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582_208

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '53-year-old', 'man', 'with', 'no', 'history', 'of', 'interest', 'who', 'after', 'a', 'bad', 'movement', 'in', 'the', 'gym', 'notices', 'low', 'back', 'pain', 'that', 'after', 'a', 'few', 'hours', 'radiates', 'to', 'the', 'back', 'of', 'the', 'right', 'leg', 'and', 'reaches', 'the', 'lateral', 'edge', 'of', 'the', 'foot.'], ['On', 'examination', 'he', 'presents', 'positive', 'Lasègue', 'maneuver', 'at', '40o,', 'abolished', 'hamstring', 'reflex', 'and', 'he', 'cannot', 'stand', 'on', 'tiptoe.'], ['The', 'most', 'probable', 'etiological', 'diagnosis', 'is:'], ['1-', 'Right', 'L2-L3', 'disc', 'herniation.'], ['2-', 'Right', 'L3-L4', 'disc', 'herniation.'], ['3-', 'Right', 'L4-L5', 'disc', 'herniation.'], ['4-', 'Right', 'L5-S1', 'disc', 'herniation.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['He', 'describes', 'S1', 'root', 'involvement', 'by', 'the', 'inability', 'to', 'tiptoe', 'and', 'the', 'absence', 'of', 'the', 'Achilles', 'reflex,', 'in', 'addition', 'to', 'the', 'distribution', 'of', 'pain', 'down', 'the', 'leg.'], ['Of', 'our', 'options,', 'the', 'cause', 'that', 'can', 'produce', 'damage', 'to', 'S1', 'is', 'L5-S1', 'disc', 'herniation.']]

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160_117

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'man', 'presenting', 'hematuria', 'after', 'respiratory', 'infections', 'for', 'several', 'years,', 'a', 'blood', 'test', 'shows', 'creatinine', '1', 'mg/dl', 'with', 'no', 'other', 'alterations', 'and', 'urine', 'hematocytes', '50/field', 'being', '80%', 'dysmorphic,', 'with', 'proteinuria', 'of', '0.8', 'grams', 'in', '24', 'hours.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Minimal', 'change', 'nephropathy.'], ['2-', 'Membranous', 'glomerulonephritis.'], ['3-', 'IgA', 'nephropathy.'], ['4-', 'Proliferative', 'and', 'diffuse', 'glomerulonephritis.'], ['5-', 'Focal', 'and', 'primary', 'segmental', 'glomerulosclerosis.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is:', '3.'], ['IgA', 'nephropathy.'], ['Given', 'that', 'the', 'clinical', 'presentation', 'of', 'this', 'nephropathy', 'appears', 'in', 'a', 'very', 'unspecific', 'way,', 'to', 'identify', 'the', 'responsible', 'disease', 'we', 'must', 'rely', 'on', 'its', 'epidemiology.'], ['Since', 'he', 'is', 'a', 'young', 'male,', 'with', 'a', 'history', 'of', 'previous', 'respiratory', 'infections,', 'a', 'relationship', 'between', 'these', 'infections', 'and', 'renal', 'pathology', 'is', 'established.'], ['Based', 'on', 'this', 'we', 'think', 'about', 'IgA', 'nephropathy,', 'which', 'besides', 'being', 'the', 'most', 'frequent', 'glomerulonephritis,', 'it', 'is', 'presented', 'in', 'most', 'of', 'the', 'cases', 'as', 'described.']]

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312_217

[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['An', '84-year-old', 'woman', 'presents', 'with', 'loss', 'of', 'vision', 'in', 'the', 'left', 'eye', 'of', '4', 'days', 'of', 'evolution', 'accompanied', 'by', 'metamorphopsia.'], ['The', 'macula', 'shows', 'abundant', 'hard', 'exudates,', 'two', 'small', 'deep', 'hemorrhages', 'and', 'a', 'localized', 'neurosensory', 'retinal', 'detachment.'], ['In', 'the', 'contralateral', 'eye', 'there', 'are', 'abundant', 'soft', 'drusen.'], ['Given', 'this', 'picture,', 'which', 'of', 'the', 'following', 'diagnoses', 'do', 'you', 'think', 'is', 'the', 'most', 'likely?'], ['1-', 'Acute', 'posterior', 'vitreous', 'detachment.'], ['2-', 'Exudative', 'age-related', 'macular', 'degeneration', '(AMD).'], ['3-', 'Central', 'retinal', 'artery', 'obstruction.'], ['4-', 'Non-arteritic', 'anterior', 'ischemic', 'optic', 'neuropathy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['In', 'principle,', 'this', 'is', 'an', 'easy', 'question,', 'as', 'it', 'deals', 'with', 'a', 'disease', 'that', 'is', 'frequently', 'repeated', 'in', 'the', 'MIR', 'exams.'], ['The', 'description', 'is', 'typical', 'of', 'option', '2.'], ['It', 'is', 'an', 'exudative', 'AMD', '(although', 'as', 'we', 'said', 'in', 'question', '215,', 'with', 'the', 'new', 'classification,', 'we', 'would', 'speak', 'of', 'an', 'advanced', 'AMD', 'in', 'its', 'neovascular', 'variant).'], ['In', 'any', 'case,', 'we', 'have', 'an', 'elderly', 'patient', 'with', 'vision', 'loss', 'and', 'metamorphopsia', 'in', 'one', 'eye.'], ['In', 'the', 'examination', 'there', 'are', 'lesions', 'in', 'the', 'macula.'], ['With', 'that', 'we', 'can', 'rule', 'out', 'acute', 'posterior', 'vitreous', 'detachment,', 'which', 'does', 'not', 'produce', 'visual', 'loss,', 'nor', 'metamorphopsia,', 'nor', 'lesions', 'in', 'the', 'macula.'], ['And', 'also', 'non-arteritic', 'anterior', 'ischemic', 'optic', 'neuropathy,', 'because', 'although', 'it', 'produces', 'visual', 'loss', 'and', 'is', 'typical', 'of', 'older', 'people,', 'it', 'does', 'not', 'produce', 'metamorphopsia.'], ['And', 'there', 'are', 'no', 'lesions', 'in', 'the', 'macula', 'but', 'papilla', 'edema.'], ['In', 'central', 'retinal', 'artery', 'obstruction,', 'metamorphopsia', 'is', 'not', 'particularly', 'characteristic', '(visual', 'loss', 'and', 'advanced', 'age', 'are),', 'but', 'the', 'lesions', 'in', 'the', 'fundus', 'of', 'the', 'eye', 'vary.'], ['In', 'the', 'case', 'of', 'arterial', 'occlusion,', 'there', 'is', 'intracellular', 'edema', 'that', 'is', 'seen', 'as', 'absence', 'of', 'hemorrhages', 'and', 'a', 'whitish,', 'pale', 'fundus.'], ['In', 'addition,', 'the', 'entire', 'retina', 'is', 'globally', 'affected,', 'and', 'a', 'cherry-red', 'spot', 'may', 'appear', 'in', 'the', 'macula.'], ['In', 'this', 'case', 'the', 'lesions', 'are', 'totally', 'different.'], ['They', 'describe', 'hard', 'exudates,', 'deep', 'hemorrhages', 'and', 'localized', 'neurosensory', 'retinal', 'detachment.'], ['All', 'this', 'in', 'the', 'macula.'], ['These', 'are', 'the', 'characteristic', 'findings', 'of', 'neovascular', '(or', 'exudative)', 'AMD.'], ['As', 'a', 'clue,', 'in', 'the', 'other', 'eye', 'there', 'are', 'abundant', 'soft', 'drusen.'], ['Drusen', 'are', 'the', 'typical', 'findings', 'of', 'AMD.'], ['So', 'he', 'has', 'AMD', 'in', 'both', 'eyes', 'and', 'in', 'the', 'right', 'eye', 'it', 'has', 'recently', 'become', 'complicated', 'by', 'the', 'appearance', 'of', 'neovascularization.']]

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24_115

[['QUESTION', 'TYPE:', 'INFECTIOUS'], ['CLINICAL', 'CASE:'], ['A', '68-year-old', 'man', 'is', 'evaluated', 'for', 'fever,', 'weight', 'loss', 'and', 'dyspnea', 'on', 'exertion.'], ['The', 'EP', 'reveals', 'a', 'new', 'aortic', 'diastolic', 'murmur', 'and', 'stigmata', 'of', 'peripheral', 'embolisms.'], ['Echocardiography', 'showed', 'a', '1', 'cm', 'vegetation', 'on', 'the', 'aortic', 'valve', 'and', 'two', 'blood', 'cultures', 'isolated', 'penicillin-sensitive', 'Streptococcus', 'bovis.'], ['After', 'starting', 'treatment', 'for', 'endocarditis,', 'which', 'of', 'the', 'following', 'examinations', 'could', 'help', 'us', 'in', 'the', 'diagnosis?'], ['1-', 'Glucose', 'tolerance', 'test.'], ['2-', 'Chest', 'X-ray.'], ['3-', 'Upper', 'gastrointestinal', 'endoscopy.'], ['4-', 'Colonoscopy.'], ['5-', 'Abdominal', 'ultrasound.'], ['CORRECT', 'ANSWER:', '4'], ['Another', 'gift', 'of', 'a', 'question,', 'the', 'association', 'of', 'S.bovis', 'endocarditis', 'and', 'colon', 'cancer.'], ['By', 'the', 'way,', 'it', 'is', 'funny', 'that', 'they', 'give', 'Chest', 'Rx', 'as', 'a', 'test', 'to', 'be', 'performed.....', 'are', 'you', 'telling', 'me', 'that', 'a', 'patient', 'with', 'fever', 'and', 'dyspnea', 'will', 'have', 'an', 'echocardiogram', 'before', 'a', 'simple', 'chest', 'x-ray?'], ['And', 'on', 'the', 'other', 'hand...', 'why', "don't", 'those', 'who', 'write', 'the', 'MIR', 'ask', 'shorter', 'questions', 'without', 'so', 'much', 'back', 'and', 'forth?'], ['If', 'what', 'they', 'want', 'is', 'to', 'ask', 'the', 'test', 'to', 'be', 'performed', 'on', 'a', 'patient', 'with', 'S.', 'bovis', 'endocarditis,', 'they', 'could', 'ask', 'the', 'question', 'directly', 'without', 'telling', 'us', 'about', 'the', "patient's", 'moles...']]

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260_99

[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman', 'comes', 'to', 'the', 'clinic', 'referred', 'from', 'surgery', 'with', 'the', 'diagnosis', 'of', 'a', 'neuroendocrine', 'tumor', 'diagnosed', 'after', 'partial', 'pancreatectomy', 'for', 'a', '2-cm', 'tumor', 'in', 'the', 'tail', 'of', 'the', 'pancreas.'], ['The', 'tumor', 'had', 'been', 'detected', 'by', 'chance', 'in', 'an', 'abdominal', 'CT', 'scan', 'requested', 'to', 'complete', 'the', 'study', 'of', 'a', 'simple', 'hepatic', 'cyst.'], ['On', 'questioning', 'the', 'patient,', 'the', 'history', 'of', 'irregular', 'menstruation,', 'amenorrhea', 'for', 'the', 'last', '6', 'months,', 'and', 'repeated', 'renal', 'colic', 'since', 'she', 'was', '20', 'years', 'old,', 'for', 'which', 'she', 'has', 'required', 'lithotripsy', 'on', 'several', 'occasions,', 'stand', 'out.'], ['She', 'also', 'has', 'a', 'family', 'history', 'of', 'renoureteral', 'colic.'], ['What', 'is', 'her', 'suspected', 'diagnosis?'], ['1-', 'Multiple', 'endocrine', 'neoplasia', 'type', '1', 'or', "Wermer's", 'syndrome.'], ['2-', 'Multiple', 'endocrine', 'neoplasia', 'type', '2', 'A', 'or', "Sipple's", 'syndrome.'], ['3-', 'Multiple', 'endocrine', 'neoplasia', 'type', '2B.'], ['4-', 'Somatostatinoma.'], ['5-', 'A', 'PTH-producing', 'neuroendocrine', 'tumor.'], ['CORRECT', 'ANSWER:', '1'], ['Very', 'nice', 'clinical', 'question', 'from', 'MEN.'], ['Pancreatic', 'neuroendocrine', 'tumor', '+', 'pituitary', 'adenoma', '(prolactinoma)', '+', 'hyperparathyroidism', '(renoureteral', 'colic', 'in', 'young', 'people):', 'MEN', '1.'], ['Medium', 'difficulty', 'because', 'you', 'have', 'to', 'know', 'the', 'MEN', 'triad', 'and', 'recognize', 'the', 'different', 'tumors.']]

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211_87

[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'woman', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'left', 'iliac', 'fossa', 'pain', 'of', '24', 'hours', 'of', 'evolution', 'associated', 'with', 'fever', 'and', 'occasional', 'vomiting.'], ['On', 'examination,', 'there', 'is', 'selective', 'pain', 'on', 'palpation', 'in', 'the', 'left', 'iliac', 'fossa', 'with', 'a', 'feeling', 'of', 'occupation,', 'defense', 'and', 'positive', 'decompression.'], ['When', 'acute', 'diverticulitis', 'is', 'suspected,', 'which', 'of', 'the', 'following', 'statements', 'is', 'correct?'], ['1-', 'The', 'safest', 'and', 'best', 'performing', 'complementary', 'examination', 'is', 'the', 'barium', 'contrast', 'enema.'], ['2-', 'In', 'case', 'of', 'contained', 'pelvic', 'abscess,', 'percutaneous', 'drainage', 'guided', 'by', 'CT', 'or', 'ultrasound', 'is', 'indicated.'], ['3-', 'If', 'surgical', 'intervention', 'is', 'required', 'after', 'resolution', 'of', 'the', 'acute', 'episode,', 'the', 'laparoscopic', 'approach', 'is', 'contraindicated.'], ['4-', 'In', 'case', 'of', 'acute', 'uncomplicated', 'diverticulitis,', 'elective', 'sigmoidectomy', 'is', 'indicated', 'after', 'cure', 'of', 'the', 'first', 'acute', 'episode.'], ['5-', 'If', 'generalized', 'peritonitis', 'occurs,', 'the', 'most', 'appropriate', 'surgical', 'technique', 'is', 'the', 'practice', 'of', 'a', 'derivative', 'colostomy', 'without', 'resection', 'of', 'the', 'affected', 'sigmoid', 'segment.'], ['CORRECT', 'ANSWER:', '2'], ['Answer', '1', 'is', 'incorrect', 'because', 'the', 'imaging', 'tests', 'of', 'choice', 'would', 'be', 'ultrasound', 'or', 'CT;', 'answer', '3', 'is', 'incorrect', 'because', 'the', 'laparoscopic', 'approach', 'is', 'indicated', 'from', 'the', 'start;', 'answer', '4', 'is', 'incorrect', 'because', 'the', 'indication', 'in', 'the', 'first', 'episode', 'is', 'for', 'those', 'under', '50', 'years', 'of', 'age,', 'in', 'the', 'rest', 'it', 'is', 'indicated', 'after', 'the', 'second', 'episode', 'or', 'in', 'cases', 'of', 'persistent', 'symptoms', 'or', 'suspected', 'neoplasia;', 'and', 'answer', '5', 'is', 'incorrect', 'because', 'surgery', 'in', 'cases', 'of', 'perforation', 'with', 'peritonitis', 'should', 'always', 'resect', 'the', 'affected', 'segment', 'of', 'colon', 'to', 'control', 'the', 'focus', 'of', 'the', 'infection.']]

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162_121

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'patient', 'with', 'stage', 'V', 'chronic', 'kidney', 'disease,', 'secondary', 'to', 'autosomal', 'dominant', 'polycystic', 'kidney', 'disease,', 'receives', 'a', 'cadaver', 'donor', 'kidney', 'graft.'], ['A', '34-year-old', 'brother', 'of', 'his', 'comes', 'to', 'visit', 'him', 'and', 'says', 'he', 'does', 'not', 'know', 'if', 'he', 'has', 'the', 'disease', 'because', 'he', 'has', 'never', 'seen', 'a', 'doctor', 'since', 'he', 'was', 'a', 'teenager.'], ['What', 'attitude', 'or', 'test', 'do', 'you', 'think', 'is', 'the', 'most', 'appropriate', 'to', 'recommend', 'at', 'that', 'moment?'], ['1-', 'Genetic', 'mutational', 'and', 'linkage', 'study.'], ['2-', 'Abdomino-pelvic', 'ultrasound.'], ['3-', 'Helical', 'computed', 'axial', 'tomography', 'with', 'iodinated', 'contrast.'], ['4-', 'Abdominal', 'and', 'cerebral', 'MRI.'], ['5-', 'Periodic', 'clinical', 'controls.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'is:', '2.'], ['Abdomino-pelvic', 'ultrasound.'], ['Abdomino-pelvic', 'ultrasound', 'is', 'undoubtedly', 'the', 'most', 'specific', 'and', 'sensitive', 'test', 'for', 'the', 'diagnosis', 'of', 'polycystic', 'kidney', 'disease', 'and,', 'above', 'all,', 'the', 'cheapest', 'to', 'demonstrate', 'whether', 'or', 'not', 'the', "patient's", 'sibling', 'has', 'inherited', 'polycystic', 'kidney', 'disease.']]

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207_181

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '43-year-old', 'woman', 'referred', 'to', 'the', "Hospital's", 'Lower', 'Genital', 'Tract', 'Pathology', 'Clinic', 'for', 'presenting', 'with', 'a', 'cervico-vaginal', 'cytology', 'reported', 'as', '"L-SIL"', '(Low', 'Grade', 'Intraepithelial', 'Lesion).'], ['She', 'refers', 'repeated', 'vaginal', 'infections', '(Trichomoniasis,...)', 'and', 'having', 'had', 'more', 'than', '5', 'sexual', 'partners', 'in', 'her', 'life.'], ['The', 'best', 'care', 'strategy', 'for', 'this', 'woman', 'is:'], ['1-', 'Conization', 'with', 'diathermy', 'loop.'], ['2-', 'Endocervical', 'curettage', 'with', 'Kevorkian', 'curettage.'], ['3-', 'Endometrial', 'biopsy', 'with', 'Cornier', 'cannula.'], ['4-', 'Hysterectomy', 'without', 'adnexectomy.'], ['5-', 'Advise', 'her', 'to', 'stop', 'smoking', 'and', 'contraceptives', 'and', 'to', 'have', 'a', 'control', 'in', '6', 'months.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'best', 'answer', 'to', 'this', 'question', 'is', 'number', '5.'], ['Most', 'of', 'the', 'lesions', 'identified', 'as', 'L-SIL', 'are', 'associated', 'with', 'HPV', 'infection:', 'for', 'this', 'reason,', 'it', 'is', 'advisable', 'to', 'stop', 'smoking,', 'as', 'this', 'is', 'a', 'factor', 'in', 'the', 'progression', 'of', 'the', 'said', 'infection.'], ['On', 'the', 'other', 'hand,', 'according', 'to', 'the', 'latest', 'studies,', '70%', 'of', 'the', 'cytologies', 'reported', 'as', 'LSIL', 'will', 'remit,', '15%', 'will', 'persist', 'and', 'another', '15%', 'will', 'show', 'a', 'more', 'severe', 'cytology,', 'without', 'being', 'able', 'to', 'differentiate', 'whether', 'it', 'is', 'a', 'biological', 'progression', 'or', 'a', 'lesion', 'hidden', 'in', 'the', 'initial', 'cytology.'], ['Because', 'of', 'this,', 'it', 'is', 'best', 'to', 'return', 'for', 'a', 'follow-up', 'at', '6', 'months.'], ['Given', 'the', "woman's", 'personal', 'history', '(more', 'than', '5', 'sexual', 'partners', 'and', 'repeat', 'infections)', 'and', 'her', 'age,', 'a', 'referral', 'for', 'colposcopy', 'would', 'be', 'ideal.'], ['However,', 'answer', '5', 'says', 'control', 'in', '6', 'months,', 'but', 'does', 'not', 'specify', 'which', 'control', '(it', 'could', 'be', 'a', 'colposcopy', 'or', 'cytology).']]

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584_73

[['QUESTION', 'TYPE:', 'OBSTETRICS', 'AND', 'GYNECOLOGY'], ['CLINICAL', 'CASE:'], ['A', '51-year-old', 'woman,', 'menopausal', 'for', 'a', 'year', 'and', 'a', 'half,', 'who', 'consults', 'for', 'vaginal', 'spotting', 'of', '2', "weeks'", 'evolution.'], ['She', 'reports', 'that', 'the', 'spotting', 'is', 'less', 'than', 'a', 'menstrual', 'period.'], ['The', 'ultrasound', 'shows', 'a', '7', 'mm', 'endometrium.'], ['Mark', 'the', 'correct', 'option:'], ['1-', 'The', 'endometrium', 'is', 'thickened', 'and', 'in', 'view', 'of', 'the', "patient's", 'symptoms,', 'an', 'endometrial', 'biopsy', 'is', 'taken', 'with', 'a', 'Cornier', 'cannula.'], ['2-', 'The', 'endometrium', 'is', 'not', 'thickened', 'so', 'she', 'is', 'prescribed', 'tranexamic', 'acid', 'and', 'ambulatory', 'follow-up.'], ['3-', 'Indications', 'for', 'diagnostic', 'hysteroscopy', 'without', 'the', 'need', 'for', 'endometrial', 'biopsy.'], ['4-', 'The', 'endometrium', 'is', 'not', 'thickened,', 'but', 'since', 'she', 'has', 'clinical', 'signs', 'of', 'metrorrhagia,', 'an', 'endometrial', 'biopsy', 'is', 'indicated.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'endometrium', 'is', 'thickened', 'for', 'a', 'menopausal', 'woman', '(some', 'guidelines', 'put', 'the', 'limit', 'at', '5', 'and', 'others', 'at', '3mm).'], ['And', 'the', 'first', 'complementary', 'test', 'to', 'perform', 'would', 'be', 'an', 'endometrial', 'biopsy.'], ['If', 'this', 'is', 'not', 'decisive,', 'hysteroscopy', 'will', 'be', 'considered', 'as', 'a', 'second', 'option.']]

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138_165

[['QUESTION', 'TYPE:', 'OTORHINOLARYNGOLOGY', 'AND', 'MAXILLOFACIAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', 'child', 'who', 'comes', 'to', 'the', 'outpatient', 'clinic', 'because', 'he', 'brings', 'his', 'hand', 'to', 'his', 'ear,', 'without', 'fever', 'or', 'acute', 'inflammatory', 'signs', 'and', 'who', 'on', 'examination', 'shows', 'a', 'pinkish/amber', 'eardrum.'], ['As', 'history', 'he', 'refers', 'that', 'one', 'month', 'ago', 'he', 'presented', 'an', 'episode', 'of', 'otalgia,', 'fever', 'accompanied', 'by', 'irritability', 'and', 'that', 'he', 'was', 'treated', 'with', 'amoxicillin', '40', 'mg/kg/day.'], ['What', 'is', 'the', 'most', 'probable', 'diagnosis?'], ['1-', 'Recurrent', 'acute', 'otitis', 'media.'], ['2-', 'Serous', 'otitis', 'media.'], ['3-', 'Simple', 'chronic', 'otitis', 'media.'], ['4-', 'Chronic', 'cholesteatomatous', 'otitis', 'media.'], ['5-', 'Mastoiditis.'], ['CORRECT', 'ANSWER:', '2'], ['Reading', 'the', 'case,', 'we', 'are', 'discarding', 'options:', 'child', 'with', 'otalgia,', 'but', 'without', 'fever', 'or', 'acute', 'inflammatory', 'signs:', 'it', 'is', 'neither', '1', '(recurrent', 'acute', 'otitis', 'media)', 'nor', '5', '(mastoiditis).'], ['On', 'otoscopy,', 'a', 'pinkish', 'and', 'amber', 'eardrum', 'is', 'observed:', 'there', 'are', 'no', 'scales,', 'so', 'it', 'is', 'not', '4', '(cholesteatomatous', 'chronic', 'otitis', 'media);', 'nor', 'perforations', 'or', 'adhesions,', 'so', 'it', 'is', 'not', '3', '(simple', 'chronic', 'otitis', 'media).'], ['Otoscopy', 'is', 'characteristic', 'of', 'serous', 'otitis', 'media', '(answer', '2', 'correct).'], ['It', 'is', 'known', 'by', 'ENT,', 'pediatricians', 'and', 'family', 'physicians', 'that', 'in', 'the', 'month', 'following', 'an', 'acute', 'otitis', 'media,', 'the', 'middle', 'ear', 'is', 'occupied', 'by', 'a', 'mucous', 'content', 'whose', 'evolution', 'should', 'be', 'monitored.'], ['I', 'do', 'not', 'think', 'that', 'this', 'is', 'a', 'contestable', 'issue', 'either.']]

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136_132

[['QUESTION', 'TYPE:', 'ONCOLOGY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'man', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'a', 'coma', 'crisis.'], ['Ex-smoker', 'for', '3', 'years,', 'with', 'no', 'other', 'history', 'of', 'interest.'], ['A', 'CT', 'scan', 'shows', 'multiple', 'metastases.'], ['What', 'is', 'the', 'most', 'probable', 'origin?'], ['1-', 'Head', 'and', 'neck', 'cancer.'], ['2-', 'Lung', 'cancer.'], ['3-', 'Urinary', 'bladder', 'cancer.'], ['4-', 'Colon', 'cancer.'], ['5-', 'Pancreatic', 'cancer.'], ['CORRECT', 'ANSWER:', '2'], ['Pretty', 'easy,', "isn't", 'it?'], ['Lung', 'cancer', 'is', 'the', 'most', 'frequent', 'cause', 'of', 'brain', 'metastases', 'and', 'in', '20-30%', 'of', 'cases', 'it', 'is', 'as', 'a', 'result', 'of', 'them', 'that', 'the', 'primary', 'tumor', 'is', 'diagnosed', '(as', 'here).']]

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518_105

[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'woman', 'with', 'a', 'history', 'of', 'migraine,', 'on', 'propranolol', 'and', 'oral', 'contraceptives,', 'presents', 'with', 'severe', 'dyspnea,', 'hoarseness,', 'rash,', 'nausea', 'and', 'vomiting', '30', 'minutes', 'after', 'taking', 'metamizole.'], ['His', 'blood', 'pressure', 'is', '90/40', 'mmHg', 'and', 'SatO2', 'is', '90%.'], ['The', 'most', 'correct', 'initial', 'treatment', 'would', 'be', 'to', 'administer:'], ['1-', 'Adrenaline.'], ['2-', 'Adrenaline', 'and', 'dexchlorpheniramine.'], ['3-', 'Adrenaline,', 'dexchlorpheniramine', 'and', 'methylprednisolone.'], ['4-', 'Adrenaline,', 'dexchlorpheniramine', 'and', 'glucagon.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['We', 'are', 'faced', 'with', 'an', 'anaphylactic', 'reaction', 'to', 'metamizole,', 'in', 'which', 'it', 'is', 'necessary', 'to', 'act', 'quickly', 'or', 'the', 'patient', 'could', 'progress', 'to', 'cardiac', 'arrest.'], ['It', 'is', 'important', 'to', 'assess', 'the', 'severity', 'of', 'the', 'allergic', 'reactions,', 'since,', 'in', 'this', 'case,', 'early', 'treatment', 'is', 'essential', 'to', 'prevent', 'high', 'mortality', 'if', 'not', 'applied.'], ['The', 'treatment', 'of', 'choice', 'is', 'IM', 'adrenaline', '(only', 'switch', 'to', 'IV', 'if', 'anaphylaxis', 'is', 'refractory),', 'which', 'has', 'been', 'shown', 'to', 'increase', 'survival,', 'and', 'administration', 'can', 'be', 'repeated', 'every', '5-15', 'minutes', 'if', 'symptoms', 'do', 'not', 'subside.'], ['As', 'adjuvant', 'treatment,', 'dexchlorpheniramine', 'could', 'be', 'administered.'], ['In', 'this', 'particular', 'case,', 'since', 'the', 'patient', 'was', 'previously', 'treated', 'with', 'propranolol,', 'this', 'indicates', 'that', 'the', 'correct', 'answer', 'is', '4,', 'which', 'includes', 'the', 'administration', 'of', 'glucagon,', 'which', 'is', 'administered', 'because', 'patients', 'taking', 'beta-blockers', 'can', 'be', 'resistant', 'to', 'treatment', 'with', 'adrenaline', 'and', 'develop', 'refractory', 'hypotension', 'and', 'prolonged', 'bradycardia.'], ['The', 'dose', 'in', 'adults', 'is', '1', 'to', '2mg,', 'IV', 'or', 'IM,', 'which', 'can', 'be', 'repeated', 'in', '5', 'minutes', 'or', 'followed', 'by', 'an', 'infusion', 'at', '5-15mcg/min.']]

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581_205

543_39

[['QUESTION', 'TYPE:', 'ALLERGOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'patient', 'consults', 'to', 'confirm', 'a', 'suspected', 'allergy', 'to', 'Anisakis', 'simplex.'], ['She', 'has', 'previously', 'suffered', 'a', 'clinical', 'picture', 'of', 'gastrointestinal', 'anisakiasis', 'after', 'eating', 'fish.'], ['The', 'tests', 'performed', 'show', 'specific', 'IgE', 'levels', 'of', '10', 'KU/l', 'against', 'Anisakis', 'simplex.'], ['Which', 'of', 'the', 'following', 'would', 'be', 'the', 'dietary', 'recommendation', 'for', 'this', 'patient?'], ['1-', 'He', 'cannot', 'eat', 'any', 'fish,', 'crustaceans,', 'mollusks', 'or', 'cephalopods.'], ['2-', 'He', 'can', 'eat', 'fresh', 'fish', 'cooked', 'on', 'the', 'grill.'], ['3-', 'May', 'eat', 'commercially', 'flash-frozen', 'fish.'], ['4-', 'You', 'can', 'eat', 'fresh', 'marinated', 'or', 'cold', 'smoked', 'fish.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Anisakis', 'simplex', 'is', 'a', 'parasite', 'frequently', 'found', 'in', 'fish.'], ['To', 'avoid', 'reactions', 'with', 'this', 'parasite,', 'a', 'diet', 'free', 'of', 'fresh', 'and', 'raw', 'fish', '(anchovies', 'in', 'vinegar,', 'smoked,', 'salted', 'fish,', 'sushi,', 'etc.)', 'should', 'be', 'followed.'], ['Deep-frozen', 'fish', 'or', 'fresh', 'fish', 'previously', 'frozen', 'at', '-20ºC', 'for', 'at', 'least', '5', 'days', 'before', 'cooking', 'can', 'be', 'consumed,', 'as', 'long', 'as', 'it', 'is', 'cooked', 'at', 'high', 'temperatures', '>60ºC', '(roasted,', 'fried,', 'etc.),', 'avoiding', 'raw,', 'grilled', 'or', 'microwaved', 'preparations.'], ['It', 'is', 'recommended', 'to', 'consume', 'preferably', 'the', 'tails', 'because', 'the', 'larvae', 'of', 'the', 'parasite', 'are', 'usually', 'close', 'to', 'the', 'viscera', 'of', 'the', 'head.']]

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2_36

[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['An', '87-year-old', 'patient', 'with', 'a', 'history', 'of', 'chronic', 'bronchitis', 'and', 'heart', 'failure', 'has', 'been', 'diagnosed', 'with', 'acute', 'calculous', 'cholecystitis.'], ['After', '4', 'days', 'of', 'hospitalization', 'and', 'treatment', 'with', 'absolute', 'diet,', 'piperacillin-tazobactam', 'serum', 'therapy,', 'the', 'patient', 'continues', 'with', 'fever,', 'persistent', 'abdominal', 'pain', 'and', 'leukocytosis.'], ['The', 'most', 'appropriate', 'attitude', 'at', 'this', 'time', 'would', 'be:'], ['1-', 'Urgent', 'surgical', 'treatment.'], ['2-', 'Biliary', 'drainage', 'by', 'percutaneous', 'cholecystostomy.'], ['3-', 'Replace', 'piperacillin-tazobactam', 'with', 'metronidazole-cefotaxime.'], ['4-', 'Replace', 'piperacillin-tazobactam', 'with', 'amikacin-clindamycin.'], ['5-', 'Add', 'an', 'aminoglycoside', 'such', 'as', 'gentamicin', 'to', 'the', 'treatment.'], ['CORRECT', 'ANSWER:', '2'], ['In', 'this', 'question,', 'they', 'insist', 'on', 'the', 'age', 'and', 'comorbidity', 'of', 'the', 'patient,', 'as', 'well', 'as', 'the', 'time', 'of', 'evolution,', 'so', 'the', 'answer', 'will', 'probably', 'not', 'be', '1.'], ['In', 'any', 'case,', 'the', 'ideal', 'would', 'be', 'to', 'drain', 'the', 'gallbladder', 'that', 'has', 'not', 'gone', 'up', 'again,', 'so', 'the', 'answer', 'I', 'would', 'give', 'would', 'be', '2.']]

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122_119

[['QUESTION', 'TYPE:', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '17-year-old', 'woman', 'came', 'to', 'the', 'emergency', 'department', 'with', 'acute', 'symptoms', 'of', 'high', 'fever,', 'pharyngeal', 'pain', 'and', 'cervical', 'lymphadenopathy.'], ['She', 'had', 'previously', 'been', 'diagnosed', 'with', 'acute', 'pharyngitis', 'and', 'was', 'treated', 'with', 'amoxicillin,', 'and', 'later', 'presented', 'with', 'a', 'generalized', 'macular', 'skin', 'rash.'], ['Laboratory', 'tests', 'showed', 'slight', 'leukocytosis', 'and', 'presence', 'of', 'activated', 'leukocytes,', 'slight', 'thrombopenia', 'and', 'slightly', 'increased', 'transaminases.'], ['What', 'would', 'be', 'the', 'most', 'likely', 'diagnosis', 'of', 'this', 'clinical', 'picture?'], ['1-', 'It', 'is', 'a', 'typical', 'picture', 'of', 'infectious', 'mononucleosis.'], ['2-', 'Varicella', 'zoster', 'infection.'], ['3-', 'Acute', 'toxoplasmosis.'], ['4-', 'Lyme', 'disease.'], ['5-', 'Infection', 'by', 'herpes', 'virus', '8.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'correct', 'answer', 'is', 'the', 'first', 'one.'], ['It', 'is', 'a', 'typical', 'picture', 'of', 'infectious', 'mononucleosis.'], ['Although', 'a', 'similar', 'picture', 'may', 'occur', 'in', 'acute', 'toxoplasmosis,', 'less', 'than', '1%', 'of', 'acute', 'toxoplasma', 'infections', 'present', 'as', 'mononucleosis.'], ['Characteristic', 'of', 'Epstein-Barr', 'infectious', 'mononucleosis', 'is', 'the', 'appearance', 'of', 'macular', 'rash', 'after', 'treatment', 'with', 'amoxicillin.']]

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36_130

[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['An', '85-year-old', 'woman', 'consults', 'for', 'fatigue', 'and', 'weakness', 'especially', 'in', 'the', 'mornings.'], ['She', 'is', 'sometimes', 'unsteady', 'when', 'walking', 'and', 'has', 'to', 'sit', 'down', 'to', 'regain', 'her', 'balance.'], ['On', 'two', 'occasions', 'she', 'has', 'had', 'to', 'sit', 'down', 'to', 'keep', 'from', 'falling', 'but', 'denies', 'symptoms', 'of', 'dizziness.'], ['She', 'has', 'arterial', 'hypertension,', 'urinary', 'incontinence', 'and', 'osteoarthritis.'], ['Her', 'treatment', 'is', 'hydrochlorothiazide', '(25', 'mg/d),', 'oxybutynin', '(10', 'mg/d),', 'lisinopril', '(10', 'mg/d),', 'calcium', '(1500', 'mg/d)', 'and', 'paracetamol', '(3', 'g/d).'], ['On', 'examination', 'he', 'has', 'a', 'blood', 'pressure', 'of', '115/70', 'mm', 'Hg,', 'pulse', '80', 'bpm.'], ['His', 'movements', 'are', 'slow.'], ['He', 'has', 'a', 'moderate', 'hand', 'tremor.'], ['She', 'can', 'get', 'up', 'from', 'the', 'chair', 'slowly', 'but', 'without', 'needing', 'to', 'lean', 'on', 'her', 'arms.'], ['She', 'walks', 'slightly', 'leaning', 'forward', 'with', 'little', 'swinging', 'of', 'the', 'arms.'], ['Turns', 'slowly', 'but', 'without', 'losing', 'balance.'], ['She', 'is', 'unable', 'to', 'stand', 'on', 'one', 'foot.'], ['Which', 'of', 'the', 'following', 'possible', 'actions', 'would', 'you', 'perform', 'first?'], ['1-', 'Assess', 'visual', 'acuity.'], ['2-', 'Perform', 'an', 'MRI.'], ['3-', 'Tilt', 'table', 'study.'], ['4-', 'Measure', 'blood', 'pressure', 'lying', 'down', 'and', 'standing', 'up.'], ['5-', 'Therapeutic', 'attempt', 'with', 'L-dopa.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'correct', 'answer', 'is', 'to', 'initiate', 'treatment', 'with', 'L-dopa,', 'since', 'the', 'clinical', 'picture', 'described', 'is', 'of', 'a', 'parkinsonism', 'whose', 'diagnosis', 'is', 'exclusively', 'clinical.'], ['The', 'rest', 'of', 'the', 'answers', 'can', 'be', 'made', 'for', 'differential', 'diagnosis,', 'but', 'the', 'performance', 'of', 'complementary', 'tests', 'does', 'not', 'justify', 'delaying', 'the', 'initiation', 'of', 'treatment.']]

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338_31

[['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'], ['Mature', 'cystic', 'teratoma', '(common', 'in', 'the', 'ovary', 'of', 'the', 'adult', 'female).'], ['Mass', 'with', 'a', 'large', 'cyst', 'occupying', 'most', 'of', 'it;', 'in', 'its', 'cavity', 'there', 'is', 'sebaceous', 'material', 'and', 'hairs.'], ['The', 'wall,', 'generally', 'a', 'few', 'millimeters', 'thick,', 'has', 'the', 'structure', 'of', 'skin,', 'with', 'its', 'epidermal', 'surface', 'towards', 'the', 'cavity.'], ['Because', 'of', 'this', 'preponderant', 'development', 'of', 'cutaneous', 'structures', 'it', 'is', 'usually', 'called', 'dermoid', 'cyst.'], ['The', 'tissues', 'that', 'compose', 'the', 'tumor', 'are', 'well', 'differentiated', '(mature', 'or', 'adult', 'type);', 'apart', 'from', 'skin', 'structures', 'many', 'other', 'tissues', 'can', 'be', 'observed,', 'particularly', 'in', 'a', 'thickening', 'or', 'spur', 'that', 'eminences', 'into', 'the', 'cavity,', 'in', 'which', 'there', 'are', 'often', 'teeth,', 'cartilage', 'and', 'bone.']]

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432_117

[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES', 'AND', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['An', '85-year-old', 'man', 'with', 'a', 'peripheral', 'venous', 'catheter', 'who,', 'one', 'week', 'after', 'being', 'hospitalized', 'for', 'a', 'stroke,', 'begins', 'with', 'shivering', 'and', 'fever.'], ['Blood', 'cultures', 'are', 'performed', 'and', 'microbiology', 'reports', 'that', 'gram-positive', 'cocci', 'are', 'growing', 'in', 'clusters.'], ['Pending', 'the', 'antibiogram,', 'what', 'is', 'the', 'most', 'appropriate', 'antibiotic', 'treatment?'], ['1-', 'Cefazolin.'], ['2-', 'Cloxacillin.'], ['3-', 'Vancomycin.'], ['4-', 'Linezolid.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'most', 'frequent', 'cause', 'of', 'catheter', 'infection', 'is', 'a', 'bacterium', 'that', 'colonizes', 'the', 'skin.'], ['The', 'Gram', 'stain', 'tells', 'us', 'that', 'it', 'is', 'a', 'staphylococcus,', 'most', 'of', 'the', 'species', 'of', 'this', 'genus', 'acquired', 'in-hospital', 'are', 'methicillin', 'resistant,', 'so', 'they', 'are', 'considered', 'resistant', 'to', 'Cloxacillin,', 'Cefazolin', 'and', 'there', 'are', 'no', 'clinical', 'data', 'about', 'the', 'efficacy', 'of', 'linezolid', 'for', 'the', 'treatment', 'of', 'systemic', 'infection', 'related', 'to', 'catheter.'], ['This,', 'plus', 'the', 'experience', 'with', 'vancomycin', 'use', 'in', 'this', 'setting', 'is', 'considered', 'the', 'empirical', 'choice', 'for', 'vancomycin.']]

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513_38

[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '72-year-old', 'patient', 'presents', 'to', 'the', 'emergency', 'department', 'with', 'severe', 'lingual', 'angioedema.'], ['She', 'has', 'no', 'associated', 'urticaria', 'and', 'no', 'history', 'of', 'drug', 'or', 'food', 'allergy.'], ['His', 'personal', 'history', 'includes', 'type', '2', 'diabetes', 'mellitus,', 'dyslipidemia,', 'hypertension,', 'hypothyroidism', 'and', "Parkinson's", 'disease.'], ['In', 'regular', 'treatment', 'with', 'metformin,', 'simvastatin,', 'enalapril,', 'thyroxine', 'and', 'levodopa.'], ['Which', 'of', 'the', 'following', 'drugs', 'is', 'most', 'likely', 'the', 'causal', 'drug', 'of', 'the', 'clinical', 'picture', 'described?'], ['1-', 'Enalapril.'], ['2-', 'Simvastatin.'], ['3-', 'Metformin', 'or', 'levodopa', 'equally.'], ['4-', 'Levodopa.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Of', 'the', 'proposed', 'drugs,', 'the', 'least', 'likely', 'options', 'would', 'be', '3,', 'since', 'metformin', 'very', 'rarely', 'causes', 'lingual', 'angioedema', '(in', 'March', '2020', 'there', 'was', 'only', 'one', 'case', 'described', 'worldwide)', 'and', '4,', 'since,', 'among', 'the', 'adverse', 'reactions', 'of', 'levodopa,', 'angioedema', 'is', 'classified', 'among', 'the', 'very', 'rare', 'ones', '(frequency', 'less', 'than', '0.1%).'], ['Of', 'the', 'two', 'remaining', 'options,', 'the', 'drugs', 'most', 'frequently', 'and', 'classically', 'associated', 'with', 'lingual', 'angioedema', 'are', 'ACE', 'inhibitors', '(frequency', 'around', '0.2%),', 'and', 'their', 'association', 'with', 'simvastatin', 'is', 'also', 'less', 'than', '0.1%.']]

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580_198

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'woman', 'referred', 'to', 'the', 'emergency', 'department', 'for', 'head', 'trauma', 'due', 'to', 'a', 'fall', 'on', 'a', 'scooter,', 'with', 'no', 'loss', 'of', 'consciousness', 'or', 'amnesia.'], ['The', 'examination', 'shows', 'a', 'closed', 'head', 'injury', 'with', 'concussion', 'and', 'mild', 'headache', 'without', 'nausea', 'and', 'vomiting.'], ['The', 'neurological', 'examination', 'is', 'normal', 'and', 'the', 'Glasgow', 'index', 'is', '15.'], ['In', 'this', 'situation,', 'which', 'imaging', 'test', 'is', 'indicated', 'first?'], ['1-', 'Cranial', 'CT', 'scan', 'without', 'contrast.'], ['2-', 'Cranial', 'CT', 'with', 'contrast.'], ['3-', 'No', 'imaging', 'test.'], ['4-', 'Simple', 'skull', 'radiography.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['After', 'a', 'TBI', 'in', 'a', 'patient', 'who', 'is', 'not', 'anticoagulated', 'or', 'antiplatelet,', 'with', 'no', 'known', 'risk', 'factors', 'for', 'hemorrhage,', 'and', 'who', 'does', 'not', 'present', 'alarming', 'data', 'in', 'the', 'anamnesis', 'or', 'physical', 'examination,', 'it', 'is', 'not', 'necessary', 'to', 'perform', 'a', 'cranial', 'imaging', 'test.']]

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248_118

[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '34-year-old', 'man', 'consults', 'for', 'fever', 'and', 'malaise.'], ['The', 'medical', 'history', 'includes', 'a', 'history', 'of', 'homosexual', 'relations', 'for', 'the', 'last', '4', 'months', 'with', 'a', 'new', 'partner.'], ['2', 'months', 'before', 'the', 'current', 'consultation', 'he', 'had', 'a', 'painless', 'ulcerative', 'lesion', 'on', 'the', 'glans', 'penis', 'with', 'bilateral', 'inguinal', 'lymphadenopathy,', 'all', 'self-limited.'], ['Serological', 'studies', 'were', 'requested', 'with', 'the', 'following', 'results:', 'HIV', 'negative,', 'RPR', '1/320,', 'HAART', '1/128.'], ['What', 'treatment', 'would', 'you', 'indicate', 'for', 'this', 'patient?'], ['1-', 'None.'], ['2-', 'Intravenous', 'penicillin', 'G,', '24', 'MU', 'every', 'day', 'for', '14', 'days.'], ['3-', 'Benzathine', 'penicillin', '2.4', 'MU', 'intramuscular,', '3', 'doses', 'in', 'three', 'consecutive', 'weeks.'], ['4-', 'Ceftriaxone', '2', 'grams', 'intramuscular', 'in', 'a', 'single', 'dose.'], ['5-', 'Benzathine', 'penicillin', '2.4', 'MU', 'intramuscularly', 'in', 'a', 'single', 'dose.'], ['CORRECT', 'ANSWER:', '5'], ['Direct', 'response', 'question.'], ['This', 'is', 'syphilis', '(both', 'by', 'antecendent', 'and', 'serology)', 'in', 'the', 'secondary', 'stage,', 'so', 'treatment', 'is', 'with', 'Benzathine', 'Penicillin', '2.4', 'MU', 'in', 'a', 'single', 'dose.']]

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222_197

[['QUESTION', 'TYPE:', 'EPIDEMIOLOGY'], ['CLINICAL', 'CASE:'], ['30-year-old', 'HIV', '(+)', 'homosexual', 'male', 'who', 'participates', 'as', 'a', 'volunteer', 'in', 'an', 'AIDS', 'patient', 'support', 'center.'], ['According', 'to', 'his', 'medical', 'history', 'he', 'received', 'diphtheria', 'toxoid', '(Td)', '6', 'years', 'ago,', 'MMR', 'vaccine', 'in', 'childhood', 'and', 'adolescence,', 'and', 'hepatitis', 'B', '3', 'years', 'ago.'], ['He', 'is', 'currently', 'asymptomatic', 'with', 'a', 'CD4', 'count', 'above', '200', 'cls/microliter.'], ['Which', 'vaccines', 'should', 'we', 'recommend?'], ['1-', 'Seasonal', 'influenza,', 'pneumococcal,', 'tetravalent', 'meningitis', 'and', 'hepatitis', 'A.'], ['2-', 'Seasonal', 'influenza,', 'Td,', 'pneumococcal', 'and', 'tetravalent', 'meningitis.'], ['3-', 'Tetravalent', 'meningitis,', 'pneumococcal', 'and', 'seasonal', 'flu.'], ['4-', 'Td,', 'tetravalent', 'meningitis,', 'pneumococcal.'], ['5-', 'Triple', 'viral,', 'seasonal', 'flu,', 'pneumococcal.'], ['CORRECT', 'ANSWER:', '1'], ['Vaccination', 'recommendations', 'for', 'HIV+', 'adults', 'include', 'hepatitis', 'B,', 'influenza,', 'MMR,', 'pneumococcal,', 'Td', 'and', 'Tdap,', 'and', 'for', 'some', 'adults,', 'hepatitis', 'A,', 'or', 'combined', 'A', 'and', 'B,', 'bacterial', 'meningitis,', 'HPV', 'and', 'meningococcal', '(Source', '[1]).'], ['Considering', 'that', 'the', 'individual', 'has', 'received', 'some', 'vaccines,', 'has', 'a', 'CD4', 'count', '>100', '(if', 'lower', 'there', 'would', 'be', 'a', 'contraindication)', 'and', 'works', 'in', 'a', 'center', 'that', 'helps', 'AIDS', 'patients', '(he', 'is', 'equated', 'to', '"health', 'personnel")', 'answers', '2,', '4', 'and', '5', 'are', 'wrong.'], ['All', 'four', 'vaccines', 'in', 'option', '1', 'are', 'administrable.'], ['In', 'a', 'little', 'more', 'detail:', 'Vaccine', 'against', 'tetanus', 'and', 'diphtheria:', 'all', 'persons', 'should', 'be', 'vaccinated', 'against', 'these', 'two', 'diseases.'], ['Hepatitis', 'B', 'vaccine:', 'hepatitis', 'B', 'and', 'HIV', 'viruses', 'share', 'the', 'same', 'routes', 'of', 'transmission,', 'so', 'it', 'is', 'common', 'for', 'HIV-infected', 'patients', 'to', 'also', 'be', 'infected', 'with', 'hepatitis', 'B', 'virus.'], ['It', 'is', 'therefore', 'important', 'to', 'know', 'whether', 'the', 'HIV-infected', 'person', 'has', 'markers', 'of', 'hepatitis', 'B', 'infection', 'and', 'to', 'proceed', 'with', 'vaccination', 'if', 'he/she', 'does', 'not', 'have', 'them.'], ['Vaccination', 'against', 'hepatitis', 'A:', 'Hepatitis', 'A', 'in', 'a', 'person', 'with', 'hepatitis', 'B,', 'hepatitis', 'C', 'or', 'other', 'liver', 'disease', 'can', 'be', 'very', 'serious.'], ['Since', 'these', 'infections', 'are', 'more', 'frequent', 'in', 'HIV-infected', 'patients,', 'vaccination', 'against', 'hepatitis', 'A', 'is', 'recommended.'], ['Vaccination', 'against', 'influenza:', 'influenza', 'in', 'a', 'patient', 'with', 'a', 'lack', 'of', 'immune', 'response', 'is', 'more', 'serious', 'and', 'presents', 'a', 'greater', 'risk', 'of', 'complications,', 'so', 'annual', 'vaccination', 'against', 'this', 'disease', 'is', 'indicated.'], ['If', 'the', "patient's", 'immune', 'status', 'is', 'very', 'deteriorated,', 'the', 'response', 'to', 'vaccination', 'is', 'diminished.'], ['In', 'this', 'case,', 'it', 'is', 'essential', 'to', 'vaccinate', 'all', 'the', 'people', 'living', 'with', 'the', 'HIV-infected', 'person', 'to', 'prevent', 'them', 'from', 'transmitting', 'the', 'disease.'], ['Pneumococcal', 'vaccine:', 'pneumococcal', 'infections', '(especially', 'pneumonia)', 'are', 'up', 'to', '10', 'times', 'more', 'frequent', 'in', 'HIV-infected', 'persons', 'than', 'in', 'HIV-uninfected', 'adults,', 'so', 'vaccination', 'is', 'recommended,', 'although', 'in', 'patients', 'with', 'counts', 'below', '200/mm3', 'the', 'protective', 'response', 'is', 'usually', 'not', 'sufficient.'], ['They', 'should', 'receive', 'a', 'second', 'dose', 'at', '3-5', 'years', 'of', 'age.'], ['HIV-infected', 'children', 'should', 'be', 'vaccinated', 'with', 'pneumococcal', 'conjugate', 'vaccine', 'with', 'the', 'corresponding', 'number', 'of', 'doses', 'according', 'to', 'age.'], ['Vaccination', 'against', 'Haemophilus', 'Influenzae', 'type', 'b:', 'this', 'bacterium', 'causes', 'pneumonia', 'and', 'meningitis,', 'especially', 'in', 'children.'], ['Although', 'in', 'HIV-infected', 'adults', 'it', 'represents', 'a', 'small', 'number', 'of', 'the', 'causes', 'of', 'infection,', 'vaccination', 'is', 'recommended.'], ['Vaccination', 'against', 'measles,', 'rubella', 'and', 'mumps', '(MMR):', 'all', 'three', 'diseases', 'can', 'become', 'more', 'serious', 'in', 'HIV-infected', 'patients,', 'especially', 'measles,', 'so', 'all', 'of', 'them', 'should', 'be', 'vaccinated,', 'provided', 'that', 'immunosuppression', 'is', 'not', 'severe', '(count', 'less', 'than', '200/mm3).']]

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'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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', '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-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 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'I-Claim', 'B-Marker', '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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', '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', 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244_114

[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '16-year-old', 'boy', 'consults', 'for', 'presenting', 'with', 'pustular', 'tonsillitis,', 'fever', 'up', 'to', '38.5°C,', 'painful', 'cervical', 'lymphadenopathy,', 'non-pruritic', 'macular', 'rash', 'on', 'the', 'chest', 'and', 'mild', 'hepatosplenomegaly,', 'of', '4-5', 'days', 'of', 'evolution.'], ['Paul-Bunnell', 'test', 'and', 'Ig', 'M', 'for', 'Epstein-Barr', 'virus', 'are', 'positive.'], ['During', 'his', 'admission', 'he', 'developed', 'continuous', 'fever', 'up', 'to', '40ºC,', 'pancytopenia,', 'icteric', 'hepatitis', 'and', 'coagulopathy', 'of', 'progressive', 'intensity.'], ['One', 'week', 'after', 'admission,', 'he', 'was', 'transferred', 'to', 'the', 'ICU', 'due', 'to', 'confusion', 'and', 'respiratory', 'failure.'], ['Blood', 'cultures', 'and', 'a', 'urine', 'culture', 'were', 'negative,', 'CSF', 'was', 'normal', 'and', 'the', 'chest', 'x-ray', 'showed', 'no', 'infiltrates.'], ['Procalcitonin', 'is', 'normal,', 'but', 'CRP', 'and', 'ferritin', 'are', 'very', 'elevated.'], ['Of', 'the', 'following', 'statements,', 'which', 'would', 'be', 'the', 'most', 'correct', 'diagnostic', 'and', 'therapeutic', 'approach?'], ['1-', 'She', 'has', 'a', 'bacterial', 'sepsis', 'of', 'undetermined', 'origin', 'and', 'should', 'be', 'given', 'ceftriaxone', 'and', 'supportive', 'care.'], ['2-', 'She', 'has', 'bacterial', 'sepsis', 'of', 'undetermined', 'origin', 'and', 'should', 'be', 'given', 'vancomycin,', 'ceftacidime', 'and', 'supportive', 'care.'], ['3-', 'This', 'is', 'infectious', 'mononucleosis', 'with', 'a', 'severe', 'course', 'and', 'glucocorticoids', 'should', 'be', 'administered.'], ['4-', 'This', 'is', 'an', 'infectious', 'mononucleosis', 'of', 'severe', 'course', 'and', 'treatment', 'with', 'Acyclovir', 'should', 'be', 'initiated.'], ['5-', 'I', 'would', 'perform', 'a', 'bone', 'marrow', 'biopsy/aspirate', 'and,', 'if', 'hemophagocytosis', 'is', 'confirmed,', 'initiate', 'treatment', 'with', 'immunosuppressants.'], ['CORRECT', 'ANSWER:', '5'], ['Difficult', 'question', 'in', 'which', 'the', 'correct', 'answer', 'could', 'give', 'rise', 'to', 'discussion.'], ['The', 'patient', 'is', 'a', '16-year-old', 'male', 'who', 'is', 'admitted', 'for', 'a', 'fairly', 'clear', 'case', 'of', 'mononucleosis', 'due', 'to', 'EBV', 'infection', 'that', 'becomes', 'complicated', 'during', 'admission.'], ['The', 'data', 'available', 'to', 'us', 'are:', '-', 'Pancytopenia.', '-', 'Hepatopathy.', '-', 'Coagulopathy.'], ['-', 'Absence', 'of', 'infectious', 'focus:', 'negative', 'blood', 'cultures,', 'negative', 'urine', 'cultures,', 'normal', 'X-ray,', 'normal', 'CSF.'], ['-', 'CRP', 'and', 'Ferritin', 'elevated', '/', 'normal', 'Procalcitonin.'], ['The', 'possible', 'complications', 'that', 'could', 'have', 'occurred', '(and', 'that', 'are', 'considered', 'in', 'the', 'answers)', 'are', 'sepsis', 'or', 'a', 'bad', 'evolution', 'of', 'mononucleosis.'], ['The', 'clinical', 'data', 'could', 'be', 'consistent', 'with', 'a', 'septic', 'process,', 'however,', 'the', 'main', 'infectious', 'foci', 'have', 'been', 'reasonably', 'ruled', 'out', 'and', 'one', 'of', 'the', 'most', 'sensitive', 'and', 'specific', 'markers', 'of', 'bacteremia', '(procalcitonin)', 'is', 'in', 'the', 'normal', 'range,', 'which', 'should', 'draw', 'our', 'attention.'], ['On', 'the', 'other', 'hand,', 'a', 'complication', 'of', 'the', 'EBV', 'mononucleosis', 'suffered', 'by', 'our', 'patient', 'should', 'be', 'evaluated,', 'among', 'the', 'possible', 'complications', 'are', 'hemolytic', 'anemia,', 'meningoecephalitis', '(normal', 'CSF)', 'or', 'Guillain-Barré', 'sd.', 'Guillain-Barré', 'syndrome,', 'which', 'are', 'not', 'very', 'consistent', 'with', 'the', 'clinical', 'picture', 'presented', 'to', 'us.'], ['Another', 'possible', 'complication', 'of', 'exceptional', 'severity', 'would', 'be', 'hemophagocytic', 'syndrome;', 'this', 'is', 'a', 'rare', 'entity', 'that', 'occurs', 'in', 'certain', 'predisposed', 'subjects', 'and', 'is', 'characterized', 'by', 'an', 'uncontrolled', 'activation', 'and', 'proliferation', 'of', 'histiocytes', 'and', 'T', 'lymphocytes,', 'which', 'produces', 'a', 'state', 'of', 'hypercytokinemia.'], ['The', 'diagnostic', 'criteria,', 'revised', 'in', '2004,', 'include', 'persistent', 'high', 'fever,', 'hepatosplenomegaly,', 'cytopenias,', 'hypertriglyceridemia,', 'hyperferritinemia,', 'and', 'hypofibrinogenemia.'], ['Hyperferritinemia', '>3000', 'in', 'a', 'suggestive', 'clinical', 'context', 'necessitates', 'treatment', 'of', 'the', 'patient', '(mainly', 'with', 'immunosuppressants', 'and', 'corticosteroids)', 'since', 'mortality', 'is', 'very', 'high', 'and', 'early', 'treatment', 'is', 'essential.'], ['The', 'definitive', 'diagnosis', 'is', 'made', 'by', 'microscopic', 'study', 'of', 'an', 'OM', 'biopsy.'], ['Although', 'in', 'this', 'question', 'they', 'do', 'not', 'quantify', 'the', 'value', 'of', 'ferritinemia,', 'it', 'is', 'a', 'remarkable', 'data', 'and', 'given', 'that', 'the', 'clinical', 'picture', 'is', 'suggestive,', 'meeting', 'the', 'diagnostic', 'criteria,', 'it', 'seems', 'to', 'me', 'that', 'answer', '5', 'would', 'be', 'the', 'most', 'accurate.']]

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'I-Claim', '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', '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', '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'], ['O', 'B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 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'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', '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']]

420_78

[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'man', 'was', 'referred', 'to', 'the', 'gastroenterology', 'department', 'for', 'hematochezia,', 'tenesmus', 'and', 'reduction', 'of', 'stool', 'diameter.'], ['A', 'series', 'of', 'tests', 'were', 'performed', 'and', 'a', 'diagnosis', 'of', 'adenocarcinoma', 'of', 'the', 'sigma', 'without', 'distant', 'metastasis', 'was', 'made.'], ['The', 'patient', 'underwent', 'surgery', 'and', 'was', 'referred', 'to', 'the', 'medical', 'oncology', 'department', 'for', 'evaluation', 'of', 'complementary', 'chemotherapy', 'treatment.'], ['Which', 'of', 'the', 'following', 'is', 'a', 'poor', 'prognostic', 'factor', 'after', 'surgical', 'resection', 'and', 'should', 'be', 'taken', 'into', 'account', 'when', 'planning', 'chemotherapy', 'treatment?'], ['1-', 'The', 'presence', 'of', 'anemia', 'at', 'diagnosis.'], ['2-', 'The', 'existence', 'of', 'a', 'family', 'history', 'of', 'colorectal', 'cancer.'], ['3-', 'The', 'size', 'of', 'the', 'primary', 'lesion', 'and', 'histological', 'differentiation.'], ['4-', 'Perforation', 'or', 'adhesion', 'of', 'the', 'tumor', 'to', 'adjacent', 'organs.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['They', 'are', 'not', 'asking', 'about', 'factors', 'that', 'affect', 'oncologic', 'prognosis', 'and', 'therefore', 'imply', 'a', 'change', 'in', 'QT', 'strategy.'], ['This', 'question', 'is', 'straightforward.'], ['Option', '4', 'is', 'describing', 'to', 'us', 'a', 'T4', 'stage,', 'either', 'by', 'invasion', 'of', 'adjacent', 'organs', 'or', 'perforation.'], ['The', 'T4s', 'carry', 'a', 'much', 'higher', 'chance', 'of', 'recurrence,', 'in', 'fact', 'there', 'are', 'ongoing', 'studies', 'that', 'propose', 'prophylactic', 'HIPEC', 'in', 'T4', 'and', 'second', 'look', 'surgery', '+', 'HIPEC', 'in', 'perforated', 'colon', 'tumors.']]

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321_144

[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '50-year-old', 'man', 'diagnosed', 'with', 'polyangiitis', 'with', 'granulomatosis', '10', 'years', 'earlier', 'and', 'untreated', 'for', 'the', 'past', '5', 'years', 'is', 'asymptomatic', 'at', 'a', 'scheduled', 'check-up.'], ['Chest', 'X-ray,', 'blood', 'tests', 'and', 'urine', 'sediment', 'are', 'normal', 'except', 'for', 'positive', 'anti-neutrophil', 'cytoplasmic', 'antibodies', '(ANCA)', 'at', 'titer', '1/320,', 'with', 'anti-proteinase', '3', 'specificity,', 'which', 'had', 'previously', 'been', 'negative.'], ['What', 'is', 'the', 'most', 'advisable', 'therapeutic', 'approach?'], ['1-', 'Start', 'treatment', 'with', 'corticosteroids.'], ['2-', 'Initiate', 'treatment', 'with', 'cyclophosphamide.'], ['3-', 'Initiate', 'treatment', 'with', 'mycophenolate', 'mofetil.'], ['4-', 'Watchful', 'waiting.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['In', 'ANCA', 'vasculitis,', 'whatever', 'it', 'is,', 'these', 'antibodies', 'have', 'been', 'shown', 'to', 'be', 'related', 'to', 'the', 'activity', 'of', 'the', 'disease,', 'but', 'at', 'no', 'time', 'are', 'changes', 'in', 'treatment', 'obligatory', 'due', 'to', 'their', 'levels.'], ['In', 'this', 'case,', 'with', 'the', 'patient', 'being', 'asymptomatic', 'and', 'with', 'objective', 'evidence', 'of', 'lack', 'of', 'activity,', 'close', 'follow-up', 'should', 'be', 'performed', 'without', 'restarting', 'or', 'modifying', 'treatment.']]

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516_103

[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '56-year-old', 'patient', 'is', 'found', 'comatose', 'at', 'home.'], ['He', 'has', 'a', 'history', 'of', 'arterial', 'hypertension', 'and', 'diabetes', 'mellitus.'], ['He', 'has', 'no', 'toxic', 'habits', 'or', 'any', 'other', 'chronic', 'disease.'], ['He', 'is', 'on', 'treatment', 'with', 'irbesartan', 'and', 'empaglifozin.'], ['He', 'shows', 'no', 'signs', 'of', 'malnutrition.'], ['His', 'blood', 'pressure', 'is', '110/60', 'mmHg,', 'heart', 'rate', '110', 'bpm,', '90%', 'SatO2,', 'capillary', 'glucose', '120', 'mg/dl', 'and', 'respiratory', 'rate', '7', 'rpm.'], ['Which', 'initial', 'therapeutic', 'approach', 'do', 'you', 'think', 'is', 'the', 'most', 'correct?'], ['1-', 'Administer', 'naloxone,', 'flumazenil', 'and', 'thiamine.'], ['2-', 'Administer', 'naloxone,', 'flumazenil', 'and', 'hypertonic', 'glucose.'], ['3-', 'Administer', 'naloxone', 'and', 'flumazenil.'], ['4-', 'Administer', 'thiamine', 'and', 'hypertonic', 'glucose.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['We', 'find', 'a', 'patient', 'with', 'hypoventilation.'], ['Glycemia', 'is', 'correct', '(we', 'rule', 'out', 'hyperosmolar', 'coma', 'and', 'hypoglycemia,', 'option', '2', 'and', '4),', 'so,', 'although', 'there', 'is', 'no', 'history', 'of', 'intoxication,', 'we', 'have', 'to', 'go', 'to', 'the', 'most', 'frequent', 'and', 'that', 'we', 'can', 'antagonize', 'with', 'antidotes:', 'benzodiazepines', '(flumazenil)', 'and', 'opiates', '(naloxone).'], ['If', 'we', 'suspect', 'ethylene', 'glycol', 'intoxication,', 'we', 'would', 'administer', 'thiamine,', 'but', 'there', 'are', 'no', 'data', 'to', 'make', 'us', 'suspect.']]

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44_153

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['Child', '28', 'days', 'old,', 'born', 'at', 'term.'], ['History', 'of', 'normal', 'pregnancy', 'and', 'delivery.'], ['He', 'has', 'been', 'breastfed', 'since', 'birth.'], ['He', 'consults', 'because', '8', 'days', 'ago', 'he', 'started', 'vomiting,', 'initially', 'sporadically', 'and', 'since', '5', 'days', 'ago,', 'after', 'all', 'feedings.'], ['He', 'is', 'permanently', 'hungry.'], ['The', 'vomiting', 'is', 'of', '"squirting"', 'food', 'content.'], ['On', 'palpation,', 'the', 'abdomen', 'is', 'soft', 'and', 'depressible,', 'without', 'visceromegaly.'], ['The', 'blood', 'gas', 'analysis', 'showed', 'pH', '7.49,', 'bicarbonate', '30', 'mEq/l,', 'pCO2', '53', 'mmHg,', 'base', 'excess', '+8', 'mEq/l.'], ['Ions:', 'Na', '137', 'mEq/l,', 'K', '3.1', 'mEq/l,', 'Cl', '94', 'mEq/l.'], ['Taking', 'into', 'account', 'the', 'most', 'probable', 'diagnosis', 'in', 'the', 'clinical', 'picture', 'described,', 'what', 'is', 'the', 'complementary', 'test', 'of', 'choice', 'to', 'confirm', 'this', 'clinical', 'diagnosis?'], ['1-', 'Simple', 'abdominal', 'X-ray.'], ['2-', 'pHmetry.'], ['3-', 'Abdominal', 'ultrasound.'], ['4-', 'Determination', 'of', 'electrolytes', 'in', 'sweat.'], ['5-', 'Esophagogastroscopy.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is', '3.'], ['Easy', 'question', 'if', 'pathology', 'is', 'suspected,', 'which', 'I', 'also', 'think', 'is', 'simple', 'because', 'the', 'clinical', 'description', 'is', 'textbook', 'hypertrophic', 'pyloric', 'stenosis.']]

[['O', 'O', 'O'], ['O', 'O'], ['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'], ['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['B-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', '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'], ['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'], ['O', 'B-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['O', 'B-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', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]

54_72

[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '22-year-old', 'female', 'student', 'with', 'no', 'history', 'of', 'pathology', 'or', 'use', 'of', 'medications', 'except', 'anovulatory', 'drugs', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'deterioration', 'of', 'general', 'condition', 'and', 'need', 'to', 'take', 'deep', 'breaths.'], ['She', 'reports', 'weight', 'loss', 'in', 'the', 'last', '2-3', 'days,', 'polydipsia,', 'polyuria', 'and', 'nausea.'], ['No', 'cough', 'or', 'febrile', 'sensation.'], ['Examination:', 'appearance', 'of', 'gravity,', 'blood', 'pressure', '100/60', 'mmHg,', 'deep', 'and', 'rapid', 'breathing', '(28rpm),', 'level', 'of', 'consciousness', 'preserved,', 'dry', 'mucous', 'membranes.'], ['No', 'fever.'], ['CBC:', 'blood', 'glucose', '420', 'mg/dL,', 'Na+', '131', 'mEq/L,', 'K+', 'normal,', 'pH', '7.08,', 'bicarbonate', '8', 'mEq/L', 'and', 'ketonuria', '(+++)', 'Which', 'answer', 'do', 'you', 'think', 'is', 'more', 'correct?'], ['1-', 'Debut', 'of', 'type', '2', 'diabetes', 'mellitus,', 'with', 'dyspnea', 'probably', 'due', 'to', 'pneumonia', 'or', 'thromboembolism,', 'since', 'she', 'is', 'taking', 'anovulatory', 'drugs.'], ['2-', 'It', 'is', 'a', 'diabetic', 'ketoacidosis.', 'It', 'must', 'be', 'treated', 'with', 'intravenous', 'insulin,', 'serum', 'therapy,', 'general', 'measures', 'and', 'search', 'for', 'precipitating', 'cause.'], ['3-', 'Debut', 'of', 'type', '1', 'diabetes', 'with', 'ketoacidosis.', 'Treat', 'with', 'bicarbonate', 'and', 'after', 'correction', 'of', 'acidosis,', 'add', 'intravenous', 'insulin.'], ['4-', 'It', 'looks', 'like', 'diabetic', 'ketoacidosis,', 'but', 'it', 'could', 'be', 'alcoholic.', 'BAC', 'should', 'be', 'determined', 'before', 'starting', 'insulin', 'therapy.'], ['5-', 'Treat', 'with', 'rapid', 'subcutaneous', 'insulin,', 'serum', 'therapy', 'and', 'ask', 'him', 'to', 'drink', 'plenty', 'of', 'fluids.'], ['CORRECT', 'ANSWER:', '2'], ['Debut', 'of', 'DM', 'with', 'ketoacidosis.'], ['Priority', 'is', 'iv', 'insulin', 'administration', 'and', 'serum', 'therapy.'], ['Bicarbonate', 'if', 'pH', '<', '7.'], ['Insulin', 'administration', 'should', 'never', 'be', 'delayed.']]

[['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'], ['B-Premise', 'I-Premise', 'I-Premise', 'I-Premise', 'I-Premise'], ['O', 'B-Premise', 'I-Premise', 'I-Premise', 'B-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', 'B-Premise', 'I-Premise', 'I-Premise'], ['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', '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', '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'], ['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'], ['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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]

553_177

[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['33-year-old', 'patient,', 'resident', 'of', 'Valencia,', 'who', 'consults', 'for', 'presenting', 'on', 'the', 'right', 'cheek', 'an', 'erythematous-orange', 'plaque', 'after', 'an', 'insect', 'bite', 'that', 'has', 'been', 'growing', 'slowly', 'until', 'reaching', '1.5', 'cm', 'and', 'that', 'in', 'the', 'last', 'weeks', 'has', 'ulcerated', 'and', 'covered', 'with', 'a', 'scammocostra.'], ['The', 'lesion', 'only', 'causes', 'discrete', 'discomfort', 'if', 'scratched.'], ['The', 'patient', 'has', 'a', 'history', 'of', 'plaque', 'psoriasis', 'treated', 'with', 'subcutaneous', 'adalimumab.'], ['She', 'is', 'in', 'good', 'general', 'condition', 'and', 'does', 'not', 'take', 'any', 'other', 'drugs', 'and', 'does', 'not', 'report', 'any', 'drug', 'allergies.'], ['Indicate', 'the', 'treatment', 'you', 'would', 'use:'], ['1-', 'Oral', 'isotretinoin.'], ['2-', 'Intralesional', 'meglumine', 'antimoniate.'], ['3-', 'Systemic', 'corticosteroids.'], ['4-', 'Oral', 'amoxicillin.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'fact', 'that', 'the', 'place', 'of', 'residence', 'is', 'mentioned', 'already', 'gives', 'us', 'many', 'clues.'], ['A', '"bite"', 'that', 'transforms', 'into', 'a', 'lesion', 'in', 'an', 'uncovered', 'area', 'with', 'a', 'crusty', 'surface', 'and', 'that', 'bothers', 'little', 'or', 'nothing...', 'in', 'the', 'Mediterranean', 'basin', 'this', 'is', 'cutaneous', 'leishmaniasis', 'or', 'oriental', 'button.'], ['And', 'while', 'it', 'is', 'true', 'that', 'the', 'lesion', 'is', '<', '4', 'cm', 'and', 'unique,', 'we', 'are', 'told', 'that', 'the', 'patient', 'is', 'being', 'treated', 'with', 'adalimumab,', 'an', 'anti-TNF', 'monoclonal', 'antibody.'], ['With', 'the', 'exception', 'of', 'meglumine', 'antimoniate,', 'none', 'of', 'the', 'other', 'treatments', 'proposed', 'in', 'the', 'different', 'options', 'are', 'indicated', 'in', 'leishmaniasis,', 'so', 'it', 'is', 'clear.'], ['The', 'only', 'thing', 'that', 'is', 'more', 'debatable', 'is', 'that,', 'as', 'this', 'is', 'an', 'immunosuppressed', 'patient,', 'systemic', 'treatment', 'would', 'probably', 'be', 'more', 'appropriate.'], ['I', "don't", 'know', 'if', 'for', 'that', 'reason', 'contestable,', 'but', 'at', 'least,', 'debatable.']]

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608_115

[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'male,', 'a', 'regular', 'athlete,', 'refers', 'pain', 'in', 'the', 'right', 'leg', 'after', 'continuous', 'running.'], ['He', 'has', 'visited', 'a', 'physiotherapist', 'on', 'several', 'occasions', 'and', 'has', 'been', 'diagnosed', 'with', 'calf', 'overload.'], ['Several', 'months', 'have', 'passed,', 'he', 'has', 'not', 'improved', 'and', 'refers', 'intense', 'pain', 'after', 'physical', 'activity', 'that', 'subsides', 'with', 'rest', 'in', 'the', 'following', 'hours', 'of', 'exercise.'], ['What', 'test', 'can', 'help', 'in', 'the', 'diagnosis?'], ['1-', 'Positron', 'emission', 'tomography', 'with', '18', 'FDG.'], ['2-', 'Determination', 'of', 'posterior', 'compartment', 'pressure', 'immediately', 'after', 'activity.'], ['3-', 'Doppler', 'ultrasound', 'to', 'rule', 'out', 'a', 'circulatory', 'disorder', 'of', 'the', 'lower', 'extremity.'], ['4-', 'Spectrometry', 'by', 'magnetic', 'resonance.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['We', 'present', 'a', 'case', 'of', 'chronic', 'compartment', 'syndrome.'], ['For', 'its', 'diagnosis', 'it', 'is', 'necessary', 'to', 'measure', 'the', 'pressure', 'of', 'the', 'affected', 'compartments', 'at', 'rest', 'and', 'after', 'activity', '(answer', '2', 'correct).']]

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294_44

[['QUESTION', 'TYPE:', 'GENETICS', 'AND', 'IMMUNOLOGY'], ['CLINICAL', 'CASE:'], ['Amalia', 'is', 'a', '3-year-old', 'girl', 'who', 'has', 'undergone', 'surgery', 'for', 'tetralogy', 'of', 'Fallot.'], ['She', 'also', 'presented', 'thymic', 'dysfunction', 'in', 'the', 'neonatal', 'period', 'and', 'hypocalcemia', 'as', 'well', 'as', 'a', 'nasal', 'voice', 'and', 'psychomotor', 'retardation.'], ['Which', 'genetic', 'test', 'do', 'you', 'consider', 'most', 'appropriate', 'to', 'reach', 'an', 'etiological', 'diagnosis?'], ['1-', '22q11', 'deletion', 'study', '(Di', 'George', 'or', 'Velo-cardio-facial', 'syndrome).'], ['2-', 'Study', 'of', 'FMR1', 'gene', 'expansion,', 'responsible', 'for', 'Fragile', 'X', 'syndrome.'], ['3-', 'Sequencing', 'of', 'genes', 'related', 'to', 'HRAS', '(Noonan', 'syndrome).'], ['4-', 'Genetic', 'study', 'of', 'Williams', 'Beuren', 'syndrome.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Question', 'in', 'which', 'the', 'clinical', 'picture', 'must', 'be', 'recognized:', 'cardiovascular', 'anomalies', '-', 'Tetralogy', 'of', 'Fallot', '-;', 'thymic', 'aplasia/hypoplasia', '-', 'leading', 'to', 'primary', 'T-cell', 'immunodeficiency;', 'parathyroid', 'aplasia/hypoplasia', '-', 'hence', 'hypocalcemia', '-;', 'palatal', 'anomalies', '-', 'nasal', 'voice;', 'psychomotor', 'retardation.'], ['In', 'my', 'opinion,', 'just', 'with', 'the', 'words', '"thymic', 'dysfunction",', 'hypocalcemia', 'and', 'cardiopathy,', 'we', 'would', 'have', 'to', 'go', 'straight', 'to', 'DiGeorge', 'syndrome.'], ['Indeed,', 'the', 'genetic', 'defect', 'is', 'a', '22q11.2', 'deletion', '(which', 'if', 'we', 'know', 'it,', 'the', 'better,', 'but', 'with', 'the', 'clinic', 'it', 'would', 'be', 'enough', 'for', 'us).'], ['The', 'only', 'option', 'with', 'which', 'there', 'could', 'be', 'doubt', 'is', 'Noonan', 'syndrome,', 'which', 'can', 'also', 'be', 'associated', 'with', 'cardiopathy,', 'but', 'above', 'all', 'it', 'is', 'characterized', 'by', 'short', 'stature,', 'cardiopathy', 'and', 'bone', 'alterations;', 'moreover,', 'in', 'most', 'cases', 'it', 'is', 'caused', 'by', 'an', 'alteration', 'in', 'the', 'PTPN11', 'gene,', 'not', 'in', 'those', 'mentioned', 'in', 'the', 'question.']]

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156_230

[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '40-year-old', 'patient', 'who', 'comes', 'to', 'the', 'emergency', 'room', 'with', 'aphthous', 'stomatitis,', 'conjunctivitis,', 'urethritis,', 'balanitis', 'and', 'joint', 'pain.'], ['Which', 'of', 'the', 'following', 'diagnoses', 'is', 'the', 'most', 'likely?'], ['1-', "Behçet's", 'disease.'], ['2-', 'Reactive', 'arthritis', 'syndrome.'], ['3-', "Sweet's", 'syndrome.'], ['4-', 'Vitamin', 'A', 'deficiency.'], ['5-', 'Gonococcal', 'infection.'], ['CORRECT', 'ANSWER:', '2'], ['Given', 'this', 'clinical', 'picture', 'and', 'without', 'having', 'complementary', 'tests', 'available,', 'the', 'most', 'likely', 'diagnosis', 'is', 'reactive', 'arthritis.'], ['The', 'only', 'problem', 'is', 'that', 'the', 'statement', 'speaks', 'of', 'joint', 'pain', 'and', 'not', 'arthritis...'], ["Reiter's", 'syndrome', '(triad', 'of', 'conjunctivitis,', 'urethritis', 'and', 'arthritis)', 'is', 'one', 'of', 'the', 'forms', 'in', 'which', 'reactive', 'arthritis', 'can', 'present.'], ['In', "Behçet's", 'disease', 'oral', 'and', 'genital', 'aphthous', 'ulcers', 'may', 'occur', 'but', 'urethritis', 'is', 'not', 'a', 'feature.'], ['And', 'the', 'characteristic', 'ocular', 'condition', 'is', 'uveitis.']]

[['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', 'B-Premise', 'B-Premise', 'O', 'B-Premise', 'I-Premise'], ['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', 'I-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'], ['B-Claim', 'I-Claim', '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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]

82_45

[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'VASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'man', 'reports', 'precordial', 'pain', 'after', 'medium', 'exertion.'], ['Coronary', 'angiography', 'shows', 'significant', 'stenosis', 'in', 'the', 'proximal', 'segments', 'of', 'the', 'three', 'main', 'vessels', 'with', 'good', 'distal', 'bed.'], ['Ventricular', 'function', 'is', 'depressed', '(<30%).'], ['What', 'is', 'the', 'best', 'therapeutic', 'option?'], ['1-', 'Percutaneous', 'revascularization.'], ['2-', 'Medical', 'treatment.'], ['3-', 'Myocardial', 'revascularization', 'surgery.'], ['4-', 'Implantation', 'of', 'balloon', 'counterpulsation.'], ['5-', 'Cardiac', 'transplantation.'], ['CORRECT', 'ANSWER:', '3'], ['We', 'are', 'talking', 'about', 'a', 'patient', 'with', '3-vessel', 'coronary', 'artery', 'disease', 'and,', 'very', 'importantly,', 'with', 'severe', 'ventricular', 'dysfunction.'], ['Under', 'these', 'conditions,', 'the', 'treatment', 'of', 'choice', 'would', 'be', 'surgical', '(myocardial', 'revascularization', 'surgery', 'or', 'by-pass).'], ['In', 'the', 'case', 'of', 'a', 'patient', 'with', 'preserved', 'LV', 'function,', 'the', 'choice', 'of', 'surgical', 'vs.', 'percutaneous', 'treatment', 'would', 'be', 'more', 'questionable,', 'since', 'today,', 'thanks', 'to', 'drug-eluting', 'stents,', 'the', 'differences', 'in', 'terms', 'of', 'morbidity', 'and', 'mortality', 'between', 'by-pass', 'surgery', 'and', 'angioplasty', 'are', 'minimal.']]

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485_49

[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'man', 'on', 'carbamazepine', 'treatment', 'for', 'epilepsy', 'presenting', 'with', 'fever', '(38.8°C),', 'odynophagia,', 'conjunctivitis,', 'brownish', 'skin', 'lesions', 'spread', 'over', 'a', 'large', 'body', 'surface,', 'target-like', 'in', 'appearance', 'and', 'accompanied', 'by', 'epidermal', 'detachment', '(greater', 'than', '30%)', 'at', 'the', 'slightest', 'friction.'], ['It', 'is', 'very', 'likely', 'that', 'she', 'is', 'presenting', 'a', 'clinical', 'picture', 'of:'], ['1-', 'Acute', 'urticaria', 'of', 'pharmacological', 'cause.'], ['2-', 'Erythema', 'minor', 'exudative', 'secondary', 'to', 'drugs.'], ['3-', 'Pharmacological', 'Stevens-Johnson', 'syndrome.'], ['4-', 'Epidermal', 'toxic', 'necrolysis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['We', 'are', 'dealing', 'with', 'a', 'severe', 'patient,', 'with', 'target', 'lesions', 'and', "Nikolsky's", 'sign', 'in', '>', '30%', 'of', 'the', 'body', 'surface', 'area.'], ['Together', 'with', 'the', 'history', 'of', 'treatment', 'with', 'carbamazepine,', 'the', 'suspicion', 'will', 'be', 'of', 'toxic', 'epidermal', 'necrolysis', '(answer', '4).'], ['If', 'the', 'epidermal', 'detachment', 'is', 'less', 'than', '10%', 'then', 'we', 'would', 'be', 'dealing', 'with', 'Stevens-Johnson', '(and', 'intermediate', 'cases', 'are', 'referred', 'to', 'as', 'overlap,', 'since', 'it', 'is', 'a', 'whole', 'spectrum).'], ['Incidentally,', 'we', 'would', 'recommend', 'immediate', 'admission', 'to', 'a', 'major', 'burn', 'unit.']]

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219_124

578_107

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '55-year-old', 'male', 'who', 'suffers', 'a', 'subarachnoid', 'hemorrhage', 'due', 'to', 'a', 'ruptured', 'middle', 'cerebral', 'artery', 'aneurysm.'], ['He', 'is', 'treated', 'surgically.'], ['After', 'a', 'good', 'evolution', 'in', 'which', 'he', 'recovers', 'the', 'ability', 'to', 'walk,', 'one', 'month', 'after', 'suffering', 'the', 'hemorrhage,', 'he', 'presents', 'a', 'progressive', 'deterioration,', 'becoming', 'cloudy', 'and', 'with', 'difficulty', 'to', 'obey', 'orders.'], ['Mark', 'the', 'correct', 'statement:'], ['1-', 'She', 'is', 'in', 'the', 'moment', 'of', 'evolution', 'in', 'which', 'vasospasm', 'is', 'more', 'frequent.'], ['2-', 'This', 'progressive', 'deterioration', 'is', 'probably', 'secondary', 'to', 'aneurysm', 'rebleeding.'], ['3-', 'Subacute', 'deterioration', 'is', 'most', 'likely', 'due', 'to', 'hydrocephalus.'], ['4-', 'The', 'diagnostic', 'technique', 'of', 'choice', 'is', 'cerebral', 'angiography.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Vasospasm', 'as', 'a', 'complication', 'of', 'subarachnoid', 'hemorrhage', 'usually', 'occurs', 'early,', 'in', 'the', 'week', 'after', 'the', 'hemorrhage.'], ['The', 'progressive', 'deterioration', 'with', 'alteration', 'of', 'the', 'level', 'of', 'consciousness', 'makes', 'us', 'suspect', 'one', 'of', 'the', 'complications', 'that', 'can', 'occur', 'in', 'this', 'condition:', 'hydrocephalus.'], ['The', 'diagnostic', 'technique', 'of', 'choice', 'in', 'this', 'case', 'is', 'neuroimaging', 'with', 'cranial', 'CT.']]

[['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'], ['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', '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'], ['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'], ['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', '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']]

199_74

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'patient', 'presenting', 'in', 'the', 'second', 'decade', 'of', 'life', 'with', 'a', 'progressive', 'picture', 'of', 'parkinsonism,', 'tremor,', 'dystonia', 'and', 'behavioral', 'alteration,', 'you', 'should', 'always', 'perform', 'a', 'study', 'to', 'rule', 'out', 'the', 'presence', 'of', 'a', 'disease', 'whose', 'appropriate', 'treatment', 'can', 'improve', 'neurological', 'symptoms', 'and', 'stop', 'the', 'clinical', 'course.'], ['What', 'disease', 'is', 'it?'], ['1-', "Huntington's", 'disease.'], ['2-', "Wilson's", 'disease.'], ['3-', "Tourette's", 'syndrome.'], ['4-', "Sydenham's", 'chorea.'], ['5-', 'Juvenile-onset', "Parkinson's", 'disease.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'key', 'in', 'the', 'question', 'is', '"stopping', 'the', 'clinical', 'course",', 'as', "Hungtinton's", 'disease,', "Tourette's", 'and', "Parkinson's", 'disease', 'do', 'not', 'have', 'treatments', 'that', 'can', 'stop', 'the', 'clinical', 'course.'], ["Sydenham's", 'chorea', 'is', 'typical', 'of', 'younger', 'children', 'with', 'a', 'history', 'of', 'streptococcal', 'infection', 'and', 'resolution', 'is', 'usually', 'spontaneous.'], ['On', 'the', 'other', 'hand,', 'in', 'clinical', 'cases', 'it', 'is', 'recommended', 'to', 'rule', 'out', "Wilson's", 'disease', 'in', 'young', 'patients', 'with', 'movement', 'and', 'neuropsychiatric', 'disorders.']]

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331_87

[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'hospitalized', 'patient', 'who', 'is', 'unable', 'to', 'feed', 'orally', 'for', 'more', 'than', '6', 'days,', 'in', 'which', 'of', 'the', 'following', 'clinical', 'situations', 'are', 'we', 'necessarily', 'to', 'use', 'parenteral', 'nutrition?'], ['1-', 'Cardioembolic', 'stroke', 'with', 'complete', 'neurologic', 'dysphagia.'], ['2-', 'Cachexia', 'due', 'to', 'chronic', 'empyema', 'in', 'immunocompromised', 'patient.'], ['3-', 'Prolonged', 'paralytic', 'syndrome.'], ['4-', 'Advanced', "Alzheimer's", 'disease', 'with', 'severe', 'risk', 'of', 'bronchial', 'aspiration.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Paralytic', 'ileus', 'is', 'a', 'failure', 'of', 'intestinal', 'propulsion', 'that', 'appears', 'acutely', 'in', 'the', 'absence', 'of', 'mechanical', 'obstruction;', 'it', 'is', 'secondary', 'to', 'various', 'causes', 'and', 'affects', 'intestinal', 'contractility.'], ['Therefore,', 'parenteral', 'administration', 'is', 'necessary.']]

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205_214

[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'young', 'man', 'who', '3', 'days', 'after', 'a', 'risky', 'sexual', 'contact', 'presents', 'numerous', 'pustular', 'lesions,', 'small,', 'very', 'pruritic', 'and', 'evolving', 'to', 'tiny', 'erosions', 'affecting', 'the', 'entire', 'glans', 'and', 'the', 'inner', 'face', 'of', 'the', 'foreskin.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'diagnostic', 'approach?'], ['1-', 'Genital', 'candidiasis.'], ['2-', 'Chancroid.'], ['3-', 'Secondary', 'syphilis.'], ['4-', 'Trichomonas', 'balanitis.'], ['5-', 'Dermatophyte', 'fungal', 'infection.'], ['CORRECT', 'ANSWER:', '1'], ['Chancroid', 'is', 'a', 'solitary', 'lesion.'], ['Secondary', 'syphilis', 'usually', 'occurs', 'as', 'a', 'generalized', 'rash', 'or', 'as', 'characteristic', 'lesions', 'on', 'palms', 'and', 'soles', '(syphilitic', 'nails)', 'with', 'a', 'longer', 'latency', 'period.'], ['Trichomonas', 'balanitis', 'is', 'always', 'associated', 'with', 'urethritis,', 'which', 'is', 'not', 'referred', 'to', 'in', 'the', 'question.'], ['Therefore,', 'the', 'answer', 'is', '1.'], ['However,', 'the', 'clinical', 'picture', 'suggests', 'herpes', 'simplex', 'rather', 'than', 'candidiasis', 'and', '5', 'also', 'refers', 'to', 'fungi', '(although', 'dermatophytes', 'do', 'not', 'cause', 'balanitis)....', 'from', 'our', 'point', 'of', 'view,', 'even', 'if', 'we', 'consider', '1', 'to', 'be', 'correct,', 'the', 'question', 'is', 'misleading', 'and', 'could', 'be', 'open', 'to', 'challenge.'], ['Moreover,', 'genital', 'candidiasis', 'is', 'not', 'necessarily', 'sexually', 'transmitted.']]

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441_98

302_111

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'patient', 'with', 'rheumatoid', 'arthritis', 'treated', 'with', 'methotrexate,', 'prednisone', 'and', 'indomethacin', 'who', 'acutely', 'presents', 'edema', 'and', 'increased', 'plasma', 'creatinine', 'with', 'a', 'poorly', 'expressive', 'urine', 'sediment', 'and', 'proteinuria', 'less', 'than', '100', 'mg/24', 'h', 'the', 'most', 'likely', 'cause', 'is:'], ['1-', 'Renal', 'amyloidosis.'], ['2-', 'Glomerulonephritis', 'secondary', 'to', 'rheumatoid', 'arthritis.'], ['3-', 'Renal', 'failure', 'due', 'to', 'non-steroidal', 'anti-inflammatory', 'drugs.'], ['4-', 'Interstitial', 'nephritis', 'due', 'to', 'methotrexate.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Prerenal', 'acute', 'renal', 'failure', 'due', 'to', 'NSAIDs', 'seems', 'the', 'most', 'plausible', 'option', 'in', 'this', 'case.'], ['Tubulointerstitial', 'nephritis', 'due', 'to', 'methotrexate', 'is', 'less', 'likely', 'due', 'to', 'the', 'absence', 'of', 'rash,', 'fever', 'or', 'eosinophilia,', 'which', 'although', 'rare', 'in', 'the', 'MIR', 'usually', 'appear.'], ['Although', 'GMN', 'and', 'renal', 'amyloidosis', 'are', 'relatively', 'frequent', 'in', 'RA,', 'the', 'anodyne', 'urine', 'sediment', 'and', 'the', 'absence', 'of', 'proteinuria', 'make', 'these', 'options', 'unlikely.']]

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517_104

[['QUESTION', 'TYPE:', 'CRITICAL', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '34-year-old', 'male', 'is', 'involved', 'in', 'a', 'traffic', 'accident', 'and', 'is', 'attended', 'at', 'the', 'scene', 'of', 'the', 'accident.'], ['The', 'medical', 'personnel', 'observe', 'that', 'he', 'is', 'pale,', 'sweaty,', 'has', 'a', 'thready', 'pulse', 'with', 'a', 'blood', 'pressure', 'of', '90/50', 'mmHg,', 'a', 'heart', 'rate', 'of', '127', 'bpm,', 'a', 'respiratory', 'rate', 'of', '28', 'rpm', 'and', 'an', 'oxygen', 'saturation', 'of', '92%.'], ['He', 'was', 'infused', 'with', '20', 'ml/kg', 'of', 'crystalloids.'], ['During', 'his', 'transfer', 'to', 'the', 'hospital', 'his', 'vital', 'signs', 'improve', 'transiently', 'and', 'then', 'deteriorate', 'on', 'arrival', 'at', 'the', 'hospital.'], ['Point', 'out', 'the', 'correct', 'answer:'], ['1-', 'Type-specific', 'blood', 'transfusion', 'required.'], ['2-', 'Requires', 'emergency', 'blood', 'transfusion', '(O', 'Rh', 'negative).'], ['3-', 'A', 'possible', 'blood', 'transfusion', 'with', 'crossmatching', 'tests', 'should', 'be', 'prepared.'], ['4-', 'Try', 'again', 'infusion', 'of', 'another', '20', 'ml/kg', 'of', 'crystalloids.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['In', 'a', 'polytraumatized', 'patient,', 'the', 'first', 'cause', 'of', 'shock', 'is', 'blood', 'loss', '(hemorrhagic', 'shock).'], ['The', 'guidelines', 'to', 'follow', 'should', 'always', 'contemplate', 'the', 'replenishment', 'of', 'blood', 'volume', '(if', 'possible,', 'with', 'blood', 'products', 'as', 'early', 'as', 'possible)', 'and', 'control', 'of', 'the', 'focus.'], ['In', 'this', 'case,', 'given', 'the', 'vital', 'compromise,', 'the', 'need', 'for', 'transfusion', 'is', 'very', 'urgent,', 'so', 'the', 'indication', 'is', 'emergency', 'blood', 'transfusion', '(O', 'Rh', 'negative).']]

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520_38

[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '72-year-old', 'patient', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'presenting', 'with', 'severe', 'and', 'significant', 'lingual', 'angioedema.'], ['She', 'does', 'not', 'present', 'associated', 'urticaria', 'and', 'has', 'no', 'history', 'of', 'drug', 'or', 'food', 'allergy.'], ['His', 'personal', 'history', 'includes', 'type', '2', 'diabetes', 'mellitus,', 'dyslipidemia,', 'hypertension,', 'hypothyroidism', 'and', "Parkinson's", 'disease.'], ['She', 'is', 'on', 'regular', 'treatment', 'with', 'metformin,', 'simvastatin,', 'enalapril,', 'thyroxine', 'and', 'levodopa.'], ['Which', 'of', 'the', 'following', 'drugs', 'is', 'most', 'likely', 'the', 'causal', 'drug', 'of', 'the', 'clinical', 'picture', 'described?'], ['1-', 'Enalapril.'], ['2-', 'Simvastatin.'], ['3-', 'Metformin', 'or', 'levodopa', 'equally.'], ['4-', 'Levodopa.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Angioedema', 'is', 'a', 'type', 'of', 'profound', 'urticaria', 'that', 'can', 'be', 'of', 'drug', 'etiology', '(not', 'IgE-mediated)', 'and', 'in', 'this', 'case,', 'ACEIs', '(such', 'as', 'enalapril)', 'are', 'considered', 'the', 'most', 'frequent', 'pharmacological', 'cause,', 'so', 'in', 'this', 'case', 'it', 'would', 'be', 'the', 'correct', 'answer', '(if', 'we', 'speak', 'in', 'probabilistic', 'terms).']]

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379_133

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '20-year-old', 'girl', 'comes', 'to', 'the', 'emergency', 'department', 'because', 'she', 'has', 'noticed', 'after', 'getting', 'up,', 'when', 'looking', 'in', 'the', 'mirror,', 'weakness', 'in', 'the', 'right', 'half', 'of', 'the', 'face', '(including', 'the', 'forehead,', 'closing', 'the', 'eyelid', 'and', 'smiling).'], ['She', 'is', 'accompanied', 'by', 'dysgeusia,', 'with', 'a', 'sensation', 'of', 'metallic', 'taste', 'of', 'food', 'as', 'well', 'as', 'hyperacusis', 'and', 'ipsilateral', 'mastoid', 'pain.'], ['On', 'examination', 'there', 'is', 'no', 'evidence', 'of', 'strength', 'deficits', 'or', 'sensory', 'deficits', 'in', 'the', 'extremities', 'or', 'speech', 'or', 'language', 'disorders.'], ['In', 'this', 'case,', 'which', 'of', 'the', 'following', 'statements', 'is', 'correct?'], ['1-', 'The', 'most', 'probable', 'diagnosis', 'is', 'a', 'demyelinating', 'plaque', 'in', 'the', 'contralateral', 'hemiprotuberance,', 'the', 'most', 'necessary', 'complementary', 'exploration', 'would', 'be', 'a', 'cranial', 'MRI.'], ['2-', 'Oral', 'corticosteroids', 'are', 'the', 'treatment', 'of', 'choice', 'for', 'the', 'patient.'], ['3-', 'Intravenous', 'fibrinolysis', 'should', 'be', 'considered', 'if', 'the', 'evolution', 'time', 'is', 'less', 'than', '3h.'], ['4-', 'Most', 'likely', 'the', 'picture', 'is', 'irreversible.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['We', 'describe', 'a', 'picture', 'of', 'typical', 'peripheral', 'facial', 'paralysis,', 'with', 'dysgeusia,', 'hyperacusis', 'and', 'mastoid', 'pain.'], ['In', 'this', 'case', 'the', 'treatment', 'is', 'corticoid.'], ['The', 'first', 'one', 'would', 'not', 'be', 'correct', 'because', 'although', 'within', 'the', 'age', 'range', 'of', 'multiple', 'sclerosis', 'debut,', 'the', 'presentation', 'is', 'usually', 'gradual', 'over', 'days', 'and', 'the', 'nuclear', 'involvement', 'of', 'the', 'VII', 'cranial', 'nerve', '(which', 'could', 'simulate', 'a', 'peripheral', 'facial)', 'would', 'not', 'cause', 'dysgeusia,', 'hyperacusis', 'or', 'mastoid', 'pain.'], ['In', 'the', 'third', 'answer', 'they', 'propose', 'us', 'that', 'it', 'is', 'a', 'vascular', 'picture', 'and', 'therefore', 'that', 'the', 'facial', 'paralysis', 'is', 'central,', 'so', 'it', 'is', 'discarded', 'and', 'the', 'last', 'one', 'is', 'not', 'correct', 'because', 'most', 'of', 'the', 'idiopathic', 'peripheral', 'facial', 'paralysis', "(Bell's", 'palsy)', 'heal', 'without', 'sequelae.']]

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600_184

[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '70-year-old', 'woman', 'who', 'has', 'been', 'complaining', 'for', '1', 'month', 'of', 'pain', 'and', 'stiffness', 'in', 'the', 'shoulder', 'girdle', 'and', 'pelvic', 'girdle,', 'which', 'predominates', 'when', 'she', 'gets', 'up', 'and', 'improves', 'with', 'mobilization,', 'without', 'fever,', 'headache', 'or', 'general', 'condition.'], ['Physical', 'examination', 'showed', 'stiffness', 'and', 'pain', 'on', 'mobilization', 'of', 'the', 'shoulders', 'and', 'hips.'], ['Laboratory', 'tests', 'show', 'elevated', 'ESR', 'and', 'C-reactive', 'protein.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis', 'and', 'what', 'treatment', 'would', 'you', 'prescribe?'], ['1-', 'Rheumatoid', 'arthritis,', 'would', 'initiate', 'treatment', 'with', 'methotrexate.'], ['2-', 'Fibromyalgia,', 'would', 'initiate', 'treatment', 'with', 'duloxetine.'], ['3-', 'Polymyalgia', 'rheumatica,', 'would', 'initiate', 'treatment', 'with', 'corticosteroids.'], ['4-', 'Ankylosing', 'spondylitis,', 'I', 'would', 'initiate', 'treatment', 'with', 'non-steroidal', 'anti-inflammatory', 'drugs.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['In', 'this', 'case,', 'he', 'is', 'describing', 'the', 'cardinal', 'symptoms', 'of', 'polymyalgia', 'rheumatica.'], ['Older', 'patient,', 'over', '50', 'years', 'of', 'age,', 'presenting', 'with', 'pain', 'and', 'stiffness', 'in', 'both', 'girdles,', 'associated', 'with', 'an', 'elevation', 'of', 'acute', 'phase', 'reactants.'], ['He', 'presents', 'all', 'the', 'indispensable', 'criteria:', 'age', 'equal', 'to', 'or', 'greater', 'than', '50', 'years,', 'bilateral', 'omalgia', 'and', 'increased', 'acute', 'phase', 'reactants.'], ['Of', 'the', 'optional', 'criteria,', 'he', 'presents', 'stiffness,', 'pain', 'or', 'limitation', 'in', 'the', 'hip.'], ['Initial', 'treatment', 'is', 'corticosteroids', 'at', 'medium', 'doses.']]

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415_72

[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'CARDIOVASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'man', 'with', 'a', 'history', 'of', 'febrile', 'illness', 'and', 'chest', 'pain', 'comes', 'to', 'the', 'hospital', 'with', 'dyspnea', 'and', 'tachypnea.'], ['On', 'physical', 'examination', 'his', 'blood', 'pressure', 'is', 'low,', 'jugular', 'venous', 'pressure', 'is', 'elevated', 'with', 'a', 'prominent', 'descending', 'sinus', 'x', 'and', 'he', 'has', 'a', 'paradoxical', 'pulse.'], ['What', 'diagnosis', 'would', 'you', 'suspect?'], ['1-', 'Dilated', 'cardiomyopathy.'], ['2-', 'Pericardial', 'effusion', 'with', 'cardiac', 'tamponade.'], ['3-', 'Constrictive', 'pericarditis.'], ['4-', 'Ischemic', 'heart', 'disease.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['It', 'is', 'the', 'classic', 'exploration:', 'he', 'had', 'a', 'fever', 'and', 'pain,', 'he', 'had', 'pericarditis', 'with', 'effusion,', 'and', 'now', 'this', 'is', 'causing', 'tamponade.'], ['Hence', 'the', 'hypotension', '(his', 'heart', 'cannot', 'fill', 'well', 'with', 'blood', 'and', 'pump),', 'jugular', 'engorgement', 'and', 'dependence', 'on', 'respiration', 'to', 'achieve', 'preload', 'and', 'cardiac', 'output', '(i.e.', 'paradoxical', 'pulse).']]

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560_180

[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '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', 'tests', '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'], ['They', 'give', 'to', 'know', 'of', 'a', 'patient', 'with', 'SLE', 'in', 'treatment', 'with', 'Hydroxychloroquine.'], ['She', 'has', 'a', 'hb', 'of', '7.4', 'and', 'a', 'MCV', 'over', '100,', 'adding', 'pallor', 'and', 'weakness,', 'we', 'would', 'be', 'dealing', 'with', 'a', 'macrocytic', 'anemia.'], ['In', 'my', 'opinion,', 'the', 'most', 'suitable', 'would', 'be', 'alternative', '2,', 'since', 'hydroxyloroquine', 'has', 'been', 'reported', 'to', 'decrease', 'the', 'absorption', 'of', 'folic', 'acid,', 'and', 'since', 'she', 'has', 'a', 'complication', 'of', 'SLE,', 'in', 'this', 'case,', 'we', 'could', 'be', 'dealing', 'with', 'an', 'autoimmune', 'hemolytic', 'anemia', 'with', 'folic', 'acid', 'consumption.'], ['And', 'for', 'this', 'it', 'would', 'be', 'first', 'to', 'determine', 'with', 'the', 'direct', 'coombs.']]

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358_232

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'woman', 'consults', 'after', 'noticing', 'inguinal', 'lymphadenopathies.'], ['The', 'interrogation', 'does', 'not', 'show', 'any', 'local', 'discomfort', 'or', 'data', 'suggestive', 'of', 'sexually', 'transmitted', 'infection.'], ['The', 'examination', 'revealed', 'two', 'lymphadenopathies,', 'one', 'in', 'each', 'groin,', '1', 'cm', 'in', 'diameter,', 'soft,', 'mobile,', 'non-painful.'], ['No', 'skin', 'lesions', 'are', 'seen', 'on', 'the', 'lower', 'limbs,', 'anus', 'or', 'perineum.'], ['Which', 'test', 'do', 'you', 'consider', 'essential?'], ['1-', 'A', 'lupus', 'serology', 'since', 'it', 'is', 'most', 'likely', 'a', 'Treponema', 'pallidum', 'infection.'], ['2-', 'A', 'gynecological', 'examination', 'to', 'rule', 'out', 'ovarian', 'cancer.'], ['3-', 'From', 'the', 'clinical', 'features', 'it', 'seems', 'to', 'be', 'normal', 'lymph', 'nodes', 'and', 'complementary', 'explorations', 'should', 'not', 'be', 'performed.'], ['4-', 'A', 'Paul-Bunell', 'test', 'should', 'be', 'performed', 'to', 'rule', 'out', 'infectious', 'mononucleosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is', '3.'], ['In', 'the', 'inguinal', 'region,', 'the', 'lymph', 'nodes', 'can', 'acquire', 'a', 'size', 'of', 'up', 'to', '1.5', 'cm', 'being', 'normal.'], ['In', 'addition,', 'the', 'rest', 'of', 'the', 'data', 'of', 'the', 'inguinal', 'exploration', '(no', 'pain,', 'mobile,', 'soft,', 'etc.)', 'corroborates', 'this.'], ['On', 'the', 'other', 'hand,', 'there', 'are', 'no', 'signs', 'or', 'symptoms', 'that', 'make', 'us', 'think', 'of', 'a', 'sexually', 'transmitted', 'infection.']]

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414_71

131_221

[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['An', 'individual', 'presents', 'with', '"muscle', 'weakness"', '(spastic', 'hemiparesis)', 'of', 'both', 'right', 'extremities,', 'with', 'hyperreflexia', 'and', "Babinski's", 'sign,', 'along', 'with', 'a', '"facial', 'flaccid', 'paralysis"', 'of', 'the', 'left', 'hemiface,', 'with', 'inability', 'to', 'close', 'the', 'left', 'eye', 'or', 'retract', 'the', 'left', 'side', 'of', 'the', 'mouth,', 'in', 'addition', 'to', 'other', 'alterations.'], ['From', 'the', 'data', 'described,', 'it', 'is', 'an', 'alteration', 'that', 'affects,', 'among', 'other', 'elements,', 'the', 'motor', 'fascicles:', 'cortico-spinal', 'and', 'cortico-nuclear,', 'but', 'at', 'what', 'level', 'of', 'the', 'neuroaxis', 'would', 'the', 'lesion', 'be', 'located?'], ['1-', 'At', 'the', 'level', 'of', 'the', 'area', '4', 'of', 'Brodmann', 'of', 'the', 'cerebral', 'cortex', 'of', 'the', 'right', 'side.'], ['2-', 'In', 'the', 'internal', 'capsule,', 'posterior', 'arm', 'on', 'the', 'right', 'side.'], ['3-', 'In', 'the', 'left', 'cerebral', 'peduncle.'], ['4-', 'In', 'the', 'medial', 'portion', 'of', 'the', 'caudal', 'protuberance', 'of', 'the', 'left', 'side.'], ['5-', 'In', 'the', 'medulla', 'oblongata', 'before', 'decussation', 'of', 'the', 'right', 'cortico-spinal', 'fascicle.'], ['CORRECT', 'ANSWER:', '4'], ['Question', 'always', 'involves', 'the', 'brainstem.'], ['We', 'have', 'a', 'right', 'hemiparesis', 'and', 'involvement', 'of', 'the', 'left', 'facial', 'nucleus,', 'since', 'it', 'has', 'affected', 'the', 'upper', 'and', 'lower', 'facial;', 'therefore', 'we', 'have', 'a', 'crossed', 'clinical', 'picture,', 'having', 'to', 'think', 'about', 'brainstem', 'involvement.'], ['If', 'we', 'have', 'in', 'a', 'quick', 'diagram', 'where', 'the', 'nuclei', 'of', 'the', 'cranial', 'pairs', 'start', 'from:', 'the', 'first', '4', 'above', 'the', 'pons,', 'the', 'next', '4', 'in', 'the', 'pons,', 'and', 'the', 'last', '4', 'below', 'the', 'pons,', 'we', 'have', 'that', 'the', 'facial', 'nucleus', 'is', 'in', 'the', 'middle', '4.'], ['That', 'is,', 'left', 'facial', 'nucleus,', 'left', 'pons,', 'so', 'answer', '4.']]

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70_127

[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY,', 'CRITICAL', 'CARE', 'AND', 'EMERGENCY', 'MEDICINE'], ['CLINICAL', 'CASE:'], ['A', '30-year-old', 'woman', 'with', 'a', 'drug', 'addiction', 'PD', 'in', 'a', 'current', 'detoxification', 'period', 'is', 'brought', 'to', 'the', 'ED', 'with', 'profound', 'somnolence,', 'with', 'no', 'other', 'symptoms.'], ['We', 'find', 'out', 'that', 'her', 'treatment', 'includes', 'olanzapine', 'and', 'benzodiazepines.'], ['What', 'should', 'we', 'do', 'first?'], ['1-', 'Proceed', 'to', 'IOT.'], ['2-', 'Perform', 'a', 'skull', 'X-ray.'], ['3-', 'Administer', 'flumazenil.'], ['4-', 'Administer', 'naloxone.'], ['5-', 'Wait', 'until', 'he', 'wakes', 'up.'], ['CORRECT', 'ANSWER:', '3'], ['Overuse', 'of', 'the', 'drugs', 'he', 'is', 'taking', 'should', 'be', 'suspected.'], ['Olanzapine', 'has', 'no', 'antidote,', 'so,', 'in', 'principle,', 'we', 'should', 'antagonize', 'the', 'effect', 'of', 'benzodiazepines.'], ['If', 'the', 'patient', 'continues', 'to', 'be', 'drowsy', 'and', 'does', 'not', 'respond', 'to', 'stimuli,', 'we', 'should', 'proceed', 'to', 'intubate', 'to', 'secure', 'the', 'airway.']]

[['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', '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', 'I-Claim'], ['O', 'B-Claim', 'I-Claim'], ['O', 'B-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', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim'], ['B-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'], ['B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]

463_71

[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE', 'AND', 'EMERGENCY'], ['CLINICAL', 'CASE:'], ['Woman', 'with', 'hypotension', 'and', 'tissue', 'hypoperfusion', 'in', 'whom', 'the', 'following', 'parameters', 'are', 'objectified', 'after', 'insertion', 'of', 'a', 'Swan-Ganz', 'catheter:', 'cardiac', 'index', '1.4', 'L/min/m2,', 'pulmonary', 'capillary', 'wedge', 'pressure', '25', 'mmHg', 'and', 'systemic', 'vascular', 'resistances', '2000', 'dynes/m2.'], ['The', 'type', 'of', 'shock', 'presented', 'by', 'the', 'patient', 'is:'], ['1-', 'Cardiogenic.'], ['2-', 'Septic.'], ['3-', 'Hypovolemic.'], ['4-', 'Anaphylactic.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['We', 'are', 'not', 'given', 'any', 'further', 'data', 'on', 'the', 'patient', 'except', 'that', 'she', 'is', 'in', 'shock', '(tissue', 'hypoperfusion)', 'and', 'on', 'introducing', 'a', 'Swan-Ganz', 'catheter', 'we', 'find', 'a', 'low', 'cardiac', 'index', '(<2),', 'elevated', 'PCP', '(25mmHg)', 'and', 'elevated', 'systemic', 'resistances', '(normal:', '600-1200', 'dyne/m2).'], ['These', 'data', 'are', 'compatible', 'with', 'cardiogenic', 'origin', 'of', 'shock.']]

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476_93

[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '58-year-old', 'hypertensive', 'man', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'a', '30-second', 'syncope', 'while', 'jogging,', 'with', 'spontaneous', 'recovery', 'and', 'no', 'sequelae.'], ['Blood', 'pressure', 'is', '135/65', 'mmHg.'], ['Cardiac', 'auscultation', 'shows', 'a', 'loud,', 'intense', 'systolic', 'murmur,', 'which', 'is', 'reduced', 'with', 'Valsalva', 'maneuvers', 'and', 'an', 'attenuated', 'second', 'tone.'], ['The', 'ECG', 'shows', 'sinus', 'rhythm', 'at', '72', 'bpm,', 'with', 'criteria', 'of', 'left', 'ventricular', 'hypertrophy', 'and', 'inverted', 'T', 'waves', 'in', 'anterior', 'face.'], ['Point', 'out', 'the', 'correct', 'statement:'], ['1-', 'The', 'clinical', 'picture', 'suggests', 'pulmonary', 'thromboembolism.'], ['2-', 'The', 'data', 'provided', 'indicate', 'hypertrophic', 'cardiomyopathy', 'with', 'severe', 'obstruction', 'of', 'the', 'left', 'ventricular', 'outflow', 'tract.'], ['3-', 'These', 'data', 'correspond', 'to', 'severe', 'aortic', 'stenosis.'], ['4-', 'Aortic', 'dissection', 'should', 'be', 'excluded', 'by', 'contrast-enhanced', 'computed', 'tomography.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'data', 'provided', 'on', 'the', 'characteristics', 'of', 'the', 'murmur', '(it', 'DECREASES', 'with', 'Valsalva)', 'and', 'the', 'data', 'on', 'left', 'ventricular', 'hypertrophy,', 'lead', 'us', 'to', 'the', 'diagnosis', 'of', 'severe', 'aortic', 'stenosis.']]

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546_124

313_177

[['QUESTION', 'TYPE:', 'ONCOLOGY'], ['CLINICAL', 'CASE:'], ['A', '57-year-old', 'patient', 'diagnosed', 'with', 'stage', 'T3N1M0', 'adenocarcinoma', 'of', 'the', 'colon.'], ['He', 'was', 'treated', 'with', 'resection', 'followed', 'by', 'postoperative', 'FOLFOX', 'chemotherapy', '(fluorouracil,', 'leucovorin', 'and', 'oxaliplatin)', 'for', '6', 'months.'], ['In', 'a', 'routine', 'control,', 'two', 'years', 'later,', 'carcinoembryonic', 'antigen', '(CEA)', 'elevation', 'to', '30', 'ng/mL', '(previously', 'less', 'than', '2', 'ng/mL)', 'was', 'detected.'], ['She', 'has', 'no', 'symptoms,', 'physical', 'examination', 'is', 'unremarkable,', 'chest', 'X-ray', 'is', 'normal.'], ['CT', 'scan', 'shows', 'a', '3', 'cm', 'mass', 'in', 'the', 'right', 'hepatic', 'lobe', 'that', 'is', 'captured', 'on', 'PET.'], ['No', 'other', 'alterations', 'are', 'observed', 'in', 'CT', 'or', 'PET.'], ['What', 'is', 'the', 'most', 'correct', 'approach?'], ['1-', 'Chemotherapy', 'with', 'FOLFIRI', '(fluorouracil,', 'leucovorin', 'and', 'irinotecan)', 'plus', 'bevacizumab.'], ['2-', 'Monochemotherapy', 'with', 'capecitabine.'], ['3-', 'Assessment', 'for', 'surgical', 'resection', 'of', 'the', 'hepatic', 'lesion.'], ['4-', 'Hepatic', 'radiotherapy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['We', 'are', 'faced', 'with', 'a', 'situation', 'of', 'probable', 'liver', 'metastasis', 'from', 'a', 'localized', 'colon', 'adenocarcinoma', 'treated', '2', 'years', 'ago.'], ['Probable', 'because', 'we', 'do', 'not', 'have', 'histological', 'confirmation,', 'although', 'as', 'it', 'usually', 'happens,', 'what', 'else', 'could', 'it', 'be?'], ['As', 'this', 'is', 'a', 'situation', 'of', 'oligometastasis', 'and', 'the', 'treatments', 'for', 'advanced', 'colon', 'adenocarcinoma', 'allow', 'prolonged', 'survival', 'with', 'good', 'quality', 'of', 'life', 'in', 'these', 'patients,', 'if', 'there', 'is', 'nothing', 'to', 'contraindicate', 'surgery,', 'this', 'should', 'be', 'the', 'first', 'option', '(correct', 'answer', '3).'], ['I', 'attach', 'the', 'algorithm', 'proposed', 'by', 'the', 'NCCN', 'in', 'situations', 'of', 'recurrence', '(http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf).'], ['In', 'case', 'of', 'an', 'unresectable', 'situation,', 'chemotherapy', 'treatment', 'would', 'be', 'considered', 'with', 'the', 'intention', 'of', 'converting', 'the', 'single', 'metastatic', 'lesion', 'into', 'a', 'resectable', 'one.'], ['Since', 'more', 'than', '12', 'months', 'have', 'passed', 'since', 'FOLFOX', 'treatment,', 'the', 'same', 'scheme', 'could', 'be', 'used,', 'although', 'FOLFIRI+bevacizumab', 'would', 'also', 'be', 'useful.'], ['Capecitabine', 'monotherapy,', 'in', 'the', "patient's", 'current', 'situation,', 'would', 'also', 'not', 'be', 'a', 'good', 'starting', 'option,', 'since', 'the', 'responses', 'are', 'lower', 'compared', 'to', 'FOLFOX', 'or', 'FOLFIRI', 'plus', 'antiangiogenic', 'combinations.'], ['Hepatic', 'radiotherapy', 'could', 'be', 'considered,', 'since', 'there', 'are', 'SBRT', 'techniques', 'that', 'achieve', 'very', 'good', 'results,', 'but', 'in', 'this', 'case', 'it', 'is', 'best', 'to', 'start', 'by', 'asking', 'for', 'an', 'assessment', 'by', 'the', 'surgeons', 'and', 'if', 'they', 'rule', 'out', 'surgery', 'we', 'would', 'consider', 'RT.']]

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482_173

[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'is', 'brought', 'to', 'the', 'ED', 'from', 'a', 'fire', 'occurring', 'inside', 'an', 'enclosed', 'building', 'where', 'polyurethane', 'foams', 'were', 'present.'], ['He', 'is', 'conscious,', 'but', 'presents', 'with', 'increasing', 'mental', 'dullness,', 'headache,', 'and', 'severe', 'dyspnea.'], ['Oxygen', 'saturation', 'by', 'pulse', 'oximetry', 'is', '92%', 'and', 'capillary', 'lactic', 'acid', 'is', '8', 'mEq/l.'], ['What', 'specific', 'treatment', 'do', 'you', 'consider', 'most', 'appropriate?'], ['1-', 'Administration', 'of', 'oxygen', 'by', 'means', 'of', 'a', '50%', 'Venturi', 'type', 'mask.'], ['2-', 'Administration', 'of', 'intravenous', 'hydroxycobalamin.'], ['3-', 'Ventilation', 'with', 'hyperbaric', 'chamber.'], ['4-', 'Fluid', 'therapy', 'with', 'infusion', 'of', 'physiological', 'saline', 'solution', 'at', '21', 'ml/h.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'first', 'thing', 'we', 'need', 'to', 'know', 'is', 'that', 'combustion', 'of', 'polyurethane', 'at', 'high', 'temperature', 'results', 'in', 'the', 'release', 'of', 'cyanide', '(very', 'intuitive,', 'yes).'], ['Knowing', 'this,', 'and', 'that', 'we', 'are', 'dealing', 'with', 'cyanide', 'poisoning,', 'it', 'is', 'easier', 'to', 'answer', 'the', 'question.'], ['Among', 'the', 'basic', 'initial', 'treatment', 'measures', 'would', 'be', 'the', 'administration', 'of', 'oxygen', 'therapy', 'with', 'FiO2', '1', '(not', '0.5', 'as', 'stated', 'in', 'option', '1),', 'and', 'an', 'antidote,', 'in', 'this', 'case', 'hydroxycobalamin', '(this', 'was', 'asked', 'similarly', 'last', 'year).'], ['Ventilation', 'with', 'hyperbaric', 'chamber', 'would', 'only', 'be', 'indicated', 'in', 'case', 'of', 'coexistence', 'of', 'carbon', 'monoxide', '(CO)', 'poisoning.'], ['What', 'is', 'stated', 'in', 'option', '4', 'about', 'fluid', 'therapy', 'is', 'not', 'indicated;', 'in', 'case', 'of', 'associated', 'shock,', 'volume', 'would', 'be', 'administered,', 'but', 'in', 'any', 'case', 'not', 'at', 'that', 'rate,', 'but', 'in', 'rapid', 'boluses.']]

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105_233

73_62

[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY,', 'CRITICAL', 'CARE', 'AND', 'EMERGENCIES'], ['CLINICAL', 'CASE:'], ['A', '37-year-old', 'man', 'with', 'no', 'past', 'history', 'of', 'interest', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'syncope', 'while', 'walking.'], ['He', 'had', 'started', 'two', 'days', 'earlier', 'with', 'dyspnea', 'on', 'exertion.'], ['Examination:', 'weight', '75', 'kg,', 'BP', '75/50', 'mm', 'Hg.'], ['SatO2', '89%.'], ['Pulmonary', 'auscultation', 'was', 'normal.'], ['Cardiac', 'auscultation:', 'rhythmic', 'tachycardic', 'tones', 'at', '130', 'bpm.'], ['Abdomen', 'normal.'], ['Extremities:', 'no', 'alterations.'], ['Normal', 'hemogram.'], ['Troponin', '1.2', 'ng', '/', 'ml.'], ['ECG:', 'Sensual', 'tachycardia', 'at', '130', 'bpm.'], ['Inverted', 'T', 'in', 'V1-V4.'], ['Thoracic', 'CT', 'angiography:', 'repletion', 'defect', 'in', 'both', 'main', 'pulmonary', 'arteries.'], ['One', 'hour', 'after', 'arrival', 'at', 'the', 'emergency', 'room,', 'BP', '70/55', 'mm', 'Hg', 'persists.'], ['What', 'would', 'be', 'the', 'most', 'appropriate', 'initial', 'treatment?'], ['1-', 'Unfractionated', 'heparin,', '10,000U', 'iv', 'on', 'clinical', 'suspicion.', 'Fibrinolysis', 'with', 'tPA', '100', 'mg', 'iv', 'once', 'the', 'diagnosis', 'is', 'confirmed.'], ['2-', 'Enoxaparin:', '80', 'mg', 'sc', 'every', '12', 'hours,', 'starting', 'upon', 'diagnostic', 'suspicion.'], ['3-', 'Enoxaparin;', '80', 'mg', 'sc', 'every', '12', 'hours,', 'starting', 'upon', 'diagnostic', 'confirmation.'], ['4-', 'Fondaparinux:', '7.5', 'mg', 'sc', 'daily.'], ['5-', 'Emergency', 'pulmonary', 'thromboendarterectomy.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'clinical', 'case', 'is', 'a', 'typical', 'pulmonary', 'thromboembolism.'], ['In', 'this', 'case', 'it', 'is', 'associated', 'with', 'persistent', 'arterial', 'hypotension.'], ['Option', '2', 'would', 'be', 'correct', 'if', 'the', 'patient', 'were', 'not', 'hypotensive.'], ['Option', '3', 'is', 'not', 'correct', 'since', 'diagnostic', 'confirmation', 'is', 'not', 'necessary', 'to', 'initiate', 'anticoagulant', 'therapy', 'in', 'case', 'of', 'PTE', 'without', 'hypotension.'], ['Option', '4', 'is', 'not', 'indicated.'], ['Option', '5', 'would', 'be', 'correct', 'only', 'if', 'the', 'patient', 'had', 'a', 'contraindication', 'to', 'fibrinolysis.'], ['Persistent', 'hypotension', 'in', 'PTE', 'is', 'the', 'most', 'widely', 'accepted', 'indication', 'for', 'fibrinolysis,', 'so', 'the', 'correct', 'option', 'is', '1.']]

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538_2

139_166

[['QUESTION', 'TYPE:', 'OTORHINOLARYNGOLOGY', 'AND', 'MAXILLOFACIAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'smoker', 'and', 'heavy', 'drinker', 'with', 'no', 'other', 'history', 'of', 'interest.'], ['The', 'picture', 'he', 'explains', 'is', 'odynodysphagia', 'of', '3', 'months', 'of', 'evolution', 'and', 'left', 'otalgia.'], ['He', 'provides', 'a', "dentist's", 'report', 'that', 'rules', 'out', 'a', 'dental', 'cause.'], ['He', 'also', 'refers', 'to', 'having', 'been', 'visited', 'by', 'different', 'specialists', 'and', 'provides', 'a', 'head', 'and', 'neck', 'CAT', 'scan', '(without', 'iodine', 'contrast)', 'which', 'is', 'reported', 'as', 'normal.'], ['On', 'examination', 'there', 'was', 'a', 'decrease', 'in', 'the', 'propulsive', 'capacity', 'of', 'the', 'tongue;', 'palpation', 'of', 'the', 'base', 'of', 'the', 'left', 'tongue', 'showed', 'an', 'induration', 'of', 'stony', 'consistency', 'of', 'approximately', '3cm', 'and', 'with', 'indirect', 'laryngoscopy', 'no', 'ulceration', 'of', 'the', 'mucosa', 'was', 'observed.'], ['Cervical', 'palpation', 'is', 'negative', 'for', 'lymphadenopathy.'], ['What', 'is', 'your', 'presumptive', 'diagnosis', 'and', 'course', 'of', 'action?'], ['1-', 'Dental', 'cause', '/', 'reevaluation', 'by', 'the', 'dentist.'], ['2-', 'Abscess', 'of', 'the', 'base', 'of', 'the', 'tongue', '/', 'debridement.'], ['3-', 'Ankyloglossia', '/', 'surgical', 'release', 'of', 'the', 'same.'], ['4-', 'Malignant', 'process', 'of', 'oropharynx', '/', 'repeat', 'CT', 'scan', 'and', 'biopsy.'], ['5-', 'Nonspecific', 'inflammation', '/', 'corticosteroid', 'treatment.'], ['CORRECT', 'ANSWER:', '4'], ['We', 'are', 'presented', 'with', 'a', 'patient', 'with', 'risk', 'factors', 'for', 'oropharyngeal', 'cancer,', 'but', 'in', 'whom', 'the', 'examination', 'and', 'tests', 'are', 'normal.'], ['What', 'is', 'going', 'on', 'here?'], ['This', 'question', 'is', 'reverse', 'psychology:', 'what', 'did', 'the', 'questioner', 'want', 'me', 'to', 'know?'], ['This', 'question', 'was', 'asked', 'by', 'an', 'otolaryngologist.'], ['He', 'already', 'tells', 'you', 'that', 'the', 'dentist', '"didn\'t', 'see', 'anything",', 'so', 'he', 'rules', 'out', '1.'], ['It', 'is', 'not', 'an', 'abscess', 'of', 'the', 'base', 'of', 'the', 'tongue', 'either,', 'because', 'in', 'three', 'months', 'it', 'would', 'have', 'killed', 'him:', 'neither', 'is', '2.'], ['So', 'we', 'are', 'left', 'with', 'ankyloglossia,', 'tongue', 'base', 'cancer', 'and', 'non-specific', 'inflammation.'], ['When', 'there', 'is', 'doubt', 'that', 'it', 'could', 'be', 'cancer,', 'we', 'should', 'not', 'fool', 'around', 'and', 'order', 'a', 'new', 'CT', 'scan', 'and', 'biopsy.'], ['Tongue', 'base', 'cancers', 'are', 'very', 'treacherous', 'and', 'it', 'is', 'one', 'of', 'the', 'fears', 'of', 'any', 'otolaryngologist', 'when', 'he', 'suspects', 'a', 'neoplasm.'], ['It', 'is', 'not', 'uncommon', 'for', 'them', 'to', 'arise', 'without', 'exophytic', 'masses', 'or', 'ulcerations', 'of', 'the', 'tongue', 'mucosa', 'and', 'they', 'are', 'difficult', 'to', 'detect', 'on', 'CT', 'when', 'contrast', 'is', 'not', 'used.'], ['The', 'correct', 'answer', 'is', '4', 'and', 'I', 'do', 'not', 'think', 'it', 'can', 'be', 'challenged.']]

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446_130

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '28-year-old', 'man', 'comes', 'to', 'the', 'hospital', 'emergency', 'room', 'with', 'gross', 'hematuria.'], ['Which', 'of', 'the', 'following', 'urinalysis', 'abnormalities', 'would', 'support', 'a', 'diagnosis', 'of', 'glomerulonephritis?'], ['1-', 'Dysmorphic', 'red', 'blood', 'cells', 'and/or', 'hematic', 'casts.'], ['2-', 'Proteinuria', 'of', '1', 'g/day,', 'with', 'negative', 'test', 'strip', 'result', 'and', 'with', 'microalbuminuria', 'greater', 'than', '300', 'mg/24', 'hours.'], ['3-', 'Coexistence', 'of', 'hematuria', 'with', 'pyuria', 'without', 'bacteriuria.'], ['4-', 'Clots', 'in', 'the', 'urine', 'with', 'the', 'naked', 'eye.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Glomerulonephritis', 'is', 'typically', 'associated', 'with', 'dysmorphic', 'red', 'blood', 'cells', 'and', 'hematic', 'casts', 'in', 'the', 'sediment', '(option', '1', 'correct).'], ['Proteinuria', 'can', 'also', 'appear', 'in', 'variable', 'range,', 'although', 'it', 'is', 'not', 'usual', 'in', 'the', 'form', 'of', 'isolated', 'microalbuminuria', '(incorrect', 'option', '2),', 'and', 'hematuria', 'with', 'pyuria', 'although', 'it', 'is', 'not', 'characteristic', '(incorrect', 'option', '3).'], ['Clots', 'usually', 'appear', 'in', 'the', 'context', 'of', 'alterations', 'of', 'the', 'lower', 'urinary', 'tract', '(option', '4', 'incorrect).']]

[['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', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'O', 'B-Disease'], ['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'], ['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', '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'], ['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', 'B-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', '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']]

551_130

383_150

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '12-month-old', 'boy,', 'who', 'in', 'the', 'health', 'examinations', 'performed', 'since', 'birth', 'presents', 'right', 'testicle', 'in', 'the', 'inguinal', 'canal', 'that', 'is', 'not', 'possible', 'to', 'descend', 'to', 'the', 'scrotum.'], ['Mark', 'the', 'correct', 'answer:'], ['1-', 'The', 'most', 'probable', 'diagnosis', 'is', 'retractile', 'testicle.'], ['2-', 'Wait', 'until', 'two', 'years', 'of', 'age', 'for', 'its', 'spontaneous', 'decrease.'], ['3-', 'Human', 'chorionic', 'gonadotropin', 'is', 'the', 'treatment', 'of', 'first', 'choice.'], ['4-', 'The', 'indication', 'for', 'orchidopexy', 'should', 'not', 'be', 'deferred.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['The', 'retractile', 'testicle', 'is', 'characterized', 'by', 'the', 'testicle', 'being', 'permanently', 'outside', 'the', 'scrotal', 'sac,', 'being', 'possible', 'to', 'descend', 'it', 'manually', '(although', 'when', 'it', 'is', 'released', 'it', 'automatically', 'returns', 'to', 'its', 'initial', 'location).'], ['It', 'is', 'usually', 'due', 'to', 'a', 'short', 'pedicle.'], ['In', 'this', 'case', 'we', 'are', 'being', 'told', 'that', 'the', 'teste', 'is', 'always', 'in', 'the', 'inguinal', 'canal', '(cryptorchidism)', 'so', 'we', 'can', 'discard', 'option', '1.'], ['Hormonal', 'treatment', 'with', 'HCG', 'has', 'already', 'fallen', 'into', 'disuse,', 'due', 'to', 'its', 'low', 'efficacy,', 'possibility', 'of', 'reascension', 'and', 'because', 'apoptotic', 'and', 'inflammatory', 'phenomena', 'have', 'been', 'described', 'in', 'the', 'teste', 'associated', 'with', 'its', 'use', '(we', 'discard', 'option', '3).'], ['Orchidopexy', 'is', 'the', 'treatment', 'of', 'choice', 'when', 'we', 'are', 'faced', 'with', 'cryptorchidism,', 'being', 'desirable', 'to', 'perform', 'it', 'between', '6', 'months', 'and', 'one', 'year', 'of', 'age,', 'and', 'should', 'not', 'be', 'deferred', 'beyond', 'two', 'years', 'of', 'age.']]

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614_118

[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '41-year-old', 'male', 'consults', 'for', 'gonalgia', 'of', 'several', "days'", 'evolution.'], ['During', 'the', 'examination,', 'the', 'Thessaly', 'test', '(pain', 'with', 'internal', 'and', 'external', 'rotation', 'movements', 'with', 'the', 'knee', 'flexed)', 'is', 'positive.'], ['Which', 'of', 'the', 'following', 'lesions', 'is', 'most', 'likely', 'to', 'occur?'], ['1-', 'Meniscal', 'injury.'], ['2-', 'Injury', 'by', 'rupture', 'of', 'the', 'anterior', 'cruciate', 'ligament.'], ['3-', 'Injury', 'by', 'rupture', 'of', 'the', 'posterior', 'cruciate', 'ligament.'], ['4-', 'Degenerative', 'arthropathy', 'injury.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['The', 'Thessaly', 'maneuver', 'consists', 'of', 'the', 'patient,', 'using', 'monopodal', 'support', 'and', 'knee', 'flexion', 'of', '5º', 'and', 'then', '20º,', 'performing', 'internal', 'and', 'external', 'rotations', 'of', 'the', 'leg.'], ['In', 'case', 'this', 'reproduces', 'the', 'pain', 'that', 'the', 'patient', 'refers,', 'the', 'test', 'will', 'be', 'considered', 'as', 'positive.'], ['It', 'is', 'a', 'test', 'used', 'for', 'the', 'diagnosis', 'of', 'meniscal', 'pathology', '(sensitivity', 'greater', 'than', '90%', 'and', 'specificity', 'greater', 'than', '95%)', '(Answer', '1', 'correct).']]

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499_182

613_118

[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '41-year-old', 'male', 'consults', 'for', 'gonalgia', 'of', 'several', "days'", 'evolution.'], ['On', 'examination,', 'the', 'Thessaly', 'test', '(pain', 'with', 'internal', 'and', 'external', 'rotation', 'movements', 'with', 'the', 'knee', 'flexed)', 'is', 'positive.'], ['Which', 'of', 'the', 'following', 'injuries', 'is', 'more', 'likely?'], ['1-', 'Meniscal', 'injury.'], ['2-', 'Injury', 'due', 'to', 'rupture', 'of', 'the', 'anterior', 'cruciate', 'ligament.'], ['3-', 'Injury', 'by', 'rupture', 'of', 'the', 'posterior', 'cruciate', 'ligament.'], ['4-', 'Degenerative', 'arthropathy', 'injury.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Thessaly', 'test.', 'Provocation', 'test', 'performed', 'in', 'suspected', 'meniscal', 'injury.']]

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247_117

[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '54-year-old', 'man', 'diagnosed', 'with', 'type', '2', 'diabetes', 'mellitus', 'comes', 'to', 'our', 'office.'], ['He', 'reported', 'a', 'fever', 'of', '40ºC', 'with', 'chills', 'and', 'shivering,', 'arthromyalgia', 'and', 'headache,', 'for', 'which', 'he', 'started', 'treatment', 'with', 'paracetamol.'], ['The', 'symptoms', 'started', '24', 'hours', 'before', 'his', 'return', 'to', 'Spain.'], ['Three', 'days', 'later', 'she', 'presented', 'a', 'generalized', 'maculopapular', 'rash', 'that', 'evolved', 'into', 'more', 'intense', 'petechiae', 'on', 'the', 'lower', 'limbs.'], ['She', 'presented', 'blood', 'tests', 'with', 'leukopenia', 'with', '3,200/mm3', 'and', 'platelets', '91,000/mm3', 'and', 'severe', 'elevation', 'of', 'aminotransferases.'], ['The', 'thick', 'blood', 'drop,', 'peripheral', 'blood', 'smear,', 'PCR', 'and', 'malaria', 'antigen', 'are', 'negative.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Coronavirus', 'infection.'], ['2-', 'Lymphocytic', 'choriomeningitis.'], ['3-', 'Dengue.'], ['4-', 'Chikungunya', 'virus', 'infection.'], ['5-', 'Saint', 'Louis', 'encephalitis.'], ['CORRECT', 'ANSWER:', '3'], ['It', 'is', 'striking', 'in', 'this', 'question', 'that', 'we', 'are', 'told', 'that', 'our', 'patient', 'has', 'returned', 'to', 'Spain,', 'but', 'not', 'from', 'where', '(which', 'could', 'help', 'us', 'to', 'make', 'digressions', 'about', 'the', 'possible', 'cause).'], ['However,', 'the', 'description', 'of', 'the', 'picture', 'is', 'very', 'exhaustive', 'as', 'well', 'as', 'typical,', 'so', 'the', 'question', 'is', 'easy.'], ['It', 'is', 'a', 'disease', 'that', 'produces', 'fever,', 'arthralgias', 'and', 'a', 'generalized', 'exanthema', 'with', 'petechiae', 'on', 'the', 'lower', 'limbs.'], ['The', 'CBC', 'shows', 'leukopenia', 'accompanied', 'by', 'plateletopenia', 'and', 'elevated', 'transaminases.'], ['Malaria', 'has', 'been', 'ruled', 'out', 'as', 'a', 'possible', 'cause.'], ['All', 'the', 'data', 'are', 'highly', 'suggestive', 'of', 'Dengue,', 'especially', 'the', 'plateletopenia', 'and', 'petechiae', '(suggestive', 'of', 'capillary', 'fragility),', 'answer', '3', 'correct.']]

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88_56

[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'VASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'woman', 'with', 'a', 'history', 'of', 'hypertension', 'treated', 'with', 'amlodipine', 'was', 'admitted', '3', 'months', 'ago', 'for', 'heart', 'failure', 'and', 'atrial', 'fibrillation.'], ['She', 'came', 'to', 'your', 'office', 'for', 'a', 'cardiological', 'check-up.'], ['The', 'discharge', 'report', 'shows', 'the', 'result', 'of', 'the', 'echocardiogram', 'showing', 'moderate', 'left', 'ventricular', 'dysfunction', 'and', 'the', 'discharge', 'treatment:', 'amlodipine', 'was', 'discontinued', 'and', 'furosemide', 'and', 'enalapril', 'were', 'started.'], ['The', 'patient', 'reports', 'feeling', 'better,', 'without', 'fatigue', 'and', 'with', 'less', 'leg', 'edema,', 'but', 'she', 'is', 'still', 'not', 'completely', 'well.'], ['Physical', 'examination', 'showed', 'no', 'signs', 'of', 'heart', 'failure,', 'but', 'her', 'blood', 'pressure', 'and', 'heart', 'rate', 'were', '150/90', 'mmHg', 'and', '120', 'bpm,', 'respectively.'], ['The', 'ECG', 'shows', 'atrial', 'fibrillation', 'at', '110-120', 'bpm.'], ['Which', 'treatment', 'is', 'most', 'likely', 'to', 'improve', 'symptoms', 'and', 'reduce', 'mortality', 'from', 'cardiovascular', 'events?'], ['1-', 'Digoxin', 'and', 'acetylsalicylic', 'acid.'], ['2-', 'Atenolol', 'and', 'acetylsalicylic', 'acid.'], ['3-', 'Verapamil', 'and', 'acenocoumarol.'], ['4-', 'Carvedilol', 'and', 'acenocoumarol.'], ['5-', 'Carvedilol', 'and', 'clopidogrel.'], ['CORRECT', 'ANSWER:', '4'], ['Typical', 'very', 'long', 'and', 'rambling', 'question', 'but', 'not', 'really', 'too', 'complicated...'], ['The', 'patient', 'is', 'in', 'heart', 'failure', 'with', 'moderate', 'ventricular', 'dysfunction', 'and', 'also', 'presents', 'atrial', 'fibrillation;', 'she', 'has', 'criteria', 'for', 'anticoagulation,', 'and', 'between', 'the', 'two', 'options', 'that', 'include', 'acenocoumarol', 'we', 'are', 'inclined', 'to', 'choose', 'option', '4,', 'since', 'it', 'includes', 'carvedilol,', 'a', 'drug', 'that', 'has', 'been', 'shown', 'to', 'increase', 'survival', 'in', 'heart', 'failure.'], ['Verapamil', '(and', 'calcium', 'antagonists', 'in', 'general)', 'are', 'contraindicated', 'in', 'systolic', 'heart', 'failure:', 'they', 'do', 'not', 'increase', 'survival', '(they', 'even', 'increase', 'morbidity', 'and', 'mortality)', 'and', 'specifically', 'the', 'non-dihydropyridines', '(verapamil', 'and', 'diltiazem)', 'should', 'not', 'be', 'associated', 'with', 'beta-blockers', 'due', 'to', 'the', 'increased', 'risk', 'of', 'conduction', 'system', 'blockade.']]

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536_122

[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['75-year-old', 'male,', 'hypertensive', 'on', 'treatment', 'with', 'enalapril', '(20', 'mg/day),', 'who', 'consults', 'for', 'deterioration', 'of', 'general', 'condition,', 'bitemporal', 'headache', 'and', 'mandibular', 'claudication', 'of', '3', 'weeks', 'of', 'evolution.'], ['In', 'addition,', 'in', 'the', 'last', 'hours,', 'he', 'refers', 'two', 'episodes', 'of', 'amaurosis', 'fugax', 'of', 'the', 'left', 'eye.'], ['Physical', 'examination', 'revealed', 'thickening', 'and', 'absence', 'of', 'pulse', 'in', 'the', 'left', 'temporal', 'artery.'], ['Analysis:', 'CRP', '6', 'mg/dl', '(VN', '<1);', 'hemoglobin', '10.5', 'g/dl;', 'ESR', '92', 'mm.'], ['Chest', 'X-ray', 'normal.'], ['Considering', 'the', 'most', 'likely', 'diagnosis,', 'check', 'the', 'correct', 'option', 'regarding', 'treatment:'], ['1-', 'Rituximab', 'should', 'be', 'administered,', 'since', 'glucocorticoids', 'have', 'been', 'relegated', 'to', 'second-line', 'treatment', 'due', 'to', 'their', 'side', 'effects.'], ['2-', 'Tocilizumab', 'has', 'been', 'shown', 'to', 'be', 'effective', 'in', 'reducing', 'recurrences', 'and', 'cumulative', 'prednisone', 'dose', 'in', 'more', 'than', '50%', 'of', 'patients.'], ['3-', 'In', 'the', 'presence', 'of', 'ischemic', 'symptoms,', 'and', 'in', 'order', 'not', 'to', 'worsen', 'the', 'vascular', 'risk', 'of', 'the', 'patient,', 'the', 'use', 'of', 'glucocorticoids', 'at', 'doses', 'higher', 'than', '30', 'mg/day', 'should', 'be', 'avoided.'], ['4-', 'In', 'conjunction', 'with', 'glucocorticoid', 'boluses', 'of', '1', 'g/day,', 'infliximab', 'should', 'be', 'used', 'as', 'a', 'first-line', 'drug', 'for', 'remission', 'induction.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Clinical', 'case', 'of', 'giant', 'cell', 'arteritis.'], ['Corticosteroid', 'therapy', 'remains', 'the', 'first', 'choice', '(answer', '1', 'incorrect),', 'to', 'be', 'administered', 'as', 'pulses', '(doses', 'differ', 'according', 'to', 'the', 'literature,', 'but', 'at', 'least', '125', 'mg/d)', 'in', 'case', 'of', 'ocular', 'involvement', '(answer', '3', 'incorrect).'], ['The', 'current', 'treatment', 'of', 'choice', 'for', 'corticosteroid', 'sparing', 'is', 'Tocilizumab', '(answer', '4', 'incorrect),', 'which', 'has', 'also', 'been', 'shown', 'to', 'reduce', 'recurrences', '(answer', '2', 'correct).']]

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492_107

[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['An', '18-year-old', 'patient', 'who', '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/μL,', 'Hb', '12.3', 'g/dL,', 'platelets', '6.0', 'x103/μL.'], ['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', 'likely', 'diagnosis?'], ['1-', 'Thrombotic', 'thrombocytopenic', 'purpura.'], ['2-', 'Disseminated', 'intravascular', 'coagulation.'], ['3-', 'Thrombocytopenia', 'induced', 'by', 'infection.'], ['4-', 'Primary', 'immune', 'thrombocytopenia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['This', 'is', 'an', 'easy', 'clinical', 'case', 'only', 'presenting', 'thrombopenia', 'with', 'clinic,', 'petechiae', 'and', 'epistaxis.'], ['1', 'is', 'false,', 'there', 'would', 'be', 'fever,', 'hemolysis', 'data,', 'neurological', 'symptoms,', 'in', 'the', 'smear', 'there', 'would', 'be', 'schistocytes.'], ['In', '2', 'the', 'coagulation', 'must', 'be', 'altered', 'and', 'in', 'this', 'case', 'it', 'is', 'not', 'mentioned.']]

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599_183

[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman', 'with', 'no', 'history', 'of', 'interest', 'consults', 'for', 'dyspneic', 'sensation', 'of', 'about', '4', 'days', 'of', 'evolution.'], ['Examination', 'shows', 'rhythmic', 'tachycardia,', 'without', 'murmurs', 'and', 'pulmonary', 'auscultation', 'is', 'normal.'], ['Arterial', 'blood', 'gases', 'showed', 'a', 'pO2', 'of', '70', 'mmHg', 'and', 'a', 'pCO2', 'of', '32', 'mmHg.'], ['Hemogram,', 'renal', 'and', 'hepatic', 'function', 'are', 'normal.'], ['Prothrombin', 'time', '90%,', 'activated', 'partial', 'thromboplastin', 'time', '(APTT)', 'ratio', 'of', '2', 'to', 'control', '(N', '<1.2).'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Antiphospholipid', 'syndrome.'], ['2-', 'Factor', 'V', 'of', 'Leiden.'], ['3-', 'Hemophilia.'], ['4-', 'Acute', 'pericarditis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['In', 'this', 'clinical', 'case,', 'we', 'are', 'presented', 'with', 'a', 'woman', 'who', 'rapidly', 'presents', 'dyspnea', 'with', 'hypoxemia,', 'a', 'picture', 'compatible', 'with', 'pulmonary', 'thromboembolism.'], ['The', 'prothrombin', 'time', 'of', '90%', 'and', 'the', 'aPTT', 'with', 'a', 'ratio', 'of', '2,', 'is', 'translating', 'a', 'coagulation', 'problem;', 'and', 'antiphospholipid', 'antibodies', 'can', 'be', 'detected', 'through', 'the', 'prolongation', 'of', 'phospholipid-dependent', 'coagulation', 'tests,', 'correct', 'answer', '1.'], ['On', 'the', 'other', 'hand,', 'although', 'factor', 'V', 'Leiden', 'has', 'been', 'identified', 'as', 'a', 'common', 'cause', 'of', 'familial', 'thrombosis,', 'it', 'would', 'not', 'alter', 'the', 'clotting', 'time.'], ['In', 'the', 'case', 'of', 'hemophilia', 'there', 'would', 'be', 'a', 'problem', 'in', 'blood', 'coagulation', 'but', 'it', 'is', 'not', 'a', 'frequent', 'cause', 'of', 'thromboembolism.'], ['Finally,', 'although', 'acute', 'pericarditis', 'could', 'manifest', 'itself', 'in', '4', 'days', 'and', 'with', 'tachycardia,', 'the', 'rest', 'of', 'the', 'symptoms', 'or', 'analytical', 'parameters', 'are', 'not', 'characteristic.']]

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134_169

[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'man', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'pain', 'in', 'his', 'right', 'eye', 'of', '3', "days'", 'evolution.'], ['Biomicroscopic', 'examination', 'of', 'the', 'anterior', 'segment', 'shows,', 'after', 'fluorescein', 'staining,', 'a', 'central', 'corneal', 'ulcer', 'in', 'the', 'form', 'of', 'a', 'dendrite.'], ['What', 'is', 'the', 'diagnosis?'], ['1-', 'Herpetic', 'keratitis.'], ['2-', 'Corneal', 'abrasion.'], ['3-', 'Fungal', 'keratitis.'], ['4-', 'Bacterial', 'keratitis.'], ['5-', 'Glaucomatocyclic', 'crisis.'], ['CORRECT', 'ANSWER:', '1'], ['Dendritic', 'corneal', 'ulcer', 'is', 'typical', 'of', 'herpes', 'simplex', 'keratitis.'], ['It', 'presents', 'with', 'pain,', 'not', 'too', 'striking,', 'and', 'scarce', 'or', 'absent', 'red', 'eye.'], ['There', 'are', 'ulcers', 'resembling', 'dendrites', 'that', 'may', 'confuse', 'us', 'in', 'the', 'diagnosis.'], ['These', 'pseudodendrites', 'are', 'found', 'in', 'herpes', 'Zoster', 'and', 'in', 'corneal', 'abrasions', 'in', 'resolution.'], ['Although', 'in', 'practice', 'we', 'should', 'pay', 'attention', 'to', 'the', 'shape', 'of', 'the', 'dendrite', '(the', 'true', 'dendrite', 'is', 'deeper', 'and', 'has', 'terminal', 'bulbs', 'at', 'the', 'end', 'of', 'each', 'branch),', 'and', 'pay', 'attention', 'to', 'the', 'evolution', 'of', 'the', 'pain', '(in', 'the', 'pseudodendrite', 'after', 'abrasion', 'the', 'pain', 'should', 'improve),', 'when', 'answering', 'a', 'MIR', 'question', 'it', 'is', 'simpler:', 'if', 'it', 'is', 'a', 'dendrite,', 'the', 'first', 'thing', 'we', 'have', 'to', 'think', 'is', 'herpes.'], ['Fungal', 'and', 'bacterial', 'keratitis', 'have', 'corneal', 'infiltrates.'], ['And', 'glaucomatocyclitic', 'crisis', '(Posner', 'Schlossman', 'syndrome)', 'is', 'a', 'type', 'of', 'idiopathic', 'hypertensive', 'anterior', 'uveitis,', 'which', 'does', 'not', 'present', 'with', 'ulceration.']]

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245_115

[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'undergoing', 'chemotherapy', 'for', 'leukemia', 'is', 'admitted', 'for', 'pneumonia', 'for', 'which', 'treatment', 'with', 'cefepime', 'has', 'been', 'prescribed.'], ['A', 'chest', 'X-ray/CT', 'scan', 'shows', 'an', 'infiltrate', 'with', 'halo', 'sign', 'and', 'crescentic', 'meniscus.'], ['The', 'lesion', 'is', 'peripheral', 'and', 'a', 'transthoracic', 'puncture', 'is', 'indicated', 'for', 'sampling.'], ['Pending', 'definitive', 'histologic', 'and', 'microbiologic', 'results,', 'what', 'antimicrobial', 'would', 'you', 'add', 'to', 'the', 'treatment?'], ['1-', 'Ganciclovir.'], ['2-', 'Caspofungin.'], ['3-', 'Fluconazole.'], ['4-', 'Piperacillin-tazobactam.'], ['5-', 'Voriconazole.'], ['CORRECT', 'ANSWER:', '5'], ['Direct', 'response', 'question.'], ['This', 'is', 'a', 'patient', 'undergoing', 'chemotherapy', 'with', 'respiratory', 'symptoms', 'and', 'the', '"halo', 'sign"', 'on', 'X-ray,', 'very', 'suggestive', 'of', 'invasive', 'pulmonary', 'aspergillosis.'], ['Treatment', 'is', 'with', 'voriconazole.'], ['Aspergillus', 'is', 'resistant', 'to', 'fluconazole,', 'so', 'it', 'would', 'not', 'be', 'a', 'valid', 'option.']]

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387_156

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '5-month-old', 'infant', 'exclusively', 'breastfed', 'until', 'the', 'present,', 'who', 'due', 'to', 'maternal', 'work', 'was', 'introduced', 'a', 'bottle', 'with', 'formula', 'and', 'a', 'few', 'days', 'ago', 'was', 'added', 'cereals', 'with', 'and', 'without', 'gluten.'], ['Family', 'history:', '28-year-old', 'mother', 'with', 'asthma,', '32-year-old', 'healthy', 'father', 'and', '5-year-old', 'brother', 'with', 'celiac', 'disease', 'and', 'atopic', 'dermatitis.'], ['As', 'personal', 'history,', 'pregnancy', 'without', 'incidents', 'and', 'delivery', 'by', 'cesarean', 'section,', 'having', 'been', 'offered', 'a', 'bottle', 'with', 'starter', 'formula', 'on', 'the', 'first', 'day', 'of', 'life', 'in', 'the', 'maternity', 'ward.'], ['Since', 'a', 'few', 'days', 'ago', 'she', 'starts', 'with', 'abdominal', 'distension,', 'diarrhea', 'stools,', 'refusal', 'to', 'feed,', 'peribuccal', 'erythema', 'with', 'longer', 'duration', 'after', 'bottle', 'feeding', 'and', 'lately', 'vomiting', 'after', 'feeding,', 'tolerating', 'well', 'the', 'breast.'], ['What', 'is', 'the', 'most', 'probable', 'diagnosis?'], ['1-', 'Celiac', 'disease.'], ['2-', 'Acute', 'gastroenteritis.'], ['3-', "Cow's", 'milk', 'protein', 'allergy.'], ['4-', 'Bottle', 'allergy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Child', 'with', 'multiple', 'family', 'history', 'of', 'allergy', '(asthma,', 'atopy),', 'who', 'has', 'received', 'artificial', 'milk', 'in', 'the', 'first', 'hours', 'of', 'life', '(sensitization', 'to', "cow's", 'milk', 'protein)', 'and', 'who,', 'coinciding', 'with', 'the', 'intake', 'of', 'artificial', 'milk,', 'starts', 'digestive', 'symptoms', 'and', 'exanthema', '=', 'APLV.']]

[['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'], ['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'], ['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', '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', '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', 'O', 'B-Claim']]

41_139

[['QUESTION', 'TYPE:', 'OTORHINOLARYNGOLOGY', 'AND', 'MAXILLOFACIAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['Given', 'a', 'patient', 'with', 'poor', 'general', 'condition,', 'fever', '(axillary', 'temperature', '39.5º),', 'bilateral', 'submandibular', 'swelling', 'of', 'six', "days'", 'evolution,', 'mouth', 'pain', 'and', 'trismus,', 'which', 'of', 'the', 'following', 'statements', 'is', 'correct?'], ['1-', 'The', 'first', 'diagnostic', 'probability', 'is', 'carcinoma', 'of', 'the', 'floor', 'of', 'the', 'mouth', 'with', 'bilateral', 'cervical', 'metastases.'], ['2-', 'The', 'therapeutic', 'priority', 'is', 'to', 'ensure', 'the', "patient's", 'nutrition.'], ['3-', 'We', 'are', 'almost', 'certainly', 'facing', 'a', 'mediastinitis.'], ['4-', 'We', 'must', 'consider', 'as', 'a', 'priority', 'the', 'risk', 'of', 'airway', 'obstruction.'], ['5-', 'We', 'must', 'perform', 'as', 'a', 'first', 'diagnostic', 'measure', 'a', 'cytology', 'by', 'fine', 'needle', 'aspiration', 'puncture.'], ['CORRECT', 'ANSWER:', '4'], ['This', 'patient', 'is', 'in', 'serious', 'condition.'], ['The', 'trismus', 'and', 'fever', 'suggest', 'a', 'deep', 'cervical', 'space', 'infection', 'and', 'that', 'is', 'not', 'a', 'game', 'because', 'the', 'airway', 'can', 'become', 'obstructed.'], ['Knowing', 'this,', 'options', '1,', '2', 'and', '5', 'are', 'out', 'of', 'place', 'and', 'I', 'am', 'left', 'with', '3', 'and', '4.'], ['There', 'may', 'already', 'be', 'mediastinitis;', 'after', 'all,', 'that', 'is', 'the', 'natural', 'history', 'of', 'cervical', 'deep', 'space', 'infections,', 'but', 'answer', '4', 'is', 'more', 'correct', 'and', 'besides,', 'we', 'are', 'in', 'the', 'ENT', 'block,', 'the', 'airway', 'specialty.'], ['I', 'like', 'this', 'question', 'because', 'it', 'requires', 'knowledge', 'that', 'is', 'important', 'in', 'clinical', 'practice.']]

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385_153

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis', 'of', 'a', 'newborn', 'with', 'microcephaly,', 'intrauterine', 'growth', 'retardation,', 'congenital', 'heart', 'disease,', 'vertical', 'talus', 'foot', 'and', 'a', 'peculiar', 'facies', '(microphthalmia,', 'small', 'palpebral', 'fissures,', 'micrognathia', 'and', 'dysplastic', 'ears),', 'hands', 'with', 'the', 'index', 'and', 'little', 'finger', 'above', 'the', 'middle', 'and', 'ring', 'fingers?'], ['1-', 'Trisomy', '18', "(Edwards'", 'syndrome).'], ['2-', 'Trisomy', '13', "(Patau's", 'syndrome).'], ['3-', 'Trisomy', '21', '(Down', 'syndrome).'], ['4-', 'Trisomy', '9.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['You', 'are', 'faithfully', 'describing', 'an', "Edwards'", 'syndrome.'], ['Although', 'the', 'cardiopathies', 'and', 'the', 'alteration', 'of', 'the', 'foot', 'that', 'he', 'describes', 'are', 'common', 'to', 'several', 'chromosomopathies,', 'the', 'alteration', 'of', 'the', 'fingers', 'and', 'toes', 'is', 'very', 'characteristic', 'of', "Edwards'", 'syndrome.']]

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194_162

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '3-year-old', 'girl', 'from', 'Bangladesh', 'consults', 'for', 'intermittent', 'febrile', 'episodes', 'of', '3', "weeks'", 'duration,', 'associated', 'with', 'weakness', 'and', 'loss', 'of', 'appetite.'], ['Physical', 'examination', 'showed', 'marked', 'splenomegaly', 'and', 'mucocutaneous', 'pallor.'], ['Complementary', 'tests', 'include:', 'hemoglobin', '8.5', 'mg/dL,', 'hematocrit', '26%,', 'MCV', '86', 'fL,', 'MCH', '29', 'pg,', 'leukocytes', '2800/mL', 'with', '300', 'neutrophils', '/ml,', 'platelets', '54000/ml,', 'GOT', '85', 'U/l,', 'GPT92', 'U/l', 'and', 'polyclonal', 'hypergammaglobulinemia', 'in', 'serum', 'proteinogram.'], ['Indicate', 'the', 'most', 'probable', 'diagnosis', 'with', 'the', 'data', 'available', 'at', 'this', 'time:'], ['1-', 'Acute', 'lymphoblastic', 'leukemia.'], ['2-', "Burkitt's", 'lymphoma.'], ['3-', 'Visceral', 'leishmaniasis.'], ['4-', 'Miliary', 'tuberculosis.'], ['5-', 'Chronic', 'malaria.'], ['CORRECT', 'ANSWER:', '3'], ['Data', 'such', 'as', 'pancytopenia', 'and', 'hypergammaglobulinemia', 'are', 'very', 'characteristic', 'of', 'kala-azar.'], ['The', 'origin', 'of', 'the', 'girl', 'is', 'also', 'indicative', 'of', 'this', 'diagnosis,', 'although', 'it', 'is', 'a', 'disease', 'that', 'also', 'occurs', 'in', 'the', 'Mediterranean', 'area.'], ['In', 'the', 'differential', 'diagnosis,', 'it', 'is', 'important', 'to', 'keep', 'in', 'mind', 'the', 'possibility', 'of', 'leukosis.']]

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371_126

283_56

109_149

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '32-year-old', 'asymptomatic', 'woman', 'goes', 'for', 'a', 'gynecological', 'health', 'check-up', 'because', 'she', 'wishes', 'to', 'become', 'pregnant.'], ['During', 'this', 'check-up,', 'a', '4cm', 'uterine', 'myoma', 'is', 'detected,', 'partly', 'intramural', 'and', 'partly', 'subserosal,', 'located', 'on', 'the', 'anterior', 'aspect', 'of', 'the', 'uterus', 'and', 'which', 'does', 'not', 'deform', 'the', 'endometrial', 'cavity.'], ['What', 'approach', 'would', 'you', 'recommend?'], ['1-', 'Laparoscopic', 'myomectomy.'], ['2-', 'Laparotomic', 'myomectomy.'], ['3-', 'Myoma', 'embolization', 'by', 'arterial', 'catheterization.'], ['4-', 'Treatment', 'with', 'Gn-Rh', 'analogues', 'for', 'three', 'months', 'before', 'attempting', 'pregnancy.'], ['5-', 'Attempting', 'pregnancy', 'without', 'any', 'previous', 'treatment.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'correct', 'answer', 'is', '5.'], ['An', 'asymptomatic', 'myoma', 'of', 'this', 'size', 'that', 'does', 'not', 'deform', 'the', 'endometrial', 'cavity', 'is', 'not', 'a', 'problem', 'for', 'pregnancy.']]

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92_235

[['QUESTION', 'TYPE:', 'PALLIATIVE', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'patient', 'diagnosed', 'with', 'breast', 'neoplasia', '10', 'years', 'ago.'], ['She', 'underwent', 'treatment', 'with', 'radiochemotherapy', 'and', 'then', 'hormonal', 'therapy', 'for', '5', 'years.'], ['A', 'bone', 'scan', 'study', 'performed', 'for', 'polytopic', 'bone', 'pain', 'showed', 'the', 'presence', 'of', 'bone', 'metastases.'], ['She', 'is', 'currently', 'under', 'treatment', 'with', 'minor', 'opioids', 'and', 'NSAIDs', 'with', 'good', 'pain', 'control.'], ['She', 'consulted', 'for', 'headache', 'that', 'did', 'not', 'subside', 'with', 'the', 'current', 'analgesia', 'and', 'a', 'CT', 'scan', 'of', 'the', 'brain', 'showed', 'images', 'compatible', 'with', 'brain', 'metastases.'], ['In', 'relation', 'to', 'the', 'treatment', 'of', 'pain,', 'indicate', 'the', 'CORRECT', 'one:'], ['1-', 'Switch', 'to', 'major', 'opioids.'], ['2-', 'Extra', 'doses', 'of', 'opioids', 'should', 'be', 'administered', 'as', 'necessary.'], ['3-', 'Corticoids', 'should', 'be', 'added.'], ['4-', 'Switch', 'to', 'a', 'major', 'opioid', 'and', 'maintain', 'NSAIDs.'], ['5-', 'The', 'patient', 'should', 'be', 'admitted', 'for', 'intravenous', 'treatment', 'with', 'major', 'opioid.'], ['CORRECT', 'ANSWER:', '3'], ['Brain', 'metastases', 'produce', 'pain', 'due', 'to', 'cranial', 'hypertension.'], ['The', 'treatment', 'of', 'choice', 'is', 'corticosteroids.'], ['Dexamethasone', 'in', 'oral', 'doses', 'of', '4', 'to', '16', 'mg/day', 'is', 'the', 'treatment', 'of', 'choice.']]

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342_158

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'woman,', 'primigestation,', 'suffers', 'a', 'spontaneous', 'abortion', 'at', '7', 'weeks', 'of', 'gestation.'], ['The', 'anatomopathological', 'study', 'of', 'the', 'abortive', 'remains', 'indicates', 'molar', 'disease.'], ['We', 'should', 'inform', 'you', 'that:'], ['1-', 'The', 'risk', 'of', 'a', 'new', 'molar', 'gestation', 'in', 'a', 'future', 'pregnancy', 'is', '50%.'], ['2-', 'She', 'should', 'not', 'become', 'pregnant', 'until', 'she', 'has', 'undergone', 'periodic', 'controls', 'and', 'has', 'spent', 'one', 'year', 'with', 'negative', 'BHCG', 'levels.'], ['3-', 'Subsequent', 'controls', 'are', 'not', 'necessary', 'if', 'the', 'evacuation', 'of', 'the', 'trophoblastic', 'tissue', 'was', 'complete.'], ['4-', 'It', 'is', 'necessary', 'to', 'carry', 'out', 'periodic', 'controls', 'since', '40%', 'of', 'the', 'cases', 'will', 'develop', 'a', 'gestational', 'trophoblastic', 'neoplasia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Gestational', 'trophoblastic', 'disease', 'should', 'be', 'followed', 'up', '(regardless', 'of', 'whether', 'the', 'evacuation', 'has', 'been', 'complete', 'or', 'not)', 'and', 'the', 'patient', 'should', 'be', 'advised', 'not', 'to', 'become', 'pregnant', 'again', 'until', 'at', 'least', '6', 'months', 'with', 'negative', 'BHCG', 'titers.'], ['The', 'risk', 'of', 'recurrence', 'in', 'another', 'pregnancy', 'is', 'low', '(1/55)', 'and', '90%', 'of', 'cases', 'progress', 'satisfactorily', 'without', 'developing', 'neoplasia.']]

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357_232

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'woman', 'consults', 'after', 'noticing', 'inguinal', 'lymphadenopathy.'], ['The', 'interrogation', 'does', 'not', 'reveal', 'any', 'local', 'discomfort', 'or', 'data', 'suggestive', 'of', 'sexually', 'transmitted', 'infection.'], ['The', 'examination', 'revealed', 'two', 'lymphadenopathies,', 'one', 'in', 'each', 'groin,', '1', 'cm', 'in', 'diameter,', 'soft,', 'mobile,', 'non-painful.'], ['No', 'skin', 'lesions', 'are', 'seen', 'on', 'the', 'lower', 'limbs,', 'anus', 'or', 'perineum.'], ['Which', 'test', 'do', 'you', 'consider', 'essential?'], ['1-', 'A', 'lues', 'serology', 'since', 'it', 'is', 'most', 'likely', 'a', 'Treponema', 'pallidum', 'infection.'], ['2-', 'A', 'gynecological', 'examination', 'to', 'rule', 'out', 'ovarian', 'cancer.'], ['3-', 'By', 'the', 'clinical', 'characteristics', 'it', 'seems', 'to', 'be', 'normal', 'lymph', 'nodes', 'and', 'complementary', 'explorations', 'should', 'not', 'be', 'done.'], ['4-', 'A', 'Paul-Bunell', 'test', 'should', 'be', 'performed', 'to', 'rule', 'out', 'infectious', 'mononucleosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'presence', 'of', 'inguinal', 'nodes', 'up', 'to', '1-1.5cm', 'may', 'be', 'normal', 'in', 'the', 'absence', 'of', 'symptoms.'], ['In', 'this', 'case,', 'they', 'are', 'very', 'nonspecific', 'nodes,', 'without', 'signs', 'of', 'malignancy', '(mobile,', 'soft,', 'not', 'painful)', 'that', 'do', 'not', 'lead', 'us', 'to', 'suspect', 'neoplastic', 'infiltration', 'and', 'the', 'lack', 'of', 'other', 'clinical', 'signs', 'also', 'leads', 'us', 'to', 'rule', 'out', 'the', 'presence', 'of', 'STD.']]

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596_121

[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['79-year-old', 'woman', 'admitted', 'for', 'an', 'osteoporotic', 'hip', 'fracture.'], ['Regarding', 'secondary', 'prevention', 'of', 'fragility', 'fractures,', 'point', 'out', 'the', 'WRONG', 'answer:'], ['1-', 'Low', 'adherence', 'to', 'treatment', 'is', 'associated', 'with', 'an', 'increased', 'risk', 'of', 'fracture.'], ['2-', 'Bone', 'remodeling', 'markers', 'may', 'be', 'useful', 'for', 'early', 'monitoring', 'of', 'response', 'to', 'treatment.'], ['3-', 'Vitamin', 'D', 'monotherapy', 'is', 'effective', 'in', 'reducing', 'such', 'fractures', 'in', 'non-institutionalized', 'elderly.'], ['4-', 'Increasing', 'dietary', 'calcium', 'or', 'taking', 'calcium', 'supplements', 'alone', 'does', 'not', 'protect', 'against', 'the', 'occurrence', 'of', 'fractures.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['This', 'question', 'corresponds', 'to', 'the', 'section', 'on', 'traumatology;', 'however,', 'it', 'could', 'be', 'answered', 'with', 'knowledge', 'of', 'rheumatology', 'and', 'with', 'the', 'osteoporosis', 'recommendations', 'of', 'the', 'Spanish', 'Society', 'of', 'Rheumatology.'], ['In', 'osteoporosis,', 'one', 'of', 'the', 'main', 'risks', 'associated', 'with', 'increased', 'fracture', 'risk', 'is', 'low', 'adherence', 'to', 'treatment,', 'so', 'answer', '1', 'is', 'correct.'], ['Answer', '2', 'is', 'found', 'in', 'the', 'SER', 'guidelines,', 'which', 'confirm', 'that', 'some', 'studies', 'conclude', 'that', 'bone', 'remodeling', 'markers', 'can', 'be', 'useful', 'for', 'early', 'monitoring', 'of', 'adherence', 'and', 'response', 'to', 'treatment.'], ['Answer', '4', 'is', 'correct', 'because', 'again', 'in', 'the', 'SER', '2019', 'guidelines', 'they', 'quote:', '"The', 'current', 'scientific', 'evidence', 'allows', 'us', 'to', 'affirm', 'that', 'neither', 'increasing', 'dietary', 'calcium', 'nor', 'taking', 'calcium', 'supplements', 'alone', 'protects', 'against', 'the', 'appearance', 'of', 'fractures".'], ['Therefore,', 'the', 'correct', 'answer', 'to', 'this', 'question', 'is', 'option', '3.'], ['Patients', 'on', 'pharmacological', 'treatment', 'for', 'OP', 'should', 'use', 'calcium', 'and', 'vitamin', 'D', 'supplements', 'because', 'practically', 'all', 'clinical', 'trials', 'that', 'have', 'demonstrated', 'efficacy', 'of', 'antiosteoporotic', 'drugs', 'routinely', 'include', 'calcium', 'supplements', 'and', 'cholecalciferol', '(vitamin', 'D3),', 'but', 'not', 'in', 'monotherapy.']]

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334_82

[['QUESTION', 'TYPE:', 'PHARMACOLOGY'], ['CLINICAL', 'CASE:'], ['A', 'woman', 'diagnosed', 'with', 'type', '1', 'diabetes', 'mellitus', 'for', '24', 'years.'], ['She', 'comes', 'to', 'the', 'office', 'with', '3', 'months', 'of', 'clinical', 'evolution', 'of', 'tingling', 'in', 'both', 'feet,', 'with', 'distribution', 'in', 'sock,', 'with', 'paresthetic', 'pain', 'and', 'sensation', 'of', 'hot', 'feet', 'predominantly', 'at', 'night,', 'which', 'significantly', 'interferes', 'with', 'sleep.'], ['Which', 'of', 'the', 'following', 'drugs', 'would', 'you', 'use', 'in', 'the', 'first', 'line', 'for', 'the', 'treatment', 'of', 'her', 'pathology?'], ['1-', 'Ibuprofen.'], ['2-', 'Oxycodone.'], ['3-', 'Duloxetine.'], ['4-', 'Paracetamol.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Duloxetine;', 'the', 'clinical', 'picture', 'described', 'is', 'of', 'diabetic', 'neuropathy.'], ['Of', 'the', 'drugs', 'proposed,', 'the', 'first', 'choice', 'would', 'be', 'a', 'dual', 'antidepressant', 'such', 'as', 'duloxetine.']]

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81_44

386_154

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['The', 'appearance', 'of', 'a', 'high', 'fever', 'of', '39°C', 'in', 'a', '10-month-old', 'infant', 'that', 'abruptly', 'subsides', 'after', '3-5', 'days,', 'followed', 'by', 'a', 'cephalocaudal', 'morbilliform', 'exanthema', 'with', 'enanthema', 'consisting', 'of', 'reddish', 'papules', 'on', 'the', 'palate,', 'and', 'resolving', 'within', 'a', 'week,', 'associated', 'with', 'good', 'general', 'condition,', 'is', 'usually', 'caused', 'by:'], ['1-', 'Parvovirus', 'B19.'], ['2-', 'Herpes', 'virus', 'type', '6.'], ['3-', 'Coxackie', 'A16', 'virus.'], ['4-', 'Primoinfection', 'by', 'Epstein-Barr', 'virus.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'question', 'of', 'exanthematous', 'diseases', 'that', 'pediatricians', 'and', 'MIR', 'exam', 'takers', 'like', 'so', 'much.'], ['By', 'the', 'picture', 'of', 'high', 'fever', 'of', 'several', 'days', 'that', 'suddenly', 'subsides', 'with', 'the', 'appearance', 'of', 'a', 'rash,', 'we', 'have', 'a', 'sudden', 'exanthem,', 'caused', 'by', 'Herpes', 'virus', 'type', '6', '(remember', 'the', 'mnemonic', 'rule', 'of', '"sudden', 'Hexanthem").'], ['Parvovirus', 'B19', 'is', 'the', 'cause', 'of', 'erythema', 'infectiosum', 'or', '"fifth', 'disease",', 'whose', 'characteristic', 'rash', 'is', 'on', 'the', 'cheeks,', 'giving', 'the', 'appearance', 'of', 'a', 'slapped', 'face.'], ['Coxackie', 'A16', 'causes', 'herpangina', 'and', 'also', 'boca-mano-pie', 'disease,', 'which', 'presents', 'an', 'initially', 'macular', 'rash,', 'which', 'does', 'not', 'respect', 'palms', 'or', 'soles', 'and', 'evolves', 'into', 'bursting', 'vesicles.'], ['Finally,', 'EBV', 'infection', 'produces', 'a', 'mononucleosis', 'syndrome', 'with', 'high', 'fever', 'lasting', 'several', 'days,', 'with', 'pharyngeal', 'erythema', 'and', 'grayish', 'exudates', 'on', 'the', 'tonsils.'], ['It', 'can', 'present', 'if', 'penicillins', 'are', 'given', 'to', 'treat', 'it', '(when', 'confused', 'with', 'a', 'streptococcal', 'pharyngotonsillitis)', 'a', 'generalized', 'exanthema.'], ['In', 'addition,', 'it', 'also', 'presents', 'with', 'fatigue,', 'hepatic', 'inflammation', 'with', 'increased', 'transaminases', 'and', 'splenomegaly.']]

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239_146

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['An', '80-year-old', 'man', 'is', 'admitted', 'for', 'a', 'sudden', 'onset', 'of', 'aphasia', 'and', 'right', 'hemiparesis.'], ['His', 'history', 'includes', 'hypertension,', 'well', 'controlled', 'with', 'diet', 'and', 'cognitive', 'deterioration', 'in', 'the', 'last', 'year', 'under', 'study', 'by', 'his', 'neurologist.'], ['The', 'emergency', 'cranial', 'CT', 'scan', 'shows', 'a', 'left', 'frontal', 'lobar', 'hematoma', 'without', 'contrast', 'uptake.'], ['What', 'is', 'the', 'most', 'probable', 'cause', 'of', 'the', 'hematoma?'], ['1-', 'Arteriovenous', 'malformation', 'masked', 'by', 'acute', 'hematoma.'], ['2-', 'Chronic', 'arterial', 'hypertension.'], ['3-', 'Isolated', 'vasculitis', 'of', 'the', 'nervous', 'system.'], ['4-', 'Brain', 'tumor.'], ['5-', 'Cerebral', 'amyloid', 'angiopathy', '(congophilic', 'angiopathy).'], ['CORRECT', 'ANSWER:', '5'], ['Amyloid', 'angiopathy', 'is', 'the', 'most', 'common', 'cause', 'of', 'spontaneous', 'non-hypertensive', 'hemorrhage', 'in', 'elderly', 'patients,', 'and', 'is', 'usually', 'lobar', 'in', 'location', '(as', 'in', 'the', 'case).'], ['They', 'often', 'appear', 'in', 'association', 'with', "Alzheimer's", 'disease', '(CTO', 'Manual).'], ['The', 'response', 'that', 'may', 'cause', 'the', 'most', 'doubts', 'is', '2,', 'hypertension,', 'but', 'the', 'most', 'frequent', 'localizations', 'are:', 'putamen,', 'thalamus,', 'pons', 'and', 'cerebellum.'], ['Therefore,', 'most', 'of', 'the', 'time', 'these', 'are', 'deep', 'hemorrhages', '(CTO', 'Manual).'], ['In', 'addition,', 'as', 'a', 'clue', 'it', 'tells', 'us', 'that', 'the', 'patient', 'has', 'well-controlled', 'hypertension', 'without', 'drugs,', 'although', 'this', 'data', 'would', 'not', 'serve', 'to', 'rule', 'out', 'the', 'response.'], ['Answer', '1,', 'a', 'malformation', 'is', 'typical', 'of', 'young', 'patients,', 'rare', 'in', 'older', 'people.'], ['It', 'also', 'decreases', 'the', 'chance', 'of', 'not', 'finding', 'a', 'malformation', 'with', 'contrast-enhanced', 'CT.'], ['Answer', '4,', 'a', 'brain', 'tumor,', 'does', 'not', 'seem', 'likely', 'since', 'the', 'mass', 'is', 'not', 'seen', 'on', 'CT,', 'and', 'as', 'in', 'the', 'previous', 'case,', 'it', 'is', 'more', 'difficult', 'not', 'to', 'find', 'such', 'a', 'lesion', 'after', 'contrast', 'administration.'], ['Answer', '3', 'does', 'not', 'seem', 'correct', 'since', 'vasculitis', 'is', 'a', 'rare', 'entity', 'and', 'more', 'so', 'in', 'older', 'people.']]

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525_53

287_64

472_140

[['QUESTION', 'TYPE:', 'ORTHOPEDIC', 'SURGERY', 'AND', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['65-year-old', 'obese', 'woman', 'who', 'suffers', 'a', 'fall', 'on', 'her', 'hand', 'with', 'her', 'elbow', 'in', 'extension.'], ['She', 'presents', 'with', 'arm', 'pain', 'with', 'swelling', 'and', 'functional', 'impotence', 'of', 'the', 'arm', 'and', 'inability', 'to', 'extend', 'the', 'wrist', 'and', 'fingers.'], ['It', 'is', 'most', 'likely', 'to', 'present:'], ['1-', 'Dislocation', 'fracture', 'of', 'proximal', 'humerus.'], ['2-', 'Elbow', 'dislocation.'], ['3-', 'Diaphyseal', 'fracture', 'of', 'the', 'humerus', 'associated', 'with', 'double', 'forearm', 'fracture.'], ['4-', 'Diaphyseal', 'fracture', 'of', 'humerus', 'with', 'radial', 'nerve', 'injury.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['We', 'must', 'take', 'into', 'account', 'all', 'the', 'clinical', 'data', 'provided:', 'after', 'trauma', 'we', 'have', 'pain', 'in', 'the', 'arm', 'with', 'soft', 'tissue', 'involvement', 'and', 'the', 'impossibility', 'of', 'extending', 'the', 'wrist', 'and', 'fingers.'], ['The', 'only', 'option', 'that', 'includes', 'all', 'the', 'data', 'is', '4.'], ['Option', '1', 'does', 'not', 'explain', 'the', 'involvement', 'of', 'the', 'wrist', 'and', 'fingers.'], ['The', 'elbow', 'dislocation', 'does', 'not', 'explain', 'the', 'lack', 'of', 'finger', 'mobility', 'as', 'well', 'as', 'the', 'diaphyseal', 'fracture', 'of', 'the', 'humerus', 'and', 'double', 'forearm.'], ['"Direct', 'mechanism', 'is', 'possible,', 'as', 'is', 'indirect', 'transmission', 'of', 'forces', 'from', 'the', 'elbow', 'and', 'hand...radial', 'nerve', 'involvement', 'is', 'extremely', 'frequent,', 'reaching', 'an', 'incidence', 'of', '10-18%', 'of', 'cases."', 'Proximal', 'humerus', 'fracture-dislocation', 'would', 'have', 'greater', 'involvement', 'at', 'the', 'shoulder,', 'elbow', 'dislocation', 'at', 'the', 'elbow,', 'and', 'there', 'is', 'no', 'data', 'to', 'suggest', 'double', 'forearm', 'fracture.']]

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173_51

[['QUESTION', 'TYPE:', 'PNEUMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '53-year-old', 'woman', 'with', 'bronchial', 'asthma', 'comes', 'to', 'the', 'allergy', 'clinic', 'for', 'a', 'checkup.'], ['She', 'reports', 'repeated', 'exacerbations', 'with', 'nocturnal', 'symptoms,', 'frequent', 'use', 'of', 'rescue', 'medication', 'and', 'dyspnea', 'on', 'exertion', 'when', 'walking', 'on', 'level', 'ground.'], ['Spirometry', 'shows', 'a', 'pre-bronchodilator', 'FEV1/FVC', 'ratio', 'of', '60%', 'and', 'FEV1', 'of', '55%.'], ['Skin', 'tests', 'are', 'positive', 'for', 'mites', 'and', 'total', 'IgE', 'of', '150', 'IU/ml.'], ['The', 'patient', 'is', 'being', 'treated', 'with', 'a', 'combination', 'of', 'high-dose', 'salmeterol/budesonide', '(50/500', 'mg:', '2', 'puffs', 'twice', 'daily),', 'maintenance', 'oral', 'prednisone', '(10', 'mg/day)', 'and', 'theophylline.'], ['Of', 'the', 'following', 'options,', 'which', 'is', 'the', 'most', 'advisable', 'therapeutic', 'approach?'], ['1-', 'Add', 'magnesium', 'sulfate.'], ['2-', 'Increase', 'the', 'dose', 'of', 'prednisone', 'to', '30', 'mg/day.'], ['3-', 'Add', 'omalizumab.'], ['4-', 'Nebulized', 'treatment', 'at', 'home.'], ['5-', 'Switch', 'to', 'a', 'combination', 'with', 'high', 'doses', 'of', 'budesonide', 'and', 'formoterol.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'indication', 'of', 'omalizumab', 'in', 'a', 'patient', 'such', 'as', 'the', 'one', 'referred', 'to', 'is', 'a', 'correct', 'indication,', 'although', 'in', 'severe', 'asthma', 'that', 'is', 'difficult', 'to', 'control,', 'there', 'are', 'other', 'prior', 'measures', 'that', 'are', 'not', 'contemplated', 'and', 'that', 'must', 'always', 'be', 'taken', 'into', 'account', 'before', 'resorting', 'to', 'this', 'treatment.'], ['It', 'is', 'mandatory', 'to', 'ensure', 'firstly', 'that', 'it', 'is', 'truly', 'asthma', 'and', 'not', 'another', 'disease', 'that', 'simulates', 'asthma,', 'secondly', 'that', 'there', 'are', 'no', 'complications', 'that', 'worsen', 'the', 'evolution', 'as', 'could', 'be', 'the', 'presence', 'of', 'gastroesophageal', 'reflux,', 'bronchiectasis,', 'presence', 'of', 'opportunistic', 'germs', 'given', 'the', 'chronic', 'treatment', 'with', 'steroids,', 'etc;', 'and', 'thirdly,', 'it', 'is', 'necessary', 'to', 'confirm', 'that', 'the', 'patient', 'complies', 'with', 'the', 'treatments', 'correctly,', 'especially', 'the', 'inhaled', 'treatment,', 'etc.'], ['Once', 'all', 'of', 'the', 'above', 'has', 'been', 'checked,', 'it', 'would', 'be', 'time', 'to', 'start', 'a', 'trial', 'treatment', 'with', 'omalizumab.']]

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480_171

58_199

[['QUESTION', 'TYPE:', 'GENETICS'], ['CLINICAL', 'CASE:'], ['An', 'asymptomatic', '31-year-old', 'woman', '(Consultant)', 'is', 'asymptomatic', 'and', 'has', 'a', '10-week', 'gestation', 'according', 'to', 'ultrasound', 'study', '(primiparous).'], ['Her', 'younger', 'brother', '(index', 'case)', 'aged', '26', 'years', 'is', 'affected', 'by', 'ataxia', 'and', 'genetically', 'diagnosed', 'as', 'a', 'heterozygous', 'carrier', 'of', 'an', 'expansive', 'mutation', 'of', '70', 'CAG', 'repeats', 'in', 'the', 'SCA3', 'gene', '(chromosome', '14).'], ['The', 'patient', 'is', 'referred', 'to', 'the', 'genetic', 'counseling', 'office', 'where', 'a', 'possible', 'chorionic', 'villus', 'biopsy', 'to', 'study', 'the', 'fetal', 'genotype', 'is', 'evaluated.'], ['Is', 'this', 'invasive', 'procedure', 'indicated', 'as', 'a', 'pre-natal', 'diagnosis', '(PND)', 'in', 'this', 'case?'], ['1-', 'It', 'is', 'indicated', 'after', 'studying', 'the', "Consultant's", 'genotype', 'and', 'only', 'if', 'it', 'is', 'heterozygous.'], ['2-', 'This', 'is', 'not', 'indicated,', 'since', 'SCA3', 'ataxia', 'is', 'full', 'penetrance', 'and', 'the', 'Consultant', 'is', 'asymptomatic', 'and', 'therefore', 'has', 'not', 'inherited', 'the', 'mutation.'], ['3-', 'It', 'may', 'be', 'indicated', 'in', 'the', 'next', 'pregnancy,', 'after', 'studying', 'the', 'genotype', 'of', 'the', 'first', 'child', 'and', 'detecting', 'the', 'mutation', 'in', 'it.'], ['4-', 'SCA3', 'ataxia', 'is', 'recessively', 'inherited,', 'so', 'there', 'is', 'no', 'appreciable', 'risk', 'of', 'disease', 'transmission', 'and', 'PND', 'is', 'not', 'indicated.'], ['5-', 'This', 'is', 'indicated', 'regardless', 'of', 'the', "Consultant's", 'genotype,', 'since', 'SCA3', 'ataxia', 'is', 'maternally', 'inherited', '(transmitted', 'by', 'women).'], ['CORRECT', 'ANSWER:', '1'], ['SCA3', 'is', 'Spinocerebellar', 'Ataxia', 'type', '3', 'also', 'called', 'Machado-Joseph', 'disease.'], ['It', 'is', 'caused', 'by', 'mutations', 'in', 'the', 'ATXN3', 'gene', 'by', 'the', 'CAG', 'triplet', 'repeat', 'expansion', 'mechanism.'], ['Affected', 'individuals', 'have', 'between', '52', 'and', '86', 'CAG', 'triplet', 'repeats', 'in', 'heterozygosis', 'with', 'complete', 'penetrance.'], ['The', 'heterozygous', 'mutation', 'carrier', 'has', 'the', 'disease', 'as', 'its', 'inheritance', 'pattern', 'is', 'autosomal', 'dominant.'], ['In', 'this', 'clinical', 'case,', 'the', 'one', 'who', 'has', 'the', 'disease', 'and', 'has', 'the', 'mutated', 'gene', 'in', 'heterozygosis', 'is', 'the', 'brother', '(26', 'years', 'old)', 'of', 'the', 'pregnant', 'woman.'], ['I', 'think', 'that', 'before', 'doing', 'the', 'chorion', 'biopsy,', 'the', 'pregnant', 'woman', 'should', 'be', 'tested', 'to', 'know', 'her', 'ATXN3', 'gene', 'status.'], ['She', 'has', 'a', '50%', 'chance', 'of', 'carrying', 'the', 'mutation', 'and', 'having', 'the', 'disease,', 'but', 'since', 'she', 'is', '31', 'years', 'old,', 'I', 'think', 'she', 'should', 'have', 'already', 'had', 'symptoms.'], ['Nevertheless,', 'I', 'would', 'do', 'the', 'genetic', 'test', 'on', 'the', 'pregnant', 'woman', 'to', 'be', 'on', 'the', 'safe', 'side.'], ['If', 'she', 'came', 'out', 'without', 'the', 'mutation,', 'there', 'would', 'be', 'nothing', 'more', 'to', 'do', 'because', 'the', 'disease', 'would', 'no', 'longer', 'be', 'transmitted.'], ['If', 'she', 'came', 'out', 'with', 'the', 'mutation,', 'then', 'I', 'would', 'do', 'a', 'chorionic', 'villus', 'biopsy.'], ['Answers', '1', 'and', '2', 'are', 'both', 'true,', 'but', 'I', 'think', 'answer', '1', 'is', 'more', 'true', 'than', 'answer', '2.']]

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51_230

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['37-week', 'pregnant', 'woman', 'with', 'positive', 'hepatitis', 'B', 'virus', 'surface', 'antigen.'], ['She', 'consults', 'about', 'the', 'guidelines', 'to', 'be', 'followed', 'with', 'the', 'newborn', 'and', 'whether', 'she', 'can', 'breastfeed.'], ['What', 'advice', 'do', 'you', 'think', 'is', 'most', 'appropriate?'], ['1-', 'Administer', 'hepatitis', 'B', 'vaccine', 'at', 'birth.', 'Artificial', 'feeding.'], ['2-', 'Vaccination', 'and', 'immunoglobulins', 'should', 'be', 'administered', 'at', 'birth.', 'Breastfeeding', 'from', 'one', 'month', 'onwards.'], ['3-', 'Immunoglobulins', 'at', 'birth', 'and', 'artificial', 'breastfeeding.'], ['4-', 'Vaccination', 'and', 'immunoglobulins', 'at', 'birth.', 'Maternal', 'feeding.'], ['5-', 'Artificial', 'feeding', 'and', 'isolation', 'for', '4', 'weeks.'], ['CORRECT', 'ANSWER:', '4'], ['The', 'correct', 'answer', 'is', '4.'], ['Children', 'born', 'to', 'HBV', 'carrier', 'mothers', 'should', 'be', 'administered', 'hepatitis', 'B', 'vaccine', 'and', 'immunoglobulin', 'at', 'different', 'puncture', 'sites', 'within', 'the', 'first', '24', 'hours', 'of', 'life.'], ['Although', 'the', 'virus', 'is', 'excreted', 'in', 'breast', 'milk,', 'the', 'risk', 'of', 'infection', 'by', 'this', 'route', 'is', 'very', 'low', 'and', 'therefore', 'it', 'is', 'not', 'currently', 'a', 'contraindication', 'for', 'breastfeeding.']]

[['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'], ['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'], ['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'], ['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', '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'], ['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', 'B-Marker', 'B-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim', 'I-Claim']]

184_65

[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'with', 'obesity', '(body', 'mass', 'index', '38)', 'is', 'referred', 'to', 'your', 'office.'], ['In', 'the', 'clinical', 'history', 'the', 'patient', 'refers', 'that', 'he/she', 'has', 'been', 'obese', 'since', 'the', 'age', 'of', '17', '(currently', '36', 'years', 'old),', 'having', 'been', 'on', 'multiple', 'diets', 'with', 'weight', 'loss', 'ranging', 'from', '5', 'to', '10', 'kg', 'but', 'has', 'subsequently', 'regained', 'weight.'], ['The', 'patient', 'is', 'currently', 'on', 'a', '1500', 'Kcal', 'diet', '(self-administered', 'and', 'not', 'restricted', 'in', 'fat)', 'with', 'a', 'good', 'follow-up', 'of', 'this', 'diet,', 'performing', 'one', 'hour', 'of', 'aerobic', 'exercise', '4', 'days', 'a', 'week.'], ['She', 'has', 'lost', '3', 'kg', 'but', 'needs', 'an', 'additional', 'loss', 'of', '7', 'kg', 'more.'], ['Given', 'the', 'possibility', 'of', 'adding', 'a', 'drug', 'against', 'obesity,', 'which', 'one', 'would', 'you', 'use', 'to', 'reduce', 'fat', 'absorption?'], ['1-', 'Orlistat.'], ['2-', 'Topiramate.'], ['3-', 'Sibutramine.'], ['4-', 'Liraglutide.'], ['5-', 'Metformin.'], ['CORRECT', 'ANSWER:', '1'], ['Orlistat', 'acts', 'by', 'decreasing', 'fat', 'absorption;', 'it', 'is', 'currently', 'the', 'only', 'drug', 'approved', 'for', 'use', 'in', 'obesity.']]

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295_75

[['QUESTION', 'TYPE:', 'GENETICS', 'AND', 'IMMUNOLOGY'], ['CLINICAL', 'CASE:'], ['Indicate', 'the', 'clinical', 'situation', 'that,', 'in', 'relation', 'to', 'hepatitis', 'B', 'virus', 'infection,', 'presents', 'a', '5-year-old', 'patient', 'from', 'Nigeria,', 'with', 'normal', 'physical', 'examination', 'and', 'with', 'the', 'following', 'serology', 'against', 'hepatitis', 'B:', 'HBsAg', '+', '/', 'ANTI-', 'HBs', '-', '/', 'HBeAg', '-', '/', 'ANTI-', 'Hbe', '+', '/', 'ANTI-', 'Hbc', 'IgM', '-', '/', 'ANTI-', 'Hbc', 'IgG', '+/', 'DNA', 'HBV', '+:'], ['1-', 'Acute', 'infection.'], ['2-', 'Chronic', 'infection.'], ['3-', 'Vaccinated', 'patient.'], ['4-', 'Asymptomatic', 'carrier.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Question', 'in', 'which', 'having', 'a', 'table', 'in', 'the', 'head', 'comes', 'out', 'alone', 'discarding', 'options:', 'Option', '1:', 'The', 'acute', 'infection', 'would', 'be', 'HBeAg', '+', 'and', 'ANTI-HBe', '-', '.', 'In', 'addition', 'the', 'ANTI-HBec', 'would', 'be', 'IgM', 'type', '(only', 'for', 'this', 'last', 'data,', 'we', 'would', 'have', 'to', 'discard', 'it', 'in', 'a', 'direct', 'way).'], ['Option', '2:', 'the', 'correct', 'one.'], ['It', 'complies', 'with', 'all', 'the', 'characteristics.'], ['Option', '3:', 'The', 'vaccinated', 'patient', 'cannot', 'have', 'DNA', 'of', 'the', 'virus', '(the', 'only', 'thing', 'that', 'positivizes', 'in', 'a', 'vaccinated', 'patient', 'is', 'the', 'AntiBs.', 'IgG', 'type).'], ['Option', '4:', 'The', 'option', 'that', 'could', 'offer', 'more', 'doubts.'], ['In', 'the', 'asymptomatic', 'carrier', '(chronic', 'carrier', '/', 'seroconverted)', 'the', 'difference', 'is', 'that', 'there', 'is', 'no', 'viral', 'DNA.']]

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559_160

[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'woman,', 'taking', 'contraceptives,', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'febrile', 'syndrome', 'and', 'paresthesias', 'in', 'the', 'left', 'hemibody.'], ['Blood', 'tests', 'show', 'Hb', '7.5', 'g/dL,', 'platelets', '7,000/microl,', 'normal', 'leukocytes', 'with', 'normal', 'differential', 'count,', 'LDH', '1,200', 'IU/l,', 'reticulocytes', '10%', '(normal', '0.5-2%),', 'undetectable', 'serum', 'haptoglobin,', 'negative', 'direct', "Coombs'", 'test', 'and', 'peripheral', 'blood', 'smear', 'with', 'schistocytes.'], ['Coagulation', '(prothrombin', 'time', 'and', 'APTT)', 'normal.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'diagnosis:'], ['1-', 'Autoimmune', 'hemolytic', 'anemia.'], ['2-', 'Thrombotic', 'thrombocytopenic', 'purpura.'], ['3-', 'Evans', 'syndrome', '(hemolytic', 'anemia', 'and', 'immune', 'thrombopenia).'], ['4-', 'Idiopathic', 'immune', 'thrombocytopenia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'fear', 'of', 'all', 'on-call', 'hematologists...', 'that', 'you', 'will', 'get', 'a', 'TTP.'], ['Because,', 'although', 'infrequent,', 'it', 'is', 'the', 'greatest', 'hematologic', 'emergency.'], ['The', 'clinical', 'case', 'is', 'fairly', 'typical.'], ['A', 'young', 'person', 'with', 'fever', 'and', 'neurological', 'symptoms', 'that', 'make', 'him', 'go', 'to', 'the', 'emergency', 'department', '(he', 'is', 'on', 'the', 'run).'], ['Laboratory', 'tests', 'show', 'anemia', 'with', 'evidence', 'of', 'hemolysis', '(increased', 'LDH', 'and', 'retis,', 'presence', 'of', 'schistocytes', 'in', 'peripheral', 'blood)', 'and', 'severe', 'thrombopenia.'], ['In', 'addition,', 'coagulation', 'is', 'normal.'], ['To', 'distinguish', 'it', 'from', 'the', 'rest', 'of', 'things', '(although', 'you', 'should', 'not', 'hesitate...)', 'it', 'tells', 'you', 'that', 'the', 'coombs', 'is', 'negative.'], ['As', 'a', 'reminder:', 'URGENT', 'TREATMENT:', 'PLASMATIC', 'REPLACEMENTS.'], ['The', 'diagnostic', 'confirmation', 'is', 'the', 'ADAMTS', '13', 'deficit,', 'but', 'treatment', 'is', 'started', 'before', 'having', 'that', 'value,', 'which', 'is', 'not', 'usually', 'done', 'urgently.'], ['And,', 'as', 'we', 'all', 'know,', 'these', 'things', 'usually', 'come', 'at', 'night', 'and/or', 'weekends,', 'to', 'make', 'things', 'more', 'difficult....']]

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558_160

[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'woman,', 'taking', 'contraceptives,', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'febrile', 'syndrome', 'and', 'paresthesias', 'in', 'the', 'left', 'hemibody.'], ['Blood', 'tests', 'showed', 'Hb', '7.5', 'g/dL,', 'platelets', '7,000/microl,', 'normal', 'leukocytes', 'with', 'normal', 'differential', 'count,', 'LDH', '1,200', 'IU/l,', 'reticulocytes', '10%', '(normal', '0.5-2%),', 'undetectable', 'serum', 'haptoglobin,', 'negative', 'direct', "Coombs'", 'test', 'and', 'peripheral', 'blood', 'smear', 'with', 'schistocytes.'], ['Coagulation', '(prothrombin', 'time', 'and', 'APTT)', 'normal.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'diagnosis:'], ['1-', 'Autoimmune', 'hemolytic', 'anemia.'], ['2-', 'Thrombotic', 'thrombocytopenic', 'purpura.'], ['3-', 'Evans', 'syndrome', '(hemolytic', 'anemia', 'and', 'immune', 'thrombopenia).'], ['4-', 'Idiopathic', 'immune', 'thrombocytopenia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'patient', 'presents', 'criteria', 'for', 'Thrombotic', 'Thrombocytopenic', 'Purpura', '(TTP):', '1.'], ['Neurological', 'alteration.'], ['2.'], ['Febrile', 'syndrome', '(fever).'], ['3.'], ['Coombs', 'negative', 'migroangiopathic', 'hemolytic', 'anemia', '(presence', 'of', 'schistocytes).'], ['4.'], ['Thrombopenia.']]

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