Datasets:

ardneebwar

/

medmcqa-and-race

like 0

<s>[INST] context: Some important definitions in Neonatology Low birth weight: Birth weight of less than 2.5 kg irrespective of gestational age Very low birth weight: Birth weight of less than 1.5 kg irrespective of gestational age. Extremely low birth weight: Birth weight of less than 1.0 kg irrespective of gestational age Neonatal: First 28 days of postnatal life. Preterm: Less than 37 completed weeks of gestations Term: After 37 completed weeks of gestations Post term: After 42 completed weeks of gestations Past Dates: After 40 completed weeks of gestations Stillbirth: Delivering dead fetus after 28 weeks of gestation. (Defn changes with the country) Abortion: Expulsion of products of conception before 28 weeks of gestation. Small for Gestational Age (SGA): Weight below the I Oth percentile for the gestational age Large for Gestational Age (LGA): Weight above the 90th percentile for the gestational age Appropriate for Gestational Age (AGA): Weight between 10 lh & 90th percentile for the gestational age [/INST] question: Definition of low birth weight | options: A: Wt <2kg B: Wt < 1.5kg C: Wt <2.5kg D: Wt <1 k | answer: C </s>

<s>[INST] context: Cluster headaches, which can cause excruciating hemicranial pain, are notable for their occurrence during characteristic episodes. Usually attacks occur during a 4-to 8-week period in which the patient experiences one to three severe brief headaches daily. There may then be a prolonged pain-free interval before the next episode. Men between ages 20 and 50 are most commonly affected. The unilateral pain is usually associated with lacrimation, eye reddening, nasal stuffiness, ptosis, and nausea. During episodes alcohol may provoke the attacks. Even though the pain caused by brain tumors may awaken a patient from sleep, the typical history and normal neurologic examination do not mandate evaluation for a neoplasm of the central nervous system. Acute therapy for a cluster headache attack consists of oxygen inhalation, although intranasal lidocaine and subcutaneous sumatriptan may also be effective. Prophylactic therapy with prednisone, lithium, methysergide, ergotamine, or verapamil can be administered durinq an episode to prevent further cluster headache attacks. [/INST] question: A 45-year-old man present with a daily headache over the past 3 weeks. Each attack lasts about an hour and awakens the patient from sleep. It is associated tearing and reddening of his right eye. The pain is deep, excruciating, and limited to the right side of the head. The neurologic examination is normal. The most likely diagnosis: | options: A: Migraine headache B: Cluster headache C: Tension headache D: Brain tumor | answer: B </s>

<s>[INST] context: Unconventional in every way, Edward Estlin Cummings made striking use of grammar. His arts were poetry, painting, and drama, and in all of them he was an experimenter. The poetry -- for which he is best remembered -- was marked by strange combinations of words and expressions and produced in very strange print. The unusual techniques that Cummings used served to present his ideas more forcefully and effectively than would have been the case with more ordinary styles. Cummings was born in Cambridge, Massachusetts, on Oct. 14, 1894. He graduated from Harvard College in 1915 and received a master's degree in 1916. During World War I he served as an ambulance driver in France. He spent six months in prison because of his friendship with another American who had supposedly criticized the countries that fought against Germany in the First World War. This experience increased his distrust of all officialdom , a distrust that showed itself in many of his later poems as well as in his first book, "The Enormous Room", published in 1922. Between the two world wars Cummings divided his time between Paris and New York City. His first book of poetry was "Tulips and Chimneys" (1923). The poems in the book were collected in "Complete Poems" (1968). The strangeness of his style was criticized by some, but others found it meaningful. Among Cummings' plays were "Him", first performed in 1927, and "Tom" (1935), a work based on "Uncle Tom's Cabin". An experimental prose book, "Eimi" (1933), recorded a 36-day visit to the Soviet Union. Cummings died at his home in North Conway, N.H., on Sept. 3, 1962. He was the second most widely read poet in the United States, after Robert Frost. He was buried in Forest Hills Cemetery in Boston, Massachusetts. [/INST] question: Cummings was chiefly famous as _ . | options: A: a poet B: an artist C: a novelist D: a playwright | answer: A </s>

<s>[INST] context: Today's 20-somethings are often called" millennials . " They grew up around the time of the millennium in the year 2000 Are these adults? The law says yes. But societies have their expectations for what being an adult means. Some say today's 20-sometbings are having a" delayed adulthood. " The term "boomerang kids" means young people leave their parents' house but, like a boomerang thrown through the air, later return. Research psychologist Jeffrey Arnett says these terms suggest many Americans are frustrated with 20-somethings. He says Americans should consider the positive aspects. They usually have various school and work experiences or they might. try living in different cities or countries. Cheryssa Jensen Cheryssa Jensen might agree. She says she expected to get married right after college and to find a job near her parents. Instead, she traveled the western part of the U. S. , went to a dozen different cities there. Her job also took her to Taiwan, Sweden and Denmark. After a year of traveling, she was not sure what to do. "Some words were nagging at me, saying, 'What else, what else can you do, what else can you do while you re young?" Julia Shaw Julia Shaw is 28, just a year older than Cheryssa, but very different in the way she has lived her life so far. After college, Julia began her career as a writer. She and her husband have stayed in Washington, and have lived there for the last two years. Julia says many people are surprised that she is married and settled in one place. But she believes she is more free than many other people of her generation and she says marriage has made her life more stable. Though their stories are different, Julia and Cheryssa still have some things in common. Both say their families are proud of them Both say they do not feel pressured by society to follow a particular path. And both say they are happy with their decisions. Julia Shaw and Cheryssa Jensen have something else in common. They have not made a high-paying career their first priority. Instead, most in the survey said the most important things to them are being good parents, having a successful marriage and helping other people. [/INST] question: Which of the following terms is NOT used to describe today's 20-somethings? ( ) | options: A: The millennials B: The lost generation C: The boomerang kids D: The delayed adults | answer: B </s>

<s>[INST] context: Somatoform pain disorder (may be) ??? Somatoform disorders The somatoform disorders are heterogenous group that have common presenting feature suggestive of physical illness, symptoms or preoccupation. As a feature of this group the symptoms are unexplained by general medical condition or are dispropoionate to symptoms that might be expected from a general medical condition. - To establish one of the these diagnosis the clinician must rule out accult physical disorders that might better explain the symptoms. Types of somatoform disoreders Category Key characteristics * Multiple symptoms - pain, gastrointestinal, sexual dysfunction Somatization * Symptoms vary over time disorder * Chronic condition-often with extensive treatment history * Not intentional * Symptoms affect voluntary motor or sensory system * Symptoms do not conform to neuroanatomic structures Conversion disorder * May reflect, symbolically, past or current stressor * Patient may not be upset by the symptoms * Not intentional * Chronic preoccupation with having a serious disease Hypochondriasis * Patient misattributes symptom or test results. * Preoccupation not solely due to affective status Body dysmorphic * Preoccupation with an imagined defect in physical appearance Disorder * May exaggerate mild anomay Chronic pain * Pain is the central anomaly Syndrome * May begin after specific injury * Can lead to serious functional impairment and medication overuse Somatization disorder Previously somatiation disorder was referred to as hysteria or Briquet's syndrome. It is a chronic fluctuating condition that usually begins after the age of 30 and extends over many years. The patient presents with multiple symptoms, including pain, gastrointestinal symtpmatology, neurologic symptoms and sexual dysfunction, which may vary considerably over time. He or she may have a long history of past extensive treatment including surgery. Typically, the patient seeks out multiple providers because of dissatisfaction with prior treatment, and may end up on complex combinations of medications because of frustration on the pa of both patient and physician Significant impairment in work and social. functioning are common Criteria for somatization disorder As described in the Diagnostic and statistical Manual-IV -Patients should have a history of pain in at least four different sites. - Two different gastrointestinal symptoms other than pain. - At least one sexual symptom, and one neurologic symptom. Conversion disorder Conversion disorder presents with deficits of the voluntary motor or sensory neurologic system and often mimic recognized neurologic or other medical conditions. As with somatization disorder the symptoms are not intentionally produced; often, the underlying psychological factors are expressed in physical symptoms. Common presentations include loss of sensation in a single limb or pa of a limb, double vision blindness, deafness, difficulty with swallowing and paralysis. On careful exam, the symptoms typically do not conform to recognized anatomic pathways. Pain disorders Pain disorders are characterized by a specific, predominant focus on pain as the presenting symptom. The pain usually does not .follow established anatomic patterns. However, if may be impossible to differentiate from established medical conditions such as lumbar disc disease. Although work-ups typically are negative, prior invasive treatment may lead to physical .findings that completely muddy the diagnosis. Indeed, pain disorders may develop after prior injury or treatment, which provides some pathophysiologic explanation. for the symptoms. Pain disorders may occur throughout the lifespan and are more common in women than man. The course may be persistent and lead to severe .functional impairment and extensive use of pain medication. [/INST] question: 20 years old female with complaints of nausea, vomiting and pain in the legs. Her physical examination and lab investigations are normal. What would be the most probable diagnosis ? | options: A: Generalized anxiety disorder B: Conversion disorder C: Somatoform pain disorder D: Somatisation disorder | answer: C </s>

<s>[INST] context: People have smoked cigarettes for a long time now. The tobacco which is used to make cigarettes was first grown in what is now part of the United States. Christopher Columbus, who discovered America, saw the Indians smoking. Soon the dried leaves were transported to Europe. In the late 1800s, the Turks made cigarettes popular. Cigarette smoke contains at least two harmful substances, tar and nicotine. Tar, which forms as the tobacco burns, damages the lungs and therefore affects breathing. Nicotine, which is found in the leaves, causes the heart to beat faster and increases the breathing rate. Nicotine in large can kill a person by stopping a person's breathing muscles. Smokers usually take in small amounts that the body can quickly break down. Nicotine can make new smokers feel dizzy or sick to their stomachs. The heart rate for young smokers increases 2 to 3 beats per minute. Nicotine also lowers skin temperature and reduces blood flow in the legs and feet. It plays an important role in increasing smokers' risk of heart disease and stroke. Smoking cigarettes is dangerous. Cigarette smoking was the cause of lung cancer and several other deadly diseases. [/INST] question: Tobacco first appeared in _ . | options: A: Asia B: Africa C: Europe D: America | answer: D </s>

<s>[INST] context: The uterus is suppoed mainly by the tone of the levator ani muscles and the condensations of pelvic fascia, which form three impoant ligaments. The Levator Ani Muscles and the Perineal Body: They form a broad muscular sheet. They effectively suppo the pelvic viscera. The medial edges of the anterior pas of the levator ani muscles are attached to the cervix of the uterus by the pelvic fascia. Transverse cervical ligaments are fibromuscular condensations of pelvic fascia that pass to the cervix and the upper end of the vagina from the lateral walls of the pelvis. Pubocervical Ligaments: The pubocervical ligaments consist of two firm bands of connective tissue that pass to the cervix from the posterior surface of the pubis. They are positioned on either side of the neck of the bladder, to which they give some suppo (pubovesical ligaments). Sacrocervical Ligaments: The sacrocervical ligaments consist of two firm fibromuscular bands of pelvic fascia that pass to the cervix and the upper end of the vagina from the lower end of the sacrum. They form two ridges, one on either side of the rectouterine pouch (pouch of Douglas). The broad ligaments and the round ligaments of the uterus are lax structures, and the uterus can be pulled up or pushed down for a considerable distance before they become taut. Clinically, they are considered to play a minor role in suppoing the uterus. The round ligament of the uterus, which represents the remains of the lower half of the gubernaculum, helps keep the uterus anteveed (tilted forward) and anteflexed (bent forward) but is considerably stretched during pregnancy. [/INST] question: Which of the following doesn't prevent prolapse of uterus: | options: A: Perineal body B: Pubocervical ligament C: Broad ligament D: Transverse cervical ligament | answer: C </s>

<s>[INST] context: After lots of hype, the new iPhone 3GS has arrived, boasting an improved camera, better battery life, and speedier performance. But is it a must? The iPhone 3GS is available in two versions: 16GB and 32GB. The 16GB version costs $199, while the 32GB version costs $299. From the outside, the iPhone 3GS looks exactly like the iPhone 3G. Like the iPhone 3G, the new model comes in black and white versions, and sports a 3.5-inch touch screen. Most of the changes to the iPhone 3GS have been made on the inside. Apple says that battery life is better, but the biggest boost is in the iPhone's speed: The iPhone 3GS runs twice as fast as the iPhone 3G. Instead of a lot of software installed on it, the iPhone 3GS comes with the most recent version of the iPhone Software --version 3.0- installed, but it does come with easy access to Apple's App Store. The speedier performance of the iPhone 3GS extends to surfing the Web, too. You can see entire Web pages, and can zoom in and out with ease. The notable new messaging feature on the iPhone 3GS is support for MMS. You can send pictures and videos by SMS, rather than having to send them via e-mail. Other new and very-handy e-mail features include the ability to search through your e-mail messages and contacts, as well as the option to use a landscape-oriented keyboard when composing messages. The camera has been upgraded from 2 megapixels to 3 megapxiels, and adds auto-focus. If you already own an iPhone 3G, the iPhone 3GS may not be worth the additional cost, since you can get many of its cool features for free with the iPhone 3.0 software upgrade. But if you've been using an older iPhone or smart phone, or are new to the smart phone world, the iPhone 3GS will amaze you with its speed and plentiful features. [/INST] question: The difference between 3G and 3GS lies mainly in _ . | options: A: their color1s B: their outside shapes C: their screens D: their batteries and speeds | answer: D </s>

<s>[INST] context: All postmenopausal and symptomatic per menopausal women who do not have contraindication particularly­ Those with high risk factors osteoporosis. Those with premature menopause Evaluation before starting HRT: History-personal, medical, gynecological, family Examination -HT, wt., BMI, BP, breast, vaginal examination Pap smear Mammography Lipid profile Transvaginal sonography-endometrial thickness Work up relevant to symptoms, e.g. urinary continence, carbohydrate intolerance, psychoemotional states. Contraindications of HRT: Pregnancy CA breast CA endometrium Undiagnosed abnormal vaginal bleeding Active liver disease Present deep vein thrombosis, thromboembolic disorder Investigation not routinely needed before starting HRT Endometrial sampling-Only done if history of abnormal vaginal bleeding, TVS shows endometrial thickness> 5 mm. Serum FSH-Only done if diagnosis of menopause is not clear, e.g. vasomotor symptoms in absence of amenorrhoea Bone densitometry-Using DEXA (dual energy X-ray absorptiometry) oflumber vertebrae, hip bone for women with risk factors for osteoprosis, persistent backache, bone aches, history of recent fracture, for research purpose [/INST] question: Major source of estrogen in postmenopausal women is: | options: A: Peripheral conversion of androstenedione B: Secretion from adrenals C: Testosterone from the ovary D: HRT | answer: A </s>

<s>[INST] context: Cisplatin: It is a platinum coordination complex that is hydrolysed intracellularly to produce a highly reactive moiety which causes cross linking of DNA. The oured siteis N7 ofguanine residue. It can also react with -SH groups in proteins and has radiomimetic propey. It is bound to plasma proteins, enters tissues and is slowly excreted unchanged in urine with a plasma half life of about 72 hrs. Negligible amounts enter brain. Cisplatin is very effective in metastatic testicular and ovarian carcinoma. It has found use in many other solid tumours as well. Cisplatin is a highly emetic drug. Antiemetics are routinely administered before infusing it. The most impoant toxicity is renal impairment which is dependent on total dose administered. Renal toxicity can be reduced by maintaining good hydration. Tinnitus, deafness, neuropathy and hyperuricaemia are other problems. Shock like state sometimes occurs during i.v. infusion. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:827,828 [/INST] question: Most emetogenic anticancer drug is: | options: A: Cisplatin B: Carboplatin C: High dose cyclophosphamide D: High dose methotrexate | answer: A </s>

<s>[INST] context: The peak incidence of aoic dissection is in the sixth and seventh decades. Men are more affected than women by a ratio of 2:1. The presentations of aoic dissection and its variants are the consequences of intimal tear, dissecting hematoma, occlusion of involved aeries, and compression of adjacent tissues.Acute aoic dissection presents with the sudden onset of pain , which often is described as very severe and tearing and is associated with diaphoresis. The pain may be localized to the front or back of the chest, often the interscapular region, and typically migrates with propagation of the dissection. Other symptoms include syncope, dyspnea, and weakness. Physical findings may include hypeension or hypotension, loss of pulses, aoic regurgitation, pulmonary edema, and neurologic findings due to carotid aery obstruction (hemiplegia, hemianesthesia) or spinal cord ischemia (paraplegia). Bowel ischemia, hematuria, and myocardial ischemia have all been observed. These clinical manifestations reflect complications resulting from the dissection occluding the major aeries. Fuhermore, clinical manifestations may result from the compression of adjacent structures (e.g., superior cervical ganglia, superior vena cava, bronchus, esophagus) by the expanding dissection, causing aneurysmal dilation, and include Horner's syndrome, superior vena cava syndrome, hoarseness, dysphagia, and airway compromise. Hemopericardium and cardiac tamponade may complicate a type A lesion with retrograde dissection. Acute aoic regurgitation is an impoant and common (>50%) complication of proximal dissection. It is the outcome of either a circumferential tear that widens the aoic root or a disruption of the annulus by a dissecting hematoma that tears a leaflet(s) or displaces it, inferior to the line of closure. Signs of aoic regurgitation include bounding pulses, a wide pulse pressure, a diastolic murmur often radiating along the right sternal border, and evidence of congestive hea failure. The clinical manifestations depend on the severity of the regurgitation. ref:Harrison&;s principles of internal medicine,ed 18,pg no 2057 [/INST] question: Manifestations of aoic dissection are - | options: A: Pericardial effusion B: AR C: MR D: AMI | answer: C </s>

<s>[INST] context: C-X-C chemokines have one amino acid residue separating the first two of the four conserved cysteine residues. It is induced by microbial products and other cytokines, mainly IL-1 and TNF. These chemokines act on neutrophils primarily. IL 8 is typical of this group. It is secreted by activated macrophages, endothelial cells, and other cell types, and causes activation and chemotaxis of neutrophils, with limited activity on monocytes and eosinophils 1.C-X-C chemokines have one amino acid residue separating the first two of the four conserved cysteines Example: IL-8 2.C-C chemokines have the first two conserved cysteine residues adjacent. Example: monocyte chemoattractant protein (MCP-1, CCL2), eotaxin (CCL11), and macrophage inflammatory protein- 1a (MIP-1a, CCL3), mainly serve as chemoattractants for monocytes, eosinophils, basophils, and lymphocytes 3.C chemokines lack the first and third of the four conserved Cysteines. Example: lymphotactin, XCL1 are relatively specific for lymphocytes. 4.CX3C chemokines contain three amino acids between the first two cysteines. Example: fractalkine (CX3CL1) [/INST] question: Which of the following chemical mediators of inflammation is an example of a C-X-C or alpha chemokine? | options: A: Lipoxin LXA4 B: Interleukin IL-8 C: Interleukin IL-6 D: Monocyte chemoattractant protein MCP-1 | answer: B </s>

<s>[INST] context: Long after its introduction into the New World, American English was still considered non-standard English. According to some people of the 1780s American English was a peasant's language that a "gentleman" will not speak. Considered in a bilingual point of view, British English was the dominant language linked to prestige and language purism . The belief in the authority or say in the superior of British English, has remained to the twentieth century, especially in the former British Empire or in the fields of British influence. Thus, it is reported that in prefix = st1 /China, teachers and school textbooks refer to and recommend Received Pronunciation as the model, as well as standard British sentence structures, spelling and words. British English is also encouraged and accepted as the criteria of some major official examinations, for example, College English Test and Test for English Majors which are conducted by government. Similar situations could be found in countries, for example, in Africa, the West African Examination Council and Joint Admission accepts the British English as the standard English. Report can also be found that inCairosome university students received lower grades if they used American spellings instead of British English. In Europe, we find teachers, British people as well as natives of the country in which they work, who follow the British English standard, and laugh at the American English. However, the above attitudes are nothing but the last influence of a long-gone period of British supermacy . The beginning of a clear lead of American English can be traced to the decades after World War II. This coincides with the simultaneous rise of the US as a military and technological power and the decline of the British Empire, which drove many to American English. And from then on, American English has continuously sent its influence to every corner of the planet. [/INST] question: Where do the students get poor mark if they use American spellings? | options: A: In China B: In Cairo C: In Europe D: In Western Africa | answer: B </s>

<s>[INST] context: DEFINITIONS OF MICROSCOPIC TERMS Hyperkeratosis Thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin. Parakeratosis Modes of keratinization characterized by the retention of the nuclei in the stratum corneum. On mucous membranes, parakeratosis is normal. Hypergranulosis Hyperplasia of the stratum granulosum, often due to intense rubbing. Acanthosis Diffuse epidermal hyperplasia. Papillomatosis Surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae. Dyskeratosis Abnormal keratinization occurring prematurely within individual cells or groups of cells below the stratum granulosum. Acantholysis Loss of intercellular connections resulting in loss of cohesion between keratinocytes. Spongiosis Intercellular edema of the epidermis. Hydropic swelling (ballooning) Intracellular edema of kerantinocytes, often seen in viral infections Exocytosis infiltration of the epidermis by inflammatory or circulating blood cells. Erosion Discontinuity of the skin exhibiting incomplete loss of the epidermis. Ulceration Discontinuity of the skin exhibiting complete loss of the epidermis and often of portions of the dermis and even subcutaneous fat. Vacuolization Formation of vacuoles within or adjacent to cells; often refers to basal cell-basement membrane zone area. Lentiginous Referring to a linear pattern of melanocyte proliferation within the epidermal basal cell layer. Lentiginous melanocytic hyperplasia can occur as a reactive change or as part of a neoplasm of melanocytes. [/INST] question: Dyskeratosis - | options: A: Leukoplakia B: Hyperpigmentation C: Nail dystrophy D: Premature keratinisation | answer: D </s>

<s>[INST] context: Clinical manifestations of diphtheria 1. Faucial (tonsillo pharyngeal) diphtheria It is the commonest type of diphtherial infection. Incubation period is 2-5 days. Patients present with malaise, sore throat and moderate fever. A thick adherent pseudomnembrane (gray or white) is present on one or both tonsils or adjacent pharynx. Dislodging the membrane is likely to cause bleeding. A small percentage of patients present with massive swelling of the tonsils and uvula with cervical lymphadenopathy (bull neck) and severe toxemia → Malignant diphtheria. Systemic toxicity (toxemia) is usually most severe when pseudomembrane extends from tonsil and pharynx (faucial diphtheria) to adjacent areas. 2. Laryngeal diphtheria Presents as hoarseness and cough. It is the most severe form of respiratory diphtheria. Trocheostomy may be required. 3.Nasal diphtheria Presents with unilateral or bilateral nasal discharge. Mildest form of respiratory diphtheria 4. Cutaneous diphtheria Caused by nontoxigenic strains Presents as distinct "punched out" ulcers. More common in tropical areas. Other less common type of diphtheria are conjunctiva, otitic, genital - (vulval, vaginal or prepucial), gastrointestinal. [/INST] question: The type of Diphtheria with highest mortality is | options: A: Pharyngeal B: Nasal C: Laryngeal D: Conjuntival | answer: C </s>

<s>[INST] context: A romantic message-in-a-bottle discovered by a mother and daughter at a Scottish beach has sparked a mystery about whether it could have travelled 5,000 miles across the seas from China. Nicola MacFarlane, 41, and daughter Lucy, four, from Portobello, near Edinburgh, were looking for driftwood on Portobello Beach when they came across an old glass bottle containing a note inside written in _ . Now the family are trying to work out if the letter has managed the extraordinary journey across the Philippine Sea, into the Indian Ocean and through both the South Atlantic and the North Atlantic Ocean's before washing up on the shores of Great Britain. It was written on Chinese Valentine's Day or Qixi Festival as it is more traditionally known, lunar July 7, 2012, so it sent off as recently as six days ago because it followed the modern calendar, which celebrated the occasion on August 23. Nicola was still excited to read about the Chinese love story after having it translated. "I really do hope that it is from China but even it is from nearer to home, it's still a lovely gesture and an inspiring find. It's a love story regardless of where it came from. Nicola, who runs a beach art business in Portobello, added: "I'm always at the beach looking for bits of driftwood but I've never come across anything like this before. We knew it was Chinese, but we had no idea what it said.' Unable to read the Mandarin text, Nicola turned to the internet and her Australian friend, Julie Gould, whose daughter attended a Chinese school in Sydney. Several hours later Julie returned with the news that it was in fact a love letter. The translated letter reads: "Da Hai(Ocean), I hope no-one will get this bottle, as we just wish you can hear our voice, and get your blessing. Today is the Chinese Valentine's Day, we pray that our relationship will last forever and we will have a long happy life together..." Nicola said: "It sounds to me like the couple are in love but cannot be together so they have sent the message to tell the world of their love." [/INST] question: When did Nicola and her daughter come across the message-in-bottle? | options: A: On July 15, 2012 B: On August 29, 2012 C: On August 31, 2012 D: On September 2, 2012 | answer: B </s>

<s>[INST] context: In the sunny night, look up at the clear night sky. You can probably see thousands of stars. The biggest thing you'll see, of course, is the moon. For thousands of years, people have wondered about this big thing in the sky. Earth's moon is a satellite. A satellite is a body that orbits a planet. All moons are satellites, and many planets have them. Some have many moons. Earth, of course, only has one. It's a special moon, though. It's the fifth largest moon in the solar system! In fact, the moon is much smaller than the sun. But it's much closer to Earth, so it looks as big as the sun. The moon is so close that you can see its dark and light spots without a telescope. Men flew and landed on the moon's surface many times by spacecrafts in the 1960s and 1970s. Neil Armstrong was the first human to step on the moon. He walked on the moon on July 20th, 1969. The flights to the moon have helped us learn much about it. Astronauts even brought rocks home with them! There's still a lot to learn about the moon. Now people still can't live on the moon because it does not have oxygen or water like the Earth. But I'm sure that humans can live there one day in the future. ,. [/INST] question: What is a satellite? | options: A: A planet B: A spacecraft C: A body that orbits a planet D: A black star | answer: C </s>

<s>[INST] context: Twelve years ago, Rachel Miller was lost when it came to her son John. The 7-year-old was seriously disabled because of his autism . Unable to speak, he withdrew from people at school and, worse, from his family. In March 2003, Miller was introduced to Jeff Hancock, a one-on-one therapist for people with autism. Hancock was hired to be John's companion. The two would go people-watching at the mall on the weekend. Hancock chatted throughout their trips, even though John couldn't talk back. Their relationship developed when Hancock introduced John to the Special Olympics. Whenever John was running or being active, he was smiling. When John turned 12, Hancock introduced him to track at the Special Olympics. For the first three years, the pair just observed the sport by watching practices and events. Hancock worked daily with John, showing him everything, including where to sit, stand and walk, so he would understand the flow of the events. Eventually, the lessons clicked, and John was off doing 50-meter sprints. But as John got older, he got stronger and faster. At 16, he was jumping hurdles and doing 800-meter races. Miller started seeing her son as a serious athlete. In May 2014, John's training brought him to the Special Olympics State Summer Games in Orlando. The 18-year-old was competing in the 800 meters and the 110-meter hurdles. As the 800 was setting up, Miller remembered, she pressed her face against the fence, anxiously waiting for John to compete. But as soon as the race started, all Miller saw was an athlete, her athlete. "I just wanted to see the best performance. It seemed much more significant than whether he would ever speak or respond to me," she said. John ended up winning the gold medal for the 800. Sports completely changed John, and Miller said that is because of Hancock."A person with a disability can feel hopeless and isolated, and I think that can happen to parents, too. " [/INST] question: Miller considered John to be a serious athlete _ . | options: A: in 2011 B: in 2012 C: in 2013 D: in 2014 | answer: B </s>

<s>[INST] context: The wallet is heading for extinction. As a day-to-day essential, it will die off with the generation who read print newspapers. The kind of shopping, where you hand over notes and count out change in return, now happens only in the most minor of our retailers , like buying a bar of chocolate or a pint of milk from a corner shop. At the shops where you spend any real money, that money is increasingly abstracted. And this is more and more true, the higher up the scale you go. At the most cutting-edge retail stores, Victoria Beckham on Dover Street, for instance, you don't go and stand at any kind of cash register when you decide to pay. The staff are equipped with iPads to take your payment while you relax on a sofa. Across society, the abstraction of the idea of cash makes me uneasy. Maybe I'm just old-fashioned. But earning money isn't quick or easy for most of us. Isn't it a bit weird that spending it should happen in half a blink of an eye? Doesn't a wallet, that time-honored Friday-night feeling of pleasing, promising fatness, represent something that matters? But I'll leave the economics to the experts. What bothers me about the death of the wallet is the change it represents in our physical environment. Everything about the look and feel of a wallet, the way the materials wear and tear and loosen with age, the plastic and paper and gold and silver, and handwritten phone numbers and printed cinema tickets, is the very opposite of what our world is becoming. The opposite of a wallet is a smart phone or an iPad. The rounded edges, cool glass, smooth and unknowable as a pebble . Instead of digging through pieces of paper, we move our fingers left and right. No more counting out coins. Show your wallet, if you still have one. It may not be here much longer. [/INST] question: What is happening to the wallet?[ | options: A: It is disappearing B: It is becoming costly C: It is being fattened D: It is changing in style | answer: A </s>

<s>[INST] context: Can food be free, fresh and easily accessible? That's the bold question that the city of Seattle is hoping to answer with a new experimental farm not far from the city's downtown area that will have fruits and vegetables for anyone to harvest this fall. On Beacon Hill, just south of central Seattle, landscape developers and a few affordable-food advocates are building an eatable food forest. Everything grown in the area will be eatable. And it'll be open around the clock to anyone who wants to come and pick some fresh blueberries or pears. Organizers shared with National Geographic a list of the crop offerings. Many are expected: apples, berries and tomatoes. But others are pretty far-out. A large Asian community in the area suggested things like Asian pears and honeyberries. A European influence led to the planting of medlar trees. The concept is modeled on permaculture, a design system and school of thought emphasizing the use of renewable nature resources and the enrichment of local ecosystems. Offering people free, fresh food is one motivation, but making the land useful and ecologically enriched is the larger goal. That being said, some potential problems come to mind. What if all of one fruit is gone the first weekend when it's ripe? What if people pick things too early and spoil the potential for everyone? Organizers aren't concerned about those questions. "We've had many discussions about what would happen if someone comes and picks all the blueberries," says Margarett Harrison, the landscape architect designing the project." But that's been considered as a good thing. We'll just plant more." Anything related to agriculture and good food -- in large quantities -- takes time. Most of the trees won't be mature enough for a few more years. But a few decades could make the area impressively productive. Idealistic? Perhaps. But it's the kind of idealism that anyone who likes to eat fresh things from time to time can get behind. And that's the type of motivation that organizers hope will keep going. [/INST] question: What's Margarett Hrrison's attitude towards the potential problems the forest may face? | options: A: Concerned B: Cautious C: Optimistic D: Uninterested | answer: C </s>

<s>[INST] context: At last, the mid-term exams are over. You've done the hard work, but you can't relax. You have to prepare for the next exams. Do you hate exams? If you do, you are not alone. Students in other countries hate them as well. Luckily for them, British students have fewer exams than Chinese students. And they only have them once a year. Every summer they take a test in each subject. Each test lasts about an hour. These exams _ , even if a student does really badly they still progress to the next grade. When the results come out, they are then placed in an end-of-year report. The report is sent to the child's parents. It describes how the student studied at school. This report is private, so only the teacher, the student and his or her parents see it. This means that the students don't know how other students scored in the test. Some students choose to tell each other, but others keep it secret. Parents' meetings are held twice a year, at the end of winter term and then at the end of the summer term. Children go along with their parents to meet their teachers privately and discuss their performance at school. [/INST] question: For British students, the school life is _ than that of Chinese students. | options: A: more relaxing B: much tenser C: more boring D: much harder | answer: A </s>

<s>[INST] context: A young man returns to his hometown of Aractataca, Colombia. He visits the house where he lived as a child. Here, he remembers the most important memories of his childhood. Standing in front of his old house, the young man makes an important decision. He says to himself, "I will start my life over again. I will become a writer." This man is the world famous writer, Gabriel Garcia Marquez. Gabriel Garcia Marquez was born on March 6, 1928. During his early life, Garcia Marquez's grandmother and grandfather told him many stories. His grandmother would tell him legends as if they were real. Garcia Marquez says that his grandmother's way of storytelling later influenced his own methods. When Garcia Marquez was about 20 years old, he left Aractataca and attended university in Bogota. He began studying law because this was what his father wanted him to study. However, Garcia Marquez was not happy. During this time Garcia Marquez returned to Aractataca. It was on this visit that he realized he must stop studying law. And he recognized that he must return to the dream of his childhood-writing. For the next few years, Garcia Marquez wrote for many different newspapers. And in 1955, he published his first book called "Leaf Storm". For many years, Garcia Marquez knew he wanted to write about his grandfather's house in Aractataca. To write this book, Garcia Marquez and his wife had to sell almost all of their possessions to survive. But their act was worth it. The book, "One Hundred Years of Solitude" was immediately successful. And this book created a path for Garcia Marquez's future success. In 1982, Gabriel Garcia Marquez was given the Nobel Prize in Literature for his book "One Hundred Years of Solitude", making him the first Colombian and the fourth Latin American to win a Nobel Prize in Literature. [/INST] question: Who influenced Garcia Marquez's writing style? | options: A: His grandfather B: His father C: His grandmother D: His wife | answer: C </s>

<s>[INST] context: Diuretics lead to aldosterone excess and hypokalemia by a variety of mechanisms. Diuretic induced volume depletion stimulates the formation of angiotensin II, which, in turn, causes a secondary increase in plasma aldosterone concentration. This increase in plasma aldosterone stimulates potassium excretion, contributing to the hypokalemia. The saline diuresis increased sodium delivery to the collecting tubule. The increased availability of sodium along with the elevated plasma aldosterone augments sodium reabsorption iin the collecting tubule, thereby raising luminal negativity. This high luminal negativity in the collecting tubule promotes secretion of cations, especially hydrogen ions, which raises bicarbonate reabsorption. The saline diuresis causes rapid fluid flow in the distal tubule, which, in turn, keeps luminal potassium concentration low by carrying it away and thus preventing the accumulation of any potassium that enters the lumen. This low luminal concentration of potassium creates a steep concentration gradient for additional potassium losses in the urine. The treatment of edema with thiazide or loop diuretics is the most common cause of metabolic alkalosis. Aerial pH is increased and aerial H+ concentration is decreased with metabolic alkalosis. Sodium depletion tends to decrease plasma sodium levels, although the effect is usually small. Overuse of the thiazide diuretic has caused depletion of sodium and potassium by the kidneys, not retention of sodium and potassium. [/INST] question: A 72-year-old woman with mild hea failure is treated overzealously with a thiazide diuretic. A few days later, the woman complains of muscle weakness, and laboratory tests demonstrate hypokalemia. Which of the following is most likely increased in this woman? | options: A: Aerial H+ concentration B: Plasma aldosterone C: Plasma sodium D: Potassium retention | answer: B </s>

<s>[INST] context: Are you looking for something fun and would you like to help others in your spare time? Then join us to be a volunteer! We're a non-profit organization. We have volunteer jobs of all ages. Anyone, from twelve-year-old children to people in their seventies can become a volunteer. You can help people in many ways. Schools need help with taking care of children while parents are working. Hospitals need volunteers to look after children while their parents are seeing a doctor. Animal lovers can help take care of those dogs and cats without homes. There is something for everyone. "As a volunteer, I don't want to get anything. Seeing the children's happy faces, I'm happy, too." Said Carlos Domingo, an old woman of 62. "I often played computer games in my spare time before. Now I help older people learn how to use computers." said another volunteer at the age of 18. If everyone helps out a bit, we'll have a better world to live in. Interested? Call us 1-800-555-5756 or visit our website: www.activol.com. [/INST] question: _ can be a volunteer. | options: A: Children B: Old women C: Anyone aged 12-70 D: Young people | answer: C </s>

<s>[INST] context: Jane Austen, a famous English writer, was born in Steventon, Hampshire, on December 16, 1775, and died on July 18,1817. She began writing early in life, although the prejudices of her times forced her to have her books published anonymously. . But Jane Austen is perhaps the best known and best loved of Bath's many famous local people and visitors. She paid two long visits during the last five years of the eighteenth century and from 1801 to 1806, Bath was her home. Her deep knowledge of the city is fully seen in two of her novels, Northanger Addey and Persuasion, which are largely set in Bath. The city is still very much as Jane Austen knew it, keeping its streets and public buildings the well--ordered world that she described so well in her novels. Now the pleasure of learning Jane Austen's Bath can be enhanced by visiting the Jane Austen Center in Gay Street. Here, in a Georgian town house in the heart of the city, you can find out more about Bath in Jane Austen's time and the importance of Bath in her life and work. The Center has been set up with the help and guidance of members of the Jane Austen Society. After your visit to the Center, you can look round the attractive shop, which offers a huge collection of Jane Austen related books, cards and many specially designed gifts. Jane Austen quizzes are offered to keep the children busy. You can also have walking tours of Jane Austen's Bath, which is a great way to find out more about Jane Austen and discover the wonderful Georgian city of Bath. The tour lasts about one and a half hours. The experienced guides will take you to the places where Jane lived, walked and shopped. [/INST] question: Jane Austen paid two long visits to Bath _ . | options: A: in her early twenties B: in her early teens C: in her late twenties D: in her late teens | answer: A </s>

<s>[INST] context: Once there lived an old man in a mountain village. He was a famous hunter. He often went hunting alone in the mountains. He was not afraid of any wild animals, not even a tiger. One night, someone saw a tiger come into the village, and stole two sheep away. The next night the tiger came again. The villagers were frightened. They asked the old hunter to catch it so that they could have a safe life. When the old man heard about the tiger, he thought hard. He wondered why the tiger came at night twice but only stole the sheep. The next night he walked outside the village. Suddenly he saw the tiger coming. He quickly threw himself on the ground. To his surprise, the tiger did not come at him, but went away. He followed it quietly and found it was running on two of its feet just like a man. Then everything was clear. On the fourth day, when it got dark, the hunter took some animal skins with him and hid himself behind a big tree near the village. He was waiting for the "tiger". As soon as the "tiger" came near the tree, the old hunter jumped out, caught the "tiger" by the "leg" and said, "Don't be afraid. I do not mean to hurt you. You know who I am, don't you?" The "tiger" said "Yes" and took off the tiger's skin. "You are poor. But you mustn't steal anything from others. Here are some animal skins for you. You may sell them at the market. With the money, you can buy food and clothes for your family. Work harder and try to make a living. " With tears in his eyes, the poor man thanked the kind-hearted old hunter and walked home. [/INST] question: Where did the hunter live? | options: A: Outside a village B: On a farm C: In a village D: Near a village | answer: C </s>

<s>[INST] context: Periodic fainting spells is known as Adams Stokes syndrome Reason: Fluctuating third degree AV block in heas with borderline ischemia of conductive system. Complete AV block -Brain cannot remain active for more than 4-7 sec without blood supply -fainting episode - ventricular escape from overdrive suppression occurs in 5-30 sec - rapid recovery from the faint and then to sustain the person. AV block types: 1. First degree block: prolonged P-Q or P-R interval >0.20, not actual blockage but delay of conduction. 2. Second degree block: a. Wenckebach or Mobitz type 1: progressive P-R prolongation followed by a dropped beat. Abnormality in AV node. b. Mobitz type 2: A fixed number of non-conducted P waves for every QRS complex. P-R interval constant. Ex: 3:1, 3:2, 2:1. Abnormality in bundle of His-Purkinje system. 3. Third degree hea block: Complete AV block. SA and AV node dissociation leading to idioventricular rhythm (ventricular escape as Purkinje fibres becomes new pacemaker, 15-40 beats/min). [/INST] question: A 50-year-old man has been having fainting "spells" for about 2 weeks. During the episodes, his ECG shows a ventricular rate of 25 beats/min and 100 P waves per minute. After about 30 seconds of fainting, a normal sinus rhythm recurs. What is his likely diagnosis? | options: A: First-degree A-V block B: Second-degree A-V block C: Third-degree A-V block D: Stokes-Adams syndrome | answer: D </s>

<s>[INST] context: Extra intestinal manifestations of IBD: The most commonly extraintestinal manifestations of IBD involve the skin, joints, eyes, and liver in up to one-third of patients. Extraintestinal manifestations of IBD:Nonintestinal manifestations are similar for both CD and UC. Dermatologic manifestationsinclude the relatively common erythema nodosum that often correlate with acute flares. The more problematic pyoderma gangrenosum is much more common in UC than CD, and its course is independent of IBD activity. Joint manifestationsinclude peripheral ahritis that correlates with exacerbations of bowel disease, and central ahritis (ankylosing spondylitis or sacroiliitis) that does not correlate with bowel activity. Ocular complicationsinclude conjunctivitis, episcleritis, and uveitis and may occur independent of bowel activity. Hepatobiliary complicationsinclude nonalcoholic fatty liver disease, cholestasis, gallstones (CD>UC, paicularly with ileal disease due to decreased bile acid reabsorption), and primary sclerosing cholangitis (UC>>CD), a fibrotic disorder of intra- and extrahepatic bile ducts that does not correlate with bowel disease activity. Renal complicationsinclude kidney stones that are more common in CD than in UC. Oxalate absorption is increased in bowel inflammation leading to calcium oxalate stones. Uric acid stones also occur with increased frequency in CD. [/INST] question: Which among the following extra intestinal manifestations of IBD correlate with bowel disease activity? | options: A: Pyoderma gangrenosum B: Erythema Nodosum C: Peripheral ahritis D: Primary sclerosing cholangitis | answer: C </s>

<s>[INST] context: Of the many methods available for antigen and antibody detection, LA, ELISA, RIA, CIE, and COA are the most widely used.Enzyme immunoassays (EIAs) can be either homogeneous (EMIT) or heterogeneous (ELISA). EMIT has been used primarily for assays of low- molecular-weight drugs. Its primary use in microbiology has been for assays of aminoglycoside antibiotics. EIAs vary as to the solid support used. A variety of supports can be used, such as polystyrene microdilution plates, paddles, plastic beads, and tubes. The number of layers in the antibody-antigen sandwich varies; usually as additional layers are added, detection sensitivity is increased. The two most common enzymes are horseradish peroxidase (HRP) and alkaline phosphatase (AP). b-Galactosidase has also been employed. O-phenylenediamine is the most common substrate for HRP and b-nitrophenyl phosphate for AP. Because EIAs are usually read in the visible color range, the tests can be read qualitatively by eye or quantitatively by machine. [/INST] question: A 7-month-old baby who is failing to thrive is brought into a neighborhood clinic. History reveals that the baby's mother died of AIDS 2 months ago. Blood is obtained and sent to the laboratory to check for HIV infection. The physician orders a test whose detection system is based on enzymatic activity. Which of the following tests is a heterogeneous immunoassay? | options: A: Coagglutination (COA) B: Counter immuno-electrophoresis (CIE) C: Enzyme-linked immunosorbent assay (ELISA) D: Latex agglutination (LA) | answer: C </s>

<s>[INST] context: When I was eleven years old, God gave me a gift of happiness and I had a carefree childhood in France. One day, on my way home from school, a truck ran over me and my legs were cut off. As I lay there bleeding, I suddenly realized that I might have to live the rest of my life without legs. How depressed I was at that moment! But then I realized that depression won't get my legs back. So I decided not to waste my life feeling depressed. When my parents arrived at the hospital, they stood there quietly, looked so shocked and sad. I told them, "I've already accepted the fact. Now you also have to get used to this." Ever since then, I often see my friends getting worried about little things: The buses comes late; they get bad grades on the tests and so on. But I just enjoy life. I was lucky to realize that it is a waste of energy to pay attention to what you have lost, and that the key to happiness is to take pleasure in what you have. Sounds simple, doesn't it? So why are many people unhappy? People often think happiness is based on what they achieve. "My whole life would improve if I had a new car." But when they get the car and what happens? For a whole week they are walking on air. Then they go right back to be unhappy. Happiness is not a happening; it's a state of mind. Even though you have the whole world and you'll still be unsatisfied. And you have relatively little but feel full of joy. Happiness comes from mastering the art of enjoying and taking pleasure in what you already have. [/INST] question: The word "depressed" most probably means" _ ". | options: A: sad and disappointed B: painful and annoyed C: smart and strong D: calm and quiet | answer: A </s>

<s>[INST] context: RA with Hepatitis B??? We are still not sure of the answer. Anti TNF-a drugs can be used in all of the conditions mentioned in the question. Anti TNF a the therapy in Hepatitis B For the treatment of HBV, Anti TNF- atherapy showed cases of fulminant HBV reactivation. But any HBV reactivation was treated success fully with lamivudine therapy, thus it was concluded that physicians should consider antiviral therapy in patients with HBV (with or without active viral replication) and initiated treatment should continue for 3-6 months after stopping anti TNF- therapy. Both published British society of Rheumatology guidelines and British society of Gastroenterology guidelines concludes:- Successful treatment of active RA with anti TNF a in patients chronically infected with HBV is possible and can be safe. Our findings together with those of others, suggest that chronic HBV infection need not preclude therapy with anti TNF a where clinically indicated but an individualized approach is required including careful counseling, collaboration with colleagues in gastroenterology and intensive monitoring. HIV and anti TNF- a therapy As of now there are only eight patients treated with HIV and Rheumatoid disease. Retrospective series of eight patients suggests that treatment with anti TNF- a therapy can be used in HIV patients without advanced disease with associated rheumatic diseases. HCV and anti TNF-- cc therapy Anti TNF- a therapy is safe in patients with HCV and Rheumatoid ahritis. In a study involving 31 patients with RA with concomitant HCV infection, TNF a blocker seemed to be safe provided there is close monitoring of clinical virological data. Pulmonary fibrosis and anti TNF- a therapy Anti TNF-a therapy is considered safe in patients with Rheumatoid ahritis and pulmonary fibrosis. In some cases pulmonary. fibrosis seems to have improved with anti-TNF- atherapy. [/INST] question: Anti TNF is not used in aEUR' | options: A: RA with HIV B: RA with Hepatitis B C: RA with HCV D: RA with pulmonary fibrosis | answer: B </s>

<s>[INST] context: At exactly eleven Sir Percival knocked and entered, with anxiety and worry in every line of his face. This meeting would decide his future life, and he obviously knew it. "You may wonder, Sir Percival," said Laura calmly, "if I am going to ask to be released from ray promise to marry you. I am not going to ask this. I respect my father's wishes too much. " His face relaxed a little, but one of his feet kept beating the carpet. "No, if we are going to withdraw. from our planned marriage, it will be because of your wish, not mine. " "Mine?" he said in great surprise. "What reason could I have for withdrawing?" "A reason that is very hard to tell you," she answered. "There is a change in me. " His face went so pale that even his lips lost their color1. He turned his head to one side. "What change?" he asked, trying to appear calm. " When the promise was made two years ago", she said, " my love did not belong to anyone. Will you forgive me, Sir Percival, if I tell you that it now belongs to another person?" "I wish you to understand", Laura continued, "that I will never see this person again, and that if you leave me, you only allow me to remain a single woman for the rest of my life. All I ask is that you forgive me and keep my secret." "I will do both those things, " he said. Then he looked at Laura, as if he was waiting to hear more. "I think I have said enough to give you reason to withdraw from our marriage,',she added quietly. "No. You have said enough to make it the est wish of my life to marry you, " he said. [/INST] question: How did Percival feel during his meeting with Laura? | options: A: Angry B: Calm C: Nervous D: Excited | answer: C </s>

<s>[INST] context: Hodgkin's lymphoma (HL) is a type of lymphoma, which is generally believed to result from white blood cells of the lymphocyte kind. Symptoms may include fever, night sweats, and weight loss. Often there will be non-painful enlarged lymph nodes in the neck, under the arm, or in the groin. Those affected may feel tired or be itchy. About half of cases of Hodgkin's lymphoma are due to Epstein-Barr virus (EBV). Other risk factors include a family history of the condition and having HIV/AIDS. There are two major types of Hodgkin lymphoma: classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Diagnosis is by finding Hodgkin's cells such as multinucleated Reed-Sternberg cells (RS cells) in lymph nodes. Hodgkin lymphoma may be treated with chemotherapy, radiation therapy, and stem cell transplant. The choice of treatment often depends on how advanced the cancer is and whether or not it has orable features. In early disease a cure is often possible. The percentage of people who survive five years in the United States is 86%. For those under the age of 20 rates of survival are 97%. Radiation and some chemotherapy drugs, however, increase the risk of other cancers, hea disease, or lung disease over the subsequent decades. [/INST] question: Best prognostic type of Hodgkin's lymphoma is - | options: A: Lymphocytic predominant B: Lymphocytic depletion C: Mixed cellularity D: Nodular sclerosis | answer: A </s>

<s>[INST] context: • Epidermoid cyst results from proliferation of epidermal cells within a circumscribed space of dermis (which had got implanted within the dermis) • Sebaceous cyst is a misnomer as the cysts are not of sebaceous origin and the white creamy material filled within is not sebum, but is keratin (desquamated epithelial cells) • Type of retention cyst (secretions are pent up in a gland owing to blockage of the duct) Pathology • Cyst wall consist of a layer of epidermis oriented with the basal layer superficial and more matured layers are deep. • Desquamated cells (keratin) collect in the centre and form creamy substance of the cyst. Clinical Features • Usually asymptomatic, unless get infected or inflamed and become painful • Firm, round, flesh colored to yellow or white subcutaneous nodules of variable size. • Central punctum may teether the cyst to the overlying epidermis, from which the white creamy material can be expressed. • Rarely malignancies (BCC, SCC) can develop in epidermoid cyst. • No punctum in scrotal and scalp sebaceous cyst. Treatment • Excision with the wall is treatment of choice. • Infected cyst: Incision and drainage (After resolution of the abscess, cyst wall must be excised to prevent recurrence) [/INST] question: Sebaceous cyst does not occur in the ................................... | options: A: Scalp B: Scrotum C: Back D: Sole | answer: D </s>

<s>[INST] context: Restriction enzymes type II identifies the palindromic sequences on the DNA and cut the DNA strand at certain specific site. Types of Restriction Enzymes Restriction enzymes are traditionally classified into four types on the basis of subunit composition, cleavage position, sequence specificity and cofactor requirements. However, amino acid sequencing has uncovered extraordinary variety among restriction enzymes and revealed that at the molecular level there are many more than four different types. Type I enzymes are complex, multisubunit, combination restriction-andmodification enzymes that cut DNA at random far from their recognition sequences. Type II enzymes cut DNA at defined positions close to or within their recognition sequences. They produce discrete restriction fragments and distinct gel banding patterns, and they are the only class used in the laboratory for DNA analysis and gene cloning. Rather than forming a single family of related proteins, Type II enzymes are a collection of unrelated proteins of many different sorts. Type II enzymes frequently differ so utterly in amino acid sequence from one another, and indeed from every other known protein, that they exemplify the class of rapidly evolving proteins that are often indicative of involvement in host-parasite interactions. The most common Type II enzymes are those like HhaI, HindIII and NotI that cleave DNA within their recognition sequences. Enzymes of this kind are the principle ones available commercially.. Type III enzymes are also large combination restriction-andmodification enzymes. They cleave outside of their recognition sequences and require two such sequences in opposite orientations within the same DNA molecule to accomplish cleavage; they rarely give complete digests. Type IV enzymes recognize modified, typically methylated DNA and are exemplified by the McrBC and Mrr systems of E. coli. [/INST] question: Restriction enzymes Type II – | options: A: Methylate specific DNA sequences B: Cleaves specific palindromic DNA sequences C: Helps in protein digestion D: Helps in Keeping the nascent protein unfolded | answer: B </s>

<s>[INST] context: M/C/C of UGI bleed = non-variceal bleed (80% - Non-Variceal bleed; 20% - variceal bleed) M/C/C of non-variceal UGI bleed = Peptic ulcer M/C site of Peptic ulcer = Duodenum (1st pa) Ulcer can be present on anterior or posterior wall of duodenum - Anterior wall ulcer - Perforate - Posterior wall ulcer - Bleed (as gastroduodenal aery runs behind the posterior wall of duodenum) M/C aery involved in duodenal ulcer = Gastroduodenal aery M/C aery involved in Gastric ulcer = Left gastric aery 1st investigation performed for UGI bleed = Endoscopy (both therapeutic and diagnostic) Treatment for bleeding gastric ulcer: "The principle of management of bleeding gastric ulcers are essentially the same. The stomach is opened at an appropriate position anteriorly and the vessel in the ulcer under-run. If the ulcer is not excised then a biopsy of the edge needs to be taken to exclude malignant transformation. Sometimes the bleeding is from the spienic aery and if there is a lot of fibrosis present then the operation may be challenging. However, most patients can be managed by conservative modality even if the incidence of recurrent bleeding is less"-Bailey 27/e page 1128 Treatment for bleeding Duodenal ulcer: - Duodenotomy; ligation of bleeding vessel; truncal vagotomy; pyloroplasty [/INST] question: Treatment of choice of bleeding gastric ulcer: | options: A: TV and drainage B: Antrectomy C: Distal gastrectomy D: Under running of ulcer | answer: D </s>

<s>[INST] context: The Cave of Lascaux It was Thursday, September 12,1940.Four French teens were out exploring in the woods off the northern slopes of the Pyrenees.Many years before, an old pine tree fell and left a large hole in the ground.The teenagers were curious and they started to explore the area and fell into one of the most important archeological finds of the twentieth century! There are over a hundred limestone caves in this region of France.Some were _ by humans thousands and thousands of years ago.Between 15,000 and 17,000 years ago, humans painted lively creatures such as cows, bulls, horses, and even cats on the walls of the caves. Why did they mark these walls? Was it to tell a story? Was it to record a famous battle? There are many mysteries and ancient secrets still waiting to be discovered in the cave of Lascaux.There were dots in many of the paintings.What do these dots mean? Were they meant to record time, a calendar? Deep in the cave, there is a drawing of a "birdman".What does this mean? Was it a place for sacred ceremonies? No one knows for sure. The actual cave of Lascaux was closed in 1963 due to the overabundance of tourists visiting the site.The carbon dioxide that people were breathing out was causing damage to the fragile cave paintings.Up till now the Lascaux cave is still closed for tourists.Only a specialist can visit the cave by a special order that must be made out almost a year in advance.Not more than six persons can enter the cave per day.Two days a week, the cave is completely closed.Due to the great interest of numerous tourists, in 1983 Lascaux IIwas opened for tourism.It is an exact replica of the cave of Lascaux. [/INST] question: The Pyrenees are the _ in France. | options: A: mountains B: forests C: rivers D: caves | answer: C </s>

<s>[INST] context: As summer comes near, many children are really happy to forget about school for a few months. However, they might be taking that goal too seriously. Studies have found that children often forget between one and three months' worth of school learning during the summer months. Spelling and math abilities drop off the most, while reading is not really influenced by the time off. The main reason for this is because most children sometimes read outside of the classroom, whether newspapers, magazines, books, or video game guides. However, their math and spelling skills only get exercised in the school setting. The first purpose of summer holidays was to let farm children have time off to help work in the fields during the growing season, but this reason is no longer a good one since fewer kids actually work on farms today. Some cities in the United States, such as Los Angeles, have moved to a year-round school timetable, which may help reduce the loss of school skills that happens during the long summer holiday. To improve skills and to keep a good level of preparation, headmasters suggest trips to museums, summer camps, holidays with educational value, and visits to libraries to keep kids interested throughout the summer. There are other educational systems that provide holidays while still keeping students' skills up to date. For example, in Japan, students attend class for seven weeks in a row, followed by two weeks of holiday. This continues the whole year. In Italy, students attend class six days per week, but finish at 1: 30 pm each day, so that school does not run their life the way that it does in America, where students attend high school from 7: 45 am until 3: 00 pm each weekday. In areas where there are not enough classrooms--in Afghanistan or Somalia, for example--older students attend classes in the morning while the younger kids go to school in the afternoon. Headmasters fear that the three-month summer holiday stops the flow of learning. Just as students become used to new math problems or new ideas in reading, writing, or thinking skills, they " _ " during the summer holiday. When they go back to school after the long summer holiday, they take up to two months to return to their previous level of skill. So the debate continues: whether to continue holidays or to make changes based on the Los Angeles or the Japanese models. [/INST] question: Which skills suffer the most over the summer holidays? | options: A: Math and reading B: Math and spelling C: Reading and writing D: Reading and thinking | answer: B </s>

<s>[INST] context: Lying in the sun on a rock, the cougar saw Jeb and his son, Tom, before they saw it. Jeb put his bag down quickly and pulled his jacket open with both hands, making himself look big to the cougar. It worked. The cougar hesitated, ready to attack Jeb, but ready to forget the whole thing, too. Jeb let go of his jacket, grasped Tom and held him across his body, making a cross. Now the cougar's enemy looked even bigger, and it rose up, ready to move away, but unfortunately Tom got scared and struggled free of Jeb. "Tom, no!" shouted his father. But Tom broke and ran and that's the last thing you do with a cougar. The second Tom broke free, Jeb threw himself on the cougar, just as it jumped from the rock. They hit each other in mid-air and both fell. The cougar was on Jeb in a flash, forgetting about Tom, which was what Jeb wanted. Cougars are not as big as most people think and a determined man stands a chance, even with just his fists. As the cougar's claws got into his left shoulder, Jeb swung his fist at its eyes and hit hard. The animal howled and put its head back. Jeb followed up with his other fist. Then out of the corner of his eye, Jeb saw Tom. The boy was running back to help his father. "Knife, Tom" shouted Jeb. The boy ran to his father's bag, while Jeb stated shouting as well as hitting, to keep the cougar's attention away from Tom. Tom got the knife and ran over to Jeb. The cougar was moving its head in and out, trying to find a way through the wall Jeb was making out of his arms. Tom swung with the knife, into the cougar's back. It howled horribly and ran off into the mountains. The whole fight had taken about thirty seconds. [/INST] question: Why did Jeb pull his jacket open when he saw the cougar? | options: A: To get ready to fight B: To frighten it away C: To protect the boy D: To cool down | answer: B </s>

<s>[INST] context: How did it make you feel when you learned that KFC'S Beijing restaurants pulled three more items from their menus last week? There were fears that the items may have contained the cancer-causing coloring Sudan I.Do you have any desire to take the food provider to court because it feeds you something dangerous? After all,the law supposedly gives people the right to fight for their rights.But some experts have said it might not be so wise to take the company directly to court. Qiu Baochang,a lawyer in Beijing,suggested that consumers not take the company directly to court."In addition to the high costs,consumers'complaints are unlikely to win unless they can prove they have had the banned dye at KFC,"--Qiu explained. One problem for those wanting to take action against the fast food chain is that few customers ask for or keep receipts .And,this must be the first step. If they can prove that their health has been damaged by KFC,they can cue the company.But that would be almost impossible to do so because the Sudan I damage is a long-term effect and is not immediately apparent. A KFC spokesperson said on Monday that the company was confdent of being able to handle customers'complaints,"We will obey legal procedure if We raceive any complaints." [/INST] question: Why did KFC's Beijing restaurants pull three more items from their menus? | options: A: Because the company was afraid to handle customers'complaints B: Because coloring Sudan I may have been contained in those items C: Because the KFC's restaurants were accused ofselling poisonous food to the customers D: Because these items were no longer popular with the customers | answer: B </s>

<s>[INST] context: Libraries give kids a quiet and safe place to read and learn. For over 100 years, libraries have played an important role in Americans' education. But how are these book-filled buildings changing with the times? You may be surprised to find out. Benjamin Franklin famously founded America's first lending library in 1731. But the public library system got its biggest development in the American history in the late 1800's. Businessman Andrew Carnegie donated millions of dollars to help build free public libraries across the country. Between 1886 and 1919, Carnegie's donations helped build 1,679 new libraries. Carnegie believed that libraries could offer the chances to Americans, young and old. He knew that the more libraries there were, the more people would have opportunities to read and use books, speeches and news. If you can easily find a public library in your community , you'll get more chances. After all, the United States has 9,225 public libraries. Today, libraries keep growing. Seven tenths of the libraries have free Internet. It provides much more information and opportunities) to ask for jobs online. Libraries are also teaching kids about the fun of reading. The new program Read! Build! Play! adds reading into playtime. As kids listen to a book that is being read aloud, they use Legos to build images from the story happily. Today's libraries are always looking for creative programs to bring people into the library. Benjamin Franklin once said, "The doors of wisdom are never shut." As long as the doors of public libraries are open, what he said is most certainly correct! [/INST] question: Benjamin Franklin founded the first lending library in _ . | options: A: 1731 B: 1800 C: 1886 D: 1919 | answer: A </s>

<s>[INST] context: (Braunwald, 15/e, pp 1450-1451.) Carbon monoxide (CO) diffusing capacity provides an estimate of the rate at which oxygen moves by diffusion from alveolar gas to combine with hemoglobin in the red blood cells. It is interpreted as an index of the surface area engaged in alveolar-capillary diffusion. Measurement of diffusing capacity of the lung is done by having the person inspire a low concentration of carbon monoxide. The rate of uptake of the gas by the blood is calculated from the difference between the inspired and expired concentrations. The test can be performed during a single 10-second breath holding or during 1 minute of steady-state breathing. The diffusing capacity is defined as the amount of carbon monoxide transferred per minute per millimeter of mercury of driving pressure and correlates with oxygen transpo from the alveolus into the capillaries. Primary parenchymal disorders, anemia, and removal of lung tissue decrease the diffusing capacity. Conversely, polycythemia, congestive hea failure, and intrapulmonary hemorrhage tend to increase the value for diffusing capacity. In this patient, the possibility of Goodpasture syndrome would be considered. [/INST] question: A 25-year-old male cigarette smoker has a history of respiratory infections and has also been found to have hematuria. A high value for diffusing capacity is noted during pulmonary function testing. This finding is consistent with which of the following disorders? | options: A: Anemia B: Cystic fibrosis C: Emphysema D: intrapulmonary hemorrhage | answer: D </s>

<s>[INST] context: "Wolf!" Lydia Angiyou's five-year-old nephew Paulussie whispered with alarm as he touched her arm. At first, she didn't believe him. Angiyou, Paulussie, her other nephew Lucassie, also five, and her youngest son Jessie, seven, were walking to her mother's house -- only two doors down from her own -- one night last February. Animals were often sighted near Ivujivik -- a village on the shore of Hudson Bay in north-eastern Canada -- but rarely on its streets. The 41-year-old teacher and mother of five turned around. Looking behind her into the darkness, at first she thought that Jessie was the wolf. But a metre behind the boy was a 350kg polar bear -- no wolf in sight -- standing on the icy road. Jessie turned and saw it, too, then ran, screaming, to his mother. Angiyou felt a rush of blood to her brain. "Get as far away as you can!" she shouted to the boys as she ran towards the bear. She stopped just in front of it, then faced it quietly. It made a move to go around her to get to the boys, who must have seemed like the easier meal. But Angiyou moved with the bear to maintain her position blocking the children. Finally she got the animal's attention. In response, it rose on its hind legs, stretching to its full 2.5m height. The bear charged, paws thundering down and knocking her into a seated position. The skin under her nose tore. Falling onto her back, she screamed for help and kicked at the animal in a bicycling motion. She soon passed out. Sirqualuk Ainalik, a fellow teacher, had been at his brother's house nearby when Jessie dashed inside for help. Grabbing a rifle , the 33-year-old ran to the road, firing a warning shot into the air. He then aimed his gun at the huge bear. At this time Angiyou came to and heard the gunshot in the distance, then watched as the animal turned its attention away from her and towards the loud sound. With two more shots, Ainalik killed the polar bear. [/INST] question: Lydia Angiyou and _ children experienced the adventure. | options: A: two B: three C: four D: five | answer: B </s>

<s>[INST] context: During the week days,they are luckily busy office people; but on weekends,they are just a brood of stay home animals.A recent survey shows that office workers in China prefer quiet and easy ways to spend their weekends. In the survey,conducted by job seeking and offering website Zhaopin.com,32.8 percent of the 6000 respondents choose to stay home at weekends and have a good rest,the Beijing Morning Post reported. Twenty percent use their days off to do housework. And only 19.3 percent are willing to have fun during the break time from work.Their first choice of fun is shopping. Other choices,though practiced by few,include meeting friends,accompanying the children,trips to the suburbs,and lessons for more skills. When they go shopping,54.5 percent of the white collars actually shop in supermarkets,while 27.9 percent attend other stores,especially when discounts are offered. These activities don't seem to cost much,as 60 percent spend average less than 200 yuan(US$26)during weekends,and 30 percent no more than 500 yuan. When asked whom they would spend the weekends with,about 40 percent mention their partners,and 30 percent prefer a weekend all by themselves.Less than 20 percent hang out with friends. Only 5.8 percent would kill the time with their colleagues.This is because we tend to avoid too many personal contacts with our coworkers when we don't have to work with them,according to some experts. [/INST] question: How many of the office workers who are the respondents do the housework at weekends? | options: A: 1968 B: 1158 C: 1200 D: 1674 | answer: C </s>

<s>[INST] context: Researchers invited 79 people between the ages of 18 and 50 years old who had been diagnosed with depression. 33 of the participants were offered 20 music therapy sessions, in addition to their usual treatment for depression. The other 46 participants received stan dard treatment, and acted as the control group. The one-on-one music therapy sessions each lasted 60 minutes and took place twice a week. Trained music therapists helped each participant to improvise music. On average, each participant attended 18 music therapy sessions. 29 individuals (88 percent) attended at least 15 sessions. The participants in both groups were followed up at three and six months and assessed forsymptoms of depression and anxiety. In the final analysis, researchers discovered that af ter three months of participation, individuals who received music therapy showed greatly fewer symptoms of depression and anxiety, and scored better on general functioning. Although improvements still remained after six months, the difference between the groups was no longer statistically significant. Co-researcher Christian Gold, Ph.D., explained the study findings: "Our trial has shown that music therapy, when added to standard care including medication, psychotherapy and counseling , helps people to improve their levels of depression and anxiety. Music therapy has specific qualities that allow people to express themselves and interact in a non-verbal way - even when they cannot find the words to describe their inner experiences." Given the success of the study, researchers say it needs to be repeated with a larger sample of people, and that further research is needed to assess the cost-effectiveness of such therapy. Outside experts believe this study shows that music ther apy is an effective addition to traditional therapy and improves outcomes. Mike Crawford, M.D., said, "This is a high-quality randomized trial of music therapy specifically for depression, and the results suggest that it can improve the mood and general functioning of people with depression." [/INST] question: A standard treatment for depression includes all the following ways EXCEPT _ . | options: A: Music therapy B: Medication C: Psychotherapy D: Counseling | answer: A </s>

<s>[INST] context: "When an American asks me this question, it's like a wall of ice crashing down between us." my Moscow-born friend Galina said. The question is "How are you?". The answer Americans give, of course is, "Fine." But when Russians hear this they think one of two things: you are experiencing a rare moment of fineness or you are lying. Ask a Russian, "How are you?" and you will hear, for better or worse, the truth. I have experienced many painful minutes of silence after my grandmother made her stock response: "Terrible," to which she might add, "Why? Because being old is terrible and I am very old." "'Fine' makes Russians think that Americans have no soul," I explained recently to an American-born friend. "That they just want to go home, eat a frozen dinner in front of the TV, and wait out the hours before going to work to make money again." He laughed, "You know, there's something to that." The thing most Russians don't realize is that, in English, "How are you?" isn't a question at all, but a form of "hi", like the Russian "privyet!" Psychologists at the University of Michigan have shown that, while Russians are, indeed, easier to be depressed than Americans, their open acceptance of bad experiences might be healthier. Recently, when I looked through a few American guides on traveling to Russia, I was disappointed to find that they all suggested that tourists adopt the American approach to "How are you". [/INST] question: When you ask a Russian "how are you" the Russian will _ . | options: A: answer "fine B: tell you the truth C: make no answer D: get angry and walk away | answer: B </s>

<s>[INST] context: According to a recent survey, Canadian parents realize their role as protectors and providers to raise their children both emotionally and physically. That's not very different from the way our parents saw themselves. But with more two-career families and busy schedules, one thing parents today recognize more than ever is the need to set aside special time for their children. These 'nurturing moments' are changed into memories that they will treasure all their lives. Nurturing moments might be the time between our work and life,bringing your child to work with you to see what you do during the day,visiting your child's make-believe world,discussing his other school day and exploring the natural world outside your door. These times are not merely a luxury , they're a necessity. It's during these moments that parents pass values and attitudes to their children. Over time, children pick up good habits and positive self-image. Here are a few tips for making the most of your family time together: Regularly sit down as a family to share a meal. Allow each person to describe something interesting about his or her day. Make one night a week family night. Family members take turns choosing a special activity for the evening everyone partakes in the fun. Show your children you care about their interests by having them teach you about their activity or hobby. Nurturing healthy children involves body, mind and spirit. The little things you do to your care are the building blocks for confidence, self-esteem and a healthy outlook. By giving your children these tools, you prepare them for life. [/INST] question: Present-day parents are different from those in the past mainly because _ . | options: A: they need more time to spend on their children B: they pay more attention to their children's health C: they are much busier with their work D: the role they play in bringing up children is different | answer: C </s>

<s>[INST] context: A number of investigations may be abnormal in patients with renovascular disease. Renal function may be impaired and plasma renin activity may be elevated, sometimes with hypokalaemia due to hyperaldosteronism. Ultrasound may reveal a discrepancy in size between the two kidneys. Unfounately, these simple non-invasive tests are insufficiently sensitive for screening in hypeensive patients and vascular imaging is required to diagnose renovascular disease. Such imaging is usually undeaken only in patients in whom intervention to improve renal perfusion would be contemplated; this is usually limited to young patients and those in whom blood pressure cannot be controlled with antihypeensive agents ('resistant hypeension'), those who have a history of 'flash' pulmonary oedema or accelerated phase ('malignant') hypeension, or those in whom renal function is deteriorating. CT and MRI angiographic techniques have largely replaced Doppler ultrasound or renal isotope scanning (including 'captopril renography') in diagnosing renal aery stenosis. Conventional renal aery cannulation and aeriography is now usually undeaken for therapeutic rather than diagnostic purposes. CT angiography entails large intravenously administered doses of contrast medium which may be nephrotoxic. ref:Harrison&;s principles of internal medicine,ed 18,pg no 3045 [/INST] question: Which of the following is most specific and sensitive screening test in a case of renovascular hypeension | options: A: HRCT B: CT guided angiography C: Captopril induced radionuclide scan D: MRl | answer: D </s>

<s>[INST] context: Paul had just left college and was offered an interview for a position in a company in New York. As he needed to move from Texas to New York if he got the job, he wanted to talk about the decision with someone before accepting it. But his parents had died. He remembered that his father had suggested he should turn to an old friend of his family if he needed advice. The older man said, "Go to New York and have the interview. But I want you to go on a train and I want you to get a private compartment . Don't take anything to write with, anything to listen to or anything to read, and don't talk to anybody except when you order the meal. Call me when you get to New York and I will tell you what to do next." At first, Paul followed the advice closely. The trip took two days. As he had brought along nothing to do, he quickly became bored. He realized he was being forced into quite time - he could do nothing but think. About three hours outside New York City he broke the rules, asked for a pencil and paper and kept writing down the thoughts until the train arrived in New York. Paul called the family friend from the train station. "Thank you, Uncle I know what you wanted. You wanted me to think. And now I know what to do.""I guessed you could understand my idea, Paul," came the reply, "Good luck." Now, years later, Paul runs a company in New York. And he always spends a couple of days being alone with no phone, no television and no people to think quietly. [/INST] question: Paul would go to New York for _ . | options: A: a conference B: a visit C: education D: an interview | answer: D </s>

<s>[INST] context: When one person gains weight, their close friends often follow. Researchers have just offered evidence in a study that says obesity appears to spread through society. But the findings might also offer hope. If friends help make obesity acceptable, then they might also be influential in losing the fat. The researchers note that support groups are already an effective tool in dealing with other socially influenced problems, like alcoholism . The findings appeared in the New England Journal of Medicine. The researchers used information collected from 12,000 people. It was collected between 1972 and 2003 as part of the Framingham Heart Study. The information was highly detailed. There was even contact information for close friends of the people in the study. The researchers examined more than 40,000 social ties. They found a person's chances of becoming severely overweight increased by 50% if a friend had become obese. A sister or brother of a person who became obese had a 40% increased chance of becoming obese. The risk for a wife or husband was a little less than that. Nicholas Christakis of Harvard Medical School was a lead researcher in the study. He says there is a direct causal relationship between a person getting fat and being followed in weight gain by a friend. The study found that the sex of the friends was also an influence. In same-sex friendship, a person had a 71% increased risk of becoming obese. Men had a 44% increased risk of becoming obese after weight gain in a brother. In sisters, it was 67%. The researchers also considered the effect of where people lived in relation to each other. James Fowler of the University of California was the other lead expert. He says a friend who lives a few hundred kilometers away has as much influence as one in the same neighborhood. He says the study demonstrates the need to consider that a major part of people's health is tied to their social connections. Both researchers say their research shows that obesity is not just a private medical issue, but also a public health problem. [/INST] question: Which of the following statements would Nicholas Christakis agree to? | options: A: If one gains weight, one's friends are likely to get fat B: Social problems like alcoholism are easy to deal with C: Friends usually don't follow each other to lose weight D: One might influence others on their social behavior | answer: A </s>

<s>[INST] context: SURVEILLANCE OF GROWTH AND DEVELOPMENT Surveillance of growth and development is an important component of the routine anticipatory care of children. The main purpose of growth surveillance is to identify those children who are not growing normally. Surveillance for physical growth can be done in the following ways. 1) Weight for age Measurement of weight and rate of gain in weight are the best single parameters for assessing physical growth. The weight should be carefully repeated at intervals: Birth -1 year → Monthly The second-year → Every two months 2-5 years → Every 3 months These measurements when compared with the reference standards of the weight of children of the same age, the trend of growth becomes obvious. Weight for age can be used to classify malnutrition and determine its prevalence. 80 % of the median weight for age of the reference is cut off point below which children should be considered malnourished. 2)   Weight for age Height is a stable measurement of growth as opposed to body weight. Whereas weight reflects only the present health status of the child, height indicates the events in the past also. Low height for age : This is also known as nutritional stunting or dwarfing. It reflects past or chronic malnutrition. The cutoff point commonly taken for the diagnosis of stunting is 90 percent of the united states NCHS height for age. 3) Weight for height Weight in relation to height is now considered more important than weight alone. It helps to determine whether a child is within range of normal weight for his height. Low weight for height This is also known as nutritional wasting or emaciation (Acute malnutrition). It is associated with an increased risk of mortality and morbidity. A child who is less than 70% of the expected weight for height is classed as severely wasted. 4) Head and chest circumference Chest circumference At birth → Less than 2 cm from head circumference 6-9 months →Two measurements become equal > 6-9 months → Overtakes head circumference In severely malnourished children this overtaking may be delayed by 3 to 4 years. [/INST] question: The deficit in weight for height in a 3-year-old child indicates – | options: A: Acute malnutrition B: Chronic malnutrition C: Concomittant acute and chronic D: Under weight | answer: A </s>

<s>[INST] context: Are you looking for some new and exciting places to take your kids to? Try some of these places: *Visit art museums. They offer a variety of activities to excite your kids' interest. Many offer workshops for making hand-made pieces, traveling exhibits, book signings by children' s favorite writers, and even musical performances and other arts. *Head to a natural history museum. This is where kids can discover the past from dinosaur models to rock collections and pictures of stars in the sky. Also, ask what kind of workshops and educational programs are prepared for kids and any special events that are coming up. *Go to a Youtheater. Look for one in your area offering plays for child and family visitors. Pre-show play shops are conducted by area artists and educators where kids can discover the secret about performing arts. Puppet making and stage make-up are just a couple of the special offerings you might find. *Try hands-on science. Visit one of the many hands-on science museums around the country. These science play-lands are great fun for kids and grown-ups alike. They'll keep your child mentally and physically active the whole day through while pushing buttons, experimenting, and building. When everyone is tired, enjoy a fun family science show, commonly found in these museums. X [/INST] question: If a child is interested in the universe, he probably will visit _ . | options: A: a hands-on science museum B: an art museum C: a Youtheater D: a natural history museum | answer: D </s>

<s>[INST] context: Tetralogy of fallot is the commonest cyanotic congenital heart disease. Cyanotic Congenitial heart diseases Cyanotic CHDs are Right to Left shunts. These are further divided into : - 1) Cyanotic CHD, with decreased pulmonary blood flow. This group includes → TOF, Pulmonary atresia with intact septum, tricuspid atresia, total anomalous pulmonary venous return with obstruction. These lesions have following components : - a) Obstruction to pulmonary blood flow at tricuspid right ventricular or pulmonary valve level. b) A pathway by which systemic venous blood enters the systemic circulation via a patent foramen ovale or ASD or VSD. The degree of cyanosis depends on the degree of obstruction to pulmonary blood flow : - Mild obstruction → Cyanosis is precipitaed by stress, but may be absent at rest. Severe obstruction → Pulmonary blood flow is dependent on patency of the ductus arteriosus. When the ductus closes (10-21 days), the neonate experience profound hypoxemia, cyanosis and shock. 2) Cyanotic CBD with increased pulmonary blood flow. This group of lesions is not associated with obstruction to pulmonary blood flow. Cyanosis caused by any of the following mechanisms. Abnormal ventricular-arterial connection (e.g., Transposition of great vessels) → In this, aorta arises from rt ventricle, So that systemic venous blood returning to the right atrium is pumped directly back to the body, and oxygenated blood returning from lung is pumped back into the lungs. Total mixing of systemic venous and pulmonary venous blood (e.g., total anomalous pulmonary venous return, truncus arteriosus, a common atrium or ventricle) → Deoxygenated systemic venous blood and oxygenated pulmonary venous blood mix completely in the heart and, as a result, oxygen saturation is equal in the pulmonary artery and aorta. lf pulmonary blood flow is not obstructed, these infants have a combination of Cyanosis and heart failure. In Contrast, if pulmonary stenosis is present, these infants have cyanosis alone. [/INST] question: The commonest type of song. cyanotic heart disease is - | options: A: ASD B: VSD C: TOF D: PDA | answer: C </s>

<s>[INST] context: Campylobacter jejuni may be part of the normal flora of different domesticated animals including poultry, sheep, and cattle. Surface waters and soil where animal graze may be contaminated with C. jejuni. Therefore, C. jejuni outbreaks, which are zoonotic, may result from the ingestion of contaminated water that has not been treated. The main symptoms of C. jejuni infection are gastroenteritis, abdominal pain, fever, and malaise. The symptoms often peak at 24 to 48 hours after onset or may last for 7 to 10 days. The disease is generally self-limited. Due to the susceptibility of Campylobacter to different antibiotics including macrolides, erythromycin is the drug of choice to treat severe enteritis caused by C. jejuni. Optimum growth of Campylobacter occurs under reduced oxygen and increased carbon dioxide (5%-10%). Infection with V. cholerae results in a massive watery diarrhea that progresses to severe dehydration and hypovolemic shock. Infection with V. parahaemolyticus is associated with explosive watery diarrhea, abdominal pain, and fever. The gastroenteritis is self-limited. V. parahaemolyticus is usually found in an estuarine and marine environment and is associated with ingestion of contaminated shellfish. Enteropathogenic and entero-invasive E. coli strains are major causes of diarrhea in underdeveloped countries. Both cause watery diarrhea and vomiting. E. coli grows rapidly under aerobic conditions. [/INST] question: An outbreak of gastroenteritis occurred in a youth group camp. Water at the camp, which was not chlorinated or filtered, was obtained from a spring on the premises. The farmland near the camp was grazed by cattle and sheep. Run-off from the pasture entered the camp spring. The isolated microorganism required an atmosphere containing reduced oxygen and increased carbon dioxide for its growth. In most cases, the gastroenteritis was self-limiting. Those requiring antibiotic treatment responded to erythromycin. Which is the most likely causative agent? | options: A: Campylobacter jejuni B: Enteroinvasive Escherichia coli (EIEC) C: Enteropathogenic Escherichia coli (EPEC) D: Vibrio cholerae | answer: A </s>

<s>[INST] context: At a primary school in a small town in the east of South Carolina, second-grade teachers Carneau and Lynne are convinced that separating primary boys and girls produces immediate academic improvement in both genders David Chadwell, South Carolina's coordinator of single gender education says, " Boys and girls learn,hear and respond to their surroundings differently. We can teach boys and girls based on what we now know." Male and female eyes are not organized in the same way,he explains. The composition of the male eye makes it sensitive to motion and direction. " Boys interpret the world as objects moving through space," he says. The male eye is also drawn to cooler color1s like silver and black. It's no accident that boys tend to create pictures of moving objects instead of drawing the happy color1ful family,as girls do in class. The female eye,on the other hand,is drawn to warmer color1s like red, yellow and orange. To attract girls, Chadwell says, the teacher doesn't need to move as much as in boys' class. Using descriptive phrases and lots of color1s in presentations or on the blackboard gets their attention. Boys and girls also hear differently. " When someone speaks in a loud tone,girls interpret it as yelling, " says Chadwell. " They think you're mad and can shut down. " Girls are more sensitive to sounds. He advises girls' teachers to watch the tone of their voices. Boys' teachers should sound more forceful, even excited. A boy's nervous system causes him to be more cautious when he is standing, moving, and the room temperature is around 6.Stress in boys,he says, tends to increase blood flow to their brains, a process that helps them stay focused. Girls are more focused when they are seated in a warmer room around 75degF. Girls also respond to stress differently. When exposed to threat and conflict, blood goes to their guts ,leaving them feeling nervous or anxious. These differences can be applied in the classroom, Chadwell adds. " Single gender programs are about maximizing the learning." [/INST] question: What is David Chadwell's attitude towards separating primary boys and girls while learning? | options: A: Worried B: Concerned C: Supportive D: Uninterested | answer: C </s>

<s>[INST] context: Five years after a deadly earthquake and tsunami hit Japan, recovery remains years away. More than 16,000 people died in the disaster and more than 470,000 were removed from their homes, says the Japanese Red Cross Society. Over 2,500 people are still missing and predicted dead. After pressure from survivors, the Japanese Coast Guard began underwater searches for the missing. In Fukushima, more than 100,000 families still cannot return home, says the Red Cross Society. This is because of radioactive pollution from the damaged Daiichi Nuclear Power Plant. In Japan, the disaster is known as "3-1-1" , marking the date five years ago. It was really three disasters rolled into one. "It started with an earthquake devastating in itself, then the tsunami, and then the radiation from the nuclear plant," said Shioko Goto, a Japan expert at the Wilson Center in Washington, D.C..Goto said the disaster showed the world, "Japanese resilience and Japanese unity." But it also showed shortcomings. Among the most notable, the long time it took to stabilize the Fukushima Daiichi Nuclear Power Plant after it was flooded from the tsunami, Goto said. That process took eight months. Another, Japan's dependence on nuclear power, she said. The disaster forced Japan to close all of its nuclear power plants, leaving parts of the country without electricity. Goto offered up one major difference from the last major Japanese disaster, the 1995 Kobe Earthquake. In 2011, social media was everywhere, she said. Social media offered up plenty of "unfounded rumors and fear-mongering ," Goto said. But it also kept pressure on Japanese authorities to do more. Chikara Yoshida lost his only son, a 43-year-old volunteer fireman, on March 11, 2011. He and his daughter posted a petition on Facebook to restart underwater searches. It drew over 28,000 signatures, according to the Associated Press. The Japanese Coast Guard announced that it would resume searches this week. There have also been complaints that reconstruction efforts in hard-hit northern Japanese communities have been too slow. This week, Japanese Prime Minister Shinzo Abe said the government will respond. [/INST] question: The number of the people who died in the disaster is _ . | options: A: more than 18,500 B: over 16,000 C: over 470,000 D: more than 2,500 | answer: B </s>

<s>[INST] context: The introduction to Music Bibliography Site Welcome to the introduction to Music Bibliography Site. In the site Friedheim Library will establish Music Bibliography Course. This year four sections of this course will be offered: two sections in fall and two sections in spring. Time and Place Section 1: Tues. & Thurs. 9:30---10:20 a.m. (Room 214) Section 2: Wed. & Fri. 4:30---5:20 p.m. (Room 116) The goals of Music Bibliography To build a tool box of music reference sources To write an article with footnotes/endnotes and a bibliography about a major musical work. Note: The Music Bibliography Site serves all the teachers and students of the Peabody Conservatory of Music. ID card is required. If you are a student with a disability for which you require accommodations , please contact Dr. Eileen Soskin, Associtate Dean for Academic Affairs, the Peabody Conservatory of the Johns Hopkins University at 410-659-8100, extension 4405, at website esoskin@peabody.jhu.edu, or Ms Peggy Hayeslip, University Coordinator of Disability Services on the Homewood Campus of the Johns Hopkins University at 410-516-6225, at website phayeslip@jhu.edu to discuss reasonable and appropriate accommodations. [/INST] question: This year four sections of this course will be offered _ . | options: A: in spring and autumn B: in summer and winter C: in spring and summer D: in autumn and winter | answer: A </s>

<s>[INST] context: The Hawaiian Islands are in the Pacific Ocean almost 4,000, kilometres west of California. Tourism is very important to Hawaii. The tropical weather and beaches bring people from all over the world. But Hawaii is also experiencing problems from the downturn . Last year was the first year since 2004 that Hawaii has had fewer than seven million visitors. The state had 6,800,000 arrivals in 2008. That was a decrease of 10% from the year before. State officials expect a decrease this year of another 2%. And they expect no growth in the economy through most of the year. The Hawaiian Islands were formed millions of years ago by hot liquid rock flowing from undersea volcanoes. Visitors can still watch the process take place on the largest island, which like the state is named Hawaii. People usually just call it the Big Island. Experts say Polynesian people first sailed to Hawaii about 2,000 years ago. A king ruled the islands when the 18th century British explorer James Cook arrived. At first, Hawaiians treated Captain Cook like a god. But in the end, he was killed on the Big Island in 1779. Britain gave the islands their independence in 1843. Then, fifty years later, a group of American businessmen ousted the ruler and founded the Republic of Hawaii. It became an American territory in 1900. That was three years after the United States set up a naval base at Pearl Harbor, on the island of Oahu, which served as the command base for American operations in the Pacific during World War Two. After the war, most Hawaiians required that Hawaii should be an independent state. In Congress , though, there was resistance from southern states because of Hawaii's non-white native population. But Congress passed the Hawaii Statehood Bill in 1959. Hawaiians accepted it, and on August 21st, President Eisenhower declared Hawaii the fiftieth state. [/INST] question: The number of visitors to Hawaii in 2009 is expected to be about _ . | options: A: 5,984,000 B: 6,664,000 C: 6,800,000 D: 6,936,000 | answer: B </s>

<s>[INST] context: Thousands of people in the world are a hundred years old - or more and certain parts of the world are famous for the long lives of their inhabitants: the Vilacamba Valley in Ecuador, and the home of the Hunzas in the Himalayas. Why do so many people live to a healthy old age in certain parts of the world? What is the secret of their long lives? Three things seem to be very important: fresh air, fresh food and a simple way of life. People work near their homes in the clean mountain air instead of traveling long distances to work by bus, car or train. They do not sit all day in busy offices or factories, but work hard outdoors in the fields. They take more exercise and eat less food than people in the cities of the West. For years the Hunzas of the Himalayas did not need policemen, lawyers or doctors. There was no crime, no divorce and not much illness in their society. They were a happy, peaceful people, famous all over India for their long, healthy lives. Do you want to live to a hundred years old? Here are some rules for success. First, live in the right place. Second, choose the right kind of job. Doctors, dentists and bus-drivers die young. Farmers, priests and orchestral conductors live much longer. If you are in the wrong kind of job, you can still improve your way of life. An old man in the Caucasus was talking about his past life. "I was young then," he said, as he described his 87th year. His secret was: "Think young and stay young." An old woman from Missouri, the USA, gave this advice, "Drink a little whisky and some warm beer every day." An English lady just said, "Take a cold bath every morning." The shortest, simplest piece of advice came from Mr Jim Chapman, aged 103. "Just keep breathing," he told reporters. [/INST] question: Who is most likely to live a long life? | options: A: A doctor B: A bus-driver C: A dentist D: An orchestral conductor | answer: D </s>

<s>[INST] context: If you are in a town in a western country, you'll often see people walking with their dogs. It is still true that a dog is the most useful animal in the world. But the reason why one keeps a dog has changed Once upon a time, a man met a dog and wanted it to help him in the fight against other animals, and he found that the dog listened to him and did what he told him to. Later people used dogs for hunting other animals, and the dogs didn't eat what they got until their master agreed. So dogs were used for driving sheep and guarding chicks. But now the people in the towns and cities do not need dogs to fight other animals. Of course they keep them to frighten thieves, but the most important reason is that people feel lonely in the city. For a child, a dog is his best friend when he has no friends to play with. For a young wife, a dog is her child when she doesn't have her own. For old people, a dog is also a child when their real children have grown up and left. Now people do not have to use a dog, but they keep it as a friend, just like a member of the family. [/INST] question: _ are more useful than a dog in the world. | options: A: No other animals B: Some animals C: Many animals D: A few animals | answer: A </s>

<s>[INST] context: Chaperones are proteins that play a role in the assembly or proper folding of other proteins without themselves being components of the later' They prevent faulty folding and unproductive interactions of other proteins. Properties of chaperones :  Present in a wide range of species from bacteria to humans Many are so-called 'Heat shock proteins' (HSP) Some are inducible by conditions that cause unfolding or aggregation of proteins (e.g. Elevated temperature and various chemicals) They bind to predominantly hydrophobic regions of unfolded or aggregated proteins They act in part as a quality control or editing mechanism for detecting misfolded in the protein chaperone interaction Found in various cellular compartments such as cytosol, mitochondria and lumen of endoplasmic reticulum. About other options Proteases are enzymes that hydrolyze proteins Proteosomes (e.g. 26S component) help in degrading the proteins marked with ubiquitin The template is involved in the synthesis of nucleic acids [/INST] question: Which of the following group of proteins assist in the 'folding' of other proteins | options: A: Proteases B: Proteosomes C: Templates D: Chaperones | answer: D </s>

<s>[INST] context: Responsibility for health Individuals health is almost inseparable from the health of larger community and the health of every community in every state and territory determines the overall health status of the nation. Therefore, it involves the joint efforts of the whole social fabric (the individual, the community, and the state) to protect and promote health. 1. Individual responsibility (Self Care) Health has to be earned and maintained by the individuals by 'Self Care', a recent trend in health care. Self care refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health. For example, measuring self BP, doing exercise, taking nutritious diet etc. 2. Community responsibility (Community participation) Health can never be adequately protected by health services without active understanding and involvement of the communities whose health is at stake. This makes community participation a very important aspect of health care. Therefore, emphasis has shifted from health care for the people to health care by the people. 3. State responsibility Responsibility for health does not end with the individual and community effort. The state assumes responsibility for the health and welfare of its citizen State shall make proper state health policy. 4. International responsibility The health of mankind requires, the cooperation of governments, the people, national and international organization both within and outside the United Nations system. [/INST] question: Which of the following is the current trend in Health Care - | options: A: Qualitative enquiry B: Community participation C: Equitable distribution D: Primary Health Care | answer: B </s>

<s>[INST] context: The Canary System is able to measure defects in the tooth crystal structure with the effective probing volume of an area of 1.5 mm in diameter and up to 5 mm below the tooth surface. It provides a Canary Number (ranging from 0-100) from an algorithm combining the PTR and LUM readings, which are directly linked to the status of the enamel or root surface crystal structure. The Canary System divides signal strength and depth characteristics of the tooth into three zone. The healthy zone (Canary Number 0-20) indicates no lesion depth with PLM. The decay zone (Canary Number 21-70) indicates lesions with depth of 532 ± 322 µm. In the advanced decay zone (Canary Number 71-100) the lesions indicates a depth of 1057 ± 441 µm. The Canary System uses energy conversion technology (PTR-LUM) to image and examine the tooth. Pulses of laser light are aimed at the tooth, and the light is then converted to heat (Photothermal Radiometry or PTR) and light (luminescence or LUM), which are emitted from the tooth surface in response to the modulated pulses. [/INST] question: The Canary System is able to measure defects in the tooth crystal structure with the effective probing volume of an area of: | options: A: 1.5 mm in diameter and up to 5 mm below the tooth surface B: 2 mm in diameter and up to 5 mm below the tooth surface C: 1.5 mm in diameter and up to 4 mm below the tooth surface D: 2 mm in diameter and up to 4 mm below the tooth surface | answer: A </s>

<s>[INST] context: This month inTravelersCorner there are three teenagers' experiences in year-abroad programmes. Mariko Okada - Tokyo My year abroad in the United States was a fantastic experience. I'm not a shy person, and I was very comfortable speaking to everyone. So I got lots of speaking practice. I also learned many English songs and lots of interesting things about American culture. When I got home, my friends all said that I had improved so much! I hope to go back again in the future. Carla Fonseca - Rio de Janeiro I spent last year studying English in London. I'm from a small town, and London is a very big city. Sometimes I felt it was too big. There were so many people to talk to, but I always felt bad about my English. I missed my family, and I really missed my two cats. My roommate was always using our telephone, so I hardly had the chance for a nice long talk with my parents. I think it was a good experience for me, but I'm glad to be home! Alvin Chen - Hong Kong Studying in New Zealand was a fun experience for me, but it was also lots of hard work! I had English classes six hours a day, five days a week----with lots of homework. I also kept a diary of my experience. I like to write, and I wrote two or three pages in my diary every day. On Saturdays, my homestay family took me to lots of interesting places and showed me so many wonderful things about the culture. I'm really glad I went. [/INST] question: Where did Mariko visit? | options: A: Tokyo B: London C: the United States D: New Zealand | answer: C </s>

<s>[INST] context: Difference John and Bobby joined a company at the same time . They both worked very hard . After several years , Bobby became the manager , but John thought it was unfair , so he gave his resignation to the boss . When the boss found out the reason why John wanted to leave , he said , "I hope you will do one more thing for our company before you leave . " John agreed . The boss asked him to find out if anyone was selling watermelons at the market . John went and soon returned . He said he had found a man selling watermelons . The boss asked him how much they were . John shook his head and went back to the market . When he returned , he told the boss they were $ 1.2 per kg . Then the boss asked Bobby to find a watermelon seller at the market . Bobby went , returned and said , "Only one person is selling watermelons . $ 1.2 per kg , 340 melons in all , and each melon weighs about 2 kg . They are fresh . " John realized the difference between himself and Bobby . He decided not to leave but to learn from Bobby. [/INST] question: John and Bobby were _ . | options: A: friends B: workmates C: classmates D: brothers | answer: B </s>

<s>[INST] context: Traveling by bicycle is a very popular means of transportation throughout China. China has a huge population, and it is said that there is at least one bicycle for every two people within the country. Of course, many people in China ride bicycles purely for sport or exercise, but it's also a much more commonly accepted means of everyday transportation, as compared to countries such as the United States. If you are living for a long period of time in China, chances are you will want to purchase your own bicycle so that you can use it whenever you want for transportation or just for the enjoyment of riding. Even if you don't use a bicycle for everyday transportation, owning one can be a great way of enjoying some of the trails in the rural areas, just for fun. However, if you are just visiting China, renting a bicycle can be a more convenient choice. It is important to choose the correct bicycle for your use. You'll find that in China, the one-speed style of bicycle is extremely popular. These bicycles are great if you want to ride around in the city to see the sights. They are quite comfortable and easy to ride. You can often rent a bicycle for an entire day for around $15. However, if you wish to ride on some of the rural paths, a mountain bike style would be a better choice. They are great for different kinds of road surfaces, providing for a safer ride. If you are planning to have a desire to tour and still be able to carry packages with you, then a touring bike would be the best choice. These are generally the most expensive to rent, but are extremely handy for carrying packages and even some of your luggage along with you. [/INST] question: If you are traveling in Beijing you'd better _ . | options: A: buy a bike B: borrow a bike C: steal a bike D: rent a bike | answer: D </s>

<s>[INST] context: Charlie Chaplin was one of the greatest and most widely loved silent movie stars. From Easy Street (1917) to Modern Times (1936), he made many of the funniest and most popular films of his time. He is best known for his character "the little tramp ". It is this kind-hearted character that we connect with the time of silent movies. Born in London in 1889, Chaplin first visited America with a theater company in 1907. Appearing as Billy in the play Sherlock Holmes, the young Chaplin toured the country twice. On his second tour, he met Mack Sennett and was signed to Keystone Studios to act in films. In 1914, Chaplin made his first short film, Making a Living. That same year, he made thirty-four more short films. These early silent shorts allowed very little time for anything but physical comedy, and Chaplin was extremely good at it. Chaplin was known as one of the most demanding men in Hollywood. No matter how big or tiny the size of the part, Chaplin walked each actor through every scene. Chaplin knew that a successful scene wasn't simply about the star, but about everyone on the screen. He required that all the actors and actresses work together in every performance. The only way to achieve it was to keep complete control over every scene. As he became more popular, he used more and more creative and difficult filming techniques. Movies such as his 1925 hit, The Gold Rush, required endless reworking of scenes and rebuilding of sets. Though Chaplin is of the silent movie era, his achievements were carried over into the films of today. His strictness and concern for the processes of acting and directing made his films great and led the way to a new and more wonderful cinema. Chaplin's working life in entertainment lasted over 75 years, from the Victorian stage and the music hall in the United Kingdom as a child performer, until close to his death at the age of 88. [/INST] question: Which of the following is NOT a Charlie Chaplin film? | options: A: Easy Street B: Making a Living C: The Gold Rush D: Sherlock Holmes | answer: D </s>

<s>[INST] context: Tu Youyou, 84, honored with the Nobel Prize in Physiology or Medicine on Oct 5, 2015. She was the first Chinese citizen to win a Nobel Prize in science for her work in helping to create an anti-malaria medicine. In 1967, Communist leader Mao Zedong decided there was an urgent national need to find a cure for malaria. At the time, malaria spread by mosquitoes was killing Chinese soldiers fighting Americans in the jungles of northern Vietnam. A secret research unit was formed to find a cure for the illness. Two years later, Tu Youyou was instructed to become the new head of Mission 523. Researchers in Mission523 _ ancient books to find historical methods of fighting malaria. When she started her search for an anti-malarial drug, over 240,000 compounds around the world had already been tested, without any success. Finally, the team found a brief reference to one substance, sweet wormwood , which had been used to treat malaria in China around 400 AD. The team isolated one active compound in wormwood, artemisinin , which appeared to battle malaria-friendly parasites . The team then tested extracts of the compound but nothing was effective until Tu Youyou returned to the original ancient text. After another careful reading, she improved the drug recipe one final time, heating the extract without allowing it to reach boiling point. After the drug showed promising results in mice and monkeys, Tu volunteered to be the first human recipient of the new drug. "As the head of the research group, I had the responsibility." she explained. [/INST] question: When did Ms. Tu start her malaria research? | options: A: When she was 84 years old B: After she entered "Mission 523" C: In 1967 D: When malaria become serious among ordinary Chinese people | answer: B </s>

<s>[INST] context: "Joe? Is chat you?" The woman speaking to me at he baseball game looked somewhat familiar, "Marci? " "It IS you ! " she exclaimed, smiling broadly. "God, it's good to see you again !" It was good to see Marci, too. Very often during the past few decades, I've wondered about her, I almost tried to reach her a few years ago after talking to a shared friend, who had indicated that the 1990s had been pretty rough for Marci. So, running into her at the baseball game was, at the very least, just happening by chance. We spent a few minutes talking about the business of our lives: kids and grandkids, husbands and houses, education and recreation. It's always a little upsetting to see how few words are required to summarize 32 years of living. We played a little "have you seen...?" and "did you know,..?" And we recalled the good old, bad old days we used to spend together. Then Marci grew quiet for a moment, looking out over the crowd walking about the marketing area at the stadium. "You know, Joe." she said, "I've always wanted to tell you...how...you know...how sorry I am for the way I treated you." Hearing that, I felt I was suffering extreme embarrassment. One does not like to remember when one has been rid of by others roughly and suddenly. "It's OK." I said. "No big deal." At least, I thought to myself, not now. "But I was so stupid: she continued. Yes, you were. I thought. "We were both pretty young:' I said. "I know," she said. "But that's no excuse for..." She hesitated. then continued. "It's just always bothered me, remembering how mean I was to you.And I've wanted to tell you that I'm sorry. So...I'm sorry." The smile on her face was warm and sincere, and there was something in her eyes, it looked a lot like relief-- _ since she had played Wif'fle ball with my heart. "OK:'I said. "Apology accepted! Overcome by the sweetness of the moment. I reached an arm around her and gave her a quick hug Just then, the crowd erupted with a huge cheer, and Marci and I both returned our attention to the game By the time I looked over to where she had been, she was gone. But the warm, wonderful feeling of our brief exchange was still there, and continues to this day whenever I think about it . We all carry bitter, discomforting memories of deeds done or undone, and words said or unsaid. And we all bear wounds --some slight, some not so slight--that have been inflicted upon us by others.The healing balm of forgiveness can calm a troubled conscience and bring peace to an injured soul, even years after the fact. Of course,it isn't enough to just say "I'm sorry," and "You're forgiven." While there is indeed great power in those simple words, it is not available to those who are insincere, or who are only looking for a way to control or exploit.But when those words are truly felt and sincerely expressed , they can open the door to miracles( )of the heart and soul - miracles of forgiveness, even at a baseball game. [/INST] question: When Joe and Marci saw each other by chance at a stadium, they both felt _ . | options: A: surprised and delighted B: embarrassed and sorry C: sensitive and curious D: upset and concerned | answer: A </s>

<s>[INST] context: Some teachers are unforgettable. They lead by example and never lose their smile. They change lives. Eileen Madden is one of them. . "It's a joy to get up early every morning to be the first one here," say the 55-year-old Holy Ghost School third grade teacher. Madden arrives shortly after 6 am to prepare her classroom and work on the school breakfast program. "My family all went to St. Teresa's School," she says. "I always said, 'One day, I'm going to come back and get one of those big desks.'" With a watchful eye always on the lookout for "one of those big desks", Madden returned to St. Teresa after graduating from college and taught second grade at the Olneyville neighborhood elementary school until it was burnt in a fire in 1990 and had to be closed. Madden then went to Holy Ghost School where she started as a second-grade teacher and then moved up one grade level. "I take care of setting up and serving breakfast," she says. "In winter it is still dark when I arrive here." Madden praises Holy Ghost School Principal Carol Soltys and the school's workers for their continued support. "It's a family," she said. Her class is small this year with 15 students, including some from the Dominican Republic, Puerto Rico, Costa Rica, Haiti, Guatemala, Nigeria and Ghana. Madden admits that she's encouraged by her former students, now grown-ups, who want their own children to enjoy a similar experience in a safe, good environment. "They tell others, 'I send my child to Eileen Madden's School, '" she adds. [/INST] question: What does Eileen Madden most probably think of the workers of Holy Ghost School? | options: A: Lazy but kind B: Careful but helpless C: Hard to get along with D: Kind and helpful | answer: D </s>

<s>[INST] context: The clinical presentation of primary hyperparathyroidism is described on page 769. Parathyroid bone disease is now rare due to earlier diagnosis and treatment. Osteitis fibrosa results from increased bone resorption by osteoclasts with fibrous replacement in the lacunae. This may present as bone pain and tenderness, fracture and deformity. Chondrocalcinosis can occur due to deposition of calcium pyrophosphate crystals within aicular cailage. It typically affects the menisci at the knees and can result in secondary degenerative ahritis or predispose to attacks of acute pseudogout Skeletal X-rays are usually normal in mild primary hyperparathyroidism, but in patients with advanced disease characteristic changes are observed. In the early stages there is demineralisation, with subperiosteal erosions and terminal resorption in the phalanges. A 'pepper-pot' appearance may be seen on lateral X-rays of the skull. Reduced bone mineral density, resulting in either osteopenia or osteoporosis, is now the most common skeletal manifestation of hyperparathyroidism. This is usually not evident radiographically and requires assessment by DEXA (p. 1065). Primary hyperparathyroidism Primary hyperparathyroidism is caused by autonomous secretion of PTH, usually by a single parathyroid adenoma, which can vary in diameter from a few millimetres to several centimetres. It should be distinguished from secondary hyperparathyroidism, in which there is a physiological increase in PTH secretion to compensate for prolonged hypocalcaemia (such as in vitamin D deficiency, p. 1126), and from teiary hyperparathyroidism, in which continuous stimulation of the parathyroids over a prolonged period of time results in adenoma formation and autonomous PTH secretion (Box 20.39). This is most commonly seen in individuals with advanced chronic kidney disease (p. 483). The prevalence of primary hyperparathyroidism is about 1 in 800 and it is 2-3 times more common in women than men; 90% of patients are over 50 years of age. It also occurs in the familial MEN syndromes (p. 795), in which case hyperplasia or multiple adenomas of all four parathyroid glands are more likely than a solitary adenoma. Clinical and radiological features The clinical presentation of primary hyperparathyroidism is described on page 769. Parathyroid bone disease is now rare due to earlier diagnosis and treatment. Osteitis fibrosa results from increased bone resorption by osteoclasts with fibrous replacement in the lacunae. This may present as bone pain and tenderness, fracture and deformity. Chondrocalcinosis can occur due to deposition of calcium pyrophosphate crystals within aicular cailage. It typically affects the menisci at the knees and can result in secondary degenerative ahritis or predispose to attacks of acute pseudogout In nephrocalcinosis, scattered opacities may be visible within the renal outline. There may be soft tissue calcif ication in aerial walls and hands and in the cornea. DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-769 [/INST] question: Osteitis fibrosa cystica is seen in | options: A: Hyperparathyroidism B: Hypoparathyroidism C: Hypothroidism D: Hypehyroidism | answer: A </s>

<s>[INST] context: Museums Skyscraper Museum Wednesday - Sunday: 10:00 AM - 6:00 PM Adults: $5 305-756-2385 Interested in tall buildings? Design? Then this museum is for you!!! Check the historical buildings and their special design right in lower Manhattan. Madame Tussaud's Wax Museum Sunday - Thursday: 10:00 AM - 8:00 PM Friday - Saturday: 10:00 AM - 10:00 PM Adults: $29 Students: $13 305-532-9623 The students in Manhattan had an exciting experience at Madame Tussaud's! They met hundreds of famous people at a discounted price! This museum is your chance to meet your idols and have a picture taken with them. Bass Museum of Art Tuesday - Saturday: 10:00 AM - 5:00 PM Sunday: 11:00 AM - 5:00 PM Adults: $8 The old / Students: $6 305-673-7530 http://www.bassmuseum.org Enjoy European paintings, and sculptures. It also includes exhibitions of modern artists from different parts of the world. You will also enjoy visiting its beautiful museum shop and media center. World Art Museum Daily: 11:00 AM - Midnight (including holidays) Cost: $15 305-532-9336 http://www.weam.com Located in the heart of the South Beach Art Deco district, this museum shouldn't be missed! It is currently one of South Florida's hottest new attractions. [/INST] question: If you are into how to build a house, you may go to _ . | options: A: Skyscraper Museum B: Bass Museum of Art C: World Art Museum D: Madame Tussaud's Wax Museum | answer: A </s>

<s>[INST] context: This patient has a sudden onset of complete, unilateral, painless loss of vision with intact extraocular muscle movement. This is consistent with occlusion of the retinal aery. The retina derives its blood supply from the internal carotid aery the ophthalmic aery, from which branch the central retinal aery and ciliary aeries. The central retinal aery supplies the inner layers of retina, while ciliary aeries supply blood to the choriocapillaris and the outer retinal layers. Occlusion of small retinal aerioles produces "cotton wool" spots while total occlusion of the ophthalmic aery leads to total ischemia and blindness. This usually occurs secondary to atherosclerotic disease. The key here is recognizing that the loss of vision is an isolated finding with no other neurologic symptoms. Other deficits would be consistent with a stroke of a larger vascular territory such as the internal carotid aery. Carotid aery dissection is less likely than retinal aery occlusion because there would likely be multiple associated neurologic findings in the case of dissection, as the internal carotid aery supplies a large poion of the anterior circulation of the brain. The most likely symptoms among a large cadre of possibilities is face and arm weakness contralateral to the dissection. Cavernous sinus thrombosis would lead to facial pain and possible cranial nerve deficits. The optic nerve (cranial nerve II) extends anteriorly from the optic chiasm through the superior orbital fissure. Posterior cerebral aery occlusion is less likely than retinal aery occlusion because there would likely be multiple associated neurologic findings. Also, the visual field loss resulting from a unilateral posterior cerebral aery occlusion would more likely be a homonymous hemianopia, it would not cause complete blindness in one eye. Other changes that may occur from posterior cerebral aery stroke are complex findings, such as the inability of recognize faces (prosopagnosia), failure to connect visual perception with conscious thought, color vision loss, and difficulty with reading (dyslexia or alexia). Memory problems and motor impairment are also common associated findings. [/INST] question: A 69-year-old man presents to the emergency depament with painless vision loss of his right eye. He describes the visual loss as a gradual progression from blurry to total blackout over the past two hours. He has no history of prior visual problems. Past medical history is significant for a myocardial infarction three years ago. The patient takes aspirin daily. Vital signs are normal. Physical examination reveals 20/20 vision of the left eye but no vision in the right eye. Extraocular muscles are intact. The neurologic examination is normal. The cardiac examination reveals an S4 hea sound. The most likely cause of this unilateral blindness is which of the following? | options: A: Carotid aery dissection B: Cavernous sinus thrombosis C: Posterior cerebral aery occlusion D: Retinal aery occlusion | answer: D </s>

<s>[INST] context: In Japan's capital city of Tokyo, earthquake danger limits the height of buildings. The city has spread out so far and the traffic has become so heavy that it is very difficult to go from one place to another. The price of the land, too, has skyrocketed. All these explains why a group of Japanese land developers came to the conclusion that there was nowhere to go but down. So far they have dug out space underground for fifteen shopping centres. What are some of the advantages of shopping and eating underground? Clean air is one of them. The city of Tokyo has one of the most serious smog problems in the world. Another advantage is that you escape the ever-present threat of traffic accidents on the city's busy streets. Still another is the convenience of getting around: you are usually right next to, or even in, a subway station. And you can even spend the night underground if you like. The Kibosh station, for example, in downtown Tokyo, has a hotel with a bar, restaurant, and barbershop. [/INST] question: The reason why buildings can not be very high in Tokyo is _ . | options: A: that the information about high buildings is limited in Tokyo B: that the workers haven't mastered enough modern science and technology C: the earthquake D: the heavy traffic | answer: C </s>

<s>[INST] context: Out of the given options only spinal muscular atrophy is able to cause hypotonia and hyporeflexia during infancy. Rest of them either present late in childhood or do not give the symptoms. Polyhydramnios and decreased fetal movements can occur in any neuromuscular disorder which present during intrauterine life. Lets see each option one by one. Spinal muscular atrophy (SMA) SMA is a degenerative disease of motor neurons that begin in fetal life and continue to progress in infancy and childhood. The cardinal features are: Hypotonia Generalized weakness Absent tendon stretch reflexes Involvement of tongue face and jaw muscle but sparing of extraocular muscle and sphincters. Congenital myotonia Congenital myotonia or myotonia congenita is a chloride channel defect of skeletal muscle. There are weakness and generalized hypertrophy of muscles. Its ruled out as Presents in early childhood (2-3 years age) Deep tendon reflexes are preserved. Congenital myasthenia It's a disease of neuromuscular junction similar to myasthenia gravis except that its not autoimmune but rather due to genetic mutations. It presents in infancy and childhood with symptom similar to myasthenia gravis. It can be ruled out as- It does not present in the intrauterine life (so does not cause polyhydramnios). DTRs are preserved Muscular dystrophies Muscular dystrophy refers to a group of hereditary progressive diseases. It includes Duchene's muscular dystrophy         Limb-girdle       Congenital myopathies Becker   Myotonic dystrophic All of these except congenital myopathies are easily ruled out as they present in childhood age. some may rarely present in infancy but never in the intrauterine life. Congenital myopathies are the most difficult one to rule out. They present with hypotonia in infancy. It may also present in intrauterine life. The only reason I'm with 'Spinal muscular atrophy' is that congenital myopathy is a very rare disease. [/INST] question: An infant presents with hypotonia and hyporeflexia. During his intrauterine period, there was polyhydramnios and decreased fetal movements. Most probable diagnosis is – | options: A: Spinal muscular atrophy B: Congenital myasthenia C: Congenital myotonia D: Muscular dystrophy | answer: A </s>

<s>[INST] context: It all started a year before when my daughter Suzanne and I were shopping in Sydney. In the window of a sports shop I noticed a photo of a group of young people climbing the rock along a canyon . "That's what I'm going to do next year," I said. Suzanne laughed. "Sure, Mom! Don't forget you're 65 years old. " I didn't feel l was that age! I joined a club and trained weekly. Each day I felt my physical energy increase and, along with it, my confidence. Then Suzanne pointed out, "It's good, but how can you clear away the fear of height?" "I've got it worked out, " I replied bravely. "We're going to the indoor climbing center. " While I was going up the high wall, I was afraid to look down as if a terrible animal was after me. Some time later, as I reached the ground, I sat down heavily on the floor. Later that night, as I lay in bed, I encouraged myself, "You've climbed the wall! You'll certainly make it! " We set off with our packages to the Grand Canyon. When we reached it, I found the canyon was a huge black hole--far deeper than I had imagined. As the guide clipped me onto the rope, _ . Time lost all meaning as I pushed my body forward. Only the strong rope kept me from losing hope. I began to think it would never end when everyone had stopped. "This is as far as we go, and we can climb out after a few steps, " the guide said finally. Two and a half hours later, we returned to the car park at last. I began to shake, one hard step after another. Getting onto the bus, I fell into the seat I had left so confidently a lifetime before. Then, while I was in the seat catching my breath, a feeling of happiness spread through me. I had done it, at the age of 66. ,. [/INST] question: At the beginning, what's her daughter's attitude towards her decision? | options: A: Supportive B: Doubtful C: Confident D: Satisfied | answer: B </s>

<s>[INST] context: Mucocele of appendix: A mucocele of the appendix is an obstructive dilatation by intraluminal accumulation of mucoid material. Mucoceles may be caused by one of four processes: retention cysts, mucosal hyperplasia, cystadenomas, and cystadenocarcinomas. The clinical presentation of a mucocele is nonspecific, and often it is an incidental finding at operation for acute appendicitis. An intact mucocele presents no future risk for the patient; however, rupture may lead to pseudomyxoma peritonei or mucinous carcinomatosis of appendiceal origin Every effort is made to keep the mucocele intact during extraction, including placing the specimen in a bag and converting a laparoscopic procedure to open. Management of Mucocele: Includes resection of the appendix, plus wide resection of the mesoappendix to include all the appendiceal lymph nodes, collection and cytologic examination of all intraperitoneal mucus, and careful inspection of the base of the appendix. Right hemicolectomy is done for patients with a positive margin at the base of the appendix or positive periappendiceal lymph nodes. [/INST] question: Mucocele of the appendix isa) Benign tumourb) Low grade malignancyc) Retention cystd) Infective process | options: A: abc B: bc C: acd D: bcd | answer: A </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 short 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 important to prevent aspiration pneumonia. It is important to make the patient NPO, to avoid further 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. But Still “Tubal feeding (either by nasogastric tube or gastrostomy) however is often unavoidable.” – Scotts Brown 7/e, vol 1 p 1278 Here it is important to note that feeding Gastrostotomy / jejunostomy are not the gold standard methods of preventing aspiration but rather are done to maintain the nutritional status of patient and prevent further aspiration. In fact according to most texts – they are a common cause of aspiration. 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 7/e, vol 1 p 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 short 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 According to Scotts Brown and Internet sites: It is the procedure of choice as it is reversible. But it has disadvantage of sacrificing voice. Alternative procedure is Tracheoesophageal diversion but has higher complication rates. [/INST] question: Gold standard surgical procedure for prevention of aspiration is - | options: A: Thyroplasty B: Tracheostomy C: Tracheal division and permanent tracheostomy D: Feeding gastrostomy jejunostomy | answer: C </s>

<s>[INST] context: Electronic waste, or e-waste, refers to electronic products that are no longer usable. This can include TVs, cell phones and computers and other office electronics, electronic toys and videos machines. Today, the average turnover rate for a computer in the United States is every two years, according to the environmental group, Greenpeace. The group's Dai Yun says e-waste is a global problem. "The electronic industry is one of the fastest growing industries in the world. The high speed of growth in this industry means more and more electronic products are being wasted and thrown away. If no one decides to retrieve the old products and process them properly, the electronic waste will sweep over the earth like the huge wave behind me and pollute the Earth seriously." Greenpeace works out that 20 to 50 million tons of e-waste are produced globally each year. The components in many electronic products contain harmful chemicals that pollute ground water and the environment. At present , the U.S. has no federal law for the disposal of e-waste although a few states have e-waste recycling programs in place, but there is no law. The U.S. exports much of its e-waste to third world countries, such as India and China, where workers took apart computers for valuable parts, hoping to sell them for money. But harmful wastes expert, Dr. Bakul Rao, says that's a dangerous practice. "From now on, the recyclers are not very educated. All they know is they can retrieve copper or gold out of it. So, the easiest way to do that is leach it out in an acid or burn it off to retrieve it. So, that's where they don't know how to deal with it, neither do they have any health systems in place. So, their exposure is more." [/INST] question: Which of the following is most likely not to be a form of e-waste? | options: A: A mobile phone B: A radio C: An e-bike D: A table | answer: D </s>

<s>[INST] context: Chronic atrophic gastritis  Chronic atrophic gastritis is a process of chronic inflammation of the stomach mucosa, leading to loss of gastric glandular cells and their eventual replacement by intestinal and fibrous tissue. Chronic atrophic gastritis is classified according to the predominant site of involvement :- 1.  Type 'A' gastritis It refers to body - predominant form involving fundus and body with sparing of antrum. It is also called as autoimmune gastritis as the damage is due to autoimmunity. It is less common of the two forms of chronic atrophic gastritis. 2.  Type `B' gastritis It is called as antral predominant gastritis as antrum is involved predominantly. However, it is misnomer as the inflammatory process may progress to body and fundus and causing pangastritis. H. pylori infection is the cause of type B gastritis. It is the most common cause of chronic gastritis and by for the most important etiological association with chronic gastritis is chronic infection with H. pylori. [/INST] question: Type B gastritis -a) Body predominant b) Fundus predominantc) Antral predominant d) H. pylorie) Autoimmune | options: A: ab B: bc C: bd D: cd | answer: D </s>

<s>[INST] context: <p>Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of PTH. The elevation of circulating hormone usually leads to hypercalcemia and hypophosphatemia.Hypercalcemia in vitamin D intoxication is due to an excessive biologic action of the vitamin, perhaps the consequence of increased levels of 25(OH)D rather than merely increased levels of the active metabolite 1,25(OH) 2 D (the latter may not be elevated in vitamin D intoxication). 25(OH)D has definite, if low, biologic activity in the intestine and bone. The production of 25(OH)D is less tightly regulated than is the production of 1,25(OH) 2 D. Hence concentrations of 25(OH)D are elevated severalfold in patients with excess vitamin D intake. The diagnosis is substantiated by documenting elevated levels of 25(OH)D >100 mg/mL. Hypercalcemia is usually controlled by restriction of dietary calcium intake and appropriate attention to hydration. These measures, plus discontinuation of vitamin D, usually lead to resolution of hypercalcemia. However, vitamin D stores in fat may be substantial, and vitamin D intoxication may persist for weeks after vitamin D ingestion is terminated. Such patients are responsive to glucocoicoids, which in doses of 100 mg/d of hydrocoisone or its equivalent usually return serum calcium levels to normal over several days; severe intoxication may require intensive therapy(harrison 18 pg 3108)</p> [/INST] question: Raised calcium and phosphorus are seen in - | options: A: CRF B: Vitamin D intoxication C: Hyperparathyroidism D: pseudohypoparathyroidism | answer: B </s>

<s>[INST] context: Liverpool, my hometown, is a unique city. It is so unique that in 2004 it became a World Heritage Site. I recently returned to my home city and my first stop was at a museum on the River Mersey. Blanketed in mist , Victorian architecture rose from the banks of the river, responded to the sounds of sea-birds, and appeared unbelievably charming. When I headed toward the centre, I found myself surrounded by buildings that mirror the best palaces of Europe. It is not hard to imagine why, on first seeing the city, most visitors would be overpowered by the beauty of the noble buildings, which are solid signs of Liverpool's history. As if to stress its cultural role, Liverpool has more museums and galleries than most cities in Britain. At Walker Art Gallery, I was told that it has the best collections of Victorian paintings in the world, and is the home of modern art in the north of England. However, culture is more than galleries. Liverpool offers many music events. As Britain's No.1 music city, it has the biggest city music festival in Europe, and its musicians are famous all over the world. Liverpool is also well-known for its football and other sports events. Every year, the Mersey River Festival attracts thousands of visitors, making the city a place of wonder. As you would expect from such a city, there are restaurants serving food from around the world. When my trip was about to complete, I chose to rest my legs in Liverpool's famous Philharmonic pub . It is a monument to perfection, and a heritage attraction itself. Being a World Heritage Site, my home city is certainly a place of "outstanding universal value". It is a treasure house with plenty of secrets for the world to explore. [/INST] question: Visitors who see the city for the first time would be deeply impressed by _ | options: A: its charming banks B: its famous museums C: its wonderful palaces D: its attractive buildings | answer: D </s>

<s>[INST] context: Any patient who has lost much of the ileum (whether from injury, disease, or elective surgery) is at high risk of developing enteric hyperoxaluria if the colon remains intact. Calcium oxalate stones can subsequently develop due to excessive absorption of oxalate from the colon. Normally, fatty acids are absorbed by the terminal ileum, and calcium and oxalate combine to form an insoluble compound that is not absorbed. In the absence of the terminal ileum, unabsorbed fatty acids reach the colon, where they combine with calcium, leaving free oxalate to be absorbed. Unabsorbed fatty acids and bile acids in the colon also promote oxalate uptake by the colon. Subsequently, the excess oxalate is excreted by the kidneys, promoting calcium oxalate stone formation. Hungry bone syndrome refers to rapid remineralization of bones leading to hypocalcemia and can be seen postoperatively in patients with secondary or teiary hyperparathyroidism. Pseudohyperparathyroidism refers to hypercalcemia associated with the production of parathyroidrelated peptide. A unicameral bone cyst is a benign lesion found in children [/INST] question: A 50-year-old patient presents with symptomatic nephrolithiasis. He repos that he underwent a jejunoileal bypass for morbid obesity when he was 39. Which of the following is a complication of jejunoileal bypass? | options: A: Pseudohyperparathyroidism B: Hyperuric aciduria C: Hungry bone syndrome D: Hyperoxaluria | answer: D </s>

<s>[INST] context: Adductor of vocal cordsThyroarytenoid muscle:- R and L muscles; attached to thyroid and arytenoid cailages on each side.Action shoens and relaxes vocal ligament.Note: deeper inner fibers referred to as "vocalis muscle".Lateral cricoarytenoid muscle: (R and L muscles):- Attached to cricoid and arytenoid cailage on each side.- Closes or adducts vocal folds.- Supplied by Recurrent laryngeal nerve.Cricothyroid muscle:Attached to cricoid and thyroid cailages.Tilts the thyroid cailage, thus increasing tension of vocal foldsSupplied by external laryngeal nerveInter-arytenoid muscle (transverse and oblique)- Attached between right and left arytenoid cailages- Closes inlet of larynx- Supplied by Recurrent laryngeal nerve Abductor of vocal cordsPosterior cricoarytenoid muscleAttached to cricoid and arytenoid cailagesMove arytenoid cailages so as to move both vocal folds apa, "open" of abduct vocal foldsSupplied by Recurrent laryngeal nerveVocalis muscle (derived from inner and deeper fibers of thyroarytenoid msucle)Supplied by Recurrent laryngeal nerveAll intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve except for cricothyroid which is supplied by external laryngeal nerve. [/INST] question: The muscle which is not supplied by recurrent laryngeal nerve is | options: A: Thyroarytenoid B: Posterior cricoarytenoid C: Cricothyroid D: Lateral cricoarytenoid | answer: C </s>

<s>[INST] context: The Underground Railroad wasn't underground and it wasn't a railroad. But it was real just the same. And it was one of the brightest chapters in American history. The Underground Railroad was a secret network of people who helped slaves flee to freedom before the Civil War. The slaves were black people from families who had been brought from Africa in chains. They were owned by their white masters and forced to work without pay. The first slaves arrived inprefix = st1 /Jamestown,Virginiain 1619. Two hundred years later, there were nearly four million slaves in theUnited States. Most worked in large plantations in the South. By then, slavery had been outlawed in most northern states. Many slaves were treated cruelly. Some were not. All could be bought and sold. Some slaves bought their own freedom by earning money during time off from work at the plantation. There were free black people in both the North and South during slavery days. Thousands of slaves ran away each year. Some fled to get away from harsh masters. Others wanted to enjoy liberty. The Underground Railroad was started to help them. The "station" of the Underground Railroad were homes, shops, and churches where runaway slaves were hidden and fed. The "agents" or "stationmasters" were people --- both black and white --- who hated slavery. They wanted to help slaves get free. "Conductors" on the Underground Railroad led or transported fugitives from station to station on their way to free states. They had to watch for slave catchers, who were paid to capture runaways and return them. Some conductors guided slaves all the way to Canada. The most famous conductor was Harriet Tubman. She was a strong, determined woman. Before she became a conductor, Mrs. Tubman had been a passenger on a dangerous journey on the Underground Railroad. She lived as a slave on the plantation inMaryland. One day in 1849, Mrs. Tubman heard that she was going to be sold. She decided to escape instead. Harriet Tubman walked away from the plantation that night. She followed the North Star toward the free state ofPennsylvania90 miles away. Sometimes she hiked all night, from station to station on the Underground Railroad. Once she was hidden under blankets and vegetables in a farm wagon, and she rode through the night. Another time she was carried in a rowboat for miles. She got toPennsylvaniaone morning just at sunrise. [/INST] question: Slaves could buy their own freedom through _ . | options: A: overtime work B: the Underground Railroad C: a secret network D: working on the plantation | answer: A </s>

<s>[INST] context: Glossopharyngeal and lesser palatine nerves supply palatine tonsilPalatine tonsilThe Palatine tonsils are two prominent masses situated one on either side between the glossopalatine and pharyngopalatine arches.Each tonsil consists fundamentally of an aggregation of lymphoid tissue underlying the mucous membrane between the palatine arches.In the child the tonsils are relatively (and frequently absolutely) larger than in the adultThe follicles of the tonsil are lined by a continuation of the mucous membrane of the pharynx, covered with stratified squamous epitheliumAeries supplying the tonsil are the:Dorsalis linguae from the lingualThe ascending palatine and tonsillar from the external maxillaryThe ascending pharyngeal from the external carotidThe descending palatine branch of the internal maxillaryA twig from the small meningeal.The veins end in the tonsillar plexus, on the lateral side of the tonsilThe nerves are derived from the sphenopalatine ganglion, and from the glossopharyngeal. [/INST] question: Sensory nerve supply of the palatine tonsils is by | options: A: Greater Palatine nerve B: Trigeminal nerve C: Glossopharyngeal nerve D: Facial nerve | answer: C </s>

<s>[INST] context: The very wealthy English Baron Fitzgerald had only one child, a son, who understandably was the apple of his eye. His wife died when the child was in his early teens. So Fitzgerald devoted himself to fathering the kid. Unfortunately the son died in his late teens. Meanwhile, Fitzgerald's wealth greatly increased. He spent a lot on art works of the masters. Later Fitzgerald himself because seriously ill. Before his death, he had carefully prepared his will as to how his wealth would be settled--to sell his entire collection at an auction . Because of the large quantity and high quality of his collection, a huge crowd of possible buyers gathered for the auction. Many of them were museum directors and private collectors eager to bid .Before the auction, the art works were shown, among which was a painting of Fitzgerald's son by an unknown artist. Because of its poor quality, it received little attention. When it was time for the auction, the auctioneer gaveled the crowd to attention. First the lawyer read from Fitzgerald's will that the first art work to be auctioned was the painting of his son. The poor-quality painting didn't receive and bidders...except one--the old servant who had served the son and loved him, and who for emotional reasons offered the only bid. As soon as the servant bought the painting for less than one English pound, the auctioneer stopped the bidding and asked the lawyer to read again from the will. The crowd became quiet, and the lawyer read from the will:"Whoever buys the painting of my son gets all my collection."Then the auction was over. [/INST] question: The English Baron Fitzgerald was _ . | options: A: a museum director B: a master of art C: an art collector D: an art dealer | answer: C </s>

<s>[INST] context: In December 2008, Caroline Kennedy -- daughter of the late U.S. President John F. Kennedy--sat down, as a frontrunner for the Senate seat in New York, for a televised interview that helped decide the future of her campaign. The result was a disaster. Her performance wasn't well received, in part because her speech was full of filler words--"ums," "ahs" and "you knows." One listener counted 27 "ums" and 38 "you knows" in the space of five minutes. A few weeks after the interview, Kennedy ended her Senate campaign. Filler words may seem natural in everyday speech, but they can be deadly in formal presentations. "Using excessive fillers is the most annoying speech habit," said Susan Ward, a speech specialist. "They take your listener's attention away often to the point that he doesn't hear anything you say. Your message is entirely lost." Many speakers are afraid of pause. They believe their audience will think they are inarticulate if they pause to think of what to say next, so they use filler words to avoid the silence. However, a pause is actually more impressive than a filler word. Listeners know that the speaker is thinking, trying to find the right word. Sometimes a pause can actually improve a speech, as when an actor uses a dramatic pause to hold the attention of his audience. A speaker shouldn't be afraid to pause occasionally during a speech; it shows self-confidence. It takes some work to cut out filler words. You can begin by taking a few seconds to think about what you want to say the next time you are asked a question. This pause will help you begin powerfully, and it will help you avoid using a filler word. The same public speaking technique applies when you are shifting from one idea to another. While you may be tempted to fill the silence between ideas with a filler word, remember to allow yourself to pause and think about what you want to say next. If you need help overcoming your "um" problem, consider asking a family member or a friend to point out when you use filler words. You also could record an upcoming presentation and then watch yourself in action. You may be amazed at how often you say "um" or "uh"! Although we live in a fast-paced society that seemingly demands instant answers, we must use the pause to our advantage. Finally, we should only speak when we are ready. [/INST] question: The reason why filler words are considered annoying by speech specialist is that _ . | options: A: they prevent the listener from focusing on what the speaker is saying B: they convey the speaker's superiority to the listener C: they mean the speaker is not articulate at all D: they make the speaker appear self-confident | answer: A </s>

<s>[INST] context: Join in the holiday fun at the powerhouse this month linked to our new exhibition,evolution Revolution:Chinese dress 17000s to now.DON'T FORGET our other special event,the Club Med Circus School which is part of the Circus !150years of circus in Australia exhibition experience! *Chinese Folk Dancing:Colorful Chinese dance and musical performances by The Chinese Folk Dancing School of Sydney.Dances include:The Golden stick dance and the Chinese drum dance.A feature will be the Qin Dynasty Emperor's court dance.Also included is a show of face painting for Beijing Opera performances. Sunday 29June and Wednesday 2July in the Turbine Hall,at 11:30am 1:30pm. *Chinese Youth League:A traditional performing arts group featuring performance highlights such as the Red scarf and Spring flower dances,and a musician playing Er Hu. Sunday 6to Tuesday 8July in the Turbine Hall,11:30am to 1:30pm. *Kids Activity:Make a Paper Horse:Young children make a paper horse cut-out.(The horse is a frequent theme in Chinese painting,indicating a kind of advancement.) Suitable for ages8-12years. Saturday 28June to Tuesday 8July in the Turbine Hall,12:00pm to 1:00pm. *Club Med Circus School:Learn circus skills,including the trapeze,trampolining and magic.Note only for children over 5.There are 40places available in each 1hour session and these must be booked at the front desk,level 4,on the day. Tuesday 1to Saturday 5July at 11:30am 1:00pm. Enjoy unlimited free visits and many other benefits by becoming a Family member of the Powerhouse. Our family membership cover two adults and all children under the age of 16years at the one address. Members receive Powerline,our monthly magazine,discounts in the shops and the restaurants,as well as free admission to the Museum.All this for as little as$50,000a year!Call (02)9217 0600for more details. [/INST] question: When can you watch the Chinese drum dance? | options: A: On July 2 B: On July 3 C: On July 6 D: On July8 | answer: A </s>

<s>[INST] context: Have you ever stayed in a hotel? Most Chinese hotel often provide guests with things like disposable toothbrushes, toothpaste, shampoo and slippers. Many guests like the idea because they don't have to bring their own. But ,if you travel to Beijing, remember to bring your own things. Starting from June, some hotels in Beijing will no longer provide guests with these disposables. They want to ask people to use fewer disposable things. Many disposable things are made of plastic. People throw them away after only using them once. It is a waste of natural resources and is very bad for the environment. Do you know that one Chinese person makes as much as as 400kg of waste a year? Most of that waste comes from disposable things. In Beijing, people throw away about 19,000 tons of plastic bags and 1,320 tons of plastic lunch bowls every year! Plastic can take between 100 and 400 years to bread down. So wherever you travel, bring your own things and use them again and again. Back at home and school, you can also do something to make our world a better place. Try to do these things in your daily life: use cloth shopping bags, not plastic ones. After using a plastic bag, wash it out and let it dry. Then you can use it over and over again. Do not use paper cups. At your school canteen . use your own bowl and chopsticks instead of disposable ones. [/INST] question: Which of the following may still be provided in Beijing hotels after June? | options: A: toothbrushes B: tea cups C: shampoo D: paper slippers | answer: B </s>

<s>[INST] context: Ketoconazole (KTZ): It is the first orally effective broad-spectrum antifungal drug, useful in both dermatophytosis and deep myc osis. The oral absorption of KTZ is facilitated by gastric acidity because it is more soluble at lower pH. Hepatic metabolism is extensive; metabolites are excreted in urine and faeces. Elimination of KTZ is dose dependent: tlh varies from llh to 6 hours. Penetration in CSF is poor: not effective in fungal men ingitis. However, therapeutic concentrations are attained in the skin and vaginal fluid. Adverse effects Ketoconazole is much less toxic than AMB, but more side effects occur than with itraconazole or fluconazole, that have largely replaced it for systemic use. The most common side effects are nausea and vomiting; can be reduced by giving the drug with meals. Others are-loss of appetite, headache, paresthesia, rashes and hair loss. Ketoconazole decreases androgen production from testes, and it displaces testosterone from protein binding sites. Gynaecomastia, loss of hair and libido, and oligozoospermia may be themanifestations. Menstrual irregularities occur in some women due to suppression of estradiol synthesis. A dose-dependent decrease in serum hydro coisone due to synthesis inhibition has also been noticed, but without any clinical manifestations in normal individuals. Mild and asymptomatic elevation of serum transaminases occurs in -5% patients, but serious hepatotoxicity is infrequent. It is contraindicated in pregnant and nursing women. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:762,763 [/INST] question: Most serious adverse effect of ketoconazole is: | options: A: Adrenal insufficiency B: Pellagra like skin lesion C: Liver injury D: Prostate cancer | answer: A </s>

<s>[INST] context: What if you arrived home to find a delicious hot meal waiting for you, prepared by your own kitchen robot? It might sound like science fiction, but professors at the University of Tokyo have taken the first steps toward making that a reality. The team recently introduced a human-shaped kitchen robot that can pour tea and other drinks into cups and serve them to guests. When teatime is over, the robot can also wash the dishes and put them away. In California, another interesting kitchen robot has been developed, called Readybot. It can pick up objects and either store them in cabinets or put them in the trash. It also carries a separate floor-cleaning robot that can operate by itself. Unlike the Japanese robot, Readybot just looks more like a large box with arms and wheels. Readybot was created by engineers and designers who established a club called the Readybot Challenge. They believe that in the future millions of robots will be needed in homes to perform ordinary household tasks. Readybot is just the first step in their plan to create a robot that can do jobs not only in kitchens but in other rooms of homes and in offices as well. Clearly there are technological difficulties to solve before robots can cook a complete dinner, and there are also many safety concerns . Not everyone (especially parents) would be comfortable with the idea of robots in their house, _ hot pans and sharp knives. The European Commission recently funded a project to study these concerns. According to lead researcher Professor Chris Melhuish, "Enabling robots to work safely with humans is a key need for the future development of robotics." [/INST] question: Compared with Readybot, the Japanese robot _ . | options: A: is more popular B: performs more jobs C: moves more quickly D: looks more like a person | answer: D </s>

<s>[INST] context: If you're into sports, you've seen it happen--tennis players jump over the net to shake hands after a hard match; football players exchange clothes after 90 minutes of knocking each other around; even boxers touch gloves at the beginning of each round. Players in every event, from spelling _ to golf, act in this way. It's all part of sportsmanship, a great tradition in sport and competition. It means playing and being calm all through the match. Everyone feels great when they win. In the last few years, you might see some players celebrate a goal with a long victory dance or talk big about their ability. However, it's always hard for people to say in public that they made a bad play. Good sportsmanship is what they really need. It's the golden rule of sports. Good sportsmanship means that you play by the rules, talk politely to everyone during games and stay cool even when you lose the game. At the school sports meeting, for example, it's more important for you to know how to work as part of a team and cheer your teammates on. That may help you enjoy more success at your future work. In competition--as in life--you may not always win, but believe me, sportsmanship will help you get through, and there is always the next match. ,. [/INST] question: What match do you know will last 90 minutes? | options: A: Tennis B: Football C: Golf D: Spelling bees | answer: B </s>

<s>[INST] context: When July comes, children know they'll have the final exams and the school year will end soon. Boys and girls will have a nearly two months' holiday, and they'll leave school by train or by car to return home to see their fathers and mothers. The summer holiday is the best time of the year for most students. The weather is good, so they can spend most of their time playing outside .If one lives in the country, he can go on a trip into the woods or in the fields. If one lives in a big city, he can go to a park to play. The best place for a summer holiday is the seaside. Some children are lucky enough to live near the sea. But for the others who do not, if they have the chance to stay at one of the big seaside towns for a week or two, they will talk about it all the following school year. Now, what makes children like the seaside so much? I think it is the sand, the sea and the sun, not anything else. Of course, there are lots of new things to see, nice things to eat and interesting things to do. But the feeling of the sand under their feet, the salt water on their skin, and the warm sun on their backs make them happier. [/INST] question: Every year, school children have the final exams in _ , and the exam means the school year will end. | options: A: May B: January C: July D: December | answer: C </s>

<s>[INST] context: "Mobile phone killed my man," screamed one headline last year. Also came claims that an unpublished study had found that mobile phones could cause memory loss. And a British newspaper devoted its front page to a picture supposedly showing how mobile phones could heat the brain. For anyone who uses a mobile phone, these are worrying times. But speak to the scientists whose work is the focus of these scares and you hear a different story. One of the oddest effects comes from the now famous"memory loss" study. Alan Preece and his colleagues at the University of Bristol placed a device that imitated the microwave radiation of mobile phones to the left ear of volunteers. The volunteers were good at recalling words and pictures they had been shown on a computer screen. Preece says he still can't comment on the effects of using a mobile phone for years on end. But he rules out the suggestion that mobile phones have an immediate effect on our cognitive abilities. "I'm pretty sure there is no effect on short-term memory," he says. Another expert, Tattersall, remarked that his latest findings have removed fears about memory loss. One result, for instance, suggests that nerve cell synapses exposed to microwaves become more -- rather than less -- receptive to undergoing changes linked to memory formation. An even happier outcome would be that microwaves turned out to be good for you. It sounds crazy, but a couple of years ago a team led by William Adey at the Veterans Affairs Medical Center in California found that mice exposed to microwaves for two hours a day were less likely to develop brain tumours when given a cancer-causing chemical. "If _ doesn't certainly cause cancer in animals and cells, then it probably isn't going to cause cancer in humans," says William. And while there's still no absolute evidence that mobile phone use does damage your memories or give you cancer, the conclusion is: don't be afraid. [/INST] question: Mobile phone users are worried because _ . | options: A: they are not sure whether mobile phones can cause memory loss B: it's said that mobile phones have a lot of side effects C: one headline reported "Mobile phone killed my man D: a British newspaper showed mobile phones could heat the brain | answer: B </s>

<s>[INST] context: "I think it's a great thing when I know it's going to help someone else."said l3-year-old Spencer Goldstein,after collecting hundreds of pieces of baseball equipment for kids who can not afford to buy their own. Spencer collected the bats,balls,gloves,helmets and masks for his mitzvah project,which is a community service project that many Jewish kids do around their bar or bat mitzvahs .A bar mitzvah is a ceremony for a boy while a bat mitzvah is intended for a girl.The ceremony means that you are old enough to take on a grown-up's responsibilities. Spencer got the idea for his mitzvah project alter seeing the Ugandan national team at last year's Little League World Series.Some of the Ugandan players didn't even have their own gloves.And Spencer's donations are going to a group called "Pitch for Baseball"--a group that gives baseball equipment to kids in low-income communities around the world. Mollie Schwartz and Mia Schwartz also came up with a sports-related mitzvah project.The money they raised went to the Israel Sport Center for the Disabled.They raised at least $9,000-enough to pay for at least three wheelchairs made for playing basketball. In Massachusetts,Abigail Miller decided to collect musical instruments for her mitzvah project.The instruments Abigail collected were then donated to groups that distribute them to kids who can't afford to buy them."I want to make sure everybody can get the chance to enjoy music like I do,"Abigail said.Abigail collected more than three-dozen instruments-wind instruments,string instruments,keyboards,even a drum set. Whether it's playing sports,playing music or something else,kids such as Spencer,Mollie,Mia and Abigail are using their mitzvah projects to change the woad for the better."They learned about generosity,''said Mollie's mother,Loft Schwartz,"and the power to make things happen". [/INST] question: How did Spencer feel after collecting some baseball equipment? | options: A: Tired B: Confident C: Proud D: Satisfied | answer: C </s>

<s>[INST] context: Some researchers claim that people's personalities can be classified by their blood types If you have blood type O, you are a leader. When you see something you want , you strive to achieve your goal. You are passionate, loyal, and self-confident, and you are often a trendsetter . Your enthusiasm for projects and goals spreads to others who happily follow you. When you want something ,you may be ruthless about getting it or blind to how your actions affect others . Aother blood type A, is a social , "people" person . You like people and work well with them . Y ou are sensitive , patient , compassionate , and affectionate .You are a good peacekeeper because you want everyone to be happy .In a team situation , you resolve conflicts and keep things on a smooth course . Sometimes type As are stubborn and find it difficult to relax. They may also find it uncomfortable to do things alone. People with type B blood are usually individualist who like to do things on their own . You may be creative and adaptable, and you usually say exactly what you mean . Also you can adapt to situations , you may choose to do so because of your strong independent streak. You may prefer working on your own to being part of a team . The final blood is type AB . If you have AB blood , you are a natural entertainer. You draw people to you because of your charm and easy-going nature .ABs are usually calm and controlled , tactful fair. On the downside ,though , they may take too long to make decisions. And they may procrastinate, putting off tasks until the last minute. [/INST] question: People with type O will do the following things except _ | options: A: manage businesses B: self-control C: be considerate D: set the fasion | answer: C </s>

<s>[INST] context: Pathogenic bacteria such as the gram-negative bacillus Pseudomonas aeruginosa and the gram-positive coccus Staphylococcus aureus colonize the surface of certain surgical appliances such as artificial heart valves and catheters. Multiple layers of the colonizing bacteria surround themselves with a polysaccharide (c) matrix, which protects them from the effect of antibiotics and host immune defenses. The remaining choices do not contribute to biofilm development. Porins (d), proteins that are located within the outer membrane of gram-negative bacteria, facilitate the transfer of hydrophilic molecules through the membrane. Teichoic acids (e) found within the cell wall of gram-positive bacteria are anionic polymers of polyglycan that provide rigidity to the cell wall. In gram-negative bacteria, the periplasmic space occupies the area between the external surface of the cytoplasmic membrane and the internal surface of the outer membrane. The periplasm (b) contains hydrolytic enzymes, virulence proteins, and components of the sugar transport systems. Endotoxin (LPS), a component of the outer membrane of gram-negative bacteria, is recognized by the host defenses and stimulates macrophages to produce cytokines. [/INST] question: A 30-year-old hospitalized patient with an intravenous (IV) catheter developed fever and systemic infection. The source of the infection was bacteria that contaminated the catheter during its insertion. The IV catheter had to be removed because the bacteria grew within the catheter forming a biofilm. Biofilm development depends on the ability of the bacteria to produce which of the following? | options: A: Endotoxin B: Periplasm C: Polysaccharides D: Porins | answer: C </s>

<s>[INST] context: Meninges of Brain i) Brain is protected by Bony covering of the cranium Three membranous coverings (Meninges) ii) The three meninges are Outer duramater Middle arachnoid mater Inner piamater iii) The dura mater is outermost and thickest of all meninges. It encloses cranial venous sinuses and has a distinct blood supply and nerve supply. iv) The duramater has two layers - an outer endosteal layer and an inner meningeal layer. v) The outer endosteal layer forms the endosteum of skull. vi) The meningeal layer is folded and form partitions which divide cranial cavity into compartments. The folds are falx cerebri falx cerebella Tentorium cerebella Diaphragma Sella. vii) FALX CEREBRI It is a large sickle shaped fold of duramater occupying the median longitudinal fissure between two cerebral hemispheres. The superior sagittal sinus, inferior sagittal sinus and the straight sinus are closely related to falx cerebri. viii) FALX CEREBELLI It is present in the posterior cerebellar notch. ix) TENTORIUM CEREBELLI It forms the roof of the posterior fossa and separates the cerebellum from occipital lobes of the cerebrum. The trigeminal or meckel's cave is present in relation to tentorium cerebelli. x) DIAPHRAGMA SELLAE It is a small circular, horizontal fold of duramater forming the roof of the hypophyseal fossa. The diaphragm has a central aperture through which the stalk of hypophysis cerebri passes. [/INST] question: Trigeminal or Meckel's cave is present in relation to: | options: A: Falx cerebri B: Falx cerebelli C: Tentorium cerebelli D: Diaphragma sellae | answer: C </s>

<s>[INST] context: Family traditions were important in our house, and none was more appreciated than the perfect Christmas tree "Dad, can we watch when you trim the tree?" My eldest son. Dan, nine, and his seven -year-old brother John, asked "I won't be cutting this year," my husband Bob said. "Dan, you and John are old enough to measure things. Do it all by yourselves. Think you boys can handle it? Dan and John seemed to _ in their chairs at the thought of such an amazing responsibility. "We can handle it." Dan promised. "We won't let you down." . A few days before Christmas. Dan and John rushed in after school. They gathered the tools they'd need and brought them out to the yard .where the tree waited. I was cooking when I heard the happy sounds as the boys carried the tree into the lying room. Then I heard the sound that every mother knows is trouble: dead silence I hurried out to them. The tree was cut too short. John crossed his arms tight across his chest. His eyes filled with angry tears. I felt worried The tree was central to our holiday. I didn't want the boys to feel ashamed every tune they looked at it. I couldn't lower the ceiling, and I couldn't raise the floor either. There was no way to undo the damage done. Suddenly, a thought came to my mind, which turned the problem into the solution. www..com "We can't make the tree taller." I said. "But we can put it on a higher position" Dan nodded his head sideways. "We could put it on the coffee table. It just might work! Let's try it!" When Bob got home and looked at the big tree on top of the coffee table, Dan and John held their breath. "What a good idea!" he declared "Why didn't I ever think of such a thing?" John broke into a grin Dan's chest swelled with pride. [/INST] question: Who trimmed the Christmas tree this year? | options: A: The writer B: Bob C: Dan and John D: The whole family | answer: C </s>