correct_option int64 1 5 | explanations dict | full_answer stringlengths 7 1.99k | full_answer_no_ref stringlengths 7 1.91k | full_question stringlengths 123 1.06k | id int64 6 621 | lang stringclasses 1
value | options dict | question_id_specific int64 5 232 | type stringlengths 7 45 | year int64 2.01k 2.02k | rag dict |
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"... | Although other hemorrhagic diseases can have a prolonged thromboplastin time, due to the intensity of the lesion and the child's sex and family history, the most likely diagnosis is hemophilia. | Although other hemorrhagic diseases can have a prolonged thromboplastin time, due to the intensity of the lesion and the child's sex and family history, the most likely diagnosis is hemophilia. | An 18-month-old boy, with complete immunization schedule to date, who consults the Emergency Department for right knee swelling after playing in the park, without obvious trauma. In the directed anamnesis, the mother refers that an uncle of hers had similar problems. The ultrasound examination is compatible with hemart... | 190 | en | {
"1": "Marfan syndrome.",
"2": "Von-Willebrand's disease.",
"3": "Ehlers-Danlos disease.",
"4": "Hemophilia A.",
"5": "Bernard-Soulier disease."
} | 94 | PEDIATRICS | 2,013 | {
"clinical_case_options": {
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{
"id": "pubmed23n0052_9437",
"title": "Further evidence for recessive inheritance of von Willebrand disease with abnormal binding of von Willebrand factor to factor VIII.",
"score": 0.0185201063,
"content":... |
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"text": "the less harmful answer is the 2. Because it i... | Knowing that we have taken measures of sleep hygiene, we have explored what provokes him not to sleep, and he does not sleep nine hours and still wants to sleep more,...then the less harmful answer is the 2. Because it is the one with the shortest half-life and he does not want the lady to fall down the next day. | Knowing that we have taken measures of sleep hygiene, we have explored what provokes him not to sleep, and he does not sleep nine hours and still wants to sleep more,...then [HIDDEN]. [HIDDEN] and he does not want the lady to fall down the next day. | We are consulted by an 84-year-old woman for insomnia of conciliation. After failing sleep hygiene measures, it is decided to initiate pharmacological treatment. Which of the following drugs would you select for the patient? | 150 | en | {
"1": "Diacepam.",
"2": "Lormetacepam.",
"3": "Phenobarbital.",
"4": "Chlordiazepoxide.",
"5": "Chloracepate."
} | 201 | PSYCHIATRY | 2,012 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0209_16856",
"title": "[Insomnia therapy and withdrawal of hypnotics].",
"score": 0.0152637486,
"content": "The aim of this study is to evaluate the efficiency of a treatment prescribed, in... |
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"text": "the imaging tests both CT, but especially MRI would help us to rule out, but would not confirm the diagnosis."
},
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"exist": tru... | The answer is 2, an EMG, which would be the diagnostic test to confirm the diagnostic suspicion of ALS, the imaging tests both CT, but especially MRI would help us to rule out, but would not confirm the diagnosis. | The answer is [HIDDEN], an EMG, which would be the diagnostic test to confirm the diagnostic suspicion of ALS, the imaging tests both CT, but especially MRI would help us to rule out, but would not confirm the diagnosis. | A 65-year-old woman consults for weakness in the right hand that has spread in a few months to other muscle territories of both arms and legs, with distal predominance. On examination there is atrophy and fasciculations in different metameric territories with preserved sensitivity. There is a bilateral Babinski's sign,... | 454 | en | {
"1": "Cerebral CT.",
"2": "Electromyographic study.",
"3": "Cerebral MRI.",
"4": "Multimodal evoked potentials.",
"5": null
} | 153 | NEUROLOGY | 2,018 | {
"clinical_case_options": {
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{
"id": "pubmed23n0091_19675",
"title": "[A case presenting manifestations of bulbospinal muscular atrophy with senile onset, rapid progression and marked asymmetry].",
"score": 0.0168617614,
"content": "A 6... |
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"text": "The management of displaced intracapsular hip fracture in a young patient is surgical and should be done early to reduce the risk of avascular n... | The management of displaced intracapsular hip fracture in a young patient is surgical and should be done early to reduce the risk of avascular necrosis of the hip. They are not talking about life threatening enough to postpone a necessary surgical procedure or to consider an external fixator following a damage containm... | The management of displaced intracapsular hip fracture in a young patient is surgical and should be done early to reduce the risk of avascular necrosis of the hip. They are not talking about life threatening enough to postpone a necessary surgical procedure or to consider an external fixator following a damage containm... | 25-year-old patient, who suffers a motorcycle accident on a Friday night. He is taken to the emergency room and diagnosed with abdominal trauma (negative echo-fast), mild head trauma (Glasgow = 14) and a displaced intracapsular fracture of the right hip. Hemodynamically she is stable, what would be the treatment of cho... | 541 | en | {
"1": "Reduction, open if necessary, and osteosynthesis of the fracture in the first 24-36 hours.",
"2": "Total hip resurfacing arthroplasty on Monday on a scheduled basis.",
"3": "Wait for improvement of the cranial trauma and schedule the following week a scheduled surgery consisting of reduction and osteosynt... | 5 | TRAUMATOLOGY | 2,021 | {
"clinical_case_options": {
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{
"id": "pubmed23n0613_1717",
"title": "[Femoral neck fractures in patients over 50 years old].",
"score": 0.0168923735,
"content": "Despite many papers and instructional course lectures, therapeutic guideli... |
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"text": "The rest of the pathologies do not have a positive Lasègue maneuver, so these options would not be correct."
},
"2": {
"exist": true,... | In this case, when speaking of "reappearance of the symptoms when we lift the lower limb with the knee extended" we are describing the Lasègue Maneuver. This maneuver is positive in cases of lumbosciatic pain, since it causes a stretching of the sciatic nerve, therefore the correct answer is number 3. The rest of the p... | In this case, when speaking of "reappearance of the symptoms when we lift the lower limb with the knee extended" we are describing the Lasègue Maneuver. This maneuver is positive in cases of lumbosciatic pain, since it causes a stretching of the sciatic nerve, therefore [HIDDEN]. The rest of the pathologies do not have... | A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third. The pain appears when the lower limb is lifted with... | 602 | en | {
"1": "Gouty arthritis of left hip.",
"2": "Left coxofemoral arthrosis.",
"3": "Radiated low back pain / lumbosciatica.",
"4": "Claudication due to canal stenosis.",
"5": null
} | 112 | TRAUMATOLOGY | 2,022 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en029_55324",
"title": "Sacroiliac joint",
"score": 0.015040515,
"content": "Signs and symptoms The following are signs and symptoms that may be associated with an SI joint (SIJ) problem... |
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"text": "although there are forms of peripheral polyneuropathy \"pseudosyringomyelic\" they are usually of lumbar onset."
},
"2": {
"exist... | This year's Neurology section's burning question. He presents a diabetic patient on insulin treatment with good control (although diabetic neuropathies do not only develop in patients with poor control) with a sensory picture limited to the upper limbs and of short onset time, without motor symptoms or at any other lev... | This year's Neurology section's burning question. He presents a diabetic patient on insulin treatment with good control (although diabetic neuropathies do not only develop in patients with poor control) with a sensory picture limited to the upper limbs and of short onset time, without motor symptoms or at any other lev... | A 32-year-old diabetic patient on insulin therapy with good control of his blood glucose levels comes to your office with tingling in both hands, with a sensation of corking and thermal insensitivity of progressive onset over the course of 2 weeks. She does not report visual disturbances, strength deficit, motor clumsi... | 127 | en | {
"1": "Peripheral sensitvo symmetric distal peripheral neuropathy of diabetic cause.",
"2": "Compressive cervical spinal cord injury.",
"3": "Bilateral carpal tunnel syndrome.",
"4": "Multiple sclerosis type demyelinating disease.",
"5": "Central cervical spinal cord injury."
} | 77 | NEUROLOGY AND NEUROSURGERY | 2,012 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en094_13074",
"title": "Intention tremor",
"score": 0.0176538908,
"content": "Intention tremors can be a first sign of multiple sclerosis, since loss or deterioration of motor function a... |
1 | {
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"text": "It is SLE with joint, skin and serositis involvement. Treatment is EC at moderate-high doses."
},
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"char_ranges"... | It is SLE with joint, skin and serositis involvement. Treatment is EC at moderate-high doses. Mycophenolate is never a treatment in acute phase but in maintenance, nor has it proved useful in joint involvement. | It is SLE with joint, skin and serositis involvement. Treatment is EC at moderate-high doses. Mycophenolate is never a treatment in acute phase but in maintenance, nor has it [HIDDEN]. | A 37-year-old man presents with arthritis of the metacarpophalangeal joints of both hands and right pleuritis. Bilateral malar erythema is seen on examination. Positive antinuclear antibodies were detected (titer 1/640), with anti native DNA antibodies also positive; anti-Sm negative What would be the initial treatment... | 316 | en | {
"1": "Glucocorticoids at high doses.",
"2": "Glucocorticoids and mycophenolate.",
"3": "Nonsteroidal anti-inflammatory drugs and antimalarials.",
"4": "The picture will probably be self-limited and does not require treatment.",
"5": null
} | 138 | RHEUMATOLOGY | 2,016 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0422_20674",
"title": "[Two cases of rheumatoid arthritis developed after polymyositis].",
"score": 0.0167701863,
"content": "We report two cases of rheumatoid arthritis (RA) who later had ... |
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"text": "Given this clinical picture, one possibility is dermatomyositis. Of the proposed tests, the determination of serum aldolase may be useful. Its e... | Given this clinical picture, one possibility is dermatomyositis. Of the proposed tests, the determination of serum aldolase may be useful. Its elevation is characteristic of this disease. The biopsy should be muscular and not subcutaneous. Anti-smooth muscle antibodies are not characteristic of this disease. | Given this clinical picture, one possibility is dermatomyositis. Of the proposed tests, the determination of serum aldolase may be useful. Its elevation is characteristic of this disease. The biopsy should be muscular and not subcutaneous. Anti-smooth muscle antibodies are not characteristic of this disease. | A 75-year-old woman consults for violaceous lesions on the hands and neck together with progressive muscle weakness of 3 months of evolution. What diagnostic tests, among those indicated, can be useful for the diagnosis? | 153 | en | {
"1": "Determination of serum aldolase.",
"2": "Electroencephalogram.",
"3": "Biopsy of subcutaneous cellular tissue.",
"4": "Determination of anti-smooth muscle antibodies.",
"5": "Genetic study of their descendants."
} | 74 | RHEUMATOLOGY | 2,012 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en065_36497",
"title": "Hereditary inclusion body myopathy",
"score": 0.0134780258,
"content": "Diagnosis The most useful information for accurate diagnosis is the symptoms and weakness ... |
2 | {
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"text": "Systemic corticosteroids in these patients should... | Systemic corticosteroids in these patients should be used primarily in acute exacerbations, not for control of exacerbations. | Systemic corticosteroids in these patients should be used primarily in acute exacerbations, not for control of exacerbations. | A 67-year-old man, ex-smoker, with a diagnosis of severe COPD (multidimensional index BODE 5, FEVl 38%, body mass index 23, dyspnea index according to the mMRC 3 scale, distance covered in the 6-minute walk test 260 m) who has had 3 hospital admissions for exacerbation of his COPD in the last 7 months, comes to the con... | 369 | en | {
"1": "Adjustment of inhaled therapy with long-acting bronchodilators combining anticholinergics and beta-2 adrenergics with inhaled glucocorticoids.",
"2": "Start oral glucocorticoids for 6 months to control exacerbations.",
"3": "Check that the patient performs the inhalation technique correctly.",
"4": "Ini... | 122 | PNEUMOLOGY AND THORACIC SURGERY | 2,016 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0794_1665",
"title": "The clinical and integrated management of COPD.",
"score": 0.015942029,
"content": "COPD is a chronic pathological condition of the respiratory system characterized by... |
4 | {
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"... | Rupture of the interventricular septum. Mechanical complications are typical in infarctions in elderly women. Likewise, a murmur that was not present indicates abnormal blood flow: the most frequent complications are mitral insufficiency, which would present with a musical or piante murmur, and VSD, which presents with... | Rupture of the interventricular septum. Mechanical complications are typical in infarctions in elderly women. Likewise, a murmur that was not present indicates abnormal blood flow: the most frequent complications are mitral insufficiency, which would present with a musical or piante murmur, and VSD, which presents with... | An 87-year-old woman with a history of hypertension was admitted 48 hours ago to the coronary unit for acute myocardial infarction with ST-segment elevation of anterior location. She reported dyspnea. Examination revealed a systolic murmur with fremitus, radiating to the right sternal border, which was not present on a... | 413 | en | {
"1": "Heart failure due to extensive necrosis.",
"2": "Anterior aneurysm.",
"3": "Left ventricular free wall rupture.",
"4": "Rupture in the interventricular septum.",
"5": null
} | 68 | CARDIOLOGY AND CARDIOVASCULAR SURGERY | 2,018 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0122_844",
"title": "[Mid-systolic ejection murmur with thrill caused by right ventricular outflow tract obstruction secondary to septal aneurysm following myocardial infarction: a case report].",
"s... |
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"text": "in the meantime we would ask for a CT scan (or abdominal MRI) to subsequently assess the plexus block (answers 1 and 2 for future managemen... | We have before us a patient with neuropathic pain, which due to the origin of the tumor, is most likely due to involvement of the celiac plexus. It is important to have a radiological diagnosis in view of a possible local treatment, such as neurolytic treatment or plexus blockade. However, we should not leave the patie... | We have before us a patient with neuropathic pain, which due to the origin of the tumor, is most likely due to involvement of the celiac plexus. It is important to have a radiological diagnosis in view of a possible local treatment, such as neurolytic treatment or plexus blockade. However, we should not leave the patie... | A 66-year-old patient diagnosed with stage IV pancreatic adenocarcinoma 8 months ago. He follows treatment with delayed release morphine 200 mg/12 hours orally, kerosene and lactulose. For the last 15 days he has reported paresthesias and occasional lancinating pain in the right lumbar and periumbilical area that does ... | 314 | en | {
"1": "Perform computed axial tomography and evaluate nerve compression since it is neuropathic pain.",
"2": "Evaluate neurolytic treatment since neuropathic pain is difficult to control.",
"3": "Decrease the dose of morphine as it is ineffective in this type of pain.",
"4": "Administer amitriptyline or gabape... | 178 | ONCOLOGY | 2,016 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en046_39133",
"title": "Neuralgia",
"score": 0.0130105402,
"content": "Treatment Treatment options include medicines and surgery. Neuralgia is more difficult to treat than other types of... |
1 | {
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"text": "It is a claude bernard horner syndrome and probably the correct one is 1."
},
"2": {
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"word_r... | The question would be more of neurology. It is a claude bernard horner syndrome and probably the correct one is 1. But for safety's sake it is better to have it checked by a neurologist. | The question would be more of neurology. It is a claude bernard horner syndrome and probably [HIDDEN]. But for safety's sake it is better to have it checked by a neurologist. | Juan is 60 years old, has been smoking 2 packs/day for years and has reported a persistent cough for the last 6 months. He notes that his left eyelid is more droopy and that the pupil of this eye is smaller. John reports that the medial side of his left hand is numb and with less strength. His physician checks for palp... | 263 | en | {
"1": "Sympathetic fibers, at some level that would span from the hypothalamus to the interinedio-lateral Clark's column of the dorsal medulla.",
"2": "Left common ocular motor nerve in the midbrain.",
"3": "Edinger-Westphal nucleus above the left common ocular motor nerve nucleus.",
"4": "Parasympathetic fibe... | 37 | PNEUMOLOGY | 2,014 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en012_32998",
"title": "Oculomotor nerve",
"score": 0.0156041287,
"content": "All these branches enter the muscles on their ocular surfaces, with the exception of the nerve to the inferi... |
2 | {
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"text": "She should not become pregnant until she has unde... | She should not become pregnant until she has undergone regular check-ups and one year has passed with negative beta-HCG levels. Patients will be monitored weekly with hCG dosing until it becomes undetectable, for three consecutive times. After that the monitoring will be monthly for six months and then every two months... | She should not become pregnant until she has undergone regular check-ups and one year has passed with negative beta-HCG levels. Patients will be monitored weekly with hCG dosing until it becomes undetectable, for three consecutive times. After that the monitoring will be monthly for six months and then every two months... | A 24-year-old woman, primigestation, suffers a spontaneous abortion at 7 weeks gestation. The anatomopathological study of the abortive remains indicates molar disease. We should inform you that: | 344 | en | {
"1": "The risk of a new molar gestation in a future pregnancy is 50%.",
"2": "She should not become pregnant until periodic check-ups and after one year with negative BHCG levels.",
"3": "Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete.",
"4": "Periodic check-u... | 158 | GYNECOLOGY AND OBSTETRICS | 2,016 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en036_29141",
"title": "Gestational trophoblastic disease",
"score": 0.0183043514,
"content": "In the past, it was seen as important not to get pregnant straight away after a GTD. Specia... |
4 | {
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"... | The correct answer is 4. What is not very clear to me is "routine urinalysis" because it is not usually done in an asymptomatic healthy child. Microhematuria without associated symptoms may be a finding without pathologic significance and must be confirmed in a subsequent new sediment (although I do not know if at 15 d... | [HIDDEN] What is not very clear to me is "routine urinalysis" because it is not usually done in an asymptomatic healthy child. Microhematuria without associated symptoms may be a finding without pathologic significance and must be confirmed in a subsequent new sediment (although I do not know if at 15 days or later). | A 10-year-old girl comes for a health check-up. Physical examination is normal with weight and height in the 50th percentile and BP 109/65. A routine urinalysis shows a specific gravity of 1035 pH6 blood 2+ with no protein. Urine sediment shows 5-10 red blood cells per field. What would be the most appropriate course o... | 43 | en | {
"1": "Determination of creatinine and nitrogen in blood.",
"2": "Refer the child for cystoscopy.",
"3": "Determine antinuclear antibodies and complement.",
"4": "Repeat urine sediment in 15 days.",
"5": "Abdominal computed axial tomography."
} | 151 | PEDIATRICS | 2,011 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0510_13943",
"title": "[Acute tubulointerstitial nephritis in children].",
"score": 0.0178628389,
"content": "Acute tubulointerstitial nephritis (ATIN) is a rare renal disorder in children.... |
2 | {
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"text": "Orthosis. Cobb angle between 25º - 45º. Immature s... | Orthosis. Cobb angle between 25º - 45º. Immature skeleton (Risser 0). | Orthosis. Cobb angle between 25º - 45º. Immature skeleton (Risser 0). | A 13-year-old female, with no relevant history, with menarche 3 months ago, followed since the age of 10 years by 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 thoracolumbar curve T4-L1 of 35 degrees of Cobb and a Risser 0.... | 616 | en | {
"1": "Recommend swimming and revision in three months.",
"2": "Prescribe a corset-type orthosis.",
"3": "Refer to physiotherapy for spine elastification.",
"4": "Review in 6 months with a new X-ray.",
"5": null
} | 119 | TRAUMATOLOGY | 2,022 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0573_15298",
"title": "The natural history of idiopathic scoliosis.",
"score": 0.0193349524,
"content": "Background. The natural history of idiopathic scoliosis is a crucial issue in the pl... |
4 | {
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"text": "The bone marrow aspirate or biopsy is only ind... | The patient is already diagnosed with chronic lymphocytic leukemia B (B-CLLL), presents lymphocytosis that is maintained for more than 3 months and by flow cytometry presents a phenotype compatible with it. Therefore, we must first know the risk factors that will indicate with what priority treatment will need to be in... | The patient is already diagnosed with chronic lymphocytic leukemia B (B-CLLL), presents lymphocytosis that is maintained for more than 3 months and by flow cytometry presents a phenotype compatible with it. Therefore, we must first know the risk factors that will indicate with what priority treatment will need to be in... | A 67-year-old patient who in the last 6 months, in two routine analyses, presents progressive lymphocytosis. In the last one, hemoglobin 15.4 g/dL; leukocytes 18.5 x103/μL with 82 % of mature lymphocytes that by flow cytometry express CD5/CD19/CD23 antigens and platelets 240 x103/μL. What do you think is the correct ap... | 489 | en | {
"1": "Study of TP53 mutations to establish prognosis.",
"2": "Bone aspirate/biopsy to confirm diagnosis.",
"3": "PET/CT to establish the therapeutic attitude.",
"4": "New clinical and analytical control in 6 months.",
"5": null
} | 105 | HEMATOLOGY | 2,020 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0771_21251",
"title": "[Chronic lymphocytic leukemia].",
"score": 0.0184479986,
"content": "Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disorder that accounts for approximat... |
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"text": "This is a clear clinical case of systemic sclerosis (Raynaud's, esophageal involvement, skin induration) presenting with renal crisis. Apart fro... | This is a clear clinical case of systemic sclerosis (Raynaud's, esophageal involvement, skin induration) presenting with renal crisis. Apart from anti-proteinase 3 antibodies, which are not related to scleroderma (incorrect answer 3), the most likely ones would be antiRNA polymerase III antibodies, which appear in youn... | This is a clear clinical case of systemic sclerosis (Raynaud's, esophageal involvement, skin induration) presenting with renal crisis. Apart from anti-proteinase 3 antibodies, which are not related to scleroderma ([HIDDEN]), the most likely ones would be antiRNA polymerase III antibodies, which appear in younger patien... | A 45-year-old female patient with a history of gastroesophageal reflux has been presenting for the past year with episodes of pallor in some fingers with exposure to cold. She had recently been prescribed prednisone at a dose of 20 mg/day for joint pain and skin induration in the hands and arms. For the last 48 hours, ... | 534 | en | {
"1": "Anti-RNA polymerase III antibodies.",
"2": "Anti-centromere antibodies.",
"3": "Anti-proteinase 3 antibodies.",
"4": "Anti-PM-Scl antibodies.",
"5": null
} | 119 | RHEUMATOLOGY | 2,021 | {
"clinical_case_options": {
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{
"id": "pubmed23n1102_22675",
"title": "Case 294: Catastrophic Antiphospholipid Syndrome.",
"score": 0.0179404666,
"content": "History A 50-year-old woman presented to the emergency department of our hospit... |
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"text": "Barrett's esophagus does not necessarily imply peptic stricture, but assuming it does, it is progressive."
},
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... | This is intermittent dysphagia. Barrett's esophagus does not necessarily imply peptic stricture, but assuming it does, it is progressive. Infectious esophagitis is more typical of immunocompromised patients. That leaves distal esophageal ring and eosinophilic esophagitis; both are possible, but the insistence on the pa... | This is intermittent dysphagia. Barrett's esophagus does not necessarily imply peptic stricture, but assuming it does, it is progressive. Infectious esophagitis is more typical of immunocompromised patients. That leaves distal esophageal ring and eosinophilic esophagitis; both are possible, but the insistence on the pa... | 18-year-old young man with a history of asthma, allergy to pollens, mites and cat hair, comes to the emergency room referring sensation of food detention at retrosternal level with practical inability to swallow his own saliva. He refers similar episodes on other occasions that have subsided spontaneously within a few ... | 273 | en | {
"1": "Barrett's esophagus.",
"2": "Distal esophageal ring (Schatzki).",
"3": "Infectious esophagitis.",
"4": "Eosinophilic esophagitis.",
"5": null
} | 71 | DIGESTIVE SYSTEM | 2,016 | {
"clinical_case_options": {
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{
"id": "wiki20220301en087_9091",
"title": "Eosinophilic esophagitis",
"score": 0.0176242236,
"content": "Esophageal strictures and rings can be safely dilated in EoE. It is recommended to use a graduated ba... |
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"text": "Answer 2 is false (Turner syndrome: low estradiol ... | Answer 2 is false (Turner syndrome: low estradiol and elevated gonadotrophins), brain tumors affecting the hypothalamus-pituitary gland do not give low gonadotrophins (5 false), and it seems obvious that refractive defects do not give hemianopsia (3 and 4 false). | Answer 2 is [HIDDEN] (Turner syndrome: low estradiol and elevated gonadotrophins), brain tumors affecting the hypothalamus-pituitary gland do not give low gonadotrophins ([HIDDEN]), and it seems obvious that refractive defects do not give hemianopsia ([HIDDEN]). | 14-year-old girl who consults for decreased growth for 2-3 years previously normal (provides data) and that other girls her age have greater physical and sexual development. Lately she has had headaches and visual problems that she notices in class and when studying. She has not had menarche or polydipsia or polyuria. ... | 56 | en | {
"1": "Decreased growth and sexual development, delayed bone age, headache and visual alteration suggest hormonal deficit and involvement of the optic chiasm.",
"2": "As she is a girl of pubertal age, it is most likely that her decreased growth and sexual retardation are due to Turner syndrome.",
"3": "She must ... | 76 | ENDOCRINOLOGY | 2,011 | {
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{
"id": "pubmed23n1132_12218",
"title": "Different Cases of Short Stature.",
"score": 0.0160781646,
"content": "This case sieries gives three different cases with three different presentation and different a... |
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"text": "The statement perfectly defines a tolerance phenomenon in which the patient has become \"used to\" the dose and needs more in order to have the... | The correct answer is 1. The statement perfectly defines a tolerance phenomenon in which the patient has become "used to" the dose and needs more in order to have the same analgesic effect. | The [HIDDEN] The statement perfectly defines a tolerance phenomenon in which the patient has become "used to" the dose and needs more in order to have the same analgesic effect. | The patient comes to the home of an oncology patient whose pain has not been well controlled lately. On physical examination there appears to be no evidence of tumor progression, and no previously known data of interest is revealed. In the anamnesis, the main caregiver states that the patient has pain 8 hours after rec... | 409 | en | {
"1": "Tolerance",
"2": "Hyperalgesia",
"3": "Dependency",
"4": "Ineffectiveness",
"5": null
} | 191 | PRIMARY CARE | 2,018 | {
"clinical_case_options": {
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{
"id": "wiki20220301en289_33584",
"title": "Patient-controlled analgesia",
"score": 0.0117360017,
"content": "With a PCA the patient is protected from overdose by the caregiver programming the PCA to delive... |
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"text": "In the presence of isolated thrombocytopenia we must not lose sight of the physical examination; thus, the presence of lymphadenopathy forces us... | In the presence of isolated thrombocytopenia we must not lose sight of the physical examination; thus, the presence of lymphadenopathy forces us to rule out the presence of lymphoma, for example. 1 is correct. When performing a bone marrow biopsy-aspirate it is seen that the number of megakaryocytes is normal or even i... | In the presence of isolated thrombocytopenia we must not lose sight of the physical examination; thus, the presence of lymphadenopathy forces us to rule out the presence of lymphoma, for example. [HIDDEN] When performing a bone marrow biopsy-aspirate it is seen that the number of megakaryocytes is normal or even increa... | A 33-year-old woman consults for repeated epistaxis, petechiae and ecchymosis. Laboratory tests show thrombocytopenia with a platelet count of 4000 platelets/microliter. The initial presumptive diagnosis is chronic immune thrombocytopenic purpura (ITP). Which of the following statements is FALSE regarding the diagnosis... | 179 | en | {
"1": "The presence of lymphadenopathy or splenomegaly in the physical examination suggests a different diagnosis of ITP.",
"2": "Bone marrow analysis shows a decreased number of megakaryocytes without other alterations.",
"3": "Complete blood count shows isolated thrombocytopenia with often large platelets, wit... | 98 | HEMATOLOGY | 2,013 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "wiki20220301en016_42764",
"title": "Immune thrombocytopenic purpura",
"score": 0.0195126594,
"content": "Despite the destruction of platelets by splenic macrophages, the spleen is normally not enlar... |
2 | {
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"text": "It is a typical case of deep endometriosis, with... | Diagnostic laparoscopy. It is a typical case of deep endometriosis, with implants in different parts of the pelvis. The definitive diagnosis will be given by the pathological anatomy, so for this we have to do Laparoscopy and send to PA. | Diagnostic laparoscopy. It is a typical case of deep endometriosis, with implants in different parts of the pelvis. The definitive diagnosis will be given by the pathological anatomy, so for this we have to do Laparoscopy and send to PA. | A 27-year-old woman referred to the gynecology office for evaluation referring dyspareunia for about 8 months, along with dyschezia and occasional rectorrhagia coinciding with menstruation for 3-4 months. She also reports dysmenorrhea for years, which she controls well with ibuprofen. She has been trying to get pregnan... | 353 | en | {
"1": "Transvaginal ultrasound.",
"2": "Diagnostic laparoscopy.",
"3": "Magnetic resonance imaging.",
"4": "Colonoscopy.",
"5": null
} | 161 | GYNECOLOGY AND OBSTETRICS | 2,016 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n1003_10794",
"title": "Sonographic Evaluation for Endometriosis in Routine Pelvic Ultrasound.",
"score": 0.0120400433,
"content": "To show how the evaluation for endometriosis can be includ... |
4 | {
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"... | As a possible disease I would consider Brucellosis, typical of cattle (milk, abortion, genital secretions...). It presents with a pseudo-flu-like symptomatology (headache, arthralgias, myalgias, fever...) and other symptoms depending on the route of entry. In our case, when attending animal births, the entry is through... | As a possible disease I would consider Brucellosis, typical of cattle (milk, abortion, genital secretions...). It presents with a pseudo-flu-like symptomatology (headache, arthralgias, myalgias, fever...) and other symptoms depending on the route of entry. In our case, when attending animal births, the entry is through... | A 38-year-old woman of veterinary profession, in charge of monitoring wild animals and assisting in the delivery of domestic livestock. She starts with a high fever with chills, headache, myalgia and non-productive cough that she interprets as a flu-like process. She presented with chest pain. Chest X-ray showed bilate... | 438 | en | {
"1": "This entity is transmitted by ticks.",
"2": "Both doxycycline and hydroxychloroquine are effective in treating acute forms of this disease.",
"3": "In the acute form, the patient also generally has elevated antibodies to phase I antigens.",
"4": "Mortality in acute forms is almost nonexistent.",
"5": ... | 119 | EPIDEMIOLOGY AND PREVENTIVE MEDICINE | 2,018 | {
"clinical_case_options": {
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{
"id": "pubmed23n1159_13154",
"title": "Importance of clinical history in the diagnosis of psittacosis: A case report.",
"score": 0.0188948307,
"content": "Psittacosis, caused by the bacteria Chlamydia psit... |
4 | {
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"text": "According to the described examination the Glasgow is 4 (O1V1M2)."
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... | Hypercapnia and acidosis produce vasodilatation causing increased cerebral blood flow. According to the described examination the Glasgow is 4 (O1V1M2). Cerebral perfusion pressure is mean arterial pressure minus intracranial pressure. Cerebral edema in which cellular edema is produced by the introduction of extracellu... | Hypercapnia and acidosis produce vasodilatation causing increased cerebral blood flow. According to the described examination the Glasgow is 4 (O1V1M2). Cerebral perfusion pressure is mean arterial pressure minus intracranial pressure. Cerebral edema in which cellular edema is produced by the introduction of extracellu... | A 49-year-old man is admitted to the ICU for traumatic brain injury after an accident at work. In the physical examination he does not open his eyes, does not emit sounds before being intubated and presents extension of extremities to nociceptive stimulus. An intracranial pressure sensor is placed and a decompressive c... | 579 | en | {
"1": "On arrival she is in a Glasgow scale coma of 7.",
"2": "Cerebral perfusion pressure is mean arterial pressure plus intracranial pressure.",
"3": "Vasogenic cerebral edema is due to cellular edema, membrane rupture and cell death.",
"4": "Cerebral vascular flow increases with hypercapnia and acidosis.",
... | 108 | NEUROLOGY | 2,022 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0576_5783",
"title": "Role of decompressive craniectomy in the management of severe head injury with refractory cerebral edema and intractable intracranial pressure. Our experience with 48 cases.",
"... |
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"text": "Answers 1, 2 and 5 are appropriate treatments for dumping syndrome or postgastrectomy, but the question is focused on initial management, so the... | Answers 1, 2 and 5 are appropriate treatments for dumping syndrome or postgastrectomy, but the question is focused on initial management, so the most appropriate answer seems to be 2. | Answers 1, 2 and 5 are appropriate treatments for dumping syndrome or postgastrectomy, but the question is focused on initial management, so the most appropriate answer seems to be [HIDDEN]. | A 45-year-old man undergoes a truncal vagotomy and antrectomy with Billroth II reconstruction for chronic peptic ulcer disease with pyloro-duodenal stricture. Six weeks after the surgery she reports that shortly after (less than half an hour) after ingestions she presents nausea, asthenia and sweating, dizziness and ab... | 212 | en | {
"1": "Apply treatment with a somatostatin inhibitor (octreotide).",
"2": "Follow specific dietary measures.",
"3": "Trial treatment with a benzodiazepine.",
"4": "Search for a probable neuroendocrine tumor (e.g. carcinoid).",
"5": "Indicate surgical treatment to perform an antiperistaltic Roux-en-Y gastroje... | 88 | GENERAL SURGERY | 2,014 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0285_22989",
"title": "[Peptic ulcer: late complications of the surgical treatment].",
"score": 0.0162989465,
"content": "The incidence of surgical treatment of peptic ulcer decreased in th... |
3 | {
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... | Be careful with lithium. Intoxications have been seen with normal lithium. It is not rare -especially due to interactions-. A very effective drug if everyone is forewarned. | Be careful with lithium. Intoxications have been seen with normal lithium. It is not rare -especially due to interactions-. A very effective drug if everyone is forewarned. | A 46-year-old man with bipolar disorder is brought to the emergency department after an over-ingestion of lithium carbonate. Examination reveals severe tremor, ataxia, dysarthria, myoclonus and fasciculations. Lithemia is 4.1 mEq/L (toxicity > 1.6 mEq/L). Which of the following therapeutic options would be most indicat... | 507 | en | {
"1": "Aminophylline associated with a cathartic.",
"2": "Activated charcoal.",
"3": "Hemodialysis.",
"4": "Forced diuresis.",
"5": null
} | 89 | PSYCHIATRY | 2,020 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0522_8152",
"title": "[Acute intoxication with sustained-release lithium carbonate tablets. A propos of a case].",
"score": 0.0192325474,
"content": "To describe the case of a patient who i... |
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"text": "There is no doubt, they are not meeting the diagnostic criteria of Kawasaki disease (fever of several days of evolution, exanthema, conjunctival... | There is no doubt, they are not meeting the diagnostic criteria of Kawasaki disease (fever of several days of evolution, exanthema, conjunctival injection, red lips, raspberry tongue, edema of acral parts and adenopathy). | There is no doubt, they are not meeting the diagnostic criteria of Kawasaki disease (fever of several days of evolution, exanthema, conjunctival injection, red lips, raspberry tongue, edema of acral parts and adenopathy). | A 4-year-old girl presenting with a high fever of 6 days' evolution. On clinical examination she presents an erythematous maculopapular rash on the trunk and genital area, with a tendency to confluence, without becoming scarlatiniform; conjunctival injection without secretions and red lips with raspberry tongue. She al... | 552 | en | {
"1": "Kawasaki disease.",
"2": "Measles.",
"3": "Rubella.",
"4": "Scarlet fever.",
"5": null
} | 89 | DERMATOLOGY | 2,022 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0735_10590",
"title": "Catastrophic Kawasaki disease unresponsive to IVIG in a 3-month-old infant: a diagnostic and therapeutic challenge.",
"score": 0.0185966423,
"content": "The present r... |
3 | {
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... | In this patient, he presents with a granulomatosis with polyangiitis formerly known as Wegener's granulomatosis. In the clinical case we are told about the otorhinolaryngologic involvement that is present in 92% of patients. At the pulmonary level, we were told that mucus with a clot was present in 85% of the patients.... | In this patient, he presents with a granulomatosis with polyangiitis formerly known as Wegener's granulomatosis. In the clinical case we are told about the otorhinolaryngologic involvement that is present in 92% of patients. At the pulmonary level, we were told that mucus with a clot was present in 85% of the patients.... | A 67-year-old man presents with 3 months of asthenia and febrile fever, with nasal obstruction and mucus emission with some clots in the last month. In the last few days she noticed pain in the right eye and asymmetry with respect to the contralateral eye. Physical examination reveals proptosis of the right eyeball and... | 598 | en | {
"1": "Eosinophilic granulomatosis with polyangiitis.",
"2": "Microscopic polyangiitis.",
"3": "Granulomatosis with polyangiitis.",
"4": "Polyarteritis nodosa.",
"5": null
} | 181 | RHEUMATOLOGY | 2,022 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en249_18855",
"title": "Systemic vasculitis",
"score": 0.0194174757,
"content": "Medium vessel vasculitis These conditions are sometimes considered together with the small vessel vasculi... |
4 | {
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"text": "An epiretinal membrane usually has a slower course."
},
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930... | Of the five options, four could be compatible with the referred symptoms. We could initially rule out central serous chorioretinopathy because by definition it occurs in young people (up to 55 years of age, more or less). The key to differentiate between the other four is that he had soft drusen in the fundus. That whi... | Of the five options, four could be compatible with the referred symptoms. [HIDDEN] because by definition it occurs in young people (up to 55 years of age, more or less). The key to differentiate between the other four is that he had soft drusen in the fundus. That while not a "diagnosis" (the question could have been b... | 75-year-old woman diagnosed 3 years ago with soft drusen in the fundus. She reports presenting, since 2 weeks ago, metamorphopsia and significant visual loss in her right eye that prevents her from reading. Indicate the most probable diagnosis: | 133 | en | {
"1": "Macular epiretinal membrane.",
"2": "Macular hole.",
"3": "Thrombosis of the central retinal vein.",
"4": "Senile macular degeneration.",
"5": "Central serous chorioretinopathy."
} | 168 | OPHTHALMOLOGY | 2,012 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0087_4306",
"title": "[Macular diseases in the elderly person].",
"score": 0.0185582954,
"content": "Macular diseases in the elderly, such as age-related macular degeneration, idiopathic se... |
3 | {
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"text": "We all agree that the patient seems to have Cushing's syndrome (we rule out 1)."
},
"2": {
"exist": true,
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... | This question is a bit convoluted for the diagnosis of Cushing's syndrome but easy if the steps are clear. We all agree that the patient seems to have Cushing's syndrome (we rule out 1). For the diagnosis we have to measure urinary free cortisol, do a dexamethasone suppression test or measure nocturnal salivary cortiso... | This question is a bit convoluted for the diagnosis of Cushing's syndrome but easy if the steps are clear. We all agree that the patient seems to have Cushing's syndrome (we [HIDDEN]). For the diagnosis we have to measure urinary free cortisol, do a dexamethasone suppression test, or measure nocturnal salivary cortisol... | A 56-year-old female patient consulted for dorso-lumbar spine pain and progressive difficulty in performing usual tasks. In the last 5 years she gained weight, she has ecchymosis easily and arterial hypertension was detected. Physical examination: Obesity of central predominance, rounded facies, increased supraclavicul... | 186 | en | {
"1": "Postmenopausal osteoporosis, type 2 diabetes mellitus and essential hypertension, with decreased strength due to diabetic polyneuropathy.",
"2": "It is necessary to rule out Cushing's disease by dexamethasone suppression test and perform a cranial CT scan.",
"3": "Suggest Cushing's. Determine urinary free... | 67 | ENDOCRINOLOGY | 2,013 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0356_4633",
"title": "Subclinical Cushing's syndrome.",
"score": 0.0190493469,
"content": "Classic Cushing's syndrome is a rare disease with an estimated incidence of 1 case per 100,000 per... |
5 | {
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"text": "By rule 1 would be easy to eliminate, the treatment of colon cancer is surgical (with neoadjuvant in rectal cancer)."
},
"2": {
"exist"... | Complicated question about an unusual adenocarcinoma. By rule 1 would be easy to eliminate, the treatment of colon cancer is surgical (with neoadjuvant in rectal cancer). If biopsies confirm adenocarcinoma, there is no need to repeat them, since it is necessary to have the complete specimen. Most colon cancer develops ... | Complicated question about an unusual adenocarcinoma. By rule 1 would be easy to eliminate, the treatment of colon cancer is surgical (with neoadjuvant in rectal cancer). If biopsies confirm adenocarcinoma, there is no need to repeat them, since it is necessary to have the complete specimen. Most colon cancer develops ... | During a colonoscopy, a 5-cm tumor located in the right colon is detected in a 48-year-old man. No other lesions were found. His maternal grandmother also suffered from colon cancer. The biopsies are superficial and show a poorly differentiated tumor with abundant inflammatory cells in the stroma that is diagnosed as a... | 7 | en | {
"1": "Chemotherapy is the treatment of choice.",
"2": "Since the biopsy is superficial, it should be repeated before proceeding with treatment.",
"3": "The prognosis of the tumor depends mainly on its high degree of anaplasia.",
"4": "It is unlikely that this tumor has developed over a previous adenoma.",
"... | 208 | DIGESTIVE | 2,011 | {
"clinical_case_options": {
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{
"id": "wiki20220301en190_40247",
"title": "Signet ring cell carcinoma",
"score": 0.0121322314,
"content": "Colorectal Primary signet ring cell carcinoma of the colon and rectum (PSRCCR) is rare, with a rep... |
3 | {
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"text": "No changes should be made in the hypouricemic treatment during this period because the uric acid metabolic chain is altered and the situation... | In the presence of acute gouty arthritis (the presence of intracellular crystals with negative birefringence confirms this) in a hyperuricemic patient previously treated with allopurinol, an NSAID should be added until the crisis subsides. No changes should be made in the hypouricemic treatment during this period becau... | In the presence of acute gouty arthritis (the presence of intracellular crystals with negative birefringence confirms this) in a hyperuricemic patient previously treated with allopurinol, an NSAID should be added until the crisis subsides. No changes should be made in the hypouricemic treatment during this period becau... | A hyperuricemic patient who usually takes 100 mg of allopurinol daily comes to the ED with acute pain and inflammatory signs in the right knee. Arthrocentesis is performed and polarized light microscopy shows intracellular crystals with negative birefringence. Which of the following therapeutic approaches is the most a... | 152 | en | {
"1": "Discontinue allopurinol and start colchicine treatment.",
"2": "Discontinue allopurinol and start NSAIDs.",
"3": "Add an NSAID until the crisis remits.",
"4": "Increase the dose of allopurinol to 300 mg/day.",
"5": "Substitute allopurinol for uricosuric acid."
} | 72 | RHEUMATOLOGY | 2,012 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0824_19774",
"title": "Does starting allopurinol prolong acute treated gout? A randomized clinical trial.",
"score": 0.0193277311,
"content": "Traditionally, allopurinol is not initiated du... |
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"text": "ELISA is a very sensitive technique, so a negative result could leave us quite calm, however, we all know that there is no medical test tha... | A simple question if we are clear about the diagnostic process of HIV. At first glance, we could directly rule out answer 2 since we know that mononucleosis can be an expression of the first phase of HIV infection, especially when we have a history of a risk contact. Answers 3 and 4 are also easily ruled out; ELISA is ... | A simple question if we are clear about the diagnostic process of HIV. At first glance, we could directly rule out answer 2 since we know that mononucleosis can be an expression of the first phase of HIV infection, especially when we have a history of a risk contact. [HIDDEN]; ELISA is a very sensitive but not very spe... | A 20-year-old girl comes to the clinic with an acute fever, cervical lymphadenopathy and skin rash. According to the patient, 3 weeks ago she had a sexual relationship that could be a risk for contracting the HIV virus. Indicate which of the following answers is true: | 243 | en | {
"1": "A negative HIV-1/HIV-2 serology performed by ELISA technique rules out the possibility that the patient has been infected with the HIV virus.",
"2": "The clinical process that the patient suffers from is not consistent with acute HIV infection.",
"3": "If the patient's ELISA test was positive, nothing fur... | 112 | INFECTIOUS DISEASES | 2,014 | {
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"title": "Diagnosis of HIV/AIDS",
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"content": "The ELISA antibody tests were developed to provide a high level of confidence that donated blood was no... |
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... | You are asking about auriculotemporal syndrome or Frey's syndrome. It is the clinical expression of a vegetative neuropathy caused by mechanical or irritative lesion of the vegetative fibers of the auriculotemporal nerve in its infratemporal pathway. In our environment the most frequent cause is surgery of the split gl... | You are asking about auriculotemporal syndrome or Frey's syndrome. It is the clinical expression of a vegetative neuropathy caused by mechanical or irritative lesion of the vegetative fibers of the auriculotemporal nerve in its infratemporal pathway. In our environment the most frequent cause is surgery of the split gl... | 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 mastication. What treatment would be the treatment of choice? | 458 | en | {
"1": "Extended total parotidectomy on suspicion of tumor recurrence.",
"2": "Pregabalin.",
"3": "Intradermal botulinum toxin injection.",
"4": "Broad-spectrum antibiotherapy.",
"5": null
} | 126 | OTOLARYNGOLOGY 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": 0.0177750058,
"content": "Most authors agree th... |
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"text": "The most frequent cause of urinary tract infections is Escherichia coli and in the case of pregnant women as well."
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"exist": ... | The correct answer is the first one. The most frequent cause of urinary tract infections is Escherichia coli and in the case of pregnant women as well. | [HIDDEN] The most frequent cause of urinary tract infections is Escherichia coli and in the case of pregnant women as well. | Pregnant woman, 27 years old, 30 weeks of gestation. She comes to the emergency room because she noticed pain in the left lumbar region and dysuria since yesterday. She has no febrile sensation. She refers repeated urinary tract infections (UTI). Urinalysis shows Hb 3+, leukocytes 3+, nitrites 2+, sediment: 15-20 leuko... | 123 | en | {
"1": "Escherichia coli.",
"2": "Enterococcus faecalis.",
"3": "Streptococcus agalactiae.",
"4": "Proteus mirabilis.",
"5": "Satphylococcus saprophyticus."
} | 223 | MICROBIOLOGY | 2,012 | {
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"id": "pubmed23n1031_21939",
"title": "Urinary Tract Infections among Indonesian Pregnant Women and Its Susceptibility Pattern.",
"score": 0.0167410714,
"content": "Pregnant women are usually at risk of ur... |
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"text": "Regarding weight, metformin to a lesser extent, SGLT-2 inhibitors and, above all, GLP-1 agonists have been associated with a significant decrea... | A somewhat more complicated question than the previous one. Regarding weight, metformin to a lesser extent, SGLT-2 inhibitors and, above all, GLP-1 agonists have been associated with a significant decrease in weight in patients with DM-2 (answers 1,3 and 4 incorrect). On the other hand, pioglitazone, as reflected in it... | A somewhat more complicated question than the previous one. Regarding weight, metformin to a lesser extent, SGLT-2 inhibitors and, above all, GLP-1 agonists have been associated with a significant decrease in weight in patients with DM-2 ([HIDDEN]). On the other hand, pioglitazone, as reflected in its data sheet, can p... | A 66-year-old woman diagnosed with type 2 diabetes mellitus since three months ago. She has a BMI of 31 kg/m2 and presents poor glycemic control despite a program of non-pharmacological measures (healthy diet, exercise). Which of the following hypoglycemic drugs is associated with weight gain and should we avoid in thi... | 522 | en | {
"1": "Metformin (biguanide).",
"2": "Pioglitazone (thiazolidinedione).",
"3": "Canagliflozin (sodium-glucose cotransporter 2 inhibitor- iSGLT2).",
"4": "Liraglutide (GLP-1 receptor agonist).",
"5": null
} | 165 | ENDOCRINOLOGY | 2,021 | {
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"title": "Role of Metformin, Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Orlistat based Multidrug Therapy in Glycemic Control, Weight ... |
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... | This is a typical case of cervical incompetence (and this patient has conization as a risk factor). This pathology consists of dilatation of the cervix in the absence of contractions, requiring cerclage to prevent miscarriage or immature delivery. The cerclage is ideally performed electively, programmed, and not when t... | This is a typical case of cervical incompetence (and this patient has conization as a risk factor). This pathology consists of dilatation of the cervix in the absence of contractions, requiring cerclage to prevent miscarriage or immature delivery. The cerclage is ideally performed electively, programmed, and not when t... | A 32-year-old woman requests preconception counseling. The patient reports that she underwent cervical conization for a high-grade intraepithelial lesion (H-SIL) and subsequently had three miscarriages between 20 and 22 weeks gestation. She has no living children. On all three occasions she came to the emergency depart... | 209 | en | {
"1": "I would prescribe oral atosiban prophylaxis throughout the pregnancy.",
"2": "I would offer lung maturation with corticosteroids from 19-20 weeks of gestation.",
"3": "I would recommend a cervical cerclage at 14 weeks gestation.",
"4": "I would advise her not to attempt any more pregnancies because of t... | 185 | GYNECOLOGY AND OBSTETRICS | 2,014 | {
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"title": "Prevention of spontaneous preterm birth: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF).",
"score": 0.0171702284,
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... | In the case of free wall rupture, there is no palpable frémito. | In the case of free wall rupture, there is no palpable frémito. | A 70-year-old female patient is admitted to the ICU after suffering anterior AMI treated by coronary angioplasty and stent placement in the anterior descending artery. Four days later she suddenly presented hypotension that required vigorous volume support, initiation of vasoactive drugs, orotracheal intubation and con... | 282 | en | {
"1": "Mortality with medical treatment is 20%.",
"2": "In case of free wall rupture there is an oximetric jump in the right ventricle in the Swan-Ganz catheterization.",
"3": "In case of free wall rupture, there is no palpable frémito.",
"4": "Mechanical complications usually appear on the first post-infarcti... | 55 | CARDIOLOGY AND VASCULAR SURGERY | 2,016 | {
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"id": "pubmed23n0114_7402",
"title": "Myocardial rupture following acute myocardial infarction.",
"score": 0.0190631808,
"content": "Ten patients, eight males and two females, suffered myocardial rupture f... |
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"text": "Sodium heparin is reserved for cases in which the patient is stable."
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3... | The patient presented pulmonary thromboembolism which, in addition to being bilateral, produced severe hemodynamic involvement, shock and required mechanical ventilation. We are not told that he has any contraindication to fibrinolysis, so this would be the most appropriate option due to its rapid administration and ac... | The patient presented pulmonary thromboembolism which, in addition to being bilateral, produced severe hemodynamic involvement, shock and required mechanical ventilation. We are not told that he has any contraindication to fibrinolysis, so [HIDDEN] due to its rapid administration and action. Sodium heparin is reserved ... | A 58-year-old man, three weeks after a severe ankle sprain presents, rapidly progressive, with dyspnea at rest, dizziness and syncope. On arrival at the hospital he has hypotension (systolic BP 80 mmHg, diastolic 40 mmHg) and poor perfusion. He is intubated and connected to mechanical ventilation and noradrenaline is s... | 464 | en | {
"1": "Intravenous perfused sodium heparin.",
"2": "Thromboendartectomy.",
"3": "Systemic fibrinolysis with rt-PA (alteplase) 100 mg intravenous.",
"4": "Inferior vena cava filter.",
"5": null
} | 155 | CRITICAL CARE AND EMERGENCIES | 2,019 | {
"clinical_case_options": {
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"id": "pubmed23n0391_7921",
"title": "Mechanical and enzymatic thrombolysis for massive pulmonary embolism.",
"score": 0.0181623932,
"content": "To assess the efficacy and safety of mechanical fragmentatio... |
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"... | The patient probably presents with bronchiolitis. At this stage, no additional tests should be performed unless there is a clinical worsening. | The patient probably presents with bronchiolitis. At this stage, no additional tests should be performed unless there is a clinical worsening. | 6-month-old infant presenting to the emergency department for respiratory distress. Examination: axillary temperature 37.2°C, respiratory rate 40 rpm, heart rate 160 bpm, blood pressure 90/45 mmHg, SatO2 95% on room air. He shows moderate respiratory distress with intercostal and subcostal retraction. Pulmonary auscult... | 502 | en | {
"1": "Request venous blood gas, leukocyte count and acute phase reactants.",
"2": "Request chest X-ray.",
"3": "Request arterial blood gases and acute phase reactants.",
"4": "Do not request complementary tests.",
"5": null
} | 77 | PEDIATRICS | 2,020 | {
"clinical_case_options": {
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"id": "wiki20220301en013_148122",
"title": "Acute bronchitis",
"score": 0.018799647,
"content": "A variety of tests may be performed in people presenting with cough and shortness of breath: A chest X-ray i... |
5 | {
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... | Low BP with high jugular pressure should always raise the suspicion of cardiac tamponade. Fever and chest pain with dyspnea and tachypnea should raise suspicion of pericardial effusion with hemodynamic compromise. Paradoxical pulse is a typical finding of cardiac tamponade. Therefore, the correct answer is 5. | Low BP with high jugular pressure should always raise the suspicion of cardiac tamponade. Fever and chest pain with dyspnea and tachypnea should raise suspicion of pericardial effusion with hemodynamic compromise. Paradoxical pulse is a typical finding of cardiac tamponade. Therefore, the [HIDDEN]. | A patient with a history of fever and chest pain comes to the hospital with dyspnea and tachypnea. On physical examination, the blood pressure cyphrads are low, jugular venous pressure is elevated with a deep descending sinus X, and he has a pulsus paradoxus. What pathology should be suspected? | 71 | en | {
"1": "Ischemic heart disease.",
"2": "Dilated cardiomyopathy.",
"3": "Severe aortic valve stenosis.",
"4": "Constrictive pericarditis.",
"5": "Pericardial effusion with cardiac tamponade."
} | 50 | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCIES | 2,012 | {
"clinical_case_options": {
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{
"id": "pubmed23n0552_7649",
"title": "[Recurrent autoreactive pericardial effusion. Impact of an aetiological classification of pericarditis].",
"score": 0.016921552,
"content": "A 36 year-old man suffered... |
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"text": "both array and NGS are usually reserved for patients with non-obvious clinical pictures, intellectual disability, or suspicion of a genetic... | This question may be a little more difficult, as the clinical case presented to us is very vague. An adolescent with pubertal delay and short stature; nothing more. With this information, she could have several genetic pathologies, but this is the MIR and we are told that the patient does not have an intellectual disab... | This question may be a little more difficult, as the clinical case presented to us is very vague. An adolescent with pubertal delay and short stature; nothing more. With this information, she could have several genetic pathologies, but this is the MIR and we are told that the patient does not have an intellectual disab... | 15-year-old female presenting with delayed menarche and short stature. She does not have intellectual disability. Which of the following genetic tests would be routinely used for the diagnosis of this patient: | 486 | en | {
"1": "Massive sequencing (NGS).",
"2": "FISH.",
"3": "DNA and/or RNA microarrays.",
"4": "Karyotype.",
"5": null
} | 45 | GENETICS | 2,020 | {
"clinical_case_options": {
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"id": "pubmed23n1102_9340",
"title": "Genetic testing in pediatric endocrine pathology.",
"score": 0.0176452458,
"content": "In genetic endocrine diseases, genetic testing is necessary for a precise diagno... |
2 | {
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"text": "option 1 speaks to us of an IgA nephropathy (it is not the case because the deposits are of IgG);"
},
"2": {
"exist": true,
"char... | The diagnostic suspicion for the data given (especially the anti-GBM antibodies and the presence of renopulmonary syndrome) is that of Goodpasture's syndrome. The rest of the data (seminules in the biopsy, linear IgG deposition) supports the diagnosis. Knowing this, the options are easily discarded: option 1 speaks to ... | The diagnostic suspicion for the data given (especially the anti-GBM antibodies and the presence of renopulmonary syndrome) is that of Goodpasture's syndrome. The rest of the data (seminules in the biopsy, linear IgG deposition) supports the diagnosis. Knowing this, the options are easily discarded: option 1 speaks to ... | A 38-year-old man consults for dyspnea and hemoptysis. Blood tests show creatinine 7 mg/dL, urea 250 mg/dL and high titer positive anti-GBM (anti-glomerular basement membrane antibodies). Renal biopsy shows crescents in 75% of the glomeruli and immunofluorescence shows a linear Ig deposition pattern. Which of the follo... | 216 | en | {
"1": "It is an IgA nephropathy with acute renal failure.",
"2": "Plasmapheresis would be indicated.",
"3": "It is a membranous glomerulonephritis.",
"4": "Mycophenolate mofetil is the initial treatment of choice.",
"5": "Glomerular involvement is caused by the presence of circulating immunocomplexes."
} | 121 | NEPHROLOGY | 2,014 | {
"clinical_case_options": {
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"id": "pubmed23n0977_267",
"title": "Development of anti-glomerular basement membrane glomerulonephritis during the course of IgA nephropathy: a case report.",
"score": 0.019609728,
"content": "Anti-glomer... |
1 | {
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"text": "If we follow the diagnostic scheme for a premature telarche or suspicion of precocious puberty, we request bone age and abdominal ultrasoun... | It seems that they want to present us with precocious puberty (or premature telarche) but they do not provide any analytical data and the ultrasound data are ambiguous (we should assume that by a small uterus they are referring to a prepubertal uterus, but they do not provide any data on ovarian size). We are presented... | It seems that they want to present us with precocious puberty (or premature telarche) but they do not provide any analytical data and the ultrasound data are ambiguous (we should assume that by a small uterus they are referring to a prepubertal uterus, but they do not provide any data on ovarian size). We are presented... | A woman comes to the office with her 3 year old daughter because she has detected a slight mammary development since 3 months without taking any medication or any relevant history. Indeed, the physical examination shows a Tanner stage IV, with no growth of pubic or axillary hair. The external genitalia are normal. Ultr... | 384 | en | {
"1": "Follow-up every 3-4 months, as this is a temporary condition that often resolves on its own.",
"2": "Breast biopsy.",
"3": "Mammography.",
"4": "Administration of GnRh analogues.",
"5": null
} | 151 | PEDIATRICS | 2,016 | {
"clinical_case_options": {
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"RRF-2": [
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"id": "wiki20220301en026_109891",
"title": "Thelarche",
"score": 0.0170426065,
"content": "Premature thelarche Premature thelarche is a benign condition in which a young female has breast development befor... |
1 | {
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"text": "Paroxysmal hemicrania predominates in women, with episodes of pain similar to cluster headache, but with a shorter duration (2-30 min), an... | In this question we are presented with a case to deduce a diagnosis and then indicate which would be the treatment of choice. Both the characteristics of the case and the answers suggest that it is a trigemino-autonomic headache (intense, periocular pain with lacrimation and rhinorrhea). The idea is to make a different... | In this question we are presented with a case to deduce a diagnosis and then indicate which would be the treatment of choice. Both the characteristics of the case and the answers suggest that it is a trigemino-autonomic headache (intense, periocular pain with lacrimation and rhinorrhea). The idea is to make a different... | A 40-year-old woman consults for approximately 20 episodes per day of intense left periocular pain lasting 15 minutes, accompanied by intense tearing and rhinorrhea. Her examination and MRI are normal. His treatment of choice would be: | 238 | en | {
"1": "Indomethacin.",
"2": "Lamotrigine.",
"3": "Verapamil.",
"4": "Prednisone.",
"5": "Lithium carbonate."
} | 145 | NEUROLOGY | 2,014 | {
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"id": "pubmed23n0771_10057",
"title": "The usual treatment of trigeminal autonomic cephalalgias.",
"score": 0.0198019802,
"content": "Trigeminal autonomic cephalalgias include cluster headache, paroxysmal ... |
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... | The correct answer is 3. If I am not mistaken, you are describing a Celso's kerion for which the treatment of choice is oral griseofulvin. | The [HIDDEN] If I am not mistaken, you are describing a Celso's kerion for which the treatment of choice is oral griseofulvin. | A 6-year-old boy comes to the clinic accompanied by the monitor of a day care center in our neighborhood because of a painful lump 3 cm in diameter on palpation in the right occipital area of the scalp. He suffers from alopecia in this area and 3 adenomegalies of quite hard consistency in the right posterior cervical r... | 47 | en | {
"1": "Incision and drainage.",
"2": "Topical Mupirocin.",
"3": "Griseofulvin orally.",
"4": "Intravenous cefazolin.",
"5": "Topical Ketoconazole."
} | 157 | PEDIATRICS | 2,011 | {
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"id": "pubmed23n0717_24038",
"title": "Unusually severe case of dermatosis neglecta.",
"score": 0.019149716,
"content": "An 18-year-old black woman with cerebral palsy was admitted for evaluation of an int... |
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"text": "the first cause to think about is giant cell a... | We are presented with a case of monocular amaurosis with a vascular profile, also in an older woman with a history of weight loss and what seems to be symptoms of mandibular claudication and polymyalgia rheumatica, so the first cause to think about is giant cell arteritis as the cause of NOIA, so the correct option wou... | We are presented with a case of monocular amaurosis with a vascular profile, also in an older woman with a history of weight loss and what seems to be symptoms of mandibular claudication and polymyalgia rheumatica, [HIDDEN]. Option 4 would be considered if we were told of an AINO but with non-arteritic characteristics ... | A 70-year-old woman with a history of anorexia, weight loss, discomfort in the muscles and proximal joints and pain in the temporomandibular region who comes to the emergency department for unilateral loss of vision (hand movement), sudden and painless onset (afferent pupillary defect).what test would you request first... | 381 | en | {
"1": "Lumbar puncture.",
"2": "C Reactive Protein.",
"3": "Magnetic resonance angiography.",
"4": "Carotid ultrasound.",
"5": null
} | 139 | NEUROLOGY | 2,016 | {
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"id": "InternalMed_Harrison_1431",
"title": "InternalMed_Harrison",
"score": 0.0117659418,
"content": "A careful neurologic examination is an essential first step in the evaluation. In most cases, patients... |
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"text": "The picture described is very suggestive of pseudocrisis with asynchronous limb movements, pelvic movements, crying and poor response to antiep... | Correct answer 1: The picture described is very suggestive of pseudocrisis with asynchronous limb movements, pelvic movements, crying and poor response to antiepileptic drugs. | Correct answer 1: The picture described is very suggestive of pseudocrisis with asynchronous limb movements, pelvic movements, crying and poor response to antiepileptic drugs. | In a patient diagnosed with epilepsy who presents with episodes of unresponsiveness to external stimuli, irregular movements of all four limbs, closed eyes, crying and pelvic movements, lasting five to twenty seconds and unresponsive to treatment with antiepileptic drugs, which complementary study is most likely to cla... | 32 | en | {
"1": "Video-EEG monitoring for diagnosis of pseudocrisis (psychogenic seizures).",
"2": "Holter ECG for diagnosis of arrhythmic heart disease.",
"3": "Routine EEG to diagnose the type of epilepsy (generalized or foc).",
"4": "Brain MRI to detect epileptogenic lesions (cortical dysplasia, tumor, medial tempora... | 64 | NEUROLOGY AND NEUROSURGERY | 2,011 | {
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"id": "wiki20220301en323_32903",
"title": "Vertiginous epilepsy",
"score": 0.0181623932,
"content": "Other means used in diagnosis of vertiginous epilepsy include: Electroencephalography (EEG) Magnetic res... |
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"text": "Among the X-linked immunodeficiencies is Wiskott-Aldrich syndrome, an entity described with an initial triad of symptoms consisting of bleed... | To correctly answer this question it should be emphasized that among the symptomatology that is exposed we find: - 2-year-old child. - ENT infections. - Pulmonary infections. - Hospital admissions. - PTI. - Family history of infections with deaths due to infections in males (maternal family). - Atopic Dermatitis. All t... | To correctly answer this question it should be emphasized that among the symptomatology that is exposed we find: - 2-year-old child. - ENT infections. - Pulmonary infections. - Hospital admissions. - PTI. - Family history of infections with deaths due to infections in males (maternal family). - Atopic Dermatitis. All t... | 2-year-old boy. His personal history includes 3 episodes of acute otitis media, 1 meningococcal meningitis and 2 pneumonias (one middle lobe and one left upper lobe). She has been admitted on 3 occasions for thrombopenic purpura (on three occasions antiplatelet antibodies were negative and bone marrow showed normal meg... | 106 | en | {
"1": "Wiskott-Aldrich syndrome.",
"2": "Hyper IgE syndrome.",
"3": "Transient hypogammaglobulinemia of childhood.",
"4": "X-linked severe combined immunodeficiency.",
"5": "Common variable immunodeficiency."
} | 135 | GENETICS AND IMMUNOLOGY | 2,012 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n0703_8952",
"title": "[Wiskott-Aldrich syndrome].",
"score": 0.0184649421,
"content": "The Wiskott-Aldrich syndrome is a primary immunodeficiency characterized by congenital microthrombocyt... |
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"text": "The confusional picture is determined by the dementia that the patient already suffers, so no matter how much we delay surgery, we are not going... | The confusional picture is determined by the dementia that the patient already suffers, so no matter how much we delay surgery, we are not going to achieve anything. The elevation of blood pressure is due, in principle, to pain (so the first option is an analgesic) and then to the stressful situation that leads an alre... | The confusional picture is determined by the dementia that the patient already suffers, so no matter how much we delay surgery, we are not going to achieve anything. The elevation of blood pressure is due, in principle, to pain (so the first option is an analgesic) and then to the stressful situation that leads an alre... | We are consulted to assess an 83-year-old woman admitted to the Trauma service for a hip fracture 6 hours ago. She has AP of hypertension, LBP, moderate dementia and lives in a nursing home. Her usual treatment is thiazide, atorvastatin, donepezil, Calcium and vitamin D. EF: Confused patient, pulse 90 bpm, respiratory ... | 62 | en | {
"1": "Delay surgery until the confusional picture has disappeared.",
"2": "Delay surgery and perform an echocardiogram.",
"3": "Delay surgery until good blood pressure control.",
"4": "Start a beta-blocker and initiate surgery.",
"5": "Perform closed osteosynthesis, avoiding in any case the implantation of ... | 119 | ANESTHESIOLOGY AND CRITICAL CARE | 2,011 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "Surgery_Schwartz_2833",
"title": "Surgery_Schwartz",
"score": 0.0112974542,
"content": "an injection of 1% lidocaine solution around this structure should attenuate this reflexive response.The most ... |
3 | {
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... | BI-RADS Breast Imaging Reporting and Data System. BI-RADS 3 is defined by answer 3. | BI-RADS Breast Imaging Reporting and Data System. BI-RADS 3 is defined by answer [HIDDEN]. | A 40-year-old woman consults because she has noticed a lump in the superoexternal quadrant of the right breast for the past month. She provides a mammography report describing a BIRADS 3 lesion. What is the best course of action? | 592 | en | {
"1": "Reassure him, since an imaging test has already been done and malignancy has been ruled out.",
"2": "This classification probably implies surgery since the probability of cancer is greater than 10%. He explains it to you and refers you preferentially to the Breast Unit.",
"3": "This is a probably benign f... | 76 | ONCOLOGY | 2,022 | {
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"RRF-2": [
{
"id": "pubmed23n0424_10969",
"title": "Evaluation of abnormal mammography results and palpable breast abnormalities.",
"score": 0.0190545323,
"content": "Because approximately 1 in 10 women with a breast l... |
5 | {
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... | The halo sign is characteristic of pulmonary aspergillosis, especially in an immuodepressed patient. But it is not pathognomonic; it has also been associated with TB, some neoplasms and Wegener's granulomatosis. | The halo sign is characteristic of pulmonary aspergillosis, especially in an immuodepressed patient. But it is not pathognomonic; it has also been associated with TB, some neoplasms and Wegener's granulomatosis. | An immunodeficient patient who presents a pneumonia with meniscus halo sign or crescentic contour on chest X-ray/CT suggests infection by a microorganism: | 26 | en | {
"1": "Staphylococcus aureus.",
"2": "Streptococcus pneumoniae.",
"3": "Candida albicans.",
"4": "Pseudomonas aeruginosa.",
"5": "Aspergillus fumigatus."
} | 117 | INFECTIOUS | 2,011 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en576_31556",
"title": "Lung cavity",
"score": 0.0135443149,
"content": "Bacteria can cause lung cavities in one of two ways; they can either enter the lung through the trachea (windpipe... |
1 | {
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"text": "It is most likely to be a pneumococcal infection that we cover with Ceftriaxone and with azithromycin we cover the so-called \"atypical\" one... | The first option seems to be the correct one, due to the low probability of P. jirovecii infection in a patient with more than 500 CD4 lymphocytes and undetectable viral load. It is most likely to be a pneumococcal infection that we cover with Ceftriaxone and with azithromycin we cover the so-called "atypical" ones. Me... | The first option seems to be [HIDDEN], due to the low probability of P. jirovecii infection in a patient with more than 500 CD4 lymphocytes and undetectable viral load. It is most likely to be a pneumococcal infection that we cover with Ceftriaxone and with azithromycin we cover the so-called "atypical" ones. Meropenem... | A 45-year-old man consults for a productive cough, pleuritic pain in the right flank and fever of 48 h of evolution. He has a baseline O2 saturation of 88% and rales in the right base. Chest X-ray shows a right basal consolidation. She has a history of HIV infection well controlled with antiretroviral drugs (CD4 lympho... | 435 | en | {
"1": "Cefiriaxone 2 g and azithromycin 500 mg every 24 hours.",
"2": "Cefiriaxone 2 g, azithrornicin 500 mg every 24 h and trimethoprim-sulfamethoxazole 5 mg/kg/8 h (based on trimethoprim doses).",
"3": "Methyl-prednisolone 40 mg/day, cefiriaxone 2 g IV 124 h and trimethoprim-sulfamethoxazole 5 mg/kg/8 h (based... | 121 | INFECTIOUS DISEASES AND MICROBIOLOGY | 2,018 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "InternalMed_Harrison_17062",
"title": "InternalMed_Harrison",
"score": 0.0132521974,
"content": "Amoxicillin, 500 mg PO q8h × 60 d, likely to be effective if strain is penicillin sensitive Active di... |
4 | {
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"text": "Fixation in this case is better external to avoid all the material around the affected area, so 4 is correct and 1 and 2 is not."
},
"2":... | The first thing is to treat the infection and for this we must remove all the osteosynthesis material, debride and give antibiotherapy. Fixation in this case is better external to avoid all the material around the affected area, so 4 is correct and 1 and 2 is not. The 3 would be considered after expiration of the infec... | The first thing is to treat the infection and for this we must remove all the osteosynthesis material, debride and give antibiotherapy. Fixation in this case is better external to avoid all the material around the affected area, so [HIDDEN] and [HIDDEN]. The [HIDDEN] would be considered after expiration of the infectio... | A 70-year-old woman, diabetic and hypertensive, who suffers a fall at home, presenting a 9 cm wound communicating with a fracture site of the right tibia. Radiographically, a short oblique fracture of the mid-distal third of the tibia was observed. An emergency operation was performed by cleaning (Friederich) and place... | 474 | en | {
"1": "Triple antibiotherapy (gram-positive, gram-negative and anaerobic) and cleaning of the surgical wound, removing the distal locks to promote bone consolidation.",
"2": "Expectant attitude and antibiotic treatment with quinolones.",
"3": "Autologous graft and growth factors (BMP 2 and 7) to stimulate the bo... | 142 | ORTHOPEDIC SURGERY AND TRAUMATOLOGY | 2,020 | {
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"RRF-2": [
{
"id": "pubmed23n0819_12704",
"title": "[Advanced bone graft combined with locking compression plate for the treatment of middle and distal tibia nonunion].",
"score": 0.0172161172,
"content": "To explore m... |
1 | {
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"text": "Acute urticaria: characterized by erythematous-edematous, evanescent, pruritic, evanescent lesions, lasting less than 24 hours, without desquama... | Acute urticaria: characterized by erythematous-edematous, evanescent, pruritic, evanescent lesions, lasting less than 24 hours, without desquamation. The general condition is usually preserved. In children the annular pattern is more frequent. In both rubella and toxicoderma, the general condition is not preserved. In ... | Acute urticaria: characterized by erythematous-edematous, evanescent, pruritic, evanescent lesions, lasting less than 24 hours, without desquamation. The general condition is usually preserved. In children the annular pattern is more frequent. In both rubella and toxicoderma, the general condition is not preserved. In ... | A 14-year-old female patient in good general condition presents since 4 days ago a very pruritic generalized cutaneous eruption formed by erythematous-edematous plaques between 2 and 15 cm in diameter without desquamation with a tendency to acquire an annular morphology that individually disappear in less than 24 hours... | 17 | en | {
"1": "Urticaria.",
"2": "Rubella.",
"3": "Toxicoderma.",
"4": "Staphylococcal toxic shock.",
"5": "Scabies."
} | 137 | DERMATOLOGY | 2,011 | {
"clinical_case_options": {
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{
"id": "wiki20220301en111_27496",
"title": "Pemphigoid",
"score": 0.0180310714,
"content": "Presentation Primary lesions of small and large blisters, known as vesicles and bullae, are found on the skin and ... |
3 | {
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... | We are faced with polyuria. Initially we rule out diabetes mellitus (our patient has a normal blood glucose of 96mg/dl). The analytical data suggest diabetes insipidus (high plasma osm with low urinary osm). Now we must differentiate between central diabetes insipidus (lack of ADH) or nephrogenic diabetes insipidus (AD... | We are faced with polyuria. Initially we rule out diabetes mellitus (our patient has a normal blood glucose of 96mg/dl). The analytical data suggest diabetes insipidus (high plasma osm with low urinary osm). Now we must differentiate between central diabetes insipidus (lack of ADH) or nephrogenic diabetes insipidus (AD... | A 34-year-old woman is admitted for polyuria and polydipsia. In the first 24 hours of admission a diuresis of 8.2 liters is found and a blood test shows a glycemia of 96 mg/dL, natremia of 148 mEq/L and plasma osmolality of 309 mOsm/kg with urinary osmolality of 89 mOsmlkg. What diagnostic test should be performed next... | 425 | en | {
"1": "Hypertonic saline infusion test for serial determination of antidiuretic hormone.",
"2": "Dehydration test (Miller test).",
"3": "Administration of desmopressin with serial monitoring of urine osmolality.",
"4": "Determination of antidiuretic hormone in plasma.",
"5": null
} | 92 | ENDOCRINOLOGY | 2,018 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0101_14281",
"title": "Disorders of antidiuretic hormone.",
"score": 0.0184995737,
"content": "Disorders of thirst and vasopressin secretion present clinically in one of three ways: as hypo... |
1 | {
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"text": "The diagnosis would be practically made with the AMA (1)."
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... | Book picture of Primary Biliary Cirrhosis, one of those that do not occur in real life. The diagnosis would be practically made with the AMA (1). With 2 we would rule out hemochromatosis, with 3 we would rule out Wilson's disease. With 4 we could rule out rare diseases such as biliary tract malformations or Caroli's di... | Book picture of Primary Biliary Cirrhosis, one of those that do not occur in real life. The diagnosis would be practically made with the AMA (1). With 2 we would rule out hemochromatosis, with 3 we would rule out Wilson's disease. With 4 we could rule out rare diseases such as biliary tract malformations or Caroli's di... | A 52-year-old woman consulted because she had noticed during the previous week a yellowish discoloration of the conjunctivae. She does not refer to risky sexual behaviors or epidemiological history of risk of viral hepatitis. She does not consume alcohol or hepatotoxic drugs. She reports a one-year history of generaliz... | 8 | en | {
"1": "Anti-mitochondrial antibodies.",
"2": "Study of Fe metabolism.",
"3": "Study of copper metabolism.",
"4": "Hepatic MRI.",
"5": "Serology for B and C viruses."
} | 232 | DIGESTIVE | 2,011 | {
"clinical_case_options": {
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"RRF-2": [
{
"id": "pubmed23n1164_2588",
"title": "Epstein-Barr Virus Hepatitis Masquerading as Painless Jaundice.",
"score": 0.0145867866,
"content": "Epstein-Barr virus (EBV) infection typically presents with pharyng... |
4 | {
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"text": "Temporomandibular ankylosis is not considered because, although relatively close to the orbital cavity, it is not part of the orbito-malar ... | Fractures of the midface in the orbito-malar region may involve the floor and, to a lesser extent, the lateral wall of the orbit. Assuming therefore that we are asked which is one of the most frequent complications of the floor of the orbit, two complications should always be highlighted that may indicate surgical trea... | Fractures of the midface in the orbito-malar region may involve the floor and, to a lesser extent, the lateral wall of the orbit. Assuming therefore that we are asked which is one of the most frequent complications of the floor of the orbit, two complications should always be highlighted that may indicate surgical trea... | 20-year-old patient who comes to the emergency department after suffering a bicycle accident with facial trauma. A cranial CT scan was performed showing a fracture of the middle third of the face involving the orbito-malar region. One of the most frequent complications of this type of fracture is: | 621 | en | {
"1": "Temporomandibular ankylosis.",
"2": "Dental malocclusion.",
"3": "Naso-ethmoidal pseudoarthrosis.",
"4": "Enophthalmos.",
"5": null
} | 60 | OPHTHALMOLOGY (ECTOPIC) | 2,022 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0584_7976",
"title": "Panfacial fractures: analysis of 33 cases treated late.",
"score": 0.0195126594,
"content": "The aim of this retrospective study was to analyze the characteristics of ... |
1 | {
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"text": "We are being described an acute pain crisis in a patient with gonarthrosis. In this situation, the first thing to do is to resolve the pain cris... | We are being described an acute pain crisis in a patient with gonarthrosis. In this situation, the first thing to do is to resolve the pain crisis and to propose an appropriate conservative treatment for this osteoarthritis (1 correct). A knee arthroplasty is not considered at the outset, so 2 is false. They are not te... | We are being described an acute pain crisis in a patient with gonarthrosis. In this situation, the first thing to do is to resolve the pain crisis and to propose an appropriate conservative treatment for this osteoarthritis ([HIDDEN]). A knee arthroplasty is not considered at the outset, so [HIDDEN]. They are not telli... | A 73-year-old woman with a history of obesity, type 2 diabetes mellitus, hypertension and dyslipidemia. She consults for unbearable pain in the right knee of 5 days of evolution, without previous trauma. Examination: globular knee, moderate varus, extension and flexion limited by pain, diffuse medial pain. X-ray shows ... | 470 | en | {
"1": "Explanation of the diagnosis, relative rest, paracetamol 1g/8h plus metamizol 500 mg/ 8 h rescue naproxen.",
"2": "Preferential referral to Traumatology outpatients for evaluation of total cemented prosthesis.",
"3": "Preferential referral to Traumatology outpatient clinic for arthroscopic debridement.",
... | 138 | ORTHOPEDIC SURGERY AND TRAUMATOLOGY | 2,020 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en012_37209",
"title": "Tendinopathy",
"score": 0.0134763787,
"content": "Tendinopathy, a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typic... |
3 | {
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"text": "The history of contact with fresh water in an endemic area points to leptospirosis, and in the clinical picture we also find jaundice and conjun... | The history of contact with fresh water in an endemic area points to leptospirosis, and in the clinical picture we also find jaundice and conjunctival injection which also points to leptospirosis and is not so characteristically related to the other three pathogens. | The history of contact with fresh water in an endemic area points to leptospirosis, and in the clinical picture we also find jaundice and conjunctival injection which also points to leptospirosis and is not so characteristically related to the other three pathogens. | A 25-year-old man with no past history of interest presents to the emergency department with fever, headache, myalgia, nausea, vomiting, abdominal pain, jaundice and conjunctival injection, 2 weeks after traveling to Thailand to participate in a freshwater regatta. What is the most likely diagnosis? | 298 | en | {
"1": "Malaria.",
"2": "Schistosomiasis.",
"3": "Leptospirosis.",
"4": "Rabies.",
"5": null
} | 103 | INFECTIOUS DISEASES | 2,016 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0497_13706",
"title": "Etiologies of acute undifferentiated febrile illness in Thailand.",
"score": 0.0165621592,
"content": "Acute pyrexia of unknown origin (Acute PUO) was reported to aff... |
4 | {
"1": {
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"text": "Tuberculosis can affect lung and brain but not... | Nocardia can typically affect immunosuppressed patients, especially those with impaired cell-mediated immunity such as that produced by steroids, and can present with pulmonary involvement, brain abscesses and skin abscesses. Tuberculosis can affect lung and brain but not cutaneous abscesses. Aspergillus also does not ... | Nocardia can typically affect immunosuppressed patients, especially those with impaired cell-mediated immunity such as that produced by steroids, and can present with pulmonary involvement, brain abscesses and skin abscesses. Tuberculosis can affect lung and brain but not cutaneous abscesses. Aspergillus also does not ... | A 64-year-old patient, farmer, former smoker (5 years), COPD and afflicted with rheumatoid arthritis on corticosteroid therapy. He consults the emergency department for presenting intense headache of 2 days of evolution with deviation of the oral commissure. As background, he reports that after a month of influenza, he... | 365 | en | {
"1": "Lung neoplasm with brain metastases.",
"2": "Disseminated tuberculosis.",
"3": "Nocardiosis.",
"4": "Aspergillosis.",
"5": null
} | 100 | PNEUMOLOGY AND THORACIC SURGERY | 2,016 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0261_10430",
"title": "[Two cases of invasive pulmonary aspergillosis in non-immunocompromised hosts].",
"score": 0.0156749083,
"content": "Invasive pulmonary aspergillosis generally occurs... |
3 | {
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"text": "if we look at the patient's ability to maintai... | In this question, one might suspect the possibility of an affective shift after the introduction of the antidepressant drug, according to the patient, but if we look at the patient's ability to maintain sleep, there is a clear fact that "rules out" the hypo/manic shift. Two weeks is not enough time for the drug to have... | In this question, one might suspect the possibility of an affective shift after the introduction of the antidepressant drug, according to the patient, but if we look at the patient's ability to maintain sleep, there is a clear fact that "rules out" the hypo/manic shift. [HIDDEN] is not enough time for the drug to have ... | 68-year-old woman, with a history of 2 major depressive episodes in her lifetime, who consults for symptoms of sadness, depressed mood, anhedonia, asthenia and anorexia compatible with a new depressive episode. She was prescribed 10 mg of escitalopram and was evaluated 2 weeks later. In this review the patient reports ... | 392 | en | {
"1": "Bipolar disorder type I.",
"2": "Drug-induced hypomania.",
"3": "Normal response to escitalopram.",
"4": "Frontal dementia.",
"5": null
} | 223 | PSYCHIATRY | 2,016 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0104_5087",
"title": "Cyclic 48-hour unipolar depression.",
"score": 0.0137833135,
"content": "This single case study reports on a 74-year-old woman with 48-hour cycles of mood disturbance ... |
2 | {
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"text": "Increase enalapril dose according to tolerance and... | Increase enalapril dose according to tolerance and administer intravenous turosemide. | Increase enalapril dose according to tolerance and administer intravenous turosemide. | A 73-year-old woman is admitted with progressive dyspnea until she becomes at rest, orthopnea and weight gain of 4 kg. Physical examination showed blood pressure of 150/84 mm Hg, heart rate 100 beats/minute, increased jugular venous pressure, crepitant in both bases and malleolar edema. Usual treatment: enalapril 5 mg ... | 285 | en | {
"1": "Administer fiirosemide intravenously.",
"2": "Increase enalapril dose according to tolerance and administer intravenous furosemide.",
"3": "Start a beta-blocker.",
"4": "Add treatment with amlodipine.",
"5": null
} | 59 | CARDIOLOGY AND VASCULAR SURGERY | 2,016 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "pubmed23n0415_3568",
"title": "Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-ter... |
3 | {
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... | In healthy adults there may be palpable inguinal nodes up to 2 centimeters that can be considered normal. A complementary study of these normal lymph nodes is not warranted. | In healthy adults there may be palpable inguinal nodes up to 2 centimeters that can be considered normal. A complementary study of these normal lymph nodes is not warranted. | A 24-year-old woman consults after noticing inguinal lymphadenopathy. The interrogation does not reveal the presence of any local discomfort or data suggestive of sexually transmitted infection. The examination revealed two lymphadenopathies, one in each groin, 1 cm in diameter, soft, mobile, non-painful. There are no ... | 301 | en | {
"1": "A lues serology since it is most likely a Treponema pallidum infection.",
"2": "A gynecological examination to rule out ovarian cancer.",
"3": "By the clinical characteristics it seems to be normal lymph nodes and complementary explorations should not be done.",
"4": "A Paul-Bunnell test should be perfo... | 232 | INFECTIOUS DISEASES | 2,016 | {
"clinical_case_options": {
"MedCorp": {
"RRF-2": [
{
"id": "wiki20220301en393_31405",
"title": "Inguinal lymphadenopathy",
"score": 0.0183043514,
"content": "Inguinal lymphadenopathy causes swollen lymph nodes in the groin area. It can be a symptom of infect... |
4 | {
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"... | I think this question is not clearly in the Infectious Diseases syllabus, and may overlap with OFT and DERMA, but as I understand it, in an immunocompromised patient and also with data of ocular involvement, admission for intravenous treatment would be indicated due to the high risk of possible complications. | I think this question is not clearly in the Infectious Diseases syllabus, and may overlap with OFT and DERMA, but as I understand it, in an immunocompromised patient and also with data of ocular involvement, admission for intravenous treatment would be indicated due to the high risk of possible complications. | A 71-year-old woman with a history of rheumatoid arthritis on sulfasalazine, prednisone and etanercept. She goes to the emergency room for 72 hours of clinical manifestations compatible with facial herpes zoster affecting the right hemiface, auricular pavilion, respecting the forehead and conjunctival chemosis. What wo... | 23 | en | {
"1": "Symptomatic treatment of pain only.",
"2": "Topical treatment with acyclovir.",
"3": "Outpatient treatment with acyclovir, valacyclovir or oral famciclovir.",
"4": "Hospital admission and treatment with acyclovir or famciclovir iv.",
"5": "Parenteral Ig and vaccination."
} | 113 | INFECTIOUS | 2,011 | {
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"text": "Therefore, it is necessary to wait for the imaging test to confirm the etiology (option 1 incorrect)."
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"... | We are presented with a patient with resistant arterial hypertension, assuming that he has primary hyperaldosteronism due to hypokalemic metabolic alkalosis. When the diagnosis is biochemically confirmed, the next test to be performed is a CT scan to determine the subtype and rule out the presence of an adrenal carcino... | We are presented with a patient with resistant arterial hypertension, assuming that he has primary hyperaldosteronism due to hypokalemic metabolic alkalosis. When the diagnosis is biochemically confirmed, the next test to be performed is a CT scan to determine the subtype and rule out the presence of an adrenal carcino... | A 58-year-old man with a 6-year history of hypertension consults for poor blood pressure control despite treatment with an angiotensin-converting enzyme inhibitor, a diuretic and a calcium antagonist. On consultation she presented with blood pressure of 149/100 mmHg. Laboratory tests: creatinine 1.2 mg/dl, potassium 2.... | 564 | en | {
"1": "The origin of hypertension in this case is excessive secretion of aldosterone caused by autonomic hyperfunction of the adrenal medulla.",
"2": "In most cases the anatomical substrate is a bilateral hyperplasia of the adrenal cortex.",
"3": "CT scan is part of the diagnostic study in case of biochemical co... | 126 | NEPHROLOGY | 2,022 | {
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... | He is describing a textbook Reiter's syndrome: palmo-plantar keratoderma, arthritis and ocular manifestations, together with probably a chlamydial urethritis, perhaps asymptomatic (they do not explain urethral exudate). Of course, the patient may also have HIV infection or even secondary syphilis (in addition to Reiter... | He is describing a textbook Reiter's syndrome: palmo-plantar keratoderma, arthritis and ocular manifestations, together with probably a chlamydial urethritis, perhaps asymptomatic (they do not explain urethral exudate). Of course, the patient may also have HIV infection or even secondary syphilis (in addition to Reiter... | Gustavo comes to the emergency room with skin lesions and general malaise of several days of evolution. He has psoriasiform lesions on the trunk with involvement of palms and soles. He also presents asymmetric non-suppurative joint inflammation and bilateral ocular redness as well as erosions on the glans penis. In the... | 292 | en | {
"1": "HIV infection.",
"2": "Secondary syphilis.",
"3": "Reiter's syndrome.",
"4": "Erythema multiforme.",
"5": null
} | 213 | DERMATOLOGY, VENEREOLOGY AND PLASTIC SURGERY | 2,016 | {
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"text": "an unstable thorax due to multiple rib fractures (costal volet) would cause progressive hypoventilation with atelectasis of the pulmonary par... | Pulmonary contusion is the most serious lesion and the one with the worst prognosis in thoracic trauma. It is also the injury that causes hypoxemia the earliest. Contrary to what we may think, an unstable thorax due to multiple rib fractures (costal volet) would cause progressive hypoventilation with atelectasis of the... | Pulmonary contusion is the most serious lesion and the one with the worst prognosis in thoracic trauma. It is also the injury that causes hypoxemia the earliest. Contrary to what we may think, an unstable thorax due to multiple rib fractures (costal volet) would cause progressive hypoventilation with atelectasis of the... | 35-year-old man admitted for severe chest trauma with multiple rib fractures. After responding favorably to treatment with analgesics and oxygen, he begins to present severe hypoxemia. Indicate the most probable cause of this deterioration: | 477 | en | {
"1": "Chest wall instability due to multiple fractures.",
"2": "Aspiration respiratory infection.",
"3": "Alteration of gas exchange due to pulmonary contusion.",
"4": "Post-traumatic hypovolemia.",
"5": null
} | 128 | CRITICAL CARE | 2,020 | {
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"title": "Long-term pulmonary function after recovery from pulmonary contusion due to blunt chest trauma.",
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"text": "Stage G3a corresponds to a filtration rate between 45-59 ml/min. Stage A1 corresponds to albuminuria less than 30 mg/ml. Therefore the correct ... | Easy question. Stage G3a corresponds to a filtration rate between 45-59 ml/min. Stage A1 corresponds to albuminuria less than 30 mg/ml. Therefore the correct option is 1. | Easy question. Stage G3a corresponds to a filtration rate between 45-59 ml/min. Stage A1 corresponds to albuminuria less than 30 mg/ml. Therefore [HIDDEN]. | A 66-year-old woman with type 2 diabetes mellitus. When assessing her renal function, she presents a G3a/A1 stage. To which values does this stage correspond, the most frequent in patients with diabetic nephropathy? | 572 | en | {
"1": "Glomerular filtration rate 45-59 ml/min/1.73 m² and albuminuria <30 mg/ml.",
"2": "Glomerular filtration rate 30-44 ml/min/1.73 m² and albuminuria <30 mg/ml.",
"3": "Glomerular filtration rate 45-59 ml/min/1.73 m² and albuminuria 30-300 mg/ml.",
"4": "Glomerular filtration rate 15-29 ml/min/1.73 m² and ... | 195 | NEPHROLOGY | 2,022 | {
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"title": "Albuminuria and estimated glomerular filtration rate as predictors of diabetic end-stage renal disease and death.",
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"text": "Transfusing this patient and stuffing him with antibiotics is giving him bread for today and hunger for tomorrow."
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"exist": tr... | Transfusing this patient and stuffing him with antibiotics is giving him bread for today and hunger for tomorrow. We want something more lasting. Androgens and platelet transfusions don't fix the problem either. We are left with the other three options. An autologous transplant is not reasonable, since the bone marrow ... | Transfusing this patient and stuffing him with antibiotics is giving him bread for today and hunger for tomorrow. We want something more lasting. Androgens and platelet transfusions don't fix the problem either. We are left with the other three options. An autologous transplant is not reasonable, since the bone marrow ... | A 29-year-old patient comes to your office with a diagnosis of severe bone marrow aplasia. What is the treatment of choice? | 180 | en | {
"1": "Periodic transfusions and antibiotics.",
"2": "Androgens and platelet transfusions.",
"3": "Allogeneic bone marrow transplantation if HLA identical sibling.",
"4": "Autologous bone marrow transplantation to avoid rejection.",
"5": "Cyclosporin A and antithymocyte globulin."
} | 232 | HEMATOLOGY | 2,013 | {
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"title": "Immunosuppressive therapy versus bone marrow transplantation for children with aplastic anemia.",
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"content": "A total of 15 patients 1 to 16 yea... |
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... | The question is tricky: it speaks of a burn of 10% of the body surface and the treatment of choice for second degree burns less than 20% of the BSA should be topical and monitored. However, there is a warning sign: there is no arterial pulse and the burn is circumferential to the limb. This is an emergency that, if all... | The question is tricky: it speaks of a burn of 10% of the body surface and the treatment of choice for second degree burns less than 20% of the BSA should be topical and monitored. However, there is a warning sign: there is no arterial pulse and the burn is circumferential to the limb. This is an emergency that, if all... | A young man comes to the emergency room with a second-degree flame burn of 10% of the body surface, affecting the right arm in an extensive and circular manner. There is no arterial pulse in the hand measured by Doppler. What is the treatment of choice? | 270 | en | {
"1": "Occlusive sulfadiazine-arginine cures and depth assessment at one week.",
"2": "Lymphatic drainage and assess a vascular by-pass.",
"3": "Escharotomy or emergency decompression incisions.",
"4": "Expectant management.",
"5": "Amputation of the extremity."
} | 135 | DERMATOLOGY AND PLASTIC SURGERY | 2,015 | {
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"content": "Neurovascular integrity should similarly be monitored frequently and in a scheduled manner. Capillary refilling t... |
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"text": "FiO2 of 1 and hyperventilation with mechanical ventilation, demonstrated by the low PCO2, fail to sufficiently raise PO2, due to a V/Q disturban... | FiO2 of 1 and hyperventilation with mechanical ventilation, demonstrated by the low PCO2, fail to sufficiently raise PO2, due to a V/Q disturbance, with probable shunt in the area of pulmonary atelectasis, probably acute, since the lung has not been able to create compensatory mechanisms to limit perfusion in the poorl... | FiO2 of 1 and hyperventilation with mechanical ventilation, demonstrated by the low PCO2, [HIDDEN], due to a V/Q disturbance, with probable shunt in the area of pulmonary atelectasis, probably acute, since the lung has not been able to create compensatory mechanisms to limit perfusion in the poorly ventilated areas. | While you are on call in the Emergency Department of your hospital, you have to attend a 64-year-old patient with acute respiratory failure. His clinical condition is critical, with low oxygen saturation and hemodynamic instability. An urgent chest X-ray was performed showing atelectasis of 2/3 of the right lung. Orotr... | 368 | en | {
"1": "Short circuit.",
"2": "Hypoventilation.",
"3": "Low inspired 02 pressure.",
"4": "Neuromuscular disease.",
"5": null
} | 121 | PNEUMOLOGY AND THORACIC SURGERY | 2,016 | {
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"title": "Respiratory failure",
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... | Basic semiology. However, emergency reasoning: systolic murmur, something that in systole had to be closed and is not, or had to open, and does not: options 1, 3 and 5. And if we see repercussion in the jugular pulse, it must be in the right cavities. Apart from the fact that the v wave appears during systole, while th... | Basic semiology. However, emergency reasoning: systolic murmur, something that in systole had to be closed and is not, or had to open, and does not: options 1, 3 and 5. And if we see repercussion in the jugular pulse, it must be in the right cavities. Apart from the fact that the v wave appears during systole, while th... | If in a patient with chronic heart failure we detect prominent v waves in the jugular venous pulse and on cardiac auscultation a holosystolic murmur is auscultated in the area of the xiphoid appendage that is accentuated with deep inspiration. What is the valvulopathy responsible for this physical examination? | 167 | en | {
"1": "Mitral insufficiency.",
"2": "Pulmonary insufficiency.",
"3": "Tricuspid insufficiency.",
"4": "Aortic insufficiency.",
"5": "Aortic stenosis."
} | 85 | CARDIOLOGY AND CARDIOVASCULAR SURGERY | 2,013 | {
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"title": "Valvular heart disease",
"score": 0.0176102572,
"content": "On auscultation of a patient with mitral stenosis, there may be a holosystolic murmur at the apex, rad... |
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"text": "as in these six months she has shown a clear cl... | This is a patient with rheumatoid arthritis. In my opinion, as in these six months she has shown a clear clinical and biological improvement (decrease in acute phase reactants), I would maintain the therapeutic approach taken and wait for a new evaluation. However, I consider that this question could have another valid... | This is a patient with rheumatoid arthritis. In my opinion, as in these six months she has shown a clear clinical and biological improvement (decrease in acute phase reactants), I would maintain the therapeutic approach taken and wait for a new evaluation. However, I consider that this question could have another valid... | A 42-year-old female patient reports pain with inflammatory features and swelling in both wrists, 2nd and 3rd metacarpophalangeal and proximal interphalangeal joints bilaterally and left ankle of 4 months of evolution accompanied by morning stiffness of more than one hour duration. Hand X-ray shows an erosion in the st... | 154 | en | {
"1": "Suspend the prescribed treatment due to lack of response and initiate prednisone at high doses for symptom control only.",
"2": "Maintain the therapeutic attitude taken since we have only been on it for 6 months and it would be necessary to wait a minimum of 9 months to evaluate therapeutic response.",
"3... | 75 | RHEUMATOLOGY | 2,012 | {
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... | As long as fever persists in an evolving pneumonia, there is a risk of empyematization, especially if a small effusion has already occurred at the beginning of the picture. In principle, antibiotic treatment is correct and before considering changes in treatment, the possibility of empyematization should be evaluated. | As long as fever persists in an evolving pneumonia, there is a risk of empyematization, especially if a small effusion has already occurred at the beginning of the picture. In principle, antibiotic treatment is [HIDDEN] and before considering changes in treatment, the possibility of empyematization should be evaluated. | A 56-year-old woman with a history of well-controlled schizophrenia and no toxic habits. Admitted for middle lobe pneumonia with a small associated metaneumonic pleural effusion and on treatment with levofloxacin 500 mg/24h . She presented good clinical evolution except for persistent febrile fever and leukocytosis on ... | 176 | en | {
"1": "The evolution is normal, treatment should be maintained until completing 10 days.",
"2": "It is considered a therapeutic failure and antibiotic treatment should be modified.",
"3": "Perform thoracentesis to rule out empyema.",
"4": "Add corticosteroids at a dose of 0.5 mg/Kg/day to antibiotic treatment.... | 57 | PNEUMOLOGY | 2,013 | {
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"text": "Lennox Gastaut develops at an early age with o... | A patient of adolescent age with myoclonus ("violent jumps") at breakfast time will almost always lead us to juvenile myoclonic epilepsy (answer 5 correct), a very well characterized entity. Among other features is the previous history of seizures or absences, the worsening with nighttime departures, and the EEG with g... | A patient of adolescent age with myoclonus ("violent jumps") at breakfast time will almost always lead us to juvenile myoclonic epilepsy ([HIDDEN]), a very well characterized entity. Among other features is the previous history of seizures or absences, the worsening with nighttime departures, and the EEG with generaliz... | An 18-year-old female patient with a history of absences between 6 and 9 years of age, generalized tonic-clonic seizures of recent onset and violent jumping of the upper limbs at breakfast. The clinical manifestations worsen with nighttime weekend outings. An EEG shows acute polyp spike discharges at 6 cycles/second. T... | 130 | en | {
"1": "Great epileptic disease.",
"2": "Lennox-Gastaut syndrome.",
"3": "Symptomatic epilepsy due to mesial temporal sclerosis.",
"4": "Small atypical disease.",
"5": "Juvenile myoclonic epilepsy."
} | 82 | NEUROLOGY AND NEUROSURGERY | 2,012 | {
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"title": "[Clinical and electroencephalographic characteristics of epilepsy with myoclonic absences].",
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"... | Having antibodies against the core implies natural contact, and that it is IgG, which is not acute. The absence of e antigen rules out active replication. And the persistence of surface antigen (HBsAg) and virus DNA indicates that it is still present. Together, these indicate an asymptomatic carrier. Carriers of the pr... | Having antibodies against the core implies natural contact, and that it is IgG, which is not acute. The absence of e antigen rules out active replication. And the persistence of surface antigen (HBsAg) and virus DNA indicates that it is still present. Together, these indicate an asymptomatic carrier. Carriers of the pr... | Indicate the clinical situation in relation to hepatitis B virus infection in a 5-year-old patient from Nigeria, with normal physical examination and the following serology for hepatitis B: HBsAg + / ANTI-HBs - / HbeAg - / ANTI-HBe + / ANTI-HBc IgM - / ANTI-HBc IgG + / DNA HBV +: | 276 | en | {
"1": "Acute infection.",
"2": "Chronic infection.",
"3": "Vaccinated patient.",
"4": "Asymptomatic carrier.",
"5": null
} | 75 | DIGESTIVE SYSTEM | 2,016 | {
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"text": "Refeeding syndrome occurs in patients with previous malnutrition exposed to either oral, enteral or parenteral nutritional therapy. All response... | Refeeding syndrome occurs in patients with previous malnutrition exposed to either oral, enteral or parenteral nutritional therapy. All responses are causes of malnutrition except 3. | Refeeding syndrome occurs in patients with previous malnutrition exposed to either oral, enteral or parenteral nutritional therapy. All responses are causes of malnutrition except [HIDDEN]. | A patient on enteral nutritional support presents 72 hours after starting enteral nutrition with a CBC showing hypophosphoremia and hypokalemia, with clinical signs of heart failure. The patient is diagnosed with refeeding syndrome. Indicate which of the following is NOT considered a risk factor for a patient presentin... | 183 | en | {
"1": "Previous caloric malnutrition.",
"2": "Anorexia nervosa.",
"3": "Non-morbid obesity.",
"4": "Elderly.",
"5": "Prolonged vomiting and diarrhea."
} | 64 | ENDOCRINOLOGY | 2,013 | {
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"title": "Refeeding syndrome in patients with gastrointestinal fistula.",
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"text": "Answer 1 cannot be because a marrow aplasia does not explain the choluria, the elevation of LDH, nor in the study of irregular antibodies is ... | A long statement full of rather confusing data. We can attack that question in two ways: by looking at the key data and going all the way to the diagnosis we are considering or by discarding one by one. The choluria, LDH, presence of panagglutinin and the peripheral blood smear "smells" like hemolytic anemia. Answer 1 ... | A long statement full of rather confusing data. We can attack that question in two ways: by looking at the key data and going all the way to the diagnosis we are considering or by discarding one by one. The choluria, LDH, presence of panagglutinin and the peripheral blood smear "smells" like hemolytic anemia. Answer 1 ... | A 32-year-old woman with cerebral palsy from childbirth comes to the emergency department for a few days of dark urine associated with an episode of high fever and dry cough. On admission, the CBC showed 16900 leukocytes/mm3 (85% S, 11% L, 4% M), hemoglobin 6.3 g/dL; MCV 109 fl, 360000 platelets/mm3. In the biochemistr... | 115 | en | {
"1": "Medullary aplasia and immunotherapy with thymoglobulin and cyclosporine.",
"2": "Hereditary spherocytosis and splenectomy.",
"3": "Autoimmune hemolytic anemia associated with respiratory infection and corticosteroids.",
"4": "Pernicious anemia and periodic injections of vitamin B12.",
"5": "Acute leuk... | 98 | HEMATOLOGY | 2,012 | {
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"title": "IgA-mediated autoimmune hemolytic anemia in an infant.",
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... | Direct response question. The question tells the story of a patient with acute pancreatitis who is developing acute respiratory failure. The statement lists the criteria for ARDS (acute respiratory distress syndrome): PaO2/fiO2 < 200 + bilateral pulmonary infiltrates + PCP<18. So the diagnosis is respiratory distress a... | Direct response question. The question tells the story of a patient with acute pancreatitis who is developing acute respiratory failure. The statement lists the criteria for ARDS (acute respiratory distress syndrome): PaO2/fiO2 < 200 + bilateral pulmonary infiltrates + PCP<18. So the diagnosis is respiratory distress a... | A patient admitted for acute pancreatitis starts with tachypnea, tachycardia, sweating and progressive cyanosis. PaO2 is 55 mm Hg (PaO2/FiO2 ratio<200). CXR shows bilateral alveolar pulmonary infiltrates. Pulmonary capillary wedge pressure is normal. Oxygen therapy does not improve the situation. What is the most proba... | 75 | en | {
"1": "Nosocomial pneumonia.",
"2": "Cardiac failure.",
"3": "Carcinomatous lymphangitis.",
"4": "Pulmonary thromboembolism.",
"5": "Respiratory distress."
} | 65 | ANESTHESIOLOGY, CRITICAL CARE AND EMERGENCIES | 2,012 | {
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"title": "[Acute respiratory distress caused by distal neoplastic pulmonary emboli].",
"score": 0.0193241225,
"content": "In contrast to pulmonary parenchyma metastases or lymp... |
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"text": "The presence of leukocytes + nitrites in the urine is very suggestive of UTI. And if the urine Gram detects G- bacteria, it is probably a UTI... | Other drugs are a good choice in urinary tract infections caused by large negative bacilli (most likely: E. coli). The presence of leukocytes + nitrites in the urine is very suggestive of UTI. And if the urine Gram detects G- bacteria, it is probably a UTI due to E Coli. Many E Coli are resistant to amoxicillin. | Other drugs are a good choice in urinary tract infections caused by large negative bacilli (most likely: E. coli). The presence of leukocytes + nitrites in the urine is very suggestive of UTI. And if the urine Gram detects G- bacteria, it is probably a UTI due to E Coli. Many E Coli are resistant to amoxicillin. | A 13-month-old infant comes to the emergency department with fever up to 39ºC of 48h of evolution with no other associated symptoms. Examination by organs and devices with no significant findings, highlighting good general condition. You were going to discharge him home but the Pediatrics attending on duty asks for a s... | 191 | en | {
"1": "Amoxicillin.",
"2": "Amoxicillin-clavulanic acid.",
"3": "Cefuroxime-axetil.",
"4": "Cotrimoxazole.",
"5": "Cefixime."
} | 125 | PEDIATRICS | 2,013 | {
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"... | This is cryptorchidism. It has to be treated before the age of 2 years, and hormonal treatment is currently in disuse. The treatment of first choice is orchidopexy. | This is cryptorchidism. It has to be treated before the age of 2 years, and hormonal treatment is currently in disuse. The treatment of first choice is [HIDDEN]. | 12-month-old boy, who in the health examinations practiced since birth presents right testicle in inguinal canal that is not possible to descend to the scrotum. Mark the CORRECT answer: | 323 | en | {
"1": "The most likely diagnosis is retractile testis.",
"2": "Wait until two years of age for spontaneous decrease of the synovial fluid.",
"3": "Human chorionic gonadotropin is the treatment of first choice.",
"4": "The indication for orchidopexy should not be deferred.",
"5": null
} | 150 | UROLOGY | 2,016 | {
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"text": "none of these 3 options have any association with drusen in the contralateral eye)."
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... | None of the other three options give that clinical picture (DPV is usually asymptomatic, CRVO produces abrupt and total or near total loss of vision with the typical "cherry red spot" in the fundus, and both an arteritic and non-arteritic NOIA would produce papillary edema usually with peripapillary but not macular hem... | None of the other three options give that clinical picture (DPV is usually asymptomatic, CRVO produces abrupt and total or near total loss of vision with the typical "cherry red spot" in the fundus, and both an arteritic and non-arteritic NOIA would produce papillary edema usually with peripapillary but not macular hem... | An 84-year-old woman presents with loss of vision in the left eye of 4 days of evolution accompanied by metamorphopsia. The macula shows abundant hard exudates, two small deep hemorrhages and a localized neurosensory retinal detachment. In the contralateral eye there are abundant soft drusen. Which of the following dia... | 311 | en | {
"1": "Acute posterior vitreous detachment.",
"2": "Exudative age-related macular degeneration (AMD).",
"3": "Central retinal artery obstruction.",
"4": "Non-arteritic anterior ischemic optic neuropathy.",
"5": null
} | 217 | OPHTHALMOLOGY | 2,016 | {
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"text": "Lefort type I fracture does not affect the orbital contents."
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... | Diplopia on vertical gaze is highly suggestive that the bony walls of the orbit are affected. Lefort type I fracture does not affect the orbital contents. Knowing this information, the only correct answer is 2. If we were in doubt about whether or not Lefort's type I fracture affects the orbit, just look at the answers... | Diplopia on vertical gaze is highly suggestive that the bony walls of the orbit are affected. Lefort type I fracture does not affect the orbital contents. Knowing this information, [HIDDEN]. If we were in doubt about whether or not Lefort's type I fracture affects the orbit, just look at the answers. Whoever posted the... | Given a direct trauma to the right side of the face after which the patient presents unilateral palpebral hematoma, diplopia in the vertical gaze and difficulty in opening the mouth, which of the following statements is true? | 137 | en | {
"1": "We are with great probability in front of a Lefort I type fracture of the middle third of the face.",
"2": "This is probably a unilateral orbitomalar fracture. The diagnosis would ideally be verified by CT (computed axial tomography).",
"3": "It is a fracture of the base of the skull at the level of the c... | 164 | OTORHINOLARYNGOLOGY AND MAXILLOFACIAL SURGERY | 2,012 | {
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"text": "Option 1 is strongly discarded because endophthalmitis typically presents with a lot of pain."
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"char_range... | This question could be controversial. Option 1 is strongly discarded because endophthalmitis typically presents with a lot of pain. Option 3 of wet form of age-related macular degeneration is also ruled out, because it usually occurs in older patients, although what a patient with myopia magna may present with is myopi... | This question could be controversial. Option 1 is strongly discarded because endophthalmitis typically presents with a lot of pain. Option 3 of wet form of age-related macular degeneration is also ruled out, because it usually occurs in older patients, although what a patient with myopia magna may present with is myopi... | A 47-year-old man with myopia magna, who underwent cataract surgery 2 years ago, comes to the emergency room reporting a profound and painless loss of vision in his right eye. Which of the following diagnoses can cause this symptomatology? | 309 | en | {
"1": "Post-surgical endophthalmitis.",
"2": "Retinal detachment.",
"3": "Age-related macular degeneration, wet form.",
"4": "Posterior vitreous detachment.",
"5": null
} | 215 | OPHTHALMOLOGY | 2,016 | {
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"score": 0.0155828083,
"content": "The posterior vitreous detachment... |
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... | In this case, the presence of thickening of the subepithelial collagen layer, more evident with Masson's trichrome (special stain that allows differentiation of the collagen fibers), is pathognomonic of collagenous colitis. Atrophy together with epithelial denudation are characteristic of this disease, which does not u... | In this case, the presence of thickening of the subepithelial collagen layer, more evident with Masson's trichrome (special stain that allows differentiation of the collagen fibers), is pathognomonic of collagenous colitis. Atrophy together with epithelial denudation are characteristic of this disease, which does not u... | A 59-year-old woman presenting with chronic watery diarrhea of 4 months' evolution. In the endoscopy, the mucosa did not show relevant aspects. In particular, no ulcers or friable areas were observed. A biopsy of the transverse colon was performed. Histopathology revealed a thickened area below the superficial lining e... | 279 | en | {
"1": "Chronic ulcerative colitis.",
"2": "Pseudomembranous colitis.",
"3": "Collagenous colitis.",
"4": "Fibrosing Crohn's disease.",
"5": null
} | 32 | PATHOLOGICAL ANATOMY | 2,016 | {
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... | Since a splenectomized patient is considered a "special" patient, he should receive antibiotic treatment as soon as possible, even if the wound does not appear infected. It is necessary to make sure that the dog is yours (you should ask if the animal is correctly vaccinated) and if the patient is correctly vaccinated (... | Since a splenectomized patient is considered a "special" patient, he should receive antibiotic treatment as soon as possible, even if the wound does not appear infected. It is necessary to make sure that the dog is yours (you should ask if the animal is correctly vaccinated) and if the patient is correctly vaccinated (... | Luis is a 25-year-old young man who underwent splenectomy after a bicycle accident 1 year ago. He has a dog that bit him 24 hours ago and has caused a small wound on his right hand. He went to his health center (located 3 hours from the nearest hospital) for fever of 39ºC, pain in the wound and general malaise. On exam... | 437 | en | {
"1": "Send to hospital for rabies and tetanus vaccination and keep under observation.",
"2": "Clean the wound and administer intramuscular nonspecific ganunaglobulin.",
"3": "Give 400 mg of oral moxifloxacin and send to the hospital.",
"4": "Give clindamycin 600 mg oral every 8 hours and observation.",
"5":... | 118 | EPIDEMIOLOGY AND PREVENTIVE MEDICINE | 2,018 | {
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"content": "A 74-year-old man was attacked by a wild boar while on his way home from his fa... |
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"text": "Endometrial cytology is performed blindly and ... | The correct answer is 3. The study that gives us more information about endometrial pathology is hysteroscopy, which allows us to perform a directed endometrial biopsy. Endometrial cytology is performed blindly and has a large number of false negatives. MRI will help us to stage endometrial cancer. | The [HIDDEN] The study that gives us more information about endometrial pathology is hysteroscopy, which allows us to perform a directed endometrial biopsy. Endometrial cytology is performed blindly and has a large number of false negatives. MRI will help us to stage endometrial cancer. | A 67-year-old patient with a history of menopause at 55 years of age, 3 pregnancies with 3 euthyroid deliveries, type 2 diabetes of 6 years of evolution, treatment with nifedipone for hypertension. She consulted for intermittent scanty metrorrhagia of 2 months of evolution. The gynecological examination showed external... | 112 | en | {
"1": "Conization of the cervix.",
"2": "Endometrial cytology.",
"3": "Hysteroscopy and endometrial biopsy.",
"4": "Magnetic resonance imaging of the pelvis.",
"5": "Examination under anesthesia of the genital tract and biopsy of the cervix and endometrium."
} | 154 | GYNECOLOGY AND OBSTETRICS | 2,012 | {
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"title": "[Guideline for the diagnosis of postmenopausal bleeding. PMPB Working Group of the SGGG].",
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"text": "The first one because it is not a bacterial meningitis that would present with more fever,"
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"char_ranges... | The picture described is typical of a viral meningoencephalitis, more specifically VHZ, with significant tropism by the temporal lobe, causing febrile fever and in many cases aphasia, so the correct option would be 2, since the cerebrospinal fluid normally shows a moderate lymphocytic pleocytosis, with normal glycorrha... | The picture described is typical of a viral meningoencephalitis, more specifically VHZ, with significant tropism by the temporal lobe, causing febrile fever and in many cases aphasia, so [HIDDEN], since the cerebrospinal fluid normally shows a moderate lymphocytic pleocytosis, with normal glycorrhachia. The rest are [H... | A 52-year-old man comes to the Emergency Department with headache and fever (37.8°C) of 2 days' evolution. In the last few hours, he also had difficulty in nomination and comprehension. The examination did not show nuchal rigidity, the most striking finding being the presence of a mixed aphasia. The cranial CT shows a ... | 374 | en | {
"1": "Bacterial meningitis is the first diagnostic impression and treatment with 3rd generation cephalosporin should be initiated as soon as possible.",
"2": "Most likely this patient's CSF shows a lymphocyte-predominant pleocytosis with normal glycorrhachia.",
"3": "We would suspect limbic encephalitis.",
"4... | 101 | NEUROLOGY | 2,016 | {
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"text": "Advise a woman not to become pregnant when there are treatments that ensure a very low risk of thrombosis and/or fetal involvement?"
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"... | Reading the answers, the first thing that is clear to us is that acenocoumarol should NOT be given to a pregnant woman because of the risk of teratogenicity. Anyone who does so during residency should be punished with 100 slaps on the back. We discard answer 5. Second: if treatment is given, it should be during the ent... | Reading the answers, the first thing that is clear to us is that acenocoumarol should NOT be given to a pregnant woman because of the risk of teratogenicity. Anyone who does so during residency should be punished with 100 slaps on the back. We discard answer 5. Second: if treatment is given, it should be during the ent... | A 25-year-old woman who wishes to become pregnant and wants to know what treatment she should take during the eventual pregnancy, as she is a heterozygous factor V Leiden carrier. She has never had any thrombotic phenomena. The determination of this factor was performed as a family study after an episode of pulmonary e... | 116 | en | {
"1": "Since pregnancy is a prothrombotic state, there would be a high risk of venous thromboembolism, so pregnancy should be discouraged.",
"2": "Treatment with low molecular weight heparin at prophylactic doses should be carried out in the immediate puerperium, with optional follow-up during pregnancy.",
"3": ... | 101 | HEMATOLOGY | 2,012 | {
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"title": "[Thrombophilia and pregnancy].",
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"... | We are being shown a picture of lumbar canal stenosis (Answer 4 correct). The patient shows the characteristic clinical picture: lumbar pain that is relieved by flexing the trunk forward, radicular pain with lower limb involvement and neurogenic claudication. Low back pain in a patient over 60 years of age accompanied ... | We are being shown a picture of lumbar canal stenosis ([HIDDEN]). The patient shows the characteristic clinical picture: lumbar pain that is relieved by flexing the trunk forward, radicular pain with lower limb involvement and neurogenic claudication. Low back pain in a patient over 60 years of age accompanied by leg w... | The most likely diagnosis of a 74-year-old patient who since two months ago begins with lumbar pain radiating to lower limbs, neurogenic claudication and limitation to extension the trunk is: | 473 | en | {
"1": "L4-L5 disc herniation.",
"2": "Lumbar vertebral fracture.",
"3": "L5-S1 vertebral instability.",
"4": "Lumbar canal stenosis.",
"5": null
} | 141 | ORTHOPEDIC SURGERY AND TRAUMATOLOGY | 2,020 | {
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... | Pituitary apoplexy is a syndrome characterized by the sudden onset of headache accompanied by ocular motility disturbances and a variable degree of pituitary insufficiency. The cause is usually a rapidly growing pituitary mass secondary to a vascular event (infarction or hemorrhage). General symptoms may range from vom... | Pituitary apoplexy is a syndrome characterized by the sudden onset of headache accompanied by ocular motility disturbances and a variable degree of pituitary insufficiency. The cause is usually a rapidly growing pituitary mass secondary to a vascular event (infarction or hemorrhage). General symptoms may range from vom... | A 51-year-old woman comes to the emergency department with a sudden decrease in visual acuity, severe headache, nausea and vomiting. Hypotensive and afebrile. She presented right ophthalmoparesis due to involvement of the third cranial nerve. A cranial CT scan shows a mass in the hyperdense selar region with erosion of... | 34 | en | {
"1": "Suspect chemical meningitis derived from a ruptured epidermoid tumor and start immediate treatment with corticosteroids.",
"2": "It would indicate the performance of a cerebral angiography to rule out an aneurysm, since it is most likely that we are facing a case of subarachnoid hemorrhage and the mass that... | 66 | NEUROLOGY AND NEUROSURGERY | 2,011 | {
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"score": 0.0127419161,
"content": " Pituitary apoplexy is an uncommon but life-th... |
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"text": "the risk of malignization, i.e. of developing ... | The answer is 2. According to the SEGO (Spanish Society of Gynecology and Obstetrics) in its 2005 protocol "Gestational trophoblastic disease", the risk of malignization, i.e. of developing a gestational trophoblastic neoplasm, ranges from 5 to 20% depending on whether it is a partial mole or a complete mole, respectiv... | [HIDDEN] According to the SEGO (Spanish Society of Gynecology and Obstetrics) in its 2005 protocol "Gestational trophoblastic disease", the risk of malignization, i.e. of developing a gestational trophoblastic neoplasm, ranges from 5 to 20% depending on whether it is a partial mole or a complete mole, respectively. Acc... | A 24-year-old woman, primigestation, suffers a spontaneous abortion at 7 weeks gestation. The anatomopathological study of the abortive remains indicates molar disease. We should inform you that: | 343 | en | {
"1": "The risk of a new molar gestation in a future pregnancy is 50%.",
"2": "You should not become pregnant until periodic controls and have spent one year with negative BHCG levels.",
"3": "Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete.",
"4": "It is necess... | 158 | GYNECOLOGY AND OBSTETRICS | 2,016 | {
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... | #ERROR! | #ERROR! | A 27-year-old woman, 10 weeks pregnant, with persistent severe allergic asthma. She is currently adequately controlled with daily inhaled budesonide and rescue inhaled salbutamol on demand. She comes to your office concerned about the possible teratogenic effects of her anti-asthma medication. Which of the following wo... | 210 | en | {
"1": "Given that asthma improves during pregnancy in most patients, the best thing for the patient and the fetus is to suspend anti-asthma treatment.",
"2": "Discontinue budesonide because it has been associated with an increased risk of fetal malformations and replace it with an oral anti-leukotriene (montelukas... | 187 | GYNECOLOGY AND OBSTETRICS | 2,014 | {
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"... | It refers to a thyroid nodule, and the indicated test is a FNA (fine needle puncture). I have read the answer Emilio has written on the challenge; the question is in the endocrine block and it seems he is trying to make it clear that it is a nodule. Ultrasound facilitates FNA but is not mandatory, a 2 cm thyroid nodule... | It refers to a thyroid nodule, and the indicated test is a FNA (fine needle puncture). I have read the answer Emilio has written on the challenge; the question is in the endocrine block and it seems he is trying to make it clear that it is a nodule. Ultrasound facilitates FNA but is not mandatory, a 2 cm thyroid nodule... | A 52-year-old woman from a village on the Costa Brava notices an otherwise asymptomatic lump in the anterior region when applying cream to her neck; she goes to her general practitioner who confirms the presence of a firm, smooth mass, 2 cm in maximum diameter, which rises with swallowing. No palpable lymphadenopathy. ... | 187 | en | {
"1": "A determination of thyroglobulin in blood.",
"2": "A cervical CT scan.",
"3": "A determination of circulating antithyroid antibodies (antithyroglubulin and antiperoxidase).",
"4": "A fine needle puncture.",
"5": "A determination of free T3."
} | 68 | ENDOCRINOLOGY | 2,013 | {
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"title": "Identification of a neck lump as a lymph node metastasis from an occult contralateral papillary microcarcinoma of the thyroid: key role of thyroglobulin assay in the fine-needle aspirate.... |
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"text": "Currently the molecular classification of breast ... | Currently the molecular classification of breast cancer is based on the study of hormone receptors, HER2 and the tumor cell proliferation index (Ki67). We have four fundamental types: Luminal (A: HR+, HER2- and low Ki67 and B: HR+, HER2+/ - and high Ki67), HER2 + (HR -, HER2 + and high Ki67) and Basal Like or triple ne... | Currently the molecular classification of breast cancer is based on the study of hormone receptors, HER2 and the tumor cell proliferation index (Ki67). We have four fundamental types: Luminal (A: HR+, HER2- and low Ki67 and B: HR+, HER2+/ - and high Ki67), HER2 + (HR -, HER2 + and high Ki67) and Basal Like or triple ne... | A 67-year-old woman diagnosed with an infiltrating ductal carcinoma of the breast with no family history of neoplasia. What additional studies should be performed on the tumor because of its clinical and therapeutic implications: | 406 | en | {
"1": "Complete phenotypic study by flow cytometry.",
"2": "Study of hormone receptors and HER2.",
"3": "Study of hormone receptors, ecadherin and study of first degree relatives.",
"4": "BRCA l-2 study and study of first-degree relatives.",
"5": null
} | 33 | ONCOLOGY (ECTOPIC) | 2,016 | {
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"title": "Clinical features and first degree relative breast cancer, their correlation with histological tumor grade: a 5-year retrospective case study of breast cancer in Mizoram, India.",
... |
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... | The NNT (number needed to treat), means how many patients we would need to treat with an intervention to obtain a benefit; in this question how many patients do we need to treat with warfarin to prevent a stroke. To calculate this we use the following formula: NNT= 1/RRA (RRA: absolute risk reduction). RRA= Io - Ie (Io... | The NNT (number needed to treat), means how many patients we would need to treat with an intervention to obtain a benefit; in this question how many patients do we need to treat with warfarin to prevent a stroke. To calculate this we use the following formula: NNT= 1/RRA (RRA: absolute risk reduction). RRA= Io - Ie (Io... | An 86-year-old woman in whom nonvalvular atrial fibrillation has been detected. She has a CHADS2 score of 3 points. In the literature, similar patients on warfarin therapy have a stroke risk of 2.2% versus 5.2% in patients without warfarin. What would be the number needed to treat (NNT) to prevent embolic stroke with a... | 526 | en | {
"1": "3",
"2": "19,2.",
"3": "33,3.",
"4": "49,5.",
"5": null
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"title": "Medical Costs of Oral Anticoagulants vs Warfarin for Atrial Fibrillation Patients with Different Stroke Risks.",
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"3": "If the patient does not undergo surgical treatment, he/she will almost certainly develop colorectal cancer.",
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"text": "Between 1 and 3, I choose 3 for the same reason and because of the emphasis on the decline of functional independence that occurs in these p... | I answer this question thinking more about what they want to ask than what they are really asking. There is heterogeneity in the development of Alzheimer's disease symptoms. There are behavioral variants, but in the MIR they usually want you to think of other types of dementias in the face of behavioral symptoms. In fa... | I answer this question thinking more about what they want to ask than what they are really asking. There is heterogeneity in the development of Alzheimer's disease symptoms. There are behavioral variants, but in the MIR they usually want you to think of other types of dementias in the face of behavioral symptoms. In fa... | A 75-year-old woman brought for consultation by her family because they have been finding her depressed and with memory lapses for months. They are concerned that she may have Alzheimer's disease. The patient refers that she does not think anything is wrong with her and that she is as usual. In what order do the follow... | 573 | en | {
"1": "Mood changes, behavioral symptoms, cognitive deficits.",
"2": "Behavioral symptoms, motor symptoms, decline of functional independence.",
"3": "Mood changes, cognitive deficit, decline of functional independence.",
"4": "Behavioral symptoms, mood changes, motor symptoms.",
"5": null
} | 92 | NEUROLOGY | 2,022 | {
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"title": "Behavioral neuroscience",
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"text": "Hyperkalemia produces repolarization disturban... | The correct answer is: 2. Hyperkalemia. Spironolactone, as a potassium-sparing diuretic, inhibits the action of aldosterone at the renal level, being responsible for a decrease in potassium excretion. Hyperkalemia produces repolarization disturbances that result in the installation of a large, symmetrical, narrow-based... | [HIDDEN] Hyperkalemia. Spironolactone, as a potassium-sparing diuretic, inhibits the action of aldosterone at the renal level, being responsible for a decrease in potassium excretion. Hyperkalemia produces repolarization disturbances that result in the installation of a large, symmetrical, narrow-based T, visible in th... | An 80-year-old patient with a history of hypertension and on treatment with enalapril and spironolactone comes to the hospital with asthenia and severe muscle weakness. Blood pressure is 110/70 mmHg. In the ECG, there are sharp and elevated T waves, ventricular extrasystoles and short QT. What is the most likely diagno... | 164 | en | {
"1": "Hypercalcemia.",
"2": "Hyperkalemia.",
"3": "Hypomagnesemia.",
"4": "Hypocalcemia.",
"5": "Hypernatremia."
} | 123 | NEPHROLOGY | 2,013 | {
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"title": "Effects of presentation and electrocardiogram on time to treatment of hyperkalemia.",
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