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{"233_104": {"text": [["QUESTION", "TYPE:", "HEMATOLOGY"], ["CLINICAL", "CASE:"], ["In", "a", "29-year-old", "woman", "the", "following", "parameters", "are", "found", "in", "the", "course", "of", "a", "routine", "blood", "test:", "Hb", "11.5", "g/dL,", "MCV", "70", "fl,", "MCH", "28", "pg,", "Ferritin", "10", "ng/mL,", "leukocytes", "5,200/mm3,", "platelets", "335,000/mm3."], ["Physical", "examination", "is", "normal."], ["The", "most", "indicated", "examination", "in", "this", "situation", "is:"], ["1-", "Gynecological", "examination."], ["2-", "Fecal", "occult", "blood", "test."], ["3-", "Radiological", "study", "of", "the", "digestive", "tract."], ["4-", "Hemoglobin", "electrophoresis."], ["5-", "Cooms", "test."], ["CORRECT", "ANSWER:", "1"], ["The", "most", "frequent", "cause", "of", "microcytic", "iron", "deficiency", "anemia", "in", "young", "women", "is", "chronic", "gynecologic", "leaks."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"315_136": ""}
{"235_107": {"text": [["QUESTION", "TYPE:", "HEMATOLOGY"], ["CLINICAL", "CASE:"], ["A", "71-year-old", "man", "presenting", "with", "severe", "pancytopenia", "without", "presence", "of", "immature", "cells", "and", "with", "a", "bone", "marrow", "study", "suggestive", "of", "severe", "aplastic", "anemia."], ["What", "would", "be", "the", "fundamental", "therapeutic", "approach?"], ["1-", "Treatment", "with", "methylprednisolone", "at", "a", "dose", "of", "1", "g/kg/day", "for", "5", "days."], ["2-", "Study", "of", "siblings", "and", "if", "any", "of", "them", "is", "HLA", "compatible,", "allogeneic", "transplantation", "of", "hematopoietic", "progenitors."], ["3-", "Immunosuppressive", "therapy", "with", "cyclosporine", "and", "antithymocyte", "immunoglobulin."], ["4-", "Hemotherapy", "support."], ["5-", "Chemotherapy", "and", "if", "response", "autologous", "transplantation", "of", "hematopoietic", "progenitors."], ["CORRECT", "ANSWER:", "3"], ["Severe", "aplastic", "anemia", "and", "not", "a", "candidate", "for", "allogeneic", "transplant", "because", "of", "his", "age."], ["Antisuppressants", "seem", "to", "be", "the", "most", "suitable."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"429_114": ""}
{"540_4": ""}
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{"13_150": {"text": [["QUESTION", "TYPE:", "SURGERY"], ["CLINICAL", "CASE:"], ["A", "one-and-a-half-year-old", "boy", "presents", "to", "the", "emergency", "department", "with", "abdominal", "pain", "and", "jaundice."], ["On", "examination,", "an", "abdominal", "mass", "is", "palpated."], ["An", "ultrasound", "shows", "the", "presence", "of", "a", "common", "bile", "duct", "cyst."], ["What", "therapeutic", "approach", "should", "we", "adopt?"], ["1-", "A", "percutaneous", "puncture", "will", "be", "performed", "for", "peritoneal", "lavage", "to", "check", "that", "the", "cyst", "contains", "bile", "in", "order", "to", "leave", "a", "drainage", "to", "improve", "abdominal", "pain."], ["2-", "Radical", "resection", "of", "the", "entire", "bile", "duct", "is", "indicated", "to", "replace", "it", "with", "a", "loop", "of", "bowel."], ["3-", "An", "exploratory", "laparotomy", "and", "drainage", "of", "the", "cyst", "will", "be", "indicated", "and", "when", "the", "dilatation", "subsides", "the", "drainage", "will", "be", "removed."], ["4-", "A", "cholangioresonance", "will", "be", "performed", "to", "delimit", "the", "cyst", "and", "a", "laparotomy", "will", "be", "indicated", "for", "resection", "of", "the", "cyst", "and", "anastomosis", "of", "the", "biliary", "tract."], ["5-", "HIDA", "scintigraphy", "is", "necessary", "to", "delimit", "the", "cyst", "and", "to", "be", "able", "to", "perform", "percutaneous", "drainage", "safely."], ["CORRECT", "ANSWER:", "4"], ["I", "believe", "that", "the", "correct", "answer", "is", "4", "the", "common", "bile", "duct", "cyst", "is", "a", "rare", "pathology", "but", "its", "treatment", "is", "surgical", "and", "consists", "of", "resection", "of", "the", "cyst", "and", "hepaticojejunosotomy."], ["Cholangioresonance", "is", "necessary", "to", "choose", "the", "appropriate", "technique", "for", "the", "four", "existing", "classes", "of", "common", "bile", "duct", "cyst", "(Todani", "classification)."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"299_104": {"text": [["QUESTION", "TYPE:", "INFECTIOUS", "DISEASES"], ["CLINICAL", "CASE:"], ["A", "46-year-old", "male", "parenteral", "drug", "user", "came", "to", "the", "emergency", "department", "with", "fever", "with", "chills,", "mental", "confusion,", "diffuse", "myalgias", "and", "intense", "pain", "in", "the", "left", "hand", "of", "24", "hours", "of", "evolution", "without", "clear", "local", "phlogosis", "signs."], ["She", "does", "not", "refer", "any", "traumatic", "history."], ["Examination", "revealed:", "temperature", "38.9\u00b0C,", "120", "beats", "per", "minute,", "respiratory", "rate", "30/min,", "blood", "pressure", "90/54", "mm", "Hg."], ["Laboratory", "tests", "showed", "leukocytosis", "with", "left", "deviation", "(25,000", "leukocytes/mm3,", "80%", "neutrophils);", "increased", "creatinine", "(1.6", "mg/dL)", "and", "CK", "(138", "U/L)."], ["Among", "the", "following,", "which", "is", "the", "most", "likely", "diagnosis:"], ["1-", "Streptococcal", "necrotizing", "fasciitis."], ["2-", "Gangrene", "due", "to", "Clostridium", "spp."], ["3-", "Mycobacterial", "cellulitis."], ["4-", "Erysipelas."], ["5-", "nan"], ["CORRECT", "ANSWER:", "1"], ["I", "have", "my", "doubts", "between", "1", "and", "2;", "exceptionally", "C.", "botulinum", "can", "infect", "traumatic", "or", "puncture", "wounds", "in", "IVDUs", "using", "brown", "heroin", "or", "cause", "sinusitis", "in", "cocaine", "addicts."], ["On", "the", "other", "hand,", "the", "case", "may", "refer", "to", "a", "severe", "sepsis", "with", "poor", "initial", "manifestation", "at", "first", "sight,", "with", "incipient", "rhabdomyolysis", "and", "muscle", "pain,", "in", "this", "case", "it", "may", "be", "a", "necrotizing", "fasciitis,", "where", "the", "most", "frequently", "implicated", "germ", "is", "S.", "pyogenes."]], "labels": [["O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"16_131": {"text": [["QUESTION", "TYPE:", "DERMATOLOGY"], ["CLINICAL", "CASE:"], ["A", "62-year-old", "man", "with", "a", "history", "of", "significant", "alcohol", "abuse,", "carrier", "of", "hepatitis", "C", "virus,", "treated", "with", "Ibuprofen", "for", "tendinitis", "of", "the", "right", "shoulder,", "goes", "to", "his", "dermatologist", "because", "after", "spending", "two", "weeks", "on", "vacation", "at", "the", "beach", "he", "notices", "the", "appearance", "of", "tense", "blisters", "on", "the", "dorsum", "of", "his", "hands."], ["On", "examination,", "in", "addition", "to", "localization", "and", "slight", "malar", "hypertrichosis."], ["The", "most", "likely", "diagnosis", "is:"], ["1-", "Epidermolysis", "bullosa", "acquisita."], ["2-", "Porphyria", "cutanea", "tarda."], ["3-", "Phototoxic", "reaction."], ["4-", "Contact", "dermatitis."], ["5-", "Acute", "intermittent", "porphyria."], ["CORRECT", "ANSWER:", "2"], ["Porphyria", "Cutanea", "Tarda:", "60%", "of", "patients", "with", "PCT", "are", "male,", "many", "of", "them", "drink", "alcohol", "in", "excess,", "women", "who", "develop", "it", "are", "usually", "treated", "with", "drugs", "containing", "estrogens."], ["Most", "are", "males", "with", "signs", "of", "iron", "overload,", "this", "overload", "reduces", "the", "activity", "of", "the", "enzyme", "uroporphyrinogen", "decarboxylase,", "which", "leads", "to", "the", "elevation", "of", "uroporphyrins."], ["HCV", "and", "HIV", "infections", "have", "been", "implicated", "in", "the", "precipitation", "of", "acquired", "PCT."], ["There", "is", "a", "hereditary", "form", "with", "AD", "pattern."], ["Patients", "with", "PCT", "present", "with", "blistering", "of", "photoexposed", "skin,", "most", "frequently", "on", "the", "dorsum", "of", "the", "hands", "and", "scalp."], ["In", "addition", "to", "fragility,", "they", "may", "develop", "hypertrichosis,", "hyperpigmentation,", "cicatricial", "alopecia", "and", "sclerodermal", "induration."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"121_114": {"text": [["QUESTION", "TYPE:", "MICROBIOLOGY"], ["CLINICAL", "CASE:"], ["47-year-old", "woman."], ["Native", "of", "Cochabamba", "(Bolivia),", "she", "has", "been", "living", "in", "Spain", "for", "8", "years."], ["In", "mid", "2009", "she", "began", "to", "experience", "palpitations,", "dyspnea", "and", "progressive", "edema", "in", "the", "lower", "extremities."], ["She", "was", "diagnosed", "with", "heart", "failure", "secondary", "to", "cardiomyopathy", "due", "to", "Chagas", "disease."], ["What", "is", "the", "etiological", "agent", "of", "this", "disease", "endemic", "in", "several", "Latin", "American", "countries?"], ["1-", "Toxoplasma", "gondii."], ["2-", "Trypanosoma", "brucei."], ["3-", "Lehismania", "donovani."], ["4-", "Giardia", "lamblia."], ["5-", "Trypanosoma", "cruzi."], ["CORRECT", "ANSWER:", "5"], ["The", "correct", "answer", "is", "the", "fifth", "one."], ["The", "cause", "of", "Chagas", "disease", "is", "Trypanosoma", "cruzi."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"241_229": {"text": [["QUESTION", "TYPE:", "NEUROLOGY"], ["CLINICAL", "CASE:"], ["A", "29-year-old", "obese", "woman,", "with", "no", "past", "history", "of", "interest,", "consults", "for", "a", "month", "of", "intense,", "bilateral,", "pulsating", "headache,", "accompanied", "by", "horizontal", "diplopia", "and", "episodes", "of", "monocular", "amaurosis", "lasting", "seconds."], ["Examination", "is", "normal,", "except", "for", "the", "presence", "of", "bilateral", "papilledema."], ["Which", "of", "these", "tests", "do", "you", "think", "will", "allow", "you", "to", "fully", "confirm", "the", "diagnosis?"], ["1-", "Ultrasound", "of", "supra-aortic", "trunks."], ["2-", "Cranial", "magnetic", "resonance", "imaging."], ["3-", "Electroencephalogram."], ["4-", "Lumbar", "puncture."], ["5-", "Visual", "evoked", "potentials."], ["CORRECT", "ANSWER:", "4"], ["Again", "we", "are", "presented", "with", "a", "case", "to", "make", "a", "diagnosis", "and", "then,", "in", "this", "case,", "perform", "a", "confirmatory", "test."], ["Now", "the", "guiding", "symptom", "is", "bilateral", "papilledema", "which", "is", "indicative", "of", "intracranial", "hypertension."], ["Although", "he", "does", "not", "comment", "that", "a", "space-occupying", "lesion", "has", "been", "ruled", "out,", "given", "the", "normal", "neurological", "examination", "and", "the", "other", "symptoms,", "it", "is", "deduced", "that", "it", "is", "idiopathic", "intracranial", "hypertension", "or", "pseudotumor", "cerebri."], ["Other", "data", "suggestive", "of", "this", "entity", "include:", "women", "of", "reproductive", "age,", "obesity,", "and", "diplopia", "(due", "to", "involvement", "of", "the", "VI", "cranial", "nerve)."], ["It", "is", "characteristic", "that", "the", "headache", "and", "visual", "blurriness", "suddenly", "worsen", "in", "the", "mornings", "when", "getting", "up", "or", "changing", "posture,", "producing", "transitory", "blindness", "(Neurology,", "Zarranz)."], ["The", "lumbar", "puncture", "invariably", "shows", "an", "increase", "in", "cerebrospinal", "fluid", "pressure,", "so", "the", "correct", "answer", "is", "4."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"576_103": {"text": [["QUESTION", "TYPE:", "NEUROLOGY"], ["CLINICAL", "CASE:"], ["A", "30-year-old", "male", "who", "consults", "for", "unilateral", "periocular", "headaches", "that", "rapidly", "progress", "to", "become", "very", "intense."], ["The", "pain", "attacks", "last", "30-60", "minutes,", "occur", "2-3", "times", "a", "day,", "and", "are", "accompanied", "by", "tearing", "in", "the", "painful", "eye", "and", "unilateral", "rhinorrhea."], ["What", "is", "the", "most", "appropriate", "preventive", "treatment?"], ["1-", "Oral", "prednisone", "with", "withdrawal", "in", "2-3", "months."], ["2-", "Oral", "prednisone", "with", "withdrawal", "in", "one", "month,", "associated", "with", "oral", "verapamil", "at", "a", "dose", "of", "80-180", "mg", "every", "8", "hours."], ["3-", "Carbamazepine", "at", "doses", "of", "600-1200", "mg", "per", "day."], ["4-", "Indomethacin", "at", "a", "dose", "of", "50", "mg", "every", "8", "hours", "for", "one", "month."], ["5-", "nan"], ["CORRECT", "ANSWER:", "2"], ["They", "describe", "a", "characteristic", "case", "of", "cluster", "headache."], ["It", "is", "more", "frequent", "in", "males,", "the", "pain", "is", "characteristically", "unilateral", "periocular", "of", "great", "intensity,", "of", "variable", "duration,", "usually", "minutes,", "and", "it", "associates", "trigeminoautonomic", "signs", "such", "as", "rhinorrhea", "and", "unilateral", "conjunctival", "injection."], ["The", "preventive", "treatment", "par", "excellence", "is", "verapamil", "associated", "with", "a", "descending", "corticosteroid", "regimen,", "as", "described", "in", "answer", "2."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"504_87": {"text": [["QUESTION", "TYPE:", "PEDIATRICS"], ["CLINICAL", "CASE:"], ["Given", "sudden-onset", "obsessive-compulsive", "disorder", "(OCD)", "in", "a", "9-year-old", "boy", "who", "also", "has", "tics", "and", "chorea", "as", "neurologic", "manifestations,", "an", "infection", "by", "should", "be", "ruled", "out:"], ["1-", "Streptococcus", "viridans."], ["2-", "Alpha-hemolytic", "streptococcus."], ["3-", "Beta-hemolytic", "streptococcus,", "group", "A."], ["4-", "Enterococcus."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["We", "are", "presented", "with", "a", "case", "of", "PANDAS", "syndrome,", "a", "rare", "complication", "of", "an", "infection", "caused", "by", "group", "A", "beta-hemolytic", "streptococcus."]], "labels": [["O", "O", "O"], ["O", "O"], ["O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"367_119": {"text": [["QUESTION", "TYPE:", "PNEUMOLOGY", "AND", "THORACIC", "SURGERY"], ["CLINICAL", "CASE:"], ["A", "38-year-old", "nonsmoking", "woman", "previously", "diagnosed", "with", "atopic", "rhinitis", "presents", "with", "a", "two-month", "history", "of", "intermittent", "cough", "and", "wheezing,", "predominantly", "at", "night."], ["Chest", "X-ray", "was", "normal."], ["Spirometry", "within", "the", "normal", "range", "with", "negative", "bronchodilator", "test."], ["Which", "of", "the", "following", "tests", "would", "you", "request", "next?"], ["1-", "Paranasal", "sinus", "Rx."], ["2-", "Thoracic", "CT."], ["3-", "Methacholine", "test."], ["4-", "Prick", "test."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["A", "normal", "spirometry", "and", "a", "negative", "bronchodilator", "test", "does", "not", "exclude", "asthma,", "and", "the", "patient's", "clinical", "picture", "is", "highly", "suggestive", "of", "asthma,", "so", "a", "methacholine", "test", "would", "confirm", "the", "diagnosis,", "at", "least", "of", "bronchial", "hyperresponsiveness."]], "labels": [["O", "O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"444_104": ""}
{"171_226": {"text": [["QUESTION", "TYPE:", "CARDIOLOGY", "AND", "CARDIOVASCULAR", "SURGERY"], ["CLINICAL", "CASE:"], ["A", "26-year-old", "male", "patient,", "competitive", "athlete,", "is", "studied", "because", "his", "brother", "has", "had", "a", "sudden", "death."], ["Complementary", "tests", "detect", "the", "existence", "of", "obstructive", "hypertrophic", "cardiomyopathy."], ["Mark", "the", "FALSE", "option", "regarding", "this", "pathology:"], ["1-", "Treatment", "with", "beta-blockers", "helps", "to", "reduce", "symptoms."], ["2-", "Abandonment", "of", "competitive", "sport", "should", "be", "recommended."], ["3-", "Digoxin", "is", "useful", "to", "reduce", "the", "subaortic", "gradient."], ["4-", "Diuretics", "should", "be", "avoided", "or", "used", "with", "great", "care."], ["5-", "Given", "the", "hereditary", "nature", "of", "the", "pathology,", "a", "screening", "study", "should", "be", "performed", "in", "the", "rest", "of", "the", "direct", "relatives."], ["CORRECT", "ANSWER:", "3"], ["Our", "myocardium", "is", "thicker", "than", "it", "should", "be,", "predominantly", "in", "the", "septum,", "and", "it", "is", "so", "thick", "that", "it", "obstructs", "the", "LV", "outflow,", "producing", "a", "\"functional\"", "stenosis", "with", "a", "pressure", "gradient."], ["Our", "objective", "will", "be,", "first", "of", "all,", "to", "\"relax\"", "the", "myocardium:", "for", "this", "purpose,", "a", "beta-blocker", "is", "recommended,", "whereas", "digoxin,", "as", "a", "good", "positive", "inotrope,", "increases", "the", "gradient", "and", "is", "contraindicated."], ["Sport", "is", "not", "highly", "recommended,", "given", "the", "increased", "risk", "of", "sudden", "death", "associated", "with", "this", "pathology."], ["And", "if", "we", "have", "a", "fat", "septum,", "which", "protrudes", "into", "the", "LV", "cavity,", "it", "is", "not", "advisable", "to", "perform", "volume", "depletion,", "since", "we", "would", "also", "be", "increasing", "the", "gradient."], ["Regarding", "number", "5,", "it", "is", "true:", "it", "is", "convenient", "to", "perform", "a", "careful", "exploration", "and", "an", "ECG", "in", "the", "relatives", "of", "patients", "with", "hypertrophy."]], "labels": [["O", "O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"555_51": {"text": [["QUESTION", "TYPE:", "ENDOCRINOLOGY"], ["CLINICAL", "CASE:"], ["55-year-old", "woman", "with", "type", "1", "diabetes", "diagnosed", "at", "age", "15", "years", "who", "refers", "nausea", "and", "abdominal", "distention,", "especially", "after", "meals."], ["Evaluation", "is", "consistent", "with", "diabetic", "gastroparesis."], ["Which", "of", "the", "following", "medications", "would", "be", "the", "most", "appropriate", "treatment", "to", "improve", "her", "symptoms:"], ["1-", "Lansoprazole."], ["2-", "Ondansetron."], ["3-", "Loperamide."], ["4-", "Metoclopramide."], ["5-", "nan"], ["CORRECT", "ANSWER:", "4"], ["It", "was", "approved", "as", "a", "treatment", "for", "gastroparesis", "by", "the", "US", "Food", "and", "Drug", "Administration", "(FDA)", "in", "1979", "and", "remains", "the", "first-line", "drug."], ["It", "acts", "as", "a", "prokinetic", "by", "its", "antagonistic", "effect", "on", "dopamine", "2", "(D2)", "receptors", "promoting", "gastric", "emptying", "and,", "in", "addition,", "binds", "to", "the", "5-hydroxytryptamine", "4", "receptor", "(serotonin", "5-HT4)", "to", "stimulate", "cholinergic", "nerve", "pathways", "in", "the", "stomach."], ["Physiologically,", "it", "accelerates", "intestinal", "transit", "by", "increasing", "the", "tone", "and", "amplitude", "of", "gastric", "contractions,", "increases", "lower", "esophageal", "sphincter", "pressure", "and", "improves", "antropyloroduodenal", "coordination."], ["In", "addition,", "this", "antiemetic", "agent", "provides", "relief", "through", "antagonism", "of", "central", "and", "peripheral", "dopamine", "receptors."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim"], ["O", "B-Claim"], ["O", "B-Claim"], ["O", "B-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"320_142": {"text": [["QUESTION", "TYPE:", "RHEUMATOLOGY"], ["CLINICAL", "CASE:"], ["A", "40-year-old", "man,", "with", "no", "history", "of", "interest,", "presents", "with", "acute", "arthritis", "of", "the", "right", "knee", "of", "5", "days", "of", "evolution", "as", "well", "as", "fever", "up", "to", "37.7\u00b0C."], ["He", "has", "no", "history", "of", "trauma."], ["He", "presented", "with", "joint", "effusion,", "warmth", "on", "palpation", "and", "functional", "limitation", "due", "to", "pain."], ["Diagnostic", "arthrocentesis", "was", "performed", "and", "showed", "30000", "cels/microliter", "with", "predominance", "of", "neutrophils."], ["Polarized", "light", "examination", "revealed", "rhomboidal", "and", "cylindrical", "crystals", "with", "weakly", "positive", "birefringence."], ["On", "plain", "radiograph", "of", "the", "knee,", "radiodense", "deposits", "are", "found", "in", "the", "external", "meniscus", "of", "the", "knee."], ["Mark", "the", "FALSE", "answer:"], ["1-", "Initial", "treatment", "will", "consist", "of", "non-steroidal", "anti-inflammatory", "drugs,", "as", "well", "as", "aspiration", "of", "synovial", "fluid."], ["2-", "It", "is", "advisable", "to", "perform", "a", "synovial", "fluid", "culture", "to", "rule", "out", "infectious", "synovitis."], ["3-", "Once", "the", "acute", "flare-up", "has", "passed,", "treatment", "with", "allopurinol", "should", "be", "started", "to", "reduce", "the", "incidence", "of", "new", "arthritis", "flare-ups", "in", "the", "future."], ["4-", "The", "most", "likely", "diagnosis", "is", "acute", "arthritis", "due", "to", "calcium", "pyrophosphate", "crystal", "deposition", "(pseudogout)."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["It", "is", "a", "chondrocalcinosis."], ["There", "is", "no", "treatment", "for", "this", "disease,", "only", "treatment", "for", "flare-ups", "(colchicine,", "NSAIDs", "or", "corticosteroids),", "although", "sometimes", "if", "the", "flare-ups", "are", "habitual", "the", "colchicine", "is", "maintained."], ["Allopurinol", "has", "not", "shown", "any", "efficacy", "in", "this", "microcrystal", "arthropathy,", "but", "it", "has", "shown", "efficacy", "in", "gout."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "B-Marker", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"617_119": {"text": [["QUESTION", "TYPE:", "TRAUMATOLOGY"], ["CLINICAL", "CASE:"], ["13-year-old", "female,", "with", "no", "relevant", "history,", "with", "menarche", "3", "months", "ago,", "followed", "since", "the", "age", "of", "10", "years", "for", "idiopathic", "scoliosis", "that", "has", "worsened."], ["In", "the", "physical", "examination", "she", "presents", "a", "hump", "of", "7", "degrees", "in", "the", "Adams", "test", "and", "in", "the", "scoliogram", "a", "T4-L1", "thoracolumbar", "curve", "of", "35", "degrees", "of", "Cobb", "and", "a", "Risser", "0:"], ["1-", "Recommend", "swimming", "and", "revision", "in", "three", "months."], ["2-", "Prescribe", "a", "brace", "type", "orthosis."], ["3-", "Refer", "to", "physiotherapy", "for", "spine", "elastification."], ["4-", "Revise", "in", "6", "months", "with", "a", "new", "X-ray."], ["5-", "nan"], ["CORRECT", "ANSWER:", "2"], ["We", "are", "presented", "with", "the", "case", "of", "a", "13", "year", "old", "patient,", "with", "menarche", "3", "months", "ago,", "a", "T4-L1", "thoracolumbar", "curve", "of", "35\u00ba", "and", "a", "Risser", "0."], ["As", "a", "general", "rule", "we", "could", "say", "that", "below", "50\u00ba", "the", "treatment", "is", "usually", "conservative,", "with", "two", "options:", "observation", "or", "use", "of", "a", "brace", "to", "slow", "down", "the", "evolution."], ["In", "this", "case,", "taking", "into", "account", "the", "remaining", "growth", "(menarche", "3", "months", "ago", "and", "Risser", "0)", "the", "most", "indicated", "would", "be", "to", "use", "a", "brace", "(Answer", "2", "correct)."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim"]]}}
{"146_231": {"text": [["QUESTION", "TYPE:", "PEDIATRICS"], ["CLINICAL", "CASE:"], ["A", "7-month-old", "infant", "comes", "to", "the", "emergency", "department", "referred", "by", "his", "pediatrician", "for", "suspected", "Kawasaki", "disease."], ["He", "reports", "a", "fever", "of", "up", "to", "39.5\u00baC", "of", "5", "days", "evolution", "that", "does", "not", "subside", "despite", "treatment", "with", "amoxicillin", "prescribed", "72", "hours", "ago", "for", "suspected", "acute", "pharyngotonsillitis."], ["During", "the", "last", "24", "hours", "he", "has", "had", "erythematous", "and", "pruritic", "exanthema", "of", "cephalocaudal", "evolution", "and", "during", "the", "last", "few", "days", "his", "parents", "have", "noticed", "a", "cough", "and", "intense", "conjunctivitis."], ["No", "rhinorrhea", "was", "reported."], ["Clinical", "examination", "showed", "subcrepitant", "in", "both", "lung", "bases", "without", "tachypnea", "or", "signs", "of", "respiratory", "distress."], ["On", "oropharyngeal", "examination", "there", "are", "whitish", "spots", "in", "the", "jugal", "mucosa."], ["What", "is", "the", "most", "probable", "diagnosis?"], ["1-", "Kawasaki", "disease."], ["2-", "Scarlet", "fever."], ["3-", "Allergic", "reaction", "to", "amoxicillin."], ["4-", "Infectious", "mononucleosis."], ["5-", "Measles."], ["CORRECT", "ANSWER:", "5"], ["The", "correct", "answer", "is", "5."], ["The", "clue", "is", "in", "the", "whitish", "lesions", "of", "the", "jugal", "mucosa", "corresponding", "to", "Koplik's", "spots,", "which", "are", "pathognomonic", "of", "measles,", "although", "as", "an", "observation", "I", "would", "say", "that", "they", "usually", "appear", "in", "the", "prodromal", "phase", "of", "the", "disease", "and", "are", "often", "no", "longer", "seen", "when", "the", "exanthema", "appears."], ["In", "this", "case", "you", "are", "describing", "measles", "complicated", "by", "pneumonia."], ["Very", "timely", "question", "at", "the", "present", "time."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O", "O", "O", "O", "O"]]}}
{"467_92": {"text": [["QUESTION", "TYPE:", "ORTHOPEDIC", "SURGERY", "AND", "TRAUMATOLOGY"], ["CLINICAL", "CASE:"], ["A", "woman", "presenting", "with", "difficulty", "walking", "after", "gynecologic", "surgery."], ["She", "has", "mild", "thigh", "pain", "and", "leg", "failure", "on", "support."], ["On", "examination", "she", "has", "weakness", "in", "hip", "flexion", "and", "knee", "extension,", "and", "dysesthesias", "in", "the", "anterior", "aspect", "of", "the", "thigh."], ["What", "is", "the", "most", "probable", "diagnosis", "of", "suspicion:"], ["1-", "Femoral", "nerve", "neuropathy."], ["2-", "Meralgia", "paresthetica", "of", "the", "femoral", "cutaneous", "nerve."], ["3-", "Obturator", "nerve", "neuropathy."], ["4-", "Neuropathy", "of", "the", "sciatic", "nerve."], ["5-", "nan"], ["CORRECT", "ANSWER:", "1"], ["The", "femoral", "nerve", "(although", "rare)", "may", "be", "damaged", "in", "a", "cesarean", "section,", "hysterectomy", "or", "lower", "abdominal", "operation."], 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{"423_89": ""}
{"449_151": {"text": [["QUESTION", "TYPE:", "NEUROSURGERY"], ["CLINICAL", "CASE:"], ["A", "13-year-old", "boy", "presents", "with", "subacute", "headache", "and", "diplopia."], ["Neurologic", "examination", "shows", "vertical", "gaze", "palsy", "and", "MRI", "shows", "a", "contrast-enhancing", "lesion", "in", "the", "pineal", "region", "obstructing", "the", "aqueduct", "of", "Sylvius."], ["The", "most", "likely", "diagnosis", "is:"], ["1-", "Glioblastoma."], ["2-", "Medulloblastoma."], ["3-", "Germ", "cell", "tumor."], ["4-", "Meningioma."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["Germinal", "tumors", "are", "the", "most", "frequent", "in", "children", "in", "the", "pineal", "region."], ["They", "usually", "capitate", "homogeneously", "and", "cause", "triventricular", "hydrocephalus", "and", "Parinaud."], ["Glioblastomas", "usually", "occur", "in", "adults", "at", "the", "lobar", "level,", "medulloblastomas", "are", "the", "most", "frequent", "malignant", "tumors", "at", "the", "posterior", "fossa", "level", "in", "children", "(vermis", "and", "roof", "of", "the", "IV", "ventricle)", "but", "rare", "at", "the", "pineal", "level", "and", "meningiomas", "are", "rare", "in", "children", "and", "also", "in", "the", "pineal", "region."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O"], ["O", "B-Claim"], ["O", "B-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"433_118": {"text": [["QUESTION", "TYPE:", "INFECTIOUS", "DISEASES", "AND", "MICROBIOLOGY"], ["CLINICAL", "CASE:"], ["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."], ["She", "comes", "to", "her", "health", "center", "(located", "3", "hours", "from", "the", "nearest", "hospital)", "with", "fever", "of", "39\u00b0C,", "pain", "in", "the", "wound", "and", "general", "malaise."], ["On", "examination,", "BP", "100/60", "mm", "Hg,", "HR", "110", "beats", "per", "minute,", "slight", "swelling", "in", "the", "wound", "without", "pus."], ["Which", "of", "the", "following", "actions", "is", "most", "indicated", "at", "this", "time?"], ["1-", "Send", "to", "hospital", "for", "rabies", "and", "tetanus", "vaccination", "and", "keep", "under", "observation."], ["2-", "Clean", "the", "wound", "and", "administer", "intramuscular", "nonspecific", "gamma", "globulin."], ["3-", "Give", "400", "mg", "of", "oral", "moxifloxacin", "and", "send", "to", "hospital."], ["4-", "Give", "clindamycin", "600", "mg", "orally", "every", "8", "hours", "and", "observation."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["This", "question", "has", "been", "complicated", "for", "us."], ["The", "question", "does", "not", "have", "all", "the", "necessary", "information,", "but", "using", "what", "we", "have", "we", "can", "try", "to", "answer."], ["The", "dog", "is", "domestic,", "known", "and", "can", "be", "monitored,", "so", "we", "would", "have", "to", "wait", "for", "the", "observation", "period", "to", "pass", "and", "prophylaxis", "is", "not", "recommended."], ["At", "this", "point", "we", "will", "only", "have", "to", "worry", "about", "the", "possible", "bacteremia", "that", "may", "be", "occurring", "in", "a", "patient", "with", "the", "possibility", "of", "high", "risk", "due", "to", "asplenia."], ["The", "treatment", "of", "choice", "in", "dog", "bite", "is", "amoxicillin/clavulanic", "acid", "but", "it", "is", "not", "available,", "so", "we", "can", "use", "another", "treatment", "such", "as", "clindamycin", "plus", "cephalosporin", "or", "clindamycin", "+", "moxifloxacin", "but", "it", "is", "not", "contemplated", "among", "the", "alternatives."], ["In", "a", "first", "attempt", "we", "answered", "4,", "but", "the", "correct", "answer", "is", "3,", "because", "of", "the", "second", "part", "of", "the", "question;", "it", "is", "a", "high", "risk", "patient", "with", "incipient", "signs", "of", "sepsis", "so", "he", "should", "be", "sent", "to", "the", "hospital,", "here", "the", "key", "more", "than", "the", "antibiotic", "is", "in", "the", "position", "to", "take,", "in", "the", "second", "part", "of", "each", "answer."], ["It", "could", "be", "challenged", "since", "they", "do", "not", "say", "in", "which", 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{"337_31": {"text": [["QUESTION", "TYPE:", "GYNECOLOGY", "AND", "OBSTETRICS"], ["CLINICAL", "CASE:"], ["20-year-old", "woman", "with", "ovarian", "tumor", "of", "15", "cm,", "solid-cystic,", "detected", "by", "ultrasound", "after", "presenting", "with", "unspecific", "abdominal", "symptoms."], ["In", "the", "histopathological", "study", "of", "the", "corresponding", "specimen,", "teeth,", "hairs,", "areas", "of", "intestinal", "epithelium,", "areas", "of", "squamous", "epithelium", "(15%)", "and", "bronchial", "epithelium,", "as", "well", "as", "neuroectodermal", "and", "embryonic", "elements", "are", "found", "in", "several", "of", "the", "histological", "preparations."], ["In", "reference", "to", "this", "case,", "point", "out", "the", "correct", "diagnosis:"], ["1-", "Teratocarcinoma."], ["2-", "Immature", "teratoma."], ["3-", "Mature", "cystic", "teratoma."], ["4-", "Dysgerminoma."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["The", "answer", "is", "3,", "mature", "cystic", "teratoma."], ["This", "is", "due", "to", "the", "characteristics", "of", "the", "tumor:", "mature", "teratomas", "are", "constituted", "by", "adult", "tissues,", "coming", "from", "the", "three", "embryonic", "leaves,", "with", "a", "clear", "predominance", "of", "ectodermal", "elements", "(epidermis,", "pilosebaceous", "structures", "and", "neural", "tissue)."], ["Mature", "teratoma", "is", "a", "tumor", "of", "ovarian", "germ", "cells."]], "labels": [["O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"296_17": {"text": [["QUESTION", "TYPE:", "INFECTIOUS", "DISEASES"], ["CLINICAL", "CASE:"], ["A", "47-year-old", "man,", "active", "smoker,", "with", "a", "history", "of", "drug", "abuse", "by", "parenteral", "route", "comes", "to", "the", "ED", "for", "a", "2-hour", "evolution", "of", "acute", "onset", "pleuritic", "left", "costal", "pain", "and", "progressive", "dyspnea", "until", "becoming", "resting."], ["In", "the", "previous", "2", "weeks", "he", "had", "presented", "febrile", "fever,", "general", "malaise", "and", "dry", "cough."], ["On", "examination,", "the", "patient", "is", "tachypneic", "at", "36", "rpm,", "with", "supraclavicular", "pull,", "oxygen", "saturation", "by", "pulse", "oximetry", "of", "81%,", "cyanosis,", "sweating,", "tachycardia", "at", "135", "beats", "per", "minute", "and", "BP", "of", "75/47", "mm", "Hg."], ["The", "trachea", "is", "deviated", "to", "the", "right", "side", "and", "auscultation", "shows", "complete", "absence", "of", "vesicular", "murmur", 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{"76_87": {"text": [["QUESTION", "TYPE:", "ANESTHESIOLOGY,", "CRITICAL", "CARE", "AND", "EMERGENCIES"], ["CLINICAL", "CASE:"], ["76-year-old", "woman", "with", "obesity", "and", "type", "2", "diabetes", "mellitus", "on", "metformin."], ["She", "comes", "to", "the", "emergency", "room", "because", "for", "3", "days", "she", "presents", "fever", "of", "38\u00baC,", "polyuria,", "dysuria,", "intense", "thirst", "and", "progressive", "decrease", "in", "the", "level", "of", "consciousness."], ["Physical", "examination", "showed", "signs", "of", "dehydration,", "BP", "95/54", "mm", "Hg", "and", "no", "signs", "of", "neurological", "localization."], ["The", "CBC", "shows", "leukocytosis,", "creatinine", "of", "1.8", "mg/dL", "and", "blood", "glucose", "of", "855", "mg/dL."], ["What", "is", "the", "most", "likely", "diagnosis?"], ["1-", "Hyperglycemic", "hyperosmolar", "non-ketotic", "hyperglycemic", "coma."], ["2-", "Cardiac", "failure."], ["3-", "Subdural", "hematoma."], ["4-", "Obstructive", "renal", "failure."], ["5-", "Diabetic", "ketoacidosis", "with", "coma."], ["CORRECT", "ANSWER:", "1"], ["The", "question", "relates", "the", "case", "of", "a", "type", "2", "diabetic", "patient", "with", "hyperglycemia", "and", "decreased", "level", "of", "consciousness", "without", "neurological", "focality", "in", "the", "context", "of", "a", "urinary", "tract", "infection", "and", "who", "has", "developed", "acute", "renal", "failure", "of", "probable", "prerenal", "origin."], ["Option", "2", "is", "immediately", "ruled", "out", "because", "the", "clinical", "picture", "is", "not", "one", "of", "heart", "failure."], ["Option", "3", "is", "also", "discarded", "because", "it", "does", "not", "fit", "with", "the", "clinical", "picture", "and", "in", "addition", "HSD", "would", "give", "neurological", "symptoms", "with", "locality."], ["Option", "4", "is", "discarded", "because", "obstructive", "renal", "failure", "does", "not", "give", "polyuria,", "dysuria", "or", "the", "rest", "of", "the", "clinical", "picture."], ["Option", "5", "is", "less", "likely", "because", "diabetic", "ketoacidosis", "is", "more", "typical", "of", "type", "1", "DM."], ["Therefore", "the", "correct", "option", "is", "1."]], "labels": [["O", "O", "O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"159_111": {"text": [["QUESTION", "TYPE:", "UROLOGY"], ["CLINICAL", "CASE:"], ["A", "45-year-old", "male", "patient", "with", "a", "history", "of", "uric", "lithiasis", "with", "repeated", "expulsive", "nephritic", "colic", "for", "25", "years,", "comes", "to", "the", "ED", "referring", "palpitations", "and", "intense", "right", "lumbar", "pain", "since", "2", "hours", "before."], ["Urinalysis", "showed", "a", "pH", "of", "5.5", "and", "leukocyturia", "without", "proteinuria."], ["The", "ECG", "confirms", "a", "previously", "unknown", "atrial", "fibrillation."], ["Blood", "biochemistry", "shows", "a", "creatinine", "of", "0.9mg/dl,", "a", "calcium", "of", "11mg/dl", "and", "an", "LDH", "of", "950", "U/l."], ["What", "is", "the", "most", "useful", "diagnostic", "maneuver", "to", "perform?"], ["1-", "Simple", "abdominal", "X-ray."], ["2-", "IVU."], ["3-", "CT", "with", "contrast."], ["4-", "Abdominal", "echography."], ["5-", "Doppler", "echocardiography."], ["CORRECT", "ANSWER:", "3"], ["In", "this", "question", "I", "have", "more", "doubts", "as", "to", "which", "is", "the", "correct", "answer,", "since", "we", "must", "interpret", "which", "is", "the", "most", "useful", "test,", "with", "which", "we", "can", "obtain", "more", "performance."], ["However,", "this", "situation", "also", "depends", "on", "the", "radiology", "services", "of", "each", "center", "and", "their", "preferences."], ["I", "will", "focus", "on", "the", "urological", "part,", "leaving", "aside", "the", "rest", "of", "the", "symptomatology."], ["-", "Abdominal", "X-ray", "is", "the", "first", "imaging", "study", "to", "be", "performed", "because", "it", "is", "fast,", "simple", "and", "practically", "innocuous", "(except", "in", "children", "and", "pregnant", "women)."], ["90%", "of", "the", "stones", "are", "radiopaque", "and", "therefore", "visible,", "but", "the", "sensitivity", "of", "this", "test,", "used", "in", "isolation,", "decreases", "to", "45-59%."], ["It", "is", "a", "mandatory", "test", "in", "any", "suspicion", "of", "colic", "pain."], ["However,", "it", "has", "a", "lower", "yield", "than", "the", "others."], ["Although", "the", "urological", "history", "speaks", "of", "uric", "lithiasis", "(radiotransparent),", "with", "an", "acid", "pH", "that", "reaffirms", "the", "diagnosis", "of", "uric", "origin,", "we", "can", "never", "rule", "out", "calcium", "oxalate", "lithiasis", "that", "can", "appear", "synchronously."], ["-", "IVUS", "seems", "to", "me", "to", "be", "one", "of", "the", "best", "performing", "options."], ["It", "will", "give", "us", "diagnostic", "clarity", "of", "obstruction,", "its", "magnitude", "and", "its", "renal", "repercussions."], ["It", "has", "long", "been", "considered", "the", "examination", "of", "choice", "for", "the", "study", "of", "patients", "with", "renal", "lithiasis."], ["It", "is", "a", "test", "with", "high", "sensitivity", "and", "specificity", "(87-90%", "and", "94-100%,", "respectively),", "relatively", "innocuous,", "and", "available", "in", "all", "hospitals."], ["It", "informs", "us", "of", "the", "number,", "size,", "shape", "and", "location", "of", "the", "stone,", "as", "well", "as", "the", "functional", "status", "of", "the", "affected", "kidney."], ["-", "Contrast-enhanced", "CT", "seems", "to", "me", "to", "be", "the", "most", "efficient", "option."], ["It", "serves", "to", "discover", "lithiasis", "that", "other", "tests", "cannot", "find", "and", "gives", "us", "a", "global", "image", "of", "the", "rest", "of", "the", "structures."], ["Great", "performance", "but", "also", "more", "expensive,", "more", "time,", "more", "radiation."], ["It", "has", "been", "confirmed", "as", "a", "high", "sensitivity", "and", "specificity", "scan,", "surpassing", "previous", "tests", "(94-100%", "and", "92-100%,", "respectively,", "for", "the", "detection", "of", "ureteral", "calculi)", "and", "with", "its", "numerous", "advantages", "it", "has", "become", "the", "reference", "test", "and", "is", 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{"185_66": {"text": [["QUESTION", "TYPE:", "ENDOCRINOLOGY"], ["CLINICAL", "CASE:"], ["A", "74-year-old", "patient", "with", "bowel", "resection", "following", "mesenteric", "thrombosis", "comes", "to", "consult", "for", "fatigue", "and", "bone", "pain."], ["He", "had", "suffered", "a", "Colles'", "fracture", "three", "months", "earlier."], ["Laboratory", "tests", "showed", "anemia", "of", "9.5", "g/dl,", "microcytic,", "albumin", "3.5", "g/di,", "calcium", "7.5", "mg/dl,", "phosphate", "2.0", "mg/dl", "and", "alkaline", "phosphatase", "224", "IU", "(normal", "up", "to", "120", "IU)."], ["Radiographs", "of", "the", "femur", "show", "radiolucent", "bands", "perpendicular", "to", "the", "cortex", "on", "the", "inner", "side", "of", "the", "upper", "femur."], ["What", "is", "the", "most", "likely", "diagnosis?"], ["1-", "Osteoporosis."], ["2-", "Paget's", "disease."], ["3-", "Osteitis", "fibrosa."], ["4-", "Prostate", "cancer", "metastasis."], ["5-", "Osteomalacia."], ["CORRECT", "ANSWER:", "5"], ["Although", "this", "one", "had", "not", "been", "assigned", "to", "me,", "I", "am", "answering", "it", "as", "well", "since", "it", "deals", "with", "an", "endocrinology", "topic:", "vitamin", "D."], ["In", "this", "case", "there", "are", "important", "data", "such", "as", "the", "history", "of", "intestinal", "resection,", "hypocalcemia", "and", "hypophosphoremoia;", "this", "should", "lead", "us", "to", "think", "in", "a", "vitamin", "D", "deficit", "due", "to", "malabsorption", "and", "therefore,", "in", "an", "osteomalacia."], ["The", "rest", "of", "the", "data:", "previous", "fracture,", "pain", "and", "the", "X-ray", "support", "the", "diagnosis."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O"], ["O", "B-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "O", "O"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"107_206": {"text": [["QUESTION", "TYPE:", "GENETICS", "AND", "IMMUNOLOGY"], ["CLINICAL", "CASE:"], ["An", "8-year-old", "girl", "(index", "case)", "is", "clinically", "diagnosed", "as", "having", "neurofibromatosis", "type", "1", "(NF1)", "or", "Von", "Recklinghausen's", "disease", "with", "multiple", "neurofibromas,", "caf\u00e9-au-lait", "spots,", "and", "Lisch", "nodules."], ["Her", "father", "(not", "diagnosed", "with", "NF1)", "died", "in", "a", "traffic", "accident", "at", "the", "age", "of", "38", "years."], ["On", "examination,", "the", "mother", "presents", "two", "caf\u00e9-au-lait", "spots", "and", "attends", "the", "genetic", "counseling", "consultation", "with", "her", "new", "partner", "where", "a", "preimplantation", "genetic", "diagnosis", "(PGD)", "is", "proposed."], ["Is", "PGD", "indicated", "in", "this", "case?"], ["1-", "Yes,", "as", "the", "mother", "has", "2", "caf\u00e9-au-lait", "spots,", "she", "is", "a", "carrier", "and", "PGD", "is", "indicated", "with", "these", "data."], ["2-", "It", "is", "indicated", "after", "detection", "of", "the", "causative", "mutation", "in", "the", "index", "case", "and", "eventually", "in", "his", "mother."], ["3-", "It", "is", "not", "indicated", "because", "NF1", "responds", "to", "mutations", "in", "the", "neurofibromin", "gene", "(17q11.2),", "with", "recessive", "inheritance."], ["4-", "No,", "two", "caf\u00e9-au-lait", "spots", "are", "not", "diagnostic", "and", "your", "new", "partner", "is", "very", "unlikely", "to", "be", "a", "carrier", "(NF1", "is", "a", "rare", "disease)."], ["5-", "With", "these", "data,", "PGD", "is", "indicated,", "consisting", "of", "selecting", "embryos", "in", "vitro,", "to", "implant", "in", "the", "maternal", "uterus", "those", "without", "the", "mutation."], ["CORRECT", "ANSWER:", "2"], ["The", "first", "step", "is", "to", "detect", "the", "mutation", "and", "once", "detected,", "if", "the", "mother", "is", "a", "carrier,", "to", "proceed", "with", "PGD."]], "labels": [["O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "B-Diagnostics", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"114_96": {"text": [["QUESTION", "TYPE:", "HEMATOLOGY"], ["CLINICAL", "CASE:"], ["A", "43-year-old", "woman", "consults", "her", "primary", "care", "physician", "for", "fatigue,", "gingivorrhea", "and", "petechiae."], ["Laboratory", "tests", "showed", "anemia", "of", "8", "g/dL,", "thrombopenia", "of", "4000/microliter", "and", "leukopenia", "of", "1200/microliter", "with", "absolute", "neutropenia."], ["The", "coagulation", "study", "showed", "APTT", "elongation", "(43\u2033),", "decreased", "prothrombin", "activity", "(55%),", "hypofibrinogenemia", "(98", "mg/dl)", "and", "presence", "of", "high", "concentration", "of", "D-Dimer", "and", "fibrin", "monomers."], ["She", "is", "referred", "for", "urgent", "hematologic", "workup", "and", "a", "bone", "marrow", "aspirate", "is", "performed", "showing", "massive", "infiltration", "by", "immature", "elements", "with", "cleaved", "nuclei", "and", "Auer", "rods", "in", "the", "cytoplasm."], ["What", "is", "the", "most", "likely", "diagnosis", "in", "this", "patient?"], ["1-", "Chronic", "myeloid", "leukemia."], ["2-", "Acute", "promyelocytic", "leukemia."], ["3-", "Acute", "monoblastic", "leukemia."], ["4-", "Chronic", "lymphoid", "leukemia."], ["5-", "Acute", "lymphoid", "leukemia."], ["CORRECT", "ANSWER:", "2"], ["After", "reading", "such", "a", "long", "statement,", "running", "out", "of", "breath,", "going", "over", "it", "and", "getting", "overwhelmed,", "it", "is", "time", "to", "take", "a", "look", "at", "it", "and", "grasp", "at", "something", "very", "characteristic."], ["A", "woman", "with", "pancytopenia."], ["A", "bone", "marrow", "showing", "massive", "infiltration", "by", "immature", "elements", "that", "are", "proliferating", "non-stop...with", "Auer's", "canes?"], ["Acute", "promyelocytic", "leukemia."], ["Those", "rods", "are", "the", "fusion", "of", "primary", "granules", "of", "developing", "myelocytes."], ["Robin&Cotran", "say", "so", "on", "page", "696", "of", "their", "book", "\"General", "Pathology\"", "[1]."], ["It", "is", "also", "said", "by", "Carr", "and", "Rodak", "in", "their", "book", "\"Atlas", "of", "clinical", "hematology\"", "on", "page", "157", "[2]."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Disease", "I-Disease", "I-Disease"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Disease", "I-Disease", "I-Disease"], ["O", "O", "O"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"]]}}
{"61_92": {"text": [["QUESTION", "TYPE:", "ANESTHESIOLOGY", "AND", "CRITICAL", "CARE"], ["CLINICAL", "CASE:"], ["A", "30-year-old", "man", "suffers", "fall", "from", "a", "standing", "height", "of", "2", "meters."], ["On", "arrival", "at", "the", "ER,", "he", "is", "cyo,", "catheterized", "with", "clear", "urine."], ["He", "shows", "swelling", "of", "the", "left", "heel,", "as", "well", "as", "mild", "tingling", "in", "the", "anterior", "aspect", "of", "the", "right", "thigh", "and", "scrotum,", "and", "dysesthesia", "in", "both", "feet."], ["The", "patient", "says", "goodbye", "to", "the", "stretcher-bearer", "with", "a", "handshake,", "with", "a", "simultaneous", "pat", "on", "the", "shoulder."], ["Rotation", "of", "the", "MMII", "on", "the", "stretcher", "grasped", "by", "the", "ankles", "is", "painless", "and", "compression", "of", "the", "pelvis", "is", "asymptomatic."], ["Next:"], ["1-", "We", "will", "sit", "him", "on", "the", "stretcher", "to", "be", "able", "to", "explore", "the", "cervical", "spine."], ["2-", "We", "will", "refer", "to", "Rx", "to", "perform", "lower", "extremities", "study."], ["3-", "Palpate", "the", "abdomen", "and", "rotate", "it", "en", "bloc", "to", "palpate", "the", "thoracolumbar", "spine."], ["4-", "Place", "a", "cervical", "collar", "and", "refer", "to", "radiology", "for", "cervical", "spine", "and", "lower", "extremity", "imaging."], ["5-", "We", "will", "request", "an", "abdominal", "echo."], ["CORRECT", "ANSWER:", "3"], ["From", "the", "symptoms", "reported,", "tingling", "in", "the", "anterior", "thigh,", "scrotum", "and", "dysesthesia", "in", "the", "feet,", "there", "seems", "to", "be", "a", "vertebral", "involvement", "at", "L2-3", "and", "sacral", "roots,", "so", "the", "correct", "thing", "to", "do", "would", "be", "to", "perform", "a", "radiological", "examination", "without", "mobilizing", "the", "patient."], ["But", "it", "is", "necessary", "to", "mobilize", "him", "to", "explore", "him,", "obviously,", "en", "bloc."], ["The", "cervical", "spine", "seems", "to", "be", "undamaged", "because", "the", "patient", "mobilizes", "both", "arms", "adequately,", "without", "paresthesia."]], "labels": [["O", "O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"]]}}
{"231_180": {"text": [["QUESTION", "TYPE:", "PEDIATRICS"], ["CLINICAL", "CASE:"], ["A", "1-month-old", "infant", "comes", "to", "the", "hospital", "emergency", "department", "referred", "by", "his", "pediatrician", "for", "jaundice."], ["He", "reports", "jaundice", "for", "10", "days", "and", "it", "has", "been", "increasing."], ["The", "blood", "test", "showed", "a", "total", "bilirubin", "of", "7mg/dl", "with", "an", "indirect", "bilirubin", "of", "1.5mg/dl."], ["The", "most", "probable", "cause,", "among", "the", "following,", "of", "this", "jaundice", "is:"], ["1-", "Bile", "duct", "atresia."], ["2-", "Breastfeeding", "jaundice."], ["3-", "Late", "onset", "0-A", "isoimmunization."], ["4-", "Gilbert's", "disease."], ["5-", "Hereditary", "spherocytosis."], ["CORRECT", "ANSWER:", "1"], ["The", "increase", "in", "direct", "bilirubin", "immediately", "rules", "out", "the", "rest", "of", "the", "options", "where", "the", "increase", "in", "total", "bilirubin", "would", "be", "at", "the", "expense", "of", "indirect", "bilirubin."], ["Bile", "duct", "atresia", "is", "the", "main", "indication", "for", "infant", "liver", "transplantation."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"87_54": {"text": [["QUESTION", "TYPE:", "CARDIOLOGY", "AND", "VASCULAR", "SURGERY"], ["CLINICAL", "CASE:"], ["An", "81-year-old", "patient", "consults", "for", "an", "episode", "of", "syncope."], ["He", "reports", "dyspnea", "on", "exertion", "for", "a", "year."], ["On", "cardiac", "auscultation", "there", "is", "a", "3/6", "systolic", "murmur", "on", "the", "left", "sternal", "border", "radiating", "to", "the", "carotids", "and", "tip."], ["Which", "pathology", "seems", "most", "likely?"], ["1-", "Third-degree", "atrioventricular", "block."], ["2-", "Degenerative", "aortic", "stenosis."], ["3-", "Mitral", "valve", "insufficiency."], ["4-", "Hypertrophic", "cardiomyopathy."], ["5-", "Dilated", "cardiomyopathy."], ["CORRECT", "ANSWER:", "2"], ["Very", "easy", "question."], ["They", "are", "describing", "the", "\"portrait\"", "of", "a", "degenerative", "aortic", "stenosis..."], ["Elderly", "patient", "with", "clinical", "dyspnea", "and", "syncope,", "and", "systolic", "murmur", "radiating", "to", "carotids", "and", "tip,", "all", "typical", "of", "this", "disease."]], "labels": [["O", "O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"]]}}
{"102_87": ""}
{"512_153": {"text": [["QUESTION", "TYPE:", "DIGESTIVE"], ["CLINICAL", "CASE:"], ["Patient", "diagnosed", "with", "acute", "diverticulitis,", "treated", "with", "amoxicillin/clavulanic", "acid."], ["After", "5", "days", "he", "starts", "with", "fever", "and", "diarrhea."], ["He", "was", "diagnosed", "with", "Clostridium", "difficile", "colitis,", "amoxicillin/clavulanic", "acid", "was", "discontinued", "and", "metronidazole", "was", "prescribed."], ["After", "4", "days", "he", "has", "not", "responded", "to", "metronidazole,", "but", "is", "clinically", "stable."], ["The", "next", "step", "of", "treatment", "is:"], ["1-", "Change", "metronidazole", "for", "oral", "vancomycin", "(125", "mg,", "four", "times", "a", "day", "for", "10", "days)."], ["2-", "Change", "metronidazole", "to", "piperacillin/", "tazobactam", "(4", "g", "piperacillin/0.5", "g", "tazobactam", "every", "8", "hours)."], ["3-", "Indicate", "a", "subtotal", "colectomy."], ["4-", "Loop", "ileostomy", "with", "antegrade", "polyethylene", "glycol", "lavage."], ["5-", "nan"], ["CORRECT", "ANSWER:", "1"], ["The", "treatment", "of", "choice", "for", "Clostridioides", "difficile", "infection", "is", "vancomycin", "orally", "125mg/6h", "for", "10", "days."], ["Metronidazole", "has", "been", "relegated", "to", "situations", "where", "vancomycin", "is", "not", "available."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
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{"566_149": {"text": [["QUESTION", "TYPE:", "NEPHROLOGY"], ["CLINICAL", "CASE:"], ["A", "67-year-old", "woman", "with", "chronic", "kidney", "disease", "secondary", "to", "diabetic", "nephropathy."], ["She", "currently", "has", "a", "creatinine", "of", "3.2", "mg/dL", "with", "estimated", "glomerular", "filtration", "rate", "(CKD-EPI)", "14", "ml/min."], ["Which", "of", "the", "following", "is", "true?"], ["1-", "He", "presents", "stage", "3", "chronic", "kidney", "disease", "and", "should", "initiate", "phosphorus", "chelators."], ["2-", "He", "has", "stage", "5", "chronic", "kidney", "disease", "and", "renal", "replacement", "therapy", "should", "be", "considered."], ["3-", "Good", "glycemic", "control", "can", "reverse", "renal", "failure."], ["4-", "It", "is", "unlikely", "to", "present", "proteinuria", "higher", "than", "500", "mg/24", "h."], ["5-", "nan"], ["CORRECT", "ANSWER:", "2"], ["A", "glomerular", "filtration", "rate", "of", "less", "than", "15", "ml/min", "is", "classified", "as", "stage", "5", "(G5),", "indicating", "that", "the", "renal", "disease", "is", "end-stage", "and", "the", "initiation", "of", "replacement", "therapy", "should", "be", "considered", "(option", "2", "true,", "option", "1", "false)."], ["In", "this", "situation,", "good", "glycemic", "control", "is", "not", "expected", "to", "reverse", "renal", "damage,", "although", "it", "may", "help", "to", "delay", "progression", "(false", "choice", "3)."], ["These", "patients", "usually", "present", "stage", "A3", "albuminuria", "(above", "300", "mg/24", "h),", "and", "may", "reach", "the", "nephrotic", "range", "(false", "choice", "4)."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim"]]}}
{"254_89": {"text": [["QUESTION", "TYPE:", "DIGESTIVE", "TRACT"], ["CLINICAL", "CASE:"], ["A", "17-year-old", "boy,", "athletic", "and", "with", "no", "history", "of", "interest,", "comes", "to", "the", "doctor", "for", "occasional", "conjunctival", "jaundice."], ["He", "denies", "drug", "intake", "and", "abdominal", "pain."], ["Laboratory", "tests", "show", "normal", "ALT,", "AST,", "GGT", "and", "FA,", "with", "total", "bilirubin", "of", "3.2", "mg/dl", "and", "direct", "bilirubin", "of", "0.4", "mg/dl."], ["She", "has", "no", "anemia", "and", "the", "liver", "is", "ultrasonographically", "normal."], ["What", "is", "her", "diagnosis?"], ["1-", "Rotor", "syndrome."], ["2-", "Choledocholithiasis."], ["3-", "Dubin-Johnson", "syndrome."], ["4-", "Acute", "hepatitis."], ["5-", "Gilbert's", "syndrome."], ["CORRECT", "ANSWER:", "5"], ["An", "increase", "in", "indirect", "bilirubin", "less", "than", "5", "(intermittently,", "under", "stress)", "in", "a", "young", "healthy", "boy", "should", "make", "us", "think", "of", "Gilbert's", "syndrome."], ["In", "Rotor", "syndrome,", "Dubin-Johnson", "syndrome", "and", "choledocholithiasis", "there", "is", "an", "increase", "in", "direct", "bilirubin."], ["In", "the", "case", "of", "acute", "hepatitis", "there", "should", "be", "an", "elevation", "of", "transaminases."]], "labels": [["O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"597_180": {"text": [["QUESTION", "TYPE:", "RHEUMATOLOGY"], ["CLINICAL", "CASE:"], ["26-year-old", "woman", "diagnosed", "with", "systemic", "lupus", "erythematosus,", "on", "treatment", "with", "hydroxychloroquine,", "who", "consults", "for", "a", "feeling", "of", "generalized", "weakness", "that", "has", "progressively", "set", "in", "over", "the", "last", "15", "days."], ["The", "physical", "examination", "reveals", "cutaneous", "pallor", "and", "the", "CBC", "shows", "Hb", "7.4", "g/dL,", "Hct", "31%,", "MCV", "108."], ["Which", "of", "the", "following", "determinations", "will", "be", "most", "useful", "in", "deciding", "the", "course", "of", "action?"], ["1-", "Haptoglobin."], ["2-", "Coombs", "test."], ["3-", "Vitamin", "B12."], ["4-", "Antinuclear", "antibodies."], ["5-", "nan"], ["CORRECT", "ANSWER:", "2"], ["In", "this", "question,", "we", "are", "presented", "with", "a", "patient", "with", "systemic", "lupus", "erythematosus", "presenting", "with", "autoimmune", "hemolytic", "anemia."], ["For", "this,", "the", "best", "option", "would", "be", "to", "request", "reticulocytes,", "however,", "as", "it", "is", "not", "among", "the", "options,", "we", "should", "request", "a", "Coombs'", "test,", "so", "the", "correct", "answer", "is", "2."], ["Although", "they", "want", "to", "confuse", "us", "with", "a", "MCV", "108,", "so", "that", "we", "think", "of", "a", "megaloblastic", "anemia,", "the", "MCV", "is", "not", "excessively", "high,", "the", "onset", "of", "anemia", "in", "our", "patient", "has", "been", "rapid", "and", "would", "not", "fit", "with", "SLE", "or", "the", "form", "of", "presentation."], ["Antinuclear", "antibodies", "are", "used", "for", "diagnosis,", "but", "not", "for", "monitoring", "SLE."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"571_170": {"text": [["QUESTION", "TYPE:", "NEPHROLOGY"], ["CLINICAL", "CASE:"], ["A", "75-year-old", "woman", "on", "sertraline", "treatment", "who", "comes", "to", "the", "emergency", "department", "with", "confusional", "symptoms."], ["There", "is", "no", "evidence", "of", "edema", "and", "blood", "pressure", "is", "130/70."], ["The", "blood", "test", "shows", "Na", "126", "mEq/l", "and", "K", "4", "mEq/l,", "natriuria", "is", "45", "mEq/l", "and", "diuretic", "intake", "has", "been", "ruled", "out."], ["Which", "of", "the", "following", "is", "the", "most", "correct", "approach?"], ["1-", "It", "is", "Addison's", "disease", "and", "corticosteroids", "should", "be", "administered", "immediately."], ["2-", "Administer", "hypertonic", "saline", "to", "restore", "natremia", "as", "soon", "as", "possible."], ["3-", "Indicate", "water", "restriction", "and", "if", "natremia", "does", "not", "rise,", "switch", "to", "slow", "infusion", "of", "saline."], ["4-", "Request", "brain", "MRI,", 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{"466_91": {"text": [["QUESTION", "TYPE:", "ORTHOPEDIC", "SURGERY", "AND", "TRAUMATOLOGY"], ["CLINICAL", "CASE:"], ["An", "11-year-old,", "6-month-old,", "premenarchal", "girl", "with", "known", "idiopathic", "scoliosis."], ["The", "spine", "x-ray", "performed", "6", "months", "ago", "showed", "a", "left", "thoracolumbar", "curve", "of", "18\u00ba", "(Cobb", "angle)."], ["The", "current", "x-ray", "shows", "a", "Cobb", "angle", "of", "28\u00ba,", "with", "an", "iliac", "crest", "maturation", "(Risser's", "sign)", "of", "2."], ["At", "this", "stage", "of", "evolution,", "what", "is", "the", "most", "appropriate", "treatment", "to", "try", "to", "stop", "the", "progression", "of", "the", "curve?"], ["1-", "Swimming", "exercises."], ["2-", "Postural", "re-education", "exercises."], ["3-", "Corrective", "orthopedic", "brace."], ["4-", "Surgical", "intervention", "by", "spinal", "arthrodesis."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["In", "the", "juvenile", "and", "adolescent", "forms,", "treatment", "depends", "on", "the", "degree", "of", "deformity:", "-", "10", "-", "20\u00b0:", "serial", "observation."], ["-", "20-50\u00b0:", "thermoplastic", "corsets", "(Boston,", "Cheneau", "or", "Milwaukee,", "according", "to", "where", "the", "apex", "of", "the", "main", "curve", "is", "located)."], ["-", "40-50\u00b0:", "with", "Risser", "less", "than", "3,", "surgical", "arthrodesis", "would", "be", "indicated;", "with", "Risser", "greater", "than", "or", "equal", "to", "3,", "the", "remaining", "growth", "potential", "of", "the", "curve", "is", "low", "and", "observation", "may", "be", "considered", "in", "case", "it", "tends", "to", "progress", "in", "adulthood."]], "labels": [["O", "O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"175_53": {"text": [["QUESTION", "TYPE:", "PULMONOLOGY"], ["CLINICAL", "CASE:"], ["71-year-old", "male,", "retired", "waiter,", "non-smoker,", "who", "consults", "for", "nocturnal", "snoring."], ["The", "patient", "has", "a", "body", "mass", "index", "of", "31.5", "kg/m2", "and", "reports", "mild", "postprandial", "daytime", "sleepiness", "(Epworth", "Sleepiness", "Scale", "of", "3)", "with", "no", "other", "relevant", "symptoms,", "signs", "or", "clinical", "history."], ["The", "apnea-hypopnea", "index", "obtained", "in", "the", "polysomnography", "was", "18."], ["With", "these", "data,", "what", "is", "the", "most", "appropriate", "measure", "to", "adopt", "in", "this", "patient?"], ["1-", "Hygienic-dietary", "measures", "and", "evolution", "control."], ["2-", "Uvulopalatopharyngoplasty."], ["3-", "Nasal", "CPAP", "(Continuous", "Positive", "Airway", "Pressure)."], ["4-", "Non-invasive", "mechanical", "ventilation."], ["5-", "Nocturnal", "oxygen", "therapy."], ["CORRECT", "ANSWER:", "1"], ["With", "an", "Apneas-Hypopnea", "Index", "of", "less", "than", "30,", "and", "in", "the", "absence", "of", "striking", "symptoms", "of", "OSAHS", "and", "in", "the", "absence", "of", "risk", "professions", "such", "as", "professional", "drivers,", "etc.,", "the", "correct", "thing", "to", "do", "is", "to", "control", "weight", "and", "the", "rest", "of", "the", "hygienic-dietary", "measures,", "with", "periodic", "follow-up."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"91_35": {"text": [["QUESTION", "TYPE:", "GENERAL", "SURGERY"], ["CLINICAL", "CASE:"], ["A", "26-year-old", "woman", "presenting", "with", "fecal", "incontinence", "after", "a", "prolonged", "instrumental", "delivery."], ["An", "endoanal", "ultrasound", "was", "performed", "showing", "a", "section", "of", "the", "external", "anal", "sphincter", "of", "30\u00ba", "amplitude."], ["The", "electrophysiological", "study", "shows", "normal", "innervation."], ["What", "is", "the", "most", "indicated", "treatment?"], ["1-", "Medical", "treatment", "with", "hygienic", "and", "dietary", "norms."], ["2-", "Sphincter", "biofeedback."], ["3-", "Surgical", "sphincteroplasty."], ["4-", "Surgical", "repair", "of", "the", "pelvic", "floor."], ["5-", "Artificial", "anal", "sphincter."], ["CORRECT", "ANSWER:", "3"], ["The", "answer", "is", "surgical", "sphincteroplasty", "3."], ["1", "is", "not", "effective,", "2", "is", "not", "effective", "for", "an", "organic", "lesion", "with", "normal", "electromyography,", "4", "is", "not", "necessary", "since", "the", "lesion", "is", "only", "of", "the", "external", "sphincter,", "5", "is", "not", "indicated", "in", "a", "lesion", "that", "can", "be", "repaired", "with", "surgery", "with", "good", "results."]], "labels": [["O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
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{"50_160": {"text": [["QUESTION", "TYPE:", "PEDIATRICS"], ["CLINICAL", "CASE:"], ["A", "5-year-old", "girl,", "completely", "asymptomatic,", "who", "comes", "to", "the", "pediatrician", "for", "a", "regular", "check-up."], ["She", "consults", "because", "her", "mother", "was", "operated", "on", "for", "a", "thyroid", "tumor", "and", "a", "grandmother", "died", "10", "years", "ago", "from", "a", "pheochromocytoma."], ["The", "priority", "therapeutic", "attitude", "we", "will", "adopt", "will", "be:"], ["1-", "Exhaustive", "physical", "examination", "with", "blood", "pressure", "control", "to", "assess", "whether", "the", "child", "may", "have", "a", "familial", "disease."], ["2-", "Biochemical", "analysis", "with", "calcitonin.", "If", "it", "is", "normal,", "no", "further", "control", "is", "necessary", "at", "this", "age."], ["3-", "Annual", "monitoring", "of", "calcitonin", "levels", "with", "pentagastrin", "stimulation", "and,", "if", "elevated,", "indication", "of", "prophylactic", "thyroidectomy."], ["4-", "Genetic", "study", "of", "the", "RET", "c634", "proto-oncogene", "mutation,", "and", "if", "positive,", "prophylactic", "radical", "thyroidectomy", "will", "be", "performed", "at", "this", "age."], ["5-", "Genetic", "study", "of", "the", "RET", "c634", "proto-oncogene", "mutation,", "calcitonin", "levels", "and", "FNA", "(fine", "needle", "aspiration)", "and", "if", "positive,", "radical", "thyroidectomy", "will", "be", "performed."], ["CORRECT", "ANSWER:", "4"], ["The", "correct", "answer", "is", "4."], ["It", "seems", "to", "me", "to", "be", "more", "of", "an", "endocrine", "question", "than", "a", "pediatric", "question."], ["Proto-oncogene", "carriers", "usually", "have", "early", "thyroid", "tumors", "so", "radical", "thyroidectomy", "is", "usually", "recommended", "before", "the", "age", "of", "5", "years."], ["Obviously", "I", "had", "to", "look", "this", "up...it", "is", "not", "very", "common", "in", "our", "routine", "practice."]], "labels": [["O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O"]]}}
{"326_173": {"text": [["QUESTION", "TYPE:", "CRITICAL,", "PALLIATIVE", "AND", "EMERGENCY", "CARE"], ["CLINICAL", "CASE:"], ["A", "35-year-old", "man", "suffers", "a", "high-voltage", "electrical", "burn", "(3000", "volts)", "from", "direct", "contact", "with", "wire", "with", "his", "left", "hand."], ["On", "admission", "he", "presents", "flexion", "contracture", "of", "the", "hand,", "pallor", "of", "the", "fingers", "and", "absence", "of", "radial", "and", "ulnar", "pulse", "on", "palpation", "What", "is", "the", "emergency", "invasive", "measure", "to", "be", "performed?"], ["1-", "Axillary", "block", "with", "catheter."], ["2-", "Decompressive", "scarotomy."], ["3-", "Intracompartmental", "pressure", "monitoring."], ["4-", "Scarectomy."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["3."], ["In", "the", "case", "of", "suspected", "compartment", "syndrome,", "the", "urgent", "invasive", "measure", "to", "perform", "would", "be", "to", "measure", "the", "intracompartmental", "pressure", "and,", "depending", "on", "the", "result,", "proceed", "with", "treatment."]], "labels": [["O", "O", "O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "O"], ["O", "O", "O"], ["O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"354_166": {"text": [["QUESTION", "TYPE:", "GYNECOLOGY", "AND", "OBSTETRICS"], ["CLINICAL", "CASE:"], ["A", "pregnant", "woman,", "10", "weeks", "pregnant,", "comes", "to", "the", "emergency", "room", "with", "a", "blood", "pressure", "of", "160/105", "mmHg."], ["She", "was", "in", "good", "general", "condition,", "with", "only", "mild", "headache,", "which", "was", "the", "reason", "for", "taking", "her", "blood", "pressure."], ["After", "4", "hours", "of", "rest", "she", "presented", "with", "a", "blood", "pressure", "of", "150/95mmHg."], ["A", "complete", "blood", "count", "is", "normal", "and", "proteinuria", "is", "negative."], ["What", "type", "of", "hypertension", "is", "present?"], ["1-", "Moderate", "preeclampsia."], ["2-", "Pregnancy-induced", "hypertension."], ["3-", "Chronic", "hypertension."], ["4-", "Eclampsia."], ["5-", "nan"], ["CORRECT", "ANSWER:", "3"], ["Chronic", "hypertension", "is", "defined", "as", "hypertension", "that", "is", "present", "before", "pregnancy", "or", "that", "is", "diagnosed", "before", "the", "20th", "week", "of", "gestation."], ["In", "this", "case,", "the", "patient", "is", "10", "weeks", "pregnant,", "so", "the", "correct", "answer", "is", "3."]], "labels": [["O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"531_58": {"text": [["QUESTION", "TYPE:", "ONCOLOGY"], ["CLINICAL", "CASE:"], ["Faced", "with", "a", "patient", "presenting", "with", "an", "ulcerovegetating", "lesion", "on", "the", "mandibular", "gingiva", "at", "the", "level", "of", "the", "molar", "region", "of", "5", "months", "of", "evolution,", "the", "appearance", "of", "hypoesthesia", "in", "the", "mentonian", "region", "requires", "ruling", "out:"], ["1-", "Paraneoplastic", "neuropathy."], ["2-", "Diagnosis", "of", "sarcoidosis", "with", "\"on", "the", "scale\"", "facial", "paralysis."], ["3-", "Herpes", "virus", "infection", "in", "immunosuppressed", "patient."], ["4-", "Diagnosis", "of", "carcinoma", "with", "infiltration", "of", "the", "mandibular", "canal."], ["5-", "nan"], ["CORRECT", "ANSWER:", "4"], ["Mentonian", "paresthesias", "(Roger's", "sign)", "are", "associated", "with", "bone", "metastases", "(it", "is", "not", "paraneoplastic", "but", "direct", "infiltration)."], ["In", "this", "case", "what", "you", "describe", "is", "an", "oral", "tumor", "growing", "locally", "and", "infiltrating", "the", "mandibular", "canal,", "I", "believe."]], "labels": [["O", "O", "O"], ["O", "O"], ["O", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Marker", "I-Marker"], ["O", "B-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"93_31": {"text": [["QUESTION", "TYPE:", "DERMATOLOGY,", "VENEREOLOGY", "AND", "PLASTIC", "SURGERY"], ["CLINICAL", "CASE:"], ["A", "17-year-old", "boy", "with", "Crohn's", "disease", "with", "colonic", "involvement", "of", "2", "years", "of", "evolution,", "in", "maintenance", "treatment", "with", "azathioprine,", "consults", "for", "the", "appearance", "for", "5", "days", "of", "subcutaneous", "purplish", "red,", "hot,", "painful,", "bilateral,", "pretibial", "localization", "nodules,", "associated", "with", "an", "increase", "in", "the", "number", "of", "stools", "and", "abdominal", "pain."], ["The", "most", "appropriate", "approach", "in", "this", "case", "is:"], ["1-", "Recommend", "relative", "rest", "and", "warm", "cloths", "on", "both", "legs", "and", "add", "antidepressant", "treatment."], ["2-", "Biopsy", "skin", "areas", "away", "from", "the", "injured", "areas", "and", "prescribe", "entry", "opioid", "analgesics."], ["3-", "Suspect", "the", "existence", "of", "a", "malignant", "intestinal", "tumor", "lesion", "as", "a", "trigger", "of", "the", "cutaneous", "process."], ["4-", "Suspect", "bilateral", "lower", "extremity", "ischemia", "of", "drug", "origin."], ["5-", "Adjustment", "of", "bowel", "disease", "treatment."], ["CORRECT", "ANSWER:", "5"], ["2", "and", "4", "are", "discarded", "alone."], ["They", "are", "explaining", "erythema", "nodosum,", "so", "we", "would", "recommend", "relative", "rest", "(but", "antidepressants", "do", "not", "make", "any", "sense,", "so", "we", "also", "rule", "out", "(1))."], ["Although", "erythema", "nodosum", "can", "be", "secondary", "to", "a", "malignant", "process,", "it", "is", "more", "frequent", "that", "it", "is", "due", "to", "Crohn's", "disease", "itself", "(moreover,", "in", "a", "17-year-old", "boy", "it", "would", "be", "extremely", "rare),", "so", "if", "the", "picture", "is", "also", "accompanied", "by", "a", "flare-up", "of", "inflammatory", "bowel", "disease,", "the", "last", "option", "(5)", "seems", "the", "most", "correct."]], "labels": [["O", "O", "O", "O", "O", "O", "O"], ["O", "O"], ["B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise"], ["O", "O", "O", "O", "O", "O", "O", "O"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["O", "O", "O"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"], ["B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim"]]}}
{"390_188": {"text": [["QUESTION", "TYPE:", "PSYCHIATRY"], ["CLINICAL", "CASE:"], ["An", "80-year-old", "man", "is", "brought", "to", "the", "ER", "by", "the", "police", "to", "find", "him", "at", "night,", "on", "the", "street,", "several", "blocks", "from", "his", "home,", "somewhat", "lost."], ["He", "tells", "the", "ER", "doctor", "\"I", "feel", "fine,", "I", "was", "walking", "and", "I", "got", "lost\"."], ["The", "examination,", "by", "systems,", "is", "anodyne."], ["When", "asked", "about", "his", "medication,", "he", "does", "not", "remember."], ["His", "history", "includes", "glipizide,", "atenolol", "and", "acenocoumarol."], ["She", "has", "been", "to", "the", "ER", "3", "times", "in", "the", "last", "three", "months", "for", "\"dizziness\",", "low", "back", "pain", "and", "an", "INR", "of", "5."], ["She", "reports", "independence", "in", "basic", "and", "instrumental", "activities", "of", "daily", "living."], ["There", "is", "no", "evidence", "of", "family", "or", "close", 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