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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\nWhich of the following is false with regards to bupivacaine\nA) Bupivacaine concentration for epidural anaesthesia is 0.5%\nB) Bupivacaine concentration for spinal anaesthesia is 0.5%\nC) Bupivacaine is used frequently for i.v regional anaesthesia\nD) Bupivacaine is most potent local anaesthetic", "output": "2, because Bupivacaine is contraindicated in Bier\u2019s block or IVRA."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBains' circuit is Mapelson type - circuit -\nA) Type A\nB) Type B\nC) Type D\nD) Type E", "output": "2, because Type A - Magills circuit Type C - Water,'s (to and from) circuit Type D - Bain's circuit Type E - Sure's T piece Type F -Jackson-Rees circuit."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIris lesion is seen in\nA) Utricaria\nB) Scabies\nC) Lichen planus\nD) Erythema multiformae", "output": "3, because Erythema multiforme(EM) is an acute ,self limiting skin disease charecterised by the abrupt onset of symmetrical target lesions. Erythema multiforme is a skin reaction that can be triggered by an infection or some medicines. The classic lesions are iris or target lesions which are less than 3 cm in diameter, rounded and have 3 zones:central area of dusky erythema, middle paler area of oedema and an outer ring of erythema with well defined margin. Sites: commonly the extremities and the face, but face,trunk ,oral and genital mucosa may be affected. There are two forms: EM major and EM minor. Ref Harrison 20th edition pg 1235, Fitzpatrick 8thednpg 434)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nMonro's abscesses are seen in all of the following except:\nA) Psoriasis.\nB) Pemphigus.\nC) Reiter syndrome.\nD) Benign migratory glossitis.", "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\nAll are true about thiopentone except \u2013\nA) NaHCO3 is a preservative\nB) Contraindicated in porphyria\nC) Agent of choice in shock\nD) Has cerebroprotective action", "output": "2, because Thiopentone causes hypotension \u2192 contraindicated in shock & hypotensive states."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDeposition of calcium in dying tissue is called\nA) Metastatic calcification\nB) Dystrophic calcification\nC) Heterotropic calcification\nD) Normal calcification", "output": "1, because Dystrophic calcification is encountered in areas of necrosis of any type. It is viually inevitable in the atheromas of advanced atherosclerosis, associated with intimal injury in the aoa and large aeries and characterized by the accumulation of lipids Metastatic calcification can occur in normal tissues whenever there is hypercalcemia( Robbins Basic Pathology, 9th edition, page 26 )"}

{"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 statement\u201cThe parietal layer develops gradually, becoming prominent when root formation is complete\u201dIs\nA) FALSE\nB) TRUE\nC) Partially True\nD) Can be completely True or False.", "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\nHeat rupture can be differentiated from incised wound by -\nA) Intact blood vessels & nerves at the floor of the wound\nB) Seen in front of thing\nC) Small in back of thing\nD) Small and multiple", "output": "0, because HEAT RUPTURE: If heat applied is very great skin contracts and heat rupture occurs either before or after death. heat rupture is differentiated from incised wounds by 1. absence of bleeding in the wound and surrounding tissues, since heat coagulates 2. intact vessels and nerves are seen in the floor 3. irregular margins 4. bruising and other signs of vital reactions are not present in the margins REF: The Synopsis of Forensic Medicine and Toxicology 29th edition page no:161."}

{"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 is involved in the post translational modification of\nA) Glutamate\nB) Aspaate\nC) Glycine\nD) GABA", "output": "0, because Refer Katzung 11/e p 595 Vitamin K causes gamma carboxylation of glutamate reduces in many clotting factors that result in their activation"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDouble stranded RNA is seen in -\nA) Reovirus\nB) Adenovirus\nC) Parvovirus\nD) Retrovirus", "output": "0, because In reoviruses the double stranded RNA is transcribed into mRNA by viral polymerase REF:ANANTHANARAYAN AND PANIKER'S TEXTBOIK OF MICROBIOLOGY 9TH EDITION PAGE NO:433"}

{"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 viruses produce disease or sequelae that is/are more severe if the infection occurs at a very young age?\nA) Epstein-Barr virus\nB) Hepatitis B virus\nC) Measles virus\nD) Poliovirus", "output": "1, because Infection with Hepatitis B virus (HBV) at bih or a very young age is associated with chronic HBV infection and the development of hepatocellular carcinoma later in life. In fact, infants born to Hepatitis B surface antigen (HBsAg)-positive mothers are commonly infected, and approximately 90% become chronic carriers of the virus. Chronic carriers suffer from hepatocellular carcinoma at an incidence over 200 times higher than a noncarrier. The current recommendation for infants born of HBsAg-positive mothers is administration of hepatitis B immunoglobulin (HBIg) in the delivery room, with the first dose of the hepatitis B vaccine given at the same time or within 1 week. The second and third dose of the vaccine are then given at 1 and 6 months. With this protocol, 94% protection is achieved. The Epstein-Barr virus is the agent of heterophile-positive infectious mononucleosis. In children, primary EBV infection is often asymptomatic. The measles virus often causes a more severe disease in adults. Over the age of 20, the incidence of complications, including pneumonia, bacterial superinfection of the respiratory tract, bronchospasm and hepatitis, is much higher than in children. Poliovirus causes asymptomatic or inapparent infections 95% of the time. Frank paralysis occurs in approximately 0.1% of all poliovirus infections. However, the probability of paralysis increases with increasing age."}

{"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 inducers of the microsomal enzyme system except?\nA) Carbamazepine\nB) Phenytoin\nC) Phenobarbitone\nD) Ticlopidine", "output": "3, because ."}

{"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 alanine during prolonged fasting represents-\nA) Increased breakdown of muscle proteins\nB) Impaired renal function\nC) Decreased utilization of amino acid from Glucogenesis\nD) Leakage of amino acids from cells due to plasma membrane leakage", "output": "0, because During prolonged fasting there is increased gluconeogenesis. Alanine is provided by the muscle is one of the substrates for gluconeogenesis and is called Glucose Alanine cycle. So plasma level of alanine increases in prolonged 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\nX-ray were discovered by -\nA) Roentgen\nB) Madam curie\nC) Becqueral\nD) Houndsfield", "output": "0, because (A) (Roentgen) (16 Apley 9th)* X-ray discovered by Roentgen in 1895.X-ray are produced by firing electrons at high speed onto a rotating anode. The resulting beam of X-rays is attenuated by the patient's soft tissues and bones, casting what are effectively, shadows, which are displayed as images on an appropriately sensitize plate or stored as digital information, which is than available to the transferred throughout the local information (IT) network.* Electromagnetic waves, non particulate, a beam of photons* Penetration power in air is 200 meters* Penetration power in lead is 0.3mmX-rays films are least sensitive to RED light* CT scan was invented by Geofiery hounds field* MRI - described fist by Bloch and Purcell, but applied as human analytical by Damadian and Lauterbur.* Radioactivity was discovered by - Henri - Becqueral"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSerum marker indicating active viral replication in hepatitis-B is: September 2006, March 2013\nA) HBsAg\nB) HBeAg\nC) HBcAg\nD) HBV DNA", "output": "1, because Ans. B: HBeAg, D: HBV DNA The first detectable viral marker for hepatitis-B is HBeAg, followed by hepatitis B, e-antigen (HBeAg) and HBV DNA. Titers may be high during the incubation period, but HBV DNA and HBeAg levels begin to fall at the onset of illness and may be undetectable at the time of peak clinical illness. Core-antigen does not appear in blood, but antibody to this antigen (anti-HBc) is detectable with the onset of clinical symptoms. The immunoglobulin M (IgM) fraction is used in an impoant diagnostic assay for acute hepatitis B, infection. Before current molecular assays were available, it was the only marker detectable in the window period, the time between the disappearance of HBsAg and the appearance of anti-HBs. Patients who clear the virus lose HBsAg and develop anti-HBsAb, a long-lasting antibody associated with immunity. The presence of anti-HBsAb and anti-HBcAb (IgG) indicates recovery and immunity in a previously infected individual, whereas a successful vaccination response produces antibody only to HBsAg. HBeAg is another viral marker detectable in blood and correlates with active viral replication and therefore high viral load and infectivity. The-antigen is synthesized from a strand of DNA immediately preceding the area that codes for the core-antigen."}

{"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 volume control ventilation:\nA) Lung inflated at constant flow rate\nB) Peak alveolar pressure equal to plateau pressure\nC) There is decelerating flow rate\nD) Plateau pressure fixed", "output": "0, because With volume control ventilation, the inflation volume is preselected, and the lung are inflated at a constant flow rate until desired volume is delivered."}

{"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 which of the following intensive management of diabetes needed except -\nA) Autonomic neuropathy causing postural hypotension\nB) Pregnancy\nC) Post kidney transplant in diabetic nephropathy\nD) DM with acute MI", "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\nMost common cataract in a newborn is \u2013\nA) Zonular\nB) Morgagnian\nC) Anterior Polar\nD) Posterior Polar", "output": "0, because A most common type of congenital cataract \u2192 punctate (blue dot) cataract.\nA most common type of cataract which is clinically (visually) significant \u2192 zonular or lamellar cataract."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAccessory organ which may be found in stomach ?\nA) Spleen\nB) Pancreas\nC) Liver\nD) Kidney", "output": "1, because Ans. is 'b' i.e., PancreasEctopic (Accessory) pancreatic tissue may be found in submucosa of :?Stomach Meckel's diveiculumDuodenum Gall bladderSmall intestine (jejunum, ileum) Spleen"}

{"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 trisomies is -\nA) Increased maternal age > 35 years\nB) Downs causes MR\nC) Most common trisomy is trisomy 21\nD) All", "output": "3, because Trisomy 21 or Down syndrome is the most common of the chromosomal disorder.\nThe most common cause of trisomy and therefore of Down syndrome is meiotic nondisjunction (type II Meiosis error). a Maternal age has a strong influence on the incidence of trisomy 21.\nIt occurs once in 1550 live births in women under age 20 in contrast to 1 in 25 live births for mothers over age 45. The correlation with maternal age suggests that in most cases the meiotic nondisjunction of chromosome 21 occurs in the ovum.\nApproximately 40% of the patients with trisomies have associated congenital heart disease, most common defects of the endocardial cushion including.\nOstium premium atrial septal defects.\nA-V valve malformations and\nVSDS\nDown syndrome is an important cause of mental retardation in children"}

{"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 therapies may be required in a 1-hour-old infant with severe bih asphyxia except-\nA) Glucose\nB) Dexamethasone\nC) Calcium gluconate\nD) Normal saline", "output": "1, because Ans. is 'b' i.e., Dexamethasone Coicosteroids should not be used' - Paediatrics for doctors - Frankshann & John Vince Management Protocol The management protocol of babies with asphyxia : Oxygen. In the absence of continuous oxygen saturation monitoring, it is reasonable to give nasopharyngeal oxygen (0.5 litre/min) until the baby recovers. If monitoring is available, oxygen is given as appropriate. Thermal control. Baby's body temperature should be kept in the normal range of 36.5-37.2degC (sometimes the babies become hyperpyrexic). Correction of shock, If peripheral perfusion is poor, it is reasonable to give 20 ml/kg of normal saline initially. If perfusion remains poor, the use of dopamine should be considered. Fluid balance. Give IV fluids at 2/3 maintenance. Use 10% dextrose. Monitor blood glucose with dextrostix and do not let it fall below 2.2 mmol (explains glucose administration) Prevent/control convulsions. In less severely affected babies, phenobarbitone should be given when there is anyuspicion of actual or impending convulsions (phenobarbitone loading dose 20 mg/kg IM or 10mg/kg slowly IV, then 5 mg/kg daily orally). Treat hvpocaleaemia if it occurs (or more practically, if the baby has uncontrollable fitting with anormal dextrostix). (explains calcium gluconate administration) Notes I. Coicosteroids should not be used, and although many paediatricians use mannitol, there is no evidence for its effectiveness. 2. Babies with severe asphyxia may appear to settle relatively quickly after the resuscitation - but there is likely to be a deterioration after 6-12 hours or so as cerebral oedema develops."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCondyloma acuminatum is caused by ?\nA) HSV\nB) HPV\nC) HIV\nD) VZV", "output": "1, because Ans. is 'b' i.e., HPV Was . Was are caused by human papilloma virus (HPV)"}

{"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 common form of PSVT?\nA) Tachycardia originating from the atrium\nB) AV nodal reentry tachycardia\nC) WPW syndrome\nD) Focal atrial tachycardia", "output": "1, because Pathologic supraventricular tachycardia A. Tachycardia originating from the atriumDefining feature: tachycardia may continue despite beats that fail to conduct to the ventricles, indicating that the AV node is not paicipating in the tachycardia circuitB. AV nodal reentry tachycardiaDefining feature: paroxysmal regular tachycardia with P waves visible at the end of the QRS complex or not visible at allThe most common paroxysmal sustained tachycardia in healthy young adults; more common in womenC. Tachycardias associated with accessory atrioventricular pathwaysDefining feature: paroxysmal sustained tachycardia similar to AV nodal reentry; during sinus rhythm, evidence of ventricular preexcitation may be present (Wolff-Parkinson-White syndrome) or absent (concealed accessory pathway)Harrison 19e pg: 1476"}

{"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 female having carcinoma cervix stage IIIb. What is the treatment:-\nA) Weheims hysterectomy\nB) Schauta's radical vaginal hysterectomy\nC) Chemotherapy\nD) Intracavitary brachytherapy with external beam radiotherapy", "output": "3, because Rx of Cervical cancer NOTE: THERE IS NO ROLE OF SURGERY IN TREATMENT OF STAGE IIB AND ABOVE - Stage I - IIA - Surgical management: Radical Hysterectomy (aka type 3 hysterectomy) - Structures removed in radical hysterectomy are : Uterus, cervix, upper 1/3 - 1/2 of vagina, entire parametrium, uterine aery ligated at its origin from internal iliac aery, uterosacral ligament at most distal attachment (rectum) - Stage >= IIB - Chemoradiation - Radiotherapy alone is effective Rx in all stages. - Maximum radiation given at Point A 2cm above and 2 cm lateral to external os Ureter crosses the uterine aery (bridge over water) here ureter is under the uterine aery Parametrium seen here Upto 7500 to 8000 RADs given here Point B 3cm lateral to point B Obturator lymph nodes at the pelvis side walls Obturator lymph nodes -sentinel group of LN Upto 6000 RADS given here."}

{"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 bottle feeding should be discontinued by the age of:\nA) 12 months\nB) 8 months\nC) 18 months\nD) 20 months", "output": "0, because Prolonged bottle feeding more than 1 year can lead to ECC."}

{"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 1-year-old girl is brought to the emergency room by her parents who report she has had a fever and diarrhea for 3 days. Her temperature is 38degC (101degF). The CBC shows a normal WBC count and increased hematocrit (48 g/dL). Which of the following is the most likely cause of increased hematocrit in this patient?\nA) Acute phase response\nB) Dehydration\nC) Diabetes insipidus\nD) Malabsorption", "output": "1, because Increased hematocrit in this patient reflects hemoconcentration caused by dehydration, secondary to diarrhea. This hematologic condition, termed relative polycythemia, is characterized by decreased plasma volume with a normal red cell mass. When patients suffer from burns, vomiting, excessive sweating, or diarrhea, they not only lose fluid but also suffer electrolyte disturbances. Systemic blood pressure falls with continuous dehydration, and declining perfusion eventually leads to death. Diabetes insipidus (choice C) may cause dehydration but is an unlikely choice because the patient has a history of diarrhea. None of the other choices cause relative polycythemia.Diagnosis: Dehydration, relative polycythemia"}

{"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 XLR diseases, a modified inheritance pattern called 'pseudodominance' occurs when\nA) One parent is affected homozygote and another is unaffected homozygote\nB) One parent is unaffected heterozygote and another is affected homozygote\nC) One parent is normal and another is unaffected het- erozygote\nD) Both parents are unaffected", "output": "1, because Ans. b (One parent is unaffected heterozygote and another is affected homozygote). (Fig. Harrison 18th/61/l 1)In most instances of AR inheritance, an affected individual is the offspring of heterozygous parents. In this situation, there is a 25% chance that the offspring will have a normal genotype, a 50% probability of a heterozygous state, and a 25% risk of homozygosity for the recessive alleles, in the case of one unaffected heterozygous and one affected homozygous parent, the probability of disease increases to 50% for each child. In this instance, the pedigree analysis mimics an autosomal dominant mode of inheritance (pseudodominance). In contrast to autosomal dominant disorders, new mutations in recessive alleles are rarely manifest because they usually result in an asymptomatic carrier state.PSEUDODOMINANCE# The sudden appearance of a recessive phenotype in a pedigree, due to deletion of a masking dominant gene.# The phenomenon in which a recessive allele shows itself in the phenotype when only one copy of the allele is present, as in hemizygous alleles or in deletion heterozygotes.# An autosomal recessive condition present in individuals in two or more generations of a family, thereby appearing to follow a dominant inheritance patterns.Common explanations include:# A high carrier frequency.# Birth of an affected child to an affected individual and a genetically related (consanguinous) reproductive partner.# In populations with high frequencies of heterozygotes for autosomal recessive conditions, such as in geographically isolated communities, the mating of a homozygote with a heterozygote may result in an inheritance pattern mimicking dominant inheritance (pseudodominance).Examples of diseases with pseudodominance# Storgordt disease (caused by ABCR mutations)# Pseudoxanthoma elasticum (is caused by mutations in the ABCC6 gene, inherited in an autosomal recessive manner and presence of disease in two generations is due to pseudodominance.)# Glycogen storage disease type VII (Tarui's) - it is autosomal recessive, although a few cases with pseudodominance or sumptomatic heterozygous individuals have been found."}

{"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 a contaminated, puctured wound of the leg of a non-immune child of 10, which one of the following measures would give the best protection against the development of tetanus -\nA) Active immunization and antibiotics\nB) Active immunization, antibotics and immobilisation\nC) Active immunization, wound excision and primary closure\nD) Active and passive immunization along with antibiotics", "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\nA 2hyr old women who had home delivery 2wks back now presents with complete perineal tear whats the next line of the management\nA) repair immediately\nB) repair after 3wks\nC) repair after 3months\nD) repair after 6 months", "output": "2, because complete prineal tear <24HRS= Repair immediately >24HRS - schedule after 3months REF : SHAW GYNECOLOGY"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOsmolality of plasma in a normal adult: September 2005, March 2012, September 2012\nA) 320-330 mOsm/L\nB) 300-310 mOsm/ L\nC) 280-290 mOsm/ L\nD) 260-270 mOsm/ L", "output": "2, because Ans. C: 280-290 mOsm/L Plasma osmolality is a measure of the concentration of substances such as sodium, chloride, potassium, urea, glucose, and other ions in blood Osmolal concencentration of plasma is 290 mOsm/L Osmolality of blood increases with dehydration and decreases with overhydration. In normal people, increased osmolality in the blood will stimulate secretion of antidiuretic hormone (ADH). This will result in increased water reabsorption, more concentrated urine, and less concentrated blood plasma. A low serum osmolality will suppress the release of ADH, resulting in decreased water reabsorption and more concentrated plasma."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPost gonococcal stricture urethra is most commonly situated in the -\nA) Bulbar Urethra\nB) Penoscrotal Jn.\nC) Distal pa of spongy urethra\nD) Just distal to external meatus", "output": "0, because Ans. is 'a' i.e., Bulbar Urethra"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nNot a second messenger:\nA) cAMP\nB) cGMP\nC) Ca\nD) None", "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\nConduction in which type of nerve fibres is blocked maximally by pressure\nA) C fibres\nB) A- alpha fibres\nC) A - Beta\nD) A- gamma", "output": "1, because The velocity of conduction through a nerve fiber is directly proportional to the thickness of the axon.\nThickest and fastest is A fibers. Among A fibers, the thickest is\u00a0A\u03b1. Hence the maximum affected by pressure will be\u00a0A\u03b1."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nHow long does it take for incipient caries to develop into clinically evident smooth surface caries?\nA) 9 \u00b1 6 months\nB) 2 + 6 months\nC) 18 + 6 months\nD) 24 \u00b1 6 months", "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\nClozapine is used in:\nA) Depression\nB) Resistant schizophrenia\nC) Mania\nD) Delirium", "output": "1, because Ans: b (Resistant schizophrenia) Ref: Katzung, 10th ed, p. 457Clozapine is an atypical antipsychotic. It has weak D2 blocking action and produces few extrapyramidal side effects.lt inhibits 5-HT, receptor.The main adverse effects are agranulocytosis and other blood dyscrasias. It reduces seizure threshold. It is reserved for resistant cases of schizophrenia."}

{"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 sensitive and specific marker for MI is?\nA) Troponin\nB) Cytokeratin\nC) Myoglobin\nD) CPK-MM", "output": "0, because Ref: Harrison 20th edition, P 384Cardiac specific markers of myocardial damage include quantitative determination of CK-MB, Troponin I and Troponin T. Troponins can become elevated by 3 hours. The circulating values remain elevated up to a week."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHuman development index includes A/E :\nA) Crude death rate\nB) Education\nC) Life expectancy at birth\nD) GDP", "output": "0, because Ans. is 'a' i.e. Crude Death Rate Human development index : includesLongevity (Life expectancy at birth)knowledge (adult literacy rate and mean years of schooling)Income (reveal GDP per capita in purchasing power parity in US Dollars).* HDI values ranges between 0 to 1. the HDI value for a country shows the distance that it has already travelled towards maximum possible value to 1.Physical quality of life index includes*infant mortalitylife expectancy at age oneliteracy"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nT/t used for lower ureteric stone is:\nA) Endoscopic removal\nB) Diuretics\nC) Drug dissolution\nD) Laser", "output": "0, because Answer is A (Endoscopic removal): Stones in the lower pa of ureter within 5-6 cm of ureteric orifice (that are small in size) are best managed by Ureteroscopic (Endoscopic) removal."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSpot the diagnosis\nA) Lead poisoning\nB) Macrocytic anemia\nC) Howell-Jolly bodies\nD) Heinz bodies", "output": "0, because Ref: Harsh Mohan, Textbook of Pathology, 7th ed. pg. 236The image shows basophilic stippling of red blood cells. The causes are:Mnemonic: LUNATIC* Lead poisoning* Unstable hemoglobin* Nucleotidase deficiency* Anemia due to B12 deficiency* Thalassemia* Infections* CirrhosisThe closest answer Pappenheimer bodies are basophilic erythrocytic inclusions that are usually located at the I periphery of the cell. They contain iron and stain with Prussian blue. Prussian blue is the stain that is used to identify that these Pappenheimer bodies are pure iron deposits, and not heme as in Heinz bodies."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nProphylactic cranial irradiation is indicated in the treatment of all of the following, except:\nA) Small cell Ca of lung\nB) ALL\nC) Hodgkin's lymphoma\nD) NHL", "output": "2, because All malignancies except hodgkin's lymphoma given in the question show discrimination CSF pathway and therefore require prophylactic Craniospinal irradiation. Ref: Harrison's Principles of Internal Medicine, 15th Edition, Page 2449"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThermophile bacteria grow at -\nA) 20deg C\nB) 20-40deg C\nC) 40-60deg C\nD) 60-8CTC", "output": "3, because Ans. is 'd' i.e., 60-80deg C Temperature requirement of bacteriao Bacteria vary in their requirements of temprature for growth.Psvchrophilic bacteria grow best at temperature below 20degCThermophilic bacteria grow best between 55-80degCMesophilic bacteria grow best between 25-40degC"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFAST is used for:\nA) Fast assessment of major visceral injuries\nB) To look for free intraperitoneal fluid at specific sites\nC) Fast assessment by CT scan to detect intraabdominal injuries\nD) Quick clinical assessment to decide about laprotomy", "output": "1, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDrug which inhibits GPIIb/IIIa and is platelet anti Aggregatory:\nA) Clopidogrel\nB) Enoxaparin\nC) Fondaparinux\nD) Tirofiban", "output": "3, because Ans. D. TirofibanGP IIb/IIIA are the fibrogen activator receptor. On stimulating they activates the aggregation of platelets. Abciximab and tirofiban are the drugs which block these receptors and inhibit the platelet aggregation."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFurcation involvement with no radio graphic evidence is\nA) Grade II\nB) Advanced grade II\nC) Grade I\nD) Early grade III", "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\nProvision of integrated preventive, curative and promotional health services are part of\nA) Comprehensive health care system\nB) Primary healthcare system\nC) Universal healthcare\nD) Basic health care", "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\nFeto maternal transfusion is detected by:\nA) Kleihauer test\nB) Spectrophotometry\nC) Benzidine test\nD) None of the above", "output": "0, because Kleihauer-Betke test may be performed on maternal blood to assess the amount of fetomaternal bleed.The maternal blood is subjected to an acid solution.Acid will elute the adult hemoglobin,but not the fetal hemoglobin from the red cells.Hence fetal red cells appear dark red,adult red cells appear pale(ghost cells). TEXT BOOK OF OBSTETRICS,Sheila Balakrishnan,2nd edition,page no.311"}

{"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 tubes is used in surgery for cleft palate\nA) Flexometallic tube\nB) RAE tube\nC) Robert shaw double lumen tube\nD) None", "output": "1, because RAE tube is used for surgery of cleft palate."}

{"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 composite muscles except?\nA) Pectineus\nB) Rectus femoris\nC) Adductor magnus\nD) Biceps femoris", "output": "1, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 72-year-old woman has had difficulty with vision in her right eye for 3 months. She also has pain in the right upper chest. The findings on physical examination include unilateral enophthalmos, miosis, anhidrosis, and ptosis on the right side of her face. A chest radiograph shows right upper lobe opacification and bony destruction of the right first rib. Which of the following conditions is most likely to be present in her?\nA) Bronchopneumonia\nB) Bronchiectasis\nC) Bronchogenic carcinoma\nD) Sarcoidosis", "output": "2, because Horner syndrome is a result of sympathetic autonomic nerve involvement by invasive pulmonary carcinoma. Such a neoplasm in this location with these associated findings is called a Pancoast tumor. Infectious processes such as pneumonia are unlikely to impinge on structures outside the lung. Bronchiectasis destroys bronchi within the lung. Sarcoidosis can result in marked hilar adenopathy with a mass effect, but involvement of the peripheral nervous system is unlikely. Likewise, tuberculosis is a granulomatous disease that can lead to hilar adenopathy, although usually without destruction of extrapulmonary tissues."}

{"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 used to show the base of the skull, sphenoid sinus, position and orientation of the condyles, and fractures of the zygomatic arch?\nA) The TMJ surgery\nB) Submentovertex projection\nC) Reverse-Towne projection\nD) The facial profile survey", "output": "1, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMost common cause of bone malignancy -\nA) Secondaries\nB) Osteosarcoma\nC) Ewing's sarcoma\nD) Osteoclastoma", "output": "0, because OSTEOLYTIC SECONDARIES Tumor cells produce growtl factors that stimulate bone destruction i.e. RANK &;igen& Osteoclasts are activated and break down bone Osteoblasts cannot build bone back fast enough Decreased bone density and strength: high risk for fracture OSTEOBLASTIC SECONDARIES Osteoblasts are stimulated by tumors to lay down new bone Bone becomes abnormally dense and stiff Paradoxically bones are also at risk of breaking REF : MAHESWARI 9TH ED"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCrPC sec. 61-69 deals with\nA) Coroner inquest\nB) Summons\nC) Police inquest\nD) Magistrate inquest", "output": "1, because Summons/Subpoena is a document compelling the attendance of a witness in a cou of law, under penalty, on a paicular day, time and place for the purpose of giving evidence. Code of Criminal Procedure, from section 61 to 69 deals with the topic of summons. Ref: Krishnan vij Textbook of Forensic Medicine and Toxicology; 5th ed; Page no: 10"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIntegrated Management of Childhood Illness (IMCI) was taken to prevent morbidity and moality from all except:\nA) Malaria\nB) Malnutrition\nC) Otitis media\nD) Neonatal tetanus", "output": "3, because INTERGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI): IMCI is a 'strategy for reducing morbidity and moality associated with major causes of childhood illness' Curative component includes management of: Diarrhoea Measles (&otitis media) Pneumonia Malaria Malnutrition"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOroya fever is caused by:\nA) B. bacilliformis\nB) B. henselae\nC) B. quintana\nD) B. elizabethae", "output": "0, because Ans: a. B. bacilliformis Baonellosis, or Carrion's disease, is caused by B. bacilliformisBaonellosis, or Carrion's disease, is caused by B. bacilliformis. The disease is characterized by two distinct phases:an acute febrile hematic phase, known as Oroya fever; andan eruptive phase manifested by cutaneous lesions, known as verruga peruana"}

{"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 30 year old male presented with insidious onset of diarrhea, steatorrhea, abdominal pain, weight loss, migratory large joint ahropathy, fever and dementia. The most probable diagnosis is:\nA) Chronic calcific pancreatitis\nB) Whipple's disease\nC) Tropical sprue\nD) Celiac sprue", "output": "1, because Whipple's disease is a chronic multisystem disease caused by tropheryma whipplei bacteria. Dementia is a late symptom. Diagnosed by PAS positive macrophages in small intestinal biopsy. DOC is double strength trimethoprim / sulfamethoxazole. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2479"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEnd tracheostomy is performed in patients undergoing surgery for\nA) Laryngectomy\nB) Laryngofissure surgery\nC) Oropharyngeal growth\nD) Obstructive sleep apnea with stridor", "output": "0, because Answer: a) Laryngectomy (DHINGRA 6th ED, P-316)TRACHEOSTOMY* Emergency tracheostomy* Elective or tranquil tracheostomy* Permanent tracheostomy* Percutaneous dilatational tracheostomy* Mini tracheostomy (cricothyroidotomy)Emergency tracheostomy* It is employed when airway obstruction is complete or almost complete and there is an urgent need to establish the airway.* Intubation or laryngotomy are either not possible or feasible in such cases.Elective tracheostomy (tranquil, orderly or routine tracheostomy)* Almost all operative surgical facilities are available, endotracheal tube can be put and local or general anaesthesia can be given.* Elective tracheostomy is often temporary and is closed when indication is over.* It is of two types:> Therapeutic, to relieve respiratory obstruction, remove tracheobronchial secretions or give assisted ventilation.> Prophylactic, to guard against anticipated respiratory obstruction or aspiration of blood or pharyngeal secretions such as in extensive surgery of tongue, floor of mouth, mandibular resection or laryngofissure.Permanent tracheostomy* This may be required for cases of bilateral abductor paralysis or laryngeal stenosis.* In laryngectomy or laryngopharyngectomy, lower tracheal stump is brought to surface and stitched to the skin.High tracheostomy* Above the level of thyroid isthmus (isthmus lies against II, III, IV tracheal rings)* It violates the I tracheal ring* Can cause perichondritis of the cricoid cartilage and subglottic stenosis* Always avoided* Only indication: carcinoma larynxMid tracheostomy* Preferred one* Through II or III rings (isthmus either divided or retracted)Low tracheostomy* Below the level of isthmus"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMaximum \"Endocapillary Proliferation\" is seen in:\nA) Membranous glomerulonephritis\nB) Mesangioproliferative glomerulonephritis\nC) Focal segmental glomerulonephritis\nD) Post streptococcal", "output": "3, because Post streptococcal"}

{"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 adhesive intestinal obstruction, TRUE is ?\nA) Avoid surgery for initial 48-72 hours\nB) Never operate\nC) Operate after minimum 10 days of conservative treatment\nD) Immediate operation", "output": "0, because Ans. is 'a' i.e., Avoid surgery for initial 48-72 hours There are three main measures in the tit of acute intestinal obstruction. These are 1) Gastro intestinal drainage (Nasogastric suction) 2) Fluid and electrolyte replacement 3) Surgery for relief of obstruction The first two steps are always necessary prior to the surgical relief of obstruction. Surgical treatment is necessary for most cases of intestinal obstruction, but it should always be delayed until resuscitation is complete. The timing of surgical intervention is dependent on clinical picture. The classical clinical advice on a case of unrelieved intestinal obstruction is that \"Sun should not both rise and set\" i.e., the operative procedure should not be delayed beyond 24 hrs. But, there are ceain exceptions to this rule. In some cases operation is delayed in the hope of spontaneous resolution. In adhesive intestinal obstruction, usually occuring after surgery the upto 72 hours in the hope of spontaneous resolution. In these cases continued radiological evidence of obstruction. Also know the four types of obstruction, where operation should be done a) Stangualtion b) Closed loop obstuction c) Colon obstruction d) Early simple mechanical obstruction More about adhesive intestinal obstruction - Commonest cause of intestinal obstruction, usually follows pelvic operations Obstruction due to postoperative adhesions commonly involve the lower small bowel."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nPGE2 cause all except -\nA) Water retention\nB) Uterine contraction\nC) Flushing\nD) Diuresis", "output": "0, because Ans. is 'a' i.e.. Water retention o Prostaglandins and thromboxanes are synthesised from arachidonic acid cobtained from membrane phospholipids due to action of phospholipase A2, rate limiting enzyme. A summary of the actions of major prostaglandins, prostacyclin and thromboxane Organ Prostaglandin E2 (PGE2a) Prostaglandin F2a (PGF2a) Prostacyclin (PGI2) Thromboxane A2 (TXA2) 1. Blood vessels Vasodilatation. X BP Vasodilatation, larger veins constrict, little effect on BP Vasodilatation (marked and widespread), || BP Vasoconstriction 2. Heart Waek inotropic, reflex cardiac stimulation Weak inotropic -- -- 3. Platelets Variable effect -- Antiaggregatory Aggregation and release reaction 4. Uterus Contraction (in vivo), relaxes nongravid human uterus in vitro, so fining of cervix contraction (in vivo and in vitro, softening of cervix 5. Bronchi Dilatation. Inhibit histamine release Constriction Dilatation (mild), inhibit histamine release Constriction 6. Stomach | acid secietion, | mucus production -- | acid secretion (weak), mucosal vasodilatation -- 7. Intestine Contracts longitudinal & relaxes circular muscles, | peristalsis, | Cl & water secretion Spasmogenic, | fluid &. Electrolyte secretion (weak) Weak spasmogenic, inhibit toxin-induced fluid secretion Weak spasmogenic 8. Kidney Natriuresis, | Cl reabsorption, inhibit ADH action, vasodilatation, renin release -- Natriuresis, vasodilatation, renin release Vasoconstrict ion 9. CNS Pyrogenic, variety of effects on i.v. inj."}

{"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 middle aged woman presented to the OPD with dull abdominal pain for 6 months. CT scan of pelvis showed a 7cm mass involving left ovary with irregular calcifications. The right fallopian tube & ovary are excised. What is the likely diagnosis?\nA) Mucinous cystadenoma\nB) Choriocarcinoma\nC) Dysgerminoma\nD) Mature cystic teratoma", "output": "3, because ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHypovitaminosis D causes \u2013\nA) Zonular cataract\nB) Blue \u2013 Dot cataract\nC) Rosette cataract\nD) Cupuliform cataract", "output": "0, because Hypocalcaemia (Hypoparathyroidism, hypovitaminosis D) causes zonular (lamellar) cataract."}

{"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 30 years old man presents with cramping gluteal pain after walking 500 meters. Which is the vessel involved?\nA) Aerial disease with aoo-iliac involvement\nB) Aerial disease with femoral aery involvement\nC) Femoral venous insufficiency\nD) Saphenous venous insufficiency", "output": "0, because Aoo-iliac disease - Tissue distal to aery occlusion becomes ischemic - as this aery supplies muscles - causes Intermittent claudication like Buttock, thigh, calf claudication andLeriche syndrome - Erectile dysfunction - Impotence"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSlit shaped nipple seen in\nA) Duct ectasia\nB) Duct pappiloma\nC) Paget's disease\nD) CA breast", "output": "0, because Answer- A. Duct ectasiaDuct ectasia is dilatation of lactiferous ducts associated with periductal inflammation.Chronic inflammation and scarring will lead to indrawing and slit-shaped inversion of the nipple.If secondary infection supervenes, a mammary duct fistula can also develop."}

{"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 27-yrs-old librarian has been worried that the small lymph nodes she can palpate in her groin are a sign of lymphoma. She also worries about developing laryngeal cancer due to the second-hand smoke she is exposed to at home. For a diagnosis of hypochondriasis, her symptoms should have been present for at least what period of time?\nA) 1 month\nB) 3 month\nC) 6 months\nD) 1 year", "output": "2, because Hypochondriasis is defined by DSM-IV as a persistent fear, despite medical reassurance, that one has a serious physical illness. The patient's beliefs are based on misinterpretation of benign bodily symptoms. The belief is not of delusional propoions, and the condition must persist for 6 months for this diagnosis to be made. It is estimated that from 3 to 14% of patients seen in a general medical practice may suffer from hypochondriasis."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPost-exposure immunization is done for\nA) Measles\nB) Polio\nC) Rabies\nD) Chicken pox", "output": "0, because *MMR vaccine if administrate within 72 hours of exposure or immunoglobulin if administrate within 6 days of exposure provide some protection or modify the clinical course of disease. Measles vaccine Prepared in chick embryo cell line Thermolabile Injected subcutaneously Indication: Under national immunisation schedule of India , measles vaccine is given at 9 months of age along with vit A supplements. Side effects: Toxic shock syndrome ,mild measles like illness may develop in 15 -20% of vaccines. REF:Anantha Narayanan and paniker's textbook of microbiology 9th 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\nIn which of the following conditions the lead pipe appearance of the colon on a barium enema is seen?\nA) Amoebiasis\nB) Ulcerative colitis\nC) Tuberculosis of the colon\nD) Crohn's involvement of the colon", "output": "1, because Ans. Ulcerative colitis"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nEpoophoron is a remnant of\nA) Wolffian duct\nB) Mullerian duct\nC) Gubernaculum\nD) None", "output": "0, because Human embryology Inderbir Singh's; Tenth edition; Pg 315 We have seen that most of the mesonephric tubules disappear. Some persist to form the vasa deferentia. Other mesonephric tubules persist to form some vestigial structures that are seen near the testes Epoophron: This consists of a longitudinal duct running parallel to the uterine tube and a number of transverse ductules that open into the longitudinal duct. It corresponds to the epididymis and vasa efferentia of male. It develops from remnants of the mesonephric tubules (Wolffian duct)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nTriad following massive blood transfusion includes: March 2012\nA) Acidosis, hypehermia, hyperkalemia\nB) Acidosis, hypothermia, hyperkalemia\nC) Alkalosis, hypothermia, hyperkalemia\nD) Alkalosis, hypehermia, hyperkalemia", "output": "2, because Ans: C i.e. Alkalosis, hypothermia, hyperkalemia The complications usually seen with massive blood transfusion are: i) hyperkalemia, ii) Hypocalcemia, iii) Hyperammonemia, iv) Hypothermia, v) Metabolic alkalosis, vi) Dilutional coagulopathies, DIC & vii) ARDS."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nUnconjugated hyperbilirubinemia is seen in\nA) Rotor syndrome\nB) Dubin-Johnson syndrome\nC) Gilbe syndrome\nD) Bile duct obstruction", "output": "2, because Classification of jaundice A. Predominantly unconjugated hyperbilirubinemia 1. increased production of bilirubin Hemolytic anemias Resorption of blood from intestinal hemorrhages(eg: gi bleeding, hematomas) Ineffective erythropoiesis 2. Reduced hepatic intake Drug that interfere with the membrane carrier systems Diffuse liver disease ( hepatitis, cirrhosis) Some cases of Gilbe syndrome 3. Impaired bilirubin conjugation Physiological jaundice of the new born Crigler-Najjar syndrome types I and II Gilbe syndrome Diffuse liver disease ( hepatitis, cirrhosis) B. Predominantly conjugated hyperbilirubinemia 1. Decreased hepatocellular excretion Deficiency of canalicular membrane transpoers - Dubin- Johnson syndrome - Rotor syndrome Liver damage or toxicity 2. Impaired intra/extra hepatic bile flow Inflammatory destruction of bile ducts( eg: primary biliary cirrhosis) Gallstones Carcinoma of pancreas GENERAL AND SYSTEMIC PATHOLOGY RAMDAS NAYAK PGNO.429"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nSappey's line denotes a line -\nA) Encircling the neck at C6 veebra level\nB) Encircling the trunk just above the umbilicus\nC) Encircling the salpigian tubes\nD) None of the above", "output": "1, because Ans. is 'b' i.e., Encircling the trunk..... Sappey's line defines a horizontal line around the waist extending from the umbilicus, along the iliac crests over to Ll. Lymphatic drainage of the skin above this line is to the axillary lymph nodes and below this line to the inguinal."}

{"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 characteristically not associated with the development of interstitial lung disease ?\nA) Organic dusts\nB) Inorganic dusts\nC) Toxic gases e.g. chlorine, sulphur dioxide\nD) Inhalation of tobacco smoke", "output": "3, because Ref: Textbook of pathology (Harsh Mohan) 6th edition, page No.483 BRONCHIAL ASTHMA Asthma is a disease of airways that is characterised by increased responsiveness of the tracheobronchial tree to a variety of stimuli resulting in widespread spasmodic narrowing of the air passages which may be relieved spontaneously or by therapy. Asthma is an episodic disease manifested clinically by paroxysms of dyspnoea, cough and Wheezing. However, a severe and unremitting form of the disease termed status asthmaticus may prove fatal."}

{"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 nephritogenic antigen is detected in subepithelial humps of PSGN?\nA) Streptococcal pyrogenic exotoxin B\nB) Nephritis associated plasmin receptor\nC) M antigen\nD) P antigen", "output": "0, because RF: Type II HSR PSGN: Type III HSR"}

{"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 common type of intussuception is\nA) Multiple\nB) Colocolic\nC) Ileoileal\nD) Ileoilecolic", "output": "3, because .It is telescoping or invagination of one poion (segment) of bowel into the adjacent segment. Types 1. Antegrade--Most common. 2. Retrograde--Rare (jejunogastric in gastrojejunostomy stoma). In elderly intussusception: * Colocolic is most common type * Apex is formed usually by growth * No role of hydrostatic reduction * It can be single or multiple (rare). * It can be ileo-colic (most common type, 75%), colocolic, ileoileocolic, colocolic. *It is common in weaning period of a child (common in male), between the period of 6-9 months. ref:SRB&;S manual of surgery,ed 3,pg no 863"}

{"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 34-year-old man presents to OPD with gynecomastia and erectile dysfunction. Physical examination reveals a palpable, non-tender testicular mass within the body of testis. His serum testosterone and estradiol levels were elevated. What is the most likely diagnosis?\nA) Leydig cell tumour\nB) Granulosa cell tumour\nC) Spermatocytic tumour\nD) Yolk sac tumour", "output": "0, because Leydig Cell Tumor Sex-cord stromal type of testicular tumor Age- usually at 5-10 years of age or in middle adulthood (30-60 years). Tumors of Leydig cells may secrete androgens, estrogens and coicosteroids. In males , testicular swelling is the most common presenting feature. Children usually present with precocious pubey due to excess of testosterone secreted by the tumor. Adults usually present with gynaecomastia, loss of libido, erectile dysfunction and infeility Histology : Large, closely packed cells with eosinophilic cytoplasm, bland nuclei, and small nucleoli. Reinke crystals are pale-staining, cylindrical, eosinophilic cytoplasmic inclusions that are pathognomonic for Leydig cell tumors and are found in up to 30% of patients ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following organism is the most common cause of acute meningitis in an AIDS patient?\nA) Streptococcus pneumoniae\nB) Streptococcus agalactiae\nC) Cryptococcus neoformans\nD) Listeria monocytogenes", "output": "2, because Oppounistic infections of the CNS generally occur in HIV infected patients with CD4 counts below 200. Most common organism that causes acute meningitis in an AIDS patients is Cyptococcus neoformans. Cryptococcus neoformans is an encapsulated budding yeast that is found worldwide in soil and on dried pigeon dung. Infections are acquired by inhalation. In the lung, the infection may remain localized, heal, or disseminate. Progressive lung disease and dissemination occur in cases of cellular immunodeficiency. Ref: Current Medical Diagnosis and Treatment, 2012, Chapter 36"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThis patient presented with chest pain. What is the diagnosis?\nA) Acute pulmonary embolism\nB) Hypertrophic cardiomyopathy\nC) Ascending aortic aneurysm\nD) Coarctation of the aorta", "output": "2, because Answer C. Ascending aortic aneurysmA widened mediastinum is visible on chest radiography. The patient was diagnosed with a 9.5-cm ascending aortic aneurysm."}

{"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 acids are the main source of energy for\nA) Muscles\nB) Heart\nC) Liver\nD) RBC", "output": "1, because Fed state Preferred fuel\nStarvation preferred fuel\n\n\n\n\nRBC\n\n\nGlucose\nGlucose\n\n\n\n\nHeart\n\n\nFatty acids\nKetone bodies\n\n\n\n\nBrain\n\n\nGlucose\nKetone bodies\n\n\n\n\nLiver\n\n\nGlucose\nFatty acids / protein\n\n\n\n\nMuscle\n\n\nGlucose\nFatty acids\n\n\n\n\nAdipose tissue\n\n\nGlucose\u00a0\nFatty acids."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSteroid is contraindicated in -\nA) Herpetic keratitis\nB) Atopic dermatitis\nC) Fungal corneal ulcer\nD) Exposure Keratitis", "output": "2, because Steroids overwhelm the fungal infection,it also causes immunosuppression. Ref khurana 6/e p243"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nConcerning normal expiration during resting conditions:\nA) Expiration is generated by the expiratory muscles\nB) Alveolar pressure is less than atmospheric pressure\nC) Intrapleural pressure gradually falls (becomes more negative) during the expiration\nD) Flow velocity of the gas (in cm/sec) in the large airways exceeds that in the terminal bronchioles", "output": "3, because The velocity of the gas in the large airways exceeds that in the terminal bronchioles because the latter have a very large combined cross-sectional area. The other choices are incorrect: Under resting conditions, expiration is passive it is associated with an alveolar pressure that exceeds atmospheric pressure intrapleural pressure gradually increases (becomes less negative) during expiration and the diaphragm moves up as expiration proceeds."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nShoest acting non depolarising muscle relaxant\nA) Succinylcholine\nB) Rapacuronium\nC) Atracurium\nD) Pancuronium", "output": "1, because Refer Miller's anesthesia 5/e p 892 Among the given options Rapacuronium IA the shoest acting drug Rapacuronium has been withdrawn from the market because it produces intense bronchospasm in a significant number of patients Mivacurium is shoest acting NDMR"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCretinism is -\nA) Dispropoionate dwarfism\nB) Sho stature with long trunk\nC) Sho stature with sho trunk\nD) Long stature with long trunk", "output": "0, because Ans. is 'a' i.e., Dispropoionate dwarfism Note - Patient has sho stature with sho limbs."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCommonest cause of lung abscess:\nA) Aspiration\nB) Hematogenous spread from distant site\nC) Direct contact\nD) Lymphatic spread", "output": "0, because Lung Abscess Lung abscess refers to a microbial infection of the lung that results in necrosis of the pulmonary parenchyma MC cause of primary lung abscess: Anaerobic bacteria Etiology of anaerobic lung abscess: Aspiration"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAmount of bile produced (ml/ day): September 2012\nA) 100 - 500\nB) 500 -1000\nC) 1000 -1500\nD) 1500 - 2000", "output": "1, because Ans. B i.e. 500 - 1000"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSpermatogenesis\nA) Starts at birth\nB) Maximum in 37degC\nC) Occurs in seminiferous tubules\nD) Time required for a spermatogonium to develop into mature spermatozoan is 6 weeks", "output": "2, because i.e. (Occurs in seminiferous tubules): (11-12-IBS-Embryology 8th)Spermatozoa are formed in the walls of the seminiferous tubules of the testesSPERMATOGENESIS - formation of gametes (spermatozoa) takes only during the reproductive periods which begins at the age of puberty (12 to 16 years) and continue even though old age* The process of spermatogenesis, including spermiogenesis requires about two months** for its completion.Difference between Spermatogenesis and SpermiogenesisSpermatogenesis is the complete process of formation of a spermatozoon from a spermatogonium. It includes first and second meiotic division and spermiogenesisSpermiogenesis - is the process of transformation of a rounded spermatid into a spermatozoanSERTOLI CELLSSertoli cells are specialized cells within the seminiferous tubules and are involved in the orchestration and coordination of all of the key events in spermatogenesis (including spermiogenesis)Function of Sertoli cells1. Provide support, nutrition to developing spermatozoa2. Protect developing germ cells by forming the blood testes barrier (BTB)3. Secretion of important substances - Androgen binding protein (ABP)*, Inhibin*, Mullerian Inhibiting substance (MIS)*, contain aromatase (CYP)*4. Presence of FSH receptors5. Important role in the final maturation phase of spermiogenesis which is characterized by shedding of excess or residual cytoplasm of the spermatids (Phagocytosis)"}

{"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 statements about clonidine are true EXCEPT\nA) It is an alpha adrenergic agonist\nB) It can cause dry mouth as an adverse effect\nC) Prazosin completely antagonizes its action\nD) It inhibits sympathetic outflow.", "output": "2, because Clonidine is a central sympatholytic. It is an agonist to alpha2 receptors. But prazosin is a selective alpha1 blocker selective alpha 2 blocker is yohimbine Clonidine can cause dryness of mouth, nose, and eyes due to central sympatholytic action. (REF. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D TRIPATHI-6th edition. Page No.545,546)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVirulence factor of the group A beta-hemolytic streptococcus is\nA) Protein M\nB) Protein T\nC) Protein R\nD) Lipotechoic acid", "output": "0, because The virulence factors of group A streptococcus or Streptococcus pyogenes: 1. Capsule 2. Carbohydrate antigen 3. Protein antigen M, T, R proteins 4. Pili M protein - acts as virulence factor by inhibiting phagocytosis. Heat and acid stable but susceptible to tryptic digestion. Antibody to M proteins promote phagocytosis of cocci and is protective. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 213"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIdeal contraceptive for a couple living in different cities meeting only occasionally :\nA) Barrier method\nB) IUCD\nC) OCP\nD) DMPA", "output": "0, because The advantages of condom are: 1 they are easily available 2 safe and inexpensive 3 easy to use 4 no side effects 5 light ,compact and disposable 6 provides protection not only against pregnancy but also against STD PARKS TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23 rd EDITION PAGE NO 494"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nObligate intracellular parasite among the following is\nA) Naegleria fowleri\nB) Acanthamoeba\nC) Toxoplasma\nD) Balamuthia", "output": "2, because Obligate intracellular parasites cannot reproduce outside their host cell, meaning that the parasite's reproduction is entirely reliant on intracellular resources. Toxoplasma,Cryptosporidium Bacteria-chlamydia ,Rickettsia"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFetal hea can be detected earliest with trans-vaginal sonography at (from the last menstrual period) :\nA) 35 days\nB) 38 days\nC) 53 days\nD) 46 days", "output": "3, because 46 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\nWhat is the clearance of a substance, if its concentration in plasma is 10 mg%, concentration in urine is 100 mg % and urine flow is 2 ml/min ?\nA) 0.02 ml/min.\nB) 0.2 ml/min\nC) 2 ml/min\nD) 20 ml/min.", "output": "3, because Ans. is 'd' i.e., 20 ml/min."}

{"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 a minor criteria for diagnosis of Rheumatic fever (RP) according to modified Jones criteria \u2013\nA) ASO titre\nB) Past history of Rheumatic fever\nC) Fever\nD) Subcutaneous nodules", "output": "2, because Fever is a minor criteria"}

{"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 a normal ECG which lead does it represent?\nA) aVL\nB) aVR\nC) V1\nD) V6", "output": "1, because The aVR is often neglected lead. It is an unipolar lead facing the right superior surface. As all the depolarization are going away from lead aVR, all waves are negative in aVR (P, QRS, T) in normal sinus rhythm."}

{"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 among the following is true statement regarding breast cancer metastasis?\nA) Metastases occur after breast cancers acquire their own NEW blood supply.\nB) Batson plexus facilitates metastasis to the lung.\nC) Natural killer cells have no role in breast cancer immunosurveillance.\nD) 20 % of women who develop breast carcinoma metastases will do so within 60 months of treatment.", "output": "0, because Metastases occur after breast cancers acquire their own blood supply.(neovascularization). Thereafter, cancer cells may be shed directly into the systemic venous blood to seed the pulmonary circulation the axillary and intercostal veins or the veebral column Batson plexus of veins, which courses the length of the veebral column. These cells are scavenged by natural killer lymphocytes and macrophages. 60% of the women who develop distant metastases will do so within 60 months of treatment."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOne of the following rules explains about the grinding of certain cusps to produce balance in lateral movements:\nA) Ante's rule\nB) Bull rule\nC) Wolfs rule\nD) Cieszynski's rule", "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\nA 70 yrs pt. is refusing for angiography but he has an episode of chest pain on walking upstairs not progressed for last 4 year what shall be done in this patienta) Aspirin lowdose givenb) Nitroglycerine sublingual before walking upstairsc) Continue exercise even after chest paind) Stop exercise if chest pains\nA) ab\nB) a\nC) ad\nD) bc", "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\nMaximum cell size in bacterial cell growth cycle?\nA) Lag phase\nB) Log phase\nC) End of plateau phase\nD) Early stage of decline", "output": "0, because Ans. is 'a' i.e., Lag phase The various phases of growth curve are associated with morphological and physiological alterations of the cells."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIrradiation can be used to sterilize A/E ?\nA) Bone graft\nB) Suture\nC) Aificial tissue graft\nD) Bronchoscope", "output": "3, because Ans. is 'd' i.e., Bronchoscope Endoscops are sterilized by chemical methods :? i) Rigid endoscope ---> Autoclave ii) Flexible endoscope --> Glutaraldehyde Bone & tissue graft, and cat gut suture are sterilized by ionizing radiation ('y - rays)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOn chronic use Linezolid leads to which of the following ?\nA) Thrombocytopenia\nB) Deranged LFT\nC) Nephrotoxicity\nD) Ototoxicity", "output": "0, because Linezolid is Oxazolidinone. MOA: It inhibits protein synthesis by preventing formation of the ribosome complex that initiates protein synthesis by binding to 23S ribosomal RNA of the 50S subunit. It is active against Gram positive organisms including Staphylococci, Streptococci, Enterococci, Gram positive Anaerobic cocci and Gram positive bacilli such as Corynebacteria, Nocardia sp. and L.monocytogenes. It is primarily a Bacteriostatic agent but is Bactericidal against Streptococci. It is also active against Mycobacterium Tuberculosis. Thrombocytopenia is the most common complication seen with its chronic use , also Optic and Peripheral Neuropathy and Lactic acidosis can occur (due to inhibition of mitochondrial protein synthesis). Anemia and Neutropenia can also occur ."}

{"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 acute respiratory response to ascent to high altitude, there is normalization of blood pH. The mechanism is\nA) Increased erythropoesis leads to increased buffering by hemoglobin\nB) Increased excretion of HCO3 - by the kidneys\nC) Increased levels of 2, 3--DPG\nD) Retention of bicarbonate by the kidneys", "output": "3, because The lung response to acute altitude exposure is mainly hyperventilation which, together with elevated hea rate, aims at achieving an adequate supply of oxygen to the tissues. At rest, ventilation increases by firstly increasing the tidal volume, at least up to 3500 m. Ref: guyton and hall textbook of medical physiology 12 edition page number:365,376,377"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPoikilocytosis is due to difference in:\nA) Size\nB) Shape\nC) Number\nD) Width", "output": "1, because Ans: b (Shape) Ref: Harshmohan,ed, p. 336Increase variation in shape of red cell is termed as poikilocytosis. Poikilocytes are produced in various types of abnormal erythropoesis.Eg:Megaloblastic anaemiaIron deficiency anaemiaThalassaemia. MyelosclerosisMicroangiopathic haemolytic anaemiaVariation in size is anisocytosis."}