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{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 38-year-old woman complains to her physician of chronic pelvic pain that is much worse during her menstrual periods. Pelvic examination demonstrates an enlarged uterus with multiple palpable masses. Ultrasound shows that a large number of ball-like masses up to 6 cm diameter are present in the uterus. Most cases of this type of tumor are found at which of the following sites?\nA) Intramurally in the cervix of the uterus\nB) Intramurally in the fundus or body of the uterus\nC) Submucosally in the cervix of the uterus\nD) Submucosally in the fundus or body of the uterus", "output": "1, because The vast majority of leiomyomas are found in the uterine fundus or body; with only 3% being found in the cervix. Of the leiomyomas in the fundus or body, 95% are intramural, with the remainder being located subserosally or submucosally."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 9-month-old girl is brought with PR bleed, vomiting, mass in right lumbar region with masked liver dullness. She is in shock like condition. Management should include all of the following EXCEPT?\nA) Barium enema\nB) IV fluid\nC) Give O2\nD) Nasogastric tube", "output": "0, because * In patients with prolonged intussusception with signs of shock, peritoneal irritation, intestinal perforation, reduction (with barium, saline or air) should not be attempted * Urgent laprotomy should be planned * But the first priority is urgent resuscitation ie A, B, C (airway, breathing, circulation). Hence in case of shock, and as the child in question is also vomiting, she should be made NPO and Nasogastric tube inseion should be done."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is not a feature of consolidation\nA) Increased vocal resonance\nB) Dull Percussion note\nC) Bronchial Breath sounds\nD) Tracheal shift to side of consolidation", "output": "3, because Answer is D (Tracheal shift to side of consolidation): Trachea stays in midline in consolidation (no mediastinal shift). Consolidation is usually caused by pneumonia. In this situation alveoli are full of inflammatory exudates but the size of the lung is unaffected so the trachea remains in its normal midline position."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCadaveric position of vocal cords ?\nA) Midline\nB) 1.5 mm from midline\nC) 3.5 mm from midline\nD) 7.5 mm from midline", "output": "2, because Ans. is 'c' i.e., 3.5 mm from midline Position of vocal cords The position of the vocal cords may be described as being in various positions. These are : ? 1. Median position The vocal cords are in midline. This is the position of normal larynx during phonation and in recurrent laryngeal nerve palsy. 2. Paramedian position Just off midline (1.5 mm form midline) This position occurs in normal larynx during strong whisper. This is the resting position of vocal cords after long-term recurrent laryngeal nerve injury. 3. Cadeveric (Intermediate) position (3.5 mm from midline) It is 15-20deg from midline. This is the position of immediate total denervation of both recurrent laryngeal nerve as well as superior laryngeal paralysis, as in high vagal paralysis. 4. Gentle abduction (7 mm from midline) This position is seen during quiet respiration in normal larynx and in paralysis of adductors (very rare). 5. Abduct position (9.5 mm from midline) It is 30-45deg from midline. This is the position of maximum adduction during deep inspiration."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich one of the following phenomena is closely associated with slow wave sleep:\nA) Dreaming\nB) Atonia\nC) Sleep walking\nD) Irregular hea rate", "output": "2, because C i.e. Sleep walking"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\n2-year-old child presents with sho stature and cafe-au lait spots. Bone marrow aspiration yields a little material and mostly containing fat. What is your diagnosis:\nA) Fanconi anemia\nB) Dyskeratosis congenita\nC) Tuberous sclerosis\nD) Osteogenesis imperfecta", "output": "0, because - All features given in the question suggests the diagnosis of Fanconi anemia Common physical findings in Fanconi Anemia (FA): - Skin pigment changes including Cafe-au-lait spots (55% cases) - Sho stature (in 50% cases) - Microcephaly - Thumb and radial malformations - Renal and cardiac malformations - Hypogonadism - Associated with Aplastic anemia."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThe following statements are true regarding Chlamydia except:\nA) Erthromycin is effective for therapy of Chamydial infections\nB) Their cell wall lacks a peptidoglycan layer\nC) They can grow in cell free culture media\nD) They are obligate intracellular bacteria", "output": "2, because Unique properties of Chlamydia are\nChlamydia is an obligate intracellular parasite. This means they can survive only by establishing residence inside\nAnimal cells\nThey need their host's ATP as an energy source for their own cellular activity. They are energy parasites using a\nCell membrane transport system that uses ATP from the host system and gives out ADP.\nThis obligate intracellular existence makes it impossible to culture these organisms on nonliving artibacterial media.\nDue to their small size and failure to grow in cell - free media they were considered to be viruses.\nChlamydiae grows in cultures of a variety of eukaryotic cell lines Me Coy or HeLa cells. It may be necessary to\nTreat cells with poly anionic compounds such as DEAD-dextran to reduce the electrostatic barrier to infection.\nAntimetabolite such as cycloheximide is added to favour competition for host cell amino acid pools. All types of\nChlamydiae proliferate in embryonated eggs particularly in the yolk sac.\nThe special features in structure and chemical composition of chlamydiae are\nThe outer cell wall resembles the cell wall of gram negative bacteria It has a relatively high lipid content\nIt is rigid but it does not contain typical bacterial peptidoglycan; perhaps it contains a Tetrapeptide linked matrix.\nN Acetyl muramic acid also appears to be absent from chlamydiae cell wall\nAntibiotic susceptibility of chlamydiae.\nPenicillin binding proteins occur in chlamydiae cell wall and chlamydiae cell wall formation is inhibited by penicillins\nAnd other drugs that inhibit transpeptidation of bacterial peptidoglycan. But remember the important point about t/t,\nThat cell wall inhibitors result in the production of morphologically defective forms but are not effective in clinical\nDisease.\n\u2022 Inhibitors of protein synthesis (tetracyclines, erythromycins) are effective in most clinical infections. Erythromycin\nOr tetracyclines are considered the drug of choice for chlamydiae infections."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following tests is best for differentiating ACTH secreting pituitary tumour from Ectopic ACTH production?\nA) 24 hour Urinary free coisol\nB) Overnight dexamethasone suppression test\nC) Low dose dexamethasone suppression test\nD) High dose dexamethasone suppression test", "output": "3, because 24 hour urinary coisol levels are elevated in both subsets: ACTH secreting pituitary tumour and Ectopic ACTH secretion. Overnight Dexamethasone suppression test involves overnight 1mg dexamethasone tablet and measurement of 8am morning serum or urinary coisol. It is used to diagnose hypercoisolism but cannot identify etiology of Cushing syndrome. High dose dexamethasone suppression test involves giving 6 hourly dexamethasone 2mg, which leads to etiological diagnosis.( differentiates between ACTH secreting pituitary tumor from Ectopic ACTH ) Serum Coisol> 5mg/dl: Ectopic ACTH production."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nForceps delivery is done in all except:\nA) Mentoposterior\nB) Deep transverse arrest\nC) After coming head\nD) Maternal heart disease", "output": "0, because Option \u2018a\u2019\nMentoposterior: Before going on to mentoposterior, lets see mentoanterior.\nMentoanterior\n\u200bDutta Obs. 7/e, p 390\nIn mentoanterior face presentation there is place for spontaneous vaginal delivery and liberal episiotomy is all that is required. In case of delay, forceps delivery is done.\nIn mentoposterior: 20 to 30% cases rotate anteriorly through 3/8 of circle and deliver as mento anterior, there fore trial of labour may be given in hope of anterior rotation of chin, followed by spontaneous/forceps delivery. In the rest 70-80%, incomplete anterior rotation/ non rotation occurs.\nIn these persistent mentoposterior: cesarean section is the only management. Therefore in mentoposterior per se forceps is not applied, only when it rotates anteriorly and becomes mentoanterior, forceps are applied.\nOption \u2018b\u2019\nDeep transverse arrest\nManagement options in case of deep transverse arrest are:\nDutta Obs. 7/e, p 372\nVentouse: Ideal for all cases\nCesarean section: If the pelvis is android or there is CPD, cesarean section should be done. In modern obstetrics, traumatic vaginal delivery causing intracranial hemorrhage is to be avoided at all costs and so there is increasing use of cesarean section for deep transverse arrest.\nOther options are:\n\nManual rotation followed by outlet forceps application.\nForceps rotation and delivery using Keilland forceps.\nCraniotomy if the baby is dead.\n\nAs far as options \u2018c\u2019 and \u2018d\u2019 are concerned: In after coming head of breech, and in heart disease forceps are routinely applied."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nPentamidine therapy causes all, EXCEPT ?\nA) Upper lobe infiltrates\nB) Cavitation\nC) Extrathoracic manifestation\nD) None", "output": "3, because Ans. is None o Patients who receive aerosolized pentamidine have increased frequency of upper lobe infiltrates. Pneumothorax also occurs. o Risk factor for extrapulmonary spread in patients with HIV is the administration of aerosolized pentamidine. o In patients with PCP who have been receiving aerosolized pentamidine for prophylaxis, one may see an X-ray picture of upper lobe cavitary disease."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTrue about hepatitis C virus are all except -\nA) Most common cause of chronic infection\nB) Has live attenuated vaccine\nC) Spread by blood transfusion\nD) Is a flavivirus", "output": "1, because Ans. is 'b1 i.e., Has live attenuated vaccineHEPATITIS C VIRUS (HCV)o The hepatitis 'C' virus has been classified as a new' genus Hepacivirus in the family flaviviridae.o The virus can not be cultured but can be cloned in Escherichia coli.o It is the commonest cause of post transfusion hepatitis and chronic hepatitis.o Incubation period is 50 days (15 - 160 days),o Modes of transmission of HCV are :-Blood transfusion : Most common mode of transmission and HCV is the most common cause of post-transfusion hepatitis.Percutaneous transmission : By needle punctures.Perinatal transmission : Transmission appears to be a function of the degree of maternal viremia which is detected by PCR for HCV RNA.Sexual transmission.o Among hepatitis viruses, HCV has the maximum propensity for chronic hepatitis and chronic carrier state. It can also cause cirrhosis and hepatocellular carcinoma.o The most common indication for liver transplantation currently is cirrhosis due to chronic hepatitis ;C' infection.o HCV usually does not cause acute liver failure (vary rare with HCV)o Extrahepatic manifestation with HCV infection may be essential mixed cryoglobulinemia (more than HBV), porphyria cutanea tarda, pulmonary fibrosis and membrano-proliferative GN.Among the Hepatitis viruses, vaccine is available for HAV and HBV.Live attenuated vaccine is available for HAV only (among hepatitis viruses)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIn IMNCI, pneumonia is classified by-\nA) Fast breathing\nB) Wheezing\nC) Fever\nD) Chest indrawing", "output": "0, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDigestion of disaccharides occurs at ?\nA) Mouth\nB) Stomach\nC) Small intestine\nD) Large intestine", "output": "2, because Ans. is 'c' i.e., Small intestine Digestion of disaccharides (maltose, sucrose and lactose) occurs by the enzymes present in brush border os small intestinal epithelial cells. Maltase (a-glucosidase) breaks 1: 4 linkages in maltose and maltotriose and releases glucose (two molecules of glucose from maltose and three molecules of glucose from maltotriose). Isomaltase (a-limit dextrinase) breaks 1 : 6 a linkages of alpha-limit dextrin and releases glucose. Isomaltase dextrinase) is the only enzyme that attacks 1 : 6a linkage. Sucrose is hydrolysed into fructose and glucose by sucrase (an enzyme present in brush border of intestinal epithelium). Lactose is hydrolysed into galactose and glucose by lactase ((3-glucosidase). Trehalase hydrolyzes trehelose (a 1:1 a - linked dimer of glucose) into two glucose molecules. Trehalose is found in mushrooms."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 30 year old female patient complains of painless hard anterior neck mass. FNAC was inconclusive. Open thyroid biopsy was performed which revealed the \ufb01brous nature of the mass, woody, non tender thyroid, mimicking carcinoma is observed. The diagnosis points towards\nA) De Quervain's thyroiditis\nB) Riedel's thyroiditis\nC) Hashimoto\u2019s thyroiditis\nD) None of the above", "output": "1, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA person's X-ray chest showing homogenous opacity on right side with shifting of mediastinum on opposite side. Most probable diagnosis is/are:\nA) Collapse\nB) Pleural effusion\nC) Pneumothorax\nD) Consolidation", "output": "1, because Answer- (B) Pleural effusionPneumonectomy chest (Early sip: within 24 hr): Paial filling of thorax, ipsilateral mediastinal shift & diaphragmatic elevation.Homogenous opacityShift of mediastinum to the opposite sideConcave upper border (Ellis's curve)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll of the following causes coloured halos except\nA) Corneal edema\nB) Retinal degeneration\nC) Foreign body\nD) Steroids", "output": "1, because Halos can sometimes be a normal response to bright lights. Halos can also be caused by wearing eyeglasses or corrective lenses (contact lenses), or they can be a side effect of cataract or LASIK surgery. ... Thehalos are a result in diffraction of light entering your eye"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is not a function of liver ?\nA) Production of albumin\nB) Detoxification of ammonia\nC) Production of vitamin K\nD) Metabolism of drugs", "output": "2, because Ans. (c) Production of vitamin KRef: Robbin's pathology 9th ed. Z821* Vitamin K is produced by the bacteria of gut and is used by liver for gamma carboxylation of factor 2/7/9/10.# Liver produces albumin which falls in liver cirrhosis producing ascites/edema.# Ammonia is combined with carbon dioxide to produce urea which in turn is excreted by the liver.# The cytochrome P450 is responsible for metabolism of drugs."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAn elderly woman suffering from schizophrenia is on antipsychotic medication. She developed purposeless involuntary facial and limb movements, constant chewing and puffing of cheeks. Which of the following drugs is least likely to be involved in this side effect -\nA) Haloperidol\nB) Clozapine\nC) Fluphenazine\nD) Loxapine", "output": "1, because Purposeless involuntary facial and limb movements, constant chewing and puffing of checks suggest the diagnosis of tardive dyskinesia (an extrapyramidal side effect of antipsychotics).\nClozapine does not produce extrapyramidal side effects."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCluster testing is used in the detection of-\nA) STD\nB) Diabetes\nC) Measles\nD) Cancer", "output": "0, because .Cluster testing is used in the detection of of STD S.here the patients are asked to name other persons of either sex ho move in the same socio-sexual environment.these persons are then screened .this technique ha been shown almost to double the number of cases found ref:park&;s textbook,ed22,pg no 312"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEthmoidal polyp is ?\nA) Due to infection\nB) Single\nC) Recurrent\nD) Occurs in children", "output": "2, because Ans. is 'c' i.e., Recurrent"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is not seen in Tuberous sclerosis ?\nA) Shagreen patch\nB) Adenoma sebacecum\nC) McCollon Plaques\nD) Depigmented nevi", "output": "2, because Ans. is 'c' i.e., McCollon Plaques"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 35 yr old pregnant female at 40 weeks gestational age presents with pain and regular uterine contractions every 4-5min . On arrival the patient is in a lot of pain and requesting relief immediately. Her cervix is 5 cm dilated. What is most appropriate method of pain control for this patient\nA) Intramuscular morphine\nB) Pudendal block\nC) Local block\nD) Epidural block", "output": "3, because When complete relief of pain is needed throughout labor epidural analgesia is safest and simplest"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSchistosomiasis is an example of -\nA) Meta-zoonoses\nB) Cyclo-zoonoses\nC) Direct-zoonoses\nD) Sporo-zoonoses", "output": "0, because Ans. is 'a' i.e., Meta-zoonoses Zoonoseso Zoonoses are diseases and infections which are naturally transmitted between vertebrate animal and man.o The zoonoses may be classified according to the direction of transmission of disease : -AnthropozoonosesInfection is transmitted to man from lower vertebrate animals.Examples - Rabies, plague, hydatid disease, anthrax, trichinosis,ZoonthroponosesInfection is transmitted from man to lower vertebrate animalsExamples - Human tuberculosis in cattle3. AmphixenosesInfection is maintained in both man and lower vertebrate animals that may be transmitted in either direction.Examples - T. cruzt S. japonicum.Based on the type of life cycle of infecting organism, zoonoses are divided into four categories : -Direct zoonosesTransmitted from an infected vertebrate host to a susceptible vertebrate host by direct contact, by contact with a fomite or by a mechanical vector.The agent itself undergoes little or no propagative changes and no essential developmental change during transmission.Example are - Rabies, Trichinosis, Burcellosis.Cyclo - zoonosesRequire more than one vertebrate host species, but no invertebrate host, in order to complete the developmental cycle of the agent.Example - Taeniasis, echinococcosis (hydatid disease).Meta-zoonosesTransmitted biologically by invertebrate hostIn invertebrate host, the agent multiplies or develop.Examples - Arbovirus infections (e.g., JE, KFD), plague. Schistosomiasis,Sporo - zoonosesThere is non-animal developmental site or reservoir e.g., organic matter (food). Soil and plants.Examples -Larva migrans and some mycoses."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTreatment of hydatid cyst\nA) Excision of cyst\nB) Percutaneous drainage\nC) Conservative management\nD) None", "output": "1, because Puncture - aspiration- injection -reaspiration (PAIR) done percutaneously because it is safe, less invasive, easier to do with low morbidity and moality. Reference: SRB 5th edition page no. 604"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThe structure damaged in the given condition is responsible for all except:\nA) Taste sensation of ant 2/3rd tongue\nB) Lacrimal gland secretion\nC) Parotid gland secretion\nD) Platysma contraction", "output": "2, because The condition given here is Bell's palsy i.e. LMN (lower motor neuron) lesion of Facial nerve . In this the ipsilateral half of the face is affected. The facial nerve emerges from the pons of the brainstem, controls: Muscles of facial expression, and Carries taste sensations from the anterior two-third of the tongue (chorda tympani branch of facial nerve) Supply lacrimal, nasal and palatal glands secretions greater petrosal nerve. Glossopharyngeal nerve supplies parasympathetic fibers to the parotid gland the otic ganglion and cause parotid gland secretion."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nH. pylori has been implicated in all, except\nA) Gastric ulcer\nB) Gastric carcinoma\nC) Gastric lymphoma\nD) GIST", "output": "3, because H pylori infection is almost always present in the setting of active chronic gastritis and is present in most patients with duodenal (80% to 95%) and gastric (60% to 90%)ulcers. Most patients with gastric cancer have current or past H. pylori infection.There is also a strong association between mucosa-associated lymphoid tissue (MALT)lymphoma and H. pylori infection.Sabiston 20e pg: 1223"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 41 year old man presented with swelling over parotid area. He has only mild pain. Which is the commonest tumor of the parotid?\nA) Pleomorphic adenoma\nB) Monomorphic adenoma\nC) Wahin's tumor\nD) Adenocarcinoma", "output": "0, because Pleomorphic adenomas or benign mixed tumors, are the most common neoplasms of the salivary glands. They represent approximately 60-70% of all parotid tumors and 90% of submandibular benign tumors. These neoplasms affect females more than males and are commonly seen in the third to sixth decades of life. Histologically, pleomorphic adenomas arise from the distal poions of the salivary ducts, including the intercalated ducts and acini."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDepression is not a side effect of\nA) Propanolol\nB) Oral contraceptives\nC) Reserpine\nD) Flupenthixol", "output": "3, because Answer is option4, flupenthisol. The antidepressive and anxiolytic efficacy of flupenthixol has been investigated in numerous controlled and open trials involving patients with endogenous, reactive as well as senile depressions. When administered at a mean daily single or multiple dose of 1-2 mg, flupenthixol proved to be a very effective and well-tolerated antidepressant. As opposed to some of the currently available antidepressants, flupenthixol has a rapid onset of action which is often displayed within the first 2-3 days following its application. Ref:"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOf the following permanent teeth, which is least likely to have two roots?\nA) Maxillary canine\nB) Mandibular canine\nC) Maxillary first premolar\nD) Mandibular first premolar", "output": "0, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDrug of choice for pregnant female suspected of having a baby with congenital adrenal hyperplasia\nA) Dexamethasone\nB) Betamethasone\nC) Hydrocoisone\nD) Prednisolone", "output": "0, because Refer Goodman Gilman 12/e p 123 To suppress fetal androgen production effectively band consequent virilization Dexamethasone must be initiated before 10 weeks of gestation To treat congenital adrenal hyperplasia is baby hydrocoisone is used."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThe drug that inhibits uterine contractility and cause pulmonary edema is :\nA) Ritodrine\nB) Nifedipine\nC) lndomethacin\nD) Atosiban", "output": "0, because Ans. is a i.e. Ritodrine Pulmonary edema is a serious complication of beta-adrenergic therapy (ritodrine) and MgSO4. This complication occurs in patients receiving oral or (more common) intravenous treatment. It occurs more frequently in patients who have excessive plasma volume expansion, such as those with twins or those who have received generous amounts of intravenous fluids and in patients with chorioamnionitis. Patient presents with respiratory distress, bilateral rales on auscultation of the lungs, pink frothy sputum, and typical X-ray picture. Patients receiving IV beta-adrenergic drugs should be monitored continuously with pulse oxymeter to anticipate the development of pulmonary edema."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA patient presents with diarrhoea. analysis of stool on wet mount shows mobile protozoa without RBCs and pus cells. The diagnosis is -\nA) Balantidium coil\nB) Giardiasis\nC) Trichomonas hominis\nD) Entamoeba histolytica", "output": "1, because Ans. is 'b' i.e., Giardiasis . Mobile protozoa with absence of RBC's and pus cells in stools in a patient with diarrhoea suggests giardiasis. . In balantidum cob and entomoeba histolytica infections, pus cells and RBC's will be present in stools. Trichomonas hominis is considered as non-pathogenic"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA clinical study involves patients diagnosed with carcinoma whose tumor stage is T4N1M1. The patients' survival rate 5 years from the time of diagnosis is less than 50%, regardless of therapy. Which of the following clinical findings is most likely to be characteristic of this group of patients?\nA) Cachexia\nB) Cardiac murmur\nC) Icterus\nD) Loss of sensation", "output": "0, because Cachexia is a common finding in advanced cancers, and weight loss without dieting in an adult is a \"red flag\" for malignancy. The exact cause for this is unknown, but increases in circulating factors such as tumor necrosis factor (TNF) may play a role. Cardiac murmurs may occur in the development of nonbacterial thrombotic endocarditis, a feature of a hypercoagulable state that may occur with advanced malignancies. Icterus is most likely to occur when there is obstruction of the biliary tract by a mass (e.g., as in pancreatic cancer), but metastases are unlikely to cause such an obstruction. Neurologic abnormalities may occur in local tumor growth impinging on nerves, but dull constant pain is the most likely abnormality in malignant neoplasms that invade nerves. Metastases to the spleen are uncommon. Tympany is uncommon in cancer because obstruction by a mass tends to be incomplete and to develop over a long time. (Hint: an empty beer keg is tympanitic when percussed.)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThiopentone is absolutely contraindicated in\nA) Porphyria\nB) Moribund patients\nC) Increased intracranial pressure\nD) Meningitis", "output": "0, because (Porphyria): (381 -- KDT 7th edition; 536- Goodman 12th7or variegate)Thiopentone can precipitate acut intermittent or variegate porphyria in susceptible individuals therefore contraindicated. The abnormal synthesis of protoporphyrin (important in hemoglobin production) results in excess porphobilinogen. Barbiturates induce amino levulinic acid synthase, an enzyme responsible for phosphobilinogen synthesis, This leads to excessive porphobilinogen levels and can precipitate acute porphyric crises, that are manifested by severe abdominal pain, nausea, vomiting, psychiatric disorders and neurologic abnormalities"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTrue regarding the rubens valve is\nA) Is a non-rebreathing valve\nB) Will not allow spontaneous respiration\nC) Is a pressure reducing valve\nD) May jam in expiratory position", "output": "0, because Rubens valve is a non \u2013 rebreathing valve used in self inflating resuscitation bags. It jams in inspiratory position occasionally. It allows spontaneous breathing ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nLoeffler's medium is-\nA) Indicator medium\nB) Selective medium\nC) Enrichment medium\nD) Enriched medium", "output": "3, because Enriched media The media containing ingredients which enhance their growth-promoting qualities E.g. Blood agar, Chocolate agar and Loeffler medium. The usual media employed for cultivation of the diphtheria bacillus are Loeffler's serum slope and tellurite blood agar. Diphtheria bacilli grow on Loeffler's serum slope very rapidly and colonies can be seen in 6-8 hours, long before the other bacteria grow. Best Selective media for Corynebaterium is Potassium tellurite agar."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are true about halothane except -\nA) Tachycardia\nB) Hepatitis\nC) Bronchodilatation\nD) Uterine relaxation", "output": "0, because Ans. is 'a' i.e., Tachycardia o Halothane causes bradycardia.Halothaneo It is a volatile liquid with sweet odour, nonirritating and noninflammable.o It is a potent anaesthetic with poor analgesic and muscle relaxant properties,o Halothane causes direct depression of myocardial contractility by reducing intracellular Ca+2.o It causes fall in BP and CO.o Heart rate decreases due to vagal stimulation.o It tends to sensitize the heart to arrhythmogenic action of adrenaline - contraindicated in pheochromocytoma.o It causes greater depression of respiration and ventilation perfusion mismatch.o It dilates the bronchi -inhalation agent of choice in asthmatics (intravaneous anaesthetic of choice in asthmatics is ketamine).o It is a hepatotoxic drug and can also cause malignant hyperthermia (Succinylcholine accentuate it),o Recovery is smooth and reasonably quick,o It causes postanaesthetic shivering and chills.o It inhibits intestinal and uterine contractions - agent of choice for assisting external or internal version during late pregnancy.o Because its uterine relaxant action it is contraindicated during labour.o It is particularly suitable for induction and maintenance in children and as maintenance anaesthetic in adults."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA man coming from a mountain whose wife died 6 months prior says that his wife appeared to him and asked him to join her. The diagnosis is\nA) Normal grief\nB) Grief psychosis\nC) Bereavement reaction\nD) Supernatural phenomenon", "output": "1, because B i.e. Grief psychosis Bereavement, Grief, or Mourning is a psychological reaction of those who survive a significant loss. Differences between normal & abnormal grief:Identifying with a deceased person such as taking on ceain admired traits or treasuring ceain possessions is normal; believing that one is the deceased person or is dying of exactly what the deceased person died of (if in fact, this is untrue) is not normal.- Hearing the fleeting, transient voice of a deceased person may be normal; persistent, intrusive, complex auditory hallucinations are not normal.Denial of ceain aspects of the death is normal; denial that includes the belief that the dead person is still alive is not normal.GriefIs a normal response of an individual to the loss of a loved object which presents with:- Various physical & mental symptoms like sighing, crying, choking, breathing difficulty, weakness, etc. - Preoccupation with the memory of deceased- Sense of presence of deceased & misinterpretation of voices & faces of others as that of lost. - Seeing a person in dreams & fleeting hallucinations.Abnormal Grief Exaggeration of one or more normal symptoms of grief- Duration > 6 months. Pathological/Morbid GriefComplicated Grief1Associated with psychotic orneurotic illness* Chronic Grief* Delayed Grief* Inhibited Grief =* Anniversary Reaction=Duration > 6 monthsOnset after 2 weeks of lost (death)Denial of lossGrief reaction on the death anniversary Over idealization of the deceased."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOcular manifestation in giant cell arteritis?\nA) Arteritic AION\nB) Nonarteritic AION\nC) Papilledema\nD) Horners Syndrome", "output": "0, because Ans. a. Arteritic AIONAION occurs due to interference of blood supply to anterior part of optic nerve (posterior ciliary artery)AION can be clinically differentiated into:Arteritic AIONNonarteritic AION*. Due to giant cell arteritis*. Due to occlusion of short posterior ciliary artery*. Sudden, severe visual loss (6/60)*. Sudden, moderate visual loss (>60/60 non-progressive)*. Most common in females, 7-8th decade*. Most common males, 5th-6th decade*. Premonitory symptoms like pain, Amaurosis Fugax present*. Premonitory symptoms like pain, Amaurosis Fugax absent*. Usually Bilateral-fellow eye affected within days to weeks*. Usually Unilateral (>70%)*. Pale optic disc*. Hyperemic optic with small cup*. Poor prognosis*. Good prognosis"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 43-year-old man suddenly develops odynophagia. Which organism is most likely to be isolated on throat culture?\nA) Mononucleosis\nB) S. aureus\nC) Normal pharyngeal flora\nD) Group A streptococci", "output": "2, because Odynophagia is a sensation of sharp retrosternal pain on swallowing. It is usually caused by severe erosive conditions such as Candida, herpes virus, and corrosive injury following caustic ingestion."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich disease is associated with the Father of Public Health?\nA) Malaria\nB) Cholera\nC) Tuberculosis\nD) Plague", "output": "1, because Dr. John Snow was the first to associate Cholera to a sewage-affected drinking water pump in London Ref: 25th edition Park&;s Textbook of Preventive and Social Medicine, Page no. 25"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCaloric test is done for\nA) Semicircular canal\nB) Macula\nC) Saccule\nD) Cochlea", "output": "0, because Ans. (a) Semicircular canalRef. Dhingra's ENT 5th ed. / 48* Caloric test is used to assess vestibular function. The basis of this test is to induce nystagmus by thermal stimulation of the vestibular system.* Done by taking water of 2 temperatures, cold (30degC) and hot (44degC).* Position of the test: Supine then lift head at 30deg forward or patient sitting with bending backwards 60*.* This position is used in order to make lateral/ horizontal SCC in vertical position.* Cold water elicits nystagmus in opposite eye and warm water elicit nystagmus in same eye (Mn: COWS).* Interpretation:# Normal: Time taken from start of irrigation to end point of Nystagmus is taken and it is 80 seconds --120 seconds.# Canal paresis: Duration of Nystagmus shortened i.e. < 80 sec.* Indicates depressed function of ipsilateral Labyrinth, vestibular nerve and vestibular nuclei.* It is seen in:# Meniere's disease# Acoustic neuroma# Vestibular neuritis# Vestibular nerve section# Postural vertigo"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIn humans, effective renal blood flow is ?\nA) 425\nB) 525\nC) 625\nD) 725", "output": "2, because C i.e., 625 ml"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTyphoid carriers are detected by following except ?\nA) Isolation of bacteria from urine\nB) Isolation of bacteria from bile\nC) Vi antigen\nD) Widal test", "output": "3, because Ans. is 'd' i.e., Widal test"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following statements regarding live vaccines is false?\nA) Two live vaccines cannot be administered simultaneously\nB) Booster doses are not required when live vaccines are administered\nC) Single dose gives life long immunity\nD) Live vaccine contains both major and minor antigens", "output": "0, because When the administration of two live vaccines is mandatory, it can be given simultaneously but either: ? at different sites of injection or ? at an interval of at least 3 weeks Ref: Park's Textbook of Preventive and Social Medicine By K. Park, 19th Edition, Page 97; Immunology for The Health Sciences By Nicholas J. Vardaxis, Pages 101-4"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMagnan's symptom is seen in:\nA) Datura\nB) Cocaine\nC) Opium\nD) Cannabis", "output": "1, because Altered tactile sensation: the person feel that some insects are crawling on his skin. This is known asMagnan's symptomorcocaine bugs(formication). Cocaine is an alkaloid derived from plantErythroxylon coca."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThe earliest manifestation of increased intrcranial pressure following head injury is\nA) Ipsilateral pupillary dilatation\nB) Contralateral pupillary dilatation\nC) Altered mental status\nD) Hemiparesis", "output": "2, because In general, symptoms and signs that suggest a rise in ICP include altered level of consciousness, headache, vomitingwithout nausea, ocular palcies, back pain and papilledema. If papilledema is protracted, it may lead to visual disturbances, optic atrophy, and eventually blindness. The headache is classically a morning headache which may wake them from sleep. The brain is relatively poorly supplied by oxygen as a result of mild hypoventilation during the sleeping hours and also cerebral edema may worsen during the night due to the lying position. ref-Graham, D. I.; Gennarelli, T. A. (2000). \"Pathology of Brain Damage After Head Injury\". In Cooper, Paul Richard; Golfinos, John (eds.). Head Injury (4th ed.). McGraw-Hill. pp. 133-54"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTrue about Bochdalek hernia is -\nA) Seen on right side\nB) Anterior position\nC) Differential diagnosis for pleuropericardial cyst\nD) All", "output": "2, because Ans. is 'c' i.e., Differential diagnosis for pleuropericardial cyst Differential diagnosis of CDH o Pulmonary sequestration o Cystic adenomatoid malformation o Pleuropericardial cysts"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich bone do not contributes to the medial wall of the orbit?\nA) Ethmoid\nB) Lacrimal\nC) Frontal\nD) Zygoma", "output": "3, because ANSWER: (D) ZygomaREF: Grays anatomy 39th edition, page 688-690 style=\"font-size: 1.04761904761905em; color: rgba(0, 0, 0, 1); font-family: Times New Roman, Times, serif\">part_8/chapter_45.htmlIndirect repeat in December 2010WALLS OF THE ORBIT:The orbit possesses four walls; a roof, lateral wall, floor, and medial wall.* The roof (frontal and sphenoid bones) presents the fossa for the lacrimal gland anterolaterally and the trochlear pit for the cartilaginous or bony pulley of the superior oblique muscle anteromedially. The optic canal lies in the posterior part of the roof, between the roots of the lesser wing of the sphenoid bone. It transmits the optic nerve and ophthalmic artery from the middle cranial fossa.The posterior aspect of the lateral wall (zygomatic and sphenoid bones) is demarcated by the superior and inferior orbital fissures, The superior orbital fissure lies between the greater and lesser wings of the sphenoid bone. It communicates with the middle cranial fossa and transmits cranial nerves III, IV, and VI, the three branches of the ophthalmic nerve, and the ophthalmic veins. The inferior orbital fissure communicates with the infratemporal and pterygopalatine fossae and transmits the zygomatic nerve. The lateral walls of the two orbits are set at approximately a right angle from one another, whereas the medial walls are nearly parallel to each otherThe floor (maxilla, zygomatic, and palatine bones) presents the infraorbital groove and canal for the nerve and artery of the same name. The inferior oblique muscle arises anteromedially, immediately lateral to the nasolacrimal canal.The medial wall (ethmoid, lacrimal, and frontal bones) is very thin. Its main component (the orbital plate of the ethmoid) is papyraceous (paper-thin). At the junction of the medial wall with the roof, the anterior and posterior ethmoidal foramina transmit the nerves and arteries of the same name."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSwan neck deformity -\nA) Flexion at PIP and DIP joint\nB) Extention at PIP and DIP joint\nC) Flexion at PIP and Extention at DIP joint\nD) Extention at PIP and Flexion at DIP joint", "output": "3, because Ans. is 'd' i.e., Extention at PIP and Flexion at DIP joint * Boutonniere deformity: Flexion contracture of PIP joint and extension of DIP joint.* Swan neck deformity: Hyperextension of PIP joint and flexion at DIP joint."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 55-year-old man with recent onset of atrial fibrillation presents with a cold, pulseless left lower extremity. He complains of left leg paresthesia and is unable to dorsiflex his toes. Following a successful popliteal embolectomy, with restoration of palpable pedal pulses, the patient is still unable to dorsi- flex his toes. The next step in management should be\nA) Electromyography (EMG)\nB) Measurement of anterior compartment pressure\nC) Elevation of the left leg\nD) Immediate fasciotomy", "output": "3, because This case illustrates two (among many) conditions that lead to the anterior compartment syndrome, namely, acute arterial occlusion without collateral inflow and rapid reperfusion of ischemic muscle. Treatment for a compartment syndrome is prompt fasciotomy Assessing a compartment syndrome and proceeding with fasciotomy are generally based on clinical judgment. Inability to dorsiflex the toes is a grave sign of anterior compartment ischemia. EMG studies and compartment pressure measurements would probably be abnormal but are unnecessary in view of the known findings and would delay treatment. Mere elevation of the leg would be an ineffective means of relieving compartment pressure, although elevation should accompany fasciotomy. Application of a splint has no role in the acute management of this problem."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is not a CT feature ofAdrenal adenoma \u2013\nA) Low attenuation\nB) Homogenous density and well defined borders\nC) Enhances rapidly, contrast stays in it for a relatively longer time and washes out late\nD) Calcification is rare", "output": "2, because Adrenal adenoma on contrast-enhanced CT/MRI shows rapid uptake and relatively rapid washout of contrast\u00a0material than do non\u00a0adenomasQ.\nAdenoma: CT features\n\nWell defined/sharply defined\u00a0\n<5 cm in size\nLow attenuation (<10 HU) due to lipid content\nMild homogenous enhancement\nRelatively rapid washout of contrast material (due to lack of large interstitial spaces\nRelatively rapid washout\u00a0is characteristic of adenoma"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMost common cause of death in primary amyloidosis is?\nA) Respiratory failure\nB) Cardiac failure\nC) Renal failure\nD) Septicemia", "output": "1, because ANSWER: (B) Cardiac failureREF: Harrison's Internal Medicine 17th edition chapter 324. AmyloidosisThe kidneys are the most frequently affected organ (80%), Renal amyloidosis is usually manifested by proteinuria, which is often in the nephrotic range and associated with significant hypoalbuminemia and edema or anasarca; rarely, tubular rather than glomerular deposition of amyloid can produce azotemia without significant proteinuria. Cardiac symptoms are the second most common presentation (40%), but cardiac dysfunction is associated with death in 75% of patients."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPyoderma-gangrenosum is most commonly associated with -\nA) Ulcerative colitis\nB) Crohns disease\nC) Amoebic colitis\nD) Ischemic colitis", "output": "0, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAML transformation common in - a) Aplastic anemia b) MDS c) Megakaryocytic thrombocytopenia d) None\nA) ab\nB) bc\nC) d\nD) ca", "output": "0, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following is false about mucocele of gallbladder\nA) Complication of gallstones\nB) Treatment is early cholecystectomy\nC) Obstruction at neck of gallbladder\nD) Gallbladder is never palpable", "output": "3, because Mucocele(Hydrops) Mucocele results from Prolonged obstruction of the cystic duct, usually by a large solitary calculus Obstructed GB lumen is progressively distented by mucus (mucocele) or by clear transudate(hydrops) produced by mucosal epithelial cells Clinical features A visible, easily palpable, non tender gallbladder sometimes extending from the RUQ into the right iliac fossa may be found on physical examination The patient with hydrops of the gallbladder frequently remains asymptomatic, although chronic RUQ pain may also occur. Treatment Early cholecystectomy, because empyema, Perforation or gangrene may complicate the condition Ref: Bailey and love 27th edition Pgno :1199 Harrison's 19th edition Pg no :2081"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMost Common Tumour of Eyelid is:\nA) Sebaceeous Ca\nB) BCC\nC) SCC\nD) Malignant melanoma", "output": "1, because BCC"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIntolerance to loud sound, nerve affected is\nA) 5th nerve\nB) 7th nerve\nC) 10th nerve\nD) None", "output": "1, because Clinical features of the 7th nerve palsy: Eyeball turns up and out Saliva dribbles Tears flow down Pain in the ear Noise intolerance Loss of taste Ref: Dhingra 7e pg 104."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThyroid hormone formation involves many steps. Which of the following amino acid is the precursor for thyroxine?\nA) Glycine\nB) Tyrosine\nC) Phenylalanine\nD) Iodine", "output": "1, because Tyrosine: Tyrosine is the precursor of triiodothyronine and thyroxine. Neural cells conve tyrosine to epinephrine and norepinephrine. While dopa is also an intermediate in the formation of melanin, different enzymes hydroxylate tyrosine in melanocytes. Dopa decarboxylase, a pyridoxal phosphate-dependent enzyme, forms dopamine. Subsequent hydroxylation by dopamine -oxidase then forms norepinephrine. In the adrenal medulla, phenylethanolamine-N-methyltransferase utilizes S-adenosylmethionine to methylate the primary amine of norepinephrine, forming epinephrine. Ref: Rodwell V.W. (2011). Chapter 30. Conversion of Amino Acids to Specialized Products. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOnce the enamel formation is complete, the tooth will erupt after approximately:\nA) One year\nB) Two years\nC) Three years\nD) Four years", "output": "2, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nSputum positive patient who should be quarantined:\nA) Pregnant women\nB) Old people\nC) Children above 6 years\nD) Children below 6 years", "output": "3, because Ans. (d) Children below 6 yearsRef: K. Park 23rd ed. /182-84* About national TB program, if a person is smear positive for TB:# All the family who is in close contact with the patient is given prophylaxis# Children under age 6 is given prophylaxisNote: India's Revised National Tuberculosis Control Programme (RNTCP) recommends screening of all household contacts of smear-positive pulmonary tuberculosis (PTB) cases for tuberculosis (TB) disease, and 6-month isoniazid preventive therapy (IPT) for asymptomatic children aged <6 years."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nCa 125 is used in diagnosis of -\nA) Ovarian cancer\nB) Gall bladder cancer\nC) Carcinoids\nD) Bronchogenic cancer", "output": "0, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of these pathologies is the most common benign tumour of the parotid gland?\nA) Mumps\nB) TB\nC) Heerfordt syndrome\nD) Pleomorphic adenoma", "output": "3, because Mumps causes the classic bilateral parotitis, but it can present as a unilateral enlargement in rare cases. Heerfordt syndrome includes sarcoidosis.\nTuberculosis historically was associated with \u2018cold abscess\u2019. It is caused by Mycobacterium tuberculosis, an acid-fast bacterium that does not stain with Gram stain. It requires Ziehl\u2013Neelsen staining."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA patient has ecchymosis and petechiae all over the body with no hepato-splenomegaly. All are true except\nA) Increased megakaryocytes in bone narrow\nB) Bleeding into the joints\nC) Decreased platelet in blood\nD) Disease resolves itself in 80% of Patients in 2-6", "output": "1, because Ans. is 'b' i.e., Bleeding into the joints Features of Acute and Chronic Idiopathic Thrombocytopenic Purpura Feature Acute ITP Chronic ITP Peak age of incidence Children 2-6 year Adults, 20-40 year Sex predilection None 3:1 female to male Antecedent infection Common 1-2 week Unusual Onset of bleeding Before Abrupt Insidious Hemorrhagic bullae in mouth Present in severe cases Usually absent Platelet count < 20000/4 3000-80000/8L Eosinophilia and yphocytosis Common Rare Spontaneous remission Occurs in 80% cases Months or years Uncommon"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich body pa is represented superiorly and medially within the postcentral gyrus?\nA) Upper limb\nB) Lower limb\nC) Abdomen\nD) Genitalia", "output": "1, because In the postcentral gyrus (somatosensory area) of each hemisphere, the sensory information from the opposite side of the body is received. The lower limb representation is found in the superior and medial poion of the postcentral gyrus (see the figure below). The lateral poion of the postcentral gyrus receives somatic sensory information from the facial and neck region."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 62 year old man has a 25 year history of alcoholism and liver disease. He visits his physician complaining of pain and swelling of his legs. A decrease in which of the following is the most likely cause of the peripheral edema?\nA) Capillary hydrostatic pressure\nB) Interstitial colloid osmotic pressure\nC) Interstitial hydrostatic pressure\nD) Plasma colloid osmotic pressure", "output": "3, because The plasma colloid osmotic pressure is often low in alcoholics with chronic liver disease (cirrhosis). The diseased liver cannot produce adequate amounts of albumin, which leads to a decrease in the concentration of albumin in the plasma, i.e., hypoalbuminemia. Because about 75% of the plasma colloid osmotic pressure can be attributed to the presence of albumin in the plasma, the decrease in plasma albumin concentration that occurs in the latter stages of cirrhosis often leads to peripheral edema. Cirrhosis also causes excess fluid to accumulate in the peritoneal cavity as ascites. In the case of ascites, the edema results not only from hypoalbuminemia, but also from poal vein obstruction (which increases capillary hydrostatic pressure) as well as the obstruction of lymphatic drainage of the liver. In fact, ascites is observed more often than peripheral edema in liver disease. A decrease in capillary hydrostatic pressure would tend to decrease fluid loss from the capillaries, and thereby oppose the development of edema. A decrease in the colloid osmotic pressure of the interstitial fluid would decrease fluid loss from the capillaries, thereby opposing the development of edema. A decrease in interstitial hydrostatic pressure would tend to increase fluid loss from the capillaries, but this cannot be considered a primary cause of edema because the interstitial hydrostatic pressure actually increases when a tissue becomes edematous. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 31. Blood as a Circulatory Fluid & the Dynamics of Blood & Lymph Flow. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMost common cause of dissecting hematoma is\nA) Hypeension\nB) Marfan's syndrome\nC) Iatrogenic\nD) Kawasaki", "output": "0, because Aoic dissection occurs when blood splays apa the laminar planes of the media to form a blood-filled channel within the aoic wall.Aoic dissection occurs mainly in two age groups: (1)men aged 40 to 60 with antecedent hypeension (more than 90% of cases); and (2) younger patients with connective tissue abnormalities that affect the aoa.Robbins Basic pathology, 9th edition, pg no.346"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCharcot's triad include\nA) Fever, pain, jaundice\nB) Fever, vomiting, jaundice\nC) Fever, Jaundice, Abd, distension\nD) Fever, chills, jaundice", "output": "0, because Charcot's triad is a feature of ascending cholangitis secondary to CBD stones.Intermittent symotoms are produced as the stone moves proximally & floats with relieving of obstruction and subsiding of symotoms.The triad includes fever,jaundice and pain(maybe colicky). SRB's manual of surgery,5th edition,page no:651."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDie is commonly seen in -\nA) MlAML\nB) M2AML\nC) M3AML\nD) M4AML", "output": "2, because Acute promyelocytic leukaemia (M3) may be associated with a serious coagulation abnormality ,disseminated intravascular coagulation.Reference :Davidson's principles & practices of medicine 22nd edition pg no 383."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThermoregulatory response activated by cold is\nA) Cutaneous vasodilatation\nB) Anorexia\nC) Increased voluntary activity\nD) Increased respiration", "output": "2, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHumans become infected by M.tuberculosis commonly by\nA) Ingestion\nB) Contact\nC) Inhalation\nD) Inoculation", "output": "2, because M.tuberculosis is mainly transmitted by direct inhalation of aerosolised bacilli contained in the droplet nuclei of expectorated sputum. Generated while coughing. sneezing,or speaking of infected patients. There may be as many as 3000 infectious nuclei per cough. The tiny droplets may remain suspended in the air for several hours and are easily inhaled. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th edition; Pg: 355"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nUmbilical cord usually separates in newborns on:\nA) Day 1\nB) Day 2-3\nC) Day 7-10\nD) After 1 month", "output": "2, because Ans. C. Day 7-10Umbilical cord is the connection between the mother and the fetus in the intrauterine stage and includes two arteries and one vein. It usually separates in children between day 7-10, either by dry gangrene or a residual moist base."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDelayed pubey is when primary amenorrhea is seen without development of secondary sexual characters beyond the age of?\nA) 12 years\nB) 14 years\nC) 16 years\nD) 18 years", "output": "2, because Delayed pubey: Girls: Absence of secondary sexual characters by 13 yrs of age / Absence of menarche by 16 years of age / within 5 yrs of onset of pubey Boys: Lack of pubeal changes by 14 yrs of age"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMost common cause of central precocious pubey in girls:\nA) Exogenous estrogen\nB) Idiopathic\nC) CNS tumor\nD) Hypothyroidism", "output": "1, because - MCC of central precocious pubey in girls is Idiopathic. - Organic causes are more common in boys. - OTHER CAUSES: Infections - TB, meningitis Injuries - Trauma, neurosurgery, Radiotherapy Tumors - Hypothalamic hamaoma (Gelastic seizures)- MCC of organic central precocious pubey CNS malformations like arachnoid cyst ,hydrocephalus, septo-optic dysplasia"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich test is used to compare kapian-meier survival curve-\nA) T-test\nB) Chi-square test\nC) Log rank test\nD) Whitneys test", "output": "2, because Ans. is 'C' i.e., Log rank test o The Kaplan-Meier estimator is an estimater for estimating the survival function from life time data. o A plot of the Kaplan-Meier estimate of the survival function is a series of horizontal steps of declining magnitude which, wrhen a large enough sample is taken, approaches the true survial function of that population. The value of the survival function between successive distinct sampled observations is assumed to be constant, o Different Kaplan-Meier curves can be compared by - The log rank test The cox proportional hazards test"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nApoptotic bodies are\nA) Clumped chromatin bodies\nB) Pyknotic nucleus without organelles\nC) Cell membrane bound with organelles\nD) No nucleus with organelles", "output": "2, because In H&E-stained tissue sections, the nuclei of apoptotic cells show various stages of chromatin condensation and aggregation and, ultimately, karyorrhexis; at the molecular level, this is reflected in fragmentation of DNA into nucleosome-sized pieces. The cells rapidly shrink, form cytoplasmic buds, and fragment into apoptotic bodies composed of membrane-bound vesicles of cytosol and organelles.( Robbins Basic Pathology, 9th edition, page 18 )"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAccording to Hellin's law chances of twins in pregnancy are:\nA) 1 in 60\nB) 1 in 70\nC) 1 in 80\nD) 1 in 90", "output": "2, because According to Hellin\u2019s rule\nThe mathematical frequency of multiple pregnancy is:\n\nTwins 1 in 80\nTriplets 1 in (80)2\nQuadruplets 1 in (80)3 and so on"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll of the following are true about OPSI (Overwhelming Postsplenectomy Infection), Except:\nA) Maximum risk is within 1 year of splenectomy\nB) Begins with mild appearing prodrome\nC) May present with septic shock\nD) Usually does not respond to antibiotic treatment", "output": "0, because Ans is A (Maximum risk is within 1 year of splenectomy) Overwhelming Postsplenectomy Infection (OPSI) Splenectomised patients are likely to suffer from severe infections. This syndrome is called overwhelming postsplenectomy infection (OPSI). OPSI is among the more devastating sequelae of asplenia and is the most common fatal late complication of splenectomy. The loss of the spleen's ability to filter and phagocytose bacteria and parasitized blood cells predisposes the patient to infection by encapsulated bacteria or parasites. Splenectomy also results in the loss of a significant source of antibody production. Infection may occur at any time after splenectomy; in one recent series, most infections occurred more than 2 years after splenectomy, and 42% occurred more than 5 years after splenectomy.\"- Sabiston I8/e The risk for OPSI is greater after splenectomy for malignancy or hematologic disease than for trauma. The risk also appears to be greater in young children (<4 years of age). OPSI may begin with a relatively mild-appearing prodrome, including fever, malaise, myalgias, headache, vomiting, diarrhea, and abdominal pain. These symptoms may then progress rapidly to fulminant bacteremic septic shock, with accompanying hypotension, anuria, disseminated intravascular coagulation, coma, and death within hours of presentation. The moality rate is between 50% and 70% for fully developed OPSI despite antibiotics and intensive care. Survivors often have a long and complicated hospital course with severe sequelae, such as peripheral gangrene requiring amputation, deafness from meningitis, mastoid osteomyelitis, bacterial endocarditis, and cardiac valvular destruction. S. pneumoniae is the most frequently involved organism in OPSI and is estimated to be responsible for between 50% and 90% of cases. Other organisms involved in OPSI include Haemophilus influenzae, Neisseria meningitidis, Streptococcus species and other pneumococcal species, Salmonella species, and Capnocytophaga canimorsus (implicated in OPSI as a sequela of dog bites). Currently, the standard of care for postsplenectomy patients includes immunization within 2 weeks of splenectomy with: - polyvalent pneumococcal vaccine (PPV23), - H. influenzae type b conjugate, and - meningococcal polysaccharide vaccine Antibiotic prophylaxis--usually a single daily dose of penicillin or amoxicillin--is recommended for asplenic children. (Antibiotic prophylaxis is controversia. Schwaz 9/e and Sabiston 18/e advise chemoprophylaxis; but Harrison 17/e does not recommend it)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\n\"La-facies sympathique\" is a condition seen in cases of\nA) Hanging\nB) Strangulation\nC) Myocardial insufficiency\nD) Railway accidents", "output": "0, because * La facies sympathique occurs in hanging* On postmortem examination, in hanging, usually the eyes are closed or partly open and the pupils are usually dilated.Sometimes, when the ligature knot presses on the cervical sympathetic, the eye on the same side may remain open and its pupil dilated (La, facies sympathiaue). This indicates antemortem hanging."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIn acute inflammation the tissue response consists of all except\nA) Vasodilation\nB) Exudation\nC) Neutrophilic response\nD) Granuloma formation", "output": "3, because Ref Robbins9/e p97 Granulomatous inflammation is a distinctive pattern of chronic inflammation characterized by aggregates of acti- vated macrophages with scattered lymphocytes. Granulo- mas are characteristic of ceain specific pathologic states; consequently, recognition of the granulomatous pattern is impoant because of the limited number of conditions (some life-threatening) that cause it (Table 2-8). Granulo- mas can form under three settings: * With persistent T-cell responses to ceain microbes (such as Mycobacterium tuberculosis, T. pallidum, or fungi), in which T cell-derived cytokines are responsible for chronic macrophage activation. Tuberculosis is the proto- type of a granulomatous disease caused by infection and should always be excluded as the cause when granulomas are identified. * Granulomas may also develop in some immune- mediated inflammatory diseases, notably Crohn disease, which is one type of inflammatory bowel disease and an impoant cause of granulomatous inflammation in the United States. * They are also seen in a disease of unknown etiology called sarcoidosis, and they develop in response to rela- tively ine foreign bodies (e.g., suture or splinter), forming so-called foreign body granulomas."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following analgesics should not be given in acute MI ?\nA) Methadone\nB) Morphine\nC) Buprenorphine\nD) Pentazocine", "output": "3, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThis condition is best treated by:\nA) Intra-keloidal injection of triamcinolone\nB) Wide excision and grafting\nC) Wide excision and suturing (\nD) Deep X-ray therapy", "output": "0, because Ans. (a) Intra-keloidal injection of triamcinolone.Diagnosis based on the image is Keloid scar* Characterized by overgrowth of scar tissue beyond the margins of original wound* Occur more commonly in females over sternum, shoulder and face, Black people are more prone for it* Treatment is with intralesional injections of triamcinolone. However best is surgery combined with postoperative interstitial radiotherapyImage Source- style=\"font-family: Times New Roman, Times, serif\">"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich joint is commonly involved in osteochondritis dissecans?\nA) Ankle joint\nB) Knee joint\nC) Wrist joint\nD) Elbow joint", "output": "1, because Kness is the most commonly affected joint. Other joints such as hip, ankle , elbow and shoulder can also be involved. Definition : * Localized condition affecting the aicular surface of a joint with separation of a segment of cailage and subchondral bone * Knee by far the most common joint involved (75% of all OCD lesions) with the ankle, elbow, wrist and other joints accounting for the remaining 25% * Most common: Lateral aspect of medial femoral condyle * Weightbearing surfaces of medial and lateral femoral condyles also affected . ref : maheswari 9th ed"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nrenal papillary necrosis is caused by ?\nA) alcohol\nB) cocaine\nC) heroin\nD) morphine", "output": "0, because Etiology # Pyelonephritis # Obstruction of the urinary tract # Sickle cell hemoglobinopathies, including sickle cell trait # Tuberculosis # Cinhosis of the liver, chronic alcoholism # Analgesic abuse # Renal transplant rejection, Radiation, Renal vein thrombosis # Diabetes mellitus # Systemic vasculitis Renal papillary necrosis # Renal papillary necrosis (RPN) is characterized by coagulative necrosis of the renal medullary pyramids and papillae # Renal papillary necrosis generally affects individuals who are in the middle decades of life or older # It is more common in women than in men # 60% of the patients have DM, 30% Urinary tract obsruction, 15% have both. # Renal papillary necrosis is primarily a bilateral process ref : harrisons 21st ed"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBilateral spider leg sign on IVP is suggestive of:\nA) Polycystic kidney\nB) Hydronephrosis\nC) Hypernephroma\nD) Renal stones", "output": "0, because Ans. Polycystic kidney"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following will you like to give to a pregnant patient to decrease the risk of neural tube defects in the offspring, if your patient is receiving antiepileptic drugs ?\nA) Folic acid\nB) Vitamin A\nC) Vitamin E\nD) Pyridoxine", "output": "0, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich is the only living pa of Hydatid cyst?\nA) Adventitia\nB) Germinal epithelium\nC) Laminated membrane\nD) Parenchyma of the organ", "output": "1, because Hydatid cyst is caused by Echinococcus granulosus. It has a thick opaque white outer cuticle / laminated layer and an inner thin germinal layer containing nucleated cells. The germinal layer is the site of asexual reproduction. It also secretes the hydatid fluid which fills the cavity. The fluid is clear, colourless / pale yellow with a pH of 6.7 containing salts and protein. It is a good antigen which sensitises the host. The fluid was used as the antigen for Casoni's intradermal test and other diagnostic serological tests. From the germinal layer, small knob like excrescences / gemmules protrude into the lumen of the cyst. These enlarge and become vacuolated and filled with fluid. These are called brood capsules. They are initially attached to the germinal layer by a stalk, but later escapes free into the fluid filled cyst cavity. From the inner wall of brood capsule, protoscolices develop, which represent head of adult worm, complete with invaginated scolex, bearing suckers and hooklets. Each of these are potential tapeworm. Many of the scolices float free in the cyst fluid. These with free brood capsules are called hydatid sand. Ref: Paniker's Textbook of parasitology, 6th Ed page 151."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVon Langenbeck repair is used for treatment of:\nA) Cleft lip\nB) Cleft palate\nC) Septal detion\nD) Saddle nose", "output": "1, because Von Langenbeck Repair: Two-stage palate repairs were originally described as a means of treating wide clefts; soft palate repair was done at the same time as lip repair, with the hard palate repaired later after the cleft width had diminished. In a way, this is analogous to lip adhesion; the surgeon is committed to a second operation and has additional scar to confront at the time of the second procedure. The use of two-stage palate repair has consistently been shown to produce poorer speech results when compared with most single-stage techniques, but is still used by some surgeons."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is not recommended in the treatment of Chronic Low Back Pain:\nA) NSAIDs\nB) Bed Rest for 3 months\nC) Exercises\nD) Epidural steroid Injection", "output": "1, because B. i.e. Bed rest for 3 months In low back ache (lumbago) bed rest should not exceed 2 (to 4) daysQ, because bed rest for longer period may lead to debilitating muscle atrophy and increased stiffness. Therefore bed rest > 2 days (Harrison)/>4 days (CDTF) is not recommended."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFatty acid synthase complex contain the following enzymes except:\nA) Enoyl reductase\nB) Ketoacyl reductase\nC) Acetyl: CoA carboxylase\nD) Dehydratase", "output": "2, because Ans. C. Acetyl: CoA carboxylase(Ref: Harper 31/e page 217)Six enzyme activities of fatty acid synthase complex are:Ketoacyl SynthaseMalonyl-acetyl transacylaseHydrataseEnoyl reductaseKetoacyl reductaseThioesterase (Deacylase)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nNot a type of Inguinal hernia\nA) Gibbon's hernia\nB) Valpeall's hernia\nC) Pantaloon's hernia\nD) Sliding hernia", "output": "1, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich is false regarding Gram positive cocci ?\nA) Staph. saprophyticus causes UTI in females\nB) Micrococci are oxidase positive\nC) Most enterococci are sensitive to penicillin\nD) Pneumococci are capsulated", "output": "2, because Unlike streptococci enterococci are not reliably killed by penicillin or ampicillin alone at concentration acheived clinically in the blood or tissues.\n\nAntimicrobial susceptibility testing should be performed routinely on enterococcal isolates.\n\nOther options\nOption \u2018a\u2019 \u2022 Staph. saprophyiticus specially causes UTI in sexually active young women.\nOption \u2018b\u2019 \u2022 Micrococci are catalase and oxidase positive Gr (+ve) cocci. They are strict aerobes and are non pathogenic.\n\nMicrococci are differentiated from Staphylococci by Hugh and deifson oxidation fermentation test in which micrococci shows oxidative pattern while staphylococci show fermentive pattern."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nBrugada syndrome is characterized by\nA) ST elevation\nB) Prolonged PR interval\nC) Prolonged QT interval\nD) Tall T waves", "output": "0, because Brugada syndrome is a rare syndrome characterized by >0.2 mV of ST-segment elevation with a coved ST segment and negative T wave in more than one anterior precordial lead (V1-V3) and episodes of syncope or cardiac arrest due to polymorphic VT in the absence of structural hea disease.Harrison 19e pg: 1497"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMalaria causing nephrotic syndrome -\nA) P. vivax\nB) P. Falciparum\nC) P. malariae\nD) P. Ovale", "output": "2, because It would appear that quaan malaria causes an immune complex nephritis in some individuals that, once established, is sustained by mechanisms not yet fully explained but which may involve an autoimmune process. Evidence to suppo an immunologic pathogenesis of the renal lesions is provided by the presence of immunoglobulin, complement (C3) and quaan malarial antigen in biopsy specimens studied by immunofluorescence microscopy"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCommonest site for colonic diverticula is-\nA) Ascending colon\nB) Sigmoid colon\nC) Transverse colon\nD) Descending colon", "output": "1, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDrug of choice for acute severe asthma is: September 2006\nA) Sho acting beta 2 agonists\nB) Long acting beta 2 agonists\nC) Oral theophylline\nD) Inhaled ipratropium bromide", "output": "0, because Ans. A: Sho acting beta 2 agonists Severe asthma (Continuous symptoms; activity limitation; frequent exacerbations/hospitalization) requires: Regular high dose of inhaled steroid (800-2000 microgram/ day) through a large volume spacer device and inhaled long acting beta2 agonist (Salmeterol). Additional treatment with one or more of the following: Leukotriene antagonist/Sustained release oral theophylline/ oral beta2 agonist/ inhaled ipratropium bromide. Rescue treatment with sho acting inhaled beta2 agonist In patients not adequately controlled or those needing frequent emergency care-institute oral steroid therapy."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFalse statement regarding myocardial infarction and depression is:\nA) Depression is a risk factor for MI\nB) MI is a risk factor for depression\nC) SSRI's can be used post MI for treatment of depression\nD) Only cognitive behavioral therapy is used after MI", "output": "3, because The first three options are correct. Depression and myocardial infarction are risk factors for each other. The treatment of depression after MI involves both medications and CBT."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nRegarding Fanconi anemia, the wrong statement is:\nA) Autosomal dominant\nB) Bone marrow show pancytopenia\nC) Usually aplastic anemia\nD) It is due to defective DNA repair", "output": "0, because Fanconi's anemia is an autosomal recessive disease Characterized:- Progressive pancytopenia Increased risk of malignancy (solid tumors and AML) Congenital developmental anomalies like sho stature, cafe au lait spots, abnormalities affecting thumb, radius and genitourinary tract. Fanconi's anemia is associated with BRCA gene."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAccording to WHO, what is given to prevent PPH by active management of third stage of labour?\nA) IV PGF2 alpha agonist\nB) IM oxytocin\nC) IV ergometrine\nD) Perrectal prostaglandins", "output": "1, because WHO recommendations for prevention of PPH by active management of third stage of labour Components of Active Management of the Third Stage of Labour (WHO)Administration of uterotonic soon after bih of baby.Delayed cord clamping and cutting.Controlled cord traction for delivery of the placenta (Brandt Andrew&;sMethod).Uterine massage.Uterotonic Agents Used in AMTSLInjectable oxytocin is the first line agent as it is effective after 2-3 minutes and has minimal side effects. Recommended dose by WHO is 10 units IM.Injectable methylergometrine (methergine) 0.2 mg IM/IV delivery of anterior shoulder or immediately after DELIVERY OF BABY.Syntometrine or Oxymatrine (ERGOMETRINE 0.5 MG +OXYTOCIN 5 UNITS) IM after delivery of the baby.Misoprostol 600 microgram tablet orally or rectally (in home delivery). Oral administration of misoprostol should be reversed for situations when the safe administration and/or appropriate storageconditions for injectable oxytocin and ergot alkaloids are not possible.Cord ClampingEarly cord clamping which was included originally in AMTSL not recommended now.Delayed cord clamping is now recommended and not immediate cord clamping.Current evidence shows that delayed cord clamping is beneficial for the baby.Immediate cord clamping has been shown to increase the incidence of iron deficiency and anemia.For premature and low bih weight babies immediate cord clamping can also increase the risk of intraventricular hemorrhage and late-onset sepsis.Controlled Cord TractionRecommended intervention for delivery of the placenta and a well-documented intervention in the active management of third stage of labour.(Refer: Mudaliar and Menon&;s Clinical Obstetrics, 11th edition, pg no: 121)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA multipara with 34 weeks pregnancy tachycardia, fever, hepatospleenomegaly, pallor has :\nA) Malaria\nB) Iron deficiency anaemia\nC) Physiological anaemia\nD) Megaloblastic anaemia", "output": "0, because Malaria"}