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<s>[INST] context: Steroid-dependent patients, frequent relapses, and steroid-resistant patients may be candidates for alternative agents, paicularly if the child suffers severe coicosteroid toxicity (cushingoid appearance, hypeension, cataracts, and/or growth failure). Cyclophosphamide prolongs the duration of remission and reduces the number of relapses in children with frequently relapsing and steroid-dependent nephrotic syndrome. The potential side effects of the drug (neutropenia, disseminated varicella, hemorrhagic cystitis, alopecia, sterility, increased risk of future malignancy) should be carefully reviewed with the family before initiating treatment. The dose of cyclophosphamide is 2-3 mg/kg/24 hr given as a single oral dose, for a total duration of 8-12 wk. Alternate-day prednisone therapy is often continued during the course of cyclophosphamide administration. During cyclophosphamide therapy, the white blood cell count must be monitored weekly and the drug should be withheld if the count falls below 5,000/mm3 [/INST] question: A 7-year-old child with steroid dependent nephrotic syndrome has developed coicosteroid toxicity and posterior subcapsular cataracts. Which of the following is the best alternative for the treatment of the patient? | options: A: Levamisole B: Cyclophosphamide C: Mycophenolate mofetil D: Rituximab | answer: B </s>

<s>[INST] context: This organism is a gram positive coccus organized into grape-like clusters. It produces a yellow pigment and the positive mannitol salt agar test showed that it could ferment mannitol and had a high salt tolerance. This organism is catalase positive and coagulase positive, two critical tests for the correct identification of Staphylococcus aureus. Bacteroides fragilis is a gram-negative rod that grows anaerobically. It does cause abscesses, but does not have the characteristics described for the organism in this case. Clostridium perfringens is a gram-positive spore forming organism that causes gangrene. It would not grow aerobically on blood agar. The organism can ceainly spread in the skin when introduced by trauma, but would not demonstrate the biochemical profile described. Escherichia coli is a gram-negative rod that would grow on the blood agar but would not produce yellow pigment. Growth on MacConkey's agar after it was gram-stained would indicate lactose fermentation, and other biochemical tests would be used to specifically identify the organism. [/INST] question: A young butcher cuts his forearm with a knife. Over the next week, he notices swelling, redness, and warmth at the site. Four days later, he presents to the emergency depament with fever, shaking chills and severe lower back pain. Physical examination reveals a temperature of 39.4 C (102.9 F), swelling in his forearm with an area of central softness, and tenderness to pressure over his lower spine. Laboratory data show a leukocyte count of 14,000/mm3 with 81% polymorphonuclear leukocytes. Blood cultures grew a gram positive cocci in clusters on blood agar; colonies show a yellow pigment, and the organism is positive on mannitol/salt agar. The organism is catalase and coagulase positive. Which of the following is the most likely pathogen? | options: A: Bacteroides fragilis B: Clostridium perfringens C: Escherichia coli D: Staphylococcus aureus | answer: D </s>

<s>[INST] context: The suboccipital triangle lies in the neck at the base of the skull. The suboccipital triangle is bounded by the inferior oblique, rectus major, and superior oblique muscles. The veebral aery can be found within the suboccipital triangle, lying on the posterior arch of the atlas, lateral to the midline, typically at about the level of the lower poion of the ear lobe. Care should be taken in accessing the vessel, since the first cervical nerve lies between the veebral aery and the posterior arch of the atlas. The anterior triangle of the neck is in the anterior neck, and is bounded by the neck midline, the mandible, and the sternocleidomastoid muscle. The anterior triangle of the neck is subdivided into the muscular, carotid, submandibular, and submental triangles. The posterior triangle of the neck is on the side of the neck, and is bounded by the sternocleidomastoid muscle, trapezius, and the middle third of the clavicle. The submental triangle, also called the suprahyoid triangle, is found below the lower jaw, and is bounded by the hyoid bone and anterior bellies of the digastric muscles. [/INST] question: An angiographic study of the distal pa of the Circle of Willis requires access to the veebral aery. Access to this aery can be obtained which of the structures? | options: A: Suboccipital triangle B: Submental triangle C: Posterior triangle of the neck D: Anterior triangle of the neck | answer: A </s>

<s>[INST] context: About 1966 or so, a NASA team doing work for the Apollo moon mission took the astronauts near Tuba City. There the land of the Navajo Reservation looks very much like the lunar surface. Among all the trucks and large vehicles were two large figures that were dressed in full lunar space suits. Nearby, a Navajo shepherd and his son were watching the strange creatures walk about, occasionally being watched over by other NASA workers. The two Navajo people were noticed and approached by the NASA people. Since the shepherd and his son did not know English, they asked the NASA people who the strange creatures were. The NASA people told them that they were just men that were getting ready to go to the moon. The shepherd became very excited and asked if he could send a message to the moon with the astronauts. The NASA officials thought this was a great idea so they provided a tape recorder. After the man gave them his message, they asked his son to translate. His son would not. Later, they tried a few more people on the Navajo Reservation to translate and every person they asked would chuckle and then refuse to translate. Finally, with cash in hand someone translated the message, "Watch out for these guys, they have come to take your land!" [/INST] question: The appearance of the Navajo Reservation is very similar to that of _ . | options: A: the Tuba City B: the moon C: the NASA research center D: the Apollo moon mission | answer: B </s>

<s>[INST] context: One day, my father and I were in line to buy tickets for the circus . And a family was standing in front of us. The family had eight children. Their clothes were not expensive but clean.The children talked about the clowns( ), elephants, monkeys and other things excitedly. It was their first time to go to the circus. The ticket lady asked the father how many tickets he wanted. He proudly answered, "I want eight children's tickets and two adults' tickets, so I can take my family to the circus." The ticket lady said the price. The man's wife lowered her head and there was no smile on th e man's face. He quietly asked, "How much did you say?" The ticket lady said the price again. The man didn't have enough money. How could he tell his eight kids the bad news? My dad put his hand into his pocket and pulled out a $20 bill and dropped it on the ground.(In fact, we were not rich!) Then my dad said, "Excuse me, sir, this dropped out of your pocket." The man knew what was going on. He looked into my dad's eyes, held my dad's hand in his, and took the $20 bill. "Thank you, sir, thank you. This really means a lot to me and my family." My father and I went back home. We didn't go to see the circus that night, but we didn't care. [/INST] question: What can children see in the circus? | options: A: clowns B: elephants C: monkeys D: all of them | answer: D </s>

<s>[INST] context: It's cool, it's hot, and everyone is doing it. People talk about _ often, and friends tell other friends how good they look. Sound like a fashion? In fact, it's another trend : "blog". What's a blog? A blog is a personal online diary. The word "blogger" means a person who writes diaries online. Many bloggers are teenagers who log onto websites to discuss anything in their lives. Many of today's teenagers are not afraid to openly discuss everything in their lives. Teenagers complain about parents and homework. They share diaries, post songs from the latest bands and show pictures of theirs. They write their own poems, say something about their girlfriends or boyfriends and complain to each other or offer support. But mostly they just write down what they do every day. However, many parents are worried about these young bloggers. Parents see the kids talking about how they got drunk last weekend and how they don't like studying. They are using language that is surprising to their parents. Besides hearing from their friends, teen bloggers also get messages from strangers. Most of the time, it's older men asking to meet teenage girls. "These strange men are dangerous for my kids. They sometimes teach my kids bad words," said Cara Cabral, a mother of two. Many teenagers and young adults know it's not safe to use blogs on the Internet. They know they are putting information about themselves in a place they can be seen by anyone. But teenagers are unwilling to give up these new communication tools that have become a way of life for many of them. [/INST] question: Parents think it's dangerous for their kids to use blogs because _ . | options: A: their kids use a surprising language B: their kids talk about how they don't like studying C: teen bloggers get messages from strangers D: their kids talk about their girlfriends or boyfriends | answer: C </s>

<s>[INST] context: Moreno, Stanley, and 23 other students from Westfield State College were on vacation in Acapulco, Mexico. This was the last night in the hotel. It was 4 am, Moreno and Stanley came back from a party. Just as Stanley went to sleep, he heard loud noise outside. From the balcony of their fourth-floor room, Moreno and Stanley saw black smoke out of one window and heard people shouting. Moreno ran out into the corridor and began knocking on doors and shouting, "Fire!" After that, he went upstairs in a hurry to tell other people. At the same time, Stanley was downstairs helping people get through the smoke-filled room. There he joined forces with Nalewanski, a 21-year-old boy who had a room on the second floor. "Let's go," Nalewanski said. He and Stanley wet their shirts in the bathroom and put them around their mouths and noses so they could breathe. Then they ran up the stairs. On the fourth floor they found Moreno feeling terrible (Moreno had made it up to the eighth floor before turning back). But after making sure he could get back down on his own, they continued upstairs, knocking on the doors on every floor. In the end, no one was seriously hurt. Moreno said, "There were hundreds of people in the hotel. It was our duty to help them." [/INST] question: _ students from Westfield State College were on vacation in Acapulco, Mexico. | options: A: Twenty-three B: Twenty-four C: Twenty-five D: Twenty-six | answer: C </s>

<s>[INST] context: People fell in love with Elizabeth Taylor in 1944, when she starred inNational Velvet-the story of Velvet Brown, a young girl who wins first place in a famous horse race, At first, the producers of the movie told Taylor that she was too small to play the part of Velvet. However, they waited for her for a few months as she exercised and trained--and added three inches to her height in four months! Her acting inNational Velvetis still considered the best by a child actress. Elizabeth Taylor was born in London in 1932. Her parents, both Americans, had moved there for business reasons. When World War II started, the Taylor moved to Beverly Hills, California, and there Elizabeth started acting in movies. After her success as a child star, Taylor had no trouble moving into adult roles and won twice for Best Actress:Butterfield8 (1960) andWho's Afraid of Virginia Woolf ? (1966) Taylor's fame and popularity gave her a lot of power with the movie industry, so she was able to demand very high pay for her movies. In 1963, she received $1 million for her part inCleopatra--the highest pay received by any star up to that time. Elizabeth Taylor is a legend of our time. Like Velvet Brown inNational Velvet, she has been lucky, she has beauty, fame and wealth. But she is also a hard worker. Taylor seldom acts in movies any more. Instead, she puts her time and efforts into her businesses, and into helping others--several years ago, she founded an organization that has raised more than $40 million for research and education. [/INST] question: The producers didn't let Taylor play the part of Velvet at first because they thought she _ . | options: A: was small in size B: was too young C: did not play well enough D: did not show much interest | answer: A </s>

<s>[INST] context: CDKN2A is a complex locus that encodes three different tumor sup- pressors, p15/INK4b, p16/INK4a, and p14/ARF. Of these, loss of p16/INK4a is clearly implicated in human melanoma, and experimental evidence also suppos a role for loss of p14/ARF. As already mentioned, p16/ INK4a inhibits cyclin-dependent kinase 4 (CDK4) and cyclin-dependent kinase 6 (CDK6), thus reinforcing the ability of the RB tumor suppressor to block cells in the G1 phase of the cell cycle. By contrast, p14/ARF enhances the activity of the p53 tumor suppressor by inhibiting MDM2, an oncoprotein that stimulates p53 degradation. CDKN2A is mutated in approximately 10% of sporadic melanomas, and these mutations uniformly abolish the production of p16/INK4a and more variably affect p14/ ARF. However, it is suspected that these mutations are the tip of the "oncogenic iceberg" with respect to molec- ular lesions affecting the G1 checkpoint. For example, 30% to 70% of melanomas show loss of p16/INK4a expression though varied mechanisms, and other famil- ial and sporadic melanomas have mutations in CDK4 [/INST] question: Mutation seen in malignant melanoma is | options: A: N-MYC B: RB gene C: CDKN2A D: p53 | answer: C </s>

<s>[INST] context: The lateral view shows that the anterior clear space behind the sternum is occupied above a poion of the lower one-third of the cardiac shadow. The truncus of the right pulmonary aery seen in front of the trachea is very large and the left main pulmonary aery coursing over the left upper lobe bronchus is greater than 16 mm. These findings are consistent with pulmonary aerial hypeension. The chest x-ray shows large pulmonary aeries, and this, coupled with the clinical scenario, is consistent with primary pulmonary hypeension (PPH). As mentioned in the general discussion, this entity is due to an unknown cause. The physical sign most likely to be present would be a loud P2, and right hea catheterization would confirm the high pulmonary aery (PA) pressures. Patients with PPH may give a history of syncopal episodes. A loud A2 is heard in systemic hypeension, and rib notching is classically seen on the x-ray in coarctation of the aoa. Right arm swelling is seen with either a localized vascular or lymphatic obstruction such as postradiation, malignancy, or superior vena cava syndrome. This patient does not exhibit any of these signs. Since the hilar shadows are of vascular nature, mediastinoscopy or bronchoscopy would not be indicated and in fact may be dangerous if PA pressures are very high. [/INST] question: A 24-year-old female graduate student repos increasing shoness of breath with exercise and has recently noticed dyspnea on mild activity. One day before presenting at the office, she experienced sudden loss of consciousness while shopping at a grocery store. On physical examination, vital signs are: pulse 88 bpm; temperature 97.8degF; respirations 18/min; blood pressure 100/70 mm Hg. BMI is 34. ABGs on RA: pH 7.43; PCO2 36 mm Hg; PO2 87 mm Hg. Chest x-rays are shown in.The clinical and chest radiographic diagnosis may be commonly associated with | options: A: A loud A2 on cardiac auscultation B: Right arm swelling C: Rib notching D: A loud P2 on cardiac auscultation | answer: A </s>

<s>[INST] context: The shoulder joint is separated from the subacromial bursa by the supraspinatus tendon, which is inseing on the greater tubercle of the humerus. So, if the supraspinatus tendon is ruptured, the synol cavity of the shoulder will be able to communicate with the subacromial bursa. If contrast dye is injected into the cavity of the shoulder joint following a rupture of the supraspinatus tendon, the contrast will flow into the subacromial bursa.This can be observed in imaging studies. You should know this relationship between the supraspinatus tendon and the subacromial bursa.The tendon of infraspinatus also inses on the greater tubercle of the humerus-however, it does not communicate with the subacromial bursa. The middle glenohumeral ligament strengthens the capsule of the shoulder joint.The subscapularis tendon inses on the lesser tubercle of the humerus-it is not near the subacromial bursa. Finally, the tendon of the long head of the biceps originates on the supraglenoid tubercle scapula and travels through the shoulder joint, lying in the inteubercular groove of the humerus. It is not a structure that communicates with the subacromial bursa. [/INST] question: The synol cavity of the glenohumeral joint communicates with the subdeltoid bursa after the rupture of? | options: A: Infraspinatus Tendon B: Middle glenohumeral ligament C: Subscapularis Tendon D: Supraspinatus Tendon | answer: D </s>

<s>[INST] context: Why do you study? Many students would simply reply: "To get good result in the college entrance examination ." For several years, many have spoken out against the exams. Some say they have turned children into studying machines. Others think that one exam cannot possibly _ a student's true level of knowledge. So, should the exams be canceled? Minister of Education Yuan Guiren doesn't think so. "Officials and the rich might take advantage if the college entrance examination were called off . And life would be more difficult for poor children. However, we do need to change the exams," Yuan said on March 7. He has put an exam reforms at the center of his fourth year in office. "I think the exam is a fair way to choose talented people. But it should pay more attention to all-around personal qualities, not just grades," said Cui Shangyu, a Senior 3 student in Sichuan. The college entrance examination was restored in 1977. From then to 2007, 46.85 million people have entered higher education through the exam. According to survey by the Ministry of Education, 90 percent of people who participate believed the college entrance examination could in some way change a person's life, especially for poor students in the countryside. The college entrance examination is not the only way to become a successful person. However, the process of preparing for the exam is a good experience, said Shen Hui, a Math teacher at Gaoyou Middle School in Jiangsu. "Through it students can learn many things, such as how to deal with stress and how to arrange a learning plan." Shen said. [/INST] question: If the college entrance exam were called off, it would be unfair for _ . | options: A: the poor B: the officials C: the rich D: the old | answer: A </s>

<s>[INST] context: Progressive multifocal leukoencephalopathy Progressive multifocal leucoencephalopathy :? . Progressive multifocal leucoencephalopathy is a progressive disorder cause by J.C. virusdeg. . The main cells affected in the disease are oligodendrocytesdeg. . Since oligodendrocytes are concerned with myelination, progressive multifocal leucoencephalopathy is characterized by multifocal areas of demyelinationQ of varying size distributed throughout the brain but sparing the spinal cord and optic nerves. Pathology . Besides demyelination there are characteristis cytological alterations in both astrocytes and oligodendrocytes : - AstrocytesQ . Enlarged and contain, hyperchromatic, deformed and bizarre nuclei and frequent mitotic figures. OligodendrocytesQ . These have enlarged densely staining nuclei that contains virus inclusions.formed by crystalline arrays. Symptoms of progressive multifocal leucoencephalopathy :? Visual defects (45%) --> Homonymous hemianopia, Conjugate gaze abnormalities Mental impairment (38%) Dementia, confusion, personality changes Weakness --> Hemi or monoparesis and ataxia Seizures (20%) ---> Speech defect aphasia, hemiparesis, ataxia Focal neurological signs . Progressive multifocal leucoencephalopathy is predominantly seen in patients with immunosuppressive disorders: ? . Most commonly associated conditions are: ? - AIDS (80%)Q - Hematological malignancies (13%) - Transplant recipients (5%) - Chronic inflammatory disease (2%) Prognosis of progressive multifocal leucoencephalopathy . In most cases death occurs in 3-6 months .from onset of neurological symptoms and even more rapidly in patients with AIDS unless aggressive interetrul treatment is undeaken. Diagnosis . MRI is used for the diagnosis of PML. . MRI is better than CT scan in the diagnosis of PML and is frequently used for the diagnosis of PML. . On MRI the lesion appears as multrfocal asymmetric coalescing white matter located periventricularly. . These lesions have increased signals on T2 and FLAIR images and decrease signal on T,-weighted images. . PML lesions are classically nonenhancingQ. . Other impoant diagnostic tool in PML is the PCR amplification of JCV DNA. . The PCR amplification of JCV DNA in association with typical MRI lesion in the appropriate clinical setting is diagnostic of PML. I am not sure of the answer, visual symptoms, aphasia dysahria are commonly seen in PML. [/INST] question: Inclusions in oligodendrogliocytes is a feature of aEUR' | options: A: Creutzfeldt-Jakob disease B: CIDP C: HSV D: Progressive multifocal leukoencephalopathy | answer: D </s>

<s>[INST] context: Cryptitis The pathology in ulcerative colitis typically involves distoion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscess, and hemorrhage or inflammatory cells in the lamina propria. Pathology of ulcerative colitis. Macroscopic features Ulcerative colitis is a mucosal disease that usually involves the rectum and extends proximally to involve all or pa of the colon. The lesion is continuous and normal areas between the lesions (skip lesions) do not occur. With mild inflammation the mucosa is erythematous and has a fine granular surface that appears like sand paper. In severe cases mucosa is hemorrhagic. ulcerated and edematous. In long standing cases. inflammatory polyps (pseudopolyp) may be present as a result of epithelial regeneration. With many years of disease the mucosa becomes atrophic and featureless and entire colon becomes narrowed and shoened. Microscopic features :? The impoant pathological characteristic is that the process is limited to the mucosa and superficial submucosa with deeper layers unaffected except in fulminant disease. Two major features in ulcerative colitis suggests chronicity Distoion of the crypt architecture of the colon (cryptitits) - Crypts may be bifid and reduced in number often with a gap between crypt bases and musculoris mucosae. Diffuse predominantly mononuclear infiltrate in lanzina propria is universally present - Neutrophilic infiltration of epithelial layer produce collection of neutrophils in crypt (crypt abscess). [/INST] question: Ulcerative colitis what is seen? | options: A: Cryptitis B: Crypt loss C: Crypt branching D: Proliferating mucosa | answer: A </s>

<s>[INST] context: Mr. Brown lives in America and has a big factory there. He is busy all the time. But when he takes his holidays, he always goes traveling and has been to about thirty countries. One summer he went to visit Moscow. There he heard the workers were paid much less than those in his countries. And most factories couldn't work because they were short of money. He thought he would save much money if he invested in a factory there. The Russians knew it and warmly met him and he was invited to visit a modern factory. He went to the workplaces, watched carefully how the machines worked. The workers worked hard when he went in. Soon it was time to have lunch. Mr. Brown went in the dining -room. Meat, eggs, milk and bread could be bough there. It seemed that they weren't short of anything. Mr. Brown came up to an old worker and sat down next to him. Are you satisfied with your life, sir? Asked Mr. Brown. "Of course," the worker answered and went on drinking. "What do you have now?" "I live in beautiful villa ," answered the man. "I have a new fridge, a new color television and I drive a new car to my factory." "What's your next wish, then?" "To buy a pair of strong shoes!" [/INST] question: Mr. Brown often spends his holidays _ . | options: A: in America B: in Moscow C: by the sea D: outside his country | answer: D </s>

<s>[INST] context: In the last fifty years, a lot of people have left Europe and gone to live in Australia. One of them was a Hungarian man. He lived in Australia for quite a long time, and he had a lot of good friends there. He always said to them, "Australia is beautiful, but Hungary is beautiful, too." Then one year he said to his friends, "I'm going to go back to Hungary to visit my home town." All his friends said to him, "We want to go with you, because you often say Hungary is a beautiful country, and we want to visit it." The Hungarian Australian took his friends from Sydney to Rome in a big plane, and then they went from Rome to Budapest in a train as they wanted to see the mountains, and the villages and the towns. They stayed in Budapest nearly a week, and they liked it very much. One day they went to the zoo in Budapest and saw two kangaroos there. These Australians were very happy because kangaroos were from their home town. They said to them, "Come here, old friends! Come and see your Australian brothers!" But the kangaroos did not move. But then the Hungarian Australian spoke to them in Hungarian, "Come here!" he said, and both of the kangaroos ran to him. The other Australians laughed and said, "Look at that. They're Australians, but they only know Hungarian!" [/INST] question: The Hungarian moved to Australia _ . | options: A: last year B: a few months ago C: many years ago D: over 100 years ago | answer: C </s>

<s>[INST] context: Below are the top four supermarket chains in the world in 2012 and the reasons behind their success. Tesco Headquartered in Chestnut, United Kingdom , this global grocery store is one of the largest supermarket chains in terms of revenues and profits. If was founded in 1919 by Jack Cohen. Tesco stores can be found across all continents. Even though it was set up only for food and beverages, Tesco has drastically branched out , not only in geographical terms, but also in terms of products. Which now include electronics , clothing, health care, home improvement and even financial services. Safeway Founded in the year 1915 by a young M. B, Skaggs. Safeway developed from just a small grocery store on the fundamentals of providing value to customers and narrow profit margins. The success story of Skaggs becomes more evident when , by the end of the year 1926,he had opened almost 428 stores across ten states. Almost two years later, Safeway was listed at the New York Stock Exchange . At present, there are more than fifteen hundred Safeway stores across US and Canada. The Kroger Company Founded at Cincinnati, Ohio, US in 1883 by Mr. Bernard Kroger, the Kroger Company is now one of the largest supermarket chains not only in the US. but across the world . Over the last couple of decades, the Kroger Company has vastly expanded by acquiring popular brand names, including those of Owen's Market. Its stores are largely spread out across Middle. Western and Central United States. Reve-Gruppe Reve - Gruppe was founded in 1927 and is presently headquartered at Cologne, Germany . This supermarket chain is easily counted among the top supermarket chains of the world . Its vast line of products includes grocery, home improvement, pharmaceuticals, cosmetics, optical as well as clothing . Its stores can be found in as many as fourteen European countries, providing employment to more than 325,000 people. [/INST] question: Which of the following was founded first ? | options: A: Tesco B: Safeway C: The Kroger Company D: Reve-Gruppe | answer: C </s>

<s>[INST] context: Joanne was stuck in a traffic jam in central Birmingham at 5:30 and at 6:30 she was expected to be chairing a meeting of the tennis club. At last, the traffic was moving. She swung quickly racing to her house. As she opened the door , she nearly tripped over Sheba. "Hey, Sheba," she said, "I've got no time for you now, but I'll take you out as soon as I get back from tennis club." Then she noticed Sheba seemed to be coughing or choking. Obviously, she could hardly breathe. Immediately, Joanne realized she would have to take her to the vet . When she got there, the vet was just about to close for the day. Seeing the state of Sheba, Dr. Sterne brought her quickly into his office. "Listen, doctor, I'm really in a rush to get to a meeting, can I leave her with you, and go and get changed? I'll be back in ten minutes to pick her up, and then I'll take her on to the meeting with me. Is that OK?" "Sure." said the doctor. Joanne made the quick trip back to her house in a couple of minutes. As she was once more entering the hallway, the phone by the door began to ring. "This is Dr. Sterne," said an anxious voice. "I want you to get out of that house immediately, "said the doctor's voice. "I'm coming round right away, and the police will be there any time now. Wait outside!" At that moment, a police car screeched to a stop outside the house. Two policemen got out and ran into the house. Joanne was by now completely confused and very frightened. Then the doctor arrived. "Where's Sheba? Is she OK?" shouted Joanne. "She's fine, Joanne. I took out the thing which was choking her, and she's OK now. " Just then, the two policemen reappeared from the house, half-carrying a white--faced man, who could hardly walk. There was blood all over him. "My God, " said Joanne, "how did he get in there? And how did you know he was there?" "I think he must be a burglar." said the doctor. "I knew he was there because when I finally removed what was stuck in Sheba's throat:it turned out to be three human fingers." [/INST] question: What was Joanne supposed to do at 6:30? | options: A: To walk her dog B: To see her doctor C: To attend a club meeting D: To play tennis with her friends | answer: C </s>

<s>[INST] context: Brad Pitt and Angelina Jolie have given $500,000 to help the town of Joplin --a town near the Mississippi River, where Pitt's mother went to school recover from a huge tornado that struck on May 22, 2011. The couple made the donation through the Jolie-Pitt Foundation on Thursday to help rebuild the town of Joplin after about 30% of the buildings were destroyed by the tornado. Over 150 people were killed. "The Joplin community faces great challenges ahead," said Brad. "Having spent most of my childhood there, I know these people to be hardworking, humble and especially resilient. "The locally based Community Foundation of the Ozarks will be working shoulder to shoulder with these Joplin citizens for long to rebuild their lives. We, too, hope to further help with these rebuilding efforts." "Last year 42 million people worldwide were hurt by natural disasters," added Angelina. "So often, these disasters seem far away; but now, the need is right here at home for thousands of people. Our hearts go out to the families in Joplin who have lost so much." The Community Foundation of the Ozarks was founded in 1973 and has since grown to include 43 branch community foundations. The Foundation's task is to improve the quality of life in the Missouri Ozarks area through resource development, community grant making, working together, and public leadership. "We had a call in the first day or two afterward from an organization representing them," said Brian Fogle, president of the Community Foundation of the Ozarks. "They made several calls afterwards, but we learned that they made a donation. [/INST] question: Where did the disaster most probably happen? | options: A: in Britain B: in the USA C: in Australia D: in China | answer: B </s>

<s>[INST] context: Compared to Iron Man 1, which I really like, Iron Man 2 has more action, better special effects and is funnier. In Iron Man 2, Tony Stark (Robert Downey Jr.) faces two enemies--a weapon producer named Justin Hammer (Sam Rockwell) and Ivan Vanko (Mickey Rourke), a horrible-looking Russian who wants revenge for something related to Tony's father. Besides the two enemies, Tony is also facing his own death. His man-made heart, which gives his Iron Man suit its power, is also harming his body. My favourite part of the movie was when Iron Man uses his laser against an army of Hammer's Iron Man robots. Everyone in the theater was cheering. My favourite special effects scene was the fight scene at a car race. Ivan tore Tony's car apart piece by piece. A funny part in the movie is when Natalie Rushman (Scarlett Johansson) is inside a boxing ring with Happy Hogan (played by director Jon Favreau). Happy Hogan tries to hit Natalie Rushman. However, he is the one who ends up on the floor. The only problem I had with the movie was that I didn't understand why Ivan had so much hate toward Tony. I loved Iron Man 1 very much, and I expected Iron Man 2 to be much better. And after watching the movie, I'd like to say it is even better than I expected. [/INST] question: When Iron Man was fighting an army of Hammer's Iron Man robots, people in the theater were _ . | options: A: relaxed B: angry C: excited D: disappointed | answer: C </s>

<s>[INST] context: Working Americans expect to retire at age 66, up from 63 in 2002, according to a recent Gallup poll .But most retirees don't stay on the job nearly that long. The average retirement age among retirees is 62, Gallup found.And even retirement at age 62 is a recent development.The average retirement age has been around 60 for most of the past decade. "Americans have two reasons for which they may project a later retirement year.One is financial, and they simply think they will need to work longer because there are fewer pensions, and now people may have a more psychologically positive view of work," says Frank Newport, editor-in-chief of Gallup poll.But a plan to work longer isn't the same as keeping a job into your mid- or late 60s. Other surveys have similarly found a significant gap between the age workers expect to retire and when they actually leave their jobs.A 2014 Employee Benefit Research Institute survey found that 33 percent of workers expect to retire after age 65, but only 16 percent of retirees report staying on the job that long.Just 9 percent of workers say they are planning to retire before age 60, but 35 percent of retirees say they retired that early.The average retirement age in the survey was 62. Many of these early retirements are unexpected and due to unforeseen circumstances.About half (49 percent) of retirees say they left the workforce earlier than planned, often as a result of a health problem or disability (61 percent) or to care for a family member (18 percent), EBRI found.Other retirees are forced out of their jobs due to changes at their company, such as a downsizing or closing (18 percent), changes in the skills required for their job (7 percent) or other work-related reasons (22 percent). "The difference is between what you know you want to do and what factors outside your control ultimately require you to do," says Dallas Salisbury, president of EBRI. [/INST] question: In the past ten years, most working Americans retired at the age of . | options: A: 63 B: over 66 C: 62 D: less than 62 | answer: D </s>

<s>[INST] context: CHLOROQUINE It is a rapidly acting erythrocytic schizontocide against all species of plasmodia; controls most clinical attacks in 1-2 days with disappearance of parasites from peripheral blood in 1-3 days. Therapeutic plasma concentrations are in the range of 15-30 ng/ml. However, it has no effect on pre- and exo-erythrocytic phases of the parasite-does not prevent relapses in vivax and ovale malaria. Resistance in P. falciparum is associated with a decreased ability of the parasite to accumulate chloroquine. Veraparnil, a Ca2+ channel blocker, has been found to restore both the chloroquine concentrating ability as well as sensitivity to this drug. For pediatric patients, the treatment options are the same as for adults except the drug dose is adjusted by patient weight. The pediatric dose should never exceed the recommended adult dose. Pediatric dosing may be difficult due to unavailability of non-capsule forms of quinine. If unable to provide pediatric doses of quinine, consider one of the other three options. If using a quinine-based regimen for children less than eight years old, doxycycline and tetracycline are generally not indicated; therefore, quinine can be given alone for a full 7 days regardless of where the infection was acquired or given in combination with clindamycin as recommended above. In rare instances, doxycycline or tetracycline can be used in combination with quinine in children less than 8 years old if other treatment options are not available or are not tolerated, and the benefit of adding doxycycline or tetracycline is judged to outweigh the risk. If infections initially attributed to "species not identified" are subsequently diagnosed as being due to P. vivax or P. ovale, additional treatment with primaquine should be administered. ESSENTIALS OF MEDICAL PHARMACOLOGY, www.cdc.gov/malaria/diagnosis_treatment K.D.TRIPATHI SIXTH EDITION PAGE NO:785 [/INST] question: Which of the following drugs can be used for the treatment of chloroquine resistant malaria in children? | options: A: Chloroquine B: Doxycycline C: Tetracycline D: Clindamycin | answer: D </s>

<s>[INST] context: Just outside the northern Italian town of Bra, there rises a church tower with a clock that is a half hour slow. Though not far from the industrial city of Turin, Bra smells of roses, and leisure is the law. It is both the home of an international movement that promotes slow food and one of Italian cities that have joined the slow cities. In Bra, population 27,866, the town fathers have declared that all small food shops be closed every Thursday and Sunday. They forbid cars in the town square. All fruits and vegetables served in local schools must be organic . And as the movement goes well, the slow concept gradually spreads across Europe. The argument for a Slow Europe is not only that it is good, but also that it can work. The Slow City Movement, which started in 1999, has improved local economies by promoting local goods and tourism. Young Italians are moving from larger cities to Bra, where unemployment is only 5 percent, about half the nationwide rate. Slow food and wine festivals draw thousands of tourists every year. Shops are doing well, many with sales rising at a rate of 15% per year. "This is our answer to the world." says Paolo Samrnini, the founder of Slow Cities. France is in favor of slow economics. Most outsiders have long been doubtful of the French model: short hours and long vacations. Yet the French are more productive than those in the United States and Britain, and have been for years. The mystery of French productivity has risen an Europewide debate about the advantages of working more slowly. [/INST] question: The church clock that is a half hour slow severs as a symbol of _ . | options: A: industrial development B: slow movement C: global economy D: city growth | answer: B </s>

<s>[INST] context: Poal hypeension occurs when the pressure in the poal system is increased due to factors that may be divided into three categories Pre-sinusoidal causes of poal hypeension include : sinistral/extrahepatic : I. splenic vein thrombosis II. splenomegaly III. splenic atrioventricular fistula intrahepatic : I. schistosomiasis II. congenital hepatic fibrosis III. idiopathic poal fibrosis IV. myeloproliferative disorder V. sarcoid VI. graft versus- host disease Sinusoidal poal hypeension is a consequence of cirrhosis of any aetiology. Postsinusoidal hypeension can also be divided into : intrahepatic - vascular occlusive disease posthepatic :- I. Budd-Chiari II. congestive hea failure III. IVC webs Post Hepatic Poal Hypeension Right hea failure Tricuspid regurgitation Constrictive pericarditis IVC obstruction Budd - Chiari syndrome Intrahepatic Poal Hypeension Cirrhosis Schistosomiasis Hepatitis Veno - occlusive disease Sclerosing cholangitis Primary biliary cirrhosis Wilson's disease Hemochromatosis Alpha - 1 antitrypsin Granulomatous disease Congenital fibrosis Pre - hepatic Poal Hypeension Poal vein thrombosis Splenic vein thrombosis Splenomegaly Mesenteric aeriovenous fistula DIAGNOSIS : In evaluating patients with suspected poal hypeension, an enlarged poal vein on routine abdominal ultrasonography may suggest poal hypeension but this is not diagnostic. Doppler ultrasound allows identification of vascular occlusion and the direction of poal venous low. CT and MR angiography are useful for evaluating poal venous patency and anatomy. The most accurate method for measuring poal hypeension is hepatic venography. This procedure introduces a balloon catheter directly into the hepatic vein where free hepatic venous pressure (FHVP) is measured. The hepatic vein is then occluded by inflation of the balloon allowing measurement of the wedged hepatic venous pressure (WHVP). The hepatic venous pressure gradient (HVPG) may then be calculated by subtracting the FHVP rom the WHVP (HVPG = WHVP-FHVP). Clinically significant poal hypeension is defined as HVPG greater than 10 mm Hg. Angiographic Findings IVC graphy or percutaneous hepatography or MR Venography 'Spider - Web Collaterals' Long segmental compression of IVC by caudate lobe Dilated hepatic aeries [/INST] question: What is the most accurate method for measuring poal hypeension ? | options: A: Doppler ultrasound B: Hepatic venography C: CT D: MRI | answer: B </s>

<s>[INST] context: Only about 10% of emboli actually cause infarction- Regarding morphologic consequences of embolic occlusion of pulmonary arteries - Robbins 7th/742 Why only 10% of emboli cause infarction? Because the lungs have a dual blood supply. In patients with adequate cardiovascular function, the bronchial arterial supply can often sustain the lung parenchyma despite obstruction to the pulmonary arterial system. Pulmonary embolism usually causes infarction only when the circulation is already inadequate as in patients with heart or lung disease. For this reason, pulmonary infarcts tend to be uncommon in the young. Consequences of pulmonary embolism The effects of pulmonary embolism depend mainly on the size of the occluded vessel, the number of emboli, and on cardiovascular status of the patients. The following consequences can result. 1. Asymptomatic Most pulmonary emboli (60% to 80%) are clinically silent because they are small. With time, they undergo organization and are incorporated into the vascular wall. 2.   Sudden death (cardiovascular collapse) Massive pulmonary embolism may result in instantaneous death, without occurrence of chest pain and dyspnea. 3.   Acute cor pulmonale (Acute right heart failure) Numerus small emboli may obstruct most of the pulmonary circulation resulting in acute heart failure. 4.   Pulmonary infarction Embolic obstruction of small end-arteriolar pulmonary branches can cause pulmonary infarction. About three-fourths of all infarcts affect the lower lobes, and in more than half, multiple lesions occur. Characteristically, they extend to the periphery of the lung substance as a wedge with the apex pointing toward the kilns of the lung. The pulmonary infarct is classically hemorrhagic infarct. 5.   Pulmonary hemorrhage Embolic obstruction of medium-sized arteries may result in pulmonary hemorrhage. 6.   Pulmonary hypertension Multiple emboli over time may cause pulmonary hypertension with right heart failure. [/INST] question: The percentage of pulmonary emboli, that proceed to an infraction, is approximate - | options: A: 0-5% B: 5-15% C: 20-30% D: 30-40% | answer: B </s>

<s>[INST] context: The Sweetest Sight I was in the most beautiful city in the world, yet I only wanted home. It was an amazing week for my husband and me--the trip of a lifetime. Months ago, when my husband told me that he would have a meeting in London, I told him my wish to go to Europe together with him. Then we asked his mother to look after our two children and started off. During the week's time, we visited London and Paris--as much as we could, Big Ben, the Eiffel Tower and so on. All these were beautiful places we expected to see before. We really had a fantastic time. On our last night in Paris, after we enjoyed the night sight of the Eiffel Tower, my husband called home. His mother answered the phone. In a second, my husband's face fell and looked so worried. I could feel there was something bad. "What's wrong?" I asked. He didn't answer and went on to listen. A few minutes later, he said sadly to me that Tony, our seven-year-old son, fell down from his bike and broke his leg. He must be sent to hospital at once. At that moment, Paris suddenly lost its charm . "I don't want to be here! I shouldn't be here! I should be home with my kids!" We hurried back to our hotel and then to the airport... Finally, we got home. We rushed into our children's bedroom. Seeing our two children, I suddenly understood the truth: There is no sweeter sight in the world than our children's faces that greet us at home. [/INST] question: Who went to the Europe countries? | options: A: The writer B: Her husband C: All her family members D: The writer and her husband | answer: D </s>

<s>[INST] context: A flock of hungry pigeons were flying across the sky in search of food. Having traveled a long distance, they felt tired and settled down on a tree. Just below the tree, they saw grains strewn all over the ground. The pigeons were happy to have found enough food to eat. All the pigeons came down from the tree and started eating the grains. As they were doing so, a huge net fell on them and trapped them all. The pigeons were taken aback. They noticed a hunter sitting at a distance from the tree, a bow and arrow in hand. The pigeons realized it was the hunter who had trapped them in the net. The hunter got up and began to move towards the pigeons. The leader of the pigeons spoke, "Friends, we are in great trouble. The hunter will catch us if we do not act swiftly in a few seconds. There is only one _ available at this moment. Let all of us use our force together and fly up along with the net. If all of us use our force and fly together, we can fly carrying the net along with us. Let us start now." All the pigeons agreed with him and flew high carrying the net along with them. After traveling enough distance away from the hunter, the pigeons settled on a tree and carefully came out of the net one by one and thus escaped the evil design of the hunter. [/INST] question: Who strewed the grains over the ground? | options: A: A villager B: The hunter C: The pigeon D: The writer | answer: B </s>

<s>[INST] context: Ms Tan,you've referred to your new novel as your eighth book. That's because it took me six or seven attempts at a second novel before I started and completed this one. *Why do you think you had so many false starts? I would say that my reasons were wrong:I was trying to prove that I wasn't just a mother-daughter storyteller,or I was trying to prove that I didn't just have to write about things that were strictly Chinese or Chinese-American.Those were never the right reasons for writing those early stories.And I could never come up with other,better reasons for continuing them. *What kept you going on this book? This book was different because it was based on my mother's real life.The reason for writing it became more personal and emotional.After The Joy Luck Club came out,my mother was always explaining to people that she wasn't any of the mothers in that book.And at one point she said to me,"Next book tells my true story."And then she started telling me things I never knew before.She also told me many,many stories,because my mother doesn't generalize.The book really grew out of that. *Have you ever visited China? Yes.I've been there twice:about three years ago and then again last November,both times with my mother and my husband. *Was it difficult to capture the Chinese-American dialect without sounding like a parody ? No,because it's the language I've heard all my life from my mother.She speaks English as it's direct translation from Chinese.But it's more than that:Her language also has more imagery than English. *Can you think of an example? Somebody might say to me,"Don't work so hard.You'll kill yourself."My mother will say to me,"Why do you press all your brains out on this page for someone else?"So it's very vivid.That's the way she talks. *Have many readers told you that the Chinese mother in your book reminded them of the typical Jewish mother? Many people have told me that.I think the mother-daughter relationship is very intense in both cases.Culturally there is an acceptance that mothers have the power to tell their children,especially their daughters,how to conduct their lives--not simply up until the time they are 18,but for the rest of their lives.However,when children grow up in a different culture from their parents',they tend to keep more secrets from their parents.The children think,"They just wouldn't understand that I had to do this."And that can really create a gap,and it can grow as the number of secrets grows. [/INST] question: Based on the questions in this interview,what do you think Ms Tan's profession is? | options: A: A journalist B: A storywriter C: An interviewer D: An interviewee | answer: B </s>

<s>[INST] context: Fractures of the navicular bone of the wrist should be suspected in anyone, particularly a young person, who falls on an outstretched hand. Although x-rays are mandatory, it is important to realize that the fracture may not be seen on the initial x-ray and that a presumptive diagnosis can and should be made on clinical grounds alone. Typically, there will be tenderness to palpation over the navicular tuberosity and limitation of wrist flexion and extension. Immobilization of the wrist for about 16 week and sometimes up to 6 month is required. Nonunion or avascular necrosis is not uncommon and may require bone grafting for correction.Dislocation of the radial head with a fracture of the proximal third of the ulna is known as Monteggia's deformity. Usually, the radial head is dislocated anteriorly. The injury is usually caused by forced pronation. The injury can be treated by reduction and stabilization of the ulna followed by reduction of the radial head via supination and direct pressure.Anterior shoulder dislocations occur more frequently than posterior dislocations. However, posterior dislocations are seen in special situations, such as during an epileptiform convulsion and during electroshock therapy. Closed reduction followed by immobilization is usually sufficient therapyA spiral fracture, frequently seen in the tibia in skiers, results from the application of torque to a long bone. Greenstick fractures are common in children. The bones of young children are able to bend to a greater degree than those of adults; the fracture may occur only at the site of maximal cortical stress but not at the opposite cortex, the site of maximal longitudinal compression. [/INST] question: Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY) | options: A: Navicular (scaphoid) fracture B: Monteggia's deformity C: Greenstick fracture D: Spiral fracture | answer: A </s>

<s>[INST] context: Familial adenomatous polyposis (FAP) is characterized by the appearance of thousands of adenomatous polyps throughout the large bowel. It is transmitted as an autosomal dominant trait. It is associated with a deletion in the long arm of chromosome 5, which contains the APC gene. The colonic polyps are usually evident by age 25. If untreated, patients usually develop colon cancer by the age of 40. Once multiple polyps are detected, patients should undergo a total colectomy, which is the primary therapy to prevent colon cancer. Current guidelines recommend that patients with a family history of FAP should have screening with flexible sigmoidoscopy or colonoscopy beginning at the age of 25, followed by annual screening until age 35. An alternative method for identifying carriers is testing peripheral blood mononuclear cell DNA for the presence of a mutated APC gene. The detection of this mutation can lead to a definitive diagnosis before the development of polyps. The MEN 1 gene is associated with multiple endocrine neoplasia type 1, which does not increase the risk of colon cancer. The RET gene is associated with multiple endocrine neoplasia type 2. The MSH gene is associated with hereditary nonpolyposis colon cancer (HNPCC), also known as Lynch syndrome. In contrast to FAP, patients with HNPCC or Lynch syndrome do not develop multiple polyps but instead develop only one or a few adenomas that rapidly progress to cancer. This condition is also strongly associated with ovarian and endometrial carcinoma. The BRCA gene is associated with familial breast and ovarian cancers. [/INST] question: A 26-year-old healthy man comes to your clinic for an annual wellness examination. He does not take any medications. He smokes half pack of cigarettes daily. He tells you that his father died of colon cancer at the age of 45. He also has a 25-year-old cousin who recently had colonoscopy for rectal bleeding was found to have multiple polyps and is scheduled for total colectomy. Your patient wants to know if he can inherit colon cancer and if there is a way to find out if he is at risk. You talk to him about how some cancers can be caused by genetic mutations. For what genetic mutation is this patient at highest risk? | options: A: MEN1 B: RET C: APC D: MSH | answer: C </s>

<s>[INST] context: When I was six, dad brought home a dog one day, who was called "Brownie". My brothers and I all loved Brownie and did different things with her. One of us would walk her, another would feed her, then there were baths, playing catch and many other games. Brownie, in return, loved each other and every one of us. One thing that most touched my heart was that she would go to whoever was sick and just be with them. We always felt better when she was around. One day , as I was getting her food, she chewed up one of dad's shoes, which had to be thrown away in the end. I knew dad would be mad and I had to let her know what she did was wrong. When I looked at her and said, "Bad girl," she looked down at the ground and then went and hid. I saw a tear in her eyes. Brownie turned out to be more than just our family pet. She went everywhere with us. People would stop and ask if they could pet her. Of course she'd let anyone pet her. She was just the most lovable dog. There were many times when we'd be out walking and a small child would come over and pull on her hair. She never barked or tried to get away. Funny thing is she would smile. This frightened people because they thought she was showing her teeth. Far from the truth, she loved everyone. [/INST] question: What would Brownie do when someone was ill in the family? | options: A: Look at them sadly B: Keep them company C: Play games with them D: Touch them gently | answer: B </s>

<s>[INST] context: The patient is presenting with signs and symptoms of bladder instability. Oxybutynin both exes a direct antispasmodic effect and inhibits the muscarinic action of acetylcholine on smooth muscle. Although this agent exes approximately one fifth the anticholinergic activity of atropine, it has 4-10 times the antispasmodic activity of this agent. In addition, oxybutynin will not interact with her current medication regimen. Bumetanide is a "loop" diuretic used in the treatment of edematous states secondary to a wide variety of pathologic conditions. Since this agent promotes diuresis, it would most likely worsen the signs and symptoms of persistent urinary urgency, and urge incontinence. Metoprolol is a beta-1 selective receptor blocking agent indicated for the treatment of hypeension and tachyarrhythmias. The use of this agent would not have an effect on this patient's persistent urinary problems. Fuhermore, this agent is generally not used in diabetic patients, since it can block the normal premonitory signs of hypoglycemia. Neostigmine inhibits acetylcholine hydrolysis in the synaptic cleft acetylcholinesterase inhibition. The net effect is an increase in cholinergic activity, leading to detrusor muscle contraction. This agent is indicated for the treatment of urinary retention, and it would most likely worsen this patient's incontinence. [/INST] question: A 72 year old woman presents with complaints of persistent urinary urgency, and incontinence. Her past medical history is significant for type 2 diabetes, for which she is currently taking glyburide, 5 mg twice daily. Which of the following is the most appropriate treatment for this patient? | options: A: Bumetanide B: Metoprolol C: Neostigmine D: Oxybutynin | answer: D </s>

<s>[INST] context: Armed only with iPhones, the inventive rock band Atomic Tom has gone viral by way of the New York subway. The band has scored an Internet hit with the video to the song "Take Me Out." Singer Luke White says the production was a top-secret operation. "We didn't tell anyone about this. It was completely top-secret from our family, from our friends, from our label, our management, everybody. So the first time that people saw this video was last Friday when we put it on YouTube,"explained White. Since uploading the video to YouTube, band members have spent several days refreshing the page to watch the number of hits rise. The video has also made its way around Twitter as many people have shared it with their friends. "I mean, it still hasn' t quite hit.It' s just kind of blowing our minds right now that we're getting this: ma ny people are fond of it, and they' re sharing it with their friends.We don' t know what it's like really to have something that's viral, so all of this is very new to us." said Eric Espiritu, the lead guitarist of the band. White explains how the video came together: "We did our research with the applications( ) and found applications that worked out really well with the instruments and then we plugged them all into, plugged our phones into mini-battery powered amplifiers that we put underneath our seats, and we did a lot of, you know, practices, in terms of figuring out what the balance of the sound and like who was overpowering, who was too loud or who was too soft." The idea for the video came from Espiritu's younger brother Benjamin. The younger Espiritu directed the video from his initial concept through the final edit and upload to the Internet. "I' ve seen a lot of the music applications come out, and I' ve never actually had the chance to play with them,"says Ben Espiritu. "When I started hearing about how they sound and e verything, I thought it might be unique to take it one step further and then create an entire band just performing solely on the iPhones, and I thought it would be a pretty cool idea." Ben says the success of the band' s music video is a credit to the talent and ability of the musicians, but it' s also a sign of the times. "It really comes down to seeing something different, seeing something unique, and I think that that' s always, in any type of art form, what will speak to people, and I think it does reflect the times that we live in, taking a smart phone and then being able to turn it into an instrument, not only just an instrument, but making it sound really good." [/INST] question: Who first saw the video of the song"Take Me Out"? | options: A: Their friends B: The people on line C: Their family D: Their management | answer: B </s>

<s>[INST] context: Henoch-Schonlein purpura (HSP), or anaphylactoid purpura, is a systemic IgA-mediated vasculitis. The rash of anaphylactoid purpura appears much like that in the picture of this child's buttocks and most often involves extensor surfaces of the extremities; the face, soles, palms, and trunk are less often affected. Other significant symptoms include edema, arthralgia or arthritis, colicky abdominal pain with GI bleeding, acute scrotal pain, and renal abnormalities ranging from microscopic hematuria to acute renal failure. As HSP is a systemic vasculitis, any organ system can be affected. The prognosis, however, is excellent, with only a small percentage of children going on to end-stage renal failure. Seizures are an uncommon complication of CNS involvement; more commonly, patients will complain of headache and will have behavioral changes. Unilateral lymphadenopathy and nonpurulent conjunctivitis are not typical of HSP (but are criteria for Kawasaki disease, another pediatric vasculitis). [/INST] question: A 7-year-old boy has cramping abdominal pain and the rash shown mainly on the back of his legs and buttocks as well as on the extensor surfaces of his forearms. Laboratory analysis reveals proteinuria and micro-hematuria. In addition to his rash and abdominal pain, what other finding is he likely to have? | options: A: Chronic renal failure B: Arthritis or arthralgia C: Seizures D: Unilateral lymphadenopathy | answer: B </s>

<s>[INST] context: Tu Youyou, an 84-year-old female scientist, became the first Chinese to win a Nobel Prize in science on Oct 5. Before that, she ever won the 2011 Lasker Award for finding out artemisinin (Qinghaosu), which saved millions of lives. She was grateful for the Lasker prize, but said, "It is just a scientist' duty. I will go on fighting for the health of all humans." Tu kept her work in the 1960s and 1970s. In that age, Malaria could took away people's health. Scientists all over the world had already tried over 240, 000 times but failed. Tu Youyou, a member of the Academy of Traditional Chinese Medicine, Beijing, began to study Chinese herbs. Before 2011, people didn't know Tu very much. Many friends played jokes with her "the Professor of Three None's" : no degree , no study experience abroad, not a member of any Chinese national colleges. But she is hard-working. She read a lot of traditional Chinese medicine books and did a lot of researches on the disease. In February, 2012, Tu was named National Outstanding Females (One of the Ten) Tu is now a model of Chinese medical workers. [/INST] question: Artemisinin is used to _ . | options: A: make medicine B: make food C: get award D: do the experiment | answer: A </s>

<s>[INST] context: Philip is a school boy. On his twelfth birthday, he decided to give up eating meat. "I don't think it's right to eat animals," he said. "They live on the Earth just like us and they are our friends." Philip's parents were not happy about that. "You are a growing boy," his mother said. "You need meat. Do you want to stay short and be weak?" His mother put some beef, rice and carrots in front of him. "I want you to eat all your food now," she said. "Don't leave anything." Philip didn't want to make his mother sad. But he ate only the rice and the carrots. "You're a silly boy!" said his father. "I'm getting very angry at you." "I'm sorry, Mum and Dad," answered Philip. "I don't want you to be sad or angry. But I really don't want to eat any meat." "Then have some fish, dear," said his mother. "Oh no, I can't!" cried Philip. "Fish are living things too." "Well, you can't have anything to eat at all if you don't eat any meat or fish," said his father. The next morning Philip got up hungry. His father walked to the school with him and asked to see the teacher. "Is this what you teach the students at school?" he asked the teacher. "Philip refuses to eat meat at home. He doesn't listen to what I say." "I don't agree with Philip," replied the teacher. "But I think he's brave to do what he thinks is right. We teach the students to do that." [/INST] question: Philip decided to give up eating meat on his _ birthday. | options: A: fifth B: twelfth C: eleventh D: eighth | answer: B </s>

<s>[INST] context: How far would you be willing to go to satisfy your need to know?Far enough to find out your possibility of dying from a terrible disease?These days that's more than an academic question,as Tracy Smith reports in our Cover Story. There are now more than a thousand genetic tests,for everything from baldness to breast cancer,and the list is growing.Question is,do you really want to know what might eventually kill you?For instance,Nobel Prizewinning scientist James Watson,one of the first people to map their entire genetic makeup,is said to have asked not to be told if he were at a higher risk for Alzheimer's . "If I tell you that you have an increased risk of getting a terrible disease,that could weigh on your mind and make you anxious,through which you see the rest of your life as you wait for that disease to hit you.It could really mess you up." said Dr.Robert Green,a Harvard geneticist. "Every ache and pain," Smith suggested,could be understood as "the beginning of the end.""That's right.If you ever worried you were at risk for Alzheimer's disease,then every time you can't find your car in the parking lot,you think the disease has started." Dr.Green has been thinking about this issue for years.He led a study of people who wanted to know if they were at a higher genetic risk for Alzheimer's.It was thought that people who got bad news would,for lack of a better medical term, _ .But Green and his team found that there was "no significant difference" between how people handled good news and possibly the worst news of their lives.In fact,most people think they can handle it.People who ask for the information usually can handle the information,good or bad,said Green. [/INST] question: Which of the following is TRUE of James Watson? | options: A: He is strongly in favor of the present genetic tests B: He is more likely to suffer from Alzheimer's disease C: He believes genetic mapping can help cure any disease D: He doesn't want to know his chance of getting a disease | answer: D </s>

<s>[INST] context: ref Robbins 9/e p97-78 a granuloma is an organized collection of macrophages. In medical practice, doctors occasionally use the term "granuloma" in its more literal meaning: "a small nodule". Since a small nodule can represent anything from a harmless nevus to a malignant tumor, this usage of the term is not very specific. Examples of this use of the term granuloma are the lesions known as vocal cord granuloma (known as contact granuloma), pyogenic granuloma and intubation granuloma, all of which are examples of granulation tissue, not granulomas. "Pulmonary hyalinizing granuloma" is a lesion characterized by keloid-like fibrosis in the lung, and is not granulomatous. Similarly, radiologists often use the term granuloma when they see a calcified nodule on X-ray or CT scan of the chest. They make this assumption since granulomas usually contain calcium, although the cells that form a granuloma are too tiny to be seen by a radiologist. The most accurate use of the term "granuloma" requires a pathologist to examine surgically removed and specially colored (stained) tissue under a microscope. Histiocytes (specifically macrophages) are the cells that define a granuloma. They often, but not invariably, fuse to form multinucleated giant cells (Langhans giant cell). The macrophages in granulomas are often referred to as "epithelioid". This term refers to the vague resemblance of these macrophages to epithelial cells. Epithelioid macrophages differ from ordinary macrophages in that they have elongated nuclei that often resemble the sole of a slipper or shoe. They also have larger nuclei than ordinary macrophages and their cytoplasm is typically more pink when stained with eosin. These changes are thought to be a consequence of "activation" of the macrophage by the offending antigen. [/INST] question: Which of the following is most characteristics of granuloma | options: A: Epitheliod cell B: Giant cells C: Fibroblast D: Endothelial cells | answer: A </s>

<s>[INST] context: Mo Yan,the winner of 2012 Nobble Prize for Literature ,is very popular around the world. He is famous as one of the greatest writers in china. Mo Yan is fifty-nine years old in 2015,and his real name is Guan Moyue.The name of Mo Yan means"Don't speak".The writer said close the name to remember to close his mouth from getting himself in trouble. Mo Yan began to write in 1970s, and his first novel was"Falling rain on a Spring Night ",published in 1981.Then his second and more books were published.including "Red Sorghum"and "Big Breast and Wide Hips." CCTV reporter Dong Qian once said to him,"I always feel that a writer is like a hen,and his works are like eggs. We may not always wonder what the hen looks like while we eat eggs. But this time, it's a golden egg. So naturally, everybody wants to know this hen who laid a golden egg. That's why so many people pay much attention to you ." China was celebrating the success of this native son soon after he got the Prize, millions of Chinese expressed pleasure and pride for Mo Yan in their own ways. [/INST] question: When did Mo Yan get the Noble Prize for Literature? | options: A: In 2012 B: In 2013 C: In 2014 D: In2015 | answer: A </s>

<s>[INST] context: Are you a bit bored with your nine-to-five routine? Have a look at our exciting range of holidays and decide what type of adventure you'd like. Activity holidays Our activity holidays are for everyone who loves danger. We have a huge of water, snow and desert holidays. We'll take you scuba diving in the Red Sea of kayaking and white water rafting in Canada. If you prefer snow, you can try skiing or snowboarding in the Alps or even igloo-building( ).For those who like warm weather, we also have sand boarding(the desert version of skateboarding) or camel safaris. Polar expeditions Take a cruise to the Antarctic or the Arctic; explore a land of white nature beauty or wonderful wildlife. Our experts will explain everything about the two poles as you watch penguins or whales in the Antarctic and polar bears in the Arctic. There's no greater adventure than traveling to the two ends of the earth. Culture journeys Our culture journeys will help you discover the secrets of distant places such as India, Thailand or Egypt. Explore their history by visiting temples, palaces and ancient ruins. You can also get to know how people live in the modem world by exploring markets, eating exotic foods and meeting local people. Hiking tours We have hiking holidays to famous places, such as Machu Picchu or the Everest Base Camp Trek,as well as some nearer to home, for example in the highlands of Scotland. You don't need to be too sporty, just fairly fit. You'll have a great time enjoying nature with a group of new friends. Some of the holidays need camping, but we'll transport the tents for you! Wildlife holidays We organize small group tours to get closer to nature in Africa, Asia or South Africa. Go on safari in Africa and watch lions and giraffes. Meet the famous turtles of Galapagos Islands. Look for tigers in India, or take an elephant safari in Sri Lanka. We use local guides and stay in a range of accommodation, from tents to tree houses. [/INST] question: What kind of activities can you do if you go to the Red Sea in summer? | options: A: White water rafting B: Diving C: Igloo-building D: Sand boarding | answer: B </s>

<s>[INST] context: Hong Kong, major commercial center for Asia, and with a population which has grown at an alarming rate to over 5 million, is a city highly dependent on mass (, ) transit of all sorts, both local and long distance. An ordinary Hong Kong worker or businessman, going about his daily activities, simply must use transportation at one time or another. Because Hong Kong is in two parts, Kowloon, on the mainland side, and Hong Kong, the island, with Hong Kong's harbor in between Hong Kong's mass transit systems, in addition to going over land they must also cross water. Going from home to work, or going shopping from one side of the harbor to the other, the Hong Kong resident has three choices. One way is to take a bus which will cross the harbor through an under water traffic tunnel moving slowly through bumper- to-bumper traffic.Another way is by ferry boat , a pleasant ride which crosses the harbor in from seven to fifteen minutes. But by far the fastest way of crossing the harbor is the newly built underground electric railway, the Hong Kong Metro . If one gets on the train in the Central District,the commercial area of Hong Kong on the island side, he can speed across the harbor in an astonishing three minutes. On the other side of the harbor the railway continues, snaking back and forth through the outlying districts of Kowloon, allowing one to get off a short distance from his destination. The story of the Metro is an encouraging one for supporters of mass transit. Although building the system was certainly a challenging task, the Japanese firm hired to construct it did so in record time. Construction got underway in 1979 and it was completed in 1980. For the average commuter the system has only one disadvantage; it is more expensive than by bus or ferry. One can ride the bus across the harbor for half as much or he can ride the ferry across for less than one-fifth as much. [/INST] question: Hong Kong public transportation extends _ . | options: A: over hills and valleys B: across land and water C: through mountains D: throughout the Kowloon area | answer: B </s>

<s>[INST] context: There is more to tourism in Britain than you might think. When you think of tourist sites in Britain, what do you think of? Big Ben and the Tower of London? Lock Ness? Shakespeare's birthplace at Strafford-upon-Avon? There are many famous tourist attractions in the UK and they attract millions of visitors each year. But along with the famous names there are thousands of other interesting places that are only open to the public for a few days each year. Heritage Open Days takes place each September and lets the public visit places that would normally be out of bounds. Among the thousands of historic sites there are castles and factories, town halls and churches. Here we look at some of the places that most tourists might not know about. Roman Baths --- Chester These Roman baths are almost two thousand years old and a fascinating insight into the history of the city but they aren't often open to visitors because they are under a clothes shop and a shop that sells baked potatoes! In Open Days week, visitors can go downstairs to the basement of the shops and find a little piece of history. Tennis Club --- Birmingham Edgbaston Tennis Club opened in 1860 and is the oldest tennis club in the world. Visitors can see the club's collection of tennis clothes and equipment and learn about the game's rich history. Ardman Animation --- Bristol The studios that produced the famous Wallace and Gromit animated films open its doors to the public to let people find out more about how the films are made. Paddock Wood --- Kent A family house where some of the rooms are unchanged since the 1920s. The home's owner, Sarah Hamilton, is happy to open her doors to the public, saying "I'm passionate about history and I love taking to people." These are just a few of the thousands of places to visit each year. If you're visiting Britain in September ---- look out for Open Days! [/INST] question: Where is the Roman Baths --- Chester? | options: A: Next to a clothes shop B: Above a potato shop C: In Open Days week D: In a basement of two shops | answer: D </s>

<s>[INST] context: (Seperation of the cranial sutures) (222-Reddy's 29th)DIASTAT1C OR SUTURAL FRACTURES - separation of the sutures occurs only in young persons due to a blow on head with blunt weapon* It may occur alone but often is associated with fracture* It is usually seen in saggital sutures* These are particularly common in traffic accidents* Most successful estimate to union of skull is done from sagittal sutures, next lambdoid and then coronal (72- Reddy 29th)* Fissured fracture - These are linear fractures involving the whole thickness of the bone or inner or outer table only about 70% skull fractures are linear* Comminuted fracture - There are two or more intersecting lines of fracture which divide the bone into three or more fragments, and blows from weapon with a large striking surface eg heavy iron bar* Depressed fracture - "fractures a la signature" (signature fracture) as their pattern often resembles the weapon or agent which caused itLocalized depressed fractures are caused by blows from heavy weapon with a small striking surface** stone, stick, axe, chapper, hammer etc.Gutter fractures - They are formed when part of the thickness of the bone is removed so as to form a gutter eg oblique bullet wounds. They are usually accompanied by irregular, depressedfracture of the inner table of the skull* Hinge fracture of base of skull is also termed as a 'Motor cycylist's fracture' *** (247-Reddy 28th)Crescent fracture is - fracture of the iliac bone with sacroiliac joint disruption**Jefferson is - is a burst fracture where both the anterior and posterior arches of atlas (C1) are fractured by a vertical force acting through the skullClay shroveller's fracture - fracture of spinous process of T1 vertebra caused by violent muscular actionHangman fracture - fracture of C2 vertebra seen injudicial hanging due to extensionBox or Bursting fracture - is an extensive fracture running parallel to the two points of contect separating the two hemisphere. It is frequently caused by being run over by heavy vehicleRing fracture - any fracture round the foramen magnum it result fromI. fall from a height on feet or buttockII. sudden violent turn of the head on the spineIII. severe blow on vertex which drives the skull down wards on the vertebral columnIV. heavy blow directed underneath the occiput or chin [/INST] question: Diastatic fracture is | options: A: Seperation of the cranial sutures B: Also known case "Fracture a-la-signature" C: There are two or more intersecting lines of fracture D: A linear fracture involving the whole thickness of the bone | answer: A </s>

<s>[INST] context: There are plenty of reasons that have put sea turtles in danger. Here are some. The sea turtles tend to live in water, but the females come over to lands for nesting. This is the time when they are in the most vulnerable position. Their nesting areas have been taken over by human settlements and recreation development. This has forced them to search for areas that are less suitable for nesting. The egg is the first step for a sea turtle to have a chance of life. And this first step of life has become vulnerable in many countries. The sea turtles have no way to protect their eggs. As a result, the poachers have an opportunity to steal their eggs. The sea turtles are caught in shrimping vessels that use nets. The nets can drown these poor creatures. They die, as the nets are not pulled out fast. Gill nets and drilling for oil also _ habitat destruction and injury to the animal. One female sea turtle can lay hundreds of eggs in one nesting season. These eggs are preyed on by crabs , foxes, birds, and humans, as they make their run towards the sea. By the time they reach the shallow water, half of them have been removed by their predators on land and some are eaten up by fish in water. Only a few lucky ones win the battle of survival and live past their 1st birthday! The sea turtles take more than a decade to reach maturity. Then they start breeding and adult turtles have to live for many years to maintain the balance of population. However, as mentioned above, the adults face a lot of hardships for surviving. Pollution, long lines of fishing fleets, high seas, and even tumors, etc., all cause death of these massive, beautiful species. [/INST] question: When sea turtles are nesting, probably _ . | options: A: they are not afraid of humans B: they usually hide behind big rocks C: they don't have anything to protect them D: they pay no attention to their surroundings | answer: C </s>

<s>[INST] context: Risk of death is 3.5 to 5 times greater for obese smokers than it is for people who have never smoked and are at a normal weight, according to a study published in the November, 2006 issue of the American Journal of Preventive Medicine. The study, which began with a self-administered questionnaire taken between 1983 and 1989, asked more than 80,000 radiologic technologists aged 22 to 92 questions about age, height, weight and smoking behavior. BMI (body mass index) was calculated, with a BMI of 30 to 34.9 being considered obese, and 35 and over being very obese. Smoking behavior was analyzed by looking at a person's tobacco consumption level, number of years smoked, and current smoking status. Researchers then followed participants through December of 2002, noting the number of deaths that occurred. The study involved researchers from the National Cancer Institute, the University of Minnesota and the American Registry of Radiolegic Technologists. Key Findings: 20 percent of obese adults in the United States smoke. Obese smokers face a greater risk of death from cancer and circulatory disease. Current smoking is a greater risk factor for death by cancer than obesity is, generally speaking. The higher a person's pack-years (number of packs smoked per day times the number of years smoked) are, the greater the risk of death.www.zxxk.com Men and women of all ages faced an elevated risk of death due to circulatory disease as BMI increased. And for those who were both obese and currently smoking, risk of circulatory disease increased 6 to 11 times under the age of 65, as compared to their never-smoking, normal weight counterparts. While it's not surprising that obesity coupled with smoking is a recipe for trouble, it is important to highlight this growing health concern in America today. Taking Charge of Your Health Making healthy choices can be difficult when we're constantly exposed to products that are dangerous to our health, but it's not impossible. With education and some motivation, we all have the ability to make lasting changes for the better. If you're an overweight smoker worried about gaining weight due to quitting, take heart. It's never too late to change your course and even reduce damage to some extent. [/INST] question: 60. What is the American Journal of Preventive Medicine? | options: A: An medical institute B: A research center C: A medical magazine D: A TV station | answer: C </s>

<s>[INST] context: Doctors say obesity,also known as severe overweight,is a complex condition.A doctor may advise medical interventions in addition to changes in behavior.But experts say the more successful weightloss plans include a wellbalanced diet and exercise. People who want to avoid weight gain have to balance the number of calories they eat with the number of calories they use.To lose weight,you can reduce the number of calories you take in,or increase the number you use,or both.Experts at the National Institutes of Health say to lose weight,a person should do some moderate or intensive physical exercise most days of the week.This could include fast walking,sports or strength training. A recent study looked at four of the most popular dieting plans in the United States.Researchers at Stanford University studied more than three hundred overweight women,mostly in their thirties or forties.Each woman went on one of the four plans:Atkins,The Zone,Ornish or LEARN.The women attended diet classes and received written information about the food plans.At the end of a year,the women on the Atkins diet had lost the most,more than four and a half kilograms on average. Christopher Gardner led the study,reported in the Journal of the American Medical Association. He said the Atkins diet may be more successful because of its simple message to lower the intake of sugar.Also,he said the advice to increase protein in the diet leads to more satisfying meals. But last week,another report suggested that only a small minority of people have longterm success in dieting.Researchers at the University of California found that most dieters regained their lost weight within five years.And often they gained back even more.But those who kept the weight off generally were the ones who exercised. [/INST] question: All the following is helpful to lose weight EXCEPT _ . | options: A: a healthy diet B: physical exercise C: medical interventions D: being polite to others | answer: D </s>

<s>[INST] context: Once upon a time there lived two brothers named Jacob and William in Germany. They liked to listen to old stories and then write them down. So they had enough stories to make a book. You can guess the name of the book! It is Grimms' Fairy Tales. The story of this little book began when the brothers were still in school. And it started with a good teacher. The teacher liked to find out how things happened. Soon the two brothers were doing the same thing. They asked questions and then looked for answers. Among the questions the brothers asked, "Who made up the old fairy tales? Who first told about Cinderella ? Why made up the story of the Snow White and the story of Sleeping Beauty?"They found that no one knew the answers to such questions. The tales were made up in very early times. Most of them were made up in the days before people knew how to write. People told the stories to one another and to their children. But only a few old people still remembered them. "When old people die, the stories will die with them," said the brothers. "We must write down all the stories we can find." Jacob and William hunted for stories for five years. At last they had 89 tales written. Just before Christmas in 1812, the first book was published. People love the book! They asked more fairy tales. So Grimms put tales into two more books. In all, they collected 210 stories to put into their books. [/INST] question: Who wrote Grimms' Fairy Tales? | options: A: Jacob and his teacher B: William and his teacher C: Jacob and William D: Some old people | answer: C </s>

<s>[INST] context: Last summer holiday, I took a trip to Yunnan. It is in the southern part of our country .It is really a very beautiful place-grand mountains, clean rivers and kind people. Trees and flowers are seen everywhere. Every year there are lots and lots of visitors. Maybe you have heard about Shi Lin (stone forests). There are all kinds of strange stones. Some of the small stones look like graceful girls; and the big stones look like handsome men. Other stones look like cats, peafowls, double-edged swords, mice, elephants and so on. Of all the stones, the stone like a beautiful girl in a legend is the most famous .Its name is A Shima. I also went to Li Jiang. The roads in that city are just like the Eight Diagrams. Any road in the city goes to the center of Li Jiang. A river runs through the whole city. If you go along the river, you'll never get lost. There are many ethnic minority people in Yunnan. They are very cordial. And they all like singing and dancing. We danced with them around the campfire that night. I really had a good time. I like the elephants and fruits there best. An elephant is even taller than me! I even mounted the elephant, though I was very afraid at first. But the elephant seemed very friendly. I took some photos with it. The fruits there are very fresh and delicious. They are very good for our health. The trip to Yunnan impressed me greatly. I will never forget it. [/INST] question: Which of the following is not included in the advantages of Yunnan? | options: A: grand mountains B: clean rivers C: kind people D: good transports | answer: D </s>

<s>[INST] context: Nikki was brought up from a very early age by her father while her sister was raised by her mother. Nikki spent a very small amount of time with her mum and sister when she was about 6 years old, but soon after contact stopped when communication broke down between her parents. She never felt she wanted to find her family while she was growing up. But now with a husband and a son she decided it was the right time. Nikki didn't know where to start, but her husband's mum had used 192.com for finding people before and recommended it to her . With the help of her son, she started by searching for her sister's full name on the electoral roll without a location, because she had no idea where she lived, even her date of birth. From that one search , the site returned two results listed in the area they used to live. Nikki decided to call the first number. To her surprise, it was her long lost sister ! So after 20 years, it was one phone call that helped her contact her sister! Her sister then passed her number on to her mother, who called Nikki straight away, and it was like they had never been apart. Her mum was so glad to find out Nikki was well that they arranged to meet everyone that Saturday (3 days after the phone call) where she was reunited with her sister and met her 2 nephews for the first time . Nikki also found out she had a half sister and brother. When talking about the reunion , Nikki said , "192.com made finding my long lost family very easy. I was not on any social networking sites before and surprisingly neither was my sister or mum, so we would never have found each other that way. [/INST] question: What did Nikki know about her sister before her searching? | options: A: Her address B: Her birthday C: Her name D: Her telephone number | answer: C </s>

<s>[INST] context: Cytokeratins are proteins of keratin-containing intermediate filaments found in the intracytoplasmic cytoskeleton of epithelial tissue. The term "cytokeratin" began to be used in the late 1970s (for example, see "Intermediate-sized filaments of human endothelial cells" by Franke, Schmid, Osborn and Weber) when the protein subunits of keratin intermediate filaments inside cells were first being identified and characterizedThe subsets of cytokeratins which an epithelial cell expresses depends mainly on the type of epithelium, the moment in the course of terminal differentiation and the stage of development. Thus this specific cytokeratin fingerprint allows the classification of all epithelia upon their cytokeratin expression profile. Fuhermore, this applies also to the malignant counterpas of the epithelia (carcinomas), as the cytokeratin profile tends to remain constant when an epithelium undergoes malignant transformation. The main clinical implication is that the study of the cytokeratin profile by immunohistochemistry techniques is a tool of immense value widely used for tumor diagnosis and characterization in surgical pathology. [/INST] question: Poorly differentiated carcinoma express- | options: A: Cytokeratin B: Vimentin C: ILA D: desmin | answer: A </s>

<s>[INST] context: YOU might go to a museum to look at old cars or something about an ancient civilization . Would you like to see ice cream? Believe it or not, there is a museum of ice cream in Iowa in the United States. Visitors can see a video that tells all about the history of the delicious snack. It seems that ice cream goes back to about 2000 years ago , when the Chinese mixed together ice, milk and sugar. Spending an afternoon looking at how to make ice cream can make you a little hungry. No problem, the museum has its own ice cream store, where you can taste some of them. In Edinburgh, Scotland, there is a museum of childhood. The museum shows objects about the lives of children in Scotland, past and present. You can expect toys, dolls, teddy bears and train sets. But there are also videos which tell you what it was like to be a kid in Scotland in old times. You can hear children reading their multiplication tables : "Seven sevens are 49, eight sevens are 56." You can also watch documentary movies of the games kids played in Edinburgh in the 1950s, look at the clothes they wore and get to know what their schools were like. It will be wonderful to visit the Children's Discovery Museum in Bangkok , Thailand. The museum has parts of nature, environment, technology and kids' activities. In this museum, you get to take part in the kids' activities. You can dress up to be a fireman in a fire truck. It is interesting. [/INST] question: The museum of ice cream is in _ . | options: A: Scotland B: Bangkok C: America D: China | answer: C </s>

<s>[INST] context: Just a Little Smile Mark was walking home from school one day when he saw the boy in front of turn fall over and drop all of the books he was carrying, along with two sweaters, a basketball and a walkman . Mark stopped and helped the boy pick up these things. Since they were going the same way, he helped to carry some of his things. As they walked, Mark knew that the boy's name was Bill, that he loved computer games, basketball and history, and that he was having lots of troubles with his other subjects and that he had just _ with his girlfriend. They arrived at Bill's home first and Mark was invited in for a Coke and to watch some television. The afternoon passed happily with a few laughs and some small talk, then Mark went home. They often saw . each other at school, had lunch together once or twice, and then they both finished middle school. They ended up in the same high school where they sometimes saw and talked with each other over the years. At last just three weeks before they finished high school, Bill asked Mark if they could talk. Bill asked Mark if he still remembered the day years ago when they had first met. "Did you ever think why I was carrying so many things home that day?" asked Bill. "You see, I cleaned out my locker because I didn't want to leave anything for anyone else. I had put away some of my mother's sleeping pills and I was going home to kill myself. But after we spent some time together talking and laughing, ! began to understand that if I killed myself, I would have missed that time and so many others that might follow. So you see, Mark, when you picked up those books that day, you did a lot more. You saved my life. " [/INST] question: When Mark met him the first time, Bill was going | options: A: to have a basketball game B: to his classroom C: to see Mark D: back home | answer: D </s>

<s>[INST] context: Findley Lake, New York is a small beautiful village that sells itself as a holiday place for all seasons. The Findley Lake Area Chamber of Commerce supports a number of events all the year round that begin in March. At Findley Lake during the summer, there is boating, fishing and water sport activities. You can watch a boat parade and a fireworks display at the Findley Lake 4thof July boat parade. The "Harvest Festival" and October's "Autumn at the Lake" show that fall season is coming. In November, Findley Lake's "Christmas through the Village" starts off the holiday shopping season. Shopping at Findley Lake is a wonderful experience. It is easy to walk along Main Street and visit all the shops. There are over twenty shops that sell different kinds of gifts. Some of the special shops are the candle making factory, the year-round Christmas shop, and the Victorian shop. At the center of Findley Lake is the Blue Heron Inn which is a pleasant place to stay in. Breakfasts, lunches and dinners are open to the public and the meals are delicious. Dine outside on the porch looking down the lake or inside the comfortable dining rooms. Take time to shop at their store, Nostalgia, for unique items. As you walk around town, you can see a working waterwheel. If you have an interest in history, stop and visit the World War II Museum as well. The Village of Findley Lake offers something for everyone. It is a fantastic way to spend an afternoon. With year-round shopping and delicious dining at the Blue Heron Inn while looking down at the beautiful view of the lake, it is certain to please the visitors to this attractive village. [/INST] question: When can you see a fireworks display in Findley Lake? | options: A: In spring B: In summer C: In autumn D: In winter | answer: B </s>

<s>[INST] context: There once lived a young man who thought himself to be poor. One day he went to a wise man to ask how to become rich. The wise man said, "Young man, you are already rich now." "But where is my wealth?" the young man asked. "It is with you. Your eyes are your wealth. You use them to see this world. You use them to see all the beautiful things in this world. Your hands are your wealth. You can use them to work. You can use them to hug your beloved ones. Your legs are your wealth. You can go to any place..." the wise man said. "You call these wealth? But everyone has them," the young man said. "These are wealth. What you have now is not what someone else can luckily have. Would you like to give your eyes to me? I'd like to give you a lot of money to exchange for them," the wise man said. "No, I'm not going to do so! My eyes are important to me!" the young man said. Everyone is rich. We should treasure our wealth, and take care of it. We should not overuse it because once it is gone, it is gone forever. Remember it is our wealth that we do not want to lose. [/INST] question: Why did the young man go to visit the wise man? | options: A: Because he was ill B: Because he wanted to be wise C: Because he was the wise man's friend D: Because he wanted to know how to be rich | answer: D </s>

<s>[INST] context: Baths and bathing have long been considered of medical importance to man. In Greece there are the ruins of a water system for baths built over 3,000 years ago. The Romans had warm public baths. In some baths, as many 3,000 persons could bathe at the same time. Treating disease by taking bathing has been popular for centuries. Modern medical bathing first became popular in Europe and by the late 1700's has also become popular in the United States. For many years frequent bathing was believed to be bad for one's health. Ordinary bathing just to keep clean was avoided , and _ was often used to cover up body smells! By the 1700's doctors began to say that soap and water were good for health. They believed that it was good for people to be clean. Slowly, people began to bathe more frequently. During the Victorian Age of the late 19th century, taking a bath on Saturday night became common. In the United States ordinary bathing was slow to become popular. During the 18th and early 19th centuries, many Americans were known as "The Great Unwashed!" In one American city , for example, a person was only allowed to take a bath every thirty days! That was a law! Frequency of bathing today is partly a matter of habit. People know that bathing for cleanliness is important to health, Doctors know that dirty bodies increase the chance of diseases. As a result, in the United States, people generally bathe often. Some people bathe once a day at least. They consider a daily bath essential to good health. [/INST] question: A water system for baths was built by _ over 3,000 years ago. | options: A: the Romans B: the Greeks C: the Americans D: the Europeans | answer: B </s>

<s>[INST] context: Back in the fifteenth century, in a tiny village near Nuremberg, lived a family with eighteen children.In spite of the hopeless condition, two of the children, Albrecht Durer and Albert, had a dream.They both wanted to pursue their talent for art.After many long discussions, the two boys finally worked out an agreement.They would toss a coin.The loser would go down into the nearby mines and, with his earnings, support his brother who attended the academy.Then, when that brother who won the toss completed his studies, in four years, he would support the other brother at the academy. Tossing a coin, Albrecht Durer won and went off to Nuremberg.Albert went down into the dangerous mines and, for the next four years, supported his brother, _ work at the academy was almost an immediate sensation .By the time he graduated, he had earned considerable fees for his outstanding works. When the young artist returned to his village, the Durer family held a festive dinner to celebrate Albrecht's triumphant homecoming.Albrecht drank a toast to his beloved brother for the years of sacrifice that had enabled him to complete his dream."And now, Albert, blessed brother of mine, now it is your turn.Now you can go to Nuremberg to look for your dream, and I will take care of you." Tears streaming down his pale face, Albert sobbed, "No...no...It is too late for me.Look...look at what four years in the mines have done to my hands!The bones in every finger have been broken at least once, and lately I have been suffering from arthritis so badly in my right hand that I cannot even hold a glass to return your toast, much less draw delicate lines with a pen or a brush." To show thanks to Albert for all that he had sacrificed, Albrecht Durer painstakingly drew his brother's injured hands with palms together and thin fingers stretched skyward.He called his powerful drawing simply "Hands", but the entire world almost immediately opened their hearts to his great masterpiece and renamed it "The Praying Hands".The next time you see a copy of that touching creation, let it be your reminder--no one ever makes any success alone! [/INST] question: Why did the two brothers work out the agreement? | options: A: They were so curious as to make a joke B: Their family couldn't afford the academy C: One of the brothers was supposed to go into mines D: They wanted to support the other sisters and brothers | answer: B </s>

<s>[INST] context: Many everyday American expressions are based on colors. Red is a hot color. Americans often use it to express heat. They may say they are red hot about something unfair. When they are red hot they are very angry about something. The small hot tasting peppers found in many Mexican foods are called red hots for their color and their fiery taste. Pink is a lighter kind of color. People sometimes say they are in the pink when they are in good health. It probably comes from the fact that many babies are born with a nice pink color that shows that they are in good health. Blue is a cool color. The traditional blues music in the United States is the opposite of red hot music. Blues is slow, sad and soulful. Someone who is blue is very sad. The color green is natural for trees and grass. But it is an unnatural color for humans. A person who has a sick stomach may say he feels a little green. A passenger on a boat who is feeling very sick from high waves may look very green. If a person is green at his job, he may be a newcomer and inexperienced. Sometimes a person may be upset because he does not have something as nice as a friend has, like a new sports car. That person may say he is green with envy. Some people are green with envy because their friend has more dollars. The color black is used often in expressions. People describe a day in which everything goes wrong as a black day. The date of a major tragedy is remembered as a black day. [/INST] question: If a person feels blue, he is _ . | options: A: annoyed B: depressed C: stressed D: encouraged | answer: B </s>

<s>[INST] context: The net effect of insulin on lipid metabolism is to reduce the release of fatty acids from the stored fat.Among the tissues, adipose tissue is the most sensitive to the action of the insulinLipogenesisIt is the process by which acetyl-CoA is conveed to fats.The former is an intermediate stage in metabolism of simple sugars, such as glucose.Through lipogenesis, the energy can be efficiently stored in the form of fats.Lipogenesis encompasses the processes of fatty acid synthesis and subsequent triglyceride synthesis (when fatty acids are esterified with glycerol to form fats).The products are secreted from the liver in the form of very-low-density lipoproteins (VLDL)Fatty acids synthesis stas with acetyl-CoA and builds up by the addition of two carbon units.The synthesis occurs in the cytoplasm in contrast to the degradation (oxidation), which occurs in the mitochondria.Many of the enzymes for the fatty acid synthesis are organized into a multienzyme complex called fatty acid synthetase.Control and regulationInsulin is an indicator of the blood sugar level of the body, as its concentration increases propoionally with blood sugar levels.Thus, a large insulin level is associated with the fed state.As one might expect, therefore, it increases the rate of storage pathways, such as lipogenesis.Insulin stimulates lipogenesis in two main ways:The enzymes pyruvate dehydrogenase (PDH), which forms acetyl-CoA, and acetyl-CoA carboxylase (ACC), which forms malonyl-CoA, are obvious control points.These are activated by insulin.So a high insulin level leads to an overall increase in the levels of malonyl-CoA, which is the substrate required for fatty acids synthesis.PDH dephosphorylation [/INST] question: Regulation of lipid metabolism by insulin lacks which of the following feature: | options: A: Reduced activity of HMG CoA synthetase B: Increased release of fatty acids from stored fat in adipose tissue C: Increased availability of glycerol-3-phosphate D: Increased Acetyl CoA carboxylase activity | answer: B </s>

<s>[INST] context: Homestay UK/Great Britain Here you will find a selection of homestay hosts and host families in the UK. If you want to learn more about the British host family of your choice, please click on information at www. Homestaybooking. Com. You will then see a personal introduction of the UK homestay host. If you don't want to search yourself, just register for free and receive our matching recommendations. Chika and Tara from London, the United Kingdom Information about the homestay host Chika is 28 years old. She is away from home most of the time. Tara is 18 years old. She is at home every day. They both speak English. Chika and Tara's guests can stay for at least 5 nights and up to a maximum of 365 nights. Chika and Tara have no children living at home. It is a non-smoking residence . No pets live in this household. Information about the homestay accommodation The accommodation is in London. The name of the neighborhood is Greenwich. The distance to the city center is 1.6km. The next access point to public transport is at 15 m distance. Three guests can stay in Tara and Chika's house at the same time. The following accommodation is generally available: Single room with shared use of the family bathroom *Size: 12.0 m2 *Facilities: desk, Internet access, mirror, hairdryer and wardrobe *Price per night per person: PS20.00 per night(one single) Twin room with shared use of the family bathroom *Size: 15.0 m2 *Facilities: TV, desk, Internet access, mirror, hairdryer and wordrobe *Price per night per person: PS20.00 per night(one guest) PS17.00 per night(two guests) The room charge includes the following services: Internet access, regular room cleaning, breakfast, free use of the washing machine. Additional available service at an extra charge: Pick-up service(PS60.00 one-way); Lunch(PS6.00 per person per day); Dinner(PS6.00 per person per night) Vegetarian meals are available. [/INST] question: Chika and Tara's house would be a good choice for _ . | options: A: a pet lover B: a heavy smoker C: a person who eats no meat D: one who needs a one-night stay | answer: C </s>

<s>[INST] context: Animals grow up in different ways. They have lots of lessons to learn. Some animals are born helpless but their mothers protect them. A newborn kangaroo is the size of a bee. She stays in her mother's safe pouch. She doesn't open her eyes for at least five months. A newborn monkey cannot walk. He is carried by his mother. Other baby animals can walk soon after they're born. They learn to run with their mother when danger is near. A baby zebra can run an hour after she is born. Some baby animals are born in a place that is safe. Other baby animals are born in the open. Baby wolves are born in large holes. A baby elephant is born on open, grassy land. Other elephants make a circle to protect her. Animals that drink their mothers' milk are called mammals. A mother bear's milk is fatty and rich. Baby bears need lots of fat to keep warm in winter. They have milk for six months. Baby zebras drink milk for six months or more! As baby animals grow they need solid food. Baby lions eat what their mother can catch. [/INST] question: Which baby animals don't open their eyes for at least five months? | options: A: Lions B: Zebras C: Kangaroos D: Elephants | answer: C </s>

<s>[INST] context: Most of the time, we choose colors for decorating based on our personal taste and our sense of aesthetics . But, a number of color experts believe that colors have an effect on our emotions and that it would be wise of us to be conscious of that before settling on a definite choice. Some of the effects of colors are well known and accepted by most people. In fact, those effects have been the subject of serious research and experiments and have been scientifically proven. But not all scientists agree on the validity of the results. When we become interested in the psychological effects of colors, it is important to know that not all societies share our opinion of those effects on our emotions. What we hold as an "objective" observation on a color is often nothing more than a reflection of our cultural belongingness, which has attributed properties to that color for generations. Why is it not possible for us to hold a really objective discourse on the subject? In part, because it is very difficult to separate the psychological from the symbolic, the symbolic aspects are definitely cultural. Often, and this without our realizing it, they influence our understanding of colors and the following emotions - both psychological aspects. Black and white are good examples. In western countries, black is considered serious, dramatic and sometimes sad. People are warned against its potentially depressing effects on decoration. Black is the traditional color of mourning. White, on the other hand, is associated with purity, peace and optimism. For those reasons, white is the traditional color of bridal dresses. No one would think of attending a funeral in white. Any more than it would occur to a bride to wear black. We simply remain convinced that it is not in the "nature" of those colors. Yet, in certain oriental countries, it is white, not black that is the color of mourning. That having been said, there is some "overlapping" in the properties different cultures attribute to certain colors. For example, Feng Shui, the traditional Chinese philosophy that distinguishes between good and evil influences explains colors much in the same way as the majority of western color specialists. Is that to say that colors have real natural properties which all humans perceive in the same way or is the phenomenon an example of the cross-influences that affect the thinking of cultures brought closer to one another by a certain Venetian called Marco Polo? It is difficult to say. But, be that as it may, colors do affect us. And if you feel emotions for a certain color, note them and remember them. You may even wish to consider them next time you are planning to decorate. The decision is yours! [/INST] question: Most of the time, we ignore _ when choosing colors for decoration. | options: A: personal taste B: our aesthetics C: cultural effects D: psychological effects | answer: D </s>

<s>[INST] context: Lupus vulgaris  Lupus vulgaris is a chronic and progressive form of cutaneous tuberculosis that occurs in tuberculin sensitive parents. It is the most common type of cutaneous tuberculosis and has a most variable presentation. Seen in children and young adults, though no age is exempted. Occurs on an exposed area like face (nose, eyelid, pinna); and sometimes on the block, trunk. Lesions are usually solitary and characterized by - Reddish brown (erythematous). Annular in shape. iii. Indurated. Slowly increases in size (gradually progressive). Healing with tissue paper like scarring at centre (most common) or edge. Peripheral cruising. Blanching with glass slide (diascopy) will reveal grey green foci → Apple jelly nodules. Match-stick test positive → Apple jelly nodule has no resistance to pressure by a sharp matchstick. The reappearance of new nodules within previously atrophic or scarred lesions is characteristic. Carlage (Ear, nose) in the affected area is progressively destroyed (Lupus vorax); bone is usually spared. Buccal, nasal and conjunctival mucosa may be involved primarily or by extension. Treatment is a tub [/INST] question: Apple jelly module is seen in - | options: A: Cutaneous anaphylaxus B: Erythroderma C: Lupus vulgaris D: Eiysepals | answer: C </s>

<s>[INST] context: STEVE EMBER: And I'm Steve Ember with People In America in VOA Special English. Today we remember the singer and actress Lena Horne. During her sixty-year career performing, Lena Horne entertained people with her beauty and rich, emotional voice. She used her fame to fight social injustices toward African-Americans. Lena Horne was born in New York. At sixteen, Lena became a dancer at the famous club in New York City in 1933. After taking voice lessons, she soon became a singer. In 1940, Lena Horne became the first African-American to perform with an all-white jazz hand. After performing at a club in Hollywood, California, she caught the attention of filmmakers. She soon began making movies. Her films became very popular. In the 1940s, Lena Horne was the first African-American in Hollywood to sing a long -term contract with a major movie studio. Her deal with MGM stated that she would never play the role of a servant. She refused to play roles that represented African-Americans disrespectfully. Lena Horne once said that World War II helped make her a star. She was popular with both black and white soldiers. She sang on army radio programs and traveled to perform for the troops. These experiences led to Lena Horne's work in the civil rights movement. Lena Horne sang at rights gatherings. She took part in the march on Washington protest in 1963. It was during this event that Martin Luther King gave his "I have a dream" speech. She protested racial separation at the hotels where she performed. She took action so that she and her musicians would be allowed to stay in those hotels. B1ack musicians at the time generally stayed in black neighborhoods. At the age of eighty, she said she did not have to act like a white woman that Hollywood hoped she would become. She said: "I'm me, and I'm like nobody else." Lena Horne died in New York in 2010. [/INST] question: How old was Lena Horne when she died? | options: A: 93 years old B: 98 years old C: 86 years old D: 88 years old | answer: A </s>

<s>[INST] context: Steven Jobs was born on February 24,1955,in San Francisco,California,and was adopted by Paul and Clara Jobs.In 1961 the family moved to Mountain View, California.At that time people started to refer to the area as "Silicon Valley". As a child, Jobs preferred doing things by himself, not interested in team sports or other group activities.He enrolled in the HewlettPackard Explorer Club. There he saw his first computer at the age of twelve. He was very impressed, and knew right away that he wanted to work with computers. At that time almost all computers were so large that one could fill a room, and so costly that individuals could not afford to buy them.Advances in electronics, however, meant that the parts of a computer were getting smaller and the power of the computer was increasing. By 1980 the personal computer era was well underway.Apple was continually forced to improve its products to remain ahead, as more competitors entered the marketplace. Apple introduced the Apple III, but the new model suffered technical and marketing problems.It was removed from the market. Early in 1983 Jobs unveiled the Lisa.It did not sell well,however, because it was more expensive than personal computers sold by competitors.Apple's biggest competitor was International Business Machines (IBM). By 1983 it was estimated that Apple had lost half of its market share ( part of an industry's sales that a specific company has) to IBM. In 1984 Apple introduced a revolutionary new model, the Macintosh.The Macintosh did not sell well to businesses,however.It lacked features other personal computers had, such as a corresponding high quality printer. The failure of the Macintosh signaled the beginning of Jobs's downfall at Apple. Late in 1988 the NeXT computer was introduced, aimed at the educational market.The product was very userfriendly,and had a fast processing speed, excellent graphics displays,and an outstanding sound system.Despite the warm reception,however, the NeXT machine never caught on. It was too costly, had a blackandwhite screen, and could not be linked to other computers or run common software. [/INST] question: When did Steven Jobs first get the chance to catch sight of a computer? | options: A: In 1955 B: In 1961 C: In 1967 D: In 1980 | answer: C </s>

<s>[INST] context: Older women who regularly drink green tea may have slightly lower risks of stomach and throat cancers than women who don't, according to a Canadian study that followed thousands of Chinese women over a decade. For the study, researchers used data from a long-running health study of over 69,000 middle-aged and older Chinese women. The researchers found that those who drank green tea at least three times a week were 14 percent less likely to develop a cancer of the digestive ( ) system. More than 19,000 were considered regular green-tea drinkers, who drank it more than three times a week. Over 11 years, 1,255 women developed a digestive system cancer, In general, the risks were somewhat lower when a woman drank green tea often and for a long time. Green tea contains certain chemicals which may reduce the body-cell damage that can lead to cancer and other diseases. Women who _ a lot of green tea in the study were also younger, ate more fruits and vegetables, exercised more and had higher-income jobs. None of the women smoked or drank alcohol regularly, and the researchers also collected information on their diets, exercise habits, weight and medical history. Yet even with all these things factored in, women's tea habits remained linked to their cancer risks, they noted, even though this type of study cannot prove cause and effect. The study adds to debate over the effect of green tea on cancer risks, Past studies have so far come to conflicting findings on whether green tea drinkers really do have lower cancer risks.Nobody can say whether green tea itself is the reason, since green tea lovers are often more health-conscious in general. [/INST] question: The study lasted for more than _ . | options: A: three years B: five years C: eight years D: ten years | answer: D </s>

<s>[INST] context: A- Anterior hip dislocation B- Posterior hip dislocation C- Fracture neck of femur D- Gluteal muscle hematoma Posterior hip dislocation Due to deceleration injury Here the left knee was forcefully impacted the vehicle's dashboard, forcing the femoral head posteriorly over the rim of the acetabulum. As he turned to reach for the seatbelt, his hip was flexed because he was in sitting position, and was adducted and medially rotated, the classic hip position for this type of injury. The painful pop was the femoral head tearing through the posterior joint capsule and ligaments. The painful lateral gluteal mass is the femoral head on the lateral aspect of the ilium, and the affected limb appears shoer than the other because of the abnormal position of the femoral head. The first step would be radiographic confirmation of the dislocation or dislocation fracture. This would be followed by urgent reduction of the dislocation to decrease the risk of avascular necrosis of the femoral head. Fracture repair, if a fracture is present, may be performed at a later time. [/INST] question: A 40-year-old male presented to the ER with history of a motor vehicle accident. The vehicle hit his car head on. The Patient was thrown forward by the sudden deceleration. His knee hit the dashboard violently, and he felt a painful pop in his right hip. The doctor on duty noted his right limb shows this deformity There is a painful mass in the lateral gluteal region. What is the most likely diagnosis? | options: A: <img style="max-width: 100%" src=" /> B: <img style="max-width: 100%" src=" /> C: <img style="max-width: 100%" src=" /> D: <img style="max-width: 100%" src=" /> | answer: B </s>

<s>[INST] context: Last Friday a storm swept through two villages in the New Territories, destroying fourteen homes. Seven others were so badly damaged that their owners had to leave them, and fifteen others had broken windows or broken roofs. One person was killed, several were badly hurt and taken to the hospital, and a number of other people received light hurt. In total, over two hundred people were homeless. Mr Tan said that the storm began early in the morning and lasted for over an hour. "I was eating with my wife and children when we heard a loud noise," he said. "Several minutes later, our house fell down on top of us. We tried our best to climb out but then I saw that one of my children was missing. I went back inside and found him safe but very frightened." Mrs Woo said that her husband had just left for work when she felt that her house was moving. She ran outside at once with her children. "There was no time to take anything," she said. "A few minutes later, the roof came down." Soldiers helped to take people out of the flooded area and the welfare department brought them food, clothes and shelter. [/INST] question: How many homes were damaged in the storm in total? | options: A: Fourteen B: Twenty-one C: Twenty-nine D: Thirty-six | answer: D </s>

<s>[INST] context: This patient is septic, and immediate therapy should be directed at correcting her hemodynamic instability. Patients with sepsis require aggressive fluid resuscitation to compensate for capillary extravasation. This patient's vital signs suggest decreased effective circulating volume. Normal saline at 100 cc/h is insufficient volume replacement. The patient should be given a saline bolus of 2 L over 20 minutes, and then her blood pressure and clinical status should be reassessed. The elevated respiratory rate could be evidence of pulmonary edema or respiratory compensation for acidosis from decreased tissue perfusion. Even if the patient has evidence of pulmonary edema, fluid resuscitation remains the first intervention for hypotension from sepsis. She is more likely to die from hemodynamic collapse than from oxygenation issues related to pulmonary edema.Stress doses of hydrocortisone and intravenous norepinephrine are both used in patients with shock refractory to volume resuscitation but should be reserved until after the saline bolus. Vancomycin is a reasonable choice to cover enterococci, which can cause UTI-associated sepsis, but again would not address the immediate hemodynamic problem. If the patient does not improve, a central line (to measure filling pressures and mixed venous oxygen saturation) would allow the "early goal-directed" sepsis protocol to be used. [/INST] question: A 64-year-old woman presents to the emergency room with flank pain and fever. She noted dysuria for the past 3 days. Blood and urine cultures are obtained, and she is started on intravenous ciprofloxacin. Six hours after admission, she becomes tachycardic and her blood pressure drops. Her intravenous fluid is normal saline (NS) at 100 mL/h. Her current blood pressure is 79/43 mm Hg, heart rate is 128/min, respiratory rate is 26/min, and temperature is 39.2degC (102.5degF). She seems drowsy yet uncomfortable. Extremities are warm with trace edema. What is the best next course of action? | options: A: Administer IV hydrocortisone at stress dose B: Begin norepinephrine infusion and titrate to mean arterial pressure greater than 65 mm Hg C: Add vancomycin to her antibiotic regimen for improved gram-positive coverage D: Administer a bolus of NS | answer: D </s>

<s>[INST] context: A few degrees can make a big difference when it comes to food storage.Foods can go bad if they get too warm.But for many of the world's poor, finding a good way to keep food cool is difficult.Refrigerators are costly and they need electricity. Yet spoiled food not only creates health risks but also economic losses.Farmers lose money when they have to throw away products that they cannot sell quickly. But in nineteen ninety-five a teacher in northern Nigeria named Mohammed Bah Abba found a solution.He developed the "Pot-in-Pot Preservation/Cooling System." It uses two round containers made of clay.A smaller pot is placed inside a larger one.The space between the two pots is filled with wet sand.The inner pot can be filled with fruit, vegetables or drinks.A wet cloth covers the whole cooling system. Food stored in the smaller pot is kept from spoiling through a simple evaporation process.Water in the sand between the two pots evaporates through the surface of the larger pot, where drier outside air is moving.The evaporation process creates a drop in temperature of several degrees.This cools the inner pot and helps keep food safe from harmful bacteria.Some foods can be kept fresh this way for several weeks. People throughout Nigeria began using the invention.And it became popular with farmers in other African countries.Mohammed Bah Abba personally financed the first 5,000 pot-in-pot systems for his own community and five villages nearby. In 2000, the Rolex Watch Company of Switzerland honored him with the Rolex Award for Enterprise.This award recognizes people trying to develop projects aimed at improving human knowledge and well-being.A committee considers projects in science and medicine, technology, exploration and discovery, the environment and cultural history.Winners receive financial assistance to help develop and extend their projects.The award is given every two years.The most recent one was given last year. [/INST] question: Compared with a refrigerator, the cooling System invented by Mohammed Bah Abba is _ . | options: A: convenient B: economical C: health-conscious D: expensive | answer: B </s>

<s>[INST] context: I was the typical"I can't"child-whatever my mother told or asked me to do was immediately followed by my cry,"I can't."As a result,very few tasks or goals that I set out to achieve were ever completed. One evening,my mother called me into the family room."I want you to read this article,"Mother began."It's about Marlo Thomas.She tells how a simple poem that she was forced to learn by her father changed her life*She went from saying'I can't'to'I can'*According to this article,she was able to reorganize her life and her career by learning the principles in the poem." I took the small magazine from Mother and looked down at the pages.There was Marlo-my idol. Beside her photo was the poem my mother had spoken of,a simple poem entitled,"I Can"."I want you to memorize that poem,"Mother said firmly."Mama," _ ."I can't learn that poem.It's too long." "It's not too long and you can learn it.1 want you to know it perfectly by this time tomorrow,"said my mother. Unwillingly,I went back to my bedroom with the magazine.With a heavy heart,I threw myself into the bed and began my task. "Can't is a word that is the enemy to ambition,"I began.I repeated the line.I repeated it again and again."An enemy ambush to shatter your will..."I continued the process until I proudly recited the poem the following evening. It has now become my principle.Marlo 1 homas did not know me,but her story forever changed my life. Saying "I can" helped me to get through the worst moments of my life: Saying "I can" encouraged me to complete things I would have otherwise seen as out of my reach. A simple poem learned at seven is a poem that will support me to seventy-seven,maybe even longer. [/INST] question: One evening my mother asked me to _ , | options: A: read an article B: meet Marlo C: write a poem D: take photos | answer: A </s>

<s>[INST] context: What will you do if you have six million dollars? Different people give different answers. David I will buy an island if I have six million dollars. Then I will be the king of the island. I will invite my friends to my island and we'll have a good time there. Cathy If I get six million dollars, I want to start my own business and I will do a lot of things for my family. For me, nothing is more important than my family. I will buy a new house for my parents and take them to travel around the world. Julie If I have six million dollars, I will put five million in the bank and spend one million. I will visit Sydney, Toronto, Moscow and other interesting cities. I want to try different kinds of delicious food, and build a house with a swimming pool. Victor If I have six million dollars, I will use the money to do everything I like. I will use two million to open my own shop. And I will give another four million to schools and charities. I would like to help students in poor areas to get good education. I want everyone to live a happy life. [/INST] question: David will invite his friends to _ . | options: A: his new house B: his island C: his country D: his factory | answer: B </s>

<s>[INST] context: “Propofol is parcularly suitable for day care surgery’ because residual impairment is less marked and shorter lasng Propofol  Propofol is a milky white powder that is preservave free; therefore, it must be used within 6 hours. It is an oil based preparaon, therefore injecon is painful.  Propofol is the most frequently used intravenous anaesthec today. — Miller 6 th /e-3l8  It can be used for both inducon as well as maintenace.  It does not possess anconvulsive acon (unlike thiopentone),  It causes fall in BP and bradycardia, o Like thiopental it does not possess muscle relaxant acon.  Propofol possess significant anemec and anpruric acon. — Miller 6 th /e - 324  Propofol decreases polymorphonuclear leukocyte chemotoxis but not aherence, phagocytosis and killing (Thiopentone blocks all these) increased life threatning infecons.  Propofol is parcularly suitable for outpaent surgery. Intermient injecon or connuous infusion of propofol is frequently used for total iv. anaesthesia (TIVA) when supplemented by fentanyl.  It is anaesthecs of choice for intubaon in ICU and for paents with malignant hyperthermia.  Side effects - pain on injecon, myoclonus, apnea, X BP and rarely thrombophlebis,  Propofol infusion syndrome A lethal syndrome, associated with infusion of propofol for 48 hours or longer. Occurs in children and crically ill It occurs as a result of failure of free fay acid metabolism and failure of the mitochondrial respiratory chain. Features are - cardiomyopathy with acute cardiac failure, metabolic acidosis, skeletal myopathy, hyperkalemia, hepatomegaly and lipemia [/INST] question: Anaesthetic of choice for day care surgery is | options: A: Thiopentone B: Nitrous oxide C: Propofol D: Halothane | answer: C </s>

<s>[INST] context: New crime prediction software should reduce not only the murder rate, but the rate of other crimes. Developed by Richard Berk, a professor at the University of Pennsylvania, the software has already used in Baltimore and Philadelphia to predict which individuals on probation or parole are most likely to murder and to be murdered. "When a person goes on probation or parole he is supervised by an officer. The question is 'what level of supervision is appropriate?'" said Berk. It used to be that parole officers used the person's criminal record, and their judgment to make decisions. "This research replaces those _ ," he said. Technology helps determine level of supervision. On average there is one murder for every 100,000 people. Even among high-risk groups the murder rate is one in 100. Predicting such a rare event is very difficult, but advances in computer technology works. Years ago, the researchers made a dataset of more than 60,000 various crimes. Using the software they developed, they found some much more likely to commit murder when paroled or probated. They could identify eight future murderers out of 100. Berk's software examines roughly two dozen variables , from criminal record to geographic location. The type of crimes, and more importantly, the age at which that crime was committed, were two of the most predictive variables. "People assume that if someone murdered then they will murder in the future," said Berk. " What really matters is what that person did as a young individual. Predicting future crimes sounds well. But we aren't anywhere near being able to do that." "Berk's scientific answer leaves policymakers with difficult questions. By labeling one group of people as high risk, and supervise them closely, there should be fewer murders, which the potential victims should be happy about. It also means that those high-risk individuals will be supervised more aggressively. For human rights advocates, that means punishing people who, most likely, will not commit a crime in the future," said Bushway. "It comes down to a question of whether you would rather make these errors or those errors." [/INST] question: For 650 people with crime records, how many potential murderers would the software find? | options: A: 6.5 B: 13 C: 52 D: 65 | answer: C </s>

<s>[INST] context: A blind boy sat on the steps of a building with a hat by his feet. He held up a sign which said, "I am blind, please help." There were only a few coins in the hat. A man was walking by. He took a few coins from his pocket and dropped them into the hat. He then took the sign, turned it around, and wrote some words. He put the sign back so that everyone who walked by would see the new words. Soon the hat began to fill up. A lot more people were giving money to the blind boy. That afternoon the man who had changed the sign came to see how things were. The boy heard his footsteps and asked, "Were you the one who changed my sign this morning? What did you write?" The man said, "I only wrote the truth. I said what you said but in a different way." What he had written was, " Today is a beautiful day but I cannot see it." Do you think the first sign and the second sign were saying the same thing? Of course, both signs told people the boy was blind. But the first sign simply told people to help by putting some money in the hat. The second sign told people that they were able to enjoy the beauty of the day, but the boy could not enjoy it because he was blind. The first sign simply said the boy was blind. The second sign told people they were so lucky that they were not blind. [/INST] question: A blind boy sat on the steps of a building in order to _ . | options: A: wait for some people B: get money from others C: make the writer help him D: hold up a sign | answer: B </s>

<s>[INST] context: Will you be excited when you finally get to relax? Here, three of the studetns tell us what they plan to do after the big exam. Li Junzhe, 15, Huaihua, Hunan Province My friends and I will travel to Beijing right after the exam. We planned to go by ourselves but were turned down by our parents. They said we were too young to travel alone. They said they would go with us. I'm okay with it because I've already traveled by myself. Zhu Hangian, 15, Dexing, Jiangxi Province What am I going to do this summer? Of course I'll go to see the Great Wall! But before that, I will watch movies. Because of the big exam, I haven't seen any movies for a long time. I will watch whatever is in the cinema! As for the Great Wall, I can't wait to see the beautiful views. Dong Xu, 14, Dalian, Liaoning Province I will, no doubt, play computer games for days after the big exam. My mother never let me during the past few years. I can't imagine how exciting it will be. Also my friends and I will go to see the Great Wall. [/INST] question: Who has the experience of travelling alone? | options: A: Dong Xu B: Nobody C: Zhu Hangjian D: Li Junzhe | answer: D </s>

<s>[INST] context: "Perhaps the feature that most clearly differentiates primary from secondary healing is the phenomenon of wound contraction, which occurs in large surface wounds. Permanent wound contraction requires the action of myofibroblasts— altered fibroblasts that have the ultrastructural characteristics of smooth muscle cells. Contraction of these cells at the wound site decreases the gap between the dermal edges of the wound"- Robbins 7th/113 Healing By First Intention (Wounds With Opposed Edges) Robbins 7th/all-113 □ The least complicated example of wound repair is the healing of a clean, uninfected surgical incision approximated by surgical sutures. Such healing is referred to as primary union or healing by the first intention. □ The narrow incisional space immediately fills with clotted blood containing fibrin and blood cells; dehydration of the surface clot forms the well-known scab that covers the wound. □ Within 24 hours, neutrophils (Polymorphonuclear leukocytes) appear at the margins of the incision, moving toward the fibrin clot. □ In 24 to 48 hours, spurs of epithelial cells move from the wound edges (with little cell proliferation) along the cut margins of the dermis, depositing basement membrane components as they move. □ By day 3, the neutrophils have been largely replaced by macrophages. Granulation tissue progressively invades the incision space. □ By day 5, the incisional space is filled with granulation tissue. Neovascularization is maximal □ During the second week, there is continued accumulation of collagen and proliferation of fibroblasts The leukocytic infiltrate, edema, and increased vascularity have largely disappeared. □ By the end of the first month, the scar is made up of a cellular connective tissue devoid of inflammatory infiltrate, covered now by the intact epidermis. [/INST] question: Wound contraction is mediated by – | options: A: Epithelial cells B: Collagen C: Myofibroblasts D: Elastin | answer: C </s>

<s>[INST] context: It was a rather hot day. Everybody seemed to be looking for some kind of relief, so an ice cream store was a natural place to stop at. A little girl, holding her money firmly, entered the store. Before she could say a word, the store clerk sharply told her to get outside and read the sign on the door, and stay out until she put on the shoes. She left slowly, and a big man followed her out of the store. The man watched as she stood in front of the store and read the sign. "No Bare Feet". Tears started rolling down her cheeks as she turned and walked away. Just then the big man called to her. After sitting down on the roadside, he took off his size-12 shoes, set them in front of the girl and saying, "Here, you won't be able to walk in these, but if you slide along, you can get your ice cream." Then he lifted the little girl up and set her feet into the shoes. "Take your time," he said, "I get tired of moving them around, and it's good to just sit here and eat my ice cream." The shining eyes of the little girl could not be missed as she ordered her ice cream. He was a big man, all right. Big body, big shoes, but most of all, he had a big heart. [/INST] question: The little girl wasn't allowed to enter the store because _ . | options: A: she was dirty B: she had no money C: the store was closed D: she had no shoes on | answer: D </s>

<s>[INST] context: What is your zodiac animal? According to the Chinese lunar calendar , 12 animals mark 12 different years. It is the basis of the Chinese zodiac. Nowadays, Chinese zodiac animals have worldwide fame and are increasingly popular among western people. The zodiac is an important part of Chinese culture. People believe that the characteristics of a zodiac animal influence the personality of every person born in that year. For example, people born in the Year of the Tiger are considered powerful and brave. Zodiac animals also have some social functions. When people think it is not proper to ask: "How old are you", they may change their question to "What is your zodiac animal?" With this question, you can figure out roughly which year someone was born and the person's age. Zodiac animals are not special to China. Many countries share a similar zodiac culture with China. For example, in the Japanese Zodiac, a wild boar takes the place of a pig and the Vietnamese zodiac has a cat instead of a rabbit. But have you ever wondered how these 12 animals were chosen to represent each year? According to legend, the Jade Emperor invited all the animals to join him for Chinese New Year. Only 12 animals went to see him. As a reward he named a year after each one in the order they arrived. The ox would have been the first to arrive, but the rat sat on his back and jumped off just before they arrived to come in first place. [/INST] question: The characteristics of a zodiac animal may influence the _ of every person born in that year. | options: A: appearance B: personality C: hobby D: education | answer: B </s>

<s>[INST] context: Subcoical centre for lateral/horizontal conjugate gaze lies in the abducent nucleus In pons, though some authors take it to be PPRF (para-median pontine reticular formation) and others as nucleus prepositus hypoglossi. This centre receives input from the contralateral frontal eye field and moves ipsilateral lateral rectus and contralateral medial rectus muscle projections of MLF (medial longitudinal fasciculus) PPRF lesion leads to inactivity of saccadic movements by lateral rectus and contralateral medial rectus. There is loss of horizontal saccades directed towards the side of the lesion but pursuit and vergence movements are preserved. One and a half syndrome: Unilateral abducent and bilateral MLF lesion. On attempted lateral gaze, the only muscle functional is the intact lateral rectus. MLF connects the nuclei controlling eyeball muscles--(LR6 SO4)3 and mediates nystagmus and lateral conjugate gaze. Its fibers originate in vestibular nucleus and terminate in abducent, trochlear and oculomotor nuclei. It coordinates eyeball movements with the head. Trochlear nucleus is concerned with veical gaze movements. Nucleus prepositus hypoglossi (and not hypoglossal nucleus), is involved in the gaze circuitry. [/INST] question: Final center for horizontal movements of the eye is | options: A: Abducent nucleus B: Irochlear nucleus C: Oculomotor nucleus D: Vestibular nucleus | answer: A </s>

<s>[INST] context: On April 20th,2013, a big earthquake hit Ya'an, Sichuan. Nearly 200 people died. Many people were hurt. Why do earthquakes happen? The surface of the earth has many pieces. These pieces are always moving. When two pieces move past each other, there is an earthquake. Scientists are working hard to find out more about earthquakes. They try to predict them, but it's very hard. Do you know how to get ready for an earthquake? Do you know what to do during an earthquake? Here are some things you should know. What to do before an earthquake Make sure you have two bottles of water, a packet of biscuits, a clean towel , a few band-aids , a radio and a flashlight at home. What to do during an earthquake If you are inside: Stay where you are. Quickly move under a strong desk, or along a wall. This will protect you from falling things. Don't stand near windows. Turn off the lights. Don't get into a lift during an earthquake. If you are in a lift, get out quickly. If you are outside: Don't stand near buildings. Things may fall on you. Lie on the ground until the shaking stops. [/INST] question: An earthquake hit Ya'an _ . | options: A: on April 12th, 2013 B: on April 20th, 2013 C: on May 14th, 2013 D: on May 12th, 2013 | answer: B </s>

<s>[INST] context: Do you want to know how and why a fall leaf changes color? We first have to understand what leaves are and what they do. Leaves are the world's food factories. Plants take water from the ground through their roots and take CO2from the air. Plants use sunlight to turn water and CO2into glucose , a kind of sugar. Plants use it as food for energy and growing. A chemical called _ in the leaves gives plants their green colour. As summer ends and autumn comes, the days get shorter and shorter, and trees "know" to begin getting ready for winter. During winter, there is not enough sunlight or water. Trees rest during this time and live on the food they store during the summer. They begin to shut down their food-making factories. As the green chlorophyll disappears from the leaves, we begin to see yellow and orange leaves. The bright reds and purples we see in leaves are made mostly in autumn. In some trees, like maples , sunlight and the cool nights of autumn turn the glucose in the leaves into a red colour. And we can enjoy the beautiful red leaves during autumn. [/INST] question: The leaves turn yellow because they are short of _ . | options: A: sunlight and water B: glucose and energy C: water and CO2 D: sunlight and CO2 | answer: A </s>

<s>[INST] context: The Harvard Student-led Walking Tour Let a student show you Harvard ... on a free walking tour. We welcome our neighbors to stop by the Harvard University Events & Information Center, located in the Holyoke Center Arcade at 1350 Massachusetts Avenue in the heart of Harvard Square in Cambridge. Let a student take you and your family,school,or organization on an interesting,hour-long historical tour of the Harvard campus.The tours leave from the Events & Information Center. Not only will you discover the location of fascinating exhibitions and programmes on campus,you will also see Harvard's rich sampling of American history and architecture from the Colonial period to the present Schedule of Tours Tours leave the Events & Information Center at 10 am and 2 pm Monday through Friday, and at 2 pm on Saturday through the academic year(February 4 through May 2;September 23 through December 16). Summer tours(June 24 through August 15)are offered at 10 am,11:15 am,2 pm,and 3:1 5 pm Monday through Saturday.Reservations for special tours of 20 or more people may be made by calling the Events & Information Center at(617)495--1573 or emailing icenter@camail. Harvard. edu. Tours are stopped March 23 through April 2 for Spring break,May 3 through June 23 for Spring intercession , and August 1 6 through September 22 for Summer intercession. NOTE:Prospective students may take tours originating at the Harvard Admissions Office,located at Byerly Hall on 8 Garden Street in Cambridge.The Admissions staff will conduct information sessions.For more information,please call at(617)495--1551. Harvard University Events & Information Center Location:Holyoke Center Arcade,1350 Massachusetts Avenue,Cambridge MA 02138 Phone:(617)495--1573 [/INST] question: If you want to join in a tour,you can go on _ . | options: A: May 2 B: June 23 C: August 20 D: September 1 | answer: A </s>

<s>[INST] context: G E N ERAL TOXICITY OF CYTOTOXIC DRUGS Majority of the cytotoxic drugs have more profound effect on rapidly multiplying cells, because the most impoant target of action are the nucleic acids and their precursors; rapid nucleic acid synthesis occurs during cell division. Many cancers (especially large solid tumours) have a lower growth fraction (lower percentage of cells are in division) than normal bone marrow, epithelial linings, reticuloendothelial (RE) system and gonads. These tissues are paicularly affected in a dose-dependent manner by majority of drugs; though, there are differences in susceptibility to individual members. 1 . Bone marrow Depression of bone marrow results in granulocytopenia, agranulocytosis, thrombocytopenia, aplastic anaemia. This is the most serious toxicity; often limits the dose that can be employed. Infections and bleeding are the usual complications. 2. Lymphoreticular tissue Lymphocytopenia and inhibition of lymphocyte function results in suppression of cell mediated as well as humoral immunity. Because of action (1) and (2) + damage to epithelial surfaces, the host defence mechanisms (specific as well as nonspecific) are broken down [/INST] question: Most impoant dose-limiting toxicity of cancer chemotherapy is: | options: A: Gastrointestinal toxicity B: Neurotoxicity C: Bone marrow suppression D: Nephrotoxicity | answer: C </s>

<s>[INST] context: CSF rhinorrhea occurs when there is a communication between the intracranial (intradural) and nasal cavities. CSF, rhinorrhea indicates a basal tear of dura mater along with a fracture involving the paranasal sinuses, frontal, ethmoid, or sphenoid bone. Cribriform plate of the ethmoid bone separates the anterior cranial fossa from the nasal cavity and is the most common site of fracture in CSF rhinorrhea because it is extremely thin. The cerebrospinal fluid has high glucose content, makes a dry hanky stiff, and if mixed with blood it classically produces a halo effect on the white bed clothes. Patients of CSF rhinorrhea are at increased risk of meningitis particularly pneumococcal. Patient should be given prophylactic antibiotic (penicillin) followed by X-ray. Fractures of the middle 1/3rd of the face should be reduced and most of the times CSF rhinorrhea stops. Indications for anterior fossa explorations are persistence of CSF rhinorrhea for> 10 days; presence of a fracture involving the frontal or ethmoidal sinus; aerocele; an attack of meningitis that has been treated. [/INST] question: CSF rhinorrhea is most commonly seen in fracture of: | options: A: Cribriform plate B: Temporal bone C: Nasal bone D: Occipital bone | answer: A </s>

<s>[INST] context: 7 ways a government shutdown will affect your daily life (CNN) -- Democrats and Republicans were unable to resolve their differences over Obamacare and now the government is shut down. The two previous shutdowns -- 1995 and early 1996 -- cost the country $1.4 billion. But what will the shutdown mean for you? Here are 7 ways the government shutdown will affect you. 7. Vacation all I ever wanted: Need to get away? Well, you can't. At least not to national parks. Or to national zoos. Or to national museums. They'll be closed. Were you thinking more along the lines of a trip to France? If you don't already have a passport, you might not get your blue book in time. The last time the government shut down, 200,000 applications for passports went unprocessed. 6. If you drive a car, I'll tax the street: You may be thinking, "No functioning government, no need to pay taxes." Think again. The Man would continue to collect taxes. U.S. bonds would still be issued. And other essential banking functions will go on. 5. Wait a minute, Mr. Postman: You know that whole "Neither snow, nor rain, nor heat, nor gloom of night" thing? Apparently, the U.S. Postal Service works through shutdowns as well. Sorry, you won't catch a break from the junk mail. 4. I want a new drug: Oh, the irony . Republicans still want to _ delay or otherwise withdraw gradually at Obamacare in exchange for funding the government. But the health care act at the center of this storm would continue its process during a shutdown. That is because its funds aren't dependent on the congressional budget process. 3. Pass the ammunition : Not so fast. A shutdown would affect the Bureau of Alcohol, Tobacco, Firearms and Explosives. Translation: That gun permit you wanted processed won't happen anytime soon if this goes on for a while. 2. Money (that's what I want): Well, if you owned a small business and needed a loan from the government, you would have to wait, depending on how long this lasts. If you were planning to buy a house and needed a federal loan, you would have to wait. 1. I'm proud to be an American: Perhaps the biggest hit would be to the collective psyche . America is the largest economy in the world and a beacon for how democracy ought to work. A recent CNN Research Corporation found that 51% would blame Republicans for the shutdown. The United States has operated without a budget since 2009 and has avoided a government shutdown with last-minute deals. Not only did the government run out of money on Tuesday, but the nation is set to hit its borrowing limit and potentially default on its debt in mid-October. Together, they serve as a double whammy . [/INST] question: When the government's shut down, what can the Americans do? | options: A: Apply for a gun permit B: Apply for a new passport C: Apply for a loan D: Pay taxes | answer: D </s>

<s>[INST] context: The Barcelonabased architects of the Galactic Suite Space Resort say it will cost $4.4 million for a threenight stay at the hotel. This price also includes an eightweek training course on an island. During their stay, guests would see the sunrise 15 times a day and travel around the world every 80 minutes. Galactic Suite Ltd's CEO Xavier Claramunt says the project will put his company in a leading position of a new industry with a huge future ahead of it, and forecasts space travel will become common in the future. "It's very normal to think that your children, possibly within 15 years, could spend a weekend in space" he told Reuters Television. A promising space tourism industry is beginning to take shape with construction in progress in New Mexico of Spaceport America, the world's first facility built specifically for passengers. British industrialist Richard Branson's space tours firm, Virgin Galactic, will use the facility to send tourists to space at a cost of $200,000 a ride. Galactic Suite Ltd, set up in 2007, hopes to start its project with a single pod in orbit 280 miles above the earth. "It will take a day and a half to reach the pod, and the passengers will join it for three days," Claramunt said. More than 200 people have expressed an interest in traveling to the space hotel and at least 43 people have already reserved it. The numbers are similar for Virgin Galactic with 300 people already paid or signed up for the trip, but unlike Branson, Galactic Suite says they will use Russian rockets to transport their guests into space from a spaceport to be built on an island in the Caribbean. But critics have questioned the project, saying the length of time that will be used is unreasonable and also where the money is coming from to support the project. [/INST] question: What's Xavier Claramunt's attitude towards the space tourism industry? | options: A: Quite critical B: Slightly worried C: Highly optimistic D: Fully satisfied | answer: C </s>

<s>[INST] context: In the middle of a dark forest, there lives an owl . All the animals know that he is the wisest among all of them. So they often go to him and tell him their troubles. Then the owl always teaches them what they should do. One day, a little bird goes up to the owl. She is crying. "what's wrong with you?" asks the owl. "I'm not happy at all. I don't want to be a bird," the bird says. "Why don't you want to be a bird?" asks the owl. "I am so small, weak and useless," she cries. "I want to be big and strong like the lion. He is very important, but I am not" Then the owl whispers something in her ear. At once the bird dries her _ and goes away. One week later, the bird came back. "Oh, thank you very much. You are a very wise owl," she says to the owl. "I am very happy now. Every day, I sit on top of the tallest tree and watch for lions and tigers. When they come near, I shout at the top of my voice. Then my friend all run and hide. They are very thankful to me. I am useful and important now" The wise owl smiles and says, "No one in this world is useless." [/INST] question: The animals in the forest visit the owl because _ | options: A: they are all afraid of him B: the owl can help them when they don't feel well C: the owl can tell them what they should do when they have some problems D: they are wiser than the owl | answer: C </s>

<s>[INST] context: Using too much water or throwing rubbish into our rivers are clear ways that humans can put our water supply in danger , but we also affect our water supply in less obvious ways. You may wonder how paving a road can lead to less useable fresh water. A major part of the water we use every day is groundwater. Groundwater does not come from lakes or rivers. It comes from underground. The more roads and parking lots we pave the less water can flow into the ground to become groundwater. Human activity is not responsible for all water shortages . Drier climates are of course more likely to have droughts than areas with more rainfall, but in any case, good management can help to make sure there is enough water to meet our basic needs. Thinking about the way we use water every day can make a big difference, too In the United States , a family of four can use 1. 5 tons of water a day! This shows how much we depend on water to live, but there's a lot we can do to lower the number. You can take steps to save water in your home. To start with use the same glass for your drinking water all day. Wash it only once a day. Run your dishwasher only when it is full . Help your parents fix any leaks in your home. You can even help to keep our water supply clean by recycling batteries instead of throwing them away. [/INST] question: Which of the following is most likely to lead to less groundwater? | options: A: Using river water B: Throwing batteries away C: Paving parking lots D: Throwing rubbish into lakes | answer: C </s>

<s>[INST] context: All young people dream of travelling the world. They are restless and very eager to see new sights. However, they have little idea how they would really do it if given the chance. Because their knowledge of geography is quite limited, they seldom know much about the places they wish to visit or how they would get there. Already hundreds of thousands of Chinese student tourists are visiting these places-Wuyi, Lhasa, Lijiang, Dali, Vientiane and Phnom Penh. Indeed, these students will soon be the most travelled generation in China's long history. The World Tourist Organization predicts that a quarter of a century from now the number of Chinese tourists going abroad will be twenty times what it is today. The largest percentage of these tourists will visit Southeast Asia. Not all Chinese who travel abroad will be tourists, however. More and more youths are deciding to volunteer their skills in this region; much like their peers in the Peace Corps and VSO. Critical thinking skills required include planning for a trip and solving problems after the trip has begun. The focus is on how to read an atlas to make travel plans and how to find ways of travelling. An atlas offers a wealth of information about geography and is one way to increase students' awareness of their global environment. Use of an atlas especially addresses the needs of students with different visual and spatial learning styles. [/INST] question: These places, Wuyi, Lhasa, Lijiang, Dali, Vientiane and Phnom Penh, lie in _ . | options: A: China B: Europe C: Vietnam D: Asia | answer: D </s>

<s>[INST] context: - Coisol is normally produced by the adrenal glands, located just above the kidneys. - It belongs to a class of hormones called glucocoicoids, which affect almost every organ and tissue in the body. Helps maintain blood pressure and cardiovascular function; Helps slow the immune systems inflammatory response; Helps balance the effects of insulin in breaking down sugar for energy; and Helps regulate the metabolism of proteins, carbohydrates, and fats. - So, afterB/L adrenalectomy coisol production decreaseswhich causes these symptoms: Chronic, worsening fatigue and muscle weakness, loss of appetite, and weight loss are characteristic of the disease. Nausea, vomiting, and diarrhoea occur in about 50 percent of cases. Blood pressure is low and falls fuher when standing, causing dizziness or fainting. Skin changes also occur with areas of hyperpigmentation, or dark tanning, covering exposed and nonexposed pas of the body. This darkening of the skin is most visible on scars; skin folds; pressure points such as the elbows, knees, knuckles, and lips; and mucous membranes. [/INST] question: A patient undergoes bilateral adrenalectomy in view of bilateral pheochromocytoma. A day after surgery patient develops lethargy, fatigue and loss of appetite. On examination BP is 90/ 60 mmHg, pulse rate of 74 beats/min. No evidence of loss of volume. The likely cause is? | options: A: Cardiogenic shock B: Hypovolemic shock C: Coisol deficiency D: Septic shock | answer: C </s>

<s>[INST] context: For anyone still doubting the belief that our emotions impact our physical health, a new study from New Zealand should be able to settle the matter. It reports that the physical wounds of healthy seniors healed more quickly if they wrote about their most upsetting experiences. This confirms the results of a 2010 study, and extends those findings to cover older adults-a group that is likely to suffer wounds (as from surgery), and one with less access to other ways of lowering tension (such as exercise). Reported in the journal Psychosomatic Medicine, a research team led by the University of Auckland's Elizabeth Broadbent made a study featuring 50 healthy adults ranging in age from 64 to 97. They were assigned to write for 20 minutes per day for three consecutive days. Half were asked to write about the most upsetting experience in their life, describing their deepest thoughts, feelings, and emotions about the events, ideally not previously shared with others. The others were asked to write about their daily activities without mentioning emotions, opinions or beliefs. Two weeks after the third day of writing, all participants received a standard 4mm skin biopsy on their inner arm. The very tiny wounds caused by the biopsy were photographed regularly over the following days to determine the rate at which they healed. On the 11th day after the biopsy, the wounds completely healed on 76.2 percent of those who had done the expressive writing. That was true of only 42.1 percent of those who had written about everyday activities. "The biological and psychological mechanisms behind this effect remain unclear," the researchers wrote, noting that those who had done the expressive writing did not report lower stress levels or fewer depressive symptoms than the others in the control group. Even if they weren't consciously aware of feeling more relaxed or positive, the expressive writing appeared to have caused some sort of bodily reaction-probably involving their immune systems-that hastened their recovery. [/INST] question: What was the difference between the two groups of participants in the study? | options: A: When they wrote B: Where they wrote C: What they wrote about D: How often they wrote | answer: C </s>

<s>[INST] context: Definition TRALI is defined as an acute lung injury that is temporally related to a blood transfusion; specifically, it occurs within the first six hours following a transfusion. * It is typically associated with plasma components such as platelets and Fresh Frozen Plasma, though cases have been repoed with packed red b coo c since there is some residual plasma in the packed cells. The blood component transfused is not pa of the case definition. Pathogenesis of TRALI The exact pathogenesis of TRALI is not known thus several theories have been proposed. Two basis mechanism have been proposed for the pathogenesis of TRALI for immune competent hosts. * It is hypothesized that TRALI may be precipitated by the infusion of donor antibodies directed against recipient leukocytes. The infusion of donor anti-HLA (human leukocyte antigens) or anti-HNA (human neutrophil antigens) antibodies is thought to directly cause complement activation, resulting in the influx of neutrophils into the lung, followed by neutrophil activation and release of cytotoxic agents, with subsequent endothelial damage and capillary leak . Immediate management of TRALI * Stop the transfusion immediately * Suppo the patient * If the patient is intubated, obtaine undiluted edema fluid as soon as possible(within 15 min) and simultaneous plasma for determination of total protein. * Obtain CBC with DC and chest radiography * Notify the blood bank of possible trali request a different unit and quarantine other unit from the same donor ref : robbins 10th ed [/INST] question: this is cxr of 35yr old patient who is a chronic smoker since 10yrs ,met with an accident 3hrs back and brought to the ER and due to blood loss he was transfused IN FIXED COMPONENT RATIO with same blood group .after 4hrs patient developed breathlessness , cough and an xray chest was advised .what is the most common componet lead to this condition ? | options: A: DUE TO PRBC TRANSUFUSION B: DUE TO PLATELETS C: PLASMA D: WHOLE BLOOD | answer: C </s>

<s>[INST] context: The symptoms of depression are there plus adding psychotic symptoms of hallucinations make it a diagnosis of MDD PLUS PSYCHOSIS. SymptomsOF DEPRESSION -(SIGECAPSS) S- Sadness of mood/ depressed mood (persistent & pervasive) I- Loss of interest / pleasure (Anhedonia) G- Guilt/ Feeling of wohlessness . E- Energy (loss)/ Fatigue C- Concentration loss, cognition (negative thoughts) A- Appetite (loss/ gain) with significant weight changes (>5% change in 1 month) P- Psychomotor Agitation/ Retardation S- Suicidal thoughts Note:Suicidal thoughts are fuher classified into 3: Death wishes (patient feels death should come to me ) - GRADE 1 Suicidal wish (patient says I wish I could commit suicide ) - GRADE 2 Suicidal intent (patient says I would be killing myself ) - GRADE 3 S - Sleep abnormalities (decreased/ increased) Early morning insomnia ( getting up >2 hrs earlier than the usual waking time ) Reduced latency of REM sleep Sleep is usually decreased but it might be increased also. Criteria for defining depression ( according to DSM - 5 ) : From the above 9 symptoms 5 must be present & at least 1 must be present out of first 2 for at least 2 weeks duration. [/INST] question: A patient complaints of sadness of mood, increased letharg, early morning awakening, loss of interest and repos no will to live and hears voices asking her to kill self. What is the diagnosis? | options: A: Schizophrenia B: Major depressive disorder plus psychosis C: Schizoaffective disorder D: Schizotypal personality disorder | answer: B </s>

<s>[INST] context: <p>Hypercalcemia can be a manifestation of a serious illness such as malignancy or can be detected coincidentally by laboratory testing in a patient with no obvious illness. The number between detection of hypercalcemia and death, especially without vigorous treatment, is often <6 months. Accordingly, if an asymptomatic individual has had hypercalcemia or some manifestation of hypercalcemia such as kidney stones for >1 or 2 years, it is unlikely that malignancy is the cause.Hypercalcemia from any cause can result in fatigue, depression, mental confusion, anorexia, nausea, vomiting, constipation, reversible renal tubular defects, increased urination, a sho QT interval in the electrocardiogram, and, in some patients, cardiac arrhythmias. There is a variable relation from one patient to the next between the severity of hypercalcemia and the symptoms. Generally, symptoms are more common at calcium levels >2.9-3 mmol/L (11.5-12 mg/dL), but some patients, even at this level, are asymptomatic. When the calcium level is >3.2 mmol/L (13 mg/dL), calcification in kidneys, skin, vessels, lungs, hea, and stomach occurs and renal insufficiency may develop, paicularly if blood phosphate levels are normal or elevated due to impaired renal function. Severe hypercalcemia, usually defined as >=3.7-4.5 mmol/L (15-18 mg/dL), can be a medical emergency; coma and cardiac arrest can occur.(harrison 18 pg 3100)</p> [/INST] question: Which of the following is not a feature of hypercalcemia? | options: A: Diarrhea B: Polyuria C: Depression D: Vomiting | answer: A </s>

<s>[INST] context: In December,2010,many American newspapers publish a list of the best books of the year. Freedom by Jonathan Franzen is one of the most repeatedly praised books on this year's list of favorites. It tells about the ups and downs of the Berglund family over many years. Mr.Franzen fills the book with sharp observations about American politics, culture and society. Jennifer Egan's book A Visit from the Goon Squad takes place in 13 chapters over 40 years. The story moves back and forth in time,from different viewpoints. One main character is former rock musician Bennie Salazar who works for a record company. The other main character is a troubled young woman named Sasha who works for Bennie. The reader learns about their pasts and those of their friends. The main character in The Imperfectionists by Tom Rachman is a failing English Language newspaper published in Rome,Italy. Each chapter of the book tells about a reporter or editor working for this paper. Their stories are filled with intelligence and great personality. Two of the most popular nonfiction books of 2010 were about rock and roll stars. Just Kids is by rock singer Patti Smith. It tells about her friendship with the artist Robert Mapplethorpe in the 1960s and 1970s before they became famous. Life is the autobiography of Rolling Stones guitarist Keith Richards. It is an honest and exciting look at the development of rock and roll and the wild times this famous band has experienced. Unbroken by Laura Hillenbrand tells about a man named Louis Zamperini. She tells about his extraordinary survival story after his plane crashed into the Pacific Ocean during Would War Two. Stacy Schiff has received great praise for her book Cleopatra: A Life. It tells about one of the most misrepresented and famous women in his story, Cleopatra. She ruled ancient Egypt about 2,000 years ago. One critic said Ms. Schiff has brought Cleopatra to life again by unearthing her story from centuries of lies. [/INST] question: The following books are related to music EXCEPT _ . | options: A: The Imperfectionists B: A Visit from the Goon Squad C: Just Kids D: Life | answer: A </s>

<s>[INST] context: Many cities have subways and underground public transportation to take locals and tourists alike rapidly around the city.However, there's something different about riding a London subway.It may not look different, but the historical value of one of England's most popular forms of transportation is enough to make riding the subway a must when visiting London.With a little under 300 different stations, the subway can take you almost anywhere you need to go. Riding a London subway, a person from other countries will notice one major difference: in London, people do not look at each other.In fact, eye contact is avoided at all times.That's not rudeness --people are just too busy to bother looking. Busy doing what, you ask? Well, they're certainly not using the time for a moment of quiet thinking.Nor are they reading a book.New technology has replaced quiet habits.Today the only acceptable form of book on the London underground is an e-book. Apple must earn a fortune from London commuters .Since the launch of the iPhone in 2007, over 40,000--yes, that's 40,000 " _ " have been designed. Commuters love them because they are the perfect time-fillers.One "app", called iShoot, is a game that features tanks.Another one, Tube Exits, tells passengers where to sit on the train to be closest to the exit of their destination.iSteam clouds the iPhone screen when you breathe into the microphone.You can then write in the "steam" on your phone screen. For those without an iPhone, another Apple product, the iPod, may be the distraction of choice.It's not just teenagers who "plug in" to their music-iPods are a popular way to pass the time for all ages. And if games, e-books and music aren't enough to keep you occupied, then perhaps you would prefer a film? The development of palm DVD technology means many commuters watch their favorite TV shows or films on the way to work.With all these distractions, it's amazing that people still remember to get off the train. [/INST] question: Those who want to save time to reach where they go can download _ to their iPhones. | options: A: iShoot B: Tube Exits C: iSteam D: iPod | answer: B </s>

<s>[INST] context: On Thursday a new boy came into the classroom. He didn't have any uniform on. Just trousers, a jacket and a shirt. Tom could see that the boy wasn't quite comfortable. He had a plastic bag with exercise books, pens, pencils, rulers and erasers in it. The boy stood at the blackboard. Mrs. Brown talked to the boy, and then she said, "Boys and girls, this is Peter. He is your new classmate. Peter is your age. I hope you'll get on well with each other. Peter will spend a lot of time together with you."Mrs Brown asked Peter to sit next to Tom at the desk near the window. The students had math after that and Tom could see that Peter was not bad at it. He counted well. It was not difficult for him at all. Then Mrs. Brown said," It is half past twelve. It's time to have lunch. "Peter joined Tom and went to wash his hands. Then the boys sat down on the floor and started to open their lunch bags. Tom opened his bag and put his hand in it. He took out an old brown apple, some old cheese and some fish from dinner."Oh, no!" cried Tom." This is rubbish. I have the wrong bag. I took the rubbish bag and left my lunch bag at home. I have only rubbish for lunch today." The other children laughed and laughed. Then Peter said," I have two eggs. Why don't you have one? I don't need two. And would you like some bread?" Tom smiled," Thanks. It's very kind of you." [/INST] question: How many kinds of things did Peter have in his plastic bag? | options: A: Three B: Four C: Five D: Six | answer: C </s>

<s>[INST] context: The description is that of a child with hypernatremia (in this case, the child's sodium was 170 meq/dL); the "doughy" skin is often seen in hypernatremia. The extracellular fluid and circulating blood volumes tend to be preserved with hypernatremic dehydration at the expense of the intracellular volume. Therefore, hypotension may not be observed, and neither are the other signs of circulatory inadequacy that are typical of isotonic or hypotonic dehydration. Signs suggesting involvement of the central nervous system (such as irritability or lethargy) are characteristic of hypeonic dehydration. Slow correction of this hypernatremia (over 24 to 48 h) prevents significant fluid shifts and increased intercranial pressure. Initial bolus therapy should be with isotonic fluid such as normal saline or lactated Ringer's solution. Blood products such as fresh-frozen plasma are not indicated, and hypotonic solutions such as D10W and 1/4 NS could cause rapid fluid shifts, resulting in cerebral edema and death. Hypeonic (3%) saline is used in the event of seizures caused by rapid rehydration, along with other measures typically used to reduce cerebral edema. [/INST] question: A 9-month-old is brought to the emergency center by ambulance. The child had been having emesis and diarrhea with decreased urine output for several days, and the parents noted that she was hard to wake up this morning. Her weight is 9 kg, down from 11 kg the week prior at her 9- month checkup. You note her hea rate and blood pressure to be normal. She is lethargic, and her skin is noted to be "doughy." After confirming that her respiratory status is stable, you send electrolytes, which you expect to be abnormal. You sta an IV. The best solution for an initial IV bolus would be | options: A: 1/4 normal saline (38.5 meq sodium/L) B: D10 water (100 g glucose/L) C: Normal saline (154 meq sodium/L) D: 3% saline (513 meq sodium/L) | answer: C </s>

<s>[INST] context: Hemostasis o Hemostasis is a physiological process whereby bleeding is halted, thus protecting the integrity' of the vascular system after tissue injury. o It is responsible for minimizing blood loss, o It is commonly referred to as stoppage of bleeding, o The hemostatic mechanisms have several functions : - 1. Maintain blood in fluid state while circulating within the vascular system. 2 Arrest bleeding at the site of injury by formation of hemostatic plug. 3. Ensure the removal of hemostatic plug when healing is complete. o The components of normal hemostasis include: - 1. Blood vessels (endothelium) 2. Platelets 3. Plasma coagulation factors and their inhibitors. 4. Fibrinolytic system. o When a blood vessel is injured, several steps occur in hemostasis at the site of injury': - A. Vasoconstriction o After initial injury, there is a brief period arteriolar vasoconstriction, minimizing vessel diameter and stowing bleeding. o This is due to reflex neurogenic mechanism and augmented by a potent endothelium derived vasoconstrictor endothelin. o However this effect is transient, bleeding would resume if there will no activation of platelet and coagulation system. B. Primary hemostasis o Endothelial injury exposes highly thrombogenic subendothelial extracellular matrix which allows the platelets to bind (adhere) with collagen of ECM. o Binding of platelets activates these cells and platelets release secretory' granules. o These secretory' products (from secretory granules) recruit additional platelets to form primary hemostatic (platelet plug). C. Secondary hemostasis o Coagulation system is activated and thrombin is generated, o Thrombin converts fibrinogen to fibrin. o Ultimately these events form an irreversibly fused mass of platelets, thrombin RBCs and fibrinogen → Definitive secondary hemostatic plug. D. Repair of vessels and dissolution of the clot o The clot attracts and stimulates the growth of fibroblast and smooth muscle cells within the vessel wall, and begins the repair process. o At this stage the fibrinolytic system is also activated, resulting in the dissolution of the clot. [/INST] question: Following an injury to a blood vessel, immediate haemostasis is achieved by - | options: A: Fibrin deposition B: Platelet adhesion C: Vasoconstriction D: Thrombosis | answer: C </s>

<s>[INST] context: Doctors in hospital emergency rooms often see accidental poisonings . A frightened parent arrives with a child who swallowed a cleaning liquid. Or perhaps the harmful substance is a medicine. Or it might be a chemical product meant to kill insects. These are common causes of accidental poisoning. In cases like this, look for medical help as soon as possible. Save the container of whatever caused the poisoning. And look on the container for information about anything that stops the effects of the poison. Save anything expelled from the mouth of the victim. That way, doctors can examine it. In the past, some people forced poisoning victims to empty the stomach. They used a liquid syrup of ipecac to do this. But an organization of children's doctors no longer advises parents to keep syrup of ipecac. The American Academy of Pediatrics says some poisons can cause additional damage when they come back up the throat. Millions of people know a way to save a person who is choking on something trapped in the throat. The method is commonly known as the Heimlich Maneuver or abdominal thrusts. The American Red Cross says a rescuer should first hit the person on the back five times between the shoulder bones. These back blows may ease the choking. If the airway is still blocked, the Red Cross suggests pushing hard five times along the victim's abdomen. The abdomen is the area between the chest and the hip bones. [/INST] question: Save the container of whatever caused the poisoning to _ . | options: A: look for harmful information B: look on it C: use it to break the poison D: look for medical help | answer: D </s>