{"402_183": [["There is no doubt that the doctor-patient relationship today transcends the physical environment of the consultation room\n", "Answer that it is important to maintain certain professional boundaries between patients and physicians and that, unfortunately, if you make the request you will not be able to accept it, so it is better not to do so\n", "Support"], ["But we must not forget that we must maintain the same ethical and professional codes as in the real environment\n", "Answer that it is important to maintain certain professional boundaries between patients and physicians and that, unfortunately, if you make the request you will not be able to accept it, so it is better not to do so\n", "Support"], ["The clinical practice of medicine by means of consultations exclusively by letter, telephone, radio, press or internet, is contrary to the deontological norms\n", "Answer that it is important to maintain certain professional boundaries between patients and physicians and that, unfortunately, if you make the request you will not be able to accept it, so it is better not to do so\n", "Support"], ["The correct action implies inescapably the personal and direct contact between the doctor and the patient\n", "Answer that it is important to maintain certain professional boundaries between patients and physicians and that, unfortunately, if you make the request you will not be able to accept it, so it is better not to do so\n", "Support"]]}
{"237_144": [["Diffuse axonal injury produces an early and sustained deterioration of the level of consciousness (as mentioned in the case statement) without a lesion on CT scan to justify the picture\n", "Severe diffuse axonal injury\n", "Support"], ["After a traffic accident a 38-year-old patient is admitted to the ICU in coma\n", "Diffuse axonal injury produces an early and sustained deterioration of the level of consciousness (as mentioned in the case statement) without a lesion on CT scan to justify the picture\n", "Support"], ["After several days the patient does not improve neurologically and a CT scan shows hemorrhagic punctate lesions in the corpus callosum and cortico-subcortical junction\n", "Sometimes, punctate hemorrhages at the level of the corpus callosum, corticosubcortical junction and dorsolateral portion of the brainstem are evidenced in this imaging test\n", "Support"], ["Sometimes, punctate hemorrhages at the level of the corpus callosum, corticosubcortical junction and dorsolateral portion of the brainstem are evidenced in this imaging test\n", "Severe diffuse axonal injury\n", "Support"]]}
[{"620_121": []}]
[{"396_136": []}]
{"253_86": [["When a severe flare does not respond to iv corticosteroid therapy at full doses (1mg/kg body weight), it is necessary to switch to cyclosporine or infliximab\n", "Intravenous cyclosporine 2mg/kg\n", "Support"], ["Etanercept is not approved in Europe for inflammatory bowel disease (for the time being)\n", "Treatment with etanercept (an anti-TNFa antibody) should be considered\n", "Attack"]]}
{"224_63": [["Something aortic\n", "this is going to be aortic stenosis...\n", "Support"], ["They give me a gradient, which without knowing the values seems somewhat high (55 mmHg!) and the area, which looks tiny to the naked eye\n", "this is going to be aortic stenosis...\n", "Support"], ["With the guidelines in hand, that's right: this is a severe stenosis both in terms of area (<1 cm\u00b2) and mean gradient (>40 mmHg), with a preserved ejection fraction, and symptomatic\n", "Surgical indication\n", "Support"], ["we allow the ventricle to claudicate\n", "If we do 1 we take away life expectancy\n", "Support"], ["If we do 1 we take away life expectancy\n", "Diuretics and more frequent check-ups by a specialist\n", "Attack"], ["2 is outdated: balloon valvuloplasty?\n", "In case of increasing dyspnea on exertion, percutaneous dilatation of the aortic valve with a balloon catheter should be performed\n", "Attack"], ["Only if the surgical risk is unaffordable, and in that case we would do 5, TAVI implantation\n", "Implantation of a percutaneous valve\n", "Support"], ["But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n", "Only if the surgical risk is unaffordable, and in that case we would do 5, TAVI implantation\n", "Attack"], ["But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n", "so to the operating room\n", "Support"], ["so to the operating room\n", "Implantation of a percutaneous valve\n", "Attack"], ["The correct thing to do is 3, without a doubt: replace with a prosthesis, preferably mechanical unless the patient has a contraindication for anticoagulation\n", "Replacement of the aortic valve with a prosthesis/bioprosthesis\n", "Support"], ["But it's rare, complex and only done in pediatrics\n", "A homograft? That's the Ross technique, I take the pulmonary and put it where the aortic\n", "Attack"], ["But it's rare, complex and only done in pediatrics\n", "Replacement of the aortic valve with a homograft\n", "Attack"], ["But this is a 52-year-old man, who we assume has good bodywork because he walks to have dyspnea\n", "Implantation of a percutaneous valve\n", "Attack"]]}
{"430_115": [["Patient on her 30th post-transplant day of hematopoietic precursor transplantation, in severe neutropenia who presents with cough with hemoptotic expectoration\n", "This picture is usually seen in infection by Aspergillus spp\n", "Support"], ["This picture is usually seen in infection by Aspergillus spp\n", "Invasive pulmonary aspergillosis\n", "Support"], ["We can rule out infection by Staphylococcus aureus because of previous treatment\n", "Pneumonia due to Staphylococcus aureus\n", "Attack"], ["She starts with cough and hemoptotic expectoration in addition to fever and moderate exertional dyspnea that does not improve despite five days of treatment with amoxicillin-clavulanic acid (875/125 mg/8 h) and levofloxacin (500 mg/12 h)\n", "We can rule out infection by Staphylococcus aureus because of previous treatment\n", "Support"]]}
[{"588_63": []}]
{"11_74": [["But if there are data of poor prognosis and the possibility of metastases - as in this case\n", "it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n", "Support"], ["it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n", "I think the correct answer is 3\n", "Support"], ["I think the correct answer is 3\n", "This is a follicular carcinoma and requires completion of thyroidectomy\n", "Support"], ["But if there are data of poor prognosis and the possibility of metastases - as in this case\n", "This is a follicular carcinoma and requires completion of thyroidectomy\n", "Support"], ["it is best to complete the thyroidectomy and perform a radioactive iodine scan to rule out metastases or treat them if they are present\n", "This is a follicular carcinoma and requires completion of thyroidectomy\n", "Support"], ["answers 2,4 and 5 are clearly false\n", "Follicular pattern is an indication for prophylactic cervical lymph node emptying\n", "Attack"], ["answers 2,4 and 5 are clearly false\n", "The report allows us to rule out with total certainty a papillary carcinoma in the remaining thyroid\n", "Attack"], ["answers 2,4 and 5 are clearly false\n", "Measurement of plasma calcitonin will allow us to distinguish between papillary and follicular carcinoma\n", "Attack"], ["The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed\n", "As there is no capsular invasion, no further surgery is necessary\n", "Support"], ["But if there are data of poor prognosis and the possibility of metastases - as in this case\n", "The statement of 1 is correct in cases of follicular carcinoma without capsular invasion a total thyroidectomy can be performed\n", "Attack"]]}
{"535_121": [["Clinical case of SLE with renal involvement, in which positive double-stranded anti-DNA increases the risk of nephritis\n", "Anti-two-stranded or native anti-DNA correlates with the risk of nephritis\n", "Support"], ["As for the rest, anti-Sm are specific to SLE\n", "The anti-Sm antibodies are not specific for this pathology\n", "Attack"], ["ANA are detected in more than 90% of cases\n", "ANA (antinuclear antibodies) are detected in 50% of cases\n", "Attack"], ["anti-centromere are typical of scleroderma\n", "Anti-centromere antibodies are detected in 90% of cases\n", "Attack"]]}
{"452_149": [["Clearly the answer is 4, with a very characteristic clinic of temporary seizures\n", "Complex partial temporal lobe seizure\n", "Support"]]}
{"55_74": [["Answer 4: simply by the way of expressing it, it should already have been ruled out\n", "The report allows to rule out papillary carcinoma with total certainty in the remaining thyroid\n", "Attack"], ["Answer 5: you already know that calcitonin is used in medullary carcinoma and not in differentiated carcinoma\n", "Measurement of plasma calcitonin will allow us to differentiate between papillary and follicular carcinoma\n", "Attack"], ["Answer 2: prophylactic emptying is indicated in the medullary\n", "The follicular pattern is an indication for prophylactic cervical lymph node emptying\n", "Attack"], ["The only ones in which complete thyroidectomy is not recommended are microcarcinomas measuring less than 1 cm\n", "As there is no capsular invasion it is not convenient to perform further surgery\n", "Attack"], ["The only ones in which complete thyroidectomy is not recommended are microcarcinomas measuring less than 1 cm\n", "It is a follicular carcinoma and requires completion of thyroidectomy\n", "Support"]]}
{"281_33": [["The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n", "Study of hormone receptors and HER2\n", "Support"], ["positive HER2 receptors imply greater aggressiveness of the tumor\n", "The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n", "Support"], ["Answer 1 can be ruled out visu visu\n", "Complete phenotypic study by flow cytometry\n", "Attack"], ["while answers 3 and 4 should be ruled out\n", "Study of hormone receptors, e-cadherin and study of first degree relatives\n", "Attack"], ["while answers 3 and 4 should be ruled out\n", "Study of BRCA 1-2 and study of first-degree relatives\n", "Attack"], ["treatment with trastuzumab and positive hormone receptors would imply the use of hormone therapy\n", "The correct answer would be 2, HORMONE AND HER2 RECEPTOR STUDY\n", "Support"], ["being the first woman in the family with breast carcinoma\n", "the study of the patient's relatives would not be obligatory\n", "Support"], ["the study of the patient's relatives would not be obligatory\n", "while answers 3 and 4 should be ruled out\n", "Support"]]}
{"310_216": [["we have a blow to the right eye area, with a hematoma on the eyelid\n", "Therefore, something other than the blow has caused hemorrhages in both retinas\n", "Support"], ["The problem is that retinal hemorrhages appear not only in that eye (which in itself is rare, because an external blow to the eye in a child rarely causes bleeding in the retina), but also in the other eye\n", "Therefore, something other than the blow has caused hemorrhages in both retinas\n", "Support"], ["we have a blow to the right eye area, with a hematoma on the eyelid\n", "Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n", "Support"], ["The problem is that retinal hemorrhages appear not only in that eye (which in itself is rare, because an external blow to the eye in a child rarely causes bleeding in the retina), but also in the other eye\n", "Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n", "Support"], ["Characteristic of this syndrome are bilateral retinal hemorrhages, cerebral edema and subdural hematoma\n", "Here we already have the two keys; we have to suspect what is not mentioned in the answers, but which is what the child has: the shaken baby syndrome (shaken baby syndrome)\n", "Support"], ["The cause of shaken baby syndrome is almost always abuse\n", "the answer is 1\n", "Support"], ["the answer is 1\n", "It is a highly suggestive history of child abuse\n", "Support"], ["The cause of shaken baby syndrome is almost always abuse\n", "It is a highly suggestive history of child abuse\n", "Support"], ["Options 2 and 3 are easy to rule out\n", "It is the normal evolution of a non-perforating intraocular trauma\n", "Attack"], ["Options 2 and 3 are easy to rule out\n", "The most likely diagnosis is Berlin edema\n", "Attack"], ["nothing indicates perforating trauma, and it does not explain the hemorrhages in the other eye\n", "Options 2 and 3 are easy to rule out\n", "Support"], ["And the berlin edema is an edema of the macula and appears as a whitish lesion, which is not described in the statement\n", "The most likely diagnosis is Berlin edema\n", "Attack"], ["However, if we read answer 4 carefully, it does not tell us that if there is child maltreatment Purstcher can occur\n", "Purstcher's retinopathy can also appear in the context of the child of the shaken child, and therefore occur in the case of child abuse\n", "Attack"], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "Purstcher's retinopathy can also appear in the context of the child of the shaken child, and therefore occur in the case of child abuse\n", "Attack"], ["In Purstcher's there are hemorrhages, but also cottony exudates and edema\n", "Purstcher's retinopathy can also appear in the context of the child of the shaken child, and therefore occur in the case of child abuse\n", "Attack"], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "If there are only hemorrhages, it's not Purstcher's\n", "Support"], ["In Purstcher's there are hemorrhages, but also cottony exudates and edema\n", "If there are only hemorrhages, it's not Purstcher's\n", "Support"], ["If there are only hemorrhages, it's not Purstcher's\n", "It is the characteristic picture of Purstcher's traumatic retinal angiopathy\n", "Attack"], ["It states that the picture described above (intraretinal hemorrhages, without other findings) is characteristic of Purstcher's angiopathy. It is not\n", "It is the characteristic picture of Purstcher's traumatic retinal angiopathy\n", "Attack"]]}
{"293_214": [["On examination, the nails show the presence of nail pitting and distal yellowish areas in an oil stain\n", "although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n", "Support"], ["although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n", "Psoriasis\n", "Support"], ["although the description of nail lesions highly suggestive of psoriasis makes this diagnosis the most likely\n", "Any of the 4 options can be the cause of erythroderma\n", "Attack"]]}
{"132_229": [["Schistocytes in smear\n", "a patient with certain history who has: - Schistocytes in smear\n", "Support"], ["Laboratory tests: creatinine 2.3 mg/dl, Hb 10.3 g/dl and platelets 20000 mm3, with normal coagulation\n", "Bicytopenia: here the causes can be very, very varied\n", "Support"], ["Elevation of LDH and Bilirubin\n", "which indicates a massive rupture of red blood cells\n", "Support"], ["Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n", "Elevation of LDH and Bilirubin\n", "Support"], ["Answer 1: it cannot be because a hemorrhagic transformation does not give such a brutal elevation of LDH and Cr, in addition to not explaining schistocytosis\n", "New cranial CT in the presence of suspected hemorrhagic transformation of ischemic stroke\n", "Attack"], ["Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n", "New cranial CT in the presence of suspected hemorrhagic transformation of ischemic stroke\n", "Attack"], ["Answer 2: urgent plasmapheresis... in case of thrombotic thrombocytopenic purpura, yes\n", "Initiate urgent plasmapheresis\n", "Support"], ["I like this answer because it justifies bicytopenia, since microangiopathic hemolytic anemia is produced by rupture of red blood cells when they are fragmented by ultralong von Willebrand factor multimers in case of deficiency of the ADAMST13 enzyme, resulting in brutal platelet aggregates and the flow cytometer does not count 400 platelets, but a molondron of platelets that form a mass, hence the thrombocytopenia\n", "Initiate urgent plasmapheresis\n", "Support"], ["Laboratory tests: creatinine 2.3 mg/dl, Hb 10.3 g/dl and platelets 20000 mm3, with normal coagulation\n", "Initiate urgent plasmapheresis\n", "Support"], ["It also explains the negative direct Coombs, elevated LDH and Cr\n", "Initiate urgent plasmapheresis\n", "Support"], ["Direct Coombs' test was negative\n", "Initiate urgent plasmapheresis\n", "Support"], ["Subsequently, he began with progressive deterioration of the level of consciousness and increase of Cr, LDH and unconjugated bilirubin\n", "Initiate urgent plasmapheresis\n", "Support"], ["Answer 3: a situation as critical as that patient's indicates that something big is going on and I would not sit and wait for glucocorticoids to take effect...and I do not know right now what pathology gives that symptomatology and has that treatment as standard\n", "Beginning of treatment with glucocorticoids at a dose of 1 mg/kg/day\n", "Attack"], ["Answer 4: looking for a trigger for DIC...it would make sense if it were not for the fact that in DIC it is VERY characteristic the consumption of coagulation factors, which is not present in this case\n", "Search for triggering cause of DIC\n", "Attack"], ["Answer 5: a myeloma does not give schistocytosis nor does it have this symptomatology, they would have to give other data that would support this pathology, such as bone pain and hypercalcemia\n", "Suspected multiple myeloma: bone marrow aspirate\n", "Attack"]]}
[{"49_159": []}]
{"120_192": [["As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n", "Do not revaccinate\n", "Support"], ["A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n", "Do not revaccinate\n", "Support"], ["A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n", "Restart vaccination schedule (0-1-6 months)\n", "Attack"], ["A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n", "Restart vaccination schedule (0-1-2-12 months)\n", "Attack"], ["A 40-year-old orthopedic surgeon who in a routine serology was found to have anti-HBs levels of 30 IU/l\n", "Give anti-hepatitis B immunoglobulin and restart vaccination schedule (0-1-2-12 months)\n", "Attack"], ["As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n", "Restart vaccination schedule (0-1-6 months)\n", "Attack"], ["As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n", "Restart vaccination schedule (0-1-2-12 months)\n", "Attack"], ["As long as the serological levels of anti-HBs are above 10 IU/l it is not necessary to revaccinate\n", "Give anti-hepatitis B immunoglobulin and restart vaccination schedule (0-1-2-12 months)\n", "Attack"]]}
{"304_174": [["In this case we are dealing with an elderly patient with chronic treatment with NSAIDs that produces arterial hypertension secondary to renal hypoperfusion\n", "The most reasonable option would be to withdraw ibuprofen and replace it with an analgesic from a group other than NSAIDs (paracetamol, opiates), subsequently monitoring the evolution of blood pressure\n", "Support"]]}
{"214_228": [["In the absence of further information (more complete anamnesis on the current disease, risk factors, personal and family history, extra-articular symptoms or signs, etc.) it can be said that also 1 and 2 (and very exceptionally 5) could debut with a similar clinical and biological picture\n", "Arthritis due to microcrystals\n", "Support"], ["In the absence of further information (more complete anamnesis on the current disease, risk factors, personal and family history, extra-articular symptoms or signs, etc.) it can be said that also 1 and 2 (and very exceptionally 5) could debut with a similar clinical and biological picture\n", "Reactive arthritis\n", "Support"], ["In the absence of further information (more complete anamnesis on the current disease, risk factors, personal and family history, extra-articular symptoms or signs, etc.) it can be said that also 1 and 2 (and very exceptionally 5) could debut with a similar clinical and biological picture\n", "Rheumatoid arthritis\n", "Support"], ["With the data provided and taking into account that this is a young male\n", "the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n", "Support"], ["the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n", "Bacterial infectious arthritis\n", "Support"], ["Acute monoarthritis associated with fever, leukocytosis with neutrophilia and increased acute phase reactants does not always have a septic origin\n", "Mycobacterial infectious arthritis\n", "Attack"], ["A 19-year-old man consults for a 24-hour history of pain, swelling and functional impotence of the right knee accompanied by a fever of 38\u00b0C\n", "the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n", "Support"], ["Physical examination reveals inflammatory signs and joint effusion in the right knee\n", "the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n", "Support"], ["Laboratory tests showed leukocytosis with neutrophilia and elevated C-reactive protein\n", "the most likely option would be bacterial infectious arthritis (that caused by mycobacteria usually have a chronic course)\n", "Support"], ["And above all, because of its implications, the first one to always rule out\n", "Arthritis due to microcrystals\n", "Attack"]]}
{"249_120": [["All these data are suggestive of visceral Leishmaniasis\n", "an OM biopsy should be performed to look for amastigotes and confirm the diagnosis\n", "Support"], ["We are told about an HIV patient with irregular follow-up of antiretroviral treatment, presenting fever, hepatosplenomegaly, pancytopenia and polyclonal hypergammaglobulinemia\n", "All these data are suggestive of visceral Leishmaniasis\n", "Support"], ["All these data are suggestive of visceral Leishmaniasis\n", "I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n", "Support"], ["an OM biopsy should be performed to look for amastigotes and confirm the diagnosis\n", "I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n", "Support"], ["We are told about an HIV patient with irregular follow-up of antiretroviral treatment, presenting fever, hepatosplenomegaly, pancytopenia and polyclonal hypergammaglobulinemia\n", "I would perform a bone marrow biopsy, since the most probable diagnosis is visceral leishmaniasis\n", "Support"]]}
{"53_146": [["We first eliminate the most striking \"acute\" personality disorder.\n", "Acute\" dependent personality disorder.\n", "Attack"], ["There are no \"acute\" characteristics in our personality.\n", "We first eliminate the most striking \"acute\" personality disorder.\n", "Support"], ["Depressive disorder? There is a time criterion that is not met\n", "it may be sad, but sad is not depression\n", "Support"], ["agoraphobia? if it was something like that we would have been told the context post-traumatic stress reaction?\n", "Agoraphobia\n", "Attack"], ["it may be sad, but sad is not depression\n", "Depressive disorder\n", "Attack"], ["So by elimination 5. Crisis of distress\n", "Anguish crisis\n", "Support"], ["according to ICD 10: \"The stressor may be a devastating traumatic experience involving a serious threat to the safety or physical integrity of the patient or loved one(s) (e.g., natural catastrophes, accidents, battles, muggings, rapes) or an abrupt and threatening change in the individual's rank or social environment (e.g., loss of several loved ones, house fire, etc.). )\" or more briefly: \"exceptionally threatening or catastrophic nature\"\n", "Breaking up with a partner I understand is hard, but not exceptional\n", "Support"], ["Breaking up with a partner I understand is hard, but not exceptional\n", "Post-traumatic stress reaction\n", "Attack"], ["The correct term would be post-traumatic stress disorder or acute stress reaction\n", "Breaking up with a partner I understand is hard, but not exceptional\n", "Support"], ["Diagnoses 1 to 4 would be like calling diabetic the one who has hyperglycemia after eating three muffins\n", "Post-traumatic stress reaction\n", "Attack"], ["Diagnoses 1 to 4 would be like calling diabetic the one who has hyperglycemia after eating three muffins\n", "Agoraphobia\n", "Attack"]]}
{"48_158": [["The correct answer is 1\n", "Inject an intravenous anticholinergic\n", "Support"], ["The anticholinergic can be administered intravenously and also intramuscularly if I am not mistaken\n", "The correct answer is 1\n", "Support"], ["The occurrence of dystonia as a side effect is common in children and is one of the main reasons why pediatricians do not usually prescribe some antiemetics in children\n", "The correct answer is 1\n", "Support"]]}
{"490_106": [["It is a definitive promyelocytic leukemia with t(15;17)\n", "as it is well known by all of you the treatment is with arsenic trioxide + ATRA\n", "Support"], ["as it is well known by all of you the treatment is with arsenic trioxide + ATRA\n", "Start treatment with arsenic trioxide, ATRA and supportive therapy\n", "Support"], ["Option 1 leaves the treatment incomplete\n", "If asymptomatic, transretinoic acid (ATRA) will be started and day hospital controls will be recommended\n", "Attack"], ["there is only ATRA and it must be treated as long as the patient's condition allows it, whether or not there are symptoms\n", "Option 1 leaves the treatment incomplete\n", "Support"], ["Option 3 3 years ago would have been the correct option but nowadays neither chemotherapy nor heparin is used\n", "It is a myeloblastic leukemia type M3, so chemotherapy and heparin will be started to control disseminated intravascular coagulation\n", "Attack"], ["that fever is due to the leukemia itself and the priority is to start specific treatment for leukemia\n", "option 4 is false\n", "Support"], ["option 4 is false\n", "Antibiotic treatment should be started. When the fever disappears, leukemia treatment should be started\n", "Attack"]]}
{"416_76": [["Atrial Fibrillation\n", "at the mir and at the ED door, any elderly person with AF and abdominal pain is emboligenic mesenteric ischemia until proven otherwise\n", "Support"], ["at the mir and at the ED door, any elderly person with AF and abdominal pain is emboligenic mesenteric ischemia until proven otherwise\n", "Mesenteric ischemia\n", "Support"], ["Acute abdominal pain\n", "ischemia\n", "Support"], ["SIRS\n", "ischemia\n", "Support"], ["renal failure\n", "ischemia\n", "Support"], ["metabolic acidosis\n", "ischemia\n", "Support"], ["probably an elevated lactic...\n", "ischemia\n", "Support"], ["we could also have been told of intestinal pneumatosis\n", "CT: The finding of portal gas is also highly indicative of mesenteric ischemia\n", "Support"], ["ischemia\n", "Mesenteric ischemia\n", "Support"], ["CT: The finding of portal gas is also highly indicative of mesenteric ischemia\n", "Mesenteric ischemia\n", "Support"], ["Perforated ulcus: We would have been told of a history of NSAID use, or a history of pain that improves with ingestion, of pneumoperitoneum on chest X-ray\n", "Perforation of gastric or duodenal ulcus\n", "Attack"], ["Biliary ileus: There would be a history of biliary colic or pain in the right hypochondrium\n", "Biliary leak\n", "Attack"], ["they would also speak of aerobilia in the imaging test and dilatation of the small loops with image (or not) of biliary lithiasis in the terminal ileum\n", "Biliary leak\n", "Attack"], ["Neo sigmoidoscopy: In the myocardial imaging they would speak of weight loss, change of stool habit, pneumoperitoneum in Rx or CT and peritonitic abdominal exploration and may even be able to palpate the mass\n", "Obstructive neoplasm of the sigma with perforation\n", "Attack"]]}
[{"45_154": []}]
{"336_31": [["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 embryonal elements are found in several of the histological preparations\n", "apart from cutaneous structures many other tissues can be seen, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone\n", "Support"], ["A 20-year-old woman with a 15-cm solid-cystic ovarian tumor detected by ultrasound after presenting with nonspecific abdominal symptoms\n", "The tissues that make up the tumor are well differentiated (mature or adult-type)\n", "Support"], ["The tissues that make up the tumor are well differentiated (mature or adult-type)\n", "Mature cystic teratoma is a common benign tumor of the ovary in adult women\n", "Support"], ["apart from cutaneous structures many other tissues can be seen, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone\n", "Mature cystic teratoma is a common benign tumor of the ovary in adult women\n", "Support"], ["Mature cystic teratoma is a common benign tumor of the ovary in adult women\n", "Mature cystic teratoma\n", "Support"]]}
{"609_115": [["Several months have passed, she has not improved and refers intense pain after physical activity that subsides with rest in the hours following exercise\n", "Exercise-induced compartment syndrome is an exercise-induced condition of the leg\n", "Support"], ["Diagnosis is made by measuring compartment pressures at rest, during exercise and after exercise\n", "answer 2 correct\n", "Support"], ["answer 2 correct\n", "Determination of posterior compartment pressure immediately after activity\n", "Support"]]}
[{"389_235": []}]
{"201_76": [["Transcortical have preserved repetition\n", "Sensitive transcortical aphasia\n", "Attack"], ["Broca's aphasia has preserved comprehension and absence of fluent speech\n", "Broca's aphasia\n", "Attack"], ["Wernicke's aphasia is characterized by fluent speech (even in excess) with paraphasias and problems with comprehension, nomination and repetition\n", "Wernicke's aphasia\n", "Support"]]}
{"345_159": [["In a case like this we must rule out endometrial neoplasia\n", "an endometrial biopsy would be indicated, either by Cornier cannula if possible, or by hysteroscopy\n", "Support"], ["We are being presented with a case of postmenopausal metrorrhagia\n", "In a case like this we must rule out endometrial neoplasia\n", "Support"], ["an endometrial biopsy would be indicated, either by Cornier cannula if possible, or by hysteroscopy\n", "Endometrial biopsy.\n", "Support"], ["A cervical biopsy is not of interest in this case\n", "Random cervical biopsies\n", "Attack"], ["the cytology is normal\n", "A cervical biopsy is not of interest in this case\n", "Support"], ["hormonal assessment is not going to be useful in the diagnosis of endometrial neoplasia\n", "A cervical biopsy is not of interest in this case\n", "Support"], ["A 69-year-old woman comes to your office reporting genital bleeding of several months' evolution\n", "Finally, prescribing cyclic progesterone is not indicated in a postmenopausal woman\n", "Support"], ["Finally, prescribing cyclic progesterone is not indicated in a postmenopausal woman\n", "Prescribe cyclic progesterone\n", "Attack"]]}
{"166_82": [["An abdominal ultrasound shows stenosis of both renal arteries\n", "If the renal arteries are stenosed, blood has difficulty reaching the kidneys\n", "Support"], ["If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glomerular filtration rate\n", "Enalapril\n", "Support"], ["If we administer an ACEI, we will provoke the relaxation of this arteriole and the fall of the glomerular filtration rate\n", "And if neither kidney filters, because both have arterial stenosis, we have a problem\n", "Support"]]}
[{"481_171": []}]
{"612_116": [["Given that this is a displaced subcapital hip fracture, the surgical treatment we should consider is hip joint replacement, given that the injury described presents a high probability of necrosis of the femoral head\n", "Correct Answer 1\n", "Support"], ["Given that this is a displaced subcapital hip fracture, the surgical treatment we should consider is hip joint replacement, given that the injury described presents a high probability of necrosis of the femoral head\n", "The options would be total or partial arthroplasty\n", "Support"], ["Correct Answer 1\n", "Hip hemiarthroplasty\n", "Support"], ["in elderly patients, partial arthroplasty is preferred because it is a shorter and less aggressive surgery than total hip arthroplasty\n", "Hip hemiarthroplasty\n", "Support"], ["We would consider this technique in basicervical fractures and trochanteric mass lesions, not in subcapital fractures\n", "Answer 2 incorrect\n", "Support"], ["Answer 2 incorrect\n", "Trochanteric nail fixation\n", "Attack"], ["We would consider this technique in nondisplaced subcapital fractures in young patients\n", "Incorrect Answer 3\n", "Support"], ["We would only consider non-surgical treatment in a patient with a very poor baseline general condition: bedridden patients with low life expectancy\n", "Incorrect answer 4\n", "Support"], ["Incorrect answer 4\n", "Conservative: bed-chair life\n", "Attack"]]}
{"585_74": [["Laboratory tests: hemoglobin 10.5 g/dL, platelets 98,000/mm3, AST 356 IU/L (0-31), ALT 234 IU/L (0-31), LDH 878 IU/L (125-243)\n", "They are describing HELLP syndrome\n", "Support"], ["34-week primigravida with blood pressure of 165/95 and headache of two days of evolution\n", "They are describing HELLP syndrome\n", "Support"], ["The laboratory is called because of the presence of schistocytes in the peripheral blood smear\n", "They are describing HELLP syndrome\n", "Support"], ["They are describing HELLP syndrome\n", "With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination\n", "Support"], ["With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination\n", "Immediate termination of pregnancy\n", "Support"], ["She received the second dose of corticosteroids for fetal maturation 24 hours ago\n", "With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination\n", "Support"], ["On obstetric ultrasound the estimated fetal weight is in the 1st percentile for gestational age and the umbilical artery Doppler shows absence of end-diastolic flow\n", "With these weeks of gestation and with the fetus recently matured (she has already been given two doses of corticosteroids), the attitude is immediate termination\n", "Support"]]}
{"3_37": [["It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5\n", "Neoadjuvant chemo/radiotherapy, conditioning the option of radical surgery on initial response\n", "Attack"], ["It is a pancreatic adenocarcinoma with metastasis, so the treatment should be palliative, so we remove options 1 and 5\n", "Cephalic duodenopancreatectomy, with percutaneous ablation by radiofrequency or alcoholization of the hepatic lesion\n", "Attack"], ["the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 being the one I consider most correct\n", "Metallic biliary prosthesis by endoscopic retrograde cholangiopancreatography with the option of palliative chemotherapy\n", "Support"], ["In principle she is a patient in moderately good general condition\n", "the ideal would be to perform a permanent biliary diversion and chemotherapy, option 4 being the one I consider most correct\n", "Support"]]}
{"439_96": [["Since the most frequent cause of vaginal bleeding in postmenopausal women is urogenital atrophy, the existence of an endometrial pathology cannot be ruled out\n", "Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n", "Support"], ["According to the SEGO: \"Abnormal genital bleeding is the main sign of suspicion that should lead us to rule out an endometrial neoplastic pathology, particularly in postmenopausal patients, or those with associated risk factors (...)\n", "Given the sign of suspicion, the performance of a transvaginal ultrasound, or in its absence transrectal, allows us to: rule out organic pathology (fibroids, polyps); measurement of endometrial thickness in a longitudinal cut\n", "Support"], ["Given the sign of suspicion, the performance of a transvaginal ultrasound, or in its absence transrectal, allows us to: rule out organic pathology (fibroids, polyps); measurement of endometrial thickness in a longitudinal cut\n", "Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n", "Support"], ["It is recommended to use a cut-off point of 3mm for endometrial biopsy in the symptomatic patient\n", "Transvaginal ultrasound and measurement of endometrial thickness. Depending on this, an endometrial biopsy should be taken or not\n", "Support"]]}
{"192_160": [["On examination the infant is in good general condition, is well nourished and hydrated and his breathing is eupneic; his weight is 4,730g and has decreased by 70g with respect to the previous week\n", "The baby is not dehydrated and is in good general condition\n", "Support"], ["The abdomen is soft and depressible, without masses or megaliths, and the fontanel is normotensive\n", "The baby is not dehydrated and is in good general condition\n", "Support"], ["Except for the presence of watery rhinorrhea, the rest of the examination by organs and devices is normal\n", "The baby is not dehydrated and is in good general condition\n", "Support"], ["Try to avoid dehydration by replenishing what is being lost, avoiding drastic changes in feeding habits as much as possible\n", "It is advisable to replace losses after each bowel movement with oral rehydration solution and continue with the patient's usual diet\n", "Support"], ["There is also no evidence of lactose intolerance (perianal irritation, frothy and acid stools, etc.) that would advise lactose-free milk\n", "The use of lactose-free formula should be recommended\n", "Attack"]]}
[{"261_100": []}]
{"289_65": [["the patient was operated 20 years ago for a Bilroth II\n", "It is usually a late complication\n", "Support"], ["If it were gastric adenocarcinoma, they would have spoken of constitutional syndrome, extradigestive manifestations (sister Maria Jose node, Krukenberg tumor, Virchow node)\n", "Gastric adenocarcinoma\n", "Attack"], ["a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n", "If it were gastric adenocarcinoma, they would have spoken of constitutional syndrome, extradigestive manifestations (sister Maria Jose node, Krukenberg tumor, Virchow node)\n", "Attack"], ["It is not dumping\n", "Rapid gastric emptying syndrome (dumping)\n", "Attack"], ["it does not speak of vegetative symptoms (palpitations, facial flushing, etc...)\n", "It is not dumping\n", "Support"], ["a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n", "it does not speak of vegetative symptoms (palpitations, facial flushing, etc...)\n", "Support"], ["a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n", "moreover it is not associated with diarrhea or malabsorption\n", "Attack"], ["Biliary reflux gastropathy is an endoscopic diagnosis\n", "Biliary reflux gastropathy\n", "Attack"], ["moreover it is not associated with diarrhea or malabsorption\n", "Biliary reflux gastropathy\n", "Attack"], ["a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n", "there is diarrhea, and if associated with bacterial overgrowth, there is malabsorption of vitamin B12\n", "Support"], ["a patient operated, 20 years ago, of gastric ulcer by antrectomy and gastrojejunostomy (Billroth II) who comes to your office referring postpradial abdominal pain, abdominal distension, diarrhea and analytical data of malabsorption of fats and vitamin B12\n", "What has occurred is a stenosis of the afferent loop, so that biliary and pancreatic secretions do not mix with the bolus, they accumulate, produce pain that is relieved by vomiting, fat absorption is not possible (lack of pancreatic lipase)\n", "Support"], ["What has occurred is a stenosis of the afferent loop, so that biliary and pancreatic secretions do not mix with the bolus, they accumulate, produce pain that is relieved by vomiting, fat absorption is not possible (lack of pancreatic lipase)\n", "Afferent loop syndrome with bacterial overgrowth\n", "Support"], ["there is diarrhea, and if associated with bacterial overgrowth, there is malabsorption of vitamin B12\n", "Afferent loop syndrome with bacterial overgrowth\n", "Support"]]}
{"366_106": [["a young patient from an area with a high rate of TB, a lymphocytic exudate pointing to TB, lymphoma or tumor\n", "Suspicion is very high for tuberculous pleural effusion\n", "Support"], ["Suspicion is very high for tuberculous pleural effusion\n", "Measurement of pleural fluid adenosine deaminase\n", "Support"], ["A 32-year-old man from Cameroon consults for fever cough and left hemithorax pain of 1 month of evolution\n", "Tumor unlikely due to age, negative cytology\n", "Support"], ["A thoracentesis shows a yellowish fluid with the following features: red blood cells 2000/\u00b5L, leukocytes 2500/\u00b5L with 90% lymphocytes, protein 4.9 g/dL, lactate dehydrogenase 550 VIL, glucose 67 mg/dL, and absence of malignant cells on cytologic study\n", "Tumor unlikely due to age, negative cytology\n", "Support"], ["High adenosine deaminase in LP would point with great certainty to a pleural TB\n", "Measurement of pleural fluid adenosine deaminase\n", "Support"]]}
{"544_40": [["In this patient the conventional treatment has not worked\n", "it is possible to escalate to specific allergen immunotherapy\n", "Support"], ["Currently the only effective treatment capable of modifying the natural course of respiratory allergy is specific allergen immunotherapy for a minimum of 3 consecutive years\n", "Specific immunotherapy by sublingual or subcutaneous route for a minimum period of 3 years\n", "Support"], ["it is possible to escalate to specific allergen immunotherapy\n", "Specific immunotherapy by sublingual or subcutaneous route for a minimum period of 3 years\n", "Support"], ["16-year-old woman diagnosed with allergic rhinoconjunctivitis due to sensitization to grass pollens since she was 10 years old, who does not fully control the symptomatology during the pollination season with oral antihistamines and nasal topical corticosteroids\n", "Omalizumab is a biological treatment that would only be indicated in cases of severe moderate bronchial asthma secondary to respiratory allergy\n", "Attack"], ["Omalizumab is a biological treatment that would only be indicated in cases of severe moderate bronchial asthma secondary to respiratory allergy\n", "Omalizumab subcutaneously every 4 weeks for up to 1 year\n", "Attack"], ["Omalizumab is a biological treatment that would only be indicated in cases of severe moderate bronchial asthma secondary to respiratory allergy\n", "Omalizumab subcutaneously every 4 weeks for a minimum period of 6 months\n", "Attack"]]}
{"533_179": [["C cells, elevated calcitonin, inherited MEN-2nd\n", "Typical medullary thyroid RET\n", "Support"], ["Typical medullary thyroid RET\n", "Multifocal medullary carcinoma\n", "Support"]]}
{"80_37": [["The treatment of choice is phlebotomy\n", "Initiate treatment with phlebotomies\n", "Support"], ["This is a patient who already has a diagnosis of hemochromatosis, due to a positive genetic study and data of iron overload (IST >45% and elevated ferritin)\n", "The treatment of choice is phlebotomy\n", "Support"], ["Biopsy would be useful if the diagnosis is uncertain or if we would like to assess liver involvement that is not suspected with this analysis\n", "The treatment of choice is phlebotomy\n", "Support"], ["Biopsy would be useful if the diagnosis is uncertain or if we would like to assess liver involvement that is not suspected with this analysis\n", "Perform liver biopsy\n", "Attack"]]}
{"394_225": [["therefore the correct answer is compulsion\n", "Compulsion\n", "Support"], ["In this question they ask for the name of the symptom, not the disease\n", "therefore the correct answer is compulsion\n", "Support"], ["This behavior, which she always does when she comes home from work, consists of turning the doorknob of the bathroom on the upper floor of the house before doing anything else, even before greeting her family\n", "According to the DSM-5, a compulsion is a repetitive behavior (e.g., washing hands, tidying up, checking things) or mental act (e.g., praying, counting, repeating words silently) that the subject performs in response to an obsession or in accordance with rules that must be rigidly enforced\n", "Support"], ["Sometimes he has tried to resist doing this but has only succeeded in distressing himself and delaying the behavior for a few minutes\n", "The goal of the behaviors or mental acts is to prevent or decrease anxiety or discomfort, or to avoid some feared event or situation\n", "Support"]]}
{"229_178": [["The infant presents with acute GEA without signs of alarm or severe dehydration\n", "The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated\n", "Support"], ["The first step would be to try oral tolerance with oral rehydration saline and continue with normal feeding if well tolerated\n", "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) and continue with his usual diet\n", "Support"], ["In this case, intravenous rehydration could be started...\n", "Answer 1 may give rise to doubts, due to the fact that the statement says that the patient \"does not tolerate the oral route\"\n", "Support"], ["but it would not be advisable to leave the patient on an absolute diet for 8 hours, nor a subsequent astringent diet\n", "Answer 1 may give rise to doubts, due to the fact that the statement says that the patient \"does not tolerate the oral route\"\n", "Attack"], ["Answer 1 may give rise to doubts, due to the fact that the statement says that the patient \"does not tolerate the oral route\"\n", "Intravenous rehydration, absolute diet 8 hours and start feeding with astringent diet\n", "Attack"], ["but it would not be advisable to leave the patient on an absolute diet for 8 hours, nor a subsequent astringent diet\n", "Intravenous rehydration, absolute diet 8 hours and start feeding with astringent diet\n", "Attack"], ["so I prefer answer 2\n", "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) and continue with his usual diet\n", "Support"], ["The rest of the treatments do not provide any benefit\n", "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) maintain usual feeding and oral amoxicillin 10 days\n", "Attack"], ["The rest of the treatments do not provide any benefit\n", "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) and start feeding with lactose-free formulas\n", "Attack"], ["The rest of the treatments do not provide any benefit\n", "Rehydration with low osmolality oral rehydration solution (sodium 60-75 mEq/L) maintain usual feeding and loperamide 7 days\n", "Attack"]]}
{"198_73": [["This case describes an Alzheimer's disease with insidious onset of short-term memory problems\n", "Alzheimer's disease\n", "Support"], ["The patient was accompanied by his wife, who reported a slow progressive evolution of memory impairment (e.g., sometimes confused with insulin doses)\n", "This case describes an Alzheimer's disease with insidious onset of short-term memory problems\n", "Support"], ["Clinically it can be distinguished from other options by the absence of behavioral problems (typical of frontotemporal dementia) and hallucinations (early in Lewy body disease)\n", "Frontotemporal dementia\n", "Attack"], ["Clinically it can be distinguished from other options by the absence of behavioral problems (typical of frontotemporal dementia) and hallucinations (early in Lewy body disease)\n", "Lewy body disease\n", "Attack"], ["There are no hallucinations or behavioral disorder.\n", "Clinically it can be distinguished from other options by the absence of behavioral problems (typical of frontotemporal dementia) and hallucinations (early in Lewy body disease)\n", "Support"], ["Vascular dementia is diagnosed by criteria that include deficits in memory and two other cognitive areas with consequent functional impairment, but cerebral vascular disease based on history, examination and/or neuroimaging tests, which are not indicated in the case\n", "Vascular dementia\n", "Attack"], ["Creutzfeldt-Jacob disease is mostly rapidly progressive and usually presents with other clinical, abnormal neurological examination and MRI alterations.\n", "Creutzfeldt-Jakob disease\n", "Attack"]]}
{"351_161": [["The clinical case presented is a woman of childbearing age (27 years) presenting dyspareunia + dysmenorrhea + infertility\n", "which should lead us to think of endometriosis\n", "Support"], ["but the diagnosis of certainty is given by direct observation (with or without associated biopsy) of ectopic endometrial tissue implants, either by laparotomy or laparoscopy\n", "The clinical history and ultrasound give a diagnosis of suspicion\n", "Attack"], ["The clinical history and ultrasound give a diagnosis of suspicion\n", "Transvaginal ultrasound\n", "Attack"], ["but the diagnosis of certainty is given by direct observation (with or without associated biopsy) of ectopic endometrial tissue implants, either by laparotomy or laparoscopy\n", "Diagnostic laparoscopy\n", "Support"]]}
{"69_124": [["which is seen in the heart rate\n", "The most likely cause is a digitalis intoxication, which would produce this slowing of conduction\n", "Support"], ["The most likely cause is a digitalis intoxication, which would produce this slowing of conduction\n", "Digitalis intoxication\n", "Support"], ["Probably secondary to renal failure due to ibuprofen toxicity (but this is a bit of a stretch)\n", "Ibuprofen toxicity\n", "Support"]]}
{"140_134": [["The correct answer is 3\n", "Because of the risk of aspiration pneumonitis\n", "Support"], ["The fact that there is intestinal aeration points to the existence of a fistula of the lower esophageal segment with the trachea or with a bronchus\n", "Because of the risk of aspiration pneumonitis\n", "Support"], ["Chest and abdominal X-ray showed an atresic esophageal pouch, with normal gastrointestinal pneumatization\n", "Because of the risk of aspiration pneumonitis\n", "Support"], ["In this case, pulmonary complications are frequent due to the passage of gastric contents into the airway\n", "Because of the risk of aspiration pneumonitis\n", "Support"], ["The fact that there is intestinal aeration points to the existence of a fistula of the lower esophageal segment with the trachea or with a bronchus\n", "In this case, pulmonary complications are frequent due to the passage of gastric contents into the airway\n", "Support"]]}
{"475_89": [["Lithemia is 4.1 mEq/L (toxicity > 1.6 mEq/L)\n", "We are dealing with a case of severe lithium intoxication (lithemia > 3.5 mEq/L is life threatening)\n", "Support"], ["therefore, the therapeutic option of choice is to start hemodialysis urgently\n", "Hemodialysis\n", "Support"], ["Remember that activated charcoal is NOT indicated in lithium intoxication\n", "Activated charcoal\n", "Attack"]]}
{"85_50": [["For all these reasons, the correct answer is 5\n", "Pericardial effusion with cardiac tamponade\n", "Support"], ["In cardiac tamponade, the deep sinus X is characteristic\n", "For all these reasons, the correct answer is 5\n", "Support"], ["In cardiac tamponade, inspiration, which causes an increase in blood flow to the right chambers, increasing their volume, secondarily causes a displacement of the interventricular septum to the left, so that the left heart lodges and expels less blood during systole and the pulse, therefore, decreases\n", "In a normal heart this exaggerated displacement, caused by the pressure exerted by the tamponade on the RV free wall, does not occur\n", "Support"], ["In a normal heart this exaggerated displacement, caused by the pressure exerted by the tamponade on the RV free wall, does not occur\n", "For all these reasons, the correct answer is 5\n", "Support"], ["Sinus X represents the systolic collapse of the venous pulse, i.e., the pressure drop due to atrial relaxation (also partly due to a downward displacement of the RV base during systole)\n", "For all these reasons, the correct answer is 5\n", "Support"], ["Paradoxical pulse is a drop in blood pressure > 10 mmHg during inspiration\n", "In cardiac tamponade, inspiration, which causes an increase in blood flow to the right chambers, increasing their volume, secondarily causes a displacement of the interventricular septum to the left, so that the left heart lodges and expels less blood during systole and the pulse, therefore, decreases\n", "Support"], ["it represents an exaggeration of the physiological phenomenon consisting of inspiratory lowering of BP (normal up to 10 mmHg)\n", "In cardiac tamponade, inspiration, which causes an increase in blood flow to the right chambers, increasing their volume, secondarily causes a displacement of the interventricular septum to the left, so that the left heart lodges and expels less blood during systole and the pulse, therefore, decreases\n", "Support"]]}
{"527_31": [["A patient's arterial blood gas result is: pH: 7.40, PaCO2 60 mmHg; bicarbonate 36 mM/L\n", "Blood gases can be misleading\n", "Support"], ["since a normal pH may suggest that there is no disturbance of acid-base balance\n", "Blood gases can be misleading\n", "Support"], ["instead it is masking a double disturbance in opposite directions as in this case\n", "Blood gases can be misleading\n", "Support"], ["PaCO2 60 mmHg\n", "The patient presents with respiratory acidosis\n", "Support"], ["normal to 50\n", "The patient presents with respiratory acidosis\n", "Support"], ["The patient presents with respiratory acidosis\n", "Respiratory acidosis and metabolic alkalosis\n", "Support"], ["bicarbonate 36 mmol/l\n", "compensatory metabolic alkalosis\n", "Support"], ["normal to 28\n", "compensatory metabolic alkalosis\n", "Support"], ["compensatory metabolic alkalosis\n", "Respiratory acidosis and metabolic alkalosis\n", "Attack"], ["This is the typical blood gas of the patient with COPD and compensated chronic respiratory failure\n", "Respiratory acidosis and metabolic alkalosis\n", "Support"]]}
{"407_81": [["Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter\n", "Factitious thyrotoxicosis\n", "Support"], ["Physical examination showed tachycardia, hyperreflexia and absence of goiter\n", "Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter\n", "Support"], ["TSH values are < 0.01 microU/mL, T4 is elevated and thyroglobulin levels are decreased\n", "Patients with this disorder voluntarily or accidentally ingest excessive amounts of thyroid hormone, resulting in hyperthyroidism in the absence of goiter\n", "Support"], ["TSH values are < 0.01 microU/mL, T4 is elevated and thyroglobulin levels are decreased\n", "In contrast to all other causes of hyperthyroidism, serum thyroglobulin is not elevated and is almost always low or at the lower limit of normal\n", "Support"], ["hyperthyroidism\n", "Factitious thyrotoxicosis\n", "Support"]]}
{"15_126": [["his wife is the representative decision maker regarding his medical care and that he does not want extraordinary measures to prolong his life including artificial nutrition\n", "Discharge home with palliative care from the health area\n", "Support"], ["We may appoint a representative to act as an interlocutor with the responsible physician or health care team to ensure that the instructions contained in the declaration are carried out\n", "Discharge home with palliative care from the health area\n", "Support"], ["We may appoint a representative to act as an interlocutor with the responsible physician or health care team to ensure that the instructions contained in the declaration are carried out\n", "It thus seems clear that the intended response is 5\n", "Support"], ["In our declaration of advance directives, we can refer to: 1. The expression of personal values, in order to help in the interpretation of the document itself and to guide physicians in making clinical decisions\n", "Discharge home with palliative care from the health area\n", "Support"], ["his wife is the representative decision maker regarding his medical care and that he does not want extraordinary measures to prolong his life including artificial nutrition\n", "It thus seems clear that the intended response is 5\n", "Support"], ["In our declaration of advance directives, we can refer to: 1. The expression of personal values, in order to help in the interpretation of the document itself and to guide physicians in making clinical decisions\n", "It thus seems clear that the intended response is 5\n", "Support"]]}
{"322_85": [["Triptorelin is a GnRH agonist, which by continuous action reduces FSH and LH, and is used in sex hormone-dependent cancers, as well as precocious puberty\n", "Monthly intramuscular administration of triptorelin\n", "Attack"], ["A 22-year-old boy with hyposmia presents lack of development of secondary sexual characteristics and infertility\n", "Triptorelin is a GnRH agonist, which by continuous action reduces FSH and LH, and is used in sex hormone-dependent cancers, as well as precocious puberty\n", "Attack"], ["Analytically, EST-I 1.2 U/L (vn 5-15); LH 0.6 U/L (vn 3-15); testosterone 100 ng/dL (vn 300-1200), prolactin normal\n", "Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pituitary tumors...\n", "Attack"], ["he has normal PRL\n", "Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pituitary tumors...\n", "Attack"], ["Analytically, EST-I 1.2 U/L (vn 5-15); LH 0.6 U/L (vn 3-15); testosterone 100 ng/dL (vn 300-1200), prolactin normal\n", "Triptorelin is a GnRH agonist, which by continuous action reduces FSH and LH, and is used in sex hormone-dependent cancers, as well as precocious puberty\n", "Attack"], ["Bromocriptine is a dopaminergic agonist used in hyperPRL (he has normal PRL), pituitary tumors...\n", "Treatment with bromocriptine\n", "Attack"], ["To induce testicular maturation, pulsatile GnRH with pump, hCG or FSH+hCG can be used\n", "GnRH infusion pump\n", "Support"], ["LH is not used as a treatment, it would be stimulated by intermittent GnRH\n", "Intramuscular administration of FSH and LH once a week\n", "Attack"]]}
[{"610_116": []}]
{"391_222": [["As a psychiatry resident, I wish the MIR questions in my specialty were a bit more thought-provoking and in-depth, although I know that the seconds you will have saved by marking the fourth one directly are very valuable\n", "Body dysmorphic disorder\n", "Support"], ["It describes a patient worried about a non-existent physical defect, whose concern distresses him and prevents him from leaving the house\n", "Body dysmorphic disorder\n", "Support"]]}
{"324_55": [["Mortality is not so low\n", "Mortality with medical treatment is 20%\n", "Attack"], ["hence the correct answer is 3\n", "In case of free wall rupture, there is no palpable fr\u00e9mito\n", "Support"], ["the oximetric jump occurs in the case of septum rupture, as well as fremitus\n", "In case of free wall rupture, there is no palpable fr\u00e9mito\n", "Support"], ["the oximetric jump occurs in the case of septum rupture, as well as fremitus\n", "In case of free wall rupture, there is an oxymetric jump in the right ventricle in the Swan-Ganz catheterization\n", "Attack"], ["complications can occur up to the first week\n", "Mechanical complications usually appear on the first post-infarction day\n", "Attack"]]}
{"240_150": [["it presents the case with the typical symptoms of dementia due to Lewy bodies, being the guiding symptom visual hallucinations\n", "The correct answer is 2\n", "Support"], ["The correct answer is 2\n", "Dementia due to Lewy bodies\n", "Support"], ["Progressive cognitive impairment, parkinsonian motor signs (inferred from clumsiness of movements) and hypersensitivity to neuroleptics even in small doses are also mentioned\n", "The correct answer is 2\n", "Support"]]}
{"68_123": [["If the ECG shows ischemic changes, we will obviously treat the patient in the emergency room and notify the cardiologist\n", "We will do an ECG in less than 10 minutes\n", "Support"], ["If not, you will be treated as if it were angina and observed, with serial enzymes and treatment in the observation area\n", "We will do an ECG in less than 10 minutes\n", "Support"]]}
{"206_125": [["The patient has a PSA >4 and a palpation with increased consistency\n", "the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer\n", "Support"], ["the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer\n", "Suggest to the patient the performance of a transrectal ultrasound and prostate biopsy\n", "Support"], ["the need for a transrectal ultrasound-guided biopsy to diagnose whether it is Benign Prostatic Hyperplasia or Prostate Cancer\n", "Suggest to the patient the performance of a transrectal ultrasound and prostate biopsy\n", "Support"]]}
{"570_153": [["Urine system: proteinuria 300 mg/dl, sediment 15 red blood cells per field\n", "The patient presents with thrombotic microangiopathy (TMA) with acute renal failure\n", "Support"], ["The patient presents with thrombotic microangiopathy (TMA) with acute renal failure\n", "This points to HUS, TTP, drug-induced TMA, or TMA mediated by complement, coagulation, or metabolism\n", "Support"], ["Normal ADAMTS-13 levels rule out TTP\n", "incorrect choice 1\n", "Support"], ["Normal ADAMTS-13 levels rule out TTP\n", "Thrombotic thrombocytopenic purpura\n", "Attack"], ["incorrect choice 1\n", "Thrombotic thrombocytopenic purpura\n", "Attack"], ["ADAMTS-13 levels are normal\n", "Normal ADAMTS-13 levels rule out TTP\n", "Support"], ["The absence of gastrointestinal symptoms rules out typical Shiga toxin HUS\n", "incorrect choice 4\n", "Support"], ["The absence of gastrointestinal symptoms rules out typical Shiga toxin HUS\n", "Typical hemolytic uremic syndrome\n", "Attack"], ["incorrect choice 4\n", "Typical hemolytic uremic syndrome\n", "Attack"], ["The history of respiratory infection (not specified, it could be pneumococcal pneumonia) together with the absence of DIC data (no mention of bleeding or altered coagulation tests) makes me think of atypical HUS\n", "Atypical hemolytic uremic syndrome\n", "Support"], ["option 2 correct\n", "Atypical hemolytic uremic syndrome\n", "Support"], ["The history of respiratory infection (not specified, it could be pneumococcal pneumonia) together with the absence of DIC data (no mention of bleeding or altered coagulation tests) makes me think of atypical HUS\n", "option 2 correct\n", "Support"], ["A 19-year-old male with no past history of interest comes to the emergency department because after a respiratory infection he presents with asthenia, malaise, oliguria and headache\n", "Pneumococcal infections can also cause HUS, although it is rare and more so in adults\n", "Support"], ["Pneumococcal infections can also cause HUS, although it is rare and more so in adults\n", "The absence of gastrointestinal symptoms rules out typical Shiga toxin HUS\n", "Support"], ["A 19-year-old male with no past history of interest comes to the emergency department because after a respiratory infection he presents with asthenia, malaise, oliguria and headache\n", "The history of respiratory infection (not specified, it could be pneumococcal pneumonia) together with the absence of DIC data (no mention of bleeding or altered coagulation tests) makes me think of atypical HUS\n", "Support"]]}
{"506_87": [["It never ceases to amaze us the strange ways of biology and that the axiom \"the longest is the right one\" is fulfilled in this case\n", "Beta-hemolytic streptococcus, group A\n", "Support"]]}
[{"619_121": []}]
{"161_118": [["The correct answer is: 4\n", "Antihypertensive\n", "Support"], ["The correct answer is: 4\n", "Antihypertensive\n", "Support"], ["In particular, hydrochlorothiazide, as a thiazide, is primarily responsible for this patient's hypokalemia\n", "Antihypertensive\n", "Support"], ["treated for 4 months with Omeprazole, Metformin, Salbutamol, Ipratropium Bromide and Enalapril 20 mg + Hydrochlorothiazide 25 mg\n", "In particular, hydrochlorothiazide, as a thiazide, is primarily responsible for this patient's hypokalemia\n", "Support"]]}
[{"269_141": []}]
{"18_138": [["Sometimes amyloid deposits appear on the tongue which can produce macroglossia\n", "Amyloidosis\n", "Support"], ["If a patient reports having for months now enlargement of the tongue, with no other alterations of the tongue causing constant biting\n", "Sometimes amyloid deposits appear on the tongue which can produce macroglossia\n", "Support"], ["Amyloidosis is a localized or systemic deposition of fibrillar proteins\n", "Amyloidosis\n", "Support"]]}
{"250_78": [["Middle-aged male with iron deficiency anemia and increased number of stools\n", "a colonoscopy should be done to rule out colorectal cancer!!!\n", "Support"], ["a colonoscopy should be done to rule out colorectal cancer!!!\n", "Colonoscopy\n", "Support"], ["If the HLA is negative it is very unlikely to be celiac disease (high negative predictive value)\n", "Determination of anti-transglutaminase IgA antibodies\n", "Attack"]]}
{"5_44": [["In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression\n", "The correct answer is 4\n", "Support"], ["This patient presents Barrett's esophagus with low grade dysplasia\n", "In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression\n", "Support"], ["not being with acid production inhibition the dysplasia may be conditioned by inflammation and not be real\n", "In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression\n", "Attack"], ["The correct answer is 4\n", "Periodic surveillance endoscopies and indefinite treatment with PPI.\n", "Support"], ["In any case, Barrett's esophagus should follow endoscopic surveillance and lifelong PPI treatment or antireflux surgery to prevent progression\n", "Periodic surveillance endoscopies and indefinite treatment with PPI.\n", "Support"]]}
{"359_91": [["Older woman with normocitic anemia and clear ferrokinetic pattern of chronic disorder (hyposideremia but hyperferritinemia)\n", "The only one that fits, and it fits perfectly, is number 3; they only needed to give us a high ESR\n", "Support"], ["The only one that fits, and it fits perfectly, is number 3; they only needed to give us a high ESR\n", "Polymyalgia rheumatica\n", "Support"], ["Polymyalgia rheumatica\n", "Polymyalgia rheumatica\n", "Support"], ["The determination in a 70-year-old woman of hematocrit 32%, Hb 9.6 g/dL, MCV 85 fL (70-99), Fe 25 ug/dL (37-145) and ferritin 350 ng/mL (15-150)\n", "1: if it is a recent loss, the MCV could remain normal, but the ferritin should be affected, and certainly not elevated\n", "Attack"], ["1: if it is a recent loss, the MCV could remain normal, but the ferritin should be affected, and certainly not elevated\n", "Recent blood loss through the digestive tract\n", "Attack"], ["2: the same. If it is due to Fe malabsorption, ferritin should be low\n", "Intestinal malabsorption\n", "Attack"], ["The determination in a 70-year-old woman of hematocrit 32%, Hb 9.6 g/dL, MCV 85 fL (70-99), Fe 25 ug/dL (37-145) and ferritin 350 ng/mL (15-150)\n", "2: the same. If it is due to Fe malabsorption, ferritin should be low\n", "Attack"], ["And if it were due to B12 malabsorption, the MCV would be clearly higher\n", "Intestinal malabsorption\n", "Attack"], ["The determination in a 70-year-old woman of hematocrit 32%, Hb 9.6 g/dL, MCV 85 fL (70-99), Fe 25 ug/dL (37-145) and ferritin 350 ng/mL (15-150)\n", "And if it were due to B12 malabsorption, the MCV would be clearly higher\n", "Attack"], ["4: 70 tachycardia and normal MCV. This one is too much\n", "Thalassemia minor\n", "Attack"], ["The determination in a 70-year-old woman of hematocrit 32%, Hb 9.6 g/dL, MCV 85 fL (70-99), Fe 25 ug/dL (37-145) and ferritin 350 ng/mL (15-150)\n", "4: 70 tachycardia and normal MCV. This one is too much\n", "Attack"]]}
{"108_219": [["It is the male who presents the disease, which we are told is X-linked, so there are only two options left: 2 and 3\n", "Their daughters will not inherit the disease, but all their future sons will be carriers and can transmit the mutation to 50%\n", "Support"], ["It is the male who presents the disease, which we are told is X-linked, so there are only two options left: 2 and 3\n", "Their sons will not inherit the disease, but all their future daughters will be carriers and can transmit the mutation to 50%\n", "Support"], ["2 is not because the males will receive the Y chromosome from the father and the X from the mother, who is healthy, so the daughters will be able to carry the disease (correct option 3)\n", "Their daughters will not inherit the disease, but all their future sons will be carriers and can transmit the mutation to 50%\n", "Attack"], ["2 is not because the males will receive the Y chromosome from the father and the X from the mother, who is healthy, so the daughters will be able to carry the disease (correct option 3)\n", "Their sons will not inherit the disease, but all their future daughters will be carriers and can transmit the mutation to 50%\n", "Support"]]}
{"255_94": [["We have yet to see jejunum and ileum\n", "we will have to perform a capsule endoscopy\n", "Support"], ["we will have to perform a capsule endoscopy\n", "Endoscopic capsule\n", "Support"], ["It is a study of iron deficiency anemia with normal gastroscopy and colonoscopy, having ruled out possible celiac disease\n", "We have yet to see jejunum and ileum\n", "Support"]]}
{"303_111": [["Amyloidosis presents with proteinuria usually in the nephrotic range, and has a more chronic course\n", "Renal amyloidosis\n", "Attack"], ["a patient with rheumatoid arthritis on methotrexate, prednisone and indomethacin who acutely presents with edema and increased plasma creatinine with poorly expressive urine sediment and proteinuria less than 100 mg/24 h\n", "Amyloidosis presents with proteinuria usually in the nephrotic range, and has a more chronic course\n", "Support"], ["GMN associated with rheumatoid arthritis characteristically alters the sediment\n", "Glomerulonephritis secondary to rheumatoid arthritis\n", "Attack"], ["a patient with rheumatoid arthritis on methotrexate, prednisone and indomethacin who acutely presents with edema and increased plasma creatinine with poorly expressive urine sediment and proteinuria less than 100 mg/24 h\n", "GMN associated with rheumatoid arthritis characteristically alters the sediment\n", "Support"], ["renal failure due to NSAIDs has a more chronic course, with papillary necrosis\n", "Renal failure due to nonsteroidal anti-inflammatory drugs\n", "Attack"], ["a patient with rheumatoid arthritis on methotrexate, prednisone and indomethacin who acutely presents with edema and increased plasma creatinine with poorly expressive urine sediment and proteinuria less than 100 mg/24 h\n", "renal failure due to NSAIDs has a more chronic course, with papillary necrosis\n", "Support"], ["Thus, given the course and the alterations described, interstitial nephritis due to methotrexate is more likely, which is more directly toxic than allergic, hence the absence of pyuria, eosinophilia, fever or other hypersensitivity data\n", "Interstitial nephritis due to methotrexate\n", "Support"], ["a patient with rheumatoid arthritis on methotrexate, prednisone and indomethacin who acutely presents with edema and increased plasma creatinine with poorly expressive urine sediment and proteinuria less than 100 mg/24 h\n", "Thus, given the course and the alterations described, interstitial nephritis due to methotrexate is more likely, which is more directly toxic than allergic, hence the absence of pyuria, eosinophilia, fever or other hypersensitivity data\n", "Support"]]}
[{"539_3": []}]
{"408_190": [["A 45-year-old woman diagnosed with stage IV breast cancer with multiple bone metastases on hormonal treatment and iv bisphosphonates\n", "if the patient has bone metastases and may suffer fractures we can control inflammatory pain with ibuprofen\n", "Support"], ["if the patient has bone metastases and may suffer fractures we can control inflammatory pain with ibuprofen\n", "The correct answer is 4\n", "Support"], ["it will also help us to use the antalgic synergy\n", "The correct answer is 4\n", "Support"], ["since she is at almost the maximum pain she can bear\n", "We should change the treatment to a major opioid and treat the disrruptive pain vigorously\n", "Support"], ["We should change the treatment to a major opioid and treat the disrruptive pain vigorously\n", "Suspend tramadol, maintain ibuprofen and initiate a major opioid such as morphine and oxycodone and at the same time treatment for breakthrough pain with sublingual fentanyl\n", "Support"], ["The correct answer is 4\n", "Suspend tramadol, maintain ibuprofen and initiate a major opioid such as morphine and oxycodone and at the same time treatment for breakthrough pain with sublingual fentanyl\n", "Support"]]}
{"29_60": [["especially considering that it is only 71 years old, but especially because the patient's \"quality of life\" is good (and I put \"quality of life\" because it is a term used erroneously, it is supposed to mean that he maintains a good functional level)\n", "2: Age should not be a limiting factor\n", "Support"], ["1 and 5: These are diagnostic tests, they are meaningless since you have already made the diagnosis\n", "Perform mediastinoscopy\n", "Attack"], ["1 and 5: These are diagnostic tests, they are meaningless since you have already made the diagnosis\n", "A trantoracic puncture should be performed\n", "Attack"], ["2: Age should not be a limiting factor\n", "Surgical intervention with curative intent should be contraindicated due to the advanced age of the patient.\n", "Attack"], ["3: Presents a very mild respiratory limitation, does not require such a test\n", "An oxygen consumption test should be performed, given the respiratory limitation he presents\n", "Attack"], ["4: Is the correct one\n", "Surgical resection (lobectomy of the lower lobe of the right lung) should be indicated directly\n", "Support"]]}
{"10_37": [["although both lesions are resectable\n", "I think the correct answer is 4\n", "Attack"], ["Surgical bypass has more complications than placing a self-expanding metallic prosthesis that has a median patency of 6 months which is similar to the median survival of a patient with hepatic metastases of pancreatic adenocarcinoma\n", "I think the correct answer is 4\n", "Support"], ["Surgical bypass has more complications than placing a self-expanding metallic prosthesis that has a median patency of 6 months which is similar to the median survival of a patient with hepatic metastases of pancreatic adenocarcinoma\n", "Metallic biliary prosthesis by endoscopic retrograde cholangiography, with the option of palliative chemotherapy\n", "Support"], ["Surgical bypass has more complications than placing a self-expanding metallic prosthesis that has a median patency of 6 months which is similar to the median survival of a patient with hepatic metastases of pancreatic adenocarcinoma\n", "Surgical biliary bypass, with or without prophylactic gastrojejunostomy depending on intraoperative findings\n", "Attack"], ["although both lesions are resectable\n", "Metallic biliary prosthesis by endoscopic retrograde cholangiography, with the option of palliative chemotherapy\n", "Attack"], ["I think the correct answer is 4\n", "Metallic biliary prosthesis by endoscopic retrograde cholangiography, with the option of palliative chemotherapy\n", "Support"], ["pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication\n", "I think the correct answer is 4\n", "Support"], ["it does not prolong survival and has a high morbidity\n", "pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication\n", "Support"], ["pancreatic adenocarcinoma with synchronous hepatic metastases has no surgical indication\n", "Metallic biliary prosthesis by endoscopic retrograde cholangiography, with the option of palliative chemotherapy\n", "Support"]]}
[{"284_57": []}]
{"188_230": [["The treatment for hypercholesterolemia is statins so we rule out answers 2 and 4\n", "Rule out hypothyroidism or other systemic disease, recommend a healthy lifestyle and treat with fibrates to normalize cholestero\n", "Attack"], ["The statin in a patient with cardiovascular disease (such as an AMI) is a lifelong treatment (we discard 1) since it is not taken until LDL levels are normalized.\n", "Treat with statins until cholesterol is normalized and recommend healthy lifestyle (diet, exercise and no smoking)\n", "Attack"], ["The treatment for hypercholesterolemia is statins so we rule out answers 2 and 4\n", "Rule out secondary dyslipidemia, treat with resins (resincholestyramine) and fibrates and re-commend a healthy lifestyle. Prohibit alcohol\n", "Attack"], ["Between 3 and 5, 5 is more complete as it includes treatment and control of other risk factors\n", "Rule out secondary dyslipidemia, request a family study and treat with statins to maintain a good lipid profile. Control of other risk factors\n", "Support"], ["A 57-year-old patient had an acute myocardial infarction and has a blood test with cholesterol 312 mg/dl, LDL 241 mg/dl, HDL 29 and normal TG\n", "Ruling out secondary dyslipidemia is easy with the patient's clinical history and a blood test with thyroid function\n", "Support"], ["He smoked 30 cig/day, was not obese, his blood pressure was 145/90 mm Hg and he did not have diabetes\n", "Ruling out secondary dyslipidemia is easy with the patient's clinical history and a blood test with thyroid function\n", "Support"], ["Ruling out secondary dyslipidemia is easy with the patient's clinical history and a blood test with thyroid function\n", "Rule out secondary dyslipidemia, request a family study and treat with statins to maintain a good lipid profile. Control of other risk factors\n", "Support"]]}
{"349_160": [["The correct answer is 2\n", "Colposcopy with possible biopsy\n", "Support"], ["Cervicovaginal cytology is compatible with a high-grade squamous intraepithelial lesion\n", "According to the 2014 SEGO Oncoguide on cervical cancer prevention, when a cytology shows a high-grade squamous intraepithelial lesion, the action to be taken is a colposcopy, with or without biopsy depending on the findings (regardless of the patient's age and parity)\n", "Support"], ["A 45-year-old woman, mother of 3 children, attends an early diagnosis consultation\n", "According to the 2014 SEGO Oncoguide on cervical cancer prevention, when a cytology shows a high-grade squamous intraepithelial lesion, the action to be taken is a colposcopy, with or without biopsy depending on the findings (regardless of the patient's age and parity)\n", "Support"]]}
{"290_50": [["A 58-year-old man referred a 3-week history of progressive, mildly painful skin lesions on his left arm\n", "The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n", "Support"], ["It had started as an erythematous lesion on his left thumb\n", "The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n", "Support"], ["The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n", "the first two would be ruled out\n", "Support"], ["the first two would be ruled out\n", "Dermatophytosis due to Microsporum gypseum\n", "Attack"], ["the first two would be ruled out\n", "Cutaneous infection by Staphylococcus aureus\n", "Attack"], ["He had been working in his garden but did not remember any injuries\n", "The history of having been working in the garden points more to a sporotrichosis\n", "Support"], ["although the fact that the question asks for the \"causative agent\" and not the name of the disease misleads a little\n", "The history of having been working in the garden points more to a sporotrichosis\n", "Attack"], ["The history of having been working in the garden points more to a sporotrichosis\n", "Sporotrichosis\n", "Support"], ["The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n", "Sporotrichosis\n", "Support"], ["The lesions with sporotrichoid or lymphocutaneous pattern described may correspond to sporotrichosis or aquarium granuloma\n", "Cutaneous infection by Mycobacterium marinum\n", "Attack"]]}
{"305_174": [["Therefore, the preferable thing to do in this patient, before increasing the medication, is to change the ibuprofen for paracetamol, which does not have this effect, and to re-evaluate it later\n", "I would change ibuprofen to paracetamol to avoid the possible influence of paracetamol on the effect of hypotensives\n", "Support"]]}
[{"104_91": []}]
{"38_232": [["A middle-aged woman with Sj\u00f6gren's-like symptoms (absence of lacrimation, dry mouth), with hyperbilirubinemia, jaundice and hepatomegaly, makes us think of primary biliary cirrhosis\n", "To diagnose it we will use antimitochondrial antibodies (AMA IgG)\n", "Support"], ["A middle-aged woman with Sj\u00f6gren's-like symptoms (absence of lacrimation, dry mouth), with hyperbilirubinemia, jaundice and hepatomegaly, makes us think of primary biliary cirrhosis\n", "Therefore, it would be answer 1\n", "Support"], ["To diagnose it we will use antimitochondrial antibodies (AMA IgG)\n", "Anti-mitochondrial antibodies\n", "Support"], ["Therefore, it would be answer 1\n", "Anti-mitochondrial antibodies\n", "Support"]]}
{"376_130": [["They refer to a partial seizure that is followed by loss of level of consciousness\n", "strictly speaking it would be a symptomatic complex partial seizure, not a secondarily generalized partial seizure (which occurs when tonic-clonic movements extend to the rest of the extremities)\n", "Support"], ["strictly speaking it would be a symptomatic complex partial seizure, not a secondarily generalized partial seizure (which occurs when tonic-clonic movements extend to the rest of the extremities)\n", "Partially symptomatic\n", "Support"], ["strictly speaking it would be a symptomatic complex partial seizure, not a secondarily generalized partial seizure (which occurs when tonic-clonic movements extend to the rest of the extremities)\n", "Partial secondarily generalized symptomatic\n", "Attack"], ["strictly speaking it would be a symptomatic complex partial seizure, not a secondarily generalized partial seizure (which occurs when tonic-clonic movements extend to the rest of the extremities)\n", "For this reason the most correct option would be two\n", "Support"], ["it does not specify that it is a simple symptomatic partial seizure, but leaves open the possibility that it is a simple or complex symptomatic partial seizure\n", "For this reason the most correct option would be two\n", "Support"], ["For this reason the most correct option would be two\n", "Partially symptomatic\n", "Support"]]}
{"163_122": [["The correct answer is: 3\n", "Subcutaneous fat biopsy\n", "Support"], ["The correct answer is: 3\n", "Subcutaneous fat biopsy\n", "Support"], ["The appearance of urinary abnormalities or renal impairment of parenchymal cause are indications for renal biopsy, even with proteinuria ranges lower than those accepted in primary nephropathies\n", "Subcutaneous fat biopsy\n", "Support"], ["He presents proteinuria of 6 grams per day with hypoalbuminemia and edema\n", "The appearance of urinary abnormalities or renal impairment of parenchymal cause are indications for renal biopsy, even with proteinuria ranges lower than those accepted in primary nephropathies\n", "Support"], ["In the urinary sediment no hematuria is detected\n", "In most cases, the relationship is established by an IgA nephropathy, which presents with hematuria, a symptom that claims not to exist in this case\n", "Support"], ["A non-negligible number of patients with evolved AD is amyloidosis, which also matches the patient's symptomatology\n", "Therefore, and given that amyloidosis can be diagnosed with a subcutaneous fat biopsy, it is answer 3 that should be considered valid\n", "Support"], ["Therefore, and given that amyloidosis can be diagnosed with a subcutaneous fat biopsy, it is answer 3 that should be considered valid\n", "Subcutaneous fat biopsy\n", "Support"]]}
{"148_158": [["A 23-year-old woman comes to the emergency department because she is very nervous after an argument with her partner\n", "The woman is 23 years old and is pissed off\n", "Support"], ["The diagnosis is 1\n", "Borderline personality disorder\n", "Support"], ["The issue is that she cannot stand rejection and has self-injurious gestures\n", "The diagnosis is 1\n", "Support"], ["3, 4 and 5 are not even close, there is no clinical picture described in the question\n", "Dysthymia\n", "Attack"], ["3, 4 and 5 are not even close, there is no clinical picture described in the question\n", "Dissociative disorder\n", "Attack"], ["3, 4 and 5 are not even close, there is no clinical picture described in the question\n", "Depersonalization disorder\n", "Attack"], ["Then in real life exploring well almost certainly there would be dissociative and depersonalization symptoms, as well as depressive symptoms... but symptom is not disorder\n", "Dissociative disorder\n", "Attack"], ["Then in real life exploring well almost certainly there would be dissociative and depersonalization symptoms, as well as depressive symptoms... but symptom is not disorder\n", "Depersonalization disorder\n", "Attack"], ["Then in real life exploring well almost certainly there would be dissociative and depersonalization symptoms, as well as depressive symptoms... but symptom is not disorder\n", "Dysthymia\n", "Attack"], ["A 23-year-old woman comes to the emergency department because she is very nervous after an argument with her partner\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Her medical history shows several similar complaints in the previous year, two of them after a self-injurious gesture\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["She says she feels misunderstood by everyone, including the psychiatrists attending her\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Borderline personality disorder\n", "Support"], ["Frantic efforts to avoid real or imagined abandonment\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Identity disturbance: marked and persistently unstable self-image or sense of self\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Impulsivity in at least two areas, which is potentially self-harming (e.g., spending, sex, substance abuse, reckless driving, binge eating)\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Recurrent suicidal behaviors, attempts or threats, or self-mutilating behavior\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Affective instability due to marked mood reactivity (e.g., episodes of intense dysphoria, irritability, or anxiety, usually lasting a few hours and rarely a few days)\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Chronic feelings of emptiness\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Inappropriate and intense anger or difficulties in controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Transient stress-related paranoid ideation or severe dissociative symptoms.\n", "The limit: A general pattern of instability in interpersonal relationships, self-image and self-efficacy, and notable impulsivity, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Not comfortable in situations where he/she is not the center of attention\n", "The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Interaction with others is often characterized by sexually seductive or provocative behavior\n", "The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Displays a superficial and rapidly changing emotional expression\n", "The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Attack"], ["Constantly uses physical appearance to draw attention to him/herself\n", "The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Has a way of speaking that is excessively subjective and lacking in nuance\n", "The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Shows self-dramatization, theatricality and exaggerated emotional expression\n", "The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["Is suggestible, e.g., easily influenced by others or by circumstances\n", "The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"], ["considers his relationships more intimate than they really are\n", "The histrionic: A general pattern of excessive emotionality and attention-seeking, beginning in early adulthood and occurring in a variety of contexts, as indicated by five (or more) of the following items\n", "Support"]]}
{"178_94": [["18-month-old boy, with complete vaccination schedule to date, who consults the Emergency Department for swelling of the right knee after playing in the park, without obvious trauma\n", "a small child who suffers a hemarthrosis without clear trauma\n", "Support"], ["The ultrasound examination is compatible with hemarthrosis\n", "a small child who suffers a hemarthrosis without clear trauma\n", "Support"], ["In the directed anamnesis, the mother refers that an uncle of hers had similar problems\n", "An uncle of his had similar problems, so we suspect hereditary disease\n", "Support"], ["in the analysis performed only an APTT lengthening of 52\u2033 (normal 25-35\u2033) stands out\n", "The APTT, which evaluates the intrinsic coagulation pathway (involving factors V, VIII, IX, X, XI and XII) is elongated\n", "Support"], ["Hereditary coagulation problem\n", "We thus discard answers 1, 2 and 5\n", "Support"], ["Hereditary coagulation problem\n", "Marfan syndrome\n", "Attack"], ["Hereditary coagulation problem\n", "Bemard-Soulier disease\n", "Attack"], ["I consider that the correct answer is 4, hemophilia A, since the inheritance pattern is X-linked and its main clinical manifestation is soft tissue bruising and spontaneous hemarthrosis, without apparent trauma, while von Willebrand disease is characterized by bleeding after surgery or trauma and a prolonged bleeding time with a normal platelet count is characteristic (data not mentioned in the statement)\n", "Hemophilia A\n", "Support"], ["I consider that the correct answer is 4, hemophilia A, since the inheritance pattern is X-linked and its main clinical manifestation is soft tissue bruising and spontaneous hemarthrosis, without apparent trauma, while von Willebrand disease is characterized by bleeding after surgery or trauma and a prolonged bleeding time with a normal platelet count is characteristic (data not mentioned in the statement)\n", "Von Willebrand's disease\n", "Attack"], ["We thus discard answers 1, 2 and 5\n", "Ehlers-Danlos disease\n", "Attack"]]}
{"100_85": [["Treatment is with thyroxine\n", "Treat with L-Tyroxine and determine antithyroid antibodies\n", "Support"], ["If there is no nodule, neither echo nor FNA is indicated\n", "Perform a thyroid ultrasound before starting treatment\n", "Attack"], ["If there is no nodule, neither echo nor FNA is indicated\n", "Perform thyroid cytology prior to treatment\n", "Attack"], ["If there is no nodule, neither echo nor FNA is indicated\n", "Determine free T3 and perform a pituitary MRI\n", "Attack"]]}
{"398_140": [["Although the diagnosis is clearly osteoarthritis, it does not lead directly to a surgical indication\n", "I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis\n", "Attack"], ["The first step is to try conservative treatment\n", "I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis\n", "Attack"], ["we ruled out the first option\n", "I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis\n", "Attack"], ["The first step is to try conservative treatment\n", "we ruled out the first option\n", "Support"], ["Osteoarthritis is a degenerative process that opioids certainly do not stop\n", "we rule out option two\n", "Support"], ["Osteoarthritis is a degenerative process that opioids certainly do not stop\n", "Start treatment with weak opioids that have shown evidence in stopping the progression of the disease\n", "Attack"], ["we rule out option two\n", "Start treatment with weak opioids that have shown evidence in stopping the progression of the disease\n", "Attack"], ["Option four can also be quickly discarded\n", "Because of the radiological features described, I need a hip MRI before making a therapeutic decision\n", "Attack"], ["We are talking about a 66-year-old patient with pain on some days, pain of an occasional nature\n", "the statement makes the diagnosis and treatment to follow clear: in this case the MRI will not provide us with any information of interest\n", "Support"], ["the statement makes the diagnosis and treatment to follow clear: in this case the MRI will not provide us with any information of interest\n", "Option four can also be quickly discarded\n", "Support"], ["the statement makes the diagnosis and treatment to follow clear: in this case the MRI will not provide us with any information of interest\n", "Because of the radiological features described, I need a hip MRI before making a therapeutic decision\n", "Attack"]]}
[{"28_58": []}]
[{"587_76": []}]
{"554_50": [["Patient with obesity, hypertension and increased HbA1C\n", "In recent studies, Empaglifozin, a highly selective inhibitor of SGLT210, significantly reduces AT, HbA1C and BMI\n", "Support"], ["In recent studies, Empaglifozin, a highly selective inhibitor of SGLT210, significantly reduces AT, HbA1C and BMI\n", "Empaglifozin\n", "Support"], ["Glipizide is of the sulfonylurea group\n", "Its use should be avoided in patients with heart disease\n", "Support"], ["Its use should be avoided in patients with heart disease\n", "Glipizide\n", "Attack"], ["Sitagliptin has been shown to decrease HbA1C but not HT or BMI\n", "Sitagliptin\n", "Attack"], ["His medication includes lisinopril, metoprolol, metformin, ASA and atorvastatin\n", "Acarbose can interact with beta-blockers, such as those taken by our patient\n", "Support"], ["Acarbose can interact with beta-blockers, such as those taken by our patient\n", "Acarbose\n", "Attack"]]}
{"251_81": [["Patient with harmful alcohol consumption (60g and female), high fever, hepatic encephalopathy (disorientation, asterixis), very high direct bilirubin, jaundice, painful hepatomegaly, coagulopathy (elevated prothrombin time) and mild elevation of transaminases (less than 5 times the upper limit of normal)\n", "suggest acute alcohol hepatitis\n", "Support"], ["suggest acute alcohol hepatitis\n", "Alcoholic hepatitis\n", "Support"]]}
{"128_79": [["Both the initially occipital location, the 2-year evolution time, and the sensation of weight lead to answer 4, a tension headache\n", "Tension\n", "Support"], ["The pain is like a weight that starts in the occipital area, spreads to both temporal regions and is barely relieved by taking 650 mg paracetamol tablets, so she requests a CT scan (she is convinced that \"something must be wrong with her head\")\n", "Tension\n", "Support"], ["Although she has been having similar episodes for more than a year, in the last 2 months they have worsened considerably\n", "Tension\n", "Support"], ["Migraine and vascular disorders, accompanied by other neurological symptoms or nausea, photophobia, etc., are quickly ruled out, as well as the rare temporal arteritis before the age of 50 years\n", "Temporal artery arteritis\n", "Attack"], ["Migraine and vascular disorders, accompanied by other neurological symptoms or nausea, photophobia, etc., are quickly ruled out, as well as the rare temporal arteritis before the age of 50 years\n", "Migraine\n", "Attack"], ["Migraine and vascular disorders, accompanied by other neurological symptoms or nausea, photophobia, etc., are quickly ruled out, as well as the rare temporal arteritis before the age of 50 years\n", "Vascular disorders\n", "Attack"], ["Tumor headache is usually \"in crescendo\", not recurrent as the case suggests, and is accompanied by other neurological symptoms or intracranial hypertension\n", "Oncologi\n", "Attack"], ["Although she has been having similar episodes for more than a year, in the last 2 months they have worsened considerably\n", "Oncologi\n", "Attack"], ["A 42-year-old married woman\n", "Temporal artery arteritis\n", "Attack"]]}
{"0_34": [["The rest of the symptoms fall perfectly within the picture\n", "In this question, they give an important piece of information when it comes to suspecting a diagnosis, which is the antitransglutaminase antibodies\n", "Support"], ["A 27-year-old woman under study in the dermatology department for recurrent episodes of oral aphthous ulcers\n", "The rest of the symptoms fall perfectly within the picture\n", "Support"], ["a blood test showing Hb 11.5 gr/dl Fe 38 AST 52 ALT 64 Ac antitrasglutaminase IgA 177\n", "The rest of the symptoms fall perfectly within the picture\n", "Support"], ["The patient reported only occasional diffuse abdominal discomfort\n", "The rest of the symptoms fall perfectly within the picture\n", "Support"], ["She reports no signs of hemorrhage or jaundice\n", "The rest of the symptoms fall perfectly within the picture\n", "Support"], ["The physical examination is normal\n", "The rest of the symptoms fall perfectly within the picture\n", "Support"], ["In this question, they give an important piece of information when it comes to suspecting a diagnosis, which is the antitransglutaminase antibodies\n", "that must lead you to suspect celiac disease\n", "Support"], ["that must lead you to suspect celiac disease\n", "the answer that will give us the diagnosis is 4 (intestinal biopsy)\n", "Support"], ["the answer that will give us the diagnosis is 4 (intestinal biopsy)\n", "Intestinal biopsy\n", "Support"], ["although probably several of the tests that it says will be done\n", "the answer that will give us the diagnosis is 4 (intestinal biopsy)\n", "Attack"]]}
{"256_162": [["The characteristics of the fluid described are milky\n", "chylous ascitic fluid\n", "Support"], ["chylous ascitic fluid\n", "Chylous ascites due to non-Hodgkin's lymphoma\n", "Support"], ["Taking into account the age of the patient and the constitutional syndrome described\n", "it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid\n", "Support"], ["it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid\n", "Chylous ascites due to non-Hodgkin's lymphoma\n", "Support"], ["there is no mention of infectious symptoms\n", "it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid\n", "Support"], ["The rest of the entities offered do not present with chylous ascitic fluid\n", "Hydropic decompensation secondary to liver cirrhosis\n", "Attack"], ["The rest of the entities offered do not present with chylous ascitic fluid\n", "Peritoneal metastasis of adenocarcinoma\n", "Attack"], ["it is most likely to be a non-Hodgkin's lymphoma and not tuberculosis, which also presents with chylous ascitic fluid\n", "Peritoneal tuberculosis\n", "Attack"], ["The rest of the entities offered do not present with chylous ascitic fluid\n", "Ascites secondary to constrictive pericarditis\n", "Attack"]]}
{"604_113": [["Conservative treatment with a success rate of 75%-90%\n", "Conservative treatment with nonsteroidal anti-inflammatory drugs, local heat and relative rest\n", "Support"]]}
[{"362_96": []}]
{"410_195": [["the patient is in a situation of psychotic depression and is not able to decide for his life and it does not seem that the patient has filled in the last will and testament\n", "The correct answer is 1\n", "Support"], ["the patient is in a situation of psychotic depression and is not able to decide for his life and it does not seem that the patient has filled in the last will and testament\n", "the most convenient thing to do is to present the case to the ethics committee of the center to make a decision on the matter in accordance with the law\n", "Support"], ["The correct answer is 1\n", "Ask the hospital ethics committee to help determine the decision that is in the best interest of the patient\n", "Support"], ["the most convenient thing to do is to present the case to the ethics committee of the center to make a decision on the matter in accordance with the law\n", "Ask the hospital ethics committee to help determine the decision that is in the best interest of the patient\n", "Support"]]}
{"361_94": [["This is a young patient with no comorbidities\n", "is therefore a candidate for treatment with curative intent\n", "Support"], ["is therefore a candidate for treatment with curative intent\n", "option 4 is ruled out\n", "Support"], ["option 4 is ruled out\n", "Treatment in this case would be transfusion only\n", "Attack"], ["we cannot know the patient's IPSS\n", "Option 3 is also incorrect\n", "Support"], ["we do not know the number of blasts and the number of leukocytes and platelets to calculate the risk\n", "we cannot know the patient's IPSS\n", "Support"], ["Option 3 is also incorrect\n", "This is a patient with a high International Prognostic Index (IPSS)\n", "Attack"], ["the indication for a bone marrow transplant in MDS is those patients with high or intermediate-2 IPSS\n", "Option 2 is also incorrect\n", "Support"], ["Option 2 is also incorrect\n", "It would be advisable in this patient to perform HLA typing in order to organize an allogeneic transplant\n", "Attack"], ["in this case we do not know the risk, the only thing we know about the risk is the cytogenetics which is of good prognosis that would give us 0 points\n", "Option 2 is also incorrect\n", "Support"], ["Therefore the correct one is 1\n", "This deletion (5q-) is an alteration of good prognosis and has a specific treatment (lenalidomide)\n", "Support"], ["it is true that it has a favorable cytogenetics (5q-) and has a specific treatment lenalidomide, also used in other pathologies such as multiple myeloma\n", "Therefore the correct one is 1\n", "Support"]]}
{"172_50": [["A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter\n", "Blood gas analysis shows an acute respiratory acidosis, due to an increase in PCO2 of short evolution time because the kidney has not yet had time to retain bicarbonates (bicarbonate level at the high limit of normality)\n", "Support"], ["Blood gas analysis shows an acute respiratory acidosis, due to an increase in PCO2 of short evolution time because the kidney has not yet had time to retain bicarbonates (bicarbonate level at the high limit of normality)\n", "The patient is in respiratory acidosis\n", "Support"], ["The patient is not hyperventilating but hypoventilating because PCO2 is elevated\n", "The patient is hyperventilating\n", "Attack"], ["A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter\n", "The patient is not hyperventilating but hypoventilating because PCO2 is elevated\n", "Support"], ["A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter\n", "The alveolar arterial oxygen gradient is altered since the patient has a normal PaO2, but because he has a high FiO2\n", "Support"], ["The alveolar arterial oxygen gradient is altered since the patient has a normal PaO2, but because he has a high FiO2\n", "The alveolar arterial oxygen gradient is elevated\n", "Support"], ["Blood gas analysis shows an acute respiratory acidosis, due to an increase in PCO2 of short evolution time because the kidney has not yet had time to retain bicarbonates (bicarbonate level at the high limit of normality)\n", "Bicarbonate level is normal\n", "Support"], ["Respiratory acidosis below 7.20 is a reason to consider noninvasive mechanical ventilation acutely and in principle temporarily in a patient with severe COPD\n", "Initiation of mechanical ventilation should be considered\n", "Support"], ["A patient with severe COPD comes to the ED with an acute onset and presents an arterial blood gas drawn with Fi02 of 31% at sea level with a Pa02 of 86 mm Hg, PaC02 65 mm Hg, pH 7.13 and Bicarbonate 27 mmol/liter\n", "Respiratory acidosis below 7.20 is a reason to consider noninvasive mechanical ventilation acutely and in principle temporarily in a patient with severe COPD\n", "Support"]]}
{"83_48": [["Coronary revascularization does not appear to be of much benefit in this patient at this time\n", "Surgical coronary revascularization\n", "Attack"], ["We are talking about a patient with heart failure with severe LV dysfunction (EF < 35%), LBBB (wide QRS), who is following optimal medical treatment and who remains in advanced functional class despite this\n", "Coronary revascularization does not appear to be of much benefit in this patient at this time\n", "Support"], ["firstly because mitral regurgitation is most likely the result of mitral annular dilatation\n", "Nor does mitral valve replacement\n", "Support"], ["secondly because we would need an echocardiographic assessment of the mitral valve to determine whether there is any alteration\n", "Nor does mitral valve replacement\n", "Support"], ["Nor does mitral valve replacement\n", "Mitral valve replacement\n", "Attack"], ["it is used in situations of cardiogenic shock, in post-AMI mechanical complications, as a bridge to cardiac Tx\n", "Intra-aortic balloon counterpulsation implantation would not be indicated in this patient\n", "Support"], ["Intra-aortic balloon counterpulsation implantation would not be indicated in this patient\n", "Implantation of an aortic balloon pump\n", "Attack"], ["The ventricular assist device would also not be indicated in this patient\n", "Implantation of a ventricular assist device\n", "Attack"], ["What would really benefit him of all the answers is number 5, the resynchronization device\n", "Implantation of a cardiac resynchronization system\n", "Support"], ["By achieving simultaneous stimulation of both ventricles, a mechanical synergy is achieved that improves cardiac function\n", "What would really benefit him of all the answers is number 5, the resynchronization device\n", "Support"], ["The indications for the application of CRT (cardiac resynchronization therapy) are precisely those mentioned at the beginning: severe ventricular dysfunction, asynchrony demonstrated by the presence of wide QRS in the ECG (usually due to LBBB) and advanced functional class (III-IV) despite optimal medical treatment\n", "What would really benefit him of all the answers is number 5, the resynchronization device\n", "Support"]]}
{"141_135": [["The correct answer is 1\n", "Wiskott-Aldrich syndrome\n", "Support"], ["Wiskott-Aldrich syndrome associates immunodeficiency, thrombopenia and atopic dermatitis with the immunological study described in the statement\n", "Wiskott-Aldrich syndrome\n", "Support"], ["She has been admitted on 3 occasions for thrombopenic purpura (on three occasions antiplatelet antibodies were negative and bone marrow showed normal megakaryocytes)\n", "Wiskott-Aldrich syndrome\n", "Support"], ["The examination showed typical lesions of atopic dermatitis\n", "Wiskott-Aldrich syndrome\n", "Support"], ["The immunological study showed a slight decrease in T lymphocyte subpopulations; elevated IgA and IgE; decreased IgM and IgG at the lower limit of normal.\n", "Wiskott-Aldrich syndrome\n", "Support"]]}
{"317_139": [["A 70-year-old woman with a history of anorexia, weight loss, muscle and proximal joint discomfort and pain in the temporomandibular region comes to the emergency department for unilateral vision loss (hand movement), sudden and painless onset (afferent pupillary defect)\n", "It is possibly a temporal arteritis, the clinical picture and a CBC with increased reactants are enough to confirm the suspicion\n", "Support"], ["It is possibly a temporal arteritis, the clinical picture and a CBC with increased reactants are enough to confirm the suspicion\n", "C Reactive Protein\n", "Support"]]}
[{"550_129": []}]
{"110_152": [["The correct answer is 5\n", "Vulvar squamous cell carcinoma\n", "Support"], ["Vulvar carcinoma is characterized by chronic vulvar itching resistant to multiple treatments, appearance of lumpiness or ulceration, dysuria and urinary urgency, and late pain and bleeding\n", "Vulvar squamous cell carcinoma\n", "Support"], ["she reports occasional dysuria and her general condition is good\n", "Vulvar squamous cell carcinoma\n", "Support"], ["She reports that for at least 4-5 years she has had vulvar pruritus of variable intensity which has been treated sometimes with self-medication and other times on the advice of her general practitioner with topical preparations (creams and washes)\n", "Vulvar squamous cell carcinoma\n", "Support"], ["The pruritus has evolved intermittently, but for the last 3-4 months she has also noticed a small lump on the left labium majus of the vulva, which has been leaking serohaematically on rubbing for a few days; she therefore consulted a gynecologist.\n", "Vulvar squamous cell carcinoma\n", "Support"]]}
{"419_77": [["A case of acute diverticulitis complicated with small mesenteric abscess (< 2-3 cm) is presented\n", "In this question we are presented with a clinical picture whose manifestations are compatible with acute diverticulitis\n", "Support"], ["the intra-abdominal approach can spread the contents into the abdominal cavity\n", "Abscesses should be drained by CT-guided percutaneous puncture\n", "Support"], ["However, in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed case, they can be managed by conservative treatment with intravenous antiobiotic therapy and absolute diet\n", "Abscesses should be drained by CT-guided percutaneous puncture\n", "Attack"], ["However, in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed case, they can be managed by conservative treatment with intravenous antiobiotic therapy and absolute diet\n", "Admission to the ward with absolute diet and broad-spectrum antibiotic treatment\n", "Support"], ["A case of acute diverticulitis complicated with small mesenteric abscess (< 2-3 cm) is presented\n", "However, in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed case, they can be managed by conservative treatment with intravenous antiobiotic therapy and absolute diet\n", "Support"], ["The urgent surgical approach should be reserved for cases that present peritonitis (grade III, IV) by resection of the affected segment and primary anastomosis in stable patients or carry out the Hartamn intervention that includes resection with terminal colostomy and closure of the distal rectal stump performing anastomosis in a second surgical time\n", "Urgent surgery with sigmoidectomy and colorectal anastomosis\n", "Attack"], ["The urgent surgical approach should be reserved for cases that present peritonitis (grade III, IV) by resection of the affected segment and primary anastomosis in stable patients or carry out the Hartamn intervention that includes resection with terminal colostomy and closure of the distal rectal stump performing anastomosis in a second surgical time\n", "Drainage by laparoscopic surgery\n", "Attack"], ["The urgent surgical approach should be reserved for cases that present peritonitis (grade III, IV) by resection of the affected segment and primary anastomosis in stable patients or carry out the Hartamn intervention that includes resection with terminal colostomy and closure of the distal rectal stump performing anastomosis in a second surgical time\n", "Discharge colostomy\n", "Attack"], ["therefore the correct option is 1\n", "Admission to the ward with absolute diet and broad-spectrum antibiotic treatment\n", "Support"], ["However, in small abscesses with Hinchey grade I divertciulitis, in patients without great deterioration of the general condition as in the proposed case, they can be managed by conservative treatment with intravenous antiobiotic therapy and absolute diet\n", "therefore the correct option is 1\n", "Support"]]}
{"37_227": [["Age and sex also point to this possibility\n", "The clinical presentation is strongly suggestive of giant cell arteritis (GCA)\n", "Support"], ["febrile fever, shoulder girdle and pelvic pain, and headache\n", "The clinical presentation is strongly suggestive of giant cell arteritis (GCA)\n", "Support"], ["The ESR is elevated\n", "Abrupt unilateral visual loss with pale papillary edema is highly indicative of arteritic ischemic optic neuropathy due to GCA\n", "Support"], ["Abrupt unilateral visual loss with pale papillary edema is highly indicative of arteritic ischemic optic neuropathy due to GCA\n", "We have to quickly start corticosteroid treatment.\n", "Support"], ["The clinical presentation is strongly suggestive of giant cell arteritis (GCA)\n", "We have to quickly start corticosteroid treatment.\n", "Support"], ["they do not contribute anything\n", "We can already rule out 1 and 5\n", "Support"], ["We can already rule out 1 and 5\n", "Request a Doppler ultrasound of temporal arteries\n", "Attack"], ["We can already rule out 1 and 5\n", "Request a brain magnetic resonance imaging\n", "Attack"], ["if we rule out 3 because the dose is too low, we would have to stay with 2.\n", "Start treatment with prednisone 10 mg per day\n", "Attack"], ["if we rule out 3 because the dose is too low, we would have to stay with 2.\n", "Start treatment with prednisone 60mg per day and aspirin 100 mg per day\n", "Support"], ["4 could make us doubt, and it is true that we will have to ask for a temporal artery biopsy, but that is not immediate: the statement makes it very clear that we have to act immediately\n", "Request a temporal artery biopsy\n", "Attack"], ["With reservations, since aspirin has a rather dubious role\n", "if we rule out 3 because the dose is too low, we would have to stay with 2.\n", "Attack"], ["The current trend is to use megadoses of intravenous corticosteroids\n", "if we rule out 3 because the dose is too low, we would have to stay with 2.\n", "Support"], ["The ESR is elevated\n", "which further clarifies the diagnosis\n", "Support"], ["which further clarifies the diagnosis\n", "Abrupt unilateral visual loss with pale papillary edema is highly indicative of arteritic ischemic optic neuropathy due to GCA\n", "Support"], ["although aspirin has traditionally been proposed to reduce ischemic events, the evidence currently indicates that antiplatelet agents do not contribute much\n", "if we rule out 3 because the dose is too low, we would have to stay with 2.\n", "Support"], ["corticosteroid dose remains ambiguous (we do not know how much the patient weighs)\n", "if we rule out 3 because the dose is too low, we would have to stay with 2.\n", "Attack"]]}
[{"532_67": []}]
{"272_69": [["A 60-year-old man with extensive ulcerative colitis of 15 years of evolution and in clinical remission for the last 3 years, comes to our office to be informed about the risk of colorectal cancer and about the possibility of participating in prevention programs\n", "Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer, whether or not they are smokers\n", "Support"], ["Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer, whether or not they are smokers\n", "It is recommended to start screening 8-10 years after diagnosis of IBD (or earlier if primary sclerosing cholangitis or other events occur during this interval)\n", "Support"], ["It is recommended to start screening 8-10 years after diagnosis of IBD (or earlier if primary sclerosing cholangitis or other events occur during this interval)\n", "The recommended techniques are colonoscopy with random biopsies (answer 3) and pancolonic chromoendoscopy with staining, which is currently the gold standard\n", "Support"], ["it detects dysplasia better, although it requires more technical experience\n", "The recommended techniques are colonoscopy with random biopsies (answer 3) and pancolonic chromoendoscopy with staining, which is currently the gold standard\n", "Support"], ["The recommended techniques are colonoscopy with random biopsies (answer 3) and pancolonic chromoendoscopy with staining, which is currently the gold standard\n", "In cases such as yours, it is considered appropriate to undergo periodic colonoscopies with multiple biopsies staggered along the entire colon\n", "Support"], ["Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer, whether or not they are smokers\n", "Ulcerative colitis is only associated with an increased risk of colorectal cancer in smokers\n", "Attack"]]}
{"428_61": [["These appear due to the presence in the urine of a high concentration of bacteria possessing the enzyme nitrate reductase, which is capable of reducing the nitrates present in the urine to nitrites\n", "This enzyme is active in most of the bacteria that most frequently cause urinary tract infection, such as many Gram-negative bacilli\n", "Support"], ["This enzyme is active in most of the bacteria that most frequently cause urinary tract infection, such as many Gram-negative bacilli\n", "Other microorganisms, relatively frequent causes of urinary tract infection, do not possess this enzyme and do not reduce nitrates, such as enterococci, staphylococci and yeasts\n", "Support"], ["Other microorganisms, relatively frequent causes of urinary tract infection, do not possess this enzyme and do not reduce nitrates, such as enterococci, staphylococci and yeasts\n", "As the Gram stain indicates that the bacteria are grouped in chains, as this is typical of enterococcus, we suggest the need to cover this group of bacteria with antibiotic treatment\n", "Support"], ["As the Gram stain indicates that the bacteria are grouped in chains, as this is typical of enterococcus, we suggest the need to cover this group of bacteria with antibiotic treatment\n", "Switch to a broad-spectrum antimicrobial treatment that covers Enterococcus spp\n", "Support"]]}
{"393_224": [["A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n", "History of multiple physical symptoms, which begins before age 30, persists for several years, and compels seeking medical attention or causes significant impairment socially, occupationally, or in other important areas of the individual's activity\n", "Support"], ["A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n", "Four painful symptoms: history of pain related to at least four areas of the body or four functions (e.g., head, abdomen, back, joints, extremities, chest, rectum; during menstruation, sexual intercourse, or urination)\n", "Support"], ["A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n", "Two gastrointestinal symptoms: history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting [not during pregnancy], diarrhea, or intolerance to different foods)\n", "Support"], ["A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n", "A sexual symptom: history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual leakage, vomiting during pregnancy)\n", "Support"], ["Everything fits with what is described in the statement\n", "Somatization disorder\n", "Support"], ["According to ICD-10 the criteria for diagnosing Somatization Disorder (F45.0)\n", "Somatization disorder\n", "Support"], ["Conversive or dissociative disorder is ruled out\n", "Conversive disorder\n", "Attack"], ["Conversive or dissociative disorder is ruled out\n", "Dissociative disorder\n", "Attack"], ["these are usually related to psychological factors, associated with the symptom or deficit (not deliberate)\n", "Conversive or dissociative disorder is ruled out\n", "Support"], ["The onset or exacerbation of the condition is preceded by conflicts or other triggers, which is not mentioned in the statement\n", "Conversive or dissociative disorder is ruled out\n", "Support"], ["A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n", "The onset or exacerbation of the condition is preceded by conflicts or other triggers, which is not mentioned in the statement\n", "Support"], ["Neither would it be a hypochondriacal disorder\n", "Hypochondriac disorder\n", "Attack"], ["this implies a preoccupation and fear of having, or the conviction of having, a serious illness based on the personal interpretation of somatic symptoms\n", "Neither would it be a hypochondriacal disorder\n", "Support"], ["But it does not involve physical signs or symptoms\n", "Neither would it be a hypochondriacal disorder\n", "Support"], ["A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n", "this implies a preoccupation and fear of having, or the conviction of having, a serious illness based on the personal interpretation of somatic symptoms\n", "Attack"], ["A patient presents with a long history of multiple physical symptoms: memory loss, headache, dizziness, vomiting, genital pain, limb pain, abdominal distention, and menstrual irregularities\n", "But it does not involve physical signs or symptoms\n", "Attack"]]}
{"124_46": [["Specifically, angiotensin II receptor blockers have demonstrated their efficacy in this field for type 2 DM, which together with the side effects that IECAS produce in the patient makes an ARAII the drug of choice\n", "Angiotensin receptor blocker\n", "Support"], ["She presents with intolerance to ACE inhibitors due to coughing\n", "Specifically, angiotensin II receptor blockers have demonstrated their efficacy in this field for type 2 DM, which together with the side effects that IECAS produce in the patient makes an ARAII the drug of choice\n", "Support"]]}
{"405_31": [["but thanks to Ram\u00f3n, when we read it more carefully, we found that it had neuroectodermal and embryonal elements in several of the histological preparations\n", "so we consider that the correct answer is 2\n", "Support"], ["so we consider that the correct answer is 2\n", "Immature teratoma\n", "Support"]]}
{"497_127": [["Typical smoker's pancoast, probably an epidermoid, with Horner's sdr\n", "Best would be chemoradio followed by surgical salvage\n", "Support"], ["Best would be chemoradio followed by surgical salvage\n", "Neoadjuvant chemotherapy with combined chemoradiotherapy, followed by surgery\n", "Support"]]}
{"307_207": [["Versions are bilateral conjugated movements of both eyes\n", "That is, a version is composed of the sum of two ductions, since duction is the movement of only one eye\n", "Support"], ["That is, a version is composed of the sum of two ductions, since duction is the movement of only one eye\n", "When you explore the versions, specifically the superior version or supraversion, both eyes rotate upward\n", "Support"], ["When you explore the versions, specifically the superior version or supraversion, both eyes rotate upward\n", "At that time, you may encounter a limitation of the movement of one eye\n", "Support"], ["In this case, when you scan the supraversion, you suspect or you detect a limitation in the movement of the left eye\n", "And we would call this a limitation to the supraversion of that eye\n", "Support"], ["What is important is that the eye that has received the blow does not go up\n", "therefore there is double vision in the superior gaze\n", "Support"], ["thinking that because the superior rectus is trapped, it does not work and therefore the eye cannot go up\n", "It might be tempting to answer 3\n", "Support"], ["However, muscles trapped in a fracture do not automatically lose their muscular action\n", "It might be tempting to answer 3\n", "Attack"], ["It might be tempting to answer 3\n", "Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n", "Support"], ["However, muscles trapped in a fracture do not automatically lose their muscular action\n", "Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n", "Attack"], ["What is important is that the eye that has received the blow does not go up\n", "It might be tempting to answer 3\n", "Support"], ["However, muscles trapped in a fracture do not automatically lose their muscular action\n", "What happens is that they become trapped, they are \"hooked\", and cannot stretch\n", "Support"], ["What happens is that they become trapped, they are \"hooked\", and cannot stretch\n", "The problem is that the inferior wall has been broken, the inferior rectus has been trapped, and when the eye must look up, this inferior rectus cannot stretch as it should\n", "Support"], ["The problem is that the inferior wall has been broken, the inferior rectus has been trapped, and when the eye must look up, this inferior rectus cannot stretch as it should\n", "It is not paralysis, but a restrictive problem\n", "Support"], ["The problem is that the inferior wall has been broken, the inferior rectus has been trapped, and when the eye must look up, this inferior rectus cannot stretch as it should\n", "Fracture of the inferior wall of the floor of the orbit with trapping of the inferior rectus muscle\n", "Support"], ["they are too far away from the extraocular muscles to produce diplopia\n", "Options 2 and 4 can be ignored\n", "Support"], ["Options 2 and 4 can be ignored\n", "Zygomatic arch fracture\n", "Attack"], ["Options 2 and 4 can be ignored\n", "Dentoalveolar fracture\n", "Attack"], ["And as for the walls of the orbit, the ones that break most frequently are the inferior and medial wall\n", "Fracture of the inferior wall of the floor of the orbit with trapping of the inferior rectus muscle\n", "Support"], ["The superior wall ruptures very rarely\n", "Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n", "Attack"]]}
[{"589_63": []}]
{"350_160": [["Colposcopy with possible biopsy\n", "Colposcopy with possible biopsy\n", "Support"], ["The cytologic diagnosis must be confirmed by biopsy, for which it is necessary to perform a directed biopsy by colposcopy\n", "Colposcopy with possible biopsy\n", "Support"], ["The cytologic diagnosis must be confirmed by biopsy, for which it is necessary to perform a directed biopsy by colposcopy\n", "Colposcopy with possible biopsy\n", "Support"], ["H-SIL (High-grade squamous intraepithelial lesion)\n", "Colposcopy with possible biopsy\n", "Support"], ["H-SIL (High-grade squamous intraepithelial lesion)\n", "includes changes suggestive of CIN2 and CIN3/CIS\n", "Support"]]}
{"25_116": [["Coraliform lithiasis are associated with urea-folding germs: Proteus in the first place, Pseudomonas, Klebsiella and some staphylococci\n", "Proteus mirabilis\n", "Support"], ["an abdominal ultrasound shows a coralliform lithiasis\n", "Proteus mirabilis\n", "Support"]]}
[{"103_89": []}]
{"22_112": [["In splenectomized patients, the risk of acquiring serious infections by encapsulated germs is increased\n", "Pneumococcus being the most frequent.\n", "Support"], ["She underwent a splenectomy 2 years ago for staging of Hosgkin's disease\n", "Pneumococcus being the most frequent.\n", "Support"], ["She underwent a splenectomy 2 years ago for staging of Hosgkin's disease\n", "Streptococcus pneumoniae\n", "Support"], ["Pneumococcus being the most frequent.\n", "Streptococcus pneumoniae\n", "Support"]]}
{"488_105": [["No clinical data are given\n", "so we assume that the patient is asymptomatic\n", "Support"], ["We are told of a leukocytosis at the expense of lymphocytes with a B-CLL phenotype\n", "It seems that there are no other alarming data\n", "Support"], ["It seems that there are no other alarming data\n", "Conclusion: FOLLOW UP\n", "Support"], ["so we assume that the patient is asymptomatic\n", "Conclusion: FOLLOW UP\n", "Support"], ["No cytopenias...\n", "Conclusion: FOLLOW UP\n", "Support"], ["Conclusion: FOLLOW UP\n", "New clinical and analytical control in 6 months\n", "Support"], ["But this is going too far\n", "Why do I consider it incorrect?\n", "Support"], ["Because the TP53 mutation, although it establishes prognosis, is not indicated at diagnosis, but when treatment is going to be initiated (first line and prior to successive lines in case they are needed)\n", "It would be possible to go too far in this question in which the percentage given does not refer directly to clonal lymphocytes\n", "Support"], ["It would be possible to go too far in this question in which the percentage given does not refer directly to clonal lymphocytes\n", "so that it could even be a monoclonal B lymphocytosis\n", "Support"], ["so that it could even be a monoclonal B lymphocytosis\n", "But this is going too far\n", "Support"], ["Why do I consider it incorrect?\n", "Study of TP53 mutations to establish prognosis\n", "Attack"]]}
{"111_153": [["The correct answer is 2\n", "Intraductal papilloma\n", "Support"], ["In the presence of unilateral and uniorificial hematic telorrhea, the most frequent cause is intraductal papilloma (50%), followed by ductal ectasia and carcinoma\n", "Intraductal papilloma\n", "Support"], ["A 59-year-old woman consults a gynecologist for a spontaneous, spontaneous, uniorificial discharge from the right nipple (unilateral\n", "Intraductal papilloma\n", "Support"], ["In hyperprolactinemia, telorrhea is bilateral and pluriorificial\n", "Tumor hyperprolactinemia\n", "Attack"], ["A 59-year-old woman consults a gynecologist for a spontaneous, spontaneous, uniorificial discharge from the right nipple (unilateral\n", "Tumor hyperprolactinemia\n", "Attack"], ["Paget's disease is of the eczematous type\n", "Paget's disease of the nipple\n", "Attack"], ["Mammography often does not show papillomas, being more useful ultrasound and galactography.\n", "Mammography will indicate the diagnosis\n", "Attack"], ["Mammography often does not show papillomas, being more useful ultrasound and galactography.\n", "Intraductal papilloma\n", "Support"], ["without palpable nodularity\n", "When associated with palpable mass, 60% correspond to carcinoma\n", "Attack"]]}
{"119_119": [["Laboratory tests showed slight leukocytosis with lymphocytosis and presence of activated lymphocytes, slight thrombopenia and slightly increased transaminases\n", "Of course it is a typical picture (EBV, CMV, VH6, Toxoplasma)\n", "Support"], ["Be careful with the bad blood in answer 3, because an acute toxoplasmosis can behave like this and also give a macular exanthema, although the one of this girl is related to the intake of amoxicillin\n", "Acute toxoplasmosis\n", "Attack"], ["She had previously been diagnosed with acute pharyngitis and was treated with amoxicillin, and later presented with a generalized macular skin rash\n", "Be careful with the bad blood in answer 3, because an acute toxoplasmosis can behave like this and also give a macular exanthema, although the one of this girl is related to the intake of amoxicillin\n", "Support"], ["if instead of a girl of 17 years so clear it were a young man/girl with risky sexual relations\n", "do not forget the HIV primoinfection as a cause of mononucleosis syndrome\n", "Support"]]}
{"562_183": [["In this question what they assume is that this is a 45-year-old woman who is diagnosed with pulmonary thromboembolism (PTE)\n", "With this diagnosis, options 3 and 4 are directly excluded\n", "Support"], ["With this diagnosis, options 3 and 4 are directly excluded\n", "Hemophilia\n", "Attack"], ["With this diagnosis, options 3 and 4 are directly excluded\n", "Acute pericarditis\n", "Attack"], ["also, she is female\n", "so we would not have to think about hemophilia\n", "Support"], ["so we would not have to think about hemophilia\n", "Hemophilia\n", "Attack"], ["As an analytical data, it says that there is a lengthening of the aPTT\n", "So, they want you to know, she has positive lupus ac and link it directly to antiphospholipid syndrome (APS)\n", "Support"], ["So, they want you to know, she has positive lupus ac and link it directly to antiphospholipid syndrome (APS)\n", "Antiphospholipid syndrome\n", "Support"], ["A Leiden's does not alter coagulation, so it is ruled out as well\n", "Factor V of Leiden\n", "Attack"], ["Prothrombin time 90%, activated partial thromboplastin time (APTT) ratio of 2 to control (N <1.2)\n", "A Leiden's does not alter coagulation, so it is ruled out as well\n", "Support"], ["Assuming that a PTE + lupus is a PFS seems to me to be a bit of a stretch, but it is the most likely with the data provided\n", "Antiphospholipid syndrome\n", "Support"]]}
{"514_97": [["In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate words (verbal response 3 out of 5) and localizes pain with right extremities (motor response 5 out of 6)\n", "ocular response 3 out of 4\n", "Support"], ["In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate words (verbal response 3 out of 5) and localizes pain with right extremities (motor response 5 out of 6)\n", "verbal response 3 out of 5\n", "Support"], ["In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate words (verbal response 3 out of 5) and localizes pain with right extremities (motor response 5 out of 6)\n", "motor response 5 out of 6\n", "Support"], ["In this case, we have a patient who has an ocular opening to the call (ocular response 3 out of 4), emits inappropriate words (verbal response 3 out of 5) and localizes pain with right extremities (motor response 5 out of 6)\n", "The Glasgow Coma Scale score would be 11 (out of 15)\n", "Support"], ["ocular response 3 out of 4\n", "The Glasgow Coma Scale score would be 11 (out of 15)\n", "Support"], ["verbal response 3 out of 5\n", "The Glasgow Coma Scale score would be 11 (out of 15)\n", "Support"], ["motor response 5 out of 6\n", "The Glasgow Coma Scale score would be 11 (out of 15)\n", "Support"], ["The Glasgow Coma Scale score would be 11 (out of 15)\n", "E3V3M5\n", "Support"], ["ocular response 3 out of 4\n", "E3V3M5\n", "Support"], ["verbal response 3 out of 5\n", "E3V3M5\n", "Support"], ["motor response 5 out of 6\n", "E3V3M5\n", "Support"], ["For example: in a polytraumatized patient (such as the one in question), the response presented with left extremities may be due to localized trauma in that area, and not strictly speaking to an underlying traumatic brain injury\n", "The best value of the examination is taken because in many cases (assessment of a polytraumatized patient, ischemic stroke or spontaneous acute cerebral bleeding), the motor examination may be artifacted by other elements\n", "Support"], ["Likewise, sometimes the verbal response may be underestimated in the polytraumatized patient due to airway obstruction (e.g., due to the tongue retreating into the oropharynx)\n", "The best value of the examination is taken because in many cases (assessment of a polytraumatized patient, ischemic stroke or spontaneous acute cerebral bleeding), the motor examination may be artifacted by other elements\n", "Support"], ["The best value of the examination is taken because in many cases (assessment of a polytraumatized patient, ischemic stroke or spontaneous acute cerebral bleeding), the motor examination may be artifacted by other elements\n", "By always assessing the best response, we will have a truer picture of the patient's condition\n", "Support"]]}
{"101_86": [["Permanent post-surgical hypoparathyroidism after parathyroidectomy of an adenoma with minimally invasive surgery is rare\n", "Permanent surgical hypoparathyroidism\n", "Attack"], ["This syndrome can be observed after surgery in patients with primary hyperparathyroidism (HPT), as well as in tertiary HPT of chronic renal failure, and to a lesser extent after treatment of processes with excess of circulating thyroid hormones (2)\n", "Hungry bone syndrome\n", "Support"], ["In PTH, there is an excess of parathyroid hormone (PTH) which stimulates osteoclastic activity causing demineralization of the bone matrix and releasing calcium into the bloodstream\n", "Hungry bone syndrome\n", "Support"], ["After parathyroidectomy, serum PTH levels drop dramatically, thus, PTH-induced bone resorption ceases, while osteoblastic activity continues resulting in increased bone uptake of calcium, phosphate and magnesium, thus SHH appears\n", "Hungry bone syndrome\n", "Support"], ["Laboratory tests reveal hypercalcemia, increased PTH and increased bone turnover markers\n", "Hungry bone syndrome\n", "Support"], ["The radiographic study shows subperiosteal resorption and osteoporosis\n", "Hungry bone syndrome\n", "Support"], ["Postoperatively, the patient developed severe hypocalcemia and tetany, with PTH below 5 ng/l\n", "Hungry bone syndrome\n", "Support"]]}
{"230_179": [["We are facing a case of Anaphylaxis\n", "the first measure is to administer Adrenaline 1/1000 intramuscular (0.01mg/kg)\n", "Support"], ["the first measure is to administer Adrenaline 1/1000 intramuscular (0.01mg/kg)\n", "Intramuscular adrenaline 1/1000\n", "Support"], ["So adrenaline first, as it is faster acting, then the rest\n", "Intramuscular adrenaline 1/1000\n", "Support"]]}
{"479_164": [["Since there are no criteria that contraindicate admission to the ICU, admission to the unit would be indicated\n", "Admission to the Intensive Care Unit\n", "Support"], ["Applying the CURB-65 severity scale (one of the most commonly used in the ED for stratifying the severity of pneumonia, although in this case simply applying common sense, the patient should be admitted to the ICU), we would have a score of at least 4 points (we would be missing the serum urea data), which gives us severity criteria\n", "Admission to the Intensive Care Unit\n", "Support"], ["although in this case simply applying common sense, the patient should be admitted to the ICU\n", "Admission to the Intensive Care Unit\n", "Support"]]}
{"515_101": [["There are two answers that we can immediately rule out if we stick to the initial management of severe chest trauma: 1 (noninvasive ventilation is not indicated because it does not secure the airway) and 3 (observation in these cases, waiting for worsening, only leads to increased morbidity and mortality)\n", "Institute noninvasive mechanical ventilation and request blood transfusion\n", "Attack"], ["There are two answers that we can immediately rule out if we stick to the initial management of severe chest trauma: 1 (noninvasive ventilation is not indicated because it does not secure the airway) and 3 (observation in these cases, waiting for worsening, only leads to increased morbidity and mortality)\n", "Orotracheal intubation, request blood transfusion and observation for, in case of worsening, indicate surgical intervention\n", "Attack"], ["tachycardia, hypoxemia, tachypnea... although we do not receive data, for example, on lactacidemia\n", "With the data provided by the question, a patient who seems to be in shock (tachycardia, hypoxemia, tachypnea... although we do not receive data, for example, on lactacidemia), and in whom we have to our knowledge a left thoracic trauma, which not only implies bone injury, but may mask other injuries of high severity and which are not diagnosed with a chest X-ray: myocardial contusion, pericardial effusion, splenic injury, diaphragmatic injury...\n", "Support"], ["We place a left pleural drain on the patient and obtain a debit of 1700cc of hematic fluid\n", "If we follow the ATLS (ATLS-Advanced Trauma Life Support 10th edition) guidelines for the care of severely polytraumatized patients, they tell us that an immediate bleeding of more than 1500cc of blood is an indication for urgent thoracotomy\n", "Support"], ["If we follow the ATLS (ATLS-Advanced Trauma Life Support 10th edition) guidelines for the care of severely polytraumatized patients, they tell us that an immediate bleeding of more than 1500cc of blood is an indication for urgent thoracotomy\n", "Therefore, the person who asked the MIR question wants us to answer option 2\n", "Support"], ["even in patients with a bleeding of less than 1500cc, if the debit persists at a rate of 200mL/h for 2 to 4h, this indication would also exist\n", "Therefore, the person who asked the MIR question wants us to answer option 2\n", "Support"], ["Therefore, the person who asked the MIR question wants us to answer option 2\n", "Analgesia, oxygen therapy, request blood transfusion and indicate urgent surgery\n", "Support"], ["However, in real life, the course of action will depend on the stability of the patient when we have applied the treatments indicated in option 2: adequate analgesia, oxygen therapy and initiation of blood transfusion\n", "Analgesia, oxygen therapy, request blood transfusion and indicate urgent surgery\n", "Support"], ["However, in real life, the course of action will depend on the stability of the patient when we have applied the treatments indicated in option 2: adequate analgesia, oxygen therapy and initiation of blood transfusion\n", "If by optimizing the patient we manage to stabilize him and assess that it is safe to transfer him, the performance of a body CT scan will define in much greater detail the lesions he has, and will help to ensure that the surgery he will probably end up undergoing will be a definitive surgery and not just damage control surgery\n", "Support"], ["If by optimizing the patient we manage to stabilize him and assess that it is safe to transfer him, the performance of a body CT scan will define in much greater detail the lesions he has, and will help to ensure that the surgery he will probably end up undergoing will be a definitive surgery and not just damage control surgery\n", "In this case, the doubt would arise with option 4\n", "Support"], ["although, as I say, everything will depend on the clinical stability of the patient and the time we have before achieving definitive control of the hemorrhagic focus (which is, after all, what we are after in this situation)\n", "In this case, the doubt would arise with option 4\n", "Attack"], ["If by optimizing the patient we manage to stabilize him and assess that it is safe to transfer him, the performance of a body CT scan will define in much greater detail the lesions he has, and will help to ensure that the surgery he will probably end up undergoing will be a definitive surgery and not just damage control surgery\n", "Orotracheal intubation and urgent CT scan for accurate assessment of lesions\n", "Support"], ["In this case, the doubt would arise with option 4\n", "Orotracheal intubation and urgent CT scan for accurate assessment of lesions\n", "Support"], ["although, as I say, everything will depend on the clinical stability of the patient and the time we have before achieving definitive control of the hemorrhagic focus (which is, after all, what we are after in this situation)\n", "Orotracheal intubation and urgent CT scan for accurate assessment of lesions\n", "Attack"]]}
{"234_105": [["Then, for extension, prognostic value and to decide treatments, the rest, but once diagnosed\n", "For diagnosis, a sample (bone marrow) and electrophoresis to determine the type of monoclonal peak\n", "Support"], ["She is going to have myeloma\n", "For diagnosis, a sample (bone marrow) and electrophoresis to determine the type of monoclonal peak\n", "Support"], ["For diagnosis, a sample (bone marrow) and electrophoresis to determine the type of monoclonal peak\n", "Bone marrow aspirate and serum and urine electrophoresis\n", "Support"]]}
{"174_52": [["In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n", "Inhaled tiotropium\n", "Support"], ["On examination he is eupneic, normocolored, with an oxygen saturation of 94%, and has generalized decreased vesicular murmur on chest auscultation as the only findings of interest\n", "In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n", "Support"], ["A 67-year-old man consults for moderate exertional dyspnea of progressive onset in recent years\n", "In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n", "Support"], ["He has daily whitish expectoration and sometimes breath sounds, especially in winter with respiratory infections\n", "In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n", "Support"], ["Chest X-ray shows an elongated cardiac silhouette, with signs of hyperinflation or pulmonary air trapping, without other alterations\n", "In a patient with a low symptomatic COPD that could probably be classified as GOLD 2, the starting treatment can be either with inhaled tiotropium or with a long-acting beta two\n", "Support"]]}
{"143_141": [["The correct answer is 3\n", "Tuberculous meningitis\n", "Support"], ["It defines a typical cerebrospinal fluid of tuberculosis\n", "Tuberculous meningitis\n", "Support"], ["Given a 7-month-old child with fever and irritability, bulging fontanel and a cerebrospinal fluid study with 110 cells/mm3 (75% lymphocytes), protein 120 mg/dl and glucose 28 mg/dl (serum glycemia 89 mg/dl)\n", "Tuberculous meningitis\n", "Support"]]}
{"9_36": [["I think the correct answer is 2\n", "Biliary drainage by percutaneous cholecystostomy.\n", "Support"], ["although the treatment for acute cholecystitis is cholecystectomy\n", "I think the correct answer is 2\n", "Support"], ["for this it is necessary that the patient is a surgical candidate, in this case it is an elderly patient, with previous diseases that increase the surgical risk and would be an ASA IV for an urgent intervention\n", "I think the correct answer is 2\n", "Support"], ["In these cases cholecystostomy can cure cholecystitis\n", "I think the correct answer is 2\n", "Support"]]}
{"601_112": [["The pain appears when the lower limb is lifted with the knee extended, but is relieved when the knee is flexed\n", "Positive Lasegue's sign, reappearance of the symptoms when performing the extension maneuver of the affected limb, compatible with involvement of nerve roots at the lumbosacral spine level\n", "Support"], ["Positive Lasegue's sign, reappearance of the symptoms when performing the extension maneuver of the affected limb, compatible with involvement of nerve roots at the lumbosacral spine level\n", "Radiated low back pain / lumbosciatica\n", "Support"]]}
{"202_44": [["Although the latest recommendations on the management of severe acute pancreatitis advise against FNA because of the risk of infection of sterile necrosis\n", "Fine needle aspiration of pancreatic necrosis guided by ultrasound or CT\n", "Attack"]]}
{"259_97": [["This is the first thing we do when diagnosed with type 2 diabetes\n", "Behavioral changes: diet and physical exercise\n", "Support"], ["This is a good question to remember that before any drug, we must insist on changing habits\n", "Behavioral changes: diet and physical exercise\n", "Support"], ["Behavioral changes: diet and physical exercise\n", "Behavioral changes. Diet and physical exercise\n", "Support"]]}
{"204_220": [["More than 2 lobar pneumonias make it necessary to rule out an immunologic deficit\n", "Serum immunoglobulin count and antibody production capacity test\n", "Support"]]}
{"4_40": [["By the form of presentation, it is clearly an acute hepatitis\n", "option 1 is ruled out\n", "Support"], ["option 1 is ruled out\n", "Chronic hepatitis B\n", "Attack"], ["By the form of presentation, it is clearly an acute hepatitis\n", "Chronic hepatitis B\n", "Attack"], ["to have delta virus you need surface antigen B\n", "the negative HBs Ag rules out 4\n", "Support"], ["the negative HBs Ag rules out 4\n", "D (delta) virus superinfection\n", "Attack"], ["The negative IgM of HAV rules out 5\n", "Acute hepatitis A and B\n", "Attack"], ["When having IgM anti HBc we speak of an acute hepatitis B (3)\n", "Acute hepatitis B\n", "Support"], ["there is a window period of negativization of the antigen\n", "When having IgM anti HBc we speak of an acute hepatitis B (3)\n", "Support"]]}
{"372_127": [["The fact that it is not accessible to endoscopic vision does not mean that it is not there\n", "The most frequent cause of recurrent nerve palsy is bronchopulmonary carcinoma\n", "Support"], ["The most frequent cause of recurrent nerve palsy is bronchopulmonary carcinoma\n", "Pulmonary neoplasia\n", "Support"]]}
{"377_131": [["it is described as an apraxic phenomenon followed by an asymmetric rigid-akinetic parkinsonism and with superimposed myoclonias\n", "it is typical of corticobasal degeneration\n", "Support"], ["it is typical of corticobasal degeneration\n", "Corticobasal degeneration\n", "Support"], ["it is described as an apraxic phenomenon followed by an asymmetric rigid-akinetic parkinsonism and with superimposed myoclonias\n", "they do not present apraxia as initial feature\n", "Attack"], ["they do not present apraxia as initial feature\n", "Parkinson's disease cannot be\n", "Support"], ["Parkinson's disease cannot be\n", "Parkinson's disease\n", "Attack"], ["it is described as an apraxic phenomenon followed by an asymmetric rigid-akinetic parkinsonism and with superimposed myoclonias\n", "Alzheimer's disease does not present an asymmetric parkinsonism\n", "Attack"], ["Alzheimer's disease does not present an asymmetric parkinsonism\n", "Alzheimer's disease\n", "Attack"], ["A 65-year-old female patient debuted two years earlier with an apraxia of speech and has developed rigid-akinetic parkinsonism predominantly in the right hemibody with superimposed myoclonias and alien hand or foreign limb phenomenon\n", "typical Huntinton's disease is not of so old people and when it debuts with advanced age it behaves like a chorea\n", "Attack"], ["typical Huntinton's disease is not of so old people and when it debuts with advanced age it behaves like a chorea\n", "Huntington's disease\n", "Attack"]]}
{"145_143": [["The correct answer is 4\n", "It is considered normal intestinal rhythm\n", "Support"], ["The normal range of stool output in young infants is very wide\n", "The correct answer is 4\n", "Support"], ["To suspect aganglionic megacolon there is usually a delay in the evacuation of meconium and often other associated symptoms such as abdominal distension, difficulty in gaining weight, et\n", "Refer to Pediatric Digestive to rule out aganglionic megacolon\n", "Attack"], ["A 1 month old infant, exclusively breastfed, consults because he has a bowel movement every 5 or 6 days with straining but with a soft consistency\n", "It is considered normal intestinal rhythm\n", "Support"]]}
{"567_150": [["A week later, she consulted again for general malaise, arthralgias and the appearance of a skin rash\n", "General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n", "Support"], ["In the sediment leukocytes are identified, being negative for nitrites\n", "General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n", "Support"], ["General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n", "option 4 correct\n", "Support"], ["General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n", "Acute interstitial nephritis\n", "Support"], ["option 4 correct\n", "Acute interstitial nephritis\n", "Support"], ["Among drugs, antibiotics are the most frequent cause, and ciprofloxacin is one of the most common\n", "General malaise, arthralgias, skin rash, acute renal failure and active sediment with sterile leukocyturia following the intake of a drug is highly suggestive of AIN\n", "Support"], ["She is diagnosed with uncomplicated urinary tract infection and treated with ciprofloxacin for 5 days\n", "Among drugs, antibiotics are the most frequent cause, and ciprofloxacin is one of the most common\n", "Support"], ["Direct nephrotoxicity is very rare and is characterized by crystallization in the renal tubules\n", "Ciprofloxacin nephrotoxicity\n", "Attack"], ["incorrect option 2\n", "Ciprofloxacin nephrotoxicity\n", "Attack"], ["Direct nephrotoxicity is very rare and is characterized by crystallization in the renal tubules\n", "incorrect option 2\n", "Support"], ["A 47-year-old woman consults for voiding syndrome\n", "Postinfectious glomerulonephritis is more typical of children and adults older than 60 years, and usually manifests with hematuria after streptococcal infections\n", "Attack"], ["Postinfectious glomerulonephritis is more typical of children and adults older than 60 years, and usually manifests with hematuria after streptococcal infections\n", "option 1 incorrect\n", "Support"], ["option 1 incorrect\n", "Postinfectious glomerulonephritis\n", "Attack"], ["Postinfectious glomerulonephritis is more typical of children and adults older than 60 years, and usually manifests with hematuria after streptococcal infections\n", "Postinfectious glomerulonephritis\n", "Attack"], ["Acute pyelonephritis would have been presented with high fever and renal fossa pain\n", "option 3 incorrect\n", "Support"], ["Acute pyelonephritis would have been presented with high fever and renal fossa pain\n", "Acute pyelonephritis\n", "Attack"], ["option 3 incorrect\n", "Acute pyelonephritis\n", "Attack"]]}
{"177_93": [["You have probably looked at answer 5, hereditary spherocytosis, associated with biliary lithiasis at an early age\n", "Hereditary spherocytosis\n", "Support"], ["The patient refers to a family history of biliary lithiasis at an early age\n", "You have probably looked at answer 5, hereditary spherocytosis, associated with biliary lithiasis at an early age\n", "Support"], ["Physical examination reveals conjunctival jaundice and splenomegaly\n", "In the statement they have not stopped giving clues: conjunctival jaundice, splenomegaly and family history of biliary lithiasis at an early age\n", "Support"], ["The patient refers to a family history of biliary lithiasis at an early age\n", "In the statement they have not stopped giving clues: conjunctival jaundice, splenomegaly and family history of biliary lithiasis at an early age\n", "Support"], ["In the statement they have not stopped giving clues: conjunctival jaundice, splenomegaly and family history of biliary lithiasis at an early age\n", "Hereditary spherocytosis\n", "Support"], ["There was no mention of microcytosis or macrocytosis to suggest thalassemia minor or B12 and/or folic acid deficiency\n", "Thalassemia minor\n", "Attack"], ["There was no mention of microcytosis or macrocytosis to suggest thalassemia minor or B12 and/or folic acid deficiency\n", "Vitamin Bl2 and/or folic acid deficiency\n", "Attack"]]}
{"125_105": [["The available literature is somewhat controversial (some guidelines advise using glucose saline\n", "Hypertonic saline (3%), 500 ml + 500 ml of 5% glucose\n", "Support"], ["others absolutely forbid it\n", "Hypertonic saline (3%), 500 ml + 500 ml of 5% glucose\n", "Attack"], ["Serum sodium levels 155 mmol/L\n", "This girl presents with hypernatremia due to extrarenal free water losses\n", "Support"], ["There are only two answers that come close to this figure, but 2 seems more correct, as it is the only one that completely covers the water deficit and uses a hyposodium solution\n", "Hyposaline saline (0.45%), 3000 ml\n", "Support"]]}
{"510_151": [["An urgent ultrasound shows a normal liver, vesicular cholesterosis and absence of bile duct dilatation, with no other alterations of interest\n", "The absence of bile duct dilatation in cholangiocarcinomas can be seen in cases of intrahepatic cholangiocarcinomas or in those with mixed histology with hepatocarcinoma\n", "Support"], ["He does not report abdominal pain, weight loss or other symptoms, except generalized pruritus\n", "It is true that the acute course and the absence of constitutional syndrome may make us think against this option and tip the balance towards ibuprofen hepatitis\n", "Attack"], ["It is true that the acute course and the absence of constitutional syndrome may make us think against this option and tip the balance towards ibuprofen hepatitis\n", "The absence of bile duct dilatation in cholangiocarcinomas can be seen in cases of intrahepatic cholangiocarcinomas or in those with mixed histology with hepatocarcinoma\n", "Attack"], ["It is true that the acute course and the absence of constitutional syndrome may make us think against this option and tip the balance towards ibuprofen hepatitis\n", "Toxic hepatitis due to ibuprofen\n", "Support"], ["The absence of bile duct dilatation in cholangiocarcinomas can be seen in cases of intrahepatic cholangiocarcinomas or in those with mixed histology with hepatocarcinoma\n", "Cholangiocarcinoma\n", "Support"], ["He does not report abdominal pain, weight loss or other symptoms, except generalized pruritus\n", "acute cholangitis is characterized by the triad of jaundice, abdominal pain and fever\n", "Attack"], ["acute cholangitis is characterized by the triad of jaundice, abdominal pain and fever\n", "Acute cholangitis due to biliary mud\n", "Attack"], ["It is true that the acute course and the absence of constitutional syndrome may make us think against this option and tip the balance towards ibuprofen hepatitis\n", "Cholangiocarcinoma\n", "Attack"], ["The CBC shows increased bilirubin at the expense of direct bilirubin\n", "Gilbert's syndrome is an increase in bilirubin at the expense of indirectness\n", "Attack"], ["Gilbert's syndrome is an increase in bilirubin at the expense of indirectness\n", "Gilbert's syndrome\n", "Attack"]]}
{"268_140": [["It is a lymphocytic exudate whose main diagnoses are tumor and tuberculous pleuritis\n", "Tuberculous pleural effusion\n", "Support"], ["They do not give the value of glucose which should be lowered\n", "if the cytology shows absence of malignant cells so we are left with tuberculous pleuritis\n", "Attack"], ["if the cytology shows absence of malignant cells so we are left with tuberculous pleuritis\n", "Tuberculous pleural effusion\n", "Support"]]}
{"465_116": [["therefore both tests are negative, and as only one answer refers to negative, that's it.\n", "The first reaction is a true negative\n", "Support"], ["But both could be false negatives\n", "therefore both tests are negative, and as only one answer refers to negative, that's it.\n", "Support"], ["that subject was not in any risk group, the positive is in the 15mm\n", "therefore both tests are negative, and as only one answer refers to negative, that's it.\n", "Support"]]}
{"340_33": [["The answer is 2, study of hormone receptors and HER2\n", "Study of hormone receptors and HER2\n", "Support"], ["there is no family history of neoplasia\n", "it does not appear to be hereditary breast cancer\n", "Support"], ["This is because no study of first-degree relatives is appropriate\n", "Study of hormone receptors, e-cadherin and study of first degree relatives\n", "Attack"], ["This is because no study of first-degree relatives is appropriate\n", "Study of BRCA 1-2 and study of first-degree relatives\n", "Attack"], ["it does not appear to be hereditary breast cancer\n", "This is because no study of first-degree relatives is appropriate\n", "Support"], ["On the other hand, there is no indication for BRCA 1-2 study\n", "Study of BRCA 1-2 and study of first-degree relatives\n", "Support"]]}
{"561_180": [["A 26-year-old woman diagnosed with systemic lupus erythematosus, on treatment with hydroxychloroquine, consults for a feeling of generalized weakness that has progressively developed in the last 15 days\n", "It tells us about a patient with a diagnosis of lupus and macrocytic anemia\n", "Support"], ["The onset of the picture seems relatively rapid and it is also associated with an autoimmune disease\n", "it seems that they want you to associate it with an autoimmune hemolytic anemia\n", "Support"], ["The ANA would not give us anything in relation to the anemia, since it already has a diagnosis\n", "Antinuclear antibodies\n", "Attack"], ["The physical examination reveals cutaneous pallor and the CBC shows Hb 7.4 g/dL, Hct 31%, MCV 108\n", "probably the MCV would be higher than 108\n", "Attack"], ["A 26-year-old woman diagnosed with systemic lupus erythematosus, on treatment with hydroxychloroquine, consults for a feeling of generalized weakness that has progressively developed in the last 15 days\n", "the onset of the clinical picture would be slower\n", "Attack"], ["probably the MCV would be higher than 108\n", "Vitamin B12\n", "Attack"], ["the onset of the clinical picture would be slower\n", "Vitamin B12\n", "Attack"], ["Vitamin B12\n", "Vitamin B12\n", "Attack"], ["The ANA would not give us anything in relation to the anemia, since it already has a diagnosis\n", "Therefore, correct answer 2\n", "Support"], ["Vitamin B12\n", "Therefore, correct answer 2\n", "Support"], ["the coombs test would tell us it is \"autoimmune\"\n", "Therefore, correct answer 2\n", "Support"], ["The low haptoglobin would tell us it is \"hemolytic\"\n", "Therefore, correct answer 2\n", "Support"], ["Therefore, correct answer 2\n", "Coombs test\n", "Support"]]}
{"451_175": [["On examination he presented: Positive right Las\u00e8ge at 10\u00ba, decreased strength in plantar flexion of the right foot, hypoesthesia in the external border of the right foot and absence of right Achilles reflex\n", "Both the sensory distribution, the paresis for plantar flexion (tiptoe) and the absence of the Achilles reflex are typical of S1 root involvement, which is typically affected with L5/S1 disc herniation (posterolateral)\n", "Support"], ["An L1/L2 (posterolateral) herniation would affect the L2 root\n", "Herniated disc L1/L2\n", "Attack"], ["A 36-year-old man with no PA of interest comes to the emergency department with sudden onset of severe pain in the posterior aspect of the right lower limb extending to the foot\n", "Both the sensory distribution, the paresis for plantar flexion (tiptoe) and the absence of the Achilles reflex are typical of S1 root involvement, which is typically affected with L5/S1 disc herniation (posterolateral)\n", "Support"], ["an L4/L5 herniation would affect the L5\n", "L4/L5 disc herniation\n", "Attack"], ["A 36-year-old man with no PA of interest comes to the emergency department with sudden onset of severe pain in the posterior aspect of the right lower limb extending to the foot\n", "An L1/L2 (posterolateral) herniation would affect the L2 root\n", "Attack"], ["A 36-year-old man with no PA of interest comes to the emergency department with sudden onset of severe pain in the posterior aspect of the right lower limb extending to the foot\n", "an L4/L5 herniation would affect the L5\n", "Attack"], ["cauda equina would involve more symptomatology than simple S1 involvement\n", "Horsetail syndrome\n", "Attack"], ["On examination he presented: Positive right Las\u00e8ge at 10\u00ba, decreased strength in plantar flexion of the right foot, hypoesthesia in the external border of the right foot and absence of right Achilles reflex\n", "cauda equina would involve more symptomatology than simple S1 involvement\n", "Attack"]]}
{"399_141": [["The patient presents the clinical features of spondylarthropathy, which is often associated with inflammatory bowel disease, as this case suggests\n", "The clinical picture is very suggestive of spondyloarthritis. Inflammatory bowel disease should be ruled out\n", "Support"]]}
{"12_92": [["The injury is not high\n", "The patient will be seated on the stretcher so that the cervical spine can be explored\n", "Attack"], ["It also does not appear to be a pelvic injury\n", "Refer to radiology for study of the lower extremities (feet, femurs, pelvis)\n", "Attack"], ["The patient, due to the mechanism of injury (foot fall), the calcaneal fracture and the neurological symptoms, suggests a low spinal cord injury due to a fracture of the lumbar spine\n", "I believe that the correct answer is 3\n", "Support"], ["The patient, due to the mechanism of injury (foot fall), the calcaneal fracture and the neurological symptoms, suggests a low spinal cord injury due to a fracture of the lumbar spine\n", "We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine\n", "Support"], ["I believe that the correct answer is 3\n", "We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine\n", "Support"], ["If there is a suspicion of pelvic injury in the primary evaluation of all polytraumatized (ATLS) a spinal exploration should be performed by rotating the spine en bloc to avoid producing more injury\n", "I believe that the correct answer is 3\n", "Support"], ["If there is a suspicion of pelvic injury in the primary evaluation of all polytraumatized (ATLS) a spinal exploration should be performed by rotating the spine en bloc to avoid producing more injury\n", "We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine\n", "Support"], ["Abdominal palpation is also part of the initial evaluation\n", "We will palpate the abdomen and roll en bloc to palpate the thoracolumbar spine\n", "Support"], ["Abdominal palpation is also part of the initial evaluation\n", "I believe that the correct answer is 3\n", "Support"], ["Abdominal ultrasound may be indicated in hemodynamically unstable patients if abdominal injuries are suspected but in any case it is done after the initial evaluation\n", "Abdominal palpation is also part of the initial evaluation\n", "Support"], ["Rotation of the lower limbs on the stretcher grasped by the ankles is painless\n", "Refer to radiology for study of the lower extremities (feet, femurs, pelvis)\n", "Attack"], ["compression of the pelvis is asymptomatic\n", "Refer to radiology for study of the lower extremities (feet, femurs, pelvis)\n", "Attack"], ["he moves his arms\n", "The injury is not high\n", "Support"], ["the absence of pain on mobilization or palpation\n", "It also does not appear to be a pelvic injury\n", "Support"]]}
{"605_113": [["In this case we describe a case of cervicobrachialgia without alarm signs at the present time\n", "so the most indicated treatment at this time would be conservative, based on NSAIDs, local heat and rest\n", "Support"], ["This is not an urgent case\n", "so answer 2 would not be valid\n", "Support"], ["so answer 2 would not be valid\n", "Urgent call to the neurosurgeon for surgical evaluation\n", "Attack"], ["so the most indicated treatment at this time would be conservative, based on NSAIDs, local heat and rest\n", "Conservative treatment with non-steroidal anti-inflammatory drugs, local heat and relative rest\n", "Support"], ["however, it is necessary to emphasize that we should first perform a correct pain management\n", "The performance of an MRI and an electromyogram are valid options for the etiological study of the picture\n", "Attack"], ["so since we are asked about the first attitude, option 1 would be more valid\n", "The performance of an MRI and an electromyogram are valid options for the etiological study of the picture\n", "Attack"], ["so since we are asked about the first attitude, option 1 would be more valid\n", "Conservative treatment with non-steroidal anti-inflammatory drugs, local heat and relative rest\n", "Support"], ["so since we are asked about the first attitude, option 1 would be more valid\n", "Preferential request for MRI and electromyogram\n", "Attack"]]}
{"443_102": [["because of the high histologic grade and high tumor proliferation\n", "According to the SEGO, this patient is a candidate for chemotherapy treatment\n", "Support"], ["A 64-year-old woman, without relevant comorbidities, operated on for a right breast cancer by means of an extended lumpectomy and selective sentinel lymph node biopsy, with the following anatomopathological result: Infiltrating ductal carcinoma poorly dlferentiated (grade 3), size 2.2 cm (pT2), estrogen and progesterone receptor positive, Ki67 25%, HER2 negative\n", "because of the high histologic grade and high tumor proliferation\n", "Support"], ["According to the SEGO, this patient is a candidate for chemotherapy treatment\n", "Adjuvant chemotherapy, preferably with anthracyclines and taxanes, followed by hormone therapy\n", "Support"]]}
{"197_71": [["The most appropriate drugs for the treatment of absences are Valproate and Ethosuximide (CTO Manual)\n", "Valproate\n", "Support"], ["brief episodes of distractibility (< 1 minute) in which he does not respond to calls and blinks\n", "Absences behave as brief episodes of abrupt loss of consciousness without alteration of postural control; they typically last seconds and can be repeated many times a day, are usually accompanied by small bilateral motor signs (blinking, chewing) and consciousness is recovered equally abruptly, without subsequent confusion or memory of the episode (MIR 03-04, 248; MIR 97-98, 51).\n", "Support"], ["A 10-year-old boy\n", "The age of onset is usually between 4 years and early adolescence, being the most frequent cause of seizures in this age range\n", "Support"], ["An EEG shows spike-wave discharges at 3 cycles per second\n", "EEG findings are typically generalized and symmetrical spike-wave discharges at 3 Hz (MIR 99-00F, 67) coinciding with seizures, although in the interictal EEG there are more periods of abnormal activity than clinically visible\n", "Support"]]}
{"478_134": [["On examination there is right thoracic hypophonesis and tympanism on percussion\n", "Hypophonesis in a hemithorax + tympanism = pneumothorax\n", "Support"], ["Hypophonesis in a hemithorax + tympanism = pneumothorax\n", "Right tension pneumothorax\n", "Support"], ["On examination there is right thoracic hypophonesis and tympanism on percussion\n", "If there is dullness on percussion: hemothorax\n", "Attack"], ["If there is dullness on percussion: hemothorax\n", "Massive right hemothorax\n", "Attack"]]}
{"97_171": [["They are undoubtedly describing the typical lesions (both on skin and oral mucosa) of a lichen planus (5)\n", "Lichen planus\n", "Support"]]}
{"426_94": [["A 73-year-old patient...swallowing a complete neurological dysphagia secondary to a cardioembolic stroke in the left middle cerebral artery territory. will require long-term nutritional support\n", "f enteral nutrition is considered to be of short duration, the route of choice is the nasogastric or nasoduodenal- nasojejunal tube...\n", "Attack"], ["f enteral nutrition is considered to be of short duration, the route of choice is the nasogastric or nasoduodenal- nasojejunal tube...\n", "Enteral nutrition by nasoduodenal tube\n", "Attack"], ["If prolonged nutrition is anticipated the route of choice is gastrostomy (option 3), with jejunostomy being reserved for cases in which it is not possible to use the gastric route\n", "Enteral nutrition by gastrostomy\n", "Support"], ["If prolonged nutrition is anticipated the route of choice is gastrostomy (option 3), with jejunostomy being reserved for cases in which it is not possible to use the gastric route\n", "Enteral nutrition by jejunostomy\n", "Attack"], ["f enteral nutrition is considered to be of short duration, the route of choice is the nasogastric or nasoduodenal- nasojejunal tube...\n", "Enteral nutrition by nasogastric tube\n", "Attack"]]}
{"262_58": [["in the case of cough it is usually dry and irritative and appears in up to 3% of patients\n", "These are typical adverse effects of ACEIs\n", "Support"], ["Hyperkalemia may also appear in 1%\n", "These are typical adverse effects of ACEIs\n", "Support"], ["A 70-year-old woman with a history of hypertension and moderate heart failure presents with a persistent, dry cough that begins as an itchy sensation in the throat\n", "in the case of cough it is usually dry and irritative and appears in up to 3% of patients\n", "Support"]]}
{"346_159": [["The correct answer is 2\n", "Endometrial biopsy\n", "Support"], ["BMI of 38kg/m2\n", "The data given on obesity should lead us to suspect endometrial cancer\n", "Support"], ["peripheral fat is converted to estrone, and these estrogens cause the endometrium to proliferate\n", "The data given on obesity should lead us to suspect endometrial cancer\n", "Support"], ["which rules out option 3\n", "Random cervical biopsies\n", "Attack"], ["On the other hand, she provides a normal cytology\n", "which rules out option 3\n", "Support"], ["She provides normal cervicovaginal cytology\n", "On the other hand, she provides a normal cytology\n", "Support"], ["The hormonal evaluation is not opportune\n", "Hormonal evaluation with FSH, LH and estradiol\n", "Attack"], ["the patient is in menopause\n", "The hormonal evaluation is not opportune\n", "Support"], ["69-year-old woman who comes to your office referring genital bleeding of several months of evolution\n", "the patient is in menopause\n", "Support"], ["We should not prescribe treatment without first ruling out organic causes\n", "Prescribe cyclic progesterone\n", "Attack"]]}
{"170_89": [["A ventricular aneurysm depresses LVEF, but does not suddenly put you into PAD\n", "Left ventricular aneurysm\n", "Attack"], ["In contrast, a VSD sharply increases flow to the pulmonary bed, causing pulmonary edema, and is also one of the most frequent complications of AMI\n", "Acute ventricular septal defect\n", "Support"], ["Two days later and after a favorable evolution, he suddenly presented heart failure with acute pulmonary edema\n", "In contrast, a VSD sharply increases flow to the pulmonary bed, causing pulmonary edema, and is also one of the most frequent complications of AMI\n", "Support"], ["And endocarditis would not require so many saddlebags\n", "Dysfunction of the bioprosthesis due to probable acute endocarditis\n", "Attack"], ["Ischemic ASD... I do not deny that it exists, but it does not even appear in the guidelines\n", "Postinfarction atrial septal defect\n", "Attack"]]}
{"40_136": [["all the adenopathies at this level that I have seen have ended up corresponding to carcinomas of the upper aerodigestive tract.\n", "I would mark 5 and rest easy\n", "Support"], ["parotid squamous cell carcinoma is rare\n", "So we are left with parotid and larynx\n", "Attack"], ["parotid squamous cell carcinoma is rare\n", "I would mark 5 and rest easy\n", "Support"], ["a dermatologist (answer 1) would not ask this\n", "Scalp\n", "Attack"], ["I would mark 5 and rest easy\n", "Larynx\n", "Support"], ["You have already passed the Pneumology and Digestive blocks\n", "Esophagus\n", "Attack"], ["You have already passed the Pneumology and Digestive blocks\n", "Lung\n", "Attack"], ["parotid squamous cell carcinoma is rare\n", "Parotid\n", "Attack"]]}
{"126_59": [["The correct answer is 2 (Perform chest X-ray and spirometry with bronchodilator test)\n", "Chest X-ray and spirometry with bronchodilator test\n", "Support"], ["It is probably COPD but we must confirm it and assess the severity of the obstruction with spirometry before starting treatment\n", "Chest X-ray and spirometry with bronchodilator test\n", "Support"], ["He is a patient at risk for lung cancer so it is mandatory to perform a chest X-ray to rule out this or other pathologies that would justify the symptoms, although most likely they are due to the debut of his COPD\n", "Chest X-ray and spirometry with bronchodilator test\n", "Support"], ["A 65-year-old man, a retired office worker and smoker of 1 pack of cigarettes a day, comes to the clinic with a persistent, generally dry cough and progressive dyspnea of 2 years of evolution which is currently grade 2\n", "Chest X-ray and spirometry with bronchodilator test\n", "Support"]]}
{"568_151": [["A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n", "option 3 correct\n", "Support"], ["Urine 24 h with proteinuria of 0.75 g/24 h, sediment with 10 erythrocytes per field (90% dysmorphic), no leukocyturia\n", "A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n", "Support"], ["Laboratory tests showed: Hb 12.8 g/dl, Hcto 39%, leukocytes 10,500/mm3 with normal formula, platelets 250,000/mm3, normal coagulation, urea 25 mg/dl, creatinine 0.8 mg/dl, ions, hepatic, lipid, albumin and total proteins normal\n", "A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n", "Support"], ["A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n", "IgA nephropathy\n", "Support"], ["option 3 correct\n", "IgA nephropathy\n", "Support"], ["He refers an upper respiratory catarrhal symptoms since 4-5 days ago for which he has taken paracetamol\n", "A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n", "Support"], ["A 22-year-old male presents to the emergency department with \"almost black\" urine for the past 12 hours\n", "A picture of macroscopic hematuria and mild proteinuria with normal creatinine levels, accompanied by an upper tract catarrhal picture, is very suggestive of IgA nephropathy\n", "Support"]]}
[{"286_60": []}]
{"228_75": [["Therefore, we rule out left heart failure: EAo, dilated with DSVI and a MHO\n", "Severe aortic stenosis\n", "Attack"], ["Therefore, we rule out left heart failure: EAo, dilated with DSVI and a MHO\n", "Dilated cardiomyopathy with significant left ventricular dysfunction\n", "Attack"], ["Therefore, we rule out left heart failure: EAo, dilated with DSVI and a MHO\n", "Obstructive hypertrophic cardiomyopathy\n", "Attack"], ["a patient with clinical signs of heart failure who presents with ascites disproportionately elevated in relation to peripheral edema\n", "Of the two we are left with, in constrictive pericarditis we have increased filling pressures in right chambers, which cause retrograde pressure increase with hepatic congestion, ascites, edema, etc\n", "Support"], ["Of the two we are left with, in constrictive pericarditis we have increased filling pressures in right chambers, which cause retrograde pressure increase with hepatic congestion, ascites, edema, etc\n", "Constrictive pericarditis\n", "Support"]]}
{"217_122": [["there are no defects of hepatic infiltration\n", "Metastases are ruled out\n", "Support"], ["it would give another symptomatology and this would be more acute\n", "intrahepatic tumor thrombosis\n", "Support"], ["they are not in context nor is it what the author of the question wants us to think\n", "acute hepatitis and hemochromatosis\n", "Support"], ["Metastases are ruled out\n", "Hepatic metastases\n", "Attack"], ["intrahepatic tumor thrombosis\n", "Intrahepatic tumor thrombosi\n", "Attack"], ["acute hepatitis and hemochromatosis\n", "Acute hepatitis\n", "Attack"], ["acute hepatitis and hemochromatosis\n", "Hemochromatosis\n", "Attack"], ["we are being presented with a patient with Stauffer's syndrome, a paraneoplastic syndrome consisting of liver dysfunction secondary to toxic products secreted by a number of tumors (most frequently, renal cell carcinoma, like the one in this case)\n", "Presence of hepatotoxic substances produced by the tumor\n", "Support"], ["As in this case, cholestasis (elevation of alkaline phosphatase), mobilization of hepatic enzymes and lengthening of the prothrombin time indicate liver dysfunction\n", "Presence of hepatotoxic substances produced by the tumor\n", "Support"]]}
{"142_138": [["If I had to choose I would choose answer 5, which seems to me the least aggressive\n", "Wilson's disease. Determine ceruloplasmin and copper in blood and urine\n", "Support"], ["In the clinical examination to start a sports activity, you find a discrete hepatomegaly of normal consistency, so you request a blood test, which highlights an ASAT of 80U / l, ALAT 105 U / l, electrophoretic proteinogram with all protein fractions in normal range and negativity of serology for hepatotropic viruses\n", "if I had to do analytical tests I would add the determination of alpha-1-antitrypsin (without CT) and markers of celiac disease, because celiac disease can also be associated with some hypertransaminemia\n", "Support"], ["The minimal elevation of liver enzymes and the fact that it has a normal protein profile goes against chronicity\n", "Autoimmune hepatitis. Liver biopsy\n", "Attack"], ["In the clinical examination to start a sports activity, you find a discrete hepatomegaly of normal consistency, so you request a blood test, which highlights an ASAT of 80U / l, ALAT 105 U / l, electrophoretic proteinogram with all protein fractions in normal range and negativity of serology for hepatotropic viruses\n", "Autoimmune hepatitis. Liver biopsy\n", "Attack"]]}
{"267_139": [["They describe pleural fluid parameters of transudate\n", "if the patient is not in heart failure it is a hydropic decompensation\n", "Support"]]}
{}
{"380_135": [["The picture presented to us is that of a Horner syndrome (miosis with ptosis)\n", "the possibilities are reduced to options 3 or 4\n", "Support"], ["the possibilities are reduced to options 3 or 4\n", "III cranial pair\n", "Attack"], ["the possibilities are reduced to options 3 or 4\n", "Optic chiasm\n", "Attack"], ["If the patient really has ataxia, the only possible location would be the spinal cord\n", "Spinal bulb\n", "Support"], ["they specify that the patient presents gait instability\n", "which is not justified by a Horner due to carotid dissection affecting the superior cervical ganglion, which is what they want us to believe when they talk about pain in the neck and in the eye\n", "Support"], ["which is not justified by a Horner due to carotid dissection affecting the superior cervical ganglion, which is what they want us to believe when they talk about pain in the neck and in the eye\n", "Superior cervical ganglion\n", "Attack"]]}
{"341_33": [["Both for the type of treatment and to study the prognostic factor and adjuvant treatment, it is necessary to know the different hormonal receptors (estrogen and progesterone) as well as HER2-neu\n", "Study of hormone receptors and HER2\n", "Support"], ["Study of hormone receptors and HER2\n", "Study of hormone receptors and HER2\n", "Support"]]}
{"308_215": [["A 47-year-old man with myopia magna, who underwent cataract surgery 2 years ago, comes to the emergency room reporting a profound and painless loss of vision in his right eye\n", "Post-surgical endophthalmitis is more associated with patients in the immediate postoperative period\n", "Attack"], ["Post-surgical endophthalmitis is more associated with patients in the immediate postoperative period\n", "it is not correct\n", "Support"], ["besides being very painful with rapidly progressive decrease in visual acuity\n", "it is not correct\n", "Support"], ["Post-surgical endophthalmitis is more associated with patients in the immediate postoperative period\n", "Post-surgical endophthalmitis\n", "Attack"], ["it is not correct\n", "Post-surgical endophthalmitis\n", "Attack"], ["ARMD usually occurs in older patients and the decrease in vision is progressive\n", "Age-related macular degeneration, wet form\n", "Attack"], ["A 47-year-old man with myopia magna, who underwent cataract surgery 2 years ago, comes to the emergency room reporting a profound and painless loss of vision in his right eye\n", "ARMD usually occurs in older patients and the decrease in vision is progressive\n", "Attack"], ["A 47-year-old man with myopia magna, who underwent cataract surgery 2 years ago, comes to the emergency room reporting a profound and painless loss of vision in his right eye\n", "In PVD there may or may not be a slight decrease in visual acuity and the patient usually reports some discomfort or pain at the onset of the clinical picture\n", "Attack"], ["In PVD there may or may not be a slight decrease in visual acuity and the patient usually reports some discomfort or pain at the onset of the clinical picture\n", "Posterior vitreous detachment\n", "Attack"], ["Retinal detachment is consistent with the clinical case\n", "Retinal detachment\n", "Support"], ["it is also a myopic patient who tend to have a special predisposition to detachment\n", "Retinal detachment is consistent with the clinical case\n", "Support"]]}
[{"519_176": []}]
{"63_200": [["Both the flexor carpi radialis and the abductor pollicis longus are anatomically far from the ulnar.\n", "Tendon of the abductor pollicis longus\n", "Attack"], ["Both the flexor carpi radialis and the abductor pollicis longus are anatomically far from the ulnar.\n", "Radial carpal flexor tendon\n", "Attack"], ["The palmaris longus is medial, as is the flexor digitorum profundus\n", "Palmaris longus tendon\n", "Attack"], ["answer 1\n", "Tendon of the flexor carpi ulnaris\n", "Support"], ["The tendon that runs alongside the ulnar nerve, inserting into the pisiform, is the flexor carpi ulnaris\n", "answer 1\n", "Support"], ["The palmaris longus is medial, as is the flexor digitorum profundus\n", "Tendon of the deep flexor of the fingers\n", "Attack"]]}
{"30_61": [["he is a \"retentive\" patient and increasing O2 flow is highly likely to increase hypercapnia and, therefore, acidosis\n", "1: Wrong\n", "Support"], ["the bicarbonate is not decreased, on the contrary, it is slightly increased trying to compensate the respiratory acidosis\n", "3: It is not a metabolic acidosis\n", "Support"], ["If we knew the first blood gas and she was much worse (i.e. she was doing very well), continuing with the same medication would be an option\n", "4: He does not reach respiratory failure by definition (pO2 60), but he has hypercapnia and slight acidosis\n", "Support"], ["but this data is missing!!!\n", "If we knew the first blood gas and she was much worse (i.e. she was doing very well), continuing with the same medication would be an option\n", "Attack"], ["but this data is missing!!!\n", "4: He does not reach respiratory failure by definition (pO2 60), but he has hypercapnia and slight acidosis\n", "Attack"], ["The trap is that they give us the initial clinical picture WITHOUT GASOMETRY and then they give us the blood gases afterwards WITHOUT CLINIC\n", "there is no way of knowing what the evolution of the patient has been with our treatment\n", "Support"], ["The trap is that they give us the initial clinical picture WITHOUT GASOMETRY and then they give us the blood gases afterwards WITHOUT CLINIC\n", "it is impossible to know what to do\n", "Support"], ["If the patient initially came with a blood gas with a pH of 7.05 and now has the one we are given, we are doing well (although we are not told the time interval between one thing and the other)\n", "in this case, it could be worthwhile to continue with the same treatment\n", "Support"], ["If nothing has evolved, the clinical picture is the same and the blood gas at the beginning was similar\n", "something should be done\n", "Support"], ["something should be done\n", "If we decide to do something, at present we might decide to use ventilation rather than theophylline\n", "Support"], ["although with \"so little\" alteration of pH (and even more so if we think that this is a chronic patient who may have a baseline blood gas similar to the one presented to us) it may seem \"exaggerated\"\n", "If we decide to do something, at present we might decide to use ventilation rather than theophylline\n", "Attack"], ["We have nothing \"against\" theophylline (we are not told of any contraindication), but nowadays it is rare to resort to it\n", "5: At present and -as already mentioned- taking into account that there is no formal contraindication, it is not usually used\n", "Support"], ["in this case, it could be worthwhile to continue with the same treatment\n", "The patient does not have respiratory insufficiency so he would continue with the same pharmacological regimen\n", "Support"], ["If we decide to do something, at present we might decide to use ventilation rather than theophylline\n", "I would add intravenous aminophylline as a respiratory stimulant, since I appreciate hypoxemia and hypercapnia\n", "Attack"], ["We have nothing \"against\" theophylline (we are not told of any contraindication), but nowadays it is rare to resort to it\n", "I would add intravenous aminophylline as a respiratory stimulant, since I appreciate hypoxemia and hypercapnia\n", "Attack"], ["If we decide to do something, at present we might decide to use ventilation rather than theophylline\n", "I would initiate noninvasive mechanical ventilation because he has acute hypercapnic respiratory failure with moderate respiratory acidosis\n", "Support"], ["1: Wrong\n", "Increase oxygen flow because he has acute respiratory acidosis and hypoxemia\n", "Attack"], ["2: We will keep this one as correct.\n", "I would initiate noninvasive mechanical ventilation because he has acute hypercapnic respiratory failure with moderate respiratory acidosis\n", "Support"], ["3: It is not a metabolic acidosis\n", "I would add sodium bicarbonate to correct the acute metabolic acidosis\n", "Attack"], ["4: He does not reach respiratory failure by definition (pO2 60), but he has hypercapnia and slight acidosis\n", "The patient does not have respiratory insufficiency so he would continue with the same pharmacological regimen\n", "Support"], ["5: At present and -as already mentioned- taking into account that there is no formal contraindication, it is not usually used\n", "I would add intravenous aminophylline as a respiratory stimulant, since I appreciate hypoxemia and hypercapnia\n", "Attack"]]}
{"226_71": [["He already takes two AV node brakers and you add a third, and are you surprised that he gets complete AV block after messing with drugs from different families but same effect (pharmacodynamics)?\n", "Three\n", "Support"], ["Three\n", "Pharmacodynamic interaction of beta-blocker, digoxin and verapamil\n", "Support"]]}
[{"565_148": []}]
{"135_38": [["The patient presents a good general condition with a recently diagnosed hepatocarcinoma, not giving him any type of treatment other than symptomatic and supportive at this stage would not be the right thing to do\n", "Symptomatic and supportive treatment, since he presented an advanced hepatocarcinoma with vascular invasion and metastasis\n", "Attack"], ["TACE would not be indicated because of extrahepatic involvement\n", "Transarterial chemoembolization (TACE), since the treatment increases survival in patients with advanced hepatocarcinoma\n", "Attack"], ["Transplantation would also not be done if he has extrahepatic disease\n", "The appropriate treatment is liver transplantation as it is the only procedure that completely eliminates the primary tumor and avoids future complications of cirrhosis\n", "Attack"], ["the correct answer is 4, for all the reasons given therein\n", "Treatment with oral sorafenib, since this is a patient with good general condition, Child A and advanced stage hepatocarcinoma BCLC-C\n", "Support"], ["answers 3 and 4, both with systemic treatment (indicated because it is metastatic)\n", "Systemic chemotherapy with doxorubicin iv since he presents disseminated disease but he is in good general condition\n", "Support"], ["answers 3 and 4, both with systemic treatment (indicated because it is metastatic)\n", "Treatment with oral sorafenib, since this is a patient with good general condition, Child A and advanced stage hepatocarcinoma BCLC-C\n", "Support"], ["This scan showed the presence of 4 liver lesions (one of them up to 6 cm) with uptake pattern typical of hepatocarcinoma, tumor vascular invasion and a metastasis in the right adrenal gland\n", "Systemic chemotherapy with doxorubicin iv since he presents disseminated disease but he is in good general condition\n", "Support"], ["This scan showed the presence of 4 liver lesions (one of them up to 6 cm) with uptake pattern typical of hepatocarcinoma, tumor vascular invasion and a metastasis in the right adrenal gland\n", "Treatment with oral sorafenib, since this is a patient with good general condition, Child A and advanced stage hepatocarcinoma BCLC-C\n", "Support"]]}
{"556_55": [["A decrease in vitamin B 12 levels is observed in patients treated with metformin\n", "Metformin\n", "Support"], ["63-year-old diabetic patient whose family physician has requested a blood test to determine vitamin B12 levels\n", "A decrease in vitamin B 12 levels is observed in patients treated with metformin\n", "Support"], ["63-year-old diabetic patient whose family physician has requested a blood test to determine vitamin B12 levels\n", "however, vitamin B 12 malabsorption, is less well known\n", "Support"]]}
{"448_148": [["edema, midline deviation, papilledema\n", "They describe a recent diagnosis of cerebral LOE with signs of intracranial hypertension\n", "Support"], ["They describe a recent diagnosis of cerebral LOE with signs of intracranial hypertension\n", "The associated headache is typically morning headache, with increasing ICP values at night\n", "Support"], ["She reports a headache that has been progressing in intensity for the past week\n", "The associated headache is typically morning headache, with increasing ICP values at night\n", "Support"]]}
{"591_64": [["A 68-year-old woman who wears +4.00 diopter glasses for distance vision in both eyes\n", "We are presented with a 68-year-old woman with moderate hyperopia and no history of cataract surgery\n", "Support"], ["We are presented with a 68-year-old woman with moderate hyperopia and no history of cataract surgery\n", "This is not a mere coincidence: the fact that the patient is hyperopic is important, because the eyeballs of hyperopic patients are shorter, with a certain conflict of space in the anterior segment when the crystalline lens undergoes a process of intumescence secondary to age (what patients call incipient cataract)\n", "Support"], ["She consults because since a few weeks ago she has been having eye pain with headache and blurred vision at night when she is watching television in twilight\n", "In the clinical case, moreover, the ocular and headache pain occurs in scotopic situations, or in situations of dim ambient lighting, which produces an average mydriasis to optimize the light influx to the eyeball\n", "Support"], ["In the clinical case, moreover, the ocular and headache pain occurs in scotopic situations, or in situations of dim ambient lighting, which produces an average mydriasis to optimize the light influx to the eyeball\n", "It is evident, therefore, that the patient suffers from primary angular closure processes that possibly self-resolve when the triggering situation ceases, and not a true acute glaucoma attack\n", "Support"], ["It is evident, therefore, that the patient suffers from primary angular closure processes that possibly self-resolve when the triggering situation ceases, and not a true acute glaucoma attack\n", "But these intermittent angular closures are contemplated within the spectrum of glaucoma due to primary angular closure\n", "Support"], ["But these intermittent angular closures are contemplated within the spectrum of glaucoma due to primary angular closure\n", "option 1 correct\n", "Support"], ["option 1 correct\n", "Glaucoma due to primary angular closure\n", "Support"], ["A 68-year-old woman who wears +4.00 diopter glasses for distance vision in both eyes\n", "however, patients are usually younger, or at least have a clear history of migraine, and, above all, they present symptomatologic worsening with intense sensory stimuli (photophobia and phonophobia), but symptoms are not worsened precisely in cases of dim lighting\n", "Attack"], ["however, patients are usually younger, or at least have a clear history of migraine, and, above all, they present symptomatologic worsening with intense sensory stimuli (photophobia and phonophobia), but symptoms are not worsened precisely in cases of dim lighting\n", "option 2 incorrect\n", "Support"], ["however, patients are usually younger, or at least have a clear history of migraine, and, above all, they present symptomatologic worsening with intense sensory stimuli (photophobia and phonophobia), but symptoms are not worsened precisely in cases of dim lighting\n", "Migraine, not being a Neurology question, can sometimes be a confounder in the usual clinic\n", "Attack"], ["option 2 incorrect\n", "Migraine\n", "Attack"], ["Actinic keratitis occurs precisely in patients exposed to ultraviolet radiation that is not properly filtered before reaching the cornea\n", "wrong option 3\n", "Support"], ["it is typical of welders (it is called welder's keratitis), skiers and other people with very intense light exposures and without adequate eye protection\n", "wrong option 3\n", "Support"], ["wrong option 3\n", "Actinic keratitis\n", "Attack"], ["She consults because since a few weeks ago she has been having eye pain with headache and blurred vision at night when she is watching television in twilight\n", "Dry eye syndrome does not usually produce headache\n", "Attack"], ["She consults because since a few weeks ago she has been having eye pain with headache and blurred vision at night when she is watching television in twilight\n", "ocular discomfort does not go beyond the persistent discomfort that patients might define as pain because of its recently more studied neuropathic component\n", "Attack"], ["Dry eye syndrome does not usually produce headache\n", "incorrect option 4\n", "Support"], ["ocular discomfort does not go beyond the persistent discomfort that patients might define as pain because of its recently more studied neuropathic component\n", "incorrect option 4\n", "Support"], ["incorrect option 4\n", "Dry eye syndrome\n", "Attack"]]}
{"291_157": [["There is not much dispute\n", "You are describing a contagious impetigo\n", "Support"], ["You are describing a contagious impetigo\n", "Contagious impetigo\n", "Support"]]}
{"213_160": [["the three of them have another conditioning factor\n", "Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n", "Support"], ["a prolonged and high-dose prednisone regimen will be established\n", "it is advisable, in addition to the non-pharmacological preventive measures, to initiate treatment in any case to minimize the secondary loss of bone mass that occurs with the administration of glucocorticoids (and, above all, in the first months)\n", "Support"], ["there are no clinical risk factors for osteoporosis prior to the current disease\n", "Request DXA and wait for the result\n", "Attack"], ["it is advisable, in addition to the non-pharmacological preventive measures, to initiate treatment in any case to minimize the secondary loss of bone mass that occurs with the administration of glucocorticoids (and, above all, in the first months)\n", "Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n", "Support"], ["Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n", "Request DXA and wait for the result\n", "Attack"], ["Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n", "Assess absolute risk of fracture using the FRAX questionnaire without BMD and treat only if it is high\n", "Attack"], ["Therefore, and for this reason alone, options 1, 2 and 5 would be discarded\n", "Assess for osteopenia on radiographs and treat if present\n", "Attack"], ["a person over 65 years of age\n", "an appropriate attitude would be to administer calcium supplements (corticosteroids are osteopenizantes because they produce, among other mechanisms, a negative balance of this element) and vitamin D\n", "Support"], ["an appropriate attitude would be to administer calcium supplements (corticosteroids are osteopenizantes because they produce, among other mechanisms, a negative balance of this element) and vitamin D\n", "Administer calcium supplementation (1g) and vitamin D (800 IU/day)\n", "Support"], ["calcium supplementation is missing in proposal 3\n", "The option of associating a bisphosphonate could also be considered\n", "Attack"], ["The option of associating a bisphosphonate could also be considered\n", "Start treatment with bisphosphonates and vitamin D (800 IU/day)\n", "Support"], ["calcium supplementation is missing in proposal 3\n", "Start treatment with bisphosphonates and vitamin D (800 IU/day)\n", "Attack"]]}
{"442_100": [["According to the SEGO: \"Excise the entire lesion so that it can be evaluated histologically\n", "When they speak of excision, it is synonymous with conization\n", "Support"], ["as the lesion is less than 8mm deep, this is the indicated treatment\n", "When they speak of excision, it is synonymous with conization\n", "Support"], ["When they speak of excision, it is synonymous with conization\n", "Conization\n", "Support"], ["as the lesion is less than 8mm deep, this is the indicated treatment\n", "Conization\n", "Support"], ["It involves excision of the entire transformation zone\n", "When they speak of excision, it is synonymous with conization\n", "Support"]]}
{"491_106": [["ATRA aside... which I'm sure you know\n", "Now it's time to find out how acute promyelocytic leukemia is currently treated\n", "Support"], ["In this case, it doesn't score anything for the score since you have <10,000 leukocytes and >40,000 platelets\n", "That is, it is a low risk\n", "Support"], ["In this case, it doesn't score anything for the score since you have <10,000 leukocytes and >40,000 platelets\n", "In high risk patients, it is treated with ATRA+chemotherapy\n", "Attack"], ["Correct answer 2\n", "Treatment with arsenic trioxide, ATRA and supportive therapy will be initiated\n", "Support"], ["As of 2017, the PETHEMA protocol for APL in low to intermediate risk patients (and/or over 70 years of age) is ATO+ATRA\n", "Treatment with arsenic trioxide, ATRA and supportive therapy will be initiated\n", "Support"], ["That is, it is a low risk\n", "In high risk patients, it is treated with ATRA+chemotherapy\n", "Attack"], ["That is, it is a low risk\n", "As of 2017, the PETHEMA protocol for APL in low to intermediate risk patients (and/or over 70 years of age) is ATO+ATRA\n", "Support"], ["One of the main causes of mortality in the induction of a promyelocyte is coagulopathy, but option 3 is totally incorrect\n", "It is a myeloblastic leukemia type M3, so chemotherapy and heparin treatment will be initiated to control disseminated intravascular coagulation\n", "Attack"], ["We could only mess things up even more by putting heparin!!!!\n", "One of the main causes of mortality in the induction of a promyelocyte is coagulopathy, but option 3 is totally incorrect\n", "Support"], ["I don't know what they are explaining right now in the academies, but it is clear that they wanted you to know that many promyelocytes, since 3 little years ago, are not treated with chemotherapy\n", "It is a myeloblastic leukemia type M3, so chemotherapy and heparin treatment will be initiated to control disseminated intravascular coagulation\n", "Attack"]]}
{"277_226": [["Carcinoma in situ is delimited by the basement membrane, i.e. it is not invasive yet\n", "therefore the treatment is polypectomy, which is already done\n", "Support"], ["therefore the treatment is polypectomy, which is already done\n", "Subsequently, an endoscopic follow-up (with biopsies) should be performed at an interval of 3 to 6 months depending on the patient's history, age and concomitant pathologies\n", "Support"], ["Subsequently, an endoscopic follow-up (with biopsies) should be performed at an interval of 3 to 6 months depending on the patient's history, age and concomitant pathologies\n", "Periodic endoscopic surveillance\n", "Support"]]}
{"155_83": [["Allopurinol is always the treatment of choice, especially in the case of tophaceous gout\n", "Its use is second choice when uricosurics have failed\n", "Support"], ["Moreover, in this case, uricosuric acid could worsen urolithiasis by increasing uricosuria\n", "Allopurinol is always the treatment of choice, especially in the case of tophaceous gout\n", "Support"]]}
{"373_86": [["it is a pituitary tumor of more than one centimeter, which secretes prolactin and with an insufficiency of the rest of pituitary hormones\n", "From what is described it is a macroprolactinoma\n", "Support"], ["The first line treatment of choice is dopaminergic agonists\n", "Dopaminergic agonists\n", "Support"], ["the surgical risk increases\n", "Transsphenoidal surgery\n", "Attack"], ["In this case, the cavernous sinus is pressured by the mass\n", "the surgical risk increases\n", "Support"], ["although when the visual field is affected, surgery may be chosen\n", "Transsphenoidal surgery\n", "Support"], ["Therefore, in this particular case, the surgical option seems more risky\n", "Transsphenoidal surgery\n", "Attack"], ["Taking this into account and the fact that it is a tumor that produces high levels of prolactin, which indicates that it probably responds to pharmacological blockade, the most appropriate option would be option 1, treatment with dopaminergic agonists\n", "Dopaminergic agonists\n", "Support"], ["In this case, the cavernous sinus is pressured by the mass\n", "Therefore, in this particular case, the surgical option seems more risky\n", "Support"]]}
{"523_124": [["A 45-year-old patient was diagnosed with HIV infection three months ago, presenting at that time with CD4 45 lymphocytes/\u00b5l and an HIV-1 viral load of 500,000 copies/ml\n", "We are dealing with a patient with HIV infection in a situation of severe immunosuppression (<50 CD4+) and a very high viral load, who has followed the expected evolution from the immunovirological point of view after the start of treatment (after 12 weeks, the viral load has ostensibly decreased\n", "Support"], ["answer 2 would not be correct\n", "Treatment failure and it is an opportunistic infection\n", "Attack"], ["although in patients with higher CV like ours, it could take longer - and the CD4+ count has begun to rise\n", "answer 2 would not be correct\n", "Support"], ["although in patients with higher CV like ours, it could take longer - and the CD4+ count has begun to rise\n", "remember that it is desirable that it becomes negative 24 weeks after the start of treatment\n", "Attack"], ["A negative Mantoux test does not rule out tuberculosis\n", "incorrect answer 4\n", "Support"], ["incorrect answer 4\n", "A negative Mantoux test rules out tuberculosis\n", "Attack"], ["A negative Mantoux test does not rule out tuberculosis\n", "A negative Mantoux test rules out tuberculosis\n", "Attack"], ["since in patients with severe immunosuppression it can give false negatives\n", "A negative Mantoux test does not rule out tuberculosis\n", "Support"], ["however: considering the patient profile, this process will have been clinically unmasked during the immunological reconstitution and the infection is not the consequence of an incomplete immunological recovery\n", "The diagnosis of lymph node tuberculosis is immediate when detecting \"isolated acid-fast bacilli and epithelioid granulomas\" in the puncture of one of the lymph nodes\n", "Attack"], ["however: considering the patient profile, this process will have been clinically unmasked during the immunological reconstitution and the infection is not the consequence of an incomplete immunological recovery\n", "This is an opportunistic infection unmasked within a picture of immune reconstitution\n", "Support"], ["however: considering the patient profile, this process will have been clinically unmasked during the immunological reconstitution and the infection is not the consequence of an incomplete immunological recovery\n", "It is a lymph node tuberculosis related to an incomplete immunologic recovery\n", "Attack"], ["however: considering the patient profile, this process will have been clinically unmasked during the immunological reconstitution and the infection is not the consequence of an incomplete immunological recovery\n", "correct answer number 3\n", "Support"], ["correct answer number 3\n", "This is an opportunistic infection unmasked within a picture of immune reconstitution\n", "Support"]]}
{"417_76": [["78-year-old woman with dementia and institutionalized is brought by her caregivers for significant abdominal pain with deterioration of general condition and abdominal distension\n", "Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease\n", "Support"], ["ECG shows atrial fibrillation\n", "Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease\n", "Support"], ["CBC shows leukocytosis, elevated hematocrit, renal failure and metabolic acidosis\n", "Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease\n", "Support"], ["Typical case of acute mesenteric ischemia, which should be suspected in elderly patients with abdominal pain and distension of sudden onset, diarrhea or vomiting and who present cardiovascular risk factors, especially emboligenic heart disease\n", "Mesenteric ischemia\n", "Support"], ["suggestive of mesenteric ischemia\n", "Mesenteric ischemia\n", "Support"]]}
{"403_135": [["The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n", "Characteristic is upper eyelid ptosis and miosis of that eye\n", "Support"], ["It explains ptosis and miosis of the left eye\n", "so we suspect Horner's in that eye\n", "Support"], ["The sympathetic nervous system innervates the M\u00fcller muscle, which is an accessory muscle to the levator of the upper eyelid\n", "Therefore, the sphincter muscle, its antagonist, is unopposed and the balance of the pupil shifts toward miosis\n", "Support"], ["If the M\u00fcller ceases to function, the eyelid descends slightly\n", "Therefore, the sphincter muscle, its antagonist, is unopposed and the balance of the pupil shifts toward miosis\n", "Support"], ["It also innervates the iris dilator muscle\n", "Therefore, the sphincter muscle, its antagonist, is unopposed and the balance of the pupil shifts toward miosis\n", "Support"], ["Therefore, the sphincter muscle, its antagonist, is unopposed and the balance of the pupil shifts toward miosis\n", "It explains ptosis and miosis of the left eye\n", "Support"], ["The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n", "It explains ptosis and miosis of the left eye\n", "Support"], ["She also describes what may have happened: after a possible sudden movement while playing tennis, she has neck pain and a Horner's\n", "We should suspect an aneurysm\n", "Support"], ["so we suspect Horner's in that eye\n", "We should suspect a dissecting carotid aneurysm, which is one of the best known (and most serious) causes of an acquired Horner's syndrome\n", "Support"], ["We should suspect a dissecting carotid aneurysm, which is one of the best known (and most serious) causes of an acquired Horner's syndrome\n", "The superior cervical ganglion is a ganglion of the sympathetic nervous system located in the sheath of the carotid artery, and at this level it has been affected\n", "Support"], ["This occurs due to a deficit of sympathetic innervation of the orbital territory\n", "Characteristic is upper eyelid ptosis and miosis of that eye\n", "Support"], ["This occurs due to a deficit of sympathetic innervation of the orbital territory\n", "The superior cervical ganglion is a ganglion of the sympathetic nervous system located in the sheath of the carotid artery, and at this level it has been affected\n", "Support"], ["The superior cervical ganglion is a ganglion of the sympathetic nervous system located in the sheath of the carotid artery, and at this level it has been affected\n", "Upper cervical ganglion\n", "Support"], ["but the pupil, if affected, should be in mydriasis\n", "An alteration of the III cranial nerve can produce ptosis\n", "Attack"], ["The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n", "but the pupil, if affected, should be in mydriasis\n", "Attack"], ["but the pupil, if affected, should be in mydriasis\n", "III cranial nerve\n", "Attack"], ["And damage to the third cranial nerve should also produce some type of ophthalmoplegia, with diplopia\n", "III cranial nerve\n", "Attack"], ["The patient maintains good visual acuity\n", "And damage to the third cranial nerve should also produce some type of ophthalmoplegia, with diplopia\n", "Attack"], ["The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n", "And damage to the third cranial nerve should also produce some type of ophthalmoplegia, with diplopia\n", "Attack"], ["We are told in the statement that he maintains good visual acuity\n", "An involvement of the optic chiasm would produce a bilateral loss of vision (probably a bitemporal hemianopsia)\n", "Attack"], ["An involvement of the optic chiasm would produce a bilateral loss of vision (probably a bitemporal hemianopsia)\n", "Optic chiasm\n", "Attack"], ["On the other hand, there would also be no ptosis or anisocoria\n", "Optic chiasm\n", "Attack"], ["The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n", "On the other hand, there would also be no ptosis or anisocoria\n", "Attack"], ["And finally, an alteration of the medulla oblongata would produce different neurological symptoms not described, and there should be no ptosis or pupillary alterations, because the third pair is located in the midbrain and the sympathetic nuclei in the spinal cord\n", "Spinal cord\n", "Attack"], ["The next morning he wakes up with a feeling of gait instability and has palpebral ptosis of the left eye and anisocoria, with the left pupil being smaller than the right\n", "And finally, an alteration of the medulla oblongata would produce different neurological symptoms not described, and there should be no ptosis or pupillary alterations, because the third pair is located in the midbrain and the sympathetic nuclei in the spinal cord\n", "Attack"]]}
{"42_150": [["A common bile duct cyst is a congenital pathology that usually presents clinically beyond the neonatal period\n", "The correct answer is 4\n", "Support"], ["It is appropriate to have a quality image that delimits the lesion in order to decide the surgical approach\n", "The correct answer is 4\n", "Support"], ["The correct answer is 4\n", "A cholangio-resonance will be performed to delimit the cyst and a laparotomy will be indicated for cyst resection and anastomosis of the biliary tract\n", "Support"], ["An ultrasound shows the presence of a common bile duct cyst\n", "The correct answer is 4\n", "Support"], ["A one-and-a-half year old boy comes to the emergency room with abdominal pain and jaundice\n", "The correct answer is 4\n", "Support"]]}
{"445_233": [["Heavy menstrual bleeding for approximately 1 year\n", "According to the SEGO, in perimenopausal women with heavy and/or prolonged menstrual bleeding who require contraception, the levonorgestrel IUD (also called MIRENA IUD) is the first option\n", "Support"], ["According to the SEGO, in perimenopausal women with heavy and/or prolonged menstrual bleeding who require contraception, the levonorgestrel IUD (also called MIRENA IUD) is the first option\n", "Levonorgestrel IUD\n", "Support"]]}
{"511_152": [["A 79-year-old hypertensive woman on treatment with olmesartan comes for consultation for watery diarrhea of 4 to 6 stools per day for the past two months\n", "The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings\n", "Support"], ["band of collagen underlying the epithelium greater than 10 microns\n", "In our case, the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns) and lymphocytic (more than 20 intraepithelial lymphocytes)\n", "Support"], ["more than 20 intraepithelial lymphocytes\n", "In our case, the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns) and lymphocytic (more than 20 intraepithelial lymphocytes)\n", "Support"], ["Gastroscopy and colonoscopy were performed, both without macroscopic alterations\n", "The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings\n", "Support"], ["In our case, the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns) and lymphocytic (more than 20 intraepithelial lymphocytes)\n", "The treatment of this pathology is topical corticosteroids with low oral bioavailability (mainly budesonide)\n", "Support"], ["In our case, the patient presents findings compatible with collagenous colitis (band of collagen underlying the epithelium greater than 10 microns) and lymphocytic (more than 20 intraepithelial lymphocytes)\n", "The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings\n", "Support"], ["The diagnostic criteria for microscopic colitis are: a)Chronic or intermittent non-bloody watery diarrhea b)Colonic mucosa assessed by colonoscopy macroscopically normal or near normal c)Characteristic histopathological findings\n", "Microscopic colitis\n", "Support"], ["Olmesartan enteropathy produces a picture similar to celiac disease and is characterized by duodenal biopsy with villous atrophy, mucosal inflammation with increased intraepithelial lymphocytes and cryptitis\n", "Olmesartan-associated enteropathy\n", "Attack"], ["Duodenal biopsies were normal, while colon biopsies showed a chronic inflammatory infiltrate of the lamina propria with an irregular band of collagen immediately below the mucosal surface epithelium with a thickness greater than 10 mm and a number of intraepithelial lymphocytes >20 per 100 epithelial cells\n", "Olmesartan enteropathy produces a picture similar to celiac disease and is characterized by duodenal biopsy with villous atrophy, mucosal inflammation with increased intraepithelial lymphocytes and cryptitis\n", "Attack"], ["In this case a normal duodenal biopsy is described\n", "Olmesartan enteropathy produces a picture similar to celiac disease and is characterized by duodenal biopsy with villous atrophy, mucosal inflammation with increased intraepithelial lymphocytes and cryptitis\n", "Attack"], ["In this case a normal duodenal biopsy is described\n", "but it would be interesting to keep the concept for future examinations\n", "Attack"]]}
{"33_65": [["He was admitted to the hospital for suspected myasthenic crisis\n", "This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement\n", "Support"], ["A 64-year-old man, diagnosed with myasthenia gravis 1 year ago, treated with low-dose steroids (3 mg/day of deflazacort) and anticholinesterase drugs, asymptomatic for 6 months, consults for mild difficulty in swallowing and evening diplopia for a few days\n", "This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement\n", "Support"], ["The respiratory symptoms correspond to an exhaustion of the muscles, first inspiratory and then accessory (the patient does not appear fatigued or tachypneic because the muscles are exhausted), progressing to a carbonic coma\n", "This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement\n", "Support"], ["This is a patient with decompensated myasthenia with bulbar symptoms (dysphagia) and therefore risk of respiratory muscle involvement\n", "Notify intensive care for suspected acute respiratory failure, to assess possible orotracheal intubation and assisted ventilation\n", "Support"]]}
{"129_81": [["Dementia with visual hallucinations at the beginning of the course (in the first 2 years) is very suggestive of Lewy bodies, and is the guiding symptom in these questions\n", "Dementia with diffuse Lewy bodies\n", "Support"], ["His family reports recurrent visual hallucinations\n", "Dementia with diffuse Lewy bodies\n", "Support"], ["If we add to this the falls and motor slowing suggestive of parkinsonism, it makes the question easier.\n", "Dementia with diffuse Lewy bodies\n", "Support"], ["occasional falls and striking motor slowing\n", "Dementia with diffuse Lewy bodies\n", "Support"], ["Therefore, number 3 is correct\n", "Dementia with diffuse Lewy bodies\n", "Support"], ["Dementia with visual hallucinations at the beginning of the course (in the first 2 years) is very suggestive of Lewy bodies, and is the guiding symptom in these questions\n", "Therefore, number 3 is correct\n", "Support"], ["If we add to this the falls and motor slowing suggestive of parkinsonism, it makes the question easier.\n", "Therefore, number 3 is correct\n", "Support"]]}
{"503_80": [["In the male, the onset of puberty is considered normal from the age of 9 years\n", "therefore in this case it is a premature puberty\n", "Support"], ["the testicular size has not increased\n", "we can rule out options 1 and 2\n", "Support"], ["we can rule out options 1 and 2\n", "Central precocious puberty\n", "Attack"], ["we can rule out options 1 and 2\n", "Peripheral precocious puberty\n", "Attack"], ["The onset of puberty is defined as an increase in testicular volume (greater than or equal to 4cc)\n", "we can rule out options 1 and 2\n", "Support"], ["The onset of puberty is defined as an increase in testicular volume (greater than or equal to 4cc)\n", "the testicular size has not increased\n", "Attack"], ["The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present\n", "Therefore, the correct option is early adrenarche\n", "Support"], ["The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present\n", "Adrenal tumor\n", "Attack"], ["An 8-year-old boy consults for the appearance of pubic hair at the base of the penis for the last 12 months\n", "The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present\n", "Attack"], ["The testicle has not increased in volume and the penis has not increased in size\n", "The excessive secretion of androgens produced by an adrenal tumor would cause a greater amount of hair and an increase in penile size, which our patient does not present\n", "Attack"], ["Therefore, the correct option is early adrenarche\n", "Early adrenarche\n", "Support"]]}
{"300_106": [["the presence of a pneumonia of long evolution that does not improve with antibiotic treatment, with an effusion with abundant leukocytes and lymphocytic predominance, in which the presence of neoplasia is ruled out, with values higher than 70 UI/L\n", "The determination of ADA, in the presence of a pneumonia of long evolution that does not improve with antibiotic treatment, with an effusion with abundant leukocytes and lymphocytic predominance, in which the presence of neoplasia is ruled out, with values higher than 70 UI/L, should lead us to have a high degree of suspicion about tuberculous etiology and send the pleural fluid to microbiology for tuberculosis study\n", "Support"], ["The determination of ADA, in the presence of a pneumonia of long evolution that does not improve with antibiotic treatment, with an effusion with abundant leukocytes and lymphocytic predominance, in which the presence of neoplasia is ruled out, with values higher than 70 UI/L, should lead us to have a high degree of suspicion about tuberculous etiology and send the pleural fluid to microbiology for tuberculosis study\n", "Measurement of adenosine deaminase in pleural fluid\n", "Support"]]}
{"434_119": [["Coxiella infection is not transmitted by ticks\n", "The way of transmission of this entity is by ticks\n", "Attack"], ["The contact can be with high probability at the time of delivery of an infected farm animal, in which the bacterium is disseminated in aerosols\n", "Coxiella infection is not transmitted by ticks\n", "Attack"], ["A serologic test was performed with elevated antibody titers against phase I antigens\n", "elevation of antibodies against phase I antigens is observed and carries a higher risk of mortality\n", "Support"], ["The combination of doxycycline plus hicroxychloroquine can be used, but for chronic Q fever\n", "Both doxycycline and hydroxychloroquine are effective in treating acute forms of this disease\n", "Attack"], ["elevation of antibodies against phase I antigens is observed and carries a higher risk of mortality\n", "In its acute form it also presents, generally, elevation of antibodies against phase I antigens\n", "Attack"], ["The treatment of choice is with doxycycline in the acute phase\n", "Both doxycycline and hydroxychloroquine are effective in treating acute forms of this disease\n", "Attack"], ["elevation of antibodies against phase I antigens is observed and carries a higher risk of mortality\n", "Mortality in acute forms is almost nonexistent\n", "Attack"]]}
{"563_175": [["Health care providers should prescribe the shorter treatments, which are more convenient, whenever possible\n", "The shortest combination would be Isoniazid + Rifapentine for three months or Rifampicin for four months\n", "Support"], ["The shortest combination would be Isoniazid + Rifapentine for three months or Rifampicin for four months\n", "Rifampicin, for four months\n", "Support"], ["The shortest combination would be Isoniazid + Rifapentine for three months or Rifampicin for four months\n", "Isoniazid and rifapentine, for three months\n", "Support"], ["As of 2018, there are four dosing schedules for treatment of latent TB infection recommended by the CDC using isoniazid (INH), rifapentine (RPT) or rifampin (RIF)\n", "All treatments are effective\n", "Support"], ["All treatments are effective\n", "Health care providers should prescribe the shorter treatments, which are more convenient, whenever possible\n", "Support"], ["However, the fact that he is taking acenocoumarol means that the indication for this patient is Isoniazid for 9 months, since there is interaction between the rifamycin derivatives (rifapentine and rifampicin)\n", "Isoniazid, for nine months\n", "Support"]]}
{"89_57": [["we can objectively assess the severity of the disease with the use of bloodless techniques\n", "The most important is the ankle-brachial index\n", "Support"], ["The most important is the ankle-brachial index\n", "answer 2 is correct\n", "Support"], ["answer 2 is correct\n", "Ankle-brachial index\n", "Support"], ["Although the diagnosis of peripheral arteriopathy is fundamentally clinical (in this patient the picture is very typical)\n", "we can objectively assess the severity of the disease with the use of bloodless techniques\n", "Attack"], ["The most important is the ankle-brachial index\n", "Ankle-brachial index\n", "Support"], ["Imaging techniques (arteriography, angioCT or angioMRI) are used when surgical repair of arterial occlusion is considered\n", "Arteriography of lower extremities\n", "Attack"], ["Imaging techniques (arteriography, angioCT or angioMRI) are used when surgical repair of arterial occlusion is considered\n", "Computerized axial tomography with vascular reconstruction of lower extremities\n", "Attack"], ["Imaging techniques (arteriography, angioCT or angioMRI) are used when surgical repair of arterial occlusion is considered\n", "Magnetic resonance imaging\n", "Attack"]]}
{"586_75": [["She is exclusively breastfeeding\n", "Given her circumstances and taking into account that she is exclusively breastfeeding, the best thing to do would be to prescribe only gestagens\n", "Support"], ["She has a history of an emergency cesarean section 7 months ago, giving birth to a 3,550 g baby girl\n", "Given her circumstances and taking into account that she is exclusively breastfeeding, the best thing to do would be to prescribe only gestagens\n", "Support"], ["Given her circumstances and taking into account that she is exclusively breastfeeding, the best thing to do would be to prescribe only gestagens\n", "He explains that she could use a gestagen-only hormonal method\n", "Support"]]}
{"461_148": [["It is a headache in the context of papilledema\n", "In this case the papilledema is due to increased intracranial pressure due to a tumor\n", "Support"], ["A brain MRI shows a right hemispheric mass with edema, midline deviation and signs of tentorial herniation\n", "In this case the papilledema is due to increased intracranial pressure due to a tumor\n", "Support"], ["On examination she presents left pyramidal signs and papillary edema\n", "It is a headache in the context of papilledema\n", "Support"], ["it increases with Valsalva maneuvers and when bending down\n", "The headache due to increased intracranial pressure is of positional type\n", "Support"], ["The headache due to increased intracranial pressure is of positional type\n", "so option 2 is not correct\n", "Support"], ["The headache due to increased intracranial pressure is of positional type\n", "It does not change with effort\n", "Attack"], ["so option 2 is not correct\n", "It does not change with effort\n", "Attack"], ["In addition, it is predominantly morning\n", "option 1 is correct\n", "Support"], ["In addition, it is predominantly morning\n", "Morning predominance\n", "Support"], ["option 1 is correct\n", "Morning predominance\n", "Support"], ["in the morning intracranial pressure naturally rises\n", "In addition, it is predominantly morning\n", "Support"], ["In this case the papilledema is due to increased intracranial pressure due to a tumor\n", "in the morning intracranial pressure naturally rises\n", "Support"], ["But this headache is not a migraine headache\n", "Migraine-type headaches may be associated with photophobia or sonophobia (answers 3 and 4)\n", "Attack"], ["But this headache is not a migraine headache\n", "Photophobia\n", "Attack"], ["But this headache is not a migraine headache\n", "Sonophobia\n", "Attack"]]}
{"547_125": [["digoxin and non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) are contraindicated\n", "Digoxin\n", "Attack"], ["digoxin and non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) are contraindicated\n", "Verapamil\n", "Attack"], ["Procainamide\n", "Procainamide\n", "Support"], ["Heart rate slowing drugs, commonly used in atrial fibrillation, are ineffective\n", "Adenosine\n", "Attack"], ["IV procainamide or amiodarone is preferred, but any class Ia, Ic or III antiarrhythmic drug can be used\n", "Procainamide\n", "Support"]]}
{"193_161": [["Dehydration may be due to diarrhea of other etiologies\n", "Hypernatremic dehydration\n", "Support"], ["We have to understand that the growth of Pseudomona aeruginosa is in the culture of bronchial secretions\n", "Because clearly the indication to perform a sweat chlorine (to rule out FQP) are the HIPOnatremic dehydrations and not the hypernatremic ones as the answer says\n", "Support"], ["Because clearly the indication to perform a sweat chlorine (to rule out FQP) are the HIPOnatremic dehydrations and not the hypernatremic ones as the answer says\n", "Hypernatremic dehydration\n", "Attack"]]}
{"431_116": [["The laboratory reports the visualization of Plasmodium falciparum in the blood with a parasitemia level of 6%\n", "In severe cases of Plasmodium infection, the greatest risk of mortality occurs in the first 24 hours of clinical presentation\n", "Support"], ["In severe cases of Plasmodium infection, the greatest risk of mortality occurs in the first 24 hours of clinical presentation\n", "treatment should be started immediately\n", "Support"], ["treatment should be started immediately\n", "Treatment with parenteral or intramuscular artesunate is more indicated in severe Plasmodium infection, both in adults and children and in pregnant women\n", "Support"], ["Treatment with parenteral or intramuscular artesunate is more indicated in severe Plasmodium infection, both in adults and children and in pregnant women\n", "Intravenous artesunate\n", "Support"]]}
{"569_152": [["Microhematuria, proteinuria and sensorineural hearing loss in a young male with a family history of women with hematuria\n", "Alport syndrome\n", "Support"], ["Alport syndrome\n", "Alport syndrome\n", "Support"]]}
{"501_76": [["Calcium gluconate has no effect on blood potassium levels\n", "therefore options 1, 2 and 3 are ruled out\n", "Support"], ["therefore options 1, 2 and 3 are ruled out\n", "Encourage the displacement of potassium from the plasma space to the intracellular space\n", "Attack"], ["therefore options 1, 2 and 3 are ruled out\n", "Chelate circulating potassium to favor its hepatic elimination\n", "Attack"], ["therefore options 1, 2 and 3 are ruled out\n", "Chelate circulating potassium to favor its renal elimination\n", "Attack"], ["Its function is to decrease the excitability of cardiac myocytes to decrease the likelihood of developing heart rhythm disorders\n", "Antagonize the action of potassium on the myocardial cell membrane\n", "Support"]]}
{"242_111": [["The patient is a man with pneumonia with isolated germ in blood culture and antibiogram\n", "According to the data provided, it is a pneumococcus sensitive to penicillin (MIC < 0.125)\n", "Support"], ["According to the data provided, it is a pneumococcus sensitive to penicillin (MIC < 0.125)\n", "treatment is started with penicillin at high doses every 4 h, despite which the fever persists\n", "Support"], ["the germ is totally sensitive to the drug and the dosage is adequate\n", "If we analyze the case carefully, the treatment should be effective\n", "Support"], ["so that high concentrations of the drug should be maintained at all times, remember that the efficacy of beta-lactams is time-dependent and the antibiotic concentrations in blood should be above the MIC permanently to achieve effectiveness and avoid the production of resistance\n", "the germ is totally sensitive to the drug and the dosage is adequate\n", "Support"], ["an empyema has probably occurred\n", "it is not reaching the infectious focus adequately\n", "Support"], ["it is not reaching the infectious focus adequately\n", "although the antibiotic is the right one\n", "Attack"], ["an empyema has probably occurred\n", "We should rule out the existence of an empyema and drain it while continuing with the antibiotic treatment\n", "Support"], ["We should rule out the existence of an empyema and drain it while continuing with the antibiotic treatment\n", "It would rule out the presence of pleural empyema\n", "Support"], ["If the dosage had not been adequate and the presence of drug resistance was possible, one option could have been to treat with ceftriaxone at high doses\n", "I would change the treatment to ceftriaxone because of its greater efficacy\n", "Support"], ["we should remember that streptococcus does not produce beta-lactamase and beta-lactam resistance is produced by another mechanism\n", "If the dosage had not been adequate and the presence of drug resistance was possible, one option could have been to treat with ceftriaxone at high doses\n", "Support"], ["using amoxicillin-clavulanate would not provide us with anything\n", "I would switch to amoxicillin/clavulanic acid\n", "Attack"], ["With quinolone we do not increase the spectrum\n", "I would add a quinolone to the treatment\n", "Attack"], ["it is evident that the poor evolution of the patient is not only a problem of time\n", "I would continue with the same treatment, assuming it is simply a timing issue\n", "Attack"], ["treatment is started with penicillin at high doses every 4 h, despite which the fever persists\n", "If we analyze the case carefully, the treatment should be effective\n", "Support"], ["According to the data provided, it is a pneumococcus sensitive to penicillin (MIC < 0.125)\n", "the germ is totally sensitive to the drug and the dosage is adequate\n", "Support"]]}
{"487_68": [["Triplet expansion diseases, such as this one, can have the anticipation phenomenon whereby females with premutations (between 55-200 repeats) can have children with full mutations (more than 200 repeats of the triplet) and more obvious, more severe and/or earlier clinical, in both males and females (Fragile X syndrome, early ovarian failure, tremor/ataxia associated with Fragile X)\n", "There is a phenomenon of genetic anticipation, so their offspring will present more severe and earlier symptoms\n", "Support"], ["Also, on the same concept as question 44, the phenomenon of genetic anticipation\n", "There is a phenomenon of genetic anticipation, so their offspring will present more severe and earlier symptoms\n", "Support"]]}
{"364_176": [["given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing, unless GELF criteria are met to initiate treatment: GELF criteria (Follicular Lymphoma Study Group)\n", "There may be debate about whether to start Rituximab with another cytostatic drug or in monotherapy\n", "Attack"], ["given the lack of survival benefit with early initiation of treatment, the NCCN guidelines recommend waiting and seeing, unless GELF criteria are met to initiate treatment: GELF criteria (Follicular Lymphoma Study Group)\n", "Do not treat and monitor (wait and see)\n", "Support"]]}
{"90_32": [["If a conventional right hemicolectomy type surgery is performed, the chances of recurrence are higher than 30%\n", "Right hemicolectomy\n", "Attack"], ["The age and right location data lead us to answer 4: total colectomy with ileorectal anastomosis\n", "Total colectomy with ileorectal anatomosis\n", "Support"]]}
{"528_134": [["normal figures in consultation and elevated on AMPA or ABPM\n", "The patient described is the definition of masked HT\n", "Support"], ["He comes in showing blood pressure recordings taken at home over several weeks with values above 140/90 mmHg\n", "normal figures in consultation and elevated on AMPA or ABPM\n", "Support"], ["Her blood pressure has been taken repeatedly at the doctor's and nurse's office, presenting figures below 140/90 mmHg\n", "normal figures in consultation and elevated on AMPA or ABPM\n", "Support"], ["The patient described is the definition of masked HT\n", "option 2 correct\n", "Support"], ["option 2 correct\n", "Presents masked arterial hypertension\n", "Support"], ["It is not secondary HT because no study has been done to confirm it\n", "option 1 incorrect\n", "Support"], ["option 1 incorrect\n", "She has secondary hypertension\n", "Attack"], ["the elevated figures are maintained for several weeks\n", "It is not isolated HT\n", "Support"], ["It is not isolated HT\n", "option 3 incorrect\n", "Support"], ["option 3 incorrect\n", "Presents isolated clinical hypertension\n", "Attack"], ["It is not refractory HT because it has not yet been treated\n", "option 4 incorrect\n", "Support"], ["option 4 incorrect\n", "Presents refractory arterial hypertension\n", "Attack"]]}
{"583_70": [["FSH >20; estradiol <5\n", "The hormonal profile we are told is in menopausal range\n", "Support"], ["the patient has systemic vasomotor symptoms\n", "The hormonal profile we are told is in menopausal range\n", "Support"], ["The hormonal profile we are told is in menopausal range\n", "Therefore, it would be more appropriate to administer systemic estrogens\n", "Support"], ["Therefore, it would be more appropriate to administer systemic estrogens\n", "Transdermal estrogens in a continuous regimen\n", "Support"]]}
{"195_163": [["The treatment of choice is intramuscular adrenaline, and effectively, without wasting too much time\n", "The first thing is INTRAMUSCULAR adrenaline NOW\n", "Support"], ["A 15-month-old boy, who during dinner, after eating a bite of tortilla, suddenly presented with facial reddening predominantly perioral, habonous lesions on the trunk and extremities and cough.\n", "She is describing egg anaphylaxis, a potentially fatal condition\n", "Support"], ["On arrival at the center, the patient was conscious and, in addition to what was described above, the following were observed: suprasternal twitching, abundant watery rhinorrhea, bilateral hypoventilation without wheezing and capillary refill of less than 2 seconds\n", "She is describing egg anaphylaxis, a potentially fatal condition\n", "Support"], ["The first thing is INTRAMUSCULAR adrenaline NOW\n", "Intramuscular adrenaline should be administered without further delay\n", "Support"], ["The treatment of choice is intramuscular adrenaline, and effectively, without wasting too much time\n", "Intramuscular adrenaline should be administered without further delay\n", "Support"], ["The venous route, corticosteroids, antihistamines, etc. will come later\n", "The priority is to cannulate a venous line\n", "Attack"], ["The venous route, corticosteroids, antihistamines, etc. will come later\n", "Intramuscular methylprednisolone is the treatment of choice\n", "Attack"], ["The venous route, corticosteroids, antihistamines, etc. will come later\n", "It is a picture of urticaria associated with asthma, and should be treated with antihistamines and inhaled bronchodilators\n", "Attack"]]}
{"84_49": [["in this case we will use bisoprolol\n", "Bisoprolol\n", "Support"], ["In a patient with multiple CVRF with concomitant heart and renal failure (presumably of multiple etiology: renal hypoperfusion, arteriosclerosis...)\n", "we must be very careful when using diuretics and ACEI/ARA-II\n", "Support"], ["we can worsen renal function and/or increase potassium levels (among diuretics, spironolactone and eplerenone are \"potassium-sparing\")\n", "we must be very careful when using diuretics and ACEI/ARA-II\n", "Support"], ["we must be very careful when using diuretics and ACEI/ARA-II\n", "Enalapril\n", "Attack"], ["we must be very careful when using diuretics and ACEI/ARA-II\n", "Losartan\n", "Attack"], ["we must be very careful when using diuretics and ACEI/ARA-II\n", "Spironolactone\n", "Attack"], ["we must be very careful when using diuretics and ACEI/ARA-II\n", "Eplerenone\n", "Attack"]]}
{"427_95": [["On examination she has a palpable neck mass and a blood test shows plasma calcium levels of 15 mg/dL\n", "normal up to 10.2 mg/dL\n", "Support"], ["therefore, the option of medullary thyroid cancer is ruled out\n", "Medullary thyroid carcinoma\n", "Attack"], ["it does not affect the level of calcemia\n", "therefore, the option of medullary thyroid cancer is ruled out\n", "Support"], ["It is associated with hypercalcemia\n", "therefore, the option of medullary thyroid cancer is ruled out\n", "Support"], ["Palpable mass in the neck\n", "suspect thyroid/parathyroid pathology\n", "Support"], ["To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors)\n", "MEN type I\n", "Attack"], ["The presence of a calcemia higher than 13mgr/dl, together with dysphonia, indicates a malignant tumor (higher calcemia level and infiltration)\n", "therefore we opt for option 1\n", "Support"], ["therefore we opt for option 1\n", "Parathyroid carcinoma\n", "Support"], ["A 45-year-old woman comes to the emergency department with confusional symptoms accompanied by dysphonia\n", "To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors)\n", "Attack"], ["On examination she has a palpable neck mass and a blood test shows plasma calcium levels of 15 mg/dL\n", "To think of MEN type I we should associate other pathologies (pituitary, pancreatic or duodenal tumors)\n", "Attack"], ["On examination she has a palpable neck mass and a blood test shows plasma calcium levels of 15 mg/dL\n", "The presence of a calcemia higher than 13mgr/dl, together with dysphonia, indicates a malignant tumor (higher calcemia level and infiltration)\n", "Support"]]}
{"462_151": [["In this case the MRI already places the origin of the symptoms in the pineal gland\n", "The most frequent tumor in this region is the germ cell tumor (answer 3)\n", "Support"], ["The most frequent tumor in this region is the germ cell tumor (answer 3)\n", "Germ cell tumor\n", "Support"]]}
{"557_168": [["Diagnostic Criteria for DM according to ISPAD 2018 *Classic symptoms of diabetes with blood glucose > 200mgr/dl or: * Fasting glycemia \u2265 126mgr/dl (fasting at least 8h) or * Glycemia at 2h SOG \u2265 200mgr/dl (on 2 occasions) or * HbA1C \u2265 6.5%\n", "Already meets diagnostic criteria for diabetes mellitus\n", "Support"]]}
{"35_68": [["It does not explain pyramidalism\n", "Answer 1 incorrect\n", "Support"], ["We would lack data to think of a Brown Sequard hemimedullary syndrome\n", "Answer 3 incorrect\n", "Support"], ["It could explain the difficulty in dorsiflexion and plantar flexion of the foot, but not the pyramidalism\n", "Incorrect answer 4\n", "Support"], ["it could explain part of the clinical picture, but not the pyramidalism\n", "Incorrect answer 5\n", "Support"], ["It would explain the pyramidalism, but we would be missing data suggestive of this picture such as a contralateral hypoesthesia\n", "Answer 3 incorrect\n", "Support"], ["It does not explain pyramidalism\n", "Mononeuropathy of the right common peroneal nerve\n", "Attack"], ["We would lack data to think of a Brown Sequard hemimedullary syndrome\n", "Right hemimedullary involvement (Brown-Sequard)\n", "Attack"], ["It would explain the pyramidalism, but we would be missing data suggestive of this picture such as a contralateral hypoesthesia\n", "Right hemimedullary involvement (Brown-Sequard)\n", "Attack"], ["It could explain the difficulty in dorsiflexion and plantar flexion of the foot, but not the pyramidalism\n", "Multiple mononeuropathy with involvement of the common peroneal and right posterior tibial nerve.\n", "Attack"], ["it could explain part of the clinical picture, but not the pyramidalism\n", "Right lumbar plexopathy\n", "Attack"]]}
{"271_170": [["The answer is obviously 4\n", "Perform electrocardiogram\n", "Support"], ["Had there been a fifth option it would have been that nothing needs to be done, which might have generated some doubt in the student, but since the question does not exist it is a piece of candy\n", "The answer is obviously 4\n", "Support"], ["Although there are many protocols on preoperative procedures, almost as many as there are hospitals, the question makes it easy by putting a very old patient, 80 years old\n", "The answer is obviously 4\n", "Support"], ["The age range from which it is considered mandatory to request an ECG varies between 45, 50, 60 or even some say 70 years\n", "The answer is obviously 4\n", "Support"], ["An 80-year-old man comes to your office for evaluation of a scheduled cholecystectomy by laparoscopy\n", "Although there are many protocols on preoperative procedures, almost as many as there are hospitals, the question makes it easy by putting a very old patient, 80 years old\n", "Support"]]}
{"306_207": [["Fracture of the roof is much less frequent\n", "Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n", "Attack"], ["entrapment of the superior rectus would cause limitation for infraduction\n", "Fracture of the superior wall of the orbit with entrapment of the superior rectus muscle\n", "Attack"], ["As the mechanical function of the left inferior rectus is compromised, it would not allow to complete the supraduccion movement generating vertical diplopia, this plus the traumatic antecedent allows to suspect a fracture of the orbital floor with muscular entrapment of the inferior rectus\n", "Fracture of the inferior wall of the floor of the orbit with entrapment of the inferior rectus muscle\n", "Support"]]}
{"328_83": [["Discontinue sulfonylurea because of Risk of hypoglycemia\n", "Discontinue sulfonylurea\n", "Support"]]}
{"223_62": [["2 is absurd: sitting down to avoid angina?\n", "Expectorant with rigorous rest, since decreasing myocardial oxygen demand should decrease angina\n", "Attack"], ["although I miss statins, ACE inhibitors and antiplatelet agents, and I have too many vasodilators (nitrates are class IIb, if my memory serves me correctly)\n", "Answer 1 is along these lines\n", "Attack"], ["Answer 1 is along these lines\n", "Medical with vasodilators and beta-blockers to avoid angina\n", "Support"], ["although I miss statins, ACE inhibitors and antiplatelet agents, and I have too many vasodilators (nitrates are class IIb, if my memory serves me correctly)\n", "Medical with vasodilators and beta-blockers to avoid angina\n", "Attack"], ["That's like cutting down the forest to prevent fires\n", "2 is absurd: sitting down to avoid angina?\n", "Support"], ["3 to 5 are about revascularization: since it is a single vessel and not a proximal LAD, revascularization would have to be percutaneous\n", "we discard 3\n", "Support"], ["we discard 3\n", "Surgical revascularization of the ischemic myocardium by means of a left mammary artery bypass distal to the lesion in the diseased coronary artery\n", "Attack"], ["Between 4 and 5, the fifth is more complete\n", "Therapeutic catheterization to dilate the lesion of the diseased artery and implantation of a stent in the dilated area\n", "Support"], ["not only would it be necessary to dilate, but also to implant a stent\n", "Between 4 and 5, the fifth is more complete\n", "Support"], ["and this is what would be done in any hospital nowadays: a suboccluded artery is dilated directly\n", "we would mark 5\n", "Support"], ["Applying the general rules of response in the MIR, if two options are similar except in one detail, the correct one is one of these\n", "we would mark 5\n", "Support"], ["we would mark 5\n", "Therapeutic catheterization to dilate the lesion of the diseased artery and implantation of a stent in the dilated area\n", "Support"], ["Between 4 and 5, the fifth is more complete\n", "Dilatation of the coronary artery lesion by therapeutic catheterization\n", "Attack"], ["I would mark 5... but I would not be surprised if it was 1\n", "Therapeutic catheterization to dilate the lesion of the diseased artery and implantation of a stent in the dilated area\n", "Support"]]}
{"468_122": [["the febrile fever and the limitation of mobility of the spine with the acute course give the key\n", "We suspect spondylodiscitis\n", "Support"], ["We suspect spondylodiscitis\n", "the indicated test is the MRI\n", "Support"], ["the indicated test is the MRI\n", "Pyogenic spondylodiscitis with magnetic resonance imaging (MRI)\n", "Support"], ["\"The most demonstrative test is magnetic resonance imaging (MRI), which is positive even in the first 2 weeks of the picture, which facilitates early diagnosis, with a sensitivity of 90%\"\n", "the indicated test is the MRI\n", "Support"], ["In addition, there is no data in the history pointing to bone metastases (oncologic history, weight loss etc)\n", "Bone metastases with technetium bone scan\n", "Attack"], ["Vertebral crushing would be seen in the simple X-ray, as well as vertebral ankylosing hyperostosis and many metastases\n", "Vertebral crush with computed tomography (CT)\n", "Attack"], ["We suspect spondylodiscitis\n", "Pyogenic spondylodiscitis with magnetic resonance imaging (MRI)\n", "Support"]]}
{"96_170": [["Clinically, it is characterized by marked skin fragility with the appearance of erosions, vesicles and blisters after minimal trauma\n", "Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n", "Support"], ["The picture is accompanied by skin fragility\n", "Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n", "Support"], ["Histopathologically there is a subepidermal blister with PAS+ deposits in and around the superficial dermal vessels\n", "Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n", "Support"], ["Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n", "Porphyria cutanea tarda\n", "Support"], ["60-year-old male patient who refers 10 days ago the appearance of blistering lesions on dorsum of hands after sun exposure\n", "Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n", "Support"], ["The most frequent sites are the back of the hands and the face, i.e. the areas of greatest photoexposure\n", "Porphyria cutanea tarda (PCT) is the most common porphyria and can present with three major clinical forms: familial, sporadic and toxic\n", "Support"]]}
{"603_112": [["A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third\n", "The most common symptomatology of a patient with coxarthrosis includes: hip pain that limits ambulation, nocturnal discomfort and even at rest, hip stiffness and locking\n", "Attack"], ["The pain appears when the lower limb is lifted with the knee extended, but is relieved when the knee is flexed\n", "Coxo-femoral osteoarthrosis presents with a negative Lasegue test\n", "Attack"], ["The most common symptomatology of a patient with coxarthrosis includes: hip pain that limits ambulation, nocturnal discomfort and even at rest, hip stiffness and locking\n", "Wrong answer 2\n", "Support"], ["Coxo-femoral osteoarthrosis presents with a negative Lasegue test\n", "Wrong answer 2\n", "Support"], ["Wrong answer 2\n", "Left coxofemoral arthrosis\n", "Attack"], ["A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third\n", "Low back pain of a neuropathic nature usually presents with unilateral and distributed radiculopathy according to dermatomes\n", "Support"], ["A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third\n", "The recognized risk factors are most frequently: women, obesity, smoking and sedentary lifestyle or situations of prolonged sitting\n", "Support"], ["A 61-year-old woman, administrative, with a history of overweight, hypertension, dyslipidemia and metabolic syndrome, who consults for pain in both buttocks, left trochanteric region, lateral aspect of the left thigh up to the knee and left leg up to the middle third\n", "The lumbosciatica is usually referred to the buttock, posterior aspect of the thighs and even inguinal\n", "Support"], ["The clinical case describes the Lasegue maneuver or test\n", "a provocation test that evidences radicular irritation in the lumbosacral region\n", "Support"], ["The pain appears when the lower limb is lifted with the knee extended, but is relieved when the knee is flexed\n", "a provocation test that evidences radicular irritation in the lumbosacral region\n", "Support"], ["a provocation test that evidences radicular irritation in the lumbosacral region\n", "Answer 3 correct\n", "Attack"], ["Low back pain of a neuropathic nature usually presents with unilateral and distributed radiculopathy according to dermatomes\n", "Answer 3 correct\n", "Support"], ["The recognized risk factors are most frequently: women, obesity, smoking and sedentary lifestyle or situations of prolonged sitting\n", "Answer 3 correct\n", "Support"], ["The lumbosciatica is usually referred to the buttock, posterior aspect of the thighs and even inguinal\n", "Answer 3 correct\n", "Support"], ["Claudication due to canal stenosis typically presents with pain that worsens with trunk extension (walking, standing) and is relieved with flexion (sitting, sleeping in the fetal position...)\n", "Wrong answer 4\n", "Support"], ["Wrong answer 4\n", "Claudication due to canal stenosis\n", "Attack"]]}
{"574_100": [["It is a semiology question that helps us to remember the types of aphasia\n", "The following aspects should be taken into account: language emission (fluent, non-fluent, non-emission), comprehension (yes or no), repetition (yes or no) and nomination\n", "Support"], ["On arrival at the hospital, an unknown atrial fibrillation is observed, and on examination she presents fluent speech with a tendency to slurred speech, poor language comprehension, inability to repeat and dysnomia\n", "Wernicke's aphasia or sensitive aphasia has a fluent language, does not understand, does not repeat and does not nominate, just like the patient in the question\n", "Support"], ["Wernicke's aphasia or sensitive aphasia has a fluent language, does not understand, does not repeat and does not nominate, just like the patient in the question\n", "Wernicke's aphasia\n", "Support"], ["On arrival at the hospital, an unknown atrial fibrillation is observed, and on examination she presents fluent speech with a tendency to slurred speech, poor language comprehension, inability to repeat and dysnomia\n", "Sensory transcortical aphasia differs from sensory aphasia in that patients are able to repeat\n", "Attack"], ["Sensory transcortical aphasia differs from sensory aphasia in that patients are able to repeat\n", "Sensitive transcortical aphasia\n", "Attack"], ["On arrival at the hospital, an unknown atrial fibrillation is observed, and on examination she presents fluent speech with a tendency to slurred speech, poor language comprehension, inability to repeat and dysnomia\n", "Conduction aphasia differs from sensory aphasia in that comprehension is preserved, all else being equal\n", "Attack"], ["Conduction aphasia differs from sensory aphasia in that comprehension is preserved, all else being equal\n", "Conduction aphasia\n", "Attack"], ["On arrival at the hospital, an unknown atrial fibrillation is observed, and on examination she presents fluent speech with a tendency to slurred speech, poor language comprehension, inability to repeat and dysnomia\n", "Finally, in broca's aphasia the language is non-fluent, comprehension is preserved, it does not repeat and does not nominate\n", "Attack"], ["Finally, in broca's aphasia the language is non-fluent, comprehension is preserved, it does not repeat and does not nominate\n", "Broca's aphasia\n", "Attack"]]}
{"67_111": [["The urine is normal (without hematuria, caused by the lithiasis as it progresses)\n", "In principle, what you tell us does not fit with a nephritic colic\n", "Support"], ["the Creat is normal (it can rise up to 1.9 in nephritic colic)\n", "In principle, what you tell us does not fit with a nephritic colic\n", "Support"], ["which, in addition, being a 45-year-old male, with no previous history, does not seem to respond to an underlying structural heart disease together with right lumbar pain, which could correspond to irritation of the pleura at the level of the right lumbar spine\n", "In this case, we have an important risk factor for embolism, which is atrial fibrillation\n", "Support"], ["The increase in LDH is non-specific and can be found in hepatic parenchymal lesions, AMI or pulmonary embolism, as well as in many other less frequent cases (tumors, myopathies, etc.)\n", "In this case, we have an important risk factor for embolism, which is atrial fibrillation\n", "Support"], ["It can also provide an alternative diagnosis in case PTE is not confirmed\n", "it would be a very useful test\n", "Support"], ["it would be a very useful test\n", "Spiral CT with contrast\n", "Support"], ["Spiral CT with contrast has acquired great value in the diagnosis of PTE\n", "Spiral CT with contrast\n", "Support"], ["It can also provide an alternative diagnosis in case PTE is not confirmed\n", "Spiral CT with contrast\n", "Support"], ["Doppler ultrasound would be the most useful test to diagnose the source of the emboli\n", "Doppler ultrasound\n", "Support"], ["it could also be a valid answer depending on what they mean by \"useful\"\n", "Doppler ultrasound\n", "Support"], ["Its limitations are the assessment of infrapopliteal thrombi and, in many cases, in patients who are not thin, of the iliac and cava veins\n", "it could also be a valid answer depending on what they mean by \"useful\"\n", "Attack"], ["Its limitations are the assessment of infrapopliteal thrombi and, in many cases, in patients who are not thin, of the iliac and cava veins\n", "Doppler ultrasound\n", "Attack"]]}
{"77_31": [["Treatment of the disease and its control usually improves the cutaneous lesions\n", "Adjustment of the treatment of the disease\n", "Support"], ["The lesions should not be biopsied\n", "Biopsy skin areas away from the injured areas and prescribe opioid analgesics at the beginning\n", "Attack"], ["The lesions should not be biopsied\n", "Biopsy skin areas away from the injured areas and prescribe opioid analgesics at the beginning\n", "Attack"], ["It appears that the patient has erythema nodosum lesions associated with a flare of his disease, which is common\n", "Treatment of the disease and its control usually improves the cutaneous lesions\n", "Support"]]}
[{"440_97": []}]
{"203_47": [["most of these situations resolve spontaneously with conservative treatment\n", "The correct answer is 5 and not 1\n", "Support"], ["The correct answer is 5 and not 1\n", "Initial management should be conservative, with serum therapy, nasogastric aspiration and periodic clinical, analytical and radiographic monitoring\n", "Support"]]}
{"158_133": [["Obese 12-year-old boy (87 kg)\n", "We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation\n", "Support"], ["He has been complaining of mechanical pain in the right thigh and knee for 4 months\n", "We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation\n", "Support"], ["Clinical examination reveals a 1 cm discrepancy in the length of the lower extremities and an attitude of the right lower extremity in external rotation with loss of internal rotation\n", "We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation\n", "Support"], ["We are presented with an adolescent patient who is overweight with pain in the thigh and knee, a length discrepancy of 1 cm and the limb in external rotation\n", "This picture should automatically lead us to mark epiphysiolysis capitis femoris (proximal femoral epiphysiolysis, the fact of reading it in Latin nomina is a bit of a misunderstanding but it should not mislead us\n", "Support"], ["This picture should automatically lead us to mark epiphysiolysis capitis femoris (proximal femoral epiphysiolysis, the fact of reading it in Latin nomina is a bit of a misunderstanding but it should not mislead us\n", "Epiphysiolysis capitis femoris\n", "Support"], ["We should think of this one because it is the most frequent and possible (correct answer 2)\n", "Epiphysiolysis capitis femoris\n", "Support"], ["If they were sequelae of hip dysplasia, it would not have this 4-month onset and the age of onset would be earlier\n", "Sequelae of developmental dysplasia of the hip\n", "Attack"], ["Obese 12-year-old boy (87 kg)\n", "Sequelae of developmental dysplasia of the hip\n", "Attack"], ["He has been complaining of mechanical pain in the right thigh and knee for 4 months\n", "Sequelae of developmental dysplasia of the hip\n", "Attack"], ["Complications of dysplasia are dislocations and subluxations that may require surgery and avascular necrosis of the head (false answer 5)\n", "Sequelae of developmental dysplasia of the hip\n", "Attack"], ["Perthes disease occurs in younger children (4-9 years) with episodes of limping and pain in the hip and knee (false answer 4)\n", "Perthes disease\n", "Attack"], ["In a child the most typical would be a fracture at the level of the physis, not at the level of the femoral neck, so we discard 3.\n", "Fracture of the femoral neck due to overload\n", "Attack"], ["As for juvenile chronic arthritis, it is a rheumatoid option surrounded by trauma options\n", "Juvenile chronic arthritis\n", "Attack"], ["They do not speak to us of rheumatologic factors in an analytical analysis, nor of a polyarticular picture\n", "Juvenile chronic arthritis\n", "Attack"], ["He has been complaining of mechanical pain in the right thigh and knee for 4 months\n", "Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false)\n", "Support"], ["Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false)\n", "Juvenile chronic arthritis\n", "Attack"], ["In addition, the knee pain in this case refers to a referred pain of the hip, without involvement of the knee\n", "Perhaps we could think about this one because they talk about pain in the right knee, but this picture that they present us is limited to the right lower limb, they do not talk about other joints or fever or other accompanying systemic symptoms, so it is not an option to evaluate, especially with the other options presented to us that would be more likely in view of the picture presented to us (option 1 false)\n", "Support"]]}
{"46_155": [["The correct answer is 5\n", "Chemoprophylaxis with INH, 8-12 weeks. Repeat PT. If negative, stop treatment. If positive, perform chest X-ray to decide whether or not there is disease\n", "Support"], ["If the result of the repeat PT is still negative, the child should not be tested again\n", "Chemoprophylaxis with INH, 8-12 weeks. Repeat PT. If negative, stop treatment. If positive, perform chest X-ray to decide whether or not there is disease\n", "Support"], ["If it is positive, the X-ray (or pulmonary CT in younger children) should be repeated\n", "Chemoprophylaxis with INH, 8-12 weeks. Repeat PT. If negative, stop treatment. If positive, perform chest X-ray to decide whether or not there is disease\n", "Support"]]}
[{"593_146": []}]
[{"395_136": []}]
{"424_91": [["values above 20ngr/ml are considered hyperprolectinemia\n", "Prolactin values are normal\n", "Support"], ["Analytically, the estradiol concentration is below normal and the prolactin value is 12 ng/mL\n", "Prolactin values are normal\n", "Support"], ["For its diagnosis we will ask for a basal FSH\n", "Basal FSH\n", "Support"], ["They tell us that the estrogen level is low\n", "In this case we should suspect early ovarian failure\n", "Support"], ["In this case we should suspect early ovarian failure\n", "For its diagnosis we will ask for a basal FSH\n", "Support"], ["in cases of premature ovarian failure it would be elevated\n", "In this case we should suspect early ovarian failure\n", "Support"]]}
{"169_87": [["At least for me, as a family physician, I usually start with the least invasive and most cost-effective tests, and in the case described, an ischemic problem in the lower limbs is the ankle-brachial index\n", "Ankle-brachial index\n", "Support"]]}
{"95_170": [["The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)\n", "Porphyria cutanea tarda\n", "Support"], ["The rest of the answers do not fit with the clinical picture or the histology\n", "Scalded skin syndrome\n", "Attack"], ["The rest of the answers do not fit with the clinical picture or the histology\n", "Pemphigus vulgaris\n", "Attack"], ["The rest of the answers do not fit with the clinical picture or the histology\n", "Pemphigoid\n", "Attack"], ["The rest of the answers do not fit with the clinical picture or the histology\n", "Familial benign pemphigus\n", "Attack"], ["A 60-year-old male patient who reported 10 days ago the appearance of blistering lesions on the dorsum of the hands after sun exposure\n", "The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)\n", "Support"], ["Histopathologically there is a subepidermal blister with PAS+ deposits in and around the superficial dermal vessels\n", "The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)\n", "Support"], ["The picture is accompanied by skin fragility\n", "The fact of being a photoinduced picture, the histology and the age make the diagnosis of PCT more probable (3)\n", "Support"]]}
[{"537_1": []}]
{"363_97": [["Acute hemolytic transfusion reactions can occur within minutes\n", "Hemolytic transfusion reaction\n", "Support"], ["5-10 minutes after starting the transfusion, she begins with fever, chills, hypotension and pain in the lumbar region\n", "Clinically they are characterized by chills, fever, urticaria, tachycardia, nausea and vomiting, lumbar pain, hemorrhage due to disseminated intravascular coagulation (DIC).....\n", "Support"], ["Clinically they are characterized by chills, fever, urticaria, tachycardia, nausea and vomiting, lumbar pain, hemorrhage due to disseminated intravascular coagulation (DIC).....\n", "Acute hemolytic transfusion reactions can occur within minutes\n", "Support"], ["We are told of a patient who, within minutes of starting a transfusion, presented with an acute and very serious condition (with shock)\n", "Such an acute and severe situation only fits option 4\n", "Support"], ["Such an acute and severe situation only fits option 4\n", "Hemolytic transfusion reaction\n", "Support"]]}
{"339_33": [["she does not have a family history of neoplasia\n", "The study of relatives and the BCRA gene is not indicated\n", "Support"], ["The study of relatives and the BCRA gene is not indicated\n", "BRCA 1-2 study and study of first-degree relatives\n", "Attack"], ["All breast carcinomas should be accompanied by the study of hormone receptors and HER-2 for the prognostic implications of the tumor, as well as the adequacy of the treatment of the same, since depending on the result will apply some drugs or others\n", "Complete phenotypic study by flow cytometry\n", "Support"], ["The study of relatives and the BCRA gene is not indicated\n", "Study of hormone receptors, e-cadherin and study of first-degree relatives\n", "Attack"]]}
{"144_142": [["The correct answer is 1\n", "Suspect anorexia nervosa and inquire about intake, body image, etc\n", "Support"], ["The symptoms and signs described are the biological findings associated with anorexia nervosa\n", "Suspect anorexia nervosa and inquire about intake, body image, etc\n", "Support"], ["A 13-year-old girl consults us for weight loss, asthenia, secondary amenorrhea and constipation\n", "Suspect anorexia nervosa and inquire about intake, body image, etc\n", "Support"], ["Examination revealed a temperature of 35\u00baC, weight below the 3rd percentile, bradycardia and orthostatic hypotension.\n", "Suspect anorexia nervosa and inquire about intake, body image, etc\n", "Support"], ["on the electrocardiogram a flattened T wave with ST-segment elevation and prolonged QTc\n", "The ECG disturbances are derived from electrolyte disturbances.\n", "Support"], ["The ECG disturbances are derived from electrolyte disturbances.\n", "Suspect anorexia nervosa and inquire about intake, body image, etc\n", "Support"]]}
{"356_166": [["This is hypertension that is detected before pregnancy or before the 20th week of pregnancy and/or persists at 12 weeks postpartum\n", "Chronic hypertension\n", "Support"], ["A pregnant woman, 10 weeks pregnant, comes to the emergency room with a blood pressure of 160/105 mmHg\n", "This is hypertension that is detected before pregnancy or before the 20th week of pregnancy and/or persists at 12 weeks postpartum\n", "Support"], ["Chronic hypertension\n", "Chronic hypertension\n", "Support"]]}
{"495_64": [["That is why today, anthracyclines (does not suffer from heart) and taxanes before RT\n", "Chemotherapy based on anthracyclines and taxanes, and radiotherapy\n", "Support"], ["High grade, and no hormone receptors or her2 (the dreaded triple negative)\n", "That is why today, anthracyclines (does not suffer from heart) and taxanes before RT\n", "Support"], ["I was there when there were no taxanes or herceptin and I was in the trials that showed that more and more are being cured, unfortunately still not all\n", "That is why today, anthracyclines (does not suffer from heart) and taxanes before RT\n", "Support"]]}
{"355_166": [["The SEGO in its 2006 protocol \"Hypertensive disorders of pregnancy\" refers that this is chronic hypertension, although diagnosed in pregnancy\n", "Chronic hypertension\n", "Support"], ["This is because it has been diagnosed at 10 weeks of gestation\n", "The SEGO in its 2006 protocol \"Hypertensive disorders of pregnancy\" refers that this is chronic hypertension, although diagnosed in pregnancy\n", "Support"], ["Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)\n", "Moderate preeclampsia\n", "Attack"], ["This is because it has been diagnosed at 10 weeks of gestation\n", "Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)\n", "Attack"], ["Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)\n", "Pregnancy-induced hypertension\n", "Attack"], ["Above 20 weeks' gestation, we would be talking about preeclampsia (if HT + proteinuria or uterine artery pulsatility index above the 95th percentile), pregnancy-induced hypertension (only HT) or eclampsia (a form of severe preeclampsia)\n", "Eclampsia\n", "Attack"], ["The SEGO in its 2006 protocol \"Hypertensive disorders of pregnancy\" refers that this is chronic hypertension, although diagnosed in pregnancy\n", "The correct answer is 3\n", "Support"], ["The correct answer is 3\n", "Chronic hypertension\n", "Support"]]}
{"94_31": [["the usefulness of antidepressants in this picture has not been described\n", "answer n\u00ba1 would not be correct\n", "Support"], ["answer n\u00ba1 would not be correct\n", "Recommend relative rest and warm cloths on both legs and add antidepressant treatment\n", "Attack"], ["About 10% of cases of erythema nodosum are associated with inflammatory bowel disease, both ulcerative colitis and Crohn's disease\n", "Adjustment of bowel disease treatment.\n", "Support"], ["When associated with inflammatory bowel disease, erythema nodosum usually resolves with treatment of the intestinal flare, and recurs with disease recurrences\n", "Adjustment of bowel disease treatment.\n", "Support"]]}
{"39_134": [["there would be infectious signs\n", "1 cannot be\n", "Support"], ["the radiotherapy that the patient received would be oriented on the breast and not on the mandible\n", "3 seems unlikely to me\n", "Support"], ["bisphosphonates create mandibular necrosis\n", "Answer 2 is possible\n", "Support"], ["it is not a case of dental root involvement\n", "I rule out number 4\n", "Support"], ["the patient already has bone metastases\n", "5 is possible\n", "Support"], ["1 cannot be\n", "Odontogenic abscess\n", "Attack"], ["Answer 2 is possible\n", "Osteonecrosis due to bisphosphonates\n", "Support"], ["3 seems unlikely to me\n", "Osteoradionecrosis\n", "Attack"], ["I rule out number 4\n", "Dental root included\n", "Attack"], ["5 is possible\n", "Metastasis of breast carcinoma\n", "Support"], ["between two possible answers you have to always answer, and between 2 and 5, you have to check 2, which is more likely\n", "Metastasis of breast carcinoma\n", "Attack"], ["between two possible answers you have to always answer, and between 2 and 5, you have to check 2, which is more likely\n", "Osteonecrosis due to bisphosphonates\n", "Support"]]}
{"252_83": [["a young patient with a frequent history of dysphagia to solids and liquids with repeated food impactions, without symptoms of heartburn and in whom oral endoscopy shows multiple concentric esophageal rings with normal mucosa (trachealized appearance)\n", "The endoscopic appearance of trachealized esophagus is very typical of eosinophilic esophagitis, which presents with dysphagia and repeated food impactions\n", "Support"], ["The endoscopic appearance of trachealized esophagus is very typical of eosinophilic esophagitis, which presents with dysphagia and repeated food impactions\n", "Eosinophilic esophagitis\n", "Support"]]}
{"57_77": [["the answer is CT\n", "An adrenal CT scan\n", "Support"], ["before doing the CT scan, ACTH should be measured and, once ACTH is suppressed, the CT scan should be done\n", "Anyway, I think that the clinical case is poorly stated\n", "Support"]]}
[{"595_88": []}]
{"98_171": [["Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n", "Lichen planus\n", "Support"], ["The patient presents since 2 weeks ago a pruritic eruption consisting of multiple polygonal erythematous-violaceous papules, with flattened surface, preferentially located on the anterior aspect of the wrists, pretibial area and lumbar area\n", "Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n", "Support"], ["Characteristically these papules show a symmetrical distribution and are preferentially located on the anterior aspect of the wrists (Figure 1) and ankles\n", "Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n", "Support"], ["She also presents whitish reticulated lesions in the jugal mucosa\n", "Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n", "Support"], ["Oral mucosal involvement is very frequent, and approximately 75% of patients with lichen planus show an asymptomatic whitish reticulation affecting the jugal or lingual mucosa\n", "Lichen planus is a very common dermatosis of unknown etiology characterized by the appearance of pruritic polygonal papules, with a purplish color and shiny surface, preferentially located in the distal areas of the extremities\n", "Support"]]}
{"118_117": [["In young contacts, chemoprophylaxis should be started even if the mantoux test is negative and repeated after 2-3 months to decide whether to continue treatment for 6 months (if it turns positive) or to stop it\n", "Start chemoprophylaxis and repeat skin test after 3 months\n", "Support"], ["A 14-year-old asymptomatic boy whose father has just been diagnosed with pulmonary TB undergoes a Mantoux test, with a negative result\n", "Start chemoprophylaxis and repeat skin test after 3 months\n", "Support"]]}
[{"388_233": []}]
{"421_78": [["Among these, less importance is given to the size of the lesion than to its degree of invasion of the intestinal wall or other adjacent structures, a criterion that must be taken into account for staging by TNM or Astler-Coller classification, which guide the indication of adjuvant treatment after the surgical approach\n", "The size of the primary lesion and histological differentiation\n", "Attack"], ["Among these, less importance is given to the size of the lesion than to its degree of invasion of the intestinal wall or other adjacent structures, a criterion that must be taken into account for staging by TNM or Astler-Coller classification, which guide the indication of adjuvant treatment after the surgical approach\n", "Perforation or adhesion of the tumor to adjacent organs\n", "Support"], ["we must know which are the poor prognostic factors in this pathology\n", "obstruction or intestinal perforation due to the lesion, invasion of adjacent organs, elevation of tumor markers such as CEA and the histology of the neoplasm stand out\n", "Support"], ["obstruction or intestinal perforation due to the lesion, invasion of adjacent organs, elevation of tumor markers such as CEA and the histology of the neoplasm stand out\n", "Among these, less importance is given to the size of the lesion than to its degree of invasion of the intestinal wall or other adjacent structures, a criterion that must be taken into account for staging by TNM or Astler-Coller classification, which guide the indication of adjuvant treatment after the surgical approach\n", "Support"]]}
{"500_45": [["15-year-old female presenting with delayed menarche and short stature\n", "In a woman with delayed puberty and short stature we should always think about and rule out Turner syndrome, whose diagnosis is made by karyotyping (45X0)\n", "Support"], ["In a woman with delayed puberty and short stature we should always think about and rule out Turner syndrome, whose diagnosis is made by karyotyping (45X0)\n", "Karyotype\n", "Support"]]}
{"611_116": [["We are told of a case of a 95-year-old patient with a displaced intracapsular (subcapital) hip fracture\n", "In this case, the surgical options may be the use of cannulated screws or hip arthroplasty\n", "Support"], ["Cannulated screws are reserved for cases of non-displaced fractures\n", "In this case, the surgical options may be the use of cannulated screws or hip arthroplasty\n", "Attack"], ["Cannulated screws are reserved for cases of non-displaced fractures\n", "Wrong answer 2\n", "Support"], ["Wrong answer 2\n", "Fixation with cannulated screws\n", "Attack"], ["Cannulated screws are reserved for cases of non-displaced fractures\n", "so the most indicated option would be arthroplasty, in this case hemiarthroplasty\n", "Support"], ["In this case, the surgical options may be the use of cannulated screws or hip arthroplasty\n", "so the most indicated option would be arthroplasty, in this case hemiarthroplasty\n", "Support"], ["so the most indicated option would be arthroplasty, in this case hemiarthroplasty\n", "Correct answer 1\n", "Support"], ["Correct answer 1\n", "Hip hemiarthroplasty\n", "Support"], ["Trochanteric pins are reserved for extracapsular fractures\n", "Wrong answer 2\n", "Support"], ["Wrong answer 2\n", "Trochanteric nail fixation\n", "Attack"], ["conservative treatment is only considered in patients with very low functional demand or surgical contraindication\n", "Wrong answer 4\n", "Support"], ["Wrong answer 4\n", "Conservative: bed-chair life\n", "Attack"]]}
{"542_38": [["She suddenly presents hypotension, tachycardia, urticaria and bronchospasm after ingesting peanuts and is transferred to the emergency department\n", "The patient is suffering from anaphylactic shock secondary to peanut ingestion\n", "Support"], ["The patient is suffering from anaphylactic shock secondary to peanut ingestion\n", "The treatment of anaphylaxis and anaphylactic shock of first choice is intramuscular adrenaline 1mg/ml (dose 0.01 mg/kg, in adults 0.5 mg maximum)\n", "Support"], ["The treatment of anaphylaxis and anaphylactic shock of first choice is intramuscular adrenaline 1mg/ml (dose 0.01 mg/kg, in adults 0.5 mg maximum)\n", "Followed by symptomatic treatment to stabilize the airway with 100% high flow O2, ensure large caliber venous access, fluid replacement and continuous monitoring (HR, BP, SatO2 , diuresis)\n", "Support"], ["The treatment of anaphylaxis and anaphylactic shock of first choice is intramuscular adrenaline 1mg/ml (dose 0.01 mg/kg, in adults 0.5 mg maximum)\n", "Intramuscular adrenaline, followed by an inhaled bronchodilator of the SABA type and intramuscular dexchlorpheniramine. Then request serum tryptase\n", "Support"], ["Followed by symptomatic treatment to stabilize the airway with 100% high flow O2, ensure large caliber venous access, fluid replacement and continuous monitoring (HR, BP, SatO2 , diuresis)\n", "As adjuvant treatment, an inhaled bronchodilator such as SABA, intramuscular dexchlorpheniramine or corticosteroids such as hydrocortisone IV or methylprednisolone IV can be administered\n", "Support"], ["As adjuvant treatment, an inhaled bronchodilator such as SABA, intramuscular dexchlorpheniramine or corticosteroids such as hydrocortisone IV or methylprednisolone IV can be administered\n", "Intramuscular adrenaline, followed by an inhaled bronchodilator of the SABA type and intramuscular dexchlorpheniramine. Then request serum tryptase\n", "Support"], ["As adjuvant treatment, an inhaled bronchodilator such as SABA, intramuscular dexchlorpheniramine or corticosteroids such as hydrocortisone IV or methylprednisolone IV can be administered\n", "Adrenaline can be repeated at the same doses every 5 minutes a maximum of 3 times and if after 15 minutes there is no response, IV adrenaline infusion should be started, Glucagon (if treatment with beta-blockers), Atropine (if prolonged bradycardia) or Vasopressors (if refractory hypotension)\n", "Support"], ["The laboratory marker that should be requested if anaphylaxis is suspected is serum tryptase in the first hour for a basal determination and another at 4-6 hours to observe its elevation curve\n", "Intramuscular adrenaline, followed by an inhaled bronchodilator of the SABA type and intramuscular dexchlorpheniramine. Then request serum tryptase\n", "Support"]]}
{"79_36": [["Although mucus is usually more frightening in the consultation, it falls within the Rome II criteria for the diagnosis of Irritable Bowel Syndrome\n", "Expulsion of mucus in more than 25% of defecations\n", "Support"], ["All the rest are typical signs of organicity\n", "Weight loss with or without rectorrhagia\n", "Attack"], ["All the rest are typical signs of organicity\n", "Persistence of diarrhea during the night\n", "Attack"], ["All the rest are typical signs of organicity\n", "Onset of symptoms after age 50\n", "Attack"], ["All the rest are typical signs of organicity\n", "Presence of dermatitis and/or arthritis during the examination\n", "Attack"], ["since any of these data (especially age) can be found in patients who in the end have nothing, what happens is that in these cases we must always look for organicity\n", "although I think the question is poorly phrased\n", "Support"]]}
{"524_54": [["On average, if 100 patients like this woman are treated with warfarin, the number of strokes is reduced by 3 (from 5.2 untreated to 3.2 treated)\n", "Therefore, if you treat 33.3 patients like this woman with warfarin, you reduce the number of strokes by 1\n", "Support"], ["Therefore, if you treat 33.3 patients like this woman with warfarin, you reduce the number of strokes by 1\n", "the NNT is 33.3\n", "Support"], ["the NNT is 33.3\n", "33,3\n", "Support"]]}
{"319_141": [["In the last 2 months, onset of diarrhea with loss of 4 kg of weight\n", "The clinical picture is typical of spondyloarthritis, and together with the digestive symptoms it is probably associated with inflammatory bowel disease\n", "Support"]]}
{"400_147": [["There is no data in the statement to suggest any of the other etiologies\n", "Scheuermann's disease\n", "Attack"], ["There is no data in the statement to suggest any of the other etiologies\n", "Thoracic scoliosis\n", "Attack"], ["There is no data in the statement to suggest any of the other etiologies\n", "Malignant tumor of the vertebral body\n", "Attack"], ["There is no data in the statement to suggest any of the other etiologies\n", "It is a mechanical overload\n", "Support"], ["There is no data in the statement to suggest any of the other etiologies\n", "the most frequent cause of mechanical back pain in adolescents is mechanical overload\n", "Support"], ["the most frequent cause of mechanical back pain in adolescents is mechanical overload\n", "The pain is of mechanical characteristics\n", "Support"], ["the most frequent cause of mechanical back pain in adolescents is mechanical overload\n", "It is a mechanical overload\n", "Support"], ["The pain is of mechanical characteristics\n", "It is a mechanical overload\n", "Support"]]}
{"196_164": [["You are describing a Sch\u00f6nlein-Henoch purpura which is a vasculitic phenomenon, so the lesions are not due to plateletopenia\n", "Plateletopenia\n", "Attack"], ["Scrotal edema (sometimes even torsion of Morgani's capsid of the testis) is not exceptional in males with S. Sch\u00f6nlein-Henoch\n", "Scrotal edema\n", "Support"]]}
{"509_150": [["83-year-old male who consults for a recurrent picture of abdominal pain in the left iliac fossa, accompanied by diarrhea of up to 6 stools per day without pathological products, of 10-15 days of evolution\n", "They refer to a concept that has emerged relatively recently and is not present in all clinical guidelines as uncomplicated symptomatic diverticular disease\n", "Support"], ["In these cases, the therapeutic trial with rifaximin is recommended, being the true number 1\n", "Empirical treatment with antibiotics\n", "Support"], ["They refer to a concept that has emerged relatively recently and is not present in all clinical guidelines as uncomplicated symptomatic diverticular disease\n", "In these cases, the therapeutic trial with rifaximin is recommended, being the true number 1\n", "Support"], ["On examination there is mild pain on palpation of the left iliac fossa without peritoneal irritation\n", "The absence of acute phase reactants in the CBC suggests that she does not have acute diverticulitis at the time of consultation that would lead us to request an imaging test to rule it out\n", "Support"], ["No fever or general condition was reported\n", "The absence of acute phase reactants in the CBC suggests that she does not have acute diverticulitis at the time of consultation that would lead us to request an imaging test to rule it out\n", "Support"], ["The absence of acute phase reactants in the CBC suggests that she does not have acute diverticulitis at the time of consultation that would lead us to request an imaging test to rule it out\n", "Request urgent abdominal ultrasound\n", "Support"]]}
[{"549_128": []}]
{"221_48": [["The statement concisely summarizes the description of pilocytic astrocytoma\n", "Pilocytic astrocytoma\n", "Support"], ["The Rosenthal fibers may confuse us as they are not very specific, and make us think, for example, of pleomorphic xanthoastrocytoma in which they can also be found\n", "The statement concisely summarizes the description of pilocytic astrocytoma\n", "Attack"], ["the cell morphology described (long and thin cytoplasmic processes, which are the ones that give the name \"pilocytic\") keeps us the first option as the correct one\n", "The Rosenthal fibers may confuse us as they are not very specific, and make us think, for example, of pleomorphic xanthoastrocytoma in which they can also be found\n", "Attack"], ["long and thin cytoplasmic processes, which are the ones that give the name \"pilocytic\"\n", "the cell morphology described (long and thin cytoplasmic processes, which are the ones that give the name \"pilocytic\") keeps us the first option as the correct one\n", "Support"], ["long and thin cytoplasmic processes, which are the ones that give the name \"pilocytic\"\n", "The Rosenthal fibers may confuse us as they are not very specific, and make us think, for example, of pleomorphic xanthoastrocytoma in which they can also be found\n", "Attack"], ["the cell morphology described (long and thin cytoplasmic processes, which are the ones that give the name \"pilocytic\") keeps us the first option as the correct one\n", "The statement concisely summarizes the description of pilocytic astrocytoma\n", "Support"]]}
{"606_113": [["Correct answer 1\n", "Conservative treatment with non-steroidal anti-inflammatory drugs, local heat and relative rest\n", "Support"], ["75% of patients with radiculopathy improve with non-surgical treatment, this being the treatment of choice in the initial stages\n", "Urgent call to the neurosurgeon for surgical evaluation\n", "Attack"], ["Magnetic resonance imaging is of choice in certain \"red flags\": fever, weight loss, nocturnal pain, persistence of symptoms despite conservative treatment and loss of strength\n", "incorrect answer 3\n", "Support"], ["incorrect answer 3\n", "Preferential request for MRI and electromyogram\n", "Attack"]]}
[{"436_223": []}]
[{"220_126": []}]
{"483_174": [["Although, be careful, that is what the guidelines say\n", "Controversial question, since amiodarone (the dose is correct, 300mg), is administered after the third shock, and not after the first defibrillation\n", "Attack"], ["I am sure that more than one of us has administered amiodarone as soon as we have had venous access available in the event of a shockable rhythm\n", "Administration of 300 mg of intravenous amiodarone\n", "Support"], ["The other options are incorrect\n", "Administration of 150 mg of intravenous amiodarone\n", "Attack"], ["The other options are incorrect\n", "Administration of 1 mg of intravenous atropine\n", "Attack"], ["The other options are incorrect\n", "Administer 2 mg of intravenous atropine\n", "Attack"], ["I am sure that more than one of us has administered amiodarone as soon as we have had venous access available in the event of a shockable rhythm\n", "Controversial question, since amiodarone (the dose is correct, 300mg), is administered after the third shock, and not after the first defibrillation\n", "Attack"]]}
{"113_93": [["A 35-year-old healthy woman consults for asthenia\n", "With the data we are given\n", "Support"], ["With the data we are given\n", "the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n", "Support"], ["the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n", "Central anemia, arregenerative, due to iron deficiency\n", "Support"], ["the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n", "Central anemia, arregenerative, due to folic acid deficiency\n", "Support"], ["the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n", "Peripheral, regenerative, hemolytic anemia\n", "Attack"], ["the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n", "Peripheral anemia, regenerative, due to acute active hemorrhage\n", "Attack"], ["The next thing that orients us towards the cause is that it is microcytic and hypochromic, which is characteristic of iron deficiency anemia, since folic deficiency gives rise to megaloblastic anemia and active hemorrhage does not give microcytosis or hypochromia, but normocytosis and normochromia\n", "Central anemia, arregenerative, due to iron deficiency\n", "Support"], ["The CBC shows microcytic and hypochromic anemia (hemoglobin 7 g/dL, mean corpuscular volume 68 fl, mean corpuscular hemoglobin 24 pg\n", "With the data we are given\n", "Support"], ["with an elevated red cell distribution amplitude (ADE 20%)\n", "With the data we are given\n", "Attack"], ["decreased reticulocytes (0.3%, 30000/l absolute)\n", "With the data we are given\n", "Support"], ["decreased hemoglobin content in reticulocytes (17 pg)\n", "With the data we are given\n", "Support"], ["discrete thrombocytosis (500000 platelets)\n", "With the data we are given\n", "Support"], ["The CBC shows microcytic and hypochromic anemia (hemoglobin 7 g/dL, mean corpuscular volume 68 fl, mean corpuscular hemoglobin 24 pg\n", "Central anemia, arregenerative, due to iron deficiency\n", "Support"], ["the first thing that comes to mind is that it is an arregenerative anemia, since the bone marrow has not responded with an exaltation of erythropoiesis; in this way we have already eliminated the options that speak of regenerative anemia\n", "Central anemia, arregenerative, due to folic acid deficiency\n", "Attack"], ["with an elevated red cell distribution amplitude (ADE 20%)\n", "Thalassemic trait\n", "Attack"], ["We are almost inclined to answer 5, central arregenerative anemia due to iron deficiency...but there remains answer 1, \"thalassemic trait\", which makes us uncomfortable and makes us doubt if we are not going for the apparently easy thing...until we remember that in thalassemia the ADE is normal\n", "Thalassemic trait\n", "Attack"], ["Definitely, this girl of childbearing age has iron deficiency anemia, something quite common\n", "Central anemia, arregenerative, due to iron deficiency\n", "Support"]]}
{"59_51": [["that encompasses all the causes of sudden loss of consciousness and that allows us to somehow filter the diagnosis\n", "Clinical history\n", "Support"], ["that encompasses all the causes of sudden loss of consciousness and that allows us to somehow filter the diagnosis\n", "Obviously, it is the only answer\n", "Support"], ["Obviously, it is the only answer\n", "Clinical history\n", "Support"]]}
{"412_54": [["one of Isabel's brothers has suffered from the disease but not her father\n", "Isabel's mother continues to carry it\n", "Support"], ["The maternal grandmother carried the mutation in one copy of the gene on an X chromosome\n", "Isabel's mother continues to carry it\n", "Support"], ["her children are all healthy\n", "we are not sure if she is a carrier\n", "Support"], ["Thus, Isabel has a 50% chance of having inherited the mutated gene from her mother\n", "therefore her daughter has a 25% chance of having inherited the mutated gene from her grandmother\n", "Support"], ["therefore her daughter has a 25% chance of having inherited the mutated gene from her grandmother\n", "1/4\n", "Support"]]}
{"347_159": [["Endometrial biopsy\n", "Endometrial biopsy\n", "Support"], ["Peri- or menopause\n", "Endometrial biopsy\n", "Support"], ["Due to the high prevalence of organic pathology during this period it is necessary to systematically perform endometrial biopsy (Cornier or Hysteroscopy)\n", "Endometrial biopsy\n", "Support"], ["Peri- or menopause\n", "Due to the high prevalence of organic pathology during this period it is necessary to systematically perform endometrial biopsy (Cornier or Hysteroscopy)\n", "Support"]]}
{"325_56": [["Examination in the emergency room was compatible with heart failure and the ECG showed complete atrioventricular block with an escape ventricular rate of 45 bpm\n", "the indications for cardiac surgery include the appearance of heart failure or new conduction disorders, and in this case it presents both\n", "Support"], ["the indications for cardiac surgery include the appearance of heart failure or new conduction disorders, and in this case it presents both\n", "The correct answer is 1\n", "Support"], ["The correct answer is 1\n", "Cardiac surgery for aortic valve replacement by mechanical prosthesis with antibiotic therapy according to antibiogram\n", "Support"]]}
{"335_175": [["both hydrochlorothiazide and lisinopril can also produce falls in the elderly, but they would generally be accompanied by dizziness\n", "Hydrochlorothiazide\n", "Attack"], ["both hydrochlorothiazide and lisinopril can also produce falls in the elderly, but they would generally be accompanied by dizziness\n", "Lisinopril\n", "Attack"], ["Paroxetine\n", "Paroxetine\n", "Support"]]}
{"19_109": [["although the clinical picture is suggestive, it does not present lymphocytosis\n", "The 1 should not be\n", "Support"], ["although the clinical picture is suggestive, it does not present lymphocytosis\n", "Infectious mononucleosis\n", "Attack"], ["What points to dengue, in addition to the clinical signs, is the plateletopenia\n", "In this case I believe that the correct answer is 5\n", "Support"], ["It does not seem to be an allergic exanthema from the clinical picture\n", "Allergic exanthema\n", "Attack"], ["certainly she does not have symptoms or clinical signs compatible with malaria or typhoid fever\n", "P. falciparum malaria\n", "Attack"], ["certainly she does not have symptoms or clinical signs compatible with malaria or typhoid fever\n", "Typhoid fever\n", "Attack"], ["What points to dengue, in addition to the clinical signs, is the plateletopenia\n", "Dengue fever\n", "Support"], ["platelets 75000/mm3 (htco 36%, leukocytes 4100 79% neutrophils)\n", "Dengue fever\n", "Support"]]}
{"401_147": [["the patient presents with a specific examination that would give us the diagnosis\n", "As for Scheuermann and scoliosis, we should be given some physical data\n", "Support"], ["A malignant tumor would also hurt at rest\n", "Malignant tumor of the vertebral body\n", "Support"], ["As for Scheuermann and scoliosis, we should be given some physical data\n", "Scheuermann's disease\n", "Attack"]]}
[{"607_115": []}]
{"453_150": [["If they are talking about a young man 20-30 years old, with tremor and dystonia, whether or not he has a family history, and especially if one of the options tells me about copper in urine\n", "they are telling me to think of Wilson's disease\n", "Support"], ["So the correct answer is 4\n", "Copper in urine of 24\n", "Support"], ["they are telling me to think of Wilson's disease\n", "Copper in urine of 24\n", "Support"], ["they are telling me to think of Wilson's disease\n", "I do not think of juvenile Parkinson's, nor an epileptic clinic\n", "Attack"], ["they are telling me to think of Wilson's disease\n", "So the correct answer is 4\n", "Support"]]}
{"529_166": [["After one month, the clinical picture has completely disappeared\n", "We describe a young patient with criteria of nephrotic syndrome with excellent response to corticosteroids\n", "Support"], ["A complete blood test showed proteinuria of 8 g/day without microhematuria, hypoalbuminemia and hypercholesterolemia with normal renal function\n", "We describe a young patient with criteria of nephrotic syndrome with excellent response to corticosteroids\n", "Support"], ["He was empirically administered corticosteroids\n", "We describe a young patient with criteria of nephrotic syndrome with excellent response to corticosteroids\n", "Support"], ["Without biopsy, the clinical presentation and evolution suggest a nephropathy with minimal changes, which usually presents with normal or slightly altered renal function together with nephrotic syndrome, and which in 85-90% of cases resolves with steroid treatment\n", "Nephropathy with minimal changes\n", "Support"], ["since although it is the most frequent cause of idiopathic nephrotic syndrome in children and adolescents, it is usually recommended to perform a biopsy prior to treatment in those older than 16 years\n", "The age is the only data that is a bit shaky\n", "Support"], ["in any case it does not admit much discussion\n", "since although it is the most frequent cause of idiopathic nephrotic syndrome in children and adolescents, it is usually recommended to perform a biopsy prior to treatment in those older than 16 years\n", "Attack"], ["The age is the only data that is a bit shaky\n", "Without biopsy, the clinical presentation and evolution suggest a nephropathy with minimal changes, which usually presents with normal or slightly altered renal function together with nephrotic syndrome, and which in 85-90% of cases resolves with steroid treatment\n", "Attack"]]}
{"258_96": [["To associate a basal insulin dose to the treatment\n", "To associate a basal insulin dose to the treatment\n", "Support"], ["Patient poorly controlled with metformin and sitagliptin with discrete cardinal symptoms (weight loss, asthenia)\n", "To associate a basal insulin dose to the treatment\n", "Support"], ["Patient poorly controlled with metformin and sitagliptin with discrete cardinal symptoms (weight loss, asthenia)\n", "The best option is insulin to control cardinal symptoms and decrease HbA1c to < 7%\n", "Support"]]}
{"375_128": [["A 45-year-old patient under study for possible meningitis, with fever, headache and vomiting of 2 days of evolution\n", "we have not been told what the initial headache was like\n", "Support"], ["we have not been told what the initial headache was like\n", "he first cannot be\n", "Support"], ["The picture they describe of intense headache with orthostatism that disappears when lying down, although it is true that the most typical presentation is between the first 24-48 hours and in this case it is somewhat earlier\n", "It is a post lumbar puncture headache\n", "Support"], ["SAH does not follow this pattern in relation to orthostasis\n", "the last one could not be either\n", "Support"], ["the last one could not be either\n", "Most likely it was not a viral meningitis, but a subarachnoid hemorrhage. For this reason, the initial headache disappears almost completely when lying down\n", "Support"], ["the third, although it could be due to the time of onset (as I said a little earlier than expected), the reality is that the headache with orthostasis is so typical that it would be the most probable cause\n", "It is necessary to look for a different cause to this headache, because it is not typical of post-lumbar puncture syndrome or meningitis\n", "Attack"], ["he first cannot be\n", "Meningitis remains the fundamental cause of her headache, as it is the same type of headache as at the onset of symptoms\n", "Attack"], ["Even so, the rest of the answers are improbable\n", "Most likely it was not a viral meningitis, but a subarachnoid hemorrhage. For this reason, the initial headache disappears almost completely when lying down\n", "Attack"], ["SAH does not follow this pattern in relation to orthostasis\n", "It is necessary to look for a different cause to this headache, because it is not typical of post-lumbar puncture syndrome or meningitis\n", "Attack"], ["Even so, the rest of the answers are improbable\n", "Meningitis remains the fundamental cause of her headache, as it is the same type of headache as at the onset of symptoms\n", "Attack"]]}
{"352_161": [["The correct answer is 2\n", "Diagnostic laparoscopy\n", "Support"], ["A 27-year-old woman referred to the gynecology office for evaluation referring dyspareunia for about 8 months, along with dyschezia and occasional rectorrhagia coinciding with menstruation for 3-4 months\n", "We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement\n", "Support"], ["She also reports dysmenorrhea for years, which she controls well with ibuprofen\n", "We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement\n", "Support"], ["She has been trying to get pregnant for 16 months without success\n", "We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement\n", "Support"], ["In the gynecological examination she only shows pain when pressing on the posterior vaginal fornix\n", "We are facing a suspicion of endometriosis, due to the symptoms and signs given in the statement\n", "Support"]]}
{"575_102": [["The clinical case makes a textbook description of a medial temporal seizure\n", "Complex focal temporal lobe seizures\n", "Support"], ["The aura of ascending epigastric sensation and olfactory alteration and the subsequent description of the seizure with alteration of the level of consciousness (disconnection from the environment) with oral and manual automatisms\n", "The clinical case makes a textbook description of a medial temporal seizure\n", "Support"]]}
{"278_31": [["we can safely rule out tumor lesions, leaving doubts between answers 2 and 3\n", "Teratocarcinoma\n", "Attack"], ["we can safely rule out tumor lesions, leaving doubts between answers 2 and 3\n", "Dysgerminoma\n", "Attack"], ["In this case, we would have to opt for IMMATURE TERATOMA, mentioning the presence of embryonic remains\n", "Immature teratoma\n", "Support"], ["At no time are atypical cellular features mentioned\n", "we can safely rule out tumor lesions, leaving doubts between answers 2 and 3\n", "Support"]]}
{"225_64": [["it is not a complete AVB\n", "Option 1 is ruled out\n", "Support"], ["Option 1 is ruled out\n", "The patient has a third-degree AVB and requires pacemaker implantation\n", "Attack"], ["Option 2 cannot be answered either: to exclude, what is said to exclude...\n", "The absence of periods of asystole >3 seconds excludes a cardiac cause of dizziness\n", "Attack"], ["It is like never/always\n", "Option 2 cannot be answered either: to exclude, what is said to exclude...\n", "Support"], ["which, in fact, he has never suffered\n", "Likewise, there are also no pauses longer than 3 seconds that could cause cardiogenic syncope\n", "Support"], ["we could suspend those that impair conduction (beta-blockers, calcium antagonists)\n", "Option 3 does not make much sense\n", "Attack"], ["but drugs that facilitate, as long as we do not give him a perfusion of atropine to take home...\n", "Option 3 does not make much sense\n", "Support"], ["he has sinoatrial block\n", "In option 4, stating that he has sinoatrial block is a bit of a rap: without an electrophysiological study it cannot be said\n", "Support"], ["he does not necessarily have SA block\n", "this alone would not indicate the implantation of a pacemaker.\n", "Support"], ["In option 4, stating that he has sinoatrial block is a bit of a rap: without an electrophysiological study it cannot be said\n", "The patient presents sinus dysfunction with sinoatrial block and requires pacemaker implantation due to symptoms\n", "Attack"], ["Option 3 does not make much sense\n", "Drug treatment to increase conduction in the AV node would be indicated\n", "Attack"], ["this alone would not indicate the implantation of a pacemaker.\n", "The patient presents sinus dysfunction with sinoatrial block and requires pacemaker implantation due to symptoms\n", "Attack"], ["So, finally, I would check option 5\n", "The alterations detected in the ambulatory electrocardiogram are typical of patients of this age and there is no indication for therapeutic intervention\n", "Support"], ["If the sinus node fails, the AV node takes over and stimulates the ventricle\n", "it is not a complete AVB\n", "Support"]]}
{"370_125": [["A former smoker patient, previously diagnosed with COPD comes in for a checkup\n", "In a digital hypokratitis of recent onset in a smoking patient, the first option to rule out is bronchopulmonary carcinoma\n", "Support"], ["The physical examination reveals digital hypokratism of recent onset\n", "In a digital hypokratitis of recent onset in a smoking patient, the first option to rule out is bronchopulmonary carcinoma\n", "Support"], ["In a digital hypokratitis of recent onset in a smoking patient, the first option to rule out is bronchopulmonary carcinoma\n", "Pulmonary carcinoma\n", "Support"]]}
[{"332_88": []}]
{"78_33": [["We have a case of chronic iron deficiency anemia, without obvious bleeding\n", "The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy,\n", "Support"], ["The first cause of iron deficiency anemia is occult bleeding of digestive origin\n", "The existence of clinical symptoms suggestive of pathology of the upper digestive tract has led us to begin the study with upper endoscopy,\n", "Support"], ["there is no pathology to justify the anemia\n", "further investigation is necessary, which rules out answers 1 and 2\n", "Support"], ["further investigation is necessary, which rules out answers 1 and 2\n", "Administer oral iron and monitor the evolution of anemia\n", "Attack"], ["further investigation is necessary, which rules out answers 1 and 2\n", "Treat with proton pump inhibitors and evaluate at three months\n", "Attack"], ["In fact the recommendations of capsule endoscopy in anemia studies are restricted\n", "Perform an endoscopic capsule study\n", "Attack"], ["Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions\n", "Recommend a complete colonoscopy\n", "Support"], ["Between 3 and 4, large bowel lesions are much more common and should be ruled out before small bowel lesions\n", "Request a gynecological evaluation\n", "Attack"], ["Laboratory tests: Hb6 gr/dL, MCV 69 fl, sideremia 13 micrograms/dL, ferritin 4 ngr/mL\n", "We have a case of chronic iron deficiency anemia, without obvious bleeding\n", "Support"], ["No metrorrhagia\n", "We have a case of chronic iron deficiency anemia, without obvious bleeding\n", "Support"], ["A 55-year-old postmenopausal woman consults for asthenia and dyspnea on exertion\n", "We have a case of chronic iron deficiency anemia, without obvious bleeding\n", "Support"], ["Gastrointestinal endoscopy: small sliding hiatal hernia with no signs of esophagitis\n", "The first cause of iron deficiency anemia is occult bleeding of digestive origin\n", "Support"]]}
{"397_140": [["Weak opioids are not the initial treatment of choice\n", "Start treatment with weak opioids that have shown evidence of halting disease progression\n", "Attack"], ["conservative options are exhausted before opting for surgical treatment\n", "I make the diagnosis of coxarthrosis and send to the traumatologist to place a hip prosthesis\n", "Attack"], ["no further imaging tests are needed\n", "Because of the radiological features described, I need a hip MRI before making a therapeutic decision\n", "Attack"], ["You present with coxarthrosis\n", "I instigate treatment with paracetamol, explain that the evolution is very variable and the surgical indication depends on functionality and pain control\n", "Support"], ["conservative options are exhausted before opting for surgical treatment\n", "I instigate treatment with paracetamol, explain that the evolution is very variable and the surgical indication depends on functionality and pain control\n", "Support"]]}
{"275_74": [["in this case there are 1,380, which is 60% of 2,300\n", "This is spontaneous bacterial peritonitis (SBP), defined by the presence of > 250 polymorphonuclears/mL in the ascitic fluid\n", "Support"], ["This is spontaneous bacterial peritonitis (SBP), defined by the presence of > 250 polymorphonuclears/mL in the ascitic fluid\n", "It is an indication to start 3rd generation cephalosporins (ceftriaxone or cefotaxime) and albumin\n", "Support"], ["It is an indication to start 3rd generation cephalosporins (ceftriaxone or cefotaxime) and albumin\n", "Treatment with a third generation cephalosporin\n", "Support"]]}
{"418_77": [["The correct answer is 1\n", "Admission to the ward with absolute diet and broad-spectrum antibiotic treatment\n", "Support"], ["the abscess is not larger than 5-6 cm\n", "it does not meet the criteria to require drainage by guided puncture\n", "Support"], ["it is not a question of solving an obstructive condition\n", "Discharge colostomy in this case makes no sense whatsoever,\n", "Support"], ["Discharge colostomy in this case makes no sense whatsoever,\n", "Discharge colostomy\n", "Attack"], ["Drainage by laparoscopic surgery is not indicated in this case\n", "Drainage by laparoscopic surgery\n", "Attack"], ["it does not meet the criteria to require drainage by guided puncture\n", "The correct answer is 1\n", "Support"], ["although it is a very controversial option at this time\n", "Drainage by laparoscopic surgery is not indicated in this case\n", "Support"], ["It could be indicated in the absence of the possibility of percutaneous drainage after failure of conservative treatment\n", "Drainage by laparoscopic surgery is not indicated in this case\n", "Attack"], ["Sigmoidectomy and anastomosis is also not required\n", "Urgent surgery with sigmoidectomy and colorectal anastomosis\n", "Attack"], ["In a high number of cases, after the resolution of the symptoms, the outbreaks are reduced and they can be prevented with diet and hygienic dietary habits\n", "Admission to the ward with absolute diet and broad-spectrum antibiotic treatment\n", "Support"]]}
[{"200_75": []}]
{"469_137": [["There is no data to suggest that he has any unstable comorbidity at the present time\n", "surgery in less than 48 hours and orthogeriatric management is of interest\n", "Support"], ["surgery in less than 48 hours and orthogeriatric management is of interest\n", "Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management\n", "Support"], ["In most cases, surgery should be performed as soon as possible, as soon as the patient is medically stabilized\n", "Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management\n", "Support"], ["There is a contraindication to surgery in patients with unstable medical comorbidity, but several studies have shown that delaying surgery beyond 48 h after admission increases mortality\n", "Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management\n", "Support"], ["This is why the ideal time to intervene in these patients is after achieving stabilization of their medical pathologies, taking care that this takes place before 48 h have elapsed\n", "Closed reduction and fixation of the fracture within 48 hours, very early sedation, orthogeriatric management\n", "Support"], ["There is no data to suggest that he has any unstable comorbidity at the present time\n", "Admission to Internal Medicine / Geriatrics, progressive stabilization of comorbidities, conservative orthopedic treatment\n", "Attack"]]}
{"378_132": [["The first option would be the correct one\n", "Neuropsychological evaluation\n", "Support"], ["it allows us to measure in a standardized way each of the cognitive domains, which will allow us to frame the patient's deficits in a specific syndrome and to monitor the deterioration with repeated scans over time\n", "The first option would be the correct one\n", "Support"], ["The characterization of cognitive deterioration processes is still clinical, with imaging tests (MRI or PET) being a support tool in some occasions\n", "Brain magnetic resonance imaging\n", "Support"], ["The characterization of cognitive deterioration processes is still clinical, with imaging tests (MRI or PET) being a support tool in some occasions\n", "Positron Emission Tomography\n", "Support"]]}
{"582_208": [["the inability to tiptoe and the absence of the Achilles reflex, in addition to the distribution of pain down the leg\n", "He describes S1 root involvement\n", "Support"], ["He describes S1 root involvement\n", "Of our options, the cause that can produce damage to S1 is L5-S1 disc herniation\n", "Support"], ["Of our options, the cause that can produce damage to S1 is L5-S1 disc herniation\n", "Right L5-S1 disc herniation\n", "Support"]]}
{"160_117": [["The correct answer is: 3\n", "IgA nephropathy\n", "Support"], ["The correct answer is: 3\n", "IgA nephropathy\n", "Support"], ["Since he is a young male, with a history of previous respiratory infections, a relationship between these infections and renal pathology is established\n", "Based on this we think about IgA nephropathy, which besides being the most frequent glomerulonephritis, it is presented in most of the cases as described\n", "Support"], ["A 35-year-old man presenting hematuria after respiratory infections for several years, a blood test shows creatinine 1 mg/dl with no other alterations and urine hematocytes 50/field being 80% dysmorphic, with proteinuria of 0.8 grams in 24 hours\n", "IgA nephropathy\n", "Support"], ["Based on this we think about IgA nephropathy, which besides being the most frequent glomerulonephritis, it is presented in most of the cases as described\n", "IgA nephropathy\n", "Support"]]}
{"312_217": [["The description is typical of option 2\n", "Exudative age-related macular degeneration (AMD)\n", "Support"], ["although as we said in question 215, with the new classification, we would speak of an advanced AMD in its neovascular variant\n", "It is an exudative AMD\n", "Attack"], ["It is an exudative AMD\n", "Exudative age-related macular degeneration (AMD)\n", "Support"], ["In any case, we have an elderly patient with vision loss and metamorphopsia in one eye\n", "With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula\n", "Attack"], ["In the examination there are lesions in the macula\n", "With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula\n", "Attack"], ["With that we can rule out acute posterior vitreous detachment, which does not produce visual loss, nor metamorphopsia, nor lesions in the macula\n", "Acute posterior vitreous detachment\n", "Attack"], ["although it produces visual loss and is typical of older people, it does not produce metamorphopsia\n", "And also non-arteritic anterior ischemic optic neuropathy\n", "Support"], ["And also non-arteritic anterior ischemic optic neuropathy\n", "Non-arteritic anterior ischemic optic neuropathy\n", "Attack"], ["And there are no lesions in the macula but papilla edema\n", "And also non-arteritic anterior ischemic optic neuropathy\n", "Support"], ["In any case, we have an elderly patient with vision loss and metamorphopsia in one eye\n", "In central retinal artery obstruction, metamorphopsia is not particularly characteristic (visual loss and advanced age are), but the lesions in the fundus of the eye vary\n", "Attack"], ["In central retinal artery obstruction, metamorphopsia is not particularly characteristic (visual loss and advanced age are), but the lesions in the fundus of the eye vary\n", "Central retinal artery obstruction\n", "Attack"], ["In this case the lesions are totally different\n", "Central retinal artery obstruction\n", "Attack"], ["In addition, the entire retina is globally affected, and a cherry-red spot may appear in the macula\n", "Central retinal artery obstruction\n", "Attack"], ["In the case of arterial occlusion, there is intracellular edema that is seen as absence of hemorrhages and a whitish, pale fundus\n", "Central retinal artery obstruction\n", "Attack"], ["They describe hard exudates, deep hemorrhages and localized neurosensory retinal detachment\n", "These are the characteristic findings of neovascular (or exudative) AMD\n", "Support"], ["All this in the macula\n", "These are the characteristic findings of neovascular (or exudative) AMD\n", "Support"], ["As a clue, in the other eye there are abundant soft drusen\n", "These are the characteristic findings of neovascular (or exudative) AMD\n", "Support"], ["As a clue, in the other eye there are abundant soft drusen\n", "Drusen are the typical findings of AMD\n", "Support"], ["These are the characteristic findings of neovascular (or exudative) AMD\n", "Acute posterior vitreous detachment\n", "Support"], ["Drusen are the typical findings of AMD\n", "Acute posterior vitreous detachment\n", "Support"], ["So he has AMD in both eyes and in the right eye it has recently become complicated by the appearance of neovascularization\n", "Acute posterior vitreous detachment\n", "Support"]]}
{"24_115": [["By the way, it is funny that they give Chest Rx as a test to be performed..... are you telling me that a patient with fever and dyspnea will have an echocardiogram before a simple chest x-ray?\n", "Chest X-ray\n", "Attack"], ["Another gift of a question, the association of S.bovis endocarditis and colon cancer\n", "Colonoscopy\n", "Support"]]}
{"260_99": [["Pancreatic neuroendocrine tumor + pituitary adenoma (prolactinoma) + hyperparathyroidism (renoureteral colic in young people)\n", "MEN 1\n", "Support"], ["MEN 1\n", "Multiple endocrine neoplasia type 1 or Wermer's syndrome\n", "Support"]]}
{"211_87": [["the imaging tests of choice would be ultrasound or CT\n", "Answer 1 is incorrect\n", "Support"], ["the laparoscopic approach is indicated from the start\n", "answer 3 is incorrect\n", "Support"], ["the indication in the first episode is for those under 50 years of age, in the rest it is indicated after the second episode or in cases of persistent symptoms or suspected neoplasia\n", "answer 4 is incorrect\n", "Support"], ["surgery in cases of perforation with peritonitis should always resect the affected segment of colon to control the focus of the infection\n", "answer 5 is incorrect\n", "Support"], ["Answer 1 is incorrect\n", "The safest and best performing complementary examination is the barium contrast enema\n", "Attack"], ["answer 3 is incorrect\n", "If surgical intervention is required after resolution of the acute episode, the laparoscopic approach is contraindicated\n", "Attack"], ["answer 4 is incorrect\n", "In case of acute uncomplicated diverticulitis, elective sigmoidectomy is indicated after cure of the first acute episode\n", "Attack"], ["A 78-year-old woman comes to the emergency department for left iliac fossa pain of 24 hours of evolution associated with fever and occasional vomiting\n", "the indication in the first episode is for those under 50 years of age, in the rest it is indicated after the second episode or in cases of persistent symptoms or suspected neoplasia\n", "Attack"], ["answer 5 is incorrect\n", "If generalized peritonitis occurs, the most appropriate surgical technique is the practice of a derivative colostomy without resection of the affected sigmoid segment\n", "Attack"]]}
{"162_121": [["The correct answer is: 2\n", "Abdomino-pelvic ultrasound\n", "Support"], ["The correct answer is: 2\n", "Abdomino-pelvic ultrasound\n", "Support"], ["Abdomino-pelvic ultrasound is undoubtedly the most specific and sensitive test for the diagnosis of polycystic kidney disease and, above all, the cheapest to demonstrate whether or not the patient's sibling has inherited polycystic kidney disease\n", "Abdomino-pelvic ultrasound\n", "Support"]]}
{"207_181": [["Most of the lesions identified as L-SIL are associated with HPV infection\n", "for this reason, it is advisable to stop smoking, as this is a factor in the progression of the said infection\n", "Support"], ["for this reason, it is advisable to stop smoking, as this is a factor in the progression of the said infection\n", "The best answer to this question is number 5\n", "Support"], ["On the other hand, according to the latest studies, 70% of the cytologies reported as LSIL will remit, 15% will persist and another 15% will show a more severe cytology, without being able to differentiate whether it is a biological progression or a lesion hidden in the initial cytology\n", "Because of this, it is best to return for a follow-up at 6 months\n", "Support"], ["Given the woman's personal history (more than 5 sexual partners and repeat infections) and her age\n", "a referral for colposcopy would be ideal\n", "Support"], ["The best answer to this question is number 5\n", "Advise her to stop smoking and contraceptives and to have a control in 6 months\n", "Support"], ["Because of this, it is best to return for a follow-up at 6 months\n", "Advise her to stop smoking and contraceptives and to have a control in 6 months\n", "Support"], ["a referral for colposcopy would be ideal\n", "Advise her to stop smoking and contraceptives and to have a control in 6 months\n", "Support"], ["However, answer 5 says control in 6 months, but does not specify which control (it could be a colposcopy or cytology)\n", "Advise her to stop smoking and contraceptives and to have a control in 6 months\n", "Support"]]}
{"584_73": [["A 51-year-old woman, menopausal for a year and a half, who consults for vaginal spotting of 2 weeks' evolution\n", "The endometrium is thickened for a menopausal woman\n", "Support"], ["The endometrium is thickened for a menopausal woman\n", "The endometrium is thickened and in view of the patient's symptoms, an endometrial biopsy is taken with a Cornier cannula\n", "Support"], ["some guidelines put the limit at 5 and others at 3mm\n", "The endometrium is thickened for a menopausal woman\n", "Support"], ["And the first complementary test to perform would be an endometrial biopsy\n", "The endometrium is thickened and in view of the patient's symptoms, an endometrial biopsy is taken with a Cornier cannula\n", "Support"]]}
{"138_165": [["child with otalgia, but without fever or acute inflammatory signs: it is neither 1 (recurrent acute otitis media) nor 5 (mastoiditis)\n", "Mastoiditis\n", "Attack"], ["child with otalgia, but without fever or acute inflammatory signs: it is neither 1 (recurrent acute otitis media) nor 5 (mastoiditis)\n", "Recurrent acute otitis media\n", "Attack"], ["without fever or acute inflammatory signs\n", "Recurrent acute otitis media\n", "Attack"], ["without fever or acute inflammatory signs\n", "Mastoiditis\n", "Attack"], ["On otoscopy, a pinkish and amber eardrum is observed: there are no scales, so it is not 4 (cholesteatomatous chronic otitis media); nor perforations or adhesions, so it is not 3 (simple chronic otitis media)\n", "Chronic cholesteatomatous otitis media\n", "Attack"], ["On otoscopy, a pinkish and amber eardrum is observed: there are no scales, so it is not 4 (cholesteatomatous chronic otitis media); nor perforations or adhesions, so it is not 3 (simple chronic otitis media)\n", "Simple chronic otitis media\n", "Attack"], ["Otoscopy is characteristic of serous otitis media (answer 2 correct)\n", "Serous otitis media\n", "Support"], ["on examination shows a pinkish/amber eardrum\n", "Serous otitis media\n", "Support"], ["It is known by ENT, pediatricians and family physicians that in the month following an acute otitis media, the middle ear is occupied by a mucous content whose evolution should be monitored\n", "Serous otitis media\n", "Support"], ["As history he refers that one month ago he presented an episode of otalgia, fever accompanied by irritability and that he was treated with amoxicillin 40 mg/kg/day\n", "Serous otitis media\n", "Support"]]}
{"136_132": [["Lung cancer is the most frequent cause of brain metastases and in 20-30% of cases it is as a result of them that the primary tumor is diagnosed (as here)\n", "Lung cancer\n", "Support"], ["A CT scan shows multiple metastases\n", "Lung cancer\n", "Support"]]}
{"518_105": [["A 24-year-old woman with a history of migraine, on propranolol and oral contraceptives, presents with severe dyspnea, hoarseness, rash, nausea and vomiting 30 minutes after taking metamizole\n", "We are faced with an anaphylactic reaction to metamizole, in which it is necessary to act quickly or the patient could progress to cardiac arrest\n", "Support"], ["In this particular case, since the patient was previously treated with propranolol\n", "this indicates that the correct answer is 4, which includes the administration of glucagon\n", "Support"], ["patients taking beta-blockers can be resistant to treatment with adrenaline and develop refractory hypotension and prolonged bradycardia\n", "this indicates that the correct answer is 4, which includes the administration of glucagon\n", "Support"], ["this indicates that the correct answer is 4, which includes the administration of glucagon\n", "Adrenaline, dexchlorpheniramine and glucagon\n", "Support"], ["The treatment of choice is IM adrenaline (only switch to IV if anaphylaxis is refractory), which has been shown to increase survival, and administration can be repeated every 5-15 minutes if symptoms do not subside\n", "Adrenaline, dexchlorpheniramine and glucagon\n", "Support"], ["As adjuvant treatment, dexchlorpheniramine could be administered\n", "Adrenaline, dexchlorpheniramine and glucagon\n", "Support"]]}
[{"581_205": []}]
{"543_39": [["Anisakis simplex is a parasite frequently found in fish\n", "To avoid reactions with this parasite, a diet free of fresh and raw fish (anchovies in vinegar, smoked, salted fish, sushi, etc.) should be followed\n", "Support"], ["To avoid reactions with this parasite, a diet free of fresh and raw fish (anchovies in vinegar, smoked, salted fish, sushi, etc.) should be followed\n", "Deep-frozen fish or fresh fish previously frozen at -20\u00baC for at least 5 days before cooking can be consumed, as long as it is cooked at high temperatures >60\u00baC (roasted, fried, etc.), avoiding raw, grilled or microwaved preparations\n", "Support"], ["Deep-frozen fish or fresh fish previously frozen at -20\u00baC for at least 5 days before cooking can be consumed, as long as it is cooked at high temperatures >60\u00baC (roasted, fried, etc.), avoiding raw, grilled or microwaved preparations\n", "May eat commercially flash-frozen fish\n", "Support"]]}
{"2_36": [["In this question, they insist on the age and comorbidity of the patient, as well as the time of evolution\n", "the answer will probably not be 1\n", "Support"], ["In any case, the ideal would be to drain the gallbladder that has not gone up again, so the answer I would give would be 2\n", "Biliary drainage by percutaneous cholecystostomy\n", "Support"]]}
{"122_119": [["The correct answer is the first one\n", "It is a typical picture of infectious mononucleosis\n", "Support"], ["It is a typical picture of infectious mononucleosis\n", "It is a typical picture of infectious mononucleosis\n", "Attack"], ["Although a similar picture may occur in acute toxoplasmosis, less than 1% of acute toxoplasma infections present as mononucleosis\n", "Acute toxoplasmosis\n", "Attack"], ["She had previously been diagnosed with acute pharyngitis and was treated with amoxicillin, and later presented with a generalized macular skin rash\n", "It is a typical picture of infectious mononucleosis\n", "Support"], ["Characteristic of Epstein-Barr infectious mononucleosis is the appearance of macular rash after treatment with amoxicillin\n", "It is a typical picture of infectious mononucleosis\n", "Support"]]}
{"36_130": [["The correct answer is to initiate treatment with L-dopa, since the clinical picture described is of a parkinsonism whose diagnosis is exclusively clinical\n", "Therapeutic attempt with L-dopa\n", "Support"], ["the performance of complementary tests does not justify delaying the initiation of treatment\n", "Therapeutic attempt with L-dopa\n", "Support"]]}
{"338_31": [["20-year-old woman with ovarian tumor of 15 cm, solid-cystic, detected by ultrasound after presenting with unspecific abdominal symptoms\n", "Mature cystic teratoma (common in the ovary of the adult female)\n", "Support"], ["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\n", "Mass with a large cyst occupying most of it; in its cavity there is sebaceous material and hairs\n", "Support"], ["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\n", "apart from skin structures many other tissues can be observed, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone\n", "Support"], ["20-year-old woman with ovarian tumor of 15 cm, solid-cystic, detected by ultrasound after presenting with unspecific abdominal symptoms\n", "The tissues that compose the tumor are well differentiated (mature or adult type)\n", "Support"], ["Mature cystic teratoma (common in the ovary of the adult female)\n", "Mature cystic teratoma\n", "Support"], ["apart from skin structures many other tissues can be observed, particularly in a thickening or spur that eminences into the cavity, in which there are often teeth, cartilage and bone\n", "Mature cystic teratoma (common in the ovary of the adult female)\n", "Support"], ["Mass with a large cyst occupying most of it; in its cavity there is sebaceous material and hairs\n", "Mature cystic teratoma (common in the ovary of the adult female)\n", "Support"], ["The wall, generally a few millimeters thick, has the structure of skin, with its epidermal surface towards the cavity\n", "Mature cystic teratoma (common in the ovary of the adult female)\n", "Support"], ["Because of this preponderant development of cutaneous structures it is usually called dermoid cyst\n", "Mature cystic teratoma (common in the ovary of the adult female)\n", "Support"], ["The tissues that compose the tumor are well differentiated (mature or adult type)\n", "Mature cystic teratoma (common in the ovary of the adult female)\n", "Support"]]}
{"432_117": [["they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n", "Cloxacillin\n", "Attack"], ["they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n", "Cefazolin\n", "Attack"], ["they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n", "Linezolid\n", "Attack"], ["The Gram stain tells us that it is a staphylococcus, most of the species of this genus acquired in-hospital are methicillin resistant\n", "they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n", "Support"], ["they are considered resistant to Cloxacillin, Cefazolin and there are no clinical data about the efficacy of linezolid for the treatment of systemic infection related to catheter\n", "This, plus the experience with vancomycin use in this setting is considered the empirical choice for vancomycin\n", "Support"], ["This, plus the experience with vancomycin use in this setting is considered the empirical choice for vancomycin\n", "Vancomycin\n", "Support"]]}
{"513_38": [["Of the proposed drugs, the least likely options would be 3\n", "and 4\n", "Support"], ["Of the proposed drugs, the least likely options would be 3\n", "Metformin or levodopa equally\n", "Attack"], ["and 4\n", "Levodopa\n", "Attack"], ["A 72-year-old patient presents to the emergency department with severe lingual angioedema\n", "metformin very rarely causes lingual angioedema (in March 2020 there was only one case described worldwide)\n", "Attack"], ["A 72-year-old patient presents to the emergency department with severe lingual angioedema\n", "among the adverse reactions of levodopa, angioedema is classified among the very rare ones (frequency less than 0.1%)\n", "Attack"], ["metformin very rarely causes lingual angioedema (in March 2020 there was only one case described worldwide)\n", "Of the proposed drugs, the least likely options would be 3\n", "Support"], ["among the adverse reactions of levodopa, angioedema is classified among the very rare ones (frequency less than 0.1%)\n", "and 4\n", "Support"], ["Of the two remaining options, the drugs most frequently and classically associated with lingual angioedema are ACE inhibitors (frequency around 0.2%), and their association with simvastatin is also less than 0.1%\n", "Enalapril\n", "Support"], ["A 72-year-old patient presents to the emergency department with severe lingual angioedema\n", "Of the two remaining options, the drugs most frequently and classically associated with lingual angioedema are ACE inhibitors (frequency around 0.2%), and their association with simvastatin is also less than 0.1%\n", "Support"], ["Of the two remaining options, the drugs most frequently and classically associated with lingual angioedema are ACE inhibitors (frequency around 0.2%), and their association with simvastatin is also less than 0.1%\n", "Simvastatin\n", "Attack"]]}
{"580_198": [["After a TBI in a patient who is not anticoagulated or antiplatelet, with no known risk factors for hemorrhage, and who does not present alarming data in the anamnesis or physical examination, it is not necessary to perform a cranial imaging test\n", "No imaging test\n", "Support"]]}
{"248_118": [["This is syphilis (both by antecendent and serology) in the secondary stage\n", "treatment is with Benzathine Penicillin 2.4 MU in a single dose\n", "Support"], ["treatment is with Benzathine Penicillin 2.4 MU in a single dose\n", "Benzathine penicillin 2.4 MU intramuscularly in a single dose\n", "Support"]]}
{"222_197": [["the individual has received some vaccines, has a CD4 count >100 (if lower there would be a contraindication) and works in a center that helps AIDS patients (he is equated to \"health personnel\")\n", "answers 2, 4 and 5 are wrong\n", "Support"], ["answers 2, 4 and 5 are wrong\n", "Seasonal influenza, Td, pneumococcal and tetravalent meningitis\n", "Attack"], ["answers 2, 4 and 5 are wrong\n", "Td, tetravalent meningitis, pneumococcal\n", "Attack"], ["answers 2, 4 and 5 are wrong\n", "Triple viral, seasonal flu, pneumococcal\n", "Attack"], ["All four vaccines in option 1 are administrable\n", "Seasonal influenza, pneumococcal, tetravalent meningitis and hepatitis A\n", "Support"], ["Vaccine against tetanus and diphtheria: all persons should be vaccinated against these two diseases\n", "All four vaccines in option 1 are administrable\n", "Support"], ["Hepatitis B vaccine: hepatitis B and HIV viruses share the same routes of transmission, so it is common for HIV-infected patients to also be infected with hepatitis B virus\n", "All four vaccines in option 1 are administrable\n", "Support"], ["It is therefore important to know whether the HIV-infected person has markers of hepatitis B infection and to proceed with vaccination if he/she does not have them\n", "All four vaccines in option 1 are administrable\n", "Support"], ["Vaccination against hepatitis A: Hepatitis A in a person with hepatitis B, hepatitis C or other liver disease can be very serious\n", "All four vaccines in option 1 are administrable\n", "Support"], ["Since these infections are more frequent in HIV-infected patients, vaccination against hepatitis A is recommended\n", "All four vaccines in option 1 are administrable\n", "Support"], ["Vaccination against influenza: influenza in a patient with a lack of immune response is more serious and presents a greater risk of complications\n", "annual vaccination against this disease is indicated\n", "Support"], ["annual vaccination against this disease is indicated\n", "All four vaccines in option 1 are administrable\n", "Support"], ["Pneumococcal vaccine: pneumococcal infections (especially pneumonia) are up to 10 times more frequent in HIV-infected persons than in HIV-uninfected adults\n", "vaccination is recommended\n", "Support"], ["although in patients with counts below 200/mm3 the protective response is usually not sufficient\n", "vaccination is recommended\n", "Attack"], ["vaccination is recommended\n", "All four vaccines in option 1 are administrable\n", "Support"], ["They should receive a second dose at 3-5 years of age\n", "although in patients with counts below 200/mm3 the protective response is usually not sufficient\n", "Support"], ["Although in HIV-infected adults it represents a small number of the causes of infection, vaccination is recommended\n", "All four vaccines in option 1 are administrable\n", "Support"], ["Vaccination against measles, rubella and mumps (MMR): all three diseases can become more serious in HIV-infected patients, especially measles\n", "all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3)\n", "Support"], ["all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3)\n", "All four vaccines in option 1 are administrable\n", "Support"], ["He is currently asymptomatic with a CD4 count above 200 cls/microliter\n", "all of them should be vaccinated, provided that immunosuppression is not severe (count less than 200/mm3)\n", "Support"]]}
{"244_114": [["the main infectious foci have been reasonably ruled out\n", "The clinical data could be consistent with a septic process\n", "Attack"], ["one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range\n", "The clinical data could be consistent with a septic process\n", "Attack"], ["the main infectious foci have been reasonably ruled out\n", "She has a bacterial sepsis of undetermined origin and should be given ceftriaxone and supportive care\n", "Attack"], ["one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range\n", "She has a bacterial sepsis of undetermined origin and should be given ceftriaxone and supportive care\n", "Attack"], ["the main infectious foci have been reasonably ruled out\n", "She has bacterial sepsis of undetermined origin and should be given vancomycin, ceftacidime and supportive care\n", "Attack"], ["one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range\n", "She has bacterial sepsis of undetermined origin and should be given vancomycin, ceftacidime and supportive care\n", "Attack"], ["the main infectious foci have been reasonably ruled out\n", "which should draw our attention\n", "Support"], ["one of the most sensitive and specific markers of bacteremia (procalcitonin) is in the normal range\n", "which should draw our attention\n", "Support"], ["which are not very consistent with the clinical picture presented to us\n", "among the possible complications are hemolytic anemia, meningoecephalitis (normal CSF) or Guillain-Barr\u00e9 sd. Guillain-Barr\u00e9 syndrome\n", "Attack"], ["this is a rare entity that occurs in certain predisposed subjects and is characterized by an uncontrolled activation and proliferation of histiocytes and T lymphocytes, which produces a state of hypercytokinemia\n", "Another possible complication of exceptional severity would be hemophagocytic syndrome\n", "Support"], ["The diagnostic criteria, revised in 2004, include persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia\n", "Another possible complication of exceptional severity would be hemophagocytic syndrome\n", "Support"], ["CRP and ferritin are very elevated\n", "The diagnostic criteria, revised in 2004, include persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia\n", "Support"], ["CRP and ferritin are very elevated\n", "Hyperferritinemia >3000 in a suggestive clinical context necessitates treatment of the patient (mainly with immunosuppressants and corticosteroids) since mortality is very high and early treatment is essential\n", "Support"], ["A 16-year-old boy consults for presenting with pustular tonsillitis, fever up to 38.5\u00b0C, painful cervical lymphadenopathy, non-pruritic macular rash on the chest and mild hepatosplenomegaly, of 4-5 days of evolution\n", "The diagnostic criteria, revised in 2004, include persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia\n", "Support"], ["Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n", "I would perform a bone marrow biopsy/aspirate and, if hemophagocytosis is confirmed, initiate treatment with immunosuppressants\n", "Support"], ["CRP and ferritin are very elevated\n", "Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n", "Support"], ["Another possible complication of exceptional severity would be hemophagocytic syndrome\n", "Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n", "Support"], ["The diagnostic criteria, revised in 2004, include persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia\n", "Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n", "Support"], ["Hyperferritinemia >3000 in a suggestive clinical context necessitates treatment of the patient (mainly with immunosuppressants and corticosteroids) since mortality is very high and early treatment is essential\n", "Although in this question they do not quantify the value of ferritinemia, it is a remarkable data and given that the clinical picture is suggestive, meeting the diagnostic criteria, it seems to me that answer 5 would be the most accurate\n", "Support"]]}
{"420_78": [["Option 4 is describing to us a T4 stage, either by invasion of adjacent organs or perforation\n", "Perforation or adhesion of the tumor to adjacent organs\n", "Support"], ["The T4s carry a much higher chance of recurrence\n", "Perforation or adhesion of the tumor to adjacent organs\n", "Support"], ["in fact there are ongoing studies that propose prophylactic HIPEC in T4 and second look surgery + HIPEC in perforated colon tumors\n", "Perforation or adhesion of the tumor to adjacent organs\n", "Support"]]}
{"321_144": [["In this case, with the patient being asymptomatic and with objective evidence of lack of activity, close follow-up should be performed without restarting or modifying treatment\n", "Watchful waiting\n", "Support"], ["A 50-year-old man diagnosed with polyangiitis with granulomatosis 10 years earlier and untreated for the past 5 years is asymptomatic at a scheduled check-up\n", "In this case, with the patient being asymptomatic and with objective evidence of lack of activity, close follow-up should be performed without restarting or modifying treatment\n", "Support"], ["In ANCA vasculitis, whatever it is, these antibodies have been shown to be related to the activity of the disease, but at no time are changes in treatment obligatory due to their levels\n", "Watchful waiting\n", "Support"]]}
{"516_103": [["His blood pressure is 110/60 mmHg, heart rate 110 bpm, 90% SatO2, capillary glucose 120 mg/dl and respiratory rate 7 rpm\n", "We find a patient with hypoventilation\n", "Support"], ["A 56-year-old patient is found comatose at home\n", "We find a patient with hypoventilation\n", "Support"], ["we rule out hyperosmolar coma and hypoglycemia, option 2 and 4\n", "Administer naloxone, flumazenil and hypertonic glucose\n", "Attack"], ["we rule out hyperosmolar coma and hypoglycemia, option 2 and 4\n", "Administer thiamine and hypertonic glucose\n", "Attack"], ["so, although there is no history of intoxication, we have to go to the most frequent and that we can antagonize with antidotes: benzodiazepines (flumazenil) and opiates (naloxone)\n", "Administer naloxone and flumazenil\n", "Support"], ["but there are no data to make us suspect\n", "If we suspect ethylene glycol intoxication, we would administer thiamine\n", "Attack"], ["If we suspect ethylene glycol intoxication, we would administer thiamine\n", "Administer naloxone, flumazenil and thiamine\n", "Attack"]]}
{"44_153": [["The correct answer is 3\n", "Abdominal ultrasound\n", "Support"], ["the clinical description is textbook hypertrophic pyloric stenosis\n", "The correct answer is 3\n", "Support"]]}
{"54_72": [["Debut of DM with ketoacidosis\n", "It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause\n", "Support"], ["Priority is iv insulin administration and serum therapy\n", "It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause\n", "Support"], ["Bicarbonate if pH < 7\n", "It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause\n", "Support"], ["Insulin administration should never be delayed\n", "It is a diabetic ketoacidosis. It must be treated with intravenous insulin, serum therapy, general measures and search for precipitating cause\n", "Support"]]}
{"553_177": [["33-year-old patient, resident of Valencia, who consults for presenting on the right cheek an erythematous-orange plaque after an insect bite that has been growing slowly until reaching 1.5 cm and that in the last weeks has ulcerated and covered with a scammocostra\n", "The fact that the place of residence is mentioned already gives us many clues\n", "Support"], ["A \"bite\" that transforms into a lesion in an uncovered area with a crusty surface and that bothers little or nothing..\n", "in the Mediterranean basin this is cutaneous leishmaniasis or oriental button\n", "Support"], ["The fact that the place of residence is mentioned already gives us many clues\n", "in the Mediterranean basin this is cutaneous leishmaniasis or oriental button\n", "Support"], ["And while it is true that the lesion is < 4 cm and unique, we are told that the patient is being treated with adalimumab, an anti-TNF monoclonal antibody\n", "With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis\n", "Attack"], ["in the Mediterranean basin this is cutaneous leishmaniasis or oriental button\n", "With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis\n", "Support"], ["With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis\n", "Intralesional meglumine antimoniate\n", "Support"], ["With the exception of meglumine antimoniate, none of the other treatments proposed in the different options are indicated in leishmaniasis\n", "it is clear\n", "Support"], ["it is clear\n", "Intralesional meglumine antimoniate\n", "Support"]]}
{"608_115": [["For its diagnosis it is necessary to measure the pressure of the affected compartments at rest and after activity\n", "answer 2 correct\n", "Support"], ["We present a case of chronic compartment syndrome\n", "For its diagnosis it is necessary to measure the pressure of the affected compartments at rest and after activity\n", "Support"], ["answer 2 correct\n", "Determination of posterior compartment pressure immediately after activity\n", "Support"]]}
{"294_44": [["Question in which the clinical picture must be recognized: cardiovascular anomalies - Tetralogy of Fallot -; thymic aplasia/hypoplasia - leading to primary T-cell immunodeficiency; parathyroid aplasia/hypoplasia - hence hypocalcemia -; palatal anomalies - nasal voice; psychomotor retardation\n", "In my opinion, just with the words \"thymic dysfunction\", hypocalcemia and cardiopathy, we would have to go straight to DiGeorge syndrome\n", "Support"], ["In my opinion, just with the words \"thymic dysfunction\", hypocalcemia and cardiopathy, we would have to go straight to DiGeorge syndrome\n", "22q11 deletion study (Di George or Velo-cardio-facial syndrome)\n", "Support"], ["Indeed, the genetic defect is a 22q11.2 deletion (which if we know it, the better, but with the clinic it would be enough for us)\n", "22q11 deletion study (Di George or Velo-cardio-facial syndrome)\n", "Support"], ["moreover, in most cases it is caused by an alteration in the PTPN11 gene, not in those mentioned in the question\n", "Sequencing of genes related to HRAS (Noonan syndrome)\n", "Attack"], ["moreover, in most cases it is caused by an alteration in the PTPN11 gene, not in those mentioned in the question\n", "The only option with which there could be doubt is Noonan syndrome, which can also be associated with cardiopathy\n", "Attack"], ["but above all it is characterized by short stature, cardiopathy and bone alterations\n", "The only option with which there could be doubt is Noonan syndrome, which can also be associated with cardiopathy\n", "Attack"]]}
{"156_230": [["Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n", "Reactive arthritis syndrome\n", "Support"], ["The only problem is that the statement speaks of joint pain and not arthritis\n", "Reactive arthritis syndrome\n", "Attack"], ["A 40-year-old patient who comes to the emergency room with aphthous stomatitis\n", "Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n", "Support"], ["conjunctivitis\n", "Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n", "Support"], ["urethritis\n", "Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n", "Support"], ["balanitis\n", "Given this clinical picture and without having complementary tests available, the most likely diagnosis is reactive arthritis\n", "Support"], ["joint pain\n", "The only problem is that the statement speaks of joint pain and not arthritis\n", "Support"], ["conjunctivitis\n", "Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present\n", "Support"], ["urethritis\n", "Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present\n", "Support"], ["The only problem is that the statement speaks of joint pain and not arthritis\n", "Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present\n", "Attack"], ["Reiter's syndrome (triad of conjunctivitis, urethritis and arthritis) is one of the forms in which reactive arthritis can present\n", "Reactive arthritis syndrome\n", "Support"], ["A 40-year-old patient who comes to the emergency room with aphthous stomatitis\n", "In Beh\u00e7et's disease oral and genital aphthous ulcers may occur but urethritis is not a feature\n", "Support"], ["urethritis\n", "In Beh\u00e7et's disease oral and genital aphthous ulcers may occur but urethritis is not a feature\n", "Attack"], ["In Beh\u00e7et's disease oral and genital aphthous ulcers may occur but urethritis is not a feature\n", "Beh\u00e7et's disease\n", "Attack"], ["A 40-year-old patient who comes to the emergency room with aphthous stomatitis\n", "Beh\u00e7et's disease\n", "Support"], ["urethritis\n", "Beh\u00e7et's disease\n", "Attack"], ["conjunctivitis\n", "Beh\u00e7et's disease\n", "Attack"], ["And the characteristic ocular condition is uveitis\n", "In Beh\u00e7et's disease oral and genital aphthous ulcers may occur but urethritis is not a feature\n", "Support"], ["conjunctivitis\n", "And the characteristic ocular condition is uveitis\n", "Attack"]]}
{"82_45": [["Under these conditions, the treatment of choice would be surgical (myocardial revascularization surgery or by-pass)\n", "Myocardial revascularization surgery\n", "Support"], ["We are talking about a patient with 3-vessel coronary artery disease and, very importantly, with severe ventricular dysfunction\n", "Under these conditions, the treatment of choice would be surgical (myocardial revascularization surgery or by-pass)\n", "Support"], ["since today, thanks to drug-eluting stents, the differences in terms of morbidity and mortality between by-pass surgery and angioplasty are minimal\n", "In the case of a patient with preserved LV function, the choice of surgical vs. percutaneous treatment would be more questionable\n", "Support"]]}
{"485_49": [["A 60-year-old man on carbamazepine treatment for epilepsy presenting with fever (38.8\u00b0C), odynophagia, conjunctivitis, brownish skin lesions spread over a large body surface, target-like in appearance and accompanied by epidermal detachment (greater than 30%) at the slightest friction\n", "We are dealing with a severe patient, with target lesions and Nikolsky's sign in > 30% of the body surface area\n", "Support"], ["Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4)\n", "Epidermal toxic necrolysis\n", "Support"], ["We are dealing with a severe patient, with target lesions and Nikolsky's sign in > 30% of the body surface area\n", "Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4)\n", "Support"], ["A 60-year-old man on carbamazepine treatment for epilepsy presenting with fever (38.8\u00b0C), odynophagia, conjunctivitis, brownish skin lesions spread over a large body surface, target-like in appearance and accompanied by epidermal detachment (greater than 30%) at the slightest friction\n", "If the epidermal detachment is less than 10% then we would be dealing with Stevens-Johnson (and intermediate cases are referred to as overlap, since it is a whole spectrum)\n", "Attack"], ["If the epidermal detachment is less than 10% then we would be dealing with Stevens-Johnson (and intermediate cases are referred to as overlap, since it is a whole spectrum)\n", "Pharmacological Stevens-Johnson syndrome\n", "Attack"], ["Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4)\n", "Incidentally, we would recommend immediate admission to a major burn unit\n", "Support"]]}
[{"219_124": []}]
{"578_107": [["After a good evolution in which he recovers the ability to walk, one month after suffering the hemorrhage, he presents a progressive deterioration, becoming cloudy and with difficulty to obey orders\n", "Vasospasm as a complication of subarachnoid hemorrhage usually occurs early, in the week after the hemorrhage\n", "Attack"], ["Vasospasm as a complication of subarachnoid hemorrhage usually occurs early, in the week after the hemorrhage\n", "She is in the moment of evolution in which vasospasm is more frequent\n", "Attack"], ["The progressive deterioration with alteration of the level of consciousness makes us suspect one of the complications that can occur in this condition: hydrocephalus\n", "Subacute deterioration is most likely due to hydrocephalus\n", "Support"], ["The diagnostic technique of choice in this case is neuroimaging with cranial CT\n", "The diagnostic technique of choice is cerebral angiography\n", "Attack"], ["The progressive deterioration with alteration of the level of consciousness makes us suspect one of the complications that can occur in this condition: hydrocephalus\n", "This progressive deterioration is probably secondary to aneurysm rebleeding\n", "Attack"]]}
{"199_74": [["The key in the question is \"stopping the clinical course\", as Hungtinton's disease, Tourette's and Parkinson's disease do not have treatments that can stop the clinical course\n", "Huntington's disease\n", "Attack"], ["The key in the question is \"stopping the clinical course\", as Hungtinton's disease, Tourette's and Parkinson's disease do not have treatments that can stop the clinical course\n", "Tourette's syndrome\n", "Attack"], ["The key in the question is \"stopping the clinical course\", as Hungtinton's disease, Tourette's and Parkinson's disease do not have treatments that can stop the clinical course\n", "uvenile-onset Parkinson's disease\n", "Attack"], ["a patient presenting in the second decade of life\n", "you should always perform a study to rule out the presence of a disease whose appropriate treatment can improve neurological symptoms and stop the clinical course\n", "Support"], ["progressive picture of parkinsonism, tremor, dystonia and behavioral alteration\n", "you should always perform a study to rule out the presence of a disease whose appropriate treatment can improve neurological symptoms and stop the clinical course\n", "Support"], ["a patient presenting in the second decade of life\n", "Sydenham's chorea is typical of younger children with a history of streptococcal infection and resolution is usually spontaneous\n", "Attack"], ["On the other hand, in clinical cases it is recommended to rule out Wilson's disease in young patients with movement and neuropsychiatric disorders\n", "Wilson's disease\n", "Support"], ["progressive picture of parkinsonism, tremor, dystonia and behavioral alteration\n", "On the other hand, in clinical cases it is recommended to rule out Wilson's disease in young patients with movement and neuropsychiatric disorders\n", "Support"], ["a patient presenting in the second decade of life\n", "On the other hand, in clinical cases it is recommended to rule out Wilson's disease in young patients with movement and neuropsychiatric disorders\n", "Support"]]}
{"331_87": [["Paralytic ileus is a failure of intestinal propulsion that appears acutely in the absence of mechanical obstruction\n", "Prolonged paralytic syndrome\n", "Support"], ["Paralytic ileus is a failure of intestinal propulsion that appears acutely in the absence of mechanical obstruction\n", "Therefore, parenteral administration is necessary\n", "Support"], ["it is secondary to various causes and affects intestinal contractility\n", "Therefore, parenteral administration is necessary\n", "Support"]]}
{"205_214": [["A 24-year-old young man who 3 days after a risky sexual contact presents numerous pustular lesions, small, very pruritic and evolving to tiny erosions affecting the entire glans and the inner face of the foreskin\n", "Chancroid is a solitary lesion\n", "Attack"], ["Chancroid is a solitary lesion\n", "Chancroid\n", "Attack"], ["Secondary syphilis usually occurs as a generalized rash or as characteristic lesions on palms and soles (syphilitic nails) with a longer latency period\n", "Secondary syphilis\n", "Attack"], ["A 24-year-old young man who 3 days after a risky sexual contact presents numerous pustular lesions, small, very pruritic and evolving to tiny erosions affecting the entire glans and the inner face of the foreskin\n", "Secondary syphilis usually occurs as a generalized rash or as characteristic lesions on palms and soles (syphilitic nails) with a longer latency period\n", "Attack"], ["Therefore, the answer is 1\n", "Genital candidiasis\n", "Support"], ["which is not referred to in the question\n", "Trichomonas balanitis is always associated with urethritis\n", "Attack"], ["Trichomonas balanitis is always associated with urethritis\n", "Trichomonas balanitis\n", "Attack"], ["A 24-year-old young man who 3 days after a risky sexual contact presents numerous pustular lesions, small, very pruritic and evolving to tiny erosions affecting the entire glans and the inner face of the foreskin\n", "Moreover, genital candidiasis is not necessarily sexually transmitted\n", "Attack"], ["However, the clinical picture suggests herpes simplex rather than candidiasis and 5 also refers to fungi\n", "Genital candidiasis\n", "Attack"], ["Moreover, genital candidiasis is not necessarily sexually transmitted\n", "Genital candidiasis\n", "Attack"], ["although dermatophytes do not cause balanitis\n", "However, the clinical picture suggests herpes simplex rather than candidiasis and 5 also refers to fungi\n", "Attack"], ["from our point of view, even if we consider 1 to be correct, the question is misleading and could be open to challenge\n", "Genital candidiasis\n", "Support"]]}
[{"441_98": []}]
{"302_111": [["Prerenal acute renal failure due to NSAIDs seems the most plausible option in this case\n", "Renal failure due to non-steroidal anti-inflammatory drugs\n", "Support"], ["Tubulointerstitial nephritis due to methotrexate is less likely due to the absence of rash, fever or eosinophilia\n", "Interstitial nephritis due to methotrexate\n", "Attack"], ["the anodyne urine sediment and the absence of proteinuria make these options unlikely\n", "Although GMN and renal amyloidosis are relatively frequent in RA\n", "Attack"], ["the anodyne urine sediment and the absence of proteinuria make these options unlikely\n", "Renal amyloidosis\n", "Attack"], ["the anodyne urine sediment and the absence of proteinuria make these options unlikely\n", "Glomerulonephritis secondary to rheumatoid arthritis\n", "Attack"]]}
{"517_104": [["In a polytraumatized patient, the first cause of shock is blood loss (hemorrhagic shock)\n", "The guidelines to follow should always contemplate the replenishment of blood volume (if possible, with blood products as early as possible) and control of the focus\n", "Support"], ["In this case, given the vital compromise, the need for transfusion is very urgent\n", "so the indication is emergency blood transfusion (O Rh negative)\n", "Support"], ["During his transfer to the hospital his vital signs improve transiently and then deteriorate on arrival at the hospital\n", "In this case, given the vital compromise, the need for transfusion is very urgent\n", "Support"], ["A 34-year-old male is involved in a traffic accident and is attended at the scene of the accident\n", "In a polytraumatized patient, the first cause of shock is blood loss (hemorrhagic shock)\n", "Support"], ["The medical personnel observe that he is pale, sweaty, has a thready pulse with a blood pressure of 90/50 mmHg, a heart rate of 127 bpm, a respiratory rate of 28 rpm and an oxygen saturation of 92%\n", "In a polytraumatized patient, the first cause of shock is blood loss (hemorrhagic shock)\n", "Support"], ["so the indication is emergency blood transfusion (O Rh negative)\n", "Requires emergency blood transfusion (O Rh negative)\n", "Support"]]}
{"520_38": [["Angioedema is a type of profound urticaria that can be of drug etiology (not IgE-mediated)\n", "in this case, ACEIs (such as enalapril) are considered the most frequent pharmacological cause\n", "Support"], ["in this case, ACEIs (such as enalapril) are considered the most frequent pharmacological cause\n", "so in this case it would be the correct answer (if we speak in probabilistic terms)\n", "Support"], ["so in this case it would be the correct answer (if we speak in probabilistic terms)\n", "Enalapril\n", "Support"], ["in this case, ACEIs (such as enalapril) are considered the most frequent pharmacological cause\n", "Enalapril\n", "Support"]]}
{"379_133": [["We describe a picture of typical peripheral facial paralysis, with dysgeusia, hyperacusis and mastoid pain\n", "In this case the treatment is corticoid\n", "Support"], ["In this case the treatment is corticoid\n", "Oral corticosteroids are the treatment of choice for the patient\n", "Support"], ["We describe a picture of typical peripheral facial paralysis, with dysgeusia, hyperacusis and mastoid pain\n", "although within the age range of multiple sclerosis debut, the presentation is usually gradual over days and the nuclear involvement of the VII cranial nerve (which could simulate a peripheral facial) would not cause dysgeusia, hyperacusis or mastoid pain\n", "Attack"], ["although within the age range of multiple sclerosis debut, the presentation is usually gradual over days and the nuclear involvement of the VII cranial nerve (which could simulate a peripheral facial) would not cause dysgeusia, hyperacusis or mastoid pain\n", "The first one would not be correct\n", "Support"], ["The first one would not be correct\n", "The most probable diagnosis is a demyelinating plaque in the contralateral hemiprotuberance, the most necessary complementary exploration would be a cranial MRI\n", "Attack"], ["In the third answer they propose us that it is a vascular picture\n", "it is discarded\n", "Support"], ["therefore that the facial paralysis is central\n", "it is discarded\n", "Support"], ["We describe a picture of typical peripheral facial paralysis, with dysgeusia, hyperacusis and mastoid pain\n", "therefore that the facial paralysis is central\n", "Attack"], ["it is discarded\n", "Intravenous fibrinolysis should be considered if the evolution time is less than 3h\n", "Attack"], ["most of the idiopathic peripheral facial paralysis (Bell's palsy) heal without sequelae\n", "the last one is not correct\n", "Support"], ["the last one is not correct\n", "Most likely the picture is irreversible\n", "Attack"]]}
{"600_184": [["Older patient, over 50 years of age, presenting with pain and stiffness in both girdles, associated with an elevation of acute phase reactants\n", "In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n", "Support"], ["He presents all the indispensable criteria: age equal to or greater than 50 years, bilateral omalgia and increased acute phase reactants\n", "In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n", "Support"], ["Of the optional criteria, he presents stiffness, pain or limitation in the hip\n", "In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n", "Support"], ["In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n", "Initial treatment is corticosteroids at medium doses\n", "Support"], ["Initial treatment is corticosteroids at medium doses\n", "Polymyalgia rheumatica, would initiate treatment with corticosteroids\n", "Support"], ["In this case, he is describing the cardinal symptoms of polymyalgia rheumatica\n", "Polymyalgia rheumatica, would initiate treatment with corticosteroids\n", "Support"]]}
{"415_72": [["It is the classic exploration: he had a fever and pain, he had pericarditis with effusion, and now this is causing tamponade\n", "Pericardial effusion with cardiac tamponade\n", "Support"], ["Hence the hypotension (his heart cannot fill well with blood and pump), jugular engorgement and dependence on respiration to achieve preload and cardiac output (i.e. paradoxical pulse)\n", "It is the classic exploration: he had a fever and pain, he had pericarditis with effusion, and now this is causing tamponade\n", "Support"]]}
{"560_180": [["She has a hb of 7.4 and a MCV over 100, adding pallor and weakness\n", "we would be dealing with a macrocytic anemia\n", "Support"], ["They give to know of a patient with SLE in treatment with Hydroxychloroquine\n", "we would be dealing with a macrocytic anemia\n", "Support"], ["In my opinion, the most suitable would be alternative 2\n", "Coombs' test\n", "Support"], ["since hydroxyloroquine has been reported to decrease the absorption of folic acid\n", "in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption\n", "Support"], ["since she has a complication of SLE\n", "in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption\n", "Support"], ["in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption\n", "In my opinion, the most suitable would be alternative 2\n", "Support"], ["in this case, we could be dealing with an autoimmune hemolytic anemia with folic acid consumption\n", "And for this it would be first to determine with the direct coombs\n", "Support"], ["And for this it would be first to determine with the direct coombs\n", "Coombs' test\n", "Support"]]}
{"358_232": [["The examination revealed two lymphadenopathies, one in each groin, 1 cm in diameter, soft, mobile, non-painful\n", "In the inguinal region, the lymph nodes can acquire a size of up to 1.5 cm being normal\n", "Support"], ["On the other hand, there are no signs or symptoms that make us think of a sexually transmitted infection\n", "A lupus serology since it is most likely a Treponema pallidum infection\n", "Attack"], ["The correct answer is 3\n", "From the clinical features it seems to be normal lymph nodes and complementary explorations should not be performed\n", "Support"], ["In the inguinal region, the lymph nodes can acquire a size of up to 1.5 cm being normal\n", "The correct answer is 3\n", "Support"], ["In addition, the rest of the data of the inguinal exploration (no pain, mobile, soft, etc.) corroborates this\n", "The correct answer is 3\n", "Support"]]}
[{"414_71": []}]
{"131_221": [["An individual presents with \"muscle weakness\" (spastic hemiparesis) of both right extremities, with hyperreflexia and Babinski's sign, along with a \"facial flaccid paralysis\" of the left hemiface, with inability to close the left eye or retract the left side of the mouth, in addition to other alterations\n", "We have a right hemiparesis and involvement of the left facial nucleus, since it has affected the upper and lower facial\n", "Support"], ["We have a right hemiparesis and involvement of the left facial nucleus, since it has affected the upper and lower facial\n", "therefore we have a crossed clinical picture, having to think about brainstem involvement\n", "Support"], ["If we have in a quick diagram where the nuclei of the cranial pairs start from: the first 4 above the pons, the next 4 in the pons, and the last 4 below the pons, we have that the facial nucleus is in the middle 4\n", "That is, left facial nucleus, left pons, so answer 4\n", "Support"], ["That is, left facial nucleus, left pons, so answer 4\n", "In the medial portion of the caudal protuberance of the left side\n", "Support"]]}
{"70_127": [["in principle, we should antagonize the effect of benzodiazepines\n", "Administer flumazenil\n", "Support"]]}
{"463_71": [["We are not given any further data on the patient except that she is in shock (tissue hypoperfusion) and on introducing a Swan-Ganz catheter we find a low cardiac index (<2), elevated PCP (25mmHg) and elevated systemic resistances (normal: 600-1200 dyne/m2)\n", "These data are compatible with cardiogenic origin of shock\n", "Support"], ["These data are compatible with cardiogenic origin of shock\n", "Cardiogenic\n", "Support"]]}
{"476_93": [["Cardiac auscultation shows a loud, intense systolic murmur, which is reduced with Valsalva maneuvers and an attenuated second tone\n", "The data provided on the characteristics of the murmur (it DECREASES with Valsalva) and the data on left ventricular hypertrophy, lead us to the diagnosis of severe aortic stenosis\n", "Support"], ["The ECG shows sinus rhythm at 72 bpm, with criteria of left ventricular hypertrophy and inverted T waves in anterior face\n", "The data provided on the characteristics of the murmur (it DECREASES with Valsalva) and the data on left ventricular hypertrophy, lead us to the diagnosis of severe aortic stenosis\n", "Support"], ["The data provided on the characteristics of the murmur (it DECREASES with Valsalva) and the data on left ventricular hypertrophy, lead us to the diagnosis of severe aortic stenosis\n", "These data correspond to severe aortic stenosis\n", "Support"]]}
[{"546_124": []}]
{"313_177": [["As this is a situation of oligometastasis and the treatments for advanced colon adenocarcinoma allow prolonged survival with good quality of life in these patients, if there is nothing to contraindicate surgery, this should be the first option\n", "Assessment for surgical resection of the hepatic lesion\n", "Support"], ["correct answer 3\n", "Assessment for surgical resection of the hepatic lesion\n", "Support"], ["the responses are lower compared to FOLFOX or FOLFIRI plus antiangiogenic combinations\n", "Capecitabine monotherapy, in the patient's current situation, would also not be a good starting option\n", "Support"], ["there are SBRT techniques that achieve very good results\n", "Hepatic radiotherapy could be considered\n", "Support"], ["but in this case it is best to start by asking for an assessment by the surgeons and if they rule out surgery we would consider RT\n", "Assessment for surgical resection of the hepatic lesion\n", "Support"], ["but in this case it is best to start by asking for an assessment by the surgeons and if they rule out surgery we would consider RT\n", "Hepatic radiotherapy could be considered\n", "Attack"], ["although FOLFIRI+bevacizumab would also be useful\n", "Chemotherapy with FOLFIRI (fluorouracil, leucovorin and irinotecan) plus bevacizumab\n", "Support"], ["Capecitabine monotherapy, in the patient's current situation, would also not be a good starting option\n", "Monochemotherapy with capecitabine\n", "Attack"], ["Hepatic radiotherapy could be considered\n", "Hepatic radiotherapy\n", "Support"], ["but in this case it is best to start by asking for an assessment by the surgeons and if they rule out surgery we would consider RT\n", "Hepatic radiotherapy\n", "Attack"]]}
{"482_173": [["The first thing we need to know is that combustion of polyurethane at high temperature results in the release of cyanide (very intuitive, yes)\n", "Knowing this, and that we are dealing with cyanide poisoning, it is easier to answer the question\n", "Support"], ["Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1), and an antidote, in this case hydroxycobalamin\n", "Administration of oxygen by means of a 50% Venturi type mask\n", "Attack"], ["Among the basic initial treatment measures would be the administration of oxygen therapy with FiO2 1 (not 0.5 as stated in option 1), and an antidote, in this case hydroxycobalamin\n", "Administration of intravenous hydroxycobalamin\n", "Support"], ["The first thing we need to know is that combustion of polyurethane at high temperature results in the release of cyanide (very intuitive, yes)\n", "Ventilation with hyperbaric chamber would only be indicated in case of coexistence of carbon monoxide (CO) poisoning\n", "Attack"], ["Ventilation with hyperbaric chamber would only be indicated in case of coexistence of carbon monoxide (CO) poisoning\n", "Ventilation with hyperbaric chamber\n", "Attack"], ["What is stated in option 4 about fluid therapy is not indicated\n", "Fluid therapy with infusion of physiological saline solution at 21 ml/h\n", "Attack"], ["in case of associated shock, volume would be administered, but in any case not at that rate, but in rapid boluses\n", "What is stated in option 4 about fluid therapy is not indicated\n", "Support"]]}
[{"105_233": []}]
{"73_62": [["In this case it is associated with persistent arterial hypotension\n", "Option 2 would be correct if the patient were not hypotensive\n", "Support"], ["Option 2 would be correct if the patient were not hypotensive\n", "Enoxaparin: 80 mg sc every 12 hours, starting upon diagnostic suspicion\n", "Attack"], ["diagnostic confirmation is not necessary to initiate anticoagulant therapy in case of PTE without hypotension\n", "Option 3 is not correct\n", "Support"], ["Option 3 is not correct\n", "Enoxaparin; 80 mg sc every 12 hours, starting upon diagnostic confirmation\n", "Attack"], ["Option 4 is not indicated\n", "Fondaparinux: 7.5 mg sc daily\n", "Attack"], ["Option 5 would be correct only if the patient had a contraindication to fibrinolysis\n", "Emergency pulmonary thromboendarterectomy\n", "Attack"], ["Persistent hypotension in PTE is the most widely accepted indication for fibrinolysis\n", "the correct option is 1\n", "Support"], ["the correct option is 1\n", "Unfractionated heparin, 10,000U iv on clinical suspicion. Fibrinolysis with tPA 100 mg iv once the diagnosis is confirmed\n", "Support"], ["Persistent hypotension in PTE is the most widely accepted indication for fibrinolysis\n", "Unfractionated heparin, 10,000U iv on clinical suspicion. Fibrinolysis with tPA 100 mg iv once the diagnosis is confirmed\n", "Support"]]}
[{"538_2": []}]
{"139_166": [["He already tells you that the dentist \"didn't see anything\", so he rules out 1\n", "Dental cause / reevaluation by the dentist\n", "Attack"], ["He provides a dentist's report that rules out a dental cause\n", "Dental cause / reevaluation by the dentist\n", "Attack"], ["It is not an abscess of the base of the tongue either, because in three months it would have killed him: neither is 2\n", "Abscess of the base of the tongue / debridement\n", "Attack"], ["The picture he explains is odynodysphagia of 3 months of evolution and left otalgia\n", "Abscess of the base of the tongue / debridement\n", "Attack"], ["When there is doubt that it could be cancer, we should not fool around and order a new CT scan and biopsy\n", "Malignant process of oropharynx / repeat CT scan and biopsy\n", "Support"], ["Tongue base cancers are very treacherous and it is one of the fears of any otolaryngologist when he suspects a neoplasm\n", "Malignant process of oropharynx / repeat CT scan and biopsy\n", "Support"], ["palpation of the base of the left tongue showed an induration of stony consistency of approximately 3cm and with indirect laryngoscopy no ulceration of the mucosa was observed\n", "Malignant process of oropharynx / repeat CT scan and biopsy\n", "Support"], ["He also refers to having been visited by different specialists and provides a head and neck CAT scan (without iodine contrast) which is reported as normal\n", "Malignant process of oropharynx / repeat CT scan and biopsy\n", "Support"], ["It is not uncommon for them to arise without exophytic masses or ulcerations of the tongue mucosa and they are difficult to detect on CT when contrast is not used\n", "Malignant process of oropharynx / repeat CT scan and biopsy\n", "Support"], ["The correct answer is 4 and I do not think it can be challenged\n", "Malignant process of oropharynx / repeat CT scan and biopsy\n", "Support"]]}
{"446_130": [["Glomerulonephritis is typically associated with dysmorphic red blood cells and hematic casts in the sediment\n", "Dysmorphic red blood cells and/or hematic casts\n", "Support"], ["Glomerulonephritis is typically associated with dysmorphic red blood cells and hematic casts in the sediment\n", "option 1 correct\n", "Support"], ["option 1 correct\n", "Dysmorphic red blood cells and/or hematic casts\n", "Support"], ["although it is not usual in the form of isolated microalbuminuria\n", "Proteinuria can also appear in variable range\n", "Attack"], ["although it is not usual in the form of isolated microalbuminuria\n", "incorrect option 2\n", "Support"], ["incorrect option 2\n", "Proteinuria of 1 g/day, with negative test strip result and with microalbuminuria greater than 300 mg/24 hours\n", "Attack"], ["although it is not usual in the form of isolated microalbuminuria\n", "Proteinuria of 1 g/day, with negative test strip result and with microalbuminuria greater than 300 mg/24 hours\n", "Attack"], ["hematuria with pyuria although it is not characteristic\n", "incorrect option 3\n", "Support"], ["incorrect option 3\n", "Coexistence of hematuria with pyuria without bacteriuria\n", "Attack"], ["hematuria with pyuria although it is not characteristic\n", "Coexistence of hematuria with pyuria without bacteriuria\n", "Attack"], ["Clots usually appear in the context of alterations of the lower urinary tract\n", "option 4 incorrect\n", "Support"], ["option 4 incorrect\n", "Clots in the urine with the naked eye\n", "Attack"], ["Clots usually appear in the context of alterations of the lower urinary tract\n", "Clots in the urine with the naked eye\n", "Attack"]]}
[{"551_130": []}]
{"383_150": [["In this case we are being told that the teste is always in the inguinal canal (cryptorchidism)\n", "we can discard option 1\n", "Support"], ["we can discard option 1\n", "The most probable diagnosis is retractile testicle\n", "Attack"], ["In this case we are being told that the teste is always in the inguinal canal (cryptorchidism)\n", "The retractile testicle is characterized by the testicle being permanently outside the scrotal sac, being possible to descend it manually (although when it is released it automatically returns to its initial location)\n", "Attack"], ["The retractile testicle is characterized by the testicle being permanently outside the scrotal sac, being possible to descend it manually (although when it is released it automatically returns to its initial location)\n", "The most probable diagnosis is retractile testicle\n", "Attack"], ["Orchidopexy is the treatment of choice when we are faced with cryptorchidism, being desirable to perform it between 6 months and one year of age, and should not be deferred beyond two years of age\n", "The indication for orchidopexy should not be deferred\n", "Support"], ["Hormonal treatment with HCG has already fallen into disuse, due to its low efficacy, possibility of reascension and because apoptotic and inflammatory phenomena have been described in the teste associated with its use\n", "we discard option 3\n", "Support"], ["Hormonal treatment with HCG has already fallen into disuse, due to its low efficacy, possibility of reascension and because apoptotic and inflammatory phenomena have been described in the teste associated with its use\n", "Human chorionic gonadotropin is the treatment of first choice\n", "Attack"], ["we discard option 3\n", "Human chorionic gonadotropin is the treatment of first choice\n", "Attack"]]}
{"614_118": [["The Thessaly maneuver consists of the patient, using monopodal support and knee flexion of 5\u00ba and then 20\u00ba, performing internal and external rotations of the leg\n", "In case this reproduces the pain that the patient refers, the test will be considered as positive\n", "Support"], ["During the examination, the Thessaly test (pain with internal and external rotation movements with the knee flexed) is positive\n", "The Thessaly maneuver consists of the patient, using monopodal support and knee flexion of 5\u00ba and then 20\u00ba, performing internal and external rotations of the leg\n", "Support"], ["It is a test used for the diagnosis of meniscal pathology\n", "Answer 1 correct\n", "Support"], ["sensitivity greater than 90% and specificity greater than 95%\n", "Answer 1 correct\n", "Support"], ["In case this reproduces the pain that the patient refers, the test will be considered as positive\n", "It is a test used for the diagnosis of meniscal pathology\n", "Support"], ["During the examination, the Thessaly test (pain with internal and external rotation movements with the knee flexed) is positive\n", "In case this reproduces the pain that the patient refers, the test will be considered as positive\n", "Support"], ["Answer 1 correct\n", "Meniscal injury\n", "Support"]]}
[{"499_182": []}]
{"613_118": [["Thessaly test. Provocation test performed in suspected meniscal injury\n", "Meniscal injury\n", "Support"]]}
{"247_117": [["the description of the picture is very exhaustive as well as typical\n", "All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n", "Support"], ["It is a disease that produces fever, arthralgias and a generalized exanthema with petechiae on the lower limbs\n", "All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n", "Support"], ["The CBC shows leukopenia accompanied by plateletopenia and elevated transaminases\n", "All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n", "Support"], ["Malaria has been ruled out as a possible cause\n", "All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n", "Support"], ["All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n", "answer 3 correct\n", "Support"], ["All the data are highly suggestive of Dengue, especially the plateletopenia and petechiae (suggestive of capillary fragility)\n", "Dengue\n", "Support"], ["answer 3 correct\n", "Dengue\n", "Support"]]}
{"88_56": [["she has criteria for anticoagulation\n", "between the two options that include acenocoumarol we are inclined to choose option 4\n", "Support"], ["it includes carvedilol, a drug that has been shown to increase survival in heart failure\n", "between the two options that include acenocoumarol we are inclined to choose option 4\n", "Support"], ["between the two options that include acenocoumarol we are inclined to choose option 4\n", "Carvedilol and acenocoumarol\n", "Support"], ["Verapamil (and calcium antagonists in general) are contraindicated in systolic heart failure: they do not increase survival (they even increase morbidity and mortality) and specifically the non-dihydropyridines (verapamil and diltiazem) should not be associated with beta-blockers due to the increased risk of conduction system blockade\n", "Verapamil and acenocoumaro\n", "Attack"]]}
{"536_122": [["The current treatment of choice for corticosteroid sparing is Tocilizumab (answer 4 incorrect), which has also been shown to reduce recurrences\n", "answer 4 incorrect\n", "Support"], ["answer 4 incorrect\n", "In conjunction with glucocorticoid boluses of 1 g/day, infliximab should be used as a first-line drug for remission induction\n", "Attack"], ["answer 1 incorrect\n", "Rituximab should be administered, since glucocorticoids have been relegated to second-line treatment due to their side effects\n", "Attack"], ["answer 3 incorrect\n", "In the presence of ischemic symptoms, and in order not to worsen the vascular risk of the patient, the use of glucocorticoids at doses higher than 30 mg/day should be avoided\n", "Attack"], ["Corticosteroid therapy remains the first choice (answer 1 incorrect), to be administered as pulses (doses differ according to the literature, but at least 125 mg/d) in case of ocular involvement\n", "answer 1 incorrect\n", "Support"], ["answer 1 incorrect\n", "answer 3 incorrect\n", "Support"], ["The current treatment of choice for corticosteroid sparing is Tocilizumab (answer 4 incorrect), which has also been shown to reduce recurrences\n", "answer 2 correct\n", "Support"], ["answer 2 correct\n", "Tocilizumab has been shown to be effective in reducing recurrences and cumulative prednisone dose in more than 50% of patients\n", "Support"]]}
{"492_107": [["there would be fever, hemolysis data, neurological symptoms, in the smear there would be schistocytes\n", "1 is false\n", "Support"], ["1 is false\n", "Thrombotic thrombocytopenic purpura\n", "Attack"], ["in this case it is not mentioned\n", "In 2 the coagulation must be altered\n", "Attack"], ["In 2 the coagulation must be altered\n", "Disseminated intravascular coagulation\n", "Attack"]]}
{"599_183": [["In this clinical case, we are presented with a woman who rapidly presents dyspnea with hypoxemia\n", "a picture compatible with pulmonary thromboembolism\n", "Support"], ["Prothrombin time 90%, activated partial thromboplastin time (APTT) ratio of 2 to control (N <1.2)\n", "The prothrombin time of 90% and the aPTT with a ratio of 2, is translating a coagulation problem\n", "Support"], ["The prothrombin time of 90% and the aPTT with a ratio of 2, is translating a coagulation problem\n", "correct answer 1\n", "Support"], ["antiphospholipid antibodies can be detected through the prolongation of phospholipid-dependent coagulation tests\n", "correct answer 1\n", "Support"], ["correct answer 1\n", "Antiphospholipid syndrome\n", "Support"], ["Prothrombin time 90%, activated partial thromboplastin time (APTT) ratio of 2 to control (N <1.2)\n", "On the other hand, although factor V Leiden has been identified as a common cause of familial thrombosis, it would not alter the clotting time\n", "Attack"], ["On the other hand, although factor V Leiden has been identified as a common cause of familial thrombosis, it would not alter the clotting time\n", "Factor V of Leiden\n", "Attack"], ["In the case of hemophilia there would be a problem in blood coagulation but it is not a frequent cause of thromboembolism\n", "Hemophilia\n", "Attack"], ["Finally, although acute pericarditis could manifest itself in 4 days and with tachycardia, the rest of the symptoms or analytical parameters are not characteristic\n", "Acute pericarditis\n", "Attack"]]}
{"134_169": [["Dendritic corneal ulcer is typical of herpes simplex keratitis\n", "Herpetic keratitis\n", "Support"], ["Biomicroscopic examination of the anterior segment shows, after fluorescein staining, a central corneal ulcer in the form of a dendrite\n", "Herpetic keratitis\n", "Support"], ["A 35-year-old man comes to the emergency department with pain in his right eye of 3 days' evolution\n", "Herpetic keratitis\n", "Support"], ["It presents with pain, not too striking, and scarce or absent red eye\n", "Herpetic keratitis\n", "Support"], ["Although in practice we should pay attention to the shape of the dendrite (the true dendrite is deeper and has terminal bulbs at the end of each branch), and pay attention to the evolution of the pain (in the pseudodendrite after abrasion the pain should improve), when answering a MIR question it is simpler: if it is a dendrite, the first thing we have to think is herpes\n", "Herpetic keratitis\n", "Support"], ["Fungal and bacterial keratitis have corneal infiltrates\n", "Fungal keratitis\n", "Attack"], ["Fungal and bacterial keratitis have corneal infiltrates\n", "Bacterial keratitis\n", "Attack"], ["Biomicroscopic examination of the anterior segment shows, after fluorescein staining, a central corneal ulcer in the form of a dendrite\n", "Glaucomatocyclic crisis\n", "Attack"], ["And glaucomatocyclitic crisis (Posner Schlossman syndrome) is a type of idiopathic hypertensive anterior uveitis, which does not present with ulceration\n", "Glaucomatocyclic crisis\n", "Attack"]]}
{"245_115": [["This is a patient undergoing chemotherapy with respiratory symptoms and the \"halo sign\" on X-ray\n", "very suggestive of invasive pulmonary aspergillosis\n", "Support"], ["very suggestive of invasive pulmonary aspergillosis\n", "Treatment is with voriconazole\n", "Support"], ["Treatment is with voriconazole\n", "Voriconazole\n", "Support"], ["Aspergillus is resistant to fluconazole\n", "it would not be a valid option\n", "Support"], ["it would not be a valid option\n", "Fluconazole\n", "Attack"], ["Aspergillus is resistant to fluconazole\n", "Fluconazole\n", "Attack"]]}
{"387_156": [["APLV\n", "Cow's milk protein allergy\n", "Support"]]}
{"41_139": [["The trismus and fever suggest a deep cervical space infection and that is not a game because the airway can become obstructed\n", "Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4\n", "Support"], ["we are in the ENT block, the airway specialty.\n", "answer 4 is more correct\n", "Support"], ["Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4\n", "The first diagnostic probability is carcinoma of the floor of the mouth with bilateral cervical metastases\n", "Attack"], ["Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4\n", "The therapeutic priority is to ensure the patient's nutrition\n", "Attack"], ["Knowing this, options 1, 2 and 5 are out of place and I am left with 3 and 4\n", "We must perform as a first diagnostic measure a cytology by fine needle aspiration puncture\n", "Attack"], ["answer 4 is more correct\n", "We must consider as a priority the risk of airway obstruction\n", "Support"], ["There may already be mediastinitis\n", "We are almost certainly facing a mediastinitis\n", "Support"]]}
{"385_153": [["You are faithfully describing an Edwards' syndrome\n", "Trisomy 18 (Edwards' syndrome)\n", "Support"], ["Although the cardiopathies and the alteration of the foot that he describes are common to several chromosomopathies, the alteration of the fingers and toes is very characteristic of Edwards' syndrome\n", "Trisomy 18 (Edwards' syndrome)\n", "Support"]]}
{"194_162": [["Complementary tests include: hemoglobin 8.5 mg/dL, hematocrit 26%, MCV 86 fL, MCH 29 pg, leukocytes 2800/mL with 300 neutrophils /ml, platelets 54000/ml, GOT 85 U/l, GPT92 U/l and polyclonal hypergammaglobulinemia in serum proteinogram\n", "Data such as pancytopenia and hypergammaglobulinemia are very characteristic of kala-azar\n", "Support"], ["Data such as pancytopenia and hypergammaglobulinemia are very characteristic of kala-azar\n", "Visceral leishmaniasis\n", "Support"], ["A 3-year-old girl from Bangladesh\n", "The origin of the girl is also indicative of this diagnosis, although it is a disease that also occurs in the Mediterranean area\n", "Support"]]}
[{"371_126": []}]
[{"283_56": []}]
{"109_149": [["The correct answer is 5\n", "Attempting pregnancy without any previous treatment\n", "Support"], ["An asymptomatic myoma of this size that does not deform the endometrial cavity is not a problem for pregnancy\n", "Attempting pregnancy without any previous treatment\n", "Support"], ["During this check-up, a 4cm uterine myoma is detected, partly intramural and partly subserosal, located on the anterior aspect of the uterus and which does not deform the endometrial cavity\n", "Attempting pregnancy without any previous treatment\n", "Support"]]}
{"92_235": [["The treatment of choice is corticosteroids\n", "Corticoids should be added\n", "Support"], ["Brain metastases produce pain due to cranial hypertension\n", "The treatment of choice is corticosteroids\n", "Support"]]}
{"342_158": [["the patient should be advised not to become pregnant again until at least 6 months with negative BHCG titers\n", "She should not become pregnant until she has undergone periodic controls and has spent one year with negative BHCG levels\n", "Support"], ["The risk of recurrence in another pregnancy is low (1/55)\n", "The risk of a new molar gestation in a future pregnancy is 50%\n", "Attack"], ["regardless of whether the evacuation has been complete or not\n", "Gestational trophoblastic disease should be followed up\n", "Support"], ["90% of cases progress satisfactorily without developing neoplasia\n", "It is necessary to carry out periodic controls since 40% of the cases will develop a gestational trophoblastic neoplasia\n", "Attack"], ["Gestational trophoblastic disease should be followed up\n", "Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete\n", "Attack"], ["regardless of whether the evacuation has been complete or not\n", "Subsequent controls are not necessary if the evacuation of the trophoblastic tissue was complete\n", "Attack"]]}
{"357_232": [["The presence of inguinal nodes up to 1-1.5cm may be normal in the absence of symptoms\n", "By the clinical characteristics it seems to be normal lymph nodes and complementary explorations should not be done\n", "Support"], ["In this case, they are very nonspecific nodes, without signs of malignancy (mobile, soft, not painful)\n", "that do not lead us to suspect neoplastic infiltration\n", "Attack"], ["the lack of other clinical signs also leads us to rule out the presence of STD\n", "A lues serology since it is most likely a Treponema pallidum infection\n", "Attack"], ["that do not lead us to suspect neoplastic infiltration\n", "A gynecological examination to rule out ovarian cancer\n", "Attack"], ["The examination revealed two lymphadenopathies, one in each groin, 1 cm in diameter, soft, mobile, non-painful\n", "The presence of inguinal nodes up to 1-1.5cm may be normal in the absence of symptoms\n", "Support"]]}
{"596_121": [["In osteoporosis, one of the main risks associated with increased fracture risk is low adherence to treatment\n", "answer 1 is correct.\n", "Support"], ["answer 1 is correct.\n", "Low adherence to treatment is associated with an increased risk of fracture\n", "Support"], ["answer 1 is correct.\n", "Low adherence to treatment is associated with an increased risk of fracture\n", "Support"], ["Answer 2 is found in the SER guidelines, which confirm that some studies conclude that bone remodeling markers can be useful for early monitoring of adherence and response to treatment\n", "Bone remodeling markers may be useful for early monitoring of response to treatment\n", "Support"], ["again in the SER 2019 guidelines they quote: \"The current scientific evidence allows us to affirm that neither increasing dietary calcium nor taking calcium supplements alone protects against the appearance of fractures\"\n", "Answer 4 is correct\n", "Support"], ["Answer 4 is correct\n", "Increasing dietary calcium or taking calcium supplements alone does not protect against the occurrence of fractures\n", "Support"], ["Therefore, the correct answer to this question is option 3\n", "Vitamin D monotherapy is effective in reducing such fractures in non-institutionalized elderly\n", "Attack"], ["Patients on pharmacological treatment for OP should use calcium and vitamin D supplements because practically all clinical trials that have demonstrated efficacy of antiosteoporotic drugs routinely include calcium supplements and cholecalciferol (vitamin D3), but not in monotherapy\n", "Vitamin D monotherapy is effective in reducing such fractures in non-institutionalized elderly\n", "Attack"]]}
{"334_82": [["the clinical picture described is of diabetic neuropathy\n", "Of the drugs proposed, the first choice would be a dual antidepressant such as duloxetine\n", "Support"], ["the clinical picture described is of diabetic neuropathy\n", "Duloxetine\n", "Support"], ["She comes to the office with 3 months of clinical evolution of tingling in both feet, with distribution in sock, with paresthetic pain and sensation of hot feet predominantly at night, which significantly interferes with sleep\n", "the clinical picture described is of diabetic neuropathy\n", "Support"], ["A woman diagnosed with type 1 diabetes mellitus for 24 years\n", "the clinical picture described is of diabetic neuropathy\n", "Support"]]}
[{"81_44": []}]
{"386_154": [["the picture of high fever of several days that suddenly subsides with the appearance of a rash, we have a sudden exanthem\n", "Herpes virus type 6\n", "Support"], ["Parvovirus B19 is the cause of erythema infectiosum or \"fifth disease\", whose characteristic rash is on the cheeks, giving the appearance of a slapped face\n", "Parvovirus B19\n", "Attack"], ["a high fever of 39\u00b0C in a 10-month-old infant that abruptly subsides after 3-5 days, followed by a cephalocaudal morbilliform exanthema with enanthema consisting of reddish papules on the palate, and resolving within a week, associated with good general condition\n", "Parvovirus B19 is the cause of erythema infectiosum or \"fifth disease\", whose characteristic rash is on the cheeks, giving the appearance of a slapped face\n", "Attack"], ["a high fever of 39\u00b0C in a 10-month-old infant that abruptly subsides after 3-5 days, followed by a cephalocaudal morbilliform exanthema with enanthema consisting of reddish papules on the palate, and resolving within a week, associated with good general condition\n", "Coxackie A16 causes herpangina and also boca-mano-pie disease, which presents an initially macular rash, which does not respect palms or soles and evolves into bursting vesicles\n", "Attack"], ["Coxackie A16 causes herpangina and also boca-mano-pie disease, which presents an initially macular rash, which does not respect palms or soles and evolves into bursting vesicles\n", "Coxackie A16 virus\n", "Attack"], ["a high fever of 39\u00b0C in a 10-month-old infant that abruptly subsides after 3-5 days, followed by a cephalocaudal morbilliform exanthema with enanthema consisting of reddish papules on the palate, and resolving within a week, associated with good general condition\n", "EBV infection produces a mononucleosis syndrome with high fever lasting several days, with pharyngeal erythema and grayish exudates on the tonsils\n", "Attack"], ["EBV infection produces a mononucleosis syndrome with high fever lasting several days, with pharyngeal erythema and grayish exudates on the tonsils\n", "Primoinfection by Epstein-Barr virus\n", "Attack"], ["Herpes virus type 6\n", "Herpes virus type 6\n", "Support"]]}
{"239_146": [["The emergency cranial CT scan shows a left frontal lobar hematoma without contrast uptake\n", "Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case)\n", "Support"], ["Amyloid angiopathy is the most common cause of spontaneous non-hypertensive hemorrhage in elderly patients, and is usually lobar in location (as in the case)\n", "Cerebral amyloid angiopathy (congophilic angiopathy)\n", "Support"], ["the most frequent localizations are: putamen, thalamus, pons and cerebellum\n", "The response that may cause the most doubts is 2, hypertension\n", "Attack"], ["The emergency cranial CT scan shows a left frontal lobar hematoma without contrast uptake\n", "the most frequent localizations are: putamen, thalamus, pons and cerebellum\n", "Attack"], ["In addition, as a clue it tells us that the patient has well-controlled hypertension without drugs\n", "The response that may cause the most doubts is 2, hypertension\n", "Attack"], ["In addition, as a clue it tells us that the patient has well-controlled hypertension without drugs\n", "although this data would not serve to rule out the response\n", "Attack"], ["An 80-year-old man is admitted for a sudden onset of aphasia and right hemiparesis\n", "Answer 1, a malformation is typical of young patients, rare in older people\n", "Support"], ["Answer 1, a malformation is typical of young patients, rare in older people\n", "Arteriovenous malformation masked by acute hematoma\n", "Attack"], ["the mass is not seen on CT\n", "Answer 4, a brain tumor, does not seem likely\n", "Support"], ["Answer 4, a brain tumor, does not seem likely\n", "Brain tumor\n", "Attack"], ["In addition, as a clue it tells us that the patient has well-controlled hypertension without drugs\n", "Chronic arterial hypertension\n", "Attack"], ["it is more difficult not to find such a lesion after contrast administration\n", "Answer 4, a brain tumor, does not seem likely\n", "Support"], ["Answer 3 does not seem correct since vasculitis is a rare entity and more so in older people\n", "Isolated vasculitis of the nervous system\n", "Attack"]]}
[{"525_53": []}]
[{"287_64": []}]
{"472_140": [["We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n", "The only option that includes all the data is 4\n", "Support"], ["The only option that includes all the data is 4\n", "Diaphyseal fracture of humerus with radial nerve injury\n", "Support"], ["We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n", "Option 1 does not explain the involvement of the wrist and fingers\n", "Attack"], ["Option 1 does not explain the involvement of the wrist and fingers\n", "Dislocation fracture of proximal humerus\n", "Attack"], ["We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n", "The elbow dislocation does not explain the lack of finger mobility as well as the diaphyseal fracture of the humerus and double forearm\n", "Attack"], ["The elbow dislocation does not explain the lack of finger mobility as well as the diaphyseal fracture of the humerus and double forearm\n", "Elbow dislocation\n", "Attack"], ["We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n", "Proximal humerus fracture-dislocation would have greater involvement at the shoulder, elbow dislocation at the elbow\n", "Attack"], ["We must take into account all the clinical data provided: after trauma we have pain in the arm with soft tissue involvement and the impossibility of extending the wrist and fingers\n", "there is no data to suggest double forearm fracture\n", "Attack"], ["Proximal humerus fracture-dislocation would have greater involvement at the shoulder, elbow dislocation at the elbow\n", "Diaphyseal fracture of the humerus associated with double forearm fracture\n", "Attack"], ["there is no data to suggest double forearm fracture\n", "Diaphyseal fracture of the humerus associated with double forearm fracture\n", "Attack"]]}
{"173_51": [["The indication of omalizumab in a patient such as the one referred to is a correct indication, although in severe asthma that is difficult to control, there are other prior measures that are not contemplated and that must always be taken into account before resorting to this treatment\n", "Add omalizumab\n", "Support"], ["Once all of the above has been checked, it would be time to start a trial treatment with omalizumab\n", "Add omalizumab\n", "Support"]]}
[{"480_171": []}]
{"58_199": [["I think answer 1 is more true than answer 2\n", "It is indicated after studying the Consultant's genotype and only if it is heterozygous\n", "Support"], ["She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms\n", "Nevertheless, I would do the genetic test on the pregnant woman to be on the safe side\n", "Attack"], ["I think answer 1 is more true than answer 2\n", "This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation\n", "Attack"], ["She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms\n", "This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation\n", "Support"], ["Answers 1 and 2 are both true\n", "It is indicated after studying the Consultant's genotype and only if it is heterozygous\n", "Support"], ["Answers 1 and 2 are both true\n", "This is not indicated, since SCA3 ataxia is full penetrance and the Consultant is asymptomatic and therefore has not inherited the mutation\n", "Support"], ["Her younger brother (index case) aged 26 years is affected by ataxia and genetically diagnosed as a heterozygous carrier of an expansive mutation of 70 CAG repeats in the SCA3 gene (chromosome 14)\n", "She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms\n", "Support"], ["In this clinical case, the one who has the disease and has the mutated gene in heterozygosis is the brother (26 years old) of the pregnant woman\n", "She has a 50% chance of carrying the mutation and having the disease, but since she is 31 years old, I think she should have already had symptoms\n", "Support"]]}
{"51_230": [["Children born to HBV carrier mothers should be administered hepatitis B vaccine and immunoglobulin at different puncture sites within the first 24 hours of life\n", "The correct answer is 4\n", "Support"], ["Although the virus is excreted in breast milk, the risk of infection by this route is very low\n", "Children born to HBV carrier mothers should be administered hepatitis B vaccine and immunoglobulin at different puncture sites within the first 24 hours of life\n", "Support"], ["it is not currently a contraindication for breastfeeding\n", "The correct answer is 4\n", "Support"]]}
{"184_65": [["Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n", "Orlistat\n", "Support"], ["Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n", "Topiramate\n", "Attack"], ["Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n", "Sibutramine\n", "Attack"], ["Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n", "Liraglutide\n", "Attack"], ["Orlistat acts by decreasing fat absorption; it is currently the only drug approved for use in obesity\n", "Metformin\n", "Attack"]]}
{"295_75": [["Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type\n", "only for this last data, we would have to discard it in a direct way\n", "Support"], ["a 5-year-old patient from Nigeria, with normal physical examination and with the following serology against hepatitis B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +\n", "Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type\n", "Attack"], ["only for this last data, we would have to discard it in a direct way\n", "Acute infection\n", "Attack"], ["Option 1: The acute infection would be HBeAg + and ANTI-HBe - . In addition the ANTI-HBec would be IgM type\n", "Acute infection\n", "Attack"], ["Option 2: the correct one\n", "Chronic infection\n", "Support"], ["It complies with all the characteristics\n", "Option 2: the correct one\n", "Support"], ["a 5-year-old patient from Nigeria, with normal physical examination and with the following serology against hepatitis B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +\n", "It complies with all the characteristics\n", "Support"], ["the only thing that positivizes in a vaccinated patient is the AntiBs. IgG type\n", "Option 3: The vaccinated patient cannot have DNA of the virus\n", "Support"], ["Option 3: The vaccinated patient cannot have DNA of the virus\n", "Vaccinated patient\n", "Attack"], ["a 5-year-old patient from Nigeria, with normal physical examination and with the following serology against hepatitis B: HBsAg + / ANTI- HBs - / HBeAg - / ANTI- Hbe + / ANTI- Hbc IgM - / ANTI- Hbc IgG +/ DNA HBV +\n", "In the asymptomatic carrier (chronic carrier / seroconverted) the difference is that there is no viral DNA\n", "Attack"], ["In the asymptomatic carrier (chronic carrier / seroconverted) the difference is that there is no viral DNA\n", "Option 4: The option that could offer more doubts\n", "Attack"], ["In the asymptomatic carrier (chronic carrier / seroconverted) the difference is that there is no viral DNA\n", "Asymptomatic carrier\n", "Attack"]]}
{"559_160": [["The fear of all on-call hematologists... that you will get a TTP\n", "Thrombotic thrombocytopenic purpura\n", "Support"], ["Because, although infrequent, it is the greatest hematologic emergency\n", "The clinical case is fairly typical\n", "Support"], ["The clinical case is fairly typical\n", "Thrombotic thrombocytopenic purpura\n", "Support"], ["it tells you that the coombs is negative\n", "To distinguish it from the rest of things (although you should not hesitate...)\n", "Support"], ["In addition, coagulation is normal\n", "To distinguish it from the rest of things (although you should not hesitate...)\n", "Support"], ["Laboratory tests show anemia with evidence of hemolysis (increased LDH and retis, presence of schistocytes in peripheral blood) and severe thrombopenia\n", "To distinguish it from the rest of things (although you should not hesitate...)\n", "Support"], ["A young person with fever and neurological symptoms that make him go to the emergency department\n", "To distinguish it from the rest of things (although you should not hesitate...)\n", "Support"], ["To distinguish it from the rest of things (although you should not hesitate...)\n", "The clinical case is fairly typical\n", "Support"]]}
{"558_160": [["The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n", "Thrombotic thrombocytopenic purpura\n", "Support"], ["Neurological alteration\n", "The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n", "Support"], ["Febrile syndrome (fever)\n", "The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n", "Support"], ["Coombs negative migroangiopathic hemolytic anemia (presence of schistocytes)\n", "The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n", "Support"], ["Thrombopenia\n", "The patient presents criteria for Thrombotic Thrombocytopenic Purpura (TTP)\n", "Support"]]}
{"227_72": [["If he has a pediatric murmur, I'm thinking congenital\n", "So we rule out aortic and mitral stenosis\n", "Support"], ["Hepatomegaly, malleolar edema and BRD, something that overloads the right heart\n", "So we rule out aortic and mitral stenosis\n", "Support"], ["So we rule out aortic and mitral stenosis\n", "Aortic stenosis\n", "Attack"], ["So we rule out aortic and mitral stenosis\n", "Mitral stenosis\n", "Attack"], ["A patent ductus would give cyanosis: ruled out\n", "Patent ductus arteriosus\n", "Attack"], ["a VSD does not produce atrial dilatation\n", "Ventricular septal defect\n", "Attack"], ["If I am told that he has AF, it is because the atria are of size XL\n", "Atrial septal defect\n", "Support"]]}
{"168_86": [["Therefore, the first thing we will have to do will be to study the valve disease: we do not want to put the patient to run or overload him with dobuta and have a syncope, nor do we want to do a catheterization without having first performed another noninvasive test\n", "A stress test\n", "Attack"], ["Therefore, the first thing we will have to do will be to study the valve disease: we do not want to put the patient to run or overload him with dobuta and have a syncope, nor do we want to do a catheterization without having first performed another noninvasive test\n", "Exercise echocardiogram\n", "Attack"], ["And cardioTC, in someone 80 years old, is going to tell us what we already know: that he has calcium up to his eyebrows\n", "Coronary CT scan.\n", "Attack"], ["Therefore, the first thing we will have to do will be to study the valve disease: we do not want to put the patient to run or overload him with dobuta and have a syncope, nor do we want to do a catheterization without having first performed another noninvasive test\n", "Doppler echocardiogram\n", "Support"], ["Therefore, the first thing we will have to do will be to study the valve disease: we do not want to put the patient to run or overload him with dobuta and have a syncope, nor do we want to do a catheterization without having first performed another noninvasive test\n", "Coronary angiography\n", "Attack"]]}
[{"329_84": []}]
{"447_131": [["the levels of complement fractions C3 and C4 are low\n", "Of the options given, only membranoproliferative glomerulonephritis presents with hypocomplementemia\n", "Support"], ["Of the options given, only membranoproliferative glomerulonephritis presents with hypocomplementemia\n", "option 4 correct\n", "Support"], ["Of the options given, only membranoproliferative glomerulonephritis presents with hypocomplementemia\n", "Membranoproliferative glomerulonephritis\n", "Support"], ["option 4 correct\n", "Membranoproliferative glomerulonephritis\n", "Support"], ["Immunological study: antiDNA negative; ANCA negative; antiMBG negative, rheumatoid factor negative; C3 20 mg/dL (normal 60-120); C4 10 mg/dL (normal 20-40)\n", "the levels of complement fractions C3 and C4 are low\n", "Support"]]}
{"72_52": [["It is evident from the patient's clinical picture that an urgent reperfusion strategy is indicated, which invalidates options 4 and 5\n", "Hemodynamic stabilization and deferred revascularization procedure\n", "Attack"], ["It is evident from the patient's clinical picture that an urgent reperfusion strategy is indicated, which invalidates options 4 and 5\n", "Immediate treatment with fondaparinux and abciximab\n", "Attack"], ["Option 2 does not make much sense\n", "Immediate transfer to a tertiary center for treatment with fibrinolysis\n", "Attack"], ["since in the event that fibrinolysis is indicated, it would only be a waste of time to make the transfer\n", "Option 2 does not make much sense\n", "Support"], ["the correct answer is 3\n", "Immediate transfer to a tertiary center for percutaneous coronary revascularization procedure\n", "Support"], ["A history of stroke (presumably ischemic) 4 months ago is a relative contraindication for fibrinolysis (if the time is less than 3 months it is an absolute contraindication)\n", "Immediate systemic fibrinolysis at the regional hospital\n", "Attack"], ["the definitive factor that tips the balance towards PCI is the extent of AMI and the presence of shock, which are indications for urgent PCI\n", "the correct answer is 3\n", "Support"], ["the definitive factor that tips the balance towards PCI is the extent of AMI and the presence of shock, which are indications for urgent PCI\n", "Immediate transfer to a tertiary center for percutaneous coronary revascularization procedure\n", "Support"], ["To begin with, this is a patient with an extensive anterior and lateral AMI, with cardiogenic shock\n", "It is evident from the patient's clinical picture that an urgent reperfusion strategy is indicated, which invalidates options 4 and 5\n", "Support"], ["On the other hand, in the history, we are told that the patient had a stroke 4 months ago\n", "It is evident from the patient's clinical picture that an urgent reperfusion strategy is indicated, which invalidates options 4 and 5\n", "Support"]]}
{"505_85": [["Altered state of consciousness\n", "Fluctuation of the alert level\n", "Support"]]}
{"360_93": [["Warfarin-induced skin necrosis is a rare and serious adverse effect of oral anticoagulant therapy, occurring in only 0.01 to 0.1% of patients and is especially related to coagulation protein C and S deficiency\n", "Protein C deficiency\n", "Support"], ["However, after starting treatment with acenocoumarol, she develops a picture of skin necrosis affecting the abdominal region and extremities\n", "Warfarin-induced skin necrosis is a rare and serious adverse effect of oral anticoagulant therapy, occurring in only 0.01 to 0.1% of patients and is especially related to coagulation protein C and S deficiency\n", "Support"]]}
{"459_173": [["I believe that the most correct is 2\n", "Exhaustive debridement-wound lavage in the operating room with at least 10 liters of saline\n", "Support"], ["Gustilo II fractures are mainly covered with Gram (+) by means of a 1st generation Cepha\n", "I believe that the most correct is 2\n", "Support"], ["it is not a question of prevention but of treatment (it is considered to be contaminated)\n", "I believe that the most correct is 2\n", "Support"]]}
{"149_162": [["The diagnosis.... can be excluded 2,3,4 because the clinical does not match: no delirium, no worry, no sadness\n", "Delusional disorder\n", "Attack"], ["The diagnosis.... can be excluded 2,3,4 because the clinical does not match: no delirium, no worry, no sadness\n", "Hypochondriasis\n", "Attack"], ["The diagnosis.... can be excluded 2,3,4 because the clinical does not match: no delirium, no worry, no sadness\n", "Major depressive disorder\n", "Attack"], ["This is not the case\n", "1 would be if he was making a profit, if he was knowingly simulating and to make a profit he was faking his illness\n", "Attack"], ["1 would be if he was making a profit, if he was knowingly simulating and to make a profit he was faking his illness\n", "Factitious disorder\n", "Attack"], ["Conversive would be if the symptom wanted to transmit something to us, that is to say, it was a metaphor of its internal world\n", "The most exact in this case: 5\n", "Support"], ["The most exact in this case: 5\n", "Conversive disorder\n", "Support"]]}
{"246_116": [["The option of adding a quinolone during the first two months of treatment (moxifloxacin or levofloxacin) is considered in cases of extensive pulmonary involvement\n", "All the factors mentioned above make us lean more towards answer number 3\n", "Support"], ["In this case, they do not tell us anything about extensive pulmonary involvement but they give us a data \"excessive alcohol consumption\"\n", "All the factors mentioned above make us lean more towards answer number 3\n", "Support"], ["Alcohol exerts a direct immunosuppressive effect\n", "All the factors mentioned above make us lean more towards answer number 3\n", "Support"], ["moreover, alcoholism is related to the affectation of immunity in the respiratory tract\n", "All the factors mentioned above make us lean more towards answer number 3\n", "Support"], ["The social context that usually accompanies the alcoholic patient does not help either\n", "All the factors mentioned above make us lean more towards answer number 3\n", "Support"], ["All the factors mentioned above make us lean more towards answer number 3\n", "Isoniazid, ethambutol, pyrazinamide for 12 months and a quinolone for two months\n", "Support"], ["although it is undeniable that number 1 could also be correct\n", "Isoniazid, ethambutol, pyrazinamide for 12 months\n", "Support"], ["Twenty days after starting treatment, a report of rifampicin resistance of M. tuberculosis isolated in sputum is received\n", "In case of resistance to rifampicin, rifampicin is withdrawn and treatment is completed with the 3 remaining drugs for 12 months\n", "Support"]]}
{"457_126": [["The treatment is intradermal botulinum toxin injection\n", "Intradermal botulinum toxin injection\n", "Support"], ["during mastication, erythema and preauricular sweating occur\n", "This clinical picture is called Frey's syndrome and consists of an anomalous reinnervation of regional structures after parotidectomy due to lesion of the auriculotemporal nerve\n", "Support"]]}
{"165_229": [["The correct answer is: 2\n", "Focal and segmental glomerulonephritis\n", "Support"], ["Focal segmental glomerulonephritis\n", "The correct answer is: 2\n", "Support"], ["In urinalysis: sediment without alterations and in 24 h urine proteinuria of 6.3 g/24 h\n", "We are in front of a patient with renal insufficiency whose manifestation is a proteinuria\n", "Support"], ["We are in front of a patient with renal insufficiency whose manifestation is a proteinuria\n", "That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two)\n", "Support"], ["That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two)\n", "Secondary membranous glomerulonephritis\n", "Support"], ["That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two)\n", "Focal and segmental glomerulonephritis\n", "Support"], ["That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two)\n", "IgA nephropathy\n", "Attack"], ["That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two)\n", "Rapidly progressive glomerulonephritis\n", "Attack"], ["That places us in the picture of nonproliferative GN (membranous, focal and segmental and minimal changes, discarding the other two)\n", "Minimal change nephropathy\n", "Support"], ["If we also consider that the patient was obese, slightly hypertensive, the most probable is that it is a focal segmental glomerulonephritis\n", "Focal and segmental glomerulonephritis\n", "Support"], ["A 58-year-old woman, weight 130 kg, height 155 cm, body mass index > 30 with mild hypertension, blood glucose 108 mg/dL and absence of edema in the lower limbs\n", "If we also consider that the patient was obese, slightly hypertensive, the most probable is that it is a focal segmental glomerulonephritis\n", "Support"]]}
{"157_73": [["A 75-year-old patient with significant gonarthrosis with \"Genu Varo\" that causes marked functional impotence, limited mobility and continuous pain that requires continuous antirheumatic, anti-inflammatory and analgesic medication\n", "We are dealing with a patient who has exhausted the pharmacological route given that he takes everything and has two important problems: genu varum and an important gonarthrosis\n", "Support"], ["We are dealing with a patient who has exhausted the pharmacological route given that he takes everything and has two important problems: genu varum and an important gonarthrosis\n", "This means that we can do nothing with an arthroscopy, let alone a synovectomy (1 and 5 false)\n", "Support"], ["This means that we can do nothing with an arthroscopy, let alone a synovectomy (1 and 5 false)\n", "Arthroscopic lavage of the knee\n", "Attack"], ["This means that we can do nothing with an arthroscopy, let alone a synovectomy (1 and 5 false)\n", "Knee synovectomy\n", "Attack"], ["Perhaps years ago before the osteoarthritis took place it would have been resolutive but not now (4 false).\n", "Abduction supratuberosity tibial supratuberosity tibial osteotomy\n", "Attack"], ["The genu varum could falsely make us think about an osteotomy, however even if we did it and corrected the varus now the damage is already done and the osteoarthrosis is severe\n", "Abduction supratuberosity tibial supratuberosity tibial osteotomy\n", "Attack"], ["Perhaps years ago before the osteoarthritis took place it would have been resolutive but not now (4 false).\n", "The genu varum could falsely make us think about an osteotomy, however even if we did it and corrected the varus now the damage is already done and the osteoarthrosis is severe\n", "Support"], ["In addition, in order to consider an osteotomy, we should be given more data to know which bone to apply the osteotomy on, the tibia or the femur\n", "Abduction supratuberosity tibial supratuberosity tibial osteotomy\n", "Attack"], ["Finally, we may think that it is best to first try rehabilitation before considering surgery, but I discard this option because the question emphasizes that we have exhausted pharmacological measures (although it could be considered because they have not specified whether it has been tried or not)\n", "Rehabilitation of the affected knee\n", "Attack"], ["In any case with the knee prosthesis we correct the problem of osteoarthritis pain and we can also correct the knee varus\n", "Arthroplasty of the affected knee\n", "Support"]]}
{"382_231": [["He is brought to the emergency department for clinical aphasia and right hemiparesis of sudden onset, 45 minutes earlier\n", "The patient suffers an abrupt neurological deficit probably related to a vascular event\n", "Support"], ["The patient suffers an abrupt neurological deficit probably related to a vascular event\n", "first we will have to perform a cranial CT scan to rule out a hemorrhagic stroke\n", "Support"], ["the patient is in a good baseline condition\n", "Given that his tumor process is under control, there are no contraindications for the administration of fibrinolysis in this case\n", "Support"], ["If the CT scan does not show bleeding, the patient has an acute ischemic stroke, probably cardioembolic due to his cardiac pathology, not anticoagulated\n", "Given that his tumor process is under control, there are no contraindications for the administration of fibrinolysis in this case\n", "Support"], ["Given that his tumor process is under control, there are no contraindications for the administration of fibrinolysis in this case\n", "Perform a cranial CT scan and if there are no hemorrhagic lesions or other contraindications in the analysis, start immediate intravenous thrombolysis\n", "Support"], ["first we will have to perform a cranial CT scan to rule out a hemorrhagic stroke\n", "Perform a cranial CT scan and if there are no hemorrhagic lesions or other contraindications in the analysis, start immediate intravenous thrombolysis\n", "Support"], ["Although the patient is 88 years old, age is no longer presented as an absolute exclusion criterion\n", "Given that his tumor process is under control, there are no contraindications for the administration of fibrinolysis in this case\n", "Support"], ["the general situation of the patient must be taken into account\n", "Given that his tumor process is under control, there are no contraindications for the administration of fibrinolysis in this case\n", "Support"], ["in this case it is specified that he presents a good baseline situation\n", "Given that his tumor process is under control, there are no contraindications for the administration of fibrinolysis in this case\n", "Support"], ["in this case it is specified that he presents a good baseline situation\n", "the general situation of the patient must be taken into account\n", "Support"]]}
{"496_71": [["Hepatocarcinoma can elevate (alone) alpha-fetus, seminoma LDH, lymphoma also LDH\n", "Metastatic hepatocarcinoma\n", "Support"]]}
{"14_213": [["FNA does not allow a histological study but a cytological one\n", "questions 1, 2 are eliminated\n", "Support"], ["I think the correct answer is 5\n", "Identify the typical cytologic features of papillary carcinoma\n", "Support"], ["FNA does not allow a histological study but a cytological one\n", "Distinguish between follicular adenoma or minimally invasive follicular carcinoma\n", "Attack"], ["FNA does not allow a histological study but a cytological one\n", "Identify the areas of capsular or vascular invasion of the follicular carcinoma\n", "Attack"], ["Question 3 seems to have been put as a filler\n", "Recognize G-cell hyperplasia associated with familial spinal cancer\n", "Attack"], ["papillary carcinoma is the most frequent.\n", "I think the correct answer is 5\n", "Support"], ["Question 4 could raise doubts if you are not a pathologist\n", "Distinguish between a Hurthle cell tumor and an oxyphilic follicular adenoma\n", "Attack"], ["papillary carcinoma is the most frequent.\n", "Identify the typical cytologic features of papillary carcinoma\n", "Support"], ["questions 1, 2 are eliminated\n", "Identify the areas of capsular or vascular invasion of the follicular carcinoma\n", "Attack"], ["questions 1, 2 are eliminated\n", "Distinguish between follicular adenoma or minimally invasive follicular carcinoma\n", "Attack"], ["it is not relevant\n", "Question 3 seems to have been put as a filler\n", "Support"], ["papillary carcinoma is the most frequent.\n", "the most logical answer is 5\n", "Support"], ["the most logical answer is 5\n", "Identify the typical cytologic features of papillary carcinoma\n", "Support"]]}
{"330_85": [["Kallman's syndrome or Morsier's syndrome is a congenital insufficiency associated with hypogonadotropic hypogonadism due to a deficit in GnRH hormone production\n", "Repeated injections of GnRH are performed to restore fertility\n", "Support"], ["Repeated injections of GnRH are performed to restore fertility\n", "Gn_RH infusion pump\n", "Support"]]}
{"181_59": [["Bicarbonate is indicated at pH < 7\n", "Sodium bicarbonate 1M 100 cc iv in 30 minutes\n", "Attack"], ["The blood test showed blood glucose 450 mg/dl, Na 142 mEq/l, K 4 mEq/l, pH 7.15, bicarbonate 12 mmol/l\n", "Sodium bicarbonate 1M 100 cc iv in 30 minutes\n", "Attack"]]}
{"182_61": [["The most influential cardiovascular factor for stroke in women over 70 is blood pressure\n", "Achieve optimal blood pressure control\n", "Support"]]}
{"21_111": [["In the face of a PPD conversion within 2 years, and ruling out current TB disease, INH chemoprophylaxis is indicated, although I thought it was for 6 months and not 9\n", "Isoniazid for 9 months\n", "Support"]]}
{"60_59": [["Actually, it can be all of them\n", "PET SCAN\n", "Support"], ["Actually, it can be all of them\n", "EAP\n", "Support"], ["Actually, it can be all of them\n", "Lobar pneumonia\n", "Support"], ["Actually, it can be all of them\n", "Alveolar hypoventilation\n", "Support"], ["Actually, it can be all of them\n", "Bronchopneumonia\n", "Support"], ["the most frequent cause of acute uncompensated respiratory acidosis in a young person is bronchopneumonia\n", "Bronchopneumonia\n", "Support"]]}
{"455_155": [["The closest answer is 1\n", "Left capsular lacunar lacunar infarction\n", "Support"], ["If we are strict we would be talking about a pure motor lacunar infarction (with mild dysarthria)\n", "Left capsular lacunar lacunar infarction\n", "Support"], ["Since the other 3 options do not give us a clinical picture like the one in the statement\n", "A cortico-subcortical left frontotemporal sylvian infarction\n", "Attack"], ["Since the other 3 options do not give us a clinical picture like the one in the statement\n", "Brain stem infarction\n", "Attack"], ["Since the other 3 options do not give us a clinical picture like the one in the statement\n", "A left lenticular hemorrhage\n", "Attack"], ["Both options 2 and 3 give us a much more florid and extensive clinical picture\n", "Brain stem infarction\n", "Attack"], ["Both options 2 and 3 give us a much more florid and extensive clinical picture\n", "A cortico-subcortical left frontotemporal sylvian infarction\n", "Attack"]]}
{"1_35": [["endoscopic therapy is recommended, preferably with 2 techniques\n", "the correct one would be 5\n", "Support"], ["an unstable patient who has bled a lot, who has a Forrest IIa ulcer with a high risk of rebleeding\n", "Answer 1 is not in accordance with what has been said\n", "Support"], ["clots were found in the stomach and a 2 cm ulcer in the gastric antrum with fibrin background and a small grayish-white protrusion of 3 mm in the center of the ulcer (visible platelet thrombus vessel)\n", "Consultation to the surgical service to consider urgent surgical treatment\n", "Attack"], ["clots were found in the stomach and a 2 cm ulcer in the gastric antrum with fibrin background and a small grayish-white protrusion of 3 mm in the center of the ulcer (visible platelet thrombus vessel)\n", "4 will only be considered if bleeding is not controlled endoscopically\n", "Support"], ["Answer 1 is not in accordance with what has been said\n", "Since the patient is young, with no associated diseases and the ulcer has stopped bleeding, he can be discharged early with treatment with a PPI and H. Pylori eradication\n", "Attack"], ["an unstable patient who has bled a lot, who has a Forrest IIa ulcer with a high risk of rebleeding\n", "Since the patient is young, with no associated diseases and the ulcer has stopped bleeding, he can be discharged early with treatment with a PPI and H. Pylori eradication\n", "Attack"], ["endoscopic therapy is recommended, preferably with 2 techniques\n", "Endoscopic treatment by injection of adrenaline into the ulcer and placement of clips (metal staples) followed by i.v. administration of PPI\n", "Support"], ["Answer 2 speaks of somatostatin, which is used for bleeding due to portal hypertension\n", "Remove the endoscope, place nasogastric tube for continuous aspiration and initiate treatment with a PPI and somatostatin\n", "Attack"], ["endoscopic therapy is recommended, preferably with 2 techniques\n", "Take biopsy for H. Pylori, remove the endoscope taking care not to dislodge the platelet thrombus and continue pharmacological treatment with i.v. PPI\n", "Attack"], ["clots were found in the stomach and a 2 cm ulcer in the gastric antrum with fibrin background and a small grayish-white protrusion of 3 mm in the center of the ulcer (visible platelet thrombus vessel)\n", "Since the patient is young, with no associated diseases and the ulcer has stopped bleeding, he can be discharged early with treatment with a PPI and H. Pylori eradication\n", "Attack"], ["4 will only be considered if bleeding is not controlled endoscopically\n", "Consultation to the surgical service to consider urgent surgical treatment\n", "Attack"], ["there is a high risk of bleeding\n", "endoscopic therapy is recommended, preferably with 2 techniques\n", "Support"]]}
{"66_106": [["in principle, unless the patient worsens and the pH is less than 7.10\n", "we should not administer bicarbonate\n", "Support"], ["We must take into account that, in this case, potassium is decreased\n", "the most frequent cause (supported by the stains on the dress) would be diarrhea\n", "Support"], ["although they do not give us urine ion data to confirm it\n", "it is most likely that their renal failure (although they do not give us urine ion data to confirm it) is of prerenal type\n", "Attack"], ["supported by the stains on the dress\n", "the most frequent cause (supported by the stains on the dress) would be diarrhea\n", "Support"], ["the most frequent cause (supported by the stains on the dress) would be diarrhea\n", "it is most likely that their renal failure (although they do not give us urine ion data to confirm it) is of prerenal type\n", "Support"], ["We must take into account that, in this case, potassium is decreased\n", "it is most likely that their renal failure (although they do not give us urine ion data to confirm it) is of prerenal type\n", "Support"], ["it is most likely that their renal failure (although they do not give us urine ion data to confirm it) is of prerenal type\n", "She has an acute renal failure of prerenal cause\n", "Support"], ["the most frequent cause (supported by the stains on the dress) would be diarrhea\n", "She has an acute renal failure of prerenal cause\n", "Support"], ["Kussmaul's respiration\n", "These patients frequently present intense tachypnea (Kussmaul's breathing) in an attempt to compensate for MCA by hyperventilation\n", "Support"]]}
{"521_76": [["It is typical that after an episode of high fever an erythema appears on both cheeks in the form of a \"slap\" that usually has a cranial-caudal extension in the following days\n", "We are being told about erythema s\u00fadenita or fifth disease (also called megaloerythema), caused by parvovirus B19\n", "Support"], ["We are being told about erythema s\u00fadenita or fifth disease (also called megaloerythema), caused by parvovirus B19\n", "Erythema infectiosum or 5th disease\n", "Support"]]}
{}
{"422_88": [["Although the majority of ACTH-producing adenomas recur, surgery is always the first therapeutic option\n", "Selective surgical resection of the adenoma\n", "Support"], ["they are not curative\n", "Initially try medical treatment and, if not effective, resort to surgery\n", "Support"], ["they are not curative\n", "The available medications (ketoconazole, somatostatin analogues) are aimed at decreasing the effects of excess cortisol or decreasing ACTH release\n", "Attack"]]}
{"348_160": [["The cervicovaginal cytology is compatible with a high-grade squamous intraepithelial lesion\n", "Colposcopy is indicated for all patients with altered cytology (intraepithelial lesion or suspicion of invasive cancer or HPV infection), as a second level of screening\n", "Support"], ["Colposcopy is indicated for all patients with altered cytology (intraepithelial lesion or suspicion of invasive cancer or HPV infection), as a second level of screening\n", "Colposcopy with possible biopsy\n", "Support"], ["If lesions are observed in this test, a biopsy of the lesion will be performed\n", "Colposcopy with possible biopsy\n", "Support"], ["this is a screening test, not a diagnostic test\n", "There is no point in repeating the cytology\n", "Support"], ["There is no point in repeating the cytology\n", "Repeat cytology in 1 month\n", "Attack"], ["performing a hysterectomy for an intraepithelial lesion that has not been confirmed by biopsy is not indicated either\n", "Hysterectomy with bilateral salpinguectomy and ovarian conservation\n", "Attack"], ["the lesion is from the cervix\n", "performing curettage of the endometrial cavity does not provide information\n", "Support"], ["performing curettage of the endometrial cavity does not provide information\n", "Fractionated uterine curettage\n", "Attack"]]}
{"411_52": [["they are not sick and have already had a homozygous child\n", "Both parents are carriers of a mutation\n", "Support"], ["the probability of receiving it from both is 50%x50%=25%\n", "The probability that the next offspring will be affected is 25%\n", "Support"], ["Both parents are carriers of a mutation\n", "the next offspring has a 50% chance of receiving the mutation from each parent\n", "Support"], ["the next offspring has a 50% chance of receiving the mutation from each parent\n", "the probability of receiving it from both is 50%x50%=25%\n", "Support"]]}
{"590_64": [["We are presented with a 68-year-old female patient\n", "At that age the crystalline lens, although it does not normally have a cataract that needs surgery, it usually has increased in thickness\n", "Support"], ["At that age the crystalline lens, although it does not normally have a cataract that needs surgery, it usually has increased in thickness\n", "This implies that it projects the iris forward and reduces the depth of the anterior chamber\n", "Support"], ["This implies that it projects the iris forward and reduces the depth of the anterior chamber\n", "In an eye with a normal anterior chamber depth this is usually not a problem\n", "Support"], ["This implies that it projects the iris forward and reduces the depth of the anterior chamber\n", "But farsighted people already have a narrow anterior chamber\n", "Support"], ["But farsighted people already have a narrow anterior chamber\n", "This is the usual combination we find in primary angular closure: farsightedness and age over 50-60 years\n", "Support"], ["This is the usual combination we find in primary angular closure: farsightedness and age over 50-60 years\n", "Younger hyperopes usually do not have this problem yet\n", "Attack"], ["This is the usual combination we find in primary angular closure: farsightedness and age over 50-60 years\n", "And neither do older people who are emmetropic, myopic or have had cataract surgery\n", "Attack"], ["With this narrow angle, what triggers angular closure is mydriasis\n", "That is, when you are in the penumbra, the pupil dilates and the iris thickens in the peripheral part, where it is already very close to the corneal endothelium in the case of a narrow chamber\n", "Support"], ["She consults because she has been having eye pain with headache and blurred vision at night when she is watching television in dim light for a few weeks\n", "Mydriasis then triggers angular closure, which is accompanied by ocular pain that may radiate backwards (headache)\n", "Support"], ["That is, when you are in the penumbra, the pupil dilates and the iris thickens in the peripheral part, where it is already very close to the corneal endothelium in the case of a narrow chamber\n", "Mydriasis then triggers angular closure, which is accompanied by ocular pain that may radiate backwards (headache)\n", "Support"], ["Mydriasis then triggers angular closure, which is accompanied by ocular pain that may radiate backwards (headache)\n", "And increased intraocular pressure produces corneal edema that causes blurred vision\n", "Support"], ["And increased intraocular pressure produces corneal edema that causes blurred vision\n", "Therefore, option 1 is correct\n", "Support"], ["Therefore, option 1 is correct\n", "Primary angular closure glaucoma\n", "Support"], ["Migraine does not have to be related to penumbra\n", "Migraine\n", "Attack"], ["ocular pain and blurred vision is not particularly typical\n", "Migraine does not have to be related to penumbra\n", "Support"], ["She consults because she has been having eye pain with headache and blurred vision at night when she is watching television in dim light for a few weeks\n", "ocular pain and blurred vision is not particularly typical\n", "Support"], ["In addition, the history of exposure is usually clear\n", "Actinic keratitis is caused by exposure to ultraviolet radiation (such as solar radiation), and is not related to hyperopia or to being in penumbra\n", "Support"], ["Actinic keratitis is caused by exposure to ultraviolet radiation (such as solar radiation), and is not related to hyperopia or to being in penumbra\n", "Actinic keratitis\n", "Attack"], ["And finally, dry eye does not produce these symptoms either: it is more a question of burning, foreign body sensation, heaviness, etc\n", "Dry eye syndrome\n", "Attack"], ["And it is also unrelated to the other elements: penumbra, hyperopia, etc\n", "And finally, dry eye does not produce these symptoms either: it is more a question of burning, foreign body sensation, heaviness, etc\n", "Support"]]}
{"86_51": [["a \"portrait\" of the typical findings that can be found in hypertrophic cardiomyopathy\n", "Hypertrophic cardiomyopathy\n", "Support"], ["A young male patient with an aortic systolic murmur that increases with the Valsalva maneuver and signs of left ventricular enlargement\n", "a \"portrait\" of the typical findings that can be found in hypertrophic cardiomyopathy\n", "Support"]]}
[{"498_129": []}]
{"31_233": [["We rule out continuing with the same treatment since the patient is symptomatic\n", "Maintain the same pharmacological regimen\n", "Attack"], ["Asthma treatment algorithm\n", "Switch to ocmbined therapy with low-dose inhaled corticosteroids and long-acting beta2-adrenergics\n", "Support"]]}
{"618_119": [["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\n", "Treatment with a brace in Risser from 0 to 2 can be considered\n", "Support"], ["Treatment with a brace in Risser from 0 to 2 can be considered\n", "Prescribe a brace-type orthosis\n", "Support"], ["Its use is considered for curves between 30-40\u00ba\n", "Treatment with a brace in Risser from 0 to 2 can be considered\n", "Support"], ["since there is still growth to occur and correction can take place\n", "Treatment with a brace in Risser from 0 to 2 can be considered\n", "Support"], ["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\n", "Its use is considered for curves between 30-40\u00ba\n", "Support"]]}