text
stringlengths 1.13k
10.8k
|
|---|
<s>[INST] context: Most people are writing blogs . Others are reading them. The word " blog" is a short way of saying Web log almost like QQ Zone .
Many popular Web sites now offer free, easy ways to create personal Web pages and fill them with writings and pictures. Blogs offer people a place to show their writings and feelings over the Internet. They can also be helpful to connect people with others.
A blog has both good and bad points, of course. People choose to write what they think in blogs, for they know that their friends will read what they write. If you are feeling sad one day and write your feelings in your blog, your friends may quickly write back to _ you or offer their help. Blogs help people keep good friendship and let them know what their friends are doing. But the problem is that anyone can read what you write in your blog. If you are not satisfied with a friend during school, and you write something bad about him in your blog, your friend read the blog and get angry. So we have to be careful of what we write.
In many ways, a blog and a diary are almost the same. So what makes a blog different from a diary? The biggest difference is that a blog is more public than a diary. [/INST] question: _ can offer free ways to create personal Web pages and fill them with writings and pictures. | options: A: QQ B: Web pages C: Web sites D: Blogs | answer: C </s> |
<s>[INST] context: Watch for us on TV
THIS summer, many Beijing middle school students had a different kind of vacation. Instead of hanging out with friends or traveling, they were training hard for the National Day celebration.
To mark the special anniversary of China this year, the students performed a group dance in a big parade on Tian'anmen Square on October 1.
Students were training from 7:30am to around 10:00am or from 4 pm to 6:30pm. It was to avoid the summer heat.
They wore white hats, T-shirts and dark-blue trousers. The hats and T-shirts were printed with a red logo, the number '60".
The first week of training was PE. Students practiced standing and squatting . Then they moved on to practice the group display. The use colored sheets in the shape of flowers as a prop . When we watch the parade on TV we will see them making colorful patterns with them.
What do the students think of their unusual summer?
"Sometimes we find it a bit tiring." says Lu Wenqi,13."But most of us think it's a great honor to take part in such an important celebration."
Li Hui, 15, thinks the same as Lu. She says her classmates are seldom late for training.
"It's a wonderful chance for us,' says Li. "When my parents were in college, they also took part in a national day celebration. Now it's my turn!"
By Wang Min
21st Century Teens staff [/INST] question: How long were the students training every day? | options: A: two and a half hours B: five hours C: six hours D: five and a half hours | answer: A </s> |
<s>[INST] context: Bicycle tour and race
A bike tour and race will be held on August 26th and 27th(Sat. &Sun. ) at 5:30 a. m. The riders will leave Tian'an Men Square and ride the first 35 kilometers as a training leg . Then the next 55 kilometers' leg, from Yanjiao to Jixian, will be the first competitive part of the tour. The riders and their bikes will then be taken from Jixian to Changli.
The second racing leg of the tour will be from Changli to the seaside of Nandaihe, covering a distance of 20 kilometers. Saturday night includes the stay at Nandaihe and supper. Sunday morning is free for the seaside. At noon all the people and their bikes will be taken back to Beijing.
Cost: 200 yuan; Telephone: 4675027
Brazilian footballers
The Brazilian Football Club play with Beijjing Guo'an Team at the Workers Stadium On August 26th. The club has four nation team players. Also coming is 1994 US World Cup star Ronario who has promised to play for at least 45 minutes.
Ticket Prices: 60/100/150 yuan
Time/date: 4: 30 p. m. August 26th(Sat. ); Telephone: 5012372
Rock climbing
The third National Rock Climbing Competition will be held on August 26th and 27that the Huairou Mountain--climbing Training Base. More than 10 teams from Beijing, Wuhan, Dalian, Jilin and other places will take part in it. A Japanese team will give an exhibition climbing. Free for audience.
Take a long-distance bus from Dongzhimen to Huairou.
Time/Date: 9~12 am, August 26th and 27th; Telephone: 7143177, 7144850 Wang Zhenghua [/INST] question: The main purpose of announcing the above events is to give information about _ . | options: A: visiting teams B: things to do for the weekend C: famous players D: prices to pay for the sports events | answer: B </s> |
<s>[INST] context: Inner Ear: It consists of three pas: 1. Vestibule 2. Semi-circular Canals 3. Cochlea The bony cochlea contains three compaments: Scala vestibule, Scala tympani and Scala media The Scala vestibule and Scala tympani are filled by peri-lymph and communicate with each at apex of cochlea through an opening called helicotrema. Perilymph is derived from CSF cochlear Aqeuduct Scala vestibuli is closed by the footplate of stapes. Movement of stapes causes vibration in scala vestibuli. Scala tympani is closed by secondary tympanic membrane(3-layered structure) and it connects with the subarachnoid space through the aqueduct of cochlea opening into dura between Endosteal Layer and Meningial layer. Endolymph is secreted from Striae Vascularis which is present on lateral surface of Scala Media . CSF or infection from brain passes into scala tympani through aqueduct of cochlea. HYLE FISSURE- It is a transient anatomic landmark in developing fetal petrous temporal bone, extending from area inferior to round window to meninges in posterior cranial fossa. It usually gets closed by normal progression of ossification in 24th week of gestation. It occasionally persists into extrauterine life and has been repoed as an unusual cause of peri labyrinthine CSF fistula. VESTIBULAR AQUEDUCT- It is a bony canal within the temporal bone which houses the endolymphatic duct that connects the endolymphatic compament of vestibule to the endolymphatic sac. AQUEDUCT OF SYLVIUS- A canal between 3rd and 4th ventricles in the brain. It carries CSF [/INST] question: Most potential route for transmission of meningitis from CNS to Inner ear is- | options: A: Aqueduct of Sylvius B: Aqueduct of Cochlea C: Vestibular aqueduct D: Hyle fissure | answer: B </s> |
<s>[INST] context: ANS. DPregnancy above 20 weeks cannot be terminated.As per consent rules, child below 18 years cannot give consent to harm like MTP (87 IPC).Important IPCsLaws related to consentSection 53 CrPcIn criminal cases as arrested person examined by the doctor without his consent and even using forceSection 54 CrPcArrested person can also request to be examined by a doctor to detect any evidenceSection 87 IPCA person >18 years of age can give consent to suffer any harm if the act is not intended and not known to cause death or grievous hurtSection 89 IPCA child <12 years of age a person of unsound mind cannot give consent to suffer any harmSection 90 IPCConsent given by an insane person or given under fear of injury, death etc. or due to misconception of a fact is invalidSection 92 IPCAny harm caused to a person in good faith even without the person's consent is not an offence if the circumstances were such that it was impossible to obtain consent of the person or his lawful guardian at that material time for that thing to be done for the benefit of the person. [/INST] question: A 14-year-old victim of rape coming with 22 weeks pregnancy, what should not be done? | options: A: Male doctor can examine in the presence of female attendants B: No need for vaginal swab C: No need to confirm pregnancy D: Can do termination of pregnancy with her consent by gyne- cologist | answer: D </s> |
<s>[INST] context: Today we bring you an old tale. It's the story of the three little pigs and the big bad wolf that blew down a house made of straw and one made of sticks. The only house left standing was the one made of bricks. Now there is new evidence to suggest that houses built with bales of straw can be very strong. They are also very environmental.
Pete Walker is a professor at the University of Bath in Britain. He and a team of researchers there have built a house made out of straw bales and hemp material. During the next twelve months the team will study the effectiveness of these materials in home building. Professor Walker says there are many good reasons for using straw.
Professor Walker: "One of the benefits is it's a relatively inexpensive renewable material that's readily available." He also agrees that straw takes in carbon dioxide as it grows and helps the environment in other ways. So it can be seen as having no harmful effects on the environment.
Professor Walker: "The straw bale walls are relatively thick and so all that straw provides very good thermal insulation. So we make buildings that require very little heating in the winter or indeed very little cooling in the summer. So they require very little additional energy."
Professor Walker says this reduces home operating expenses. It also reduces the effect on the environment. He says the current interest in straw bale houses is a direct response to the problem of climate change.
David Lanfear owns an eco-friendly home building service in the United States called Bale on Bale Construction. He says he laughed when some friends first told him about houses built of straw. But after doing his own research, he learned that building with straw bales made a lot of sense. He has now helped to build more than ten straw bale houses and says the building material is becoming more widely accepted.
To build the houses, he fills a wood frame with tightly packed bales of straw. Next he coats the walls inside and out with layers of clay plaster. He says the common ideas about straw houses continue, including stories about the threat of fire. Mr. Lanfear says straw bale houses have done well when tested for fire resistance. And he says his builders use the same building methods as traditional builders to keep out rain.
David Lanfear: "We use what we call good shoes and a good hat, and that would be a solid foundation and a really good roof." [/INST] question: What's David Lanfear's attitude towards the straw houses at last? | options: A: Ridiculous B: Approving C: Defensive D: Unbelievable | answer: B </s> |
<s>[INST] context: Prenatal factors
1. Metabolic
i) Aminoaciduria-phenylketonuria, homocystinemia, histidinemia, organic aciduria
ii) Galactosemia
iii) Mucopolysaccharidosis
iv)Inherited degenerative disorders of the central nervous system
2. Chromosomal disorders. Down's syndrome, Fragile X syndrome, Klinefelter
3. Environment and nutrition gaps, iodine deficiency
4. Neuroectodermal dysplasia. Tuberous sclerosis.
5. Developmental defects. Microcephaly, craniostenosis, cretinism, porencephaly.
6. Maternal factors
i) Use of teratogenic drugs in the first trimesters of pregnancy
ii) Infections such as rubella, toxoplasmosis, cytomegalic inclusion disease, herpes syphilis and HIV.
iii) Placental insufficiency
iv)Toxemia of pregnancy
v) Antepartum hemorrhage
vi)Radiation during pregnancy
Natal factors
Birth injuries 3. Intracerebral hemorrhage
Hypoxic, ischemic encephalopathy
Postnatal factors
Infections of central nervous system.
Meningoencephalitis
2. Head injuries
3. Hypoxia
4. Cerebrovascular. Thrombosis of cerebral vessels
5. Post-vaccinal encephalopathies
6. Kemicterus
7. Hypoglycemia
8. Malnutrition
9. Child abuse
10. Autism [/INST] question: Mental retardation is not seen in - | options: A: Downs syndrome B: Cretinism C: Hypopituitarism D: Birth asphyxia | answer: C </s> |
<s>[INST] context: In 1896, the first modern Olympic Games was held in Athens. Since then many countries have successfully held the Olympics, such as England, France, Germany, Canada, the USA, Spain and Australia. After more than a century the Games returns to its hometown.
When people hold the Olympic Games, they always make an emblem . The emblem of the Athens Olympic Games this year is a white circle of olive branches in the sky.
" Athens is developing a spirit of peace ." An officer said, "While in Athens, the world should be at peace. We hope the peace is not just for a short time. We would like the message from the Athens Games to help countries come together and solve their problems."
Four years from then, the Olympic Games will be held in Beijing ,China. And China has already made a seal as the emblem of the Beijing 2008 Olympic Games. The emblem has a single Chinese character on a red seal and means "Chinese Seal, Dancing Beijing(.)". Below it, there are the words "Beijing 2008". The character in the emblem is "Jing". It means "capital'' of China and it is also like a runner or a dancer. The running figure on the emblem shows the spirit of the Olympics--faster, higher and stronger. [/INST] question: In which country was the first modern Olympics held? | options: A: Greece B: China C: Australia, D: France | answer: A </s> |
<s>[INST] context: According to the given scenario and clinical presentation, most likely the patient is having physiological dyspnea of pregnancy which is quite common. In case of Pulmonary embolism, there is chest pain associated with dyspnea and hemoptysis and is a more acute event associated with desaturation. Asthmatic patient will usually have a past history, chest findings of wheezing and decreased oxygen saturation Left hea failure presents with dyspnea of varying severity, B/L basal crepts Physiological dyspnea It occurs in 60% to 70% of normal pregnant women by 30 weeks of gestation, but can occur as early as at the end of first trimester. There is decrease in FRC (Functional Residual Capacity) mores significantly by 6th month Total lung capacity is unchanged Tidal volume and minute ventilation increase significantly as pregnancy advances. Increase in minute ventilation is secondary to stimulatory effect of progesterone to increase respiratory drive Due to increase in minute ventilation during pregnancy, it may make the patient feel as if they are hyperventilating and contribute to the feeling of shoness of breath/dyspnea Reassurance is enough and no medical intervention is needed. [/INST] question: A 31 year old woman in 2nd trimester of her pregnancy, has come to OPD with a complaint of dyspnea on exeion. There is no history of chest pain, cough or fever and the patient has no known cardiac disease .On physical examination examination, her pulse is 75 / min, BP is 110/70, and Sp02 is 96% . Chest and CVS examination is unremarkable. What could be the most probable cause of this patient's clinical presentation? | options: A: Asthma B: Pulmonary embolism C: Physiological dyspnea of pregnancy D: Left hea failure | answer: C </s> |
<s>[INST] context: Top 5 Must See Places in Beijing
Beijing is an old capital city with a lot of tourists attractions. What is the most representative place in Beijing? The answers are various. Here are the Top 5 Must See Places in Beijing.
1. Forbidden City
The Forbidden City is the ideal place for you to begin your exploration of Beijing. Make sure to wear comfortable shoes as you have to walk a lot! A multilingual guide recorder is recommended, as it can tell you the stories behind the palace.
Opening Hour: 8:30-17:00
Entrance Fee: RMB 60
2. Tian'anmen Square
Lying in the heart of Beijing City, it is the place for massive parades and gathering. It boasts of the largest square of such kind in the world. At sunrise and sunset the raising and lowering ceremony of the Chinese National Flag is well worth seeing.
Ticket fees: Free
Opening Time: Whole Day
3. Great Wall
Most of the sections of the Great Wall in Beijing are well-preserved, and the most famous section is Badaling. For the Great Wall hiking, get ready for strong footwear. For hot weather, please also prepare sunblock, sunglasses and water.
Badaling Great Wall:
Ticket Fees: RMB40 (Nov. 01 to Mar. 31); RMB 45 (Apr. 01 to Oct. 31)
Open Hours: 6:40 to 18:30
4. Summer Palace
Regarded as the largest imperial garden in China, the Summer Palace is in fact a park-styled royal retreat. With masterly design and artistic architecture integrating the highlight of Chinese garden arts, it has earned a title of "Royal Garden Museum".
Open Time: 6:30-20:30
Ticket Fee: RMB 40 (low season) / RMB 50 (peak season during the holidays)
5. Temple of Heaven
The Temple of Heaven worked as sacrificial compound buildings for the Ming and Qing emperors. What's the intriguing by-production of the temple is that if you enter the Temple of Heaven in the early morning, you can find many people doing all types of Kungfu, Taiji, dancing and other morning exercises.
Open Time: 6:00-21:00
Ticket Fee: RMB 35 [/INST] question: At 5:45 in the morning, what could one enjoy? | options: A: The artistic architectural design of the Summer Palace B: Wandering about on the Tian'anmen Square C: The sunrise on the Badaling Great Wall D: Exercises of Kungfu and Taiji in the Temple of Heaven. [:Zxxk.Com] | answer: B </s> |
<s>[INST] context: There are four types of isolation precautions that can be implemented in health care settings. Any given patient might require more than one type of precaution. Standard precautions apply when interacting with any patient, regardless of the diagnosis. They include hand washing before and after contact with every patient and the use of gloves, gowns, masks, and eye protection when contact with open sores, blood, or body secretions is anticipated. Contact precautions reduce the risk of spreading microorganisms that are transmitted by direct or indirect contact. They include private room placement of the patient and the use of gloves and gowns when in contact with the patient or the immediate environment. Contact precautions are indicated in patients colonized or infected with MRSA, vancomycin-resistant enterococci (VRE), and C difficile.Droplet precautions limit the transmission of infections that are carried in respiratory droplets (>5 mm in size) such as influenza and meningococcal meningitis. Droplet precautions include placing the patient in a private room and asking health care professionals to use surgical masks within 3 ft from the patient. Airborne precautions reduce the risk of airborne particulate (particles less than 5 mm in size) transmission of infectious agents such as tuberculosis. The patient is placed in a private negative-pressure room with high-efficiency masks, such as the N95 mask, worn by all health care professionals upon entering those rooms. The patient has meningococcal meningitis and requires droplet precautions for 24 hours of effective antibiotic therapy. [/INST] question: An 18-year-old college student presents with fever, headache, neck stiffness, and petechial rash on his ankles. Lumbar puncture shows abundance of white blood cells with extracellular as well as intracellular gram-negative diplococci. Select the most appropriate isolation precaution. | options: A: Standard precautions B: Contact precautions C: Droplet precautions D: Airborne precautions | answer: C </s> |
<s>[INST] context: Dogs have long been used to find explosives and drugs.Now,a new study shows that man's best friend can also help to find lung and breast cancer,researchers report in integrative Cancer Therapies.The findings show that trained ordinary household dogs can detect early--stage lung and breast cancers by smelling the breath samples of patients.
Researchers have found that cancer cells send out molecules different from those of healthy ones,and that might be sensed by smell by the highly sensitive dog's nose.
For the study,five dogs were trained by a professional instructor to respond differently to breath samples of healthy and cancer patients."The dogs learned to sit or lie down in front of cancer patient samples and to ignore control samples through the method of food reward," McCulloch explained.
After a period of training,researchers tested the animals'ability to distinguish cancer patients from controls.The animals were given breath samples from 55 patients with lung cancer,3 1 with breast cancer and 83 healthy controls who were not included in the original training period.
McCulloch's group found that the dogs were able to correctly distinguish the breath samples of cancer patients from those of the control subjects in about 90 percent of the cases.The dogs were also able to detecting early-stage lung and breast cancers.
"These results show that there is hope for early detection,"McCulloch said.The re-searches are planning to conduct further studies on the breath composition of cancer patients to possibly design an electronic device that can do the dogs'job."A dog's nose is so powerful it can detect odors 10 000 to 100 000 times better than a human nose can.I hope people will be interested in doing this research,"McCulloch added,"It shows that there is definitely something out there." [/INST] question: McCulloch and his group used_in their research. | options: A: 10 dogs and 55 people B: 5 dogs and 86 people C: 10 dogs and 83 people D: 5 dogs and 169 people | answer: D </s> |
<s>[INST] context: If you look at the sky one night and see something moving and shining that you have never seen before, it might be a comet .
A comet sometimes looks like a star. Like a planet, a comet has no light of its own. It shines from the sunlight it reflects . Like the earth a comet goes around the sun, but on a much longer path than the earth travels.
If a comet isn't a star, what is it then?
Some scientists think that a large part of a comet is water frozen into pieces of ice and mixed with iron and rock dust and perhaps a few big pieces of rock. When sunshine melts the ice in the comet, great clouds of gas go trailing after it. These clouds, together with the dust, form a long tail.
Many people have seen a comet. However, no one knows how many comets there are. There may be millions of comets, but only a few come close enough for us to see.
An Englishman named Edmund Halley, who lived from 1656 to 1742, found out a lot about the paths that comets take through the sky. Some comets move out of our sight and never come back. Others keep coming back at regular times. A big comet that keeps coming back was named after Halley comet, because the last time it came close to the sun and the earth was in the year 1986. Then people all over the world were outside at night to look at it. You will probably be able to see Halley's comet when it comes near the earth again.
,A, B, C, D,. [/INST] question: A comet is like. | options: A: the sun B: the moon C: sunlight D: the earth | answer: D </s> |
<s>[INST] context: Playing basketball isn't a sport for women.That's what Jewell Chapman's high school headmaster told her in 1961 when he forbade the girls to play basketball."We were very sad,"said Chapman,a player for her high school team of Des Moines.
Nearly 50 years later,Chapman is back on the basketball playground.She is 62 years old and plays for the Hot Pink Grannies,joining about 10 other women on a team whose uniforms are black trousers and hot pink socks.They play in the Iowa Granny Basketball League.
It is one of the twelve of basketball leagues for women over 50 that have spread up across the country.For some, it's an opportunity to exercise and socialize;for others,it's a once-refused chance to compete."You see more and more senior women's teams taking part in state and national competitions,"said Michael Rogers,a professor in sports studies at Wichita State University."In the future it will be a common thing to have leagues like this."
Yearly researches by the National Sporting Goods Association show the number of women of 55 and older who play basketball at least 50 times a year has grown from 16,000 in 1995 to nearly 131,000 ten years later.
The women on the Hot Pink Grannies are good-natured but they are competitive when game time comes."I think I'm tough,"says Hot Pink Granny Colleen Pulliam, 69, showing her biceps in a game against the Strutters, known for their bright yellow socks.
Granny Basketball Leagues and similar groups are scattered through much of the country, including California,Connecticut, Louisiana,New Mexico,North Carolina,Pennsylvania and Washington, D.C. [/INST] question: Why does Colleen Pulliam show her biceps? She wants to prove that she is_. | options: A: beautiful B: hard C: thin D: strong | answer: D </s> |
<s>[INST] context: Mouth bacteria grow fast in airless conditions. Oxygen rich saliva keeps their numbers down. When we sleep, for example, the saliva stream slows, and sulfur producing bacteria gains the upper hand, producing classic "morning breath".
Alcohol drinking, too much talking, breathing through the mouth during exercise, anything that dries the mouth produces bad breath. So can stress, though it's not understood why. Some people's breath turns sour every time they go on a job interview.
Saliva flow gradually slows with age, which explains why the elderly have more bad breath trouble than younger people do. Babies, however, who make plenty of saliva and whose mouths contain ly few bacteria have characteristically sweet breath.
For most of us, the simple, dry mouth variety of bad breath is easily cured. Eating or drinking starts saliva and sweeps away many of the bacteria. Breakfast often stops morning breath.
Those with constant dry mouth find that it helps to keep gum, hard candy, or a bottle of water or juice around. Brushing the teeth wipes out dry mouth bad breath because it clears away many of the offending bacteria.
Surprisingly, one thing that rarely works is mouthwash. The liquid can mask bad breath smell with its own smell, but the effect lasts no more than an hour. Some mouthwashes claim to kill the bacteria responsible for bad breath. The trouble is, they don't necessarily reach all offending germs. Most bacteria are well protected from mouthwash under thick layers of mucus . If the mouthwash contains alcohol--as most do--it can worsen the problem by drying out the mouth. [/INST] question: Which of the following is mentioned as one of the causes of bad breath? | options: A: Tooth trouble B: Sulfur rich food C: Too much exercise D: Mental pressure | answer: D </s> |
<s>[INST] context: Angioedema (angioedema/ Quincke’s edema/ angioneurotic edema)
Characterized by rapid swelling (edema) of the dermis, subcutaneous tissue, mucosa and submucosal tissues. It is very similar to urticaria, but urticaria, commonly known as hives, occurs in the upper dermis
Angioedema is classified as either hereditary or acquired.
a) Acquired angioedema (AAE) can be immunologic, nonimmunologic, or idiopathic.
It is usually caused by allergy and occurs together with other allergic symptoms and urticaria.
It can also occur as a side effect of certain medications, particularly ACE inhibitors.
b) Hereditary angioedema (HAE) exists in three forms, all of which are caused by a genetic mutation inherited in an autosomal dominant form.
i) Types I and II are caused by mutations in the SERPINGl gene, which result in either diminished levels of the C1-esterase inhibitor protein (type I HAE) or dysfunctional forms of the same protein (type II HAE).
ii) Type III HAE has been linked with mutations in the F12 gene, which encodes the coagulation protein factor, XII.
All forms of HAE lead to abnormal activation of the complement system.
The end product of this cascade, bradykinin, is produced in large amounts and is believed to be the predominant mediator leading to increased vascular permeability and vasodilation that induces typical angioedema "attacks". [/INST] question: Angioedema is seen due to deficiency of? | options: A: Angiotensin converting enzyme B: C1 esterase inhibitor C: Histamine D: Angiotensin 1 | answer: B </s> |
<s>[INST] context: When Kyle walks into Ernie's Pet World, he looks very _ . The shop owner, Ernie, jumps out of his seat to greet Kyle. He is the shop's first customer of the day.
"Good morning, sir!" Ernie says, "What can I help you with?"
"Well, I... "Kyle starts to say.
"Wait, don't tell me," Ernie stops him, "You're looking for a...a little dog... for your daughter's birthday. Right?"
"Not really, I just... "
Ernie doesn't let him finish. "Ah, I've got it. You just moved to a new office, and you want some fish for it, I have some very nice fish bowls over here."
"In fact, I..."Kyle starts to look very _ and strange .
"No fish? Ah, a cat! You look like a cat person. At Ernie's Pet World, we have the best cats. Take a look at this lovely one with long, white hair. She's looking at you. She's thinking, 'Take me home. Take me home. 'Would you like some cat food and toys, too?"
"No, thank you," Kyle says. By this time, he is walking up and down. He has a terrible look on his face. "Really, I'm not interested in cats or fish or little dogs."
"What do you want, then?" Ernie asks.
Kyle looks like he is going to cry. "I just want to know if I can use your toilet!" he says at last. [/INST] question: When does Kyle walk into Ernie's Pet World? | options: A: In the morning B: In the afternoon C: At lunch time D: In the evening | answer: A </s> |
<s>[INST] context: Keeping the kids busy over the school holidays can be discouraging and cost parents a lot. But we've found some cheap and cheerful ways to enjoy family time this Easter from free days out to fun-filled theme parks which won't cost us much. We've done the homework so you can get started on having a great time.
Theme Parks
Save from 10% to 25% off the price of tickets for Legoland in Windor by booking in advance online. A family of four can save up to L45.90 on a one-day ticket, paying L137.70.
Book seven days in advance and save L43 off the price of a family of four tickets for Drayton Manor Theme Park. Call 0844-472-1950 or book online and you'll pay L65 on the day.
You can pick up a family of four ticket for a day at Alton Towers in Staffordshire for L43.80 off the day price.
Save L16 off the price for a family trip to The Making of Harry Potter by buying a family ticket (two adults and two children) online. Family of four L101, compared to L117.
Activities
Students looking for a cut-price trip to see the animals can save 15% off the ticket price at Bristol Zoo and pay L12.71 rather than the full adult price L14.53. Teens should show their identity as students.
Freebies
Let your kids discover what it's like to be an animal on the African Plain in the ocean. Or, they can learn to love leaf beetles or become a scientist for the day at the Natural History Museum in London. [/INST] question: Which of the following theme parks can save you most on Easter Day? | options: A: Alton Towers B: Legoland in Windsor C: Drayton Manor Theme Park D: The Making of Harry Potter | answer: B </s> |
<s>[INST] context: The posterior superior pancreaticoduodenal artery arises from the gastroduodenal artery and travels behind the first part of the duodenum, supplying the proximal portion, with branches to the head of the pancreas. Duodenal ulcers commonly arise within the first portion of the duodenum, thus making the posterior superior pancreaticoduodenal artery one of the more frequently injured vessels. The superior mesenteric artery supplies derivatives of the midgut from the distal half of the duodenum to the left colic flexure. It lies inferior to the region of ulceration. The inferior pancreaticoduodenal artery arises from the superior mesenteric artery and supplies the distal portion of the second part of the duodenum, with anastomoses with its superior counterparts. The inferior mesenteric artery is responsible for supplying most of the hindgut derivatives, generally supplying intestine from the left colic flexure to the superior aspect of the rectum. The right gastric artery is responsible for supplying the pyloric portion of the lesser curvature of the stomach. [/INST] question: Radiographic examination of a 42-year-old female reveals penetration of the duodenal bulb by an ulcer, resulting in profuse intraabdominal bleeding. Which of the following arteries is the most likely source of the bleeding? | options: A: Posterior superior pancreaticoduodenal B: Superior mesenteric C: Inferior mesenteric D: Inferior pancreaticoduodenal | answer: A </s> |
<s>[INST] context: When Steven was a young boy, he moved quite often with his family and so he never had many friends. He spent a lot of time on his own and liked to play with electronic things. Steven had a neighbour, Steve Wozniak. Steve was a little bit younger than Steven but also liked to play with electronic things. Steven made a microphone and Steve asked him many questions about it until he understood how it worked. Steven liked the fact that such a young boy was also interest ed in electronic things and so he taught him everything he knew.
When they were a little older and knew more about electronic things, they made a "blue box". People could make free phone calls by breaking into the phone company's system with this box. They sold this to many people even though it was illegal , but this is not why they are famous today.
Steven and Steve were the inventors of the first PC--personal computer. They called their first computer the Apple I. They invented it only for fun and to make themselves known among their friends. They did not think it would become so popular. They just liked playing computer games on it. Their computer made it cheaper and easier for people to own and use a computer. Their PCs were so popular that they made a new PC called the Apple II. Soon many schools, families and factories were using their computers.
Without the two clever men, the personal computers might never have appeared. [/INST] question: Why didn't Steven have many friends? | options: A: Because he wasn't a very nice boy B: Because he liked electronic things C: Because his family moved a lot D: Because he did some illegal things | answer: C </s> |
<s>[INST] context: Long ago, Bluebird's feathers were the colour of dust. She did not like her ugly colour. She was attracted by the colour of the lake near her home. It was as blue as the sky after a storm. Bluebird wanted to be the colour of that beautiful lake very much. Flapping her wings one morning, Bluebird flew from her tree to the blue lake. Then she bathed in the water three times. After each bath, she sang, "Blue water. Still water. I went in. I am blue." Bluebird repeated this every morning. On the third day, she came out of the lake with beautiful blue feathers.
Now Coyote was a trickster --and hungry too. He stayed behind Bluebird's tree for a long time every day and watched her go to the lake. He pretended to be interested in everything she did. He wanted Bluebird for lunch, but he was afraid of the blue water. On the third morning, Coyote saw Bluebird come out of the lake with beautiful blue feathers. Impressed, he sat next to Bluebird's tree and waited for her. When she returned, he asked, "How did you get blue feathers? I want to be blue like the mountains too." Bluebird didn't believe Coyote, but she taught him how to bathe three times each morning and how to sing her song. Coyote did what she said, and after three days of bathing in the lake, his white fur turned deep blue.
Convinced that blue fur was even more beautiful than blue feathers, Coyote forgot all about being hungry. He ran as fast as he could to the top of the hill. Standing on his back legs, he raised his front legs off the ground and howled. But Coyote slipped and rolled down the hill. He couldn't stop himself, and the dust and dirt covered his new blue fur. He rolled and rolled until he hit into Bluebird's tree heavily. No matter how much he tried, foolish Coyote could not shake the dust from his fur. And so the fur of all coyotes had the dull colour of dust to this very day. [/INST] question: How many times did Bluebird bathe every morning before she had beautiful blue feathers? | options: A: Three times B: Four times C: Five times D: Six times | answer: A </s> |
<s>[INST] context: We have two daughters: Kristen is seven years old and Kelly is four.Last Sunday evening, we invited some people home for dinner.I dressed them nicely for the party, and told them that their job was to join Mommy in answering the door when the bell rang.Mommy would introduce them to the guests, and then they would take the guests' coats upstairs and put them on the bed in the second bedroom.
The guests arrived.I introduced my two daughters to each of them.The adults were nice and kind and said how lucky we were to have such good kids.
Each of the guests paid too much attention to Kelly, the younger one, admiring her dress, her hair and her smile.They said she was a remarkable girl to be carrying coats upstairs at her age.
I thought to myself that we adults usually make a big "to do" over the younger one because she's the one who seems more easily hurt.We do it with the best of intention .
But we seldom think of how it might affect the other child.I was a little worried that Kristen would feel she was being outshined .I was about to serve dinner when I realized that she had been missing for twenty minutes.I ran upstairs and found her in the bedroom, crying.
I said, "What are you doing, my dear?"
She turned to me with a sad expression and said, "Mommy, why don't people like me the way they like my sister? Is it because I'm not pretty? Is that why they don't say nice things about me as much?"
I tried to explain to her, kissing and held her in arms to make her feel better.
Now, whenever I visit a friend's home, I make it a point to speak to the elder child first. [/INST] question: The guests praised Kelly for carrying coats upstairs because of her _ . | options: A: young age B: lovely smile C: pretty clothes D: beautiful hair | answer: A </s> |
<s>[INST] context: For 99% of human history, people took their food from the world around them. They ate all that they could find, and then moved on. Then around 10,000 years ago, about 1% of human history, people learned to farm the land.
The kind of food we eat depends on which part of the world we live in, or which part of our country we live in. For example, in the south of China they eat rice, but in the north they eat noodles. In European countries near the sea, people eat a lot of fish. In central Europe, away from the sea, people don't eat so much fish, but they eat more meat. For example, in Germany and Poland, there are hundreds of different kinds of sausages.
In North America, Australia, and Europe, people eat with knives and forks. In China, people eat with chopsticks. In parts of India and the Middle East, people use their fingers to pick up food.
Nowadays it is possible to transport food easily from one part of the world to another. We can eat whatever we like, at any time of the year. In Britain, bananas come from Africa; rice comes from India or the U.S.A.; strawberries come from Chile or Spain. Food is a very big business. But people in poor countries are still hungry while people in rich countries eat too much. [/INST] question: 10,000 years ago, people _ . | options: A: learned to farm the land B: cooked different kinds of food C: couldn't find food around them D: transported food from one country to another | answer: A </s> |
<s>[INST] context: Insulin levels decrease, and glucagon levels rise, stimulating lipolysis. (Epinephrine and other hormones promote lipolysis by the same mechanism.)a. cAMP levels rise, and PKA is activated.b. PKA phosphorylates perilipin-1, which then dissociates from the enzyme ATGL.c. When free of perilipin-1, ATGL is active and converts triacylglycerol to a free fatty acid and DAG.d. PKA directly phosphorylates and activates hormone sensitive lipase, which converts DAG to a free fatty acid and monoacylglycerol.e. Monoglyceride lipase then converts the monoacylglycerol to a free fatty acid and glycerol.The hormone-sensitive lipase of adipose tissue is responsible for degrading diacylglycerol to a free fatty acid and monoacylglycerol. The enzyme is activated by glucagon via a cAMP-mediated process (the activation of protein kinase A). Thus, mutations in PKA or the glucagon receptor may interfere with the eventual phosphorylation and activation of the hormone-sensitive lipase. Adenylate kinase is not involved in this cascade (although a mutation in adenylate cyclase would be involved, as that is the enzyme that produces cAMP). The insulin receptor promotes triglyceride synthesis and storage in the adipocyte, so a mutation in the insulin receptor would not promote triglyceride degradation. Glycerol kinase is only expressed in the liver and is not present in adipose cells. [/INST] question: A scientist has developed an adipocyte cell line that, at 42degC, cannot degrade triglycerides to glycerol and free fatty acids. At 25degC, the triglyceride degradation is normal. Which one of the following best reflects enzymes in which a temperature-sensitive mutation may lead to this phenotype? | options: A: Protein Kinase A - yes; Adenylate Kinase - no; Insulin Receptor - no; Glucagon Receptor - yes; Glycerol Kinase - yes B: Protein Kinase A - no; Adenylate Kinase - no; Insulin Receptor - yes; Glucagon Receptor - no; Glycerol Kinase - yes C: Protein Kinase A - yes; Adenylate Kinase - no; Insulin Receptor - no; Glucagon Receptor - yes; Glycerol Kinase - no D: Protein Kinase A - no; Adenylate Kinase - yes; Insulin Receptor - yes; Glucagon Receptor - no; Glycerol Kinase - no | answer: C </s> |
<s>[INST] context: Serum ceruloplasmin measurement is useful in the diagnosis of Wilson's disease, but Wilson's disease in the above patient can easily be ruled out because in Wilson's disease there is no renal involvement, whereas the patient in question is having renal involvement (Serum Creatinine 3 mg/dL).
Leptospiral antibody level
Leptospiral antibody measurement is useful in the diagnosis of leptospirosis.
The symptomatic profile of the patient is very similar to that of severe leptospirosis (Weil's syndrome).
C/F of Well's syndrome
Jaundice
Hemolysis
Renal failure (During 2nd wk).
Hemorrhagic diathesis
Hepatomegaly
Rhabdomyolysis
Spleenomegaly
Congestive heart failure
Pulmonary involvement
G-6PD level -
During G-6 PD deficiency hemolysis occurs which can give rise to unconjugated bilirubinemia.
The patient is giving evidence of unconjugated hyperbilirubinemia. So G-6PD level can be checked to find out the cause of unconjugated hyperbilirubinemia.
Reticulocyte count -
The reticulocyte count is done to check whether the patient is suffering from any hemolytic anaemia (which can be a cause of unconjugated bilirubinemia). [/INST] question: A child presents with complaints of oliguria, abdominal distension and diarrhoea. On examination, there is deep jaundice. Hepatomegaly was present measuring 4 cm below the costal margin. Conjugated bilirubin of the following tests is of least importance toin blood was 38 mg/dL, and there was urine urobilinogen and bile pigments. Hemoglobin was 4mg/dL, and serum creatinine was 3mg/dL. Which diagnose this case - | options: A: G–6–PD level in blood B: Serum ceruloplasmin C: Reticulocyte count D: Leptospiral antibody level | answer: B </s> |
<s>[INST] context: Riding School:
You can start horse-riding at any age. Choose private or group lessons any weekday between 9 a. m.and 8:30 p.m.(3:30 p.m.on Saturdays). There are 10 kilometers of tracks and paths for leisurely rides across farmland and open country. You will need a riding hat.
Opening Hours: Monday through Friday:9:00 a.m.--8:30 p.m.
Phone:( 412)396--6644 FaxL412) 396-6752
Sailing Club:
Our Young Sailor's Course leads to the Stage 1 Sailing qualification. You'll learn how to sail safely and the course also covers sailing theory and first aid. Have fun with other course member, afterwards in the clubroom. There are 10 weekly two-hour lessons (Tuesday 6:00 p.m--8:00p.m)
Opening Hours:Tuesdays:6:00p.m--8:00 p.m.
Phone: (412)396--6644 Fax: (412)396--6644
Diving Center:
Our experienced instructors offer one-month courses in deep-sea diving for beginners. There are two evening lessons a week, in which you learn to breathe underwater and use the equipment safely. You only need a swimming costume and towel. Reduced rates for couples.
Opening Hours: Monday and Friday:6:30p.m-8:30p.m.
Phone: (412)396-6312 Fax: (412)396-6706
Medical Center:
The staff of the Medical Center aim to provide convenient and comprehensive medical care to students and staff of the university. The center is well equipped and the staff here are trained to deal with a broad range of medical problems. Both female and male doctors as well as nursing staff are available for consultation. Also, all kinds of medicines are sold here and are cheaper for students than other drugstores.
Opening Hours: 24 hours from Monday to Sunday
Phone:(412)396--6649 Fax:(412) 396--6648
Watersports Club:
We use a two-kilometer length of river for speedboat racing and water-skiing.A beginners' course consists of ten 20-minute lessons. You will learn to handle boats safely and confidently, but must be able to swim. The club is in a convenient central position and is open daily from 9 a. m to 4 p.m, with lessons all through the day.
Opening Hours: Monday through Friday: 9:00a.m.--4:00 p.m.
Phone: (412)39606899 Fax: (412) 396-6890 [/INST] question: If you want to swim and enjoy activities which are fast and a bit dangerous, you should join _ . | options: A: Diving Center B: Watersports Club C: Riding School D: Sailing Club | answer: B </s> |
<s>[INST] context: To learn an instrument such as the violin or accordion takes years. The job opportunities for musicians are scarce and competition is fierce. Then why are more people than ever before paying a lot of good cash to get their children the best music teaching they can afford?
The secret lies in the influence of music on the whole person. It has been found that learning a musical instrument actually increases a person's IQ over time. Different instruments and different trypes of music have varying effect, with classical music and the string family coming out on top, potentially increasing you IQ by up to 12 points!
When is a good time to start learning music? Experts have found that even the fetus can benefit from listening to classical music. Surround yourself and your family with good music from the first. The Suzuki Piano Method teaches children from the age of 3 years piano, with two lessons per week. From preschool, children can learn to read music and play from sheet music. Progress in learning your instrument is directly proportional to the amount of practicing.
Is there such a thing as an unmusical child? Shinichi Suzuki proposes that music is the native home language of all human beings and therefore nobody can be "unmusical". Of course there are exceptional talents, compared to which others may seem to be slower learners.
Is there any benefit for adults in starting an instrument? Apart from the purely relaxing aspect, yes. Learning an instrument can earn even adults additional IQ points, and as an added benefit in improves your health by reducing your stress levels. Your social life may benefit too, if you are prepared to come out of your box and join occasions such as Ceilidhs (musical get-togethers) or arrange house concerts. It has been established that people who play instruments tend to be more emotionally balanced and more patient with themselves, others and life in general.
So go ahead, sign up for that amateur orchestra, dust off your old trombone or take your first real six-string down from the attic ; get out there and play! [/INST] question: Playing which of the following musical instruments can help increase a person's IQ most? | options: A: The piano B: The violin C: The trombone D: The accordion | answer: B </s> |
<s>[INST] context: My friend Robert started a new job this week and he's been in the training class for two days. The employer has a very strict dress code--dark blue shirts and pants.
On the first day, an older gentleman in his class did not have the proper clothes and he was strictly told that he would be fired if he didn't have the right clothes the next day. He explained, "Sir, I had not been told about this. Because of my larger size, it's sometimes difficult to find the right clothing for a price I can afford."
Last night, Robert and I decided that this old man shouldn't lose the chance of work simply because he couldn't afford the clothes. I had some cash on hand and Robert took it with him this morning just in case it was needed.
When training started this morning, the trainer was ready to fire the older gentleman. "You have 10 minutes to be in proper clothes," he was told. At this point, Robert spoke up and asked if he could have 10 minutes to get him the clothes. He then ran out to the store and bought the proper-sized pants and a shirt; he returned with both and gave them to the older man.
The older gentleman began to cry and told him that he couldn't accept such a gift from a stranger. Robert told him he had to because he had lost the receipt and couldn't return them--a little white lie. The pants were a perfect fit, the shirt was a bit tight but he was able to keep his job.
"My wife and I tried to gather together some money last night, but we didn't have enough to buy the clothes," he told Robert. "It's unbelievable to me that anybody would do such a thing for only knowing me a day!"
More unbelievable is how good it has made Robert and me feel to do this. [/INST] question: If the older man did not have the proper clothes, he would _ | options: A: be punished B: be offered another job C: put off the training class D: lose his job | answer: D </s> |
<s>[INST] context: This patient has glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is an X-linked disorder that leads to hemolytic crises within hours of exposure to oxidant stress. The most common stressors are viral and bacterial infections, sulfa drugs, quinines, and a beans. During an acute hemolytic crisis, hemoglobin becomes denatured and leads to the formation of Heinz bodies. The diagnosis is made by the demonstration of Heinz bodies during an acute crisis, and low levels of G6PD during normal times. The treatment includes maintaining adequate urine output and the prevention of future episodes. Lead poisoning (choice A) leads to a normochromic, normocytic anemia with basophilic stippling. The clinical features include abdominal pain, headache, irritability, and peripheral motor neuropathy. Treatment includes the use of chelating agents. Folate deficiency (choice B) leads to megaloblastic anemia and is most common in alcoholics. Hereditary spherocytosis (choice D) is an inherited membrane disorder that leads to hemolytic anemia and red blood cell swelling. Small, round, hyperchromatic red cells without a central area of pallor are seen on blood smears. [/INST] question: A 22-year-old man comes to the emergency depament because of dyspnea, palpitations, and a headache. These symptoms came on soon after he took trimethoprim-sulfamethoxazole for a urinary tract infection. Laboratory studies show a normochromic, normocytic anemia. A peripheral blood smear reveals Heinz bodies. Which of the following is the most likely cause of this patient's anemia? | options: A: Lead poisoning B: Folate deficiency C: Glucose-6-phosphate dehydrogenase deficiency D: Hereditary spherocytosis | answer: C </s> |
<s>[INST] context: Come And Join Us!
We warmly welcome you to the Shine Sports Centre!
All the young people in this city can become members of the Shine Sports Centre and each member should pay $10 every year. To be a member of us and get your membership card ,you need to come to us between 2 pm and 6 pm, Monday to Thursday. I have to tell you that we don't accept new members on Friday. Now, there are three things that you must remember to bring with you when you come for a membership card. They are your ID card, a recent passport-sized photo of yourself and the money. We can't give you the card unless you bring all the three.
Once you have got your membership card, you need to bring it with you whenever you come to book or use any facility in Shine Sports Centre. Booking over the phone is not allowed, so you have to come here with your card when you want to book. There is one more thing I have to tell you. Our opening hours is from 9 am to 10 pm on weekdays and from 10 am to 6 pm on weekends. We hope that every member can have a great time in the Shine Sports Centre. [/INST] question: You can use the facilities in the Shine Sports Centre at _ . | options: A: 9 am on Sunday B: 5 pm on Wednesday C: 7 am on Thursday D: 9 am on Saturday | answer: B </s> |
<s>[INST] context: The iron concentration and iron-binding capacity are low; however, in contrast to the finding in anemia of iron deficiency, the serum ferritin level is increased. This increase is typical of anemia of chronic disease. In this case, the chronic disease is rheumatoid arthritis. Underlying chronic inflammatory or neoplastic diseases increases the secretion of cytokines such as interleukin-1, tumor necrosis factor, and interferon-g. These cytokines promote the sequestration of iron in storage compartments and depress erythropoietin production. Autoantibody hemolytic anemias occur in several autoimmune diseases, such as systemic lupus erythematosus, but not usually in patients with rheumatoid arthritis, as in this case. Normal serum haptoglobin rules out intravascular hemolysis; iron is recycled at a rapid rate. Impaired synthesis of b-globin chains gives rise to b-thalassemia, also characterized by hemolysis. Complement lysis is enhanced in paroxysmal nocturnal hemoglobinuria, which results from mutations in the PIGA gene. Patients with this disorder have a history of infections. Sequestration of RBCs in the spleen occur when RBC membranes are abnormal, as in hereditary spherocytosis or sickle cell anemia, or RBCs are coated by antibodies, as in autoimmune hemolytic anemias. Metastases are space-occupying lesions (myelophthisic process) that can lead to leukoerythroblastosis, with nucleated RBCs and immature WBCs appearing on the peripheral blood smear. [/INST] question: A 45-year-old woman has experienced worsening arthritis of her hands and feet for the past 15 years. On physical examination, there are marked deformities of the hands and feet, with ulnar deviation of the hands and swan-neck deformities of the fingers. Laboratory studies show an elevated level of rheumatoid factor. CBC shows hemoglobin, 11.6 g/dL; hematocrit, 34.8%; MCV, 87 mm3; platelet count, 268,000/ mm3; and WBC count, 6800/ mm3. There is a normal serum haptoglobin level, serum iron concentration of 20 mg/ dL, total iron-binding capacity of 195 mg/dL, percent saturation of 10.2, and serum ferritin concentration of 317 ng/mL. No fibrin split products are detected. The reticulocyte concentration is 1.1%. What is the most likely mechanism underlying this patient's hematologic abnormalities? | options: A: Autoantibodies against RBC membranes B: Impaired synthesis of b-globin chains C: Inadequate usage of stored iron D: Sequestration of RBCs in splenic sinusoids | answer: C </s> |
<s>[INST] context: The American newspaper publisher Arthur Sulzberger Sr died at the age of 86.Mr Sulzberger led The New York Times for more than three decades,before passing the business to his son.He took over the paper in 1963 when it was in financial trouble,and transformed it into the heart of a multibillion dollar media empire.
His family announced he had died at his home in Southampton,New York State,after a long illness.His son,Arthur Sulzberger Jr,said in a statement that his father,whom he referred to by his childhood nickname of Punch,was "one of our industry's most admired executives"."Punch,the old Marine captain who never backed down from a fight,was an absolutely fierce defender of the freedom of the press," he said.
The New York Times was bought by Mr Sulzberger Sr's grandfather Adolph Ochs in 1896.During Mr Sulzberger's tenure,The New York Times won 31 Pulitzer prizes.
Born in New York City,5 February 1926,Sr served in Marine Corps during World War II and Korean War,joined The New York Times in 1951 after graduating from Columbia College,took over as publisher in 1963 after his brotherinlaw died suddenly,stepped down in 1997 and passed stewardship to his son,Arthur Sulzberger Jr.
He oversaw a huge circulation boost at the paper,and increased its parent company's annual revenues from $100m in 1963 to $1.7bn by the time he stepped down in 1997.He also led the paper through highlevel clashes with the political establishment.In 1971,The Times published a series of stories saying that politicians had systematically lied over the US involvement in Vietnam.The source was thousands of leaked government documents known as the Pentagon Papers.The Nixon administration demanded that the paper stop publishing the stories on grounds of national security.But the paper refused,and then won the subsequent court case by arguing that the First Amendment of the US Constitution guaranteed free speech.The case is seen as a landmark in the history of free speech in the US.Mr Sulzberger said he read more than 7,000 pages of the Pentagon Papers before personally deciding to publish them.
His family still holds a controlling stake in The New York Times.He was a strong believer in family ownership of newspapers.He once joked:"My conclusion is simple. _ works." [/INST] question: When did Arthur Sulzberger Sr die? | options: A: In 1997 B: In 2012 C: In 1963 D: In 1971 | answer: C </s> |
<s>[INST] context: When the sand began kicking up and hitting our faces, I started to worry that maybe we had made a mistake.
That afternoon, my dad had stood on the deck of our home and laughed as our neighbors packed up their cars and headed inland. They left to spend the night in motels or at friends' homes that were out of range of approaching summer storm.
Challenging the weather that threatened to damping our spirits, we lit a fire on the beach. Dad told jokes and we had a good time. When it was 6:30 p.m., all laughter disappeared. Our eyes were drawn to the sky. A tornado was headed straight for us! In a flash, we were all on our feet. The wind started screaming and now we were running to the cottage. My mom stopped next to the front door. "Where can we go?" She shouted at my dad.
Most cottages on this part of Lake Michigan had been built without basements. Ours was no exception. The huge windows and the cottage itself wouldn't offer safety from high wind.
"Follow me!" my dad yelled. We crawled beneath the deck, pressing ourselves against the foundation of the cottage. Between the deck supports, we watched the approaching storm in silent terror.
My dad shouted, "Hold on!" and something else I couldn't hear over the screaming wind. I think he was praying. By the time it reached our cottage, it was nothing more than a strong wind. The rest of the storm lasted for an hour and then simply blew away.
"Next time, we'll stay inland at Grandma's. Okay?" my dad said. [/INST] question: What did the family do before the storm came? | options: A: The B: They stayed on the beach C: They packed up the cars D: They visited their neighbors | answer: B </s> |
<s>[INST] context: No one goes on an adventure tour with the thought that he won't make it back alive. It is unclear what Markus Groh thought when he signed up for a late February dive that could put him face-to-face with killer Sharks--without a cage to separate him from the man-eaters. He surely didn't expect to end up dead. But the 49-year-old man from Australia died on February 24 after being bitten on the leg while swimming with the sharks in the Bahamas.
Every year, thousands of people die while living life to the fullest-- battling white-water rapids (every year a great number of people go white-water rafting in states like California and Colorado), climbing the world's tallest mountain peak, or descending to the depths of the ocean. The extreme sports are dangerous and you take your chances.
Diving with dangerous sharks without a cage appeals to the thrill seekers. The tour , provided by Scuba Adventurers of River Beach, Florida, promoted its dives as great shark expeditions . "To ensure the best results, we will put fish and fish parts in the water," The Scuba Adventures website stated. "Consequently, there will be food in the water at the same time. Please be aware that these are not 'caged' dives; they are open water experiences. We will have crew members in the water at all times to ensure divers' safety."
Rodney Barreto, chairman of the Florida Fish and Wildlife Conservation Commission, maintains there's no way the crew could ensure the safety of the divers. "That's not a controlled environment, " Barreto says.
In 2001, the Florida Fish and Wildlife Conservation Commission banned the practice of fish feeding off the coast of Florida. Because the tour operator couldn't legally attract sharks with chum in Florida, Groh went to the Bahamas. Barreto says, " We are not discouraging people from going diving. We are telling them to be responsible and obey the law. One of the reasons why they went to the Bahamas was that they were doing something outside the law." [/INST] question: Where was Markus Groh from? | options: A: Florida B: Australia C: The Bahamas D: Colorado | answer: B </s> |
<s>[INST] context: Songs that make our hearts soar can make them stronger too, US researchers reported on Tuesday.
They found that when people listened to their favorite music, their blood vessels dilated in much the same way as when they are laughing, or taking blood medications.
"We have a pretty impressive effect," said Dr Michael Miller, director of preventive cardiology at the University of Maryland Medical Center in Baltimore.
"Blood vessel diameter improved," he said. "The vessel opened up pretty significantly. You can see the vessels opening up with other activities such as exercise." A similar effect is seen with drugs such as statins and ACE inhibitors.
When blood vessels open up more, blood flows more smoothly and is less likely to form the clots that cause heart attacks and strokes. Elastic vessels also resist the hardening activity of atherosclerosis .
"We are not saying to stop your statins or not to exercise but rather to add this to an overall program of heart health," said Miller, who presented his findings to a meeting of the American Heart Association in New Orleans. Miller's team tested 10 healthy, non-smoking men and women, who were told to bring their favorite music. They spent half an hour listening to the recordings and half an hour listening to music they said made them feel anxious while the researchers did ultrasound tests designed to show blood vessel function. Compared to their normal baseline measurements, blood vessel diameter increased 26 percent on average when the volunteers heard their joyful music. Listening to music they disliked - in most cases in this group heavy metal - blood vessels narrowed by six percent, Miller said.
Miller said he came up with the idea after discovering the laughter caused blood to literally flow more smoothly." I asked myself what other things make us feel real good, besides calories from dark chocolate of course. Music came to mind. ... It makes me feel real good," he said. Most of the volunteers chose country music but Miller said the style is not so important rather what pleases each individual. [/INST] question: The following things can make the blood vessel open up EXCEPT _ . | options: A: laughing B: taking some exercise C: drinking some wine D: listening to favorite music | answer: C </s> |
<s>[INST] context: You need to be of a certain age to understand why so many people in Hollywood are caring about the possible closing down of Metro-Goldwyn-Mayer .For the past 40 years, its output has been good, but now it is on the ropes, with debts of $ 3.7 billion and will have to sell off its most valuable assets.
In its golden time, MGM stood for something.If Warner Brothers meant social dramas and gangster movies, and Disney meant cartoon films, then MGM was healthy fantasy.This business model found its most glorious expression in its musicals of the post-war era.It also featured such many famous stars as Fred Astaire, Frank Sinatra, Gene Kelly and Judy Garland.
But MGM had always put its hopes on the quality of stars it could attract.From the time MGM became a company in 1924, the studio and his associate proved themselves good at creating big names.
For 35 years, this worked well enough, but the growing power of television disturbed Hollywood.MGM continued to throw money into making gorgeous-looking musicals, but despite some big successes audiences gradually started to drift away.Throughout the sixties, MGM's decline set in.Things went from bad to worse.In 1973, MGM stopped distributing its own films.Since then, the Lion's roar has been reduced to a whimper .
How far MGM has fallen can be shown by its recent releases.This was a studio that for years offered a reliable supply of first-class films.Yet last year its total output was three.To make it worse, all were co-produced with other studios.And this year? Only one so far, and maybe the last.
What now? MGM will probably be sold, though recent buyers have been cautious about a price thought to be around $ 2 billion. [/INST] question: MGM is becoming the focus in Hollywood because it _ . | options: A: has more supporters B: has produced good films C: might be closed down D: has lost all its assets | answer: C </s> |
<s>[INST] context: Primary biliary cirrhosis (nonsuppurative destructive cholangitis) is caused by chronic destruction of intrahepatic bile ducts in the portal tracts. Primary biliary cirrhosis evolves through ductal lesions, scarring, and eventually cirrhosis. Early PBC features chronic destructive cholangitis affecting intrahepatic small and medium-sized bile ducts. The bile ducts are surrounded primarily by lymphocytes (CD8+ T cells), but plasma cells and macrophages are also seen. In some portal tracts, lymphoid follicles are conspicuous. Discrete epithelioid granulomas often occur in the portal tracts and may impinge on the bile ducts. As a result of the destructive chronic inflammatory process, small bile ducts virtually disappear, and scarring of medium-sized bile ducts is common. Proliferation of bile ductules within portal tracts is common and may be florid. Collagenous septae extend from the portal tracts into the lobular parenchyma and encircle some lobules. Cholestasis, when present, may be severe and is located at the periphery of the portal tracts. The end-stage of PBC is cirrhosis, characterized by a dark green bile-stained liver that exhibits fine nodularity. The other choices do not feature destruction of intrahepatic bile ducts.Diagnosis: Primary biliary cirrhosis [/INST] question: A 36-year-old woman presents with a 6-month history of progressive generalized itching, weight loss, fatigue, and yellow sclerae. She denies use of oral contraceptives or any other medication. Physical examination reveals mild jaundice and steatorrhea. Blood studies show a high cholesterol level of 350 mg/dL, elevated serum alkaline phosphatase (240 U/L), and normal levels of AST and ALT. An intravenous cholangiogram shows no evidence of obstruction. An antimitochondrial antibody test is positive; antinuclear antibodies are not present. For the patient, a liver biopsy would most likely show which of the following pathologic findings? | options: A: Central hyaline sclerosis B: Cholangiocarcinoma C: Hemosiderosis D: Intrahepatic bile duct damage | answer: D </s> |
<s>[INST] context: Two major types of "cold antibody" may produce autoimmune hemolytic anemia. Cold agglutinins, which directly agglutinate RBCs, mediate cold agglutinin disease. The Donath-Landsteiner autoantibody, which is not an agglutinin but a potent hemolysin, mediates paroxysmal cold hemoglobinuria. - Cold agglutinin disease : In current usage, cold agglutinin disease peains to patients with chronic AHA in which the autoantibody directly agglutinates human RBCs at temperatures below body temperature, maximally at 0 to 5degC. IgM Ab against I Antigen of RBC. Attaches at cold temperatures resulting in clumping/ agglutination - Acrocyanosis Extravascular hemolysis is seen. - Cold Hemolysin type : The Donath-Landsteiner antibody is responsible for complement-mediated hemolysis in paroxysmal cold hemo-globinuria, a rare form of AHA in adults. The disorder is characterized by recurrent episodes of massive hemolysis following cold exposure. IgG Ab against P Antigen of RBC. Ab binds at 40 C ,complement system is activated at 370C Causes intravascular hemolysis. [/INST] question: Cold agglutinins are directly against which of the following RBC antigens? | options: A: P antigen B: I antigen C: Le antigen D: Rh antigen | answer: B </s> |
<s>[INST] context: Vitelliform macular dystrophy or vitelliform dystrophy is an irregular autosomal dominant eye disorder which can cause progressive vision loss. This disorder affects the retina, specifically cells in a small area near the center of the retina called the macula Vitelliform macular dystrophy causes a fatty yellow pigment (lipofuscin) to build up in cells underlying the macula. The retinal pigment epithelium also degenerates. Over time, the abnormal accumulation of this substance can damage the cells that are critical for clear central vision. As a result, people with this disorder often lose their central vision and may experience blurry or distoed vision, and loss is rarely symmetric. Scotomata appear, first with red light and then for green; finally, relative (or in more serious cases, absolute) scotomata occur with white light. Vitelliform macular dystrophy does not affect side (peripheral) vision or the ability to see at night. Researchers have described two forms of vitelliform macular dystrophy with similar features. The early-onset form (known as Best disease) usually appears in childhood; however, the onset of symptoms and the severity of vision loss vary widely. The adult-onset form begins later, usually in middle age, and tends to cause relatively mild vision loss. The two forms of vitelliform macular dystrophy each have characteristic changes in the macula that can be detected during an eye examination. [/INST] question: Which of the following has autosomal dominant inheritance - | options: A: Best's disease B: Gyrate atrophy C: Laurence Moon Biedl syndrome D: Bassen-Kornzweig's disease | answer: A </s> |
<s>[INST] context: What is the senior project?
The Senior Project at Clark Magnet High School is a program that shows a senior's ability to apply knowledge and skills, speak, write, solve problems and practice the life skills of time management, organization and risk-taking. Clark teaching staff, community members and school district staff act as advisers, evaluators during the research, project and presentation stages.
The key parts of the Senior Project are:
1) A research paper
A six to eight page persuasive research paper on a topic chosen by the students. The research paper strengthens effective writing skills learned in English class. Because the paper is persuasive, students should choose a topic about which they have a strong opinion. They should use elements learned when debating to convince the readers of the strong opinion stated in the paper, and prove it through research.
2) A physical product and fieldwork
A physical product and fieldwork (15-hour minimum requirement) related to some aspect of the paper. The 15 hours can be obtained through community service, job shadowing, or making an actual project. Students explore topics that are academic in nature, a hobby, a passion, or a possible future career.
3) Data collection
Data collection that combines the first two parts and records hours spent on the fieldwork. The collection contains evidence of the fieldwork presented through letters from the students' advisors, pictures showing the process of the project or anything else that would show proof of the work completed.
4) Speech presentation
A fifteen minute speech presented before a review board composed of school staff, district representatives, former students, and community representatives. The speech is a chance to show the students' senior project. Students are to dress professionally and summarize their senior project journey. Students will talk briefly about their research paper, their project, and what they learned. The speech should include visual aids. If the presentation includes performing, the students must speak for at least five minutes.
The Senior Project is a vehicle that allows students to use the knowledge and skills they have acquired in a "real-world" application. It has the potential to motivate the students, connect the school with the community, and create pathways from school to career. [/INST] question: What is the main purpose of the project? | options: A: To offer students chances to apply their learning to practice B: To strengthen students' writing and speaking abilities C: To encourage students to carry on scientific research D: To help students find some part-time jobs | answer: A </s> |
<s>[INST] context: Now,I'll tell you something about the Internet.The Internet is a network of computers.It became popular in the 1990s.Now,we live in the Internet Age.The Internet is very useful.You can get information,do some shopping or talk with people all over the world.You can do all these things in your own room.
You can set up your own space on the Internet.We call it a homepage.It's open to anyone in the world.Write your message on your homepage.Soon,you can get answers by email from people around the world.
The Internet is also useful when a flood or an earthquake happens somewhere in the world.We can learn about the needs of the people there and send them food and medicine more quickly than before.
In the world of the Internet,everyone is equal.Famous writers,artists,and scientists--they are all your friends.A lucky person can even find a message from the president of a country.
Some people lose themselves in the world of the Internet.That's really bad.Remember that the world of the Internet is not a real world.Facetoface communication with family,friends,and neighbours is very important.Don't forget that the Internet is only a tool for communication and information.
Many people say that the Internet has some problems,but most people agree the Internet still has a wonderful future.For the first time in history,anyone can exchange messages and information immediately with other people. [/INST] question: The Internet became popular _ . | options: A: in the 1980s B: in the 1990s C: in the year 2000 D: in the 21st century | answer: B </s> |
<s>[INST] context: The picture given in the question classically represents a case of ruptured ectopics pregnancy.
Symptoms – In Ectopic pregnancy triad of:
Amenorrhea (seen in 75% cases) followed by:
Abdominal pain (seen in 100% cases, it is the most consistent symptom of ectopic pregnancy).
Appearance of vaginal bleeding are seen:
The above triad may be accompanied by nausea, vomiting, fainting attacks or syncope.
Patient may present in shock with pallor, tachycardia, hypotension and cold clammy extremities, if ectopic pregnancy has ruptured
Examination:
General examination: In case of rupture—
P/R ↑
Pallor +nt
BP ↓
Slight intermittent pyrexia due to absorption of products of degeneration.
Per Abdomen - Abdomen is tense, tender and distended.
Shifting dullness may be present (depending on the amount of hemorrhage in ruptured ectopic).
Rigidity/muscle guarding +/–,
Cullen’s sign - bluish discolouration around the umbilicus may be present.
On Bimanual examination
Vaginal mucosa appears blanched.
Uterus: normal size/slightly bulky.
Extreme tenderness on cervical movement
Fornices-tender (Remember - tenderness in pelvis is the most constant sign of Ectopic pregnancy).
U/L adnexal mass: is palpable in one third to half of patient.
Culdocentesis:
It is a simple technique used to identify hemoperitoneum.
Fluid is aspirated from cul-de-sac via posterior fornix with the help of a needle.
If non clotting blood is obtained, it is indicative of an intraperitoneal bleed and probably a ruptured ectopic. [/INST] question: Basanti, a 28 yrs aged female with a history of 6 weeks of amenorrhoea presents with pain in abdomen; USG shows fluid in pouch of douglas. Aspiration yields dark color blood that fails to clot.Most probable diagnosis is: | options: A: Ruptured ovarian cyst B: Ruptured ectopic pregnancy C: Red degeneration of fibroid D: Pelvic abscess | answer: B </s> |
<s>[INST] context: TIPSS is a percutaneous procedure used for treatment of patients who have gastroesophageal varices in the setting of poal hypeension. It has largely replaced surgical poosystemic shunts due to the fact that it is both safe and effective while also providing a minimally invasive alternative to major abdominal surgery. TIPSS functions by creating an intrahepatic shunt between the poal and systemic circulation which causes a reduction in the poal pressure and ultimately in the blood flow through varices. It is accomplished by endovascular access through the jugular vein to a hepatic vein radical and subsequent creation of a needle tract that connects it to a branch of the poal vein. After dilation of the tract, a metallic stent is deployed to hold the new poosystemic connection open. Because this shunt reduces first pass metabolism of the liver, the most common complication of TIPS is encephalopathy which occurs in 25 to 30% of patients. Other complications such as hepatic ischemia, infection, renal failure, and hemorrhage may occur, but are rare [/INST] question: What is the most common complication following TIPSS? | options: A: Encephalopathy B: Hepatic ischemia C: Infection D: Life-threatening hemorrhage | answer: A </s> |
<s>[INST] context: A mother in Australia was told by a doctor that her new born son was dead but she helped to bring him back to life by holding the baby against her body. She used a method known as a kangaroo care. The child, named Jamie ,was born after only 27 weeks with his twin sister, Emily, in a hospital in Sydney. Her birth went well ,but his was a different story. The doctor struggled for 20 minutes to save Jamie before announcing him dead.
"His little arms and legs were just falling down away from his body." Kate Ogg said ,"I took off my coat and put him on my chest with his head over my arm." She and her husband, David ,said to the child as she continued to hold him for nearly 2 hours. During that time, the two-pound baby showed the sign of life. She said , "I told my mum ,who was there, that he was still alive. Then he held out his hand and grabbed my finger. "Their tiny baby grew stronger and stronger in his mother's arms, and their final goodbye turned into a hello.
The doctor at first ignored the baby's movements, but when he put the stethoscope to his chest, his mouth was wide open and he said ,"It's my fault, It's a miracle( ).
"The kangaroo care helps the baby keep body warmth" Dr Pinchi Srinivasan said, "It also regulates heartbeat and breathing rates and is believed to help weight gain and improve sleeping habits. Fathers can also use kangaroo care. The key to the method is skin-to-skin contact."
The practice began in less developed nations. It has become a recognized pracitce in helping premature babies. The techniques is good for babies, and is used in many baby care centers. [/INST] question: After hearing what the doctor said, the mother _ . | options: A: became so sad that she almost became mad B: didn't give up and tried to bring her baby to life C: chose to believe the doctor D: became angry at what the doctor did to the baby | answer: B </s> |
<s>[INST] context: To live forever was the dream of many emperors in ancient China.People were ordered to call them Wansui,which means 10,000 years,but no human could live that long.How long can humans really live? According to the latest scientific discovery,humans are able to live up to the age of 120 or perhaps even longer.
Several recent studies showed that our life span can be extended far beyond normal limits.Cynthia Kenyon,a professor at the University of California in San Francisco doubled the life of a worm from two weeks to a month.By changing the function of a single gene,known as daf-2,the scientist not only added extra days to the worm's life but also kept it a healthy as worms which were half its age.
There are two similar genes in the bodies of mammals.By changing the function of on gene,scientists extended the life of a mouse by 1 8 per cent(or 4.5 months).Another gene is called IGF-1.Researchers still don't know how it affects our body.But by reducing its functions the life of a mouse increases by 33 per cent for 8.6 months).The average life span of a mouse is 26 months.
In the experiment of extending life,an ancient saying,"you are what you eat." also seems to be true.Vegetables contain fewer calories than meat,and help to prolong life,scientists say. Research has found that taking in fewer calories affects our lives in a similar way to reducing IGF-1.
US biologist John Phelan suggests low calorie diets could increase human life span,but there is no proof yet.
Researchers are still waiting for the results of a study started in 1987.Monkeys are fed with low calorie food to see what happens.A monkey's typical life span is 40 years,so there is a little while to wait.
In China,average,life expectancy has now reached 70,double that of 1949. Increasing the length of our lives may bring us closer to the dreams of our ancient emperors.But it may also cause social problems such as housing and employment,social scientists have warned. [/INST] question: Which of the following is TRUE about statement of life span? | options: A: A few emperors in ancient China could live up to 10,000 years B: Creatures aren't able to lives up to 120 years C: The dream of living forever is coming true D: In China,the average life span is twice as long as it was half a century ago | answer: D </s> |
<s>[INST] context: We know that many animals do not stay ill one place. Birds, fish and other animals move from one place to another at a certain time. They move for different reasons: most of them move to find food more easily, but others move to get away from places that are too crowed.
When cold weather comes, many birds move to warmer places to find food. Some fishes give birth in warm water and move to cold water to feed. The most famous migration is probably the migration of the fish, which is called "salmon" . This fish is born in fresh water but it travels many miles to salt water. There it spends its life. When it is cold, it returns to its birthplace in fresh water. Then it gives birth and dies there. In northern Europe, there is a kind of mouse. They leave their mountain homes when they become too crowded. They move down to the low land. Sometimes they move all the way to the seaside, and many of them are killed when they fall into the sea.
Recently, scientists have studied the migration of a kind lobster . Every year, when the season of bad weather arrives, the lobster get into a long time and start to walk across tile floor of the ocean. Nobody knows why they do this, and nobody knows where they go.
So, sometimes we know why humans and animals move from one place to another, but at other times we don't. Maybe living things just like to travel.
,. [/INST] question: Most animals move from one place to another at a certain time to _ . | options: A: give birth B: enjoy warmer weather C: find food more easily D: find beautiful places | answer: C </s> |
<s>[INST] context: Management of salivary gland tumors1) Surgery (principle Rx) - Surgical excision alone or in combination with radiotherapy- For Parotid tumor: depending on the involvement* Superficial parotidectomy* Deep lobe parotidectomy* Total parotidectomy* Radical parotidectomy- Other salivary gland tumors - En block excision of tumor + gland 2) Neck dissection: performed in- Clinically palpable nodes- High grade malignancies3) Radio therapy - Indications* High Grade tumor* Large primary tumor* Perineural invasion* Invasion of Lymph node* Positive margins* Cervical lymph node metastasis 4) No role of chemotherapy- In salivary gland tumors due to* Incomplete & sho-lived response* No survival advantages Types of Parotidectomy1. Superficial or lateral or classical parotidectomy:* For benign and malignant tumors involving superficial lobe* Salivary tissue lateral to facial nerve is removed2. Deep lobe parotidectomy:* For benign and malignant tumor involving deep lobe* Salivary tissue deep to facial nerve is removed3. Total conservative parotidectomy* For benign and malignant tumor involving both superficial + deep lobe* All salivary tissue is removed* Facial nerve is preserved4. Radical parotidectomy* For tumors invading facial nerve* All salivary tissue is removed + excision of facial nerve5. Extended radical parotidectomy* Radical parotidectomy + removal of adjacent structures (mandible, temporal bone,muscles) [/INST] question: Surgical treatment of parotid tumor involving the deep lobe is:- | options: A: Total parotidectomy with facial nerve preservation B: Total parotidectomy with facial nerve sacrifice C: Deep lobe parotidectomy with facial nerve preservation D: Deep lobe parotidectomy with facial nerve sacrifice | answer: C </s> |
<s>[INST] context: There is plenty for kids and teens to do in the Syracuse area during the summer, including some great educational opportunities. Here are the top four.
Rosamond Gifford Zoo Camp
The zoo offers separate camps for kids. The camps for kindergarteners run from 9 am to 12:30 pm, and cost $115 for zoo members and $135 for non-members. Kids entering 7thand 8thgrades will have half a day from 1 pm to 4:30 pm. The cost is $149 for members and $160 for non-members. All camps feature numerous educational activities and animal encounters. The camps run from August 14 to August 19. Registration starts from July 10 for members and July 15 for non-members.
Active Learning Services at Christian Brothers Academy
From August 1 to August 5, Christian Brothers Academy will host Active Learning Services from USA Chess. Topics of learning will include Chess Camp (age 5-15), and Video Game Creation Program (age 8-15). Chess Camp promises improved chess skills through chess instructors utilizing demo boards and historic games. Half day sessions will cost $280 for the Computer Camps. A full day of Chess costs $400, and a half day of Chess followed by a half day of Computer Camps cost $430.
Syracuse University Summer College
From July 5thto August 12th, Syracuse University will host pre-college programs for high school students. The Summer College will offer a wide variety of programs including architecture, engineering and computer science, public communications, and eco-fashion. The programs are taught by the teachers of Syracuse University and include hands-on activities. The costs range from $2325 to $7642.
The Sheldon Institute at SUNY Oswego
The State University of New York will hold two-week educational enrichment programs for students entering grades2-4 from July 25 to August 5. Children will have a set program featuring art, science, technology, cultural appreciation and writing. Tuition for the programs is only $320 and a downloadable application is available. [/INST] question: If a preschool boy and his 8th-grade brother attend the Zoo Camps, they should pay _ . | options: A: $264 B: $275 C: $295 D: It depends | answer: D </s> |
<s>[INST] context: Goodwill welcomes the proven talent of retired soldiers and military family members to its workforce. As Goodwill expands its social enterprise and life-changing mission services, America's heroes and their families are helping us strengthen communities. Goodwill is uniquely intended to connect retired soldiers and military family members with their next careers. Goodwill links retired soldiers and their families with a broad array of career and financial fitness services as they transition from the military into hometowns and careers across the country. Services include but are not limited to financial education, housing assistance, primary health care, meal service, transportation, and connection to rehabilitation services .
In 2011, First Lady Michelle Obama and Dr Jill Biden carried out the Joining Forces plan to connect service men and women retired soldiers and their husbands or wives with the resources they need to find jobs. In April of that year, Goodwill set a new plan going, Goodwill for America's Heroes and Their Families, to expand its face-to-face career and family strengthening services. From April 2011 through March 2013, Goodwill has employed 1,856 retired soldiers and their families, and provided services to 99,386 retired soldiers and their families. And our commitment continues.
With the support of the Bank of America Charitable Foundation, Goodwill launched Vested in Retired Soldiers in the communities of Atlanta, Houston, Los Angeles and San Antonio to help military retired soldiers and their families connect with the education, training and support services they need to succeed on the homefront. Goodwill also launched an initiative known as Operation: GoodJobs, as funded by the Walmart Foundation, which provides a complete career assessment and an individualized development plan that include a range of family needs, from basic needs like nutrition, shelter and child care, to specific job training identified in the assessment process for participants and their families. The initiative currently exists in Austin, Houston and Tacoma, and will add additional markets in 2014. [/INST] question: Which of the following services is offered by Goodwill to retired soldiers and military family members? | options: A: Job opportunities B: Financial support C: Work training D: Child care | answer: A </s> |
<s>[INST] context: At one time no one could travel on an English road faster than four miles an hour. That was the law until 1896. A man had to walk in front of a car which could not go faster than the man. At night the man had to carry a red lamp.
Once Charles Rolls brought a car from France to England, but he wanted to drive faster than four miles an hour. In order to have no trouble with the police, he had a talk with some of the police officers, who ordered their policemen to look the other way when the car came along the road. This was a good plan in the country, but not so easy to follow in the busy streets of London.
One night Rolls and some friends started from London on their journey to Cambridge. One of the men walked in front with the red lamp, but he walked as fast as he could. The police became very interested in walls and shop-fronts when they heard the car and not one of them saw it.
They reached a hill, but what a waste of time it was to drive down the hill at four miles an hour! Rolls was getting ready to jump into the car, but then he noticed a policeman who was not looking the other way. The slow car reached him.
"Good evening," said the policeman, looking at the car.
"Good evening," said Rolls, holding the lamp.
"One of these horseless things," said the policeman, looking at it with interest.
"Yes," said Rolls, and waited.
"I've often wanted a ride in one, but of course policemen can't buy things like that." He turned and looked hopefully in Rolls's face.
"Jump in," said Rolls.
"Thanks," said the policeman, and did so. "Now," he said, sitting down, "You can let it go just as you like down this hill. There isn't another policeman on this road for a mile and a half." [/INST] question: The policemen were told "to look the other way" so that _ . | options: A: they could watch the car coming from the other direction B: Rolls's car could go faster than four miles an hour C: they could make sure no one was in the way D: the car would not hit them on the road | answer: B </s> |
<s>[INST] context: Practicing yoga is a helpful, popular way to keep fit. It has many followers around the world. There are many kinds of yoga. You may have heard of "hot yoga" before. Now, in India, a new kind of yoga, water yoga, is becoming more and more popular among the local people.
In the city of Agra, people practice yoga in water. It is more difficult to practice yoga in water than on land. But practicing yoga in water can be good for your flexibility .
Harish Chaturvedi, a lawyer, teaches people water yoga _ --even the poor people can learn from him. "Water yoga can become more popular than other kind of yoga, because the body does not get tired so quickly," he said. "Everybody can learn to swim, but if they learn yoga at the same time, they will never feel tired."
"The level of Oxygen is very high in water, and you will not have any breathing problem," he added.
Harish believes that water yoga really helps people to keep away from illness. He mainly trains children. He has classes at the swimming pool of a local sports room regularly. Many children are interested in it and come to team from him.
"Harish is very good at performing yoga in water," said Sudhir Narayan, a water yoga student. "He is teaching children free of cost and that is a very good thing." [/INST] question: What is Harish Chaturvedi? | options: A: A teacher B: A lawyer C: A doctor D: A swimmer | answer: B </s> |
<s>[INST] context: This is noncommunicating hydrocephalus with obstruction below the level of the third ventricle. If hydrocephalus had been present at birth, there would be increasing head size because the sutures are not yet closed, and congenital aqueductal stenosis would be suspected. At his age, a neoplasm should be suspected, and ependymomas arise in the ventricular system, often in the fourth ventricle, to cause obstruction of CSF flow. The increased CSF protein comes from this tumor, but the shedding of cells from the mass into the CSF is unlikely. Except for vascular malformation, the other options are uncommon at his age. An abscess is typically accompanied by fever, and most would be located in the cerebral hemispheres away from the ventricular system. Cryptococcal meningitis is accompanied by fever, and exudate can be found within the ventricular system and subarachnoid space, but there is more likely to be cerebral edema, not hydrocephalus. The demyelinating plaques of multiple sclerosis are small and do not usually act as mass lesions. Vascular malformations usually arise in the cerebral hemispheres. [/INST] question: A 16-year-old boy with no prior medical problems has complained of headaches for the past 9 months. There are no abnormal findings on physical examination. CT scan of the head shows an enlargement of the lateral cerebral ventricles and third ventricle. A lumbar puncture is performed with normal opening pressure, and clear CSF is obtained, which has a slightly elevated protein, normal glucose, and no leukocytes. Which of the following intracranial lesions is most likely to cause these findings? | options: A: Aqueductal stenosis B: Cerebral abscess C: Cryptococcal meningitis D: Ependymoma | answer: D </s> |
<s>[INST] context: Diffuse Esophageal Spasm Esophageal contractions are repetitive, simultaneous, and of high amplitude. Basic pathology is related to a motor abnormality of the esophageal body that is most notable in the lower two thirds of the esophagus. More common in women and is often found in patients with multiple complaints. Clinical feature Clinical presentation: Chest pain and dysphagia (may be related to eating or exeion and may mimic angina) Complain of squeezing pressure in the chest that may radiate to the jaw, arms, and upper back. The symptoms are often pronounced during times of heightened emotional stress. Diagnosis Barium swallow: Corkscrew or rosary-bead esophagus, segmental spasm or pseudodiveiculosis appearance Due to presence of teiary contractions Indicative of advanced disease Manometry is gold standard test for diagnosis. Treatment: Mainstay of treatment for DES is nonsurgical, and pharmacologic (Nitrates, calcium channel blockers) or endoscopic intervention (Bougie dilation) is preferred. Indications of surgery (long esophagomyotomy): Incapacitating chest pain or dysphagia who have failed medical and endoscopic therapy Presence of pulsion diveiculum of the thoracic esophagus [/INST] question: Corkscrew esophagus is seen in which of the following condition? | options: A: Carcinoma esophagus B: Scleroderma C: Achalasia cardia D: Diffuse esophageal spasm | answer: D </s> |
<s>[INST] context: During the lag time, by definition, bacteria newly introduced into a culture will undergo metabolic changes necessary for use of the medium, but will NOT increase in number. Therefore, at the end of the first 30 minutes elapsed time, the number of bacteria in the culture will be 2 x 10^2. Thereafter, the number of bacteria will double every 20 minutes (the definition of generation time). This means that after 2 1/2 hours of total elapsed time, 6 generations will have occurred, so the original inoculum number is multiplied by 2, 6 times. 6 x 10^2 (1st Choice) is not the correct answer. If this was your answer, you forgot that lag periods occur only once per culture, and also incorrectly multiplied the staing inoculum number by an incorrect number of generations (three). 1.2 x 10^3 (2nd Choice) is not the correct answer, and reflects the common student error of counting the number of possible generations and multiplying by that number. Remember that every generation time means that every bacterium in that culture has divided into two, so you must multiply by two, 6 times or 26. 1.6 x 10^3 (3rd Choice) is not the correct answer, and reflects the common error of forgetting that the lag time occurs only one time per culture. If you picked this answer, you divided the 2.5 hours of culture time between three lag periods and three correctly calculated generations (23). [/INST] question: 2x102 Streptococcus viridans are inoculated into a flask containing one liter of enriched broth. If the lag time is 30 minutes and the generation time is 20 minutes. How many bacteria will there be in the culture after two and a half hours? | options: A: 6 x 10^2 B: 1.2 x 10^3 C: 1.6 x 10^3 D: 1.28 x 10^4 | answer: D </s> |
<s>[INST] context: Poor Alice was very unhappy. "What a wonderful garden!" she said to herself. "I'd like to be out there - not in this dark room. Why can't I get smaller?" It was already a very strange day. and Alice was beginning to think that anything was possible.
After a while she locked the door again, got up and went back to the glass table. She put the key down and she saw a little bottle on the table. Round the neck of the bottle was a piece of paper with the words DRINK ME in large letters.
But Alice was a careful girl. "It can be dangerous to drink out of strange bottles," she said. "What will it do to me?" She drank a little bit very slowly. The taste was very nice. like chocolate and oranges and hot sweet coffee. and very soon Alice finished the bottle.
"What a strange feeling!" said Alice. "I think I' m getting smaller and smaller every second."
And she was. A few minutes later she was only 25 centimeters high. "And now," she said happily,
"I can get through the little door into that beautiful garden."
She ran at once to the door. When she got there. she remembered that the little gold key was back on the glass table. She ran back to the table for it, but of course, she was now much too small! There was the key, high above her, on top of the table. She tried very hard to climb up the table leg, but she could not do it.
At last, tired and unhappy, Alice sat down on the floor and cried. But after a while she spoke to herself angrily.
"Come now," she said, "Stop crying at once. What's the use of crying?" She was a strange child, and often talked to herself like this.
Soon she saw a little glass box near her on the floor. She opened it and found a very small cake with the words EAT ME on it.[:. . ]
Nothing could surprise Alice now. "Well, I'II eat it," she said. "If I get taller, I can take the key off the table. And if I get smaller, I can get under the door. _ I'll get into the garden. So it doesn't matter what happens!" She went on eating, but nothing happened. [/INST] question: Why couldn't Alice get into the beautiful garden? | options: A: She couldn't find the key to the door B: She was too small to get the key to the door C: She didn't know how to get through the door D: She was not allowed to go into the garden | answer: B </s> |
<s>[INST] context: (Manganese) (410-H) (449-H17th) Deficiencies of manganese have been reported to result in bone demineralization, poor growth, ataxia, disturbances in carbohydrate and lipid metabolism and convulsion Deficiency and Toxicities of Metals Element Deficiency Toxicity Boron No-biologic function determined Developmental defects, male sterility, testicular atrophy Copper Anemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deterioration. Hepatic failure, tremor, mental deterioration, hemolytic anemia, renal dysfunction Chromium Impaired glucose tolerance* Occupational renal failure dermatitis, pulmonary cancers. Manganese Impaired growth and skeletal development, reproduction, lipid and carbohydrate metabolism: upper body rash General:- Neurotoxicity, Parkinson like symptoms. Occupational:- Encephalitis like syndrome, Parkinson like syndrome, psychosis pneumoconiosis. Molybdenum Severe Neurologic abnormalities Reproductive and fetal abnormalities Selenium Cardiomyopathy, heart failure, striated muscle degeneration General:- Alopecia, abnormal nails, emotional lability, peripheral neuropathy, lassitude, garlic odor to breath, dermatitis. Occupational:- Lung and nasal carcinoma, liver necrosis, pulmonary inflammation. [/INST] question: A chronic alcoholic patient on high carbohydrate diet develops a deficiency of | options: A: Selenium B: Cadmium C: Manganese D: Iodine | answer: C </s> |
<s>[INST] context: This patient has clinical features of a pituitary adenoma with acromegaly. Pituitary adenomas range from small lesions that do not enlarge the gland to expansive tumors that erode the sella turcica and impinge on adjacent cranial structures. Adenomas smaller than 10 mm in diameter are referred to as microadenomas, and larger ones are termed macroadenomas. Microadenomas do not produce symptoms unless they secrete hormones. The mass effects of pituitary macroadenomas include impingement on the optic chiasm, often with bitemporal hemianopsia and loss of central vision, oculomotor palsies when the tumor invades the cavernous sinuses, and severe headaches. Large adenomas may invade the hypothalamus and lead to loss of temperature regulation, hyperphagia, and hormonal syndromes because they interfere with the normal hypothalamic input to the pituitary. Symptoms of acromegaly include characteristic facial changes, goiter, barrel chest, abnormal glucose tolerance, male sexual dysfunction, menstrual disorders in women, degenerative arthritis, peripheral neuropathy, and thickened skin. The other choices represent tests that will not provide the diagnosis of pituitary tumor.Diagnosis: Acromegaly, pituitary adenoma [/INST] question: A 30-year-old woman complains of headache, visual disturbances, deepening of the voice, and generalized weakness. She reports amenorrhea for the past year and states that she recently required a larger shoe size. Laboratory studies show impaired glucose tolerance. What other procedure would be useful for establishing your diagnosis? | options: A: CBC with differential count B: CT scan of the abdomen C: MRI of the sella turcica D: Test for serum 21-hydroxylase | answer: C </s> |
<s>[INST] context: Circulatory adjustments at birth
These are brought about because of a shift from placental dependance for gas exchange in the fetus to pulmonary gas exchange in the neonate.
1) Pulmonary circulation
Immediately after birth lungs expand due to the first few breaths of the neonate.
This causes a fall in pulmonary vascular resistance (O2 causes pulmonary vasodilatation).
This results in increased flow into pulmonary trunk and arteries.
The pulmonary artery pressure falls due to lowering of pulmonary vascular resistance.
The pressure relations between the aorta and pulmonary trunk are reversed so that the blood flow through the ductus arteriosus is reversed → Instead of blood flowing from the pulmonary artery to aorta, the direction of flow through ductus, is from the aorta to pulmonary trunk.
Increasing oxygen saturation causes the muscle of ductus to constrict →
In full term neonates, the ductus arteriosus closes within 10 to 25 days.
2) System circulation and circulation through the heart
Loss of placental circulation and clamping of the cord after birth results in an increase in systemic vascular resistance.
This tends to increase the aortic blood pressure and the left ventricular systolic pressure.
The loss of placental circulation results in a sudden reduction of flow through ductus venosus which closes off → Flow through ductus venosus disappears by the 7th day of postnatal life.
The loss of placental flow results in a decrease in the volume of blood returning to right atrium → Right atrial pressure decreases.
The left atrial pressure becomes higher than right atrial pressure and the septum primum which ats as a valve of fossa ovalis, approximates with the septum secundum to close off formen ovale.
Functional closure of foramen ovale occurs very quickly.
Over a period of months, the septum primtun and septum secundum become firmly adherent resulting in anatomical closure of the foramen ovale.
After closure of ductus arteriosus, there is establishment of postnatal circulation : -
The blood reaching the right atrium through IVC and SVC is emptied into the right ventricle from where it is pumped into pulmonary trunk.
After coursing through lungs for gas exchange, it reaches the left atrium and ventricle.
The left ventricle pumps it out for distribution in the body for oxygenation of the tissues.
The venous return again comes back to right atrium through IVC and SVC.
All of the blood leaving the right ventricle, after coursing through lungs, reaches the left ventricle → The two ventricles are connected in series and therefore, the output of right and left ventricles are same (in contrast to fetal circulation, where right ventricular output is more). [/INST] question: Anatomical closure of ductus arteriosus occurs at – | options: A: Birth B: 3–4 day C: 10th day D: 30th day | answer: C </s> |
<s>[INST] context: People hold different views on what or how much homework should be. It is partly due to the fact that people can't seem to agree on the purpose of homework.
Some teachers think that homework is necessary to reinforce what is learned in school. And so they ask their students to memorize what was discussed in class through homework. Some teachers think the point of homework is to cover material that the class didn't have time to get to, so their homework is to let students learn additional things. Other teachers like homework simply because they want students to form work habits and still others believe homework is necessary because it's the best way for parents to learn what their children do in school.
However, many parents seem to have different ideas. Elisa Cohen, who has twins at Lafayette Elementary School, doesn't like the fact that third-grade students in DC elementary schools are asked to write about 25 book summaries a year. She said, "They do the same thing over and over without really getting into alternate ways of thinking about books, reading and writing."
Some education reformers , such as Howard Gardner, a Harvard University professor well-known for his theory on multiple intelligence, think that Cohen is on the right track. But it's often hard to persuade overworked teachers to give much thought to homework tasks. [/INST] question: How many opinions do the teachers have on "homework"? | options: A: 3 B: 4 C: 5 D: 6 | answer: B </s> |
<s>[INST] context: Derivatives of the Pharyngeal Arches and their Innervation Pharyngeal arch Nerve Muscles Skeleton 1st Vth nerve- trigeminal: maxillary and mandibular divisions - Muscles of Mastication (temporal: masseter, medial, lateral pterygoids) - Myelohyoid - Anterior belly of digastric - Tensor veli palatini - Tensor tympani Premaxilla, Maxilla, Zygomatic bone, Pa of temporal bone. Meckel's cailage, Mandible, Malleus. Incus, Anterior ligament of malleus, Sphenomandibular ligament 2nd VIIth nerve- Facial - Muscles of facial expression (buccinator, auricularis, frontalis, platysma, orbicularis oris, orbicularis oculi) - Posterior belly of digastric, - Stylohyoid, - Stapedius Stapes, Styloid process, Stylohyoid ligament, Lesser cornu and upper poion of body of hyoid bone 3rd IXth nerve- glossopharyngeal - Stylopharyngeus Greater cornu and lower poion of body of hyoid bone 4th Xth nerve- Superior laryngeal nerve - Pharyngeal muscles - Cricothyroid - Levator veli palatini Thyroid cailage Epiglottis 6th Xth nerve - Recurrent laryngeal nerve - All Intrinsic muscles of larynx except cricothyroid Cricoid cailage Arytenoid cailage Corniculate Cuneiform [/INST] question: Which of the following muscles develop from 6th pharyngeal arch | options: A: Cricothyroid B: Thyrohyoid C: Stylopharyngeus D: Thyroaretynoid | answer: D </s> |
<s>[INST] context: When someone says "SHARK" most people think of a big, toothy, underwater animal; basically we are imagining a Great White. In fact sharks come in all shapes, sizes and even colors! Follow me please; I'd like to show you a very special small shark commonly known as horn sharks, only found in the coastal waters of north-west North America.
Look at this shark, and you can easily see the horns on it and you will know the reason why it is called the horn shark is that it has the broad, flattened head and two large horn-like spines found behind its eyes and makes it one of the hardiest of all shark species. What makes it unique is that as its enemy attempts to swallow it, the spines on its back will stick into the enemy's mouth and give a good chance for it to get away.
The horn shark is brown in color with black spots all over its body. The adults can reach up to a length of 4 feet and weigh up to 10 kg. An interesting fact about the horn shark is that it has five gills . The horn shark is a clumsy swimmer using its flexible pectoral fins to push itself along the bottom of the ocean. The maximum distance that has ever been recorded for a horn shark to have traveled out from its habitat is 10 miles.
Today, as so little is known about its population off the Californian coast, they have been listed as being "Data Deficient" in the World Conservation Union. The horn shark is being threatened both by water pollution and commercial fishing in the area. Though they are not among those sea creatures hunted primarily for food, but they often get caught as a by-catch in fishing expeditions. [/INST] question: The horn shark gets its name for _ . | options: A: its small size B: its large eyes C: its two large spines D: its brown color with spots | answer: C </s> |
<s>[INST] context: Closed head injuries may result in cerebral concussion from depression of the reticular formation of the brainstem. This type of injury is usually reversible. Local bleeding and swelling (intracranial or extracranial) produce an increase in the intracranial pressure. A characteristic symptom pattern occurs initiated by progressive depression of mental status. Increasing intracranial pressure tends to displace brain tissue away from the source of the pressure; if the pressure is sufficient, herniation of the uncal process through the tentorium cerebri occurs. Pupillary dilation is caused by compression of the ipsilateral oculomotor nerve and its parasympathetic fibers. If the pressure is not relieved, the contralateral oculomotor nerve will become involved and, ultimately, the brainstem will herniate through the foramen magnum and cause death. Hypeension and bradycardia are preterminal events. Emergency measures to reduce intracranial pressure while preparing for localization of the clot or for a craniotomy or both include hyperventilation, dexamethasone (Decadron), and mannitol infusion. Of these, hyperventilation produces the most rapid decrease in brain swelling. [/INST] question: Initial emergency reduction of intracranial pressure is most rapidly accomplished by | options: A: Saline-furosemide (Lasix) infusion B: Urea infusion C: Hyperventilation D: Intravenous dexamethasone (Decadron) | answer: C </s> |
<s>[INST] context: The wall of the vagina from the lumen outwards consists firstly of a mucosa of non-keratinized stratified squamous epithelium with an underlying lamina propria of connective tissue, secondly a layer of smooth muscle with bundles of circular fibers internal to longitudinal fibers, and thirdly an outer layer of connective tissue called the adventitia. Some texts list four layers by counting the two sublayers of the mucosa (epithelium and lamina propria) separately. The lamina propria is rich in blood vessels and lymphatic channels. The muscular layer is composed of smooth muscle fibers, with an outer layer of longitudinal muscle, an inner layer of circular muscle, and oblique muscle fibers between. The outer layer, the adventitia, is a thin dense layer of connective tissue, and it blends with loose connective tissue containing blood vessels, lymphatic vessels and nerve fibers that is present between the pelvic organs.The epithelial covering of the cervix is continuous with the epithelial lining of the vagina. The vaginal mucosa is absent of glands. The vaginal epithelium consists of three rather arbitrary layers of cells - superficial flat cells, intermediate cells and basal cells - and estrogen induces the intermediate and superficial cells to fill with glycogen. The superficial cells exfoliate continuously and basal cells replace them Under the influence of maternal estrogen, newborn females have a thick stratified squamous epithelium for two to four weeks after bih. After that, the epithelium remains thin with only a few layers of cells without glycogen until pubey, when the epithelium thickens and glycogen containing cells are formed again, under the influence of the girl's rising estrogen levels. Finally, the epithelium thins out during menopause onward and eventually ceases to contain glycogen, because of the lack of estrogen In abnormal circumstances, such as in pelvic organ prolapse, the vaginal epithelium may be exposed becoming dry and keratinized [/INST] question: Vaginal epithelium is derived from: | options: A: Endoderm of urogenital sinus B: Mesoderm of urogenital sinus C: Endoderm of genital ridge D: Mesoderm of genital ridge | answer: A </s> |
<s>[INST] context: Mittelschmerz Afemale giving history of sharp pain in lower abdomen, every month, 2 weeks before the menstruation suggests mittelschmerz as the diagnosis. Mittelschmez is synonymous to painful ovulation. Pain is associated with rupture of ovarian follicle at the time of ovulation Characteristics of : Mittelschmerz or Ovular pain It appears in the mid-menstrual period.o Pain is usually situated in the hypogastrium or to one iliac fossa.o Pain is usually located on one side and does not change side according to which ovary is ovulating.o Nausea and vomitinois consDicuouslv absent.o It rarelv lasts for more than 12 hours.o It may be associated with slight vaginal bleeding or mucoid discharge.o The probable factors are : - Increased tension of graffian follicle just prior to rupture.o - Peritoneal irritation by follicular fluid following ovulation.o - Contraction of tubes and uterus.o Management : Assurance and analgesics In refractory cases cycles are made anovular by giving OCPs Also Know : The phenomenon of ovulation bleeding or mucus tinged with blood at the time of ovulation is called as mittel bluto . This may be associated with ovulation pain, although each may occur independently. [/INST] question: A 20 year old woman gives a history of sharp pain in the lower abdomen tor 2 - 3 days every month approximately 2 weeks before the menses. The most probable etiology for her pain is : | options: A: Endometriosis B: Dysmenorrhea C: Pelvic tuberculosis D: Mittelschmerz | answer: D </s> |
<s>[INST] context: In front of my daughter, Shelly, was a bowl filled with cabbage. She hated cabbage. She only sat there in silence with tears in her eyes.
"Shelly, my dear, why don't you eat a little? If not, your mum will shout at us."
Shelly didn't feel happy. "OK, dad. I will eat, just a little." Then Shelly said, "Dad, if I eat it all, will you give me what I want?"
"Yes."
Slowly she began to eat. It took her almost half an hour to finish all the food in the bowl. Then she came up to me and said, "Dad, I want to have my hair cut off!"
"Shelly, why don't you ask for something else? If we see your head like that, we'll feel very sad," I said.
"But Dad, you promised! Now you're going back on your words. "
I had to keep my promise. Shelly had all her hair cut off. She smiled.
On Monday morning, I took Shelly to school. Just when I arrived, a boy got out of a car and shouted, "Shelly, please wait for me!"
Guess what? The boy had no hair, either.
"Sir, your daughter is great!" a man got out of the car and said, "This boy is my son, Harish. He has cancer. He lost his hair when he got ill. Shelly cut hers off so Harish felt less different. She is a special girl."
I stood for a while, "My little daughter, you teach me how selfless real love is!" [/INST] question: Shelly _ before she ate her meal. | options: A: felt happy B: felt unhappy C: cut off her hair D: shouted at her dad | answer: B </s> |
<s>[INST] context: Does everyone want a challenging job? In spite of all the attention focused by the media, academicians, and social scientists on human potential and the needs of individuals, there is no evidence to support that the vast majority of workers want challenging jobs. Some individuals prefer highly complex and challenging jobs; others develop in simple, routine work.
The individual-difference variable that seems to gain the greatest support for explaining who prefers a challenging job and who doesn't is the strength of an individual's needs for personal growth and self-direction at work. Individuals with these higher-order growth needs are more responsive for challenging work. What percentage of ordinary workers actually desire higher-order need satisfactions and will respond positively to challenging jobs? No current data is available, but a study from the 1970s estimated the figure at about 15%. Even after adjusting for changing work attitudes and the growth in white-collar jobs, it seems unlikely that the number today exceeds 40%.
The strongest voice advocating challenging jobs has not been workers--it's been professors, social science researchers, and media people. Professors, researchers, and journalists undoubtedly made their career choices, to some degree, because they wanted jobs that gave them autonomy, recognition and challenge. That, of course, is their choice. But for them, to force their needs onto the workforce in general is presumptuous .
Not every employee is looking for a challenging job. Many workers meet their higher-order need off the job. There are 168 hours in every individual's week. Work rarely consumes more than 30% of this time. That leaves considerable opportunities, even for individuals with strong growth needs, to find higher-order need satisfaction outside the workplace. So don't feel you have a responsibility to create challenging jobs for all your employees. For many people, work is something that will never excite or challenge them. And they don't expect to find their growth opportunities at work. Work is merely something they have to do to pay their bills. They can find challenges outside of work on the golf course, fishing, at their local pub, with their friends in social clubs, with their family, and the like. [/INST] question: What makes people choose challenging jobs? | options: A: Positive responses B: Work attitudes C: Higher-order growth needs D: Personal self-direction | answer: C </s> |
<s>[INST] context: Laser Trabeculoplasty is useful in patients with primary or secondary open angle glaucoma. It acts by producing a thermal energy at the point of application which will produce micro scars. As the micro scars contract, surrounding un-lasered tissue is stretched there by allowing for better drainage. Repopulation of the trabecular meshwork by stimulation of the cellular division is another possible mechanism. New formed cells are more efficient at allowing drainage. In the given options, Pseudoexfoliation syndrome and Uveitic glaucoma are secondary open angle glaucoma. Uveitic glaucoma patients require control of the uveitis and usually medical treatment of glaucoma. Surgical intervention including laser treatment can worsen the uveitic component of the disease. Pseudo exfoliation syndrome (PES) is characterized by deposition of an amorphous grey dandruff-like material on the pupillary border, anterior lens surface, posterior surface of iris, zonules and ciliary processes. Secondary open-angle glaucoma is associated in about 50% of the cases. Exact mechanism of rise of IOP is also not clear. Trabecular blockage by the exfoliative material is considered as the probable cause. Clinically, the glaucoma behaves like POAG and is managed by Laser Trabeculoplasty (Increases Trabecular Outflow) Laser trabeculoplasty causes damage, inflammation and scarring of trabecular mesh work causing opening up of trabecular spaces. Since it causes a lot of inflammation it is not used for cases where already there is a lot of inflammation like uveitic glaucoma and neovascular glaucoma. [/INST] question: Laser trabeculoplasty is done for | options: A: Chronic angle closure glaucoma B: Neovascular glaucoma C: Pseudoexfoliative glaucoma D: Uveitic glaucoma | answer: C </s> |
<s>[INST] context: Being shy keeps many Chinese people from getting to know westerners. You may feel nervous about making language mistakes in front of a native English speaker.
But remember, westerners living in Asia know how it feels to try to communicate in a foreign language. They have made many mistakes when speaking Chinese!
So don't worry about speaking imperfect English. The important thing is just to communicate. Start talking, and make some foreign friends!
Many westerners value their privacy . Don't be surprised if your new friend doesn't want to include you in everything he does. This may seem strange to Chinese who worry about that their friends will get lonely.
Chinese people often expect their good friends to give advice and take care of them in many ways. If you expect this kind of care from westerners, you may be disappointed. Why? Because most westerners value _ . They feel insulted if others think they can't take care of themselves. They will assume you feel the same way.
Of course, these tips are just rules of thumb and may not apply to all westerners. Each person you meet will have his or her own ideas about friendship. When you get confused , don't be shy and worry to ask questions. Your new western friends may also have many questions about Chinese culture, and they may be hesitant to ask. So encourage them to ask questions, too.
Be honest and open to your friends. Respect each other's differences. The friendships you make can be lifelong treasure both for you and your new friends. [/INST] question: .Why do many Chinese people feel worried to speak to the foreigners? | options: A: Being shy B: Making a lot of language mistakes C: Nothing to say D: Can't speak a foreign language | answer: A </s> |
<s>[INST] context: Davos----the highest Alpine resort in Europe offers all the amenities of a small town, while nestling in landscape of unspoilt natural beauty and marvelous mountain splendor . Davos is ideal for an active holiday in a magnificent mountain setting. Whether in summer or winter, you can almost enjoy every type of sport. Skiing, snowboarding, cross-country skiing and ice-sports in winter. Hiking, running, mountain biking, golfing and water sports in summer. Tennis, squash, horse-riding, hand-gliding and paragliding are year-round attractions, Spengler Cup Ice Hockey Tournament and the UBS Snowboard World Championships are just a few of the highlights from an impressive palette of sporting attractions.
During the last 35 years, Davos has firmly established itself as a successful and competitive international congress venue , despite its slightly distant location. World Economic Forum for example, is held here annually. The town's strong point lies in its contrast to the conventional congress resort, offering an inviting combination of education and relaxation far from the hustle and bustle of city life.
Davos boasts a long skiing tradition. At the turn of the 19thcentury it was mainly the British, who together with a few local people influenced the beginning of Alpine ski sport. The world's first ski lift was opened at Bolgen in 1934. Parts of this lift are now exhibited in the Davos Winter Sports Museum. But Davos was not just one of the pioneers of Alpine skiing. It was also one of the first resorts to recognize and support snowboarding as a sign of the times rather than just an insignificant passing trend. By the beginning of the 1990's,Davos had already gained a reputation as a snowboarding Mecca ,a reputation which has grown with every passing year.
Wonderful winter days can be spent without skis. At the coldest time of year, 84 km of well-prepped winter walking paths offer an irresistible invitation to discover the fresh Davos countryside. Thy snowshoe hiking, definitely different way to cheer up on sunshine and energy. And if you dream of soaring the Alpine skies with a paraglider or a color1ful hang-glider,wintertime Davos can make your dreams come true!
Davos,the largest mountain resort of Europe,offers unforgettable natural experiences and a broad range of delights. And anyone favoring the tranquil idyll over the anxious life in the thriving center, will find peace and quiet at heart of nature in the wide Davos outdoors. [/INST] question: In Summer, which sport is ideal in Davos except_. | options: A: Hiking B: Mountain biking C: Hose-riding D: Cross-country skiing | answer: D </s> |
<s>[INST] context: Hypocalcemia is associated with physical findings including spasm of the muscles of the forearm and hand when a blood pressure cuff is inflated (Trousseau sign) and spasm of the facial muscles when the facial nerve is stimulated (Chvostek sign). Hypocalcemia is also associated with a prolonged QT interval and may be aggravated by both hypomagnesemia and alkalosis. Additionally, massive transfusion is associated with hypocalcemia secondary to chelation with citrate in banked blood. Severe, symptomatic hypocalcemia, encountered most frequently following parathyroid or thyroid surgery or in patients with acute pancreatitis, should be treated with intravenous calcium gluconate. The myocardium is very sensitive to calcium levels; therefore, calcium is considered a positive inotropic agent. Calcium increases the contractile strength of cardiac muscle as well as the velocity of shoening. In its absence, the efficiency of the myocardium decreases. Hypocalcemia often occurs with hypoproteinemia, even though the ionized serum calcium fraction remains normal. [/INST] question: A 42-year-old man sustains a gunshot wound to the abdomen and is in shock. Multiple units of packed red blood cells are transfused in an effo to resuscitate him. He complains of numbness around his mouth and displays carpopedal spasm. An electrocardiogram demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment? | options: A: Intravenous bicarbonate B: Intravenous potassium C: Intravenous calcium D: Intravenous digoxin | answer: C </s> |
<s>[INST] context: Music is an international language. Popular music in America is what every student likes.
Students carry small radios with earphones and listen to music before class, after class, and
at lunch. Students with cars buy large speakers and play the music loudly when they drive
streets. Adult drivers listen to music on the car radio when they drive to work. They also listen to the News about sports, the weather, politics , and activities of the American people. Most of the radio broadcast is music.
Pop or popular music singers make much money. They make a CD or tape which radio stations use in every state . Once the popular singer is heard all over the country, young people buy his or her tape. Some of the money from these tapes comes to the singer. Whenever the singer goes, all the young people want to meet him or her. Now the singer has become a national star.
There are other kinds of music that are important to Americans. One is called folk music. It has stories about the common life of Americans. Another is called western or country music. This was started by cowboys who would sing at night to the cows they were watching. Today, any music about country boy and his girl is called western or country music. Serious music for the concert halls is called classical music. Music for instruments is called orchestra music, such as the symphonies of Beethoven. [/INST] question: Almost every American student likes _ . . | options: A: popular music B: American songs C: folk music D: classical music | answer: A </s> |
<s>[INST] context: Millions of children in the United States go to summer camps. Some go to play outdoors at traditional camps in the woods, in the mountains or on lakes. But families now have many choices of special camps. These can be in the middle of nature or a big city. Special camps offer young people the chance to learn about different subjects: anything from space exploration to business to medicine.
In technology camps, one subject that children can learn about is video game design. They learn how to use computer programs to create games of their own. One program that teaches video game design is called Cybercamps. Children can learn how to design their own virtual worlds to set their video game in. Then, they program their own rules and objects into the game.
Cybercamps also offers courses in robot building and Web design. A recent story in the Washington Post described how one child made a robot that could sing a song. Another made a robot that could follow a black line drawn on a piece of cardboard. Also, children can learn how to make Web sites. One child made a site for Pokemon, one of his favourite cartoon shows. [/INST] question: Traditional camps are _ . | options: A: in the woods B: in the mountains C: on lakes D: all above | answer: D </s> |
<s>[INST] context: Dear Economist,
My newly-wedded wife and I are deeply in love.There is, however, one issue that threatens the happiness of our marriage.I absolutely insist on shopping at Walmart.My wife, meanwhile, would rather avoid Walmart at all costs.
I have recently tried to convince her that not only does Walmart offer the lowest prices known to man, but that the chain is also a force for good--lower prices mean better standards of living for all consumers, increased global trade means a tighter-knit international community, and efficient operations translate into higher productivity growth for the economy.My wife complains about poor labour policies, the "fact" that Walmart squeezes suppliers, and that it puts local shops out of business.
Who is right? Will our marriage survive?
Brian Gee
Dear Brian,
I have to agree with you about Walmart.Jason Furman, then an economist at New York University, now an adviser to President Obama, famously argued in 2005 that Walmart was unwittingly a progressive success story.The chain's prices don't much affect me (I prefer Whole Foods) but Furman estimated that they benefited low-and-middle-income Americans to the sum of around $250 billion a year.
Walmart does not pay much, so it may depress wages.Then again, it may increase wages by offering jobs to the otherwise-unemployed.Either way, the benefits of low prices to Walmart shoppers far outweigh any seemingly reasonable costs to Walmart employees.And while it is true that Walmart employees tend to be poor, the same is true of Walmart shoppers.
Armed with this information you can face your wife with confidence.You are sure to win the conversation.The divorce is likely to be more argued.
Economist [/INST] question: What concerns Brian Gee so much that he wrote the letter? | options: A: His wife refuses to shop at Walmart B: They are faced with a divorce C: They can't afford the costs of shopping at Walmart D: They are in conflict about shopping at Walmart | answer: D </s> |
<s>[INST] context: As we all know, the ocean moves. But waves breaking on the beach make the ocean fun. When you stand on the shore and look at the waves, it seems like the water is moving towards you. But the water is not really moving forward. The moving you see is wave energy. And wave energy comes from the wind.
Let's think about how this works. As wave energy passes through the water, the energy makes particles of water move up and down. Just give you an example of a wave passing under a basketball. We put a basketball on the sea. When the wind blows, a wave comes from behind the basketball. The basketball moves up to the top with the wave. Then the wave continues and leaves the basketball behind. The basketball looks lower, but it doesn't move forward. That's because the wave energy just moves the water which is under the basketball.
So why can you see a wave knock you down on the shore?When a wave moves toward the shore, the bottom of the wave slows down because _ meets the ocean floor. But the top, which is called crest , keeps moving. The different action causes the wave to fall over or break onto the shore. If a wave is very large, it carries a lot of energy when it hits the land. As time goes by, waves can break up and carry away the rocks and other things on the shore. Shorelines are changing all the time because of wave action. [/INST] question: _ is really moving forward when you look at the wave. | options: A: Water B: The basketball C: Water and wave energy D: Wave energy | answer: D </s> |
<s>[INST] context: Trendelenberg test :
It tests the stability of the hip and particularly of the abductor mechanism of the limb on which the patient is standing.
The principle of the test :
Normally when one leg is raised from the ground the pelvis tilts upwards on that side, through the action of the hip abductors of the standing limb.
If the abductors are inefficient they are unable to sustain the pelvis against the body weight and it tilts downwards instead of rising up on the side of the lifted leg.
Note that the test is performed with the patients standing on the affected leg.
Abductor mechanism :
It can be compared with the lever, with the body weight is trying to tilt the pelvis down; the hip joint being the fulcrum and the abductor muscles being the power acting through the lever arm (from the head of the femur to attachment of the abductor's muscles on the greater trochanter - the neck of the femur)
Causes of the positive Trendelenburg test :
Any failure of the abductor mechanism causes dipping of the pelvic (ASIS) on the normal side.
There are three fundamental causes :
1) Paralysis of the abductor's muscles
eg. Polio.
Paralysis of superior gluteral nerve (Supplies gluteus medius & minimus)
2) Marked approximation of the insertion of the abductor muscles to their origin by upward displacement of the greater trochanter ; so that the muscles are slack.
eg. Severe coxa vara,
dislocation of hip
3) The absence of stable fulcrum & lever arm about which the abductor muscles can act
Neck femur fracture
Dislocation of hip,
Destructruction of head as in Perthe's diseases. [/INST] question: Trendelenburg sign is positive in damage of the following nerve - | options: A: Inferior gluteal nerve B: Pudendal nerve C: Superior gluteal nerve D: Posterior tibial nerve | answer: C </s> |
<s>[INST] context: "Clean your plate!" and "Be a member of the clean-plate club!" Just about every kid in the US heard this from a parent or grandparent. Often, it's accompanied by an appeal: "Just think about those starving orphans in Africa." Sure, we should be grateful for every bite of food. Unfortunately, many people in the US take too many bites. Instead of "cleaning the plate', perhaps we should save some food for tomorrow.
According to news reports, US restaurants are partly to blame for the growing bellies(,). A waiter puts a plate of food in front of each customer, with two to four times the amount recommended by the government, according to a USA Today story. Americans traditionally associate (......) quantity with value and most restaurants try to give them that. They prefer to have customers complain about too much food rather than too little.
Barbara Rolls, a nutrition professor at Pennsylvania State University, told USA Today that restaurant portion(,) sizes began (or grew) in the 1970s, the same time that the American waistline began to expand .
Health experts have tried to get many restaurants to serve smaller portions. Now, apparently, some customers are calling for this too. The restaurant industry trade magazine QSR reported last month that 57 percent of more than 4,000 people surveyed believe restaurants serve portions that are too large; 23 percent had no opinion; 20 percent disagreed. But a closer look at the survey indicates that many Americans who can't afford fine dining still prefer large portions. Seventy percent of those earning at least $150,000 per year prefer smaller portions; but only 45 percent of those earning less than $25,000 want smaller.
It's not that working-class Americans don't want to eat healthily. It's just that, "after long hours at low-paying jobs, getting less on their plate hardly seems like a good deal. They live from paycheck, happy to save a little money for next year's Christmas presents." [/INST] question: Parents in the United States tend to ask their children _ . | options: A: not to save food B: to wash the dishes C: not to eat too much D: not to waste food | answer: D </s> |
<s>[INST] context: ESSENTIALS of medical PHARMOCOLOGY SEVENTH EDITION KD TRIPATHI Page :636,637 Impoant statins are :lovastatin Simvastain, pravastatin, rosuvastatin etc Rosuvastatin This is the latest and the most potent statin (10 mg rosuvastatin :::::. 20 mg atorvastatin), with a plasma tlh. of 18-24 hours. Greater LDL-CH reduction can be obtained in severe hypercholesterolaemia; paly due to its longer persistence in the plasma. In patients with raised TG levels, rosuvastatin raises HDL-CH by 15--20% (greater rise than other statins). Dose: Sta with 5 mg OD, increase if needed upto 20 mg/ day, (max 40 mg/ day) ROSUV AS, ROSYN 5, 10, 20 mg tabs. Adverse effects All statins are remarkably well tolerated; overall incidence of side effects not differing from placebo. Notable side effects are: * Headache, nausea, bowel upset, rashes. * Sleep disturbances (probably more with lipophilic drugs). * Rise in serum transaminase can occur, but liver damage is rare. * Muscle tenderness and rise in CPK levels occurs infrequently. Myopathy is the only serious reaction, but is rare ( < 1 per 1000). Few fatalities due to rhabdomyolysis are on record. Myopathy is more common when nicotinic acid/ gemfibrozil or CYP3A4 inhibitor- ketoconazole I erythromycin/ cyclosporine I HIV protease inhibitor is given concurrently. Gemfibrozil inhibits the hepatic uptake of statins by the organic anion traspoer OATP2.it must not be given to pregnant ladies. Uesd in primary hyperlipipidemias. [/INST] question: Svere myopathy commonly is a side effect of | options: A: Rosuvastatin B: Nicotinic acid C: Ezetimibe D: Colesevelam | answer: A </s> |
<s>[INST] context: Tinea capitis is a dermatophyte infection of the scalp that may cause multiple patches of alopecia and severe itching. The dermatophytoses are diseases caused by a group of closely related filamentous fungi with a propensity for invading the stratum corneum, hair, and nails. Dermatophyte infections are designated by the word tinea, followed by the Latin name of the site. Thus, tinea capitis is a dermatophyte infection of the head. The three genera generally responsible for dermatophyte infections are Trichophyton, Microsporum, and Epidermophyton. Both Microsporum and Trichophyton species commonly cause tinea capitis. The most common pathogens are Trichophyton tonsurans followed by Microsporum canis. These two pathogens are distinguished by the fact that hairs infected with Microsporum species fluoresce a bright blue green color whereas those infected by Trichophyton species usually do not fluoresce. In addition, T. tousurans often causes a unique pattern on the scalp known as "black dot ringworm," characterized by circular patches of alopecia with hairs broken off close to the follicle. Epidermophyton species usually iuvade the iuteriginous skin, not the scalp. Epidermophyton floccosum is a cause of tinea crnsis, not tinea capitis. Neither Candida nor Aspergillus species are dermatophytes. Candida albicans is responsible for oral thrush and, in infants, diaper dermatitis. Aspergillus species are inhaled agents rather than skin pathogens. [/INST] question: An 8-yrs-old male presents with multiple patches of alopecia and severe pruritus. A bright blue-green fluorescence is seen on examination of the scalp with a wood lamp. Pathogen most likely responsible is? | options: A: Epidermophyton floccosum B: Microsporum canis C: Candida albicans D: Trichophyton tonsurans | answer: B </s> |
<s>[INST] context: The patient has cervical intraepithelial neoplasia (CIN) III with koilocytic atypia secondary to the human papillomavirus. The designation CIN III encompasses both severe dysplasia and carcinoma in situ.Cervical dysplasia is a precursor lesion of cervical squamous cancer. Most cases of cervical dysplasia occur in women in their late 20s and 30s. The pathogenesis of cervical dysplasia and cancer is an early age of first intercourse, multiple sexual paners, male paner(s) with multiple previous sexual panners, smoking, immunosuppression (renal transplants, AIDS), a strong association with human papillomavirus (HPV) types 16, 18, 31, and herpes infection (possible cocarcinogen with HPV).Cervical intraepithelial neoplasia (CIN) is a system for classifying dysplasia into mild, moderate, severe, and carcinoma in situ. The histologic correlations to these designations include CIN I (mild dysplasia), which involves the innermost one third of the cervical epithelium; CIN II (moderate dysplasia), which involves two thirds the thickness of the epithelium; and CIN III (severe dysplasia or carcinoma in situ), which involves in the full thickness of the epithelium.Koilocytosis refers to squamous cells with wrinkled nuclei surrounded by a perinuclear halo. It correlates with the presence of HPV. Colposcopy involves inspection of the cervix with a stereoscopic binocular microscope after the cervix has been saturated with acetic acid. It aids the clinician in identifying abnormal areas to biopsy. [/INST] question: A 22-year-old woman has an abnormal cervical Pap smear. A biopsy is obtained from a suspicious area on the cervix. The pathology repo says, "There is a loss of the normal orientation of the squamous cells. Atypical cells with wrinkled nuclei and perinuclear halos involve the full thickness of the squamous epithelium. The basement membrane is intact." Your diagnosis? | options: A: Cervical intraepithelial neoplasia (CIN) I with koilocytic atypia B: CIN II with koilocytic atypia C: CIN III with koilocytic atypia D: Inflammatory atypia secondary to colposcopyaifact | answer: C </s> |
<s>[INST] context: * Electricity exes its tissue damaging effects by conversion to thermal energy. * Tissue damage following a high-voltage electrical injury not only occurs at the Cutaneous contact site but may also involve underlying tissues and organs along the route taken by the current between the entrance and exit sites. * Misleading small cutaneous lesions may overlie extensive areas of devitalized muscle, which may liberate significant quantities of myoglobin and cause acute renal failure if an adequate renal output is not maintained. * High-voltage electric injury and lightning injury both can cause cardiopulmonary arrest. Cardiopulmonary resuscitation (CPR) must be initiated immediately for the treatment of cardiac arrest. *Patients may require operative treatment as soon as hemodynamic stability is achieved. *A number of neurological changes may occur in the patient ranging from immediate peripheral deficits to relatively late- appearing deficits. *In general motor nerves appear to be more commonly affected than the sensory nerves. *Liver necrosis, intestinal perforation, focal pancreatic necrosis and focal gall bladder necrosis have been repoed. * Late complications include delayed hemorrhage even from moderate sized blood vessels. [/INST] question: High tension electrical burns from overhead electric lines can cause- | options: A: Myoglobinuria and Acute renal failure B: Severe alkalosis C: No ECG change will be seen in the first 24 hours D: Blood vessels are spared | answer: A </s> |
<s>[INST] context: Initial resuscitation requires rapid reexpansion of the circulating intravascular blood volume along with interventions to control ongoing losses. In accordance with Starling's law stroke volume and cardiac output rise with the increase in preload. After resuscitation, the compliance of the ventricles may remain reduced due to increased interstitial fluid in the myocardium. Therefore, elevated filling pressures are frequently to maintain adequate ventricular performance. Volume resuscitation is initiated with the rapid infusion of either isotonic saline (although care must be taken to avoid hyperchloremic acidosis from loss of bicarbonate buffering capacity and replacement with excess chloride) or a balanced salt solution such as Ringer's lactate (being cognizant of the presence of potassium and potential renal dysfunction) through large-bore intravenous lines. Data, paicularly on severe traumatic brain injury (TBI), regarding benefits of small volumes of HYPEONIC SALINE that more rapidly restore blood pressure are variable, but tend to show improved survival thought to be linked to immunomodulation. No distinct benefit from the use of colloid has been demonstrated, and in trauma patients it is associated with a higher moality, paicularly in patients with TBI. The infusion of 2-3 L of salt solution over 20-30 min should restore normal hemodynamic parameters. ref:harrison&;s principles of internal medicine,ed 18,pg no 2221 [/INST] question: 40 % Loss of blood volume in a patient is Managed by- | options: A: Vasopressor agents B: Cardiac stimulants C: Saline infusion D: Intracardiac adrenaline | answer: C </s> |
<s>[INST] context: Have you ever heard of the group Westlife? Maybe you have, but I'm sure many of you don't know very much about it.
Westlife is an Irish boy band group, which was made up of 6 boys in the beginning and called IOU. The group quickly became popular with young people thanks to their song Swear It Again, which was at the top of the UK charts in April 1999.
Chinese fans got their first chance to see Westlife on March 6th, 2006 in Beijing. Although the four-member group has been singing pop for seven years, the young boys have all since grown up and their songs are still very popular. When they performed in Beijing, Westlife released their new album Face to Face in China. Face to Face has been at the top of the British charts for a long time. The album's most popular song You Raise Me Up mixes traditional Irish music with pop music.
Although hip-hop is quite popular among the young, Westlife has no plans to change. They said, "Hip-hop is for the young, but pop can be enjoyed by moms who are busy cooking meals and raising the kids. [/INST] question: Westlife is from _ . | options: A: America B: China C: Ireland D: Germany | answer: C </s> |
<s>[INST] context: Transurethral prostate surgery TURP remains the most commonly performed procedure for the surgical correction of BOO. Strips of tissue are cut from the bladder neck down to the level of the verumontanum. Cutting is performed by a high-frequency diathermy current, which is applied across a loop mounted on the hand-held trigger of the resectoscope. Coagulation of bleeding points can be accurately achieved. The 'chips' of prostate are then removed from the bladder using an Ellik evacuator. Resection proceeds at 1g/minute in experienced hands. The duration of resection for monopolar TURP is limited to 1 hour due to the risk of resorption of water if 1% glycine is used as an irrigant. The advent of bipolar TURP where normal saline is used as an irri- gant permits resection of larger prostates. Following TURP, careful haemostasis is performed, and a three-way, self-re- taining catheter irrigated with isotonic saline is introduced into the bladder to prevent any fuher bleeding from form- ing blood clots. Irrigation is continued until the outflow is pale pink, and the catheter is usually removed on the sec- ond or third postoperative day. In men with small prostates or bladder neck dyssynergia or stenosis, it is better to divide the bladder neck and prostatic urethra with a collings knife. Laser can be used to evaporate (e.g. Green light laser) or enucleate the prostate (e.g. HOLEP). The advantage of green light laser is that vaporisation is haemostatic and this procedure can be performed even while patients are antico- agulated. HOLEP involves the use of a laser to coagulate any of the small vessels crossing the relatively avascular plane between the peripheral and transitional zones of the prostate while the tip of the cystoscope is used, much like the surgeons finger at Millin's prostatectomy, to enucleate the transition zone adenoma. The enucleated adenoma is pushed into the bladder, where it is morcellated and extracted the cysto- scope. Damage to the external sphincter is avoided provided one uses the verumontanum as a guide to the most distal point of the resection/vaporisation/enucleation. [/INST] question: Which of the following is the most common cause of delayed UT obstructive symptom after TURP | options: A: Stricture of navicular fossa B: Stricture of membranous urethra C: Stricture of bulb of urethra D: Bladder neck stenosis | answer: D </s> |
<s>[INST] context: Dana Cummings was in his thirties before he first went surfing. But, even more interesting is that Dana Cummings chose to learn the sport after losing a leg in a car accident. Now, nine years later, he helps other disabled people learn how to ride the waves in AmpSurf.
On the coast of Maine, he is working with 27-year-old Matthew Fish, who is partly blind. Cummings takes hold of Fish and leads him into the ocean. The surfboard floats next to them. Fish lies on the surfboard. He tries to stand up on it. After a few attempts he is up and riding all the way back to land. "That was exciting," Fish says.
A car accident in 2002 took Dana Cummings' leg. He says the crash changed him more than just physically. "Losing my leg made me realize how precious life is and get off the couch and start living. I do more things now than I ever did before. Next week I am going to compete in a contest in Hawaii," Dana says.
One year later Dana Cummings formed AmpSurf. AmpSurf is a group that volunteers to hold surfing classes and events for people with all kinds of disabilities.
Recently, AmpSurf took its training programs to the East Coast. Eleven students attended the class in Maine. They came from all over the northeastern United States.
Dana Cummings thinks AmpSurf can change the way a disabled person thinks. "Most people with disabilities consider himself or herself unlucky and useless, but we want them to see what they can do. Who cares you lose your leg or you are blind, whatever? Have fun. Just enjoy life. Take the most advantage of _ you can," Dana says. [/INST] question: Matthew Fish thinks learning to ride the waves is _ . | options: A: boring B: easy C: interesting D: difficult | answer: C </s> |
<s>[INST] context: San Russell is not your average baseball fan. He is a die-hard Boston Red Sox fan. He has a season ticket and he arranges his work schedule so he does not miss a game. San also attends game dressed in their uniform, and his car is red. He has even lost some friends by choosing to watch the Red Sox instead of going to their weddings. Is this healthy behavior?
Although Russell's case is extreme, being a sports fan can be healthy for you. According to a study at the University of Kansan in the USA, sports fans suffer from depression less than people who are not interested in sports, fans also experience other effects from watching their team play. When their team wins a game, their own confidence and happiness increase, just like the athletes. Losing, on the other hand, always leads to some sense of disappointment.
What about die-hard fans whose team always loses? The team spirit keeps those fans from losing hope. Knowing that other fans are probably feeling the same way also helps them. In addition, there is always the hope that their team will win the next game. Russell has lost some friends because of his love for baseball and although you may think that would make him unhappy, he has made many more new friends because of his team spirit.
For Sam Russell, supporting the Red Sox is not just a hobby; it is a way of life and the secret of his happiness. [/INST] question: From the reading we can infer that a die-hard fan _ . | options: A: goes to a game without caring for work B: prefers going to a game to a friend's wedding C: suffers from more depression than ordinary people D: is not willing to help other fans | answer: B </s> |
<s>[INST] context: "Whenever neonate presents with delayed passage of stool, Hirschsprung's disease should be suspected".
Diagnosis of Hirschsprung's disease
The diagnosis of Hirschsprung's disease is confirmed by rectal suction biopsies
Rectal suction biopsies demonstrate —
Hypertrophied nerve bundles
The absence of ganglion cells
Other diagnostic procedures in Hirschsprung's disease
Rectal manometry
Anorectal manometry measures the pressure of internal anal sphincter while a balloon is distended in the rectum. The results are interpreted as —Normal individual → Reflex decline in internal sphincter pressure.
Hirschsprung's disease → Pressure fails to drop, the Paradoxical rise in pressure with rectal distention.
Radiography (Barium enema)
It demonstrates the presence of the transition zone between the normal dilated proximal colon and a smaller calibre obstructed distal colon caused by non-relaxation of aganglionic bowel.
Delayed passage of stool (meconium) and abdominal distension suggests low intestinal obstruction. [/INST] question: A male infant presented with distension of abdomen shortly after birth with the passing of less meconium. Subsequently, a full–thickness biopsy of the rectum was performed. The rectal biopsy is likely to show – | options: A: Fibrosis of submucosa B: Lack of ganglion cells C: Thickened muscularis propria D: Hyalinisation of the muscular coat | answer: B </s> |
<s>[INST] context: Yao Beina was not only a popular singer but also an energetic and warm-hearted angel. She donated her corneas to two men after her death.
Yao was born in a music family in September 1981 in Wuhan. She started to learn music at the age of 4, and she sang her first song on the stage when she was 9. Yao did quite well in singing, so she took part in the 13th Youth Singing Competition and won the first prize.
She became well-known to the pubic after making some songs for the hit TV drama The Legend of Zhenhuan , and the mandarin version of Let It Go from Disney's Frozen . In July 2013, she competed in The Voice of China II and finally got the second place in Na Ying's team. She had won many music prizes.
Yao Beina was unlucky to be diagnosed with breast cancer . She had a successful operation in 2011. She has fought against the illness for about four years while keeping singing, but sadly she failed. Although she's gone, her fans will remember her beautiful voice and kindness forever. [/INST] question: How old was Yao Beina when she started to learn music? | options: A: Four B: Nine C: Thirteen D: Fourteen | answer: A </s> |
<s>[INST] context: Glynis
I piled on the pounds and I couldn't lose them. Then I joined a slimming club. My target weight was 140 pounds and I lost 30 pounds in six months. I felt great and people kept saying how good I looked. But Christmas came and I started to slip back into my old eating habits. I told myself I'd lose the weight at slimming classes in the next year, but it didn't happen. Instead of losing the pounds, I put them on. I'd lost will power and tried to believe the saying that fish and chips didn't make any difference but the scales don't lie.
Roz
To be honest, I never weigh myself any more. I've leant to be happy with myself. It seemed to me that I would feel sorry about every spoonful of tasty food that passed my lips. My idea is simple. You shouldn't think too much about food and dieting. Instead, you should get on with life and stop dreaming of a super-thin body. This is obviously the size I'm meant to be and, most of all I'm happy with it.
Lesley
I was very happy about winning Young Slimmer of the Year. I'd look in the mirror, unable to believe this slim lady was me! That might have been my problem-perhaps from then on I didn't pay any attention to myself. Winning a national competition makes everything worse, though because you feel the eyes of the world are fixed upon you. I feel a complete failure because I've put on weight again.
Ros
Before moving in with my husband Gavin, I'd always been about 110 pounds, but the pleasant environment went straight to my waist and I put on 15 pounds in a year. Every so often I try to go on a diet. I always do well in the first few days, then end up having the children's leftovers or eating chocolate happily-my weakness. I'd like to be slim. I decided to take more exercise when my kids are older. [/INST] question: What are the four women talking about? | options: A: Their figure B: Their future life C: Their work as a housewife D: Their eating habits | answer: A </s> |
<s>[INST] context: Your mom tells you to put on your hat and gloves. But as the cold winter season gets closer, it's so cold that even mom's advice does not work.
That means it's time to put on your qiuku! This is a kind of "thermal underwear " or long underpants that keep people warm in the coldest months of the year.
In Western countries, qiuku is usually known as long johns, but they aren't popular. Long johns in the US are usually two pieces, a long-sleeved shirt and long pants, worn under other clothing or sometimes even used as pajamas .
Long johns first appeared in England during the 17thcentury. We call them long johns because the US boxer John L. Sullivan wore them while he boxed. But this is not a historical fact.
In the US, it gets quite cold and snowy in many places. And while parents often push kids to wear more clothes and long underwear, _
Part of the reason might be because it's not very fashionable and another reason might be because people don't spend much time outside during the cold months. So they just deal with the freezing temperatures when they have to leave the warm building. But in their parents' eyes, staying warm is more important than looking nice. [/INST] question: People wear qiuku to be _ . | options: A: fashionable B: popular C: friendly D: Warm | answer: D </s> |
<s>[INST] context: Next time you hear a funny joke you'd better not laugh too hard. According to a paper published by the British Medical Journal, laughter isn't always the best medicine. Sometimes it can even be harmful. Professor Robin Ferner from the University of Birmingham, one of the authors of the study, found that bad things could happen to people who laughed too much. He says: "We found people with heartbeat problems which had stopped their heart, we found people who had fainted, and we found people who'd dislocated their jaws or burst their lungs."
It seems that laughing can be no laughing matter. But it's not all _ . Professor Ferner says there are benefits to laughing when you want to lose weight, for example. Yes, that's right: laugh and be slimmer! Professor Ferner explains that: "You use energy when you laugh, you move your diaphragm , you expand your lungs, and both those things can be helpful."
According to the research, laughing for a quarter of an hour can burn up to 40 calories, and if you laughed all day you'd use up about 2,000 calories, which is what most people consume in a day. But don't do that or you might end up with a painful jaw. Ouch! Or you might find people looking at you in a funny way.
But I don't want to finish this article leaving you feeling desperate. Laughter comes naturally for most of us. Babies begin to laugh at around 3-6 months. So give in to your sense of humour and keep smiling. Life is short anyway. [/INST] question: Laughing too much may cause the following harmful results EXCEPT _ . | options: A: heart stop B: diaphragm movement C: lung burst D: jaw dislocation | answer: B </s> |
<s>[INST] context: For most families, a long car journey is the _ of any trip.But for the Zapps, their 83-year-old vehicle has been a home for the past 11 years, as the couple travel around the world on a never ending trip of a lifetime, covering 142,000 miles over four continents.
Herman and Candelaria Zapp, who got married to each other in 1996 and to their journey in 2000, Set off from Patagonia, Argentina, heading for Alaska. They came back to Argentina in2004,but settled there only for a couple of weeks, before deciding the open road is the only way to live. They have been traveling ever since, with a trip around South America between 2005 and 2007, then central America, the U.S. and Canada until 2009.The car was shipped to Australia, New Zealand, Japan and South Korea as they traveled those countries and they are currently in the Philippines on a tour of South East Asia.
As a proof that life is possible in such a mobile style, the family of the two slowly grew to a number of six.They became, over the years and while on the road, parents to four children, Pampa (eight), Tehue (five), Paloma (three) and Wallaby (one). Remarkably, each of their kids has a different nationality.
"My grandfather knew that we wanted to travel and to never stop so he gave me the old Grdham-Paige car he used on his farm," Herman said. Each night the six Zapps either sleep in or around a tent set up next to their car, but more often than not they find a friendly local who will put them up for the night.The only hard rule the couple have to stick by, is the 40mph speed limit the 83-year old car is restricted to.
Their trip is supported with the money coming from selling books they write about the places they visit. [/INST] question: _ years after their marriage, the couple decided to travel forever. | options: A: Four B: Eight C: Nine D: Eleven | answer: B </s> |
<s>[INST] context: Do you have an emotional brain or a rational one? Researchers at Australia's Monash University have found actual difference in the brains of people who respond emotionally to others' feelings compared with those who respond more rationally.
A study published in the journal NeuroImage has looked at whether people who have more brain cells in certain areas of the brain are better at certain types of empathy, according to Science Daily. Empathy is the ability to understand and share the feelings of another person, and the two types investigated were cognitive empathy and affective empathy.
"Every day people use empathy with, and without, their knowledge to get around in the social world," said Robert Eres from Monash University's School of Psychological Sciences. "We use it for communication, to build relationships, and to increase our understanding of others."
"People who are high on affective empathy are often those who get quite fearful when watching a scary movie, or start crying during a sad scene. Those who have high cognitive empathy are those who are more rational, for example a psychologist helping someone," explained Eres.
The results of the study showed that people with high scores for affective empathy had more gray matter in a part of the brain called the insula, found right in the "middle" of the brain. Those who scored higher for cognitive empathy had more in a part called the midcingulate cortex--an area above the corpus callosum, which connects the two halves of the brain.
The discovery "raises new questions--like whether people could train themselves to have more empathy, and whether those areas of the brain would become larger if they did, or whether we can lose our ability to empathize if we don't use it enough", according to Science Daily.
"In the future we want to investigate further by testing whether training people in empathy-related tasks can lead to changes in these brain areas. We also want to investigate if damage to these brain areas, as a result of a stroke for example, can lead to empathy problems." said Eres.
Perhaps in the future we will all be able to empathize more with other people. Maybe you will cry at that sad movie after all! [/INST] question: Empathy can be used in the following situations EXCEPT that _ . | options: A: when a psychologist is helping a patient with his mental disease B: when a teacher is comforting a student about his father's death C: when a mathematician is calculating the area of a farmland D: when people are reading a story with a frightening ending | answer: C </s> |
<s>[INST] context: Counterfeit ( ) medicines are a widespread problem in developing countries. Like other counterfeits, they look like real products. But counterfeit drugs may contain too little or none of the active ingredients of the real thing.
People do not get the medicine they need. And in some cases counterfeits cause death. Twenty children in Bangladesh died last year after being given acetaminophen . The medications contained ingredients that looked, smelled and tasted like the real thing. The medicine was produced by a local drug company that used a dangerous substitute to save money.
The problem of counterfeit medicines is especially serious in Africa, Asia and Latin America. The W.H.O. estimates that up to thirty percent of medicines on sale in many of those countries are counterfeit. The problem is less widespread among industrialized countries. The W.H.O. says counterfeits make up less than one percent of the illegal drug market in countries like the United States, Canada, Japan, and New Zealand.
But the agency also says as much as fifty percent of the medicine sold on the Internet is counterfeit.
Much is being done to fight counterfeit drugs. Several companies are developing ways to make counterfeits easier to identify. And there are existing methods, like a machine that can quickly identify chemicals in pills to confirm if the pills are real. Other ideas include things like special tracking codes for drug packages. People could send a text message with the code and get a message back, which proves that what they bought is listed in a database. Some drug makers and other companies put three-dimensional images called holograms on their products as a security device. [/INST] question: Last year twenty children in Bangladesh died because of _ . | options: A: online medicines B: unreal drugs C: acetaminophen D: unclean water | answer: B </s> |
<s>[INST] context: A study by St. Louis University has found that a lovable dog named Sparky and a robotic dog AIBO, were about equally effective at reducing the loneliness of nursing home residents. The study confirmed previous findings that dogs have a good effect on nursing home residents .
Dr. Andrew Smith led the Stanford University teamat built a home-assistance robot. "If humans can feel an emotional tie with robots, some day they could be not just our assistants, but also our companions," he said.
To test whether residents responded better to Sparky, a trained dog, or the Sony-made robotic dog, researchers divided 38 nursing home residents into three groups at three long-term care centers in St, Louis.
One group had weekly 30-minute one-on-one visits with Sparky; another group had similar visits with AIBO; a control group had no contact with either dog.The groups' respective levels of loneliness were tested by having them answer a number of questions at the beginning and near the end of the visits.
After two months, both groups that had contact with the dogs were less lonely and more attached. Most of the elderly regarded Sparky, a 9-year-old dog, as an audience for their life stories, said investigator Marian Banks.
"He listened attentively, wagged his tail, and allowed them to pet him," said Banks, who adopted and trained Sparky after finding him in a street behind her home seven years ago.
Those who were together with AIBO took a little longer to warm to the robotic creature.Over time, however, they grew comfortable with him, and petted and talked to him. He would respond by wagging his tail, vocalizing , and blinking his lights.
"AIBO is charming once you start to interact with him," said the study's author, Dr. William Banks, " He's an attractive sort of guy. He gives a feeling: of being personal, not just a robot. " [/INST] question: Before the new study, it was known that _ . | options: A: dogs could help get rid of old people's loneliness B: robots could build close connection with humans C: robots were more effective at reducing people's loneliness D: dogs and robots were equally effective at reducing loneliness | answer: C </s> |
<s>[INST] context: Terms used in Health Planning
Objectives
An objective is a planned end-point of all activities.
It is a precise point. It is either achieved or not achieved.
Target
Target often refers to a discrete activity such as the number of blood films collected or vasectomies done, it permits the concept of degree of achievement.
Goal
A goal is defined as the ultimate desired state towards which objectives are directed.
Goals are not necessarily attainable
Unlike objectives and targets, goals are not constrained by time or existing resources.
Monitoring
Monitoring is the day-to-day follow-up of activities during their implementations to ensure that they are proceeding as planned and are on schedule.
Evaluation
Evaluation measures the degree to which objectives and targets are fulfilled and the quality of results obtained.
The purpose of evaluation is to assess the achievement of the stated objectives of a programme.
While monitoring is confined to day-to-day or on-going operation, evaluation is concerned with the final outcome. [/INST] question: Which of the following is a set point for term plans but is yet something cannot be quantified or measured – | options: A: Target B: Goal C: Objective D: Mission | answer: B </s> |
<s>[INST] context: - Mink and Hill have referred to methods of modifying steel crowns for primary and permanent teeth
- The oversized crown may be cut and the cut edges overlapped.
- The crown is replaced on the tooth to ensure that it now fits snugly at the cervical region, and a scratch is made at the overlapped margin. The crown is removed from the tooth and the overlapped material repositioned and welded. A small amount of solder is flowed over the outside margin. The crown is finished in the previously recommended manner and cemented to the prepared tooth.
- If the dentist encounters a tooth that is too large for the largest crown, a similar technique may be helpful. The crown may be cut on the buccal or lingual surface. After the crown has been adapted to the prepared tooth, an additional piece of 0.004-inch stainless steel band material may be welded into place. A small amount of solder should be added to the outer surface of the margins. The crown may then be contoured in the usual manner, polished, and cemented into place. [/INST] question: The crown size modification technique was given by | options: A: Bailey & Haskell B: Hill and Bailey C: Mink & Pink D: Mink & Hill | answer: D </s> |
<s>[INST] context: The patient in question appears to have vulval cancer with stage 1A with unifocal lateral lesion VULVAL CARCINOMA: STAGING AND MANAGEMENT STAGE 1 1A Limited to vulva/perineum Size<=2cm stromal invasion <=1mm Wide local excision + sentinel lymph node study 1B Size >2cm stromal invasion >1mm Radical local excision plus * B/L LAD: central lesion * U/L LAD: lateral lesion (>2cm from midline) STAGE 2 Any size ,Spreads to lower 1/3 urethra, lower 1/3 vagina, anus Early: radical excision/ radical vulvectomy plus B/L LAD Advanced: radiation + surgery + LAD STAGE 3 Positive inguinofemoral lymph nodes Radiation + surgery + LAD STAGE 4A 4B Upper urethra, upper vagina, bladder, rectum, pelvis side wall Distant metastasis, Pelvic or other lymph nodes Radiation + surgery + LAD LAD= lymphadenectomy Radical local excision: excision of entire tumour with at least 1 cm grossly negative margin and extended down to inferior fascia of urogenital diaphragm. Senrinel lymph nodes studies: reliable and suitable in early stage disease with unifocal lesion less than 4 cm and clinically negative lymph nodes on groin examination and imaging. [/INST] question: A woman is found to have a unilateral invasive carcinoma of vulva that is 1 cm in diameter with no stromal invasion and is not associated with evidence of lymph node spread. Initial management should consists of : | options: A: Chemotherapy B: Radiation therapy C: Wide excision and Sentinel lymph node biopsy D: Radical vulvectomy and bilateral inguinal lymphadenectomy | answer: C </s> |
<s>[INST] context: The Voice of China was hot during the summer of 2012!
The Voice of China is the large music show in China. This show is also the only one which regards the Voice as the only ruler. It premiered at 21:15 on July 13, 2012, on the Zhejiang Television. It has attracted great attention. _ .
The first season used "Real voice, real music" as its slogan. As a mentor , singers like Liu Huan, Na Ying, Yu Chengqing and Yang Kun will be responsible for seeking world-shaking voices of China in the following three and a half months, through four stages, namely, "blind choosing", "selecting", "team PK" and "yearly grand ceremony".
It is really a miracle that The Voice of China can stand out in the flood of today's talent shows in China and attracts the audience. A great many of audience said this will be the best television show in this summer. They were all proud for these good voices of China.
The students' beautiful voices moved everyone. Xu Haixing, a girl from Chengdu, sang "Self" to realize her father's dream and Liu Huan was moved to tears by her song. Huang Yong sang "In Spring" showing his persistence on his dream and Yang Kun cried for this. The blind girl Zhang Yuxia, a busker from Taiwan, played while singing. She was praised as "Deng Lijun No.2" for her unique voice, and her sincere feelings touched everybody. Na Ying went to the stage to sing with the students together for two times.
The Voice of China casts off magnificent clothes and wonderful dancing. It regards "inspiration" and "professionalism" as the ruler of music. The singer uses their songs to tell their real stories and the happiness of life. [/INST] question: If you want to be the winner of The Voice of China, you must _ . | options: A: have a good-looking B: have special talent C: have a wonderful voice D: dance and sing well | answer: C </s> |
<s>[INST] context: DORSAL DIGITAL EXPANSION: The dorsal digital expansion {extensor expansion} is a small triangular aponeurosis covering the dorsum of the proximal phalanx. Its base, which is proximal, covers the metacarpophalangeal joint. The main tendon of the extensor digitorium occupies the central pa of the extension and is separated from the MP joint by a bursa. The posterior corners of the extensor expansion are joined by tendons of the interossei {proximal} and {distal} are often called' wing tendons' Near the proximal interphalangeal joint, the extensor tendon divides into a central slip and two collateral slips. The central slip is joined by some fibres from the margins of the expansion, crosses the proximal interphalangeal joint, and is inseed on the dorsum of the base of the middle phalanx. The two collateral slips are joined by the remaining thick margin of the extensor expansion. They then join each other and are inseed on the dorsum of the base of the distal phalanx. As the metacarpophalangeal and interphalangeal joints, the extensor expansion forms the dorsal pa of the fibrous capscule of the joints. The retinacular ligaments {limk ligaments} extend from the side of the proximal phalanx, and form its fibrous flexor sheath, to the margins of the extensor expansion to reach the base of the distal phalanx. THE MUSCLES INSEED INTO THE DORSAL DIGITAL EXPANSION OF: INDEX FINGER: First dorsal interosseous, second palmar interosseous, first lumbrical, extensor digitorum slip, and extensor indicis. MIDDLE FINGER: Second and third dorsal interossei, second lumbrical, extensor digitorum slip. RING FINGER: Fouh dorsal interosseous, third palmar interosseous, third lumbrical and extensor digitorum slip. LITTLE FINGER: Fouh palmar interosseous, fouh lumbrical, extensor digitorum slip and extensor digiti minimi. [/INST] question: Which muscle does not take pa in dorsal digital expansion | options: A: Interossei B: Lumbricals C: Extensor digitorum D: Adductor pollicis | answer: D </s> |
<s>[INST] context: As discussed in previous question:
• BRCA-1 and BRCA-2 are tumour suppressor genes.
• Individuals who inherit mutations of BRCA-1 and BRCA-2 are highly susceptible for the development of hereditary breast or ovarian cancer. The mutations are inherited as autosomal dominant.
Strategies for prevention of hereditary ovarian cancer
• Genetic testing for susceptibility to ovarian cancer is rapidly becoming integrated into the clinical practice of oncology.
Strategies have been adopted to reduce the incidence of ovarian cancer in patient with BRCA-1 and BRCA-2 mutations.
a. Prophylactic oophorectomy:
“The only proven way to prevent ovarian cancer is surgical oophorectomy. As another possible site of disease among these high risk patients is fallopian tube therefore should be removed. IN BRCA 1 or BRCA-2 mutation carriers, prophylactic bilateral salpingo-oophorectomy (BS0) may be performed on either completion of childbearing or at age 35. In these patients, the procedure is approximately 90% effective in preventing epithelial ovarian cancer. In women with HNPCC, the risk reduction approaches 100%.”
• Additional benefit of prophylactic oophorectomy is that the risk of breast cancer is reduced by 50-80%.
b. Oral contraceptive pills:
• Data received from a multicenter control of genetic screening centers indicates that the use of oral contraceptive pill is associated with 50% decreased risk for developing ovarian cancer in women who have mutation in either in BRCA - 1 or BRCA - 2. However there is short term increased risk of developing breast cancer.
c. Role of screening with CA 125 and transvaginal ultrasound:
“In BRCA1- BRCA2 mutation carriers who donot wish to undergo prophylactic surgery a combination of through pelvic examination, transvaginal sonographic examination and CA125 blood testing should be done”.
• Best method of prevention: Prophylactic hysterectomy and BSO at 35 years or as soon as family is complete.
• 2nd line: OCP’s + screening
• Screening: TVS + Ca 125 started at 35 years and done every 6 or 12 months, breast screening by MRI and mamography at 30 years done annually. [/INST] question: Which of the following strategy has been recommended to reduce the heredity risk for ovarian cancer in women with BRCA - 1 and BRCA - 2 mutations: | options: A: Use of oral contraceptive pills B: Screening with transvaginal ultrasound C: Screening with CA - 125 D: Prophylactic oophorectomy | answer: D </s> |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.