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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 single question.\n\nOsmotic fragility is increased in ?\nA) Sickle cell anaemia\nB) Thalassemia\nC) Hereditary spherocytosis\nD) Chronic lead poisoning", "output": "2, because Ans. is 'c' i.e., Hereditary spherocytosis Osmotic fragility of Red blood cells. Red blood cell osmotic fragility is the resistance of RBC hemolysis to osmotic changes. o Normally RBC maintains osmotic equilibrium with the surrounding medium i.e., with serum that has 0.9% NaCl. o As the surrounding medium becomes hypotonic fluid will enter into the cell along osmotic gradiant, eventually under very hypotonic conditions the cell will enlarge to capacity and rupture -4 Osmotic lysis. Osmotic fragility is determined by measuring the degree of hemolysis in hypotonic saline. o Normal red cell begins to lyse at 0.5% NaC1 and the hemolysis is complete at 0.3 NaCl. o Red blood cells osmotic fragility is considered to be increased if hemolysis occur in a NaC1 concentration > 0.5%. o Osmotic fragility is considered to be decreased if the hemolysis is not complete in a 0.3% of NaCl. Increased osmotic fragility o Hereditary spherocytosis o Hemolytic anemia (acquired immune) o Malaria o Severe pyruvate kinase dificiency o Hemolytic disease of newborn Decreased osmotic fragility o Iron deficiency anemia Thalassemia Liver disease Reticulocytosis o Hemoglobinopathies, MS, HbC."}

{"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 drug is not used to prevent contrast nephropathy -\nA) Fenoldopam\nB) N-acetylcysteine\nC) Infusion of Hair normal saline\nD) Hemodialysis", "output": "0, because Ans. is 'a' i.e., Fenoldopam Summary And Recommendations for prevention of contrast induced nephropathy (uptodate recommendation )o Optimal therapy to prevent contrast-induced acute renal failure remains uncertain. Patients with near-normal renal function are at little risk and few precautions are necessary other than avoidance of volume depletion.o We recommend the following preventive measures for patients at increased risk of contrast nephropathy, which is defined a serum creatinine >1.5 mg/dL (132 micromol/L) or an estimated glomerular filtration rate <60 ml/l 73 m2, particularly in those with diabetes.o Use, if possible, ultrasonography, MRI without gadolinium contrast, or CT scanning without radiocontrast agents.o We recommend NOT using high osmolal agents is not recommendedo We recommend the use of iodixanol or nonionic low osmolal agems such as iopamidol or ioversol rather than iohexol.o Use lower doses of contrast and avoid repetitive, closely spaced studies.o Avoid volume depletion and nonsteroidal anti-inflammatory drugs.o If there are no contra indications to volume expansion, we recommend isotonic intravenous fluids prior to and continued for several hours after contrast administration. The optimal type offluid and timing of administration are not well established. We suggest isotonic bicarbonate rather than isotonic saline.o Despite conflicting data, we suggest that acetylcysteine be administered the day before and the day of the procedure, based upon its potentialfor benefit and low toxicity and cost. If acetylcysteine is administered, we suggest giving 1200 mg orally twice daily rather than 600 mg twice daily the day before and the day of the procedure.o Based upon the lack of convincing evidence of benefit and ihe potential risk of anaphylactoid reactions, we suggest not using intravenous acetylcysteine for the prevention of contrast nephropathy. (Note: Oral acetylcysteine is used)o We recommend NOT using mannitol or other diuretics prophytactically.o Among patients with stage 3 and 4 CKD, we recommend NOTperforming prophylactic hemofiltration or hemodialysis after contrast exposure.o Among patients with stage 5 CKD, we suggest prophylactic hemodialysis after contrast exposure if there is already a functioning hemodialysis access."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAminoacyl t-RNA is not require for -\nA) Proline\nB) Lysine\nC) Hydroxy lysine\nD) Methionine", "output": "2, because Ans. is 'c' i.e., Hydroxylysine o The initial step in protein synthesis is the activation of amino acid in which each of the 20 amino-acids is covalently attached to their respective t-RNA, forming specific amino acyl t-RNA.o The reaction is catalyzed by ami noacyl t-RNA synthase.o Hydroxyproline and hydroxylysine are not represented into genetic code, i.e. they to not have t-RNA capable of accepting them and inserting them into polypeptide chain. Therefore, they have to be synthesized post-translational ly from proline and lysine residues in the polypeptides."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIntermediate host for hydatid disease:\nA) Man\nB) Dog\nC) Cat\nD) Foxes", "output": "0, because Man"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEpisodes of depression in major depressive disorder tend to:\nA) Increase in frequency with age\nB) Decrease in length with age\nC) Last for about 9 months when treated\nD) Have a rapid onset", "output": "0, because Episodes of major depression tend to increase in both length and frequency with age. When treated, episodes of major depression last for about 3 months. If untreated, depression lasts from 6 to 12 months. Episodes of major depression often have a gradual onset and occur an average of 5 to 6 times over a 20-year period."}

{"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 does cause epidemic kerato conjuctivitis -\nA) Adenovirus\nB) Enterovirus\nC) Coxsakie virus\nD) Herpes virus", "output": "0, because adeno virus cause epidemic keratoconjuctivitis REF:<\\p> MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.482"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSacrococcygeal teratoma is associated with:\nA) Meningocele\nB) Cardiac detects\nC) Hepatic cysts\nD) Cystic adenoid malformation", "output": "0, because Ans: A (Menigocele) Ref: Robbins and Cotran Pathologic Basis of Disease: 8th editionExplanation:Sacrococcygeal TeratomasMost common teratomas of childhoodAccounts for 40% or more of casesFour times more common in girlsApproximately 10% of sacrococcygeal teratomas are associated with congenital anomaliesPrimarily defects of the hindgut and cloacal regionMid line defectsMeningocele and spina bifidaApproximately 75% of these tumors are mature teratomas, and about 12% are unequivocally malignant and lethal. The remainder is immature teratomas.Most of the benign teratomas are encountered in younger infants (<4 months), whereas children with malignant lesions tend to be older.Other sites for teratomas in childhood include:TestisOvariesMediastinumRetroperitoneumHead and neck."}

{"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 poisoning causes 'pink disease'?\nA) Arsenic\nB) Mercury\nC) Copper\nD) Lead", "output": "1, because Ans. is 'b' i.e. Mercury Pink disease or Acrodvniao It is thought to be an idiosyncratic hypersensitivity reaction particularly seen in children. This can be caused by chronic mercury exposure in any form usually in children. The onset is insidious with anorexia, insomnia, sweating, skin rash and photophobia. Hands and feet become puffy, pinkish, painful, paraesthetic with peeling of skin (5Ps). Teeth may be shed."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhat is the treatment of threshold ROP?\nA) laser photocoagulation\nB) slow reduction in oxygen\nC) retinal reattachment\nD) antioxidants", "output": "0, because Ans is 'a' i.e. Laser Photocoagulation Threshold disease in ROP is defined as stage 3+ ROP in Zones 1 or 2 occupying at least five contiguous clock-hours or eight noncontiguous clock-hours of retina.Treatment of threshold disease is Laser Photocoagulation.'Laser therapy has largely replaced cryotherapy because visual and anatomical outcomes are superior and laser induces less myopia. \" -Kanski 6/e p610Other options:Antioxidants like vit E and slow reduction in 02 has no role in established ROP (threshold disease in our patient); although both are mentioned in few texts for prevention of ROP and even that is not well proven.Retinal reattachment is required when retina is detached like in stage 4 and 5 while Threshold disease is Stage 3 + disease.Also know:\"Low birth weight and decreased gestational age are now considered the primary causative factors for ROP. Supplemental oxygen administration which was for a long time considered as the important causative factor is now considered only a risk factor. \" - Khuran Ophthalmology 4/e p264 \"ROP is confined to those with a birth weight of under 1.5 kg and/or a gestational age of under 32 wks. \"- Parson 21/e P310 The hallmark of retinopathy of prematurity (ROP) is abnormal retinal vasculature. Ophthalmologists diagnose and make decisions about the initial treatment of ROP based on the appearance of the retinal blood vessels. Dilatation and tortuosity of the retinal vessels at the posterior pole is termed 'plus' disease. It is a sign of rapidly progressive ROP and is an indication for early laser ablation of the peripheral avascular retina.Retinopathy of prematurity (ROP)ROP is a bilateral proliferative retinopathy that develops in premature infants due to incomplete vasculogenesis of retina at the time of birth.During normal retinal development, vessels migrate from the optic disc to the ora serrata beginning at 16weeks of gestation. Capillary network is formed differentiating into mature vessels which extend to nasal ora by 36 wks and tangential ora by 39-41 wks.The pathogenesis of ROP begins with premature birth. Exposure of extrauterine environment causes phases of hyperoxia-vasocessation (obliteration of retinal vessels) and hypoxia-Vaso proliferation (neovascularization). VEGF is thought to be the most important molecule involved in the neovascularization.Neovascularization leads to retinal and vitreous changes which ultimately lead to retinal detachment.Classification of ROP:ROP is described using a number of parameters. These are location of the disease into zones (1, 2, and 3), the circumferential extent of the disease based on the clock hours (1-12), the severity of the disease (stage 1-5) and the presence or absence of \"Plus Disease\".Classification on the basis of severity, ROP is divided into 5 stages:-Stage I- the first sign of ROP (stage 1) is the appearance of a thin, fiat, white structure (termed a demarcation line) at the junction of vascularized retina posteriorly and avascular retina anteriorly.Stage II- the demarcation line develops into a pink or white elevation (ridge) of thickened tissueStage III- proliferation of vessels over the ridge and into vitreous (extra vitreal fibrovascular proliferation)Stage IV- partial retinal detachmentIVa- partial detachment with macular sparing IVb- partial detachment with macula involvedStage V- total retinal detachmentClassification on basis of anatomical location:-Since there is a direct correlation between severity of disease and amount of avascular retina, the location of the border between vascularized and avascular retina is an important prognostic sign.3 zones are divided to describe the location of ROP. Location of the border in zone 1 is the most severe disease and in zone 3 least.Zone 1 is defined as a circle, the center of which is the disc, and the radius of which is twice the distance of the disc to the fovea.Zone 2 is a doughnut-shaped region that extends from the anterior border of Zone 1 to within one disc-diameter of the ora serrata nasally and to the anatomic equator temporally.Zone 3 encompasses the residual temporal retina.Plus disease:- As ROP progresses, more and more shunting occurs in the neovascular tissue at the retinal vascular- avascular junction. This increased retinal vascular blood flow results in dilation and tortuosity of the major retinal arteries and veins in the posterior pole - described as \"plus disease\". Plus disease is the hallmark of rapidly progressive ROP and is notated by adding a plus sign after the number of the ROP stage.Management:Most of the cases (approx. 80%) of ROP resolve spontaneously, hence intervention is chosen according to the below given protocol.ROP is divided into Threshold and Pre threshold disease.Threshold disease: It is defined as stage 3+ ROP in Zones 1 or 2 occupying at least five contiguous clock-hours or eight noncontiguous clock-hours of retina.Treatment of Threshold disease is - Laser photocoagulation.Pre threshold disease is divided into 2 types:High risk or Type I - treatment is Laser photocoagulationLow risk or Type II - treatment is Weekly or Twice weekly observationType 1 Pre thresholdType 2 Pre thresholdZone I ROP (any stage) + Zone I, Stage 3 Zone II, Stage 2/3 +Zone I, Stage 1/2 - Zone II, Stage 3 -Laser PhotocoagulationWeekly or Twice weekly observationROP diseases less severe than Pre threshold are followed up.In this question, the child with zone 1, stage II 'plus' ROP falls into Pre threshold disease- Type 1 or high risk type, hence Laser Photocoagulation would be the management of choice."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDiplopia is usually seen in ?\nA) Paralytic squint\nB) Non-paralytic squint\nC) Both of the above\nD) None of the above", "output": "0, because Ans. is 'a' i.e., Paralytic squint"}

{"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 most common lymphoma in adults?\nA) Adult T-cell leukemia/lymphoma (ATLL)\nB) Hodgkin lymphoma\nC) Diffuse large B-cell lymphoma (DLBCL)\nD) Follicular lymphoma", "output": "2, because DLBCL - Most common lymphoma in adults Follicular lymphoma - Most common indolent lymphoma in adults Chronic lymphocytic leukemia - Most common leukemia 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\nMooning is a form of\nA) Exhibitionism\nB) Transvestism\nC) Voyeurism\nD) Eonism", "output": "0, because Flashing: The act of momentarily exposing or revealing sexual body pa by quickly moving the clothing. Streaking: The act of running naked through a public place. Mooning: The act of displaying one's bare buttocks, by lowering the pants and bending over"}

{"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 seen in vitamin C deficiency except:\nA) Swollen bleeding gums\nB) Delayed wound healing\nC) Anemia\nD) Infeility", "output": "3, because Vitamin C/Ascorbic acid deficiency leads toScurvy Clinical manifestation of scurvy: Swollen and bleeding gums Subcutaneous bleeding and brushing into skin/joints Delayed wound healing Anemia Weakness."}

{"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 had injury to right upper limb he is not able to extend fingers but able to extend wrist and elbow. Nerve injured is -\nA) Radial\nB) Median\nC) Ulnar\nD) Posterior interosseus", "output": "3, because Posterior interosseous emerges from the supinator on the back of the forearm .Here it lies between the superficial and deep muscles.At the lower border of the extensor pollicis brevis, it passes deep to extensor pollicis longus.it then runs on the posterior surface of the interosseous membrane up to the wrist where it enlarges into pseudoganglion and ends by supplying the wrist and intercarpal joints."}

{"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 patient with least risk of pulmonary aspiration of gastric contents during induction of anesthesia is:-\nA) Markedly obese and NPO for eight hours\nB) Fed coffee four hours before elective surgery\nC) Scheduled for elective cesarean delivery and NPO for 20 hours\nD) NPO for four hours after a full meal", "output": "0, because NPO is same for obese and normal. NPO guidelines - 6hrs for liquid and semisolid, 2 hours NPO for clear fluids. Subset of patients who are at high risk for aspiration - pregnant women, morbidly obese (rapid sequence induction), full fatty meal - 8 hours NPO."}

{"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 enzyme uses citrate in fatty acid synthesis?\nA) Aconitase\nB) Citrate synthase\nC) Malic enzyme\nD) ATP citrate lyase", "output": "1, because Reference: Harpers illustrated biochemistry 30th edition"}

{"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 changes does not occur in malignant hypeension :\nA) Peticheal Haemorrhages on coical surface\nB) Fibrinoid necrosis of aerioles\nC) Intimal concentric thickening\nD) Hyaline aeriosclerosis", "output": "3, because Answer is D (Hyaline Aeriosclerosis) : Hyaline aeriosclerosis is a feature of Benign Nephrosclerosis associated with benign phase of Hypeension. It is not a ,feature of Malignant Hypeension."}

{"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 nerves has the best prognosis for repair after injury -\nA) Ulnar\nB) Radial\nC) Median\nD) Lateral popliteal", "output": "1, because Ans. is 'b' i.e., Radial nerveRecovery potential after nerve repairExcellent :- Radial, Musculocutaneous, femoral, digital nervesModerate :- Median, Ulnar, TibialPoor :- Common peroneal (lateral popliteal)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nTreatment in post operative shivering?\nA) Pethidine\nB) Piritramide\nC) Methadone\nD) Pentazocine", "output": "0, because Ans. is 'a' i.e., Pethidine Post-anaesthesia shivering (PAS) Post anaesthesia (post operative) shivering occurs in 40% of patients recovering from general anaesthesia. Some time it is preceded by central hypothermia and peripheral vasoconstriction, indicating that it is a thermoregulatory mechanism Pethidine is most effective drug for treatment of PAS. Other drugs used are --clonidine, doxapram, ketanserin, alfentonil, butorphanol, chlorpromazine."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBirbeck\u2019s granules in the cytoplasm are seen in:\nA) Langerhans cells\nB) Mast cells\nC) Myelocytes\nD) Thrombocytes", "output": "0, because Birbeck granules are rod Shaped/Tennis-racket shaped cytoplasmic organelles with a central linear density and a striated appearance.\nThey are diagnostic microscopic feature in Langerhans cell histiocytosis (Histiocytosis X)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCrural index is:\nA) Length of tibia/femur x 100\nB) Length of radius/humerus x 100\nC) Length of fibula/tibia x 100\nD) Length of radius/ulna x 100", "output": "0, because Ans. Length of tibia/femur x 100"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPrimordial prevention is done to prevent development of ?\nA) Disease\nB) Risk factors\nC) Impairment\nD) Disability", "output": "1, because Ans. is 'b' i.e., Risk factors LEVELS OF PREVENTION There are four levels of prevention :? Primordial prevention Primary prevention Secondary prevention Teiary prevention Primordial Level of Prevention: Is primary prevention (see below) in purest sense It is the prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared Modes of Intervention: Individual Education Mass Education Primordial Level is Best level of prevention for Non-communicable diseases"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAnakinra is a -\nA) IL - 1 antagonist\nB) IL - 2 antagonist\nC) IL - 6 antagonist\nD) IL - 10 antagonist", "output": "0, because Ans. is 'a' i.e., IL-1 antagonisto Anakinra is an IL-1 antagonist.o It is used for some rare syndromes dependent on IL-1 production :Neonatal - onset inflammatory diseaseMuckle - Wells syndromeFamilial cold urticariaSystemic juvenile - onset inflammatory arthritisRA"}

{"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 gold standard for the definitive diagnosis of the extrahepatic biliary atresia is\nA) Per operative cholangiography\nB) Hepatobiliary scintigraphy\nC) Alkaline phosphatase level\nD) Liver biopsy", "output": "3, because Biliary atresia Evaluation of biliary anatomy begins with ultrasound Other imaging modalities such as HIDA scintigraphy, MRCP and ERCP have been used with varying success Although these are useful adjuncts, liver biopsy is gold standard for the diagnosis of biliary atresia and can safely be done percutaneously under local anaesthesia Ref: Sabiston 20th edition Pgno : 639"}

{"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 passes through lesser sciatic foramen, except ?\nA) Pudendal nerve\nB) Internal pudendal vessels\nC) Nerve to obturator internus\nD) Inferior gluteal vessels", "output": "3, because The lesser sciatic foramen is formed by the lesser sciatic notch of the pelvic bone, the ischial, the sacrospinous ligament and the sacrotuberous ligament. It transmits the following structures: The tendon of the Obturator internus Internal pudendal vessels Pudendal nerve Nerve to the obturator internus"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIncreased osmotic fragility is characteristic of:September 2009\nA) Hereditary spherocytosis\nB) Sickle cell anemia\nC) Thalassemia\nD) Iron deficiency anemia", "output": "0, because Ans. A: Hereditary spherocytosisThe normal red blood cell is a relatively impermeable biconcave disc which maintains osmotic equilibrium with the surrounding medium. As the surrounding medium becomes hypotonic, fluid will be taken into the cell to maintain stability. Eventually under very hypotonic conditions the cell will fill to capacity and rupture. Spherocytic red blood cells have a decreased capacity to expand, and will rupture in mildly hypotonic conditions that fail to lyse normal red cells. They thus exhibit increased osmotic fragility.Osmotic fragility is determined by measuring the degree of hemolysis in hypotonic saline solution. With the unincubated test, red cell osmotic fragility is considered to be increased if hemolysis occurs in a sodium chloride concentration > 0.5%. Although increased osmotic fragility is characteristically associated with hereditary spherocytosis, it may also be increased in other types of hemolytic anemia associated with the presence of spherocytes, paicularly auto-immune hemolytic anemia, and in hypernatermia (Na > 155 meq/L).Often the increased osmotic fragility in spherocytosis is limited to a small fraction of cells that are unusually susceptible to lysis. After incubation, the defect is magnified, and a striking increase in fragility will be seen in hereditary spherocytosis. Osmotic fragility is considered to be decreased if hemolysis is not complete in a 0.30% NaC1 solution. Decreased osmotic fragility is associated with chronic liver disease, iron deficiency anemia, thalassemia, hyponatremia (Na < 130 meq/ L), polycythemia vera, and sickle cell anemia after splenectomy."}

{"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 three year old child is brought to the emergency depament having just ingested a large overdose of an antihistaminic drug. This drug is a weak base capable of entering most tissues including the brain. On physical examination the hea rate is 100/ minute, blood pressure is 110/60 mm Hg and the respiratory rate is 20/ minute. In this case of poisoning:\nA) Urinary excretion would be accelerated by administration of NH4Cl, an acidifying agent\nB) Urinary excretion would be accelerated by administration of NaHCO 3, an alkalinizing agent\nC) More of the drug would be ionized at blood pH than at stomach pH\nD) Absorption of the drug would be faster from the stomach than from the small intestine.", "output": "0, because This question can be solved by the knowledge that basic drugs are ionized in the acidic medium and vice-a-versa. This antihistaminic drug is a weak base and will be highly ionized in the acidic urine. As ionized drugs cannot be reabsorbed in the nephron, urinary acidifying agents like NH4Cl will accelerate the excretion of this agent. On the other hand, NaHCO3 will decrease its excretion by increasing the unionized form. Blood pH is slightly alkaline (7.4) whereas gastric pH is highly acidic. Basic drugs are ionized more in the acidic pH, therefore option (c) is false. Only unionized molecules can cross the membranes, therefore more drug will be absorbed by the small intestine (alkaline pH)."}

{"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 on t/t for psychiatric disorder takes overdose of a drug, develops bradycardia, hypotension, decreased sweating and salivation. The likely drug is\nA) Amitryptilline\nB) Lithium\nC) Selegiline\nD) Amphetamine", "output": "0, because A i.e. Amitryptilline"}

{"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 an absolute indication for surgery in cases of benign prostatic hyperplasia -\nA) Bilateral hydroureteronephrosis\nB) Nocturnal frequency\nC) Recurrent urinary tract infection\nD) Voiding bladder pressures > 50 cm of water", "output": "2, because Absolute indications for surgical treatment of BPH 1) Refractory urine retention (failing at least one attempt at catheter removal 2) Recurrent UTI from BPH 3) Bladder stones d/t BPH 4) Renal insufficiency d/t BPH 5) Large bladder diveicula secondary to BPH 6) Recurrent gross hematuria from BPH Ref : Cambell's Urology 8/e p1340"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPhenylketonuria caused by deficiency of\nA) Tyrosine transaminase\nB) Tyrosine hydroxylase\nC) Phenylalanine hydroxylase\nD) Phenylketonuria hydroxylase", "output": "2, because (C) Phenyalanine hydroxylase # Phenylketonuria is a genetic disorder inherited from a person's parents.> It is due to mutations in the PAH gene which results in low levels of the enzyme phenylalanine hydroxylase.> This results in the build up of dietary phenylalanine to potentially toxic levels. It is autosomal recessive meaning that both copies of the gene must be mutated for the condition to develop.> There are two main types, classic PKU and variant PKU, depending on if any enzyme function remains.> Those with one copy of a mutated gene typically do not have symptoms."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nTelefono is:\nA) Pulling of hair\nB) Beating on soles\nC) Beating on ears\nD) Beating on fingers", "output": "2, because Simultaneous beating of both ears with the palms of the hands is known as TELEFONO. This may lead to rupture of the tympanic membrane causing pain, bleeding and hearing loss. It is difficult to detect this. The external ear may also get torn during pulling of the ears."}

{"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 direct causes of maternal moality except:\nA) APH\nB) PPH\nC) Hea disease\nD) Eclampsia", "output": "2, because Ans. is c i.e. Hea disease"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nwho introduced ECT\nA) manfred bleuler\nB) moerin seligman\nC) lucio bini\nD) freud", "output": "2, because HISTORY * Medunna ====IM injection of camphor to induce seizures * Ugo cerletti and lucio bini==== ECT in a catatonic patient INDICATIONS * DEPRESSION SUICIDAL IDEAS-------------- first choice * CATATONIC SCHIZOPHRENIA * SCHIZOPHRENIA * MANIA * ELECTRODE PLACEMENT * Most commonly used=== bi fronto temporal * More cognitive side effects==bi fronto temporal * Less cognitive side effect======bi frontal * SIDE EFFECTS * RETROGRADE AMNESIA * BODY ACHE * MEDICATIONS USED IN THE PROCEDURE * ANAESTHETIC======Thiopentone / ethosuximide * MUSCLE RELAXANT====Succynyl choline CURARE IN PSEUDOCHOLINEESTERASE DEFICIENCY * ANTICHOLINERGIC=====Atropine CONTRA INDICATIONS * NO ABSOLUTE Contra indication * RELATIVE -----------------Brain tumour / arrythmia Ref. kaplon and saock, synopsis of psychiatry, 11 th edition, 1055"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nMELD score includes all except\nA) S. bilirubin\nB) S. creatinine\nC) Prothrombin time\nD) Serum albumin", "output": "3, because Serum albumin is not a part of MELD SCORE.\nIt is\u00a0a part of child - pugh classification."}

{"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 carcinogenic except\nA) H. pylori\nB) Hepatitis B virus\nC) E.B. virus\nD) Campylobacter", "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 multi question.\n\nAll are hypercoagulable states, except ?\nA) Protein C resistance\nB) Protein S deficiency\nC) Antiphospholipid antibody\nD) None", "output": "3, because Ans. is 'None' o All are hypercoagulable states."}

{"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 the most common cause of meningoencephalitis in children:\nA) Mumps\nB) Arbovirus\nC) HSV\nD) Enterovirus", "output": "3, because Answer is D (Enterovirus): Enteroviruses are the most common cause of viral meningoencephalitis. Arboviruses, HSV and Mumps virus are all impoant agents associated with viral meningoencephalitis, but Enteroviruses are the most commonly associated agents and the answer of choice. 'Enteroviruses are the most common cause of viral meningoencephalitis' -"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nUse of this instrument during examination of the ear provides all except\nA) Magnification\nB) In suctioning of middle ear secretions\nC) Assessing Tympanic Membrane Movement\nD) Removal of Foreign body", "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\nPneumocystic carnii infects:\nA) Human\nB) Monkey\nC) Rat\nD) Cats", "output": "2, because Ans. c. Rat"}

{"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 Roll back malaria except:(AIIMS November 2013, Nov 2012)\nA) Insecticide treated mosquito nets\nB) Strengthening health system\nC) Development of newer insecticide\nD) Training of health workers", "output": "2, because Ans. c. Development of newer insecticide (Ref; Harrison 19/e p14,18/e p14 WHO Roll Back Malaria Document] HTM_ MAL 2005. 1101.pdf (Roll Back Malaria)Roll Back Malaria:Messages on malaria case management, intermittent preventive treatment during pregnancy and insecticide- treated netsQ (ITNs) were promoted using volunteers, social marketing of unit-dose, prepackaged antimalarial medicines and trainingQ of patent medicine dealers (BASICS II, 2004).The key to the success of this programme was the shift from supply to demand creation for health servicesQ, increased access to medicines, and community ownershipRoll Back Malaria* In Nigeria, a communication strategy for behavioural change was initiated using both the public and private sectors.* Messages on malaria case management, intermittent preventive treatment during pregnancy and insecticide-treated nets (ITNs) wrere promoted using volunteers, social marketing of unit-dose, prepackaged antimalarial medicines and training of patent medicinedealers (BASICS II. 2004).* The channels used included interpersonal communication, traditional communication channels such as 'town criers' and local festivals, and social marketing through medicine packaging, radio spots and distribution of booklets to patent medicine dealers.* The strategy resulted in an increased knowledge of the role and benefits of ITNs in malaria prevention and an increased awareness of the danger signs of malaria and of the importance of seeking early treatment for febrile children through antimalarial medicines.* The key to the success of this programme was the shift from supply to demand creation for health services, increased access to medicines, and community ownership* The experience gained from such training programmes has demonstrated the need for training to address the following gaps in skills and knowledge, depending on the specific roles undertaken:- Knowledge and skills to recognize uncomplicated malaria, danger signs and when to refer the patient Knowledge and skills to manage malaria appropriately (recommended medications/dosages)- Awareness of the need for prompt and early treatment, and completion of the dose- Communication skills to counsel and offer health education on other aspects (e.g. ITNs. intermittent preventive treatment during pregnancy)- Recording/reporting tasks- Drug storage* The highest level of political commitment by the national government is required to ensure that the cross-ministerial activities beyond the purview of the ministry of health required for the implementation of HMM are facilitated at the policy level.Central and regulatory factors:* Regulatory status of recommended antimaiarial medicines.* Quality assurance mechanisms for medicine manufacture and Distribution, and their application.* Regulatory status of potential provider groups.* Current curricula for pre-service and in-service training for* Health providers and other stakeholders in the HMM programme (e.g. teachers) and for schools."}

{"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 associated with EBV except -\nA) Infectious mononucleosis\nB) Nasopharyngeal carcinoma\nC) Oral hairy leukoplakia\nD) Epidermodysplasi", "output": "3, because EBV causes nadopharyngeal carcinoma,oral hairy luekoplakia&infectious mononucleosis REF:MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.475"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSingle most sensitive tool for evaluating the iron status is\nA) Haemoglobin concentration\nB) Serum ion concentration\nC) Serum ferritin\nD) Serum transferrin saturation", "output": "2, because Serum ferritin is the single most sensitive tool for evaluating the iron status.It reflects the size of Iron stores in the body. Values below 10 mcg/L indicate an absence of stored iron.Park 23e pg: 623"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nChandu 32 years male presents with abdominal pain and vomitting. He also complain of some psychiatric symptoms & visual hallucination. Most likely diagnosis is\nA) Hypothyroidism\nB) Hypehyroidism\nC) Hysteria\nD) Intermittent Porphyria", "output": "3, because D i.e. Intermittent porphyria"}

{"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 ARDS, all are seen except :\nA) Dilated bronchioles\nB) Edema\nC) Fibrosis\nD) Alveolar damage", "output": "0, because Acute respiratory distress syndrome\nAetiology and pathogenesis\nAcute respiratory distress syndrome (ARDS) is a diffuse neutrophilic alveolitis caused by a range of conditions and characterised by bilateral radiographic in\ufb01ltrates and hypoxaemia. Activated neutrophils are sequestered into the lungs and capillary permeability is increased, with damage to cells within the alveoli. The pathophysiology is part of the in\ufb02ammatory spectrum, and the triggers are similar: infective and non-infective in\ufb02ammatory processes. These processes result in exudation and accumulation of protein-rich cellular \ufb02uid within alveoli and the formation of characteristic \u2018hyaline membranes\u2019. Local release of cytokines and chemokines by activated macrophages and neutrophils results in progressive recruitment of in\ufb02ammatory cells. Secondary effects include loss of surfactant and impaired surfactant production. The net effect is alveolar collapse and reduced lung compliance, most marked in dependent regions of the lung (mainly dorsal in supine patients).\u00a0\nThe affected airspaces become \ufb02uid-\ufb01lled and can no longer contribute to ventilation, resulting in hypoxaemia (due to increased pulmonary shunt) and hypercapnia (due to inadequate ventilation in some areas of the lung): that is, ventilation\u2013perfusion mismatch.\nReference: : Davidson P R I N C I P L E S\u00a0 \u00a0and Practice O F M E D I C I N E 23rd edition page no\u00a0 198"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPopulation covered by a PHC in hilly region is \u2013\nA) 20000\nB) 30000\nC) 40000\nD) 25000", "output": "0, because One PHC for every 30,000 rural population in the plains.\nOne PHC for every 20,000 population in hilly, tribal and backward areas."}

{"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 factor determines the destructive power of bullet after firing?\nA) Weight of bullet\nB) Shape of bullet\nC) Size of bullet\nD) Velocity of bullet", "output": "3, because A bullet's ability to injure is directly related to its kinetic energy at the moment of impact. Kinetic energy i.e. E = mv2 /2 The kinetic energy is directly propoional to weight (mass) of the bullet and the square of its velocity. Thus a bullet traveling at twice the speed of a second bullet of equal weight and similar size and shape, possesses four times much energy and injuring power. Ref: The Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 189."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBaroreceptor stimulation producesa) Decreased heart rate & BPb) Increased heart rate & BPc) Increased cardiac contractilityd) Decreased cardiac contractility\nA) b\nB) c\nC) ac\nD) ad", "output": "3, because Baroreceptors are present in carotid sinus and aortic arch. Increase in BP activates them which results in decrease in the sympathetic discharge. This leads to decrease in cardiac contraction, heart rate and BP."}

{"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 anti\u2013cancer drug is NOT 'S'\u2013phase specific ?\nA) Methotrexate\nB) Mercaptopurine\nC) Ifosfamide\nD) Thioguanine", "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\nDose of vitamin A prophytaxis given in age group 16 years -\nA) 2000 iu\nB) 20000 iu\nC) 200000 iu\nD) 100000 iu", "output": "2, because Ans. is 'c' i.e., 200000 iu"}

{"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 principle that is the spinal cord dorsal roots are sensory and the ventral roots are motor is known as -\nA) Laplace's law\nB) Bell-Magendle's law\nC) Frank-Starling's law\nD) Weber-Fechner's law", "output": "1, because (B) (Bell Magendie law's) (157 - Ganang 23rd)* Bell Magandie law - In the spinal cord dorsal roots are sensory and ventral roots are motors (DS - VM)* Weber Fachner law - Magnitude of sensation felt in proportionate to the log of intensity of the stimulus**.* Law of pro jection states than no matter where a particular sensory pathway is stimulated along its course to the cortex. The conscious sensation produced is referred to the location of the receptor (eg. Phantom limb).* Within physiological limits, the force of contraction of the ventricular muscle fibers is directly proportional to its initial length i.e. larger the initial length of the cardiac muscle fibers, greater will be the force of contraction of the ventricles. This is known as the Frank Starling Law of the heart.* All or none relationship between the stimulus and the response is called. All or none law, applies to the whole of the functional syncytium in the heart, the unit bring the entire atria or entire ventricle.Points to remember* Arterioles - Resistance vessel, capillaries - exchange vessels, veins - capacitance vessels, main arteries conduct (muscular) arteries.* Windkessel effect is seen in - large elastic vessels- Major reservoir of blood is veins- Highest compliance is seen in veinsa) Neurons of first order - Axon of bipolar cells (in Retina)b) Neurons of second order - Axons of ganglionic cell (Retina i.e. optic disc) optic nerve** (optic chiasma, optic tract).c) Neurons of third order : Axons from nerve cells in lateral geniculate body (optic radiation)* Dorsal root ganglia have - Pseudounipolar.* Neurons in sympathetic ganglia are - Multipolar"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBullet that leaves a visible mark in its flight so that person can see the path is\nA) Tandem bullet\nB) Tracer bullet\nC) Dum-dum bullet\nD) Incendiary bullet", "output": "1, because Tracer bullet: It leaves a visible mark or 'trace' while in flight, so that the path of bullet can be seen . Dum - dum bullet: The nose of the bullet is not covered by jacket & exposed. It expands or mushrooms on striking the target, producing a large hole & more damage. Incendiary bullets: Incendiary bullets contain phosphorus. Type of army bullet used to cause fire in the target. Tandem bullet: Bullets ejected one after the other, when the first bullet having been struck in the barrel fails to leave the barrel and is ejected by a subsequently fired bullet."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nOf the following which does not categorise under Rape? Sexual intercourse with :\nA) Wife below 15 years\nB) Wife above 15 years\nC) Women below 16 years\nD) Women above 20 years", "output": "3, because B i.e. Wife above 20"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nCongenital rubella syndrome - true is A/E?\nA) Microcephaly\nB) VSD\nC) Conduction defect\nD) All", "output": "2, because Ans. is 'c' i.e., Conduction defect"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAnaesthetic agent with vasoconstrictor is contraindicated in ?\nA) Digital block\nB) Spinal block\nC) Epidural block\nD) Regional anaesthesia", "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\nMesencephalo-oculo-facial-angiomatosis is seen in:\nA) KTW Syndrome\nB) NF-1 & 2\nC) Sturge-Weber syndrome\nD) Wyburn-Mason syndrome", "output": "3, because D i.e. Wyburn-Mason syndrome - Wyburn-Mason syndrome (or Bonnet-Dechaume Blanc syndrome mesencephalo-oculo-facial or mesencephalo-optico retinal angiomatosis syndrome) is characterized by neuro (mesencephalo) - optico / oculo / retinal - facial angiomatosis (vascular-malformations). - Wyburn-Mason syndrome presents with telangiectasia of skinQ (i.e cutaneous vascular nevi) on face + retinal cirsoid aneurysmQ and aerio-venous malformation (AVM) involving the visual pathways and midbrainQ (= entire optic tract = optic nerve, thalamus, geniculate bodies and calcarine coex). The lesions are typically unilateral mostly. It may be a/w AVMs of postrior fossa, neck, mandible/maxilla presenting in childhood. Rendu-Osler-Weber syndrome (hereditary hemorrhagic telangiectasia) is AD neurocutaneous syndrome that result in a variety of systemic fibrovascular dysplasia (i.e. telangiectasia, AVM, AV hemangioma/fistula, and aneurysm) affecting mucous membrane, skin, lung, brain and GI tract-Q. Telangiectasi is primarily found in the skin & mucous membranes. AVM and fistula are found manly in liver > brain > lung > spine. Aneurysm can invovle any size vessel. Frequent bleeding into mucous membrane, skin, lungs, genitourinary and gestrointestinal system is d/ t vascular weakness. Klippel-Trenaunay syndrome (KTS) is angio-osteo-hyperophy i.e. hyperophy of soft tissue & over growth of bone IR abnormalitie of finger/toes /limb and venous varicosities d/t large angiomatous nevus (AVM). Several KTS patients exhibit CNS findings of Sturg-Weber syndrome and are called Klippel-TrenaunayWeber syndrome. They exhibit cutaneous angiomata, soft tissue /bony hyperophy and leptomeningeal vascular malformation."}

{"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 following drug has anxiolytic action with least sedation\nA) Buspirone\nB) Triazolam\nC) Alprazolam\nD) Chlordiazepoxide", "output": "0, because Features of Buspirone Non-benzodiazepine anxiolytic agentDoes not produce significant sedation or cognitive/functional impairmentDoes not interact with BZD receptor or modify GABAergic transmissionDoes not produce tolerance or physical dependence Does not suppress BZD or barbiturate withdrawal syndrome Has no muscle relaxant or anticonvulsant activity (Refer: KD Tripathi's Essentials of Medical Pharmacology, 7th edition, pg no: 466-467)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAge of gestation when ovaries and testis are first distinguishable :\nA) 4 weeks\nB) 8 weeks\nC) 12 weeks\nD) 16 weeks", "output": "1, because 8 weeks"}

{"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 testis descends the inguinal canal during...month.\nA) 5th\nB) 6th\nC) 7th\nD) 8th", "output": "2, because C i.e. 7th"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIndex measuring deprivation in basic dimensions of human development\nA) Human povey index\nB) Human development index\nC) Physical quality of life index\nD) Development deprivation index", "output": "0, because The Human Povey Index (HPI) was considered to better reflect the extent of deprivation to the HDI. In 2010 it was supplanted by the UN&;s Multidimensional Povey Index."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCells occurring in greatest number in pulp are\nA) Cementoblasts\nB) Fibroblasts\nC) Osteoblasts\nD) Ameloblasts", "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\nKeratocyst has all of the following features except:\nA) It is more common in mandible\nB) May be filled with thin straw coloured fluid\nC) Low recurrence rate\nD) Expansion of bone clinically seen", "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\nA child with vesicoureteric reflex of grade 2 comes to OPD. What is the\npreferred treatment method\nA) Antibiotics\nB) Observation\nC) Sting operation\nD) Ureteric reimplantation", "output": "0, because Prophalyctatic antibiotics is given to all vesicoureteric reflex pts."}

{"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 60 yr old person presents with a mass located at central bronchus causing distal bronchiectasis and recurrent pneumonia. Which of the following findings is expected from biopsy of the mass?\nA) Abundant osteoid matrix formation\nB) Contains all three germ layers\nC) Spindle cells with abundant stromal matrix\nD) Small round cells and hyperchromatic nuclei with nuclear moulding", "output": "3, because Ans. (d) Small round cells and hyperchromatic nuclei with nuclear moulding(Ref: Robbins 9th/pg 715-717)This typical presentation of 60 yr/M presenting with a mass located at central bronchus causing distal bronchiectasis and recurrent pneumonia is suggestive of small cell Carcinoma.In Small cell Ca lung, location in lungs are most commonly central and usually presents with mass within the bronchus.Light Microscopy feature of Small cell Ca is:Small cells with salt and pepper pattern, hyperchromatic nuclei, Q, nuclear molding Q is prominentBasophilic staining of vascular walls due to encrustation by DNA from necrotic tumor cells (Azzopardi effect) QAbout other options:A. Abundant osteoid matrix formation points towards metastatic Osteosarcoma;B. Contains all three germ layers: is consistent with a Teratoma;C. Spindle cells with abundant stromal matrix is suggestive of Sarcoma;"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\npatient has decreased weight, need for thinness, the diagnosis is\nA) refeeding syndrome\nB) anorexia nervosa\nC) metabolic syndrome\nD) bulimia nervosa", "output": "1, because Anorexia nervosa Anorexia nervosa is a eating disorder where the patient has decreased weight and altered body image and persistent desire to maintain thinness * Gender==== more common in females * Age=======adolescence * Comorbidity=== depression and social phobia * Duration====3 months * Criteria= * Intense fear of becoming fat * Restriction of food intake * Restricting type * Binge eating and purging type * Amenorrhea is not needed for diagnosis, previously amenorrhea is considered as a diagnostic criteria for diagnosis, in recent DSM 5 amenorrhea is considered for a diagnosis * Association= * OCD and depression * Decreased interest in sex * Complication * 7-14% moality * ECG changes * Hypokalemic alkalosis because of induced vomiting * Gastric dilation * Drugs * Cypro hepatidine * SSRI * Management * Admit in severe cases * Prevent vomiting by making restroom inaccessible for 2 hours after food intake * Avoid laxatives * Small frequent meals * Avoid refeeding syndrome Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 509"}

{"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 cause viral hepatitis except -\nA) Measles\nB) EBV\nC) Rhinovirus\nD) Reovirus", "output": "2, because Ans. is 'c' i.e., Rhinovirus Impoant viruses causing hepatitis:? 1) Hepatotropic viruses : HAV, HBV, HCV, HD V, HEV. 2) Herpes viruses : CMV, EBV, HSV-1, VZV. 3) Flaviviruses : Yellow fever, dengue fever. 4) Filoviruses : Marburg virus, Ebola virus. 5) Occasinal causes Measles virus, adenovirus, Echoviruses, Coxsackieviruses, influenza virus, parvoviruses, reoviruses, mumps virus."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nKrukenberg tumor is associated mostly with which cancer?\nA) Stomach\nB) Breast\nC) Liver\nD) Pancreas", "output": "0, because Krukenberg tumor is a distinctive bilateral tumor metastatic to the ovaries by the transcoelomic spread. The tumor is generally secondary to a gastric carcinoma but other primary sites where mucinous carcinomas occur (e.g. colon, appendix, and breast) may also produce Krukenberg tumor in the ovary. Rarely, a tumor having the pattern of Krukenberg tumor is primary in the ovary.Grossly, Krukenberg tumor forms rounded or kidney-shaped firm large masses in both ovaries. Microscopically, it is characterized by the presence of mucus-filled signet ring cells which may lie singly or in clusters. It is accompanied by a sarcoma-like cellular proliferation of ovarian stroma HARSH MOHAN Textbook of pathology 6th edition pg no 750"}

{"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 Nizatidine except\nA) It is a H2 blocker used in peptic ulcer disease\nB) It has 100% Bioavailability\nC) It also enhances gastric emptying\nD) It can also lead to tachycardia", "output": "3, because Nizatidine is a H2\u00a0blocker with anticholinesterase activity, thus enhances gastric emptying and can also cause bradycardia."}

{"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 Halstead Retain battery involves all except :\nA) Finger oscillation\nB) Constructional praxis\nC) Rhythm\nD) Actual performance", "output": "1, because In Halstead - Reitan battery test, the battery is composed of ten tests :\n\nCategory test.\nTactual performance test.\nRhythm test.\nFinger - oscillation test.\nSpeech-sound perception test.\nTrail - making test.\nCritical flicker frequency.\nTime sense test.\nAphasia screening test.\nSensory - perceptual 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\nAfter mandibulectomy, muscle preventing falling back of tongue -\nA) Genioglossus\nB) Hyoglossus\nC) Palatopharyngeus\nD) All 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 multi question.\n\nWhich of the following is NOT TRUE about post - traumatic stress disorder?\nA) The onset of illness may occur many months after the traumatic event\nB) Individual debriefing and early counselling are most effective method of treatment\nC) Eye movement desensitization and reprocessing is effective\nD) There is high risk of alcohol abuse in patients suffering from this disorder", "output": "1, because Treatment of choice for PTSD is psychotherapy in the form of cognitive behavior therapy often in combination with pharmacotherapy.\nThere is no evidence that single - session individual psychological briefing is a useful treatment for PTSD.\nEye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD.\nSymptoms of PTSD develop within 6 months of the stressor, however, 10% patients have delayed onset.\nPTSD patients are high risk for alcohol abuse."}

{"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 malignancy shows least lymph node involvement:\nA) Supraglottic\nB) Subglottic\nC) Glottic cancer\nD) Ca nasopharynx", "output": "2, because Ans: c (Glottic cancer) Ref: Dhingra, 3rd ed, p. 372; 4th ed, p. 286No lymphatics in vocal cords so nodal metastasis are practically never seen in cord lesions unless the disease spreads beyond the membraneous cord. SupraglottisGlottisSubglottisSiteEpiglottisAryepiglottic foldArytenoidVentricular bandsVentricles & sacculeTrue vocal cordsAnt.commissurePost.commissureWall of subglottis upto lower border of cricoid cartilageFrequencyLess frequent than glotticMost commonLeast commonNodal metsNodal mets earlyNo lymph node metsNodal mets as common as in supraglottic varietySymptomsOften silent, hoarseness lateHoarsenessStridor"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nComplex polysaccharides are converted to glucose and absorbed by the help of:\nA) Na+k+ATPase\nB) Sucrase\nC) Enterokinase\nD) Carboxypeptidase", "output": "1, because Ans: b (Sucrase) Ref: Vasudevan, 4th ed, p.Sucrase or invert sugar converts sucrose (which is a complex polysaccharide) into 1 molecule of glucose and 1 molecule of fructose.Na+k+ ATPase is a membrane protein.Enterokinase is a brush border enzyme in intestinal mucosa which will activate trypsinogen to trypsin.Proteolytic enzyme are secreted as zymogens which are converted into their active forms in the intestinal lumen. This will prevent the auto digestion of secretory acini. Once activated trypsin activates other molecules.Carboxypeptidase is a proteolytic enzyme present in pancreatic juice."}

{"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 most prominent toxic effect associated with acetaminophen use is\nA) Respiratory alkalosis\nB) Haemorrhage\nC) Hepatic necrosis\nD) Gastric Ulceration", "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\nA 47-year-old woman is admitted to the hospital with signs of cavernous sinus thrombosis. Radiographic examination reveals a pituitary tumor involving the cavernous sinus, confirming the initial diagnosis. During physical examination it is suspected that the right abducens nerve of the patient has been damaged by the tumor. In which direction will the physician most likely ask the patient to turn her right eye to confirm the abducens nerve damage, assuming she is unable to perform this task?\nA) Inward\nB) Outward\nC) Downward\nD) Down and out", "output": "1, because (b) Source: GAS 849-852, 855; GA 450, 465, 536The right abducens nerve innervates the right lateral rectus, which mediates outward movement (abduction) of the right eye. Inward movement is accomplished by the medial rectus, supplied by the oculomotor nerve. Downward movement in the midline is accomplished by joint activation of the superior oblique and inferior rectus muscle. Downward movement of the pupil from the adducted position is a function of the superior oblique alone, which is supplied by the trochlear nerve. Down and out motion is mediated by the combined actions of the lateral rectus and inferior rectus, which are innervated by the abducens and oculomotor nerves. Downward movement of the pupil from a forward gaze is a result of combined actions of inferior rectus and superior oblique muscles, supplied by oculomotor and trochlear nerves, respectively."}

{"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 about osteoahritis is ?\nA) Involves synol joints\nB) Progressive softening of the aicular cailage\nC) It is an inflammatory ahritis\nD) Marginal osteophytes are produced", "output": "2, because Ans. is 'c' i.e., It is an inflammatory ahritis Osteoahritis (OA) is a chronic disorder of synol joints in which there is progressive softening and disintegration of aicular cailage accompanied by new growth of cailage and bone at the joint margins (osteophytes), cyst formation and sclerosis in the subchondral bone, mild synovitis and capsular fibrosis. The term osteoahritis is a misnomer as it is a non-inflammatory condition. The right term is osteoahrosis or degenerative joint disorder because it is a degenerative wear - and - tear process occuring in joints."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOrange-skin cornea results due to:\nA) Chalcosis\nB) Siderosis\nC) Ammonia burn\nD) Mustard gas", "output": "3, because Ans. Mustard gas"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFracture of the hyoid bone results from all except :\nA) Throttling\nB) Hanging\nC) Choking\nD) Ligature strangulation", "output": "2, because C i.e. Choking - Burking is a method of homicidal smothering and traumatic asphyxiaQ. In smothering lips, gums, tongue, inner side of mouth & nose may show bruising or lacerationQ. Asphyxial signs (eg congestion, cynosis & patechiae) are severe except when the head & face is enclosed in plastic bag. In smothering, choking, gagging, there is no fracture of hyoid bone, because in these throat (neck) is not touched."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAccordian sign is seen in\nA) Pseudomembranous colitis\nB) Intussusception\nC) Ileocecal TB\nD) Ischemic colitis", "output": "0, because The 'Accordion sign' (also known as 'conceina sign') is seen on CT examinations of the abdomen Refers to the similarity between the thickened oedematous wall of Pseudomembranous colitis and the folds of an accordion. This appearance is the result of hyperaemic enhancing mucosa stretched over markedly thickened submucosal folds. Also seen when contrast is trapped between oedematous haustral folds and pseudomembranes formed on the luminal surface of the colon."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nMelting temperature of DNA is directly proportional to\nA) GC Pairing\nB) AT Pairing\nC) Length of DNA\nD) None of the above", "output": "0, because GC pairs have 3 hydrogen bonds and therefore melt at higher temperature compared to AT pairs which have 2 hydrogen bonds."}

{"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 latest antiviral drug for bronchitis due to RSV-\nA) Ribavarin\nB) Acyclovir\nC) Amantadine\nD) Idoxuridine", "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\nPhase 2 of Damage control surgery occurs at\nA) Pre hospital management\nB) Resuscitation in ICU\nC) Resuscitation in operating room\nD) Definitive repair", "output": "1, because Deadly triad of trauma Following a trauma protracted surgery in physiologically unstable patient, the three factors that carry moality are Hypothermia Acidosis Coagulopathy Hence originated a phenomenon - DAMAGE CONTROL SURGERY Phases of damage control surgery Phase1 :Initial exploration Phase 2: Secondary Resucitation Phase 3: Definitive operation Phase 1(initial exploration) Control of active hemorrhage and contamination Midline incision--4 quadrant packing done GIT perforation done with sutures or staples External drains kept for pancreatic or bile duct injuries Temporary closure of abdomen using plastic sheet known as OPSITE This technique of closure is known as VACPAC or OPSITE SANDWICH Phase 2( secondary resuscitation) Transfer to ICU Ventilatory suppo Correct the deadly triad Hypothermia, acidosis, Coagulopathy Phase 3(definitive treatment) Planned re exploration and definitive surgery Done 48-72 hrs after secondary phase Complex reconstruction must be avoided Ref : Bailey and love 27th edition Pgno: 318-326, 378-380, 426"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nRomana's sign is seen in -\nA) Toxoplasma\nB) Trypanosoma cruzi\nC) Loaloa\nD) Wuchereria", "output": "1, because Ans. is 'b' i.e., Trypanosoma cruzi Romana's signo The classic finding in acute Chagas disease, which consists of unilateral painless edema of the palpebrae and periocular tissues - can result when the conjunctiva is the portal of entry.o These initial local signs may be follwed by malaise, fever, anorexia, and edema of the face and lower extremities.o Generalized lymphadenopathy and hepatosplenomegaly may develop."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\n30 Yr old man which is most likely organism causing infection of epididymis -\nA) E.coli\nB) Gonococci\nC) Chlamydia\nD) Ureaplasma ureolyticum", "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\nAn elderly diabetic with excruciating pain in ear, appearance of granulation in meatus, skull base infection with facial paralysis should be treated with\nA) Penicillin\nB) Ciprofloxacin\nC) 2nd generation ciphalosporin\nD) Erythromycin", "output": "0, because All clinical features are suggestive of malignant otitis externa, an inflammatory condition of the external ear. Malignant otitis externa (also k/a Necrotizing external otitis) Malignant otitis externa is an inflammatory condition of the external ear usually spreading deep to cause osteomyelitis of temporal bone and base of skull. It occurs primarily in immunocompromised persons, especially older persons with diabetes mellitus, and is often initiated by self-inflicted or iatrogenic trauma to the external auditory canal [May also be seen in pts. who received radiotherapy to skull base I The most frequent pathogen is Pseudomonas aeruginosa. Others may be S. aureus, Staphylococcus epidermidis, Aspergillus, Actinomyces, and some gram-negative bacterial. One of the hallmarkof malignant otitis externs is granulation tissue in the external auditory canal, especially at the hone-cailage junction. As the infection spreads to the temporal bone, it may extend into the cranium and result in cranial nerve palsies (commonly the facial nerve) Cranial nerve involvement indicates poor prognosis. Death is usually due to intracranial complications such as sigmoid sinus thrombosis. It has high moality rate due to which the name 'malignant' is used for this disease. Treatment Includes correction of immunosuppression (when possible), local treatment of the auditory canal, long-term systemic antibiotic therapy, and in selected patients, surgery. - In all cases, the external ear canal is cleansed and a biopsy specimen of the granulation tissue sent for culture. - IV antibiotics is directed against the offending organism. - For Pseudomonas aeruginosa, the most common pathogen, the regimen involves an antipseudomonal penicillin or cephalosporin (3rd generation-piperacillin or ceftazidime) with an aminoglycoside. A fluoroquinolone antibiotic can be used in place of the aminoglycoside. Ear drops containing antipseudomonal antibiotic e.g. ciproflaxacin plus a glucocoticoid is also used. - Early cases can be managed with oral and otic fluoroquinolones only. - Extensive surgical debridement once an impoant pa of the treatment is now rarely needed."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nMeniere's disease is characterized by all except -\nA) Conductive deafness\nB) Sensorineural deafness\nC) Vertigo\nD) Tinnitus", "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\nDigoxin toxicity may result from the concurrent administration of digoxin with all of the following drugs EXCEPT\nA) Quinidine\nB) Hydrochlorothiazide\nC) Triamterene\nD) Furosemide", "output": "2, because Triamterene is a potassium-sparing diuretic that may protect against diuretic-induced digoxin toxicity. Digoxin toxicity may be caused by drugs that increase serum digoxin levels or increase the binding of digoxin to its receptor, the sodium-potassium adenosine tn phosphatase (ATPase). Quinidine decreases digoxin volume of distribution and clearance. Verapamil also decreases the clearance of digoxin. Both drugs may\nthereby increase serum digoxin levels and precipitate digoxin toxicity. Diuretics (e.g., hydrochlorothiazide, furosemide) may cause hypokalemia and hypomagnesemia, both of which may predispose to cardiac arrhythmias. Furthermore, hypokalemia increases di-goxin binding to sodium-potassium ATPase."}

{"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 drugs is contraindicated along with spironolactone\nA) Chlorothiazide\nB) Beta blockers\nC) ACE inhibitors\nD) Amlodipine", "output": "2, because CONTRAINDICATIONS / PRECAUTIONS Adrenal insufficiency, anuria, diabetes mellitus, hyperkalemia, renal disease, renal failure, renal impairment. ... Acid/base imbalance, metabolic acidosis, metabolic alkalosis, respiratory acidosis. ... Ascites, biliary cirrhosis, hepatic disease. ... Menstrual irregularity."}

{"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 3-year-old male has come for a routine dental check up. Intra-oral examination reveals good oral hygiene and open proximal contacts. During previous dental appointments, he was cooperative. Which radiographic assessment should be done for this patient?\nA) No radiographic assessment.\nB) Bitewing Radiographs\nC) Intraoral periapical radiograph\nD) Occlusal radiographs", "output": "0, because The American Dental Association (ADA), the American Academy for Pediatric Dentistry (AAPD), the European Academy for Pediatric Dentistry (EAPD), and other organizations have published criteria that are meant to guide the dental professional in decision-making regarding appropriate radiographic imaging (Table 2-5). These guidelines clearly state that if the patient cannot cope with the procedure, one should attempt other strategies to handle the situation. The guidelines all acknowledge that, in some cases, radiographs are not possible, in which case, one should balance the benefit against the risk even more carefully. Sometimes it is better to postpone the radiographic exposure until the patient is older or better conditioned. The guidelines also clearly state that if there are no clinical signs of pathology, the need for a radiographic assessment is up to the professional\u2019s judgment, and that these decisions have to be made on an individual patient basis. Radiographs are never to be used for economic and screening reasons since they involve a potential health risk for the patient. A 3-year-old with a sound dentition and open proximal contacts does not need a radiographic assessment. In contrast, for a 3-year-old with only 10 teeth visible in the mouth and no history of dental treatment, the dental professional should make a radiographic assessment. If a 4-year-old shows rampant decay, a radiographic assessment is certainly justifiable and indicated."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFirst to recover from post-operative ileus:\nA) Small intestine\nB) Stomach\nC) Colon\nD) None", "output": "0, because POST-OPERATIVE ILEUS - Following most abdominal operations or injuries, the motility of GI tract is transiently impaired. - Proposed mechanisms responsible for this dysmotility are surgical stress-induced sympathetic reflexes, inflammatory response mediator release, and anesthetic / analgesic effects; each of which can inhibit intestinal motility. Return of normal motility: small intestineQ (within 24 hours) > Gastric (48 hours)Q>Colonic(3-5 days) Post-operative ileus is most pronounced in colon. - Because small bowel motility is returned before colonic and gastric motility, listening for bowel sounds is not a reliable indicator that ileus has fully resolved."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWatershed zone of large intestine ?\nA) Cecum\nB) Ascending colon\nC) Rectosigmoid\nD) Transverse colon", "output": "2, because There are areas of colon with poor blood supply resulting from incomplete anastomosis of marginal aeries. These are watershed areas of colon and include :Splenic flexure (Griffith point) : Watershed area between superior mesenteric aery and inferior mesenteric aery.Rectosigmoid junction (Sudeck's point) : Watershed zone between inferior mesenteric aery and internal iliac aery."}

{"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 is a relatively selective \u03b12 adrenergic blocker with short duration of action ?\nA) Prazosin\nB) Yohimbine\nC) Terazosin\nD) Doxazosin", "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\nOxidative deamination is catalyzed by ?\nA) Glutaminase\nB) Glutamine synthase\nC) Glutamate dehydrogenase\nD) None of the above", "output": "2, because Ans. is 'c' i.e., Glutamate dehydrogenase"}

{"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 indicated by the term 'mittelschmerz'?\nA) Fern pattern of cervical mucus\nB) Peritoneal irritation from corpus hemorrhagicum\nC) Rise of body temperature due to effect of progesterone\nD) LH surge before ovulation", "output": "1, because The follicle that ruptures at the time of ovulation promptly fills with blood, forming what is sometimes called a corpus hemorrhagicum. Minor bleeding from the follicle into the abdominal cavity may cause peritoneal irritation and fleeting lower abdominal pain (\"mittelschmerz\"). The granulosa and theca cells of the follicle lining promptly begin to proliferate, and the clotted blood is rapidly replaced with yellowish, lipid-rich luteal cells, forming the corpus luteum. Ref: Alford C., Nurudeen S. (2013). Chapter 4. Physiology of Reproduction in Women. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBest prognostic indicator for head injured patients: AIIMS 10\nA) GCS\nB) CT findings\nC) Age of the patient\nD) History", "output": "0, because Ans. GCS"}

{"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 the following are cyanotic hea disease except\nA) TOF\nB) PDA\nC) Tricuspid atresia\nD) Eisenmenger's complex", "output": "1, because Ref Harrison 19 th ed pg 1523 Patent ductus aeriosus is not classified as a cyanotic congenital heayh disease. PDA is an acyanotic hea disease with left to right shunt."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAicular cailage is made up of-\nA) Type I collagen\nB) Type II collagen\nC) Type III collagen\nD) Type IV collagen", "output": "1, because Ans. is `b' i.e., Type H Collegen type Tissue distributionUbiquitous in hard & soft tissuesII & IX Cailage, interveebral disc, vitreousIn Hollow organs & soft tissuesIV Basement membraneV Blood vesselsVI Ubiquitous in microfibrilsVII Dermoepidemal junctionIX Cailage & VitrousNote : Amongst these type I, II, III, V & IX are fibrillary Interstitial collegen, all others are nonfibrillary collegen."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMechanism of action of the sulfonylureas is\nA) K+ ATP channel blocker\nB) Na ATP channel blocker\nC) Cl ATP channel blocker\nD) Ca ATP channel blocker.", "output": "0, because Ans. is 'a' i.e., K ATP channel blocker * Sulfonylurease provoke a brisk release of insulin from pancreas. They act on the so called \"Sulfonylurea receptors\" (SUR1) on pancreatic b-cell membrane - cause depolarization by reducing conductance of ATP sensitive K+ channels. This enhances influx of Ca+2 - degranulation. They do not cause hypoglycemia in pancreatectomized animals and type 1 diabetes (Presence of at least 30% of functional b-cells in essential for their action). A minor action reducing glucagon secretion by increasing insulin and somatostatin release has been demonstrated."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nLower lobe fibrosis is seen in :\nA) Silicosis\nB) Sarcoidosis\nC) Cystic Fibrosis\nD) Asbestosis", "output": "3, because Answer is D (Asbestosis): Lower lobe fibrosis is seen in Asbestosis. Silicosis, Sarcoidosis and Cystic Fibrosis are all associated with Upper Lobe Fibrosis Upper Lobe Fibrosis Fibrotic Disease Old Granulomatous Infection (Tuberculosis; Histoplasmosis; Coccidioidomycosis) Sarcoidosis Silicosis, Berylliosis Coal Worker's Pneumoconiosis Ankylosing Spondylitis Radiation Pneumonitis Chronic Hypersensitivity Pneumonitis Airway Disease Cystic Fibrosis Allergic Bronchopulmonary Aspergillosis (ABPA) Fibrotic Disease Idiopathic Pulmonary Fibrosis Asbestosis Collagen Vascular Disease (SLE; Systemic Sclerosis; RA) Drugs (Busulphan; Bleomycin; Methotrexate etc.) Airway Disease Chronic Aspiration Basal Bronchiectasis"}

{"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 ocular muscle does NOT arises from apex of orbit\nA) Superior rectus\nB) Inferior rectus\nC) Superior oblique\nD) Inferior oblique", "output": "3, because D. i.e. Inferior oblique"}

{"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 cuspal inclines of the maxillary buccal cusps and the mandibular lingual cusps should be grounded if they are in deflective occlusal contact in:\nA) Working position only\nB) Balancing position only\nC) Both working and balancing positions\nD) Central position", "output": "0, because None"}