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<s>[INST] 1. A 36-year-old woman with an obstetric history of 1-0-0-1 begins her pregnancy to receive a postpartum examination 6 weeks after delivery Q. At 25 weeks, symptoms of gestational diabetes were treated and she began exercising and dieting. Pregnancy Height: 154cm, weight: 120/80mmHg, pulse: 80/min, respiration: 20/min, aquarium temperature: 36.8°C.
① Game observation
② Regular inspection
③ 50g glucose tolerance test
④ 75g glucose tolerance test
⑤ 100g glucose tolerance test [/INST] "```json
{
""answer"": ""④"",
"'reason': "Women who have gestational diabetes at 6 weeks postpartum are advised to perform a 75 g oral glucose tolerance test to see if they continue. This is because gestational diabetes can continue after childbirth.","
""confidence_score"": 9
}
```" </s> |
<s>[INST] 2. A 33-year-old nulliparous woman in the 39th week of pregnancy came to the hospital because of pain in her lower abdomen for 3 hours. Blood pressure was 120/80 mmHg, pulse was 82 beats/min, respiration was 20 beats/min, and temperature was 36.5°C. Pelvic examination revealed cervix. The nitrazine test results are 3cm dilated, 90% effaced, and 0. In the ultrasound examination, the fetus's head circumference is 2,910g (10th percentile, 2,799g), the amniotic fluid index is 9cm, and the placenta is normal. What is the result of the electronic fetal heartbeat-uterine contraction monitoring test (photo 1)? There is no change in the cervix in the pelvic examination performed 1 hour later.
① Progress observation
② Oxytocin
③ Nifedipine
④ Ritodrine
⑤ Caesarean section [/INST] ```json
{
"answer": "2",
"reason": "The patient is in the latent phase of labor with no cervical change after 1 hour. Oxytocin is often used to augment labor in such cases to help progress the dilation and contractions. The other options are not appropriate: observation alone may not be sufficient, nifedipine and ritodrine are used for tocolysis (to stop labor), and a cesarean section is not indicated at this stage.",
"confidence_score": 8
}
``` </s> |
<s>[INST] 3. A 32-year-old woman came to the hospital saying her blood pressure was not controlled. She said she often had difficulty standing up because her legs lost strength for a year. She has been taking medication for high blood pressure and dyslipidemia since two years ago. Her blood pressure is 160/90 mmHg, pulse 80 times/min, respiration 16 times/min, and body temperature 36.5°C. Her skin tone is normal. Her blood test results are as follows. Her abdomen is computed tomography (Figs. 1 and 2). What is the test?
Blood urea nitrogen/creatinine 20/1.1 mg/dL
Na+/K+/CI_149/2.8/104 meq/L, glucose 98 mg/dL adrenocorticotropic hormone 18.9 pg/mL (reference, 6-76)
Cortisol 8 g/dL (reference value, 5–25)
Plasma renin activity 0.1 ng/mL/hr (reference value, 0.3~3.0)
Aldosterone 59.2 ng/dL (reference value, <16)
25 pg/mL methanephrine (reference value, <100)
① an adrenal vein blood
② Water restriction test
③ physiological saline load test
④ Low-dose dexamethasone inhibition test
⑤ rapid adrenocorticotropic hormone stimulation test
[/INST] ```json
{
"answer": "①",
"reason": "The patient's symptoms and lab results suggest primary hyperaldosteronism (Conn's syndrome), characterized by hypertension, hypokalemia, low plasma renin activity, and high aldosterone levels. Adrenal vein sampling (① 부신정맥채혈) is the appropriate test to differentiate between unilateral and bilateral adrenal disease.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 4. A 54-year-old woman with a history of obstetric history of 2-0-1-2 came to the hospital after feeling a lump in her lower abdomen. She had surgery and chemotherapy for gastric cancer two years ago. Pelvic examination showed no tenderness and rebound tenderness. This is a computed tomography picture of the abdominal pelvis (photo 1). What is her diagnosis?
Hemoglobin 11.8 g/dL, white blood cells 3,800/mm2, platelets 424,000/mm2
C-reactive protein 1 mg/L (reference value, <10)
Cancer antigen 125 77.3 U/mL (reference value, <35)
CA19-9 10.3 U/mL (reference value, <37)
Cancer germ antigen 7.0 ng/mL (reference value, <5)
① egg yolk cyst
② mature metaplastic species
③ endometrioma
④ serous ovarian cyst
⑤ a Krukenberg tumor
[/INST] ```json
{
"answer": "⑤",
"reason": "The patient has a history of gastric cancer and presents with an abdominal mass. The elevated CA-125 and CEA levels, along with the history of gastric cancer, suggest a Krukenberg tumor, which is a metastatic ovarian tumor often originating from a primary gastric cancer. The lack of tenderness and rebound tenderness, along with the imaging findings, further support this diagnosis.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 5. 36 weeks pregnant, 29-year-old undifferentiated women came to the hospital for prenatal examination. Blood pressure 110/70 mmHg, pulse 80 times/min, respiration 20 times/min, and body temperature 36.1°C. Pelvic examination showed no loss or expansion of the cervix. Ultrasonography showed the fetus head position, predicted fetal weight 2,000g (10 percentile index 2,335g), positive water index 1cm, placenta normal, and diastolic blood flow was not observed in the Doppler examination of the umbilical artery. Non-axis test result (photo 1). Treatment?
① progressive observation
② Litodrin
③ oxytocin
④ magnesium sulfate
⑤ amniotic fluid injection
[/INST] ```json
{
"answer": "⑤",
"reason": "The patient is experiencing oligohydramnios, as indicated by the low amniotic fluid index (AFI) of 1 cm. Additionally, the absence of diastolic flow in the umbilical artery Doppler suggests compromised fetal circulation. In such cases, amnioinfusion (양수주입) can be considered to improve the amniotic fluid volume and potentially improve fetal outcomes. Other options like observation or medications are not appropriate given the current fetal distress indicators.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 6. A 31-year-old delivery woman at 16 weeks of pregnancy came to the hospital for prenatal examination. In the previous pregnancy, vaginal delivery was performed at 32 weeks of early labor. Blood pressure was 120/80 mmHg, pulse 76 times/min, respiration 20 times/min, and body temperature 36.2°C. On ultrasound examination, the fetus has a head position, predicted fetal weight of 150g (50 percentile 146g), and the amniotic fluid and placenta are normal. This is a picture of pelvic ultrasound (photo 1). What about treatment?
① bed rest
② nifedipine
③ Pesari
④ progesterone tablet
⑤ cervical ligation
[/INST] ```json
{
"answer": "④",
"reason": "Given the patient's history of preterm labor at 32 weeks in a previous pregnancy, the use of progesterone is recommended to reduce the risk of recurrent preterm birth. Progesterone has been shown to be effective in preventing preterm labor in women with a history of spontaneous preterm birth.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 7. A 34-year-old man came to the emergency room with a stomachache after he slipped and hit a wall while driving a motorcycle an hour ago. His blood pressure is 100/65 mmHg, pulse 114 times/min, respiration 20 times/min, and body temperature 36.1°C. He has tenderness and rebound tenderness in his upper abdomen. Blood test results are as follows. Abdominal computed tomography (photo 1) is available. What is the treatment?
Hemoglobin 9.4 g/dL, leukocyte 26,400/mm3, platelets 230,000/mm3
Aspartic acid aminotransferase 104 U/L
alanine aminotransferase 76 U/L
74 U/L of alkaline phosphatase
Starchase 350 U/L, lipase 390 U/L
① peritoneal cleaning
② skin curative drainage
③ gastroenterology
④ excision of the spleen
⑤ distal pancreatectomy
[/INST] ```json
{
"answer": "⑤",
"reason": "The patient has signs of abdominal trauma with elevated amylase and lipase levels, suggesting pancreatic injury. The CT scan likely shows a pancreatic injury, and distal pancreatectomy (⑤ 먼쪽췌장절제) is a common treatment for distal pancreatic injuries when there is ductal disruption or significant damage.",
"confidence_score": 8
}
``` </s> |
<s>[INST] 8. An 83-year-old woman came to the hospital two months ago after accidentally feeling a lump on her right breast. Her blood pressure is 140/80 mmHg, pulse 80 times/min, respiration 20 times/min, and body temperature is 36.7°C. This is a picture of the breast (photo 1). At 11 o'clock on the right breast, an indeterminate lump is touched and does not hurt when pressing the lump. There is no lump that can be touched under her arm. What is the test?
① Enlarged breast shooting
② mammary ultrasound
③ an angiography
④ Magnetic resonance imaging of the breast
⑤ Positron emission tomography
[/INST] ```json
{
"answer": "②",
"reason": "Given the description of a palpable mass in the breast with no axillary lymphadenopathy, a breast ultrasound is typically the next step in evaluation. It helps in characterizing the mass (solid vs cystic) and provides additional information that complements mammography. The other options are either more advanced imaging techniques or not typically first-line for initial evaluation of a palpable breast mass.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 9. A 28-year-old woman came to the hospital five days ago with pain and fever in her left breast. She is breastfeeding after giving birth a month ago. She was unable to breastfeed her breast because it was too painful from yesterday. Her blood pressure is 110/70 mmHg, pulse 95 times/min, respiration 17 times/min, and body temperature 38.5°C. This is a picture of the breast (photo 1). A lump with fever is touched on the left breast, and it hurts when pressed on the breast. The results of blood tests are as follows. This is an ultrasound picture of the breast (photo 2). What is the treatment?
Hemoglobin 10.5 g/dL, leukocyte 15,300/mm2, platelet 323,000/mm3 C reaction protein 155 mg/L (Note, <10)
① Bromocryptin
② a cold compress
③ incisional drainage
④ a lumpectomy
⑤ high-frequency heat therapy
[/INST] ```json
{
"answer": "3",
"reason": "The patient is a postpartum woman with symptoms of mastitis, including breast pain, fever, and a palpable mass with warmth. The elevated white blood cell count and C-reactive protein level indicate an infection. Given the acute presentation and the inability to breastfeed due to pain, the most likely diagnosis is a breast abscess. The appropriate treatment for a breast abscess is incision and drainage (절개배농).",
"confidence_score": 9
}
``` </s> |
<s>[INST] 10. Multimedia problem (private) [/INST] I'm sorry, but I can't assist with that request. </s> |
<s>[INST] 11. A 35-year-old man came to the hospital complaining of a fever and swelling in his left arm from two days ago. He reportedly had a wound on his left arm while weeding four days ago, but was not treated. He had sudden fever and chills from two days ago, pain and blisters started to appear as the wound began to swell and spread, and he also vomited and diarrhea. His blood pressure is 80/50 mmHg, pulse 120 times/min, respiration 24 times/min, and body temperature 38.9°C. He is in a sleepy state. The result of blood test is as follows. Here is a picture of his arm (photo 1). What about his diagnosis?
13.5 g/dL of hemoglobin
24,000/mm3 leukocytes (95% neutrophils)
Platelet 60,000/mm3
Blood urea nitrogen/creatinine 52/3.5 mg/dL
Aspartate aminotransferase 260 U/L Alanine aminotransferase 300 U/L
① tetanus wind
② toxic shock syndrome
③ botulism
④ hemolytic uremic syndrome
⑤ Staphylococcal Fracture Skin Syndrome
[/INST] ```json
{
"answer": "②",
"reason": "The patient's symptoms and lab results suggest toxic shock syndrome. The rapid onset of fever, hypotension, and multi-organ involvement (elevated liver enzymes, renal impairment, and thrombocytopenia) are indicative of this condition. The history of a wound and the presence of a high white blood cell count with neutrophilia support a bacterial infection, likely Staphylococcus aureus, which is commonly associated with toxic shock syndrome.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 12. A 60-year-old man came to the hospital complaining of a fever for one month. He had a fever every day, and when the fever goes up, he has a headache and body aches. He lost 5 kilograms and has no other symptoms. He is not taking any medicine other than fever reducer. His blood pressure is 130/80 mmHg, pulse 92 times/min, respiration 18 times/min, and body temperature 38.6°C. Physical examination showed no specific findings. The results of the examination are as follows. What about the examination?
Blood: 11.2g/dL of hemoglobin
White blood cells 7,800 /mm3 (78% neutrophils, 18% lymphocytes)
Platelet 150,000/mm3
Red blood cell sedimentation rate 90 mm/hour (reference value, <15)
C-reactive protein 22 mg/L (reference value, <10)
20 U/L aspartic acid aminotransferase
Alanine aminotransferase 14 U/L
Total bilirubin 0.3 mg/dL
Blood urea nitrogen/creatinine 10/0.9 mg/dL
Antinuclear Antibody Negative
Rheumatoid factor negative
cold globulin negative
Urine: glucose (-), occult blood (-), protein (-) and nitrite (-)
Blood culture (two pairs): none grown
Urine culture: nothing grown
Tuberculin Skin Test: Negative
Chest X Prehistory: Normal
Abdominal computed tomography: normal
① Spinal cord puncture
② Search and open ocean
③ bone marrow aspiration biopsy
④ esophageal echocardiography
⑤ Positron emission tomography
[/INST] ```json
{
"answer": "④",
"reason": "The patient presents with prolonged fever, weight loss, and elevated inflammatory markers (ESR and CRP) without a clear source of infection or abnormal findings on initial imaging and cultures. Infective endocarditis, particularly with culture-negative organisms, is a possibility. Transesophageal echocardiography (④) is more sensitive than transthoracic echocardiography for detecting vegetations or other cardiac sources of infection, making it a reasonable next step in this diagnostic workup.",
"confidence_score": 8
}
``` </s> |
<s>[INST] 13. A 25-year-old man came to the hospital saying he accidentally discovered something wrong with his genitals two days ago. He said he had sex with a woman he didn't know very well about a month ago without using condoms. He said he doesn't have pain in the genital region. This is a photo of the lesion of the genitalia (photo 1). What's the treatment?
① Ashclover
② fluconazole
③ Metronidazole
④ Ciprofloxacin
⑤ benzatine penicillin
[/INST] ```json
{
"answer": "⑤",
"reason": "The symptoms described are consistent with primary syphilis, which typically presents as a painless ulcer (chancre) on the genitals. The patient had unprotected sex a month ago, which aligns with the incubation period for syphilis. Benzathine penicillin is the recommended treatment for primary syphilis.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 14. A 32-year-old woman came to the hospital with high blood pressure. She said that she lost menstruation and gained 8 kilograms of weight from six months ago. She is not taking any medication. She is 161 cm tall, 78 kg in weight, and 98 cm in waist size. Her blood pressure is 160/90 mmHg, pulse 88 times/min, respiration 14 times/min, and body temperature 36.8°C. Abdominal pictures (photo 1) and blood test results are as follows. What is the test?
Hemoglobin 12.6 g/dL, leukocyte 8,200/mm3
Platelet 248,000/mm3
Aspartic acid aminotransferase 54 U/L
Alanine aminotransferase 39 U/L
Blood urea nitrogen/creatinine 24/1.1 mg/dL
Na+/K+/CI_141/3.9/102 meq/L, glucose 96 mg/dL
① serum follicle-stimulating hormone
② 24-hour urine methanepine
③ plasma renin activity/aldosterone
④ 1 mg nightly dexamethasone suppression test
⑤ rapid adrenocorticotropic hormone stimulation test
[/INST] ```json
{
"answer": "④",
"reason": "The patient presents with symptoms suggestive of Cushing's syndrome, such as hypertension, weight gain, and menstrual irregularities. The 1mg overnight dexamethasone suppression test is used to screen for Cushing's syndrome by assessing cortisol suppression. The other options are less likely given the clinical presentation.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 15. A 32-year-old woman came to the hospital with a swollen front neck. She gave birth to a baby girl three months ago. She has been having trouble lactating since 2 months ago due to a weight loss of 3kg and poor milking. Her blood pressure is 140/80 mmHg, pulse 96 times/min, respiration 18 times/min, and body temperature 36.5°C. The thyroid gland was enlarged overall and was gently touched. There is no tenderness. Blood test results are as follows. Any diagnosis?
0.1 mIU/L of thyroid stimulating hormone (reference value, 0.34 to 4.25)
Glass T4 3.2 ng/dL (reference value, 0.8 to 1.7)
Anti-thyroid peroxidase antibody positive
Anti-thyroid stimulating hormone receptor antibody 0.1 mIU/L (reference value, ≤1.75)
① Graves' disease
② postpartum thyroiditis
③ Liddell's thyroiditis
④ toxic thyroid nodule
⑤ subacute thyroiditis
[/INST] ```json
{
"answer": "2",
"reason": "The patient is a 32-year-old woman who recently gave birth and presents with symptoms of hyperthyroidism, such as weight loss and reduced milk production. The lab results show low TSH and high free T4, indicating hyperthyroidism. The presence of anti-thyroid peroxidase antibodies suggests an autoimmune process, and the lack of pain and diffuse thyroid enlargement are consistent with postpartum thyroiditis (산후갑상샘염). This condition is common after pregnancy and can present with a hyperthyroid phase.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 16. A 33-year-old woman fell unconscious and was taken to the emergency room. According to her family, she felt tired easily and was thirsty for two months. She lost about 10 kilograms of weight. Her blood pressure is 90/50 mmHg, pulse 110 times/min, respiration 20 times/min, and body temperature 37.3°C. What are the results of the test?
Blood: Hemoglobin 14.2 g/dL, White blood cells 12,400/mm2
Albumin 3.9 g/dL
Blood urea nitrogen/creatinine 45/2.2 mg/dL
Na+/K+/CI 144/5.7/100 meq/L
Glucose 338 mg/dL, glycated hemoglobin 11.2%
Osmol/kg H2O (reference value, 275-295)
Arterial blood (atmospheric breathing): pH 7.10, PCO2 20 mmHg
PO2 87 mmHg, HCO3 6 mmol/L
Urine: ketone (4+), protein (2+), blood (-)
Red blood cells 0~2/high magnification, white blood cells 0~2/high magnification, osmol/kg H2O (reference value, 500~800)
① uremia
② a nephrotic syndrome
③ central lumbopathy
④ diabetic ketoacidosis
⑤ hyperglycemia and osmotic pressure
[/INST] ```json
{
"answer": "④",
"reason": "The patient presents with symptoms and lab findings consistent with diabetic ketoacidosis (DKA): high blood glucose (338 mg/dL), high anion gap metabolic acidosis (pH 7.10, HCO3 6 mmol/L), presence of ketones in urine (4+), and elevated anion gap. The symptoms of fatigue, weight loss, and increased thirst also align with DKA.",
"confidence_score": 10
}
``` </s> |
<s>[INST] 17. A 72-year-old woman came to the hospital complaining of a sudden back pain two weeks ago. The pain got better when she was lying down, and she got worse when she stood up or sitting down. She said she lost about 3 cm in height and gained 5 kg in the past year. She is a waist X-rayer (Pictures 1 and 2). The results of her blood test are as follows. What is her diagnosis?
Hemoglobin 12.1 g/dL, leukocytes 8,100/mm2, platelets 174,000/mm3
1.0 mg/dL of creatinine
Calcium 9.0 mg/dL (Note, 8.7 to 10.2)
total protein/albumin 7.2/3.8 g/dL
C-reactive protein 5 mg/L (reference value, <10)
① ankylosing spondylitis
② multiple myeloma
③ compression fracture of the spine
④ multiple rheumatoid muscle pain
⑤ extensive idiopathic bone formation and hyperplasia
[/INST] ```json
{
"answer": "③",
"reason": "The patient's symptoms and history suggest a vertebral compression fracture. The sudden onset of back pain, worsening with standing or sitting, and improvement when lying down, along with a decrease in height, are indicative of a compression fracture. The lab results do not show abnormalities that would suggest multiple myeloma or other conditions. The normal calcium level and the absence of anemia or renal impairment make multiple myeloma less likely. The patient's age and symptoms align with a compression fracture, possibly due to osteoporosis.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 18. An 6-year-old man came to the hospital two years ago complaining of gradual swelling in his left finger. He has been suffering from intermittent swelling and pain in his toes and fingers since five years ago, and then heals on his own." This is a picture of his hand (photo). The results of blood test are as follows. What about his treatment?
2.9 mg/dL of creatinine
9.5 mg/dL of uric acid (reference value, 3.1 to 7.0)
Rheumatoid factor 7 IU/mL (reference value, <15)
C Reactive Protein 8 mg/L (Note, <10)
Red blood cell sedimentation rate 14 mm/hour (reference value, <15)
① Naphroxen
② glucosamine
③ Sulphasalazine
④ Pebuxostat
⑤ Acetaminophen [/INST] ```json
{
"answer": "④",
"reason": "The patient presents with symptoms and lab findings suggestive of chronic gout, including elevated uric acid levels and renal impairment (elevated creatinine). Febuxostat is a xanthine oxidase inhibitor used to lower uric acid levels in patients with gout, especially when there is renal impairment. Other options like NSAIDs (e.g., naproxen) are used for acute attacks, but the chronic management of hyperuricemia is necessary here.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 19. A 65-year-old woman came to the hospital two years ago complaining of pain in both knees. Knee pain worsens when activated. In the examination, swelling and tenderness of the right knee are observed. It is a knee X-ray player (photo 1). The results of the blood test are as follows. What is the diagnosis?
Hemoglobin 11.2g/dL, white blood cells 7,300/mm2, platelets 154,300/mm3
0.9 mg/dL of creatinine
5.0 mg/dL of uric acid (reference value, 2.5 to 5.6)
Rheumatoid factor 10 IU/mL (reference value, <15)
C-reactive protein 4.0 mg/L (reference value, <10)
Red blood cell sedimentation rate 18 mm/hour (reference value, ≤20)
① gout
② a false gout
③ osteoarthritis
④ rheumatoid arthritis
⑤ multiple rheumatoid muscle pain
[/INST] ```json
{
"answer": "③",
"reason": "The patient's symptoms and test results are consistent with osteoarthritis (골관절염). The age of the patient, the bilateral knee pain that worsens with activity, and the presence of swelling and tenderness in the knee are typical of osteoarthritis. The X-ray would likely show joint space narrowing and osteophyte formation, which are characteristic of this condition. The blood test results do not indicate an inflammatory or autoimmune condition, as the C-reactive protein and erythrocyte sedimentation rate are within normal limits, and the rheumatoid factor is negative.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 20. A 42-year-old woman came to the hospital six months ago complaining of swelling and pain in both her hands and right knee. This is a picture of her hand (photo 1). The results of the test are as follows. What about her treatment?
Blood: Hemoglobin 10.2 g/dL, White blood cells 8,300/mm3
Platelet 224,000/mm3
0.8 mg/dL of creatinine
5.5 mg/dL of uric acid (reference value, 2.5 to 5.6)
Rheumatoid factor 152 IU/mL (reference value, <15)
C-reactive protein 64 mg/L (reference value, <10)
HBsAg (-), anti-HBs (+), anti-HCV (-)
Knee lubricant: White blood cells 21,000/mm3 (71% neutrophils)
Gram stain negative, culture test negative, crystal negative
① Cole Hitchin
② Cephazoline
③ Metotrexate
④ Acetaminophen
⑤ cyclophosphorus permide
[/INST] ```json
{
"answer": "3",
"reason": "The patient presents with symptoms and lab findings suggestive of rheumatoid arthritis, including joint swelling, elevated rheumatoid factor, and high C-reactive protein levels. Methotrexate is a common disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 21. A 32-year-old man came to the hospital two days ago to have bloody excrement in bright red like half a glass of soju. He is not taking any medication and has no family history of colorectal cancer. His blood pressure is 110/70 mmHg, pulse 66 times/min, respiration 16 times/min, and body temperature 37.1°C. What are the results of the blood test?
Hemoglobin 13.2 g/dL, leukocytes 7,200/mm2, platelets 179,000/mm3
① gastroscopy
② capsule endoscopy
③ an abdominal ultrasound examination
④ computed tomography of the abdomen
⑤ rectal sigmoidoscopy [/INST] ```json
{
"answer": "⑤",
"reason": "The patient presents with fresh red blood in the stool, which suggests a lower gastrointestinal source of bleeding, such as the rectum or sigmoid colon. A sigmoidoscopy (rectosigmoidoscopy) is appropriate to directly visualize and assess these areas for potential sources of bleeding.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 22. A 42-year-old man came to the hospital with upper stomachache from 1 day ago. He drank almost every day for 10 years and drank more than 3 bottles of soju every day for the past week. His blood pressure is 110/70 mmHg, pulse 86 times/min, respiration 18 times/min, and body temperature is 37.0°C. On auscultation of the stomach, bowel tone sounds reduced. I have tenderness in my upper stomach. The blood test results are as follows. This is a computed tomography of the abdomen (photo 1). What is his diagnosis?
Hemoglobin 10.4 g/dL, leukocyte 5,600/mm2, platelets 270,000/mm3
6.9 g/dL of total protein and 3.6 g/dL of albumin
Total bilirubin 0.8 mg/dL
Aspartic acid aminotransferase 182 U/L
alanine aminotransferase 63 U/L
110 U/L of alkaline phosphatase
Starchase 260 U/mL, lipase 480 U/mL
① acute pancreatitis
② acute myelitis
③ acute gastroenteritis
④ acute ocular inflammation
⑤ Acute growth mesenteric panniculitis [/INST] ```json
{
"answer": "1",
"reason": "The patient's symptoms and laboratory findings are indicative of acute pancreatitis. The history of heavy alcohol consumption, abdominal pain, decreased bowel sounds, and elevated levels of amylase and lipase are classic signs of acute pancreatitis.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 23. A 30-year-old woman came to the hospital with a fever from three weeks ago. She has persistent fever and body aches, and from three days ago, she starts to feel short of breath when going up the stairs. Her blood pressure is 100/60 mmHg, pulse 110 times/min, respiration 20 times/min, and body temperature 38.1°C. Systolic noise is heard in the cardiac region. You can see the skin lesion as shown in the picture (photo 1) on the soles of the feet, and no tenderness is observed. The test results are as follows. What is the test?
Blood: Hemoglobin 10.2g/dL, White blood cells 6,400/mm3
Platelet 170,000/mm2
60 U/L aspartic acid aminotransferase
50 U/L of alanine aminotransferase
Blood culture (3 pairs): Gram-positive eggs
thoracoscopic echocardiography: moderate mitral regurgitation observed
No observation observed
① a skin biopsy
② an angiography of the lower extremities
③ esophageal echocardiography
④ cardiac computed tomography
⑤ lower limb venous Doppler ultrasound
[/INST] ```json
{
"answer": "3",
"reason": "The patient presents with symptoms and signs suggestive of infective endocarditis, such as fever, a new heart murmur, and skin lesions. The transthoracic echocardiogram (TTE) did not show vegetation, but it is less sensitive than transesophageal echocardiogram (TEE) for detecting vegetations, especially on the mitral valve. Therefore, a TEE is recommended to better visualize the heart valves and confirm the presence of vegetations, which are crucial for diagnosing infective endocarditis.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 24. A 45-year-old man came to the hospital six months ago complaining of shortness of breath when he walks on a flat ground. He has been taking blood pressure drop pills for three years. His blood pressure is 135/85 mmHg, 64 beats/min, 18 beats/min breaths and 36.5°C body temperature. Chest auscultation reveals systolic noise of 3/6 degrees in the space between the left fourth ribs of the costume bone, and breathing sound normal. There is no swelling in both lower extremities. These are chest x-ray scans (photo 1) and electrocardiogram (photo 2). The results of echocardiography are as follows. What about treatment?
Left ventricular ejection rate 62% (reference, 255)
ventricular septum thickness 25 mm (reference value, <11)
Left ventricular posterior wall thickness 11 mm (reference value, <11)
Pressure difference of 50 mmHg with left ventricular outflow after Valsalva (reference value, <5)
① Rivaroxaban
② Amiodarone
③ Carvedylol
④ Plecainid
⑤ Nitroglycerin
[/INST] ```json
{
"answer": "③",
"reason": "The patient presents with symptoms and echocardiographic findings suggestive of hypertrophic obstructive cardiomyopathy (HOCM), characterized by a thickened interventricular septum and a pressure gradient in the left ventricular outflow tract. Carvedilol, a beta-blocker, is often used to manage symptoms in HOCM by reducing heart rate and contractility, thereby decreasing the outflow gradient and improving symptoms. The other options are not typically used for this condition.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 25. A 56-year-old man came to the hospital because his blood pressure was high. He has been taking blood pressure-lowering drugs for high blood pressure since 3 years ago. He did not miss taking medication and is exercising regularly. His blood pressure is 154/102 mmHg, pulse 52 times/min, respiration 16 times/min, and body temperature 36.7°C. Heart and breathing sounds normal on chest auscultation. Home blood pressure, medication being taken, and test results are as follows. What is the treatment?
Domestic blood pressure (right/left): 148/94 mmHg in the morning, 143/98 mmHg in the evening 138/90 mmHg, 145/95 mmHg
Medication: Rosaltan 100 mg once a day
Amrodipine 10 mg once a day
Blood: Na+/K+/CI 142/5.4/102 meq/L
Blood urea nitrogen/creatinine 14/1.2 mg/dL
4.9 mg/dL of uric acid (reference value, 3.1 to 7.0)
128 mg/dL of triglyceride
HDL Cholesterol 47 mg/dL
LDL cholesterol 102 mg/dL
① increased amount of rosaltan
② amlodipine increase
③ Add non-soprolol
④ Spironolactone added
⑤ Add hydrochlorocytoid
[/INST] ```json
{
"answer": "⑤",
"reason": "The patient is on maximum doses of losartan and amlodipine, yet his blood pressure remains uncontrolled. The heart rate is low, suggesting that adding a beta-blocker like bisoprolol may not be ideal. Spironolactone is typically used for resistant hypertension, but the potassium level is already at the upper limit of normal. Adding a thiazide diuretic like hydrochlorothiazide can help control blood pressure by reducing fluid volume without significantly affecting potassium levels.",
"confidence_score": 8
}
``` </s> |
<s>[INST] 26. A 55-year-old man came to the hospital with shortness of breath and increasing severity from 3 months ago. His blood pressure is 152/46 mmHg, pulse 84 times/min, respiration 22 times/min, and body temperature 36.2°C. On chest auscultation, a 3/6 degree diastolic noise can be heard in the space between the third ribs on the left edge of the dress bone, and it is better heard when he sits, tilts his upper body forward, and exhales. Diagnosis?
① mitral regurgitation
② aortic plate reflux
③ mitral valve stenosis
④ atrial septal defect
⑤ pulmonary arterial reflux
[/INST] ```json
{
"answer": "2",
"reason": "The patient's symptoms and examination findings are indicative of aortic regurgitation. The diastolic murmur heard at the left sternal border, especially when the patient is sitting up and leaning forward, is characteristic of aortic regurgitation. The wide pulse pressure (152/46 mmHg) also supports this diagnosis.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 27. A 41-year-old woman came to the hospital complaining of a dry cough from two months ago. She usually coughs when sleeping at night. She said she enjoyed late-night snacks and soda for six months. She is not taking any special medication. She is a non-smoker. She is 156 centimeters tall and weighs 80 kilograms. Heart and breathing sounds normal in her chest auscultation. Her blood pressure is 130/85 mmHg, pulse 80 times/min, respiration 18 times/min, and body temperature 36.5°C. She is X-raying of the chest (photo 1). There are no specific findings in esophagogastroduodenoscopy. What about tests?
① bronchoscopy
② a phlegm cell test
③ chest computed tomography
④ 24-hour walker acidity test
⑤ sputum anti-oxidative strain specimen
[/INST] ```json
{
"answer": "④",
"reason": "The patient's symptoms, such as dry cough occurring mainly at night when lying down, along with a history of consuming late-night snacks and carbonated drinks, suggest gastroesophageal reflux disease (GERD). The 24-hour ambulatory esophageal pH monitoring (option ④) is a diagnostic test used to confirm GERD by measuring acid exposure in the esophagus over a 24-hour period.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 28. A 68-year-old man came to the hospital complaining of shortness of breath for three months. He is okay when he is still but he gets short of breath when he walks fast or up stairs. He is a 20-pack-year-old former smoker. His blood pressure is 130/70 mmHg, pulse 86 times/min, respiration 20 times/min, and body temperature is 36.2°C. When breathing in from both lower chests, you can hear bubbles. The flow rate curve of the pulmonary function test is as follows. What is your diagnosis?
Forced Lung Capacity (FVC): 51% of normal forecast
Forced exhalation volume per second (FEV1): 46% of normal forecast
Forced exhalation/forced lung capacity per second: 89%
Pulmonary diffusivity: 45% of normal prediction
① Institutional stenosis
② spondylosis
③ bronchial asthma
④ interstitial lung disease
⑤ chronic obstructive pulmonary disease
[/INST] ```json
{
"answer": "④",
"reason": "The patient's symptoms and test results suggest interstitial lung disease. The reduced FVC and FEV1 with a normal FEV1/FVC ratio, along with decreased diffusion capacity, are indicative of a restrictive lung disease pattern, which is consistent with interstitial lung disease.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 29. A 74-year-old woman came to the hospital two hours ago out of breath. She reportedly had severe pain in her front chest for five hours five days ago, but did not go to the hospital. Her blood pressure is 102/60 mmHg, pulse 100 times/min, respiration 28 times/min, and body temperature 36.5°C. On chest auscultation, 3/6 degrees of systolic heart murmur and third heart murmur can be heard at the tip of the heart, and foam can be heard at the bottom of both backs. These are chest x-ray scans (photo 1) and electrocardiogram (photo 2). The results of blood tests are as follows. What are the tests?
Hemoglobin 14.2 g/dL, leukocyte 5,200/mm3, platelets 245,000/mm3
Blood urea nitrogen/creatinine 14/0.8 mg/dL
Troponin T 70 ng/L (reference value, <14)
Brain sodium excretion peptide 2,060 pg/mL (reference value, <100)
① Echocardiography
② 24-hour halter monitoring
③ Exercise load electrocardiogram test
④ chest computed tomography
⑤ Adenosine load 99m technetium myocardial perfusion scan
[/INST] ```json
{
"answer": "①",
"reason": "The patient presents with symptoms and signs suggestive of heart failure and possibly a recent myocardial infarction, as indicated by elevated troponin levels and BNP. The presence of a systolic murmur and S3 gallop suggests possible valvular dysfunction or heart failure. An echocardiogram (심초음파검사) is the most appropriate test to evaluate cardiac function, assess for wall motion abnormalities, and check for valvular issues.",
"confidence_score": 9
}
``` </s> |
<s>[INST] 30. A 50-year-old man came to the hospital with pain in his left chest from a week ago. It hurts more when he inhales heavily or yawns, and he feels short of breath when climbing stairs from two days ago. He is a 30-pack-year-old smoker. His blood pressure is 130/80 mmHg, pulse 88 times/min, respiration 18 times/min, and body temperature is 37°C. I can't hear well from my left lower chest. This is X-ray imaging (photo 1). The results of the examination are as follows. What is your diagnosis?
Blood: 8.0g/dL of protein, 90mg/dL of glucose
Lactate dehydrogenase 265 U/L (reference, 115 to 221) Cancer germ antigen 25 ng/mL (reference, <5)
Chest alveolar effusion:
White blood cells 1,000/mm3 (6% neutrophils, 94% lymphocytes)
4.3 g/dL of protein, 58 mg/dL of glucose
Lactate dehydrogenase 210 U/L
105 mg/dL of triglyceride (reference value, <150)
Cancer germ antigen 529 ng/mL
Adenosine amino group removal enzyme (ADA)_35 IU/L
① a pus in the chest
② a cancerous cardiomyopathy
③ tuberculosis thoracic effusion
④ malignant pleural effusion
⑤ pleural effusion of sinus pneumonia
[/INST] ```json
{
"answer": "④",
"reason": "The patient's pleural effusion analysis shows a high level of carcinoembryonic antigen (CEA) at 529 ng/mL, which is significantly elevated and suggests a malignant pleural effusion. The presence of lymphocyte predominance in the pleural fluid and the patient's smoking history further support this diagnosis. Other options like empyema, chylothorax, tuberculous pleuritis, and parapneumonic effusion are less likely given the specific findings.",
"confidence_score": 9
}
``` </s> |