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{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFamilial adenomatous polyposis is characterized by all except\nA) Autosomal recessive transmission\nB) More than 100 polyps in colorectal area\nC) Polyps seen in duodenum\nD) Extra-intestinal manifestations are present", "output": "0, because Familial adenomatous polyposis (FAP) Is a rare, inherited condition caused by a defect in the adenomatous polyposis coli (APC) gene - located in 5q 21 chromosome. FAP is autosomal dominant- >50% chance of inheritance in family members Has > 100 adenomatous polyps 100% RISK of malignancy Polyp formation - by 15 yrs. 100% develop malignancy - by 40 yrs. TOC: Total proctocolectomy + ileal pouch-anal anastomosis (TPC + IPAA) M/C/C of death after TPC = Peri-ampullary Ca (polyps in duodenum - periampullary region) Two variants of FAP Gardner's syndrome Osteoma (mandible) Congenital hyperophy of the retinal pigmented epithelium (CHRPE) lesions Sebaceous cysts Benign lymphoid polyposis of ileum Desmoid tumors Supernumerary teeth Turcot's syndrome: Brain tumors Medulloblastoma - m/c associated with FAP Glioblastoma multiforme - m/c associated with HNPCC"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIn Steiner's analysis, SNA demonstrates:\nA) Position of mandible in relation to cranial base\nB) Position of maxilla in relation to cranial base\nC) Maxillo-mandibular relationship\nD) None of the above", "output": "1, because Relating the Maxilla to the Skull: The angle SNA is formed by joining the lines S-N and N-A . The mean\u00a0reading for this angle is 82\u00b0.\nSteiners analysis demonstrates the position of maxilla and mandible in relation to the cranial base.\u00a0\nIf the angular reading is more than 82\u00b0, it would indicate a relative forward positioning or protrusion\u00a0of the maxilla. Conversely, should the reading be less than 82\u00b0, it would indicate a relative backward or recessive location of the maxilla."} |
{"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. Sulphasalazine is NOT used for the treatment of-\nA) Crohn's disease\nB) Rheumatoid ahritis\nC) Sarcoidosis\nD) Ulcerative colitis", "output": "2, because Sulhasalazine is not used for treatment of sarcoidosis As a treatment for sarcoidosis, these drugs are most likely to be effective in people who have skin symptoms or a high level of calcium in their blood. Hydroxychloroquine (Plaquenil) and chloroquine (Aralen) are antimalarial drugs that are used to treat sarcoidosis Ref Davidson 23rd edtion pg 981"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPost traumatic stress disorder is differentiated from other anxiety disorders by which of the following symptoms?\nA) Nightmares\nB) Re-living of past adverse event\nC) Hypervigilance\nD) Avoidance", "output": "1, because This question is not about the diagnostic features of PTSD. This is about the differential diagnosis. PTSD is an anxiety disorder and it shares symptoms with other disorders. Impoant features in distinguishing the condition are given below. Differential diagnosis: Point 1: Etiologically significant trauma should be present for a diagnosis of PTSD. E.g. A traumatic event in the past. Point 2: 'Intentionality' or 'aboutness' is an impoant factor for PTSD. Nightmares, flashbacks or reliving experiences should be related to the past event. PTSD concerns memory - Intrusion of past stressors into the present. Point 3: Avoid a 'stimulus' or 'activity' that provokes the memory of the past event. In the above question, only reliving experience is mentioned as connected to the past experiences. Hence, that is the answer for this question. All other symptoms can be see in other anxiety disorders. Ref: Kaplan & Sadock's, Comprehensive Textbook of Psychiatry, 9th Edition, Page 2659"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich muscle is responsible for unlocking of knee?\nA) Popliteus\nB) Quadriceps femoris\nC) Semitendinosus\nD) Semimembranosus", "output": "0, because Ans. A PopliteusRef: BDC, vol II pg. 155* Quadriceps femoris is the main and only extensor of knee.* It produces locking action as a result of medial rotation of the femur during the last stage of extension.* To reverse this lock popliteus muscle comes into action and does so by the lateral rotation of femurRemember: Lock is: Quadriceps femoris muscle and, Key is popliteus muscle.Muscles producing movements at the knee jointMovementPrincipal musclesA. Flexion * Biceps femoris* Semitendinosus* SemimembranosusB. ExtensionQuadriceps femorisC. Medial rotation of flexed leg* Popliteus* Semimembranosus* SemitendinosusD. Lateral rotation of flexed leg * Biceps femorisExtra Mile* Quadriceps femoris incudes: Rectus femoris, Vastus Lateralis, Vastis Medialis, Vastus Intermedius.* Rectus femoris is also known as \"kicking muscle\""} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPolymorphic ventricular tachycardia can occur when terfenadine(antihistaminic):\nA) Is coadministrator with azithromycin\nB) Is coadministrator with fluconazole\nC) Is given in higher doses\nD) Reduces QT interval", "output": "2, because Torsades de pointes (polymorphic ventricular tachycardia) occurs\u00a0when terfenadine is taken in higher doses or when hepatic\u00a0metabolism is impaired by disease or by drugs which inhibit the\u00a0cytochrome P450 responsible for metabolism of terfenadine.\u00a0Drugs include erythromycin, clarithromycin, ketoconazole and\u00a0itraconazole. Azithromycin and fluconazole that are excreted\u00a0unchanged in the urine have not been associated with impaired\u00a0metabolism of terfenadine. Terfenadine blocks the delayed rectifier\u00a0potassium channels and prolongs cardiac repolarization and the\u00a0QT interval."} |
{"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 component transfers four protons:\nA) NADH-Q Oxidoreductase\nB) Cytochrome -C oxidase\nC) Cytochrome C - Q oxidoredictase\nD) Isocitrate Dehydrogenase", "output": "0, because A i.e. NADH-Q Oxidoreductase; C i.e. Cytochrome C-Q oxidoreductase"} |
{"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 true about Asthma, Except:\nA) Charcol Leydin crystals may be seen in sputum\nB) Reversible Airflow obstruction is a characteristic feature\nC) Large airways are involved\nD) Small airways are not involved", "output": "3, because Answer is D (Small airways are not involved): Asthma involves both large and small airways but alveoli are not involved Charcot Leyden crystals may be seen in sputum: Pathology by woolf lsr (1998)/434 Sputum from Asthmatics show ceain characteristic features, including charcot leydencrystas The microscopically identifiable features described in sputum are three 'C's Charcot Leyden crystals - Derived from granules of eosnophils andfbund only in Asthma Curshmann spirals - Curiously twisted casts of airways : Whorls of shed epethelium Creola bodies - Clumps of cells or isolated metaplastic cells Reversible Airflow obstruction is a charachteristic feature (Davidsons 18th/55, 326) Reversible Bronchoconstriction is the hallmark of Asthma The charachteristic feature of Asthma is Intermittent and Reversible airflow obstruction. Narrowing of airways is usually reversible, but in some patients with chronic asthma there may be an element of irreversible airflow obstruction Asthma involves both large and small airways Asthma involves Large and small airways hut not alveoli - 'Allergic Diseases: Diagnosis Treatment' 3rd/ 120 The large and small airways are both involved in Asthma -'Childhood Asthma: Diagnosis, Treatment & Management' r/15 Intermittent Asthma responds better to bronchodilator therapy than persistant Asthma Bronchodilators are effective drugs for the treatment of acute exacerbations or intermittent episodes of Asthma but they are not sufficient to control asthma in patients with persistant symptoms (persistant asthma) Bronchodilators are not sufficient to control Asthma in patients with persistant symptoms'"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nIn emergency, which aery can be safely ligated ?\nA) Internal iliac\nB) Popliteal\nC) Renal aeryInternal carotid\nD) All", "output": "0, because Ans. is 'a' i.e. Internal iliac"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nLate metabolic acidosis is seen in-\nA) Term infant given formula feed\nB) Preterm baby getting cow milk\nC) Long term breast feeding\nD) None of the above", "output": "1, because Ans. is 'b' i.e., Preterm baby getting cow milk Late metabolic acidosis (LMA) o Late metabolic acidosis is a special type of acidosis in apparently healthy premature infant. o This hyperchloremic acidosis appeares during second and third week of life, and resolves spontaneously within a couple of weeks. Definition \"An acidosis occuring after second day of life, in which base excess values are lower than -5meq/L on two consecutive estimations done at least 24 hours apa\". Etiology o Prematurity is the most impoant single predisposing factor in the development of LMA. o The incidence varies considerably depending upon the gestational maturity and protein content of feeding formula. o In preterm neonates fed on a modified cow's milk the risk of developing LMA is very high."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nChemotherapeutic drugs can cause?\nA) Only necrosis\nB) Only apoptosis\nC) Both necrosis and apoptosis\nD) Anoikis", "output": "2, because Ans. is 'c' i.e., Both necrosis and apoptosis o Injurious stimuli, e.g., radiation, cytotoxic anticancer durgs, heat and hypoxia, can induce apoptosis if the insult is mild, but large doses of same stimuli result in necrotic cell death."} |
{"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 nerve is involved in Frey's syndrome?\nA) Trigeminal\nB) Mandibular\nC) Ariculo temporal\nD) Lingual", "output": "2, because Syndrome (Gustatory Sweating) aka auriculotemporal syndrome: Frey's syndrome arises as a complication of parotid surgery usually manifesting several months after the operation. lt is characterised by sweating and flushing of the preauricular skin during mastication causing nuisance to the person or social embarrassment. It is the result of damage to auriculotemporal nerve and aberrant innervation of sweat glands by parasympathetic secretomotor fibres which were destined for the parotid. Now instead of causing salivary secretion from the parotid, they cause secretion from the sweat glands. The condition can be treated by tympanic neurectomy which intercepts these parasympathetic fibres at the level of middle ear. Some people like to place a sheet of fascia lata between the skin and the underlying fat to prevent secretomotor fibres reaching the sweat glands. Generally, no treatment other than reassurance is required in most of these patients. Also known as Crocodile tears (gustatory lacrimation): There is unilateral lacrimation with mastication. This is due to faulty regeneration of parasympathetic fibres which now supply lacrimal gland instead of the salivary glands. It can be treated by section of greater superficial petrosal nerve or tympanic neurectomy."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOpening of mouth is caused by:\nA) Lateral pterygoid\nB) Medial pterygoid\nC) Temporalis\nD) Masseter", "output": "0, because Ans. A Lateral pterygoidRef: Grays, 41st ed. pg. 507-508* The primary function of the lateral pterygoid muscle is to pull the head of the condyle out of the mandibular fossa along the articular eminence to protrude the mandible.* The effort of the lateral pterygoid muscles acts in helping lower the mandible and open the jaw whereas unilteral action of a lateral pterygoid produces contralateral excursion (a form of mastication), usually performed in concert with the medial pterygoids.* Unlike the other three muscles of mastication, the lateral pterygoid is the only muscle of mastication that assists in depressing the mandible i.e. opening the jaw. At the beginning of this action it is assisted by the digastric, mylohyoid and geniohyoid muscles."} |
{"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 streptococcus Except\nA) M-protein is responsible for production of mucoid colonies\nB) M-protein is responsible for virulence\nC) Mucoid colonies are virulent\nD) Classified based on their haemolytic propeies.", "output": "0, because Mucoid colonies are due to the production of the capsule of hyaluronic acid not due to M-protein. Growth characteristic of Strep. pyogenes: On blood agar, virulent stains form matt or mucoid colonies while avirulent from glossy colonies. M, T, R are proteins found on the outer pa of the cell wall and forms the basis of Griffith classification. M protein - acts as virulence factor and antibody against it is protective. T and R protein - No relation to virulence Ref : 208"} |
{"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 monitored in a patient of Pre eclamsia ?\nA) Uric acid\nB) Platlet count\nC) LFT\nD) All of the above", "output": "3, because Ans. is 'd' i.e. All of the abov Investigations in a case of Pre eclampsia* URINE for proteins/albumin. 24 hours urine protein* CBC: There is hemoconcentration so HB values are false elevated. Low platlets indicate HELLP syndrome* Sr uric acid: It is a biochemical marker of preeclampsia. Raised levels (>4.5 mg/dl) indicate renal involvement and also correlate with severity of preeclampsia, volume contraction and fetal jeopardy.* LFT: SGOT, SGPT, Bilirubin* RFT: Sr creatinine* Coagulation profile may be required in severe cases:i) BTii) CTiii) PT, APTTiv) Fibrinogen levelsv) FDP"} |
{"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 young female of reproductive age an absolute contraindication for prescribing oral contraceptive pills is:\nA) Diabetes\nB) Hypertension\nC) Obesity\nD) Impaired liver function", "output": "3, because Ans-D i.e., Impaired liver function Repeat Q No 173 (Nov. 2004)Absolute contraindications include:A personal h/O thromboembolic venous, arterial or cardiac disease or severe or multiple risk factor for these. Transient cerebral ischaemic attacks without a headache.Infective hepatitis, until 3 months after liver function tests has become normal, and another liver disease including disturbances of hepatic excretion e.g. cholestatic jaundice, Dubin Johnson and Rotor syndromes.A migraine, if there is a typical aura, focal features or if it is severe and lasts > 72 hours despite t/t or is treated with an ergot derivative.Carcinoma of the breast or the genital tractOther conditions including SLE, porphyria, following the evacuation of a hydatidiform mole (until urine and plasma gonadotropin concentrations are normal), undiagnosed vaginal bleeding.Relative contraindications of OCP'sThe family history of venous thromboembolism, arterial disease or a known prethrombotic condition e.g. Factor V Leiden (pretreatment coagulation investigation is advised).Diabetes mellitus which may be precipitated or become more difficult to control (avoid if there are diabetic complications).Hypertension (avoid if B.P. exceeds 160/100)Smoking > 40 Cigarettes per day (15 Cigarettes/day enhances the risk of circulatory disease and constitutes an absolute contraindication for women over 35 years.Long-term immobility (e.g. due to Leg plaster, confinement to bed.Breastfeeding (until weaning or for 6 months after birth).Obesity"} |
{"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 tracheostomised patient, with poex tracheostomy tube, in the ward, developed sudden complete blockage of the tube. Which of the following is best next step in the management?\nA) Immediate removal of the tracheostomy tube\nB) Suction of tube with sodium bicarbonate\nC) Suction of tube with saline\nD) Jet ventilation", "output": "0, because Immediate removal of the tracheostomy tube is best next step in the management in the above case -Suction of tube with sodium bicarbonate is done to avoid the blockage. -Suction of the tube with saline can't be used when there's a complete obstruction. - Jet ventilation is done below the level of larynx, when we're operating on the larynx."} |
{"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 well recognised predisposing factors for adult respiratory distress syndrome, except:\nA) Multiple blood transfusions\nB) Septicemia\nC) Status asthmaticus\nD) Toxic gas inhalation", "output": "2, because Status asthmaticus is an example of type 2 respiratory failure while ARDS is type 1 respiratory failure. All other choices lead to cytokines release and damage the alveoli leading to ARDS."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nGottron papules is seen in ?\nA) Dermatomyositis\nB) Scleroderma\nC) Sarcoidosis\nD) Behcets syndrome", "output": "0, because Ans. is 'a' i.e., Dermatomyositis"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich among the following is the BEST irrigating fluid during ECCE?\nA) Ringer lactate\nB) Normal saline\nC) Balanced salt solution\nD) Balanced salt solution + glutathione", "output": "3, because BSS plus a balanced salt solution enhanced with bicarbonate, dextrose and glutathione. It is specially used for surgeries requiring prolonged irrigation such as phacoemulsification, pars plana vitrectomy and automated extracapsular cataract extraction. Balanced sterile solution is a sterile physiologically balanced irrigating fluid. It is the most frequently used solution during ophthalmic surgery to keep the cornea from drying out. BSS plus solution causes less corneal edema and endothelial cell damage following vitrectomy. The glutathione protects against depletion of endothelial ATP levels and maintains the integrity of the cell membrane by counteracting endogenous and exogenous oxidative agents. Ref: Surgical Technology for the Surgical Technologist: A Positive Care Approach By Association of Surgical Technologists page 223. Ocular Toxicity of Intraoperatively Used Drugs and Solutions By Rudolph Marie Matheus Antonius Nuijts page 16. Clinical Ophthalmology: Contemporary Perspectives, 9/e By Gupta page 43."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAcute Gouty ahritis is seen early in treatment following -\nA) Probenecid\nB) Allopurinol\nC) Rasburicase\nD) All of the above", "output": "3, because All of the above Rapid lowering of urate level in chronic gout, by any means, may precipitate an attack of acute gout, probably by causing the dissolution of tophi. o It is therefore usual to give prophylactic suppressive treatment with indomethacine, colchicine or steroid cover during first 2 months of allopurinol or uricosurics. o Amongs the given options, allopurinol, probenecid and Rasburicase are the drugs that lower serum urate level. So, all three can precipitate acute gout. However, among these three, allopurinol is used most commonly therefore is the best answer here."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nChandler's index is associated with: September 2006\nA) Round worm\nB) Hook worm\nC) Pin worm\nD) Tape worm", "output": "1, because Ans. B: Hook worm Morbidity and moality from hookworm infection depend much on the worm load. Chandler worked out an index on the basis of an average number of hookworm eggs per gram of feces for the entire community, Chandler's index is still used in epidemiological studies of hookworm disease. By this index, worm loads in different population groups can be compared and also the degree of reduction of egg output after mass treatment."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nHeparin is the commonly used anticoagulant in cardiac surgery. All of the following are true about heparin except-\nA) Weakest acid found in living things\nB) Most commercial preparations of heparin now utilize pig intestinal slimes\nC) Act via Antithrombin activation\nD) Produce thrombocytopenia", "output": "0, because Ans. is 'a' Weakest acid found in living organism Heparin is a direct acting anticoagulant Chemical nature and preparationHeparin is a sulfated mucopolysaccharide which occurs in the secretory granules of mast cells.It is the strongest organic acid in the body and in the solution it carries an electronegative charge.It is prepared commercially from a variety of animal tissues (generally porcine intestinal mucosa or bovine lung).Mechanism of Action of HeparinHeparin acts by activating antithrombin which is a naturally occuring inhibitor of activated coagulation factors of intrinsic and common pathway. 'Adverse effects of HeparinBleedingHeparin induced thrombocytopeniaOccurs more commonly in heparin derived from bovine lung.Heparin induced thrombocytopenia should be suspected in whom the platelet count falls by 50% or more after starting heparin and usually occurs 5 or more days after starting therapy.In patients with heparin induced thrombocytopenia following drugs should be substituted.Danaparoid sodiumHirudinArgatrobanOsteoporosis - (most frequently seen in pregnancy)Hypersensitivity reactions & skin necrosis"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOne of the following is the first enzyme to be released at the site of wound?\nA) Aminopeptidase\nB) ATPase\nC) Acid phosphatase\nD) Alkaline phosphatase", "output": "1, because Ref - Krishan Vij textbook of forensic medicine and toxicology 5e pg - 202"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSign of diabetic ketoacidosis is-\nA) Loss of sweating\nB) Depression\nC) Dehydration\nD) Absent deep tendon reflexes", "output": "2, because Physical findings of diabetic ketoacidosis are tachycardia, dehydration/hypotension, hypothermia, tachypnea/Kussmaul respirations/ respiratory distress, abdominal tenderness (may resemble acute pancreatitis or surgical abdomen), lethargy/obtundation/cerebral edema/possibly coma. Reference : page 2418 Harrison's Principles of Internal Medicine 19th 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 drug is used in scabies as single oral dose agent: March 2011\nA) Permethrin\nB) Retinoids\nC) Ivermectin\nD) Co-trimoxazole", "output": "2, because Ans. C: Ivermectin Ivermectin is used as single oral dose of 200 microgram/ kg body weight It can be repeated after 2 weeks It is indicated in epidemics of scabies in orphanages and Norwegian scabies Scabies: Incubation period: 4 weeks Pathognomic lesion: Burrow, which lies in stratum corneum MC site in infants: Scalp, face Most severe form: Norwegian scabies Drug used orally: Ivermectin"} |
{"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 complication after ERCP is\nA) Acute Pancreatitis\nB) Acute cholangitis\nC) Acute cholecystitis\nD) Duodenal perforation", "output": "0, because Complication perforation(1.3%)/hemorrhage (1.4%),pancreatitis (4.3%) and sepsis (3-30%). Bailey & Love 26th, 208"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nProgesterone production in the ovary is primarily by:\nA) Stroma\nB) Corpora albicans\nC) Corpora lutea\nD) Mature follicles", "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 clinical situations is associated with an increase in predominantly conjugated (\"direct\") bilirubin?\nA) Physiologic jaundice of the neonate\nB) Kernicterus Following Rhesus Incompatibility\nC) Gilbe's Syndrome\nD) Pancreatic head tumor", "output": "3, because Of the conditions listed, only pancreatic head tumors are associated with an increase in conjugated (\"direct\") bilirubin (obstructive jaundice). Increased levels of unconjugated (\"direct\") bilirubin result from hemolysis over liver defects that impair uptake or conjugation mechanism in liver cells (Gilbe's syndrome, Crigler- Najjar syndrome) positive. Unconjugated bilirubin may cross the immature blood brain Barrier of the newborn and cause Kernicterus. The physiologic jaundice of the newborn observed during the first week of bih is usually mild and due to relatively immature liver conjugation. Ref: Cothren C., Biffl W.L., Moore E.E. (2010). Chapter 7. Trauma. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nThe use of kinematic face bow is contraindicated in the\nedentulous patients because\nA) It has to be used on the mandibular ridge\nB) Recording base may be unstable on the edentulous mandible\nC) Movement of bases may lead to inaccuracy in recording hinge axis\nD) All of the above", "output": "3, because None"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nRegarding carcinoma Gallbladder true statement\nA) Squamous cell carcinoma is the most common\nB) Present with jaundice\nC) Good prognosis\nD) 65% survival after surgery", "output": "1, because Clinical features Most commonly presents with right upper quadrant pain often mimicking cholecystitis and cholelithiasis Weight loss, jaundice and abdominal pain are less common presenting symptoms Chronic cholecystitis with a recent change in quality or frequency of the painful episodes in 40% patients Malignant biliary obstruction with jaundice, weight loss and RUQ pain Ref: Sabiston 20th edition Pgno : 1512-1514"} |
{"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 anaesthetic agent increases intracranial tension among the following\nA) Thiopentone\nB) Propofol\nC) Lignocaine\nD) Sevoflurane", "output": "3, because All inhalational anaesthetics directly act on cerebral blood vessels\u2192vasodilatation\u2192increase cerebral blood flow\u2192 increase intracranial tension"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nGranules of Eleidin are present in which of the following layer?\nA) Stratum corneum\nB) Stratum lucidum\nC) Stratum spinosum\nD) Stratum basale", "output": "1, because Stratum Lucidum - Also called clear cell layer. Present only in skin of palms and soles. Translucent due to presence of refractile Eleidin granules"} |
{"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 is a long acting beta\u20132 agonist ?\nA) Albuterol\nB) Salmeterol\nC) Pirbuterol\nD) Orciprenaline", "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\nAntidepressant drug used in nocturnal enuresis is:\nA) Imipramine\nB) Fluoxetine\nC) Trazodone\nD) Seraline", "output": "0, because Sleep related enuresis- Treatment Bed alarms (behavioral therapy)- TOC Desmopressin (DOC) Imipramine (TCA Antidepressant)"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFive days after an uneventful cholecystectomy, an asymptomatic middle-aged woman is found to have a serum sodium level of 125 mEq/L. Which of the following is the most appropriate management strategy for this patient?\nA) Administration of hypeonic saline solution\nB) Restriction of free water\nC) Plasma ultrafiltration\nD) Hemodialysis", "output": "1, because The initial, and often definitive, management of hyponatremia is free-water restriction. Symptomatic hyponatremia, which occurs at serum sodium levels less than or equal to 120 mEq/L, can result in headache, seizures, coma, and signs of increased intracranial pressure and may require infusion of hypeonic saline. Rapid correction should be avoided so as not to cause central pontine myelinolysis, manifested by neurologic symptoms ranging from seizures to brain damage and death. Additionally, a search for the underlying etiology of the hyponatremia should be undeaken. Acute severe hyponatremia sometimes occurs following elective surgical procedures due to a combination of appropriate stimulation of antidiuretic hormone and injudicious administration of excess free water in the first few postoperative days. Other potential etiologies include hyperosmolarity with free-water shifts from the intra- to the extracellular compament (eg, hyperglycemia), sodium depletion (eg, gastrointestinal or renal losses, insufficient intake), dilution (eg, drug-induced), and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH)."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nReversible cause of dementia is -\nA) Alzheimer's disease\nB) Parkinsonism\nC) Hypothyroidism\nD) Vascular dementia", "output": "2, because Ans. is 'c' i.e., Hypothyroidism Causes of dementiaReversible causesSurgically treatableMedically treatableo Normal pressure hydrocephaluso Brain tumors (frontal lobe tumor)o Meningiomao Subdural hematoma (Head injury)o Hydrocephaluso Hypothyroidismo Depressiono HIV infectiono Alcohol abuseo Vitamin B12, Folate, Niacin deficiencyo Any metabolic or endocrine disturbanceo Neurosyphiliso Hashimoto's encephalopathy o Wilson's diseaseo Celiac disease or Whipple's diseaseo Chronic meningoencephalitiso Drugs and toxin (toxic dementia)Irreversible causeso Alzheimer's diseaseo Huntington's choreao Lewy body dementiao Vascular (Multi-infarct) dementiao Parkinson's diseaseo Creutzfeld Jakob diseaseo Pick's diseaseo Overall Alzheimer's disease is the most common cause. Vascular dementia is the 2nd most common cause."} |
{"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 obese female having hirsutism on laboratory investigation has high level of LH and androgens. Likely cause is-\nA) PCOS\nB) Exogenous steroid ingestion\nC) Turner syndrome\nD) Kleinfelter syndrome", "output": "0, because Ans. is 'a' i.e., PCOS o The clinical and laboratory features of the patient described in the question match with those of PCOS as depicted in the table. So the most appropriate answer is PCOS.Clinical features of polycystic ovarian diseaseClinical featureHannonalSequelaeo Young womano | E2. levelo Diabaetes (15%)o Central obesityo | FSH | LH > 10 IU/mlo CVS disorder# SMI > 30kg/cm2o | FSK/LH ratioo Lipidaemia# Waist line > 35o | Androgenso Hypertensiono Gligomenorrhoea, amenorrhoeao Testosterone,epiandrostenedione. |dehydropepiandrosterone |o Endometrial cancero Infertility (20%)o Breast cancero Hirsutismo Premature ovariano Acanthosis nigra due to insulin resistance, Thick pigmented skin over the nape of neck, inner thigh and axillao 17-alpha-hvdroxy progesterone> 800 ng.'dLfailure following surgeryo Testosterone > 2 ng/mlo Most androgens from ovaryo | fasting insulin > l0mlu/Lo Protactin |o Sex hormone binding globulin (SHBG)o | E2/oestrone (E1) ratioo F glucose,'insulin ratio <4-5 (normal 2-4-4-5)"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following is a feature of papillon lefevre\nsyndrome?\nA) destructive periodontitis\nB) palmar-plantar keratosis\nC) calcification of dura\nD) all the above", "output": "3, because None"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nAll are used in the management of head injury patient except?\nA) Neuromuscular paralysis\nB) Nor-epinephrine\nC) Sedation\nD) Glucocoicoids", "output": "3, because Glucocoicoids are useful for management of vasogenic edema from tumor or brain abscess. In contrast glucocoicoids are avoided in case of head trauma, ischemic and hemorrhagic stroke. Norepinephrine or pressor therapy is used to maintain a MAP to maintain CPP> 60 mm Hg. Sedation is done with propofol or midazolam. Neuromuscular paralysis will be necessary and the patient will need ventilator suppo. This will ensure securing the airway and keeping pCO2 between 30-35mmHg."} |
{"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 premalignant condition: March 2005\nA) Retinitis pigmentosa\nB) Crohn's disease\nC) Ulcerative colitis\nD) Leukoplakia", "output": "0, because Ans. A: Retinitis pigmentosaGIT premalignant conditionsOf the four major primary small-bowel tumors (adenocarcinomas, lymphomas, carcinoid, and leiomyosarcomas), adenocarcinomas and lymphomas are associated with diseases that seem to increase the risk of developing these malignancies.Immunoproliferative small intestinal disease and celiac disease, are thought to predispose patients to the development of primary lymphoma.Increased risk is also associated with conditions, such as immunodeficiency syndromes, nodular lymphoid hyperplasia, Crohn's disease, the gastrointestinal polyposis syndromes, hereditary nonpolyposis colon cancer, neurofibromatosis, long-standing ileostomy, and urinary diversion procedures.Patient with long standing ulcerative colitis are at risk of developing colonic epithelial dysplaia and carcinoma.Oral cavity premalignant conditionsMany oral SCCs develop from premalignant conditions of the oral cavity.A wide array of conditions have been implicated in the development of oral cancer, including leukoplakia, erythroplakia, palatal lesion of reverse cigar smoking, oral lichen planus, oral submucous fibrosis, discoid lupus erythematosus, and hereditary disorders such as dyskeratosis congenital and epidermolysis bullosaOther pre-malignant conditions include actinic keratosis, Barrett's esophagus and cervical dysplasia."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nWhich of the following is false about Takotsubo Cardiomyopathy\nA) Due to major catecholamine discharge\nB) Lv Contractile dysfunction\nC) Presents with acute chest pain\nD) Echo never reverts back to normal", "output": "3, because Echo comes back to normal in two weeks."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIn rheumatic heart disease, infective endocarditis is detected by echocardiogram and the largest vegetations seen are due to-\nA) Streptococcus viridans\nB) Staphylococcus aureus\nC) Candida albicans\nD) Salmonella typhi", "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\nHereditary non-polyposis colorectal cancer (HNPCC) has an increased risk of all the following except\nA) Endometrium\nB) Ovary\nC) Stomach\nD) Pancreas", "output": "3, because Hereditary non-polyposis colorectal cancer (Lynch syndrome)Hereditary non-polyposis colorectal cancer (HNPCC) is characterised by an increased risk of colorectal cancer and also cancers of the endometrium, ovary, stomach and small intestine.It is an autosomal dominant condition caused by a mutation in one of the DNA mismatch repair genes. The most commonly affected genes are MLH1 and MSH2. The lifetime risk of developing colorectal cancer is 80%, and the mean age of diagnosis is 45 years. Most cancers develop in the proximal colon. Females have a 30-50% lifetime risk of developing endometrial cancerRef: Bailey and Love, 27e, page: 1260"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIodine RDA is -\nA) 300 microgram\nB) 500 microgram\nC) 150 microgram\nD) 50microgram", "output": "2, because Ans. is 'c' i.e., 150 microgram o The RDA of iodine for adults is 150 microgram.GroupRecommended daily intakePreschool children (0-59 months)School children (6 - 12 years)Adults (>12 years)Pregnancy and lactation90 meg120 meg150 meg250 meg"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSpanish windlass was practices in Spain as a method of execution. It is a type of:\nA) Bansdola\nB) Mugging\nC) Garrotting\nD) Hanging", "output": "2, because Garrotting Garrotting: One of the methods of hemicidal strangulation The victim is attacked from behind without warning and strangled by grasping throat or by throwing a ligature over the neck and tightening it quickly. In this way a single assailant can kill a healthy robust adult. Garrotting was practices as a mode of execution in Spain. Pougal and Turkey. In Spain it was known as `spanish windlass' in which an iron collar around the neck was tightened by a screw for strangling Other common methods of homicidal strangulation are: Throttling - by hand Bansdola - In this type of strangulation the neck is compressed between two sticks of bamboos one in front and other behind the neck. Both the ends are tied with a rope squeezing the victim to the death. Sometimes a single stick is placed across the .front of the neck with a foot on each end of the stick. Mugging - Strangulation is caused by holding the neck of the victim in the bend of the elbow."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDispropoionately increased blood urea levels compared to serum creatinine (urea creatinine ratio 20:1) can be seen in the following except -\nA) Prerenal failure\nB) CCF\nC) Intrinsic renal failure\nD) Hypovolemia", "output": "2, because Intrinsic or intrarenal acute renal failure (ARF) occurs when direct damage to the kidneys causes a sudden loss in kidney function. The most common causes of intrinsic acute renal failure are acute tubular necrosis (ATN), acute glomerulonephritis (AGN), and acute interstitial nephritis (AIN) . Ref Harrison20th edition pg 236"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nFor RNA, which blotting technique is used -\nA) Western blot\nB) Northern blot\nC) Southernblod\nD) None", "output": "1, because Ans. is 'b' i.e., Northern blot TechniqueSample analyzedGel usedProbeSouthern blotDNAQYesRadioactive DNAAllele specific oligonucleotide (ASO)DNANoAllele specific oligonucleotideMicroarravm-RNA or c-DNANoDNA probeNorthern blotRNAQYesDNA probeWestern (immuno) blotProtein QYesLabeled antibody QSouth Western blotProtein DNANoDNA probeELISAProtein or antibodiesNoAntibody Q (Specific for protein to be measured)ProteomicsProtein QYes-"} |
{"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 bacteria acts by inhibiting protein synthesis?\nA) Pseudomonas\nB) Staphylococcus\nC) Streptococcus\nD) Klebsiella", "output": "0, because Ans. is 'a' i.e., Pseudomonas"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nPanthothenic acid is coenzyme of which of the following reaction (s):\nA) Dehydrogenation\nB) Oxidation\nC) Decarboxylation\nD) Acetylation", "output": "3, because D i.e. Acetylation Pantothenic acid is necessary for synthesis of coenzyme A (CoA)Q, which functions as a coenzyme for acetylation reactionsQ"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nDelusion that someone from high socio economic status is loving you is in -\nA) Othello syndrome\nB) Capgras syndrome\nC) De clerambault syndrome\nD) Franklin syndrome", "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\nOesophageal motility disorder are best diagnosed by?\nA) Barium studies\nB) Endoscopy\nC) 24 hour pH monitoring\nD) Manometry", "output": "1, because Answer is B (Endoscopy): Dysphagia for solids alone suggests a probable mechanical cause for dysphagia such as carcinoma, stricture or esophageal web. The investigation of choice for such cases is Endoscopy."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nQuinine given to a patient of falciparum malaria caused sweating and palpitation, the likely cause is?\nA) Cinchonism\nB) Hyperglycemia\nC) Hypoglycemia\nD) Hypokalemia", "output": "2, because Ans. is 'c' i.e., Hypoglycemia o Sweating and palpitations suggest hypoglycemia; which can occur due to quinine. Cinchonism is characterized by ringing in ears, nausea, vomiting, veigo, headache, mental confusion, difficulty in hearing and vision. Hypotension and cardiac arrhythmias develop on rapid i.v. injection."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nGood pasture's syndrome is characterized by all of the following, except:\nA) Glomerulonephritis\nB) Leucocytoclastic Vasculitis\nC) Diffuse alveolar haemorrhage\nD) Presence of antibodies to Basement Membrane", "output": "1, because Answer is B (Leucocytoclastic Vasculitis) Leucocytoclastic vasculitis is not a typical feature of Good pasture's syndrome Triad of Goodpasture's syndrome (Ferri 's Color Atlas & Text of Clinical Medicine) Glomerulonephritisdeg (RPGN; crescents) Pulmonary HaemorrhageQ (Diffuse Alveolar Haemorrhage) Antibodies to basement membrane antigensQ (Anti-GBM antibodies)"} |
{"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 source of energy derived from\nA) Fat\nB) Glycogen\nC) Lactate\nD) Ketone", "output": "1, because Glycogen is the reserve carbohydrate in animals. It is stored in liver and muscles.The phosphorylated enzyme is less sensitive to allosteric inhibitors. Thus even if cellular ATP and glucose-6-phosphate are high, Phosphorylase will be active. The glucose-1-phosphate produced from glycogen in the liver may be conveed to free glucose for release to the blood."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nReverse Coarctation is seen in\nA) Giant cell arteritis\nB) Takayasu arteritis\nC) Polyarteritis nodosa\nD) Microscopic polyangitis", "output": "1, because Reverse Coarctation ;weak or absent pulse in upper limb + pulse present in lower limb."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nMeasures involved in sentinel surveillance includes all of the following except.\nA) Identifying missing cases in notification of diseases\nB) Identifying new cases of infection\nC) Identifying old and new cases\nD) Identifying cases free of disability", "output": "3, because Ans. (d) Identifying cases free of disability* Surveillance: Is the ongoing systematic collection and analysis of data and the provision of information which leads to action being taken to prevent and control a disease, usually one of an infectious nature* Surveillance is of many types:- Passive Surveillance: Data is itself reported to the health system; For e.g., A patient with fever coming on his own to the PHC, CHC, Dispensary, Private Practitioner, Hospital- Active Surveillance: Health system seeks out 'actively' the collection of data, i.e., goes out to community to collect data; For e.g., Stool sample collection from home in Polio Program.- Sentinel Surveillance: Monitoring of rate of occurrence of specific conditions to assess the stability or change in health levels of a population, It is also the study of disease rates in a specific cohort, geographic area, population subgroup, etc. to estimate trends in larger population; For e.g., Use of health practitioners to monitor trends of a health event in a population- 1. Sentinel Surveillance helps in 'identifying missing cases' and 'supplementing notified cases'ALSO REMEMBER* Most of the national health programs in India rely on Passive Surveillance for morbidity and mortality data collection.* Active Surveillance: Is seen in NVBDCP (Health worker goes house to house every fortnight to detect fever cases, collect blood slides and provide presumptive treatment under malaria component) and National Leprosy Elimination Program (Modified Leprosy Elimination Campaigns)* Sentinel Surveillance is done in National AIDS Control Program wherein STD Clinics, ANC Clinics have been identified as sentinel sites to monitor trends of HIV/AIDS in the country"} |
{"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 crosses placenta\nA) Heparin\nB) Warfarin\nC) Dicumarol\nD) Nicoumalone", "output": "1, because (Warfarin) (601-KDT6th)* WARFARIN - It crosses placenta and is secreted in milk however quantity of active form is generally insufficient to affect the suckling infants* HEPARIN - does not cross BBB or placenta**- It is the anticoagulant of choice during pregnancy*** Bleeding due to overdose is the most serious complication of heparin therapy** other side effects are thrombocytopenia, * alopecia, * osteoporosis*, hypersensitivity reactions."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVocal cord palsy is not associated with -\nA) Vertebral secondaries\nB) Left atrial enlargement\nC) Bronchogenic carcinoma\nD) secondaries in mediastinum", "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\nThymic hypoplsia is seen in which of the following\nA) Wiskott Aldrich syndrome\nB) Digeorge syndrome\nC) IgA deficiency\nD) Agammaglobulinamia", "output": "3, because Ref Robbins 9/e p224 Thymic Hypoplasia: DiGeorge Syndrome DiGeorge syndrome results from a congenital defect in thymic development with deficient T cell maturation. T cells are absent in the lymph nodes, spleen, and peripheral blood, and infants with this defect are extremely vulnera- ble to viral, fungal, and protozoal infections. Patients are also susceptible to infection with intracellular bacteria, because of defective T cell-mediated immunity. B cells and serum immunoglobulins are generally unaffected. The disorder is a consequence of a developmental mal- formation affecting the third and fouh pharyngeal pouches, structures that give rise to the thymus, parathy- roid glands, and poions of the face and aoic arch. Thus, in addition to the thymic and T cell defects, there may be parathyroid gland hypoplasia, resulting in hypocalce- mic tetany, as well as additional midline developmental abnormalities. In 90% of cases of DiGeorge syndrome there is a deletion affecting chromosomal region 22q11, as discussed in Chapter 6. Transplantation of thymic tissue has successfully treated some affected infants. In patients with paial defects, immunity may improve spontane- ously with 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\nRett's syndrome occurs due to deficiency of ?\nA) Niacin\nB) Biotin\nC) Carotene\nD) Vit D", "output": "1, because Ans. is 'b' i.e., Biotin"} |
{"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 Triat in which the parents are clinically normal and only siblings are affected but males and females are affected in equal propoions is:\nA) AD\nB) AR\nC) XLD\nD) XLR", "output": "1, because AR"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVitamin K is ivolved in the posttranslational modification?\nA) Glutamate\nB) Aspartate\nC) Leucine\nD) Lysine", "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\nTrue about primary peritonitis\nA) Mostly monobacterial\nB) It is chemical peritonitis proceeds secondary peritonitis\nC) Needs peritoneal lavage\nD) Occurs with Cirrhosis of liver", "output": "3, because (D) Occurs with Cirrhosis of liver # # PRIMARY (SPONTANEOUS) BACTERIAL PERITONITIS> Peritonitis is either primary (without an apparent source of contamination) or secondary.> The types of organisms found and the clinical presentations of these two processes are different. In adults, primary bacterial peritonitis (PBP) occurs most commonly in conjunction with cirrhosis of the liver (frequently the result of alcoholism).> However, the disease has been reported in adults with metastatic malignant disease, postnecrotic cirrhosis, chronic active hepatitis, acute viral hepatitis, congestive heart failure, systemic lupus erythematosus, and lymphedema as well as in patients with no underlying disease. PBP virtually always develops in patients with ascites.> While enteric gram-negative bacilli such as Escherichia coli are most commonly encountered, gram-positive organisms such as streptococci, enterococci, or even pneumococci are sometimes found.> In PBP, a single organism is typically isolated; anaerobes are found less frequently in PBP than in secondary peritonitis, in which a mixed flora including anaerobes is the rule. In fact, if PBP is suspected and multiple organisms including anaerobes are recovered from the peritoneal fluid, the diagnosis must be reconsidered and a source of secondary peritonitis sought."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nOsgood Schlatter disease is associated with osteochondritis of\nA) Patella\nB) Femur medial condyle\nC) Tibial tubercle\nD) Femur lateral condyle", "output": "2, because Types of Osteochondritis and Nomenclature Traction apophysitis (chronic strain injuries) Tibial Tuberosity Osgood-Schlatter Calcaneum Sever The lower pole of patella Sinding-Larsen&;s"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nDatura seeds resemble -\nA) Ricinus communis\nB) Capsicum\nC) Opium\nD) None", "output": "1, because \u21b5The seeds of datura closely resemble those of the capsicum universally used over India as a condiment, and the difficulty of their detection is enhanced by the fact that, apart from the bitterness, the poison-seeds have little taste and as impure salt is generally used in India."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nMeasles is infective for:\nA) One day before and 4 days after rash\nB) Four days before and five days after rash\nC) Entire incubation period\nD) Only during scabs falling", "output": "1, because Measles/English Measles is spread through respiration (contact with fluids from an infected person&;s nose and mouth, either directly or through aerosol transmission), and is highly contagious -- 90% of people without immunity sharing a house with an infected person will catch it. The infection has an average incubation period of 14 days (range 6-19 days) and Period of communicability in measles is approximately 4 days before and 5 days after the appearance of the rash. Measles is an infection of the respiratory system caused by a virus, specifically a paramyxovirus. REF : ananthanarayana 10th 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\nTrue about Caspases is?\nA) Involved in apoptosis\nB) Cause necrosis\nC) Involved in pain pathway\nD) Are cytokines inhibitor", "output": "0, because ANSWER: (A) Involved in apoptosisREF: Robbins pathology 7th edition page 27-29Caspases are essential in cells for apoptosis, or programmed cell death, in development and most other stages of adult life, and have been termed \"executioner\" proteins for their roles in the cell Some Caspases are also required in the immune system for the maturation of lymphocytes"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMetachromatic granules are stained by?\nA) Ponder's stain\nB) Negative stain\nC) Gram's stain\nD) Leishman stain", "output": "0, because Ans. is 'a' i.e., Ponder's stain"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nFinger print bureau was first established in the following country:\nA) India\nB) England\nC) USA\nD) France", "output": "0, because Dactylography or fingerprint system or dermatoglyphics or Galton system was first used in India in 1858, by Sir William Herschel in Bengal. Sir Francis Galton systematised this in 1892. Finger print bureau was first established in Kolkata.Fingerprints are impressions of patterns formed by the papillary or epidermal ridges of the fingeips. Ref: The essentials of forensic medicine and toxicology by Dr K S Narayan Reddy, 27th edition, Page 76."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich of the following drug acts against Pseudomonas -\nA) Piperacillin\nB) Methicillin\nC) Nafcillin\nD) Cloxacillin", "output": "0, because Ans. is 'a' i.e., Piperacillin Drugs acting against Pseudomonas. o Penicillins- Piperacillin, Carbenicillin, Ticarcillin, Mezlocillin. o Cephalosporins - Ceftazidime, Cefoperazone, Cefepime. o Carbapenems- Imipenem, meropenem o Monobactams - Aztreonam. o Aminoglycosides - Tobramycin, Gentamycin, Amikacin. o Fluroquinolones - Ciprofloxacin, Levofloxacin, Norfloxacin.. o Other - Polymixin B, Colistin."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCicatrial Alopecia is seen in:\nA) Tenia Capitis\nB) Psoriasis\nC) DLE\nD) Alopecia Aereta", "output": "2, because C. i.e. DLE"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nAccording to Spetzler-Main criteria, how much score is given for a 5 cm nidus with AV malformation?\nA) 3\nB) 4\nC) 2\nD) 5", "output": "2, because Spetzler-Main AVM grading scale. Graded Feature Points Assigned Size of AVM < 3 cm 3-6 cm >6 cm 1 2 3 Eloquence1 of adjacent brain Noneloquent Eloquent 0 1 Venous drainage Superficial Deep 0 1 'Eloquent areas include: visual, language, and sensorimotor coex; the thalamus and hypothalamus; the internal capsule; the brainstem; the cerebellar peduncles; and the deep cerebellar nuclei."} |
{"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 these following statements is wrong about Tacrolimus?\nA) It is one of the macrolide antibiotic\nB) It can be safely administered with any nephrotoxic drug\nC) Glucose intolerance is a well known side effect\nD) It is used as prophylaxis for transplant rejection", "output": "1, because The side effects of Tacrolimus includes, nephro and hepato toxicity. It can also cause hypeension, tremors, seizure, diabetes mellitus and blurred vision. It should be better avoided with other hepato and renal toxicity drugs. Ref: Manzoor M. Khan (2008), Chapter 4 \"Immunesupressive Agents\", In the book, \"Immunopharmacology\", Springer Publications, USA, Page 91 ; Katzung, 9th Edition, Pages 941, 942"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMacrosomia is a\nA) Large size baby\nB) Big mouth\nC) Large head\nD) Large tongue", "output": "0, because Macrosomia:- A condition where a baby is large before bihFactors causing macrosomia:Mother having diabetesMother having gestational diabetesObese mother(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 777, 897 - 899)"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nWhich one of the following device conves radioactive emissions to light for detection?\nA) Geiger counter\nB) Photographic film\nC) Scintillation counter\nD) Radiotracer", "output": "2, because Scintillation counter: It measures ionizing radiation. The sensor, called a scintillator, consists of a transparent crystal, usually phosphor, plastic, or organic liquid that fluoresces when struck by ionizing radiation. A sensitive photomultiplier tube (PMT) measures the light from the crystal. The PMT is attached to an electronic amplifier and other electronic equipment to count and possibly quantify the amplitude of the signals produced by the photomultiplier. Geiger counter: Is a type of paicle detector that measures ionizing radiation. They detect the emission of nuclear radiation: alpha paicles, beta paicles or gamma rays. It detects radiation by ionization produced in a low pressure gas in a Geiger Muller tube."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nEnterobius commonly inhabit the: September 2011\nA) Duodenum\nB) Jejunum\nC) Ileum\nD) Caecum", "output": "3, because Ans. D: Caecum Adult Enterobius vermicularis worms inhabit the caecum, appendix and adjacent poions of the ascending colon, lying closely applied to the mucosal surface. Pinworm (genus En terobius)/Threadworm/Seatworm, It is a nematode (roundworm) and a common human intestinal parasite, especially in children. It inhabits the caecum, appendix and adjacent poion of the ascending colon, lying closely applied to the mucosal surface It causes enterobiasis, or less precisely as oxyuriasis in reference to the family Oxyuridae. The pinworm appears as a white, small and delicate nematode. The adult female has a sharply pointed posterior end, is 8 to 13 millimeters long, and 0.5 millimeter thick. The adult male is considerably smaller, measuring 2 to 5 millimeters long and 0.2 millimeter thick, and has a curved posterior end. The eggs are translucent and have a surface that adheres to environmental objects. The eggs measure 50 to 60 micrometers by 20 to 30 micrometers, and have a thick shell that is flattened on one side. The small size and colorlessness of the eggs make them invisible to the naked eye, except in barely visible clumps of thousands of eggs. Eggs may contain a developing embryo or a fully developed pinworm larva.Inside the host, the larvae grow to 140-150 micrometers in length Pinworms spread through human-to-human transmission, by ingesting (i.e., swallowing) infectious pinworm eggs and/or by anal sex. The eggs are hardy and can remain ble (i.e., infectious) in a moist environment for up to three weeks.They do not tolerate heat well, but can survive in low temperatures: two-thirds of the eggs are still ble after 18 hours at -8 degrees Celsius (18 degF). After the eggs have been initially deposited near the anus, they are readily transmitted to other surfaces through contamination. The surface of the eggs is sticky when laid, and the eggs are readily transmitted from their initial deposit near the anus to fingernails, hands, night-clothing and bed linen.From here, eggs are fuher transmitted to food, water, furniture, toys, bathroom fixtures and other objects.Household pets often carry the eggs in their fur, while not actually being infected. Dust containing eggs can become airborne and widely dispersed when dislodged from surfaces, for instance when shaking out bed clothes and linen.Consequently the eggs can enter the mouth and nose through inhalation, and be swallowed later. Although pinworms do not strictly multiply inside the body of their human host, some of the pinworm larvae may hatch on the anal mucosa, and migrate up the bowel and back into the gastrointestinal tract of the original host. This process is called retroinfection. Despite the limited, 13 week lifespan of individual pinworms, autoinfection (i.e., infection from the original host to itself), either through the anus-to-mouth route or through retroinfection, causes the pinworms to inhabit the same host indefinitely"} |
{"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 results in increase in secretion of ADH?\nA) Hypervolemia\nB) Hypeension\nC) Hypovolemia\nD) Decrease osmolarity", "output": "2, because Ans: C HypovolemiaRef: Guyton 12th/e p. 9051Hypovolemia (Decreased ECF) stimulates the release of ADH.Vasopressin secretion is increased by: - i) Increased osmolarity (osmotic pressure) of plasma; ii) Decreased ECF volume; iii) Pain, emotion, stress, exercise; iv) Nausea and vomiting; v) Standing; vi) Clofibrate, Carbamazapine; vii) Angiotensin II."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nUrine osmolality in Diabetes insipidus is\nA) <150 mmol/L\nB) <300 mmol/L\nC) <600 mmol/L\nD) <900 mmol/L", "output": "0, because Diabetes insipidus is condition characterised by excessive thirst excretion of large amounts of severely diluted urine Those with diabetes insipidus continue to uinate large amount of urine in spite of water deprivation.Ref: DM Vasudevan, 7th edition, page no: 373"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\n1-a hydroxylation in Vitamin-D metabolism takes place in\nA) Skin\nB) Liver\nC) Kidney\nD) Blood", "output": "2, because Vitamin D is a fat-soluble vitamin molecule found in fish liver oils, and also produced in the skin when subjected to ultraviolet rays from sunlight. The main function of the vitamin is to increase the utilization of calcium and phosphorus in bones and teeth. A mixture of several forms of vitamin D: Vitamin D3 is synthesized in the skin upon exposure to ultraviolet light; in contrast, vitamin D2 is obtained only from the diet. Both vitamins D2 and D3 are metabolized to 25-hydroxyvitamin D in the liver, and then to the active 1,25 dihydroxy form in the kidney. Vitamin D has a major role in the intestinal absorption of calcium, bone calcium balance and renal excretion of calcium.Ref: Ganong&;s review of medical physiology;24th edition; page no-379"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nMagaldrate is conveed by gastric acid to ?\nA) Magnesium hydroxide\nB) Magnesium hydroxide and calcium carbonate\nC) Magnesium hydroxide and Aluminium hydroxide\nD) Calcium carbonate and aluminium hydroxide", "output": "2, because Ans. is `c' i.e., Magnesium hydroxide and Aluminium hydroxide Magaldrate: Magaldrateis a common antaciddrug that is used for the treatment of duodenal and gastric ulcers, esophagitis from gastroesophageal reflux. Magaldrate is a hydroxymagnesium aluminate complex that is conveed rapidly in gastric acid to Mg(OH), and Al(OH)3, which are absorbed poorly and thus provide a sustained antacid effect."} |
{"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 nerves are affected after spinal anaesthetic block \u2013\nA) Motor and sensory only\nB) Sensory and autonomic nerve only\nC) Sensory nerves only\nD) Sensory, autonomic and motor nerves", "output": "3, because Local anesthetics block generation and conduction of nerve impulse at all part of neuron where they come in contact, without causing structural damage. Thus not only sensory but motor impulses and autonomic control is also interrupted."} |
{"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 of choice for Treponema Pallidum is?\nA) Penicillin G\nB) Tetracycline\nC) Azithromycin\nD) Doxycycline", "output": "0, because ANSWER: (A) Penicillin GREF: Microbiology, Volume 2; Volume 9, Part 2 edited by E. Edward Bittar, Neville Bittar p; 241See APPENDIX-65 for \"SEXUALLY TRANSMITTED DISEASES\"\"Parenteral penicillin G remains the treatment of choice for syphilis (Treponema pallidu and resistance to penicillin has not been reported\""} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nIf hemoglobin status of a population with mean value is 10.3 gm % with SD 2 gm%, then 5% population will be below what value of Hb?\nA) 6.67\nB) 7.35\nC) 9\nD) 8.6", "output": "1, 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\nInclusion body conjunctivitis true is all except:\nA) Self limiting\nB) Present only in infants\nC) Occurs while passage from bih canal\nD) Caused by chlamydia", "output": "1, because Ans. Present only in infants"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nA 55 year old man, a chronic smoker is brought to emergency with history of polyuria, polydipsia, nausea and altered sensorium for last two days. He had been diagnosed as having squamous cell carcinoma of lung two months prior to this. On examination, he was lethargic and confused. An ECG was normal except for a narrowed QT interval. Which one of the following is the most likely metabolic abnormality ?\nA) Hypematremia\nB) Hypercalcemia\nC) Hypokalemia\nD) Hyponatremia", "output": "1, because None"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a multi question.\n\nEBV causes all EXCEPT:\nA) Nasopharyngeal carcinoma\nB) Burkitt s lymphoma\nC) Verrucous lymphoma\nD) Hodgkin's lymphoma", "output": "2, because ANSWER: (C) Verrucous lymphomaREF: Jawett's 24th edition Section IV. Virology > Chapter 33. Herpesviruses Cancer by EBV:EBV is recognized as a cause of Burkitt's lymphoma, nasopharyngeal carcinoma, Hodgkins disease, and some other lymphomas. Sera from patients with Burkitt's lymphoma or nasopharyngeal carcinoma contain elevated levels of antibody to virus-specific antigens, and the tumor tissues contain EBV DNA and express a limited number of viral genes. EBV-associated B cell lymphomas are a complication for immunodeficient patients"} |
{"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 required more during lactation as compared to pregnancy, except ?\nA) Iron\nB) Vitamin A\nC) Niacin\nD) Energy", "output": "0, because Ans. is 'a' i.e., Iron Required more during lactation as compared to pregnancy : Energy, Vitamin A, thiamin, riboflavin, Vitamin C, niacin, and Vitamin B12. Required more during pregnancy : Iron, protein, and folate. Same requirment in pregnancy and lactation : Fat, calcium, zinc, magnesium, and vitamin B6."} |
{"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 B cell marker -\nA) CD 19\nB) CD 20\nC) CD 134\nD) CD 10", "output": "2, because . CD 134"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nActinomycosis is commonly seen in -\nA) Tibia\nB) Mandible\nC) Scapula\nD) Femur", "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 sebaceous glands, accumulation of sebum leads to:\nA) Milia\nB) Acne\nC) Epidermoid cyst\nD) Miliaria", "output": "1, because Ans. b. Acne4 steps in pathogenesis of Acne are:Sebum productionHyperkeratosis of pilosebaceous unitPropionibacterium acnes colonization of pilosebaceous unit Inflammation"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nA young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is-\nA) Irritable bowel syndrome\nB) Ulcerative colitis\nC) Crohn's disease\nD) Amebiasis", "output": "0, because Childhood Chronic ill health in childhood or adolescent IBD may result in growth failure, metabolic bone disease and delayed pubey. Loss of schooling and social contact, as well as frequent hospitalisation, can have impoant psychosocial consequences.Treatment is similar to that described for adults and may require glucocoicoids, immunosuppressive drugs, biological agents and surgery. Monitoring of height, weight and sexual development is crucial. Children with IBD should be managed by specialised paediatric gastroenterologists and transitioned to adult care in dedicated clinics . Pregnancy A women's ability to become pregnant is adversely affected by active IBD. Pre-conceptual counselling should focus on optimising disease control. During pregnancy, the rule of thirds applies: roughly one-third of women improve, one-third get worse and one-third remain stable with active disease. In the post-paum period, these changes sometimes reverse spontaneously. Drug therapy, including aminosalicylates, glucocoicoids Delayed growth and pubeal development: chronic active inflammation, malabsorption, malnutrition and long-term glucocoicoids contribute to sho stature and delayed development, with physical and psychological consequences. * Metabolic bone disease: more common with chronic disease beginning in childhood, resulting from chronic inflammation, dietary deficiency and malabsorption of calcium and vitamin D. * Drug side-effects and adherence issues: young people are more likely to require azathioprine or biological therapy than adults. Poor adherence to therapy is more common than with adults, as younger patients may feel well, lack self-motivation to adhere and believe that drugs are ineffective or cause side-effects. * Loss of time from education: physical illness, surgery, fatigue in chronic inflammatory bowel disease, privacy and dignity issues, and social isolation may all contribute. * Emotional difficulties: may result from challenges in coping with illness, problems with forming interpersonal relationships, and issues relating to body image or sexual function. Ref Davidson edition23rd pg823"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nLength of umbilical cord is?\nA) 40-50 cms\nB) 60- 120 cms\nC) 30-100 cms\nD) 25-40 cms", "output": "2, because ANSWER: (C) 30-100 cmsREF: Dutta 6th ed p. 40The normal length of umblical cord is around 50cms with usual variation between 30-100 cms"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nVinyl chloride has been implicated in -\nA) Angiosarcoma of liver\nB) Angiofibroma of nose\nC) Hepatomas\nD) Bladder cancer", "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\nVitamin B12 intrinsic factor absorption occurs in\nA) Duodenum\nB) Ileum\nC) Jejunum\nD) Colon", "output": "1, because Most of the vitamins are absorbed in the upper small intestine, but vitamin B12 is absorbed in the ileum.Vitamin B12 binds to intrinsic factor and the complex is absorbed across the ileal mucosa.Vitamin B12 and folate absorption are Na+ independent.Other vitamins are absorbed by carriers that are Na+ cotranspoers.(Ref: Ganong&;s Review of medical physiology, 23 rd edition, page 458)"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nSplenunculi are commonly seen in\nA) Hilum of spleen\nB) Tail of spleen\nC) Mesocolon\nD) Splenic ligaments", "output": "0, because A. (Hilum of spleen) (1103-B & L 25th)ACCESSORY SPLEEN (Splenunculi) - probably results from a failure of infusion of splenic embryonic tissues* They are located near the hilum of the spleen in 50% of cases and related to the splenic vessels or behind the tail of pancreas in 30%. The remainder are located in the mesocolon or the splenic ligaments* These are functionally similar to the spleen and while performing splenectomy for blood dyscrasias removal of these accessory spleens are obligatory, otherwise there always remains a chance of recurrence* Axis of spleen enlargement projects into- Greater sac**"} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nCausative agent of Favus is:\nA) Tinea schoenleinii\nB) Tinea rubrum\nC) Malassezia furfur\nD) Epidermophyton floccosum", "output": "0, because Ans. A. Tinea schoenleiniiFavous usually affect scalp, but occurring occasionally on any part of the skin and even at times on mucous membrane, caused by Tinea schoenleinii."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nZona Pellucida disappears by:-\nA) Before ferilisation\nB) During feilization\nC) 5th day after feilization\nD) 7th day after feilization", "output": "2, because Zona pellucida is thick membranous covering made up of glycoprotein, the microvilli of oocyte and follicular cells project into zona pellucida for nutrition. it prevent polyspermy and implantation. Blastocyst forms at 4th day and by the end of 5th day, zona pellucida disappears and implantation takes place at 6th -7th day after feilization."} |
{"instruction": "Analyze the question and answer the multiple-choice question. All questions are related to medical subjects.", "input": "This is a single question.\n\nStorage form of thyroid hormone-\nA) Tri-iodo tyrosine\nB) Tri - iodo thyronine\nC) Thyroglobulin\nD) Di-iodo tyrosine", "output": "2, because The synthesis and storage of thyroid hormones occurs between the follicular cells and the colloid. The storage form of thyroid hormone is thyroglobulin. Thyroglobulin is a large glycoprotein synthesized in the follicular cells and has a molecular weight of around 650 000 with about 140 tyrosine residues, depending on the form of thyroglobulin. Approximately one quaer of these residues is iodinated at the apical-colloid interface. Once iodinated, thyroglobulin is taken up into the colloid of the follicle where, still incorporated in the protein, a coupling reaction between pairs of iodinated tyrosine molecules occurs. The coupling of two tyrosine residues each iodinated at two positions (di-iodotyrosine, DIT) produces tetra-iodothyronine or thyroxine (T4 ) whilst the combination of DIT with mono-iodotyrosine (MIT) produces tri-iodothyronine (T3 ). Such coupling can occur within a single molecule of thyroglobulin or between dimerized molecules of the protein. This coupling is catalyzed by TPO. Thyroid hormones are stored in this state and are only released when the thyroglobulin molecule is taken back up into the follicular cells. Stimulated by TSH, thyroglobulin droplets are captured by the follicular cells by a process of pinocytosis. Fusion of the droplets with lysosomes results in hydrolysis of the thyroglobulin molecules and release of T3 and T4. Reference : page 2285 Harrison's Principles of Internal Medicine 19th 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\nCongenital hepatic fibrosis is a characteristic feature of\nA) Multicystic renal dysplasia\nB) ARPKD\nC) Familial juvenile nephronophthisis\nD) Medullary sponge kidney", "output": "1, because Infantile and Iuvenile forms are associated with congenital Hepatic fibrosis."} |