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<s>[INST] context: The days of a pain-free visit to the dentist may not be far off. This is thanks to a little Japanese woman in a pink sweater, named Simroid. With a limited vocabulary, Simroid, the 160cm-tall robot is happy to feel your pain. Simroid is designed to be used at medical colleges. She has realistic looking skin, eyes, and a mouth fitted with replica teeth. Her chest also rises and falls as if she is breathing. Simroid releases a clear "ouch!" whenever a trainee dentist presses her teeth too hard with a tool. And she gives a reassuring "that's better" when the drill hits the right place. "We want to use the robots to train dentists to worry about whether patients are comfortable, and not just focus on medical techniques," said Naotake Shubui, a professor at Nippon Dental University inprefix = st1 /Japanwho helped develop Simroid. The robot was one of hundreds of cutting-edge devices on display at the world's biggest robot exhibition last week inJapan. As scientists improve the design of robots, they could soon be serving tea to office workers or directing shoppers. Today's robots look and act much like the humans who invented them. InJapan, robots can already be found working as home helps, office receptionists and security guards, as well as on the factory floor. There were more than 370,000 industrial robots in use inJapanin 2005, according to a report by Macquarie bank,40 percent of the world total, with 32 robots for every 1,000 workers. The economy ministry believes that the Japanese robot market will be worth more than $52 billion by 2025. Human work is being helped, and even replaced, by mechanical efficiency in almost every area, from golf-bag carriers to public toilet cleaners. But many scientists believe the age of the service robot is not far off. It will arrive once machines are capable of connecting with humans on an emotional level. Judging by theTokyoexhibition, _ has already begun. [/INST] question: Simroid is designed to _ . | options: A: aid dental trainees to focus on their medical techniques B: train dentists to be able to share patients' feelings C: help patients relax during dental surgery D: serve as the dentists' assistance during dental surgery | answer: B </s>

<s>[INST] context: Movie Extras Would you mind lying in a coffin ? Would you shave your head? Are you willing to take out your false teeth? These are just a few of the questions Anne Marie Stewart and her staff sometimes ask the "talent" who serve as non-speaking "extras" in special films, television series, and made-for-TV movies produced in Toronto. Of course, the majority of extra calls are for more ordinary people, and Stewart has a list of about 650 registered extras. Crowd scenes, which are common, call for everyday people of all ages, ethnic backgrounds, and sizes. Over at Movie People, last-minute requests are not unusual. "We got a request once for an entire brass band of 30 people. They wanted it within the hour," said manager Yvonne McCartney. Another time, the company got a last-minute request for a newborn baby. "We found a baby that was three weeks premature," said Jonathan Aiken, an owner of the company. Then there was the worried call from a casting director whose "Star" got doggone stubborn one day and decided to just lie down and not work. The director needed a replacement dog, fast. "We got them two in one hour." said Aiken. "It was a matter of good connections and fast phone work." The eight phone lines needed to make 350 to 400 calls a day are one of Movie People's major expenses. Phone lines are the only way to stay in touch with casting directors and extras; but the latter are a group not necessarily interested in a long-term relationship. Most extra jobs pay only $7 an hour (with a six-hour minimum), while most agencies charge an annual $75 registration fee and get 10 to 15 per cent of extras' earnings. It's no wonder that the _ rate is fairly high. Some people who are between jobs do extra work as a temporary measure, said McCartney. But professionals, such as lawyers, also do the work because it's interesting. Others with flexible jobs have a desire to do something different. Some homemakers want to get out of the house and onto a movie set. Money's not the motivating reason. "One of the first things I say to people who walk in and ask about being an extra is, 'You have to be available,' "said a person at Karen Clifton Agency. Inc. "The next thing I say is, 'You can't make a living at this.' " [/INST] question: What kind of people are movie extras? | options: A: TV series makers B: Casting directors C: Non-professional movie actors D: Agents for movie stars | answer: C </s>

<s>[INST] context: The new high-speed railway line between Urumqi,capital of the Xinjiang Uygur self-governing region,and Lanzhou,capital of Gansu province,has cut train travel time by half to less than 12 hours. The dramatic improvement will benefit many families planning reunions for Spring Festival. "For the first time,I feel home is not that far away after all,"said Liang Shaofu as he boarded a high-speed train in Urumqi with six members of his family. The 35-year-old left Lanzhou to set up a dry fruit business in Xinjiang eight years ago,and he has now settled in Urumqi. The 1,776-km line,which passes through Qinghai province and is the country's first high-speed railway to be built in a high-altitude region,came into service on Dec 26. "We normally drive home for Spring Festival to avoid the difficulties of buying seven train tickets for the whole family during the peak season,"Liang said."Driving can be very tiring and dangerous sometimes,so one year we even decided not to go back to Lanzhou simply to avoid the trip." More than 600,000 passengers traveled on the line during its first month,and the Urumqi Railway Bureau said the introduction of high-speed services will ease transport pressure during the Spring Festival peak season. The existing usual railway line could no longer support Xinjiang's development.All passenger trains will gradually shift to the new link,leaving the old one to be used for goods.As a result,Xinjiang's annual goods ability could reach 200 million metric tons from the current 70 million. The line passes through areas that experience high winds,and it also crosses parts of the deserted Qinghai-Tibet Plateau and the bone-dry sands of the Gobi Desert. The project could help China to promote its high-speed railway technology abroad,said Ma Xi zhang,director of the Lanzhou-Xinjiang railway project's _ management department in Xinjiang. [/INST] question: How long did it take to go from Urumqi to Lanzhou by the usual train before? | options: A: about 12 hours B: About 6 hours C: About 18 hours D: About 24 hours | answer: D </s>

<s>[INST] context: The American Dental Association (ADA), the American Academy for Pediatric Dentistry (AAPD), the European Academy for Pediatric Dentistry (EAPD), and other organizations have published criteria that are meant to guide the dental professional in decision-making regarding appropriate radiographic imaging (Table 2-5). These guidelines clearly state that if the patient cannot cope with the procedure, one should attempt other strategies to handle the situation. The guidelines all acknowledge that, in some cases, radiographs are not possible, in which case, one should balance the benefit against the risk even more carefully. Sometimes it is better to postpone the radiographic exposure until the patient is older or better conditioned. The guidelines also clearly state that if there are no clinical signs of pathology, the need for a radiographic assessment is up to the professional’s judgment, and that these decisions have to be made on an individual patient basis. Radiographs are never to be used for economic and screening reasons since they involve a potential health risk for the patient. [/INST] question: The best method to screen a 3-year-old with a sound dentition and open proximal contacts would be: | options: A: No radiographic assessment B: Bitewing Radiographs C: Intraoral periapical radiograph D: Occlusal radiographs | answer: A </s>

<s>[INST] context: Reading for pleasure is the easiest way to become a better reader in English. It is also the most important way. Some students say they don't want to read for pleasure. They say they want to use their time to learn the rules of the language and new words. They say that pleasure reading is too busy. Many experts say pleasure reading is very important for learning English. Dr Stephen Krashen, a famous expert on learning languages, says that pleasure reading helps you learn many important things about English. Students learn more grammar and more words when they read for pleasure. They also learn more about good writing. Dr Krashen tells us that pleasure reading helps each student in a different way. Each student needs to learn something different. Pleasure reading makes it possible for each student to learn what he or she needs. Reading for pleasure is not the same as studying. When you read for pleasure, you choose your own books, and you don't have to remember everything. There are no tests on your pleasure reading books. Pleasure reading will help you: *learn how English speakers use English *read faster in English *find examples of good writing in English *learn new words *learn about the culture of English speakers [/INST] question: Many experts say students learn more _ when they read for pleasure. | options: A: grammar and listening B: listening and spelling C: listening and speaking D: grammar and words | answer: D </s>

<s>[INST] context: Here seum iron is reduced and TIBC is on the higher side. These are the first major pointers towards iron deficiency anaemia. This rules out Beta thalassemia minor and anemia due to chronic infection. Second pointer towards iron deficiency anemia is reduced Hb A2, which should haven been in a range of 4-9% in case of beta thalassemia trait. Sideroblastic anemia can be ruled out as it reveals a dimorphic blood picture. Parameter Iron deficiency anaemia Anaemia of chronic disease b Thalassaemia 1. MCV | N or | Markedly |sed 2. RDW | | or N | or N 3. Red cell morphology Microcytic hypochromic, pencil cells, anisocytosis Normocytic normochromic or microcytic hypochromic Microcytic hypochromic, basophilic stippling, target cells, polychromasia 4. Red cell count | | N 5. Serum iron | | N 6. TIBC | | N 7.Transferrin saturation | |or N | or N 8. FEP | | N 9. Serum TfR | N | 10. Serum ferritin decreases Increased or normal Normal 11. Hb electrophoresis Normal Normal HbA2>3.5% 12. Marrow haemosiderin Low or absent Normal or increased Normal [/INST] question: A 29-year-old woman was found to have Hb of 7.8mg/dl with a reticulocyte count of 0.8%. The peripheral blood smear showed microcytic hypochromic anemia. On HPLC, Hb A2 and Hb F was 2.4% and 1.3% respectively. The serum iron and TIBC were 15mg/dl and 420 micro g/dl respectively. The most likely cause of anemia is: | options: A: Iron deficiency anemia B: Beta thalassemia minor C: Sideroblastic anemia D: Anemia due to chronic infection | answer: A </s>

<s>[INST] context: Chinese e-commerce websites fail to pay more attention to older consumers, says a news report. There's been a thought that younger consumers have been the driving force of online buying. That may not be the case. According to a statement from Alipay, the average expenditure of Alipay users born before the 1960s was 31,000 yuan in 2012, much higher than 14,000 yuan of those born after the 1980s. It shows that online shopping has become a key part of people's daily consumption, for both young and old. Besides shopping, people pay bills such as water bill, electricity bill, and credit card repayment online. The middle-aged and senior consumers are also participating in that consumption revolution. Liu Chen, 56, said that his online expenditure in 2014 was over 50,000 yuan, about half of the total annual expenditure. He always pays his telephone bill online. Clothes, electrical appliances and kids' snacks are the main items he purchases online. Liu's shopping strategy is to find something good online first, then go to shops to check it out, and finally buy it online because it is cheaper. As quality concerns him, Liu only buys items that come with a guarantee. Stories such as those from Liu are representative of millions of middle-aged and older Chinese, which show the great potential of the aged in the Chinese consumption market. Yet, the market seems not to be valued as it should be. Some Chinese e-commerce websites such as jd. com, dangdang. com and amazon. cn don't have a category for goods for the elderly on their main pages. Alibaba's platform does have one, but the goods in it are not as abundant as other categories. Moreover, Taobao's category is not really designed for elders, but their children. Despite the seeming lack of commitment to older consumers, the Chinese market for the elderly is clearly huge, and e-commerce websites should take great efforts to develop it. [/INST] question: Liu Chen chooses online shopping mainly because of its _ . | options: A: low price B: convenience C: great potential D: quality guarantee | answer: A </s>

<s>[INST] context: Winston Churchill was born into a famous family.His father was a successful politician.However, as a boy, Churchill was considered a slow learner in school.Later he entered the Army and saw action in various countries. In October 1900, Churchill began his political career.For the next sixty years Churchill's work as a great politician was both brighter and more difficult than his father's had been.In 1939 German attacked Poland.Churchill prepared to fight.In 1940 he became the Prime Minister of English. France fell.The Germans fought their way through Western Europe.It looked as if Britain was about to lose the war.Was it now possible to ask for peace, and listen to Hitler? Churchill spoke: "I have nothing to offer but blood, hard work , tears and sweat... You ask what is our policy? I will tell you, it is to fight, by sea , by land and air, with all our force and with all the strength that God can give us.You ask what is our aim? I can answer in one word: Victory." The Germans began moving their armies to the French coast and prepared to go to war with British.The British had not enough guns to go around.Churchill gave the answer: " We shall defend our island, whatever the cost may be.We shall fight on the coast ; we shall fight on the landing grounds; we shall fight in the fields and in the streets; we shall fight in the hills; we shall never give up." By his courage and hard work, Churchill _ his people and other nations fighting together against Hitler.Victory finally came when the Germans lost World War II. Churchill died in 1965 and was given a state funeral.This was a fitting payment to one of all the greatest men the world had ever seen. [/INST] question: Churchill _ before he became a politician. | options: A: was a slow student B: was an army man C: helped his father in his career D: had little interest in politics | answer: B </s>

<s>[INST] context: Not long ago, I asked large mid-aged persons a question. I asked, "How many of you had a hobby when you were children?" Nearly everyone raised a hand. I then asked them to keep their hands in the air if they knew at least one of their children had a hobby. Most of the hands went down. I felt sad. It's terrible if the children don't have a hobby. How I wish all the parents can care their children's hobbies! Thirty years ago, almost every child in my neighborhood had some kinds of hobbies. Collecting and trading baseball cards was a popular hobby. Others, like coin collecting and stamp collecting, are also popular. One of my friends was collecting photos, another was collecting radios. In fact, hobbies can benefit children in several ways. _ are expressions of personal success and self-discovery . Hobbies also help build self- respect . Hobbies are educational tools, as well. For example, a child who becomes interested in rocketry --one of the most popular hobbies, can explore those skills in many ways. By working on hobbies, children learn to set goals, make decisions, and solve all sorts of problems. ,. [/INST] question: What's the age the persons I questioned? | options: A: 3--10 B: 15--25 C: 30--40 D: 50--60 | answer: C </s>

<s>[INST] context: Choice of glucocorticoid in patient with acute adrenal insufficiency In a patient without a previous diagnosis of adrenal insufficiency. - Dexamethasone 4 mg i.v. is preferred because in contrast to hydrocortisone it is not measured in serum cortisol assays so it does not interfere with the measurement. For patients with known diagnosis of adrenal insufficiency. - Dexamethasone, i.v. hydrocortisone or any intravenous glucocorticoid preparation may be used. This can rapidly decrease the inappropriate vasopressin production with increased clearance of free water and correction of hyponatremia. In contrast to glucocorticoid replacement, mineralocorticoid replacement is not necessary acutely because it takes several days for its sodium retaining effects to appear and adequate sodium replacement can be achieved by intravenous saline alone. However in patients with known primary adrenal insufficiency with potassium > 6.0 meq./L hydrocortisone is preferred because of its mineralocorticoid activity. Treatment of acute adrenal insufficiency (adrenal crisis) in adults Emergency measures Establish intravenous access with a large-gauge needle. Draw blood for immediate serum electrolytes and glucose and routine measurement of plasma cortisol and ACTH. Do not wait for lab results. Infuse 2 to 3 liters of isotonic saline or 5 percent dextrose in isotonic saline as quickly as possible. Frequent hemodynamic monitoring and measurement of serum electrolytes should be performed to avoid iatrogenic fluid overload. Give 4 mg dexamethasone as intravenous bolus over one to five minutes and every 12 hours thereafter. Dexamethasone is the drug of choice because it does not interfere with the measurement of plasma cortisol. If dexamethasone is unavailable, intravenous hydrocortisone, 100 mg immediately and every six hours thereafter, may be used. Use supportive measures as needed. Subacute measures after stabilization of the patient Continue intravenous isotonic saline at a slower rate for next 24 to 48 hours. Search for and treat possible infections precipitating causes of the adrenal crisis. Perform short ACTH stimulation test to confirm the diagnosis of adrenal insufficiency, if patient does not have know adrenal insufficiency. Determine the type of adrenal insufficiency and its cause if not already known. Taper parenteral glucocorticoid over one to three days, if precipitating or complicating illness permits, to oral glucocorticoid maintenance dose. Begin meneralocorticoid replacement with fludrocortisone, 0.1 mg by mouth daily, when saline infusion is stopped.   Pheochromocytoma [/INST] question: DOC in adrenal insufficiency?a) Hydrocortisoneb) Adrenalinec) Dexamethasoned) Fludrocortisone | options: A: a B: bc C: ad D: ac | answer: D </s>

<s>[INST] context: Dear friends, The recent success of children's books has made the general public aware that there's a huge market out there. And there's a growing need for new writers trained to create the $3 billion worth of children's books bought each year... plus stories and articles needed by over 650 publishers of magazines for children and teenagers. Who are these needed writers? They're ordinary people like you and me. But am I good enough? I was once where you might be now. My thoughts of writing had been pushed down by self-doubt, and I didn't know where to turn for help. Then, I accepted a free offer from the Institute to test my writing ability, and it turned out to be the inspiration I needed. The promise that paid off The Institute made the same promise to me that they will make to you, if you show basic writing ability: you will complete at least one manuscript suitable to hand in to a publisher by the time you finish our course. I really didn't expect any publication before I finished the course, but that happened. I sold three stories. And I soon discovered that was not unusual at the Institute. Since graduation, I have written 34 nationally published children's books and over 300 stories and articles. Free test and brochure We offer a free ability test and will send you a copy of our brochure describing our recognized home-study courses on the basis of one-on-one training. Realize your writing dream today. There's nothing sadder than a dream delayed until it disappears forever. Sincerely, Kristi Hill Institute of Children's Literature [/INST] question: You are promised to publish one manuscript when you _ . | options: A: show basic ability B: finish the course C: have sold three stories D: have passed the test | answer: B </s>

<s>[INST] context: Syringomyelia: A long cavity (the syrinx) filled with CSF develops within the spinal cord, most commonly in the cervical region. Usually the cause is unknown but the condition is sometimes associated with prolapse of the cerebellar tonsils and hydrocephalus The expanding cyst presses on the anterior horn cells, producing weakness and wasting of the hand muscles. Destruction of the decussating spinothalamic fibers in the center of the cord produces a characteristic dissociated sensory loss in the upper limbs - impaired response to pain and temperature but preservation of touch.(light touch along with vibration and position is transmitted through posterior column) CT may reveal an expanded cord and the syrinx can be defined on MRI. Deterioration may be slowed down by decompression of the foramen magnum. Tuberculosis of spine: Predominantly motor involvement. Disc Prolapse: In the lumbar region it commonly affects the nerve roots thus involving all five sensory modalities. Tabes dorsalis(teiary syphillis): Involvement of posterior column thus involving light touch, proprioception and vibration. [/INST] question: Dissociative sensory loss occurs in | options: A: Tuberculosis of spine B: Disc prolapse C: Tabes dorsalis D: Syringomyelia | answer: D </s>

<s>[INST] context: The Ministry of Construction has released the names of the first group of 20 national parks, including 9 Suzhou classical gardens: Zhuozheng Garden, Liu Garden, Wangshi Garden, Huanxiu Villa, Lion Grove, Yipu Garden, Ou Garden, Tuisi Garden and Canglang Pavilion. National parks refer to the famous city parks and gardens. Suzhou classical gardens are parts of China's precious cultural heritage (all the 9 gardens are on the list of World Cultural Heritage) as well as a necessary part of the life of Suzhou citizens, not to mention they are also world-famous tourism resorts . In fact, their unique historical and cultural background serves to contribute to their ranking among national parks. The earliest classical gardens in Suzhou can date back to the Song Dynasty. However, the gardens impress their visitors not only with their age-old history but also with their _ scenes, particularly Canglang Pavilion, Zhuozheng Garden, Lion Grove and Liu Garden, the most famous four that represent different styles of dynasties of Song, Yuan, Ming and Qing. In 1978, an imitation of a Suzhou classical garden was set up by Chen Congzhou (the author of the book Suzhou Classical Gardens) in the City Museum of Art in New York, US, which was the first time ever to directly introduce Chinese ancient architecture to Westerners. [/INST] question: _ parks and gardens are selected as National Parks in the first group. | options: A: 9 B: 8 C: 20 D: 4 | answer: C </s>

<s>[INST] context: The electroretinogram (ERG) is a diagnostic test that measures the electrical activity generated by neural and non-neuronal cells in the retina in response to a light stimulus. The electrical response is a result of a retinal potential generated by light-induced changes in the flux of trans retinal ions, primarily sodium and potassium.  A-wave: initial corneal-negative deflection, derived from the cones and rods of the outer photoreceptor layers. This wave reflects the hyperpolarization of the photoreceptors due to the closure of sodium ion channels in the outer segment membrane. Absorption of light triggers the rhodopsin to activate transducin, a G-protein. This leads to the activation of cyclic guanosine monophosphate phosphodiesterase (cGMP PDE) eventually leading to a reduction in the level of cGMP within the photoreceptor. This leads to closure of the sodium ion channels resulting in a decrease of inwardly directed sodium ions, or a hyperpolarization of the cell. The a-wave amplitude is measured from the baseline to the trough of the A-wave. [/INST] question: ‘A’ wave in Electro Retinogram corresponds to the activity | options: A: Rods and cones B: Pigment epithelium C: Ganglion cell layer D: Nerve fibre layer | answer: A </s>

<s>[INST] context: For hundreds Of years, scientists have been trying to answer what things have an effect on people's emotions . How you feel is controlled by many things. Your emotions can be affected by your personality, by the actions of others and by events around you. Perhaps you don't know your emotions can be influenced by the weather as well. People often say they feel good when the sun is shining and sad when it is cloudy. In fact, sunlight makes us feel good. When sunlight hits our skins, our bodies produce a vitamin. Vitamins are natural chemicals which we all need to stay healthy. Sunlight helps our bodies produce vitamin D. Vitamin D helps our bodies make a special chemical. This special chemical affects our brains and makes us feel happy. For example, there are long, dark winters of little sunlight in Sweden and Norway, so many people in these countries often feel sad. Without much sunlight, their bodies produce less vitamin D. Without enough vitamin D, their bodies make less of this special chemical which makes them feel good. To help the people in these countries feel better, special "sunrooms" with artificial lights have been built. People can go there and get "sunlight" for an hour or two! The weather can also affect people's emotions in other ways. Hot weather can make people angry because people feel uncomfortable when they are hot. In the same way, rain can make people angry because being wet can be unpleasant. As you can see, the weather can have an effect on the chemicals which control our brains. Through these ways, the weather can influence our emotions. Sadly, while the weather can change us, we can hardly change the weather. [/INST] question: Which of the following is NOT mentioned as a factor that can affect one's emotions? | options: A: Weather B: Actions of others C: Personality D: Age | answer: D </s>

<s>[INST] context: Image 1.- p30 test (Best test for seminal fluid is microscopy.) Image 2 -Barberio's test Image3-Florence test Image 4-Acid phosphatase test Some hot points for Blood Stain and Semen1. For identification of a blood stain the most reliable test is Spectroscopic test.2. Screening bloodstain --> presence of enzyme Peroxidase.3. Benzidine test has been banned due to carcinogenic effect.4. Takayama reagent is used in Hemochromogen.5. positive Kastle Mayer test -->a pink stain colour.6. Positive cases of Teichmann's test--> Dark brown rhombic crystals7. Species identification of a bloodstain -->Precipitin test.8. The best method to detect disputed paternity -->DNA fingerprinting.9. Group specific substance are not found in CSF.10. Best specimen for DNA fingerprinting in a living person blood preserved with EDTA.11. Best post-moem tissue sample for DNA fingerprinting in a decomposed body bone marrow.12. Tests for an old blood stain -->Benzidine test.13. Brain-mapping is---> lie-detection test.14. The drug used for narco-analysis --> Pentothal.15. eeg is used in Brain fingerprinting16. Semen has luminescence in UV light.17. Florence test produces choline iodide crystals.18. Barberio's test produces sperm in picrate crystals.19. Acid phosphatase levels in semen are > 100 Bodansky units. [/INST] question: Best test for detecting seminal stain is: | 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: A </s>

<s>[INST] context: Acute kidney injury (AKI) in children is defined: Increase in S. creatinine of >0.3 mg/dl over 48 hrs or Increase in S. creatinine 1.5-2 fold from baseline in last 7 days Urine output <0.5 ml/kg/hour for > 6 hours Pediatric-Modified Rifle (pRIFLE) Criteria: CRITERIA ESTIMATED Creatinine clearance (eCCl) URINE OUTPUT Risk eCCl decrease by 25% <0.5 mL/kg/hr for 8 hr Injury eCCl decrease by 50% <0.5 mL/kg/hr for 16 hr Failure eCCl decrease by 75% oreCCl <35 mL/min/1.73 m2 <0.3 mL/kg/hr for 24 hror anuric for 12 hr Loss Persistent failure >4 wk End-stage End-stage renal disease(persistent failure >3 mo) Comparison of RIFLE versus AKIN versus KDIGO criteria for AKI Criteria RIFLE Creatinine definition Criteria AKIN Creatinine definition Criteria KDIGO Creatinine definition Urine output Risk >1.5 - fold increase from baseline SCr or decrease in GFR>25% Stage 1 >0.3 mg/dL increrase or>1.5 fold increase from baseline SCr within 48 hrs Stage 1 >0.3 mg/dl increase within 48 hrs or 1.5-1.9 times baseline within 7 days <0.5 ml/kg/h for >6 hours Injury >2 fold increase from baseline SCr or decrease in GFR>50% Stage 2 >2 fold increase from baseline SCr Stage 2 2.0 - 2.9 times baseline within 7 days <0.5 mL/kg/h for 12 hours Failure >3 fold increase from baseline SCr or increase to>4 mg/dl or decrease in GFR >75% Stage 3 >3 fold increase from baseline SCr or increase to>4.0 mg/dl with an acute vincrease of >0.5 mg/dl or initiation of R Stage 3 >3 times baseline within 7 days or increase to>4.0 mg/dL with an acute increase of >0.5 mg/dL or initiation of R <0.3 mL/Kg /h for 24 hours or anuria for > 12 hours **SCr- Serum Creatinine; AKIN: Acute Kidney Injury Network; KDIGO: Kidney Disease Improving Global Outcomes [/INST] question: In children, acute kidney injury in terms of urine output is defined as? | options: A: Less than 0.3 ml/kg/hr for >6 hrs B: Less than 0.5 ml/kg/hr for >6 hrs C: Less than 0.8 ml/kg/hr for >6 hrs D: Less than 1 ml/kg/hr for >6 hrs | answer: B </s>

<s>[INST] context: Showering typically sends water down the drain, but a new space-age shower could change that. The design, inspired by NASA, saves water and money. Astronauts have no choice but to recycle the water they use in space. _ This futuristic shower comes from Orbital Systems, a Swedish advanced technology company. Its CEO, Mehrdad Mahdjoubi, invented the product. "The shower of the future is a water-recycling shower, thus enabling water savings up to 90 percent, energy savings up to 80 percent, at the same time increasing comfort and hygiene. The water is being collected in the drain, it's being analyzed, purified and then pumped back up to the shower head. So what is so special about the purification technology? Well, it's based on a patented purification capsule system that makes sure that the water is always crystal clear," he explained. Mahdjoubi was inspired by a project between NASA and Sweden's Lund University to come up with designs for a mission to Mars. He adapted the closed-loop system that allows astronauts to re-use shower water again and again. The product already has been tested in Sweden, where it saved up to 100,000 liters of water over four months. Based on those results, Mahdjoubi is confident his company can distribute the shower system worldwide. "Our market is anyone who takes a shower, actually, and the biggest benefit it gives is to the market segment where the water consumption is the highest, such as bathing establishments, gyms, sports centers. Also, private households where the water consumption and the prices are high," said Mahdjoubi. The "out of this world" design has won several business and innovation [/INST] question: What's Mahdjoubi's attitude towards the new product? | options: A: Optimistic B: Uncertain C: Negative D: Indifferent | answer: A </s>

<s>[INST] context: Films provide more than just entertainment.For many people,watching English films is a way to develop language skills.While watching a film,you are immersed in the language and can pick up new expressions that you might not find in a textbook.Some difficulties can arise when watching English films--for example,unfamiliar colloquial language or strong regional accents.With this in mind,here are my tips to help you make progress in English learning while enjoying the films. Choose a film genre that you enjoy. If you like action films,watch an action film--for example Indiana Jones.If you prefer comedies,watch a comedy--anything with Hugh Grant in always provides a laugh!It's simple enough,but if you choose something you enjoy watching in your native language,you're more likely to enjoy it in English. Choose something that you are familiar with. It's best to start off with something simple because in this way you have a higher chance of understanding the film.Disney films such asThe Lion King,or the more recently releasedTangled,are classic examples.Other cartoons such as Up and The Lego Movieare also worth a watch. Ask friends for advice Perhaps you have friends who have already seen English film? If so, they may be able to recommend one. If you need to,use the English _ Subtitles are very helpful for beginners.Using subtitles in your own language is the easiest choice,but for more advanced learners why not consider using English subtitles? This way,you can match the written subtitles to the words spoken on screen.It helps you to develop your language further. [/INST] question: What kind of film will you probably watch if you like Hugh Grant? | options: A: Action films B: Cartoon films C: Comedy films D: Detective | answer: C </s>

<s>[INST] context: Jamaican sprinter Usain Bolt plans to send a message to rival Tyson Gay by breaking the world 100m record in the London Grand Prix on Friday. Bolt, who won gold in the 100m,200m and 4*100m relay in reord times at the Beijing Olympics last year, is determined to use the Crystal Palace event to crush the morale of his main rival for gold at next month's World Athletics Championships in Berlin. The 22-year-old is slowly returning to peak form after posting 19.59 sec for the 200m in Lausanne earlier this month and clocking a time of 9.79 sec over 100m in cold, rainy conditions in Paris on Friday. Despite Bolt's impressive times, Gay still believes he has the beating of the Jamaican. But Bolt insists there is no one in the sport who scares him and he will prove the point in south London this weekend. Although Bolt believes he is only running at 85 percent at the moment while he recovers from injuries suffered in a recent car crash in Jamaica, he sees no reason why he can't break his world record 100m time of 9.69 seconds. However he won't get the chance to _ Gay in the 100m in London as the American is only running in the 200m, which Bolt is not competing in, so he will have to settle for underlining his own ability. "You never know what is possible. I will give my best either way. My friends are saying I'm bringing the rain wherever I go but we will see on Friday." While Bolt would love to make a big impact in London, he knows the main event is the World Championships. "The London Grand Prix will show me where I'm at and what I need to do. After, we can analyse what I need to do ahead of the World Championships." [/INST] question: Which of the following is true? | options: A: Jamaican sprinter Usain Bolt broke the world 100m record in the London Grand Prix on Friday B: Bolt will not compete in the 200m in London because of Gay's impressive times C: Bolt won 3 gold medals at the Beijing Olympic Games at the age of 22 D: Bolt suffered a car crash in London recently | answer: D </s>

<s>[INST] context: Carcinoma of the head of the pancreas is treated with radical excision of the head of the pancreas along with the duodenum. Continuity of the biliary and GI tract is established by performing hepaticojejunostomy, pancreaticojejunostomy, and gastrojejunostomy (Figure below). The 5-year survival rate is higher for periampullary carcinoma (30%) than that for pancreatic head lesions (10%). Most centers do not give irradiation routinely before or after surgery, because pancreatic cancers do not respond well to radiotherapy. Endoscopically placed stents alone are used only in palliative circumstances in patients with limited life expectancy.Pancreaticoduodenectomy (Whipple procedure). A: Preoperative anatomic relationships showing a tumor in the head of the pancreas. B: Postoperative reconstruction showing pancreatic, biliary, and gastric anastomoses. A cholecystectomy and bilateral truncal vagotomy are also part of the procedure. In many cases, the distal stomach and pylorus can be preserved, and vagotomy is then unnecessary [/INST] question: A 66-year-old man with obstructive jaundice is found on ERCP to have periampullary carcinoma. He is otherwise in excellent physical shape and there is no evidence of metastasis. What is the most appropriate treatment? | options: A: Radical excision (Whipple procedure) where possible B: Local excision and radiotherapy C: External radiotherapy D: Internal radiation seeds via catheter | answer: A </s>

<s>[INST] context: But what is teacher quality? How can one measure it reliably? An analysis is issued on a sample of data from a Texas school district. Experts argue convincingly that teacher effectiveness should be measured by students' gains on standardized tests: Mr. Smith is probably a better teacher than Ms. Brown if his students consistently improve their test scores more than hers do. Though this approach is appealing, there are tricky issues. For example, what if Ms. Brown teaches in a school where students score so high there is little room for improvement? The authors try to correct for this problem, as well as other sorts of measurement issues, to generate a measurement of teacher effectiveness. The paper is primarily concerned with how this measure is related to other observable characteristics. The first finding is that there is a large variation in teacher effectiveness: some teachers consistently have a larger impact on their students' achievement than others. Second, easily observable characteristics like having a master's degree or a passing score on the teacher certification exam are not correlated with teacher effectiveness. Then what does matter? The most important single influence is experience: first-year teachers are much less effective than others. The second year is significantly better, and by the fourth year, _ . It is not entirely clear whether this experience effect is learning by doing (the more you teach, the more effective you become) or survival of the fittest (those who are not good at teaching tend to drop out early.) From my reading of the paper, both effects appear important and there is no simple answer. The data do suggest, however, that teacher effectiveness is pretty clear by the end of the second year, so the information to make an informed decision is available at that time. The authors also investigate the contentious issue of racial matching of students and teachers. Here they find strong evidence that minority teachers tend to be more effective with minority students. Again, it is unclear whether this is because of a role model effect (students respond better to a teacher of their own race) or an empathy effect (teachers empathize better with students of their own race) or something else entirely. The authors also look at teacher mobility. There is some evidence that teachers who quit teaching or switch schools tend to be below average in effectiveness. This is consistent with the survival-of-the-fittest model. [/INST] question: The schoolmaster could decide wisely whether to further employ the teacher by the end of the _ . | options: A: the first year B: the second year C: the third year D: the fourth year | answer: D </s>

<s>[INST] context: Even after his death, Mitchell Whisenhunt has found a way to surprise and bring comfort to his wife and young daughter, with some letters he designated to be opened on certain dates. Mitchell lost his battle with Marfan syndrome at 26. The rare genetic disorder affects the body's connective tissue, which is used to hold together organs, cells and tissue. Ashley Whisenhunt, 22, cared for her husband until his death but said she was astonished when she discovered the 30 letters he left for her, their 18-month-old daughter Brynleigh and the community. The little girl will grow up with a letter every year from her second to 18th birthday from a man she didn't get to spend much time with but who left no doubt that he loved her unconditionally. "Through his testimony,there is so much she is going to learn," Ashley told ABC News. One letter was also addressed to their Longview, Texas, community, thanking them for their support. "It just blows my mind," Ashley said of her husband's secret gesture. "He thought about everybody else instead of himself." Ashley said she would respect her husband's wishes and open each letter as he planned, however there was one special surprise left for her that she said hit her the hardest. In a spiral notebook that Ashley used before she dropped out of college to care for her husband, he wrote a letter to her asking that she publish a book of poetry he had written. Mitchell Whisenhunt even planned his own funeral, and the funeral director said he couldn't tell Ashley because it was Mitchell's plan and secret. Ashley said she couldn't help but wonder what other surprises her husband had in store. "There are ones we still don't know about it," she said. [/INST] question: How many letters will Ashley Whisenhunt receive from her husband? | options: A: 30 B: 22 C: 12 D: 13 | answer: C </s>

<s>[INST] context: For skin graft to get accepted - the recipient bed should be vascularized For avascular places like bone, tendon, etc. - flap is used * Pedicel Graft or Flap Flap: Paially or completely isolated segment of tissue with its own blood supply Absolute Indications for Flaps Exposed bone Radiated vessel Brain Open joint or non-biological implant materials Pressure sores at bony prominences Full-thickness graft/Wolfe's Graft: - Consists of epidermis + full thickness of dermis. Only small graft can be taken For critical and small areas such as an eyelid, a full thickness graft is selected, so that contraction of the grafted material is minimum. Composite graft: Is a graft that contains tissue in addition to the epidermis and dermis. Depending on the donor site, it can contain subcutaneous fat, cailage, and even muscle. It is ideal for repair of deeper defects. Free Flap: - It involves autogenous transplant of vascularised tissues. There is devascularization from donor site & revascularization at recipient bed. [/INST] question: Split thickness skin graft is not taken up by:- | options: A: Fat B: Muscle C: Deep fascia D: Skull bone | answer: D </s>

<s>[INST] context: ACHALASIA CARDIA Characterized by absence of LES relaxation Clinical features - MC symptom - Dysphagia > weight loss | (Liquid > Solid) - Triad Dysphagia Regurgitation Weight loss IOC - Manometry On Barium Swallow * Bird beak appearance * Pencil tip appearance * Rat tail appearance TypeI: classic achalasia,incomplete LES relaxation, aperistalsis and absence of esophageal pressurization.Elevated median IRP(integrated relaxation pressure) >15 mmHg, 100% failed peristalsis DCT <100mmHg cm,premature contractions with DCT <450mmHg cm TypeII: incomplete LES relaxation, aperistalsis ,Elevated median IRP(integrated relaxation pressure) >15 mmHg, 100% failed peristalsis,panesophageal pressurization in at least 20% of swallows., contractions may be masked by oesophageal pressurisation and DCT should not be calculated Type III achalasia(spastic achalasia) Elevated median IRP (>15 mmHg), No normal peristalsis, Premature (spastic) contractions with DCI >450 mmHg*s*cm with >=20% of swallows May be mixed with panoesophageal pressurisation Jackhammer esophagus : is characterized by DCI > 8000 mmHg*sec*cm in at least 20% of swallows and normal DL [/INST] question: On esophageal manometry, abnormal spastic contractions in esophagus > 450 mmHgs cm in the body is suggestive of: | options: A: Type I achalasia B: Type II achalasia C: Type III achalasia D: Jackhammer esophagus | answer: C </s>

<s>[INST] context: First lets briefly review the anatomy of male internal genitalia Sperms are produced in testes and then stored and mature within the epididymis. Vas deferens carries the sperms from epididymis to the urethra where they open by separate openings into the prostatic urethra. Just before opening each vas deferens is joined by ducts of seminal vesicles. Vas deferens and seminal vesicle ducts join to form the ejaculatory duct. The secretions of seminal vesicles form a large part of seminal fluid and contain fructose and a coagulating enzyme called the vesiculase. Now coming to the question. Semen analysis forms an important part of infertility assessment. Low ejaculatory volume is caused by retrograde ejaculation into the bladder or obstruction of the vas deferens or the ejaculatory duct Azoospermia may be seen in testicular failure or obstruction of vas deferens Absence of fructose suggests seminal vesicles agenesis or obstruction. A semen that is low in volume with azoospermia and absence of fructose suggests → either obstruction of the ejaculatory ducts or congenital absence of the vas deferens and seminal vesicles. The anatomy of the vas deferens & seminal vesicles can be investigated by vasography (where contrast medium is injected into the vas deferens) or TRUS (Trans rectal ultrasonography), however TRUS is superior to vasography and is the investigation of choice. Also know Semen specimen should be obtained following at least 3 days of abstinence and examined within 1 to 2 hrs. At least 2 specimens are examined several weeks apart. [/INST] question: Semen analysis of a young man who presented with primary infertility revealed low volume, fructose negative ejaculate with azoospermia. Which of the following is the most useful imaging modality to evaluate the cause of his infertility? | options: A: Colour duplex ultrasonography of the scrotum B: Transrectal ultrasonography C: Retrograde urethrography D: Spermatic venography | answer: B </s>

<s>[INST] context: Alexi s Vaughan,17,sat tiredly in the passenger seat of her dad's car.The early Saturday morning run with her father,Michael,was part of the punishment.She stared sadly out of the window at the cornfields. An experienced hunter,Alexis let her eyes lazily search for wildlife.She was shocked when a deer came into view about 200 yards in front of them.Mule deer never appeared in plain sight ten days before hunting season.It was a buck--a male deer with sharp,three-pronged antlers . Suddenly Alexis heard a scream and saw an arm fly up near the deer's head.She realized the buck was attacking a woman.Sue Panter had been Out for her morning run.The deer had appeared from the tall corn and begun following her.Having lived in the countryside of Idaho for years,Sue knew that most deer got frightened by humans.But this deer moved closer,even when she threw a handful of small stones at it. "I knew I was in trouble,"she says. The buck rushed forward,lifted her up with its antlers and threw her into the air. Sue could feel the antlers made small holes in her leg and blood ran down her leg. When the Vaughans pulled up,the buck was throwing Sue like a rag doll. Before her father had stopped the car,Alexis rushed out of the car and down the slope toward the buck."1 was kicking and hitting it hard with my fists to get its attention so that It will leave the woman,"she says.However,the animal was not frightened at all.Then Michael pushed the buck away from the woman by the antlers. Alexis helped Sue up the slope and into the Vaughans'car.Then she tied a tourniquet to Sue's right leg.Her neck was cut.Then she heard her father shout loudly. Michael had been knocked to the ground,his right leg seriously cut by the buck. Alexis took a hammer from the car and ran to where Michael lay on his back in the dirt.She beat the buck's head and neck,but the blows didn't frighten it away."I was losing faith,"she says. "A couple more strikes,Alexis,"said Michael."You can do it."Alexis closed her eyes and hit with all her strength at the deer's neck with the hammer. When she opened her eyes, the deer was running away. A1exis got in the driver's seat and sped toward the hospital in Franklin,hearing her dad's breathing grow difficuIt and unsmooth as the blood from his wounded leg had flowed through the T--shirt he'd wrapped around it.In the backseat,Sue looked unconscious. After doctors treated Sue and Michael,Sue tearfully thanked her rescuers." _ [/INST] question: How did Alexis help Sue soon after she ran out of the car? | options: A: By trying to bring the buck's life to an end B: By frightening the buck to run away down the slope C: By trying to draw the buck's attention away from Sue D: By pushing the buck away from Sue by the antlers | answer: C </s>

<s>[INST] context: To whom it may concern, This letter describes the worst travel experience I have ever had.The problems we had were the result of poor management and thoughtless employees.Your airline should be ashamed of treating its customers so poorly. On January 5, we arrived in Denver from Houston and checked in for our next flight.It wasn't long before the agent announced that our flight would be delayed because of a mechanical problem. The equipment was in Aspen, and they expected it to be repaired soon. Soon shortly turned to much later, and during the delay, weather temporarily closed the Aspen airport.The weather cleared in Aspen and the plane took off very late for Denver.While it was in the air, the agent announced that the plane would be used for the next flight and that our flight was being cancelled. This cancellation struck me as being unfair.There was a mad scramble as the 50 or so passengers scheduled for our flight fought for seats on later flights.When the dust settled, we were wait-listed on the 9'-00 flight the next morning.We had to spend the night in the airport. Coming home was no better.Because of a mechanical problem, it looked like we would miss our connection in Denver.The agent assured us they would hold the Newark flight for us.Needless to say, the flight to Houston taxied out as we pulled into the gate.Arrangements were made for us to take the next flight, so we sat in the airport for 5 hours.When we finally arrived in Houston, our skis were missing.As of this writing, the skis have not been found. Nothing you can do will make us feel better about our flights.If you are a responsible business, however, you will do what you can to see that passengers in the future are treated better. With great displeasure, Phyllis Dooley [/INST] question: When Phyllis wrote her letter, she felt _ . | options: A: tired B: fooled C: annoyed D: ashamed | answer: C </s>

<s>[INST] context: Oh, boy! Time for a game now. The oldest brother is the seeker so I have to hide extra good because he's smart and will find me quickly. But where? Behind the garage won't work. The barn is too easy. Wait, I know. The door leading under the porch is perfect. No one would look for me under there. It smells unpleasant under this porch. Wish I had picked another place to hide. Smelly cats! Too late now, I can hear brother seeking everyone out. I'll just sit here quiet as a mouse. Hah hah hah! I can hear you out by the barn! You'll never find me over there! It's been a while and he hasn't found me yet. What's that I hear? Now all my brothers are looking for me. They've all been caught, but not me. They'll never trick me into coming out to catch me. Wait, is that Dad I hear calling my name? Oh no, now I hear someone going to call Grandpa to help look for me. I'm not coming out now because I'm in really big trouble. What to do? If I come out and say I heard them calling me, I'll be in big trouble. Think, think! How do I get out of trouble? I know what to do! I'll tell them I fell asleep while waiting. Is that Grandpa's voice? Heh heh heh! Now's my chance. I'll crawl out slowly and rub my eyes. Now that I see Grandpa go towards me quickly, I say. "I fell asleep." "Oh! You had us all worried!" says Grandpa. "You little devil, I'm just glad you're all right, but next time try not to fall asleep and scare us like that, okay?" says Dad. Whew! I pulled it off . Now to keep my mouth shut. And I did, for over 42 years. Once in a while, a kid pulls the wool over people's eyes. So that's one of my little secrets I've never revealed before. Don't tell anyone now! [/INST] question: The place where the boy was hiding smelt terrible because it_. | options: A: was too wet there B: was used as a barn C: was dirtied by animals D: was just under the garage | answer: C </s>

<s>[INST] context: Nowadays people are troubled by the violence that spreads throughout the media. Movies, television and video games are full of gunplay and bloodshed, and one might reasonably ask what's wrong with a society that presents videos of violence as entertainment. Viewing large amounts of violent television and video games may well contribute to violent behavior in certain individuals. The trouble comes when researchers downplay uncertainties in their studies or overstate the case for causality . Skeptics were dismayed several years ago when a group of societies including the American Medical Association tried to end the debate by issuing a joint statement: "At this time, well over 1,000 studies... point to a causal connection between media violence and aggressive behavior in some children." Freedom-of-speech advocates accused the societies of catering to politicians, and even disputed the number of studies (most were review articles and essays, they said). When Jonathan Freedman, a social psychologist at the University of Toronto, reviewed the literature, he found only 200 or so studies of television-watching and aggression. And when he weeded out "the most doubtful measures of aggression", only 28% supported a connection. The critical point here is causality. The alarmists say they have proved that violent media cause aggression. But the assumptions behind their observations need to be examined. When labeling games as violent or non-violent, should a hero eating a ghost really be counted as a violent event? And when experimenters record the time it takes game players to read "aggressive" or "non-aggressive" words from a list, can we be sure what they are actually measuring? The intention of the new Harvard Center on Media and Child Health to collect and standardize studies of media violence in order to compare their methodologies, assumptions and conclusions is an important step in the right direction. Another appropriate step would be to tone down the criticism until we know more. Several researchers write, speak and testify quite a lot on the threat posed by violence in the media. That is, of course, their privilege. But when doing so, they often come out with statements that the matter has now been settled, drawing criticism from colleagues. In response, the alarmists accuse critics and news reporters of being deceived by the entertainment industry. Such clashes help neither science nor society. [/INST] question: Why is there so much violence shown in movies, TV and video games? | options: A: Showing violence is thought to be entertaining B: Something has gone wrong with today's society C: Many people are fond of gunplay and bloodshed D: There is a lot of violence in the real world today | answer: A </s>

<s>[INST] context: Laboratory work is your chance to learn science firsthand. It can be fun but you must be careful to prevent injury. Listen closely when your teacher reads and explains the rules before your first lab lesson. LABORATORYRULES Throughout the lesson *Do not enter the science lab without the teacher's permission.*No food or drinks are to be alowed in the science lab. Before the Experiment *Read al instructions carefuly before every experiment. *Prepare al apparatus and arrange them so that you wil not knock them over while doing the experiment. During the Experiment *If you are unsure of how to use any apparatus or how to operate, ask your teacher for help.*Never smel or taste chemicals unless your teacher gives permission. After the Experiment *Wash al apparatus after use and return them to the places where they were. *Throw waste materials in proper waste baskets. First Aid *Report al accidents to your teacher immediately. *If you spil( )any chemicals onto your body or clothing, wash with plenty of water and report to your teacher. [/INST] question: Your teacher wil probably tel you the rules above _ the first lab lesson. | options: A: before B: since C: during D: after | answer: A </s>

<s>[INST] context: Left medial visceral rotation Repeat from Nov 06 The major abdominal vessels are retroperitoneal structures that lie posterior to the contents of peritoneal sac & close to the midline. The vessels which are notoriously difficult to expose are: retrohepatic vena cava, suprarenal aoa; the coeliac axis; the proximal superior mesentric aery; the junction of the superior mesentric, splenic and poal veins and the bifurcation of the vena cava. Rapid exposure of these vessels can be accomplished during abdominal trauma by following maneuvers: - The principle behind visceral rotation is to rotate the viscera of one side towards the midline after freeing their lateral peritoneal attachments so as to expose the vessels of that side A left medial visceral rotation (Mattox maneuver) provides excellent exposure of the aoa, coeliac axis, superior mesentric aery, left renal aery and iliac aeries. A right medial visceral rotation (Catell maneuver) readily exposes the vena cava (with a combined Kocher maneuver), right renal vessels and iliac veins. The infrarenal aoa may be approached a transperitoneal incision at the base of the mesocolon. The junction of the superior mesentric, splenic and poal veins can be readily exposed in trauma surgery by dividing the neck of the pancreas. The bifurcation of the vena cava is obscured by the right common iliac aery. This vessel is to be divided to expose extensive vena caval injuries of this area. [/INST] question: In order to expose the coeliac axis, left renal aery, superior mesenteric aery and abdominal aoa in a case of trauma, which of the following is performed : | options: A: Left medial visceral rotation B: Right medial visceral rotation C: Cranial visceral rotation D: Caudal visceral rotation | answer: A </s>

<s>[INST] context: The diagnostic evaluation of an infertile couple should be thorough and completed as rapidly as possible. The primary diagnostic steps in the workup of the infertile couple include (1) documentation of ovulation by measurement of basal body temperature (BBT) or mid-luteal phase serum progesterone; (2) semen analysis; (3) postcoital test; (4) hysterosalpingogram; and (5) endometrial biopsy. Women should record their BBT for evidence of ovulation. In addition, serial serum progesterone levels may be helpful to confirm ovulation. Serum progesterone values should be obtained 7 days after ovulation and may also be helpful in evaluating inadequate luteal phase. An endometrial biopsy may also provide valuable information regarding the status of the luteal phase. The biopsy is obtained 12 days after the thermogenic shift, or 2 to 3 days before the expected onset of menses, on about day 26 of a 28-day cycle. A postcoital test is an in vivo test that evaluates the interaction of sperm and cervical mucus. It is performed during the periovulatory period up to 12 h after coitus. The cervical mucus is obtained, and its quantity and quality as well as its interaction with the sperm are evaluated. The hysterosalpingogram is performed in the mid follicular phase in order to evaluate the fallopian tubes and the contour of the uterine cavity; it should not be done while the patient is menstruating or after ovulation has occurred. Although gonadotropin levels are not routinely evaluated, they should be obtained in the early follicular phase when testing is indicated, e.g., in cases where there is a history of oligoovulation. [/INST] question: "Gonadotropin evaluation" For the evaluation, select the most appropriate day of a normal 28-day menstrual cycle for a woman with 5-day menstrual periods. (SELECT 1 DAY) | options: A: Day 3 B: Day 8 C: Day 14 D: Day 21 | answer: A </s>

<s>[INST] context: Geoff Hoon is one of prefix = st1 /Britain's most experienced politicians. Mr Hoon joined the Foreign and Commonwealth office in May 1999 as Minister of State with responsibility for Asia, the Pacific, the Middle East and North Africa; he was then made Minister for Europe. Later, in 1999, Mr Hoon joined Tony Blair's Cabinet as Secretary of State for Defence, where he oversaw four major deployments of British troops, including to Iraq. After the 2005 general election he became leader of the House of Commons and earlier this year (2006) he was appointed as Minister for Europe again. On Friday 24thNovember Mr Horn is visiting Nottingham to address Forum. He will speak about his experience in the public spotlight, and explain what life as a Cabinet Minister is really like. There will be an opportunity for questions after the talk, which is open to all students and staff at NottinghamUniversity. Please arrive early as there are limited spaces and nobody will be admitted once the event had begun. FRIDAY 24THNOVEMBER 4 O'LOCK A48 SIR CLIVE GRANGER (GEOGRAPHY & ECONOMICS) FREE ENTRY www.nottingham.forum.org [/INST] question: At the time of the writing, Geoff Hoon was a _ . | options: A: retired politician B: university scholar C: state leader D: military consultant | answer: C </s>

<s>[INST] context: Ophthalmologic manifestations of HIV infection • The MC abnormal finding on fundus examination are “cotton wool spots”. They represent area of retinal ischemia secondary to microvascular disease. These lesions are not associated with visual loss. • CMV Retinitis : – MC cause of vision loss in AIDS patient. – Usually occurs when CD-4 <50/ μ l. – Usually present as painless progressive of vision, patient may also complain of floaters and scintillations. – The characteristic appearance is that of perivascular hemorrhage and exudate. – It may be complicated by rheumatogenous retinal detachment. – Treatment - oral valganciclovir, IV ganciclovir - DOC • Acute retinal necrosis syndrome = Progressive outer retinal necrosis (PORN) : – Caused by herpes simplex virus, varicella zoster virus. – Associated with pain, keratopathy iritis. – Ophthalmologic examination show widespread pale grey lesions. – DOC is intravenous acyclovir. • Other secondary infections include : – P.carnii - Cause lesion of choroid. – Toxoplasmosis - Cause chorioretinitis. [/INST] question: An HIV patient complains for visual disturbances fundal examination shows bilateral retinal exudates and perivascular hemorrhages. Which of the following viruses are most likely to be responsible for this retinitis : | options: A: Herpes simplex retinitis B: Human herpes virus C: Cytomegalovirus D: EBV | answer: C </s>

<s>[INST] context: When Cathleen Gardiner's twins were born 17 years ago, doctors told her that they were a pair in a million. One had Down syndrome , while the other did not. Here, Cathleen tells their touching story. Since Sean was born 17 years ago, I have always thought that he is just as wonderful as his brother and sister. Though he had a disability , we have never viewed him as a burden. He has always been a blessing. The doctors explained that though they were twins, they came from two different eggs. Lisa could walk at 11 months old, while Sean didn't take his first steps till he was three. By two, Lisa was talking a lot, but Sean wasn't able to speak until he was nearly four. For the first five years of his life, Sean needed a great deal of care. Looking after him was my full-time job, though I also worked as a technical adviser in a computing company. We never treated them differently. We gave them the same toys and spoke to them in the same way. We encouraged Sean to keep up with Lisa, even though he never could, and we would help him develop his abilities. We sent them to the same primary school even after doctors advised us that Sean should go to a school for the disabled. We had to explain to Lisa that he wouldn't learn as quickly as she would. She told us that she'd help him with his school work. Having a non-disabled twin has really helped Sean develop. The love they share has given him a great deal of support. Now Sean and Lisa are both about to finish high school. I don't think he would have done nearly as well today without Lisa's help. [/INST] question: At least how many children does Mrs. Gardiner have? | options: A: Two B: Three C: Four D: One | answer: B </s>

<s>[INST] context: The forest in Senegal, a country in western Africa, is full of the chimps' usual noises. Suddenly dogs bark. Larger male chimps drop from the trees to face the threat while the others climb to safety. Then the dogs' young human masters appear. One mother chimp with a tiny baby tries to run. The dogs attack and separate them. The two teenage boys quickly catch the baby chimp. But they don't act out of sympathy --- they save the baby so they can sell it. After the teenagers return to their hometown, they visit a man who is said to be very interested in chimps. When they ask the man, Johnny Kante, if he wants to buy the baby, he replies, "That's not what we do." Kante is a member of a scientific team. Although Kante is angry with the teens for capturing the chimp, he hides his anger and persuades them to take him to the baby chimp. Unsure of what to do next upon seeing the chimp, Kante calls Jill Pruetz, the head of the chimp research team. "I'm really worried," says Pruetz, doubtful that the mother is still alive. But knowing that wild chimps sometimes adopt orphans , Kante and pruetz decide they must try to return the baby chimp to its wild community. Kante pays another visit to the teenagers. After he explains how much trouble they are in, because chimps are an endangered species, he requests they should give him the frightened baby without payment. They agree. Kante takes the baby chimp to his home and feeds her milk from a bottle whenever she cries. The next morning, Pruetz and Kante leave the baby with another team member and begin their search for the wild chimps. Pruetz quickly finds the group in the woods. She recognizes the female that is without her child. Pruetz is so excited that she runs the entire mile back to bring the baby chimp to the tree where the chimps are hanging out. The researchers place the baby on the ground near the tree and back away. Almost immediately, a male chimp drops to the ground and stares at the baby curiously. He carries her back to where the mother is waiting. Pruetz still can't believe how fortunate they were to have reunited the mother and child. "Surprising is the only word I can think of," she says. [/INST] question: The dogs' master visit Johnny Kante to _ . | options: A: sell the baby chimp B: ask him to take care of the baby chimp C: wash the baby chimp's wound D: ask him to return the baby chimp to its wild community | answer: A </s>

<s>[INST] context: Adrian's "Amazing Race started early when his parents realized that he, as a baby, couldn't hear a thing, not even loud noises.In a special school for the hearing.impaired , he learned sign language and got to mix with other disabled childRn. However, the sight of all the disabled children communicating with one another upset his mother. She wanted him to lead a normal life. So after speaking to an advisor, she sent him to private classes where he learned to read lips and pronounce words. Later OHg Adrian's paRnts decided to send him to a regular school. But the headmaster tried to prevent them from doing so, saying regular schools couldn-t take care of a special-needs student His parents were determined to take the risk and push him hard to go through his work every day because they want to prove that, given the opportunity, he could do anything.Adrian made the grade and got accepted.lt was a big challenge. The pace was faster so he had to sit at the front of the class and really pay attention to the teacher, which wasn' t always easy. But he stuck to it and did a lot of extra work after schooL The effort made by Adrian and his parents paid off. Adrian graduated with good grades and got into a top high school. He also achieved a lot in life outside school. He developed a love for the outdoors and went to Nepal to climb mountains. He even entered the World Yacht Race 05/06-being the first hearing-impaired Asian to do so. But none of these achievements would have been possible without one of the most important lessons from his mother. "If you believe in yourself and work hard, you can achieve great result, she often said. [/INST] question: How did Adrian communicate with other children in the special school? | options: A: By spealding B: By using sign language C: By reading lips D: By making loud noises | answer: B </s>

<s>[INST] context: We are naturally drawn to friends and colleagues with familiar voices, scientists have found.People prefer those who have a similar accent,intonation and tone of voice to themselves , they discovered. Previous research has focused on how masculine or feminine a voice sounds.Men with deeper voices and women with slightly higher voices were thought to sound more attractive,because they suggest a bigger or a smaller body. But the new study,published by a linguistics expert in Canada,suggests there is a more complex mechanism at play.Dr Molly Babel, from the University of British Columbia in Canada, said,"The voice is an amazingly flexible tool that we use to construct our identity.Very few things in our voices are changeless,so we felt that our preferences had to be about more than a person's shape and size.'' She recorded 30 volunteers' voices and asked each to rate the others' attractiveness on a scale of one to nine.Each participant was from western America,with similar accents.The people we assessed were all in the same dialect group,but they showed that dialect to different degrees. "We seem to like people who sound like we sound,we like people who fit within what we know,"Dr Babel said.She also found that breathy voices in women-typified by the famous American actress Marilyn Monroe-were seen as more attractive. The breathy tone,caused by younger and thinner vocal cords ,implied youthfulness and health A creaky voice,suggesting a person has a cold,is tired or smokes,was seen as unattractive.The participants preferred men who spoke with a shorter average word length and deeper voices. The linguist,whose work is published in the journal PLOS One,said,"Once you're outside of a certain range of familiarity,novel and exotic sounding voices might become more attractive.We also have to keep in mind we find some accents more preferable than others because of social fixed ideas." [/INST] question: In terms of voice preferences,the new findings highlight _ . | options: A: body size and shape B: shorter word length C: thicker vocal cords D: the same social groups | answer: D </s>

<s>[INST] context: Welcome to Our Clubs in Masonic Village Art Club The Art Club provides a place for aged people to paint, improve their artistic talents and show their works of art. Members can also sell items that they painted. The money raised goes toward providing painting supplies for club members. Anyone may join the Art Club, whether you already know how to paint or you want to learn how to better express your creativity. Painting supplies are provided by the club for free. Time: Wednesdays, Thursdays & Sundays from 1 p.m. to 3 p.m. in the Freemasons Cultural Center Art Studio. Cost: $12 per year Computer Club This club is meant for aged people with little knowledge of computers. Various topics are discussed at each meeting about computers (such as the Internet, software and email) as well as related technologies. The club has a computer lab with high-speed Internet connection. Members of the club have free access to the computer lab. Time: Tuesdays and Thursdays from 1 p.m. to 3 p.m. in the Computer Resource Room on Level 2 of Smith North. Open general lab sessions are available for free. Cost: $35 per year Tai Chi for Arthritis Arthritis is a common disease for old people. The joints in the patients' body often hurt badly. Tai Chi for Arthritis is designed to improve the quality of life of those people who are suffering from arthritis using Sun-style Tai Chi. This style includes quick-moving steps and exercises that may improve mobility, breathing and relaxation. The movements don't require deep bending. Time: Wednesdays from 3:30 p.m. to 4:30 p.m. in the Irem Clubhouse. Cost: $65 per year [/INST] question: For whom are these clubs probably designed for? | options: A: Retired workers B: Talented teenagers C: Curious kids D: Learned experts | answer: A </s>

<s>[INST] context: A "secret" message, unseen for almost 150 years and making the start of the U.S. Civil War (1861-1865), has been uncovered in Abraham Lincoln's gold pocket watch, prefix = st1 /U.S.media reported on Wednesday. "Lincolnnever knew of the message he carried in his pocket," Brent D. Glass, director of the National Museum of American History said in a statement. The message, which was engraved by an Irish immigrant and watchmaker named Jonathan Dillon, is dated April 13, 1861, and reads in part: "FortSumpter[sic] was attacked by the rebels" and "thank God we have a government." "It's a personal side of history about an ordinary watchman being inspired to record something for _ ," Glass said. The museum decided to open the watch after being contacted by the watchmaker's great-great-grandson, Doug Stiles, who had received a letter from a in Ireland. It said that the family had found a letter Dillon had written about the purported message in the watch. Then Stiles, a 57 -year-old real estate lawyer in Waukegan,Illinois, searched on the Internet and found a New York Times article from 1906, where Dillon told the story at the age of 84. During the interview, Dillon said that he unscrewed the dial of the watch and wrote on the metal as soon as he heard the news about the first shot of the Civil War. "The first gun is fired. Slavery is dead. Thank God we have a President who at least will try." However, the actual message that the museum found is different from what Dillon recalled. It reads, "Jonathan Dillon, April 13-1861, Fort Sumpter [sic] was attacked by the rebels on the above date J Dillon, April 13 -1861, Washington, thank God we have a government, Jonth Dillon." [/INST] question: Who wrote the message in Abraham Lincoln's pocket watch? | options: A: Lincoln himself B: Brent C: Jonathan Dillon D: Doug Stiles | answer: C </s>

<s>[INST] context: One little miracle has been happening to me recently, and it gives me a special joy. A few months ago, I was telling my daughter, Sally, some stories about my mother. Mydaughter was so young when my mother died that she doesn't remember her well. I told her allI could remember, like how wonderful my mother was and how much she meant to me. One day, Sally was sad because her grandmother was in heaven and she couldn't see her. I explained that though her grandmother was dead, now she was still watching over usand could send us something to let us know she was there. She could be anywhere, even ridinginvisibly on the back of a butterfly . Just after I said this, a butterflyflew down right by us, and we laughed happily. Now many people would say it was just luck that the butterfly flew down at that time. A funnything, however, has happened since then. Every time I go out in any type of weather I seebutterflies. Very often they fly right by my face to get my attention. I always say hi to Mom,send her my love, and thank God for little miracles. Everyone is always looking for some big miracles to come out and save them when they are introuble, but they don't notice the little miracles that happen every day right in front of theireyes. I know what they really are, however. For me little miracles are the best kind. So manylittle miracles happen around me all the time that I know _ are not just luck. ,. [/INST] question: When her grandmother died, Sally was _ . | options: A: at school B: quite young C: in trouble D: not at home | answer: B </s>

<s>[INST] context: What is America's number one sport? Can I still say baseball? You could make that statement 30 years ago,but things have changed.Baseball of course has the richest history of all sports.But with the popularity of basketball and American football,there can now be an argument on which sport is American's number one sport. Basketball really took a turn in the1980's as Magic Johnson and Larry Bird took the NBA to another level.Of course,basketball was already popular and had seen such stars as Jerry West and Dr.J,but the real breakthrough came in the 1980's and from there it really took off with Michael Jordan into the 90's.Basketball has even become very global now as many NBA stars competed in the Olympics and faced no competition.Today,they had better be ready because there are so many talents in other countries and the competition will be stiff. Like basketball,American football has always been a favorite of many sports fans and its popularity has grown widely.The ratings that Super Bowl Sunday brings are amazing.They have even talked about making Super Bowl Sunday a national holiday. In the year 2050,basketball and American football will have history like baseball's rich history and maybe American national sport.They have been trying for years,but it is not going to happen. So what is American's number one sport? To me baseball will always be Americans' hobby--rich in history and many memories for people of all ages.If you have any comments on this subject,do give your opinions. [/INST] question: The most powerful basketball player in l980's is | options: A: Larry Bird B: Michael Jordan C: Jerry West D: Magic Johnson | answer: B </s>

<s>[INST] context: Expressions about water are mostly as common as water itself. The expression "to be in hot water" is one of them. It is a very old expression. Hot water was used five hundred years ago to mean being in trouble. One story says it got that meaning from the custom of throwing extremely hot water down on enemies attacking a castle. That no longer happens. But we still get "in hot water". When we are in hot water, we are in trouble. It can be any kind of trouble, serious or not so serious. A person who breaks a law can be in hot water with the police. A young boy can be in hot water with his mother if he walks in the house with dirty shoes. "Being in deep water" is almost the same as being in hot water. When you are in deep water, you are in a difficult position. Imagine a person who can not swim being thrown in water over his head. You are in deep water when you are facing a problem that you don't have the ability to solve. You can be in deep water, for example, if you invest in stocks without knowing anything about the stock market. "To keep your head above water" is a color1ful expression that means staying out of debt. A company seeks to keep its head above water during economic hard times. A man who loses his job tries to keep his head above water until he finds a new job. "Water over the dam" is another expression about past events. It is something that is finished, and cannot be changed. The expression comes from the idea that water has floated over a dam and cannot be brought back again. When a friend is troubled by a mistake she has made, you might tell her to forget about it. You say it is water over the dam. Another common expression "to hold water" is about the strength or weakness of an idea or opinion that you may be arguing about. It probably comes from a way of testing the condition of a container. If it can hold water, it is strong and has no holes in it. If your argument can hold water, it is strong and does not have any holes; if it does not hold water, then, it is weak and not worth debating. "Throwing cold water" also is an expression that deals with ideas or proposals. For example, you want to buy a new car because the old one has some problems, but your wife throws cold water on the idea because she says a new car costs too much. [/INST] question: Don't cheat in this exam! Or you'll _ if you're caught cheating by the teacher. | options: A: be in hot water B: have to hold water C: be in deep water D: keep your head above water | answer: A </s>

<s>[INST] context: Today I want to introduce a writer Greg Mortenson to you, especially one of his works called Three Cups of Tea. It has been one of the best sellers. Why can it be so popular? Greg Mortenson was born in the state of Minnesota and grew up near Mount Kilimanjaro in Tanzania. Mortenson later became a nurse. He loved to climb K2 in Pakistan, the second highest mountain in the world. One day, he failed to reach the top of K2, and he became separated from his climbing group on the way down. He was very tired, sick and lost. He had no food, water or shelter . Mortenson reached a poor village called Korphe in the Karakoram mountains of Pakistan. The villagers had never seen a foreigner before. They provided food and a place for him. Mortenson became friends with the villagers and he wanted to see their school. But they had no school. He promised to return and build a school for the children of the village. This was not easy. He had to return to the United States, ask people for money, buy materials in Pakistan, send them to the village and build the school. But he finally carried out his promise after more than three years. That first school in Korphe was so successful that he decided to continue building schools in Pakistan and Afghanistan. It _ to be a great act. Three cups of Tea is about many interesting people Mortenson met and the problems he faced. I think he is really wonderful. He should be the pride of his country. [/INST] question: Three Cups of Tea is _ . | options: A: a book B: a kind of drink C: a kind of cup D: a programme | answer: A </s>

<s>[INST] context: Bacillus stearothermophilus Sterilization is generally defined as the process of completely destroying ble microorganisms including structures such as spores. Standandard practice in sterilization process is to include sterility indicator along with the aicles to be sterilized. The use of sterility indicators allows a direct and sensitive approach to test the effectiveness of the sterilization process. Sterility indicators can be biological or chemical. Biological indicators A biological indicator is broadly defined as a characteristic preparation of specific microorganism that provides a defined and stable ressitance to specific sterilization procedures. The biological indicators selected should provide a greater challenge to the sterilization process than the bioburden in or on the product. Microorganisms widely recognized as biological indicators are spore forming bacterias because these organisms are significantly more resistant than the normal. - With the exception of ionizing radiation process, these microorganisms are significantly more resistant than the normal micro flora. A biological indicator can be used to assist in the performance qualification of the sterilization equipment and in the development and establishment of a validated sterilization process for a paicular process. "Biological indicator used in plasma sterilization is Bacillus stearothermophilus". Plasma sterilization Plasma is described as the fouh state of matter (It is neither liquid, gas or solid). it is defined as reactive cloud of ionized atoms, electrons and neutral atomic paicles. In order to generate the plasma for sterilization, matter (for example H202) a gaseous state is exposed to strong electrical or magnetic .field. This is performed in a vaccum so that high temperature are not required. In practice, a hydrogen peroxide solution is dispersed in a vaccum chamber creating a plasma cloud. This result in the generation (ionisation) of a cloud of charged paicles and free radicals that interact with vital cell component. The free radicals generated during this process interacts with vital cell component (mainly nucleic acids and destroy them). Sterilization occurs as a result of the dual phase process of the oxidative propeies of the vapour and plasma. Gas plasma is capable of penetrating medical packaging, is safe to use and the sterilization cycles are easy to control and monitor. The temperature attained in these process is not very high so there is no risk of damage of the instruments as in Heat methods. Biological indicators for various sterilization methods B. stearothernzophilus spores are used to monitor -Steam sterilization - Plasma sterilization (hydrogen peroxide) - Liquid peracetic acid sterilizers [/INST] question: In plasma sterilization control used is aEUR' | options: A: Bacillus subtilis B: Bacillus stearothermophilus C: C. Perfringes D: C. tetani | answer: B </s>

<s>[INST] context: On May 23rd the United States Department of Agriculture will meet to discuss the pressing topic of wild pigs. These beasts, which number 6 million or so, are an increasing bother. At their worst, they can damage crops, spread diseases, attack humans and kill farm animals. And things are getting worse: a study show that they are likely to double in number over the next 3 years. Why is it so hard to control wild pigs? Introduced to America in the 16th century, and related to the wild pigs found in Europe, wild pigs can be found in 75% of all states. No single law exists to control them and regulations differ between states: while in Missouri they can only be shot if met by chance, in Texas hunting is actively encouraged. A "pork chopper" law allows Texan hunters to shoot wild pigs from helicopters, and some people in Louisiana have even built their own pighunting drone . As well as being popular with hunters, wild pigs are cheaper for game raisers to breed than deer. In Michigan and Pennsylvania suggested bans on the private breeding of pigs for hunting have caused quarrels between game raisers and wildlife officials. Wild pigs' double nature----considered pests by farmers, but valued by hunters----makes it hard to pass laws to control them. Two other factors also contribute. Nearly 70% of land in America is privately owned. And it is difficult for lawmakers to impose breeding and hunting laws on private landowners. Secondly, it is hard to define a wild pig. In some states, laws are being introduced to redefine the term "wild animal" to keep out wild pigs. This is good news for those raising pigs for hunting, but less are to those who consider them pests whose number should be limited. Meanwhile, discussions continue over how to deal with this problem. [/INST] question: People are not permitted to hunt wild pigs freely in _ . | options: A: Texas B: Michigan C: Missouri D: Louisiana | answer: C </s>

<s>[INST] context: Thanks for signing up for the 2014 Black Friday Turkey Trot! This email will provide some basics about the race and some great news! First, your race packet is ready and can be picked up at the Fleet Feet Sports Tulsa location you've specified during registration. Hours for pickup. Tuesday, 10 am to 8 pm (Fleet Feet Kings Point) Tuesday, 10 am to 7 pm (Fleet Feet Blue Dome) Wednesday, 10 am to 5 pm (both stores, closing early for Thanksgiving) Packets can also be picked up on the race day at BOK Center, beginning at 8:30 am. Race Start Times 1) 5 mile, 8:30 am 2) 1 mile fun run, 9:30 am Parking There is surface parking to the east of the BOK Center, and some surface parking to the west of the Convention Center. Many lots will be pay-lots. Please pay attention to the signs. We suggest arriving early to find parking. Racing Timing The 5 km run will be timed using the BIB-TAG system. Your race number will have a timing device attached to the back of the race number; don't remove or bend this device. Simply wear the Bib on the front of your body on the outside of your clothing so it is visible and facing forward. You don't need to return the Bib, which is disposable. The Turkey Trot is also a kick-off event for our weekend long "FITNATIC" celebration---we also have a huge number of events and specials all weekend. For more information, please visit _ . See you on Friday. [/INST] question: Where should a runner go to pick up his packet at 8:30 am on Friday? | options: A: Kings Point B: Convention Center C: Blue Dome D: BOK Center | answer: D </s>

<s>[INST] context: • MC cause: Trauma >Spontaneous rupture of Berry aneurysm Clinical Features • Sudden transient loss of consciousness (occurs in nearly half of the patients) • Excruciating severe headache: presenting complaint in 45% of cases (worst headache of patients life) more common upon regaining consciousness when loss of consciousness is associated • Neck stiffness and vomiting: are common associations • Focal neurological deficit: uncommon. • Sudden headache in the absence of focal neurological deficit is the hallmark of aneurysmal rupture. • Associated prodromal symptoms (suggest location of progressively enlarging unruptured aneurysm): −− Third cranial nerve palsy: Aneurysm at junction of PCA and ICA −− Sixth nerve palsy: Aneurysm in cavernous sinus −− Occipital and posterior cervical pain: Inferior cerebellar artery aneurysm −− Pain in or behind the eye: MCA aneurysm Diagnosis • Non contrast CT scan: Investigation of choice (Lumbar puncture is not indicated prior to an imaging procedure) • CSF picture: Hallmark of aneurysmal rupture is blood in CSF (Xanthochromic spinal fluid) [/INST] question: A patient presents with sudden headache and vomiting and unconsciousness. The diagnosis is | options: A: Subarachnoid hemorrhage - B: Intracerebral hemorrhage C: Subdural hemorrhage D: Extradural hemorrhage | answer: A </s>

<s>[INST] context: ANTIVIRAL DRUGS: CLASSI FICATION 1.Anti-Herpes virus Idoxuridine, Acyclovir, Valacyclovir, Famciclovir, Ganciclovir*, Foscarnet* 2 Anti-Retrovirus (a) Nucleoside reverse transcriptase inhibitors (Nis): Zidovudine (AZT), Didanosine, Zalcitabine*, Stavudine, Lamivudine, Abacavir (b) Nonnucleoside reverse transcriptase inhibitors (NNis): Nevirapine, Eirenz, Delavirdine* (c) Protease inhibitors: Ritonavir, Indinavir, Nelfinavir, Saquinavir, Amprenavir*, Lopinavir 3.Anti influenza virus: Amantadine, Rimantadine*,oseltamivir 4. Nonselective antiviral drugs: Ribavirin, Lamivudine, Adefovir dipivoxil, Interferon alpha. * Not yet marketed in India. Oseltamivir (TAMIFLU): This recently developed antiinfluenza virus drug has a broader-spectrum activity covering influenza A (amantadine sensitive as well as resistant), influenza B and an-influenza (bird flu) H5Nl and other strains. It is an ester prodrug that is rapidly and nearly completely hydrolysed during absorption in intestine and by liver to the active form oseltamivir carboxylate. The active metabolite is not fuher metabolized and is excreted by the kidney with a tV! of 6--10 hours. It acts by inhibiting influenza virus neuraminidase enzyme which is needed for release of progeny virions from the infected cell. Spread of the virus in the body is thus checked. Oseltamivir is indicated both for prophylaxis as well as treatment of influenza A, B and bird flu. Staed at the onset of symptoms, it reduces the severity and durationof illness. However, considering the cost, and to preserve its efficacy, use should be restricted to high risk subjects. Dose: therapeutic 75 mg oral BD for 5 days; prophylactic 75 mg OD. Side effects are nausea and abdominal pain due to gastric irritation (reduced by taking the drug with food), headache, diarrhoea, cough and insomnia. Skin reactions have been repoed. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:767,777 [/INST] question: An influenza is treated by: | options: A: Amantadine B: Ribavarin C: Cidofovir D: Oseltamivir | answer: D </s>

<s>[INST] context: Grandpa was a carpenter . One day he was making some boxes for the clothes his church was sending to an orphanage in Egypt. On his way home, he reached into his shirt pocket to find his glasses, but they were gone. He drove back to the church, but his search turned out to be fruitless. Suddenly, he realized what happened. The glasses had slipped out of his pocket and fallen into one of the boxes, which he had nailed shut. His new glasses were heading for Africa! Grandpa had six children and he had paid twenty dollars for the glasses that morning. "It's not fair," he told God as he drove home. "I've been very faithful in giving my time and money to YOUR work." Several months later, the director of the orphanage was on holiday in the United States. He wanted to visit all the churches that helped him in Egypt, so he came to speak on Sunday night at my grandfather's small church in Chicago. "But most of all," he said, "I must thank you for the glasses you sent last year. You see, I had just broken my glasses. Then your boxes arrived. To my surprise, I found a pair of glasses in it and it fit me very well!" The people listened, happy for the amazing glasses, but thought that the man must have confused their church with another. There were no glasses on their list of items to be sent overseas. Sitting quietly in the back, with tears in his eyes, Grandpa realized that God had played a big trick on him. [/INST] question: Where were Grandpa's glasses lost? | options: A: In a church in Egypt B: In the box he made C: On his way home D: At the orphanage | answer: B </s>

<s>[INST] context: With roads and tube lines set to be more crowded than ever this summer, a few people may be tempted to use it as an excuse for a day off. But for employees at data services provider, Interxion, a chaotic commute during the Olympics will _ . That's because, in an effort to keep things from progressing slowly this summer, bosses at the London company are asking staff to sleep at work -- in space pods. Far from sleeping on the job, engineers will be asked to stay behind and sleep in the closed capsules to avoid the rush hour. And while other companies are planning to offer staff the luxury of working from home during the Games, the firm behind the capsules hopes to get more workplaces on board. Podtime, the firm behind the unusual cabins, are describing them as the perfect solution to the Olympics' crowded commute. On their official website they state 'London businesses will be severely affected by the transport problems caused by the Olympics.' Reasonable prices and various pods provide the best solution to this by allowing your staff to stay on site as necessary, in comfort and privacy. Coming in a range of colours, the capsules, made of polycarbonate, sell at anything from PS1,375. The stock models are fitted with either foam mattresses or a standard single mattress as well as a storage shelf, mirror and power points. These types of capsules have been around for years, in hotels, but Interxion is thought to be among the first to have them installed at the workplace. An independent report carried out by Oxford Economics last year estimated that around 450,000 visitors will stay in London while 5.5 million people will visit for at least a day during the Games. This will inevitably mean more cars on the road and greater congestion on the Underground. [/INST] question: Interxion intends to place the space capsules _ . | options: A: in the Olympic stadium B: in the hotels of London C: at the workplace D: at the staff's homes | answer: C </s>

<s>[INST] context: When you buy a T-shirt, or a fur coat in a store, it often carries a label telling who made it or from what store it was bought. Instead, some labels show the dress is famous and it is very expensive, so buyers secretly wish they could be carried forever. On the other hand, buyers who deal with the cheapest products would be pleased to be away with labels _ . However, there is another label more important than the one showing from which store the dress was bought. When a person buys a fur coat, or a jacket from a store, a label telling what the product is made of should be carried to it. The label is required by law. Besides telling what the product on show is made of, the label should be in clear English and be where one can find it easily. The information on the label must be true. The reason for this is that most buyers today aren't expert enough to know exactly what kind of fur or material they are buying. The buyers must believe in the store that sells the products or in what the label says. [/INST] question: The law requires that furs should carry _ . | options: A: clean labels B: clear labels C: no label D: secret labels | answer: B </s>

<s>[INST] context: Benin is one of the smallest African states. It lies in West Africa on the Gulf of Guinea, to the south of Burkina Faso and Niger, between Togo on the west and Nigeria on the east. Benin used to be called Dahomey and was controlled and ruled by France from 1893 to 1960, when it became independent. In 1963 the army general Soglo overthrew the first president Maga. Soglo set up an army government and called himself head of state in 1965, but was overthrown and replaced by a civilian government in 1967. In December 1969 Benin had another change of power with the army again taking over. In May 1970, Maga and two other men set up a new government, with each of them acting as president in turn for two years. However, half a year after Maga turned over power to the second man Ahomadegbe, the three-man government was overthrown by the army once more and General Kerekou became president. In November 1975 Kerekou changed the name of the nation from Dahomey to Benin, Benin being the name of a 17th century kingdom covering the same place. Kerekou also announced that Benin would be a People's Republic based on Marxism-Leninism. [/INST] question: For how long was Benin an independent state before it became a People's Republic? | options: A: 30 years B: 25 years C: 20 years D: 15 years | answer: D </s>

<s>[INST] context: One of the best-loved American writers was William Sydney Porter, or O.Henry. From 1893 he lived with his family in a house in Austin, Texas, which is now a museum. Visitors to Austin can see the house. It was saved from destruction and turned into a museum in1934. The museum is a good way to learn about the interesting life of the American writer. William Porter rented this house in Austin and lived there with his wife Athol and daughter Margaret for about two years. Many objects in the museum belonged to the Porters. Others did not. An important piece in the room is the original photograph over here. It was taken there in the house about 1895. The piano there goes back to the 1860s. His wife took lessons on it when she first moved to Austin. Porter did not start his career as a successful writer. He worked at a farm, land office and bank. He also loved words and writing. The museumm has a special proof of Porter's love of language --- his dictionary. It is said that he had read every word in that dictionary. Later William Porter was forced to leave Austin because he was charged with financial wrongdoing at the bank and lost his job. Because he was afraid of a trail , he left the country secretly. But he returned because his wife was dying. After her death, he faced the trial and became a criminal. He served three and a half years in a prison in Ohio. William Porter would keep his time in prison a secret. But there was one good thing about it. It provided him with time to write. By the time he was freed, he had published 14 stories and became well known as O.Henry. Porter later moved to New York City and found great success there. He published over 180 stories in the last eight years of his life. [/INST] question: What do we know about the piano in the house? | options: A: It was hated by Porter's daughter B: It has a long history of about 150 years C: Porter's wife gave music lessons on it D: Porter usually created music on it | answer: B </s>

<s>[INST] context: There was a Bulgarian boy who was an exchange student in the USA. He lived with an American family. One day, he went to his room in the evening, and did his homework. His host-mom came to him and asked if he would like to go along to the movies. He wanted to go, so he shook his head from side to side, said "Yes". His host-mom did a couple of steps back, and looked puzzled. She thought that he didn't want to go out because he shook his head from side to side. However, he wanted to go out to the movies. Bulgarians shake their heads from side to side when they mean "yes". People in other countries shake their heads from side to side when they mean "no". Gestures can have different meanings according to different cultures. For example, in America, putting your index finger and your thumb in a circle is commonly used as an OK sign that means everything is all right. However, in France, that sign is used to express "nothing" or "zero", which can have a negative meaning. Generally speaking, gestures are a type of communication that uses a part of our body, and when speaking with people from other cultures, gestures can be important keys or clues to understand them. However, we need to understand that those gestures vary from culture to culture, and it is necessary for us to have an open mind in understanding the different gestures. [/INST] question: Why did the Bulgarian boy shake his head from side to side? | options: A: He thought it rude of him to go with the family B: He didn't understand what the host-mom said C: He changed his mind after saying "Yes D: He wanted to go out to the movies | answer: D </s>

<s>[INST] context: The anterior continuation of the cavernous sinus, the superior ophthalmic vein, passes through the superior orbital fissure to enter the orbit. Veins of the face communicate with the superior ophthalmic vein. Because of the absence of valves in emissary veins, venous flow may occur in either direction. Cutaneous infections may be carried into the cavernous sinus and result in a cavernous sinus infection which may lead to an infected cavernous sinus thrombosis. The cavernous sinus is lateral to the pituitary gland and contains poions of cranial nerves III, IV, V1, V2 and VI, and the internal carotid aery.The occipital sinus is at the base of the falx cerebelli in the posterior cranial fossa. It drains into the confluence of sinuses.The sigmoid sinus is the anterior continuation of the transverse sinus in the middle cranial fossa. The sigmoid sinus passes through the jugular foramen and drains into the internal jugular vein.The superior petrosal sinus is at the apex of the petrous poion of the temporal bone and is a posterior continuation of the cavernous sinus. The superior petrosal sinus connects the cavernous sinus with the sigmoid sinus. [/INST] question: A 46 year old man sustains a spider bite on his upper eyelid, and an infection develops. The physician is very concerned about spread of the infection to the dural venous sinuses of the brain emissary veins. With which of the following dural venous sinuses does the superior ophthalmic vein directly communicate? | options: A: Cavernous sinus B: Occipital sinus C: Sigmoid sinus D: Superior petrosal sinus | answer: A </s>

<s>[INST] context: ERYTHROMYCIN It was isolated from Streptomyces erythreus in 1952. Since then it has been widely employed, mainly as alternative to penicillin. Water solubility of erythromycin is limited, and the solution remains stable only when kept in cold. A . As an alternative to penicillin 1 . Streptococcal pharyngitis, tonsillitis, mastoiditis and community acquired respiratory infections caused by pneumococci and H. influenzae respond equally well to erythromycin. It is an alternative drug for prophylaxis of rheumatic fever and SABE. However, many bacteria resistant to penicillin are also resistant to erythromycin. 2. Diphtheria: acute stage as well as for carriers-7 day treatment. Some prefer it over penicillin. Antitoxin is the primary treatment. 3. Tetanus: as an adjuvant to antitoxin, toxoid therapy. 4. Syphilis and gonorrhoea: only if other alternative drugs, including tetracyclines also cannot be used: relapse rates are higher. 5. Leptospirosis: 250 mg 6 hourly for 7 days in patients allergic to penicillins. B. As a first choice drug for 1 . Atypical pneumonia caused by Mycoplasma pneumoniae: rate of recovery is hastened. 2. Whooping cough: a 1-2 week course of erythromycin is the most effective treatment for eradicating B. peussis from upper respiratory tract. However, effect on the symptoms depends on the stage of disease when treatment is staed. (a) Prophylactic: during the 10 day incubation period-disease is prevented (b) Catarrhal stage: which lasts for about a week-erythromycin may abo the next stage or reduce its duration and severity. (c) Paroxysmal stage: lasting 2-4 weeks-no effect on the duration and severity of &;croup&; despite eradication of the causative organism. (d) Convalescent stage: during which &;croup&; gradually resolves (4-12 weeks)-is not modified. 3. Chancroid : erythromycin 2 g/ day for 7 days is one of the drugs of choice, as effective as azithromycin or ceftriaxone. C. As a second choice drug in 1 . Campylobacter enteritis: duration of diarrhoea and presence of organisms in stools is reduced. However, fluoroquinolones are superior. 2. Legionnaires&; pneumonia: 3 week erythromycin treatment is effective, but azithromycin/ ciprofloxacin are preferred. 3. Chlamydia trachomatis infection of urogenital tract: erythromycin 500 mg 6 hourly for 7 days is an effective alternative to single dose azithro mycin. 4. Penicillin-resistant Staphylococcal infections: its value has reduced due to emergence of erythromycin resistance as well. It is not effective against MRSA. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:728,729 [/INST] question: Drug of choice in peussis is: | options: A: Penicillin B: Doxycycline C: Erythromycin D: Ciprofloxacin | answer: C </s>

<s>[INST] context: The assessment of a child for the absence or presence of Heart disease can be done with the help of some guidelines suggested by NADA and are called NADA's criteria. NADA's Criteria Either one major or two minor criteria are necessary for indicating the presence of heart disease. A) Major Criteria 1) Systolic murmur of grade III or more. The systolic murmur is classified into : - Ejection systolic murmur Pansystolic murmur Pansystolic murmur is always abnormal no matter what is its intesity. Only three lesions produce pansystolic murmur           i) VSD                          ii) MR                        iii) TR Ejection systolic murmur, on the other hand, may be organic or functional.  an If ejection systolic murmur is associated with thrill, it is always organic. If ejection systolic murmur is more than grade III intensity → It is organic. Grade III or less ejection systolic murmur of a functional type may be heard in anemia or high fever in otherwise normal children. 2) Diastolic murmur Presence of diastolic murmur always indicates the presence of organic heart disease. There are two exceptions. Severe hypertension → Reduction of BP may cause an AR murmur to disappear. Anemia → May result in delayed diastolic murmur across the tricuspid and mitral area. 3) Cyanosis Central cyanosis indicates the presence of heart disease if lung disease has been excluded. 4) CHF Presence of CHF indicates the presence of heart disease except in neonates and infants who get CHF from causes such as hypoglycemia and anemia. B) Minor criteria Systolic murmur less than grade III in intensity. Abnormal second heart sound Abnormal S2 always indicates the presence of heart disease. It has been included as a minor criterion only because auscultation is an individual and subjective finding 3) Abnormal ECG The main value of ECG lies in determining the : - Mean QRS axis Right or left atrial hypertrophy Right or left ventricular hypertrophy 4) Abnormal X-ray  If there is cardiomegaly in a good inspiratory film, it is highly suggestive for the presence of heart disease. 5) Abnormal BP [/INST] question: NADA's criteria are used for – | options: A: Assessment of child for degree of dehydration B: Assessment of child for degree of malnutrition C: Assessment of child for presence of heart disease D: Assessment of child for degree of mental retardation | answer: C </s>

<s>[INST] context: Clean your ears, because airport security might soon be scanning them. According to a recent discovery, the shape of ears could provide a reliable new way of identifying people at airports. Researchers discovered that ears of each person have a unique shape and they have created a system that can scan them. The ear scanning technique uses a technology called image ray transform that highlights all the tubular structures of the ear and measures them. Professor Mark Nixon, a computer scientist who led the team from the University of Southampton, believes ear scanning could take place as passengers walk through security gates, for example, by placing cameras on either side to record an image of their ears. Comparing the results against a database of ear shapes, the new system could help airport security workers instantly identify passengers. Nixon and his team tested 252 images of different ears and found the system was able to match each ear to a separate image held in its database with 99 percent accuracy. Besides ear scanning, there have been other systems developed for identity recognition. "With facial recognition, the systems are often confused by crows feet and other signs of ageing," Nixon said. "Your ears, however, age very gracefully. They grow proportionally and your lobe gets a bit larger, but otherwise your ears are fully formed from birth." What's more, facial recognition software is often confused by changes in expression so people need to control their faces and in some cases even avoid wearing make-up. An ear scan system would also offer a less _ alternative toretina scanning, which requires passengers to stare at scanners from a close range. Fingertip detection has long been the most effective way of identifying someone. Nixon expects there to be a combination of different techniques that can be used at the same time to identify a person." [/INST] question: The ear scanning system would help to find out _ . | options: A: where you come from B: whether you are healthy C: who you are D: who shares your ear shape | answer: C </s>

<s>[INST] context: Try this: for a whole day, _ . Eat when you're hungry and sleep when you're tired. What do you think will happen? You may be surprised to find that your day is much like most other days. You'll probably get hungry when you normally eat and tired when you normally sleep. Even though you don't know what time it is, your body does. Inside our bodies are several clocklike systems that follow a 24- hour cycle. Everyone is unique, which is why you might like to stay up late while your sister always wants to go to bed early. Regularly staying up late can make kids do worse on tests and quizzes. And working shifts at night leads to higher rates of heart disease. "There is a growing sense that when we eat and when we sleep are important parts of how healthy we are," says Steven Shea, Director of the Sleep Disorders Research Program at Brigham and Women's Hospital in Boston. "During the night, we are prepared to sleep," Shea says. "During the day, we are prepared to eat and move around, If you reverse ( ) what you are doing, everything is out of phase. That can have adverse consequences. [/INST] question: What makes some like to stay up late while others go to bed early? | options: A: our bodies B: our minds C: the clock D: our unique system | answer: D </s>

<s>[INST] context: Paracutin was born in Mexico in February, 1943. At the end of one week Paracutin was 500 feet high, and it is now over 9,000 feet high. Today Paracutin is asleep. What is Paracutin? It was the first volcano in the world which was seen from its birth right up to the present day. On February 20, 1943, a peasant and his wife set out to work in their corn fields from the Mexican village of Paracutin. They were surprised to find the earth warm under their feet. Suddenly they heard noises deep in the earth and a small hole appeared in their field. In the afternoon there was a sudden loud noise and stones were thrown high in the air. The peasants ran from the field and turned to watch. They saw the birth of a volcano. Large quantities of stone and lava broke out and a little hill began to form. By evening this hill was 100 feet high and hot ashes were falling on the village. At night the strong light of the hot lava lit up the countryside. The trees near the village were killed and the villagers had to leave their houses. When the village was destroyed, its name was given to the volcano. The news quickly reached Mexico City, far to the east. Many people came to watch the scene. The volcano grew and grew for ten years and hundreds of square miles of forest were destroyed. Then Paracutin went to sleep. [/INST] question: Paracutin was once the name of _ . | options: A: a peasant B: a village C: an old mountain D: a Mexican | answer: B </s>

<s>[INST] context: Emergency Contraceptives Drug Dose Levonorgestrel (POP) 1 dose 1.5 mg within 72 hrs Copper IUDs ( NOT THE DOC ! ) Inseion within 5 days Ulipristal acetate (SPRM) 30 mg orally within 120 hours Ethinyl estradiol 50 ug + Norgestrel 0.25 mg (COC) 2 tab stat and 2 after 12 hour Mifepristone RU 486 (PA) 25 to 100 mg single dose ICUDs are the most effective methods, no doubt, but they can never be the DOC. Thats because they require seeing a gynecologist take a prescription and then a specialist to inse the device. Emergency contraception is based on the principle of 'over the counter' easy to use medication to prevent a pregnancy and when there is unplanned intercourse, which can happen many times in a year, a person cannot be expected to take an IUCD every time! However, a LNG tablet can be easily, and effectively, be taken whenever there is unplanned intercourse * Please note: We are in the early pa of year 2020 now. Mifepristone or Ullipristal may be soon termed as the best drugs for EC. Please be on the look out for recent updates. [/INST] question: When used for emergency contraception, What is the dose of ulipristal acetate? | options: A: 300mg B: 30mg C: 300ug D: 30ug | answer: B </s>

<s>[INST] context: Mrs. Thompson stood in front of her 5th grade class on the first day of school. She found a boy sleeping in his seat. He was Teddy. Also Thompson noticed the boy didn't play well with the other children. It got to the point "F" at the top of his papers. Mrs. Thompson reviewed each child's past records. However, when she reviewed Teddy's file , she was in a surprise. Teddy's first grade teacher wrote, "Teddy is a bright child. He does his work neatly and has good manners..." His second grade teacher wrote, "Teddy is an excellent student, but he is troubled because his mother has an illness and life at home is difficult." His third grade teacher wrote, "His mother's death had been hard on him. He tries his best, but his father doesn't show much interest in his study..." Teddy's fourth grade teacher wrote, "Teddy is _ and doesn't talk with other's. Also he doesn't show much interest in school. He doesn't have many friends and he sometimes sleeps in class." By now, Mrs. Thompson realized the problem. She felt even worse when her students brought her Christmas presents wrapped in beautiful and bright paper, except for Teddy's. He sent a rhinestone bracelet with some stones missing. But Mrs. Thompson told him with a smile, "I like it very much." After school Teddy said, "Mrs. Thompson, today you smell just like my Mother used to be." Mrs. Thompson paid particular attention to Teddy. The more she encouraged him, the faster he responded. By the end of the year, Teddy had become one of the smartest children in the class. Teddy became one of her "teacher's pets." ,. [/INST] question: Teddy is a _ student when Mrs. Thompson first taught him. | options: A: naughty B: good C: sick D: troubled | answer: D </s>

<s>[INST] context: Marco Polo was from Venice, Italy. In 1271, at age 17, Marco went on a trip with his father and uncle to China. Today people often travel to different places around the world. But it was very hard for people from Europe to visit China then. After three and a half years, the Polos reached China on 1275. While he was there, Marco Polo worked for Kublai Khan, the emperor of China. He was able to learn and experience many things that were new to Europeans. In his diary, he wrote, "Kublai Khan's palace is the greatest I've ever seen. The streets of the new capital. Daidu, are so straight and so wide." Paper money also took him by surprise, since it was not yet in use in the West at that time. Homes were heated with "black stones... which burn like wood." These stones were coal, and most of the Europeans knew little about it then. After 17 years in China, Marco and his family finally returned to Venice in 1292. After he returned home, Marco completed a book about his trip, full of facts about his wonderful experiences in China. [/INST] question: How was Marco Polo's three-and-a-half-year journey to China? | options: A: Expensive B: Comfortable C: Difficult D: Smooth | answer: C </s>

<s>[INST] context: When the plane was waiting at the airport,a big snake climbed up the steps and into the plane. It went to sleep under the pilot's seat. Nobody noticed. Soon the passengers get on the plane and it took off. A little girl called Mary took out a whistle and began playing. But none of the passengers liked the music. They got the stewardess to ask the girl to stop. The sound of the plane's engines woke up the snake. It put its head out and looked around the captain's room. When the captain saw the snake, he was so frightened that he could hardly breath. He was so afraid that he could not control the plane. The plane began to swing from side to side. The stewardess told the passengers what was happening and ask them to calm down. Mary was not afraid. She ran to the captain's room with her whistle and began to play the slow tune . At once the snake followed her. The girl returned to her seat and the snake lay on the floor beside her. Dancing to the music. When the plane landed the airport the snake was taken in a net to a zoo near Mary's house. She often went to visit the snake. [/INST] question: _ saw the snake climb into the plane. | options: A: Somebody B: Nobody C: Anybody D: Everybody | answer: B </s>

<s>[INST] context: Refer Robbins page no 915By light microscopy the glomeruli either appear normal in the early stages of the disease or exhibit uniform, diffuse thick- ening of the glomerular capillary wall (Fig. 20-12A). By electron microscopy the thickening is seen to be caused by irregular electron dense also deposits containing immune com- plexes between the basement membrane and the overlying epithelial cells, with effacement of podocyte foot processes (Fig. 20-12B and D). Basement membrane material is laid down between these deposits, appearing as irregular spikes protrud- ing from the GBM. These spikes are best seen by silver stains, which color the basement membrane, but not the deposits, black. In time, these spikes thicken to produce domelike protru- sions and eventually close over the immune deposits, burying them within a markedly thickened, irregular membrane. Immunofluorescence microscopy demonstrates that the granu- lar deposits contain both immunoglobulins and complement (Fig. 20-12C). As the disease advances segmental sclerosis may occur; in the course of time glomeruli may become totally sclerosed. The epithelial cells of the proximal tubules contain protein reabsorption droplets, and there may be consider [/INST] question: On electron microscopy in most of the cases characteic slpiiting of GBM with subepithelial deposits in few cases is seen in | options: A: RPGN B: Membranous nephropathy C: FSGS D: Minimal change disease | 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: Avascular necrosis is not uncommon. 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: Henoch-Schonlein purpura Henoch-Schonlein purpura also referred to as anaphylactoid purpura, is a small-vessel vasculitis characterized by palpable purpura (most commonly distributed over the buttocks and lower extremities), arthralgias, gastrointestinal signs and symptoms, and glomerulonephritis. Clinical features It is seen pediatric patients having palpable purpura. Most patients develop polyarthralgias in the absence of frank arthritis. Gastrointestinal involvement is seen in almost 70% of pediatric patients. It is characterized by colicky abdominal pain usually associated with nausea, vomiting, diarrhea, or constipation and is frequently accompanied by the passage of blood and mucus per rectum; bowel intussusception may occur. Renal involvement occurs in 10-50% of patients and is usually characterized by mild glomerulonephritis leading to proteinuria and microscopic hematuria, with red blood cell casts in the majority of patients; it usually resolves spontaneously without therapy. Rarely, a progressive glomerulonephritis will develop [/INST] question: A 5-year-old female presents with palpable purpura over the buttocks, arthralgias, abdominal pain with diarrhoea with passage of blood per rectum. The patient also has the presence of proteinuria. What is the most probable diagnosis - | options: A: Nephrotic syndrome B: Nephritic syndrome C: Henoch-Schonlein purpura D: Thalassemia | answer: C </s>

<s>[INST] context: Like most cultures around the world, the Zulu people of Africa tell stories that have animals as heroes. These stories are meant to have fun, but they are also used to teach important lessons to children. This is one of those stories. One hot afternoon, Jackal was walking along the rocky road sniffing the ground. He was hoping to smell a mouse or a lizard , or something else that would be good to eat. He was so much lost in sniffing that he wasn't really paying attention to what was around himself. Suddenly, Jackal looked up to see his neighbor, Lion, walking straight toward him. He did not have enough time to run way. Jackal had played many tricks on Lion over the years, so he knew he would be in trouble if he was caught. Jackal needed to think of something quickly. "Help! Help!" cried Jackal as he quickly jumped upon a large rock hanging over the road. "The rocks are falling down, and I can't hold them much longer. We shall both be crushed if you do not do your best to hold these rocks back, Lion" At once, Lion pushed his strong shoulder against the rocks to keep them from moving any further. "I'll just run over here to get something to stop the rocks." shouted Jackal as he ran way to safety. Lion stayed _ against the unmoving rocks for quite a long time before he realized that Jackal had tricked him yet again! [/INST] question: Why was Jackal sniffing the ground? | options: A: To play with Lion B: To push a rock C: To run after a mouse D: To look for something to eat | answer: D </s>

<s>[INST] context: On March 19, Malala Yousafzai, a 15-year-old Pakistani student and women's education activist, returned to the classroom for the first time since being violently attacked by a member of the Taliban--a terrorist organization-- on October 9, 2012. Malala was shot on her way home from school in Mingora, Pakistan. A Taliban group took responsibility for the attack, saying the attack should serve as a warning to others. Members of the group follow a strict version of the local religion and believe girls should not go to school. Malala was targeted because she is appealing for girls' rights to education in Swat Valley, Pakistan. Malala recovers from the attack at Queen Elizabeth Hospital in Birmingham, England. After a long period of recovery, Malala is starting as a ninth-year student at Edgbaston High School. It is the oldest independent girl school in Birmingham, England. Though she has no concrete plans to return to Pakistan, Malala still speaks out as a voice for change in her country, and everywhere. "I am excited that today I have achieved my dream of going back to school. I want all girls in the world to have this basic opportunity," Malala said in a statement. "I miss my classmates from Pakistan very much but I am looking forward to meeting my teachers and making new friends here in Birmingham." Malala has been an Internet blogger, or writer, since she was 11 years old. In 2011 she was awarded Pakistan's National Peace Award for her bravery in writing about the difficulties of life and education in the shadow of the Taliban. She has spoken publicly about children's rights and been nominated for an international children's peace prize. After the attack in 2012, support for Malala poured in from around the world. The United Nations declared November 10 Malala Day. Former British Prime Minister Gordon Brown said the day honors Malala and shows the world that people of all sexes, all backgrounds and all countries stand behind the heroine . [/INST] question: Malala was violently attacked by the Taliban when _ . | options: A: serving as a warner B: going home after school C: staying in classroom D: playing at home | answer: B </s>

<s>[INST] context: The US will have a new president this fall. Voters will decide between the Democratic candidate , Hillary Clinton, and Donald Trump of the Republicans. But the voting is not a must for each person in the US. So quite a lot of people choose not to vote, especially the young generation. According to Fox News, one-in-five young voters between the ages of 18 and 35 said clearly that they wouldn't vote for either of the two candidates. Just 12 percent of voters aged 35-54, and only nine percent of voters aged 55 and older said the same thing. This is not only because young people don't like Clinton or Trump, according to theFortunemagazine. The truth is that they are traditionally less likely to vote than their parents. "Young people are not at an age in their life when they think politics or government has anything to do with them," said Rodd Freitag, a political science professor at the University of Wisconsin-Eau Claire, US. "But for the older age groups, they have a home, they pay taxes , they care about schools and the community." Many believe that the civic education of an American youth is another reason why they don't vote. Students usually just do community services like cleaning the neighborhoods. This means they haven't learned how to link real life problems to politics through voting, according to Christopher Beem, a politics professor at the Pennsylvania State University. He said the country needs to help young people learn how to take part in politics and get them to see that they can make a difference. [/INST] question: What percentage of young voters wouldn't go to vote? | options: A: 9 percent B: 12 percent C: 20 percent D: 55 percent | answer: C </s>

<s>[INST] context: Many years ago, there was an old man who had four sons. He wanted his sons to learn not to judge things too quickly. So he told them to go and look at a pear tree. It was far away from his home. The first son went in winter, the second in spring, the third in summer, and the youngest son in autumn. When the sons came back, the old man asked them to say what they had seen. The first son complained the tree was ugly. The second son said the tree was covered with buds and full of hope. The third son said the tree was full of green leaves. They looked so beautiful, and it was the most wonderful thing he had ever seen. The youngest son said that the tree was bowed down with heavy fruits. It was full of life and fulfillment . The man explained that all of his sons were right, but each of them had seen just one season of the tree. He told them that they couldn't judge a tree or a person by only one season. "If you give up when it's winter, you will miss the hope of your spring, the beauty of your summer, and the fulfillment of your autumn." said the old man. It is true that we shouldn't let the hard season break the happiness of the other seasons. Never give up during the difficult days and better times are sure to come some day. [/INST] question: In which season did the fourth son go and look at a pear tree? | options: A: Spring B: Summer C: Autumn D: Winter | answer: C </s>

<s>[INST] context: Trip 1 One Week in The Mountains Bring your strong shoes and warm clothes for this walk in a beautiful area of the Green Mountains. You may go hiking or have a try of rock climbing. This is also a protection area for wild animals. You can find many kinds of animals living in this area. Time: May 8--May 14 Tel: 64639818 Adult : $1l0.00 Child: $55.00 Trip 2 Three Days In The Country There are many beautiful gardens. Take your camera and enjoy the wonderful sight in Hunter Valley. It is a good place for fishing and horse riding. You can also find different kinds of flowers here. This is also a great walk for bird-lovers. Time: May 20--May 22 Tel: 63986432 Adult $50:00 Child: $25.00 Trip 3 Flashlight Adventure Put on your warm clothes, bring a flashlight and come for a night walk along the Dungog Valley. It is a trip full of adventure . A guide will lead the tour. Many of the plants you will see on this trip can only be seen at night. Time: May 16--May 18 Tel: 63875629 Adult: $30.00 Not for children Trip 4 Five Days By The Sea Wear your sun hat and enjoy wonderful sunshine all the time from morning to evening. Our hotel is next to the sea. We have our own boats too. You can swim in the sea or in the swimming pool. Every day our boat will take you to different places for swimming. Time: May 23--May 27 Tel: 67538293 Adult: $80.00 Child: $40.00 ,. [/INST] question: What number may you call if you and your friends want to enjoy the sunshine at the seaside? | options: A: 67538293 B: 63986432 C: 64639818 D: 63875629 | answer: A </s>

<s>[INST] context: It remains a curiosity and a bit of a historical mystery why we don't all drive on the same side of the road. The fact is that most people are right-handed; that's why, for much of history, drivers have stuck to the left. Ancient Romans using two-wheeled carriages are believed to have held the reins with their right hands and a whip with their left; to avoid whipping the near drivers, they favored the left-hand side the road. It's also easier for right-handers to get on a horse from the left, so riders were attracted to that side to avoid the near traffic as they climbed on and off. Finally, knights and the other drivers favored the left so they could do battle, if necessary, with their good hand. So why does most of the world travel on the right side today? Theories differ, but there's no doubt Napoleon was a major influence. The French have used the right since the late 18th century. Some say that before the French Revolution, people in upper class drove their carriages on the left, forcing the _ to the right. During the violence, fearful rich people sought to mix with the peasantry by traveling on the right as well. Regardless of the origin, Napoleon brought right-hand traffic to the nations he conquered, including Russia, Switzerland and Germany. Hitler, in turn, ordered right-hand traffic in Czechoslovakia and Austria in the 1930s. Nations that escaped right-handed conquest, like Great Britain, kept their left-handed tradition. [/INST] question: Who had a major effect on "keep-right" traffic law? | options: A: Ancient Romans B: Hitler C: Napoleon D: Austrians | answer: C </s>

<s>[INST] context: Single-agent chemotherapy is used as palliative therapy in head and neck cancers with the recurrent or metastatic form of cancer. The drugs which are used are - Cisplatin Methotrexate 5 Fu Paclitaxel Docetaxel Sometimes combinations of these drugs are used . a) Treatment of localized head and neck cancers - These tumors are treated with curative intent either with surgery or radiotherapy. The choice of modality differs according to anatomic location and institutional expeise. In early laryngeal cancer generally, radiotherapy is done to preserve voice while in early oral cavity cancers, surgery is preferred to avoid the long-term complication of radiation such as xerostomia and dental decay. b) Locally or advanced regional disease - Combined modality therapy including surgery, radiation therapy, and chemotherapy is used. Concomitant chemotherapy and radiotherapy appear to be most effective. c) Recurrent or metastatic disease - chemotherapy is used. Management of neck lymph nodes The neck lymph nodes should be treated when there are clinically positive nodes or the risk for occult disease is high based on the location and stage of the primary lesion. The decision to perform neck dissection or irradiate the neck is related to the treatment of the primary lesion. If the primary tumor is being treated with radiation and the neck is N0 or N1, the nodes are usually treated with irradiation. For surgically treated primary lesions, N0 or N1 neck disease may be treated surgically as well (Radical neck dissection/Modified neck dissection/Selective neck dissection). Negative prognostic factors such as extracapsular spread of tumor, perineural invasion, vascular invasion, fixation to surrounding structures, and multiple positive nodes are indicators for postoperative adjuvant radiation therapy. For N2 or N3 neck disease, neck dissection with planned postoperative radiation therapy is performed. [/INST] question: In carcinoma cheek what is the best drug for single drug chemotherapy | options: A: Cyclophosphamide B: Vincristine C: Danorubicin D: Cisplatin | answer: D </s>

<s>[INST] context: Although Americans are well known for getting down to business, Indians working in overseas teams, MNCs, and BPOs should know the importance of small talk. While Indians have a true interest in talking to Americans and getting to know them, they also hesitate to do so for some reasons. Americans engage in less personal small talk than Indians. And the topics and questions used in English vary widely based on language differences and cultural differences. Here are three things to keep in mind while you are trying to make small talk with your American clients and colleagues. Amencans love to ask about, and then complain about the weather. They may talk about how the weather prevented them from having fun or how the weather supported their outdoor events. You can talk about the weather with them to begin a conversation. While talking, they always try to follow up on their answer by asking another open-ended question or make a statement, such as "Wow, that sounds like fun ! " or "You went to St. Louis. In which state is that?" Be creative in your questions. Feel free to ask one or two, but not very personal ones about relations. Stick to the facts or events that were already referred to. Sometimes, some words used in India will totally confuse an American. For example, Americans use the word "weekend" instead of "holiday" for Saturdays and Sundays ( non-working days) , and use the word " vacation" or " days off" instead of " out-of-station" . Always be interested, optimistic and happy. Talk with a smile! Vary the sound of your voice. Do not sound like a computer. If you are unsure how you sound, a good tip is to record yourself and listen to it later. Doing this helps you know how your voice sounds, and if you don't sound as you want to be heard, it may be time to work on _ your voice. [/INST] question: For Indians, having small talk with American colleagues is _ . | options: A: boring B: useless C: important D: interesting | answer: C </s>

<s>[INST] context: All over the world mothers and fathers teach their children manners. Other children may have manners that are not like yours. There are all kinds of manners. Many years ago, children who had good manners were seen and not heard. They kept quite quiet if grown-ups were talking. Today, well-mannered children have more freedom. Sometimes good manners in one place are bad manners in other places. Suppose you are a visitor in the land of Mongolia. Some friends ask you to eat with them. What kind of manners do they want you to have? They want you to give a loud "burp" after you finish eating. Burping would show that you liked your food. In some countries, if you give a loud burp, you are told to say "excuse me, please." In many places people like to eat together. But in some parts of Polynesia it is bad manners to be seen eating at all. People show good manners by turning their backs on others while they eat. What are manners like in an East African town? The people try not to see you. They are being polite. You may see a friend. He may not see you at all. If you are polite, you will sit down beside him. You will wait until he finishes what he is doing. Then he will talk to you. Suppose you visit a friend in Arabia. You should walk behind the other tents until you come to his tent. If you pass in front of the other tents, you will be asked into each one. The people will ask you to eat with them. And it is bad manners if you say no. Manners are different all over the world. But it is good to know that all manners begin in the same way. People needed ways to show that they wanted to be friends. [/INST] question: People turn their backs on others while they eat in _ . | options: A: Mongolia B: an East African town C: some parts of Polynesia D: Arabia | answer: C </s>

<s>[INST] context: Analysis of the composition of quicksand shows that there are four key ingredients--sand, obviously water, clay and salt. Together these materials form a structure resembling a house of cards, with large water-filled gaps between the sand particles, which are loosely glued in place by the clay. As long as it's left alone, the structure remains stable. But as soon as it's disturbed, by stepping on it, the clay changes from a jelly-like consistency to a runny liquid. The effect is the same as stirring a pot of yoghurt. Liquefying the clay makes the quicksand about one million times runnier, and the whole house of cards comes tumbling down, with you inside it. Very quickly, the sand sinks to the bottom and the water floats to the top. This is where the salt comes in. When there's enough salt present, as soon as the clay particles liquefy, electrical charges make them begin to stick together to form bigger particles and these also settle with the sand. Quicksand is a mixture which looks like solid, but behaves more like a liquid. Despite its murderous reputation, quicksand does not such people under and swallow them, although it can hold a person in firm grip. The human body is more buoyant in quicksand than in water, and sooner or later anyone trapped in it will float. Unlike most liquids, quicksand's viscosity, or "runniness" can suddenly change if it comes under pressure, for example under a human foot. The surface gives way and the victim quickly sinks in up to the knees, surrounded by an area of dirty things that turns semi-solid around its victim. Escaping from the quicksand's grip requires a large amount of force. Without something solid to pull at, people often find they are stuck fast. Pulling at one leg simply makes the other one sink further. So how do you escape from quicksand's control? Stay still and call for help. Staying still stops you sinking any further, until--with luck--help arrives on the scene. If no one appears and you need to draw yourself out, gently lie down on your back until your body is floating on the sand. Next, roll over onto your stomach and pull yourself forwards with your hands, so that you gradually "swim" towards firmer ground. It is a slow and dirty business, but it works. This technique has one barrier: it goes against a very powerful human nature. Faced with danger in the open, nine out of ten stay on their feet so that they can run away, in which case it can worsen the situation. [/INST] question: Which ingredient of the quicksand make someone trapped in it stuck and stuck fast? | options: A: Sand B: Clay C: Water D: Salt | answer: B </s>

<s>[INST] context: bcl-2 inhibits apoptosis; a (14;18) translocation resulting in overexpression of the bcl-2 protein in B lymphocytes causes apoptosis of neoplastic cells to be permanently inhibited, producing follicular lymphoma. Follicular lymphoma involves the lymph nodes and bone marrow of older people and is characterized by slow, but relentless, growth. Thus, this lymphoma allows a long survival even without any treatment. Indeed, follicular lymphoma is resistant to aggressive therapy because of its low mitotic activity. Acute lymphoblastic leukemia (ALL) is a neoplasm of pre-B cells that affects children. Different molecular mechanisms probably account for different cases. Hyperdiploidy, the Philadelphia chromosome, t(12;21), and t(4;11) are variably found in patients with ALL. Burkitt lymphoma occurs in different clinical settings, including the African endemic, sporadic non endemic, and AIDS-associated forms. Histologically, all these forms are identical and are derived from neoplastic transformation of B cells expressing surface IgM. Common to all forms are translocations involving the c-myc oncogene (chromosome 8) and Ig loci (chromosome 14). These translocations lead to overexpression of c-myc, which encodes a nuclear transcription protein, resulting in sustained cell replication. The African form is associated with Epstein-Barr virus infection. Multiple myeloma is a neoplasm of terminally differentiated B lymphocytes that secrete large amounts of monoclonal Ig or its fragments (light or heavy chains). Approximately 25% of cases have translocations that lead to overexpression of FGFR3, a receptor for fibroblast growth factor implicated in control of cell proliferation. [/INST] question: Which of the following conditions is associated with overexpression of bcl-2? | options: A: Acute lymphoblastic leukemia B: Burkitt lymphoma C: Follicular lymphoma D: Multiple myeloma | answer: C </s>

<s>[INST] context: Dear Victor, I have received your loving letter from school and I am glad to know that you are becoming responsible enough to decide on your career . You are now in the final year of high school and are going to start further education in college. You know that we belong to different times, and my social life is different from yours. However, all I can say as advice is that you must choose a career wisely. The first consideration is your interest. You can only succeed and feel happy when you do something you enjoy. You must get a job which not only provides you with something useful, but also you are pleased with. Then, you must read a lot in the field you are aiming at. Also, you should get to know the men and women who work in that field, when mind and heart work together, success is _ . No career is more or less important. I think your interest may be in the field of making TV programmes. Your good communication skills, your taking an active part in school plays and the prizes you have won in speech competitions all lead you to that direction. So a career in Mass Communication and TV film production will bring luck to you. If you succeed in that field, you will become famous and rich. Think a thousand times before making any final decision about your career. After all, we want you to be a man of success. We all know that you are old enough to think for yourself. With all the best wishes ! Your loving father [/INST] question: We can infer that Victor wrote a letter to ask for advice on how to _ . | options: A: get good marks B: choose a career C: prepare for a competition D: communicate with others | answer: B </s>

<s>[INST] context: Good manners are important, but you can easily make a social blunder when you visit a foreign country, because sometimes good manners in one place are bad manners in other places. Suppose you visit some friends in Mongolia and they ask you to eat with them. What kind of manners do they want you to have? They want you to give a loud "burp" after you finish eating. Burping shows that you like your food. But in some other countries, if you give a loud "burp", you are supposed to say, "Excuse me, please." In many places people like to eat together. But in some parts of Polynesia it is bad manners to be seen eating together. People show their good manners by turning their backs on others while they eat. What are manners like in an East African town? The people try not to see you. When you are visiting a friend, he may not see you at all. If you are polite, you will sit down beside him. You will wait until he finishes what he is doing. Then he will talk to you. If you visit a friend in Arabia you should walk behind other tents until you come to his tent. If you pass in front of other tents, you will be asked into each one. The people will ask you to eat with them. And it is bad manners if you say no. Manners are different all over the world. But it is good to know that all manners help people show that they want to be friends. [/INST] question: People turn their backs to others while they eat in some places in _ . | options: A: Mongolia B: an East African town C: Polynesia D: Arabia | answer: C </s>

<s>[INST] context: How many men do housework? Recently a European commission tried to find out people's ideas and reactions to the women's movement. As part of their survey , they asked many men and women the question, "Who does the housework?" The men answered very differently from the women! The housework they asked people about was: preparing meals, washing dishes, cleaning the house and babysitting. 48% of British husbands said they did these things. 37% of Danish men helped in the house. But only 15% of Italian men said they did the housework; many of them said they never helped at all! But there was an interesting point of view from the wives. According to British wives, only 38% of their husbands helped in the house. And Italian wives said that their husbands hardly ever helped. The Italian and British men did not tell the truth! The Commission found that Danish men were the most truthful husbands; their answers were the same as their wives' answers. Do the men you know help in the house? Do you think the survey gives a true picture in your experience? Write and tell us what you think. [/INST] question: The survey was carried out in _ . | options: A: Britain B: Italy C: Denmark D: Europe | answer: D </s>

<s>[INST] context: Colovesical fistulaA colovesical fistula is the presence of a communication between the lumen of the CausesDiveiculitis:Crohn&;s disease: ~ 10%RadiotherapyTraumaClinical presentationRadiographic featuresIn most instances, the diagnosis is suspected clinically due to pneumaturia, faecaluria, recurrent urinary tract infections, or passage of urine rectally.In some cases, it will be first diagnosed radiologically at the time of investigation for the primary diseaseCT scan - Presence of gas within the lumen of the bladder. Contrast may be instilled into the rectum &;on table&; prior to the acquisition of images in order to demonstrate a fistulaFluoroscopy Treatment and prognosisSurgical resection of the fistula and abnormal segment of bowel is usually required for cure, although in the setting of malignancy this suggests advanced disease (T4) making surgery complex.In such cases, if palliation only is required then de-functioning colostomy, colonic stent placement or a nephrostomy may be required.(Refer: [/INST] question: Colovesical fistula | options: A: Most commonly presents with pneumaturia B: More common in females C: Most commonly caused by colon cancer D: Readily diagnosed on barium enema | answer: A </s>

<s>[INST] context: We're always looking for well-written reviews of books, music, movies, television shows, websites, video games and other products. When writing a review, concentrate on exactly what you liked or didn't like. Give examples of strengths and weaknesses, be descriptive and provide background information on an author, director, actor or musician, if possible. Find professional reviews in magazines or newspapers and see how reviewers deal with their topic, but be sure to express your own voice in your review. Grammar Hint for Reviews: When describing a book, movie, album or anything else, use the present tense. Book Reviews Discuss an author's technique, strengths and weaknesses instead of focusing on the plot. Does the story flow? Is there a strong sense of character and place? Did you stay up until dawn to finish it? Is it good reading for teenagers? What influence did it have on you and why? If you've read other books by the same author, discuss how this book compares. Movie Reviews Think of the major Oscar categories and consider the performances, music, lighting and setting, etc. Do these work together? Did some hold up while others didn't? If the movie is based on a book, discuss whether one is better than the other and why. If the movie is a remake, compare the film to its original. Remember that a well-written movie review should discuss strengths and weaknesses. Some readers may not have seen a movie yet, so don't give away an exciting scene or the ending! College Reviews Begin by providing an overview of the college, including location, size and a description of the campus and/or dorm life. Think about all aspects of your college visit. What academic, athletic and after-class programs are available? What are the students like? What makes the college different from others? Every school has strengths and weaknesses. Be objective. Consider what the school has to offer and who might enjoy or benefit the most from attending there. [/INST] question: Which aspects should be included in all three reviews? | options: A: Strengths and weaknesses B: Plot and character C: Programs and scenes D: Location and description | answer: A </s>

<s>[INST] context: * Progressive multifocal leukoencephalopathy (PML) is a viral infection of oligodendrocytes that results in demyelination of the central nervous system. * Signs and symptoms of PML are varied but include dementia and ataxia along with abnormal vision and speech. The causative agents of PML are two closely related polyomaviruses, JC virus and SV40. * The pathognomonic feature of PML is the oligodendrocytes in areas of demyelination, which have a "ground-glass' appearance of their nuclei due to infection with the viral paicles. * PML occurs as a terminal complication in immuno suppressed individuals, especially individuals with AIDS. In contrast to the viral inclusions of PML, beta-A4 amyloid is found in the walls of medium to small aeries an aerioles in the brain and meninges of individuals with cerebral amyloid angiopathy (CAA) , a significant cause of intracerebral hemorrhage in non hypeensive elderly patients. * Prion protein paicles are causes of the spongiform encephalopathies, while Rosenthal fibers within astrocytes are characteristic of juvenile pilocytic astrocytomas, and ubiquitin protein within neurons is associated with Alzheimer's disease. [/INST] question: A 42-yrs-old immunosuppressed male presents with rapidly progressed neurologic symptoms including mental deterioration, visual loss, abnormal speech, and ataxia, Radiographic studies demonstrate multifiocal lesions in the white matter without mass effect. A stereotactic brain biopsy reveals areas of demyelination. Which histologic feature is most likely to be present in this? | options: A: Beta-A4 amyloid within blood vessels B: Prion protein within extracellular plaques C: Rosenthal fibers within astrocytes D: Viral paicles within oligodendrocytes | answer: D </s>

<s>[INST] context: Writing one or two articles a day is a fair goal for a human writer. By contrast, the Wordsmith platform can produce up to 2,000 articles a second! Wordsmith is one example of natural language-generation software, often referred to as a robot journalist. To be fair, the software doesn't start from the beginning, like a human writer might. Instead, the software takes a set of structured data and transforms it into readable text. Natural language-generation software, such as Wordsmith and Quill, does its work by identifying trends and highlights in sets of data. The software then searches its own dictionary for the words to express its findings.[:] Why keep human writers around Although this type of software writes faster than any human, it requires sets of structured data to work. That's why it's especially useful for writing earnings reports and other types of "dry" writing. Humans, on the other hand, are good at turning their unstructured thoughts directly into prose. The reports produced by Wordsmith and Quill read naturally, and they can match the tone of human writers. But for now, the robot journalists probably won't steal many jobs or win any Pulitzer Prizes! Current applications of natural language-generation software Financial reports: The software is commonly used by banks or traders to analyze large amounts of financial data and then produce reports in plain English. Health and fitness: The software can turn data gathered from wearable devices or fitness trackers into personalized reports. The writing tone can even be adjusted to sound more encouraging! Sports reporting: The software is often used to turn real baseball, basketball and football statistics into exciting stories. [/INST] question: What does natural Language-generation software refer to? | options: A: The Wordsmith platform B: A robot journalist C: A special dictionary D: Articles written by computer | answer: B </s>

<s>[INST] context: In hemochromatosis, hypogonadism is caused by impairment of hypothalamic pituitary function and not due to deposition of Iron in the Testis. Hemochromatosis Hemochromatosis is characterized by the excessive accumulation of body iron, most of which is deposited in parenchymal organs such as liver and pancreas. The total body content of the iron is tightly regulated, as the daily losses are matched by gastrointestinal absorption. In hereditary hemochromatosis, regulation of intestinal absorption of dietary iron is lost, leading to net iron accumulation of 0.5 to 1.0 gm/year. It may be recalled that the total body iron pool ranges from 2-6 gm in normal adults; about 0.5 gm is stored in the liver 98% of which are hepatocytes. In hemochromatosis, the iron accumulation may exceed 50 gm, over one-third of which accumulates in the liver. The iron accumulation is lifelong, the rate of net iron accumulation is 0.5 to 1.0 gm/year. The disease manifests itself typically after 20 gm of storage iron have accumulated. The disease first manifests itself in the fifth to sixth decades of life. Excessive iron is directly toxic to host tissues The clinical features of hemochromatosis are characterized principally by deposition of excess iron in the following organs in decreasing order of severity. [/INST] question: Raised iron content is NOT found in which organ in Hemochromatosis - | options: A: Heart B: Skin C: Testis D: Pituitary | answer: C </s>

<s>[INST] context: Chinese writer Mo Yan has won the 2012 Nobel Prize in Literature, announced Peter, the Secretary of the Swedish Academy in Stockholm on Thursday. The awarding ceremony will be held on December 10. The winner will win a medal, a personal diploma and a cash award of 8 million Swedish Kronor (about 1 million U.S. dollars). Mo Yan was born in 1955 and grew up in Gaomi in Shandong province in eastern China. As a 12-year-old during that very unordinary time, he left school to work, first as a farmer like his parents, later as a worker in a factory. He didn't begin to study literature or write until he joined the People's Liberation Army in 1976. His first short story was published in 1981. In his writing, Mo Yan draws the readers' attention to his youthful experiences and the cultures in the province of his birth. His novel Hong Gaoliang Jiazu (1987, in English Red Sorghum 1993), which consists of five stories was successfully filmed in 1987, directed by famous Chinese director Zhang Yimou. In addition to his novels, Mo Yan has published many short stories and essays on many different topics. his stories have been translated into English, French , Japanese and many other languages. Mo Yan not only brings a great shot to the world but also a great joy to China. [/INST] question: Mo Yan will go to Stockholm for the ceremony _ . | options: A: in October ,2012 B: in February ,2013 C: on Dec. 10 2012 D: on Thursday | answer: C </s>

<s>[INST] context: Obsessive compulsive disorder - Obsessive-compulsive disorder (OCD) is a condition characterized by obsessions and/or compulsions that the person feels driven to perform according to specific rules in order to prevent an imagined dreaded event. OCD is the fouh most common psychiatric disorder and is usually a chronic condition Obsessions - recurrent persistent thoughts, impulses, or images that enter the mind despite effos to exclude them Patient try to resists them Compulsions - Behavior on mental acts that follow obsession & reduce anxiety temporarily Both obsession and compulsion are ego dystonic Presentation m/c presentation - obsession of contamination followed by compulsions of washing Pathological doubts Intrusive thoughts Symmetry - compulsion of slowness Hoarding Depression is most common comorbidity Treatment - best - combination of pharmacotherapy and psychotherapy pharmacotherapy - SSRI PSYCHOTHERAPY - Brief cognitive behavioral therapy (CBT) based on exposure with response prevention is the treatment of choice, and can be delivered in a variety of ways: Brief individual CBT (up to 10 hours) with structured self-help materials CBT by telephone Group CBT [/INST] question: A woman comes to psychiatrist with history of spending a lot of time in washing her hands. She is distressed about it but says that she is not able to stop washing. This has staed to affect her social life as well. What is the best mode of treatment for her? | options: A: Cognitive behavioral therapy B: Exposure and response prevention C: Systematic desensitization D: Pharmacological agents | answer: B </s>

<s>[INST] context: Welcome Aboard Just 15 minutes from Banff is Lake Minnewanka where a 90minute cruise to the Devil's Gap is sure to be the highlight of your summer adventure! For information & group reservations,phone 7623473! www.minnewankaboattours.com GUIDED MOUNTAIN FLIGHTS of the Columbia Ice Field & Canadian Rockies Leave the Crowds Behind Tour Narrated by Your Host Owner/Pilot Steve Neill (from $110/person) *Comfortable window seats *Headsets for clients/pilot conversation *Ski plane available for glacier landings Reservations : 18773447117 www.rockiesairtours.com THREE SISTERS MOUNTAIN VILLAGE Which stars will you be watching tonight? When you discover the beauty that surrounds Three Sisters Mountain Village,you will be surprised at how much brighter they are in the sky than on the screen.So make some popcorn,pull up a comfortable chair and settle in for a quiet night in the mountain.All the stars will be there. Call rollfree (866) 3882877 www.threesistersmountainvillage.com PERFECT PICTURES Discover the Rockies's most desirable natural attractions on a Brewster guided excursion.As national park specialists,we are proud to share the wonders of Canada's largest outdoor living museum.Our 111 years'experience ensures a most memorable guided adventure! *Wildlife viewing *Nature walks *Sightseeing Tollfree:18007606934 www.brewster.ca RAFTING & OUTDOOR ADVENTURES Youth & group rates available! A spectacular adventure is waiting for you between Banff and Calgary,a short scenic drive to paradise.Join us for a fun,exciting and safe adventure in the Kananaskis and Bow Valley. Adventures are available for all ages and skill levels. Our professional and highly qualified guides are all Wilderness First Aid and River Rescue certified. Tollfree:18779997238 www.insideoutexperience.com [/INST] question: The Smiths,a retired couple,would probably call _ for several quiet starry nights. | options: A: 7623473 B: 18773447117 C: (866) 3882877 D: 18007606934 | answer: C </s>

<s>[INST] context: Minimal change glomerulopathy causes 90% of the nephrotic syndrome in young children and 15% in adults. Proteinuria is generally more selective (albumin > globulins) than in the nephrotic syndrome caused by other diseases, but there is too much overlap for this selectivity to be used as a diagnostic criterion. This disease is characterized pathologically by fusion (effacement) of visceral epithelial foot processes; however, this can be visualized only by electron microscopy. Minimal change glomerulopathy is successfully treated with corticosteroids and does not progress to renal failure. Focal segmental glomerulosclerosis (FSGS) is the cause of nephrotic syndrome in 10% of children and 30% of adults. FSGS is the term applied to a heterogeneous group of glomerular diseases that have different causes, including mutations, viruses, drugs, and serum factors. Henoch-Schonlein purpura and lupus nephritis (choice A) generally present with nephritic syndrome and rash, among other signs and symptoms. Wilms tumor (choice E) is not a cause of nephrotic syndrome.Diagnosis: Minimal change nephrotic syndrome [/INST] question: A 12-year-old boy complains of swelling of his feet for the past 3 weeks. He is otherwise healthy, with no known previous illness. Vital signs are normal. Physical examination reveals pitting edema of the lower legs and a swollen abdomen. Urinalysis shows 4+ protein but no RBCs or WBCs. Which of the following are the most likely diagnoses to consider in your evaluation of this patient? | options: A: Henoch-Schonlein purpura, lupus nephritis B: Malignant hypertension, renal vein thrombosis C: Minimal change disease, focal segmental glomerulosclerosis D: Pyelonephritis, acute tubular necrosis | answer: C </s>

<s>[INST] context: The global population is living longer,and getting older,which presents new challenges. "The question becomes:who will take care of everyone? While people will always be the best caregivers for people,there just aren't enough people. That's where robotic technology can really make a difference," says Professor Maja Mataric at the University of Southern California. Her group is developing robots to work with stroke patients and elderly people. The research team has found that people react well to a robot gym instructor,and seem to get less frustrated with it than with instructions given on a computer screen. The robot can act as a perfect trainer,with infinite patience. "People say things like 'I prefer this robot to my husband!Can I take it home?'" according to Professor Mataric. "In fact there's a really important point here. As we create these care giving technologies,we're helping not only the people that need the care,but also the people caring for them. We can give them a break,and help them avoid _ ." People are going to have to like,and importantly trust robots before they welcome them into their homes,and several groups around the world are working on making it easier to communicate with them. Much of human communication takes place through body language. Gestures, eye contact , and concepts of personal space are all things that robots are being taught. In learning about how people interact with machines,researchers are also discovering new roles for robots in our lives. Robots can communicate with humans in ways that other technologies can not. "If someone finds the robot to be more persuasive and more reliable,that's going to affect how they interact with it," says Dr Cynthia Breazeal, director of the Personal Robots Group at the Massachusetts Institute of Technology. "We can now start to think about fields where it's the social interaction,which is the main means by which a robot helps someone." Dr Breazeal says that means robots could be used in education,learning,and health care,where social support is important. [/INST] question: Professor Maja Mataric mainly focused on robots' function of _ . | options: A: teaching B: exploring C: making things D: giving care | answer: D </s>

<s>[INST] context: Ellie lived with her six children in a small house. One winter, there was a big flood and quite a few houses were washed away, but Ellie's house was high enough to keep them safe. Many families lost everything in the flood. And Ellie took in one of the families. She shared her home with them until the family could build their own new house. Ellie's friends could not understand why she did so because she already had so many children to look after. "Well," Ellie said to her friends, "At the end of World War I, there was a poor woman in a town in Germany. Her husband had been killed in the war and she had a lot of children, just like me now." "The day before Christmas, this woman said to her children, 'We will not be able to have much for Christmas. I am going to get just one present for us all. Now I will go and get it.' She came back with a little girl who had no parents, 'Here is our present,' she said to her own children." "The children were very excited to get such a present. They welcomed the little girl warmly, and she grew up as their sisters. I was that Christmas present." [/INST] question: How many children did Ellie had in total? | options: A: Five B: Six C: Seven D: Eight | answer: B </s>

<s>[INST] context: What is the hottest topic at your school? In Hangzhou Yongjin Middle School, it's money. The school had an activity called "making a living" recently. About 800 Junior 1 and Junior 2 students were divided into 112 teams. They went out to make money by selling things. What did they choose to sell? Some sold newspapers; some chose bottled water; some sold environmentally friendly shopping bags and bamboo baskets. Huqi's team decided to sell educational books in front of the Children Activity Centre. They thought parents would like to buy books for their children. But unfortunately , they came across urban management officers . The officers asked them to leave. "We played hide-and-seek with the officers for the whole morning," said Hu. "Finally we gave up and moved to other place. Wang Yongyi and her team sold ice cream in a square. They didn't meet any officers. But few people were interested in what they were selling. The team then put up a board saying the money was to help the "Project Hope" for country kids. It worked. More people came to their stall. A foreigner even gave them 100 yuan. Meng Zhaoxiang and his team were luckier. They sold all their cakes in four hours, spending 39.5 yuan and getting back 80 yuan. "It was not easy to make the money," said Meng. "Some people just looked. Others just tasted but didn't buy. Now I know how hard it is for our parents to earn the money we need to lead happy lives." [/INST] question: The students in Hangzhou Yongjin Middle School had an activity about _ . | options: A: earning money B: passing exams C: helping Project Hope D: selling books | answer: A </s>

<s>[INST] context: Sam, an unemployed piano tuner, said it was only the second thing he had ever won in his life. The first thing was an Afghan blanket at a church raffle when he was 25 years old. But this was much bigger: it was $120,000! He had won the Big Cube, a state lottery game. To win, a contestant must first guess which number a spinning cube will stop on. The cube has six numbers on it: 1X, 10X, 50X, 100X, 500X, and 1000X. If he is correct, the contestant must then guess which of two selected variables is going to be greater. So, just guessing which number appears on the cube does not guarantee that you will win any money. Sam correctly guessed 1000X, but he still had to choose between two variables. One variable was the number of cars that would run the stop sign at Hill Street and Lake Avenue in six hours. The other variable was the number of times that a teenage boy would change TV channels in a three-hour period. This was a tough decision. Finally, Sam flipped a coin. It came up heads, so Sam picked the teenager. He picked right. The stop sign was run only 76 times, but the teen clicked 120 times. Sixty-year-old Sam jumped for joy, for he had just won 1000 times 120, or $120,000. Sam dreamily left the lottery studio. Talking excitedly on his cell phone while crossing the street, he got hit by a little sports car. Sam is slowly getting better. He was in the hospital for a month. His hospital bill was $110,000. And the insurance company for the little sports car's owner sued Sam for $9,000 worth of repairs. Also, Sam still has to pay federal taxes on his winnings. Sam doesn't play the state lottery any more. He says it's better to be unlucky. [/INST] question: When Sam won the second thing that he'd won in his life, he was _ . | options: A: 25 years old B: six years old C: 76 years old D: sixty years old | answer: D </s>

<s>[INST] context: Among various programs, TV talk shows have covered every inch of space on daytime television. And anyone who watches them regularly knows that each one is different in style . But no two shows are more opposite in content, while at the same time standing out above the rest, than the Jerry Springer and the Oprah Winfrey shows. Jerry Springer could easily be considered the king of "rubbish talk". The contents on his show are as surprising as can be. For example, the show takes the ever-common talk show titles of love, sex, cheating, and hate, to a different level. Clearly, the Jerry Springer show is about the dark side of society, yet people are willing to eat up the troubles of other people's lives. Like Jerry Springer, Oprah Winfrey takes TV talk show to its top. But Oprah goes in the opposite direction. The show is mainly about the improvement of society and different quality of life. Contents are from teaching your children lessons, managing your work week, to getting to know your neighbors. Compared to Oprah, the Jerry Springer show looks like poisonous waste being poured into society. Jerry ends every show with a "final word". He makes a small speech about the entire idea of the show. Hopefully, this is the part where most people will learn something very valuable. Clean as it is, the Oprah show is not for everyone. The show's main viewers are middleclass Americans. Most of these people have the time, money, and ability to deal with life's tough problems. Jerry Springer, on the other hand, has more of a connection with the young adults of society. These are 18-to-21-year-olds whose main troubles in life include love, relationship, sex, money and drug. They are the ones who see some value and lessons to be learned through the show's exploitation. [/INST] question: Compared with other TV talk shows, both the Jerry Springer and the Oprah Winfrey are _ . | options: A: more interesting B: very popular C: more detailed D: more formal | answer: B </s>

<s>[INST] context: 40 years ago the idea of disabled people doing sport was never heard of. But when the yearly games for the disabled were started at Stoke Mandeville, England in 1948 by Sir Ludwig Guttmann, the situation began to change. Sir Ludwig Guttmann, who had been driven to England in 1939 from Nazi Germany, had been asked by the British government to set up an injuries center at Stoke Mandeville Hospital near London, His ideas about treating injuries included sport for the disabled. In the first games just two teams of injured soldiers took part .The next year, 1949, five teams took part. From those beginnings, things have developed fast. Teams now come from abroad to Stoke Mandeville every year. In 1990 the first Olympics for the disabled were held in Rome, in the same place as the normal Olympic Games. Now, every four years the Olympic Games for the disabled are held, if possible, in the same place as the normal Olympic Games, although they are organized separately. In other years games for the disabled are still held at Stoke Mandeville, In the 1984 Wheelchair Olympic Games, 1,064 wheelchair athletes form about 40 countries took part. Unfortunately, they were held at Stoke Mandeville and not in Los Angeles, along with the other Olympics. The games have been a great success in helping the progress of international friendship and understanding, and in proving that being disabled does not mean you can't enjoy sport. One small source of disappointment for those who organize and take part in the games, however, has been the unwillingness of the International Olympic Committee to include disabled events at the Olympic Games for the able-bodied. Perhaps a few more years are still needed to persuade those fortunate enough not to be disabled that their disabled fellow athletes should be included. [/INST] question: The first games for the disabled were held _ after Sir Ludwig Guttmann arrived in England. | options: A: 40 years B: 21 years C: 10 years D: 9 years | answer: D </s>

<s>[INST] context: Zellweger syndrome is a rare disease characterized by the absence of functional peroxisomes. The long chain fatty acids (C26-C36) are not oxidized. They accumulate in tissues, paicularly in brain, liver and kidney. Hence the disorder is also known as cerebrohepatorenal syndrome. This condition is apparent at bih and is characterized by profound neurologic impairment, victims often dying within a year. Two closely related conditions are neonatal adrenoleukodystrophy and infantile Refsum disease. Zellweger syndrome and these two conditions represent a spectrum of overlapping features, with Zellweger syndrome being the most severe (many proteins affected) and infantile Refsum disease the least severe Dicarboxylic aciduria - characterized by the excretion of C6--C10 o-dicarboxylic acids and by nonketotic hypoglycemia, and is caused by a lack of mitochondrial medium-chain acyl-CoA dehydrogenase. Jamaican vomiting sickness - caused by eating the unripe fruit of the akee tree, which contains the toxin hypoglycin. This inactivates medium and sho-chain acyl-CoA dehydrogenase, inhibiting b-oxidation and causing hypoglycemia. Refsum disease - defect in the alpha-oxidation due to the deficiency of the enzyme phytanic acid alpha-oxidase. Phytanic acid cannot be conveed to a compound that can be degraded by beta-oxidation. Cerebral ataxia and peripheral neuropathy. Phytanic acid mostly found in plant .it's also present in milk and dairy products so this food is restricted in patient of refsum disease. [/INST] question: Which of the following is a peroxisomal disorder? | options: A: Zellweger syndrome B: Dicarboxylic aciduria C: Jamaican vomiting sickness D: Refsum disease | answer: A </s>

<s>[INST] context: To my Charlie on his wedding day-- I know you think these notes are silly. I have watched you wear a long face over the years when I give them to you. But understand that sometimes I want to tell you something and I want to get it just right. Putting it down on paper helps me do that. I wish I had been a better writer. I wish I had gone to college. If I had, I think I would have studied English and maybe my vocabulary would have improved. So many times I feel I am using the same words over and over. Like a woman wearing the same dress every day. So boring! What I want to say to you, Charley, is you are marrying a wonderful girl. I think of Catherine in many ways like I think of Roberta. Like a daughter. She is sweet and patient. You should be the same with her, Charley. Here is what you are going to find out about marriage: you have to work at it together. And you have to love three things. You have to love 1) Each other. 2) Your children (when you have some). 3) Your marriage. What I mean by that last one is, there may be times that you fight, and sometimes you and Catherine won't even like each other. But those are the times you have to love your marriage. It's like a third party. Look at your wedding photos. Look at any memories you've made. And if you believe in those memories, they will pull you back together. I'm very proud of you today, Charley. I am putting this in your tuxedo pocket because I know how you lose things. I love you every day! Mom [/INST] question: Why did the mother write the letter to Charlie? | options: A: To congratulate her son B: To give him some advice C: To show her pity D: To talk things through | answer: B </s>