correct_option int64 1 5 | explanations dict | full_answer stringlengths 26 2.98k | full_answer_no_ref stringlengths 26 2.89k | full_question stringlengths 123 1.09k | id int64 0 620 | lang stringclasses 1
value | options dict | question_id_specific int64 1 235 | type stringclasses 64
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"text": "If I am told that he has AF, it is because the atria are of size XL, and a VSD does not produce atrial dilatation."
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"exist"... | If he has a pediatric murmur, I'm thinking congenital. Hepatomegaly, malleolar edema and BRD, something that overloads the right heart. So we rule out aortic and mitral stenosis. A patent ductus would give cyanosis: ruled out. VSD or ASD? If I am told that he has AF, it is because the atria are of size XL, and a VSD do... | If he has a pediatric murmur, I'm thinking congenital. Hepatomegaly, malleolar edema and BRD, something that overloads the right heart. So we rule out aortic and mitral stenosis. A patent ductus would give cyanosis: [HIDDEN]. VSD or ASD? If I am told that he has AF, it is because the atria are of size XL, and a VSD doe... | A 45-year-old woman with a history of heart murmur detected in childhood. She is admitted to the emergency department for palpitations, easy fatigue and malleolar edema. Physical examination revealed absence of cyanosis. Oxygen saturation by pulse oximeter 97% BP 120/80 mmHg. Irregular heart rhythm at 100 bpm. Ejective... | 227 | en | {
"1": "Ventricular septal defect.",
"2": "Aortic stenosis.",
"3": "Mitral stenosis.",
"4": "Atrial septal defect.",
"5": "Patent ductus arteriosus."
} | 72 | CARDIOLOGY | 2,014 | {
"clinical_case_options": {
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"id": "pubmed23n0758_11903",
"title": "Natural history of atrial septal defect in the sixth decade : study of 5 cases.",
"score": 0.017908538535337384,
"content": "Atrial septal defect (ASD) is one of the ... |
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"text": "we do not want to put the patient to run"
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... | Ejective murmur, our first suspicion is aortic stenosis. Angina may be due to the stenosis itself or to underlying coronary artery disease (probable, given the age). And with this information, we cannot know if the stenosis is severe. Therefore, the first thing we will have to do will be to study the valve disease: we ... | Ejective murmur, our first suspicion is aortic stenosis. Angina may be due to the stenosis itself or to underlying coronary artery disease (probable, given the age). And with this information, we cannot know if the stenosis is severe. Therefore, the first thing we will have to do will be to study the valve disease: we ... | What examination would you advise in the first place for an 82-year-old patient with exertional angina and a systolic ejection murmur of intensity 3/6 on auscultation? | 168 | en | {
"1": "A stress test.",
"2": "Coronary angiography.",
"3": "Exercise echocardiogram.",
"4": "Coronary CT scan.",
"5": "Doppler echocardiogram."
} | 86 | CARDIOLOGY AND CARDIOVASCULAR SURGERY | 2,013 | {
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"id": "wiki20220301en015_15772",
"title": "Echocardiography",
"score": 0.014059514059514059,
"content": "A stress echocardiogram, also known as a stress echo, uses ultrasound imaging of the heart to assess... |
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... | Diabetes with ecv ldlc<70. | Diabetes with ecv ldlc<70. | In a 70-year-old diabetic man with a history of ischemic heart disease, what is the therapeutic target for LDL cholesterol and glycosylated hemoglobin (Hb A1c)? | 329 | en | {
"1": "LDLc<15 mg/dL and Hb A1c <6.5%.",
"2": "LDLc<100 mg/dL and Hb A1c <7%.",
"3": "LDLc<70 mg/dL and Hb A1c <7%.",
"4": "LDLc< 115mg/dL and Hb A1c <7%.",
"5": null
} | 84 | ENDOCRINOLOGY | 2,016 | {
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"id": "pubmed23n1035_8927",
"title": "In patients with stable coronary heart disease, low-density lipoprotein-cholesterol levels < 70 mg/dL and glycosylated hemoglobin A1c < 7% are associated with lower major cardiovasc... |
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"... | We are presented with a lot of analytical data but we only have to look at two: the levels of complement fractions C3 and C4 are low. Of the options given, only membranoproliferative glomerulonephritis presents with hypocomplementemia (option 4 correct). | We are presented with a lot of analytical data but we only have to look at two: the levels of complement fractions C3 and C4 are low. Of the options given, only membranoproliferative glomerulonephritis presents with hypocomplementemia ([HIDDEN]). | A 25-year-old man with no known history of interest. He has been presenting with foamy and loaded urine for 2 months, with no other symptoms. Physical examination without findings. Elemental urine: pH 5; glucose negative; hemoglobin ++; protein ++; leukocyte esterase negative; proteinuria 1.5 g/24 hours; urinary Na 60 ... | 447 | en | {
"1": "Membranous glomerulonephritis.",
"2": "Glomerulonephritis with minimal changes.",
"3": "Mesangial IgA glomerulonephritis.",
"4": "Membranoproliferative glomerulonephritis.",
"5": null
} | 131 | NEPHROLOGY | 2,018 | {
"clinical_case_options": {
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"id": "pubmed23n0497_11164",
"title": "[Rapidly progressive glomerulonephritis in a 68-year-old man].",
"score": 0.01637840670859539,
"content": "A 68-year-old male with macroscopic hematuria and constitut... |
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"text": "A history of stroke (presumably ischemic) 4 months ago is a relative contraindication for fibrinolysis (if the time is less than 3 months i... | This question combines several important facts. To begin with, this is a patient with an extensive anterior and lateral AMI, with cardiogenic shock. On the other hand, in the history, we are told that the patient had a stroke 4 months ago. It is evident from the patient's clinical picture that an urgent reperfusion str... | This question combines several important facts. To begin with, this is a patient with an extensive anterior and lateral AMI, with cardiogenic shock. On the other hand, in the history, we are told that the patient had a stroke 4 months ago. It is evident from the patient's clinical picture that an urgent reperfusion str... | A 72-year-old man, ex-smoker, hypertensive and diabetic. History of stroke with residual paresis in the left arm 4 months ago. He comes to the emergency department of a regional hospital with intense precordial pain of 2 hours of evolution; in the physical examination he presents cold and sweaty skin, blood pressure of... | 72 | en | {
"1": "Immediate systemic fibrinolysis at the regional hospital.",
"2": "Immediate transfer to a tertiary center for treatment with fibrinolysis.",
"3": "Immediate transfer to a tertiary center for percutaneous coronary revascularization procedure.",
"4": "Hemodynamic stabilization and deferred revascularizati... | 52 | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCIES | 2,012 | {
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"id": "pubmed23n0547_14526",
"title": "[Coronary angioplasty for primary cardiogenic shock following acute myocardial infarction].",
"score": 0.018108816781383152,
"content": "In the setting of acute myoca... |
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"... | Little to comment.... is the definition of delirium. Altered state of consciousness. | Little to comment.... is the definition of delirium. Altered state of consciousness. | A 79-year-old patient is brought to the ED at 7 pm from a nursing home, but we do not have the referral report and therefore do not know his history. He is disoriented in time and space. He has trouble remembering simple information. Sometimes he becomes very nervous and agitated, because he sees threatening people, ev... | 505 | en | {
"1": "The presence of visual hallucinations.",
"2": "Cognitive symptoms.",
"3": "Psychomotor agitation.",
"4": "Fluctuation of the alert level.",
"5": null
} | 85 | PSYCHIATRY | 2,020 | {
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{
"id": "pubmed23n0950_15602",
"title": "Visual Hallucinations and Paranoid Delusions.",
"score": 0.015566323440339189,
"content": "Visual well-formed hallucinations, fluctuations in the level of cognition, ... |
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"... | Warfarin-induced skin necrosis is a rare and serious adverse effect of oral anticoagulant therapy, occurring in only 0.01 to 0.1% of patients and is especially related to coagulation protein C and S deficiency. | Warfarin-induced skin necrosis is a rare and serious adverse effect of oral anticoagulant therapy, occurring in only 0.01 to 0.1% of patients and is especially related to coagulation protein C and S deficiency. | 46-year-old woman with a history of rheumatic valve disease, requiring mitral valve replacement with a mechanical prosthesis. The initial postoperative evolution is favorable. However, after starting treatment with acenocoumarol, she develops a picture of skin necrosis affecting the abdominal region and extremities. Wh... | 360 | en | {
"1": "Antithrombin deficiency.",
"2": "Factor V Leiden.",
"3": "Hyperhomocysteinemia.",
"4": "Protein C deficiency.",
"5": null
} | 93 | HEMATOLOGY | 2,016 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0214_12167",
"title": "[Role of thrombolytic treatment in thrombosis of valvular prostheses. Apropos of 2 cases and review of the world literature].",
"score": 0.017324133793310333,
"conten... |
2 | {
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"text": "I believe that the most correct is 2, since Gusti... | I believe that the most correct is 2, since Gustilo II fractures are mainly covered with Gram (+) by means of a 1st generation Cepha, and it is not a question of prevention but of treatment (it is considered to be contaminated). | I believe that [HIDDEN], since Gustilo II fractures are mainly covered with Gram (+) by means of a 1st generation Cepha, and it is not a question of prevention but of treatment (it is considered to be contaminated). | A 36-year-old man with no past history of interest who, after a high-energy trauma following a fall from a motorcycle, presents with a Gustilo grade II open midshaft fracture of the tibia. Which of the following maneuvers or therapies is most effective for preventing infection? | 459 | en | {
"1": "Immediate intravenous broad-spectrum antibiotherapy.",
"2": "Exhaustive debridement-wound lavage in the operating room with at least 10 liters of saline.",
"3": "Urgent stabilization of the fracture by external fixation and early wound closure.",
"4": "Early wound closure with antiseptics and oxygen the... | 173 | TRAUMATOLOGY AND ORTHOPEDICS | 2,018 | {
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"RRF-2": [
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"id": "wiki20220301en305_15769",
"title": "Gustilo open fracture classification",
"score": 0.018362533692722373,
"content": "In 1976, Gustilo and Anderson refined the early classification system proposed b... |
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"text": "1 would be if he was making a profit, if he was knowingly simulating and to make a profit he was faking his illness. This is not the case."
... | The nice word to describe this is: "Belle indeference", this woman shows herself with an elegant indifference to a paralysis. The diagnosis.... can be excluded 2,3,4 because the clinical does not match: no delirium, no worry, no sadness. 1 would be if he was making a profit, if he was knowingly simulating and to make a... | The nice word to describe this is: "Belle indeference", this woman shows herself with an elegant indifference to a paralysis. The diagnosis.... can be excluded 2,3,4 because the clinical does not match: no delirium, no worry, no sadness. 1 would be if he was making a profit, if he was knowingly simulating and to make a... | A 52-year-old woman comes to the emergency room with bilateral paralysis of the upper extremities that had started abruptly two hours earlier. In the interview she is smiling and says she does not understand why her family is so worried. The family refers that the day before her son had been arrested by the police for ... | 149 | en | {
"1": "Factitious disorder.",
"2": "Delusional disorder.",
"3": "Hypochondriasis.",
"4": "Major depressive disorder.",
"5": "Conversive disorder."
} | 162 | PSYCHIATRY | 2,012 | {
"clinical_case_options": {
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{
"id": "pubmed23n1038_19259",
"title": "Filicide In Depressive Psychosis: Case Report Of An Emotionally Unstable Woman Slaughtering Her Two Children.",
"score": 0.0112096887762287,
"content": "Filicide is t... |
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... | Another question that may generate discussion. When a diagnosis of active tuberculosis infection is made, treatment is initiated with isoniazid, rifampicin and pyrazinamide together with ethambutol in case of suspicion of strains resistant to any of the drugs. Once the existence of resistance has been ruled out, ethamb... | Another question that may generate discussion. When a diagnosis of active tuberculosis infection is made, treatment is initiated with isoniazid, rifampicin and pyrazinamide together with ethambutol in case of suspicion of strains resistant to any of the drugs. Once the existence of resistance has been ruled out, ethamb... | A patient with a history of excessive alcohol consumption has been diagnosed with pulmonary tuberculosis due to cough, fever, expectoration, and sputum culture isolation of Mycobacterium tuberculosis. The patient started treatment with isoniazid, rifampicin, ethambutol and pyrazinamide, with adequate tolerance. Twenty ... | 246 | en | {
"1": "Isoniazid, ethambutol, pyrazinamide for 12 months.",
"2": "Isoniazid, ethambutol, pyrazinamide for 12 months and streptomycin for two months.",
"3": "Isoniazid, ethambutol, pyrazinamide for 12 months and a quinolone for two months.",
"4": "Isoniazid, ethambutol, pyrazinamide and a quinolone for 18 month... | 116 | INFECTIOUS DISEASES | 2,014 | {
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"id": "pubmed23n0225_3332",
"title": "Controlled trial of 4 three-times-weekly regimens and a daily regimen all given for 6 months for pulmonary tuberculosis. Second report: the results up to 24 months. Hong Kong Chest Servic... |
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... | This clinical picture is called Frey's syndrome and consists of an anomalous reinnervation of regional structures after parotidectomy due to lesion of the auriculotemporal nerve, so that during mastication, erythema and preauricular sweating occur. The treatment is intradermal botulinum toxin injection. | This clinical picture is called Frey's syndrome and consists of an anomalous reinnervation of regional structures after parotidectomy due to lesion of the auriculotemporal nerve, so that during mastication, erythema and preauricular sweating occur. The treatment is intradermal botulinum toxin injection. | A 47-year-old man, with a history of a right parotid pleomorphic adenoma, treated with surgery (extrafacial parotidectomy) 6 months ago, who comes to our office for presenting pain with sweating and reddening of the skin in the preauricular region during chewing. Which treatment would be the treatment of choice? | 457 | en | {
"1": "Extended total parotidectomy on suspicion of tumor recurrence.",
"2": "Pregabalin.",
"3": "Intradermal botulinum toxin injection.",
"4": "Broad-spectrum antibiotherapy.",
"5": null
} | 126 | OTORHINOLARYNGOLOGY AND MAXILLOFACIAL SURGERY | 2,018 | {
"clinical_case_options": {
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{
"id": "pubmed23n0680_6897",
"title": "[Thirteen years' experience with superficial partial parotidectomy as treatment for benign parotid tumours].",
"score": 0.0177750058470414,
"content": "Most authors ag... |
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"text": "We are in front of a patient with renal insuffic... | The correct answer is: 2. Focal segmental glomerulonephritis. We are in front of a patient with renal insufficiency whose manifestation is a proteinuria. That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two). If we also consider that the pat... | The [HIDDEN]. We are in front of a patient with renal insufficiency whose manifestation is a proteinuria. That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two). If we also consider that the patient was obese, slightly hypertensive, the most ... | A 58-year-old woman, weight 130 kg, height 155 cm, body mass index > 30 with mild hypertension, blood glucose 108 mg/dL and absence of edema in the lower limbs. Blood analysis showed Cr 2.0 mg/dL, Urea 86 mg/dL, Alb 3.8 g/1, Na 142 mEq/L, K 4 mEq/L. In urinalysis: sediment without alterations and in 24 h urine proteinu... | 165 | en | {
"1": "Secondary membranous glomerulonephritis.",
"2": "Focal and segmental glomerulonephritis.",
"3": "IgA nephropathy.",
"4": "Rapidly progressive glomerulonephritis.",
"5": "Minimal change nephropathy."
} | 229 | NEPHROLOGY | 2,013 | {
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{
"id": "pubmed23n0820_14586",
"title": "Renal biopsy findings and clinical indicators of patients with hematuria without overt proteinuria.",
"score": 0.014789355829818256,
"content": "Whether to perform a ... |
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"text": "We are dealing with a patient who has exhausted the pharmacological route given that he takes everything and has two important problems: genu va... | We are dealing with a patient who has exhausted the pharmacological route given that he takes everything and has two important problems: genu varum and an important gonarthrosis. This means that we can do nothing with an arthroscopy, let alone a synovectomy (1 and 5 false). The genu varum could falsely make us think ab... | We are dealing with a patient who has exhausted the pharmacological route given that he takes everything and has two important problems: genu varum and an important gonarthrosis. This means that we can do nothing with an arthroscopy, let alone a synovectomy ([HIDDEN]). The genu varum could falsely make us think about a... | A 75-year-old patient with significant gonarthrosis with "Genu Varo" that causes marked functional impotence, limited mobility and continuous pain that requires continuous antirheumatic, anti-inflammatory and analgesic medication. What treatment should be indicated in this case? | 157 | en | {
"1": "Arthroscopic lavage of the knee.",
"2": "Rehabilitation of the affected knee.",
"3": "Arthroplasty of the affected knee.",
"4": "Abduction supratuberosity tibial supratuberosity tibial osteotomy.",
"5": "Knee synovectomy."
} | 73 | TRAUMATOLOGY AND ORTHOPEDICS | 2,012 | {
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{
"id": "pubmed23n0739_20976",
"title": "Arthroscopic lavage and debridement for osteoarthritis of the knee: an evidence-based analysis.",
"score": 0.0172002601720026,
"content": "The purpose of this review ... |
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"text": "we will have to perform a cranial CT scan to rule out a hemorrhagic stroke. If the CT scan does not show bleeding, the patient has an acute is... | The patient suffers an abrupt neurological deficit probably related to a vascular event, so first we will have to perform a cranial CT scan to rule out a hemorrhagic stroke. If the CT scan does not show bleeding, the patient has an acute ischemic stroke, probably cardioembolic due to his cardiac pathology, not anticoag... | The patient suffers an abrupt neurological deficit probably related to a vascular event, so first we will have to perform a cranial CT scan to rule out a hemorrhagic stroke. If the CT scan does not show bleeding, the patient has an acute ischemic stroke, probably cardioembolic due to his cardiac pathology, not anticoag... | A 33-year-old man, independent in all activities of daily living, with a history of well-controlled hypertension, antiplatelet atrial fibrillation and an adenocarcinoma of the prostate at 73 years of age, currently free of disease. He is brought to the emergency department for clinical aphasia and right hemiparesis of ... | 382 | en | {
"1": "Perform a cranial CT scan and if there are no hemorrhagic lesions or other contraindications in the analysis, start immediate intravenous thrombolysis.",
"2": "Perform urgent cranial CT scan and if there is no bleeding, start anticoagulation.",
"3": "Perform cranial CT scan and admission to rehabilitation... | 231 | NEUROLOGY | 2,016 | {
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{
"id": "pubmed23n0057_18090",
"title": "[Two cases of cerebral embolism showing global aphasia without hemiparesis].",
"score": 0.017304393227418516,
"content": "We report two cases of typical global aphasi... |
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"text": "Hepatocarcinoma can elevate (alone) alpha-fetus, seminoma LDH, lymphoma also LDH."
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... | Very typical too. In the ED it can be diagnosed with a pregnancy test (in males), because it detects that beta HCG in urine. Hepatocarcinoma can elevate (alone) alpha-fetus, seminoma LDH, lymphoma also LDH. | Very typical too. In the ED it can be diagnosed with a pregnancy test (in males), because it detects that beta HCG in urine. Hepatocarcinoma can elevate (alone) alpha-fetus, seminoma LDH, lymphoma also LDH. | 40-year-old patient, with normal physical examination, in whom a mediastinal mass and a hepatic nodule have been evidenced in the CT scan, and in the CBC a serum elevation of lactic dehydrogenase (LDH), human chorionic betagonadotropin (beta-HCG) and alpha-fetoprotein.What is your diagnostic suspicion. What is your dia... | 496 | en | {
"1": "Metastatic hepatocarcinoma.",
"2": "Extragonadal metastatic seminoma.",
"3": "Mediastinal lymphoma.",
"4": "Metastatic extragonadal nonseminomatous germ cell cancer.",
"5": null
} | 71 | MEDICAL ONCOLOGY | 2,020 | {
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{
"id": "pubmed23n0933_4769",
"title": "Germ cell tumor causing pleural effusion: A diagnostic dilemma.",
"score": 0.019142700128228614,
"content": "Straw colored pleural fluid with raised adenosine deaminas... |
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"text": "FNA does not allow a histological study but a cytological one, therefore questions 1, 2 are eliminated."
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"... | I think the correct answer is 5; FNA does not allow a histological study but a cytological one, therefore questions 1, 2 are eliminated. Question 3 seems to have been put as a filler because it is not relevant. Question 4 could raise doubts if you are not a pathologist but the most logical answer is 5 since papillary c... | I think [HIDDEN]; FNA does not allow a histological study but a cytological one, therefore questions [HIDDEN]. Question 3 seems to have been put as a filler because it is not relevant. Question 4 could raise doubts if you are not a pathologist but [HIDDEN] since papillary carcinoma is the most frequent. | A 41-year-old man comes to the clinic with a nodule in the right thyroid, a fine needle aspiration is performed. Cytological analysis will allow us: | 14 | en | {
"1": "Distinguish between follicular adenoma or minimally invasive follicular carcinoma.",
"2": "Identify the areas of capsular or vascular invasion of the follicular carcinoma.",
"3": "Recognize G-cell hyperplasia associated with familial spinal cancer.",
"4": "Distinguish between a Hurthle cell tumor and an... | 213 | SURGERY | 2,011 | {
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"id": "pubmed23n0540_8293",
"title": "Does Hurthle cell lesion/neoplasm predict malignancy more than follicular lesion/neoplasm on thyroid fine-needle aspiration?",
"score": 0.017966484047695776,
"content"... |
1 | {
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"text": "Kallman's syndrome or Morsier's syndrome is a congenital insufficiency associated with hypogonadotropic hypogonadism due to a deficit in GnRH ho... | Kallman's syndrome or Morsier's syndrome is a congenital insufficiency associated with hypogonadotropic hypogonadism due to a deficit in GnRH hormone production. Repeated injections of GnRH are performed to restore fertility. | Kallman's syndrome or Morsier's syndrome is a congenital insufficiency associated with hypogonadotropic hypogonadism due to a deficit in GnRH hormone production. Repeated injections of GnRH are performed to restore fertility. | A 22-year-old boy with hyposmia presents with lack of development of secondary sexual characteristics and infertility. Bilateral testicular volume of 4 mL. Analytically, FSH 1.2 U/L (vn 5-15); LH 0.6 U/L (vn 3-15); testosterone 100 ng/diu (vn 300-1200), prolactin normal. Indicate the treatment you will propose to achie... | 330 | en | {
"1": "Gn_RH infusion pump.",
"2": "Monthly intramuscular administration of triptorelin.",
"3": "Intramuscular administration of FSH and LH once a week.",
"4": "Treatment with bromocriptine.",
"5": null
} | 85 | ENDOCRINOLOGY | 2,016 | {
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"title": "Hypogonadism, galactorrhoea and hyper-prolactinaemia: Evaluation of pituitary gonadotrophins reserve before and under bromocriptine.",
"score": 0.015537488708220417,
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... | Easy question since the treatment of diabetic ketoacidosis is a very repeated topic in the MIR. Bicarbonate is indicated at pH < 7. | Easy question since the treatment of diabetic ketoacidosis is a very repeated topic in the MIR. Bicarbonate is indicated at pH < 7. | A type 1 diabetic who comes to the emergency room for dyspnea and general malaise. The blood test showed blood glucose 450 mg/dl, Na 142 mEq/l, K 4 mEq/l, pH 7.15, bicarbonate 12 mmol/l. Which treatment would NOT be indicated? | 181 | en | {
"1": "Fast IV saline.",
"2": "Serum glucose 5% iv when blood glucose is less than 250 mg/dl.",
"3": "Rapid human insulin iv.",
"4": "Potassium chloride 100 mEq / day diluted in sera.",
"5": "Sodium bicarbonate 1M 100 cc iv in 30 minutes."
} | 59 | ENDOCRINOLOGY | 2,013 | {
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"id": "pubmed23n0924_22169",
"title": "[Opportunities to improve hospital emergency care of patients with diabetic ketoacidosis].",
"score": 0.016662057522123894,
"content": "To identify opportunities to i... |
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"text": "The most influential cardiovascular factor for stroke in women over 70 is blood pressure."
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"char_ranges": [... | The most influential cardiovascular factor for stroke in women over 70 is blood pressure. | The most influential cardiovascular factor for stroke in women over 70 is blood pressure. | A 76-year-old woman consults us because she is concerned about her risk of stroke since her mother died of stroke a year ago. She is diagnosed with arterial hypertension and type 2 diabetes mellitus and is being treated with glipizide, aspirin, enalapril and atorvastatin. She smokes 20 cigarettes a day and leads a sede... | 182 | en | {
"1": "Achieve optimal blood pressure control.",
"2": "Achieve optimal hemoglobin A1C levels.",
"3": "Add an antioxidant to the treatment.",
"4": "Smoking cessation.",
"5": "Achieve LDL levels below 100 mg/dl."
} | 61 | ENDOCRINOLOGY | 2,013 | {
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"id": "pubmed23n0695_19851",
"title": "Intensive glycaemic control in type 2 diabetes mellitus: does it improve cardiovascular outcomes?",
"score": 0.019149715961150816,
"content": "With growing urbanizati... |
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... | In the face of a PPD conversion within 2 years, and ruling out current TB disease, INH chemoprophylaxis is indicated, although I thought it was for 6 months and not 9. The rest is not questionable. | In the face of a PPD conversion within 2 years, and ruling out current TB disease, INH chemoprophylaxis is indicated, although I thought it was for 6 months and not 9. The rest is [HIDDEN]. | A 32-year-old man, ADVP and recently released from prison, has a protein derivative skin test (PPD) with 10 mm of induration. One year ago, the PPD was negative, he is currently asymptomatic, his HIV serology is negative, and his Chest X-ray is normal. Which of the following approaches do you think is most appropriate? | 21 | en | {
"1": "Do not perform treatment and annual Rx control.",
"2": "Sputum culture for mycobacteria and treat only if positive.",
"3": "Isoniazid for 9 months.",
"4": "Treatment with 4 drugs 4 months.",
"5": "Treatment with RIF and PRZ for 2 months."
} | 111 | INFECTIOUS | 2,011 | {
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"id": "wiki20220301en039_79799",
"title": "Tuberculosis management",
"score": 0.01409470277635837,
"content": "Deviations from the standard regimen There is evidence supporting some deviations from the sta... |
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... | Actually, it can be all of them, but the most frequent cause of acute uncompensated respiratory acidosis in a young person is bronchopneumonia. | Actually, it can be all of them, but the most frequent cause of acute uncompensated respiratory acidosis in a young person is bronchopneumonia. | A 40-year-old male, foreign tourist, is referred to the ED for low level of consciousness, temperature of 37.7°C and dyspnea. He has no trauma. Several tests were performed. The most immediate is an ABE without oxygen, showing PH 7.33, PCO2 50, PO2 65, HCO3 27: | 60 | en | {
"1": "PET SCAN.",
"2": "Lobar pneumonia.",
"3": "EAP.",
"4": "Alveolar hypoventilation.",
"5": "Bronchopneumonia."
} | 59 | ANESTHESIOLOGY AND CRITICAL CARE | 2,011 | {
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"title": "Using 99mTc-DTPA radioaerosol inhalation lung scan as compared with computed tomography to detect lung injury in blunt chest trauma.",
"score": 0.012928194993412384,
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"text": "The closest answer is 1. If we are strict we would be talking about a pure motor lacunar infarction (with mild dysarthria). Since the other 3 op... | The closest answer is 1. If we are strict we would be talking about a pure motor lacunar infarction (with mild dysarthria). Since the other 3 options do not give us a clinical picture like the one in the statement. Both options 2 and 3 give us a much more florid and extensive clinical picture. | [HIDDEN] If we are strict we would be talking about a pure motor lacunar infarction (with mild dysarthria). Since the other 3 options do not give us a clinical picture like the one in the statement. Both options 2 and 3 give us [HIDDEN] extensive clinical picture. | In a 70-year-old man, hypertensive, with a right hemiplegia of sudden onset with mild dysarthria, without alterations in evocation or language comprehension, what type of stroke do you think is most likely to have suffered? | 455 | en | {
"1": "Left capsular lacunar lacunar infarction.",
"2": "A cortico-subcortical left frontotemporal sylvian infarction.",
"3": "Brain stem infarction.",
"4": "A left lenticular hemorrhage.",
"5": null
} | 155 | NEUROLOGY | 2,018 | {
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"title": "[Aphasias for verbal and sign languages are due to lesions of nearly localised but not identical brain regions of the left hemisphere].",
"score": 0.0178585665311329,
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"text": "Young patient, with no previous history, who after taking NSAIDs presents bleeding with hemodynamic instability requiring transfusion. Answer 1... | Question about non-varicose ADH. Young patient, with no previous history, who after taking NSAIDs presents bleeding with hemodynamic instability requiring transfusion. Answer 1 is not in accordance with what has been said, this is an unstable patient who has bled a lot, who has a Forrest IIa ulcer with a high risk of ... | Question about non-varicose ADH. Young patient, with no previous history, who after taking NSAIDs presents bleeding with hemodynamic instability requiring transfusion. Answer 1 is [HIDDEN], this is an unstable patient who has bled a lot, who has a Forrest IIa ulcer with a high risk of rebleeding. Answer 2 speaks of som... | A 43-year-old man with no diseases of interest comes to the emergency department for 4 melaenic stools in the last 12 hours. He refers taking NSAIDs in previous days. Physical examination revealed pale skin and mucous membranes. BP 95/65 and HR 110 bpm. The abdomen is not painful and rectal examination shows melenic st... | 1 | en | {
"1": "Since the patient is young, with no associated diseases and the ulcer has stopped bleeding, he can be discharged early with treatment with a PPI and H. Pylori eradication.",
"2": "Remove the endoscope, place nasogastric tube for continuous aspiration and initiate treatment with a PPI and somatostatin.",
"... | 35 | DIGESTIVE | 2,011 | {
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"id": "pubmed23n0608_5566",
"title": "[Diagnosis and treatment of bleeding peptic ulcer: our experience].",
"score": 0.018375566370196342,
"content": "Bleeding peptic ulcer (PU) is the commonest cause of a... |
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... | This is a case of hyperchloremic metabolic acidosis with normal anion gap. Severe metabolic acidosis causes myocardial contractile depression, reduced effectiveness of catecholamines, increased incidence of arrhythmias, vasodilatation and increased capillary permeability, with the consequent reduction of tissue flow, a... | This is a case of hyperchloremic metabolic acidosis with normal anion gap. Severe metabolic acidosis causes myocardial contractile depression, reduced effectiveness of catecholamines, increased incidence of arrhythmias, vasodilatation and increased capillary permeability, with the consequent reduction of tissue flow, a... | Elderly woman brought to the ER by her neighbors because they see her somewhat groggy and with stool stains on her clothes. BP 100/60 mmHg, HR 100 bpm, sitting 70/30, HR 105 bpm. PVY normal. Kussmaul's respiration. No neurological focality. Weight 50 kg. Lab: PH 7.25, PCO2 14, Bicarbonate 5, Na 133, K 2.5, Cl 118, Crea... | 66 | en | {
"1": "The presenting acid-base disorder is a respiratory acidosis.",
"2": "Compensation to correct the acidosis is inadequate.",
"3": "With this exploration, we rule out that she is dehydrated.",
"4": "In any case, we should not put bicarbonate.",
"5": "She has an acute renal failure of prerenal cause."
} | 106 | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCY MEDICINE | 2,012 | {
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"title": "Base excess",
"score": 0.01695156695156695,
"content": "Interpretation Base excess beyond the reference range indicates metabolic alkalosis if too high (more than... |
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... | Although this question straddles the line between derma and pediatrics, we would like to do our bit. We are being told about erythema súdenita or fifth disease (also called megaloerythema), caused by parvovirus B19. It is typical that after an episode of high fever an erythema appears on both cheeks in the form of a "s... | Although this question straddles the line between derma and pediatrics, we would like to do our bit. We are being told about erythema súdenita or fifth disease (also called megaloerythema), caused by parvovirus B19. It is typical that after an episode of high fever an erythema appears on both cheeks in the form of a "s... | A 7-year-old girl who comes for consultation because her parents notice her red face since the previous day and in the last few hours they have noticed red spots on her body. On examination she is afebrile, with tonsils and ears without alterations, normal cardiopulmonary auscultation. He presents a confluent maculo pa... | 521 | en | {
"1": "Chickenpox.",
"2": "Rubella.",
"3": "Erythema infectiosum or 5th disease.",
"4": "Sudden exanthema or 6th disease.",
"5": null
} | 76 | DERMATOLOGY | 2,021 | {
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"title": "Fifth disease",
"score": 0.01647457627118644,
"content": "Signs and symptoms Fifth disease starts with a low-grade fever, headache, rash, and cold-like symptoms,... |
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... | This is a fairly easy epidemiology question, in adults without other data, Pneumococcus is the 1st. | This is a fairly easy epidemiology question, in adults without other data, Pneumococcus is the [HIDDEN]. | A 40-year-old male patient, smoker since he was 18 years old, with no history of interest. He consults for symptoms of 24 hours of evolution of chills, thermometric fever of 39ºC and cough with expectoration. Chest X-ray shows an increased density with alveolar pattern in the LSD and the patient is diagnosed with CAP. ... | 20 | en | {
"1": "Mycoplasma pneumoniae.",
"2": "Chlamydia pneumoniae.",
"3": "Streptococcus pneumoniae.",
"4": "Legionella pneumophila serogroup 1.",
"5": "Haemophilus influenzae."
} | 110 | INFECTIOUS | 2,011 | {
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"title": "The incidence and etiology of community-acquired pneumonia in fever outpatients.",
"score": 0.019327731092436976,
"content": "The purpose of this study was to analyze... |
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... | Although the majority of ACTH-producing adenomas recur, surgery is always the first therapeutic option. The available medications (ketoconazole, somatostatin analogues) are aimed at decreasing the effects of excess cortisol or decreasing ACTH release, but they are not curative. | Although the majority of ACTH-producing adenomas recur, surgery is always the first therapeutic option. The available medications (ketoconazole, somatostatin analogues) are aimed at decreasing the effects of excess cortisol or decreasing ACTH release, but they are not curative. | What is the treatment of choice for a 38-year-old man diagnosed with Cushing's disease in relation to a pituitary macroadenoma of 22 mm in diameter? | 422 | en | {
"1": "Initially try medical treatment and, if not effective, resort to surgery.",
"2": "Adrenalectomy.",
"3": "Selective surgical resection of the adenoma.",
"4": "Radiotherapy to try to reduce tumor size.",
"5": null
} | 88 | ENDOCRINOLOGY | 2,018 | {
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"id": "pubmed23n0302_5541",
"title": "[Cushing's disease. A challenge of size].",
"score": 0.018129614438063987,
"content": "Cushing's syndrome constitutes a real challenge for the clinician who has to elu... |
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"text": "There is no point in repeating the cytology (since this is a screening test, not a diagnostic test),"
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"c... | Colposcopy is indicated for all patients with altered cytology (intraepithelial lesion or suspicion of invasive cancer or HPV infection), as a second level of screening. If lesions are observed in this test, a biopsy of the lesion will be performed. There is no point in repeating the cytology (since this is a screening... | [HIDDEN], as a second level of screening. If lesions are observed in this test, a biopsy of the lesion will be performed. [HIDDEN], performing a hysterectomy for an intraepithelial lesion that has not been confirmed by biopsy is not indicated either, and performing curettage of the endometrial cavity does not provide i... | 45-year-old woman, mother of 3 children, attends an early diagnosis consultation. The cervicovaginal cytology is compatible with a high-grade squamous intraepithelial lesion. Which of the following options would you choose? | 348 | en | {
"1": "Repeat cytology in 1 month.",
"2": "Colposcopy with possible biopsy.",
"3": "Hysterectomy with bilateral salpinguectomy and ovarian conservation.",
"4": "Fractionated uterine curettage.",
"5": null
} | 160 | GYNECOLOGY AND OBSTETRICS | 2,016 | {
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"id": "Gynecology_Novak_3040",
"title": "Gynecology_Novak",
"score": 0.01308227465214761,
"content": "2. Treatment is recommended for a histologic diagnosis of CIN 3 or if colposcopy is unsatisfactory. Alt... |
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"text": "Both parents are carriers of a mutation (because they are not sick and have already had a homozygous child), and the next offspring has a 50% ch... | Both parents are carriers of a mutation (because they are not sick and have already had a homozygous child), and the next offspring has a 50% chance of receiving the mutation from each parent, so the probability of receiving it from both is 50%x50%=25%. | Both parents are carriers of a mutation (because they are not sick and have already had a homozygous child), and the next offspring has a 50% chance of receiving the mutation from each parent, so the probability of receiving it from both is 50%x50%=25%. | A couple with a first male child (index case) with cystic fibrosis (mucoviscidosis) come for genetic counseling. Molecular diagnosis indicates that the index case is homozygous for the F5O8del mutation and his parents are heterozygous carriers. The clinical geneticist will inform them about the mode of transmission of ... | 411 | en | {
"1": "The probability that the next offspring will be affected is 25%.",
"2": "The probability that the next offspring will be affected is 50%.",
"3": "Having had an affected child, the next offspring will also be affected.",
"4": "Having had a homozygous F5O8del child, the next offspring will be heterozygous... | 52 | BIOSTATISTICS | 2,018 | {
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"title": "Bayes' theorem",
"score": 0.018329427519250083,
"content": "Using genetic test results Parental genetic testing can detect around 90% of known disease alleles in... |
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"text": "That is, when you are in the penumbra, the pupil dilates and the iris thickens in the peripheral part, where it is already very close to t... | We are presented with a 68-year-old female patient. At that age the crystalline lens, although it does not normally have a cataract that needs surgery, it usually has increased in thickness. This implies that it projects the iris forward and reduces the depth of the anterior chamber. In an eye with a normal anterior ch... | We are presented with a 68-year-old female patient. At that age the crystalline lens, although it does not normally have a cataract that needs surgery, it usually has increased in thickness. This implies that it projects the iris forward and reduces the depth of the anterior chamber. In an eye with a normal anterior ch... | A 68-year-old woman who uses +4.00 diopter glasses for distance vision in both eyes. She consults because she has been having eye pain with headache and blurred vision at night when she is watching television in dim light for a few weeks. Which of the following pathologies is she most likely to have? | 590 | en | {
"1": "Primary angular closure glaucoma.",
"2": "Migraine.",
"3": "Actinic keratitis.",
"4": "Dry eye syndrome.",
"5": null
} | 64 | OPHTHALMOLOGY | 2,022 | {
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"content": "Dx: Diagnosis is based on clinical history and examination. Those that resolve may mimic a migraine heada... |
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"... | A young male patient with an aortic systolic murmur that increases with the Valsalva maneuver and signs of left ventricular enlargement is practically a "portrait" of the typical findings that can be found in hypertrophic cardiomyopathy. Very easy question. | A young male patient with an aortic systolic murmur that increases with the Valsalva maneuver and signs of left ventricular enlargement is practically a "portrait" of the typical findings that can be found in hypertrophic cardiomyopathy. [HIDDEN] | A 26-year-old man with no history of interest, asymptomatic, presents on examination with a mesosystolic murmur in the aortic focus and left parasternal border that increases with the Valsalva maneuver. BP and peripheral pulses are normal and the ECG shows signs of marked left ventricular enlargement and very deep nega... | 86 | en | {
"1": "Functional murmur.",
"2": "Aortic stenosis.",
"3": "Aortic insufficiency.",
"4": "Hypertrophic cardiomyopathy.",
"5": "Ventricular septal defect."
} | 51 | CARDIOLOGY AND VASCULAR SURGERY | 2,012 | {
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"title": "[Deep Q waves in the ECG of children--an electro-, vector- and echocardiographic study].",
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... | Preoperative chemoradio in all the guidelines. | Preoperative chemoradio in all the guidelines. | 65-year-old man who consults for dysphagia to solids since two months ago. Esophagoscopy shows a tumor 30 cm from the dental arch, partially stenosing, with pathological anatomy of squamous cell carcinoma. Endoscopic ultrasound and PET-CT scan were requested where no pathological lymphadenopathies were observed. Which ... | 498 | en | {
"1": "Transhiatal esophagectomy.",
"2": "Esophagectomy according to the Ivor-Lewis technique.",
"3": "Chemotherapy plus preoperative radiotherapy.",
"4": "Neoadjuvant chemotherapy.",
"5": null
} | 129 | MEDICAL ONCOLOGY | 2,020 | {
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"title": "The controversy of esophageal carcinosarcoma: A case report and brief review of literature.",
"score": 0.01752123786407767,
"content": "Esophageal carcinosarcoma (ECS... |
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"... | Asthma treatment algorithm. We rule out continuing with the same treatment since the patient is symptomatic. | Asthma treatment algorithm. We rule out continuing with the same treatment since the patient is symptomatic. | A patient diagnosed with bronchial asthma who is being treated with low-dose inhaled steroids (200 micrograms of budesonide every 12 hours) and rescue medication (salbutamol on demand) comes for periodic clinical monitoring. The patient reports that in the last 3 months he has had no exacerbations and that he uses salb... | 31 | en | {
"1": "Increase the dose of inhaled corticosteroids to 800 micrograms/day.",
"2": "Add tiotropium.",
"3": "Maintain the same pharmacological regimen.",
"4": "Switch to ocmbined therapy with low-dose inhaled corticosteroids and long-acting beta2-adrenergics.",
"5": "Add leukotrienes."
} | 233 | NEUROLOGY AND THORACIC SURGERY | 2,011 | {
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{
"id": "pubmed23n0519_11719",
"title": "The CONCEPT trial: a 1-year, multicenter, randomized,double-blind, double-dummy comparison of a stable dosing regimen of salmeterol/fluticasone propionate with an adjustable maintenance ... |
2 | {
"1": {
"exist": false,
"char_ranges": [],
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"text": ""
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"exist": true,
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"text": "Treatment with a brace in Risser from 0 to 2 can ... | Treatment with a brace in Risser from 0 to 2 can be considered since there is still growth to occur and correction can take place. Its use is considered for curves between 30-40º. | Treatment with a brace in Risser from 0 to 2 can be considered since there is still growth to occur and correction can take place. Its use is considered for curves between 30-40º. | 13-year-old female, with no relevant history, with menarche 3 months ago, followed since the age of 10 years for idiopathic scoliosis that has worsened. In the physical examination she presents a hump of 7 degrees in the Adams test and in the scoliogram a T4-L1 thoracolumbar curve of 35 degrees of Cobb and a Risser 0: | 618 | en | {
"1": "Recommend swimming and review in three months.",
"2": "Prescribe a brace-type orthosis.",
"3": "Refer to physiotherapy for spine elastification.",
"4": "Check in 6 months with a new X-ray.",
"5": null
} | 119 | TRAUMATOLOGY | 2,022 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0825_810",
"title": "Effectiveness of brace treatment for adolescent idiopathic scoliosis.",
"score": 0.019704911667637354,
"content": "Effectiveness of brace treatment for adolescent idiop... |
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