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<s>[INST] context: Snowflakes! You can catch them on your tongue or use them to make a perfect snowball. But have you ever thought about taking pictures of them? Ken Libbrecht did. He is a physics professor from California. Although the weather in California is usually warm and sunny, Ken's hobby is taking pictures of snowflakes. He travels to cold areas like Alaska and Canada to find snowstorms and take pictures of the snowflakes. "They are often beautiful, and every snowfall brings new surprises," says Ken. Ken takes pictures of snowflakes with a high-quality digital camera. He uses a microscope to make the tiny snowflakes larger. To get the best images, Ken built a special photo-microscope just for snowflakes. He collects flakes by letting them fall onto a piece of foam board . The pictures must be taken outdoors, so Ken wears lots of clothes to stay warm. But his fingers often get cold, because it's difficult for him to take pictures of a tiny snowflake with gloves. Each snowflake has shapes and patterns that make it as unique as a person's fingerprint. The hobby of snowflake photography is also unique. Next time a snowstorm blows through your town, take a closer look at the flakes before you gather them into a snowball. See if you can notice their unique patterns. Millions of snowflakes are waiting for you! ,. [/INST] question: What's the weather in Ken Libbrecht's hometown usually like? | options: A: Cold and snowy B: Windy and rainy C: Warm and sunny D: Cloudy and foggy | answer: C </s>

<s>[INST] context: Inprefix = st1 /Chinahe's known as "the Flying Fish"; inAmericathey call him "the Baltimore Bulet". Whatever you call him, American swimmer Michael Phelps looks destined to become a household name across the world after breaking the Olympic record for most gold medals in a single Games. Phelps's total of eight gold medals in Beijingput him one ahead of Mark Spitz's previous record set in 1972. Now people are already calling him the greatest Olympian of all time. But whether he is or not, what is it that makes Michael Phelps so good? A good place to start might be his physique . Phelps has the perfect body shape for a swimmer: his arm span is longer than his height, he has very flexible joints, huge lungs, and his incredibly large feet (size 14 in the US, size 49 inChina) act like flippers in the water. To feed his huge swimmer's body, Phelps eats an astonishing 12,000 calories a day, six times the average for a man of his age. He then owes it to a swimsuit which has been making waves in the world of swimming. Designed by NASA, the American space agency, the suit is made of a special material which is said to help athletes swim 2% faster. Michael Phelps should spare a thought for his mum, who first pushed him into swimming as a way of making friends, and who believed in him when one teacher said he would never be a success. Whatever the reason for his success, Phelps admits there was perhaps also a bit of luck involving in winning his eight medals. "I guess eight is a lucky number for me, too, now. The opening ceremony started on 8/8/08. Maybe it was meant to be," he said. [/INST] question: How many gold medals did Mark Spitz won in 1972? | options: A: 6 B: 7 C: 8 D: 9 | answer: B </s>

<s>[INST] context: Earth Day is on April 22nd. People say thanks to the Earth and learn ways to keep the Earth safe and clean. But saving the Earth is not just for grow-ups. Kids are also taking an active part in it. The American writer and filmmaker Lynne made a film called Young Voices for the Planet. It lists a lot of stories about different kids who help to keep our environment clean. Team Marine, US A group of students at Santa Monica High School started an organization called Team Marine. They tell people why plastic bags are bad for sea animals and environment. In 2011, they successfully made lawmakers in their city stop people using plastic bags. Felix, 15 Germany In 2007, a 9-year-old boy, Felix, started a club. Plant for the Planet . It encourages children around the world to plant trees in their own countries. Felix helped plant 25 million trees in Germany and 120 million trees worldwide. Alec, 17, us When he was 12, Alec set up Kids VS Global Warming. It teaches kids about weather change and ways to stop the world getting warmer and warmer. Alec travels widely to encourage people to help stop global warming. He has given more than 70 talks across the country. Olivia, 13, US When Olivia was 11, she heard about the 2010 oil spill in gulf of Mexico. She painted 500 pictures of birds to raise money for the clean-up. She raised more than $200,000 to protect birds and other wild animals. [/INST] question: Young Voices for the Planet made by Lynne is _ . | options: A: a TV play B: a film C: a club D: a book | answer: B </s>

<s>[INST] context: Gavin Joseph, a teenager with Asperger's Syndrome, was beaten up by a group of people for just being different. Asperger's Syndrome is a developmental disorder that affects a person's ability to socialize. But instead of putting them into prison for what they did to him, Gavin offered them a chance to become more tolerant and understanding. On Thursday night, some kids were talking about how "it's weird " that he is always by himself, attending events alone and watching people, and it was "creepy" that he wanted to be friends with people he didn't know. On Friday night, another kid that overheard that conversation decided to take matters into his own hands and become judge and jury, and this is the result of that. He didn't ask questions, didn't get to know Gavin, never met him, and didn't give him a chance to leave. Gavin was called to meet someone, surrounded by people he didn't know, choked, punched , and left lying on the pavement so he would "learn his lesson". Gavin emerged from the attack with a concussion , a fractured nose, a bruised esophagus and some damage to his eyes, but thankfully, none of the injuries resulted in permanent damage. But here's the truly amazing part -- Gavin refused to press charges against the people who did this to him. Instead of wanting to see them punished, he wants to see them educated. Gavin asked that his attackers do community service that is disability-related. According to his mother, Gavin also asked that they watch a 20-minute video statement he taped while their families were present so they could see the damage they did and hear the event from his perspective. "If you are reading this, I hope you talk to your teens," his mother wrote. "Tell them about disabilities you can't see, teach them to be tolerant of people that are different, teach them that if they continuously see someone alone that maybe it is not their choice to be alone, remind them to ask questions first and get to know one another." [/INST] question: Gavin is always alone because he_. | options: A: enjoys being alone B: is always upsetting C: suffers from a disease D: doesn't like his schoolmates | answer: C </s>

<s>[INST] context: When people introduce themselves,I always hear them say"I'm just a housewife."I don't understand why their introduction is always filled with regret and self-pity.Is it,really a crime to be a housewife?Is it really embarrassing when you choose not to work outside and instead choose to work in your home? How could you be"just a housewife"when the basic social unit of society depends on you and your service?A housewife works for the longest hour,supporting your husband,child studies,caring for elders,managing finances,paying bills,grocery shopping,cooking according to individual taste,cleaning,etc.A housewife could be anyone:daughter,wife,mother,teacher,financial advisor,fashion designer and nurse,gardener,driver,cook,and so on.Don't think you are not being paid for it.You get the reward that no money can offer----the love and affection of your family,their trust in you,a happy home and your own satisfaction. It is you who choose to be in this occupation,willingly or for any other reason.After a busy day,all wait to return to the comfortable home set by you.They know you will be there to absorb all their stress and tiredness and relax them.Would the life have been the same had you been working outside to earn some money?Would you along with your family have been able to buy all the content in life that you are enjoying now with that money? Respect yourself for what you are.Introduce yourself to the world with the same dignity.The world understands the importance of your job; it's time to make them accept it.Introduce yourself with pride and with twinkle in your eyes"I am a housewife".Kick that"just"out. [/INST] question: How do people feel when they say"I'm just a housewife"? | options: A: Satisfied B: Proud C: Regretful D: Anxious | answer: C </s>

<s>[INST] context: Radiation-induced thyroid cancer Authors: Section Editors: Deputy Editor: INTRODUCTION Radiation exposure of the thyroid during childhood is the most clearly defined environmental factor associated with benign and malignant thyroid tumors. The risk of thyroid cancer following irradiation is related to radiation dose and age (greater for children exposed early in life), and the risk persists throughout life. Radiation exposure during childhood also increases the risk of benign thyroid nodules and hypothyroidism. The purpose of this topic is to review the evaluation of a patient with a history of childhood radiation exposure and how such a history affects treatment of patients with thyroid tumors. Radiation injury to other organs is reviewed separately. (See and .) RADIATION EXPOSURE Type of exposure -- Radiation exposure may be external or internal. *External - The predominant types of external radiation are diagnostic radiographs, therapeutic radiation for the treatment of cancer, and historical use of external radiation to treat a wide variety of nonmalignant conditions. External radiation also includes brachytherapy, whereby a sealed radiation source is placed adjacent to a treatment area. *Internal - Internal radiation exposure includes ingestion of foods or liquids contaminated with radioactivity or by inhalation of radioactive gases or paicles. Internal radiation occurs after exposure to nuclear fallout (from testing and accidents at operating nuclear power plants or above ground nuclear explosive testing) or after ingestion of radioiodine for diagnostic tests and for therapy of hypehyroidism. [/INST] question: Radiation induced thyroid cancer is - | options: A: Papillary B: Follicular C: Anaplastic D: Medullary | answer: A </s>

<s>[INST] context: _ Pass for a native. Pimsleur courses help people who need to speak another language quickly. Our courses took 40 years to develop and are now used by the FBI, CIA, and business professionals everywhere. They are so effective that you have nothing to lose! You will get everything in 10 days: * Language instruction that is proven effective * No boring charts or meaningless rules *8 fluency-oriented lessons on 4 audio CDs (or cassettes) * Audio teaching with a 25-year history of success. *Full 30-day money-back guarantee *Special offers on our more advanced courses There are so many reasons to learn a new language with the Pimsleur approach : * Speak without an accent so you sound like a native. *Form new sentences that sound right and make sense. Practice what is natural to you in English. *Feel safe and confident. You will know how to deal with any situation. *Protect your busy life. 30-minute lessons are perfect for your lunch break or workout. *Remember without trying. Material is scientifically arranged so you remember without pain. *Join 25 million people who have graduated with success since 1980. The purpose of the course ; The entire Pimsleur approach is what language learning should be : quick, fun and easy J Many foreign language students have difficulty in learning. Their textbooks teach boring drills, grammar rules and lists of words. But textbooks alone can never bring it all together. Your only real goal in taking any language course is to speak naturally with others. You will keep building on what you have learned. Best of all,Pimsleur courses do not waste your time by cramming grammar down your throat. You learn to recognize what sounds right through practice. [/INST] question: What does the ad promise? | options: A: No boring CDs B: No meaningless rules C: 25-hours of teaching D: Free lessons for 30 days | answer: A </s>

<s>[INST] context: MOD Onlay An indirect restoration, which is partly intracoronal and partly extracoronal that covers all the cusps of a posterior tooth. Onlay has cuspal protection as the main feature. The use of an onlay keeps the stresses at a low level and creates no hazard to the remaining tooth structure. Indications If the width of the lesion is 1/3 to 1/2 the intercuspal distance - cuspal protection is to be considered. Width of the lesion exceeds 1/2 the intercuspal distance - cuspal protection is mandatory. If the length : width of the cusp is more than 1:1, but not exceeding 2:1 - cuspal protection is to be considered. If the length : width of the cusp is more than 2:1 - cuspal protection is mandatory. When there is need to change the dimension, shape and inter relationship of the occluding tooth surfaces. Abutment teeth for RPD and fixed prosthesis. When wear facets that exceed the cusp tips and triangular ridge crests facially / lingually are to be included. MDS Prep Bytes (Cast Restoration – Inlay) [/INST] question: Which of the following is an indication of onlay cast restoration? | options: A: Width of the lesion exceeds ½ the intercuspal distance B: Strong, self-resistant cusps are there C: Occlusal surfaces are not to be changed D: The tooth is not to be used as an abutment | answer: A </s>

<s>[INST] context: A fellow speaker from California named Geri flew to Japan, in her favorite jeans and a casual jacket, to give her first speech. Fourteen hours later, four perfectly dressed Japanese gentlemen greeted her at Narita Airport. Smiling and bowing low, they handed her their business cards. With her bag in one hand, Geri took their cards with the other. She thanked them, glanced briefly at the cards, and put them into her jeans pocket quickly. When the five of them arrived at the hotel, they invited Geri to tea in the lobby . While sipping tea, the gentlemen presented her with a small gift which she eagerly opened. She was thrilled with the gift and shouted excitedly, "Oh, it's beautiful!" At this point, the four Japanese gentlemen stood up and, bowing only very slightly, said "Sayonara" and left immediately. Poor Geri was left astonished. What did she do wrong? Everything! Her jeans were the first gaffe. Even if you're coming off a bicycle in Japan, you do not meet c1ients casually dressed. The second mistake was Geri's handling of their business cards rudely. In Japan, the business card is one of the most important communicative tools. It is always presented and accepted respectfully with both hands. However, Geri put their cards away much too quickly. In Japan, people use business cards as a conversation starter. You chat about each other's cards and work and do not put theirs away until they gently and respectfully place yours in safekeeping. Putting it carelessly into her jeans pocket was the ultimate disrespect. Then, the fourth horror of horrors was that Geri should not have opened the gift in front of her clients. In a land where saving face is critical, it would be embarrassing to discover the gift they gave was not as nice as the one they received. What is worse, Geri hadn't even given them a gift! [/INST] question: In the four Japanese gentlemen's eyes, Geri took their cards _ . | options: A: excitedly B: embarrassingly C: politely D: disrespectfully | answer: D </s>

<s>[INST] context: Organisms may be transmitted in a number of ways, such as by air, food, hands, sexual contact, and infected needles. However, for each disease or disease category, there is usually a portal of entry not always unique to the organism. The respiratory tract is a common portal of entry to such airborne organisms as M. tuberculosis. This is why respiratory precautions must be taken when patients are harboring viable M. tuberculosis.The gastrointestinal tract is usually infected from ingestion of contaminated food or water (Shigella, Salmonella, Campylobacter) or by an alteration of the normal microbial flora such as with C. difficile disease. The skin is a tough integument and intact, is resistant to most infectious organisms except those that may break down human skin. Breaches of the skin as by wounds, burns, and the like predispose patients to a variety of infections such as tetanus caused by wound contamination with spores of C. tetani, or direct infection by Staphylococcus, Streptococcus, or Gram-negative rods (such as Serratia or Pseudomonas).The genital tract may become infected either by sexual contact or by alteration of the genital environment as often occurs with yeast infections. Several bacteria such as N. gonorrhoeae, Chlamydia, and Treponema pallidum are transmitted by direct sexual contact with infected partners. [/INST] question: The most common portal of entry for C. tetani, the cause of tetanus, is the | options: A: Skin B: Gastrointestinal tract C: Respiratory tract D: Genital tract | answer: A </s>

<s>[INST] context: The clinical features, especially ocular features like blurring of vision are suggestive of methyl alcohol poisoning. Moreover, Methyl alcohol is commonly used to adulterate ethyl alcohol. Impoant facts related to Methanol poisoning: 1) Cheap liquor is commonly adulterated by Methanol which leads to toxicity after consumption by poor people. Adulteration with Methanol is done because it is presumed to give the kick effect earlier with a smaller dose. Methanol is cheap and easily available. 2) Methanol as such is not a toxic agent. Methanol is metabolized to formaldehyde (by alcohol dehydrogenase) and then to formic acid (by aldehyde dehydrogenase), and these metabolites of methanol are responsible for retinal toxicity as well as metabolic acidosis. 3) Ethanol or 4 methyl pyrazole (fomepizole) are used for the treatment of methanol poisoning. They preferentially compete with methyl alcohol for the same enzyme alcohol dehydrogenase and prevents the metabolism of methanol which is then excreted unchanged in the urine. [/INST] question: A 39 year old carpenter has taken two bottles of liquor from the local shop. After about and hour, he develops confusion, vomiting and blurring of vision. He has been brought to the emergency depament. He should be given: | options: A: Naloxone B: Diazepam C: Flumazenil D: Ethyl alcohol | answer: D </s>

<s>[INST] context: Last March, the H7N9 virus hit Shanghai, Anhui, Jiangsu, Zhejiang and so on. It seemed that most people who were infected with H7N9 had the common flu . Some people suffered from a fever or a cough. Don't be afraid--it's not easy to be infected with the virus. Here is some advice to help you protect yourself when it comes. Wash your hands. You need to wash your hands with soap and hot water before you eat, after you use the toilet, and after you touch animals, because your hands may carry viruses. Cover your nose and mouth. When someone sneezes or coughs, flu viruses can travel as far as one meter through the air, so you'd better stand a proper distance while talking to someone who has a cold. And always cover your mouth and nose with a piece of paper when you sneeze or cough, and then clean your hands. Wear a mask . Some doctors say that masks can stop the flu as much as 80%, but if you don't wash your hands often, it's no use wearing a mask. And it's necessary to wear the mask in the groups of people. Do sports often. Exercises will help make your body strong enough to resist the virus. [/INST] question: When did the H7N9 virus hit Shanghai? | options: A: In March, 2013 B: In May, 2013 C: In March, 2012 D: In April,2013 | answer: A </s>

<s>[INST] context: Clinical Features :Males predominate (in a ratio of 5 to 7 : 1), with slightly earlier clinical presentation, paly because physiologic iron loss (with menstruation or pregnancy) retards iron accumulation in women. In the most common forms, caused by HFE mutations, symptoms usually first appear in the fifth and sixth decades of life in men and later in women. The principal manifestations include hepatomegaly, skin pigmentation (paicularly in sun-exposed areas), deranged glucose homeostasis or frank diabetes mellitus from destruction of pancreatic islets, cardiac dysfunction (arrhythmias, cardiomyopathy), and atypical ahritis. In some patients the presenting complaint is loss of libido and impotence. The classic clinical triad of cirrhosis with hepatomegaly, skin pigmentation, and diabetes mellitus may not develop until late in the course of the disease. Death may result from cirrhosis, hepatocellular carcinoma, or cardiac disease. TEXT BOOK OF ROBBINS BASIC PATHOLOGY NINTH EDITION PAGE.630 [/INST] question: Diabetic patient with liver cirrhosis and hyperpigmentation, diagnosis is | options: A: Wilson's disease B: Hemochromatosis C: Primary sclerosing cholangitis D: Hepatitis B | answer: B </s>

<s>[INST] context: Two new whale sharks arrived at the world's largest aquarium on Friday. Both whale sharks, the world's largest fish, arrived at the Georgia Aquarium in Atlanta after 6 a.m. The pair had been flown 8,000 miles from Taipei, Taiwan. They will join the aquarium's three whale sharks--the only ones on display outside of Asia. " We re the only people in the world that can claim three times, " aquarium director Jeff Swanagan said, " Each time we learn more and more." The two young males were given Asian names. One is Taroko, named after Taroko Gorge, a national park in Taiwan. The other is Yushan, which means "Jade Mountain", and is named after a mountain in Taiwan. The sharks were flown from Taiwan on a plane in 20-foot-long tanks with oxygen machines and other equipment to keep the water suitable for them. They arrived at about 3:30 a.m. in Atlanta, where their tanks were moved to two trucks and driven to the aquarium surrounded by some of Atlanta police cars with their blue lights flashing. They were lowered into their new home--as Norton and two females, Alice and Trixie, circled nearby, seemingly curious about the new arrivals. It is difficult to tell the age of the whale sharks, but at least one of the new arrivals is believed to be the smallest the aquarium has got. They are believed to be the aquarium's youngest whale sharks yet. [/INST] question: The two new whale sharks were carried away from Taiwan _ . | options: A: by ship B: by truck C: by air D: by train | answer: C </s>

<s>[INST] context: Once Dr. Mellinkoff invited me to join him at the hospital to discuss interesting cases with his students . The case at hand was a Guatemalan man , aged 34 , who had a fever and many other medical problems . His condition was not improving , and there was not much hope he would live . Dr. Mellinkoff asked to see the patient . He introduced himself in Spanish and , in a very gentle voice , asked how he felt . The patient smiled and said everything was all right . Then the doctor asked if he was able to eat . The patient said that he had no desire to eat . " Are you getting food you like ? " The patient said nothing . " Do you get the kind of food you have at home ? " The answer was no . The doctor put his hand on the man's shoulder and his voice was very soft . " If , you had food that you liked , would you eat it ? " " Yes , yes . " the patient said . The change in the patient's appearance couldn't have been more obvious . Nothing was said , but it was easy to tell that a message had been sent and had also been received . Later , the doctor asked why the Guatemalan man wasn't getting food he could eat . One of the students said , " We all know how difficult it is to get the kitchen to make special meals . " " Suppose , " the doctor replied , " you felt a certain medicine was ly necessary but that our hospital didn't carry it , would you accept defeat or would you insist the hospital meet your request ? " " I would probably insist , " the student said . " Very well , " the doctor said . " You might want to try the same method in the kitchen . It won't be easy , but I can help you . Meanwhile , let's get some food inside this man as fast as possible , and stay with it . Or he'll be killed by hunger . By the way , there must be someone among you who can speak Spanish . If we want to make real progress , we need to be able to talk with him . " Three weeks later , Dr. Mellinkoff told me that the Guatemalan man had left the hospital under his own power . It takes more than medicine to help sick people ; you also have to talk to them and make them comfortable . [/INST] question: The patient had no desire to eat because _ . | options: A: he was not hungry B: he was seriously ill C: he was given special meals D: he was not satisfied with the food | answer: D </s>

<s>[INST] context: Restaurants in the USA _ So many pizza chains compete for the attention of tourists in South Beach, but ask a Miami Beach local where to get the best pizza and they'll tell you about Steve's. This is New York-style pizza, handmade with care and good ingredients . New branches of Steve's are opening elsewhere in Miami, all in non-tourist areas. Opening hours: 11am-3am _ This place is 20 miles east of the city, but local folks would probably drive 200 miles to eat here. The food is good, and the scenery is even better. Come early and wander around the grounds of Indian Cliffs Ranch, where you'll see everything from rabbits to buffalo , then catch the sunset either before or after your meal. Opening hours: 5pm-10pm _ The screen door is always swinging open at this town hot spot with giant breakfasts. Try the green chili on eggs - it's made from scratch, as are the organic breads. Lunch includes salads, big sandwiches and local grass-fed beef burgers. Don't miss a square of soft, fresh carrot cake. Opening hours: 7am-2pm _ Everybody's favorite for fresh fish (some drive in from LA), Walt's packs them in on weekends. You can't make reservations for dinner (though they're accepted for lunch), but it's worth the wait for the tree fire-grilled seafood and steaks in the many-windowed ground floor or upstairs in captain's chairs. Opening hours: 11am-3:30pm [/INST] question: The new branches of Steve's Pizza are mainly intended for _ . | options: A: New Yorkers B: tourists C: the locals D: foreigners | answer: C </s>

<s>[INST] context: Esophagogastrectomy celiotomy ......... Perforation of the esophagus in the chest is a surgical catastrophe that requires aggressive intervention in viually all circumstances. While that intervention can usually consist of effos to patch the perforation and drain the mediastinum concomitant obstructive esophageal disease, whether inflammatory stenosis or cancer, mandates removal or bypass of the obstruction if control of the leak and its consequent persisting mediastinal and pleural contamination is to be accomplished. For distal esophageal cancers, many thoracic surgeons would use the classic Ivor-Lewis operation, which consists of mobilizing the stomach in the abdomen and then performing a right thoracotomy with mediastinal clean out, esophagectomy, and esophagogastrostomy. In some circumstances, and by some surgeons' preference, a left thoracotomy approach might be used. The transhiatal approach would probably be avoided in this situation where an unknown amount of mediastinal contamination has taken place. [/INST] question: During endoscopic biopsy of a distal esophageal cancer, perforation of the esophagus is suspected when the patient complains of significant new substernal pain. An immediate chest film reveals air in the mediastinum. You would recommend | options: A: Placement of a nasogastric tube to the levels of perforations, antibiotics, and close observation B: Spit fistula (cervical pharyngostomy) and gastrostomy C: Left thoracotomy, pleural patch oversewing of the perforation, and drainage of the mediastinum D: Esophagogastrectomy celiotomy and right thoracotomy | answer: D </s>

<s>[INST] context: Virginia is set to begin enforcing the toughest drunken-driving punishment, one that will require thousands of first-time offenders--whether they were highly drunk or slightly over the limit - to install in their cars blood-alcohol testing devices that can lock the ignition. The devices work like this-A driver must blow into a blood alcohol device linked to the car's ignition. If the result is higher than the legal limit, the car will not start. The device also requires random "rolling retests" once the driver is on the road. Virginia's current law requires only repeat drunken-driving offenders or those with a blood alcohol level of 0.15 or higher to have an ignition interlock device in their car. The new law, which takes effect in July, will roughly increase the number of people required to use ignition interlock devices four times, and offenders will have to pay about $ 480 for a typical six-month installation. The measure has caused a debate between groups battling drunken driving and those representing offenders. Such groups as Mothers Against Drunk Driving and the Washington Regional Alcohol Program say that Virginia's 274 alcohol-related road deaths and more than 5,500 injuries in 2010 remained unacceptably high despite years of cracking down on drunken driving. Ignition interlock devices, they say, reduce repeat offenses. But some public defenders and lawyers argue that the devices are too severe a punishment for offenders at the legal blood alcohol limit of 0.08, and that the court system will be burdened by more cases going to trial and lower-income drivers will be affected by the fees. Del. Sal R. laquinto, who sponsored the bill, had a simple reply for concerns about the costs of the interlock devices: "How much does a life cost?" "Blowing into a tube for six months, you will remember that, " Iaquinto said, " and you are not likely to offend again. " [/INST] question: The ignition probably refers to the part in a car where _ . | options: A: the alarm goes off B: the car is fueled C: the key is placed D: the engine starts | answer: D </s>

<s>[INST] context: This is the true story of a great woman. Her name was Helen Keller. She was born in 1880 in Alabama in the USA. When Helen was one year and a half, she got ill and then she became blind and deaf. Her parents tried to do their best for their daughter and they asked a young teacher called Anne Sullivan to their home to teach Helen. Anne herself was almost blind in her youth. Helen was a smart girl but she couldn't hear or talk. She was angry at this. So she was always crying and shouting. Then Anne often went for walks with Helen in the country near her home. After two weeks, Helen became quiet. Anne began to teach her how to spell and Helen learned to write. Boards with lines on them helped her to keep the words straight. Soon her talents were famous all over the world. There were her stories in newspapers and magazines. By the time she was 17, she was studying French, German, Latin, Physics and many other subjects. She was still blind and deaf. In 1902, she wrote a book The Story of my life. It became well-known all over the world. [/INST] question: Helen became blind and deaf when she was _ . | options: A: one year old B: half a year old C: one year and a half old D: two years old | answer: C </s>

<s>[INST] context: Management of PDA After birth ductus arieriosus constricts within a few hours producing functional closure. Permanent anatomic closure follows in the next 10-21 days due to extensive intimal thickening. The mechanism producing the initial constriction is not completely understood, but the increase in arterial 02 tension plays an important role. One more factor which helps in closure of the ductus arteriosus is the decrease in concentration of prostaglandins at the time of birth In the intrauterine period the concentration of prostaglandin PGF2 a is very high. This prostaglandin has a vasodilatory effect which keeps the ductus open. The synthesis of these vasodilator is inhibited at birth by the inhibition of the enzyme cycloxygenase at birth. Cycloxygenase is an important enzyme in the synthetic pathway of prostaglandin. In many premature infants the ductus fail to close spontaneously. In these cases the closure can be produced by infusion of drugs that inhibit cyclooxygenase. Indomethacin is a potent inhibitor of prostaglandin synthesis. It inhibits prostaglandin synthesis by inhibiting the enzyme cyclooxygenase. Indomethacin is routinely used to close the PI A in premature infants, it does not close the P I.A of full term  infants or children. The success of indomethacin therapy is as high as 80-90% in premature infants with birth  weight over 1200 g. If indomethacin is not successful and the ductus remains hemodynamically significant, surgical ligation should be performed without hesitation. Recent studies from Europe indicate that ibuprofen may be as effective as indomethacin for the medical closure of pretenn PDA. [/INST] question: A premature infant is born with a patent ductus arteriosus. Its closure can be stimulated by administration of – | options: A: Prostaglandin analogue B: Estrogen C: Anti-estrogen compounds D: Prostaglandin inhibitors | answer: D </s>

<s>[INST] context: Beijing plans to build huge free or low-cost parking lots beyond the Fourth and Fifth Ring Roads to encourage more car owners to take buses or subways to the downtown area. The plan is just one of the many measures the city plans to take to reduce its traffic jams. Low or no parking fees would be used as economic leverage to reduce growing parking demands from urban areas. Car owners living in the suburbs will be encouraged to park their cars beyond the Fourth and Fifth Ring Roads and take buses or subways to the downtown area. Statistics show that nearly one quarter of the city's traffic flow is concentrated in the 62-square-kilometre downtown area within the Second Ring Road, which makes up only 12 percent of the city's total area. The Beijing Traffic Management Bureau receives between 400 and 500 calls reporting traffic jams every day and more than 90 percent of the roads are filled to capacity during rush hour every morning and evening. Part of the problem is the lack of easy links between bus routes, subways and cars. According to the communication commission, half of the city's investment in transportation will go towards public transit construction in the next few years, making a jump from the current only 20 percent. Moreover, Beijing plans to change its layout by building new city centers, such as at Yizhuang, Tongzhou, Shunyi and Changping, in a bid to reduce the traffic flow to the downtown. The current layout of Beijing-expanded ring roads around the same center of the Forbidden City, is seen as the root cause of the endless traffic jams. The downtown area is crowded with three business centers and one financial centre, as well as nearly 400 government organs and institutions. Traffic experts say building more urban centers around Beijing may reduce the number of residents living in the suburbs and traveling long distances to work downtown every day, thus reducing traffic flow. [/INST] question: In the coming years, if a man beyond the Fourth Ring Road goes to work in the downtown of Beijing, he is encouraged to _ . | options: A: take buses or subways B: take a taxi C: drive the car quickly D: park his car in a place which asks for no fees | answer: A </s>

<s>[INST] context: There are many unusual hotels around the world .In Greenland ,there is a hotel made out of ice ,open between December and April every year .In Turkey ,there is a cave hotel with a television ,furniture ,and a bathroom in each room .And in Bolivia ,there is the Salt Palace Hotel . Thousands of years ago ,the area has the Salt Palace Hotel was a large lake . But over time ,all the water disappeared . Today ,the area has only two small lakes and two salt deserts . The larger of the two deserts the Uyuni salt desert ,is 12000 square kilometers .During the day ,the desert is bright white because of the salt .There are no roads across the Uyuni desert ,so local people must show guests the way to the hotel . In the early 1900s ,a man named Juan Quesada built the hotel .He cut big blocks of salt from the desert and used the blocks to build it. Everything in the hotel is made out of salt ;the walls , the roof , the chairs , the tables ,the beds ,and the hotels bar . The Sun heats the walls and the roof during the day . At night is very cold , but the rooms stay warm . The hotel has twelve rooms . A single room costs 40 dollars a night .and a double room costs 60 dollars . A sign on the hotels wall tells guests ,Please do not lick the walls. [/INST] question: What is unique about the Salt palace hotel ? | options: A: Its long history B: The price of the rooms C: The guests that stay there D: What it is made of | answer: D </s>

<s>[INST] context: People around the world used their computers to buy goods, communicate with others, listen to music, see pictures and learn about different places and ideas. In 2006, more people around the world used new ways to communicate and connect with each other through the Internet. The blog is one form of communication that enjoys growing popularity. Blog is a short way of saying Web log. Through these personal websites, people can share their experiences, ideas and opinions with anyone on the Internet. People of all ages have their own blogs. For young people, they are a way to show their writings and other forms of self-expression. Many websites offer free services to create personal Web pages and fill them with writings and pictures. These sites include "MySpace" used mainly by teenagers and young adults. My Space is an online community that lets people share messages and pictures with an increasing number of friends. It is the most popular social networking site on the Web. YouTube is another Internet site that became more popular this year. This website lets anyone create, share and watch short videos. People can watch almost anything on YouTube: news, sports and entertainment events. There are music videos, and videos made by people in their own homes. These include videos of people singing or dancing, or animals doing funny things. Three young men created YouTube almost two years ago as a personal video sharing service. They recently sold it to Google for more than one and one half billion dollars. Games and entertainment also became a larger part of the Internet this year. One Internet social site is called Second Life. It is an online world in which computer users create a new self and live a different life. They get married, build homes, operate businesses, buy and sell goods, work, play and attend school. [/INST] question: People all around the world use blogs to _ . | options: A: buy goods B: express themselves C: listen to music D: watch videos | answer: B </s>

<s>[INST] context: It is reported that some developed countries have shipped broken parts of computers to China. Such a thing can be founded every day although it is against international laws. Last month Hong Kong officers found 131,000 kilograms of broken computers, TVs and phones sent from Japan. Things like these are called electronic waste, or e-waste. Dealing with them is not an easy job because dangerous poison like mercury and lead can be found in them. Every time an old computer breaks down, it needs to be dealt with safely. But at present, broken computer parts are usually _ . It may be hundreds of years before they are really goes in the earth. Many places in China are polluted by e-waste. Guiyu in Guangdong province is one of them. This town is named as "the e-waste capital of the world". It has to deal with 1.5 million kilograms of e-waste each year, from which it makes 75 million years. But it comes at a cost. Many of the poison in e-waste find their way into the environment. Plastic is burned outdoors and chemical water is poured into rivers, Greenpeace, an environmental group, has found the air, the earth and the rivers in Guiyu badly polluted. The Chinese government wants the country to develop, but in a way that doesn't do harm to the environment and people's life. This year, China presents a new protection law, the strictest one we have ever had. Computer companies like Lenovo and Dell will be asked to take back their old computers. This is because the companies that make computers know best to deal with them safely. Hopefully, the problem with e-waste will be solved in the near future. [/INST] question: The e-waste found in Hong Kong last month was from _ . | options: A: France B: Japan C: Germany D: Australia | answer: B </s>

<s>[INST] context: What are the biggest problems that society will have to deal with in the new age? There are diseases like AIDS and cancer. There's climate change, of course. And what about producing enough cheap food and energy for the world's growing population? Who's going to solve all these terrible problems? Yes, politicians and world leaders will have a big part to play. Yes, businesses will need to create the economic wealth to pay for some of these things. But who's going to make a much greater difference to something like AIDS or climate change? It's going to be a scientist. It is the scientist who can turn some new bit of science into a new technology to solve these problems. If you like thinking about the world around you, why not become a scientist? It doesn't mean you have to wear a white coat and plastic glasses and spend all your time in a lab as most people often imagine! Scientists do all kinds of amazing things that are actually interesting! Military scientists develop not only new weapons but new military technologies that could help make wars out of date. Forensic scientists work with the police to find quite small clues to catch criminals. Scientists work in schools and colleges as the teachers and professors who will train tomorrow's scientists. Don't think a scientist is far away! Maybe you like cooking? You could be a food technologist helping to keep fruit and vegetables fresher for longer. Perhaps sport is your thing? Do you know that most top athletes work with sports scientists in order to improve their performance? You could even be the science writer who gets to spend the life studying the latest advances and sharing them with the world. Looking for something to do for the rest of your life? My advice? Take a long and hard look at science. It is interesting and ever. [/INST] question: What is needed to solve these problems? | options: A: Advanced weapons B: Enough energy C: New technologies D: A growing population | answer: C </s>

<s>[INST] context: We are always using body language in our daily life. When we have a conversation with someone, we may be using more body language than words. However, the same body language may mean different things in different countries. That's why people sometimes do not understand each other correctly. Pointing to one part of the body can mean differently in different cultures. For example, in the USA people point to their heads when they think someone is clever. However, in Europe it means 'He or she is stupid or something is wrong with his or her head'. In our Chinese culture, nodding our head up and down means 'yes' and shaking our head from side to side means 'no'. However, in parts of India, Greece and Turkey, it means just the opposite . In England or the USA, when you raise your hand and make a circle with the thumb and the second finger, it means 'You're all right or Everything is OK'. However, if we do this in France or Belgium, it means 'You're worth zero'. In Greece or Turkey, we should not make this gesture . Or we are thought to be very rude. The meaning of gestures can also change over time. In the 1960s, the V sign meant 'peace'. However, during World War II, it meant 'victory'. In Greece, it is a very insulting sign. Though the meaning of body language is different, there are some expressions having the same meaning throughout the world, such as smiling and crying. [/INST] question: In England, if people point to their heads it means they think someone is _ . | options: A: clever B: stupid C: headache D: angry | answer: B </s>

<s>[INST] context: The time may soon come when we say goodbye to most of the world's languages. Today humans express themselves in over 6,000 different languages. But that is quickly changing. Many scientists say that over half of these languages will disappear within the next 50 years. After 100 years, the languages used in the world will not be more than 20. Why? It is because people from different cultures live and work together much more often than before. This brings changes. The languages of the world's main culture are replacing the languages of the smaller cultures. Most international trade takes place in world languages such as English. People respect their own cultures and traditions, but when it comes to getting a job, knowing a world language is often necessary. It may mean the difference between success and failure. Technology works on the change of languages in an even more amazing way. Modern media such as radio and television give young people in developing countries much knowledge about the world. But this knowledge doesn't come in words from the mouths of their parents or the elders in their neighborhood. It usually comes in the language of a different culture. People in different cultures think it good for them to share a popular language. They can quickly share ideas and work together. Knowing the same language means easier communication and is a basis for trust. Is the death of a small local language such a terrible thing? The answer is maybe. Many cultures may have words for many useful things we know nothing about. If their languages die, their valuable wisdom may be lost forever. The future of the world's language depends on our actions now. Will we protect endangered languages or allow them to quietly disappear? Time will have the last word. [/INST] question: Scientists say that within 50 years, perhaps, there will be only _ languages in the world. | options: A: no more than 20 B: over 3,000 C: 4,000 D: around 3,000 | answer: D </s>

<s>[INST] context: chloroquine is a rapidly acting erythrocytic schizontocide against all species of plasmodia; controls most clinical attacks in 1-2 days with disappearance of parasites from peripheral blood in 1-3 days. The mechanism of action of chloroquine is not completely known. It is actively concentrated by sensitive intraerythrocytic plasmodia: higher concentration is found in infected RBCs. By accumulating in the acidic vesicles of the parasite and because of its weakly basic nature, it raises the vesicular pH and thereby interferes with degradation of haemoglobin by parasitic lysosomes. Polymerization of toxic haeme to nontoxic parasite pigment hemozoin is inhibited by formation of chloroquine-heme complex. Heme itself or its complex with chloroquine then damages the plasmodial membranes. Clumping of pigment and changes in parasite membranes follow. Other related antimalarials like quinine, mefloquine, lumefantrine appear to act in an analogous manner. It has additional antiinflammatory local irritant and local anaesthetic propeies Essentials of medical pharmacology K D Tripathi Sixth dition Page no 821, 822: [/INST] question: Chloroquine is used in the treatment of : | options: A: DLE B: Pemphigus C: Psoriasis D: Nummular eczema | answer: A </s>

<s>[INST] context: Apoptosis in Biologic Processes: Apoptosis is responsible for mediating cell death in a wide variety of physiologic and pathologic processes as under: Physiologic Processes: Organised cell destruction in sculpting tissues during development of embryo. Physiologic involution of cells in hormone-dependent tissues. E.g, endometrial shedding, regression of lactating breast after withdrawal of breast-feeding. Normal cell destruction followed by replacement proliferation such as in intestinal epithelium. Involution of the thymus in early age. Pathologic Processes: Cell death in tumors exposed to chemotherapeutic agents. Cell death by cytotoxic T cells in immune mechanisms such as in graft-versus-host disease and rejection reactions. Progressive depletion of CD4+T cells in the pathogenesis of AIDS. Cell death in viral infections e.g, the formation of Councilman bodies in viral hepatitis. Pathologic atrophy of organs and tissues on withdrawal of stimuli e.g. prostatic atrophy after orchiectomy, atrophy of kidney or salivary gland on obstruction of ureter or ducts, respectively. Cell death in response to injurious agents involved in causation of necrosis e.g. radiation, hypoxia and mild thermal injury. In degenerative diseases of CNS e.g. in Alzheimer’s disease, Parkinson’s disease, and chronic infective dementias. Heart diseases e.g. heart failure, acute myocardial infarction (20% necrosis and 80% apoptosis). Harshmohan - Essential Pathology for Dental Students Ed 4th P: 40,41 [/INST] question: Which is not an example of physiological apoptosis? | options: A: Organogenesis B: Hormonal dependent apoptosis C: Graft versus host disease D: Selective death of lymphocytes | answer: C </s>

<s>[INST] context: Never try to work when you are very hungry. If you decide to do your homework right after school, you may get something to eat before going to work. Always do your homework before you get too tired. Don't wait until very late in the evening, or your work will seem much harder than it really is. If you have more than an hour's work, give yourself a break after an hour. On the other hand don't break it up so much that you can't get anything down. You should be able to work at least a half at a time without stopping. Don't put it off until the last minute. If you put off doing your homework, you will have it on your mind, and you won't enjoy your free time so much. If you put it off until the end of the week or until before a test, you will have too much catching up to do. A little bit each night, enough to keep up with what is happening each day in school, will take the fear out of tests and keep you on top of it all. Do your homework at the same time every evening. This will help you make it a _ . It will make it easier to do, and it will make your free time more enjoyable as well. [/INST] question: If we wait very late in the evening, our work will _ . | options: A: become a bit hard B: seem much harder C: look very easy D: go to so much trouble | answer: B </s>

<s>[INST] context: Theories and concepts of thumb sucking Psychosexual/psychoanalytical theory by Sigmund Freud: According to this, a child goes through various distinct phases of psychological development. In oral phase, it is believed that the mouth is an erogenous zone. During this phase,  the child takes anything and everything to the oral cavity. It is believed that any kind of deprivation of this activity will lead to fixation resulting in oral habits. Oral drive theory by Sears and Wise (1960): Strength of oral drive is, in part, a function of how long a child continues to feed by sucking. The oral drive is strengthened by prolongation of nursing; this is the cause and not the frustration of weaning. Rooting reflex by Benjamin (1962): The rooting reflex is movement of the infant’s head and tongue towards an object touching its cheeks. He suggested that, it arises from the rooting and placing reflexes common to all mammalian infants during the first 3 months of life.  Pediatric Dentistry, Principles and Practice / M.S. Muthu, N. Sivakumar - 2nd Ed  pdf no: 1057 [/INST] question: Who gave the oral drive theory? | options: A: Benjamin B: Sigmund Freud C: Sears & Wise D: Sheldon | answer: C </s>

<s>[INST] context: We discuss the issue of when to help a patient die. Doctors of our generation are not newcomers to this question. Going back to my internship days, I can remember many patients in pain, sometimes in coma , with late, hopeless cancer. For many of them, we wrote an order for heavy medication--morphine by the clock. This was not talked about openly and little was written about it. It was essential, not controversial. The best way to bring the problem into focus is to describe two patients whom I cared for. The first, formerly a nurse, had an automobile accident. A few days later her lungs seemed to fill up; her heart developed dangerous rhythm disturbances. So there she was: in coma, on a breathing machine, her heartbeat maintained with an electrical device. One day after rounds, my secretary said the husband and son of the patient wanted to see me. They told me their wife and mother was obviously going to die; she was a nurse and had told her family that she never wanted this kind of terrible death, being maintained by machines. I told them that while I respected their view, there was nothing deadly about her situation. The kidney failure she had was just the kind for which the artificial kidney was most effective. While possibly a bit reassured, they were disappointed. Here was the head surgeon seemingly determined to keep everybody alive, no matter what. Within a few days the patient's pacemaker could be removed and she awoke from her coma. About six months later, the door of my office opened and in walked a gloriously fit woman. After some cheery words of appreciation, the father and son asked to speak to me alone. As soon as the door closed, both men became quite tearful. All that came out was, "We want you to know how wrong we were." The second patient was an 85-year-old lady whose hair caught fire while she was smoking. She arrived with a deep burn; I knew it would surely be deadly. As a remarkable coincidence there was a meeting for discussion going on at the time in medical ethics . The speaker asked me if I had any sort of ethical problem I could bring up for discussion. I described the case and asked the students their opinion. After the discussion, I made a remark that was, when looking back, a serious mistake. I said, "I'll take the word back to the nurses about her and we will talk about it some more before we decide." The instructor and the students were shocked: "You mean this is a real patient?" The teacher of ethics was not accustomed to being challenged by actuality. In any event, I went back and met with the nurses. A day or two later, when she was making no progress and was suffering terribly, we began to back off treatment. Soon she died quietly and not in pain. As a reasonable physician, you had better move ahead and do what you would want done for you. And don't discuss it with the world first. There is a lesson here for everybody. Assisting people to leave this life requires strong judgment and long experience to avoid its misuse. [/INST] question: The first patient's husband and son wanted the doctor _ . | options: A: to save her life B: to end her life C: use an artificial kidney D: to maintain her life with machines | answer: B </s>

<s>[INST] context: Scaphoid Fractures * The scaphoid is the most frequently fractured carpal bone, accounting for 71% of all carpal bone fractures. * Scaphoid fractures often occur in young and middle-aged adults, typically those aged 15-60 years. * About 5-12% of scaphoid fractures are associated with other fractures * 70-80% occur at the waist or mid-poion * 10-20% proximal pole Management # Proximal pole -- Depends on size and vascularity of fracture -- Growing sentiment that most should be treated operatively because of high propensity for non-union and increased duration of immobilisation required for non-operative management -- If large enough to accommodate a screw than every attempt should be made Complication * Malunion -- Malunion may lead to limited motion about the wrist, decreased grip strength, and pain. -- The most frequent pattern of malunion is persistent angular deformity, or the humpback deformity. -- Malunion usually can be treated with osteotomy and bone grafting to correct angular deformity and length. * Literature confusing with no comparative studies to document improvement in hand function * Delayed union and non-union -- Delayed union is incomplete union after 4 months of cast immobilization. -- Non-union is an unhealed fracture with smooth fibrocailage covering the fracture site. -- About 10-15% of all scaphoid fractures do not unite. -- Some degree of delayed union or non-union occurs in nearly all proximal pole fractures and in 30% of scaphoid waist fractures # Delayed union is anticipated if fracture treatment is delayed for several weeks. # The risk of non-union increases after a delay of 4 weeks. * These delays may be related to the patient&;s failure to seek treatment for a presumed sprain, but they more frequently are related to improper or incomplete immobilization or a failure to diagnose and treat the acute fracture ref : maheswari 9th ed [/INST] question: Most common complication of scaphoid fracture is | options: A: Malunion B: Avascular necrosis C: Wrist stiffners D: Ahritis | answer: B </s>

<s>[INST] context: The child described in the question has no cyanosis or murmur, no cardiac or pulmonary vascular abnormalities by chest x-ray, and no evidence of structural anomalies by echocardiogram, and therefore is unlikely to have an underlying gross anatomic defect. The ECG pattern in the figure shows the configuration of preexcitation, the pattern seen in the WPW syndrome. These patients have an aberrant atrioventricular conduction pathway, which causes the early ventricular depolarization appearing on the ECG as a shortened PR interval. The initial slow ventricular depolarization wave is referred to as the delta wave. Seventy percent of patients with WPW syndrome have single or repeated episodes of paroxysmal supraventricular tachycardia, which can cause the symptoms described in the question. The preexcitation ECG pattern and WPW syndrome can occur in Ebstein malformation, but this is unlikely in the absence of cyanosis and with a normal echocardiogram. If ventricular tachycardia were present, the symptoms would likely be more profound. Active play and exposure to over-the-counter medications containing sympathomimetics in a healthy 4- year-old child can cause symptoms such as those described in the question in children with WPW syndrome by precipitating paroxysmal supraventricular tachycardia. [/INST] question: A 4-year-old girl is brought to the pediatrician's office. Her father reports that she suddenly became pale and stopped running while he had been playfully chasing her and her pet Chihuahua. After 30 minutes, she was no longer pale and wanted to resume the game. She has never had a previous episode and has never been cyanotic. Her physical examination was normal, as were her chest x-ray and echocardiogram. An ECG showed the pattern seen on the next page, which indicates which of the following? | options: A: Paroxysmal ventricular tachycardia B: Paroxysmal supraventricular tachycardia C: Wolff-Parkinson-White syndrome D: Stokes-Adams pattern | answer: C </s>

<s>[INST] context: The historical documentary, Mr. Deng Goes to Washington, which was first shown in the capital on May 12, not only reveals the details of an attempted assassination of Deng, but is also the first time that animated images of China's leaders have appeared on the silver screen. The film tells the story of Deng's nine-day visit to the US in 1979, only a month after China established diplomatic relations with the US for the first time after the founding of the People's Republic of China in 1949. Lv Muzi, the film's producer, said the film includes 12 animated sequences of Deng, drawn in French, American and Japanese styles, as well as China's traditional shadow puppetry style. Hu Yuchen, who has drawn cartoons for leaders including former premier, Wen Jiabao, is the artist behind the animated images of Deng. Among the three versions of images he drew, director, Fu Hongxing, chose to use the version which was moderately realistic. "Deng's animated images are not static in the film. When he's at meetings, the images are more serious, and when he's at a party, he's _ in a more lively way," said Zhu. For the young animator, animation can tell the story of that period of history better to younger viewers. "At first glance, animation may seem simple, but in reality, we need to do a large amount of homework, like checking what dishes were served at a dinner or what paintings were displayed in a particular room." Zhu said he and the team went through a lot of historical documents and reviewed video clips in the process of creation. Fu said the film is in honor of Deng's contribution to China as well as his influence on generations of Chinese people. Production was completed last year, which marked the l10th anniversary of Deng's birth and also the 35thanniversary of Sino-US diplomatic relations. [/INST] question: Mr. Deng Goes to Washington uses all of the following styles EXCEPT _ . | options: A: French and American styles B: Japanese style C: traditional Chinese style D: Korean style | answer: D </s>

<s>[INST] context: These are tough times for the charities, many of which will be experiencing lower levels of donations -- so if you can support them please do. HIPPO HIPPO is dedicated to relieving poverty and overcoming hunger and malnutrition in poor countries through the provision and production of vegan food. They help vegan orphanages and some of the poorest families in the community, and encourage and assist the development of sustainable agriculture and gardening. Plants for a Future Plants for a Future(a project based in Cornwall)researches perennial , eatable and useful plants for sustainable agriculture / living. Their achievements include the creation of an online database of 7,000 plants. Respect for Animals Respect for Animals campaigns against the fur trade. They run the annual Design Against Fur competition and were responsible for the anti-fur advertising campaign of the 80's. Vegan-Organic Trust The Vegan-Organic Trust is a charity "devoted to education about animal-free food growing". They produce a regular magazine and provide information for both large- and small-scale growers. Vega Research Vega Research campaigns on farming and human health issues. Sponsors research into vegan nutrition and the links between diet and health. [/INST] question: Which of the following campaigns against animal products? | options: A: Hippo B: Plants for a Future C: Vega Research D: Vegan-Organic Trust | answer: D </s>

<s>[INST] context: There are four types of isolation precautions that can be implemented in health care settings. Any given patient might require more than one type of precaution. Standard precautions apply when interacting with any patient, regardless of the diagnosis. They include hand washing before and after contact with every patient and the use of gloves, gowns, masks, and eye protection when contact with open sores, blood, or body secretions is anticipated. Contact precautions reduce the risk of spreading microorganisms that are transmitted by direct or indirect contact. They include private room placement of the patient and the use of gloves and gowns when in contact with the patient or the immediate environment. Contact precautions are indicated in patients colonized or infected with MRSA, vancomycin-resistant enterococci (VRE), and C difficile.Droplet precautions limit the transmission of infections that are carried in respiratory droplets (>5 mm in size) such as influenza and meningococcal meningitis. Droplet precautions include placing the patient in a private room and asking health care professionals to use surgical masks within 3 ft from the patient. Airborne precautions reduce the risk of airborne particulate (particles less than 5 mm in size) transmission of infectious agents such as tuberculosis. The patient is placed in a private negative-pressure room with high-efficiency masks, such as the N95 mask, worn by all health care professionals upon entering those rooms. The patient has health care-associated MRSA pneumonia and requires contact precautions. [/INST] question: A 60-year-old nursing home resident presents with a 3-day history of progressive shortness of breath and cough. The lung examination reveals right basilar crackles. The chest x-ray shows right lower lobe consolidation. Sputum culture grows methicillin-resistant Staphylococcus aureus (MRSA) Select the most appropriate isolation precaution. | options: A: Standard precautions B: Contact precautions C: Droplet precautions D: Airborne precautions | answer: B </s>

<s>[INST] context: The MIT Museum is located near the north shore of the Charles River Basin in Cambridge, MA, a few blocks from the central part of the MIT campus. The MIT Museum is accessible via public transportation, and is within three miles of two major interstate highways. The Museum is approximately a 30 minute walk from downtown Boston or from Harvard Square. BY SUBWAY Take the Red Line to either Central Square Station or Kendall Square/MIT Station. From Central Square: Walk down Mass. Ave. toward Boston and the main MIT campus. The Museum is on the left at the corner of Front St. From Kendall/MIT Station at the east end of campus: Walk down Main St., away from Boston, to Windsor St., turn left, take the second right onto Front St., and continue to the museum entrance. BY BUS The Dudley/Harvard Square bus travels along Massachusetts Ave. between Boston and Harvard Square. The MIT Museum is across the street from Novartis and a gas station. From Harvard Square, get off at either Sidney St. or Albany St. From Boston, get off at Front St. BY CAR For directions from your doorstep to MIT, Google offers excellent mapping services including directions from anywhere in the U.S. and Canada. Recorded Directions to the Museum: (415) 561-0399 Besides, you can go the Museum via Commuter Rail. You can easily connect to the MBTA Red Line from South Station, or take the green line to the red line from North Station and get off at Central or Kendall Square. [/INST] question: If you go to the Museum by subway, you should go to_first and then walk down Main St. to Windsor St.. | options: A: Kendall/ MIT Station B: Harvard Square C: The MBTA Red Line D: the main MIT campus | answer: A </s>

<s>[INST] context: Acute monoarticular arthritis in association with linear calcification of the cartilage of the knee (chondrocalcinosis) suggests the diagnosis of pseudogout, a form of calcium pyrophosphate dihydrate deposition (CPPDD) disease. In its acute manifestation, the disease resembles gout. Positively birefringent crystals (looking blue when parallel to the axis of the red compensator on a polarizing microscope) can be demonstrated in joint fluid, although careful search is sometimes necessary. Serum uric acid and calcium levels are normal, as are rheumatoid factor and ANA. Pseudogout is about half as common as gout but becomes more common after the age of 65. CPPDD disease is diagnosed in symptomatic patients by characteristic x-ray findings and crystals in synovial fluid. Pseudogout is treated with NSAIDs, colchicine, or steroids. Arthrocentesis and drainage with intra-articular steroid administration is also an effective treatment. Linear calcifications or chondrocalcinosis are often found in the joints of elderly patients who do not have symptomatic joint problems; such patients do not require treatment. [/INST] question: A 65-year-old man develops the onset of severe right knee pain over 24 hours. The knee is red, swollen, and tender. The patient does not have fever or systemic symptoms; he has never had severe joint pain before. Plain film of the knee shows linear calcification of the articular cartilage without destructive change. Definitive diagnosis is best made by which of the following? | options: A: Serum uric acid B: Serum calcium C: Arthrocentesis and identification of positively birefringent rhomboid crystals D: Rheumatoid factor | answer: C </s>

<s>[INST] context: Going to school from 8 am until 5 pm may sound terrible,but Sydney Shaw,a seventh grader at the Alain Locke Charter Academy on Chicago's West Side,has come to like it--as well as the extra 20 or so days that she's in class every year."I'm sure every kid at this school says bad things about the schedule sometimes,"says Sydney, who was at school on Columbus Day, when most Chicago schools had a holiday."But we all know it's for our benefit." Finding ways to give kids more classroom time,through longer hours,a longer school year,or both,is getting more attention."If you want to look at schools where the achievement gap is narrowing, they're saying they couldn't do it without the added time,"says Jennifer Davis."Even when you get good teachers into schools,you also need more time." According to studies, low-income students fall back more than two months in their reading skills over summer vacations."It's over the summer months that poor kids fall behind,"says Karl Alexander,a sociologist."If you have parents who themselves didn't succeed at school and aren't highly educated,kids aren't going to get those skills at home." Schools are asked to take a full year to plan how to best use the extra time--a process involving teachers,principals,students and parents.They are given outside support to help them base their plans on the best available analyses of student needs.It's still early,but officials are already seeing stronger test scores and a narrowing achievement gap. But some critics are worried."We risk producing something that's very expensive and time-consuming, and that will give educators a lot of trouble,"says Frederick Hess."Before we spend all that extra money,I'd much rather see if we can figure out how to get 50 percent more instructional time out of the current school day." [/INST] question: Low-income students fall behind in summer because _ . | options: A: no good teachers are willing to teach them B: they can't get help from their parents C: their parents are unwilling to hire private teachers D: they themselves have no desire to learn | answer: B </s>

<s>[INST] context: Freda Bright says, "Only in opera do people die of love." It's true. You really can't love somebody to death. I've known people to die from no love, but I've never known anyone to be loved to death. We just can't love one another enough. A hear-warming story tells of a woman who finally decided to ask her boss for a raise in salary. All day she felt nervous and late in the afternoon she summoned the courage to approach her employer. To her delight, the boss agreed to the raise. The woman arrived home that evening to a beautiful table set with their best dishes. Candles were softly glowing. Her husband had come home early and prepared a festival meal. She wondered if someone from the office had tipped him off, or --- did he just somehow know that she would not get turned down? She found him in the kitchen and told him the good news. They embraced and kissed, then sat down to the wonderful meal. Next to her plate the woman found a beautifully lettered note. It read: "Congratulations, darling! I knew you'd get the raise! These things will tell you how much I love you." Someone has said that the measure of love for his wife is love without measure. What this man feels for his wife is total acceptance and love, whether she succeeds or fails. His love celebrates her victories and soothes her wounds. He stands with her, no matter what life throws in their direction. Upon receiving the Nobel Peace Prize, Mother Teresa said, "What can you do to promote world peace? Go home and love your family. And love your friends. Love them without measure." [/INST] question: That the husband prepared her a second letter about her raise suggests that _ . | options: A: he loves her because he believes that she is sure to receive a raise B: he has a great way to promote his wife's love towards him C: he has a false love for people even if the person is his wife D: he loves his family members truly, whether they are in good conditions or not | answer: D </s>

<s>[INST] context: A Bite of China Are you an eating-lover? Do you want to eat every delicious food in the world? Then do you watch the popular program A Bite of China? It's a TV program on Chinese delicious food which has been produced by CCTV. Is there any holiday that isn't celebrated with special festival food? Here are several traditional Chinese foods: Noodles are a symbol of long life in Chinese culture. They are as much a part of Chinese birthday celebration as a birthday cake with its candles lit in many western countries. Since noodles mean long life, it is considered very unlucky to cut it off. Although westerners sometimes may be very sorry to see fish lying on the plate, in China a whole fish is a symbol of richness. In fact, at a party it is a tradition to serve the whole fish last, pointed towards the most valued guest. Fish also has a special meaning because the Chinese word for fish, yu, sounds like the word for richness or plenty, and it is believed that eating fish will help your wishes come true in the year to come. A very popular dish during the Dragon Boat Festival is Zongzi. This tasty dish is made of rice dumplings with meat, peanuts or other delicious food in bamboo leaves. The tradition of Zongzi is meant to remind us of a great man, Qu Yuan in Chinese history. [/INST] question: A Bite of China is _ . | options: A: a magazine B: a newspaper C: a film D: a TV program | answer: D </s>

<s>[INST] context: Du Kun,a Chinese boy is called"the youngest writer in the world."He has written three books till now.Du Kun was born in Jiangsu in 1994.When he was 7 months old.his parents started working in over 30 different cities,such as xi'an and Shenzhen.This kind of life gave him things to think and write about.When he was 9 months old,he could speak and at the age of one,he could say five to six hundred words.At three,he could look up words in the dictionary.At four,his father taught him how to learn by himself.His parents like reading very much.So does he.At the age of 5,he began writing fairy tales.At the age of 6.he wrote a novel about his life in different cities with his parents.His fairy tales are all from his life.One day,he found many mice in the house.They not only ate their food but also hurt his mother's hand.So he thought,"If we give mice the stomach of cows,they will eat grass and they will be helpful to people."This was his first fairy tales Change Stomach for Mice.Now he studies well in a middle school. He has written his third book.The novel called Eyes of Children.He says," _ ,I just wrote several books." [/INST] question: Thanks to his _ ,Du Kun could write his books. | options: A: mother B: father C: school life D: life in different cities | answer: D </s>

<s>[INST] context: Causes of HEMOPTYSIS A:Infections:y 1.viral bronchitis 2.chronic bronchitis super infected with streptococcus,hemophilus etcwhich increase airway inflammation and potential for bleeding. 3.bronchiectasis(with recurrent infections) LEADING CAUSE OF MASSIVE HEMOPTYSIS AND SUBSEQUENT DEATH. 4.Tuberculosis Development of cavity is frequent source of bleed Erosion of pulmonary aery(Rasmussen aneurysm) 5.others like Nocardia,non tb mycobacterium,aspergillus in pre existing cavities, pulmonary abscess,,paragonimiasis. B:vascular 1 pulmonary edema 2.pulmonary embolisms 3.pulmonary a v malformations 4.aoo bronchial fistula 5.diffuse alveolar hemorrhage cause significant bleed in to lung but NOT PRESENT AS HEMOPTYSIS CAUSES OF DAH:SLE,COCAINE TOXICITY,PULMONARY RENAL SYNDROME BY ANTI GBM,Granulomatosis with polyangitis.(these people also have hematuria). C:MALIGNANCY Bronchigenic carcinoma(any histology). Carcinoid Metastasis from melanoma ,sarcoma,adenocarcinoma of breast and colon. Kaposi sarcoma in hiv patients D: MECHANICAL and others Diagnostic and therapeutic procedures Pulmonary endometriosis Foreign body Coagulopathy. Source:HARRISON 20TH EDITION [/INST] question: A 60-year old patient with a past history of treated pulmonary TB presents with massive hemoptysis. What is the most likely cause for hemoptysis? | options: A: Pulmonary amyloidosis B: Aspergilloma C: Broncholitis D: Relapse of TB | answer: B </s>

<s>[INST] context: Streptococcus bovis is a Group D streptococcus. There is a significant association between S. bovis bacteremia and endocarditis with carcinoma of the colon and other colonic diseases. Every patient with S. bovis bacteremia should undergo gastrointestinal and cardiac evaluation. Up to 50% of patients with S. bovis bacteremia are repoed to have underlying colonic malignancies. In another study, 25-50% of cases of S. bovis bacteremia were associated with endocarditis, especially in patients with preexisting valvular lesions. Streptococcus agalactiae is an impoant cause of maternal and neonatal bacteremia and neonatal meningitis. It is pa of the normal flora of the gastrointestinal tract and the female genital tract. Streptococcus pneumoniae is a leading cause of community-acquired pneumonia, meningitis in adults, otitis media (especially in children), and sinusitis. Spontaneous peritonitis due to S. pneumoniae is repoed in children with ascites from nephrotic syndrome. Asplenia predisposes patients to severe infections with S. pneumoniae and other encapsulated organisms. S. pneumoniae infections are also more frequent and unusually severe in patients with sickle cell anemia, multiple myeloma, alcoholism, and hypogammaglobulinemia. S. pneumoniae is now the leading cause of invasive bacterial respiratory disease in patients with AIDS. Streptococcus pyogenes is the most common cause of bacterial pharyngitis. Complications include peritonsillar abscesses, otitis media, and sinusitis. Long-term sequelae include rheumatic fever and poststreptococcal glomerulonephritis. S. pyogenes is also responsible for many skin and soft tissue infections. The organism also produces many toxins that produce a variety of diseases. [/INST] question: A patient with colorectal cancer develops septicemia complicated by endocarditis. You would expect the blood cultures to grow? | options: A: Streptococcus agalactiae B: Streptococcus bovis C: Streptococcus pneumoniae D: Streptococcus pyogenes | answer: B </s>

<s>[INST] context: Isoniazid (lsonicotinic acid hydrazide, H): Isoniazid is the antitubercular drug parexcellence, and an essential component of all antitubercular regimens, unless the patient is not able to tolerate it or bacilli are resistant. lt is primarily tuberculocidal. Fast multiplying organisms are rapidly killed, but quiescent ones are only inhibited. It acts on extracellular as well as on intracellular TB (bacilli present within macrophages); is equally active in acidic and alkaline medium. It is one of the cheapest antitubercular drugs. However, most atypical mycobacteria are not inhibited by INH. Pharmacokinetics: INH is completely absorbed orally and penetrates all body tissues, tubercular cavities, placenta and meninges. Adverse effects :INH is well tolerated by most patients. Peripheral neuritis and a variety of neurological manifestations (paresthesias, numbness, mental disturbances, rarely convulsions) are the most impoant dose-dependent toxic effects. These are due to interference with utilization of pyridoxine and its increased excretion in urine ( see Ch. 67). Pyridoxine given prophylactically 1 10 mg I day) prevents the neurotoxicity even with higher doses, but routine use is not mandatory. INH neurotoxicity is treated by pyridoxine lOO mg/day. Hepatitis, a major adverse effect of iNH, is rare in children, but more common in older people and in alcoholics. It is due to dose-related damage to liver cells and is reversible on stopping the drug. Other side effects are rashes, fever, acne and ahralgia. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:740,741 [/INST] question: Which anti-tubercular drug is implicated in the causation of transient memory loss? | options: A: Ethionamide B: Isoniazid C: Ethambutol D: Pyrazinamide | answer: B </s>

<s>[INST] context: Quinolones block bacterial DNA synthesis by inhibiting DNA gyrase. This introduces negative superhelical turns into duplex DNA, thereby maintaining the negative superhelical tension of the bacterial chromosome during DNA replication. Ciprofloxacin and norfloxacin are active against a broad range of organisms that cause infections of the lower respiratory tract, intestinal tract, urinary tract and soft tissues. The original form, nalidixic acid, is useful only for urinary tract infections. Rifampin directly inhibits bacterial RNA polymerase. The reverse transcriptase of human immunodeficiency virus is inhibited by azidothymidine (AZT). Penicillins and cephalosporins are transpeptidase enzymes that function in the final stages of cell wall synthesis. They are inactivated by f3-lactamase enzymes, which break a single bond in the f3-lactam ring of these antibiotics. Nonclinical useful drugs such as mitomycin C and actinomycin D can directly interfere with DNA polymerase activity, but they are useful only as biochemical tools in experiments. [/INST] question: Quinolone antibiotics inhibit bacterial growth by affecting | options: A: Reverse transcriptase B: RNA polymerase C: DNA polymerase D: DNA gyrase | answer: D </s>

<s>[INST] context: On the first evening, the three of us were tired after walking for about eight hours. We soon fell asleep. In the morning, I was surprised to find the bag of food had been open. "Bears," said Joe, "we should hang the food in a tree tonight." Later that day we stopped in a beautiful field by a river. We put up the tent and fell asleep. During the night the bears came again. This time they took the food from the tree. "Bears can climb trees. They can smell food from a long way away," said Ben. "We must keep the camp clean. Bears must think our rubbish is food," I said. "And we should make lots of noise, too. If they know where we are, they may not come any closer," said Joe. "But if you see a bear," said Ben, "you mustn't make any sudden moves or make a sound, and you mustn't run either. No one can run faster in the forest than a bear. And remember we don't have a gun to keep us safe." That night, we went to sleep ... or we tried to. The next day, while the others were resting, I went for a walk in the forest. Suddenly, I saw a baby bear playing with some sticks and stones. He looked so soft and friendly, and I thought, "If I reach out, I can just touch him." There was a loud noise behind me. I didn't dare to move, not even turn my head. There was another loud noise. The baby bear looked up, and ran towards me. I turned pale and he ran past me into the woods. I couldn't turn round until a few minutes later. Then I saw the baby bear and his huge mother walking away. I ran back to my friends. I have never run so fast. For the next 10 days, every time there was sudden noise, my blood went cold. [/INST] question: Who moved the food bag on the first night? | options: A: Joe B: Ben C: The writer D: A bear | answer: D </s>

<s>[INST] context: (Dermatomyositis) (760-CMDT-10, 2696-H 17th)* "Gottron sign" - scaly patches over of the dorsum of PIP and MCP joints are highly suggestive of dermatomyositisDERMATOMYOSITIS - the characteristic rash is dusky red and may appear in a malar distribution mimicking the classic rash of SLE* Facial erythema beyond the malar distribution is also characteristic of dermatomyositis (Shawl's sign)* Periorbital edema and a purplish (heliotrope) suffusion over the eyelids are typical signs, periungual erythema, dilations of nailbed capillaries* Bilateral proximal muscle weakness*** *** Increased risk of malignancy** - in descending order of frequency are ovarian, lung, pancreatic, stomach, colorectal and NHL)* Biopsy of clinically involved muscle is the only specific diagnostic test*** A pathologic hall mark of dermatomyositis is perifascicular atrophy. In polymyositis - endomysical infiltration of the inflammatory infiltrate**** Various auto antibodies against nuclear antigens (antinuclear antibodies) and cytoplasmic antigens are found in upto 20% of patients with inflammatory myopathies* Glucocorticoids: oral prednisone is the initial treatment of choice* Myositis may also be associated with other connective tissue diseases especially - Scleroderma, lupus, mixed connective tissue disease and Sjogren syndrome, overlap syndrome* Antisvnthetase syndrome - polymyositis and dermatomyositis develops- inflammatory arthritis, Raynaud phenomenon, interstitial lung disease, auto antibodies (eg anti Jo I antibodies)* Most common myositis-specific antibody -anti Jo-I antibody** (ILD)* Anti Mi-2 associated with dermatomyositis* Anti SRP (anti- signal recognition particle) associated with polymyositisPolymyositis can occur as a complication of HIV or HTLV-1 infection and with zidovudine therapy as well**** Anti-endomysial antibody - Celiac sprue*** Anti mitochondrial antibody - Primary biliary cirrhosis*** Anti-smooth muscle antibody - Auto immune hepatitis* Anti centromere antibody - CREST syndrome (limited scleroderma)* Histidyl-t-RNA antibody - Inflammatory myopathy * Anti DNA topoisomerase antibody (Scl-70)- Systemic sclerosis * Antibodies of ribonucleoprotein antigen containing ULRNP- Mixed connective tissue disease * SSb(La)* SSb(La)}Antibodies to ribo nucleoprotein antigen- Sjogren syndrome [/INST] question: "Gottron sign" seen in | options: A: Polymyositis B: Dermatomyositis C: Polymyositis + Sjogren's syndrome D: Polymyositis + SLE | answer: B </s>

<s>[INST] context: The world's oldest person, Ms. Baines, died. She celebrated her 115th birthday with congratulations from Barack Obama, President of the United States. Over her life she lived through the terms of 21 US presidents. Gertrude Baines passed away peacefully in her sleep at the Western Convalescent Hospital in Los Angeles, where she had lived for her last ten years. Emma Camanag , the hospital's leader ,said she was a respectable lady. "It is really an honor for the hospital to take care of her over the last 10 years and we will greatly miss her. It is just like we have lost a relative ," said Emma. Ms. Baines, who was born in Shellman, Georgia, in 1894, had no living relatives. She grew up in the southern US during difficult times. During that time, African American people were required to use separate, often poor, public services. She married young and later divorced . Her only child, a daughter, was born in 1909 and died of a terrible disease at the age of 18. Ms. Baines worked as a maid in Ohio before moving to Los Angeles where she lived on her own until she was well over 100. She once told an interviewer , "As for the secrets of long life, I do not have any disappointments in my own life." She gained some fame when she voted for Mr. Obama in the US presidential election , saying she supported him "because he's for the colored people". It was only the second time in her life she had voted, the first time being for John F. Kennedy. Ms. Baines became the world's oldest person in January. Japanese woman, Kama Chien, 114, has now taken over the title. [/INST] question: It was an honor for the hospital to take care of Ms. Baines because _ . | options: A: she was a respectable lady B: she was a relative of the hospital's leader C: she lived in the hospital for years D: she voted for Mr. Obama in the election | answer: A </s>

<s>[INST] context: A girl complained to her father about her hard life. She didn't know what she had to do and wanted to give up. She felt tired of fighting and fighting. One problem had been finished but another came over. Her father, a cook, took her into the kitchen. He poured water into three pans and boiled them. After boiling, in the first pan was put some carrots, the second was put some eggs and the last was put with coffee. The girl waited impatiently, confused by what her father did. About 20 minutes later, her father took out the carrots and put them in a bowl. He took the eggs and put them in a bowl. After that the coffee was poured into a cup. "My sweet heart, what do you see?" he asked. "Carrots, eggs and coffee." she replied. Her father told her to close her eyes and asked her to touch the carrots. She did so and felt that the carrots were soft. After that he asked her to take the eggs and break them. After peeling them, she got the eggs, cooked and hard. The last, the father let her smell the coffee. She asked, "What did you do this for, father?" He explained that each had the same unlucky experience -- the boiling water, but each had a different result. The strong and hard carrots had become soft and weak. The _ eggs became hard after being cooked. The coffee was very special, it could change water. "Who are you?" asked her father. "When bad luck knocks at your door, what is your decision? Are you carrots, eggs or coffee?" [/INST] question: The girl complained about her hard life because she didn't _ . | options: A: want to give up B: finish one problem C: know what to do D: get tired of fighting | answer: C </s>

<s>[INST] context: Ethiopia has greatly reduced its death rates for children under the age of five years during the last two decades, new UN statistics show. The report says Ethiopia has cut the number of child deaths, by two thirds or so, to 68 per 1,000 births compared to that in 1990. The government owed the improved figures to its growing economy. Despite the reduction, the UN Children's Fund said Ethiopia needed to do much more to improve health facilities for pregnant women. Ethiopia is one of Africa's poorest states, although it has experienced rapid economic growth in recent years and is one of the continent's leading coffee producers. Its economy centers around agriculture, which in turn relies on rainfall. The BBC's Emmanuel Igunza in the capital, Addis Ababa, says Ethiopia was once representative of poor nutrition in Africa. But the latest UNICEF figures show Ethiopia is one of the few African countries on the path to realizing the development goal of reducing child death rates, he says. Ethiopia's Health Minister Kesetebirhan Admasu said increasing family incomes had helped improve people's health. "This has also resulted in better nutrition for children and women; this has translated into better medical conditions ---- all these have a direct or indirect influence on the survival of children," he told BBC Africa. He said the government has also been "aggressively expanding its primary health care network". "We have now 93% coverage( ) of one health centre for 25,000 people, which basically means one health facility within a 7km area," he said. [/INST] question: How many in 1000 births would die in Ethiopia in 1990? | options: A: about 680 B: about 330 C: about 68 D: about 200 | answer: D </s>

<s>[INST] context: When people travel in another city or country ,they sometimes stay in the homes of the local people. This is called _ . It is a great experience because you can meet people from a different country or city and learn something new about that place . I am Wan Li from China. I came to the UK with my friends for a short visit . we are living with an English couple ,Mr. and Mrs.Green ,in the west of London. They have a wonderful four -bedroom house . This is a new house . It has two bathrooms and a garden with many beautiful flowers. I have a bedroom of my own . There are some shopping centres and restaurants near the house, and the house is close to an underground station. It takes about thirty minutes to get to the centre of London. I think a homestay may be a good choice for you if it is your first time to visit abroad . The local people are friendly and willing to help. If you happen to celebrate the holidays with them, you will get to know more about western culture and customs. [/INST] question: Wan Li and his friends live with _ in London. | options: A: Mr. and Mrs. Bush B: Mr. and Mrs. Green C: Mr. and Mrs D: Mr. and Mrs. Brown | answer: B </s>

<s>[INST] context: Adventure Vacations People like different kinds of vacations. Some go camping. They swim, fish, cook over a fire and sleep outside. Others like to stay at a hotel in an exciting city. They go shopping all day and go dancing all night. Or maybe they go sightseeing to places such as Disneyland, the Tai Mahan or the Louver. Some people are bored with sightseeing trips. They don't want to be "tourists". They want to have an adventure--a surprising and exciting trip. They want to learn something and maybe help people too. How can they do this? Some travel companies and environmental groups are planning special adventures. Sometimes these trips are difficult and full of hardships, but they're a lot of fun. One organization, Earth watch, sends small groups of volunteers to different parts of the world. Some volunteers spend two weeks and study the environment. Others work with animals. Others learn about people of the past. Would you like an adventure in the Far North? A team of volunteers is leaving from Mormons, Russia. The leader of this trip is a professor from Alaska. He's worried about chemicals from factories. He and the volunteers will study this pollution in the environment. If you like exercise and cold weather, this is a good trip for you. Volunteers need ski sixteen kilometers every day. Do you enjoy ocean animals? You can spend two to four weeks in Hawaii. There, you can teach language to dolphins. Dolphins can follow orders such as "Bring me the large ball." They also understand opposites. How much more can they understand? It will be exciting to learn about these intelligent animals. Another study trip goes to Washington State and follows orcas. We call orcas "killer Whale", but they're really dolphins--the largest kind of dolphin. This beautiful animal travels together in family groups. They move through the ocean with their mothers, grandmothers and great-grandmothers. Ocean pollution is chasing their lives. Earth watch is studying how this happens. Are you interested in history? Then Greece is the place for your adventure. Thirty-five hundred years ago a volcano exploded there, on Santorum. This explosion was more terrible than Karate or Mount Saint Helens. But today we know a lot about the way of life of the people from that time. There are houses, kitchens, and paintings as interesting as those in Pompeii. Today teams of volunteers are learning more about people from the past. Do you want a very different vacation? Do you want to travel far, work hard and learn a lot? Then an Earth watch vacation is for you. [/INST] question: The Tai Mahan may be _ . | options: A: a shopping center B: a hotel C: a dancing hall D: a place of interest | answer: D </s>

<s>[INST] context: Betty and I are best friends. Our birthdays are on the same day, so every year we have a birthday party together. But this year we had a costume party instead. While we were writing the invitations, my mom came in and asked, "Nancy, what about inviting John?" John had been in our class for only a few months, but he was already getting better grades in math than anyone else in our class. "Mom, he wears the same pants to school every day. How could he even afford a costume?" Mom said nothing. The next day, mom gave me an envelope with a shopping card in it. "I thought it would be nice for you to give this to John." Mom said. But how? We didn't want to make John embarrassed. We discussed it for a long time. Finally, Betty and I had a good idea. On the day of our party, John arrived, in an old sheet ,but still in the same brown pants as usual. Before eating the birthday cake, Betty said in a loud voice, "Now it's time for the great prize game." It was a math game. None of us were surprised when John gave the right answer first and walked off with the envelope. Everything went well as we planned. John wore a new pair of pants and a new shirt the next week. He felt happy. So did we. [/INST] question: Nancy and Betty are _ . | options: A: best friends B: cousins C: sisters D: brother and sister | answer: A </s>

<s>[INST] context: My wife Julie and I were out on the road that runs around where we live, when we saw an old worn-out dog stumbling painfully up the road. We stopped, bent down, talked gently to the dog and patted it. I checked and there was a collar with a phone number. I called but no one answered. The dog was painfully thin. So Julie ran home to get some of our dog's food while I tried to encourage the dog. After Julie came back, we sat down on the sidewalk while our new friend made short work of the food. Eventually we got her home. After trying for many times we got a response from the number. A lady came around with a bunch of flowers for us. She explained that Tara had been her father's dog. She was very old and got lost that morning. So, Tara was safely returned home. Here is the truth of the story: Actually Julie and I were out that morning because I was leaving. She was trying to persuade me to come back, but I wasn't hearing anything that made that sound likely. I was about to turn and go when an old black dog walked between us and almost fell down. Suddenly we had something more important than _ to worry about. There was a creature in need right before us and we had to work together to help it. We did help it. And here I am writing the story in my own home, in my own family. In the song "Love Is Not a Fight" Warren Barfield talks about marriage. At one point he sings, "And if we try to leave, may God send angels to guard the door." Sometimes angels come disguised as dogs. [/INST] question: How was the dog when found? | options: A: Too weak to walk B: Thin and worn out C: Unable to eat food D: Homeless but gentle | answer: B </s>

<s>[INST] context: Jack was a pumpkin farmer. He lived in a big house on the edge of a town and grew the largest Pumpkin farm around the town. Jack's pumpkins were famous , for they always had the perfect shape and never rotted ( ) until well after Halloween . Every year around Halloween , people came from all over the town to buy his pumpkins to make their jack-o-lanterns ( ) One year, Jack was thinking about his pumpkin harvest ( ) of the year when his good friend Pete came to visit him. I have some bad news , Jack ," Pete said. "What is it ? " Jack asked . a little worried. The town decided not to have Halloween this year! They said there was simply no reason for it and they didn't have time to celebrate it because many other holidays were coming up soon . Peter told him. He knew this was very bad news for jack. Jack became very sad and lowered ( ) his head . "What can I do now , Peter?" I have all these beautiful pumpkins and I can't keep them until next Halloween ." Peter replied, " Well , there are always pumpkin pies and pumpkin bread for other holidays." Jack was worried and said, "I sell most of my pumpkins for the Halloween . I can only sell a few pumpkins during the rest of the year. And Pete, it's not so much about the money . I live a simple life out here in the country and I don't need much money . But I feel happy every year when thousands of people get my pumpkins and take them and make them into beautiful jack-o-lanterns. Now all these pumpkins will be useless because people won't make jack-o-lanterns this year. oh, this is very bad news ." Jack began to weep . large tears ran down his face. [/INST] question: Jack's pumpkins were famous because they have the perfect _ . | options: A: colour B: size C: shape D: taste | answer: C </s>

<s>[INST] context: At Institute for the Future, game designer Jane McGonigal creates massive multi-player free online role-playing games (MMORPGs), which focus on social changes and environmental problems. She hopes that players will use their new skills to make the real world better. According to Jane, our addiction to gaming is actually a great thing, so long as we use it properly.Speaking at the TED (Technology/Entertainment/Design)2010 Conference, Jane says that people should devote more time to games to build the skills necessary to make the world better.People who take part in MMORPGs develop specialized skills in problem-solving as a team.So, if gamers are willing to take part in role-playing games based on real-world problems,they will be able to work together to find ways that can be used in the real world. Jane focuses on creating the kinds of video games that enable players to make a difference in their own lives and the lives of those around them.In 2007, she helped create a video game called A World Without Oil, in which 1, 800 players tried to find new ways to transport themselves in a world without oil.Even after completing the game, the players focused on the problem and its possible solutions.Her next game, Evoke, takes an even more practical way.Game players are mainly young people in Africa.They will learn to create a business that will help stop problems such as poverty and AIDS on a local level.By the end of the game, players will be guided by experts on how to start their own businesses. "We can make any future we imagine and we can play any games we want," she said at the TED Conference."So let the world-changing games begin." [/INST] question: The MMORPGs are created by Jane McGonigal to _ . | options: A: give gamers more chances to play online games B: develop gamers' problem-solving skills C: help gamers get used to social changes D: make gamers take proper attitudes towards games | answer: B </s>

<s>[INST] context: Have you ever wanted to achieve something really amazing in life? Well, Greg Mortenson wanted to climb a mountain, but he ended up helping thousands of people to have a better life. Greg's story began with failure. In 1993, he set out to climb K2, the world's second highest mountain. But Greg never made it to the top. After five days, he stumbled into the village of Korphe in northern Pakistan, injured and hungry. The kind villagers there looked after him for several days. Greg saw that the villagers were very poor and hungry, and some of them were ill. Also, the village school didn't have a roof and the children wrote on the ground with sticks, Greg knew he wanted to do something to help. "I'll build you a school," he told the villagers. "I promise." Greg went back home to the USA to raise money for the school. He even lived in the car to save money! Finally he went back to Korphe and built the school. But _ was just the beginning of something bigger! Since then, Greg's organization has built around 80 schools and runs many others in Pakistan and other countries, too. Greg hasn't finished yet. He does many other things to help people in poor countries. He has got many prizes, but it's the smiles of the children he has helped that makes him happy! Greg has just written a best-selling book about his story called Three Cups of Tea. It's an interesting and exciting book which tells us what ordinary people can do with courage and determination . [/INST] question: What was wrong with Greg when he got to the village for the first time? | options: A: He fell ill B: He was badly hurt and hungry C: He lost his way D: He failed in his business | answer: B </s>

<s>[INST] context: Do you know who is the most popular star on the Internet now? Yes, he is "Brother Coat" Zhu Zhiwen! A few months ago, Zhu Zhiwen was an unknown farmer. A video of his show has been watched by more than millions of people,now his videos are the most popular. Zhu Zhiwen attracts Chinese netizens' hearts. And he is called "Brother Coat" by them. In March 2011, he took part in a program called "I'm a Big Star". He walked out onto the stage in a dark green coat. Then he began to sing the song of the TV drama Romance of Three Kingdoms. When the audiences heard rich and powerful voice,all of them stood up and cheered. After that, he became a well-known person. The judges asked him if he had any professional training. Zhu said no. "When he started, I thought someone played the original tape by mistake. But later on, I got it, " said one of them, "we can't _ ." At last, he won the first prize in the program of "I'm a Big Star". Zhu Zhiwen was born in a village of Shandong in 1969. He liked listening to the radio. When the music played, he sang it along. Every morning, he would get up early and practiced singing near a river. He keeps doing it for nearly 30 years. "When I'm working in the fields, "said Zhu Zhiwen, "I often sing for myself, some villagers even think me crazy,but I really love it. I'm not singing for money, I'm singing for ordinary people in China." Mrs. Sun, a 56-year-old engineer, one of his fans said, "I watched his videos without getting tired of it! It is so amazing, and every time I watch it, I am filled with excitement and his voice is perfect! I am crossing my fingers in hope that he has a bright future." [/INST] question: Who gave Zhu Zhiwen the nickname of "Brother Coat" ? | options: A: His father B: The villagers C: His mother D: The netizens | answer: D </s>

<s>[INST] context: New Zealand is in the Pacific Ocean and it' s made up of two islands: the North Island and the South Island. About a thousand years ago, the Maori people came from the islands of the Pacific Ocean to New Zealand and made _ their home. Since then, people have come from all over the world to live in New Zealand. New Zealand has three official languages: English, Maori and New Zealand Sign Language. Many places in New Zealand have Maori names. "Kia ora" is a Maori language greeting . In 1865, Wellington took Auckland's place and became the capital ( ) of New Zealand, but the largest city is Auckland. Both cities are on the North Island. New Zealand has high mountains, active volcanoes , lakes, rainforests and beautiful sandy beaches, which made it a location for the movie The Lord of the Rings. New Zealand has mild ( ) temperatures and lots of sunshine. January and February are the warmest months of the year, while July is the _ . New Zealand has many special birds. The best known is the kiwi. The kiwi, about the size of a large chicken, can' t fly. It is the symbol of the country and you can find pictures of kiwis on New Zealand stamps and coins. The kiwi is named after its calls-- kewe,kewe. New Zealanders are also called Kiwis, but very. few New Zealanders have ever seen a kiwi bird in the wild! New Zealand is also famous for its sheep. There are millions of sheep living in farms all over New Zealand. ,. [/INST] question: "Kia ora" probably means" _ "in English. | options: A: Hi B: Goodbye C: Sorry D: Thanks | answer: A </s>

<s>[INST] context: Patients with cystic fibrosis are now surviving into adulthood. The median survival exceeds age 40. Most cases are diagnosed in childhood; however, because of variable penetration of the genetic defect, approximately 7% are not found until the patient is an adult. Most male patients (>95%) are azoospermic. Chronic pulmonary infections occur, and bronchiectasis frequently develops. Diabetes mellitus and gastrointestinal problems indicate pancreatic insufficiency. This patient should have sweat chloride measurement; if abnormal (sweat Cl above 70 mEq/L), cystic fibrosis transmembrane conductance regulator (CFTR) mutation analysis should be ordered. COPD or emphysema at this age would be unusual unless the patient were deficient in alpha- 1 antitrypsin. Immunoglobulin deficiencies can cause recurrent sinopulmonary infections but would not cause malabsorption or infertility. Whipple disease causes malabsorption but not the pulmonary manifestations or infertility; it would be vanishingly rare in a young patient. Asthma would not cause the abdominal symptoms, diabetes, or changes of bronchiectasis. [/INST] question: A 25-year-old man presents to the clinic for evaluation of infertility. He has a lifelong history of a productive cough and recurrent pulmonary infections. On his review of symptoms he has indicated chronic problems with abdominal pain, diarrhea, and difficulty gaining weight. He also has diabetes mellitus. His chest x-ray suggests bronchiectasis. Which is the most likely diagnosis? | options: A: Chronic obstructive pulmonary disease (COPD) B: Immunoglobulin deficiency C: Cystic fibrosis D: Whipple disease | answer: C </s>

<s>[INST] context: Phrenic nerve lies in the superior mediastinum and not in the posterior mediastinum. All other choices lies within the posterior mediastinum.Posterior mediastinum: The region containing anatomic structures deep to the pericardial sac, including the thoracic poion of the descending aoa, the azygos system of veins, the thoracic duct, the esophagus, and the vagus and sympathetic nerves. Also Know:Superior mediastinum: The region superior to the sternal angle containing the aoic arch and its three branches, the superior vena cava (SVC) and the brachiocephalic veins, the trachea, the esophagus, and the phrenic and vagus nerves. The superior mediastinum also contains the thymus; however, in an adult, the thymus is usually atrophied and presents as a fatty mass.Anterior mediastinum: The region between the sternal angle, the deep sternal surface, the pericardial sac, and the diaphragm. The anterior mediastinum contains fat and areolar tissue and the inferior pa of the thymus or its remnant.Middle mediastinum: This region contains the pericardial sac and hea. [/INST] question: Which one of the following DOES NOT lie within the posterior mediastinum? | options: A: Phrenic nerve B: Vagus nerve C: Esophagus D: Thoracic aoa | answer: A </s>

<s>[INST] context: HONG KONG,Sept .12,2005-Hong Kong Disneyland,the 11th theme park of Walt Disney Co.,opened here on Monday morning.Chinese Vice President Zeng Qinghong,Donald T&-mg Yam-kuen,chief executive of Hong Kong-Special Administrative Region(HKSAR),and Tung Chee-hwa,attended the opening. The Hong Kong Disneyland project, worth 3.5 billion US dollars,was jointly funded by Walt Disney Co.and the HKSAR government.Some 16, 000 people attended the opening.The park estimates that it will attract 5.6 million visitors in its opening year and is expected to draw up to 7.4 million annually after 15 years.About 40 percent of the visitors are expected to come from the mainland,Disney has said. Walt Disney officials claimed that choosing Hong Kong as the first place of China to build Disneyland bas three major reasons:Hong Kong people are wonderful,Hong Kong is a beautiful city and Hong Kong is the richest city in China* "Hong Kong Disneyland is the first Disney theme park that,. modeled so c1osrly to the first Disneyland in California,"Jay Rasulo,president of Walt Disney Parks and Resorts,said.Hong Kong Disneyland is smaller than the other parks at only 121 hectaresa fact that Disney tries not to point out.Some of the thousands of guests who got a sneak peak at the park in the past month complained that it was too small,and Disney has plans to expand it. the project was announced in 1999 and construction began in 2003.Disney, other part are Tokyo,Paris and. the U.S. states of prefix = st1 /Californiaand Florida. The company confirmed that Disney had been talking to the government in Shanghai about opening a park that wouldn't open until at least 2010. [/INST] question: How long does it take to build the Hong Kong Disneyland? | options: A: Three years B: Six years C: Four years D: Two years | answer: D </s>

<s>[INST] context: Across the globe, single parent homes are on the rise. In the US, the 2000 census showed 24.8 million, or nearly 24 percent of the nation's 105.5 million households, were traditional two-parent homes. By comparison, 9.8 million households, or 9 percent of all US households were headed by an adult raising a child alone. The 1990 census showed 26 percent of homes were led by a married mother and father, and 8 percent of homes were led by a single parent. Similar increases occurred in other countries. In the UK, lone-parent homes increased from 3.3 percent in 1990 to 5.5 percent in 1999. Single parent households in Australia rose from 5.8 percent in 1990 to 7.6 percent in 1999. Belgium saw the increase from 1.8 percent to 2.7 percent during the same period of time. These countries tend to have greater acceptance of the single parent because there are fewer nearby family members to disapprove, Riche, a Census Bureau director, said. Just as in the US, those changes raised new questions about how involved govenment should be in helping single parent families. Some research suggests children raised in two-parent families are better off than those who depend on one. "The position of one-parent families in any country is very much a gender issue-women's opportunities, especially working-class women on low income," said Sue Cohen, coordinator of the Single Action Parents Network in England. [/INST] question: Not considering the exact number of the single-parent families, which country saw the fastest rise rate in 1999, compared with 1990? | options: A: UK B: Australia C: America D: Belgium | answer: A </s>

<s>[INST] context: James Proud, a British businessman who settled in San Francisco launched a Twitter campaign called "Stop DST". Daylight Saving Time (DST) refers to the time during the summer when clocks are one hour ahead of standard time. "Daylight saving was created to save energy, and it doesn't really do that." Proud said, "but what's even worse are its negative health effects. It's both outdated and harmful." daylight saving has been linked to a surprising number of health issues such as heart attacks, but Proud has a particular interest in the topic because of its disruptive effects on sleep. Last year, German researchers suggested that our body cocks never really adjust t daylight saving, which causes a host of health problems. Till Roenneberg of Ludwig-Maximillians University said that because of DST, "the majority of the population has severely decreased productivity, decreased quality of life, increasing chance of getting illness, and is just plain tired." The week after daylight saving also witnesses a sudden increase in fatal traffic accidents, according to the University of Colorado. It is believed that this is caused both by disrupted sleep schedules and the shift of daylight hours from the morning to the evening. "Daylight saving is an economic tradition. And all economic choices involve achieving a balance. " said behavioral economist David Gerard. "Even if we decide to abolish daylight saving, there would be a large number of unhappy people." Some such people are shift works, students and parents of schoolchildren, all of whom get to enjoy an extra hour of daylight after work or class with DST. Plus, restaurants love the extra evening sales DST allows. Daylight saving has also been linked to lower crime rates, due to the "deterrent effect" of longer daylight. Basically, more light increase a criminal's chances of being seen by witnesses or police, which discourages criminal activity. Gerard also point out that an extra hour of daylight has vastly more influence in the American South, where the sun sets earlier, even in the summer, than in the north. That's why residents of southern states may values DST more. [/INST] question: What causes Proud's greatest concern? | options: A: DST not keeping up with economic development B: DST resulting in disorder in people's sleep schedule C: DST stopping people from working productively D: DST not helping to save energy any more | answer: B </s>

<s>[INST] context: People who traveled in the past had to put up with many discomforts which we do not have nowadays, and of course they traveled far more slowly. Roads were bad indeed and you often found you could not get along at all because of the mud. In dry weather many places were thick in dust and when it was stormy, trees might fall across the road and it was nobody's business to clear _ away. Ordinary people traveled on foot or on horseback, but everyone who could afford it kept a private coach. There were public coaches too. called "stage coaches" because long journeys took several days and were done in stages, with stops over night at inns. Some stage, coaches ran only in the summer months. Others all the year around. They were very slow and crowded and passengers often became in on the way because of the swaying . Break downs were frequent, since many roads were not smooth. So a coach might very easily turn right over. Early in the century coach and wagon builders were encouraged to put very wide wheels on their vehicles. So that these might level the roads a little. But many people complained of this since it slowed travel down a good deal. Most travelers during the 18th century wrote bitterly about the state of the roads. One visitor to Sussex took six hours to travel nine miles in his coach; another wrote to a friend that on time of his journeys "almost every mile was marked by the overturn of a carriage". [/INST] question: Which of the following mainly prevented people from travelling fast in the past? | options: A: Falling trees B: Thick dust C: Muddy road D: Many discomforts | answer: C </s>

<s>[INST] context: Yao Ming edged Kobe Bryant as the top votegetter in fanballoting1for the 55th NBA All-Star game Thursday, and Shaquille O'Neal became the fifth player in league history to earn 13consecutive2selections for the midseason showcase. Yao and Tracy McGrady give the host Houston Rockets two starters in the Feb.19 game. They were joined on the Western Conference squad by Bryant, San Antonio's Tim Duncan and reigning MVP Steve Nash of Phoenix -- who will be a first-time All-Star starter. Yao edged Bryant by 71,107 votes for the top overall spot in the balloting, despite missing 21 games following surgery to clean out aninfection3in his left big toe. It's the fourth All-Star trip for the 7-foot-6 center from China and the eighth for Bryant, who leads the NBA in scoring and had an 81-point effort -- the second-biggest night in NBA history -- last month in the Los Angeles Lakers' win over Toronto. Yao finished with 2,342,738 votes; Bryant had 2,271,631 in the closest finish among the top two players in All-Star balloting since Vince Carter, then of Toronto, edged Miami's Alonzo Mourning by 33,385 votes in 2000. Notes: 1 ballot vi. 2 consecutive adj. 3 infection n. , [/INST] question: Yao Ming's got _ Kobe Bryant in fan balloting for the 55th NBA All-Star game Thursday. | options: A: the same votes as B: more votes than C: less votes than D: no more than | answer: B </s>

<s>[INST] context: When Julio Diaz stepped off the subway after work one night, he was simply planning to go to his favorite local diner for a meal. But when a teenage boy approached him with a knife, Diaz knew the evening was about to take a more dramatic turn. The young man demanded Diaz's wallet, and Diaz passed it over without objection . But just as he turned to walk away, Diaz called, "Hey, wait a minute. You forgot something." The young man turned around, surprised. "If you're going to rob people for the rest of the night, you might as well take my coat to keep warm." The teenager looked at Diaz in disbelief, and asked why he would do such a thing. Diaz replied, "If you're willing to risk your freedom for a few dollars, I guess you must really need the money."He said he was heading out for dinner, and that he would be happy to take someone with him. The young man decided to _ his offer. As they were sitting at the table, the manager, dishwashers and waiters all stopped over to say hello to Diaz, and the young man was amazed at his popularity. "Haven't you been taught that you should be nice to everybody?"Diaz asked him. "Yeah, but I didn't think people actually behaved that way," the teenager replied. Thanks to Diaz, he was beginning to see that kindness wasn't so strange, after all. When the bill came, Diaz told the teen that he'd have to get the check. After all, he still had Diaz's wallet. But the teenager put the wallet on the table without a moment's thought, and Diaz treated him to dinner. Diaz also gave the would-be robber a $20 bill -- in exchange for his knife. "I figure, you know, if you treat people right, you can only hope that they treat you right," Diaz said. [/INST] question: When a teenage boy approached him with a knife, Diaz was on his way _ . | options: A: to the subway station B: to his workplace C: to have a meal D: to see a drama | answer: C </s>

<s>[INST] context: Tracheal stenosis Management of tracheal stenosis The optimal treatment of tracheal stenosis remains undefined Traditionally tracheal stenosis has been managed by thoracic and otorhinolaryngology surgeons. Endoscopic procedures are usually performed as bridge to definitive surgical intervention. With the development of interventrical pulmonology field in the last 20 years definitive management of tracheal stenosis using minimally invasive endoscopic methods becomes a possibility. Endoscopic surgery has been shown to be useful especially in patients who are deemed high risk and too unwell for reconstructive surgery. One of the main drawbacks of endoscopic tit and surgery is the risk of recurrence of tracheal stenosis due to granulation and fibrotic tissue. Scar formation and restenosis is the main cause. Studies have shown that most of the recurrence of tracheal stenosis occurs within one to three months after the procedure and use of mitomycin C has been repoed in case studies to reduce the rate of recurrence. - Both in vitro and invivo mitomycin C has been proved to be a potent inhibitor of human fibroblasts at concentrations of .04 mg/L Topical mitomycin C is a useful adjunct in the management of sho concentric membranous stenosis which does not involve the cailage. [/INST] question: Topical mitomycin C is used in the treatment of aEUR' | options: A: >Basal skull ca B: >Tracheal stenosis C: >Skull base osteomyelitis D: >Angiofibroma | answer: C </s>

<s>[INST] context: Disneyland in Shanghai Built from 2011, Shanghai Disney Resort is the sixth Disneyland park in the world, and the first one on the Chinese mainland. Like other Disneyland parks, the one in Shanghai will have classic Disney characters and stories. But it will also have new attractions designed for Chinese people. It is open to the public now in 2016. Enchanted Storybook Castle Located at the heart of the theme park, the Enchanted Storybook Castle will be the tallest and largest Disney castle yet. Inside the castle, there are spaces for entertainment, dining and performance. There you can meet all the Disney princesses. Treasure Cove This is the first pirates-themed land in a Disney park. The land will have a major attraction, which is a high-technology boat ride attraction. The attraction will bring visitors along a pirate adventure. Are you ready to jump on the boat? Garden of the Twelve Friends In almost every other Disneyland park around the world, there is a "Main Street, USA" at the entrance. But Shanghai Disneyland park is the first without that attraction. Instead, it has the Garden of the Twelve Friends. Each friend stands for the 12 animal signs using popular Disney characters. Toy Story Hotel Living experience is also fun inside the park. Toy Story Hotel features the characters of the film Toy Story. There are about 800 rooms for visitors to stay. In the restaurant of the hotel, you may even see characters walking around and take photos with them. [/INST] question: How many Disneyland parks can people visit in the world now? | options: A: 4 B: 5 C: 6 D: 7 | answer: C </s>

<s>[INST] context: Shangri-La Hotel Singapore 22 Orange Grove Road, Singapore, 258350 Singapore General * Air-condition public areas; * Ballroom(s); * Ballroom(s); * Bar; * Elevator/lift; * Gift shops or newsstand(,); * Restaurant(s) in hotel; * Number of rooms:110; * Swimming pool--outdoor; * Tennis on site; * Wired(high-speed) Internet access--free Check-in time is 2PM Check-out time is Noon Pets not allowed 2 Swissotel Merchant Court---Singapore 20 Merchant Road, Singapore, 058281 Singapore General * Air-conditioned public areas; * Ballroom(s); * Bar; * Coffee shop or cafe; * Elevator/lift; * Number of floors:5; * Number of rooms: 120; * Restaurant(s)in hotel; * Swimming pool-outdoor; * Television in entrance hall Check-in time is 3PM Check-out time is Noon Pets not allowed 3 Royal Plaza On Scotts-Singapore 25 Scotts Road, Singapore, 228220 Singapore General * Air-conditioned public areas; *Ballroom(s); * Bar/lounge; * Elevator/lift; * Gift shops or newsstand; * Number of floors: 6; * Number of rooms: 160; * Restaurant(s) in hotel; * Smoke-free property ; * Swimming pool--outdoor; Check-in time is 2PM Check-out time is Noon Pets not allowed 4 Rendezvous Singapore--Singapore 9 Bras Basah Road, Marina Bay, 189559 Singapore General * Air-conditioned public areas; * Ballroom(s); * Bar/lounge; * Coffee shop or cafe; * Elevator/lift; * Number of floors: 6; * Number of rooms: 150; * Restaurant(s) in hotel; * Swimming pool--children's; * Swimming pool--outdoor; Check-in time is 2PM Check-out time is Noon Pets not allowed 5 Landmark Village Hotel - Singapore 390 Victoria Street, Singapore, 188061 Singapore General Air-conditioned public areas; * Ballroom(s); * Bar; * Coffee shop or cafe; * Elevator/lift; * Number of floors: 6; * Number of rooms: 156; * Restaurant(s) in hotel; * Swimming pool--outdoor; Check-in time is 2PM Check-out time is Noon Pets not allowed [/INST] question: If you have a child who loves swimming, you should stay in _ . | options: A: Landmark Village Hotel B: Royal Plaza On Scotts C: Rendezvous Singapore D: Swissotel Merchant Court | answer: C </s>

<s>[INST] context: Much has been said and written recently about heroes, mainly because many people think we have too few of them. There are many different kinds of heroes, but they all seem to have two things in common. First, heroes, by their actions, show the great possibilities of human nature. Second, heroes can also stand the test of time, and their achievements will not be easily forgotten. Because of these good points, we need to choose our heroes carefully. Olympic sports star Jackie Joyner-Kersee, who is believed to be a hero, warns young people to be careful of making athletes heroes. She hopes that if someone tries to copy her, it will be because she has achieved her goals by working hard. Joyner-Kersee says that a hero should be someone who has an influence on another person's life. Poet Maya Angelou believes that a hero encourages people to treat others well and to be concerned about the greater good. A hero should show politeness, courage, patience, and strength all the time. A hero should encourage others to follow him with actions that improve the world, even if only in small ways. Author Daniel Boorstin suggests that, " _ are people who make news, but heroes are people who make history." Thus, if a person is truly worthy to be called a hero, he or she will not be soon forgotten. We all need heroes. We need to be able to respect people who have been there, done that, and succeeded. Many times the greatest heroes are the people we deal with every day -- relatives , friends, and neighbors -- who will keep going when it is easier to give up. The parent who puts her or his family ahead of herself or himself, the teacher who will make more money at another job but chooses to help others -- all these people can be considered as heroes. A hero quietly and continuously sets a good example, an example that inspires others to follow. [/INST] question: Joyner-Kersee hopes that young people _ . | options: A: will work hard B: will become heroes C: will follow her D: will achieve her goal | answer: A </s>

<s>[INST] context: In Hirchprung's disease the absence of ganglion cells gives rise to a contracted non peristaltic segment with a dilated hypertrophied segment of normal colon above it. Almost all cases present in infancy and childhood. Approximately half are diagnosed in the neonatal period and most of the remainder are diagnosed in early childhood. Schwartz and (9/e p1056) Bailey (24/e, p 1154) write that Hirschprung's ds. can present in adults too. Schwartz writes- "Although Hirschsprung's disease is primarily a disease of infants and children, it occasionally presents later in adulthood, especially if an extremely short segment of the bowel is affected (ultrashort-segment Hirschsprung's disease)." In the newborn period, most common symptoms are abdominal distention and failure to pass meconium. Older patients may experience chronic or intermittent constipation. Occasionally, infants may present with a dramatic complication of Hirschprung's disease called enterocolitis. Surgery is always required. The basic principle is removal of most or all of the aganglionic segment and anastomosing the ganglionic bowel to the rectum Operations done are - Swenson - Duhamel - Soave [/INST] question: Hirchprung's disease -a) Is seen in infants and children onlyb) Absence of ganglia in involved segementc) The involved segment is the dilated colond) Bleeding PR is a presenting featuree) Surgery is used in therapy | options: A: be B: ad C: bc D: ce | answer: A </s>

<s>[INST] context: In the Ituri forest of America live many tribes,one of which is Pygmy. Most of the Pygmies in the tribe are not taller than four feet. They weigh only about eighty pounds each. In spite of their small size, they are the best hunters among all the jungle people. Even the great elephant can be caught by them. Since they do not plant any crops, Pygmies are constantly moving around. They seldom sleep in one camp for more than a few days. In their camps there is not furniture at all except for some weapons such as spears, bows and arrows. There are no cooking pots either. Food is eaten uncooked or smoked over a lire. So when the tribe moves to a new camp there is nothing to carry except these weapons and babies too small to walk. Pymies can move on the tree tops almost as skillfully as monkeys. Often they travel great distances through the branches without touching the ground. One of the surprising facts about these small men and women is their great appetite . A Pygmy can eat up sixty bananas at a single meal besides quantities of meat. After eating, they will lie on their hard earth bed and groan in all night. But in the morning, they are ready to eat the same amount of food or fight among themselves. [/INST] question: Pygmies are small in size, but they are brave in _ . | options: A: hunting B: shooting C: eating D: fighting with their enemies | answer: A </s>

<s>[INST] context: Interview With God I dreamed I had an interview with God."So you would like to interview me?"God asked."If you have the time,"I said."My time is eternity."God smiled,"what questions do you have in mind for me?""What surprises you most about humankind?"God answered,"That they get bored with childhood,they rush to grow up,and then long to be children again.That they lose their health to make money... and then lose their money to restore their health.That by thinking anxiously about the future,they forget the present,such that they live in neither the present nor the future.That they live as if they will never die,and die as though they had never lived."God's hand took mine and we were silent for a while.And then I asked,"As a parent,what are some of life's lessons you want your children to learn?To learn they cannot make anyone love them.All they can do is to let themselves be loved.To learn that it is not good to compare themselves to others.To learn to forgive by practicing forgiveness.To learn that it only takes a few seconds to open profound wounds in those they love,and it can take many years to heal them.To learn that a rich person is not one who has the most,but is one who needs the least.To learn that there are people who love them dearly,but simply have not yet learned how to express or show their feelings.To learn that two people can look at the same thing and see it differently.To learn that it is not enough that they forgive one another,but they must also forgive themselves.""Thank you for your time,"I said humbly."Is there anything else you would like your children to know?"God smiled and said;"Just know that I am here always." [/INST] question: .In answering how many questions did God give "me" his opinion? | options: A: One B: Two C: Three D: Four | answer: C </s>

<s>[INST] context: In England three foreign gentlemen came to a bus stop. They studied the information on the post sign and decided which bus to take. About five minutes later the bus they wanted came along. They prepared to get on. Suddenly people rushed onto the bus and tried to push them out of the way. Someone shouted _ remarks about the foreigners. The bus conductor came rushing down the stairs to see what all the trouble was about. The three foreign gentlemen looked puzzled and ashamed. No one had told them about the British custom of lining up for a bus so that the first person who arrived at a bus-stop is the first person to get on the bus. Learning the language of a country isn't enough. If you want to ensure a pleasant visit, find out as much as possible about the manners and customs of your hosts. You will probably be surprised just how different they can be from your own. A visitor to India would do well to remember that people there consider it impolite to use the left hand for passing food at table. The left hand is supposed to be used for washing yourself. Also in India, You might see a man apparently shaking his head at another and assume that he is disagreeing. But in many parts of India a rotating movement of the head is a gesture that express agreement or acceptance. _ In that country you shake your head to express "yes" -- a nod means "no". In Europe it is quite usual to cross your legs when sitting, talking to someone, even at an important meeting. Doing this when meeting an important person in Thailand, however, could cause offence . It is considered too informal an attitude for such an occasion. Also when in Thailand avoid touching the head of an adult -- it's just not done. Attitudes to women vary considerably around the world. In Japan, for example, it is quite usual for men to plan evening entertainments for themselves and leave their wives at home. Knowing about customs and attitudes is useful when you are travelling, but you also need to know the language used to express different degrees of formality . [/INST] question: The three foreign gentlemen looked puzzled and ashamed because _ . | options: A: they didn't know the English language B: the bus conductor told them to jump the queue C: they didn't know the custom of lining up for a bus D: they thought they were looked down upon | answer: C </s>

<s>[INST] context: Primary Hyperlipoproteinemias Causing Hypertriglyceridemia Familial Chylomicronemia Syndrome (Type I Hyperlipoproteinemia) Biochemical abnormalities: Lipoprotein Lipase (LPL) or Apo CII defect. Lipoprotein Lipase is required for hydrolysis of TGs in Chylomicrons and VLDL. Apo CII is the cofactor for Lipoprotein Lipase. Lipoprotein accumulated is Chylomicron and VLDL, but chylomicron predominates. Fasting Triglycerides is > 1000 mg/dL. Fasting cholesterol is elevated to a lesser degree. Clinical Presentation: Present in childhood with recurrent abdominal pain due to acute pancreatitis. On fundoscopic examination, opalescent retinal blood vessels (lipemia retinalis). Lactescent plasma. Eruptive xanthoma (small yellowish-white papules appear in clusters on backs, buttocks, extensor surfaces of arms and legs. These are painless skin lesions may become pruritic). Hepatosplenomegaly. Premature CHD is not a feature of FCS. Diagnosis: Assaying triglyceride lipolytic activity in post heparin plasma (IV heparin injection to release the endothelial-bound LPL). Key Concept: Xanthomas (present in clusters on back, buttocks and arms, legs) and hepatomegaly and splenomegaly (on percussion) with the chief complaint of pain in abdomen in children is the clinical presentation of Type I Hyperlipoproteinemia. [/INST] question: A 15 year old male patient presents with the chief complaint of pain in abdomen. General examination reveals xanthomas present in clusters on back, buttocks and arms, legs. On percussion, hepatomegaly and splenomegaly can be appreciated. What is the most probable diagnosis for this child? | options: A: Type I Hyperlipoproteinemia B: Autosomal Dominant Hypercholesterolemia Type I (ADH Type I) C: Autosomal Recessive Hypercholesterolemia (ARH) D: Abetalipoproteinemia | answer: A </s>

<s>[INST] context: A. (Optic tract) (290 - Khurana 4th)* Incongrous homonymous hemianopia - caused by lesion in the optic tract* Congruous homonymous hemianopia - caused by lesion in the visual cortexLESIONS OF THE VISUAL PATHWAYSite of lesionManifestations ;; Optic nerve- Complete blindness on affected side associated with abolition of the direct light reflex on the I/L and consensual on the C/L side, Near (accommodation) reflex is present Central lesion of the chiasma .- * Bitemporal hemianopia and bitemporal hemianopic paralysis of pupillary reflexes Lateral chiasmal lesions- Binasal hemianopia associated with binasal hemianopic paralysis of the pupillary reflexes Optic tract- * Incongruous homonymous hemianopia associated with C/L hemianopic pupillary reaction (Wernicke's reaction) Lateral geniculate body- Homonymous hemianopia with sparing of pupillary reflexes Optic radiation- Complete homonymous hemianopia Inferior quadrantic hemianopia (pie on the floor)- Superior quadrantic hemianopia (pie in the sky)[G1 Visual cortex- Congruous homonymous hemianopia [/INST] question: Incongruous homonymous hemianopia is caused by lesion in the | options: A: Optic tract B: Optic chiasma C: Optic nerve D: Optic radiation | answer: A </s>

<s>[INST] context: I worked for a short time as a cashier at a restaurant a few months ago. I also helped to clean up the tables when it was very busy. One night, just before Christmas, I found a large black wallet on the floor near one of the tables. I guessed I should check it to find out who was the owner, but I was very busy at the time. And I imagined that if there was something valuable in the wallet, the owner would be back. Sure enough, an hour later a man came up to the counter and asked if anyone had found a wallet. I asked him to describe the lost wallet, and after he described it exactly, I gave him the wallet. He expressed his thanks when I handed it to him. He asked me if I had opened it, and when I told him "no". At once he opened it and showed that it had nearly $ 800 in cash . He took out a twenty-dollar bill and handed it to me and I was amazed at this. "A reward for your honesty," he said and then turned and walked away. Thinking about it later, I began wondering whether I would have been honest if I had known what was in the wallet! I thought that if I had no way to find the owner and no one returned to get it, I might keep it. But it also came into my mind that I actually saved someone's Christmas plans by finding and returning the wallet. The good feeling it gave me was worth more than anything could buy. [/INST] question: Which of the following is true? | options: A: The owner of the wallet found a twenty-dollar bill gone B: The writer wasn't surprised when the man gave her a reward C: Nothing in the wallet was missing D: The man was very, very excited when he got his wallet back | answer: C </s>

<s>[INST] context: When you're having a hard time with your homework or when you're preparing for your term paper, these student-focused websites can help you with just about anything you need. The key to getting the most out of these online resources is to know how they can best be used to your advantage. Facebook Although Facebook can be one of your biggest time-wasters and distractions when you are supposed to getting work done, it can also be one of your most valuable resources. Most of your classmates will probably have a Facebook account, so anyone you need to connect with about a class you missed or about a problem is usually just a few clicks away. SparkNotes With a free library of history, philosophy study guides and summaries, SparkNotes has covered just about any reading-related tasks you have to finish. Just search for the book, play, or short summary of the material you are supposed to read. Amazon.com Do you finish every term with many expensive textbooks you will never open again? Instead of letting the money spent go to waste, get back some of your cash by selling your books on Amazon. RateMyProfessors.com Choosing new classes can sometimes be like trying to pick out your clothes in the dark, a total guessing game. Which teacher gives out the hardest problem? How much homework will that history professor give you every week? At RateMyProfessors.com, students all over the country rate their professors on quality, helpfulness, and how hard their classes are. Wikipedia While Wikipedia isn't aimed specially at students, it is difficult to think of another website that does more to reduce the pain of paper writing and researching. Wikipedia gives you a quick way to find sources and get the details of almost any topic you need research - all without walking to the library. [/INST] question: While you are taking great pains to write a research report, _ can most probably be a help. | options: A: Wikipedia B: SparkNotes C: Amazon.com D: Facebook | answer: A </s>

<s>[INST] context: Surgical treatment in thoracic outlet syndrome has been known to have devastating complications, especially brachial plexopathy (eg, injury to the long thoracic nerve with scapular winging). Conservative treatment appears to be the most universally accepted approach, with even surgeons recommending a prolonged trial before any operative procedure Complications of surgical tit of thoracic outlet syndrome Brachial plexus injury Injury to long thoracic nerve leading to winging of the scapula Homer's syndrome Vascular injuries — subclavian artery , subclavian vein Air embolus as a result of subclavian vein injury Pneumothorax Thoracic Outlet Syndrome Thoracic outlet syndrome ( TOS ) refers to compression of the subclavian vessels and nerves of the brachial plexus in the region of the thoracic inlet. ( note that even though the actual site of pathology is the thoracic inlet the condition is called thoracic outlet syndrome ) These neurovascular structures of the upper extremity may be compressed by a variety of structures, such as Bone- cervical rib, abnormal first rib, long transverse process of C7, osteoarthritis Muscles- scalenus Trauma- neck hematoma, bone dislocation, clavicular fracture Fibrous bands- congenital or acquired Neoplasms- Pancoast's tumor emedicine.com writes The primary cause is believed to be mechanical or postural. Stress, depression, overuse, and habit all can lead to the forward head, droopy shoulder, and collapsed chest posture that allows the thoracic outlet to narrow and compress the neurovascular structures. Accessory ribs or fibrous bands when present, predispose the site to narrow and compression. Management Initial method of management is nonsurgical. Physical and occupational therapy: improvements in a postural sitting, standing, and sleeping positions are recommended, along with behavior modification at work. muscle strengthening and stretching exercises superficial or deep heat therapy 50 to 90% of patients can be treated with these nonsurgical measures. Surgery resection of the first rib, accessory rib or fibrous band, scalenectomy [/INST] question: Which of the following is not a complication of surgery for thoracic outlet syndrome. | options: A: Pneumothorax B: Brachial plexus injury C: Lymphocutaneous fistula D: Long thoracic nerve injury | answer: C </s>

<s>[INST] context: Many people believe that the only way to make our communities safer is to build more prisons. But there's a way better protect cities and towns by doing just the opposite. In many countries throughout the world, prison populations have risen dramatically over the past decade. One of the main reasons for this is the large number of repeat offenders; that is people who break the law again once freed from jail. Statistics show that about one in four prisoners freed every year return to jail within three years. This is partly because ex-prisoners face huge difficulty finding employment. More than a third of them cannot find any job at all. Data show that having a job greatly reduces the chances that a person will commit a crime again or commit one in the first place. Released prisoners who do manage to find steady employment are 50 percent less likely to return to prison. Rather than harming a community, having a job helps ex-prisoners to change their ways and make a positive and productive contribution to their communities. What's more, helping these men and women find jobs would also save taxpayers a lot of money. Few prisoners would save governments millions or possibly even billions of dollars annually: the costs of building and operating jails. There are many things that the government can do to help ex-prisoners find work. More job training programs should be introduced to provide prisoners with work skills before they are freed. Companies and factories should also be given tax benefits if they employ ex-prisoners. Such programs have been shown to work in several countries. Such policies of course assure that freed criminals actually want to work. But shouldn't they be given the chance? Our goal, after all, shouldn't be to incarcerate as many prisoners as possible, but to build a society that doesn't need to put such a large percentage of its population in jail. We should take a step in that direction and help prisoners find self-respect and purpose through work. [/INST] question: What percentage of freed prisoners returns to prison within three years? | options: A: 65% B: 50% C: 33% D: 25% | answer: D </s>

<s>[INST] context: Metformin If the patient is taking an oral hypoglycemic agent preoperatively the drug can be continued until the day of surgery, but sulfonylureas and nzetfornzin should not be used 24-48 h before surgery beause of their long half-lives. Patients with type 11 diabetes mellitus should be stopped oral hypoglycemics several days prior to surgery (especially metformin which is known to contribute to postoperative lactic acidosis) About other options Antihypeensive agents With rare exceptions antihypeensive drug therapy should be continued upto the time of surgery. Some clinicians withhold ACE inhibitors on the morning of surgery because of their association with an increased incidence of intraoperative hypotension. However withholding these agents increases the risk of marked perioperative hypeension and the need for parenteral antihypeensive agents. Surgical procedures on patients with sustained preoperative diastolic blood pressure higher than 110 mmHg-paicularly those with evidence of endorgan damage should be delayed until blood pressure is better controlled over the course of several days. Beta blockers A sudden stop can result in rebound hypeension, tachycardia and recurrent myocardial ischemia. They are continued up to and including morning of surgery and restaed immediately afterwards. Antianginal drugs Antianginal drugs such as calcium channel blockers or nitrates (GTN) should not be stopped before surgery without a very specific reason or angina may recur. Calcium channel blockers They have antiischaemic propey despite a theoretical risk of increased bleeding. They should be continued upto including the day of surgery. Nitrates To be continued up to and including day of surgery. About other classes of drugs Statins They should have a beneficial effect on outcome especially after coronary aery bypass grafting thus they are continued up to the day of surgery. Alpha 2 agonists Abrupt withdrawl an result in extreme hypeension and myocardial ischemia. So it should be continued upto and including the day of surgery. Diuretics There is risk of hypovolemia and hypotension but still should be continued up to the day of surgery. Digoxin and antiarryhthmics Should be continued upto the day of surgery. ACE inhibitors Continued use can result in perioperative hemodynamic instability For hypeension: continued to the day of surgery For hea failure: discontinue on the day of surgery especially if baseline blood pressure is low. Drugs that should be stopped before surgery Lithium It should be stopped 2 days before major surgery as it potentiates the non depolarizing group of relaxants and in emergency cases suxamethonium and regional blocks should be considered as alternative. Oestrogen containing oral contraceptive pills They are stopped before surgery beause they increase the risk of deep venous thrombosis. Surgery and the combined pill both reduce the activity of antithrombin Combined pills, should if possible be discontinued 4 weeks before major elective surgery or leg surgery such as varicose veins and staed again at the first period following an interval of 2 weeks after the operation. Aspirin Use may be associated with increased bleeding due to platelet dysfunction. They should be stopped 5-7 days before surgery if possible. Oral anticoagulants (warfarin) Should be stopped 4 days prior to surgery and substituted by iv heparin. Oral hypoglycemics Patients with type II diabetes mellitus should stop oral hypoglycemics several days prior to surgery (especially metformin which is known to contribute to postoperative lactic (acidosis) Patients on insulin (SC or iv) should omit their morning dose. Also know about these Monoamine oxidase inhibitors These drugs irreversibly inhibit monoamine oxidase. Stopping these drugs three weeks prior to anaesthesia to allow resynthesis of the enzyme is no longer considered necessary. Tricyclic antidepressants It competitively blocks norepinephrine reuptake by postganglionis sympathetic nerve endings. Patients taking these drugs are therefore more sensitive to catecholamines so any sympathominetic given simultaneously may cause hypeension and arryhthmia. These drugs were discontinued earlier but nowdays they are used. [/INST] question: Which of the following drugs is to be discontinued on the day of surgery | options: A: Atenolol B: Amlodipine C: Metformin D: Statins | answer: C </s>

<s>[INST] context: Dear Editor, I'm a Senior I study in a middle school. This term, my favorite teacher, Miss Mao, no longer teaches us. I want to see her, but I'm afraid that she no longer likes me and I don't want to trouble her. I really miss her. What should I do? Tian Yan Dear Tian Yan, It's bad luck that you have lost your favorite teacher, But if she is still in your school , nothing can stop you going to see her. When she isn't busy, ask her if she minds having a quick chat. You can then tell her she was your favorite teacher------ everyone is happy to know that they are liked! If she has left the school, it will be more difficult to meet her. It will be hard, but remember people always come and go in their lives. We can't rely on them to be with us all the time. You may be sad to say goodbye to her, but we can remember and learn from her. Think of her best qualities. You could also try looking for similar qualities in your other teachers. Study hard and give your new teacher a chance. In time, you might start to see that he or she has different qualities to learn from. Finally, you can not completely rely on other people to get you through your studies , or even your life. Editor [/INST] question: The letters are from _ . | options: A: book B: newspaper C: poster D: advertisement | answer: B </s>

<s>[INST] context: Orthomyxoviruses and paramyxoviruses are RNA viruses that contain a single-stranded RNA genome. The influenza viruses belong to the orthomyxoviruses. They cause acute respiratory tract infections that usually occur in epidemics. Isolated strains of influenza virus are named after the virus type (influenza A, B, or C) as well as the host and location of initial isolation, the year of isolation, and the antigenic designation of the hemagglutinin and neuraminidase. Both the hemagglutinin and neuraminidase are glycoproteins under separate genetic control, and because of this they can and do vary independently. The changes in these antigens are responsible for the antigenic drift characteristic of these viruses. The paramyxoviruses include several important human pathogens (mumps virus, measles virus, respiratory syncytial virus, and parainfluenza virus). Both paramyxoviruses and orthomyxoviruses possess an RNA-dependent RNA polymerase that is a structural component of the virion and produces the initial RNA. Respiratory syncytial viruses (RSV) are not related to the paramyxoviruses. They are 150-nm single-stranded RNA viruses. There are 2 antigen groups, A and B, which play no role in diagnosis and treatment. While the overall mortality is 0.5%, at-risk groups may be 25 to 35% mortality if untreated. Some parainfluenza virus infections (type 3) may be indistinguishable from RSV, but most parainfluenza infections produce a laryngotracheobronchitis known as croup. [/INST] question: This is a paramyxovirus and causes the syndrome known as croup. | options: A: Measles virus B: Influenza virus C: Respiratory syncytial virus D: Parainfluenza virus | answer: D </s>

<s>[INST] context: Little stream ran down from a high mountain through many villages and forests. Then it reached a desert. "I went through so many difficulties.I should have no problem crossing the desert," she thought. As she started, she found herself slowly disappearing into the sand. After many tries, she still failed. "Maybe I can't reach the ocean," she said sadly to herself. At this time, a deep voice said, "If a breeze can cross the desert,so can a river." It was the voice of the desert. But the little stream answered, "That's because a breeze can fly, but I cannot." "That's because you _ what you are. Let yourself evaporate into the breeze, and it can take you across," said the desert. "Give up what I am now? No!No!" The little stream could not accept this idea. "The breeze can carry the vapor across the desert and let it leave as rain. The rain will form a river again," said the desert. "And whether you're a river or vapor, your nature never changes." Hearing this,the little stream went into the open arms of breeze. It carried her to the next stage of her life. The course of our lives is like the experience of the little stream. If you want to go through difficulties in your life to head for success, you should also change the way you are sometimes. [/INST] question: Before the stream reached the desert, she didn't _ . | options: A: believe in herself B: meet any difficulties C: want to cross the desert D: worry about the journey to the ocean | answer: D </s>

<s>[INST] context: The TV science-fiction seriesStar Trekno longer looked far-fetched as four men and four women in black space-suits locked themselves into a giant hi-tech greenhouse, known as a 'biosphere', in the Arizona desert yesterday for a two-year study of the environment. As dawn broke over the Santa Catalina mountains, the eight waved goodbye to television cameras. Edward Ross, their multibillionaire sponsor from a Texas oil family, closed the door of the $150 million structure, with its mini-ocean, marsh, desert, savanna, rain-forest and 3,800 plant and animal species designed to allow the team to recreate Earth and its ecosystems. The so-called Biosphere 2 is the latest of a dozen environmental projects started by the self-titled 'ecopreneur'. The project's main aim is to set up a self-sustaining community for possible use in a spaceship or on another planet. The crew members must plant, harvest and process their food on a half-acre farm in the seven-storey glass and metal structure, while conducting a series of experiments. 'We will be custodians of our new little world,' said Abigail Mayer, aged 31, a US marine biologist on the team, her voice choking with emotion. 'It is a brave new step.' Many scientists, however, are more than skeptical. They point out that the largest closed ecosystem which survived more than a few days was smaller than a football. It was developed at the University of Miami and contained only shrimp, algae and other micro-organisms. Critics have also accused Mr. Ross of being more interested in producing a profitable theme park than in carrying out serious scientific research. Hundreds of tourists visited the site daily in the summer before it was occupied by the team. They paid $9.95 to enter and all stopped at the souvenir shop. [/INST] question: What's the location of the project? | options: A: Texas B: University of Miami C: Arizona desert D: The space | answer: C </s>

<s>[INST] context: Pan Aiying, a Chinese teacher at Wutou Middle School in Qihe County, in East China's Shandong Province, didn't think her text messages would help to get her belongings back. A young man riding a motorcycle robbed her of her bag, in which there was her mobile phone, bank cards and 4,900 yuan, as she was riding her bicycle home on Saturday evening. Pan said at first she considered calling the police, but then decided to try to persuade the young man to return her bag. Pan called her lost phone with her friend's, but couldn't get through. So she began sending messages. "Hey, I'm Pan Aiying, a teacher from Wutou Middle School. You must be going through a difficult time. If so, I will not blame you. " Wrote Pan in her first text message, which got no answer. "Keep the 4,900 yuan if you really need it, but please return the other things to me. You are still young. To make mistakes is human. Correcting your mistake is more important than anything. " Pan wrote in another message. She gave up hope after sending 21 text messages without any answer and planned to call the police the next morning. However, as she left her home on Sunday morning, Pan found her stolen bag lying in the courtyard. Nothing was lost. "Dear Pan: I am sorry. I made a mistake. Please forgive me. You are so kind even though I stole from you. I'll correct my ways and be an honest person," said a letter left with the bag. [/INST] question: Where was Pan Aiying robbed? | options: A: In the school B: At home C: In the courtyard D: In the street | answer: D </s>

<s>[INST] context: Maple syrup urine disease Maple syrup urine disease (MSUD) is a rare (1:185,000), autosomal recessive disorder in which there is a paial or complete deficiency in BCKD, a mitochondrial enzyme complex that oxidatively decarboxylates leucine, isoleucine, and valine (see Figure 20.10). These BCAAs and their corresponding a-keto acids accumulate in the blood, causing a toxic effect that interferes with brain functions. The disease is characterized by feeding problems, vomiting, ketoacidosis, changes in muscle tone, neurologic problems that can result in coma (primarily due to the rise in leucine), and a characteristic maple syrup-like odor of the urine due to the rise in isoleucine. If untreated, the disease is fatal. If treatment is delayed, intellectual disability results. 1. Classification: The term "maple syrup urine disease" includes a classic type and several variant forms of the disorder. The classic, neonatal-onset form is the most common type of MSUD. Leukocytes or cultured skin fibroblasts from these patients show little or no BCKD activity. Infants with classic MSUD show symptoms within the first several days of life. If not diagnosed and treated, classic MSUD is lethal in the first weeks of life. Patients with intermediate forms have a higher level of enzyme activity (up to 30% of normal). The symptoms are milder and show an onset from infancy to adolescence. Patients with the rare thiamine-dependent variant of MSUD respond to large doses of this vitamin. 2. Screening and diagnosis: As with PKU, prenatal diagnosis and neonatal screening are available, and most affected individuals are compound heterozygotes. 3. Treatment: MSUD is treated with a synthetic formula that is free of BCAAs, supplemented with limited amounts of leucine, isoleucine, and valine to allow for normal growth and development without producing toxic levels. Early diagnosis and lifelong dietary treatment is essential if the child with MSUD is to develop normally. [/INST] question: Branched-chain keto acid decarboxylation is defective in | options: A: Alkaptonuria B: GM1 gangliosidosis C: Maple syrup urine disease D: Hanup's disease | answer: C </s>

<s>[INST] context: Experience the Colorado River the Hualapai Way! River Runners offers the ONLY One Day Whitewater trip ANYWHERE at the GRAND CANYOU! Since1973,Hualapai River Runners has been conducting whitewater rafting journey to the Colorado River. Our experienced guides expertly sail along the river and share the history of the Canyon and the Hualapai people with you. Visitors experience the excitement of whitewater rapids and then stop to enjoy the impressive beauty of Travertine Falls and a tasty lunch.No charge for children 2 years and under. One-Day Trip Retail$249.00+$79.00(helicopter and round-trip ground transportation) Whitewater rafting tours begin in Peach Springs.Hualapai River Runners transports you to Diamond Creek, which is the starting point for the 37 mile rafting tour. Lunch is included and upon arrival at the rafting tour termination point ,fly out of the Grand Canyon by helicopter to Grand Canyon West. Two-Day Trip Retail$549.00+$79.00(helicopter and round-trip ground transportation) Two-day rafting trips with one night on the Colorado River. All supplies and meals are included. Two days in the Grand Canyon,on the Colorado River allows more time to explore one of the Seven Wonders of the World. Tours Include: *Round-trip transportation from Peach Springs to the starting point and from the termination point back to Peach Springs. *Snack, drinks and lunch(vegetarian meals available upon request) *Waterproof dry bags for storing your cameras, sunscreen, dry clothes, etc. *The helicopter part of transportation is weather permitting. If the helicopter transportation is cancelled because of bad weather, the raft will continue an additional two hours to South Cove and a maximum $20.00 per customer will be given back. Special Website booking rate 15% off rafting in April 2010. So book now! Call us Toll Free Today! Tel: 1-888-868-9378 [/INST] question: Where do whitewater rafting tours start? | options: A: Travertine Falls B: Peach Springs C: Diamond Creek D: Grand Canyon West | answer: B </s>

<s>[INST] context: For the last seventeen years CPSB has had the pleasure of hosting a learning event we call a Forum. We started offering programs inprefix = st1 /Sarasotain February in 1991 and our first Forum was held in 1992 as a small group meeting. Being from the Northern USA, this was a particularly good time to go South for the warmth of our friendship with Dr. Treffinger and Dr. Noller and to keep away from the cold winter. The Forum is the only chance to learn about various topics of the creativity and innovation from those who have rich experience and interest in the field. The theme of the 2009 Forum includes searching for a few new methods, sharing lessons from experience, and learning and exchange ideas on _ research. Space is limited, so early registration is welcome. Meeting the Innovation Challenge February 6 and 7,2009 The Lido Holiday Inn Sarasota,Florida $ 750(registration includes some meals and materials) Interested in becoming qualified to use the VIEW assessment of Problem Solving Style? The two days just before our Forum provides you just that chance. For more information on VIEW see pages 24-25. VIEW Qualification Course February 4 and 5, 2009 The Lido Holiday Inn Sarasota,Florida $650(registration includes lunch and course materials) Special Offer: If you would like to attend the VIEW qualification course and the Forum, you can register for both events for $ 1,050. [/INST] question: If you register both the VIEW qualification course and the Forum at the same time, you will save _ . | options: A: $350 B: $300 C: $100 D: $400 | answer: A </s>

<s>[INST] context: Aflatoxin B1 Fungal metabolite found on moldy nuts and grain Co-carcinogen with hepatitis B, Increase the incidence of hepatocellular carcinoma -C. sinensis is a parasite associated with cholangiocarcinoma. -Hepatitis A has no association with malignancy. -Polyvinyl chloride is associated with Angiosarcoma of the liver. -Tetracyclines can cause microvesicular fatty change in the liver. Pattern of injury Morphological features Examples Cholestatic Cholestasis without inflammation OCP, steroids, antibiotics, HAA Cholestatic hepatitis Cholestasis with necrosis & inflammation Antibiotics, phenothiazines, statins Hepatocellular necrosis Massive necrosis Chronic hepatitis Acetaminophen, halothane Isoniazid Fatty liver disease Microvesicular steatosis Steatohepatitis with Mallory Denk bodies Valproate, tetracyclin Ethanol, amiodarone Fibrosis & cirrhosis Peripoal & pericellular fibrosis Alcohol, methotrexate Granulomas Fibrin ring granulomas Allopurinol Vascular lesions Budd Chiari syndrome OCP [/INST] question: A 36-year-old man from sub-Saharan Africa presents to the clinic with jaundice and right upper quadrant pain. On examination, the liver is palpably enlarged. Laboratory studies demonstrate an increase in liver enzymes. Computed tomography demonstrates a single large mass in the right lobe of the liver, and serum a-fetoprotein is markedly elevated. Which of the following is likely to have contributed to the patient's condition? | options: A: Aflatoxin B1 B: C. Sinensis C: Hepatitis A D: Polyvinyl chloride | answer: A </s>

<s>[INST] context: Spanish men will have to learn to change diapers and do dishwashing under the terms of a new law designed to strike a blow. The law, due to be passed this month, is likely to cause a revolution in family affairs in a country where 40% of men reportedly don't do housework at all. It will oblige men to "share domestic responsibilities and the care and attention" of children and elderly family members, according to the draft approved by the Spanish parliament's justice commission. "This will be a good way of reminding people what their duties are. It is something feminists have been wanting for a long time," said Margarita Uria, of the Basque Nationalist Party, who was behind what is an amendment to a new divorce law. Failure to meet the obligations will be taken into consideration by judges when determining the terms of divorces. Men who refuse to do their part may be given less frequent contact with their children. Spanish women spend five times longer on housework than husbands. Even when both have jobs outside the home, Spanish women still do three times as much work in the house. "It is not just about housework, though," said Ms. Uria. A study five years ago by Spain's Center for Sociological Investigation concluded that fathers spent an average of 13 minutes each day looking after their children. Only 19 % of Spanish men thought it was right for mothers of school-age children to have a full-time job. More than a third thought mothers should not work outside the home at all. The Change to the Spanish legal code will see domestic obligations added to a list of marital duties that currently includes fidelity, living together and helping one another. That should guarantee that, when the law--which will also make divorce proceedings faster and easier--is voted on in parliament in the next few weeks, the obligation to share domestic chores will be added to the statute books. [/INST] question: What is the percentage of Spanish men who don't do any housework? | options: A: 19% B: 40% C: 60% D: 80% | answer: B </s>

<s>[INST] context: There are lots of controversies regarding the reflux laryngitis secondary to reflux gastrointestinal disease. But now some studies document that there is a clear relation between the two. Reflux laryngitis may have the following sequlae: – Bronchospasm – Chemical pneumonitis – Refractory subglottic stenosis – Refractory contact ulcer – Peptic laryngeal granuloma – Acid laryngitis (Heart burn, burning pharyngeal discomfort, nocturnal chocking due to interarytenoid pachydermia) – Laryngeal Carcinoma (According to recent reports laryngeal reflux is the cause of laryngeal carcinoma in patients who are life time non-smokers). Laryngopharyngeal Reflux Here classical GERD symptoms are absent. Patients have more of daytime/upright reflux without the nocturnal/supine reflux of GERD. In laryngopharyngeal reflux esophageal motility and lower esophageal sphincter is normal, while upper esophageal sphincter is abnormal. The traditional diagnostic tests for GERD are not useful in LPR. Symptom Chronic or Intermittent dysphonia, vocal strain, foreign body sensation, excessive throat mucus, Postnasal discharge and cough. Laryngeal findings: Interarytenoid bunching, Posterior laryngitis and subglottic edema (Pseudosulcus) Sequelae of Laryngopharyngeal Reflux Subglottic stenosis Carcinoma larynx Contact ulcer/granuloma Cricoarytenoid joint fixity Vocal nodule/polyp Sudden infant deaths Laryngomalacia (Association) Treatment is in similar lines as GERD, but we need to give proton pump inhibitors at a higher dose and for a longer duration (at least 6–8 months). [/INST] question: Reflux laryngitis produces -a) Sub- glottic stenosis b) Ca larynxc) Cord fixationd) Acute supra- glottitise) Laryngitis | options: A: abe B: bcd C: cde D: acd | answer: A </s>

<s>[INST] context: prefix = st1 /Mauritius, with its full name the Republic of Mauritius, an island country, lies 1,200 miles off the southeastern coast of Africa, and just east of Madagascar, another African island country, which is larger by far thanMauritius. It covers 788 square miles and has a population of 1,00,000, about 750.000 Indians, 300,000 Chinese and 20,000 Whites included. They are living together peacefully, although they share such different beliefs as Hindu, Roman Catholic, Muslim and so on. The country can be divided into many parts with different climate all because of its peculiar terrains . In the center there are volcanoes several thousand feet high, and 90% of its arable land is covered with sugarcane. There are no people living on the island before the Dutch landed on it in 1638. The Dutch _ it in 1710, and five years later, the French came and succeeded in planting sugarcane there. It was conquered byBritainin 1818. As a result, its official language is English. The main big cities are Beau - Bassin and Mahebourg, withPort Louisas its capital. Mauritius has many rare and unique animals, such as the snakes, parrots and lizards. The giraffe is a type of animal with a very long neck and legs and yellow skin with dark spots. It is the tallest of all living animals. Mauritius was extremely poor when it declared its independence in 1968. In the past ten years, obvious economic prosperity has shown itself in this island country. Nowadays its business, culture and tourism are developing rapidly. Every year, thousands of millions of people rush there to enjoy the silver sand beach and song and dance performances with native national characters. [/INST] question: Who succeeded in planting sugarcane? | options: A: The Dutch B: Only the French C: The Dutch and the French D: The French and British people | answer: D </s>

<s>[INST] context: American and British people use different greetings. In the USA the commonest greeting is "Hi". In Britain it is "Hello!" or "How are you?" "Hi!" is creeping into British, too. When they are introduced to someone, the Americans say, "Glad to know you. " The British say, "How do you do?" or "Pleased to meet you. " When Americans say "Good-bye", they nearly always add, "Have a good day. " or "Have a good trip. " etc. to friends and strangers alike. Britons are already beginning to use "Have a good day. " The British usually use "got" in the sense of "have". The Americans hardly ever do. AmE: Do you have a car, room, etc. ? Yes, I do. BrE: Have you got a car, room, etc. ? Yes, I have. There are a number of differences between American and British English in the spelling of words, e. g. check(US)/cheque(UK). Many American words ending in "or", e. g. honor, labor are spelt in British English with an "our," e. g. honour, labour. Many verbs in American English with "ize" or "izing" forms, e. g. organize, realizing are spelt in BrE with "ise" or "ising", e. g. organise, realising. In American English, "practice" is used both for the verb and noun. In BrE, the verb is spelt "practise", and the noun "practice. " In AmE, one writes "traveler," while in BrE, one writes "traveller". It was once _ that British and American English would become separate languages finally. But the opposite has happened. The links between the two countries are so strong that linguistically ,and probably culturally too, they are closer together than ever before. AmE---- American English BrE----British English [/INST] question: The Americans hardly say " _ " | options: A: Good-bye. Have a good day! B: Glad to know you! C: Hi! D: Have you got a car? | answer: D </s>

<s>[INST] context: Michelle , a famous lady , has found that over 25% students are too fat in her country . It's a very serious problem . So she stats a health program to deal with it . The health program is to reduce the amount of fat students today and in the future . The program will get families , schools , news papers , magazines and TVs to join together and deal with the students _ so that students will be at a healthier weight . The program includes : Food stores should sell healthier foods . Schools should serve healthier meals with less fat and should also offer gym classes . The lady is trying to fight the students' obesity all over the country because it can cause illnesses and higher cost . She wants the students to eat right, exercise more and control their weight . She also wants the students to understand it is important to have less sweet food , and drink water , milk and fresh juices , but not to choose cokes . The health program is really helpful to the students today and in the future . As she says , we can't always build the future for our youth , but we can built youth for the future . [/INST] question: In Michelle's country over _ of the students are too fat . | options: A: 75% B: a quarter C: a half D: 25% | answer: B </s>

<s>[INST] context: For millions of years, sharks have been the kings of the oceans, the top of the food chain. But these days, the hunter has become the hunted, because of better methods from commercial fishermen who are looking for fins to make expensive soup sold mostly in Asia. Shark fins are far more valuable than shark meat, so fishermen cut the fins off live fish and throw the sharks overboard to maximize the catch they bring back. Shark finning is illegal in the United States, but there're tournament sport fishermen, who target and kill the biggest ones they take from the sea. These tournaments, the prizes of which can reach $5,000 or more, attract large crowds of anglers but also draw protests from animal rights groups and environmentalists. The competitors say they are enjoying a fun and legal sport, the impact on the overall shark population is very small, and most of the sharks caught are returned to the ocean. Dave Johnson, who is from Kennebunkport, Maine, said no one ever comes close to the limit set by the government of killing one shark per day during the three-month season. "I enjoy watching these animals, but I also enjoy catching and releasing them, and very rarely killing them and eating them," he said. "If I thought killing one shark was endangering the species and contributing to their decline I'd stop doing it tomorrow." That is exactly what marine biologists like Luke Tipple want to happen. "I believe that they should just stop it. In fact, we don't need to be targeting, in any way, any of these threatened populations," he said. Up to 73 million sharks are killed annually, and many species are at risk of extinction . [/INST] question: Fishermen throw the sharks back into the sea after catching them to _ . | options: A: drop useless shark meat B: let them grow new fins C: avoid law punishment D: make higher profits | answer: D </s>

<s>[INST] context: First Man-Bear-Pig, and now global warming; it seems Al Gore never stops to surprise the world. Recently Al Gore produced the movie An Inconvenient Truthwhich explained the threats and told us how to control global warming. What it left out is that there is no proof that human activity is even causing global warming, let alone if global warming is even taking place. Global warming is the idea that greenhouse gases that shut in infra-red radiation in the earth' s atmosphere are becoming more powerful and heating our planet up. The theory is that if the planet continues to heat up the polar ice caps could melt and cover the earth in water. Over the last 100 years the Earth has increased one degree in temperature, and sea level has risen millimeters. Even though this "eye-opening" news is taking place, there is no clear proof saying that it is due to global warming. It could be just a regular weather pattern the earth is circulating. The polar ice caps have not grown or reduced in size since man began tracking them. Also the ground-based temperature has remained the same besides growing cities. In fact most clues support the idea that global warming is not taking place and human activity isn't causing any earth to melt down. Although Al Gore insists the world is on its way to certain destruction, the facts say otherwise. It seems that driving to work won' t lead to the doom ( ) of mankind, and the movie Water World won' t be happening any time soon. [/INST] question: It is likely that Al Gore _ . | options: A: is concerned about the threat of global warming B: holds that human doesn't cause global warming C: knows how to stop global warming successfully D: doesn't believe global warming is taking place | answer: A </s>