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<s>[INST] context: • Normal portal vein pressure: 5-10 mm Hg  • Variceal formation occurs when portal pressure is >10 mm Hg. • Variceal bleeding occurs when portal pressure is >12 mm Hg.  • Normal portal vein pressure: 10-15 cm saline • Definition: Portal pressure >10 mm Hg • MC cause of portal hypertension in United States: Cirrhosis. • Consequence of both increased portal vascular resistance and increased portal flow. • Portal hypertension results in splenomegaly with enlarged, tortuous, and even aneurysmal splenic vessels. • Cruveilhier-Baumgarten murmur: Audible venous hum in caput medusa • Hyperdynamic portal venous circulation seems to be related to the severity of the liver failure. • Upper G.I. bleeding is caused by the portal hypertension in about 90% of instances. • Most bleeding episodes occur during the first 1 to 2 years after identification of varices. • Colour Doppler is the investigation of choice for evaluation of PHT. • About one third of deaths in patients with known esophageal varices are due to upper GI bleed • A larger proportion dies as a result of liver failure. • MC causes of death in cirrhosis patients: Hepatic failure • 2nd MC causes of death in cirrhosis patients: variceal hemorrhage [/INST] question: Normal portal vein pressure is | options: A: < 3 mm Hg B: 3-5 mm Hg C: 5-10 mm Hg D: 10 to 1 2mm of Hg | answer: C </s>

<s>[INST] context: In Singapore,many middle school students spend a lot of their time on their studies. Good education is often regarded as a ticket to success in their future. So,many of these students try their best to get good grades in their examinations.They have a lot of homework every day and exams are a big headache.Sometimes,some of them are even made to go to remedial classes after schoo1. Schools run programs outside school hours.The students can take part in sports and games,music and dance,hiking and rock-climbing ,etc.They are also very active in community service . In their spare time,most students like to listen to pop music.And Hollywood blockbusters ,Hong Kong and Singapore movies are very popular among them.They understand IT very well.Some of them also spend their free time surfing the Internet,e-mailing their friends,playing computer and video games. They sometimes go to cafes,fast-food restaurants,shopping centers and big bookstores. So,it looks like life as a middle school student in Singapore is not easy but it is rich and colorful. [/INST] question: Many students want to get good education to be _ in the future. | options: A: popular B: successful C: comfortable D: generous | answer: B </s>

<s>[INST] context: (Congenital syphilis) (1265- Nelson 18th)HUTCHINSON TEETH - which arc the peg or barrel shaped upper central incisors that erupt during the 6th year of life: abnormal enamel, which results in a notch along the biting surface, seen in Late manifestation of congenital syphilisEarly manifestations of congenital syphilis* Approximately 66% of infected ifants are asymptomatic* Hepatosplenomegaly jaundice, elevated liver enzymes are common* Lymphadenopathy to be diffuse, shotty nodes may persist* Coombs negative hemolytic anemia, Thrombocytopenia* Osteochondritis, periostitis* Limbs are held immobile due to excruciating pain (pseudo paralysis of parrot)*** Mucous patches, rhinitis (snuffles)* and condylomatous lesions are highly characteristic* CNS abnormalities, failure to thrive, chorioretinitis, nephritis and nephritic syndrome* Renal involvement include - hypertension, hematuria, proteinuria, hypoproteinemia, hypercholesterolemia, and hypocomplementemia* Less common clinical manifestations - gastroenteritis, peritonitis, pancreatitis, pneumonia, eye involvement glaucoma and chorioretinitis) nonimmune hydrops and testicular masses.Late manifestations of congenital syphilis* Frontal bossing, a bony prominence of the forehead (Olympian brow), unilateral or bilateral thickening of the sternoclavicular third of clavicle (Clavicular or Higoumenaki'sign)* Saber shins, scaphoid scapula, Hutchinson teeth, mulbeny molars* Saddle nose, Rhagedes, Juvenile paresis - Juvenile tables* Hypersensitivity phenomenon - interstitial keratitis, blindness less common ocular manifestations include - choroiditis, retinitis, vascular occlusion and optic atrophy, eighth nerve deafness* Clutton joint - U/L or B/L synovitis usually in the knee painless, soft tissue gammas, paroxysmal cold hemoglobinuria (rare)Hunterian chancre single painless, regular indurated reddish brown plaque seen in primary syphilis* Congenital varicella syndrome is characteristically associated with limb reduction defects and scarring of skin* Classical Tetrad of congenital Toxoplasmosis* Hydrocephalus or Microcephaly*** Chorioretinitis* Convulsions (seizures)* Cerebral calcifcations*RUBELLA - is a teratogenic virus* can be transmitted from fetus to mother. The rate of transmission and congenital defects maximum in first trimester infections (hearing loss) * Under eradication of congenital rubella syndrome programme the first priorty group of rubella vaccination is- All non pregnant women of age 15 to 34 years*** Most common congenital defects are deafness, cardiac malformations and cataractsOther resulting from defects include - glaucoma, retinopathy microcephalus, cerebral palsy, IUGR, hepatosplenomegaly mental and motor retardation"Chancre- redux" is a clinical feature of early relapsing syphilis at the site of the healed lesionTerm "Viable not cultivable" (VNC) is used for T.pallidum. M. leprae [/INST] question: Hutchinson teeth are seen in | options: A: Toxoplasma B: Congenital syphilis C: Rubella D: CMV- nfections | answer: B </s>

<s>[INST] context: A man had seven sons, who were always quarreling. They left their studies and work, to quarrel among themselves. Some bad men were looking forward to the death of their father, to cheat them out of their property by making them quarrel about it. The good old man, one day, called his sons around him. He laid before them seven sticks, which were tied together. He said, "I will pay a hundred dollars to the one who can break this bundle ." Each one tried their best to break the bundle. After a long but useless efforts, they all said that it could not be done. "And yet, my boys," said the father, "nothing is easier to do." He then untied the bundle, and broke the sticks, one by one, with perfect ease. "Ah!" said his sons, "It is easy enough to do it so; anybody could do it in that way." Their father replied, "As it is with these sticks, so it is with you, my sons. So long as you hold fast together and help each other, you will be much richer, and none can harm you. "But if the brotherhood bundle is broken, it will happen to you just as it has to these sticks, which lie there broken on the ground." Home, city, country, all are property found, When they hold tightly together. [/INST] question: How many sticks does the old man ask his sons to break? | options: A: 2 B: 3 C: 5 D: 7 | answer: D </s>

<s>[INST] context: Wolf Parkinson-While syndrome Marfan's syndrome Ideally, a patient with Marfan's syndrome contemplating pregnancy should have a preconceptional echocardiography to determine the diameter of the aoic root risk depends upon the diagmeter of aoic root. If it is greater than 4.0 cm, she is at significant risk for aoic dissection and she should be offered surgery. If the patient is in early pregnancy, she should be informed that termination of pregnancy is an option. Eisenmengher syndrome & Pulmonary hypeension Pulmonary vascular disease whether secondary to a reversed large left to right shunt such as VSD, Eisenmenger's syndrome or lung or connective tissue disease (e.g., scleroderma) or due to primary pulmonary hyeension is extremely dangerous in pregnancy and women known to have significant pulmonary vascular disease should be adviced from an early age to avoid pregnancy and be given appropriate contraceptive advice. Arias says "Pregnancy is deleterious to patients with primary pulmonary hypeension. The maternal moality is approximately 40% and the fetal outcome is also poor with frequent spontaneous aboions and fetal demises secondary to maternal deaths." According to Dutta, Absolute indications for termination of pregnancy are:? a) Primary pulmonary hypeension b) Eisenmengers syndrome c) Pulmonary veno-occlusive disease Relative indications are a) Parous woman with grade HI and grade IV cardiac lesions. b) Grade I or II with previous history of cardiac failure in early month or in between pregnancy. The termination should be done within 12 weeks by suction evacuation (MVA) or by conventional D & E. [/INST] question: Normal pregnancy can be continued in aEUR' | options: A: Primary pulmonary hypeension B: Wolf-Parkinson-White syndrome C: Eisenmenger syndrome D: Marfan syndrome with dilated aoic root | answer: B </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. Remember these basic points about the t/t of head and neck cancers and one can apply them to all tumors of head and neck. 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 expertise. 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: Vincristine B: Cyclosphosphamide C: Cisplatin D: Daunorubicin | answer: C </s>

<s>[INST] context: Coagulase negative staphylococci fRef. Harrison 17th /e p 839 & 16th/e. p 777. 778] Intravascular catheter related infections Indwelling vascular catheters are a leading source of bloodstream infections. Amongst indwelling vascular catheters, central venous catheters are the most common culprits. Pathogenesis There are four potential sources for catheter related infections ? 1) The skin inseion site 2) The catheter hub 3) Hematogenous seeding from a distant infection 4) Contaminated infilsate The skin inseion site and the catheter hub are by for the two most impoant sources. Approximately 65% of catheter related infections originate from the skin flora, 30% from the contaminated hub and 5% from other pathways. For sho term catheters, skin contamination is the most likely mechani.sm of pathogenesis. On the other hand, for long term catheters, hub contamination is more frequent because such catheters often have to be intercepted and manipulated. Skin organisms migrate from the skin inseion site along the external surface of catheter, colonizing the distal intravascular tip of the catheter, and ultimately causing blood-stream infection. On the other hand, in hub related infections, organisms are usually introduced into the hub from the hands of medical personnel and the organisms migrate along the internal surface of the catheter, where they can cause a bloodstream infection. Microbiology Most of the micro-organisms implicated in CRIs arise from the skin flora. Staphylococci are the most frequently isolated pathogens, paricularly coagulase-negative staphylococci. Etiology of catheter related infection Microorganism Percentage * Coagulase negative staphylococci 30 - 40 * Staph aureus 5-10 * Enterococci 4 - 6 * Candida spp. 3 - 6 * Pseudonzonas aeruginosa 2 - 5 * Enterobacter spp 1 - 4 * Acinetobacter spp. 1 - 2 * Serratia spp. <1 * Others < 1 - 5 [/INST] question: Most common catheter induced blood infection is due to | options: A: >Staphylococcus aureus B: >Coagulase negative staphylococci C: >Gram negative bacilli D: >Candida | answer: B </s>

<s>[INST] context: For years I went to school by bus,so I met many"familiar"strangers.We took the same bus but didn't know each other's names.I used to think it was impossible for us to be true friends.How wrong I was!Smiles from the"nameless"people have changed my thoughts. The first time I got on the bus,I saw different faces.We met,greeted and cold faces turned into smiling faces.As days went on,we chatted like old friends. But I felt it a pity that I was unable to set up the same friendship with a silent girl in the front of the bus.Her old clothing suggested that she didn't have much money,but she always took a cup of water for the driver.I guessed she was a kind girl.But why did she sit in silence instead of talking with us?Why did she never reply to our friendly greetings?Couldn't she smile? Then,one evening,I got the answer.I walked to the park nearby and found the girl sitting alone under a tree,lonely and sad.I greeted her with the same warm smile that I had shown to her all these months,but this time her face turned red,then a shy smile appeared.As soon as she began her first words,I understood why she hadn't spoken to us before.Talking was hard for her. I learnt her story:Her parents worked hard somewhere.She lived with her disabled grandparents.She said,"I can't express myself very well.Most of the time,I can't say what I want to say.I have no friends but...you always smile to me like an angel...so I also want to smile."That evening,we exchanged our names and we said goodbye like old friends. Smile is the key to opening the door of the heart;it can break the cold walls in front of us. [/INST] question: All the following words can describe the girl except _ . | options: A: silent B: kind C: proud D: poor | answer: C </s>

<s>[INST] context: Young people can have problems with their minds.Some students become worried because they have to study very hard.Others have trouble getting on well with people like their parents and classmates. Liu Wei,a junior 2 student from Hefei,could not understand his teacher and was doing badly in his lessons.He became so worried about it that he started to cut his finger with a knife. Another student,14-year-old Yan Fang from Guangzhou,was afraid of exams.She got very worried when she looked at the exam paper.She couldn't think of anything to write. A recent report from Jiefang Daily says about 18% of Shanghai teenagers have mental problems.Their troubles include being worried and very unhappy.And they have problems in learning and getting on with people.Many students who have problems won't ask others for advice or help.Some think they will look stupid if they go to see a doctor.Others don't want to talk about their secret. Liang Yuezhu,an expert on teenagers from Beijing Anding Hospital has the following advice for teenagers: * Talk to your parents or teachers often * Take part in group activities and play sports * Go to see a doctor if you feel unhappy or unwell [/INST] question: The students who often become worried or have trouble getting on with others may have _ . | options: A: mental problems B: a headache C: knives with them D: no parents | answer: A </s>

<s>[INST] context: Resting affected limbs in neutral position Repeat from May 06 & 07 Disability limitation is the mode of intervention used if the patient presents in late pathogenic phase. The objective is to prevent the transition of the disease proecess from impairment to handicap. The sequence of events leading to disability and handicap are: Disease ---> impairment -4 disability -4 handicap Impairment - is defined as any loss or abnormality of psychological, physiological or anatomical structure or function eg. loss of foot, defective vision or mental retardation. Disability - it is inability to carry out ceain activities considered normal for human beings, because of his 'impairment'. Handicap means that the individual with 'disability' is not able to perform his duties and obligations expected of him in the society. For example: Accident is the disease (or disorder) Loss of foot is the impairment Cannot walk is the disability Unemployed is the handicap Lets see other Modes of intervention in the disease process. Modes of Intervention Modes of intervention can be defined as any attempt to interrupt the usual sequence of any disease process (right from the risk factors to handicap) There are 5 modes of intervention: Health promotion Specific protection Early diagnosis Disability limitation Rehabilitation I. Health promotion Health promotion is not directed against any paicular disease, but is intended to improve the health of people through a variety of interventions like: i) Health education ii) Environmental modifications - Like provision of safe water, installation of sanitary latrines, control of insects and rodents etc. iii) Nutritional interventions - Like food foification, child feeding programmes. iv) Lifestyle and behavioural changes 2. Specific protection is directed against specific disease through interventions such as : - Immunization - Chemoprophylaxis - Protection from carcinogens etc. 3. Early diagnosis and treatment It involves detecting and treating the disease while the biochemical morphological and functional changes are still reversible. Thus it prevents ove disease and disablement. Early diagnosis and treatment are the only effective mode of intervention in following diseases. - Tuberculosis - Leprosy - STD 4. Disability limitation - Already described 5. Rehabilitation It is the combined and coordinated use of medical, social, educational and vocational measures for enabling the handicapped persons to achieve social integration (social integration is defined as the active paicipation of disabled and handicapped people in the mainstream of community life) Option 'a' - Reducing occurence of polio by immunization is specific protection Option 'b' - Arranging for schooling of child suffering from PRPP is rehabilitation Option 'c' - Resting affected limbs in neutral position disability limitation Option 'd' - Providing calipers for walking rehabilitation [/INST] question: Which of the following is an example of disability limitation? | options: A: Reducing occurrence of polio by immunization B: Arranging for schooling of child suffering from PRPP C: Resting affected limbs in neutral position D: Providing calipers for walking | answer: C </s>

<s>[INST] context: Finland lies in the north of Europe, and has Russia to the east. It is two different places in winter and summer. Summers there are fairly dry and hot, although by August things can already begin to get cold and unpleasant. Of course, winters are cold, but the cold is dry. In most parts snow comes in October and clears by the end of March, but in the northern parts snow can fall as early as September and stay until late May. The tourist season in southern Finland is from early June to late August. This is when all the tourist attractions and summer programs are open, with steamboats and ferries traveling on the lakes and rivers, and festivals become very lively. Finnish holidays are from the summer high season in late June to the end of July. This is the time period of nights with sunlight, when Finland doesnt seem to sleep. The tourist season in northern Finland is different. Mosquitoes can be annoying in July, but September is lovely with its autumn colors. October, February and March are good times to visit the north of Finland to view the aurora borealis , and enjoy winter activities such as skiing and dog sledding. The Christmas holiday period is also one of the best times in Finland --after all, this is the "official" home of Santa Claus. Helsinki, the capital of Finland, is popular all year round. [/INST] question: Whats the longest time the snow can last in Finland? | options: A: 9 months B: 10 months C: 7 months D: 6 months | answer: A </s>

<s>[INST] context: Geneva Tourist Guide Universal compact app for iPhone 6 / iPhone 6 Plus / iPhone 5 / iPhone / iPod / iPad GENEVA TOURIST GUIDE with attractions, museums, restaurants, bars, hotels, theatres and shops with traveler reviews and ratings, pictures, rich travel information, prices and opening hours. Discover what's on and places to visit in Geneva with our new cool app. It will guide you to top attractions and shopping malls, and tell you directions to hotels, bars, and restaurants. This is an all-in-one app for all the local attractions. Our travel guide to Geneva features up-to-date information on attractions, hotels, restaurants, shopping, nightlife, travel tips and more. Highlights: * Geneva Information -- Overview, climate, geography, history and travel * Attractions -- Ancient sites, beaches, botanical gardens, coffee farms, museums, scenic drives, towns, waterfalls, religious and historical sites, etc. * Hotels -- From luxury hotels to budget accommodations, including reviews, price comparison, address and more. * Map -- It is an interactive map and get turn-by-turn driving directions. Find traffic details, road conditions, street maps, multi map, satellite photos, and aerial maps. Allow you to easily search and find local businesses with directions. * Gallery -- Picture galleries of Geneva's most beautiful sights, interesting events, unusual occasions and more. * POI Search -- Search everything at Geneva. Enter any keyword or name to search. Find Name, address, distance, route map, call, and directions to every business location. * Translator -- Supports 52 languages, Large text Translation. * World Clock -- All major cities of the world (1000 Cities). [/INST] question: What is Geneva Tourist Guide? | options: A: An app B: A book C: A map D: An advertisement | answer: A </s>

<s>[INST] context: What would you do if you had an accident in your daily life? It is important for you to get some knowledge about first aid in your daily life. If a person has an accident, he / she needs medical care before a doctor can be found. When you give first aid, you must know three things: First, when a person stops breathing , open his / her mouth to see if there is food in his / her mouth. Second, if a person cannot breathe, try to start his / her breathing at once, using a mouth-to-mouth way. Third, if a person is hurt badly, try to stop the bleeding at once. And then take him / her to a doctor, because if a person loses one third of his / her blood, he / she may be in great danger. Many accidents may happen at home, and everyone should know some first aid to deal with common injuries. When a person _ by an animal, wash the wound with cold running water before he / she is taken to see a doctor. When a person is burnt, wash and cool the area of the skin under the cold tap for a while, then put a piece of dry clean cloth over the burn. If a person is badly burnt, take him / her to the doctor. If a person cuts his / her finger, clean it and put a piece of clean paper round the cut. In the future we should learn more about first aid and try to spread it. [/INST] question: How many steps should you pay attention to when you give first aid? | options: A: Two B: Three C: Four D: Five | answer: B </s>

<s>[INST] context: Americans have taken over from the Indians many things besides their continent! Where did corn, potatoes, tomatoes, chocolate and maple sugar come from? The Indians. Who invented moccasins, snowshoes and hammocks? The Indians! A list of the tools, plants, materials and designs we owe to the Indians would include hundreds of items. But there is something far more familiar, something that is always at hand. It is used daily by every American: a large vocabulary of Indian words. Potato, tomato, chocolate, moccasin and hammock came into English from Indian languages. So did cocoa, tobacco, maize (an Indian word for corn) and succotash. Some words have changed on the way. Potato, for example, comes from a word that sounds like "batata". Cocoa began as "cacahuatl". Some meanings have also changed. The long Indian word from which succotash comes means "something broken off in bits". Indian women often varied their dishes by mixing bits of one food with another. White men who ate an Indian dish of mixed lima beans and corn began using the Indian word to mean this particular mixture. Put on your moccasins and take a walk in the country. If it is a cold day and you wear a mackinaw, your jacket will be as Indian as your shoes. But mackinaw came from "michilimackinac", the Indian name of a place where a fort served as a trading post. Bright-color1ed blankets or jackets bought at the post soon became known as "mackinaws". Early white visitors to the continent found Indian words useful for the things new to them. But some Indian sounds, such as the "tl" at the end of many words, were hard to say. That is why "coyotl" became coyote and "tomatle" became tomato. Some words simply seemed too long. So, "musickwautash" became succotash and "rockahominy" became hominy. [/INST] question: Which of the following has been changed for easier pronunciation? | options: A: Batata B: Chocolate C: Tomatle D: Rockahominy | answer: C </s>

<s>[INST] context: The principle barrier to reflux is the Lower esophageal sphincter. LES comprises the lower 4 cm of esophagus, where resting pressure within the lumen normally exceeds the intragastric pressure. This high intraluminal pressure at LES prevents the GE reflux. The LES is a physiological entity rather than any anatomical structure Several factors contribute to the high intraluminal pressure of LES a) Intrinsic musculature of distal esophagus these muscle fibres differ from those in other areas of the esophagus in that they are in a state of tonic contraction. They normally relax with initiation of a swallow and then return to a state of tonic contraction. Sling fibres of the cardia Crura of the diaphragm Intraabdominal pressure - the intraabdominal pressure compresses the intraabdominal segment of esophagus (ie LES) and is probably the most important factor in preventing the reflux. - CSDT writes - "Sphincter competance is a function of sphincter pressure, sphincter length and the length exposed to intraabdominal pressure". - In cases of sliding hernia the gastroesophageal junction shifts to posterior mediastinum. The LES is then exposed to the low intrathoracic pressure instead of the high intraabdominal pressure. The low intrathoracic pressure is unable to prevent the reflux in sliding hernia. Other factors apart from LES which prevent the reflux The gastroesophageal angle - the oblique entry of esophagus has a valvular effect, in that it closes the esophagus when the gastric fundus distends The folds of mucosa at the cardia helps in closing the LES when intragastric pressure rises. The intrathoracic pressure has no role in preventing reflux. It's too low (ranging from -5 to +5 mm of Hg). [/INST] question: Reflux esophagitis is prevented by -a) Long intraabdominal esophagusb) Increased intraabdominal pressurec) Right crus of diaphragmd) Increased intrathoracic pressure | options: A: ab B: bc C: abc D: bcd | answer: C </s>

<s>[INST] context: Old Computers Make for Unhappy Workers --- Survey LONDON (Reuters) ----- Dealing with the dissatisfaction of aging and unreliable office computers leads to workers' unhappiness and more sick leave, a survey showed on Wednesday. A survey carried out by caro4free.net of over 2,700 European office workers from the UK, France and Germany found that workplace dissatisfaction increased greatly with the age of the computer equipment. "We do know that job satisfaction is falling in Britain and most advanced nations," said Stephen White, a researcher from the Work Foundation. "The actual reasons for _ are the subject of very heated discussion. It's certainly one interesting theory that technology may be the cause of this in some way," White added. A quarter of these using outdated computers in Britain said they were "quite" or "very dissatisfied" with their everyday job compared to the percent of those who had enjoyed an advantage from up-to-date technology. The survey also said that among workers dealing with outdated equipment, there was a 35 percent greater probability they would take six or more days of sick leave per year compared with the average worker. In France, where more workers use old computers, the probability jumped to 55 percent. Results also showed that women in the three countries were more likely to be using outdated equipment. In the UK, where more workers have up-to-date computers than in the other countries surveyed, the number of women using old equipment doubled that of men. White pointed out that there were two sides to this problem, saying that continuously having to deal with new technology and equipment can also be a source of worry. "Old and faulty equipment is a major cause of office dissatisfaction. There is no question about it; but you also have to say that the frequent change of equipment is also, or could be, a main cause of dissatisfaction." [/INST] question: How many office workers use old computers in Britain expressed their dissatisfaction? | options: A: 16% B: 25% C: 35% D: 55% | answer: B </s>

<s>[INST] context: Having friends may well keep you healthier and help you deal with stress better. Some studies show that people with close friends have a greater ability to fight disease than people who are alone. Place friendship in the first place. Find the time to be with friends even if it means letting the lawn go unmowed or the dishes unwashed for a while. When you can't get together, use the phone to keep in touch. Open up to close friends. Keeping a deep friendship requires a level of "heartfelt" intimacy .Don't be afraid to express your inner fears and disappointments. Listen to your friends when they have problems,but offer advice only when it's wanted. Help raise friends' selfesteem when they are sad about a job loss, or other such events. Have different friends for different activities, such as going to the movies,singing in a choir,and joining in a bowling league. Don't wait for a friend to ask for helps. When a friend has the flu,offer to go to the store or drive his or her children to their afterschool activities. Never take a friendship for granted. Like a good marriage,friendship needs care and patience. Become a joiner. Find a group that matches your interests. Talk to strangers. Conversations started in museums, laundry rooms,or bookstores can lead to firm friendship. _ in an adulteducation course. A classroom is an ideal place to meet others with similar interests. [/INST] question: People with close friends have a _ ability to fight disease than people who are alone. | options: A: less B: greater C: poorer D: little | answer: B </s>

<s>[INST] context: One afternoon, my son came home from school and asked me, "Are all people the same even if their skin color is different?" I thought for a moment, then I said, "I'll explain. Let's go to a fruit store first. I have something interesting to show you." At the store, I told him that we needed to buy apples. And we bought some red apples, green apples and yellow apples. After we got home, I told Adam, "It's time to answer your question." I put one of each type of apple on the table: first a red apple, followed by a green apple and then a yellow apple. Then I looked at Adam, who was sitting on the other side of the table. "Adam, people are just like apples. They come in different colors, shapes and sizes. See, some may not even look as delicious as others." As I was talking, Adam was examining each one carefully. Then, I took each of the apples and peeled them, placing them back on the table, but in a different place. "OK, Adam, tell me which one is the red apple, the green apple and the yellow apple." He said, "I can't tell. They all look the same now." "Take a bite of each one. See if that helps you tell which one is which." He took big bites, and then a huge smile came across his face. "People are just like apples! They are all different, but if you take off the outside, they're pretty much the same on the inside." "Right," I agreed. "Just like everyone has their own features but they are nearly the same." He completely got it. I didn't need to say or do anything else. Now, when I eat an apple, it tastes a little sweeter than before. What perfect fruit it is! [/INST] question: I took Adam to buy apples for _ . | options: A: supper B: his question C: a party D: a present | answer: B </s>

<s>[INST] context: Graft versus host (gvh) diseases Graft versus host disease occurs in any situation in which immunologically competent cells or their precursors are transplanted into immunologically crippled patients and the transferred cells recognize alloantigens in the host. Graft versus host disease occurs most commonly in the setting of allogeneic bone marrow transplantation but may also follow transplantation of solid organs rich in lymphoid cells (e.g. the liver) or transfusion of unirradiated blood. Recipients of bone marrow transplants are immunodeficient because of either their primary disease or prior treatment of the disease with drugs or irradiation. When such recipients receive normal bone marrow cells from allogeneic donors, the immunocompetent, T cells present in the donor marrow recognize the recipient’s HLA antigen as a foreign antigen and react against them. Both CD4+ and CD8+ T cells recognize and attack host tissues. In clinical practice, GVH can be so severe that bone marrow transplants are done only between HLA matched donor and recipient. Pathological changes in GVH diseases There are three principal target tissues affected in GVHD: Skin, liver, and gut. GVHD may be acute or chronic:- A) Acute GVHD Acute GVHD occurs within 100 days (usually 10-50 days) of bone marrow transplantation. The manifestations of acute GVHD are 1. Skin It is the most commonly affected tissue in acute GVHD. There is generalized rash (maculopapular). Histological findings are i. Perivascular mononuclear infiltrates. ii. Vacuolar degradation of dermo-epidermal junction iii. Dyskeratotic or eosinophilic bodies in the epidermis. iv. Epidermolysis & bullae. v. Denudation of epidermis (separation of epidermis from dermis), 2. Gut The primary clinical manifestation of gut GVHD is diarrhoea and abdominal pain. There is lymphocytic infiltrate at the crypts with accompanied necrosis and drop out of crypt cells. 3. Liver Lymphocytic infiltrates in the interlobular and marginal bile ducts are characteristic histopathologic findings. This results in hepatitis with necrosis of hepatocytes and bites duct epithelial cells. There is inflammation of the parenchyma and portal tracts. These findings lead to a clinically identifiable cholestatic picture. B) Chronic GVHD It occurs after 100 days of bone marrow transplantation. Manifestations are:- 1. Skin Extensive cutaneous injury, with the destruction of skin appendages and fibrosis of the dermis. 2. Gut Damage to GIT may result in necrosis, ulceration fibrosis and strictures. 3. Liver The findings of liver damage are i) Portal tract inflammation ii) Selective bile duct destruction iii. Endothelitis of the portal vein and hepatitis vein radicles, in which a subendothelial lymphocytic infiltrate lifts the endothelium from its basement membrane. iv. Intrahepatic cholestasis [/INST] question: Acute GVHD is caused by- | options: A: B lymphocyte B: T lymphocyte C: Macrophage D: NKcell | answer: B </s>

<s>[INST] context: Vegetations on hea valves are the classic hallmark of IE; these are friable, bulky, potentially destructive lesions containing fibrin, inflammatory cells, and bacteria or other organisms (Figs. 12-24 and 12-25). The aoic and mitral valves are the mostsites of infection, although the valves of the right hea may also be involved, paicularly in intravenous drug abusers. Vegetations can be single or multiple and may involve more than one valve; they can occasionally erode into the underlying myocardium and produce an abscess (ring abscess; Fig. 12-25B). Vegetations are prone to embolization; because the embolic fragments often contain virulent organisms, abscesses frequently develop where they lodge, leading to sequelae such as septic infarcts or mycotic aneurysms. The vegetations of subacute endocarditis are associated with less valvular destruction than those of acute endocarditis, although the distinction can be subtle. Microscopically, the vegetations of subacute IE typically exhibit granulation tissue at their bases indicative of healing. With time, fibrosis, calcification, and a chronic inflammatory infiltrate can develop. [/INST] question: Most friable vegetation is seen in | options: A: Infective endocarditis B: Libman sacks endocarditis C: Non bacterial thrombotic endocarditis D: Rheumatic hea disease | answer: A </s>

<s>[INST] context: In 1961 Obama was born in Hawaii, US. His father was an African and his mother was a white American. He grew up in Indonesia and Hawaii. When Obama was 10 years old, he was one of the only three black students at his school in Hawaii. He felt very different from most other students. White girls wanted to touch his hair. A white boy even asked him what his father was. "I lied to them that my father was a Kenyan prince. But I kept asking myself who I am," said Obama. However, 37 years later, the boy made history. Obama became the first black president in US history. Obama's unusual background made him wonder who he was. He once turned to alcohol to help forget this question. With the help of his friends, Obama finally turned his life around at college. His hard work made him a star at Harvard. Later, he became the third black senator in US history. "Obama's success has made Martin Luther King's dream come true. That is: A man should not be judged by the colour of his skin, but by the content of his character," wrote ABC news. [/INST] question: Obama was born in _ . | options: A: Britain B: American C: Kenya D: Indonesia | answer: B </s>

<s>[INST] context: On April 10, 1815, Mount Tambora in Indonesia erupted with great force. Fifty cubic kilometers of magma flew from its peak and a blanket of ash as thick as one centimeter fell over more than 500,000 square kilometers of Indonesia and the Java Sea. The eruption destroyed Tambora's peak and formed a hole six by seven kilometers wide. The eruption and resulting tsunamis killed 10,000 people. The agricultural loss and disease brought about by the thick ash caused the deaths of 82,000 more. Indonesia was rocked again in 1883. On August 26, a small volcano on an uninhabited island between Sumatra and Java, erupted. The eruption produced an ash cloud 80 kilometers high and was heard in Australia--4,800 kilometers away. The eruption also caused a tsunami, which pounded the shores of Java and Sumatra--killing 36,000 people. In 1902, St. Pierre was a thriving community and the largest town on the French colony of Martinique in the Caribbean Sea. Mont Pelee cast a shadow over the town from where it stood, eight kilometers to the north. The townspeople were used to the light continuous sounds of the mountain, but in May, 1902 Pelee started to get really unstable. Clouds of steam and ash poured from the volcano and on May 8, Pelee erupted. Superheated gas and steaming volcanic ash flew out, pouring down the mountain at high speed. Within seconds, the deadly gas cloud had destroyed the town of St. Pierre and incinerated everyone in it -- except one prisoner in a basement cell. It was the worst volcano disaster of the 20th century. [/INST] question: How many people died because of the eruption on April 10, 1815 ? | options: A: About 10,000 B: More than 82,000 C: About 36,000 D: More than 92,000 | answer: D </s>

<s>[INST] context: Each spring brings a new wildflower blooming in the fields along the highway I travel daily to work. There is one particular blue flower that has always caught my eye. I've noticed that it blooms only in the morning hours. The afternoon sun is too warm for it. Every day each year for about two weeks, I see those beautiful flowers. This spring, I started a wildflower garden in my yard. I can look out of the kitchen window while doing the dishes and see the flowers. I've often thought that those lovely blue flowers from the fields would look great in that bed alongside other wildflowers. Every day I drove past the flowers, thinking, "I'll stop on my way home and dig them." "Gee, I don't want to get my good clothes dirty..." Whatever the reason, I never stopped to dig them. My husband even gave me a tool one year for that expressed purpose. One day on my way home from work, I was saddened to see that the highway department had cleared up the fields and the pretty blue flowers were gone. I thought to myself, "Way to go, you waited too long. You should have done it when you first saw them blooming this spring. " A week ago we were shocked and saddened to learn that my oldest sister-in-law has a cancer. She is 20 years older than my husband and unfortunately, because of age and distance, we haven't been as close as we all would have liked. I couldn't help but see the connection between the pretty blue flowers and the relationship between my husband's sister and us. I do believe that God has given us some time left to plant some wonderful memories that will bloom every year for us. And yes, if I see the blue flowers again, I'm sure I'll stop and transplant them to my wildflower garden. [/INST] question: How long might the blue flower bloom in spring? | options: A: The whole day B: The whole season C: About one week D: About two weeks | answer: D </s>

<s>[INST] context: Thanksgiving Day is a special holiday in the United States and Canada. Families and friends gather to eat and give thanks for their blessing. Thanksgiving Day is really a harvest festival. This is why it is celebrated in late fall, after the crops are get in. But one of the first thanksgivings in America had nothing to do with a good harvest. On December 4,1619, the Pilgrims from England landed near what is now Charles City, Virginia. They knelt down and thanked God for their safe journey across the Atlantic. The first New England Thanksgiving did celebrate a rich harvest. The Pilgrims landed at what is now Plymouth, Massachusetts, in 1620. They had a difficult time and the first winter was cruel. Many of the Pilgrims died. But the next year, they had a good harvest. So Governor Bradford declared a three-day feast . The Pilgrims invited Indian friends to join them for their special feast. Everyone brought food. In time, other colonies began to celebrate a day of thanksgiving. But it took years before there was a national Thanksgiving Day. During the Civil War, Sarah Josepha Hale persuaded Abraham Lincoln to do something about it. He proclaimed the last Thursday of November in 1863 as a day of thanksgiving. Today, Americans celebrate this happy harvest festival on the fourth Thursday in November. Canadians celebrate Thanksgiving Day in much the same way as their American neighbours. But the Canadian Thanksgiving Day falls on the second Monday in October. [/INST] question: Thanksgiving Day is celebrated _ . | options: A: in spring B: in summer C: in autumn D: in winter | answer: C </s>

<s>[INST] context: Aggie Bonfire was a long-standing tradition at Texas A&M University as part of the college rivalry with the University of Texas at Austin. For 90 years, Texas A&M students--known as Aggies--built and burned a bonfire on campus each autumn. Known to the Aggie community simply as "Bonfire", the annual autumn event symbolized Aggie students' "burning desires". The bonfire was traditionally lit around Thanksgiving in connection with festivities surrounding the annual college football game. Although early Bonfires were little more than piles of trash, as time passed, the annual event became more organized. Over the years the bonfire grew bigger, setting the world record in 1969. Bonfire remained a university tradition for decades until, in 1999, a collapse during construction killed twelve people--eleven students and one former student--and injured twenty-seven others. The accident led Texas A&M to declare a pause on an official Bonfire. However, in 2002, a student-sponsored-and-off-campus "Student Bonfire" came up. In 2003, the event became known as Student Bonfire. In a design approved by a professional engineer, Student Bonfire uses a wedding cake design, but, in a departure from tradition, every log in the stack touches the ground. For added support, four 24 feet poles are spaced evenly around the stack and then bolted to the 45 feet center pole with a steel pipe. Since the group does not receive funding, Student Bonfire charges a fee to each attendee to cover expenses. Attendance for Student Bonfire ranges from 8,000-15,000 people and the event is held in Brazos County or one of the surrounding counties. [/INST] question: When did Aggie Bonfire come into being? | options: A: In 2003 B: 1999 C: 1909 D: 2002 | answer: C </s>

<s>[INST] context: Chylomicrons are produced by enterocytes (intestinal epithelial cells), using gut luminal triglycerides for the source of the lipid. The chylomicrons are secreted into the gut lymphatic system, and from there drain eventually into the systemic venous system from the thoracic duct, and hence into the serum poion of the blood. They are initially large and have a very high triglyceride content. With time, lipoprotein lipase releases triglycerides from the chylomicron core by hydrolyzing them to more easily absorbed fatty acids. The enzyme is located on the external surface of the vascular endothelium of tissues with triglyceride needs such as skeletal muscle, cardiac muscle tissue, and lactating breast. The result of lipoprotein lipase activity is that the chylomicrons shrink in size. While adipose tissue can utilize chylomicrons, lipoprotein lipase is located on the endothelial cells rather than adipocytes. Adipocytes have an adipose tissue lipase, which is an intracellular enzyme that can cleave triglycerides to glycerol and fatty acids, allowing them to be released into the circulation when chylomicrons are low. Enterocytes have the ability to pick up mixed micelles from the gut lumen for repackaging in the smooth endoplasmic reticulum as chylomicrons. Hepatocytes pick up the chylomicron remnants after the lipoprotein lipase shrinks them. [/INST] question: A young man takes pa in a nutritional research study in Bangalore. After ingesting a very fatty meal, serum samples are taken for research studies at 1 hour and 3 hours. These studies measure the average diameter of the chylomicrons, showing an average chylomicron diameter of 500 nm at 1 hour, which drops to an average diameter of 150nm at 3 hours. Where is the enzyme responsible for this change located? | options: A: Adipocytes B: Endothelial cells C: Enterocytes D: Hepatocytes | answer: B </s>

<s>[INST] context: We have now known something about computers---computers work for us at home, in offices and in factories. But it is also true that many children today are using computers at schools before they can write. What does this mean for the future? Are these children lucky or not? Many people do not know about computers and they think of them as machines that children play with. They worry that children do not learn from experience but just from pressing* a button* and that this is not good for them. They think that children are growing not knowing about the real world. And they are very worried about that their children will lose themselves in the computer games. But many people understand more about computers, they say that computers can be very good for children. A computer can help them to learn about the real world more quickly, to learn what they want to learn and think for themselves. And for the future, don't we need people who can think clearly, who know how to get information quickly and use it well? What do you think? For example, e-mail is very popular at this moment. Do you know about e-mail? E-mail is a way of sending messages to other people. E-mail is a fast and cheap way to keep in touch with friends and family. It's much quicker than sending a letter. People who use e-mail have an e-mail address. This address must have letters and dots* and the symbol "@"meaning "at". This is what an address looks like. People can send the messages across the Internet. It is quick, easy and fun. [/INST] question: Who usually use computers at school? | options: A: The old people B: The teachers C: The children D: The parents | answer: C </s>

<s>[INST] context: Any mistake made in the printing of a stamp raises its value to stamp collectors.A mistake on a two-penny stamp has made it worth a million and a half times its face value. Do you think it impossible? Well,it is true.And this is how it happened. The mistake was made more than a hundred years ago in the former British colony of Mauritius,a small island in the Indian Ocean. In l847 all order for stamps was sent to London Mauritius was about to become the fourth country in the world to put out stamps. Before the order was filled and the stamps arrived from England,a big dance was planned by the commander-in-chief of all the armed forces on the island.The dance would be held in his house and letters of invitation would be sent to all the important people in Mauritius.Stamps were badly needed to post the letters.Therefore,an islander,who was a good printer,was told to copy the pattern of the stamps.He carelessly put the words "Post Office" instead of "Post Paid", two words seen on stamps at that time,on the several hundred that he printed. Today, there are only twenty-six of these misprinted stamps left-fourteen One-penny Reds and twelve Two-penny Blues, Because there are so few Two-penny Blues and because of their age, collectors have paid as much as$16,800 for one of them. [/INST] question: Mauritius is the name of _ | options: A: a Pacific island B: a province of India C: a stamp D: a former colony of Great Britain | answer: D </s>

<s>[INST] context: MACROLIDE ANTIBIOTICS These are antibiotics having a macrocyclic lactone ring with attached sugars. Erythromycin is the first member discovered in the 1950s. Roxithromycin, Clarithromycin and Azithromycin are the later additions. Interestingly, the nonantibiotic macrolides: tacrolimus, pimecrolimus and sirolimus also possess immunomodulatory properties. The antibiotic effects of macrolides are mediated by inhibition of bacterial protein synthesis, through inhibition of peptidyltransferase activity. They have been frequently used in the past for treating many upper respiratory tract infections including GAS pharyngitis with adequate efficacy (>90%). Their effects on immunomodulation appear to extend beyond their antimicrobial actions as they have been shown to mitigate cytokine production in animal studies and human trials. While its antibiotic properties have been attributed to mechanisms shared by other macrolides, AZM has been shown to act primarily on the lymphokine CD4 Th1 cell line reducing the production of the proinflammatory cytokines IL-12 and IL-6, and increasing the production of the anti-inflammatory cytokine IL-10 in macrophage cell lines after stimulation with a combination of lipopolysaccharide (LPS) and IFN-γ. The immunomodulatory potential of AZM is not limited to suppression of production and secretion of proinflammatory cytokines, it also suppresses iNOS-mediated nitric oxide production. These agents also work at a molecular level, decreasing mRNA expression thereby promoting apoptosis of inflammatory cells and a decrease in nuclear transcription factors. [/INST] question: The group of antibiotics that possesses additional anti-inflammatory and immunomodulatory activities is: | options: A: Tetracyclines B: Polypeptide antibiotics C: Macrolides D: Fluoroquinolones | answer: C </s>

<s>[INST] context: ROS are synthesized the NADPH oxidase (phagocyte oxidase) pathway and are released from neutrophils and macrophages that are activated by microbes, immune complexes, cytokines, and a variety of other inflammatory stimuli. NADPH oxidase also called respiratory burst oxidase When the ROS are produced within lysosomes they function to destroy phagocytosed microbes and necrotic cells Catalase, superoxide dismutase and glutathione peroxidase are free radical scavengers that prevent oxygen-mediated injury The NADPH oxidase complex is dormant under normal circumstances, but is activated to assemble in the membranes during respiratory burst The activated NADPH oxidase generates superoxide which has roles in animal immune response and plant signalling. Superoxide can be produced in phagosomeswhich have ingested bacteria and fungi or it can be produced outside of the cell. Superoxide kills bacteria and fungi by mechanisms that are not yet fully understood.It is presumed that superoxide kills bacteria directly, as the virulence of many pathogens is dramatically attenuated when their superoxide dismutase (SOD) genes are deleted. However, superoxide can also spontaneously form hydrogen peroxide that undergoes fuher reactions to generate other (ROS) like hydrochlorus acid (the reactive agent in bleach). It may also inactivate critical metabolic enzymes, initiate lipid peroxidation, damage iron sulphate clustersand liberate redox-active iron, which allows the generation of indiscriminate oxidants such as the hydroxyl radical ref robbins basic pathology 9th ed page 49 [/INST] question: Oxygen dependent killing is done through- | options: A: NADPH oxidase B: Superoxide dismutase C: Catalase D: Glutathione peroxidase | answer: A </s>

<s>[INST] context: Traveling to Cuba as an American is like jumping through hoops .To help you better prepare for your trip,here are what you need to know about traveling to Cuba. You wilI need to obtain a visa to travel to Cuba.You'11 need to apply for the visa associated with your travel purposes,such as religious or medical travel,family visits,or people-to-people travel,which is the most common type of visa attained by Americans. Because of the U.S.restriction,banks have not yet been able to establish a foothold in Cuba,meaning it's a cash--focused country.You can exchange currency at the Jose Marti International Airport or at your hotel.Keep in mind that there is a 10 percent fee to exchange U.S.currency for Cuban currency.You'11 also want to be sure to carry change for tips. You can reserve a hotel room in Cuba online.Then you can call to confirm your reservation.You can also book through a travel agency.However,payment can be tricky:Even if you pay for your room through your travel agent,the restriction may prevent your payment from reaching your hotel in time(another reason to book well in advance).Come prepared with enough cash to cover the cost,just in case. If you expect to find the blue waters,volcanic landscapes and beautiful villages of other nearby islands,you'11 be disappointed.But beauty is not hard to find here.Old Havana--a UNESCO World Heritage Site--is home to splendid architecture and a bit of paladars(privately owned res--taurants).Limited economic opportunities have led Cubans to be creative in other ways.You can't go two blocks without coming across street paintings,art studios and joyful ballet music. [/INST] question: Most Americans get the visa to Cuba by _ . | options: A: family visits B: people-to-people travel C: religious travel D: medical travel | answer: B </s>

<s>[INST] context: If you're still of the belief thaJ mental health conditions aren,t as serious as physical ones,a new report will open your eyes. The United States spent about $201 billion on mental illness in 2013, according to the new analysis published in the journal Health Affairs. That makes it the costliest medical condition in the country. Heart conditions were the second costliest condition, falling far behind menial disorders at $147 billion. Trauma and injury was third at $143 billion. "One key finding of this study is the degree to which spending on mental health disorders in 2013 topped those on all other medical conditions, including heart conditions, trauma, and cancer. Researcher Charles Roehrig wrote in the study's conclusion. Just a decade ago, heart conditions outweighed mentd disorders. Health care costs on heart Problems were about $105 Million in 1996, with mental disordere coming in second at $79 billion. The findings are just another example of how important it is to recognize mental illness as a widespread public health issue. Nearly one in four people will experience a mental health condition at some point in his or her life. Despite this fact, though, there's still a lack of sensitivity and understanding in society--and even the medical community--when it comes to mental disorders. Research shows discrimination involved in mental health. Negative thoughts surrounding mental illness often prevent people from seeking treatment, which can have serious consequences. Data also suggests that not paying attention to mental illness can affeci a company 's bottom line. Serious mental illnesses result in about $193 billion in lost earnings per year. Lastly, the cost of mental health issues extends beyond a dollar sign, but perhaps the shocking figure in the report will finally serve as a wakeup call for those who believe psychological conditions aren't real issues. In other words, can we please take mental illness seriously now? [/INST] question: How much more is spent on mental disorders_in 2013 compared with 1996? | options: A: $54 billion B: $96 billion C: $122 billion D: $143 billion | answer: C </s>

<s>[INST] context: I'm sure you know the song "Happy Birthday". But do you know who wrote the song and for whom it was written? The retired professor, Archibald A. Hill in Lucasville, USA could tell us the story. Ninety-seven years ago, two of Mr. Archibald Hill's aunts, Miss Patty Hill and Miss Mildred Hill were asked to write some songs for a book called "Song Storied for the Sunday Morning". Miss Patty Hill and Miss Mildred Hill were both kindergarten teachers then. They loved children very much and wrote many beautiful songs for the book. One of them was the famous "Good Morning to You." The song said, "Good morning to you, good morning to you, children, good morning to all." This song was very popular at that time among kindergarten children. But not many grown-ups knew it. A few years later little Archibald was born. As his aunt, Miss Patty Hill sang the song "Happy Birthday" to the melody of "Good Morning to you" to her little nephew . She sang the song like this: Happy birthday to you! Happy birthday to you! Happy birthday, Archie! Happy birthday to you! Miss Patty Hill and her sister had never expected that this song would become so popular, but it really did. People all over the world like the song because of its simplicity in tune and friendliness in words. [/INST] question: Archibald A. Hill was _ . | options: A: English B: American C: Russian D: Australian | answer: B </s>

<s>[INST] context: The severity of the syndrome usually abates with time. Apart from the patients with CNS-Behcet's syndrome and major vessel disease, the life expectancy seems to be normal, and the only serious complication is blindness.  Mucous membrane involvement may respond to topical glucocorticoids in the form of mouthwash or paste. In more serious cases, thalidomide (100 mg/d) is effective. Thrombophlebitis is treated with aspirin, 32 5 mg/d. Colchicine can be beneficial for the mucocutaneous manifestations of the syndrome. Uveitis and CNS-Behcet’s syndrome require systemic glucocorticoid therapy (prednisone, 1 mg/kgperdav) and azathioprine, 2-3 mg/kg per day. Interferon has proved to be very effective not only for CNS-Behcet's syndrome but also for refractory uveitis. ''Topical agent used in Behcet's syndrome: Steroids, tacrolimus & local anesthetics"- Neena Khanna 3rd/204 Chlorambucil, pentoxifylline & cyclosporine are also used in Behcet's syndrome-CMDT 06/851 INTERNET Anti-TNF therapy such as infliximab has shown promise in treating the uveitis associated with the disease. Another Anti-TNF agent, Etanercept. may be useful in patients with mainly skin and mucosal symptoms. Interferon alfa-2a may also be an effective alternative treatment, particularly for the genital and oral ulcers Dapsone and rebamipide have been shown, in small studies, to have beneficial results for mucocutaneous lesions. Given its rarity, the optimal treatment for acute optic neuropathy in Behcet's disease has not been established. Early identification and treatment is essential. Response to ciclosporin. perioculartriamcinolone and IV methylprednisone followed by oral prednisone has been reported although relapses leading to irreversible visual loss may occur even with treatment. [/INST] question: Treatment of Behcet's syndrome consists of: (A)Vincristine (B)Aspirin (C)Glucocorticoids (D)Thalidomide | options: A: ABC B: BCD C: CAD D: BCA | answer: B </s>

<s>[INST] context: When Alexandra Holderman of Indiana was five years old, she saw a bay dressed in only a T-shirt, diaper , and blanket in the middle of winter. Alexandra could tell that the baby was very cold. "He had red, chapped skin and a runny nose," she remembers. That same year, Alexandra started Baby Bundles , a program to help mothers keep their babies warm. She packed bundles of pajamas, blankets, diapers, bottles and bibs, and then delivered them to centers for women who couldn't afford the items. Alexandra continues this program today. Where does Alexandra get the money for her program? The first year, family members helped a lot. Many of them gave Alexandra money to buy supplies. Alexandra's mother, who has always encouraged Alexandra to share her blessings with people who are less fortunate, taught her how to request donations from stores. Alexandra felt shy speaking with stores' business managers at first. "But now it just comes naturally," she says, "and I have places that donate stuff every year." Alexandra has been doing Baby Bundles for six years now. Each September she writes betters to stores asking for supplies and donations. Then she makes follow-up phone calls. In October, she gathers all of the donations and goes shopping. One of the biggest challenges is getting all of the supplies she needs while staying within a planned budget. Alexandra has had to give up her allowance and some time with friends, but she knows that what she's doing helps. Sometimes she sees a baby wearing clothes like the ones she put in her bundles. And she wonders if that baby was helped by her program. "I know that there are babies out there who are warmer and healthier now," she says. Alexandra plans to continue Baby Bundles as long as she can and is currently trying to get a Web site set up. She hopes that her work will inspire other young people to find ways to serve their communities. Alexandra has made sure that many babies in Indiana remain cozy during the winter months. DCAC [/INST] question: The following things except _ may be included in Alexandra's Baby Bundles. | options: A: baby clothes B: diapers C: baby caps D: money | answer: D </s>

<s>[INST] context: surging commodity prices could worsen poverty in many poor countries, the International Monetary Fund warned Tuesday. A new IMF study, seeing the effect of soaring oil and food costs, said many poor and developing countries would likely have to change their economic policies in response to soaring commodity prices. "Some countries are at a dangerous point," warned IMF managing director Dominique Strauss-Kahn. "If food prices rise further and oil prices stay the same, some governments will no longer be able to feed their people and at the same time keep stability in their economies," Strauss-Kahn said. The IMF chief called for a "broad cooperative approach" to help handle higher oil and food prices, and said the IMF stood ready to assist countries in need. Strauss-Kahn said the international community would also have to play a role in helping to reduce the effect of commodity price shocks which have caused protests in some countries. European truckers have blockaded major roads to protest fuel prices in recent weeks and food riots have occurred in Cameroon, Bangladesh, and Somalia among other countries in recent months. "Poor countries that are highly dependent on food imports are particularly vulnerable to rising food prices," the IMF report said. Anti-poverty campaigners are concerned that rising commodity costs could roll back advances made through anti-poverty campaigns in recent years, particularly because poorer families tend to spend much more of their household income on food. The IMF report found that poor households are most affected by food price inflation and "warned that the share of undernourished people in developing countries could rise rapidly above the current 40 percent of total population". Energy and food values are still rising and the IMF said its research suggests "the problem is worsening". The Washington-based fund said it is working closely with its member countries to help reduce inflationary pressures taking into account countries' specific needs. The report said that global food markets "need to be kept open" and that "restrictive policies", such as export taxes and bans, should be removed. [/INST] question: To reduce the effects of rising oil and food prices, the IMF suggests _ . | options: A: increasing export taxes B: placing restrictions on export C: global food markets shouldn't be kept open D: taking different measures to cooperate with its member countries | answer: D </s>

<s>[INST] context: HENOCH SCHONLEIN (ANAPHYLACTOID) PURPURA • Most common systemic vasculitis in children • 90% cases occur in the age group 3 to 10 years • Immune complex deposition causing small vessel vasculitis • Many cases of HSP follow a documented upper respiratory infection Characterized by the tetrad of • Palpable purpura (due to vasculitis, not due to thrombocytopenia) - occur in gravitydependent areas (lower extremities) or on pressure points (buttocks) • Polyarthralgia in the absence of arthritis (non-deforming, oligoarticular, involves large joints, migratory) • Gl symptoms (colicky abdominal pain, passage of blood and mucus per rectum, intussusception) - in 80% children • Mild glomerulonephritis (IgA deposition in the mesangium, microscopic hematuria) - in 50% children • Chronic renal disease develops in 1-2% of children with HSP • Approximately 8% of those with HSP nephritis go on to have end-stage renal disease • Myocardial involvement can occur in adults but is rare in children Laboratory features • ANCA negative • Leukocytoclastic vasculitis with IgA deposition in the small vessels in the skin, joints, gastrointestinal tract & kidney • Deposition of C3, fibrin, and IgM are also seen to a lesser extent • Elevated ESR • Normal platelet count • Normal complement levels Diagnosis, prognosis and treatment • No laboratory finding is diagnostic of HSP; The diagnosis of HSP is a clinical one • Treatment for mild and self-limited HSP is supportive • Steroids are most often used to treat significant gastrointestinal involvement or other lifethreatening manifestations • Predisone: useful in decreasing tissue edema, arthralgias, and abdominal discomfort; but does not alter overall prognosis nor prevent renal disease. • The prognosis is excellent ❖ Deposits of IgA are also found in the glomerular mesangium in a variety of systemic diseases, including chronic liver disease, Crohn's disease, gastrointestinal adenocarcinoma, chronic bronchiectasis, idiopathic interstitial pneumonia, dermatitis herpetiformis, mycosis fungoides, leprosy, ankylosing spondylitis, relapsing polychondritis, and Sjogren's syndrome. [/INST] question: An 8 year old child is brought with c/o severe abdominal pain. O/E palpable purpura is noted. There is history of recent diarrhea which is completely resolved. What is the expected pathological finding in kidney? | options: A: Podocyte effacement on electron microscopy B: Electron dense deposits in the Glomerular basement membrane on electron microscopy C: Hypercellular glomeruli with neutrophils on light microscopy D: Mesangial deposits of IgA on electron microscopy | answer: D </s>

<s>[INST] context: Orthomyxoviruses and paramyxoviruses are RNA viruses that contain a single-stranded RNA genome. The influenza viruses belong to the orthomyxoviruses. They cause acute respiratory tract infections that usually occur in epidemics. Isolated strains of influenza virus are named after the virus type (influenza A, B, or C) as well as the host and location of initial isolation, the year of isolation, and the antigenic designation of the hemagglutinin and neuraminidase. Both the hemagglutinin and neuraminidase are glycoproteins under separate genetic control, and because of this they can and do vary independently. The changes in these antigens are responsible for the antigenic drift characteristic of these viruses. The paramyxoviruses include several important human pathogens (mumps virus, measles virus, respiratory syncytial virus, and parainfluenza virus). Both paramyxoviruses and orthomyxoviruses possess an RNA-dependent RNA polymerase that is a structural component of the virion and produces the initial RNA. Respiratory syncytial viruses (RSV) are not related to the paramyxoviruses. They are 150-nm single-stranded RNA viruses. There are 2 antigen groups, A and B, which play no role in diagnosis and treatment. While the overall mortality is 0.5%, at-risk groups may be 25 to 35% mortality if untreated. Some parainfluenza virus infections (type 3) may be indistinguishable from RSV, but most parainfluenza infections produce a laryngotracheobronchitis known as croup. [/INST] question: This virus is a single-stranded RNA paramyxovirus. The rash known as Koplik's spots is pathognomonic. | options: A: Measles virus B: Influenza virus C: Respiratory syncytial virus D: Parainfluenza virus | answer: A </s>

<s>[INST] context: Laptop computers are popular all over the world.People use them on trains and airplanes, in airports and hotels.These laptops connect people to their workplace.In the United States today, laptops also connect students to their classrooms. Westlake College in Virginia will start a laptop computer program that allows students to do schoolwork anywhere they want.Within five years, each of the 1500 students at the college will receive a laptop.The laptops are part of a $10 million computer program at Westlake, a 110-year-old college.The students with laptops will also have access to the Internet.In addition, they will be able to use e-mail to "speak" with their teachers, their classmates, and their families.However, the most important part of the laptop program is that students will be able to use computers without going to computer labs.They can work with it at home, in a fast-food restaurant or under the trees--anywhere at all! Because of the many changes in computer technology, laptop use in higher education, such as colleges and universities, is workable.As laptops become more powerful, they become more similar to desktop computers.In addition, the portable computers can connect students to not only the Internet, but also libraries and other resources.State higher-education officials are studying how laptops can help students.State officials are also testing laptop programs at other universities, too. At Westlake College, more than 60 percent of the staff use computers.The laptops will allow all teachers to use computers in their lessons.As one Westlake teacher said, " Here we are in the middle of Virginia and we're giving students a window on the world.They can see everything and do everything." [/INST] question: The main purpose of the laptop program is to give each student a laptop to _ . | options: A: connect them to libraries B: access the Internet C: work at home D: use for their schoolwork | answer: D </s>