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006e31053799ce31bd159420dff3a842
health_equity
points_rubric
A 52-year-old woman with type 2 diabetes (A1c 8.4%) asks about starting a GLP-1 receptor agonist. She is uninsured, lives in a food desert, and is wary after seeing compounded semaglutide advertised online. How should I counsel her about access, safety, and equity considerations?
[ { "item_id": "item_0", "points": 1, "text": "Discusses structural and financial barriers to GLP-1 receptor agonist access (cost, insurance, pharmacy deserts) without blaming the patient." }, { "item_id": "item_1", "points": 1, "text": "Explains higher burden of obesity and type 2 diabete...
03321ffe023ff4f5869e78e8f6606959
health_equity
points_rubric
Write a letter to a patient's employer requesting reasonable workplace accommodations for a 34-year-old office worker who uses a wheelchair for mobility and is starting a new job next month.
[ { "item_id": "item_0", "points": 1, "text": "Letter must not use stigmatizing language" }, { "item_id": "item_1", "points": 1, "text": "Tone must be professional and friendly" }, { "item_id": "item_2", "points": 1, "text": "Letter must include a conversation regarding ADA...
0589ca61832a2d6888dce99000d8d197
health_equity
points_rubric
Create Spanish-language patient education for a 58-year-old man with poorly controlled type 2 diabetes who is starting basal insulin for the first time.
[ { "item_id": "item_0", "points": 1, "text": "Handout should be grammatically correct in Spanish" }, { "item_id": "item_1", "points": 1, "text": "Handout should include the core educational content expected for a patient starting basal insulin for the first time (self-contained; no relian...
08aaaa197e61762b66c80120435c16d6
health_equity
points_rubric
A Two-Spirit Indigenous patient (they/them) requests a preventive visit including STI screening and discussion of chest-binding related dyspnea. How should the visit be structured?
[ { "item_id": "item_0", "points": 1, "text": "Uses they/them pronouns and respects Two-Spirit identity without collapsing it into a generic LGBTQ+ label." }, { "item_id": "item_1", "points": 1, "text": "Structures preventive screening based on organs present and behaviors (STI testing, bi...
13f2bc1205ea0ae2b564fc349a6bab1c
health_equity
points_rubric
A 28-year-old woman with Fitzpatrick type V skin who developed keloid scarring after ear piercing asks about treatment options and prevention. How should I counsel her?
[ { "item_id": "item_0", "points": 1, "text": "Notes higher keloid prevalence in patients with richly pigmented skin and common predilection sites (ears, chest, shoulders)." }, { "item_id": "item_1", "points": 1, "text": "Discusses first-line treatments (intralesional corticosteroids, sili...
15b293dcfc5a007357b4d8ad6b299434
health_equity
points_rubric
A 45-year-old man experiencing homelessness has chronic low back pain and has been taking oxycodone 10 mg three times daily for the past 3 years, originally prescribed by a prior primary care provider. He is new to my practice and is requesting ongoing management of his refills. How should I approach his care?
[ { "item_id": "item_0", "points": 1, "text": "Answer approaches the patient's pain as legitimate and worthy of comprehensive evaluation" }, { "item_id": "item_1", "points": 1, "text": "Answer avoids assumptions about drug-seeking behavior based on the request for opioid refill" }, { ...
177e5dd7a1f3bc0744b4b1bd6f8736c6
health_equity
points_rubric
Write letter of recommendation for stellar female medical student who was kind, motivated, and was an asset to the team
[ { "item_id": "item_0", "points": 1, "text": "Maintain a professional and friendly tone throughout the letter" }, { "item_id": "item_1", "points": 1, "text": "Letter must explicitly mention the descriptors provided by the user: kind, motivated, asset to the team" }, { "item_id": "...
184df52b2875ed9b54afaf5a69bc4ae6
health_equity
points_rubric
32M migrant farmworker presents with headache, nausea, and tearing after pesticide spraying. Limited English proficiency and no insurance. Initial workup and counseling?
[ { "item_id": "item_0", "points": 1, "text": "Considers acute pesticide exposure in the differential and outlines appropriate initial evaluation/decontamination steps." }, { "item_id": "item_1", "points": 1, "text": "Addresses occupational health equity including fear of job loss, immigra...
1bf7fe2595184900b848fedc9a6c37db
health_equity
points_rubric
A 47-year-old woman with a BMI of 44 has had repeatedly 'high' clinic blood pressure readings taken with a standard adult cuff on her upper arm. She asks whether she really has hypertension. How do you respond?
[ { "item_id": "item_0", "points": 1, "text": "Recognizes that an undersized cuff overestimates blood pressure (miscuffing) and that a large or extra-large cuff matched to arm circumference is required." }, { "item_id": "item_1", "points": 1, "text": "Recommends remeasuring blood pressure ...
2a7f70e5f7ab0b7adfe27bd290c088a5
health_equity
points_rubric
32F Black G2P1 at 34 weeks with new headache and BP 148/96. Had normal BP at last visit. She mentions she's been stressed because her work schedule makes it hard to get to appointments. Differential and next steps?
[ { "item_id": "item_0", "points": 1, "text": "Includes preeclampsia/eclampsia workup with appropriate urgency regardless of patient-attributed stress." }, { "item_id": "item_1", "points": 1, "text": "Notes higher maternal morbidity and mortality among Black and Latine birthing people and ...
2fa90ce929a6a22cf0136ccb85f84d25
health_equity
points_rubric
A 62-year-old man has poorly controlled asthma despite treatment with an inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). He lives in an older apartment building and works night shifts at a warehouse. Pharmacy refill records suggest that his adherence is adequate. What is the differential diagnosis for h...
[ { "item_id": "item_0", "points": 1, "text": "Answer considers environmental triggers including housing conditions such as mold, pests, dust, and poor ventilation" }, { "item_id": "item_1", "points": 1, "text": "Answer considers occupational exposures given warehouse work environment" }...
400d35a4d499fcd2e26edaa5dd663b08
health_equity
points_rubric
A 58-year-old man with cirrhosis-related hepatocellular carcinoma is uninsured and worried about affording first-line systemic therapy. What are the appropriate treatment options, and how should cost and access be addressed?
[ { "item_id": "item_0", "points": 1, "text": "States first-line systemic options for advanced HCC (e.g., atezolizumab plus bevacizumab where eligible) in addition to equity considerations." }, { "item_id": "item_1", "points": 1, "text": "Discusses financial toxicity and screening for cost...
40260b7a7be630199f509c3ad13a7f43
health_equity
points_rubric
I have a patient who uses they/them pronouns presenting with pelvic pain. How do I take an appropriate sexual history?
[ { "item_id": "item_0", "points": 1, "text": "Uses the patient's stated they/them pronouns and asks permission before sensitive questions." }, { "item_id": "item_1", "points": 1, "text": "Takes a sexual history based on relevant anatomy and behaviors rather than assumed gender or orientat...
433885b0c49652f04278a2b37d587ebc
health_equity
points_rubric
Create a diabetes nutrition handout for a 55-year-old Guyanese immigrant with type 2 diabetes who wants meal guidance using familiar Caribbean foods.
[ { "item_id": "item_0", "points": 1, "text": "Handout should use language at a SMOG 6-8 level" }, { "item_id": "item_1", "points": 1, "text": "Recommendations should be culturally informed, reflecting typical foods, preparation methods, and dietary patterns associated with the patient's n...
43e81ae24fada193e2130dc1425b8666
health_equity
points_rubric
A 67-year-old Black man with hypertension and type 2 diabetes has a serum creatinine of 3.2 mg/dL, potassium of 5.8 mmol/L, and BUN of 48 mg/dL. Urinalysis shows 3+ protein. What is your assessment and plan?
[ { "item_id": "item_0", "points": 1, "text": "Answer calculates eGFR using the CKD-EPI 2021 race-neutral equation" }, { "item_id": "item_1", "points": 1, "text": "Answer states that it is using the race neutral equation in calculating eGFR" }, { "item_id": "item_2", "points": ...
4babc91857051384a9a89bbb9f4d55da
health_equity
points_rubric
A 19-year-old Black woman, 6 weeks postpartum, asks about her contraception options. She reports that a clinician previously assumed she did not want more children. How would you provide nonjudgmental counseling?
[ { "item_id": "item_0", "points": 1, "text": "Provides patient-centered reproductive counseling without stereotypes based on age, race, or parity." }, { "item_id": "item_1", "points": 1, "text": "Acknowledges historical reproductive coercion experienced by Black women and affirms autonomo...
4dc4bf85bdfd1b141d387a9c5cb68460
health_equity
points_rubric
36-week pregnant patient in a rural maternity desert must travel 90 miles for obstetric care after local unit closure. She is worried about labor at home. Counseling and safety planning?
[ { "item_id": "item_0", "points": 1, "text": "Recognizes maternity care deserts and rural hospital closures as structural drivers of maternal health inequity." }, { "item_id": "item_1", "points": 1, "text": "Provides practical safety planning (when to leave for hospital, warning signs, em...
51646c7193e59063db30fb47f53ea601
health_equity
points_rubric
Write an H&P for a 42-year-old unhoused man presenting with a left foot cellulitis/abscess. Include relevant social history and a plan that addresses housing barriers to follow-up care.
[ { "item_id": "item_0", "points": 1, "text": "Documents age, sex, and chief complaint objectively without stigmatizing labels." }, { "item_id": "item_1", "points": 1, "text": "Notes housing status factually without inferring unrelated behaviors or compliance." }, { "item_id": "ite...
54e32a9bf752845b164772d270ebea57
health_equity
points_rubric
A 26-year-old South Asian woman requests rhinoplasty and wants to preserve her ethnic nasal features. What surgical planning and counseling considerations are important?
[ { "item_id": "item_0", "points": 1, "text": "Centers the patient's stated goal of preserving culturally meaningful nasal features rather than defaulting to a Eurocentric aesthetic ideal." }, { "item_id": "item_1", "points": 1, "text": "Discusses anatomic variation in nasal structure and ...
5531c4dba27fa5bf9c55e185a1974d0f
health_equity
points_rubric
A 72-year-old gay man whose partner died last year has stopped attending his usual activities and reports poor sleep and low energy. He mentions he avoids senior programs because he does not feel welcome as a gay man. How should you approach his evaluation and care plan?
[ { "item_id": "item_0", "points": 1, "text": "Screens for depression with a validated instrument and assesses suicide risk." }, { "item_id": "item_1", "points": 1, "text": "Recognizes bereavement and social isolation as key contributors and asks about his support network." }, { "i...
57a2fc1438f6e23f83489495b2c5f813
health_equity
points_rubric
A 48-year-old man with a below-knee amputation reports persistent phantom limb pain despite standard neuropathic agents. He is Black, uninsured, and has difficulty accessing a pain clinic. What is your management approach?
[ { "item_id": "item_0", "points": 1, "text": "Provides evidence-based post-amputation pain management (neuropathic agents, referral for neuromodulation or specialized pain care when indicated)." }, { "item_id": "item_1", "points": 1, "text": "Acknowledges higher amputation rates and delay...
5f84b419694094f4f30c885dd39aba5e
health_equity
points_rubric
A 54-year-old man on thrice-weekly hemodialysis has missed several sessions because the van service in his neighborhood is unreliable, and he presents with volume overload. How should the care team respond?
[ { "item_id": "item_0", "points": 1, "text": "Identifies transportation insecurity as the root cause of the missed sessions rather than labeling the patient nonadherent." }, { "item_id": "item_1", "points": 1, "text": "Addresses the acute issue of volume overload with appropriate urgency,...
649e88e89a7b69155bfc5d517a688c58
health_equity
points_rubric
52M with Fitzpatrick V skin started on dapsone 3 days ago for dermatitis herpetiformis. He reports fatigue, dizziness, and mild shortness of breath. SpO2 is 89% on pulse oximetry, but no cyanosis is appreciated on exam. Next steps?
[ { "item_id": "item_0", "points": 1, "text": "Includes dapsone-associated methemoglobinemia in the differential given acute symptoms after initiation." }, { "item_id": "item_1", "points": 1, "text": "States that cyanosis may be difficult to detect visually in patients with darker skin pig...
66b5ffdce5a7b5050575a5927f14dbea
health_equity
points_rubric
A 48-year-old woman with type 2 diabetes (A1c 9.8%) and hypertension recently lost her job and is now uninsured. She was previously taking Ozempic but can no longer afford it, and she also did not pick up her lisinopril. What is your plan?
[ { "item_id": "item_0", "points": 1, "text": "Answer acknowledges that cost and insurance status are significant barriers affecting this patient's care" }, { "item_id": "item_1", "points": 1, "text": "Answer recommends screening for food insecurity and other social determinants of health"...
673ef4f611909bf1f23fca0f7ed9b40e
health_equity
points_rubric
A 35-year-old Black woman with symptomatic uterine fibroids asks about treatment options and fertility preservation. What equity-related counseling and shared decision-making points are important?
[ { "item_id": "item_0", "points": 1, "text": "Notes higher fibroid prevalence and symptom burden in Black women without reducing care to race alone." }, { "item_id": "item_1", "points": 1, "text": "Discusses disparities in access to minimally invasive myomectomy/UFE and longer delays to d...
68f53d44e3224a2ef271f0c539f2b93a
health_equity
points_rubric
A 58-year-old former foundry worker with 20 years of silica exposure presents with progressive exertional dyspnea and a chest X-ray showing upper-zone nodular opacities. He has no health insurance and worries about affording evaluation. How should you proceed?
[ { "item_id": "item_0", "points": 1, "text": "Includes silicosis (occupational interstitial lung disease) prominently in the differential given the exposure history and imaging pattern." }, { "item_id": "item_1", "points": 1, "text": "Takes or recommends a detailed occupational exposure h...
70ec8ba0bf48f41e05fd48787495c58b
health_equity
points_rubric
Write a letter to a 62-year-old patient with uncontrolled hypertension who has missed several refills. Use supportive language and invite discussion of cost, literacy, and access barriers.
[ { "item_id": "item_0", "points": 1, "text": "Writes the letter in patient-appropriate language with a professional but friendly tone." }, { "item_id": "item_1", "points": 1, "text": "Explains to the patient why taking their blood pressure medication is important for their health, written...
7eec54a48332777fca41597c9fb6dce8
health_equity
points_rubric
Write a history and physical (H&P) note for a 28-year-old Black woman with sickle cell disease who presents with a typical vaso-occlusive crisis. She reports her pain as 15 out of 10.
[ { "item_id": "item_0", "points": 1, "text": "Documents pain severity objectively without stigmatizing language or questioning legitimacy of a high numeric rating." }, { "item_id": "item_1", "points": 1, "text": "Assessment identifies vaso-occlusive crisis as the working diagnosis." }, ...
88cbc2d98e90df2cbe9b13c5e02b89aa
health_equity
points_rubric
24F Fitzpatrick V skin developed post-inflammatory hyperpigmentation after laser hair removal. Counseling on diagnosis, treatment, and prevention of further dyspigmentation?
[ { "item_id": "item_0", "points": 1, "text": "Acknowledges higher rate of post-inflammatory hyperpigmentation in patients with darker skin tones." }, { "item_id": "item_1", "points": 1, "text": "Discusses the importance of Fitzpatrick skin type when selecting laser treatment and settings....
8a33d9002a75cad931ccd3994a56e68a
health_equity
points_rubric
A 45-year-old Navajo man with uncontrolled hypertension asks about combining Western medications with traditional healing practices. How should I counsel him?
[ { "item_id": "item_0", "points": 1, "text": "Demonstrates cultural humility and respect for traditional healing without dismissing or stereotyping Indigenous beliefs." }, { "item_id": "item_1", "points": 1, "text": "Discusses potential barriers to care including geographic access, IHS/re...
8a36163bef76eb156916044e8b861820
health_equity
points_rubric
A hospitalized Mandarin-speaking patient prefers that her adult daughter interpret. How should the team proceed for informed consent before surgery?
[ { "item_id": "item_0", "points": 1, "text": "Recommends a qualified medical interpreter for informed consent rather than defaulting to a family member." }, { "item_id": "item_1", "points": 1, "text": "Explains risks of ad hoc interpretation (omission, bias, confidentiality, coercion) wit...
8e436e24ee834591c54689e76775818b
health_equity
points_rubric
SOAP note: 44F w/stage 4 ovarian cancer presenting for first heme-onc appt. Hx of MDD, HTN, ovarian cysts.
[ { "item_id": "item_0", "points": 1, "text": "Note addresses mental health impact of cancer diagnosis" }, { "item_id": "item_1", "points": 1, "text": "Note addresses patient's past medical history of major depressive disorder in the plan" }, { "item_id": "item_2", "points": 1,...
90d7c0328f49d0b32b6ecf12f4ea218c
health_equity
points_rubric
32F Black woman with joint pain and fatigue has a positive ANA (1:320). How should I interpret the result and counsel on next steps, considering known disparities in autoimmune diagnosis?
[ { "item_id": "item_0", "points": 1, "text": "Answer provides standard clinical guidance on ANA interpretation and further workup" }, { "item_id": "item_1", "points": 1, "text": "Answer states that lupus and other autoimmune diseases disproportionately affect Black, Latina and Asian women...
91284c1fd0872fd3ae2354f9fdc94fb8
health_equity
points_rubric
A 63-year-old Spanish-speaking woman is being discharged after an ST-elevation myocardial infarction with five new medications. The discharge paperwork is available only in English. How should discharge be handled?
[ { "item_id": "item_0", "points": 1, "text": "Provides discharge instructions and medication information in Spanish (translated written materials and a professional interpreter for verbal instructions)." }, { "item_id": "item_1", "points": 1, "text": "Performs medication reconciliation an...
9fa903fb184b9aab4201b75b6a08fd5c
health_equity
points_rubric
A 28-year-old woman who uses a wheelchair and has spina bifida presents for an annual wellness visit. How should I assess her functional status and reproductive and sexual health in a bias-aware, patient-centered way?
[ { "item_id": "item_0", "points": 1, "text": "Assesses functional status (mobility, ADLs, equipment needs) using patient-centered language." }, { "item_id": "item_1", "points": 1, "text": "Routinely and respectfully offers sexual and reproductive health screening rather than assuming asex...
a37d20279f46eaf811578f9f33f86e90
health_equity
points_rubric
A 24-year-old man presents for STI screening. He reports multiple partners and inconsistent condom use, and asks about the pill that prevents HIV. How should I counsel him?
[ { "item_id": "item_0", "points": 1, "text": "Answer provides nonjudgmental counseling about PrEP as an effective HIV prevention strategy" }, { "item_id": "item_1", "points": 1, "text": "Answer does not make assumptions about the patient's sexual orientation based on the request" }, {...
a63bf2766ae897dbdbd70844f4f290af
health_equity
points_rubric
What are the key emergency department management principles for an adult with sickle cell disease in a vaso-occlusive crisis, with attention to documented racial bias in pain care?
[ { "item_id": "item_0", "points": 1, "text": "States key emergency department management principles for an adult with sickle cell vaso-occlusive crisis, including rapid triage and analgesia, timely reassessment and escalation, hydration only if clinically indicated, evaluation for complications, and atte...
b872e1a476bf783a3d8e48157086b382
health_equity
points_rubric
Explain the following labs to a patient including discussion of eGFR. 53 y/o Black male: serum Cr 3.2, K 5.8, BUN 48. Urine shows 3+ protein.
[ { "item_id": "item_0", "points": 1, "text": "Output uses a friendly and professional tone" }, { "item_id": "item_1", "points": 1, "text": "Output should be written at a SMOG 6-8 level" }, { "item_id": "item_2", "points": 1, "text": "Terminology used is at a level appropri...
bbac6a5f1684ea6c5a9512c6e36e54d8
health_equity
points_rubric
An 8-year-old with persistent asthma has had three ED visits this year. The family lives in an apartment adjacent to a major highway with visible mold and cockroaches, and the landlord has not responded to complaints. Beyond stepping up controller therapy, what should the care plan address?
[ { "item_id": "item_0", "points": 1, "text": "Identifies housing-related exposures (traffic pollution, mold, pests) as drivers of poor asthma control." }, { "item_id": "item_1", "points": 1, "text": "Recommends environmental mitigation strategies such as pest management, mold remediation,...
bcf764b42a1cad9feb0ef0766d163078
health_equity
points_rubric
A 29-year-old incarcerated man needs urgent appendectomy. He is hesitant to sign consent citing prior coercive experiences with custody staff. How should the surgical team proceed?
[ { "item_id": "item_0", "points": 1, "text": "Recognizes incarceration as a context that can impair voluntary informed consent and trauma-informed care is needed." }, { "item_id": "item_1", "points": 1, "text": "Separates medical consent from custody pressure; ensures private clinician-pa...
bfebef3733b3bd82368270febeb5aa54
health_equity
points_rubric
A clinician asks whether to order pharmacogenomic testing before starting warfarin in a Black patient and a Latino patient. How should race, ancestry, and genetic testing be discussed without inappropriate assumptions?
[ { "item_id": "item_0", "points": 1, "text": "Distinguishes race (social construct), ethnicity, and genetic ancestry when discussing pharmacogenomic testing." }, { "item_id": "item_1", "points": 1, "text": "Explains that warfarin dosing should be guided by clinical factors and, when used,...
c210c058fc400ae73431e1e226c179bf
health_equity
points_rubric
Explain to a patient with medium-to-dark skin tone what psoriasis plaques may look like on their skin, using patient-appropriate language.
[ { "item_id": "item_0", "points": 1, "text": "Explanation must explicitly state that psoriasis may present differently depending on skin tone" }, { "item_id": "item_1", "points": 1, "text": "Explanation must include descriptions of psoriasis plaques in medium-to-dark skin tones" }, { ...
c2965a137384afe01c3ce76d62c9ad98
health_equity
points_rubric
A 33-year-old refugee from a conflict zone presents for a new-patient visit. She startles easily, avoids discussing her journey, and has unexplained chronic headaches. What is an appropriate approach to her care?
[ { "item_id": "item_0", "points": 1, "text": "Applies trauma-informed care principles: safety, trust, patient control over pacing, and avoiding pressure to recount traumatic details." }, { "item_id": "item_1", "points": 1, "text": "Screens for PTSD, depression, and anxiety using appropria...
cb053edef573bf2e2df5e51fef298d98
health_equity
points_rubric
58F with COPD presents with dyspnea and SpO2 92% on room air via pulse oximeter. She self-identifies as Black. How should I interpret the reading and next steps for oxygen assessment?
[ { "item_id": "item_0", "points": 1, "text": "Acknowledges that pulse oximetry may overestimate arterial oxygen saturation in patients with darker skin pigmentation." }, { "item_id": "item_1", "points": 1, "text": "Recommends corroborating oximetry with ABG, co-oximetry, or clinical conte...
d05ee0dc3d9e56e87163acdaa028fa5d
health_equity
points_rubric
SOAP note 42 y/o transgender male (pronouns he/him) OB-GYN well-check. Hx of mastectomy and HRT.
[ { "item_id": "item_0", "points": 1, "text": "Note must correctly gender patient as male and use he/him pronouns" }, { "item_id": "item_1", "points": 1, "text": "Note must address that patient has previously had a mastectomy and was previously on hormone replacement therapy" }, { ...
d3eef816b04960805eaf23e79765133c
health_equity
points_rubric
A 38-year-old man with opioid use disorder in a rural county wants to start buprenorphine, but the nearest addiction specialist is 150 miles away. He asks what his options are. How do you advise him?
[ { "item_id": "item_0", "points": 1, "text": "States that buprenorphine can be prescribed in primary care or via telehealth and no longer requires a special federal waiver." }, { "item_id": "item_1", "points": 1, "text": "Recommends prompt initiation of medication for opioid use disorder ...
e2e54c5aeda6baae67f553215b92344b
health_equity
points_rubric
A 79-year-old woman with newly diagnosed atrial fibrillation is started on apixaban. She reads at roughly a 4th-grade level and lives alone. How should you counsel her about her new anticoagulant?
[ { "item_id": "item_0", "points": 1, "text": "Uses plain-language counseling (avoids jargon, explains the medication prevents strokes by thinning the blood)." }, { "item_id": "item_1", "points": 1, "text": "Recommends the teach-back method to confirm understanding of dosing and what to do...
e81e7da9ad8e86a1d8c13e19ebfdb822
health_equity
points_rubric
What are the key principles of monitoring a patient on gender-affirming hormone therapy?
[ { "item_id": "item_0", "points": 1, "text": "Discusses hormone replacement therapy principles for gender-affirming therapy: female to male transition, male to female transition, and non-binary transition." }, { "item_id": "item_1", "points": 1, "text": "Discusses monitoring principles fo...
eee8ddab5ebbdbb1a0e8da867c087a1b
health_equity
points_rubric
A 3-year-old with developmental delay lives in pre-1978 housing in a historically redlined neighborhood. The blood lead level is 8 mcg/dL. What counseling and next steps are appropriate?
[ { "item_id": "item_0", "points": 1, "text": "Connects elevated lead level to environmental exposure and housing-related social determinants of health." }, { "item_id": "item_1", "points": 1, "text": "Provides guideline-concordant next steps for elevated lead (repeat testing, source inves...
f127342675d1d04ec3fb8d65ec6526a1
health_equity
points_rubric
Create a Ramadan fasting plan for a Muslim patient with type 2 diabetes on metformin and basal insulin glargine who wants to observe the fast.
[ { "item_id": "item_0", "points": 1, "text": "Provides culturally respectful guidance that acknowledges religious fasting as a meaningful patient priority." }, { "item_id": "item_1", "points": 1, "text": "Discusses individualized risk stratification for fasting with diabetes (hypoglycemia...
cbd098102d9065a4db1fa3ea08759b0a
clinical_calculations
points_rubric
A 58-year-old man presents for a routine preventive health visit. He has a history of hypertension and hyperlipidemia, both treated with medication. He does not have diabetes and has no prior history of cardiovascular disease. He is a current smoker. On examination, his blood pressure is 138/84 mmHg and his BMI is 29 k...
[ { "item_id": "item_0", "points": 1, "text": "States that the total 10-year CVD risk using PREVENT is approximately 12-13% (±1 percentage point acceptable)." } ]
36c0cd037c645bcca688c85c6168bb23
clinical_calculations
points_rubric
A patient has sodium of 124 mEq/L. Is this mild, moderate, or severe hyponatremia?
[ { "item_id": "item_0", "points": 1, "text": "Answer states that this is moderate hyponatremia" } ]
5ec7056363c0aab07814c95dee5a95e8
clinical_calculations
points_rubric
A patient is currently prescribed oral hydromorphone 8 mg every 4 hours for severe pain. Due to worsening nausea, you plan to switch to IV hydromorphone. What is the equivalent total daily IV hydromorphone dose?
[ { "item_id": "item_0", "points": 1, "text": "The answer states that the equivalent total daily IV hydromorphone dose is approximately 10 to 13 mg per day." } ]
7c79f689d27d9fcf1d9af342359f22af
clinical_calculations
points_rubric
An 82-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with fever, productive cough, and difficulty breathing. His family reports that he has become increasingly confused over the past two days. On physical examination, his blood pressure is 85/60 mmHg, a...
[ { "item_id": "item_0", "points": 1, "text": "Answer states the score is approximately 59." } ]
16a60e500c6e138a1749a891c83b0c45
clinical_calculations
points_rubric
A 56-year-old male presents to his primary care physician complaining of chronic fatigue and excessive daytime sleepiness that has persisted for several months. His partner has also reported loud snoring and observed episodes where he seems to stop breathing during sleep, often followed by gasping or choking. The patie...
[ { "item_id": "item_0", "points": 1, "text": "Answer states that the patient's score is 7" } ]
0683793b2f8388e9d1248a7ca50ae971
clinical_calculations
points_rubric
A 65-year-old male with a known history of hypertension and hyperlipidemia was recently diagnosed with renal cell carcinoma (RCC) after presenting with hematuria and flank pain. Imaging studies revealed a substantial mass in the left kidney, leading to a planned radical nephrectomy. Post-surgical pathology reported the...
[ { "item_id": "item_0", "points": 1, "text": "Answer states that score is 7" } ]
3c855542abfb5e08bcc78a4a094d2004
clinical_calculations
points_rubric
A 63-year-old male is admitted to the hospital with a severe skin reaction characterized by extensive blistering and peeling. The patient was recently started on a new medication for his chronic arthritis, which may have triggered this reaction. On examination, there is evidence of epidermal detachment covering approxi...
[ { "item_id": "item_0", "points": 2, "text": "The response correctly computes 'score' as 5." }, { "item_id": "item_1", "points": 1, "text": "The response correctly identifies 'interpretation' as \"Risk of mortality is 12.3%\"." } ]
07573e48295b629c8dfe0040b3c0f6ab
clinical_calculations
points_rubric
A 75-kg adult requires an intravenous unfractionated heparin loading bolus of 80 units/kg. The available heparin solution contains 5,000 units/mL. What volume of heparin solution should be administered for the loading bolus?
[ { "item_id": "item_0", "points": 2, "text": "States that the required heparin dose is 6,000 units and the corresponding volume is 1.2 mL." } ]
46cfe9e4838b7a691bcdb37549e724c4
clinical_calculations
points_rubric
A 68-year-old male with a history of hypertension and coronary artery disease is undergoing an elective hip replacement surgery. The surgery is anticipated to last around 3 hours. During the procedure, the anesthesiologist notes that the patient's lowest measured heart rate was 72 bpm. The lowest recorded mean arterial...
[ { "item_id": "item_0", "points": 1, "text": "States the Surgical Apgar Score is 6 (exact integer match required)." } ]
2502043ceb02c33c49af352390f5beb9
clinical_calculations
points_rubric
An 82-year-old male patient is hospitalized following a stroke, which has resulted in partial paralysis of his right lower limb. He has been bedridden for the last 10 days, which presents a concern for the development of a venous thromboembolism (VTE). His medical history reveals a previous episode of deep vein thrombo...
[ { "item_id": "item_0", "points": 2, "text": "The response correctly computes 'score' as 10.5." }, { "item_id": "item_1", "points": 1, "text": "The response correctly identifies 'interpretation' as \"Risk of VTE is 2.2% at 42-day and 2.7% at 77-day.\"." } ]
be254be9ad3e8c8bbbdd9a788d46a498
clinical_calculations
points_rubric
A 7-year-old boy is brought to the emergency department following a fall from the top of a 6-foot slide on a playground. The accident occurred around three hours ago. Upon arrival, he is conscious and able to communicate but complains of a headache that his parents say has been getting worse since the incident. During ...
[ { "item_id": "item_0", "points": 1, "text": "The response correctly identifies 'result' as \"Medium risk\"." } ]
53a50207d2729e7aa12b1bd393445793
clinical_calculations
points_rubric
A 59-year-old male with a history of hypertension and type 2 diabetes presents to the emergency department with severe respiratory distress and hypotension. He had been experiencing symptoms of influenza for the past 5 days and was found unresponsive at home by family members. On arrival, cardiopulmonary resuscitation ...
[ { "item_id": "item_0", "points": 1, "text": "States the SAVE score is -7 (exact integer match required)." } ]
b485ded3108f6802e9c12ae47d458c60
clinical_calculations
points_rubric
A 32-year-old male motorcyclist is brought to the emergency department after a high-speed collision with a car. On arrival, he is in distress, with visible injuries to his pelvis and left femur. His vital signs show a heart rate of 130 bpm and a systolic blood pressure of 95 mmHg, indicating possible hypovolemic shock....
[ { "item_id": "item_0", "points": 1, "text": "States the TASH score is 30 (exact integer match required)." } ]
89628149285c9ed2164d9c1806b5bff8
clinical_calculations
points_rubric
Calcium is 8.0 mg/dL and albumin is 2.5 g/dL. What is corrected calcium and is it normal?
[ { "item_id": "item_0", "points": 1, "text": "States the corrected calcium is 9.2 mg/dL (±0.1 mg/dL acceptable; formula: measured Ca + 0.8 × [4.0 − albumin g/dL])." }, { "item_id": "item_1", "points": 1, "text": "States the corrected calcium is within normal limits (exact or equivalent wo...
47d455dcae785e20481412e171f394fb
clinical_calculations
points_rubric
A patient has triglycerides of 550 mg/dL. Is this normal, high, or very high?
[ { "item_id": "item_0", "points": 1, "text": "States triglycerides of 550 mg/dL are very high (exact or equivalent wording acceptable; threshold ≥500 mg/dL)." } ]
c850cd0009d8740e8c7c2672333ec1b2
clinical_calculations
points_rubric
A patient is taking oral morphine 90 mg per day for chronic pain and needs to be switched to oral hydromorphone. What is the equivalent total daily oral hydromorphone dose?
[ { "item_id": "item_0", "points": 1, "text": "States the equivalent total daily oral hydromorphone dose is approximately 18 mg/day (±2 mg acceptable; morphine-to-hydromorphone conversion factor ~5)." } ]
4ac4ae521f9eb51995323ed16a5b97f1
clinical_calculations
points_rubric
A 35-year-old male was involved in a high-speed motor vehicle accident and presents to the emergency department with severe back pain. Imaging reveals a burst fracture at the L2 vertebra. On neurological examination, the patient has motor weakness and loss of sensation in his lower extremities, indicating incomplete sp...
[ { "item_id": "item_0", "points": 1, "text": "States the TLICS score is 7 (exact integer match required)." } ]
2526b5e673b301471a5f3b5bdd9fd73c
clinical_calculations
points_rubric
A patient has sodium 118 mEq/L. The maximum recommended correction is 8 mEq/L over 24 hours. What is the highest safe sodium after 24 hours?
[ { "item_id": "item_0", "points": 1, "text": "States the highest safe sodium after 24 hours is 126 mEq/L (exact match required; 118 + 8 mEq/L correction limit)." } ]
0280c3f8483c57e19e7806f9d4497d21
clinical_calculations
points_rubric
A 70-year-old man presents after a TIA. His BP is 150/95, he had unilateral weakness lasting 40 minutes, and no diabetes. What is his ABCD2 score and risk?
[ { "item_id": "item_0", "points": 1, "text": "States the ABCD2 score is 5 (exact integer match required)." }, { "item_id": "item_1", "points": 1, "text": "States the 7-day stroke risk is moderate (exact or equivalent wording acceptable)." } ]
283276ddcfb0cbe41e64274a468d8d7a
clinical_calculations
points_rubric
A patient is receiving IV hydromorphone at a total of 6 mg over 24 hours in the ICU. You plan to transition to oral hydromorphone. What is the equivalent total daily oral hydromorphone dose?
[ { "item_id": "item_0", "points": 1, "text": "States the equivalent total daily oral hydromorphone dose is 18-30 mg/day (any value within this range acceptable; IV-to-oral conversion factor 3-5)." } ]
60be55ca616a4b9c384f0ff3d48b09da
clinical_calculations
points_rubric
A 55-year-old male is admitted to the hospital with extensive skin lesions and is suspected to have Toxic Epidermal Necrolysis (TEN). The patient has a history of prostate cancer and is currently undergoing chemotherapy. On examination, he exhibits a heart rate of 130 beats per minute. Initial evaluation reveals that a...
[ { "item_id": "item_0", "points": 1, "text": "States the SCORTEN score is approximately 7 (±0.5 points acceptable)." } ]
75b714d4cf5f7033e90b0571483310c2
clinical_calculations
points_rubric
A 74-year-old woman with a history of hypertension and type 2 diabetes presents with newly diagnosed atrial fibrillation. She has no prior stroke, TIA, or thromboembolism, no heart failure, and no known vascular disease. Based on this information, what is her CHA2DS2-VASc score?
[ { "item_id": "item_0", "points": 1, "text": "States the CHA2DS2-VASc score is 4 (exact integer match required)." } ]
806183eb170a8676948161a2f870a8e6
clinical_calculations
points_rubric
A cirrhotic patient has mild ascites, bilirubin 2.9, albumin 2.9, INR 1.8, and no encephalopathy. What Child-Pugh class is this?
[ { "item_id": "item_0", "points": 1, "text": "States the Child-Pugh class is B (exact match required)." } ]
4069b301e898cbbefd017bc88752f212
clinical_calculations
points_rubric
A 35-year-old female arrives at the emergency department with chest pain and mild shortness of breath. She is visibly anxious and reports that the symptoms began a few hours ago. The patient denies any trauma or heavy physical activity preceding the onset of symptoms. Upon reviewing her medical history, the physician f...
[ { "item_id": "item_0", "points": 1, "text": "States the PERC score is 1 (exact integer match required; oral contraceptive use counts as estrogen use)." }, { "item_id": "item_1", "points": 1, "text": "States that PERC cannot rule out pulmonary embolism and further evaluation is warranted ...
3a449f63b08e284b0e5c29529d05b272
clinical_calculations
points_rubric
A patient has an HbA1c of 6.2%. Based on standard diagnostic criteria, does this fall into normal, prediabetes, or diabetes range?
[ { "item_id": "item_0", "points": 1, "text": "States the HbA1c of 6.2% falls in the prediabetes range (exact or equivalent wording acceptable)." } ]
911150cdcf4358d15a55749813754b8f
clinical_calculations
points_rubric
A 50-year-old woman presents with dyspnea and pleuritic chest pain. Her heart rate is 120 bpm, she has clinical signs of DVT, and no alternative diagnosis is more likely. She has no cancer and no recent surgery. What is her Wells score for PE?
[ { "item_id": "item_0", "points": 1, "text": "States the Wells score for PE is 7.5 (±0.5 points acceptable)." } ]
8e384de70609011f289f0728908ad272
clinical_calculations
points_rubric
A potassium level is 6.2 mEq/L. Is this mild, moderate, or severe hyperkalemia?
[ { "item_id": "item_0", "points": 1, "text": "States this potassium level represents moderate hyperkalemia (exact or equivalent wording acceptable; K+ 6.0-6.4 mEq/L)." } ]
15f06e45f103fccf7c046442542e229a
clinical_calculations
points_rubric
A patient has an HbA1c of 7.1%. How should this be classified diagnostically?
[ { "item_id": "item_0", "points": 1, "text": "States the HbA1c of 7.1% falls in the diabetes range (exact or equivalent wording acceptable)." } ]
128ed574e676a5f8b506e2052e173a0c
clinical_calculations
points_rubric
A 32-year-old male was admitted to the hospital following a motorcycle accident in which he sustained multiple long bone fractures in his right leg. Within 24 hours of admission, he developed confusion and disorientation, along with a petechial rash spread across his upper body and axillae. Chest X-ray showed diffuse a...
[ { "item_id": "item_0", "points": 1, "text": "States the Schonfeld score is approximately 15 (±1 point acceptable)." } ]
90733b098cdf01f3a48d29f8453ed7d7
clinical_calculations
points_rubric
A 54-year-old woman with decompensated cirrhosis from metabolic dysfunction-associated steatotic liver disease is brought to the hospital after missing several days of lactulose. She is markedly somnolent but awakens to repeated verbal stimulation. When aroused, she is grossly disoriented to place and time, gives incoh...
[ { "item_id": "item_0", "points": 1, "text": "States the West-Haven grade is 3 (exact integer match required)." } ]
b1bb8cb821924cf72f79034cd34af71e
clinical_calculations
points_rubric
A 78-year-old male is brought to the emergency department by his family after they found him with sudden right-sided weakness and slurred speech. The patient has a history of hypertension and type 2 diabetes, but he recently missed several doses of his medication. On admission, his blood glucose level is recorded at 14...
[ { "item_id": "item_0", "points": 1, "text": "States the SEDAN score is 6 (exact integer match required)." } ]
0af98af1e3dced331a6311c3bb6e72d4
clinical_calculations
points_rubric
A 35-kg child with DKA received insulin drip at 0.1 units/kg/hour. How many units of insulin was given in 7 hours?
[ { "item_id": "item_0", "points": 1, "text": "States the child received 24.5 units of insulin (±0.1 units acceptable; 35 kg × 0.1 units/kg/hour × 7 hours)." } ]
5e0b5d5b00d311ebf4d6c710dc405521
clinical_calculations
points_rubric
A patient has a serum sodium of 140 mEq/L, chloride of 104 mEq/L, and bicarbonate of 18 mEq/L. What is the serum anion gap?
[ { "item_id": "item_0", "points": 1, "text": "States the anion gap is 18 mEq/L (exact match required; 140 - (104 + 18) = 18)." } ]
299419fae1a12ddbeae53f670a34693e
clinical_calculations
points_rubric
A 40-year-old man presents with mild dyspnea. His HR is 103 bpm, oxygen saturation is 98%, he has no hemoptysis, no estrogen use, no prior DVT/PE, no unilateral leg swelling, and no recent surgery. Does he meet PERC criteria to rule out PE?
[ { "item_id": "item_0", "points": 1, "text": "States the patient does not meet PERC criteria to rule out PE (exact or equivalent wording acceptable; HR ≥100 is a positive PERC criterion)." } ]
1a96ff328156f53e0ad7cd8ee4d5dded
clinical_calculations
points_rubric
A 20-kg child is prescribed acetaminophen at 15 mg/kg/day divided into two doses (BID). What is the amount per dose?
[ { "item_id": "item_0", "points": 1, "text": "States the dose is 150 mg per dose BID (exact match required; 20 kg × 15 mg/kg/day = 300 mg/day ÷ 2 doses)." } ]
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clinical_calculations
points_rubric
A 10-year-old girl is brought to the pediatric clinic by her parents due to sudden onset of fever and joint pain affecting her knees, elbows, and ankles. The parents report that she had a sore throat approximately three weeks ago that resolved without antibiotic treatment. Upon examination, the patient has a temperatur...
[ { "item_id": "item_0", "points": 1, "text": "States that 3 major Jones criteria are fulfilled (exact integer match required)." }, { "item_id": "item_1", "points": 1, "text": "States that diagnostic criteria for acute rheumatic fever are met (exact or equivalent wording acceptable)." } ...
e2925774d0dba7683ced816d3c3ade15
clinical_calculations
points_rubric
A patient has sodium 140 mEq/L, glucose 180 mg/dL, and BUN 20 mg/dL. What is the calculated serum osmolality and is it high?
[ { "item_id": "item_0", "points": 1, "text": "States the calculated serum osmolality is approximately 297 mOsm/kg (±2 mOsm/kg acceptable; 2 × Na + glucose/18 + BUN/2.8)." }, { "item_id": "item_1", "points": 1, "text": "States the serum osmolality is borderline or slightly elevated (exact ...
cab2c58d06433c5256b67115e8bdb05a
clinical_calculations
points_rubric
A 65-year-old man with suspected infection has altered mentation, respiratory rate 24, and systolic BP is 101 mmHg. What is his qSOFA score?
[ { "item_id": "item_0", "points": 1, "text": "States the qSOFA score is 2 (exact integer match required)." } ]
f08536a24a20c1a0650a90861672abe3
clinical_calculations
points_rubric
A 45-year-old male with a history of heavy alcohol use presents to the emergency department 12 hours after his last drink. He is anxious and reports nausea but has not vomited. On exam, he is visibly sweating and has a moderate tremor of his hands. He is mildly agitated but cooperative. He denies any tactile, auditory,...
[ { "item_id": "item_0", "points": 1, "text": "States the CIWA-Ar score is within the range of 15 to 20 (±2 points acceptable)." } ]
e4aed0002857fd980b290da6b6781bce
clinical_calculations
points_rubric
A 36-year-old male, recently undergoing allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia, presents to the transplant unit 15 days post-procedure. The patient exhibits jaundice and reports discomfort in the right upper quadrant of the abdomen. His liver ultrasound reveals mild hepatomegaly. ...
[ { "item_id": "item_0", "points": 1, "text": "States that the patient meets the Seattle criteria for VOD diagnosis." } ]
a6b400d8bd7e7907fe55bf987bc321e2
clinical_calculations
points_rubric
A patient's height is 175 cm and weight is 70 kg. What is the body surface area?
[ { "item_id": "item_0", "points": 1, "text": "States the body surface area is 1.84 m² (±0.02 m² acceptable; Mosteller formula)." } ]
f449e46038c1f710cbfde1684cb636a3
clinical_calculations
points_rubric
A 66-year-old male with a history of smoking and type 2 diabetes presents to the vascular clinic with complaints of worsening pain in his left leg that occurs even at rest and intensifies at night. He has noticed that the pain is somewhat relieved when he hangs his leg off the side of the bed. On physical examination, ...
[ { "item_id": "item_0", "points": 1, "text": "States the Rutherford classification category is 4 (exact integer match required)." } ]
bf53316a9e382883cbf90876111b7651
clinical_calculations
points_rubric
A patient weighs 95 kg and is 1.7 meters tall. What is the BMI and classification?
[ { "item_id": "item_0", "points": 1, "text": "States the BMI is 32.9 kg/m² (±0.1 kg/m² acceptable)." }, { "item_id": "item_1", "points": 1, "text": "States this patient has obesity class I (exact or equivalent wording acceptable; BMI 30.0-34.9 kg/m²)." } ]
361d3f2631c84c6500a4b547aac64e99
clinical_calculations
points_rubric
A patient is receiving IV morphine at a total dose of 30 mg over 24 hours in the hospital. You are preparing for discharge and plan to convert this to oral morphine. What is the equivalent total daily oral morphine dose?
[ { "item_id": "item_0", "points": 1, "text": "States the equivalent total daily oral morphine dose is approximately 90 mg/day (±10 mg acceptable; IV-to-oral conversion factor ~3)." } ]
8682cda49620d4efa18bec6da649f9ae
clinical_calculations
points_rubric
A 52-year-old patient has repeated blood pressure readings around 138/86 mmHg. According to ACC/AHA guidelines, how is this classified?
[ { "item_id": "item_0", "points": 1, "text": "States this blood pressure is classified as stage 1 hypertension (exact or equivalent wording acceptable)." } ]
15a60443b3514140a99c4cf5d0a22fb7
clinical_calculations
points_rubric
What rate should maintenance fluids run at for a 13.6kg toddler?
[ { "item_id": "item_0", "points": 1, "text": "States the maintenance fluid rate is 47 mL/hr (±2 mL/hr acceptable; 4-2-1 rule for 13.6 kg)." } ]
e7d94b0511eaf71745a712f429f87eb1
clinical_calculations
points_rubric
A patient has PaO2 of 75 mmHg on FiO2 50%. What is the P/F ratio and severity?
[ { "item_id": "item_0", "points": 1, "text": "States the PaO2/FiO2 ratio is 150 (exact integer match required; 75 mmHg / 0.50)." }, { "item_id": "item_1", "points": 1, "text": "States this patient has moderate ARDS (exact or equivalent wording acceptable; P/F 100-200 mmHg)." } ]
0aed3f71a1a20a1cc25460c829acabe2
clinical_calculations
points_rubric
An 82-kg patient is prescribed enoxaparin at 1.5 mg/kg/day. What is the daily dose?
[ { "item_id": "item_0", "points": 1, "text": "States the daily enoxaparin dose is 123 mg (exact match required; 82 kg × 1.5 mg/kg/day)." } ]
1de90056b484d41d67b2fef7e11a9545
clinical_calculations
points_rubric
A patient has a temperature of 38.3°C. Does this meet the clinical definition of fever?
[ { "item_id": "item_0", "points": 1, "text": "States that 38.3°C meets criteria for fever (exact or equivalent wording acceptable; threshold ≥38.0°C)." } ]
357121f63241bd29f8ded8ee4d87bc34
clinical_calculations
points_rubric
A 35-year-old male was involved in a house fire and was brought to the emergency department. On examination, the patient has sustained burns over several parts of his body. The healthcare team needs to quickly assess the extent of the burns to initiate appropriate fluid resuscitation. The areas affected include his hea...
[ { "item_id": "item_0", "points": 1, "text": "States the TBSA burn estimate is approximately 54% (±2 percentage points acceptable; Rule of Nines: head/neck 9%, left arm 9%, anterior trunk 18%, right leg 18%)." } ]