[ { "id": 27473, "text": [ [ "QUESTION", "TYPE:", "DIGESTIVE", "SYSTEM" ], [ "CLINICAL", "CASE:" ], [ "A", "52-year-old", "man", "with", "no", "concomitant", "diseases", "comes", "to", "the", "emergency", "department", "for", "melena", "of", "24", "hours", "evolution", "without", "hemodynamic", "repercussions." ], [ "He", "denies", "taking", "nonsteroidal", "anti-inflammatory", "drugs." ], [ "The", "hematocrit", "is", "33%", "and", "the", "rest", "of", "the", "laboratory", "tests", "are", "normal." ], [ "The", "upper", "gastrointestinal", "endoscopy", "performed", "urgently", "6", "hours", "after", "admission", "shows", "a", "normal", "stomach,", "without", "blood", "or", "hematic", "debris", "and", "an", "excavated", "ulcer", "of", "8", "mm", "in", "diameter", "in", "the", "anterior", "face", "of", "the", "duodenal", "bulb", "with", "\"visible", "vessel\"", "at", "its", "base", "and", "without", "active", "bleeding." ], [ "Which", "of", "the", "following", "statements", "is", "true?" ], [ "1-", "In", "the", "initial", "endoscopy", "it", "is", "indicated", "to", "apply", "an", "endoscopic", "therapy", "and", "subsequently", "to", "establish", "endovenous", "treatment", "with", "high", "doses", "of", "a", "proton", "pump", "inhibitor.", "This", "strategy", "has", "been", "shown", "to", "reduce", "the", "risk", "of", "hemorrhagic", "recurrence", "and", "mortality." ], [ "2-", "In", "the", "initial", "endoscopy,", "given", "the", "absence", "of", "active", "bleeding,", "endoscopic", "therapy", "is", "not", "indicated.", "Subsequently,", "to", "reduce", "the", "risk", "of", "hemorrhagic", "recurrence,", "intravenous", "treatment", "with", "high", "doses", "of", "a", "proton", "pump", "inhibitor", "should", "be", "started." ], [ "3-", "n", "initial", "endoscopy,", "endoscopic", "therapy", "is", "indicated.", "Subsequent", "treatment", "with", "high", "doses", "of", "a", "proton", "pump", "inhibitor", "has", "not", "been", "shown", "to", "be", "of", "any", "additional", "benefit." ], [ "4-", "Since", "this", "is", "a", "complicated", "ulcer", "(hemorrhage)", "the", "best", "therapeutic", "option,", "once", "the", "hemorrhagic", "episode", "is", "resolved,", "is", "a", "vagotomy", "and", "pyloroplasty." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "1" ], [ "This", "is", "a", "grade", "IIa", "ulcer", "(Forrest", "classification),", "with", "a", "high", "risk", "of", "recurrence." ], [ "Therefore,", "endoscopic", "treatment", "and", "hospitalization", "with", "intravenous", "treatment", "with", "PPIs", "(in", "our", "setting", "it", "is", "usually", "omeprazole)", "for", "at", "least", "72", "hours", "is", "clearly", "indicated." ], [ "Surgery", "is", "indicated", "in", "massive", "bleeding", "or", "bleeding", "refractory", "to", "medical", "treatment." ] ], "labels": [ [ "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 233104, "text": [ [ "QUESTION", "TYPE:", "HEMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "In", "a", "29-year-old", "woman", "the", "following", "parameters", "are", "found", "in", "the", "course", "of", "a", "routine", "blood", "test:", "Hb", "11.5", "g/dL,", "MCV", "70", "fl,", "MCH", "28", "pg,", "Ferritin", "10", "ng/mL,", "leukocytes", "5,200/mm3,", "platelets", "335,000/mm3." ], [ "Physical", "examination", "is", "normal." ], [ "The", "most", "indicated", "examination", "in", "this", "situation", "is:" ], [ "1-", "Gynecological", "examination." ], [ "2-", "Fecal", "occult", "blood", "test." ], [ "3-", "Radiological", "study", "of", "the", "digestive", "tract." ], [ "4-", "Hemoglobin", "electrophoresis." ], [ "5-", "Cooms", "test." ], [ "CORRECT", "ANSWER:", "1" ], [ "The", "most", "frequent", "cause", "of", "microcytic", "iron", "deficiency", "anemia", "in", "young", "women", "is", "chronic", "gynecologic", "leaks." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 315136, "text": "", "labels": "" }, { "id": 235107, "text": [ [ "QUESTION", "TYPE:", "HEMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "71-year-old", "man", "presenting", "with", "severe", "pancytopenia", "without", "presence", "of", "immature", "cells", "and", "with", "a", "bone", "marrow", "study", "suggestive", "of", "severe", "aplastic", "anemia." ], [ "What", "would", "be", "the", "fundamental", "therapeutic", "approach?" ], [ "1-", "Treatment", "with", "methylprednisolone", "at", "a", "dose", "of", "1", "g/kg/day", "for", "5", "days." ], [ "2-", "Study", "of", "siblings", "and", "if", "any", "of", "them", "is", "HLA", "compatible,", "allogeneic", "transplantation", "of", "hematopoietic", "progenitors." ], [ "3-", "Immunosuppressive", "therapy", "with", "cyclosporine", "and", "antithymocyte", "immunoglobulin." ], [ "4-", "Hemotherapy", "support." ], [ "5-", "Chemotherapy", "and", "if", "response", "autologous", "transplantation", "of", "hematopoietic", "progenitors." ], [ "CORRECT", "ANSWER:", "3" ], [ "Severe", "aplastic", "anemia", "and", "not", "a", "candidate", "for", "allogeneic", "transplant", "because", "of", "his", "age." ], [ "Antisuppressants", "seem", "to", "be", "the", "most", "suitable." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 429114, "text": "", "labels": "" }, { "id": 5404, "text": "", "labels": "" }, { "id": 266138, "text": [ [ "QUESTION", "TYPE:", "PNEUMOLOGY" ], [ "CLINICAL", "CASE:" ], [ "In", "a", "patient", "with", "mild", "chronic", "obstructive", "pulmonary", "disease", "(COPD)", "in", "stable", "phase,", "polyglobulia", "and", "respiratory", "insufficiency", "are", "evident." ], [ "In", "the", "chest", "X-ray", "there", "are", "no", "notable", "alterations." ], [ "Which", "of", "the", "following", "procedures", "would", "you", "consider", "performing", "first", "to", "rule", "out", "the", "coexistence", "of", "other", "diseases", "that", "may", "justify", "the", "findings", "described?" ], [ "1-", "Respiratory", "polygraphy." ], [ "2-", "Echocardiogram." ], [ "3-", "Thoracic", "computed", "tomography." ], [ "4-", "Pulmonary", "scintigraphy." ], [ "5-", "Bone", "marrow", "puncture." ], [ "CORRECT", "ANSWER:", "1" ], [ "The", "approach", "is", "questionable", "due", "to", "lack", "of", "sufficient", "data." ], [ "The", "correct", "answer", "could", "be", "respiratory", "polygraphy,", "especially", "in", "the", "case", "of", "an", "obese", "patient,", "which", "we", "do", "not", "know,", "but", "it", "could", "also", "be", "correct", "2", "(echocardiogram)", "in", "the", "case", "of", "suspicion", "of", "associated", "cardiopathy,", "less", "frequent", "but", "also", "possible." ], [ "The", "association", "of", "COPD", "with", "OSAHS", "is", "a", "frequent", "cause", "of", "COPD", "deterioration,", "greater", "than", "that", "which", "would", "correspond", "to", "functional", "impairment." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ] ] }, { "id": 13150, "text": [ [ "QUESTION", "TYPE:", "SURGERY" ], [ "CLINICAL", "CASE:" ], [ "A", "one-and-a-half-year-old", "boy", "presents", "to", "the", "emergency", "department", "with", "abdominal", "pain", "and", "jaundice." ], [ "On", "examination,", "an", "abdominal", "mass", "is", "palpated." ], [ "An", "ultrasound", "shows", "the", "presence", "of", "a", "common", "bile", "duct", "cyst." ], [ "What", "therapeutic", "approach", "should", "we", "adopt?" ], [ "1-", "A", "percutaneous", "puncture", "will", "be", "performed", "for", "peritoneal", "lavage", "to", "check", "that", "the", "cyst", "contains", "bile", "in", "order", "to", "leave", "a", "drainage", "to", "improve", "abdominal", "pain." ], [ "2-", "Radical", "resection", "of", "the", "entire", "bile", "duct", "is", "indicated", "to", "replace", "it", "with", "a", "loop", "of", "bowel." ], [ "3-", "An", "exploratory", "laparotomy", "and", "drainage", "of", "the", "cyst", "will", "be", "indicated", "and", "when", "the", "dilatation", "subsides", "the", "drainage", "will", "be", "removed." ], [ "4-", "A", "cholangioresonance", "will", "be", "performed", "to", "delimit", "the", "cyst", "and", "a", "laparotomy", "will", "be", "indicated", "for", "resection", "of", "the", "cyst", "and", "anastomosis", "of", "the", "biliary", "tract." ], [ "5-", "HIDA", "scintigraphy", "is", "necessary", "to", "delimit", "the", "cyst", "and", "to", "be", "able", "to", "perform", "percutaneous", "drainage", "safely." ], [ "CORRECT", "ANSWER:", "4" ], [ "I", "believe", "that", "the", "correct", "answer", "is", "4", "the", "common", "bile", "duct", "cyst", "is", "a", "rare", "pathology", "but", "its", "treatment", "is", "surgical", "and", "consists", "of", "resection", "of", "the", "cyst", "and", "hepaticojejunosotomy." ], [ "Cholangioresonance", "is", "necessary", "to", "choose", "the", "appropriate", "technique", "for", "the", "four", "existing", "classes", "of", "common", "bile", "duct", "cyst", "(Todani", "classification)." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 299104, "text": [ [ "QUESTION", "TYPE:", "INFECTIOUS", "DISEASES" ], [ "CLINICAL", "CASE:" ], [ "A", "46-year-old", "male", "parenteral", "drug", "user", "came", "to", "the", "emergency", "department", "with", "fever", "with", "chills,", "mental", "confusion,", "diffuse", "myalgias", "and", "intense", "pain", "in", "the", "left", "hand", "of", "24", "hours", "of", "evolution", "without", "clear", "local", "phlogosis", "signs." ], [ "She", "does", "not", "refer", "any", "traumatic", "history." ], [ "Examination", "revealed:", "temperature", "38.9\u00b0C,", "120", "beats", "per", "minute,", "respiratory", "rate", "30/min,", "blood", "pressure", "90/54", "mm", "Hg." ], [ "Laboratory", "tests", "showed", "leukocytosis", "with", "left", "deviation", "(25,000", "leukocytes/mm3,", "80%", "neutrophils);", "increased", "creatinine", "(1.6", "mg/dL)", "and", "CK", "(138", "U/L)." ], [ "Among", "the", "following,", "which", "is", "the", "most", "likely", "diagnosis:" ], [ "1-", "Streptococcal", "necrotizing", "fasciitis." ], [ "2-", "Gangrene", "due", "to", "Clostridium", "spp." ], [ "3-", "Mycobacterial", "cellulitis." ], [ "4-", "Erysipelas." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "1" ], [ "I", "have", "my", "doubts", "between", "1", "and", "2;", "exceptionally", "C.", "botulinum", "can", "infect", "traumatic", "or", "puncture", "wounds", "in", "IVDUs", "using", "brown", "heroin", "or", "cause", "sinusitis", "in", "cocaine", "addicts." ], [ "On", "the", "other", "hand,", "the", "case", "may", "refer", "to", "a", "severe", "sepsis", "with", "poor", "initial", "manifestation", "at", "first", "sight,", "with", "incipient", "rhabdomyolysis", "and", "muscle", "pain,", "in", "this", "case", "it", "may", "be", "a", "necrotizing", "fasciitis,", "where", "the", "most", "frequently", "implicated", "germ", "is", "S.", "pyogenes." ] ], "labels": [ [ "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 16131, "text": [ [ "QUESTION", "TYPE:", "DERMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "62-year-old", "man", "with", "a", "history", "of", "significant", "alcohol", "abuse,", "carrier", "of", "hepatitis", "C", "virus,", "treated", "with", "Ibuprofen", "for", "tendinitis", "of", "the", "right", "shoulder,", "goes", "to", "his", "dermatologist", "because", "after", "spending", "two", "weeks", "on", "vacation", "at", "the", "beach", "he", "notices", "the", "appearance", "of", "tense", "blisters", "on", "the", "dorsum", "of", "his", "hands." ], [ "On", "examination,", "in", "addition", "to", "localization", "and", "slight", "malar", "hypertrichosis." ], [ "The", "most", "likely", "diagnosis", "is:" ], [ "1-", "Epidermolysis", "bullosa", "acquisita." ], [ "2-", "Porphyria", "cutanea", "tarda." ], [ "3-", "Phototoxic", "reaction." ], [ "4-", "Contact", "dermatitis." ], [ "5-", "Acute", "intermittent", "porphyria." ], [ "CORRECT", "ANSWER:", "2" ], [ "Porphyria", "Cutanea", "Tarda:", "60%", "of", "patients", "with", "PCT", "are", "male,", "many", "of", "them", "drink", "alcohol", "in", "excess,", "women", "who", "develop", "it", "are", "usually", "treated", "with", "drugs", "containing", "estrogens." ], [ "Most", "are", "males", "with", "signs", "of", "iron", "overload,", "this", "overload", "reduces", "the", "activity", "of", "the", "enzyme", "uroporphyrinogen", "decarboxylase,", "which", "leads", "to", "the", "elevation", "of", "uroporphyrins." ], [ "HCV", "and", "HIV", "infections", "have", "been", "implicated", "in", "the", "precipitation", "of", "acquired", "PCT." ], [ "There", "is", "a", "hereditary", "form", "with", "AD", "pattern." ], [ "Patients", "with", "PCT", "present", "with", "blistering", "of", "photoexposed", "skin,", "most", "frequently", "on", "the", "dorsum", "of", "the", "hands", "and", "scalp." ], [ "In", "addition", "to", "fragility,", "they", "may", "develop", "hypertrichosis,", "hyperpigmentation,", "cicatricial", "alopecia", "and", "sclerodermal", "induration." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 121114, "text": [ [ "QUESTION", "TYPE:", "MICROBIOLOGY" ], [ "CLINICAL", "CASE:" ], [ "47-year-old", "woman." ], [ "Native", "of", "Cochabamba", "(Bolivia),", "she", "has", "been", "living", "in", "Spain", "for", "8", "years." ], [ "In", "mid", "2009", "she", "began", "to", "experience", "palpitations,", "dyspnea", "and", "progressive", "edema", "in", "the", "lower", "extremities." ], [ "She", "was", "diagnosed", "with", "heart", "failure", "secondary", "to", "cardiomyopathy", "due", "to", "Chagas", "disease." ], [ "What", "is", "the", "etiological", "agent", "of", "this", "disease", "endemic", "in", "several", "Latin", "American", "countries?" ], [ "1-", "Toxoplasma", "gondii." ], [ "2-", "Trypanosoma", "brucei." ], [ "3-", "Lehismania", "donovani." ], [ "4-", "Giardia", "lamblia." ], [ "5-", "Trypanosoma", "cruzi." ], [ "CORRECT", "ANSWER:", "5" ], [ "The", "correct", "answer", "is", "the", "fifth", "one." ], [ "The", "cause", "of", "Chagas", "disease", "is", "Trypanosoma", "cruzi." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 241229, "text": [ [ "QUESTION", "TYPE:", "NEUROLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "29-year-old", "obese", "woman,", "with", "no", "past", "history", "of", "interest,", "consults", "for", "a", "month", "of", "intense,", "bilateral,", "pulsating", "headache,", "accompanied", "by", "horizontal", "diplopia", "and", "episodes", "of", "monocular", "amaurosis", "lasting", "seconds." ], [ "Examination", "is", "normal,", "except", "for", "the", "presence", "of", "bilateral", "papilledema." ], [ "Which", "of", "these", "tests", "do", "you", "think", "will", "allow", "you", "to", "fully", "confirm", "the", "diagnosis?" ], [ "1-", "Ultrasound", "of", "supra-aortic", "trunks." ], [ "2-", "Cranial", "magnetic", "resonance", "imaging." ], [ "3-", "Electroencephalogram." ], [ "4-", "Lumbar", "puncture." ], [ "5-", "Visual", "evoked", "potentials." ], [ "CORRECT", "ANSWER:", "4" ], [ "Again", "we", "are", "presented", "with", "a", "case", "to", "make", "a", "diagnosis", "and", "then,", "in", "this", "case,", "perform", "a", "confirmatory", "test." ], [ "Now", "the", "guiding", "symptom", "is", "bilateral", "papilledema", "which", "is", "indicative", "of", "intracranial", "hypertension." ], [ "Although", "he", "does", "not", "comment", "that", "a", "space-occupying", "lesion", "has", "been", "ruled", "out,", "given", "the", "normal", "neurological", "examination", "and", "the", "other", "symptoms,", "it", "is", "deduced", "that", "it", "is", "idiopathic", "intracranial", "hypertension", "or", "pseudotumor", "cerebri." ], [ "Other", "data", "suggestive", "of", "this", "entity", "include:", "women", "of", "reproductive", "age,", "obesity,", "and", "diplopia", "(due", "to", "involvement", "of", "the", "VI", "cranial", "nerve)." ], [ "It", "is", "characteristic", "that", "the", "headache", "and", "visual", "blurriness", "suddenly", "worsen", "in", "the", "mornings", "when", "getting", "up", "or", "changing", "posture,", "producing", "transitory", "blindness", "(Neurology,", "Zarranz)." ], [ "The", "lumbar", "puncture", "invariably", "shows", "an", "increase", "in", "cerebrospinal", "fluid", "pressure,", "so", "the", "correct", "answer", "is", "4." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 576103, "text": [ [ "QUESTION", "TYPE:", "NEUROLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "30-year-old", "male", "who", "consults", "for", "unilateral", "periocular", "headaches", "that", "rapidly", "progress", "to", "become", "very", "intense." ], [ "The", "pain", "attacks", "last", "30-60", "minutes,", "occur", "2-3", "times", "a", "day,", "and", "are", "accompanied", "by", "tearing", "in", "the", "painful", "eye", "and", "unilateral", "rhinorrhea." ], [ "What", "is", "the", "most", "appropriate", "preventive", "treatment?" ], [ "1-", "Oral", "prednisone", "with", "withdrawal", "in", "2-3", "months." ], [ "2-", "Oral", "prednisone", "with", "withdrawal", "in", "one", "month,", "associated", "with", "oral", "verapamil", "at", "a", "dose", "of", "80-180", "mg", "every", "8", "hours." ], [ "3-", "Carbamazepine", "at", "doses", "of", "600-1200", "mg", "per", "day." ], [ "4-", "Indomethacin", "at", "a", "dose", "of", "50", "mg", "every", "8", "hours", "for", "one", "month." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "2" ], [ "They", "describe", "a", "characteristic", "case", "of", "cluster", "headache." ], [ "It", "is", "more", "frequent", "in", "males,", "the", "pain", "is", "characteristically", "unilateral", "periocular", "of", "great", "intensity,", "of", "variable", "duration,", "usually", "minutes,", "and", "it", "associates", "trigeminoautonomic", "signs", "such", "as", "rhinorrhea", "and", "unilateral", "conjunctival", "injection." ], [ "The", "preventive", "treatment", "par", "excellence", "is", "verapamil", "associated", "with", "a", "descending", "corticosteroid", "regimen,", "as", "described", "in", "answer", "2." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 50487, "text": [ [ "QUESTION", "TYPE:", "PEDIATRICS" ], [ "CLINICAL", "CASE:" ], [ "Given", "sudden-onset", "obsessive-compulsive", "disorder", "(OCD)", "in", "a", "9-year-old", "boy", "who", "also", "has", "tics", "and", "chorea", "as", "neurologic", "manifestations,", "an", "infection", "by", "should", "be", "ruled", "out:" ], [ "1-", "Streptococcus", "viridans." ], [ "2-", "Alpha-hemolytic", "streptococcus." ], [ "3-", "Beta-hemolytic", "streptococcus,", "group", "A." ], [ "4-", "Enterococcus." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "We", "are", "presented", "with", "a", "case", "of", "PANDAS", "syndrome,", "a", "rare", "complication", "of", "an", "infection", "caused", "by", "group", "A", "beta-hemolytic", "streptococcus." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 367119, "text": [ [ "QUESTION", "TYPE:", "PNEUMOLOGY", "AND", "THORACIC", "SURGERY" ], [ "CLINICAL", "CASE:" ], [ "A", "38-year-old", "nonsmoking", "woman", "previously", "diagnosed", "with", "atopic", "rhinitis", "presents", "with", "a", "two-month", "history", "of", "intermittent", "cough", "and", "wheezing,", "predominantly", "at", "night." ], [ "Chest", "X-ray", "was", "normal." ], [ "Spirometry", "within", "the", "normal", "range", "with", "negative", "bronchodilator", "test." ], [ "Which", "of", "the", "following", "tests", "would", "you", "request", "next?" ], [ "1-", "Paranasal", "sinus", "Rx." ], [ "2-", "Thoracic", "CT." ], [ "3-", "Methacholine", "test." ], [ "4-", "Prick", "test." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "A", "normal", "spirometry", "and", "a", "negative", "bronchodilator", "test", "does", "not", "exclude", "asthma,", "and", "the", "patient's", "clinical", "picture", "is", "highly", "suggestive", "of", "asthma,", "so", "a", "methacholine", "test", "would", "confirm", "the", "diagnosis,", "at", "least", "of", "bronchial", "hyperresponsiveness." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 444104, "text": "", "labels": "" }, { "id": 171226, "text": [ [ "QUESTION", "TYPE:", "CARDIOLOGY", "AND", "CARDIOVASCULAR", "SURGERY" ], [ "CLINICAL", "CASE:" ], [ "A", "26-year-old", "male", "patient,", "competitive", "athlete,", "is", "studied", "because", "his", "brother", "has", "had", "a", "sudden", "death." ], [ "Complementary", "tests", "detect", "the", "existence", "of", "obstructive", "hypertrophic", "cardiomyopathy." ], [ "Mark", "the", "FALSE", "option", "regarding", "this", "pathology:" ], [ "1-", "Treatment", "with", "beta-blockers", "helps", "to", "reduce", "symptoms." ], [ "2-", "Abandonment", "of", "competitive", "sport", "should", "be", "recommended." ], [ "3-", "Digoxin", "is", "useful", "to", "reduce", "the", "subaortic", "gradient." ], [ "4-", "Diuretics", "should", "be", "avoided", "or", "used", "with", "great", "care." ], [ "5-", "Given", "the", "hereditary", "nature", "of", "the", "pathology,", "a", "screening", "study", "should", "be", "performed", "in", "the", "rest", "of", "the", "direct", "relatives." ], [ "CORRECT", "ANSWER:", "3" ], [ "Our", "myocardium", "is", "thicker", "than", "it", "should", "be,", "predominantly", "in", "the", "septum,", "and", "it", "is", "so", "thick", "that", "it", "obstructs", "the", "LV", "outflow,", "producing", "a", "\"functional\"", "stenosis", "with", "a", "pressure", "gradient." ], [ "Our", "objective", "will", "be,", "first", "of", "all,", "to", "\"relax\"", "the", "myocardium:", "for", "this", "purpose,", "a", "beta-blocker", "is", "recommended,", "whereas", "digoxin,", "as", "a", "good", "positive", "inotrope,", "increases", "the", "gradient", "and", "is", "contraindicated." ], [ "Sport", "is", "not", "highly", "recommended,", "given", "the", "increased", "risk", "of", "sudden", "death", "associated", "with", "this", "pathology." ], [ "And", "if", "we", "have", "a", "fat", "septum,", "which", "protrudes", "into", "the", "LV", "cavity,", "it", "is", "not", "advisable", "to", "perform", "volume", "depletion,", "since", "we", "would", "also", "be", "increasing", "the", "gradient." ], [ "Regarding", "number", "5,", "it", "is", "true:", "it", "is", "convenient", "to", "perform", "a", "careful", "exploration", "and", "an", "ECG", "in", "the", "relatives", "of", "patients", "with", "hypertrophy." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 55551, "text": [ [ "QUESTION", "TYPE:", "ENDOCRINOLOGY" ], [ "CLINICAL", "CASE:" ], [ "55-year-old", "woman", "with", "type", "1", "diabetes", "diagnosed", "at", "age", "15", "years", "who", "refers", "nausea", "and", "abdominal", "distention,", "especially", "after", "meals." ], [ "Evaluation", "is", "consistent", "with", "diabetic", "gastroparesis." ], [ "Which", "of", "the", "following", "medications", "would", "be", "the", "most", "appropriate", "treatment", "to", "improve", "her", "symptoms:" ], [ "1-", "Lansoprazole." ], [ "2-", "Ondansetron." ], [ "3-", "Loperamide." ], [ "4-", "Metoclopramide." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "4" ], [ "It", "was", "approved", "as", "a", "treatment", "for", "gastroparesis", "by", "the", "US", "Food", "and", "Drug", "Administration", "(FDA)", "in", "1979", "and", "remains", "the", "first-line", "drug." ], [ "It", "acts", "as", "a", "prokinetic", "by", "its", "antagonistic", "effect", "on", "dopamine", "2", "(D2)", "receptors", "promoting", "gastric", "emptying", "and,", "in", "addition,", "binds", "to", "the", "5-hydroxytryptamine", "4", "receptor", "(serotonin", "5-HT4)", "to", "stimulate", "cholinergic", "nerve", "pathways", "in", "the", "stomach." ], [ "Physiologically,", "it", "accelerates", "intestinal", "transit", "by", "increasing", "the", "tone", "and", "amplitude", "of", "gastric", "contractions,", "increases", "lower", "esophageal", "sphincter", "pressure", "and", "improves", "antropyloroduodenal", "coordination." ], [ "In", "addition,", "this", "antiemetic", "agent", "provides", "relief", "through", "antagonism", "of", "central", "and", "peripheral", "dopamine", "receptors." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 320142, "text": [ [ "QUESTION", "TYPE:", "RHEUMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "40-year-old", "man,", "with", "no", "history", "of", "interest,", "presents", "with", "acute", "arthritis", "of", "the", "right", "knee", "of", "5", "days", "of", "evolution", "as", "well", "as", "fever", "up", "to", "37.7\u00b0C." ], [ "He", "has", "no", "history", "of", "trauma." ], [ "He", "presented", "with", "joint", "effusion,", "warmth", "on", "palpation", "and", "functional", "limitation", "due", "to", "pain." ], [ "Diagnostic", "arthrocentesis", "was", "performed", "and", "showed", "30000", "cels/microliter", "with", "predominance", "of", "neutrophils." ], [ "Polarized", "light", "examination", "revealed", "rhomboidal", "and", "cylindrical", "crystals", "with", "weakly", "positive", "birefringence." ], [ "On", "plain", "radiograph", "of", "the", "knee,", "radiodense", "deposits", "are", "found", "in", "the", "external", "meniscus", "of", "the", "knee." ], [ "Mark", "the", "FALSE", "answer:" ], [ "1-", "Initial", "treatment", "will", "consist", "of", "non-steroidal", "anti-inflammatory", "drugs,", "as", "well", "as", "aspiration", "of", "synovial", "fluid." ], [ "2-", "It", "is", "advisable", "to", "perform", "a", "synovial", "fluid", "culture", "to", "rule", "out", "infectious", "synovitis." ], [ "3-", "Once", "the", "acute", "flare-up", "has", "passed,", "treatment", "with", "allopurinol", "should", "be", "started", "to", "reduce", "the", "incidence", "of", "new", "arthritis", "flare-ups", "in", "the", "future." ], [ "4-", "The", "most", "likely", "diagnosis", "is", "acute", "arthritis", "due", "to", "calcium", "pyrophosphate", "crystal", "deposition", "(pseudogout)." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "It", "is", "a", "chondrocalcinosis." ], [ "There", "is", "no", "treatment", "for", "this", "disease,", "only", "treatment", "for", "flare-ups", "(colchicine,", "NSAIDs", "or", "corticosteroids),", "although", "sometimes", "if", "the", "flare-ups", "are", "habitual", "the", "colchicine", "is", "maintained." ], [ "Allopurinol", "has", "not", "shown", "any", "efficacy", "in", "this", "microcrystal", "arthropathy,", "but", "it", "has", "shown", "efficacy", "in", "gout." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "B-Marker", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 617119, "text": [ [ "QUESTION", "TYPE:", "TRAUMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "13-year-old", "female,", "with", "no", "relevant", "history,", "with", "menarche", "3", "months", "ago,", "followed", "since", "the", "age", "of", "10", "years", "for", "idiopathic", "scoliosis", "that", "has", "worsened." ], [ "In", "the", "physical", "examination", "she", "presents", "a", "hump", "of", "7", "degrees", "in", "the", "Adams", "test", "and", "in", "the", "scoliogram", "a", "T4-L1", "thoracolumbar", "curve", "of", "35", "degrees", "of", "Cobb", "and", "a", "Risser", "0:" ], [ "1-", "Recommend", "swimming", "and", "revision", "in", "three", "months." ], [ "2-", "Prescribe", "a", "brace", "type", "orthosis." ], [ "3-", "Refer", "to", "physiotherapy", "for", "spine", "elastification." ], [ "4-", "Revise", "in", "6", "months", "with", "a", "new", "X-ray." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "2" ], [ "We", "are", "presented", "with", "the", "case", "of", "a", "13", "year", "old", "patient,", "with", "menarche", "3", "months", "ago,", "a", "T4-L1", "thoracolumbar", "curve", "of", "35\u00ba", "and", "a", "Risser", "0." ], [ "As", "a", "general", "rule", "we", "could", "say", "that", "below", "50\u00ba", "the", "treatment", "is", "usually", "conservative,", "with", "two", "options:", "observation", "or", "use", "of", "a", "brace", "to", "slow", "down", "the", "evolution." ], [ "In", "this", "case,", "taking", "into", "account", "the", "remaining", "growth", "(menarche", "3", "months", "ago", "and", "Risser", "0)", "the", "most", "indicated", "would", "be", "to", "use", "a", "brace", "(Answer", "2", "correct)." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 146231, "text": [ [ "QUESTION", "TYPE:", "PEDIATRICS" ], [ "CLINICAL", "CASE:" ], [ "A", "7-month-old", "infant", "comes", "to", "the", "emergency", "department", "referred", "by", "his", "pediatrician", "for", "suspected", "Kawasaki", "disease." ], [ "He", "reports", "a", "fever", "of", "up", "to", "39.5\u00baC", "of", "5", "days", "evolution", "that", "does", "not", "subside", "despite", "treatment", "with", "amoxicillin", "prescribed", "72", "hours", "ago", "for", "suspected", "acute", "pharyngotonsillitis." ], [ "During", "the", "last", "24", "hours", "he", "has", "had", "erythematous", "and", "pruritic", "exanthema", "of", "cephalocaudal", "evolution", "and", "during", "the", "last", "few", "days", "his", "parents", "have", "noticed", "a", "cough", "and", "intense", "conjunctivitis." ], [ "No", "rhinorrhea", "was", "reported." ], [ "Clinical", "examination", "showed", "subcrepitant", "in", "both", "lung", "bases", "without", "tachypnea", "or", "signs", "of", "respiratory", "distress." ], [ "On", "oropharyngeal", "examination", "there", "are", "whitish", "spots", "in", "the", "jugal", "mucosa." ], [ "What", "is", "the", "most", "probable", "diagnosis?" ], [ "1-", "Kawasaki", "disease." ], [ "2-", "Scarlet", "fever." ], [ "3-", "Allergic", "reaction", "to", "amoxicillin." ], [ "4-", "Infectious", "mononucleosis." ], [ "5-", "Measles." ], [ "CORRECT", "ANSWER:", "5" ], [ "The", "correct", "answer", "is", "5." ], [ "The", "clue", "is", "in", "the", "whitish", "lesions", "of", "the", "jugal", "mucosa", "corresponding", "to", "Koplik's", "spots,", "which", "are", "pathognomonic", "of", "measles,", "although", "as", "an", "observation", "I", "would", "say", "that", "they", "usually", "appear", "in", "the", "prodromal", "phase", "of", "the", "disease", "and", "are", "often", "no", "longer", "seen", "when", "the", "exanthema", "appears." ], [ "In", "this", "case", "you", "are", "describing", "measles", "complicated", "by", "pneumonia." ], [ "Very", "timely", "question", "at", "the", "present", "time." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O" ] ] }, { "id": 46792, "text": [ [ "QUESTION", "TYPE:", "ORTHOPEDIC", "SURGERY", "AND", "TRAUMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "woman", "presenting", "with", "difficulty", "walking", "after", "gynecologic", "surgery." ], [ "She", "has", "mild", "thigh", "pain", "and", "leg", "failure", "on", "support." ], [ "On", "examination", "she", "has", "weakness", "in", "hip", "flexion", "and", "knee", "extension,", "and", "dysesthesias", "in", "the", "anterior", "aspect", "of", "the", "thigh." ], [ "What", "is", "the", "most", "probable", "diagnosis", "of", "suspicion:" ], [ "1-", "Femoral", "nerve", "neuropathy." ], [ "2-", "Meralgia", "paresthetica", "of", "the", "femoral", "cutaneous", "nerve." ], [ "3-", "Obturator", "nerve", "neuropathy." ], [ "4-", "Neuropathy", "of", "the", "sciatic", "nerve." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "1" ], [ "The", "femoral", "nerve", "(although", "rare)", "may", "be", "damaged", "in", "a", "cesarean", "section,", "hysterectomy", "or", "lower", "abdominal", "operation." ], [ "This", "nerve", "injury", "produces", "hypoesthesia", "and", "weakness", "along", "its", "distribution." ], [ "Femoroneuropathy", "is", "manifested", "by", "paralysis", "(25%", "of", "cases)", "of", "the", "quadriceps", "muscles,", "abolition", "of", "patellar", "reflexes", "and", "hypoesthesia", "of", "the", "anterior", "and", "inner", "thigh." ], [ "Therefore,", "answer", "1", "is", "correct." ], [ "The", "femoral", "cutaneous", "or", "lateral", "femoral", "cutaneous", "nerve", "(L2,L3)", "is", "only", "sensitive", "and", "is", "responsible", "for", "the", "sensitivity", "of", "the", "skin", "of", "the", "lateral", "and", "anterior", "aspect", "of", "the", "thigh", "up", "to", "the", "knee,", "so", "it", "would", "not", "explain", "the", "motor", "problem", "of", "gait", "and", "2", "is", "false." ], [ "The", "obturator", "nerve", "(L2-L4)", "is", "a", "mixed", "nerve." ], [ "At", "the", "motor", "level,", "it", "invests", "the", "obturator", "externus,", "pectineus,", "short", "approximator,", "the", "approximators", "(adductors)", "and", "gracilis." ], [ "At", "the", "sensory", "level", "the", "capsule", "of", "the", "coxofemoral", "joint,", "medial", "aspect", "of", "the", "thigh", "above", "the", "knee." ], [ "Therefore", "neither", "affects", "the", "sensitivity", "of", "the", "anterior", "aspect", "of", "the", "thigh", "nor", "the", "extension", "of", "the", "knee", "so", "that", "3", "is", "false." ], [ "A", "lesion", "of", "the", "sciatic", "nerve", "at", "motor", "level", "affects", "to", "the", "flexion", "of", "the", "knee", "not", "to", "its", "extension", "and", "at", "distal", "level", "to", "this", "one", "(they", "do", "not", "count", "anything", "of", "distal", "clinic)", "and", "at", "sensitive", "level", "also", "it", "is", "distal", "in", "the", "external", "face", "of", "the", "leg", "and", "in", "the", "foot", "reason", "why", "4", "also", "is", "false." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 42389, "text": "", "labels": "" }, { "id": 449151, "text": [ [ "QUESTION", "TYPE:", "NEUROSURGERY" ], [ "CLINICAL", "CASE:" ], [ "A", "13-year-old", "boy", "presents", "with", "subacute", "headache", "and", "diplopia." ], [ "Neurologic", "examination", "shows", "vertical", "gaze", "palsy", "and", "MRI", "shows", "a", "contrast-enhancing", "lesion", "in", "the", "pineal", "region", "obstructing", "the", "aqueduct", "of", "Sylvius." ], [ "The", "most", "likely", "diagnosis", "is:" ], [ "1-", "Glioblastoma." ], [ "2-", "Medulloblastoma." ], [ "3-", "Germ", "cell", "tumor." ], [ "4-", "Meningioma." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "Germinal", "tumors", "are", "the", "most", "frequent", "in", "children", "in", "the", "pineal", "region." ], [ "They", "usually", "capitate", "homogeneously", "and", "cause", "triventricular", "hydrocephalus", "and", "Parinaud." ], [ "Glioblastomas", "usually", "occur", "in", "adults", "at", "the", "lobar", "level,", "medulloblastomas", "are", "the", "most", "frequent", "malignant", "tumors", "at", "the", "posterior", "fossa", "level", "in", "children", "(vermis", "and", "roof", "of", "the", "IV", "ventricle)", "but", "rare", "at", "the", "pineal", "level", "and", "meningiomas", "are", "rare", "in", "children", "and", "also", "in", "the", "pineal", "region." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O" ], [ "O", "B-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 433118, "text": [ [ "QUESTION", "TYPE:", "INFECTIOUS", "DISEASES", "AND", "MICROBIOLOGY" ], [ "CLINICAL", "CASE:" ], [ "Luis", "is", "a", "25-year-old", "young", "man", "who", "underwent", "splenectomy", "after", "a", "bicycle", "accident", "1", "year", "ago." ], [ "He", "has", "a", "dog", "that", "bit", "him", "24", "hours", "ago", "and", "has", "caused", "a", "small", "wound", "on", "his", "right", "hand." ], [ "She", "comes", "to", "her", "health", "center", "(located", "3", "hours", "from", "the", "nearest", "hospital)", "with", "fever", "of", "39\u00b0C,", "pain", "in", "the", "wound", "and", "general", "malaise." ], [ "On", "examination,", "BP", "100/60", "mm", "Hg,", "HR", "110", "beats", "per", "minute,", "slight", "swelling", "in", "the", "wound", "without", "pus." ], [ "Which", "of", "the", "following", "actions", "is", "most", "indicated", "at", "this", "time?" ], [ "1-", "Send", "to", "hospital", "for", "rabies", "and", "tetanus", "vaccination", "and", "keep", "under", "observation." ], [ "2-", "Clean", "the", "wound", "and", "administer", "intramuscular", "nonspecific", "gamma", "globulin." ], [ "3-", "Give", "400", "mg", "of", "oral", "moxifloxacin", "and", "send", "to", "hospital." ], [ "4-", "Give", "clindamycin", "600", "mg", "orally", "every", "8", "hours", "and", "observation." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "This", "question", "has", "been", "complicated", "for", "us." ], [ "The", "question", "does", "not", "have", "all", "the", "necessary", "information,", "but", "using", "what", "we", "have", "we", "can", "try", "to", "answer." ], [ "The", "dog", "is", "domestic,", "known", "and", "can", "be", "monitored,", "so", "we", "would", "have", "to", "wait", "for", "the", "observation", "period", "to", "pass", "and", "prophylaxis", "is", "not", "recommended." ], [ "At", "this", "point", "we", "will", "only", "have", "to", "worry", "about", "the", "possible", "bacteremia", "that", "may", "be", "occurring", "in", "a", "patient", "with", "the", "possibility", "of", "high", "risk", "due", "to", "asplenia." ], [ "The", "treatment", "of", "choice", "in", "dog", "bite", "is", "amoxicillin/clavulanic", "acid", "but", "it", "is", "not", "available,", "so", "we", "can", "use", "another", "treatment", "such", "as", "clindamycin", "plus", "cephalosporin", "or", "clindamycin", "+", "moxifloxacin", "but", "it", "is", "not", "contemplated", "among", "the", "alternatives." ], [ "In", "a", "first", "attempt", "we", "answered", "4,", "but", "the", "correct", "answer", "is", "3,", "because", "of", "the", "second", "part", "of", "the", "question;", "it", "is", "a", "high", "risk", "patient", "with", "incipient", "signs", "of", "sepsis", "so", "he", "should", "be", "sent", "to", "the", "hospital,", "here", "the", "key", "more", "than", "the", "antibiotic", "is", "in", "the", "position", "to", "take,", "in", "the", "second", "part", "of", "each", "answer." ], [ "It", "could", "be", "challenged", "since", "they", "do", "not", "say", "in", "which", "community", "the", "bite", "occurred", "(if", "it", "was", "in", "Ceuta", "or", "Melilla", "the", "protocol", "may", "vary)." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 33731, "text": [ [ "QUESTION", "TYPE:", "GYNECOLOGY", "AND", "OBSTETRICS" ], [ "CLINICAL", "CASE:" ], [ "20-year-old", "woman", "with", "ovarian", "tumor", "of", "15", "cm,", "solid-cystic,", "detected", "by", "ultrasound", "after", "presenting", "with", "unspecific", "abdominal", "symptoms." ], [ "In", "the", "histopathological", "study", "of", "the", "corresponding", "specimen,", "teeth,", "hairs,", "areas", "of", "intestinal", "epithelium,", "areas", "of", "squamous", "epithelium", "(15%)", "and", "bronchial", "epithelium,", "as", "well", "as", "neuroectodermal", "and", "embryonic", "elements", "are", "found", "in", "several", "of", "the", "histological", "preparations." ], [ "In", "reference", "to", "this", "case,", "point", "out", "the", "correct", "diagnosis:" ], [ "1-", "Teratocarcinoma." ], [ "2-", "Immature", "teratoma." ], [ "3-", "Mature", "cystic", "teratoma." ], [ "4-", "Dysgerminoma." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "The", "answer", "is", "3,", "mature", "cystic", "teratoma." ], [ "This", "is", "due", "to", "the", "characteristics", "of", "the", "tumor:", "mature", "teratomas", "are", "constituted", "by", "adult", "tissues,", "coming", "from", "the", "three", "embryonic", "leaves,", "with", "a", "clear", "predominance", "of", "ectodermal", "elements", "(epidermis,", "pilosebaceous", "structures", "and", "neural", "tissue)." ], [ "Mature", "teratoma", "is", "a", "tumor", "of", "ovarian", "germ", "cells." ] ], "labels": [ [ "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 29617, "text": [ [ "QUESTION", "TYPE:", "INFECTIOUS", "DISEASES" ], [ "CLINICAL", "CASE:" ], [ "A", "47-year-old", "man,", "active", "smoker,", "with", "a", "history", "of", "drug", "abuse", "by", "parenteral", "route", "comes", "to", "the", "ED", "for", "a", "2-hour", "evolution", "of", "acute", "onset", "pleuritic", "left", "costal", "pain", "and", "progressive", "dyspnea", "until", "becoming", "resting." ], [ "In", "the", "previous", "2", "weeks", "he", "had", "presented", "febrile", "fever,", "general", "malaise", "and", "dry", "cough." ], [ "On", "examination,", "the", "patient", "is", "tachypneic", "at", "36", "rpm,", "with", "supraclavicular", "pull,", "oxygen", "saturation", "by", "pulse", "oximetry", "of", "81%,", "cyanosis,", "sweating,", "tachycardia", "at", "135", "beats", "per", "minute", "and", "BP", "of", "75/47", "mm", "Hg." ], [ "The", "trachea", "is", "deviated", "to", "the", "right", "side", "and", "auscultation", "shows", "complete", "absence", "of", "vesicular", "murmur", "in", "the", "left", "hemithorax." ], [ "HIV", "serology", "is", "positive", "and", "shows", "an", "ADC", "lymphocyte", "count", "of", "176", "cells/ml." ], [ "What", "is", "the", "most", "likely", "diagnosis?" ], [ "1-", "Subpleural", "emphysematous", "bulla", "rupture." ], [ "2-", "Community-acquired", "necrotizing", "bacterial", "pneumonia." ], [ "3-", "Pulmonary", "tuberculosis." ], [ "4-", "Pneumocystis", "jiroveci", "pneumonia." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "4" ], [ "Patient", "with", "risk", "factor", "for", "HIV", "acquisition,", "who", "comes", "to", "the", "emergency", "department", "for", "a", "subacute", "onset", "of", "2", "weeks", "of", "evolution", "(fever,", "malaise", "and", "dry", "cough)", "that", "worsens", "abruptly", "(pleuritic", "pain)", "and", "progressively", "(dyspnea)." ], [ "Physical", "examination", "suggests", "a", "pneumothorax", "(tachypnea,", "tugging,", "low", "saturation,", "cyanosis,", "diaphoresis,", "tachycardia,", "deviated", "trachea", "and", "absence", "of", "vesicular", "murmur)." ], [ "He", "has", "a", "positive", "HIV", "serology", "and", "a", "CD4", "less", "than", "200", "cells/mL." ], [ "The", "radiograph", "shows", "hyperclarity", "in", "the", "left", "lung", "field", "with", "absence", "of", "vessels", "between", "the", "lung", "border", "and", "the", "chest", "wall", "on", "the", "left", "side,", "displacement", "of", "the", "mediastinum", "and", "trachea", "to", "the", "right", "side,", "and", "a", "stump", "in", "the", "left", "pulmonary", "hilum", "corresponding", "to", "the", "collapsed", "lung." ], [ "The", "suspicion", "of", "HIV", "is", "high", "and", "although", "it", "is", "pending", "confirmation,", "in", "the", "emergency", "it", "is", "valid", "to", "assume", "this", "option." ], [ "That", "said,", "I", "am", "looking", "for", "pathologies", "that", "are", "associated", "with", "this", "picture,", "the", "rupture", "of", "a", "bulla", "although", "it", "is", "related", "to", "the", "appearance", "of", "abrupt", "symptoms", "does", "not", "go", "hand", "in", "hand", "with", "the", "other", "symptoms", "(you", "have", "to", "look", "for", "something", "that", "explains", "everything", "or", "almost", "everything),", "pneumonia", "although", "it", "is", "true", "that", "it", "can", "be", "related", "to", "many", "of", "the", "symptoms", "does", "not", "correlate", "with", "the", "image,", "Pulmonary", "TB", "could", "be", "manifested", "with", "all", "of", "the", "above", "and", "cause", "a", "pneumothorax,", "but", "here", "in", "a", "patient", "with", "a", "respiratory", "picture", "with", "more", "than", "7", "days", "of", "evolution", "that", "is", "complicated", "abruptly,", "in", "a", "patient", "with", "a", "high", "suspicion", "of", "HIV", "infection", "the", "clearest", "option", "goes", "for", "pneumonia", "due", "to", "P.", "jirovecii", "pneumonia." ], [ "In", "patients", "with", "Pneumocystis,", "10%,", "pneumatoceles", "appear", "which", "can", "sometimes", "open", "into", "the", "pleural", "space", "producing", "a", "spontaneous", "pneumothorax." ], [ "As", "a", "reminder,", "the", "most", "frequent", "germs", "in", "pulmonary", "involvement", "in", "patients", "with", "HIV/AIDS", "infection", "are", "P.", "jiroveci", "(alone", "or", "associated", "with", "tuberculosis", "or", "other", "mycobacteria),", "S.", "pneumoniae,", "H.", "influenzae,", "S.", "aureus,", "cytomegalovirus,", "Legionella,", "staphylococci", "and", "gram-negative", "bacilli", "(Pseudomonas)." ], [ "Patients", "with", "P.", "jirovecii", "pneumonia", "have,", "in", "90%", "of", "cases,", "a", "CD4", "count", "<", "250", "cells/mL." ], [ "Other", "agents", "that", "can", "cause", "pulmonary", "involvement", "less", "frequently", "are", "Rhodococcus", "equi,", "Nocardia,", "Aspergillus,", "Cryptococcus,", "Toxoplasma", "and", "Leishmania." ], [ "Although", "the", "frequency", "of", "the", "different", "opportunistic", "infections", "has", "varied", "as", "a", "consequence", "of", "the", "administration", "of", "highly", "effective", "antiretroviral", "treatments,", "our", "patient", "would", "be", "in", "a", "setting", "where", "he", "has", "not", "yet", "received", "HAART." ] ], "labels": [ [ "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "O", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ] ] }, { "id": 7687, "text": [ [ "QUESTION", "TYPE:", "ANESTHESIOLOGY,", "CRITICAL", "CARE", "AND", "EMERGENCIES" ], [ "CLINICAL", "CASE:" ], [ "76-year-old", "woman", "with", "obesity", "and", "type", "2", "diabetes", "mellitus", "on", "metformin." ], [ "She", "comes", "to", "the", "emergency", "room", "because", "for", "3", "days", "she", "presents", "fever", "of", "38\u00baC,", "polyuria,", "dysuria,", "intense", "thirst", "and", "progressive", "decrease", "in", "the", "level", "of", "consciousness." ], [ "Physical", "examination", "showed", "signs", "of", "dehydration,", "BP", "95/54", "mm", "Hg", "and", "no", "signs", "of", "neurological", "localization." ], [ "The", "CBC", "shows", "leukocytosis,", "creatinine", "of", "1.8", "mg/dL", "and", "blood", "glucose", "of", "855", "mg/dL." ], [ "What", "is", "the", "most", "likely", "diagnosis?" ], [ "1-", "Hyperglycemic", "hyperosmolar", "non-ketotic", "hyperglycemic", "coma." ], [ "2-", "Cardiac", "failure." ], [ "3-", "Subdural", "hematoma." ], [ "4-", "Obstructive", "renal", "failure." ], [ "5-", "Diabetic", "ketoacidosis", "with", "coma." ], [ "CORRECT", "ANSWER:", "1" ], [ "The", "question", "relates", "the", "case", "of", "a", "type", "2", "diabetic", "patient", "with", "hyperglycemia", "and", "decreased", "level", "of", "consciousness", "without", "neurological", "focality", "in", "the", "context", "of", "a", "urinary", "tract", "infection", "and", "who", "has", "developed", "acute", "renal", "failure", "of", "probable", "prerenal", "origin." ], [ "Option", "2", "is", "immediately", "ruled", "out", "because", "the", "clinical", "picture", "is", "not", "one", "of", "heart", "failure." ], [ "Option", "3", "is", "also", "discarded", "because", "it", "does", "not", "fit", "with", "the", "clinical", "picture", "and", "in", "addition", "HSD", "would", "give", "neurological", "symptoms", "with", "locality." ], [ "Option", "4", "is", "discarded", "because", "obstructive", "renal", "failure", "does", "not", "give", "polyuria,", "dysuria", "or", "the", "rest", "of", "the", "clinical", "picture." ], [ "Option", "5", "is", "less", "likely", "because", "diabetic", "ketoacidosis", "is", "more", "typical", "of", "type", "1", "DM." ], [ "Therefore", "the", "correct", "option", "is", "1." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 159111, "text": [ [ "QUESTION", "TYPE:", "UROLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "45-year-old", "male", "patient", "with", "a", "history", "of", "uric", "lithiasis", "with", "repeated", "expulsive", "nephritic", "colic", "for", "25", "years,", "comes", "to", "the", "ED", "referring", "palpitations", "and", "intense", "right", "lumbar", "pain", "since", "2", "hours", "before." ], [ "Urinalysis", "showed", "a", "pH", "of", "5.5", "and", "leukocyturia", "without", "proteinuria." ], [ "The", "ECG", "confirms", "a", "previously", "unknown", "atrial", "fibrillation." ], [ "Blood", "biochemistry", "shows", "a", "creatinine", "of", "0.9mg/dl,", "a", "calcium", "of", "11mg/dl", "and", "an", "LDH", "of", "950", "U/l." ], [ "What", "is", "the", "most", "useful", "diagnostic", "maneuver", "to", "perform?" ], [ "1-", "Simple", "abdominal", "X-ray." ], [ "2-", "IVU." ], [ "3-", "CT", "with", "contrast." ], [ "4-", "Abdominal", "echography." ], [ "5-", "Doppler", "echocardiography." ], [ "CORRECT", "ANSWER:", "3" ], [ "In", "this", "question", "I", "have", "more", "doubts", "as", "to", "which", "is", "the", "correct", "answer,", "since", "we", "must", "interpret", "which", "is", "the", "most", "useful", "test,", "with", "which", "we", "can", "obtain", "more", "performance." ], [ "However,", "this", "situation", "also", "depends", "on", "the", "radiology", "services", "of", "each", "center", "and", "their", "preferences." ], [ "I", "will", "focus", "on", "the", "urological", "part,", "leaving", "aside", "the", "rest", "of", "the", "symptomatology." ], [ "-", "Abdominal", "X-ray", "is", "the", "first", "imaging", "study", "to", "be", "performed", "because", "it", "is", "fast,", "simple", "and", "practically", "innocuous", "(except", "in", "children", "and", "pregnant", "women)." ], [ "90%", "of", "the", "stones", "are", "radiopaque", "and", "therefore", "visible,", "but", "the", "sensitivity", "of", "this", "test,", "used", "in", "isolation,", "decreases", "to", "45-59%." ], [ "It", "is", "a", "mandatory", "test", "in", "any", "suspicion", "of", "colic", "pain." ], [ "However,", "it", "has", "a", "lower", "yield", "than", "the", "others." ], [ "Although", "the", "urological", "history", "speaks", "of", "uric", "lithiasis", "(radiotransparent),", "with", "an", "acid", "pH", "that", "reaffirms", "the", "diagnosis", "of", "uric", "origin,", "we", "can", "never", "rule", "out", "calcium", "oxalate", "lithiasis", "that", "can", "appear", "synchronously." ], [ "-", "IVUS", "seems", "to", "me", "to", "be", "one", "of", "the", "best", "performing", "options." ], [ "It", "will", "give", "us", "diagnostic", "clarity", "of", "obstruction,", "its", "magnitude", "and", "its", "renal", "repercussions." ], [ "It", "has", "long", "been", "considered", "the", "examination", "of", "choice", "for", "the", "study", "of", "patients", "with", "renal", "lithiasis." ], [ "It", "is", "a", "test", "with", "high", "sensitivity", "and", "specificity", "(87-90%", "and", "94-100%,", "respectively),", "relatively", "innocuous,", "and", "available", "in", "all", "hospitals." ], [ "It", "informs", "us", "of", "the", "number,", "size,", "shape", "and", "location", "of", "the", "stone,", "as", "well", "as", "the", "functional", "status", "of", "the", "affected", "kidney." ], [ "-", "Contrast-enhanced", "CT", "seems", "to", "me", "to", "be", "the", "most", "efficient", "option." ], [ "It", "serves", "to", "discover", "lithiasis", "that", "other", "tests", "cannot", "find", "and", "gives", "us", "a", "global", "image", "of", "the", "rest", "of", "the", "structures." ], [ "Great", "performance", "but", "also", "more", "expensive,", "more", "time,", "more", "radiation." ], [ "It", "has", "been", "confirmed", "as", "a", "high", "sensitivity", "and", "specificity", "scan,", "surpassing", "previous", "tests", "(94-100%", "and", "92-100%,", "respectively,", "for", "the", "detection", "of", "ureteral", "calculi)", "and", "with", "its", "numerous", "advantages", "it", "has", "become", "the", "reference", "test", "and", "is", "expected", "to", "replace", "IVUS", "and", "ultrasound", "worldwide." ], [ "It", "performs", "a", "helical", "scan", "with", "5", "mm", "slices", "allowing", "the", "detection", "of", "stones", "up", "to", "2", "mm." ], [ "With", "the", "administration", "of", "contrast,", "it", "allows", "the", "evaluation", "of", "renal", "function." ], [ "-", "Ultrasound", "is", "a", "fast,", "cheap", "and", "innocuous", "test,", "but", "very", "radiologist-dependent." ], [ "It", "gives", "great", "renal", "information", "on", "obstructive", "repercussions,", "but", "less", "quality", "in", "terms", "of", "finding", "a", "lithiasis." ], [ "Ultrasonography", "only", "detects", "calculi", "larger", "than", "4", "mm,", "located", "in", "the", "pyelo-ureteral", "junction", "or", "the", "uretero-vesical", "junction,", "while", "the", "lumbar", "and", "pelvic", "ureter", "is", "not", "very", "accessible", "due", "to", "the", "interposition", "of", "the", "intestinal", "loops." ], [ "Therefore,", "ultrasound", "performed", "in", "isolation", "is", "not", "very", "sensitive", "(20-45%)", "for", "the", "detection", "of", "calculi,", "but", "associated", "with", "simple", "abdominal", "radiography", "increases", "its", "sensitivity", "and", "specificity." ], [ "-", "Doppler", "echocardiography", "has", "no", "use", "in", "urological", "diagnosis." ], [ "My", "answer", "would", "be", "CT", "with", "ev", "contrast", "and", "excretory", "phase", "(answer", "(c)),", "in", "terms", "of", "performance,", "sensitivity", "and", "specificity." ], [ "There", "are", "radiology", "services", "more", "skilled", "or", "predisposed", "to", "one", "or", "the", "other." ], [ "Without", "forgetting", "that", "abdominal", "X-ray", "should", "always", "be", "done", "in", "the", "suspicion", "of", "colic." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 52144, "text": [ [ "QUESTION", "TYPE:", "PSYCHIATRY" ], [ "CLINICAL", "CASE:" ], [ "A", "36-year-old", "patient", "from", "another", "culture", "who", "has", "been", "living", "in", "Spain", "for", "the", "last", "4", "years", "presents", "at", "a", "National", "Health", "Service", "office." ], [ "He", "reports", "presenting", "with", "anxious", "symptoms", "and", "depressive", "mood", "for", "the", "last", "10", "months." ], [ "This", "condition", "moderately", "interferes", "with", "her", "daily", "activities." ], [ "She", "has", "no", "previous", "psychiatric", "history." ], [ "This", "situation", "is", "the", "result", "of", "the", "death,", "in", "a", "car", "accident,", "of", "an", "older", "brother", "with", "whom", "he", "was", "very", "close." ], [ "Indicate", "which", "of", "the", "following", "diagnoses", "is", "appropriate:" ], [ "1-", "Major", "depression." ], [ "2-", "Bipolar", "II", "disorder." ], [ "3-", "Adjustment", "disorder." ], [ "4-", "Dysthymia." ], [ "5-", "Cyclothymia." ], [ "CORRECT", "ANSWER:", "3" ], [ "The", "relative", "mildness", "of", "the", "symptoms,", "which", "do", "not", "seriously", "interfere", "with", "daily", "activities,", "excludes", "in", "principle", "the", "diagnosis", "of", "major", "depression." ], [ "There", "is", "no", "evidence", "of", "hypomanic", "phases", "to", "justify", "a", "bipolar", "II", "disorder." ], [ "Dysthymia", "requires", "a", "duration", "of", "at", "least", "two", "years." ], [ "Cyclothymia", "is", "a", "very", "rare", "diagnosis", "nowadays", "(because,", "as", "Castilla", "del", "Pino", "said", "in", "an", "interview,", "what", "used", "to", "be", "cyclothymics", "are", "now", "called", "bipolar,", "contributing", "to", "one", "of", "the", "multiple", "psychiatric", "epidemics", "of", "our", "time),", "which", "consists", "of", "oscillations", "between", "the", "depressive", "pole", "and", "the", "manifest,", "mild." ], [ "But", "there", "are", "no", "data", "on", "such", "oscillations." ], [ "The", "correct", "answer", "is,", "in", "all", "probability,", "3." ], [ "The", "adaptive", "disorder", "appears", "within", "3", "months", "after", "the", "stressful", "event", "and", "does", "not", "last", "more", "than", "6", "months", "if", "the", "stressful", "event", "or", "its", "consequences", "have", "ceased", "(which", "is", "not", "the", "case", "because", "the", "brother", "of", "the", "imaginary", "patient", "is", "still", "dead)." ], [ "Mild", "anxious-depressive", "symptoms", "fit", "such", "a", "diagnosis." ], [ "One", "more", "example", "of", "how", "to", "conceptualize", "as", "illness", "what", "are", "facts", "(albeit", "painful)", "of", "life." ], [ "Surely", "the", "imaginary", "patient", "takes", "some", "antidepressant", "because", "maybe", "something", "helps", "(1)." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ] ] }, { "id": 29750, "text": [ [ "QUESTION", "TYPE:", "INFECTIOUS", "DISEASES" ], [ "CLINICAL", "CASE:" ], [ "A", "58-year-old", "man", "reported", "a", "weeks-long", "history", "of", "progressive,", "mildly", "painful", "skin", "lesions", "on", "his", "left", "arm." ], [ "It", "had", "started", "as", "an", "erythematous", "lesion", "on", "his", "left", "thumb." ], [ "He", "had", "visible", "reddish", "striae", "as", "connecting", "lines", "between", "the", "lesions." ], [ "The", "patient", "had", "no", "fever", "or", "other", "general", "symptoms." ], [ "He", "had", "been", "working", "in", "his", "garden", "but", "did", "not", "remember", "any", "injuries." ], [ "The", "etiologic", "diagnosis", "was", "made", "by", "culture", "of", "a", "skin", "biopsy." ], [ "What", "is", "the", "most", "likely", "causative", "agent", "of", "this", "process?" ], [ "1-", "Dermatophytosis", "by", "Microsporum", "gypseum." ], [ "2-", "Cutaneous", "infection", "by", "Staphylococcus", "aureus." ], [ "3-", "Sporotrichosis." ], [ "4-", "Cutaneous", "infection", "by", "Mycobacterium", "marinum." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "The", "patient", "carries", "out", "an", "activity", "in", "contact", "with", "soil", "and", "plants", "(which", "are", "not", "provided", "free", "of", "charge)." ], [ "The", "symptoms", "are", "chronic,", "which", "started", "distally", "(left", "thumb)", "and", "are", "affecting", "the", "ipsilateral", "arm", "(reddish", "striae)." ], [ "There", "were", "no", "systemic", "symptoms." ], [ "They", "also", "comment", "that", "the", "diagnosis", "was", "made", "on", "the", "basis", "of", "a", "skin", "biopsy." ], [ "Of", "the", "microorganisms", "discussed,", "Microsporum", "gypseum", "does", "not", "usually", "manifest", "dissemination", "of", "infection", "of", "a", "lymphangitic", "aspect,", "in", "general", "keratinophilic", "fungi", "(dermatophytes)", "do", "not", "have", "any", "ability", "to", "invade", "deep", "tissues,", "so", "we", "ruled", "out", "this", "option." ], [ "Staphylococcus", "aureus", "infection", "can", "affect", "superficial", "and", "deep", "tissue", "layers,", "they", "can", "spread", "following", "a", "lymphangitic", "path,", "but", "it", "is", "not", "usual", "such", "a", "long", "evolution,", "it", "is", "usually", "acute", "(days)", "and", "usually", "accompanied", "by", "systemic", "symptoms,", "so", "we", "discard", "this", "option." ], [ "Mycobacterium", "marinum", "(and", "not", "Mycobacterum", "marinum)", "is", "a", "non-tuberculous", "mycobacterium", "characterized", "by", "being", "environmental,", "opportunistic", "and", "photochromogenic." ], [ "It", "has", "a", "slow", "growth,", "from", "2", "to", "8", "weeks,", "at", "a", "temperature", "ranging", "from", "30", "to", "37", "\u00b0C." ], [ "It", "affects", "different", "species", "of", "fish", "in", "cold,", "warm,", "fresh", "or", "salt", "water,", "especially", "stagnant", "waters", "of", "fish", "tanks", "and", "pools", "without", "chlorine." ], [ "Infection", "in", "humans", "occurs", "by", "direct", "contact", "with", "fish", "or", "contaminated", "water", "in", "the", "presence", "of", "a", "loss", "of", "continuity", "in", "the", "skin", "of", "the", "host." ], [ "Our", "patient", "has", "no", "history", "of", "exposure", "to", "fish", "or", "water", "(they", "don't", "say),", "so", "considering", "that", "usually", "the", "diagnosis", "is", "based", "on", "a", "high", "index", "of", "suspicion", "and", "specifically", "asking", "for", "this", "history,", "our", "case", "is", "far", "from", "this", "possibility." ], [ "The", "Sporothrix", "schenckii", "complex", "is", "the", "causative", "agent", "of", "Sporotrichosis,", "this", "dimorphic", "fungus", "is", "located", "in", "the", "soil,", "the", "complex", "is", "formed", "by", "5", "species,", "S.", "schenckii", "sensu", "strictu,", "S.", "brasiliensis", "and", "S.", "globosa,", "capable", "of", "causing", "human", "and", "animal", "disease;", "the", "other", "two", "are", "S.", "mexicana", "and", "S.", "albicana", "not", "associated", "with", "any", "disease." ], [ "Patients", "are", "usually", "infected", "by", "exposure", "to", "soil", "by", "means", "of", "a", "sharp", "object", "(thorns,", "stems,", "animal", "claws,", "etc.)", "and", "have", "a", "slow", "evolution,", "affect", "deep", "tissues", "and", "their", "dissemination", "typically", "follows", "a", "pathway", "as", "described", "in", "the", "question." ] ], "labels": [ [ "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 7463, "text": [ [ "QUESTION", "TYPE:", "ANESTHESIOLOGY,", "CRITICAL", "CARE", "AND", "EMERGENCIES" ], [ "CLINICAL", "CASE:" ], [ "A", "67-year-old", "woman", "with", "a", "history", "of", "congestive", "heart", "failure", "(treated", "with", "ramipril", "and", "furosemide)", "and", "type", "2", "diabetes", "(treated", "with", "insulin)", "comes", "to", "the", "emergency", "room", "for", "dyspnea." ], [ "Blood", "gas", "analysis", "performed", "while", "breathing", "room", "air", "shows", "pH", "7.45,", "paO2", "56,", "PaCO2", "30", "mm", "Hg,", "HCO3", "26", "mm", "Hg." ], [ "What", "gasometric", "alteration", "does", "the", "patient", "present?" ], [ "1-", "Hypoxemic", "respiratory", "failure", "with", "compensated", "respiratory", "alkalosis." ], [ "2-", "Acute", "metabolic", "alkalosis", "with", "hypoxemic", "and", "hypocapnic", "respiratory", "failure." ], [ "3-", "Chronic", "normocapnic", "respiratory", "insufficiency,", "without", "alteration", "of", "acid-base", "balance." ], [ "4-", "Chronic", "hypoxemic", "respiratory", "failure", "with", "compensated", "metabolic", "acidosis." ], [ "5-", "Hypoxemic", "respiratory", "failure", "with", "compensated", "mixed", "alkalosis." ], [ "CORRECT", "ANSWER:", "1" ], [ "I", "found", "this", "question", "tricky." ], [ "The", "separate", "findings", "are:", "normal", "pH", "but", "with", "alkalosis", "tendency,", "acute", "respiratory", "failure,", "hypocapnia", "and", "normal", "bicarbonate." ], [ "The", "most", "appropriate", "answer", "seems", "to", "me", "to", "be", "1,", "since", "the", "patient", "does", "not", "present", "a", "metabolic", "alkalosis", "(bicarbonate", "would", "be", "higher),", "much", "less", "an", "acidosis", "(bicarbonate", "would", "be", "low)." ], [ "The", "alkalosis", "is", "not", "mixed", "either,", "but", "is", "mainly", "respiratory." ], [ "The", "patient", "is", "probably", "hyperventilating", "because", "of", "her", "respiratory", "failure,", "and", "the", "kidney", "which", "always", "compensates", "later", "is", "starting", "to", "retain", "HCO3", "to", "compensate", "and", "maintain", "pH." ], [ "Therefore", "I", "believe", "the", "correct", "answer", "is", "1." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "O", "O", "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 288227, "text": "", "labels": "" }, { "id": 460174, "text": [ [ "QUESTION", "TYPE:", "TRAUMATOLOGY", "AND", "ORTHOPEDICS" ], [ "CLINICAL", "CASE:" ], [ "A", "60-year-old,", "insulin-dependent", "diabetic", "woman", "presents", "with", "right-sided,", "nocturnal-predominant", "omalgia", "of", "several", "weeks'", "duration." ], [ "She", "does", "not", "report", "any", "trauma." ], [ "Physical", "examination", "shows", "active", "and", "passive", "limitation", "of", "all", "the", "arcs", "of", "movement", "of", "the", "shoulder." ], [ "Which", "clinical", "picture", "do", "you", "suspect", "as", "the", "first", "diagnostic", "possibility?" ], [ "1-", "A", "malignant", "tumor", "located", "in", "the", "proximal", "epiphysis", "of", "the", "humerus." ], [ "2-", "Septic", "arthritis", "of", "the", "shoulder." ], [ "3-", "Adhesive", "capsulitis." ], [ "4-", "A", "degenerative", "acromioclavicular", "arthrosis", "process." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "Everything", "points", "to", "adhesive", "capsulitis,", "as", "you", "say." ], [ "The", "age,", "the", "sex,", "the", "clinic...", "the", "DM...." ] ], "labels": [ [ "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 33390, "text": [ [ "QUESTION", "TYPE:", "ENDOCRINOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "35-year-old", "woman", "consults", "for", "a", "right", "thyroid", "nodule", "detected", "incidentally", "one", "morning", "when", "she", "observed", "in", "the", "mirror", "a", "lump", "on", "the", "anterior", "aspect", "of", "the", "neck." ], [ "After", "the", "pertinent", "studies,", "it", "was", "decided", "to", "operate", "on", "the", "patient,", "performing", "a", "total", "thyroidectomy", "with", "emptying", "of", "the", "central", "lymph", "node", "component." ], [ "The", "pathologist's", "report", "was", "that", "the", "2.3", "cm", "thyroid", "nodule", "was", "entirely", "occupied", "by", "a", "papillary", "thyroid", "carcinoma,", "tall", "cell", "variant,", "without", "vascular", "infiltration", "but", "with", "capsular", "infiltration." ], [ "Thyroglobulin", "concentrations", "24", "h", "after", "thyroidectomy", "are", "14", "ng/mL." ], [ "What", "would", "be", "the", "next", "step", "you", "would", "take", "in", "this", "patient?" ], [ "1-", "Refer", "patient", "back", "to", "surgeon", "for", "right", "laterocervical", "lymph", "node", "stripping." ], [ "2-", "Initiate", "treatment", "with", "a", "dose", "of", "TSH-suppressing", "levothyroxine", "and", "schedule", "for", "review", "6", "months", "later", "with", "a", "new", "analytical", "determination", "of", "thyroglobulin", "and", "cervical", "ultrasound." ], [ "3-", "Request", "a", "PET-CT", "scan", "for", "lymph", "node", "involvement." ], [ "4-", "Delay", "initiation", "of", "TSH", "replacement-suppressive", "treatment", "with", "levothyroxine", "and", "refer", "the", "patient", "to", "the", "Nuclear", "Medicine", "service", "for", "administration", "of", "an", "ablative", "dose", "of", "100", "mCi", "of", "I131." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "4" ], [ "The", "verification", "of", "the", "presence", "of", "thyroglobulin", "in", "blood", "and", "the", "development", "of", "techniques", "by", "which", "it", "can", "be", "determined", "have", "provided", "a", "new", "procedure", "for", "monitoring", "patients", "with", "papillary", "or", "follicular", "thyroid", "carcinoma." ], [ "Thyroglobulin", "is", "synthesized", "in", "the", "follicular", "cells", "and", "then", "secreted", "into", "the", "circulation,", "therefore,", "after", "total", "thyroidectomy", "it", "should", "disappear,", "if", "this", "does", "not", "occur", "we", "must", "think", "about", "the", "existence", "of", "remnants", "of", "metastatic", "tissue." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 18566, "text": [ [ "QUESTION", "TYPE:", "ENDOCRINOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "74-year-old", "patient", "with", "bowel", "resection", "following", "mesenteric", "thrombosis", "comes", "to", "consult", "for", "fatigue", "and", "bone", "pain." ], [ "He", "had", "suffered", "a", "Colles'", "fracture", "three", "months", "earlier." ], [ "Laboratory", "tests", "showed", "anemia", "of", "9.5", "g/dl,", "microcytic,", "albumin", "3.5", "g/di,", "calcium", "7.5", "mg/dl,", "phosphate", "2.0", "mg/dl", "and", "alkaline", "phosphatase", "224", "IU", "(normal", "up", "to", "120", "IU)." ], [ "Radiographs", "of", "the", "femur", "show", "radiolucent", "bands", "perpendicular", "to", "the", "cortex", "on", "the", "inner", "side", "of", "the", "upper", "femur." ], [ "What", "is", "the", "most", "likely", "diagnosis?" ], [ "1-", "Osteoporosis." ], [ "2-", "Paget's", "disease." ], [ "3-", "Osteitis", "fibrosa." ], [ "4-", "Prostate", "cancer", "metastasis." ], [ "5-", "Osteomalacia." ], [ "CORRECT", "ANSWER:", "5" ], [ "Although", "this", "one", "had", "not", "been", "assigned", "to", "me,", "I", "am", "answering", "it", "as", "well", "since", "it", "deals", "with", "an", "endocrinology", "topic:", "vitamin", "D." ], [ "In", "this", "case", "there", "are", "important", "data", "such", "as", "the", "history", "of", "intestinal", "resection,", "hypocalcemia", "and", "hypophosphoremoia;", "this", "should", "lead", "us", "to", "think", "in", "a", "vitamin", "D", "deficit", "due", "to", "malabsorption", "and", "therefore,", "in", "an", "osteomalacia." ], [ "The", "rest", "of", "the", "data:", "previous", "fracture,", "pain", "and", "the", "X-ray", "support", "the", "diagnosis." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 107206, "text": [ [ "QUESTION", "TYPE:", "GENETICS", "AND", "IMMUNOLOGY" ], [ "CLINICAL", "CASE:" ], [ "An", "8-year-old", "girl", "(index", "case)", "is", "clinically", "diagnosed", "as", "having", "neurofibromatosis", "type", "1", "(NF1)", "or", "Von", "Recklinghausen's", "disease", "with", "multiple", "neurofibromas,", "caf\u00e9-au-lait", "spots,", "and", "Lisch", "nodules." ], [ "Her", "father", "(not", "diagnosed", "with", "NF1)", "died", "in", "a", "traffic", "accident", "at", "the", "age", "of", "38", "years." ], [ "On", "examination,", "the", "mother", "presents", "two", "caf\u00e9-au-lait", "spots", "and", "attends", "the", "genetic", "counseling", "consultation", "with", "her", "new", "partner", "where", "a", "preimplantation", "genetic", "diagnosis", "(PGD)", "is", "proposed." ], [ "Is", "PGD", "indicated", "in", "this", "case?" ], [ "1-", "Yes,", "as", "the", "mother", "has", "2", "caf\u00e9-au-lait", "spots,", "she", "is", "a", "carrier", "and", "PGD", "is", "indicated", "with", "these", "data." ], [ "2-", "It", "is", "indicated", "after", "detection", "of", "the", "causative", "mutation", "in", "the", "index", "case", "and", "eventually", "in", "his", "mother." ], [ "3-", "It", "is", "not", "indicated", "because", "NF1", "responds", "to", "mutations", "in", "the", "neurofibromin", "gene", "(17q11.2),", "with", "recessive", "inheritance." ], [ "4-", "No,", "two", "caf\u00e9-au-lait", "spots", "are", "not", "diagnostic", "and", "your", "new", "partner", "is", "very", "unlikely", "to", "be", "a", "carrier", "(NF1", "is", "a", "rare", "disease)." ], [ "5-", "With", "these", "data,", "PGD", "is", "indicated,", "consisting", "of", "selecting", "embryos", "in", "vitro,", "to", "implant", "in", "the", "maternal", "uterus", "those", "without", "the", "mutation." ], [ "CORRECT", "ANSWER:", "2" ], [ "The", "first", "step", "is", "to", "detect", "the", "mutation", "and", "once", "detected,", "if", "the", "mother", "is", "a", "carrier,", "to", "proceed", "with", "PGD." ] ], "labels": [ [ "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "B-Diagnostics", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 11496, "text": [ [ "QUESTION", "TYPE:", "HEMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "43-year-old", "woman", "consults", "her", "primary", "care", "physician", "for", "fatigue,", "gingivorrhea", "and", "petechiae." ], [ "Laboratory", "tests", "showed", "anemia", "of", "8", "g/dL,", "thrombopenia", "of", "4000/microliter", "and", "leukopenia", "of", "1200/microliter", "with", "absolute", "neutropenia." ], [ "The", "coagulation", "study", "showed", "APTT", "elongation", "(43\u2033),", "decreased", "prothrombin", "activity", "(55%),", "hypofibrinogenemia", "(98", "mg/dl)", "and", "presence", "of", "high", "concentration", "of", "D-Dimer", "and", "fibrin", "monomers." ], [ "She", "is", "referred", "for", "urgent", "hematologic", "workup", "and", "a", "bone", "marrow", "aspirate", "is", "performed", "showing", "massive", "infiltration", "by", "immature", "elements", "with", "cleaved", "nuclei", "and", "Auer", "rods", "in", "the", "cytoplasm." ], [ "What", "is", "the", "most", "likely", "diagnosis", "in", "this", "patient?" ], [ "1-", "Chronic", "myeloid", "leukemia." ], [ "2-", "Acute", "promyelocytic", "leukemia." ], [ "3-", "Acute", "monoblastic", "leukemia." ], [ "4-", "Chronic", "lymphoid", "leukemia." ], [ "5-", "Acute", "lymphoid", "leukemia." ], [ "CORRECT", "ANSWER:", "2" ], [ "After", "reading", "such", "a", "long", "statement,", "running", "out", "of", "breath,", "going", "over", "it", "and", "getting", "overwhelmed,", "it", "is", "time", "to", "take", "a", "look", "at", "it", "and", "grasp", "at", "something", "very", "characteristic." ], [ "A", "woman", "with", "pancytopenia." ], [ "A", "bone", "marrow", "showing", "massive", "infiltration", "by", "immature", "elements", "that", "are", "proliferating", "non-stop...with", "Auer's", "canes?" ], [ "Acute", "promyelocytic", "leukemia." ], [ "Those", "rods", "are", "the", "fusion", "of", "primary", "granules", "of", "developing", "myelocytes." ], [ "Robin&Cotran", "say", "so", "on", "page", "696", "of", "their", "book", "\"General", "Pathology\"", "[1]." ], [ "It", "is", "also", "said", "by", "Carr", "and", "Rodak", "in", "their", "book", "\"Atlas", "of", "clinical", "hematology\"", "on", "page", "157", "[2]." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Disease", "I-Disease", "I-Disease" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Disease", "I-Disease", "I-Disease" ], [ "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ] ] }, { "id": 6192, "text": [ [ "QUESTION", "TYPE:", "ANESTHESIOLOGY", "AND", "CRITICAL", "CARE" ], [ "CLINICAL", "CASE:" ], [ "A", "30-year-old", "man", "suffers", "fall", "from", "a", "standing", "height", "of", "2", "meters." ], [ "On", "arrival", "at", "the", "ER,", "he", "is", "cyo,", "catheterized", "with", "clear", "urine." ], [ "He", "shows", "swelling", "of", "the", "left", "heel,", "as", "well", "as", "mild", "tingling", "in", "the", "anterior", "aspect", "of", "the", "right", "thigh", "and", "scrotum,", "and", "dysesthesia", "in", "both", "feet." ], [ "The", "patient", "says", "goodbye", "to", "the", "stretcher-bearer", "with", "a", "handshake,", "with", "a", "simultaneous", "pat", "on", "the", "shoulder." ], [ "Rotation", "of", "the", "MMII", "on", "the", "stretcher", "grasped", "by", "the", "ankles", "is", "painless", "and", "compression", "of", "the", "pelvis", "is", "asymptomatic." ], [ "Next:" ], [ "1-", "We", "will", "sit", "him", "on", "the", "stretcher", "to", "be", "able", "to", "explore", "the", "cervical", "spine." ], [ "2-", "We", "will", "refer", "to", "Rx", "to", "perform", "lower", "extremities", "study." ], [ "3-", "Palpate", "the", "abdomen", "and", "rotate", "it", "en", "bloc", "to", "palpate", "the", "thoracolumbar", "spine." ], [ "4-", "Place", "a", "cervical", "collar", "and", "refer", "to", "radiology", "for", "cervical", "spine", "and", "lower", "extremity", "imaging." ], [ "5-", "We", "will", "request", "an", "abdominal", "echo." ], [ "CORRECT", "ANSWER:", "3" ], [ "From", "the", "symptoms", "reported,", "tingling", "in", "the", "anterior", "thigh,", "scrotum", "and", "dysesthesia", "in", "the", "feet,", "there", "seems", "to", "be", "a", "vertebral", "involvement", "at", "L2-3", "and", "sacral", "roots,", "so", "the", "correct", "thing", "to", "do", "would", "be", "to", "perform", "a", "radiological", "examination", "without", "mobilizing", "the", "patient." ], [ "But", "it", "is", "necessary", "to", "mobilize", "him", "to", "explore", "him,", "obviously,", "en", "bloc." ], [ "The", "cervical", "spine", "seems", "to", "be", "undamaged", "because", "the", "patient", "mobilizes", "both", "arms", "adequately,", "without", "paresthesia." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ] ] }, { "id": 231180, "text": [ [ "QUESTION", "TYPE:", "PEDIATRICS" ], [ "CLINICAL", "CASE:" ], [ "A", "1-month-old", "infant", "comes", "to", "the", "hospital", "emergency", "department", "referred", "by", "his", "pediatrician", "for", "jaundice." ], [ "He", "reports", "jaundice", "for", "10", "days", "and", "it", "has", "been", "increasing." ], [ "The", "blood", "test", "showed", "a", "total", "bilirubin", "of", "7mg/dl", "with", "an", "indirect", "bilirubin", "of", "1.5mg/dl." ], [ "The", "most", "probable", "cause,", "among", "the", "following,", "of", "this", "jaundice", "is:" ], [ "1-", "Bile", "duct", "atresia." ], [ "2-", "Breastfeeding", "jaundice." ], [ "3-", "Late", "onset", "0-A", "isoimmunization." ], [ "4-", "Gilbert's", "disease." ], [ "5-", "Hereditary", "spherocytosis." ], [ "CORRECT", "ANSWER:", "1" ], [ "The", "increase", "in", "direct", "bilirubin", "immediately", "rules", "out", "the", "rest", "of", "the", "options", "where", "the", "increase", "in", "total", "bilirubin", "would", "be", "at", "the", "expense", "of", "indirect", "bilirubin." ], [ "Bile", "duct", "atresia", "is", "the", "main", "indication", "for", "infant", "liver", "transplantation." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 8754, "text": [ [ "QUESTION", "TYPE:", "CARDIOLOGY", "AND", "VASCULAR", "SURGERY" ], [ "CLINICAL", "CASE:" ], [ "An", "81-year-old", "patient", "consults", "for", "an", "episode", "of", "syncope." ], [ "He", "reports", "dyspnea", "on", "exertion", "for", "a", "year." ], [ "On", "cardiac", "auscultation", "there", "is", "a", "3/6", "systolic", "murmur", "on", "the", "left", "sternal", "border", "radiating", "to", "the", "carotids", "and", "tip." ], [ "Which", "pathology", "seems", "most", "likely?" ], [ "1-", "Third-degree", "atrioventricular", "block." ], [ "2-", "Degenerative", "aortic", "stenosis." ], [ "3-", "Mitral", "valve", "insufficiency." ], [ "4-", "Hypertrophic", "cardiomyopathy." ], [ "5-", "Dilated", "cardiomyopathy." ], [ "CORRECT", "ANSWER:", "2" ], [ "Very", "easy", "question." ], [ "They", "are", "describing", "the", "\"portrait\"", "of", "a", "degenerative", "aortic", "stenosis..." ], [ "Elderly", "patient", "with", "clinical", "dyspnea", "and", "syncope,", "and", "systolic", "murmur", "radiating", "to", "carotids", "and", "tip,", "all", "typical", "of", "this", "disease." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ] ] }, { "id": 10287, "text": "", "labels": "" }, { "id": 512153, "text": [ [ "QUESTION", "TYPE:", "DIGESTIVE" ], [ "CLINICAL", "CASE:" ], [ "Patient", "diagnosed", "with", "acute", "diverticulitis,", "treated", "with", "amoxicillin/clavulanic", "acid." ], [ "After", "5", "days", "he", "starts", "with", "fever", "and", "diarrhea." ], [ "He", "was", "diagnosed", "with", "Clostridium", "difficile", "colitis,", "amoxicillin/clavulanic", "acid", "was", "discontinued", "and", "metronidazole", "was", "prescribed." ], [ "After", "4", "days", "he", "has", "not", "responded", "to", "metronidazole,", "but", "is", "clinically", "stable." ], [ "The", "next", "step", "of", "treatment", "is:" ], [ "1-", "Change", "metronidazole", "for", "oral", "vancomycin", "(125", "mg,", "four", "times", "a", "day", "for", "10", "days)." ], [ "2-", "Change", "metronidazole", "to", "piperacillin/", "tazobactam", "(4", "g", "piperacillin/0.5", "g", "tazobactam", "every", "8", "hours)." ], [ "3-", "Indicate", "a", "subtotal", "colectomy." ], [ "4-", "Loop", "ileostomy", "with", "antegrade", "polyethylene", "glycol", "lavage." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "1" ], [ "The", "treatment", "of", "choice", "for", "Clostridioides", "difficile", "infection", "is", "vancomycin", "orally", "125mg/6h", "for", "10", "days." ], [ "Metronidazole", "has", "been", "relegated", "to", "situations", "where", "vancomycin", "is", "not", "available." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 218123, "text": "", "labels": "" }, { "id": 493107, "text": [ [ "QUESTION", "TYPE:", "HEMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "An", "18-year-old", "patient", "comes", "to", "the", "emergency", "department", "with", "epistaxis", "of", "several", "days'", "evolution,", "with", "no", "personal", "or", "family", "history", "of", "interest." ], [ "On", "examination", "he", "is", "afebrile,", "multiple", "ecchymoses", "are", "observed,", "no", "splenomegaly", "is", "palpable." ], [ "Laboratory", "tests:", "leukocytes", "7.2", "x103/\u03bcL,", "Hb", "12.3", "g/dL,", "platelets", "6.0", "x103/\u03bcL." ], [ "Thrombocytopenia", "is", "confirmed", "in", "the", "smear,", "where", "platelets", "of", "increased", "size", "are", "observed." ], [ "Coagulation", "and", "biochemistry", "studies", "are", "normal." ], [ "What", "do", "you", "consider", "the", "most", "probable", "diagnosis?" ], [ "1-", "Thrombotic", "thrombocytopenic", "purpura." ], [ "2-", "Disseminated", "intravascular", "coagulation." ], [ "3-", "Thrombocytopenia", "induced", "by", "infection." ], [ "4-", "Primary", "immune", "thrombocytopenia." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "4" ], [ "If", "they", "wanted", "us", "to", "answer", "that", "it", "is", "a", "TTP", "(answer", "1)", "they", "would", "probably", "associate", "anemia", "and", "in", "the", "smear", "they", "would", "surely", "tell", "us", "about", "schistocytes." ], [ "Not", "to", "say", "that", "the", "patient's", "symptoms", "would", "probably", "be", "much", "more", "than", "epistaxis." ], [ "The", "other", "two", "answers,", "you", "do", "not", "have", "to", "hesitate", "with", "them." ], [ "Nothing", "points", "to", "that." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 566149, "text": [ [ "QUESTION", "TYPE:", "NEPHROLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "67-year-old", "woman", "with", "chronic", "kidney", "disease", "secondary", "to", "diabetic", "nephropathy." ], [ "She", "currently", "has", "a", "creatinine", "of", "3.2", "mg/dL", "with", "estimated", "glomerular", "filtration", "rate", "(CKD-EPI)", "14", "ml/min." ], [ "Which", "of", "the", "following", "is", "true?" ], [ "1-", "He", "presents", "stage", "3", "chronic", "kidney", "disease", "and", "should", "initiate", "phosphorus", "chelators." ], [ "2-", "He", "has", "stage", "5", "chronic", "kidney", "disease", "and", "renal", "replacement", "therapy", "should", "be", "considered." ], [ "3-", "Good", "glycemic", "control", "can", "reverse", "renal", "failure." ], [ "4-", "It", "is", "unlikely", "to", "present", "proteinuria", "higher", "than", "500", "mg/24", "h." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "2" ], [ "A", "glomerular", "filtration", "rate", "of", "less", "than", "15", "ml/min", "is", "classified", "as", "stage", "5", "(G5),", "indicating", "that", "the", "renal", "disease", "is", "end-stage", "and", "the", "initiation", "of", "replacement", "therapy", "should", "be", "considered", "(option", "2", "true,", "option", "1", "false)." ], [ "In", "this", "situation,", "good", "glycemic", "control", "is", "not", "expected", "to", "reverse", "renal", "damage,", "although", "it", "may", "help", "to", "delay", "progression", "(false", "choice", "3)." ], [ "These", "patients", "usually", "present", "stage", "A3", "albuminuria", "(above", "300", "mg/24", "h),", "and", "may", "reach", "the", "nephrotic", "range", "(false", "choice", "4)." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 25489, "text": [ [ "QUESTION", "TYPE:", "DIGESTIVE", "TRACT" ], [ "CLINICAL", "CASE:" ], [ "A", "17-year-old", "boy,", "athletic", "and", "with", "no", "history", "of", "interest,", "comes", "to", "the", "doctor", "for", "occasional", "conjunctival", "jaundice." ], [ "He", "denies", "drug", "intake", "and", "abdominal", "pain." ], [ "Laboratory", "tests", "show", "normal", "ALT,", "AST,", "GGT", "and", "FA,", "with", "total", "bilirubin", "of", "3.2", "mg/dl", "and", "direct", "bilirubin", "of", "0.4", "mg/dl." ], [ "She", "has", "no", "anemia", "and", "the", "liver", "is", "ultrasonographically", "normal." ], [ "What", "is", "her", "diagnosis?" ], [ "1-", "Rotor", "syndrome." ], [ "2-", "Choledocholithiasis." ], [ "3-", "Dubin-Johnson", "syndrome." ], [ "4-", "Acute", "hepatitis." ], [ "5-", "Gilbert's", "syndrome." ], [ "CORRECT", "ANSWER:", "5" ], [ "An", "increase", "in", "indirect", "bilirubin", "less", "than", "5", "(intermittently,", "under", "stress)", "in", "a", "young", "healthy", "boy", "should", "make", "us", "think", "of", "Gilbert's", "syndrome." ], [ "In", "Rotor", "syndrome,", "Dubin-Johnson", "syndrome", "and", "choledocholithiasis", "there", "is", "an", "increase", "in", "direct", "bilirubin." ], [ "In", "the", "case", "of", "acute", "hepatitis", "there", "should", "be", "an", "elevation", "of", "transaminases." ] ], "labels": [ [ "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 597180, "text": [ [ "QUESTION", "TYPE:", "RHEUMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "26-year-old", "woman", "diagnosed", "with", "systemic", "lupus", "erythematosus,", "on", "treatment", "with", "hydroxychloroquine,", "who", "consults", "for", "a", "feeling", "of", "generalized", "weakness", "that", "has", "progressively", "set", "in", "over", "the", "last", "15", "days." ], [ "The", "physical", "examination", "reveals", "cutaneous", "pallor", "and", "the", "CBC", "shows", "Hb", "7.4", "g/dL,", "Hct", "31%,", "MCV", "108." ], [ "Which", "of", "the", "following", "determinations", "will", "be", "most", "useful", "in", "deciding", "the", "course", "of", "action?" ], [ "1-", "Haptoglobin." ], [ "2-", "Coombs", "test." ], [ "3-", "Vitamin", "B12." ], [ "4-", "Antinuclear", "antibodies." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "2" ], [ "In", "this", "question,", "we", "are", "presented", "with", "a", "patient", "with", "systemic", "lupus", "erythematosus", "presenting", "with", "autoimmune", "hemolytic", "anemia." ], [ "For", "this,", "the", "best", "option", "would", "be", "to", "request", "reticulocytes,", "however,", "as", "it", "is", "not", "among", "the", "options,", "we", "should", "request", "a", "Coombs'", "test,", "so", "the", "correct", "answer", "is", "2." ], [ "Although", "they", "want", "to", "confuse", "us", "with", "a", "MCV", "108,", "so", "that", "we", "think", "of", "a", "megaloblastic", "anemia,", "the", "MCV", "is", "not", "excessively", "high,", "the", "onset", "of", "anemia", "in", "our", "patient", "has", "been", "rapid", "and", "would", "not", "fit", "with", "SLE", "or", "the", "form", "of", "presentation." ], [ "Antinuclear", "antibodies", "are", "used", "for", "diagnosis,", "but", "not", "for", "monitoring", "SLE." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 571170, "text": [ [ "QUESTION", "TYPE:", "NEPHROLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "75-year-old", "woman", "on", "sertraline", "treatment", "who", "comes", "to", "the", "emergency", "department", "with", "confusional", "symptoms." ], [ "There", "is", "no", "evidence", "of", "edema", "and", "blood", "pressure", "is", "130/70." ], [ "The", "blood", "test", "shows", "Na", "126", "mEq/l", "and", "K", "4", "mEq/l,", "natriuria", "is", "45", "mEq/l", "and", "diuretic", "intake", "has", "been", "ruled", "out." ], [ "Which", "of", "the", "following", "is", "the", "most", "correct", "approach?" ], [ "1-", "It", "is", "Addison's", "disease", "and", "corticosteroids", "should", "be", "administered", "immediately." ], [ "2-", "Administer", "hypertonic", "saline", "to", "restore", "natremia", "as", "soon", "as", "possible." ], [ "3-", "Indicate", "water", "restriction", "and", "if", "natremia", "does", "not", "rise,", "switch", "to", "slow", "infusion", "of", "saline." ], [ "4-", "Request", "brain", "MRI,", "since", "it", "is", "probably", "diabetes", "insipidus." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "We", "are", "presented", "with", "a", "patient", "with", "moderate", "euvolemic", "hyponatremia,", "suggesting", "a", "syndrome", "of", "inadequate", "antidiuresis", "(SIAD)", "secondary", "to", "sertraline,", "although", "it", "would", "be", "necessary", "to", "have", "urinary", "osmolality", "to", "confirm", "this." ], [ "Primary", "adrenal", "insufficiency", "produces", "hypovolemic", "hyponatremia", "(incorrect", "option", "1)." ], [ "Diabetes", "insipidus", "is", "the", "opposite", "of", "this", "pathology,", "usually", "presenting", "with", "hypernatremia", "(option", "4", "incorrect)." ], [ "The", "question", "remains", "whether", "to", "treat", "aggressively", "with", "hypertonic", "saline,", "or", "to", "be", "more", "conservative", "by", "indicating", "hydric", "restriction." ], [ "With", "natremia", "above", "125", "mmol/l", "it", "is", "not", "indicated", "to", "treat", "with", "HSS", "unless", "the", "patient", "has", "severe", "neurological", "symptoms,", "which", "does", "not", "seem", "to", "be", "the", "case", "(they", "describe", "a", "confusional", "picture", "that", "would", "be", "a", "moderate", "hyponatremic", "encephalopathy),", "and", "it", "is", "not", "indicated", "to", "restore", "natremia", "as", "soon", "as", "possible", "(due", "to", "the", "risk", "of", "osmotic", "demyelination", "syndrome)." ], [ "Therefore,", "the", "correct", "answer", "would", "be", "3." ], [ "What", "I", "do", "not", "like", "about", "this", "answer", "is", "that", "the", "second", "part", "(\"if", "natraemia", "does", "not", "rise,", "switch", "to", "slow", "infusion", "of", "saline\")", "is", "incorrect,", "since", "in", "this", "case", "the", "use", "of", "furosemide,", "tolvaptan", "or", "urea", "should", "be", "considered,", "not", "saline", "(and", "it", "does", "not", "indicate", "tonicity", "either,", "since", "isotonic", "is", "not", "the", "same", "as", "hypertonic)." ], [ "In", "any", "case,", "I", "do", "not", "see", "it", "as", "very", "likely", "to", "be", "overridden." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 46691, "text": [ [ "QUESTION", "TYPE:", "ORTHOPEDIC", "SURGERY", "AND", "TRAUMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "An", "11-year-old,", "6-month-old,", "premenarchal", "girl", "with", "known", "idiopathic", "scoliosis." ], [ "The", "spine", "x-ray", "performed", "6", "months", "ago", "showed", "a", "left", "thoracolumbar", "curve", "of", "18\u00ba", "(Cobb", "angle)." ], [ "The", "current", "x-ray", "shows", "a", "Cobb", "angle", "of", "28\u00ba,", "with", "an", "iliac", "crest", "maturation", "(Risser's", "sign)", "of", "2." ], [ "At", "this", "stage", "of", "evolution,", "what", "is", "the", "most", "appropriate", "treatment", "to", "try", "to", "stop", "the", "progression", "of", "the", "curve?" ], [ "1-", "Swimming", "exercises." ], [ "2-", "Postural", "re-education", "exercises." ], [ "3-", "Corrective", "orthopedic", "brace." ], [ "4-", "Surgical", "intervention", "by", "spinal", "arthrodesis." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "In", "the", "juvenile", "and", "adolescent", "forms,", "treatment", "depends", "on", "the", "degree", "of", "deformity:", "-", "10", "-", "20\u00b0:", "serial", "observation." ], [ "-", "20-50\u00b0:", "thermoplastic", "corsets", "(Boston,", "Cheneau", "or", "Milwaukee,", "according", "to", "where", "the", "apex", "of", "the", "main", "curve", "is", "located)." ], [ "-", "40-50\u00b0:", "with", "Risser", "less", "than", "3,", "surgical", "arthrodesis", "would", "be", "indicated;", "with", "Risser", "greater", "than", "or", "equal", "to", "3,", "the", "remaining", "growth", "potential", "of", "the", "curve", "is", "low", "and", "observation", "may", "be", "considered", "in", "case", "it", "tends", "to", "progress", "in", "adulthood." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 17553, "text": [ [ "QUESTION", "TYPE:", "PULMONOLOGY" ], [ "CLINICAL", "CASE:" ], [ "71-year-old", "male,", "retired", "waiter,", "non-smoker,", "who", "consults", "for", "nocturnal", "snoring." ], [ "The", "patient", "has", "a", "body", "mass", "index", "of", "31.5", "kg/m2", "and", "reports", "mild", "postprandial", "daytime", "sleepiness", "(Epworth", "Sleepiness", "Scale", "of", "3)", "with", "no", "other", "relevant", "symptoms,", "signs", "or", "clinical", "history." ], [ "The", "apnea-hypopnea", "index", "obtained", "in", "the", "polysomnography", "was", "18." ], [ "With", "these", "data,", "what", "is", "the", "most", "appropriate", "measure", "to", "adopt", "in", "this", "patient?" ], [ "1-", "Hygienic-dietary", "measures", "and", "evolution", "control." ], [ "2-", "Uvulopalatopharyngoplasty." ], [ "3-", "Nasal", "CPAP", "(Continuous", "Positive", "Airway", "Pressure)." ], [ "4-", "Non-invasive", "mechanical", "ventilation." ], [ "5-", "Nocturnal", "oxygen", "therapy." ], [ "CORRECT", "ANSWER:", "1" ], [ "With", "an", "Apneas-Hypopnea", "Index", "of", "less", "than", "30,", "and", "in", "the", "absence", "of", "striking", "symptoms", "of", "OSAHS", "and", "in", "the", "absence", "of", "risk", "professions", "such", "as", "professional", "drivers,", "etc.,", "the", "correct", "thing", "to", "do", "is", "to", "control", "weight", "and", "the", "rest", "of", "the", "hygienic-dietary", "measures,", "with", "periodic", "follow-up." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 9135, "text": [ [ "QUESTION", "TYPE:", "GENERAL", "SURGERY" ], [ "CLINICAL", "CASE:" ], [ "A", "26-year-old", "woman", "presenting", "with", "fecal", "incontinence", "after", "a", "prolonged", "instrumental", "delivery." ], [ "An", "endoanal", "ultrasound", "was", "performed", "showing", "a", "section", "of", "the", "external", "anal", "sphincter", "of", "30\u00ba", "amplitude." ], [ "The", "electrophysiological", "study", "shows", "normal", "innervation." ], [ "What", "is", "the", "most", "indicated", "treatment?" ], [ "1-", "Medical", "treatment", "with", "hygienic", "and", "dietary", "norms." ], [ "2-", "Sphincter", "biofeedback." ], [ "3-", "Surgical", "sphincteroplasty." ], [ "4-", "Surgical", "repair", "of", "the", "pelvic", "floor." ], [ "5-", "Artificial", "anal", "sphincter." ], [ "CORRECT", "ANSWER:", "3" ], [ "The", "answer", "is", "surgical", "sphincteroplasty", "3." ], [ "1", "is", "not", "effective,", "2", "is", "not", "effective", "for", "an", "organic", "lesion", "with", "normal", "electromyography,", "4", "is", "not", "necessary", "since", "the", "lesion", "is", "only", "of", "the", "external", "sphincter,", "5", "is", "not", "indicated", "in", "a", "lesion", "that", "can", "be", "repaired", "with", "surgery", "with", "good", "results." ] ], "labels": [ [ "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 65218, "text": [ [ "QUESTION", "TYPE:", "PATHOLOGICAL", "ANATOMY" ], [ "CLINICAL", "CASE:" ], [ "A", "56-year-old", "man,", "diabetic", "and", "moderately", "overweight,", "presents", "a", "discrete", "hepatomegaly." ], [ "The", "patient", "indicates", "that", "he", "is", "not", "a", "regular", "drinker,", "only", "exceptionally", "does", "he", "drink", "some", "wine." ], [ "A", "liver", "biopsy", "shows", "accumulations", "of", "clear", "cytoplasmic", "vacuoles", "in", "50%", "of", "the", "hepatocytes." ], [ "Multiple", "inflammatory", "foci", "with", "neutrophils,", "Mallory's", "hyaline", "degeneration", "and", "fibrosis", "around", "the", "terminal", "hepatic", "venules." ], [ "Point", "out", "the", "correct", "answer", "in", "this", "case:" ], [ "1-", "Biopsy", "should", "be", "repeated", "to", "see", "if", "the", "changes", "are", "diffuse." ], [ "2-", "Diagnosis", "is", "hepatic", "glycogenosis", "associated", "with", "diabetes." ], [ "3-", "Histological", "changes", "are", "irreversible", "and", "will", "eventually", "lead", "to", "cirrhosis." ], [ "4-", "The", "injury", "is", "clearly", "caused", "by", "alcohol", "despite", "the", "patient's", "refusal." ], [ "5-", "It", "is", "important", "to", "reduce", "weight", "and", "adequately", "control", "diabetes", "to", "avoid", "the", "possible", "development", "of", "cirrhosis." ], [ "CORRECT", "ANSWER:", "5" ], [ "The", "changes", "described", "in", "the", "question", "statement", "correspond", "to", "an", "early", "precirrhotic", "situation." ], [ "Although", "alcohol", "is", "the", "most", "frequent", "toxicant", "that", "causes", "this", "condition,", "it", "is", "not", "the", "exclusive", "cause." ], [ "Diabetes", "mellitus", "causes", "similar", "hepatic", "alterations:", "fat", "accumulation", "in", "hepatocytes,", "centroacinar", "fibrosis,", "inflammatory", "infiltrate", "by", "polymorphonuclear", "neutrophils", "and", "hyaline", "degeneration", "of", "perinuclear", "mallory." ], [ "Taking", "this", "into", "consideration,", "we", "can", "rule", "out", "the", "second", "question", "(they", "are", "intracellular", "fat", "accumulations,", "not", "glycogen)", "and", "the", "fourth", "(if", "diabetes", "also", "produces", "this", "situation,", "there", "is", "no", "reason", "to", "mistrust", "the", "patient)." ], [ "Based", "on", "the", "primum", "non", "nocere", "and", "not", "having", "special", "relevance", "for", "the", "treatment", "if", "it", "is", "a", "focal", "or", "generalized", "disease,", "it", "is", "not", "necessary", "to", "repeat", "a", "liver", "biopsy", "that", "would", "not", "expand", "information,", "discarding", "the", "first", "question." ], [ "Fortunately", "for", "the", "hypothetical", "patient,", "in", "the", "initial", "phase", "these", "changes", "are", "reversible", "when", "the", "noxa", "disappears,", "so", "we", "are", "left", "with", "answer", "number", "5." ] ], "labels": [ [ "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 50160, "text": [ [ "QUESTION", "TYPE:", "PEDIATRICS" ], [ "CLINICAL", "CASE:" ], [ "A", "5-year-old", "girl,", "completely", "asymptomatic,", "who", "comes", "to", "the", "pediatrician", "for", "a", "regular", "check-up." ], [ "She", "consults", "because", "her", "mother", "was", "operated", "on", "for", "a", "thyroid", "tumor", "and", "a", "grandmother", "died", "10", "years", "ago", "from", "a", "pheochromocytoma." ], [ "The", "priority", "therapeutic", "attitude", "we", "will", "adopt", "will", "be:" ], [ "1-", "Exhaustive", "physical", "examination", "with", "blood", "pressure", "control", "to", "assess", "whether", "the", "child", "may", "have", "a", "familial", "disease." ], [ "2-", "Biochemical", "analysis", "with", "calcitonin.", "If", "it", "is", "normal,", "no", "further", "control", "is", "necessary", "at", "this", "age." ], [ "3-", "Annual", "monitoring", "of", "calcitonin", "levels", "with", "pentagastrin", "stimulation", "and,", "if", "elevated,", "indication", "of", "prophylactic", "thyroidectomy." ], [ "4-", "Genetic", "study", "of", "the", "RET", "c634", "proto-oncogene", "mutation,", "and", "if", "positive,", "prophylactic", "radical", "thyroidectomy", "will", "be", "performed", "at", "this", "age." ], [ "5-", "Genetic", "study", "of", "the", "RET", "c634", "proto-oncogene", "mutation,", "calcitonin", "levels", "and", "FNA", "(fine", "needle", "aspiration)", "and", "if", "positive,", "radical", "thyroidectomy", "will", "be", "performed." ], [ "CORRECT", "ANSWER:", "4" ], [ "The", "correct", "answer", "is", "4." ], [ "It", "seems", "to", "me", "to", "be", "more", "of", "an", "endocrine", "question", "than", "a", "pediatric", "question." ], [ "Proto-oncogene", "carriers", "usually", "have", "early", "thyroid", "tumors", "so", "radical", "thyroidectomy", "is", "usually", "recommended", "before", "the", "age", "of", "5", "years." ], [ "Obviously", "I", "had", "to", "look", "this", "up...it", "is", "not", "very", "common", "in", "our", "routine", "practice." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ] ] }, { "id": 326173, "text": [ [ "QUESTION", "TYPE:", "CRITICAL,", "PALLIATIVE", "AND", "EMERGENCY", "CARE" ], [ "CLINICAL", "CASE:" ], [ "A", "35-year-old", "man", "suffers", "a", "high-voltage", "electrical", "burn", "(3000", "volts)", "from", "direct", "contact", "with", "wire", "with", "his", "left", "hand." ], [ "On", "admission", "he", "presents", "flexion", "contracture", "of", "the", "hand,", "pallor", "of", "the", "fingers", "and", "absence", "of", "radial", "and", "ulnar", "pulse", "on", "palpation", "What", "is", "the", "emergency", "invasive", "measure", "to", "be", "performed?" ], [ "1-", "Axillary", "block", "with", "catheter." ], [ "2-", "Decompressive", "scarotomy." ], [ "3-", "Intracompartmental", "pressure", "monitoring." ], [ "4-", "Scarectomy." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "3." ], [ "In", "the", "case", "of", "suspected", "compartment", "syndrome,", "the", "urgent", "invasive", "measure", "to", "perform", "would", "be", "to", "measure", "the", "intracompartmental", "pressure", "and,", "depending", "on", "the", "result,", "proceed", "with", "treatment." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 354166, "text": [ [ "QUESTION", "TYPE:", "GYNECOLOGY", "AND", "OBSTETRICS" ], [ "CLINICAL", "CASE:" ], [ "A", "pregnant", "woman,", "10", "weeks", "pregnant,", "comes", "to", "the", "emergency", "room", "with", "a", "blood", "pressure", "of", "160/105", "mmHg." ], [ "She", "was", "in", "good", "general", "condition,", "with", "only", "mild", "headache,", "which", "was", "the", "reason", "for", "taking", "her", "blood", "pressure." ], [ "After", "4", "hours", "of", "rest", "she", "presented", "with", "a", "blood", "pressure", "of", "150/95mmHg." ], [ "A", "complete", "blood", "count", "is", "normal", "and", "proteinuria", "is", "negative." ], [ "What", "type", "of", "hypertension", "is", "present?" ], [ "1-", "Moderate", "preeclampsia." ], [ "2-", "Pregnancy-induced", "hypertension." ], [ "3-", "Chronic", "hypertension." ], [ "4-", "Eclampsia." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "Chronic", "hypertension", "is", "defined", "as", "hypertension", "that", "is", "present", "before", "pregnancy", "or", "that", "is", "diagnosed", "before", "the", "20th", "week", "of", "gestation." ], [ "In", "this", "case,", "the", "patient", "is", "10", "weeks", "pregnant,", "so", "the", "correct", "answer", "is", "3." ] ], "labels": [ [ "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 53158, "text": [ [ "QUESTION", "TYPE:", "ONCOLOGY" ], [ "CLINICAL", "CASE:" ], [ "Faced", "with", "a", "patient", "presenting", "with", "an", "ulcerovegetating", "lesion", "on", "the", "mandibular", "gingiva", "at", "the", "level", "of", "the", "molar", "region", "of", "5", "months", "of", "evolution,", "the", "appearance", "of", "hypoesthesia", "in", "the", "mentonian", "region", "requires", "ruling", "out:" ], [ "1-", "Paraneoplastic", "neuropathy." ], [ "2-", "Diagnosis", "of", "sarcoidosis", "with", "\"on", "the", "scale\"", "facial", "paralysis." ], [ "3-", "Herpes", "virus", "infection", "in", "immunosuppressed", "patient." ], [ "4-", "Diagnosis", "of", "carcinoma", "with", "infiltration", "of", "the", "mandibular", "canal." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "4" ], [ "Mentonian", "paresthesias", "(Roger's", "sign)", "are", "associated", "with", "bone", "metastases", "(it", "is", "not", "paraneoplastic", "but", "direct", "infiltration)." ], [ "In", "this", "case", "what", "you", "describe", "is", "an", "oral", "tumor", "growing", "locally", "and", "infiltrating", "the", "mandibular", "canal,", "I", "believe." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "O", "O", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "O", "B-Marker", "I-Marker" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 9331, "text": [ [ "QUESTION", "TYPE:", "DERMATOLOGY,", "VENEREOLOGY", "AND", "PLASTIC", "SURGERY" ], [ "CLINICAL", "CASE:" ], [ "A", "17-year-old", "boy", "with", "Crohn's", "disease", "with", "colonic", "involvement", "of", "2", "years", "of", "evolution,", "in", "maintenance", "treatment", "with", "azathioprine,", "consults", "for", "the", "appearance", "for", "5", "days", "of", "subcutaneous", "purplish", "red,", "hot,", "painful,", "bilateral,", "pretibial", "localization", "nodules,", "associated", "with", "an", "increase", "in", "the", "number", "of", "stools", "and", "abdominal", "pain." ], [ "The", "most", "appropriate", "approach", "in", "this", "case", "is:" ], [ "1-", "Recommend", "relative", "rest", "and", "warm", "cloths", "on", "both", "legs", "and", "add", "antidepressant", "treatment." ], [ "2-", "Biopsy", "skin", "areas", "away", "from", "the", "injured", "areas", "and", "prescribe", "entry", "opioid", "analgesics." ], [ "3-", "Suspect", "the", "existence", "of", "a", "malignant", "intestinal", "tumor", "lesion", "as", "a", "trigger", "of", "the", "cutaneous", "process." ], [ "4-", "Suspect", "bilateral", "lower", "extremity", "ischemia", "of", "drug", "origin." ], [ "5-", "Adjustment", "of", "bowel", "disease", "treatment." ], [ "CORRECT", "ANSWER:", "5" ], [ "2", "and", "4", "are", "discarded", "alone." ], [ "They", "are", "explaining", "erythema", "nodosum,", "so", "we", "would", "recommend", "relative", "rest", "(but", "antidepressants", "do", "not", "make", "any", "sense,", "so", "we", "also", "rule", "out", "(1))." ], [ "Although", "erythema", "nodosum", "can", "be", "secondary", "to", "a", "malignant", "process,", "it", "is", "more", "frequent", "that", "it", "is", "due", "to", "Crohn's", "disease", "itself", "(moreover,", "in", "a", "17-year-old", "boy", "it", "would", "be", "extremely", "rare),", "so", "if", "the", "picture", "is", "also", "accompanied", "by", "a", "flare-up", "of", "inflammatory", "bowel", "disease,", "the", "last", "option", "(5)", "seems", "the", "most", "correct." ] ], "labels": [ [ "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Marker", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Marker", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 390188, "text": [ [ "QUESTION", "TYPE:", "PSYCHIATRY" ], [ "CLINICAL", "CASE:" ], [ "An", "80-year-old", "man", "is", "brought", "to", "the", "ER", "by", "the", "police", "to", "find", "him", "at", "night,", "on", "the", "street,", "several", "blocks", "from", "his", "home,", "somewhat", "lost." ], [ "He", "tells", "the", "ER", "doctor", "\"I", "feel", "fine,", "I", "was", "walking", "and", "I", "got", "lost\"." ], [ "The", "examination,", "by", "systems,", "is", "anodyne." ], [ "When", "asked", "about", "his", "medication,", "he", "does", "not", "remember." ], [ "His", "history", "includes", "glipizide,", "atenolol", "and", "acenocoumarol." ], [ "She", "has", "been", "to", "the", "ER", "3", "times", "in", "the", "last", "three", "months", "for", "\"dizziness\",", "low", "back", "pain", "and", "an", "INR", "of", "5." ], [ "She", "reports", "independence", "in", "basic", "and", "instrumental", "activities", "of", "daily", "living." ], [ "There", "is", "no", "evidence", "of", "family", "or", "close", "friends." ], [ "Several", "references", "from", "the", "social", "work", "in", "the", "area", "indicate", "that", "she", "refuses", "medical", "or", "nursing", "aids", "or", "visits." ], [ "In", "the", "physical", "examination,", "only", "temperature", "of", "37.7,", "BMI", "of", "16,", "BP", "of", "160/90,", "HR", "of", "90", "and", "SO2", "of", "99%", "stand", "out." ], [ "He", "has", "global", "loss", "of", "muscle", "mass." ], [ "He", "is", "dressed", "in", "his", "robe", "and", "smells", "of", "urine." ], [ "He", "refuses", "to", "answer", "Minimental's", "questions." ], [ "Laboratory", "tests", "include", "13,000", "leukocytes,", "blood", "glucose", "300,", "glycosylated", "hemoglobin", "11%,", "INR", "0.9,", "urine", "over", "50", "leukocytes/field,", "nitrites+", "and", "urine", "culture", ">", "100,000", "Gram", "negative", "bacilli." ], [ "He", "is", "admitted", "to", "the", "hospital,", "receives", "antibiotics,", "insulin", "and", "restarts", "acenocoumarol", "with", "good", "evolution." ], [ "He", "is", "stable", "and", "wants", "to", "go", "home." ], [ "The", "ward", "nurse", "says", "he", "is", "unable", "to", "self-administer", "insulin." ], [ "Which", "of", "the", "following", "is", "the", "next", "step", "in", "determining", "the", "patient's", "safety", "at", "home?" ], [ "1-", "Refer", "to", "Primary", "Care", "and", "social", "work", "in", "the", "area", "to", "determine", "safety", "at", "home." ], [ "2-", "Formal", "evaluation", "of", "the", "capacity", "to", "make", "decisions", "concerning", "their", "health." ], [ "3-", "Evaluation", "to", "rule", "out", "dementia." ], [ "4-", "Evaluation", "to", "rule", "out", "depression." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "2" ], [ "Assessing", "capacity", "is", "not", "about", "taking", "away", "the", "patient's", "autonomy,", "but", "making", "sure", "that", "the", "patient", "understands", "and", "is", "aware", "of", "the", "consequences", "of", "his", "decisions." ], [ "In", "fact,", "it", "is", "a", "protective", "measure", "for", "the", "most", "fragile", "patients", "to", "ensure", "the", "best", "care." ], [ "This", "is", "not", "done", "by", "a", "psychiatrist,", "but", "by", "the", "attending", "physician." ], [ "There", "are", "several", "tests", "or", "semi-structured", "interviews", "to", "assess", "the", "capacity", "of", "patients,", "and", "all", "physicians", "should", "be", "familiar", "with", "these", "instruments." ], [ "It", "is", "important", "that", "it", "is", "the", "attending", "physician", "who", "performs", "this", "assessment,", "because", "he/she", "is", "the", "one", "who", "previously", "informs", "the", "patient", "(informed", "consent)", "of", "the", "therapeutic", "plan", "and", "is", "the", "one", "who", "is", "best", "able", "to", "assess", "whether", "the", "patient", "has", "understood", "everything:", "what", "the", "medical", "problem", "is,", "what", "treatment", "is", "proposed,", "the", "alternatives", "if", "any,", "whether", "to", "accept", "or", "reject", "any", "of", "them", "and", "why,", "the", "consequences", "of", "making", "these", "decisions", "(also", "those", "of", "not", "wanting", "treatment),", "even", "assessing", "psychopathology", "susceptible", "to", "an", "ICP", "to", "Psychiatry." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ] ] }, { "id": 577105, "text": [ [ "QUESTION", "TYPE:", "NEUROLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "45-year-old", "male", "brought", "to", "the", "consultation", "by", "his", "relatives", "for", "a", "one-year", "history", "of", "memory", "loss,", "which", "has", "progressed", "to", "the", "point", "of", "needing", "help", "with", "some", "activities", "of", "daily", "living." ], [ "He", "has", "a", "history", "of", "migraines", "and", "some", "episode", "of", "self-limited", "neurological", "focality", "for", "which", "he", "has", "never", "consulted." ], [ "The", "neuropsychological", "examination", "is", "compatible", "with", "an", "initial", "dementia", "and", "the", "brain", "MRI", "shows", "a", "severe", "leukoencephalopathy." ], [ "Which", "test", "should", "be", "ordered?" ], [ "1-", "Lumbar", "puncture", "to", "analyze", "amyloid", "and", "tau", "protein", "in", "CSF." ], [ "2-", "Genetic", "study", "for", "presenilin", "1", "(PSEN1)." ], [ "3-", "Genetic", "study", "for", "NOTCH3." ], [ "4-", "Genetic", "study", "for", "progranulin." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "3" ], [ "They", "describe", "a", "characteristic", "case", "of", "CADASIL", "(Cerebral", "Autosomal", "Dominant", "Arteriopathy", "with", "Sub-cortical", "Infarcts", "and", "Leukoencephalopathy)." ], [ "It", "is", "a", "genetic", "disease", "of", "autosomal", "dominant", "inheritance", "by", "mutation", "of", "the", "NOTCH3", "gene." ], [ "This", "mutation", "causes", "vascular", "involvement", "of", "small", "vessel", "that", "generates", "severe", "leukoencephalopathy", "early,", "which", "generates", "various", "symptoms." ], [ "Migraines,", "cerebrovascular", "disease", "and", "cognitive", "impairment", "at", "early", "ages", "stand", "out,", "as", "shown", "in", "the", "clinical", "case", "of", "the", "question." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 615118, "text": [ [ "QUESTION", "TYPE:", "TRAUMATOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "41-year-old", "male", "consults", "for", "gonalgia", "of", "several", "days'", "evolution." ], [ "During", "the", "examination,", "the", "Thessaly", "test", "is", "performed", "(pain", "with", "internal", "and", "external", "rotation", "movements", "with", "the", "knee", "flexed),", "which", "is", "positive." ], [ "Which", "of", "the", "following", "lesions", "is", "more", "probable?" ], [ "1-", "Meniscal", "injury." ], [ "2-", "Injury", "due", "to", "rupture", "of", "the", "anterior", "cruciate", "ligament." ], [ "3-", "Injury", "due", "to", "rupture", "of", "the", "posterior", "cruciate", "ligament." ], [ "4-", "Injury", "due", "to", "degenerative", "arthropathy." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "1" ], [ "Answer", "1", "correct:", "The", "Thessaly", "test", "is", "a", "meniscal", "exploration", "maneuver." ], [ "The", "statement", "focuses", "exclusively", "on", "this", "part", "of", "the", "examination", "and", "also", "explains", "that", "it", "is", "indeed", "positive,", "which", "leads", "to", "the", "suspicion", "of", "a", "meniscal", "lesion." ], [ "\"The", "Thessaly", "test", "is", "a", "dynamic", "reproduction", "of", "load", "transmission", "in", "the", "knee", "joint", "and", "is", "performed", "at", "5\u00b0", "and", "20\u00b0", "of", "flexion." ], [ "The", "examiner", "supports", "the", "patient", "by", "holding", "his", "or", "her", "outstretched", "hands", "while", "the", "patient", "stands", "flatfooted", "on", "the", "floor." ], [ "The", "patient", "then", "rotates", "his", "or", "her", "knee", "and", "body,", "internally", "and", "externally,", "three", "times,", "keeping", "the", "knee", "in", "slight", "flexion", "(5\u00b0)." ], [ "Then", "the", "same", "procedure", "is", "carried", "out", "with", "the", "knee", "flexed", "at", "20\u00b0." ], [ "Patients", "with", "suspected", "meniscal", "tears", "experience", "medial", "or", "lateral", "joint-line", "discomfort", "and", "may", "have", "a", "sense", "of", "locking", "or", "catching." ], [ "The", "theory", "behind", "the", "test", "is", "that,", "with", "this", "maneuver,", "the", "knee", "with", "a", "meniscal", "tear", "is", "subjected", "to", "excessive", "loading", "conditions", "and", "almost", "certainly", "will", "have", "the", "same", "symptoms", "that", "the", "patient", "reported." ], [ "The", "test", "is", "always", "performed", "first", "on", "the", "normal", "knee", "so", "that", "the", "patient", "may", "be", "trained,", "especially", "with", "regard", "to", "how", "to", "keep", "the", "knee", "in", "5\u00b0", "and", "then", "in", "20\u00b0", "of", "flexion", "and", "how", "to", "recognize,", "by", "comparison,", "a", "possible", "positive", "result", "in", "the", "symptomatic", "knee.\"", "Answer", "2", "incorrect:", "At", "no", "time", "do", "they", "describe", "any", "exploration", "maneuvers", "of", "the", "anterior", "cruciate", "ligament,", "nor", "do", "they", "mention", "any", "trauma", "that", "may", "have", "injured", "it." ], [ "Answer", "3", "incorrect:", "At", "no", "time", "do", "they", "describe", "any", "exploration", "maneuvers", "of", "the", "posterior", "cruciate", "ligament,", "nor", "do", "they", "mention", "any", "trauma", "that", "could", "have", "injured", "it." ], [ "Wrong", "answer", "4:", "Although", "it", "could", "occur,", "it", "is", "not", "to", "be", "expected", "in", "a", "41", "year", "old", "person", "with", "an", "acutely", "established", "clinical", "condition." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] }, { "id": 456200, "text": [ [ "QUESTION", "TYPE:", "OPHTHALMOLOGY" ], [ "CLINICAL", "CASE:" ], [ "A", "67-year-old", "man,", "diabetic", "and", "asthmatic,", "with", "primary", "open-angle", "glaucoma", "in", "both", "eyes." ], [ "He", "has", "an", "ocular", "pressure", "of", "34", "mmHg", "in", "his", "right", "eye", "and", "31", "mmHg", "in", "his", "left", "eye." ], [ "Which", "of", "the", "following", "pharmacological", "groups", "is", "the", "most", "indicated", "as", "first", "choice", "as", "hypotensive", "treatment?" ], [ "1-", "Carbonic", "anhydrase", "inhibitors." ], [ "2-", "Beta-blockers." ], [ "3-", "Alpha-2", "agonists." ], [ "4-", "Prostaglandin", "derivatives." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "4" ], [ "We", "are", "asked", "about", "the", "first", "choice", "treatment", "for", "glaucoma." ], [ "In", "the", "past,", "beta-blockers", "were", "the", "first", "choice,", "but", "nowadays", "they", "have", "been", "displaced", "by", "the", "group", "that", "lowers", "intraocular", "pressure", "the", "most:", "prostaglandins." ], [ "Their", "efficacy", "and", "more", "convenient", "dosage", "(once", "a", "day)", "generally", "make", "them", "the", "group", "of", "choice." ], [ "Beta-blockers", "would", "remain", "as", "a", "second", "choice", "in", "cases", "in", "which", "the", "side", "effects", "of", "prostaglandins", "(change", "in", "eye", "color,", "increase", "in", "eyelash", "size)", "make", "us", "initially", "leave", "them", "aside." ], [ "Since", "the", "patient", "is", "asthmatic,", "we", "should", "rule", "out", "beta-blockers", "(wrong", "answer", "2)." ], [ "Also,", "since", "we", "need", "a", "significant", "drop", "in", "intraocular", "pressure", "because", "the", "numbers", "are", "high", "(34", "and", "31),", "we", "can", "also", "rule", "out", "carbonic", "anhydrase", "inhibitors", "and", "alpha-2", "agonists", "(options", "1", "and", "3", "incorrect)." ], [ "And", "opt", "for", "the", "group", "that", "can", "lower", "intraocular", "pressure", "the", "most." ], [ "Answer", "4", "correct." ], [ "And", "then", "a", "couple", "of", "nuances", "of", "the", "statement." ], [ "It", "would", "be", "more", "correct", "to", "talk", "about", "intraocular", "pressure", "and", "not", "\"ocular", "pressure\"." ], [ "And", "the", "wording", "could", "be", "improved", "so", "as", "not", "to", "repeat", "the", "word", "\"as\"", "in", "the", "last", "sentence." ] ], "labels": [ [ "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ], [ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ] ] }, { "id": 484175, "text": [ [ "QUESTION", "TYPE:", "CRITICAL", "CARE" ], [ "CLINICAL", "CASE:" ], [ "An", "18-year-old", "man", "arrives", "at", "the", "hospital", "emergency", "department", "transported", "by", "a", "basic", "life", "support", "unit." ], [ "He", "has", "been", "hit", "by", "a", "car", "while", "riding", "a", "bicycle." ], [ "On", "arrival", "he", "has", "a", "heart", "rate", "of", "115", "bpm,", "a", "blood", "pressure", "of", "110/75", "mmHg,", "a", "palpable", "radial", "pulse,", "a", "capillary", "refill", "of", "2.5", "seconds", "and", "a", "respiratory", "rate", "of", "25", "rpm." ], [ "What", "do", "these", "data", "tell", "us:" ], [ "1-", "The", "patient", "has", "lost", "15", "to", "30%", "of", "blood", "volume", "and", "requires", "volume", "replacement." ], [ "2-", "She", "has", "lost", "more", "than", "30%", "of", "volemia", "and", "needs", "volume", "and", "blood", "replacement." ], [ "3-", "He", "has", "lost", "more", "than", "40%", "of", "blood", "volume", "and", "will", "require", "surgical", "treatment." ], [ "4-", "Has", "lost", "more", "than", "50%", "of", "volemia", "and", "requires", "volume", "and", "blood", "replacement." ], [ "5-", "nan" ], [ "CORRECT", "ANSWER:", "1" ], [ "Technically", "the", "patient", "is", "in", "a", "grade", "II", "hemorrhage", "according", "to", "the", "ATLS", "classification,", "in", "principle", "this", "means", "a", "loss", "of", "between", "750", "and", "1500mL", "of", "blood", "and", "the", "indicated", "action", "is", "resuscitation", "with", "crystalloids;", "however,", "in", "the", "guidelines", "for", "the", "care", "of", "severe", "polytraumatized", "patients,", "the", "early", "use", "of", "blood", "products", "is", "increasingly", "recommended,", "especially", "in", "borderline", "cases", "like", "this", "one,", "and", "in", "young", "patients,", "who", "may", "not", "be", "able", "to", "translate", "the", "severity", "of", "the", "blood", "loss", "until", "it", "becomes", "much", "more", "significant." ], [ "I", "would", "therefore", "hesitate", "between", "options", "1", "and", "2." ] ], "labels": [ [ "O", "O", "O", "O" ], [ "O", "O" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "B-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise", "I-Premise" ], [ "O", "O", "O", "O", "O", "O" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "O", "O" ], [ "O", "O", "O" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ], [ "B-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim", "I-Claim" ] ] } ]