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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\nAllen's test is used to diagnose:\nA) Thoracic outlet syndrome\nB) Palmar arch insufficiency\nC) Superior vena cava syndrome\nD) Coarctation of aorta", "output": "1, because Ref: Bailey and One's Short Practice of Surgery 25th EditionExplanation:Allen's testIt is a test for the patency of the radial artery after insertion of an indwelling monitoring catheter. The patient's hand is formed into a fist *nd the ulnar artery is compressedcompression continues while the fist is opened.If blood perfusion through the radial artery is adequate, the hand should Hush and resume its normal pinkish coloration.Adsonks testIt is the loss of the radial pulse in the arm by- rotating head to the ipsi lateral side with extended neck following deep inspiration.It is seen in thoracic outlet syndrome (TOS)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich is denatured collagen in humans?\nA) Gelatin\nB) Homocollagen\nC) Tropocollagen\nD) None", "output": "0, because heat denatured collagen is gelatin . REFERENCE; DM VASUDEVAN TEXTBOOK SEVENTH EDITION ; Page no;39"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIsoform of LDH in skeletal muscles ?\nA) LDH-1\nB) LDH-2\nC) LDH-3\nD) LDH-4", "output": "3, because Ans. is 'd' i.e., LDH-4"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFalse statement about lateral medullary syndrome?\nA) 5,7,nerve lesions\nB) I/L pain ,temperature loss of body\nC) I/L pain temperature loss of face\nD) 10 nerve palsy", "output": "1, because Lateral medullary syndrome also known as Wallenberg syndrome. Lateral medullary ischemia d/o ipsilateral veebral aery (in most cases) or PICA(in few cases) I/L Horner's + I/L sensory alternation of pain and temp on face (V nerve nucleus involvement) I/L Cerebellar ataxia (involvement of inferior cerebellar peduncle) C/L Alternation of pain and temp on body (Spinothalamic tract involvement) I/L Loss of taste (involvement of Nucleus tractus solitarious) Difficulty in speech and swallowing (involvement of Nucleus ambiguus)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nRate limiting step in cholesterol synthesis is:\nA) HMG CoA synthetase\nB) HMG CoA reductase\nC) Thiokinase\nD) Mevalonate kinase", "output": "1, because HMG CoA reductase"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nReinke's crystals are seen in?\nA) Leydig cells\nB) Sertoli cells\nC) Curschmann spirals\nD) Creola bodies", "output": "0, because Ans. (a) Leydig cellsRef: Bailey & Love 26th ed. /1341Rectangular, crystal-like inclusions, composed of protein, with pointed or rounded ends in the interstitial cells of the testis (Leydig cells) and hilus cells in the ovary. Inside the Leydig cells of human males can be found Reinkes crystals. The purpose of these crystals is uncertain, some believe that they are a by-product of a degenerative process related to aging. They appear to have no contribution to androgen or testosterone production, and they can be used to identify Leydig cells easily when viewing testicular tissue under a microscope"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDystrophic calcification is seen in ?\nA) Milk alkali syndrome\nB) Atheromatous plaque\nC) Hyperparathyroidism\nD) Vitamin A intoxication", "output": "1, because Ans. is 'b' i.e., Atheromatous plaqueDystrophic calcification o When pathological calcification takes place in dead, dying or degenerated tissue, it is called dystrophic calcification. o Calcium metabolism is not altered and serum calcium level is normal.Dystrophic calcification in dead tissues1.In caseous necrosis of tuberculosis(most common which may be in lymph nodes)2.Chronic abscess in liquifactive necrosis3.Fungal granuloma4.Infarct5.Thrombi6.Haematomas7.Dead parasites-Cystecercosis/Toxoplasma Hydatid/Schistosoma8.In fat necrosis of breast & other tissuesDystrophic calcification in degenerated tissuesAtheromatous plagueMonkeberg's sclerosisPsommama bodiesDens old scarsSenile degenrated changes such as in costal cailage, tracheal, bronchial rings, Pineal gland in brain.Hea valves damaged by rheumatic fever.How does calcification occurs in these site with normal serum calcium ?o Calcification of dead and dying cells and tissues is a common finding in human pathologic conditions. o Denatured proteins in dead or irreversible damaged tissues preferentially bind phosphate ions. o Phosphate ions react with calcium ions to form a precipitate or calcium phosphate.o Thus, necrotic tissue serves as a calcium sink."}

{"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 55-year-old woman present due to recent onset of chest pain and dyspnea. Six weeks prior, patient suffered MI. On physical examination, friction rub over 5th intercostal space in midclavicular line along with elevated JVP. What is the most likely cause of this presentation?\nA) Cardiac rupture syndrome\nB) Thromboembolism\nC) Dressler syndrome\nD) Ventricular aneurysm", "output": "2, because Dressler syndrome is an autoimmune phenomenon that result in fibrinous pericarditis. Fibrinous pericarditis is both an early and late complication of MI. The delayed pericarditis typically develops 2-10 weeks post MI and present clinically as chest pain and pericardial friction rub. It is generally treated with aspirin or coicosteroid. Cardiac arrythmia is a common cause of post MI death, typically occurring the first few days following the event. It is not associated with friction rub. Ventricular rupture is a serious cause of post MI death typically occurs 3-7 days after initial event. It can present with persistent chest pain, syncope and distended jugular veins."}

{"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 pressure at which oxygen is stored ?\nA) 75 psi\nB) 1600 psi\nC) 760 psi\nD) 2200 psi", "output": "3, because Oxygen is stored at a pressure of 1900psi"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following is false about varicocele\nA) Most common in left testis\nB) Causes infertility\nC) Treated by palomo procedure\nD) Present in old age patients", "output": "3, because It is common in young males.\nBag of worms consistency e is present on examination\nIt has high recurrence rate."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTesticular Feminization syndrome is characterised by all except\nA) Absent uterus\nB) Primary amenorrhea\nC) Normal breast\nD) Barr body present", "output": "3, because Karyotype in testicular feminization syndrome is 46 XY. Barr body is therfore absent."}

{"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 Periapical lesion that would most likely contain bacteria within the lesion is\nA) Periapical abscess\nB) Periapical cyst\nC) Periapical granuloma\nD) Condensing osteitis", "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\nFacial nerve exits the skull through\nA) Stylomastoid foramen\nB) Internal acoustic meatus\nC) Foramen Lacerum\nD) Foramen Rotundum", "output": "0, because Facial nerve enters the temporal bone through - Internal acoustic meatus Facial nerve exits the skull through - Stylomastoid foramen. Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 99"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA child presenting with clinical features of an endocrine abnormality showed epiphyseal dysgenesis in imaging studies. Epiphyseal dysgenesis is a pathognomonic feature of:\nA) Hypoparathyroidism\nB) Hyperparathyroidism\nC) Hypothyroidism\nD) Hypehyroidism", "output": "2, because Epiphyseal dysgenesis is radiological finding of hypothyroidism which is characterized by centers of ossification, especially of the hip, may show multiple small centers or a single stippled, porous, or fragmented center. Other radiological findings of hypothyroidism: Delayed bone age Cardiomegaly Thyrotrophic hyperplasia characterized by an enlarged sella or pituitary gland Ref: Zeitler P.S., Travers S.H., Nadeau K., Barker J.M., Kelsey M.M., Kappy M.S. (2012). Chapter 34. Endocrine Disorders. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e."}

{"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 statement regarding stones in the submandibular gland are true except: March 2008\nA) 80% of stones occur in the submandibular gland\nB) Majority of submandibular stones are radio-lucent\nC) Stones are the most common cause of obstruction within the submandibular gland\nD) Patient presents with acute swelling in the region of the submandibular gland", "output": "1, because Ans. B: Majority of submandibular stones are radio-lucent"}

{"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 90-year-old woman with mild diabetes and Alzheimer's disease die in her sleep. At autopsy, hepatocytes are noted to contain golden cytoplasmic granules that do not stain with Prussian blue. Which of the following best accounts for pigment accumulation in the liver of this patient?\nA) Advanced age\nB) Alzheimer disease\nC) Congestive hea failure\nD) Diabetic ketoacidosis", "output": "0, because The answer is A: Advanced age. Substances that cannot be metabolized accumulate in cells. Examples include:- (1) endogenous substrates that are not processed because a key enzyme is missing (lysosomal storage diseases) (2) insoluble endogenous pigments (lipofuscin and melanin) (3) exogenous paiculates (silica and carbon) Lipofuscin is a \"wear and tear\" pigment of aging that accumulates in organs such as the brain, hea, and liver. None of the other choices are associated with lipofuscin accumulation.Diagnosis: Aging, lipofuscin"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIliac crest graft should ideally be taken from\nA) Lateral aspect\nB) Medial aspect\nC) Posterosuperior aspect\nD) Antero inferior aspect", "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 lymphatic drainage from the tip of tongue first passes to:\nA) Submental nodes\nB) Supra clavicular nodes\nC) Sub mandibular nodes\nD) Superior deep cervical nodes", "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 following statements are related to clear cell carcinoma of the vagina except :\nA) Common to those whose mothers were given diethylstilbestrol during early pregnancy\nB) Vaginal adenosis may progress to this conditions\nC) The middle one-third is the commonest site\nD) May be multicentric and may involve even the cervix as well", "output": "2, because clear cell adenocarcinoma of vagina: Found in adolescent girls who have a history of intrauterine exposure to diethylstilbestrol Incidence following DES exposure is 1:1000 may develop vaginal adenosis lesion usually involves upper third of anterior vaginal wall and cervix may be involved Treatment: radical hysterectomy,vaginectomy with pelvic lymphadenectomy. D.C.DUTTA'S TEXTBOOKOF GYNECOLOGY,Pg no:339,6th 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\nA 55 years old smoking presents with history of five episodes of macroscopic hematuria each lasting for about 4-5 days in the past five years. Which of the following investigations should be performed to evaluate the suspected diagnosis?\nA) Urine microscopy and cytology\nB) X-ray KUB\nC) Ultrasound KUB\nD) DTPA scan", "output": "0, because Ans. (a) Urine microscopy and cytologyRef: Smith 17th Edition, Pages 308-315Diagnosis of Urinary bladder carcinoma:* Cystoscopy and transurethral resection is the IOC for obvious lesions.* Urinary cytology is the IOC for carcinoma in situ.* Cytological examination of exfoliated cells from tumor is useful in detecting cancer in symptomatic patients and assessing the response to treatment.* Cytological examination is also most useful to detect early recurrence* CT and MRI are used in stagingExfoliative markers:* NMP22 (Nuclear matrix protein 22)* Hyaluronidase* Lewis X ag* Telomerase activity"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nRight shift of oxygen dissociation curve is caused by?\nA) Hypothermia\nB) Hypoxia\nC) Alkalosis\nD) HbF", "output": "1, because Ans. is `b' i.e., Hypoxia"}

{"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 manifestation of congenital toxoplasmosis\nA) Deafness\nB) Chorioretinitis\nC) Hepatosplenomegaly\nD) Thrombocytopenia", "output": "1, because *Congenital toxoplasmosis is caused by toxoplasma gondi .The transmissibility increases but the risk of feral disease decreases with advancing pregnancy * The classical triad of toxoplasmosis includes intracranial calcification, hydrocephalus and chorioretinitis. Diagnosis is confirmed by demonstrating IgM in serum of the baby Image : Severe, active retinochoroiditis. Reference : Ghai essential pediatrics, 9 th edition, pgno :264"}

{"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 diagnostic procedure not done in case of ph eochromoc ytoma.\nA) CT scan\nB) MRI\nC) FNAC\nD) MIBG scan", "output": "2, because FNAC \"Percutaneous fine-needle aspiration of chromallin tumors is contraindicated; indeed, pheochronwcytoma should be considered before adrenal lesions are aspirated.\" -Harrison \"Catastrophic hypeensive crisis and fatal cardiac arrhythmias can occur spontaneously or may be triggered by intravenous contrast dye or glucagon injection, needle biopsy of the mass, anesthesia, and surgical procedures.\" -"}

{"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 necrosis occurs characteristically in brain infarcts?\nA) Caseous necrosis\nB) Fibrinoid necrosis\nC) Coagulative necrosis\nD) Liquefactive necrosis", "output": "3, because CNS parenchymal infarcts organize an influx of macrophages into the area of necrosis. The macrophages ingest the lipid-rich, necrotic parenchyma, ultimately conveing the area to a fluid-filled cavity (liquefactive necrosis). This process is usually complete by about 6 months after the development of the infarct."}

{"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 deltoid paralysis, which nerve is involved :\nA) Circumflex N\nB) Musculocutaneous N\nC) Axillary N\nD) Radial N", "output": "2, because C. i.e. Axillary nerve"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 41 year old woman presented with a history of aches and pains all over the body and generalized weakness for four years. She cannot sleep because of the illness and has lost her appetite as well. She has a lack of interest in work and doesn't like to meet friends and relatives. She denies feelings of sadness. Her most likely diagnosis is -\nA) Somatoform pain disorder\nB) Major depression\nC) Somatization disorder\nD) Dissociative", "output": "1, because This is a case of somatized (masked) depression which is a form of major depression in which the depressed patients may present their distress as somatic symptoms, e.g. chronic pain, anorexia (loss of appetite), insomnia (cannot sleep), paresthesia, atypical facial pain, and generalized weakness. Depressive mood is not easily apparent as it is usually hidden behind the somatic symptoms, (e.g. in this question she denies the feeling of sadness)."}

{"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'Tentative cuts' are seen with\nA) Homicide\nB) Suicide\nC) Culpicide\nD) Fabricated wounds", "output": "1, because Ans. b (Suicide) (Ref. FMT by N. Reddy 5th/pg.93)TENTATIVE (preliminary cuts) CUTS# Hesitation cuts derive their name from the hesitation with which these incisions are made by a person intending to commit suicide by a cutting instrument.# He or she usually makes preliminary cuts before gathering sufficient courage to make final deep incision.# These are generally small, multiple, superficial, and usually skin deep.# They are seen with commencement of the incised wound and merge with the main incision."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following is FALSE about SOMATIZATION Syndrome -\nA) Involves 2 sexual disturbance Symptoms\nB) Two GI symptoms\nC) Four pain symptoms\nD) Multiple recurrent symptoms", "output": "0, because Ans. is 'a' i.e., Involves 2 sexual disturbance Symptomso For diagnostic criteria at least 1 sexual symptom should be there (not two),o All other diagnostic criteria (other three options) are true.Somatization disordero The essential features of somatization disorder are multiple recurrent somatic symptoms of long duration (chronic) that are caused by psychological basis and no physical illness can be found,o The disorder begins before the age of 30 years and then has a chronic course (over a period of several years).Diagnostic criteria for somatization disordero Each of the following should be present: -Four pain symptoms: - Pain, at least at four different sites or functions - Head (headache), abdomen, back, joint, extremites, chest, rectum, during mensturation or sexual intercourse or urination.Two gastrointestinal symptoms : - Nausea, bloating, vomiting, diarrhea.One sexual symptom : - Erectile dysfunction ( Impotence), ejaculatory dysfunction, irregular menses, excessive menstural bleeding.One pseudoneurological symptom : - Conversion symptoms (impaired coordination or balance, paralysis, weakness, blindness, deafness, glove & stocking anesthesia. Paresthesia, seizure, aphonia); Dissociative symptoms (amnesia); loss of consciousness."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCoagulation defect associated with increased coagulation are seen in\nA) Increased protein C\nB) Increased protein S\nC) Increased anti thrombin 3\nD) Protein C resistance", "output": "3, because Ref Harrison 16/e p1491 ,9/e p123 Protein C and protein S are two vitamin K-dependent proteins that act in a complex to proteolytically inacti- vate cofactors Va and VIIIa. Protein C activation by thrombomodulin was described earlier; protein S is a cofactor for protein C activity Resistance to activated protein C due to the factor V R506Q (Leiden) mutation is the most common clotting abnormality in patients with venous thromboembolism"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPatient with leprosy, smear sample taken show 10 - 100 bacilli in one field. Bacterial index is ?\nA) 1+\nB) 2+\nC) 3+\nD) 4+", "output": "3, because Ans. is 'd' i.e., 4+ Bacteriological Index For Leprosy It is a rough index expressing probable number of acid fast bacilli for standardized microscopic field in skin smear. It is indicative of the load of bacteria at the site from which smear is taken. It does not differentiate between live and dead bacilli. It is not an indication of total bacillary load in the body. Ridleys scale is followed to calculate the bacterial index. = no bacilli in 100 fields 1+ = 1 - 10 bacilli in 100 fields 2+ = 1 - 10 bacilli in 10 fields 3+ = 1 - 10 bacilli in 1 fields 4+ = 10 - 100 bacilli in 1 field 5+ = 100 - 1000 bacilli in 1 field 6+ = >1000 bacilli in 1 field. Our patient has 10 - 100 bacilli in 1 field thus the bacteriological index is - 4+"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nEnteroviruses are associated with all of the following, EXCEPT:\nA) Aseptic Meningitis\nB) Pleurodynia\nC) Herpangina\nD) Hemorrhagic fever", "output": "3, because Acute hemorrhagic fever is not caused by the enteroviruses. It usually causes non specific febrile illness, hand foot mouth disease, Herpangina, coryza, conjunctivitis, pericarditis, myocarditis, gastrointestinal symptoms and neurological symptoms. Ref: Kliegman, Behrman, Jenson, Stanton (2008), \"Nelson Textbook of Pediatrics\", Chapter 247, \"Nonpolio Enteroviruses\", Volume 1, Page 1350; Medical Microbiology By Jawetz , 24th Edition, Page 494; Harrison's Principle of Internal Medicine, 17th Edition, Page 1208"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThe commonest type of Pemphigus is\nA) Pemphigus vulgaris\nB) Pemphigus foliaceous\nC) Pemphigus erythematous\nD) Pemphigus vegetans", "output": "0, because Pemphigus vulgaris is the most common form of pemphigus and occurs when antibodies attack Desmoglein 3. Usually begins with painful blisters in your mouth and then on the skin or genital mucous membranes. Ref Harrison20th edition pg 1334"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nUnder-running may involve:\nA) Crush injury abdomen\nB) Run over injury\nC) Decapitation\nD) Chest injury", "output": "2, because Under-running/ tail gating Tail-gating occasionally occurs with cars driving into the back of large trucks. In such case, the windscreen and front of the passenger compament are smashed with severe injuries to the head and in some cases decapitation of the occupants of the front seat. Also seen where the motorcyclist drives under the rear of the truck, causing head injuries and even decapitation."}

{"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 branches originate directly from the subclavian artery, except\nA) Vertebral\nB) Thyro-cervical trunk\nC) Internal Thoracic\nD) Supra scapular", "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\nThe highest quantity of lipid and lowest concentration of protein are found in\nA) Chylomicrons\nB) Very low density lipoproteins\nC) Low density lipoproteins\nD) High density lipoproteins", "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\nA young tourist presents with a skin lesion after being to Rajastan. He presents with an erythematous lesion on the cheek with central crusting. What is the likely dermatological condition?\nA) Cutaneous Leishmaniasis\nB) Systemic Lupus Erythematosis\nC) Lupus vulgaris\nD) Chilblains", "output": "0, because A typical lesion of Acute Cutaneous Leishmaniasis is papule at the site of the sand fly bite which enlarges and breaks down in the centre. The ulcer usually has a rolled border. When the lesion heals in a year's time it leaves a distinctive depressed hyper pigmented scar. The typical sites are cheeks and arms (exposed areas). Localised Cutaneous Leishmaniasis (LCL) is seen in India in the forests of Rajastan, caused mostly by Leishmania tropica. Himachal Pradesh is repoed as a recent focus. Ref: Thieme Clinical Companions Dermatology By Wolfram Sterry, Ralf Paus, Walter H. C. Burgdo; Leishmania: After the Genome By Peter J. Myler, Nicolas Fasel, Pages 2-3."}

{"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 association is true regarding facial nerve palsy in temporal bone fractures?\nA) Common with Longitudinal fractures\nB) Common with Transverse Fracture\nC) Always associated with CSF Otorrhea\nD) Facial nerve injury is always complete", "output": "1, because Longitudinal fractures of Temporal bone are more common than transverse fracture but, facial nerve injury is most commonly associated with Transverse fracture of the temporal bone."}

{"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 1-year-old female infant has failure to thrive, poor neurologic development, and poor motor function. Physical examination shows a \"cherry red\" spot on the macula of the retina. The infant's muscle tone is poor. Both parents and a brother and sister are healthy, with no apparent abnormalities. One brother with a similar condition died at the age of 18 months. This genetic disorder most likely resulted from a mutation involving a gene encoding for which of the following?\nA) Mitochondrial enzyme\nB) Lysosomal enzyme\nC) Cell surface receptor protein\nD) Structural protein", "output": "1, because The findings listed suggest a severe inherited neurologic disease, and the pattern of inheritance (e.g., normal parents, an affected sibling) is consistent with an autosomal recessive disorder. This inheritance pattern and the cherry red spot in the retina are characteristic of Tay-Sachs disease, caused by mutations in the gene that encodes a lysosomal enzyme hexosaminidase A. Mitochondrial genes have a maternal pattern of transmission. Mutations in genes affecting receptor proteins and structural proteins typically give rise to an autosomal dominant pattern of inheritance."}

{"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 prolactinoma most common symptom other than galactorrea is?\nA) Bitemporal hemianopia\nB) Amennorhea\nC) Thyroid dysfuntion\nD) Headache", "output": "1, because Pituitary tumors 1.Eosinophil (Acidophil) adenomas: Tumour is usually small. Rarely it causes compressive features. It secretes excess growth hormone causing acromegaly in adults and gigantism in children. 2. Chromophobe adenomas are common in females and in the age group--20-50 years. Initially, it is intrasellar and after sometime becomes suprasellar. Later, it extends intracranially often massively, causing features of intracranial space occupying lesion. It presents with myxoedema, amenorrhoea, infeility, headache, visual disturbances, bitemporal hemianopia, blindness, intracranial hypeension, epilepsy. Differential diagnosis: Meningiomas, aneurysms. CT scan, angiogram, X-ray skull are diagnostic. Treatment is surgical decompression by craniotomy through subfrontal approach or trans-sphenoidal approach. Deep external radiotherapy and steroids are also used. 3. Basophil adenomas are usually small. They secrete ACTH and presents as Cushing's disease with all its features. 4. Prolactin-secreting adenomas causes infeility, amenorrhoea and galactorrhoea. Ref: SRB's Manual of Surgery 5th Pgno : 1105"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nLens develops from.\nA) Neuroectoderm\nB) Surface ectoderm\nC) Mesoderm\nD) Neural crest", "output": "1, because Ans. (b) Surface ectodermSurface EctodermNeural EctodermMesodermNeural Crest* Conjunctival Epithelium* Corneal Epithelium* Lacrimal gland* Tarsal gland* Lens* Smooth muscle of Iris* Iris Epithelium* Ciliary Epithelium* Retina & its pigment epithelium* Optic nerve fibre* Part of vitrous* EOM* Sclera* Iris* Vascular endothelium* Choroid* Part of vitrous* Corneal stroma* Ciliary ganglion* Schwann cell* Uveal and conj melanocytes* Meningeal sheath of ON* Part of vitrous"}

{"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 lower lip gets its sensory supply through the:\nA) Buccal branch of the facial nerve\nB) Buccal branch of the mandibular nerve\nC) Mandibular branch of the facial nerve\nD) Mental nerve", "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\nRough, poorly polished areas of pontics may cause\nA) Halitosis\nB) Discomfort\nC) Chronic inflammation of the ridge tissue\nD) All of the above", "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\nManoeuvre carried out for diagnosing medial meniscus injury is: March 2010, March 2013 (c, d)\nA) McMurray's test\nB) Lachmann's test\nC) Valgus stress test\nD) Varus stress test", "output": "0, because Ans. A: McMurray's Test McMurray's test is performed for meniscus injury For medial meniscus: Patient lying flat (non-weight bearing), the knee is completely flexed. The foot is rotated externally and the leg abducted. The joint is now slowly extended keeping the leg externally rotated and abducted. As the torn cailage gets caught during this manoeuvre, the patient will experience pain or a click may be heard and felt."}

{"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 young boy came with dyspnea and was found to have a mediastinal mass. Which of the following is known to produce mediastinal lymphadenopathy?\nA) Diffuse large B cell Lymphoma\nB) B cell rich T cell lymphoma\nC) Mediastinal rich B cell lymphoma\nD) T cell Lymphoblastic ALL", "output": "3, because mediastinal lymphadenopathy ,sternal tenderness and mediastinal mass are seen with ALL."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOnly male are affected in\nA) Scheie's syndrome\nB) Hunter's syndrome\nC) Hurler's syndrome\nD) Gaucher's disease", "output": "1, because Hunter's syndrome belongs to Type II mucopolysaccharidoses in which mucopolysaccharides accumulate in the lysosomes causing disorganization of the cell structure & function.This syndrome is characterised by mild mental retardation;marked skeletal changes like thickening of the skull,marked deformity of sella tursica,broad spatula like ribs,beak shaped veebrae(around L1 veebra) and proximal tapering of metacarpals-these abnormalities are referred to as dysostosis multiplex;coarse facies & hepatosplenomegaly. Reference:Essential pediatrics-Ghai,8th edition,page no: 660,661."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAdoptive immunity is by?\nA) Infection\nB) Injection of antibodies\nC) Injection of lymphocytes\nD) Immunization", "output": "2, because Aadoptive immunity: a special type of immunisation is the injection of immunologically competent lymphocytes. - instead of whole lymphocytes, an extract of immunologically competent lymphocytes, known as the transfer factor can be used. Reference: Anathanarayan & paniker's 9th edition, pg no:84 <\\p>"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 41 y/o male presents with complaints of inability to achieve proper erections during sexual intercourse. He repos that there were no abnormalities till last month, when on one occasion he tried having sex with wife while he was drunk. He was not able to achieve a proper erection at that time and since than, on four other occasions , he was not able to have an erection during attempted sex. He repos that his morning erections are fine and erection during masturbation was also normal. He is a diabetic, and the blood repos show, FBS-103 mg/dl, HbA1C- 6.6. His BP was 138/88 mm Hg What is the likely cause of erection disturbances?\nA) Anxiety\nB) Diabetes\nC) Alcohol\nD) Hypeension", "output": "0, because History of sudden onset, normal morning erections and normal erection during masturbation is suggestive of Psychogenic Erectile dysfunction. The cause is usually performance anxiety. To differentiate between psychogenic and organic erectile dysfunction best test is ask for nocturnal / early morning erections as patient is relaxed in these conditions. So in the above case it rules out all organic causes."}

{"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 can cause hypersecretion of prolactin, except?\nA) Prolactinoma\nB) Haloperidol\nC) Hypothyroidism\nD) Cabergoline", "output": "3, because The function of dopamine is to supress the prolactin secretion. Prolactin agonists reduce secretion of prolactin and antagonists increase the secretion of prolactin. Cabergoline is a long acting dopamine agonist. The drug suppresses prolactin secretion. Used to treat prolactinoma. All others can cause increased secretion. High prolactin levels are also associated with Hypothyroidism."}

{"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 10 years boy presented with sensory neural deafness not benefited with hearing aid, Next treatment is\nA) Cochlear implant\nB) Fenestromy\nC) Stapedectomy\nD) Stapes fixation", "output": "0, because A. i.e. (Cochlear implant) (125- Maqbool 11th) (121- Dhingra 4th)COCHLEAR IMPLANT - is indicated in patients with bilateral severe sensorineural deafness who do not respond to amplified sound stimuli* Cochlear implants are more useful in post lingually deaf patients i.e. who lost their hearing after acquisition of language* Stapedectomy with prosthesis replacement is the treatment of choice for otosclerosis*** Pathway for extension of the infection from meninges to labyrinth - Cochlear aqueduct*** **Cochlear implants electrodes are most commonly placed at cochlea to directly stimulate the fibre of VIII. nerve"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 15-year-old boy complains of right-sided weakness and gait impairment. A CT scan shows a large, non-enhancing cyst in the posterior cranial fossa, with an enhancing tumor nodule in the left cerebellum. What is the most likely diagnosis?\nA) An arachnoid cyst\nB) A cystic astrocytoma\nC) Rathke's cleft cyst\nD) Glioblastoma multiforme", "output": "1, because Cystic astrocytoma's are neoplasms of the CNS. They usually consist of a large, non-enhancing cyst on the wall of which is an enhancing tumor nodule. They are most commonly found within the substance of the cerebellar hemispheres of children and young adults. A Rathke's cleft cyst is a remnant of the embryologic Rathke's pouch. These are found within the sella turcica."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nKetamine produces ?\nA) Emergence delirium\nB) Pain on injection\nC) Bronchoconstriction\nD) Depression of cardiovascular system", "output": "0, because Ans. is 'a' i.e., Emergence delirium Ketamine The primary site of action is in the coex and subcoical areas; not in the reticular activating system (site of action of barbiturates). It acts on NMDA receptors. Sho duration of action (10-15 minutes) is due to redistribution from brain and blood to other tissues of the body. Ketamine is different from most other anaesthetic induction agents in that it has significant analgesic action. Ketamine increases IOT and cerebral metabolism --> contraindicated in head injury. It causes sympathetic stimulation with elevation of HR, CO & BP --) contraindicated in hypeension and ischemic hea disease. It also raises IOT --> contraindicated in glaucoma. It relieves bronchospasm --> intravenous anaesthetic of choice in asthmatics (inhalation anaesthetic of choice in asthmatic is halothane). Injection is not painful (All other inducing agents cause pain on injection). It is i.v. anaesthetic of choice in children (Sevoflurane is inhalation agent of choice). Because it causes sympathetic stimulation it is intravenous anaesthetic of choice in patients with shock and hypovolumia. It has no muscle relaxant propey rather muscle tone is increased. Airway reflexes (pharyngeal and laryngeal) are not depressed --> intravenous anaesthetic of choice for emergency anaesthesia (no starvation is required). Ketamine produces emergence reaction during awakening from anaesthesia --> vivid dreaming, illusions, extracorporeal experiences, excitment, confusion, fear and euphoria --> contraindicated in psychiatric illness like schizophrenia."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nSplenectomy is done to tide over the acute crises of uncontrollable:\nA) ITP\nB) TTP\nC) HUS\nD) All of the above", "output": "0, because Indications of splenectomy in ITP: Failure of medical therapy Prolonged use of steroids with undesirable effects Most cases of first relapse Splenectomy provides a permanent response without subsequent need for steroids in 75-85% of patients. Laparoscopic splenectomy has become the gold standard for ITP patients. Responses usually occur within the first postoperative 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\nOsteoahritis not seen in ?\nA) Ankle joints\nB) Knee joints\nC) Hip joints\nD) I stmetacarpophalangeal joint", "output": "0, because Ans. is 'a' i.e., Ankle joints OA affects ceain joints, yet spares others. Commonly affected joints include the cervical and lumbosacral spine, hip, knee, and first metatarsal phalangeal joint (MTP). In the hands, the distal and proximal interphalangeal joints and the base of the thumb are often affected. Usually spared are the wrist, elbow, and ankle. Our joints were designed, in an evolutionary sense, for brachiating apes, animals that still walked on four limbs. We thus develop OA in joints that were ill designed for human tasks such as pincer grip (OA in the thumb base) and walking upright (OA in knees and hips). Some joints, like the ankles, may be spared because their aicular cailage may be uniquely resistant to loading stresses."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCompared with cow's milk, mother's milk has more-\nA) Lactose\nB) Vitamin D\nC) Proteins\nD) Fat", "output": "0, because Ans. is 'a' i.e., Lactose Lactose (g) Cow's milk 4.4 Human milk 7.4 Proteins (g) 3.2 1.1 Fat (g) 4.1 3.4 Calcium (mg) 120 28 Iron (mg) 0.2 1.0 Water (g) 87 Energy (Kcal) 67 65"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nCharacteric finding in restrictive lung disease is:\nA) Decreased FEV1\nB) Increased TLC\nC) Normal FEV1/VC\nD) All", "output": "2, because Ans. c (Normal FEV, /Vc). (Ref. Harrison, Principles of Medicine, 18th/1448)OBSTRUCTIVE PATTERNRESTRICTIVE PATTERN (Al 2005)EXTRAPARENCHYMAL PATTERN (INSPIRATORY DYSFUNCTION)Decreased expiratory flow rates (hallmark)Normal forced expiratory flow ratesExpiratory flow rates not affectedDecreased FEV1/VC (in fully established disease)-FEVl/FVC variableTLC normal or increased (Minor change)Decreased lung violume (TLC and VC)TLC not predictableIncreased residual volume (striking)Decreased residual volumeIncreased RVIncresed ratio of RV/TLC--Decreased VC-Decreased MIP"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDown beat nystagmus is seen in?\nA) Arnold chiari malformation\nB) Brain stem damage\nC) Pontine hemorrhage\nD) Labyrinthine damage", "output": "0, because Ans. is 'a' i.e., Arnold chiari malformation Down-beat nystagmus are seen in cerebellar lesion and Arnold-chiary malformation"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following is not true for ZollingerEllison syndrome: September 2008\nA) Recurrence after operation\nB) Reduced BAO : MAO ratio\nC) Gastrin producing tumour\nD) Diarrhoea may be a presenting feature", "output": "1, because Ans. B: Reduced BAO : MAO ratio Zollinger-Ellison syndrome (ZES) is a rare condition characterized by peptic ulcers that are refractory to conventional medical therapy. Gastrin-producing tumors or gastrinomas cause excessive gastric acid secretion, leading to ulcers of the upper GI tract, as well as diarrhea and severe abdominal pain. Laboratory studies to confirm the diagnosis of ZES include the following: Measurements of fasting serum gastrin levels - Gastrin levels higher than 100 pg,/mL are highly suggestive of ZES. If the gastric pH level is less than 2.5, a gastrin level of higher than 1000 pg/mL is diagnostic of ZES. If the patient is not receiving acid-suppressing medication and the gastric pH levels are higher than 2, ZES can be ruled out. Secretin stimulation test After blood to measure the basal gastrin level is obtained, 2 IU/kg of secretin is intravenously administered. Blood is obtained at 2.5 minutes, 5 minutes, 10 minutes, 15 minutes, and 30 minutes. An increase of serum gastrin levels to higher than 200 pg/mL is diagnostic of ZES. - It is the most impoant diagnostic test to exclude other conditions with increased acid secretion, hypergastrinemia, or both. - Clinical conditions in which patients present with hypergastrinemia, such as gastric outlet obstruction, pernicious anemia, renal failure, and achlorhydria due to atrophic gastritis, must be excluded with secretin provocative testing. Measurement of basal acid output - Before measurement of the basal acid output (BAO), acid-inhibitory agents must be discontinued: 24 hours for H2 receptor antagonists and 7 days for proton pump inhibitors (PPIs). - In the 24 hours prior to the test, the patient receives antacids. - In an unoperated stomach, a BAO of more than 15 mEq/h is diagnostic of Zollinger-Ellison syndrome. If the patient underwent gastric resection for acid reduction, a BAO of more than 10 mEq/h is diagnostic for Zollinger-Ellison syndrome. If the patient has multiple endocrine neoplasia type 1 (MEN-1), other laboratory abnormalities may be suggestive of Zollinger-Ellison syndrome. - High plasma calcium levels High parathyroid hormone (PTH) levels - High prolactin levels"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are seen in Malignant hyperthermia except :\nA) Bradycardia\nB) Hyperkalemia\nC) Metabolic acidosis\nD) Hypertension", "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\nEdman's reagent is -\nA) 2-4 dinitrophenol\nB) 1 -fluoro-2, 4-dinitrobenzene\nC) Phenyl-isocyanate\nD) Cynogen bromide", "output": "2, because Ans. is 6c' i.e., Phenyl-isocyanateo Determination of amino acid sequence (sequence analysis) is performed by Edman degradation method on automatic mechines, called cyclic sequentors. Edman's reagent is phenyl-isothiocyanate, and forms a covalent bond to N- terminal of amino-acid. This can be identified.o Sanger's reagent (l-fluoro-2,4-dinitrobenzene) can be used in place of Edman's reagent."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFarmer presents with the features of high fever, painful inguinal lymphadenopathy, vomiting and diarrhea and 'Ivpotension. Which stain will help in the diagnosis\nA) Neisser stain\nB) Wayson's stain\nC) Albe's stain\nD) McFadyean's stain", "output": "1, because Ans. b. Wayson's stain Farmer presents with the features of high fever, painful inguinal lymphadenopathy, vomiting and diarrhea and hypotension. This clinical picture is suggestive of Bubonic plague. Bubonic plague Bubonic plague symptoms can occur within two to six days of being infected by the bacteria Yersinia pestisdeg. If left untreated, symptoms, such as vomiting, abdominal pain, and diarrhea, can progress rapidly to septicemic plaguedeg. Approximately 10 to 20 percent of people with bubonic plague symptoms will also develop symptoms in the lungs. This is called pneumonic plague, and is often fataldeg. Plague Caused by bacteria Yersinia pestisdeg. Animal reservoir for Yersinia pestis: Rodentsdeg Vector: Rat flea (Xenopsylla cheopsisdeg) carries infection from rat to rat and rat to humans Characterized by rapid onset of fever and other systemic manifestations of Gram (-)ve bacterial infections. It is of Bubonic Plague Incubation period 2-7 daysdeg MC type of plague and almost always caused by bite of infected fleadeg. MC site of bubo- femoral, inguinal regiondeg >axillary, cervical. Distinguished from lymphadenitis by its rapid onset, its extreme tenderness, accompanying signs of toxemia and absence of cellulites or obvious ascending lymphadenitis DIC is common and may lead to gangrenedeg. Y. pestis can also be cultured from blood of most bubonic plague patientdeg. Septicemic Plague: Often present with GI symptoms, DIC, multiorgan failuredeg Incubation period 2-7 days Pneumonic Plague Most infectious, most fatal type of plague with incubation period of 1-3 daysdeg Primary pneumonia: Cyanosis is very prominent, with bloody mucoid sputumdeg Secondary pneumonia: Diffuse interstitial pneumonia, less infectious. Diagnosis Yersinia pestis is best demonstrated by polychromatic stains (Wayson, Wright-Giemsadeg). These polychromatic stains accurately highlight bipolar stainingdeg characteristics of these gram negative bacilli"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nArea of Cornea indented in Goldman Applanation tonometer for measuring IOP\nA) 3.66mm\nB) 3.6mm\nC) 3.0mm\nD) 3.06mm", "output": "3, because Area of Cornea indented in Goldman Applanation\u00a0 tonometer\u00a0 for measuring IOP is 3.06mm."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nNot used in the treatment of Juvenile Larynegeal papillomatosis\nA) INF \u03b1\nB) INF \u03b2\nC) Bevacizumab\nD) Cedofovir", "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 commonest extradural spinal tumour is ?\nA) Neurofibroma\nB) Glioma\nC) Meningioma\nD) Metastasis", "output": "3, because Ans. is 'd' i.e., Metastasis"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nCauses of acute flaccid paralysis -\nA) Poliomyelitis\nB) Tick paralysis\nC) ADEM\nD) All of the above", "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 45 year old woman presents with a hard and mobile lump in the breast. Next investigation is -\nA) FNAC\nB) USG\nC) Mammography\nD) Excision biopsy", "output": "0, because Ans. is 'a' i.e., FNAC In any patient with a breast lump or other symptoms suggestive of carcinoma, diagnosis should be made by a combination of : 'Triple Assessment' : a. Clinical assessment b. Radiological imaging c. Tissue sampling for either cytological or histological examination. FNAC is more than often the first investigation for a tissue assessment. Bailey writes ? \"FNAC is the least invasive technique for obtaining a cell diagnosis and is very accurate if both operator and cytologists are experienced. However false negatives do occur, mainly through sampling error, and invasive cancer cannot be distinguished from 'in situ' disease. A histological specimen taken by core biopsy allows a definitive preoperative diagnosis, differentiates between duct carcinoma in situ (DCIS) and invasive disease and also allows the tumor to be stained for receptor status. This is impoant before commencing neoadjuvant therapy.\""}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPrimary Regulator for central chemoreceptor -\nA) PaCO2\nB) PCO2\nC) H+\nD) O2", "output": "2, because Ans. is 'c' i.e., H+ Central chemoreceptors o These receptors are located in a chemosensitive area on the ventral surface of the medulla near the exit of the ninth and tenth cranial nerves. The primary stimulus for the central chemoreceptors is an increase in the hydrogen ion concentration. Stimulation of central chemoreceptors by increased hydrogen ion concentration leads to excitation of the respiratory neurons, thereby producing an increase in the rate and depth of respiration o Although the primary stimulus for central chemoreceptors is an increase in hydrogen ion concentration, in actual practice the physiological stimulus is an increase in PCO2. The reason is that hydrogen ions cannot cross the blood-brain barrier. Therefore, a change in the blood hydrogen ion concentration does not change the hydrogen ion concentration in the immediate vicinity of the chemosensitive neurons (i.e., in CSF and brain interstitial fluid). On the other hand, CO2 being lipid soluble can easily cross the blood-brain barrier. It enters the brain, where it is hydrated to give rise to H+ and HCO2 ions. Now these H+ directly stimulate the central chemoreceptors. o Thus, central chemoreceptors are directly stimulated by an increase in H+ concentration in CSF and brain interstitial tissue, which is brought about by the change in arterial PCO2 (PaCO2). o Change in CSF & Brain interstitial tissue - | H+ concentration (Primary direct stimulus) o Change in Blood - | PCO2 (Actual physiological stimulus). o Central chemoreceptors are not stimulated by hypoxia; rather like any other cells, they are depressed by hypoxia."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThe commonest cause of primary Amenorrhoea is:\nA) Genital tuberculosis\nB) Ovarian dysgenesis\nC) Mullerian duct anomalies\nD) Hypothyroidism", "output": "1, because Most common cause of Primary Amenorrhea = Gonadal dysgenesis/ovarian dysgenesis\n2nd most common cause of Primary Amenorrhea = Mullerian agenesis (Mayer Rokitansky Kuster Hauser Syndrome)\u00a0\n\n\u201cMullerian agenesis is a relatively common cause of primary amenorrhea, more frequent than congenital androgen insensitivity and second only to gonadal dysgenesis\u201d\n\n\u00a03rd most common cause is testicular feminizing syndrome."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll the following types of hypersensitivity reactions can be demonstrated by skin test except ?\nA) Type I\nB) Type II\nC) Type III\nD) Type IV", "output": "1, because Ans. is 'b' i.e., Type II Has been explained"}

{"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 these hormones use cAMP as second messenger except:\nA) Corticotropin\nB) Dopamine\nC) Glucagon\nD) Vasopressin", "output": "3, because Ans. (D) Vasopressin(Ref: Katzung 11/e p301, Gationg 22/e p41-43)Vasopressin acts via V1 and V2 receptors. V1 receptors use IP3 -DAG-Ca2+ pathway whereas V2 use cAMP as second messenger. All other drugs mentioned in the question act by cAMP pathway only. Thus, all of these use cAMP as second messenger, but if we need to choose one option we can answer vasopressin as it is acting through IP3 -DAG-Ca2+ pathway also."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAn elderly multigravida female presents in labor. She has multiple fibroids in lower uterine segment. Management is:\nA) Vaginal delivery\nB) Trial of labor\nC) LSCS\nD) Classical cesarean followed by hysterectomy", "output": "3, because Ans. is d, i.e. Classical cesarean section followed by hysterectomySince this female is multigravida with multiple fibroids in lower uterine segments - vaginal delivery is not possible as multiple fibroids are present in lower uterine segment. We will have to do cesarean - but LSCS is also not feasible due to fibroids in lower segment (a lot of bleeding will occur if we cut through fibroid). Hence classical cesarean section should be done. The treatment of multiple fibroids in a multipara is hysterectomy, so classical cesarean section should be followed by hysterectomy)."}

{"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 post-operative patients must be supplemented with\noxygen concentration of at least\n:\nA) 50-60%\nB) 40-45%\nC) 30-35%\nD) 20-25%", "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\nMicrofalaria in Culex depicts what kind of Biological transmission?\nA) Cyclo-developmental\nB) Cyclo-propagative\nC) Developmental\nD) Propagative", "output": "0, because Microfalaria in culex is an example of cyclo-developmental transmission. In Culex mosquito, it undergoes only development. stages will change There is no multiplication taking place in it. TYPES OF BIOLOGICAL TRANSMISSION- Propogative transmission Cyclo-developmental Cyclo-propogative"}

{"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 extra-ocular muscles are supplied by the oculomotor nerve except\nA) Superior rectus\nB) Inferior oblique\nC) Lateral rectus\nD) Medial rectus", "output": "2, because The superior oblique is supplied by the trochlear nerve The lateral rectus is supplied by abducent nerve The superior rectus, inferior rectus, medial rectus and inferior oblique are supplied by occulomotor nerve Ref BDC volume 3,sixth edition pg 208"}

{"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 chemical mediator of inflammation is an example of a C-X-C or alpha chemokine\nA) Lipoxin LXA4\nB) Interleukin IL8\nC) Interleukin IL 6\nD) Monocyte chemo attractant protein MPC1", "output": "1, because Ref Robbins 9/e p87 IL-8, also known as neutrophil chemotactic factor, has two primary functions. It induces chemotaxis in target cells, primarily neutrophils but also other granulocytes, causing them to migrate toward the site of infection. IL-8 also stimulates phagocytosis once they have arrived. IL-8 is also known to be a potent promoter of angiogenesis. In target cells, IL-8 induces a series of physiological responses required for migration and phagocytosis, such as increases in intracellular Ca2+, exocytosis (e.g. histamine release), and the respiratory burst. IL-8 can be secreted by any cells with toll-like receptors that are involved in the innate immune response. Usually, it is the macrophages that see an antigen first, and thus are the first cells to release IL-8 to recruit other cells. Both monomer and homodimerforms of IL-8 have been repoed to be potent inducers of the chemokine receptors CXCR1 and CXCR2. The homodimer is more potent, but methylation of Leu25 can block the activity of homodimers."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEpidural anaesthesia is preferred over spinal anaesthesia because: September 2006\nA) Prolonged duration of effect\nB) Cheaper\nC) Less incidence of intravascular injection\nD) Less incidence of epidural hematoma", "output": "0, because Ans. A: Prolonged duration of effect Epidural anaesthesia, a form of regional anaesthesia involving injection of drugs through a catheter placed into the epidural space. The injection can cause both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord The anaesthetist may use epidural analgesia in addition to general anaesthesia. This may reduce the patient's requirement for opioid analgesics. This is suitable for a wide variety of surgery, for example gynaecological surgery (e.g. hysterectomy), ohopaedic surgery (e.g. hip replacement), general surgery (e.g. laparotomy) and vascular surgery (e.g. open aoic aneurysm repair) which are longer duration surgeries. Other features of epidural anaesthesia: Expensive compared to spinal anaesthesia More incidence of intravascular injection (epidural space has venous plexus of Batson) More incidence of epidural hematoma Level of block can be changed by increasing the dose through the catheter"}

{"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 cause relaxation of LES? 1. Nitrates 2. Histamine blockers 3. Morphine 4. Atropine 5. Calcium channel blockers\nA) 1,2 & 3\nB) 1,4 & 5\nC) 1,2 & 5\nD) All", "output": "1, because Factor causing relaxation of LES Factor increasing LES pressure Pharmacological agents:nitrates, anticholinergics, barbiturates, calcium channel blockers, caffeine, theophylline, diazepam, dopamine, prostaglandin E1 and E2 and meperidine Pepperdine Chocolate Coffee Alcohol Smoking Fat Antacids Cholinergics Domperidone Metoclopramide Prostaglandin F2 Also know: LES pressure is higher in the supine position than in the upright position. Ref: Schwarz 9/e, Page 812; Harrison 17/e, Page 1741."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPlasma membrane is freely permeable to -\nA) Glucose\nB) Urea\nC) Glycerol\nD) Alcohol", "output": "3, because Ans. is 'd' i.e., Alcoholo As the major middle portion of membrane (core of the membrane) is formed by hydrophobic region of phospholipids, this portion is impermeable to the usual water-soluble substances, such as ions, glucose and urea.o Conversely, fat-soluble substances, such as oxygen, carbon dioxide, and alcohol, can penetrate this portion of the membrane with ease.o Permeability coefficient and permeability of some important molecules in increasing order of frequency are Na+ < K+ < Cl- < Glucose < Tryptophan < Urea = Glycerol< Indole < H2O."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following drugs is not useful in the management of Postpaum Hemorrhage(PPH)?\nA) Mifepristone\nB) Misoprostol\nC) Oxytocin\nD) Ergotamine", "output": "0, because Mifepristone is a progestin analogue and it blocks the effects of progesterone. It is used as a medical termination of pregnancy in the first trimester and as a post-coital contraceptive. While misoprostol, oxytocin and ergotamine are oxytocics and as uterine stimulants are used in the management of postpaum hemorrhage. Ref: Dutta textbook of Obstetrics 6th edition, Pages 175, 550, 411-22"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich is not a alkylating agent?\nA) Cyclophosphamide\nB) Chlorambucil\nC) 5-FU\nD) Melphalan", "output": "2, because 5-FU is an metabolite"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\n100% Oxygen is not effective in: March 2005\nA) Pulmonary edema\nB) MI\nC) Tetralogy of fallot\nD) COPD", "output": "2, because Ans. C: Tetralogy of fallot"}

{"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 lymph nodes first involved in cancer of the skin of the scrotum are -\nA) Superfical inguinal\nB) External iliac\nC) Para aortic\nD) Gland of Cloquet", "output": "0, because \u2022 Squamous cell carcinoma of scrotumQ, most commonly resulted from exposure to environmental carcinogens including chimney soot, tars, paraffin and petroleum products.\n\u2022 Superficial inguinal lymph nodes are the first lymph nodes involved.\u00a0\nRisk Factors\n\u2022 Most cases results from poor hygiene and chronic inflammation.\nDiagnosis\n\u2022 Diagnosis is established by biopsy of scrotal skin.\nTreatment\n\u2022 Wide excision with 2 cm margins\u00a0should be performed for malignant tumors.\n\u2022 Prognosis correlates with presence or absence of nodal involvement."}

{"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 primary therapy to prevent oesophageal varices is :\nA) Surgical approaches\nB) Sclerotherapy\nC) TIPPS\nD) Shunt operation", "output": "1, because The treatment of patients with varices that have never bled is usually referred to as prophylactic therapy (eg, prophylactic sclerotherapy or prophylactic propranolol). By convention, procedures performed on patients who have bled previously are referred to as therapeutic (eg, therapeutic shunts). Prophylactic therapy is of value, since the moality rate of variceal bleeding is high (25%), the risk of bleeding in patients with varices is relatively high (30%), and varices can often be diagnosed before the initial episode of bleeding. Ref :Jarnagin W.R. (2010). Chapter 24. Liver & Poal Venous System. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e."}

{"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 followng does not occur with asbestosis -\nA) Methaemoglobinemia\nB) Pneumoconiosis\nC) Pleural mesothelioma\nD) Pleural calcification", "output": "0, because Ref:Textbook of pathology (Harsh mohan) 6th edition,page no.492 Overexposure to asbestos is associated with 3 types of lesions: asbestosis, pleural disease and ceain tumours. A. ASBESTOSIS. The gross pulmonary fibrosis caused by asbestos exposure and histologic demonstration of asbestos bodies on asbestos fibres is termed asbestosis. Grossly, the affected lungs are small and firm with cailage-like thickening of the pleura. The sectioned surface shows variable degree of pulmonary fibrosis, especially in the subpleural areas and in the bases of lungs . The advanced cases may show cystic changes. Histologically, the following changes are observed: 1. There is non-specific interstitial fibrosis. 2. There is presence of characteristic asbestos bodies in the involved areas . These are asbestos fibres coated with glycoprotein and haemosiderin and appear beaded or dumbbell-shaped. The coating stains positively for Prussian blue reaction. 3. There may be changes of emphysema in the pulmonary parenchyma between the areas of interstitial fibrosis. 4. The involvement of hilar lymph nodes in asbestosis is not as significant as in silicosis. B. PLEURAL DISEASE. Pleural disease in asbestos exposure may produce one of the following 3 types of lesions: 1. Pleural effusion. It develops in about 5% of asbestos workers and is usually serious type. Pleural effusion is generally accompanied by subpleural asbestosis. 2. Visceral pleural fibrosis. Quite often, asbestosis is associated with dense fibrous thickening of the visceral pleura encasing the lung. 3. Pleural plaques. Fibrocalcific pleural plaques are the most common lesions associated with asbestos exposure. Grossly, the lesions appear as circumscribed, flat, small (upto 1 cm in diameter), firm or hard, bilateral nodules. They are seen more often on the posterolateral pa of parietal pleura and on the pleural surface of the diaphragm. Microscopically, they consist of hyalinised collagenous tissue which may be calcified so that they are visible on chest X-ray. Asbestos bodies are generally not found within the plaques. C. TUMOURS. Asbestos exposure predisposes to a number of cancers, most impoantly bronchogenic carcinoma and malignant mesothelioma . A few others are: carcinomas of oesophagus, stomach, colon, kidneys and larynx and various lymphoid malignancies. 1. Bronchogenic carcinoma is the most common malignancy in asbestos workers. Its incidence is 5 times higher in non-smoker asbestos workers than the nonsmoker general population and 10 times higher in smoker asbestos workers than the other smokers. 2. Malignant mesothelioma is an uncommon tumour but association with asbestos exposure is present in 30 to 80% of cases with mesothelioma. The exposure need not be heavy because mesothelioma is known to develop in people living near asbestos plants or in wives of asbestos workers."}

{"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 phobia are all, except: NIMHANS 08; NEET 13\nA) Generalized anxiety\nB) Avoiding paicular situation\nC) Fear and anxiety of specific thing\nD) Insight is present", "output": "0, because Ans. Generalized anxiety"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAn adolescent is brought to the emergency depament following an episode of myoclonic jerks at morning after waking up. His consciousness was not impaired. His EEG shows generalized 3-4 Hz spike and slow wave complexes. Most probable diagnosis is?\nA) Generalized tonic clonic seizure\nB) Absent seizure\nC) Temporal lobe epilepsy\nD) Juvenile myoclonic epilepsy", "output": "3, because Juvenile myoclonic epilepsy is a subtype of idiopathic generalized epilepsy with onset usually between 8 and 20 years of age. Myoclonic jerks, especially in the morning, are of variable intensity ranging from simple twitching (\"flying saucer syndrome\") to falls; consciousness is not impaired in it. It is precipitated by alcohol and sleep deprivation. Patients will have normal intelligence. The typical interictal EEG abnormality consists of a generalized 4- to 6-Hz spike or polyspike and slow-wave discharges lasting 1-20 seconds. Usually, 1-3 spikes precede each slow wave. Also know: In Generalized tonic clonic seizure EEG shows a normal background with generalized epileptiform discharges such as spike or polyspike wave complexes at 2.5 to 4 Hz. During absence seizures there is an abrupt onset of bilaterally synchronous and symmetrical 3 Hz spike-wave discharge, irrespective of whether typical absences are simple or complex. Ictal recordings from patients with typical temporal lobe epilepsy usually exhibit 5-7 Hz, rhythmic, sharp theta activity, maximal in the sphenoidal and the basal temporal electrodes on the side of seizure origin. Ref: A-Z of Neurological Practice: A Guide to Clinical Neurology By Andrew J. Larner, Alasdair J Coles, Neil J. Scolding, Roger A Barker, 2011, Page 368 ; Clinical Electroencephalography by Misra,2005, Page 188"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThiopentone is not used in?\nA) Induction of anesthesia\nB) Medically induced coma\nC) As truth serum\nD) As antidepressant", "output": "3, because Ans. is 'd' i.e., As antidepressant"}

{"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 tracheal bifurcation -\nA) At lower border of T4\nB) At lower border of T4 Tracheal ring has hoop-shaped process\nC) Called Carina\nD) All of the above", "output": "3, because Trachea\n\nThe trachea is 10-15 cm long tube formed by C-Shaped hyaline cartilaginous rings and fibromuscular membrane.\nIt extends from the lower border of cricoid cartilage (at C6 level) to lower border of T4 or upper border of T5 vertebra (T4-T5 disc space) where it bifurcates.\nIts external diameter is about 2 cm in males and about 1.5 cm in females.\nIt has 16-20 cartilaginous rings.\n\nThe first tracheal ring is the broadest. The last ring at tracheal bifurcation shows carina, a triangular hoop-shaped process separating the bronchi, i.e.\nCarina is a bifurcation of the trachea.\n\nThe trachea is lined by ciliated columnar epithelium.\n\u00a0It is supplied by the inferior thyroid artery and is drained by left brachiocephalic vein.\n\u00a0Sensory and motor supply to the trachea is provided by the parasympathetic system through vagi and recurrent laryngeal nerve.\n\nVasomotor supply is by sympathetic fibres through middle cervical ganglion along inferior thyroid arteries."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAutopsy of lung of an old man shows that the bronchi are lined by stratified squamous epithelium. What is this change\nA) Metaplasia\nB) Dysplasia\nC) Hyperplasia\nD) Hypertrophy", "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\nHow does hyperammonemia inhibit TCA cycle?\nA) By depleting alpha ketoglutarate\nB) By depleting oxaloacetate\nC) By increasing concentration of alpha ketoglutarate\nD) By increasing concentration of oxaloacetate.", "output": "0, because Build up of cummonemia which occurs in urea cycle disorder or advanced liver disease, inhibits TCA cycle by depleting alpha ketoglutarate."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTrue regarding neoplasms of the ovary are:a) Stromal invasion is commonly present in ovarian tumours of borderline malignancyb) Lymphocytic infiltration is characteristic to dysgerminomac) Presence of ascites and pleural effusion in Brenner tumour indicates poor prognosisd) Endometrioid carcinoma of the ovary may coexist with endometrial adenocarcinoma\nA) c\nB) d\nC) bd\nD) ac", "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\nGenital ulcer is/are caused by \u2013 a) HPVb) HSVc) HIVd) Treponema pallidum\nA) c\nB) d\nC) ab\nD) bd", "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\nThe most common cause of painful pericarditis is\nA) Viral\nB) Tuberculous\nC) Uraemic\nD) All of these", "output": "0, because The cause of pericarditis is believed to be most often due to a viral infection. Other causes include bacterial infections such as tuberculosis, uremic pericarditis, following a hea attack, cancer, autoimmune disorders, and chest trauma Ref: guyton and hall textbook of medical physiology 12 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 site of ectopic salivary gland is?\nA) Cheek\nB) Palate\nC) Angle of mandible\nD) Tongue", "output": "2, because Ans is 'c' i.e. Angle of mandible * An accessory salivary gland is ectopic salivary gland tissue with a salivary gland duct system. The most common location of accessory salivary gland tissue is an extra major salivary gland in front of the parotid gland.* Salivary gland heterotopia is where salivary gland acini cells are present in an abnormal location without any duct system. The most common location is the cervical lymph nodes.* Most common ectopic salivary gland tissue is Stafne bone cyst.* It presents as asymptomatic, clearly demarcated radiolucency of the angle of mouth, characteristically, below inferior dental neurovascular bundle."}

{"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 reducing sugars except\nA) Glucose\nB) Lactose\nC) Maltose\nD) Sucrose", "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\nAn eight-year-old boy had abdominal pain, fever with bloody diarrhea for 18 months. His height is 100 cm and weight is 14.5 kg. Stool culture was negative for known entero-pathogens. The sigmoidoscopy was normal. During the same period child had an episode of renal colic and passed urinary gravel. The Mantoux test was 5 x 5 mm. The most probable diagnosis is:\nA) Ulcerative colitis\nB) Crohn's disease\nC) Intestinal tuberculosis\nD) Strongyloidiasis", "output": "1, because The boy in question is obviously malnourished (Expected weight is 20-25 kg and expected height is 125-130 cm) A normal sigmoidoscopy rules out ulcerative colitis as it extends in a continuous fashion proximally from the rectum. A negative Mantoux test goes against active tuberculosis and a negative stool culture also rules out strongyloidiasis. Interpretation of Mantoux test: If the width of the induration is: >= 10 mm: Positive (tuberculin reactors) 6-9 mm: Equivocal/doubtful reaction <=5 mm: Negative reaction Hence, the obvious choice left is option '2', i.e. Crohn's disease."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are autosomal recessive EXCEPT: September 2004\nA) Sickle cell anemia\nB) Phenylketonuria\nC) Marfan's syndrome\nD) Wilson's disease", "output": "2, because Ans. C i.e. Marfan's syndrome Marfan syndrome is a disorder of connective tissue, manifested principally by changes in the skeleton, eyes, and cardiovascular system. It is transmitted by autosomal dominant inheritance."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll the following drugs are used for Absence seizures except \u2013\nA) Clonazepam\nB) Phenytoin\nC) Valproate\nD) Ethosuximide", "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\nMinimum thickness of calcium hydroxide required to protect near or actual pulp exposure is?\nA) 2-3 mm\nB) 0.5-1mm\nC) 3-4mm\nD) 5mm", "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 17-year-old girl with amenorrhea, atrophied breast, hypoplastic uterus :\nA) Turner's syndrome\nB) Gonadal dysgenesis\nC) Androgen insensitivity syndrome\nD) Klinefelter's syndrome", "output": "0, because Turner's syndrome Phenotype is female Karyotype is 45,XO Sho stature,webbed neck underdeveloped uterus and vagina ovaries lack graffian follicles breasts are not developed,axillary and pubic hair is scanty or absent SHAW'S TEXTBOOK OF GYNAECOLOGY,pg no:111,115th 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\nAll are fibrinolytic, except -\nA) Streptokinase\nB) Urokinase\nC) Alteplase\nD) Epsilon amino caproic acid", "output": "3, because Ans. is 'd' i.e., Epsilon amino caproic acid"}