: In the scientists' opinion, _ is contributing to the puffin trouble. | options: A: a lack of herring B: environmental pollution C: the increase of birds D: the huge size of butterfish | answer: A </s> |
<s>[INST] context: Sporothrix schenekii Multiple vesicles on hand and multiple eruptions along the lymphatics in a gardner suggest the diagnosis of cutaneous sporotrichosis. Sporotrichosis Sporotrichosis is caused by the thermally dimorphic fungus sporothrix schenckii. Because S.schencki is naturally found in soil, hay, sphagnum moss, and plants, it usually affects farmers, gardeners, and agricultural workers. This fungal disease usually affects the skin although rare forms can affect the lungs, joints, bones, and CNS. Fungus enters through small cuts and abrasions in the skin to cause the infection. Because roses can spread the disease, it is one of a few diseases referred to as rose-thorn or rose gardener's disease. Forms and symptoms of sporotrichosis I) Cutaneous (skin) sporotrichosis - This is the most common form of this disease. Symptoms of this form includes nodular lesions or bumps in the skin, at the point of entry and also along lymph nodes and vessels. - The lesion stas off as small and painless, nodule and ranges in colour from pink to purple. - Left untreated, the lesion becomes larger and look similar to a boil and more lesions will apear, until a chronic ulcer develops. Usually cutaneous sporotrichosis lesions occur in the finger, hand and arm. 2) Pulmonary sporotrichosis - This rare form of the disease occur when S.schenckii spores are inhaled. - Symptoms include productive cough, nodules, cavitations and fibrosis of lungs; and hilar lymph node enlargement. - Patients with this form of sporotrichosis are susceptible to developing tuberculosis and pneumonia. 3) Disseminated sporotrichosis - When the infection spreads from the primary site to secondary sites in the body, the disease develops into a rare and critical form called disseminated sporotrichosis. - The infection can spread to joints and bones (called osteoaicular sporotrichosis) as well as the CNS and brain (sporotrichosis meningitis). About other options Cladosporium Cladosporium genus of fungi includes some of the most common indoor and outdoor molds. Many species of cladosporium are commonly found on living and dead plant material. Some species are plant pathogens, others parasitize other fungi. Cladosporium species are rarely pathogenic to humans, but have been repoed to cause infection of the skin and toenails, as well as sinusitis and pulmonary infections. [/INST] question: A gardener has multiple vesicles on hand andmultiple eruptions along the lymphatics. Most common fungus responsible is ? | options: A: Sporothrix schenckii B: Cladosporium C: Histoplasma D: Candida | answer: A </s> |
<s>[INST] context: What is language for? Some people seem to think it's for practicing grammar rules and learning lists of words -- the longer the lists, the better. That's wrong. Language is for the exchange of ideas and information. It's meaningless to know all about a language if you can't use it freely. Many students I have met know hundreds of grammar rules, but they can't speak correctly or fluently . They are afraid of making mistakes. One shouldn't be afraid of making mistakes when speaking a foreign language.
Native speakers often make mistakes and break rules, too. Bernard Shaw once wrote, "Foreigners often speak English too correctly." But the mistakes that native speakers make are different from those that Chinese students make. They are English mistakes in the English language. And if enough native speakers break a rule, it is no longer a rule. What used to be wrong becomes right. People not only make history, but they also make language. But people can only make their own language. They can't make another people's language. So Chinese students of English should pay attention to grammar, but they shouldn't overdo it. When they learn a foreign language, they should put communication first. [/INST] question: Language is used to _ . | options: A: exchange ideas B: practice grammar rules C: talk with foreigners only D: learn lists of words | answer: A </s> |
<s>[INST] context: 5 Holiday Gifts
By Liz Kennedy and Janice Lieberman
Your family's life story in print? Priceless. An appetizer plate that holds a wine glass?Genius. Read on to see our picks for the best holiday gifts on the Web--all available at bargain prices.
For Your Family
Share your life story with your kids and grandkids. Record your answers to 500 questions, from"What was your engagement proposal like?" to "What is a typical family meal?" This hardcover book is a great way to store your life stories and pass them on for generations to come.
Story of a Lifetime: $70 ( 15%discount for 2 ) at www.redenvelope.com
For the Entertainer
Hold a party with ease with wooden appetizer plates that can be attached to your wine glass. No longer will you have your hands full holding a plate in one and a glass in the other. Instead, be a one-handed wonder at your next party!
Wooden Appetizer Plates: $40 ( 5%discount for 4 ) at www.homewetbar.com
For the Pet Lover
Ever wonder what your pet does when you're out of the room? See the world through your dog's eyes with Uncle Milton's Pet Eye View Camera. This mini video camera clips onto your dog's or cat's collar to give you a glimpse into your pet's secret life.
Eye View Camera: $60 ( 10%discount for 3) at www. babyage. com
For the Athlete
Find a new level of motivation with the Nike+iPod Sports Kit. Listen to your favorite music while Nike records how far you've run, how many calories you've burned, and your personal best times. Upload your data to the Nike website, and see the progress you're making.
Nike+iPod Sports kit: $30 (5 %discount for 2) at www. store. nike. com
For the Nature Lover
A symbol of long life and memory, a Ginkgo Bilobatree is the perfect gift for your earth-conscious friends. The kit includes everything you need to grow a tree. After 10 to 12 years, your tree will stand about 20 feet tall.
Ginkgo Tree-to-Be with Personalized Tag: $50 (10 %discount for 3) at www. gifttree. com [/INST] question: How much would it cost to buy 3 Eye View Cameras and a Nike + IPod Sports Kit? | options: A: $208.50 B: $210.00 C: $192.00 D: $190.50 | answer: C </s> |
<s>[INST] context: Antonia left Athens and came to America to make her fortune. She wanted to be a famous actress, so she went to live in Hollywood, California.
At first, Antonia had very little money, so she was forced to watch every penny while _ of movie agents' offices. For over a year, she worked only in small parts. She found life extremely hard. She had to take buses or walk everywhere, and she ate only one meal a day. Even though she worked nights as a waitress, Antonia could not really make ends meet.
Suddenly, one day, the star of a film became ill, and the director asked Antonia to take the part. Her acting was superb. After the first show of the film, she became an overnight success. Everyone gave her mad notice, and she received many offers for future starring roles.
Since then, Antonia has changed her whole way of life. Now she wears expensive furs and drives a Rolls-Royce. She lives in a twenty-seven room house in Beverly Hills, with seven servants. All her needs are cared for. For Antonia, America is truly the land of streets paved with gold. Through her hard work, she has earned the fame she desired so much. [/INST] question: What changed Antonia's way of life? | options: A: Wearing expensive furs B: Her good fortune C: Her superb acting D: Her experience as a waitress | answer: C </s> |
<s>[INST] context: Whether you are fitness fan or plan to go eco-friendly, you have a countless number of bikes to choose from. Here are some tips on how to choose bikes for women.
Firstly, if you have decided to buy a bike, let me congratulate you! This is because you are kind to the environment. Before you go to a store to buy a bicycle, first know your need. Once the basic need is determined, then go into the small details like the frame size (Too small frames can increase the risk of the knee injuries while too large ones can be uncomfortable, so it has to be just right to suit your body frame.),brakes, chains, its efficiency and the technology employed. Don't forget the budget ! Experts say that you should be ready to spend at least 500 dollars, because anything less than that would not probably be the best. ks5u
There are a range of bikes to choose from. However, it's important to choose the correct one that fits a woman perfectly. This is because women usually tend to have a shorter torso and longer legs than men of the same height and so does the arm size vary. Moreover, the strength of the back needs to be considered too. Therefore, you have to find the best that suits your body type and gives you a comfortable ride. [/INST] question: In choosing a bike, women should first consider _ . | options: A: the materials used B: their body frames C: the technology employed D: their personal needs | answer: D </s> |
<s>[INST] context: The nature of the light chains in mesangial IgA deposits and serum IgA was studied in patients with IgA nephropathy. Immunofluorescence (IF) studies using murine monoclonal antibodies, rabbit and goat anti-human monospecific antisera were performed in kidney sections from 15 IgA nephritic patients with only IgA isotype detected in the renal biopsy. Lambda light chain IF was demonstrated in all biopsy specimens and kappa light chain IF in 11 renal biopsy specimens. The majority of renal biopsies showed a predominance of lambda light chain IF staining in the mesangial deposits. The concentration of individual immunoglobulins and their light chain fractions, and the kappa/lambda ratio were determined in the serum and the supernate from peripheral blood mononuclear cells culture of 30 IgA nephritic patients and 30 age-matched healthy controls. The IgA nephritic patients had a higher serum concentration of total IgA (P less than 0.001) and a significantly lower IgA kappa/lambda ratio (P less than 0.001) compared with the controls. The kappa/lambda ratio of supernatant IgA from IgA nephritic patients (N = 20) was also significantly lower than that of the normal subjects (N = 14), both in the unstimulated (P less than 0.01) and pokeweed mitogen stimulated, peripheral blood mononuclear-cell culture (P less than 0.05). Our results showed that patients with primary IgA nephropathy displayed a unique immunologic response characterized by a predominance of IgA with lambda light chain in circulation [/INST] question: Mesangial deposits of Lambda chain is seen in | options: A: Amyloidosis B: Focal segmental glomerulosclerosis C: membranoproliferative glomerulonephritis D: Membranous nephropathy | answer: A </s> |
<s>[INST] context: Brain natriuretic peptide or B type natriuretic peptide: It is a hormone produced by the ventricles of the heart.
It has been shown to increase in response to ventricular volume expansion and pressure overload. B.N.P. is a marker of ventricular systolic and diastolic function.
Like Atrial natriuretic peptide, it is degraded by neutral endopeptidase. Atrial natriuretic peptide:
Atrial natriuretic factor (ANP) is a hormone released by atrial walls of the heart when they become stretched.
Because in heart failure,
there is an almost always excessive increase in both the right and left atrial pressures that stretch the atrial walls the circulating levels of ANP in the blood increase
fivefold to tenfold in severe heart failure. The ANF, in turn, has a direct effect on the kidneys to increase greatly their excretion of salt and water.
Therefore ANP plays a natural role to prevent the extreme congestive symptoms of cardiac failure.
But the other factors promoting cardiac decompensation quickly overrides this ANP effect.
More on the physiological properties of ANP: Circulating ANP has a short half-life.
Their steady level in blood is maintained by clearance receptors. It is metabolized by neutral endopeptidase (NEP) which is inhibited by Thiorphan. [/INST] question: Brain natriuretic peptide is degraded by | options: A: Neutral endopeptidase B: Elastase C: Collagenase D: Ompatrilat | answer: A </s> |
<s>[INST] context: If you go to Hawaii, you can stay at the Garden Hotel. When you go there for holiday, you will find everything as comfortable as you would expect in a first-class international hotel.
Every bedroom has its own bathroom, telephone, special tables and colourful, modern sofa.
In the Mitsui Restaurant, you can choose your meals from different dishes, both Eastern and European. You can also find the dishes anywhere in the country. In the Beach Bar, you can drink with your family and friends comfortably to the music of famous musicians . Or you can take your drink outside into the beautiful garden of the hotel. You can also swim in the swimming pool. In the hotel, you will find _ . It will not take you a long time to wait for your service.
The Garden Hotel is right on the beach, only five minutes on foot from Hawaii's modern shopping centre. Here you will find all things at prices you can agree.
The Waikiki Beachside Hotel is also one of the most famous hotels in Hawaii. Beachside Hotel is close to restaurants, bars, Honolullu nightlife, Waikiki beaches, Oahu and all of the Hawaii adventure activities!
We are sure that your stay here at our Waikiki Beachside Hotel will be the best stay you have in Hawaii or the world. [/INST] question: Every bedroom at the Garden Hotel has _ . | options: A: a colourful telephone B: no bathroom C: a colourful sofa D: modern tables | answer: C </s> |
<s>[INST] context: Recurrent hypoglycemic attack with hepatomegaly is seen in Type I glycogen storage disease (Von Gierke disease).
Glycogen storage diseases
Glycogen storage diseases result from a hereditary deficiency of one of the enzymes involved in the synthesis or sequential degradation of glycogen.
Clinical features depend on the type of enzyme deficiency and organ involvement.
Glycogen storage diseases can be divided into:-
1) Hepatic form (Liver glycogenolysis)
The liver is the key player in glycogen metabolism.
It contains enzymes that synthesize glycogen for storage and ultimately break it down into free glucose, which is then released into the blood.
So, An inherited deficiency of hepatic enzymes that are involved in glycogen metabolism leads to
i) Storage of glycogen in liver → Hepatomegaly.
ii) Reduction in blood glucose → Hypoglycemia.
Examples of liver glycogenoses are -
Type I glycogenosis → Glucose - 6 - phosphatase deficiency (Von Gierke disease).
Type III glycogenosis → Debranching enzyme def
Type IV glycogenesis → Branching enzyme def
Type VI glycogenosis → Liver phosphorylase def
2) Myopathic form (Muscular glycogenoses)
In skeletal muscle, as opposed to the liver, glycogen is used predominantly as a source of energy.
This is derived from glycolysis, which leads ultimately to the formation of lactate.
So, enzyme deficiency leads to -
Glycogen deposition in muscle
Muscle cramp after exercise
The exercise-induced rise in blood lactate levels owing to block in glycolysis
There may be myoglobinuria
Examples are -
Type V glycogenosis → phosphorylase deficiency (McArdle disease).
Type VII glycogenosis → phosphofructokinase def
3) Miscellaneous types
Associated with glycogen storage in many organs and death in early life.
Examples -
i) Type II glycogenosis → Acid maltase deficiency (Pompe's disease) [/INST] question: A child with recurrent hypoglycemic attack and hepatomegaly is likely to have – | options: A: Von Gierke's disease B: Neonatal diabetes C: Neonatal hepatitis D: Galactosemia | answer: A </s> |
<s>[INST] context: Lead poisoning often causes a peripheral neuropathy with primary motor involvement. It can superficially resemble ALS, but upper motor neuron signs (such as hyperreflexia) are not seen in lead poisoning. In addition, the cognitive changes of lead encephalopathy are not seen in early ALS, in peripheral nerve injuries (e.g., carpal or tarsal tunnel syndromes), or in myasthenia. Alcoholism can cause peripheral neuropathy but would not cause this patient's prominent motor weakness or the basophilic stippling. The presence of any anemia in a patient with peripheral neuropathy should prompt the clinician to think of a single disease entity (such as heavy metal poisoning) that can cause both entities. Lead lines may be seen at the gingiva-tooth border. Laboratory testing focuses on protoporphyrin levels (free erythrocyte or zinc) and blood lead levels. Industries often associated with lead exposure include battery and ceramic manufacturing, the demolition of lead-painted houses and bridges, plumbing, soldering, and, occasionally, exposure to the combustion of leaded fuels. [/INST] question: A 37-year-old factory worker develops increasing weakness in the legs; coworkers have noted episodes of transient confusion. The patient has bilateral foot drop and atrophy; mild wrist weakness is also present. Deep tendon reflexes are absent in the lower extremities. His CBC shows an anemia with hemoglobin of 9.6 g/dL; examination of the peripheral blood smear shows basophilic stippling. Which of the following is the most likely cause of this patient's symptoms? | options: A: Amyotrophic lateral sclerosis B: Lead poisoning C: Overuse syndrome D: Myasthenia gravis | answer: B </s> |
<s>[INST] context: Odontoid view "The lateral cervical spine x-ray is perhaps the single most impoant radiological study that can be obtained during an emergency evaluation, with the single exception of the admission chest x-ray to rule out major intrathoracic life-threatening injury. The next most impoant cervical spine x-ray is the odontoid view for assessment of the craniocervical junction; lateral cervical spine x-rays can miss nondisplaced fractures in this area."- Handbook of head and vine trauma By Jonathan Greenberg 1/e p428 The odontoid view is an AP view taken with the patient supine and his or her mouth open. The beam is directed into the open mouth toward the pharynx, and the film is placed posterior to the patient's cervical spine. The odontoid view is also called the "open-mouth" view because the patient's mouth is opened to move the maxilla, mandible, and teeth out of the way of the x-ray beam. This unique view is designed to demonstrate the odontoid and lateral masses of C Also Know: Best view to visualize C7 and T1____________ Swimmer's view [/INST] question: C-1 and C-2 can be best visualized by: | options: A: A-P view B: Lateral view C: Oblique view D: Odontoid view | answer: D </s> |
<s>[INST] context: Renal Glycosuria Exp. D/D of glycosuria: * When glycosuria is found, it should be determined whether it is secondary to hyperglycemia (DM) or renal glycosuria. Glycosuria occurs when blood glucose level exceeds the renal glucose threshold threshold of 180 mg/ dl. * Nondiabetic melituria occurs in a number of conditions, the most impoant being renal glycosuria and alimentary (lag storage)glycosuria. Renal glycosuria- diagnosis is based on the marbel's criteria. * Glycosuria in the absence of hypeeglycemia * Constant glycosuria with little fluctuation related to diet * Normal oral glucose tolerance test * Identification of urinary reducing substance as glucose * Normal storage and utilization of carbohydrates Alimentary (lag storage) glycosuria: Here there is a transient abnormal rise in blood glucose level following a meal, and the concentration exceeds the normal renal threshold. During this time, gloucose spills into the urine. This may occur in the following conditions: * Following gastric surgery with rapid gastric emptying time * Same normal people * Hypehyroidism * Hepatic diseases [/INST] question: Which of the following is the most probable diagnosis in a 35 years old man whose fasting and his post prandial blood sugar are within normal limits but urine sugar is three plus (+++)? | options: A: Renal glycosuria B: Pancreatic insufficiency C: Alimentary glycosuria D: High carbohydrate diet taken in the morning | answer: A </s> |
<s>[INST] context: Five-time world overall short-track speed skating champion Yang Yang(A)won China's first-ever Winter Olympic gold medal with a runaway victory in the 500m final on Saturday.
Yang Yang, putting behind her a dismal fourth place finish in the 1,500 meters three days ago, got off to a sparking lead and never looked back to cross the line in 44.187 seconds.
World-record holder and four-time European champion Evgenia Radanova followed home 0.065 seconds behind.
Another Chinese, Wang Chunju, the world champion in the shortest distance came in third, two-hundredths of a second further behind.
Yang, 25, whose name is tagged with the letter A to distinguish her from her younger teammate and namesake, Yang Yang(S), is the overall World Cup winner this season, with the top points in the 1,000m and 1,500m.
In the 1,500m, the younger Yang, 24, who won two silver medals in Nagano four years ago, crashed out while chasing herd after two South Korean teenagers, KoGi-Hyun and Choi Eun-Kyungm who eventually finished first and second. Yang Yang(A) ended up fourth.
Yang Yang(S) did not compete in the 500 meters. [/INST] question: How long did Evgenia Radanova take to finish the 500m final? | options: A: 44.252 seconds B: 44.187 seconds C: 44.122 seconds D: None of the above | answer: A </s> |
<s>[INST] context: Points in or of diagnosis of Wilson's disease- Low hematocrit of 26% and increased reticulocyte count: hemolysis of RBC due to excess intracellular copper. Unconjugated jaundice due to hemolysis and defective conjugation in liver due to hepatocyte damage. Mild elevation of enzymes unlike acute viral hepatitis where gross elevations in enzyme values Nodular liver with splenomegaly indicating a chronic process. Poal hypeension has already developed in the patient. Hepatitis B positivity in the question was given to confuse you, since it can be an incidental finding. Points against the diagnosis of acute viral hepatitis Jaundice with mild elevation of AST/ALT Nodular enlarged liver Enlarged spleen ALSO KNOW: A prognostic index for wilson diseasecalculated by Nazer (score range 0-12) based on serum bilirubin, serum AST, and prolongation in prothrombin time. KING'S COLLEGE CRITERIA:(were developed to determine which patients with fulminant hepatic failure (FHF) should be referred for liver transplant.) [/INST] question: A 22 year old woman is evaluated in the emergency for a 3 day h/o dark urine and abdominal distension. O/E: normal mental status, icterus present, hea and lungs normal, Hematocrit: 26, Reticulocytes: 5%, Platelets: 1.3 lakhs, Alk.Phos: 30 units/L, ALT: 110 units/L, AST: 220 units/L, Total bilirubin:13mg% (Direct:4 mg) HBsAg positive and Hepatitis 'A' &'C' negative. Urine drug screen negative. USG abdomen shows a nodular appearing liver and enlarged spleen. Which is the most likely diagnosis? | options: A: Acetaminophen intoxication B: Acute viral hepatitis C: Primary biliary cirrhosis D: Wilson disease | answer: D </s> |
<s>[INST] context: In peritoneal dialysis, 1.5-3 L of a dextrose-containing solution is infused into the peritoneal cavity and allowed to dwell for a set period of time, usually 2-4 h. Peritoneal dialysis solutions are available in volumes typically ranging from 1.5 to 3 L. The major difference between the dialysate used for peritoneal rather than hemodialysis is that the hypeonicity of peritoneal dialysis solutions drives solute and fluid removal, whereas solute removal in hemodialysis depends on concentration gradients, and fluid removal requires transmembrane pressure. Typically, dextrose at varying concentrations contributes to the hypeonicity of peritoneal dialysate. Icodextrin is a nonabsorbable carbohydrate that can be used in place of dextrose. Studies have demonstrated more efficient ultrafiltration with icodextrin than with dextrose-containing solutions. Icodextrin is typically used as the "last fill" for patients on CCPD or for the longest dwell in patients on CAPD. The most common additives to peritoneal dialysis solutions are heparin to prevent obstruction of the dialysis catheter lumen with fibrin and antibiotics during an episode of acute peritonitis. Insulin may also be added in patients with diabetes mellitus ref - harrisons internal medicine 20e pg2124 [/INST] question: Fluid containing which of the following substance is used in peritoneal dialysis | options: A: NaCl B: Urea C: Heparin D: Dextrose | answer: D </s> |
<s>[INST] context: Poor Sultan,who was lying close by them,heard all that the shepherd and his wife said to one another,and was very much frightened to think tomorrow would be his last day.So in the evening he went to his good friend,the wolf,who lived in the wood,and told him all his sorrows,and how his master meant to kill him in the morning.
"Make yourself easy,"said the wolf,"I will give you some good advice.Your master,you know,goes out every morning.very early with his wife into the field,and they take their little child with them,and lay it down in the shade while they are at work.Now you lie down close by the child,and pretend to be watching it,and I will come out of the wood and run away with it.You must run after me as fast as you can, and I will let it drop.Then you may carry it back,and they will think you have saved their child,and will be so thankful to you that they will take care of you as long as you live."
The dog liked this plan very well,and accordingly so it was managed.The wolf ran with the child a little way.The shepherd and his wife cried out,but Sultan soon overtook him and carried the poor little thing back to his master and mistress.Then the shepherd patted him on the head and said,"Old Sultan has saved our child from the wolf,and therefore he shall live and be well taken care of,and have plenty to eat.Wife,go home,and give him a good dinner and let him have my old cushion to sleep on as long as he lives."So from this time forward Sultan had all that he could wish for. [/INST] question: Sultan was the name of_. | options: A: a child B: a wolf C: a dog D: a servant | answer: C </s> |
<s>[INST] context: Orthomyxoviruses and paramyxoviruses are RNA viruses that contain a single-stranded RNA genome. The influenza viruses belong to the orthomyxoviruses. They cause acute respiratory tract infections that usually occur in epidemics. Isolated strains of influenza virus are named after the virus type (influenza A, B, or C) as well as the host and location of initial isolation, the year of isolation, and the antigenic designation of the hemagglutinin and neuraminidase. Both the hemagglutinin and neuraminidase are glycoproteins under separate genetic control, and because of this they can and do vary independently. The changes in these antigens are responsible for the antigenic drift characteristic of these viruses. The paramyxoviruses include several important human pathogens (mumps virus, measles virus, respiratory syncytial virus, and parainfluenza virus). Both paramyxoviruses and orthomyxoviruses possess an RNA-dependent RNA polymerase that is a structural component of the virion and produces the initial RNA. Respiratory syncytial viruses (RSV) are not related to the paramyxoviruses. They are 150-nm single-stranded RNA viruses. There are 2 antigen groups, A and B, which play no role in diagnosis and treatment. While the overall mortality is 0.5%, at-risk groups may be 25 to 35% mortality if untreated. Some parainfluenza virus infections (type 3) may be indistinguishable from RSV, but most parainfluenza infections produce a laryngotracheobronchitis known as croup. [/INST] question: This virus is a single-stranded RNA orthomyxovirus. Annual vaccination is necessary because of antigenic drift and shift. | options: A: Measles virus B: Influenza virus C: Respiratory syncytial virus D: Parainfluenza virus | answer: B </s> |
<s>[INST] context: The ophthalmic artery is a branch of the internal carotid artery and provides origin to the ocular and orbital vessels, including the central artery of the retina, which supplies the retina. The central artery of the retina is an end artery that has no anastomoses with other arterial sources; therefore, occlusion of this artery will result in loss of vision. The nasociliary nerve is a branch of the ophthalmic nerve. It is the general sensory nerve for the eye and is the afferent limb of the corneal blink reflex; it has no direct effect on vision. The anterior ethmoidal nerve is a branch of the nasociliary nerve and supplies the anterior ethmoid air cells, the nasal septum, and the lateral walls of the nasal cavity; it also supplies the skin on the bridge of the nose. The trochlear nerve is the fourth of the 12 cranial nerves and innervates the superior oblique muscle, one of the six extraocular muscles. The extraocular muscles function in the movement of the eyeball and not the perception of light. The optic nerve is the second of the 12 cranial nerves and is responsible for vision. A lesion of the optic nerve would lead to blindness; however, based on the location of the patient's infection, the optic nerve was not affected by the loss of arterial supply. [/INST] question: A 22-year-old man is admitted to the emergency department with a sinus infection. Radiographic examination reveals posterior ethmoidal cell infection. During physical examination the patient complains of progressive loss of vision. Which of the following structures is most likely affected? | options: A: Ophthalmic artery B: Nasociliary nerve C: Anterior ethmoidal nerve D: Trochlear nerve | answer: A </s> |
<s>[INST] context: British Summer Time runs from the last Sunday in March to the last Sunday in October. In the depths of winter the nights in the UK are anything from 15-19 hours long. Longer nights mean frost and fog are more likely to form.
Twice a year the clocks change, forward in the spring and then back again in the autumn. But why? It happens twice a year. We all change our clocks and watches by one hour. In the spring, we add an hour, and go onto what is called British Summer Time, while in the autumn, we do the reverse, and return to Greenwich Mean Time.
Why bother?
It's all to do with saving the hours of daylight, and was started by a guy called William Willett, a London builder, who lived in Petts Wood in Kent. Basically, he figured that you could improve the population's health and happiness by putting forward the clocks by twenty minutes every Sunday in April and do the opposite in September.
Economics
His idea was not taken up, even though a "Daylight Saving Bill" was introduced some five years before the outbreak of World War One. But once the war started, it was considered wise to economics, to promote greater efficiency in using daylight hours, and in the use of artificial lighting. And so in 1916, "Daylight Saving Time" was introduced. Even though most countries abandoned this after that war, some eventually decided that it was a good idea, and most of these nations began to keep it throughout the year.
Experiment
Since 1972, Britain has decided to go with Greenwich Mean Time in winter, and British Summer Time in Summer.
But back in 1968, Britain tried a four-year experiment by advancing time one hour ahead of GMT throughout the year.
But those living further north, particularly in Scotland, found it most unsatisfactory, with dark mornings for much of the year, and the experiment was dropped. [/INST] question: Why some countries decide to change the clocks after World War One? | options: A: To improve the people's health and happiness B: To do a certain experiment C: To save energy to develop economies D: All of the above | answer: C </s> |
<s>[INST] context: Earthquake safety tips
On April 14,2010, a big earthquake hit Yushu,Qinghai.Over,2,000 people died. Many people were hurt. Why are there earthquakes?
The surface of the Earth has many pieces. These pieces are always moving. When two pieces move past each other, there is an earthquake.
Scientist are working hard to find out more about earthquakes. They try to predict them, but it's very hard.
Do you know how to get ready for an earthquake? Do you know what to do during an earthquake? Here are some things you should know.
What to do before an earthquake
Make sure you have two bottles of water, a packet of biscuits ,a clean towel ,a few band-aids ,a radio and a flashlight at home.
What to do during an earthquake
If you are inside:
Stay where you are. Quickly move under a strong desk, or along a wall. This will protect you from falling things.
Don't stand near windows.
Turn off the lights.
Don't get into a lift during an earthquake. If your are in a lift, get out as quickly as possible.
If you are outside:
Don't stand near buildings. Things may fall on you.
Lie on the ground until the shaking stops. [/INST] question: An earthquake hit Yushu _ . | options: A: on April 12,2010 B: on April 14,2010 C: on May 14,2010 D: on May 12,2010 | answer: B </s> |
<s>[INST] context: Hyperophic cardiomyopathy (HCM) is a common (incidence, 1 in 500), clinically heterogeneous, genetic disorder characterized by myocardial hyperophy, poorly compliant left ventricular myocardium leading to abnormal diastolic filling, and (in about one third of cases) intermittent ventricular outflow obstruction. The essential feature of HCM is massive myocardial hyperophy,usually without ventricular dilation. The classic pattern involves dispropoionate thickening of the ventricularseptum relative to the left ventricle free wall (with a ratio of septum to free wall greater than 3 : 1), termed asymmetric septal hyperophy. In about 10% of cases, the hyperophy is concentric and symmetrical. On longitudinal sectioning, the normally round-to-ovoid left ventricular cavity may be compressed into a "banana-like" configuration by bulging of the ventricular septum into the lumen. Although marked hyperophy can involve the entire septum, it is usually most prominent in the subaoic region. The left ventricular outflow tract often exhibits a fibrous endocardial plaque associated with thickening of the anterior mitral leaflet. The most impoant histologic features of HCM myocardium are: (1) massive myocyte hyperophy (2) haphazard disarray of bundles of myocytes, individual myocytes, and contractile elements in sarcomeres within cells (termed myofiber disarray). (3) interstitial and replacement fibrosis Mutations causing HCM are found most commonly in the gene encoding b-myosin heavy chain (b-MHC), followed by the genes coding for cardiac TnT, a-tropomyosin, and myosin-binding protein C (MYBP-C). [/INST] question: Characteristic feature of hyperophic obstructive cardiomyopathy is:- | options: A: Asymmetric septal hyperophy of septum B: Increased size of atria C: Increased size of ventricle D: Normal myofiber arrangement | answer: A </s> |
<s>[INST] context: Function of Hb. Hb, found in the red blood cells, carries oxygen from the lungs to the tissues and returns carbon dioxide and protons from the tissues to the lungs.a. The oxygen saturation curve for Hb is sigmoidal (Figure I).(1). Each heme binds one O2 molecule, for a total of four O2 molecules per HbA molecule. HbA changes from the taut or tense (T) form to the relaxed (R) form when oxygen binds.(2). Binding of O2 to one heme group in Hb increases the affinity for O2 of its other heme groups. This effect produces the sigmoidal oxygen saturation curve and is known as positive cooperativity.b. The binding of protons to HbA stimulates the release of O2 , a manifestation of the Bohr effect (see Figure I).(1). Thus, O2 is readily released in the tissues where is high because of the production of CO2 by metabolic processes.(2). These reactions are reversed in the lungs. O2 binds to HbA, and CO2 is exhaled (see Figure II).c. Covalent binding of CO2 to HbA in the tissues also causes the release of O2 .d. Binding of 2,3-bisphosphoglycerate (BPG), a side product of glycolysis in red blood cells, decreases the affinity of HbA for O2 . Consequently, O2 is more readily released in tissues when BPG is bound to HbA (see Figure I).e. Fetal hemoglobin (HbF), composed of two a subunits and two g subunits, has a lower affinity for BPG than does HbA, and therefore, HbF has a higher affinity for O2 than does HbA.The child has an inherited pyruvate kinase deficiency. This step converts phosphoenolpyruvate (PEP) to pyruvate, thereby producing ATP. A pyruvate kinase deficiency would slow down glycolysis, and less ATP would be produced. As PEP accumulates, so does 2-PG, 3-PG, and 1,3-BPG. The Luebering-Rapoport shunt converts 1,3-BPG to 2,3-BPG (via bisphosphoglycerate mutase), which aids in releasing oxygen from hemoglobin in the tissues. The other intermediates of glycolysis before the blocked step would accumulate, and glucose-6-phosphate would inhibit hexokinase. Because of a lack of ATP, the life span of the cells would decrease. Fatty acids cannot serve as a source of energy because RBCs lack mitochondria, which is the site of fatty acid oxidation.I. Oxygen saturation curves for myoglobin and adult hemoglobin (HbA). Myoglobin has a hyperbolic saturation curve. HbA has a sigmoidal curve. The HbA curve shifts to the right at lower pH, with higher concentrations of BPG, or as CO2 binds to HbA in the tissues. Under these conditions, O2 is released more readily. P50 is the partial pressure of O2 at which half-saturation with O2 occurs. BPG, 2,3-bisphosphoglycerate.II. Effect of H+ on oxygen binding by hemoglobin (Hb). A. In the tissues, CO2 is released. In the red blood cells, this CO2 forms carbonic acid, which releases protons. The protons bind to Hb, causing it to release oxygen to the tissues. B. In the lungs, the reactions are reversed. O2 binds to protonated Hb, causing the release of protons. The protons bind to bicarbonate, forming carbonic acid, which is cleaved to water and CO2 , which is exhaled. RBC, red blood cell [/INST] question: A 3-year-old boy was found to have reduced red blood cell (RBC) numbers yet exhibited very few signs of anemia. An analysis of labeled RBCs indicated a greatly reduced ATP yield as compared to someone without the anemia. In this child, which one of the following would be expected to increase in RBC? | options: A: The life span of the RBCs B: The rate of fatty acid oxidation C: ATP production D: The levels of 2,3-bisphosphoglycerate | answer: D </s> |
<s>[INST] context: Hydroxyurea: It blocks the conversion of ribonucleotides to deoxyribonucleotides by inhibiting the enzyme ribonucleoside diphosphate reductase-thus interferes with DNA synthesis; exes S-phase specific action. Its primary therapeutic value is in chronic myeloid leukaemia, psoriasis, polycythaemia vera and in some solid tumours. Myelosuppression is the major toxicity. Hydroxyurea (Droxia) is used to reduce the frequency of painful crises and reduce the need for blood transfusions in patients with sickle cell anemia (an inherited blood disorder in which the red blood cells are abnormally shaped and cannot bring enough oxygen to all pas of the body). Hydroxyurea is in a class of medications called antimetabolites. Hydroxyurea treats cancer by slowing or stopping the growth of cancer cells in your body. Hydroxyurea treats sickle cell anemia by helping to prevent formation of sickle-shaped red blood cells ESSENTIALS OF MEDICAL PHARMACOLOGY, www.medlineplus.gov K.D.TRIPATHI SIXTH EDITION PAGE NO:827 [/INST] question: Which of the following drug is used for the treatment of sickle cell anemia? | options: A: Hydroxyurea B: Cisplatin C: Paclitaxel D: Carboplatin | answer: A </s> |
<s>[INST] context: Adrian's "Amazing Race" started early when his parents realized that he, as a baby, couldn't hear a thing, not even loud noises. In a special school for the hearing-impaired, he learned sign language and got to mix with other disabled children. However, the sight of all the disabled children communicating with one another upset his mother. She wanted him to lead a normal life. So after speaking to an advisor, she sent him to private classes where he learned to read lips and pronounce words.
Later on, Adrian's parents decided to send him to a regular school. But the headmaster tried to prevent them from doing so, saying regular school couldn't take care of a special needs students. His parents were determined to take the risk and push him hard to go through his work everyday because they wanted to prove that, given the opportunity, he could do anything. Adrian made the grade and got accepted. It was a big challenge. The pace was faster so he had to sit at the front of the class and really pay attention to the teacher, which wasn't always easy. But he stuck to it and did a lot of extra work after school.
The efforts made by Adrian and his parents paid off. Adrian graduated with good grades and got into a top high school. He also achieved a lot in life outside school. He developed a love for the outdoors and went to Nepal to climb mountains. He even entered the World Yacht Race 05/06--- being the first hearing-impaired Asian to do so.
But none of these achievements would have been possible without one of the most important lessons from his mother." "If you believe in yourself and work hard, you can achieve great results." she often said. [/INST] question: How did Adrian communicate with other children in the special school? | options: A: By speaking B: By using sign language C: By reading lips D: By making loud noises | answer: B </s> |
<s>[INST] context: Owning a smartphone may not be as smart as you think. They may let you surf the Internet, listen to music and take photos wherever you are, but they also turn you into a workaholic .
A study suggests that, by giving you access to emails at all times, the smartphone adds as much as two hours to your working day. Researchers found that Britons work an additional 460 hours a year on average as they are able to respond to emails on their mobiles. The study shows the average UK working day is between 9 and 10 hours, but a further 2 hours is spent responding to or sending work emails, or making work calls.
Almost one in ten admits spending up to three hours outside their normal working day checking work emails. Some workers say they are on call almost 24 hours a day. Nearly two-thirds say they often check work emails just before they go to bed and as soon as they wake up, while over a third have replied to one in the middle of the night. The average time for first checking emails is between 6 am and 7 am, with more than a third checking their first email in this period, and a quarter checking them between 11pm and midnight.
Ghadi Hobeika, marketing director of Pixmania, said: "The ability to access millions of applications has made smartphones invaluable for many people. However, there are disadvantages. Many companies expect their employees to be on call 24 hours a day, seven days a week, and smartphones mean that people cannot get away from work. The more constantly in touch we become, the more is expected of us in work . " [/INST] question: With a smartphone the average UK working day is _ . | options: A: 2 hours B: 9 to 10 hours C: 11 to 12 hours D: 24 hours | answer: C </s> |
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