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<s>[INST] context: The Venice Carnival is the largest and the most important Venetian festival. It is a festival that celebrates the passage from winter to spring, a time when seemingly anything is possible, including the illusion that the people at the bottom become the most powerful by wearing masks on their faces.
The Venice Carnival could date back to 1296. It was confirmed on the day before Lent, a public holiday, but it had no direct religious connection at that time. However, the participants were not allowed to wear masks around the city at night; men could not enter convents if they pretended to be women, and celebrations within the convents were strictly forbidden. People who broke the rules could be put into prison.
The laws were not relaxed until the late 17thcentury, when the carnival-goers were allowed to wear masks throughout the carnival. Participants would wear a white mask in old days, while costumes have become even wilder today.
St. Mark's Square is the center for the carnival, while Campo San Polo and Sestiere are two other popular places where events take place. Most of the events are free, along with several unusual masked balls for which visitors will have to buy tickets in advance.
The 2012 Venetian Carnival was celebrated from February 11 to 21. There were the liveliest celebrations of parties, performances, show, music, dances, dinner sets along streets, and hotels. It attracted a great number of visitors around the world. Many travelers booked Venice hotels and prepared costumes and masks well ahead of time so that they couldn't be made fun of by local people. [/INST] question: In the Venice Carnival people wearing masks _ . | options: A: are usually rich B: like to daydream C: can imagine they have great power D: frighten those without masks | answer: C </s> |
<s>[INST] context: • Vitamin K is produced by our gut flora. The gut of a New-born baby is sterile and hence no vitamin K is being produced.
Moreover vitamin k is negligible in breast milk. In lieu of these factors all babies are susceptible to development of Hemorrhagic disease of New-born.
• To prevent this from happening therefore, as standard operating procedure in all hospitals injection vitamin K 1 :
1 mg intramuscular is given to prevent hemorrhagic disease of new born referred to as H.D.N.
• In our country where a large number of children are born via home deliveries,
no vitamin K would be given to the child and therefore the child may be brought to the hospital on day 5 with umbilical stump bleeding.
• For management: the child should be given injection vitamin K lmg intravenously.
If bleeding is still present then FFP needs to be administered. Previous Year Questions on Topic: Bleeding Disorders in Children
• Type of vitamin K used for treatment of H.D.N= vitamin K1
• Umbilical stump bleeding in child on day 1 of life= factor 13 deficiency
• Umbilical stump bleeding in child on day 5 of life= H.D.N
• Male baby with excessive circumcision bleeding= hemophilia A
• Vaginal bleeding in a girl child on day 5 of life= No intervention required [/INST] question: Hemorrhagic disease of the newborn is attributed to the deficiency of | options: A: Vitamin K B: Vitamin A C: Vitamin E D: Vitamin C | answer: A </s> |
<s>[INST] context: NEPHROTIC SYNDROME:-
Characterised by massive proteinuria, hypoalbuminemia and edema, hyperlipidemia is often associated.
Some patients show hematuria and hypertension.
Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl).
The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin-angiotensin-aldosterone axis and ADH secretion that enhances sodium and water retention.
Hypoalbuminemia also induces hepatic synthesis of beta-lipoproteins resulting in hypercholesterolemia.
Main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy.
Steroid sensitive nephrotic syndrome:-
MCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non-specific obliteration of epithelial foot processes. Immunofluorescence studies show deposits of occasional mesangial IgM.
Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia imparts a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated.
Low serum calcium level.
Steroid-resistant nephrotic syndrome:-
Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and Wilms a tumour (WT1) genes. [/INST] question: Which is seen in nephrotic syndrome | options: A: Low serum calcium B: Raised AT-III C: Low lipid D: Platelet activation | answer: A </s> |
<s>[INST] context: Here are many kinds of vacations. People can go traveling abroad or spend their holidays at the seaside. One kind of vacation is camping. Many Americans enjoy going camping because it is good for them. Each summer millions of Americans drive to the countryside where they find places to camp. There are a lot of national parks in the USA and these national parks mostly stand on the mountains. They are people's favorite camping places.
Campers are free from the busy life in the noisy and crowded city. They throw themselves into the arms of Mother Nature. They enjoy the fresh air, lakes and forests in these parks. Hiking, swimming and fishing are the main kinds of exercise. They can see different sorts of animals and plants there.
Some campers have trailers which they pull behind their cars to the camping places. Trailers are like small houses on wheels, having many of the things that people use in their homes, such as electricity, hot water, kitchen tools and things like that. But most campers don't have trailers. Tent campers lead a very simple but healthy life.
Camping is a pleasant sports activity. After living a while in the open, campers become as fresh as paintings. They feel relaxed. [/INST] question: What kind of life do campers live before they go camping? | options: A: An easy life B: A happy life C: A busy life D: A healthy life | answer: C </s> |
<s>[INST] context: Explanation: Fimbriae Certain (Gram-negative bacilli carry very fine, hair-like surface appendages called fimbriae or pili.
They are shorter and thinner than flagella Fimbriae can be seen only under the electron microscope.
Fimbriae function as organs of adhesion, helping the cells to adhere firmly to particles of various kinds Fimbriated bacteria form surface pellicles in liquid media.
Many fimbriated cells (for example Escherichia, Klebsiella) agglutinate red blood cells. Hemagglutination provides a simple method of detecting the presence of such fimbriae.
The hemagglutination is specifically inhibited by D- mannose (mannose sensitive) A special type of fimbria is the sex pili.
They are found on ‘male’ bacteria and help in the attachment of those cells to ‘female’ bacteria.
They do not mediate attachment to epithelium Flagella Flagella are the organs of locomotion.
Flagellum consists of three distinct parts the filament, the hook and the basal Flagella are made up of a protein (flagellin) Flagella are less than 0.02 Jim in thickness and hence beyond the limit of resolution of the light microscope.
They may, in some instances, be seen under dark ground illumination.
They can be visualised by special staining techniques in which their thickness is increased by mordanting, or by electron microscopy Mesosoxnes Mesosomes (chondroid) are vesicular,
convoluted or niultilaniinated structures formed as invaginations of the plasma membrane into the cytoplasm.
They are more prominent in Gram-positive bacteria. They are the principal sites of respiratory enzymes in bacteria and are analogous to the mitochondria of eukaryotes.
Mesosomes are often seen in relation to the nuclear body and the site of synthesis of crosswall septa,
suggesting that they coordinate nuclear and cytoplasmic division during binary fission [/INST] question: Bacterial adherence to epithelium is mediated through | options: A: Sex pili B: Fimbriae C: Flagella D: Mesosomes | answer: B </s> |
<s>[INST] context: "What is success"? Mr. Black asked his 6th grade business class. It was his opening conversation for the first class of the term.
"Success is riding in a sweet car, watching an 80-inch( TV, and living in a place with at least twelve rooms." One student answered, earning laughs from all the students.
Mr. Black smiled, but shook his head. "Tom, that is excess . That is not success."
"How about being able to provide for your family?" A blonde girl named Sandy in the front suggested as an answer.
"Now we're getting closer," Mr. Black smiled, "but try thinking about what you need and what you want."
"Getting everything you want." Tom shouted out an answer again, trying for more laughs.
Mr. Black sighed ." I believe we've already talked about excess versus(...) success."
"Getting everything you need, but some of what you want?" James, sitting in the back wondered aloud.
"Quite right!" Mr. Black clapped. "Success is getting everything you need and some of what you want. The more you get that you want, the more successful you are. You do reach a point where you are living in excess, though."
"What does this have to do with business?" Tom asked. It seemed if it wasn't funny, he wasn't happy.
"Well, Tom, think of it this way: the point of business is to make a living to support your family. Once you have properly seen to their needs, you can then seen to getting the extras that you want."
"What if I don't have a family?" he continued to be difficult.
"Then you have to provide for yourself, a family of one."
"He has goldfish to think about!" Peter, Tom's friend, shouted out.
"Then he needs to provide for a family of one with a fishbowl." Mr. Black corrected himself.
Tom nodded, satisfied with that answer.
"So in the next nine weeks, we're going to study basic business situations, like having a checking account and understanding credit cards ."
Tom rubbed his hands together excitedly. "When do we get to start spending?"
"You already are, Tom. You're spending time with us!" Mr. Black laughed. "Now, let's see what you guys know about credit cards..." [/INST] question: What was Mr. Black? | options: A: A historyteacher B: A scienceteacher C: A business teacher D: A math teacher | answer: C </s> |
<s>[INST] context: Maggots in nose/ Myiasis narium/ Maggots in nose/ Larvae in nose Myiasis is the infestation of tissue with fly larvae, commonly referred to as maggots. Maggots infest nose, nasopharynx and paranasal sinuses causing extensive destruction and obvious deformity. Flies especially of genus Chrysomyia - Chrysomia beziarma (other common species are Lucilia hominivora or Sacrophaga Georginia) are attracted by the foul smelling discharge emanating from case of atrophic rhinitis, syphilis, leprosy or infected wounds and lay eggs about 200 at a time, which within 24 hours hatch into larvae The predisposing factors for Nasal Myiasis are: - Poor nourishment with poor hygiene - Atrophic rhinitis - Leprosy in the nose - Diabetes with purulent sinus infections - Midline granulomatous lesions involving the nose - Malignancy involving the nose - Syphilitic disease involving the nose Clinical features (Signs and Symptoms): 1st 3-4 days: - intense irritation, sneezing, lacrimation - headache blood-stained discharge from nostrils - puffy eyelids and lips - epistaxis 3rd or 4th day: - maggots may crawl out of nose foul smelling serosanguinous discharge - extensive destruction of nose, sinuses, soft tissue of face, palate and eyeball - fistulae may form in the palate or around the nose - death may occur from meningitis Treatment: - Visible maggots should be picked up with forceps - Instillation of chloroform water/ether and oil (liquid paraffin) kills them - docuhe with warm saline is used to remove slough, crusts and dead maggot - Avoid contact of the patient with flies by use of mosquito nets - Nasal hygiene for prevention [/INST] question: Management of maggots in a child's nose: | options: A: Removed by hand picking B: Surgical removal C: Conservative treatment with oil and removal D: Wash it with warm saline | answer: C </s> |
<s>[INST] context: After a serious earthquake happened, a father left his wife safely at home and rushed to his son's school, only to find that the building where his son studied had collapsed and looked like a pancake.
He was shocked. He didn't know what he should do for a while, then he remembered the words he had said to his son, "No matter what happens, I'll always be there for you! "And tears began to fill his eyes. He started digging through the ruins .
As he was digging, other helpless parents and the firemen arrived and tried to pull him off the ruins, saying, "It's too late! They're all dead! There's nothing you can do! " To them he replied with one line, "Are you going to help me now? " And then he kept on digging.
No one helped, however. He went on alone because he needed to know for himself: "Is my boy alive or is he dead? " He dug for eight hours. . . 12 hours. . . 24 hours. . . 36 hours. . . then, in the 39th hour, he pulled back a rock and heard his son's words. He shouted his son's name, "ARMAND! " He heard back, "Dad!?! It's me, Dad! I told the other kids not to worry. I told them that if you were alive, you'd save me and when you saved me, they'd be saved. You promised, 'No matter what happens, I'll always be there for you!' You did it, Dad! "
"What's going on in there? How is it? " the father asked.
"There are 14 of us left out of 33, Dad. We're frightened, hungry, thirsty and thankful you're here. When t he building fell down, it made a triangle , and it saved us. "
"Come out, boy! "
"No, Dad! Let the other kids out first, because I know you'll get me! No matter what happens, I know you'll always be there for me! " [/INST] question: Who came to help the father when he was digging? | options: A: His wife B: Other parents C: The firemen D: No one | answer: D </s> |
<s>[INST] context: With hospitals and nursing homes tending to thousands of patients every year accidents can---and do ---happen. These incidents whether they are through carelessness or otherwise, can leave patients feeling powerless. That's not the case.
"There is growing public awareness. People are feeling they have more rights and they have tools in hand to make a complaint," said Ralph Montano, spokesman for the California Department of Public Health, which regulates hospitals and long term care facilities in the state.
That department received more than 6000 complaints about hospitals in 2007; in the most recent year statistics are available. The complaints can be about mixed-up lab results, medicine errors, foreign objects left in a patient during surgery or a host of other topic.
Similarly, the California Department of Aging received 43000 nursing home complaints in 2009. Some said patient abuse or neglect of patients; others reported missing items. And some commented on the quality of the food.
But finding the channels through them to put forward a complaint can be tiring and time consumption. Many consumers simply don't bother, and some become lost in the system. Whether the complaint is against a hospital or a long-term care facility, the process is similar--- and many people can help, including the facility's staff, insurance company representatives and state regulators.
If you want to make a complaint while in the hospital, Patti Harvey, vice president of quality and patient care services for Kaiser Permanente in Southern California, recommends talking with the bedside nurse. If that doesn't work, you can talk with other people higher in the chain of command, up to the hospital administrator. If the problem isn't still taken care of ---say you disagree with your treatment plan or have a problem with your doctor---member service offices at each hospital can help address your concerns. [/INST] question: Why are there more complaints from patients? | options: A: Because hospitals have more and more rights B: Because it's convenient for people to put forward complaints C: Because in the hospital there are more accidents than before D: Because there are more departments to deal with complaints | answer: B </s> |
<s>[INST] context: Seven tips to good table manners
Whether it's a dinner at a friend's house or a business meeting over lunch, we judge people based on their table manners. But what can you do if your kids do not behave themselves at the dinner tables? The following are seven tips to set your children on the road to good table manners:
*Look for the good. Instead of pointing out all the things your children do wrong, point out what they do right. Please say, for example, "I am so proud of you. It was wonderful the way you served yourself."
*Don't turn dinner into an unpleasant "lecture time". That will turn kids off not only manners, but dinner, and you, too.
*Check your own example. Don't show up for dinner in just your underwear unless you want your kids to do the same.
*Don't always consider your kids lazy and dirty ones. Instead, point out the behavior in a tender way. For example: " It' s a good idea to unfold your napkin, so if food falls you won't dirty your clothes."
*Teach your kids good manners in the form of a game. One night a week, try to have a formal dinner. Try dressing up, serve a special meal, and expect more formal manners. That will help improve their sense of manners.
*Make kids understand part of the tradition. Invite guests over and let kids help serve them. This helps them indirectly learn about table manners.
*Try dining out once in a while. Fast food restaurants aren't counted. Try a nice restaurant and let kids order their own food, pay the bill and give the tip. [/INST] question: Which of the following should parents do to help their kids learn good table manners? | options: A: Try dining out in fast food restaurants once in a while B: Point out what's wrong with the kids' behavior at dinner C: Keep telling the kids how to behave themselves at dinner D: Improve kids' sense of manners by having a formal dinner at times | answer: D </s> |
<s>[INST] context: In 2007.five young people in the American state of Massachusetts developed an idea. The team knew that the world is filled with mobile phones.About eighty percent of all people are said to live within reach of a wireless telephone signal.
The idea was to use mobile phones and the Internet to connect job seekers with employers.The young people wrote a business plan and formed a company called Assured Labor.
Assured Labor won a development competition at the Massachusetts Institute of Technology (MIT).Three of the founders were graduate students there. '
Assured Labo is an electronic market place.It has two parts.One is for;the United States.That operation was launched in January in Boston.It links people with employees offering temporary jobs.
The other arm of the business is for developing markets.That operation is meant to help people get mbfe permanent jobs.A representative is currently building partnerships with universities,and international companies in Central America.
Assured Labor's president David Reich,says the companies now place job advertisements on radio or in newspapers.Some even drive around in cars with loudspeakers announcing that jobs are available.He says the companies are interested.in having more modem hiring practices.
Through Assured Labor, companies will list open positions on the Internet.People who think
they could do the job could reply by text messages or on their cellophanes.
This is how the system works inprefix = st1 /Boston.
The jobs available include house cleaning.Dog walking and home repay. People who want their house cleaned,for example,can look online at a list of twenty housekeepers.The list tells what services.they offer,and how much they want to be paid.People need two letters praising their work to get on the list of service providers.
The employer chooses workers they would like jot hire ,The company then sends the workers a text or e-mail message so they can respond quickly to an offer.
After a job is completed,the employer and employee rate each other, The rating is kept for future use.Assured Labor is not charging anyone,right now, but the plan is to have employers pay for the service. [/INST] question: what kinds of jobs does Assured Labor offer? | options: A: Temporary jobs B: Permanent jobs C: Free jobs D: Both A and B* | answer: D </s> |
<s>[INST] context: Branham sign Nicoladoni sign* or Branham sign* Pressure on the aery proximal to an A-V fistula causes the swelling to diminish in size, a thrill or bruit to cease, the pulse rate to fall and the pulse pressure return to normal. Aeriovenous fistula (AVF) AVF may be congenital or acquired (by trauma of a penetrating wound, or surgically created for renal dialysis) Structural effect on veins Veins are aerialised*, they become dilated touous and thick walled. Physiological effects of fistula ? Increased pulse pressure (Increased systolic & decreased diastolic) Enhanced venous return result in Increased HR* and Increased CO*. Left ventricular enlargement and later cardiac failure may occur A congenital .fistula in the young may cause overgrowth of limb*. In the leg, indolent ulcers may result* from relative ischemia below the sho circuit. Clinical signs A pulsatile swelling* A thrill on palpation* Continuous bruit on auscultation* Nicoladoni sign* or Branham sign* Pressure on the aery proximal to fistula causes the swelling to diminish in size, a thrill or bruit to cease, the pulse rate to. fall and the pulse pressure return to normal. [/INST] question: Nicoldoni sign is also known as: | options: A: Murray sign B: Frei sign C: Darner sign D: Branham sign | answer: D </s> |
<s>[INST] context: The USA, New York--Whales and dolphins are facing increasing threats from climate change, according to a new report published by WWF and the Whale and Dolphin Conservation Society (WDCS).
The report "Whales in hot water?" draws attention to the growing impacts of climate change on whales.They range from changes in sea temperature and the freshening of the seawater because of the melting of ice and increased rainfalls, to a sea level rise, loss of icy polar habitats and the _ of krill populations in key areas.Krill, a tiny shrimp that is dependent on sea ice, is the main source of food for many of the great whales.
The speeding up of climate change adds greatly to trouble from other human activities, such as chemical and noise pollution, which kills some 1000 whales every day.
"Whales and dolphins have an ability to adapt to their changing environment," said Mark Simmonds, International Director of Science at WDCS."But the climate is now changing at such a fast pace that it is unclear to what extent whales and dolphins will be able to adjust."
Climate change impacts are currently greatest in the Arctic and the Antarctic.According to the report, cetaceans that rely on polar, icy waters for their home and food resources are likely to be greatly affected by the reduction of sea ice cover.
WDCS and WWF are urging governments to cut global production of C02 by at least 50 percent by the middle of this century.The latest report of the Intergovernmental Panel on Climate Change showed it was possible to stop global warming if the world's emissions start to decline before 2015. [/INST] question: Which of the following is the most important for whales and dolphins? | options: A: Rainfall B: Krill C: Sea ice cover D: High sea level | answer: C </s> |
<s>[INST] context: That cold January night, I was growing sick of my life in San Francisco. There I was, walking home at one in the morning after a tiring practice at the theatre. With opening night only a week ago, I was still learning my lines. I was having trouble dealing with my part-time job at the bank and my acting at night at the same time. As I walked, I thought seriously about giving up both acting and San Francisco. City life had become too much for me.
As I walked down empty streets under tall buildings, I felt very small and cold. I began running, both to keep warm and to keep away from any possible robbers . Very few people were still out except a few sad-looking homeless people under blankets.
About a block from my apartment , I heard a sound behind me. I turned quickly, half expecting to see someone with a knife or a gun. The street was empty. All I saw was a shining streetlight. Still, the noise had made me nervous, so I started to run faster. Not until I reached my apartment building and unlocked the door did I realize what the noise had been. It had been my wallet falling to the sidewalk.
Suddenly I wasn't cold or tired anymore. I ran out of the door and back to where I'd heard the noise. Although I searched the sidewalk anxiously for fifteen minutes, my wallet was nowhere to be found.
Just as I was about to give up the search, I heard the garbage truck pull up to the sidewalk next to me. When a voice called from the inside, " Alisa Camacho?" I thought I was dreaming. How could this man know my name? the door opened, and out jumped a small red-haired man with an amused look in his eye. "Is this what you're looking for?" he asked, holding up a small square shape.
It was nearly 3 A.M. by the time I got into bed. I wouldn't get much sleep that night, but I had gotten my wallet back. I also had gotten back some enjoyment of city life. I realized that the city couldn't be a bad place as long as people were wiling to help each other. [/INST] question: How did the write feel when she was walking home after work? | options: A: Cold and sick B: Fortunate and helpful C: Satisfied and cheerful D: Disappointed and helpless | answer: D </s> |
<s>[INST] context: Schizogony in the Human Host: Man is the intermediate host for malaria, wherein the asexual phase of the life cycle occurs. The sporozoites inoculated by the infested mosquito initiate this phase of the cycle from the liver, and the latter pa continues within the red blood cells, which results in the various clinical manifestations of the disease. Pre-erythrocytic Phase - Schizogony in the Liver: With the mosquito bite, tens to a few hundred invasive sporozoites are introduced into the skin. Following the intradermal deposition, some sporozoites are destroyed by the local macrophages, some enter the lymphatics, and some others find a blood vessel. The sporozoites that enter a lymphatic vessel reach the draining lymph node wherein some of the sporozoites paially develop into exoerythrocytic stages and may also prime the T cells to mount a protective immune response. The sporozoites that find a blood vessel reach the liver within a few hours. It has recently been shown that the sporozoites travel by a continuous sequence of stick-and-slip motility, using the thrombospondin-related anonymous protein (TRAP) family and an actin-myosin motor. The sporozoites then negotiate through the liver sinusoids, and migrate into a few hepatocytes, and then multiply and grow within parasitophorous vacuoles. Each sporozoite develop into a schizont containing 10,000-30,000 merozoites (or more in case of P. falciparum). The growth and development of the parasite in the liver cells is facilitated by a a orable environment created by the The circumsporozoite protein of the parasite. The entire pre-eryhrocytic phase lasts about 5-16 days depending on the parasite species: on an average 5-6 days for P. falciparum, 8 days for P. vivax, 9 days for P. ovale, 13 days for P. malariae and 8-9 days for P. knowlesi. The pre-erythrocytic phase remains a "silent" phase, with little pathology and no symptoms, as only a few hepatocytes are affected. This phase is also a single cycle, unlike the next, erythrocytic stage, which occurs repeatedly. [/INST] question: The cycle of malaria parasite is in sequence of - | options: A: 1,2,3,4 B: 1,3,2,4 C: 1,4,2,3 D: 1,4,3,2 | answer: B </s> |
<s>[INST] context: On June 30, 2009, a Yemenia airplane from Paris to Comoros, Africa, crashed into the Indian Ocean. There were 153 people on the plane, including some French officials. Though people have been searching since the plane went down, the result looked unpleasant, for most of the passengers might be in bad luck. But a 13-year-old girl called Bahia Bakari was discovered in the water, where she had been staying afloat by holding a piece of wreckage( ) from the plane tightly for over 13 hours. When they found her, the girl was too weak to catch the lifebuoy( ) thrown to her, instead, a Comoran police officer jumped into the water to pull the child onto the boat. Bahia Bakari was injured, especially her collarbone( ).Her father was pleased to see his daughter although his wife had gone away in this _ . He said that his daughter could hardly swim. It was really a miracle for her to escape in this way. In her daddy's warm arms, the girl could soon remember what she had experienced. "I was thrown out of the plane and then I saw the plane fall into the water. Next I found myself in the water. I couldn't swim very well and I caught something but I didn't know what is was," said the girl. "She is really a lucky young girl," said Alain Joyandet, France's minister for International Cooperation. [/INST] question: The Yemenia airplane took off in _ . | options: A: Africa B: Paris C: Comoros D: the Indian Ocean | answer: B </s> |
<s>[INST] context: Marked coronary artery occlusion with this degree of stenosis prevents adequate perfusion of the heart when myocardial demand is increased during exertion. He has angina on exertion and recently developed unstable angina, which is manifested by increased frequency and severity of the attacks and angina at rest. The ST-segment elevation suggests a developing acute coronary syndrome with myocardial ischemia, but the lack of cardiac enzyme elevation suggests infarction has not yet occurred. In most patients, unstable angina is induced by disruption of an atherosclerotic plaque followed by a mural thrombus and possibly distal embolization, vasospasm, or both. An acute myocardial infarction (MI) can lead to focal fibrinous pericarditis, but it is unlikely to lead to extensive scarring that surrounds the heart. Fibrosis is a late finding from the healing of infarction. Hypertrophy of the heart is unlikely to progress significantly in this case because there is neither hypertension nor a valvular lesion. Mural thrombosis may develop on the endocardial surface overlying an infarction and may fill a ventricular aneurysm following an MI. An acute MI may be complicated by papillary muscle rupture with mitral valve insufficiency. [/INST] question: A 60-year-old man has had angina on exertion for the past 6 years. A coronary angiogram performed 2 years ago showed 75% stenosis of the left circumflex coronary artery and 50% stenosis of the right coronary artery. For the past 3 weeks, the frequency and severity of his anginal attacks have increased, and pain sometimes occurs even when he is lying in bed. On physical examination, his blood pressure is 110/80 mm Hg, and pulse is 85/min with irregular beats. An ECG shows ST-segment elevation. Laboratory studies show serum glucose, 188 mg/dL; creatinine, 1.2 mg/dL; and troponin I, 1.5 ng/mL. Which of the following is most likely to explain these findings? | options: A: Atheromatous plaque fissure with thrombosis B: Constrictive pericarditis with calcification C: Endomyocardial fibrosis D: Extensive myocardial fiber hypertrophy | answer: A </s> |
<s>[INST] context: The son of a Lutheran pastor, Albert Schweitzer was born in a small village in Alsace, then part of Germany.By age 29, Schweitzer had already authored three books and made landmark scholarly contributions in the fields of music, religion, and philosophy.He was an acclaimed organist, a world authority on Bach, a church pastor, a head of a theological seminary , and a university professor with two doctoral degrees.
At the age of 30, aware of the desperate medical needs of Africans, he decided to become a doctor and devote the rest of his life to direct service in Africa. In 1913, at the age of 38, Dr.Schweitzer and his wife, Helene, opened a hospital in Lambarene, Gabon- then a province of French Equatorial Africa.Not even serious setbacks of World War I, part of which he and Helene spent as prisoners of war in France, _ him from continuing commitment to his job.
In 1915,troubled daily by the vast numbers of suffering patients coming to his hospital for help, he experienced as a revelation the idea of "Reverence for Life" as the elementary and universal principle of ethics that he had been seeking for so long. By stressing the interdependence and unity of all life, he was a forerunner of the environmental and animal welfare movements - Rachel Carson dedicated Silent Spring to him.
In 1952, at the age of 77, Schweitzer was awarded the Nobel Peace Prize. During the last twelve years of his life, his speeches and writings emphasized the dangers of atmospheric nuclear test explosions and the suicidal nuclear arms race between the superpowers.
After retiring as a practicing doctor, Albert Schweitzer continued to oversee the hospital until his death at the age of 90. To the end, his one frustration was that he had not succeeded in convincing the world to abolish nuclear weapons. He and his wife are buried on the Hospital grounds in Lambarene. [/INST] question: What field did Albert SchweitzerNOT contribute his efforts to? | options: A: Philosophy B: Music C: Architecture D: Theology | answer: C </s> |
<s>[INST] context: Category: Comedy
Best known for his role on the Emmy award-winning sitcom Everybody Loves Raymond, Brad Garrett returns to his Vegas roots with his comedy club at the MGM Grand. It is a good place to check out when you need a break from work.
Prices from: $56.40 and up
Age restriction: Must be 21 years of age or older
Show Length: 115 minutes
MAC KING COMEDY MAGIC SHOW
Category: Comedy, Magic
Mac King Comedy Magic Show is different every afternoon, with lots of audience participation. He is willing to make fun of himself instead of his guests in order to make everyone feel welcome and entertained. The afternoon is kid-friendly from start to finish. Still, whether you're eight or 80, you won't be able to figure out King's secrets.
Prices from: $40.90 and up
Age restriction: No age restriction
Show Length: 90 minutes
THE MENTALIST, GERRY MCCAMBRIDGE
Category: Comedy, Magic
Using his skills as a "mentalist", Gerry McCambridge shocks the crowds as he uses his abilities to predict just what audience members will do next. Anyone who has seen the show has walked away in disbelief, amazed by his unusual power.
Prices from: $34.99 and up
Age restriction: Under 13 will not be admitted into the theater
Show Length: 75 minutes
ROCK OF AGES
Category: Plays & Musicals
The cheerful Rock of Ages brings audiences back to the times of big hair and even bigger bands with 28 popular rock songs from the 80s including "Every Rose Has Its Thorn," "I Wanna Know What Love Is," "Here I Go Again," and more.
Rock of Ages has been nominated for five Tony Awards including Best Musical and Best Direction of a Musical. It also received a Drama League nomination for Distinguished Production for a Musical.
Prices from: $74.00 and up
Age restriction: Must be 15 years of age or older
Show Length: 125 minutes [/INST] question: Who is most likely to be able to read audiences' minds? | options: A: Raymond B: Mac King C: Brad Garrett D: Gerry McCambridge | answer: D </s> |
<s>[INST] context: As a middle school student, you are in an age group that is both fascinating and complex. You are no longer a "baby", but you are not yet an adult. You are experiencing biological, physical, and behavioral and social changes. Relationships with your friends and family take on new meanings. This time period, called adolescence, can be joyful and painful at the same time. However, it is always a time of growth. You will be dealing with more complex intellectual tasks. You will be expected to behave in a more mature manner and you will be held more responsible for your actions. In other words, you are growing up. Use your curiosity, imagination, energy, and idealism to make your school an exciting place to learn and play.
As an adolescent, you now have more control over how you apply yourself to your school work and on the kinds of friends you make. As an intelligent and thinking adolescent, be aware of health risks to avoid such as involvement with drugs, alcohol, tobacco, and sexual activity. This involvement reduces your quality of life. Be kind and gentle to yourself, seek the advice and wisdom of your parents/guardians regularly, and talk with your teachers and school counselor.
Middle school students are expected to be respectful and considerate of others. You are responsible for your behavior. Think of ways to improve your behavior
^in your classroom
^in the lunchroom
^on school grounds
^during school activities
^on the school bus
^in your community
If you need assistance in working on ways to improve yourself as a person, contact your counselor. The counselor is trained to help students solve personal problems. [/INST] question: A middle school student is considered to be a(n) _ . | options: A: baby B: adolescent C: adult D: wiser | answer: B </s> |
<s>[INST] context: Malls are popular places for Americans to go. Some people spend so much time at malls that they are called "mall rats ". Mall rats shop until they drop in the hundreds of stores.
People like malls for many reasons. They feel safe because malls have police stations. Parking is usually free, and the weather inside is always fine. The newest malls have beautiful rest places with waterfalls and large green trees.
The largest mall in the United States is the Mall of America in Minnesota. It covers 4. 2 million square feet . It has 350 stores, eight nightclubs, and a large park! There are parking spaces for 12,750 cars. About 750,000 people shop there every week.
The first indoor mall in the United States was built in 1965 in Edina Minnesota. People love doing all their shopping in one place. More malls are built around the country. Now malls are like town centers where people come to do many things. They shop, of course, they also eat in food courts that have food from all over the world. They see films at theaters. Some people even get their exercise by doing the new sport of "mall walking". Others go to malls to meet friends.
In some malls, people can see a doctor and even go to the church. In other words, people can do just about everything in malls. Now people can live in their favorite shopping center in fact. [/INST] question: Here "mall" means " _ ". | options: A: a large park B: a big church C: a square D: a shopping center | answer: D </s> |
<s>[INST] context: 2010 was a good year for American farmers. They earned about eighty-two billion dollars. That is almost one-third more than that they earned last year. And it is twenty-six percent higher than the ten-year average. Values for grain and oilseed crops are up about three percent from last year. The value of animal production is up by almost seven percent.
In 2011, farm exports are expected to break the all-time high set in 2008.The Agriculture Department says exports in 2011 could top one hundred and twenty-six billion dollars. The largest buyer of agricultural products is expected to be Canada. But farm exports to China are predicted to come within five hundred million dollars of Canadian purchases. Secretary Vilsack says countries in Southeast Asia and the Middle East are also buying more from American farmers.
Poor growing conditions overseas played an important part in higher prices for American crops in 2010.Charlotte Hebe brand is chief executive of the International Food and Agricultural Trade Policy Council in Washington. She said drought conditions had a big effect over the summer. She said,"There were horrible weather problems, not just in Russia but also in some of the other former Soviet Union countries."
Wheat prices rose after Russia stopped wheat exports,although Russia later eased the ban ."Wheat used to be America's top crop. What's interesting,though,is that wheat production has actually become less over the past few years because corn has become the most popular crop,"said economist Charlotte Hebebrand.
Corn is mostly fed to animals. But Miss Hebebrand said with the recent increase in wheat prices, American farmers might plant more wheat again. Corn and wheat are the two largest crops supported by the government. [/INST] question: We know that compared to 2009,in 2010 American farmers----. | options: A: planted less corn B: planted morn crops C: planted morn wheat D: earned more money | answer: D </s> |
<s>[INST] context: Life in the future will be different from life today.Between then and now many changes will happen.But what will the changes be?
The population is growing fast.There will be many people in the world and most of them will live longer than people live now.
Computers will be much smaller and more useful,and there will be at least one in every home.And computer studies will be one of the important subjects in schools then.People will work fewer hours than they do now and they will have more free time for sports,watching TV and traveling.Traveling will be much cheaper and easier.And many more people will go to other countries for holidays.
There will be changes in our food,too.More land will be used for building new towns and houses for all the people.Then there will be less room for cows and sheep,so meat will be more expensive.Maybe no one will eat it every day.Instead,they will eat more fruits and vegetables.Maybe people will be healthier.Work in the future will be different,too.Robots will do dangerous and hard work.Because of this,many people will not have enough work to do.This will be a problem. [/INST] question: In the future there will be _ . | options: A: much more people B: fewer people C: less vegetables D: less people | answer: A </s> |
<s>[INST] context: If you are like millions of other people in the world, you probably want to live a healthy lifestyle. While many people are able to achieve this lifestyle, there are even more that are looking for ways to improve their health. Here are 5 tips to help you.
1.Healthy diet
The food you eat plays a huge role in what type of lifestyle you live. If you eat fast food every day, you clearly don't have the best diet. You should eat vegetables, fruits, bread as well as meat and fish, and even some snack foods once in a while.
2.Water
Drink plenty of water every day and it is good for your health. Usually you need to drink 8~10 glasses of water a day.
3.Exercise
Take some exercise every day. You can take a walk, play ball games with your friends, or ride a bike. Exercise is a necessary part of a healthy lifestyle.
4.Have fun
Getting out and having fun is _ because it helps let out the stresses. Go out for a movie with your friends once in a while. Go to the park and enjoy a nice sunny day. Or just lie down and read a book.
5.Sleep
Without enough sleep, our immune system will be weak and it will be difficult to get through the day. Getting a good night's sleep can make the world of a difference in how you feel and how much you can do the next day. [/INST] question: A healthy diet includes all of the following EXCEPT _ . | options: A: vegetables and fruit B: bread and fish C: snack foods sometimes D: fast food very often | answer: D </s> |
<s>[INST] context: A Charlotte, N.C., man was charged with first-degree murder of a 79-year-old woman whom police said he scared to death. In an attempt to evade policemen after a bank robbery, the Associated Press reports that 20-year-old Larry Whitfield broke into the home of Mary Parnell. Police say he didn't touch Parnell but that she died after suffering a heart attack that was caused by terror. Can the guy be held responsible for the woman's death? Prosecutors said that he can under the state's murder rule, which allows someone to be charged with murder if he or she causes another person's death while committing or fleeing from a severe crime like robbery--even if he or she doesn't kill someone on purpose.
But, medically speaking, can someone actually be frightened to death? We asked Martin Samuels, chairman of the neurology department at Brigham and Women's Hospital in Boston.
Absolutely, no question about it.
The body has a natural protective method called the fight-or-flight response , which was originally described by Walter Cannon,the chairman of Harvard University's physiology department from 1906 to 1942. If, in the wild, an animal is faced with a life-threatening situation, the autonomic nervous system responds by increasing heart rate, increasing blood flow to the muscles, and slowing digestion, among other things. All of this increases the chances of succeeding in a fight or running away from an aggressive beast. This process certainly would be of help to primitive humans. However, in the modern world there is obvious decline of the fight-or-flight response.
The autonomic nervous system uses the chemical messenger to send signals to various parts of the body to activate the fight-or-flight response. This chemical is toxic in large amounts; it damages the organs such as the heart, lungs, liver and kidneys. It is believed that almost all sudden deaths are caused by damage to the heart. There is almost no other organ that would fail so fast as to cause sudden death. Kidney failure, liver failure, those things don't kill you suddenly.
By the way, any strong positive or negative emotions such as happiness or sadness can cause the same result. There are people who have died in intercourse or in religious passion. There was a case of a golfer who hit a hole in one, turned to his partner and said, "I can die now", and then he dropped dead. For about seven days after the 9/11 terrorist attacks on the World Trade Center and Pentagon there was an increase of sudden cardiac death among New Yorkers. [/INST] question: Why the Charlotte, N.C., man was charged? | options: A: Because he threatened the policemen to kill an old woman B: Because he caused an old woman's terror and she died C: Because he beat an old woman and caused her heart attack D: Because he murdered an old woman while robbing a bank | answer: B </s> |
<s>[INST] context: In October, Ubayd Steed, a sixth grader in Philadelphia, Pennsylvania, was taking a math test when he noticed a classmate looking at his paper. " I quickly turned my paper over," he said. Later that day, Ubayd met the cheater and told him not to do it again.
Unfortunately, Ubayd' s experience is not unusual. Whether it's kids copying class -mates' answers during tests or friends sharing homework, cheating happens in schools every day. Experts say the behavior starts in the lower grades. Surveys show that one in three elementary students admits to cheating.
Jacob Harder, a fourth grader in Ware, Massachusetts, has had classmates ask to copy his homework. "I wouldn't want to just tell them the answers," he says. So instead, he explains the task and encourages his classmates to do it themselves.
But many kids find it hard to say no. "l hear from kids all the time, ' I can' t say no to a friend,'" says Eric Anderman, a professor at The Ohio State University who studies cheating in school. He says it' s important to say no from the start. "Then you _ , and the other kid gets the message," he says. Plus, he points out, "a real friend is not going to disown you because he or she couldn't copy your math homework."
The kids doing the copying may feel they need to cheat to be accepted by other kids. And some students may cheat simply because others do. "If you' re in an atmosphere where cheating is common, you may think that if you don' t cheat, you' re at a disadvantage," says Michael Josephson, founder of the Josephson Institute of Ethics.
But Josephson says students shouldn't think that way. "There are a lot of things kids do," he says. "You have to decide what kind of person you' re going to be."
When school becomes too challenging, Anderman suggests going to the teacher rather than relying on the work of others. "It' s good to ask for help," he says. [/INST] question: Ubayd' s experience serves as a(n) _ | options: A: explanation B: introduction C: comment D: background | answer: B </s> |
<s>[INST] context: Dysgerminoma 10-15% of dysgerninomas are bilateral Dysgerminoma is the only germ cell malignancy that has this significant rate of bilaterily, other germ tumors are rarely being bilateral. Fewer than 5% of all ovarian tumours are germ cell in origin. They include : - Teratonia - Dysgerminoma - Endodermal sinus tumour (yolk sac tumour) - Embryonal carcinoma The unique characteristics of germ cell tumours are : - They generally occur in younger women - They display an unusual aggressive natural history and are commonly cured with less extensive nonsterlizing surgery and chemotherapy. The germ cell neoplasmas can be divided into three groups. (i) Benign tumour (usually dermoid cyst) (ii) Malignant tumours that arise from dermoid cyst (iii) Primitive malignant germ cell tumours including dysgerminoma, yolk sac tumours, immature teratomas embryonal carcinoma choriocarcinoma. Clinical features of malignant germ cell tumours - Malignant germ cell tumours are usually large - Bilateral disease is rare, except in dysgerminoma (10-15% are bilateral) - Abdominal or pelvic pain in young women is the usual presenting symptom. - Serum human chorionic gonadotropicin ((3-hCG) and a fetoprotein levels are useful in diagnosis and management. - Most of the malignant germ cell tumours are managed with chemotherapy after surgery. - Dysgerminoma is the ovarian counterpa of testicular carcinoma. The tumour is very sensitive to radiation therapy. [/INST] question: Ovarian tumour which is bilateral | options: A: >Dysgerminoma B: >Endodermal sinus tumour C: >Immature teratoma D: >Embryonal cell carcinoma | answer: A </s> |
<s>[INST] context: October 31, 2009, California
Tsien Hsue-shen, PhD'39, one of the founders of the Jet Propulsion Laboratory, died on October 31, He was 98.
Tsien, born in the eastern Chinese city of Hangzhou, graduated from the National Qinghua University in 1934 and in August of 1935 he left China to study at the Massachusetts Institute Technology. In 1936 he went to the California Institute of Technology to _ graduate studies .Tsien obtained his doctor degree in 1939 and would remain at Caltech for 20 years, becoming the Goddard Professor and establishing a reputation as one of the leading rocket scientists in the United States.
In 1943, Tsien and two others in the Caltech rocketry group drafted the first document to use the name Jet Propulsion Laboratory. During the Second World War, he was amongst the other scientists participated the "Manhattan Project" .After World War II he served as a consultant to the United States Army Air Force. During this time, Conlonel Tsien worked on designing an intercontinental space plane. His work would inspire the X--20Dyna-Soar which would later be the inspiration for the Space Shuttle. In1945 Tsien Hsue--shen married Jiang Ying, the daughter of Jiang Baili--one of the Chinese nationalist leader Chiang Kai--shen's leading military strategists. But in 1950, the Chinese-born scientist was accused of harboring Communist sympathies and stripped of his security clearance.
In September 1955 he was permitted to leave for China, where Tsien resumed his research, founded the Institute of Mechanics, and went on to become the father of China's missile program, a trusted member of the government and Party's inner circle, and the nation's most honored scientist, Tsien retired in 1991 and has maintained a low public profile in Beijing, China. The PRC government launched its manned space program in 1992 and used Tsien's research as the basis for the Long March rocket which successfully launched the Shenzhou V mission in October of 2003.The elderly Tsien was able to watch China's first manned space mission on television from his hospital bed.
In his late years, since the 1980s, Tsien devoted himself to spirituality research, and advocated scientific investigation of traditional Chinese medicine, Qigong and "special human body functions". [/INST] question: Tsien Hsue--shen got married at the age of _ | options: A: 45 B: 28 C: 24 D: 34 | answer: D </s> |
<s>[INST] context: Are you a foreigner in Shanghai, China, wanting to find a job? Here's some information for you.
Teaching Job in High School
Description:
High school(students aged 14-18)
12 classes/week
Benefits and Compensation :
Salary: 7,000-8,000 RMB/month
Paid public holidays and winter holidays
Free accommodation with full furniture
Medical insurance
Requirements:
English native speaker
Bachelor's degree or above
New graduates are welcome
To apply, please send your resume, and one recent photo copy to: _
Coffee & Bar Manage Needed
Description:
A big Coffee & Bar in Ganghui Plaza, Xujiahui, Shanghai, is looking for a manager. The Coffee & Bar has about 300 seats; main service is western food and coffee.
Benefits and Compensation:
Salary: 12,000 RMB/month
Requirements:
Male, about or above 30
Speak fluent Chinese
5 years' experience in restaurant management
If you're qualified and interested, please send me your resume with picture: [email protected].
Office receptionist &Sales Assistant
Description:
We are a well-known tourism company in Shanghai, and started our business at the beginning of 2000.
Responsibility:
Assist the sales manager and sales representatives
Welcome the visitors
Requirements:
Female, 20 to 30 years old
Sales experience will be an advantage, but not a must
If you're interested, please send me your resume with picture(we won't accept without it): [email protected] [/INST] question: What can we learn about the Coffee & Bar in Ganghui Plaza? | options: A: The applicants can get medical insurance once accepted B: The position it advertised won't accept females C: It mainly serves Chinese food to westerners D: It started business at the beginning of 2000 | answer: B </s> |
<s>[INST] context: Fibre optic devise is ideal for intubation in difficult / inadequate mouth opening , inadequate neck movement. indications Difficult intubation (e.g. awake fiberoptic intubation) Suction of secretions or blood from the airways Guide placement of a percutaneous tracheostomy, double-lumen tube, bronchial blockers and endobronchial valves Treatment of specific disorders (e.g. control bleeding from focal lesions) DESCRIPTION Flexible long, thin plastic tube enclosing a fibreoptic system that attaches to a light source and transmits views from the distal tip to an eyepiece eyepiece can attach to a camera and/or video system that displays images on a screen flexible tip can be moved to negotiate passage of the tip into the airways using a lever controlled by the operators hand (Bowden cable system) suctioning channel connected to the tip and controlled on the proximal hand piece instrumentation po (for inseing instruments such as brushes or biopsy forceps or injecting saline) ergonomic design of the control section that fits the hand 120deg field of view with 180deg up and 130deg down angulation Range of tip diameters (e.g. 2.8 mm to 5.9 mm for Olympus scopes), sizes of instrument channels and lengths (e.g. longer length with smaller diameter needed for double-lumen tubes) Accessories can be either disposable or autoclavable (e.g. suction connector; instrument channel cover) [/INST] question: A 42 yr old patient came to AIIMS emergency dept with history difficulty in breathing after 7months she was discharged from BURNS UNIT O/E O2sat was decreasing to 80%, RR-20/min BP-110/74mmHg & on local examination of neck there was post burns contracture of neck with restricted neck extension ideal method of intubation in this case....? | options: A: Laryngeal mask airway B: Nasal intubation after intravenous induction C: Fiber optic intubation D: Tracheostomy | answer: C </s> |
<s>[INST] context: Presence of tachypnea and retractions classifies as pneumonia in this child. Hence this child should be given oral antibiotics. SIGNS CLASSIFY AS TREATMENT Any general danger sign or stridor in a calm child Severe pneumonia or VERY severe disease Give 1st dose of Inj. Ampicillin & Gentamycin and refer urgently to hospital Chest indrawing AND/ or fast breathing Fast Breathing < 2 months ->60/min < 2-12 months ->50/min < 1-5 years ->40/min PNEUMONIA 1. Give oral Amoxycillin x 5 days 2. If wheezing present, inhaled bronchodilator x 5D 3. Soothe the throat & relieve cough with a safer remedy 4. If Cough > 15 days or recurrent wheeze - refer for the evaluation of TB or bronchial asthma 5. Advise the mother when to return immediately 6. Follow up in 2 days If the O2 saturation < 90% - refer urgently No sign of pneumonia or very severe disease NO PNEUMONIA Cough or cold Steps 2 to 5 Follow up in 5 days General danger signs - Persistent vomiting - Unconsciousness - Convulsions - Inability to drink or breast feed - Lethargy CAUTION : CHEST INDRAWING IS NOW CLASSIFIED AS PNEUMONIA & NOT AS SEVERE PNEUMONIA [/INST] question: A 6 month baby presented with RR of 54/min with retractions. How should the doctor at PHC manage the case? | options: A: Classify as very severe pneumonia and refer immediately B: Classify as severe pneumonia, sta injectable antibiotic and then refer C: Classify as pneumonia and sta oxygen therapy D: Classify as pneumonia, sta oral antibiotics | answer: D </s> |
<s>[INST] context: Anastomotic urethroplasty is the procedure of choice in the totally obliterated bulbar urethra after a straddle injury. The typical scar is 1.5 to 2 cm long and should be completely excised. The proximal and distal urethra can be mobilized for a tension-free, end-to-end anastomosis. This is a highly successful procedure in more than 95% of cases. Endoscopic incision (urethrotomy) through the scar tissue of an obliterated urethra is a hopeless procedure and uniformly fails. Paial urethral narrowing can initially be treated by endoscopic incision with higher success. It is now recognized that repeated urethrotomy and dilation is neither clinically effective nor cost-effective for the treatment of urethral strictures. Fuher, patients who have had repeated endoscopic procedures are also more likely to require complex reconstructive procedures such as grafts" -- Campbell's Urology "Urethroplasty should be considered when the stricture has arisen following trauma, and when a stricture has recurred following endoscopic treatment. "- Bailey Urethroplasty can be of two types: excision and end-to-end anastomosis- done for sho stricture segments (<=2 cm) patch urethroplasty- for longer segments [/INST] question: A 40 yr old patient of pelvic injury presents with stricture bulbar urethra of 1.5 cm length. What would be the management? | options: A: Urethral dilatation B: Excision and end to end urethroplasty C: Patch graft urethroplasty D: Urethrotomy | answer: B </s> |
<s>[INST] context: “Below the age of 20 years 60% of the tumours are of germ cell origin and in girls under the age of 10 years almost 85% are of germ cell origin and are invariably malignant.”
“Dysgerminoma is the most common malignant germ cell tumour accounting for about 40% of all ovarian cancers of germ cell origin.”
“Dysgerminomas are the most common malignant germ cell tumours of the ovary and have been considered the female - equivalent of seminoma.”
Most common germ cell tumour of ovary is dermoid cyst (mature teratoma). It is benign in nature.
Remember:
• Most common ovarian tumour (overall) – Epithelial cell tumour.
• Most common tumour in young woman is – Germ cell tumour.
• Most common malignant tumour of ovary – Serous cystadenocarcinoma.
• Most common benign tumour of ovary (overall) – Dermoid cyst.
• Most common benign epithelial tumor of ovary – Serous cystadenoma.
• Most common germ cell tumour – Mature teratoma (Dermoid cyst).
• Most common malignant GCT – Dysgerminoma.
• Most common ovarian tumour in pregnancy (but in remains undiagnosed) – Serous cystadenoma.
• Most Common benign tumour diagnosed in pregnancy – Dermoid cyst.
• Overall most common ovarian tumour diagnosed in pregnancy – Dermoid cyst.
• Most common malignant ovarian tumor detected during pregnancy – Dysgerminoma.
• Germ cell Tumor with best pregnosis Dyserminoma
• Germ cell tumor with worst prognosis- endodermal sinus tumor
• Germ cell tumor which has maximum bilaterality– Dysgerminoma
• Germ cell tumor which presents as accute abdomen- Endodermal Sinus Tumor
• Most common ovarian tumour to undergo torsion during pregnancy – Dermoid cyst.
• Most common ovarian tumour to involve opposite ovary by metastasis – Granulosa cell tumour.
• Most radiosensitive ovarian tumour – Dysgerminoma.
• Most rapidly growing ovarian tumour – Yolk sac Tm- (Endodermal Sinus Tumor)
• Most connective tissue tumour – Fibroma.
Ovarian Tumour: Causing:
• Pseudomyxoma peritonei – Mucinous cystadenoma.
• Meig’s syndrome – Ovarian fibroma
• Pseudomeig’s syndrome: – Brenner’s tumour
– Granulosa cell tumour
– Thecoma
• Ovarian tumour associated with hyperpyrexia and hypercalcemia – Mesonephroid tumour.
• Ovarian tumour arising from epithelium of urinary tract – Brenner Tm
• Feminizing tumours: – Granulosa cell tumour
– Theca cell tumour
– Fibromas
• Virilising tumour: – Androblastoma
– Hilus cell Tm
– Gynadroblastoma
– Adrenal cortical tumour
• Largest benign ovarian Tm – Mucinous cyst adenoma
• Mucinous tumours are associated with: – Dermoid cyst (MBD)
– Brenner’s tumour
• Tumour with lymphocytic infilteration: [/INST] question: Which of the following is the most radiosensitive ovarian tumors: | options: A: Dysgerminoma B: Dermoid cyst C: Serous cystadenoma D: Endodermal sinus tumour | answer: A </s> |
<s>[INST] context: Antibodies used in diagnosing Celiac sprue: Anti endomysial (anti EMA) - highest sensitivity and specificity, best performance for detection of celiac sprue. The antigen recognized by them is tissue transglutaminase. Anti gliadin (AGN) - variability and lower accuracy, unsuitable for diagnosis and screening. Anti reticulin (ARA) - not used routinely Anti transglutaminase (anti-Ttga) - highly sensitive and specific, but anti endomysial is more superior. Some impoant points about celiac disease: Intolerance to food containing gliadin like rye, oats, barley and wheat IgA antibodies. 95% express HLA -DQ2 allele Small intestine biopsy is characteristic but not diagnostic and shows absent or reduced height of villi, flat appearance, crypt hyperplasia, villous atrophy, but not mucosal atrophy, increased lymphocytes and plasma cells in lamina propria. Associated diseases: Dermatitis herpetiformis IgA deficiency Lymphomas Autoimmune diseases like Addison's, Diabetes mellitus. Graves, Myasthenia, Sjogren's etc. [/INST] question: Which is the most sensitive and specific antibody for Celiac sprue? | options: A: Anti endomysial B: Anti TTG C: Anti gliadin D: Anti reticulin | answer: A </s> |
<s>[INST] context: Life comes in a package.This package includes happiness and sadness, failure and success, hope and _ .Life is a learning process.Experiences in life teach us new lessons and make us a better person.With each passing day we learn to deal with various situations.
Love plays a main role in our life.Love makes you feel wanted.Without love a person could become cruel.In the early stage of our life, our parents are the ones who show us with love and care.They teach us about what is right and wrong, good and bad.But we don't always care about it.It is only after marriage and having kids that a person understands others' feelings.
Happiness can bring people a peaceful mind.No mind is happy without peace.Sadness is the cause of the death of a loved one or the failure.But all of these things will pass away.
Failure is the path to success.It helps us to touch the sky, teaches us to survive and shows us a specific way.Success brings in money, pride and self-respect.
Hope is what keeps life going.Parents always hope their children will do well.Hope makes us dream.Hope builds in patience.Life teaches us not to despair even in the darkest hour, because after every night there is a day.
Life teaches us not to regret over yesterday, for it has passed and is out of our control.Tomorrow is unknown, for it could either be bright or dark. _ [/INST] question: We usually have to accept _ if we want to be successful. | options: A: love B: failure C: sadness D: hope | answer: B </s> |
<s>[INST] context: Asbestosis Q, & SLE cause alveolis, intersal inflammaon & fibrosis, not granulomatous lesion (HI 7/1643, H16/1555) SLE pulmonary manifestation (H17/2078)
"The most common pulmonary-' manifestation of SLE is pleuritisR with or without pleural effusion.
Life threatening pulmonary manifestation include interstitial inflammation leading to fibrosis,
shrinking lung syndrome 1 ' & intraalveoiar hemoorrhage."
It is characterized by an accumulation of T lymphocyte, macrophage & epithelioid cells organized into discrete structures (granuloma) in lung parenchyma.
These lesions can progress to fibrosis Many paents with granulomatous lung disease remain free of severe impairment of lung funcon,
or, when symptomac they improve aer treatment. Lung Response : Granulomatous (H19th/1708,17th/i643) Known Cause Hypersensivity
pneumonis Q (organic dust) Inorganic dusts : beryllium Q , silica Unknown cause Sarcoidosis' 3 Langerhan's cell granulomatosis Wegener's granulomatosis'
3 Allergic granulomatosis of Churgstrauss disease Bronchocentric granulomatosis Lymphomatoid granulomatosis "3 Granulomatous vasculides Granuloma of Lung:
Causes (Dahnert 5th/489) 1. Sarcoidosis Q 2. Non Sarcoid granulomatous disease Infecons Bacterial: TB, gumma Opportunisc:
Crytococcosis Parasic : Dirofilaria immis (dog heartworm) Fungal: Histoplasmosis^, Coccidioidomycosis' 3 , nocardiosis Nonifecons Foreign body :
Talc, beryllium 13 , algae, pollen, cellulose, lipids, abuse of nasally inhaled drugs, aspiraon of medicaon Angiocentric lymphoproliferave disease Vasculides
Extrinsic allergic alveolis Langerhans cell hisocytosis Pulmonary' hyalinizing granuloma [/INST] question: Granulomatous disease(s) is/ are
(A)Lichen planus
(B)Histoplasmosis
(C)Sarcoidosis
(D)Lupus erythromatosis
(E)Asbestosis | options: A: AD B: BC C: DA D: BC | answer: B </s> |
<s>[INST] context: EB comprises a heterogeneous group of disorders loosely bound by their hereditary nature and by a tendency to form blisters at sites of minor trauma. EB simplex has been attributed to mutations of genes encoding cytokeratin intermediate filaments. The clinical spectrum of the disease ranges from a minor annoyance to a widespread, life-threatening blistering disease. These blisters are almost always noted at birth or shortly thereafter. The classification of these disorders is based on the site of blister formation in the basement membrane zone. Although epidermolytic EB is cosmetically disturbing and sometimes debilitating, it is not life threatening. Blisters seen in bullous pemphigoid (choice A) and pemphigus vulgaris (choice E) are associated with immunoglobulin deposits that are visualized by direct immunofluorescence microscopy. Dermatitis herpetiformis (choice B) occurs at a later age and is associated with gluten hypersensitivity. In ichthyosis vulgaris (choice D), scaly skin results from increased cohesiveness of the stratum corneum.Diagnosis: Epidermolysis bullosa [/INST] question: Examination of a 2-day-old neonate reveals numerous blisters on the trunk and extremities. Skin biopsy discloses separation of the basal layer of the epidermis from its basement membrane and is devoid of inflammatory cells. No antibody deposits are identified by immunofluorescence microscopy. Which of the following is the most likely diagnosis? | options: A: Bullous pemphigoid B: Dermatitis herpetiformis C: Epidermolysis bullosa D: Ichthyosis vulgaris | answer: C </s> |
<s>[INST] context: It was a cold night in Washington, D. C., and I was heading back to the hotel when a man approached me. He asked if l would give him some money so he could get something to eat. I'd read the signs "Don't give money to beggars." So I shook my head and kept walking.
I wasn't prepared for a reply, but he said, "I really am homeless and I really am hungry! You can come with me and watch me eat!" But I kept on walking.
The incident bothered me for the rest of the week. I had money in my pocket and it wouldn't have killed me to hand over a buck or two even if he had been lying. Flying back to Anchorage, I couldn't help thinking of him. I tried to rationalize my failure to help by thinking government agencies, churches and charities were there to feed him. Besides, you're not supposed to give money to beggars.
Somewhere over Seattle, I started to write my weekly garden column for The Anchorage Daily News. _ , I came up with an idea. Bean's Cafe, the soup kitchen in Anchorage, feeds hundreds of hungry Alaskans every day. Why not try to get all my readers to plant one row in their gardens dedicated to Bean's? Dedicate a row and take it down to Bean's. Clean and simple.
The idea began to take off. Readers would fax or call me when they got something in their garden. Those who only grew flowers donated them. Food for the spirit.
In 1995, the Garden Writers Association of America held their annual convention in Anchorage and after learning of Anchorage's program, Plant a Row for Bean's became Plant a Row for the Hungry. The original idea was to have every member of the Garden Writers Association of America write or talk about planting a row for the hungry sometime during the month of April.
As more and more people started working with the Plant a Row idea, new changes appeared unexpectedly. Many companies gave free seed to customers and displayed the logo, which also appeared in national gardening publications. Row markers with the Plant a Row logo were delivered to gardeners to set apart their "Row for the Hungry."
Garden editor Joan Jackson, supported by The San Jose Mercury News and California's nearly year-round growing season, raised more than 30,000 pounds of fruits and vegetables her first year, and showed GWAA how the program could really work. Texas fruit farms donated food to their local food bank after being inspired by Plant a Row. Today the program continues to thrive and grow.
I am surprised that millions of Americans are threatened by hunger. If every gardener in America--and we're seventy million strong--plants one row for the hungry, we can make quite a decrease in the number of neighbors who don't have enough to eat. Maybe then I will stop feeling guilty about abandoning a hungry man I could have helped. [/INST] question: The program has been supported by many farmers, journalists and people in different fields for many years. They usually donate many things to it except _ . | options: A: money B: flowers C: seeds D: beans | answer: B </s> |
<s>[INST] context: There were three brothers. They each decided to find a precious treasure and meet a year later.
One year later, the three brothers gathered again. They each _ the treasure they had.
The oldest brother brought a telescope. "I found a telescope which can see far away."
The second brother brought a flying carpet." I found a flying carpet that can be anywhere."
The third brother said." I found an apple that cures all diseases."
The brothers were amazed at the treasures they found. "Let's see what we can do with our treasures now." The brothers all nodded.
The oldest brother looked through his telescope and saw a palace in the distance. A princess was lying in bed sick. The second opened his carpet and said. "Let's ride this carpet and go to the palace." The three brothers went to the palace on the flying carpet to save the sick princess.
The three brothers met the king and told him why they had come. The king said. "If you cure the princess, I will let one of you marry the princess." The youngest brother gave the princess the apple he found.
The princess had been sick for a long time, but with one bite of the apple, she was cured.
The king hugged the princess with joy. "Okay, as promised, one of you can marry the princess." The brothers each wanted the other to marry the princess. No matter how pretty and princess was, the brothers thought their loyalty was more important.
The king was moved and gave them gold and silver and high positions. The three brothers lived happily ever after. [/INST] question: Which the following sentence is true? | options: A: The three brothers didn't get along well with each other B: All the brothers wanted to marry the princess C: The king didn't want to keep his promise D: None of the three brothers married the princess | answer: D </s> |
<s>[INST] context: One Sunday evening, it was quite dark when old Stanley went for his walk. He was walking along the sidewalk, Suddenly, he saw a white car coming around the corner at high speed. It was going too fast and crashed into a red car in the street where he was walking. He rushed up to the cars to see if anyone was hurt and needed help.
The two drivers were arguing.
"You came around the corner too fast," one man said.
"No!" said the driver of the white car, "That's not true! Your car was parked in a wrong place."
Stanley listened to their argument and then said the white car driver was wrong to drive too fast. The driver of red car asked Stanley to prove he was right in court . Stanley gave the driver his name and telephone number.
Next Thursday morning, Stanley was asked to go to the court. The lawyer for the driver of the white car asked him a lot of questions about what he had seen. Then he asked Stanley how old he was.
"I'm eighty-two," answered Stanley.
"Do you usually wear glasses ?" asked the lawyer.
"Yes, I do," answered Stanley.
"Were you wearing them on the night of the accident?" the lawyer asked.
"No," replied Stanley.
Then the lawyer said, "Why should the court believe you? You are eighty-two years old, you were not wearing your glasses, and it was dark. How far can you see in the dark?"
Stanley thought about it for a minute. "Well," he said, "when it's dark, I can see the moon. How far is that?" [/INST] question: The car accident happened _ . | options: A: one Sunday morning B: next Thursday morning C: one Sunday evening D: next Thursday evening | answer: C </s> |
<s>[INST] context: The passages below discuss the retirement age.
Passage 1:
In the United States,the financial crisis has left the country with 11 million fewer jobs than Americans need now.No matter how tough the policy ,we are not going to find 11 million new jobs soon.So common sense suggests we should make some decisions about who should come first:older people,who have already worked three or four decades at hard jobs? Or younger people,many just out of school,with fresh skills and ambitions?
The answer is obvious.Older people who would like to retire and would do so if they could afford it should get some help.The right step is to reduce,not increase,the retirement age.As a rough cut,why not make it a law to set a three--year window during which the age for receiving full Social Security benefits would drop to 62----providing a voluntary ,one--time,grab-it-now bonus for leaving work? Let them go home! With a secure pension and medical care,they will be happier.Young people who need work will be happier.And there will also be more jobs.With pension security, older people will consume services until the end of their lives.They will become.each and every one,an employer.
Passage 2:
Too many people see longer working lives as a worry rather than an opportunity--and not just because they are going to be chained to their desks.Some worry that there will not be enough jobs to go around.This misunderstanding,known to economists as the"lump of labour fallacy ",was once used to argue that women should stay at home and leave all the jobs for breadwinning males.Now lump-of-labourites say that keeping the old at work would deprive the young of employment.The idea that society can become
better-off by paying more of its citizens to be idle is clearly ridiculous.On that reasoning,if the retirement age came down to 25 we would all be as rich as Bill Gates. [/INST] question: In Passage 1,one reason for suggesting earlier retirement in the US is the _ | options: A: tough policy B: stable pension C: high unemployment D: free medical care | answer: C </s> |
<s>[INST] context: For hundreds of years, Japan has been hit, from time to time, by enormous tsunamis. These awful sudden risings of the sea are caused by earthquakes or underwater volcanic action. The story of the boy Yuuki is the story of such a disaster.
Yuuki lived with his family in a sea-side village, below a small mountain. One day, as he played on top of the mountain, he felt an earthquake beneath his feet. It was not strong enough to frighten anybody and passed quickly. Soon after, however, Yuuki noticed the sea darken and begin running away from the shore very fast, leaving behind wide stretches of beach that had never been exposed before.
With a gasp, Yuuki remembered reading that just before a terrible tsunami, the sea suddenly and quickly rolls backward. He ran to the beach, warning the villagers who had gathered to admire the huge new stretch of beach.
"Get back!" shouted the boy. "There is terrible danger!"
But no one listened. They laughed at him and continued playing in the new sand and watching the sea roll backward even more.
Desperate, Yuuki could think of only one thing to do. He lit a tree branch, raced to the rice fields and began burning the stacks of harvested rice. Then he called out, "Fire! Fire! Everyone run to the mountain! Now!"
When everyone reached the mountain-top, a villager cried out, "Yuuki is mad! I saw him set the fire." Yuuki hung his head in shame, but said nothing as the villagers cursed him.
Just then, someone cried, "Look!"
In the distance what seemed to be a huge dark line was speeding towards the shore. As it got nearer the people realized the long thin line of darkness was the returning sea, towering like a mountain.
The villagers watched in terror as the water struck the shore, smashing over their homes then tearing out the land as it receded.
On the mountain everyone stared speechlessly at the destruction below.
"I'm sorry I burned the fields," said Yuuki, his voice trembling.
"Yuuki," village-chief answered. "You saved us all."
The villagers cheered and raised Yuuki into the air. "We were going to celebrate our rice harvest tonight," said one, "but now we'll celebrate that we're all still alive!"
,(A, B, CD),. [/INST] question: Where was Yuuki when the earthquake struck? | options: A: On the beach B: On the mountain C: In the rice fields D: At his family home | answer: B </s> |
<s>[INST] context: (By CCTV correspondent Vanessa Duffy 04/28/2013 08:36)
It's been eight days since a 7.0-magnitude strong earthquake hit China's Lushan Ya'an Sichuan Province.How the earthquake has affected one of Sichuan Province's special residents --pandas.How are the animals living? And do they have enough food to eat?
There are more than 80 pandas living here at the Chengdu Panda Breeding Base .The quake was felt strongly in Chengdu.Fortunately,all of the pandas here were out on the grounds when the earthquake hit,so they were very safe.
Several days have passed and the earthquake seems to have made no negative impact on the pandas.These two baby pandas Chengshuang and Chengdui are playfighting with each other and climbing trees.When they climbed too high,the breeders have to _ them from the trees.
The quake zone is not only the home of these pandas,it's also the source of their food.Fortunately,enough bamboo has been stored away in five bamboo storehouses for the pandas,so there are no worries about food supplies.
Wu Kongju,Breeder,Chengdu Panda Breeding Base,said,"When the Wenchuan earthquake happened on May 12,2008,we were unprepared and had a shortage of bamboo.But we've been able to handle this earthquake event more smoothly.There are no problems with the food supply." [/INST] question: When did the 7.0-magnitude earthquake happen in Lushan Sichuan Province? | options: A: On April 28,2013 B: On May 12,2008 C: On April 20,2013 D: On May 20,2013 | answer: C </s> |
<s>[INST] context: Manchester-Point A SystemThe Manchester System was designed for use with LDR radium brachytherapy. It is the most commonly used technique. Point A - Representing the paracervical triangle (where the uterine aery crosses the ureter). This is the commonly repoed dose point. The position has varied several times, but the most modern definition is 2 cm along the most inferior source within the tandem (alternatively 2 cm along the tandem from the external cervical os), and 2 cm lateral to the tandem. Point A is recorded for all brachytherapy treatments, even those that use image-guided techniques.Point B - Representing the pelvic sidewall/obturator nodes, Point B is located 5 cm lateral to the midline at the same level as point A. It also gives a guide as to the lateral spread of the radiation dose.ICRU Repo 38The ICRU released repo 38 regarding dosimetry of cervical cancer brachytherapy. It discouraged the use of Point A and Point B.It also recommended that bladder and rectal point doses be included.Bladder Point - After inseion of a Foley catheter, the balloon is inflated with 7 ml of contrast. The catheter is then pulled until the balloon rests against the urethra. The bladder point is the most posterior pa of an anteroposterior line drawn through the center of the balloon.Rectal Point - The rectal point is located 5 mm posterior to the posterior vaginal wall, along with a line perpendicular to the midpoint of the activity of the ovoids.The ICRU also recommended repoing of multiple other dose points, including pelvic wall points. These are not commonly repoed. The repoing of the dose delivered to the treatment volume was based on the length, width, and depth of the pear-shaped volume generated by the treatment.(Diagnosis and Management of Cancer by Asok Metha,page73) [/INST] question: Point A in radiotherapy for Ca cervix corresponds to | options: A: Lateral pelvic lymph nodes B: Urinary bladder C: Rectum D: Uterine vessel crossing ureter | answer: D </s> |
<s>[INST] context: Important Health Legislations passed in India
The Quarantine Act, 1870
The Vaccination Act, 1880
The Child Marriage Restraint (SARDA) Act, 1929
The Employees State Insurance (ESI) Act, 1948
The factories Act, 1948
The prevention of Food Adulteration (PFA) Act, 1954
o;The Immoral Traffic (Prevention) Act, 1956
The Indian Medical Council (Prof. Conduct and Ethics) Act 1956
The dowry Prohibition Act, 1961
The maternity Benefit Act, 1961
The Registration of Births and Deaths Act, 1969
The Medical Termination of Pregnancy (MTP) Act, 1971
The Narcotic Drugs and Psychotropic Substances Act, 1985
The Consumer Protection Act (COPRA), 1986
The Environmental Protection Act (EPA), 1986
The Mental Health Act, 1987
The Infant Milk Substitutes, Feeding Bottles and Infant Food (Regulation of production, supply and distribution) Act, 1992
The Protection of Human Rights Act, 1993
The Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994
The Biomedical Waste (Management and Handling) Rules, 1998
The National Rural Employment Guarantee Act (NREGA), 2005
The protection of Women from Domestic Violence Act, 2005
The Right to Information (RTI) Act, 2005 [/INST] question: Which of the following act(s) passed before 1980 – a) ESI actb) PNDT c) Factories actd) MTP acte) Air pollution act | options: A: acd B: ad C: bc D: bde | answer: A </s> |
<s>[INST] context: My name is Sam. I joined a club called "Passing help" last month. Now let me tell you why I joined it.
One evening this May, on my way home my old car broke down. It was 25 miles from my home. I wanted to _ in somebody else's car, but it was dark and there was no car. It was also hard to take a taxi. I decided to take a bus home. I went to a bus stop nearby.
After a while, a bus came ,but it did not go to my town. The bus driver was a young woman. She was kind and she told me which bus I should take. I waited there for about thirty minutes, but no bus came . At last a car came to me and a woman came out of the car. She was just the bus driver.
" When I reached the bus station. I got to know that the bus to your town couldn't come, so I returned here. I just can't leave you here," she said ."Get in my car and I will take you back to your home."
"It is a long way," I said.
"Come on, sir," she said."Let's go."
On the way she told me a story. A few days ago. There wasn't gas in her car. An old man drove her up to a gas station and then back to her car.
When we got to my home ,I wanted to give her some money to thank her, but she didn't accept it. " I only want to help others and do something nice for somebody. Pass it along." She said. [/INST] question: What happened to Sam one evening this May? | options: A: He lost his way B: His car broke down C: He was in danger D: He missed the bus | answer: B </s> |
<s>[INST] context: COMMON CAROTID ARTERIES:
There are two common carotid arteries: right and left. They are the chief arteries of the head and neck.
Origin:
The right common carotid artery arises in neck from brachiocephalic trunk (innominate artery) behind the
sternoclavicular joint.
The left common carotid artery arises in thorax (superior mediastinum) directly from the arch of aorta. It ascends to the back of left sternoclavicular joint and enters the neck.
Course, Termination, and Relations:
In the neck, both arteries (right and left) have similar course.
Each artery runs upwards from sternoclavicular joint to the upper border of the lamina of thyroid cartilage (opposite the disc between the 3rd and 4th cervical vertebrae), where it terminates by dividing into internal and external carotid arteries.
Key Concept:
Left and right CCA runs upwards from sternoclavicular joint to the upper border of the lamina of thyroid cartilage (opposite the disc between the 3rd and 4th cervical vertebrae), where it terminates by dividing into internal and external carotid arteries. [/INST] question: The level of branching of common carotid artery: | options: A: Upper border of thyroid cartilage B: Lower border of cricoid cartilage C: Lower border of thyroid cartilage D: Hyoid | answer: A </s> |
<s>[INST] context: Lucy, whose skeleton was discovered in Ethiopia in 1974, died shortly after she fell out of a tree, according to a new study published Monday in the British journalNature.
For their research, Kappelman and Dr. Richard Ketcham used a CT scanner to create more than 35,000 "slices" of Lucy's skeleton. Scientists named her Lucy from the Beatles song "Lucy in the Sky with Diamonds", which was played at the camp the night of her discovery.
The following analysis of the slices showed sharp, clean breaks seen at the end of Lucy's right humerus are similar to bone breaks seen in victims of falls.
The researchers concluded that these and other breaks in her skeleton show that Lucy, who is believed to have stood about 3 feet 6 inches and weighed about 60 pounds, fell feet first and used her arms to support herself -- but that the injury was too severe to have been survivable.
The researchers estimate that Lucy was going about 35 miles an hour when she hit the ground after falling from a height of roughly 40 feet, according to the statement.
That sounds _ . But other scientists are doubtful. "There are countless explanations for bone breaks," Dr, Donald C, Johanson, director of the Institute of Human Origins and one of the scientists who discovered Lucy, said, "The suggestion that she fell out of a tree is largely a just-so story and therefore unprovable." Johanson said it was more likely that Lucy's breaks occurred long after she died, saying that "elephant bones appear to have the same kind of breaks, It's unlikely they fell out of a tree. "
But the new research focused on "a small number of breaks" that are consistent with "high-energy bone-to-bone influences" and which differ from the sorts of breaks commonly seen in other collected bones. Kappelman responded in an email, "These appear to have occurred at or near the time of death." [/INST] question: What can we know about Lucy from Kappelman and Dr. Richard Ketcham's research? | options: A: She got her name from a song B: She had more than 35,000 slices C: She couldn't use her arms properly D: She made an effort to save herself | answer: D </s> |
<s>[INST] context: Perfect Disaster
All around us buildings shook. We decided to leave the town. We stopped once we had left the buildings behind us. The carts were moving in opposite directions, though the ground was perfectly flat, and they wouldn't stay in place even with their wheels blocked by stones.
In addition, it seemed as though the sea was being sucked backwards, as if it were being pushed back by the shaking of the land. Certainly the shoreline moved outwards, and many sea animals were left on dry sand.
Behind us were frightening dark clouds that opened up to show fire--like lightning, but bigger. Not long after that the clouds reached down to the ground and covered the sea. Now came the dust, though still thin. I looked back. A dense cloud appeared behind us, following us like a flood pouring across the land. Then a darkness came that was not like a moonless or cloudy night, but more like being in a closed and unlighted room. You could hear women and children crying, men shouting. Some were calling for parents, others for children; they could only recognize them by their voices.
Darkness and ashes came again, a great weight of them. We stood up and shook the ash off again and again; otherwise we would have been covered with it and crushed by the weight.
At last the cloud became thinner and thinner until it was no more than smoke or fog. Soon there was real daylight. The sight that met our still terrified eyes was a changed world, buried in ash like snow.
--from Pliny's letter to a friend [/INST] question: Pliny left the town after _ . | options: A: the eruption B: the sky became dark C: the buildings began shaking D: the sea went back | answer: C </s> |
<s>[INST] context: Weather has a strong effect on people. It influences health, intelligence and feelings. In August, it is very hot and wet in the southern part of the United States. People there easily have heart trouble and other kinds of health problems during this month. In the Northeast and the Middle West, it is hot at some times and very cold at other times. People in those states will have heart trouble after the weather changes in February or March.
The weather can also influence intelligence. For example, in a 1983 study by scientists, the IQ scores of some college students were very high during storm, but after the storm, their scores were low. Storms can increase intelligence. Very hot weather, on the other hand, can decrease it. Students in many schools of the United States often do badly in exams in the hot months of the year(July and August).
Weather also has a strong effect on people's feeling. Winter may be a bad time for thin people. They usually feel cold during these months. They might feel depressed during cold weather. In hot summer weather, on the other hand, fat people may feel unhappy. At about 65F, people become stronger.
Low air pressure makes people feel free, but it also increases forgetful- ness. People leave more bags and umbrellas on buses and in stores on low pressure days. There is a"perfect weather"for work and health. People feel best at a tempera- ture of about 64F with 65 percent humidity .
Are you feeling sick, sad, tired, forgetful, or very intelligent today? The weather may be the reason. [/INST] question: Intelligence may be lower _ . | options: A: during a storm B: when it is sunny C: on a very hot day D: when you take in an exam | answer: C </s> |
<s>[INST] context: Bainbridge reflex: Increase in atrial pressure causes increase in hea rate by nervous reflex called Bainbridge reflex 40 - 60 % increase in rate is due to this reflex while 15% increase is by direct effect of increased atrial volume to stretch sinus node. Stretch receptors of atria that elicit Bainbridge reflex transmit their afferent signals through vagus nerve to medulla of brain. These efferent signals are transmitted back through vagal & sympathetic nerves to increase H.R & strength of hea contraction. This reflex helps prevent damming of blood in atria, veins & pulmonary circulation Best known nerve mechanisms for aerial pressure control Reflex is initiated by stretch receptors called baroreceptors /pressoreceptors located at specific points in walls of several large systemic aeries A rise in aerial pressure stretches baroreceptor & causes them to transmit signals into CNS. "feedback" signals are then sent back through autonomic nervous system to circulation to reduce aerial pressure downward towards the normal level [/INST] question: Bainbridge reflex is due to:- | options: A: Stretching of atria B: Baroreceptor reflex C: Decreased venous return D: Increased ventricular activity | answer: A </s> |
<s>[INST] context: Leptospirosis is a zoonosis of worldwide distribution. Human infection results from ingestion of water or food contaminated with leptospirae. Rats, mice, wild rodents, dogs, swine, and cattle excrete the organisms in urine and feces during active illness and during an asymptomatic carrier state. Drinking, swimming, bathing, or food consumption may lead to human infection. Children acquire the disease from dogs more often than do adults. Treatment can include doxycycline, ampicillin, or amoxicillin. Symptoms in humans range from fever and rash to jaundice through aseptic meningitis.Leptospirae are tightly coiled, thin, flexible spirochetes 5 to 15mm long, with one end bent into a hook. It stains best where silver can be impregnated into the organism. The gram stain would not be useful. The organisms derive energy from oxidation of fatty acids, so EMB or TM agar would be inadequate. Agglutination testing and CIE is complicated by the fact that all Leptospirae strains exhibit cross-reactivity in serologic tests. [/INST] question: A 12-year-old boy has sudden onset of fever, headache, and stiff neck. Two days earlier, he swam in a lake that is believed to have been contaminated with dog excreta. Leptospirosis is suspected. Which of the following laboratory tests is most appropriate to determine whether he has been infected with leptospira? | options: A: Agglutination test for leptospiral antigen B: Counter immune-electrophoresis of urine sample C: Gram stain of urine specimen D: Spinal fluid for dark-field microscopy and culture in Fletcher serum medium | answer: D </s> |
<s>[INST] context: Many of us don't pay attention to the importance of eye care. It's said that if you take care of your body, then you can be healthy. That is why our eyes should be given a lot of care. Natural eye care should be put in a number one place.
There are several causes leading to poor eyesight like not enough food, gene and aging . Televisions, computers and reading are also the causes of having poor eyesight.
If you happen to work in front of the computer, it is best to take a rest every once in a while. Something dirty can cause redness and they will make you feel uncomfortable. It is bad for your eyes, too. If this happens, the best way is to clean your eyes by using cold water. You must also try your best to protect your eyes from harmful thing. For example, sunglasses are not just fashion but they can also serve as a great way to protect your eyesight from _ .
Eating healthy foods will do good to your eyesight. Remember that vitamins A, C and E are good for eyes. Try to eat food groups that have these vitamins. And you should do eye exercises because exercise protects your eyesight, too. If a person exercises regularly and eats the right kind of food, his eyes will stay in good condition for a long time.
All above are natural ways of eye care that help us keep healthy eyes. Being happy all the time can be helpful to a person's eyesight, too. In a word, eye care is very important, no matter how old a person is.
,. [/INST] question: _ is the most important way to protect our eyes. | options: A: Natural eye care B: Taking medicine C: Seeing the doctor D: Being happy all the time | answer: A </s> |
<s>[INST] context: Features of CD
Ileum is involved most commonly; therefore, CD is also known as terminal ileitis.
In the affected segment, mesentric fat wraps around the bowel surface → creeping fat.
The intestinal wall is rubbery and thick, as a consequence of edema, inflammation, fibrosis, and hypertrophy of the muscularis propria → lumen is almost always narrowed string sign on barium meal.
A classic feature of CD is the sharp demarcation of diseased bowel segments from adjacent uninvolved bowel. When multiple bowel segments are involved, the intervening bowel is normal → skip lesions.
There are serpentine linear ulcer along the axis of bowel.
As the intervening mucosa tends to be relatively spared, the mucosa acquires a coarsely textured → Cobblestone appearance.
Narrow fissures develop between the folds of the mucosa.
Fissures can penetrate deeply through the bowel wall and leading to bowel adhesions and serositis.
Further extension of fissures leads to fistula or sinus tract formation.
There is transmural inflammation affecting all layers of bowel wall.
Sarcoid like noncaseating granulomas may be present in all tissue layers.
Neutrophilic infiltration into the crypts results in formation of crypt abscess.
Fibrosis of the submucosa, muscularis propria, and mucosa enentually leads to stricture fromation.
There is an increased incidece of cancer of GIT in patints with long- standing CD, but the risk of cancer in CD is considerably less then in patients with chronic UC.
Screening test is presence of anti-Saccharomyces cerevisae antibody (ASCA). Antibody formation is common against cell wall of yeast, Saccharomyces cerevisae in patients of CD.
To confirm the diagnosis endoscopy is done so that direct visualization of the lesion can be done and even a biopsy can be done if needed. [/INST] question: Skip granulomatous lesions are seen in - | options: A: Ulcerative colitis B: Crohn's disease C: Whipple's disease D: Reiter's disease | answer: B </s> |
<s>[INST] context: A man came home from work late, tired and irritated, to find his 5-year-old son waiting for him at the door. "Daddy, may I ask you a question?" "Yeah sure, what is it?" replied the man. "Daddy, how much do you make an hour?" "That's none of your business. Why do you ask such a thing?" the man said angrily. "I just want to know. Please tell me. How much do you make an hour?" pleaded the little boy. "If you must know, I make $20 an hour." "Oh," the little boy replied, with his head down. Looking up, he said, "Daddy, may I please borrow $10?"
The father was furious, "If the only reason you asked that is so you can borrow some money to buy a silly toy or some other nonsense, then you march yourself straight to your room and go to bed. Think about why you are being so selfish. I don't work hard every day for such childish behavior." The little boy quietly went to his room and shut the door. The man sat down and started to get even angrier about the little boy's questions. How dare he ask such questions only to get some money? About an hour or so, the man had calmed down, and started to think: maybe there was something he really needed to buy with that $10 and he really didn't ask for money very often.
The man went to the door of the little boy's room and opened the door. "Are you asleep, son?" He asked. "No daddy, I'm awake," replied the boy. "I've been thinking, maybe I was too hard on you earlier," said the man. "It's been a long day and I took out my aggravation on you. Here's the $10 you asked for."
The little boy sat straight up, smiling. "Oh, thank you, daddy!" he yelled. Then, reaching under his pillow he pulled out some crumpled up bills. The man, seeing that the boy already had money, started to get angry again. The little boy counted out his money, then looked up at his father. "Why do you want more money if you already have some?" the father grumbled. "Because I didn't have enough, but now I do," the little boy replied. "Daddy, I have $20 now. Can I buy an hour of your time? Please come home early tomorrow. I would like to have dinner with you." [/INST] question: When the boy asked his father how much he earned an hour, his father _ . | options: A: was very happy B: answered him immediately C: was not willing to tell him D: didn't tell him at all | answer: C </s> |
<s>[INST] context: Benjamin Franklin was born on January 17,1706 in Boston,America. In his life he built a successful printing and publishing business in Philadelphia;he conducted scientific studies of electricity and made several important discoveries;he was a diplomat and statesman;he helped establish Pennsylvania's first university and America's first city hospital;he also organized the country's first subscription library .
Franklin was also _ in America as an inventor until Thomas Edison. Ben had poor eyesight and needed glasses to read. He got tired of always taking them off and putting them back on,so he decided to figure out a way to make his glasses let him see both near and far. He had two pairs of glasses cut in half and put half of them together. Today,we call them bifocals .Another invention of his,an iron stove,allowed people to warm their homes.
He loved to learn about new things. He also thought it was important to make life better with the things that he invented. Electricity was one of the things he experimented with when he retired from his business. Ben discovered that lightning and electricity were the same thing. The lightning rod was an important invention that we still use today to protect buildings and ships from lightning damage.
Franklin preferred to have his inventions used freely for the comfort and convenience of everyone. Thomas Jefferson,the third president of America,called Benjamin Franklin "the greatest man of the age and country in which he lived".To Benjamin Franklin there was no greater purpose in life than to "live usefully". [/INST] question: Benjamin Franklin was NOT a _ . | options: A: diplomat B: scientist C: businessman D: president | answer: D </s> |
<s>[INST] context: HARBIN - A wild Siberian tiger was spotted on a forestry farm in northeast China's Heilongjiang Province on Sunday, forestry officials said Tuesday.
The tiger, believed to have been hunting for a wild boar at the time, came face to face with several workers late in the afternoon on a forestry farm administered by the Dongfanghong Forestry Bureau (DFB) in the eastern part of the province, said an official with the provincial Forestry Industry Bureau. The farm is located on the scarcely populated Wandashan Mountain, where wild Siberian tigers have been spotted many times, but it was the first time for such an animal to come so close to human beings.
"We had just finished work in the forest when the tiger appeared." said Shi Chun, one of the workers who saw the tiger. Upon seeing the animal, the workers rushed to their tractor to avoid possible attacks. The tiger followed the tractor for several hundred meters before going away.
The tiger remained mild throughout the encounter, and the workers even managed to snap a few photos of it. The pictures, though blurry due to the darkened sky, show a Siberian tiger with white hair in its face. Local authorities on Monday checked the site where the big cat was spotted and found plum-shaped paw prints, which they believe belong to a grown wild Siberian tiger.
Yang Lijuan, a wild animal protection official with the DFB, said the forestry farm is a good site for wild animal reproduction. "The farm is in a zone where coniferous and broad-leaved trees grow, which provides much food for the tigers' prey, such as a boar and deer." she said.
Siberian tigers, otherwise known as Amur or Manchurian tigers, mainly live in eastern Russia, northeast China and the northern part of the Korean Peninsula. It is estimated that only about 500 currently live in the wild, with about twelve in Heilongjiang Province and eight to ten in neighboring Jilin Province. The DFB has stepped efforts to increase food for wild boar, roe deer and red deer in its forestry farms where Siberian tigers have been spotted to ensure enough prey for the endangered species. [/INST] question: Where can you find a wild Siberian tiger probably? | options: A: Russia B: Australia C: South China D: Canada | answer: A </s> |
<s>[INST] context: Alan worked in an office in the city. He worked very hard and really wanted to take a
holiday. He usually went to the seaside, but one day he saw an ad in a newspaper. "Enjoy
country life. Spend a few weeks at Willow Farm. Good food, fresh air, horse riding, walking,
fishing. Good prices ." "This sounds like a good idea," he thought. "I'll spend a month at
Willow Farm. I'll enjoy horse riding, walking and fishing. They'll make a change from sitting by
the seaside."
Four days later he returned home.
"What's wrong with Willow Farm?" his friend Jack asked him. "Didn't you enjoy country
life?"
"Country life was fine," Alan said, "but there was another problem ."
"Oh, what?"
"Well, the first day I was there a sheep died, and we had roast mutton for dinner."
"Fresh meat is the best."
"I know, but on the second day a cow died, and we had roast beef for dinner."
"Lucky you!"
"You don't understand," Alan said. "On the third day a pig died and we had roast pork for
dinner." '
"A different roast every day," Jack said.
"Let me finish," Alan said, "on the fourth day the farmer died and I didn't dare to stay for
dinner!" [/INST] question: Where did Alan work? He worked _ . ' | options: A: on a farm B: at a school C: in a restaurant D: in an office in a city | answer: D </s> |
<s>[INST] context: "Anastomotic urethroplasty is the procedure of choice in the totally obliterated bulbar urethra after a straddle injury. The typical scar is 1.5 to 2 cm long and should be completely excised. The proximal and distal urethra can be mobilized for a tension-free, end-to-end anastomosis. This is a highly successful procedure in more than 95% of cases. Endoscopic incision (urethrotomy) through the scar tissue of an obliterated urethra is a hopeless procedure and uniformly fails. Partial urethral narrowing can initially be treated by endoscopic incision with higher success. It is now recognized that repeated urethrotomy and dilation is neither clinically effective nor cost-effective for the treatment of urethral strictures. Further, patients who have had repeated endoscopic procedures are also more likely to require complex reconstructive procedures such as grafts" — Campbell's Urology
"Urethroplasty should be considered when the stricture has arisen following trauma, and when a stricture has recurred following endoscopic treatment. "- Bailey
Urethroplasty can be of two types:
excision and end-to-end anastomosis- done for short stricture segments (≤2 cm)
patch urethroplasty- for longer segments [/INST] question: A 40-yr-old patient of pelvic injury presents with stricture bulbar urethra of 1.5 cm length. What would be the management? | options: A: Urethral dilatation B: Excision and end to end urethroplasty C: Patch graft urethroplasty D: Urethrotomy | answer: B </s> |
<s>[INST] context: Sir Arthur Conan Doyle, who wrote the story of the detective Sherlock Holmes, was having a trip in Europe. One day he got out of the railway station and climbed into a taxi. Before he could say a word, the driver turned to him and asked, "Where can I take you, Mr. Doyle?"
Doyle was rather surprised. He asked the driver if he had ever seen him before. "No, sir," the driver replied, "I have never seen you before." Then he explained, "This morning's newspaper had a story about your being on vacation in Marseilles. This is the taxi stop where people who return from Marseilles always come. Your skin color tells me you have been on vacation. The ink spot on your right fingers suggests to me that you are a writer. Your clothes are very English, not French. Adding up all those pieces of information, I conclude that you are Sir Arthur Conan Doyle."
"This is truly surprising!" the writer cried out. "You are a real-life copy to my fictional story, Sherlock Holmes!"
"And there is one other thing," the driver added, with a smile on his face.
"What's that?"
"Your name is on the front of your suitcase." [/INST] question: The conversation between the two people took place _ . | options: A: at a bus stop B: in a taxi C: in Marseilles D: in a railway station | answer: B </s> |
<s>[INST] context: A new study shows students who write notes by hand during lectures perform better on exams than those who use laptops .
Students are increasingly using laptops for note-taking because of speed and legibility . But the research has found laptop users are less able to remember and apply the concepts they have been taught.
Researchers performed experiments that aimed to find out whether using a laptop increased the tendency to make notes "mindlessly" by taking down word for word what the professors said.
In the first experiment, students were given either a laptop or pen and paper. They listened to the same lectures and were told to use their usual note-taking skills. Thirty minutes after the talk, they were examined on their ability to remember facts and on how well they understood concepts.
The researchers found that laptop users took twice as many notes as those who wrote by hand. However, the typists performed worse at remembering and applying the concepts. Both groups scored similarly when it came to memorizing facts.
The researchers' report said, "While more notes are beneficial, if the notes are taken mindlessly, as is more likely the case on a laptop, the benefit disappears."
In another experiment aimed at testing long-term memory, students took notes as before but were tested a week after the lecture. This time, the students who wrote notes by hand performed significantly better on the exam.
These two experiments suggest that handwritten notes are not only better for immediate learning and understanding, but that they also lead to superior revision in the future. [/INST] question: More and more students favor laptops for note-taking because they can _ . | options: A: write more notes B: digest concepts better C: get higher scores D: understand lectures better | answer: A </s> |
<s>[INST] context: Nowadays they are giving homework even during the holidays and I hate that very much. But I think there is a reason for it. Homework is given so that we can remember whatever we have learnt. Regular drilling and repetition make perfect. But teachers have started to give too much homework. Anything in excess is bad.
Jane
What's the use of just homework without allowing children to get an insight into the subject? It just makes them bookworms but nothing else. Homework such as writing some things 5 times at home will just make them memorize things but not put them into use. I regret to say that teachers find it easy to bundle the children with homework rather than making them get interested to understand what they learn. The same trend continues even in college. I find that most of the so-called high scorers are unable to answer simple things in an interview.
Sally
It is OK to give homework. But it should be given less. We are spending most of our time in school and at least we must be free in our home. If you give homework, we will be very tired and we wouldn't be able to pay attention to extra-curricular activities, which in turn may affect our physical and mental health. So please give less homework to us.
Johnson
It is part of our work to give students homework. There will be some punishments if we won't do our work. So I have to do that though I know such a teacher is not liked by students. [/INST] question: Who thinks that too much homework may do harm to students' physical and mental health? | options: A: Sunny B: Jane C: Sally D: Johnson | answer: C </s> |
<s>[INST] context: Food,football and fashion--Milan has it a11.The city is perhaps most famous for its annual Milan Fashion Week and its world-class soccer teams AC Milan and Inter Milan.And May will see it host the six-month Milan Expo,the theme of which is food and nutrition.
Milan may not the first place tourists think of when they think of Italy.Rome is the most famous city in Italian history,Venice draws visitors who want to travel along its canals and Florence is popular with art lovers.Yet Milan can often be left off tourists'lists.But although some see Milan as the"ugly sister"of these cities,according to Lonely Planet,in 2015 the city is"suddenly back in fashion in a big way".
The Milan Expo will look at the future of food,trying to answer the question of how Earth's fast-growing population can be fed in the future.According to Lonely Planet website."144 countries will set up shop northwest of central Milan,forming a mini city-within-a-city".
Milan's famous opera house,La Scala,normally closed in the summer,will also host daily performances during the expo,reported Fox News.
Not interested in opera?Don't worry.Visitors who prefer sports may want to visit the San Siro stadium,home of the soccer teams AC Milan and Inter Milan.Tile stadium is one of the most famous in Europe and has seen many important games over the years,both in Serie A and the European Champions League.
So even if all of its fashion and beautiful people can make Milan seem"soulless",as Lonely Planet said.it still has"a serious sense of history and place".Many people will be discovering it this year,and eating great food from all over the world to help solve world problems.Will you? [/INST] question: Which of the following statements is True about Milan? | options: A: It is the largest city in Italy and has the longest history B: It is hosting the world's largest Fashion Week in 2015 C: Football,fashion and ancient canals are three features of the city D: The city's La Scala opera house will offer additional performances in 2015 | answer: D </s> |
<s>[INST] context: Every evening, 15-year-old Rashida returns home from school, changes out of her uniform, and rushes to a neighboring farm to help her mother harvest vegetables. Her father is disabled, so the modest profit the two of them earn must cover food, clothing and other necessities for all seven children and their parents. Despite having precious little time to study, Rashida is one of the top students at her junior secondary school. But with so much responsibility on her small shoulders, she admits that it is sometimes hard for her to imagine a more promising future.
Last year, Rashida was invited to join 155 other girls at Camfed Ghana's first Girls' Career Camp, a program designed to inspire girls growing up in the country's Northern Region to dream big, and to support them to pursue those dreams. "We organized this camp because we wanted to let girls know that even if they are struggling with poverty, their lives will not be defined by limitations," says Dolores Dickson, Camfed Ghana's Executive Director.
Over the course of five days, the camp led the junior and secondary school students through a range of experiences and career opportunities that were entirely new to them. Dr. Agnes Apusiga, a lecturer from the University of Development Studies, ran the workshop on goal-setting and career choices, describing the universities and training colleges in Ghana that could help them achieve their dreams. Participants then visited the University for Development Studies, where they toured the medical school and science labs. Another highlight was a workshop at the computer lab at Tamale Secondary School. Many of the girls had studied information technology from a book but had never before seen a computer.
"When the girls arrived at camp, they were not ambitious, because they didn't have any idea what the world held for them," says Eugenia Ayagiba, Project Officer with Camfed Ghana. "Many had scarcely traveled beyond their own villages."
"I think the most important thing that happened at the camp is that we opened a window of hope for a group of girls coming from backgrounds of poverty," says Eugenia. For Rashida, who has been laughed at in the past by her schoolmates because of her father's disability, the experience was important. "She told one of the camp mentors that when she is at school, she often feels like a misfit, and she prefers to keep to herself," says Eugenia. "But at the camp, it was different. She made friends with girls who have similar struggles. She took part in every single activity, every single game. On the last day, she said to her mentor, "The camp has challenged me to study hard. Now I see that there is light at the end of the tunnel." [/INST] question: How many members are there in Rashida's family? | options: A: Seven B: Eight C: Nine D: Ten | answer: C </s> |
<s>[INST] context: Refer Robbins 9/e p953 Clear cell carcinoma. This is the most common type, accounting for 70% to 80% of renal cell cancers. The tumors are made up of cells with clear or granular cytoplasm and are nonpapillary. They can be familial, but in most cases (95%) are sporadic. In 98% of these tumors, whether familial, sporadic, or associated with VHL syndrome, there is loss of sequences on the sho arm of chromosome 3. The deleted region harbors the VHL gene (3p25.3). A second nondeleted allele of the VHL gene shows somatic mutations or hypermethylation-induced inactivation in up to 80% of clear cell cancers, indicating that the VHL gene acts as a tumor suppressor gene in both sporadic and familial cancers (Chapter 7). The VHL gene encodes a protein that is pa of a ubiquitin ligase complex involved in targeting other proteins for degradation. Impoant among the targets of the VHL protein is the transcription factor hypoxia- inducible factor-1 (HIF-1). When VHL is inactive, HIF-1 levels remain high, even under normoxic conditions, causing inappropriate expression of a number of genes that are turned on by HIF. These include genes that promote angiogenesis, such as VEGF, and genes that stimulate cell growth, such as insulin-like growth factor-1 (IGF-1). In addition, HIF collaborates in complex ways with the oncogenic factor MYC to "reprogram" cellular metabolism in a way that ors growth. D [/INST] question: Most common histological type of renal cell carcinoma | options: A: Clear cell B: Medullary C: Papillary D: Mixed type | answer: A </s> |
<s>[INST] context: In 1996, John Tierney suggested in the New York Times Magazine article that "recycling is garbage." He wrote, "The money spent on recycling programs should have been spent on real social and environmental problems. Recycling programs not only increase energy use and pollution, but also cost more money than the disposal of plain old garbage. Recycling may be the most wasteful activity in modern America."
Environmental groups were quick to express their disagreement. They wrote reports on how recycling programs in cities can reduce pollution and cost less than regular garbage pickup and disposal. Michael Shapiro, an official of the US Environmental Protection Agency(EPA), said that "recycling can be good value for money, although there's still room for improvements."
But in 2002, New York City, a pioneer of recycling, found that its recycling program was losing money, so it stopped glass and plastic recycling. Other major cities watched closely to see how New York was dealing with its remaining program (the city never stopped paper recycling). But then it closed its last landfill , and private companies out of New York raised prices due to the increased workload of carrying away and disposing New York's garbage. As a result, glass and plastic recycling became profitable for the city again, and New York brought the program back. According to Cecil Adams of The Chicago Reader, the lessons learned by New York are relevant everywhere. He believes that, if managed correctly, recycling programs should cost cities less than garbage disposal.
Even though the benefits of recycling over disposal are many, keep in mind that it better serves the environment to "reduce and reuse" before recycling is even considered as a choice. [/INST] question: Why did John Tierney think "recycling is garbage"? | options: A: Because he considered recycling a wasteful activity B: Because he didn't think recycling was a new idea C: Because he found few people would like to recycle D: Because he didn't like the environmental groups | answer: A </s> |
<s>[INST] context: How many things can you see in the night sky? A lot! On a clear night you can see the moon, some planets, and thousands of sparking stars.
You can see even more with a telescope. You might see that many stars look larger than others. You might see that some stars that look white are really red or blue. With bigger and bigger telescopes you can see more and more objects in the sky. And you can see those objects in more and more detail.
But scientists believe there are some things in the sky that we will never see. We won't see them with the biggest telescope in the world, on the clearest night of the year.That's because they're _ . They're the mysterious dead stars called black holes.
You might find it hard to imagine that stars die. After all, our sun is a star. Year after year we see it up in the sky, burning brightly and giving us heat and light. The Sun certainly doesn't seem to be getting old or weak. But stars do burn out and die after billions of years.
As a star's gases burn, they give off light and heat. But when the gases run out, the star stops burning and begins to die.
So next time you look up at the night sky, remember: there's more in the sky than we can see! [/INST] question: On a clear night we might see things except _ . | options: A: the moon B: some planets C: sparkling stars D: the sun | answer: D </s> |
<s>[INST] context: Cutaneous T cell lymphoma (CTCL) represents a spectrum of lymphoproliferative disorders affecting the skin. Two different clinical types of malignant T-cell disorders were originally recognized: mycosis fungoides, a chronic proliferative process; and a more aggressive nodular eruptive variant, mycosis fungoides d'emblée. Lesions of mycosis fungoides usually involve truncal areas and include scaly, red -brown patches; raised, scaling plaques that may even be confused with psoriasis; and fungating nodules. In some individuals, seeding of the blood by malignant T cells is accompanied by diffuse erythema and scaling of the entire body surface (erythroderma), a condition known as Sézary syndrome. The histologic hallmark of CTCL of the mycosis fungoides type is the presence of the Sézary-Lutzner cells. These are T-helper cells (CD4+) that characteristically form band-like aggregates within the superficial dermis ( Fig. 25-19B ) and invade the epidermis as single cells and small clusters (Pautrier microabscesses). These cells have markedly in folded nuclear membranes, imparting a hyperconvoluted or cerebriform contour. Although patches and plaques show pronounced epidermal infiltration by Sézary-Lutzner cells (epidermotropism), in more advanced nodular lesions the malignant T cells often lose this epidermotropic tendency, grow deeply into the dermis, and eventually spread systemically. [/INST] question: Sézary-Lutzner cells are seen in | options: A: ALCL B: Hairy cell leukemia C: Mycosis fungoides D: PTCL | answer: C </s> |
<s>[INST] context: Paclitaxel It is a complex diterpin taxane obtained from bark of the Western yew tree, which exes cytotoxic action by a novel mechanism. It enhances polymerization of tubulin: a mechanism opposite to that of vinca alkaloids. The microtubules are stabilized and their depolymerization is prevented. This stability results in inhibition of normal dynamic reorganization of the microtubule network that is essential for vital interphase and mitotic functions. Abnormal arrays or &;bundles&; of microtubules are produced throughout the cell cycle. Cytotoxic action of paclitaxel emphasizes the impoance of tubulin-microtubule dynamic equilibrium. The approved indications of paclitaxel are metastatic ovarian and breast carcinoma after failure of first line chemotherapy and relapse cases. It has also shown efficacy in advanced cases of head and neck cancer, small cell lung cancer, esophageal adenocarcinoma and hormone refractory prostate cancer. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:825 [/INST] question: Mechanism of action of paclitaxel is: | options: A: Topoisomerase inhibition B: Increases the polymerization of tubulin C: Inhibits protein synthesis D: Alkylation of DNA | answer: B </s> |
<s>[INST] context: "Choo,Choo!"Here comes the Chunnel train. Get aboard if you want to learn more about this underground transportation system. This is an unusual form of transportation, because it is a tunnel that trains travel through and not an actual form of transportation.
The Chunnel is actually the English nickname for the Channel Tunnel. In French,it is called le tunnel sous la Manche. It is a rail tunnel beneath the English Channel at the Straits of Dover. It connects Cheriton in Kent, England with Sangatte in northern France. It is the second longest rail tunnel in the world.
Did you know that the British and the French had a race while they were building the Chunnel? The race was to see who could get to the middle of the tunnel first. The British won by a little bit. It took 15,000 workers over seven years to dig the tunnel. The tunnel was finished in 1994.
The completed Chunnel cost about $21 billion. But it all paid off, because it became very popular, very quick. Millions of people use it. Now it is getting even more popular.
There are three complete tunnels in the Chunnel. The two outside ones are the passenger trains. The small inner one is a guidance train. The guidance train is not used for transportation. Each track is exactly parallel to each other.
There are four different train systems in the Chunnel. The Eurostar is a high speed passenger service that connects London, Paris, Brussels and Lille. The Eurotunnel shuttle is a rail ferry service. These shuttles carry cars and vans. These are railcars that allow drivers to drive their vehicles on and off. There are also two Eurotunnel goods service trains.
Now you know more about the Chunnel. Everybody off,this is the last stop. [/INST] question: The Channel Tunnel links _ with _ . | options: A: London; Paris B: Cheriton; Sangatte C: Lille; Brussels D: Dover; Kent | answer: B </s> |
<s>[INST] context: Prostate cancers account for 43% of all cancers diagnosed in American men. It is estimated that in 1996, 317,000 new cases of prostate cancer were diagnosed and 41,000 men died of the disease. The challenge of treating prostate cancer lies in accurately distinguishing those histologically-localized cancers which will complete metastatic progression from those that will remain indolent. At this time, we lack appropriate histological markers to make such distinctions, therefore, it is often difficult to accurately predict the clinical course of an individual patient's disease. There is growing evidence that a critical event in the progression of a tumor cell from a non-metastatic to metastatic phenotype is the loss of function of metastasis-suppressor genes. These genes specifically suppress the ability of a cell to metastasize. Work from several groups has demonstrated that human chromosomes 8, 10, 11 and 17 encode prostate cancer metastasis suppressor activities. As a result of these effos the first prostate cancer metastasis-suppressor gene, KAI1, was identified and mapped to the p11-2 region of chromosome 11. In subsequent studies, an additional gene encoded by the same region, CD44 was also determined to have metastasis-suppressor activity. Recent studies have shown a correlation between decreased expression of KAI1 and CD44 and an increased malignant potential of prostate cancers. It is anticipated that the identification of other metastasis suppressor genes may allow for the development of diagnostic markers useful in the clinical substaging of individual tumors. This manuscript is intended to present our perspective on the impoance of these genes in the understanding of prostate cancer progression. More impoantly, we present new findings from our laboratory's effo to identify the metastasis-suppressor genes encoded by human chromosome 17. Specifically we repo the strategy currently being used to evaluate a series of candidate genes and the approach being utilized to pinpoint the metastasis-suppressor region on human chromosome 17. [/INST] question: Which of the following is a metastasis suppressor gene in relation to prostate cancer | options: A: KAI - 1 B: NM 23 C: KISS D: p53 | answer: A </s> |
<s>[INST] context: Do you prefer British English or American English? Here are opinions from our readers.
Andy: Well, being in British for 3 years now from New Zealand I've come to realize that a lot of British people pronounce words how Americans do. But in saying that, I guess the more educated British people do not pronounce words the way some Americans do. So, I prefer Educated British English.
Bill: Well, I am studying English and I think British sounds funny and I prefer Americans sounds. Although I can tell that everyone else in my class loves British pronunciation and thinks American English is less pretty or even ugly. I don't agree at all, though.
Cindy: At first British English accent sounds better and wonderful but then it gets annoying, so I love American English.
Dale: I prefer the British accent. It sounds like someone reading a poem. I just like the pronunciation of the British people, very clear and sounds like music! British accent is more musical.
Edward: When I listen to the BBC announcers, I notice that they're exploding the letters out, not pronouncing them. And some British people from the North of England or Scotland speak with strange accents. I mean it is difficult to understand their English.
Frank: As a matter of fact, English for International Communication is very much like American accent. I love the American accent. [/INST] question: How many of the readers said they preferred British English? | options: A: One B: Two C: Three D: Four | answer: B </s> |
<s>[INST] context: Li Siyi, a student from Jinan Foreign Language School, takes up a new habit. She refuses to believe everything that she reads. "Not everything in books is true," she said.
Many other students in her school think the same thing as Li. They learned this through finding a mistake in their Chinese textbook. They learned a Tang poem, Ci Beigu Shanxia, last year. There was a picture that showed a boat in full sail on a river. "But according to the famous line from the poem, feng zheng yifan xuan, the sail shouldn't be spread ," said Zhang Jiayi, Li's classmate.
To get the right answer, the students turned to their Chinese teacher, Liu Yan. Liu and the students looked up books, searched on the Internet and made sure that the People's Education Press had really made a mistake about the picture.
The students wrote a letter to them about the mistake. "I think my students did a right thing but I never expected a reply," said Liu. "I took it as a way of letting them know the importance of spirit of questioning."
To their surprise, one month later, they got the reply from Gu Zhenbiao, the expert of Chinese textbooks in middle schools. Gu said sorry for the mistake and he also said he really thinks the students are very great.
When Liu read the letter loudly to all the students, everyone was excited. "We are very happy we have our own ideas!" said Li. [/INST] question: What new habit does Li Siyi take up? | options: A: Refusing to read B: Reading more poems C: Writing letters to experts D: Making sure if what she reads is true | answer: D </s> |
<s>[INST] context: An excerpt from The Card
Edward Henry Machin first saw daylight on the 27thof May, 1867, in Brougham Street in Bursley, the oldest of the Five Towns. Brougham Street goes down a hill to the canal .The rent for one of these houses was not high -- only about twenty-two pence a week.
Edward Henry's mother (his father was dead) lived by making and washing clothes for fine ladies. She did not often laugh. She was a woman of few words, and saved time every day by calling her son Denry, instead of Edward Henry.
Denry did not work hard at school, and boys who were lazy and not very clever usually just found jobs in the potbanks. Luckily, at the age of twelve, he won a place at the best school in Bursley. It happened like this. On the second day of the examination, Denry arrived a little early. As he walked around the examination room, he came to the teacher's desk, where he saw a list of names with marks for the first day of the examination. The highest possible mark was 30, but next to his name he saw the number 7. The numbers were written in pencil, and the pencil was on the desk. He picked it up, looked around the empty room, and at the door, and them wrote a 2 in front of the 7. Of course, this was not honest, but how many truly honest schoolboys are there? Denry was no worse than most of them. [/INST] question: What was Edward Henry's mother like? | options: A: Patient B: Dishonest C: Hard-working D: Kind | answer: C </s> |
<s>[INST] context: Vitamins are organic molecules that function in a wide variety of capacities within the body. The most prominent function of the vitamins is to serve as cofactors (co-enzymes) for enzymatic reactions. The distinguishing feature of the vitamins is that they generally cannot be synthesized by mammalian cells and, therefore, must be supplied in the diet. The vitamins are of two distinct types, water soluble and fat soluble Alpha-lipoic acid, LA, (chemical name: 1,2-dithiolane-3-pentanoic acid; also known as thioctic acid), is a naturally occurring dithiol compound synthesized enzymatically in the mitochondrion from the medium-chain fatty acid octanoic acid. Because LA can be synthesized in the body it is not technically considered a vitamin but because of its vital role in overall cellular metabolism, it is considered as an impoant, but not necessary, dietary supplement. Given that LA is a necessary cofactor for mitochondrial a-ketoacid dehydrogenases, it thus serves a critical role in mitochondrial energy metabolism. In addition to de novo synthesis, LA is also absorbed intact from dietary sources, and it transiently accumulates in many tissues [/INST] question: Non-vitamin coenzyme is | options: A: Lipoic acid B: CoA C: S-adenosyl methionine D: Niacin | answer: A </s> |
<s>[INST] context: (Imatinib mesylate) (444-CMDT-08) (685-H17th)CHRONIC MYELOID LEUKEMIA* **Allogenic stem cell transplant (SCT) is the only curative therapy for CML and when feasible is the treatment of choice* * * When allogenic SCT is not feasible, Interferon a therapy is the treatment of choice* Recombinant a - Interferon had largely replaced hydroxy urea as the treatment of choice for CML* Leukapheresis - role in the treatment of pregnant women in whom it is important to avoid potentially teratogenc drugs* Splenectomy - used rarely to reduce the size of the spleenTreatment of blast crises* The treatment of all forms of the blast crises is generally ineffective* Myeloid crises and erythroid crises are treated as for AML* Lymphoid blast crises is treated like ALL with vincristine plus prednisone induction therapy with or without an anthracycline* Even SCT is minimally effective during blast crises* The treatment of CML has been transformed by the introduction of imatinib mesylate. Which specifically inhibits the tyrosine kinase activity of the bcr/abl oncogene (444-CMDT- 08) [/INST] question: Drug of choice in CML is | options: A: Busulfan B: Chlorambucil C: Imatinib mesylate D: Hydroxy urea | answer: C </s> |
<s>[INST] context: Cushing's reflex , is a physiological nervous system response to increased intra cranial pressure.Results in cushings triad - increased BP, irregular breathing and bradycardia. Usually seen in terminal stages of head injury . It can also be seen after iv administration of epinephrine. In head injury- CPP=MAP-ICP. CPP- cerebral perfusion pressure. MAP- Mean aerial pressure. ICP- intra cranial pressure Head injury causes increased ICP thus lowering CPP causing ischemia. When ICP approaches the level of mean systemic pressure , cerebral perfusion falls . Bodys response to fall in cerebral perfusion is raise systemic blood pressure and dialate cerebral vessels which increases cerebral blood volume and increases ICP followed by lowering CPP.And causes a vicious cycle. When aerial pressure lowers , a reflex called CNS ischaemic response is initiated by the hypothalamus . Hypothalamus activates sympathetic nervous system causing peripheral vasoconstriction and increased cardiac output. This increases aerial pressure and cerebral blood flow is restored. This response stimulates the baroreceptors in the carotid bodies thus slowing the hea rate drastically- bradycardia(baroreceptor reflex -refer image) 2) Marey's law- Explained by barereceptor reflex States that' hea rate is inversely propoional to blood pressue '(but not the vice versa) . Bainbridge reflex- infusion of saline or blood --- increased venous filling of atria--- stimulation of tachycardia producing atrial receptor(TPAR)---tachycardia [/INST] question: A Patient with increased BP and decreased hea rate is likely to have | options: A: Increased ICT B: Deep sea diving C: Brain tumor D: Head tumor | answer: A </s> |
<s>[INST] context: Cryptosporidium is an intracellular protozoan parasite that is associated with self-limited diarrhea in immunocompetent hosts and severe debilitating diarrhea with weight loss and malabsorption in H1V-infected patients.
Treatment of immunocompetent patients
Recovery from Cryptosporidium infection depends largely upon the immune status of the host.
- Immunologically healthy patients
- Usually have a spontaneous recovery within a few weeks and parasitologic cure within a few months without requiring any specific therapy.
When therapy is required, nitazoxanide, a nitrotlziazole benzamide, is the preferred drug in children 1 to 11 years of age and has also been studied in adults :
Treatment in HIV-infected patients
Antiretroviral therapy
For HIV-infected patients, the most important part of therapy is initiating HAART in order to reconstitute immunity.
In such patients, clinical resolution may occur, but it is unclear whether organisms are completely eliminated.
Supportive care
For patients with severe symptoms, antidiarrheal agents and supportive care with enteral or parenteral nutrition can be considered. Repletion of electrolyte losses by either oral or intravenous routes is important in patients who experience significant volume loss associated with severe.
Antimicrobial agents
- If these measures fail, it is reasonable to consider antimicrobial therapy. However, there is limited efficacy of any of the currently available agents. Due to the clinical impact of persistent cryptosporidial infection, the Centers for Disease Control and Prevention suggests a trial of nitazoxanide treatment based on the data below. [/INST] question: Nituzoxomide in AIDS - | options: A: Cryptococcosis B: Cryptosporidiosis C: Histoplasmosis D: Candidiasis | answer: B </s> |
<s>[INST] context: Tattoos and body piercings have moved up on the trend list in recent years. Around Western schools lots of teens are sporting new holes and "flesh ink" . As with all other subjects, the Chinese will surely have to deal with this situation with respect to their children. To get a better view of what has happened in the West, 1et's sit down and hear what they say.
Tiara from Indiana:
I personally think body piercing is sickening. If there were supposed to be holes in your body,you would have been born with them. I do,however,think that ear piercing is not wrong. There is a difference between ear piercing and belly button piercing. Ear piercing is not nearly as dangerous. I would be sick if someone stuck a needle in my belly button.
Lee from Illinois:
Hi! I live in Illinois. I am 23. I have 12 tattoos and three piercings. I love my tattoos and consider myself an art collector. You would be surprised at who has given me the thumbs up on my art work. People on the street stop me to look at the tattoo on my leg. Most of them don't know what it is. They just think the work itself is great.
Subotai from California:
I'm not forbidden of self-expression,but when I see high school students getting these piercings, I really wonder. In some cases, the drive is deeper and darker than mere fashion. A friend of mine tried piercing her own tongue with a safety pin. It got infected and she had a tongue the size of a cow's.
Jackson from Ohio:
I don't think it is wrong, but when people do it all over the place like their face and everything--I think that's ridiculous. People who get the big "dragons that cover the whole body--I don't think that's necessary." When I see naked chicks on guys, I think, "You have no respect for women." [/INST] question: Who doesn't think tattoos and piercings except ear piercing are beautiful? | options: A: Jackson B: Lee C: Tiara D: Subotai | answer: C </s> |
<s>[INST] context: Submandibular gland This walnut sized gland lies below the mandible in the anterior pa of digastric triangle. It is .1-shaped and consists of a large superficial and a small deep pas, separated by mylohyoid muscle and continuous with each other around the posterior border of mylohyoid muscle. Superficial pa It is situated in the anterior pa of digastric triangle. The gland is paially closed in a capsule formed by two layers of deep cervical fascia. It has three surfaces : (i) inferior, (ii) lateral, and (iii) medial. i) Inferior surface is covered by skin, platysma, cervical branch of facial nerve, deep fascia, facial vein and submandibular lymph nodes. ii) Lateral surface is related to submandibular fossa (on mandible), medial pterygoid (inseion) and facial aery. iii) Medial surface is related to mylohyoid, hyoglossus and styloglossus muscles. Deep pa It lies on the hyoglossus muscle deep to mylohoid. It is related above to lingual nerve and submandibular ganglion; and below to hypoglossal nerve. [/INST] question: Submandibular gland is divided into superficial and deep pas by ? | options: A: Digastric B: Geniohyoid C: Mylohyoid D: Stylohyoid | answer: C </s> |
<s>[INST] context: Blistering diseases are potentially serious conditions. Blisters that are smaller than 0.5 cm are termed vesicles; larger lesions are called bullae. The proper diagnosis and treatment of bullous disorders are paramount in order to prevent disability and even death from burn-like denudation of the skin and associated infection. Although many skin diseases such as allergic contact dermatitis, erythema multiforme, and bullous impetigo can cause blisters, this patient is more likely to have bullous pemphigoid or pemphigus. These are immunologically mediated disorders. Skin biopsy with immunofluorescence staining will reveal antibodies at the basal layer of the epidermis (bullous pemphigoid) or within the epidermis (pemphigus). Mucosal, especially oral, involvement is characteristic of pemphigus. Immunosuppressive agents including systemic corticosteroids are often necessary to treat these conditions. Antihistamines, sometimes helpful if itching is prominent, will not treat the underlying condition. It is no longer felt that bullous dermatoses are indicative of underlying malignancy, so a "shotgun" search for occult malignancy is not recommended. Dermatitis herpetiformis and porphyria cutanea tarda are other skin diseases that can be associated with blisters. [/INST] question: A 68-year-old man complains of several blisters arising over the back and trunk for the preceding 2 weeks. He takes no medications and has not noted systemic symptoms such as fever, sore throat, weight loss, or fatigue. The general physical examination is normal. The oral mucosa and the lips are normal. Several 2- to 3-cm bullae are present over the trunk and back. A few excoriations where the blisters have ruptured are present. The remainder of the skin is normal, without erythema or scale. What is the best diagnostic approach at this time? | options: A: Culture of vesicular fluid for herpes viruses B: Trial of corticosteroids C: Biopsy of the edge of a bulla with some surrounding intact skin D: CT scan of the chest and abdomen looking for occult malignancy | answer: C </s> |
<s>[INST] context: Post-term or prolonged pregnancies are those pregnancies that have gone beyond 42 completed weeks of gestation. In general, obstetricians do not allow pregnancies to persist after 42 weeks because of the significantly increased incidence of perinatal morbidity and mortality. If a patient has a ripe cervix, it is reasonable to induce the patient at 41 weeks because the chance of having a successful vaginal delivery is very high. On the other hand, if the patient has an unripe cervix, it is generally recommended that she continue with the pregnancy. Alternatively, a patient can be induced at 41 weeks with an unripe cervix if cervical ripening agents are used. If a patient waits until 42 weeks and still has an unripe cervix, then admission with administration of cervical ripening agents prior to Pitocin induction is recommended to improve the likelihood of a successful vaginal delivery. The Bishop score is a way to determine the favorability of the cervix to induction. The elements of the Bishop score include effacement, dilation, station, consistency, and position of the cervix (see table). Induction to active labor is usually successful with a Bishop score of 9 or greater. In the scenario described here, the patient has a Bishop score of 4, which is unfavorable for induction. Therefore, expectant management is a reasonable management plan to try to give the cervix time to ripen to avoid a cesarean section. It is not recommended to perform an elective section without a trial of labor because of the risks of major surgery.Bishop ScoreDilationEffacementStationConsistencyPosition0Closed0-30%-3FirmPosterior11-2 cm40-50%-2MediumMid-position23-4 cm60-70%-1,0SoftAnterior3>=5 cm>=80%+1,+2-- [/INST] question: A healthy 23-year-old G1P0 has had an uncomplicated pregnancy to date. She is disappointed because she is 41 weeks gestational age by good dates and a first-trimester ultrasound and wants to have her baby She feels like she has been pregnant forever and wants to have her baby now. The patient reports good fetal movement; she has been doing kick counts for the past several days and reports that the baby moves about eight times an hour on average. On physical exam, her cervix is firm, posterior, 50% effaced, and 1 cm dilated, and the vertex is at a -1 station. As her obstetrician, which of the following would you recommend to the patient? | options: A: She should be admitted for an immediate cesarean section B: She should be admitted for Pitocin induction C: You will schedule a cesarean section in 1 week if she has not undergone spontaneous labor in the meantime D: She should continue to monitor kick counts and to return to your office in 1 week to reassess the situation | answer: D </s> |
<s>[INST] context: Father upset by Manchester school's 'Victorian' wall of shame
Josie Robinson, who appeared on a so-called wall of shame at her school in south Manchester, was in tears. Her father has hit out at the "Victorian" methods.
Chorlton High School put up pictures of year 10 pupils who teachers believed had behaved badly. Children singled out for praise were placed on the wall of fame. Its head teacher said the scheme was designed to motivate pupils.
Carlo Robinson, whose daughter Josie was put on the wall after missing lessons, wants to make a complaint. The teenager had been missing school and turning up late because she was upset that her mother was ill. She said: " I thought it was embarrassing."
Mr Robinson added: "She was in tears. She couldn't tell me at first - it took her about an hour- because she wasn't sure what I would think of it. When she told me I was really shocked. I contacted at least 20 friends and they all agreed it was wrong - it's like Victorian times."
Head teacher Andy Park said: "We've successfully used a similar scheme in the past with Year 11 students to _ pupils and it really did make a difference - pupils took it in the right spirit and were motivated by it to improve their performance. Obviously this latest scheme wasn't intended to cause offence to pupils. It was actually developed to praise the students moving forwards successfully and to support pupils who needed to make improvements. No parents have complained directly to the school and I'd be very happy to meet with any parents to discuss further."
Mr Robinson told the reporter he had contacted the school to schedule a meeting with the head teacher. [/INST] question: What does Mr. Robinson mean by saying this is the "Victorian" methods? | options: A: The methods ignore women's rights B: The methods are totally out of time C: The methods have a long history D: The methods worked well in the past | answer: B </s> |
<s>[INST] context: One day a lonely girl found two weak birds while she was walking in the woods . She took them home and put them in a small cage. She fed them with love and the birds grew strong. Every morning they greeted her with a beautiful song. The girl loved them very much and wanted their singing to last forever.
One day the girl left the cage's door open. The larger and stronger of the two birds flew out of the cage. The girl watched worriedly as it circled high above her. She was afraid that it would fly away and she would never see it again. So when it flew close, she grasped at it wildly. She was very happy that she held it tightly within her hand! Suddenly, she felt something had happened to the bird. She opened her hand and was surprised to find the bird was dead. Her love for the bird killed it.
She noticed the other bird jumping in the cage. She could feel that it wanted to be free. It hoped to fly into the clear, blue sky. She lifted it from the cage and flew it into the air. The bird circled once, twice, three times...
When the bird was flying happily in the sky, she was so glad. Just then the bird flew closer and sat softly on her shoulder. It sang the sweetest song she had ever heard. [/INST] question: One day the girl forgot to close the door to the cage and _ of the two birds flew out of the cage. | options: A: the sick B: the female C: the larger and stronger D: the white and blue | answer: C </s> |
<s>[INST] context: The patient is having congenital AV fistula which has caused overgrowth of the leg.
Arteriovenous fistula (AVF)
AVF may be congenital or acquired (by the trauma of a penetrating wound, or surgically created for renal dialysis)
Structural effect on veins → Veins are arterialised*, they become dilated tortuous and thick walled.
Physiological effects of fistula -
Increased pulse pressure (Increased systolic & decreased diastolic)
Enhanced venous return result in Increased HR* and Increased CO*.
Left ventricular enlargement and later cardiac failure may occur
A congenital fistula in the young may cause overgrowth of limb*.
In the leg, indolent ulcers may result* from relative ischemia below the short circuit.
Clinical signs
A pulsatile swelling*
A thrill on palpation*
Continuous bruit on auscultation*
Nicoladonis sign' or Branham sign* → Pressure on the artery proximal to fistula causes the swelling to diminish in size, a thrill or bruit to cease, the pulse rate to fall and the pulse pressure return to normal. [/INST] question: A patient presented with local gigantism of the leg and increased pulsations of the lower limb veins. Most probable diagnosis is : | options: A: Tumor B: AV fistula C: Varicose veins D: Incompetence of the saphenofemoral junction | answer: B </s> |
<s>[INST] context: Here are some books published this year. The following introductions of these books may help you choose a book to your own taste.
Life Simplified
If you are looking for a book that will transform your life for good, Life Simplified is that book. If you are looking for a guide to inspire and lead you back to your inherent self, Life simplified will act as your compass. Life Simplified provides readers with a carefully mapped approach to create life changes. The reader will develop a sense of personal pride in their progress as each chapter is completed, motivating them further. The book is an absolute must read if you would like an uncomplicated method in positively improving your life.
Building the Best You
How can you become the person you've always dreamed of being? Personal transformation begins when you take stock of where you are and what you are doing right now...and work to change it. All you have to do is to answer some basic questions and take five minutes of "focus time" daily to get there. You are responding to questions like "What am I grateful for today?", "What challenged me?" and "How can I overcome that challenge?"
The Gifts of Imperfection
In this latest book, the writer Brown emphasizes that above all other ingredients of living an emotionally healthy life is the importance of loving ourselves. The point is to embrace life and oneself with all the imperfections, releasing the stress of overdoing and overworking. Brown offers exercises for readers to understand their own emotions and begin to develop the kind of resilience needed to refuse unrealistic expectations of others and ourselves.
The Strengths Book
You are remarkable. But do you always realize it? Realize your strengths and you will be realizing the best of you. Do you want to be confident, successful, and sustainably happy? Do you want to achieve your goals and enjoy better relationships? The Strengths Book reveals the sixty strengths that make us who we are. If you are a manager, a parent, a career changer, or even just you, remarkable as you are, The Strengths Book is for you. Discover your strengths--what you do best and love to do--and transform your life by realizing the best of you. [/INST] question: Building the Best You helps you achieve personal transformation by _ . | options: A: reading some stories B: asking some questions C: answering some questions D: accepting some suggestions | answer: C </s> |
<s>[INST] context: You may have noticed that the world's population is not evenly distributed around our planet. There are some countries where people seem to be living nearly _ each other because conditions are overcrowded. Then there are others where it seems that hardly anybody lives. What influences this unequal distribution of people? There are specific advantages and disadvantages of *diving in a certain area.
The two main factors that influence people`s choice of location are climate and resources. Climate is the usual weather conditions in a region. Areas that have bad weather are generally less deal as places to live in. The north and south poles at the top and bottom of the world may be beautiful in their rugged, natural way, but the disadvantage of the bitterly cold and windy conditions usually keeps people away. When it comes to climate, warm conditions and a normal amount of rainfall are advantages that attract people.
Natural resources are things that we get from nature that help us survive. Each region offers different resources, and therefore attracts different groups of people. People who enjoy the beach can make their living by catching and selling the ocean's many fish and other sea creatures. Those who prefer farming can take advantage of rich soil in valleys near rivers. Some people are willing to accept the disadvantages of the terrible conditions of deserts or mountains in order to take advantage of the resources like oil or woods. [/INST] question: What are the main factors that influence the distribution of people? | options: A: Resources and oceans B: Climate and rivers C: Climate and resources D: Warm conditions and rainfall | answer: C </s> |
<s>[INST] context: One cold winter evening, some young families and young couples were eating in a McDonald's when an old couple walked slowly into McDonald's hand in hand.
Some of the customers looked admiringly at them .You could tell what the admirers were thinking. Look, there is a couple who has been through a lot together, probably for 60 years or more." The little old man walked right up to the cash register, placed his order with no hesitation and then paid for their meal. The couple took a table near the back wall and started taking food off the tray. There was one hamburger, one order of French fries and one drink. The little old man unwrapped the plain hamburger and carefully cut it in half. He placed one half in front of his wife. Then he carefully counted out the French fries, divided them in two piles and neatly placed one pile in front of his wife. He took a sip of the drink, his wife took a sip and then set the cup down between them.
When the man began to eat his few bites of hamburger, the crowd began to get restless. Again you could tell what they were thinking. "That poor old couple. All they can afford is one meal for the two of them." Then, the man began to eat his French fries, when one young man stood and came over to the old couple's table. He politely offered to buy another meal for the old couple to eat. But the old man replied that they were just fine and they were used to sharing everything.
Then the crowd noticed that the little old lady hadn't eaten a bite. She just sat there watching her husband eat and occasionally taking turns sipping the drink. When the little old man finished eating and was wiping his face neatly, the young man could stand it no longer. Again he came over to their table and offered to buy some food.
After being politely refused again, he finally asked a question of the little old lady. "Ma'am, why aren't you eating? You said that you shared everything. What is it that you are waiting for?"
She answered, "The false teeth". [/INST] question: The little old man cut the plain hamburger in half because _ . | options: A: he couldn't finish eating it with one bite B: he was very careful with his food C: he ordered more than he could eat D: he wanted to share it with his wife | answer: D </s> |
<s>[INST] context: Spores of Bacillus stearothermophilus are used as a control in an autoclave.
“Sterilization control of autoclave: For determining the efficacy of moist heat sterilization, spores of Bacillus stearothermophilus are used as the test organism.
This is a thermophilic organism with an optimum growth temperature of 55-60 degree and its spores require an exposure of 12 minutes at 121 degrees to be killed."
“Plasma sterilization is a safe method to sterilize instruments at low temperature under vacuum.
Vacuum is required to prevent large concentrations of species from absorbing the UV rays created by the plasma during the sterilization process.
The bacterial organism most resistant to the sterilization technique was Bacillus stearothermophilus.
The organism was then used in Survival Analysis Curve testing and was effectively sterilized to a level of <106 with 30 min of diffusion time using both survivor curve and fraction negative analysis. So that Bacillus stearothermophilus is used as a control in plasma sterilization.” “B. subtilis is used in Guthrie's test.” "Sterilization control of Hot air oven: The spores of a non-toxigenic strain of Clostridium tetani are used as a microbiological test of dry heat efficiency." [/INST] question: Spores of which of the following are used as a control in an autoclave | options: A: Clostridium tetani B: Bacillus stearothermophilus C: Bacillus pumilus D: Bacillus subtilis var niger | answer: B </s> |
<s>[INST] context: Santa Fe, the capital of New Mexico, U.S.A.,is in the central part of the state, on the Santa Fe River, which flows into the Rio Grande 35 kilometres west of the city. More than two thousand metres above sea level, it lies in the Sangre de Cristo Mountains with the Ortiz Mountains to the southeast.
Santa Fe was founded in 1609 by the Spanish on an old Indian village.In 1680 the Indians seized the place but only held it for twelve years before the Spanish retook it. The city remained under Spanish rule until Mexico won its independence in 1821. From then on it was a Mexican city until 1846 when it was taken over by American troops.
With a population of 48,953, Santa Fe is now the second largest city in the state. Because of its sunny weather, rich history and surrounding mountains, it is a good place for holiday makers. Besides hunting and skating in the mountains people enjoy shopping in the Indian and Spanish shops, which brings a large income to the city every year. In summer there is an international opera season when operas are shown in a partly-roofed ,open-air theatre daily for people from all over the world. [/INST] question: At present Santa Fe belongs to _ . | options: A: India B: Mexico C: Spain D: the United States | answer: D </s> |
<s>[INST] context: Podocin The glomerular capillary wall is a filtering membrane and consists of the following structures i) Endothelial cells ii) Glomerular basement membrane iii) Visceral epithelial cells (podocytes) iv) Mesangial cells The visceral epithelial cell known as podocyte is impoant for the maintenance of glomerular barrier function. They are structurally complex cells that possess interdigitating foot processes (pedicels). The adjacent foot processes are separated by 20-30 rim wide filtration slits. The filtration slit or slit diaphragm maintains glomerular barrier function. They present a size selective distal diffusion barrier to the filtration of proteins and it is the cell type that is largely responsible for the synthesis of GBM components. Proteins located in the slit diaphragm control glomerular permeability. Impoant proteins have been identified in this regard - Nephrin - Podocin (impoant in structural organization of slit diaphragm) - CD2 associated protein and - Actin cytoskeleton The impoance of these proteins in maintaining glomerular permeability is demonstrated by the observation that mutations in the gene encoding them give rise to nephrotic syndrome. The mutations in these genes commonly lead to focal segmental glomerulosilerosis Gene Chromosome Protein encoded Disease NPHS1 19q 13 Nephrin Congenitial nephritic syndrome of the finnish type NPHS2 lq 25-31 Podocin Steroid resistant nephritic syndrome 30% cases Mutations in the podocyte action-binding protein oc actinin 4 also produce FSGS [/INST] question: Steroid resistant nephritic syndrome ? | options: A: Nephrin B: Alpha-actinin-4 C: Podocin D: Transient Receptor Potential 6 | answer: C </s> |
<s>[INST] context: It's a goal for millions and millions of families every year to keep the Christmas spending within a certain amount of money, but you can still afford the gifts because your loved ones will
enjoy them. This concern is becoming greater and greater theses days. Even so, there are several things that you can do to help.
Hit the sales. No one wants to get up at four o'clock in the morning and fight to get a good deal on Black Friday (the first Friday at Christmas time). It's surely very difficult to pick up the courage and get out there in the cold for a good deal. But sometimes it can be well worth. Many retailers offer _ all through the day. Some even offer online Black Friday specials, so we may still be able to get a great deal on Black Friday.
Read advertisements regularly.Once the Christmas shopping season is coming, retailers will be hungry for business. They will try their best to get us into the store. Please read the weekly advertisements of sales among the major retailers from time to time. We may be lucky enough to find different prices for the same thing in different shops.
Shop online. Some of us don't like running from store to store to get the best price on the perfect gift. Some of us don't like to go out in the cold at all, and then, we can do online shopping. The world of online shopping makes it possible for us to visit all the major retailers and some specialty stores on the Internet. We can find exactly what we are looking for at the best possible price without even having to leave the house. With traditional Christmas shopping, it will always take us a long time to wait if we want to get the perfect gift. [/INST] question: We can have more choices to get a good deal _ . | options: A: on the Internet B: in specialty stores C: from salesmen D: from retailers | answer: A </s> |
<s>[INST] context: Learning how to be patient with people can be challenging for some. After all, not everybody is gifted with great patience. The good news is that it is something that can be learned and eventually perfected.
When the customer before you takes ages to pay for his or her groceries, you tap your foot impatiently and cough every now and then; but no, the customer is still not hurrying up. It takes all of your power not to _ However, if you picture that customer to be someone you like (say your partner), then you will find yourself not getting too annoyed, right? So the next time you find yourself losing patience with somebody, simply visualize that person to be someone you really, really like and your patience will extend its life.
The second step on how to be patient with people involves whistling. When you whistle a happy tune, you instantly cheer up. You can sing your favorite song if you can't whistle - it really doesn't make a difference. What's important here is that you have done something that makes you feel good. And when you feel good, you are more likely to be patient with the people around you.
Next, when you're stressed, it's almost impossible to learn how to be patient with people. If you know you're going to be in a situation where your patience will be tested, meditate or get yourself a massage first. Don't dive into anything unless you've managed to clear yourself off negative emotions. Remember: the more stressed you are, the faster you'll lose your temper. The less stress you have in your life, the longer your patience.
Learning how to patient with people is not a necessity in life. You've seen people who manage to survive day to day with incredibly bad tempers after all. But do you really want to live like they do? If, however, you want a life that has better quality than that, then just follow these steps and embrace the fact that patience is a virtue. [/INST] question: When you realized that your patience is being examined, you should _ . | options: A: it is possible to control it B: let it known by whoever you are facing C: do whatever you like and don't care what others say D: learn to relax yourself in a possible way | answer: D </s> |
<s>[INST] context: Do you want to make friends with a special man? Here is some information about him.
He is quiet and shy. He likes to hide his eyes behind his hair. He doesn't smile very often. However, if you talk to him about music, he'll have a lot to say.
This is Jay Chou, the 34-year-old Taiwanese pop king . His fans are so excited because he will have a singing party next month. Many pop stars will come, too.
Chou grew up just with his mother. He did not talk much and did badly in many school subjects. His mother noticed the boy's special interest in music and sent him to learn piano when he was only three years old. He loved it and kept on practicing.
Chou is not very handsome. He does not speak clearly when he sings or talks. But the singer has a lot of fans. "He is really good at music. It makes him attractive to me, " said Liu Jiajun, a Junior 2 student in No. 101 Middle School in Beijing. "He is true to himself. _ , "said Zhang Yujie, a Junior 1 girl at No.23 Middle School in Nanjing, Jiangsu Province. [/INST] question: How old is Jay Chou now? | options: A: Thirty-one B: Thirty-two C: Thirty-three D: Thirty-four | answer: D </s> |
<s>[INST] context: A, B, C, D,. Phantom of the OperaThe Phantom of the Opera, by Andrew Lloyd Webber, debuts (appears in public for the first time ) in Shanghai , marking the production's first Asian performance. Since it was first staged in London , the play has been seen by 58million people all over the world.. The Phantom of the Opera, depicts a mysterious person with a beautiful voice living under the Paris Theatre. The Grand stage sets and music have made the musical famous throughout the world.
7:15 pm, December 18
200---2000yuan
7:15pm, December 19,24--26,31
100 -800 yuan
Shanghai Grand Theatre,300 Renmin Dadao
Tel: 5466-0206
Cello recital
Cellist Nina Kotova will stage a recital in Shanghai . Kotova, from Russia, is an excellent musician and composer . She gained world attention when she won first prize in an international music contest at the age of 15. She is also a model and has graced the covers of many fashion magazines.
7:30 pm., December 15
50--500 yuan
Shanghai Concert Hall. 523 Yan'an Donglu
Tel: 6386-2836
Pipa concert
Yang Jing plays the pipa in concert. The pipa player found her distinctive musical character through the ancient pieces of an ancient culture and the most contemporary( )music of the world. Rooted in the millennia -old tradition of Chinese music, she builds on a vast body of musical history from the East and West.
7:15 pm, December 10
40--100 yuan
He Luting Concert Hall ,20 Fenyang Lu
Tel: 6437-1192 [/INST] question: To attend two different concerts listed above will cost at least _ . | options: A: 80 yuan B: 90 yuan C: 600 yuan D: 1,000 yuan | answer: B </s> |
<s>[INST] context: The traditional holiday is the most important to Chinese both home and abroad.
United Kingdom
Celebrations for Spring Festival in the UK started in 1980, with the first evening party held in 2002. Every new year, people get together and have a lot of activities. They sing songs, dance to music, share photos with friends or enjoy films in a cinema.
United States
Spring Festival has become a key time for Chinese living or working in the US. They join in a large evening party to welcome the traditional new year. It is a good chance for people to build a circle of friends and feel that they are not alone because they share the same culture and values.
Australia
The Chinese new year will be welcomed with three weeks of celebrations across Australia. Many people come to Sydney's Chinatown or Little Bourke in Melbourne. They enjoy fireworks, lion dances, dragon boat races and many other traditional activities. The celebrations are also a bridge towards better understanding between Chinese and non-Chinese.
Singapore
The family dinner on new year's eve is an important tradition for Chinese whether they were born in Singapore or moved there from China. They place traditional food on a table as an act of remembering their past. Then the whole family enjoy their dinner together. They usually hold it at home because having it in a restaurant takes away the meaning of the tradition. [/INST] question: Celebrations for Spring Festival in the UK started in . | options: A: 1890 B: 1980 C: 2000 D: 2002 | answer: B </s> |
<s>[INST] context: The symptoms and laboratory finding of the patient confirms the diagnosis of AML.
Let us discuss each findings -
H/o fever weakness and bleeding gum -
Most of the books agree that patients of acute leukemia present with nonspecific symptoms as fatigue, fever, weight loss. These are consequence of anemia or leucocytosis. Some patients may also present with signs of abnormal hemostatis such as bleeding gum.
Peripheral smear shows pancytopenia-
The no. of Leukemic cells in peripheral blood in AML is highly variable sometimes being more than 10000 cell/ ml but being under 10,000 in 50% of patients.
Occasionally the peripheral smear may not contain any blasts (aleukemic leukemia). So even in pts with ancytopenia bone marrow examination is essential to exclude acute leukemia.
Bone marrow examination reveals 26% blast/cells :-
Harrison says - "The diagnosis of AML is' established by presence of more than 20% myeloblast in bone marrow."
The blast cells were mature and contain Auer rods:
Auer rods are red staining rod like structures (representing abnormal azurophilic granules) present in myeloblast in AML. The presence of Auer rods is considered as definite evidence of myeloid differentiation. They are most numerous in M3 form of AML.
Neutrophil with Pseudo Pelger Huet anomaly :-
Pseudo Pelger Huet cells are neutrophils with only 2 nuclear lobes and are frequently seen in myelodysplastic syndrome. Myelodysplatic syndrome progresses to AML in10% of cases so it can be assumed that in this patient AML has developed from myelodysplastic syndrome. [/INST] question: A 42 -year old man was referred with a 2 week history of fever weakness and bleeding gum. Peripherial smear showed pancytopenia. The bone marrow examination revelaed 26% blasts frequently exhibiting Auer rods and mature myeloid cells. An occasional neutrophil with pseudo Pelger-Huet anomaly was also noted : Which of the following cytochemical stains is most likely to be positive - | options: A: Acid phosphatase B: Non specific esterase C: Myeloperoxidase D: Toluidine blue | answer: C </s> |
<s>[INST] context: Refractory glaucoma (refractory glaucoma), the drug is difficult to control intraocular pressure, and poor prognosis for conventional surgery glaucoma, the past filtration surgery failed glaucoma, juvenile glaucoma, aphakic eye glaucoma, there are more long-term glaucoma medication history, neovascular glaucoma, secondary glaucoma. Symptoms of Refractory Glaucoma The treatment of refractory glaucoma: multiple surgeries fail the means that may belong to the super healing reaction; teenagers the more hyperophy Tenon and active wound healing response; no lens ocular vitreous can release a trauma fibroblasts stimulating hormone to promote scarring; neovascular glaucoma surgery Road often neovascularization and vascular connective tissue growth, blocking it; yet fully calm inflammation secondary glaucoma, uveitis refractory glaucoma surgery organization strong reaction to the destruction of blood - aqueous barrier, fibronectin and growth factor release, can activate fibroblast proliferation, scarring of the filtration channel. [/INST] question: Drug used in refractory glaucoma - | options: A: Systemic glucocoicoid B: ACE inhibitor C: Alpha agonist D: Beta blocker | answer: C </s> |
<s>[INST] context: The diagnostic approach to ureteric colic has changed due to the introduction of new radiological imaging such as non-contrast CT. The role of intravenous urography, which is regarded as the gold standard for the diagnosis of ureteric colic, is being challenged by CT, which has become the first-line investigation in a number of centres.CT has the following advantages over IVU: it has higher sensitivity and specificity for calculus detection, it does not use intravenous contrast medium, it permits alternative diagnoses, and requires a shoer examination time.CT can visualise all radiopaque stones, as well as radiolucent stones such as uric acid and cystine calculi. An impoant limitation of CT is the fact that it does not permit functional evaluation of the kidneys and it is unable to assess the degree of obstruction. Another disadvantage is higher radiation exposure of the patient compared with KUB or IVU. ref :- Bailey and Love 27th ed , chapter 76 , pg no :- 1406 Campbell - Walsh urology 11th ed , chapter 52 , pg no 1202 [/INST] question: Best investigation for renal calculi is? | options: A: X-ray B: USG C: CECT D: NCCT | answer: D </s> |
<s>[INST] context: The rate of synthesis of primary bile acids from cholesterol is inversely related to the rate at which bile acids are extracted from the hepatic poal blood and resecreted into the bile canaliculi. Therefore, an increase in the rate of synthesis occurs following ileal resection. Ileal resection decreases the ability to absorb bile acids from the small intestine and causes a decrease in enterohepatic recirculation of the bile acids. Therefore, secretion of new bile acids is increased.Injection of cholecystokinin or stimulation of the vagus nerve contract the gallbladder and relax the sphincter of Oddi, causing increased delivery of bile acids to the duodenum. These bile acids are absorbed in the ileum and returned to the liver in the hepatic poal blood. Therefore, synthesis of new bile acids is decreased. Lovastatin, which decreases the activity of 3 hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase, decreases synthesis of cholesterol and, therefore, decreases the synthesis of bile acids. A decrease in dietary cholesterol would decrease the synthesis of primary bile acids. [/INST] question: Which would lead to an increase in hepatocyte synthesis of primary bile acids? | options: A: An injection of cholecystokinin B: An ileal resection C: Stimulation of the vagus nerve D: Lovastatin | answer: B </s> |
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