input: The following are multiple choice questions (with answers) about medical knowledge.   **Question:** A 3-day-old boy is brought to the emergency department because of a 4-hour history of somnolence, poor feeding, and one episode of vomiting. He is exclusively breastfed. His serum glucose concentration is 88 mg/dL and his serum ammonia concentration is 850 μmol/L (N<90). Urinalysis shows an increased orotic acid to creatinine ratio. Urinary ketones are absent. This patient is most likely deficient in an enzyme that catalyzes which of the following reactions?   (A) Ornithine and carbamoyl phosphate to citrulline   (B) Orotic acid to uridine monophosphate   (C) Pyruvate to acetyl-coenzyme A   (D) Glutamate and acetyl-coenzyme A to N-acetylglutamate
output: ['(A) Ornithine and carbamoyl phosphate to citrulline <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Ornithine and carbamoyl phosphate to citrulline  (B) Orotic acid to uridine monophosphate  (C) Pyruvate to acetyl-coenzyme A  (D) Glutamate and acetyl-coenzyme A to N-acetylglutamate <> possible answers', '  A 3-day-old boy is brought to the emergency department because of a 4-hour history of somnolence, poor feeding, and one episode of vomiting. He is exclusively breastfed. His serum glucose concentration is 88 mg/dL and his serum ammonia concentration is 850 μmol/L (N<90). Urinalysis shows an increased orotic acid to creatinine ratio. Urinary ketones are absent. This patient is most likely deficient in an enzyme that catalyzes which of the following reactions? <> context']