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{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following clinical laboratory observations is suggestive of Hanup disease?\nA) Burnt sugar smell in urine\nB) High plasma phenylalanine levels\nC) Extremely high levels of citrulline in urine\nD) High fecal levels of tryptophan and indole derivatives", "output": "3, because High fecal levels of tryptophan and indole derivatives Hanup disease is autosomal recessive metabolic disorder also known as pellagra like dermatosis. This affect the absorption of nonpolar( neutral ) amino acids specially tryptophan. So there is no absorption of tryptophan."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are true about pathogenesis of Ovarian Hyperstimulation Syndrome, EXCEPT?\nA) Due to ovarian enlargement and fragility\nB) Increase in intravascular volume\nC) Role of VEGF and inflammatory cytokines\nD) Secondary to infeility treatment", "output": "1, because Symptoms of OHSS are the result of ovarian enlargement and fragility, extravascular fluid accumulation, and intravascular volume depletion (and not increase as stated in option b). Fluid shifts that accompany OHSS are due to increased protein-rich fluid secretion from the stimulated ovaries, increased renin and prorenin within follicular fluid, increased capillary permeability and VEGF"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBiological value of a protein is related to\nA) Nitrogen content\nB) amino acid content\nC) Sulphur content\nD) Energy content", "output": "0, because Ans) a (Nitrogen content) Ref paik 20th ed p 549Biological value of a protein is Retained N2 / Absorbed N2 x 100Protein efficiency ratio = Wt gain in gms / Gram of protein consumedNet protein utilization =Digestibility Coefficent x Biological value100 Aminoacid score =No of mg of one AA/gm of proteinNo of mg of same AA/gm of egg proteinx 100Quality of protein is assessed by comparison to the reference protein which is usually egg protein."}

{"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 study for correlation of genetic disease to consanguinity -\nA) Case Contral Study\nB) Cohort study\nC) Cross-sectional study\nD) Case report", "output": "0, because Ans. is 'a' i.e., Case Control Study \" The association of consanguinity with complex disorders can be studied using different approaches. For example, epidemialogial surveys could compare the frequency of a disorder in the progeny offirst cousin parents with that of unrelated parents, whereas case-control studies could compare the rates of first cousins among affected individuals and controls\"."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVon Gierke&;s occurs due to deficiency of\nA) Glucose-6-phosphatase\nB) Liver Phosphorylase\nC) Muscle phosphorylase\nD) Debranching enzyme", "output": "0, because Glycogen storage disease type I (GSD I) or von Gierke&;s disease, is the most common of the glycogen storage disease. This genetic disease results from deficiency of the enzyme glucose-6-phosphatase and has an incidence in the American population of approximately 1 in 100,000 bihs.Ref: DM Vasudevan, 7th edition, page no: 128"}

{"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 38 year old male has paroxysmal hypeension. He is subsequently found to have medullary carcinoma of the thyroid, pheochromocytoma, and mucosal neuromas. Parathyroid involvement is not noted. What is the most likely diagnosis?\nA) MEN type I\nB) MEN type II\nC) MEN type III\nD) Sipple's syndrome", "output": "2, because MEN III, also known as MEN IIb, is characterized by medullary thyroid carcinoma, pheochromocytoma, and mucosal neuromas.Wermer's syndrome is also called MEN type I . It is characterized by pancreatic (insulinoma), pituitary, and parathyroid involvement.Sipple's syndrome, or MEN type II , is similar to MEN III, but it has parathyroid involvement (tumor or adenoma) as opposed to neuromas. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 18. Endocrine Pathology. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMrs Shikha, 50-years-old woman is diagnosed with cervical cancer. Which lymph node group would be the first involved in metastatic spread of this disease beyond the cervix and uterus? NOT RELATED -anatomy\nA) Common iliac nodes\nB) Parametrial nodes\nC) External iliac node\nD) Paracervical or ureteral nodes", "output": "3, 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\nA viral infection causes damage to both hippocampi in a patient. This damage would cause the patient to exhibit functional deficits in\nA) Recalling an old declarative memory\nB) Recalling an old procedural memory\nC) Forming a new sho-term memory\nD) Forming a new long-term memory", "output": "3, because The hippocampus is crucial for the formation of long-term (declarative) memory. Without the hippocampus, sho-term memory is intact but the conversion to long-term does not take place.The retrieval of stored declarative memory does not require the hippocampus. The hippocampus is not needed for the retrieval of procedural memory.Ref: Guyton; 13th 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\nType of collagen maximum in skin:-\nA) Type I\nB) Type II\nC) Type III\nD) Type IV", "output": "0, because Collagen - the most abundant protein in mammals contains 4-hydroxyproline and 5-hydroxylysine. Vitamin C plays the role of a coenzyme in hydroxylation of proline and lysine while protocollagen is conveed to collagen The hydroxylation reaction is catalysed by lysyl hydroxylase (for lysine) and prolyl hydroxylase (for proline) This reaction is dependent on vitamin C, molecular oxygen and a-ketoglutarate Type Distribution I Noncailaginous connective tissues, including bone, tendon, skin II Cailage, vitreous humor III Extensible connective tissues, including skin, lung, vascular system IV Basement membranes"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nRotameters\nA) Depend on laminar low for their accuracy\nB) Will only function when upright\nC) Are constant pressure drop-constant orifice devices\nD) Are not accurate below 1L/min", "output": "1, because Rotameters are constant pressure drop-variable orifice devices. They are accurate at values as low as 200mL/min\u00a0both laminar and turbulent flow determine their accuracy ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following is true of Wilson's disease all except -\nA) Autosomal recessive\nB) Serum ceruloplasmin level < 20 mg/d1\nC) Urinary coppor excretion < 100 microgram/c11\nD) Zinc acetate is used as maintence therapy", "output": "2, because Urinary copper excretion <100 microgram/di Symptomatic pts. of Wilson disease invariably have urine copper levels > 100 pg per day. Wilson disease is an autosomal recessive disorder caused by mutation in the ATP 7B gene (a copper transpoing ATPase) Diagnosis - The gold standard for diagnosis is Liver biopsy with quantitative copper assayQ. Other diagnostic tests used are ? - Serum ceruloplasmin levelQ - KF rings(2 - Urine copper excretiono - DNA Helpful-ye analysisQ Serum copper values have no diagnostic value, since they may be low, normal or elevated depending upon the stage of evolution of disease. Table : Useful Diagnostic Tests for Wilson Disease Test Normal Value Wilson Disease Serum 180-350 mg/L ceruloplasmin (18-35 mg/d1) * Low in 85% * Present in 99% KF rings Absent - If neurologic or psychiatric symptoms present. * Present in 30-50% - in hepatic presentation and presymptomatic state * Urinary copper excretion is increased 24-h urine Cu 0.3-0.8 mmol - >1.6intn ol(>100mg) in symptomatic patients * 0.9 to > mmol (60 to > 100 mg) - in presymptomatic patients Liver Cu 0.3 -- 0.8 mmol/g * Liver copper is increased (20-50 mg) tissue * > 3.1 mmol (200 mg) Haplotype analysis 0 Matches 2 Matches Treatment Zinc is the treatment of choice for Wilson diseaseQ. It produces a negative copper balance - By blocking intestinal absorption of copper - By inducing hepatic metallothionein synthesis which sequesters additional toxic copper. Table : Recommended Anticopper Treatments for Wilson Disease Disease Status First Choice Second Choice Initial hepatic manifestations Zinc Trientine and zinc Trientine and zinc Hepatic transplantation Trientine Penicillainine and zinc Hepatic transplantation Trientine and zinc * Hepatitis or cirrhosis without decompensation * Hepatitis or Cirrhosis with decompensation - Mild - Moderate - Severe Initial neurologic/psychiatric Tetraioinolybdate and zinc Trientine and zinc Maintenance therapy Zinc Trientine Presymptomatic therapy Zinc Trientine Pediatric Zinc Trientine Pregnant Zinc Trientine"}

{"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 25 year male presented with high grade fever, headache, neck stiffness, on examination found to have neck rigidity, kernig's sign positive, csf analysis showed neutrophilic predominance, low glucose and limulus amebocyte lysate assay was positive. Which of the following is the likely pathogen?\nA) Staphylococcus aureus\nB) Streptococcus pneumonia\nC) Neisseria meningitides\nD) Listeria monocytogenes", "output": "2, because The Limulus amebocyte lysate assay is a rapid diagnostic test for the detection of gram-negative endotoxin in CSF and thus for making a diagnosis of gram-negative bacterial meningitis. The test has a specificity of 85-100% and a sensitivity approaching 100%. Thus, a positive Limulus amebocyte lysate assay occurs in viually all patients with gram-negative bacterial meningitis, but false positives may occur. Ref Harrison 20th edition page 1001"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nTuberculin test denotes:\nA) Previous or present sensitivity to tubercle proteins\nB) Patient is resistant to TB\nC) Person is susceptible to TB\nD) Protective immune status of individual against TB", "output": "0, because Ans. is 'a' i.e., Previous or present sensitivity to tubercle proteins(a) Tuberculin test denotes Type IV (delayed) hypersensitivity to tuberculoprotein 0.1 ml (Purified protein derivative) and used in diagnosis of latent tuberculosis.(b) Positive tuberculin test indicates exposure to Mycobacterium tuberculosis in the form of infection or immunization with or without active 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\nTumor suppressor gene p53 prevents carcinoma by?\nA) DNA repair\nB) Cell cycle arrest\nC) Apoptosis induction\nD) All of the above", "output": "3, because Ans. is 'd' i.e., All of the above * p53 gene is located on chromosome 17 & acts as molecular policeman that prevents the propagation of genetically damage cell. p53 gene product, i.e. p53 protein is a DNA binding protein in the nucleus, when called into action, it controls the transcription of several other genes.* When there is DNA damage due to irradiation, UV light or mutagenic chemicals, there is rapid increase in p53 levels.* p53 causes :-a) Cell cycle arrest: p-53 induces transcription of p21, a CDK inhibitor. p21 inhibit cyclin DCDK- 4 complex and there is arrest of cell cycle late in G1 phase. This allow time for DNA repair.b) DNA repair: p-53 also helps in DNA repair directly by inducing transcription of GADD 45 (growth arrest and DNA damage). GADD 45 encodes a protein that is involved in DNA repair.* If DNA damage is repaired successfully, p53 activate MDM-3 and this MDM-3 induce degradation of p-53 - Relieve in cell cycle block. If DNA damage cannot be successfully repaired, p53 induces apoptosis by inducing the activation of apoptosis inducing gene BAX. So p-53 prevents replication of cell with defective DNA - p53 functions as a critical gatekeeper against formation of cancer. Mutation in p53 leads to carcinogenesis because of loss of above protective mechanism."}

{"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 specific enzyme for mi is:\nA) Cpk-MM\nB) Cpk-MB\nC) Cpk-BB\nD) LDH", "output": "1, because Ans: bRef: Harrison, 16thed, p. 1450"}

{"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 part of fatty acid synthase Complex?\nA) Ketoacyl reductase\nB) Enoyl reductase\nC) Acetyl-CoA carboxylase\nD) Ketoacyl synthase", "output": "2, because Ans. C. Acetyl-CoA carboxylase(Ref: Harper 31/e page 217)Fatty Acid Synthase (FAS) Multienzyme ComplexThe complex is a homodimer of two identical polypeptide monomers in which six enzyme activities and the acyl carrier protein (ACP)ACP contains the vitamin pantothenic acid in the form of 4'-phosphopantetheineX-ray crystallography of the three-dimensional structure, shown that the complex is arranged in an X shapeAcetyl-CoA carboxylase is not a part FAS ComplexQ."}

{"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 followings are responsible for Right shifting of O2 saturation curve; except:\nA) Hypoxia\nB) Hypocapnia\nC) Increase temp\nD) Increased 2,3 DPG", "output": "1, because Ans. b. HypocapniaThe factors shift the curve to the right:Increased CO2 (Bohr effect)Increased hydrogen ion (decrease pH)Increased temperatureIncreased 2,3-bisphosphoglycerate (2,3-BPG)Shifts in Hb-O2 dissociation curveStored blood loses 2, 3-bisphosphoglycerate, causing a left shift in the curve, while hypoxia stimulates the production of 2,3-bisphosphoglycerate, thereby causing a right shift.Extra MileRight shiftAcidCO2 Exercise2, 3-BPGAltitudeTemperatureMnemonics: ACE BATs right handed"}

{"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 nineteen year old female with short stature, wide spread nipples and primary amenorrhoea most likely has karyotype of \u2013\nA) 47, XX + 18\nB) 46XXXY\nC) 47, XXY\nD) 45 XO", "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\nTrue about rash of chickenpox\nA) Centripetal\nB) Deep Seated\nC) Affectspalm\nD) Slow to evolute", "output": "0, because Rash of chicken pox : Superficial, unilocular, centripetal, pleomorphic, symmetrical, affects flexor surfaces and axilla, spares palms and sales, has inflammation around, rapid evolution and dew-drop on rose petal appeamace."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are true about Klumpke's paralysis except\nA) Claw hand is never seen\nB) Intrincsic muscles of hand are paralysed\nC) Horner's syndrome can be associated\nD) Involves lower trunk of brachial plexus", "output": "0, because Klumpke's paralysis\n\nC8\u00a0and T1\u00a0roots involved.\nIntrinsic muscles of hand paralysed.\nWrist and finger flexous are weak.\nUnilateral Horner's syndrome.\nClaw hand is seen."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nHyperglycemia is seen in all except?\nA) Cirrhosis\nB) Myotonic dystrophy\nC) Lipodystrophy\nD) Sarcoma", "output": "3, because In cirrhosis, blood sugar is elevated, due to reduced uptake of sugar by liver. In myotonic dystrophy and lipodystrophy, there is tissue insensitivity to insulin leading to hyperglycemia. Sarcoma especially large retroperitoneal sarcomas secrete IGF-2 and lead to hypoglycaemia."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nLSD was introducd by\nA) albe hoffman\nB) delay and deniker\nC) John F Cade\nD) Egaz Moniz", "output": "0, because Hallucinogens * ALSO CALLED AS Psychotomimetic/ Psychedelic * FIRST Man made HALLICINOGEN ==================== Albe Hoffman * MECHANISM OF ACTION Lysergic acid diethylamide=======serotonin * Introduced by Albe Hoffmann and he himself experienced its effects * Phencyclidine =======NMDA antagonist * Also known as angel dust * Related to ketamine=== dissociative anesthetic * Has anti-suicidal propey Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.649"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDecreased basal metabolic rate is seen in\nA) Obesity\nB) Hypehyroidism\nC) Feeding\nD) Exercise", "output": "0, because The remaining options utilise energy. Basal metabolic rate and obesity The basal metabolic rate accounts for about 60 to 75% of the daily calorie expenditure by individuals. It is influenced by several factors. BMR typically declines by 1-2% per decade after age 20, mostly due to loss of fat-free mass, although the variability between individuals is high. Ref guyton and hall textbook of medical physiology 12/e pg843"}

{"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 70 kg athlete is taken for surgery, due to unavailability of vecuronium, succinylcholine is given repeatedly (>640mg). He now is unable to take breath and his lower limbs are paralyzed. What will be cause?\nA) Phase II block\nB) Succinylcholine causes muscle paralysis due to fasciculation\nC) Hidden muscle dystrophy\nD) Pseudo cholinesterase deficiency", "output": "0, because Prolonged apnea due to repeated dosing with succinylcholine is due to it entering phase 2 block. Phase I depolarizing block is preceded by muscle fasciculation. During paial neuromuscular block, phase I depolarizing block is characterised by: No fade during repetitive stimulation (tetanic or TOF) No post tetanic facilitation (potentiation) Rapid hydrolysis by butyrylcholinesterase (plasma cholinesterase) terminates phase I depolarizing blockade of succinylcholine. Phase II block resembles non depolarizing block, is characterised by: Fade during repetitive stimulation (tetanic or TOF) Post tetanic facilitation (potentiation) Phase II block can be antagonized by administering a cholinesterase inhibitor like neostigmine."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nInheritance of ABO blood group is:\nA) X-linked inheritance\nB) Recessive inheritance\nC) Mitochondria] inheritance\nD) Codominance", "output": "3, because Ans. d. Codominance (Ref Robbins 9/e p140; Ganong 23/e p527)Inheritance of ABO blood group is Codominance.\"Although Mendelian traits are usually described as dominant or recessive, in some cases both of the alleles of a gene pair contribute to the phenotype--a condition called codominance. Histocompatibility and blood group antigens are good examples of codominant inheritance. \"--Robbins 9/e p140Codominance is a relationship between two versions of a gene, individuals receive one version of a gene, called an allele, from each parent. If the alleles are different, the dominant allele usually will be expressed, while the effect of the other allele, called recessive, is masked. In Codominance, however, neither allele is recessive nor are the phenotypes of both alleles are expressed, e.g., ABO blood group, where in AB blood group both A and B are dominant.\"Codominance: When both alleles of a gene pair contribute to the phenotype. E.g., Blood group AB.ABO Blood Group SystemA and B antigens of the ABO blood group system are glycoproteins present on the RBC membrane.H substance is the immediate precursor on which A and B antigens are added.H substance is formed by the addition of fucose to the glycolipid or glycoprotein backbone.The subsequent N-acetyl glucosamine creates the A antigen, while the addition of galactose produces the B antigen.Bombay phenotypeIndividuals with the rare Bombay phenotype (hh) do not express the H antigen (also called the H substance), the antigen, which is present in blood group OQ.As a result of the absence of the H antigen they cannot make either the A antigen or the B antigenQ.These individuals have antibodies not only against A and B antigens but also against the H antigenQ."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich is not ketogenic\nA) Leucine\nB) Lysine\nC) Methionine\nD) Tryptophan", "output": "2, because Ans. is 'c >d' i.e., Methionine > TryptophanLeucine and lysine are purely ketogenic.Trypotophan is not purely ketogenic, but it is ketogenic along with glucogenic. Methionine is purely glucogenic."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nGlossodynia is\nA) Pain in the tongue\nB) Burning of the tongue\nC) Swelling of the tongue\nD) White patch on tongue", "output": "0, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are the branches of internal iliac artery except:\nA) Obturator artery\nB) Middle rectal artery\nC) Femoral artery\nD) Internal pudendal artery", "output": "2, because Ans. C. Femoral arteryThe internal iliac artery supplies the walls and viscera of the pelvis, the buttock, the reproductive organs, and the medial compartment of the thigh.It arises at the bifurcation of the common iliac artery, opposite the lumbosacral articulation, and, passing downward to the upper margin of the greater sciatic foramen, divides into two large trunks, an anterior and a posterior.The anterior division gives rise to these arteries:a. Umbilical artery (in fetus),b. Obturator artery,c. Vaginal artery,d. Superior &inferior vesical artery,e. Uterine artery,f. Middle rectal artery,g. Internal pudendal artery,h. Inferior gluteal artery.The posterior division gives rise to the superior gluteal, iliolumbar, and lateral sacral 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\nSACD (Subacute combined degeneration of cord) is feature of which vitamin deficiency?\nA) Vitamin A\nB) Vitamin B6\nC) Vitamin B9\nD) Vitamin B12", "output": "3, because Ans. d (Vitamin B12) (Ref. H - 17th/pg. Table 71-1).Vitamins: Major FunctionsVITAMINFUNCTIONVitamin AA component of visual pigment; Maintenance of specialized epithelia; Maintenance of resistance to infectionVitamin DFacilitates intestinal absorption of calcium and phosphorus and mineralization of boneVitamin EMajor antioxidant; scavenges free radicalsVitamin KCofactor in hepatic carboxylation of procoagulants--factors II (prothrombin), VII, IX, and X; and protein C and protein S.Vitamin B1 (thiamine)As pyrophosphate, is coenzyme in decarboxylation reactions. Converted to coenzymes flavin mononucleotide and flavin adenine dinucleotide, cofactors for many enzymes in intermediary metabolismNiacinIncorporated into nicotinamide adenine dinucleotide (NAD) and NAD phosphate, involved in a variety of redox reactionsVitamin B6 (pyridoxine)Derivatives serve as coenzymes in many intermediary reactionsVitamin B12Required for normal folate metabolism and DNA synthesis; Maintenance of myelinization of spinal cord tractsVitamin CServes in many oxidation-reduction (redox) reactions and hydroxylation of collagenFolateEssential for transfer and use of 1-carbon units in DNA synthesisPantothenic acidIncorporated in coenzyme ABiotinCofactor in carboxylation reactionsVitamin B12.introductionStored primarily in the liver. Very large reserve pool (several years). Synthesized only by microorganisms. Found only in animal products.FunctionCofactor for homocysteine methyltransferase (transfers CH3 groups as methylcobalamin) and methyimalonyl-CoA mutase. Abnormal myelin is seen in B12 deficiency, possibly due to | methionine or | methylmalonic acid (from metabolism of accumulated methylmalonyl-CoA).Causes of deficiencyVitamin B12 deficiency is usually caused by malabsorption (sprue, enteritis, Diphyllobothrium latum), lack of intrinsic factor (pernicious anemia, gastric bypass surgery), or absence of terminal ileum (Crohn's disease). Use Schilling test to detect the etiology of the deficiency.Deficiency featuresMacrocytic, megaloblastic anemia; neurologic symptoms (optic neuropathy, subacute combined degeneration, paresthesia); glossitis.PRINCIPAL CLINICAL FINDINGS OF VITAMIN MALNUTRITIONNutrientClinical findingDietary level per day associated with overt deficiency in adultsContributing factors to deficiencyThiamineBeriberi:Neuropathy,Muscle weakness and wasting, Cardiomegaly,Edema,Ophthalmoplegia,Confabulation<0.3 mg/1000 kcalAlcoholism, chronic diuretic use, hyperemesisRiboflavinMagenta tongue,Angular stomatitis,Seborrhea,Cheilosis<0.6 mg-NiacinPellagra:Dermatitis: Pigmented rash with silvery/ varnish-like scales of sun-exposed areas.Bright red beefy tongue.DiarrheaDementiaApathyDisorientationDeath (if untreated)<9.0 niacin equivalentsAlcoholism, vitamin B6 deficiency, riboflavin deficiency, tryptophan deficiencyVitamin B6SeborrheaGlossitisConvulsions (especially in neonates),Neuropathy,Depression,Confusion,Microcytic anemia<0.2 mgAlcoholism, isoniazid (most common cause)FolateMegaloblastic anemia,Atrophic glossitis,Depression, -Homocysteine<100 mg/dAlcoholism, sulfasalazine, pyrimethamine, triamtereneVitamin B12Megaloblastic anemia,SACD:Loss of vibratory and position sense, Abnormal gait,Dementia, impotence,Loss of bladder and bowel control, -homocysteine, -methylmalonic acid.<1.0 mg/dGastric atrophy (pernicious anemia), terminal ileal disease, strict vegetarianism, acid reducing drugs (e.g., H2 blockers)Vitamin CScurvy:petechiae, ecchymosis, coiled hairs, inflamed and bleeding gums, joint effusion, poor wound healing, fatigue, perifollicular hemorrhages, subperiosteal hematoma (Woody leg).<10 mg/dSmoking, alcoholismVitamin AXerophthalmia, night blindness, Bitot's spots,Follicular hyperkeratosis,Impaired embryonic development, Immune dysfunction<300 mg/dFat malabsorption, infection, measles, alcoholism, protein-energy malnutritionVitamin DRickets: skeletal deformation, rachitic rosary, bowed legs; osteomalacia<2.0 mg/dAging, lack of sunlight exposure, fat malabsorption, deeply pigmented skinVitamin EPeripheral neuropathy,Spinocerebellar ataxia,Skeletal muscle atrophy, retinopathyNot described unless underlying contributing factor is presentOccurs only with fat malabsorption, or genetic abnormalities of vitamin E metabolism/transportVitamin KElevated prothrombin time, bleeding<10 mg/dFat malabsorption, liver disease, antibiotic use"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMain aim for treatment of TB ?\nA) Prevention of complication\nB) Prevention of disease transmission\nC) Complete clinical cure\nD) Complete bacteriological cure", "output": "3, because Ans. is 'd' i.e., Complete bacteriological cure Chemotherapy is indicated in every case of active tuberculosis. The objective of treatment is cure-that is, the elimination of both the fast and slowly multiplying bacilli from the patient's body. The effects of chemotherapy are judged not by the anatomic healing of lesions, but maily by the elimination of bacilli from the patient's sputum."}

{"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 functions of CD 4 helper cells, except-\nA) Immunogenic memory\nB) Produce immnoglobulins\nC) Activate macrophages\nD) Activate cytotoxic cells", "output": "1, because CD4 T cells are helper T cells. They stimulate B cells to produce antibodies, release of cytokines and are responsible for memory. They do not directly produce any antibody by their own. Basic Pathology, Robbins. Page no.:101"}

{"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 35-year-old man with duodenal stump leak after partial gastrectomy is receiving central parenteral nutrition containing the standard D25W, 4.25% amino acid solution. Which is TRUE of essential fatty acid deficiency seen after hyperalimentation?\nA) It occurs if soybean oil is given only once weekly.\nB) It is usually noted at the end of the first week.\nC) It causes dry scaly skin with loss of hair.\nD) It is accompanied by hypercholesterolemia.", "output": "2, because Essential fatty acid deficiency usually occurs if hyperalimentation is extended for more than 1 month and when soybean oil is not administered at least twice a week. There is a decrease in linolenic, linoleic, and arachidonic acids and an increase in oleic and palmitoleic acid. In addition to the skin changes, there may be poor wound healing, increased susceptibility to infection, lethargy, and thrombocytopenia. It is characterized by a triene-to-tetraene ratio >0.4."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSacrum becomes a single bone at ___ years of age.:-\nA) 15\nB) 25\nC) 30\nD) 40", "output": "1, because Sacrum The five sacral veebrae are separated by cailage until pubey. Later, fusion of epiphyses takes place and ossification of interveebral discs extend from below upwards. Sacrum becomes single bone at 21-25 years of age. Sometimes, it leaves a gap between S1 and S2, until 32 years called as 'lapsed union'."}

{"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 True about dobutamine?\nA) Dobutamine decreases peripheral resistance\nB) Acts on D1 and D2 receptors\nC) Decrease kidney circulation\nD) Has no effect on coronary circulation", "output": "0, because Ref: HL Sharma 3rd ed pg no: 177 Dobutamine is a derivative of dopamine and is a selective beta1 agonist. It causes an increase in the force of contraction without a significant increase in hea rate. It also produces some vasodilatation by stimulating the beta 2 receptors. It doesn't decrease kidney circulation."}

{"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 about cutaneous shunt~vessels is true?\nA) Perform nutritive function\nB) Have role in thermoregulation\nC) Not under the control of autonomic nervous system\nD) These vessels are evenly distributed throughout the skin", "output": "1, because These are low resistance connection between the aerioles and veins bypassing the capillariesAbundantly innervated by sympathetic nerve fibresEspecially found in skin of fingers, toes and earlobes where they are involved in the thermoregulationRef: Medical Physiology Indu Khurana 2015 edition page No: 237"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nVolume of infarcted area in acute myocardial infarction (AMI) can be detected by -a) ECHOb) ECGc) Levels of CPKMBd) Thallium scan\nA) b\nB) c\nC) ac\nD) ad", "output": "3, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nBlow out fracture of orbit commonly produces\nA) Deviation of septum\nB) Retinal haemorrhage\nC) Fracture of nasal bones\nD) Fracture of floor of orbit", "output": "3, because (D) Fracture of floor of orbit # Blow out fracture of orbit; Intraorbital haemorrhages, proptosis, paralysis of extrinsic muscles and fracture of the floor of the orbit are not infrequent following a blunt injury to the orbital region> Proptosis develops due to reactive oedema and intra-orbital haemorrhage.> Partial or complete ophthalmoplegia occurs as a result of injury to the muscles or due to profuse orbital oedema.> In the fracture of the floor of orbit, the eyeball is depressed into the maxillary antrum & the inferior rectus and inferior oblique muscles are entrapped causing diplopia.> There occurs limitation of upward gaze, and downward gaze may also be reduced because of the pinched inferior rectus muscle in between the chips of the broken bone> A positive forced duction test, downwards and inwards displacement of the globe and radiological evidence virtually confirm the diagnosis of blowout fracture with incarcerated orbital tissue.> The fracture of the base of skull implicates optic foramen and may cause optic atrophy or pulsating exophthalmos.> The fracture of the optic canal is characterised by a wound at the lateral part of the eyebrow, loss of direct homolateral pupillary reaction and hemianopic field defects.> The patient may suffer from epistaxis and varying periods of unconsciousness.> The pallor of the optic disc may be noticed 2-3 weeks after the injury. Serial radiological tomograms taken at one minute intervals may confirm the diagnosis."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDrug used in cancer chemotherapy induced vomiting is?\nA) Aprepitant\nB) Dexamethasone\nC) Ondansetrin\nD) All of the above", "output": "3, because Ondansetron is drug of choice for chemotherapy induced vomiting Dexamethasone,lorazepam and aprepitant are also used for chemotharapy induced vomiting.( ref KDT 7/e p876)"}

{"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 cause of granular contracted kidney ?\nA) Diabetes mellitus\nB) Chronic pyelonephritis\nC) Benign nephrosclerosis\nD) Chronic glomerulonephritis", "output": "0, because Ans. is 'a' i.e., Diabetes mellitusCauses of Granular contracted kidney ?Chronic glomerulonephritis (symmetric)Chronic pyelonephritis (asymmetric) o Benign Nephrosclerosis (Symmetric) Sometimes, Diabetes too can cause granular contracted kidney"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAnticoagulant of choice for prophylaxis of venous thromboembolism in patient with cancer surgery is:-\nA) Heparin sulfate\nB) Protamine sulfate\nC) Low molecular weight heparin\nD) Warfarin", "output": "2, because Venous Thromboembolism- precipitating factor -estrogen in females PREVENTION OF Venous Thromboembolism AMONG HOSPITALIZED PATIENTS Condition Prophylaxis High risk non - ohopedic surgery Unfractionated heparin Low molecular weight heparin (LMWH) Cancer surgery(associated thromboembolism ) LMWH Major ohopedic surgery Warfarin LMWH Aspirin Factor Xa inhibitors (Apixaban) Dabigatran Medically ill patients during hospitalization Unfractionated heparin LMWH Medically ill patients after hospitalization Betrixaban"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following does not belong to dystrophin-glycoprotein complex\nA) Perlecan\nB) Dystrophin\nC) Dystroglycan\nD) Sarcoglycan", "output": "0, because Perlecan is a large extracellular matrix proteoglycan that plays a crucial role in tissue development and organogenesis. Dystrophin-glycoprotein complex The dystrophin-glycoprotein complex provides a structural link between the cytoskeleton of the muscle cell and the extracellular matrix, which appears to stabilize the sarcolemma, adds strength to the muscle by providing a scaffolding for the fibrils and prevents contraction-induced injury(rupture). Organisation of DG complex Dystrophin connects F-actin to the transmembrane protein b-dystroglycan smaller proteins called syntrophins. This b-dystroglycan, in turn connects to the merosin subunit of laminin 211 in the extracellular matrix a-dystroglycan The dytroglycans are also associated with a complex of four transmembrane glycoproteins, a-,b-,g- and d- sarcoglycan and sarcospan. Ref: Ganong's Review of Medical physiology 25th edition Pgno: 103"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPatient came to the OPD with recent onset photphobia within 24 hours and sloughing corneal ulcer. There is greenish ulcer base. Which of the following can be the causative organism:\nA) Acanthamoeba\nB) Nocardia\nC) Pseudomonas\nD) Herpes", "output": "2, because Pseudomonas Ulcer Rapid onset & Greenish ulcer base Produce biofilm that cause resistance MC cause of infection in contact lens users Nocardia ulcer resembles fungal ulcer in its characteristics."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCulture media used for leptospira\nA) MYPA agar\nB) BYCE agar\nC) EMJH Medium\nD) Skirrow's medium", "output": "2, because Culture media for leptospira is EMJH media, Korthof's, Stuart's and fletcher's media."}

{"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 advantage of using a tooth positioner as a retainer is :\nA) Final setting of occlusion\nB) Used in uncooperative patients\nC) Esthetics\nD) Gingival margin inflamed during orthodontic treatment", "output": "3, because The use of a tooth positioner rather than final settling archwires has two advantages:\u00a0\n\nIt allows the fixed appliance to be removed somewhat more quickly than otherwise would have been the case (i.e., some finishing that could have been done with the final archwires can be left to the positioner)\nIt serves not only to reposition the teeth but also to massage the gingiva, which is almost always at least slightly inflamed and swollen after comprehensive orthodontic treatment. The gingival stimulation provided by a positioner is an excellent way to promote a rapid return to normal gingival contours.\n\nAs a general rule, a tooth positioner in a cooperative patient will produce any changes it is capable of within 2-3 weeks. Final (post-treatment) records and retainer impressions can be taken 2 or 3 weeks after the positioner is placed. Beyond that time, if the positioner is continued, it is serving as a retainer rather than a finishing device-and positioners, as a rule, are not good retainers.\nContemporary orthodontics- proffit 4th edition page 614"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nCryosurgery is used in treatment of cervical intraepithelial neoplasia. It is appropriate in all except\nA) Transformation zone lying entirely on ectocervix.\nB) Smooth cervical surface without deep crevices.\nC) Cervical intraepithelial neoplasia -3.\nD) CIN limited to two quadrants of the cervix.", "output": "2, because Cryosurgery is generally not favoured for treatment of CIN-3 due to higher rates of disease persistence following treatment, and lack of histologic specimen to exclude occult invasive cancer."}

{"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 respiratory and GIT infections, which is the most affected immunoglobulin -\nA) IgA\nB) IgG\nC) IgM\nD) IgD", "output": "0, because IgA Antibody:- IgA is the second most abundant antibody (2nd highest for DHS). It is of two types: Serum IgA: Predominantly in monomeric form. Secretory IgA (SIgA): It is dimeric (valency four); Secretory IgA is responsible for Mucosal /local immunity. IgA also exist in two subclasses/isotypes: IgA1 is mainly found in serum. IgA2 predominates in secretions. IgA (Secretory IgA) is selectively concentrated in secretions and on mucous surfaces forming an antibody paste and is believed to play, an impoant role in local immunity against respiratory and intestinal pathogens. It protects the mucous membranes against microbial pathogens. It serves an impoant effector function at mucous membrane surfaces, which are the main entry sites for most pathogenic organisms."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are risk factors of squamous cell carcinoma except\nA) Ultraviolet radiation\nB) Tar\nC) Tobacco\nD) HPV 18", "output": "3, because Ultraviolet radiation, chronic inflammation, and chemical carcinogens (arsenicals, tar) and infection with HPV 5 and 16.There is also evidence that current and previous tobacco use doubles the relative risk of SCC.Ref: Bailey and Love, 27e, page: 606"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nJudge can ask questions: Punjab 07\nA) During cross-examination\nB) Examination-in-Chief\nC) Any time during trial\nD) Re-examination", "output": "2, because Ans. Any time during trial"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich is not an aryl phosphate -\nA) Parathion\nB) TIK-20\nC) Malathion\nD) Paraoxon", "output": "2, because Organophosphate poisoning is the most common poisoning in India followed by aluminium phosphide. Organophosphorus compounds are classified as 1. Alkyl compounds -- such as tetraethyl pyrophosphate (TEPP), hexa ethyl tetraphosphate (HETP), octa methyl pyrophosphate (OMPA), malathion etc. 2. Aryl compounds -- such as parathion, chlorothion, diazinon (Tik-20), paraoxon etc. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 291"}

{"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 female, Lalita, aged 26 yrs accidentally takes 100 tablets of paracetamol. What is the treatment of choice -\nA) Lavage with charcoal\nB) Dialysis\nC) Alkaline diuresis\nD) Acetylcysteine", "output": "3, because Ans. is 'd' i.e Acetylcysteine \"In cases of moderate to severe poisoning N acetylcysteine (Mucomyst) should be given orally. It is most effective when given within 16-24 hours of overdosage. It prevents hepatic damage\". - Parikh"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTrue for Bochdalek hernia:\nA) Commonly occurs on the right side\nB) Congenital disorder\nC) Anterior position\nD) Breathing difficulty in newborns from day 2-3", "output": "1, because Ans. B. Congenital disorderBochdalek hernia is the other name for congenital diaphragmatic hernia. It is a posterior (and not anterior) congenital defect of the diaphragm and is primarily due to lack of closure of the pleuroperitoneal cavity between the eighth and tenth week of embryonic life. Majority of cases occur on the left side. Affected newborns frequently present with breathing difficulty, particularly within the first few hours of life."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHypercalcemia is most commonly associated in which of the following cancers?\nA) Renal cell cancer\nB) Carcinoma stomach\nC) Squamous cell carcinoma of lung\nD) Hepatocellular carcinoma", "output": "2, because The most common neoplasm associated with hypercalcemia is squamous cell carcinoma. Other tumors often associated with paraneoplastic hypercalcemia are carcinomas of the lung, kidney, breast and ovary. Paraneoplastic hypercalcemia is caused by parathyroid hormone-related protein (PTHRP) secreted by these tumours. PTHRP increases bone resorp-tion and renal calcium uptake, while inhibiting renal phosphate transpo, effects that raise serum calcium levels."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nEthanol is given in methyl alcohol poisoning because:\nA) It inhibit alcohol dehydrogenase\nB) It inhibit aldehyde synthetase\nC) It binds 100 times stronger than methanol\nD) None", "output": "0, because Ethanol is preferentially metabolised by alcohol dehydrogenase over methanol.At a concenteration 100mg/DL in blood it saturates alcohol dehydrogenase over methanol &retads methanol metabolism. This reduces formation of formaldehyde & formic acid. 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 multi question.\n\nA term born 6-month-old, lethargic blonde infant, presented with multiple episodes of vomiting, poor feeding, convulsions and severe psychomotor retardation. O/E: - Microcephaly with prominent maxillae and widely spaced teeth Blue iris Seborrheic or eczematoid rash Spasticity, hyperreflexia, and tremor Musty odour of urine MRI brain All of the following statements are true about the disease except: -\nA) May be caused due to the deficiency of cofactor tetrahydrobiopterin BH4\nB) Tandem mass spectrometry is useful in the diagnosis.\nC) The complications can't be prevented by restricting the use of the involved amino acid in diet.\nD) Pegvaliase can be given in adults suffering from this.", "output": "2, because This is a case of Phenylketonuria. Autosomal recessive Deficiency of Phenylalanine hydroxylase May also be due to deficiency of cofactor tetrahydrobiopterin BH4 Leads to hyperphenylalaninemia - Impairs brain development Normal at bih Becomes symptomatic later on in life Present with seizures, hypopigmentation of skin and hair, mental retardation. Complications can be avoided by restricting phenylalanine intake in diet. Diagnosed by: - Guthrie test Tandem mass spectrometry- measure amino acid Immunoassays MRI image shows affected periventricular/ parieto-occipital white matter (due to hypomyelination). Pegvaliase can be given in adults."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPK reactio detects -\nA) IgG\nB) IgA\nC) IgE\nD) IgM", "output": "2, because The Prausnitz-Kustner test (PK test, Prausnitz-Kustner reaction) is an immunologic test formerly used by physicians to determine if a patient has an allergic reaction to a specific antigen i.e, IgE Ref: Ananthanarayan & Parkers textbook of microbiology 9th edition pg:98"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMost common cause of facial nerve palsy:\nA) Idiopathic Bell's palsy\nB) Herpes zoster oticus\nC) Mastoid surgery\nD) Chronic suppurative Otitis media", "output": "0, because Facial Nerve - Course Intracranial pa 15-17mm Intra temporal pa Meatal segment 8-10mm Labyrinthine segment 4.0mm Tympanic / horizontal segment 11.0mm Mastoid / veical segment 13.0mm Extracranial pa Branches Greater superficial petrosal nerve 1st branch Nerve to stapedius Chorda tympani Communicating branch Posterior auricular nerve Muscular branches, peripheral branches Causes of facial nerve palsy Most common cause is idiopathic bell's palsy paralysis acute onset Bell's palsy idiopathic, Ipsilateral lower motor neuron palsy Loss of forehead and brow movements Inability to close eyes drooping of eyelids Loss of nasolabial folds, drooping of lower lip herpes zoster oticus/Ramsay hunt syndrome herpes zoster oticus/Ramsay hunt syndrome Mastoid surgery is the most common iatrogenic cause of facial nerve palsy."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nSinus of Morgagni is between:\nA) Middle constrictor and inferior constrictor\nB) Middle constrictor and superior constrictor\nC) Superior constrictor and skull\nD) None of the above", "output": "2, because Sinus of Morgagni is a gap between the base of skull and the upper concave border of superior constrictor muscle.\nStructures passing through that are: Auditory tube, levator palati muscle, ascending palatine artery and palatine branch of the\u00a0ascending pharyngeal artery."}

{"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 typical bone marrow finding in ITP is:March 2004\nA) Absent megakaryocytes\nB) Foam cells\nC) Increased megakaryocytes\nD) Fragmented megakaryocytes", "output": "2, because Ans. C i.e. Increased megakaryocytesDiagnosis of ITPDespite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged.In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.Bleeding time is usually prolonged in ITP patients.Normal bleeding time does not exclude a platelet disorder.Bone marrow examination may be performed on patients over the age of 60 and those who do not respond to treatment, or when the diagnosis is in doubt.On examination of the marrow, an increase in the production of megakaryocytes may be observed and may help in establishing a diagnosis of ITP.An analysis for anti-platelet antibodies is a matter of clinician's preference"}

{"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 final sugars in intestinal chyme are\nA) Glucose and fructose\nB) Ribose and mannose\nC) Ribose and xylulose\nD) Xylulose and fructose", "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\nAbdominal ultra-sonography in a 3 year old boy show a solid circumscribed hypoechnoic renal mass. Most likely diagnosis is -\nA) Wilm's tumor\nB) Renal cell carcinoma\nC) Mesoblastic nephroma\nD) Oncocytoma", "output": "0, because Amongst the given options only Wilms tumor is common at 3 years of age :-\n\t\u00a0Wilm's tumor\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u2192 young children (mean 3 years)\n\tMesoblastic nephroma \u00a0 \u00a0 \u2192 < 1 year\n\tRenal cell carcinoma \u00a0 \u00a0 \u00a0 \u00a0\u2192\u00a0> 40 years\n\tOncocytoma \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u2192\u00a025-95 years (mean 65)"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThe term that best describes the nuclear dissolution is\nA) Pyknosis\nB) Karyorrhexis\nC) Karyolysis\nD) None of the above", "output": "2, because Pyknosis is condensation of nucleus.\nKaryorrhexis is fragmentation of nucleus.\nKaryolysis is dissolution of nucleus."}

{"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 test is used to estimate the amount of fetal maternal hemorrhage:\nA) Coomb's test\nB) Apt test\nC) Liley's spectrophotometer\nD) Kleihauer betke test", "output": "3, because KLEIHAUER BETKE TEST or ACID ELUTION TEST done to measure the amount of feto maternal hemorrhage usually in an Rh negative mother to calculate the dose of anti D required This method is based on the fact that an acid solution (citric acid phosphate buffer, pH 3.5) elutes the adult but not the fetal hemoglobin from the red cells; can detect as little as 0.2 ml of fetal blood diluted in 5 L of maternal blood. More accurate tests are immunofluorescence and flow cytometry. Schiller test:- Schiller's iodine solution is applied to the uterine cervix under direct vision. Normal mucosa contains glycogen and stains brown, whereas abnormal areas, such as early CIN, do not take up the stain and appear white/yellow. Liley's spectrophotometer: Spectrophotometric analysis of amniotic fluid at optical density difference at 450 nm wavelength to see detion bulge in Rh hemolytic 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\nFailure to initiate and maintain spontaneous respiration following birth is clinically k/a \u2013\nA) Birth asphyxia\nB) RDS\u2013Respiratory distress syndrome\nC) Respiratory failure\nD) Pulmonary oedema", "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\nIn volume cycled ventilation the inspiratory' flow rate is set at:\nA) 140-160 L/min\nB) 110-130L/min\nC) 60-100 L/min\nD) 30-50L/mm", "output": "2, because In volume cycled ventilation the inspiratory flow rate is usually set at 60-100 U/min to allow greater expiration time for each breath. Use of high inspiratory flow rate can minimize end inspiratory lung volume and intrinsic PEEP, but it can cause higher peak airway pressures. Volume cycled assist control mode of ventilation is the most commonly used mode of ventilation. Volume targeted modes deliver a preset volume unless a specified circuit pressure limit is exceeded. Its major advantages are capacity to deliver unvarying tidal volumes, flexibility of flow and volume adjustments, and power to ventilate difficult patients. Disadvantages of this type of ventilation are: Unless the airway is well sealed volume cycled modes cannot ventilate effectively and consistently. After the flow rate and profile are set the inflation time of machine is set and remains unresponsive to patients native cycling rythm and flow demands. Ref: Respiratory Emergencies By Stephan Kamholtz, page 413. Critical Care Medicine: The Essentials By John J. Marini, page 134."}

{"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 statement is/are true about Obstructive lung disease ?\nA) mMRC dyspnea scale ,grade 2 includes shoness of breath when hurrying up inclines\nB) Decreased FEV1/FVC ,TLC is increased\nC) Normal PEFR and decreased in Lung volume\nD) Roflumilast is introduced in management of COPD in Group C", "output": "1, because Acute asthma and Emphysema- TLC | due to air trapping Myasthenia gravis- TLC | RV| Obstructive Restrictive | in airflow | Lung volume - Expiratory -Inspiratory COPD Asthma Bronchiectasis ILD Scoliosis NM causes FEV1-| FVC- Normal or | TLC - Normal or | | PEFR Normal | | |PEFR Management of COPD Group A Low Risk, low symptom Bronchodilator Group B Low Risk, High symptom LABA/LAMA, if failed- LAMA+LABA Group C High Risk, Low symptom LAMA+LABA or LABA+ICS Group D High Risk, High symptom LAMA+LABA+ICS | symptoms persists Phosphodiesterase inhibitor (Roflumilast) or Macrolides mMRC DYSPNOEA SCALE (for COPD patients) Grade Impact 1 Incline (Breathlessness on going upstairs) 2 Slow walk than peers (Breathlessness on walking in straight surface) 3 Stops (Keeps on stops walking in between) 4 Too breathless to go out of his house GOLD (Global Initiative for Obstructive Lung Disease) classification"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDiplopia is not a presenting feature in:\nA) Manifest squint\nB) Paralytic squint\nC) Latent squint\nD) Anisometropia", "output": "2, because C i.e. Latent squint Hetrophoria or latent strabismus is a condition in which there is a tendency to misalignment of the visual axis, which is corrected by the fusional capacity. Often latent squints give no trouble until the demand of near vision increase the strain. No symptoms arise, perhaps, until after reading or writing for an hour or two when the letter seems to run together'. There diplopia, which is often not appreciated as actual double vision, causes blurring of the print. With effo, blurring is overcome, but eventually this becomes impossible, headache supervenes & the work has to be abandoned. Anisometropia presents with - imperfect binocular vision, amblyopia, squint & diplopia (Basak p-68)."}

{"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 branch of external carotid aery:-\nA) Superior thyroid\nB) Ophthalmic\nC) Lingual\nD) Ascending pharyngeal", "output": "1, because Branch of ECA: - Superior thyroid aery Lingual aery Facial aery Anteriorly Ascending pharyngeal aery medially Occipital aery Posteriorly Posterior auricular aery Superficial temporal aery Maxillary aery Terminal aery Branches of ICA Ophthalmic aery Anterior choroidal aery Anterior cerebral Middle cerebral Posterior communication aery."}

{"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 marker for hyperparathyroidism is :\nA) Increase in serum calcium\nB) Increase in 24 hour urinary calcium excretion\nC) Decrease in serum calcitonin\nD) Subperiosteal resorption of phalanges", "output": "2, because Answer is C (Decrease in serum calcitonin) : Serum calcitonin is no marker fir hyperparathyroidism. It antagonizes the actions of parathyroid hormone and may be used as a modality of treatment of hypercalcemia secondary to hyperparathyroidism. Markers of hyperparathyroidism (|ed PTH): 1. Increased serum calcium: Stimulates Vit D which causes increased absorption of Ca-H- from gut Increased calcium reabsorption from tubules Increases osteoblastic activity in bones and mobilizes calcium from bone into serum. 2. Decreased serum phosphorus: - PTH acts on tubules to increase excretion of phosphorus. 3. Increased 24 hr urine calcium: - Despite increased reabsorption of Ca++ in renal tubules urinary calcium is increased owing to increased filtration of calcium in glomerular filtrate. 4. Increased Alkaline phosphatase: -Increased resorption of bone leads to compensatory elevation of osteoblastic activity 5. Radiological changes: Subperiosteal resorption of phalanges is characteristic (hand X Rays are always advised) Bone resorption i.e. osteitis fibrosa et cystica (brown tumours) `Salt pepper' or 'pepper pot skull' appearance - Loss of lamina dura"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following is TRUE about branchial cyst?\nA) Usually seen along the posterior border of the sternocleidomastoid muscle\nB) Mostly arises from 2nd branchial system\nC) Always present in preschool children\nD) Conservatory treatment is indicated", "output": "1, because Branchial cleft cysts usually present as a soft cystic mass along the anterior border of the sternocleidomastoid muscle. These lesions are usually recognized in the second or third decades of life. To prevent recurrent infection and possible carcinoma, they should be completely excised, along with their fistulous tracts. First branchial cleft cysts present high in the neck, sometimes just below the ear. A fistulous connection with the floor of the external auditory canal may be present. Second branchial cleft cysts, which are far more common, may communicate with the tonsillar fossa. Third branchial cleft cysts, which may communicate with the piriform sinus, are rare and present low in the neck. Ref: Lustig L.R., Schindler J.S. (2013). Chapter 8. Ear, Nose, & Throat Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow, T.G. Berger (Eds), CURRENT Medical Diagnosis & Treatment 2014."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIn a UK study, it was found that there were more deaths from asthma than the sale of anti-asthma drugs. This is an example of:\nA) Cohort study.\nB) Case reference study.\nC) Ecological study.\nD) Experimental study.", "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\nPawaer burr, appearance on laparoscopy is characteristic of :\nA) Endometriosis\nB) Endometroid tumour\nC) Epithelial ovarian tumour\nD) Endometrial cancer", "output": "0, because Endometriosis"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAn adult female patient presents with asthma symptoms for at least 4 days a week and wakes up at night due to breathlessness approximately 2 -3 days in a month. she is classified to be having.\nA) Severe persistent Asthma\nB) Mild persistent Asthma\nC) Intermittent Asthma\nD) Moderate persistent Asthma", "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\nWhich structure(s) passes behind the inguinal ligament -a) Femoral branch of genitofemoral nerveb) Superficial epigastric arteryc) Psoas majord) Femoral veine) Saphenous vein\nA) abc\nB) ad\nC) bc\nD) acd", "output": "3, because Structures passing deep to inguinal ligament.\n-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Psoas major, Iliacus, pectineus\n-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Femoral nerve and vessels\n-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lateral cutaneous nerve of thigh\n-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Femoral branch of genitofemoral nerve\n-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Lymphatics"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nI/V contrast is not used in \u2013\nA) HRCT\nB) MRI\nC) IVP\nD) Myelography", "output": "3, because IV contrast agent is given in :-\n\n\nX-ray based investigation (Radiocontrast agent) :- Radiography (simple x-ray), CT-Scan.\nMRI (MR contrast agents).\nUltrasound (USG contrast agents).\n\n\nIVP (intravenous pyelography) as the name suggests, the contrast agent is given intravenously.\nIn myelography, the contrast agent is injected into subarachnoid space."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPatient with persistent diarrhea & hypotension. Diagnosis -\nA) VIPoma\nB) ACTHoma\nC) GRFoma\nD) Glucagnoma", "output": "0, because Ans. is 'a' i.e., VIPoma Pancreatic Neuroendocrine TumorsTumourBiologicaly active peptide secretedTumour locationMalignant percentageMain symptoms and signsGastrinoma (non b cell tumour)GastrinDuodenum (70%) Pancreas (25%) other sites (5%)60-90o Pain (79-J 00%)o Diarrhoea (30-73%)o GERD (30-35%)o Peptic ulcerInsulinoma (b cell tumour)InsulinPancreas > 99% (Insulinomas are distributed equally on head body and tail of pancrease)< 10o Symptoms of hypoglycemiao Symptoms releive on administration of glucoseVIPOMA (Verner-Morrison syndrome, pancreatic cholera (WDHA)Vasoactive intestinal peptidePancreas 90%40-70o Watery diarrhoea (90-100%)o Hypokalemia (80-100%)o Hypochlorhydriao Dehydration (83%)GlucagonomaGlucagonPancreas 100% (usually occurs singly in pancreatic tail)50-80%o Dermatitis (migratory necrolytic erythema) 67-90%o Glucose intolerance (40-90%)o Weight loss (66 to 96%)o .Anemia(33-85%)o Diarrhoea (15-29%)o Thromboembolism"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nLamina densa of the basal lamina beneath the epithelium is composed of\nA) Type I Collagen\nB) Type II Collagen\nC) Type III Collagen\nD) Type IV Collagen", "output": "3, because None"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nHaascheiben cells in epidermis are responsible for?\nA) Touch\nB) Temperature\nC) Pressure\nD) Proprioception", "output": "0, because Ans. is 'a' i.e., Touch"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nPancytopenia with cellular marrow is seen in all Except:\nA) Megaloblastic anemia\nB) Myelodysplasia\nC) Paroxysmal nocturnal hemoglobinuria\nD) G6 PD deficiency", "output": "3, because Answer is D (G-6PD Deficiency) Glucose - 6 - PD Deficiency is not associated with Pancytopenia and a cellular marrow Myelodysplasias, PNH and Megaloblastic anemia (Vit B12,Folate deficiency) may present with Pancytopenia and a cellular marrow."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThe following are adverse effects of SSRIs except\nA) Weight changes\nB) Diarrhoea\nC) Delayed ejaculation\nD) Galactorrhea", "output": "3, because Galactorrhea is a side effect of hyperprolactinemia is not usually seen with SSRIs Side effects of SSRIs include weight changes, delayed ejaculation,diarrhoea,bleeding , discontinuation syndrome,insomnia. 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\nThe germinal cell layer surrounding the oocyte before ovulation is known as :\nA) Zona pellucida\nB) Zona reticularis\nC) Cumulous oophorus\nD) Zona glomerulosa", "output": "2, because In one area , the granulosa cells are collected together to form a projection into the cavity of graffian follicle. This projection is referred to as the discus proligerus or cumulus oophorus. The ovum itself lies within it.With the exception of area around the discus, the peripheral granulosa cells form a layer only a few cells in thickness.,whereas at the discus the cells are between 12 and 20 layers thick. Reference: Shaw's Textbook of Obstetrics 15th edition page 28"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFolie a deux is\nA) OCD\nB) Shared delusion disorder\nC) Hysteria\nD) Neurasthenia", "output": "1, because Shared psychotic disorder or folie a deux, the characteristic feature is the transmission of delusions from \"inducer\" (primary patient), who is the \"originally\" ill patient and suffers from a psychotic disorder to another person who may share the inducer's delusions in entirety or in pa. the person who receives the delusion is usually financially dependent on the inducer person the person who receives the delusion is intellectually less normal and tend to beleive everything that the inducer person tells. both the person who induces and receives the delusion live in close proximity they live in social isolation with less contact with the outside world as they remain together delusion system perpetutes. treament of choice for such patients is seperation of the receiver of delusion from the inducer and the symptom of delusion reduces. Depending on whether the delusions are shared among two, three, four, five and even twelve people, it is called as folie a deux, folie a trios, folie a quatre, folie a cinq and folie a douze. Shared psychotic disorder is mostly observed among people who live in close proximity and in close relationships. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 390"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAfter the death of the 78 years old male patient in a hospital , who was suffering from COPD. His relatives entered the hospital with heavy sharp weapons and damaged the hospital propey and stared abusing and beating the doctor as well as his staff, Violence against a medical practitioner is considered as:\nA) Non-cognizable and non-bailable offense\nB) Non-cognizable and bailable offense\nC) Cognizable and bailable offense\nD) Cognizable and non-bailable offense", "output": "3, because Medical protection act: The Act, covering doctors affiliated to institutions as well as independent practitioners, outlaws attacks against physicians and damage to their propey. Offenders can get a jail term of up to 3 years and a fine of Rs 50,000. As per the medicare service persons and damage to propey in medicare service institutions (Prevention of violence and damage or loss to propey) Act , Violence against a registered medical practitioner is considered as a cognizable and non-bialable offence."}

{"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 soft tissue sarcoma commonly gives to bone secondaries: (PGI June 2008)\nA) Fibrosarcoma\nB) Liposarcoma\nC) Osteosarcoma\nD) Neurofibroma", "output": "2, because Ans. C (Osteosarcoma) \"Any cancer can spread to bone ,but in adults more than 75% of skeletal metastases originate from cancers of the prostate,breast,kidney & lung. In children, metastases to bone originate from Neuroblastoma, Wilm's tumor, Osteosarcoma, Ewing sarcoma & Rhabdomyosarcoma\"- Robbins7th/1303Sarcoma Metastasizing through lymhatics (causing L.N involvement) LymhosarcomaQ RhabdomyosarcomaQ AngiosarcomaQ Clear cell sarcomaQ Epithelial sarcoma M aligna nt fibrous histiocytomaQ Synovial cell sarcomaQ"}

{"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 intermediate host for T. Saginata is:\nA) Man\nB) Cow\nC) Dog\nD) Pig", "output": "1, because Cow"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following is associated with cough?\nA) Lisinopril\nB) Propranolol\nC) Verapamil\nD) Sodium nitroprusside", "output": "0, because Ans: a (Lisinopril) Ref: KDT, 6th ed, p. 484* Cough is a side effect of ACE-1.* Bradykinin and substance P seem to be responsible for the cough. Thromboxane antagonism, aspirin, and iron supplementation reduce cough induced by ACE inhibitors. Once ACE inhibitors are stopped, the cough disappears, usually within 4 days.Important points on ACE inhibitorsEnalapril, fosinopril, perindopril, and ramipril are prodrags.Captopril & lisinopril does not require hydrolysis to become active ACE inhibitorEnalapril is converted in the body into enalaprilat. Enalaprilat differs from captopril in that it is an analog of a tripeptide rather than a dipeptide.Adverse effects of ACE inhibitors are cough; hypotension; hyperkalaemia; acute renal failure in patients with bilateral renal artery stenosis, stenosis of the artery to a single remaining kidney, heart failure, or volume depletion owing to diarrhea or diuretics; teratogenicity; skin rash; proteinuria, angioedema and dysguesia."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nLowest most level of integration of stretch reflex is at\nA) Cerebral cortex\nB) Lower Medulla\nC) Spinal cord\nD) All of the above", "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\nWernicke&;s encephalopathy involves\nA) Mammillary body\nB) Thalamus\nC) Frontal lobe\nD) Arcuate fasciculus", "output": "0, because Wernicke's encephalopathy : The neuropathological lesions are symmetrical and paraventricular, involving the mammillary bodies, the thalamus, the hypothalamus, the midbrain, the pons, the medulla, the fornix, and the cerebellum. Ref: Synopsis of Psychiatry, 11th edition, page 632."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhen VA/Q is infinity, it means\nA) Dead space\nB) The PO2 of alveolar air is 159 mmHg and PCO2 is 40 mmHg\nC) Paial pressure of O2 and CO are equal\nD) Atelectasis", "output": "0, because -Ventilation / perfusion ratio - normal = 4l/min/5l/min=0.8 - AV/Q= INFINITY - Means Perfusion (Q) to lungs is zero that is blood supply to that area is hindered making it awasted ventilationin those alveoli. - This may be due to pulmonary embolism causing |ed Physiological DEAD space . DEAD SPACE- Some of the air a person breathes never reaches the gas exchange areas but simply fills respiratory passages where gas exchange does not occur, - called so as its not useful for gas exchange. Physiologial / total dead space = anatomical dead space +alveolar dead space (non perfused/ non functioning Alveoli) In Atelectasisventilation: perfusion ratio (VA/Q) iszero. it is is the most common cause of a physiologic shunt."}

{"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 true regarding Savage syndrome?\nA) Receptor defect to gonadotrophic hormones\nB) Sho stature\nC) Ovaries do not contain follicles\nD) FSH is normal", "output": "0, because In Savage syndrome, there is receptor defect to gonadotrophic hormones. The clinical features resemble autoimmune disease. Height is normal. The ovaries contain follicles. FSH is raised. Ref: Shaw's Textbook of Gynaecology, 18th edition, p286"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhat is the dosage of retinol palmitate for early stages of xerophthalmia: September 2011\nA) 90 mg orally on two successive days\nB) 100 mg orally on two successive days\nC) 110 mg orally on two successive days\nD) 120 mg orally on two successive days", "output": "2, because Ans. C: 110 mg orally on two successive days Nearly all of the early stages of xerophthalmia can be reversed by administration of a massive dose (2,00,000 IU or 110 mg of retinol palmitate) orally on 2 successive days Xerophthalmia/ Dry eyes Condition in which the eye fails to produce tears. Xerophthalmia caused by a severe vitamin A deficiency is described by pathologic dryness of the conjunctiva and * cornea. The conjunctiva becomes dry, thick and wrinkled. If untreated, it can lead to corneal ulceration and ultimately to blindness as a result of corneal damage. Xerophthalmia is a term that usually implies a destructive dryness of the conjunctival epithelium due to dietary vitamin A deficiency -- a rare condition in developed countries, but still causing much damage in developing countries. Other forms of dry eye are associated with aging, poor lid closure, scarring from previous injury, or autoimmune diseases such as rheumatoid ahritis and SjOgren's syndrome, and these can all cause chronic conjunctivitis. Radioiodine therapy can also induce xerophthalmia, often transiently Xerophthalmia from hypovitaminosis A is specifically due to lack of the hormone-like vitamin A metabolite retinoic acid Treatment can occur in two ways: treating symptoms and treating the deficiency. Treatment of symptoms usually includes use of aificial tears in the form of eye drops, increasing the humidity of the environment with humidifiers, and wearing wrap around glasses when outdoors. Treatment of the deficiency can be accomplished with a Vitamin A or multivitamin supplement or by eating foods rich in Vitamin A. Treatment with supplements and/or diet can be successful until the disease progresses as far as corneal ulceration, at which point only an extreme surgery can offer a chance of returning sight."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich among the following organisms causes Buruli ulcer?\nA) M. Marinum\nB) M. Ulcerans\nC) M. kansasii\nD) M. Smegmatis", "output": "1, because Ans. B. M. UlceransM. Ulcerans causes Buruli ulcer.* It starts as a nodule or papule which progresses further to form a shallow necrotic ulcer.* Children (5-15 years old) have the highest incidence of Buruli ulcers, with most lesions on the lower extremities.Image: Extensive Buruli ulcer"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA 41 year old patient presented with chronic diarrhoea for 3 months. A d-xylose absorption test was ordered to look for:\nA) Carbohydrate malabsorption due to mucosa] disease\nB) Carbohydrate malabsorption due to chronic pancreatitis\nC) Fat malabsorption due to mucosal disease\nD) Fat malabsorption due to chronic pancreatitis", "output": "0, because Ans is A (Carbohydrate malabsorption due to mucosal disease) `The urinary D-xylose test for carbohydrate absorption provides an assessment of proximal small intestine mucosal function.' Urinary D-xylose test: Principle D-xylose is a `pentose. that is completely absorbed almost exclusively in the proximal small intestine and excreted subsequently in the urine. The level of excreted D-xylose in urine is estimated. Any decrease in its level in urine means abnormality in carbohydrate absorption in proximal intestine. Procedure & interpretation 25g D-xylose is given and urine is collected for 5 hrs. An excretion of < 4.5e primarily reflects the presence of duodenal /jejuna) mucosal disease."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following extraocular muscles does not arise from annulus:\nA) Inferior rectus\nB) Medial rectus\nC) Lateral rectus\nD) Superior oblique", "output": "3, because The annulus of Zinn, also known as the annular tendon or common tendinous ring, is a ring of fibrous tissue surrounding the optic nerve at its entrance at the apex of the orbit.It can be used to divide the regions of the superior orbital fissure.The aeries surrounding the optic nerve are sometimes called the \"circle of Zinn-Haller\" (CZH).Some sources distinguish between these terms more precisely, with the annulus tendineus communis being the parent structure, divided into two pas:A lower, the ligament or tendon of Zinn, which gives origin to the Rectus inferior, pa of the Rectus internus, and the lower head of origin of the Rectus lateralis.An upper, which gives origin to the Rectus superior, the rest of the Rectus medialis, and the upper head of the Rectus lateralis. This upper band is sometimes termed the superior tendon of Lockwood.The site of origin of the superior oblique muscle is from the lesser wing of sphenoid above the optic canal."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCompared to follicular Ca, papillary Ca of thyroid have :a) More male preponderanceb) Bilateralityc) Local recurrence commond) Increased mortalitye) Increased lymph node metastasis.\nA) ab\nB) bce\nC) acd\nD) ace", "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\nPtosis is due to:\nA) 3rd CN palsy\nB) 4th CN palsy\nC) 5th CN palsy\nD) 6th CN palsy", "output": "0, because Ans. (a) 3rd CN palsy (oculomotor)Ref.:BDC 6th ed. Vol-III/361-62* Ptosis is drooping of eyelid.* Eyelid is comprised of 4 muscles:Muscles, their innervation and functionMuscleCN innervationFunction* LPSIIIOpens the eyelid* Muller's muscleT1 (NOT a CN; sympathetic nerve)Opens eyelid when LPS tired* FrontalisVIICloses the eyelid* Orbicularis oculiVIICloses the eyelid* CN III palsy leads to drooping of eyelid (Ptosis).* CN VII palsy may also cause ptosis.Also Know*All the extraocular muscles are supplied by CN III except lateral rectus and superior oblique.* Lateral rectus supplied by- CN VI* Superior oblique supplied by- CN IVRemember- LR6; So4"}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nTrue about isoenzymes is/are\nA) Different km value\nB) Consist of multimeric complex\nC) Have different physical properties\nD) All of these", "output": "3, because Consist of multimeric complex & `e' i.e., Have different physical properties\n\nisozymes are the physically distinct forms of the same enzymes that catalyze the same reaction, and differ from each other structurally, electrophoretically and immunologically.\nThey differ in their physical properties because of genetically determined difference in amino acid sequence.\nThey are separated by electrophoresis as they have different electrophoretic mobility.\nThey have different Kin value.\nIsoenzyme of an oligomeric enzyme process differ in combination of its peptide protomer."}

{"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 an action of epinephrine when administered intravenously in a high dose?\nA) Increases liver glycogenolysis\nB) Causes broachiolar constriction\nC) Evokes extrasystoles in the heart\nD) Produces restlessness and anxiety", "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\nOsteoclast has specific receptor for:\nA) Parathyroid hormone\nB) Calcitonin\nC) Thyroxin\nD) Vit D3", "output": "1, because Calcitonin receptor is expressed in osteoclasts. Calcitonin inhibits bone resorption by inhibiting osteoclasts; and promotes Ca2+ from blood to be deposited on the bone. This decreases blood Ca2+. PTH is a primary endocrine regulator of bone remodeling in adults. The PTH/PTHrP receptor is expressed on osteoblasts, but not on osteoclasts."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are true about precocious puberty except -\nA) Secondary sexual characters before the age of 8 years\nB) Secondary sexual characters before the age of 6 years\nC) Menstruation before the age of 10 years\nD) Most common cause is constitutional", "output": "1, because Ans. is 'b' i.e., Secondary sexual characters before the age of 6 years o Precocious puberty is the appearance of appropriate secondary sexual characters before the age of 8 years and occurrence of menstruation before 10 years of chronological age.o It is divided into the following types:A) Gonadotropin dependent precocious puberty/ Central precocious puberty / True precocious puberty:# Most common cause is constitutional, due to early maturation and activation of the hypothalamic - pituitary - gonadal axis.# Both breast and pubic hair development in girls# Pubic hair development and testicular enlargement in boys# Early developing sexual characteristics are \"isosexual\", meaning they are consistent with the child's gender.# Initial spurt in the height followed by premature closure of epiphysis with the result the ultimate height remains stunted.B) Gonadotropin - independent precocious puberty/ Peripheral precocious puberty/Pseudo - precocious puberty:# Exposure to sex steroid hormones that derive from the gonads, the adrenals or the environment.# Further subclassified as isosexual when sexual characters are consistent with gender, and as contrasexual when inconsistent with gender (virilization in girls, or feminization in boys).# Autonomous functional ovarian follicular cysts are the most common cause of gonadotropin - independent precocious puberty in girls.C) Incomplete precocious puberty':# Children with isolated premature thelarche or premature adrenarche. Both usually represent variants of normal pubertal development, but some will progress to complete precocious puberty that may be gonadotropin - dependent or independent."}

{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nInitiation of nerve impulse occurs at the axon hillock because :\nA) It has a lower threshold than the rest of axon\nB) It is unmyelinated\nC) Neurotransmitter release occurs here\nD) None of the above", "output": "0, because A i.e. It has lower threshold than rest of axonAxon hillock is the initial segment of neuron, nerve impulses begin in this initial segment of axon because it has lowest threshold potential.QAxon hillock:- This is a thickened area of cell body from which originates the long fibrous axon.AP is generated in this segment because the membrane at the axon hillock has grater concentration of voltage gated Na+ channels and therefore the threshold for excitation is lower than the rest of neuronsQ"}