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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\nWhich of the following conditions is not considered\nas premalignant\nA) Erosive lichen planus\nB) Syphilitic glossitis\nC) Leukoedema\nD) Leukoplakia", "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\nMolecular mimicry is an explanation for -\nA) Immune tolerance\nB) Autoimmune disorders\nC) Hypersensitivity\nD) Immunosuppression", "output": "1, because Ans. is 'b' i.e., Autoimmune disorders* Molecular mimicry is defined as the structural similarity between foreign antigens and self-antigens, because of which T cells and B cells directed against foreign antigens cross react with self antigens resulting in autoimmunity.* Molecular mimicry does not always demand a structural similarity between foreign antigens and self antigens. Sometimes electrostatic attraction between foreign antigen and MHC molecule can cause self antigen damage by immune response generated against foreign antigens.* Molecular mimicry is also possible between two recognized peptides that have similar antigenic surfaces in the absence of primary sequence homology. For example, specific single amino acid residues such as cysteine (creates di-sulfide bonds), arginine or lysine (form multiple hydrogen bonds), could be essential for T cell cross-reactivity.* Immunological tolerance is the ability to discriminate self-antigens from foreign antigens and to not produce antibodies against self-antigens* Loss of this immunological tolerance is generally considered as a initiation factor for autoimmunity* Immunological tolerance is generally established in foetus, soon after the pre-T cells leave the bone marrow and they reach the thymus* In thymus, any clone of T cell which binds only weekly to self-antigen i.e., MHC class I antigen is positively selected and is allowed to undergo maturation.* Any clone which binds avidly to one's own MHC class I molecules are negatively selected and apoptosis is induced. This is called as clonal deletion* For exposure to more antigens, this process is found to continue even in peripheral circulation. The clonal deletion analogue which happens in peripheral circulation is called as clonal anergy* B cell tolerance is mediated by VDJ rearrangements and somatic hypermutation* Failure of these immunological tolerance rules can result in autoimmunity"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVariation in eruption in permanent dentition\nA) 4-5 months\nB) 7-9 months\nC) 1-2 months\nD) 12-18 months", "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\nNephrocalcinosis is seen in all except -\nA) Sarcoidosis\nB) Distal RTA\nC) Milk alkali syndrome\nD) Medullary cystic kidney", "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 9-year-old boy is diagnosed with multiple sclerosis (MS). Which of the following nervous structures would most likely be affected by this disease?\nA) Trigeminal ganglion\nB) Superior cervical ganglion\nC) Optic nerve\nD) Facial nerve", "output": "2, because Multiple sclerosis affects only axons in CNS (spinal cord and brain) that have myelin sheaths formed by oligodendrocytes. Optic nerve is considered to be pa of CNS, as it is derived from an outpouching of diencephalon. All other nervous structures are in the PNS and have their myelin sheaths formed by Schwan cells"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are true about gang rape, except: Bihar 11\nA) Sexual intercourse by one person\nB) Sexual intercourse by two persons\nC) Sexual intercourse by three persons\nD) Sexual intercourse by many persons", "output": "0, because Ans. Sexual intercourse by one person"}

{"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 a risk factor for development of gastric carcinoma?\nA) Blood group O\nB) Intestinal metaplasia type III\nC) Duodenal ulcer\nD) All of the above", "output": "1, because Blood group A, not O was considered as the risk factor for Gastric carcinoma but blood group A is also not considered as risk factor according to standard books. About duodenal ulcers standard books writes \"Although once considered a premalignant conditions, it is likely that older literatures was confounded by mistakenly labeling inadequately biopsied ulcers and healing ulcers as 'benign' when in fact they were malignant to begin with\". Intestinal metaplasia is a premalignant condition and among intestinal metaplasia , intestinal metaplasia type III is more likely to progress to gastric cancer. Ref: Schwaz 9/e, Page 927; Maingot's 10/e, Page 1006."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFollowing are the findings in later stages of sickle cell Anemia, except -\nA) Fish veebra\nB) Enlarged hea\nC) Splenomegaly usually seen\nD) Leukocytosis", "output": "2, because Ans. is 'c' i.e., Splenomegaly usually seen o Splenomegaly is found in early stage of sickle cell anemia. By continued infarction and hypoxia leads to progressive scarring and shrinkage of spleen, so that by adolescent or the adulthood, only a small nubbin of fibrous tissue may be left; this is called autosplenctomy. o Bone changes in sickle cell anemia are : - (i) Crew haircut appearance of skull bone. (ii) Fish mouth veebrae. o Cardiomegaly, paicularly increase in left ventricular dimension and mass results from increase in cardiac output caused by chronic anemia and has its onset in early childhood. o The WBC count is consistently elevated owing to an increase in the number of mature granulocytes. This increase is explained to a large extent by a shift of granulocytes from the marginated to the circulating compaments"}

{"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 with cancer developed an extreme degree of radiation toxicity. Further history revealed that the dose adjustment of a particular drug was missed during the course of radiotherapy. Which of the following drugs required a dose adjustment during radiotherapy in order to prevent radiation toxicity\nA) Vincristine\nB) Dactinomycin\nC) Cyclophosphamide\nD) 6\u2013Mercaptopurine", "output": "1, because Anthracyclines and actinomycin-D (dactinomycin) can cause severe radiation toxicity. This is known as radiation recall syndrome."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFincham test is used to diagnose\nA) Open angle glaucoma\nB) Cataract\nC) Mucopurulent conjunctivitis\nD) Acute angle closure glaucoma", "output": "1, because Ans. (b) CataractRef: Khurana 4/e, p. 146If the halos break it is due to cataract and if not it is due to angle closure glaucoma.Thus, the test is positive in diagnosing cataract. Glaucoma is not being diagnosed by this test. It is a diagnosis by exclusion."}

{"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 CNS tumor present with calcification -\nA) Oligodendroglioma\nB) Astrocytoma\nC) Medulloblastoma\nD) Pheochromocytoma", "output": "0, because Although many intracranial tumors show calcification, oligodendroglioma shows calcification in 70-90% of cases. Ref : Robbins 8/e p1333 ("}

{"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 ideal place to record temperature in a dead body is from:\nA) Axilla\nB) Groin\nC) Rectum\nD) Mouth", "output": "2, because Reddy - \u201cThe rectum is the ideal place to record temperature except in cases of sodomy.\nThe temperature can also be recorded by making a small opening into the peritoneal cavity and inserting the thermometer in contact with the inferior surface of the liver.\nThe external auditory meatus or the nasal passages also can be used to record temperature \u201d"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nKostmann's syndrome\u2013treatment is \u2013\nA) Anti\u2013thymocyte globulin + cyclosporin\nB) Anti\u2013thymocyte globulin + cyclosporin + GM\u2013CSF\nC) G\u2013CSF\nD) GM\u2013CSF", "output": "2, because Kostmann's syndrome (severe congenital neutropenia)\n\nKostmann's syndrome, an autosomal recessive disorder, is an inherited disorder of the bone marrow in which there is the arrest of maturation of neutrophils at promyelocyte stage.\nThere is congenital neutropenia and neutrophils are often completely absent in the blood at the time of diagnosis.\nBecause of neutropenia, these patients suffer from severe infections e.g., omphalitis (infection of the navel), Pneumonia, Skin abscesses, otitis media.\nKostmann's syndrome is believed to be caused due to defect in the receptor of granulocyte colony stimulating factor (GCSF) on neutrophils (granulocytes). The purpose of this receptor is the binding of the granulocyte to the cytokine (GCSF) in order to give the signal to the cell to mature and multiply.\nPatients with Kostamann's syndrome produce GCSF but because of the defect in GCSF receptor the response of neutrophils to normal amounts of GCSF in the blood is reduced: However, they can respond if the amount of GCSF is increased \u2192 These patients will respond to a higher dose of GCSE"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\n\"Child guidance clinic\" is most helpful in all except\nA) Bed Wetting\nB) Cerebral palsy\nC) Squint\nD) School adjustment problems", "output": "2, because C Squint * Child guidance clinic was started in 1922, as part of a programme sponsored by a private organization 'Common Wealth fund's Programme' for the prevention of juvenile delinquency. * The first CGC was started in India in 1939 at the TATA Institute Mumbai. The CGC in Delhi was started in 1955 at RAK con, simultaneously with madras. * Child guidance clinic are specialized clinics that deal with children of normal and abnormal intelligence, exhibiting a range of behaviors and psychological problems which are summed up as maladjustments OBJECTIVES: * Providing help for children with behavioral problem like pica, bed-wetting, sleep walking, speech defects etc * Providing care and guidance for children with mental retardation * Providing care for children with learning difficulties * Providing counseling, guidance and information to parents regarding care and upbringing of children"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nClue cells are found in:\nA) Bacterial vaginosis\nB) Chlamydia trachomatis\nC) Neisseria gonorrhoea\nD) Trichoomonas", "output": "0, because Bacterial vaginosis"}

{"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 impact on fetus in case of use of Indomethacin in utero in third trimester?\nA) Patent ductus aeriosus\nB) Early closure of ductus aeriosus\nC) Ventricular septal defect\nD) Atrial septal defect", "output": "1, because Prostaglandins helps to keep ductus aeriosus open. Indomethacin inhibits prostaglandins levels | So, closure of ductus aeriosus | DOC for PDA"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nArrange coverings on peripheral nerve from inner to outer\nA) Endoneurium, Epineurium, Perineurium\nB) Endoneurium, Perineurium, Epineurium\nC) Perineurium, Endoneurium, Epineurium\nD) Epineurimn, Endoneuriu, Perineurium", "output": "1, because coverings on peripheral nerve from inner to outer are Endoneurium, Perineurium, EpineuriumINDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY PAGE NO:171"}

{"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 cyst which arises from the remnants of mesonephric duct and is seen in the vaginal wall is:\nA) Baholin's cyst\nB) Inclusion cyst\nC) Endometriotic cyst\nD) Ganer's duct cyst", "output": "3, because Ganer's duct cyst is a benign vaginal cyst that originates from the Ganer's duct, which is a vestigial remnant of the mesonephric duct (wolffian duct) in females. Treatment is simple excision."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nErgot alkaloids are used in all except ?\nA) Migraine\nB) Acromegaly\nC) Hypeension\nD) Parkinsonism", "output": "2, because Ans. is 'c' i.e., Hypeension Uses of ergot alkaloids 1. Migraine In migraine, throbbing headache is due to dilatation of pain sensitive aeries outside the brain, i.e. extracerebral vessels. Ergot alkaloids are vasoconstrictor (due to a agonistic action) and oppose these effects. Ergot alkaloids used in migraine ? Prophylaxis - Methysergide Acute attack - Ergotamine & dihydroergotamine 2. Parkinsonism In parkinsonism, there is degeneration of dopaminergic neurons. Bromocriptine, an ergot alkaloid,.is dopamine agonist at D2 receptor - can be used in parkinsonism. 3. Hyperprolactinemia Prolactin is under predominant inhibitory control of hypothalamus through dopamine that act on D2 receptor of pituitary lactotroph. Bromocriptine by D2 agonistic activity, decreases prolactin secretion. 4. Acromegaly Dopamine increases GH release in normal subjects but decreases it in acromegalics. Bromocriptine also acts in same way due to its dopamine agonistic action. 5. Dementia Dihydroergotoxin increases cerebral blood flow and act by protecting altered brain 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\nA diabetic female on INH and Rifampicin for TB developed DVT. She was started on Warfarin, PT is not raised, and next step should be:\nA) Increase the dose of Warfarin\nB) Replace Warfarin with Acenocoumarol\nC) Switch Ethambutol for Rifampicin\nD) Use LMW heparin", "output": "3, because The anticoagulant effect of warfarin is assessed by the measurement of prothrombin time (PT). Failure of elevation of PT indicates the decreased effect of warfarin. Rifampicin is an enzyme inducer and can decrease the effect of warfarin.\nRifampicin is the most effective drug for tuberculosis and should not be replaced.\nAcenocoumarol\u00a0is also an oral anticoagulant. Its metabolism is also subjected to induction by rifampicin.\nEffect of warfarin starts in 4-5 days. Therefore if we increase the dose of warfarin, it will take 5 days to prevent DVT. For immediate action, we should start heparin or LMW heparin.\nHowever, heparin needs to be given by injection, thus not suitable for long-term use.\nTherefore, the next step will be to shift to heparin but long-term treatment will be by increasing the dose of warfarin."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAbdominal pa of esophagus is supplied by\nA) Bronchial aery\nB) Abdominal aoa\nC) Right gastric aery and inferior phrenic aery\nD) Left gastric aery and inferior phrenic aery", "output": "3, because AERIAL BLOOD SUPPLY TO ESOPHAGUS: Cervical pa of esophagus Esophageal branches of inferior thyroid aery. Thoracic pa of esophagus PICA (posterior Inter costal aery) (Branch of descending Thoracic aoa) + Bronchial aeries. Abdominal pa of esophagus Left gastric aery (Branch of Celiac trunk) + Inferior phrenic aery (Branch Of abdominal aoa)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nInverse agonist of GABA receptor is\nA) Benzodiazepines\nB) Flumazenil\nC) \u03b2- Carboline\nD) None of the above", "output": "2, because \u03b2 - Carboline is the inverse agonist.\nBenzodiazepines are full agonists that open chloride channels by acting on GABA receptors.\nFlumazenil is\u00a0antagonist for Benzodiazepines given to treat toxicity."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIn the following X-ray marked structure is-\nA) Transverse process\nB) Lamina\nC) Pedicle\nD) None of the above", "output": "2, because Ans. is 'c' i.e., Pedicle* Given image is the AP view spine and the marked structure is pedicle of vertebra."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich one of the following lymphoma is associated with translocation of c-myc gene on chromosome 8?\nA) Burkitt's lymphoma\nB) Mantle cell lymphoma\nC) Follicular lymphoma\nD) Anaplastic large cell lymphoma", "output": "0, because All forms of Burkitt lymphoma are highly associated with translocation of MYC gene on chromosome 8 that lead to increased MYC protein levels. Mantle cell lymphomas have an (11;14) translocation involing the IgH locus on chromosome 14 and the cyclin D1 locus on chromosome 11 that leads to overexpression of cyclin D1. In follicular lymphoma there (14;18)translocation that juxtaposes the IGH locus on chromosome 14 and BCL2 locus on chromosome 18. In Anaplastic large cell lymphoma there is rearrangement of ALK. REFERENCE; ROBBINS AND COTRAN PATHOLOGIC BASIS OF DISEASE.SOUTH ASIA EDITION VOLUME 1.PAGE NO. 591,594,597,602"}

{"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 regarding acute conjuctivitis\nA) Vision is not affected\nB) Cornea is infiltrated\nC) Topical antibiotics is the treatment of choice\nD) Pupil is not affected", "output": "0, because Among all four options, option A seems the most appropriate as any corneal infiltration will lead to decreased vision though in conjunctivitis it is commonly reversible Refer: Khurana 6th edition page number 76"}

{"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 not a fungal infection: September 2007\nA) Blastomycosis\nB) Cryptococcus\nC) Actinomycosis\nD) Histoplasmosis", "output": "2, because Ans. C: Actinomycosis Actinomycosis is an infectious bacterial disease caused by Actinomyces species such as Actinomyces israelii or A. gerencseriae. It can also be caused by Propionibacterium propionicus, and the condition is likely to be polymicrobial."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA female developing haemarrhagic cystitis, with following -- treatment\nA) 5-FU\nB) Methotrexate\nC) Bleomycin\nD) Cyclophosphamide", "output": "3, because (Cyclophosphamide) (320- CSDT 12th)* Haemorrhagic cystitis can develop in patients recieving cyclophosphamide or Ifosamide* Other drugs causing hemorrhagic cystitis- Carmustine- Chlorumbucil- Extended spectrum penicilline- Nitrogen mustard- Vincristine* Remember these following two very important points* Hemorrhagic cystitis due to cyclophosphamide is attributed to the presence of its metabolite ACROLEIN in urine* Hemorrhage cystitis due to cyclophosphamide can be prevented by I.V- injection of MESNA (Sodium- 2 mercaptoethane sulfonate) and adequate hydration* Haemorrhagic cystitis is also seen in patients who undergo Bone marrow transplantation (BMT)* In BMT setting1. Early onset haemorrhagic cystitis - due to drugs (cyclophosphamide)2. Late onset haemorrhagic cystitis - due to polyoma virus BKV or adenovirus type II"}

{"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 belong to Picorna viruses except -\nA) Enterovirus 70\nB) Coxsackie virus\nC) Rhinovirus\nD) Herpes simplex virus", "output": "3, because General of picornavirus are a)enterovirus, rhinovirus, hepatovirus,parechovirus REF:ANANTHANARYANAN TEXTBOOK OF MICROBIOLOGY 9EDITION PGNO.484"}

{"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 innocent murmur is best heard in children at:\nA) Pulmonic area\nB) Aoic area\nC) Left lower mid-sternal border\nD) Apex", "output": "2, because Innocent murmurs Murmurs not associated with significant hemodynamic abnormalities. Aka functional/ normal or insignificant murmurs >30% of children have innocent murmur at some time in their lives; MC innocent murmur is a medium - pitched, vibratory or \"musical,\" relatively sho systolic ejection murmur, best heard along left lower & mid-sternal border & has no significant radiation to the apex, base, or back. It is heard most frequently in children b/w 3 and 7 yr of age. Intensity of murmur often changes with respiration and position, may be attenuated in the sitting or prone position."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nElimination of leprosy is define as prevalence -\nA) < 1 per 1000\nB) < 1 per 10000\nC) < 1 per 1 lakh\nD) < 1 per 100", "output": "1, because <p> Prevalence <1 per 10,000. Reference:Park&;s textbook of preventive and social medicine,K.Park,22nd edition,page no:288. <\\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\nSunflower cataract is seen in ?\nA) Wilson's disease\nB) Congenital rubella\nC) Blunt trauma to eye\nD) Myotonicdystrophica", "output": "0, because Ans. is 'a' i.e., Wilson'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\nFollowing are the findings in sickle cell Anemia, except \u2013\nA) Fish vertebra\nB) Enlarged heart\nC) Splenomegaly usually seen\nD) Leukocytosis", "output": "2, because Splenomegaly is found in the early stage of sickle cell anemia. By continued infarction and hypoxia - leads to progressive scaring and shrinkage of the spleen, so that by adolescent or adulthood, only a small nubbin of fibrous tissue may be left; this is called autosplenctomy.\n\nAbout other options\nOption 'a'\nBone changes in sickle cell anemia are -\n\nCrew haircut appearance of skull bone\nFish mouth vertebrae\n\nOption 'b'\n\nCardiomegaly particularly increases in left ventricular dimension and mass results from an increase in cardiac output caused by chronic anaemia and has its onset in early childhood.\n\nOption 'd'\n\nThe WBC count is consistently elevated owing to an increase in the number of mature granulocytes. This increase is explained to a large extent by a shift of granulocytes from the marginated to the circulating compartments."}

{"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 37 year old woman has cyclical premenstrual pain. Her breasts have a \"lumpy-bumpy\" texture on palpation. A biopsy is performed. The histopathologic features include small cysts lined by epithelial cells with apocrine metaplasia, calcium deposits, areas of fibrosis, increased number of acini (adenosis), and foci of florid hyperplasia of ductal epithelium. Which of these changes increase the risk of breast cancer?\nA) Adenosis\nB) Apocrine metaplasia\nC) Calcium deposits\nD) Epithelial hyperplasia", "output": "3, because Fibrocystic changes usually come to clinical attention by causing pain(often cyclical, in premenstrual phase), palpable lumps, or mammographic densities and calcifications. A \"lumpy-bumpy\" texture is caused by cysts and fibrosis. Fibrocystic changes, per se, do not increase the risk of developing breast cancer, unless there are associated proliferative changes. Epithelial hyperplasia is defined as an increase in the number of epithelial cell layers in the ductal epithelium. Florid epithelial hyperplasia leads to an increased risk of developing carcinoma, especially if there is associated cellular atypia (atypical ductal hyperplasia). Adenosis refers to an increase in the number of acini and can be observed in fibrocystic changes as well as in other breast conditions, such as sclerosing adenosis. Physiologic adenosis is pa of the changes that occur during pregnancy. Adenosis is not associated with increased risk of breast cancer, except as a component of sclerosing adenosis. Apocrine metaplasia describes a benign change of breast epithelial cells that come to resemble the apocrine epithelium of sweat glands. Apocrine cells have abundant granular eosinophilic cytoplasm. Apocrine metaplasia is seen frequently in fibrocystic changes, as well as in normal breast. Calcium deposition is a nonspecific finding that may occur in a number of both benign and malignant breast changes, including fibrocystic changes, ductal carcinoma in situ, and invasive carcinoma. Calcification is not clinically significant except for its diagnostic value. Mammographic detection of calcium may serve to guide biopsy procedures. Ref: Hunt K.K., Newman L.A., Copeland E.M., Bland K.I. (2010). Chapter 17. The Breast. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEntropion is\nA) Inversion of eyelid\nB) Inversion of eyelashes\nC) Eversion of eyelid\nD) Eversion of eyelashes", "output": "0, because Entropion is a condition in which the lower eyelid turns inward, rubbing against the eye. Entropion occurs most commonly as a result of aging. Infection and scarring inside the eyelid are other causes of entropion."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBasement membrane around Schwann cells contains which of the following collagen?\nA) Type IV\nB) Type X\nC) Type XX\nD) Type XXVIII", "output": "3, because Type XXVIII is distributed in Basement membrane around Schwann cells Reference: Harper; 30th edition; Page no: 628 Table no: 50-1"}

{"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 1947 a committee at ADA recommended symbolically, which of the following tooth numbering system\nA) Zsigmondy/Palmer system\nB) ADA system\nC) Two digit system\nD) Zsigmondy/Palmer system & ADA system", "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\nOho-toluidine test measures the levels of:-\nA) Combined chlorine\nB) Both free and combined chlorine\nC) Nitrates in water\nD) Hardness of water", "output": "1, because 1. OHOTOLUIDINE (OT) TEST Gives value of free and total (combined + free) chlorine levels. Combined chlorine can be easily calculated by subtracting free chlorine from total chlorine. Reagent: Ohotoluidine dissolved in 10% solution of hydrochloric acid. Yellow color produced on reacting with chlorine. Reading within 10 seconds of addition of chlorine --> Free chlorine. Reading after a lapse of 15-20 mins --> Total chlorine. 2. OHOTOLUIDINE-ARSENITE (OTA) TEST Modification of OT test. Gives value of free and combined chlorine separately. Not affected by presence of nitrates/iron/manganese (Thus, superior to OT test)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFalse regarding Anganwadi worker-\nA) Training for 4 months\nB) Under ICDS scheme\nC) Gets 1500 Rs per month\nD) Full-time worker", "output": "3, because Ans. is 'd' i.e., Full time worker o Anganwadi workers are under ICDS scheme.o There is an anganwadi worker for a population of 400-800 in plains and 300-800 in hilly/tribal areas.o She undergoes training in various aspects of health, nutrition and development for 4 months. o She is a part-time worker.o She is paid an honorarium of Rs. 1500 per month."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is used in the treatment of hyperprolactinemia\nA) Cimetidine\nB) Methysergide\nC) Bromocriptine\nD) Ondansetron", "output": "2, because Refer KDT 6/e p 236 It is an ergot alkaloid and is a Dopamine agonist Dopamine acts as prolactin inhibiting hormonal big the brain Agonism of Dopamine receptors by Bromocriptine is responsible for it's use in hyperprolactinemia"}

{"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 lesion is hyperdense on CT?\nA) Ependymoma\nB) Medulloblastoma\nC) Oligodendroglioma\nD) Astrocytoma", "output": "1, because Most Brain tumors are Hypodense on NCCT Hyperdense Brain tumors include Medulloblastoma, CNS Lymphoma, and Pineal Germinomas. NCCT showing a hyperdense lesion in 4th ventricle s/o Medulloblastoma."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA person having CD-4 count of 200 presents with difficulty of breathing. Most probable diagnosis is?\nA) Tuberculosis\nB) Histoplasmisis\nC) Candidiasis\nD) Pneumocystis carinii", "output": "3, because Pneumocystis carini REF: Harrison's 17th ed chapter 182, CURRENT Medical Diagnosis & Treatment Chapter 31. HIV Infection & AIDS The host factors that predispose to the development of Pneumocystis pneumonia (PcP) include defects in cellular and humoral immunity. The risk of PcP among HIV-infected patients rises markedly when circulating CD4+ T cell counts fall below 200/[tL. Pneumocystis pneumonia is the most common oppounistic infection associated with AIDS. Pneumocystis pneumonia may be difficult to diagnose because the symptoms--fever, cough, and shoness of breath--are nonspecific. Other persons at risk for PcP are patients receiving immunosuppressive agents (paicularly glucocoicoids) for cancer and organ transplantation; those receiving biologic agents such as infliximab and etanercept for rheumatoid ahritis and inflammatory bowel disease; children with primary immunodeficiency diseases; and premature malnourished infants."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDangerous area of face is so called because?\nA) Its infection can lead to cavernous sinus thromobosis and can be life threatning\nB) Trauma here leads to massive bleeding and death\nC) It is easily scarred\nD) it's easily hurt in injuries", "output": "0, because ANSWER: (A) Its infection can lead to cavernous sinus thromobosis and can be life threateningREF: Dhingra 4th ed page 191The dangerous triangle of the face or maxillofacial death pyramid (MDP) consists of the area from the corners of the mouth to the bridge of the nose, including the nose and maxilla. Due to the special nature of the blood supply to the human nose and surrounding area, it is possible (although very rare) for retrograde infections from the nasal area to spread to the brain.This is possible because of venous communication (via the ophthalmic veins) between the facial vein and the cavernous sinus. The cavernous sinus lies within the cranial cavity, between layers of the meninges and is a major conduit of venous drainage from the brain."}

{"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 non symmetrical frequency distribution is known as -\nA) Normal distribution\nB) Skewed distribution\nC) Cumulative frequency distribution\nD) None of the above", "output": "1, because ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is associated with an increased incidence of heterotopic pregnancy?\nA) Obesity\nB) Multiparity\nC) Prior cesarean delivery\nD) Assisted reproductive technologies", "output": "3, because A heterotopic pregnancy is more likely associated with any of the following: Conception achieved by Assisted reproductive techniques Persistent or rising hCG levels after dilatation and curettage for an induced or spontaneous aboion A uterine fundus larger than menstrual dates More than one corpus luteum Absent vaginal bleeding in the presence of signs and symptoms of an ectopic pregnancy Sonographic evidence of uterine and extrauterine pregnancy."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nRaju, a 10 yr old boy is having difficulty in learning at school. He has sho lapses of awareness with eyelid fluttering that occur every 5-10 minutes. EEG studies reveal brief 3 Hz spike and wave discharges appearing synchronously in all the leads. Which of the following drugs would be effective but has the disadvantage that it causes sedation and tolerance?\nA) Diazepam\nB) Ethosuximide\nC) Clonazepam\nD) Valproic acid", "output": "2, because Diagnosis of the patient is petit mal epilepsy (absence seizures). Drugs effective against absence seizures are: Ethosuximide Valproate Clonazepam Lamotrigine Clonazepam is a benzodiazepine that can cause sedation and tolerance. Thedrug of choicefor childhood absence seizures (in India) issodium valproate."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPeak level of LH required for ovulation:\nA) 15 ng/ml\nB) 50ng/ml\nC) 30ng/ml\nD) 75ng/ml", "output": "3, because Peak level of LH required for ovulation is 75 ng/ml It lasts for 24 hrs Ref: Shaw Gynecology 17 e pg 40."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAnesthetic agent of choice in asthma patient is?\nA) Thiopentone\nB) Methexitone\nC) Ketamine\nD) Propofol", "output": "2, because Ans. is 'c' i.e., Ketamine * Ketamine is a potent bronchodilator; therefore it is the anesthetic agent of choice in bronchial asthma patients.* Halothane is the inhalational agent of choice in asthmatics.Anesthetics safe in asthma patientsInducing agentPropofol, etomidate, ketamineOpioidsPethidine, Fentanyl, AlfentanilMuscle relaxantsVecuronium, rocuronium, PancuroniumVolatile agentsHalothane, Sevoflurane, Desflurane, Isoflurane, N2OOthersBenzodiazepines (among hypnotics BZDs are safe)"}

{"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 used as adjunct therapy for treatment of fungal corneal ulcer?\nA) Atropine eye drops\nB) Dexamethasone eye drops\nC) Pilocarpine eye drops\nD) Lidocaine", "output": "0, because Atropine eye drops are used to reduce pain from ciliary spasm and prevent formation of posterior synechiae."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nNerve supply to stylohyoid is from?\nA) 1st arch\nB) 2nd arch\nC) 3rd arch\nD) 4th arch", "output": "1, because The stylohyoid is supplied by the facial nerve, which is the nerve of the second pharyngeal arch. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th 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\nHyponatremia is seen in\nA) Hypehyroidism\nB) Hypothyroidism\nC) DM\nD) Increased insensible loss", "output": "1, because Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. .Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (<135 mmol/L) Ref Davidson 23rd edition pg 370"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThreonine, while metabolism is conveed to which amino acid:\nA) Proline\nB) Alanine\nC) Glycine\nD) None of the above", "output": "2, because Threonine aldolase cleaves threonine to acetaldehyde and glycine. Ref: Harper 28th edition, chapter 29."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIn a child, non - functioning kidney is best diagnosed by-\nA) Ultrasonography\nB) IVU\nC) DTPA renogram\nD) Creatinine clearance", "output": "2, because Ans. is 'c' i.e., DTPA renogram o The most convenient method of estimation of renal function is by isotope renography. Kumar/85] o Two types of isotope renography is there ? 1) Renogram, DTPA scan or MAG3 DTPA and MAG3 are rapidly excreted by the kidney and are therefore used as radiopharmaceutical agents for dynamic scan. This scan is preferred for the information ? i) About the blood flow of kidney ii) How well each kidney is functioning iii) It there is any obstruction to urine output 2) DMSA scan DMSA is concentrated in the renal parenchyma for a time and is therefore used as static scan. This scan is preferred to lood at structure of kidney, i.e. size, shape and position."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nGround glass hepatocytes are seen in which of the viral hepatitis -\nA) HAV\nB) HBV\nC) HCV\nD) HDV", "output": "1, because HBV-infected hepatocytes may show a cytoplasm packed with spheres and tubules of HBs Ag, producing a finely granular cytoplasm (\"ground-glass hepatocytes\")."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nExample of Dimorphic fungus -\nA) Cryptococcus\nB) Blastomyces\nC) Cladosporum\nD) T. montagrophytes", "output": "1, because Ans. is 'b' i.e., Blastomyces Dimorphic fungio Fungi that have two growth forms, such as mold (filaments) and a yeast, which develop under different growth conditions.o In host tissues or cultures at 3 / C they occur as yeasts, while in the soil and in cultures at 22 C they appear as moulds.o Most fungi causing systemic infections are dimorphic fungi.Examples:# Coccidioides# Histoplasma# Blastomyces# Paracoccidioides# Sporothrix (Sporotrichum)# Candida albicans# Penicillium mameffiNote - Candida albicans is a dimorphic fungus, while other species of Candida are not dimorphic."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFirst cell of RBC development:\nA) Proerythroblast\nB) Intermediate normoblast\nC) Reticulocyte\nD) Basophilic erythroblast", "output": "0, because a. Proerythroblast(Ref: Nelson's 20/e p 2304-2308, Ghai 8/e p 330)Stage of RBC development are: Proerythroblast - Basophillic - polychromatic - Orthochromatic erythroblast - Nucleated RBC - Reticulocyte - Mature RBC."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHair on end appearance is seen in:\nA) Thalassemia\nB) Scurvy\nC) Rickets\nD) Sickle cell disease", "output": "0, because Ans. Thalassemia"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAmalgam often tends to discolor the teeth. This can be inhibited by using:\nA) A zinc free alloy\nB) An alloy containing zinc\nC) Calcium hydroxide on the pulpal floor\nD) Cavity varnish on all cut surfaces", "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\nLevel III neck nodes are\nA) In the sub-mental triangle\nB) In the posterior triangle\nC) In the midline from hyoid to suprasternal notch\nD) around the middle 1/3rd of internal jugular vein", "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 patient with multiple hypopigmented & hypesthetic patches on lateral aspect of forearm with abundance of AFB and granulomatous inflammation on histology. The diagnosis is\nA) Tuberculoid leprosy\nB) Indetermediate leprosy\nC) Borderline leprosy\nD) Lepromatous leprosy", "output": "2, because C i.e. Border line leprosy"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nGartners duct cyst lies in\nA) Lateral aspect of uterine wall\nB) Upper edge of broad ligament\nC) Anterolateral wall of vagina\nD) Posterior to ovarian ligament", "output": "2, because Gartners duct cyst lies in anterolateral wall of vagina."}

{"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 can laugh aloud at the age of:-\nA) 2 months\nB) 4 months\nC) 6 months\nD) 9 months", "output": "1, because A child laughs aloud at the age of 4 month. 1 month - ales to sound 2 months - Vocalizes 3 months - Coos 4 months - Laughs aloud"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIn which of the following conditions of malabsorption, an intestinal biopsy is diagnostic-:\nA) Celiac disease\nB) Tropical sprue\nC) Whipple's disease\nD) Lactose intolerance", "output": "2, because Answer is C (Whipple's Disease): An intestinal biopsy is diagnostic/specific for malabsorption due to Whipple's disease. Three most commonly asked forms of Malabsorption Syndromes Whipple's Disease Tropical Sprue Coeliac Disease Malabsorption syndrome with systemic Malabsorption syndrome of infectious Malabsorption syndrome of non infectious features with infectious etiology etiology without systemic features etiology without systemic features Etiology Etiology Etiology Gram negative actinomycetee Caused by some strains of E.coli Caused by intolerance to 'gliadin' gluten a Tropheryma whippelii protein found in wheat rye, barley . Biopsy Biopsy Biopsy Biopsy is Abnormal and Biopsy is abnormal but not Biopsy is abnormal but not specific/diagnostic specific/diagnostic specific/diagnostic Lamina Propria is infiltrated with Shoened, thickened villi increased Blunting and flattening surface with villi macrophages containing PAS positive crypt depth infiltration by either absent or broad and sho glycoproteins and rod shaped bacilli mononuclear cells Crypts are elongated"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nConstrictions in esophagus are seen at all the levels except:\nA) At the begining of esophagus\nB) At the site of crossing of esophagus by aoic arch\nC) Where esophagus pierces the diaphragm\nD) At the point of crossing of thoracic duct", "output": "3, because The esophagus has four constrictions.Where the pharynx joins the upper end - 15 cm from incisor teethThe second is at the where the aoic arch - 22.5 cm from incisor teethThe left bronchus cross its anterior surface - 27.5 cm from incisor teethWhere the esophagus passes through the diaphragm into the stomach - 37.5 cm from incisor teeth These constrictions are of considerable clinical impoance because they are sites where swallowed foreign bodies can lodge or through which it may be difficult to pass an esophagoscope.Because a slight delay in the passage of food or fluid occurs at these levels, strictures develop here after the drinking of caustic fluids. Those constrictions are also the common sites of carcinoma of the esophagus."}

{"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. Immunity by vaccine of yellow fever is provided for:\nA) 6 years staing from 6 days after vaccination\nB) 6 years staing from 10 days after vaccination\nC) 10 years staing from 6 days after vaccination\nD) 10 years staing from 10 days after vaccination", "output": "3, because 10 years staing from 10 days after vaccination"}

{"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 Hepatitis virus which can be cultured is:\nA) HAV\nB) HBV\nC) HDV\nD) HCV", "output": "0, because HAV"}

{"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 muscles are useful in Supination and Pronation of Hand EXCEPT\nA) Anconeus\nB) Brachio-radialis\nC) Supinator\nD) Biceps brachii", "output": "0, because (A) Anconeus # Supination & Pronation are rotatory movements of forearm (and hand) around a vertical axis.> In a semiflexed elbow, the palm is turned upwards in supination, and downwards in pronation Remember: Kings pronate, Beggars supinate> The movements are permitted at the superior and inferior radioulnar joints, there is no middle radioulnar joint, and so no role. The radius is pronated by the pronator teres and pronator quadratus muscles. Pronation is performed by pronator quadratus and pronator teres muscle. Brachioradialis puts the forearm into a midpronated/supinated position from either full pronation or supination. Hand is supinated by the brachioradialis, supinator (brevis), and biceps muscles. The hand is supine in the anatomical position (i.e., palms facing up during autopsy).This action is performed by the Biceps brachii and the Supinator muscle"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVitamin required for collagen synthesis\nA) Vitamin A\nB) Vitamin C\nC) Thiamine\nD) Folic acid", "output": "1, because The active form of vitamin C is ascorbic acid (Figure 28.8). The main function of ascorbate is as a reducing agent in several different reactions. Vitamin C has a well-documented role as a coenzyme in hydroxylation reactions, for example, hydroxylation of prolyl and lysyl residues of collagen (see p. 47). Vitamin C is, therefore, required for the maintenance of normal connective tissue, as well as for wound healing. Vitamin C also facilitates the absorption of dietary iron from the intestine.Deficiency of ascorbic acid A deficiency of ascorbic acid results in scurvy, a disease characterized by sore and spongy gums, loose teeth, fragile blood vessels, swollen joints, and anemia (Figure 28.9). Many of the deficiency symptoms can be explained by a deficiency in the hydroxylation of collagen, resulting in defective connective tissue.Ref: Lippincott, 5th edition, page no: 377"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nGlobal removal of disease agent refers to\nA) Disease control\nB) Disease elimination\nC) Disease eradication\nD) Prevent disease", "output": "2, because Disease control : Is decrease in incidence of disease, so that it is no more public health problem.\nDisease elimination : Complete reduction in incidence of disease in defined geographical area, but organism persists.\nDisease Eradication : Global removal of organism."}

{"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 drug of choice in mycoplasma pneumonia in children is \u2013\nA) Tetracycline\nB) Streptomycin\nC) Cotrimoxazole\nD) Erythromycin", "output": "3, because Treatment of pneumonia in children\n\nFor mildly ill patient (not require hospitalization)\n\n\nEmpirical treatment \u2192 Amoxicillin is the DOC.\n\n\nAtypical (mycoplasma) pneumonia \u2192 macrolides (Azithromycin, Erythromycin).\n\nFor Hospitalized patients\n\nIV cefuroxime or cefotaxime or ceftriaxone.\nIf clinical features suggest staphylococcal pneumonia, vancomycin or clindamycin are also added."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following does not cross blood brain barrier ?\nA) Glycopyrolate\nB) Atropine\nC) Scopolamine\nD) Promethazine", "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\nAll of the following are advantages of paralleling technique except:\nA) An excellent bone level assessment\nB) The shadow of the zygomatic bone frequently overlies the roots of the upper molars\nC) No elongation or foreshortening seen in periapical region\nD) Interproximal caries is clearly indicated", "output": "1, because Advantage of Long Cone Technique:\n1. Accuracy: The paralleling technique produces an image that has dimensional accuracy (A profile view of the tooth with buccal and lingual roots projected in their normal respective lengths as\u00a0buccal and lingual cusps correctly related on the same plane); the image is very representative of the actual tooth. The radiographic image is free of distortion and exhibits maximum details and definition. There is no overlap of related structures (eg. the zygomatic shadow), all shadows of anatomical structures are cast in\u00a0their proper anatomic position.\nThis accuracy is due to:\n\nIncreased source film distance.\nObject and film are parallel to each other.\nCentral ray strikes perpendicular to the long axis of the tooth and film.\nThough the object film distance is increased, it is compensated by increased source film distance and therefore, there is decreased enlargement.\nThe increased kVp, to reduce exposure time, as the source film distance is increased, helps by reducing secondary and unwanted, short wavelength radiations.\n\n2. Simplicity: This technique is simple and easy to learn and use. The film holder with a beam alignment device eliminates the need for all dental surgeons to determine horizontal and vertical angulations and also eliminates chances of dimensional distortion and coning off.\n3. Duplication: This technique is easy to standardize and can be accurately duplicated or repeated, when serial radiographs are indicated. As a result, comparison of serial radiographs exposed using this technique have great validity.\n4. Facial screens can be used.\n5. There is decreased secondary radiation.\n6. The radiographs produced give,\n\nAn excellent bone level assessment.\nNo elongation or foreshortening seen in the periapical region.\nInterproximal caries is\u00a0clearly indicated.\n\n7. The shadow of the zygomatic bone appears above the apices of the molar teeth.\n8. The periodontal bone levels are well represented.\n9. The periapical tissues are accurately shown with minimal foreshortening or elongation.\n10. The crowns of the teeth are well shown enabling detection of proximal caries.\n11. The relative positions of the film packet, teeth and X-ray beam are always maintained, irrespective of the position of the patient\u2019s head. This is useful for handicapped and compromised patients."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich muscle is attached to intra-articular disc of temporomandibular joint ?\nA) Masseter\nB) Temporalis\nC) MedialPterygoid\nD) Lateral pterygoid", "output": "3, because Ans. is 'd' i.e., Lateral pterygoid Temporomandibular jointo It is a synovial, bicondylar joint between the mandibular fossa and articular tubercle of temporal bone above and the head of mandible below. The joint is completely divided into two compartments (upper and lower) by a fibro cortilaginous articular disc. Ligaments of TM joints are fibrous capsule, Lateral temporomandibular ligament, and stylomandibular ligament.o The articular disc is a fibrocartilaginous disc which divides joint cavity into an upper and a lower compartment. The upper compartment permits gliding movement and the lower compartment permits rotatory as well as gliding movements. The articular disc represents the degenerated premitive insertion of lateral pterygoid: Central portion of articular disc is least vascular. Articular disc acts as shock absorber, prevents friction between articular surfaces and also has proprioceptive function. Articular disc also increases the area of contact and hence helps in distribution of weight across the joint, o There are following movements in TM joints1) Protrusion (protraction of chin):- Lateral and medial pterygoid of both sides acting together, assisted by superficial fibers of masseter.2) Retraction (Retraction of chin):- Posterior fibers of temporalis assisted by deep fibers of masseter.3) Elevation (Closing of mouth):- Masseter, temporalis, and medial pterygoid, of both sides.4) Depression (opening of mouth):- Both lateral pterygoids assisted by digastric, mylohyoid and geniohyoid.5) Side to side (lateral) movement:- Lateral and medial pterygoid of one side acting alternately with each other.o Dislocation of mandible occurs when mouth is opened too widely by excessive contraction of lateral pterygoid. Head of the mandible slips anteriorly into infratemporal fossa, o TM joints is supplied by auriculotemporal nerve and masseteric 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\nThe commonest cause of death in a patient with primary amyloidosis is -\nA) Renal failure\nB) Cardiac involvement\nC) Bleeding diathesis\nD) Respiratory failure", "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\nFlowing wax appearance on anterior and posterior borders of veebrae is seen in -\nA) Ankylosing spondylitis\nB) DISH\nC) Psoriatic ahropathy\nD) Rheumatoid ahritis", "output": "1, because Radiological features of DISH (Diffuse Idiopathic skeletal hyperostosis) : Flowing calcification and ossification along the anterolateral aspect of veebral bodies. - Flowing wax appearance Preserved disc space. Absence of bony ankyosis of facet joints,absence of sacroiliac bony erosion,sclerosis or bony fusion."}

{"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 4-year-old child presented with a palpable abdominal mass in the right flank region which was painless and slowly increasing in size along with some episodes of fever and hematuria. On examination, hypeension was noted. CT scan of the abdomen was done. The patient was operated and the mass was resected. The gross specimen and the HPE examination are given below. All of the following drugs are approved for the above condition except: -\nA) Doxorubicin\nB) Dactinomycin\nC) Vincristine\nD) Bleomycin", "output": "3, because This is a case of Wilm's tumour. Wilms tumor is often associated with mutations in the WT1 gene, CTNNB1 gene, or AMER1 gene CT image shows a mass in the right kidney. Gross nephrectomy specimen shows a Wilms tumor pushing the normal renal parenchyma to the side. HPE image shows the characteristic three components: Malignant small round (blue) cells ~ 2x the size of resting lymphocyte (blastema component) Tubular structures/rosettes (epithelial component) Loose paucicellular stroma with spindle cells (stromal component) The median age at diagnosis of this kidney tumor (see the image below) is approximately 3.5 years. Clinical findings include the following: Asymptomatic abdominal mass (in 80% of children at presentation) Abdominal pain or hematuria (25%) Urinary tract infection and varicocele (less common) Hypeension, gross hematuria, and fever (5-30%) Hypotension, anemia, and fever (from hemorrhage into the tumor; uncommon) Respiratory symptoms related to lung metastases (in patients with advanced disease; rare) Drugs approved for chemotherapy are: - Cyclophosphamide Vincristine Doxorubicin Dactinomycin"}

{"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 hormone increases with age ?\nA) GI\nB) Prolactin\nC) FSH\nD) Insulin", "output": "2, because Ans. is 'c' i.e., FSHIncreasing age affects the hormonal secretion of body."}

{"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 hypercalcemic crisis is -a) Carcinoma breastb) Parathyroid hyperplasiac) Parathyroid adenomad) Paget's disease\nA) a\nB) bc\nC) ad\nD) ac", "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\nMost common genetic mutation in Ca pancreas\nA) KRAS\nB) p-16\nC) P53\nD) COX - II", "output": "0, because MC genetic mutation in Ca pancreas/ Cholangiocarcinoma - KRAS > p-16 MC genetic mutation in Ca- GB - P53 > K-RAS MC genetic mutation in Ca stomach - P53 > COX - II"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nLeukocyte alkaline phosphate is increased in all, except\nA) Polycythemia vera\nB) CML\nC) Myelofibrosis\nD) Myeloid metaplasia", "output": "1, because Answer is B (CML): Leucocyte Alkaline phosphatase is decreased in CML (chronic myeloid leukemia) PNH (Paroxysmal nocturnal hemoglobinuria)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are true about FTA -ABS in Syphilis, except\nA) FTA - ABS becomes negative after treatment\nB) Present in secondary syphilis\nC) It is a specific test\nD) May be positive in Lyme's disease", "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\nThe protein synthesis is soed out at/by\nA) Ribosomes\nB) Mitochondria\nC) Golgi-apparatus\nD) Endoplasmic reticulum", "output": "2, because Main function of Golgi apparatus is protein soing, packaging, and secretion. Mitochondria are the powerhouse of cell. Detoxification of various drugs is an impoant function of ER. Ribosomes are involved in protein synthesis.Ref: DM Vasudevan - Textbook of Biochemistry for Medical Students, 7th edition, page no: 12"}

{"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 below mentioned fundus shows presence of:\nA) Forster-Fuchs spots\nB) Papilledema\nC) Papillitis\nD) Optic neuritis", "output": "0, because Ans. (a) Forster-Fuchs spots."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOpen fracture is treated by\nA) Tourniquet\nB) Internal fixation\nC) Debridement\nD) External fixation", "output": "2, because C i.e. Debridement"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMaxillary prominence develops in\nA) 1st pharyngeal arch\nB) 1st pharyngeal groove\nC) 1st pharyngeal pouch\nD) 1st pharyngeal membrane", "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 59 yr old man with severe myxomatous mitral regurgitation is asymptomatic,wi wia left ventricular ejection fraction of 45% and an endsystollic diameter index of 2.9cm/m2 . The most appropriate treatment is\nA) Mitral valve repair or replacement\nB) No treatment\nC) ACE inhibitor therapy\nD) Digoxin and diuretic therapy", "output": "0, because Ref Harrison 19 th ed pg 1545 Valve repair for ischemic MR is associated with lower periopera- tive moality rates but higher rates of recurrent MR over time. In patients with ischemic MR and significantly impaired LV systolic function (EF <30%), the risk of surgery is higher, recovery of LV per- formance is incomplete, and long-term survival is reduced."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPregnant and lactating mothers need_____ mg of dietary calcium per day\nA) 400 mg\nB) 600 mg\nC) 800 mg\nD) 1000 mg", "output": "3, because Ans. d (1000 mg) (Ref. Park Textbook of PSM 22nd/pg.590; table 29)PREGNANCYLACTATION# Extra calories - 300,# Extra calories - 550 (0 to 6 months) 400 (6 to 12 months),# Extra proteins - 15 g,# Extra proteins - 25 gm (0 to 6 months) 18 gm (6 to 12 months),# Calcium 1000 mg/day,# Calcium 1000 mg/day, iron - 30 mg/day,# Iron - 38 mg/day,# Folic acid - 150 mg/day.# Folic acid - 400 mg/day."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nMost common malignancy in children is\nA) ALL\nB) AML\nC) Neuroblastoma\nD) Wilm's tumor", "output": "0, because Leukemia is most common malignancy in the pediatric age groupLeukemia/lymphoma =40% (ALL is more common than AML)CNS Tumor=30%Embryonal & Sarcoma=10%2nd most common is CNS Tumor (30%)(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2437-2445)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBlood loss in class III hemorrhagic shock\nA) < 750 mL\nB) 750 - 1500 mL\nC) 1500 - 2000 mL\nD) > 2000 mL", "output": "2, because Class I - < 750 mL\nClass II - 750 - 1500mL\nClass III - 1500 - 2000mL\nClass IV - 2000mL."}

{"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 agents is recommended for treatment of Gastrointestinal Stromal Tumors (GIST) -\nA) Sorafenib\nB) Imatinib\nC) Gefitinib\nD) Erlotinib", "output": "1, because Ans. is 'b' i.e., Imatinib Tyrosine kinase inhibitors imatinib and sunitinib are approved for the treatment of Gastrointestinal Stromal Tumors (GIST)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDrug causing impaired taste is\nA) metronidazole\nB) losaan\nC) paracetamol\nD) aspirin", "output": "0, because antibiotics, such as ACE inhibitors like <a class=\"content-link\" style=\"-webkit-font-smoothing: antialiased; box-sizing: inherit; background-color: transparent; cursor: pointer; text-decoration-line: none; border-color: currentcolor; color: ;\" href=\" anhydrase inhibitors, such as methazolamide etc</li> ESSENTIALS of medical PHARMACOLOGY SIXTH EDITION-KD TRIPATHI Page:688,689"}

{"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 syndrome is due to non-disjunction of?\nA) 21\nB) 18\nC) 11\nD) 15", "output": "0, because Ans. is 'a' i.e., 21 Chromosome In 95% of cases of Down syndrome-trisomy of 21:? Extra chromosome is of maternal in origin. 1% have mosaic with some all have 46 chromosome. 4% have robesonian translocation. t (13 21) o t (14 : 21) t (15 : 21) Very rarely long arm of chromosome 21 is triplicate (Paial trisomy)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSecretin stimulation test used for -\nA) Gastrinoma\nB) Pituitary adenoma\nC) Incidenteloma\nD) Insulinoma", "output": "0, because Ans. is 'a' i.e., Gastrinoma Gastrin Provoking tests* Gastrin provocative tests have been developed in an effort to differentiate between the causes of hypergastrinemia.* The tests are the secretin stimulation test and the calcium infusion study.* The most sensitive and specific gastrin provocative test for the diagnosis of gastrinoma is the secretin study. An increase in gastrin of >120 pg within 15 minutes of secretin injection has a sensitivity and specificity of >90% for ZES. PPI induced hypochlorhydria or achlorhydria may lead to a false-positive secretin test, thus this agent must be stopped for 1 week before testing.* The calcium infusion study is less sensitive and specific than the secretin test, which coupled with it being a more cumbersome study with greater potential for adverse effects, relegates it to rare utilization in the cases where the patient's clinical characteristics are highly suggestive of ZES, but the secretin stimulation is inconclusive."}

{"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 has Bullous Lesion; on Tzank smear\nA) Langerhans cells are seen\nB) Acontholysis\nC) Leucocytosis\nD) Absence of melanin pigment", "output": "1, because B i.e. Acantholysis"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nKlatskin tumor: (Repeat)\nA) Primitive neuroectodermal tumor in chest\nB) Cholangiocarcinoma arising from bifurcation of bile duct\nC) Lung adenocarcinoma involving apical region\nD) Enterochromaffin cell tumor", "output": "1, because Ans: B (Cholangiocarcinoma arising from bifurcation of bile duct) Ref: Benbrahim Z et al. Askin's tumor: a case report and literature review. World J Surg Oncol. 2013: 11: 10.Explanation:Cholangiocarcinoma arising from bifurcation of bile duct - Klatsin tumorLung adenocarcinoma involving apical region - Pancoast tumorAskin tumors - Primitive neuroectodermal tumors (PNET) arising from the chest wallOther named TumorsBuschke-Lowenstein tumor-- Giant condyloma acuminatumAckerman tumor - Subtype of Verrucous Carcinoma (Carcinoma cuniculatum)Grawitz tumor - Renal cell carcinomaKrukenberg tumor - Metastatic secondaries in GIT from an ovarian primaryKuttner's stumor - Sialadenitis (sialoadenitis) - Inflammation of a salivary glandPotts puffy tumor - Frontal osteomyelitis with subperiosteal abscess e:Wilms tumor - Nephroblastoma affecting children"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTRUE about Vein of Labbe:\nA) Drains into Superior Sagittal Sinus\nB) Drains into Transverse Sinus\nC) Anastomotic channel for Superior Cerebral Veins\nD) Superior anastomotic channel for Superficial Middle Cerebral Vein", "output": "1, because Superficial Middle Cerebral Vein communicates with the transverse sinus inferior anastomotic vein of Labbe. The Vein of Labbe is inferior (not superior) anastomotic vein, which crosses and anastomoses at its two ends with the Middle Cerebral Vein and the transverse sinus (not superior sagittal sinus). It drains its adjacent coical regions gathering tributaries from minor veins of the temporal lobe (not superior cerebral veins)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAldosterone regulates extracellular volume and potassium homeostasis by binding to its receptors present in all, EXCEPT:\nA) Liver\nB) Colon\nC) Hippocampus\nD) Distal nephron", "output": "0, because Aldosterone regulates extracellular volume and potassium homeostasis by binding to renal coical collecting duct principal epithelial cell mineralocoicoid receptors. The mineralocoicoid receptor -- a member of the nuclear receptor family and also found in the hea, colon, and hippocampus -- is localized to the cytoplasm prior to activation, undergoes a conformational change on binding to aldosterone, and translocates into the nucleus where it functions as a transcription factor. Aldosterone is rapidly inactivated to tetrahydroaldosterone in the liver. Ref: Young, Jr W.F. (2011). Chapter 10. Endocrine Hypeension. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDisorders of phagocytosis are all, except:\nA) Job's syndrome\nB) Chediak-Higashi syndrome\nC) Myeloperoxidase deficiency\nD) Wiskott-Aldrich syndrome", "output": "3, because Ans. (d) Wiskott-Aldrich syndrome Ref. Anantlumarayan 9/e, p 172 Disorders of phagocytosis Chronic granulomatous disease Myeloperoxidase deficiency Chediak-Higashi syndrome Leukocyte G6PD deficiency Job's syndrome Tuftsin deficiency Lazy leukocyte syndrome Hyper-IgE syndrome Actin binding protein deficiency Shwachman's disease"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nConsider the following characteristics of vaginal discharge in bacterial vaginosis :\nA) Green and thick\nB) pH < 4.5\nC) Increase in number of lactobacilli\nD) Whiff test positive", "output": "3, because Whiff test positive"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich among the following is ANCA negative?\nA) Wegener's granulomatosis\nB) Microscopic polyangitis\nC) Polyarteritis nodosa\nD) Churg-Strauss syndrome", "output": "2, because Ans: c (PAN) Ref: Robbins, 7th ed, p. 539 & Harrison, 16th ed, p. 2002\"PAN has no association with ANCA\"More about PAN:* Vasculitis of medium sized/small muscular arteries sparing pulmonary circulation* Characteristic -- All stages of inflammation coexist in different vessels.Microaneurysms (< 1 cm) - but not pathognomonic* 30% patients have hepatitis B Ag in their serum* MC organ system involved -- musculoskeletal > renal* MC cause of death -- gastrointestinal* Involvement of venules is suggestive of microscopic polyangitis"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEdema occurs due to:\nA) Increased capillary permeability\nB) Decreased capillary permeability\nC) Decreased interstitial fluid\nD) Decreased blood flow", "output": "0, because None"}