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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\nAll of the following activities of Junior Red cross except \u2013\nA) Military hospital worker\nB) Village uplift\nC) Prevent epidemic work\nD) Any of the above", "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\nWeb of causation of disease, which statement is most appropriate?\nA) Mostly applicable for common diseases\nB) Requires complete understanding of all factors associated with causation of disease\nC) Epidemiological ratio\nD) Helps to suggest ways to interrupt the risk of transmission", "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\nGhotna is:-\nA) Heavy wooden log rolled on leg\nB) Compressing the thighs with two roads\nC) Tying the limps to the pole\nD) Electric shock to genitalia", "output": "0, because Ghotna: Rolling a wooden log over the thighs up and down, while the log is weighed by one or two policemen standing on it Cattle prod: Electric shock especially over the genitals Sham execution: Victim is blind folded and asked to stand before a wall and then threatened that a vehicle is going to hit him. He hears the sound of a vehicle very near to him, causing fear and shock."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEpiphyseal enlargement occurs in -\nA) Paget's disease\nB) Sheurmann's disease\nC) Epiphyseal dysplasia\nD) Hemophilia", "output": "3, because Epiphyseal enlargement\n\nMost common causes of epiphyseal enlargement are chronic inflammation (e.g. JRA) or chronic increase in blood flow. Causes of Epiphyseal enlargement are:-\n\na)\u00a0Solitary (Enlargement of particular epiphysis)\n\nPost-inflammatory (JRA, Septic arthritis)\nPerthe's disease (in repair stage)\nStatus post hip dislocation\nHemophilia (Hemophilic arthropathy)\nTurner syndrome\nKlippel-trenaunay syndrome (angiohypertrophy syndrome)\nKascibach - Merritt syndrome\nBeckwith - Wiedemann syndrome (Hemihypertrophy)\nTrevor disease (Dysplasia epiphysealis hemimelica)\n\nb) Generalized\n\nHyperthyroidism \u00a0\u00a0\nAcromegaly or cerebral gigantism \u00a0 \u00a0 \u00a0 \u00a0\u00a0\nAdrenogenital syndrome\u00a0\u00a0 iv) Rickets\nSpondyloepiphyseal dysplasia\nMcCune-Albright syndrome\nKniest syndrome"}

{"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 Hodgkin&;s disease -\nA) CHOP\nB) MOPP\nC) ABVD\nD) None", "output": "2, because <p>The ABVD(doxorubicin,vinblastine,bleomycin,dacarbazine) is used in the treatment of Hodgkin&;s disease .Thd incidence of infeility & secondary myelodysplasia /ALL is low with this regime. </p><p>Reference :Davidson&;s principles & practice of medicine 22nd edition pg no 1043 </p>"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDOC of GTCS in pregnancy\nA) Lamotrigine\nB) CBZ\nC) Levetiracetam\nD) Valproate", "output": "0, because Ans. is 'a' i.e., Lamotrigine"}

{"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 20 year female presents with a ovarian mass 6x 6 x 6cm in size. Ultrasonography reveals solid structures in the mass. Her serum biomarkers such as AFP. fO-hCG and CA 125 are normal, however, her serum alkaline phosphatase was found to be elevated. The most likely diagnosis is\nA) Dysgerminoma\nB) Endodermal sinus tumor\nC) Malignant teratoma\nD) Mucinous cystadenocarcinoma", "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\nWhen patient is on isotretinoin therapy, monitoring of which of the following is done\nA) Liver function test\nB) Lipid profile\nC) Renal function tests\nD) CBC", "output": "1, because Isotretinoin is indicated in severe nodulo cystic acne vulgaris. It may result in hyperlipidemia, arthralgia and myalgia"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIf GCS score is 8, head injury is classified as:\nA) Mild\nB) Moderate\nC) Severe\nD) Very severe", "output": "2, because Head injury can be classified as mild, moderate, or severe. For patients with a history of head trauma, classification is as follows: severe head injury if the GCS score is 3 to 8, moderate head injury if the GCS score is 9 to 12, and mild head injury if the GCS score is 13 to 15. Ref: Schwaz's principle of surgery 9th edition, chapter 42."}

{"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 pencillins act by: September 2007\nA) Inhibiting protein synthesis\nB) Inhibiting cell wall synthesis\nC) Antifolate\nD) Inhibitis DNA gyrase", "output": "1, because Ans. B: Inhibiting cell wall synthesis All penicillin derivatives produce their bacteriocidal effects by inhibition of bacterial cell wall synthesis. Specifically, the cross linking of peptides on the mucosaccharide chains is prevented. If cell walls are improperly made cell walls allow water to flow into the cell causing it to burst and bacterial lysis occurs."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nCause of Coxa vera ?\nA) Congenital\nB) Pehe's disease\nC) SCFE\nD) All of the above", "output": "0, because Ans. is 'd' i.e., All of the above Coxa vera Coxa vera refers to reduced angle between the neck and shaft of the femur. Coxa vera may be congenital or acquired. 1. Congenital (developmental / Infantile) coxa vera This is coxa vara resulting from some unknown growth anomaly at the upper femoral epiphysis. It is noticed as a painless limp in a child who has just staed walking. In severe cases, shoening of the leg may be obvious. On examination, abduction and internal rotation of the hip are limited and the leg is sho. X - rays will show a reduction in neck - shaft angle. The epiphyseal plate may be too veical. There may be a separate triangle of bone in the inferior poion of the metaphysis, called Fairbank's triangle. Treatment is by a subtrochanteric corrective osteotomy. 2. Aquired coxa - vera Aquired coxa-vera is seen in :- SCFE (slipped capital femoral epiphysis) Sequelae of avascular necrosis of femoral epiphysis Legg-Calve Pehe's disease Femoral neck fracture Traumatic hip dislocation Post reduction of CDH Septic necrosis Associated with pathological bone disorders Osteogenesis imperfecta Fibrous dysplasia Osteopetrosis"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nStrength of topical ophthalmic preparations of tobramycin is : September 2009\nA) 3 mg/ ml\nB) 8 mg/ ml\nC) 10 mg/ml\nD) 13 mg/ml", "output": "0, because Ans. A: 3 mg/ml Tobramycin works by binding to a site on the bacterial 30S and 50S ribosome, preventing formation of the 70S complex. As a result, mRNA cannot be translated into protein and cell death ensues. Sterile Tobramycin Ophtha Solution (eye-drops) contains tobramycin concentration of 0.3%. It is mixed with 0.01% benzalkonium chloride as a preservative. This concentrations result in 3 mg per ml."}

{"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 given to prevent methotrexate toxicity?\nA) MESNA\nB) Flumazenil\nC) Fomipezole\nD) Calcium leucovorin", "output": "3, because Ans. d (Calcium leucovorin) (Ref. Harrison 18th/ p 476, 607)# Methotrexate inhibits dihydrofolate reductase, which regenerates reduced folates from the oxidized folates produced when thymidine monophosphate is formed from deoxyuridine monophosphate.# Without reduced folates, cells die a \"thymineless\" death.# N-5 tetrahydrofolate or N-5 formyltetrahydrofolate (leucovorin) can bypass this block and rescue cells from methotrexate, which is maintained in cells by polyglutamylation.METHOTREXATE - Side Effects:# In addition to bone marrow suppression and mucosal irritation, methotrexate can cause renal failure itself at high doses owing to crystallization in renal tubules; therefore high-dose regimens REQUIRE ALKALINIZATION OF URINE with increased flow by hydration.6# Less frequent adverse effects include reversible increases in transaminases and hypersensitivity-like pulmonary syndrome.# Chronic low-dose methotrexate can cause hepatic fibrosis.# When administered to the intrathecal space, methotrexate can cause chemical arachnoiditis and CNS dysfunction.# Trimetrexate is a methotrexate derivative that is not polyglutamylated and does not use the reduced folate carrier.# The effects of folate antagonists that inhibit dihydrofolate reductase can be counteracted by folinic acid (5-formyl tetrahydrofolate ) in a dose of 100 to 200 mg/d, which circumvents the block in folate metabolism by providing a form of folate that can be converted to 5,10-methylene THF.Methotrexate(Antimetabolite)# A folic acid analog that inhibits dihydrofolate reductase; decreased dTMP levels hinder DNA and thus protein synthesis# S-phase specificNeoplastic indications: leukemia, lymphomas, breast cancer, choriocarcinomaNonneoplastic indications; rheumatoid arthritis, psoriasis, termination of pregnancy (e.g., ectopic) Toxicities: suppresses bone marrow reversibly; folinic acid (leucovorin) is used to \"rescue\"; fatty change in liver"}

{"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 baby is born at 27 weeks of gestation required mechanical ventilation for next 4 weeks & O2 for next 1 week. He maintained at room temperature subsequently. As per new Bronchopulmonary dysplasia definition, he has which of the following \u2013\nA) Mild BPD\nB) Moderate BPD\nC) Severe BPD\nD) No BPD", "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\nWhich drugs are used for prenatal therapy of congenital adrenal hyperplasia?\nA) Hydrocoisone\nB) Prednisolone\nC) Fludrocoisone\nD) Dexamethasone", "output": "3, because High risk pregnancies should be staed of Dexamathasone, that readily crosses placenta, in an amount of 20 mu/kg in 2-3 divided doses. This surpasses secretion of steroids by fetal adrenals, including secretion of fetal adrenal androgens. If staed 6 weeks of gestation, it ameliorates virilization of external genitals in affected female fetus. Ref: Kligman, Behrman, Jenson, Stanton (2008), Chapter 577, \"Congenital Adrenal Hyperplasia\", In the book, \"Nelson's Textbook of Pediatrics\", Volume 2, 18th Edition, New Delhi, Page 2364"}

{"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 Breslau's second life test, organ tested is\nA) Brain\nB) Hea\nC) Lung\nD) Stomach and Intestine", "output": "3, because D i.e. Stomach & Intestine Breslau's second life (or Stomach Bowel) test says that air will be swallowed & so may pass into stomach & small intestine when respiration establishes."}

{"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 with eyes closed & mind wondering will have the following wave in\nA) a-waves\nB) b-waves\nC) d-waves\nD) t-waves", "output": "0, because (A) a-waves # Alpha Rhythm> In adult humans who are awake but at rest with the mind wandering and the eyes closed, the most prominent component of Ihe EEG is fairly regular pattern of waves at a frequency of 8-12 Hz and an amplitude of 50-100 pV when recorded from the scalp> This pattern is the alpha rhythm.> It is most marked in the parieto-occipital area."}

{"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 used for topical application in respiratory papillomatosis?\nA) Acyclovir\nB) Ranitidine\nC) Cidofovir\nD) Ribavirin", "output": "2, because Cidofovir Gold standard treatment for respiratory papillomatosis is Laser MLS/ Powered MLS (using microdebrider). Cidofovir is a recent drug which is used intralesionally or topically. Its active metabolite, cidofovir diphosphate, inhibits viral replication by selectively inhibiting viral DNA polymerase."}

{"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 years old lady presented with acute pain abdomen, constipation and vomiting suspecting acute intestinal obstruction. The investigation of choice for the patient is -\nA) Ba enema\nB) X-ray abdomen erect posture\nC) USG\nD) CT scan", "output": "1, because Ans. is 'b' i.e. X-ray abdomen erect posture"}

{"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 reflex is NOT prominent in child at bih?\nA) Moro's reflex\nB) Glabellar tap\nC) Crossed extensor reflex\nD) Tonic neck reflex", "output": "3, because Tonic neck reflex is prominent between 2nd and 4th months. Persistence of reflex beyond the age of 6-9 months is abnormal. Impoant neonatal reflexes: Sucking, rooting, and swallowing reflexes Grasp reflex Moro's reflex Glabellar tap Crossed extension Ref: Essential paediatrics by OP Ghai, 6th edition, Page 146."}

{"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 potent statin is?\nA) Simvastatin\nB) Pitavastatin\nC) Rosuvastatin\nD) Atorvastatin", "output": "2, because Rosuvastatin - most potent best bioavailability: fluvastatin most commonly prescribed- atorvastatin safe for children- pravastatin Ref: KD Tripathi 8th 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\nNiacin is synthesized from:\nA) Phenylalanine\nB) Tryptophan\nC) Tyrosine\nD) Methionine", "output": "1, because The liver can synthesize niacin from the essential amino acid tryptophan, but the synthesis is extremely inefficient; 60 mg of tryptophan are required to make one milligram of niacin. The 5-membered aromatic heterocycle of the essential amino acid, tryptophan, is cleaved and rearranged with the alpha amino group of tryptophan into the 6-membered aromatic heterocycle of niacin."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhat is irregular astigmatism-\nA) Perpendicular principal meridians\nB) Non perpendicular principal meridians\nC) Any of the above\nD) None of the above", "output": "1, because Ans. is 'b' i.e., Non perpendicular principal meridians ASTIGMATISMo Astigmatism is a type of refractive error wherein the refraction varies in the different meridia. Consequently, the rays of light entering in the eye cannot converge to a point focus but form focal lines. The refractive error of the astigmatic eye stems from a difference in degree of curvature refraction of the two different meridians (i.e.,, the eye has different focal point in different planes). For example, the image may be clearly focused on retina in the horizontal plane, but not in the vertical plane.o The most common cause of astigmatism is abnormality of corneal curvature. Other less common causes are lenticular (curvature abnormality of lens,oblique position of lens) and retinal (oblique placement of macula). Types of astigmatismBased on axis of the principal meridiansRegular stigmatism : Principal meridians are perpendicularo With-the-rule astigmatism-the vertical meridian is steepest.o Against-the-rule astigmatism-the horizontal meridian is steepest.o Oblique astigmatism-the steepest curve lies in between 120 and 150 degrees and 30 and 60 degrees.Irregular astigmatism - principal meridians are not perpendicular.Based on focus of the principal meridiansSimple astigmatismo Simple hyperopic astigmatism - first focal line is on retina while the second is located behind the retinao Simple myopic astigmatism - first focal line is in front of the retina while the second is on the retina.Compound astigmatismo Compound hyperopic astigmatism-both focal lines are located behind the retina,o Compound myopic astigmatism-both focal lines are located in front of the retina.Mixed astigmatism-focal lines are on both sides of the retina (straddling the retina).Treatment of Astigmatismo Treatment of astigmatism consists : -Optical treatment: - It consists of cylindrical power spectacles or contact lens. Types of contact lenses used are permeable contact tens, Soft toric contact lens (for high degree astigmatism), hybrid lens, i.e,, soft on hard lens, hard contact lens.Surgical treatment: - Non-laser (astigmatic keratotomy) or laser (PRK, LASIK)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nPterygium all are true except:\nA) Arise from any pa of conjunctiva\nB) Can cause astigmatism\nC) Surgery is treatment of choice\nD) UV exposure is risk factor", "output": "0, because Ans. Arise from any pa of conjunctiva"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nGradient in pulmonary aery wedge pressure and left ventricular end diastolic pressure is seen in\nA) Aoic regurgitation\nB) Constrictive pericarditis\nC) Left atrial myxoma\nD) Pulmonary thromboembolism", "output": "2, because Answer is C (Left atrial myxoma) An increased gradient during diastole is suggestive of an obstructive lesion between Left atrium and Left ventricle that is not allowing pressures to normalize between the atria and ventricle such as atrial myxoma. Pulmonary aery wedge pressure represents Left atrial pressure. Left ventricular end diastolic pressure represents Left ventricular pressure. Gradient between Left atrial pressure (PCWP) and Left ventricular pressure during diastole: Normally there is no gradient during diastole as both pressures are equal. An increased gradient during diastole is suggestive of an obstructive lesion between Left atrium and Left ventricle that is not allowing pressures to normalize between the atria and ventricle. This may thus be seen in obstructive lesions between Left atria and ventricle such as : Mitral stcnosis Atrial myxomas"}

{"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 opioid can be given intranasally?\nA) Tramadol\nB) Pethidine\nC) Butorphanol\nD) Buprenorphine", "output": "2, because Butorphanol is full agonist at kappa & antagonist at \u03bc\u00a0receptor that can be given intranasally."}

{"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 important in diagnosing Acute Hepatitis B is\nA) IgG Anti-HBc\nB) Anti HBs\nC) IgM Anti-HBc\nD) HBsAg", "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\nA 55-year-old woman was found to have Ca cervix, FIGO stage 2-3, locally advanced. What would be the management?:\nA) Surgery plus chemotherapy\nB) radiotherapy plus chemotherapy\nC) Chemotherapy\nD) Radiotherapy plus HPV vaccine", "output": "1, because As discussed in detail in preceeding text best for cervical cancer of (stages II B to IV A) is chemoradiation (i.e. chemotherapy and radiotherapy), where by cisplatin is used as a radiosensitiser to increase the sensitivity of the cells to radiotherapy before giving radiotherapy.\nSince in this question \u2013chemotherapy + radiotherapy is given as one of the options, hence, we will mark it as the correct option."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhat is TRUE about Lovastatin\nA) Inhibits HMG CoA synthetase\nB) Inhibits HMG CoA reductase\nC) Myositis may result from its prolonged use\nD) Decrease synthesis of cholesterol and causes lenticular opacity", "output": "1, because Ans. is 'b' i.e., Inhibits HMG CoA reductase 'c' i.e., Myositis results from prolonged use 'd' i.e., Decrease synthesis of cholesterol and cause lenticular opacityLovastatin:Mechanism of actionInhibition of HMGCoA reductase Mode of actionDecreased cholesterol synthesis Increased LDL receptors Lipoproteins affectedLDL- DecreasedVLDL- DecreasedTG- DecreasedHDL- IncreasedSite EffectsHepatic dysfunction Severe myositis, | CPK Lens opacities ContraindicationsImpaired renal function andIn combination with Gemfibrozil or Nicotinic acid Risk of myositis is increased in these conditions"}

{"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 cancer is most commonly associated with increased estrogen levels?\nA) Cervix\nB) Ovarian\nC) Breast\nD) GTN", "output": "2, because Ans. is 'c' i.e., Breast Important risk factors for breast cancer1) Increased age8) High fat diet2) Female sex9) High socioeconomic status3) Western countries10) Irradiation4) Early menarche11) Hormone replacement therapy5) Late menopause12) Family history positive6) Obesity13) Somatic mutation in p53 gene (in 40% cases)7) Nulliparity * Most of these factors are related to increased exposure of estrogen to breast.* Breast feeding is protective against breast cancer. Thus women who avoid breast cancer are at increased risk to develop breast cancer. Oral contraceptives and smoking do not appear to increase the risk of breast cancer.* 3 most important cancer associated with estrogen are breast, endometrium and uterine.Note - There is also an increased risk of ovarian cancer with long term large dose estrogen therapy, but much less common as compared to breast cancer."}

{"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 among the following occupation is a risk factor for this presenting illness?\nA) A lifeguard in swimming pool\nB) A poultry worker\nC) Farmer\nD) A kennel worker", "output": "0, because Ans. (a) A lifeguard in swimming poolCutaneous larva migrans (CLM) is a clinical syndrome consisting of an erythematous migrating linear or serpiginous cutaneous track;It is also called as creeping eruptionsIndividuals at greatest risk include travelers, children, swimmers in lakes, and laborers whose activities bring their skin in contact with contaminated soilLarva migrans:* It is caused by nematodes that usually cause infection to animals* When they accidentally enters humans - it cannot complete the cycle and hence gets arrested in the body causing larva migrans* It is of two types:# Cutaneous larva migrans# Visceral larva migransComparison between Cutaneous and visceral larva migransCutaneous larva migransVisceral larva migrans* Ancylostoma braziliense (M/c)* Toxocara can is* Ancylostoma caninum (second M/c)* Toxocara cati* Necator americanus* Gnathostoma* Ancylostoma duodenale* Anisakis* Gnathostoma spinigerum * Strongloides * Loa loa * Fasciola * Paragonimus * The question is quite a tricky one. A lifeguard in swimming pool has risk comparatively, as poultry has no link with these organisms. Most of the organisms are dog and canines sources."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVaccination causing intussusception is\nA) Rotavirus\nB) Parvovirus\nC) Poliovirus\nD) BCG", "output": "0, because Rotavirus vaccination - there is a potentially high risk of intussusception with the first dose when this vaccine is given to infants aged more than 12weeks. Ref: Park&;s textbook of preventive and social medicine; 23rd 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\nMost common cause of urethral stricture is\nA) Trauma\nB) Infection\nC) Congenital\nD) Post endoscopy", "output": "0, because Urethral stricture CAUSES The common causes of urethral stricture are: * Inflammatory * Secondary to urethritis * Secondary to balanitis xerotica obliterans (BXO) * Traumatic (MC) * Bulbar urethral injury * Pelvic fracture urethral disruption injury * Iatrogenic * Secondary to urethral instrumentation including cath- eterisation and transurethral prostatectomy * Secondary to radical prostatectomy * Secondary to radiotherapy for prostate cancer * Idiopathic CLINICAL FEATURES Symptoms are usually hesitancy of micturition, straining to void and a poor urinary stream. The relative youthfulness of the patient often rules out prostatic enlargement, which characteristically occurs after the age of 50. As the stream becomes narrower, micturition is prolonged and is followed by postmicturition dribbling as a result of urine trickling from the dilated urethra proximal to the stricture. Urinary frequency by day and night is common and is due to incomplete bladder emptying, coexisting detrusor overactivity or urinary infection. If the stricture is tight enough, the patient will go into acute retention, although this is rare. If this happens, there is a danger that clumsy attempts to pass a urethral catheter will result in a false passage. If a patient has gone into retention because of a urethral stricture, its lumen will be too narrow to pass even a tiny catheter and suprapubic catheterisation is required. Investigation involves uroflowmetry, urethroscopy, urethrography and ultrasound scanning to assess bladder emptying and to detect any upper tract dilatation. The urinary flow rate is typically prolonged and plateau shaped while urethroscopy allows the stricture to be viewedas a circumferential scar. Openings of false passages commemorate previous misguided attempts to pass a urethral catheter. Urethrography using a water-soluble contrast medium will show the extent and severity of the stricture Ref: Bailey and love 27th edition Pgno : 1482"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEgg on side appearance of heart is seen in the radiograph of?\nA) TAPVC\nB) TGA\nC) ASD\nD) VSD", "output": "1, because Ans. (b) TGARef: Sutton 7thed different pages. Pediatrics Radiology: The Requisites by Johan G. Blickman, Bruce R. Parker; M.D. Patrick D. Barnes p-52"}

{"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 amino acid migrates fastest on paper chromatography on methylcellulose medium?\nA) Aspartic acid\nB) Valine\nC) Lysine\nD) Glycine", "output": "1, because Chromatography paper contains about 15-20% water, held to the paper fibers. This water acts as the stationary phase in paper chromatography. Amino acids are separated according to their solubility in the water and in an organic solvent (the mobile phase) moving up the paper. The most non-polar amino acids migrate the farthest, due to their greater solubility in the organic solvent.\nPaper also acts as an adsorbent, having an affinity for polar groups.\nAmong the given options, Glycine and Valine are non-polar amino acids (hydrophobic). Aspartic acid and Lysine are polar amino acids. Valine is more non-polar than glycine."}

{"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 eleven year old boy is having tinea capitis on his scalp. The most appropriate line of treatment is \u2013\nA) Oral griseofulvin therapy\nB) Topical griseofulvin therapy\nC) Shaving of the scalp\nD) Selenium sulphide shampoo", "output": "0, because Systemic therapy for all dermatophytosis\n\nTerbinafm\u00a0\u00a0\u2192\u00a0DOC\nGriseofulvin\u00a0\u2192\u00a02nd choice\n\nOnce the mainstay of systemic therapy for dermatophytic infection, has now replaced by terbinafine."}

{"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 metabolic abnormality is seen in multiple myeloma -\nA) Hyponatremia\nB) Hypokalemia\nC) Hypercalcemia\nD) Hyperphosphatemia", "output": "2, because Ans: C"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIPC 193 is for -\nA) Perjury\nB) Punishment for perjury\nC) Issuing false certificate\nD) Causing disappearance of evidence", "output": "1, because Ans. is 'b' i.e., Punishment for perjury Perjury, Hostile witness and false certificate* 191 IPC: (i) Giving false evidence (perjury) under oath and (ii) hostile witness.* 192 IPC: Fabricating false evidence (perjury).* 193 IPC: Punishment for false evidence (punishment for perjury): imprisonment upto 7 years + fine.* 194 IPC: Giving or fabricating false evidence to procure conviction of capital offence.* 195 IPC: Giving or fabricating false evidence to procure conviction of offence punishable with imprisonment for life.* 197 IPC: Issuing or signing (attesting) false certificate by a doctor is a criminal offence.* 201 IPC: Causing disappearance of evidence."}

{"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 types of bronchogenic carcinomas are most likely to develop within a residual area of peripheral scar tissue?\nA) Small-cell carcinoma\nB) Squamous-cell carcinoma\nC) . Large-cell carcinoma\nD) Adenocarcinoma", "output": "3, because Adenocarcinomas are the most common primary lung cancer to develop within an area of peripheral scar. Scar tissue formation may be secondary to previous granulomatous disease (tuberculosis), infarction, or interstitial diseases of the lung associated with fibrosis (e.g., progressive systemic sclerosis). The pathogenesis of scar carcinoma is not completely understood. One theory is that scar tissue blocks lymphatic drainage, causing an increased concentration of anthracotic pigment-containing carcinogens. Persistent hyperplasia of tissue and the potential for a mutation leading to cancer are other mechanisms that may be similar to those of cancers that develop in fistulous tracts draining pus (e.g., chronic osteomyelitis)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nProvison of PHC was done by\nA) Bhore Committee\nB) Chadah Committee\nC) Shrivastava Committee\nD) Bajaj Committee", "output": "0, because Ans. is 'a' i.e.,Bhore Committe Bhore CommitteIt is also known as 'Health Survey and Development Committee'. Its recommendations were :1) Integration of preventive and curative services at all administration levels2) Sho term and long term recommendationsSho term : PHC to cater to a population of 40,000Long term (3 million plan) : PHC units to be set up with 75 bedded hospital for each 10,000 to 20,000 population3) Major charger in medical education including 3 months training in social and preventive medicine to prepare 'social physicians'."}

{"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 most common malignancy affecting spleen\nA) Angiosarcoma\nB) Hamaoma\nC) Secondaries\nD) Lymphoma", "output": "3, because The most common neoplastic tumour is lymphoma(Hodgkin) and the most common benign tumour is a hemangioma, rest like angiosarcoma, secondaries and hamaomas are rare tumours of the spleen. Bailey and love&;s 24 the edition page no. 1091"}

{"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 key gluconeogenic amino acid is:\nA) Alanine\nB) Serine\nC) Valine\nD) Tyrosine", "output": "0, because Alanine is a key gluconeogenic amino acid. The rate of hepatic gluconeogenesis from alanine is far higher than from all other amino acids. The capacity of the liver for gluconeogenesis from alanine does not reach saturation until the alanine concentration reaches 20 to 30 times its normal physiologic level.\nRef: Harper\u2019s illustrated biochemistry. 30th edition page no: 289"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nNARP syndrome is seen in\nA) A. Mitochondrial diseases\nB) B. Glycogen storage diseases\nC) C. Lysosomal storage diseases\nD) D. Lipid storage diseases", "output": "0, because NARP syndrome (neuropathy ,ataxia, & retinitis pigmentosa) is a condition related to changes in mitochondrial DNA Refer Harrison 17/316-317 Robbins 8/1328"}

{"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 post splenectomy infection is:\nA) Pneumococcus\nB) Meningococcus\nC) Staphy lococcus\nD) Corynebacterium", "output": "0, because Pneumococcus"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nHand signs of liver cell failure are all except?\nA) Palmar erythema\nB) Clubbing\nC) Dupuytren's contracture\nD) Splinter hemorrhages", "output": "3, because The hand manifestations of CLD consist of: Spider naevi (invariably on the upper half of the body), Palmar erythema (mottled redness of the thenar & hypothenar eminences) Dupuytren's contractures Clubbing."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMembranous urethral rupture causes collection of blood in -\nA) Ischiorectal fossa\nB) Deep perineal pouch\nC) Superficial inguinal region\nD) Pelvic diaphragm", "output": "1, because Ans. is 'b' i.e., Deep perineal pouch"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFunction of peroxisomes is:\nA) Generate hydrogen peroxide\nB) Degrade hydrogen peroxide\nC) Both\nD) None", "output": "2, because Peroxisomes are associated with: Production of peroxides and degradation of peroxides"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nProtrusion of tongue not possible in damage of ?\nA) Styloglossus\nB) Hyoglossus\nC) Palatoglossus\nD) Genioglossus", "output": "3, because Ans. is 'd i.e., Genioglossus"}

{"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 doesn't require chemoprophylaxis?\nA) Measles\nB) Conjunctivitis\nC) Cholera\nD) Malaria", "output": "0, because Measles prevention is only by immunisation and vaccination. No chemoprophylaxis(Ref.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 21st Edition page no.136)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAlpha la adrenergic blocker giving symptomatic relief in BPH?\nA) Tamsulosin\nB) Prazosin\nC) Oxazocin\nD) Dolazoline", "output": "0, because ANSWER: (A) TamsulosinREF: KDT 7th ed p. 135, Goodman Gillman s 11th ed p. 173Tamsulosin:This unselective alpha! ./alpha blocker has been found to be as effective as terazocin for symptomatic control of BPHPrazosin: blocks all subtypes of alpha receptors equally, used for symptomatic control of BPH Terazosin: long acting, more popular for BPH due to single daily dose"}

{"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 glycolysis are all except ?\nA) Provide nutrition to cancer cells\nB) Substrate level phosphorylation at pyruvate kinase\nC) Two carbon end product is formed\nD) NADPH is formed by glyceraldhyde-3-phosphate dehydrogenase", "output": "2, because Ans. is 'c' i.e., Two carbon end product is formed Impoant facts about glycolysis An impoant biochemical significance is the ability of glycolysis to provide ATP in the absence of oxygen (anerobic glycolysis) and allows tissues to survive anoxic episodes. It occurs in cytosol 3 Carbon atoms end product (pyruvate or lactate) is produced. Irreversible steps are catalyzed by : - Glucokinase/Hexokinase, phosphofructohnase-I, and pyruvate kinase. Reversible steps are catalyzed by : - Phosphohexose isomerase, aldolase, phosphotriose isomerase, glyceraldehyde 3-phosphate dehydrogenase, Phosphoglycerate kinase, Phosphoglycerate mutase, Enolase. Energy (ATP) using steps are catalyzee by : - Hexokinase/glucokinase, phosphofurctokinase. Energy (ATP) production at substrate level are catalyzed by : Phosphoglycerate kinase, Pyruvate kinase. Reducing equivalent (NADH) production is catalyzed by : Glyceraldehyde 3-phosphate dehydrogenase. Cancer cells derive nutrition from glycolysis as they have lack of 02 supply because of lack of capillary network. Glycolysis (anaerobic glycolysis) is the only metabolic pathway in the body which can provide energy by glucose metabolism in anerobic conditions."}

{"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 68-year-old male is brought to the outpatient by his wife due to increasing forgetfulness. On taking history in details, wife repoed that for around 6 months patient is having trouble in organising the finances and paying bills, something he has done all his life. He has also become withdrawn and has decreased meeting people. The patient also behaved inappropriately with a female neighbour couple of says back, which is much against his usual nature. The patient denies having any problems and seems indifferent to his wife's concern. He has a medical history of hypeension and type 2 diabetes mellitus There is a family history of Alzheimer disease. On MMSE, score came out to be 23. Which of the following is the most likely diagnosis?\nA) Alzheimer disease\nB) Creutzfeldt-Jakob disease\nC) Dementia with Lewy bodies\nD) Frontotemporal dementia", "output": "3, because The history is suggestive of executive dysfunction (trouble in organising the finances and paying bills), apathy and disinhibition (decreased socialisation and inappropriate behaviour with women), lack of insight (denies having any problem) and memory disturbances. This is suggestive of frontotemporal dementia, in which personality changes are prominent, memory disturbances appear later in frontotemporal dementia. In contrast, in alzheimers disease memory disturbances are prominent early in the disorder and personality changes later. Creutzfeldt-Jakob disease which is caused by a prion manifests with rapidly progressive dementia, myoclonus, and cerebellar dysfunction."}

{"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 anesthetic agent of choice in a case of status asthmaticus?\nA) Ketamine\nB) Thiopentone\nC) Ether\nD) Nitrous Oxide", "output": "0, because Ketamine along with adjunctive therapy is the standard therapy in the treatment of children with status asthmaticus and impending respiratory failure. Ketamine cause bronchodilation through the inhibition of vagal tone, release of endogenous catecholamines and by direct muscle relaxation."}

{"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 starvation activities of all of the following enzyme is increased except ?\nA) Pyruvate carboxylase\nB) Pyruvate kinase\nC) PEP carboxykinase\nD) Glucose 6 phosphatase", "output": "1, because In starvation activity of all enzymes responsible for gluconeogenesis are increased.\nPyruvate kinase is the enzyme of glycolysis. Activity of enzymes of glycolysis are suppressed in starvation. So pyruvate kinase activity is suppressed in starvation.\nAll other enzymes given in this question are gluconeogenic\nenzyme whose activity is enhanced in starvation."}

{"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 22 year old man had a Beef sandwich and Potato salad. He Vomited 2 hours after the meal. What is the probable diagnosis\nA) S. aureus poisoning\nB) Bacillus cereus poisoning\nC) Clostridial poisonong\nD) Helicobacter pylori poisoning", "output": "0, because Preformed toxin of S. aureus causes nausea within 1-6 hours of ingestion.\nCommon food associated are: Poultry, potato and egg salad."}

{"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 potent drugs to reduce plasma cholesterol level are:\nA) Plant sterols\nB) Fibrates\nC) Anion exchange resins\nD) Statins", "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\nWhich of the following is an alkaloid\nA) Morphine\nB) Neostigmine\nC) Emetine\nD) Atropine", "output": "1, because Neostigmine, sold under the brand name Prostigmin among others, is a medication used to treat myasthenia gravis, Ogilvie syndrome, and urinary retention without the presence of a blockage. It is also used together with atropine to end the effects of neuromuscular blocking medication of the non-depolarizing type. Refer 7/105"}

{"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 incubation period of mumps is-\nA) 1 -2 weeks\nB) 2-3 weeks\nC) 3-4 weeks\nD) 4-5 weeks", "output": "1, because Incubation period of mumps is 2-3 wks Ref Harrison20th edition pg 897"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDuring a hysterectomy and an oophorectomy, the uterine and ovarian vessels must be ligated. These vessels can be found in which ligaments?\nA) Broad and ovarian\nB) Broad and suspensory\nC) Round and ovarian\nD) Round and suspensory", "output": "1, because The uterine vessels are found in the inferior poion of the broad ligament, while the ovarian vessels are found in the suspensory ligaments of the ovaries. The suspensory ligaments of the ovaries are peritoneal folds covering ovarian aeries , veins, nerves, and lymphatics as the structures pass over the pelvic brim to reach the ovary. The ovarian ligament proper is a round cord which attaches the ovary to the uterus, just below the entrance of the uterine tube into the uterus. The round ligament of the uterus is a connective tissue band that attaches the uterus to the inner aspect of the labium majus,it traverses the inguinal canal and it is found in the broad ligament. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 38. Anatomy. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e."}

{"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 10-year-old male child with sho stature presented to the pediatric OPD with complaints of frequent headaches over the past 6 months along with slowly progressive loss of vision of the right eye. Lately the child has also staed having trouble in walking along with frequent mood changes and excessive thirst. MRI brain showed a tumour in the sellar region which was resected. HPE examination showed reticular epithelial cells that have appearances reminiscent of the enamel pulp of developing teeth along with calcifications and wet keratin nodules. The gene involved in causing the above condition is also involved in causing which other condition: -\nA) Hepatocellular carcinoma\nB) Melanoma\nC) Neuroblastoma\nD) CML", "output": "0, because This is a case of Craniopharyngioma. Benign tumour Arise in sellar/suprasellar region Arise from vestigial remnants of Rathke's pouch Bimodal age distribution Presents with headache and visual disturbance May present with sho stature due to GH deficiency (Pituitary hypofunction). Most commonly due to abnormalities in WNT signaling pathway including the activating mutations of the beta-catenin. MRI image shows a mass in the suprasellar region- likely craniopharyngioma OTHER CANCERS DUE TO WNT PATHWAY Mutations in b-catenin are present in: - 50% of hepatoblastomas. 20% of Hepatocellular carcinomas GENES INVOLVED IN: - Melanoma- NRAS, FGF3, HST1 Neuroblastoma- N-MYC, ALK CML- ABL"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFatty acid present in breast milk which is important for growth and CNS development is:\nA) Docosahexaenoic acid\nB) Palmitic acid\nC) Linoleic acid\nD) Linolenic acid", "output": "0, because Ans. A. Docosahexaenoic acidDocosahexaenoic acid (DHA) is a long-chain polyunsaturated fatty acid found in breast milk that plays a role in neurodevelopment. Breast milk DHA concentration is influenced by DHA in the mother's diet."}

{"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 commonest cause of limp in a child of seven years is -\nA) T.B. hip\nB) C.D.H\nC) Perthe's disease\nD) Slipped upper femoral epiphysis", "output": "2, because The most common cause of limp in a child between 3-10 years is transient synovitis of hip.\nHowever, among the given options Perthe's disease is the best answer as Perthes disease is the second most common cause of limp in a child between 5-10 years."}

{"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 64-year-old lady Kamla complains of severe unilateral headache on the right side and blindness for 2 days. On examination, there is a thick cord-like structure on the lateral side of the head. The ESR is 80 mm / hr. in the first hour. The most likely diagnosis is :\nA) Temporal arteritis\nB) A migraine\nC) Cluster headache\nD) Sinusitis", "output": "0, because Ans. is 'a' i.e.,. Temporal Arteritis The symptom and the laboratory examination of the patients almost confirm the diagnosis of temporal arteritis.This question has been asked too frequently in various PGME examination you are required to be well versed with the differential diagnosis of a headache.Let's see the diagnostic features of various headaches.A migraineAge - Females after pubertySex - Females > malePresentationLateralised*usually frontotemporalPain preceded by Aura*Builds up gradually*May lasts for several hoursUsually throbbing but may be dull*Onset is after awakening & quietened by Sleep*.* Associated symptoms includeNausea, vomiting, Diarrhoea, photophobia* & Visual disturbance*Paresthesia with tingling and numbness*Other focal neurological symptoms such as clumsiness & weakness *.Cluster HeadacheMen in 20 - 50*Male>F (7 to 8 times)*Lateralised*Periorbital*Pain(periodic attacks 1-2/days)*Begins without warning. Reach crescendo within 5 min last for 45 minutes*Excruciating deep, explosive but only rarely pulsatile*.Commonly awakens the patients from sleep*.Associated SymptomsHomolateral lacrimation*Reddening of eye*Nasal stuffiness*Ptosis*Nausea*Trigeminal Neuralgia> 40 YearsOccurs along the distribution of Maxillary nerve*Electric in character*Episodic each episode lasts 2-4 min.The typical course is relapsing-remitting over several years.Temporal ArteritisMedian age 75 yrs*Female (Account for 65% cases)*Unilateral or Bilateral located temporarily in 50% patients*Usually appear graduallyOccasionally it is explosive.Dull and boring in character,Seldom throbbing.Scalp tenderness*Patients also complains of pain in jaw*Headache is usually worse at night.Associated symptomsHeadache, fever, weight lossJaw claudication*Polymyalgia Rheumatica*ESR Increase*Anemia*Blindness d/t ophthalmic artery involvement*.A tension HeadacheAt all agesFemalesBilateral Frontal area *Builds up slowlyFluctuates in severityPersists continuously for many days.A headache may be episodic or chronic.A tight band like discomfort*Associated symptomsNot prominentSometimes post neck muscles are tight*May be associated with anxiety & depression*."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHalf\u2013life of lithium is:\nA) 8 hours\nB) 16 hours\nC) 24 hours\nD) 36 hours", "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 44-year-old patient comes to his primary care physician complaining of double vision. On examination, he is unable to adduct or abduct his right eye- On further examination, he is also found to be unable to adduct his left eye. The remainder of the physical examination is normal. \nwhich of the following is the most likely location of the patient\u2019s lesion?\nA) Left abducens nerve\nB) Left abducens nucleus and left medial longitudinal fasciculus\nC) Right abducens nerve\nD) Right abducens nucleus and right medial longitudinal fasciculus", "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\nAn 85 years old man underwent transurethral resection of prostate. A histological examination of his specimen showed T1a stage of adenocarcinoma: management will be:\nA) Endocrine therapy\nB) Radical surgery\nC) Hormone therapy\nD) No fuher treatment", "output": "3, because Management of CA prostate- T1a- observation+ Follow up (DRE+ PSA)- T1b, T1c, T2* > 70 years - Observation + follow up* < 70 years - Radical prostectomy Or RadiotherapyT3, T4 * Hormone therapy > Palliative radiotherapy* Bilateral Orchidectomy + Flutamide* LHRH Agonist (Goserelin, Leuperolide) + Flutamide- Goserelin -Recently FDA approved for advanced and metastatic CA prostate"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nUlnar nerve supplies all except-\nA) Adductor pollicis\nB) Abductor digiti minimi\nC) Interossei\nD) 1st & 2nd lumbricals", "output": "3, because Ans. is 'd' i.e., 1st & 2nd lumbricals Nerve supply of intrinsic muscles of HandThenar muscleso Abductor pollicis brevis. Flexor pollicis brevis, opponens pollicis - Median nerveo Adductor pollicis - Deep branch of ulnar nerveHypothenar muscleso Abductor digiti minimi, Flexor digiti minimi, opponens digiti minimi - Deep branch of ulner nerveo Palmaris brevis - Superficial branch of ulnar nerveInterosseio Palmar interossei - Deep branch of ulnar nerveo Dorsal interossei - Superficial branch of ulnar nerveLumbricalso 1st & 2nd (lateral two) lumbricals - Median nerveo 3rd & 4th (medial two) lumbricals - Deep branch of ulnar nerve"}

{"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 gene is most often implicated in congenital cataract and alpha crystallin mutation?\nA) GLC3A\nB) PAX6\nC) PITX2\nD) CRYAA", "output": "3, because CRYAA is implicated in congenital cataract and alpha crystallin mutation."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAccording to WHO guideline, all are indications for hospital admission in Pneumonia except\nA) Convulsions\nB) Persistent vomiting\nC) Chest indrawing\nD) Severe malnutrition", "output": "2, because Child with chest indrawing\u00a0\u21d2 Pneumonia\u00a0\u21d2 Oral Amoxycillin\nRest are danger signs\u00a0\u21d2 Severe Pneumonia\u00a0\u21d2 Referal to hospital."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nNaltrexone is used to maintain abstinence following opioid withdrawal in addicts. It blocks all of the following featues of opioid use, except -\nA) Euphoriant effects of opioids\nB) Craving for opioids\nC) Miosis\nD) Respiratory depression", "output": "1, because Ans. is 'b' i.e., Craving for opioids o Naltrexone can reverse all effects of opioids like sedation, analgesia, constipation, respiratory depression and miosis, but it does not reduce craving. \"Craving for opioids may continue during naltrexone treatment\" Principles of addiction medicine o It is interesting to know that naltrexone does not reduce craving for opioid, but it reduces craving for alcohol in chronic alcoholism"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCausing hu by means of poison, etc with an intent to commit an offence is punishable under\nA) Sec. 328 IPC\nB) Sec.326 A IPC\nC) Sec.327 IPC\nD) Sec. 329 IPC", "output": "0, because - Sec. 328 IPC - Causing hu by means of poison, etc with an intent to commit an offence shall be Punishment is imprisonment upto 10 years and also fine. - Sec.326 A IPC - voluntarily causing grievous hu by means of acid - Sec.327 IPC - voluntarily causing hu to exto propey - Sec. 329 IPC - voluntarily causing grievous hu to exto propey"}

{"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 precipitating factor for hepatic encephalopathy in patients with chronic liver disease except\nA) Hypokalemia\nB) Hyponatremia\nC) Hypoxia\nD) Metabolic acidosis", "output": "3, because Answer is D (Metabolic acidosis): Hepatic encephalopathy is precipitated by metabolic alkalosis and not by metabolic acidosis. Electrolyte and Metabolic imbalances that precipitate Hepatic Encephalopathy Hypokalemia Alkaosis (Metabolic Alkalosis) Hypoxia Hyponatremia"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDIC is seen most commonly seen in which ANIL type?\nA) M2\nB) M3\nC) M4\nD) M5", "output": "1, because Answer is option 2 M3 DIC is common, especially in M3, with prolonged prothrombin time, low levels of fibrinogen and fibrin degradation products (FDPs) present. myeloid luekemia."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAspirin is contraindicated in?\nA) Fever\nB) Peptic ulcer\nC) Unstable angina\nD) Myalgia", "output": "1, because Ans. is 'b' i.e., Peptic ulcer Contraindications of Aspirin Peptic ulcer Prostaglandin has cytoprotective function for gastric mucosa by inhibiting acid secretion and promoting secretion of mucus. Aspirin inhibits synthesis of cytoprotective PG -3 bleeding & perforation may occur. Children with chicken pox & influenza Aspirin can cause Reye's syndrome (hepatic encephalopathy). Acknowledging this aspirin should not be given to children < 12 years, e.g. in JRA. Bleeding tendencies By its antiplatelet action, aspirin can exacerbate bleeding. Chronic liver disease Long-term therapy with high dose aspirin can cause insidious onset hepatic injury."}

{"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 the international death ceificate, one of the following is not true-\nA) Pa I of the ceificate deals with the immediate cause only\nB) Pa I of of the ceificate deals with the immediate cause and also the underlying cause\nC) Pa II records significantly associated diseases\nD) The ceificate has been recommended by the WHO for international use", "output": "0, because ref: Park&;s 23rd edition pg 56 International Death Ceificate: Recommended by WHO for international use. 2 pas: PA 1: deals with immediate cause, and the underlying cause which staed the whole trend of events leading to death. The underlying cause of death is reccorded on line (c). PA 2: any significant associated diseases that contributed to the death but did not directly lead to 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\nSemicircular canals are stimulated by:\nA) Gravity\nB) Linear acceleration\nC) Rotation\nD) Sound", "output": "2, because Semicircular canals contain cristae which sense angular or rotational acceleration"}

{"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 true regarding ovary:\nA) Mesovarium contains ovarian vessels\nB) Ovarian ligament connects ovaries to uterus\nC) Ovarian fossa is related to ilioinguinal\nD) Suspensory ligament of ovary connects ovaries to uterus", "output": "1, because Ans. is b i.e. Ovarian ligament connects ovar ovaries to uterus.REMEMBERMesovarium connects ovary posteriorly to the broad ligament.Ovarian ligament connects ovary to uterus (option b)Suspensory ligament or infundibulopelvic ligament connects ovary to lateral pelvic wall.Ovarian vessels and nerves are present in suspensory ligament.Ovarian fossa is related posteriorly to obturator nerve, not ilioinguinal nerve."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVitamin K dependent coagulation factors include\nA) II and III\nB) IX and X\nC) III and V\nD) VIII and XII", "output": "1, because Vitamin K is an essential factor to a liver carboxylase that adds a carboxyl group to glutamic acid residues on five of the impoant clotting factors: prothrombin, Factor VII, Factor IX, Factor X, and protein C.Ref: Guyton and Hall textbook of medical physiology 13th edition. Page: 490"}

{"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 are most radio-resistant in\nA) S phase\nB) M phase\nC) G1 phase\nD) G2 phase", "output": "0, because Cell cycle Correct sequence: G0-G1-S-G2-M Most impoant checkpoint: G1-S Cellular content doubled in: S phase Cyclins D,E,A,B appears sequentially Cyclin D - first to increase in cell cycle Cyclin D - controls G1-S transition P16 (CDKN2A), P53& RB - Induce cell cycle arrest at G1-S Cyclin B - controls G2-M transition Fixed time is required for: S & M phase Most radio-resistant phase: S Most radio-sensitive phase: M"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nUseful diagnostic studies in the evaluation of upper-extremity pain include all of the following, EXCEPT?\nA) Cervical spine x-ray\nB) Chest X-ray\nC) Neural conduction studies of the median nerve\nD) Adson's test", "output": "3, because Pain in the upper extremity may be of musculoskeletal or neurologic origin. Compression of the nerves supplying the upper extremity can occur at various levels from the spinal cord all the way down to the fingers. Cervical spine x-ray is helpful for detecting bony abnormalities, which may cause nerve compression. Pancoast's tumor, which can be demonstrated on chest x-ray, may be responsible for pain. Neural conduction studies of the median nerve may disclose the presence of carpal tunnel syndrome as the cause of pain. Finkelstein's test produces pain in patients with de Quervain's disease. The test is performed by asking the patient to grab his own thumb with the other fingers of the same hand and then move the wrist in the ulnar direction. If pain is elicited, then the test is positive. Adson's test is very helpful in detecting the presence or absence of collateral circulation between the radial and ulnar aeries and is not diagnostic for pain."}

{"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 following is the feature of Y chromosome?\nA) Acrocentric\nB) Telocentric\nC) Submetacentric\nD) Metacentric", "output": "0, because A normal chromosome appear constricted at the centromere, this divides each chromosome into two arms. The sho arm is designated as p arm and the long arm is designated as q. Ref: Primate Anatomy: An Introduction By Friderun Ankel-Simon, 3rd Edition, Page 552 ; Clinical Laboratory Medicine By Kenneth D. McClatchey 2nd Edition, Page 568 ; Folia Biologica 2001, Page 146"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCalcification of interveebral disc is seen in -\nA) Gout\nB) Rheumatoid ahritis\nC) Alkaptonuria\nD) Psoriasis", "output": "2, because Interveebral disc calcification seen in : Ochronosis /Alkaptonuria Ankylosing spondylitis Pseudogout Hemochromatosis Hypervitaminosis D Transient interveebral disc calcification Juvenile chronic ahritis Hyperparathyroidism Amyloidosis Poliomyelitis Acromegaly"}

{"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 70 - year old male presents with a C/O fatigue & jaundice. There is no H/O alcohol or liver disease. The liver and spleen are nonpalpable. He has a normocytic, normochromic anemia. The first step in evaluation of this patient is\nA) CT scan of the abdomen\nB) Hepatitis profile\nC) LFT\nD) Abdominal ultrasound", "output": "2, because The first step in evaluating patient with asymptomatic jaundice is to determine whether the increased bilirubin, as evidenced by scleral icterus, is conjugated or unconjugated hyperbilirubinemia. Patients with unconjugated hyperbilirubinemia do not have bilirubin in their urine because unconjugated bilirubin (bound to albumin) is not excreted in the urine; these patients usually have either hemolysis or an enzyme deficiency in the path way for excretion of bilirubin. Conjugated hyperbilirubinemia suggests liver dysfunction and requires fuher assessment"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nNormal turnover rate of epidermis:\nA) 2 weeks\nB) 4 weeks\nC) 6 weeks\nD) 8 weeks", "output": "3, because Epidermal turnover time - skin doubling time -Time taken by keratinocytes to move from Stratum Basale to environment. -Around 14 days are required to move from Stratum Basale to reach lowermost layer of Stratum Corneum & 14 days to cross Stratum Corneum. -Sloughing off requires 28 days So total ETT =56 days (8 weeks) The turnover time in psoriasis = 4 days."}

{"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 describes the flavouring substance asafoetida (Fling)?\nA) Dried leaf extract\nB) Exudate from chopped roots\nC) Pith of stem boiled and dried\nD) Dried and hardened paste of fruit", "output": "1, because Ans. is 'b' i.e., Exudate from chopped roots"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAnion gap is increased in all except: September 2009\nA) Ureterostomy\nB) Ethylene glycol\nC) Methylene glycol\nD) Diabetic ketoacidosis", "output": "0, because Ans. A: Ureterostomy"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nHypopituitarism in the adult is usually due to infarction of the pituitary called as:\nA) Simmonds\u2019 diseases\nB) Hilton's disease\nC) Wilson disease\nD) Addison disease", "output": "0, because Hypopituitarism in the adult is usually due to an infarction of the pituitary called Simmonds\u2019 disease.\u00a0\n\u00a0It is characterized by loss of weight and diminished sexual function.\u00a0The basal metabolic rate is\u00a0markedly lowered, and since Simmonds\u2019 disease represents a panhypopituitarism, there is a decrease\u00a0in the activity of the many hormones of the pituitary gland and of those glands that are under\u00a0pituitary regulation. In this disease, the skin shows atrophic alterations. Changes in the head include\u00a0thin eyebrows, loss of eyelashes, sharp features, thin lips, and an immobile expression. There will be a decreased salivary \ufb02ow due to hyperfunctioning of salivary glands which leads to increased caries\u00a0activity and periodontal 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\nDuring diastole, arterial pressure is maintained by\nA) Elastic recoil of aorta\nB) Musculature of arteries\nC) Constriction of capillaries\nD) Contraction of left ventricle", "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\nVesicular lesions, indistinguishable from primary infection, which arise in other pas of the body of an allergic individual infected with Trichophyton are referred to as\nA) Dermatiphytids\nB) Trichophytins\nC) Eschars\nD) Carbuncles", "output": "0, because Dermatiphytids - Hypersensitivity to dermatophyte antigen may occur which leads to appearence of secondary eruption in sensitized patients because of circulation of allergic products. These lesions are indistinguishable , but these lesions are distinct from the primary ringworm lesion as they occur distal to primary site and fungal culture often turns negative."}

{"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 which of the following condition serum ascites-to-albumin gradient is > 1.1\nA) Nephrotic syndrome\nB) Pancreatitis\nC) Peritoneal carcinomatosis\nD) Budd chiari syndrome", "output": "3, because The development of the serum ascites-to-albumin gradient (SAAG) has replaced the description of exudative or transudative fluid. When the gradient between the serum albumin level and the ascitic fluid albumin level is >1.1 g/dL, the cause of the ascites is most likely due to poal hypeension; this is usually in the setting of cirrhosis. When the gradient is <1.1 g/dL, infectious or malignant causes of ascites should be consideredIn Budd Chiari syndrome SAAG is >1.1 i.e poal hypeensionReference: Harrison&;s Principles of Internal medicine; 19th edition; Chapter 35; Cirrhosis and its complications"}

{"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 autoimmune hemolytic anemia in pregnancy all are true except\nA) Direct coombs test is usually positive\nB) Pregnancy accelerates hemolysis\nC) Usually does not respond to steroids\nD) Fetal michrochimerism results in aberrant antibody production", "output": "2, because During pregnancy, autoimmune hemolytic anaemia usually responds to prednisolone."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAIDS day is: September 2004\nA) 7 April\nB) 3-May\nC) 5-Jun\nD) 1-Dec", "output": "3, because Ans. D i.e. 1 December"}

{"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 strength attained by amalgam within 8 hours is\nA) 60%\nB) 70%\nC) 80%\nD) 90%", "output": "1, because The strength attained by amalgam within 8 hours is 70%.\nReference: Phillip\u2019s Science of Dental Materials, Pg-353"}

{"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 cause of Respiratory distress in newborn and Ipsilateral shift of mediastinum\nA) Alelectasis\nB) Lung collapse\nC) Pulmonary hypoplasia\nD) Hyaline membrane disease", "output": "3, because No mediastinal shift in\u00a0hyaline membrane 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\nA non diabetic, non hypertensive patient has some extra beats in pulse. Doctor informed that is benign and no intervention required. But patient is worried that it is a serious cardiac disorder and is still going for repeated investigation & going from doctor to doctor. This is a type of:\nA) Conversion disorder\nB) Hypochondriosis\nC) Somatization\nD) Depression", "output": "1, because Interpretation of benign symptom (extra beats) as a serious illness (cardiac disorder) is suggestive of Hypochondriosis."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAscorbic acid is a potent enhancer of iron absorption because it:\nA) Enhances the absorption of heme iron\nB) Enhances the activity of heme oxygenase\nC) Is a reducing agent, thereby helping to keep iron in the ferrous state\nD) Decreases the production of ferritin by enterocytes", "output": "2, because Ans. C. Is a reducing agent, thereby helping to keep iron in the ferrous stateAscorbic acid enhances iron absorption mostly by its reducing capacity, keeping iron in the ferrous state. Ascorbic acid does not enhance heme iron absorption, nor does it affect heme oxygenase activity or the production of ferritin or transferrin."}

{"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 unilateral proptosis is\nA) Thyrotoxicosis\nB) Retinoblastoma\nC) Intraocular haemorrhage\nD) Raised intracranial tension", "output": "0, because A i.e. Thyrotoxicosis Grave's ophthalmopathy is most common cause of U/L or B/L proptosis in adults Q between age of 25-50 yrsQ"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPowders of dental plaster and dental stone differ\nmainly in:\nA) Solubility\nB) Shelf life\nC) Chemical formula\nD) Particle porosity", "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\nMacrophage is -\nA) Monocytes\nB) Eosinophils\nC) Neutrophils\nD) Lymphocytes", "output": "0, because Ans. is 'a'i.e., Monocytes o The monocytes migrate to tissues and become part of the tissue (fixed) macrophages.o Blood macrophages - Monocyteso Tissue macrophages - HistiocytesTissue macrophages (histiocytes) in different tissue are mentioned below -o Lung: 'Alveolar macrophages' or 'Dust' cellso Placenta: Hoffbauer cellso Brain: Microgliao Kidney : Mesangial cellso Liver : Kupffer cellso Spleen : Littoral cellso Bone: Osteoclastso Synovium: Type-A lining cellso Skin: Langerhans cellso Spleen: Red pulp sinusoidal lining cellso Connective tissue: Histiocytes (tissue macrophages)o Life span of monocytes in circulation is 1-3 days whereas tissue macrophages have life span of 3 months to years"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nINH induced neuropathy is treated with\nA) Thiamine\nB) Pyridoxine\nC) Niacin\nD) Riboflavin", "output": "1, because None"}