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<s>[INST] context: Selenocysteine is defined as substance with Cysteine containing selenium in place of one sulfur atom.Deiodinase is an enzyme that deiodinates two of the iodinated amino acids (iodothyronines) within the thyroid gland. Selenium-dependent deiodinase conves thyroxine (T4) to triiodothyronine (T3), the more active thyroid hormone.Pyruvate carboxylase an enzyme that catalyzes the irreversible carboxylation of pyruvate, a reaction necessary for gluconeogenesis from lactate or amino acids forming pyruvate and also providing four-carbon compounds for the citric acid cycle. The enzyme is a mitochondrial protein occurring in liver but not in muscle. Deficiency of the enzyme, an autosomal-recessive trait, causes severe psychomotor retardation and lactic acidosis in infants.Xanthine oxidase flavoprotein containing molybdenum; an oxidoreductase catalyzing the reaction of xanthine, O2, and H2O to produce urate and superoxide. Also oxidizes hypoxanthine, some other purines and pterins, and aldehydes. A lower rate of oxidation is observed in patients with molybdenum cofactor deficiency.Lysyl oxidase is an enzyme, which requires Cu2+ and O2, that oxidizes ceain lysyl residues in collagen to allysyl residues andhydroxylysyl residues to hydroxyalkyl residues; this is a required step for the crosslinking ( aldol condensations and through Amadori rearrangements) of collagen strands; a lower activity of this enzyme is associated with occipital horn syndrome. [/INST] question: Selenocysteine residues are present in | options: A: Pyruvate carboxylase B: Xanthine oxidase C: Deiodinase D: Lysyl oxidase | answer: C </s> |
<s>[INST] context: The way to teach the kids to take good care of pets
The best way to teach your child how to be responsible pet caregivers is to be on yourself. This should start before you even get a pet--make sure you have realistic expectations about pet ownership. And take steps to select the right animal at the right time.
As soon as you bring a pet in, set up and enforce rules regarding proper pet care. For example, tell your child not to pull the animal's tail, ears, or other body parts, and insist they never tease(,), hit, or chase it. Teach the child how to properly pick up, hold, and pat the animal. These simple lessons are essential to helping the kid become a responsible caretaker.
Although a certain pet-care activity must be handled by an adult, you can still include your child by explaining why and what you're doing. For example, when you take your pet to the veterinarian to be spayed or neutered, explain to your child how the operation not only reduces pet overpopulation but can also make it healthier, calmer, and more affectionate.
Also involve your child in a pet-training activity, which not only make your pet a more well-mannered family member, but teach your child humane treatment and effective communication.
Ultimately, your child will learn how to treat animals--and people--by watching how you treat the family pet. And they'll pay close attention to how you react when a pet scratches the furniture, barks excessively, or soils in the house. Frustrating as these problems are, "getting rid of" the pet isn't just unfair to the pet and your child, but it also sends the wrong message about commitment, trust, and responsibility. When faced with pet problems, get to the root of the problem. Often a veterinarian, animal shelter professional, or dog trainer can help you resolve pet issues so you can keep the whole family together. [/INST] question: When involved in pet-care activities, children are likely to become more _ . | options: A: responsible B: ambitious C: energetic D: patient | answer: A </s> |
<s>[INST] context: Justin Bieber's birthday wish has come true. The teenage star announced earlier this week that he wanted his fans to donate $17,000 to charity---so far the total of gifts that have poured in is more than $31000.
"I have had a great year and it is all because of the fans helping me live my dream," said the young singer. "I'm turning 17 years old on Tuesday, and have so much to be grateful for! So this year, I really want my birthday to be all about helping others. Instead of asking for gifts, I'm asking friends, family and fans to consider donating $17 for my 17thbirthday to help make a change."
Bieber asked his fans to donate to a charity that builds clean water projects in developing countries.
"Together, we've made a big difference for many causes. Did you know that about 4,500 kids die each day from waterborne diseases ? By building clean water projects for villages that need them, we can prevent this! I want to make my birthday matter this year--- let's make it so more kids can grow up to have a 17thbirthday like me. Join me to make a change.
"I'm really so grateful for my family, friends and fans--- and I believe we can do something big to help bring clean water to people in need. Even if you don't have $17 to give I just ask you to go out in your community and try and make a positive difference. Even the smallest act of kindness can go a long way."
,. [/INST] question: What does Bieber ask his friends for his 17thbirthday? | options: A: Gifts B: $17 C: Birthday wish D: Clean water | answer: B </s> |
<s>[INST] context: Crouzon Syndrome | Brachycephaly (d/t premature fusion of coronal suture) Bulging eyes, mid-face hypoplasia Prognathism (protruding jaw) Williams syndrome is caused by hemizygous microdeletion on chromosome 7q11.23; It is characterized by cardiovascular, intellectual disability, unique personality, growth and endocrine abnormalities like hypercalcemia and hypothyroidism. Characteristic facial features include thick lower lip, bulbous nasal tip, periorbital fullness and long philtrum.Clinical diagnostic criteria are available for Williams syndrome; But the definitive diagnosis requires demonstration of the gene microdeletion. Alagille syndrome - Triangular facies - (Also seen in Russell Silver syndrome) - Butterfly veebra - Pulmonary Stenosis - Cholestatic Jaundice Smith Lemli Opitz syndrome Mutations in DHCR7 gene (chr 11) | Deficiency of microsomal enzyme 7-dehydro cholesterol-D7 reductase (DHCR7) | Low plasma cholesterol and accumulation of precursors (7-dehydrocholesterol) | Multiple congenital anomalies and developmental delay Clinical features of Smith-Lemli-Opitz syndrome: Craniofacial: Microcephaly, Retromicrognathia, Midline cleft palate Skeletal Anomalies: Syndactyly of toes II/III, Postaxial polydactyly Genital Anomalies: Ambiguous genitalia, Hypospadias, Cryptorchidism Development: Growth retardation, Feeding problems, Mental impairment CNS: Holoprosencephaly, Corpus callosal Agenesis, Cerebellar hypoplasia CVS: Atrioventricular canal defect, Patent ductus aeriosus, VSD Urinary Tract: Renal hypoplasia, Hydronephrosis, Ureteral duplication GI: Hirschsprung disease, Pyloric stenosis, progressive liver disease Pulmonary: Pulmonary hypoplasia [/INST] question: What is the syndrome that this child with cholestatic jaundice and an ejection systolic murmur, on auscultation, in the pulmonary area, is suffering from? | options: A: Crouzon syndrome B: William syndrome C: Smith Lemli Opitz syndrome D: Alagille syndrome | answer: D </s> |
<s>[INST] context: Music is often thought of as "easy" or "play time", but it's not that at all. Music plays a very important part in our education. Students who learn music learn a lot of music history at school. This includes "modes ",which were used in churches during the development of music. They are still used today. Students learn about the historical events that were taking place when the music they play was written. They learn what the music was used for. So much of our culture is in music and has been for centuries. Music also helps with science. Students use science to help them discover what sounds good together and what doesn't. Students also need science to understand something called the "overtone series", which is about how music is produced by vibration and why. Students learn a lot about languages. Many songs are written in other languages, including ancient ones. Students must learn to translate these works to understand what they are singing about. Some songs are famous poems or short works set to music. Students learn a huge amount of coordination through music, so parts of the body can work better together. Students must use fine motor skills in order to play an instrument. Singers and players must learn breath control and be in good shape to play.
Students learn about art. Some famous pieces were written about important works of art, and students learn about the artists and styles as they're playing the music. Music education also brings higher thinking to our children. It allows them to think about complex patterns (How can I make my part sound better?How do this music and these different parts fit together?). Students have to know absolutely what every other musician does at all times. In that way, it develops teamwork. As one can see, music is very important to education besides bringing us fun. [/INST] question: Learning music is helpful to the following subjects EXCEPT _ . | options: A: science B: language C: politics D: history | answer: C </s> |
<s>[INST] context: If you choose a hot tourist spot for your holiday, you are likely to be drowned by a great number of tourists, noise and long lines. At this point you might wonder why you ever left home. Here are some tips to deal with crowds and avoid the trouble that might ruin your trip.
Book Tickets In Advance
Buy tickets online before you leave home, and skip the crowds and endless lines at your destination . Smart travelers can avoid the queue when visiting abroad with online ticket sales.
Talk To People
You can ask the travel agency and the hotel for help. Ask questions, get maps, ask about taxis, restaurants and the sites you wish to visit. These people are experts and can save you lots of time trying to find things out for yourself.
Sign Up For Special Tours
If there are any special events or tours being offered for your vacation, buy them in advance. Firstly they are usually cheaper bought in advance and secondly it makes sure you get booked in before they are sold out.
Visit During the Weekdays
We all know that most sites and events are less crowded during the week than on weekends when people are off work and the kids are out of school. Flights are also usually cheaper on weekdays than they are on weekends.
Watch The Weather
_ controls a lot of what we do especially for outdoor activities. Check the weather forecasts and plan your indoor and outdoor activities according to the weather ahead of time. [/INST] question: How do you feel when you are drowned by a lot of tourists? | options: A: Happy B: Excited C: Cool D: Upset | answer: D </s> |
<s>[INST] context: Patients who have sustained a major thermal burn of 35% or more of their body surface area are at a predictably high risk for the development of gastric erosions and hemorrhage. Endoscopy has demonstrated that gastric erosions are present in 93% of these patients, whereas the occurrence of severe acute upper gastrointestinal hemorrhage in severely burned patients ranges between 25% to 50%. At least 60% of patients at risk develop stress erosions within 1 to 2 days after the precipitating event. Painless upper gastrointestinal bleeding may be the only clinical sign. The onset of hemorrhage is often delayed, usually occurring 3 to 10 days after the onset of the primary disease. Esophagogastroduodenoscopy is the diagnostic modality of choice to confirm the diagnosis and to differentiate stress erosion from other sources of upper gastrointestinal hemorrhage. Correct identification of the bleeding source is made in greater than 90% of instances. If endoscopy is not diagnostic, visceral angiography through selective catheterization of the left gastric or splenic vessels may provide information regarding the primary vessel supplying the bleeding site. In contrast, barium examinations are usually of little value, due to the superficial nature of stress erosions, and in fact may be detrimental by interfering with the interpretation of subsequent aeriography. [/INST] question: A 35-year-old smoker is involved in a house fire and receives a 45% total surface area burn. One half of the burned surface appears to be third degree. On the third post-burn day, the patient is noted to have bloody drainage from a nasogastric tube and a decrease of 5% in his hematocrit. Appropriate management should include which of the following? | options: A: Urgent upper gastrointestinal contrast study to delineate site of bleeding B: Immediate selective aeriography the left gastric aery to diagnose and treat presumed stress ulceration C: Urgent esophagogastroduodenoscopy to diagnosis the cause of bleeding D: Urgent intravenous infusion of vasopressin at 0.2-0.4 IU/min | answer: C </s> |
<s>[INST] context: Phaethon stood impatiently at the heavy golden doors. He ordered the guards, Month and Year, to let him approach his father's throne. As the doors opened slowly, the sun's rays almost blinded him. Phaethon protected his eyes and felt his way toward Apollo's throne. "Come here, my son. Follow my voice," Apollo's voice echoed. "What is so urgent that you have my guards hurrying to do your bidding?"
"Father, I have a problem. All of my friends have been teasing me. They don't believe that you're my father or that you make the sun rise and set," complained Phaethon.
Apollo replied, "Oh? That problem again? Well, just to prove it to your friends once and for all, I will satisfy any wish you desire."
"Really? Then I have only one wish," answered Phaethon. "I'd like to drive your chariot and make the sun rise tomorrow morning!"
Apollo was horrified. "No, not that! No one but me can drive the chariot. The horses are too powerful!"
"You said I could have anything," murmured Phaethon.
Bound by his promise, Apollo had to agree. His heart was sick with worry as he ordered Dawn to prepare the horses, Hour and Day, to the Golden Chariot. Phaethon could hardly wait to jump in the driver's seat and take the reins . He hoped all his friends were watching the sky and waiting for him through the stars.
"Wait, my son! There are things you need to know!" cried Apollo.
"Oh, Father! You worry too much. I've often seen you drive. I know what to do," Phaethon answered.
Apollo hurried to give directions. "You have never driven my chariot before. You must make the horses stay on the path. If you are too low, you will _ the earth and large land on it could be thrown into a world of fire."
"I know, Father. Now watch me take off!" shouted Phaethon.
Dawn stepped back and released the horses go. The horses were filled with excitement. The sky begged for Dawn's light, so she ran toward the horizon to make the darkness fade. As Phaethon was about to get on, Apollo took him by the arm and said, "Please listen to me! If you go too high, you will warm the cold depths of the heavens, and the Bear or Snake or the Scorpion will come alive!"
Phaethon just laughed. "My friends are waiting. I've got to go!" he shouted.
With that, the chariot was off. It was a wild ride. Hour and Day were difficult to control. Phaethon did not have his father's strong arms or years of experience. The horses wove from side to side and jumped up and down through the heavens, hitting everything in their way. The sun bounced along behind the chariot like a basketball. It scratched the stars and slipped along mountaintops, leaving burnt remains behind. Phaethon's friends ran for cover as they watched. Just as his father had warned him, the figures in the sky began to move. Suddenly the Scorpion appeared suddenly before him, but Phaethon dashed by in time. The Snake struck out and bit a wheel off the chariot.
Apollo, seeing the destruction, rushed up toward the heavens, but he was too late! The Bear had waken up from his icy hibernation and seized Phaethon before his father could reach him. Apollo took hold of the reins and finally regained control of Hour and Day, but it was years before the earth's mountaintops were white with snow again. The scorched areas became deserts where very little would grow. Phaethon became a part of the stars alongside the Bear, where his father could regretfully keep an eye on him. [/INST] question: What caused Apollo to allow Phaethon to drive the chariot? | options: A: Apollo wanted to protect Phaethon from teasing B: Phaethon dared to approach Apollo's throne C: Apollo was bound by his promise to Phaethon D: Apollo asked Phaethon to do it as a favour | answer: C </s> |
<s>[INST] context: There are few bacteria for which antimicrobial susceptibility is highly predictable. However, some agents are the drug of choice because of their relative effectiveness. Among the three antibiotics that have been shown to treat legionellosis effectively (erythromycin, rifampin, and minocycline), erythromycin is clearly superior, even though in vitro studies show the organism to be susceptible to other antibiotics.Penicillin remains the drug of choice for S. pneumoniae and the group A streptococci, although a few isolates of penicillin-resistant pneumococci have been observed. Resistance among the pneumococci is either chromosomally mediated, in which case the minimal inhibitory concentrations (MICs) are relatively low, or plasmid-mediated, which results in highly resistant bacteria. The same is generally true for H. influenzae. Until the mid-1970s, virtually all isolates of H. influenzae were susceptible to ampicillin. There has been a rapidly increasing incidence of ampicillin-resistant isolates, almost 35 to 40% in some areas of the United States. Resistance is ordinarily mediated by b-lactamase, although ampicillin-resistant, b-lactamase-negative isolates have been seen. No resistance to penicillin has been seen in group A streptococci.C. difficile causes toxin-mediated pseudomembranous enterocolitis as well as antibiotic-associated diarrhea. Pseudomembranous enterocolitis is normally seen during or after administration of antibiotics. One of the few agents effective against C. difficile is vancomycin. Alternatively, bacitracin can be used.Lyme disease, caused by B. burgdorferi, has been treated with penicillin, erythromycin, and tetracycline. Treatment failures have been observed. Ceftriaxone has become the drug of choice, particularly in the advanced stages of Lyme disease. [/INST] question: The therapy of choice for pseudomembranous enterocolitis is | options: A: Penicillin B: Ampicillin C: Erythromycin D: Vancomycin | answer: D </s> |
<s>[INST] context: A woman repeated a bit of gossip about a neighbour. Within a few days the whole neighbourhood knew the story. The neighbour was deeply hurt. Later the woman responsible for spreading the gossip learned that it was completely untrue. She was very sorry and went to a wise old man to find out what she could do to repair the harm.
"Go to the marketplace," he said. "and buy a chicken, and have it killed, then on your way home, pluck its feathers and drop them one by one along the road. " Although surprised by this advice, the woman did what she was told.
The next day the wise man said, " Now, go and collect all those feathers you dropped yesterday and bring them back to me. "
The woman followed the same road, but she was so discouraged when she found the wind had blown all the feathers away. After searching for hours, she returned with only three in her hand.
" You see, " said the old man, "it's easy to drop them, but it's impossible to get them back . So it is with gossip. It doesn't take much to spread a gossip, but once you do, you can never completely undo the wrong." [/INST] question: The woman was very _ the harm she had done to her neighbour. | options: A: happy about B: angry about C: sorry for D: excited about | answer: C </s> |
<s>[INST] context: Lisa has always been overweight. She wanted to lose weight, not just because she wanted to look more beautiful and healthier, but also because it would make life easier. For example, it was difficult for Lisa to find ready-made clothes that would fit. She had to ask a tailor to make clothes that were large enough. In school, she needed a special chair which was bigger and stronger than the other chairs. If she went for a walk, she got tired very quickly. She was also unhappy about the way people treated her sometimes. "People look at me and even make fun of me. That's unfair! It's true that I'm overweight, but I don't think people should treat me differently because I'm big. I can't enjoy having dinner with my friends because I'm afraid of getting fatter. "Her friends and family never made fun of her. They tried to help her instead. They wanted her to be happy and healthy. Sometimes when Lisa was feeling sad, she didn't want to speak to anyone.
But now things are quite different. Last month her classmates were preparing for the School Art Week. Someone advised Lisa to play the lead role of the Proud Queen who was tall and fat. Lisa agreed and practiced a lot.
Soon after the play, Lisa became the star! She did so well that everybody remembered the Proud Queen. They stood around her and said "Congratulations"to her. She even won the School Best Actress Award for her wonderful performance.
Now Lisa doesn't worry about being fat any more. She believes in the English saying " _ [/INST] question: How did Lisa feel about her weight at first? | options: A: Proud B: Worried C: Happy D: Strange | answer: B </s> |
<s>[INST] context: Securing a stable airway is one of the most fundamental and impoant aspects of the management of the severely injured patient. The level of control required will vary from a simple oropharyngeal airway to tracheostomy, depending on the clinical situation. Full control of the airway should be secured in the emergency room if the patient is unstable. Endotracheal intubation will usually be the method chosen, but the physician should be prepared to do a tracheotomy if attempts at perioral or perinasal intubation are failing or are impractical because of maxillofacial injuries. The most dangerous period is just prior to and during the initial attempts to get control of the airway. Manipulation of the oronasopharynx may provoke combative behavior or vomiting in a patient already confused by drugs, alcohol, hypoxia, or cerebral trauma. The risk of aspiration is high during these initial attempts, and the physician should make no assumptions about the state of the contents of the patient's stomach. Antacids are recommended just prior to the intubation attempt, if feasible. Although steroids have been recommended in the past, they are no longer considered of value in the management of aspiration of acidic gastric juice. The best management requires prevention of the complication of aspiration. In a reasonably cooperative patient, awake intubation with topical anesthesia may help to prevent some of the risks of hypotension, arrhythmia, and aspiration associated with the induction of anesthesia. If awake intubation is inappropriate, then an alternative is rapid-sequence induction with a thiobarbiturate followed by muscle paralysis with succinylcholine. If elevated intracranial pressure is suspected, or if a penetrating eye injury exists, awake intubation is contraindicated. [/INST] question: A 33-year-old woman is brought to the emergency room from the scene of a severe motor vehicle accident. She is combative, confused, uncooperative, and appears dusky and dyspneic. Which of the following is the most appropriate management of her airway? | options: A: Awake endotracheal intubation is indicated in patients with penetrating ocular injury B: Steroids have been shown to be of value in the treatment of aspiration of acidic gastric secretions C: The stomach may be assumed to be empty only if a history is obtained indicating no ingestion of food or liquid during the prior 8 hours D: Intubation should be performed as soon as possible (in the emergency room) if the patient is unstable | answer: D </s> |
<s>[INST] context: Show Biz Summer 2014
Location: Rosewood Center for Family arts
Important Information:
* Tuition paid on the first day of class. No tuition refunds .
* DCT reserves the right to cancel any class; refunds made for cancelation .
* Please accompany student to the first day of class.
* Registration begins one-half hour before class time.
How To Register:
* Mail : fill out the form in this brochure.
* Be sure to list the class and group that you want & the dates.
Drama Days! --$ 175
Entering Grades : Group A : lst -- 2nd Group B : 3rd -- 5th .
Time: June 2--June 6
* create the situations and scenes
* SHOWTLME-invite family and friends to your Friday Showcase !
* Bring a sack lunch and drink each day!
Laugh Out Loud --$ 175
Entering Grade : 5 th
Time: June 23--June 27
* Tell a joke! Learn why old jokes can be the best!
* Work with your class to put on a Comedy Show for family and friends!
Acting --Just Acting--$225
Entering Grades : Group A: lst --2nd Group B: 3rd -- 4th
Time: August 4 -- August 8
* Start with the characters: Who are you ? Be the Star of your Dreams.
* Work with your class to create the plot.
Summer Scenes --$ 225
Entering Grades: 5th -- 6th
Time: August 11-- August 15
* Do you want to be an actor?
* Improve your skills with instruction from professional actors & directors. [/INST] question: Which of the following classes suits those who want to be actors ? | options: A: Summer Scenes B: Acting --Just Acting C: Laugh Out Loud D: Drama Days | answer: A </s> |
<s>[INST] context: I'm Bessy. I began to learn English in Grade 6,not like most of my friends who have been learning English since kindergarten( ) or at least in Grade 3.I fell in love with this foreigner language at once. As an old saying goes, "Interest is the best teacher." I began to be crazy about English. I learned words and grammar, made sentences, wrote essays and read English storybo oks as many as I could.
Some of my friends find it easy to forget the words they learned the other day. So do I! You can't remember words well without using them often. So you should turn to a dictionary for help when you meet new words and want to know their other meanings and usages. Then make your own sentences from time to time.Another way to keep new words in mind is reading articles. You can easily remember new words through _
As for spoken English, I'm lucky to have some foreign friends. So I have more chances to improve my spoken English. If you want to communicate with foreigners, don't be shy, and just practice with anyone who knows English. [/INST] question: When did Bessy fall in love with English? | options: A: In kindergarten B: In high school C: In Grade 3 D: In Grade 6 | answer: D </s> |
<s>[INST] context: Did you know that about 55% of communication is unspoken, so in fact, our bodies are actually saying more than our words. I find that the key to a successful conversation in any language is to speak to people not only in their spoken language but also with the body language they know best.
Britain, along with much of Northern Europe, has a non-touch culture, so personal space is very important. In a formal situation, we would usually greet each other with a handshake. Informally, but not so often, my British friends and I would greet with a hug. Hardly ever would we greet with a kiss on the cheek, let alone a hug and two kisses on the cheek![:||]
Here in the south of Italy, and in many different parts of the world, both men and women greet with two kisses on the cheek, use a lot of hand signs and often touch each other. In other words, little personal space is left between people when communicating.
At university, I have learnt to successfully communicate in spoken Italian. And since I moved to live with the local people, I have also started to pick up their body language. Sometimes, I find myself not knowing what hand signs to use when expressing myself. However, what I know for sure is that I would miss the opportunity to fully put myself in the Italian culture if I keep my personal space unbroken.
Here are 5 body language tips in Italy;
* Use different signs; head, arms and hands.
* Use facial expressions. Always smile at people! It is said that smiling is the most powerful unspoken way to communicate friendliness.
* Use eye contact , because "the eyes are the window to the soul."
* Don't worry about personal space. Italians are a people who like to use the sense of touch, so moving away or keeping your distance may be considered as being unfriendly.
* Touch. When meeting and leaving, always shake hands. [/INST] question: In Britain, people usually greet each other with _ . | options: A: a warm hug B: a handshake C: a kiss on the cheek D: two kisses on the cheek | answer: B </s> |
<s>[INST] context: This patient with well advanced cirrhosis and portal hypertension has developed the onset of renal insufficiency consistent with hepatorenal syndrome. This occurs during the end stages of cirrhosis and is characterized by diminished urine output and low urinary sodium. In the setting of end-stage liver disease, renal vasoconstriction occurs, and the distal convoluted tubule responds by conserving sodium. Unless the renal function is allowed to deteriorate further, liver transplantation will reverse this vasoconstriction and kidney function will return to normal.
A large volume paracentesis may relieve the ascites but will have no significant benefit on the impaired renal function. There are no indications in this question to suggest that the patient requires acute hemodialysis. A mesocaval shunt is a surgical procedure that may decompress the portal pressure but will not have any benefit on renal function. Renal transplantation is of no value in this patient since the underlying lesion is in the liver; the kidneys will return to normal function if there is improvement in hepatic function. [/INST] question: A 58-year-old man with cirrhosis complains of worsening fatigue and confusion over the past 5 days. He also reports that over the past 48 hours he has had a declining urinary output. On examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Lab result reveal a WBC 4600/mm3, Hb 9.4 g/dL, and PCB 29%. BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary Na <10 mEq/L. Most appropriate treatment for his elevated BUN and creatinine? | options: A: Large volume paracentesis B: Hemodialysis C: Mesocaval shunt D: Liver transplantation | answer: D </s> |
<s>[INST] context: Osteonecrosis is a disease caused by reduced blood flow to bones in the joints. In people with healthy bones, new bone is always replacing old bone. In osteonecrosis, the lack of blood causes the bone to break down faster than the body can make enough new bone . The most common causes of osteonecrosis are: Serious trauma (injury), which interrupts a bone's blood supply Coicosteroid medications (such as prednisone, coisone or methylprednisolone), mainly when a high dose is used for a prolonged period of time Excess alcohol consumption SLE Other less common risk factors for osteonecrosis include: Decompression disease (also called the "Bends" that can occur with scuba diving) Blood disorders such as sickle cell anemia, antiphospholipid antibody syndrome (APS) and lupus anticoagulant HIV infection (the virus that causes AIDS) Radiation therapy Bisphosphonates, which may be linked to osteonecrosis of the jaw Organ transplants REf - Harrisons internal medicine 20e p2617t , 225, 677, 2936, 2955 , 1441 [/INST] question: Which of the following cause osteonecrosis - | options: A: Sickle cell anemia B: Coicosteroid use C: Die D: SLE | answer: D </s> |
<s>[INST] context: March 5 is Lei Feng Day. Lei Feng is one of the most famous role models in China. He is known for his warm heart and kind deeds . We should learn from him. In honor of this great person, we did lots of kind deeds on March 4. Take a look!
Xu Hanchi, 13:
I went to a square in a local university with my classmates to do cleaning. We swept off the fallen leaves and picked up rubbish. When we finished, the ground was very clean. Though no one came up to praise us, we still felt very happy. We learned that doing good things itself could make us happy.
Zhu Lingyue, 14:
My group cleaned the teachers' office that day. When we got there, we were surprised that the office was not as clean as we expected. How could teachers work in such an untidy place? We started cleaning quickly. Teachers work really hard and may not have the time to clean their offices. It's great that we can do something to help make them less tired.
Tom Rui, 14:
We helped clean the yard in the front of a hospital, but some patients there left us a very bad impression . They were very impolite and shouted at nurses and doctors. I think nurses and doctors' work is hard. They try their best to help us. We should give them more respect and understanding. [/INST] question: The three children did lots of kind deeds _ | options: A: on March 5 B: on March 8 C: on March 4 D: on March 3 | answer: C </s> |
<s>[INST] context: Rivers are one of our most important natural resources . Many of the world's great cities are located on rivers, and almost every country has at least one river running through it that plays an important role in the lives of its people.
Since the beginning of the history, people have used rivers for transportation . The longest one in the United States is the Mississippi. The lifeline of Egypt is the Nile. To the people of India, the Gangs is great, but it is also important for transportation; Ships can travel along it for a thousand miles. Other great rivers are the Congo in Africa and the Mekong in southeast Asia. The greatest of all for navigation , however, is the Amazon in Brazil. It is so wide and so deep that large ships can go about two thousand miles upon it.
Besides transportation, rivers give food, water to drink, water for crops , and chances for fun and entertainment for the people who live along their banks. In order to increase the supply of crops, engineers sometimes build a dam across a river and let a lake from behind the dam. Then people can use the water not only to irrigate their fields but also to make electricity for their homes and industries.
However, large cities and industries that are located upon rivers often make problems. As the cities grow in size and industries increase in number, the water in the rivers becomes polluted with chemicals and other materials. People are learning the importance, however, of doing more to keep their rivers clean if they want to enjoy the benefits of this natural resource. [/INST] question: The greatest river for navigation is _ . | options: A: the Amazon B: the Nile C: the Mekong D: the Mississippi | answer: A </s> |
<s>[INST] context: The best UK cottages for Christmas and New Year
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It's a solid little Victorian gatehouse outside Ballycastle. It has an association with Irish nationalist Roger Casement. Close to the Causeway Coast, the closest beach is five minutes' drive away. It is a good choice for those who want to avoid stairs, since all the main rooms are on the ground floor.
Sleeps 2 adults + 2 children, PS730 a week at Christmas or New Year (three nights from PS389), 353 1 670 4733, irishlandmark.com
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It is located in a peaceful island, where a priory was built 1,400 years ago. Guests at Coastguard's Cottage, the latest addition to English Heritage's portfolio of holiday houses, can explore the priory ruins. The attractive whitewashed house is decorated with calming tones and contemporary furnishings and has views of Lindisfarne Castle.
Sleeps 6, PS1,600 a week from 19 Dec, 0370 333 1187, english-heritage.org.uk
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It sits on a 350-acre private nature reserve. Surrounded by woodlands, wetlands and wild meadows, it's a heaven for wildlife. You might meet a few animals on a walk around the reserve. Built by local craftsmen using natural materials, it is a light-filled living space with huge windows, a woodburner and other essential for winter evenings -- a home cinema system.
Sleeps 6, PS1,430 a week from 29 Dec, 01580 720770 kentandSussexcottages.co.uk
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In snowy winter, the quiet 16th-century cottage near Stowmarket is like a perfect picture on Christmas cards. The inside is also appealing, with a big farmhouse kitchen, antique furniture, comfortable carpets and an impressive fireplace. A good selection of films, music and books are provided. Approached via a single track lane, the cottage sits in three acres of wild meadow, surrounded by plenty of farmland.
Sleeps 5, PS1,003 a week from 30 Dec (three nights PS725), 01787 211115, grove-cottages.co.uk [/INST] question: How much will be charged if a couple with two children stay in Victorian gatehouse for a week at Christmas? | options: A: PS389 B: PS730 C: PS1,430 D: PS1,600 | answer: B </s> |
<s>[INST] context: Dear Died,
Today I was at the shopping centre and I spent a lot of time reading the Father's Day cards. But as I chose add read, and chose add read again, it seemed that not a single card said what I really wanted to you.
You'll soon be 84 years old, Dad,and you and I will have had 56 Father's Days together. I didn't think that you were too old. But the sad thing happened last week. I watched as you turned at the corner in your car. I didn't realize at once that it was you because _ who was driving looked so elderly.
Fifty years ago this spring, we planted carrots together in a garden in Charles City, Iowa. This week, we'll plant carrots together again, perhaps for the last time but I hope not. I don't understand why planting carrots with you is so important to me. Well, I don't quite know how to tell you this, dad ... I don't like carrots.... but I like planting them with you.
I guess what am trying to say, Dad, is what every son and daughter wants to say to their dad today. Praising a father on Father's Day is about more than a dad who brings home, money or shares a dinner. It's more about a dad deeply loving children who know everything and won't listen to anyone. It's about sharing. It's about loving someone more than words can say, and I wish that it would never end.
Lover,
Jenny [/INST] question: Where did Jenny go today? | options: A: A garden B: A shopping center C: A cinema D: A hospital | answer: B </s> |
<s>[INST] context: We often use the words "growth" and "development" as if they meant basically the same thing. But this may not always be the case. One can easily imagine instances in which a country has achieved higher levels of income (growth) with little or no benefit coming to most of its citizens (development).
In the past, most development policies were aimed at increasing the growth rate of income per capita . Many are still based on the theory that benefit of economic growth will come to all members of society. If this theory is correct, growth should encourage development.
By the early 1970s, however, the relationship between growth and development was being questioned. A major study by the World Bank in 1974 concluded that it is now clear that more than decades of rapid growth in developing countries has been of little benefit to a third of their population.
The World Bank study showed that increase in GNP per capita did not promise important improvements in such development indicators as nutrition, health, and education. Although GNP per capita did indeed rise, its benefit came down to only a small part of the population. This realization gives rise to a call for new development policies. These new policies favor agriculture over industry, call for national redistribution of income and wealth, and encourage programs to satisfy such basic needs as food and shelter.
In the late 1970s and early 1980s the international macroeconomic crises of high oil prices, worldwide recession and the third world debt, forced attention away from programs designed to get rid of poverty. However, the lesson remains: economic growth does not promise economic development. Efforts may be required to change growing output capacity into economic benefit that reaches most of a nation's people. [/INST] question: Before the 1970s, most development policies were based on theory that economic growth would benefit _ . | options: A: most people in society B: some people in society C: few people in society D: everyone in society | answer: D </s> |
<s>[INST] context: A single complete denture is a complete denture that occludes against some or all of the natural teeth, a fixed restoration, or a previously constructed removable partial denture or a complete denture.
The primary consideration for a single complete denture is preservation. By opposing the natural teeth, the magnitude of force transmitted to the denture and arrangement of artificial teeth will be the major considerations while planning the denture. These will be discussed in this chapter.
Disadvantages
The unfavourable force distribution by the natural teeth can cause the following adverse changes:
Extensive morphological changes in denture foundation.
Jaw relationship extremes which make it difficult to arrange artificial teeth for the denture along the line of support.
Excessively displaceable denture-bearing tissue (flabby ridges).
Indications
A single complete denture may be desirable when it is to oppose any one of the following conditions:
Natural teeth sufficient in numbers not to necessitate a fixed or removable partial denture.
A partially edentulous arch in which the missing teeth have been or will be replaced by the fixed partial denture.
A partially edentulous arch in which the missing teeth have been or will be replaced by a removable partial denture.
An existing complete denture.
Key Concept:
The characteristic features that occur when an edentulous maxilla is opposed by natural mandibular anterior teeth, including loss of bone from the anterior portion of the maxillary ridge, overgrowth of the tuberosities, papillary hyperplasia of the hard palate’s mucosa, extrusion of the lower anterior teeth, and loss of alveolar bone and ridge height beneath the mandibular removable dental prosthesis bases – also called anterior hyperfunction syndrome (Combination Syndrome)(GPT8). [/INST] question: During clinical examination, it was noted that patient has natural lower anterior teeth which occlude against the complete upper denture. Clinician is most likely to find: | options: A: Underlying systemic disease B: Post extraction bone scars C: Displaceable mandibular ridge D: Displaceable maxillary ridge | answer: D </s> |
<s>[INST] context: Margins of excision: Malignant melanoma: Margins to be taken depends on the tumor thickness and depth of invasion* < 1mm thickness - 1 cm margin* 1-4 mm thickness - 2cm margin* > 4mm thickness - 2-3 cm margin BCC: If tumor is non-aggressive involving trunk or extremities -Wide Local Excision If tumor is aggressive involving vital areas, cosmetic areas and recurrent - MOH'Smicrographic surgery SCC: Small or non-invasive SCC - Wide Local excision MOH'S MICROGRAPHIC Surgery- Large tumors- Aggressive tumors- Tumors involving vital areas/ cosmetic areas- Recurrent tumorsMOH'S MICROGRAPHIC SURGERY- Serial excision of tumor in small increments- Coupled with immediate microscopic analysis to ensure tumor removal- To limit resection of aesthetically valuable tissues Dermatofibrosarcoma protuberans: WLE with 2-4 cm circumferential margin + removal of underlying fascia Has unpredictable radial extensions of tumor|Permeate through large distances from primarynodule|Increased risk of recurrence after simple excision|(2-4 cm) circumferential margin is resected toprevent recurrence [/INST] question: Maximum margin of excision is needed for: | options: A: Malignant melanoma B: BCC C: SCC D: Dermatofibrosarcoma protuberans | answer: D </s> |
<s>[INST] context: The expression "down to earth" means being open and honest. It is easy to get on with some one who is down to earth. A down-to-earth person is the opposite of someone who acts important or proud.
Down-to-earth people could be important members of society. But they do not consider themselves to be better than others who are less important. A person who is filled with his own importance and pride is said to" have his nose in the air".
Americans use another expression that is similar in some ways to down to earth. The expression is" both feet on the ground". Someone with both feet on the ground is a person with a good understanding of reality. He may have dreams, but he does not allow them to have influence on his understanding of what is real.
The opposite kind of person is one who "has his head in the clouds". Someone with his head in the clouds is a person whose mind is not on what is happening in real life. Such a person may be called a day-dreamer.
When we have both our feet on the ground, and when we are down to earth, we do not have our noses in the air. We act honestly and openly to others. Our lives are like the ground below us---solid and strong. [/INST] question: A down-to-earth person could be _ . | options: A: social and proud B: good and opposite C: real and important D: strong and changeable | answer: C </s> |
<s>[INST] context: Safety and Security Procedures
Your safety and the security of your personal property are of the primary concern to those of us who welcome you as our guest. We urge you to take advantage of the following suggestions.
YOUR VEHICLE
Lock it and don't leave money or valuable items inside. We are not responsible for their loss.
TRAVELING
Be good at noticing things around you when sightseeing or traveling. Stay in well-lit and heavily traveled areas. Don't display large amounts of cash.
GUEST ROOM SECURITY
For additional security use the deadbolt provided on your door and make sure the windows are locked. As an additional precautious measure, please secure the secondary locks provided. Do not admit anyone to your room without first making identification . A one-way viewer is provided in your door to assist with identification. If there is any doubt about the person's identity, please contact the Front Desk.
SAFETY BOXES
Do not leave money or valuables in your room or vehicle. We provide free safety boxes for your use. Hotel is not responsible for items left in the room valued over $200.
KEYS
Safeguard your key. Please do not leave it in the door. Do not give your key to others or leave it unattended. Please leave your key at the Front Desk when you check out.
REPORTING
Please report any suspicious activity, or safety concerns to management.
FIRE
Please familiarize yourself with the nearest fire exits. Report fire or smoke to the hotel guard. In the unlikely event of a fire, please move quickly and calmly to the nearest safe exit and leave the building. Avoid the use of elevator. [/INST] question: The suggestions are most probably from _ . | options: A: a hotel manager B: a police officer C: an experienced traveler D: a tour guide | answer: A </s> |
<s>[INST] context: Pocket Tape-Recorders "Family and Home Magazine" test what's on the market now.
Pearl corder S702 $64
This simple model at the bottom of the Olympus range scored the most points for its excellent quality of recording. Background noise hardly affects the sound and recording from a pocket is perfectly possible, but it doesn't turn off automatically.
Tape length: 30 minutes per side. Weight : 240 g
Sony M9 $49.95
Small and very good looking, Sony's latest offering scored most for appearance.
Sounds clear, but there is slight machine noise. The big control buttons are a great improvement on some of the complicated little controls on other tape-recorders.
Doesn't switch off automatically but a red light shows if the machine is still running.
Tape length : 60 minutes per side. Weight : 195g.
Sony M400 $115
Lots of little control buttons that make a noise and are difficult to use. Rcording is good but machine noise loses points. Tape counter and automatic switch-off when tape has finished recording or rewinding are useful.
Tape length : 60 minutes per side. Weight : 230g
Imperial OEM MC7 $29.95
Cheap and simple compared with the rest, but recording is good as long as there is no background noise. Use only its own make of cassette. No light to show it is on; no fast forward button and the record button makes a loud noise.
Tape length: 30 minutes per side. Weight: 285g.
Philips 585$ 80
Handsome and simple to use, but recording is very poor at more than the recommended distance of 5 cm designed for dictation. No recording light.
Tape length : 15 minutes per side. Weight : 220g. [/INST] question: Which machine is unsuitable for general use? | options: A: Pearlcorder S702 B: Sony M400 C: Imperial OEM MC7 D: Philips 585 | answer: D </s> |
<s>[INST] context: A rocket began countdown . It was a common sound in the 1960s. But this was not just another countdown. It was the beginning of a historic event. It was the countdown of Apollo 11 -the space fligh that would carry men to the first landing on the moon.
In the spaceship at the top of the rocket were three American astronauts whose names would soon be known around the world: Neil Armstrong. Edwin Aldrin and Michael Collins.
Neil Armstrong was the commander of the spaceship. Edwin Aldrin was the pilot of the moon lander. The astronauts gave it the name the Eagle. Michael Collins was the pilot of the command module , Columbia. He would wait in orbit around the moon while Armstrong and Aldrin landed and explored the surface.
On Earth, all activity seemed to stop. President Richard Nixon gave federal government workers the day off to watch the moon landing on television. Around the world, 500 million people watched the television report. Countless millions more listened on their radios.
Armstrong and Aldrin started the lander rocket engine. It slowed the spacecraft and sent it down toward the landing place. It was in an area known as the "Sea of Tranquility ".
The moon lander, controlled by a computer, dropped toward the airless surface of the moon. 140 meters from the surface, the astronauts look control of the lander from the computer. They moved the Eagle forward, away from a very rocky area that might have caused a difficult landing.
It took the astronauts more than three hours to complete the preparations for leaving the lander. It was difficult - in the Eagle's small space - to get into space suits that would protect them on the moon's surface.
Finally, Armstrong and Aldrin were ready. They opened the door. Armstrong went out first and moved slowly down the ladder. At 2:56 on July 20th, 1969, Neil Armstrong put his foot on the moon.
"That's one small step for man,"he said, "one giant leap for mankind." [/INST] question: Why did the three American astronauts on Apollo 11 soon become famous around the world? | options: A: Because people had never seen such brave astronauts as them before B: Because the first landing on the moon attracted the world's attention C: Because people all over the world watched the moon landing on TV live D: Because President Richard Nixon thought highly of what they did | answer: B </s> |
<s>[INST] context: WHO CASE DEFINITION FOR AIDS SURVEILLANCE
For the purposes of AIDS surveillance an adult or adolescent (> 12 years of age) is considered to have AIDS if at least 2 of the following major signs are present in combination with at least 1 of the minor signs listed below, and if these signs are not known to be related to a condition unrelated to HIV infection.
Major signs (2 signs or more) :
Weight loss of at least 10% of body weight
Chronic diarrhoea for> 1 month
Prolonged fever for> 1 month (intermittent or constant)
Minor signs (1 or more) :
A persistent cough for> 1 month
Generalized pruritic dermatitis
History of herpes zoster
Oropharyngeal candidiasis
Chronic progressive or disseminated herpes virus infection
Generalized lymphadenopathy.
The presence of either generalized Kaposi sarcoma or cryptococcal meningitis is sufficient for the diagnosis of AIDS for surveillance purposes.
EXPANDED WHO CASE DEFINITION FOR AIDS SURVEILLANCE:
For the purpose of epidemiological surveillance, an adult (> 12 years of age) is considered to have AIDS if a test for HIV antibody shows positive results, and one or more of the following are present:
10% body weight loss or cachexia, with diarrhoea or fever, or both, intermittent or constant, for at least 1 month, not known to be due to a condition unrelated to HIV infection.
Cryptococcal meningitis.
Pulmonary or extra-pulmonary tuberculosis.
Kaposi sarcoma.
Neurological impairment sufficient to prevent independent daily activities not known to be due to a condition unrelated to HIV infection (for example, trauma or cerebrovascular accident).
Candidiasis of the oesophagus (which may presumptively be diagnosed based on the presence of oral candidiasis accompanied by dysphagia).
Clinically diagnosed life-threatening or recurrent episodes of pneumonia, with or without etiological confirmation.
Invasive cervical cancer. [/INST] question: Major signs included by WHO for AIDS diagnosisa) Chronic diarrhea > 1 monthb) Chronic cough > 1 monthc) Chronic fever > 1 month d) Weight loss of at least 10% of body weighte) Generalized Lymphadenopathy | options: A: abc B: acd C: bc D: bde | answer: B </s> |
<s>[INST] context: Lupus vulgaris o Lupus vulgaris is a chronic and progressive form of cutaneous tuberculosis that occurs in tuberculin sensive paents.
It is the most common type of cutaneous tuberculosis and has most variable presentaon.
Seen in children and young adults, though no age is exempted.
Occurs on exposed area like face (nose, eyelid, pinna); and somemes on buock, trunk.
Lesions are usually solitary and characterized by : -
i. Reddish brown (erythematous).
ii. Annular in shape.
iii. Indurated.
iv. Slowly increases in size (gradually progressive).
v. Healing with ssue paper like scarring at centre (most common) or edge.
vi. Peripheral crusng.
vii. Blanching with glass slide (diascopy) will reveal grey green foci → Apple jelly nodules.
viii ) Match-sck test posive → Apple jelly nodule has no resistance to pressure by a sharp matchsck.
Reappearance of new nodules within previously atrophic or scarred lesions is characterisc. Carlage (Ear, nose) in the affected area is progressively destroyed (Lupus vorax); bone is usually
spared. Buccal, nasal and conjucval mucosa may be involved primarily or by extension.
Treatment is antubercula [/INST] question: Apple jelly noddule is seen in | options: A: Cutaneous anaphylaxus B: Lupus vulgaris C: Erythroderma D: Eiysepals | answer: B </s> |
<s>[INST] context: Stephen Hawking knew what he wanted to do by the time he was eight years old. His parents lived in London where his father was researching medicine. He did not want to follow his father as his parents hoped. Mathematics was not available at University College, so he did physics instead. Stephen was interested in studying the universe.
When he was 21, however, he was told that he had ALS --an incurable nerve disease, which affects walking, speaking, breathing, swallowing, and many other things. The doctors predicted that he had only a few years to live, but he didn't die. Instead, as his physical condition became worse, Hawking became more well-known in scientific circles. Hawking himself said that his disease was a big reason why he focused his attention on what turned out to be his real strength: theoretical research. "What the doctors said made me determine to get the most from life, and life was no longer boring for me," Hawking says today, speaking from his wheelchair through a computer. In 1988, Stephen Hawking published a book called A Brief History of Time. The book tries to explain many of Hawking's physical and mathematical ideas and calculations without using maths. The book became a best-seller. His later books are Black Holes and Baby Universes and Other Essays and most recently in 2001, The Universe in a Nutshell. Of the three, the first one was made into a film in 1991. Hawking says, "Nowadays, muscle power is out of date. What we need is mind power --and disabled people are as good at that as anyone else." [/INST] question: What did Hawking's parents want him to study in the university? | options: A: Physics B: Geography C: Medicine D: Mathematics | answer: C </s> |
<s>[INST] context: Hypopigmented anaesthetic patch in a child, who is coming from endemic zone of Leprosy, can be leprosy. Here the option provided is intermediate leprosy. Higher incidence of leprosy is seen in Assam, West Bengal, Bihar, Orissa, Madhya Pradesh, Madras, Andhra, and Kerala. In intermediate or dimorphous leprosy, the lesions are slow growing, indeterminate, paly anaesthetic macules and sometimes with satellite lesions. Later lesions resemble those of tuberculoid or lepramoatous leprosy or both. Peripheral nerves are involved early and severely. Pityriasis alba is a form of atopic dermatitis. It presents as ill-defined, hypopigmented, round patches on the face, neck, and trunk. Nevus anemicus is a congenital vascular anomaly that appears as a permanently pale, mottled lesion that occurs most often on the trunk. The lesions appear hypopigmented but contain normal amounts of pigment. Nevus achromicus or depigmentosus is a hypopigmented patch occurring as long linear streaks or as well circumscribed isolated patches. Affected areas are usually unilateral and may be small. [/INST] question: A 7 year old child is has a hypo pigmented anesthetic patch on his face. What is the most probable diagnosis? | options: A: Intermediate leprosy B: Pityriasis alba C: Nevus anemicus D: Nevus achromicus | answer: A </s> |
<s>[INST] context: A synol sarcoma (also known as: malignant synovioma is a rare form of cancer which occurs primarily in the extremities of the arms or legs, often in close proximity to joint capsules and tendon sheaths. As one of the soft tissue sarcomas, it is one of the rarest forms of soft tissue cancer. The name "synol sarcoma" was coined early in the 20th century, as some researchers thought that the microscopic similarity of some tumors to synovium, and its propensity to arise adjacent to joints, indicated a synol origin; however, the actual cells from which the tumor develops are unknown and not necessarily synol. Primary synol sarcomas are most common in the soft tissue near the large joints of the arm and leg but have been documented in most human tissues and organs, including the brain, prostate, and hea. Synol sarcoma occurs most commonly in the young, representing about 8% of all soft tissue sarcomas but about 15-20% of cases occur in adolescents and young adults. The peak of incidence is in the third decade of life, with males being affected more often than females (ratio around 1.2:1). [/INST] question: SYT-SSXI gene is associated with- | options: A: Liposarcoma B: Rhabdomyosarcoma C: Synol sarcoma D: Ewings sarcoma | answer: C </s> |
<s>[INST] context: A super drug that could remove Alzheimer's ,heart disease and diabetes and help people live to 100 is being developed by scientists. Their research is based on the identification of three genes that help prolong lives and prevent diseases which occur in old age. Medically controlling the proteins made by the " longevity genes" will allow millions to live longer, predicts Dr Nir Barzilai.
Those whose DNA strongly features the three genes are 80 percent less likely to develop Alzheimer's. The genes also fight against the deadly impact of smoking, poor diet, obesity and lack of exercise.
Already, several laboratories are working on a pill to imitate the benefits of the genes and Dr Barzilai thinks it could be tested within three years. The pill could remove some diseases that damage old age. " The advantage of finding a gene that involves longevity is that we can develop a drug that will imitate exactly what this gene is doing," he said.
Of the three longevity genes, two genes increase the production of so-called good cholesterol , which reduces the risk of heart disease. The third prevents diabetes. They were discovered by Dr Barzilai's team while studying the DNA of 500 Ashkenazi Jews with an average age of 100. The chances of living that long are one in 10,000 but the group, which shared relatively few common ancestors, was 20 times more likely to hit the entury. Dr Barzilai said: " 30 percent of them were obese or overweight and 30 percent smoked two acks of cigarettes a day for more than 40 years, however they can live to 100."
But Andrew Ketteringham of the Alzheimer's Society said: "Alzheimer's disease, a most common disease, is likely to be caused by a combination of genetic disosition , lifestyles and life events. Many genes are probably involved. [/INST] question: Some people are able to live to 100 years because of _ . | options: A: a magical medicine B: three special genes C: good living habits D: longevity proteins | answer: B </s> |
<s>[INST] context: Amphotericin B (AMB): The polyenes have high affinity for ergosterol present in fungal cell membrane: combine with it, get inseed into the membrane and several polyene molecules together orient themselves in such a way as to form a &;micropore&;. The hydrophilic side forms the interior of the pore through which ions, amino acids and other watersoluble substances move out. The micropore is stabilized by membrane sterols which fill up the spaces between the AMB molecules on the lipophilic side-constituting the outer surface of the pore. Thus, cell permeability is markedly increased. Adverse effects: The toxicity of AMB is high. 1)acute reaction This occurs with each infusion and consists of chills, fever, aches and pain all over,nausea, vomiting and dyspnoea lasting for 2-5 hour, probably due to release of cytokines (IL, TNF). When these are severe--the dose is increased gradually.Injection of hydrocoisone 0.6 mg/kg with the infusion may reduce the intensity of reaction. Thrombophlebitis of the injected vein can occur. 2)Long term toxicity: Nephrotoxicity is the most impoant. It occurs fairly uniformly and is dose related. manifestations are--azotemia, reduced gfr,acidosis, hypokalaemia and inability to concentrate urine.It reverses slowly and often incompletely after stoppage of therapy. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:758,759 [/INST] question: Amphotericin B causes deficiency of? | options: A: Sodium B: Calcium C: Potassium D: Chloride | answer: C </s> |
<s>[INST] context: What do you think are the most important inventions of the past 2,000 years? The TV? The printing? The telephone? Or the computer? A report shows that these are not the only important inventions. Here are four other important ones.
Paper is one of the most important inventions. You can't have printing without paper. In 105 AD, Cai Lun invented paper in China. Long before the printing and Internet, Cai Lun's invention allowed us to write down information, stories and history.
One of the simplest inventions to save life is the toilet. Before toilets, waste ran into the rivers from people's houses. Illnesses were common in big cities, and it was often difficult to find clean drinking water.
Animal food is another invention. Before the invention, most animals were killed every autumn because there was not enough food for them in the winter. After hay became a kind of common animal food, animals could live through the long winter.
Reading glasses is the fourth invention. People start getting far-sighted from the age of 45. Glasses mean that anyone can read, write and do "close work" after that age. Without glasses, the world would be difficult for the people above 45. [/INST] question: Cai Lun's invention of paper makes it possible to _ . | options: A: have printing B: feed animals C: drink clean water D: do "close work | answer: A </s> |
<s>[INST] context: A new expression of egocentrism, presume that they and others are thinking about the same thing. Because young adolescents are experiencing tremendous biologic changes in growth and sexual development, they are preoccupied with these events. Arhen an adolescent considers what others are thinking about, he assumes that others are thinking about the same thing he is thinking about, namely, himself. Adolescents assume that others are as concerned with their bodies, actions, and feelings as they themselves are. They feel as though they are constantly "on stage," being observed and criticized by those around them. This phenomenon has been called the "imaginary audience" by Elkind.' The imaginary audience is a powerful influence on young adolescents, making them quite self-conscious and particularly susceptible to peer influence. They are very worried about what peers will think about their appearance and actions, not realizing that others are too busy with themselves to be paying attention to much other than themselves. [/INST] question: A 13 year old female patient presents to the dental clinic and requests to get braces. On intra-oral examination Class I molar and incisor relationship is seen along with mild lower anterior crowding. Further along the conversation, she reveals how she feels left out as the rest of her classmates have braces while she does not. Patient appears to be very conscious of her appearance and has an inferiority complex. This phenomenon is described by Elkind as: | options: A: Cognitive equilibrium B: Constructivism C: Imaginary audience D: Centering | answer: C </s> |
<s>[INST] context: Before answering this questions, let us first understand what is bioassay, immunoassay and Radioimmunoassay
Bioassay – A Bioassay is a test that uses animals or live tissues to look for a response to the hormone that is injected.
Immunoassay – An Immunoassay is a test that uses antibodies detected against the hormone to “capture” the hormone. The test uses materials or substances that are related to or are a part of the immune system. To perform an immunoassay, cells are introduced from the immune system which may or may not have an antibody and cell clumping is observed.
Radioimmunoassay – An radioimmunoassay uses a radioisotope as the label to detect and measure the amount of hormone present in the sample.
Bioassay for detecting hCG was developed in 1930’s. wherein samples were injected in rabbits, frogs etc and ovulation was observed. These tests were expensive, slow and insensitive for hCG as they couldnot differentiate between LH and hCG.
Bioassay for hCG is an outdated test these days.
ELISA – It consists of immunosorbent assay of monocional antibodies to detect B-hCG. It forms the bases of home pregnancy tests. This is more sensitive and specific and can detect hCG in serum upto 1-2 mIU/ml. Radioimmunoassay and Radio receptor assay are more sensitive than ELISA and detect hCG Gupto .002 mLU/ml in serum (RIA) or .05 mLU/ml (IRMA)
But between the two, Radioimmunoassay is more specific as it doesnot cross react with luteinizing hormone and is the best test for detecting B-hCG
“Radioreceptor assays are more sensitive, but not much used as there is cross reactivity with LH.” [/INST] question: Best test for estimating hCG: | options: A: Radio immunoassay B: ELISA C: Radio receptor assay D: Bioassay | answer: A </s> |
<s>[INST] context: Wind is the great maker of waves. There are exceptions , such as the tidal waves sometimes caused by earthquakes under the sea. But the waves most of us know are caused by winds blowing over the sea .
Now let's learn some physical things about it. A wave has height, from low point to high point . It has length --the distance from this high point to that of the following wave. The period of the wave means the time it takes for succeeding high points to pass a fixed point. None of these things stays the same--for all depend upon the wind, upon the depth of the water and many other matters.
The water that makes up a wave does not advance with it across the sea. Each drop of water turns around in a little circle with the passing of the wave, but returns very nearly to its original position . And it is lucky that this is so. For if the huge groups of water that make up a wave really moved across the sea, sailing would be impossible. If we want to find the speed of a wave, we may use the following way : Speed =" wavelength" x frequency .
Here, wavelength is the distance between two high points , frequency means the number of cycles per second [/INST] question: What causes waves? | options: A: Earthquakes and nothing else B: Only wind C: Wind causes most waves D: Wind causes some waves | answer: C </s> |
<s>[INST] context: Dangerous as they are, extreme sports remain appealing among many Australian young people! Camp Xtreme is the perfect test of your heart.
Kite Surfing
It's the exciting mixture of kite, board and waves. The idea of using a kite to accelerate speed seems like a new challenge, yet the art of kite flying dates back to the 13th-century Chinese when _ was used as a simple means of transport.
Catch a wind and you're moving -- up, down and across the surf. "It's always exciting. You'd jump 5 feet or 35 feet. You never know if you're going to go up in the air, and your heart is just going boom, boom, boom."
Coasteering
It is by far the best activity and the event that everyone is still talking about. This is exploring the coastline without worrying about a coastal path or finding a rocky bay blocking your route. You climb, dive and swim from one place to another. With Coasteering, you don't have to be able to swim as the wet suit and buoyancy aid will keep you floating when you are in the water.
Sky Diving
Traditional parachuting doesn't sound risky enough. So now sky diving is the name for jumping from a plane and listening to your heart beating heavily as you move fast towards earth before you open your parachute at the last moment.
Mountain Biking
It's been around so long that bikers are no longer satisfied with just going up and down a mountain. Mountain biking is a sport which consists of riding bicycles off-road, often over rough land, using specially adapted mountain bikes. Mountain bikes share similarities with other bikes, but include features designed to improve strength and performance in rough areas.
For details, please call us on 1300-792-668 or click here: www.xtremecamp.com.au. [/INST] question: All the four extreme sports are mainly intended to test one's _ . | options: A: heart beat B: physical health C: potential strength D: courage | answer: D </s> |
<s>[INST] context: The electrocardiogram exhibited in the question demonstrates changes that are essentially diagnostic of severe hyperkalemia. Correct treatment for the affected patient includes administration of a source of calcium ions (which will immediately oppose the neuromuscular effect of potassium) and administration of sodium ions (which, by producing a mild alkalosis, will shift potassium into cells); each will temporarily reduce serum potassium concentration. Infusion of glucose and insulin would also effect a temporary transcellular shift of potassium. However, these maneuvers are only temporarily effective; definitive treatment calls for removal of potassium from the body. The sodium- potassium exchange resin sodium polystyrene sulfonate (Kayexalate) would accomplish this removal, but over a period of hours and at the price of adding a sodium ion for each potassium ion that is removed. Hemodialysis or peritoneal dialysis is probably required for this patient, since these procedures also rectify the other consequences of acute renal failure, but they would not be the first line of therapy given the acute need to reduce the potassium level. Both lidocaine and digoxin would not only be ineffective but contraindicated since they would further depress the myocardial conduction system. [/INST] question: A 43-year-old woman develops acute renal failure following an emergency resection of a leaking abdominal aortic aneurysm.Three days after surgery, the following laboratory values are obtained:* Serum electrolytes (mEq/L): Na+:127;K+:5.9;Cl-:92;HCO3-:15* Blood urea nitrogen: 82 mg/dL* Serum creatinine: 6.7 mg/dLThe patient has gained 4 kg since surgery and is mildly dyspneic at rest. Eight hours after these values are reported, the electrocardiogram shown below is obtained. The initial treatment for this patient should be | options: A: 10% calcium gluconate, 10 mL B: Digoxin, 0.25 mg every 3 h for three doses C: Oral Kayexalate D: Lidocaine, 100 mg | answer: A </s> |
<s>[INST] context: The capsized accident which happened in Yangtze River on June 1st, 2015 shocked the whole country.There are so many people related to this accident.Zhang Shunwen, the captain of the vessel , has been probably the person being mostly discussed now.
Born in 1963, Zhang has been working on this ship for 35 years and became captain of it in 2007.Until the accident, Zhang was regarded as an effective captain and his experience as a sailor was flawless with numerous awards.
Zhang Shunwen said the wind was coming from the South, and the wind then was about three to four grade.He first tried to ride the ship northward on the leeside in an effort to counter it with the vessel's speed.However, the wind suddenly gathered speed and he lost control of the ship."We couldn't fend off the wind even if we made a full left turn." he said.
Zhang escaped alive and is under watching by police, although he has not yet been accused of any wrongdoing. Every person has his opinion toward this kind behavior of police. Some of them think of it to be improper because the captain himself is also a victim in this accident, what's more, his wife, who also boarded on this boat, remains missing now. While others are in support of this action, to them, it is the captain who should shoulder the responsibility. For me, I agree with the former. Because the captain has made every effort to deal with the accident. [/INST] question: Zhang becomes the captain after_years of work. | options: A: 25 B: 26 C: 27 D: 28 | answer: C </s> |
<s>[INST] context: We often think of future. We often wonder what the world would be like in a hundred years'time.
Think of space,perhaps a permanent station on the moon will have been set up. Perhaps people will be able to visit the moon as tourists. Cheap rockets for space travel will have been developed,permitting long journeys throughout the solar system . When that time comes,people will be taking holidays in space and visiting other planets. Great progress will have been made in medicine,too. Perhaps a cure will have been discovered for the most terrible of all diseases--cancer. Pollution is a problem we must solve. In a hundred years'time it will have been controlled.
All the world will have been developed -- even Antarctica. There will be large cities in Antarctica. We already have supersonic flight,but in a hundred years'time we will have supersonic land travel as well.
We will have used up most of earth's land to build our cities, so floating cities will have been built. The Japanese already have plans for cities of this kind. And there will be cities under the sea. The first of these will have been completed. [/INST] question: We will have developed _ in a hundred years'time,permitting long journeys all over the solar system. | options: A: cheap rockets for space travel B: a plane C: a spaceship D: a satellite | answer: A </s> |
<s>[INST] context: Football is, I believe, the most popular game in England: one has only to go to one of the important matches to see this. Rich and poor, young and old, one can see them all there, shouting for their teams. One of the most surprising things about football in England is the great knowledge of the game which even the smallest boy seems to have. He can tell you the names of the players in most of the important teams. He has pictures of them and knows the results of large numbers of matches. He will tell you who he thinks will win such a match, and his opinion is usually as good as that of men three or four times of his age.
Most schools in England take football seriously -- much more seriously than nearly all European schools, where lessons are all very important and games are left for the children themselves. In England it is believed that education is not only a matter of filling a boy's mind with facts in the classroom; education also means the training of character by means of games, especially team games, where the boy or girl has to learn to work with others for his or her team instead of working for himself or herself alone. _ the school plans games and matches for its students. Football is a good team game. It is good both for the body and the mind. That is why it is every school's game in England. [/INST] question: Football games are very popular in England among _ . | options: A: all the people B: grown-ups C: boys only D: boys and girls | answer: A </s> |
<s>[INST] context: Great Wall Xmas BBQ
Beijing Hikers are organizing a three-hour hike on a rarely visited part of the Great Wall and will celebrate Christmas afterwards with a Christmas barbecue dinner in a small hotel at the foot of the Great Wall . Meet at 8:30 am. Dec. 25 in front of Starbucks at Lido Holiday Inn , Jiangtai Lu. Please write to [email protected] or 139-100-25516.
Pingyao tour
High Club will guide a weekend trip to Pingyao , an ancient walled town near Taiyuan , capital city of Shanxi Province . The town is one of the best-preserved featuring courtyard buildings of the Ming and Qing dynasties (1368-1911) . Among them is the Qiao family courtyard house, the shooting location of Zhang Yimou's Raise the Red Lantern (<<>> ). Leave on Friday (December 23) night by train and back to Beijing on Sunday morning . For sign-up and more information , contact Lucy at [email protected] or 8580-5080,130-11171326.
New Year Harbin trip
The Chinese Culture Club is running a new year trip to Harbin , to catch a fresh view of its yearly ice and snow lantern festival .
As the temperature is expected to fall between minus 20 to 30degC, visitors are warned to prepare well with jackets , masks , fur gloves and boots. The trip sets out by train at night on December 31 and gets back on the morning January 2. The cost is 2,300 yuan (US$ 284) . Reservation is required at 8457-2772. [/INST] question: One who is interested in life of ancient Chinese is more likely to contact _ . | options: A: 139-100-25516 B: 1368-1911 C: 8580-5080 D: 8457-2772 | answer: C </s> |
<s>[INST] context: The Boy Made It!
One Sunday, Nicholas, a teenager, went skiing at Sugarloaf Mountain in Maine. In the early afternoon, when he was planning to go home, a fierce snowstorm swept into the area. Unable to see far, he accidentally turned off the path. Before he knew it, Nicholas was lost, all alone! He didn't have food, water, a phone, or other supplies. He was getting colder by the minute.
Nicholas had no idea where he was. He tried not to panic. He thought about all the survival shows he had watched on TV. It was time to put the tips he had learned to use.
He decided to stop skiing. There was a better chance of someone finding him if he stayed put. The first thing he did was to find shelter form the freezing wind and snow. If he didn't, his body temperature would get very low, which could quickly kill him.
Using his skis, Nicholas built a snow cave. He gathered a huge mass of snow and dug out a hole in the middle. Then he piled branches on top of himself, like a blanket, to stay as warm as he could.
By that evening, Nicholas was really hungry. He ate snow and drank water from a nearby stream so that his body wouldn't lose too much water. Not knowing how much longer he could last, Nicholas did the only thing he could- he huddled in his cave and slept.
The next day, Nicholas went out to look for help, but he couldn't find anyone. He followed his tracks and returned to the snow cave, because without shelter, he could die that night. On Tuesday, Nicholas went out to find help. He had walked for about a mile when a volunteer searcher found him. After two days stuck in the snow, Nicholas was saved.
Nicholas might not have survived this snowstorm had it not been for TV. He had often watched Grylls' survival show. Man vs. Wild. That's where he learned the tips that saved his life, In each episode of Man vs. Wild, Grylls is abandoned in a wild area and has to find his way out.
When Grylls heard about Nicholas' amazing deeds, he was super impressed that Nicholas had made it since he knew better than anyone how hard Nicholas had to work to stay alive. [/INST] question: What happened to Nicholas one Sunday afternoon? | options: A: He got lost B: He broke his skis C: He hurt his eyes D: He caught a cold | answer: A </s> |
<s>[INST] context: Can you imagine that someone could cure all the diseases in the world? It seems like an impossible job, But Priscilla Chan wants to make it come true.
Chan, 31, is from the United States. Many people may know her as a wife of Mark Zuckerberg , the founder of Facebook. But Chan herself has done a lot to help people.
Chan and Zuckerberg said in September that they would give out $3 billion , that's about Y=20 billion in the next 10 years to help deal with all of the world's diseases. As a doctor for children, Chan was a big driver in this decision. "By investing in science today, we hope to build a future in which all of our children can live long and meaningful lives," she said.
She cares about not only children's health but also their education. Before becoming a doctor, Chan taught science to the 4th and 5th graders at a school in California for a year. That year she started a project called The Primary School. It provides education for children from kindergarten to the 12th grade.
Chan herself knows how important education is to a child. She has a Chinese father and a Vietnamese mother. Her parents didn't come to the US with much. But they worked hard to make sure Chan and their other two daughters had the best opportunities possible. Chan went to Harvard University in 2003 and now works as a doctor.
"I realized that I was so lucky to be what I was," said Chan. "It drives me to make sure others, no matter what background they have, can have their opportunities, to reach their dreams and their full potential ." [/INST] question: How much money will Chan and Zuckerburg give out in the next 10 years? | options: A: 3 billion yuan B: 3 billion dollars C: 20 billion dollars D: 10 billion yuan | answer: B </s> |
<s>[INST] context: Anger is good for you, as lon g as you control it, according to new psychology research. A new study from Carnegie Mellon University shows anger may help people reduce the negative impacts of stress and help you become healthier.
"Here getting emotional is not bad for you if you look at the case of anger," said Jennifer Lerner of Carnegie Mellon. "The more people display anger, the lower their stress responses."
Lerner studied 92 UCLA students by asking them to count back from 6,200. They must say out loud every thirteenth number. Researchers disturbed them by asking them to count faster or ask them other questions. If they made any mistakes, they had to restart from the very beginning. Many students felt depressed about making so many mistakes or got angry because the researchers were interrupting them.
Lerner used a hidden video camera and recorded all their facial expressions during the test. The researchers describe their reactions as fear, anger and disgust.
Other researchers recorded the students' blood pressure, pulse and production of a high-stress hormone called cortisol. People whose faces showed more fear during th e experiment had higher blood pressure and higher levels of the hormone. Both can have lasting effects such as diabetes , heart disease, depression and extra weight gain.
When people feel fear, negative impacts increase, but when they get angry, those negatives go down, according to the study.
"Having that sense of anger leads people to actually feel some power in what otherwise is maddening situation,"
Lerner said. Lerner previously studied Americans' emotional response to the 911 terrorist attacks two months after the incident. She found people who reacted with anger were more optimistic. These people are healthier compared with those who were frightened during the event. So in maddening situations, anger is not a bad thing to have. It's a healthier response than fear. [/INST] question: Which statement will Jennifer Lerner agree with? | options: A: It's better to be angry than to be frightened B: Different reactions reflect different outlooks on life C: Don't control your anger and it makes you powerful D: Pessimistic people are generally healthier than opt imistic people | answer: A </s> |
<s>[INST] context: Once upon a time, there was a family with eighteen children in a small village not far from Nuremberg. Eighteen! In spite of the hopeless condition, two of the children had a dream. They both wanted to pursue their talent for art. After many long discussions, the two boys finally worked out an agreement. They would toss a coin. The loser would go down into the nearby mines and, with his earnings, support his brother who attended the academy. Then, when that brother who won the toss completed his studies, in four years, he would support the other brother at the academy.
They tossed a coin on a Sunday morning after church. Albrecht Durer won and went off to Nuremberg. Albert went down into the dangerous mines and, for the next four years, financed his brother, whose work at the academy was excellent. By the time he graduated, he had earned considerable fees for his works.
When the young artist returned to his village, the Durer family held a festive dinner to celebrate Albrecht's triumphant homecoming, where Albrecht drank a toast to his beloved brother for the years of sacrifice that had enabled him to fulfill his ambition. His closing words were, "Now you can go to Nuremberg to look for your dream, and I will take care of you."
Tears streaming down his pale face, shaking his lowered head from side to side, Albert sobbed, "No... no... no...no. It is too late for me. Look...look at what four years in the mines has done to my hands! I have been suffering from arthritis so badly in my right hand that I cannot even hold a glass to return your toast, much less draw delicate lines with a pen or a brush... For me, it is too late."
To show thanks to Albert for all that he had sacrificed, Albrecht Durer painstakingly drew his brother's abused hands with palms together and thin fingers stretched skyward. He called his powerful drawing simply "Hands", but the entire world almost immediately opened their hearts to his great masterpiece and renamed it "The Praying Hands".
The next time you see a copy of that touching creation, take a second look. Let it be your reminder, if you still need one, that no one - no one - no one ever makes it alone! [/INST] question: The reason why the two brothers worked out the agreement was that _ . | options: A: they had no choice but to make a list B: their family was so poor that it couldn't afford the academy C: one of the brothers deserved to go down to mines D: they wanted to think out a way to support the other sisters and brothers | answer: B </s> |
<s>[INST] context: Explanation:
Juvenile Papillomatosis of the breast
● It is a relatively common benign localised proliferative lesion in the breast.
● It is mainly seen in young women (mean age: 19-23 years)
● Caused by HPV 6 and 11.
Clinical presentation
● Patients present with a firmt well-defined, mobile mass often in the periphery of the breast.
● There is usually no nipple discharge.
Pathology
● Papillary proliferation of the ductal epithelium which partly fills up smaller ducts causing distension.
● Grossly, well-circumscribed mass containing multiple small cysts (<2 cm) within a dense fibrous stroma
(therefore sometimes termed swiss cheese disease by pathologists).
● Lesions can vary in size, usually ranging from 1 to 8 cm.
Radiographic features
Breast ultrasound
● They can appear as an ill-defined, inhomogenous hypoechoic mass with multiple small (up to 4mm) predominantly peripheral cysts.
● Microcalcifications may be seen at sonography.
Mammography
● These lesions are usually negative on mammography.
● Occasionally may show microcalcifications, an asymmetric density or a prominant intraductal pattern.
Galactography
● May show a multiple irregular filling defects within the breasts. Breast MRI
Signal characteristics according to one report include
● T1 : hypo-intense lobulated mass
● T2 : may show- presence of multiple small internal cysts, best shown on this sequence and is considered the most specific feature
● T1 C+ (Gd) : may or may not show marked rapid enhancement
● Dynamic sequence: shows a benign enhancement profile.
Complications
● Despite being a benign entity, it is considered by some to be a marker for familial breast cancer.
● Approximately /0% develop breast cancer later in life. [/INST] question: Type of human papilloma virus associated with cacinoma cervix | options: A: Types 6, 12, 18 B: Types 16, 18, 31 C: Types 6, 8, 11 D: Types 3, 10, 19 | answer: B </s> |
<s>[INST] context: In the question, there is Grievous hu (disfiguring of the face), caused by a dangerous weapon (Knife). Hence the section applicable is 326 IPC (Punishment for Grievous hu by dangerous weapons) Dangerous weapon: Basically, any weapon of offense, which is likely to cause death can be considered as a dangerous weapon. It also depends upon facts of each case. The knife will ceainly be a dangerous weapon in this case. Following items constitute dangerous weapon: Any instrument for shooting, stabbing or cutting or any instrument which, used as a weapon of offence, is likely to cause death, Fire or any heated substance, Any poison, Any explosive substance Any animal IPC Sections related to Hu etc 319. Definition of Hu (Any Bodily pain, Infirmity or Disease) 320. Definition of Grievous hu. 321: Defines Voluntarily causing hu 322: Defines Voluntarily causing Grievous hu 323: Punishment for causing hu: Up to 01 years, fine up to 1000 Rs 324: Punishment for causing Hu by dangerous weapon: Up to 03 years, or fine 325: Punishment for causing Grievous hu: Up to 07 years, and also fine. 326: Punishment for Grievous hu by dangerous weapons: Imprisonment for life, or up to 10 yrs, and fine [/INST] question: Mr. Y caused multiple Incised wounds on the face of Mr. Z by a Knife. Mr. Y is liable for arrest under which section of IPC? | options: A: 323 B: 324 C: 325 D: 326 | answer: D </s> |
<s>[INST] context: Doctor Seuss was born in 1904. By the middle 1950s, he had become one of the best-loved and most successful children's book writers in the world. His books are very popular with young readers. They enjoy the invented words and the pictures of unusual funny animals and plants.
In 1954, life magazine published a report about school children who could not read. The report said many children's books were not interesting. Doctor Seuss strongly hoped to help children and decided to write books that were interesting and easy to read. He used words with the same ending sound, like fish and wish. He did not receive training in art. Yet, he drew the pictures for most of his books.
In 1957, Dr. Seuss wrote The Cat in the Hat. He used less than 230 words to write the book and even a six-year-old should be able to read it. It was a fun story and easy to read. Children loved it. Their parents loved it, too. Today it is still one of the stories they like best. The success of The Cat in the Hat made him want to write more books for children. In 1960, he wrote a book using less than fifty words. The book is called Green Eggs and Ham.
In 1984, Doctor Seuss won a Pulitzer Prize . He was honored for the education and enjoyment his books provided American children and their parents.
He died at the age of 87, but his influence remains. Millions of his books have been sold worldwide. People say his books helped change the way American children learned to read. Yet, his books are loved by people of all ages. Doctor Seuss once said, "I do not write for children. I write for people." [/INST] question: Doctor Seuss learned from the magazine that _ . | options: A: some school children could not read B: many children's books were interesting C: children wanted to learn to read D: a writer for children was wanted | answer: A </s> |
<s>[INST] context: When Abraham Lincoln was invited to give a speech in Brooklyn, New York, in February 1860, he was already famous throughout Illinois, but almost no one in the East knew what he looked like.
The presidential election of 1860 was coming, and Lincoln, as a possible Republican candidate , wanted to increase his popularity. Hoping to introduce himself to hundreds of new voters , Lincoln eagerly accepted the invitation to the East. He wrote a powerful speech opposing slavery . Then he went to Springfield, Illinois by train.
When Lincoln arrived in New York, he was surprised to learn that so many people had bought tickets for his speech that it had been moved from a small Brooklyn church to a New York City college.
Lincoln got to town exhausted. His suit was badly wrinkled , and his one piece of luggage was old and covered with dust. Worst of all, his plain face, uncombed hair shocked those who greeted him. However, his admirers decided to have Lincoln photographed . If the cameraman could make Lincoln a little handsome, perhaps he could win more votes. They found the city's most famous photographer Brady. Brady and his assistants looked through the camera and surprised by what they saw. So they decided to make an adjustment before they took the picture.
Brady walked over to Lincoln and pulled up Lincoln's shirt collar as high as it would go. As a result, the picture successfully covered up his long, ugly neck, which made Lincoln appear quite handsome.
Lincoln's speech that day proved to be a triumph. So did the photograph. The photo inspired thousands of copies; so many that Brady insisted that this picture became the means to Lincoln's election to the Presidency nine months later. If that's true it might be said that Lincoln won the election by a neck--a neck that had been shortened in New York. [/INST] question: Lincoln went to the East in order to _ . | options: A: take a trip B: have himself photographed C: make a speech about Illinois D: convince voters to support him | answer: D </s> |
<s>[INST] context: Sunray appearance is a typical type of Periosteal reaction along Sharpeys fibres OSTEOSARCOMA * Highly malignant tumor arising from primitive mesenchymal bone-forming cells. * Histologic hallmark is production of malignant osteoid. * Mc histological form of primary bone cancer . * A most common primary malignant bone tumor after Etiology * Rapid bone growth - adolescence growth spu in the metaphyseal area near the growth plate. * Radiation exposure - mostly causes secondary forms. * Genetic predisposition : * - hereditary form of retinoblastoma( RB gene mutation) * - Li-Fraumeni syndrome (p53 gene mutation) * - Rothmund - Thomson syndrome ( autosomal recessive) * Paget&;s disease of bone - mostly secondary forms. Classification * PRIMARY or SECONDARY * PRIMARY OSTEOSARCOMAS (15 - 25 yrs) Conventional /classic osteosarcoma (high grade, intra medullar y) Low-grade intramedullary osteosarcoma Paraosteal osteosarcoma Periosteal osteosarcoma High-grade surface osteosarcoma Telangiectatic osteosarcoma, and Small cell osteosarcoma. * SECONDARY OSTEOSARCOMAS * Osteosarcoma occurring at the site of another disease process. * more common in >50 years of age most commonly a/w premalignant condition like - Paget disease - Previous radiation treatment - endochondromatosis - Fibrous dysplasia - Osteochondromas - Osteogenesis imperfecta Clinical Presentation * Pain- progressive pain paicularly with activity. * Swelling - Palpable mass in the region of metaphysis. - skin over the swelling shiny with prominent veins. - swelling may be warm & tender. * Decreased range of motion of the involved joint. * Lymphadenopathy - unusual focal & regional lymph node involvement. * Respiratory finding - late stage with lung metastasis. * Fever & night sweats are rare. Refer Maheshwari 9th/e 239 [/INST] question: A child is diagnosed with Osteosarcoma based on Sunray appearance seen on x-ray. This is because of | options: A: Calcification along the periosteum B: Calcification along the blood vessels C: Perosteal reaction D: Soft tissue invasion | answer: C </s> |
<s>[INST] context: Pneumothorax Repos of a more than 50% incidence of negative explorations of the neck, iatrogenic complications, and serious injuries overlooked at operation have caused a reassessment of the dictum that all penetrating neck wounds that violate the platysmaQ must be explored. Stable patients with zone II (between the angle of the mandible and the skull) or zone I (inferior to the cricoid cailage) injuries, or multiple neck wounds, should undergo initial angiographyQ irrespective of the ultimate treatment plan. Algorithms exist for nonoperative management of asymptomatic patients that employ observation alone or combinations of vascular and aerodigestive contrast studies and endoscopy. Neveheless, recognition of acute signs of airway distress (stridor, hoarse ness, dysphonia), visceral injury (subcutaneous air, hemoptysis, dysphagia), hemorrhage (expanding hematoma, unchecked external bleeding), or neurologic symptoms referable to carotid injury (stroke or altered mental status) or lower cranial nerve or brachial plexus injury requires formal neck exploration. Pneumothorax would mandate a chest tube; the necessity for exploration would depend on clinical judgment and institutional policy. [/INST] question: You evaluate an 18 yrs old male who sustained a right sided cervical laceration during a gang fight. Which of the following is a relative rather than an absolute indication for neck exploration? | options: A: . Expanding hematoma B: Dysphagia C: Dysphonia D: Pneumothorax | answer: D </s> |
<s>[INST] context: A new supermarket put on a notice inside the entrance. It said, "Remember, once a week, one of our customers gets free goods(things that cost nothing). This may be your lucky day!" All the housewives who went to the supermarket had one great hope: to be the lucky customer who didn't have to pay for her shopping.
For several weeks Mrs. Blake hoped to be the lucky customer. Unlike many other customers, she never gave up hope. The cupboards in her kitchen were full of things she did not need. She dreamed of the day, when the manager of the supermarket would come and say to her, "Madam, this is your lucky day and everything in your basket is free."
One Friday morning, after she finished her shopping and had taken all the things to her car, she found that she had forgotten to buy tea. She went to the supermarket, got the tea and went towards the check-out. As she did so, she saw the manager of the supermarket come to her. "Madam," he said, "congratulations! You are our lucky customer and everything in your basket is free!" [/INST] question: From the notice in the new supermarket, we know that _ . | options: A: customers could buy things at lower prices once a week B: the customer who bought the least goods didn't have to pay C: just one customer could get free goods once a week D: the first customer who bought goods in the supermarket was the lucky one | answer: C </s> |
<s>[INST] context: Some spiders hunt on the ground, others build webs to trap their food, but the grass water spider catches its prey by running along the surface of the water.
This special water spider lives on the grassy banks of streams where mosquitoes, damsel flies and other insects come to feed and breed.
Although it is one of the largest spiders in prefix = st1 /New Zealand, it has an unusual ability. It doesn't disturb the water as it waits for its meal, and there is barely a ripple when it skims across the surface at lightning speed to catch its prey.
Grass water spiders deal swiftly with larger insects like damsel flies by pulling their heads under the water and holding them there until they drown.
After a meal, the grass water spider spends up to half an hour grooming itself. It wipes its eight eyes, brushes its antennae , and takes special care to clean the hairs on its body.
It is the hairs that trap tiny bubbles of air so that the spider can run down a blade of grass and stay underwater for up to an hour when it is frightened. The hairs also keep the spider dry, even underwater.
It is only when the female spider is caring for the young that she does not hunt on the water. After mating, she produces a large egg sac , which she carries around for five weeks. Once the eggs start to hatch, she attaches the sac to some blades of grass or a thistle. She then tears the sac open and releases the tiny spiders into the nursery web. [/INST] question: How does the grass water spider kill its prey? | options: A: in a web B: by drowning C: by poisoning D: with its antennae | answer: B </s> |
<s>[INST] context: (Central lesion of the Chiasma) (290-Khurana 4rd) (35-P)LESIONS OF THE VISUAL PATHWAY1. Lesions of the optic nerve - Marked loss of vision or complete blindless on the affected side associated with abolition of the direct light reflex on the ipsilateral side and consensual on the contralateral side.Common causes - Optic atrophy, Traumatic avulsion of the optic nerve, Indirect optic neuropathy and acute optic neuritis2. Lesions through proximal part of the optic nerve - Ipsilateral blindness, contralateral hemianopia and abolition of direct light reflex on the affected side and consensual on the contralateral side, Near reflex is intact.3. Sagittal (Cental) lesions of the Chiasma - Bitemporal hemianopia and bitemporal hemianopic paralysis of the pupillary reflexes.Common causes - Suprasellar aneurysm, tumours of the pituitary glands*, Craniopharyngioma, suprasellar Meningioma, glioma of third ventricle, third ventricular dilatation due to obstructive hydrocephalus and chronic chiasmal arachnoiditis.4. Lateral chiasmal lesions - Binasal hemianopia associated with binasal hemianopic paralysis of the pupillary reflexes.Common causes are - Distension of third ventricles causing pressure on each side of the chiasma, and atheroma of the carotids or posterior communicating arteries.5. Lesions of the optic tract - in congruous homonymous, hemianopia associated with contralateral hemianopic pupillary reactions {Wernicke's reaction)Common causes are - syphilitic meningitis or gumma, TB and tumours of optic thalamus and aneurysms of superior cerebellar or posterior cerebral arteries.6. Lesion of the lateral geniculate body - homonymous hemianopia with sparing of pupillary reflexes and may end in partial optic atrophy7. Lesions of optic radiation(I) Inferior quadrantic hemianopia {Pie on the floor) - lesions of parietal lobe(II) Superior quadrantic hemianopia {Pie in the sky) lesions of the temporal lobes [/INST] question: Bitemporal hemianopia is caused by lesions at | options: A: Optic tract B: Central lesions of the chiasma C: Lateral part of chiasma D: Optic radiation | answer: B </s> |
<s>[INST] context: Producing money requires both artistic and technological skills. Dollar bills are made so that they are interesting to look at but very hard to copy. In total, there are sixty-five separate steps required to make a dollar bill.
The money making process begins when. a yearly order is sent by the Federal Reserve Board. That order will then be divided in half. Half will be done here in Washington, D. C.and the other half will be done in Fort Worth, Texas. Next, the Bureau orders special paper which is actually cloth since it is 75% cotton and 25% linen.
This paper is made so that it can last a long time. And, it is made with details that make it hard to copy. For example, bills contain security threads. These narrow pieces of plastic are inside the paper and run along the width of the bill. This special paper is also made with very small blue and red fibers.
Once the money is printed, guillotine cutters separate the sheets into two notes, then into individual notes. The notes are organized in "bricks," each of which contains forty one-hundred-note packages. The bricks then go to one of twelve Federal Reserve Districts, which then give the money to local banks. Ninety-five percent of the bills printed each year are used to replace money that is in circulation, or that has already been removed from circulation.
You may know that America's first president, George Washington, is pictured on the one- dollar bill. But do you know whose face is on the two, five, ten, twenty, fifty and one hundred-dollar bills? They are, in order. President Thomas Jefferson, President Abraham Lincoln, Treasury Secretary Alexander Hamilton, President Andrew Jackson, President Ulysses Grant and statesman Benjamin Franklin.
The average life span of a one-dollar bill is twenty-one months. But a ten-dollar bill lasts only about eighteen months. The one hundred-dollar bill lasts the longest, eighty-nine months. One popular question is about the two-dollar bill. This bill is not printed very often. This is because many Americans believe two-dollar bills are lucky, so they keep them. [/INST] question: During money production, we must consider all EXCEPT that it must _ . | options: A: last a long time B: be hard to copy C: be interesting to look at D: be done by the president's order | answer: D </s> |
<s>[INST] context: Transketolase is an enzyme of both the pentose phosphate pathway in all organisms and the Calvin cycle of photosynthesis. It catalyzes two impoant reactions, which operate in opposite directions in these two pathways. In the first reaction of the non-oxidative pentose phosphate pathway, the cofactor thiamine diphosphate accepts a 2-carbon fragment from a 5-carbon ketose (D-xylulose-5-P), then transfers this fragment to a 5-carbon aldose (D-ribose-5-P) to form a 7-carbon ketose (sedoheptulose-7-P). The abstraction of two carbons from D-xylulose-5-P yields the 3-carbon aldose glyceraldehyde-3-P. In the Calvin cycle, transketolase catalyzes the reverse reaction, the conversion of sedoheptulose-7-P and glyceraldehyde-3-P to pentoses, the aldose D-ribose-5-P and the ketose D-xylulose-5-P.The second reaction catalyzed by transketolase in the pentose phosphate pathway involves the same thiamine diphosphate-mediated transfer of a 2-carbon fragment from D-xylulose-5-P to the aldose erythrose-4-phosphate, affording fructose 6-phosphate and glyceraldehyde-3-P. Again, in the Calvin cycle exactly the same reaction occurs, but in the opposite direction. Moreover, in the Calvin cycle, this is the first reaction catalyzed by transketolase, rather than the second. [/INST] question: Erythrocyte transketolase activity is seen in which vitamin? | options: A: Riboflavin B: Thiamine C: Folic acid D: Niacine | answer: B </s> |
<s>[INST] context: Subclan steal syndrome refers to steno-occlusive disease of the proximal subclan aery with retrograde flow in the ipsilateral veebral aery and associated cerebral ischaemic symptoms.CausesClinical presentationIpsilateral upper limbNeurological, radiationCongenital Weak or absent pulseDecreased blood pressure (>20 mmHg)Arm claudication (rare due to collateral perfusion)DizzinessVeigoSyncopeAtaxiaVisual changesDysahriaWeaknessSensory disturbancesRadiographic featuresUltrasoundCT angiographyMR angiographyRetrograde flow in ipsilateral veebral aeryEarly changes prior to reversal of flow: decreased velocity, biphasic flow (in veebral aery)Changes can be augmented with arm exercise or inflation of BP cuff above systolic pressureProximal subclan aery usually can't be seen well enough to assessDistal subclan aery shows parvus-tardus waveform and monophasic waveformSubclan aery stenosis or occlusion easily identifiedDelayed enhancement of ipsilateral veebral aeryDirection of flow in veebral aery cannot be determinedOther intracranial or extracranial cerebral vascular lesions can be identifiedSubclan aery stenosis or occlusion easily identifiedDelayed enhancement of ipsilateral veebral aeryRetrograde direction of flow in ipsilateral veebral aeryOther intracranial or extracranial cerebral vascular lesions can also be identifiedTreatmentEndovascular: angioplasty & stent inseionSurgical: bypass surgery [/INST] question: Subclan steal syndrome is due to | options: A: Blockage of first pa of subclan aery B: Blockage of second pa of subclan aery C: Blockage of third pa of subclan aery D: Thrombosis of subclan vein | answer: B </s> |
<s>[INST] context: For many years, Yang Shanzhou was the local party secretary in a remote, mountainous village in southwest China's Yunnan Province. Though he could live a better life in the city, he still decided to move even further into the mountains, and devoted himself to greening the land. He passed away in 2010, but his story lives on.
A blanket of green - And it all started with a surprising decision made by Yang Shanzhou back in 1988.
The 62 year old decided to return to his hometown in Daliang Mountain, to bring green back to the _ hills. Along with fifteen other people, Yang settled down deep in the mountains and began to work on his plan.
It was a life that was harder than most people could ever imagine.
Su Jiaxiang, Yang Shanzhou's secretary, said, "I went to visit him several times. He didn't even have decent shoes and it was very cold at night. But you know he was almost seventy!"
In 2010, Yang Shanzhou passed away. He was buried in Daliang Mountain, according to his will. More than twenty years has passed since he first began his planting in the mountains.The hills are now covered with kinds of trees. By planting trees, Yang Shanzhou also planted hope. This hidden hero left his local government with a priceless legacy. [/INST] question: Yang Shanzhou lived in _ . | options: A: Jiangsu B: Guizhou C: Yunnan D: Guangxi | answer: C </s> |
<s>[INST] context: Did you ever look up at the moon and think you saw a man's face there? When the moon is round and full, the shadows of the moon mountains and the lines of the moon valleys sometimes seem to show a giant nose and mouth and eyes. At least, some people think so.
If there were a man on the moon--instead of mountains and valleys that just look like the face of a man--what would he be like?
He would not be like anyone you know. He would not be like anyone anybody knows.
If the man on the moon were bothered by too much heat or cold the way Earth people are, he could not stay on the moon.
The moon becomes very, very hot. It becomes as hot as boiling water. And the moon becomes very, very cold. It becomes colder than ice.
Whatever part of the moon the sun shines on is hot and bright. The rest of the moon is cold and dark.
If the man on the moon had to breathe to stay alive, he couldn't live on the moon because there's no air there. He'd have to carry an oxygen tank, as astronauts do. There's no food on the moon, either. Nothing grows--not even weeds(grass).
If the man on the moon liked to climb mountains, he would be very happy. There are many high places there, such as the raised land around the holes, or craters , of the moon. Some of these _ are as tall as Earth's highest mountains.
But if the man on the moon liked to swim, he would be unhappy. There is no water on the moon--just dust and rock.
When you think of what it's like on the moon, you may wonder why it interests our scientists. One reason is that the moon is Earth's nearest neighbor--it is the easiest place in space to get to.
Going back and forth between the moon and Earth, astronauts will get a lot of practice in space travel. Things learned on moon trips will be of great help to astronauts who later take long, long trips to some of the planets.
Scientists are also interested in the moon because it has no air. The air that surrounds Earth cuts down the view of the scientists who look at the stars through telescopes. A telescope on the moon would give them a clearer, closer view of the stars.(words: 411) [/INST] question: What is the reason why our scientists are interested in the moon.? | options: A: The moon is beautiful B: The moon is different from the earth C: The moon is Earth's nearest neighbor--it is the easiest place in space to get to D: The moon is the easiest place in space to get to and it has no air, unlike Earth | answer: D </s> |
<s>[INST] context: Have you ever watched movies in a 4D cinema? It is going to be the next wave in movie theatre experience, and it will take your experience to the next level.
The 4D cinema experience has actual smells, mists and vibrations . While you're watching a movie about water fighting, _ nozzles in the seats might let out a mist of water. What about watching a movie about street racing or war? The nozzles can give out the smell of burning rubber or gunpowder . Those all-important little nozzles have about 1,000 options for you, everything from mists to smells.
Seats in the theatre are movable as well. When a car crash happens on the screen, it can also feel like it's happening in your chair. Large fans set around the theatre can make you feel like you're caught in a windstorm, and a lot of lights set around the cinema can be used to create huge flashes like you might see in a lightning storm.
Watching movies in a 4D cinema can offer you an amazing and unusual experience. You can not only see the movie, but also feel and smell it. [/INST] question: The nozzles in a 4D cinema can let out _ . | options: A: street racing or war B: a mist of gunpowder C: the smell of water D: everything from mists to smells | answer: D </s> |
<s>[INST] context: (As bicarbonates) (670- Ganong 22nd) (642- K.S 4th) (612-13- Ganong 23rd)Carbon dioxide is transported in blood in four wavs1. As dissolved CO2 form - 7%2. As carbonic acid - negligible3. As bicarbonates - 63%4. As carbamino compounds - 30%Transport of carbon dioxide as BicarbonatesAbout 63% of CO2 is transput ted as bicarbonate. From plasma, the CO2 enters the RBCs. In the RBCs, CO2 combines with water to form carbonic acid. The reaction inside RBCs is very rapid. The rapid formation of carbonic acid inside the RBCs is due to the presence of an enzyme called carbonic anhydrase. This enzyme accelerates the reaction, carbonic anhydrase is present only inside the RBCs and not in plasma. This is why the carbonic acid formation is at least 200 to 300 times more in the RBCs than in plasmaThe carbonic acid is very unstable. Almost all carbonic acid (99.9%) formed in red- blood corpuscles dissociates into bicarbonates and hydrogen ions. The concentration of bicarbonates ions in the cell increases more and more. The increased concentration of bicarbonate inside the RBC causes diffusion of bicarbonates ions through the cell membrane in to the plasma [/INST] question: Most important form of carbon-dioxide transport in the blood | options: A: It is mostly transported as carboxy hemoglobin B: As dissolved CO2 C: As bicarbonates D: Due to CO2 molecules attached to hemoglobin | answer: C </s> |
<s>[INST] context: Bilirubin metabolism
Bilirubin is the end product of heme degradation.
The heme is derived from -
Senescent erythrocytes by the mononuclear phagocytic system in the spleen, liver and bone marrow (major source).
Turnover of hemoproteins (e.g. cytochrome p.450).
Heme is oxidized to biliverdin by heme oxygenase.
Biliverdin is then reduced to bilirubin by biliverdin reductase.
Bilirubin is transported to the liver in bound form with albumin.
There is the carrier-mediated uptake of bilirubin in the liver.
This bilirubin is conjugated with glucuronic acid by UDP glucuronosyl transferase (UGT1A1) to from conjugated bilirubin (bilirubin glucuronides).
Conjugated bilirubin is excreted into bile.
Most of the conjugated bilirubin is deconjugated and degraded to urobilinogen.
The most of the urobilinogen is excreted in the faeces.
Approximately 20% of the urobilinogen is reabsorbed in the ileum and colon and is returned to the liver, and promptly excreted into bile → Enterohepatic circulation.
The small amount that escapes this enterohepatic circulation is excreted in urine. [/INST] question: Bilirubin is the degradation product of - | options: A: Albumin B: Globulin C: Heme D: Transferrin | answer: C </s> |
<s>[INST] context: Tzanck smear is a very simple and rapid technique. For viral infections, samples should be taken from a fresh vesicle.The vesicle should be unroofed or the crust removed, and the base scraped with a scalpel or the edge of a spatula. The material is transferred to a glass slide.In the case of blistering disorders, the intact roof of a blister is opened along one side, folded back and the floor gently scraped. The material thus obtained is smeared onto a microscopic slide, allowed to air dry, and stained with Giemsa stain. Pemphigus vulgaris: It reveals multiple acantholytic cells (Tzanck cells). A typical Tzanck cell is a large round keratinocyte with a hyperophic nucleus, hazy or absent nucleoli, and abundant basophilic cytoplasm. The basophilic staining is deeper peripherally on the cell membrane ("mourning edged" cells) due to the cytoplasm's tendency to get condensed at the periphery, leading to a perinuclear halo. Herpes simplex, varicella, herpes zoster: multinucleated syncytial giant cells contain multiple nuclei Molluscum contagiosum: basophilic intracytoplasmic molluscum bodies (Henderson-Patterson bodies), the largest known inclusion bodies (30-35 m). Vaccinia, orf, milker's nodules and variola:[ eosinophilic cytoplasmic inclusion called a "Guarnieri body", Leishmaniasis:Cytology is very useful in detecting Leishman-Donovan (LD) bodies in early, untreated patients of leishmaniasis. LD bodies appear as light-blue, ellipsoid bodies IADVL Textbook of dermatology page 1099 [/INST] question: Tzank smear in a case of pemphigus vulgaris shows | options: A: Acantholytic cells B: Macrophages C: Fibroblasts D: Neutrophils | answer: A </s> |
<s>[INST] context: Branches of femoral nerveAnterior division: In the thigh the anterior division of the femoral nerve gives off anterior cutaneous and muscular branches.- Anterior cutaneous branches: The anterior cutaneous branches comprise the following nerves:Intermediate femoral cutaneous nerve andMedial femoral cutaneous nerve- Muscular branches (rami musculares):The nerve to the Pectineus arises immediately below the inguinal ligament.The nerve to the Saorius arises in common with the intermediate cutaneous.Posterior division: The posterior division- muscular branches supply the four pas of the Quadriceps femoris.- The branch to the Rectus femoris enters the upper pa of the deep surface of the muscle, and supplies a filament to the hip-joint.- The branch to the Vastus lateralis, of large size, accompanies the descending branch of the lateral femoral circumflex aery.The branch to the Vastus medialis descends lateral to the femoral vessels in company with the saphenous nerve.- The branches to the Vastus intermedius.- The aicular branch to the hip-joint is derived from the nerve to the Rectus femoris.The aicular branches to the knee-joint are three in number.One, a long slender filament, is derived from the nerve to the Vastus lateralis.- Another, derived from the nerve to the Vastus medialis- The third branch is derived from the nerve to the Vastus intermedius. [/INST] question: Saphenous nerve is a branch of: | options: A: Tibial nerve B: Sciatic nerve C: Common peroneal nerve D: Femoral nerve | answer: D </s> |
<s>[INST] context: If touring in a large group isn't fit for you and the idea of driving yourself doesn't attract you, a small group journey with the Great New Zealand Travel Company might be just the answer.
Panorama -- 24 Days
Discover why New Zealand remains one of the world's most popular destinations. This _ , 24-day journey offers you a wide choice of things to do and places to see. You will enjoy plenty of time to sightsee, relax and experience the lifestyle that is in New Zealand.
Departure Dates: Jan. 12, 26; Feb. 9, 23 Price: NZ$10,715
Nikau -- 13 Days
This 13-day journey from Auckland to Christchurch lets you experience the true diversity of this beautiful country. History, culture, scenery and adventure, they all feature on this trip to give you a brief insight into the land.
Departure Dates: Jan. 2, 23; Feb. 2, 16 Price: NZ$5,680
Southern Adventure -- 11 Days
Enjoy a South Island holiday with exciting sightseeing and activities, including the world-famous whale-watch at KaiKoura and a wildlife tour on Akaroa Harbour. This tour will take you on a journey of discovery.
Departure Dates: Jan. 17, 31; Feb. 7, 24 Price: NZ$5,820
Northland -- 4 Days
The Bay of Islands is a great place and should not be missed if time permits. You will visit the Northland region, the birthplace of New Zealand as we know it today. See the oldest Maori and European Settlements in the country and take an eco-cultural trip into the Waipoua Forest. Enjoy free time to learn more of the early days of the nation.
Departure Dates: daily Price: NZ$2,015 [/INST] question: Tourists who are interested in wild animals should choose _ | options: A: Panorama -- 24 Days B: Nikau -- 13 Days C: Southern Adventure -- 11 Days D: Northland -- 4 Days | answer: C </s> |
<s>[INST] context: Patricia was worried.She had a job interview, and she wanted to look good.She decided to get some new clothes.The store owner, Pallas Hansen, helped Patricia find a suit.But when she left the store, she didn't pay for the suit!
How could Patricia do this? She was in a special store called Career Closet in San Jose, California.Pallas Hansen and Charlotte Krumwiede started this nonprofit store to help women.They knew that many women don't find jobs because they don't have the right clothes for a job interview.Women who don't have a lot of money have to use their money to buy food and clothes for their children.They can't buy clothes for themselves.
Pallas and Charlotte started the store in 1992 after they heard about a store like this in Chicago.Volunteers work in the store.Working women donate most of the clothes to the store.This makes it possible for the customers at Career Closet to get clothes for free.
Career Closet has helped 2,500 San Jose women, but clothes aren't the only things women get at the store.They also get confidence.Patricia is 36 years old.Her husband was hurt in an accident, and Patricia needed a job to support her seven children.She went to Career Closet and got a jacket, a skirt, and a blouse."The whole day made me feel special," she said.Patricia was a success at her interview, and she got the job.One reason why she got it was that she was wearing the right clothes for the workplace.
Pallas says," I love this job.Sixty percent of the women get jobs.It's like being a fairy god-mother." [/INST] question: What do the women get besides clothes at Career Closet? | options: A: Money B: Shoes C: Confidence D: Chances | answer: C </s> |
<s>[INST] context: Archaeology, like many academic words, comes from Greek and means, more or less, "the study of old things". So, it is really a part of the study of history. However, most historians use paper evidence, such as letters, paintings and photographs, but archaeologists learn from the objects left behind by the humans of long ago. Normally, _ are the hard materials that don't break down or disappear very quickly--things like human bones and objects made from stone and metal.
It is very unusual to find anything more than the hard evidence of history--normally, the bacteria in the air eat away at soft materials, like bodies, clothes and things made of wood. Occasionally, things are different.
In 1984, two men made an amazing discovery while working in a bog called Lindow Moss, in the north of England. A bog is a very wet area of earth, with a lot of plants growing in it. It can be like a very big and very thick vegetable soup--walk in the wrong place and you can sink and disappear forever. The men were working when one of them saw something sticking out--a human foot! Naturally, the men called the police, who then found the rest of the body. Was it a case of murder? Possibly--but it was a death nearly two thousand years old. The two men had found a body from the time of the Roman invasion of Britain. Despite being so old, this body had skin, muscles, hair and internal organs--the scientists who examined him were able to look inside the man's stomach and find the food that he had eaten for his last meal!
Why was this man so well preserved? It was because he was in a very watery environment, safe from the bacteria that need oxygen to live. Also, the water in the bog was very acidic. The acid preserved the man's skin in the way that animal skin is preserved for leather coats and shoes.
How did he die? Understandably, archaeologists and other scientists wanted to know more about the person that they called "Lindow Man". His hands and fingernails suggested that he hadn't done heavy manual work in his life--he could have been a rich man. They found that he hadn't died by accident. The archaeologists believe that he was sacrificed to three different gods. [/INST] question: Which of the following helped to preserve "Lindow Man"? | options: A: Ice and low temperature B: Acid and water C: Soil and energy D: Bacteria and oxygen | answer: B </s> |
<s>[INST] context: The White House Correspondents' Dinner is an annual event, and a highlight of the evening is the President's comedy routine. This year, President Obama decided to make a good-natured hit at Michelle's expense. You might remember the "bangs" that the First Lady introduced to the world several months ago! Oh yes he did! Obama bangs joke shows how, with professional helps, presidents are now just as funny as the comedian hosts.
For his second term, President Obama will be making big changes! He _ his White House Correspondents' Dinner speech at the Washington Hilton on Saturday, Apr. 27 by joking, "Second term, baby!" "I recognize that this job can take an attack on you. I understand that second term you need a burst of new energy and try some new things," Obama, 51, said. "My team and I talked about it and we're willing to try anything, so we borrowed one of Michelle's tricks." He then presented a slideshow of funny photoshopped images of himself sporting his wife's famous new bangs, a photo of himself and the first lady side by side, both with bangs. "I think this looked pretty good."
After Obama's speech, Conan O'Brien took the stage and kept the jokes coming. The late night host made a joke about the President's focus on job creation. "Since he was reelected," he said, " the number of popes has doubled and the number of Tonight Show hosts had three times." [/INST] question: President Obama made a good-natured hit at Michelle's expense to _ . | options: A: laugh at Michelle B: show his humor C: remember the "bangs D: make big changes | answer: B </s> |
<s>[INST] context: Aspiration is the passage of foreign material beyond the vocal cords: The larynx has 3 distinct functions - respiration, phonation and airway protection. Dysfunction of larynx can lead to aspiration. The primary goal of treatment of aspiration is to separate the upper digestive tract from the upper respiratory tract for a sho period of time or in some cases, permanently. There are 3 broad categories of treatment. Temporary/Adjunct Treatments Medical Therapy - in the form of antibiotics is impoant to prevent aspiration pneumonia. It is impoant to make the patient NPO, to avoid fuher aspiration and to find an alternate feeding route to maintain the patients nutritional status. A nasogastric tube (feeding gastostomy/jejunostomy) is commonly placed, but this may actually increase the aspiration reflux by making the lower esophageal and upper esophageal sphincters incompetent. Vocal cord medialization (by injecting Gel foam) is useful in unilateral paralysis.This is helpful but is rarely curative, if there is a serious aspiration problem. Tracheostomy will often make aspiration worse by preventing laryngeal elevation on swallowing. It does however, allow easy access to the chest for suctioning. Even a cuffed tube doesn't prevent aspiration as secretions pool above the cuff and the seal is never perfect"- Scotts Brown 7th/ed vol 1 pg. 1278 Definite - Reversible Procedures Endolaryngeal stents: They function like a cork in the bottle. There job is to seal the glottis and therefore thay need to be used in conjunction with a tracheostomy tube. But they are not often used as they are effective only as a sho term solution, plus there is risk of glottic stenosis. Laryngotracheal separation: The procedure involves transecting the cervical trachea and bringing out the lower end as a permanent end stoma But it has disadvantage of sacrificing voice. Alternative procedure is Tracheoesophageal diversion but has higher complication rates. Definite - Irreversible Procedure It includes: Narrow field laryngectomy: it was considered as a gold standard prior to 1970s, when the irreversible procedures like laryngo tracheal separation were not done. Also Know Investigation of choice for diagnosing aspiration = Fibreoptic endoscopic evaluation of swallow (FESS) Videofluoroscopic modified Barium swallow (often called as ideofluoroscopy) [/INST] question: "Gold standard" surgical procedure for prevention of aspiration is: | options: A: Thyroplasty B: Tracheostomy C: Tracheal division and permanent tracheostome D: Feeding gastrostomy/jejunostomy | answer: C </s> |
<s>[INST] context: Lymphocytes positive for CD 19, CD20, CD23, CD5 suggest the diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma.
In CLL/SLL larger lymphocytes show high mitotic activity and form proliferation centre.
Chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL).
CLL and SLL are identical neoplasm/arise due to an abnormal neoplastic proliferation of B cells.
CLL involves primarily bone marrow and blood, while SLL involves lymph nodes
Morphology of CLL/SLL
The tumor cells of CLL are small B lymphocytes.
Leukemic cells have the morphological appearance of normal small to medium sized lymphocytes with clumped chromatin, inconspicuous nuclei and a small ring of cytoplasm.
The lymph node architecture is diffusely effaced by these tumor cells.
These cells are mixed with variable numbers of larger cells called prolymphocytes.
In many cases, prolymphyocytes gather together focally to form as proliferation centers, so called because they contain relatively large number of mitotic activity.
When present proliferation centers are pathognomonic for CLL/SLL.
In CLL, the peripheral blood contains increased numbers of small, round lymphocytes with scant frequently disrupted in the process of making smears, producing So called smudge cells..
Markers of CLL tumor cells
CLL is a tumor of mature -cells, therefore it expresses the B-cell markers such as CD19, CD20 and surface IgM and IgD.
In addition CD23 and CD5 are also present (In contrast to mantle cell lymphoma which is positive for CD5 but negative for CD23). [/INST] question: A 48 year old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 2.7 × 109/L and total leukocyte count 40 × 109/ L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD5, CD20 and CD23 and were negative for CD 79 B and FMC-7.The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by - | options: A: A pseudofollicular pattern with proliferation centers B: A monomorphic lymphoid proliferation with a nodular pattern C: A predominantly follicular pattern D: A diffuse proliferation of medium to large lymphoid cells with high mitotic rate | answer: A </s> |
<s>[INST] context: Arriving in Sydney on his own from India, my husband ,Rashid, stayed in a hotel for a short time while looking for a house for me and our children.
During the first week of his stay, he went out one day to do some shopping. He came back in the late afternoon to discover that his suitcase was gone. He was extremely worried as the suitcase had all his important papers, including his passport.
He reported the case to the police and then sat there,lost and lonely in strange city, thinking of the terrible troubles of getting all the paperwork organized again from a distant country while trying to settle down in a new one.
Late in the evening, the phone rang. It was a stranger. He was trying to pronounce my husband's name and was asking him a lot of questions. Then he said they had found a pile of papers in their trash can that had been left out on the footpath.
My husband rushed to their home to find a kind family holding all his papers and documents. Their young daughter had gone to the trash can and found a pile of unfamiliar papers. Her parents had carefully sorted them out, although they had found mainly foreign addresses on most of the documents. At last they had seen a half-written letter in the pile in which my husband had given his new telephone number to a friend.
That family not only _ the important documents to us that day but also restoredour faith and trust in people.We still remember their kindness and often send a warm wish their way. [/INST] question: What did Rashid plan to do after his arrival in Sydney? | options: A: Go shopping B: Find a house C: Join his family D: Take his family | answer: B </s> |
<s>[INST] context: Six Chinese surveillance ships have entered waters near islands claimed by both China and Japan.
China said the ships were carrying out "law enforcement" to demonstrate its jurisdiction over the islands, known as Diaoyu in China and Senkaku in Japan.
At least two of the vessels left after the Japanese coast guard issued a warning, Japanese officials say.
The move came after Japan sealed a deal to buy three of the islands from their private Japanese owner. Japan controls the uninhabited but resource-rich East China Sea islands, which are also claimed by Taiwan.
The Japanese Coast Guard said the first two Chinese boats entered Japan's territorial waters at 06:18 local time (21:18 GMT Thursday), followed by another fleet of four other ships just after 07:00. The first two ships then left the area. A third ship left later on Friday morning, one report said. No force was used, Japanese officials added. "Our patrol vessels are currently telling them to leave our country's territorial waters," the coastguard said in a statement.
The Chinese foreign ministry confirmed that its ships were there. "These law enforcement and patrol activities are aimed to demonstrate China's jurisdiction over the Diaoyu Islands and its affiliated islets and ensure the country's maritime interests," a statement said.
The US has called for ''cooler heads to prevail'' as tension intensifies between China and Japan over the islands, which lie south of Okinawa and north of Taiwan. US Defense Secretary Leon Panetta is due to visit both Japan and China from this weekend as part of a tour of the region that also includes New Zealand.
The dispute has seriously marred diplomatic relations between China and Japan and threatens to damage the strong trading relationship, says the BBC's John Sudworth in Beijing. The row has also generated strong nationalist sentiment on both sides that observers say now makes it very difficult to be seen to be backing down, says our correspondent.
The Japanese government says it is buying the islands to promote their stable and peaceful management. Its move followed a bid by right-wing Tokyo Governor Shintaro Ishihara to buy the islands using public donations - an action that would likely have further provoked China.
China, on the other hand, says the islands have historically been its territory and fishing grounds.
Meanwhile Japan's newly-appointed ambassador to China, Shinichi Nishimiya, remains in hospital in Tokyo after he was found unconscious near his home in Tokyo on Thursday. No details have been given on his condition. He was appointed on Tuesday to replace Uichiro Niwa, who has been criticised for his handling of one of the worse diplomatic rows between Japan and China in recent years. [/INST] question: The Diaoyu Islands are actually inhabited by _ . | options: A: Japan B: China C: Taiwan D: Nobody | answer: D </s> |
<s>[INST] context: (Iron) (121 -Shaw's 15th)Adequate energy intake and a diversified diet that includes fruit,vegetables, and animal products throughout the life cycle help ensure that women enter pregnancy and lactation without dcficienciesand obtain adequate nutrients during periods of heightened dcmand.Some nutrient requirements, particularly iron, folic acid, and vitaminA, aremore difficult to achieve than others through food sources.For this reason, supplements with these nutrients are recommendedin addition to improved diets. Fortified foods should be promotedthrough counseling and social marketing in countries where foodsfortified with iron, iodine, folic acid, or vitamin A are available andaffordable.IRON* In the absence of Iron supplementation, there is drop in hemoglobin serum iron, and serum ferritin concentration at term pregnancy thus pregnancy is an inevitable iron deficiency state* Daily iron requirement in non menstruating women to compensate the overage daliy loss is 1 mg. Thus in the second help, the daily requirement, actually becomes very much increased to the extent of about 6-7 mg* Total iron requirement during pregnancy is estimated approximately 1000 mg* The fall in the hemoglobin concentration during pregnancy is due to combined effect of hemodilution and negative iron balance* Folic acid supplementation beginning 1 month before conception to about 12 weeks of pregnancy has reduced the incidence of neural tube defects signilicantly A dose of 4 mg daily is recommended* Folic acid deficient most commonly seen in a pregnant mother who is on phenytoin therapy for epilepsy [/INST] question: The requirement of which nutrient cannot be compensated by dietary intake in pregnancy | options: A: Iron B: Protein C: Carbohydrate D: Fats | answer: A </s> |
<s>[INST] context: National Iron Plus Initiative is an attempt to work on Iron deficiency anemia, in which its beneficiaries will receive Iron and Folic acid supplementation irrespective of their iron / hemoglobin status. Thus its Primary level of prevention (Specific protection). Iron and folic acid supplementation is given as a prophylaxis and hence would be an example of primary prevention. In primary prevention, it is specific protection against Anemia. LEVELS OF PREVENTION: Primordial prevention Prevention of emergence of development of risk factors Done by health education. Primary prevention Action taken prior to the onset of disease Done by health promotion & specific protection. Secondary prevention Action which halts the progress of a disease Done by early diagnosis & treatment Teiary prevention Action taken during the progression/ end of disease Done by diability limitation & rehabilitation. - Note: All vaccines comes under primary level of prevention - specific protection. All screening & diagnostic tests comes under secondary level of prevention. [/INST] question: National Iron Plus Initiative is an example of:- | options: A: Primordial prevention B: Primary prevention C: Secondary prevention D: Teiary prevention | answer: B </s> |
<s>[INST] context: Blood Flow Regulation in Skeletal Muscle at Rest and During Exercise Very strenuous exercise is one of the most stressful condi- tions that the normal circulatory system faces. This is true because there is such a large mass of skeletal muscle in the body, all of it requiring large amounts of blood flow. Also, the cardiac output often must increase in the nonathlete to four to five times normal, or in the well-trained ath- lete to six to seven times normal, to satisfy the metabolic needs of the exercising muscles. Rate of Blood Flow Through the Muscles During rest, blood flow through skeletal muscle averages 3 to 4ml/min/100g of muscle. During extreme exercise in the well-conditioned athlete, this can increase 25- to 50-fold, rising to 100 to 200ml/min/100g of muscle. Peak blood flows as high as 400ml/min/100g of muscle have been repoed in thigh muscles of endurance-trained athletes. Blood Flow During Muscle Contractions. Figure 21-1 shows a record of blood flow changes in a calf muscle of a human leg during strong rhythmical muscular exercise. Note that the flow increases and decreases with each muscle contraction. At the end of the contractions, the blood flow remains very high for a few seconds but then returns toward normal during the next few minutes. The cause of the lower flow during the muscle contrac- tion phase of exercise is compression of the blood vessels by the contracted muscle. During strong tetanic contrac- tion, which causes sustained compression of the blood vessels, the blood flow can be almost stopped, but this also causes rapid weakening of the contraction. Increased Blood Flow in Muscle Capillaries During Exercise. During rest, some muscle capillaries have little or no flowing blood. But during strenuous exercise, all the capillaries open. This opening of dormant capillaries diminishes the distance that oxygen and other nutrients must diffuse from the capillaries to the contracting muscle fibers and sometimes contributes a twofold to threefold increased capillary surface area through which oxygen and nutrients can diffuse from the blood to the tissues. Control of Blood Flow in Skeletal Muscles Local Regulation--Decreased Oxygen in Muscle Greatly Enhances Flow. The tremendous increase in muscle blood flow that occurs during skeletal muscle activity is caused mainly by chemicals acting directly on the muscle aerioles to cause dilation. One of the most impoant chemical effects is reduction of oxygen in the muscle tissues. When muscles are active they use oxygen rapidly, thereby decreasing the oxygen concentration in the tissue fluids. This in turn causes local aeriolar vaso- dilation because the aeriolar walls cannot maintain contraction in the absence of oxygen and because oxy- gen deficiency causes release of vasodilator substances. Adenosine may be an impoant vasodilator substance, but experiments have shown that even large amounts of adenosine infused directly into a muscle aery cannot increase blood flow to the same extent as during intense exercise and cannot sustain vasodilation in skeletal muscle for more than about 2 hours. Founately, even after the muscle blood vessels have become insensitive to the vasodilator effects of adeno- sine, still other vasodilator factors continue to maintain increased capillary blood flow as long as the exercise continues. These factors include (1) potassium ions, (2) adenosine triphosphate (ATP), (3) lactic acid, and (4) carbon dioxide. We still do not know quantitatively how great a role each of these plays in increasing muscle blood flow during muscle activity; this subject was dis- cussed in additional detail in Chapter 17. Nervous Control of Muscle Blood Flow. In addition to local tissue vasodilator mechanisms, skeletal muscles are provided with sympathetic vasoconstrictor nerves and (in some species of animals) sympathetic vasodilator nerves as well. Sympathetic Vasoconstrictor Nerves. The sympa- thetic vasoconstrictor nerve fibers secrete norepineph- rine at their nerve endings. When maximally activated, this can decrease blood flow through resting muscles to as little as one-half to one-third normal. This vasocon- striction is of physiologic impoance in circulatory shock and during other periods of stress when it is necessary to maintain a normal or even high aerial pressure. In addition to the norepinephrine secreted at the sym- pathetic vasoconstrictor nerve endings, the medullae of the two adrenal glands also secrete large amounts of nor- epinephrine plus even more epinephrine into the circu- lating blood during strenuous exercise. The circulating norepinephrine acts on the muscle vessels to cause a vaso- constrictor effect similar to that caused by direct sympa- thetic nerve stimulation. The epinephrine, however, often has a slight vasodilator effect because epinephrine excites more of the beta-adrenergic receptors of the vessels, which are vasodilator receptors, in contrast to the alpha vasocon- strictor receptors excited especially by norepinephrine At rest, skeletal muscle blood flows may be 1-4 ml/min per 100g; maximal blood flows may reach 50-100 ml/min per 100g depending upon the muscle type. Therefore, blood flow can increase 20 to 50-fold with maximal vasodilation or <a style="color: ; font-family: arial, helvetica, verdana, sans-serif;" href=" hyperemia</a> Totally800ml [/INST] question: Blood flow to skeletal muscles (ml/min) | options: A: 100 B: 200 C: 400 D: 800 | answer: D </s> |
<s>[INST] context: Multiple myeloma would best explain this patient's presentation. The onset of myeloma is often insidious. Pain caused by bone involvement, anemia, renal insufficiency, and bacterial pneumonia often follow. This patient presented with fatigue and bone pain, then developed bacterial pneumonia probably secondary to Streptococcus pneumoniae, an encapsulated organism for which antibody to the polysaccharide capsule is not adequately produced by the myeloma patient. There is also evidence for renal insufficiency. Hypercalcemia is frequently seen in patients with multiple myeloma and may be life-threatening. Definitive diagnosis of multiple myeloma is made by demonstrating greater than 30% plasma cells in the bone marrow. Seventy-five percent of patients with myeloma will have a monoclonal M spike on serum protein electrophoresis, but 25% will produce primarily Bence-Jones proteins, which, because of their small size, do not accumulate in the serum but are excreted in the urine. Urine protein electrophoresis will identify these patients. Approximately 1% of patients with myeloma will present with a non-secretory myeloma. Patients with non-secretory myeloma have no M-protein on serum/urine electrophoresis and immunofixation; the diagnosis can be made only with bone marrow biopsy. The bone scan in myeloma is usually negative. The radionuclide is taken up by osteoblasts, and myeloma is usually a purely osteolytic process. Renal biopsy might show monoclonal protein deposition in the kidney or intratubular casts but would not be the first diagnostic procedure. Rouleaux formation in peripheral smear is a characteristic finding of myeloma, although it is neither sensitive nor specific.Waldenstrom macroglobulinemia may cause hyper-viscosity syndrome with CNS manifestations including headache, blurring of vision, dizziness, nystagmus, ataxic gait, drowsiness, or even coma. Peripheral neuropathy, coagulopathy, lymphadenopathy, hepatosplenomegaly, and nonspecific constitutional symptoms are often present. An unusual gap between serum total protein and albumin indicates hyperglobulinemia, and a monoclonal IgM spike on serum protein electrophoresis helps establish an initial diagnosis. Bone marrow biopsy revealing more than 10% of lymphoid and plasmacytoid cells confirms the diagnosis. Unlike multiple myeloma, bony lesions are uncommon in Waldenstrom macroglobulinemia, whereas lymphadenopathy and organomegaly are uncommon in myeloma.Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant plasma cell disorder which is often suspected and detected incidentally from routine blood workup. The patients are asymptomatic with no end-organ damage such as renal failure, hypercalcemia, anemia, or lytic bone lesion. The serum electrophoresis reveals an M spike but the amount of M-protein on immunofixation is usually less than 3 gm/dL and bone marrow contains less than 10% of monoclonal plasma cells. Monitoring of patients is important since MGUS can progress to multiple myeloma over a period of time. It is recommended to get the first evaluation 6 months after initial diagnosis followed by annual or biannual checkup. [/INST] question: A 71-year-old man is evaluated in the ER for a recent finding of high ESR in a routine blood test. He has history of hypertension, well controlled with metoprolol. His physical examination is completely normal. His laboratory workup reveals hemoglobin 12.6 gm/dL, leukocyte count 8500/mL, and platelet 265,000/mL. Total protein 6.2 g/dL, albumin 3.4 g/dL, BUN 16 mg/dL, creatinine 0.75 mg/dL, and calcium 9.2 mg/dL. Serum protein electrophoresis reveals a sharp, narrow spike, serum immunofixation reveals M-protein 1.2 gm/dL, bone marrow examination reveals less than 10% of monoclonal plasma cells. A skeletal survey is negative for any lytic lesions. | options: A: Multiple myeloma B: Smoldering multiple myeloma C: Monoclonal gammopathy of undetermined significance D: Waldenstrom macroglobulinemia | answer: C </s> |
<s>[INST] context: Lillan Hanson, a college junior, expects to graduate in about two years. Mrs Hanson, a rather unusual student, plans to go on to take more courses after she gets her degree. What makes Mrs Hanson different from most of her classmates?
What sets Lillian Hanson apart from the college crowd is her age-73 years. She has been going to college, a few courses at a time, for 27 years.
When Mrs Hanson graduated from high school, she went to her local bank and asked for a loan for college tuition and fees. The banker gave her no encouragement. He didn't think that country girl should be borrowing money to go to college. He thought she should be home doing work in the house or around the farm. So Mrs Hanson went home and raised a family of nine children instead of going to college. She still lives with her husband on the farm that has been in the family for five generations.
Mrs Hanson never forgot her dream of getting a higher education. When her children were grown, she tried again.
She finds the hardest part of going back to school at her age is to be sitting in class for long periods of time, because she is not as agile as she used to be. Mrs Hanson often gets up and walks around between classes to keep her joints from getting stiff. At the beginning of a course in using the computer, the other students all gave Mrs Hanson a warm round of applause when she introduced herself and explained why she was there and what her goals were. [/INST] question: Mrs Hanson has gone through college_. | options: A: rapidly and well B: slowly but surely C: without any help at all D: as a form of entertainment | answer: B </s> |
<s>[INST] context: General 1.Bedrest 2.Local heat 3.Analgesics 4.Exercise: Regular walking or other weight bearing exercise for 1 hour 3 times a week protects bone mass 5.Prevention of injury (most hip and wrist fractures are caused by falls). 6.Excessive thyroid hormone replacement therapy should be avoided. B.Antiresorptive agents 1.Oestrogen: Oestrogen 0.625 mg + Medroxyprogesterone (cyclic progestin) 5-10 mg per day 10-14 days/month. Progesterone to be added to prevent endometrial carcinoma. Transdermal oestrogen patches are used to avoid deep vein thrombosis and pulmonary embolism. Oestrogen therapy is impoant in women with premature or surgical menopause. Contraindications of oestrogen therapy are carcinoma breast or endometrial cancer, recurrent thromboembolic disease, acute liver disease and unexplained vaginal bleeding. 2.Calcium: The recommended daily calcium intake for postmenopausal women is 1,500 mg, and 1,000 mg for premenopausal women. 3.Calcitonin: Salmon calcitonin for 1-2 years increases veebral bone density and decreases the risk of veebral fracture. The usual dose is 50 IU SC per day 3 times a week. (salmon calcitonin 200 units/day as nasal spray). The side effects are nausea, flushing, and rarely allergic reactions.4.Bisphosphonates: They specifically impair osteoclast function and reduce osteoclast number paly by induction of apoptosis. a.Alendronate 5-10 mg/day b.Risedronate 5 mg/day The prominent adverse effect is esophageal irritation and hence both should be taken with a full glass of water and the patient should remain upright for 30 min after taking the drug. c.Etidronate is given as an intermittent cyclical regimen, 400 mg orally for 2 weeks, has some efficacy against veebral fractures. 5.Selective oestrogen receptor modulators (SERMS) a.Raloxifene 60 mg/day b.Tamoxifen Both reduce bone turnover and bone loss in postmenopausal women. In addition Tamoxifen is beneficial in women at increased risk of breast cancer and Raloxifene reduces serum total and LDL cholesterol, Lp (a), and fibrinogen. C.Bone forming agents a.Fluoride--75 mg/day b.Anabolic steroids: Testosterone is used in the treatment of osteoporotic man with gonadal deficiency. D.Supplementation of Vitamin D metabolites and thiazide diuretics. R ALAGAPPAN MANUAL OF PRACTICAL MEDICINE FOUH EDITION PAGE NO-691,692 [/INST] question: Treatment of osteoporosis includes - | options: A: Conjugated equines estrogen B: Estradiol valerate C: Raloxifene D: Biphosphonate | answer: A </s> |
<s>[INST] context: Every year 2.2 million tons of oil are spilled ( , ) into the ocean. Actually, this only amounts to a small percentage of the total 1.6 billion tons of oil shipped around the world each year.However, this spilled oil has terrible effects on ocean life, including the coastlines where the off washes up onto shore. Some of the largest spills in history were caused by oil tankers running into each other or by an oil tanker sailing into shallow water and hitting the bottom of the ocean. After these spills, officials try to discover who or what was at fault to help prevent similar accidents in the future.
One of the worst oil spills in history occurred along the Alaskan coastline in 1989. In this accident, 42,000 tons of oil spilled from a tanker which resulted in terrible damage to this sensitive natural area. In this spill, the tanker's captain, who was tired from overwork and drinking alcohol, had gone to take a rest. He gave control of the ship to the third mate. The third mate was unfamiliar with the path the ship took, and he ran the ship onto Blighe Reef. Blighe Reef is a natural underwater rock wall near the Alaskan coast. Damaged by the reef, the ship leaked oil out into the ocean. More than 1,600 kilometers of coastline were affected by the oil spill. Some scientists who studied nature in the area guessed that 580,000 birds and 5,500 otters died when the oil from the spill covered their skin. As well, smaller shellfish and other sea creatures were later eaten by seals, whales, and other animals.
The most oil ever spilled was actually dumped on purpose as an act of ecological warfare. The term ecological warfare means to fight by doing harm to nature in the area under attack. In 1990, Iraq sent soldiers into Kuwait and set off the Persian Gulf War. As part of the Iraq war plan,900,000 tons of oil were let out into the Persian Gulf Way Iraq. This oil covered 1,500 square kilometers of water in the Persian Gulf. The oil also damaged 650 kilometers of the coastline of both Kuwait and Saudi Arabia. In some places, oil floating on the water was measured to be 43 centimeters thick. Water birds, water plants, and baby fish were all seriously affected by the oil. The long-term effects of this act on the food chain in the area are bound to cause problems tar into the future. [/INST] question: The creatures affected by the oil spill near Alaska were _ . | options: A: birds and otters B: shellfish C: seals and whales D: all of the above | answer: D </s> |
<s>[INST] context: Many college students have given up taking class notes by hand. Instead, they type on computers. But scientists say that method is less helpful.
If you need to remember something, write it. Writing notes by hand is much better for long-term memory of idea. So, turn off your computer if you want to remember something.
Students who type notes on a keyboard often write down what the teacher says word-for-word. They may write without really thinking about what they are writing. These electronic notes contained more words. But scientists say it leads to " _ ." Transcription means to write down something exactly as you hear it.
However, students taking notes by writing them, need to first process the information they hear. Then they record just the main parts. They use fewer words. This is because people usually write slower than they type. This kind of process leads to a deeper understanding.
The scientists did a research. In the research, students listened to a teacher and then took a test. Some took notes by typing on a computer. The others took notes by writing them down.
Both groups performed about the same in remembering facts. But students who typed their notes did much worse on conceptual questions. These questions required them to understand an idea.
Also, scientists found that those who wrote their notes remembered conceptual information better a week later. Scientists believe that the students who took notes by writing them had a deeper understanding of ideas.
Scientists know that students probably will still use their computers in class. But they suggest to take notes by hand on screens. They say this might be a good way between different schools. [/INST] question: _ to take class notes is more helpful for a long-term memory of idea. | options: A: Using a computer B: Writing by hand C: Typing on a keyboard D: Recording with a computer | answer: B </s> |
<s>[INST] context: Warfarin is metabolized by a specific subset of induced P450 isozymes. The P450 system is used by cells to modify the xenobiotic (in this case the warfarin) such that it can be more easily excreted. Erythromycin, along with other macrolide antibiotics, inhibits the P450 oxidizing system, which in this case would lead to a higher blood level of warfarin and, therefore, the balance of clotting and bleeding is shifted toward excessive bleeding. A stimulation of P450 production by erythromycin would lead to a lower level of warfarin (because of increased metabolism and loss of warfarin by P450) and the potential for excessive clotting. This effect of P450 is a common drug-drug interaction. The causative agents of community- acquired pneumonia do not affect vitamin K absorption in the small intestine, or distribution throughout the body. Erythromycin does not affect mitochondrial transcription, although it may affect mitochondrial translation. Inhibition of mitochondrial protein synthesis, however, will not alter the inhibition of cytochrome P450 activity, and the increased levels of warfarin present, which may lead to increased bleeding. [/INST] question: A 40-year-old male is well controlled on warfarin for a factor V Leiden deficiency and recurrent deep vein thrombosis. He presents today with a community-acquired pneumonia and is placed on erythromycin. Three days later, he develops bleeding and his INR is 8.0 (indicating an increased time for blood clotting to occur, where INR is international normalized ratio). Which of the following best explains why this bleeding occurred? | options: A: The erythromycin inhibited cytochrome P450 B: The erythromycin stimulated cytochrome P450 C: The causative agent of the pneumonia inhibited vitamin K utilization D: The causative agent of the pneumonia stimulated vitamin K utilization | answer: A </s> |
<s>[INST] context: The combination of nongonococcal urethritis, arthritis, and conjunctivitis suggests reactive arthritis, one of the spondyloarthropathies; the changes in the spine can resemble ankylosing spondylitis and can be equally debilitating. ANCA is indicative of various forms of vasculitis, such as granulomatous vasculitis and microscopic polyangiitis. The ANA test result is positive in many autoimmune diseases, such as systemic lupus erythematosus (SLE), but it is not a feature of spondyloarthropathies. Lyme disease can include large joint arthritis, but not urethritis or conjunctivitis. Rapid plasma reagin (RPR) is a screening test for syphilis, which can include arthritis of large joints (Charcot joint) in the tertiary form, but it takes decades to develop. Rheumatoid factor is a feature of rheumatoid arthritis, which initially manifests more commonly in small joints of the hands and feet. U1-RNP is a marker for mixed connective tissue disease, which has features of rheumatoid arthritis, scleroderma, polymyositis, and SLE; arthralgias are not accompanied by joint destruction or deformity. [/INST] question: A 29-year-old man notes burning pain on urination with a urethral discharge that has persisted for 3 days. A sample of the exudate is positive by ELISA for Chlamydia trachomatis. The man has increasing stiffness of the knees and ankles and lower back pain 3 weeks later. A radiograph of the lumbar spine shows narrowing with sclerosis of the sacroiliac joints. One month later, he develops painful erythema of the glans penis, and the conjunctivae are red. A follow-up examination shows a slightly irregular heart rate and a murmur suggestive of aortic regurgitation. The back pain continues off and on for 5 more months. Which of the following test results is most likely to be positive in this man? | options: A: ANCA B: ANA C: HLA-B27 genotype D: Anti-Borrelia antibodies | answer: C </s> |
<s>[INST] context: The first Beijing Fair of National Culture and Art kicked off August 3 and ran till August 12. The fair features more than 21 old Beijing business brands, more than 80 examples of intangible cultural heritage and 6 official Olympics merchandise. One of the highlights is a show featuring 15 lanterns.
The fair aims at starting cultivating the cultural atmosphere for the Beijing Olympic Games, by highlighting the long history and culture of the city. The fair is divided into 12 districts and is open from 430--930 pm. There are both exhibitions and performances and interactive items tourists can enjoy. Sports competitions and craftmaking are available to teenagers, who can learn from old masters.
Some of the most notable art elements include three luxury items worn by nobles in ancient China:a wooden craft called"pillow of Lu Ban", after a legendary civil engineer and carpenter who lived from 507--444 B.C., and whose designs are still used, and glass grapes. Some items are for sale and shoppers can hear about the history of the items from craftspeople.
The lantern show includes 15 pieces installed along the park's main roads, providing both light and decor. There will be lantern shows accompanied by music and some lanterns feature designs including flowers, the moon and animal paintings.
The fair also provides opportunities to teenagers to take part in interactive activities. For example, children can learn how to make dough figures from artist Wang Xingshan. They can also learn the art of papercutting, get some practice of braiding Chinese knots, and learn how to make sugar figures. [/INST] question: The first Beijing Fair of National Culture and Art lasted _ days. | options: A: 9 B: 21 C: 8 D: 15 | answer: A </s> |
<s>[INST] context: In supraclavicular approach of brachial block as pleura is in close vicinity. The anterior rami of C5 to T1 form the brachial plexus, which exits the cervical spine to form the superior, middle, and inferior trunks that travel between the anterior and middle scalene muscles. Each trunk divides into an anterior and posterior branch, which subsequently rejoins to form the lateral, posterior, and medial cords as it travels distally to the clavicle. The supraclavicular approach blocks the brachial plexus from the distal trunks to the proximal cords but often is targeted at the divisions level. General complications to peripheral nerve blockade apply to supraclavicular blocks including risk for infection, bleeding, and neuropathy. With the advent of ultrasonography, constant visualization of the needle tip, first rib, and pleura can decrease the risk for pneumothorax. Common, self-limited, side effects associated with other proximal brachial plexus blockade include hoarseness due to an ipsilateral laryngeal nerve block, Horner syndrome from stellate ganglion block, and hemidiaphragmatic paresis from a phrenic nerve blockade. [/INST] question: Pneumothorax is seen most commonly with which approach of brachial block:- | options: A: Interscalene B: Supraclavicular C: Infraclavicular D: Axillary | answer: B </s> |
<s>[INST] context: If you see a person carelessly throw a cigarette to the ground, what are you likely to think?
If you hate people throwing things on the ground, you might think, "That person shouldn't litter." If you are a smoker, you might think, "I would sure like a cigarette right now."
Most likely, though, you are not thinking, "That unused cigarette butt could be used to make something amazing!"
That is, unless you are a creative scientist. If you are, you may see potential--a possibility--where others simply see trash . That is just what has happened in South Korea.
The spirit of invention can hit at the strangest times and in the most unusual places. In South Korea, it happened near a trash can.
Kin Gil-Pyo is with the Seoul National University. He says he saw people throwing away cigarette butts, which got him thinking. He began wondering if something useful could be made from them.
He and other researchers found a way to convert cigarette butts into materials required for high-performance batteries.
Kim Gil-Pyo says they looked closely at used cigarette filters , the parts of cigarettes smokers put into their mouths. Filters are made of a material called "cellulose acetate ."
Mr. Kim explains that cellulose acetate can be made into another material: carbon. The pieces of cellulose acetate, known as fibers, are changed through a one-step burning process. After this, they are turned into an energy storage material.
But why use carbon? Carbon has many qualities that seem to make it the perfect material. Carbon has a high surface area. It conducts electricity well. It also stays stable, unlikely to change, for a long time. And carbon does not cost a lot. All these qualities make it the most popular material for making super-capacitors .
Super-capacitors are good at storing energy. They have high-power mass, or density . They require only a short time for recharging. And they have a long lifecycle. Super-capacitors are used in products such as laptop computers and cell phones. They are also used in industrial energy converters, like wind turbine machines.
Combining carbon and super-capacitors seems like a perfect marriage.
Kim Gil-Pyo tells the Reuters News Agency that cigarette butts could affect the economy is a huge way. They could prove to be a low-cost source of carbon material. They are so cheap that smokers throw them to the ground. And you don't get much cheaper than that. [/INST] question: What may people think seeing a person throw a cigarette to the ground? | options: A: That all depends B: He should be blamed C: It causes them to smoke D: The butts can be reused | answer: A </s> |
<s>[INST] context: Determination of CVP can be helpful in the overall hemodynamic assessment of the patient. This pressure can be affected by a variety of factors, including those of cardiac, noncardiac, and aifactual origin. Venous tone, right ventricular compliance, intrathoracic pressure, and blood volume all influence CVP. Vasoconstrictor drugs, positive-pressure ventilation (with and without PEEP), mediastinal compression, and hypervolemia all increase CVP. Acute pulmonary embolism, when clinically significant, elevates CVP by causing right ventricular overload and increased right atrial pressure. Sepsis, on the other hand, decreases CVP through both the release of vasodilatory mediators and the loss of intravascular plasma volume due to increased capillary permeability. Trends in CVP measurement are more reliable than isolated readings. CVP, along with other hemodynamic parameters, can also be useful in differentiating septic shock from other etiologies of shock; shock is inadequate tissue perfusion. Septic shock has two phases: (1) a hypodynamic phase that is characterized by hypovolemia and myocardial depression and (2) a hyperdynamic phase that follows fluid resuscitation and is characterized by a normal to increased cardiac output [/INST] question: A 42-year-old man has had a rocky course for the 3 days following a bowel resection for intestinal perforation due to inflammatory bowel disease. His CVP had been 12 to 14 but is now 6, in the face of diminished blood pressure and oliguria. Which of the following is the most likely etiology of his hypotension? | options: A: Pulmonary embolism B: Hypervolemia C: Positive-pressure ventilation D: Gram-negative sepsis | answer: D </s> |
<s>[INST] context: Clinical features of chronic lead poisoning/ plumbism/saturism:
Facial pallor especially around mouth is the earliest and most consistent sign
Polycythemia with polychromatophilia followed by anemia with punctate basophilia (basophilic stippling), reticulocytosis, poikilocytosis, nucleated RBC(sideroblasts), increased neutrophils & decreased platelets are seen in early stages.
Stippled blue line known as Burtonian or lead line is seen on gums, only near carious teeth in upper jaw as an early sign.
It is bluish black epithelial deposition of lead sulphide granules on gums. Similar blue line may also be seen in mercury; copper, silver, bismuth & iron poisoning.
Colic & constipation is a late manifestation
Paralysis, encephalopathy, cardiovascular, renal & reproductive system manifestations are late manifestations,
Tremors, numbness, hyperesthesia & cramps preceding actual muscle paralysis more commonly involve muscle groups prone to fatigue .
Paralysis is associated with muscle atrophy Sc nerve degeneration due to interference with resynthesis of phosphocreatinine.
Encephalopathy is present in every case but is more common in children Sc in poisoning by tetra ethyl lead salt.
Menstrual derangements (amenorrhoea, dysmenorrhoea, menorrhagia), abortion (between 3-6 months), dead fetus & sterility in both sexes.
Vascular constriction due to lead results in hypertension & interstitial nephritis. [/INST] question: Burtonian lines on gums is seen in poisoning with | options: A: Lead B: Mercury C: Arsenic D: Zinc | answer: A </s> |
<s>[INST] context: For as long as humans have lived on the earth, they have made use of various forms of communication. Generally, this expression of thoughts and feelings has been in the form of oral speech. When there is a spoken language problem, communication can be carried out through sign language, in which gestures stand for letters, words, and ideas. Tourists and people unable to hear or speak have often had to turn to this form of expression. When gestures describe words or ideas, they can often be used internationally. When used for spelling words however, where each gesture stands for a single letter, people must share the same written language.
Body language sends ideas or thoughts by certain actions, either meaningfully or not. A wink can be a way of showing that the person is only joking. A nod means agreement, while shaking the head indicates disagreement.
Other forms of language can be found in Braille (a reading system of raised dots read with the fingertips used by the blind), signal flags, Morse code, and smoke signals. Road maps and picture signs also guide and warn people. While language is the most common form of communication, other systems and techniques also express human thoughts and feelings. [/INST] question: Which of the following ways can not be used as a form of communication? | options: A: oral speech B: sign language C: body language D: thought | answer: D </s> |
<s>[INST] context: R ifampin (Rifampicin, R) It is a semisynthetic derivative of rifamycin B obtained from Streptomyces mediterranei. Rifampin is bactericidal to M. tu berculosis and many other gram-positive and gram-negative bacteria like Staph. aureus, N. meningitidis, H. influenzae, E . coli, Klebsiella, Pseudomonas, Proteus and Legionella. Against TB bacilli, it is as efficacious as INH and better than all other drugs. The bactericidal action covers all subpopulations of TB bacilli, but acts best on slowly or intermittently (spuers) dividing ones, as well as on many atypical mycobacteri a . Both extra- and intracellular organisms are affected. It has good sterilizing and resistance preventing actions. Other uses of rifampin (i) Leprosy (ii) Prophylaxis of Meningococcal and H. influenzae meningitis and carrier state. (iii) Second/third choice drug for MRSA, diphtheroids and Legionella infections. (iv) Combination of doxycycline and rifampin is the first line therapy of brucellosis ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:741,742 [/INST] question: Drug of choice for prophylaxis of meningococcal meningitis is: | options: A: Penicillin B: Erythromycin C: Septran D: Rifampicin | answer: D </s> |
<s>[INST] context: The autosomal recessive disease is a-1-antitrypsin deficiency, in which an abnormal form of a-1-antitrypsin can be produced by, but not released from, liver cells. This enzyme was named when it was found in vivo to function as a good inhibitor of the pancreatic protease trypsin. However, it actually inactivates a wide variety of enzymes with protease activity that have an essential serine residue in the catalytic centers. Examples of these serine proteases include all of the question choices, and additionally, cathepsin G and plasminogen. Surprisingly, a-1-antitrypsin disease specifically targets only the liver and the lungs. The liver disease, which can be mild to life-threatening (either due to cirrhosis or, rarely, massive acute hepatic failure), is related to retained a-1-antitrypsin with residual enzymatic activity. The lung disease seems to be the specific result of an inability to turn off elastase produced by neutrophils during lung infections. Neutrophil elastase is one of the few enzymes that can successfully destroy the heavily cross-linked, insoluble, elastin that is presented in the lung interstitium and contributes to its elasticity. With destruction of this lattice-like elastic tissue suppo structure, emphysema can develop in the lungs. Chymotrypsin is a pancreatic enzyme formed in the intestinal lumen that cleaves aromatic aminoacyl bonds. Plasmin is an enzyme in the blood-clotting cascade. Thrombin is an enzyme in the blood-clotting cascade. [/INST] question: A family suffering a hereditary form of severe emphysema, with some family members also showing hepatic disease. Liver biopsy in one of the family members demonstrates increased reactivity with antibodies directed against a-1-antitrypsin. Serum levels of the enzyme are low, leading to increased activity of a number of serine proteases. Increased activity of which of the following serine proteases has been most closely tied to the emphysema that develops in these patients? | options: A: Chymotrypsin B: Elastase C: Plasmin D: Thrombin | answer: B </s> |
<s>[INST] context: Many of us don't pay much attention to the importance of eye care. It is said that if you take care of your body, then you can surely be healthy. That is why our eyes should be given a lot of care. Natural eye care should be put in a number one place.
There are several causes leading to poor eyesight like not enough food, genes and aging . Televisions, computers and reading are also the causes of having poor eyesight. If you happen to work in front of the computer, it is best to take a break every once in a while. Something dirty can cause redness and they will make you feel uncomfortable. It is bad for your eyes, too. If this happens, the best way is to clean your eyes by using cold water. You must also try your best to protect your eyes from harmful things. For example, sunglasses are not just for fashion but they can also serve as a great way to protect your eyesight form UV rays.
Eating healthy foods will do good to your eyesight. Remember that vitamins A, C and E are good for eyes. Try to eat food groups that have these vitamins. And you should do eye exercises because exercise protects your eyesight, too. If a person exercises regularly and eats the right kind of food, his eyes will stay in good condition for a long time.
All above are natural ways of eye care that help us keep healthy eyes. Being happy all the time can be helpful to a person's eyesight, too. In a word, eye care is very important, no matter how old a person is. [/INST] question: _ is the most important way to protect our eyes. | options: A: Seeing the doctor B: Taking medicine C: Natural eye care D: Being happy all the time | answer: C </s> |
<s>[INST] context: We grow up, even if we don't want to. But hey, you're not the only one. Read this article. It can help you look at life the way you did as a kid.
Read a lot of Chicken Soup for the Soul----they have so many good stories about kids and getting the right feeling. Also try reading children's books, it helps you keep _
When you feel sad, smile. If you can, jump up and down, or move around until you feel sick. Act like a kid! But whatever you do, SMILE! This can help cheer you up if you feel unhappy.
Spend time with little kids. Although you won't be one again, spending time with them can make you smile more. If you have children of your own, great! Spend lots of time with them.
Think back on a time when you were a kid. Then, try to remember how old your parents were. If you're not as old as they were when you were 8, you will get the feeling that you are 8 again.
If you are a kid, take a piece of paper and write " In 15 years I am going to do." Then, put the letter in an envelope and read it once every five years. This will make you feel like a kid again. [/INST] question: Chicken Soup for the Soul is a _ | options: A: storybook B: math book C: science book D: newspaper | answer: A </s> |
<s>[INST] context: (Stop chest compressions and continue ventilation) (99-0.P. Ghai 7th)Indications of chest compressions are absence of signs of circulation after delivering rescue breaths (no spontaneous breathing, coughing, movment or pulse)Child is pale or cyanosedHeart rate / pulse rate < 60 beats per minute with signs of poor perfusion after rescue breathsChest compressions provide circulation as a result of increase in intrathoracic pressure and / or directed compression of the heart and should be provided with ventilation in infants and children at a rate at least 100 compressions per minute in infants and 80 per minute in childrenBag and Mask ventilation - for full term neonates, infants and children <8 years of age, ventilation bags of minimum volume 450-500 ml should be used to deliver adequate amount of tidal volume. Neonatal size bags (250ml) may be useful for preterm neonatesSellick Maneuver (Compression of the cricoid cartilage backward, compressing the esophagus against the vertebral column) should be used to prevent aspiration of gastric contents* If ventilation and chest compression do not restore the circulation and spontaneous respiration, medications may be needed. If there is ECG evidence of potentially perfusing rhythm. But no pulse is palpated, one should consider the causes of pulseless electrical activity (electrical mechanical dissociation) these include hypothermia, hypoxia, hypovolemia, hyperkalemia, tension pneumothorax, pericardial tamponade, toxins and pulmonary thromboembolism, Acidosis, Hypoglycemia, TraumaIf there is bradycardia, asystole, venticualar tachycardia, or ventricular fibrillation, the patient requires drug therapy and when indicated defibrillation (400-Nelson 18th)Tracheal Intubation for ventilation - 4 major1. Suspected diaphragmatic hernia2. Tracheal suctioning for meconium aspiration3. Bag and mask is ineffective4. Prolong IPPV is requiredAdministration of epinephrine is not recommended unless the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressionHeimlich manoeuvre - used for management of airway obstruction due to foreign body* Manual thrust with the patients standing , rescuer behind the patiet and compressing the abdomen 6 to 10 timesAssisted ventilation (112-Suraj Gupta)Indication - Assisted ventilation should be initiated after stimulation if the infant remains apneic, is gasping or the heart rate remains <100 bpm**The assisted ventilation rate should be 40 to 60 inflations per minute - Lower rates allow longer inflation times and better coordinaton with chest compressions higher rate permit higher minute ventilation. [/INST] question: A neonate on bag and mask ventilation in cardio pulmonary resuscitation. The heart rate is 60-100 perminute. Next treatment is | options: A: Continue ventilation and start adranaline B: Continue ventilation and start chest compressions C: Continue chest compressions and ventilation D: Stop chest compressions and continue ventilation | answer: D </s> |
<s>[INST] context: Remembering names is an important social skill. Here are some ways to master it.
Recite and repeat in conversation.
When you hear a person's name, repeat it. Immediately say it to yourself several times without moving your lips. You could also repeat the name in a way that does not sound forced or artificial.
Ask the other person to recite and repeat.
You can let other people help you remember their names. After you've been introduced to someone, ask that person to spell the name mad pronounce it correctly for you. Most people will be pleased by the effort you're making to learn their names.
Admit you don't know.
Admitting that you can't remember someone's name can actually make people relaxed. Most of them will feel sympathy if you say. "I'm working to remember names better. Yours is right on the tip of my tongue. What is it again?"
Use connections.
Link each person yon meet with one thing you find interesting or unusual. For example, you could make a mental note: "Vicki Cheng -- tall, black hair." To reinforce your associations, write them on a small card as soon as possible.
Limit the number of new names you learn at one time.
When meeting a group of people, concentrate on remembering just two or three names. Free yourself from remembering every one. Few of the people in mass introductions expect you to remember their names. Another way is to limit yourself to learning just first names. Last names can come later.
Go early.
Consider going early to conferences, parties and classes. Sometimes just a few people show up on time. There're fewer names for you to remember. And as more people arrive, you can hear them being introduced to others --- an automatic review for you. [/INST] question: How will most people feel when you try hard to remember their names? | options: A: They will be moved B: They will be upset C: They will be delighted D: They will be discouraged | answer: C </s> |
<s>[INST] context: Levonorgestrel Levonorgestrel alone, 0.75 mg stat F/B another 0.75 mg 12 hrs later, taken within 72 hrs of unprotected intercourse is the method of choice .for emergency contraception Emergency contraception is also k/a postcoital morning after contraception. Basically the methods used interfere with the physiological events before implantation, for e.g. inhibition or delaying of ovulation or interference with postovulatory events necessary for implantation & longevity of the blastocyst. Agents used for emergency contraception are known as 'interceptives'. Methods of emergency contraception Drugs Dosage Time frame Preg. rate * High dose estrogens (not used now) - Ethinyl estradiol (EE) 2.5 mg BD x 5 days Within 72 hrs of coitus L-0.15% - Conjugated equine estrogen (CEE) 15 mg BD x 5 days 0-0.6% * Estrogen & progestin combination pill ,, - Yuzpe method EE 50 rg + d, l-NG 0.5 mg (Ovral) 2 tabs stat & 2 tabs after 12 hrs ,, ,, 0-2% (Total dose EE 0.2 mg & LNG 2 mg) - Low dose pills ,, II 0-2% EE 30 lig + LNG 0.15mg (Ovral L, Mala-N etc.) 4 tabs stat & 4 tabs after 12 hors * Levonorgestrel (LNG) alone (Ecee 2, i- 0.75 mg stat F/B Preferably 0-1% pill, E-pill, unwanted-72, Plan-B) 0.75 mg after 12 hrs or 1.5 mg stat within 72 hrs but can be given upto 5 days * Centchroman 30mg 2 tab BD x 1 day Within 5 days not known (Saheli) * Danazol 400/800 mg BD x Within 72 hrs 0.8 - 1.7% 3 days or 1200 mg BD x 2 days * Mifepristone (RU 486) 600 mg/200 mg / Within 5 days to - 1.3% 10 mg single dose 27th day of cycle * Copper IUD (more effective than steroids) To be inseed within 7 days < 1% [/INST] question: Progesterone of choice in emergency contraception is | options: A: Norethisterone B: Medroxy progesterone C: Desogestrel D: Levonorgestrel | answer: D </s> |
<s>[INST] context: The clinical findings of congenital hypothyroidism are subtle, and may not be present at all at birth; this is thought to be a result of passage of some maternal T4 transplacentally. Infants with examination findings will usually have an umbilical hernia and a distended abdomen. The head may be large, and the fontanelles will be large as well. The child may be hypothermic and have feeding difficulties; constipation and jaundice may be persistent. Skin may be cold and mottled, and edema may be found in the genitals and extremities. The heart rate may be slow, and anemia may develop. As these findings may be subtle or nonexistent, neonatal screening programs are extremely important for early diagnosis of these infants.Sepsis can cause hypothermia and poor feeding, but the 2-week course makes this choice unlikely. Hirschsprung disease may cause chronic constipation and abdominal distension, but not the other findings. Botulism can cause a flaccid paralysis and poor feeding, but the large fontanelles and umbilical hernia are not caused by this infection. [/INST] question: The mother of a 2-week-old infant reports that since birth, her infant sleeps most of the day; she has to awaken her every 4 hours to feed, and she will take only an ounce of formula at a time. She also is concerned that the infant has persistently hard, pellet-like stools. On your examination you find an infant with normal weight and length, but with an enlarged head. The heart rate is 75 beats per minute and the temperature is 35degC (95degF). The child is still jaundiced. You note large anterior and posterior fontanelles, a distended abdomen, and an umbilical hernia. This clinical presentation is likely a result of which of the following? | options: A: Congenital hypothyroidism B: Congenital megacolon (Hirschsprung disease) C: Sepsis D: Infantile botulism | answer: A </s> |
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