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{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA patient at 8 weeks pregnancy is diagnosed to have dermoid cyst it should be removed at :\nA) Immediately\nB) At 14-16 weeks\nC) Only when it undergoes torsion\nD) At term along with LSCS", "output": "1, because At 14-16 weeks"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 30-year-old theatre actress developed few wrinkles on the face. The treating physician advised her to have local injections of a drug. This drug is also indicated in cervical dystonia and other spastic disorders like cerebral palsy. Very recently, it has also been approved for prophylaxis of migraine. The physician warned of the drug to cause dry mouth and blurring of vision. The actress searched the compound on internet and found the site of action of the drug as shown in the Figure below.Which of the following drug is being talked about?\nA) Hemicholinium\nB) Vesamicol\nC) Botulinum toxin\nD) Physostigmine", "output": "2, because Ans. (C) Botulinum toxin(Ref: KK Sharma 2/e p217)As shown in the diagram, the drug is inhibiting the exocytosis of ACh. Botulinum toxin act by this mechanism. Other features pointing towards botulinum toxin are:Anticholinergic adverse effects (dry mouth, blurring of vision)Use in wrinkles, spastic disorders, prophylaxis of migraine."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAccumulation of sphingomyelin in lysosome occurs in which disease -\nA) Niemann-Pick disease\nB) Farber's disease\nC) Tay Sach's disease\nD) Krabbe's disease", "output": "0, because Ans. is 'a' i.e., Niemann-Pick disease o Gaucher's disease is due to deficiency of b-glucosidase (glucocerebrosidase).DiseaseEnzyme deficiencyLipid accumulatedTay-sach diseaseHexosaminidase AGM2 gangliosideSandoff diseaseHexosaminidase BGM2 gangliosideNiemann-Pick diseaseSphingomyelinaseSphingomyelineFarber's diseaseCeramidaseAcyl-sphingosine (ceramide)Fabry's diseasea-galactosidaseGlobotrisylceramideKrabbe's diseaseb-galactosidase (Galactosylceramidase)GalactosylceramideGaucher's diseaseb-glucosidase (glucocerebrosidase)GlucosylceramideMetachromatic leukodystrophyArylsulfatase A3-Sulfogalactosylceramide"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSaccule develops from\nA) Saccus anterior\nB) saccus medius\nC) Pars superior\nD) Pars Inferior", "output": "3, because ref : hazarika 4th ed"}

{"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 hallucinations is pathognomonic of schizophrenia\nA) Auditory hallucinations commanding the patient\nB) Auditory hallucinations giving running commentary\nC) Auditory hallucinations criticizing the patient\nD) Auditory hallucinations talking to patient", "output": "1, because Hallucinations are common in schizophrenia. Auditory hallucinations are by far the most frequent, these can be an elementary auditory hallucination (hearing simple words rather than voices), Thought echo, Third person hallucination, Voice commenting on ones on the action. Only the third person hallucinations are believed to be characteristic of schizophrenia (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, page no.56)"}

{"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 dietary source contains the lowest percent of linoleic acid?\nA) Coconut oil\nB) Mustard oil\nC) Groundnut oil\nD) Corn oil", "output": "0, because <p> Essential fatty acids: Those that cannot be synthesised by humans.They can be derived from food only. The most impoant essential fatty acid is linoleic acid, which serves as the basis for production of other essential fatty acids( linolenic and arachidonic acid) . Not all PUFA are essential fatty acids. Linoleic acid:- dietary source and per cent content . Safflower oil- 73 Corn oil- 57 Sunflower oil-56 Soyabean oil-51 Sesame oil-40 Ground nut oil-39 Mustard oil -15 Palmoil- 9 Coconut oil- 2 Eichosapentanoic acid: Fish oil: 10 % present. Linolenic acid : Soyabean oil-7 {Reference: Park&;s textbook of community medicine 23 rd edition, pg no. 611}"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nSite of lesion in endocarditis of rheumatic hea disease -\nA) Along lines of closure of valves\nB) Free margin of valves\nC) Both sides of valves\nD) Valve cusps", "output": "0, because Ans. is 'a' i.e., Along lines of closure of valves"}

{"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 Statement about silicosis -a) Produces pleural plaqueb) Associated with tuberculosisc) Lower lobe infiltrationd) Hilar adenopathy\nA) c\nB) d\nC) bd\nD) ac", "output": "2, because Silicosis\n\nSilicosis is a lung disease caused by inhalation of crystalline silicon dioxide (silica).\nCurrently, it is the most prevalent occupational disease in the world.\nSilicosis is a slowly progressive disease, usually presenting after decades of exposure as slowly progressive nodular fibrosing pneumoconiosis.\nSilica occurs in both crystalline and amorphous forms but crystalline forms are much more fibrogenic. The crystalline form are quartz, crystobalite.\nSilicosis is characterized in its early stages by nodules in the upper zones of the lung. As the disease progresses these nodules may coalesce into hard collagenous scars.\nFibrotic lesions occur in the hilar lymph node and pleura. Sometimes thin sheets of calcification occur in the lymph nodes and are seen radiographically as egg shell calcification i.e. (calcium surrounding a zone lacking calcification.\nIt the disease continues to progress, expansion and coalescence of lesions produce progressive massive fibrosis.\nHistologically the lesions of silicosis consists of concentric layers of hyalinized collagen surrounded by a dense capsule of more condensed collagen.\nExamination of the nodules by polarized microscopy reveals the birefringent silica particles.\nSilicosis is associated with an increased susceptibility to TB. It is postulated that silicosis results in depression of cell mediated immunity and the crystalline silica may inhibit the ability of pulmonary macrophages to kill phagocytosed mycobacteria.\nNodules of silicotuberculosis often display a central zone of caseation."}

{"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 % Body surface area involved in burns of the perineum?\nA) 1%\nB) 3%\nC) 5%\nD) 9%", "output": "0, because Ans. (a) 1%Ref: Sabiston 19th ed. 1523Perineum involved in burns is 1% of body surface area."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nUrsodeoxycholic acid is a :\nA) Urinary stone dissolving drug\nB) Thrombolytic drug\nC) Gall stone dissolving drug\nD) Antifibrinolytic", "output": "2, because \u2022 Medical therapy for gallstones utilizes bile acids: Chenodeoxycholic acid (CDCA) and Ursodeoxycholic acid (UDCA)\nMechanism of Action\n\u2022 They inhibit HMG-CoA reductase, the rate limiting enzyme for cholesterol synthesis, thus decreases cholesterol saturation of bile\n\u2022 They cause dispersion of the cholesterol from the stones by physico-chemical means"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBest contraceptive method during lactation\nA) IUD\nB) Progesterone only pill (POP)\nC) Lactational amenorrhoea\nD) Barrier method", "output": "1, because (B) (Progesterone- only pill) (491- Dutta 6th)POP/MINIPILL* POP is contain very low dose of a progestin Leuonorgestrel, Norethisterone, desogestrel, lynestrenol or norgestrel* It has to be taken daily from the first day of the cycle*** Mechanism of action - it works mainly by making cervical mucus thick and viscous, thereby prevents sperm penetration**AdvantagesDisadvantages1. Side effects attributed to estrogen in the combined pill are totally eliminated1. Acne, mastalgia headache back through bleeding2. No adverse effect on lactation (''Lactation pill\")2. All the side effects, attributed to progestins may be evident3. Easy to take as there is no ''on and off' regime3. Simple cysts of the ovary may be seen, but they do not require any surgery4. It may be prescribed in patients having (medical disorder) Hypertension, fibroid DM, epilepsy, smoking and history of thrombo-embolism4. Failure rate is about o.5-2 per 100 women years of use5. Reduces the risk of PID and endometrial cancerCONTRAINDICATION1. Pregnancy2. Unexplained vaginal bleeding3. Recent breast cancer4. Arterial disease5. Thromboembolic disease* OCP do not act by interference with placental functioning* Contraceptive of choice for Rheumatic heart disease is Barrier method (condom)* Ideal contraceptive for newly married couple is combined OCP* Ideal contraceptive for a couple living in different cities meeting only occasionally - Barrier method* Best contraceptive for parous young women- IUCD* Progesterone of choice in emergency contraceptive is Levonorgestrel*** Effective life of device - Nova Cu-T (5 years) Multiload Cu-T 375 (5years) Cu-T 380A (10 years)* OCP should be avoided in patients on antiepileptic medication* The risk of chlamydial infections is increased in patients using OCP. In most patients such chlamydial infection is asymptomaticAzithromycin is drug of choice in chlaraydial infection in pregnancy* Fishy vaginal odor is most characteristic of Bacterial vaginosis due to Gardnella viginalis (Gram negative bacilli, decreased number of lactobacilli, clue cells, few leucocytes (polymorphs), PH of discharge is >4.5)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOnion peel appearance in X-ray suggests\nA) Osteogenic sarcoma\nB) Ewings sarcoma\nC) Osteoclastoma\nD) Chondrosarcoma", "output": "1, because Onion peel appearancne Typical of ---Ewings sarcoma May also be seen in ----Osteosarcoma and osteomyelitis Refer Campbell 13th/e p 953"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nRetinitis pigmentosa patients doesn't have:-\nA) DHA\nB) Eicosa pentaenoic acid\nC) Arachidonic acid\nD) Timnodonic acid", "output": "0, because Not all, but many studies have found that patients with retinitis pigmentosa tend to have lower blood levels of DHA (Docosa Hexaenoic Acid, o3, 22:6), an omega -3 fatty acid found in the photoreceptor cells. ADDITIONAL READING ON DHA: Also known as Cervonic acid. This is having 22 C and 6 double bonds (Docosa means 22, Hexaenoic means 6 double bonds). These days health drinks (bournvita, horlicks) are foified with DHA, as it is impoant for the brain and retina development in infants and children. Decreased amounts lead to increase risk of Retinitis Pigmentosa. DHA is present in high concentration in sperms, retina, cerebral coex. Constant source of DHA is breast milk. Synthesized to a limited extent from a-linolenic acid or obtained directly from fish oils."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nRisk factors for preeclampsia:a) Chronic hypertenstionb) Obesityc) Placental ischaemiad) Multigravidae) Antiphospholipid syndrome\nA) acd\nB) ace\nC) cde\nD) ade", "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\nThe technique to produce limited removal of epithelial tissue in the sulcus while a chamfer finish line is being created in tooth structure is called\nA) Soft tissue modification\nB) Gingettage\nC) Gingival displacement\nD) Electrosurgery", "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\nChediak_higashi syndrome is due to defect in\nA) Opsonisation\nB) Chemotaxis\nC) LAD\nD) Extracellular microbacterial killing", "output": "1, because Ref Walter and Israel 7/e p150 Chediak Higashi syndrome is an autosomal ressive Condition in which polymorphs exhibit defective random movements , defective chemotaxis and impairee degranulation on phagocytosis paicles"}

{"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 abundant group of fibres in the PDL are\nA) Trans-septal\nB) Horizontal\nC) Oblique\nD) Apical", "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\nZero order kinetics is followed by all of the following drugs EXCEPT\nA) Phenytoin\nB) Barbiturates\nC) Alcohol\nD) Theophylline", "output": "1, because Zero order (linear) kinetics; The rate of elimination remains constant irrespective of drug concentration, Clearance decreases with increase in concentration, or a constant amount of the drug is eliminated in unit time, e.g. ethyl alcohol, methanol. The elimination of some drugs approaches saturation over the therapeutic range, kinetics changes from first order to zero order at higher doses. As a result plasma concentration increases dispropoionately with an increase in dose, as occurs in case of phenytoin, tolbutamide, theophylline, warfarin, aspirin, digoxin Barbiturates follow first order kinetics. Ref:KD Tripathi pharmacology 7th edition (page.no: 31)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCapilary Refill time in child with shock is ?\nA) > 1 second\nB) > 2 seconds\nC) > 3 seconds\nD) > 4 seconds", "output": "2, because 1. Capillary refill time (C) * The accepted upper normal time is < 3 sec. * A study of 469 preterm and term healthy neonates at 1-7 days of age demonstrated significant site and observer variations when C was measured on the chest, forehead, palm, and heel. * C is more reliable when measured on the chest but not the forehead, palm or heel. A positive predictive value of C for SBF was found only when the refill time was over 6 s. When the refill time is this long, the clinician generally does not need to press the skin to know that something is wrong. Press on the finger for five seconds using moderate pressure at an ambient temperature of 20-25 degrees Celsius. A capillary refill time of three seconds or more should be considered abnormal. ... Normal capillary refill time is usually 2 seconds or less. Reference: GHAI Essential pediatrics, 8th 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 stridor in children is -\nA) Laryngeal papilloma\nB) Laryngeal web\nC) Laryngomalacia\nD) Vocal cord palsy", "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\nIn G6PD deficiency, which cells are more prone for hemolysis:\nA) Older red cells\nB) Young red cells\nC) Reticulocytes\nD) All are susceptible", "output": "0, because - Mature red cells do not synthesize new proteins - Hence, as red cells ages G6PD enzyme levels fall quickly & becomes inadequate to protect against oxidant stress. - Thus, older red cells are much more prone to hemolysis than younger ones."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 60-year-old man is hit by a pickup truck and brought to the emergency department with a blood pressure of 70/0 mm Hg. Peritoneal lavage showed no blood in the abdomen. The blood pressure is elevated to 85 systolic following the administration of 2 L of Ringer's lactate. An x-ray showed a pelvic fracture. What is the next step in management?\nA) Exploratory laparotomy with packing of the pelvis\nB) CT scan of the pelvis\nC) External fixation of the pelvis\nD) Open reduction and internal fixation (ORIF) of the pelvis", "output": "2, because Early external fixation of the pelvis has been shown to reduce bleeding and mortality in patients in shock consequent to pelvic fractures. An unstable patient should not be sent for a CT scan. Selective angiography with embolization of the bleeding vessel may also be helpful in these patients. Laparotomy usually results in uncontrollable pelvic bleeding."}

{"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 branches of nasociliary nerve include following except\nA) Anterior ethmoidal nerve\nB) Posterior ethmoidal nerve\nC) Supratrochlear nerve\nD) Infratrochlear nerve", "output": "2, because ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nMetabolic acidosis is seen in all except:September 2005\nA) Diabetic ketaacidosis\nB) Emphysema\nC) Aspirin overdose\nD) Uremia", "output": "1, because Ans. B: EmphysemaMetabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the bodyDiabetic acidosisHyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body,Lactic acidosis is a buildup of lactic acid-alcohol, cancer, liver failure, low blood sugarCommon mnemonic is mudpileM - Methanol U - UremiaD - Diabetic Ketoacidosis (also alcohol ketosis, starvation ketosis)P - Para-aldehydeI - Isoniazid, Iron, Inborn Errors of MetabolismL - Lactic AcidE - Ethylene GlycolS - Salicylates"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nPalpatory thud, audible slap is seen in\nA) Tracheal foreign body\nB) Bronchial foreign body\nC) Laryngeal foreign body\nD) None", "output": "0, because A sharp foreign body will only produce a cough and haemoptysis. A loose foreign body like seed may move up and down the trachea between the carina and the undersurface of vocal cords causing \"audible slap\" and \"palpatory thud.\" Asthmatic wheeze may also be present. It is best heard at the patient's open mouth. Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 365"}

{"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 known as \"Gateway of tears\" -\nA) Killian's dehiscence\nB) Rathke's pouch\nC) Waldeyer's ring\nD) Sinus of Morgagni", "output": "0, because Inferior constrictor muscle has 2 parts; thyropharyngeus with oblique fibres and cricopharyngeus with transverse fibres. Between these 2 parts, there is a potential gap called as killians dehiscence or gateway of tears as perforation can occur at this site during oesophagoscopy and it is also the site for herniation of pharyngeal mucosa in case of the pharyngeal pouch."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nStage of surgical anesthesia during ether administration is\nA) Loss of Consciousness\nB) failure of circulation\nC) Regular respiration to cessation of breathing\nD) Loss of Consciousness to beginning of regular respiration", "output": "2, because Guedel's classification is a means of assessing of depth of general anesthesia introduced by Ahur Ernest Guedel for Ether in1937. Stage I (stage of analgesia or disorientation) Stage II (stage of excitement or delirium) Stage III (stage of surgical anesthesia) plane I to IV Stage IV: from stoppage of respiration till death Stage III (stage of surgical anesthesia): from onset of automatic respiration to respiratory paralysis. It is divided into four planes: Plane I - from onset of automatic respiration to cessation of eyeball movements Plane II - from cessation of eyeball movements to beginning of paralysis of intercostal muscles Plane III - from beginning to completion of intercostal muscle paralysis. Plane IV - from complete intercostal paralysis to diaphragmatic paralysis Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSource of epistaxis after ligation of external carotid aery is:\nA) Maxillary aery\nB) Greater palatine aery\nC) Superior labial aery\nD) Ethmoidal aery", "output": "3, because A, B and C are branches of external carotid aery. If external carotid aery is ligated,the source of epistaxis will be Ethmoidal aery which is a branch of internal carotid aery. Ref Dhingra 6/e,p 178."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAnaphylactic shock is caused by w hich type of hypersensitivity reaction?\nA) I\nB) II\nC) III\nD) IV", "output": "0, because Ans. is 'a' i.e., IAnaphylactic shock is caused by type 1 Hypersensitivity reaction."}

{"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 effective buffer system in the blood which is controlled by respiration is:\nA) Bicarbonates\nB) Hemoglobin\nC) Protein\nD) Phosphate", "output": "0, because The bicarbonate buffer system is one of the most effective buffer systems in the body because the amount of dissolved CO2 is controlled by respiration (ie, it is an \"open\" system). Additional control of the plasma concentration of HCO3- is provided by the kidneys. Additional factors that make the carbonic-acid-bicarbonate system such a good biological buffer: The reaction CO2 + H2O ? H2CO3 proceeds slowly in either direction unless the enzyme carbonic anhydrase is present. There is no carbonic anhydrase in plasma, but there is an abundant supply in red blood cells, spatially confining and controlling the reaction. The presence of hemoglobin in the blood increases the buffering of the system by binding free H+ produced by the hydration of CO2 and allowing for movement of the HCO3- into the plasma. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 35. Gas Transpo & pH. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nGenetic risk factors for leukemia are all except-\nA) Down's syndrome\nB) Bloom syndrome\nC) Ataxia telangiectasia\nD) None", "output": "3, because Ans. is 'None' Genetic conditions predisposing to leukemia Down syndrome Diamond-Blackfan anemia Turner syndrome Fanconi syndrome Klinefelter syndrome Neurofibromatosis type 1 Bloom syndrome Schwachman syndrome Paroxysmal nocturnal hemoglobinuria Li-Fraumani syndrome Ataxia - telangiectasia Severe combined immune deficiency"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nOil drop cataract is characteristically seen in -\nA) Diabetes\nB) Chalcosis\nC) Galactosemia\nD) Wilson's disease", "output": "2, because Oil drop cataract is seen in galactosemia. Ref: Clinical ophthamology 2nd/e p.791."}

{"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 middle aged person presented with the complaints of fear of leaving home, fear of travelling alone and fear of being in a crowd. He develops marked anxiety with palpitations and sweating, if he is in these situations. The most likely diagnosis is:AIIMS 06; NIMHANS 11\nA) Generalized anxiety disorder\nB) Schizophrenia\nC) Personality disorder\nD) Agoraphobia", "output": "3, because Ans. Agoraphobia"}

{"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 mechanism of acute rheumatic fever\nA) Cross reactivity with endogenous antigen\nB) Innocent by slender effect\nC) Due to toxin secretion by streptococci\nD) Release of pyrogenic cytokines", "output": "0, because Cross reactivity with endogenous antigen Acute Rheumatic fever results from immune response to group A streptococci. - The main factor responsible for virulence in infection with streptococcal A group is \"M\" protein. - The body mounts an immune response against streptococci A organism by producing antibodies directed against the \"M\" protein. Antibodies directed against the \"M\" protein of streptococci have been shown to cross react with self antigens in the hea. - The streptococcal M protein and the human myocardium appears to be identical antigenically. - Epitopes present in the cell wall membrane and the A,B,C repeat regions of the \"M\" protein are immunologically similar to molecules in human myosin. tropomysin, keratin actin, laminin, vimentin. - \"This molecular mimicry is the basis for autoimmune response that leads to Acute Rheumatic fever\"."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFacial colliculus covers-\nA) Facial nucleus\nB) Abducent nucleus\nC) Vestibular nucleus\nD) Vagal nucleus", "output": "1, because Ans. is 'b' i.e., Abducent nucleus o There is some misprinting in the question. It is abducent nucleus (not abducent nerve) which is covered by facial colliculus.o Facial colliculus is a small elevation in pons, produced by genu (recuring fibers) of facial nerve looping around (covering) abducent nucleus.o Facial colliculus produces medial eminence on each side of median sulcus in 4th ventricle"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nRecently used irrigation solution is:\nA) MTAB\nB) MTAC\nC) MTAD\nD) MTAE", "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\nTwin peak sign seen in\nA) Monochorionic Monoamniotic\nB) Monochorionic Diamniotic\nC) Dichorionic Diamniotic\nD) Dichorionic Monoamniotic", "output": "2, because Twin peak or lambda sign it is characterized of dichorionic pregnancies and is due to the chorionic tissue between the two layers of the intewin membrane at the placental origin . twin peak appears as a triangle with base at chorionic surface and apex in intewin membrane."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAkinesia (hypoactivity) and mutism is a feature of\nA) Twillight state\nB) Stupor\nC) Cataplexy\nD) Torpor", "output": "1, because Akinesia + Mutism is a feature of stupor, which is seen in catatonic schizophrenia or catalepsy.\nOption c :\u00a0Cataplexy is sudden loss of muscle tone seen in Norcolepsy, which is not a correct answer."}

{"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 pathognomonic sign of neurofibromatosis is\nA) Cafe-au-lait macules\nB) Axillary frekling\nC) Shagreen patch\nD) None of the above", "output": "1, because B i.e. Axillary freckling Neurofibromatosis is autosomal dominantQ disorder. Axillary freckling (crowe sign) is a pathognomic sign of von- Reckling hausen's type 1 neurofibromatosisQ. Cafe - au - lait macules alone are not absolutely diagnostic of NF1, regardless of their size and number."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAtaxia telangiectasia is chracterised by all of the following except :\nA) Chronic sinopulmonary disease\nB) Decreased level of a-fetoprotein\nC) Chromosomal breakage\nD) IgA deficiency", "output": "1, because Answer is B (Decreased levels of a fetoproteins) Persistance of very high levels of oncofetal proteins, including alpha fetoproteins and carcinoembryonic antigens is of diagnostic value - Harrison All other features mentioned as options are characteristics of Ataxia-telengiectasia"}

{"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 enzymes inhibit the production of cAMP?\nA) Glucagon\nB) Angiotensin II\nC) ACTH\nD) Beta-Adrenergics", "output": "1, because Cyclic AMP was the first intracellular second messenger signal identified in mammalian cells. Different peptide hormones can either stimulate (s) or inhibit (i) the production of cAMP from adenylyl cyclase, which is encoded by at least nine different genes. Hormones that Inhibit Adenylyl Cyclase (HI) and the production of cAMP: Acetylcholine Alpha 2-Adrenergics Angiotensin II Somatostatin Hormones that stimulate Adenylyl Cyclase (HI) and the production of cAMP: ACTH ADH Beta -Adrenergics Calcitonin CRH FSH Glucagon hCG LH LPH MSH PTH TSH Ref: Weil P. (2011). Chapter 42. Hormone Action & Signal Transduction. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhat is the mechanism of action of sacubitril?\nA) ACE inhibitor\nB) Neutral endopeptidase inhibitor\nC) Endothelin antagonist\nD) Angiotensin receptor blocker", "output": "1, because Ans. b. Neutral endopeptidase inhibitorRef: CMDT 2018/P 414Sacubitril is a neutral endopeptidase or neprilysin inhibitor approved for treatment of chronic CHF in combination with angiotensin receptor blocker like valsartan.It can cause angioedema and hence is contraindicated with ACE inhibitors or within 36 hours of use of ACE inhibitors."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA man presents with fatigue. Hemogram analysis done suggested low Hb, high MCV. The next investigation is?\nA) Vit B12/folatelevels\nB) Bone Marrow\nC) S. Iron studies\nD) Reticulocyte count", "output": "3, because Ans. (d) Reticulocyte count(Ref: Robbins 9th/pg 645-648)This is a tricky question as the initial investigation looks like B12 /folate levels, as the patient has macrocytosis.But remember, Macrocytosis can also be seen in hemolytic anemia, as newer RBC precursors released are larger in size.So the initial investigation should be reticulocyte countIf reticulocyte % is low it can be macrocytic anemia & if there is reticulocytosis, then it can be a case of hemolytic anemia."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nTumors of the minor salivary glands are most frequently found at the:\nA) Upper lip.\nB) Lower lip.\nC) Palate.\nD) Tongue.", "output": "2, because Palate is the most common site."}

{"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 true regarding pulp component of PUFA?\nA) Detected without use of probe\nB) Pus drainage with swelling\nC) Sinus tract detected with pain\nD) Ulceration with pulp involvement", "output": "0, because PUFA index by Monse et al (2010)\nThe PUFA index records the presence of severely decayed teeth with:\n\nVisible pulpal involvement - (P/p)\nUlceration caused by dislocated tooth fragments - (U/u)\nFistula - (F/f)\u00a0\u00a0\nAbscess - (A/a).\n\nPediatric Dentistry Principles and Practice\nM.S.Muthu"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThe earliest immunoglobulin to be synthesized by the fetus is -\nA) IgA\nB) IgG\nC) IgE\nD) IgM", "output": "3, because Option 1, 3, 4 IgM: IgM is the first immunoglobulin to be synthesized by a neonate in about 20 weeks of age. IgM is not transpoed across the placenta; hence, the presence of IgM in the fetus or newborn indicates intrauterine infection. The first immunoglobulin produced in response to an antigen is IgM. after 3 monts of bih class switching is staed and then other class of immunoglobulins are synthesised. IgM is secreted as a pentamer and is composed of five H2L2 units (similar to one IgG unit) and one moleculeof a J chain.. It is the most efficient Because its interaction with antigen can involve all 10 binding sites, it has the highest binding capacity and cross-linking of all the immunoglobulins. Option 2 IgG is the only immunoglobulin class to cross the placenta and therefore is the most abundant immunoglobulinin newborns.( this is not the the first to be synthesised in newborn)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDissociative Fugue is characterised by\nA) Wandering away from home\nB) Irreversible amnesia\nC) Gradual recovery\nD) Normal recall", "output": "0, because Dissociative Disorders result after emotional trauma, conflicts over unacceptable urges or impulses Dissociative Identity Disorder*: multiple personality disorder, alters, the self-states presence of two or more distinct identities or personality states that recurrently take control of the individual's behavior accompanied by an inability to recall impoant personal information that is too extensive to be explained by ordinary forgetfulness. Dissociative Amnesia*: an inability to recall impoant personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness. Dissociative Fugue*: sudden, unexpected travel away from home or one's customary place of daily activities, with the inability to recall some or all of one's past, accompanied by confusion about personal identity or even the assumption of a new identity. Depersonalisation, Derealization Reference: P.666 chap 20.Dissociative DisordersKaplan & Sadock's Synopsis of Psychiatry: Clinical Psychiatry, 10th 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\nDeficiency of which of the following enzymes is associated with Tyrosinosis:\nA) Tyrosine aminotransferase\nB) 4-Hydroxyphenylpyruvate dioxygenase\nC) Homogentisate oxidase\nD) Fumarylacetoacetate hydroxylase", "output": "3, because Tyrosinosis is synonymous with Type-1 Tyrosinemia and is caused by a deficiency of Enzyme Fumarylacetoacetate hydrolase. Tyrosine Catabolic pathway and Associated Disorders: Tyrosine aminotransferase 4-Hydroxyphenylpyruvate dioxygenase Homogentisate oxidase Fumarylacetoacetatehydrolase Tyrosine aminotransferase Tyrosinemia type II (Richner-Hanha sydrome) 4-Hydroxyphenylpyruvate deoxygenase Tyrosinemia type III (Complete deficiency of Enzyme) 4-Hydroxyphenylpyruvate dioxygenase complex Transient Tyrosinemia of the new-born (immaturity of Enzyme ) 4-Hydroxyphenylpyruvate dioxygenase complex Hawkinsinuria (Mutant enzyme) Catalyses a paial reaction Fumarylacetoacetate hydrolase Tyrosinemia type I (Tyrosinosis) Homogentisate oxidase Alkaptonuria Disorders associated with 4-Hydroxyphenylpyruvate dioxygenase: Immaturity of 4-hydroxyphenylpyruvate dioxygenase (4HPPD) enzyme Transient neonatal Tyrosinemia (TNT) is a form of hypeyrosinemia produced by the complete deficiency of 4-Hydroxyphenylpyruavate dioxygenase (4HPPD) leads to Tyrosinemia III. Ref: Harper 30th edition Pgno: 304"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nNKX3-1 immunohistochemical used for diagnosis of?\nA) Colorectal carcinoma\nB) Pancreatic carcinoma\nC) Prostate\nD) Renal cell carcinoma", "output": "2, because NKX3-1 expression acts as a transcription factor that has been found to play a main role in prostate development and tumor suppression. The loss of NKX3-1 expression is frequently observed in prostate. Other markers for prostate cancer are:- PSA(prostate specific antigen) AMACR Urinary PCA 3 TMPRSS2"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\n'Square root' sign is characteristic of\nA) Dilated cardiomyopathy\nB) Restrictive cardiomyopahty\nC) Constrictive pericarditis\nD) Contractile dysfuncation seen in which type of cardiomyopathy?", "output": "2, because square root sign is a charecteristic feature of Constrictive pericarditis Dip & plateau pattern' or 'square root sign': Early diastolic filling of the ventricles is unimpeded and abnormally rapid, but late diastolic filling is abbreted and halts abruptly when total cardiac volume expands to the volume limit set by the stiff pericardium Ref Harrison 20th edition pg 1436"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\n3 year old girl has a central incisor removed because of\ntrauma. What is the best appliance to use to replace the\nmissing tooth?\nA) A removable appliance\nB) Fixed lingual wire with a tooth attached\nC) A fixed lingual wire only\nD) Hawley appliance with replacement tooth", "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\nThe epithelioid cell and multinucleated giant cells of Granulomatous inflammation are derived from which of the following cells?\nA) Basophils\nB) Eosinophils\nC) CD4-T lymphocytes\nD) Monocytes - Macrophages", "output": "3, because Granulomatous inflammation is a characteristic feature of Type IV hypersensitivity reaction against tubercle bacilli. When ceain non degradable antigen such as tubercle antigen is present, the initial perivascular mononuclear cell monocyte infiltrate is replaced by macrophages over a period of 2-3 weeks. The accumulated macrophage then undergo morphological transformation into epithelial like cells and are then referred to as epithelioid cells. A microscopic aggregation of epithelioid cells, usually surrounded by a collar of lymphocytes, is referred to as granuloma. And this pattern of inflammation is called granulomatous inflammation.Ref: Robbins Pathologic Basis of Disease, 6th Edition, Pages 204-6"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBest uterine relaxation is seen with:\nA) Chloroform\nB) Nitrous oxide\nC) Ether\nD) Halothane", "output": "3, because Halothane inhibit intestinal and uterine contractions. This propey is used for facilitating external or internal version during late pregnancy. However it&;s use during labour can prolong delivery bad increase postpaal blood loss. Muscle relaxation is minimal with nitrous oxide. Rest of the drugs donot have uterine contractions as a propey. From KD Tripati 7th edition Page no 378,379"}

{"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 drugs can cause malignant hypehermia?\nA) Succinyl choline\nB) Halothane\nC) Lidocaine\nD) All the above", "output": "3, because Mepivacaine, Gallamine, Methoxy flurane, Ethyl chlonde etc also cause malignant hypehermia."}

{"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 typical febrile seizure is characterized by all Except\nA) Male children are more prone\nB) Occurs with sudden rise in temperature\nC) Manifests with paial seizures\nD) Phenobarbitone prevents fuher attacks", "output": "2, because FEBRILE SEIZURES:Febrile seizures are defined as seizures which occurring during fever.Febrile seizures are the commonest cause of seizures in childhoodMost common age of presentation is 6 months to 5 yearsOccurs at the sudden rise of core temperature.Recurrence rate is 30-50%Types: typical and atypical febrile seizuresTypical febrile seizureAtypical febrile seizureSingle episode/dayMore than 1 episode/dayDuration:<15 min>15minGeneralized tonic-clonic typePaial seizuresDrugs such as diazepam, clobazam, phenobarbitone can prevent fuher attacks, but not eliminate the risk completely.Febrile seizures - no postictal neurological deficit and EEG is normal.Most common seizures in childhood- FEBRILE SEIZURESMost common neonatal seizures - SUBTLE SEIZURES."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThiamine deficiency causes decreased energy production because?\nA) It is required for the process of transamination\nB) It is co-factor in oxidative reduction\nC) It is co-enzyme for transketolase in pentose phosphate pathway\nD) It is co-enzyme for pyruvate dehydrogenase", "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\nErb's point is:\nA) C4, C5\nB) C5, C6\nC) C6, C7\nD) C7, C8, T1", "output": "1, because C5, C6"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nCA-19-9 is seen in all except\nA) Breast carcinoma\nB) Ovarian carcinoma\nC) Colonic carcinoma\nD) Pancreatic carcinoma", "output": "0, because (A) Breast carcinoma # CA19-9: CA19-9 is a monoclonal antibody generated against a colon carcinoma cell line to detect a monosialoganglioside found in patients with gastrointestinal adenocarcinoma.> It is found to be elevated in 21 to 42 percent of cases of gastric cancer, 20 to 40 percent of colon cancer, and 71 to 93 percent of pancreatic cancer, and has been proposed to differentiate benign from malignant pancreatic disease, but this capability remains to be established.> CA19-9 (carbohydrate antigen 19-9 or sialylated Lewis (a) antigen) is a blood test from the tumor marker category.> It was discovered in patients with colon cancer and pancreatic cancer in 1981. Increased levels of CA19-9 are also found in non- malignant conditions, such as Mirizzi's syndrome and diseases of the bile ducts and liver.> The main use of CA19-9 is to see whether a pancreatic tumor is secreting it; if that is the case, then the levels should fall when the tumor is treated, and they may rise again if the disease recurs.> In patients who lack the Lewis antigen (a blood type protein on red blood cells), which is about 5% of the population, CA19-9 is not elevated in pancreatic cancer even with large tumors because they have a deficiency of a fucosyltransferase enzyme that is needed to produce CA19-9 as well as the Lewis antigen."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nTreatment of Ca larynx in stage. T1MoNo is -\nA) Radiotherapy\nB) Surgery total laryngectomy\nC) Laser therapy\nD) Microlaryngoscopic surgery", "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\nThe complex process of leukocyte movements through the blood vessels are all EXCEPT -\nA) Rolling\nB) Adhesion\nC) Migration\nD) Phagocytosis", "output": "3, because Ans. is 'd' i.e., Phagocytosis"}

{"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 HIV positive patient presents with fever, dyspnoea and non-productive cough. Patient is cyanosed. His chest X-ray reveals bilateral, symmetrical interstitial infiltrates. Which of the following is the most likely diagnosis?\nA) Tuberculosis\nB) Cryptococcosis\nC) Toxoplasmosis\nD) Pneunocystis carinii pneumonia", "output": "3, because This HIV positive patient is showing clinical features and X-ray findings suggestive of pneumocystis carnii pneumonia. PCP infection occur in HIV positive individuals with CD4 count less than 200. It is an oppounistic fungal pulmonary pathogen that is an impoant cause of pneumonia in the immunocompromised host. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 207"}

{"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 cholangitis -\nA) Viral infection\nB) CBD stone\nC) Surgery\nD) Amoebic infection", "output": "1, because Gall stones are the most common cause of obstruction in cholangitis.\n\nOther causes are\n\nbenign & malignant strictures\nparasites\ninstrumentation of the ducts and indwelling stents\npartially obstructed biliary enteric anastomosis\n\nMost common organisms cultured from bile in patients with cholongitis include\n\nEscherichia coli\nKlebsiella pneumoniae\nStreptococcus faecalis\nEnterobacter\nBacteroides fragilis"}

{"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 human corneal transplantation, the donor tissue is\nA) Synthetic polymer\nB) Donated human cadaver eyes\nC) Donated eyes from live human beings\nD) Monkey eyes", "output": "1, because B i.e. Donated human cadaver eyes Donor corneas are harvested from cadaveric donors within 6 hours after death Q (upto 12 hours after death in cold countries.) Corneal Transplantation (Grafting) /Keratoplasty General Indications To provide a clear visual axis and restore good vision (Optical Keratoplasty) To restore the integrity of the globe in corneal diseases (Tectonic Graft) To remove infective tissue unresponsive to conservative treatment (Therapeutic Graft) To improve the appearance of the eye (Cosmetic Graft) Contraindications Death of unknown cause CNS disease such as Creutzfeldt-Jacob disease, subacute sclerosing panencephalitis, rubella, Reye's syndrome, rabies & infectious encephalitis. Infections such as HIV, Hepatitis, septicemia, syphilis, & endocarditis. Eye disease as retinoblastoma, malignant tumor of anterior segment & active ocular inflammation (uveitis, scleritis, retinitis & choroiditis) Prior ocular surgery (although pseudophakic eyes may be used with good cell density) Congenital or acquired anterior segment abnormalities such as Keratoconus & Fuch's endothelial dystrophy. * Corneas from infants (53 year) are used only very occasionally, even for pediatiric transplants as they are a/w surgical, refractive and rejection problems Graft-Harvesting Donor corneas are harvested from cadaveric donors within 6 hours after death Q (upto 12 hours after death in cold countries.) Graft-Preservation Sho term (upto 96 hours) - Moist chamber (at +40C) method for 24 hours. - M-K (Mc Carey-Kaufman) medium upto 96 hours. Intermediate-term (upto 2 weeks) - K-SOL / DEXOL / OPTISOL-medium Long term (months - years) - Viable: Organ culture & cryopreservation - Nonble: Glycerine Types Full Thickness or Penetrating keratoplasty Paial Thickness or Lamellar Keratoplasty - Superficial LK (replacement of corneal epithelium & superficial stroma) Deep anterior LK (DALK). all opaque tissue almost upto the level of Descemet membrane is removed Descemet stripping endothelial Keratoplasty (DSEK)/DS automated EK (DSAEK; when a microkeratome is used to perform donor lamellar dissection)/ Posterior LK (PLK) Small Patch grafts which can again be full or paial thickness Full Thickness/ Penetrating Keratoplasty (PKP) It is full thickness replacement of diseased corneal tissue with a healthy donor. It can be done in disease involving all or few layers of cornea eg keratoconus, pseudophakic bullous keratopathy, Fuchs endothelial & other dystrophies. An ideal graft size is 7.5 mm; grafts smaller than this may 1/t high astigmatism. Grafts 8.5 mm are prone to postoperative anterior synechiae formation, vascularization and increased intraocular pressure. - PKP has long been the gold standard for treatment of endothelial dysfunction. The limitations of PK include However, because of recent advances & lack of these limitations, endothelial keratoplasty is rapidly gaining popularity. It takes 6 months to many years for the refraction to stabilize 10-15% of patients typically require a hard contact lens for best vision and final mean refractive cylinder of 45D is common PKP incision cuts all corneal nerves, so the inclination to blink and produce tears is reduced postoperatively. This, together with prolonged presence of corneal sutures, increases the risk that ocular surface complications will interfere with recovery. PKP wound never heals back to the full strength of a virgin cornea, so a PKP eye is forever at increased risk of loss from a traumatic injury. Paial Thickness /Lamellar Keratoplasty (LKP) - It is a procedure in which a paial thickess graft of donor tissue is used to provide tectonic stability and /or optical improvement. - It may be of 2 types: anterior LKP and posterior LKP. - In anterior LKP, the transplanted tissue does not include corneal endothelium. This procedure avoids endothelial rejection and thus donor tissue may be obtained from older eyes. Indications for anterior LKP mainly include anterior corneal pathology in which the posterior cornea is unaffected - In deep LKP and posterior LKP, the diseased corneal endothelium is replaced while keeping the anterior corneal surface intact. - Because the donor endothelium is not used, the criteria for anterior LKP are less stringent than those used in PKP; the tissue does not need to be as fresh as that used in PKP. Corneal stroma may be used upto 7 days postmoem (whereas, Posterior LKP has same criteria as PKP) . Endothelial Keratoplasty (EK) i.e. posterior lamellar keratoplasty/ Descemet's Stripping endothelial Keratoplasty involves selective removal of dysfunctional recipient corneal endothelium and replacement with donor tissue consisting of posterior stroma and healthy endothelium. EK is performed through a small incision and spares the majority of host cornea so corneal strength and surface topography are minimally altered & technique is essentially refractive neutral. Fuhermore, corneal innervaton is retained and corneal sutures are not required. So corneal surface complications are minimal. The small incison allows rapid healing and rapid visual recovery after surgery. While fewer patients may achieve 20/20 vision after EK compared with PKP, overall the visual results are more predectible. - DSEK increases corneal thickness because posterior donor stroma is implanted without removal of any recipient stoma. In general, younger patients are likely to achieve better visual acuity after DSEK than older patients (even when have no retinal problems). Whereas PKP was often post phoned until after retirement or at least until visual problems were quite disturbing, EK is now being performed earlier, when visual problems begin to interfere with daily activities, such as reading or driving Infact, it is preferable to perform EK before long standing corneal edema 1/ anterior stromal scarring, because the anterior stroma is not replaced in EK."}

{"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 condition is associated with normal anion gap metabolic acidosis?\nA) Cholera\nB) Starvation\nC) Lactic acidosis\nD) Ethylene glycol poisoning", "output": "0, because A normal anion gap metabolic acidosis is caused by the loss of bicarbonate with a reciprocal increase in chloride concentration. It is also known as hyperchloremic acidosis. It most commonly results from abnormal gastrointestinal or renal losses of HCO3-. Diarrhea is the most common cause of hyperchloremic metabolic acidosis. Cholera is associated with massive diarrhea. This diarrheal fluid consist of small bowel, biliary, and pancreatic fluids which contains 20-50 mEq/L of HCO 3 -. This loss of large volumes of fluids lead to hyperchloremic metabolic acidosis. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 47 ; Current Diagnosis & Treatment Emergency Medicine, 7th Edition, Chapter 44"}

{"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 25-year-old sexually active woman complains of purulent discharge and dysuria after having intercourse with a new paner. Most sensitive investigation for diagnosis:\nA) Grams staining\nB) Bacterial growth or culture on selective media\nC) Wet mount\nD) Nucleic Acid Amplification Test (NAAT)", "output": "0, because Ans. d. Nucleic Acid Amplification Test (NAAT) Most sensitive investigation for diagnosis in a 25 year old sexually active woman who complains of purulent discharge and dysuria after having intercourse with a new paner (sexually transmitted urethritis) is Nucleic Acid Amplification Test (NAAT). `Gonorrhea and chlamydial infection should be sought by specific tests (e.g., NAATc on the first 10 mL of voided urine). Among dysuric women with sterile pyuria caused by infection with N. gonorrhoeae or C. trachomatis, appropriate treatment alletes dysuria.'-Harrison 18/e p1098 `However, an increasing propoion of men with symptoms and/or signs of urethritis are simultaneously assessed for infection with N. gonorrhoeae and C. trachomatis by 'multiplex' NAAR of first-voided urine. Culture or NAAT for N. gonorrhoeae may be positive when Gram's staining is negative; ceain strains of N. gonorrhoeae can result in negative urethral Gram's stains in up to 30% of cases of urethritis.'- Harrison 18/e p1098 `All men with suspected urethritis should be tested for gonorrhea and chlamydia. The availability of sensitive and specific testing Sexually Transmitted Urethritis Sexually transmitted urethritis can be gonococcal or Non-gonococcal Investigation: PCR: Rapid, specific and sensitive but expensive to use. Multiplex PCR available to detect concomitant T. pallidium, H. ducreyi, HSV infection. Serology: Serological screening for IgM antibodies is useful but presence of elevated levels of IgM antibodies does not differentiate between present and past infection. Recent point of care test based on glycoprotein G has high sensitivity and specificity"}

{"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 large for gestational age baby delivered at 40 weeks was observed to be lethargic. The Blood sugar was measured to be 35mg/dl. The management is __________\nA) Foified Breast Milk\nB) 10% IV Dextrose\nC) Oral Glucose Solution\nD) Normal saline", "output": "1, because .A plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45mg/dL (2.5 mmol/L) thereafter constitutes hypoglycemia in the newborn. Dextrose also has medical purposes, Because dextrose is a \"simple\" sugar, the body can quickly use it for energy. Simple sugars can raise blood sugar levels very quickly, and they often lack nutritional value. Reference: GHAI Essential pediatrics, 8th edition"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThe following are realated to bromocriptine therapy except : (Irrelevant Question)\nA) It is used to inhibit inappropriate lactation with secondary amenorrhea\nB) It is specific in suppressing only the prolactin secretion\nC) If pregnancy occurs there is increased incidence of multiple pregnancy\nD) Its teratogenic effect on the fetus is inconclusive", "output": "2, because Bromocriptine A synthetic ergot derivative and powerful dopamine agonist It supress prolactin while promoting the secretion of gonadotropins, hence induces menstruation, ovulation and promotes pregnancy. It also suppresses lactation USES Supression of lactation Cyclical mastalgia Anovulatory infeility Pituitary Microadenoma If pregnancy follows treatment can be continued; no teratogenic effect is repoed in fetus Ref: SHAW&;S TEXTBOOK OF GYNAECOLOGY; 15 TH EDITION; PG NO:320"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThreshold level of herd immunity for Peussis is\nA) 80%\nB) 70%\nC) 90%\nD) 50%", "output": "2, because Ans. is 'c' i.e., 90% Advantage of herd immunity o It is not necessary to achieve 100% immunization to control a disease by providing herd immunity. o When a ceain percentage of population, is vaccinated, the spread of disease is effectively stopped. o This critical percentage is referred to as herd immunity threshold. Disease Herd immunity threshod Diphtheria 85% Measles 83-94% Mumps 75-86% Peussis 92-94% Polio 80-86% Rubella 80-85% Small pox 83-85% Limitation of Herd immunity o Only a small fraction of the population (or herd) can be left un-vaccinated for this method to be effective."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSibutramine belongs to which group of drugs according to it's indication of use?\nA) Antipsychotic\nB) Antihypeensive\nC) Anti-Obesity\nD) Anti-Diabetic", "output": "2, because Sibutramine is a centrally acting anorectic drug which was used as anti obesity drug. The target site of action is ventromedial and lateral hypothalamic regions in the CNS. It functions as a serotonin and nor epinephrine reuptake inhibitor. It was withdrawn from US market in October 2010, due to an increased risk of non fatal myocardial infarction and non fatal stroke among individuals with pre existing cardiovascular disease. Ref: Harrison's Principles of Internal Medicine, 18th edn, Chapter 78"}

{"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 term \"Dementia precox\" was coined by\nA) Freud\nB) Bleuler\nC) Kraepelin\nD) Schneider", "output": "2, because C i.e., Kraepelin Benedict Morel used term demence precoce (in french) for deteriorated patients whose illness began in adolescence. Emil Kraeplin translated it into dementia. PrecoxQ i.e. dementia = deteriorated cognitive process & precox = early onset Eugen Bleuler coined term schizophreniaQ Kahlbaum described catatoniaQ, Hacker decribed hebephrenia"}

{"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 rhinophyma:\nA) Premalignant\nB) Common in alcoholics\nC) Acne rosacea\nD) Fungal etiology", "output": "2, because Rhinophyma is a slow-growing benign tumor which occurs due to hyperophy of the sebaceous glandsdeg of the tip of the nose.Seen in long standing cases of acne rosacea.Mostly affects men past middle age.Presents as a pink, lobulated mass over the nose.TreatmentParing down the bulk of the tumor with a sharp knife, or carbon dioxide laser or scalpel (dermabraions), and the area is allowed to re-epithelize.Sometimes tumor is completely excised and the raw area is covered with skin graft."}

{"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 neuropathic joint -\nA) Leprosy\nB) Tabes dorsalis\nC) Diabetes\nD) Nerve injury", "output": "2, because Ans. is 'c' i.e., DiabetesNeuropathic joint (Charcot's joint)o It is a progressive destructive arthritis associated with loss of pain sensationx, proprioception or both, in addition normal muscular reflexes that modulate joint movements are decreased.o Without these protective mechanisms, joints are subjected to repeated trauma, resulting in progressive cartilage and bone damage.o It is most commonly caused by diabetes mellitus.Causes of Neuropathic joint disease (Charcoat's joint)o Diabetes mellitus {most common) o Amyloidosiso Tabes Dorsalis o Leprosyo Meningomyelocele o Congenital indifference to paino Syringomyelia o Peroneal muscular atrophy"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPreferred material for femoro popliteal bypass-\nA) Dacron\nB) PTNE\nC) Saphenous vein\nD) Gortex", "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\nMost appropriate treatment for acute paranychia\nA) Paial nail removal\nB) Nail removal\nC) Lifting of eponychium\nD) Incision and drainage", "output": "0, because .ACUTE PARONYCHIA * It is the most common hand infection. * It occurs in subcuticular area under the eponychium. * Minor injury to finger is the common cause. * Suppuration occurs very rapidly. * It tracks around the skin margin and spreads under the nail causing hang nail or floating nail. * Organisms are Staphylococcus aureus and Streptococcus pyogenes Treatment --* Pus is sent for culture and sensitivity. * Antibiotics like cloxacillin, amoxycillin. * Analgesics. * The pus is drained by making an incision over the eponychium. * If there is a floating nail, then the nail is dead and it has to be removed. Recovery is fast. ref:SRB&;s manual of surgery,ed 3,pg no 132 ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nLarval form of which parasite resides in muscle -\nA) Taenia saginata\nB) Echinococcus\nC) Trichuris\nD) All of the above", "output": "3, because Larval form of trichuris ,taenia saginata,echinococcus resides in muscle"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFoci of granulomatous inflammation show all of the following except?\nA) Eosinophils\nB) Epithelioid cells\nC) Fibrosis\nD) Lymphocytes", "output": "0, because Ans- (a) EosinophilsRef: Robbiris pathology 9th ed. /97* A special form of chronic inflammation is seen in response to tissue invasion by Mycobacterium tuberculosis.* Macrophages and multinucleated giant cells accumulate about the organisms, and fibrous tissue form about these small focal lesions or tubercles.* This combination of macrophages and fibrosis is granulomatous inflammation.* Epithelioid cells and multinucleated Langhans giant cells are present. The former are derived from macrophages and the latter by cytoplasmic fusion of macrophages.* These lesions may heal by scarring and become calcified, or they undergo caseation necrosis."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTriple negative breast cancer- What is true -\nA) It has good prognosis\nB) There are no receptors postitve for ER, PR and HER2 NEU\nC) It is a cancer that cannot be diagnosed by triple assessment\nD) Three Radiologic investigations ic CT scan, MRI and USG are needed for diagnosis", "output": "1, because Ans. is 'b' i.e., There are no receptors postitve for ER, PR and HER2 NEU o Triple-negative breast cancer refers to any breast cancer that does not express the genes for estrogen receptor (ER), progesterone receptor (PR) or Her2/neu. This makes it more difficult to treat since most chemotherapies target one of the three receptors, so triple-negative cancers often require combination therapies. Triple negative is sometimes used as a surrogate term for basal-like; however, more detailed classification may provide better guidance for treatment and better estimates for prognosis.o Triple-negative breast cancers comprise a very heterogeneous group of cancers. There are conflicting information over prognosis for the various subtypes but it appears that the Nottingham prognostic index is valid and hence general prognosis is rather similar with other breast cancer of same stage, except that more aggressive treatment is required. Some types of triple-negative breast cancer are known to be more aggressive with poor prognosis, while other types have very similar or better prognosis than hormone receptor positive breast cancers. Pooled data of all triple-negative subtypes suggest that with optimal treatment 20-year survival rates are very close to those of hormone positive cancer.o Triple-negative breast cancers have a relapse pattern that is very different from hormone-positive breast cancers: the risk of relapse is much higher for the first 3-5 years but drops sharply and substantially below that of hormonepositive breast cancers after that. This relapse pattern has been recognized for all types of triple-negative cancers for which sufficient data exists although the absolute relapse and survival rates differ across subtypes"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSingle skin lesion is seen in which type of leprosy -\nA) LL\nB) TT\nC) BL\nD) BT", "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 67 year old lady is brought in by her 6 children saying that she has gone senile. Six months after her husband's death she has become more religious, spiritual and gives lots of money in donation. She is occupied in too many activities and sleeps less. She now believes that she has a goal to change the society. She does not like being brought to the hospital and is argumentative on being questioned on her doings. The diagnosis is:-\nA) Depression\nB) Schizophrenia\nC) Mania\nD) Impulse control disorder", "output": "2, because Kindly don't get confused with the fact that the symptoms are following husband's death. Even negative life events can precipitate manic episode. This patient has increased religiosity, overspending, increased activity levels, decreased sleep, new interests and goals and lack of insight. All these symptoms are suggestive of mania."}

{"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 14 year old boy having lost his father a year ago, is caught shoplifting. The boy will be sent to -\nA) An orphanage\nB) An anganwari\nC) A prison\nD) A remand home", "output": "3, because parks textbook of preventive and social medicine 23rd edition * in remand homes ,the child is placed under the care of doctors,psychiatrists and other trained personnel.every effos is made to improve mental and physical well beiing of the child .elementary schooling is given,various as and crafts are taught,gaames are played and other recreational activites are arranged. *boys over16years who are too difficult to be handled in a ceified school or have misbehavedvthere are sent to brostal."}

{"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 important regulator of serum 1,25 (OH)2 vitamin D concentration is:\nA) Serum calcium\nB) Serum magnesium\nC) Serum 25 (OH) vitamin D\nD) Parathyroid hormone", "output": "3, because A major function of parathyroid hormone is to act as a trophic hormone to regulate the rate of formation of 1,25(OH)2 vitamin D. The mechanism by which parathyroid hormone exerts this effect may be secondary to its effects on phos\u00adphorus metabolism. Other hormones, including prolactin and estrogen, also may playa role in stimulating the production of 1,25(OH)2 vitamin D."}

{"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 tendons passes below the sustenticulum Tali -\nA) Tibialis Anterior\nB) Tibialis Posterior\nC) Flexor digitorum longus\nD) Flexor hallucis longus", "output": "3, because Tendon of flexor hallucis longus passes below sustenticulum tali."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHypercalcemia is NOT seen in -\nA) Primary hyperparathyroidism\nB) Tumour lysis syndrome\nC) Multiple sclerosis\nD) Sarcoidosis", "output": "1, because tumor lysis syndrome is characterized by hyperuricemia, hyperkalemia, hyper phosphate moa, and hypocalcemia .caused by destruction of large number of rapidly proliferating neoplastic cells.acidosis may develop.acute renal failure occur frequently. Hyperuricemia may be present at time of chemotherapy. The finding of uric acid crystals in urine is strong evidence for uric acid nephropathy. Hyperphospatemia caused by release of intracellular phosphate pools by tumor lysis , produce reciprocal depression in serum calcium (Harrison 17 pg 1736)"}

{"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 aspect in gold inlay and amalgam cavity design is\nA) Axiopulpal bevel\nB) Gingival bevel\nC) Occlusal bevel\nD) Axiofacial bevel", "output": "1, because The gingival bevel removes the unsupported enamel and compensates for casting shrinkage. It is a feature of resistance form. Reverse\u00a0bevel is given in inlay for lap sliding fit. It locks the restoration and prevents proximal displacement."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAtracurium is excreted by\nA) Renal excretion\nB) Hepatic elimination\nC) Nonenzymatic degradation\nD) All of the above", "output": "2, because Ans. is 'c' i.e., Nonenzymatic degradation The unique feature of atracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofmann elimination) in addition to that by alkaline ester hydrolysis. Consequently its duration of action is not altered in patients with hepatic / renal insufficiency or hypodynamic circulation Preferred muscle relaxant for such patients as well as for neonates and the elderly.o Atracurium is metabolised to laudanosine that is responsible for seizures. It can cause histamine release Hypotension & bronchoconstriction."}

{"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 water soluble vitamin is synthesized in our body -\nA) Niacin\nB) Folic acid\nC) Cobalamine\nD) Pyridoxine", "output": "0, because Ans. is 'a' i.e., Niacin o This question is confusing one (Read text below)o Niacin (Vitamin B3) is synthesized from tryptophan inside the bodo Some vitamins are also formed by bacterial activity in coloni) Vitamin Kii) Vitamin B12Thiamin (Vitamin Bl)iv) Riboflavin (Vitamin B2)v) Biotin (Vitamin B7)o Thus, options a, b & d all are correct here. But best answer among these is niacin as it is the only vitamin which is synthesized by proper anabolic metabolism."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nVision 2020-Right to sight by WHO targets all except: September 2009\nA) Cataract\nB) Trachoma\nC) Epidemic conjunctivitis\nD) Onchocerciasis", "output": "2, because Ans. C: Epidemic conjunctivitis VISION 2020 is the global initiative for the elimination of avoidable blindness, launched in 1999, jointly by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) with an international membership of NGOs, professional associations, eye care institutions and corporations."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCeruloderma is characterised by-\nA) Excess melanin in dermis , pigmentation not accentuated under Wood's lamp\nB) Excess melanin in basal and suprabasal layers, pigmentation accentuated under Wood's lamp\nC) Increased epidermal and dermal melanin\nD) Excess melanin in basal and suprabasal layers, pigmentation not accentuated under Wood's lamp", "output": "0, because Ceruloderma- Due to defect in migration of melanocyte. Melanocyte derived from neural crest and migrate to stratum basale (epidermis) Defect in migration of melanocytes due to which they remain in dermis Eg. Of Ceruloderma - 1. Mongolian spot 2. Nevus of OTA3. Nevus of ITO Clinical features - Dermis- Blue lesion - Don't become dark under wood's lamp . Blue d/t - Tyndall effect/optical effect i.e. paial scattering of light Most of light reflected back is blue in colour."}

{"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 mechanism of action of Enteropathogenic E.coli is -\nA) Adherance to enterocytes\nB) Stimulates adenyl cyclase\nC) Produces secretory diarrohea\nD) None of the above", "output": "0, because Ans. is 'a' i.e., Adherance to enterocytes . EPEC adheres to the mucosa of upper small intestine and causes disruption of the brush border microvilli. The name enteroadherent E. coli has been proposed for these strains, which can be indentified by their adhesion to HEP-2 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\nWhich of the following endocrine tumors is most commonly seen in MEN I\nA) Insulinoma\nB) Gastrinoma\nC) Glucagonoma\nD) Somatostatinoma", "output": "1, because Ans. is 'b' i.e., Gastrinoma"}

{"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 breech presentation:\nA) Contrcted pelvis\nB) Hydramnios\nC) Prematurity\nD) Oligohydramnios", "output": "2, because Prematurity"}

{"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 therapeutic uses of penicillin G, except\nA) Bacterial meningitis\nB) Rickettsial infection\nC) Syphilis\nD) Anthrax", "output": "1, because Ans. is 'b' i.e., Rickettsial infection Penicillin G is the DOC for 1. Meningococcal meningitis 7. Leptospira 2. Bacillus anthracis (anthrax) 8. Actinomyces israelii (Actinomycosis) 3. Clostridium perfringens (gas gangrene) 9. Borrel i a burgdorferi (Lyme disease) 4. Clostridium tetani (tetanus) 10. Enterococci 5. Corynebacterium diphtheriae 11. Streptococci 6. Treponema pallidum (syphilis) 12. Susceptible pneumococci"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA patient was on treatment with penicillin. He developed pallor but there was no shoness of breath, uicaria or wheezing. On investigation, antibodies against penicillin were found in his blood. What is the type of hypersensitivity reaction that most likely occurred in this patient?\nA) Type I hypersensitivity\nB) Type II hypersensitivity\nC) Type III hypersensitivity\nD) Type IV hypersensitivity", "output": "1, because Ans. b. Type II hypersensitivity"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHynes pharyngoplasty is used to improve a child's ?\nA) Appearance\nB) Teething\nC) Speech\nD) Feeding", "output": "2, because Ans. is 'c' i.e., Speech"}

{"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 HSP gross hematurea is seen in what % of children?\nA) 5 - 10%\nB) 10 - 20%\nC) 20 - 30%\nD) 30 - 40%", "output": "2, because Ans. is 'c' i.e., 20 - 30% Henoch-schonlein_purpura (HSP) Small vessel vasculitis Purpuric rash Ahritis Abdominal pain Glomerulonephritis Gross hematuria is seen in 20-30% of cases"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFeatures of Horner's syndrome include all of the following except-\nA) Miosis\nB) Ptosis\nC) Anhydrosis\nD) Exopthalmos", "output": "3, because There is enophthalmos (not exophthalmos)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFerritin biosynthesis is regulated by serum level of ?\nA) Ceruloplasmin\nB) Hepcidin\nC) Iron\nD) Transferrin", "output": "2, because Ans. is `c' i.e., Iron\"The level of iron in plasma is sensed by specific iron regulatory proteins which control the rate offerritin synthesis and to maintain homeostasis\" - Human physiologyHepicidin regulates absorption of iron. But, it is also according to the serum iron level. If serum iron is deficiem, hepacidin level falls and there is increased iron absorption."}

{"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 standard normal distribution\nA) Is skewed to the left\nB) Has variance = 1.0\nC) Has standard deviation = 0.0\nD) Has mean = 1.0", "output": "1, because Normal Distribution:\n\nIs also known as \u2018Gaussian distribution\u2019 or \u2018Standard distribution\u2019\nType of distribution: Is the distribution of values of a quantitative variable such that they are symmetric with respect to\u00a0a middle value with same mean, median and mode, and then the frequencies taper off rapidly and symmetrically on\u00a0both sides \u2013 \u2018bell shaped distribution\u2019."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSpanish windlass is practiced in Spain as a method of execution, it is a type of\nA) Bansdola\nB) Mugging\nC) Garrotting\nD) Hanging", "output": "2, because In Spanish Windlass, an iron collar is tightened by a screw for strangulation. It is an example of garrotting where the victim&;s throat may be grasped or a ligature is thrown over the neck & quickly tightened by twisting it with a lever, which result in sudden loss of consciousness & collapse Reff: The synopsis of forensic medicine & Toxicology 28th edition pg : 187"}

{"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 site for peripheral aneurysm is:\nA) Popliteal\nB) Profunda femoral\nC) Femoral\nD) External iliac", "output": "0, because Ans: A (Popliteal) Ref: Robbins Pathologic Basis of Disease, 8th edition & Harrison online Chapter 249.Explanation:\"Popliteal artery aneurysms are the most common peripheral artery aneurysms\".Popliteal Artery AneurysmPopliteal artery aneurysms are the most common peripheral artery aneurysms.Approximately 50% are bilateral.Associated with aneurysms of other arteries, especially the aorta.The most common clinical presentation is limb ischemia secondary to thrombosis or embolism.Rupture occurs less frequently.Other complications include compression of the adjacent popliteal vein or peroneal nerve.Popliteal artery aneurysm can be detected by palpation and confirmed by duplex ultrasonography.Repair is indicated for symptomatic aneurysms or when the diameter exceeds 2-3 cm. owing to the risk of thrombosis, embolism or rupture"}