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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\nUnmet need for contraception in a 35 years female is for ?\nA) Spacing bih\nB) Limiting bih\nC) Improve maternal health\nD) Improve family health", "output": "1, because Ans. is 'b' i.e., Limiting bih Many women who are sexually active would prefer to avoid pregnancy, but neveheless are not using any method of contraception.These women are considered to have 'unmet need' for family planning.The concept is usually applied to married women.According to the National Family Health Survey-3, Unmet need for family planning is highest (27.1%) among women below 20 years age and is almost entirely for spacing the bihs rather than for limiting the bihs.It is also relatively high for women in age group 20-24 years (21-1%) with 75% need for spacing and 25% for limiting the bih.Unmet need for contraception among women aged 30 years and above are mostly for limiting"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhile shaving, a 45-year-old teacher notices a marble-sized mass beneath his left ear. The mass is eventually excised, revealing which of the following benign parotid gland lesions?\nA) Glandular hyperophy, secondary to vitamin A deficiency\nB) Cystic dilation\nC) Mikulicz's disease\nD) Wahin's tumor", "output": "3, because Papillary cystadenoma lymphomatosum /Wahin's tumor/Adenolymphoma Exclusively seen in parotid gland Derived from salivary tissue inclusion in lymph node More common in males Associated with smoking Only tumor to show hot spot on TC99m-Peecnate Histopathology Papillary cystic pattern lined with columnar oncocytes and cuboidal cells with marked lymphoid component. Lined by a double layer of neoplastic epithelial cells resting on a dense lymphoid stroma sometimes bearing germinal centers =Mikulicz's disease involves chronic inflammation and swelling of the salivary glands, which is benign and usually painless"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSubstrate for gluconeogenesis include?\nA) Glycerol\nB) Leucine\nC) Fatty acids\nD) Acetyl CoA", "output": "0, because Only 5 amino acids are both glucogenic and ketogenic. Mnemonic - TTT I P Both glucogenic and ketogenic amino acids: Tryptophan Tyrosine Threonine, Isoleucine, Phenylalanine Note: there is a controversy regarding Lysine, some book says it is purely ketogenic some say it is both Ketogenic and glucogenic serine is only glucogenic amino acid."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nLangerhans cells in skin are\nA) Antigen presenting cells\nB) Pigment producing cells\nC) Keratin synthesising cells\nD) Sensory neurons", "output": "0, because Ans. is 'a' i.e., Antigen presenting cells"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBlack eye is a type of-\nA) Patterend abrasion\nB) Ectopic abrasion\nC) Ectopic bruise\nD) Friction abrasion", "output": "2, because Ans. is 'c' i.e., Ectopic bruise [Ref: Reddy 30th/ep. 167-168\\o Site of bruise is at the site of impact most of the time however it may be away from the site of impact due to gravity shifting of blood, i.e., ectopic bruise. So, site of bruise does not always indicate site of violencet.o Example of ectopic bruise are : -Black eye (or spectacle hematoma in eyes & eyelids) may be due to fracture of floor of anterior cranial fossa or trauma of forehead (and rarely due to direct trauma),Bruise behind ear indicates basal fracture (rather than a direct blow).Jaw fracture may produce bruise in neck; fracture pelvis my produce bruise in thigh; fracture femur may produce bruise in lowrer thigh or above knee; Calf injury may produce bruise in ankle."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIdeally Dentist population ration should be\nA) 5.597222222\nB) 1:10000\nC) 1:20000\nD) 1:40000", "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\nTongue develops from which branchial arches?\nA) I, II, IV\nB) I, II, III\nC) I, III, IV\nD) I, II, III, IV", "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\nUmbilical cord attached to the margin of placenta:\nA) Circumvallate placenta\nB) Battledore placenta\nC) Velamentous insertion\nD) Vasa previa", "output": "1, because Ans. (b) Battledore placentaRef. William's Obstetrics 23rd ed. Ch: 27* Normally, the cord usually is inserted at or near the center of the fetal surface of the placenta.* Cord insertion at the placental margin is sometimes referred to as a Battledore placenta. It is found in about 7% of term placentas.* Velamentous insertion: This type of insertion is of considerable clinical importance. The umbilical vessels spread within the membranes at a distance from the placental margin, which they reach surrounded only by a fold of amnion. As a result, vessels are vulnerable to compression, which may lead to fetal anoxia. Incidence: 1%"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCataracts in a newborn is:\nA) Zonular\nB) Nuclear\nC) Snowflake\nD) Cortical", "output": "0, because a zonular refkhurana 3rd/e p. 187"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThe causative agent of Lyme's disease:\nA) Borrelia burgdorferi\nB) Borrelia recurrentis\nC) Leptospira icterohemorrhagiae\nD) Clostridium difficile", "output": "0, because Borrelia burgdorferi"}

{"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 presented with vomiting and ataxia. There were oxalate crystals in the urine. The patient was given ethanol and 4 methyl pyrazole for treatment. The likely diagnosis of the patient was?\nA) Methanol poisoning\nB) Ethanol poisoning\nC) Ethylene glycol poisoning\nD) Diazepam poisoning", "output": "2, because Ans. (C) Ethylene glycol poisoning(Ref: Harrison 19/e p319)Symptoms of alcohol overdose along with oxalate crystalluria points towards ethylene glycol poisoning. It is confirmed because the patient is being treated with antidotes like ethanol and fomepizol (4 methyl pyrazole)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nLoeffler's syndrome is seen with all except :\nA) >Toxocara\nB) >Strongyloides stercoralisL. tryptophan\nC) >Giardiasis\nD) Giardiasis", "output": "3, because Giardiasis Pulmonary diseases associated with tissue or blood eosinophilia are a heterogenous group of disorders. They are classified as : Loeffler's syndrome It is a benign acute eosinophilic pneumonia of unknown cause characterized by migrating pulmonary infiltrates and minimal clinical manifestations. These are usually secondary to parasites or drugs. Loeffler's syndrome reflects a hypersensitive response to an ingested or inhaled antigen from food, medication or an infectious agent. Causes of Loeffler's syndrome Parasitic infections Ascaris Schistosomiasis Strongyloides Ancyclostomiasis Trichomoniasis Clonorchiasis Visceral larva migrans Tapeworm Paragonimiasis"}

{"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 muscles elevates the mandible?\nA) Buccinator\nB) Temporalis\nC) Caninus\nD) Lateral pterygoid", "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 60-year-old woman presents with symptoms of weight loss, anxiety, and palpitations. On examination, she has a thyroid goiter. Which of the following is the most likely cardiac finding?\nA) prolonged circulation time\nB) decreased cardiac output\nC) paroxysmal atrial fibrillation\nD) pericardial effusion", "output": "2, because Thyroid disease may affect the heart muscle directly or there may be excessive sympathetic stimulation. Common symptoms of thyrotoxic heart disease include palpitations, exertional dyspnea, and worsening angina. Atrial fibrillation is particularly common in older individuals."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPedigree analysis - Analyze the following pedigree and give the mode of inheritance ?\nA) Autosomal recessive\nB) Autosomal dominant\nC) Mitochondrial inheritance\nD) X linked dominant", "output": "2, because Ans. is 'c' i.e., Mitochondrial inheritance i) Disease is manifesting in both males and females. ii) But, the disease is transmitting to next generation only by females (mother). Both these are characteristics of mitochondrial diseases. Mitochondrial diseaes o Mitochondria' DNA is the only non-chromosomal DNA in human cells DNA in humans may be found either in the Nucleus (Nuclear DNA) or in the Mitochondria (Organelle DNA) o Mitochondria' DNA,is always maternally inherited. Mitochondrial and nuclear DNA are located in different places in the cell. During feilization, the sperm and egg cell nuclei fuse to form an embryo. The egg cell is very large compared to the sperm, so although the cells' nuclei fuse, the rest of the cell mass in the embryo comes from the egg only. Nuclear DNA is therefore co-inherited but the mitochondrial DNA, which is located outside of the nucleus, is always maternally inherited because all mitochondria in a foetus and later adult are derived from the mitochondria in the mother's egg. All children from affected mother will inherit the disease but it will not be transmitted from an affected father to his 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\nTerm cafe coronary was coined by -\nA) Roger Haugen\nB) J. Morton\nC) NeilMarkson\nD) M.Hoppefield", "output": "0, because Ans. is 'a' i.e., Roger Haugen \"A popular term 'cafe coronary * was coined by Dr. Roger Haugen, Medical Examiner of Broward County, Florida for such impaction of food in the respiratory passage \".-- Krishan Vij"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDemyelinating disorder among the following is\nA) Multiple sclerosis\nB) Typhoid\nC) Cholera\nD) All", "output": "0, because Multiple sclerosis is a autoimmune disorder It leads to demyelination of myelinated nervefibers Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:72,73"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIL1 antagonist is -\nA) Anakinra\nB) Abatacept\nC) Adalimumab\nD) Leflunomide", "output": "0, because Ans. is 'a' i.e., Anakinra Drugs used for Rheumatoid arthritisDisease modifying antirheumatic drugs (DMARDs)Biologic response modifier (BRMs)Adjuvant drugs1. Immunosuppresants - Methotrexate, azathioprine, cyclosporine2. Sulfasalazine3. Choloroquine or hydroxychloroquine4. Leflunomide5. Gold sod. thiomalate, Auranofin6. d - Penicillamineo TNF a - inhibitors Etanercept, Infliximab, Adalimumabo IL-1 antagonist Anakinrao CorticosteroidsNote- Other immunosuppressants like cyclosporine, chlorambucil, cyclophosphomide are reserved for cases not responding to other DMARDs."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDirect filling gold formed by electrolytic precipitation is called by all the terms, EXCEPT:\nA) Crystalline gold\nB) Granular gold\nC) Mat gold\nD) Sponge gold", "output": "1, because Electrolytic Precipitate Gold\nAnother form of direct filling gold is microcrystalline gold powder formed by electrolytic precipitation, which is sandwiched between sheets of gold foil and formed into strips. It is also called mat or sponge gold.\nGranular (Powdered) Gold\nGold powders in agglomerated form can also be prepared by chemical precipitation or atomization from molten gold.\nDirect filling gold is supplied in three basic forms:\n\nFoil (also known as fibrous gold)\nElectrolytic precipitate (also\u00a0called crystalline\u00a0gold)\nGranular gold (also called powdered gold)\n\nPhillips 12 Ed, page no. 413"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPredominant blood supply to the supraduodenal bile duct is from vessels:\nA) Which run upward from the major vessels located near the lower pa of bile duct such as the gastroduodenal and retro duodenal aery\nB) Which run downward along the bile duct from right hepatic aery\nC) That arise from hepatic aery proper as it carries up along the common bile duct and supplies it with twigs in a non-axial distribution\nD) That run from cystic aery", "output": "0, because Approximately 60% of the blood supply to the supraduodenal bile duct originates from the pancreaticoduodenal and retroduodenal aeries, whereas 38% of the blood supply originates from the right hepatic aery and cystic duct aery and 2 percent is non-axial.Ref: Gray's Anatomy (40th Edition), Pages 1177, 1185; Essentials of Human Anatomy A.K.Datta 8th Edition, Page 259"}

{"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 gastric polyp is -\nA) Hyperplastic polyp\nB) Inflammatory polyp\nC) Adenomatous polyp\nD) Part of familial polyposis", "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\nWhich of the following is not involved in intrinsic pathway?\nA) Factor XII\nB) Factor XI\nC) Factor IX\nD) Factor VII", "output": "3, because Factor VII is required for the activation of Factor X in extrinsic pathway Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:533"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nGeneral feility rate is a better measure of feility than the crude bih rate because the denominator includes\nA) 15 - 45 years of aged females\nB) Midyear population\nC) Total women population\nD) Married women population", "output": "0, because General feility rate is the number of live bihs per 1000 women in the reproductive are group ( 15-44 or 49 years) in a given year GFR = number of live bih in an area during the year X 1000/ mid year female population age group 15-44 (or 49) in the same area in same year General feility rate is a better measure of feility than the crude bih rate because the denominator includes the number of women in the child bearing age rather than the whole population Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 488"}

{"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 a feature of Hartnup's disease:\nA) Pellagroid skin lesion\nB) Cerebellar ataxia\nC) Mental retardation\nD) Psychological disturbances", "output": "2, because c. Mental retardation(Ref: Nelson's 20/e p 636-642, Ghai 8/e p 653-655)Clinical features of Hartnup disease:Most children with Hartnup defect remain asymptomaticMajor clinical manifestation in symptomatic patient is cutaneous photosensitivity: pellagra-like rash on sun exposureSome patients may have intermittent ataxia & Psychological disturbances, but mental development is usually normal."}

{"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 65-year-old chronic smoker presents with a rapidly enlarging large hilar mass on a chest film associated with significant adenopathy. He also experiences recurrent hypoglycemic spells these days. A provisional diagnosis of Lung carcinoma being considered which of the following subtype will most commonly lead to this spectrum?\nA) Squamous cell carcinoma\nB) Adenocarcinoma\nC) Large cell carcinoma\nD) Small cell tumour", "output": "3, because Small cell - Mediastinal adenopathy, - Hilar mass, - Small or invisibleftlung nodule, - High metastatic potential, - Rapid growth. - May be associated with Hypoglycemia, Cushing's syndrome, Inappropriate secretion of ADH, excessive gonadotropin secretion."}

{"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 not a feature of non cirrhotic poal HT?\nA) Ascites\nB) Hematemesis\nC) Splenomegaly\nD) All are seen", "output": "0, because ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nGiardiasis is best diagnosed by:\nA) CFT\nB) Presence of both cysts and trophozoites in stools\nC) Presence of cysts only\nD) Haemaglutination", "output": "1, because Presence of both cysts and trophozoites in stools"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBiopsy of the parotid gland in Sjogren\u2019s shows:\nA) Neutrophils\nB) Eosinophils\nC) Basophils\nD) Lymphocytes", "output": "3, because \"The earliest histologic finding in both the major and the minor salivary glands is periductal and\u00a0perivascular lymphocytic infiltration.\" (Ref: Robbins)\nSjogren Syndrome\n\nIt is an immune-mediated destruction of the lacrimal and salivary glands characterized by dry eyes\u00a0{keratoconjunctivitis sicca) and dry mouth (xerostomia)\nIt occurs as an isolated disorder (primary form), also known as the sicca syndrome, or more often in\u00a0association with another autoimmune disease (secondary form).\nAssociated diseases\nRheumatoid Arthritis (Me)\nSLE\nPolymyositis\nSystemic sclerosis\nVasculitis\nThyroiditis\nThe ductal epithelial cells of the exocrine glands are the primary target for autoantibodies.\nThere is also systemic B-cell hyperactivity, as evidenced by the presence of ANAs and RF.\nAutoantibodies to the RNP antigens SS-A (Ro) and SS-B (La) (also present in SLE)\nOther secretory glands like nasopharynx, upper airway, and vagina, may also be involved\nInvolved tissues show an intense lymphocyte (primarily activated CD4+ T cells) and plasma cell\u00a0infiltrate.\nLacrimal gland destruction results in a lack of tears, leading to drying of the corneal epithelium, with\u00a0subsequent inflammation, erosion, and ulceration (keratoconjunctivitis).\nSimilar changes may occur in the oral mucosa as a result of the loss of salivary gland output, giving rise to\u00a0mucosal atrophy, with inflammatory Assuring and ulceration (xerostomia).\nDryness and crusting of the nose may lead to ulcerations and even perforation of the nasal septum.\nWhen the respiratory passages are involved, secondary laryngitis, bronchitis, and pneumonitis may\u00a0appear.\nApproximately 25% of the patients (especially those with anti-SS-A antibodies) develop extra-glandular\u00a0disease affecting the CNS, skin, kidneys, and muscles.\nRenal lesions take the form of mild interstitial nephritis associated with tubular transport defects: Unlike\u00a0in SLE. glomerulonephritis is rare.\n90%\u00a0of cases occur in women between 35 and 45 years\nExtraglandular manifestations include synovitis, pulmonary fibrosis, and peripheral neuropathy.\nThere is a 40-fold increased risk of developing non-Hodgkin B-cell lymphoma."}

{"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 disease for which vaccination ceificate is required for international travel is -\nA) Cholera\nB) Hepatitis\nC) Yellow fever\nD) Tetanus", "output": "2, because All travellers including infants exposed to the risk of yellow fever or passing through an endemic zones of yellow fever should possess a valid international ceificate of vaccination against yello fever before they are allowed to enter yellow fever receptive areas. Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 301"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\n24 hours after fever, maculopapular rash and erythema appears on the face of infant. This organism can also cause\nA) ALL\nB) CML\nC) Pure red cell aplasia\nD) Hairy cell leukemia", "output": "2, because It\u2019s caused by Parvo B19 virus, and it causes the following diseases\n\nErythema infectiosum\nFifth disease.\nSlapped cheek appearances.\nArthropathy.\nTransient Aplastic crisis.\nHydrops fetalis (most sensitive period 2nd trimester)\nMyocarditis.\nPPGSS\nPapular - Purpuric Gloves & Stock Syndrome.\n\n\u00a0\nTransient Aplastic Crisis\n\nThe transient arrest of erythropoiesis and absolute reticulocytopenia.\nRBC aplasia or transient aplastic crisis in patients with chronic hemolytic conditions, including:\n\n\nSickle cell disease.\nThalassemia.\nHereditary spherocytosis.\nPyruvate kinase deficiency.\n\n\nIn contrast to children with erythema infectiosum only, patients with aplastic crisis are ill with fever, malaise, and lethargy and have signs and symptoms of profound anemia, including pallor, tachycardia and tachypnea.\nThe incubation period tor transient aplastic crisis is shorter than that for erythema infectiosum because the crisis occurs coincident with the viremia.\nChildren with sickle cell disease may also have a concurrent vasoocclusive pain crisis."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCementum is primarily\nA) Amorphous\nB) Organic\nC) Inorganic\nD) Soft tissue", "output": "2, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is not a bronchodilator\nA) Beta 2 agonist\nB) Methylxanthines\nC) Steroids\nD) Anticholinergics", "output": "2, because Classification: bronchodilators: beta 2 agonists anticholinergics and methylxanthines like caffeine and theophylline ref KD Tripathi 8th ed"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDifference between contusion and post-moem lividity is that post-moem lividity-\nA) Shows sequential color change\nB) Easily washable\nC) Shows diffuse irregular margins\nD) Has raised enzyme levels", "output": "1, because The synopsis of forensic medicine & toxicology;Dr k.s narayan reddy; 28th edition;pg.no. 88; Contusion or bruises are not washable but postmoem lividity is washable. Also refer page no.106"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFomepizole acts as antidote for ?\nA) Methanol poisoning\nB) Cannabis poisoning\nC) Lead poisoning\nD) Cadmium Poisoning", "output": "0, because Ans. is 'a' i.e., Methanol poisoning Methanol is highly toxic alcohol. It is metabolized to formaldehyde (by alcohol dehydrogenas) and formic acid (by acetaldehyde dehydrogenase). It is the accumulation of formic acid which causes toxic effects in methanol poisoning. Accumulation of formic acid results in lactic acidosis/high anion gap metabolic acidosis with low plasma bicarbonates, blindness due to retinal damage, papilledema. Methanol poisoning can be treated by suppoive measures, gastric lavage and sodium bicarbonate (to treat acidosis). Ethanol is useful because it competitively inhibits the conversion of methanol to formic acid. Fomepizole can also be used as it is a specific inhibitor of alcohol dehydrogenase. Folic acid or folinic acid. Enhance the metabolism formic acid to CO2. Hemodialysis may also be used."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nChancroid is caused by?\nA) H. Ducrei\nB) N. Gonnorrea\nC) T. Pallidum\nD) H. Influenza", "output": "0, because Ans:A.)H. Ducrei CHANCROID (SOFT SORE) This venereal infection is caused by the Gram-negative bacillus Haemophilus ducreyi. One to 5 days post-infection, a soft sloughy ulcer appears on the penis or vulva. The treatment of choice is erythromycin (500 mg 6-hourly for 14 days)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBlue daper syndrome is associated with\nA) Tryptophan malabsorption\nB) Tryptophan hyperabsorption\nC) Tyrosine malabsorption\nD) Tyrosine hyperabsorption", "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\nPentavalent immunoglobin is -\nA) IgA\nB) IgG\nC) IgM\nD) IgE", "output": "2, because Ans. is 'c' i.e., IgiMValency of antibodyo The valency of antibody refers to the number of antigenic determinants that an individual antibody molecule can bind.o The valency of all antibodies is at least two and in some instances more.AntibodyValencyIgG2IgA2,4IgM10IgD2IgE2Though the theoretical valency of Ig M is ten, this is observed only with small haptens. With larger antigens, the effective valency falls to five, probably due to steric hindrance. Physical, chemical, and Biologic Properties of Human ImmunoglobulinsPropertyIgGIgAIgMIgDIgEUsual molecular formMonomerMonomer, dimerPentamer, hexamerMonomerMonomerOther chainsNoneJ chain, SCJ chainNoneNoneSubclassesG1G2, G3, G4Al, A2NoneNoneNoneHeavy chain allotypesGm (=30)No Al, A2m (2)NoneNoneNoneMolecular mass, kDa150160, 400950, 1150175190Sedimentation constant, Sw206.6S7S, 11S19S7S8SCarbohydrate content, %3710913Serum level in average adult, mg/mL9.5-12.51.5-2.60.7-3.70.040.0003Percentage of total serum Ig75-857-155-100.30.019Serum half-life, days236532.5Synthesis rate, mg'kg per day3 365'0.40.016Antibody valency22, 430, 12O Classical complement activation+ (G1, 2?, 3)----Alternate complement activation-(G4)+-+-Binding cells via FcMacrophages neutrophils, large granular lymphocytesLymphocytesLymphocytesNoneMast cells, basophils, B cellsBiologic propertiesPlacental transfer, secondary Ab for most antipathogen responsesSecretory immunoglobulinPrimary Ab responsesMarker for mature B-cellsAllergy, antipaTasite responses"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nBCR ABL gene mutation is seen in ?\nA) CML\nB) AML\nC) CLL\nD) ALL", "output": "0, because ANSWER: (A) CMLREF: Robbins 7th ed p. 697BCR gene on chromosome 9 gets translocated to ABL gene on chromosome 22 leading to the formation of a fusion protein with a tyrosine kinase 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\nT helper cells recognizes -\nA) MHC class I\nB) MHC class II\nC) Processed peptides\nD) Surface Ig", "output": "1, because MHC restriction\n\nT cells (in contrast to B cells) cannot be activated by soluble antigens.\nTherefore, presentation of processed antigen by antigen presenting cells is required for induction of cell mediated immunity.\nT cell receptors recognizes peptide antigens that are displayed by major histo compatibility complex (MHC) molecules on the surface of antigen presenting cells.\nT cells develop MHC restriction so that :-\n\n\nHelper (CD4) T cells respond only to foreign antigens presented along with HLA class II (MHC class II).\nCD8 T cells respond to antigens presented along with HLA class I (MHC class I).\nMHC restriction refers to the fact that a given T cell will recognize a peptide antigen only when it is bound to a particular MHC molecule."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMost sensitive test for detection of argemone oil?\nA) Nitric acid test\nB) Paper chromatography\nC) Phosphatase test\nD) Methylene blue test", "output": "1, because Ans. is 'b' i.e., Paper chromatography o Paper chromatography is the most sensitive test. o Note : In previous question, paper chromatography was not there in options, therefore the answer was nitric acid 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\nProstaglandin inhibiting action of Aspirin is useful in the treatment of all of the following conditions except\nA) Analgesia and antipyresis\nB) Closure of ductus aeriosus\nC) Uricosuria\nD) Anti-inflammatory and antiplatelet aggregation", "output": "2, because Inhibition of prostaglandin synthesis is responsible for analgesia, antipyretic, anti-inflammatory and antiplatelet action of aspirin. this action is also utilised in the treatment of PDA. high doses of Aspirin causes uricosuria various therapeutic doses result in hyperuricemia these effects are and related to its action on prostaglandin synthesis Ref kdt 6/e p188"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDermatological sign of carcinoma stomach is?\nA) Palmoplantar keratoderma\nB) Acquired ichthyosis\nC) Acanthosis Nigrans\nD) Acrokeratosis paraneopiastica", "output": "2, because ANSWER: (C) Acanthosis NigransREF: Fitz Patricks Dermatology 6th Edition Page 1612, Harrison's 18th ed chapter 53Indirect repeat Dermatology 2008,2003 (See table of TYPES AND CAUSES OF ACANTHOSIS NIGRICANS) 8t Surgery June 2009"}

{"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 one of the following statements best describe pseudoaneurysm\nA) Focal dilation of vessel in which intimal and medial layers are disrupted and the dilated segment is lined by adventitia\nB) Focal dilation of a vessel only involving one poion of the circumference\nC) Apparent dilation of a vessel due to intrinsic narrowing proximal and distal to the point of apparent narrowing\nD) Dilation of a vessel, though not to the size necessary to be diagnosed as a true aneurysm", "output": "0, because Pseudoaneurysm Wall is not formed by all the three layers Pseudoaneurysms can arise from Primary defects in the aoic wall (e.g -After trauma or contained aneurysm rupture) Anastomotic or cannulation site leaks that occur after cardiovascular surgery. Anastomotic pseudoaneurysms can be caused by Technical problems Deterioration of the native aoic tissue, graft material, or suture. Associated with Marfan syndrome, Loeys-Dietz syndrome Progressive degenerative disease Infection. Saccular aneurysm: affect only one pa of aerial circumference"}

{"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'Brush burn' is\nA) An abrasion\nB) Electric bum\nC) Chemical bum\nD) Contusion", "output": "0, because Ans. a (An abrasion) (Ref. FMT by Reddy. 27th/ Pg. 145 & FMT by Krishan Vij 4th/Pg. 282-283).# An abrasion (or a graze) is a superficial injury involving only the outer layers of the skin and not penetrating the full thickness of the epidermis.# A graze is an injury, which is produced when a broad surface of the skin slides or scrapes against a rough surface.# It is also k/a 'brush burn' as it is caused by the frictional force of rubbing against a surface causes it; resembles a bum.ABRASIONS (GRAZES, SCRATCHES, BRUSH BURNS)# Loss/crushing of outer skin layer due to impact with a rough surface- Tangential impact produces a moving abrasion:# Indicates direction.# Trace material (e.g., grit).- Direct impact produces an imprint abrasion:# Pattern of causative object.# All abrasions reflect site of impact (contrast bruises).# Assessment of age difficult.# Postmortem abrasion - Brown, leathery.- Patterned Abrasions:o Patterned abrasions occur when the force is applied at or around right angle to the surface of skin. The classical example of this is seen in traffic accidents when tyre of a motor car passes over the skin leaving the pattern when the skin has been squeezed into the grooves of the rubber thread.- Pressure Abrasions (Crushing Abrasions / Imprint Abrasions):o When the impact is vertical to the skin surface, the epidermis gets crushed and pressure type of abrasions result and the imprint of the impacting object may be produced. These may be seen in manual strangulation (abrasions produced by fingernails) and in hanging, where weave of the ligature material may be reproduced."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCharacteristic feature of nephritic syndrome in children -\nA) Lipid casts in urine\nB) WBC casts in urine\nC) RBC casts in urine\nD) Albumin in urine", "output": "2, because Ans. is 'c' i.e., RBC casts in urine Acute nephritic syndrome o Nephritic syndrome is a collection of signs associated with disorders affecting the kidneys, more specifically glomerular disorders and is characterized by haematuria, protenuria, hypeension, edema and oliguria. 1. Haematuria The haematuria is slight giving the urine smok appearance. Erythrocytes are detectable by microscopy or by chemical testing for hemoglobin. Presence of RBC casts in urine is classical feature of nephritic syndrome. 2. Proteinuria Proteinuria is mild (< 3 gm/day) also called nephritic range proteinuria or subnephrotic range proteinuria. Proteinuria is nonselective. Edema --> Usually mild and results from sodium and water retention. Liguria --> Reflects the severity of glomerular involvement. Note ? Edema and proteinuria are not as severe as in nephrotic 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\nA 24-year old woman notices increasing shortness of breath after recent treatment for right lower lobe pneumonia. She has no fever, cough, or sputum production. On examination, the pertinent findings are decreased fremitus, dullness on percussion, and absent breath sounds of the right lower lung. In addition, the trachea has shifted to the left.For the above patient with abnormal pulmonary physical findings, select the most likely diagnosis.\nA) acute asthmatic attack\nB) complete pneumothorax\nC) large pleural effusion\nD) atelectasis", "output": "2, because Careful physical examination can be very useful in diagnosing many common pulmonary disorders. Atelectasis and large pleural effusions both can present with decreased fremitus, dullness or flatness to percussion, and absent breath sounds. In atelectasis, tracheal shift, if present, is toward the affected side, and the opposite for a large pleural effusion. Asthma's most typical manifestations are prolonged expiration and diffuse wheezing. However, impaired expansion, decreased fremitus, hyperresonance, and low diaphragms can also be found. A complete pneumothorax results in absent fremitus, hyperresonance or tympany, and absent breath sounds. Lobar pneumonia is characterized by consolidation with increased fremitus, dullness, and auscultatory findings of bronchial breathing, bronchophony, pectoriloquy, and crackles."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\n6 years old girl with vaginal spotting. Diagnosis is \u2013\nA) Ovarian cancer\nB) Foreign body\nC) Sexual abuse\nD) PID", "output": "1, because A foreign body is commonly responsible for vaginal bleeding in pediatric 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\nMcNaughton's rule is related to:\nA) IPC 82\nB) IPC 84\nC) IPC 87\nD) IPC 85", "output": "1, because - Mc Naughton's rule is related to Criminal responsibility of Insane person - Sec. 84 IPC also deals with the Criminal responsibility of Insane person Section 84 IPC embodies McNaughton rules as follows: \"Nothing is an offence which is done by a person who, at the time of doing it, by reason of unsoundness of mind, is incapable of knowing the nature of the act or that he is doing what is either wrong or contrary to the law.\""}

{"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 many vascular segments are present in each kidney?\nA) 3\nB) 4\nC) 5\nD) 6", "output": "2, because Ans. is 'c' i.e., 5o Renal artery Right renal artery is longer and passes behind I VC. Renal artery divides into : -Posterior division :- Supplies posterior segment.Anterior division :-Divides further into 4 branches to supply apical, upper anterior, middle anterior and lower segments.o Thus, there are five vascular segments in each kidney Posterior, apical, upper anterior, middle anterior and lower.o Branches of renal artery are end 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\nWhy are rounded internal line angles desirable in the preparation of amalgam restorations in primary teeth?\nA) They increase retention\nB) They conserve tooth structure\nC) They increase resistance\nD) They decreases internal stresses in the restorative material", "output": "3, because They decreases internal stresses in the restorative material.\nDue to the small size of primary molars and, therefore, small restorations as well, it is helpful to reduce stresses within the restorative material. It has been demonstrated that rounded internal line angles aid in reducing stress when compared to sharp internal line angles. Many of the burs recommended for use in primary molars have a rounded end to help achieve softened internal line angles."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBence Jones proteins are best described as:\nA) u chains\nB) g chains\nC) Kappa and Lambda chains\nD) Fibrin split products", "output": "2, because Ans. is 'c' i.e., Kappa and Lambda chains (Ref: Ananthanarayan, 9th/e, p. 99 and 8th/e, p. 100)* A Bence Jones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine, with a molecular weight of 22-24 kDa. Detection of Bence Jones protein may be suggestive of multiple myeloma or Waldenstrom's macroglobulinemia.* Bence Jones proteins are light chains of immunoglobulins so may occur as Lambda or Kappa forms, but in any other patient the chain is either Kappa or Lambda, never both."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDichotomy means -\nA) Erasure of name\nB) Disclosure of secrets of patients\nC) Fee-splitting\nD) Adultery", "output": "2, because Dichotomy means fee splitting or bribery or commissioning.\nReceiving commissions on referral of a patient to a doctor or forwarding commissions, both are included under dichotomy.\nDichotomy is infamous conduct as defined under the rules and regulations of MCI, 2002.\nIf a doctor repeatedly indulges in dichotomy, a warning notice could be issued against him, if he still indulges in dichotomy, his name could be erased from the medical register and it is called as professional death sentence."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDNA of HBV is?\nA) Single-stranded\nB) Double-stranded\nC) Partially single stranded\nD) Partially double stranded", "output": "3, because Ans- D Ref 1 - Although HBV is among the smallest viruses in terms of virion and genome size, it has numerous unique features that make it completely distinct from other DNA viruses. It has a partially double stranded DNA with highly complex genome organization, life cycle and natural history. Remarkably distinct from other DNA viruses, it uses an RNA intermediate called pregenomic RNA (pgRNA) and reverse transcriptase for its genome replication. Genome replication is accomplished by a complex mechanism of primer shifting facilitated by direct repeat sequences encoded in the genome. Ref 2 - jvi.asm.org/content/81/12/6164.full Hepatitis B virus (HBV) contains a small, partially double-stranded, relaxed circular (RC) DNA genome. RC DNA needs to be converted to covalently closed circular (CCC) DNA, which serves as the template for all viral RNA transcription. As a first step toward understanding how CCC DNA is formed, we analyzed the viral and host factors that may be involved in CCC DNA formation, using transient and stable DNA transfections of HBV and the related avian hepadnavirus, duck hepatitis B virus (DHBV). Ref 3 - Genome Introduction The Hepatitis B Virus (HBV) is a major health problem worldwide with more than 350 million people being chronic carriers. HBV causes Hepatitis B, a serious and common infectious disease of the liver. Chronic infection is associated with an increased risk to develop severe liver diseases, including liver cirrhosis, and hepatocellular carcinoma (HCC), one of the most common forms of human cancer. The estimated risk of HCC in chronic HBV carriers is approximately 100 times greater than in uninfected individuals. Currently available anti-HBV drugs have limitations. Interferon alpha administration is associated with adverse reactions ; nucleoside analogues are virostatic and require long-term administration. Genome organization HBV is an enveloped DNA virus that belongs to the Hepadnaviridae family (NCBI taxonomy, ICTV, ViralZone). It contains a small, partially double-stranded (DS), relaxed-circular DNA (rcDNA) genome that replicates by reverse transcription of an RNA intermediate, the pregenomic RNA (pgRNA). Its length is comprised between 3182 and 3248 bp depending on genotypes. The genome encodes four overlapping open reading frames (ORFs) that are translated into viral core protein, surface proteins, polymerase/reverse transcriptase (RT), and HBx. Replication cycle The HBV life cycle begins when the virus attaches to the host cell and is internalized. Recent studies have demonstrated that sodium-taurocholate cotransporting polypeptide (NTCP) is a functional receptor in HBV infection.The virion rcDNA is delivered to the nucleus, where it is repaired to form a covalently closed-circular DNA (cccDNA). The episomal cccDNA serves as the template for the transcription of the pgRNA and the other viral mRNAs by the host RNA polymerase II. The transcripts are then exported to the cytoplasm, where translation of the viral proteins occurs. RT binds to pgRNA and triggers assembly of the core proteins into immature, RNA-containing nucleocapsids. The immature nucleocapsids then undergo a process of maturation whereby pgRNA is reversed transcribed by RT to make the mature rcDNA. A unique feature of hepadnavirus reverse transcription is the RT primed initiation of minus-strand DNA synthesis, which leads to the covalent linkage of RT to the 5' end of the minus-strand DNA. The mature, rcDNA-containing nucleocapsids are then enveloped by the viral surface proteins and secreted as virions (secretion pathway) or alternatively, are recycled back to the nucleus to further amplify the pool of cccDNA (recycling pathway). Persistence of cccDNA in hepatocyte plays a key role in viral persistence, reactivation of viral replication after cessation of antiviral therapy and resistance to 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\nA 5-week-old male infant is born without a thymus or inferior parathyroid glands. Which of the following pharyngeal arches is most likely involved?\nA) First\nB) Second\nC) Third\nD) Fourth", "output": "2, because Absence of the thymus and inferior parathyroid glands would be due to defective development of the third pharyngeal pouch, their normal site of origin. The first pouch gives rise to the tympanic membrane and cavity. The second pouch gives rise to the palatine tonsils and tonsillar sinus. The fourth pharyngeal pouch gives rise to the superior parathyroid glands and the parafollicular cells of the thyroid gland. The fifth pharyngeal pouch contributes to the formation of the parafollicular cells of the thyroid gland."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPompholyx affects:\nA) Groin\nB) Trunk\nC) Scalp\nD) Palm and soles", "output": "3, because Ans. d. Palm & solesPompholyx is a form of recurrent palmoplantar eczema with firm deep-seated vesicles on sides of finger giving sago grain or tapioca like feel"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBest quality proteins are found in highest quantities in \u2013\nA) Rice\nB) Wheat\nC) Ragi\nD) Bajra", "output": "0, because Rice proteins are richer in lysine than other cereal proteins, and for this reason, rice protein is considered to be a better quality."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nJet black pigmentation of tongue with tactile hallucination is a feature of which substance use\nA) Heroin\nB) Cannabis\nC) Cocaine\nD) LSD", "output": "2, because Chronic cannabis use can lead to jet black pigmentation of tongue. And patients may also have feeling of insects crawling under the skin also known as magnan phenomenon."}

{"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 extended supraomohyoid neck dissection, lymph node dissection is done upto:\nA) 2\nB) 3\nC) 4\nD) 5", "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\nSIADH -- all are features except,\nA) Decreased sodium, maintaining the concentrating ability of the urine osmolality (> 100 mOsm)\nB) Normal sodium balance maintained indicating excess urinary sodium is due to efficient sodium intake\nC) Hypouricemia\nD) Low blood pressure due to volume depletion", "output": "3, because Low blood pressure due to volume depletion The serum sodium concentration is normally regulated by ? The balance of water intake. Renal excretion of sodium and ADH mediated water conservation by distal renal tubule. These processes are mediated by ? Stimulation of thirst Secretion of ADM Feedback mechanisms of the renin angiotensin aldosterone system and variation of renal handling of .filtered sodium. Disorders in any one of the these components of sodium balance can result in sodium imbalance. Action of ADH ADH is secreted by the posterior pituitary glandQ. Its effect in kidney is mediated by the vasopressin. (V2 receptors) on the basolateral surface of the principal cells of the collecting duct. The key action of ADH in the kidney is increasing the permeability of water. It allows water to be reabsorbed from the medullary interstitium thus enhancing water reabsorption. In SIADH the A.D.IL level is inappropriately elevated The inappropriately elevated level of vasopressin enhances the reabsomtion of water thereby leading to. - Production of concentrated urine. - Inability to excrete water and consequently - Hyponatrernia Clinical features of SIADH - HyponatrenziaQ (sodium < 135 mEq/L) - Inappropriately elevated urine osmolalityQ (> 150 mosm/kg) - Excessive urine sodium excretionQ (it Nu > 30 mEq/L) - Decreased serum osmolalityQ (< 280 mosm/kg) These findings occur in - Absence of diuretic therapy - In the presence of euvulemiaQ without edemaQ - In the setting of otherwise normal cardiac, renal, adrenal, hepatic and thyroid function. Remember, The key to pathophysiological signs, symptoms and eventual treatment of SIADH is an understanding that the hyponatremia is a result of excess water and not a sodium deficiency. Laboratory features of SIADH . HyponatrentiaQ (sodium < 135 mEq/L) . B.U.N. and serum uric acid tends to falP because of plasma dilution' and increased excretion of nitrogenous products. . Serum potassium and Bicarbonate levels are normal in SIADH (hypokalemia and metabolic acidosis suggests, diuretic therapy or vomiting) . Low serum osmolalityQ. Remember, These characteristic features of SIADH - There is increase in urinary concentration of sodium in the presence of hyponatremia. - There is increase in urine osmolarity in the presence of with decrease in serum osmolarity."}

{"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 regarding Turner syndrome are true except -\nA) Occurence of Turner syndrome is influenced by maternal age.\nB) Most patients have primary amenorrhoea.\nC) Most patients have short stature.\nD) Edema of hands and feet is an important feature during infancy.", "output": "0, because Occurence of Turner syndrome is not affected by maternal age. It is Down's syndrome which is affected by maternal age (Risk of Down's syndrome increases after 35 yrs. of maternal age*)"}

{"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 33-year-old man presents at OPD complaining of fever and headache. On examination, he had leukopenia and increased liver enzymes, and inclusion bodies were seen in his monocytes. History revealed that he went on camping and remembered removing a tick from his leg. Which of the following diseases is most likely causing the symptoms described?\nA) Lyme disease\nB) Ehrlichiosis\nC) Rocky Mountain spotted fever\nD) Q fever", "output": "1, because All the listed diseases except Q fever are tick-borne. The rickettsia C. burnetii causes Q fever, and humans are usually infected by aerosol of a sporelike form shed in milk, urine, feces, or placenta of infected sheep, cattle, or goats. Lyme disease is caused by a spirochete, Borrelia burgdorferi, and produces the characteristic lesion erythema chronicum migrans (ECM). The etiologic agent of Rocky Mountain spotted fever is R. rickettsia. It usually produces a rash that begins in the extremities and then involves the trunk. Two human forms of ehrlichiosis can occur: human monocytic ehrlichiosis (HME), caused by E. chaffeensis; and human granulocytic ehrlichiosis (HGE), caused by an as yet unnamed Ehrlichia. HME infection is transmitted by the brown dog tick and A. americanum. HGE infection is transmitted by I. scapularis, the same tick that transmits Lyme disease. Both infections cause fever and leukopenia. A rash rarely occurs. E. chaffeensis infects monocytes, and HGE infects granulocytes; both organisms produce inclusion bodies called morulae. Francisella tularensis is a small, Gram-negative, nonmotile coccobacillus. Humans most commonly acquire the organism after contact with tissues or body fluid of an infected mammal or the bite of an infected tick."}

{"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 causative agent of Primary Amoebic Meningoencephalitis is:\nA) Endolimax nana\nB) Dientamoeba fragilis\nC) Naegleria fowleri\nD) Entamoeba histolytica", "output": "2, because (C) Naegleria fowleri # Human infection of naegleria comes from water containing the amoebae and usually follows swimming or diving in ponds.> Patients are mostly previously healthy young adults and children.> The amoebae invade the nasal mucosa, pass through the olfactory nerve and initiate an acute meningitis and encephalitis (primary amoebic meningoencephalitis)."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAdult polycystic kidney disease is inherited:March 2005\nA) X-linked dominant\nB) X-linked recessive\nC) Autosomal recessive\nD) Autosomal dominant", "output": "3, because Ans. D: Autosomal dominantAutosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited disorders. It is the most frequent genetic cause of renal failure in adults,It is a multisystemic and progressive disorder characterized by the formation and enlargement of cysts in the kidney and other organs (e.g., liver, pancreas, spleen).Clinical features usually begin in the third to fouh decade of life, but cysts may be detectable in childhood and in utero.Some other autosomal dominant disorders:Huntington choreaNeurofibromatosisMyotonic dystrophyHereditary spherocytosisMarfan syndromeOsteogenesi imperfectAchondroplasia"}

{"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 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise. Choose the sleep disturbance most consistent with the history\nA) Night terrors\nB) Nightmares\nC) Learned behavior\nD) Obstructive sleep apnea", "output": "2, because Sleep disturbances are fairly common in childhood. Many children resist going to bed, and parents frequently give in just to get the child to sleep by allowing the child to sleep in the parents' bed or allowing them to stay up late. Unfortunately, children learn remarkably well how to get what they want, and the parents' concessions only make the problem worse. Learned behavior (behavioral insomnia, dyssomnia) is the root of many sleep disturbances in young children.Other types of sleep disturbance in children fall into the category of sleep disruptions, such as nightmares and night terrors.A nightmare is a scary or disturbing dream that usually awakens the child and causes agitation about the content of the dream. Nightmares occur during rapid eye movement (REM) sleep. Many children and adults have an occasional nightmare; recurrent or frequent nightmares, however, may be indicative of an ongoing stress in the child's life. Night terrors (pavor nocturnus) are non-REM phenomena seen less commonly than nightmares, occurring in 1% to 6% of all children. The child will be described as apparently awake but unresponsive; they can have evidence of autonomic arousal such as tachycardia, sweating, and tachypnea, and appear frightened and agitated. Attempts at calming the child are usually not effective, and the child will eventually go back to sleep. Although usually a problem in early childhood, night terrors can sometimes continue through adolescence.Somnambulism, or sleepwalking, occurs in 15% of children and is described as recurrent episodes of rising from bed and walking around. The child is typically hard to arouse and will have amnesia after the event. This usually happens in the first third of the sleep cycle, during stage 4 non- REM sleep. Somniloquy, or sleep talking, can occur at any sleep stage and is seen in all ages."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMonetary benefit is measured in\nA) Program budgeting system\nB) Network analysis\nC) Cost effective analysis\nD) cost benefit analysis", "output": "3, because ref : park 21st ed"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 26-year-old woman complains of early fatigue and weakness in doing strenuous activity. Her symptoms are worse near the end of the day. She appears well, muscle bulk, tone, and reflexes are normal. Handgrip strength decreases with repetitive testing.For the above patient with muscle weakness, select the most likely anatomic site for the disorder\nA) anterior horn cell\nB) peripheral nerve\nC) neuromuscular junction\nD) muscle", "output": "2, because Diurnal fluctuations and pathologic fatigue are common in disorders of neuromuscular transmission (e.g., myasthenia gravis). (Ropper, pp. 1250-1251)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nReichert-Meissl number:\nA) 0.1 N KOH\nB) 0.5 KOH\nC) 0.1 N NaOH\nD) 0.5 NaOH", "output": "0, because Ans. A. 0.1NKOHReichert-Meissl number is defined as the number of moles of 0.1NKOH required to Completely neutralize the soluble volatile fatty acids distilled from 5g fat."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThis kind of graph can be seen in all of the following condition except\nA) Ventilatory malfunction\nB) hypoventilation\nC) hyperventilation\nD) malignant hyperpyrexia", "output": "2, because In hyperventilation the EtCO2 value will decrease. Increases ETCO2 is seen in thyrotoxicosis, fever (increased CO2production) and high spinal anesthesia (alveolar hypoventilation). Factors affecting ETCO2 Increased ETCO2 Decreased ETCO2 Metabolism Hypehermia Fever Thyrotoxicosis Pain Shivering Metabolism Hypothermia Metabolic acidosis Respiratory Hypoventilation Respiratory depression COPD Paial airway obstruction Rebreathing Respiratory Hyperventilation Total airway obstruction Extubation Circulatory Increased cardiac output (ROSC after cardiac arrest) Hypeension Circulatory Hypotension Cardiac arrest Pulmonary emboli Apparatus malfunction Exhausted CO2 absorber Inadequate fresh gas flow Ventilatory malfunction Apparatus malfunction Circuit disconnection Leak in sampling Ventilatory malfunction"}

{"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 was hospitalized after an automobile accident. The wounds became infected and the patient was treated with tobramycin, carbenicillin, and clindamycin. Five days after antibiotic therapy was initiated, the patient developed severe diarrhea and pseudomembranous enterocolitis. Antibioticassociated diarrhea and the more serious pseudomembranous enterocolitis can be caused by\nA) Clostridium sordellii\nB) Clostridium perfringens\nC) Clostridium difficile\nD) S. aureus", "output": "2, because Patients treated with antibiotics develop diarrhea that, in most cases, is self-limiting. However, in some instances, paicularly in those patients treated with ampicillin or clindamycin, a severe, life-threatening pseudomembranous enterocolitis develops. This disease has characteristic histopathology, and membranous plaques can be seen in the colon by endoscopy. Pseudomembranous enterocolitis and antibiotic-associated diarrhea are caused by an anaerobic Gram-positive rod, Clostridium difficile. It has been recently shown that C. difficile produces a protein toxin with a molecular weight of about 250,000. The \"toxin\" is, in fact, two toxins, toxin A and toxin B. Both toxins are always present in fecal samples, but there is approximately one thousand times more toxin B than toxin A. Toxin A has enterotoxic activity--that is, it elicits a positive fluid response in ligated rabbit ileal loops-- whereas toxin B appears to be primarily a cytotoxin. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth 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\nWhich of the following muscle is derived from 1st pharyngeal arch ? (2019)\nA) Anterior belly of digastric\nB) Posterior belly of digastric\nC) Stylopharyngeus\nD) Tensor tympani", "output": "0, 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 an autosomal dominant metabolic disorder -\nA) Cystic fibrosis\nB) Phenylketonuria\nC) Alpha-I anti-trypsin deficiency\nD) Familial hypercholesterolemia", "output": "3, because Mutations involving single genes follow one of three patterns of inheritance: autosomal dominant, autosomal recessive, or X-linked. Autosomal Dominant Inheritance Familial hypercholesterolemia Huntington disease Marfan syndrome Ehlers-Danlos syndrome Hereditary spherocytosis Neurofibromatosis, type 1 Adult polycystic kidney disease Autosomal Recessive Inheritance Cystic fibrosis Phenylketonuria Tay-Sachs disease Severe combined immunodeficiency a- and b-Thalassemias Sickle cell anemia Mucopolysaccharidoses--all types Glycogen storage diseases--all types Galactosemia X-linked Recessive Inheritance Hemophilia A Duchenne/Becker muscular dystrophy Fragile X syndrome (Robbins Basic Pathology,9th edition,pg no. 219)"}

{"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 statements is true about capillaries\nA) Contains 5% of total blood volume\nB) Contain 10% of total blood volume\nC) Velocity of blood flow is maximum\nD) Offer maximum resistance to blood flow", "output": "0, because Capillaries contain 5% of the blood volume."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA Patient falls down often with behavioral change and enuresis. What is the condition associated with him?\nA) Frontotemporal dementia\nB) Normal pressure hydrocephalus\nC) Parkinson's disease\nD) Alzheimer's disease", "output": "1, because Ans- B. Normal pressure hydrocephalus Frontotemporal dementia - Associated with poor behavioral control, decision making, and language.Normal-pressure hydrocephalus - Associated with gait disturbance, behavioural change, enuresis, and dementia.Parkinson's disease - Associated with tremor and muscular stiffnessAlzheimer's disease-Associated mainly with memory loss and confusionRef: Normal Pressure Hydrocephalus By Michael J. Fritsch, Uwe Kehler, Ullrich Meier P .16; Oxford textbook of neurological surgery by Adel Helmy P.94"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nLife spon of a housefly ?\nA) 1-2 days\nB) 5-10 days\nC) 10-15 days\nD) 15-20 days", "output": "3, because Ans. is 'd' i.e., 15-20 days Houseflies 'Houseflies should be regarded as a sign of insanitation' and their number as index of that sanitation. Impoant species : Musca domestica, M. vicinia, M. nebula, M. sorbens Life span : 15-25 days Eggs : 8-24 hours Larvae (maggots) : 2-7 days Pupae : 3-6 days Adults : 5-20 days Impoant breeding places (In order of impoance). Fresh horse manure Human excreta Manure of other animals Garbage Decaying fruits and vegetables Rubbish dumps containing organic matter Grounds where liquid wastes are spilled Feeding habits : Housefly does not bite : It cannot eat solid foods; it vomits on ssolid foods to make a solution of it, and sucks in a liquid state. Modus of disease transmission: Mechanical transmission: Houseflies are known as 'Poers of infection' Vomit-drop Defecation Houseflies in disease causation: As vector of diseases : Typhoid and paratyphoid fevers, diarrhoeas and dysenteries, cholera and gastroenteritis, amoebiasis, helminthic manifestations, Poliomyelitis, Yaws, Anthrax, Trachoma, conjunctivitis. As causative agent of disease : Myiasis."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThreshold radiation dose for hematological syndrome is?\nA) 2 Gy\nB) 6 Gy\nC) 15 Gy\nD) 50 Gy", "output": "0, because Ans. is'a'i.e., 2 GyBone marrow or hematological syndrome:- Full syndrome occurs with a dose between 0.7 and 3 Gy (70-300 rads).The destruction of bone marrow cells results in pancytopenia."}

{"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 drug causes hemorrhagic cystitis ?\nA) Cyclophosphamide\nB) Cycloserine\nC) Ciprofloxacin\nD) Cyclosporine", "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\nCauses of reduced bioavailability of a drug includes\nA) High first pass metabolism\nB) Increased absorption\nC) IV drug administration\nD) High lipid solubility", "output": "0, because When the metabolism of a drug is high during its passage from the site of absorption into the systemic circulation, the rate, and extent of absorption of that drug decreases. absorption- amount of drug reaching the systemic circulation from the site of administration (Ref.Essentials of medical pharmacology TD Tripathi 7th edition page no.16,27)"}

{"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 strain of streptococci is implicated in neonatal meningitis is:\nA) Group-A\nB) Group-B\nC) Group-C\nD) Group-D", "output": "1, because Group-B"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nASO (Antistreptolysin o) test Is used for the diagnosis of-\nA) Rheumatoid ahritis\nB) Typhoid fever\nC) Rheumatic fever\nD) Rickettsial fever", "output": "2, because Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:146-147 Jones Criteria for Diagnosis of Rheumatic Fever Major Criteria Carditis Pancarditis, seen in 50-60% of patients, develops within the first 2 weeks of rheumatic fever. Pericarditis is evidenced by presence of a pericardial rub, myocarditis by tachycardia, soft S1, presence of S3 and CCF and endocarditis by the presence of Carey-Coombs' murmur (mitral diastolic murmur). Ahritis (60-75%) Flitting and fleeting type of polyahritis involving large joints with no residual deformity is seen in 60-75% of patients and occurs early in rheumatic fever. Jaccod's ahritis: Ulnar detion of 4th and 5th finger with flexion at metacarpophalangeal joints is the only residual deformity seen in rheumatic polyahritis. Subcutaneous Nodules Non-tender nodules are seen over bony prominences like elbows, shin, occiput, spine in 3-5% of patients and occur 3-6 weeks after onset of rheumatic fever. Patients who have subcutaneous nodules almost always have carditis. Erythema Marginatum (< 5% and evanescent) Macular lesions with an erythematous rim and central clearing in a bathing suit distribution are seen in < 5% of patients and occur early in rheumatic fever. Chorea (Sydenham's Chorea) (2-30%) A neurological disorder with rapid, involuntary and purposeless non-repetitive movements with a self limiting course of 2-6 weeks is more common in females and is a late manifestation of rheumatic fever. Minor Criteria Clinical 1. Fever 2. Ahralgia 3. Previous history of rheumatic fever or rheumatic hea disease. Laboratory 1. Acute phase reactants (leucocytosis, raised ESR, C-reactive protein) 2. Prolonged PR interval in ECG (> 0.2 sec). WHO Criteria Jones major and pa of the minor criteria except prior history of rheumatic fever/rheumatic hea disease and C-reactive protein. Essential Criteria Evidence for recent streptococcal infection as evidenced by: 1. Increase in ASO titre a. > 333 Todd units (in children) b. > 250 Todd units (in adults). 2. Positive throat culture for streptococcal infection. 3. Recent history of scarlet fever. Two major (or) one major and two minor criteria, in the presence of essential criteria, is required to diagnose Acute Rheumatic Fever. A Positive Rheumatic Fever history is usually elicited in only 50% of patient with Rheumatic Hea 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 the following enzymes are involved in the metabolism of xenobiotics except\nA) Hydroxylase\nB) Cytochrome oxidase\nC) Cytochrome P450\nD) Methylase", "output": "1, because Oxidation, reduction, and hydroxylation are phase 1 reactionsCyp. 450 is the most common enzyme involved in the metabolism of various drugs in phase 1 and phase 2.Methylase - phase 2 reactionRef: Goodman Gillman 11th ed, pg 71"}

{"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 sites is not involved in a posterior cerebral aery infarct:\nA) Midbrain\nB) Thalamus\nC) Temporal lobe\nD) Anterior Coex", "output": "3, because Answer is D (Anterior Coex) : Anterior Coex (Frontal lobe) is not involved in posterior cerebral aery infarct Posterior Cerebral Aery infarcts The posterior Cerebral Aery supplies the midbrain, thalamus, lateral geniculate bodies, posterior poion of choroid plexus, occipital lobes, inferior and medial aspect of the temporal lobe and posterior inferior areas of the parietal lobe. Occlusion of the Posterior Cerebral Aery usually results in two common clinical syndromes depending on the areas involved P1 Syndrome Occlusion of the proximal segment of PCA from its origin to its union with the posterior communicating aery P1 syndrome present primarily with the following signs Midbrain signs Thalamic signs Subthalamic signs P2 Syndrome Occlusion of the distal segment of PCA distal to the junction of PCA with the posterior communicating aery P2 syndrome presents primarily with the following signs Temporal lobe signs Occipital lobe signs"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFor a weight of 98 kgs and height of 175 cms, BMI is:\nA) 28\nB) 32\nC) 36\nD) 46", "output": "1, because 32"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHighest fat content is present in:\nA) Rice\nB) Wheat\nC) Bajra\nD) Jowar", "output": "2, because Fat content of food items: Food item Fat content Jowar 4% Bajra 6.5% - Highest fat content Rice 3% Wheat 3%"}

{"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 accurate treatment of erectile dysfunction:\nA) Sildenafil\nB) Master and johnson technique\nC) B-blockers\nD) Papaverine", "output": "0, because A i.e. SildenafilSildenafil is only approved & effective oral agent for erectile dysfunctionQ. It is useful in wide range of e.d.including - pyschogenic, diabetogenic, vasculogenic, post radical prostatectomy (nerve sparing procedure) & spinal cord injury.It acts by inhibiting phosphodiesterase - 5 (PDE-5)Q & releasing NOQ from nerve endings & endotheliumOther t/t for Erectile dysfunction are:PIPE therapy (PapaverineQ/ Phentolamine Induced Penile Erection)- AndrogenIntraurethral - alprostodil (PGE1)Penile prosthasis, vaccum constriction deviceMaster Johnson technique is for premature ejaculationQp Blockers can cause erectile dysfunctionQ"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSecondary amyloidosis complicates which of the following\nA) Pneumonia\nB) Chronic glomerulonephritis\nC) Irritable bowel sydrome\nD) Chronic osteomyelitis", "output": "3, because Ref Robbins 9/e p257;8/e p253;7/e p261 TB , bronchiectasis and chronic osteomyelitis were the most impoant underlying conditions but with the advent of effective antimicrobial chemotherapy the connective tissue disorders such as rheumatoid ahritis , ankylosing spondylitis and inflammation bowel disease . paicularly crohn disease and ulcerative colitis"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA patient underwent breast conservation surgery for 3 cm lesion along with sentinel lymph node biopsy., which showed one-third of sentinel lymph nodes are positive for macrometastasis. Next step is\nA) Completion axillary lymph node dissection chemotherapy and radiotherapy\nB) MRM with level I lymphadenectomy\nC) MRM with level III lymphadenectomy\nD) Only chemotherapy and radiotherapy", "output": "0, because Lymphatic metastasis in Carcinoma Breast: Lymphatic spread in CA breast occurs through subareolar lymphatic plexus of Sappey&;s lymphatic plexus, cutaneous lymphatics & inflammatory lymphatics. Lymphatic metastasis occurs primarily to the axillary (75%) & internal mammary lymph nodes. Tumors in the posterior one-third of breast are more likely to drain to the internal mammary nodes. Involvement of LNs has both biological & chronological significance It represents not only an evolutional event in the spread of the carcinoma but is also a marker for the metastatic potential of that tumor Involvement of supraclavicular nodes and of any contralateral lymph nodes represents advanced disease, LN metastasis is treated by surgical dissection and radiotherapy Axillary Lymph node levels in relation with pectoralis minor Level Relation with pectoralis minor Axillary LNs included I Below or lateral Anterior, Posterior, Lateral II Posterior (behind) Central, Interpectoral (Rotter&;s nodes) III Medial or above Apical Ref: Sabiston 20th edition Pgno: 853"}

{"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\u201cSmack\u201d is the \u201ccommon\u201d name for\nA) Heroin\nB) Cocaine\nC) Opium\nD) None", "output": "0, because Heroin or di-acetyl-morphine is about two times more potent than morphine in injectable form. Apart from the parenteral mode of administration,\nheroin can also be smoked or \u2018chased\u2019 ( chasing the dragon), often in an impure form (called \u2018 smack\u2019 or \u2018 brown sugar\u2019 in India). \nHeroin is more addicting than morphine and can cause dependence even after a short period of exposure."}

{"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 signs of uterine scar dehiscence except: September 2009\nA) Tachycardia\nB) Fetal distress\nC) Strong uterine contractions\nD) Falling BP", "output": "2, because Ans. C: Strong Uterine Contractions The signs and symptoms of uterine rupture largely depend on the timing, site, and extent of the uterine defect. Uterine rupture at the site of a previous uterine scar is typically less violent and less dramatic than a spontaneous or traumatic rupture because the scar is relatively avascular. The classic signs and symptoms of uterine rupture are as follows: fetal distress (as evidenced most often by pattern of abnormalities in fetal hea rate), diminished baseline uterine pressure, loss of uterine contractility, abdominal pain, recession of the presenting fetal pa, hemorrhage, and shock."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nYoung female with 3 day fever presents with headache, BP 90/60 mmHg, Hea rate of 114/min, and pin point spots developed distal to BP cuff. Most likely organism is:\nA) Brucella abous\nB) Brucella suis\nC) N. meningitidis\nD) Staphylococcus aureus", "output": "2, because Ans. (c). i.e. N. meningitidis The patient here is under state of shock (hypotension, tachycardia) in conjunction with meningitis (headache fever)and rash. Meningococcal meningitis is the most common meningitis complicated by shock. CLINICAL MANIFESTATION OF MENINGOCOCCAL DISEASE Rash A nonblanching rash (petechial or purpuric) develops in >80% of cases of meningococcal disease. Rashesare initially blanching in nature but within hours become non-blanching. In severe cases large purpuriclesions (purpura fulminons) develops. Meningitis Commonly present as fever, vomiting, headache, irritability, petechial or purpuric rash occurs in 2/3 of cases. Headache is seen in adults usually. In upto 40% of cases there are some features of septicemia too. Septicemia Can be isolated or as a accomplication of meningitis. The condition may cause death within hours. Purpura fulminans is a specific feature. Chronic meningococcemia Present as repeated episodes of petechial rash associated with fever joint pain, ahritis and splenomegaly. The main differential diagnosis is acute rheumatic fever. This condition has been associated with complement deficiently and with inadequate sulfonamide therapy. If left untreated chances of progression to meningococcal septicemia are high. Postmeningococcal reactive disease In small propoion of patients, an immune complex disease develops 4-10 days after the onset of meningococcal disease with manifestations that include a maculopapular or vasculitic rash, ahritis, pericarditis and/or polyserosites associated with fever."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThe most impoant cells in type I hypersensitivity\nA) Macrophages\nB) Mast cells\nC) Neutrophils\nD) Lymphocytes", "output": "1, because Ans. is 'b' i.e., Mast cells Type I hypersensitivity (Immediate hypersensitivity) o It is a rapidly developing immunological reaction occuring within minutes after the combination of an antigen with antibody bound to mast cells in individuals previously sensitized to the antigen. o Immediate hypersensitivity reactions are mediated by Ig E, but T and B cells play impoant role in the development of these antibodies. o Type I reaction requires prior sensitization to a specific antigen (allergen). o Most exposures occur either by inhalation (respiratory route) or ingestion (GIT) of antigen. o Type one hypersensitivity has two phases :- 1.Initial response o After first antigen exposure, this antigen is presented to CD-4 helper T cells (TH2 type) by antigen presenting cells. These primed TH2 cells release IL-4 that acts on B-cells to form Ig E specific for that paicular antigen. The antigen specific lg E antibodies then bind to the surface receptors of mast cells and basophils. The process from first antigen exposure to the coating of mast cells by Ig E acts as sensitization (prior sensitization) and first exposure is also called priming or sensitizing exposure (dose). Subsequent exposure (shocking dose) to same antigen then result in activation of mast cells and basophils with release of mediator from these cells that leads to ? Smooth muscle spasm Increase mucus secretion from the epithelial cells. Vasodilatation Increased vascular permeability Recuritment of inflammatory cells Note - Most of the clinical effects are due to smooth muscle spasm. 2. Late phase response In this phase additional leukocytes are recruited. These cells amplify and sustain the inflammatory response without additional exposure to the triggred antigen. Among the cells that are recruited in the late-phase reaction, eosinophils are paicularly impoant. Eosinophils produce major basic protein and eosinophilic cataionic protein that are toxic to epithelial cells. Platelet activating factor (PAF) recruits and activates inflammatory cells and is most impoant cytokine in the initatiation of late phase response. Type I hypersensitivity occurs in two forms Anaphylaxis --> Acute, potentially fatal, systemic. Atom --> Chronic, Nonfatal, Lacalized. Remember o Mast cells are the most impoant cells in type I hypersensitivity. o Eosinophils are the most impoant cells in the late phase reaction of type I hypersensitivity. o Histamine is the most impoant mediator in type I hypersensitivity. o IL-4 is paicularly impoant, it is essential for turning on IgE secreting B cells. o PAF is the most impoant cytokine in the initiation of late phase reaction. o Most potent eosinophilic activating cytokine is IL-5."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAtrial fibrillation may occur in all the following conditions, except-\nA) Mitral stenosis\nB) Hypothyroidism\nC) Dilated cardiomyopathy\nD) Mitral regurgitation", "output": "1, because Answer is B (Hypothroidism) Atrial Fibrillation is associated with hypehyroidism and not hypothyroidism Impoant causes of Atrial Fibrillation Cardiovascular causes of Atrial Fibrillation Rheumatic Hea disease (Includes mitral stenosis and mitral regurgitation) Non Rheumatic Mitral valve disease Chronic Hypeension Cardiomyopathy Myocarditis Pericarditis Congenital Hea Disease (eg ASD) Coronary Hea Disease Other Systemic Causes of AF Hypehroidism Pulmonary embolism Hypoxia Excess consumption of alcohol (Also alcohol withdraw) Excess consumption of Caffeine May be seen in normal individuals Paicularly during emotional stress or following surgery, exercise or prominent surge of vagal tone (vasovagal response) AF often develops in patients with hea or lung disease who develop hypoxia, hypercapria or metabolic or hemodynamic derangements Holiday Hea Syndrome: In predisposed individuals, AF may be precipitated by consumption of even small amounts of alcohol. This is called Holiday Syndrome and is usually transient and self limited"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHigh Glycemic index is defined as value more than?\nA) 55\nB) 60\nC) 70\nD) 100", "output": "2, because High Glycemic index foods have values of 70 or greater and include baked potato, white bread and white rice. Low Glycemic index foods have values of 55 or lesser and include multi grain breads, pasta, legumes."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nThreshold of hearing in a young normal adult is ?\nA) 0 dB\nB) 10 dB\nC) 20 dB\nD) 30 dB", "output": "0, because Ans. is'a'i.e.,0 dBAudiometric zeroThreshold of hearing, i.e. The faintest intensity which a normal healthy person can hear will vary from person to person.The International Standards Organisation (ISO) adopted a standard for this, which is represented as the zero level on the audiometer (0 dB).According to ISO, audiometric zero is the mean value of minimal audible intensity in a group of normally hearing healthy young adults."}

{"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 years old child suffered from a fall on outstretched hand. X rays revealed a fracture with the fracture line at the physes with a small metaphyseal fragment. There was no epiphyseal fracture. What type of injury by Salter harris Classification is this?\nA) I\nB) II\nC) III\nD) IV", "output": "1, because (Refer: Mohindra\u2019s Fundamentals of Orthopedics, 2nd edition, pg no. 510)\n\nType II: the fracture involves the physis and a triangle of metaphyseal bone (Thurston Holland sign).\u00a0 This is the commonest type of epiphyseal injury accounting for 73 percent of cases over 10 years of age."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nPositive hepatojugular reflux is found in all of the following conditions except -\nA) Tricuspid regurgitation\nB) Right heart failure\nC) Decreased after load\nD) Increased capillary bed pressure", "output": "2, because Ans. is 'c' i.e., Associated with decreased afterload [Ref: CMDT 2007p. 318; British Medical Journal May 1999\\ Hepatojugular refluxThis is done by applying firm pressure with the palm of the hand to the right upper quadrant of the abdomen for 10- 30 seconds with the patients breathing quietly while the jugular vein is observed.In normal subjects (Negative hepatojugular reflux)Jugular venous pressure rises only transiently with rapid return to the baseline.Positive hepatojugular reflux (Left ventricular failure Q)A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds.ExplanationPushing on the liver (or even midabdomen) for about 15 seconds increases the amount of blood returned to the right atrium and right ventricle (increased preload).Concurrently, there is increase in right ventricle afterload, owing to upward movement of the diaphragm which reduces intrathoracic volumes. (Pulmonary artery pressure is increased due to reduced intrathoracic volumes). (Leading to increased right ventricle afterload)In a normal person the jugular venous pressure would rise temporarily and then normalize quickly as the healthy right ventricle pumps out the additional blood i.e. it handles the increase in preload and afterload quite well.A dysfunctioning right ventricle however fails to accept this increase in preload and afterload and therefore there is persistent elevation of systemic venous pressure.The abdominojugular reflux is not specific to any disorder but rather is a reflection of the inability of the right ventricle to accept or reject the transiently increased venous return.\"Positive abdominojugular reflux is most commonly associated with left ventricular failure\".In the absence of left heart failure a positive abdominal jugular reflex sign should prompt consideration of :-Impaired right ventricular preloadA Decrease in right ventricular compliance.A decrease in right ventricular systolic function orAn elevation in right ventricular afterload.Conditions associated with abdominojugular reflux -Left ventricular failure Q (MC)Right heart failure QConstrictive pericarditis QRight ventricular infarction QRestrictive cardiomyopathy QNote - Both pulmonary stenosis and tricuspid regurgitation cause right heart failure."}

{"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 neurodevelopmental disorder which is characterized by impaired social interaction, impaired verbal and nonverbal communication, and restricted and repetitive behavior is description for:\nA) Autism\nB) Anxiety disorder\nC) Antisocial personality disorder\nD) Paranoid schizophrenia", "output": "0, because Autistic disorder (childhood autism) Social deficits. Examples include babies who don't like being held, and also reduced eye contact, unusual facial expressions, lack of gestures, poor understanding of others' feelings, lack of empathy, and few peer relationships. Communication deficits. Speech in autistic children shows wide variety; it may be completely absent (30 per cent), or merely show unusual or asocial qualities. Common abnormalities of speech include echolalia, odd prosody and pronoun reversal. These children have difficulty in two-way conversations, and some ask a string of questions instead. Restricted/repetitive interests and behaviors. Autistic children often show a deep interest in things others regard as very mundane; for example, washing machines or license plates."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAdrenal aldosteronoma is best diagnosed by -\nA) HRCT\nB) MRI\nC) JVP\nD) KUB", "output": "0, because Ans is option 1 HRCT The usual screening test is to measure the serum potassium level. If it is low, diagnostic tests are done including measuring blood and urinary aldosterone levels and blood renin levels. In Conn's syndrome, the aldosterone is elevated and the renin is suppressed. If these tests are diagnostic then imaging studies are done to see if a tumor can be localized. Since these tumors are small they can be hard to find even with the best CT or CT with contrast or MRI scan. Some patients may have no obvious radiographic tumor but one adrenal is affected (unilateral primary adrenal hyperplasia) and they can benefit from surgical removal. Other patients may have both adrenals affected with no visible tumor (idiopathic hyperaldosteronism) and surgery will not help. In these situations blood has to be drawn from each adrenal vein (so called adrenal venous sampling) in order to measure aldosterone levels to be sure which adrenal has the tumor. The symptoms of hyperaldosteronism may resemble other conditions or medical problems. Always consult your physician for a diagnosis. the diagnostic procedures for aldosteronoma may include: Blood and urine tests to measure potassium and hormone levels Computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI) - are non-invasive procedures that take cross-sectional images of the adrenal or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray Adrenal venous sampling- an invasive test performed by a radiologist where a catheter is placed in the adrenal veins to measure the hormone level and confirms the tumor location. Ref Harrison 17/e p2260 , Semantischolar.org"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 70 year old male chronic smoker is diagnosed of having cancer of the urinary bladder. It is confined to the trigone and extention is upto the submucosa. The management would be\nA) Complete transurethral resction\nB) Complete transurethral resection with intravesical chemotherapy\nC) Palliative radiotherapy\nD) Radical cystectomy", "output": "1, because Answer- B. Complete transurethral resection with intravesical chemotherapyTreatment-T1Complete TUR followed by intravesical chemo- or immunotherapy or radical cystectomy"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWeakness of extensor Hallucis longus is due to which nerve root mainly?\nA) L5\nB) L4\nC) S1\nD) S2", "output": "0, because Ans. is 'a' i.e., L5 Important muscles and their chief myotomesMuscleMyotomeExtensor Hallucis LongusL5Tibialis anteriorL4Flexor Hallucis LongusS1GastrosoleusS1Gluteus Medius and MinimusL5Gluteus MaximusS1Quadriceps FemorisL3"}

{"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 branch of the basilar aery ?\nA) Labrynthine aery\nB) Anterior inferior cerebellar aery\nC) Pontine aery\nD) Posterior communicating aery", "output": "3, because Posterior communicating aery is a branch of internal carotid aery. The other branches of basilar aery are: Superior cerebellar aery Posterior cerebral aeries . The branches of cerebral pa of internal carotid aery are: Ophthalmic aery Anterior cerebral aery Middle cerebral aery Posterior communicating aery Anterior choroidal aery . imageref - Vishram singh 2e pg 174"}