{"id": 0, "question": "The mechanism of action of the medication given blocks cell wall synthesis, which of the following was given?", "context": ["A 21-year-old sexually active male complains of fever, pain during urination, and inflammation and pain in the right knee.", "A culture of the joint fluid shows a bacteria that does not ferment maltose and has no polysaccharide capsule.", "The physician orders antibiotic therapy for the patient."], "context_len": 3, "options": {"A": "Gentamicin", "B": "Ciprofloxacin", "C": "Ceftriaxone", "D": "Trimethoprim"}, "answer": "Ceftriaxone", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "21 years old", "specialties": ["Internal Medicine", "Urology"], "subspecialties": ["Infectious Disease", "General Urology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is a 21-year-old male.", "2. Patient is sexually active.", "3. Patient complains of fever.", "4. Patient complains of pain during urination.", "5. Patient complains of inflammation and pain in the right knee.", "6. Culture of joint fluid shows a bacteria.", "7. Bacteria does not ferment maltose.", "8. Bacteria has no polysaccharide capsule.", "9. Physician orders antibiotic therapy for the patient."], "atomic_facts": ["1. A culture of the joint fluid shows a bacteria.", "2. The bacteria does not ferment maltose.", "3. The bacteria has no polysaccharide capsule.", "4. The physician orders antibiotic therapy for the patient."]}
{"id": 1, "question": "Which of the following is the most likely diagnosis?", "context": ["A 5-year-old girl is brought to the emergency department by her mother because of multiple episodes of nausea and vomiting that last about 2 hours.", "During this period, she has had 6\u20138 episodes of bilious vomiting and abdominal pain.", "The vomiting was preceded by fatigue.", "The girl feels well between these episodes.", "She has missed several days of school and has been hospitalized 2 times during the past 6 months for dehydration due to similar episodes of vomiting and nausea.", "The patient has lived with her mother since her parents divorced 8 months ago.", "Her immunizations are up-to-date.", "She is at the 60th percentile for height and 30th percentile for weight.", "She appears emaciated.", "Her temperature is 36.8\u00b0C (98.8\u00b0F), pulse is 99/min, and blood pressure is 82/52 mm Hg.", "Examination shows dry mucous membranes.", "The lungs are clear to auscultation.", "Abdominal examination shows a soft abdomen with mild diffuse tenderness with no guarding or rebound.", "The remainder of the physical examination shows no abnormalities."], "context_len": 14, "options": {"A": "Cyclic vomiting syndrome", "B": "Gastroenteritis", "C": "Hypertrophic pyloric stenosis", "D": "Gastroesophageal reflux disease"}, "answer": "Cyclic vomiting syndrome", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "5 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 5-year-old girl is brought to the emergency department by her mother.", "2. She has had multiple episodes of nausea and vomiting that last about 2 hours.", "3. During this period, she has had 6\u20138 episodes of bilious vomiting and abdominal pain.", "4. The vomiting was preceded by fatigue.", "5. She feels well between these episodes.", "6. She has missed several days of school and has been hospitalized 2 times during the past 6 months for dehydration due to similar episodes of vomiting and nausea.", "7. The patient has lived with her mother since her parents divorced 8 months ago.", "8. Her immunizations are up-to-date.", "9. She is at the 60th percentile for height and 30th percentile for weight.", "10. She appears emaciated.", "11. Her temperature is 36.8\u00b0C (98.8\u00b0F), pulse is 99/min, and blood pressure is 82/52 mm Hg.", "12. Examination shows dry mucous membranes.", "13. The lungs are clear to auscultation.", "14. Abdominal examination shows a soft abdomen with mild diffuse tenderness with no guarding or rebound.", "15. The remainder of the physical examination shows no abnormalities."], "atomic_facts": ["1. The patient has had 6\u20138 episodes of bilious vomiting and abdominal pain.", "2. The vomiting was preceded by fatigue.", "3. The girl feels well between these episodes.", "4. She has missed several days of school.", "5. She has been hospitalized 2 times during the past 6 months for dehydration due to similar episodes of vomiting and nausea.", "6. The patient has lived with her mother since her parents divorced 8 months ago.", "7. Her immunizations are up-to-date.", "8. She is at the 60th percentile for height and 30th percentile for weight.", "9. She appears emaciated.", "10. Her temperature is 36.8\u00b0C (98.8\u00b0F), pulse is 99/min, and blood pressure is 82/52 mm Hg.", "11. Examination shows dry mucous membranes.", "12. The lungs are clear to auscultation.", "13. Abdominal examination shows a soft abdomen with mild diffuse tenderness with no guarding or rebound.", "14. The remainder of the physical examination shows no abnormalities."]}
{"id": 2, "question": "Which of the following is the best course of treatment in this patient?", "context": ["A 40-year-old woman presents with difficulty falling asleep, diminished appetite, and tiredness for the past 6 weeks.", "She says that, despite going to bed early at night, she is unable to fall asleep.", "She denies feeling anxious or having disturbing thoughts while in bed.", "Even when she manages to fall asleep, she wakes up early in the morning and is unable to fall back asleep.", "She says she has grown increasingly irritable and feels increasingly hopeless, and her concentration and interest at work have diminished.", "The patient denies thoughts of suicide or death.", "Because of her diminished appetite, she has lost 4 kg (8.8 lb) in the last few weeks and has started drinking a glass of wine every night instead of eating dinner.", "She has no significant past medical history and is not on any medications."], "context_len": 8, "options": {"A": "Diazepam", "B": "Paroxetine", "C": "Zolpidem", "D": "Trazodone"}, "answer": "Trazodone", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "40 years old", "specialties": ["Psychiatry"], "subspecialties": ["Sleep Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is a 40-year-old woman.", "2. Patient has difficulty falling asleep for the past 6 weeks.", "3. Patient goes to bed early at night but is unable to fall asleep.", "4. Patient denies feeling anxious or having disturbing thoughts while in bed.", "5. Patient wakes up early in the morning and is unable to fall back asleep.", "6. Patient has grown increasingly irritable and feels increasingly hopeless.", "7. Patient's concentration and interest at work have diminished.", "8. Patient denies thoughts of suicide or death.", "9. Patient has lost 4 kg (8.8 lb) in the last few weeks.", "10. Patient has started drinking a glass of wine every night instead of eating dinner.", "11. Patient has no significant past medical history.", "12. Patient is not on any medications."], "atomic_facts": ["1. The patient has trouble falling asleep despite going to bed early at night.", "2. She denies feeling anxious or having disturbing thoughts while in bed.", "3. Even when she manages to fall asleep, she wakes up early in the morning and is unable to fall back asleep.", "4. The patient has grown increasingly irritable and feels increasingly hopeless.", "5. Her concentration and interest at work have diminished.", "6. The patient denies thoughts of suicide or death.", "7. She has lost 4 kg (8.8 lb) in the last few weeks due to diminished appetite.", "8. She has started drinking a glass of wine every night instead of eating dinner.", "9. The patient has no significant past medical history and is not on any medications."]}
{"id": 3, "question": "Which of the following is the next best step in management?", "context": ["A 37-year-old female with a history of type II diabetes mellitus presents to the emergency department complaining of blood in her urine, left-sided flank pain, nausea, and fever.", "She also states that she has pain with urination.", "Vital signs include: temperature is 102 deg F (39.4 deg C), blood pressure is 114/82 mmHg, pulse is 96/min, respirations are 18, and oxygen saturation of 97% on room air.", "On physical examination, the patient appears uncomfortable and has tenderness on the left flank and left costovertebral angle."], "context_len": 4, "options": {"A": "Obtain an abdominal CT scan", "B": "Obtain a urine analysis and urine culture", "C": "Begin intravenous treatment with ceftazidime", "D": "No treatment is necessary"}, "answer": "Obtain a urine analysis and urine culture", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "37 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 37-year-old female presents to the emergency department.", "2. She has a history of type II diabetes mellitus.", "3. She is complaining of blood in her urine, left-sided flank pain, nausea, and fever.", "4. She also states that she has pain with urination.", "5. Her temperature is 102 deg F (39.4 deg C).", "6. Her blood pressure is 114/82 mmHg.", "7. Her pulse is 96/min.", "8. Her respirations are 18.", "9. Her oxygen saturation is 97% on room air.", "10. On physical examination, she appears uncomfortable.", "11. She has tenderness on the left flank.", "12. She has tenderness on the left costovertebral angle."], "atomic_facts": ["1. The patient reports pain with urination.", "2. Vital signs: temperature is 102 deg F (39.4 deg C), blood pressure is 114/82 mmHg, pulse is 96/min, respirations are 18, and oxygen saturation of 97% on room air.", "3. On physical examination, the patient appears uncomfortable.", "4. The patient has tenderness on the left flank.", "5. The patient has tenderness on the left costovertebral angle."]}
{"id": 4, "question": "Which of the following should be treated first in this patient?", "context": ["A 19-year-old boy presents with confusion and the inability to speak properly.", "The patient's mother says that, a few hours ago, she noticed a change in the way he talked and that he appeared to be in a daze.", "He then lost consciousness, and she managed to get him to the hospital.", "She is also concerned about the weight he has lost over the past few months.", "His blood pressure is 80/55 mm Hg, pulse is 115/min, temperature is 37.2\u00b0C (98.9\u00b0F), and respiratory rate is 18/min.", "On physical examination, the patient is taking rapid, deep breaths, and his breath has a fruity odor.", "Dry mucous membranes and dry skin are noticeable.", "He is unable to cooperate for a mental status examination.", "Results of his arterial blood gas analysis are shown. | Pco2 16 mm Hg | HCO3\u2013  10 mEq/L | Po2 91 mm Hg | pH 7.1 | His glucose level is 450 mg/dL, and his potassium level is 4.1 mEq/L."], "context_len": 9, "options": {"A": "Hypoperfusion", "B": "Hyperglycemia", "C": "Metabolic acidosis", "D": "Hypokalemia"}, "answer": "Hypoperfusion", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "19", "specialties": ["Neurology"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 19 years old.", "2. Patient presents with confusion and inability to speak properly.", "3. Patient's mother noticed a change in the way he talked and he appeared to be in a daze a few hours ago.", "4. Patient lost consciousness and mother managed to get him to the hospital.", "5. Mother is concerned about weight loss over past few months.", "6. Patient's blood pressure is 80/55 mm Hg.", "7. Patient's pulse is 115/min.", "8. Patient's temperature is 37.2\u00b0C (98.9\u00b0F).", "9. Patient's respiratory rate is 18/min.", "10. Patient is taking rapid, deep breaths.", "11. Patient's breath has a fruity odor.", "12. Patient has dry mucous membranes and dry skin.", "13. Patient is unable to cooperate for mental status examination.", "14. Patient's Pco2 is 16 mm Hg.", "15. Patient's HCO3\u2013 is 10 mEq/L.", "16. Patient's Po2 is 91 mm Hg.", "17. Patient's pH is 7.1.", "18. Patient's glucose level is 450 mg/dL.", "19. Patient's potassium level is 4.1 mEq/L."], "atomic_facts": ["1. The patient's mother noticed a change in the way he talked and that he appeared to be in a daze.", "2. The patient lost consciousness.", "3. The patient's blood pressure is 80/55 mm Hg.", "4. The patient's pulse is 115/min.", "5. The patient's temperature is 37.2\u00b0C (98.9\u00b0F).", "6. The patient's respiratory rate is 18/min.", "7. On physical examination, the patient is taking rapid, deep breaths, and his breath has a fruity odor.", "8. Dry mucous membranes and dry skin are noticeable.", "9. The patient is unable to cooperate for a mental status examination.", "10. Results of his arterial blood gas analysis: Pco2 16 mm Hg, HCO3\u2013 10 mEq/L, Po2 91 mm Hg, pH 7.1.", "11. The patient's glucose level is 450 mg/dL.", "12. The patient's potassium level is 4.1 mEq/L."]}
{"id": 5, "question": "Which of the following represents the most likely etiology of her anemia.", "context": ["A 41-year-old woman presents to her primary care physician with complaints of fatigue and weakness.", "She denies any personal history of blood clots or bleeding problems in her past, but she says that her mother has had to be treated for breast cancer recently and is starting to wear her down.", "Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia.", "She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and currently denies any illicit drug use.", "Her vital signs include: temperature, 36.7\u00b0C (98.0\u00b0F); blood pressure, 126/74 mm Hg; heart rate, 111/min; and respiratory, rate 23/min.", "On physical examination, her pulses are bounding and irregular, complexion is pale, but breath sounds remain clear.", "On examination, the physician finds diffuse skin pallor and orders a complete blood count.", "Her laboratory data demonstrate a hematocrit of 27.1%, MCV of 79 fL, and a reticulocyte count of 2.0%.", "The patient is diagnosed with anemia."], "context_len": 9, "options": {"A": "Vitamin B12 deficiency", "B": "Folate deficiency", "C": "Iron deficiency", "D": "Intravascular hemolysis"}, "answer": "Iron deficiency", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "41", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 41 years old.", "2. Patient complains of fatigue and weakness.", "3. Patient denies personal history of blood clots or bleeding problems.", "4. Patient's mother has been treated for breast cancer recently.", "5. Patient's past medical history includes preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia.", "6. Patient smokes 1 pack of cigarettes per day.", "7. Patient drinks 1 glass of wine per day.", "8. Patient denies any illicit drug use.", "9. Patient's temperature is 36.7\u00b0C (98.0\u00b0F).", "10. Patient's blood pressure is 126/74 mm Hg.", "11. Patient's heart rate is 111/min.", "12. Patient's respiratory rate is 23/min.", "13. Patient's pulses are bounding and irregular.", "14. Patient's complexion is pale.", "15. Patient's breath sounds are clear.", "16. Physician finds diffuse skin pallor.", "17. Physician orders complete blood count.", "18. Patient's hematocrit is 27.1%.", "19. Patient's MCV is 79 fL.", "20. Patient's reticulocyte count is 2.0%.", "21. Patient is diagnosed with anemia."], "atomic_facts": ["1. Patient denies personal history of blood clots or bleeding problems.", "2. Patient's mother has been treated for breast cancer recently.", "3. Patient's past medical history includes preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia.", "4. Patient currently smokes 1 pack of cigarettes per day.", "5. Patient drinks a glass of wine per day.", "6. Patient denies any illicit drug use.", "7. Vital signs: temperature 36.7\u00b0C (98.0\u00b0F), blood pressure 126/74 mm Hg, heart rate 111/min, respiratory rate 23/min.", "8. Patient's pulses are bounding and irregular.", "9. Patient's complexion is pale.", "10. Breath sounds remain clear.", "11. Physician finds diffuse skin pallor and orders a complete blood count.", "12. Laboratory data: hematocrit 27.1%, MCV 79 fL, reticulocyte count 2.0%.", "13. Patient is diagnosed with anemia."]}
{"id": 6, "question": "Which of the following is the most likely primary mechanism underlying this woman's temporal muscle atrophy?", "context": ["A 59-year-old woman with stage IV lung cancer comes to the physician because of progressively worsening weakness in the past 3 months.", "She has had a 10.5-kg (23-lb) weight loss during this period.", "Her BMI is 16 kg/m2.", "She appears thin and has bilateral temporal wasting."], "context_len": 4, "options": {"A": "Cytochrome c-mediated activation of proteases", "B": "Lipase-mediated degradation of triglycerides", "C": "TNF-\u03b1-mediated activation of caspases", "D": "Proteasomal degradation of ubiquitinated proteins"}, "answer": "Proteasomal degradation of ubiquitinated proteins", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "59 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 59-year-old woman has stage IV lung cancer.", "2. She has experienced progressively worsening weakness in the past 3 months.", "3. She has lost 10.5 kg (23 lbs) in the past 3 months.", "4. Her BMI is 16 kg/m2.", "5. She appears thin.", "6. She has bilateral temporal wasting."], "atomic_facts": ["1. She has had a 10.5-kg weight loss during this period.", "2. The weight loss is equivalent to 23 lbs.", "3. Her BMI is 16 kg/m2.", "4. She appears thin.", "5. She has bilateral temporal wasting."]}
{"id": 7, "question": "Which of the following is the most likely diagnosis?", "context": ["A 67-year-old man presents to the emergency department with a fever and altered mental status.", "The patient has a history of Alzheimer dementia and is typically bed bound.", "His son found him confused with a warm and flushed complexion thus prompting his presentation.", "The patient has a past medical history of dementia, diabetes, and hypertension and typically has a visiting home nurse come to administer medications.", "Prior to examination, he is given haloperidol and diphenhydramine as he is combative and will not allow the nurses near him.", "His temperature is 102.9\u00b0F (39.4\u00b0C), blood pressure is 104/64 mmHg, pulse is 170/min, respirations are 22/min, and oxygen saturation is 100% on room air.", "Physical exam is notable for dry and flushed skin and a confused man.", "There is no skin breakdown, and flexion of the patient\u2019s neck elicits no discomfort.", "Laboratory studies are drawn as seen below. |  | Hemoglobin: 15 g/dL | Hematocrit: 45% | Leukocyte count: 4,500/mm^3 with normal differential | Platelet count: 227,000/mm^3 |  | Serum: | Na+: 139 mEq/L | Cl-: 100 mEq/L | K+: 4.3 mEq/L | HCO3-: 24 mEq/L | BUN: 30 mg/dL | Glucose: 97 mg/dL | Creatinine: 1.5 mg/dL | Ca2+: 10.2 mg/dL | AST: 12 U/L | ALT: 10 U/L |  | Urine: | Color: Yellow | Bacteria: Absent | Nitrites: Negative | Red blood cells: Negative |  | An initial chest radiograph is unremarkable.", "The patient is given 3 liters of Ringer's lactate and an electric fan to cool off.", "Two hours later, his temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 154/94 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 100% on room air.", "The patient\u2019s mental status is at the patient\u2019s baseline according to the son."], "context_len": 12, "options": {"A": "Exertional heat stroke", "B": "Neuroleptic malignant syndrome", "C": "Non-exertional heat stroke", "D": "Septic shock"}, "answer": "Non-exertional heat stroke", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "67", "specialties": ["Internal Medicine", "Emergency Medicine"], "subspecialties": ["Infectious Disease", "Neurocritical Care"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 67-year-old man presents to the emergency department with a fever and altered mental status.", "2. The patient has a history of Alzheimer dementia and is typically bed bound.", "3. His son found him confused with a warm and flushed complexion thus prompting his presentation.", "4. The patient has a past medical history of dementia, diabetes, and hypertension.", "5. The patient typically has a visiting home nurse come to administer medications.", "6. Prior to examination, he is given haloperidol and diphenhydramine as he is combative and will not allow the nurses near him.", "7. His temperature is 102.9\u00b0F (39.4\u00b0C), blood pressure is 104/64 mmHg, pulse is 170/min, respirations are 22/min, and oxygen saturation is 100% on room air.", "8. Physical exam is notable for dry and flushed skin and a confused man.", "9. There is no skin breakdown, and flexion of the patient\u2019s neck elicits no discomfort.", "10. Laboratory studies show a hemoglobin of 15 g/dL, hematocrit of 45%, leukocyte count of 4,500/mm^3 with normal differential, and platelet count of 227,000/mm^3.", "11. Serum Na+ is 139 mEq/L, Cl- is 100 mEq/L, K+ is 4.3 mEq/L, HCO3- is 24 mEq/L, BUN is 30 mg/dL, glucose is 97 mg/dL, creatinine is 1.5 mg/dL, Ca2+ is 10.2 mg/dL, AST is 12 U/L, and ALT is 10 U/L.", "12. Urine color is yellow, bacteria are absent, nitrites are negative, and red blood cells are negative.", "13. An initial chest radiograph is unremarkable.", "14. The patient is given 3 liters of Ringer's lactate and an electric fan to cool off.", "15. Two hours later, his temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 154/94 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 100% on room air.", "16. The patient\u2019s mental status is at the"], "atomic_facts": ["1. The patient has a history of Alzheimer dementia.", "2. The patient is typically bed bound.", "3. The patient has a past medical history of dementia, diabetes, and hypertension.", "4. The patient typically has a visiting home nurse come to administer medications.", "5. Prior to examination, the patient is given haloperidol and diphenhydramine.", "6. The patient's temperature is 102.9\u00b0F (39.4\u00b0C).", "7. The patient's blood pressure is 104/64 mmHg.", "8. The patient's pulse is 170/min.", "9. The patient's respirations are 22/min.", "10. The patient's oxygen saturation is 100% on room air.", "11. Physical exam is notable for dry and flushed skin and a confused man.", "12. There is no skin breakdown.", "13. Flexion of the patient\u2019s neck elicits no discomfort.", "14. Laboratory studies show: Hemoglobin: 15 g/dL, Hematocrit: 45%, Leukocyte count: 4,500/mm^3 with normal differential, Platelet count: 227,000/mm^3, Serum: Na+: 139 mEq/L, Cl-: 100 mEq/L, K+: 4.3 mEq/L, HCO3-: 24 mEq/L, BUN: 30 mg/dL, Glucose: 97 mg/dL, Creatinine: 1.5 mg/dL, Ca2+: 10.2 mg/dL, AST: 12 U/L, ALT: 10 U/L, Urine: Color: Yellow, Bacteria: Absent, Nitrites: Negative, Red blood cells: Negative.", "15. An initial chest radiograph is unremarkable.", "16. The patient is given 3 liters of Ringer's lactate and an electric fan to cool off.", "17. Two hours later, the patient\u2019s temperature is 99\u00b0F (37.2\u00b0C).", "18. The patient\u2019s blood pressure is 154/94 mmHg.", "19. The patient\u2019s pulse is 100/min.", "20. The patient\u2019s respirations are 17/min.", "21. The patient\u2019s oxygen saturation is 100% on room air.", "22. The patient\u2019s mental status is at the patient\u2019s baseline according to the son."]}
{"id": 8, "question": "The most likely cause of this patient's symptoms is associated with which of the following enzymatic reactions?", "context": ["A 32-year-old man presents to a mission hospital in Cambodia because he has had difficulty walking from his village to the market.", "He says that he has always been healthy other than occasional infections; however, over the last year he has been having numbness in his hands and feet.", "Furthermore, he has noticed weakness, muscle wasting, and pain in his lower extremities.", "The only change he can remember is that after having a poor harvest last year, he and his family have been subsisting on white rice.", "Physical exam reveals normal skin color and decreased deep tendon reflexes."], "context_len": 5, "options": {"A": "Alpha-ketoglutarate dehydrogenase", "B": "Acyl transferases", "C": "Glycogen phosphorylase", "D": "Homocysteine methyltransferase"}, "answer": "Alpha-ketoglutarate dehydrogenase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "32 years old", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Physical Medicine and Rehabilitation"}, "facts_old": ["1. A 32-year-old man presents to a mission hospital in Cambodia.", "2. He has had difficulty walking from his village to the market.", "3. He has always been healthy other than occasional infections.", "4. Over the last year he has been having numbness in his hands and feet.", "5. He has noticed weakness, muscle wasting, and pain in his lower extremities.", "6. The only change he can remember is that after having a poor harvest last year, he and his family have been subsisting on white rice.", "7. Physical exam reveals normal skin color.", "8. Physical exam reveals decreased deep tendon reflexes."], "atomic_facts": ["1. He has always been healthy other than occasional infections.", "2. Over the last year, he has been having numbness in his hands and feet.", "3. He has noticed weakness, muscle wasting, and pain in his lower extremities.", "4. After having a poor harvest last year, he and his family have been subsisting on white rice.", "5. Physical exam reveals normal skin color.", "6. Physical exam reveals decreased deep tendon reflexes."]}
{"id": 9, "question": "Which of the following is the best next step in management?", "context": ["A 60-year-old woman presents to her primary care physician for a wellness checkup.", "She has a past medical history of hypertension and was discharged from the hospital yesterday after management of a myocardial infarction.", "She states that sometimes she experiences exertional angina.", "Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 147/98 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air.", "Physical exam is within normal limits."], "context_len": 5, "options": {"A": "Atenolol", "B": "Furosemide", "C": "Hydrochlorothiazide", "D": "Nitroglycerin"}, "answer": "Atenolol", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "60 years old", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 60-year-old woman presents to her primary care physician for a wellness checkup.", "2. She has a past medical history of hypertension.", "3. She was discharged from the hospital yesterday after management of a myocardial infarction.", "4. She states that sometimes she experiences exertional angina.", "5. Her temperature is 99.5\u00b0F (37.5\u00b0C).", "6. Her blood pressure is 147/98 mmHg.", "7. Her pulse is 90/min.", "8. Her respirations are 17/min.", "9. Her oxygen saturation is 98% on room air.", "10. Physical exam is within normal limits."], "atomic_facts": ["1. The patient has a past medical history of hypertension.", "2. The patient was discharged from the hospital yesterday after management of a myocardial infarction.", "3. The patient sometimes experiences exertional angina.", "4. The patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "5. The patient's blood pressure is 147/98 mmHg.", "6. The patient's pulse is 90/min.", "7. The patient's respirations are 17/min.", "8. The patient's oxygen saturation is 98% on room air.", "9. The physical exam is within normal limits."]}
{"id": 10, "question": "When this hormone is produced by the hypothalamus, it has which of the following effects?", "context": ["A 42-year-old male presents to his primary care physician complaining of abdominal pain.", "He reports a 5-month history of epigastric pain that improves with meals.", "He has lost 15 pounds since the pain started.", "His past medical history is significant for a prolactinoma for which he underwent transphenoidal resection.", "He drinks alcohol socially and has a 10 pack-year smoking history.", "His family history is notable for a maternal uncle with a parathyroid adenoma.", "His temperature is 98.8\u00b0F (37.1\u00b0C), blood pressure is 125/80 mmHg, pulse is 85/min, and respirations are 18/min.", "After further workup, the patient is started on octreotide, an analogue of an endogenously produced hormone."], "context_len": 8, "options": {"A": "Decrease production of growth hormone", "B": "Decrease production of prolactin", "C": "Decrease production of gastrin", "D": "Decrease production of thyrotropin-releasing hormone"}, "answer": "Decrease production of growth hormone", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "42", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 42-year-old male presents to his primary care physician.", "2. He is complaining of abdominal pain.", "3. He has a 5-month history of epigastric pain that improves with meals.", "4. He has lost 15 pounds since the pain started.", "5. His past medical history is significant for a prolactinoma for which he underwent transphenoidal resection.", "6. He drinks alcohol socially.", "7. He has a 10 pack-year smoking history.", "8. His family history is notable for a maternal uncle with a parathyroid adenoma.", "9. His temperature is 98.8\u00b0F (37.1\u00b0C).", "10. His blood pressure is 125/80 mmHg.", "11. His pulse is 85/min.", "12. His respirations are 18/min.", "13. He is started on octreotide, an analogue of an endogenously produced hormone."], "atomic_facts": ["1. The patient reports a 5-month history of epigastric pain that improves with meals.", "2. He has lost 15 pounds since the pain started.", "3. His past medical history includes a prolactinoma for which he underwent transphenoidal resection.", "4. He drinks alcohol socially and has a 10 pack-year smoking history.", "5. His family history includes a maternal uncle with a parathyroid adenoma.", "6. His temperature is 98.8\u00b0F (37.1\u00b0C), blood pressure is 125/80 mmHg, pulse is 85/min, and respirations are 18/min.", "7. After further workup, the patient is started on octreotide, an analogue of an endogenously produced hormone."]}
{"id": 11, "question": "What is the minimum amount of time this patient must exhibit these symptoms in order to meet the diagnostic criteria for dysthymia?", "context": ["A 28-year-old female reports that, for more days than not over the past 3 years, she has felt \"down\" and, at times, \"mildly depressed.\" Over this period, she also endorses feeling fatigued, difficulty concentrating, and often sleeping more than in the past.", "The patient denies any manic or hypomanic periods and also reports that she did not have any periods of extreme worsening of her depressed mood beyond that described above.", "She also denies any suicidal ideation."], "context_len": 3, "options": {"A": "2 months", "B": "6 months", "C": "2 years", "D": "5 years"}, "answer": "2 years", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "28", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is 28 years old.", "2. Patient has felt \"down\" and \"mildly depressed\" for more days than not over the past 3 years.", "3. Patient endorses feeling fatigued.", "4. Patient endorses difficulty concentrating.", "5. Patient has been sleeping more than in the past.", "6. Patient denies any manic or hypomanic periods.", "7. Patient denies any periods of extreme worsening of her depressed mood beyond that described above.", "8. Patient denies any suicidal ideation."], "atomic_facts": ["1. The patient denies any manic periods.", "2. The patient denies any hypomanic periods.", "3. The patient reports not having any periods of extreme worsening of her depressed mood beyond that described above.", "4. The patient denies any suicidal ideation."]}
{"id": 12, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 42-year-old man is being treated by his female family medicine physician for chronic depression.", "Recently, he has been scheduling more frequent office visits.", "He does not report any symptoms or problems with his SSRI medication during these visits.", "Upon further questioning, the patient confesses that he is attracted to her and says \"You are the only one in the world who understands me\".", "The physician also manages his hypertension."], "context_len": 5, "options": {"A": "Re-evaluate this patient for borderline personality disorder", "B": "Ask closed-ended questions and use a chaperone for future visits", "C": "Immediately tell this patient that you can not continue to treat him and avoid any further communication", "D": "Increase the dosage of this patient\u2019s SSRI"}, "answer": "Ask closed-ended questions and use a chaperone for future visits", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "42", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 42-year-old man is being treated by his female family medicine physician.", "2. The patient has chronic depression.", "3. The patient has been scheduling more frequent office visits.", "4. The patient does not report any symptoms or problems with his SSRI medication during these visits.", "5. Upon further questioning, the patient confesses that he is attracted to his physician.", "6. The patient says \"You are the only one in the world who understands me\".", "7. The physician also manages the patient's hypertension."], "atomic_facts": ["1. He has been scheduling more frequent office visits.", "2. He does not report any symptoms or problems with his SSRI medication during these visits.", "3. The patient confesses that he is attracted to her.", "4. The patient says \"You are the only one in the world who understands me.\"", "5. The physician manages his hypertension."]}
{"id": 13, "question": "What is the most likely cause of the gallstone coloring?", "context": ["A 51-year-old female presents with intermittent right upper quadrant discomfort.", "The physician suspects she is suffering from biliary colic and recommends surgery.", "Following surgery, brown stones are removed from the gallbladder specimen."], "context_len": 3, "options": {"A": "E. coli infection; beta-glucoronidase release", "B": "Shigella infection; HMG-CoA reductase release", "C": "Shigella infection; beta-glucoronidase release", "D": "Bile supersaturated with cholesterol; beta-glucoronidase release"}, "answer": "E. coli infection; beta-glucoronidase release", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "51 years", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 51-year-old female presents with intermittent right upper quadrant discomfort.", "2. The physician suspects she is suffering from biliary colic.", "3. The physician recommends surgery.", "4. Following surgery, brown stones are removed from the gallbladder specimen."], "atomic_facts": ["1. The physician suspects the patient is suffering from biliary colic.", "2. The physician recommends surgery for the patient.", "3. Brown stones are removed from the gallbladder specimen following surgery."]}
{"id": 14, "question": "What is the most likely cause of his condition?", "context": ["A 56-year-old man with known coronary artery disease presents to the emergency department complaining of chest discomfort and palpitations for 2 hours.", "On arrival, the vital signs include blood pressure 122/76 mm Hg, heart rate 180/min, respiratory rate 22/min, temperature 37.0\u2103 (98.6\u2109), and blood oxygen saturation (SpO2) 98% on room air.", "A 12-lead electrocardiogram demonstrated ST-segment elevation in the anterolateral leads.", "The troponin level was 0.8 ng/mL (normal 0\u20130.4 ng/mL).", "The patient declined primary percutaneous intervention and was treated with antifibrinolytics in the coronary care unit.", "After 1 hour of treatment, the patient loses consciousness and the blood pressure falls to 60/40 mm Hg.", "Cardiac monitoring shows the electrocardiogram (ECG) pattern in lead 2 shown below."], "context_len": 7, "options": {"A": "Monomorphic ventricular tachycardia", "B": "Mitral regurgitation", "C": "Third-degree heart block", "D": "Acute pericarditis"}, "answer": "Monomorphic ventricular tachycardia", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "56 years old", "specialties": ["Cardiology"], "subspecialties": ["Cardiovascular Disease", "Clinical Cardiac Electrophysiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 56-year-old man with known coronary artery disease presents to the emergency department.", "2. The patient is complaining of chest discomfort and palpitations for 2 hours.", "3. On arrival, the vital signs include blood pressure 122/76 mm Hg, heart rate 180/min, respiratory rate 22/min, temperature 37.0\u2103 (98.6\u2109), and blood oxygen saturation (SpO2) 98% on room air.", "4. A 12-lead electrocardiogram demonstrated ST-segment elevation in the anterolateral leads.", "5. The troponin level was 0.8 ng/mL (normal 0\u20130.4 ng/mL).", "6. The patient declined primary percutaneous intervention and was treated with antifibrinolytics in the coronary care unit.", "7. After 1 hour of treatment, the patient loses consciousness and the blood pressure falls to 60/40 mm Hg.", "8. Cardiac monitoring shows the electrocardiogram (ECG) pattern in lead 2."], "atomic_facts": ["1. Vital signs on arrival: blood pressure 122/76 mm Hg, heart rate 180/min, respiratory rate 22/min, temperature 37.0\u2103 (98.6\u2109), and blood oxygen saturation (SpO2) 98% on room air.", "2. 12-lead electrocardiogram demonstrated ST-segment elevation in the anterolateral leads.", "3. Troponin level was 0.8 ng/mL (normal 0\u20130.4 ng/mL).", "4. Patient declined primary percutaneous intervention and was treated with antifibrinolytics in the coronary care unit.", "5. After 1 hour of treatment, the patient loses consciousness.", "6. Blood pressure falls to 60/40 mm Hg.", "7. Cardiac monitoring shows the electrocardiogram (ECG) pattern in lead 2."]}
{"id": 15, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 16-year-old female high school student is brought to the physician by her parents for her repeated behavioral problems at home and school during the past 10 months.", "Her teachers describe her behavior as uncooperative and disruptive as she persistently refuses to answer questions, insults her teachers, and annoys her classmates on a daily basis.", "At home, her parents try to address her frequent violations of curfew, but attempts at discussing the issue often result in their daughter losing her temper and screaming at her parents.", "Her grades have deteriorated over the past year.", "She has no history of psychiatric illness.", "On questioning, the patient refuses to answer and frequently disrupts the physician\u2019s conversation with the parents."], "context_len": 6, "options": {"A": "Reactive attachment disorder", "B": "Conduct disorder", "C": "Antisocial personality disorder", "D": "Oppositional defiant disorder"}, "answer": "Oppositional defiant disorder", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "16", "specialties": ["Psychiatry"], "subspecialties": ["Child and Adolescent Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is a 16-year-old female high school student.", "2. Patient was brought to the physician by her parents.", "3. Patient has had repeated behavioral problems for 10 months.", "4. Patient's teachers describe her behavior as uncooperative and disruptive.", "5. Patient refuses to answer questions, insults teachers, and annoys classmates on a daily basis.", "6. Patient's parents have tried to address her frequent violations of curfew.", "7. Attempts at discussing the issue often result in the patient losing her temper and screaming at her parents.", "8. Patient's grades have deteriorated over the past year.", "9. Patient has no history of psychiatric illness.", "10. Patient refuses to answer and frequently disrupts the physician's conversation with the parents."], "atomic_facts": ["1. Her teachers describe her behavior as uncooperative and disruptive.", "2. She persistently refuses to answer questions.", "3. She insults her teachers.", "4. She annoys her classmates on a daily basis.", "5. Her parents try to address her frequent violations of curfew.", "6. Attempts at discussing the issue often result in their daughter losing her temper and screaming at her parents.", "7. Her grades have deteriorated over the past year.", "8. She has no history of psychiatric illness.", "9. On questioning, the patient refuses to answer.", "10. She frequently disrupts the physician\u2019s conversation with the parents."]}
{"id": 16, "question": "Which of the following findings indicates that the cause of shock is cardiogenic?", "context": ["A 22-year-old man is brought to the emergency room with a penetrating stab injury to his left chest.", "He appears pale, drowsy, and diaphoretic.", "His pulse is feeble, systolic blood pressure is 86 mm Hg, the respirations are 22/min with an oxygen saturation of 88% at room air, and the temperature is 36.6\u00b0C (98.0\u00b0F).", "His jugular vein is distended.", "Chest auscultation reveals equal breath sounds bilaterally, with muffled heart sounds.", "Immediate IV fluid resuscitation is initiated."], "context_len": 6, "options": {"A": "Elevated serum creatinine", "B": "High central venous pressure (CPV)", "C": "Arterial blood gas (ABG) showing base deficit and metabolic acidosis", "D": "White blood cell (WBC) count < 4000/mm3"}, "answer": "High central venous pressure (CPV)", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "22 years old", "specialties": ["Emergency Medicine", "Cardiology"], "subspecialties": ["General Emergency Medicine", "Cardiovascular Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Thoracic Surgery"}, "facts_old": ["1. A 22-year-old man is brought to the emergency room.", "2. He has a penetrating stab injury to his left chest.", "3. He appears pale, drowsy, and diaphoretic.", "4. His pulse is feeble.", "5. His systolic blood pressure is 86 mm Hg.", "6. His respirations are 22/min.", "7. His oxygen saturation is 88% at room air.", "8. His temperature is 36.6\u00b0C (98.0\u00b0F).", "9. His jugular vein is distended.", "10. Chest auscultation reveals equal breath sounds bilaterally.", "11. Chest auscultation reveals muffled heart sounds.", "12. Immediate IV fluid resuscitation is initiated."], "atomic_facts": ["1. The patient appears pale, drowsy, and diaphoretic.", "2. His pulse is feeble.", "3. Systolic blood pressure is 86 mm Hg.", "4. The respirations are 22/min.", "5. Oxygen saturation is 88% at room air.", "6. The temperature is 36.6\u00b0C (98.0\u00b0F).", "7. The jugular vein is distended.", "8. Chest auscultation reveals equal breath sounds bilaterally.", "9. Muffled heart sounds are present.", "10. Immediate IV fluid resuscitation is initiated."]}
{"id": 17, "question": "Which of the following characteristics best describes the most likely causal pathogen?", "context": ["A 56-year-old woman is brought to the physician by her husband because of a two-day history of fever, malaise, headaches, and confusion.", "She recently immigrated from rural China and her immunization status is unknown.", "Her temperature is 39.1\u00b0C (102.4\u00b0F).", "Physical examination shows nuchal rigidity and photophobia.", "Cerebrospinal fluid analysis shows a neutrophil count of 1,500/mm3.", "Cerebrospinal fluid cultured on Thayer-Martin agar and normal sheep blood agar shows no growth.", "However, when the sheep blood agar sample is heated, numerous non-hemolytic, opaque, cream-colored colonies grow."], "context_len": 7, "options": {"A": "Gram-negative coccobacillus", "B": "Gram-positive, lancet-shaped diplococcus", "C": "Gram-negative diplococcus", "D": "Gram-positive, facultative intracellular bacillus"}, "answer": "Gram-negative coccobacillus", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "56", "specialties": ["Internal Medicine", "Infectious Disease"], "subspecialties": ["Infectious Disease", "General Infectious Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 56-year-old woman is brought to the physician by her husband.", "2. She has a two-day history of fever, malaise, headaches, and confusion.", "3. She recently immigrated from rural China.", "4. Her immunization status is unknown.", "5. Her temperature is 39.1\u00b0C (102.4\u00b0F).", "6. Physical examination shows nuchal rigidity and photophobia.", "7. Cerebrospinal fluid analysis shows a neutrophil count of 1,500/mm3.", "8. Cerebrospinal fluid cultured on Thayer-Martin agar and normal sheep blood agar shows no growth.", "9. When the sheep blood agar sample is heated, numerous non-hemolytic, opaque, cream-colored colonies grow."], "atomic_facts": ["1. She recently immigrated from rural China.", "2. Her immunization status is unknown.", "3. Her temperature is 39.1\u00b0C (102.4\u00b0F).", "4. Physical examination shows nuchal rigidity and photophobia.", "5. Cerebrospinal fluid analysis shows a neutrophil count of 1,500/mm3.", "6. Cerebrospinal fluid cultured on Thayer-Martin agar and normal sheep blood agar shows no growth.", "7. When the sheep blood agar sample is heated, numerous non-hemolytic, opaque, cream-colored colonies grow."]}
{"id": 18, "question": "The pathogen associated with this patient\u2019s condition is also known to cause which of the following?", "context": ["A 35-year-old male presents to his primary care physician complaining of a one-month history of progressively worsening fatigue.", "He sought medical attention because this has affected his ability to complete his work as a graduate student.", "As a child, he was hospitalized for hemolytic uremic syndrome.", "His past medical history is also notable for diabetes mellitus and obesity.", "He takes metformin and glyburide.", "He does not smoke and drinks alcohol occasionally.", "His family history is notable for chronic lymphocytic leukemia in his paternal uncle and stroke in his father.", "His temperature is 99.9\u00b0F (37.7\u00b0C), blood pressure is 100/70 mmHg, pulse is 110/min, and respirations are 18/min.", "Physical examination reveals diffuse pallor.", "Hematologic labs are shown below: |  | Hemoglobin: 8.9 g/dL | Hematocrit: 24% | Leukocyte count: 7,500 cells/mm^3 with normal differential | Platelet count: 180,000/mm^3 | Mean corpuscular volume: 85 \u00b5m^3 | Reticulocyte count: 0.4% |  | Head and neck imaging is negative for neck masses."], "context_len": 10, "options": {"A": "Kaposi\u2019s sarcoma", "B": "Erythema infectiosum", "C": "Mononucleosis", "D": "Croup"}, "answer": "Erythema infectiosum", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "35", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 35-year-old male.", "2. Patient has a one-month history of progressively worsening fatigue.", "3. Patient sought medical attention because fatigue has affected his ability to complete his work as a graduate student.", "4. Patient was hospitalized for hemolytic uremic syndrome as a child.", "5. Patient has past medical history of diabetes mellitus and obesity.", "6. Patient takes metformin and glyburide.", "7. Patient does not smoke and drinks alcohol occasionally.", "8. Patient's family history is notable for chronic lymphocytic leukemia in his paternal uncle and stroke in his father.", "9. Patient's temperature is 99.9\u00b0F (37.7\u00b0C).", "10. Patient's blood pressure is 100/70 mmHg.", "11. Patient's pulse is 110/min.", "12. Patient's respirations are 18/min.", "13. Physical examination reveals diffuse pallor.", "14. Hemoglobin is 8.9 g/dL.", "15. Hematocrit is 24%.", "16. Leukocyte count is 7,500 cells/mm^3 with normal differential.", "17. Platelet count is 180,000/mm^3.", "18. Mean corpuscular volume is 85 \u00b5m^3.", "19. Reticulocyte count is 0.4%.", "20. Head and neck imaging is negative for neck masses."], "atomic_facts": ["1. The patient sought medical attention due to an impact on his ability to complete his work as a graduate student.", "2. As a child, the patient was hospitalized for hemolytic uremic syndrome.", "3. The patient's past medical history includes diabetes mellitus and obesity.", "4. The patient takes metformin and glyburide.", "5. The patient does not smoke and drinks alcohol occasionally.", "6. The patient's family history includes chronic lymphocytic leukemia in his paternal uncle and stroke in his father.", "7. The patient's temperature is 99.9\u00b0F (37.7\u00b0C).", "8. The patient's blood pressure is 100/70 mmHg.", "9. The patient's pulse is 110/min.", "10. The patient's respirations are 18/min.", "11. Physical examination reveals diffuse pallor.", "12. Hemoglobin: 8.9 g/dL", "13. Hematocrit: 24%", "14. Leukocyte count: 7,500 cells/mm^3 with normal differential", "15. Platelet count: 180,000/mm^3", "16. Mean corpuscular volume: 85 \u00b5m^3", "17. Reticulocyte count: 0.4%", "18. Head and neck imaging is negative for neck masses."]}
{"id": 19, "question": "Which of the following is the best treatment for the most likely cause for this patient\u2019s illness?", "context": ["A 30-year-old man is brought to the doctor's office by his wife.", "She complains that over the past week there have been 3 episodes where he has fallen asleep while speaking with her.", "She mentioned that these events began a few months ago and have been increasing in frequency.", "She also says that his snoring has gotten to the point where she has a hard time sleeping next to him.", "When asked, the patient says that he frequently falls asleep while reading or watching television in the afternoons and feels refreshed after a short nap.", "The patient is worried because he sometimes hears people who aren\u2019t in the room as he falls asleep.", "He is worried he might be \u201cgoing crazy.\u201d He has noticed that when his friends tell him a joke or he laughs at something on the TV, he drops whatever he\u2019s holding and feels like his legs become weak.", "These episodes self-resolve in a few seconds.", "Examination shows a morbidly obese man in no acute distress."], "context_len": 9, "options": {"A": "Modafinil", "B": "Taking longer naps", "C": "Continuous positive airway pressure", "D": "Changing bedtime to earlier in the evening"}, "answer": "Modafinil", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "30", "specialties": ["Internal Medicine", "Sleep Medicine"], "subspecialties": ["Sleep Medicine", "Pulmonary Disease", "General Sleep Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 30-year-old man is brought to the doctor's office by his wife.", "2. The wife complains that over the past week there have been 3 episodes where he has fallen asleep while speaking with her.", "3. The wife mentions that these events began a few months ago and have been increasing in frequency.", "4. The wife also says that his snoring has gotten to the point where she has a hard time sleeping next to him.", "5. When asked, the patient says that he frequently falls asleep while reading or watching television in the afternoons and feels refreshed after a short nap.", "6. The patient is worried because he sometimes hears people who aren\u2019t in the room as he falls asleep.", "7. He is worried he might be \u201cgoing crazy.\u201d", "8. He has noticed that when his friends tell him a joke or he laughs at something on the TV, he drops whatever he\u2019s holding and feels like his legs become weak.", "9. These episodes self-resolve in a few seconds.", "10. Examination shows a morbidly obese man in no acute distress."], "atomic_facts": ["1. The patient has experienced 3 episodes of falling asleep while speaking over the past week.", "2. The events of falling asleep began a few months ago and have been increasing in frequency.", "3. The patient's snoring has reached a point where it affects her ability to sleep next to him.", "4. The patient frequently falls asleep while reading or watching television in the afternoons and feels refreshed after a short nap.", "5. The patient hears people who aren't in the room as he falls asleep, causing worry about his mental health.", "6. The patient experiences weakness in his legs and drops objects when laughing, but the episodes self-resolve in a few seconds.", "7. The examination shows a morbidly obese man in no acute distress."]}
{"id": 20, "question": "Which of the following is the best next treatment for this patient?", "context": ["A 55-year-old homeless man presents to the emergency department acutely confused.", "The patient was found wandering the streets with an abnormal gait.", "The patient has a past medical history of alcohol and IV drug abuse.", "His temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 103/61 mmHg, pulse is 120/min, respirations are 16/min, and oxygen saturation is 97% on room air.", "Physical exam is notable for a poorly kempt man with ataxic gait.", "Ophthalmoplegia is noted on cranial nerve testing, and he has decreased vibration sensation in the bilateral lower extremity.", "Dermatologic exam reveals perifollicular hemorrhages, bleeding gums, and many bruises along the patient\u2019s upper and lower extremities.", "An initial ECG is notable for sinus tachycardia and the patient is given 2L of Ringer lactate.", "Laboratory values are ordered as seen below. |  | Hemoglobin: 8.0 g/dL | Hematocrit: 30% | Leukocyte count: 3,500/mm^3 with normal differential | Platelet count: 192,000/mm^3 | MCV: 119 fL |  | Serum: | Na+: 139 mEq/L | Cl-: 100 mEq/L | K+: 4.3 mEq/L | HCO3-: 25 mEq/L | BUN: 20 mg/dL | Glucose: 47 mg/dL | Creatinine: 1 mg/dL | Ca2+: 9.2 mg/dL | Mg2+: 1.2 mEq/L | AST: 82 U/L | ALT: 70 U/L |  | ."], "context_len": 9, "options": {"A": "Folate", "B": "Magnesium", "C": "Thiamine", "D": "Vitamin C"}, "answer": "Thiamine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Emergency Medicine", "Neurology"], "subspecialties": ["General Emergency Medicine", "Neurocritical Care"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old homeless man presents to the emergency department acutely confused.", "2. The patient was found wandering the streets with an abnormal gait.", "3. The patient has a past medical history of alcohol and IV drug abuse.", "4. His temperature is 98.5\u00b0F (36.9\u00b0C).", "5. Blood pressure is 103/61 mmHg.", "6. Pulse is 120/min.", "7. Respirations are 16/min.", "8. Oxygen saturation is 97% on room air.", "9. Physical exam is notable for a poorly kempt man with ataxic gait.", "10. Ophthalmoplegia is noted on cranial nerve testing.", "11. He has decreased vibration sensation in the bilateral lower extremity.", "12. Dermatologic exam reveals perifollicular hemorrhages, bleeding gums, and many bruises along the patient\u2019s upper and lower extremities.", "13. An initial ECG is notable for sinus tachycardia.", "14. The patient is given 2L of Ringer lactate.", "15. Hemoglobin: 8.0 g/dL.", "16. Hematocrit: 30%.", "17. Leukocyte count: 3,500/mm^3 with normal differential.", "18. Platelet count: 192,000/mm^3.", "19. MCV: 119 fL.", "20. Serum Na+: 139 mEq/L.", "21. Serum Cl-: 100 mEq/L.", "22. Serum K+: 4.3 mEq/L.", "23. Serum HCO3-: 25 mEq/L.", "24. Serum BUN: 20 mg/dL.", "25. Serum Glucose: 47 mg/dL.", "26. Serum Creatinine: 1 mg/dL.", "27. Serum Ca2+: 9.2 mg/dL.", "28. Serum Mg2+: 1.2 mEq/L.", "29. Serum AST: 82 U/L.", "30. Serum ALT: 70 U/L."], "atomic_facts": ["1. The patient was found wandering the streets with an abnormal gait.", "2. The patient has a past medical history of alcohol and IV drug abuse.", "3. His temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 103/61 mmHg, pulse is 120/min, respirations are 16/min, and oxygen saturation is 97% on room air.", "4. Physical exam is notable for a poorly kempt man with ataxic gait.", "5. Ophthalmoplegia is noted on cranial nerve testing, and he has decreased vibration sensation in the bilateral lower extremity.", "6. Dermatologic exam reveals perifollicular hemorrhages, bleeding gums, and many bruises along the patient\u2019s upper and lower extremities.", "7. An initial ECG is notable for sinus tachycardia and the patient is given 2L of Ringer lactate.", "8. Laboratory values: Hemoglobin: 8.0 g/dL, Hematocrit: 30%, Leukocyte count: 3,500/mm^3 with normal differential, Platelet count: 192,000/mm^3, MCV: 119 fL, Serum: Na+: 139 mEq/L, Cl-: 100 mEq/L, K+: 4.3 mEq/L, HCO3-: 25 mEq/L, BUN: 20 mg/dL, Glucose: 47 mg/dL, Creatinine: 1 mg/dL, Ca2+: 9.2 mg/dL, Mg2+: 1.2 mEq/L, AST: 82 U/L, ALT: 70 U/L."]}
{"id": 21, "question": "Which of the following is the most likely initial step in the pathogenesis of this patient's coronary condition?", "context": ["A 61-year-old woman is brought to the emergency department because of crushing substernal chest pain at rest for the past 2 hours.", "She is diaphoretic.", "Her temperature is 37.5\u00b0C (99.5\u00b0F), pulse is 110/min, respirations are 21/min, and blood pressure is 115/65 mm Hg.", "An ECG shows ST elevation in I, aVL, and V2\u2013V4.", "Coronary angiography shows an 80% stenosis in the left anterior descending artery."], "context_len": 5, "options": {"A": "Intimal monocyte infiltration", "B": "Platelet activation", "C": "Endothelial cell dysfunction", "D": "Fibrous plaque formation"}, "answer": "Endothelial cell dysfunction", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "61 years old", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Cardiovascular Disease", "General Cardiology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 61-year-old woman is brought to the emergency department.", "2. She has crushing substernal chest pain at rest for the past 2 hours.", "3. She is diaphoretic.", "4. Her temperature is 37.5\u00b0C (99.5\u00b0F).", "5. Her pulse is 110/min.", "6. Her respirations are 21/min.", "7. Her blood pressure is 115/65 mm Hg.", "8. An ECG shows ST elevation in I, aVL, and V2\u2013V4.", "9. Coronary angiography shows an 80% stenosis in the left anterior descending artery."], "atomic_facts": ["1. She is diaphoretic.", "2. Her temperature is 37.5\u00b0C (99.5\u00b0F).", "3. Her pulse is 110/min.", "4. Her respirations are 21/min.", "5. Her blood pressure is 115/65 mm Hg.", "6. An ECG shows ST elevation in I, aVL, and V2\u2013V4.", "7. Coronary angiography shows an 80% stenosis in the left anterior descending artery."]}
{"id": 22, "question": "What is the most likely etiology of this patient\u2019s presentation?", "context": ["A 4-year-old boy presents to the office with his mother.", "She states that the patient has been complaining of pain in his scrotum with swelling, abdominal pain, and nausea for the last 2 or 3 days.", "On exam, the abdomen is soft and nontender to palpation.", "The right scrotal sac is mildly enlarged without erythema.", "A tender mass is palpated in the right scrotal area.", "The mass does not transilluminate when a penlight is applied.", "The patient is afebrile and all vital signs are stable."], "context_len": 7, "options": {"A": "Patent processus vaginalis", "B": "Collection of fluid in the tunica vaginalis", "C": "Infection of the epididymis", "D": "Neoplasm of the testicle"}, "answer": "Patent processus vaginalis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Urology", "General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old boy presents to the office with his mother.", "2. The patient has been complaining of pain in his scrotum with swelling, abdominal pain, and nausea for the last 2 or 3 days.", "3. On exam, the abdomen is soft and nontender to palpation.", "4. The right scrotal sac is mildly enlarged without erythema.", "5. A tender mass is palpated in the right scrotal area.", "6. The mass does not transilluminate when a penlight is applied.", "7. The patient is afebrile.", "8. All vital signs are stable."], "atomic_facts": ["1. The patient has been complaining of pain in his scrotum with swelling, abdominal pain, and nausea for the last 2 or 3 days.", "2. On exam, the abdomen is soft and nontender to palpation.", "3. The right scrotal sac is mildly enlarged without erythema.", "4. A tender mass is palpated in the right scrotal area.", "5. The mass does not transilluminate when a penlight is applied.", "6. The patient is afebrile.", "7. All vital signs are stable."]}
{"id": 23, "question": "What is the most likely diagnosis?", "context": ["A 59-year-old man presents to his primary care physician, accompanied by his wife, who requests treatment for his \u201cchronic pessimism.\u201d The patient admits to feeling tired and \u201cdown\u201d most of the time for the past several years but insists that it is \u201cjust part of getting old.\u201d His wife believes that he has become more self-critical and less confident than he used to be.", "Neither the patient nor his wife can identify any stressors or triggering events.", "He has continued to work as a librarian at a nearby college during this time and spends time with friends on the weekends.", "He sleeps 7 hours per night and eats 3 meals per day.", "He denies suicidal ideation or periods of elevated mood, excessive irritability, or increased energy.", "Physical exam reveals a well-dressed, well-groomed man without apparent abnormality.", "Basic neurocognitive testing and labs (CBC, BMP, TSH, cortisol, testosterone, and urine toxicology) are within normal limits."], "context_len": 7, "options": {"A": "Adjustment disorder with depressive features", "B": "Bipolar disorder", "C": "Cyclothymia", "D": "Dysthymia"}, "answer": "Dysthymia", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "59 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 59-year-old man presents to his primary care physician.", "2. He is accompanied by his wife.", "3. His wife requests treatment for his \u201cchronic pessimism.\u201d", "4. The patient admits to feeling tired and \u201cdown\u201d most of the time for the past several years.", "5. He insists that it is \u201cjust part of getting old.\u201d", "6. His wife believes that he has become more self-critical and less confident than he used to be.", "7. Neither the patient nor his wife can identify any stressors or triggering events.", "8. He has continued to work as a librarian at a nearby college during this time.", "9. He spends time with friends on the weekends.", "10. He sleeps 7 hours per night.", "11. He eats 3 meals per day.", "12. He denies suicidal ideation or periods of elevated mood, excessive irritability, or increased energy.", "13. Physical exam reveals a well-dressed, well-groomed man without apparent abnormality.", "14. Basic neurocognitive testing and labs (CBC, BMP, TSH, cortisol, testosterone, and urine toxicology) are within normal limits."], "atomic_facts": ["1. The patient and his wife cannot identify any stressors or triggering events.", "2. He has continued to work as a librarian at a nearby college.", "3. He spends time with friends on the weekends.", "4. He sleeps 7 hours per night.", "5. He eats 3 meals per day.", "6. He denies suicidal ideation.", "7. He denies periods of elevated mood.", "8. He denies excessive irritability.", "9. He denies increased energy.", "10. Physical exam reveals a well-dressed, well-groomed man without apparent abnormality.", "11. Basic neurocognitive testing and labs (CBC, BMP, TSH, cortisol, testosterone, and urine toxicology) are within normal limits."]}
{"id": 24, "question": "What is the most likely explanation for the patient\u2019s presentation?", "context": ["A 17-month-old girl was brought to the emergency department by her mom following a fall.", "The mom reports that the patient was playing in the playground when she tripped and fell onto the mulch.", "She had an uncomplicated birth history and has been meeting developmental goals except for language delay, for which she is to receive a hearing test for further evaluation next week.", "Physical exam reveals bruising along the left lateral thigh, knee, and elbow; all lab tests are within normal limits.", "Radiograph shows a fracture of the olecranon.", "Serum chemistry and liver panels were within normal limits."], "context_len": 6, "options": {"A": "Child abuse", "B": "Defective type 1 collagen gene", "C": "Low levels of phosphate", "D": "Low levels of vitamin D"}, "answer": "Defective type 1 collagen gene", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "17 months", "specialties": ["Pediatrics"], "subspecialties": ["Child Abuse Pediatrics", "Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 17-month-old girl was brought to the emergency department by her mom.", "2. The mom reports that the patient was playing in the playground when she tripped and fell onto the mulch.", "3. She had an uncomplicated birth history.", "4. She has been meeting developmental goals except for language delay.", "5. She is to receive a hearing test for further evaluation next week.", "6. Physical exam reveals bruising along the left lateral thigh, knee, and elbow.", "7. All lab tests are within normal limits.", "8. Radiograph shows a fracture of the olecranon.", "9. Serum chemistry and liver panels were within normal limits."], "atomic_facts": ["1. The patient was playing in the playground when she tripped and fell onto the mulch.", "2. The patient had an uncomplicated birth history.", "3. The patient has been meeting developmental goals except for language delay.", "4. The patient is to receive a hearing test for further evaluation next week.", "5. Physical exam reveals bruising along the left lateral thigh, knee, and elbow.", "6. All lab tests are within normal limits.", "7. Radiograph shows a fracture of the olecranon.", "8. Serum chemistry was within normal limits.", "9. Liver panels were within normal limits."]}
{"id": 25, "question": "Which of the following is the most likely diagnosis?", "context": ["\u0650A 62-year-old man comes to the emergency department because of colicky pain in the lower abdomen and abdominal distension for the past 12 hours.", "He has chronic constipation for which he takes lactulose and senna laxatives.", "His temperature is 37.1\u00b0C (98.7\u00b0F), blood pressure is 110/60 mm Hg and pulse is 85/min.", "On physical examination, there is diffuse abdominal distension and tenderness, and bowel sounds are faint.", "His plain abdominal radiograph is shown."], "context_len": 5, "options": {"A": "Infectious colitis", "B": "Bowel adhesions", "C": "Volvulus", "D": "Acute diverticulitis"}, "answer": "Volvulus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "62 years old", "specialties": ["General Surgery", "Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 62-year-old man comes to the emergency department.", "2. He has colicky pain in the lower abdomen and abdominal distension for the past 12 hours.", "3. He has chronic constipation for which he takes lactulose and senna laxatives.", "4. His temperature is 37.1\u00b0C (98.7\u00b0F).", "5. His blood pressure is 110/60 mm Hg.", "6. His pulse is 85/min.", "7. On physical examination, there is diffuse abdominal distension and tenderness.", "8. Bowel sounds are faint.", "9. His plain abdominal radiograph is shown."], "atomic_facts": ["1. He has chronic constipation.", "2. He takes lactulose and senna laxatives.", "3. His temperature is 37.1\u00b0C (98.7\u00b0F).", "4. His blood pressure is 110/60 mm Hg.", "5. His pulse is 85/min.", "6. On physical examination, there is diffuse abdominal distension.", "7. On physical examination, there is tenderness.", "8. Bowel sounds are faint.", "9. His plain abdominal radiograph is shown."]}
{"id": 26, "question": "The addition of this drug is most likely to increase the risk of which of the following adverse effects?\"", "context": ["A 73-year-old African American man comes to the physician for a routine health maintenance examination.", "He has type 2 diabetes mellitus, hypertension, hypercholesterolemia, and coronary artery disease.", "His current medications include metformin, hydrochlorothiazide, amlodipine, rosuvastatin, isosorbide mononitrate, aspirin, and dipyridamole.", "He is 180 cm (5 ft 11 in) tall and weighs 110 kg (242 lb); BMI is 34 kg/m2.", "His vital signs are within normal limits.", "His hemoglobin A1c concentration is 6.7%.", "Serum lipid studies show: | Cholesterol, total 302 mg/L | HDL-cholesterol 39 mg/dL | LDL-cholesterol 197 mg/dL | Triglycerides 292 mg/dL | The physician prescribes a drug that inhibits intestinal cholesterol absorption."], "context_len": 7, "options": {"A": "Hepatotoxicity", "B": "Hyperkalemia", "C": "Cutaneous flushing", "D": "Hyperuricemia"}, "answer": "Hepatotoxicity", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "73", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine", "General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Preventive Medicine"}, "facts_old": ["1. A 73-year-old African American man comes to the physician for a routine health maintenance examination.", "2. He has type 2 diabetes mellitus, hypertension, hypercholesterolemia, and coronary artery disease.", "3. His current medications include metformin, hydrochlorothiazide, amlodipine, rosuvastatin, isosorbide mononitrate, aspirin, and dipyridamole.", "4. He is 180 cm (5 ft 11 in) tall.", "5. He weighs 110 kg (242 lb).", "6. His BMI is 34 kg/m2.", "7. His vital signs are within normal limits.", "8. His hemoglobin A1c concentration is 6.7%.", "9. His cholesterol, total is 302 mg/L.", "10. His HDL-cholesterol is 39 mg/dL.", "11. His LDL-cholesterol is 197 mg/dL.", "12. His triglycerides are 292 mg/dL.", "13. The physician prescribes a drug that inhibits intestinal cholesterol absorption."], "atomic_facts": ["1. He has type 2 diabetes mellitus.", "2. He has hypertension.", "3. He has hypercholesterolemia.", "4. He has coronary artery disease.", "5. His current medications include metformin.", "6. His current medications include hydrochlorothiazide.", "7. His current medications include amlodipine.", "8. His current medications include rosuvastatin.", "9. His current medications include isosorbide mononitrate.", "10. His current medications include aspirin.", "11. His current medications include dipyridamole.", "12. He is 180 cm (5 ft 11 in) tall.", "13. He weighs 110 kg (242 lb).", "14. His BMI is 34 kg/m2.", "15. His vital signs are within normal limits.", "16. His hemoglobin A1c concentration is 6.7%.", "17. Serum lipid studies show: Cholesterol, total 302 mg/L.", "18. Serum lipid studies show: HDL-cholesterol 39 mg/dL.", "19. Serum lipid studies show: LDL-cholesterol 197 mg/dL.", "20. Serum lipid studies show: Triglycerides 292 mg/dL.", "21. The physician prescribes a drug that inhibits intestinal cholesterol absorption."]}
{"id": 27, "question": "Which of the following is the next best diagnostic step?", "context": ["A 15-year-old girl is brought to the clinic by her mother because she is worried the patient has not yet had her period.", "The patient\u2019s older sister had her first period at age 14.", "The mother had her first period at age 13.", "The patient reports she is doing well in school and is on the varsity basketball team.", "Her medical history is significant for asthma and atopic dermatitis.", "Her medications include albuterol and topical triamcinolone.", "The patient\u2019s temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 111/72 mmHg, pulse is 65/min, and respirations are 14/min with an oxygen saturation of 99% on room air.", "Her body mass index (BMI) is 19 kg/m^2.", "Physical exam shows absent breast development and external genitalia at Tanner stage 1.", "Serum follicle stimulating hormone (FSH) level is measured to be 38 mIU/mL."], "context_len": 10, "options": {"A": "CYP17 gene work-up", "B": "Estrogen levels", "C": "Gonadotrophin-releasing hormone stimulation test", "D": "Karotype"}, "answer": "Karotype", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "15 years old", "specialties": ["Pediatrics", "Obstetrics and Gynecology"], "subspecialties": ["Pediatric Endocrinology", "Pediatric Gynecology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is 15 years old.", "2. Patient's mother brought her to the clinic.", "3. Patient's mother is worried because patient has not had her period.", "4. Patient's older sister had her first period at age 14.", "5. Patient's mother had her first period at age 13.", "6. Patient reports she is doing well in school.", "7. Patient is on the varsity basketball team.", "8. Patient has a medical history of asthma and atopic dermatitis.", "9. Patient's medications include albuterol and topical triamcinolone.", "10. Patient's temperature is 98\u00b0F (36.7\u00b0C).", "11. Patient's blood pressure is 111/72 mmHg.", "12. Patient's pulse is 65/min.", "13. Patient's respirations are 14/min.", "14. Patient's oxygen saturation is 99% on room air.", "15. Patient's BMI is 19 kg/m^2.", "16. Physical exam shows absent breast development and external genitalia at Tanner stage 1.", "17. Serum follicle stimulating hormone (FSH) level is measured to be 38 mIU/mL."], "atomic_facts": ["1. The patient\u2019s older sister had her first period at age 14.", "2. The mother had her first period at age 13.", "3. The patient reports she is doing well in school and is on the varsity basketball team.", "4. Her medical history is significant for asthma and atopic dermatitis.", "5. Her medications include albuterol and topical triamcinolone.", "6. The patient\u2019s temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 111/72 mmHg, pulse is 65/min, and respirations are 14/min with an oxygen saturation of 99% on room air.", "7. Her body mass index (BMI) is 19 kg/m^2.", "8. Physical exam shows absent breast development and external genitalia at Tanner stage 1.", "9. Serum follicle stimulating hormone (FSH) level is measured to be 38 mIU/mL."]}
{"id": 28, "question": "Further evaluation is most likely to show which of the following findings?", "context": ["A 15-month-old girl is brought to the physician by her mother for grossly bloody diarrhea for 2 days.", "The girl has had a few episodes of blood-tinged stools over the past 3 weeks.", "She has not had pain, nausea, or vomiting.", "She is at the 55th percentile for height and 55th percentile for weight.", "Examination shows conjunctival pallor.", "The abdomen is soft and nontender.", "There is a small amount of dark red blood in the diaper.", "Her hemoglobin concentration is 9.5 g/dL, mean corpuscular volume is 68 \u03bcm3, and platelet count is 300,000/mm3."], "context_len": 8, "options": {"A": "Neutrophil infiltrated crypts on colonic biopsy", "B": "Absent ganglionic cells on rectal suction biopsy", "C": "Target sign on abdominal ultrasound", "D": "Ectopic gastric mucosa on Technetium-99m pertechnetate scan"}, "answer": "Ectopic gastric mucosa on Technetium-99m pertechnetate scan", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "15 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 15-month-old girl is brought to the physician by her mother.", "2. She has had grossly bloody diarrhea for 2 days.", "3. She has had a few episodes of blood-tinged stools over the past 3 weeks.", "4. She has not had pain, nausea, or vomiting.", "5. She is at the 55th percentile for height.", "6. She is at the 55th percentile for weight.", "7. Examination shows conjunctival pallor.", "8. The abdomen is soft and nontender.", "9. There is a small amount of dark red blood in the diaper.", "10. Her hemoglobin concentration is 9.5 g/dL.", "11. Her mean corpuscular volume is 68 \u03bcm3.", "12. Her platelet count is 300,000/mm3."], "atomic_facts": ["1. The girl has had a few episodes of blood-tinged stools over the past 3 weeks.", "2. She has not had pain, nausea, or vomiting.", "3. She is at the 55th percentile for height and 55th percentile for weight.", "4. Examination shows conjunctival pallor.", "5. The abdomen is soft and nontender.", "6. There is a small amount of dark red blood in the diaper.", "7. Her hemoglobin concentration is 9.5 g/dL.", "8. Mean corpuscular volume is 68 \u03bcm3.", "9. Platelet count is 300,000/mm3."]}
{"id": 29, "question": "Which of the following is the most likely underlying cause of this patient's findings?", "context": ["A 3855-g (8-lb 8-oz) newborn is examined shortly after birth.", "She was delivered at 40 weeks' gestation by cesarean delivery because of breech presentation.", "Pregnancy was otherwise uncomplicated.", "Physical examination shows asymmetric thigh creases.", "The left leg is shorter than the right leg and positioned in external rotation."], "context_len": 5, "options": {"A": "Fracture of the femoral neck", "B": "Inflammation of the hip synovium", "C": "Abnormal development of the acetabulum", "D": "Displacement of the femoral epiphysis"}, "answer": "Abnormal development of the acetabulum", "answer_idx": "C", "explanation": "", "patient": {"gender": "Not specified", "age": "Newborn", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery", "Pediatric Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 3855-g newborn was examined shortly after birth.", "2. The newborn was delivered at 40 weeks' gestation.", "3. The newborn was delivered by cesarean delivery.", "4. The cesarean delivery was due to breech presentation.", "5. The pregnancy was otherwise uncomplicated.", "6. Physical examination showed asymmetric thigh creases.", "7. The left leg was shorter than the right leg.", "8. The left leg was positioned in external rotation."], "atomic_facts": ["1. She was delivered at 40 weeks' gestation.", "2. The delivery was by cesarean delivery.", "3. The reason for the cesarean delivery was breech presentation.", "4. The pregnancy was otherwise uncomplicated.", "5. Physical examination shows asymmetric thigh creases.", "6. The left leg is shorter than the right leg.", "7. The left leg is positioned in external rotation."]}
{"id": 30, "question": "Which of the following is the most likely cause of this patient's anemia?", "context": ["A 27-year-old G1P0 woman at 9 weeks estimated gestational age presents for a prenatal visit.", "She has no current complaints and takes no medications.", "She is vegetarian and emigrated from Nepal 7 years ago.", "She does not use tobacco, alcohol or recreational drugs.", "The patient\u2019s vital signs include: blood pressure 111/95 mm Hg, temperature 36.7\u00b0C (98.6\u00b0F), pulse 88/min.", "Laboratory results are significant for the following: | Hemoglobin 10.2 g/dL | Erythrocyte count 5.5 million/mm3 | Mean corpuscular volume 65 \u03bcm3 | Mean corpuscular hemoglobin 21 pg/cell | Red cell distribution width 13.5% (ref: 11.5\u201314.5%) | Serum ferritin 170 ng/mL | ."], "context_len": 6, "options": {"A": "Vitamin B12 deficiency", "B": "Zinc deficiency", "C": "Gestational anemia", "D": "Thalassemia trait"}, "answer": "Thalassemia trait", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Gestational anemia", "General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 27-year-old G1P0 woman.", "2. Patient is at 9 weeks estimated gestational age.", "3. Patient has no current complaints.", "4. Patient takes no medications.", "5. Patient is vegetarian.", "6. Patient emigrated from Nepal 7 years ago.", "7. Patient does not use tobacco, alcohol or recreational drugs.", "8. Patient's blood pressure is 111/95 mm Hg.", "9. Patient's temperature is 36.7\u00b0C (98.6\u00b0F).", "10. Patient's pulse is 88/min.", "11. Patient's hemoglobin is 10.2 g/dL.", "12. Patient's erythrocyte count is 5.5 million/mm3.", "13. Patient's mean corpuscular volume is 65 \u03bcm3.", "14. Patient's mean corpuscular hemoglobin is 21 pg/cell.", "15. Patient's red cell distribution width is 13.5% (ref: 11.5\u201314.5%).", "16. Patient's serum ferritin is 170 ng/mL."], "atomic_facts": ["1. The patient has no current complaints.", "2. The patient takes no medications.", "3. The patient is vegetarian.", "4. The patient emigrated from Nepal 7 years ago.", "5. The patient does not use tobacco.", "6. The patient does not use alcohol.", "7. The patient does not use recreational drugs.", "8. The patient's blood pressure is 111/95 mm Hg.", "9. The patient's temperature is 36.7\u00b0C (98.6\u00b0F).", "10. The patient's pulse is 88/min.", "11. The patient's hemoglobin level is 10.2 g/dL.", "12. The patient's erythrocyte count is 5.5 million/mm3.", "13. The patient's mean corpuscular volume is 65 \u03bcm3.", "14. The patient's mean corpuscular hemoglobin is 21 pg/cell.", "15. The patient's red cell distribution width is 13.5% (ref: 11.5\u201314.5%).", "16. The patient's serum ferritin level is 170 ng/mL."]}
{"id": 31, "question": "What will be the change in the kinetics of the reaction catalyzed by carbonic anhydrase under the influence of acetazolamide?", "context": ["A 31-year-old woman presents to your clinic with a persistent headache.", "She reports she has suffered from headaches since the age of 27 when she gained 12 kg (26.4 lb) after the birth of her second child.", "The headache is generalized and throbbing in nature.", "It worsens in the morning and is aggravated with coughing, laughing, and sneezing.", "The patient\u2019s blood pressure is 130/85 mm Hg, heart rate is 90/min, respiratory rate is 14/min, and the temperature is 36.6\u2103 (97.9\u2109).", "The patient\u2019s weight is 101 kg (222.7 lb), height is 165 cm (5.4 ft), and BMI is 36.7 kg/m2.", "Examination reveals papilledema.", "Head CT scan does not reveal any abnormalities.", "Lumbar puncture shows an opening pressure of 32 cm H2O.", "The patient is prescribed a carbonic anhydrase inhibitor, acetazolamide, for idiopathic intracranial hypertension."], "context_len": 10, "options": {"A": "Activation energy (Ea) will increase", "B": "Activation energy (Ea) will decrease", "C": "Free energy (G) of the reactants will increase", "D": "Increase reaction free energy change (\u2206G) by increasing free energy (G) of reactants and decreasing G of products"}, "answer": "Activation energy (Ea) will increase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "31 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 31-year-old woman.", "2. Patient has suffered from headaches since the age of 27.", "3. Patient gained 12 kg (26.4 lb) after the birth of her second child.", "4. Headache is generalized and throbbing in nature.", "5. Headache worsens in the morning.", "6. Headache is aggravated with coughing, laughing, and sneezing.", "7. Patient's blood pressure is 130/85 mm Hg.", "8. Patient's heart rate is 90/min.", "9. Patient's respiratory rate is 14/min.", "10. Patient's temperature is 36.6\u2103 (97.9\u2109).", "11. Patient's weight is 101 kg (222.7 lb).", "12. Patient's height is 165 cm (5.4 ft).", "13. Patient's BMI is 36.7 kg/m2.", "14. Examination reveals papilledema.", "15. Head CT scan does not reveal any abnormalities.", "16. Lumbar puncture shows an opening pressure of 32 cm H2O.", "17. Patient is prescribed a carbonic anhydrase inhibitor, acetazolamide, for idiopathic intracranial hypertension."], "atomic_facts": ["1. The patient has suffered from headaches since the age of 27.", "2. The headaches started after she gained 12 kg (26.4 lb) after the birth of her second child.", "3. The headache is generalized and throbbing in nature.", "4. It worsens in the morning and is aggravated with coughing, laughing, and sneezing.", "5. The patient\u2019s blood pressure is 130/85 mm Hg.", "6. The patient\u2019s heart rate is 90/min.", "7. The patient\u2019s respiratory rate is 14/min.", "8. The patient\u2019s temperature is 36.6\u2103 (97.9\u2109).", "9. The patient\u2019s weight is 101 kg (222.7 lb).", "10. The patient\u2019s height is 165 cm (5.4 ft).", "11. The patient\u2019s BMI is 36.7 kg/m2.", "12. Examination reveals papilledema.", "13. Head CT scan does not reveal any abnormalities.", "14. Lumbar puncture shows an opening pressure of 32 cm H2O.", "15. The patient is prescribed a carbonic anhydrase inhibitor, acetazolamide, for idiopathic intracranial hypertension."]}
{"id": 32, "question": "Which of the following is the most likely cause of this patient's symptoms?", "context": ["A 55-year-old man comes to the emergency department because of a dry cough and severe chest pain beginning that morning.", "Two months ago, he was diagnosed with inferior wall myocardial infarction and was treated with stent implantation of the right coronary artery.", "He has a history of hypertension and hypercholesterolemia.", "His medications include aspirin, clopidogrel, atorvastatin, and enalapril.", "His temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 92/min, respirations are 22/min, and blood pressure is 130/80 mm Hg.", "Cardiac examination shows a high-pitched scratching sound best heard while sitting upright and during expiration.", "The remainder of the examination shows no abnormalities.", "An ECG shows diffuse ST elevations.", "Serum studies show a troponin I of 0.2 ng/mL (N < 0.01)."], "context_len": 9, "options": {"A": "Cardiac tamponade", "B": "Constrictive pericarditis", "C": "Reinfarction", "D": "Dressler syndrome"}, "answer": "Dressler syndrome", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "55 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old man comes to the emergency department.", "2. He has a dry cough and severe chest pain beginning that morning.", "3. Two months ago, he was diagnosed with inferior wall myocardial infarction.", "4. He was treated with stent implantation of the right coronary artery.", "5. He has a history of hypertension and hypercholesterolemia.", "6. His medications include aspirin, clopidogrel, atorvastatin, and enalapril.", "7. His temperature is 38.5\u00b0C (101.3\u00b0F).", "8. His pulse is 92/min.", "9. His respirations are 22/min.", "10. His blood pressure is 130/80 mm Hg.", "11. Cardiac examination shows a high-pitched scratching sound best heard while sitting upright and during expiration.", "12. The remainder of the examination shows no abnormalities.", "13. An ECG shows diffuse ST elevations.", "14. Serum studies show a troponin I of 0.2 ng/mL (N < 0.01)."], "atomic_facts": ["1. Two months ago, he was diagnosed with inferior wall myocardial infarction.", "2. He was treated with stent implantation of the right coronary artery.", "3. He has a history of hypertension.", "4. He has a history of hypercholesterolemia.", "5. His medications include aspirin.", "6. His medications include clopidogrel.", "7. His medications include atorvastatin.", "8. His medications include enalapril.", "9. His temperature is 38.5\u00b0C (101.3\u00b0F).", "10. His pulse is 92/min.", "11. His respirations are 22/min.", "12. His blood pressure is 130/80 mm Hg.", "13. Cardiac examination shows a high-pitched scratching sound best heard while sitting upright and during expiration.", "14. The remainder of the examination shows no abnormalities.", "15. An ECG shows diffuse ST elevations.", "16. Serum studies show a troponin I of 0.2 ng/mL (N < 0.01)."]}
{"id": 33, "question": "Which of the following is the most appropriate treatment for this patient\u2019s condition?", "context": ["A 27-year-old man presents to the physician with concern for pain in both of his knees that he is unable to attribute to any activities that he has recently performed.", "He had an acute episode of diarrhea 2 weeks ago, prior to the onset of symptoms.", "He has also been experiencing a burning sensation during urination for the past week.", "When questioned about any other symptoms, he notes that he has also noticed that his eyes occasionally feel irritated and painful, leading to bouts of blurry vision.", "On physical examination, the patient is afebrile and has conjunctival injection surrounding the iris.", "A synovial fluid aspiration of the knee is performed and reveals a white blood cell count of 51,000/\u00b5L."], "context_len": 6, "options": {"A": "Acetaminophen", "B": "Allopurinol", "C": "Indomethacin", "D": "Leflunomide"}, "answer": "Indomethacin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "27", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 27 years old.", "2. Patient has pain in both knees.", "3. Patient cannot attribute pain to any recent activities.", "4. Patient had an acute episode of diarrhea 2 weeks ago.", "5. Patient has burning sensation during urination for the past week.", "6. Patient has noticed eyes occasionally feel irritated and painful.", "7. Patient has bouts of blurry vision.", "8. Patient is afebrile on physical examination.", "9. Patient has conjunctival injection surrounding the iris.", "10. Synovial fluid aspiration of the knee reveals white blood cell count of 51,000/\u00b5L."], "atomic_facts": ["1. He had an acute episode of diarrhea 2 weeks ago.", "2. He has been experiencing a burning sensation during urination for the past week.", "3. He has noticed that his eyes occasionally feel irritated and painful, leading to bouts of blurry vision.", "4. On physical examination, the patient is afebrile.", "5. On physical examination, the patient has conjunctival injection surrounding the iris.", "6. A synovial fluid aspiration of the knee is performed.", "7. The synovial fluid aspiration of the knee reveals a white blood cell count of 51,000/\u00b5L."]}
{"id": 34, "question": "Of the following organisms, infection with which one is most consistent with her symptoms?", "context": ["A 22-year old active duty soldier presents to your clinic with complaints of intense fatigue, fevers, abdominal pain, and a nonproductive cough.", "Her symptoms began a few days ago, but she returned from a tour of duty in Malawi and Mozambique four weeks ago.", "She endorses sleeping outside, using minimal bug spray, and swimming in rivers during her tour.", "On physical exam, her temperature is 101.5, and she appears exhausted.", "She has a hive-like rash scattered over her body.", "Her abdominal exam is notable for hepatosplenomegaly, and her lung exam is notable for scattered crackles.", "Her CBC with diff is remarkable for marked eosinophilia, and she has an elevated IgE."], "context_len": 7, "options": {"A": "Plasmodium falciparum", "B": "Schistosoma mansoni", "C": "Mycobacterium tuberculosis", "D": "Trypanosoma brucei rhodesiense"}, "answer": "Schistosoma mansoni", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "22 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 22-year old active duty soldier.", "2. Patient presents with complaints of intense fatigue, fevers, abdominal pain, and a nonproductive cough.", "3. Symptoms began a few days ago.", "4. Patient returned from a tour of duty in Malawi and Mozambique four weeks ago.", "5. Patient endorses sleeping outside, using minimal bug spray, and swimming in rivers during her tour.", "6. On physical exam, patient's temperature is 101.5, and she appears exhausted.", "7. Patient has a hive-like rash scattered over her body.", "8. Abdominal exam is notable for hepatosplenomegaly.", "9. Lung exam is notable for scattered crackles.", "10. CBC with diff is remarkable for marked eosinophilia.", "11. Patient has an elevated IgE."], "atomic_facts": ["1. Her symptoms began a few days ago", "2. She returned from a tour of duty in Malawi and Mozambique four weeks ago", "3. She endorses sleeping outside", "4. She endorses using minimal bug spray", "5. She endorses swimming in rivers during her tour", "6. On physical exam, her temperature is 101.5", "7. She appears exhausted", "8. She has a hive-like rash scattered over her body", "9. Her abdominal exam is notable for hepatosplenomegaly", "10. Her lung exam is notable for scattered crackles", "11. Her CBC with diff is remarkable for marked eosinophilia", "12. She has an elevated IgE"]}
{"id": 35, "question": "Which of the following best describes the mechanism of action of the drug that is most likely responsible for this patient's symptoms?", "context": ["A 72-year-old man comes to the emergency room because of a 4-day history of progressively worsening pain and swelling on the right side of his face.", "The patient was diagnosed with multiple myeloma 8 months ago and is currently undergoing treatment.", "His vital signs are within normal limits.", "Physical exam shows erythema and swelling over the right cheek and mandible.", "An orofacial fistula is present."], "context_len": 5, "options": {"A": "Cross-linking DNA at guanine", "B": "Inhibition of proteosome activity", "C": "Stimulation of PTH receptor", "D": "Binding to hydroxyapatite"}, "answer": "Binding to hydroxyapatite", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "72 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 72-year-old man comes to the emergency room.", "2. He has a 4-day history of progressively worsening pain and swelling on the right side of his face.", "3. He was diagnosed with multiple myeloma 8 months ago.", "4. He is currently undergoing treatment.", "5. His vital signs are within normal limits.", "6. Physical exam shows erythema and swelling over the right cheek and mandible.", "7. An orofacial fistula is present."], "atomic_facts": ["1. The patient was diagnosed with multiple myeloma 8 months ago.", "2. The patient is currently undergoing treatment.", "3. His vital signs are within normal limits.", "4. Physical exam shows erythema and swelling over the right cheek and mandible.", "5. An orofacial fistula is present."]}
{"id": 36, "question": "Which of the following is the most important risk factor for the development of this condition?", "context": ["A 12-month-old girl is brought to the physician because she is unable to sit and has not learned how to crawl.", "She keeps her hips and elbows flexed and her parents have to use considerable force to passively extend her joints.", "She attained neck control at 4 months and could roll from front to back at 5 months of age.", "She does not engage in play, reach for toys, or maintain eye contact.", "She babbles and does not mimic sounds.", "She does not follow simple instructions.", "She has difficulty swallowing solid foods and often coughs at meal times.", "Her maternal cousin has Down syndrome.", "Her vital signs are within normal limits.", "She is at the 25th percentile for length and 10th percentile for weight.", "Neurological examination shows increased muscle tone in all extremities.", "The ankle clonus and extensor plantar responses are present bilaterally.", "The Moro reflex is present.", "An MRI of the head shows periventricular leukomalacia."], "context_len": 14, "options": {"A": "Premature birth", "B": "Congenital rubella infection", "C": "Congenital CMV infection", "D": "Advanced maternal age"}, "answer": "Premature birth", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "12 months", "specialties": ["Pediatrics"], "subspecialties": ["Developmental"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 12-month-old girl.", "2. Patient is unable to sit and has not learned how to crawl.", "3. Patient keeps hips and elbows flexed and parents have to use considerable force to passively extend her joints.", "4. Patient attained neck control at 4 months and could roll from front to back at 5 months of age.", "5. Patient does not engage in play, reach for toys, or maintain eye contact.", "6. Patient babbles and does not mimic sounds.", "7. Patient does not follow simple instructions.", "8. Patient has difficulty swallowing solid foods and often coughs at meal times.", "9. Patient's maternal cousin has Down syndrome.", "10. Patient's vital signs are within normal limits.", "11. Patient is at the 25th percentile for length and 10th percentile for weight.", "12. Neurological examination shows increased muscle tone in all extremities.", "13. Ankle clonus and extensor plantar responses are present bilaterally.", "14. Moro reflex is present.", "15. MRI of the head shows periventricular leukomalacia."], "atomic_facts": ["1. She keeps her hips and elbows flexed and her parents have to use considerable force to passively extend her joints.", "2. She attained neck control at 4 months and could roll from front to back at 5 months of age.", "3. She does not engage in play, reach for toys, or maintain eye contact.", "4. She babbles and does not mimic sounds.", "5. She does not follow simple instructions.", "6. She has difficulty swallowing solid foods and often coughs at meal times.", "7. Her maternal cousin has Down syndrome.", "8. Her vital signs are within normal limits.", "9. She is at the 25th percentile for length and 10th percentile for weight.", "10. Neurological examination shows increased muscle tone in all extremities.", "11. The ankle clonus and extensor plantar responses are present bilaterally.", "12. The Moro reflex is present.", "13. An MRI of the head shows periventricular leukomalacia."]}
{"id": 37, "question": "What is the most likely diagnosis?", "context": ["A 31-year-old male presents with a 2-day history of watery diarrhea that began 8 days after his arrival from Africa.", "None of the other members of his family became ill.", "He reports symptoms of malaise, anorexia, and abdominal cramps followed by watery diarrhea.", "He denies tenesmus, urgency, and bloody diarrhea.", "His temperature is 98.6\u00b0F (37\u00b0C), respiratory rate is 15/min, pulse is 107/min, and blood pressure is 90/68 mm Hg.", "A physical examination is performed and is within normal limits.", "Intravenous fluids are started, and a stool sample is sent to the lab, which comes out to be negative for any ova/parasites, blood cells, or pus cells."], "context_len": 7, "options": {"A": "Giardiasis", "B": "Irritable bowel syndrome (IBS)", "C": "Traveler\u2019s diarrhea due to Norovirus", "D": "Traveler\u2019s diarrhea due to ETEC"}, "answer": "Traveler\u2019s diarrhea due to ETEC", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "31", "specialties": ["Infectious Disease"], "subspecialties": ["General Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 31-year-old male.", "2. Patient has a 2-day history of watery diarrhea.", "3. Patient's diarrhea began 8 days after his arrival from Africa.", "4. None of the other members of his family became ill.", "5. Patient reports symptoms of malaise, anorexia, and abdominal cramps.", "6. Patient denies tenesmus, urgency, and bloody diarrhea.", "7. Patient's temperature is 98.6\u00b0F (37\u00b0C).", "8. Patient's respiratory rate is 15/min.", "9. Patient's pulse is 107/min.", "10. Patient's blood pressure is 90/68 mm Hg.", "11. Physical examination is within normal limits.", "12. Intravenous fluids are started.", "13. Stool sample is sent to the lab.", "14. Stool sample is negative for any ova/parasites, blood cells, or pus cells."], "atomic_facts": ["1. None of the other members of his family became ill.", "2. He reports symptoms of malaise, anorexia, and abdominal cramps followed by watery diarrhea.", "3. He denies tenesmus, urgency, and bloody diarrhea.", "4. His temperature is 98.6\u00b0F (37\u00b0C).", "5. His respiratory rate is 15/min.", "6. His pulse is 107/min.", "7. His blood pressure is 90/68 mm Hg.", "8. A physical examination is performed and is within normal limits.", "9. Intravenous fluids are started.", "10. A stool sample is sent to the lab.", "11. The stool sample comes out to be negative for any ova/parasites, blood cells, or pus cells."]}
{"id": 38, "question": "Which of the following is the primary cause of the patient\u2019s lab results?", "context": ["A 46-year-old woman presents to the emergency department with progressive dyspnea and chest pain.", "She reports that her symptoms started 1 week ago and have gotten progressively worse.", "The chest pain is left-sided and is exacerbated by coughing or deep breaths.", "She also endorses a 6-month history of joint pains involving her knees, elbows, and digits.", "She does not have a significant medical or surgical history.", "She takes ibuprofen as needed.", "She works as a pre-school teacher.", "The patient\u2019s temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 120/78 mmHg, pulse is 89/min, and respirations are 17/min with an oxygen saturation of 93% on room air.", "On physical examination, a friction rub upon inspiration/expiration and crackles are appreciated at the base of the left lung.", "She has an erythematous rash that spans the bilateral cheeks and nose.", "There are also scattered ecchymoses on her arms and legs.", "A chest radiograph shows a small left-sided pleural effusion.", "A complete blood count is obtained, as shown below: |  | Hemoglobin: 9 g/dL | Hematocrit: 28% | Leukocyte count: 1,500/mm^3 with normal differential | Platelet count: 80,000/mm^3 |  | A urinalysis shows elevated protein levels.", "Serologic antibodies are pending."], "context_len": 14, "options": {"A": "Hematologic malignancy", "B": "Immune-mediated destruction", "C": "Mechanical shearing", "D": "Viral infection"}, "answer": "Immune-mediated destruction", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "46", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 46-year-old woman.", "2. Patient presents to the emergency department with progressive dyspnea and chest pain.", "3. Symptoms started 1 week ago and have gotten progressively worse.", "4. Chest pain is left-sided and is exacerbated by coughing or deep breaths.", "5. Patient has a 6-month history of joint pains involving her knees, elbows, and digits.", "6. Patient does not have a significant medical or surgical history.", "7. Patient takes ibuprofen as needed.", "8. Patient works as a pre-school teacher.", "9. Patient's temperature is 99\u00b0F (37.2\u00b0C).", "10. Patient's blood pressure is 120/78 mmHg.", "11. Patient's pulse is 89/min.", "12. Patient's respirations are 17/min with an oxygen saturation of 93% on room air.", "13. Physical examination reveals a friction rub upon inspiration/expiration and crackles at the base of the left lung.", "14. Patient has an erythematous rash that spans the bilateral cheeks and nose.", "15. Patient has scattered ecchymoses on her arms and legs.", "16. Chest radiograph shows a small left-sided pleural effusion.", "17. Complete blood count shows hemoglobin of 9 g/dL, hematocrit of 28%, leukocyte count of 1,500/mm^3 with normal differential, and platelet count of 80,000/mm^3.", "18. Urinalysis shows elevated protein levels.", "19. Serologic antibodies are pending."], "atomic_facts": ["1. Symptoms started 1 week ago", "2. Symptoms have gotten progressively worse", "3. Chest pain is left-sided", "4. Chest pain is exacerbated by coughing or deep breaths", "5. 6-month history of joint pains involving knees, elbows, and digits", "6. No significant medical or surgical history", "7. Takes ibuprofen as needed", "8. Works as a pre-school teacher", "9. Temperature is 99\u00b0F (37.2\u00b0C)", "10. Blood pressure is 120/78 mmHg", "11. Pulse is 89/min", "12. Respirations are 17/min", "13. Oxygen saturation is 93% on room air", "14. Friction rub upon inspiration/expiration and crackles are appreciated at the base of the left lung", "15. Erythematous rash spans the bilateral cheeks and nose", "16. Scattered ecchymoses on arms and legs", "17. Chest radiograph shows a small left-sided pleural effusion", "18. Hemoglobin: 9 g/dL", "19. Hematocrit: 28%", "20. Leukocyte count: 1,500/mm^3 with normal differential", "21. Platelet count: 80,000/mm^3", "22. Urinalysis shows elevated protein levels", "23. Serologic antibodies are pending"]}
{"id": 39, "question": "The cell type responsible for the regeneration of the patient's alveolar epithelium is also functions in:", "context": ["A 48-year-old patient is recovering from acute lung injury following a diffuse pulmonary viral infection."], "context_len": 1, "options": {"A": "Protease release", "B": "Phagocytosis", "C": "Surfactant secretion", "D": "Recruitment of neutrophils"}, "answer": "Surfactant secretion", "answer_idx": "C", "explanation": "", "patient": {"gender": "Not specified", "age": "48 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 48 years old.", "2. Patient is recovering from acute lung injury.", "3. Patient had a diffuse pulmonary viral infection."], "atomic_facts": ["1. The patient is 48 years old.", "2. The patient is recovering from acute lung injury.", "3. The acute lung injury is following a diffuse pulmonary viral infection."]}
{"id": 40, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 36-year-old woman comes to the physician because of fatigue for 4 months.", "She is unable to do her chores and complains of excessive sleepiness during the day.", "She has generalized itching.", "She has not had abdominal pain, fever, or weight loss.", "She has had chronic low back pain for 6 years.", "Her current medications include acetaminophen and vitamin supplements.", "Examination shows scratch marks over the trunk.", "The remainder of the examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 13.2 g/dL | Leukocyte count 8,300/mm3 | Platelet count 280,000/mm3 | ESR 32 mm/h | Serum | Glucose 89 mg/dL | Creatinine 0.7 mg/dL | TSH 4.8 \u03bcU/ml | Bilirubin | Total 1.4 mg/dL | Direct 0.9 mg/dL | Alkaline phosphatase 480 U/L | Aspartate aminotransferase 62 U/L | Alanine aminotransferase 32 U/L | Total cholesterol 288 mg/dL | HDL-cholesterol 57 mg/dL | LDL-cholesterol 189 mg/dL | Triglycerides 212 mg/dL | \u03b3-Glutamyl transferase 92 U/L (N = 5\u201350) | Antimitochondrial antibody (AMA) positive | Antinuclear antibody (ANA) positive | Urinalysis shows no abnormalities.", "Ultrasound of the abdomen shows gallbladder sludge."], "context_len": 10, "options": {"A": "Liver biopsy", "B": "Atorvastatin", "C": "Cholestyramine", "D": "Ursodeoxycholic acid"}, "answer": "Ursodeoxycholic acid", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "36", "specialties": ["Internal Medicine", "Hepatology"], "subspecialties": ["Gastroenterology", "General Hepatology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 36-year-old woman comes to the physician because of fatigue for 4 months.", "2. She is unable to do her chores and complains of excessive sleepiness during the day.", "3. She has generalized itching.", "4. She has not had abdominal pain, fever, or weight loss.", "5. She has had chronic low back pain for 6 years.", "6. Her current medications include acetaminophen and vitamin supplements.", "7. Examination shows scratch marks over the trunk.", "8. The remainder of the examination shows no abnormalities.", "9. Laboratory studies show: Hemoglobin 13.2 g/dL.", "10. Laboratory studies show: Leukocyte count 8,300/mm3.", "11. Laboratory studies show: Platelet count 280,000/mm3.", "12. Laboratory studies show: ESR 32 mm/h.", "13. Laboratory studies show: Serum Glucose 89 mg/dL.", "14. Laboratory studies show: Creatinine 0.7 mg/dL.", "15. Laboratory studies show: TSH 4.8 \u03bcU/ml.", "16. Laboratory studies show: Bilirubin Total 1.4 mg/dL.", "17. Laboratory studies show: Direct 0.9 mg/dL.", "18. Laboratory studies show: Alkaline phosphatase 480 U/L.", "19. Laboratory studies show: Aspartate aminotransferase 62 U/L.", "20. Laboratory studies show: Alanine aminotransferase 32 U/L.", "21. Laboratory studies show: Total cholesterol 288 mg/dL.", "22. Laboratory studies show: HDL-cholesterol 57 mg/dL.", "23. Laboratory studies show: LDL-cholesterol 189 mg/dL.", "24. Laboratory studies show: Triglycerides 212 mg/dL.", "25. Laboratory studies show: \u03b3-Glutamyl transferase 92 U/L (N = 5\u201350).", "26. Laboratory studies show: Antimitochondrial antibody (AMA) positive.", "27. Laboratory studies show: Antinuclear antibody (ANA) positive.", "28. Urinalysis shows no abnormalities.", "29. Ultrasound of the abdomen shows gallbladder sludge."], "atomic_facts": ["1. She is unable to do her chores and complains of excessive sleepiness during the day.", "2. She has generalized itching.", "3. She has not had abdominal pain, fever, or weight loss.", "4. She has had chronic low back pain for 6 years.", "5. Her current medications include acetaminophen and vitamin supplements.", "6. Examination shows scratch marks over the trunk.", "7. The remainder of the examination shows no abnormalities.", "8. Laboratory studies show: Hemoglobin 13.2 g/dL, Leukocyte count 8,300/mm3, Platelet count 280,000/mm3, ESR 32 mm/h, Serum Glucose 89 mg/dL, Creatinine 0.7 mg/dL, TSH 4.8 \u03bcU/ml, Bilirubin Total 1.4 mg/dL, Direct 0.9 mg/dL, Alkaline phosphatase 480 U/L, Aspartate aminotransferase 62 U/L, Alanine aminotransferase 32 U/L, Total cholesterol 288 mg/dL, HDL-cholesterol 57 mg/dL, LDL-cholesterol 189 mg/dL, Triglycerides 212 mg/dL, \u03b3-Glutamyl transferase 92 U/L (N = 5\u201350), Antimitochondrial antibody (AMA) positive, Antinuclear antibody (ANA) positive.", "9. Urinalysis shows no abnormalities.", "10. Ultrasound of the abdomen shows gallbladder sludge."]}
{"id": 41, "question": "Which of the following arterial blood findings for the partial pressure of oxygen (PaO2), oxygen saturation (SaO2), and oxygen concentration (CaO2) are expected in this patient?", "context": ["A 40-year-old woman presents to the physician with complaints of frequent headaches and fatigue for a month.", "Her headaches are mild and occur at random times.", "They are relieved by over the counter analgesics.", "Furthermore, she feels tired most of the time and sometimes gets short of breath with exertion.", "She denies low mood, loss of interest, inability to concentrate, sleep disturbance, or suicidal ideation.", "She was diagnosed with Crohn\u2019s disease 20 years ago for which she currently takes methotrexate.", "Additionally, she takes a folic acid-containing multivitamin daily.", "Her medical history is otherwise insignificant and she does not smoke, drink, or use recreational drugs.", "She has a pulse rate of 110/min, respiratory rate of 20/min, and temperature of 37.0\u00b0C (98.6\u00b0F).", "Physical examination reveals pallor in her palms and lower palpebral conjunctiva."], "context_len": 10, "options": {"A": "Normal PaO2, normal SaO2, normal CaO2", "B": "Low PaO2, low SaO2, low CaO2", "C": "Low PaO2, normal SaO2, normal CaO2", "D": "Normal PaO2, normal SaO2, low CaO2"}, "answer": "Normal PaO2, normal SaO2, low CaO2", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "40", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 40-year-old woman.", "2. Patient has been experiencing frequent headaches and fatigue for a month.", "3. Headaches are mild and occur at random times.", "4. Headaches are relieved by over the counter analgesics.", "5. Patient feels tired most of the time.", "6. Patient sometimes gets short of breath with exertion.", "7. Patient denies low mood, loss of interest, inability to concentrate, sleep disturbance, or suicidal ideation.", "8. Patient was diagnosed with Crohn\u2019s disease 20 years ago.", "9. Patient currently takes methotrexate.", "10. Patient takes a folic acid-containing multivitamin daily.", "11. Patient's medical history is otherwise insignificant.", "12. Patient does not smoke, drink, or use recreational drugs.", "13. Patient has a pulse rate of 110/min.", "14. Patient has a respiratory rate of 20/min.", "15. Patient has a temperature of 37.0\u00b0C (98.6\u00b0F).", "16. Physical examination reveals pallor in patient's palms and lower palpebral conjunctiva."], "atomic_facts": ["1. Her headaches are mild.", "2. Her headaches occur at random times.", "3. Her headaches are relieved by over the counter analgesics.", "4. She feels tired most of the time.", "5. She sometimes gets short of breath with exertion.", "6. She denies low mood.", "7. She denies loss of interest.", "8. She denies inability to concentrate.", "9. She denies sleep disturbance.", "10. She denies suicidal ideation.", "11. She was diagnosed with Crohn\u2019s disease 20 years ago.", "12. She currently takes methotrexate for Crohn\u2019s disease.", "13. She takes a folic acid-containing multivitamin daily.", "14. Her medical history is otherwise insignificant.", "15. She does not smoke.", "16. She does not drink.", "17. She does not use recreational drugs.", "18. She has a pulse rate of 110/min.", "19. She has a respiratory rate of 20/min.", "20. She has a temperature of 37.0\u00b0C (98.6\u00b0F).", "21. Physical examination reveals pallor in her palms.", "22. Physical examination reveals pallor in her lower palpebral conjunctiva."]}
{"id": 42, "question": "What is the most logical diagnostic test for this patient?", "context": ["A 25-year-old woman complains of dyspnea and mild chest pain on exertion, which increases gradually with continued exertion.", "She had similar symptoms last year and her medical record included the following arterial blood gas findings: | pH 7.51 | pO2 77 mm Hg | pCO2  32 mm Hg | An ECG last year demonstrated a right axis deviation.", "The current chest X-ray showed enlarged pulmonary arteries but no parenchymal in\ufb01ltrates.", "A lung perfusion scan revealed a low probability for pulmonary thromboembolism.", "The current ECG showed right heart strain but no evidence of primary cardiac disease."], "context_len": 5, "options": {"A": "Echocardiography", "B": "Holter monitoring", "C": "Lung biopsy", "D": "Transbronchial biopsy"}, "answer": "Echocardiography", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "25", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Pulmonary Disease", "General Cardiology", "Adult Congenital Heart Disease", "Echocardiography"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 25-year-old woman.", "2. Patient complains of dyspnea and mild chest pain on exertion, which increases gradually with continued exertion.", "3. Patient had similar symptoms last year.", "4. Medical record included arterial blood gas findings of pH 7.51, pO2 77 mm Hg, and pCO2 32 mm Hg.", "5. ECG last year demonstrated right axis deviation.", "6. Chest X-ray showed enlarged pulmonary arteries but no parenchymal infiltrates.", "7. Lung perfusion scan revealed low probability for pulmonary thromboembolism.", "8. Current ECG showed right heart strain but no evidence of primary cardiac disease."], "atomic_facts": ["1. She had similar symptoms last year", "2. Her medical record included the following arterial blood gas findings: pH 7.51, pO2 77 mm Hg, pCO2 32 mm Hg", "3. An ECG last year demonstrated a right axis deviation", "4. The current chest X-ray showed enlarged pulmonary arteries but no parenchymal infiltrates", "5. A lung perfusion scan revealed a low probability for pulmonary thromboembolism", "6. The current ECG showed right heart strain but no evidence of primary cardiac disease"]}
{"id": 43, "question": "Which of the following is the most likely diagnosis?", "context": ["A 4-year-old boy is brought to the physician because of a progressive rash for 2 days.", "The rash started behind the ears and now involves the trunk and extremities.", "Over the past 4 days, he has had mild sore throat, red, itchy eyes, and headache.", "He was born at term and has been healthy except for recurrent episodes of tonsillitis and occasional asthma attacks.", "Two weeks ago, he was treated for tonsillitis that resolved with penicillin therapy.", "He immigrated with his family from Brazil 3 weeks ago.", "His immunization status is unknown.", "The patient appears weak and lethargic.", "His temperature is 38\u00b0C (100.4\u00b0F), pulse is 100/min, and blood pressure is 100/60 mm Hg.", "Examination shows postauricular and suboccipital lymphadenopathy.", "There is a non-confluent, pink maculopapular rash over the torso and extremities.", "His palms and soles show no abnormalities."], "context_len": 12, "options": {"A": "Rubella", "B": "Allergic drug reaction", "C": "Scarlet fever", "D": "Erythema infectiosum"}, "answer": "Rubella", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics", "Dermatology"], "subspecialties": ["General Pediatrics", "Pediatric Dermatology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 4-year-old boy.", "2. Patient has had a progressive rash for 2 days.", "3. Rash started behind the ears and now involves the trunk and extremities.", "4. Patient has had mild sore throat, red, itchy eyes, and headache for 4 days.", "5. Patient was born at term and has had recurrent episodes of tonsillitis and occasional asthma attacks.", "6. Patient was treated for tonsillitis 2 weeks ago and it resolved with penicillin therapy.", "7. Patient immigrated with his family from Brazil 3 weeks ago.", "8. Patient's immunization status is unknown.", "9. Patient appears weak and lethargic.", "10. Patient's temperature is 38\u00b0C (100.4\u00b0F).", "11. Patient's pulse is 100/min.", "12. Patient's blood pressure is 100/60 mm Hg.", "13. Examination shows postauricular and suboccipital lymphadenopathy.", "14. Patient has a non-confluent, pink maculopapular rash over the torso and extremities.", "15. Patient's palms and soles show no abnormalities."], "atomic_facts": ["1. The rash started behind the ears.", "2. The rash now involves the trunk and extremities.", "3. Over the past 4 days, the patient has had a mild sore throat.", "4. Over the past 4 days, the patient has had red, itchy eyes.", "5. Over the past 4 days, the patient has had a headache.", "6. The patient was born at term.", "7. The patient has been healthy except for recurrent episodes of tonsillitis.", "8. The patient has been healthy except for occasional asthma attacks.", "9. Two weeks ago, the patient was treated for tonsillitis.", "10. The tonsillitis resolved with penicillin therapy.", "11. The patient immigrated from Brazil 3 weeks ago.", "12. The patient's immunization status is unknown.", "13. The patient appears weak and lethargic.", "14. The patient's temperature is 38\u00b0C (100.4\u00b0F).", "15. The patient's pulse is 100/min.", "16. The patient's blood pressure is 100/60 mm Hg.", "17. Examination shows postauricular and suboccipital lymphadenopathy.", "18. There is a non-confluent, pink maculopapular rash over the torso and extremities.", "19. The patient's palms and soles show no abnormalities."]}
{"id": 44, "question": "Which of the following should be monitored as the patient continues treatment?", "context": ["A 66-year-old man presents to the office complaining of fatigue.", "He reports that for the past year he has been experiencing a progressive decrease in energy.", "This week he began having some difficulty breathing while climbing the stairs.", "He denies chest pain or palpitations.", "He has no other chronic medical conditions and has had no prior surgeries.", "The patient is found to be anemic.", "A fecal occult blood test is positive, and a colonoscopy is obtained.", "The patient is subsequently diagnosed with colorectal cancer.", "He undergoes a partial colectomy and is started on 5-fluorouracil as adjuvant chemotherapy."], "context_len": 9, "options": {"A": "Creatinine", "B": "Fecal leukocytes", "C": "Neutrophil count", "D": "Peak flow"}, "answer": "Neutrophil count", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "66 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology", "Geriatric Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 66-year-old man presents to the office complaining of fatigue.", "2. He reports that for the past year he has been experiencing a progressive decrease in energy.", "3. This week he began having some difficulty breathing while climbing the stairs.", "4. He denies chest pain or palpitations.", "5. He has no other chronic medical conditions and has had no prior surgeries.", "6. The patient is found to be anemic.", "7. A fecal occult blood test is positive.", "8. A colonoscopy is obtained.", "9. The patient is subsequently diagnosed with colorectal cancer.", "10. He undergoes a partial colectomy.", "11. He is started on 5-fluorouracil as adjuvant chemotherapy."], "atomic_facts": ["1. Patient reports progressive decrease in energy for the past year.", "2. Patient began having difficulty breathing while climbing stairs this week.", "3. Patient denies chest pain or palpitations.", "4. Patient has no other chronic medical conditions.", "5. Patient has had no prior surgeries.", "6. Patient is found to be anemic.", "7. Fecal occult blood test is positive.", "8. Colonoscopy is obtained.", "9. Patient is diagnosed with colorectal cancer.", "10. Patient undergoes a partial colectomy.", "11. Patient is started on 5-fluorouracil as adjuvant chemotherapy."]}
{"id": 45, "question": "The molecular structure of the drug most likely recommended by the physician closely resembles a drug used to treat which of the following conditions?", "context": ["A 15-year-old girl comes to the physician for a follow-up evaluation.", "She has multiple erythematous pustules and nodules over her face, for which she has received erythromycin and topical benzoyl peroxide.", "She is concerned that the therapy is ineffective.", "The physician recommends a drug on the condition that the patient agrees to use oral contraceptives."], "context_len": 4, "options": {"A": "EGFR-positive non-small cell lung cancer", "B": "Acute promyelocytic leukemia", "C": "BRAF-positive metastatic melanoma", "D": "Choriocarcinoma"}, "answer": "Acute promyelocytic leukemia", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "15 years old", "specialties": ["Internal Medicine", "Pediatrics"], "subspecialties": ["Medical Oncology", "Pediatric Hematology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 15-year-old girl comes to the physician for a follow-up evaluation.", "2. She has multiple erythematous pustules and nodules over her face.", "3. She has received erythromycin and topical benzoyl peroxide.", "4. She is concerned that the therapy is ineffective.", "5. The physician recommends a drug.", "6. The patient must agree to use oral contraceptives in order to receive the drug."], "atomic_facts": ["1. The patient has multiple erythematous pustules and nodules over her face.", "2. The patient has received erythromycin and topical benzoyl peroxide for her condition.", "3. The patient is concerned that the therapy is ineffective.", "4. The physician recommends a drug for the patient.", "5. The physician's recommendation is conditional on the patient agreeing to use oral contraceptives."]}
{"id": 46, "question": "A biopsy of one of this lesion would most likely reveal which of the following?", "context": ["A 62-year-old female presents to her primary care provider complaining of a mass near her right jaw.", "She reports that the mass is painless and has grown very slowly over the past six months.", "She initially did not see a physician due to being very busy at her work as a lawyer.", "However, she reports that she noticed some right-sided facial weakness in the past week which prompted her to visit the physician.", "Her past medical history is notable for Hodgkins lymphoma as a child which required radiation therapy to the neck.", "She has a 20 pack-year smoking history and drinks alcohol socially.", "Her temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 120/85 mmHg, pulse is 85/min, and respirations are 18/min.", "Physical examination reveals a painless firm mass at the angle of the right jaw.", "There is also a small palpable firm mass beneath the floor of the mouth.", "A right facial droop along with an inability to elevate her right eyebrow is noted."], "context_len": 10, "options": {"A": "Cystic configurations of anaplastic squamous and mucoid cells", "B": "Non-infiltrative clusters of epithelial and mesenchymal cells", "C": "Epithelial cells with dense lymphoid stroma and germinal centers", "D": "Uniform spindle cells with scant cytoplasm and cigar-shaped nuclei"}, "answer": "Cystic configurations of anaplastic squamous and mucoid cells", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "62 years old", "specialties": ["Pathology"], "subspecialties": ["Dermatopathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is a 62-year-old female.", "2. Patient presents with a mass near her right jaw.", "3. Mass is painless and has grown slowly over the past six months.", "4. Patient initially did not see a physician due to being very busy at her work as a lawyer.", "5. Patient noticed some right-sided facial weakness in the past week which prompted her to visit the physician.", "6. Patient's past medical history is notable for Hodgkins lymphoma as a child which required radiation therapy to the neck.", "7. Patient has a 20 pack-year smoking history.", "8. Patient drinks alcohol socially.", "9. Patient's temperature is 98.6\u00b0F (37\u00b0C).", "10. Patient's blood pressure is 120/85 mmHg.", "11. Patient's pulse is 85/min.", "12. Patient's respirations are 18/min.", "13. Physical examination reveals a painless firm mass at the angle of the right jaw.", "14. Physical examination reveals a small palpable firm mass beneath the floor of the mouth.", "15. Physical examination reveals a right facial droop along with an inability to elevate her right eyebrow."], "atomic_facts": ["1. The mass is painless.", "2. The mass has grown very slowly over the past six months.", "3. She initially did not see a physician due to being very busy at her work as a lawyer.", "4. She noticed some right-sided facial weakness in the past week.", "5. Her past medical history is notable for Hodgkins lymphoma as a child.", "6. The Hodgkins lymphoma required radiation therapy to the neck.", "7. She has a 20 pack-year smoking history.", "8. She drinks alcohol socially.", "9. Her temperature is 98.6\u00b0F (37\u00b0C).", "10. Her blood pressure is 120/85 mmHg.", "11. Her pulse is 85/min.", "12. Her respirations are 18/min.", "13. Physical examination reveals a painless firm mass at the angle of the right jaw.", "14. There is also a small palpable firm mass beneath the floor of the mouth.", "15. A right facial droop along with an inability to elevate her right eyebrow is noted."]}
{"id": 47, "question": "Which of the following additional findings would most likely be present in this patient?", "context": ["A 29-year-old woman presents with low-grade fever, rash, and joint pain.", "She says her symptoms started gradually about 3 months ago and have progressively worsened.", "The patient describes her rash as pruritic, flat, and localized to her face.", "She reports a different type of rash on her shoulders and arms that are aggravated by exposure to sunlight.", "She describes her joint pain as moderate, dull and aching in character, and present mainly in the small bones of her wrists and hands, worse on the right than the left.", "She has no other relevant medical history and takes no current medications.", "Her family history is notable for her maternal grandmother, who had an unknown autoimmune condition.", "The patient denies any smoking history, alcohol use, or recreational drug use.", "Her temperature is 38.0\u2103 (100.3\u2109), pulse is 59/min, respiratory rate is 19/min, and blood pressure is 129/84 mm Hg.", "On physical examination, there is a macular, erythematous rash that involves both cheeks and the bridge of her nose, sparing the nasolabial folds.", "There is also a mild macular rash on the sun-exposed areas of her upper extremities and shoulders.", "She has moderate to severe point tenderness in the small joints of her wrists and hands, worse on the right, with minimal erythema and swelling.", "Multiple painless ulcers are present on the soft and hard palate."], "context_len": 13, "options": {"A": "Swelling and proliferation of endothelial and mesangial cells in portions of each glomerulus with neutrophil infiltration", "B": "Immunologically mediated destruction of the salivary glands", "C": "Abnormal accumulation of fibrous tissue in the skin and multiple organs", "D": "Amyloid deposits within the myocardium between the muscle fibers"}, "answer": "Swelling and proliferation of endothelial and mesangial cells in portions of each glomerulus with neutrophil infiltration", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "29", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 29-year-old woman.", "2. Patient has low-grade fever, rash, and joint pain.", "3. Symptoms started gradually about 3 months ago and have progressively worsened.", "4. Rash is pruritic, flat, and localized to her face.", "5. Different type of rash on her shoulders and arms that are aggravated by exposure to sunlight.", "6. Joint pain is moderate, dull and aching in character, and present mainly in the small bones of her wrists and hands, worse on the right than the left.", "7. No other relevant medical history and takes no current medications.", "8. Family history is notable for her maternal grandmother, who had an unknown autoimmune condition.", "9. Patient denies any smoking history, alcohol use, or recreational drug use.", "10. Temperature is 38.0\u2103 (100.3\u2109).", "11. Pulse is 59/min.", "12. Respiratory rate is 19/min.", "13. Blood pressure is 129/84 mm Hg.", "14. Physical examination reveals macular, erythematous rash that involves both cheeks and the bridge of her nose, sparing the nasolabial folds.", "15. Mild macular rash on the sun-exposed areas of her upper extremities and shoulders.", "16. Moderate to severe point tenderness in the small joints of her wrists and hands, worse on the right, with minimal erythema and swelling.", "17. Multiple painless ulcers are present on the soft and hard palate."], "atomic_facts": ["1. Symptoms started gradually about 3 months ago", "2. Symptoms have progressively worsened", "3. Rash is pruritic, flat, and localized to her face", "4. Different type of rash on shoulders and arms aggravated by sunlight", "5. Joint pain is moderate, dull, and aching in character", "6. Joint pain mainly in the small bones of wrists and hands, worse on the right", "7. No other relevant medical history", "8. Takes no current medications", "9. Family history notable for maternal grandmother with an unknown autoimmune condition", "10. Denies smoking history, alcohol use, or recreational drug use", "11. Temperature is 38.0\u2103 (100.3\u2109)", "12. Pulse is 59/min", "13. Respiratory rate is 19/min", "14. Blood pressure is 129/84 mm Hg", "15. Macular, erythematous rash involves both cheeks and the bridge of her nose, sparing the nasolabial folds", "16. Mild macular rash on the sun-exposed areas of her upper extremities and shoulders", "17. Moderate to severe point tenderness in the small joints of her wrists and hands, worse on the right, with minimal erythema and swelling", "18. Multiple painless ulcers present on the soft and hard palate"]}
{"id": 48, "question": "The child likely has:", "context": ["A 3-year-old Cuban-American male has a history of recurrent Pseudomonas and Candida infections.", "Laboratory analysis reveals no electrolyte abnormalities.", "Examination of his serum shows decreased levels of IgG and CT scan reveals the absence of a thymus."], "context_len": 3, "options": {"A": "Severe combined immunodeficiency syndrome", "B": "DiGeorge syndrome", "C": "Isolated IgA deficiency", "D": "Common variable immunodeficiency"}, "answer": "Severe combined immunodeficiency syndrome", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics", "Allergy and Immunology"], "subspecialties": ["Immunology", "Immunology and Allergy", "General Allergy and Immunology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. Patient is a 3-year-old Cuban-American male.", "2. Patient has a history of recurrent Pseudomonas and Candida infections.", "3. Laboratory analysis reveals no electrolyte abnormalities.", "4. Examination of patient's serum shows decreased levels of IgG.", "5. CT scan reveals the absence of a thymus."], "atomic_facts": ["1. Laboratory analysis reveals no electrolyte abnormalities.", "2. Examination of his serum shows decreased levels of IgG.", "3. CT scan reveals the absence of a thymus."]}
{"id": 49, "question": "Which of the following is the most likely underlying cause of the patient's condition?\"", "context": ["A 7-year-old girl is brought to the physician for evaluation of recurrent epistaxis.", "Her mother reports that she bruises easily while playing.", "Her pulse is 89/min and blood pressure is 117/92 mm Hg.", "Examination shows multiple bruises in the upper and lower extremities.", "Laboratory studies show: | Platelet count 100,000/mm3 | Prothrombin time 12 seconds | Partial thromboplastin time 33 seconds | Bleeding time 13 minutes | A peripheral blood smear shows enlarged platelets.", "Ristocetin assay shows no platelet aggregation."], "context_len": 6, "options": {"A": "Glycoprotein Ib deficiency", "B": "Vitamin K deficiency", "C": "Von Willebrand factor deficiency", "D": "ADAMTS13 deficiency"}, "answer": "Glycoprotein Ib deficiency", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 7-year-old girl is brought to the physician for evaluation of recurrent epistaxis.", "2. Her mother reports that she bruises easily while playing.", "3. Her pulse is 89/min.", "4. Her blood pressure is 117/92 mm Hg.", "5. Examination shows multiple bruises in the upper and lower extremities.", "6. Laboratory studies show a platelet count of 100,000/mm3.", "7. Prothrombin time is 12 seconds.", "8. Partial thromboplastin time is 33 seconds.", "9. Bleeding time is 13 minutes.", "10. A peripheral blood smear shows enlarged platelets.", "11. Ristocetin assay shows no platelet aggregation."], "atomic_facts": ["1. Her mother reports that she bruises easily while playing.", "2. Her pulse is 89/min.", "3. Her blood pressure is 117/92 mm Hg.", "4. Examination shows multiple bruises in the upper and lower extremities.", "5. Platelet count is 100,000/mm3.", "6. Prothrombin time is 12 seconds.", "7. Partial thromboplastin time is 33 seconds.", "8. Bleeding time is 13 minutes.", "9. A peripheral blood smear shows enlarged platelets.", "10. Ristocetin assay shows no platelet aggregation."]}
{"id": 50, "question": "Which of the following is the most likely diagnosis?", "context": ["A 38-year-old woman comes to the emergency department because of progressive headache, blurry vision, and nausea for 1 day.", "Four days ago, she was diagnosed with a right middle ear infection.", "She appears lethargic.", "Her temperature is 39.1\u00b0C (102.3\u00b0F), and blood pressure is 148/95 mm Hg.", "Ophthalmologic examination shows bilateral swelling of the optic disc.", "The corneal reflex in the right eye is absent.", "Sensation to touch is reduced on the upper right side of the face.", "Serum studies show increased concentrations of fibrin degradation products."], "context_len": 8, "options": {"A": "Cerebral venous thrombosis", "B": "Hypertensive emergency", "C": "Subarachnoid hemorrhage", "D": "Viral meningitis"}, "answer": "Cerebral venous thrombosis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "38", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 38-year-old woman comes to the emergency department.", "2. She has progressive headache, blurry vision, and nausea for 1 day.", "3. Four days ago, she was diagnosed with a right middle ear infection.", "4. She appears lethargic.", "5. Her temperature is 39.1\u00b0C (102.3\u00b0F).", "6. Her blood pressure is 148/95 mm Hg.", "7. Ophthalmologic examination shows bilateral swelling of the optic disc.", "8. The corneal reflex in the right eye is absent.", "9. Sensation to touch is reduced on the upper right side of the face.", "10. Serum studies show increased concentrations of fibrin degradation products."], "atomic_facts": ["1. Four days ago, she was diagnosed with a right middle ear infection.", "2. She appears lethargic.", "3. Her temperature is 39.1\u00b0C (102.3\u00b0F).", "4. Her blood pressure is 148/95 mm Hg.", "5. Ophthalmologic examination shows bilateral swelling of the optic disc.", "6. The corneal reflex in the right eye is absent.", "7. Sensation to touch is reduced on the upper right side of the face.", "8. Serum studies show increased concentrations of fibrin degradation products."]}
{"id": 51, "question": "Which of the following features are not associated of Waardenburg\u2019s syndrome?", "context": ["A 35-year-old female presents to your office for a routine physical.", "She informs you that she is pregnant, and that the father of her child has Waardenburg\u2019s syndrome.", "She asks you about common findings in Waardenburg\u2019s syndrome."], "context_len": 3, "options": {"A": "Heterochromia", "B": "Conductive hearing loss", "C": "Lateral displacement of inner canthi", "D": "Broad nasal root"}, "answer": "Conductive hearing loss", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "35", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 35-year-old female presents to your office for a routine physical.", "2. She informs you that she is pregnant.", "3. The father of her child has Waardenburg's syndrome.", "4. She asks you about common findings in Waardenburg's syndrome."], "atomic_facts": ["1. The woman is pregnant.", "2. The father of her child has Waardenburg\u2019s syndrome.", "3. She is asking about common findings in Waardenburg\u2019s syndrome."]}
{"id": 52, "question": "Which of the following is the most likely underlying mechanism of this patient's fall?", "context": ["A 4-year-old boy is brought to the emergency department for evaluation after falling.", "He has fallen multiple times in the last year.", "His parents report that he did not walk until he was 18 months old.", "Examination shows a mildly swollen right ankle with no tenderness over the medial or lateral malleolus; range of motion is full with mild pain.", "He has marked enlargement of both calves.", "When standing up, the patient uses his hands against his knees and thighs to slowly push himself up into a standing position."], "context_len": 6, "options": {"A": "Loss of the ATM protein", "B": "Absence of dystrophin protein", "C": "Arylsulfatase A deficiency", "D": "SMN1 gene defect"}, "answer": "Absence of dystrophin protein", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old boy is brought to the emergency department for evaluation after falling.", "2. He has fallen multiple times in the last year.", "3. His parents report that he did not walk until he was 18 months old.", "4. Examination shows a mildly swollen right ankle with no tenderness over the medial or lateral malleolus.", "5. Range of motion is full with mild pain.", "6. He has marked enlargement of both calves.", "7. When standing up, the patient uses his hands against his knees and thighs to slowly push himself up into a standing position."], "atomic_facts": ["1. He has fallen multiple times in the last year.", "2. His parents report that he did not walk until he was 18 months old.", "3. Examination shows a mildly swollen right ankle with no tenderness over the medial or lateral malleolus.", "4. Range of motion is full with mild pain in the right ankle.", "5. He has marked enlargement of both calves.", "6. When standing up, the patient uses his hands against his knees and thighs to slowly push himself up into a standing position."]}
{"id": 53, "question": "Administering succinylcholine during this procedure would most likely result in which of the following complications?", "context": ["A 25-year-old man is brought to the emergency department with second- and third-degree burns covering 30% of the surface area of his body.", "He is alert and active.", "He has no personal or family history of serious illness.", "His temperature is 36.5\u00b0C (97.7\u00b0F), pulse is 62/min, respirations are 18/min, and blood pressure is 105/70 mm Hg.", "Pulse oximetry on 2 liters by nasal cannula shows an oxygen saturation of 98%.", "Intravenous fluids, intravenous and topical antibiotics, and intravenous pain medications are administered in the intensive care unit.", "Twenty-four hours later, the patient develops respiratory distress.", "Respirations are 30/min.", "There is an inspiratory stridor.", "The patient requires rapid sequence intubation."], "context_len": 10, "options": {"A": "Prolonged muscle weakness", "B": "Malignant hyperthermia", "C": "Cardiac arrhythmia", "D": "Respiratory depression"}, "answer": "Cardiac arrhythmia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Anesthesiology"], "subspecialties": ["General Anesthesiology", "Pain Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Anesthesiology"}, "facts_old": ["1. A 25-year-old man is brought to the emergency department.", "2. He has second- and third-degree burns covering 30% of the surface area of his body.", "3. He is alert and active.", "4. He has no personal or family history of serious illness.", "5. His temperature is 36.5\u00b0C (97.7\u00b0F).", "6. His pulse is 62/min.", "7. His respirations are 18/min.", "8. His blood pressure is 105/70 mm Hg.", "9. Pulse oximetry on 2 liters by nasal cannula shows an oxygen saturation of 98%.", "10. Intravenous fluids, intravenous and topical antibiotics, and intravenous pain medications are administered in the intensive care unit.", "11. Twenty-four hours later, the patient develops respiratory distress.", "12. His respirations are 30/min.", "13. There is an inspiratory stridor.", "14. The patient requires rapid sequence intubation."], "atomic_facts": ["1. The patient is alert and active.", "2. The patient has no personal or family history of serious illness.", "3. The patient's temperature is 36.5\u00b0C (97.7\u00b0F).", "4. The patient's pulse is 62/min.", "5. The patient's respirations are 18/min.", "6. The patient's blood pressure is 105/70 mm Hg.", "7. Pulse oximetry on 2 liters by nasal cannula shows an oxygen saturation of 98%.", "8. Intravenous fluids, intravenous and topical antibiotics, and intravenous pain medications are administered in the intensive care unit.", "9. Twenty-four hours later, the patient develops respiratory distress.", "10. The patient's respirations are 30/min.", "11. The patient has an inspiratory stridor.", "12. The patient requires rapid sequence intubation."]}
{"id": 54, "question": "What ausculatory finding would explain the mechanism by which her more recent complaint occurred?", "context": ["A 32-year-old woman presents to the emergency department with 2 hours of left-sided weakness.", "Her husband reports that she had been complaining of pain and swelling in her right calf for several weeks prior to this event.", "The couple had recently returned from a vacation in Europe."], "context_len": 3, "options": {"A": "Holosystolic murmur radiating to the axilla", "B": "Wide, fixed splitting of S2", "C": "Crescendo-decrescendo murmur heard loudest at the right second intercostal space", "D": "An S2 that splits during expiration"}, "answer": "Wide, fixed splitting of S2", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "32", "specialties": ["Internal Medicine", "Neurology"], "subspecialties": ["Neurology", "Vascular Neurology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 32-year-old woman presents to the emergency department.", "2. She has had left-sided weakness for 2 hours.", "3. Her husband reports she had been complaining of pain and swelling in her right calf for several weeks prior to this event.", "4. The couple had recently returned from a vacation in Europe."], "atomic_facts": ["1. The patient's husband reported her complaints of pain and swelling in her right calf.", "2. The pain and swelling had been ongoing for several weeks before the event.", "3. The couple had recently returned from a vacation in Europe."]}
{"id": 55, "question": "Which of the following hormones most likely is the cause of the postprandial aggravation of this patient's symptoms?", "context": ["A 41-year-old woman presents with pain in her abdomen for the last couple of hours.", "She says pain is intermittent and localized to the right hypochondriac region.", "She admits to eating fatty foods this morning before the pain started.", "She also complains of nausea but has not vomited yet.", "She describes episodes with similar symptoms in the past after a fatty meal but were less severe.", "Past medical history is irrelevant.", "The vital signs include: heart rate 85/min, respiratory rate 16/min, temperature 37.6\u00b0C (99.6\u00b0F), and blood pressure 120/80 mm Hg.", "Physical examination is within normal limits.", "An abdominal ultrasound is pending."], "context_len": 9, "options": {"A": "Somatostatin", "B": "Cholecystokinin", "C": "Gastrin", "D": "Secretin"}, "answer": "Cholecystokinin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "41 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. Patient is a 41-year-old woman.", "2. Patient has been experiencing pain in her abdomen for the last couple of hours.", "3. Pain is intermittent and localized to the right hypochondriac region.", "4. Patient admits to eating fatty foods this morning before the pain started.", "5. Patient also complains of nausea but has not vomited yet.", "6. Patient has had episodes with similar symptoms in the past after a fatty meal but were less severe.", "7. Patient's past medical history is irrelevant.", "8. Patient's heart rate is 85/min.", "9. Patient's respiratory rate is 16/min.", "10. Patient's temperature is 37.6\u00b0C (99.6\u00b0F).", "11. Patient's blood pressure is 120/80 mm Hg.", "12. Patient's physical examination is within normal limits.", "13. An abdominal ultrasound is pending."], "atomic_facts": ["1. Pain is intermittent", "2. Pain is localized to the right hypochondriac region", "3. Ate fatty foods this morning before the pain started", "4. Complains of nausea", "5. Has not vomited yet", "6. Episodes with similar symptoms in the past after a fatty meal were less severe", "7. Past medical history is irrelevant", "8. Vital signs: heart rate 85/min", "9. Vital signs: respiratory rate 16/min", "10. Vital signs: temperature 37.6\u00b0C (99.6\u00b0F)", "11. Vital signs: blood pressure 120/80 mm Hg", "12. Physical examination is within normal limits", "13. Abdominal ultrasound is pending"]}
{"id": 56, "question": "Which of the following is the most likely causal pathogen?", "context": ["A 53-year-old man comes to the physician because of a 1-day history of fever and chills, severe malaise, and cough with yellow-green sputum.", "He works as a commercial fisherman on Lake Superior.", "Current medications include metoprolol and warfarin.", "His temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 96/min, respirations are 26/min, and blood pressure is 98/62 mm Hg.", "Examination shows increased fremitus and bronchial breath sounds over the right middle lung field.", "An x-ray of the chest shows consolidation of the right upper lobe."], "context_len": 6, "options": {"A": "Pseudomonas aeruginosa", "B": "Streptococcus pyogenes", "C": "Haemophilus influenzae", "D": "Streptococcus pneumoniae"}, "answer": "Streptococcus pneumoniae", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "53 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 53-year-old man comes to the physician.", "2. He has a 1-day history of fever and chills, severe malaise, and cough with yellow-green sputum.", "3. He works as a commercial fisherman on Lake Superior.", "4. His current medications include metoprolol and warfarin.", "5. His temperature is 38.5\u00b0C (101.3\u00b0F).", "6. His pulse is 96/min.", "7. His respirations are 26/min.", "8. His blood pressure is 98/62 mm Hg.", "9. Examination shows increased fremitus and bronchial breath sounds over the right middle lung field.", "10. An x-ray of the chest shows consolidation of the right upper lobe."], "atomic_facts": ["1. He works as a commercial fisherman on Lake Superior.", "2. Current medications include metoprolol and warfarin.", "3. His temperature is 38.5\u00b0C (101.3\u00b0F).", "4. His pulse is 96/min.", "5. His respirations are 26/min.", "6. His blood pressure is 98/62 mm Hg.", "7. Examination shows increased fremitus and bronchial breath sounds over the right middle lung field.", "8. An x-ray of the chest shows consolidation of the right upper lobe."]}
{"id": 57, "question": "Which of the following is the most appropriate antibiotic to pair with the tamsulosin?", "context": ["A 46-year-old man presents to his physician because of persistent pelvic and scrotal pain for the past month.", "He also has had occasional fevers, chills, dysuria, and increased urinary frequency over the last few months.", "He was prescribed trimethoprim and sulfamethoxazole for the urinary symptoms, but he is still having symptoms currently.", "He is sexually active with multiple male and female partners and uses condoms inconsistently.", "The patient has hypertension and takes lisinopril.", " He also takes PrEP (Truvada, which contains tenofovir and emtricitabine).", "On physical exam, his temperature is 36.7\u2103 (98.1\u2109), the blood pressure is 115/70 mm Hg, the pulse is 74/min, and the respirations are 14/min.", "A digital rectal exam reveals a mildly tender and mildly enlarged prostate.", "Urine specimens are sent for culture and sensitivity testing.", "A urine sample taken after prostate massage shows a 10-fold increase in bacteria counts.", "The test results for antimicrobial sensitivity include ampicillin, cefepime, gentamicin, levofloxacin, and meropenem.", "The patient is prescribed tamsulosin."], "context_len": 12, "options": {"A": "Cefepime", "B": "Gentamicin", "C": "Levofloxacin", "D": "Trimethoprim and sulfamethoxazole"}, "answer": "Levofloxacin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "46 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is 46 years old.", "2. Patient has persistent pelvic and scrotal pain for the past month.", "3. Patient has occasional fevers, chills, dysuria, and increased urinary frequency over the last few months.", "4. Patient was prescribed trimethoprim and sulfamethoxazole for the urinary symptoms, but still having symptoms.", "5. Patient is sexually active with multiple male and female partners and uses condoms inconsistently.", "6. Patient has hypertension and takes lisinopril.", "7. Patient takes PrEP (Truvada, which contains tenofovir and emtricitabine).", "8. Patient's temperature is 36.7\u2103 (98.1\u2109).", "9. Patient's blood pressure is 115/70 mm Hg.", "10. Patient's pulse is 74/min.", "11. Patient's respirations are 14/min.", "12. Digital rectal exam reveals a mildly tender and mildly enlarged prostate.", "13. Urine specimens sent for culture and sensitivity testing.", "14. Urine sample taken after prostate massage shows a 10-fold increase in bacteria counts.", "15. Test results for antimicrobial sensitivity include ampicillin, cefepime, gentamicin, levofloxacin, and meropenem.", "16. Patient is prescribed tamsulosin."], "atomic_facts": ["1. The patient has had occasional fevers, chills, dysuria, and increased urinary frequency over the last few months.", "2. The patient was prescribed trimethoprim and sulfamethoxazole for the urinary symptoms.", "3. The patient is still having symptoms currently.", "4. The patient is sexually active with multiple male and female partners.", "5. The patient uses condoms inconsistently.", "6. The patient has hypertension.", "7. The patient takes lisinopril.", "8. The patient takes PrEP (Truvada, which contains tenofovir and emtricitabine).", "9. On physical exam, the patient's temperature is 36.7\u2103 (98.1\u2109).", "10. On physical exam, the patient's blood pressure is 115/70 mm Hg.", "11. On physical exam, the patient's pulse is 74/min.", "12. On physical exam, the patient's respirations are 14/min.", "13. A digital rectal exam reveals a mildly tender and mildly enlarged prostate.", "14. Urine specimens are sent for culture and sensitivity testing.", "15. A urine sample taken after prostate massage shows a 10-fold increase in bacteria counts.", "16. The test results for antimicrobial sensitivity include ampicillin, cefepime, gentamicin, levofloxacin, and meropenem.", "17. The patient is prescribed tamsulosin."]}
{"id": 58, "question": "This drug is most likely to result in which of the following laboratory changes?", "context": ["A 29-year-old woman comes to the emergency department because of progressive numbness and weakness in her right arm and right leg for 1 day.", "Two months ago, she had blurry vision and headache for a week, which resolved without treatment.", "She does not smoke or drink alcohol.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 78/min, respirations are 14/min, and blood pressure is 115/71 mm Hg.", "Muscle strength is 3/5 in the right arm and leg and 5/5 on the left side.", "MRI of the brain shows gadolinium-enhancing lesions in the left central sulcus, cervical spinal cord, and optic nerve.", "Intravenous methylprednisolone therapy is started."], "context_len": 7, "options": {"A": "Monocytosis", "B": "Lymphocytosis", "C": "Eosinopenia", "D": "Granulocytopenia"}, "answer": "Eosinopenia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "29", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 29-year-old woman comes to the emergency department.", "2. She has progressive numbness and weakness in her right arm and right leg for 1 day.", "3. Two months ago, she had blurry vision and headache for a week, which resolved without treatment.", "4. She does not smoke or drink alcohol.", "5. Her temperature is 37\u00b0C (98.6\u00b0F).", "6. Her pulse is 78/min.", "7. Her respirations are 14/min.", "8. Her blood pressure is 115/71 mm Hg.", "9. Muscle strength is 3/5 in the right arm and leg.", "10. Muscle strength is 5/5 on the left side.", "11. MRI of the brain shows gadolinium-enhancing lesions in the left central sulcus, cervical spinal cord, and optic nerve.", "12. Intravenous methylprednisolone therapy is started."], "atomic_facts": ["1. Two months ago, she had blurry vision and headache for a week", "2. The blurry vision and headache resolved without treatment", "3. She does not smoke or drink alcohol", "4. Her temperature is 37\u00b0C (98.6\u00b0F)", "5. Her pulse is 78/min", "6. Her respirations are 14/min", "7. Her blood pressure is 115/71 mm Hg", "8. Muscle strength is 3/5 in the right arm and leg and 5/5 on the left side", "9. MRI of the brain shows gadolinium-enhancing lesions in the left central sulcus, cervical spinal cord, and optic nerve", "10. Intravenous methylprednisolone therapy is started"]}
{"id": 59, "question": "Which of the following disorders does this patient potentially suffer from?", "context": ["A 30-year-old male biology graduate student was dismissed from his PhD program after 8 years because he was not able to produce a thesis, claiming that his data was never exactly how he wanted it.", "He would spend weeks planning out a simple experiment, since everything had to be just right.", "For many experiments, he would start over because he felt he went out of order in adding the reagents to his media for his cells.", "He has had similar problems in his undergraduate courses, often failing to complete his assignments on time because he had to revise them until they were perfect."], "context_len": 4, "options": {"A": "Schizoid personality disorder", "B": "Narcissistic personality disorder", "C": "Obsessive compulsive personality disorder", "D": "Paranoid personality disorder"}, "answer": "Obsessive compulsive personality disorder", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "30", "specialties": ["Psychiatry"], "subspecialties": ["Obsessive compulsive personality disorder"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 30-year-old male biology graduate student was dismissed from his PhD program after 8 years.", "2. He was not able to produce a thesis, claiming that his data was never exactly how he wanted it.", "3. He would spend weeks planning out a simple experiment, since everything had to be just right.", "4. For many experiments, he would start over because he felt he went out of order in adding the reagents to his media for his cells.", "5. He has had similar problems in his undergraduate courses.", "6. He often failed to complete his assignments on time because he had to revise them until they were perfect."], "atomic_facts": ["1. He spends weeks planning out a simple experiment.", "2. Everything has to be just right for his experiments.", "3. He starts over for many experiments because he feels he went out of order in adding reagents to his media for his cells.", "4. He has had similar problems in his undergraduate courses.", "5. He often fails to complete his assignments on time.", "6. He revises his assignments until they are perfect."]}
{"id": 60, "question": "Which of the following serum markers is most strongly associated with this patient\u2019s condition?", "context": ["A 62-year-old male presents to his primary care physician complaining of an unintended 10-pound weight loss over the last 4 months.", "He also reports vague abdominal discomfort, weakness, and occasional yellowing of his skin and eyes.", "He has a history of cirrhosis secondary to alcohol abuse and hepatitis C infection.", "Physical exam demonstrates hepatomegaly and abdominal distention."], "context_len": 4, "options": {"A": "Carcinoembryonic antigen (CEA)", "B": "Cancer antigen 19-9 (CA 19-9)", "C": "Alpha-fetoprotein (AFP)", "D": "Beta-human chorionic gonadotropin (\u00df-HCG)"}, "answer": "Alpha-fetoprotein (AFP)", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "62 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology", "Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 62-year-old male presents to his primary care physician.", "2. He has experienced an unintended 10-pound weight loss over the last 4 months.", "3. He reports vague abdominal discomfort, weakness, and occasional yellowing of his skin and eyes.", "4. He has a history of cirrhosis secondary to alcohol abuse and hepatitis C infection.", "5. Physical exam demonstrates hepatomegaly.", "6. Physical exam demonstrates abdominal distention."], "atomic_facts": ["1. The patient reports vague abdominal discomfort.", "2. The patient reports weakness.", "3. The patient reports occasional yellowing of his skin and eyes.", "4. The patient has a history of cirrhosis secondary to alcohol abuse.", "5. The patient has a history of hepatitis C infection.", "6. Physical exam demonstrates hepatomegaly.", "7. Physical exam demonstrates abdominal distention."]}
{"id": 61, "question": "This study is best described as which of the following?", "context": ["A research group designed a study to investigate the epidemiology of syphilis in the United States.", "The investigators examined the total number of cases of syphilis and genitourinary chlamydia in the United States using a national health survey of a nationally representative sample of US citizens conducted in 2012.", "The investigators ultimately found that a history of genitourinary chlamydia infection is associated with syphilis."], "context_len": 3, "options": {"A": "Single-blind clinical trial", "B": "Double-blind clinical trial", "C": "Cross-sectional study", "D": "Case-control study"}, "answer": "Cross-sectional study", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine", "Pathology"], "subspecialties": ["Infectious Disease", "Medical Microbiology Pathology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A research group designed a study to investigate the epidemiology of syphilis in the United States.", "2. The investigators examined the total number of cases of syphilis and genitourinary chlamydia in the United States.", "3. The investigators used a national health survey of a nationally representative sample of US citizens conducted in 2012.", "4. The investigators ultimately found that a history of genitourinary chlamydia infection is associated with syphilis."], "atomic_facts": ["1. The investigators examined the total number of cases of syphilis in the United States.", "2. The investigators examined the total number of cases of genitourinary chlamydia in the United States.", "3. The examination was based on a national health survey.", "4. The survey was conducted in 2012.", "5. The survey used a nationally representative sample of US citizens.", "6. A history of genitourinary chlamydia infection is associated with syphilis."]}
{"id": 62, "question": "Which of the following is the best treatment for this patient\u2019s condition while waiting for the ascitic fluid culture results?", "context": ["A 56-year-old African American male presents with altered mental status, abdominal pain, and a fever of 100.4F.", "His past medical history is significant for alcohol use and cirrhosis of the liver.", "Shifting dullness is noted on physical exam.", "Paracentesis demonstrates serum ascites albumen gradient of 1.3 g/dL, and the ascitic fluid polymorphonuclear cell count is 280 cells/mm^3."], "context_len": 4, "options": {"A": "Nadolol", "B": "Cefotaxime", "C": "Penicillin", "D": "Gentamicin"}, "answer": "Cefotaxime", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 56-year-old African American male.", "2. Patient presents with altered mental status, abdominal pain, and fever of 100.4F.", "3. Patient has past medical history of alcohol use and cirrhosis of the liver.", "4. Physical exam reveals shifting dullness.", "5. Paracentesis demonstrates serum ascites albumen gradient of 1.3 g/dL.", "6. Ascitic fluid polymorphonuclear cell count is 280 cells/mm^3."], "atomic_facts": ["1. His past medical history includes alcohol use.", "2. His past medical history includes cirrhosis of the liver.", "3. Shifting dullness is noted on physical exam.", "4. Paracentesis demonstrates a serum ascites albumin gradient of 1.3 g/dL.", "5. The ascitic fluid polymorphonuclear cell count is 280 cells/mm^3."]}
{"id": 63, "question": "Which of the following additional findings is most likely in this patient?", "context": ["A 4-year-old boy who recently emigrated from Ghana is brought to the physician because of a 5-day history of pain and swelling in his hands.", "He has had similar episodes in the past.", "The patient appears distressed.", "His temperature is 38.1\u00b0C (100.5\u00b0F).", "Physical examination shows pallor.", "The dorsum of his hands and fingers are swollen, warm, and tender to palpation."], "context_len": 6, "options": {"A": "Coronary artery aneurysm", "B": "Hyperuricemia", "C": "Thickened heart valves", "D": "Microhematuria"}, "answer": "Microhematuria", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics", "Rheumatology"], "subspecialties": ["Pediatric Rheumatology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old boy recently emigrated from Ghana.", "2. He has a 5-day history of pain and swelling in his hands.", "3. He has had similar episodes in the past.", "4. The patient appears distressed.", "5. His temperature is 38.1\u00b0C (100.5\u00b0F).", "6. Physical examination shows pallor.", "7. The dorsum of his hands and fingers are swollen.", "8. The dorsum of his hands and fingers are warm.", "9. The dorsum of his hands and fingers are tender to palpation."], "atomic_facts": ["1. He has had similar episodes in the past.", "2. The patient appears distressed.", "3. His temperature is 38.1\u00b0C (100.5\u00b0F).", "4. Physical examination shows pallor.", "5. The dorsum of his hands and fingers are swollen, warm, and tender to palpation."]}
{"id": 64, "question": "Which of the following is the most likely explanation for the laboratory findings in this patient?", "context": ["A 47-year-old woman is admitted to the hospital because of a 2-week history of low-grade fever, fatigue, and a 3-kg (6.6-lb) weight loss.", "Her temperature is 38\u00b0C (100.4\u00b0F).", "Physical examination shows pallor and a cardiac murmur.", "Her serum creatinine is 1.8 mg/dL.", "Urinalysis shows red cell casts and 2+ protein.", "A CT scan of the abdomen with contrast shows no abnormalities.", "Despite appropriate medical therapy, the patient dies.", "A photograph of the heart taken during autopsy is shown."], "context_len": 8, "options": {"A": "Occlusion of renal arteries by cholesterol crystals", "B": "Deposition of antigen-antibody complexes", "C": "Intravascular fragmentation of red blood cells", "D": "Hypersensitivity to penicillin haptens"}, "answer": "Deposition of antigen-antibody complexes", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "47 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease", "General Internal Medicine", "Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 47-year-old woman is admitted to the hospital.", "2. She has a 2-week history of low-grade fever, fatigue, and a 3-kg (6.6-lb) weight loss.", "3. Her temperature is 38\u00b0C (100.4\u00b0F).", "4. Physical examination shows pallor and a cardiac murmur.", "5. Her serum creatinine is 1.8 mg/dL.", "6. Urinalysis shows red cell casts and 2+ protein.", "7. A CT scan of the abdomen with contrast shows no abnormalities.", "8. Despite appropriate medical therapy, the patient dies.", "9. A photograph of the heart taken during autopsy is shown."], "atomic_facts": ["1. Her temperature is 38\u00b0C (100.4\u00b0F).", "2. Physical examination shows pallor and a cardiac murmur.", "3. Her serum creatinine is 1.8 mg/dL.", "4. Urinalysis shows red cell casts and 2+ protein.", "5. A CT scan of the abdomen with contrast shows no abnormalities.", "6. Despite appropriate medical therapy, the patient dies.", "7. A photograph of the heart taken during autopsy is shown."]}
{"id": 65, "question": "Which of the following nerve roots is most likely to be affected in this patient?", "context": ["A 36-year-old woman comes to the physician because of a 2-month history of progressively worsening lower back pain and weakness in the lower extremities.", "The pain is worse with movement and improves with lying down on a flat surface.", "She was diagnosed with pulmonary tuberculosis 6 months ago and is currently taking isoniazid and rifampin.", "Physical examination shows sensory loss over the lateral aspect of the mid-thigh, patella, and medial aspect of the right lower leg.", "Strength is 2/5 with right-sided dorsiflexion and the patellar reflex is absent.", "An x-ray of the spine shows a paravertebral opacity with anterior wedging of the vertebral body."], "context_len": 6, "options": {"A": "S2", "B": "S1", "C": "L3", "D": "L4"}, "answer": "L4", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "36", "specialties": ["Neurology", "Orthopaedic Surgery"], "subspecialties": ["General Neurology", "Neurology with Special Qualification in Child Neurology", "Orthopaedic Sports Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 36-year-old woman comes to the physician.", "2. She has a 2-month history of progressively worsening lower back pain and weakness in the lower extremities.", "3. The pain is worse with movement and improves with lying down on a flat surface.", "4. She was diagnosed with pulmonary tuberculosis 6 months ago.", "5. She is currently taking isoniazid and rifampin.", "6. Physical examination shows sensory loss over the lateral aspect of the mid-thigh, patella, and medial aspect of the right lower leg.", "7. Strength is 2/5 with right-sided dorsiflexion.", "8. The patellar reflex is absent.", "9. An x-ray of the spine shows a paravertebral opacity with anterior wedging of the vertebral body."], "atomic_facts": ["1. The pain is worse with movement.", "2. The pain improves with lying down on a flat surface.", "3. She was diagnosed with pulmonary tuberculosis 6 months ago.", "4. She is currently taking isoniazid and rifampin.", "5. Physical examination shows sensory loss over the lateral aspect of the mid-thigh, patella, and medial aspect of the right lower leg.", "6. Strength is 2/5 with right-sided dorsiflexion.", "7. The patellar reflex is absent.", "8. An x-ray of the spine shows a paravertebral opacity.", "9. The x-ray shows anterior wedging of the vertebral body."]}
{"id": 66, "question": "Arterial blood gas analysis on room air shows: | pH 7.56 | PCO2 40 mm Hg | PO2 94 mm Hg | HCO3- 30 mEq/L | Measurement of which of the following is the most appropriate next step in diagnosis?\"", "context": ["A 24-year-old primigravid woman at 8 weeks' gestation is brought to the emergency department because of a 5-day history of nausea and vomiting.", "She has not been able to tolerate much food or drink.", "Her symptoms are worse in the morning.", "She has tried multiple oral antiemetics with limited relief.", "She has not had fevers, chills, abdominal pain, urinary symptoms, or diarrhea.", "She appears tired.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 105/min, and blood pressure is 108/60 mm Hg.", "Examination shows dry mucous membranes and cool extremities, with delayed capillary refill time."], "context_len": 8, "options": {"A": "Serum osmolal gap", "B": "Serum anion gap", "C": "Urine albumin to urine creatinine ratio", "D": "Urine chloride concentration"}, "answer": "Urine chloride concentration", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "24 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 24-year-old primigravid woman.", "2. Patient is 8 weeks' gestation.", "3. Patient has a 5-day history of nausea and vomiting.", "4. Patient has not been able to tolerate much food or drink.", "5. Symptoms are worse in the morning.", "6. Patient has tried multiple oral antiemetics with limited relief.", "7. Patient has not had fevers, chills, abdominal pain, urinary symptoms, or diarrhea.", "8. Patient appears tired.", "9. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "10. Patient's pulse is 105/min.", "11. Patient's blood pressure is 108/60 mm Hg.", "12. Examination shows dry mucous membranes.", "13. Examination shows cool extremities.", "14. Examination shows delayed capillary refill time."], "atomic_facts": ["1. She has not been able to tolerate much food or drink.", "2. Her symptoms are worse in the morning.", "3. She has tried multiple oral antiemetics with limited relief.", "4. She has not had fevers, chills, abdominal pain, urinary symptoms, or diarrhea.", "5. She appears tired.", "6. Her temperature is 37\u00b0C (98.6\u00b0F).", "7. Her pulse is 105/min.", "8. Her blood pressure is 108/60 mm Hg.", "9. Examination shows dry mucous membranes and cool extremities.", "10. Examination shows delayed capillary refill time."]}
{"id": 67, "question": "Which of the following is the most appropriate recommendation at this time?", "context": ["A 34-year-old pregnant woman, gravida 2, para 0, at 28 weeks of gestation presents to the physician for a prenatal visit.", "She has not had regular prenatal care.", "Her most recent abdominal ultrasound was at 20 weeks of gestation, and it confirmed accurate fetal dates and appropriate fetal development.", "She takes levothyroxine for hypothyroidism.", "She used to work as a nurse before she emigrated from Brazil 13 years ago.", "She lost her immunization records during the move and cannot recall all of her vaccinations.", "She appears well.", "Her vital signs are within normal limits.", "The physical examination reveals a fundal height of 26 cm.", "No abnormalities are found during the physical exam.", "An ELISA test conducted for HIV is negative.", "Serology test results for hepatitis B surface antibody and hepatitis C antibody are positive for both.", "The laboratory test results for hepatitis B core antibody, hepatitis B surface antigen, and hepatitis A antibody are negative.", "The polymerase chain reaction analysis of hepatitis C RNA is positive for genotype 1."], "context_len": 14, "options": {"A": "Hepatitis A vaccination", "B": "Plan to formula feed the newborn", "C": "Start combination therapy with interferon \u03b1 and ribavirin", "D": "Undergo liver biopsy"}, "answer": "Hepatitis A vaccination", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "34 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 34-year-old pregnant woman presents to the physician for a prenatal visit.", "2. She is gravida 2, para 0, and 28 weeks of gestation.", "3. She has not had regular prenatal care.", "4. Her most recent abdominal ultrasound was at 20 weeks of gestation.", "5. The ultrasound confirmed accurate fetal dates and appropriate fetal development.", "6. She takes levothyroxine for hypothyroidism.", "7. She used to work as a nurse before she emigrated from Brazil 13 years ago.", "8. She lost her immunization records during the move and cannot recall all of her vaccinations.", "9. She appears well.", "10. Her vital signs are within normal limits.", "11. The physical examination reveals a fundal height of 26 cm.", "12. No abnormalities are found during the physical exam.", "13. An ELISA test conducted for HIV is negative.", "14. Serology test results for hepatitis B surface antibody and hepatitis C antibody are positive for both.", "15. The laboratory test results for hepatitis B core antibody, hepatitis B surface antigen, and hepatitis A antibody are negative.", "16. The polymerase chain reaction analysis of hepatitis C RNA is positive for genotype 1."], "atomic_facts": ["1. She has not had regular prenatal care.", "2. Her most recent abdominal ultrasound was at 20 weeks of gestation, and it confirmed accurate fetal dates and appropriate fetal development.", "3. She takes levothyroxine for hypothyroidism.", "4. She used to work as a nurse before she emigrated from Brazil 13 years ago.", "5. She lost her immunization records during the move and cannot recall all of her vaccinations.", "6. She appears well.", "7. Her vital signs are within normal limits.", "8. The physical examination reveals a fundal height of 26 cm.", "9. No abnormalities are found during the physical exam.", "10. An ELISA test conducted for HIV is negative.", "11. Serology test results for hepatitis B surface antibody and hepatitis C antibody are positive for both.", "12. The laboratory test results for hepatitis B core antibody, hepatitis B surface antigen, and hepatitis A antibody are negative.", "13. The polymerase chain reaction analysis of hepatitis C RNA is positive for genotype 1."]}
{"id": 68, "question": "Which of the following does this screening test detect?", "context": ["A 36-year-old man presents with a 3-week history of fever, enlarged lymph nodes, fatigue, and a dry cough.", "The patient\u2019s wife says she has noticed that he lost a lot of weight over the last 6 months and seems very pale.", "Over the last week, he has noticed a worsening non-productive cough and night sweats.", "His blood count shows anemia and low lymphocyte count.", "He tells the physician that he had multiple unprotected sexual relationships with women other than his wife about 6 years ago and is fearful this may be related to his current health concerns.", "A test is performed which screens for the cause of this patient's immunodeficiency."], "context_len": 6, "options": {"A": "Anti-HCV antigen", "B": "Lactic dehydrogenase", "C": "p24 antigen", "D": "CCR5 mutation"}, "answer": "p24 antigen", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "36 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 36 years old.", "2. Patient has a 3-week history of fever, enlarged lymph nodes, fatigue, and a dry cough.", "3. Patient's wife has noticed weight loss and paleness over the last 6 months.", "4. Patient has a worsening non-productive cough and night sweats over the last week.", "5. Patient's blood count shows anemia and low lymphocyte count.", "6. Patient had multiple unprotected sexual relationships with women other than his wife about 6 years ago.", "7. Patient is fearful this may be related to his current health concerns.", "8. Test is performed to screen for cause of patient's immunodeficiency."], "atomic_facts": ["1. The patient has lost a lot of weight over the last 6 months.", "2. The patient seems very pale.", "3. Over the last week, the patient has noticed a worsening non-productive cough and night sweats.", "4. The patient's blood count shows anemia.", "5. The patient's blood count shows low lymphocyte count.", "6. The patient had multiple unprotected sexual relationships with women other than his wife about 6 years ago.", "7. The patient is fearful this may be related to his current health concerns.", "8. A test is performed which screens for the cause of the patient's immunodeficiency."]}
{"id": 69, "question": "Laboratory studies show: | Hemoglobin 9 g/dL | Leukocyte count 1,500/mm3 | Percent segmented neutrophils 50% | Platelet count 85,000/mm3 | To reduce the likelihood of complications, it is most appropriate to administer which of the following?", "context": ["Seven days after initiation of induction chemotherapy for acute myeloid leukemia, a 56-year-old man develops leukopenia.", "He feels well.", "He has no history of serious cardiopulmonary disease.", "His temperature is 36.7\u00b0C (98.1\u00b0F), blood pressure is 110/65 mm Hg, pulse is 72/min, and respiratory rate is 14/min.", "Examination of the skin, head and neck, heart, lungs, abdomen, and perirectal area reveals no abnormalities."], "context_len": 5, "options": {"A": "Ciprofloxacin", "B": "Granulocyte colony-stimulating factor", "C": "Vancomycin", "D": "No pharmaco-prophylaxis at this time"}, "answer": "Ciprofloxacin", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "56 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 56-year-old man developed leukopenia seven days after initiation of induction chemotherapy for acute myeloid leukemia.", "2. He feels well.", "3. He has no history of serious cardiopulmonary disease.", "4. His temperature is 36.7\u00b0C (98.1\u00b0F).", "5. His blood pressure is 110/65 mm Hg.", "6. His pulse is 72/min.", "7. His respiratory rate is 14/min.", "8. Examination of the skin, head and neck, heart, lungs, abdomen, and perirectal area reveals no abnormalities."], "atomic_facts": ["1. He feels well.", "2. He has no history of serious cardiopulmonary disease.", "3. His temperature is 36.7\u00b0C (98.1\u00b0F).", "4. His blood pressure is 110/65 mm Hg.", "5. His pulse is 72/min.", "6. His respiratory rate is 14/min.", "7. Examination of the skin reveals no abnormalities.", "8. Examination of the head and neck reveals no abnormalities.", "9. Examination of the heart reveals no abnormalities.", "10. Examination of the lungs reveals no abnormalities.", "11. Examination of the abdomen reveals no abnormalities.", "12. Examination of the perirectal area reveals no abnormalities."]}
{"id": 70, "question": "Which of the following drugs most likely caused prolonged muscle paralysis in this patient?", "context": ["A 40-year-old man undergoes an elective cholecystectomy for repeated attacks of cholelithiasis over the last 5 years.", "In the operating room, rapid sequence intubation is performed using a certain muscle relaxant to prevent aspiration of gastric contents.", "During the procedure, atracurium is administered to maintain muscle relaxation and, 1.5 hours after the operation, the anesthesiologist administers neostigmine to reverse the paralysis.", "The patient, however, continues to remain paralyzed and cannot be extubated."], "context_len": 4, "options": {"A": "Midazolam", "B": "Pancuronium", "C": "Succinylcholine", "D": "Tubocurarine"}, "answer": "Succinylcholine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "40", "specialties": ["Anesthesiology"], "subspecialties": ["General Anesthesiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Anesthesiology"}, "facts_old": ["1. A 40-year-old man underwent an elective cholecystectomy.", "2. The man had repeated attacks of cholelithiasis over the last 5 years.", "3. Rapid sequence intubation was performed using a certain muscle relaxant to prevent aspiration of gastric contents.", "4. Atracurium was administered to maintain muscle relaxation.", "5. 1.5 hours after the operation, the anesthesiologist administered neostigmine to reverse the paralysis.", "6. The patient continued to remain paralyzed and could not be extubated."], "atomic_facts": ["1. Rapid sequence intubation is performed in the operating room.", "2. A muscle relaxant is used to prevent aspiration of gastric contents during rapid sequence intubation.", "3. Atracurium is administered during the procedure to maintain muscle relaxation.", "4. 1.5 hours after the operation, neostigmine is administered by the anesthesiologist.", "5. Neostigmine is administered to reverse the paralysis.", "6. The patient remains paralyzed and cannot be extubated."]}
{"id": 71, "question": "The most likely pathology underlying this patient's symptoms is derived from which of the following embryonic layers?", "context": ["A 12-year-old boy is brought to the emergency department by ambulance after he was struck by a car while crossing the road.", "He is found to have a femur fracture and multiple bruises on presentation, but he is alert and hemodynamically stable.", "He says that the car \"came out of nowhere\" and that he has had multiple similar near misses in recent months.", "He has no past medical history but says that he has been having headaches that he describes as dull and continuous.", "He has also noticed that he has been waking up at night several times to go to the restroom.", "Otherwise, he has been healthy with no major concerns.", "A basic metabolic panel shows mild hypernatremia."], "context_len": 7, "options": {"A": "Mesoderm", "B": "Neural crest", "C": "Neuroectoderm", "D": "Surface ectoderm"}, "answer": "Surface ectoderm", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "12 years old", "specialties": ["Neurology", "Pediatrics"], "subspecialties": ["Neurodevelopmental Disabilities", "Pediatric Emergency Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 12-year-old boy was brought to the emergency department by ambulance.", "2. He was struck by a car while crossing the road.", "3. He has a femur fracture and multiple bruises on presentation.", "4. He is alert and hemodynamically stable.", "5. He says the car \"came out of nowhere\" and he has had multiple similar near misses in recent months.", "6. He has no past medical history.", "7. He has been having headaches that he describes as dull and continuous.", "8. He has been waking up at night several times to go to the restroom.", "9. He has been healthy with no major concerns.", "10. A basic metabolic panel shows mild hypernatremia."], "atomic_facts": ["1. He is found to have a femur fracture on presentation.", "2. He is found to have multiple bruises on presentation.", "3. He is alert on presentation.", "4. He is hemodynamically stable on presentation.", "5. He says that the car \"came out of nowhere\".", "6. He has had multiple similar near misses in recent months.", "7. He has no past medical history.", "8. He has been having headaches.", "9. He describes the headaches as dull and continuous.", "10. He has been waking up at night several times to go to the restroom.", "11. He has been healthy with no major concerns.", "12. A basic metabolic panel shows mild hypernatremia."]}
{"id": 72, "question": "Which of the following is most likely to be the underlying cause for the fracture in this patient?", "context": ["A 40-year-old man presents with left hip pain.", "He says that symptoms started a month ago and have progressively worsened.", "He says the pain has rendered him unable to report to work for the last 2 weeks.", "The pain was initially 4/10 in intensity, dull with no radiation and was aggravated to 5/10 in intensity upon weight-bearing.", "Initially, it improved with rest and Tylenol.", "He initially attributed it to heavy work and took a few days off work, but he did not seek medical attention.", "However, it worsened over time to its present 8/10 intensity and does not respond to Tylenol anymore.", "The patient denies any history of injury, weight loss, change in appetite, or recent travel.", "His past medical history is significant for Crohn's disease, managed with a combination of prednisone and mesalamine and presently in remission.", "On physical examination, there is limited flexion and extension at the left hip.", "The rest of the examination, including a complete neurological examination, is unremarkable.", "On abdominal imaging of the left hip joint, a transcervical fracture is noted in the left hip with surrounding bony sclerosis.", "A DEXA scan shows a T-score of  -2.5 at the hips and -1.5 at the lumbar spine (normal T-score \u2265 -1.0)."], "context_len": 13, "options": {"A": "Trauma", "B": "Chronic steroid use", "C": "Metastatic lesion", "D": "Sciatica"}, "answer": "Chronic steroid use", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "40", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is a 40-year-old man.", "2. Patient presents with left hip pain.", "3. Symptoms started a month ago and have progressively worsened.", "4. Pain has rendered him unable to report to work for the last 2 weeks.", "5. Pain initially 4/10 in intensity, dull with no radiation.", "6. Pain aggravated to 5/10 in intensity upon weight-bearing.", "7. Initially improved with rest and Tylenol.", "8. Patient attributed it to heavy work and took a few days off work, but did not seek medical attention.", "9. Pain worsened over time to 8/10 intensity and does not respond to Tylenol anymore.", "10. Patient denies any history of injury, weight loss, change in appetite, or recent travel.", "11. Patient's past medical history is significant for Crohn's disease, managed with a combination of prednisone and mesalamine and presently in remission.", "12. On physical examination, there is limited flexion and extension at the left hip.", "13. Rest of the examination, including a complete neurological examination, is unremarkable.", "14. Abdominal imaging of the left hip joint shows a transcervical fracture with surrounding bony sclerosis.", "15. DEXA scan shows a T-score of -2.5 at the hips and -1.5 at the lumbar spine (normal T-score \u2265 -1.0)."], "atomic_facts": ["1. Symptoms started a month ago", "2. Symptoms have progressively worsened", "3. Pain has rendered him unable to report to work for the last 2 weeks", "4. Pain was initially 4/10 in intensity", "5. Pain was dull with no radiation", "6. Pain was aggravated to 5/10 in intensity upon weight-bearing", "7. Pain initially improved with rest and Tylenol", "8. Patient attributed pain to heavy work and took a few days off work", "9. Pain worsened over time to its present 8/10 intensity", "10. Pain does not respond to Tylenol anymore", "11. Patient denies history of injury, weight loss, change in appetite, or recent travel", "12. Past medical history is significant for Crohn's disease", "13. Crohn's disease is managed with a combination of prednisone and mesalamine", "14. Crohn's disease is presently in remission", "15. On physical examination, there is limited flexion and extension at the left hip", "16. Rest of the examination, including a complete neurological examination, is unremarkable", "17. Abdominal imaging of the left hip joint shows a transcervical fracture in the left hip with surrounding bony sclerosis", "18. DEXA scan shows a T-score of -2.5 at the hips and -1.5 at the lumbar spine"]}
{"id": 73, "question": "Where was the thoracentesis needle most likely placed?", "context": ["A 78-year-old woman with a history of breast cancer, status-post bilateral mastectomy, presents to the emergency department with progressive difficulty breathing, worsening fatigue, and 5 pounds of unintended weight loss over the past month.", "A portable chest x-ray reveals a massive right pleural effusion.", "The ED resident performs thoracentesis with chest tube placement and admits her to the floor.", "Overnight, the patient requests multiple pain medications for right upper abdominal pain and is found to have increasingly sanguinous drainage."], "context_len": 4, "options": {"A": "Lower border of the 10th rib at the right midaxillary line", "B": "Lower border of the 9th rib at the right midaxillary line", "C": "Upper border of the 7th rib at the right midclavicular line", "D": "Upper border of the 10th rib at the right midaxillary line"}, "answer": "Lower border of the 10th rib at the right midaxillary line", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "78", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Radiology"}, "facts_old": ["1. A 78-year-old woman presents to the emergency department.", "2. She has a history of breast cancer and a bilateral mastectomy.", "3. She has progressive difficulty breathing and worsening fatigue.", "4. She has lost 5 pounds in the past month.", "5. A portable chest x-ray reveals a massive right pleural effusion.", "6. The ED resident performs thoracentesis with chest tube placement.", "7. The patient is admitted to the floor.", "8. The patient requests multiple pain medications for right upper abdominal pain.", "9. The patient has increasingly sanguinous drainage."], "atomic_facts": ["1. A portable chest x-ray reveals a massive right pleural effusion.", "2. The ED resident performs thoracentesis with chest tube placement.", "3. The patient is admitted to the floor.", "4. Overnight, the patient requests multiple pain medications for right upper abdominal pain.", "5. The patient is found to have increasingly sanguinous drainage."]}
{"id": 74, "question": "Which of the following statements best describes the effects of molecule A on Vmax and Km on the metabolic reactions of the novel drug?", "context": ["While studying the metabolism of a novel drug, the researcher identifies a molecule that inhibits its metabolism by binding with enzyme E.", "Molecule A inhibits the enzyme E by reversibly binding at the same active site on the enzyme where the drug binds."], "context_len": 2, "options": {"A": "Value of Vmax is unchanged but value of Km is increased", "B": "Value of Vmax is decreased but value of Km is unchanged", "C": "Values of both Vmax and Km are unchanged", "D": "Value of Vmax is unchanged but value of Km is decreased"}, "answer": "Value of Vmax is unchanged but value of Km is increased", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine", "Clinical Biochemical Genetics"], "subspecialties": ["Clinical Pharmacology", "Clinical Pharmacology and Therapeutics", "Clinical Pharmacology and Toxicology", "General Medical Genetics and Genomics"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. The researcher is studying the metabolism of a novel drug.", "2. The researcher identifies a molecule, A.", "3. Molecule A inhibits enzyme E.", "4. Molecule A binds reversibly at the same active site on the enzyme where the drug binds."], "atomic_facts": ["1. Molecule A inhibits enzyme E", "2. Inhibition is achieved by reversibly binding", "3. Molecule A binds at the active site on enzyme E", "4. The active site is the same site where the drug binds"]}
{"id": 75, "question": "Inhibition of which of the following hormones would be most beneficial for this patient?", "context": ["A 70-year-old man presents to a physician\u2019s office with shortness of breath for 1 month.", "He is \u201ceasily winded\u201d and is unable to keep up with his grandchildren when playing in the park.", "Over the last few weeks, he had to increase the number of pillows under his head to sleep comfortably.", "He denies a cough and fever.", "The medical history includes hypercholesterolemia and hypertension.", "His current medications are aspirin, carvedilol, and rosuvastatin.", "The vital signs are as follows: blood pressure 150/90 mm Hg, pulse 90/min, and respiratory rate 14/min.", "The physical examination reveals distended jugular veins, bilateral pitting edema of the lower limbs, and fine crackles at the base of the lungs.", "An echocardiogram reveals an ejection fraction of 40%."], "context_len": 9, "options": {"A": "Angiotensin II", "B": "Prostaglandin E1", "C": "Aldosterone", "D": "Epinephrine"}, "answer": "Angiotensin II", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "70", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 70 years old.", "2. Patient has shortness of breath for 1 month.", "3. Patient is \"easily winded\" and cannot keep up with grandchildren when playing in the park.", "4. Patient has had to increase number of pillows under head to sleep comfortably.", "5. Patient denies cough and fever.", "6. Patient has medical history of hypercholesterolemia and hypertension.", "7. Patient is taking aspirin, carvedilol, and rosuvastatin.", "8. Blood pressure is 150/90 mm Hg.", "9. Pulse is 90/min.", "10. Respiratory rate is 14/min.", "11. Physical examination reveals distended jugular veins, bilateral pitting edema of lower limbs, and fine crackles at base of lungs.", "12. Echocardiogram reveals ejection fraction of 40%."], "atomic_facts": ["1. He is \u201ceasily winded\u201d and is unable to keep up with his grandchildren when playing in the park.", "2. Over the last few weeks, he had to increase the number of pillows under his head to sleep comfortably.", "3. He denies a cough and fever.", "4. The medical history includes hypercholesterolemia and hypertension.", "5. His current medications are aspirin, carvedilol, and rosuvastatin.", "6. The vital signs are as follows: blood pressure 150/90 mm Hg, pulse 90/min, and respiratory rate 14/min.", "7. The physical examination reveals distended jugular veins, bilateral pitting edema of the lower limbs, and fine crackles at the base of the lungs.", "8. An echocardiogram reveals an ejection fraction of 40%."]}
{"id": 76, "question": "WBC 20\u201325/hpf | Which of the following would have most likely prevented this complication?\"", "context": ["A 51-year-old man comes to the physician because of severe pain while urinating for 4 days.", "He has also had to urinate more often than usual.", "Three weeks ago, he underwent surgery for an incarcerated hernia.", "While recovering, he developed septic shock and was treated in the intensive care unit.", "He was discharged 6 days ago.", "He has a history of hypertension.", "Current medications include amlodipine and oxycodone.", "He appears anxious.", "His temperature is 37.8\u00b0C (100\u00b0F), pulse is 96/min, and blood pressure is 122/80 mm Hg.", "Examination shows tenderness to palpation in the suprapubic area; no guarding is present.", "There is a well-healed surgical scar in the right inguinal region.", "There is no costovertebral angle tenderness.", "Urinalysis shows: | Blood 1+ | Protein 1+ | Nitrite positive | Leukocyte esterase positive | RBC 1\u20132/hpf | ."], "context_len": 13, "options": {"A": "Intermittent catheterization", "B": "Prophylactic oral ciprofloxacin", "C": "Topical mupirocin application", "D": "Screening for bacteriuria"}, "answer": "Intermittent catheterization", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "51 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 51-year-old man comes to the physician because of severe pain while urinating for 4 days.", "2. He has also had to urinate more often than usual.", "3. Three weeks ago, he underwent surgery for an incarcerated hernia.", "4. While recovering, he developed septic shock and was treated in the intensive care unit.", "5. He was discharged 6 days ago.", "6. He has a history of hypertension.", "7. Current medications include amlodipine and oxycodone.", "8. He appears anxious.", "9. His temperature is 37.8\u00b0C (100\u00b0F).", "10. Pulse is 96/min.", "11. Blood pressure is 122/80 mm Hg.", "12. Examination shows tenderness to palpation in the suprapubic area; no guarding is present.", "13. There is a well-healed surgical scar in the right inguinal region.", "14. There is no costovertebral angle tenderness.", "15. Urinalysis shows: Blood 1+.", "16. Urinalysis shows: Protein 1+.", "17. Urinalysis shows: Nitrite positive.", "18. Urinalysis shows: Leukocyte esterase positive.", "19. Urinalysis shows: RBC 1\u20132/hpf."], "atomic_facts": ["1. He has had to urinate more often than usual.", "2. Three weeks ago, he underwent surgery for an incarcerated hernia.", "3. While recovering, he developed septic shock and was treated in the intensive care unit.", "4. He was discharged 6 days ago.", "5. He has a history of hypertension.", "6. Current medications include amlodipine and oxycodone.", "7. He appears anxious.", "8. His temperature is 37.8\u00b0C (100\u00b0F), pulse is 96/min, and blood pressure is 122/80 mm Hg.", "9. Examination shows tenderness to palpation in the suprapubic area; no guarding is present.", "10. There is a well-healed surgical scar in the right inguinal region.", "11. There is no costovertebral angle tenderness.", "12. Urinalysis shows: | Blood 1+ | Protein 1+ | Nitrite positive | Leukocyte esterase positive | RBC 1\u20132/hpf |"]}
{"id": 77, "question": "Which of the following is the most appropriate pharmacotherapy for this patient's neurological symptoms?", "context": ["A 40-year-old woman with HIV infection comes to the emergency department because of a 4-week history of progressively worsening fatigue and headache.", "On mental status examination, the patient is somnolent and oriented only to person.", "Her CD4+ lymphocyte count is 80/mm3 (N \u2265 500).", "Analysis of this patient's cerebrospinal fluid (CSF) shows a leukocyte count of 30/mm3 (60% lymphocytes), a protein concentration of 52 mg/dL, and a glucose concentration of 37 mg/dL.", "An India ink stain of the CSF is shown."], "context_len": 5, "options": {"A": "Pyrimethamine, sulfadiazine, and folinic acid", "B": "Isoniazid, rifampin, pyrazinamide, and ethambutol", "C": "Amphotericin B and flucytosine", "D": "Fluconazole"}, "answer": "Amphotericin B and flucytosine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "40", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 40-year-old woman with HIV infection comes to the emergency department.", "2. She has a 4-week history of progressively worsening fatigue and headache.", "3. On mental status examination, the patient is somnolent and oriented only to person.", "4. Her CD4+ lymphocyte count is 80/mm3 (N \u2265 500).", "5. Analysis of this patient's cerebrospinal fluid (CSF) shows a leukocyte count of 30/mm3 (60% lymphocytes).", "6. Analysis of this patient's cerebrospinal fluid (CSF) shows a protein concentration of 52 mg/dL.", "7. Analysis of this patient's cerebrospinal fluid (CSF) shows a glucose concentration of 37 mg/dL.", "8. An India ink stain of the CSF is shown."], "atomic_facts": ["1. On mental status examination, the patient is somnolent.", "2. On mental status examination, the patient is oriented only to person.", "3. Her CD4+ lymphocyte count is 80/mm3 (N \u2265 500).", "4. Analysis of this patient's cerebrospinal fluid (CSF) shows a leukocyte count of 30/mm3.", "5. Analysis of this patient's cerebrospinal fluid (CSF) shows 60% lymphocytes.", "6. Analysis of this patient's cerebrospinal fluid (CSF) shows a protein concentration of 52 mg/dL.", "7. Analysis of this patient's cerebrospinal fluid (CSF) shows a glucose concentration of 37 mg/dL.", "8. An India ink stain of the CSF is shown."]}
{"id": 78, "question": "Which of the following is the most likely cause of these findings?\"", "context": ["A 64-year-old man comes to the physician because of a 2-week history of intermittent epigastric discomfort.", "He reports that his urine has been very dark, and his stools have been pale for the past week.", "His appetite has decreased, and he has had a 4.5-kg (10-lb) weight loss during this period.", "He has smoked 1 pack of cigarettes daily for 30 years.", "He drinks a few shots of vodka daily.", "He has no history of severe illness.", "He has chronic left knee pain, for which he takes acetaminophen.", "Vital signs are within normal limits.", "Examination shows jaundice of the skin and scleral icterus.", "There are scratch marks on the extremities.", "Abdominal examination shows a nontender, palpable mass in the right upper quadrant.", "The remainder of the examination is normal.", "Laboratory studies show: | Hemoglobin 11.6 g/dL | Leukocyte count 8,700/mm3 | Platelet count 172,000/mm3 | Serum | Urea nitrogen 17 mg/dL | Creatinine 1.1 mg/dL | Bilirubin | Total 6 mg/dL | Direct 5.2 mg/dL | Alkaline phosphatase 220 IU/L | Ultrasonography shows dilated extrahepatic and pancreatic ducts and a distended gall bladder."], "context_len": 13, "options": {"A": "Malignant biliary tract obstruction", "B": "Acetaminophen-induced liver injury", "C": "Hemolysis", "D": "Chronic pancreatitis"}, "answer": "Malignant biliary tract obstruction", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "64 years old", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 64-year-old man comes to the physician because of a 2-week history of intermittent epigastric discomfort.", "2. He reports that his urine has been very dark, and his stools have been pale for the past week.", "3. His appetite has decreased, and he has had a 4.5-kg (10-lb) weight loss during this period.", "4. He has smoked 1 pack of cigarettes daily for 30 years.", "5. He drinks a few shots of vodka daily.", "6. He has no history of severe illness.", "7. He has chronic left knee pain, for which he takes acetaminophen.", "8. Vital signs are within normal limits.", "9. Examination shows jaundice of the skin and scleral icterus.", "10. There are scratch marks on the extremities.", "11. Abdominal examination shows a nontender, palpable mass in the right upper quadrant.", "12. The remainder of the examination is normal.", "13. Laboratory studies show: Hemoglobin 11.6 g/dL", "14. Laboratory studies show: Leukocyte count 8,700/mm3", "15. Laboratory studies show: Platelet count 172,000/mm3", "16. Laboratory studies show: Serum Urea nitrogen 17 mg/dL", "17. Laboratory studies show: Creatinine 1.1 mg/dL", "18. Laboratory studies show: Bilirubin Total 6 mg/dL", "19. Laboratory studies show: Direct 5.2 mg/dL", "20. Laboratory studies show: Alkaline phosphatase 220 IU/L", "21. Ultrasonography shows dilated extrahepatic and pancreatic ducts and a distended gall bladder."], "atomic_facts": ["1. Patient reports dark urine and pale stools for the past week.", "2. Patient has experienced decreased appetite and 4.5-kg weight loss in the same period.", "3. Patient has smoked 1 pack of cigarettes daily for 30 years.", "4. Patient drinks a few shots of vodka daily.", "5. Patient has no history of severe illness.", "6. Patient has chronic left knee pain and takes acetaminophen for it.", "7. Vital signs are within normal limits.", "8. Examination shows jaundice of the skin and scleral icterus.", "9. Scratch marks are present on the extremities.", "10. Abdominal examination shows a nontender, palpable mass in the right upper quadrant.", "11. The remainder of the examination is normal.", "12. Laboratory studies show: Hemoglobin 11.6 g/dL, Leukocyte count 8,700/mm3, Platelet count 172,000/mm3, Serum Urea nitrogen 17 mg/dL, Creatinine 1.1 mg/dL, Bilirubin Total 6 mg/dL, Direct 5.2 mg/dL, Alkaline phosphatase 220 IU/L.", "13. Ultrasonography shows dilated extrahepatic and pancreatic ducts and a distended gall bladder."]}
{"id": 79, "question": "Which of the following is the most appropriate treatment for this patient?", "context": ["A 27-year-old woman is brought to the physician after passing out at home.", "Her husband reports that she suddenly lost consciousness for approximately 30 seconds while shoveling snow in the driveway.", "Immediately before the episode, she felt light-headed and short of breath.", "Two months ago, she experienced a similar episode while running in her yard with her children.", "She has no history of serious illness.", "Her father died of sudden cardiac death at the age of 44 years.", "Vital signs are within normal limits.", "Cardiac examination shows a systolic ejection murmur best heard along the left sternal border that decreases with hand grip.", "The remainder of the examination shows no abnormalities."], "context_len": 9, "options": {"A": "Septal myectomy", "B": "Amlodipine", "C": "Cardiac pacemaker", "D": "Metoprolol"}, "answer": "Metoprolol", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["General Cardiology", "Cardiology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 27-year-old woman is brought to the physician.", "2. Her husband reports that she suddenly lost consciousness for approximately 30 seconds while shoveling snow in the driveway.", "3. Immediately before the episode, she felt light-headed and short of breath.", "4. Two months ago, she experienced a similar episode while running in her yard with her children.", "5. She has no history of serious illness.", "6. Her father died of sudden cardiac death at the age of 44 years.", "7. Vital signs are within normal limits.", "8. Cardiac examination shows a systolic ejection murmur best heard along the left sternal border that decreases with hand grip.", "9. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. Her husband reports that she suddenly lost consciousness for approximately 30 seconds while shoveling snow in the driveway.", "2. Immediately before the episode, she felt light-headed and short of breath.", "3. Two months ago, she experienced a similar episode while running in her yard with her children.", "4. She has no history of serious illness.", "5. Her father died of sudden cardiac death at the age of 44 years.", "6. Vital signs are within normal limits.", "7. Cardiac examination shows a systolic ejection murmur best heard along the left sternal border that decreases with hand grip.", "8. The remainder of the examination shows no abnormalities."]}
{"id": 80, "question": "The patient most likely has a deficiency of which of the following enzymes?", "context": ["A 7-month-old male infant is brought to the physician because of a 2-month history of fatigue and weakness.", "His mother reports that he has difficulty feeding.", "He is at the 20th percentile for height and 3rd percentile for weight.", "Physical examination shows an enlarged tongue.", "Crackles are heard at both lung bases.", "The liver is palpated 1 cm below the right costal margin.", "Neurologic examination shows decreased muscle tone in the extremities.", "Serum glucose is 105 mg/dL.", "An x-ray of the chest shows cardiomegaly."], "context_len": 9, "options": {"A": "Acid maltase", "B": "Iduronate sulfatase", "C": "Glucose-6-phosphatase", "D": "Alpha-galactosidase"}, "answer": "Acid maltase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "7 months", "specialties": ["Pediatrics", "Medical Genetics and Genomics"], "subspecialties": ["General Pediatrics", "Clinical Biochemical Genetics"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 7-month-old male infant is brought to the physician.", "2. The infant has a 2-month history of fatigue and weakness.", "3. His mother reports that he has difficulty feeding.", "4. He is at the 20th percentile for height.", "5. He is at the 3rd percentile for weight.", "6. Physical examination shows an enlarged tongue.", "7. Crackles are heard at both lung bases.", "8. The liver is palpated 1 cm below the right costal margin.", "9. Neurologic examination shows decreased muscle tone in the extremities.", "10. Serum glucose is 105 mg/dL.", "11. An x-ray of the chest shows cardiomegaly."], "atomic_facts": ["1. His mother reports that he has difficulty feeding.", "2. He is at the 20th percentile for height.", "3. He is at the 3rd percentile for weight.", "4. Physical examination shows an enlarged tongue.", "5. Crackles are heard at both lung bases.", "6. The liver is palpated 1 cm below the right costal margin.", "7. Neurologic examination shows decreased muscle tone in the extremities.", "8. Serum glucose is 105 mg/dL.", "9. An x-ray of the chest shows cardiomegaly."]}
{"id": 81, "question": "What is the standard deviation for the systolic blood pressure readings?", "context": ["A 43-year-old man presents to a medical office for follow-up of hypertension.", "He was recently diagnosed and has been managing his condition with diet modification and moderate-intensity exercise.", "Today, he brings a list of his recent at-home morning blood pressure readings.", "The systolic blood pressure readings over the last 5 days are as follows: | Day 1: 130 mm Hg | Day 2: 132 mm Hg | Day 3: 128 mm Hg | Day 4: 132 mm Hg | Day 5: 128 mm Hg | ."], "context_len": 4, "options": {"A": "1 mm Hg", "B": "1.5 mm Hg", "C": "2 mm Hg", "D": "2.5 mm Hg"}, "answer": "2 mm Hg", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "43", "specialties": ["Internal Medicine", "Family Medicine"], "subspecialties": ["General Internal Medicine", "General Family Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 43-year-old man presents to a medical office for follow-up of hypertension.", "2. He was recently diagnosed and has been managing his condition with diet modification and moderate-intensity exercise.", "3. Today, he brings a list of his recent at-home morning blood pressure readings.", "4. The systolic blood pressure reading on Day 1 was 130 mm Hg.", "5. The systolic blood pressure reading on Day 2 was 132 mm Hg.", "6. The systolic blood pressure reading on Day 3 was 128 mm Hg.", "7. The systolic blood pressure reading on Day 4 was 132 mm Hg.", "8. The systolic blood pressure reading on Day 5 was 128 mm Hg."], "atomic_facts": ["1. The patient was recently diagnosed with a medical condition.", "2. The patient has been managing his condition with diet modification.", "3. The patient has been managing his condition with moderate-intensity exercise.", "4. The patient brings a list of his recent at-home morning blood pressure readings.", "5. The systolic blood pressure reading on Day 1 was 130 mm Hg.", "6. The systolic blood pressure reading on Day 2 was 132 mm Hg.", "7. The systolic blood pressure reading on Day 3 was 128 mm Hg.", "8. The systolic blood pressure reading on Day 4 was 132 mm Hg.", "9. The systolic blood pressure reading on Day 5 was 128 mm Hg."]}
{"id": 82, "question": "Based on this electrophoresis, which of the following types of hemoglobin are dominant in this patient's blood?", "context": ["An 11-year-old boy is brought to the physician by his mother because of worsening fatigue.", "His mother reports that he seems to have trouble keeping up with his older brothers when playing outside.", "Physical examination shows conjunctival pallor.", "A hemoglobin electrophoresis is performed.", "This patient's results are shown in comparison to those of a patient with known sickle cell anemia and a child with normal hemoglobin."], "context_len": 5, "options": {"A": "HbA and HbC", "B": "HbS only", "C": "HbA only", "D": "HbS and HbC"}, "answer": "HbS and HbC", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "11 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology", "Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 11-year-old boy is brought to the physician by his mother.", "2. The mother reports that the boy has worsening fatigue.", "3. The boy has trouble keeping up with his older brothers when playing outside.", "4. Physical examination shows conjunctival pallor.", "5. A hemoglobin electrophoresis is performed.", "6. The patient's results are compared to those of a patient with known sickle cell anemia.", "7. The patient's results are compared to those of a child with normal hemoglobin."], "atomic_facts": ["1. His mother reports that he seems to have trouble keeping up with his older brothers when playing outside.", "2. Physical examination shows conjunctival pallor.", "3. A hemoglobin electrophoresis is performed.", "4. This patient's results are shown in comparison to those of a patient with known sickle cell anemia and a child with normal hemoglobin."]}
{"id": 83, "question": "Which of the following is the most likely diagnosis?", "context": ["A 55-year-old African American man presents to the emergency department with central chest pressure.", "His symptoms started 1 day before.", "The pain was initially intermittent in nature but has become constant and radiates to his jaw and left shoulder.", "He also complains of some difficulty breathing.", "The patient was diagnosed with essential hypertension 1 year ago, but he is not taking any medications for it.", "The patient denies smoking, alcohol, or drug use.", "Family history is unremarkable.", "His blood pressure is 230/130 mm Hg in both arms, the temperature is 36.9\u00b0C (98.4\u00b0F), and the pulse is 90/min.", "ECG shows diffuse T wave inversion and ST depression in lateral leads.", "Laboratory testing is significant for elevated troponin."], "context_len": 10, "options": {"A": "Hypertensive urgency", "B": "Hypertensive emergency", "C": "Aortic aneurysm", "D": "Malignant hypertension"}, "answer": "Hypertensive emergency", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Internal Medicine", "Emergency Medicine"], "subspecialties": ["Cardiovascular Disease", "General Emergency Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old African American man presents to the emergency department with central chest pressure.", "2. His symptoms started 1 day before.", "3. The pain was initially intermittent in nature but has become constant and radiates to his jaw and left shoulder.", "4. He also complains of some difficulty breathing.", "5. The patient was diagnosed with essential hypertension 1 year ago, but he is not taking any medications for it.", "6. The patient denies smoking, alcohol, or drug use.", "7. Family history is unremarkable.", "8. His blood pressure is 230/130 mm Hg in both arms.", "9. The temperature is 36.9\u00b0C (98.4\u00b0F).", "10. The pulse is 90/min.", "11. ECG shows diffuse T wave inversion and ST depression in lateral leads.", "12. Laboratory testing is significant for elevated troponin."], "atomic_facts": ["1. Symptoms started 1 day before", "2. Pain was initially intermittent, now constant and radiates to jaw and left shoulder", "3. Difficulty breathing reported", "4. Diagnosed with essential hypertension 1 year ago", "5. Not taking any medications for hypertension", "6. Denies smoking, alcohol, or drug use", "7. Unremarkable family history", "8. Blood pressure is 230/130 mm Hg in both arms", "9. Temperature is 36.9\u00b0C (98.4\u00b0F)", "10. Pulse is 90/min", "11. ECG shows diffuse T wave inversion and ST depression in lateral leads", "12. Laboratory testing significant for elevated troponin"]}
{"id": 84, "question": "Further evaluation of this patient is most likely to show which of the following findings?", "context": ["A 38-year-old woman comes to the physician for the evaluation of progressive weakness and numbness for 3 months.", "The symptoms started in her lower legs and gradually moved to her upper legs and arms.", "During the last 5 days, she has also had bilateral facial weakness with headaches.", "She has hepatitis B and Graves' disease.", "She is sexually active with one male partner and they use condoms inconsistently.", "Her current medications include methimazole and a multivitamin.", "Vital signs are within normal limits.", "She is alert and fully oriented.", "She has bilateral upper and lower facial paralysis.", "There is generalized weakness of the muscles.", "Sensation to light touch is decreased throughout and is absent in her fingertips and toes.", "Deep tendon reflexes are 1+ bilaterally."], "context_len": 12, "options": {"A": "Positive GM1 ganglioside autoantibodies", "B": "Positive Lyme ELISA test", "C": "Low vitamin B12 level", "D": "Elevated TSH and decreased FT4 levels"}, "answer": "Positive GM1 ganglioside autoantibodies", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "38 years old", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 38-year-old woman comes to the physician for the evaluation of progressive weakness and numbness for 3 months.", "2. The symptoms started in her lower legs and gradually moved to her upper legs and arms.", "3. During the last 5 days, she has also had bilateral facial weakness with headaches.", "4. She has hepatitis B and Graves' disease.", "5. She is sexually active with one male partner and they use condoms inconsistently.", "6. Her current medications include methimazole and a multivitamin.", "7. Vital signs are within normal limits.", "8. She is alert and fully oriented.", "9. She has bilateral upper and lower facial paralysis.", "10. There is generalized weakness of the muscles.", "11. Sensation to light touch is decreased throughout and is absent in her fingertips and toes.", "12. Deep tendon reflexes are 1+ bilaterally."], "atomic_facts": ["1. The symptoms started in her lower legs and gradually moved to her upper legs and arms.", "2. During the last 5 days, she has also had bilateral facial weakness with headaches.", "3. She has hepatitis B and Graves' disease.", "4. She is sexually active with one male partner and they use condoms inconsistently.", "5. Her current medications include methimazole and a multivitamin.", "6. Vital signs are within normal limits.", "7. She is alert and fully oriented.", "8. She has bilateral upper and lower facial paralysis.", "9. There is generalized weakness of the muscles.", "10. Sensation to light touch is decreased throughout and is absent in her fingertips and toes.", "11. Deep tendon reflexes are 1+ bilaterally."]}
{"id": 85, "question": "Infection with which of the following organisms would portend the worst prognosis with the highest mortality rate for this patient?", "context": ["A 32-year-old G2P1 at 32 weeks gestation presents to the emergency department with complaints of severe abdominal pain, fatigue, and nausea.", "Physical examination is significant for profound jaundice and tenderness to palpation of the right upper quadrant of the abdomen.", "The patient returned 2 weeks ago from a 1 month-long trip to India.", "She received sporadic pre-natal care while traveling and reports no known complications in her current pregnancy to date.", "She denies any past medical problems and states that her prior pregnancy proceeded as a normal vaginal birth without any complications."], "context_len": 5, "options": {"A": "Hepatitis A", "B": "Hepatitis B", "C": "Hepatitis D", "D": "Hepatitis E"}, "answer": "Hepatitis E", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "32 years old", "specialties": ["Internal Medicine", "Obstetrics and Gynecology"], "subspecialties": ["Infectious Disease", "Gastroenterology", "Maternal"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is 32 years old.", "2. Patient is G2P1.", "3. Patient is 32 weeks gestation.", "4. Patient presents to emergency department with severe abdominal pain, fatigue, and nausea.", "5. Physical examination is significant for profound jaundice.", "6. Physical examination is significant for tenderness to palpation of right upper quadrant of abdomen.", "7. Patient returned 2 weeks ago from 1 month-long trip to India.", "8. Patient received sporadic pre-natal care while traveling.", "9. Patient reports no known complications in current pregnancy to date.", "10. Patient denies any past medical problems.", "11. Patient states prior pregnancy proceeded as normal vaginal birth without any complications."], "atomic_facts": ["1. Physical examination shows profound jaundice.", "2. Physical examination shows tenderness to palpation of the right upper quadrant of the abdomen.", "3. The patient returned from a 1 month-long trip to India 2 weeks ago.", "4. The patient received sporadic pre-natal care while traveling.", "5. The patient reports no known complications in her current pregnancy.", "6. The patient denies any past medical problems.", "7. The patient's prior pregnancy proceeded as a normal vaginal birth without complications."]}
{"id": 86, "question": "Pathologic examination of the biopsy specimen is most likely to show which of the following?", "context": ["A 42-year-old woman comes to the physician because of an episode of coughing with bloody sputum.", "Over the past 5 months, she has had a persistent nonproductive cough, excessive fatigue, and a 5.6-kg (12.3-lb) weight loss.", "She does not smoke.", "Physical examination shows no abnormalities.", "An x-ray of the chest shows a 2.0-cm nodule with irregular borders at the upper lobe of the left lung.", "A CT-guided biopsy of the lung nodule is performed."], "context_len": 6, "options": {"A": "Small cell lung carcinoma", "B": "Large cell lung carcinoma", "C": "Bronchial carcinoid tumor", "D": "Adenocarcinoma"}, "answer": "Adenocarcinoma", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Pathology", "Pulmonary Disease"], "subspecialties": ["Pulmonary Pathology", "Hematopathology", "General Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 42-year-old woman comes to the physician.", "2. She has had a persistent nonproductive cough for the past 5 months.", "3. She has had excessive fatigue for the past 5 months.", "4. She has had a 5.6-kg (12.3-lb) weight loss for the past 5 months.", "5. She does not smoke.", "6. Physical examination shows no abnormalities.", "7. An x-ray of the chest shows a 2.0-cm nodule with irregular borders at the upper lobe of the left lung.", "8. She had an episode of coughing with bloody sputum.", "9. A CT-guided biopsy of the lung nodule is performed."], "atomic_facts": ["1. Over the past 5 months, she has had a persistent nonproductive cough.", "2. Over the past 5 months, she has had excessive fatigue.", "3. Over the past 5 months, she has had a 5.6-kg (12.3-lb) weight loss.", "4. She does not smoke.", "5. Physical examination shows no abnormalities.", "6. An x-ray of the chest shows a 2.0-cm nodule with irregular borders at the upper lobe of the left lung.", "7. A CT-guided biopsy of the lung nodule is performed."]}
{"id": 87, "question": "Which of the following statements is correct regarding this study result?", "context": ["A group of researchers is conducting a prospective study to examine if dietary fiber intake is protective against coronary heart disease.", "Specifically, they are looking at the frequency of coronary heart incidents in a group of middle-aged men taking various daily amounts of water-insoluble fiber.", "The Pearson correlation coefficient that was obtained regarding the relationship between the amount of daily water-insoluble fiber intake and the frequency of coronary heart incidents in their study was 0.11 with a p-value of 0.006."], "context_len": 3, "options": {"A": "There is a significant correlation between the daily fiber intake and the frequency of coronary heart incidents because the correlation coefficient is significant.", "B": "There is a significant correlation between fiber intake and the frequency of coronary heart incidents because the correlation coefficient is not significant.", "C": "There is a significant correlation between fiber intake and the frequency of coronary heart incidents because the value of the correlation coefficient shows a very good and robust correlation.", "D": "There is no correlation between fiber intake and the frequency of coronary heart incidents because the correlation coefficient is significant."}, "answer": "There is no correlation between fiber intake and the frequency of coronary heart incidents because the correlation coefficient is significant.", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Preventive Medicine"}, "facts_old": ["1. A group of researchers is conducting a prospective study.", "2. The study is examining if dietary fiber intake is protective against coronary heart disease.", "3. The study is looking at the frequency of coronary heart incidents in a group of middle-aged men.", "4. The men are taking various daily amounts of water-insoluble fiber.", "5. The Pearson correlation coefficient obtained regarding the relationship between the amount of daily water-insoluble fiber intake and the frequency of coronary heart incidents was 0.11.", "6. The p-value of the Pearson correlation coefficient was 0.006."], "atomic_facts": ["1. Researchers are studying the frequency of coronary heart incidents in middle-aged men.", "2. The study involves middle-aged men taking various daily amounts of water-insoluble fiber.", "3. The Pearson correlation coefficient obtained for the relationship between daily water-insoluble fiber intake and coronary heart incidents was 0.11.", "4. The p-value for the correlation coefficient was 0.006."]}
{"id": 88, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 24-year-old man comes to the physician because of a painful swelling above his buttocks for 1 week.", "He is unable to sit for extended periods because of the pain.", "He has obstructive sleep apnea and type 2 diabetes mellitus.", "His only medication is metformin.", "He appears anxious.", "He is 175 cm (5 ft 9 in) tall and weighs 114 kg (251 lb); BMI is 37 kg/m2.", "His temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 96/min and blood pressure is 124/86 mm Hg.", "Examination shows facial acne.", "A cyst is seen above the natal cleft.", "There is tenderness to palpation at the cyst and surrounding tissue.", "The skin around the cyst is warm and erythematous."], "context_len": 11, "options": {"A": "Coccygectomy", "B": "Incision and drainage", "C": "Retinoid therapy", "D": "Surgical resection and primary wound closure"}, "answer": "Incision and drainage", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "24 years old", "specialties": ["General Surgery", "Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. Patient is 24 years old.", "2. Patient has a painful swelling above his buttocks for 1 week.", "3. Patient is unable to sit for extended periods because of the pain.", "4. Patient has obstructive sleep apnea and type 2 diabetes mellitus.", "5. Patient's only medication is metformin.", "6. Patient appears anxious.", "7. Patient is 175 cm (5 ft 9 in) tall.", "8. Patient weighs 114 kg (251 lb).", "9. Patient's BMI is 37 kg/m2.", "10. Patient's temperature is 38.1\u00b0C (100.6\u00b0F).", "11. Patient's pulse is 96/min.", "12. Patient's blood pressure is 124/86 mm Hg.", "13. Patient has facial acne.", "14. Patient has a cyst above the natal cleft.", "15. Patient has tenderness to palpation at the cyst and surrounding tissue.", "16. Skin around the cyst is warm and erythematous."], "atomic_facts": ["1. He is unable to sit for extended periods because of the pain.", "2. He has obstructive sleep apnea.", "3. He has type 2 diabetes mellitus.", "4. His only medication is metformin.", "5. He appears anxious.", "6. He is 175 cm (5 ft 9 in) tall.", "7. He weighs 114 kg (251 lb).", "8. His BMI is 37 kg/m2.", "9. His temperature is 38.1\u00b0C (100.6\u00b0F).", "10. His pulse is 96/min.", "11. His blood pressure is 124/86 mm Hg.", "12. Examination shows facial acne.", "13. A cyst is seen above the natal cleft.", "14. There is tenderness to palpation at the cyst and surrounding tissue.", "15. The skin around the cyst is warm and erythematous."]}
{"id": 89, "question": "Which of the following is the most appropriate initial treatment?", "context": ["A 17-year-old girl comes to the physician because of a 3-year history of acne on her face and chest.", "She has no itching or scaling.", "She is concerned about the possibility of facial scarring and has never sought treatment.", "She has no history of serious illness.", "She takes no medications.", "She is 160 cm (5 ft 3 in) tall and weighs 58 kg (130 lb); BMI is 23 kg/m2.", "Her vital signs are within normal limits.", "Examination shows several open comedones on the face and chest."], "context_len": 8, "options": {"A": "Oral antibiotics", "B": "Topical benzoyl peroxide", "C": "Topical antibiotic", "D": "Oral isotretinoin"}, "answer": "Topical benzoyl peroxide", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "17 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 17-year-old girl comes to the physician.", "2. She has a 3-year history of acne on her face and chest.", "3. She has no itching or scaling.", "4. She is concerned about the possibility of facial scarring.", "5. She has never sought treatment.", "6. She has no history of serious illness.", "7. She takes no medications.", "8. She is 160 cm (5 ft 3 in) tall.", "9. She weighs 58 kg (130 lb).", "10. Her BMI is 23 kg/m2.", "11. Her vital signs are within normal limits.", "12. Examination shows several open comedones on the face and chest."], "atomic_facts": ["1. She has no itching or scaling.", "2. She is concerned about the possibility of facial scarring and has never sought treatment.", "3. She has no history of serious illness.", "4. She takes no medications.", "5. She is 160 cm (5 ft 3 in) tall and weighs 58 kg (130 lb); BMI is 23 kg/m2.", "6. Her vital signs are within normal limits.", "7. Examination shows several open comedones on the face and chest."]}
{"id": 90, "question": "Which of the following drugs most likely has a similar mechanism of action as the drug prescribed to this patient?", "context": ["A 12-year-old boy is brought to the emergency department by his mother because he has been having difficulty breathing.", "He started having symptoms about 3 days ago when he started experiencing persistent coughing, runny nose, and a low grade fever.", "Since then he has been experiencing dyspnea that grew worse until he felt that he could no longer breathe.", "His mom says that this has happened many times before.", "On presentation, physical exam reveals an anxious, thin boy who is using his accessory muscles to breathe.", "Prolonged expiratory wheezes are heard on auscultation of his lungs bilaterally.", "During stabilization, he is prescribed a drug for treatment of his condition.", "The patient's mother recognizes the drug since her father, a 40-pack-year smoker, also takes the medication and she is told that the drug is able to beneficially inhibit a receptor on smooth muscle in both cases."], "context_len": 8, "options": {"A": "Cortisol", "B": "Glycopyrrolate", "C": "Theophylline", "D": "Zileuton"}, "answer": "Glycopyrrolate", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "12 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 12-year-old boy.", "2. Patient was brought to the emergency department by his mother.", "3. Patient has been having difficulty breathing.", "4. Patient started having symptoms 3 days ago.", "5. Symptoms included persistent coughing, runny nose, and a low grade fever.", "6. Patient has been experiencing dyspnea that grew worse until he felt he could no longer breathe.", "7. Patient's mother says this has happened many times before.", "8. On presentation, physical exam reveals an anxious, thin boy who is using his accessory muscles to breathe.", "9. Prolonged expiratory wheezes are heard on auscultation of his lungs bilaterally.", "10. During stabilization, patient is prescribed a drug for treatment of his condition.", "11. Patient's mother recognizes the drug since her father, a 40-pack-year smoker, also takes the medication.", "12. Drug is able to beneficially inhibit a receptor on smooth muscle in both cases."], "atomic_facts": ["1. He started having symptoms about 3 days ago", "2. Symptoms include persistent coughing, runny nose, and a low grade fever", "3. He has been experiencing dyspnea that grew worse", "4. His mom says this has happened many times before", "5. On presentation, physical exam reveals an anxious, thin boy", "6. He is using his accessory muscles to breathe", "7. Prolonged expiratory wheezes are heard on auscultation of his lungs bilaterally", "8. He is prescribed a drug for treatment of his condition", "9. The patient's mother recognizes the drug", "10. The drug is able to beneficially inhibit a receptor on smooth muscle"]}
{"id": 91, "question": "Which of the following medications would you prescribe for this patient?", "context": ["A 35-year-old taxi driver presents to his physician with complaints of itchy, watery eyes and excessive sneezing that have become more severe with the change of the seasons.", "He has previously taken an over-the-counter medication in the past with moderate relief of his symptoms, but it made him very drowsy.", "He asks to switch to a medication that will not cause drowsiness that may impair his driving."], "context_len": 3, "options": {"A": "Cetirizine", "B": "Chlorpheniramine", "C": "Diphenhydramine", "D": "Hydroxyzine"}, "answer": "Cetirizine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "35", "specialties": ["Allergy and Immunology"], "subspecialties": ["General Allergy and Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A 35-year-old taxi driver presents to his physician.", "2. He has itchy, watery eyes and excessive sneezing.", "3. His symptoms become more severe with the change of the seasons.", "4. He has previously taken an over-the-counter medication with moderate relief of his symptoms.", "5. The over-the-counter medication made him very drowsy.", "6. He asks to switch to a medication that will not cause drowsiness.", "7. The medication should not impair his driving."], "atomic_facts": ["1. He has previously taken an over-the-counter medication.", "2. The over-the-counter medication provided moderate relief of his symptoms.", "3. The over-the-counter medication made him very drowsy.", "4. He asks to switch to a medication that will not cause drowsiness.", "5. Drowsiness may impair his driving."]}
{"id": 92, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 19-year-old female college student comes to the physician for a sudden loss of visual acuity of her right eye.", "She noticed that she was unable to read the time on the alarm clock when she woke up in the morning.", "When she closes her right eye, she is able to see sharply.", "When she closes her left eye, she has blurry double vision.", "She does not recall trauma to her eye but has been working long nights on her honors thesis.", "She has a history of occasional shoulder luxation.", "She is 180 cm (5 ft 11 in) tall, and weighs 62 kg (136 lbs); her BMI is 19.1 kg/m2.", "Her vital signs are within normal limits.", "On physical examination, slender and long fingers are noted.", "She has several flat, demarcated brownish nevi on her left cheek.", "Ocular examination shows upward temporal subluxation of her right lens."], "context_len": 11, "options": {"A": "Joint hypermobility syndrome", "B": "Sturge-Weber syndrome", "C": "Ehlers-Danlos syndrome", "D": "Marfan syndrome"}, "answer": "Marfan syndrome", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "19", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. Patient is a 19-year-old female college student.", "2. Patient has sudden loss of visual acuity of her right eye.", "3. Patient was unable to read the time on the alarm clock when she woke up in the morning.", "4. When she closes her right eye, she is able to see sharply.", "5. When she closes her left eye, she has blurry double vision.", "6. Patient does not recall trauma to her eye.", "7. Patient has been working long nights on her honors thesis.", "8. Patient has a history of occasional shoulder luxation.", "9. Patient is 180 cm (5 ft 11 in) tall.", "10. Patient weighs 62 kg (136 lbs).", "11. Patient's BMI is 19.1 kg/m2.", "12. Patient's vital signs are within normal limits.", "13. On physical examination, slender and long fingers are noted.", "14. Patient has several flat, demarcated brownish nevi on her left cheek.", "15. Ocular examination shows upward temporal subluxation of her right lens."], "atomic_facts": ["1. She noticed that she was unable to read the time on the alarm clock when she woke up in the morning.", "2. When she closes her right eye, she is able to see sharply.", "3. When she closes her left eye, she has blurry double vision.", "4. She does not recall trauma to her eye but has been working long nights on her honors thesis.", "5. She has a history of occasional shoulder luxation.", "6. She is 180 cm (5 ft 11 in) tall, and weighs 62 kg (136 lbs); her BMI is 19.1 kg/m2.", "7. Her vital signs are within normal limits.", "8. On physical examination, slender and long fingers are noted.", "9. She has several flat, demarcated brownish nevi on her left cheek.", "10. Ocular examination shows upward temporal subluxation of her right lens."]}
{"id": 93, "question": "Which of the following serum markers is most likely elevated in this patient?", "context": ["A 62-year-old man presents to his primary care provider complaining of abdominal pain.", "He reports a 6-month history of gradually progressive epigastric pain and 10 pounds of unexpected weight loss.", "He has also noticed that his skin feels itchier than usual.", "His past medical history is notable for gout, hypertension, and diabetes mellitus.", "He takes allopurinol, enalapril, and glyburide.", "He has a 10-pack-year smoking history and a distant history of cocaine abuse.", "His temperature is 100.1\u00b0F (37.8\u00b0C), blood pressure is 135/85 mmHg, pulse is 100/min, and respirations are 20/min.", "On exam, he has notable hepatomegaly and a palpable gallbladder.", "A right upper quadrant ultrasound reveals an irregular extrahepatic mass originating from the gallbladder wall."], "context_len": 9, "options": {"A": "Bombesin", "B": "CA-125", "C": "CA 19-9", "D": "S-100"}, "answer": "CA 19-9", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "62", "specialties": ["Internal Medicine", "Gastroenterology"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 62-year-old man presents to his primary care provider complaining of abdominal pain.", "2. He reports a 6-month history of gradually progressive epigastric pain.", "3. He has also noticed 10 pounds of unexpected weight loss.", "4. His past medical history is notable for gout, hypertension, and diabetes mellitus.", "5. He takes allopurinol, enalapril, and glyburide.", "6. He has a 10-pack-year smoking history.", "7. He has a distant history of cocaine abuse.", "8. His temperature is 100.1\u00b0F (37.8\u00b0C).", "9. His blood pressure is 135/85 mmHg.", "10. His pulse is 100/min.", "11. His respirations are 20/min.", "12. On exam, he has notable hepatomegaly.", "13. On exam, he has a palpable gallbladder.", "14. A right upper quadrant ultrasound reveals an irregular extrahepatic mass originating from the gallbladder wall."], "atomic_facts": ["1. Patient reports a 6-month history of gradually progressive epigastric pain", "2. Patient reports 10 pounds of unexpected weight loss", "3. Patient reports itchy skin", "4. Patient's past medical history includes gout, hypertension, and diabetes mellitus", "5. Patient takes allopurinol, enalapril, and glyburide", "6. Patient has a 10-pack-year smoking history", "7. Patient has a distant history of cocaine abuse", "8. Patient's temperature is 100.1\u00b0F (37.8\u00b0C)", "9. Patient's blood pressure is 135/85 mmHg", "10. Patient's pulse is 100/min", "11. Patient's respirations are 20/min", "12. On exam, patient has hepatomegaly", "13. On exam, patient has a palpable gallbladder", "14. Right upper quadrant ultrasound reveals an irregular extrahepatic mass originating from the gallbladder wall"]}
{"id": 94, "question": "Which of the following could be used to culture the most likely cause of this disorder?", "context": ["A 4-year-old girl from a recently immigrated family presents to the emergency department with episodes of severe coughing lasting up to several minutes followed by vomiting.", "She had a low grade fever and runny nose over the last 2 weeks but these coughing episodes just began one day prior to presentation.", "A complete blood count shows a lymphocytic infiltrate and Gram stain reveals a gram-negative coccobacillus.", "The emergency department physician explains that this organism causes disease by toxin-mediated inactivation of an inhibitory signaling molecule."], "context_len": 4, "options": {"A": "Charcoal yeast with iron and cysteine", "B": "Eaton agar", "C": "Loffler medium", "D": "Regan-Lowe medium"}, "answer": "Regan-Lowe medium", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology", "Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old girl from a recently immigrated family presents to the emergency department.", "2. She has episodes of severe coughing lasting up to several minutes followed by vomiting.", "3. She had a low grade fever and runny nose over the last 2 weeks.", "4. The coughing episodes just began one day prior to presentation.", "5. A complete blood count shows a lymphocytic infiltrate.", "6. Gram stain reveals a gram-negative coccobacillus.", "7. The emergency department physician explains that this organism causes disease by toxin-mediated inactivation of an inhibitory signaling molecule."], "atomic_facts": ["1. She had a low grade fever and runny nose over the last 2 weeks.", "2. Coughing episodes began one day prior to presentation.", "3. A complete blood count shows a lymphocytic infiltrate.", "4. Gram stain reveals a gram-negative coccobacillus.", "5. The emergency department physician explains that this organism causes disease by toxin-mediated inactivation of an inhibitory signaling molecule."]}
{"id": 95, "question": "Which of the following histopathologic findings characteristic of this patient\u2019s most likely diagnosis is marked by the yellow circle?", "context": ["A 28-year-old man presents with episodic abdominal pain and bloody diarrhea for the past week.", "He says that the abdominal pain is diffusely localized to the periumbilical region and is dull and cramping in character.", "He also reports episodes of painful, bloody diarrhea up to 7 times per day.", "A colonoscopy is performed and shows continuous erythema, superficial ulcers, and pseudopolyps in the rectum and sigmoid colon.", "A biopsy is taken and sent for histological evaluation.", "One of the slides from the biopsy is shown in the image below."], "context_len": 6, "options": {"A": "Goblet cell hyperplasia", "B": "Paneth cells metaplasia", "C": "Crypt abscess", "D": "Enterocyte dysplasia"}, "answer": "Crypt abscess", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "28 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 28-year-old man presents with episodic abdominal pain and bloody diarrhea for the past week.", "2. He says that the abdominal pain is diffusely localized to the periumbilical region and is dull and cramping in character.", "3. He also reports episodes of painful, bloody diarrhea up to 7 times per day.", "4. A colonoscopy is performed.", "5. The colonoscopy shows continuous erythema, superficial ulcers, and pseudopolyps in the rectum and sigmoid colon.", "6. A biopsy is taken and sent for histological evaluation.", "7. One of the slides from the biopsy is shown in the image below."], "atomic_facts": ["1. The abdominal pain is diffusely localized to the periumbilical region.", "2. The abdominal pain is dull and cramping in character.", "3. The patient reports episodes of painful, bloody diarrhea up to 7 times per day.", "4. A colonoscopy shows continuous erythema, superficial ulcers, and pseudopolyps in the rectum and sigmoid colon.", "5. A biopsy is taken during the colonoscopy.", "6. The biopsy is sent for histological evaluation.", "7. One of the slides from the biopsy is shown in the image below."]}
{"id": 96, "question": "Which of the following is the most likely underlying cause of these findings?\"", "context": ["A 14-year-old boy is brought to the emergency department because of a 2-day history of fatigue.", "He reports that during this time he has had occasional palpitations and shortness of breath.", "He has sickle cell disease.", "Current medications include hydroxyurea and folic acid.", "He appears fatigued.", "His temperature is 38.3\u00b0C (100.9\u00b0F), pulse is 120/min, respirations are 24/min, and blood pressure is 112/74 mm Hg.", "Examination shows pale conjunctivae.", "Cardiac examination shows a midsystolic ejection murmur.", "Laboratory studies show: | Hemoglobin 6.4 g/dl | Leukocyte count 6,000/mm3 | Platelet count 168,000/mm3 | Mean corpuscular volume 84 \u03bcm3 | Reticulocyte count 0.1% | ."], "context_len": 9, "options": {"A": "Parvovirus B19", "B": "Medication-induced hemolysis", "C": "Defect in erythrocyte membrane proteins", "D": "Hemolytic crisis"}, "answer": "Parvovirus B19", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "14 years old", "specialties": ["Pediatrics"], "subspecialties": ["Hematology", "General Pediatrics", "Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 14-year-old boy.", "2. Patient has a 2-day history of fatigue.", "3. Patient has occasional palpitations and shortness of breath.", "4. Patient has sickle cell disease.", "5. Patient is currently taking hydroxyurea and folic acid.", "6. Patient appears fatigued.", "7. Patient's temperature is 38.3\u00b0C (100.9\u00b0F).", "8. Patient's pulse is 120/min.", "9. Patient's respirations are 24/min.", "10. Patient's blood pressure is 112/74 mm Hg.", "11. Patient has pale conjunctivae.", "12. Cardiac examination shows a midsystolic ejection murmur.", "13. Laboratory studies show hemoglobin 6.4 g/dl.", "14. Laboratory studies show leukocyte count 6,000/mm3.", "15. Laboratory studies show platelet count 168,000/mm3.", "16. Laboratory studies show mean corpuscular volume 84 \u03bcm3.", "17. Laboratory studies show reticulocyte count 0.1%."], "atomic_facts": ["1. The patient reports occasional palpitations and shortness of breath.", "2. The patient has sickle cell disease.", "3. The patient's current medications include hydroxyurea and folic acid.", "4. The patient appears fatigued.", "5. The patient's temperature is 38.3\u00b0C (100.9\u00b0F).", "6. The patient's pulse is 120/min.", "7. The patient's respirations are 24/min.", "8. The patient's blood pressure is 112/74 mm Hg.", "9. Examination shows pale conjunctivae.", "10. Cardiac examination shows a midsystolic ejection murmur.", "11. Laboratory studies show: Hemoglobin 6.4 g/dl.", "12. Laboratory studies show: Leukocyte count 6,000/mm3.", "13. Laboratory studies show: Platelet count 168,000/mm3.", "14. Laboratory studies show: Mean corpuscular volume 84 \u03bcm3.", "15. Laboratory studies show: Reticulocyte count 0.1%."]}
{"id": 97, "question": "Which of the following is the most likely underlying mechanism of these findings?", "context": ["A 44-year-old woman comes to the office because of 4 episodes of loss of consciousness over the past 2 weeks.", "She recovered immediately and was not confused following the episodes.", "For the past 6 months, she has also had increased shortness of breath, palpitations, and chest tightness that resolves with rest.", "She immigrated with her family from India 10 years ago.", "Pulse is 115/min and irregular and blood pressure is 108/70 mm Hg.", "Cardiac examination shows an accentuated and split S2.", "There is an opening snap followed by a low-pitched diastolic murmur in the fifth left intercostal space at the midclavicular line.", "An ECG shows atrial fibrillation and right axis deviation."], "context_len": 8, "options": {"A": "Increased pulmonary capillary wedge pressure", "B": "Increased central venous pressure", "C": "Increased oxygenated blood in the right ventricle", "D": "Increased mean arterial pressure"}, "answer": "Increased pulmonary capillary wedge pressure", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "44 years old", "specialties": ["Neurology", "Internal Medicine"], "subspecialties": ["General Neurology", "Cardiology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 44-year-old woman comes to the office.", "2. She has had 4 episodes of loss of consciousness over the past 2 weeks.", "3. She recovered immediately and was not confused following the episodes.", "4. She has also had increased shortness of breath, palpitations, and chest tightness for the past 6 months that resolves with rest.", "5. She immigrated with her family from India 10 years ago.", "6. Pulse is 115/min and irregular.", "7. Blood pressure is 108/70 mm Hg.", "8. Cardiac examination shows an accentuated and split S2.", "9. There is an opening snap followed by a low-pitched diastolic murmur in the fifth left intercostal space at the midclavicular line.", "10. An ECG shows atrial fibrillation and right axis deviation."], "atomic_facts": ["1. She recovered immediately and was not confused following the episodes.", "2. For the past 6 months, she has also had increased shortness of breath, palpitations, and chest tightness that resolves with rest.", "3. She immigrated with her family from India 10 years ago.", "4. Pulse is 115/min and irregular.", "5. Blood pressure is 108/70 mm Hg.", "6. Cardiac examination shows an accentuated and split S2.", "7. There is an opening snap followed by a low-pitched diastolic murmur in the fifth left intercostal space at the midclavicular line.", "8. An ECG shows atrial fibrillation and right axis deviation."]}
{"id": 98, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 43-year-old woman is brought to the emergency department because of severe central chest pain, mild shortness of breath, and one episode of coughing up blood since waking up that morning.", "The pain worsens on inspiration, and she describes it as 8 out of 10 in intensity.", "Three months ago, she underwent a left modified radical mastectomy for invasive ductal carcinoma.", "Her temperature is 37.8\u00b0C (100\u00b0F), pulse is 103/min, respirations are 20/min, and blood pressure is 102/74 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 93%.", "The lungs are clear to auscultation.", "Cardiac examination shows no abnormalities.", "The left lower extremity is swollen and erythematous.", "Laboratory studies show a normal complete blood count, creatinine of 1.0 mg/dL, and a creatinine clearance of 81 mL/min (N = 75\u2013115).", "Arterial blood gas analysis on room air shows: | pH 7.49 | PCO2 29 mm Hg | PO2 69 mm Hg | HCO3- 22 mEq/L | An x-ray of the chest shows no abnormalities."], "context_len": 10, "options": {"A": "CT pulmonary angiography", "B": "D-dimer levels", "C": "Catheter embolectomy", "D": "Low molecular weight heparin therapy"}, "answer": "Low molecular weight heparin therapy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "43 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 43-year-old woman is brought to the emergency department.", "2. She has severe central chest pain, mild shortness of breath, and one episode of coughing up blood since waking up that morning.", "3. The pain worsens on inspiration and is 8 out of 10 in intensity.", "4. Three months ago, she underwent a left modified radical mastectomy for invasive ductal carcinoma.", "5. Her temperature is 37.8\u00b0C (100\u00b0F).", "6. Her pulse is 103/min.", "7. Her respirations are 20/min.", "8. Her blood pressure is 102/74 mm Hg.", "9. Pulse oximetry on room air shows an oxygen saturation of 93%.", "10. The lungs are clear to auscultation.", "11. Cardiac examination shows no abnormalities.", "12. The left lower extremity is swollen and erythematous.", "13. Laboratory studies show a normal complete blood count.", "14. Creatinine is 1.0 mg/dL.", "15. Creatinine clearance is 81 mL/min (N = 75\u2013115).", "16. Arterial blood gas analysis on room air shows: pH 7.49, PCO2 29 mm Hg, PO2 69 mm Hg, HCO3- 22 mEq/L.", "17. An x-ray of the chest shows no abnormalities."], "atomic_facts": ["1. The pain worsens on inspiration", "2. She describes the pain as 8 out of 10 in intensity", "3. Three months ago, she underwent a left modified radical mastectomy for invasive ductal carcinoma", "4. Her temperature is 37.8\u00b0C (100\u00b0F)", "5. Her pulse is 103/min", "6. Her respirations are 20/min", "7. Her blood pressure is 102/74 mm Hg", "8. Pulse oximetry on room air shows an oxygen saturation of 93%", "9. The lungs are clear to auscultation", "10. Cardiac examination shows no abnormalities", "11. The left lower extremity is swollen and erythematous", "12. Laboratory studies show a normal complete blood count", "13. Laboratory studies show creatinine of 1.0 mg/dL", "14. Laboratory studies show a creatinine clearance of 81 mL/min (N = 75\u2013115)", "15. Arterial blood gas analysis on room air shows: pH 7.49, PCO2 29 mm Hg, PO2 69 mm Hg, HCO3- 22 mEq/L", "16. An x-ray of the chest shows no abnormalities"]}
{"id": 99, "question": "Which of the following matches a drug with its correct characteristic?", "context": ["A 58-year-old Caucasian male with a history of peripheral vascular disease is admitted to the hospital with a painful, pulseless foot.", "He is prescribed antiplatelet and anticoagulant drugs."], "context_len": 2, "options": {"A": "Warfarin: directly inhibits thrombin", "B": "Heparin: activates antithrombin 3", "C": "Aspirin: reversibly inhibits COX-1", "D": "Prasugrel: reduced risk of bleeding compared to other drugs in its class"}, "answer": "Heparin: activates antithrombin 3", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "58", "specialties": ["Vascular Surgery"], "subspecialties": ["General Vascular Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 58 years old.", "2. Patient is Caucasian.", "3. Patient has a history of peripheral vascular disease.", "4. Patient is admitted to the hospital.", "5. Patient has a painful, pulseless foot.", "6. Patient is prescribed antiplatelet drugs.", "7. Patient is prescribed anticoagulant drugs."], "atomic_facts": ["1. He is prescribed antiplatelet drugs.", "2. He is prescribed anticoagulant drugs."]}
{"id": 100, "question": "Which of the following is the most likely diagnosis?", "context": ["A 64-year-old woman comes to the physician because of several episodes of dizziness during the last month.", "The episodes last between 30\u201340 seconds and during the episodes she feels as though she is spinning.", "Episodes usually occur immediately after lying down or suddenly sitting up from a reclined position.", "They also sometimes happen when she suddenly turns her head to look at something.", "She has no nausea.", "Last month, she had an upper respiratory tract infection that resolved spontaneously.", "She has hypertension treated with hydrochlorothiazide.", "Otoscopic examination shows no abnormalities.", "There is no lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead."], "context_len": 9, "options": {"A": "Benign paroxysmal positional vertigo", "B": "Persistent postural-perceptual dizziness", "C": "Meniere disease", "D": "Acoustic neuroma"}, "answer": "Benign paroxysmal positional vertigo", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "64 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 64-year-old woman comes to the physician.", "2. She has experienced several episodes of dizziness in the last month.", "3. The episodes last between 30\u201340 seconds.", "4. During the episodes she feels as though she is spinning.", "5. Episodes usually occur immediately after lying down or suddenly sitting up from a reclined position.", "6. Episodes also sometimes happen when she suddenly turns her head to look at something.", "7. She has no nausea.", "8. Last month, she had an upper respiratory tract infection that resolved spontaneously.", "9. She has hypertension treated with hydrochlorothiazide.", "10. Otoscopic examination shows no abnormalities.", "11. There is no lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead."], "atomic_facts": ["1. The episodes last between 30\u201340 seconds.", "2. During the episodes, she feels as though she is spinning.", "3. Episodes usually occur immediately after lying down or suddenly sitting up from a reclined position.", "4. They also sometimes happen when she suddenly turns her head to look at something.", "5. She has no nausea.", "6. Last month, she had an upper respiratory tract infection that resolved spontaneously.", "7. She has hypertension treated with hydrochlorothiazide.", "8. Otoscopic examination shows no abnormalities.", "9. There is no lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead."]}
{"id": 101, "question": "Which of the following findings would most likely be seen in this patient?", "context": ["A 31-year-old woman presents to her primary care physician because she has been experiencing diarrhea over the last several days.", "She returned from a cruise ship vacation 3 days ago and has recently been to many countries in Central and South America.", "After returning, she developed bloody diarrhea, nausea, and right-upper quadrant abdominal pain.", "Stool examination shows blood and neutrophils and imaging reveals abscesses in the liver."], "context_len": 4, "options": {"A": "Acid fast cysts", "B": "Motile bacteria", "C": "Non-invasive trophozoites", "D": "Ulcers that are flask-shaped"}, "answer": "Ulcers that are flask-shaped", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "31", "specialties": ["In this case, the most relevant medical specialty would be Gastroenterology", "In this case, the most relevant specialty would be Gastroenterology", "Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology.", "General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.25, 0.25, 0.25, 0.25], "subspecialty_prob": [0.5, 0.25, 0.25], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 31-year-old woman presents to her primary care physician.", "2. She has been experiencing diarrhea over the last several days.", "3. She returned from a cruise ship vacation 3 days ago.", "4. She has recently been to many countries in Central and South America.", "5. After returning, she developed bloody diarrhea, nausea, and right-upper quadrant abdominal pain.", "6. Stool examination shows blood and neutrophils.", "7. Imaging reveals abscesses in the liver."], "atomic_facts": ["1. She returned from a cruise ship vacation 3 days ago.", "2. She has recently been to many countries in Central and South America.", "3. After returning, she developed bloody diarrhea, nausea, and right-upper quadrant abdominal pain.", "4. Stool examination shows blood and neutrophils.", "5. Imaging reveals abscesses in the liver."]}
{"id": 102, "question": "Which of the following mechanisms most likely contributes to the efficacy of this patient's pharmacotherapy?", "context": ["A 35-year-old woman that is currently being treated for chronic hepatitis C comes to the physician because of progressive fatigue for 10 days.", "Examination shows pale conjunctivae.", "Her hemoglobin concentration is 10.1 g/dL, serum total bilirubin concentration is 1.9 mg/dL, and LDH is 259 U/L (N = 45\u201390 U/L)."], "context_len": 3, "options": {"A": "Activation of leukocytes", "B": "Inhibition of reverse transcriptase", "C": "Inhibition of RNA polymerase", "D": "Decreased GMP synthesis"}, "answer": "Decreased GMP synthesis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "35 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 35-year-old woman is being treated for chronic hepatitis C.", "2. She comes to the physician because of progressive fatigue for 10 days.", "3. Examination shows pale conjunctivae.", "4. Her hemoglobin concentration is 10.1 g/dL.", "5. Her serum total bilirubin concentration is 1.9 mg/dL.", "6. Her LDH is 259 U/L.", "7. The normal range for LDH is 45\u201390 U/L."], "atomic_facts": ["1. Examination shows pale conjunctivae.", "2. Hemoglobin concentration is 10.1 g/dL.", "3. Serum total bilirubin concentration is 1.9 mg/dL.", "4. LDH is 259 U/L (N = 45\u201390 U/L)."]}
{"id": 103, "question": "Which of the following effects are most likely to have occurred in this child\u2019s eye from these eye drops?", "context": ["A 7-year-old boy is brought to a pediatrician by his parents.", "The parents say that the patient accidentally instilled a drop from a bottle of medicated eye drops into his right eye.", "According to them, the patient\u2019s grandfather uses the eye drops which were prescribed for him by an ophthalmologist.", "The parents have brought the eye drops with them.", "The pediatrician notes that the eye drops contain an \u03b11 adrenergic agonist drug.", "He examines the patient\u2019s eye and finds that the eye drops have produced their expected effects.", "He reassures the parents about the self-limited effect of the drug and the absence of any risk of long-term complications."], "context_len": 7, "options": {"A": "Contraction of the pupillary dilator muscle with no effect on the ciliary muscle", "B": "Relaxation of the pupillary dilator muscle with no effect on the ciliary muscle", "C": "Relaxation of the pupillary sphincter muscle with contraction of the ciliary muscle", "D": "Contraction of the pupillary dilator muscle with contraction of the ciliary muscle"}, "answer": "Contraction of the pupillary dilator muscle with no effect on the ciliary muscle", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. A 7-year-old boy is brought to a pediatrician by his parents.", "2. The parents say that the patient accidentally instilled a drop from a bottle of medicated eye drops into his right eye.", "3. According to them, the patient\u2019s grandfather uses the eye drops which were prescribed for him by an ophthalmologist.", "4. The parents have brought the eye drops with them.", "5. The pediatrician notes that the eye drops contain an \u03b11 adrenergic agonist drug.", "6. He examines the patient\u2019s eye and finds that the eye drops have produced their expected effects.", "7. He reassures the parents about the self-limited effect of the drug and the absence of any risk of long-term complications."], "atomic_facts": ["1. The patient accidentally instilled a drop from a bottle of medicated eye drops into his right eye.", "2. The eye drops were prescribed for the patient's grandfather by an ophthalmologist.", "3. The parents have brought the eye drops with them.", "4. The eye drops contain an \u03b11 adrenergic agonist drug.", "5. The pediatrician notes that the eye drops have produced their expected effects.", "6. The pediatrician reassures the parents about the self-limited effect of the drug and the absence of any risk of long-term complications."]}
{"id": 104, "question": "The most effective medication for her disorder has what mechanism of action?", "context": ["A 21-year-old female comes to the physician\u2019s office because of insomnia.", "For the past 9 months, the patient has been having a hard time falling asleep because she \u201ccan\u2019t turn her mind off.\u201d She is a student in a nearby university and spends hours at the end of each day worrying about her classes as well as her upcoming tests.", "When she doesn\u2019t have tests, she worries about her family and her boyfriend even though admits she has no specific concerns about them.", "This constant worrying has led to insomnia and an inability to focus in class.", "She has also been fatigued and hasn\u2019t had the energy to go the gym as she usually does."], "context_len": 5, "options": {"A": "Inhibit reuptake of serotonin", "B": "Inhibition of monoamine oxidase", "C": "Increase norepinephrine and dopamine", "D": "Block dopamine receptors"}, "answer": "Inhibit reuptake of serotonin", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "21", "specialties": ["Psychiatry"], "subspecialties": ["Sleep Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 21-year-old female comes to the physician\u2019s office because of insomnia.", "2. For the past 9 months, the patient has been having a hard time falling asleep because she \u201ccan\u2019t turn her mind off.\u201d", "3. She is a student in a nearby university.", "4. She spends hours at the end of each day worrying about her classes.", "5. She spends hours at the end of each day worrying about her upcoming tests.", "6. She worries about her family and her boyfriend even though admits she has no specific concerns about them.", "7. This constant worrying has led to insomnia.", "8. This constant worrying has led to an inability to focus in class.", "9. She has been fatigued.", "10. She hasn't had the energy to go the gym as she usually does."], "atomic_facts": ["1. The patient has been having a hard time falling asleep for the past 9 months.", "2. The patient's difficulty falling asleep is due to her inability to \"turn her mind off.\"", "3. The patient is a student at a nearby university.", "4. The patient spends hours at the end of each day worrying about her classes and upcoming tests.", "5. When she doesn't have tests, the patient worries about her family and her boyfriend.", "6. The patient admits she has no specific concerns about her family and boyfriend.", "7. The constant worrying has led to insomnia for the patient.", "8. The patient has an inability to focus in class due to her constant worrying.", "9. The patient has been experiencing fatigue.", "10. The patient hasn't had the energy to go to the gym as she usually does."]}
{"id": 105, "question": "Which of the following is the most appropriate pharmacotherapy?", "context": ["A 7-year-old girl is brought to the physician because of a slightly itchy rash that first appeared 3 days ago.", "Her mother says she has also been complaining of headaches and achy muscles since yesterday evening.", "The girl went on a camping trip for school 10 days ago.", "She recalls being bitten several times by mosquitoes.", "She has a history of atopic dermatitis.", "She lives in Massachusetts with both parents and her 4-year-old sister.", "Her temperature is 39\u00b0C (102.2\u00b0F).", "Physical examination shows a 3-cm, nontender rash on her left upper torso.", "A photograph of the rash is shown.", "There are also multiple 5 to 8-mm erythematous papules over the lower legs and forearms."], "context_len": 10, "options": {"A": "Amoxicillin", "B": "Ceftriaxone", "C": "Penicillin G", "D": "Azithromycin"}, "answer": "Amoxicillin", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology", "Pediatric Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 7-year-old girl.", "2. Patient has a slightly itchy rash that first appeared 3 days ago.", "3. Patient has been complaining of headaches and achy muscles since yesterday evening.", "4. Patient went on a camping trip for school 10 days ago.", "5. Patient recalls being bitten several times by mosquitoes.", "6. Patient has a history of atopic dermatitis.", "7. Patient lives in Massachusetts with both parents and her 4-year-old sister.", "8. Patient's temperature is 39\u00b0C (102.2\u00b0F).", "9. Physical examination shows a 3-cm, nontender rash on her left upper torso.", "10. There are also multiple 5 to 8-mm erythematous papules over the lower legs and forearms."], "atomic_facts": ["1. Her mother says she has been complaining of headaches and achy muscles since yesterday evening.", "2. The girl went on a camping trip for school 10 days ago.", "3. She recalls being bitten several times by mosquitoes.", "4. She has a history of atopic dermatitis.", "5. She lives in Massachusetts with both parents and her 4-year-old sister.", "6. Her temperature is 39\u00b0C (102.2\u00b0F).", "7. Physical examination shows a 3-cm, nontender rash on her left upper torso.", "8. A photograph of the rash is shown.", "9. There are also multiple 5 to 8-mm erythematous papules over the lower legs and forearms."]}
{"id": 106, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 45-year-old man presents to the clinic for the third time in the past 3 weeks asking for an MRI of his lower back.", "He had initially gone to the gym as advised by his wife and had started doing some back exercises.", "The next day, he developed soreness in his lower back and spent the whole day online trying to figure out what was wrong with him.", "He has been to the emergency department a few times and subsequently has been redirected to the clinic where each time he was thoroughly examined and investigated for all the possible causes.", "The patient still exhibits worry and would like to get an MRI to make sure everything is \u2018okay.\u2019 ."], "context_len": 5, "options": {"A": "Illness anxiety disorder", "B": "Somatic symptom disorder", "C": "Factitious disorder", "D": "Munchausen syndrome"}, "answer": "Illness anxiety disorder", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 45-year-old man presents to the clinic for the third time in the past 3 weeks.", "2. He had initially gone to the gym as advised by his wife and had started doing some back exercises.", "3. The next day, he developed soreness in his lower back.", "4. He spent the whole day online trying to figure out what was wrong with him.", "5. He has been to the emergency department a few times.", "6. He has subsequently been redirected to the clinic.", "7. Each time he was thoroughly examined and investigated for all the possible causes.", "8. The patient still exhibits worry.", "9. He would like to get an MRI to make sure everything is \u2018okay.\u2019"], "atomic_facts": ["1. He initially went to the gym as advised by his wife.", "2. He started doing some back exercises.", "3. The next day, he developed soreness in his lower back.", "4. He spent the whole day online trying to figure out what was wrong with him.", "5. He has been to the emergency department a few times.", "6. He has been redirected to the clinic each time.", "7. Each time he was thoroughly examined and investigated for all possible causes.", "8. The patient still exhibits worry.", "9. He would like to get an MRI to make sure everything is \u2018okay.\u2019"]}
{"id": 107, "question": "What is the best initial step in management?", "context": ["A 25-year-old woman presents to the urgent care clinic for cough for the past five days.", "She recently moved to the area and has not yet established a primary care doctor.", "She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days.", "She initially thought that it was just due to dust from moving boxes into her new apartment, but her symptoms did not improve after cleaning her belongings and vacuuming her floor.", "She feels some relief after splashing her face with cold water, but her symptoms recur within ten minutes.", "She has no pets and does not take any medications.", "Her physical exam reveals examples of findings shown in Figures A-C.", "No rales or wheezes are appreciated on lung auscultation, but bronchial breath sounds are heard at the bases.", "The patient states that she will need to drive back home after this visit."], "context_len": 9, "options": {"A": "Oral loratadine", "B": "Intranasal corticosteroids", "C": "Sublingual oseltamivir", "D": "Oral montelukast"}, "answer": "Intranasal corticosteroids", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Internal Medicine", "Pediatrics"], "subspecialties": ["Pulmonary Disease", "General Pediatrics", "Infectious Disease", "Pediatric Pulmonology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 25-year-old woman presents to the urgent care clinic for cough for the past five days.", "2. She recently moved to the area and has not yet established a primary care doctor.", "3. She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days.", "4. She initially thought that it was just due to dust from moving boxes into her new apartment.", "5. Her symptoms did not improve after cleaning her belongings and vacuuming her floor.", "6. She feels some relief after splashing her face with cold water.", "7. Her symptoms recur within ten minutes.", "8. She has no pets.", "9. She does not take any medications.", "10. Her physical exam reveals examples of findings shown in Figures A-C.", "11. No rales or wheezes are appreciated on lung auscultation.", "12. Bronchial breath sounds are heard at the bases.", "13. The patient states that she will need to drive back home after this visit."], "atomic_facts": ["1. She recently moved to the area and has not yet established a primary care doctor.", "2. She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days.", "3. She initially thought that it was just due to dust from moving boxes into her new apartment, but her symptoms did not improve after cleaning her belongings and vacuuming her floor.", "4. She feels some relief after splashing her face with cold water, but her symptoms recur within ten minutes.", "5. She has no pets and does not take any medications.", "6. Her physical exam reveals examples of findings shown in Figures A-C.", "7. No rales or wheezes are appreciated on lung auscultation, but bronchial breath sounds are heard at the bases.", "8. The patient states that she will need to drive back home after this visit."]}
{"id": 108, "question": "What is her CHADS2 score?", "context": ["A 73-year-old woman with atrial fibrillation presents to your clinic to discuss the need for anticoagulation.", "Her PMH is significant for high blood pressure, diabetes mellitus type II, osteoporosis, and depression.", "She previously smoked but quit about 16 years ago.", "She has never had a stroke or TIA.", "Her physical examination is remarkable for an irregular heart rate.", "She has a blood pressure of 136/94 mm Hg and a heart rate of 74/min."], "context_len": 6, "options": {"A": "1", "B": "2", "C": "4", "D": "Too little information to tell"}, "answer": "2", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "73", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 73-year-old woman presents to clinic to discuss need for anticoagulation.", "2. Patient's past medical history (PMH) is significant for high blood pressure, diabetes mellitus type II, osteoporosis, and depression.", "3. Patient previously smoked but quit about 16 years ago.", "4. Patient has never had a stroke or TIA.", "5. Patient's physical examination is remarkable for an irregular heart rate.", "6. Patient's blood pressure is 136/94 mm Hg.", "7. Patient's heart rate is 74/min."], "atomic_facts": ["1. PMH includes high blood pressure, diabetes mellitus type II, osteoporosis, and depression.", "2. She previously smoked but quit about 16 years ago.", "3. She has never had a stroke or TIA.", "4. Physical examination is remarkable for an irregular heart rate.", "5. Blood pressure is 136/94 mm Hg.", "6. Heart rate is 74/min."]}
{"id": 109, "question": "Which of the following is most likely responsible for the improvement in this patient's neurological status?", "context": ["A 26-year-old woman is admitted to the hospital because of a 3-day history of tingling and weakness in the lower extremities.", "Neurologic examination shows areflexia of the ankle and knee joints bilaterally.", "Motor strength is 1/5 in both lower legs.", "Over the next 3 weeks, the patient's condition progresses to involve both upper extremities, and she requires ventilatory support.", "Six weeks after admission, deep tendon reflexes are 1+ in the ankles, and she is able to wiggle her toes."], "context_len": 5, "options": {"A": "Synthesis of monoamine neurotransmitters", "B": "Remyelination of peripheral nerves", "C": "Replication of oligodendrocyte precursor cells", "D": "Lymphocytic infiltration in the endoneurium\n\""}, "answer": "Remyelination of peripheral nerves", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "26 years old", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 26-year-old woman is admitted to the hospital.", "2. She has a 3-day history of tingling and weakness in the lower extremities.", "3. Neurologic examination shows areflexia of the ankle and knee joints bilaterally.", "4. Motor strength is 1/5 in both lower legs.", "5. Over the next 3 weeks, her condition progresses to involve both upper extremities.", "6. She requires ventilatory support.", "7. Six weeks after admission, deep tendon reflexes are 1+ in the ankles.", "8. She is able to wiggle her toes."], "atomic_facts": ["1. Neurologic examination shows areflexia of the ankle and knee joints bilaterally.", "2. Motor strength is 1/5 in both lower legs.", "3. Over the next 3 weeks, the patient's condition progresses to involve both upper extremities, and she requires ventilatory support.", "4. Six weeks after admission, deep tendon reflexes are 1+ in the ankles, and she is able to wiggle her toes."]}
{"id": 110, "question": "This patient is most likely deficient in a vitamin that has which of the following functions?", "context": ["A 42-year-old woman presents to her primary care physician for fatigue and blurry vision.", "She is a refugee from Syria who arrived in the United States 1 week ago.", "She has lived for the last 8 months in a refugee camp.", "She worked at a grocery store in Syria before being displaced from her home.", "She has one son who is 9 years old and was seen by a pediatrician the day prior.", "She reports that while she was in the refugee camp, she ate very little and gave most of her food to her son to ensure that he stayed healthy.", "She denies any past medical history and takes no medications.", "She does not smoke or drink alcohol.", "Her temperature is 97.8\u00b0F (36.6\u00b0C), blood pressure is 108/68 mmHg, pulse is 102/min, and respirations are 18/min.", "On exam, she appears fatigued but is fully cooperative with the examination.", "There are fissures at the corners of her mouth.", "A funduscopic examination reveals corneal vascularization in both eyes.", "Her tongue is darkly erythematous."], "context_len": 13, "options": {"A": "Cofactor for homocysteine methyltransferase", "B": "Cofactor for pyruvate dehydrogenase enzyme", "C": "Precursor to FAD and FMN", "D": "Constituent of NAD+ and NADP+"}, "answer": "Precursor to FAD and FMN", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "42", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 42-year-old woman.", "2. Patient presents with fatigue and blurry vision.", "3. Patient is a refugee from Syria.", "4. Patient arrived in the United States 1 week ago.", "5. Patient lived in a refugee camp for 8 months.", "6. Patient worked at a grocery store in Syria before being displaced from her home.", "7. Patient has one son who is 9 years old.", "8. Patient's son was seen by a pediatrician the day prior.", "9. Patient ate very little and gave most of her food to her son while in the refugee camp.", "10. Patient denies any past medical history and takes no medications.", "11. Patient does not smoke or drink alcohol.", "12. Patient's temperature is 97.8\u00b0F (36.6\u00b0C).", "13. Patient's blood pressure is 108/68 mmHg.", "14. Patient's pulse is 102/min.", "15. Patient's respirations are 18/min.", "16. Patient appears fatigued but is fully cooperative with the examination.", "17. Patient has fissures at the corners of her mouth.", "18. Funduscopic examination reveals corneal vascularization in both eyes.", "19. Patient's tongue is darkly erythematous."], "atomic_facts": ["1. She is a refugee from Syria.", "2. She arrived in the United States 1 week ago.", "3. She has lived for the last 8 months in a refugee camp.", "4. She worked at a grocery store in Syria before being displaced from her home.", "5. She has one son who is 9 years old.", "6. Her son was seen by a pediatrician the day prior.", "7. She reports that while she was in the refugee camp, she ate very little and gave most of her food to her son.", "8. She denies any past medical history.", "9. She takes no medications.", "10. She does not smoke or drink alcohol.", "11. Her temperature is 97.8\u00b0F (36.6\u00b0C).", "12. Her blood pressure is 108/68 mmHg.", "13. Her pulse is 102/min.", "14. Her respirations are 18/min.", "15. On exam, she appears fatigued.", "16. She is fully cooperative with the examination.", "17. There are fissures at the corners of her mouth.", "18. A funduscopic examination reveals corneal vascularization in both eyes.", "19. Her tongue is darkly erythematous."]}
{"id": 111, "question": "Which of the following statements describing the patient\u2019s current state is most accurate?", "context": ["A 70-year-old man was first evaluated for an enlarging neck mass with complaints of night sweats, fever, and weight loss.", "Excisional biopsy confirms the diagnosis of Burkitt lymphoma.", "The patient is started on a CODOX-M/IVAC chemotherapy regime.", "The physician notes a marked improvement, but is concerned about a common complication of chemotherapy.", "The patient is prescribed rasburicase in response to this complication."], "context_len": 5, "options": {"A": "Rasburicase is a xanthine oxidase inhibitor", "B": "This complication only occurs in response to radiation", "C": "Rasburicase converts uric acid to allantoin, increasing its secretion", "D": "Hypophosphatemia is expected to develop in this patient"}, "answer": "Rasburicase converts uric acid to allantoin, increasing its secretion", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 70-year-old man was first evaluated for an enlarging neck mass.", "2. The man had complaints of night sweats, fever, and weight loss.", "3. Excisional biopsy confirmed the diagnosis of Burkitt lymphoma.", "4. The patient was started on a CODOX-M/IVAC chemotherapy regime.", "5. The physician noted a marked improvement.", "6. The physician was concerned about a common complication of chemotherapy.", "7. The patient was prescribed rasburicase in response to this complication."], "atomic_facts": ["1. Excisional biopsy confirms the diagnosis of Burkitt lymphoma.", "2. The patient is started on a CODOX-M/IVAC chemotherapy regime.", "3. The physician notes a marked improvement.", "4. The physician is concerned about a common complication of chemotherapy.", "5. The patient is prescribed rasburicase in response to this complication."]}
{"id": 112, "question": "The patient's condition is most likely associated with which of the following pathophysiologic changes?", "context": ["A previously healthy 41-year-old man is brought to the emergency department 30 minutes after collapsing at home.", "Cardiopulmonary resuscitation is attempted for 10 minutes without success.", "A photograph of sections of the heart obtained at autopsy is shown."], "context_len": 3, "options": {"A": "Retrograde blood flow from the aorta into the left ventricle", "B": "Fixed obstruction of the left ventricular outflow tract", "C": "Marked noncompliance of the left ventricular wall", "D": "Severe narrowing of the left anterior descending artery"}, "answer": "Marked noncompliance of the left ventricular wall", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "41 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 41-year-old man was brought to the emergency department.", "2. He was previously healthy.", "3. He collapsed at home 30 minutes prior.", "4. Cardiopulmonary resuscitation was attempted for 10 minutes.", "5. It was unsuccessful.", "6. A photograph of sections of the heart was obtained at autopsy."], "atomic_facts": ["1. Cardiopulmonary resuscitation was attempted for 10 minutes.", "2. The resuscitation attempt was not successful.", "3. A photograph of sections of the heart was obtained at autopsy."]}
{"id": 113, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?\"", "context": ["A 68-year-old woman comes to the physician with increasing fatigue and shortness of breath for 2 weeks.", "She has only passed very small amounts of urine over the past few days.", "During this time, she has also noticed that her feet appear unusually puffy for a few hours every morning.", "Three weeks ago, she had a sore throat that resolved spontaneously after several days without antibiotic therapy.", "She has a 6-month history of lower back and thoracic pain, for which she takes ibuprofen daily.", "Her only other medication is a laxative for constipation, which she first experienced 8 months ago.", "Her sister has systemic lupus erythematosus.", "Her temperature is 37.9\u00b0C (98.9\u00b0F), pulse is 110/min, respirations are 22/min, and blood pressure is 150/100 mm Hg.", "Examination shows pedal edema and conjunctival pallor.", "There is tenderness to palpation over the lumbar spine and the 8th rib on the right.", "Cardiac examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 9.8 mg/dL | Serum | Urea nitrogen 50 mg/dL | Creatinine 2.8 mg/dL | Calcium 12.9 mg/dL | Urine | Protein negative | Blood negative | ."], "context_len": 12, "options": {"A": "Renal deposition of AL amyloid", "B": "Immunoglobulin light chains", "C": "Decreased cardiac ejection fraction", "D": "Anti-streptococcal antibodies"}, "answer": "Immunoglobulin light chains", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "68 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 68-year-old woman comes to the physician with increasing fatigue and shortness of breath for 2 weeks.", "2. She has only passed very small amounts of urine over the past few days.", "3. During this time, she has also noticed that her feet appear unusually puffy for a few hours every morning.", "4. Three weeks ago, she had a sore throat that resolved spontaneously after several days without antibiotic therapy.", "5. She has a 6-month history of lower back and thoracic pain, for which she takes ibuprofen daily.", "6. Her only other medication is a laxative for constipation, which she first experienced 8 months ago.", "7. Her sister has systemic lupus erythematosus.", "8. Her temperature is 37.9\u00b0C (98.9\u00b0F), pulse is 110/min, respirations are 22/min, and blood pressure is 150/100 mm Hg.", "9. Examination shows pedal edema and conjunctival pallor.", "10. There is tenderness to palpation over the lumbar spine and the 8th rib on the right.", "11. Cardiac examination shows no abnormalities.", "12. Laboratory studies show: Hemoglobin 9.8 mg/dL.", "13. Serum Urea nitrogen 50 mg/dL.", "14. Creatinine 2.8 mg/dL.", "15. Calcium 12.9 mg/dL.", "16. Urine Protein negative.", "17. Urine Blood negative."], "atomic_facts": ["1. She has only passed very small amounts of urine over the past few days.", "2. She has also noticed that her feet appear unusually puffy for a few hours every morning.", "3. Three weeks ago, she had a sore throat that resolved spontaneously after several days without antibiotic therapy.", "4. She has a 6-month history of lower back and thoracic pain, for which she takes ibuprofen daily.", "5. Her only other medication is a laxative for constipation, which she first experienced 8 months ago.", "6. Her sister has systemic lupus erythematosus.", "7. Her temperature is 37.9\u00b0C (98.9\u00b0F), pulse is 110/min, respirations are 22/min, and blood pressure is 150/100 mm Hg.", "8. Examination shows pedal edema and conjunctival pallor.", "9. There is tenderness to palpation over the lumbar spine and the 8th rib on the right.", "10. Cardiac examination shows no abnormalities.", "11. Laboratory studies show: Hemoglobin 9.8 mg/dL, Serum Urea nitrogen 50 mg/dL, Creatinine 2.8 mg/dL, Calcium 12.9 mg/dL, Urine Protein negative, Blood negative."]}
{"id": 114, "question": "From whom should the surgeon get consent for the procedure?", "context": ["A 13-month-old male needs to have surgery for an undescended testicle.", "The child lives with his 16-year-old mother only.", "His 19-year-old father is not involved."], "context_len": 3, "options": {"A": "The mother", "B": "The father", "C": "A grandparent", "D": "The hospital's medical ethics committee"}, "answer": "The mother", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "13 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 13-month-old male needs to have surgery.", "2. The surgery is for an undescended testicle.", "3. The child lives with his 16-year-old mother only.", "4. His 19-year-old father is not involved."], "atomic_facts": ["1. The child lives with his 16-year-old mother.", "2. The mother is the only caregiver for the child.", "3. The father of the child is 19 years old.", "4. The father is not involved in the child's life."]}
{"id": 115, "question": "Which of the following is the best next step in management?", "context": ["A 7-year-old boy is brought to the emergency department after he was bitten by a dog.", "The patient was at a friend's house, and he was bitten when he pulled the dog's tail while it was eating.", "The patient is currently doing well and has a dog bite on his right distal forearm.", "His temperature is 98.2\u00b0F (36.8\u00b0C), blood pressure is 100/60 mmHg, pulse is 123/min, respirations are 19/min, and oxygen saturation is 98% on room air.", "The wound is thoroughly irrigated in the emergency department."], "context_len": 5, "options": {"A": "Closure of the wound via sutures", "B": "Euthanasia of the animal", "C": "Quarantine and observe the animal", "D": "Rabies vaccine and rabies immunoglobulin"}, "answer": "Quarantine and observe the animal", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 7-year-old boy was brought to the emergency department.", "2. He was bitten by a dog.", "3. He was at a friend's house when he was bitten.", "4. He pulled the dog's tail while it was eating.", "5. The patient is currently doing well.", "6. He has a dog bite on his right distal forearm.", "7. His temperature is 98.2\u00b0F (36.8\u00b0C).", "8. His blood pressure is 100/60 mmHg.", "9. His pulse is 123/min.", "10. His respirations are 19/min.", "11. His oxygen saturation is 98% on room air.", "12. The wound was thoroughly irrigated in the emergency department."], "atomic_facts": ["1. The patient was at a friend's house.", "2. The patient was bitten when he pulled the dog's tail while it was eating.", "3. The patient has a dog bite on his right distal forearm.", "4. The patient is currently doing well.", "5. The patient's temperature is 98.2\u00b0F (36.8\u00b0C).", "6. The patient's blood pressure is 100/60 mmHg.", "7. The patient's pulse is 123/min.", "8. The patient's respirations are 19/min.", "9. The patient's oxygen saturation is 98% on room air.", "10. The wound is thoroughly irrigated in the emergency department."]}
{"id": 116, "question": "Which of the following set of laboratory results and peripheral blood smear findings would most likely be seen in this patient?", "context": ["A 35-year-old woman, otherwise healthy, presents with frequent nosebleeds and bruising on her legs.", "She says that her symptoms started about 6 months ago and have not improved.", "She remembers that her 8-year-old son had similar symptoms about a month ago following a viral respiratory infection, but his symptoms quickly resolved without treatment.", "No significant past medical history and no current medications.", "Family history is significant for her father dying at age 65 of myocardial infarction.", "Review of systems is significant for her last period 2 weeks ago being a bit heavier than usual.", "Her vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 100/75 mm Hg, pulse 98/min, respirations 15/min, and oxygen saturation 99% on room air.", "On physical examination, the patient is alert and cooperative.", "Cardiac exam is normal.", "Lungs are clear to auscultation.", "There is non-palpable purpura present on the lower extremities bilaterally."], "context_len": 11, "options": {"A": "Platelets: Decreased | Bleeding time: Increased | PT: Normal | PTT: Normal | Blood smear: Schistocytes present", "B": "Platelets: Decreased | Bleeding time: Increased | PT: Increased| PTT: Increased | Blood smear: Schistocytes present", "C": "Platelets: Increased | Bleeding time: Decreased| PT: Normal| PTT: Normal | Blood smear: Schistocytes absent", "D": "Platelets: Decreased | Bleeding time: Increased | PT: Normal| PTT: Normal| Blood smear: Schistocytes absent"}, "answer": "Platelets: Decreased | Bleeding time: Increased | PT: Normal| PTT: Normal| Blood smear: Schistocytes absent", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "35", "specialties": ["Hematology"], "subspecialties": ["General Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 35-year-old woman.", "2. Patient is otherwise healthy.", "3. Patient presents with frequent nosebleeds and bruising on her legs.", "4. Symptoms started about 6 months ago and have not improved.", "5. Patient's 8-year-old son had similar symptoms about a month ago following a viral respiratory infection, but his symptoms quickly resolved without treatment.", "6. No significant past medical history and no current medications.", "7. Family history is significant for her father dying at age 65 of myocardial infarction.", "8. Patient's last period 2 weeks ago was a bit heavier than usual.", "9. Vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 100/75 mm Hg, pulse 98/min, respirations 15/min, and oxygen saturation 99% on room air.", "10. Patient is alert and cooperative on physical examination.", "11. Cardiac exam is normal.", "12. Lungs are clear to auscultation.", "13. Non-palpable purpura present on the lower extremities bilaterally."], "atomic_facts": ["1. Symptoms started about 6 months ago and have not improved", "2. 8-year-old son had similar symptoms about a month ago following a viral respiratory infection", "3. Son's symptoms quickly resolved without treatment", "4. No significant past medical history", "5. No current medications", "6. Family history significant for father dying at age 65 of myocardial infarction", "7. Last period 2 weeks ago was a bit heavier than usual", "8. Vital signs: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 100/75 mm Hg, pulse 98/min, respirations 15/min, oxygen saturation 99% on room air", "9. Patient is alert and cooperative", "10. Cardiac exam is normal", "11. Lungs are clear to auscultation", "12. Non-palpable purpura present on the lower extremities bilaterally"]}
{"id": 117, "question": "Which of the following is the most appropriate modification in this patient\u2019s drug therapy?", "context": ["A 65-year-old woman comes to the physician because of urinary straining and delayed flow of urine for 1 month.", "She has a medical history significant for long-standing asthma.", "Recently, she has been taking albuterol more frequently on an as-needed basis.", "She was diagnosed with major depression last year.", "Currently, her symptoms of depression are under control.", "Her medications include inhaled salmeterol and fluticasone propionate and oral amitriptyline, the dose of which was increased recently due to uncontrolled depressive symptoms.", "The vital signs include: temperature 37.1\u00b0C (99.8\u00b0F), pulse rate 80/min, respiratory rate 14/min, and blood pressure 110/70 mm Hg.", "On examination, she has dry oral mucous membranes.", "The remainder of the examination shows no abnormalities."], "context_len": 9, "options": {"A": "Adding ipratropium bromide inhaler", "B": "Reducing the dose of albuterol", "C": "Switching amitriptyline to fluoxetine", "D": "No change is required at this time"}, "answer": "Switching amitriptyline to fluoxetine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "65 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 65-year-old woman comes to the physician because of urinary straining and delayed flow of urine for 1 month.", "2. She has a medical history significant for long-standing asthma.", "3. Recently, she has been taking albuterol more frequently on an as-needed basis.", "4. She was diagnosed with major depression last year.", "5. Currently, her symptoms of depression are under control.", "6. Her medications include inhaled salmeterol and fluticasone propionate and oral amitriptyline.", "7. The dose of amitriptyline was increased recently due to uncontrolled depressive symptoms.", "8. The vital signs include: temperature 37.1\u00b0C (99.8\u00b0F), pulse rate 80/min, respiratory rate 14/min, and blood pressure 110/70 mm Hg.", "9. On examination, she has dry oral mucous membranes.", "10. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. She has a medical history significant for long-standing asthma.", "2. She has been taking albuterol more frequently on an as-needed basis.", "3. She was diagnosed with major depression last year.", "4. Currently, her symptoms of depression are under control.", "5. Her medications include inhaled salmeterol and fluticasone propionate and oral amitriptyline.", "6. The dose of amitriptyline was increased recently due to uncontrolled depressive symptoms.", "7. Vital signs: temperature 37.1\u00b0C (99.8\u00b0F), pulse rate 80/min, respiratory rate 14/min, and blood pressure 110/70 mm Hg.", "8. On examination, she has dry oral mucous membranes.", "9. The remainder of the examination shows no abnormalities."]}
{"id": 118, "question": "Based on the description of these patients symptoms and current treatment regime, which of the following categories describes the severity of this child\u2019s symptoms?", "context": ["An 8-year-old girl is brought by her mother to her pediatrician\u2019s office for a follow-up visit.", "She was diagnosed with asthma about 4 years ago and has been on medications ever since.", "She came into the doctor\u2019s office about a month ago with an escalation of her symptoms.", "She told her doctor that she has been struggling to breathe almost every single day.", "This difficulty increased when she played outdoors with her friends.", "She said that she used to wake up at least 3 times a week from sleep to use her inhaler.", "She uses a short-acting \u03b2-agonist inhaler to control her symptoms.", "At the previous visit, her doctor had started her on a small dose of fluticasone (inhaled) as well as a long-acting \u03b2-agonist inhaler.", "She has some improvement in her symptoms.", "On physical examination, she doesn\u2019t seem to be in distress, and currently, the lungs are clear on auscultation.", "Her forced expiratory volume in one second is about 70% of the predicted value."], "context_len": 11, "options": {"A": "Mild intermittent", "B": "Mild persistent", "C": "Moderate persistent", "D": "Severe persistent"}, "answer": "Moderate persistent", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 8-year-old girl is brought by her mother to her pediatrician\u2019s office for a follow-up visit.", "2. She was diagnosed with asthma about 4 years ago and has been on medications ever since.", "3. She came into the doctor\u2019s office about a month ago with an escalation of her symptoms.", "4. She told her doctor that she has been struggling to breathe almost every single day.", "5. This difficulty increased when she played outdoors with her friends.", "6. She said that she used to wake up at least 3 times a week from sleep to use her inhaler.", "7. She uses a short-acting \u03b2-agonist inhaler to control her symptoms.", "8. At the previous visit, her doctor had started her on a small dose of fluticasone (inhaled) as well as a long-acting \u03b2-agonist inhaler.", "9. She has some improvement in her symptoms.", "10. On physical examination, she doesn\u2019t seem to be in distress.", "11. Currently, the lungs are clear on auscultation.", "12. Her forced expiratory volume in one second is about 70% of the predicted value."], "atomic_facts": ["1. She was diagnosed with asthma about 4 years ago.", "2. She has been on medications ever since.", "3. She came into the doctor\u2019s office about a month ago with an escalation of her symptoms.", "4. She has been struggling to breathe almost every single day.", "5. Her difficulty increased when she played outdoors with her friends.", "6. She used to wake up at least 3 times a week from sleep to use her inhaler.", "7. She uses a short-acting \u03b2-agonist inhaler to control her symptoms.", "8. At the previous visit, her doctor had started her on a small dose of fluticasone (inhaled) as well as a long-acting \u03b2-agonist inhaler.", "9. She has some improvement in her symptoms.", "10. On physical examination, she doesn\u2019t seem to be in distress.", "11. Currently, the lungs are clear on auscultation.", "12. Her forced expiratory volume in one second is about 70% of the predicted value."]}
{"id": 119, "question": "Which drug is suitable in her case for the prevention of headaches?", "context": ["An 18-year-old woman presents with recurrent headaches.", "The pain is usually unilateral, pulsatile in character, exacerbated by light and noise, and usually lasts for a few hours to a full day.", "The pain is sometimes triggered by eating chocolates.", "These headaches disturb her daily routine activities.", "The physical examination was within normal limits.", "She also has essential tremors."], "context_len": 6, "options": {"A": "Ergotamine", "B": "Verapamil", "C": "Valproic", "D": "Propranolol"}, "answer": "Propranolol", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "18 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology", "Headache Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. An 18-year-old woman presents with recurrent headaches.", "2. The pain is usually unilateral.", "3. The pain is pulsatile in character.", "4. The pain is exacerbated by light and noise.", "5. The pain usually lasts for a few hours to a full day.", "6. The pain is sometimes triggered by eating chocolates.", "7. These headaches disturb her daily routine activities.", "8. The physical examination was within normal limits.", "9. She also has essential tremors."], "atomic_facts": ["1. The pain is usually unilateral.", "2. The pain is pulsatile in character.", "3. The pain is exacerbated by light and noise.", "4. The pain usually lasts for a few hours to a full day.", "5. The pain is sometimes triggered by eating chocolates.", "6. These headaches disturb her daily routine activities.", "7. The physical examination was within normal limits.", "8. She also has essential tremors."]}
{"id": 120, "question": "An MRI scan of the head is most likely to show which of the following?", "context": ["A 26-year-old man is brought to the emergency department by the police after threatening to harm his roommate earlier today.", "He reports that someone on the radio told him to do so.", "His family reports that, during the past two years, the patient has become increasingly more withdrawn from family and friends.", "He states that he has spent the majority of the last year alone in his room \u201cworking on a project at home to save the earth from an evil alien power.\u201d There is no family history of serious illness.", "He has smoked marijuana on a daily basis since he was thirteen.", "Vital signs are within normal limits.", "On mental status examination, he has a flat affect and his speech is disorganized."], "context_len": 7, "options": {"A": "Periventricular plaques and white matter lesions", "B": "Ring-enhancing lesion", "C": "Hyperintense temporal lobe lesion", "D": "Enlarged cerebral ventricles"}, "answer": "Enlarged cerebral ventricles", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "26 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 26-year-old man is brought to the emergency department by the police. ", "2. He threatened to harm his roommate earlier today. ", "3. He reports that someone on the radio told him to do so. ", "4. His family reports that he has become increasingly more withdrawn from family and friends during the past two years. ", "5. He states that he has spent the majority of the last year alone in his room \u201cworking on a project at home to save the earth from an evil alien power.\u201d ", "6. There is no family history of serious illness. ", "7. He has smoked marijuana on a daily basis since he was thirteen. ", "8. Vital signs are within normal limits. ", "9. On mental status examination, he has a flat affect. ", "10. On mental status examination, his speech is disorganized."], "atomic_facts": ["1. He reports that someone on the radio told him to do so.", "2. His family reports that, during the past two years, the patient has become increasingly more withdrawn from family and friends.", "3. He states that he has spent the majority of the last year alone in his room \u201cworking on a project at home to save the earth from an evil alien power.\u201d", "4. There is no family history of serious illness.", "5. He has smoked marijuana on a daily basis since he was thirteen.", "6. Vital signs are within normal limits.", "7. On mental status examination, he has a flat affect and his speech is disorganized."]}
{"id": 121, "question": "Which of the following is the most life-threatening complication of amobarbital withdrawal?", "context": ["A 46-year-old anesthesiologist is found placing several syringes of amobarbital in his backpack prior to leaving the hospital.", "When confronted, the anesthesiologist admits that he began abusing the medication the previous year, after his divorce was finalized.", "He has been using it on a daily basis since then, and his most recent usage was 8 hours ago."], "context_len": 3, "options": {"A": "Internal bleeding", "B": "Respiratory depression", "C": "Cardiovascular collapse", "D": "Self-inflicted violence"}, "answer": "Cardiovascular collapse", "answer_idx": "C", "explanation": "", "patient": {"gender": "Not specified", "age": "46 years old", "specialties": ["Emergency Medicine", "Psychiatry"], "subspecialties": ["Medical Toxicology", "Addiction Psychiatry"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 46-year-old anesthesiologist was found placing several syringes of amobarbital in his backpack.", "2. He was confronted about it.", "3. He admitted to abusing the medication since the previous year.", "4. His divorce was finalized the previous year.", "5. He has been using the medication on a daily basis since then.", "6. His most recent usage was 8 hours ago."], "atomic_facts": ["1. The anesthesiologist admits to abusing medication.", "2. The abuse began the previous year.", "3. The abuse started after his divorce was finalized.", "4. He has been using the medication daily since then.", "5. His most recent usage was 8 hours ago."]}
{"id": 122, "question": "What is the mechanism of action of the medication that can be used in the management of this patient\u2019s condition?", "context": ["A 55-year-old man is brought to the emergency department for 1 episode of bloody emesis.", "He reports feeling lightheaded this morning and shortly after breakfast, he felt nauseous and had an episode of bloody emesis.", "He denies any trauma, fever, abnormal ingestions, or recent infections.", "He endorses black stools over the past few days.", "His past medical history is significant for alcohol abuse and cirrhosis.", "A physical examination demonstrates mild jaundice and ascites."], "context_len": 6, "options": {"A": "Antagonists of \u00df1 and \u00df2 adrenergic receptors", "B": "Reversible block of histamine H2 receptors", "C": "Somatostatin analog leading to constriction of the splanchnic vessels", "D": "Stimulation of cGMP production leading to vascular smooth muscle relaxation"}, "answer": "Somatostatin analog leading to constriction of the splanchnic vessels", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old man is brought to the emergency department.", "2. He reports feeling lightheaded this morning.", "3. He felt nauseous shortly after breakfast.", "4. He had an episode of bloody emesis.", "5. He denies any trauma, fever, abnormal ingestions, or recent infections.", "6. He endorses black stools over the past few days.", "7. His past medical history is significant for alcohol abuse and cirrhosis.", "8. A physical examination demonstrates mild jaundice.", "9. A physical examination demonstrates ascites."], "atomic_facts": ["1. He reports feeling lightheaded this morning.", "2. Shortly after breakfast, he felt nauseous.", "3. He had an episode of bloody emesis.", "4. He denies any trauma.", "5. He denies fever.", "6. He denies abnormal ingestions.", "7. He denies recent infections.", "8. He endorses black stools over the past few days.", "9. His past medical history is significant for alcohol abuse.", "10. His past medical history is significant for cirrhosis.", "11. A physical examination demonstrates mild jaundice.", "12. A physical examination demonstrates ascites."]}
{"id": 123, "question": "Which of the following is the most likely diagnosis?", "context": ["Shortly after undergoing a bipolar prosthesis for a displaced femoral neck fracture of the left hip acquired after a fall the day before, an 80-year-old woman suddenly develops dyspnea.", "The surgery under general anesthesia with sevoflurane was uneventful, lasting 98 minutes, during which the patient maintained oxygen saturation readings of 96\u2013100% on 8 L of oxygen.", "She has a history of hypertension, osteoporosis, and osteoarthritis of her right knee.", "Her medications include ramipril, naproxen, ranitidine, and a multivitamin.", "She appears cyanotic, drowsy, and is oriented only to person.", "Her temperature is 38.6\u00b0C (101.5\u00b0F), pulse is 135/minute, respirations are 36/min, and blood pressure is 155/95 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 81%.", "There are several scattered petechiae on the anterior chest wall.", "Laboratory studies show a hemoglobin concentration of 10.5 g/dL, a leukocyte count of 9,000/mm3, a platelet count of 145,000/mm3, and a creatine kinase of 190 U/L.", "An ECG shows sinus tachycardia."], "context_len": 10, "options": {"A": "Fat embolism", "B": "Thyrotoxic crisis", "C": "Malignant hyperthermia", "D": "Meningitis\n\""}, "answer": "Fat embolism", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "80 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. An 80-year-old woman underwent a bipolar prosthesis for a displaced femoral neck fracture of the left hip acquired after a fall the day before.", "2. The surgery was uneventful, lasting 98 minutes, during which the patient maintained oxygen saturation readings of 96\u2013100% on 8 L of oxygen.", "3. The patient has a history of hypertension, osteoporosis, and osteoarthritis of her right knee.", "4. Her medications include ramipril, naproxen, ranitidine, and a multivitamin.", "5. Shortly after the surgery, the patient suddenly develops dyspnea.", "6. She appears cyanotic, drowsy, and is oriented only to person.", "7. Her temperature is 38.6\u00b0C (101.5\u00b0F), pulse is 135/minute, respirations are 36/min, and blood pressure is 155/95 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 81%.", "9. There are several scattered petechiae on the anterior chest wall.", "10. Laboratory studies show a hemoglobin concentration of 10.5 g/dL, a leukocyte count of 9,000/mm3, a platelet count of 145,000/mm3, and a creatine kinase of 190 U/L.", "11. An ECG shows sinus tachycardia."], "atomic_facts": ["1. The surgery was under general anesthesia with sevoflurane.", "2. The surgery lasted 98 minutes.", "3. The patient maintained oxygen saturation readings of 96\u2013100% on 8 L of oxygen during the surgery.", "4. The patient has a history of hypertension, osteoporosis, and osteoarthritis of her right knee.", "5. The patient's medications include ramipril, naproxen, ranitidine, and a multivitamin.", "6. The patient appears cyanotic, drowsy, and is oriented only to person.", "7. The patient's temperature is 38.6\u00b0C (101.5\u00b0F).", "8. The patient's pulse is 135/minute.", "9. The patient's respirations are 36/min.", "10. The patient's blood pressure is 155/95 mm Hg.", "11. Pulse oximetry on room air shows an oxygen saturation of 81%.", "12. There are several scattered petechiae on the anterior chest wall.", "13. Laboratory studies show a hemoglobin concentration of 10.5 g/dL.", "14. Laboratory studies show a leukocyte count of 9,000/mm3.", "15. Laboratory studies show a platelet count of 145,000/mm3.", "16. Laboratory studies show a creatine kinase of 190 U/L.", "17. An ECG shows sinus tachycardia."]}
{"id": 124, "question": "Laboratory studies will most likely demonstrate the following in this patient?", "context": ["A 34-year-old woman presents to her primary care physician complaining of weakness and rash for the past 2 months.", "She says her symptoms had a gradual onset at first, but over the past 2 weeks she has grown more concerned as she now has difficulty going up and down the stairs in her apartment.", "Her rash is nonpruritic and confined to her knuckles.", "She denies fever, chills, and changes in bowel habits, cough, or shortness of breath.", "Up until the onset of her symptoms she had been an avid hiker in upstate New York.", "Temperature is 98.0\u00b0F (36.7\u00b0C) blood pressure is 110/72 mmHg, pulse is 88/min, and respirations are 20/min.", "Physical examination demonstrates 4-/5 strength in the proximal lower extremities.", "The patient's cutaneous findings are demonstrated in figure A."], "context_len": 8, "options": {"A": "Anti-histidyl tRNA synthetase antibodies", "B": "Anti-histone antibodies", "C": "Anti-HMG CoA reductase antibodies", "D": "Anti-mitochondrial antibodies"}, "answer": "Anti-histidyl tRNA synthetase antibodies", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 34-year-old woman.", "2. Patient has been experiencing weakness and rash for the past 2 months.", "3. Symptoms had a gradual onset at first.", "4. Over the past 2 weeks patient has difficulty going up and down stairs.", "5. Rash is nonpruritic and confined to knuckles.", "6. Patient denies fever, chills, changes in bowel habits, cough, or shortness of breath.", "7. Patient was an avid hiker in upstate New York prior to onset of symptoms.", "8. Temperature is 98.0\u00b0F (36.7\u00b0C).", "9. Blood pressure is 110/72 mmHg.", "10. Pulse is 88/min.", "11. Respirations are 20/min.", "12. Physical examination demonstrates 4-/5 strength in proximal lower extremities.", "13. Cutaneous findings are demonstrated in figure A."], "atomic_facts": ["1. The patient's symptoms had a gradual onset at first.", "2. Over the past 2 weeks, the patient has had difficulty going up and down the stairs in her apartment.", "3. The rash is nonpruritic.", "4. The rash is confined to the patient's knuckles.", "5. The patient denies fever, chills, and changes in bowel habits, cough, or shortness of breath.", "6. Up until the onset of her symptoms, the patient had been an avid hiker in upstate New York.", "7. The patient's temperature is 98.0\u00b0F (36.7\u00b0C).", "8. The patient's blood pressure is 110/72 mmHg.", "9. The patient's pulse is 88/min.", "10. The patient's respirations are 20/min.", "11. Physical examination demonstrates 4-/5 strength in the proximal lower extremities.", "12. The patient's cutaneous findings are demonstrated in figure A."]}
{"id": 125, "question": "Which of the following is the most likely etiology of the patient's presentation?", "context": ["A 4-day-old, full-term infant born by uncomplicated vaginal delivery is brought to a pediatrician by his mother, who notes that her son's skin appears yellow.", "She reports that the child cries several times per day, but sleeps 7-8 hours at night, uninterrupted.", "She has been breastfeeding exclusively and feels that he has been feeding well.", "He has been having a bowel movement on average once every 3 days."], "context_len": 4, "options": {"A": "Breastfeeding jaundice", "B": "Breast milk jaundice", "C": "Glucose-6-phosphate dehydrogenase deficiency", "D": "Hepatitis A"}, "answer": "Breastfeeding jaundice", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "4-day-old infant", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-day-old, full-term infant was born by uncomplicated vaginal delivery.", "2. The infant was brought to a pediatrician by his mother.", "3. The mother noted that her son's skin appears yellow.", "4. The child cries several times per day.", "5. The child sleeps 7-8 hours at night, uninterrupted.", "6. The mother has been breastfeeding exclusively.", "7. The mother feels that the infant has been feeding well.", "8. The infant has been having a bowel movement on average once every 3 days."], "atomic_facts": ["1. The child cries several times per day.", "2. The child sleeps 7-8 hours at night, uninterrupted.", "3. The mother has been breastfeeding exclusively.", "4. The mother feels that the child has been feeding well.", "5. The child has been having a bowel movement on average once every 3 days."]}
{"id": 126, "question": "Which of the following is the strongest predisposing factor for this patient's condition?", "context": ["A 23-year-old female comes to the office because of a 3-week history of vaginal discharge and itching despite cleaning her genitals with a vaginal douche.", "Her last menstrual period was one week ago.", "She is sexually active with her new boyfriend.", "She has an intrauterine device and does not use barrier protection.", "She was treated for a sore throat infection one month ago.", "Speculum examination shows erythema around the vaginal introitus and copious white discharge.", "Vaginal pH is 4.3 and a KOH test shows multiple pseudohyphae on microscopy."], "context_len": 7, "options": {"A": "Suppression of vaginal bacterial flora", "B": "Increased vaginal pH", "C": "Intrauterine device", "D": "Unprotected sexual intercourse"}, "answer": "Suppression of vaginal bacterial flora", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "23", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 23-year-old female comes to the office.", "2. She has a 3-week history of vaginal discharge and itching.", "3. She has been cleaning her genitals with a vaginal douche.", "4. Her last menstrual period was one week ago.", "5. She is sexually active with her new boyfriend.", "6. She has an intrauterine device.", "7. She does not use barrier protection.", "8. She was treated for a sore throat infection one month ago.", "9. Speculum examination shows erythema around the vaginal introitus and copious white discharge.", "10. Vaginal pH is 4.3.", "11. A KOH test shows multiple pseudohyphae on microscopy."], "atomic_facts": ["1. Her last menstrual period was one week ago.", "2. She is sexually active with her new boyfriend.", "3. She has an intrauterine device and does not use barrier protection.", "4. She was treated for a sore throat infection one month ago.", "5. Speculum examination shows erythema around the vaginal introitus and copious white discharge.", "6. Vaginal pH is 4.3.", "7. KOH test shows multiple pseudohyphae on microscopy."]}
{"id": 127, "question": "Which of the following interventions would have been most effective to prevent this condition?", "context": ["A 3-year-old boy who has no known past medical or family history is brought by his parents to his pediatrician for new symptoms.", "Specifically, his parents state that he has suffered from a fever associated with diarrhea and conjunctivitis over the past week or so.", "His parents note that he has never had an episode of diarrhea like this previously, but that several other children at his daycare had been ill recently.", "The blood pressure is 112/70 mm Hg, heart rate is 94/min, respiratory rate is 14/min, and temperature is 37.0\u00b0C (98.6\u00b0F).", "The physical exam is significant for preauricular adenopathy."], "context_len": 5, "options": {"A": "Appropriate immunization", "B": "Better hand-washing practices", "C": "Keeping all food stored in the refrigerator", "D": "Avoiding undercooked seafood"}, "answer": "Better hand-washing practices", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 3-year-old boy.", "2. Patient has no known past medical or family history.", "3. Patient has been suffering from a fever associated with diarrhea and conjunctivitis over the past week or so.", "4. Patient has never had an episode of diarrhea like this previously.", "5. Several other children at patient's daycare had been ill recently.", "6. Patient's blood pressure is 112/70 mm Hg.", "7. Patient's heart rate is 94/min.", "8. Patient's respiratory rate is 14/min.", "9. Patient's temperature is 37.0\u00b0C (98.6\u00b0F).", "10. Physical exam is significant for preauricular adenopathy."], "atomic_facts": ["1. The patient has suffered from a fever associated with diarrhea and conjunctivitis over the past week.", "2. The patient has never had an episode of diarrhea like this previously.", "3. Several other children at his daycare had been ill recently.", "4. The patient's blood pressure is 112/70 mm Hg.", "5. The patient's heart rate is 94/min.", "6. The patient's respiratory rate is 14/min.", "7. The patient's temperature is 37.0\u00b0C (98.6\u00b0F).", "8. The physical exam is significant for preauricular adenopathy."]}
{"id": 128, "question": "What would be the most likely finding on wet mount?", "context": ["A 24-year-old woman with no past medical history presents to her PCP for a routine checkup.", "She feels generally healthy but has noticed a new vaginal discharge that has a strange odor.", "The patient has been in a long-term relationship and denies any new sexual partners.", "She denies vaginal itching, abnormal menstruation, or dyspareunia.", "Vital signs are within normal limits.", "The physical exam reveals thin, greyish-white vaginal discharge but is otherwise unremarkable.", "A sample of this discharge is collected."], "context_len": 7, "options": {"A": "Motile, flagellated protozoans", "B": "Long, branching filamentous structures", "C": "Epithelial cells with stippling", "D": "Large mucoid capsules"}, "answer": "Epithelial cells with stippling", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "24", "specialties": ["Internal Medicine", "Obstetrics and Gynecology", "Pathology"], "subspecialties": ["Infectious Disease", "General Obstetrics and Gynecology", "Medical Microbiology Pathology"], "specialty_prob": [0.4, 0.4, 0.2], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 24-year-old woman presents to her PCP for a routine checkup.", "2. She feels generally healthy.", "3. She has noticed a new vaginal discharge with a strange odor.", "4. She has been in a long-term relationship.", "5. She denies any new sexual partners.", "6. She denies vaginal itching, abnormal menstruation, or dyspareunia.", "7. Vital signs are within normal limits.", "8. The physical exam reveals thin, greyish-white vaginal discharge.", "9. The physical exam is otherwise unremarkable.", "10. A sample of this discharge is collected."], "atomic_facts": ["1. The patient feels generally healthy.", "2. The patient has noticed a new vaginal discharge with a strange odor.", "3. The patient has been in a long-term relationship.", "4. The patient denies any new sexual partners.", "5. The patient denies vaginal itching.", "6. The patient denies abnormal menstruation.", "7. The patient denies dyspareunia.", "8. Vital signs are within normal limits.", "9. The physical exam reveals thin, greyish-white vaginal discharge.", "10. The physical exam is otherwise unremarkable.", "11. A sample of the discharge is collected."]}
{"id": 129, "question": "Laboratory studies show: | Hemoglobin 13.5 g/dL | Leukocyte count 9,520/mm3 | Platelet count 853,000/mm3 | Serum | Na+ 136 mEq/L | K+ 3.7 mEq/L | Cl- 96 mEq/L | Ca2+ 11.0 mg/dL | HCO3- 25 mEq/L | Glucose 102 mg/dL | Creatinine 1.0 mg/dL | Uric acid 10.5 mg/dL | Further evaluation of this patient is most likely to show which of the following?", "context": ["A 50-year-old African-American woman comes to the physician because of right elbow pain for the past 12 hours.", "The pain is currently at 7 out of 10 in intensity.", "She has not had any trauma to the right elbow.", "She also reports general malaise.", "She had a miscarriage at the age of 37 years.", "One year ago, she had carpal tunnel syndrome that was treated with a volar splint.", "Three months ago, she was diagnosed with thrombophlebitis, which responded well to treatment with ibuprofen and compression therapy.", "She runs 5 km (3.1 miles) per week.", "She works as an accountant.", "She drinks 1\u20132 glasses of wine on weekends.", "She is 171 cm (5 ft 7 in) tall and weighs 70 kg (154 lbs); BMI is 23.9 kg/m2.", "Her pulse is 110/min, blood pressure is 130/80 mm Hg, and temperature is 38.3\u00b0C (101\u00b0F).", "On physical examination, the skin above her right elbow is erythematous and severely tender to palpation."], "context_len": 13, "options": {"A": "Mutation in Janus kinase 2 gene", "B": "Howell-Jolly bodies", "C": "Antibodies against citrullinated peptides", "D": "Anti-phospholipid antibodies"}, "answer": "Mutation in Janus kinase 2 gene", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "50", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 50-year-old African-American woman.", "2. Patient has right elbow pain for the past 12 hours.", "3. Pain is currently at 7 out of 10 in intensity.", "4. Patient has not had any trauma to the right elbow.", "5. Patient also reports general malaise.", "6. Patient had a miscarriage at the age of 37 years.", "7. Patient had carpal tunnel syndrome one year ago.", "8. Patient was treated with a volar splint for carpal tunnel syndrome.", "9. Patient was diagnosed with thrombophlebitis three months ago.", "10. Patient was treated with ibuprofen and compression therapy for thrombophlebitis.", "11. Patient runs 5 km (3.1 miles) per week.", "12. Patient works as an accountant.", "13. Patient drinks 1\u20132 glasses of wine on weekends.", "14. Patient is 171 cm (5 ft 7 in) tall.", "15. Patient weighs 70 kg (154 lbs).", "16. Patient's BMI is 23.9 kg/m2.", "17. Patient's pulse is 110/min.", "18. Patient's blood pressure is 130/80 mm Hg.", "19. Patient's temperature is 38.3\u00b0C (101\u00b0F).", "20. On physical examination, the skin above patient's right elbow is erythematous and severely tender to palpation."], "atomic_facts": ["1. The pain is currently at 7 out of 10 in intensity.", "2. She has not had any trauma to the right elbow.", "3. She also reports general malaise.", "4. She had a miscarriage at the age of 37 years.", "5. One year ago, she had carpal tunnel syndrome that was treated with a volar splint.", "6. Three months ago, she was diagnosed with thrombophlebitis, which responded well to treatment with ibuprofen and compression therapy.", "7. She runs 5 km (3.1 miles) per week.", "8. She works as an accountant.", "9. She drinks 1\u20132 glasses of wine on weekends.", "10. She is 171 cm (5 ft 7 in) tall and weighs 70 kg (154 lbs); BMI is 23.9 kg/m2.", "11. Her pulse is 110/min, blood pressure is 130/80 mm Hg, and temperature is 38.3\u00b0C (101\u00b0F).", "12. On physical examination, the skin above her right elbow is erythematous and severely tender to palpation."]}
{"id": 130, "question": "Which of the following is a treatment option for the patient\u2019s most likely diagnosis?", "context": ["A 64-year-old man is brought to his primary care physician by his daughter for forgetfulness.", "The patient\u2019s daughter reports that over the past 2 weeks the patient has become more confused.", "He did not remember to pick up his car from the body shop last week, and yesterday, he did not show up to his grandson\u2019s birthday party.", "When she went over to the patient\u2019s house to check on him, she noticed the mailbox was stuffed with unopened letters.", "The patient says \u201cI\u2019m fine.", "I just have a headache.\u201d The patient\u2019s daughter adds, \u201cI just hope you\u2019re not drinking again dad.", "Your neighbor saw you fall outside the house a few weeks ago, and the other day you said you were nauseous and vomited.\u201d The patient\u2019s medical history is significant for a history of alcohol abuse, hypertension, hyperlipidemia, and atrial fibrillation.", "He takes aspirin, amlodipine, metoprolol, atorvastatin, and warfarin.", "He smokes cigars, but denies alcohol use since he started psychotherapy 7 months ago.", "The patient\u2019s temperature is 97\u00b0F (36.1\u00b0C), blood pressure is 144/92 mmHg, and pulse is 82/min.", "On physical examination, there is a 3 cm ecchymosis on the right scalp.", "No focal neurological deficits are appreciated.", "Gait is normal.", "An initial complete blood count shows normocytic anemia.", "The patient\u2019s INR is 2.5.", "Imaging is pending."], "context_len": 16, "options": {"A": "Alteplase", "B": "Burr hole", "C": "Donepezil", "D": "Thiamine supplementation"}, "answer": "Burr hole", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "64 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 64-year-old man is brought to his primary care physician by his daughter. ", "2. The daughter reports that the patient has become more confused over the past 2 weeks. ", "3. The patient did not remember to pick up his car from the body shop last week. ", "4. The patient did not show up to his grandson\u2019s birthday party yesterday. ", "5. The daughter noticed the mailbox was stuffed with unopened letters when she went to check on the patient. ", "6. The patient says he has a headache. ", "7. The daughter is concerned the patient is drinking again. ", "8. The patient's neighbor saw him fall outside the house a few weeks ago. ", "9. The patient said he was nauseous and vomited the other day. ", "10. The patient's medical history is significant for a history of alcohol abuse, hypertension, hyperlipidemia, and atrial fibrillation. ", "11. The patient takes aspirin, amlodipine, metoprolol, atorvastatin, and warfarin. ", "12. The patient smokes cigars. ", "13. The patient denies alcohol use since he started psychotherapy 7 months ago. ", "14. The patient's temperature is 97\u00b0F (36.1\u00b0C). ", "15. The patient's blood pressure is 144/92 mmHg. ", "16. The patient's pulse is 82/min. ", "17. On physical examination, there is a 3 cm ecchymosis on the right scalp. ", "18. No focal neurological deficits are appreciated. ", "19. Gait is normal. ", "20. An initial complete blood count shows normocytic anemia. ", "21. The patient's INR is 2.5. ", "22. Imaging is pending."], "atomic_facts": ["1. The patient's daughter reports increased confusion over the past 2 weeks.", "2. The patient forgot to pick up his car from the body shop last week.", "3. The patient did not attend his grandson's birthday party.", "4. The patient's mailbox was stuffed with unopened letters.", "5. The patient claims to be fine but complains of a headache.", "6. The patient's neighbor witnessed a fall outside the house a few weeks ago.", "7. The patient experienced nausea and vomiting recently.", "8. The patient has a history of alcohol abuse, hypertension, hyperlipidemia, and atrial fibrillation.", "9. The patient takes aspirin, amlodipine, metoprolol, atorvastatin, and warfarin.", "10. The patient smokes cigars but denies alcohol use since starting psychotherapy 7 months ago.", "11. The patient's temperature is 97\u00b0F (36.1\u00b0C), blood pressure is 144/92 mmHg, and pulse is 82/min.", "12. A 3 cm ecchymosis is present on the right scalp.", "13. No focal neurological deficits are observed.", "14. Gait is normal.", "15. Initial complete blood count shows normocytic anemia.", "16. The patient's INR is 2.5.", "17. Imaging is pending."]}
{"id": 131, "question": "Which of the following is the most likely diagnosis?", "context": ["A 60-year-old man presents to the physician for a follow-up examination.", "During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound.", "He has no complaints other than fatigue for several months.", "There is no history of serious illness.", "His only medication is acetaminophen for knee pain.", "The temperature is 36.7\u2103 (98.1\u2109), pulse is 68, respirations are 12/min, and blood pressure is 125/70 mm Hg.", "On physical examination, the spleen size on percussion is 16 cm (6.2 in).", "Otherwise, the physical examination shows no abnormalities.", "The laboratory test results are as follows: | Hemoglobin 10 g/dL | Mean corpuscular volume 90 \u03bcm3 | Leukocyte count 80,000/mm3 | Platelet count 450,000/mm3 | The peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "The cytogenetic study shows t(9;22)."], "context_len": 10, "options": {"A": "Acute lymphoid leukemia", "B": "Chronic myeloid leukemia", "C": "Hairy cell leukemia", "D": "Burkitt lymphoma"}, "answer": "Chronic myeloid leukemia", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "60", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 60-year-old man presents to the physician for a follow-up examination.", "2. During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound.", "3. He has no complaints other than fatigue for several months.", "4. There is no history of serious illness.", "5. His only medication is acetaminophen for knee pain.", "6. The temperature is 36.7\u2103 (98.1\u2109).", "7. Pulse is 68.", "8. Respirations are 12/min.", "9. Blood pressure is 125/70 mm Hg.", "10. On physical examination, the spleen size on percussion is 16 cm (6.2 in).", "11. Otherwise, the physical examination shows no abnormalities.", "12. The laboratory test results are as follows: Hemoglobin 10 g/dL.", "13. Mean corpuscular volume 90 \u03bcm3.", "14. Leukocyte count 80,000/mm3.", "15. Platelet count 450,000/mm3.", "16. The peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "17. The cytogenetic study shows t(9;22)."], "atomic_facts": ["1. Splenomegaly was detected during the previous visit.", "2. The splenomegaly was confirmed by abdominal ultrasound.", "3. The patient has been experiencing fatigue for several months.", "4. There is no history of serious illness.", "5. The patient's only medication is acetaminophen for knee pain.", "6. The temperature is 36.7\u2103 (98.1\u2109).", "7. The pulse is 68.", "8. The respirations are 12/min.", "9. The blood pressure is 125/70 mm Hg.", "10. The spleen size on percussion is 16 cm (6.2 in).", "11. The physical examination shows no other abnormalities.", "12. Laboratory test results: Hemoglobin 10 g/dL.", "13. Laboratory test results: Mean corpuscular volume 90 \u03bcm3.", "14. Laboratory test results: Leukocyte count 80,000/mm3.", "15. Laboratory test results: Platelet count 450,000/mm3.", "16. The peripheral blood smear shows a predominance of neutrophils.", "17. The peripheral blood smear shows the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "18. The cytogenetic study shows t(9;22)."]}
{"id": 132, "question": "Which of the following enzymes is most likely impaired?", "context": ["A 55-year-old man comes to the physician because of balance problems.", "He follows a vegan diet and does not eat meat, eggs, or dairy.", "Physical examination shows pale oral mucosa and conjunctivae.", "Neurologic examination shows normal strength in all extremities and decreased sense to vibration in his lower extremities bilaterally.", "A peripheral blood smear is shown."], "context_len": 5, "options": {"A": "Succinate dehydrogenase", "B": "Propionyl-CoA carboxylase", "C": "Pyruvate carboxylase", "D": "Methylmalonyl-CoA mutase"}, "answer": "Methylmalonyl-CoA mutase", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "Balance problems could be related to a neurological issue. The subspecialty that would be most relevant for this patient is General Neurology."], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 55-year-old man comes to the physician because of balance problems.", "2. He follows a vegan diet and does not eat meat, eggs, or dairy.", "3. Physical examination shows pale oral mucosa and conjunctivae.", "4. Neurologic examination shows normal strength in all extremities.", "5. Neurologic examination shows decreased sense to vibration in his lower extremities bilaterally.", "6. A peripheral blood smear is shown."], "atomic_facts": ["1. He follows a vegan diet.", "2. He does not eat meat, eggs, or dairy.", "3. Physical examination shows pale oral mucosa.", "4. Physical examination shows pale conjunctivae.", "5. Neurologic examination shows normal strength in all extremities.", "6. Neurologic examination shows decreased sense to vibration in his lower extremities bilaterally.", "7. A peripheral blood smear is shown."]}
{"id": 133, "question": "Which of the following is the next best step in management?", "context": ["A 32-year-old woman presents to her primary care physician for generalized fatigue.", "She states that she is doing well but that she always feels tired.", "She started exercising to have more energy, finds that she tires easily, and has not felt motivated to return to the gym.", "She is doing well and is excelling at her job.", "She recently started a vegan diet in order to try and become healthy.", "She is currently struggling with dating and is unable to find a compatible mate and feels hopeless about this.", "The patient has a past medical history of uterine leiomyomas.", "Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 100/68 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air.", "Laboratory values are ordered as seen below. |  | Hemoglobin: 10 g/dL | Hematocrit: 32% | MCV: 78 \u00b5m^3 | Ferritin: 10 mg/mL | Total iron binding capacity: 620 mcg/dL | Leukocyte count: 6,500/mm^3 with normal differential | Platelet count: 190,000/mm^3 |  | Serum: | Na+: 141 mEq/L | Cl-: 102 mEq/L | K+: 4.1 mEq/L | HCO3-: 24 mEq/L | BUN: 20 mg/dL | Glucose: 99 mg/dL | Creatinine: 1.1 mg/dL | Ca2+: 10.2 mg/dL | TSH: 4.7 mIU/mL | AST: 12 U/L | ALT: 10 U/L |  | ."], "context_len": 9, "options": {"A": "Vitamin B9", "B": "Vitamin B12", "C": "Iron", "D": "Assess for depression"}, "answer": "Iron", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "32 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology", "General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 32-year-old woman presents to her primary care physician for generalized fatigue.", "2. She states that she is doing well but that she always feels tired.", "3. She started exercising to have more energy, finds that she tires easily, and has not felt motivated to return to the gym.", "4. She is doing well and is excelling at her job.", "5. She recently started a vegan diet in order to try and become healthy.", "6. She is currently struggling with dating and is unable to find a compatible mate and feels hopeless about this.", "7. The patient has a past medical history of uterine leiomyomas.", "8. Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 100/68 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air.", "9. Laboratory values are ordered as seen below.", "10. Hemoglobin: 10 g/dL", "11. Hematocrit: 32%", "12. MCV: 78 \u00b5m^3", "13. Ferritin: 10 mg/mL", "14. Total iron binding capacity: 620 mcg/dL", "15. Leukocyte count: 6,500/mm^3 with normal differential", "16. Platelet count: 190,000/mm^3", "17. Serum: Na+: 141 mEq/L", "18. Serum: Cl-: 102 mEq/L", "19. Serum: K+: 4.1 mEq/L", "20. Serum: HCO3-: 24 mEq/L", "21. Serum: BUN: 20 mg/dL", "22. Serum: Glucose: 99 mg/dL", "23. Serum: Creatinine: 1.1 mg/dL", "24. Serum: Ca2+: 10.2 mg/dL", "25. Serum: TSH: 4.7 mIU/mL", "26. Serum: AST: 12 U/L", "27. Serum: ALT: 10 U/L"], "atomic_facts": ["1. The patient states that she is doing well but always feels tired.", "2. She started exercising to have more energy, but finds that she tires easily and has not felt motivated to return to the gym.", "3. She is excelling at her job.", "4. She recently started a vegan diet to try and become healthy.", "5. She is currently struggling with dating and is unable to find a compatible mate, feeling hopeless about this.", "6. The patient has a past medical history of uterine leiomyomas.", "7. Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 100/68 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air.", "8. Laboratory values: Hemoglobin: 10 g/dL, Hematocrit: 32%, MCV: 78 \u00b5m^3, Ferritin: 10 mg/mL, Total iron binding capacity: 620 mcg/dL, Leukocyte count: 6,500/mm^3 with normal differential, Platelet count: 190,000/mm^3, Serum: Na+: 141 mEq/L, Cl-: 102 mEq/L, K+: 4.1 mEq/L, HCO3-: 24 mEq/L, BUN: 20 mg/dL, Glucose: 99 mg/dL, Creatinine: 1.1 mg/dL, Ca2+: 10.2 mg/dL, TSH: 4.7 mIU/mL, AST: 12 U/L, ALT: 10 U/L."]}
{"id": 134, "question": "The hormone responsible for the observed laboratory changes most likely increases glucose transport into which of the following types of cells?", "context": ["A 28-year-old woman, gravida 1, para 0, at 24 weeks' gestation comes to the physician for a prenatal visit.", "She feels well.", "She has no history of medical illness and takes no medications.", "Her fasting serum glucose is 91 mg/dL.", "One hour after drinking a concentrated glucose solution, her serum glucose concentration is 94 mg/dL."], "context_len": 5, "options": {"A": "Spermatocytes", "B": "Islet cells", "C": "Adipocytes", "D": "Placental cells"}, "answer": "Adipocytes", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 28-year-old woman comes to the physician for a prenatal visit.", "2. She is gravida 1, para 0, and at 24 weeks' gestation.", "3. She feels well.", "4. She has no history of medical illness.", "5. She takes no medications.", "6. Her fasting serum glucose is 91 mg/dL.", "7. One hour after drinking a concentrated glucose solution, her serum glucose concentration is 94 mg/dL."], "atomic_facts": ["1. She feels well.", "2. She has no history of medical illness.", "3. She takes no medications.", "4. Her fasting serum glucose is 91 mg/dL.", "5. One hour after drinking a concentrated glucose solution, her serum glucose concentration is 94 mg/dL."]}
{"id": 135, "question": "Which of the following risk factors is associated with the most likely diagnosis?", "context": ["A 27-year-old woman presents to the emergency department with weakness of her legs which has progressed to an inability for her to stand.", "The patient works as a school teacher in Alaska and regularly goes hiking and camping.", "She recently returned from a camping trip where she hiked through tall brush and drank from mountain streams.", "The patient was also involved in a motor vehicle accident 2 days ago but did not seek treatment.", "The patient has a medical history that is unremarkable and is currently taking multivitamins and other than a recent bout of diarrhea is generally healthy.", "Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 120/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for a very anxious woman with 1/5 strength of the patient\u2019s lower extremities and 2/5 strength of her trunk muscles with diminished sensation.", "Laboratory studies are ordered as seen below. |  | Hemoglobin: 15 g/dL | Hematocrit: 43% | Leukocyte count: 6,500/mm^3 with normal differential | Platelet count: 194,000/mm^3 |  | Serum: | Na+: 138 mEq/L | Cl-: 102 mEq/L | K+: 4.4 mEq/L | HCO3-: 24 mEq/L | BUN: 20 mg/dL | Glucose: 120 mg/dL | Creatinine: 1.0 mg/dL | Ca2+: 10.2 mg/dL | pH: 7.44 | PaCO2: 10 mmHg | PaO2: 90 mmHg | AST: 12 U/L | ALT: 10 U/L |  | The patient complains about difficulty breathing.", "Repeat laboratory values are notable for the findings below. |  | pH: 7.35 | PaCO2: 30 mmHg | PaO2: 80 mmHg |  | The patient is intubated and sent to the MICU."], "context_len": 9, "options": {"A": "Female sex living in a Northern latitude", "B": "Hiking in tick-infested woods", "C": "Consuming meats cooked over a campfire", "D": "Central cervical spine trauma"}, "answer": "Consuming meats cooked over a campfire", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 27-year-old woman presents to the emergency department with weakness of her legs which has progressed to an inability for her to stand.", "2. The patient works as a school teacher in Alaska and regularly goes hiking and camping.", "3. She recently returned from a camping trip where she hiked through tall brush and drank from mountain streams.", "4. The patient was also involved in a motor vehicle accident 2 days ago but did not seek treatment.", "5. The patient has a medical history that is unremarkable and is currently taking multivitamins and other than a recent bout of diarrhea is generally healthy.", "6. Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 120/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air.", "7. Physical exam is notable for a very anxious woman with 1/5 strength of the patient\u2019s lower extremities and 2/5 strength of her trunk muscles with diminished sensation.", "8. Laboratory studies are ordered as seen below: Hemoglobin: 15 g/dL, Hematocrit: 43%, Leukocyte count: 6,500/mm^3 with normal differential, Platelet count: 194,000/mm^3, Serum: Na+: 138 mEq/L, Cl-: 102 mEq/L, K+: 4.4 mEq/L, HCO3-: 24 mEq/L, BUN: 20 mg/dL, Glucose: 120 mg/dL, Creatinine: 1.0 mg/dL, Ca2+: 10.2 mg/dL, pH: 7.44, PaCO2: 10 mmHg, PaO2: 90 mmHg, AST: 12 U/L, ALT: 10 U/L.", "9. The patient complains about difficulty breathing.", "10. Repeat laboratory values are notable for the findings below: pH: 7.35, PaCO2: 30 mmHg, PaO2: 80 mmHg.", "11. The patient is intubated and sent to the MICU."], "atomic_facts": ["1. The patient works as a school teacher in Alaska.", "2. The patient regularly goes hiking and camping.", "3. The patient recently returned from a camping trip where she hiked through tall brush and drank from mountain streams.", "4. The patient was involved in a motor vehicle accident 2 days ago but did not seek treatment.", "5. The patient has a medical history that is unremarkable.", "6. The patient is currently taking multivitamins.", "7. The patient had a recent bout of diarrhea.", "8. The patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "9. The patient's blood pressure is 120/68 mmHg.", "10. The patient's pulse is 120/min.", "11. The patient's respirations are 17/min.", "12. The patient's oxygen saturation is 98% on room air.", "13. Physical exam is notable for a very anxious woman.", "14. The patient has 1/5 strength of the lower extremities and 2/5 strength of her trunk muscles with diminished sensation.", "15. Laboratory studies show: Hemoglobin: 15 g/dL, Hematocrit: 43%, Leukocyte count: 6,500/mm^3 with normal differential, Platelet count: 194,000/mm^3, Serum: Na+: 138 mEq/L, Cl-: 102 mEq/L, K+: 4.4 mEq/L, HCO3-: 24 mEq/L, BUN: 20 mg/dL, Glucose: 120 mg/dL, Creatinine: 1.0 mg/dL, Ca2+: 10.2 mg/dL, pH: 7.44, PaCO2: 10 mmHg, PaO2: 90 mmHg, AST: 12 U/L, ALT: 10 U/L.", "16. The patient complains about difficulty breathing.", "17. Repeat laboratory values show: pH: 7.35, PaCO2: 30 mmHg, PaO2: 80 mmHg.", "18. The patient is intubated and sent to the MICU."]}
{"id": 136, "question": "Which of the following reaction is favored under this condition?", "context": ["An 18-year-old male presents to the emergency room smelling quite heavily of alcohol and is unconscious.", "A blood test reveals severe hypoglycemic and ketoacidemia.", "A previous medical history states that he does not have diabetes.", "The metabolism of ethanol in this patient's hepatocytes resulted in an increase of the [NADH]/[NAD+] ratio."], "context_len": 4, "options": {"A": "Pyruvate to acetyl-CoA", "B": "Citrate to isocitrate", "C": "Oxaloacetate to malate", "D": "Oxaloacetate to phosphoenolpyruvate"}, "answer": "Oxaloacetate to malate", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "18", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. An 18-year-old male presents to the emergency room.", "2. The patient smells quite heavily of alcohol.", "3. The patient is unconscious.", "4. A blood test reveals severe hypoglycemic and ketoacidemia.", "5. The patient does not have diabetes according to their medical history.", "6. The metabolism of ethanol in the patient's hepatocytes increased the [NADH]/[NAD+] ratio."], "atomic_facts": ["1. A blood test reveals severe hypoglycemia.", "2. A blood test reveals ketoacidemia.", "3. The patient does not have diabetes according to previous medical history.", "4. The metabolism of ethanol in the patient's hepatocytes resulted in an increase of the [NADH]/[NAD+] ratio."]}
{"id": 137, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A previously healthy 7-year-old girl is brought to the physician for a well-child examination.", "She feels well.", "She emigrated from India 3 months ago.", "There is no family history of serious illness.", "Her immunizations are up-to-date.", "She is at 60th percentile for height and weight.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 90/min, and respirations are 26/min.", "Examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 13.2 g/dL | Leukocyte count 8900/mm3 | Platelet count 310,000/mm3 | Serum | Hepatitis B surface antigen negative | Hepatitis B antibody positive | Interferon-\u03b3 release assay positive | An x-ray of the chest shows no abnormalities."], "context_len": 9, "options": {"A": "Perform acid-fast stain on induced sputum", "B": "Administer isoniazid", "C": "Perform tuberculin skin test", "D": "Administer isoniazid, rifampin, ethambutol and pyrazinamide"}, "answer": "Administer isoniazid", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 7-year-old girl.", "2. Patient feels well.", "3. Patient emigrated from India 3 months ago.", "4. No family history of serious illness.", "5. Immunizations are up-to-date.", "6. Patient is at 60th percentile for height and weight.", "7. Temperature is 37\u00b0C (98.6\u00b0F).", "8. Pulse is 90/min.", "9. Respirations are 26/min.", "10. Examination shows no abnormalities.", "11. Hemoglobin is 13.2 g/dL.", "12. Leukocyte count is 8900/mm3.", "13. Platelet count is 310,000/mm3.", "14. Serum Hepatitis B surface antigen is negative.", "15. Serum Hepatitis B antibody is positive.", "16. Interferon-\u03b3 release assay is positive.", "17. X-ray of the chest shows no abnormalities."], "atomic_facts": ["1. She feels well.", "2. She emigrated from India 3 months ago.", "3. There is no family history of serious illness.", "4. Her immunizations are up-to-date.", "5. She is at 60th percentile for height and weight.", "6. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 90/min, and respirations are 26/min.", "7. Examination shows no abnormalities.", "8. Laboratory studies show: Hemoglobin 13.2 g/dL, Leukocyte count 8900/mm3, Platelet count 310,000/mm3, Serum Hepatitis B surface antigen negative, Hepatitis B antibody positive, Interferon-\u03b3 release assay positive.", "9. An x-ray of the chest shows no abnormalities."]}
{"id": 138, "question": "Based on the study results, which of the following statements best addresses the mother's question?\"", "context": ["Please refer to the summary above to answer this question | An 8-year-old boy is brought to the physician by his mother for a well-child examination at a clinic for low-income residents.", "Although her son's elementary school offers free afterschool programming, her son has not been interested in attending.", "Both the son's maternal and paternal grandmothers have major depressive disorder.", "The mother is curious about the benefits of afterschool programming and asks for the physician's input."], "context_len": 4, "options": {"A": "The patient's family history of psychiatric illness prevents any conclusions from being drawn from the study.", "B": "High-quality afterschool programming for low-income 8-year-olds may correlate with decreased bipolar disorder risk in adults.", "C": "High-quality afterschool programming should be free of charge for low-income children to improve adult mental health.", "D": "High-quality afterschool programming for low-income 8-year-olds may correlate with decreased ADHD risk in adults.\n\""}, "answer": "High-quality afterschool programming for low-income 8-year-olds may correlate with decreased ADHD risk in adults.\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. An 8-year-old boy is brought to the physician by his mother.", "2. The examination is at a clinic for low-income residents.", "3. The son's elementary school offers free afterschool programming.", "4. The son has not been interested in attending the afterschool programming.", "5. The son's maternal grandmother has major depressive disorder.", "6. The son's paternal grandmother has major depressive disorder.", "7. The mother is curious about the benefits of afterschool programming.", "8. The mother asks for the physician's input."], "atomic_facts": ["1. The son's elementary school offers free afterschool programming.", "2. The son has not been interested in attending the afterschool programming.", "3. Both the son's maternal and paternal grandmothers have major depressive disorder.", "4. The mother is curious about the benefits of afterschool programming.", "5. The mother asks for the physician's input."]}
{"id": 139, "question": "Which of the following is the child most likely to develop?", "context": ["Two days after delivery, a 2450-g (5-lb 6-oz) male newborn has three episodes of green vomitus.", "He has passed urine twice a day, but has not yet passed stool.", "He was born at 34 weeks' gestation.", "He appears irritable.", "His temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 161/min, respirations are 56/min, and blood pressure is 62/44 mm Hg.", "Examination shows a distended abdomen; there is diffuse tenderness to palpation over the abdomen.", "Bowel sounds are decreased.", "Digital rectal examination is unremarkable.", "The remainder of the examination shows no abnormalities.", "An x-ray of the abdomen shows dilated bowel loops.", "Contrast enema demonstrates inspissated meconium plugs in the distal ileum and microcolon."], "context_len": 11, "options": {"A": "Infertility", "B": "Alzheimer's disease", "C": "Asthma", "D": "Necrotizing enterocolitis"}, "answer": "Infertility", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "Newborn", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Two days after delivery, a 2450-g (5-lb 6-oz) male newborn has had three episodes of green vomitus.", "2. He has passed urine twice a day, but has not yet passed stool.", "3. He was born at 34 weeks' gestation.", "4. He appears irritable.", "5. His temperature is 37.3\u00b0C (99.1\u00b0F).", "6. His pulse is 161/min.", "7. His respirations are 56/min.", "8. His blood pressure is 62/44 mm Hg.", "9. Examination shows a distended abdomen.", "10. There is diffuse tenderness to palpation over the abdomen.", "11. Bowel sounds are decreased.", "12. Digital rectal examination is unremarkable.", "13. The remainder of the examination shows no abnormalities.", "14. An x-ray of the abdomen shows dilated bowel loops.", "15. Contrast enema demonstrates inspissated meconium plugs in the distal ileum and microcolon."], "atomic_facts": ["1. He has passed urine twice a day", "2. He has not yet passed stool", "3. He was born at 34 weeks' gestation", "4. He appears irritable", "5. His temperature is 37.3\u00b0C (99.1\u00b0F)", "6. His pulse is 161/min", "7. His respirations are 56/min", "8. His blood pressure is 62/44 mm Hg", "9. Examination shows a distended abdomen", "10. There is diffuse tenderness to palpation over the abdomen", "11. Bowel sounds are decreased", "12. Digital rectal examination is unremarkable", "13. The remainder of the examination shows no abnormalities", "14. An x-ray of the abdomen shows dilated bowel loops", "15. Contrast enema demonstrates inspissated meconium plugs in the distal ileum and microcolon"]}
{"id": 140, "question": "Which of the following is most likely a cause of this baby\u2019s symptoms?", "context": ["A 6-week-old boy is brought to see his pediatrician.", "His mother says that he has not been feeding well and forcefully vomited after every feed over the past 4 days.", "The infant was born at 39 weeks gestation via spontaneous vaginal delivery.", "He is up to date on all vaccines and is meeting all developmental milestones.", "However, a week after delivery he developed a respiratory infection involving an aggressive cough followed by a high-pitched intake of breath.", "Respiratory cultures were positive for a gram-negative coccobacilli for which he received erythromycin.", "Since then he has remained healthy until now.", "On examination, the infant\u2019s vitals are normal but he appears lethargic and mildly dehydrated with depressed fontanelles and decreased skin turgor.", "A firm non-tender mass is palpated in the epigastric region."], "context_len": 9, "options": {"A": "Deficiency of nitric oxide synthase", "B": "Antibiotic use", "C": "Inadequate myenteric plexus innervation", "D": "Telescoping of the proximal bowel into a distal segment"}, "answer": "Antibiotic use", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "6 weeks", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Surgery", "Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-week-old boy is brought to see his pediatrician.", "2. His mother says that he has not been feeding well and forcefully vomited after every feed over the past 4 days.", "3. The infant was born at 39 weeks gestation via spontaneous vaginal delivery.", "4. He is up to date on all vaccines and is meeting all developmental milestones.", "5. A week after delivery he developed a respiratory infection involving an aggressive cough followed by a high-pitched intake of breath.", "6. Respiratory cultures were positive for a gram-negative coccobacilli for which he received erythromycin.", "7. Since then he has remained healthy until now.", "8. On examination, the infant\u2019s vitals are normal.", "9. He appears lethargic and mildly dehydrated with depressed fontanelles and decreased skin turgor.", "10. A firm non-tender mass is palpated in the epigastric region."], "atomic_facts": ["1. His mother reports poor feeding and forceful vomiting after feeds for the past 4 days.", "2. The infant was born at 39 weeks gestation via spontaneous vaginal delivery.", "3. He is up to date on all vaccines.", "4. He is meeting all developmental milestones.", "5. A week after delivery, he developed a respiratory infection with an aggressive cough and high-pitched intake of breath.", "6. Respiratory cultures were positive for a gram-negative coccobacilli.", "7. He received erythromycin for the infection.", "8. On examination, the infant's vitals are normal.", "9. He appears lethargic and mildly dehydrated.", "10. He has depressed fontanelles and decreased skin turgor.", "11. A firm non-tender mass is palpated in the epigastric region."]}
{"id": 141, "question": "Which of the following is most likely associated with the cause of this patient's symptoms?", "context": ["A 67-year-old man presents to his primary care physician because he has been feeling increasingly short of breath.", "Specifically, after retirement he has been going on daily morning walks with his wife; however, over the last year he feels that his endurance has decreased.", "His medical history is significant for well-controlled hypertension but is otherwise unremarkable.", "When asked, he reveals that he worked in a variety of industries throughout his life.", "Testing demonstrates decreased forced vital capacity (FVC) and a normal forced expiratory volume (FEV) to FVC ratio.", "Pathology demonstrates changes primarily in the upper lobes where macrophages can be seen with dark round ingested particles."], "context_len": 6, "options": {"A": "Increased risk of lung cancer", "B": "Increased risk of tuberculosis", "C": "Mesothelioma", "D": "Lung rheumatoid nodules"}, "answer": "Lung rheumatoid nodules", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "67 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 67-year-old man presents to his primary care physician.", "2. He has been feeling increasingly short of breath.", "3. After retirement he has been going on daily morning walks with his wife.", "4. Over the last year he feels that his endurance has decreased.", "5. His medical history is significant for well-controlled hypertension.", "6. His medical history is otherwise unremarkable.", "7. He worked in a variety of industries throughout his life.", "8. Testing demonstrates decreased forced vital capacity (FVC).", "9. Testing demonstrates a normal forced expiratory volume (FEV) to FVC ratio.", "10. Pathology demonstrates changes primarily in the upper lobes.", "11. Pathology demonstrates macrophages can be seen with dark round ingested particles."], "atomic_facts": ["1. After retirement, he has been going on daily morning walks with his wife.", "2. Over the last year, he feels that his endurance has decreased.", "3. His medical history is significant for well-controlled hypertension.", "4. His medical history is otherwise unremarkable.", "5. He reveals that he worked in a variety of industries throughout his life.", "6. Testing demonstrates decreased forced vital capacity (FVC).", "7. Testing demonstrates a normal forced expiratory volume (FEV) to FVC ratio.", "8. Pathology demonstrates changes primarily in the upper lobes.", "9. Macrophages can be seen with dark round ingested particles in the upper lobes."]}
{"id": 142, "question": "Which of the following is the most likely cause of this patient\u2019s recent condition?", "context": ["A 75-year-old woman is brought to the emergency department because of vomiting, abdominal pain, and constipation for the past 2 days.", "She has urinated frequently over the past week and has become excessively thirsty during this time.", "She has no significant past medical history.", "She is a 30-pack-year smoker.", "She appears confused.", "Her blood pressure is 95/70 mm Hg, pulse is 110/min, respirations are 25/min, and temperature is 37.1\u00b0C (98.8\u00b0F).", "She has dry oral mucosa.", "Lung auscultation shows rhonchi and wheezing localized to the right middle lobe area.", "An electrocardiogram (ECG) shows a shortened QT interval.", "A computed tomography scan is shown."], "context_len": 10, "options": {"A": "Adenocarcinoma", "B": "Bronchoalveolar carcinoma", "C": "Large-cell carcinoma", "D": "Squamous cell carcinoma"}, "answer": "Squamous cell carcinoma", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "75 years old", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 75-year-old woman is brought to the emergency department.", "2. She has been vomiting, having abdominal pain, and constipated for the past 2 days.", "3. She has been urinating frequently over the past week and has become excessively thirsty during this time.", "4. She has no significant past medical history.", "5. She is a 30-pack-year smoker.", "6. She appears confused.", "7. Her blood pressure is 95/70 mm Hg.", "8. Her pulse is 110/min.", "9. Her respirations are 25/min.", "10. Her temperature is 37.1\u00b0C (98.8\u00b0F).", "11. She has dry oral mucosa.", "12. Lung auscultation shows rhonchi and wheezing localized to the right middle lobe area.", "13. An electrocardiogram (ECG) shows a shortened QT interval.", "14. A computed tomography scan is shown."], "atomic_facts": ["1. She has urinated frequently over the past week.", "2. She has become excessively thirsty during this time.", "3. She has no significant past medical history.", "4. She is a 30-pack-year smoker.", "5. She appears confused.", "6. Her blood pressure is 95/70 mm Hg.", "7. Her pulse is 110/min.", "8. Her respirations are 25/min.", "9. Her temperature is 37.1\u00b0C (98.8\u00b0F).", "10. She has dry oral mucosa.", "11. Lung auscultation shows rhonchi and wheezing localized to the right middle lobe area.", "12. An electrocardiogram (ECG) shows a shortened QT interval.", "13. A computed tomography scan is shown."]}
{"id": 143, "question": "The virulence factor responsible for the edema seen in this patient has a mechanism of action similar to which of the following enzymes?", "context": ["A 23-year-old woman comes to the physician because of a painless lesion on the arm that first appeared 5 days after she visited a petting zoo.", "The lesion began as a small papule and then became a blister that has since ulcerated.", "Her temperature is 38.3\u00b0C (101\u00b0F).", "Examination shows a black eschar with edematous borders on the left upper arm.", "There is axillary lymphadenopathy."], "context_len": 5, "options": {"A": "Adenylate cyclase", "B": "Catalase", "C": "Guanylate cyclase", "D": "SNARE protein"}, "answer": "Adenylate cyclase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "23 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 23-year-old woman comes to the physician.", "2. She has a painless lesion on her arm.", "3. The lesion first appeared 5 days after she visited a petting zoo.", "4. The lesion began as a small papule.", "5. The lesion then became a blister.", "6. The blister has since ulcerated.", "7. Her temperature is 38.3\u00b0C (101\u00b0F).", "8. Examination shows a black eschar with edematous borders on the left upper arm.", "9. There is axillary lymphadenopathy."], "atomic_facts": ["1. The lesion began as a small papule.", "2. The lesion then became a blister.", "3. The blister has since ulcerated.", "4. Her temperature is 38.3\u00b0C (101\u00b0F).", "5. Examination shows a black eschar on the left upper arm.", "6. The eschar has edematous borders.", "7. There is axillary lymphadenopathy."]}
{"id": 144, "question": "A genetic defect, in which of the following proteins is most likely responsible for this patient\u2019s condition?", "context": ["A 54-year-old man with a history of hypertension presents 6 days after being admitted for new-onset atrial fibrillation with the rapid ventricular rate with a painful lesion on his left leg.", "He says his heart rate has been well-controlled since starting metoprolol and warfarin in the hospital but says he has developed a painful lesion on his left leg.", "His blood pressure is 114/78 mm Hg, the heart rate is 84/min, and the respiratory rate is 15/min.", "On physical examination, there is a large, dark lesion on his left leg that feels cold (see image)."], "context_len": 4, "options": {"A": "Factor V", "B": "Factor XII", "C": "Protein C", "D": "Factor VIII"}, "answer": "Protein C", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "54 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 54-year-old man has a history of hypertension.", "2. He was admitted 6 days ago for new-onset atrial fibrillation with a rapid ventricular rate.", "3. He has been taking metoprolol and warfarin since being admitted.", "4. His heart rate has been well-controlled since starting the medications.", "5. He has developed a painful lesion on his left leg.", "6. His blood pressure is 114/78 mm Hg.", "7. His heart rate is 84/min.", "8. His respiratory rate is 15/min.", "9. On physical examination, there is a large, dark lesion on his left leg.", "10. The lesion feels cold."], "atomic_facts": ["1. Patient reports well-controlled heart rate since starting metoprolol and warfarin.", "2. Patient has developed a painful lesion on his left leg.", "3. Blood pressure is 114/78 mm Hg.", "4. Heart rate is 84/min.", "5. Respiratory rate is 15/min.", "6. Physical examination reveals a large, dark lesion on the left leg.", "7. The lesion feels cold."]}
{"id": 145, "question": "The patient\u2019s condition is most likely caused by antibodies against which of the following compounds?", "context": ["A 35-year-old patient presents to the dermatologist with a new skin rash.", "The patient has noticed new bumps on her arm over the past 1 month.", "The bumps are about 0.5 cm in diameter and are filled with a clear fluid.", "They extend on both arms but are not in her mouth or torso.", "The lesions do not pop with pressure but remain tense.", "Her skin does not slough off with rubbing.", "The patient denies any other symptoms including joint pain or fever.", "The patient has no other medical history."], "context_len": 8, "options": {"A": "Desmoglein", "B": "Hemidesmosomes", "C": "Double-stranded DNA", "D": "U1 ribonucleotide polypeptide"}, "answer": "Hemidesmosomes", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "35 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is 35 years old.", "2. Patient presents to dermatologist with new skin rash.", "3. Patient has noticed new bumps on arm over past 1 month.", "4. Bumps are 0.5 cm in diameter and filled with clear fluid.", "5. Bumps extend on both arms but not in mouth or torso.", "6. Lesions do not pop with pressure but remain tense.", "7. Skin does not slough off with rubbing.", "8. Patient denies any other symptoms including joint pain or fever.", "9. Patient has no other medical history."], "atomic_facts": ["1. The patient has noticed new bumps on her arm over the past 1 month.", "2. The bumps are about 0.5 cm in diameter and are filled with a clear fluid.", "3. The bumps extend on both arms but are not in her mouth or torso.", "4. The lesions do not pop with pressure but remain tense.", "5. Her skin does not slough off with rubbing.", "6. The patient denies any other symptoms including joint pain or fever.", "7. The patient has no other medical history."]}
{"id": 146, "question": "Which of the following confirmatory tests is most appropriate?", "context": ["A 59-year-old woman presents to the emergency department because of shortness of breath.", "She has been experiencing an increasing inability to breathe following strenuous activity.", "This includes climbing stairs and walking a few blocks down the street.", "During the day, her breathing becomes more pronounced when she takes her a nap or lies down to sleep at night.", "Another concerning symptom is the increased swelling in her legs.", "She has a history of few episodes of syncope.", "Her past medical history is otherwise unremarkable.", "The vital signs include: blood pressure 110/70 mm Hg, pulse 90/min, and respiratory rate 18/min.", "An electrocardiogram (ECG) shows low voltage.", "Echocardiography shows granular speckling with concentric thickening of the ventricular walls, more prominently of the right wall."], "context_len": 10, "options": {"A": "Pulmonary function test", "B": "Biopsy of cardiac tissue", "C": "Chest X-ray", "D": "No further testing required"}, "answer": "Biopsy of cardiac tissue", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "59", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 59-year-old female.", "2. Patient presents to the emergency department with shortness of breath.", "3. Patient has increasing inability to breathe following strenuous activity, such as climbing stairs and walking a few blocks.", "4. Patient's breathing becomes more pronounced when she takes a nap or lies down to sleep at night.", "5. Patient has increased swelling in her legs.", "6. Patient has a history of few episodes of syncope.", "7. Patient's past medical history is otherwise unremarkable.", "8. Patient's vital signs include: blood pressure 110/70 mm Hg, pulse 90/min, and respiratory rate 18/min.", "9. An electrocardiogram (ECG) shows low voltage.", "10. Echocardiography shows granular speckling with concentric thickening of the ventricular walls, more prominently of the right wall."], "atomic_facts": ["1. She has been experiencing an increasing inability to breathe following strenuous activity.", "2. This includes climbing stairs and walking a few blocks down the street.", "3. During the day, her breathing becomes more pronounced when she takes her a nap or lies down to sleep at night.", "4. Another concerning symptom is the increased swelling in her legs.", "5. She has a history of few episodes of syncope.", "6. Her past medical history is otherwise unremarkable.", "7. The vital signs include: blood pressure 110/70 mm Hg, pulse 90/min, and respiratory rate 18/min.", "8. An electrocardiogram (ECG) shows low voltage.", "9. Echocardiography shows granular speckling with concentric thickening of the ventricular walls, more prominently of the right wall."]}
{"id": 147, "question": "What is the most likely diagnosis?", "context": ["A 30-year-old previously healthy male presents to your office with complaints of facial pressure and rhinorrhea for the past 3 weeks.", "The patient reports that several weeks prior, he had a \u201ccommon cold\u201d which resolved.", "However, he has since developed worsening facial pressure, especially over his cheeks and forehead.", "He reports over 1 week of green tinged rhinorrhea.", "His temperature is 100.1 deg F (37.8 deg C), blood pressure is 120/70 mmHg, pulse is 85/min, and respirations are 15/min.", "Nasal exam reveals edematous turbinates and purulent discharge."], "context_len": 6, "options": {"A": "Acute viral rhinosinusitis", "B": "Acute bacterial rhinosinusitis", "C": "Allergic rhinitis", "D": "Chronic rhinosinusitis"}, "answer": "Acute bacterial rhinosinusitis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "30", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is a 30-year-old male.", "2. Patient is previously healthy.", "3. Patient has had complaints of facial pressure and rhinorrhea for the past 3 weeks.", "4. Patient had a \"common cold\" several weeks prior which resolved.", "5. Patient has worsening facial pressure, especially over his cheeks and forehead.", "6. Patient has had over 1 week of green tinged rhinorrhea.", "7. Patient's temperature is 100.1 deg F (37.8 deg C).", "8. Patient's blood pressure is 120/70 mmHg.", "9. Patient's pulse is 85/min.", "10. Patient's respirations are 15/min.", "11. Nasal exam reveals edematous turbinates and purulent discharge."], "atomic_facts": ["1. The patient had a \"common cold\" several weeks prior which resolved.", "2. The patient has developed worsening facial pressure, especially over his cheeks and forehead.", "3. The patient reports over 1 week of green tinged rhinorrhea.", "4. The patient's temperature is 100.1 deg F (37.8 deg C).", "5. The patient's blood pressure is 120/70 mmHg.", "6. The patient's pulse is 85/min.", "7. The patient's respirations are 15/min.", "8. Nasal exam reveals edematous turbinates.", "9. Nasal exam reveals purulent discharge."]}
{"id": 148, "question": "Based on these findings, which of the following nerves is most likely injured in this patient?", "context": ["A 25-year-old man is brought to the emergency department 30 minutes after he was involved in a motorcycle collision.", "Physical examination shows a deep laceration on the volar surface of the distal left forearm.", "Neurological examination shows loss of abduction and opposition of the left thumb.", "The radial and ulnar pulses are palpable."], "context_len": 4, "options": {"A": "Posterior interosseous nerve", "B": "Axillary nerve", "C": "Median nerve", "D": "Ulnar nerve"}, "answer": "Median nerve", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 25-year-old man was brought to the emergency department.", "2. He was involved in a motorcycle collision 30 minutes prior.", "3. Physical examination revealed a deep laceration on the volar surface of the distal left forearm.", "4. Neurological examination showed loss of abduction and opposition of the left thumb.", "5. The radial and ulnar pulses were palpable."], "atomic_facts": ["1. Physical examination shows a deep laceration on the volar surface of the distal left forearm.", "2. Neurological examination shows loss of abduction and opposition of the left thumb.", "3. The radial and ulnar pulses are palpable."]}
{"id": 149, "question": "Which of the following is the most likely location of his intestinal bleeding?", "context": ["A 70-year-old man presents to the emergency department after several episodes of bloody stools that started 6 hours ago.", "The patient denies nausea, vomiting, or diarrhea.", "On examination, he is pale and cachectic.", "The patient\u2019s abdomen is nontender to palpation on the exam.", "His heart rate is 120/min and blood pressure is 80/60 mm Hg.", "A stool sample from the patient shows stools with bright red blood, and a hemoccult test is positive."], "context_len": 6, "options": {"A": "Ascending colon", "B": "Sigmoid colon", "C": "Stomach", "D": "Ileum"}, "answer": "Sigmoid colon", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 70-year-old man presents to the emergency department.", "2. The patient had several episodes of bloody stools that started 6 hours ago.", "3. The patient denies nausea, vomiting, or diarrhea.", "4. On examination, the patient is pale and cachectic.", "5. The patient's abdomen is nontender to palpation on the exam.", "6. The patient's heart rate is 120/min.", "7. The patient's blood pressure is 80/60 mm Hg.", "8. A stool sample from the patient shows stools with bright red blood.", "9. A hemoccult test is positive."], "atomic_facts": ["1. The patient denies nausea.", "2. The patient denies vomiting.", "3. The patient denies diarrhea.", "4. On examination, the patient is pale.", "5. On examination, the patient is cachectic.", "6. The patient\u2019s abdomen is nontender to palpation.", "7. The patient's heart rate is 120/min.", "8. The patient's blood pressure is 80/60 mm Hg.", "9. A stool sample from the patient shows stools with bright red blood.", "10. A hemoccult test is positive."]}
{"id": 150, "question": "Which of the following is the most likely diagnosis?", "context": ["A 48-year-old man comes to the physician because of a 4-month history of persistent cough productive of white phlegm.", "He coughs consistently throughout the day, and he has not noticed any particular triggers that make it worse.", "He has also recently experienced some shortness of breath with exertion.", "He has not had any weight loss, fever, or chills.", "He had similar symptoms last year, which lasted about 6 months.", "He has hypertension, for which he takes amlodipine.", "He has worked in construction for the past 10 years.", "He has smoked a pack of cigarettes per day for 30 years.", "Vital signs are within normal limits.", "Examination shows an end-expiratory wheeze throughout all lung zones."], "context_len": 10, "options": {"A": "Asbestosis", "B": "Hypersensitivity pneumonitis", "C": "Asthma", "D": "Chronic bronchitis"}, "answer": "Chronic bronchitis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "48 years old", "specialties": ["Pulmonary Disease", "Internal Medicine"], "subspecialties": ["General Pulmonary Disease", "Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 48 years old.", "2. Patient has had a persistent cough for 4 months.", "3. Cough is productive of white phlegm.", "4. Cough is consistent throughout the day.", "5. Patient has not noticed any particular triggers that make it worse.", "6. Patient has recently experienced shortness of breath with exertion.", "7. Patient has not had any weight loss, fever, or chills.", "8. Patient had similar symptoms last year, which lasted about 6 months.", "9. Patient has hypertension and takes amlodipine.", "10. Patient has worked in construction for the past 10 years.", "11. Patient has smoked a pack of cigarettes per day for 30 years.", "12. Vital signs are within normal limits.", "13. Examination shows an end-expiratory wheeze throughout all lung zones."], "atomic_facts": ["1. He coughs consistently throughout the day.", "2. He has not noticed any particular triggers that make it worse.", "3. He has recently experienced some shortness of breath with exertion.", "4. He has not had any weight loss, fever, or chills.", "5. He had similar symptoms last year, which lasted about 6 months.", "6. He has hypertension, for which he takes amlodipine.", "7. He has worked in construction for the past 10 years.", "8. He has smoked a pack of cigarettes per day for 30 years.", "9. Vital signs are within normal limits.", "10. Examination shows an end-expiratory wheeze throughout all lung zones."]}
{"id": 151, "question": "What is the best immediate treatment for this patient?", "context": ["A 26-year-old female with no significant past medical history presents to the emergency department complaining of chest pain.", "She states that she was visiting her boyfriend in the hospital and, approximately 10 minutes ago, she developed chest pain associated with sweating, palpitations, nausea, and chills.", "She appears very nervous and states that she is scared that she is dying.", "Vital signs reveal tachycardia, hypertension, and tachypnea.", "An EKG is obtained that is unremarkable besides tachycardia.", "TSH and free T4 are within normal limits.", "A urine drug screen is obtained and it is negative."], "context_len": 7, "options": {"A": "Morphine, oxygen, nitrogylcerin, aspirin, beta blockers, ACE inhibitor, and heparin", "B": "Alprazolam, reassurance, encouraging patient to slow breathing", "C": "Albuterol breathing treatment", "D": "Cognitive behavioral therapy"}, "answer": "Alprazolam, reassurance, encouraging patient to slow breathing", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "26", "specialties": ["Emergency Medicine", "Internal Medicine"], "subspecialties": ["General Emergency Medicine", "Cardiovascular Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 26-year-old female presents to the emergency department.", "2. She has no significant past medical history.", "3. She was visiting her boyfriend in the hospital.", "4. Approximately 10 minutes ago, she developed chest pain.", "5. The chest pain is associated with sweating, palpitations, nausea, and chills.", "6. She appears very nervous and states that she is scared that she is dying.", "7. Vital signs reveal tachycardia, hypertension, and tachypnea.", "8. An EKG is obtained that is unremarkable besides tachycardia.", "9. TSH and free T4 are within normal limits.", "10. A urine drug screen is obtained and it is negative."], "atomic_facts": ["1. The patient was visiting her boyfriend in the hospital.", "2. Approximately 10 minutes ago, she developed chest pain.", "3. The chest pain was associated with sweating, palpitations, nausea, and chills.", "4. The patient appears very nervous.", "5. She states that she is scared that she is dying.", "6. Vital signs reveal tachycardia, hypertension, and tachypnea.", "7. An EKG is obtained and shows tachycardia.", "8. TSH and free T4 levels are within normal limits.", "9. A urine drug screen is obtained and it is negative."]}
{"id": 152, "question": "Which of the following responses by the treating physician is the most appropriate?", "context": ["A 36-year-old woman is brought to the emergency department by her sister 1 hour after she was found unconscious at home.", "She appears lethargic.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 80/min, respirations are 5/min, and blood pressure is 120/70 mm Hg.", "Urine toxicology screening is positive for alcohol, benzodiazepines, and barbiturates.", "The patient's condition improves with supportive treatment, and she is admitted for psychiatric evaluation.", "Three days later, a physician colleague approaches the physician who treated the patient in the lobby of the hospital and states, \u201cI just want to know what happened.", "I'm her neighbor and childhood friend, and I'm worried about her.\u201d ."], "context_len": 7, "options": {"A": "\"\"\"Why don't you go ahead and ask her directly? She is currently in the psychiatric ward.\"\"\"", "B": "\"\"\"Her urine toxicology screening was positive for alcohol, benzodiazepines, and barbiturates.\"\"\"", "C": "\"\"\"I'm not the right person to ask. Please ask her primary care physician.\"\"\"", "D": "\"\"\"I understand your concern, but I am unable to provide information about this situation.\"\"\""}, "answer": "\"\"\"I understand your concern, but I am unable to provide information about this situation.\"\"\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "36 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine", "Toxicology", "Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 36-year-old woman was brought to the emergency department by her sister 1 hour after she was found unconscious at home. ", "2. She appears lethargic. ", "3. Her temperature is 37\u00b0C (98.6\u00b0F). ", "4. Her pulse is 80/min. ", "5. Her respirations are 5/min. ", "6. Her blood pressure is 120/70 mm Hg. ", "7. Urine toxicology screening is positive for alcohol, benzodiazepines, and barbiturates. ", "8. The patient's condition improves with supportive treatment. ", "9. She is admitted for psychiatric evaluation. ", "10. Three days later, a physician colleague approaches the physician who treated the patient in the lobby of the hospital. ", "11. The physician colleague is the patient's neighbor and childhood friend. ", "12. The physician colleague is worried about the patient."], "atomic_facts": ["1. She appears lethargic.", "2. Her temperature is 37\u00b0C (98.6\u00b0F).", "3. Her pulse is 80/min.", "4. Her respirations are 5/min.", "5. Her blood pressure is 120/70 mm Hg.", "6. Urine toxicology screening is positive for alcohol, benzodiazepines, and barbiturates.", "7. The patient's condition improves with supportive treatment.", "8. She is admitted for psychiatric evaluation.", "9. Three days later, a physician colleague approaches the physician who treated the patient in the lobby of the hospital and states, \u201cI just want to know what happened. I'm her neighbor and childhood friend, and I'm worried about her.\u201d"]}
{"id": 153, "question": "Which of the following best describes the mechanism of rejection that happened in this patient?", "context": ["A 40-year-old man presents to a clinic for a regular follow-up.", "He was diagnosed with Wilson\u2019s disease 20 years ago and underwent a human leukocyte antigen\u2013matched liver transplant 15 years ago.", "Today he is feeling fine and has no complaints except for a new, mild jaundice that his wife noticed a few weeks ago.", "He denies any changes in stool or urine color and is not having any abdominal pain.", "On physical examination, his vital signs are within normal limits, and only mild scleral icterus is noticed."], "context_len": 5, "options": {"A": "Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to donor T cells.", "B": "Donor allogeneic MHC molecules are taken up by donor APCs and processed into peptides, and then the peptides are presented by unprocessed donor allogeneic MHC molecules to recipient T cells.", "C": "Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to recipient T cells.", "D": "Recipient MHC molecules are taken up by donor APCs and processed into peptides, and then the peptides are presented by donor allogeneic MHC molecules to recipient T cells."}, "answer": "Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to recipient T cells.", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "40", "specialties": ["Immunology", "Internal Medicine"], "subspecialties": ["General Allergy and Immunology", "Nephrology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 40-year-old man presents to a clinic for a regular follow-up.", "2. He was diagnosed with Wilson\u2019s disease 20 years ago.", "3. He underwent a human leukocyte antigen\u2013matched liver transplant 15 years ago.", "4. He is feeling fine and has no complaints except for a new, mild jaundice.", "5. His wife noticed the jaundice a few weeks ago.", "6. He denies any changes in stool or urine color.", "7. He is not having any abdominal pain.", "8. On physical examination, his vital signs are within normal limits.", "9. Only mild scleral icterus is noticed."], "atomic_facts": ["1. Diagnosed with Wilson\u2019s disease 20 years ago", "2. Underwent a human leukocyte antigen\u2013matched liver transplant 15 years ago", "3. Feeling fine today with no complaints except for mild jaundice", "4. Wife noticed the new jaundice a few weeks ago", "5. Denies changes in stool or urine color", "6. Not having any abdominal pain", "7. Vital signs are within normal limits", "8. Mild scleral icterus is noticed on physical examination"]}
{"id": 154, "question": "Which of the following was most likely prescribed during the previous visit?", "context": ["A 6-year-old boy is brought to his pediatrician due to increased shortness of breath.", "His mother is particularly disturbed because her son wakes up breathless one or 2 nights every week.", "He was diagnosed with asthma 2 years ago.", "Over the past few months, he has not been able to participate in any sport and is also using his inhaler more than 3 times a week.", "On examination, the patient appears to be in slight distress and seems pale and fatigued.", "There are slight expiratory wheezes and crackles in both lungs.", "The pediatrician starts him on a low dose of another inhaler which needs to be taken once daily.", "She asks his mother to avoid any conditions that might aggravate her son\u2019s symptoms and make it difficult for him to breathe.", "Three months later, the mother is back with her son at the same pediatrician\u2019s office.", "She is concerned about a painless white plaque on his tongue.", "When the physician scrapes the lesion it reveals a red base with minimal bleeding.", "A photograph of the lesion is shown."], "context_len": 12, "options": {"A": "Inhaled beclomethasone", "B": "Inhaled ipratropium bromide", "C": "Nebulized theophylline", "D": "Inhaled salmeterol"}, "answer": "Inhaled beclomethasone", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-year-old boy is brought to his pediatrician due to increased shortness of breath.", "2. His mother reports that her son wakes up breathless one or 2 nights every week.", "3. He was diagnosed with asthma 2 years ago.", "4. Over the past few months, he has not been able to participate in any sport.", "5. He is using his inhaler more than 3 times a week.", "6. On examination, the patient appears to be in slight distress.", "7. He seems pale and fatigued.", "8. There are slight expiratory wheezes and crackles in both lungs.", "9. The pediatrician starts him on a low dose of another inhaler which needs to be taken once daily.", "10. She asks his mother to avoid any conditions that might aggravate her son\u2019s symptoms and make it difficult for him to breathe.", "11. Three months later, the mother is back with her son at the same pediatrician\u2019s office.", "12. She is concerned about a painless white plaque on his tongue.", "13. When the physician scrapes the lesion it reveals a red base with minimal bleeding.", "14. A photograph of the lesion is shown."], "atomic_facts": ["1. The patient wakes up breathless one or 2 nights every week.", "2. He was diagnosed with asthma 2 years ago.", "3. He has not been able to participate in any sport.", "4. He is using his inhaler more than 3 times a week.", "5. On examination, the patient appears to be in slight distress.", "6. The patient seems pale and fatigued.", "7. There are slight expiratory wheezes and crackles in both lungs.", "8. The pediatrician starts him on a low dose of another inhaler which needs to be taken once daily.", "9. The mother is asked to avoid any conditions that might aggravate her son\u2019s symptoms.", "10. Three months later, the mother is back with her son at the same pediatrician\u2019s office.", "11. She is concerned about a painless white plaque on his tongue.", "12. When the physician scrapes the lesion it reveals a red base with minimal bleeding.", "13. A photograph of the lesion is shown."]}
{"id": 155, "question": "How do you expect the venous pH, arterial pCO2, and venous pCO2 to respond?", "context": ["A 25-year-old medical student enrolls in an exercise research study.", "Spirometry testing, along with arterial and venous blood gases, are performed immediately before and after 15 minutes of exercising on a stationary bicycle."], "context_len": 2, "options": {"A": "Venous pH decreases, arterial pCO2 decreases, venous pCO2 decreases", "B": "Venous pH increases, arterial pCO2 decreases, venous pCO2 increases", "C": "Venous pH increases, arterial pCO2 increases, venous pCO2 increases", "D": "Venous pH decreases, arterial pCO2 stays the same, venous pCO2 increases"}, "answer": "Venous pH decreases, arterial pCO2 stays the same, venous pCO2 increases", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 25-year-old medical student enrolls in an exercise research study.", "2. Spirometry testing is performed immediately before and after 15 minutes of exercising on a stationary bicycle.", "3. Arterial and venous blood gases are performed immediately before and after 15 minutes of exercising on a stationary bicycle."], "atomic_facts": ["1. Spirometry testing is performed.", "2. Arterial blood gases are tested.", "3. Venous blood gases are tested.", "4. The tests are performed immediately before exercising.", "5. The tests are performed immediately after 15 minutes of exercising on a stationary bicycle."]}
{"id": 156, "question": "Which of the following enzymes contributes most to maintaining a normal serum glucose level in this patient?", "context": ["A 38-year-old imprisoned man is brought to the physician after going on a hunger strike for 36 hours.", "During this time, he has only had two cups of water.", "Physical examination shows dry mucous membranes.", "His serum glucose concentration is 70 mg/dL."], "context_len": 4, "options": {"A": "Phosphoenolpyruvate carboxykinase", "B": "Hydroxymethylglutaryl-CoA lyase", "C": "Glycogen phosphorylase", "D": "Phosphofructokinase-1"}, "answer": "Phosphoenolpyruvate carboxykinase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "38 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 38-year-old man is imprisoned.", "2. He has gone on a hunger strike for 36 hours.", "3. During this time, he has only had two cups of water.", "4. He is brought to the physician.", "5. Physical examination shows dry mucous membranes.", "6. His serum glucose concentration is 70 mg/dL."], "atomic_facts": ["1. He has only had two cups of water.", "2. Physical examination shows dry mucous membranes.", "3. His serum glucose concentration is 70 mg/dL."]}
{"id": 157, "question": "Which of the following best describes the most likely diagnosis?", "context": ["A 27-year-old man presents to the emergency department with a chief concern of abdominal pain and diarrhea.", "The patient states that for the past 4 days he has experienced abdominal pain, diarrhea, weakness and a subjective fever.", "He also endorses a weight loss of 11 pounds during this time.", "The patient has a past medical history of celiac disease, constipation, and depression.", "His current medications include fish oil, a multivitamin, sodium docusate, and fluoxetine.", "His temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 110/75 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for a young man in mild distress.", "Cardiac and pulmonary exams are within normal limits.", "Abdominal exam is notable for generalized tenderness and increased bowel sounds.", "Oral exam is notable for multiple shallow painful ulcers.", "Laboratory values are ordered as seen below: |  | Hemoglobin: 12 g/dL | Hematocrit: 36% | Leukocyte count: 8,000 cells/mm^3 with normal differential | Platelet count: 227,500/mm^3 |  | Serum: | Na+: 141 mEq/L | Cl-: 101 mEq/L | K+: 4.5 mEq/L | HCO3-: 24 mEq/L | BUN: 17 mg/dL | Glucose: 82 mg/dL | Creatinine: 1.0 mg/dL | Ca2+: 10.1 mg/dL | AST: 12 U/L | ALT: 11 U/L |  | A stool guaiac test is performed which returns positive.", "The patient is started on IV fluids and morphine."], "context_len": 12, "options": {"A": "ANCA positivity", "B": "ASCA positivity", "C": "Dilated vascular structure in the anal canal", "D": "Mucosal disruption"}, "answer": "ASCA positivity", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "27 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 27 years old.", "2. Patient presents to the emergency department with abdominal pain and diarrhea.", "3. Patient has experienced abdominal pain, diarrhea, weakness and a subjective fever for the past 4 days.", "4. Patient has lost 11 pounds during this time.", "5. Patient has a past medical history of celiac disease, constipation, and depression.", "6. Patient's current medications include fish oil, a multivitamin, sodium docusate, and fluoxetine.", "7. Patient's temperature is 98.5\u00b0F (36.9\u00b0C).", "8. Patient's blood pressure is 110/75 mmHg.", "9. Patient's pulse is 90/min.", "10. Patient's respirations are 13/min.", "11. Patient's oxygen saturation is 98% on room air.", "12. Physical exam is notable for a young man in mild distress.", "13. Cardiac and pulmonary exams are within normal limits.", "14. Abdominal exam is notable for generalized tenderness and increased bowel sounds.", "15. Oral exam is notable for multiple shallow painful ulcers.", "16. Hemoglobin is 12 g/dL.", "17. Hematocrit is 36%.", "18. Leukocyte count is 8,000 cells/mm^3 with normal differential.", "19. Platelet count is 227,500/mm^3.", "20. Serum Na+ is 141 mEq/L.", "21. Serum Cl- is 101 mEq/L.", "22. Serum K+ is 4.5 mEq/L.", "23. Serum HCO3- is 24 mEq/L.", "24. Serum BUN is 17 mg/dL.", "25. Serum glucose is 82 mg/dL.", "26. Serum creatinine is 1.0 mg/dL.", "27. Serum Ca2+ is 10.1 mg/dL.", "28. Serum AST is 12 U/L.", "29. Serum ALT is 11 U/L.", "30. Stool guaiac test is positive.", "31. Patient is started on IV fluids and morphine."], "atomic_facts": ["1. The patient has experienced abdominal pain, diarrhea, weakness, and a subjective fever for the past 4 days.", "2. The patient has experienced a weight loss of 11 pounds during the past 4 days.", "3. The patient has a past medical history of celiac disease, constipation, and depression.", "4. The patient's current medications include fish oil, a multivitamin, sodium docusate, and fluoxetine.", "5. The patient's temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 110/75 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air.", "6. The patient's physical exam is notable for a young man in mild distress.", "7. The patient's cardiac and pulmonary exams are within normal limits.", "8. The patient's abdominal exam is notable for generalized tenderness and increased bowel sounds.", "9. The patient's oral exam is notable for multiple shallow painful ulcers.", "10. Laboratory values: Hemoglobin: 12 g/dL, Hematocrit: 36%, Leukocyte count: 8,000 cells/mm^3 with normal differential, Platelet count: 227,500/mm^3, Serum: Na+: 141 mEq/L, Cl-: 101 mEq/L, K+: 4.5 mEq/L, HCO3-: 24 mEq/L, BUN: 17 mg/dL, Glucose: 82 mg/dL, Creatinine: 1.0 mg/dL, Ca2+: 10.1 mg/dL, AST: 12 U/L, ALT: 11 U/L.", "11. A stool guaiac test is performed which returns positive.", "12. The patient is started on IV fluids and morphine."]}
{"id": 158, "question": "Which of the following is the mechanism of action of the medication?", "context": ["A previously healthy 31-year-old man is rushed to the emergency department after an all-night binge that included smoking, alcohol, and cocaine.", "He complains of chest fluttering, fatigue, and lightheadedness.", "His past medical and family history are noncontributory.", "Social history is positive for occasional smoking and social drinking.", "At the hospital, the blood pressure is 110/70 mm Hg and the heart rate of 160/min and regular.", "The electrocardiogram (ECG) is shown.", "A physical maneuver involving massage of the neck is attempted without improvement.", "The patient is given the appropriate medication that improves his heart rate and returns his ECG to normal."], "context_len": 8, "options": {"A": "Gamma-aminobutyric acid receptor agonist", "B": "Slowing of the atrioventricular (AV) node conduction time", "C": "Blocking of sodium/potassium adenosine triphosphatase pump", "D": "Prolongation of repolarization phase of cardiac action potential"}, "answer": "Slowing of the atrioventricular (AV) node conduction time", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "31 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 31-year-old man is rushed to the emergency department.", "2. He had an all-night binge that included smoking, alcohol, and cocaine.", "3. He complains of chest fluttering, fatigue, and lightheadedness.", "4. His past medical and family history are noncontributory.", "5. Social history is positive for occasional smoking and social drinking.", "6. At the hospital, the blood pressure is 110/70 mm Hg.", "7. The heart rate is 160/min and regular.", "8. The electrocardiogram (ECG) is shown.", "9. A physical maneuver involving massage of the neck is attempted without improvement.", "10. The patient is given the appropriate medication.", "11. The medication improves his heart rate.", "12. The ECG returns to normal."], "atomic_facts": ["1. Patient complains of chest fluttering, fatigue, and lightheadedness.", "2. Past medical and family history are noncontributory.", "3. Social history is positive for occasional smoking and social drinking.", "4. Blood pressure at the hospital is 110/70 mm Hg.", "5. Heart rate at the hospital is 160/min and regular.", "6. Electrocardiogram (ECG) is shown.", "7. Physical maneuver involving massage of the neck is attempted without improvement.", "8. Patient is given appropriate medication that improves heart rate and returns ECG to normal."]}
{"id": 159, "question": "Which of the following drugs would most likely achieve the desired effect?", "context": ["A scientist is studying how animals regulate their blood pressure in response to various stimuli.", "In particular, she is interested in how much a novel compound that binds to both alpha-1 and beta-1 adrenergic receptors will affect blood pressure.", "She studies this question in non-human primates, but finds that her results are confounded by the fact that the animals' heart rates start to decrease several minutes after administration of this novel compound.", "She therefore decides to pretreat these animals with a drug that is known to prevent this decrease in heart rate."], "context_len": 4, "options": {"A": "Dobutamine", "B": "Hexamethonium", "C": "Metoprolol", "D": "Scopolamine"}, "answer": "Hexamethonium", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Physical Medicine and Rehabilitation"}, "facts_old": ["1. A scientist is studying how animals regulate their blood pressure in response to various stimuli.", "2. She is interested in how much a novel compound that binds to both alpha-1 and beta-1 adrenergic receptors will affect blood pressure.", "3. She studies this question in non-human primates.", "4. Her results are confounded by the fact that the animals' heart rates start to decrease several minutes after administration of this novel compound.", "5. She decides to pretreat these animals with a drug that is known to prevent this decrease in heart rate."], "atomic_facts": ["1. The researcher is interested in a novel compound that binds to alpha-1 and beta-1 adrenergic receptors.", "2. The researcher studies the compound's effect on blood pressure in non-human primates.", "3. The animals' heart rates start to decrease several minutes after administration of the novel compound.", "4. The researcher decides to pretreat the animals with a drug known to prevent the decrease in heart rate."]}
{"id": 160, "question": "Based on the information provided in the drug advertisement, which of the following patients with HCC would be an appropriate treatment candidate and benefit the most from treatment with Noxbinle 100 mg in comparison to Metalimus 100 mg?", "context": ["A hepatologist has learned about the survival benefit of Noxbinle (tumorolimus) in hepatocellular carcinoma (HCC) patients from a fellow physician.", "She is looking at a list of HCC patients on her hospital's hepatology consult service and trying to identify candidates who might derive more survival benefits from Noxbinle as opposed to Metalimus."], "context_len": 2, "options": {"A": "Non-cirrhotic patient with a history of hepatitis B and alcohol dependence", "B": "Alcoholic patient with severe cirrhosis on immunosuppressive therapy", "C": "Patient with severe cirrhosis, history of hepatitis C, and kidney stones", "D": "Patient with severe cirrhosis, history of hepatitis C, and asthma"}, "answer": "Patient with severe cirrhosis, history of hepatitis C, and asthma", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Hepatology"], "subspecialties": ["General Hepatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A hepatologist has learned about the survival benefit of Noxbinle (tumorolimus).", "2. The survival benefit is for hepatocellular carcinoma (HCC) patients.", "3. The hepatologist learned about the survival benefit from a fellow physician.", "4. The hepatologist is looking at a list of HCC patients on her hospital's hepatology consult service.", "5. The hepatologist is trying to identify candidates who might derive more survival benefits from Noxbinle as opposed to Metalimus."], "atomic_facts": ["1. She is looking at a list of HCC patients.", "2. The list is for her hospital's hepatology consult service.", "3. She is trying to identify candidates for Noxbinle.", "4. She is trying to identify candidates for Metalimus.", "5. She is trying to identify candidates who might derive more survival benefits from Noxbinle.", "6. She is trying to identify candidates who might derive more survival benefits from Metalimus."]}
{"id": 161, "question": "In this fetus, what other renal structure would be expected to be absent?", "context": ["An error occurs during the embryologic development of the kidney.", "It is found that the fetus lacks proper ureters, major and minor calyces, and renal pelvises."], "context_len": 2, "options": {"A": "Collecting ducts", "B": "Ductus deferens", "C": "Distal convoluted tubule", "D": "Bowman's capsule"}, "answer": "Collecting ducts", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An error occurs during the embryologic development of the kidney.", "2. It is found that the fetus lacks proper ureters.", "3. It is found that the fetus lacks major calyces.", "4. It is found that the fetus lacks minor calyces.", "5. It is found that the fetus lacks renal pelvises."], "atomic_facts": ["1. The fetus lacks proper ureters.", "2. The fetus lacks major calyces.", "3. The fetus lacks minor calyces.", "4. The fetus lacks renal pelvises."]}
{"id": 162, "question": "Which of the following is most likely to achieve this desired effect?", "context": ["An investigator is studying the effects of tissue hypoxia on skeletal muscles.", "Skeletal muscle hypoxia is induced by decreasing oxygen delivery to peripheral tissues."], "context_len": 2, "options": {"A": "Decrease the serum 2,3-bisphosphoglycerate concentration", "B": "Increase the serum hydrogen ion concentration", "C": "Increase the arterial partial pressure of carbon dioxide", "D": "Increase the serum temperature"}, "answer": "Decrease the serum 2,3-bisphosphoglycerate concentration", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Anesthesiology"], "subspecialties": ["Critical Care Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. An investigator is studying the effects of tissue hypoxia.", "2. Tissue hypoxia affects skeletal muscles.", "3. Skeletal muscle hypoxia is induced by decreasing oxygen delivery.", "4. Oxygen delivery is decreased to peripheral tissues."], "atomic_facts": ["1. Skeletal muscle hypoxia", "2. Induced by decreasing oxygen delivery", "3. To peripheral tissues"]}
{"id": 163, "question": "Which histological finding would place her at the highest risk of developing esophageal adenocarcinoma in the near future?", "context": ["A 48-year-old woman presents to the doctor\u2019s office complaining of frequent episodes of severe heartburn and chest pain.", "It feels like food is getting stuck in her throat somewhere.", "She wakes up at night in fits of coughing and in pain.", "Antacids and other over the counter remedies do not improve the discomfort.", "The physician feels that the patient has acid reflux and recommends upper gastrointestinal endoscopy and a trial of omeprazole.", "Several biopsies are taken during the endoscopy: one from the distal esophagus, one from the gastroesophageal junction, and one from the body of the stomach."], "context_len": 6, "options": {"A": "The presence of inflammatory cells in the body of the stomach", "B": "The presence of metaplasia at the Z line", "C": "The presence of goblet cells at the Z line", "D": "The presence of high grade dysplasia at the Z line"}, "answer": "The presence of high grade dysplasia at the Z line", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "48 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 48-year-old woman presents to the doctor's office.", "2. She is complaining of frequent episodes of severe heartburn and chest pain.", "3. She feels like food is getting stuck in her throat somewhere.", "4. She wakes up at night in fits of coughing and in pain.", "5. Antacids and other over the counter remedies do not improve the discomfort.", "6. The physician feels that the patient has acid reflux.", "7. The physician recommends upper gastrointestinal endoscopy and a trial of omeprazole.", "8. Several biopsies are taken during the endoscopy.", "9. One biopsy is taken from the distal esophagus.", "10. One biopsy is taken from the gastroesophageal junction.", "11. One biopsy is taken from the body of the stomach."], "atomic_facts": ["1. Patient feels like food is getting stuck in her throat.", "2. Patient wakes up at night in fits of coughing and in pain.", "3. Antacids and other over the counter remedies do not improve the discomfort.", "4. Physician feels that the patient has acid reflux.", "5. Physician recommends upper gastrointestinal endoscopy.", "6. Physician recommends a trial of omeprazole.", "7. Several biopsies are taken during the endoscopy.", "8. One biopsy is taken from the distal esophagus.", "9. One biopsy is taken from the gastroesophageal junction.", "10. One biopsy is taken from the body of the stomach."]}
{"id": 164, "question": "Which of the following is the most likely vector of this patient's condition?", "context": ["A 26-year-old man comes to the physician because of a 3-week history of malaise and recurrent fever.", "He has also had a 4.5-kg (10-lb) weight loss over the past 3 months.", "He came back from his honeymoon in Kenya 6 months ago.", "He appears ill.", "His temperature is 39\u00b0C (102.2\u00b0F).", "He is alert and oriented to person, time, and place.", "Physical examination shows generalized lymphadenopathy and hepatosplenomegaly.", "Laboratory studies show a hemoglobin concentration of 9.1 g/dL, leukocyte count of 2,900/mm3, and platelet count of 108,000/mm3."], "context_len": 8, "options": {"A": "Tsetse fly", "B": "Sand fly", "C": "Freshwater snail", "D": "Anopheles mosquito"}, "answer": "Sand fly", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "26 years old", "specialties": ["Infectious Disease"], "subspecialties": ["General Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 26-year-old man comes to the physician.", "2. He has a 3-week history of malaise and recurrent fever.", "3. He has had a 4.5-kg (10-lb) weight loss over the past 3 months.", "4. He came back from his honeymoon in Kenya 6 months ago.", "5. He appears ill.", "6. His temperature is 39\u00b0C (102.2\u00b0F).", "7. He is alert and oriented to person, time, and place.", "8. Physical examination shows generalized lymphadenopathy.", "9. Physical examination shows hepatosplenomegaly.", "10. Laboratory studies show a hemoglobin concentration of 9.1 g/dL.", "11. Laboratory studies show a leukocyte count of 2,900/mm3.", "12. Laboratory studies show a platelet count of 108,000/mm3."], "atomic_facts": ["1. He has had a 4.5-kg (10-lb) weight loss over the past 3 months.", "2. He came back from his honeymoon in Kenya 6 months ago.", "3. He appears ill.", "4. His temperature is 39\u00b0C (102.2\u00b0F).", "5. He is alert and oriented to person, time, and place.", "6. Physical examination shows generalized lymphadenopathy and hepatosplenomegaly.", "7. Laboratory studies show a hemoglobin concentration of 9.1 g/dL.", "8. Laboratory studies show a leukocyte count of 2,900/mm3.", "9. Laboratory studies show a platelet count of 108,000/mm3."]}
{"id": 165, "question": "Which best describes the principal action(s) of prazosin?", "context": ["A 68-year-old Caucasian male presents to your office complaining of urinary hesitancy and decreased urinary flow.", "His blood pressure is measured to be 168/95.", "You prescribe prazosin."], "context_len": 3, "options": {"A": "Relaxation of urinary sphincter and reduction of peripheral vascular resistance", "B": "Relaxation of urinary sphincter and suppression of renin release", "C": "Contraction of urinary bladder wall smooth muscle and suppression of renin release", "D": "Contraction of urinary bladder wall smooth muscle and reduction of peripheral vascular resistance"}, "answer": "Relaxation of urinary sphincter and reduction of peripheral vascular resistance", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "68", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 68-year-old Caucasian male presents to your office.", "2. The patient is complaining of urinary hesitancy and decreased urinary flow.", "3. The patient's blood pressure is measured to be 168/95.", "4. You prescribe prazosin."], "atomic_facts": ["1. Blood pressure is measured to be 168/95.", "2. Prazosin is prescribed."]}
{"id": 166, "question": "Which of the following is the next best step in the management of this patient?", "context": ["A 4-year-old boy is referred to the infectious disease clinic for recurrent pneumonia.", "Although he has had several previous hospital admissions and received multiple courses of antibiotic therapy, he continues to get sick.", "On his most recent hospital admission, the boy presented with mild fever, right-sided chest pain, and yellow-colored sputum.", "He had difficulty breathing and diminished breath sounds on the right side of the chest.", "A CT scan of the thorax revealed multiple right-sided ground-glass opacities.", "Sputum cultures grew Aspergillus galactomannan.", "The boy\u2019s medical history is significant for neonatal sepsis and recurrent episodes of pyoderma and otitis media.", "His younger brother had recurrent purulent skin infections before he died of an otogenic brain abscess at the age of 2.", "His mother says that skin infections are common in the male members of her family.", "The patient\u2019s HIV status is negative and his complete blood count, T cell and B cell counts, immunoglobulin profile, and complement tests are within normal limits."], "context_len": 10, "options": {"A": "CD4+ cell count", "B": "Bone marrow biopsy", "C": "Dihydrorhodamine (DHR) test", "D": "Adenosine deaminase levels"}, "answer": "Dihydrorhodamine (DHR) test", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old boy is referred to the infectious disease clinic for recurrent pneumonia.", "2. He has had several previous hospital admissions and received multiple courses of antibiotic therapy.", "3. He continues to get sick.", "4. On his most recent hospital admission, the boy presented with mild fever, right-sided chest pain, and yellow-colored sputum.", "5. He had difficulty breathing and diminished breath sounds on the right side of the chest.", "6. A CT scan of the thorax revealed multiple right-sided ground-glass opacities.", "7. Sputum cultures grew Aspergillus galactomannan.", "8. The boy\u2019s medical history is significant for neonatal sepsis.", "9. He has had recurrent episodes of pyoderma and otitis media.", "10. His younger brother had recurrent purulent skin infections before he died of an otogenic brain abscess at the age of 2.", "11. His mother says that skin infections are common in the male members of her family.", "12. The patient\u2019s HIV status is negative.", "13. His complete blood count, T cell and B cell counts, immunoglobulin profile, and complement tests are within normal limits."], "atomic_facts": ["1. The patient has had several previous hospital admissions.", "2. The patient has received multiple courses of antibiotic therapy.", "3. On his most recent hospital admission, the boy presented with mild fever.", "4. On his most recent hospital admission, the boy presented with right-sided chest pain.", "5. On his most recent hospital admission, the boy presented with yellow-colored sputum.", "6. The patient had difficulty breathing.", "7. The patient had diminished breath sounds on the right side of the chest.", "8. A CT scan of the thorax revealed multiple right-sided ground-glass opacities.", "9. Sputum cultures grew Aspergillus galactomannan.", "10. The boy\u2019s medical history is significant for neonatal sepsis.", "11. The boy\u2019s medical history is significant for recurrent episodes of pyoderma.", "12. The boy\u2019s medical history is significant for recurrent episodes of otitis media.", "13. The patient's younger brother had recurrent purulent skin infections.", "14. The patient's younger brother died of an otogenic brain abscess at the age of 2.", "15. The patient's mother says that skin infections are common in the male members of her family.", "16. The patient\u2019s HIV status is negative.", "17. The patient\u2019s complete blood count is within normal limits.", "18. The patient\u2019s T cell and B cell counts are within normal limits.", "19. The patient\u2019s immunoglobulin profile is within normal limits.", "20. The patient\u2019s complement tests are within normal limits."]}
{"id": 167, "question": "Which of the following will most likely be found on physical exam?", "context": ["A 72-year-old man is being transported by emergency medical services to the emergency department for a stroke code.", "He was found on the ground by his daughter earlier today, and he was last known to be without neurological deficits two hours prior to presentation.", "His temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 185/105 mmHg, pulse is 102/min, and respirations are 18/min.", "A non-contrast head CT is performed, which demonstrates a hypodense lesion affecting the left medial frontal and parietal lobe."], "context_len": 4, "options": {"A": "Contralateral hemiparesis", "B": "Contralateral lower extremity weakness", "C": "Hemineglect", "D": "Wernicke aphasia"}, "answer": "Contralateral lower extremity weakness", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "72 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 72-year-old man is being transported by emergency medical services to the emergency department for a stroke code.", "2. He was found on the ground by his daughter earlier today.", "3. He was last known to be without neurological deficits two hours prior to presentation.", "4. His temperature is 99\u00b0F (37.2\u00b0C).", "5. His blood pressure is 185/105 mmHg.", "6. His pulse is 102/min.", "7. His respirations are 18/min.", "8. A non-contrast head CT is performed.", "9. The CT demonstrates a hypodense lesion affecting the left medial frontal and parietal lobe."], "atomic_facts": ["1. He was found on the ground by his daughter earlier today.", "2. He was last known to be without neurological deficits two hours prior to presentation.", "3. His temperature is 99\u00b0F (37.2\u00b0C).", "4. His blood pressure is 185/105 mmHg.", "5. His pulse is 102/min.", "6. His respirations are 18/min.", "7. A non-contrast head CT is performed.", "8. The head CT demonstrates a hypodense lesion affecting the left medial frontal and parietal lobe."]}
{"id": 168, "question": "This medication is associated with an increased risk of which of the following complications?", "context": ["A 33-year-old G1P0 at 39 weeks gestation is admitted to the labor and delivery floor for induction of labor.", "She feels well and is no acute distress.", "She is accompanied by her husband.", "Her past medical history is notable for major depressive disorder and generalized anxiety disorder.", "She takes sertraline.", "Her temperature is 99.2\u00b0F (37.3\u00b0C), blood pressure is 120/75 mmHg, pulse is 95/min, and respirations are 18/min.", "To initiate labor induction, the obstetrician injects the patient with a hormone that is endogenously made in the hypothalamus and released by the posterior pituitary."], "context_len": 7, "options": {"A": "Placental abruption", "B": "Vasa previa", "C": "Placenta accreta", "D": "Preeclampsia"}, "answer": "Placental abruption", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "33", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is 33 years old.", "2. Patient is G1P0.", "3. Patient is 39 weeks gestation.", "4. Patient is admitted to labor and delivery floor for induction of labor.", "5. Patient feels well and is in no acute distress.", "6. Patient is accompanied by her husband.", "7. Patient has past medical history of major depressive disorder and generalized anxiety disorder.", "8. Patient takes sertraline.", "9. Patient's temperature is 99.2\u00b0F (37.3\u00b0C).", "10. Patient's blood pressure is 120/75 mmHg.", "11. Patient's pulse is 95/min.", "12. Patient's respirations are 18/min.", "13. Obstetrician injects patient with hormone endogenously made in hypothalamus and released by posterior pituitary to initiate labor induction."], "atomic_facts": ["1. She feels well and is in no acute distress.", "2. She is accompanied by her husband.", "3. Her past medical history includes major depressive disorder and generalized anxiety disorder.", "4. She takes sertraline.", "5. Her temperature is 99.2\u00b0F (37.3\u00b0C).", "6. Her blood pressure is 120/75 mmHg.", "7. Her pulse is 95/min.", "8. Her respirations are 18/min.", "9. The obstetrician injects the patient with a hormone to initiate labor induction."]}
{"id": 169, "question": "Which drug has been prescribed?", "context": ["A 57-year-old Caucasian male presents to your office with heart palpitations and shortness of breath.", "On exam, he is tachycardic and his rhythm is irregularly irregular.", "He fails standard pharmacologic therapy and you refer to cardiology, where he is started on an antiarrhythmic medication.", "The action of this agent results in a longer action potential duration, an increased effective refractory period, and a longer QT interval."], "context_len": 4, "options": {"A": "Flecanide", "B": "Mexiletine", "C": "Diltiazem", "D": "Sotalol"}, "answer": "Sotalol", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "57", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 57-year-old Caucasian male presents to office with heart palpitations and shortness of breath.", "2. On exam, he is tachycardic and his rhythm is irregularly irregular.", "3. He fails standard pharmacologic therapy.", "4. Referred to cardiology.", "5. Started on an antiarrhythmic medication.", "6. Action of this agent results in a longer action potential duration.", "7. Action of this agent results in an increased effective refractory period.", "8. Action of this agent results in a longer QT interval."], "atomic_facts": ["1. On exam, the patient is tachycardic.", "2. On exam, the patient's rhythm is irregularly irregular.", "3. The patient fails standard pharmacologic therapy.", "4. The patient is referred to cardiology.", "5. In cardiology, the patient is started on an antiarrhythmic medication.", "6. The action of the antiarrhythmic medication results in a longer action potential duration.", "7. The action of the antiarrhythmic medication results in an increased effective refractory period.", "8. The action of the antiarrhythmic medication results in a longer QT interval."]}
{"id": 170, "question": "Which of the following is the most likely diagnosis?", "context": ["A 2-year-old girl is brought to the physician because of abdominal distention and twitching of her feet, which her mother noticed a week ago.", "The patient has also had a low-grade fever for 5 days.", "She has not had a bowel movement in 3 days.", "She was born at term and has been healthy since.", "She is at the 40th percentile for height and 20th percentile for weight.", "Her temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 128/min, and blood pressure is 135/82 mm Hg.", "Examination shows an irregular palpable mass that crosses the midline of the abdomen.", "The liver is palpated 3 cm below the right costal margin.", "There are erratic movements of the eyes.", "A 24-hour urine collection shows elevated homovanillic acid and vanillylmandelic acid levels."], "context_len": 10, "options": {"A": "Hodgkin lymphoma", "B": "Hepatoblastoma", "C": "Nephroblastoma", "D": "Neuroblastoma"}, "answer": "Neuroblastoma", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Oncology", "Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 2-year-old girl.", "2. Mother noticed abdominal distention and twitching of feet a week ago.", "3. Patient has had a low-grade fever for 5 days.", "4. Patient has not had a bowel movement in 3 days.", "5. Patient was born at term and has been healthy since.", "6. Patient is at the 40th percentile for height and 20th percentile for weight.", "7. Patient's temperature is 38.1\u00b0C (100.6\u00b0F).", "8. Patient's pulse is 128/min.", "9. Patient's blood pressure is 135/82 mm Hg.", "10. Examination shows an irregular palpable mass that crosses the midline of the abdomen.", "11. Liver is palpated 3 cm below the right costal margin.", "12. There are erratic movements of the eyes.", "13. 24-hour urine collection shows elevated homovanillic acid and vanillylmandelic acid levels."], "atomic_facts": ["1. The patient has had a low-grade fever for 5 days.", "2. She has not had a bowel movement in 3 days.", "3. She was born at term and has been healthy since.", "4. She is at the 40th percentile for height and 20th percentile for weight.", "5. Her temperature is 38.1\u00b0C (100.6\u00b0F).", "6. Her pulse is 128/min.", "7. Her blood pressure is 135/82 mm Hg.", "8. Examination shows an irregular palpable mass that crosses the midline of the abdomen.", "9. The liver is palpated 3 cm below the right costal margin.", "10. There are erratic movements of the eyes.", "11. A 24-hour urine collection shows elevated homovanillic acid and vanillylmandelic acid levels."]}
{"id": 171, "question": "Which of the following additional findings is most likely in this patient?", "context": ["A 53-year-old man is brought to the emergency department by his wife after the sudden onset of dizziness, nausea, and left-sided weakness.", "His blood pressure is 165/95 mm Hg.", "Neurological examination shows decreased muscle tone and hyperreflexia in the right upper and lower extremities.", "His gait is unsteady, and he falls to the left when attempting to walk.", "Finger-to-nose testing shows dysmetria on the left side.", "A CT scan of the head shows a small lesion in the left lateral pons that involves the nucleus of a cranial nerve that exits the brain at the middle cerebellar peduncle."], "context_len": 6, "options": {"A": "Ptosis and inability to look up with the right eye", "B": "Winging of the left scapula and weakness turning the head to the right", "C": "Difficulty chewing and deviation of the jaw to the left", "D": "Inability to smell vanilla or coffee"}, "answer": "Difficulty chewing and deviation of the jaw to the left", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "53", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 53-year-old man is brought to the emergency department by his wife.", "2. The man has sudden onset of dizziness, nausea, and left-sided weakness.", "3. His blood pressure is 165/95 mm Hg.", "4. Neurological examination shows decreased muscle tone and hyperreflexia in the right upper and lower extremities.", "5. His gait is unsteady, and he falls to the left when attempting to walk.", "6. Finger-to-nose testing shows dysmetria on the left side.", "7. A CT scan of the head shows a small lesion in the left lateral pons.", "8. The lesion involves the nucleus of a cranial nerve.", "9. The cranial nerve exits the brain at the middle cerebellar peduncle."], "atomic_facts": ["1. His blood pressure is 165/95 mm Hg.", "2. Neurological examination shows decreased muscle tone in the right upper and lower extremities.", "3. Neurological examination shows hyperreflexia in the right upper and lower extremities.", "4. His gait is unsteady.", "5. He falls to the left when attempting to walk.", "6. Finger-to-nose testing shows dysmetria on the left side.", "7. A CT scan of the head shows a small lesion in the left lateral pons.", "8. The lesion involves the nucleus of a cranial nerve that exits the brain at the middle cerebellar peduncle."]}
{"id": 172, "question": "Which of the following would you expect to see upon chest X-ray:", "context": ["A 38-year-old African American female presents to her primary care physician with uveitis, cough, and arthralgias in her ankles and legs.", "Bloodwork reveals elevated angiotensin converting enzyme levels, and skin PPD testing shows no observable induration after 48 hours.", "The patient demonstrates reduced FEV1 and FVC upon spirometry.", "FEV1/FVC is 85%."], "context_len": 4, "options": {"A": "Enlarged hilar lymph nodes", "B": "Kerley B Lines", "C": "Bilateral diaphragmatic elevation.", "D": "Fluid in alveolar walls"}, "answer": "Enlarged hilar lymph nodes", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "38", "specialties": ["Rheumatology", "Internal Medicine"], "subspecialties": ["General Rheumatology", "Rheumatology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 38 years old.", "2. Patient is African American.", "3. Patient is female.", "4. Patient presents to primary care physician with uveitis, cough, and arthralgias in ankles and legs.", "5. Bloodwork reveals elevated angiotensin converting enzyme levels.", "6. Skin PPD testing shows no observable induration after 48 hours.", "7. Patient demonstrates reduced FEV1 and FVC upon spirometry.", "8. FEV1/FVC is 85%."], "atomic_facts": ["1. Bloodwork reveals elevated angiotensin converting enzyme levels.", "2. Skin PPD testing shows no observable induration after 48 hours.", "3. The patient demonstrates reduced FEV1 upon spirometry.", "4. The patient demonstrates reduced FVC upon spirometry.", "5. FEV1/FVC is 85%."]}
{"id": 173, "question": "A mutation of which of the following genes is most likely responsible for this patient's condition?", "context": ["A previously healthy 41-year-old man comes to the physician for evaluation of a 1-month history of painless, intermittent bleeding on defecation, which he discovered while wiping.", "His younger sister was recently diagnosed with endometrial cancer, and his mother was diagnosed with gastric cancer at 58 years of age.", "Physical examination shows no abnormalities.", "Test of the stool for occult blood is positive.", "Colonoscopy shows a tumor in the ascending colon.", "Histopathologic examination of the tumor shows a mucinous, poorly-differentiated adenocarcinoma."], "context_len": 6, "options": {"A": "MLH1", "B": "TP53", "C": "DCC", "D": "KRAS"}, "answer": "MLH1", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "41 years old", "specialties": ["Colon and Rectal Surgery", "Colorectal Surgery"], "subspecialties": ["General Colon and Rectal Surgery", "General Colorectal Surgery"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Colon and Rectal Surgery"}, "facts_old": ["1. A 41-year-old man comes to the physician for evaluation of a 1-month history of painless, intermittent bleeding on defecation.", "2. He discovered the bleeding while wiping.", "3. His younger sister was recently diagnosed with endometrial cancer.", "4. His mother was diagnosed with gastric cancer at 58 years of age.", "5. Physical examination shows no abnormalities.", "6. Test of the stool for occult blood is positive.", "7. Colonoscopy shows a tumor in the ascending colon.", "8. Histopathologic examination of the tumor shows a mucinous, poorly-differentiated adenocarcinoma."], "atomic_facts": ["1. His younger sister was recently diagnosed with endometrial cancer.", "2. His mother was diagnosed with gastric cancer at 58 years of age.", "3. Physical examination shows no abnormalities.", "4. Test of the stool for occult blood is positive.", "5. Colonoscopy shows a tumor in the ascending colon.", "6. Histopathologic examination of the tumor shows a mucinous, poorly-differentiated adenocarcinoma."]}
{"id": 174, "question": "This medication has which of the following mechanisms of action?", "context": ["A 49-year-old woman presents to her pulmonologist for a follow-up visit.", "She reports a longstanding history of chronic dyspnea and fatigue.", "Her past medical history is notable for asthma.", "She has a known mutation in the BMPR2 gene.", "She was recently trialed on nifedipine but stopped due to severe lower extremity edema.", "She does not smoke and does not drink alcohol.", "Her temperature is 99.4\u00b0F (37.4\u00b0C), blood pressure is 135/80 mmHg, pulse is 80/min, and respirations are 20/min.", "Physical examination reveals an increased P2 on cardiac auscultation.", "Her physician recommends starting a medication to slow the patient\u2019s clinical worsening that requires regular monitoring of liver function tests."], "context_len": 9, "options": {"A": "Endothelin-1 receptor antagonist", "B": "Beta-2-adrenergic receptor agonist", "C": "Phospholipase A2 antagonist", "D": "Phosphodiesterase type 5 antagonist"}, "answer": "Endothelin-1 receptor antagonist", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "49", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 49-year-old woman.", "2. Patient has longstanding history of chronic dyspnea and fatigue.", "3. Patient has past medical history of asthma.", "4. Patient has known mutation in BMPR2 gene.", "5. Patient was recently trialed on nifedipine but stopped due to severe lower extremity edema.", "6. Patient does not smoke.", "7. Patient does not drink alcohol.", "8. Patient's temperature is 99.4\u00b0F (37.4\u00b0C).", "9. Patient's blood pressure is 135/80 mmHg.", "10. Patient's pulse is 80/min.", "11. Patient's respirations are 20/min.", "12. Physical examination reveals increased P2 on cardiac auscultation.", "13. Physician recommends starting medication to slow patient's clinical worsening.", "14. Medication requires regular monitoring of liver function tests."], "atomic_facts": ["1. She reports chronic dyspnea and fatigue.", "2. Her past medical history includes asthma.", "3. She has a known mutation in the BMPR2 gene.", "4. She was trialed on nifedipine but stopped due to severe lower extremity edema.", "5. She does not smoke or drink alcohol.", "6. Her temperature is 99.4\u00b0F (37.4\u00b0C), blood pressure is 135/80 mmHg, pulse is 80/min, and respirations are 20/min.", "7. Physical examination reveals an increased P2 on cardiac auscultation.", "8. Her physician recommends starting a medication to slow clinical worsening that requires regular monitoring of liver function tests."]}
{"id": 175, "question": "Which of the following is the most appropriate next step in treatment?\"", "context": ["A 14-year-old girl is brought to the physician by her mother for the evaluation of recurrent episodes of nose bleeding for several months.", "The episodes occur unexpectedly and stop after a few minutes by elevating the upper body and bending the head forward.", "Menses occur at regular 27-day intervals with heavy flow.", "Her last menstrual period was 3 weeks ago.", "Vital signs are within normal limits.", "Physical examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 11 g/dL | Hematocrit 34% | Leukocyte count 7,000/mm3 | Platelet count 180,000/mm3 | Prothrombin time 13 sec | Partial thromboplastin time 45 sec | Fibrin split products negative | The bleeding time is 10 minutes."], "context_len": 7, "options": {"A": "Oral prednisone", "B": "Intravenous immunoglobulins", "C": "Tranexamic acid", "D": "Desmopressin"}, "answer": "Desmopressin", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "14 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 14-year-old girl is brought to the physician by her mother.", "2. The girl has had recurrent episodes of nose bleeding for several months.", "3. The episodes occur unexpectedly and stop after a few minutes by elevating the upper body and bending the head forward.", "4. The girl's menses occur at regular 27-day intervals with heavy flow.", "5. Her last menstrual period was 3 weeks ago.", "6. Vital signs are within normal limits.", "7. Physical examination shows no abnormalities.", "8. Laboratory studies show a hemoglobin level of 11 g/dL.", "9. Laboratory studies show a hematocrit level of 34%.", "10. Laboratory studies show a leukocyte count of 7,000/mm3.", "11. Laboratory studies show a platelet count of 180,000/mm3.", "12. Laboratory studies show a prothrombin time of 13 sec.", "13. Laboratory studies show a partial thromboplastin time of 45 sec.", "14. Laboratory studies show fibrin split products are negative.", "15. Laboratory studies show a bleeding time of 10 minutes."], "atomic_facts": ["1. The episodes occur unexpectedly and stop after a few minutes by elevating the upper body and bending the head forward.", "2. Menses occur at regular 27-day intervals with heavy flow.", "3. Her last menstrual period was 3 weeks ago.", "4. Vital signs are within normal limits.", "5. Physical examination shows no abnormalities.", "6. Laboratory studies show: Hemoglobin 11 g/dL.", "7. Laboratory studies show: Hematocrit 34%.", "8. Laboratory studies show: Leukocyte count 7,000/mm3.", "9. Laboratory studies show: Platelet count 180,000/mm3.", "10. Laboratory studies show: Prothrombin time 13 sec.", "11. Laboratory studies show: Partial thromboplastin time 45 sec.", "12. Laboratory studies show: Fibrin split products negative.", "13. The bleeding time is 10 minutes."]}
{"id": 176, "question": "Which of the following is the most probable cause of the newborn\u2019s condition?", "context": ["A 29-year-old G3P2 undergoes a cesarean section at 38 weeks gestation and delivers a boy weighing 4570 g with Apgar scores of 5 and 8 at 1 and 5 minutes, respectively.", "The current pregnancy was complicated by gestational diabetes with poor glycemic control.", "The newborn\u2019s heart rate is 122/min, the respiratory rate is 31/min, and the temperature 36.4\u2103 (97.5\u2109).", "On examination, the newborn is pale, lethargic, diaphoretic, and has poor muscular tone.", "The liver is 2 cm below the right costal margin."], "context_len": 5, "options": {"A": "Microangiopathy", "B": "Hyperinsulinemia", "C": "Hyperglycemia", "D": "Polycythemia"}, "answer": "Hyperinsulinemia", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "29 years old", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is 29 years old. ", "2. Patient is G3P2. ", "3. Patient underwent cesarean section at 38 weeks gestation. ", "4. Patient delivered a boy. ", "5. Boy weighed 4570 g. ", "6. Apgar scores at 1 and 5 minutes were 5 and 8, respectively. ", "7. Current pregnancy was complicated by gestational diabetes with poor glycemic control. ", "8. Newborn's heart rate is 122/min. ", "9. Newborn's respiratory rate is 31/min. ", "10. Newborn's temperature is 36.4\u2103 (97.5\u2109). ", "11. On examination, newborn is pale, lethargic, diaphoretic, and has poor muscular tone. ", "12. Liver is 2 cm below the right costal margin."], "atomic_facts": ["1. The current pregnancy was complicated by gestational diabetes with poor glycemic control.", "2. The newborn\u2019s heart rate is 122/min.", "3. The newborn\u2019s respiratory rate is 31/min.", "4. The newborn\u2019s temperature is 36.4\u2103 (97.5\u2109).", "5. On examination, the newborn is pale.", "6. On examination, the newborn is lethargic.", "7. On examination, the newborn is diaphoretic.", "8. On examination, the newborn has poor muscular tone.", "9. The liver is 2 cm below the right costal margin."]}
{"id": 177, "question": "What medication is the patient most likely taking?", "context": ["A 19-year-old woman is brought to the emergency department by ambulance after experiencing a first-time seizure.", "She as preparing for an exam at her college\u2019s library, in her normal state of health and collapsed.", "When she regained consciousness she was surrounded by students and staff.", "The emergency personnel assessed her condition and brought her in.", "Past medical history is significant for major depressive disorder.", "Her primary care physician prescribed a medication for her depression, but she has not taken it for several days because she was concerned about weight gain.", "Family medical history is insignificant for neurological disorders.", "Instead, for the past 10 days, she has been taking her roommate\u2019s antidepressant medication instead.", "Today her blood pressure is 100/80 mm Hg, pulse 102/min, respirations 12/min and he BMI is 15 kg/m2.", "Physical examination reveals pale and dry mucosa and conjunctiva, and lanugo on her arms and legs."], "context_len": 10, "options": {"A": "Bupropion", "B": "Gabapentin", "C": "Selegiline", "D": "Amitriptyline"}, "answer": "Bupropion", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "19 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 19-year-old woman was brought to the emergency department by ambulance.", "2. She was in her normal state of health and collapsed while preparing for an exam at her college\u2019s library.", "3. When she regained consciousness she was surrounded by students and staff.", "4. The emergency personnel assessed her condition and brought her in.", "5. Her past medical history is significant for major depressive disorder.", "6. Her primary care physician prescribed a medication for her depression, but she has not taken it for several days because she was concerned about weight gain.", "7. Her family medical history is insignificant for neurological disorders.", "8. For the past 10 days, she has been taking her roommate\u2019s antidepressant medication instead.", "9. Her blood pressure is 100/80 mm Hg, pulse 102/min, respirations 12/min and BMI is 15 kg/m2.", "10. Physical examination reveals pale and dry mucosa and conjunctiva, and lanugo on her arms and legs."], "atomic_facts": ["1. She was preparing for an exam at her college\u2019s library.", "2. She collapsed in her normal state of health.", "3. When she regained consciousness, she was surrounded by students and staff.", "4. The emergency personnel assessed her condition and brought her in.", "5. Her past medical history is significant for major depressive disorder.", "6. Her primary care physician prescribed a medication for her depression.", "7. She has not taken her prescribed medication for several days.", "8. She was concerned about weight gain from the medication.", "9. Her family medical history is insignificant for neurological disorders.", "10. For the past 10 days, she has been taking her roommate\u2019s antidepressant medication instead of her prescribed medication.", "11. Today her blood pressure is 100/80 mm Hg.", "12. Her pulse is 102/min.", "13. Her respirations are 12/min.", "14. Her BMI is 15 kg/m2.", "15. Physical examination reveals pale and dry mucosa and conjunctiva.", "16. Physical examination also reveals lanugo on her arms and legs."]}
{"id": 178, "question": "Which of the following intracellular changes is most likely to occur in renal vascular smooth muscle as a result of this drug?", "context": ["A 59-year-old man with long-standing hypertension is brought to the emergency department because of vomiting and headache for 2 hours.", "He reports that he has been unable to refill the prescription for his antihypertensive medications.", "His blood pressure is 210/120 mm Hg.", "Fundoscopy shows bilateral optic disc swelling.", "An ECG shows left ventricular hypertrophy.", "Treatment with intravenous fenoldopam is begun."], "context_len": 6, "options": {"A": "Increased activity of protein kinase C", "B": "Increased activity of guanylate cyclase", "C": "Increased production of cyclic adenosine monophosphate", "D": "Increased intracellular concentration of calcium"}, "answer": "Increased production of cyclic adenosine monophosphate", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "59 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 59-year-old man is brought to the emergency department.", "2. He has long-standing hypertension.", "3. He has been vomiting and has had a headache for 2 hours.", "4. He has been unable to refill the prescription for his antihypertensive medications.", "5. His blood pressure is 210/120 mm Hg.", "6. Fundoscopy shows bilateral optic disc swelling.", "7. An ECG shows left ventricular hypertrophy.", "8. Treatment with intravenous fenoldopam is begun."], "atomic_facts": ["1. The patient is unable to refill the prescription for his antihypertensive medications.", "2. His blood pressure is 210/120 mm Hg.", "3. Fundoscopy shows bilateral optic disc swelling.", "4. An ECG shows left ventricular hypertrophy.", "5. Treatment with intravenous fenoldopam is begun."]}
{"id": 179, "question": "Of the following options, which underlying condition could cause this reaction?", "context": ["A 4-year-old boy is referred to the transfusion clinic with malaise, fever, bilateral conjunctivitis, erythema of the oral mucosa, macular rash of the trunk, and inguinal lymphadenopathy following several days of loose stool.", "The boy was born at 39 weeks gestation via spontaneous vaginal delivery.", "He is up to date on all vaccines and is meeting all developmental milestones.", "Kawasaki\u2019s disease is suspected and therapy with intravenous immunoglobulin and aspirin is initiated.", "Later that day, the patient develops trouble breathing, facial flushing, and rapidly evolving pruritic abdominal rash.", "He is rushed to the emergency department where his blood pressure is 85/48 mm Hg, heart rate is 120/min, respiratory rate is 26/min, and temperature is 37.0\u00b0C (98.6\u00b0F).", "On physical examination, the patient has severe facial edema and severe stridor, which can be heard without a stethoscope.", "A complete blood count is normal."], "context_len": 8, "options": {"A": "Bruton's agammaglobulinemia", "B": "IgA deficiency", "C": "Hyper-IgM syndrome", "D": "Hyper-IgD syndrome"}, "answer": "IgA deficiency", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old boy is referred to the transfusion clinic.", "2. He has malaise, fever, bilateral conjunctivitis, erythema of the oral mucosa, macular rash of the trunk, and inguinal lymphadenopathy.", "3. He had several days of loose stool prior to referral.", "4. He was born at 39 weeks gestation via spontaneous vaginal delivery.", "5. He is up to date on all vaccines and is meeting all developmental milestones.", "6. Kawasaki\u2019s disease is suspected and therapy with intravenous immunoglobulin and aspirin is initiated.", "7. Later that day, the patient develops trouble breathing, facial flushing, and rapidly evolving pruritic abdominal rash.", "8. He is rushed to the emergency department.", "9. His blood pressure is 85/48 mm Hg, heart rate is 120/min, respiratory rate is 26/min, and temperature is 37.0\u00b0C (98.6\u00b0F).", "10. On physical examination, the patient has severe facial edema and severe stridor, which can be heard without a stethoscope.", "11. A complete blood count is normal."], "atomic_facts": ["1. The boy was born at 39 weeks gestation.", "2. The boy was born via spontaneous vaginal delivery.", "3. The boy is up to date on all vaccines.", "4. The boy is meeting all developmental milestones.", "5. Kawasaki\u2019s disease is suspected.", "6. Therapy with intravenous immunoglobulin and aspirin is initiated.", "7. The patient develops trouble breathing.", "8. The patient develops facial flushing.", "9. The patient develops rapidly evolving pruritic abdominal rash.", "10. The patient's blood pressure is 85/48 mm Hg.", "11. The patient's heart rate is 120/min.", "12. The patient's respiratory rate is 26/min.", "13. The patient's temperature is 37.0\u00b0C (98.6\u00b0F).", "14. The patient has severe facial edema.", "15. The patient has severe stridor.", "16. The patient's complete blood count is normal."]}
{"id": 180, "question": "What is the mode of inheritance for this patient's disease?", "context": ["A 19-year-old man presents to the physician due to progressively worsening weakness.", "He also notes that he has been getting tired easily and frequently feels short of breath.", "Additionally, he notes a protuberant belly that he cannot seem to reduce with diet and exercise.", "His past medical history is significant for easy bruising since he was very young, requiring at least one transfusion when he was younger.", "He takes no medications.", "His blood pressure is 125/92 mm Hg, pulse is 90/min, respiratory rate 12/min, and temperature is 36.6\u00b0C (97.9\u00b0F).", "Physical examination reveals hepatomegaly and splenomegaly.", "Several bruises can be seen on the inside of his arms and legs.", "Laboratory testing shows: | Hematocrit 23% | Erythrocyte count 2.2 million/mm3 | Thrombocyte count  25,000/mm3 | A bone marrow biopsy shows decreased trilineage hematopoiesis and macrophages with a crinkled tissue-paper appearance."], "context_len": 9, "options": {"A": "Autosomal dominant", "B": "X-linked recessive", "C": "Autosomal recessive", "D": "X-linked dominant"}, "answer": "Autosomal recessive", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "19 years old", "specialties": ["Pediatrics", "Medical Genetics and Genomics"], "subspecialties": ["General Medical Genetics and Genomics", "Neuromuscular Medicine", "General Pediatrics"], "specialty_prob": [0.5, 0.5], "subspecialty_prob": [0.5, 0.25, 0.25], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 19-year-old man presents to the physician due to progressively worsening weakness.", "2. He also notes that he has been getting tired easily and frequently feels short of breath.", "3. Additionally, he notes a protuberant belly that he cannot seem to reduce with diet and exercise.", "4. His past medical history is significant for easy bruising since he was very young, requiring at least one transfusion when he was younger.", "5. He takes no medications.", "6. His blood pressure is 125/92 mm Hg.", "7. His pulse is 90/min.", "8. His respiratory rate is 12/min.", "9. His temperature is 36.6\u00b0C (97.9\u00b0F).", "10. Physical examination reveals hepatomegaly and splenomegaly.", "11. Several bruises can be seen on the inside of his arms and legs.", "12. Laboratory testing shows a hematocrit of 23%.", "13. Laboratory testing shows an erythrocyte count of 2.2 million/mm3.", "14. Laboratory testing shows a thrombocyte count of 25,000/mm3.", "15. A bone marrow biopsy shows decreased trilineage hematopoiesis and macrophages with a crinkled tissue-paper appearance."], "atomic_facts": ["1. Patient reports feeling tired easily and frequently experiences shortness of breath.", "2. Patient has a protuberant belly that does not reduce with diet and exercise.", "3. Patient has a history of easy bruising since childhood and required at least one transfusion when younger.", "4. Patient is not taking any medications.", "5. Patient's blood pressure is 125/92 mm Hg, pulse is 90/min, respiratory rate is 12/min, and temperature is 36.6\u00b0C (97.9\u00b0F).", "6. Physical examination reveals hepatomegaly and splenomegaly.", "7. Several bruises are visible on the inside of the patient's arms and legs.", "8. Laboratory testing shows: Hematocrit 23%, Erythrocyte count 2.2 million/mm3, Thrombocyte count 25,000/mm3.", "9. A bone marrow biopsy shows decreased trilineage hematopoiesis and macrophages with a crinkled tissue-paper appearance."]}
{"id": 181, "question": "What is the best next step in terms of managing this patient?", "context": ["A 1-day-old boy is brought to the emergency room by his parents for difficulty breathing.", "He was delivered at home via vaginal birth with no complications.", "The mom received minimal prenatal care as she wanted the most natural process for her child.", "The mom reports that he has been relatively healthy expect for when he feeds he gets a little fussy.", "However, these episodes self-resolve after he curls up his legs.", "A physical examination demonstrates a baby in acute distress with subcostal retractions and cyanosis at the distal extremities.", "A 5/6 systolic ejection murmur is heard at the left upper sternal border."], "context_len": 7, "options": {"A": "Administer warming blankets", "B": "Give prostaglandin E1", "C": "Immediate surgical repair", "D": "Obtain lumbar puncture for CSF analysis"}, "answer": "Give prostaglandin E1", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "1 day old", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 1-day-old boy is brought to the emergency room by his parents.", "2. He was delivered at home via vaginal birth with no complications.", "3. The mom received minimal prenatal care.", "4. The mom wanted the most natural process for her child.", "5. The mom reports that he has been relatively healthy.", "6. He gets a little fussy when he feeds.", "7. These episodes self-resolve after he curls up his legs.", "8. A physical examination demonstrates a baby in acute distress.", "9. Subcostal retractions and cyanosis at the distal extremities are present.", "10. A 5/6 systolic ejection murmur is heard at the left upper sternal border."], "atomic_facts": ["1. He was delivered at home via vaginal birth with no complications.", "2. The mom received minimal prenatal care as she wanted the most natural process for her child.", "3. The mom reports that he has been relatively healthy expect for when he feeds he gets a little fussy.", "4. These episodes self-resolve after he curls up his legs.", "5. A physical examination demonstrates a baby in acute distress with subcostal retractions and cyanosis at the distal extremities.", "6. A 5/6 systolic ejection murmur is heard at the left upper sternal border."]}
{"id": 182, "question": "Which medication would most likely further improve her lipid profile?", "context": ["A 40-year-old woman schedules an appointment for a routine medical check-up.", "She admits to being careless about her health, but is motivated to improve.", "She is working with a personal trainer at the gym and is following a weight reduction diet plan.", "Despite a 20 kg (44 lb) weight loss over the last year, she still feels that she is fat.", "She was a frequent binge drinker, but now she has reduced her alcohol consumption to a single glass of wine with dinner and an occasional beer on the weekend.", "She also has a 15 pack-year smoking history, but quit 6 months ago after she developed a cough and shortness of breath that later improved.", "She admits to trying various recreational drugs in the past.", "On her last visit, she was started on rosuvastatin for an elevated cholesterol level.", "She is sexually active with her partner and they have 2 children.", "She is uncertain about her family history as she was raised in foster care.", "The vital signs include: pulse 80/min, respirations 16/min, and blood pressure 122/80 mm Hg.", "The physical examination reveals a visibly overweight woman with a body mass index (BMI) of 34 kg/m2.", "The remainder of the examination yields no significant findings.", "An electrocardiogram (ECG) and chest X-ray are both normal.", "Lab tests show the following: | Serum glucose (fasting) 95 mg/dL |     Serum electrolytes: | Sodium 140 mEq/L | Potassium 3.8 mEq/L | Chloride 101 mEq/L | Serum creatinine 0.8 mg/dL | Blood urea nitrogen 10 mg/dL | Cholesterol, total 180 mg/dL | HDL-cholesterol 42 mg/dL | LDL-cholesterol 70 mg/dL | Triglycerides 365 mg/dL |     Urinalysis:   | Glucose negative | Ketones negative | Leucocytes negative | Nitrites negative | RBC negative | Casts negative | ."], "context_len": 15, "options": {"A": "Niacin", "B": "Orlistat", "C": "Fenofibrate", "D": "Ezetimibe"}, "answer": "Fenofibrate", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "40", "specialties": ["Internal Medicine"], "subspecialties": ["Lipidology", "Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 40-year-old woman schedules an appointment for a routine medical check-up.", "2. She admits to being careless about her health, but is motivated to improve.", "3. She is working with a personal trainer at the gym and is following a weight reduction diet plan.", "4. Despite a 20 kg (44 lb) weight loss over the last year, she still feels that she is fat.", "5. She was a frequent binge drinker, but now she has reduced her alcohol consumption to a single glass of wine with dinner and an occasional beer on the weekend.", "6. She also has a 15 pack-year smoking history, but quit 6 months ago after she developed a cough and shortness of breath that later improved.", "7. She admits to trying various recreational drugs in the past.", "8. On her last visit, she was started on rosuvastatin for an elevated cholesterol level.", "9. She is sexually active with her partner and they have 2 children.", "10. She is uncertain about her family history as she was raised in foster care.", "11. The vital signs include: pulse 80/min, respirations 16/min, and blood pressure 122/80 mm Hg.", "12. The physical examination reveals a visibly overweight woman with a body mass index (BMI) of 34 kg/m2.", "13. The remainder of the examination yields no significant findings.", "14. An electrocardiogram (ECG) and chest X-ray are both normal.", "15. Lab tests show the following: Serum glucose (fasting) 95 mg/dL.", "16. Serum electrolytes: Sodium 140 mEq/L.", "17. Serum electrolytes: Potassium 3.8 mEq/L.", "18. Serum electrolytes: Chloride 101 mEq/L.", "19. Serum creatinine 0.8 mg/dL.", "20. Blood urea nitrogen 10 mg/dL.", "21. Cholesterol, total 180 mg/dL.", "22. HDL-cholesterol 42 mg/dL.", "23. LDL-cholesterol 70 mg/dL.", "24. Triglycerides 365 mg/dL.", "25. Urinalysis: Glucose negative.", "26. Urinalysis: Ketones negative.", "27. Urinalysis: Leucocytes negative"], "atomic_facts": ["1. She admits to being careless about her health", "2. She is motivated to improve", "3. She is working with a personal trainer at the gym", "4. She is following a weight reduction diet plan", "5. She has lost 20 kg (44 lb) over the last year", "6. She still feels that she is fat", "7. She was a frequent binge drinker", "8. She has reduced her alcohol consumption to a single glass of wine with dinner and an occasional beer on the weekend", "9. She has a 15 pack-year smoking history", "10. She quit smoking 6 months ago after developing a cough and shortness of breath", "11. She admits to trying various recreational drugs in the past", "12. She was started on rosuvastatin for an elevated cholesterol level", "13. She is sexually active with her partner", "14. She and her partner have 2 children", "15. She is uncertain about her family history as she was raised in foster care", "16. Her vital signs include: pulse 80/min, respirations 16/min, and blood pressure 122/80 mm Hg", "17. She is visibly overweight with a body mass index (BMI) of 34 kg/m2", "18. The remainder of the examination yields no significant findings", "19. An electrocardiogram (ECG) and chest X-ray are both normal", "20. Lab tests show: Serum glucose (fasting) 95 mg/dL, Serum electrolytes: Sodium 140 mEq/L, Potassium 3.8 mEq/L, Chloride 101 mEq/L, Serum creatinine 0.8 mg/dL, Blood urea nitrogen 10 mg/dL, Cholesterol, total 180 mg/dL, HDL-cholesterol 42 mg/dL, LDL-cholesterol 70 mg/dL, Triglycerides 365 mg/dL, Urinalysis: Glucose negative, Ketones negative, Leucocytes negative, Nitrites negative, RBC negative, Casts negative"]}
{"id": 183, "question": "Which of the following is the most likely explanation for this patient's presentation?", "context": ["A 59-year-old man presents to the emergency department with abdominal pain.", "He states that it seemed to come on abruptly, though he does endorse feeling pain the past several days.", "He has been experiencing bloody diarrhea as well as a subjective fever.", "His past medical history is notable for an ST elevation myocardial infarction (STEMI) treated 1 year ago, an abdominal aortic aneurysm (AAA) treated 1 week ago, chronic obstructive pulmonary disease (COPD), asthma, obesity, hypertension, stroke treated 5 years ago, an atrial arrhythmia, diabetes, constipation, and post-traumatic stress disorder (PTSD).", "His temperature is 102.0\u00b0F (39\u00b0C), blood pressure is 197/128 mmHg, pulse is 135/min, respirations are 22/min, and oxygen saturation is 92% on room air.", "On physical exam, you note an obese man in distress.", "Cardiopulmonary exam is notable for bilateral wheezes and a systolic murmur.", "There is bilateral lower extremity pitting edema and venous stasis ulcers.", "Abdominal exam reveals diffuse tenderness which the patient describes as 10/10 in severity.", "Laboratory values are ordered as seen below. |  | Hemoglobin: 14 g/dL | Hematocrit: 42% | Leukocyte count: 15,500/mm^3 with normal differential | Platelet count: 199,000/mm^3 |  | Serum: | Na+: 139 mEq/L | Cl-: 100 mEq/L | K+: 4.4 mEq/L | HCO3-: 22 mEq/L | BUN: 32 mg/dL | Glucose: 189 mg/dL | Creatinine: 1.9 mg/dL | Ca2+: 10.2 mg/dL | Lactate: 4.5 mg/dL | AST: 12 U/L | ALT: 10 U/L |  | ."], "context_len": 10, "options": {"A": "Abdominal aortic aneurysm repair complication", "B": "Atrial fibrillation", "C": "Obstruction of the small bowel", "D": "Ruptured appendix"}, "answer": "Abdominal aortic aneurysm repair complication", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "59", "specialties": ["General Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 59-year-old man presents to the emergency department with abdominal pain.", "2. He states that it seemed to come on abruptly, though he does endorse feeling pain the past several days.", "3. He has been experiencing bloody diarrhea as well as a subjective fever.", "4. His past medical history is notable for an ST elevation myocardial infarction (STEMI) treated 1 year ago.", "5. His past medical history is also notable for an abdominal aortic aneurysm (AAA) treated 1 week ago.", "6. His past medical history is further notable for chronic obstructive pulmonary disease (COPD), asthma, obesity, hypertension, stroke treated 5 years ago, an atrial arrhythmia, diabetes, constipation, and post-traumatic stress disorder (PTSD).", "7. His temperature is 102.0\u00b0F (39\u00b0C).", "8. His blood pressure is 197/128 mmHg.", "9. His pulse is 135/min.", "10. His respirations are 22/min.", "11. His oxygen saturation is 92% on room air.", "12. On physical exam, you note an obese man in distress.", "13. Cardiopulmonary exam is notable for bilateral wheezes and a systolic murmur.", "14. There is bilateral lower extremity pitting edema and venous stasis ulcers.", "15. Abdominal exam reveals diffuse tenderness which the patient describes as 10/10 in severity.", "16. Laboratory values show a hemoglobin of 14 g/dL.", "17. Laboratory values show a hematocrit of 42%.", "18. Laboratory values show a leukocyte count of 15,500/mm^3 with normal differential.", "19. Laboratory values show a platelet count of 199,000/mm^3.", "20. Laboratory values show a serum Na+ of 139 mEq/L.", "21. Laboratory values show a serum Cl- of 100 mEq/L.", "22. Laboratory values show a serum K+ of 4.4 mEq/L.", "23. Laboratory values show a serum HCO3- of 22 mEq/L.", "24. Laboratory values show a serum BUN of 32 mg/dL.", "25. Laboratory values show a serum glucose of 189 mg/dL.", "26. Laboratory"], "atomic_facts": ["1. Patient reports sudden onset of symptoms but has been experiencing pain for several days", "2. Patient has been experiencing bloody diarrhea and subjective fever", "3. Past medical history includes ST elevation myocardial infarction (STEMI) 1 year ago, abdominal aortic aneurysm (AAA) treated 1 week ago, chronic obstructive pulmonary disease (COPD), asthma, obesity, hypertension, stroke treated 5 years ago, atrial arrhythmia, diabetes, constipation, and post-traumatic stress disorder (PTSD)", "4. Patient's temperature is 102.0\u00b0F (39\u00b0C), blood pressure is 197/128 mmHg, pulse is 135/min, respirations are 22/min, and oxygen saturation is 92% on room air", "5. Physical exam reveals an obese man in distress", "6. Cardiopulmonary exam shows bilateral wheezes and a systolic murmur", "7. Bilateral lower extremity pitting edema and venous stasis ulcers are present", "8. Abdominal exam reveals diffuse tenderness described as 10/10 in severity by the patient", "9. Laboratory values: Hemoglobin: 14 g/dL, Hematocrit: 42%, Leukocyte count: 15,500/mm^3 with normal differential, Platelet count: 199,000/mm^3, Serum: Na+: 139 mEq/L, Cl-: 100 mEq/L, K+: 4.4 mEq/L, HCO3-: 22 mEq/L, BUN: 32 mg/dL, Glucose: 189 mg/dL, Creatinine: 1.9 mg/dL, Ca2+: 10.2 mg/dL, Lactate: 4.5 mg/dL, AST: 12 U/L, ALT: 10 U/L"]}
{"id": 184, "question": "Which of the following processes is most likely targeted by this drug?", "context": ["An investigator is studying an experimental treatment for HIV infection that inhibits the maturation of new HIV virions.", "Patients who are taking the drug are observed for several years and side effects are recorded.", "A correlation is established between the drug and the development of impaired glucose tolerance.", "In addition, a significant portion of the patients who take the drug for several years shows increased fat accumulation in the neck with loss of subcutaneous fat in the face and extremities."], "context_len": 4, "options": {"A": "Viral entry into host cell", "B": "Viral polypeptide cleavage", "C": "Viral budding from host cells", "D": "Reverse transcription of viral RNA"}, "answer": "Viral polypeptide cleavage", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An investigator is studying an experimental treatment for HIV infection.", "2. The treatment inhibits the maturation of new HIV virions.", "3. Patients who are taking the drug are observed for several years.", "4. Side effects are recorded.", "5. A correlation is established between the drug and the development of impaired glucose tolerance.", "6. A significant portion of the patients who take the drug for several years shows increased fat accumulation in the neck.", "7. There is loss of subcutaneous fat in the face and extremities."], "atomic_facts": ["1. Patients taking the drug are observed for several years.", "2. Side effects are recorded.", "3. A correlation is established between the drug and impaired glucose tolerance development.", "4. A significant portion of patients taking the drug for several years shows increased fat accumulation in the neck.", "5. There is loss of subcutaneous fat in the face and extremities in some patients taking the drug for several years."]}
{"id": 185, "question": "Which of the following additional findings would most likely be seen in this patient?", "context": ["A 30-year-old G1P1 woman gives birth to a healthy infant at 39 weeks gestation.", "The mother attended all her prenatal visits and took all her appropriate prenatal vitamins.", "Her past medical history is notable for diabetes mellitus, for which she takes metformin.", "Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.", "The infant's temperature is 99.2\u00b0F (37.3\u00b0C), blood pressure is 65/40 mmHg, pulse is 110/min, and respirations are 22/min.", "On exam, the child has ambiguous genitalia.", "A karyotype analysis demonstrates the presence of a Y chromosome.", "Further workup reveals internal testes with normal levels of serum luteinizing hormone and testosterone."], "context_len": 8, "options": {"A": "Decreased androgen receptor responsiveness", "B": "Impaired sense of smell", "C": "Long extremities", "D": "Testosterone-to-dihydrotestosterone ratio > 20"}, "answer": "Testosterone-to-dihydrotestosterone ratio > 20", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 30-year-old G1P1 woman gave birth to a healthy infant at 39 weeks gestation.", "2. The mother attended all her prenatal visits.", "3. The mother took all her appropriate prenatal vitamins.", "4. The mother's past medical history is notable for diabetes mellitus.", "5. The mother takes metformin for her diabetes mellitus.", "6. The infant's Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.", "7. The infant's temperature is 99.2\u00b0F (37.3\u00b0C).", "8. The infant's blood pressure is 65/40 mmHg.", "9. The infant's pulse is 110/min.", "10. The infant's respirations are 22/min.", "11. On exam, the child has ambiguous genitalia.", "12. A karyotype analysis demonstrates the presence of a Y chromosome.", "13. Further workup reveals internal testes with normal levels of serum luteinizing hormone and testosterone."], "atomic_facts": ["1. The mother attended all her prenatal visits.", "2. The mother took all her appropriate prenatal vitamins.", "3. The mother has a past medical history of diabetes mellitus.", "4. The mother takes metformin for diabetes mellitus.", "5. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.", "6. The infant's temperature is 99.2\u00b0F (37.3\u00b0C).", "7. The infant's blood pressure is 65/40 mmHg.", "8. The infant's pulse is 110/min.", "9. The infant's respirations are 22/min.", "10. On exam, the child has ambiguous genitalia.", "11. A karyotype analysis demonstrates the presence of a Y chromosome.", "12. Further workup reveals internal testes.", "13. The internal testes have normal levels of serum luteinizing hormone and testosterone."]}
{"id": 186, "question": "Which of the following statements best describes the properties of drug A when compared to drug B?\"", "context": ["An investigator is studying the pharmacokinetic properties of two novel inhalational anesthetics and reports the following findings. | Blood-gas partition coefficient Minimum alveolar concentration | Drug A 0.42 3.20% | Drug B 2.31 7.45% | ."], "context_len": 1, "options": {"A": "More blood soluble and faster induction of anesthesia", "B": "More potent and slower recovery from anesthesia", "C": "More lipid-soluble and faster recovery from anesthesia", "D": "Less potent and faster induction of anesthesia"}, "answer": "More lipid-soluble and faster recovery from anesthesia", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Anesthesiology"], "subspecialties": ["General Anesthesiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Anesthesiology"}, "facts_old": ["1. An investigator is studying the pharmacokinetic properties of two novel inhalational anesthetics.", "2. The investigator reports the following findings.", "3. The blood-gas partition coefficient for Drug A is 0.42.", "4. The minimum alveolar concentration for Drug A is 3.20%.", "5. The blood-gas partition coefficient for Drug B is 2.31.", "6. The minimum alveolar concentration for Drug B is 7.45%."], "atomic_facts": ["1. An investigator is studying the pharmacokinetic properties of two novel inhalational anesthetics.", "2. The blood-gas partition coefficient for Drug A is 0.42.", "3. The blood-gas partition coefficient for Drug B is 2.31.", "4. The minimum alveolar concentration for Drug A is 3.20%.", "5. The minimum alveolar concentration for Drug B is 7.45%."]}
{"id": 187, "question": "Which of the following best describes the mechanism of development of these skin lesions in this patient?", "context": ["A 56-year-old man presents to an initial visit to his primary care physician complaining of excessive fatigue, weight loss, and increased abdominal girth.", "He drinks about 2\u20134 glasses of wine with dinner and recalls having abnormal liver enzymes in the past.", "He has a remote history of intravenous drug use.", "Physical examination reveals shifting dullness, firm liver, and splenomegaly.", "The skin lesion in this photo is present in on the face, arms, and upper trunk of the patient."], "context_len": 5, "options": {"A": "Anastomoses between portal vein tributaries and the arterial system", "B": "Hormonal imbalance", "C": "Coagulation defects", "D": "Increase in serum ammonia"}, "answer": "Hormonal imbalance", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 56-year-old man presents to an initial visit to his primary care physician.", "2. He is complaining of excessive fatigue, weight loss, and increased abdominal girth.", "3. He drinks about 2\u20134 glasses of wine with dinner.", "4. He recalls having abnormal liver enzymes in the past.", "5. He has a remote history of intravenous drug use.", "6. Physical examination reveals shifting dullness, firm liver, and splenomegaly.", "7. There is a skin lesion present on the face, arms, and upper trunk of the patient."], "atomic_facts": ["1. He drinks about 2\u20134 glasses of wine with dinner.", "2. He recalls having abnormal liver enzymes in the past.", "3. He has a remote history of intravenous drug use.", "4. Physical examination reveals shifting dullness.", "5. Physical examination reveals firm liver.", "6. Physical examination reveals splenomegaly.", "7. The skin lesion in the photo is present on the face, arms, and upper trunk of the patient."]}
{"id": 188, "question": "Which of the following is the most likely diagnosis?", "context": ["A 44-year-old man presents to the emergency department due to sudden chest pain and difficulty breathing for the past 3 hours.", "The pain is felt in the retrosternal area and radiates up to his left shoulder and arm; it worsens on inspiration, and is relieved when he is leaning forward.", "His heart rate is 61/min, respiratory rate is 16/min, temperature is 36.5\u00b0C (97.7\u00b0F), and blood pressure is 115/78 mm Hg.", "Physical examination shows no abnormalities.", "Pericardial friction rub is heard on auscultation.", "Laboratory results show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.", "An ECG is performed."], "context_len": 7, "options": {"A": "Acute pericarditis", "B": "Aortic stenosis", "C": "Infective endocarditis", "D": "Myocardial infarction"}, "answer": "Acute pericarditis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "44", "specialties": ["Internal Medicine", "Emergency Medicine"], "subspecialties": ["Cardiovascular Disease", "General Emergency Medicine"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 44-year-old man presents to the emergency department.", "2. He has had sudden chest pain and difficulty breathing for the past 3 hours.", "3. The pain is felt in the retrosternal area and radiates up to his left shoulder and arm.", "4. The pain worsens on inspiration and is relieved when he is leaning forward.", "5. His heart rate is 61/min, respiratory rate is 16/min, temperature is 36.5\u00b0C (97.7\u00b0F), and blood pressure is 115/78 mm Hg.", "6. Physical examination shows no abnormalities.", "7. Pericardial friction rub is heard on auscultation.", "8. Laboratory results show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.", "9. An ECG is performed."], "atomic_facts": ["1. The pain is felt in the retrosternal area and radiates up to his left shoulder and arm.", "2. The pain worsens on inspiration.", "3. The pain is relieved when he is leaning forward.", "4. His heart rate is 61/min.", "5. His respiratory rate is 16/min.", "6. His temperature is 36.5\u00b0C (97.7\u00b0F).", "7. His blood pressure is 115/78 mm Hg.", "8. Physical examination shows no abnormalities.", "9. Pericardial friction rub is heard on auscultation.", "10. Laboratory results show elevated erythrocyte sedimentation rate (ESR) levels.", "11. Laboratory results show elevated C-reactive protein (CRP) levels.", "12. An ECG is performed."]}
{"id": 189, "question": "The bacteriostatic effect of this drug is most likely due to which of the following mechanisms?", "context": ["A 27-year-old woman comes to the physician because of a rash and headache.", "She recently returned from a camping trip in North Carolina.", "She has a severe allergy to doxycycline.", "Her temperature is 38.2\u00b0C (100.8\u00b0F).", "Physical examination shows a blanching erythematous rash and petechiae over both ankles and the soles of her feet.", "A drug is prescribed that can cause fatal aplastic anemia."], "context_len": 6, "options": {"A": "Inhibition of initiation complex formation at the 30S ribosomal subunit", "B": "Inactivation of prokaryotic topoisomerase II and IV", "C": "Inhibition of tRNA binding site at the 30S ribosomal subunit", "D": "Inactivation of bacterial peptidyltransferase at the 50S ribosomal subunit"}, "answer": "Inactivation of bacterial peptidyltransferase at the 50S ribosomal subunit", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "27", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 27-year-old woman comes to the physician.", "2. She recently returned from a camping trip in North Carolina.", "3. She has a severe allergy to doxycycline.", "4. Her temperature is 38.2\u00b0C (100.8\u00b0F).", "5. Physical examination shows a blanching erythematous rash and petechiae over both ankles and the soles of her feet.", "6. A drug is prescribed.", "7. The drug can cause fatal aplastic anemia."], "atomic_facts": ["1. She recently returned from a camping trip in North Carolina.", "2. She has a severe allergy to doxycycline.", "3. Her temperature is 38.2\u00b0C (100.8\u00b0F).", "4. Physical examination shows a blanching erythematous rash and petechiae over both ankles and the soles of her feet.", "5. A drug is prescribed that can cause fatal aplastic anemia."]}
{"id": 190, "question": "Which of these benefits can the physician ethically accept?", "context": ["The research of an academic physician helps to discover a novel small molecule that improves outcomes after myocardial infarction in animal models due to decreasing the severity of reperfusion injury.", "A pharmaceutical company then approached the university of this physician in order to sign an agreement allowing the molecule to proceed to clinical trials.", "After several years of work, the physician has obtained a wealth of new data from human trials and has published several high profile papers. |  | A major national conference then invites this physician to give a keynote presentation on his work with the novel small molecule.", "In order to prepare for this speech, the pharmaceutical company offers: | 1.", "A speaking honorarium | 2.", "Compensation for travel expenses | 3.", "Help with preparing slides for the speech |  | ."], "context_len": 7, "options": {"A": "1 only", "B": "1 and 2", "C": "1 and 3", "D": "1, 2, and 3"}, "answer": "1 and 2", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Cardiology"], "subspecialties": ["Interventional Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An academic physician conducted research that discovered a novel small molecule that improves outcomes after myocardial infarction in animal models due to decreasing the severity of reperfusion injury.", "2. A pharmaceutical company approached the university of this physician in order to sign an agreement allowing the molecule to proceed to clinical trials.", "3. After several years of work, the physician has obtained a wealth of new data from human trials and has published several high profile papers.", "4. A major national conference invited this physician to give a keynote presentation on his work with the novel small molecule.", "5. The pharmaceutical company offered a speaking honorarium, compensation for travel expenses, and help with preparing slides for the speech."], "atomic_facts": ["1. A pharmaceutical company approached the university of a physician to sign an agreement allowing a molecule to proceed to clinical trials.", "2. The physician has obtained new data from human trials and has published several high profile papers.", "3. A major national conference invited the physician to give a keynote presentation on his work with the novel small molecule.", "4. The pharmaceutical company offered a speaking honorarium to the physician.", "5. The pharmaceutical company offered compensation for travel expenses to the physician.", "6. The pharmaceutical company offered help with preparing slides for the speech to the physician."]}
{"id": 191, "question": "Which of the following options best describes the pathogenesis of edema in this patient?", "context": ["A 6-year-old boy is brought to the pediatrician with swelling around the eyes, lower extremity edema, and abdominal distension for the past 3 days.", "There is no history of hematuria or decreased urine output.", "His temperature is 36.9\u00b0C (98.4\u00b0F), pulse rate is 88/min, blood pressure is 98/70 mm Hg, and respiratory rate is 20/min.", "On physical examination, 2+ pitting edema is present in the lower limbs and the periorbital region.", "The abdomen is distended with a positive fluid wave.", "Laboratory studies show: | Serum creatinine 0.8 mg/dL | Serum albumin 1.5 g/dL | Serum cholesterol 260 mg/dL | Serum C3 and C4 Normal | Urine protein/creatinine ratio 3.1 mg/mg | The patient is diagnosed with minimal change disease."], "context_len": 6, "options": {"A": "Increased capillary hydrostatic pressure", "B": "Increased capillary permeability", "C": "Increased interstitial oncotic pressure", "D": "Decreased oncotic pressure gradient across capillary"}, "answer": "Decreased oncotic pressure gradient across capillary", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-year-old boy is brought to the pediatrician with swelling around the eyes, lower extremity edema, and abdominal distension for the past 3 days.", "2. There is no history of hematuria or decreased urine output.", "3. His temperature is 36.9\u00b0C (98.4\u00b0F).", "4. His pulse rate is 88/min.", "5. His blood pressure is 98/70 mm Hg.", "6. His respiratory rate is 20/min.", "7. On physical examination, 2+ pitting edema is present in the lower limbs and the periorbital region.", "8. The abdomen is distended with a positive fluid wave.", "9. Laboratory studies show serum creatinine 0.8 mg/dL.", "10. Laboratory studies show serum albumin 1.5 g/dL.", "11. Laboratory studies show serum cholesterol 260 mg/dL.", "12. Laboratory studies show serum C3 and C4 Normal.", "13. Laboratory studies show urine protein/creatinine ratio 3.1 mg/mg.", "14. The patient is diagnosed with minimal change disease."], "atomic_facts": ["1. No history of hematuria", "2. No history of decreased urine output", "3. Temperature is 36.9\u00b0C (98.4\u00b0F)", "4. Pulse rate is 88/min", "5. Blood pressure is 98/70 mm Hg", "6. Respiratory rate is 20/min", "7. 2+ pitting edema present in lower limbs and periorbital region", "8. Abdomen is distended", "9. Positive fluid wave on abdominal examination", "10. Serum creatinine is 0.8 mg/dL", "11. Serum albumin is 1.5 g/dL", "12. Serum cholesterol is 260 mg/dL", "13. Serum C3 and C4 levels are normal", "14. Urine protein/creatinine ratio is 3.1 mg/mg", "15. Diagnosis of minimal change disease"]}
{"id": 192, "question": "This patient's condition is most likely associated with decreased production of which of the following substances?", "context": ["A 73-year-old woman is brought to the physician by her son because of a 2-year history of increasing forgetfulness.", "She does not remember her children's names; she cannot go outside the house unaccompanied because she forgets where she is and what she is supposed to do.", "Her son reports that over the past year, she has withdrawn herself from social gatherings and avoids making conversation.", "Mental status examination shows both impaired short- and long-term memory.", "She is oriented only to person.", "Her abstract reasoning is impaired.", "She appears indifferent about her memory lapses and says this is normal for someone her age."], "context_len": 7, "options": {"A": "Gamma-aminobutyric acid", "B": "Acetylcholine", "C": "Norepinephrine", "D": "Dopamine"}, "answer": "Acetylcholine", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "73 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 73-year-old woman is brought to the physician by her son.", "2. She has a 2-year history of increasing forgetfulness.", "3. She does not remember her children's names.", "4. She cannot go outside the house unaccompanied.", "5. She forgets where she is and what she is supposed to do.", "6. Her son reports that over the past year, she has withdrawn herself from social gatherings.", "7. She avoids making conversation.", "8. Mental status examination shows both impaired short- and long-term memory.", "9. She is oriented only to person.", "10. Her abstract reasoning is impaired.", "11. She appears indifferent about her memory lapses.", "12. She says this is normal for someone her age."], "atomic_facts": ["1. She does not remember her children's names.", "2. She cannot go outside the house unaccompanied because she forgets where she is and what she is supposed to do.", "3. Her son reports that over the past year, she has withdrawn herself from social gatherings and avoids making conversation.", "4. Mental status examination shows impaired short-term memory.", "5. Mental status examination shows impaired long-term memory.", "6. She is oriented only to person.", "7. Her abstract reasoning is impaired.", "8. She appears indifferent about her memory lapses and says this is normal for someone her age."]}
{"id": 193, "question": "What type of medication would be best long-term for our patient?", "context": ["During an emergency room shift, you encounter a disheveled looking man claiming that he is President Kennedy\u2019s love child and the FBI is out to get him.", "He also endorses that the aliens are responsible for his fathers death and that the aliens implanted a chip in his head to constantly speak to him.", "Upon review of his medical record, you notice that he made a previous visit to the ER for a similar episode about 8 months ago.", "Besides his eccentric demeanor and disorganized speech, his vitals and physical exam are all within in normal range.", "No illicit substances were identified following a urinary toxicology screening."], "context_len": 5, "options": {"A": "Quetiapine", "B": "Lithium", "C": "Fluoxetine", "D": "Chlorpromazine"}, "answer": "Quetiapine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "Not specified", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. During an emergency room shift, you encounter a disheveled looking man.", "2. The man claims that he is President Kennedy\u2019s love child.", "3. The man claims that the FBI is out to get him.", "4. The man endorses that the aliens are responsible for his father's death.", "5. The man claims that the aliens implanted a chip in his head to constantly speak to him.", "6. Upon review of his medical record, you notice that he made a previous visit to the ER for a similar episode about 8 months ago.", "7. Besides his eccentric demeanor and disorganized speech, his vitals and physical exam are all within in normal range.", "8. No illicit substances were identified following a urinary toxicology screening."], "atomic_facts": ["1. The patient believes that aliens are responsible for his father's death.", "2. The patient claims that aliens implanted a chip in his head to constantly speak to him.", "3. The patient had a previous visit to the ER for a similar episode about 8 months ago.", "4. The patient's vitals and physical exam are within normal range.", "5. No illicit substances were found in the patient's urinary toxicology screening."]}
{"id": 194, "question": "What is the most likely pathological process seen in this type of infection?", "context": ["A 20-year-old man presents to an outpatient clinic with complaints of fever and sweating for 2 months.", "He says that he does not have the same appetite as before.", "He lost 2.7 kg (6.0 lb) in the last 2 months.", "He also complains of pleuritic chest pain and difficulty breathing, which is not nocturnal and is unrelated to position.", "He has had a mild cough for several months.", "On examination, the patient is afebrile with normal auscultatory findings.", "A chest X-ray reveals a right upper lobe homogeneous density.", "Ziehl-Neelsen staining of sputum shows Mycobacterium tuberculosis."], "context_len": 8, "options": {"A": "Caseous necrosis", "B": "Liquefactive necrosis", "C": "Fat necrosis", "D": "Fibrinoid necrosis"}, "answer": "Caseous necrosis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "20 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 20-year-old man.", "2. Patient has had fever and sweating for 2 months.", "3. Patient has decreased appetite.", "4. Patient has lost 2.7 kg (6.0 lb) in the last 2 months.", "5. Patient has pleuritic chest pain and difficulty breathing.", "6. Patient's chest pain and difficulty breathing is not nocturnal and is unrelated to position.", "7. Patient has had a mild cough for several months.", "8. Patient is afebrile with normal auscultatory findings on examination.", "9. Chest X-ray reveals a right upper lobe homogeneous density.", "10. Ziehl-Neelsen staining of sputum shows Mycobacterium tuberculosis."], "atomic_facts": ["1. He does not have the same appetite as before.", "2. He lost 2.7 kg (6.0 lb) in the last 2 months.", "3. He complains of pleuritic chest pain and difficulty breathing, which is not nocturnal and is unrelated to position.", "4. He has had a mild cough for several months.", "5. On examination, the patient is afebrile with normal auscultatory findings.", "6. A chest X-ray reveals a right upper lobe homogeneous density.", "7. Ziehl-Neelsen staining of sputum shows Mycobacterium tuberculosis."]}
{"id": 195, "question": "Which of the following is the next best step in the management of this patient?", "context": ["A 19-year-old man presents with a 10-day history of progressive lower back pain and leg weakness, followed by severe lower abdominal pain for the past 12-hours.", "He describes the back pain as moderate in intensity which radiates to both legs.", "The weakness has progressively increased, and he cannot ambulate without support.", "He is also complaining of fever but never checks it.", "He is a captain of the college basketball team and the back pain and lower limb weakness is preventing him from participating in practices or games.", "Past medical history is significant for schizophrenia and a suicide attempt.", "His vital signs include: blood pressure 128/84 mm Hg, temperature 38.8\u00b0C (101.8\u00b0F).", "A mass is palpable in the lower abdomen.", "Strength is 5 out of 5 in the upper limbs bilaterally and 3 out of 5 in the lower limbs bilaterally.", "Deep tendon reflexes are 2+ in the upper limbs while they are reduced in the lower limbs.", "Sensitivity to pinprick is absent from below the umbilicus.", "1270 mL of urine is collected after placing a Foley catheter."], "context_len": 12, "options": {"A": "Nerve conduction studies", "B": "Psychiatric consultation", "C": "Spinal magnetic resonance imaging (MRI)", "D": "Ultrasound of kidneys, ureters, and bladder"}, "answer": "Spinal magnetic resonance imaging (MRI)", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "19", "specialties": ["Orthopaedic Surgery", "Neurology"], "subspecialties": ["Orthopaedic Sports Medicine", "General Orthopaedic Surgery", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 19 years old.", "2. Patient has 10-day history of progressive lower back pain and leg weakness.", "3. Patient has severe lower abdominal pain for the past 12-hours.", "4. Patient describes back pain as moderate in intensity which radiates to both legs.", "5. Patient's weakness has progressively increased.", "6. Patient cannot ambulate without support.", "7. Patient is complaining of fever but never checks it.", "8. Patient is captain of college basketball team.", "9. Back pain and lower limb weakness is preventing patient from participating in practices or games.", "10. Patient has past medical history of schizophrenia and a suicide attempt.", "11. Patient's blood pressure is 128/84 mm Hg.", "12. Patient's temperature is 38.8\u00b0C (101.8\u00b0F).", "13. Mass is palpable in lower abdomen.", "14. Strength is 5 out of 5 in upper limbs bilaterally and 3 out of 5 in lower limbs bilaterally.", "15. Deep tendon reflexes are 2+ in upper limbs and reduced in lower limbs.", "16. Sensitivity to pinprick is absent from below the umbilicus.", "17. 1270 mL of urine is collected after placing a Foley catheter."], "atomic_facts": ["1. The patient describes the back pain as moderate in intensity.", "2. The back pain radiates to both legs.", "3. The weakness has progressively increased.", "4. The patient cannot ambulate without support.", "5. The patient is complaining of fever.", "6. The patient has not checked their fever.", "7. The patient is a captain of the college basketball team.", "8. The back pain and lower limb weakness are preventing the patient from participating in practices or games.", "9. The patient's past medical history includes schizophrenia and a suicide attempt.", "10. The patient's blood pressure is 128/84 mm Hg.", "11. The patient's temperature is 38.8\u00b0C (101.8\u00b0F).", "12. A mass is palpable in the lower abdomen.", "13. The patient's strength is 5 out of 5 in the upper limbs bilaterally.", "14. The patient's strength is 3 out of 5 in the lower limbs bilaterally.", "15. The patient's deep tendon reflexes are 2+ in the upper limbs.", "16. The patient's deep tendon reflexes are reduced in the lower limbs.", "17. Sensitivity to pinprick is absent from below the umbilicus.", "18. 1270 mL of urine is collected after placing a Foley catheter."]}
{"id": 196, "question": "Which of the following deposits would most likely be detected on the renal biopsy in this patient?", "context": ["A 72-year-old man is diagnosed with multiple myeloma.", "His blood work shows mild anemia and urinalysis detects proteinuria at a level of 670 mg/24 h.", "A kidney biopsy is performed."], "context_len": 3, "options": {"A": "\u0410\u03b2 amyloid", "B": "Calcitonin", "C": "AL amyloid", "D": "Mutated transthyretin"}, "answer": "AL amyloid", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "72", "specialties": ["Internal Medicine", "Pathology"], "subspecialties": ["Medical Oncology", "Renal Pathology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 72-year-old man is diagnosed with multiple myeloma.", "2. His blood work shows mild anemia.", "3. Urinalysis detects proteinuria at a level of 670 mg/24 h.", "4. A kidney biopsy is performed."], "atomic_facts": ["1. Blood work shows mild anemia.", "2. Urinalysis detects proteinuria at a level of 670 mg/24 h.", "3. A kidney biopsy is performed."]}
{"id": 197, "question": "Which of the following options would be most appropriate for the management of this patient?", "context": ["A 29-year-old woman, gravida 1, para 0 at 11 weeks' gestation, comes to the physician because of a 2-day history of left lower-extremity pain and swelling.", "Her temperature is 37.9\u00b0C (100.2\u00b0F).", "She denies any trauma but says she has not been ambulating due to swelling and the pain in her lower extremities.", "Physical examination shows diffuse pain on palpation and swelling of the left leg, as well as warmth and tenderness.", "Compression ultrasound shows poor compressibility of the femoral vein."], "context_len": 5, "options": {"A": "Aspirin", "B": "Dipyridamole", "C": "Heparin", "D": "Warfarin"}, "answer": "Heparin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "29 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology", "Maternal"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 29-year-old woman is gravida 1, para 0 at 11 weeks' gestation.", "2. She has a 2-day history of left lower-extremity pain and swelling.", "3. Her temperature is 37.9\u00b0C (100.2\u00b0F).", "4. She denies any trauma.", "5. She has not been ambulating due to swelling and the pain in her lower extremities.", "6. Physical examination shows diffuse pain on palpation and swelling of the left leg, as well as warmth and tenderness.", "7. Compression ultrasound shows poor compressibility of the femoral vein."], "atomic_facts": ["1. Her temperature is 37.9\u00b0C (100.2\u00b0F).", "2. She denies any trauma.", "3. She has not been ambulating due to swelling and pain in her lower extremities.", "4. Physical examination shows diffuse pain on palpation.", "5. Physical examination shows swelling of the left leg.", "6. Physical examination shows warmth and tenderness.", "7. Compression ultrasound shows poor compressibility of the femoral vein."]}
{"id": 198, "question": "Which of the following is the most likely underlying diagnosis in this patient?", "context": ["A 65-year-old woman presents to the emergency department with a new-onset seizure.", "The patient was at home watching television when she suddenly began jerking her limbs and not responding according to her partner.", "The patient works as a gardener is often dehydrated but drinks large volumes of water to compensate for her work.", "She does not wear protective gear or sunscreen while working.", "She has smoked 1.5 packs of cigarettes per day for the past 40 years.", "She drinks liquor before bed every night.", "The patient has a past medical history of hypertension and diabetes and recently lost 9 pounds.", "Physical exam is within normal limits."], "context_len": 8, "options": {"A": "Glioblastoma multiforme", "B": "Infiltrating ductal carcinoma of the breast", "C": "Primary seizure disorder", "D": "Small cell carcinoma of the lung"}, "answer": "Small cell carcinoma of the lung", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "65 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "Epilepsy", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 65-year-old woman presented to the emergency department with a new-onset seizure.", "2. The patient was at home watching television when she suddenly began jerking her limbs and not responding according to her partner.", "3. The patient works as a gardener.", "4. The patient is often dehydrated but drinks large volumes of water to compensate for her work.", "5. The patient does not wear protective gear or sunscreen while working.", "6. The patient has smoked 1.5 packs of cigarettes per day for the past 40 years.", "7. The patient drinks liquor before bed every night.", "8. The patient has a past medical history of hypertension and diabetes.", "9. The patient recently lost 9 pounds.", "10. Physical exam is within normal limits."], "atomic_facts": ["1. The patient was at home watching television when she suddenly began jerking her limbs and not responding according to her partner.", "2. The patient works as a gardener and is often dehydrated.", "3. The patient drinks large volumes of water to compensate for her work.", "4. The patient does not wear protective gear or sunscreen while working.", "5. The patient has smoked 1.5 packs of cigarettes per day for the past 40 years.", "6. The patient drinks liquor before bed every night.", "7. The patient has a past medical history of hypertension and diabetes.", "8. The patient recently lost 9 pounds.", "9. Physical exam is within normal limits."]}
{"id": 199, "question": "What is inoculation of the tetanus vaccine able to stimulate the production of?", "context": ["A 32-year-old man presents to the emergency department after puncturing his foot while working on his garage last week.", "His past medical history is significant for bronchial asthma and seasonal allergies.", "On examination, the patient\u2019s jaw seems rigid, and his temperature is 38.3\u00b0C (100.9\u00b0F).", "The puncture on the sole of his foot is 2 cm deep and 0.5 cm long.", "The patient is immediately given tetanus immunoglobulin."], "context_len": 5, "options": {"A": "Anti-tetanus antibodies", "B": "Allotype antibodies", "C": "Hypersensitive reaction type III", "D": "Idiotype antibodies"}, "answer": "Allotype antibodies", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "32", "specialties": ["Emergency Medicine", "Internal Medicine"], "subspecialties": ["General Emergency Medicine", "Infectious Disease"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 32-year-old man presents to the emergency department.", "2. He punctured his foot while working on his garage last week.", "3. His past medical history is significant for bronchial asthma and seasonal allergies.", "4. On examination, the patient's jaw seems rigid.", "5. His temperature is 38.3\u00b0C (100.9\u00b0F).", "6. The puncture on the sole of his foot is 2 cm deep and 0.5 cm long.", "7. The patient is immediately given tetanus immunoglobulin."], "atomic_facts": ["1. His past medical history includes bronchial asthma and seasonal allergies.", "2. On examination, the patient's jaw appears rigid.", "3. The patient's temperature is 38.3\u00b0C (100.9\u00b0F).", "4. The puncture on the sole of his foot is 2 cm deep and 0.5 cm long.", "5. The patient is immediately given tetanus immunoglobulin."]}
{"id": 200, "question": "Which of the following explains these findings?", "context": ["A 28-year-old woman presents to the clinic with 2 months of palpitations, tremor, heat intolerance, insomnia, and loose bowel movements.", "She has lost 20 kg (44 lb).", "A physical examination indicates that the body temperature is 37.8\u00b0C (100.0\u00b0F), the heart rate is 120/min, and the blood pressure is 130/80 mm Hg.", "The examination also reveals that a moderately-sized diffuse goiter and a bruit were present.", "She was agitated and experienced a fine tremor with warm moist palms; she also had increased deep tendon reflexes.", "No exophthalmos was noted.", "The laboratory tests revealed TSH < 0.01 mIU/L (normal: 0.5\u20134.0 mIU/L), T4: 57 pmol/L (normal: 10\u201325 pmol/L), T3: 24 pmol/L (normal 3.1\u20135.4 pmol/L).", "Complete blood count was normal.", "A thyroid scan demonstrated diffusely increased uptake.", "A high level of thyroid-stimulating immunoglobulin antibodies was detected."], "context_len": 10, "options": {"A": "Exogenous thyroxine intake", "B": "Graves\u2019 disease", "C": "Hashimoto\u2019s thyroiditis", "D": "Pregnancy"}, "answer": "Graves\u2019 disease", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Internal Medicine", "Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Endocrinology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 28-year-old woman presents to the clinic with 2 months of palpitations, tremor, heat intolerance, insomnia, and loose bowel movements.", "2. She has lost 20 kg (44 lb).", "3. A physical examination indicates that the body temperature is 37.8\u00b0C (100.0\u00b0F).", "4. The heart rate is 120/min.", "5. The blood pressure is 130/80 mm Hg.", "6. The examination also reveals that a moderately-sized diffuse goiter and a bruit were present.", "7. She was agitated and experienced a fine tremor with warm moist palms.", "8. She also had increased deep tendon reflexes.", "9. No exophthalmos was noted.", "10. The laboratory tests revealed TSH < 0.01 mIU/L (normal: 0.5\u20134.0 mIU/L).", "11. T4: 57 pmol/L (normal: 10\u201325 pmol/L).", "12. T3: 24 pmol/L (normal 3.1\u20135.4 pmol/L).", "13. Complete blood count was normal.", "14. A thyroid scan demonstrated diffusely increased uptake.", "15. A high level of thyroid-stimulating immunoglobulin antibodies was detected."], "atomic_facts": ["1. She has lost 20 kg (44 lb).", "2. The body temperature is 37.8\u00b0C (100.0\u00b0F).", "3. The heart rate is 120/min.", "4. The blood pressure is 130/80 mm Hg.", "5. A moderately-sized diffuse goiter and a bruit were present.", "6. She was agitated and experienced a fine tremor with warm moist palms.", "7. She had increased deep tendon reflexes.", "8. No exophthalmos was noted.", "9. The laboratory tests revealed TSH < 0.01 mIU/L (normal: 0.5\u20134.0 mIU/L).", "10. T4: 57 pmol/L (normal: 10\u201325 pmol/L).", "11. T3: 24 pmol/L (normal 3.1\u20135.4 pmol/L).", "12. Complete blood count was normal.", "13. A thyroid scan demonstrated diffusely increased uptake.", "14. A high level of thyroid-stimulating immunoglobulin antibodies was detected."]}
{"id": 201, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?\"", "context": ["A 45-year-old woman comes to the physician because of fatigue and irregular menstrual cycles for the past year.", "She also complains of recurrent sinus infections.", "During the past 6 months, she has had increased urinary frequency and swelling of her feet.", "She has also had difficulty lifting her 3-year-old niece for the past 3 weeks.", "She was recently diagnosed with depression.", "She works as a medical assistant.", "The patient has smoked one half-pack of cigarettes daily for 25 years and drinks four beers on the weekends.", "Her only medication is escitalopram.", "She is 160 cm (5 ft 3 in) tall and weighs 79 kg (175 lb); BMI is 31 kg/m2.", "She appears tired.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 80/min, respirations are 18/min, and blood pressure is 140/82 mm Hg.", "Physical examinations shows neck obesity and an enlarged abdomen.", "Examination of the skin shows multiple bruises on her arms and legs.", "There is generalized weakness and atrophy of the proximal muscles.", "Laboratory studies show: | Serum | Na+ 150 mEq/L | K+ 3.0 mEq/L | Cl- 103 mEq/L | HCO3- 30 mEq/L | Urea nitrogen 19 mg/dL | Creatinine 0.9 mg/dL | Glucose 136 mg/dL | A 1 mg overnight dexamethasone suppression test shows a serum cortisol of 167 nmol/L (N < 50) and a 24-hour urinary cortisol is 425 \u03bcg (N < 300 \u03bcg).", "Serum ACTH is 169 pg/mL (N = 7\u201350).", "Subsequently, a high-dose dexamethasone suppression test shows a serum cortisol level of 164 nmol/L (N < 50)."], "context_len": 17, "options": {"A": "Adrenal carcinoma", "B": "Hypothyroidism", "C": "Small cell lung cancer", "D": "Adrenal adenoma"}, "answer": "Small cell lung cancer", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "45", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 45-year-old woman.", "2. Patient has been experiencing fatigue and irregular menstrual cycles for the past year.", "3. Patient has had recurrent sinus infections.", "4. Patient has had increased urinary frequency and swelling of her feet for the past 6 months.", "5. Patient has had difficulty lifting her 3-year-old niece for the past 3 weeks.", "6. Patient was recently diagnosed with depression.", "7. Patient works as a medical assistant.", "8. Patient has smoked one half-pack of cigarettes daily for 25 years.", "9. Patient drinks four beers on the weekends.", "10. Patient's only medication is escitalopram.", "11. Patient is 160 cm (5 ft 3 in) tall.", "12. Patient weighs 79 kg (175 lb); BMI is 31 kg/m2.", "13. Patient appears tired.", "14. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "15. Patient's pulse is 80/min.", "16. Patient's respirations are 18/min.", "17. Patient's blood pressure is 140/82 mm Hg.", "18. Physical examinations shows neck obesity and an enlarged abdomen.", "19. Examination of the skin shows multiple bruises on her arms and legs.", "20. There is generalized weakness and atrophy of the proximal muscles.", "21. Serum Na+ is 150 mEq/L.", "22. Serum K+ is 3.0 mEq/L.", "23. Serum Cl- is 103 mEq/L.", "24. Serum HCO3- is 30 mEq/L.", "25. Serum urea nitrogen is 19 mg/dL.", "26. Serum creatinine is 0.9 mg/dL.", "27. Serum glucose is 136 mg/dL.", "28. A 1 mg overnight dexamethasone suppression test shows a serum cortisol of 167 nmol/L (N < 50).", "29. 24-hour urinary cortisol is 425 \u03bcg (N < 300 \u03bcg).", "30. Serum ACTH is 169 pg/mL (N = 7\u201350).", "31. High-dose dexamethasone suppression test shows a serum cortisol level of 164 nmol/L (N < 50)."], "atomic_facts": ["1. The patient complains of recurrent sinus infections.", "2. Over the past 6 months, she has experienced increased urinary frequency and swelling of her feet.", "3. She has had difficulty lifting her 3-year-old niece for the past 3 weeks.", "4. The patient was recently diagnosed with depression.", "5. She works as a medical assistant.", "6. The patient has smoked one half-pack of cigarettes daily for 25 years and drinks four beers on the weekends.", "7. Her only medication is escitalopram.", "8. She is 160 cm (5 ft 3 in) tall and weighs 79 kg (175 lb); BMI is 31 kg/m2.", "9. The patient appears tired.", "10. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 80/min, respirations are 18/min, and blood pressure is 140/82 mm Hg.", "11. Physical examination shows neck obesity and an enlarged abdomen.", "12. Examination of the skin shows multiple bruises on her arms and legs.", "13. There is generalized weakness and atrophy of the proximal muscles.", "14. Laboratory studies show: Serum Na+ 150 mEq/L, K+ 3.0 mEq/L, Cl- 103 mEq/L, HCO3- 30 mEq/L, Urea nitrogen 19 mg/dL, Creatinine 0.9 mg/dL, Glucose 136 mg/dL.", "15. A 1 mg overnight dexamethasone suppression test shows a serum cortisol of 167 nmol/L (N < 50) and a 24-hour urinary cortisol is 425 \u03bcg (N < 300 \u03bcg).", "16. Serum ACTH is 169 pg/mL (N = 7\u201350).", "17. Subsequently, a high-dose dexamethasone suppression test shows a serum cortisol level of 164 nmol/L (N < 50)."]}
{"id": 202, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 39-year-old woman, gravida 3, para 2, at 39 weeks' gestation is admitted to the hospital with leakage of fluid and contractions.", "She noticed the fluid leak about an hour ago and has no associated bleeding.", "Contractions have been about 20 minutes apart.", "On admission, she is dilated 2 cm, 50% effaced, and at -2 station.", "Spontaneous rupture of membranes is confirmed and she is monitored by external tocodynamometer.", "Repeat evaluation after 2 hours shows dilation of 6 cm , 70% effacement, and -1 station.", "Four hours later, her pelvic exam shows no changes and she has 4 strong contractions every 10 minutes.", "The fetal heart rate is 120/min, with moderate accelerations and no late or variable decelerations."], "context_len": 8, "options": {"A": "Cesarean delivery", "B": "Assisted vaginal delivery", "C": "Amnioinfusion", "D": "Intrauterine pressure catheter\n\""}, "answer": "Cesarean delivery", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "39 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is 39 years old.", "2. Patient is gravida 3, para 2.", "3. Patient is at 39 weeks' gestation.", "4. Patient has leakage of fluid and contractions.", "5. Patient noticed fluid leak about an hour ago.", "6. Patient has no associated bleeding.", "7. Contractions are about 20 minutes apart.", "8. On admission, patient is dilated 2 cm, 50% effaced, and at -2 station.", "9. Spontaneous rupture of membranes is confirmed.", "10. Patient is monitored by external tocodynamometer.", "11. Repeat evaluation after 2 hours shows dilation of 6 cm, 70% effacement, and -1 station.", "12. Four hours later, pelvic exam shows no changes.", "13. Patient has 4 strong contractions every 10 minutes.", "14. Fetal heart rate is 120/min.", "15. Fetal heart rate has moderate accelerations.", "16. Fetal heart rate has no late or variable decelerations."], "atomic_facts": ["1. She noticed the fluid leak about an hour ago", "2. She has no associated bleeding", "3. Contractions have been about 20 minutes apart", "4. On admission, she is dilated 2 cm", "5. She is 50% effaced", "6. She is at -2 station", "7. Spontaneous rupture of membranes is confirmed", "8. She is monitored by external tocodynamometer", "9. Repeat evaluation after 2 hours shows dilation of 6 cm", "10. She is 70% effaced", "11. She is at -1 station", "12. Four hours later, her pelvic exam shows no changes", "13. She has 4 strong contractions every 10 minutes", "14. The fetal heart rate is 120/min", "15. The fetal heart rate shows moderate accelerations", "16. There are no late or variable decelerations"]}
{"id": 203, "question": "Which of the following is the best initial management for this patient?", "context": ["A 32-year-old homeless man presents to the emergency department with dyspnea, left-sided chest pain, chills, and a productive cough over the last week or so.", "He does not have medical insurance and has not seen a doctor for many years.", "His chest pain increases with inspiration.", "The pain does not radiate or worsen with movement.", "He states that has a productive cough with yellow sputum with flecks of blood.", "He drinks 6 beers a night and does not smoke or take illicit drugs.", "Temperature is 37.8\u00b0C (100.0\u00b0F), blood pressure is 124/90 mm Hg, pulse is 92/min, and respiration rate is 16/min.", "On physical examination, tactile fremitus is increased and there is a dullness to percussion over the lower part of the left lung.", "No murmurs are heard.", "Oral examination reveals poor dentition.", "Chest X-ray reveals a large left lobar opacification with extensive pleural effusion."], "context_len": 11, "options": {"A": "Supplemental oxygen", "B": "IV antibiotics and thoracentesis", "C": "Inhaled bronchodilators", "D": "Upper endoscopy"}, "answer": "IV antibiotics and thoracentesis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "32 years old", "specialties": ["Emergency Medicine", "Internal Medicine"], "subspecialties": ["General Emergency Medicine", "Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 32 years old.", "2. Patient is homeless.", "3. Patient presents with dyspnea, left-sided chest pain, chills, and a productive cough over the last week or so.", "4. Patient has not had medical insurance and has not seen a doctor for many years.", "5. Patient's chest pain increases with inspiration.", "6. Patient's chest pain does not radiate or worsen with movement.", "7. Patient has a productive cough with yellow sputum with flecks of blood.", "8. Patient drinks 6 beers a night.", "9. Patient does not smoke or take illicit drugs.", "10. Patient's temperature is 37.8\u00b0C (100.0\u00b0F).", "11. Patient's blood pressure is 124/90 mm Hg.", "12. Patient's pulse is 92/min.", "13. Patient's respiration rate is 16/min.", "14. On physical examination, tactile fremitus is increased.", "15. On physical examination, there is a dullness to percussion over the lower part of the left lung.", "16. On physical examination, no murmurs are heard.", "17. Oral examination reveals poor dentition.", "18. Chest X-ray reveals a large left lobar opacification with extensive pleural effusion."], "atomic_facts": ["1. He does not have medical insurance.", "2. He has not seen a doctor for many years.", "3. His chest pain increases with inspiration.", "4. The pain does not radiate or worsen with movement.", "5. He has a productive cough with yellow sputum with flecks of blood.", "6. He drinks 6 beers a night.", "7. He does not smoke or take illicit drugs.", "8. His temperature is 37.8\u00b0C (100.0\u00b0F).", "9. His blood pressure is 124/90 mm Hg.", "10. His pulse is 92/min.", "11. His respiration rate is 16/min.", "12. On physical examination, tactile fremitus is increased.", "13. There is a dullness to percussion over the lower part of the left lung.", "14. No murmurs are heard.", "15. Oral examination reveals poor dentition.", "16. Chest X-ray reveals a large left lobar opacification with extensive pleural effusion."]}
{"id": 204, "question": "Which of the following is the most likely etiology of this patient\u2019s condition?", "context": ["A 43-year-old woman presents with left calf pain.", "She denies any previous episodes of such pain.", "Past medical history is significant for cervical carcinoma treated with cryosurgery with no evidence of recurrence.", "Current medications are an estrogen-containing oral contraceptive and a multivitamin.", "The patient reports a 40-pack-year smoking history, but no alcohol or recreational drug use.", "The patient is afebrile and her vital signs are within normal limits.", "On physical examination, her left calf is swollen, erythematous, and tender to palpation.", "A D-dimer level is positive."], "context_len": 8, "options": {"A": "Fibromyalgia", "B": "Oral contraceptives", "C": "Protein C deficiency", "D": "Protein S deficiency"}, "answer": "Oral contraceptives", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "43", "specialties": ["Internal Medicine", "Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine", "General Internal Medicine", "Vascular Medicine"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 43 years old.", "2. Patient presents with left calf pain.", "3. Patient denies any previous episodes of such pain.", "4. Patient has past medical history of cervical carcinoma treated with cryosurgery with no evidence of recurrence.", "5. Patient is currently taking an estrogen-containing oral contraceptive and a multivitamin.", "6. Patient has a 40-pack-year smoking history, but no alcohol or recreational drug use.", "7. Patient is afebrile and her vital signs are within normal limits.", "8. On physical examination, her left calf is swollen, erythematous, and tender to palpation.", "9. D-dimer level is positive."], "atomic_facts": ["1. She denies any previous episodes of such pain.", "2. Past medical history is significant for cervical carcinoma treated with cryosurgery with no evidence of recurrence.", "3. Current medications are an estrogen-containing oral contraceptive and a multivitamin.", "4. The patient reports a 40-pack-year smoking history, but no alcohol or recreational drug use.", "5. The patient is afebrile and her vital signs are within normal limits.", "6. On physical examination, her left calf is swollen, erythematous, and tender to palpation.", "7. A D-dimer level is positive."]}
{"id": 205, "question": "Assuming all other parameters remain constant, which of the following is most likely to decrease the volume of retrograde blood flow in this patient?", "context": ["A 53-year-old woman with hypertension and hyperlipidemia comes to the physician because of a 3-month history of progressively worsening shortness of breath.", "Her pulse is 92/min, respirations are 22/min, and blood pressure is 110/70 mm Hg.", "Cardiac examination shows a grade 3/6 holosystolic murmur at the apex that radiates to the axilla and an extra heart sound during early diastole."], "context_len": 3, "options": {"A": "Increase in atrioventricular orifice size", "B": "Increase in left ventricular inotropy", "C": "Decrease in systemic vascular resistance", "D": "Increase in left ventricular end-diastolic pressure"}, "answer": "Decrease in systemic vascular resistance", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "53 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 53-year-old woman comes to the physician.", "2. She has hypertension and hyperlipidemia.", "3. She has a 3-month history of progressively worsening shortness of breath.", "4. Her pulse is 92/min.", "5. Her respirations are 22/min.", "6. Her blood pressure is 110/70 mm Hg.", "7. Cardiac examination shows a grade 3/6 holosystolic murmur at the apex.", "8. The murmur radiates to the axilla.", "9. There is an extra heart sound during early diastole."], "atomic_facts": ["1. Pulse rate: 92/min", "2. Respiratory rate: 22/min", "3. Blood pressure: 110/70 mm Hg", "4. Cardiac examination: Grade 3/6 holosystolic murmur at the apex", "5. Murmur radiation: To the axilla", "6. Extra heart sound: During early diastole"]}
{"id": 206, "question": "What is the most likely cause of his symptoms?", "context": ["A 66-year-old man presents to his primary care physician with abdominal pain in the setting of progressively worsening constipation.", "He complains of epigastric pain that waxes and wanes, and expressed concern that he has not defecated for the past 5 days.", "Upon further questioning, he relates that he has been taking three of his wife's multivitamins each day for the past three weeks to \"combat a cold.\" Vital signs are within normal limits.", "Physical exam reveals an abdomen with nonspecific tenderness to deep palpation without rebound tenderness, hyperpercussion, or flank tenderness."], "context_len": 4, "options": {"A": "Magnesium overdose", "B": "Iron overdose", "C": "Potassium overdose", "D": "Folic acid overdose"}, "answer": "Iron overdose", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "66 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 66-year-old man presents to his primary care physician with abdominal pain.", "2. The abdominal pain is in the setting of progressively worsening constipation.", "3. He complains of epigastric pain that waxes and wanes.", "4. He has not defecated for the past 5 days.", "5. He has been taking three of his wife's multivitamins each day for the past three weeks.", "6. Vital signs are within normal limits.", "7. Physical exam reveals an abdomen with nonspecific tenderness to deep palpation.", "8. There is no rebound tenderness, hyperpercussion, or flank tenderness."], "atomic_facts": ["1. Patient complains of epigastric pain", "2. Pain waxes and wanes", "3. Patient has not defecated for the past 5 days", "4. Patient has been taking three of his wife's multivitamins each day for the past three weeks", "5. Patient took multivitamins to combat a cold", "6. Vital signs are within normal limits", "7. Physical exam reveals nonspecific tenderness in the abdomen to deep palpation", "8. No rebound tenderness, hyperpercussion, or flank tenderness"]}
{"id": 207, "question": "Which of the following findings in the nephron best describes the tubular osmolality, compared with serum, in this patient?", "context": ["Two days after undergoing transsphenoidal removal of a pituitary macroadenoma, a 35-year-old woman reports increased thirst and frequent urination.", "The surgery was uncomplicated.", "Neurologic examination shows no abnormalities.", "Her serum sodium concentration is 153 mEq/L and serum glucose concentration is 92 mg/dL."], "context_len": 4, "options": {"A": "Distal ascending loop of Henle is hypertonic", "B": "Proximal convoluted tubule is hypertonic", "C": "Collecting duct is hypotonic", "D": "Distal convoluted tubule is hypertonic"}, "answer": "Collecting duct is hypotonic", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "35", "specialties": ["Nephrology"], "subspecialties": ["General Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 35-year-old woman underwent transsphenoidal removal of a pituitary macroadenoma.", "2. Two days after the surgery, the woman reported increased thirst and frequent urination.", "3. The surgery was uncomplicated.", "4. Neurologic examination showed no abnormalities.", "5. The woman's serum sodium concentration was 153 mEq/L.", "6. The woman's serum glucose concentration was 92 mg/dL."], "atomic_facts": ["1. The surgery was uncomplicated.", "2. Neurologic examination shows no abnormalities.", "3. Her serum sodium concentration is 153 mEq/L.", "4. Her serum glucose concentration is 92 mg/dL."]}
{"id": 208, "question": "This patient's symptoms are most likely caused by obstruction at which of the following locations?", "context": ["A 67-year-old woman comes to the physician because of a 5-day history of episodic abdominal pain, nausea, and vomiting.", "She has coronary artery disease and type 2 diabetes mellitus.", "She takes aspirin, metoprolol, and metformin.", "She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); her BMI is 34 kg/m2.", "Her temperature is 38.1\u00b0C (100.6\u00b0F).", "Physical examination shows dry mucous membranes, abdominal distension, and hyperactive bowel sounds.", "Ultrasonography of the abdomen shows air in the biliary tract."], "context_len": 7, "options": {"A": "Third part of the duodenum", "B": "Distal ileum", "C": "Proximal jejunum", "D": "Pancreatic duct"}, "answer": "Distal ileum", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "67 years old", "specialties": ["Surgery", "General Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 67-year-old woman comes to the physician.", "2. She has a 5-day history of episodic abdominal pain, nausea, and vomiting.", "3. She has coronary artery disease and type 2 diabetes mellitus.", "4. She takes aspirin, metoprolol, and metformin.", "5. She is 163 cm (5 ft 4 in) tall.", "6. She weighs 91 kg (200 lb).", "7. Her BMI is 34 kg/m2.", "8. Her temperature is 38.1\u00b0C (100.6\u00b0F).", "9. Physical examination shows dry mucous membranes.", "10. Physical examination shows abdominal distension.", "11. Physical examination shows hyperactive bowel sounds.", "12. Ultrasonography of the abdomen shows air in the biliary tract."], "atomic_facts": ["1. She has coronary artery disease.", "2. She has type 2 diabetes mellitus.", "3. She takes aspirin.", "4. She takes metoprolol.", "5. She takes metformin.", "6. She is 163 cm (5 ft 4 in) tall.", "7. She weighs 91 kg (200 lb).", "8. Her BMI is 34 kg/m2.", "9. Her temperature is 38.1\u00b0C (100.6\u00b0F).", "10. Physical examination shows dry mucous membranes.", "11. Physical examination shows abdominal distension.", "12. Physical examination shows hyperactive bowel sounds.", "13. Ultrasonography of the abdomen shows air in the biliary tract."]}
{"id": 209, "question": "Which of the following is the most likely diagnosis?", "context": ["A 47-year-old man presents to his ophthalmologist for abnormal vision.", "The patient was discharged from the hospital 2 weeks ago after a motor vehicle accident where he was given 1L of blood.", "He also underwent several surgical procedures including enucleation of the right globe and exploratory abdominal laparotomy to stop internal bleeding.", "Currently, he states that he has noticed decreased vision in his left eye.", "The patient has a past medical history of poorly controlled diabetes, asthma, and atopic dermatitis.", "His temperature is 98.9\u00b0F (37.2\u00b0C), blood pressure is 167/108 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 97% on room air.", "Physical exam is notable for 20/200 vision in the patient's left eye, which is worse than usual.", "The patient's left eye appears red and irritated."], "context_len": 8, "options": {"A": "Anterior uveitis", "B": "Normal post-operative visual adaptations", "C": "Seasonal allergies", "D": "Sympathetic ophthalmia"}, "answer": "Sympathetic ophthalmia", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "47", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. Patient is 47 years old.", "2. Patient was discharged from hospital 2 weeks ago after motor vehicle accident.", "3. Patient was given 1L of blood.", "4. Patient underwent enucleation of right globe and exploratory abdominal laparotomy.", "5. Patient has noticed decreased vision in left eye.", "6. Patient has past medical history of poorly controlled diabetes, asthma, and atopic dermatitis.", "7. Patient's temperature is 98.9\u00b0F (37.2\u00b0C).", "8. Patient's blood pressure is 167/108 mmHg.", "9. Patient's pulse is 90/min.", "10. Patient's respirations are 14/min.", "11. Patient's oxygen saturation is 97% on room air.", "12. Patient's vision in left eye is 20/200.", "13. Patient's left eye appears red and irritated."], "atomic_facts": ["1. The patient was discharged from the hospital 2 weeks ago after a motor vehicle accident.", "2. The patient was given 1L of blood.", "3. The patient underwent enucleation of the right globe.", "4. The patient underwent exploratory abdominal laparotomy to stop internal bleeding.", "5. The patient has noticed decreased vision in his left eye.", "6. The patient has a past medical history of poorly controlled diabetes, asthma, and atopic dermatitis.", "7. The patient's temperature is 98.9\u00b0F (37.2\u00b0C).", "8. The patient's blood pressure is 167/108 mmHg.", "9. The patient's pulse is 90/min.", "10. The patient's respirations are 14/min.", "11. The patient's oxygen saturation is 97% on room air.", "12. The patient's physical exam is notable for 20/200 vision in the left eye.", "13. The patient's left eye appears red and irritated."]}
{"id": 210, "question": "Which of the following is the best next step in management?", "context": ["A 26-year-old female presents to her primary care physician with several months of mood swings, which she feels are affecting her work and personal relationships.", "She states that on roughly a quarter of days each month, she feels highly irritable, sensitive to criticism and rejection, and easily saddened.", "She also feels that her appetite varies greatly, and on the days when she is particularly emotional, she also feels especially hungry.", "As a result of these symptoms, her performance at work has suffered, and her boyfriend has been complaining that she is difficult to live with.", "She is anxious that she cannot \u201cget my mood under control.\u201d The patient has no past medical history, regular periods every 28 days, and no obstetric history.", "She uses condoms for contraception.", "Her mother has major depressive disorder, and her father has hypertension and coronary artery disease.", "At this visit, the patient\u2019s temperature is 98.4\u00b0F (36.9\u00b0C), pulse is 75/min, blood pressure is 130/76 mmHg, and respirations are 13/min.", "She appears slightly anxious but has overall normal affect and is pleasantly conversational.", "Physical exam is unremarkable."], "context_len": 10, "options": {"A": "Selective serotonin reuptake inhibitor", "B": "Combined oral contraceptive therapy", "C": "Serotonin-norepinephrine reuptake inhibitor", "D": "Cognitive behavioral therapy"}, "answer": "Selective serotonin reuptake inhibitor", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "26", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is a 26-year-old female.", "2. Patient has been experiencing mood swings for several months.", "3. Patient feels highly irritable, sensitive to criticism and rejection, and easily saddened on roughly a quarter of days each month.", "4. Patient's appetite varies greatly on days when she is particularly emotional.", "5. Patient's performance at work has suffered.", "6. Patient's boyfriend has been complaining that she is difficult to live with.", "7. Patient is anxious that she cannot \"get my mood under control.\"", "8. Patient has no past medical history.", "9. Patient has regular periods every 28 days.", "10. Patient has no obstetric history.", "11. Patient uses condoms for contraception.", "12. Patient's mother has major depressive disorder.", "13. Patient's father has hypertension and coronary artery disease.", "14. Patient's temperature is 98.4\u00b0F (36.9\u00b0C).", "15. Patient's pulse is 75/min.", "16. Patient's blood pressure is 130/76 mmHg.", "17. Patient's respirations are 13/min.", "18. Patient appears slightly anxious but has overall normal affect.", "19. Patient is pleasantly conversational.", "20. Patient's physical exam is unremarkable."], "atomic_facts": ["1. The patient experiences irritability, sensitivity to criticism and rejection, and sadness on roughly a quarter of days each month.", "2. She also experiences varying appetite and increased hunger on emotional days.", "3. Her work performance has suffered due to these symptoms.", "4. Her boyfriend has complained about her being difficult to live with.", "5. The patient is anxious about not being able to control her mood.", "6. She has no past medical history, regular 28-day periods, and no obstetric history.", "7. She uses condoms for contraception.", "8. Her mother has major depressive disorder, and her father has hypertension and coronary artery disease.", "9. At the visit, her temperature is 98.4\u00b0F (36.9\u00b0C), pulse is 75/min, blood pressure is 130/76 mmHg, and respirations are 13/min.", "10. She appears slightly anxious but has overall normal affect and is pleasantly conversational.", "11. The physical exam is unremarkable."]}
{"id": 211, "question": "In addition to restarting medications for his hypertension and diabetes, what of the following is most appropriate treatment for the patient\u2019s symptoms?", "context": ["A 63-year-old male presents to the emergency department complaining of worsening nausea.", "He reports that the nausea began several months ago and is accompanied by occasional bloating and heartburn.", "He reports that he frequently feels full even after eating only a little at each meal, and occasionally he will vomit if he eats too much.", "The vomit is non-bloody and contains bits of undigested food.", "A review of systems is notable for occasional headaches, tingling in his distal extremities, and constipation.", "His medical history is significant for Parkinson\u2019s disease diagnosed 3 years ago, hypertension diagnosed 8 years ago, and type II diabetes mellitus diagnosed 10 years ago.", "The patient reports that he was given prescriptions for both his blood pressure and diabetes medications, but he has not taken either for months because one of them was causing erectile dysfunction.", "He reports he regularly takes his levodopa.", "An endoscopy is performed, which rules out cancer."], "context_len": 9, "options": {"A": "Ondansetron", "B": "Scopolamine", "C": "Proton-pump inhibitor", "D": "Erythromycin"}, "answer": "Erythromycin", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "63", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 63 years old.", "2. Patient is male.", "3. Patient presents to emergency department with worsening nausea.", "4. Nausea began several months ago.", "5. Symptoms include occasional bloating and heartburn.", "6. Patient frequently feels full after eating only a little.", "7. Patient occasionally vomits if he eats too much.", "8. Vomit is non-bloody and contains bits of undigested food.", "9. Review of systems is notable for occasional headaches, tingling in distal extremities, and constipation.", "10. Medical history is significant for Parkinson's disease diagnosed 3 years ago.", "11. Medical history is significant for hypertension diagnosed 8 years ago.", "12. Medical history is significant for type II diabetes mellitus diagnosed 10 years ago.", "13. Patient was given prescriptions for blood pressure and diabetes medications, but has not taken either for months.", "14. Patient regularly takes levodopa.", "15. Endoscopy is performed, which rules out cancer."], "atomic_facts": ["1. The patient reports nausea that began several months ago.", "2. The nausea is accompanied by occasional bloating and heartburn.", "3. The patient frequently feels full even after eating only a little at each meal.", "4. Occasionally, the patient will vomit if he eats too much.", "5. The vomit is non-bloody and contains bits of undigested food.", "6. A review of systems is notable for occasional headaches, tingling in distal extremities, and constipation.", "7. The patient has a medical history significant for Parkinson\u2019s disease diagnosed 3 years ago, hypertension diagnosed 8 years ago, and type II diabetes mellitus diagnosed 10 years ago.", "8. The patient was given prescriptions for both blood pressure and diabetes medications but has not taken either for months due to one of them causing erectile dysfunction.", "9. The patient regularly takes his levodopa.", "10. An endoscopy is performed, which rules out cancer."]}
{"id": 212, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 27-year-old Japanese man presents to the emergency department with diarrhea.", "The patient states that whenever he goes out to eat he experiences bloating, flatulence, abdominal cramps, and watery diarrhea.", "Today, his symptoms started after he went out for frozen yogurt.", "The patient is otherwise healthy and is not currently taking any medications.", "His temperature is 98.0\u00b0F (36.7\u00b0C), blood pressure is 122/80 mmHg, pulse is 81/min, respirations are 13/min, and oxygen saturation is 99% on room air.", "Physical exam demonstrates a nontender abdomen and an unremarkable rectal exam with guaiac-negative stools."], "context_len": 6, "options": {"A": "Hydrogen breath test", "B": "Lactose-free diet", "C": "Loperamide", "D": "Stool osmotic gap"}, "answer": "Lactose-free diet", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "27", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 27-year-old Japanese man.", "2. Patient presents to emergency department with diarrhea.", "3. Patient experiences bloating, flatulence, abdominal cramps, and watery diarrhea when going out to eat.", "4. Symptoms started today after going out for frozen yogurt.", "5. Patient is otherwise healthy and not taking any medications.", "6. Patient's temperature is 98.0\u00b0F (36.7\u00b0C).", "7. Patient's blood pressure is 122/80 mmHg.", "8. Patient's pulse is 81/min.", "9. Patient's respirations are 13/min.", "10. Patient's oxygen saturation is 99% on room air.", "11. Physical exam demonstrates a nontender abdomen.", "12. Rectal exam is unremarkable with guaiac-negative stools."], "atomic_facts": ["1. The patient experiences bloating, flatulence, abdominal cramps, and watery diarrhea when going out to eat.", "2. Symptoms started after the patient went out for frozen yogurt.", "3. The patient is otherwise healthy.", "4. The patient is not currently taking any medications.", "5. The patient's temperature is 98.0\u00b0F (36.7\u00b0C).", "6. The patient's blood pressure is 122/80 mmHg.", "7. The patient's pulse is 81/min.", "8. The patient's respirations are 13/min.", "9. The patient's oxygen saturation is 99% on room air.", "10. Physical exam demonstrates a nontender abdomen.", "11. Physical exam demonstrates an unremarkable rectal exam with guaiac-negative stools."]}
{"id": 213, "question": "Which of the following is the most likely etiology of this patient's symptoms?", "context": ["A 29-year-old woman presents to her primary care physician with worsening fatigue and lightheadedness over the past several months.", "She states that she has felt easily fatigued and has experienced several falls during this time frame as well.", "She drinks 5 to 8 drinks per day and works as a waitress.", "Her temperature is 98.2\u00b0F (36.8\u00b0C), blood pressure is 114/64 mmHg, pulse is 98/min, respirations are 12/min, and oxygen saturation is 98% on room air.", "Laboratory studies are ordered as seen below. |  | Hemoglobin: 9.0 g/dL | Hematocrit: 29% | Leukocyte count: 6,700/mm^3 with normal differential | Platelet count: 199,400/mm^3 | Methylymalonic acid: 1.0 umol/L (normal < 0.40 umol/L) |  | ."], "context_len": 5, "options": {"A": "Alcohol use", "B": "Folate deficiency", "C": "Iron deficiency", "D": "Vitamin B12 deficiency"}, "answer": "Vitamin B12 deficiency", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "29", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 29-year-old female.", "2. Patient has been experiencing worsening fatigue and lightheadedness over the past several months.", "3. Patient has felt easily fatigued and has experienced several falls during this time frame.", "4. Patient drinks 5 to 8 drinks per day and works as a waitress.", "5. Patient's temperature is 98.2\u00b0F (36.8\u00b0C).", "6. Patient's blood pressure is 114/64 mmHg.", "7. Patient's pulse is 98/min.", "8. Patient's respirations are 12/min.", "9. Patient's oxygen saturation is 98% on room air.", "10. Laboratory studies show hemoglobin of 9.0 g/dL.", "11. Laboratory studies show hematocrit of 29%.", "12. Laboratory studies show leukocyte count of 6,700/mm^3 with normal differential.", "13. Laboratory studies show platelet count of 199,400/mm^3.", "14. Laboratory studies show methylymalonic acid of 1.0 umol/L (normal < 0.40 umol/L)."], "atomic_facts": ["1. The patient has felt easily fatigued.", "2. The patient has experienced several falls.", "3. The patient drinks 5 to 8 drinks per day.", "4. The patient works as a waitress.", "5. The patient's temperature is 98.2\u00b0F (36.8\u00b0C).", "6. The patient's blood pressure is 114/64 mmHg.", "7. The patient's pulse is 98/min.", "8. The patient's respirations are 12/min.", "9. The patient's oxygen saturation is 98% on room air.", "10. The patient's hemoglobin level is 9.0 g/dL.", "11. The patient's hematocrit level is 29%.", "12. The patient's leukocyte count is 6,700/mm^3 with normal differential.", "13. The patient's platelet count is 199,400/mm^3.", "14. The patient's methylymalonic acid level is 1.0 umol/L (normal < 0.40 umol/L)."]}
{"id": 214, "question": "Which of the following laboratory tests should be performed in this patient prior to initiating treatment?", "context": ["A 32-year-old man from the Czech Republic is brought to the emergency department by his girlfriend with a 2-day history of yellowing of the skin.", "His girlfriend also reports a several-week history of anorexia, nausea without vomiting, and diffuse low-grade abdominal pain.", "He is a frequent injection drug user.", "His temperature is 38.1\u00b0C (100.6\u00b0F).", "He is grossly confused and somnolent.", "Physical examination is notable for scleral icterus and diffuse jaundice; when asked to hold his hands in wrist extension, a flapping movement is observed.", "Liver function tests show alanine aminotransferase 1,830 U/L, aspartate aminotransferase 1,377 U/L, and direct bilirubin 15 mg/dL.", "Coagulation studies reveal an international normalized ratio of 3.8.", "On serological testing, HBsAg is positive, and HBsAb is negative."], "context_len": 9, "options": {"A": "Hepatitis D serologies", "B": "HIV ELISA", "C": "PPD skin test", "D": "Lumbar puncture"}, "answer": "Hepatitis D serologies", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "32 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 32-year-old man from the Czech Republic is brought to the emergency department by his girlfriend. ", "2. His girlfriend reports a 2-day history of yellowing of the skin and a several-week history of anorexia, nausea without vomiting, and diffuse low-grade abdominal pain. ", "3. He is a frequent injection drug user. ", "4. His temperature is 38.1\u00b0C (100.6\u00b0F). ", "5. He is grossly confused and somnolent. ", "6. Physical examination is notable for scleral icterus and diffuse jaundice. ", "7. When asked to hold his hands in wrist extension, a flapping movement is observed. ", "8. Liver function tests show alanine aminotransferase 1,830 U/L, aspartate aminotransferase 1,377 U/L, and direct bilirubin 15 mg/dL. ", "9. Coagulation studies reveal an international normalized ratio of 3.8. ", "10. On serological testing, HBsAg is positive, and HBsAb is negative."], "atomic_facts": ["1. His girlfriend reports a several-week history of anorexia.", "2. His girlfriend reports a several-week history of nausea without vomiting.", "3. His girlfriend reports a several-week history of diffuse low-grade abdominal pain.", "4. He is a frequent injection drug user.", "5. His temperature is 38.1\u00b0C (100.6\u00b0F).", "6. He is grossly confused and somnolent.", "7. Physical examination is notable for scleral icterus.", "8. Physical examination is notable for diffuse jaundice.", "9. A flapping movement is observed when asked to hold his hands in wrist extension.", "10. Liver function tests show alanine aminotransferase 1,830 U/L.", "11. Liver function tests show aspartate aminotransferase 1,377 U/L.", "12. Liver function tests show direct bilirubin 15 mg/dL.", "13. Coagulation studies reveal an international normalized ratio of 3.8.", "14. On serological testing, HBsAg is positive.", "15. On serological testing, HBsAb is negative."]}
{"id": 215, "question": "What is the most likely cause of her symptoms?", "context": ["A 63-year-old woman with a history of adult polycystic kidney disease and COPD presents to her optometrist after having difficulty watching a movie.", "She has no other complaints.", "She is accompanied by her daughter, who notes that her mother hasn\u2019t been able to look at her since the previous day.", "On exam, her right eye has full range of motion, but her left eye is fixed in a down and outward position."], "context_len": 4, "options": {"A": "Vascular abnormality", "B": "Seizure", "C": "Demyelinating disease", "D": "Impaired dopaminergic neurons"}, "answer": "Vascular abnormality", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "63 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 63-year-old woman presents to her optometrist.", "2. She has a history of adult polycystic kidney disease and COPD.", "3. She has difficulty watching a movie.", "4. She has no other complaints.", "5. She is accompanied by her daughter.", "6. Her daughter notes that her mother hasn't been able to look at her since the previous day.", "7. On exam, her right eye has full range of motion.", "8. Her left eye is fixed in a down and outward position."], "atomic_facts": ["1. She has no other complaints.", "2. She is accompanied by her daughter.", "3. Her daughter notes that her mother hasn\u2019t been able to look at her since the previous day.", "4. On exam, her right eye has full range of motion.", "5. Her left eye is fixed in a down and outward position."]}
{"id": 216, "question": "Which of the following laboratory findings would confirm the most likely diagnosis in this patient?", "context": ["An 11-year-old boy presents to the office with his mother for the evaluation of weight loss, rash, and several weeks of bloating and diarrhea.", "The mother states that the patient\u2019s father had similar symptoms at his age.", "On physical examination, the patient is pale with dry mucous membranes.", "There is a vesicular rash on the bilateral lower extremities which he says is \u2018very itchy\u2019."], "context_len": 4, "options": {"A": "HLA-DQ2", "B": "Anti-tTG or gliadin antibodies", "C": "Anti-lactase antibodies", "D": "HLA-B27"}, "answer": "Anti-tTG or gliadin antibodies", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "11 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 11-year-old boy presents to the office with his mother.", "2. The evaluation is for weight loss, rash, and several weeks of bloating and diarrhea.", "3. The mother states that the patient's father had similar symptoms at his age.", "4. On physical examination, the patient is pale with dry mucous membranes.", "5. There is a vesicular rash on the bilateral lower extremities.", "6. The patient says the rash is 'very itchy'."], "atomic_facts": ["1. The mother states that the patient\u2019s father had similar symptoms at his age.", "2. On physical examination, the patient is pale with dry mucous membranes.", "3. There is a vesicular rash on the bilateral lower extremities.", "4. The patient says the rash is \u2018very itchy\u2019."]}
{"id": 217, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 23-year-old African American G1P0 woman at 18 weeks estimated gestational age presents with fatigue and lethargy.", "She says the symptoms onset gradually about 1 week ago and have progressively worsened.", "She has been otherwise healthy.", "Past medical history is unremarkable.", "She denies smoking, drug or alcohol use.", "The patient is afebrile and vital signs are within normal limits.", "Her physical examination is unremarkable.", "Her blood count shows the following: | Hemoglobin 10.8 g/dL | Red blood cell count 5.7 million/mm3 | Mean corpuscular volume (MCV) 76 \u03bcm3 | Red cell distribution width 12.4% (ref: 11.5\u201314.5%) | She is empirically started on ferrous gluconate tablets.", "Five weeks later, she shows no improvement in her hemoglobin level.", "Hemoglobin electrophoresis is normal."], "context_len": 10, "options": {"A": "Iron deficiency anemia", "B": "Beta-thalassemia trait", "C": "Alpha-thalassemia trait", "D": "Folate deficiency anemia"}, "answer": "Alpha-thalassemia trait", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "23 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 23-year-old African American G1P0 woman.", "2. Patient is at 18 weeks estimated gestational age.", "3. Patient presents with fatigue and lethargy.", "4. Symptoms onset gradually about 1 week ago and have progressively worsened.", "5. Patient has been otherwise healthy.", "6. Past medical history is unremarkable.", "7. Patient denies smoking, drug or alcohol use.", "8. Patient is afebrile and vital signs are within normal limits.", "9. Physical examination is unremarkable.", "10. Hemoglobin is 10.8 g/dL.", "11. Red blood cell count is 5.7 million/mm3.", "12. Mean corpuscular volume (MCV) is 76 \u03bcm3.", "13. Red cell distribution width is 12.4% (ref: 11.5\u201314.5%).", "14. Patient is empirically started on ferrous gluconate tablets.", "15. Five weeks later, patient shows no improvement in her hemoglobin level.", "16. Hemoglobin electrophoresis is normal."], "atomic_facts": ["1. Symptoms onset gradually about 1 week ago", "2. Symptoms have progressively worsened", "3. Patient has been otherwise healthy", "4. Past medical history is unremarkable", "5. Patient denies smoking, drug, or alcohol use", "6. Patient is afebrile", "7. Vital signs are within normal limits", "8. Physical examination is unremarkable", "9. Blood count shows: Hemoglobin 10.8 g/dL", "10. Blood count shows: Red blood cell count 5.7 million/mm3", "11. Blood count shows: Mean corpuscular volume (MCV) 76 \u03bcm3", "12. Blood count shows: Red cell distribution width 12.4% (ref: 11.5\u201314.5%)", "13. Patient is empirically started on ferrous gluconate tablets", "14. Five weeks later, no improvement in hemoglobin level", "15. Hemoglobin electrophoresis is normal"]}
{"id": 218, "question": "Which of the following structures was most likely injured during the surgery?", "context": ["A 26-year-old woman comes to the physician for a follow-up examination 1 week after undergoing rotator cuff repair surgery.", "Physical examination of the right shoulder shows decreased sensation to pinprick and light touch over the lateral shoulder.", "There is normal passive range of motion of the shoulder, but she has difficulty externally rotating and abducting her right arm."], "context_len": 3, "options": {"A": "Upper trunk of the brachial plexus", "B": "Axillary nerve", "C": "Lower trunk of the brachial plexus", "D": "Long thoracic nerve"}, "answer": "Axillary nerve", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "26 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 26-year-old woman comes to the physician for a follow-up examination.", "2. The follow-up examination is 1 week after undergoing rotator cuff repair surgery.", "3. Physical examination of the right shoulder shows decreased sensation to pinprick and light touch over the lateral shoulder.", "4. There is normal passive range of motion of the shoulder.", "5. She has difficulty externally rotating her right arm.", "6. She has difficulty abducting her right arm."], "atomic_facts": ["1. Physical examination of the right shoulder shows decreased sensation to pinprick.", "2. Physical examination of the right shoulder shows decreased sensation to light touch over the lateral shoulder.", "3. There is normal passive range of motion of the shoulder.", "4. She has difficulty externally rotating her right arm.", "5. She has difficulty abducting her right arm."]}
{"id": 219, "question": "Which of the following antibodies is most likely responsible for this patient\u2019s condition?", "context": ["A 25-year-old man presents to his primary care physician with complaints of coughing up blood in his sputum and dark-colored urine for 1 week.", "There are streaks of blood intermixed with phlegm.", "He also expresses concerns about his urine being grossly dark brown.", "He denies any history of major bleeding from minor injuries.", "He is currently not taking any medications.", "His family history is negative for bleeding disorders.", "The vital signs include blood pressure 160/100 mm Hg, pulse 88/min, temperature 36.8\u00b0C (98.2\u00b0F), and respiratory rate 11/min.", "On physical examination, there are no significant clinical findings.", "The urinalysis results are as follows: | pH 6.7 | Color dark brown | Red blood cell (RBC) count 12\u201314/HPF | White blood cell (WBC) count 3\u20134/HPF | Protein absent | Cast RBC and granular casts | Glucose absent | Crystal none | Ketone absent | Nitrite absent  | 24 hours of urine protein excretion 1 g |     His renal function test showed: | Sodium 136 mEq/L | Potassium 5.1 mEq/L | Chloride 101 mEq/L | Bicarbonate 22 mEq/L | Albumin 3.5 mg/ dL | Urea nitrogen 28 mg/dL | Creatinine 2.5 mg/dL | Uric Acid 6.8 mg/ dL | Calcium 8.7 mg/ dL | Glucose 111 mg/dL | HPF: high-power field | A kidney biopsy is obtained and the immunofluorescence shows linear immunoglobulin G (IgG) deposition in the glomeruli."], "context_len": 9, "options": {"A": "Anti-neutrophil cytoplasmic antibody (c-ANCA)", "B": "Anti-phospholipid antibody", "C": "Anti-glomerular basement membrane antibody (anti-GBM)", "D": "Anti-dsDNA antibody"}, "answer": "Anti-glomerular basement membrane antibody (anti-GBM)", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 25-year-old man presents to his primary care physician with complaints of coughing up blood in his sputum and dark-colored urine for 1 week.", "2. There are streaks of blood intermixed with phlegm.", "3. He also expresses concerns about his urine being grossly dark brown.", "4. He denies any history of major bleeding from minor injuries.", "5. He is currently not taking any medications.", "6. His family history is negative for bleeding disorders.", "7. The vital signs include blood pressure 160/100 mm Hg, pulse 88/min, temperature 36.8\u00b0C (98.2\u00b0F), and respiratory rate 11/min.", "8. On physical examination, there are no significant clinical findings.", "9. The urinalysis results show a pH of 6.7, color dark brown, RBC count 12\u201314/HPF, WBC count 3\u20134/HPF, protein absent, RBC and granular casts, glucose absent, crystal none, ketone absent, and nitrite absent.", "10. 24 hours of urine protein excretion is 1 g.", "11. His renal function test shows sodium 136 mEq/L, potassium 5.1 mEq/L, chloride 101 mEq/L, bicarbonate 22 mEq/L, albumin 3.5 mg/dL, urea nitrogen 28 mg/dL, creatinine 2.5 mg/dL, uric acid 6.8 mg/dL, calcium 8.7 mg/dL, and glucose 111 mg/dL.", "12. A kidney biopsy is obtained and the immunofluorescence shows linear immunoglobulin G (IgG) deposition in the glomeruli."], "atomic_facts": ["1. Streaks of blood intermixed with phlegm", "2. Concerns about urine being grossly dark brown", "3. Denial of history of major bleeding from minor injuries", "4. Not taking any medications", "5. Family history negative for bleeding disorders", "6. Vital signs: blood pressure 160/100 mm Hg, pulse 88/min, temperature 36.8\u00b0C (98.2\u00b0F), respiratory rate 11/min", "7. No significant clinical findings on physical examination", "8. Urinalysis results: pH 6.7, color dark brown, RBC count 12\u201314/HPF, WBC count 3\u20134/HPF, protein absent, cast RBC and granular casts, glucose absent, crystal none, ketone absent, nitrite absent, 24 hours of urine protein excretion 1 g", "9. Renal function test results: sodium 136 mEq/L, potassium 5.1 mEq/L, chloride 101 mEq/L, bicarbonate 22 mEq/L, albumin 3.5 mg/dL, urea nitrogen 28 mg/dL, creatinine 2.5 mg/dL, uric acid 6.8 mg/dL, calcium 8.7 mg/dL, glucose 111 mg/dL", "10. Kidney biopsy obtained", "11. Immunofluorescence shows linear IgG deposition in the glomeruli"]}
{"id": 220, "question": "Of the steps leading to the formation of this structure, which occurs first?", "context": ["The lung of a 45-year-old Caucasian male who died from Mycobacterium tuberculosis infection reveals the following at autopsy (Image A)."], "context_len": 1, "options": {"A": "Th1 cell activation", "B": "Bacterium-mediated inhibition of phagosome-lysosome fusion", "C": "Formation of epithelioid cells", "D": "Formation of giant cells"}, "answer": "Bacterium-mediated inhibition of phagosome-lysosome fusion", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Pathology"], "subspecialties": ["Medical Microbiology Pathology", "General Pathology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pathology"}, "facts_old": ["1. The lung belongs to a 45-year-old Caucasian male.", "2. The cause of death was Mycobacterium tuberculosis infection.", "3. Autopsy was performed on the lung.", "4. Image A was taken during the autopsy."], "atomic_facts": ["1. The lung belongs to a 45-year-old Caucasian male.", "2. The male died from Mycobacterium tuberculosis infection.", "3. The autopsy revealed specific findings in the lung."]}
{"id": 221, "question": "Which of the following recommendations is most appropriate at this time?", "context": ["A 57-year-old man comes to the physician because of a 3-month history of bloating and nausea after eating food.", "He has also had episodic abdominal pain during this period.", "He has osteoarthritis of the left knee.", "There is no family history of serious illness.", "He has smoked one pack of cigarettes daily for 21 years.", "He drinks two to three beers daily.", "Current medications include ibuprofen.", "He is allergic to amoxicillin and latex.", "Vital signs are within normal limits.", "The lungs are clear to auscultation.", "Cardiac examination shows no abnormalities.", "The abdomen is soft; there is mild tenderness to palpation over the epigastrium.", "Rectal examination shows no abnormalities.", "An esophagogastroduodenoscopy is performed and shows 3 shallow ulcers of the gastric mucosa.", "Biopsy shows chronic inflammation of the gastric mucosa and Helicobacter pylori.", "He is prescribed a 2-week course of antibiotics and omeprazole to treat the H.", "pylori infection."], "context_len": 17, "options": {"A": "Avoid drinking alcohol for the next 2 weeks", "B": "Begin prophylactic steroid therapy for anaphylaxis", "C": "Check liver enzymes in 2 weeks", "D": "Perform urea breath test in 2 weeks"}, "answer": "Avoid drinking alcohol for the next 2 weeks", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 57-year-old man comes to the physician.", "2. He has a 3-month history of bloating and nausea after eating food.", "3. He has had episodic abdominal pain during this period.", "4. He has osteoarthritis of the left knee.", "5. There is no family history of serious illness.", "6. He has smoked one pack of cigarettes daily for 21 years.", "7. He drinks two to three beers daily.", "8. His current medications include ibuprofen.", "9. He is allergic to amoxicillin and latex.", "10. Vital signs are within normal limits.", "11. The lungs are clear to auscultation.", "12. Cardiac examination shows no abnormalities.", "13. The abdomen is soft; there is mild tenderness to palpation over the epigastrium.", "14. Rectal examination shows no abnormalities.", "15. An esophagogastroduodenoscopy is performed.", "16. It shows 3 shallow ulcers of the gastric mucosa.", "17. Biopsy shows chronic inflammation of the gastric mucosa and Helicobacter pylori.", "18. He is prescribed a 2-week course of antibiotics and omeprazole to treat the H. pylori infection."], "atomic_facts": ["1. He has episodic abdominal pain.", "2. He has osteoarthritis of the left knee.", "3. There is no family history of serious illness.", "4. He has smoked one pack of cigarettes daily for 21 years.", "5. He drinks two to three beers daily.", "6. Current medications include ibuprofen.", "7. He is allergic to amoxicillin and latex.", "8. Vital signs are within normal limits.", "9. The lungs are clear to auscultation.", "10. Cardiac examination shows no abnormalities.", "11. The abdomen is soft; there is mild tenderness to palpation over the epigastrium.", "12. Rectal examination shows no abnormalities.", "13. An esophagogastroduodenoscopy is performed and shows 3 shallow ulcers of the gastric mucosa.", "14. Biopsy shows chronic inflammation of the gastric mucosa and Helicobacter pylori.", "15. He is prescribed a 2-week course of antibiotics and omeprazole to treat the H. pylori infection."]}
{"id": 222, "question": "Which of the following would be the best next step in the management of this patient?", "context": ["A 72-year-old man presents to his physician\u2019s office with difficulty breathing and chronic fatigue.", "Over the past few months, he has felt that it is difficult to retain his energy throughout the day.", "He is disturbed because he has to skip many social events because of his inability to participate.", "He also says that lately, he has had difficulty catching his breath after walking for just a few blocks.", "Other than well-controlled diabetes, his past medical history is insignificant.", "On physical examination, moderate conjunctival pallor is noted.", "His recent blood count shows a hemoglobin level of 10.3 g/dl, hematocrit of 24%, serum ferritin level of 10 ng/ml, and a red cell distribution width of 16.5%."], "context_len": 7, "options": {"A": "Colonoscopy", "B": "Vitamin B12 levels", "C": "Endoscopy", "D": "Iron supplementation"}, "answer": "Colonoscopy", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "72 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 72-year-old man presents to his physician's office with difficulty breathing and chronic fatigue.", "2. Over the past few months, he has felt that it is difficult to retain his energy throughout the day.", "3. He is disturbed because he has to skip many social events because of his inability to participate.", "4. He also says that lately, he has had difficulty catching his breath after walking for just a few blocks.", "5. Other than well-controlled diabetes, his past medical history is insignificant.", "6. On physical examination, moderate conjunctival pallor is noted.", "7. His recent blood count shows a hemoglobin level of 10.3 g/dl.", "8. His recent blood count shows a hematocrit of 24%.", "9. His recent blood count shows a serum ferritin level of 10 ng/ml.", "10. His recent blood count shows a red cell distribution width of 16.5%."], "atomic_facts": ["1. Over the past few months, he has felt that it is difficult to retain his energy throughout the day.", "2. He is disturbed because he has to skip many social events because of his inability to participate.", "3. He also says that lately, he has had difficulty catching his breath after walking for just a few blocks.", "4. Other than well-controlled diabetes, his past medical history is insignificant.", "5. On physical examination, moderate conjunctival pallor is noted.", "6. His recent blood count shows a hemoglobin level of 10.3 g/dl.", "7. His recent blood count shows a hematocrit of 24%.", "8. His recent blood count shows a serum ferritin level of 10 ng/ml.", "9. His recent blood count shows a red cell distribution width of 16.5%."]}
{"id": 223, "question": "What is the most likely injury?", "context": ["A 17-year-old rugby player limped into the emergency room and says he \u201crolled his ankle\u201d while running during a game.", "You conclude that the mechanism involved ankle plantar flexion and inversion.", "There is no medial or lateral malleolus point tenderness.", "Anterior drawer test of the ankle is positive.", "Talar tilt test is negative."], "context_len": 5, "options": {"A": "Anterior talofibular ligament (ATFL) sprain", "B": "Deltoid ligament sprain", "C": "Tibia fracture", "D": "Fibula fracture"}, "answer": "Anterior talofibular ligament (ATFL) sprain", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "17 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 17-year-old rugby player limped into the emergency room.", "2. The player said he \"rolled his ankle\" while running during a game.", "3. The mechanism involved ankle plantar flexion and inversion.", "4. There is no medial or lateral malleolus point tenderness.", "5. Anterior drawer test of the ankle is positive.", "6. Talar tilt test is negative."], "atomic_facts": ["1. Mechanism involved ankle plantar flexion and inversion.", "2. No medial or lateral malleolus point tenderness.", "3. Anterior drawer test of the ankle is positive.", "4. Talar tilt test is negative."]}
{"id": 224, "question": "Which of the following statements concerning positive predictive value (PPV) is correct?", "context": [], "context_len": 0, "options": {"A": "PPV is the proportion of tests that are true positives; if disease prevalence is low, then PPV will be low.", "B": "PPV is the proportion of tests that are true positives; disease prevalence has no effect on PPV.", "C": "PPV is the proportion of tests that are false positives; if disease prevalence is low, then PPV will be low.", "D": "PPV is the proportion of tests that are false positives; if disease prevalence is high then PPV will be low."}, "answer": "PPV is the proportion of tests that are true positives; if disease prevalence is low, then PPV will be low.", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["General Pathology", "Clinical Informatics"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pathology"}, "facts_old": [], "atomic_facts": []}
{"id": 225, "question": "The organism that is most likely responsible for this patient's symptoms has which of the following structures?", "context": ["A 32-year-old man presents to the emergency department with fever, weight loss, and right upper quadrant pain.", "He says that he started experiencing nausea and fatigue after he returned from a honeymoon trip to Asia with his wife.", "Notably, she is 5 months pregnant with their first child.", "On presentation, his temperature is 100.8\u00b0F (38.2\u00b0C), blood pressure is 118/79 mmHg, pulse is 81/min, and respirations are 14/min.", "Physical exam reveals a jaundiced patient with a palpable liver edge as well as splenomegaly.", "Labs are sent in order to confirm the diagnosis.", "After confirmation, the patient's wife is immediately tested as well because she is at a much higher risk of fatal complications from this infection."], "context_len": 7, "options": {"A": "Enveloped dsDNA virus", "B": "Enveloped (-) RNA virus", "C": "Enveloped (+) RNA virus", "D": "Non-enveloped (+) RNA hepevirus"}, "answer": "Non-enveloped (+) RNA hepevirus", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "32 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease", "Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 32-year-old man presents to the emergency department.", "2. He has fever, weight loss, and right upper quadrant pain.", "3. He started experiencing nausea and fatigue after returning from a honeymoon trip to Asia with his wife.", "4. His wife is 5 months pregnant with their first child.", "5. On presentation, his temperature is 100.8\u00b0F (38.2\u00b0C).", "6. His blood pressure is 118/79 mmHg.", "7. His pulse is 81/min.", "8. His respirations are 14/min.", "9. Physical exam reveals a jaundiced patient with a palpable liver edge.", "10. Physical exam reveals splenomegaly.", "11. Labs are sent in order to confirm the diagnosis.", "12. After confirmation, the patient's wife is immediately tested as well.", "13. She is at a much higher risk of fatal complications from this infection."], "atomic_facts": ["1. The patient started experiencing nausea and fatigue after returning from a honeymoon trip to Asia with his wife.", "2. The patient's wife is 5 months pregnant with their first child.", "3. On presentation, the patient's temperature is 100.8\u00b0F (38.2\u00b0C).", "4. On presentation, the patient's blood pressure is 118/79 mmHg.", "5. On presentation, the patient's pulse is 81/min.", "6. On presentation, the patient's respirations are 14/min.", "7. Physical exam reveals a jaundiced patient.", "8. Physical exam reveals a palpable liver edge.", "9. Physical exam reveals splenomegaly.", "10. Labs are sent to confirm the diagnosis.", "11. The patient's wife is immediately tested due to a higher risk of fatal complications from the infection."]}
{"id": 226, "question": "What medication should be administered to this patient?", "context": ["A 59-year-old man presents to the emergency room with shortness of breath and swelling of his feet and legs.", "He denies any past medical problems, surgeries, medications, or illicit drug use.", "He reports drinking a few beers each night.", "He is diagnosed with a first episode of congestive heart failure and is admitted to the hospital.", "The next day, the nurse notices that his hands are shaky when he extends his arms.", "The patient says that he couldn\u2019t sleep the night before and that he feels restless, anxious, and slightly nauseated.", "On the second night of admission the patient becomes agitated.", "He is disoriented, cannot remember where he is, and appears globally confused.", "His pulse is 125/min, blood pressure is 170/110 mmHg, and temperature is 101.7\u00b0F (38.7\u00b0C).", "He is diaphoretic and his hands are shaking at rest.", "He cries out in fear reporting voices whispering in his room and strange shadows passing over the walls."], "context_len": 11, "options": {"A": "Flumazenil", "B": "Benzodiazepines", "C": "Dantrolene", "D": "Fomepizole"}, "answer": "Benzodiazepines", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "59", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 59-year-old man presents to the emergency room with shortness of breath and swelling of his feet and legs.", "2. He denies any past medical problems, surgeries, medications, or illicit drug use.", "3. He reports drinking a few beers each night.", "4. He is diagnosed with a first episode of congestive heart failure and is admitted to the hospital.", "5. The next day, the nurse notices that his hands are shaky when he extends his arms.", "6. The patient says that he couldn\u2019t sleep the night before and that he feels restless, anxious, and slightly nauseated.", "7. On the second night of admission the patient becomes agitated.", "8. He is disoriented, cannot remember where he is, and appears globally confused.", "9. His pulse is 125/min, blood pressure is 170/110 mmHg, and temperature is 101.7\u00b0F (38.7\u00b0C).", "10. He is diaphoretic and his hands are shaking at rest.", "11. He cries out in fear reporting voices whispering in his room and strange shadows passing over the walls."], "atomic_facts": ["1. The patient denies any past medical problems, surgeries, medications, or illicit drug use.", "2. The patient reports drinking a few beers each night.", "3. The patient is diagnosed with a first episode of congestive heart failure and is admitted to the hospital.", "4. The nurse notices that the patient's hands are shaky when he extends his arms.", "5. The patient says that he couldn\u2019t sleep the night before and that he feels restless, anxious, and slightly nauseated.", "6. On the second night of admission, the patient becomes agitated.", "7. The patient is disoriented, cannot remember where he is, and appears globally confused.", "8. The patient's pulse is 125/min, blood pressure is 170/110 mmHg, and temperature is 101.7\u00b0F (38.7\u00b0C).", "9. The patient is diaphoretic and his hands are shaking at rest.", "10. The patient cries out in fear reporting voices whispering in his room and strange shadows passing over the walls."]}
{"id": 227, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 49-year-old woman otherwise healthy presents to the outpatient department with swelling of the neck.", "Family history is negative for any thyroid disorders.", "Physical examination shows a nontender thyroid gland with a nodule on the right side.", "The thyroid gland is mobile on deglutition.", "Cervical lymphadenopathy is present.", "Fine needle aspiration and cytology show empty appearing nuclei with central clearing, nuclear grooves and branching structures interspersed with calcific bodies."], "context_len": 6, "options": {"A": "Follicular carcinoma", "B": "Papillary carcinoma", "C": "Anaplastic carcinoma", "D": "Follicular adenoma"}, "answer": "Papillary carcinoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "49 years old", "specialties": ["Otolaryngology", "Internal Medicine", "ENT (Otolaryngology)"], "subspecialties": ["General Otolaryngology", "Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 49-year-old woman is presenting to the outpatient department.", "2. The woman is otherwise healthy.", "3. Family history is negative for any thyroid disorders.", "4. Physical examination shows a nontender thyroid gland.", "5. There is a nodule on the right side of the thyroid gland.", "6. The thyroid gland is mobile on deglutition.", "7. Cervical lymphadenopathy is present.", "8. Fine needle aspiration and cytology show empty appearing nuclei.", "9. The nuclei have central clearing.", "10. The nuclei have nuclear grooves.", "11. The nuclei have branching structures.", "12. The nuclei have calcific bodies."], "atomic_facts": ["1. Family history is negative for any thyroid disorders.", "2. Physical examination shows a nontender thyroid gland with a nodule on the right side.", "3. The thyroid gland is mobile on deglutition.", "4. Cervical lymphadenopathy is present.", "5. Fine needle aspiration and cytology show empty appearing nuclei with central clearing, nuclear grooves and branching structures interspersed with calcific bodies."]}
{"id": 228, "question": "Which of the following is the most appropriate pharmacotherapy?", "context": ["A 33-year-old woman comes to the physician because of a 2-year history of intermittent episodes of pain in all her fingers bilaterally.", "The episodes are worse during the winter.", "The fingers become white when exposed to cold weather, then severely painful and numb once they warm up.", "She has started wearing gloves at all times to prevent these episodes.", "She has generalized anxiety disorder.", "Her mother has systemic lupus erythematosus.", "Current medications include lorazepam and fluoxetine.", "She appears anxious.", "Her temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 92/min, and blood pressure is 116/72 mm Hg.", "Examination of both hands shows no abnormalities.", "Allen's test is negative.", "Her hemoglobin concentration is 14.4 g/dL, leukocyte count is 9,800/mm3, and platelet count is 156,000/mm3.", "Serum electrolyte concentrations are within normal limits.", "Nailfold capillary microscopy is normal."], "context_len": 14, "options": {"A": "Oral aspirin", "B": "Oral nifedipine", "C": "Oral epoprostenol", "D": "Oral prednisone"}, "answer": "Oral nifedipine", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "33 years old", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 33-year-old woman.", "2. Patient has a 2-year history of intermittent episodes of pain in all her fingers bilaterally.", "3. Episodes are worse during the winter.", "4. Fingers become white when exposed to cold weather, then severely painful and numb once they warm up.", "5. Patient has started wearing gloves at all times to prevent these episodes.", "6. Patient has generalized anxiety disorder.", "7. Patient's mother has systemic lupus erythematosus.", "8. Current medications include lorazepam and fluoxetine.", "9. Patient appears anxious.", "10. Patient's temperature is 37.3\u00b0C (99.1\u00b0F).", "11. Patient's pulse is 92/min.", "12. Patient's blood pressure is 116/72 mm Hg.", "13. Examination of both hands shows no abnormalities.", "14. Allen's test is negative.", "15. Patient's hemoglobin concentration is 14.4 g/dL.", "16. Patient's leukocyte count is 9,800/mm3.", "17. Patient's platelet count is 156,000/mm3.", "18. Serum electrolyte concentrations are within normal limits.", "19. Nailfold capillary microscopy is normal."], "atomic_facts": ["1. The episodes are worse during the winter.", "2. The fingers become white when exposed to cold weather.", "3. The fingers then become severely painful and numb once they warm up.", "4. She has started wearing gloves at all times to prevent these episodes.", "5. She has generalized anxiety disorder.", "6. Her mother has systemic lupus erythematosus.", "7. Current medications include lorazepam and fluoxetine.", "8. She appears anxious.", "9. Her temperature is 37.3\u00b0C (99.1\u00b0F).", "10. Her pulse is 92/min.", "11. Her blood pressure is 116/72 mm Hg.", "12. Examination of both hands shows no abnormalities.", "13. Allen's test is negative.", "14. Her hemoglobin concentration is 14.4 g/dL.", "15. Her leukocyte count is 9,800/mm3.", "16. Her platelet count is 156,000/mm3.", "17. Serum electrolyte concentrations are within normal limits.", "18. Nailfold capillary microscopy is normal."]}
{"id": 229, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 43-year-old man comes to the physician because of redness and swelling of his right leg.", "He reports that it is very painful to touch.", "He has had fever and chills.", "He has no chest pain or shortness of breath.", "He has a history of type 2 diabetes mellitus and underwent saphenous vein stripping and ligation in his right leg 3 years ago.", "He works as a security guard.", "He does not smoke or drink alcohol.", "His medications include metformin and sitagliptin.", "His temperature is 38.7\u00b0C (101.7\u00b0F), pulse is 99/min, and blood pressure is 138/72 mm Hg.", "Examination shows an 8-cm, indurated, tender, warm, erythematous skin lesion with sharply demarcated margins.", "There is no inguinal lymphadenopathy.", "Toe web intertrigo is noted."], "context_len": 12, "options": {"A": "Oral cephalexin therapy", "B": "Intravenous cefazolin therapy", "C": "Intravenous ciprofloxacin therapy", "D": "Subcutaneous heparin injection"}, "answer": "Intravenous cefazolin therapy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "43 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 43-year-old man comes to the physician.", "2. He has redness and swelling of his right leg.", "3. It is very painful to touch.", "4. He has had fever and chills.", "5. He has no chest pain or shortness of breath.", "6. He has a history of type 2 diabetes mellitus.", "7. He underwent saphenous vein stripping and ligation in his right leg 3 years ago.", "8. He works as a security guard.", "9. He does not smoke or drink alcohol.", "10. His medications include metformin and sitagliptin.", "11. His temperature is 38.7\u00b0C (101.7\u00b0F).", "12. His pulse is 99/min.", "13. His blood pressure is 138/72 mm Hg.", "14. Examination shows an 8-cm, indurated, tender, warm, erythematous skin lesion with sharply demarcated margins.", "15. There is no inguinal lymphadenopathy.", "16. Toe web intertrigo is noted."], "atomic_facts": ["1. He reports that it is very painful to touch.", "2. He has had fever and chills.", "3. He has no chest pain or shortness of breath.", "4. He has a history of type 2 diabetes mellitus.", "5. He underwent saphenous vein stripping and ligation in his right leg 3 years ago.", "6. He works as a security guard.", "7. He does not smoke or drink alcohol.", "8. His medications include metformin and sitagliptin.", "9. His temperature is 38.7\u00b0C (101.7\u00b0F).", "10. His pulse is 99/min.", "11. His blood pressure is 138/72 mm Hg.", "12. Examination shows an 8-cm, indurated, tender, warm, erythematous skin lesion with sharply demarcated margins.", "13. There is no inguinal lymphadenopathy.", "14. Toe web intertrigo is noted."]}
{"id": 230, "question": "Of the following options, which is the next best step in patient management?", "context": ["A 52-year-old thoracic surgeon presents to his primary care physician with an eczematous dermatitis overlying his hands and forearms.", "He notes that he has recently started using a new type of surgical gloves.", "He notes that he washes his hands frequently, but he has never had issues with skin irritation before.", "On physical examination, there are erythematous plaques with areas of vesicles on his bilateral hands and dorsal forearms."], "context_len": 4, "options": {"A": "Patch testing", "B": "KOH examination", "C": "Skin biopsy", "D": "Radioallergosorbent test"}, "answer": "Patch testing", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology", "Micrographic Dermatologic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 52-year-old thoracic surgeon presents to his primary care physician.", "2. He has an eczematous dermatitis overlying his hands and forearms.", "3. He recently started using a new type of surgical gloves.", "4. He washes his hands frequently.", "5. He has never had issues with skin irritation before.", "6. On physical examination, there are erythematous plaques.", "7. There are areas of vesicles on his bilateral hands and dorsal forearms."], "atomic_facts": ["1. The patient has recently started using a new type of surgical gloves.", "2. The patient washes his hands frequently.", "3. The patient has never had issues with skin irritation before.", "4. On physical examination, there are erythematous plaques on the patient's bilateral hands and dorsal forearms.", "5. There are areas of vesicles on the patient's bilateral hands and dorsal forearms."]}
{"id": 231, "question": "What is the most likely diagnosis?", "context": ["A 43-year-old woman presents to a new primary care physician complaining of anxiety.", "She has been worrying non-stop recently about the possibility that her husband will lose his job as a teacher.", "Her husband, who is present, assures the physician that his job is entirely secure and states that she has \"fretted\" for their entire marriage, though the exact topic causing her anxiety varies over time.", "She also worries excessively about everyday tasks, such as whether she will catch the train on time and whether their house in Southern California is sufficiently earthquake-proof.", "She has no way to overcome these worries.", "She endorses other symptoms including poor sleep (associated with racing thoughts about her various worries), fatigue, and impaired concentration at work, all of which have been present for at least the past year.", "Her vital signs are within normal limits and there are no abnormalities on physical exam."], "context_len": 7, "options": {"A": "Social phobia", "B": "Agoraphobia", "C": "Posttraumatic stress disorder", "D": "Generalized anxiety disorder"}, "answer": "Generalized anxiety disorder", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "43", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is a 43-year-old female.", "2. Patient is presenting to a new primary care physician with anxiety.", "3. Patient's husband is present and states that she has \"fretted\" for their entire marriage.", "4. Patient worries excessively about everyday tasks, such as catching the train on time and whether their house is earthquake-proof.", "5. Patient has no way to overcome these worries.", "6. Patient endorses other symptoms including poor sleep, fatigue, and impaired concentration at work.", "7. Symptoms have been present for at least the past year.", "8. Patient's vital signs are within normal limits.", "9. No abnormalities on physical exam."], "atomic_facts": ["1. She has been worrying non-stop recently about the possibility of her husband losing his job as a teacher.", "2. Her husband assures the physician that his job is entirely secure.", "3. Her husband states that she has \"fretted\" for their entire marriage.", "4. The exact topic causing her anxiety varies over time.", "5. She worries excessively about everyday tasks, such as catching the train on time and the earthquake-proofing of their house in Southern California.", "6. She has no way to overcome these worries.", "7. She endorses other symptoms including poor sleep associated with racing thoughts about her worries.", "8. She experiences fatigue and impaired concentration at work.", "9. These symptoms have been present for at least the past year.", "10. Her vital signs are within normal limits.", "11. There are no abnormalities on physical exam."]}
{"id": 232, "question": "A biopsy of one of these areas of affected thyroid tissue is most likely to show which of the following?", "context": ["A 60-year-old woman comes to the physician because of palpitations and a 5.4-kg (11.9-lb) weight loss over the past 3 months.", "She appears anxious.", "Her pulse is 104/min and blood pressure is 148/101 mm Hg.", "Physical examination shows warm skin, mild tremor, and an enlarged thyroid gland.", "A thyroid scintigraphy scan shows several focal areas with increased uptake."], "context_len": 5, "options": {"A": "Sheets of parafollicular cells surrounded by amyloid stroma", "B": "Follicle destruction with lymphocytic infiltrate and germinal center formation", "C": "Patches of enlarged follicular cells distended with colloid", "D": "Crowded follicular cells with scalloped colloid"}, "answer": "Patches of enlarged follicular cells distended with colloid", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "60 years old", "specialties": ["Endocrinology, Diabetes, and Metabolism", "Internal Medicine"], "subspecialties": ["General Endocrinology", "Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 60-year-old woman comes to the physician.", "2. She has experienced a 5.4-kg (11.9-lb) weight loss over the past 3 months.", "3. She appears anxious.", "4. Her pulse is 104/min.", "5. Her blood pressure is 148/101 mm Hg.", "6. Physical examination shows warm skin, mild tremor, and an enlarged thyroid gland.", "7. A thyroid scintigraphy scan shows several focal areas with increased uptake."], "atomic_facts": ["1. She appears anxious.", "2. Her pulse is 104/min.", "3. Her blood pressure is 148/101 mm Hg.", "4. Physical examination shows warm skin.", "5. Physical examination shows mild tremor.", "6. Physical examination shows an enlarged thyroid gland.", "7. A thyroid scintigraphy scan shows several focal areas with increased uptake."]}
{"id": 233, "question": "This patient is most likely experiencing toxicity from which of the following substances?\"", "context": ["A 47-year-old man is brought to the emergency department 1 hour after his neighbor found him collapsed on his front porch in a pool of vomitus.", "On arrival, he is oriented only to self.", "His pulse is 103/min and respirations are 30/min.", "Neurologic examination shows muscle spasms in the arms and jaw.", "Serum studies show: | Na+ 137 mEq/L | Cl- 99 mEq/L | HCO3- 8 mEq/L | Osmolality 328 mOsm/kg | The difference between the calculated and observed serum osmolality is 32 mOsm/kg.", "Urinalysis shows oxalate crystals."], "context_len": 6, "options": {"A": "Methanol", "B": "Ethylene glycol", "C": "Parathion", "D": "Aspirin"}, "answer": "Ethylene glycol", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "47 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 47-year-old man is brought to the emergency department.", "2. His neighbor found him collapsed on his front porch in a pool of vomitus 1 hour prior.", "3. On arrival, he is oriented only to self.", "4. His pulse is 103/min.", "5. Respirations are 30/min.", "6. Neurologic examination shows muscle spasms in the arms and jaw.", "7. Serum studies show Na+ 137 mEq/L.", "8. Serum studies show Cl- 99 mEq/L.", "9. Serum studies show HCO3- 8 mEq/L.", "10. Serum studies show Osmolality 328 mOsm/kg.", "11. The difference between the calculated and observed serum osmolality is 32 mOsm/kg.", "12. Urinalysis shows oxalate crystals."], "atomic_facts": ["1. On arrival, the patient is oriented only to self.", "2. The patient's pulse is 103/min.", "3. The patient's respirations are 30/min.", "4. Neurologic examination shows muscle spasms in the arms and jaw.", "5. Serum studies show: Na+ 137 mEq/L, Cl- 99 mEq/L, HCO3- 8 mEq/L, Osmolality 328 mOsm/kg.", "6. The difference between the calculated and observed serum osmolality is 32 mOsm/kg.", "7. Urinalysis shows oxalate crystals."]}
{"id": 234, "question": "Which of the following is the most probable cause of his complaints?", "context": ["A 13-year-old boy presents to the clinic for evaluation of pain, swelling, and redness in the left knee.", "This began a month ago and has been progressively worsening.", "He thinks his pain is due to playing soccer.", "He is frustrated that the pain does not respond to Tylenol.", "History is non-contributory.", "The vital signs are unremarkable.", "On examination, there is tenderness and warmth present over the knee with limitation of movement.", "The laboratory values show a normal white blood cell (WBC) count and elevated alkaline phosphatase.", "A radiograph of the knee shows mixed lytic and blastic lesions."], "context_len": 9, "options": {"A": "Osteomyelitis", "B": "Osteosarcoma", "C": "Ewing\u2019s sarcoma", "D": "Chondrosarcoma"}, "answer": "Osteosarcoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "13 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 13-year-old boy presents to the clinic for evaluation of pain, swelling, and redness in the left knee.", "2. This began a month ago and has been progressively worsening.", "3. He thinks his pain is due to playing soccer.", "4. He is frustrated that the pain does not respond to Tylenol.", "5. History is non-contributory.", "6. The vital signs are unremarkable.", "7. On examination, there is tenderness and warmth present over the knee with limitation of movement.", "8. The laboratory values show a normal white blood cell (WBC) count.", "9. The laboratory values show an elevated alkaline phosphatase.", "10. A radiograph of the knee shows mixed lytic and blastic lesions."], "atomic_facts": ["1. The symptoms began a month ago.", "2. The symptoms have been progressively worsening.", "3. The patient attributes the pain to playing soccer.", "4. The patient is frustrated that the pain does not respond to Tylenol.", "5. The patient's medical history is non-contributory.", "6. The vital signs are unremarkable.", "7. On examination, there is tenderness and warmth present over the knee.", "8. On examination, there is limitation of movement in the knee.", "9. Laboratory values show a normal white blood cell (WBC) count.", "10. Laboratory values show elevated alkaline phosphatase.", "11. A radiograph of the knee shows mixed lytic and blastic lesions."]}
{"id": 235, "question": "Which of the following is the most likely explanation for this patient\u2019s clinical findings?", "context": ["A 55-year-old woman presents to the emergency department because of palpitations and generalized weakness.", "She has a history of type 2 diabetes, for which she has been receiving medication for the past 15 years.", "Consequently, her recent medical history involves diabetic retinopathy as well as end-stage renal disease.", "She is advised dialysis; however, she does not attend her regular dialysis sessions.", "The physical examination shows motor strength of 3/5 in the upper limbs and 4/5 in the lower limbs.", "Cranial nerve capacity is intact.", "Her electrocardiogram (ECG) is shown.", "Medical management is initiated for the patient."], "context_len": 8, "options": {"A": "Skipped dialysis appointment", "B": "Insulin supplementation", "C": "Administration of \u03b1-agonist", "D": "Alkalosis"}, "answer": "Skipped dialysis appointment", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "55", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old woman presents to the emergency department because of palpitations and generalized weakness.", "2. She has a history of type 2 diabetes, for which she has been receiving medication for the past 15 years.", "3. Her recent medical history involves diabetic retinopathy.", "4. Her recent medical history also involves end-stage renal disease.", "5. She is advised dialysis; however, she does not attend her regular dialysis sessions.", "6. The physical examination shows motor strength of 3/5 in the upper limbs and 4/5 in the lower limbs.", "7. Cranial nerve capacity is intact.", "8. Her electrocardiogram (ECG) is shown.", "9. Medical management is initiated for the patient."], "atomic_facts": ["1. She has a history of type 2 diabetes.", "2. She has been receiving medication for the past 15 years.", "3. Her recent medical history involves diabetic retinopathy.", "4. Her recent medical history involves end-stage renal disease.", "5. She is advised dialysis.", "6. She does not attend her regular dialysis sessions.", "7. The physical examination shows motor strength of 3/5 in the upper limbs.", "8. The physical examination shows motor strength of 4/5 in the lower limbs.", "9. Cranial nerve capacity is intact.", "10. Her electrocardiogram (ECG) is shown.", "11. Medical management is initiated for the patient."]}
{"id": 236, "question": "Based on Ranson\u2019s Criteria, what is this patient\u2019s overall risk of mortality, assuming all other relevant factors are negative?", "context": ["A 59-year-old man presents to the emergency department with diffuse abdominal pain that radiates to his back, nausea, and vomiting.", "The vital signs include: temperature 36.7\u00b0C (98.0\u00b0F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min.", "The laboratory evaluation on admission is significant for a serum glucose 241 mg/dL, aspartate aminotransferase (AST) 321 IU/dL, and leukocyte count 21,200/mL.", "Within 3 days of admission with supportive care in the intensive care unit, the patient\u2019s clinical condition begins to improve."], "context_len": 4, "options": {"A": "20%", "B": "40%", "C": "80%", "D": "100%"}, "answer": "20%", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "59", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 59-year-old man presents to the emergency department with diffuse abdominal pain that radiates to his back, nausea, and vomiting.", "2. The vital signs include: temperature 36.7\u00b0C (98.0\u00b0F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min.", "3. The laboratory evaluation on admission is significant for a serum glucose 241 mg/dL.", "4. The laboratory evaluation on admission is significant for an aspartate aminotransferase (AST) 321 IU/dL.", "5. The laboratory evaluation on admission is significant for a leukocyte count 21,200/mL.", "6. Within 3 days of admission with supportive care in the intensive care unit, the patient\u2019s clinical condition begins to improve."], "atomic_facts": ["1. Vital signs: temperature 36.7\u00b0C (98.0\u00b0F), blood pressure 126/74 mm Hg, heart rate 74/min, respiratory rate 14/min.", "2. Laboratory evaluation on admission: serum glucose 241 mg/dL, aspartate aminotransferase (AST) 321 IU/dL, leukocyte count 21,200/mL.", "3. Patient admitted to intensive care unit.", "4. Patient's clinical condition begins to improve within 3 days of admission."]}
{"id": 237, "question": "What is the most likely diagnosis?", "context": ["A 68-year-old male presents to your office for his annual physical exam.", "He has no complaints at this time and his chronic hypertension is well controlled.", "You notice a .5cm papule on the patient's eyelid that has a pink pearly appearance, rolled borders, and overlying telangiectasias.", "On further questioning, you find out the patient was a door-to-door salesman and spent a lot of time outdoors, and he did not wear sunscreen.", "He has fair skin and blonde hair.", "The patient states that he first noticed the lesion about 6 months prior, and it has grown slightly since then."], "context_len": 6, "options": {"A": "Squamous cell carcinoma", "B": "Keratoacanthoma", "C": "Verrucous carcinoma", "D": "Basal cell carcinoma"}, "answer": "Basal cell carcinoma", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "68", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 68-year-old male presents to your office for his annual physical exam.", "2. He has no complaints at this time.", "3. His chronic hypertension is well controlled.", "4. You notice a .5cm papule on the patient's eyelid.", "5. The papule has a pink pearly appearance.", "6. The papule has rolled borders.", "7. The papule has overlying telangiectasias.", "8. The patient was a door-to-door salesman.", "9. The patient spent a lot of time outdoors.", "10. The patient did not wear sunscreen.", "11. The patient has fair skin.", "12. The patient has blonde hair.", "13. The patient first noticed the lesion about 6 months prior.", "14. The lesion has grown slightly since then."], "atomic_facts": ["1. The patient has no complaints at this time.", "2. The patient's chronic hypertension is well controlled.", "3. There is a .5cm papule on the patient's eyelid.", "4. The papule has a pink pearly appearance.", "5. The papule has rolled borders.", "6. The papule has overlying telangiectasias.", "7. The patient was a door-to-door salesman.", "8. The patient spent a lot of time outdoors.", "9. The patient did not wear sunscreen.", "10. The patient has fair skin.", "11. The patient has blonde hair.", "12. The patient first noticed the lesion about 6 months prior.", "13. The lesion has grown slightly since then."]}
{"id": 238, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 67-year-old woman is brought to the emergency room after complaining of back pain with a gradual loss of sensation in her lower extremities.", "She was recently diagnosed with radiosensitive metastatic breast cancer and was scheduled to receive chemotherapy and palliative surgery.", "Her temperature is 99.0\u00b0F (37.2\u00b0C), blood pressure is 133/81 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for decreased sensation bilaterally over the patient's lower extremities.", "She demonstrates 2/5 strength of leg extension on the left and 1/5 on the right which is slightly worse than her baseline neurological exam taken 2 months ago.", "Pain to her lumbar region worsens with coughing.", "An initial CT scan of the spine does not demonstrate any unstable fractures of the spine.", "A MRI of the spine is ordered and pending."], "context_len": 8, "options": {"A": "Biopsy", "B": "Chemotherapy", "C": "Radiation therapy", "D": "Surgical decompression"}, "answer": "Radiation therapy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "67 years old", "specialties": ["Neurological Surgery", "Neurology"], "subspecialties": ["General Neurological Surgery", "Neurosurgery"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 67-year-old woman is brought to the emergency room.", "2. She is complaining of back pain with a gradual loss of sensation in her lower extremities.", "3. She was recently diagnosed with radiosensitive metastatic breast cancer.", "4. She was scheduled to receive chemotherapy and palliative surgery.", "5. Her temperature is 99.0\u00b0F (37.2\u00b0C).", "6. Her blood pressure is 133/81 mmHg.", "7. Her pulse is 82/min.", "8. Her respirations are 15/min.", "9. Her oxygen saturation is 98% on room air.", "10. Physical exam is notable for decreased sensation bilaterally over the patient's lower extremities.", "11. She demonstrates 2/5 strength of leg extension on the left.", "12. She demonstrates 1/5 strength of leg extension on the right.", "13. Her neurological exam taken 2 months ago was slightly better than her current exam.", "14. Pain to her lumbar region worsens with coughing.", "15. An initial CT scan of the spine does not demonstrate any unstable fractures of the spine.", "16. A MRI of the spine is ordered and pending."], "atomic_facts": ["1. Patient diagnosed with radiosensitive metastatic breast cancer", "2. Scheduled to receive chemotherapy and palliative surgery", "3. Temperature is 99.0\u00b0F (37.2\u00b0C)", "4. Blood pressure is 133/81 mmHg", "5. Pulse is 82/min", "6. Respirations are 15/min", "7. Oxygen saturation is 98% on room air", "8. Physical exam notable for decreased sensation bilaterally over lower extremities", "9. Demonstrates 2/5 strength of leg extension on the left", "10. Demonstrates 1/5 strength of leg extension on the right", "11. Strength is slightly worse than baseline neurological exam taken 2 months ago", "12. Pain to lumbar region worsens with coughing", "13. Initial CT scan of the spine does not demonstrate any unstable fractures", "14. MRI of the spine is ordered and pending"]}
{"id": 239, "question": "What is the most likely diagnosis for this patient?", "context": ["An obese 50-year-old woman presents to the emergency department of a rural hospital due to chest pain for the last 12 hours.", "The pain is substernal, crushing in nature, radiating into her neck, and accompanied by profuse sweating.", "Her history is significant for hypertension, and she admits poor compliance with her medications.", "An ECG done at the clinic confirmed the presence of STEMI, and the patient was given aspirin.", "The ambulance was in an accident on the way to the hospital and by the time the patient reached the angiography suite, the cardiologist decided intervention should be delayed due to the late presentation.", "Also, the patient\u2019s pain has improved.", "The patient is admitted and is stable for 3 nights with no dyspnea or edema.", "Her blood pressure is kept under control while in the hospital.", "On the fourth night, the patient becomes quite agitated and soon thereafter she is unresponsive.", "Her pulse cannot be palpated.", "She has an elevated JVP and upon auscultation, heart sounds are distant."], "context_len": 11, "options": {"A": "Acute pericarditis", "B": "Left ventricular free wall rupture", "C": "Papillary muscle rupture", "D": "Pulmonary embolism"}, "answer": "Left ventricular free wall rupture", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "50", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 50-year-old woman.", "2. Patient is obese.", "3. Patient presents to the emergency department of a rural hospital.", "4. Patient has had chest pain for the last 12 hours.", "5. Pain is substernal, crushing in nature, radiating into her neck, and accompanied by profuse sweating.", "6. Patient has a history of hypertension.", "7. Patient admits poor compliance with her medications.", "8. ECG done at the clinic confirmed the presence of STEMI.", "9. Patient was given aspirin.", "10. Ambulance was in an accident on the way to the hospital.", "11. By the time the patient reached the angiography suite, the cardiologist decided intervention should be delayed due to the late presentation.", "12. Patient's pain has improved.", "13. Patient is admitted and is stable for 3 nights with no dyspnea or edema.", "14. Patient's blood pressure is kept under control while in the hospital.", "15. On the fourth night, the patient becomes quite agitated.", "16. Soon thereafter, the patient is unresponsive.", "17. Pulse cannot be palpated.", "18. Patient has an elevated JVP.", "19. Upon auscultation, heart sounds are distant."], "atomic_facts": ["1. The pain is substernal", "2. The pain is crushing in nature", "3. The pain is radiating into her neck", "4. The pain is accompanied by profuse sweating", "5. Her history is significant for hypertension", "6. She admits poor compliance with her medications", "7. An ECG done at the clinic confirmed the presence of STEMI", "8. The patient was given aspirin", "9. The ambulance was in an accident on the way to the hospital", "10. By the time the patient reached the angiography suite, the cardiologist decided intervention should be delayed due to the late presentation", "11. The patient\u2019s pain has improved", "12. The patient is admitted", "13. The patient is stable for 3 nights with no dyspnea or edema", "14. Her blood pressure is kept under control while in the hospital", "15. On the fourth night, the patient becomes quite agitated", "16. Soon thereafter she is unresponsive", "17. Her pulse cannot be palpated", "18. She has an elevated JVP", "19. Upon auscultation, heart sounds are distant"]}
{"id": 240, "question": "Which of the following is responsible for the exact mechanism of diapedesis that allows for inflammatory cells to enter the tissue space of this patient?", "context": ["A 20-year-old woman presents to the emergency department with painful swelling in the middle of her neck for the past 3 days.", "She is not experiencing pain during swallowing, difficulty in breathing, or changes in her voice.", "On examination, a red, 5 x 5 cm, exquisitely tender, non-pulsatile, fluctuating mass is present in the midline on the anterior aspect of the neck.", "The patient is prepared for an incision and drainage of the neck abscess."], "context_len": 4, "options": {"A": "Adhesion", "B": "Margination", "C": "Transmigration and chemotaxis", "D": "Rolling"}, "answer": "Transmigration and chemotaxis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Internal Medicine", "Emergency Medicine"], "subspecialties": ["Rheumatology", "General Emergency Medicine"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 20-year-old woman presents to the emergency department.", "2. She has had painful swelling in the middle of her neck for the past 3 days.", "3. She is not experiencing pain during swallowing, difficulty in breathing, or changes in her voice.", "4. On examination, a red, 5 x 5 cm, exquisitely tender, non-pulsatile, fluctuating mass is present in the midline on the anterior aspect of the neck.", "5. The patient is prepared for an incision and drainage of the neck abscess."], "atomic_facts": ["1. The patient is not experiencing pain during swallowing.", "2. The patient is not experiencing difficulty in breathing.", "3. The patient is not experiencing changes in her voice.", "4. On examination, a red, 5 x 5 cm mass is present in the midline on the anterior aspect of the neck.", "5. The mass is exquisitely tender.", "6. The mass is non-pulsatile.", "7. The mass is fluctuating.", "8. The patient is prepared for an incision and drainage of the neck abscess."]}
{"id": 241, "question": "Which of the following treatment strategies would be most appropriate for this patient?", "context": ["A 45-year-old G2P2 presents with episodes of urgency accompanied by an involuntary passage of urine.", "These symptoms take place during the day and night.", "The symptoms are not linked with physical exertion, laughing, or coughing.", "Her occupation does not involve weight lifting, but she says that sometimes it is very stressful for her.", "She denies any other genitourinary symptoms.", "She had  1 vaginal delivery and 1 cesarean section.", "She does not have a history of genitourinary or neurologic disorders.", "The weight is 91 kg (200.6 lb) and the height is 172 cm (5 ft 60 in).", "The vital signs are as follows: blood pressure, 128/75 mmHg; heart rate, 77/min; respiratory rate, 13/min; and temperature, 36.6\u2103 (97.9\u2109).", "The physical examination shows no abdominal masses and no costovertebral angle or suprapubic tenderness.", "On gynecologic examination, there are no vulvar lesions.", "The external urethral orifice appears normal.", "A Q-tip test is negative.", "The cervix is normally positioned, non-tender, movable, and without visible lesions.", "The uterus is not enlarged and the ovaries are not palpable.", "A urinalysis, urine culture, and ultrasound examination of the bladder were all normal.", "Cystometric studies show the following findings: |   Measured value Normal range | Residual volume 10 ml < 50 ml | Sensation-of-fullness volume 190 ml 200\u2013225 ml | Urge-to-void volume 700 ml 400\u2013500 ml | Involuntary contractions present absent | ."], "context_len": 17, "options": {"A": "Instillation of the urethral mesh sling", "B": "Topical estrogen therapy", "C": "Augmentation cystoplasty", "D": "Start her on a muscarinic antagonist"}, "answer": "Start her on a muscarinic antagonist", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "45 years old", "specialties": ["Urology"], "subspecialties": ["Female Pelvic Medicine and Reconstructive Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is 45 years old.", "2. Patient is G2P2.", "3. Patient has episodes of urgency accompanied by an involuntary passage of urine.", "4. Symptoms take place during the day and night.", "5. Symptoms are not linked with physical exertion, laughing, or coughing.", "6. Patient's occupation does not involve weight lifting.", "7. Patient says occupation is sometimes very stressful.", "8. Patient denies any other genitourinary symptoms.", "9. Patient had 1 vaginal delivery and 1 cesarean section.", "10. Patient does not have a history of genitourinary or neurologic disorders.", "11. Patient's weight is 91 kg (200.6 lb).", "12. Patient's height is 172 cm (5 ft 60 in).", "13. Patient's blood pressure is 128/75 mmHg.", "14. Patient's heart rate is 77/min.", "15. Patient's respiratory rate is 13/min.", "16. Patient's temperature is 36.6\u2103 (97.9\u2109).", "17. Physical examination shows no abdominal masses.", "18. Physical examination shows no costovertebral angle or suprapubic tenderness.", "19. Gynecologic examination shows no vulvar lesions.", "20. External urethral orifice appears normal.", "21. Q-tip test is negative.", "22. Cervix is normally positioned, non-tender, movable, and without visible lesions.", "23. Uterus is not enlarged.", "24. Ovaries are not palpable.", "25. Urinalysis, urine culture, and ultrasound examination of the bladder were all normal.", "26. Cystometric studies show residual volume of 10 ml (normal range < 50 ml).", "27. Cystometric studies show sensation-of-fullness volume of 190 ml (normal range 200\u2013225 ml).", "28. Cystometric studies show urge-to-void volume of 700 ml (normal range 400\u2013500 ml).", "29. Cystometric studies show presence of involuntary contractions (normal range absent)."], "atomic_facts": ["1. Symptoms occur during the day and night.", "2. Symptoms are not linked with physical exertion, laughing, or coughing.", "3. Occupation does not involve weight lifting, but is sometimes stressful.", "4. Denies any other genitourinary symptoms.", "5. Had 1 vaginal delivery and 1 cesarean section.", "6. No history of genitourinary or neurologic disorders.", "7. Weight is 91 kg (200.6 lb) and height is 172 cm (5 ft 60 in).", "8. Vital signs: blood pressure 128/75 mmHg, heart rate 77/min, respiratory rate 13/min, temperature 36.6\u2103 (97.9\u2109).", "9. Physical examination shows no abdominal masses, costovertebral angle tenderness, or suprapubic tenderness.", "10. Gynecologic examination shows no vulvar lesions, normal external urethral orifice, and negative Q-tip test.", "11. Cervix is normally positioned, non-tender, movable, and without visible lesions.", "12. Uterus is not enlarged and ovaries are not palpable.", "13. Urinalysis, urine culture, and ultrasound examination of the bladder were all normal.", "14. Cystometric studies show specific measured values and normal ranges for residual volume, sensation-of-fullness volume, urge-to-void volume, and presence of involuntary contractions."]}
{"id": 242, "question": "The patient's symptoms are most likely caused by disruption of which of the following steps in protein synthesis?", "context": ["A 4-year-old girl is brought to the physician with progressively worsening fever, malaise, and a sore throat.", "Her parents say \u201cOur daughter has not received vaccinations because her body has to learn how to fight infections.\u201d Her temperature is 38.5\u02daC (101.3 F).", "Physical examination shows marked cervical lymphadenopathy.", "There are gray-white membranes over the tonsils and posterior pharynx that bleed when scraped off."], "context_len": 4, "options": {"A": "Folding of completed proteins", "B": "Translocation of the ribosome along the mRNA", "C": "Binding of tRNA to the A site", "D": "Release of completed protein from ribosome"}, "answer": "Translocation of the ribosome along the mRNA", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old girl is brought to the physician.", "2. She has progressively worsening fever, malaise, and a sore throat.", "3. Her parents say she has not received vaccinations because her body has to learn how to fight infections.", "4. Her temperature is 38.5\u02daC (101.3 F).", "5. Physical examination shows marked cervical lymphadenopathy.", "6. There are gray-white membranes over the tonsils and posterior pharynx.", "7. The gray-white membranes bleed when scraped off."], "atomic_facts": ["1. Her parents say \"Our daughter has not received vaccinations because her body has to learn how to fight infections.\"", "2. Her temperature is 38.5\u02daC (101.3 F).", "3. Physical examination shows marked cervical lymphadenopathy.", "4. There are gray-white membranes over the tonsils and posterior pharynx that bleed when scraped off."]}
{"id": 243, "question": "Which of the following therapies would have been first line for improving this patient\u2019s symptoms early in the course of this disease?", "context": ["A 56-year-old man presents to his family physician for issues with his back that have persisted since he was in his 20\u2019s.", "For the last 6 months, his neck has been very stiff and he has been unable to tilt his head backwards.", "He also has severe kyphosis and feels limited in his range of motion.", "He tries to get at least 8 hours of sleep each night, but he says he rarely feels rested.", "On examination, the patient has no pain on active and passive movements.", "His cervical spine is moderately stiff; limitations are in extension, flexion, and rotation.", "There is also evidence of mild swelling of his wrist joints.", "The patient is sent for an X-ray of his lumbar spine.", "Unfortunately, he did not seek medical care for years due to financial hardships."], "context_len": 9, "options": {"A": "Infliximab", "B": "Indomethacin", "C": "Methotrexate", "D": "Sulfasalazine"}, "answer": "Indomethacin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Physical Medicine and Rehabilitation"}, "facts_old": ["1. Patient is 56 years old.", "2. Patient has had back issues since his 20's.", "3. Patient has had a stiff neck for the last 6 months.", "4. Patient has severe kyphosis.", "5. Patient has limited range of motion.", "6. Patient tries to get 8 hours of sleep each night.", "7. Patient has no pain on active and passive movements.", "8. Patient's cervical spine is moderately stiff.", "9. Limitations in extension, flexion, and rotation.", "10. Patient has mild swelling of his wrist joints.", "11. Patient is sent for an X-ray of his lumbar spine.", "12. Patient did not seek medical care for years due to financial hardships."], "atomic_facts": ["1. His neck has been very stiff for the last 6 months.", "2. He has been unable to tilt his head backwards.", "3. He has severe kyphosis.", "4. He feels limited in his range of motion.", "5. He tries to get at least 8 hours of sleep each night.", "6. He rarely feels rested despite getting 8 hours of sleep.", "7. On examination, the patient has no pain on active and passive movements.", "8. His cervical spine is moderately stiff.", "9. Limitations are in extension, flexion, and rotation.", "10. There is evidence of mild swelling of his wrist joints.", "11. The patient is sent for an X-ray of his lumbar spine.", "12. He did not seek medical care for years due to financial hardships."]}
{"id": 244, "question": "What is the most likely cause of this patient\u2019s cervicitis?", "context": ["A 24-year-old woman visits the health services of her university for vaginal itching, dysuria, pelvic discomfort, and foul-smelling vaginal discharge.", "She states this is the eighth time she has had such symptoms within the last year, for which she and her sexual partners have received multiple courses of doxycycline and ceftriaxone or azithromycin and ceftriaxone.", "A pelvic examination showed a mucopurulent cervical discharge with cervical friability.", "A vaginal wet-mount showed an elevated number of polymorphonuclear leukocytes."], "context_len": 4, "options": {"A": "Chlamydia trachomatis", "B": "Mycoplasma hominis", "C": "Mycoplasma genitalium", "D": "Neisseria gonorrhoeae"}, "answer": "Mycoplasma genitalium", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "24 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 24-year-old woman visited the health services of her university.", "2. She had vaginal itching, dysuria, pelvic discomfort, and foul-smelling vaginal discharge.", "3. This was the eighth time she had these symptoms in the last year.", "4. She and her sexual partners had received multiple courses of doxycycline and ceftriaxone or azithromycin and ceftriaxone.", "5. A pelvic examination showed a mucopurulent cervical discharge with cervical friability.", "6. A vaginal wet-mount showed an elevated number of polymorphonuclear leukocytes."], "atomic_facts": ["1. The patient has experienced similar symptoms eight times in the past year.", "2. The patient and her sexual partners have received multiple courses of doxycycline and ceftriaxone or azithromycin and ceftriaxone.", "3. A pelvic examination revealed mucopurulent cervical discharge.", "4. The cervical discharge showed cervical friability.", "5. A vaginal wet-mount showed an elevated number of polymorphonuclear leukocytes."]}
{"id": 245, "question": "Which of the following is the most appropriate next step in management?", "context": ["A previously healthy 11-month-old boy is brought to the emergency department for the evaluation of abdominal pain and vomiting.", "His mother states that over the past 6 hours he has been having intermittent episodes of inconsolable crying, during which he \u201cgrabs his abdomen and draws up his legs.\u201d These episodes have been accompanied by nonbloody, nonbilious vomiting and reddish, mucoid bowel movements.", "He appears sleepy.", "His temperature is 38.1\u00b0C (100.6\u00b0F), blood pressure 100/60 mm Hg, pulse is 110/min, and respirations are 24/min.", "He cries when his abdomen is palpated.", "The remainder of the examination shows no abnormalities.", "A complete blood count shows a leukocyte count of 12,000/mm3.", "Serum electrolyte levels are within normal limits.", "An abdominal x-ray shows no free air.", "An abdominal ultrasonography is shown."], "context_len": 10, "options": {"A": "Air enema", "B": "Appendectomy", "C": "Technetium-99m pertechnetate scan", "D": "Pyloromyotomy"}, "answer": "Air enema", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "11 months", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A previously healthy 11-month-old boy is brought to the emergency department for the evaluation of abdominal pain and vomiting.", "2. His mother states that over the past 6 hours he has been having intermittent episodes of inconsolable crying, during which he \u201cgrabs his abdomen and draws up his legs.\u201d", "3. These episodes have been accompanied by nonbloody, nonbilious vomiting and reddish, mucoid bowel movements.", "4. He appears sleepy.", "5. His temperature is 38.1\u00b0C (100.6\u00b0F), blood pressure 100/60 mm Hg, pulse is 110/min, and respirations are 24/min.", "6. He cries when his abdomen is palpated.", "7. The remainder of the examination shows no abnormalities.", "8. A complete blood count shows a leukocyte count of 12,000/mm3.", "9. Serum electrolyte levels are within normal limits.", "10. An abdominal x-ray shows no free air.", "11. An abdominal ultrasonography is shown."], "atomic_facts": ["1. His mother reports intermittent episodes of inconsolable crying over the past 6 hours.", "2. During the episodes, he grabs his abdomen and draws up his legs.", "3. The episodes are accompanied by nonbloody, nonbilious vomiting and reddish, mucoid bowel movements.", "4. He appears sleepy.", "5. His temperature is 38.1\u00b0C (100.6\u00b0F).", "6. His blood pressure is 100/60 mm Hg.", "7. His pulse is 110/min.", "8. His respirations are 24/min.", "9. He cries when his abdomen is palpated.", "10. The remainder of the examination shows no abnormalities.", "11. A complete blood count shows a leukocyte count of 12,000/mm3.", "12. Serum electrolyte levels are within normal limits.", "13. An abdominal x-ray shows no free air.", "14. An abdominal ultrasonography is shown."]}
{"id": 246, "question": "Which of the following best explains the findings in this patient?", "context": ["A 68-year-old man comes to the physician because of a 4-month history of bad breath and progressive difficulty swallowing solid food.", "Physical examination shows no abnormalities.", "An upper endoscopy is performed and a photomicrograph of a biopsy specimen obtained from the mid-esophagus is shown."], "context_len": 3, "options": {"A": "Atrophy and fibrosis of the esophageal smooth muscle", "B": "Metaplastic transformation of esophageal mucosa", "C": "Neoplastic proliferation of squamous epithelium", "D": "Eosinophilic infiltration of the esophageal walls\n\""}, "answer": "Neoplastic proliferation of squamous epithelium", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "68 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 68-year-old man comes to the physician.", "2. He has a 4-month history of bad breath.", "3. He has progressive difficulty swallowing solid food.", "4. Physical examination shows no abnormalities.", "5. An upper endoscopy is performed.", "6. A photomicrograph of a biopsy specimen is obtained from the mid-esophagus."], "atomic_facts": ["1. Physical examination shows no abnormalities.", "2. An upper endoscopy is performed.", "3. A photomicrograph of a biopsy specimen is obtained from the mid-esophagus."]}
{"id": 247, "question": "Which of the following is the most appropriate next step in diagnosis?", "context": ["A 43-year-old woman comes to the physician because of a 2-month history of progressive muscle pain and stiffness that worsens with exercise.", "She also has difficulty climbing stairs, getting out of chairs, and putting things on shelves or in cupboards.", "She has had constipation, occasional headaches, and a 9-kg (20-lb) weight gain during the past year.", "She has hypertension controlled with atenolol and amlodipine.", "She has used calamine lotion for the past 6 months for dry skin.", "Her pulse is 80/min and her blood pressure is 138/76 mm Hg.", "Physical examination shows weakness of the proximal muscle groups.", "She has delayed tendon reflex relaxation, with a mounding of the muscle surface occurring just before relaxation.", "Creatine kinase level is 3,120 U/L."], "context_len": 9, "options": {"A": "Serum TSH levels", "B": "Acetylcholine receptor antibody testing", "C": "Serum potassium levels", "D": "Temporal artery biopsy"}, "answer": "Serum TSH levels", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "43 years old", "specialties": ["Rheumatology", "Neurology"], "subspecialties": ["General Rheumatology", "Neuromuscular Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 43-year-old woman.", "2. Patient has a 2-month history of progressive muscle pain and stiffness that worsens with exercise.", "3. Patient has difficulty climbing stairs, getting out of chairs, and putting things on shelves or in cupboards.", "4. Patient has had constipation, occasional headaches, and a 9-kg (20-lb) weight gain during the past year.", "5. Patient has hypertension controlled with atenolol and amlodipine.", "6. Patient has used calamine lotion for the past 6 months for dry skin.", "7. Patient's pulse is 80/min.", "8. Patient's blood pressure is 138/76 mm Hg.", "9. Physical examination shows weakness of the proximal muscle groups.", "10. Patient has delayed tendon reflex relaxation, with a mounding of the muscle surface occurring just before relaxation.", "11. Patient's creatine kinase level is 3,120 U/L."], "atomic_facts": ["1. She has difficulty climbing stairs.", "2. She has difficulty getting out of chairs.", "3. She has difficulty putting things on shelves or in cupboards.", "4. She has had constipation.", "5. She has occasional headaches.", "6. She has had a 9-kg (20-lb) weight gain during the past year.", "7. She has hypertension controlled with atenolol and amlodipine.", "8. She has used calamine lotion for the past 6 months for dry skin.", "9. Her pulse is 80/min.", "10. Her blood pressure is 138/76 mm Hg.", "11. Physical examination shows weakness of the proximal muscle groups.", "12. She has delayed tendon reflex relaxation.", "13. She has a mounding of the muscle surface occurring just before relaxation.", "14. Creatine kinase level is 3,120 U/L."]}
{"id": 248, "question": "Which of the following genetic principles is most likely responsible for this patient's condition?", "context": ["A 34-year-old woman comes to the physician because of a rapidly growing lump in her right breast.", "Eight months ago, she underwent excision of a liposarcoma from the dorsum of her right forearm.", "Her brother was diagnosed with osteosarcoma of the maxilla at the age of 22 years.", "Her mother died at the age of 43 years from complications of acute myeloid leukemia.", "She has smoked a pack of cigarettes daily for 7 years.", "Examination shows a fixed, firm mass in the right breast with axillary lymphadenopathy.", "A biopsy of the mass confirms the diagnosis of invasive ductal carcinoma."], "context_len": 7, "options": {"A": "Loss of heterozygosity in tumor suppressor gene", "B": "Methylation of a previously normal gene copy", "C": "Oncogenic transformation of a previously normal gene", "D": "Chronic exposure to carcinogenic material"}, "answer": "Loss of heterozygosity in tumor suppressor gene", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Internal Medicine", "General Surgery", "Obstetrics and Gynecology"], "subspecialties": ["Medical Oncology", "Surgical Oncology", "Gynecologic Oncology"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 34-year-old woman comes to the physician.", "2. She has a rapidly growing lump in her right breast.", "3. Eight months ago, she underwent excision of a liposarcoma from the dorsum of her right forearm.", "4. Her brother was diagnosed with osteosarcoma of the maxilla at the age of 22 years.", "5. Her mother died at the age of 43 years from complications of acute myeloid leukemia.", "6. She has smoked a pack of cigarettes daily for 7 years.", "7. Examination shows a fixed, firm mass in the right breast with axillary lymphadenopathy.", "8. A biopsy of the mass confirms the diagnosis of invasive ductal carcinoma."], "atomic_facts": ["1. Eight months ago, she underwent excision of a liposarcoma from the dorsum of her right forearm.", "2. Her brother was diagnosed with osteosarcoma of the maxilla at the age of 22 years.", "3. Her mother died at the age of 43 years from complications of acute myeloid leukemia.", "4. She has smoked a pack of cigarettes daily for 7 years.", "5. Examination shows a fixed, firm mass in the right breast with axillary lymphadenopathy.", "6. A biopsy of the mass confirms the diagnosis of invasive ductal carcinoma."]}
{"id": 249, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 31-year-old woman comes to the doctor because of episodic nosebleeds and gingival bleeding for the past 2 weeks.", "She has no history of serious illness and takes no medications.", "She is sexually active with two male partners and uses condoms inconsistently.", "Vital signs are within normal limits.", "Examination shows punctate, non-blanching macules on the chest.", "The remainder of the examination shows no abnormalities.", "The hemoglobin concentration is 13.1 g/dL, leukocyte count is 6600/mm3, and platelet count is 28,000/mm3.", "A peripheral blood smear shows reduced platelets with normal morphology.", "HIV test is negative."], "context_len": 9, "options": {"A": "Blood cultures", "B": "D-dimer testing", "C": "Hepatitis C antibody testing", "D": "Anti-platelet antibody testing"}, "answer": "Hepatitis C antibody testing", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "31 years old", "specialties": ["Hematology", "Internal Medicine"], "subspecialties": ["General Hematology", "Hematology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 31-year-old woman.", "2. Patient has had episodic nosebleeds and gingival bleeding for the past 2 weeks.", "3. Patient has no history of serious illness.", "4. Patient takes no medications.", "5. Patient is sexually active with two male partners.", "6. Patient uses condoms inconsistently.", "7. Vital signs are within normal limits.", "8. Examination shows punctate, non-blanching macules on the chest.", "9. The remainder of the examination shows no abnormalities.", "10. Hemoglobin concentration is 13.1 g/dL.", "11. Leukocyte count is 6600/mm3.", "12. Platelet count is 28,000/mm3.", "13. Peripheral blood smear shows reduced platelets with normal morphology.", "14. HIV test is negative."], "atomic_facts": ["1. She has no history of serious illness and takes no medications.", "2. She is sexually active with two male partners and uses condoms inconsistently.", "3. Vital signs are within normal limits.", "4. Examination shows punctate, non-blanching macules on the chest.", "5. The remainder of the examination shows no abnormalities.", "6. The hemoglobin concentration is 13.1 g/dL, leukocyte count is 6600/mm3, and platelet count is 28,000/mm3.", "7. A peripheral blood smear shows reduced platelets with normal morphology.", "8. HIV test is negative."]}
{"id": 250, "question": "Which of the following is the most likely diagnosis?", "context": ["A 40-year-old woman presents to the clinic for hair loss.", "She was in her usual state of health until earlier this month when she started noticing more and more hair on her pillow in the morning.", "The problem has only been getting worse since then; she's even started pulling out clumps of hair when she shampoos in the morning.", "She has no other symptoms, and her past medical history is unremarkable.", "The physical exam is notable for smooth, circular, non-scarring, hairless patches across her scalp.", "A firm tug on a bundle of hair causes almost all of the hair to be removed."], "context_len": 6, "options": {"A": "Alopecia areata", "B": "Secondary syphilis", "C": "Tinea capitis", "D": "Trichotillomania"}, "answer": "Alopecia areata", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "40 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 40-year-old woman presents to the clinic for hair loss.", "2. She was in her usual state of health until earlier this month.", "3. She started noticing more and more hair on her pillow in the morning.", "4. The problem has only been getting worse since then.", "5. She's even started pulling out clumps of hair when she shampoos in the morning.", "6. She has no other symptoms.", "7. Her past medical history is unremarkable.", "8. The physical exam is notable for smooth, circular, non-scarring, hairless patches across her scalp.", "9. A firm tug on a bundle of hair causes almost all of the hair to be removed."], "atomic_facts": ["1. She was in her usual state of health until earlier this month.", "2. She started noticing more and more hair on her pillow in the morning.", "3. The problem has only been getting worse since then.", "4. She's even started pulling out clumps of hair when she shampoos in the morning.", "5. She has no other symptoms.", "6. Her past medical history is unremarkable.", "7. The physical exam is notable for smooth, circular, non-scarring, hairless patches across her scalp.", "8. A firm tug on a bundle of hair causes almost all of the hair to be removed."]}
{"id": 251, "question": "Which of the following is the most likely karyotype abnormality in this infant?", "context": ["A 2-day-old girl born at 32 weeks gestation to a 42-year-old woman is being examined by a resident.", "The examination reveals a very small head circumference with low set ears, a prominent occiput, and a comparatively small mandible.", "A picture of the infant\u2019s fist is given below.", "A bilateral foot deformity is present."], "context_len": 4, "options": {"A": "47, XXX", "B": "Trisomy 21", "C": "Trisomy 18", "D": "47, XXY"}, "answer": "Trisomy 18", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "2 days old", "specialties": ["Pediatrics", "Medical Genetics and Genomics"], "subspecialties": ["Neonatal", "Clinical Genetics and Genomics"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 2-day-old girl was born at 32 weeks gestation.", "2. The girl's mother is 42 years old.", "3. The girl is being examined by a resident.", "4. The examination reveals a very small head circumference.", "5. The examination reveals low set ears.", "6. The examination reveals a prominent occiput.", "7. The examination reveals a comparatively small mandible.", "8. A picture of the infant's fist is given.", "9. A bilateral foot deformity is present."], "atomic_facts": ["1. The examination reveals a very small head circumference.", "2. The examination reveals low set ears.", "3. The examination reveals a prominent occiput.", "4. The examination reveals a comparatively small mandible.", "5. A picture of the infant\u2019s fist is given below.", "6. A bilateral foot deformity is present."]}
{"id": 252, "question": "This patient's cognitive symptoms are most likely the result of which of the following neuropathologic changes?", "context": ["A 44-year-old male is brought to the physician by his father.", "Over the past year, the patient has become progressively forgetful and withdrawn.", "He frequently has trouble remembering names of acquaintances, and has been requiring increasing amounts of assistance with getting dressed, cooking, and personal hygiene.", "He was diagnosed with a genetic disorder during infancy.", "Physical examination shows prominent epicanthal folds, low-set small ears, and a protruding tongue.", "Mental examination shows significant deficits in short- and long-term memory."], "context_len": 6, "options": {"A": "Intracellular aggregations of alpha-synuclein", "B": "Multifocal deposition of excess copper", "C": "Synaptic build-up of abnormal prion protein", "D": "Extracellular accumulation of amyloid plaques"}, "answer": "Extracellular accumulation of amyloid plaques", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "44", "specialties": ["Neurology"], "subspecialties": ["General Neurology", "Neurology with Special Qualification in Child Neurology", "Neurodevelopmental Disabilities"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 44-year-old male is brought to the physician by his father.", "2. Over the past year, the patient has become progressively forgetful and withdrawn.", "3. He frequently has trouble remembering names of acquaintances.", "4. He has been requiring increasing amounts of assistance with getting dressed, cooking, and personal hygiene.", "5. He was diagnosed with a genetic disorder during infancy.", "6. Physical examination shows prominent epicanthal folds.", "7. Physical examination shows low-set small ears.", "8. Physical examination shows a protruding tongue.", "9. Mental examination shows significant deficits in short-term memory.", "10. Mental examination shows significant deficits in long-term memory."], "atomic_facts": ["1. The patient has become progressively forgetful over the past year.", "2. The patient has become progressively withdrawn over the past year.", "3. The patient frequently has trouble remembering names of acquaintances.", "4. The patient has been requiring increasing amounts of assistance with getting dressed.", "5. The patient has been requiring increasing amounts of assistance with cooking.", "6. The patient has been requiring increasing amounts of assistance with personal hygiene.", "7. The patient was diagnosed with a genetic disorder during infancy.", "8. Physical examination shows prominent epicanthal folds.", "9. Physical examination shows low-set small ears.", "10. Physical examination shows a protruding tongue.", "11. Mental examination shows significant deficits in short-term memory.", "12. Mental examination shows significant deficits in long-term memory."]}
{"id": 253, "question": "Which of the following is the most likely diagnosis?", "context": ["A previously healthy 75-year-old man comes to the physician with a 6-month history of fatigue, weight loss, and abdominal pain.", "He drinks 2 oz of alcohol on the weekends and does not smoke.", "He is retired but previously worked in a factory that produces plastic pipes.", "Abdominal examination shows right upper quadrant tenderness; the liver edge is palpable 2 cm below the ribs.", "A liver biopsy specimen shows pleomorphic spindle cells that express PECAM-1 on their surface."], "context_len": 5, "options": {"A": "Cavernous hemangioma", "B": "Kaposi sarcoma", "C": "Angiosarcoma", "D": "Cholangiocarcinoma\n\""}, "answer": "Angiosarcoma", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "75 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 75-year-old man comes to the physician.", "2. He has a 6-month history of fatigue, weight loss, and abdominal pain.", "3. He drinks 2 oz of alcohol on the weekends.", "4. He does not smoke.", "5. He previously worked in a factory that produces plastic pipes.", "6. Abdominal examination shows right upper quadrant tenderness.", "7. The liver edge is palpable 2 cm below the ribs.", "8. A liver biopsy specimen shows pleomorphic spindle cells.", "9. The spindle cells express PECAM-1 on their surface."], "atomic_facts": ["1. He drinks 2 oz of alcohol on the weekends.", "2. He does not smoke.", "3. He is retired.", "4. He previously worked in a factory that produces plastic pipes.", "5. Abdominal examination shows right upper quadrant tenderness.", "6. The liver edge is palpable 2 cm below the ribs.", "7. A liver biopsy specimen shows pleomorphic spindle cells.", "8. The pleomorphic spindle cells express PECAM-1 on their surface."]}
{"id": 254, "question": "Which of the following muscles is responsible for the displacement of this segment?", "context": ["A 28-year-old man is brought to the emergency department 20 minutes after being involved in a bicycling accident.", "He complains of severe pain over the front of his right shoulder.", "He refuses to move his right arm.", "Physical examination shows supraclavicular swelling and bruising.", "The shoulder's range of motion is limited by pain.", "An x-ray of the shoulder shows a fracture of the middle third of the clavicle with complete superior displacement of the medial clavicular segment."], "context_len": 6, "options": {"A": "Trapezius", "B": "Subclavius", "C": "Pectoralis major", "D": "Sternocleidomastoid"}, "answer": "Sternocleidomastoid", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "28 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 28-year-old man is brought to the emergency department.", "2. He was involved in a bicycling accident 20 minutes prior.", "3. He complains of severe pain over the front of his right shoulder.", "4. He refuses to move his right arm.", "5. Physical examination shows supraclavicular swelling and bruising.", "6. The shoulder's range of motion is limited by pain.", "7. An x-ray of the shoulder shows a fracture of the middle third of the clavicle.", "8. The x-ray shows complete superior displacement of the medial clavicular segment."], "atomic_facts": ["1. Patient complains of severe pain over the front of his right shoulder.", "2. Patient refuses to move his right arm.", "3. Physical examination shows supraclavicular swelling and bruising.", "4. Shoulder's range of motion is limited by pain.", "5. X-ray of the shoulder shows a fracture of the middle third of the clavicle.", "6. X-ray shows complete superior displacement of the medial clavicular segment."]}
{"id": 255, "question": "Echocardiography of this patient will most likely show which of the following?", "context": ["A 49-year-old woman presents to her oncologist with progressive difficulty breathing at rest, decreased exercise tolerance, and ankle swelling bilaterally for the past 2 weeks.", "She was diagnosed with breast cancer 4 years ago which was treated with radical mastectomy, radiation, and aggressive chemotherapy.", "She does not smoke or drink alcohol.", "Her family history is positive for breast cancer in her elder sister.", "Vital signs include: blood pressure 85/50 mm Hg, temperature 36.7\u00b0C (98.1\u00b0F), and a regular pulse of 110/min.", "The physician notices that, with inspiration, the radial pulse becomes weak.", "On physical examination, she looks anxious and tachypneic.", "Jugular venous pressure is 14 cm and heart sounds are distant.", "Lungs are clear and 1+ pedal edema is noted.", "Her chest X-ray is shown in the exhibit."], "context_len": 10, "options": {"A": "Rapid early diastolic filling and impaired late diastolic filling", "B": "Impairment of both early and late diastolic filling with respiratory variation of ventricular filling", "C": "Abnormal myocardial texture, and restrictive diastolic dysfunction", "D": "Dilated left and/or right ventricle and low ejection fraction"}, "answer": "Impairment of both early and late diastolic filling with respiratory variation of ventricular filling", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "49", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology", "Congestive Heart Failure and Transplant Cardiology", "Congestive Heart Failure/Cardiomyopathy"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 49-year-old woman presents to her oncologist with progressive difficulty breathing at rest, decreased exercise tolerance, and ankle swelling bilaterally for the past 2 weeks.", "2. She was diagnosed with breast cancer 4 years ago which was treated with radical mastectomy, radiation, and aggressive chemotherapy.", "3. She does not smoke or drink alcohol.", "4. Her family history is positive for breast cancer in her elder sister.", "5. Vital signs include: blood pressure 85/50 mm Hg, temperature 36.7\u00b0C (98.1\u00b0F), and a regular pulse of 110/min.", "6. The physician notices that, with inspiration, the radial pulse becomes weak.", "7. On physical examination, she looks anxious and tachypneic.", "8. Jugular venous pressure is 14 cm and heart sounds are distant.", "9. Lungs are clear and 1+ pedal edema is noted.", "10. Her chest X-ray is shown in the exhibit."], "atomic_facts": ["1. Diagnosed with breast cancer 4 years ago", "2. Treated with radical mastectomy, radiation, and aggressive chemotherapy", "3. Does not smoke or drink alcohol", "4. Family history positive for breast cancer in elder sister", "5. Blood pressure 85/50 mm Hg", "6. Temperature 36.7\u00b0C (98.1\u00b0F)", "7. Regular pulse of 110/min", "8. Radial pulse becomes weak with inspiration", "9. Looks anxious and tachypneic", "10. Jugular venous pressure is 14 cm", "11. Distant heart sounds", "12. Lungs are clear", "13. 1+ pedal edema noted", "14. Chest X-ray is shown in the exhibit"]}
{"id": 256, "question": "Which of the following is the most likely diagnosis?", "context": ["A 5-year-old boy is brought to the physician because of high-grade fever and generalized fatigue for 5 days.", "Two days ago, he developed a rash on his trunk.", "He returned from a family hiking trip to Montana 1 week ago.", "His immunization records are unavailable.", "His temperature is 39.8\u00b0C (103.6\u00b0F), pulse is 111/min, and blood pressure is 96/60 mm Hg.", "Examination shows injection of the conjunctivae bilaterally.", "The tongue and pharynx are erythematous.", "Tender cervical lymphadenopathy is present on the left.", "There is a macular rash over the trunk and extremities.", "Bilateral knee joints are swollen and tender; range of motion is limited by pain.", "Cardiopulmonary examination shows no abnormalities."], "context_len": 11, "options": {"A": "Staphylococcal scalded skin syndrome", "B": "Juvenile idiopathic arthritis", "C": "Granulomatosis with polyangiitis", "D": "Kawasaki disease\n\""}, "answer": "Kawasaki disease\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "5 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 5-year-old boy is brought to the physician.", "2. He has had high-grade fever and generalized fatigue for 5 days.", "3. Two days ago, he developed a rash on his trunk.", "4. He returned from a family hiking trip to Montana 1 week ago.", "5. His immunization records are unavailable.", "6. His temperature is 39.8\u00b0C (103.6\u00b0F).", "7. His pulse is 111/min.", "8. His blood pressure is 96/60 mm Hg.", "9. Examination shows injection of the conjunctivae bilaterally.", "10. The tongue and pharynx are erythematous.", "11. Tender cervical lymphadenopathy is present on the left.", "12. There is a macular rash over the trunk and extremities.", "13. Bilateral knee joints are swollen and tender.", "14. Range of motion is limited by pain.", "15. Cardiopulmonary examination shows no abnormalities."], "atomic_facts": ["1. Two days ago, he developed a rash on his trunk.", "2. He returned from a family hiking trip to Montana 1 week ago.", "3. His immunization records are unavailable.", "4. His temperature is 39.8\u00b0C (103.6\u00b0F), pulse is 111/min, and blood pressure is 96/60 mm Hg.", "5. Examination shows injection of the conjunctivae bilaterally.", "6. The tongue and pharynx are erythematous.", "7. Tender cervical lymphadenopathy is present on the left.", "8. There is a macular rash over the trunk and extremities.", "9. Bilateral knee joints are swollen and tender; range of motion is limited by pain.", "10. Cardiopulmonary examination shows no abnormalities."]}
{"id": 257, "question": "This patient\u2019s condition is likely due to a lesion in which of the following locations?", "context": ["A 61-year-old female presents to the emergency room for a headache and vision loss.", "She reports a 3-hour history of acute-onset dull headache.", "She also says she cannot see out of part of her eye.", "Her past medical history is notable for hypertension, hyperlipidemia, and a prior myocardial infarction.", "She takes enalapril, atorvastatin, aspirin, and metoprolol.", "On exam, she is alert and oriented to person, place, and time.", "She has 5/5 strength and full sensation to light touch in her bilateral upper and lower extremities.", "Her brachioradialis, triceps, patellar, and Achilles reflexes are symmetric and 2+ bilaterally.", "Fundoscopic examination reveals a normal retina.", "Visual field examination demonstrates an inability to see in the superior right visual field."], "context_len": 10, "options": {"A": "Optic nerve", "B": "Pituitary gland", "C": "Parietal lobe", "D": "Temporal lobe"}, "answer": "Temporal lobe", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "61", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 61-year-old female.", "2. Patient presents to the emergency room for a headache and vision loss.", "3. Patient has a 3-hour history of acute-onset dull headache.", "4. Patient cannot see out of part of her eye.", "5. Patient's past medical history is notable for hypertension, hyperlipidemia, and a prior myocardial infarction.", "6. Patient takes enalapril, atorvastatin, aspirin, and metoprolol.", "7. Patient is alert and oriented to person, place, and time.", "8. Patient has 5/5 strength and full sensation to light touch in her bilateral upper and lower extremities.", "9. Patient's brachioradialis, triceps, patellar, and Achilles reflexes are symmetric and 2+ bilaterally.", "10. Fundoscopic examination reveals a normal retina.", "11. Visual field examination demonstrates an inability to see in the superior right visual field."], "atomic_facts": ["1. She reports a 3-hour history of acute-onset dull headache.", "2. She cannot see out of part of her eye.", "3. Her past medical history includes hypertension, hyperlipidemia, and a prior myocardial infarction.", "4. She takes enalapril, atorvastatin, aspirin, and metoprolol.", "5. On exam, she is alert and oriented to person, place, and time.", "6. She has 5/5 strength and full sensation to light touch in her bilateral upper and lower extremities.", "7. Her brachioradialis, triceps, patellar, and Achilles reflexes are symmetric and 2+ bilaterally.", "8. Fundoscopic examination reveals a normal retina.", "9. Visual field examination demonstrates an inability to see in the superior right visual field."]}
{"id": 258, "question": "Which of the following is the best next step in management?", "context": ["A 37-year-old G2P1001 presents to her obstetrician\u2019s office at 31 weeks gestation for decreased fetal movement over the last day.", "She states that although she occasionally feels some movement, it is decreased from baseline.", "She denies any gush of fluid, vaginal bleeding, or painful contractions.", "This pregnancy has been complicated by gestational diabetes for which the patient was prescribed insulin.", "She reports not always taking postprandial fingersticks; therefore, she infrequently uses her insulin.", "She also had a urinary tract infection in the first trimester that was successfully treated with nitrofurantoin.", "The patient has a past medical history of obesity and rosacea, and she had an uncomplicated spontaneous vaginal delivery six years ago.", "At this visit, the patient\u2019s temperature is 98.6\u00b0F (37.0\u00b0C), blood pressure is 148/71 mmHg, pulse is 75/min, and respirations are 14/min.", "The patient appears comfortable and has a fundal height of 33 centimeters.", "An initial attempt with Doppler ultrasound is unable to detect fetal heart tones."], "context_len": 10, "options": {"A": "Non-stress test", "B": "Biophysical profile", "C": "Contraction stress test", "D": "Cervical exam"}, "answer": "Non-stress test", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "37 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Biophysical profile"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is 37 years old.", "2. Patient is G2P1001.", "3. Patient is 31 weeks gestation.", "4. Patient has decreased fetal movement over the last day.", "5. Patient occasionally feels some movement, but it is decreased from baseline.", "6. Patient denies any gush of fluid, vaginal bleeding, or painful contractions.", "7. Patient has gestational diabetes.", "8. Patient was prescribed insulin.", "9. Patient does not always take postprandial fingersticks.", "10. Patient infrequently uses her insulin.", "11. Patient had a urinary tract infection in the first trimester.", "12. Patient was successfully treated with nitrofurantoin.", "13. Patient has a past medical history of obesity and rosacea.", "14. Patient had an uncomplicated spontaneous vaginal delivery six years ago.", "15. Patient's temperature is 98.6\u00b0F (37.0\u00b0C).", "16. Patient's blood pressure is 148/71 mmHg.", "17. Patient's pulse is 75/min.", "18. Patient's respirations are 14/min.", "19. Patient appears comfortable.", "20. Patient has a fundal height of 33 centimeters.", "21. Initial attempt with Doppler ultrasound is unable to detect fetal heart tones."], "atomic_facts": ["1. The patient occasionally feels some movement, but it is decreased from baseline.", "2. The patient denies any gush of fluid, vaginal bleeding, or painful contractions.", "3. The pregnancy has been complicated by gestational diabetes, and the patient was prescribed insulin.", "4. The patient reports not always taking postprandial fingersticks and infrequently uses her insulin.", "5. The patient had a urinary tract infection in the first trimester, successfully treated with nitrofurantoin.", "6. The patient has a past medical history of obesity and rosacea.", "7. The patient had an uncomplicated spontaneous vaginal delivery six years ago.", "8. At this visit, the patient\u2019s temperature is 98.6\u00b0F (37.0\u00b0C), blood pressure is 148/71 mmHg, pulse is 75/min, and respirations are 14/min.", "9. The patient appears comfortable and has a fundal height of 33 centimeters.", "10. An initial attempt with Doppler ultrasound is unable to detect fetal heart tones."]}
{"id": 259, "question": "Which of the following is the most likely predisposing factor for this patient\u2019s current condition?", "context": ["A 59-year-old man is brought to the emergency department by his wife because of fever, chills, night sweats, and generalized fatigue for 2 weeks.", "His temperature is 39.1\u00b0C (102.4\u00b0F).", "He appears ill.", "Physical examination shows a grade 3/6 mid-diastolic murmur at the left sternal border, and crackles at both lung bases.", "A transesophageal echocardiography shows a 12 mm vegetation on the aortic valve.", "Blood cultures show gram-positive, catalase-negative, gamma-hemolytic cocci in chains that are unable to grow in a 6.5% NaCl medium."], "context_len": 6, "options": {"A": "Periodontal disease", "B": "Colon cancer", "C": "Valve replacement", "D": "Urinary tract infection"}, "answer": "Colon cancer", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "59 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 59-year-old man is brought to the emergency department by his wife.", "2. He has been experiencing fever, chills, night sweats, and generalized fatigue for 2 weeks.", "3. His temperature is 39.1\u00b0C (102.4\u00b0F).", "4. He appears ill.", "5. Physical examination shows a grade 3/6 mid-diastolic murmur at the left sternal border.", "6. Physical examination also shows crackles at both lung bases.", "7. A transesophageal echocardiography shows a 12 mm vegetation on the aortic valve.", "8. Blood cultures show gram-positive, catalase-negative, gamma-hemolytic cocci in chains.", "9. The cocci are unable to grow in a 6.5% NaCl medium."], "atomic_facts": ["1. His temperature is 39.1\u00b0C (102.4\u00b0F).", "2. He appears ill.", "3. Physical examination shows a grade 3/6 mid-diastolic murmur at the left sternal border.", "4. Physical examination shows crackles at both lung bases.", "5. A transesophageal echocardiography shows a 12 mm vegetation on the aortic valve.", "6. Blood cultures show gram-positive, catalase-negative, gamma-hemolytic cocci in chains.", "7. The blood cultures are unable to grow in a 6.5% NaCl medium."]}
{"id": 260, "question": "What diagnostic test should this patient receive?", "context": ["A 65-year-old woman presents to her family doctor to reestablish care since her retirement from her corporate job and loss of her employer-sponsored health insurance.", "She states that she has not had time for regular check-ups.", "She exercises 3-4 times a week and consumes red meat sparingly.", "She drank and smoked cigarettes socially with coworkers but never at home or on vacation.", "She wakes up with achy wrists and elbows that she suspects is from years of using a computer keyboard.", "She completed menopause at age 52.", "Her family history is notable for coronary artery disease on her father's side and colon cancer on her mother's side.", "She last had a colonoscopy 5 years ago that revealed no abnormal findings.", "Her vital signs are within normal limits and her physical exam is grossly unremarkable."], "context_len": 9, "options": {"A": "Chest radiograph", "B": "Colonoscopy", "C": "Mammography", "D": "Pelvic ultrasound"}, "answer": "Mammography", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "65", "specialties": ["Radiology"], "subspecialties": ["General Radiology", "Diagnostic Radiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Family Medicine"}, "facts_old": ["1. Patient is 65 years old.", "2. Patient recently retired from a corporate job and lost employer-sponsored health insurance.", "3. Patient has not had time for regular check-ups.", "4. Patient exercises 3-4 times a week.", "5. Patient consumes red meat sparingly.", "6. Patient drank and smoked cigarettes socially with coworkers, but not at home or on vacation.", "7. Patient wakes up with achy wrists and elbows, which she suspects is from years of using a computer keyboard.", "8. Patient completed menopause at age 52.", "9. Patient's family history is notable for coronary artery disease on her father's side and colon cancer on her mother's side.", "10. Patient last had a colonoscopy 5 years ago that revealed no abnormal findings.", "11. Patient's vital signs are within normal limits.", "12. Patient's physical exam is grossly unremarkable."], "atomic_facts": ["1. She has not had time for regular check-ups.", "2. She exercises 3-4 times a week.", "3. She consumes red meat sparingly.", "4. She drank and smoked cigarettes socially with coworkers.", "5. She never drank or smoked at home or on vacation.", "6. She wakes up with achy wrists and elbows.", "7. She suspects it is from years of using a computer keyboard.", "8. She completed menopause at age 52.", "9. Her family history includes coronary artery disease on her father's side.", "10. Her family history includes colon cancer on her mother's side.", "11. She had a colonoscopy 5 years ago.", "12. The colonoscopy revealed no abnormal findings.", "13. Her vital signs are within normal limits.", "14. Her physical exam is grossly unremarkable."]}
{"id": 261, "question": "Which of the following is the most likely explanation for this patient's symptoms?\"", "context": ["A 52-year-old woman comes to the physician because of mild fatigue and dizziness for the past 2 days.", "She has not been to work since yesterday due to her symptoms.", "She says she has \"\"very high blood sugar\u201d and has had similar episodes often in the past 2 years, for which she has visited multiple doctors around the city.", "She has also purchased a home glucose monitoring device, which she uses daily.", "Since the symptoms began, she has become socially withdrawn and spends much of her time at home researching diabetes on the internet.", "One week ago, she took a day off work because of her symptoms.", "She is not on any treatment.", "She has had 3 laboratory test reports that all show normal fasting and post-meal blood glucose levels.", "Her father and brother have diabetes mellitus type 2.", "She appears anxious.", "Vital signs are normal.", "Physical examination shows no abnormalities.", "Random serum glucose is 128 mg/dL."], "context_len": 13, "options": {"A": "Somatic symptom disorder", "B": "Unipolar major depression", "C": "Illness anxiety disorder", "D": "Impaired glucose homeostasis"}, "answer": "Illness anxiety disorder", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "52", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 52-year-old woman comes to the physician.", "2. She has mild fatigue and dizziness for the past 2 days.", "3. She has not been to work since yesterday due to her symptoms.", "4. She says she has \"very high blood sugar\".", "5. She has had similar episodes often in the past 2 years.", "6. She has visited multiple doctors around the city.", "7. She has purchased a home glucose monitoring device.", "8. She uses the device daily.", "9. Since the symptoms began, she has become socially withdrawn.", "10. She spends much of her time at home researching diabetes on the internet.", "11. One week ago, she took a day off work because of her symptoms.", "12. She is not on any treatment.", "13. She has had 3 laboratory test reports.", "14. All show normal fasting and post-meal blood glucose levels.", "15. Her father and brother have diabetes mellitus type 2.", "16. She appears anxious.", "17. Vital signs are normal.", "18. Physical examination shows no abnormalities.", "19. Random serum glucose is 128 mg/dL."], "atomic_facts": ["1. She has not been to work since yesterday due to her symptoms.", "2. She says she has \"very high blood sugar\u201d and has had similar episodes often in the past 2 years.", "3. She has visited multiple doctors around the city for her symptoms.", "4. She has purchased a home glucose monitoring device, which she uses daily.", "5. Since the symptoms began, she has become socially withdrawn and spends much of her time at home researching diabetes on the internet.", "6. One week ago, she took a day off work because of her symptoms.", "7. She is not on any treatment.", "8. She has had 3 laboratory test reports that all show normal fasting and post-meal blood glucose levels.", "9. Her father and brother have diabetes mellitus type 2.", "10. She appears anxious.", "11. Vital signs are normal.", "12. Physical examination shows no abnormalities.", "13. Random serum glucose is 128 mg/dL."]}
{"id": 262, "question": "Which of the following is most likely to have prevented this infant's condition?\"", "context": ["A 4800 g (10.6 lb) male newborn is delivered at term to a 35-year-old woman, gravida 1, para 1.", "Significant lateral neck traction is required during delivery.", "Apgar scores are 9 and 9 at 1 and 5 minutes, respectively.", "Vital signs are within normal limits.", "At rest, his right shoulder is adducted and internally rotated.", "The baby cries with passive movement of the arm.", "Laboratory studies show: | Hematocrit 66% | Leukocyte count 9000/mm3 | Serum | Na+ 142 mEq/L | Cl- 103 mEq/L | K+ 5.1 mEq/L | HCO3- 20 mEq/L | Urea nitrogen 8 mg/dL | Glucose 34 mg/dL | Creatinine 0.6 mg/dL | ."], "context_len": 7, "options": {"A": "Avoidance of soft cheeses", "B": "Administration of insulin", "C": "Abstinence from cocaine", "D": "Avoidance of cat feces"}, "answer": "Administration of insulin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "Newborn", "specialties": ["Obstetrics and Gynecology", "Pediatrics"], "subspecialties": ["Maternal", "Neonatal", "Maternal\u2013Fetal Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Family Medicine"}, "facts_old": ["1. A 4800 g male newborn is delivered at term.", "2. The mother is 35 years old and gravida 1, para 1.", "3. Significant lateral neck traction is required during delivery.", "4. Apgar scores are 9 and 9 at 1 and 5 minutes, respectively.", "5. Vital signs are within normal limits.", "6. At rest, the baby's right shoulder is adducted and internally rotated.", "7. The baby cries with passive movement of the arm.", "8. Hematocrit is 66%.", "9. Leukocyte count is 9000/mm3.", "10. Serum Na+ is 142 mEq/L.", "11. Serum Cl- is 103 mEq/L.", "12. Serum K+ is 5.1 mEq/L.", "13. Serum HCO3- is 20 mEq/L.", "14. Serum urea nitrogen is 8 mg/dL.", "15. Serum glucose is 34 mg/dL.", "16. Serum creatinine is 0.6 mg/dL."], "atomic_facts": ["1. Significant lateral neck traction is required during delivery.", "2. Apgar scores are 9 and 9 at 1 and 5 minutes, respectively.", "3. Vital signs are within normal limits.", "4. At rest, his right shoulder is adducted and internally rotated.", "5. The baby cries with passive movement of the arm.", "6. Laboratory studies show: Hematocrit 66%", "7. Laboratory studies show: Leukocyte count 9000/mm3", "8. Laboratory studies show: Serum Na+ 142 mEq/L", "9. Laboratory studies show: Serum Cl- 103 mEq/L", "10. Laboratory studies show: Serum K+ 5.1 mEq/L", "11. Laboratory studies show: Serum HCO3- 20 mEq/L", "12. Laboratory studies show: Serum Urea nitrogen 8 mg/dL", "13. Laboratory studies show: Serum Glucose 34 mg/dL", "14. Laboratory studies show: Serum Creatinine 0.6 mg/dL"]}
{"id": 263, "question": "Which of the following is the most sensitive test for diagnosing pregnancy at this time?", "context": ["A 30-year-old woman comes to the physician for evaluation of successful conception.", "She and her husband are trying to conceive, and they have had frequent sexual intercourse over the past month.", "Her menstrual cycles occur at regular 28-day intervals, and her last menstrual period began 25 days ago."], "context_len": 3, "options": {"A": "Serum testing", "B": "Transvaginal ultrasound", "C": "Transabdominal Doppler ultrasound", "D": "Urine testing"}, "answer": "Serum testing", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 30-year-old woman comes to the physician for evaluation of successful conception.", "2. She and her husband are trying to conceive.", "3. They have had frequent sexual intercourse over the past month.", "4. Her menstrual cycles occur at regular 28-day intervals.", "5. Her last menstrual period began 25 days ago."], "atomic_facts": ["1. She and her husband are trying to conceive.", "2. They have had frequent sexual intercourse over the past month.", "3. Her menstrual cycles occur at regular 28-day intervals.", "4. Her last menstrual period began 25 days ago."]}
{"id": 264, "question": "Which of the following is also most likely associated with the auscultatory findings in this patient?", "context": ["A 25-year-old healthy man presents to the physician for an annual checkup.", "He doesn\u2019t have any concerns and feels completely healthy.", "He recently started a new job and has been working out at a gym regularly.", "He does not smoke cigarettes, drinks occasionally, and does not use illicit substances.", "His vital signs include: pulse 80/min, respirations 14/min, and blood pressure 120/80 mm Hg.", "Physical examination is significant for a splitting of the second heart sound heard on inspiration but not on expiration."], "context_len": 6, "options": {"A": "Decreased venous return", "B": "Increased intrapleural pressure", "C": "Increased right ventricular output", "D": "Increased systemic blood pressure"}, "answer": "Increased right ventricular output", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "25", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 25-year-old man presents to the physician for an annual checkup.", "2. He does not have any concerns and feels completely healthy.", "3. He recently started a new job.", "4. He has been working out at a gym regularly.", "5. He does not smoke cigarettes.", "6. He drinks occasionally.", "7. He does not use illicit substances.", "8. His pulse is 80/min.", "9. His respirations are 14/min.", "10. His blood pressure is 120/80 mm Hg.", "11. Physical examination is significant for a splitting of the second heart sound heard on inspiration but not on expiration."], "atomic_facts": ["1. The patient doesn't have any concerns.", "2. The patient feels completely healthy.", "3. The patient recently started a new job.", "4. The patient has been working out at a gym regularly.", "5. The patient does not smoke cigarettes.", "6. The patient drinks occasionally.", "7. The patient does not use illicit substances.", "8. The patient's pulse is 80/min.", "9. The patient's respirations are 14/min.", "10. The patient's blood pressure is 120/80 mm Hg.", "11. The physical examination is significant for a splitting of the second heart sound heard on inspiration but not on expiration."]}
{"id": 265, "question": "Which of the following will increase the intensity of this patient\u2019s murmur?", "context": ["A 79-year-old man presents to his primary care physician complaining of progressive shortness of breath on exertion for the past 2 months.", "He was first aware of having to catch his breath while gardening, and he is now unable to walk up the stairs in his house without stopping.", "He has had type 2 diabetes mellitus for 30 years, for which he takes metformin and sitagliptin.", "His blood pressure is 110/50 mm Hg, the temperature is 37.1\u00b0C (98.8\u00b0F), and the radial pulse is 80/min and regular.", "On physical examination, there is a loud systolic murmur at the right upper sternal border with radiation to the carotid arteries."], "context_len": 5, "options": {"A": "Squatting", "B": "Standing up from a sitting position", "C": "Diuretics", "D": "Volume depletion"}, "answer": "Squatting", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "79 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 79 years old.", "2. Patient is complaining of progressive shortness of breath on exertion for the past 2 months.", "3. Patient first noticed shortness of breath while gardening.", "4. Patient is unable to walk up stairs without stopping.", "5. Patient has type 2 diabetes mellitus for 30 years.", "6. Patient takes metformin and sitagliptin for diabetes.", "7. Patient's blood pressure is 110/50 mm Hg.", "8. Patient's temperature is 37.1\u00b0C (98.8\u00b0F).", "9. Patient's radial pulse is 80/min and regular.", "10. Physical examination reveals loud systolic murmur at right upper sternal border with radiation to carotid arteries."], "atomic_facts": ["1. He first noticed difficulty catching his breath while gardening.", "2. He is unable to walk up the stairs in his house without stopping.", "3. He has had type 2 diabetes mellitus for 30 years.", "4. He takes metformin and sitagliptin for his diabetes.", "5. His blood pressure is 110/50 mm Hg.", "6. His temperature is 37.1\u00b0C (98.8\u00b0F).", "7. His radial pulse is 80/min and regular.", "8. On physical examination, there is a loud systolic murmur at the right upper sternal border with radiation to the carotid arteries."]}
{"id": 266, "question": "Which of the following is the best prophylactic treatment for this patient\u2019s most likely diagnosis?", "context": ["A 47-year-old woman presents with intermittent throbbing headaches.", "She says that she has had at least 1\u20132 every week for the last 3 months.", "She describes the pain as severe, pulsatile, and localized to the right frontotemporal and periorbital areas.", "She says the headaches usually last for several hours and are made worse by the presence of light.", "She endorses nausea with occasional vomiting during the most severe episodes.", "She denies any seizures, loss of consciousness, or focal neurologic deficits.", "Her past medical history is significant for myocardial infarction (MI) 1 year ago, status post percutaneous transluminal coronary angioplasty complicated by residual angina, and severe asthma, managed medically.", "The patient is afebrile, and the vital signs are within normal limits.", "A physical examination is unremarkable.", "A noncontrast computed tomography (CT) scan of the head appears normal."], "context_len": 10, "options": {"A": "Amitriptyline", "B": "Valproic acid", "C": "Propranolol", "D": "Ibuprofen"}, "answer": "Valproic acid", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "47 years old", "specialties": ["Neurology"], "subspecialties": ["Headache Medicine", "Vascular Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 47-year-old woman.", "2. Patient has had intermittent throbbing headaches for the last 3 months, 1-2 per week.", "3. Pain is severe, pulsatile, and localized to the right frontotemporal and periorbital areas.", "4. Headaches usually last for several hours and are made worse by the presence of light.", "5. Patient endorses nausea with occasional vomiting during the most severe episodes.", "6. Patient denies any seizures, loss of consciousness, or focal neurologic deficits.", "7. Patient's past medical history is significant for MI 1 year ago, status post percutaneous transluminal coronary angioplasty complicated by residual angina, and severe asthma, managed medically.", "8. Patient is afebrile, and vital signs are within normal limits.", "9. Physical examination is unremarkable.", "10. Noncontrast CT scan of the head appears normal."], "atomic_facts": ["1. The patient reports having at least 1\u20132 headaches every week for the last 3 months.", "2. She describes the pain as severe, pulsatile, and localized to the right frontotemporal and periorbital areas.", "3. The headaches usually last for several hours and are exacerbated by the presence of light.", "4. She experiences nausea with occasional vomiting during the most severe episodes.", "5. The patient denies any seizures, loss of consciousness, or focal neurologic deficits.", "6. Her past medical history includes myocardial infarction (MI) 1 year ago, status post percutaneous transluminal coronary angioplasty complicated by residual angina, and severe asthma, managed medically.", "7. The patient is afebrile, and the vital signs are within normal limits.", "8. A physical examination is unremarkable.", "9. A noncontrast computed tomography (CT) scan of the head appears normal."]}
{"id": 267, "question": "What conditions can the given test predict?", "context": ["A 37-year-old 11-week primigravida will soon undergo a prenatal evaluation.", "The doctor wants to exclude chromosomal abnormalities with a test.", "He tells her that the test includes extracting a blood sample to determine the chances of having certain genetic conditions.", "This process involves analyzing fetal DNA in the mother\u2019s blood."], "context_len": 4, "options": {"A": "Trisomy 21, Ebstein anomaly", "B": "Trisomy 21, trisomy 13, trisomy 18, fetal sex", "C": "Trisomy 21, trisomy 13, spina bifida", "D": "Trisomy 21, spina bifida"}, "answer": "Trisomy 21, trisomy 13, trisomy 18, fetal sex", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "37 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Maternal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 37-year-old 11-week primigravida will soon undergo a prenatal evaluation.", "2. The doctor wants to exclude chromosomal abnormalities with a test.", "3. The test includes extracting a blood sample.", "4. The blood sample is used to determine the chances of having certain genetic conditions.", "5. This process involves analyzing fetal DNA in the mother\u2019s blood."], "atomic_facts": ["1. The doctor wants to exclude chromosomal abnormalities with a test.", "2. The test includes extracting a blood sample.", "3. The blood sample is used to determine the chances of having certain genetic conditions.", "4. The process involves analyzing fetal DNA in the mother\u2019s blood."]}
{"id": 268, "question": "Which of the following is the most likely mechanism of the patient illness?", "context": ["A 41-year-old man presents with progressive fatigue, pain in the front of the chest, and difficulty breathing with minimal exertion while trying to sleep.", "He reports having a flu-like illness consisting of fatigue, muscle pain, and cough 10 days ago that resolved spontaneously without seeking a medical help.", "He has no past medical history.", "He does not smoke cigarettes or drink alcohol.", "His vital signs include a blood pressure of 100/70 mm Hg, a temperature of 37.5\u00b0C (99.5\u00b0F), and a regular radial pulse of 105/min.", "On physical examination, the patient looks tired, the jugular venous pressure is elevated, pulmonary rales are present on both sides, and an S3 gallop is audible.", "His ECG shows nonspecific ST-segment and T-wave abnormalities.", "A 2-dimensional echocardiogram shows global left ventricular motion abnormalities and dilatation of the left ventricle.", "Troponin I  and Creatine Kinase-MB are elevated."], "context_len": 9, "options": {"A": "Rupture of an atherosclerotic plaque in the coronary artery", "B": "Viral-mediated inflammation with local and systemic immunological activation", "C": "Infection of the endocardial surface of the heart with microembolization and immune complex deposition", "D": "Immune-mediated inflammation of the heart triggered by a preceding streptococcal infection"}, "answer": "Viral-mediated inflammation with local and systemic immunological activation", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "41 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 41-year-old man.", "2. Patient has progressive fatigue, pain in the front of the chest, and difficulty breathing with minimal exertion while trying to sleep.", "3. Patient had a flu-like illness consisting of fatigue, muscle pain, and cough 10 days ago that resolved spontaneously without seeking a medical help.", "4. Patient has no past medical history.", "5. Patient does not smoke cigarettes or drink alcohol.", "6. Patient's blood pressure is 100/70 mm Hg.", "7. Patient's temperature is 37.5\u00b0C (99.5\u00b0F).", "8. Patient's radial pulse is 105/min.", "9. Patient looks tired on physical examination.", "10. Patient's jugular venous pressure is elevated.", "11. Pulmonary rales are present on both sides.", "12. An S3 gallop is audible.", "13. Patient's ECG shows nonspecific ST-segment and T-wave abnormalities.", "14. 2-dimensional echocardiogram shows global left ventricular motion abnormalities and dilatation of the left ventricle.", "15. Troponin I is elevated.", "16. Creatine Kinase-MB is elevated."], "atomic_facts": ["1. He had a flu-like illness 10 days ago with fatigue, muscle pain, and cough.", "2. The flu-like illness resolved spontaneously without seeking medical help.", "3. He has no past medical history.", "4. He does not smoke cigarettes or drink alcohol.", "5. His blood pressure is 100/70 mm Hg.", "6. His temperature is 37.5\u00b0C (99.5\u00b0F).", "7. His radial pulse is regular and 105/min.", "8. On physical examination, the patient looks tired.", "9. The jugular venous pressure is elevated.", "10. Pulmonary rales are present on both sides.", "11. An S3 gallop is audible.", "12. His ECG shows nonspecific ST-segment and T-wave abnormalities.", "13. A 2-dimensional echocardiogram shows global left ventricular motion abnormalities and dilatation of the left ventricle.", "14. Troponin I and Creatine Kinase-MB are elevated."]}
{"id": 269, "question": "Which of the following public health interventions is most likely to decrease this number?", "context": ["A group of epidemiologists is studying the rates of cardiac surgeries performed in several Southeast Asian countries compared to the United States.", "Results show a significant increase in the number of mitral valve replacements performed in Vietnam in adults aged 30\u201350 years compared to the same age group in the United States."], "context_len": 2, "options": {"A": "Prompt antibiotic treatment for bacterial pharyngitis", "B": "Improved access to drug rehabilitation centers", "C": "Genetic screening program for FBN1 gene mutation", "D": "Screening echocardiography for prolapsed anterior mitral valve leaflets"}, "answer": "Prompt antibiotic treatment for bacterial pharyngitis", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Preventive Medicine", "Internal Medicine"], "subspecialties": ["Public Health and General Preventive Medicine", "General Internal Medicine", "Cardiology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A group of epidemiologists is studying the rates of cardiac surgeries performed in several Southeast Asian countries compared to the United States.", "2. Results show a significant increase in the number of mitral valve replacements performed in Vietnam.", "3. The increase is in adults aged 30\u201350 years.", "4. The same age group in the United States is being compared."], "atomic_facts": ["1. Results show a significant increase in the number of mitral valve replacements performed in Vietnam.", "2. The increase is in adults aged 30\u201350 years.", "3. The increase is compared to the same age group in the United States."]}
{"id": 270, "question": "Which of the following treatment regimens is most appropriate in this patient?", "context": ["A 31-year-old male presents to his primary care physician complaining of low back pain and fevers.", "He reports a four-day history of intermittent fevers, chills, and low back pain.", "He denies trauma or recent illness.", "His past medical history is notable for recurrent renal stones, diabetes mellitus, and alcohol abuse.", "He takes metformin but admits to missing several doses.", "He has had multiple sexual partners and uses condoms intermittently.", "His temperature is 100.6\u00b0F (38.1\u00b0C), blood pressure is 110/70 mmHg, pulse is 110/min, and respirations are 21/min.", "On examination, he demonstrates mild tenderness to palpation along his lower back.", "Sensation to touch is intact in the bilateral lower extremities.", "Strength in leg and hip flexion and extension is 5/5 bilaterally.", "The physician is unable to perform a digital rectal examination due to pain.", "A urinalysis demonstrates leukocytes."], "context_len": 12, "options": {"A": "Ampicillin and gentamicin", "B": "Ciprofloxacin and trimethroprim-sulfamethoxazole", "C": "Terazosin", "D": "Ceftriaxone and doxycycline"}, "answer": "Ceftriaxone and doxycycline", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "31", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 31-year-old male.", "2. Patient is complaining of low back pain and fevers.", "3. Patient has a four-day history of intermittent fevers, chills, and low back pain.", "4. Patient denies trauma or recent illness.", "5. Patient's past medical history is notable for recurrent renal stones, diabetes mellitus, and alcohol abuse.", "6. Patient takes metformin but admits to missing several doses.", "7. Patient has had multiple sexual partners and uses condoms intermittently.", "8. Patient's temperature is 100.6\u00b0F (38.1\u00b0C).", "9. Patient's blood pressure is 110/70 mmHg.", "10. Patient's pulse is 110/min.", "11. Patient's respirations are 21/min.", "12. On examination, patient demonstrates mild tenderness to palpation along his lower back.", "13. Sensation to touch is intact in the bilateral lower extremities.", "14. Strength in leg and hip flexion and extension is 5/5 bilaterally.", "15. Physician is unable to perform a digital rectal examination due to pain.", "16. Urinalysis demonstrates leukocytes."], "atomic_facts": ["1. He reports a four-day history of intermittent fevers, chills, and low back pain.", "2. He denies trauma or recent illness.", "3. His past medical history is notable for recurrent renal stones, diabetes mellitus, and alcohol abuse.", "4. He takes metformin but admits to missing several doses.", "5. He has had multiple sexual partners and uses condoms intermittently.", "6. His temperature is 100.6\u00b0F (38.1\u00b0C), blood pressure is 110/70 mmHg, pulse is 110/min, and respirations are 21/min.", "7. On examination, he demonstrates mild tenderness to palpation along his lower back.", "8. Sensation to touch is intact in the bilateral lower extremities.", "9. Strength in leg and hip flexion and extension is 5/5 bilaterally.", "10. The physician is unable to perform a digital rectal examination due to pain.", "11. A urinalysis demonstrates leukocytes."]}
{"id": 271, "question": "Which of the following treatments would be effective for this patient\u2019s most likely condition?", "context": ["A 12-year-old boy is brought to his pediatrician in order to be medically cleared for playing baseball.", "On presentation, the boy\u2019s only complaint is that he has never been able to completely keep up with his classmates during gym or on the playground because he feels fatigued and short of breath.", "A review of his prior medical history reveals that he hit all his developmental milestones as expected and has otherwise been healthy.", "He lives with his parents and eats a diet consisting of mostly fast food and soda.", "Physical exam reveals a thin, pale boy with decreased color under his eyelids.", "A panel of hematologic tests are obtained with the following results: |  | Hemoglobin: 11 g/dL | Leukocyte count: 4,250/mm^3 | Platelet count: 185,000/mm^3 | Mean corpuscular volume: 116 \u00b5m^3 | Blood smear: neutrophils with extra lobes |  | Crystals are also found within this patient's urine."], "context_len": 6, "options": {"A": "Administration of uridine", "B": "Administration of purine", "C": "Cobalamin supplementation", "D": "Folate supplementation"}, "answer": "Administration of uridine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "12 years old", "specialties": ["Pediatrics"], "subspecialties": ["Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 12-year-old boy is brought to his pediatrician in order to be medically cleared for playing baseball.", "2. The boy's only complaint is that he has never been able to completely keep up with his classmates during gym or on the playground because he feels fatigued and short of breath.", "3. A review of his prior medical history reveals that he hit all his developmental milestones as expected and has otherwise been healthy.", "4. He lives with his parents and eats a diet consisting of mostly fast food and soda.", "5. Physical exam reveals a thin, pale boy with decreased color under his eyelids.", "6. A panel of hematologic tests are obtained with the following results: Hemoglobin: 11 g/dL, Leukocyte count: 4,250/mm^3, Platelet count: 185,000/mm^3, Mean corpuscular volume: 116 \u00b5m^3, Blood smear: neutrophils with extra lobes.", "7. Crystals are also found within this patient's urine."], "atomic_facts": ["1. The boy complains of feeling fatigued and short of breath during physical activities.", "2. The boy has hit all his developmental milestones as expected.", "3. The boy lives with his parents and consumes a diet consisting mostly of fast food and soda.", "4. Physical exam reveals a thin, pale boy with decreased color under his eyelids.", "5. Hemoglobin level is 11 g/dL.", "6. Leukocyte count is 4,250/mm^3.", "7. Platelet count is 185,000/mm^3.", "8. Mean corpuscular volume is 116 \u00b5m^3.", "9. Blood smear shows neutrophils with extra lobes.", "10. Crystals are found in the patient's urine."]}
{"id": 272, "question": "Which of the following is the most likely cause of this patient's presentation?", "context": ["A 27-year-old woman presents to her primary care physician for a follow-up appointment.", "At her previous visit she had missed her previous two menses and also had a blood pressure of 147/100 mmHg.", "The patient has a past medical history of anxiety, depression, bulimia nervosa and irritable bowel syndrome.", "Her physician prescribed her an exercise program as well as started her on hydrochlorothiazide and ordered lab work.", "The results of the patient's lab work are below: |  | Serum: | Na+: 145 mEq/L | K+: 2.9 mEq/L | Cl-: 100 mEq/L | HCO3-: 30 mEq/L | BUN: 18 mg/dL | Ca2+: 10.9 mg/dL | Mg2+: 2.0 mEq/L | Creatinine: 1.2 mg/dL | Glucose: 110 mg/dL |  | The patient's blood pressure at this visit is 145/100 mmHg and she has still not experienced her menses.", "Her cardiac, abdominal, and pulmonary exams are within normal limits.", "Inspection of the patient's oropharynx is unremarkable as is inspection of her extremities.", "The patient is started on furosemide and sent home."], "context_len": 8, "options": {"A": "Increased mineralocorticoid production", "B": "Vomiting", "C": "Increased reabsorption at the collecting duct", "D": "Decreased renal artery blood flow"}, "answer": "Increased mineralocorticoid production", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "27", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 27-year-old woman presents to her primary care physician for a follow-up appointment.", "2. At her previous visit she had missed her previous two menses and also had a blood pressure of 147/100 mmHg.", "3. The patient has a past medical history of anxiety, depression, bulimia nervosa and irritable bowel syndrome.", "4. Her physician prescribed her an exercise program as well as started her on hydrochlorothiazide and ordered lab work.", "5. The results of the patient's lab work are: Na+: 145 mEq/L, K+: 2.9 mEq/L, Cl-: 100 mEq/L, HCO3-: 30 mEq/L, BUN: 18 mg/dL, Ca2+: 10.9 mg/dL, Mg2+: 2.0 mEq/L, Creatinine: 1.2 mg/dL, Glucose: 110 mg/dL.", "6. The patient's blood pressure at this visit is 145/100 mmHg and she has still not experienced her menses.", "7. Her cardiac, abdominal, and pulmonary exams are within normal limits.", "8. Inspection of the patient's oropharynx is unremarkable as is inspection of her extremities.", "9. The patient is started on furosemide and sent home."], "atomic_facts": ["1. The patient missed her previous two menses.", "2. The patient had a blood pressure of 147/100 mmHg.", "3. The patient has a past medical history of anxiety, depression, bulimia nervosa, and irritable bowel syndrome.", "4. The physician prescribed an exercise program for the patient.", "5. The physician started the patient on hydrochlorothiazide.", "6. The physician ordered lab work for the patient.", "7. The results of the patient's lab work are as follows: ", "8. Serum: Na+: 145 mEq/L, K+: 2.9 mEq/L, Cl-: 100 mEq/L, HCO3-: 30 mEq/L, BUN: 18 mg/dL, Ca2+: 10.9 mg/dL, Mg2+: 2.0 mEq/L, Creatinine: 1.2 mg/dL, Glucose: 110 mg/dL.", "9. The patient's blood pressure at this visit is 145/100 mmHg.", "10. The patient has still not experienced her menses.", "11. The patient's cardiac, abdominal, and pulmonary exams are within normal limits.", "12. Inspection of the patient's oropharynx is unremarkable.", "13. Inspection of the patient's extremities is unremarkable.", "14. The patient is started on furosemide and sent home."]}
{"id": 273, "question": "Which of the following is most likely to confirm the diagnosis?", "context": ["A 59-year-old man is brought to the emergency room by his wife.", "Thirty minutes ago, he was carrying heavy moving boxes from his house to a truck when he felt short of breath and suddenly lost consciousness.", "His wife states that he fell to the ground and was unresponsive for 15 seconds before he regained consciousness.", "He was not confused after this episode.", "He does not have chest pain.", "On questioning, he recalls experiencing episodic shortness of breath and chest tightness while playing tennis over the past year.", "These symptoms resolved with rest.", "He has no personal history of serious illness and takes no medication.", "Vital signs are within normal limits.", "His temperature is 36.7\u00b0C (98\u00b0F), heart rate is 95/min and pulse is delayed but regular, respirations are 20/min, and blood pressure is 104/80 mm Hg."], "context_len": 10, "options": {"A": "CT angiography", "B": "Echocardiogram", "C": "Cardiac enzymes", "D": "Electroencephalogram\n\""}, "answer": "Echocardiogram", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "59", "specialties": ["Internal Medicine", "Cardiology"], "subspecialties": ["Cardiovascular Disease", "Echocardiogram"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 59-year-old man is brought to the emergency room by his wife.", "2. Thirty minutes ago, he was carrying heavy moving boxes from his house to a truck.", "3. He felt short of breath and suddenly lost consciousness.", "4. His wife states that he fell to the ground and was unresponsive for 15 seconds before he regained consciousness.", "5. He was not confused after this episode.", "6. He does not have chest pain.", "7. On questioning, he recalls experiencing episodic shortness of breath and chest tightness while playing tennis over the past year.", "8. These symptoms resolved with rest.", "9. He has no personal history of serious illness and takes no medication.", "10. Vital signs are within normal limits.", "11. His temperature is 36.7\u00b0C (98\u00b0F).", "12. Heart rate is 95/min.", "13. Pulse is delayed but regular.", "14. Respirations are 20/min.", "15. Blood pressure is 104/80 mm Hg."], "atomic_facts": ["1. Thirty minutes ago, he was carrying heavy moving boxes from his house to a truck.", "2. He felt short of breath and suddenly lost consciousness.", "3. His wife states that he fell to the ground and was unresponsive for 15 seconds before he regained consciousness.", "4. He was not confused after this episode.", "5. He does not have chest pain.", "6. On questioning, he recalls experiencing episodic shortness of breath and chest tightness while playing tennis over the past year.", "7. These symptoms resolved with rest.", "8. He has no personal history of serious illness and takes no medication.", "9. Vital signs are within normal limits.", "10. His temperature is 36.7\u00b0C (98\u00b0F).", "11. Heart rate is 95/min and pulse is delayed but regular.", "12. Respirations are 20/min.", "13. Blood pressure is 104/80 mm Hg."]}
{"id": 274, "question": "Which of the following is the most appropriate initial step in treatment?", "context": ["A previously healthy 2-year-old girl is brought to the physician by her mother because of a dry, harsh cough for 2 days that worsens at night.", "She has also had mild rhinorrhea and fever.", "Her older brother has asthma and had a cold last week.", "Immunizations are up-to-date.", "She appears to be in mild distress.", "Her temperature is 38.1\u00b0C (100.5\u00b0F), pulse is 140/min, respirations are 35/min, and blood pressure is 99/56 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 96%.", "Examination shows clear rhinorrhea and a dry, hoarse cough.", "There is mild inspiratory stridor upon agitation that resolves with rest.", "The remainder of the examination shows no abnormalities."], "context_len": 10, "options": {"A": "Ceftriaxone", "B": "Bronchoscopy", "C": "Chest x-ray", "D": "Cool mist and dexamethasone"}, "answer": "Cool mist and dexamethasone", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 2-year-old girl.", "2. Patient is brought to the physician by her mother.", "3. Patient has a dry, harsh cough for 2 days that worsens at night.", "4. Patient has mild rhinorrhea and fever.", "5. Patient's older brother has asthma and had a cold last week.", "6. Patient's immunizations are up-to-date.", "7. Patient appears to be in mild distress.", "8. Patient's temperature is 38.1\u00b0C (100.5\u00b0F).", "9. Patient's pulse is 140/min.", "10. Patient's respirations are 35/min.", "11. Patient's blood pressure is 99/56 mm Hg.", "12. Pulse oximetry on room air shows an oxygen saturation of 96%.", "13. Examination shows clear rhinorrhea and a dry, hoarse cough.", "14. Examination shows mild inspiratory stridor upon agitation that resolves with rest.", "15. Examination shows no other abnormalities."], "atomic_facts": ["1. She has mild rhinorrhea.", "2. She has fever.", "3. Her older brother has asthma.", "4. Her older brother had a cold last week.", "5. Her immunizations are up-to-date.", "6. She appears to be in mild distress.", "7. Her temperature is 38.1\u00b0C (100.5\u00b0F).", "8. Her pulse is 140/min.", "9. Her respirations are 35/min.", "10. Her blood pressure is 99/56 mm Hg.", "11. Pulse oximetry on room air shows an oxygen saturation of 96%.", "12. Examination shows clear rhinorrhea.", "13. Examination shows a dry, hoarse cough.", "14. There is mild inspiratory stridor upon agitation.", "15. The inspiratory stridor resolves with rest.", "16. The remainder of the examination shows no abnormalities."]}
{"id": 275, "question": "Which of the following is the most likely diagnosis?", "context": ["A 78-year-old man comes to the physician for evaluation of progressive hearing loss in both ears over the past year.", "He has difficulties understanding conversations in crowded places and when more than one person talks at the same time.", "He has no dizziness, ear discharge, ringing noise, or ear pain.", "He has a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus.", "Medications include enalapril, metformin, and atorvastatin.", "Vital signs are within normal limits.", "Otoscopic examination shows pearly gray, translucent tympanic membranes with a normal light reflex.", "A vibrating 512 Hz tuning fork is placed on the left mastoid process.", "Once the patient no longer hears a tone, the fork is held over the ipsilateral ear and the patient reports to hear the tone again.", "The same test is repeated on the right side with similar results.", "There is no lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead."], "context_len": 11, "options": {"A": "Cerumen impaction", "B": "Ototoxicity", "C": "Vestibulocochlear nerve damage", "D": "Presbycusis"}, "answer": "Presbycusis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "78", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 78 years old.", "2. Patient has progressive hearing loss in both ears over the past year.", "3. Patient has difficulties understanding conversations in crowded places and when more than one person talks at the same time.", "4. Patient has no dizziness, ear discharge, ringing noise, or ear pain.", "5. Patient has a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus.", "6. Patient is taking enalapril, metformin, and atorvastatin.", "7. Vital signs are within normal limits.", "8. Otoscopic examination shows pearly gray, translucent tympanic membranes with a normal light reflex.", "9. A vibrating 512 Hz tuning fork is placed on the left mastoid process.", "10. Patient no longer hears a tone when the fork is placed on the left mastoid process.", "11. Patient reports to hear the tone again when the fork is held over the ipsilateral ear.", "12. Similar results when the same test is repeated on the right side.", "13. No lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead."], "atomic_facts": ["1. He has difficulties understanding conversations in crowded places and when more than one person talks at the same time.", "2. He has no dizziness, ear discharge, ringing noise, or ear pain.", "3. He has a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus.", "4. Medications include enalapril, metformin, and atorvastatin.", "5. Vital signs are within normal limits.", "6. Otoscopic examination shows pearly gray, translucent tympanic membranes with a normal light reflex.", "7. A vibrating 512 Hz tuning fork is placed on the left mastoid process.", "8. Once the patient no longer hears a tone, the fork is held over the ipsilateral ear and the patient reports to hear the tone again.", "9. The same test is repeated on the right side with similar results.", "10. There is no lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead."]}
{"id": 276, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 35-year-old woman, gravida 3, para 2, at 37 weeks' gestation comes to the physician for a prenatal visit.", "She feels well.", "She states that she did not follow up with her gynecologist on a regular basis due to a busy work schedule.", "Pregnancy and delivery of her first two children were uncomplicated.", "Her blood pressure was 127/75 mm Hg at her initial obstetrics appointment.", "Her temperature is 37.2\u00b0C (99\u00b0F), pulse is 90/min, and blood pressure is 145/95 mm Hg.", "Pelvic examination shows a uterus consistent in size with a 37-week gestation.", "Physical examination shows 2+ edema in the lower extremities.", "Urinalysis shows: | Blood negative | Protein 3+ | RBC 1\u20132/hpf | RBC casts negative | After four hours of observation, her vital signs are unchanged."], "context_len": 9, "options": {"A": "Induce labor", "B": "Administration of methyldopa", "C": "Reassurance", "D": "Fetal monitoring with continuous cardiotocography"}, "answer": "Induce labor", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "35 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 35-year-old woman is gravida 3, para 2, at 37 weeks' gestation.", "2. She feels well.", "3. She did not follow up with her gynecologist on a regular basis due to a busy work schedule.", "4. Pregnancy and delivery of her first two children were uncomplicated.", "5. Her blood pressure was 127/75 mm Hg at her initial obstetrics appointment.", "6. Her temperature is 37.2\u00b0C (99\u00b0F).", "7. Her pulse is 90/min.", "8. Her blood pressure is 145/95 mm Hg.", "9. Pelvic examination shows a uterus consistent in size with a 37-week gestation.", "10. Physical examination shows 2+ edema in the lower extremities.", "11. Urinalysis shows: Blood negative, Protein 3+, RBC 1\u20132/hpf, RBC casts negative.", "12. After four hours of observation, her vital signs are unchanged."], "atomic_facts": ["1. She feels well.", "2. She did not follow up with her gynecologist on a regular basis due to a busy work schedule.", "3. Pregnancy and delivery of her first two children were uncomplicated.", "4. Her blood pressure was 127/75 mm Hg at her initial obstetrics appointment.", "5. Her temperature is 37.2\u00b0C (99\u00b0F), pulse is 90/min, and blood pressure is 145/95 mm Hg.", "6. Pelvic examination shows a uterus consistent in size with a 37-week gestation.", "7. Physical examination shows 2+ edema in the lower extremities.", "8. Urinalysis shows: | Blood negative | Protein 3+ | RBC 1\u20132/hpf | RBC casts negative.", "9. After four hours of observation, her vital signs are unchanged."]}
{"id": 277, "question": "Which of the following trinucleotide repeats is found in this disease?", "context": ["A 31-year-old presents with self-described complaints of being \"fidgety and irritable\" that is unlike his \"calm personality a few years ago\".", "What is concerning to him is that his father was diagnosed with a similar condition at the age of 38.", "His father began a progressive decline - losing interest in his life and family, becoming messy, experiencing involuntary movements, and worsening dementia as he grew older.", "Genetic tests were performed on the patient which confirmed that he has a larger number of repeats than his father.", "He is concerned that the disease may begin earlier for him or may have already started."], "context_len": 5, "options": {"A": "CAG", "B": "CTG", "C": "GAA", "D": "UGA"}, "answer": "CAG", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "31 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 31-year-old presents with self-described complaints of being \"fidgety and irritable\".", "2. This is unlike his \"calm personality a few years ago\".", "3. His father was diagnosed with a similar condition at the age of 38.", "4. His father began a progressive decline.", "5. His father's decline included losing interest in his life and family, becoming messy, experiencing involuntary movements, and worsening dementia as he grew older.", "6. Genetic tests were performed on the patient.", "7. The genetic tests confirmed that he has a larger number of repeats than his father.", "8. He is concerned that the disease may begin earlier for him or may have already started."], "atomic_facts": ["1. His father was diagnosed with a similar condition at the age of 38.", "2. His father began a progressive decline.", "3. His father lost interest in his life and family.", "4. His father became messy.", "5. His father experienced involuntary movements.", "6. His father's dementia worsened as he grew older.", "7. Genetic tests were performed on the patient.", "8. The genetic tests confirmed that he has a larger number of repeats than his father.", "9. He is concerned that the disease may begin earlier for him or may have already started."]}
{"id": 278, "question": "This patient's condition is most likely caused by mutation of an oncogene that encodes for a protein involved in which of the following cellular processes?", "context": ["A 48-year-old woman comes to the physician because of a 3-month history of low-grade fever, unintentional weight loss, night sweats, and a right-sided neck mass.", "Examination shows pallor.", "There is a non-tender and immobile right-sided cervical mass and enlarged axillary and inguinal lymph nodes.", "The liver is palpated 4 cm below the right costal margin, and the spleen is palpated 3 cm below the left costal margin.", "Histopathologic examination of a cervical lymph node biopsy specimen shows a nodular proliferation of centrocytes and centroblasts that stain positive for CD20.", "Genetic analysis shows a reciprocal translocation of chromosomes 14 and 18."], "context_len": 6, "options": {"A": "Hydrolysis of guanosine triphosphate", "B": "Upregulation of cytokine receptor binding", "C": "Transfer of phosphate from ATP to cellular protein", "D": "Inhibition of programmed cell death"}, "answer": "Inhibition of programmed cell death", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "48 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Medical Oncology", "Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 48-year-old woman comes to the physician.", "2. She has a 3-month history of low-grade fever.", "3. She has a 3-month history of unintentional weight loss.", "4. She has a 3-month history of night sweats.", "5. She has a right-sided neck mass.", "6. Examination shows pallor.", "7. There is a non-tender and immobile right-sided cervical mass.", "8. There are enlarged axillary and inguinal lymph nodes.", "9. The liver is palpated 4 cm below the right costal margin.", "10. The spleen is palpated 3 cm below the left costal margin.", "11. Histopathologic examination of a cervical lymph node biopsy specimen shows a nodular proliferation of centrocytes and centroblasts.", "12. The nodular proliferation stains positive for CD20.", "13. Genetic analysis shows a reciprocal translocation of chromosomes 14 and 18."], "atomic_facts": ["1. Examination shows pallor.", "2. There is a non-tender and immobile right-sided cervical mass.", "3. Enlarged axillary and inguinal lymph nodes are present.", "4. The liver is palpated 4 cm below the right costal margin.", "5. The spleen is palpated 3 cm below the left costal margin.", "6. Histopathologic examination of a cervical lymph node biopsy specimen shows a nodular proliferation of centrocytes and centroblasts.", "7. The centrocytes and centroblasts stain positive for CD20.", "8. Genetic analysis shows a reciprocal translocation of chromosomes 14 and 18."]}
{"id": 279, "question": "What is the mechanism of action of the medication that can treat this patient\u2019s condition?", "context": ["A 59-year-old man is brought to the emergency department for changes in mental status.", "His wife noticed that since lunch time today, he has been \u201czoning out\u201d and forgetting simple things such as where the bathroom is.", "She decided to call the ambulance as he got uncharacteristically violent during dinner when he threw his plate to the floor.", "The patient denies fevers, weight loss, chills, chest pain, or shortness of breath, but reports mild abdominal discomfort and some dark stools that he attributes to iron supplements.", "A physical examination demonstrates a moderate fluid wave of the abdomen and shaking of the hands while the wrists are extended."], "context_len": 5, "options": {"A": "Antagonist against 5-HT3", "B": "Long-acting somatostatin analog", "C": "Mu-opioid receptor agonist", "D": "Trapping of ammonia in the colon"}, "answer": "Trapping of ammonia in the colon", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "59 years old", "specialties": ["Neurology", "Emergency Medicine", "Internal Medicine"], "subspecialties": ["Neurocritical Care", "Neurology with Special Qualification in Child Neurology", "Neurology"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 59-year-old man is brought to the emergency department for changes in mental status.", "2. His wife noticed that since lunch time today, he has been \u201czoning out\u201d and forgetting simple things such as where the bathroom is.", "3. She decided to call the ambulance as he got uncharacteristically violent during dinner when he threw his plate to the floor.", "4. The patient denies fevers, weight loss, chills, chest pain, or shortness of breath.", "5. The patient reports mild abdominal discomfort and some dark stools that he attributes to iron supplements.", "6. A physical examination demonstrates a moderate fluid wave of the abdomen.", "7. A physical examination demonstrates shaking of the hands while the wrists are extended."], "atomic_facts": ["1. His wife noticed that since lunch time today, he has been \u201czoning out\u201d and forgetting simple things such as where the bathroom is.", "2. She decided to call the ambulance as he got uncharacteristically violent during dinner when he threw his plate to the floor.", "3. The patient denies fevers, weight loss, chills, chest pain, or shortness of breath.", "4. The patient reports mild abdominal discomfort and some dark stools that he attributes to iron supplements.", "5. A physical examination demonstrates a moderate fluid wave of the abdomen.", "6. A physical examination demonstrates shaking of the hands while the wrists are extended."]}
{"id": 280, "question": "Which of the following manifestations is more specific for this patient\u2019s condition?", "context": ["An otherwise healthy 49-year-old man presents to his primary care doctor for routine screening.", "He does not have any symptoms and take no medications.", "He has smoked 15\u201320 cigarettes daily for the past 9 years.", "His father died of diabetes complications and his mother has been recently diagnosed with proliferative diabetic retinopathy.", "His blood pressure is 160/95 mm Hg, temperature is 36.9\u00b0C (98.4\u00b0F), pulse is 90/min, body mass index is 36 kg/m\u00b2, fasting blood sugar 170 mg/dL, and A1c is 9%."], "context_len": 5, "options": {"A": "Kussmaul respiration", "B": "Unintentional weight loss", "C": "Acanthosis nigricans", "D": "Polyurea"}, "answer": "Acanthosis nigricans", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "49", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine", "Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An otherwise healthy 49-year-old man presents to his primary care doctor for routine screening.", "2. He does not have any symptoms and take no medications.", "3. He has smoked 15\u201320 cigarettes daily for the past 9 years.", "4. His father died of diabetes complications.", "5. His mother has been recently diagnosed with proliferative diabetic retinopathy.", "6. His blood pressure is 160/95 mm Hg.", "7. His temperature is 36.9\u00b0C (98.4\u00b0F).", "8. His pulse is 90/min.", "9. His body mass index is 36 kg/m\u00b2.", "10. His fasting blood sugar is 170 mg/dL.", "11. His A1c is 9%."], "atomic_facts": ["1. The patient does not have any symptoms.", "2. The patient takes no medications.", "3. The patient has smoked 15\u201320 cigarettes daily for the past 9 years.", "4. The patient's father died of diabetes complications.", "5. The patient's mother has been recently diagnosed with proliferative diabetic retinopathy.", "6. The patient's blood pressure is 160/95 mm Hg.", "7. The patient's temperature is 36.9\u00b0C (98.4\u00b0F).", "8. The patient's pulse is 90/min.", "9. The patient's body mass index is 36 kg/m\u00b2.", "10. The patient's fasting blood sugar is 170 mg/dL.", "11. The patient's A1c is 9%."]}
{"id": 281, "question": "Which of the following is the most likely site of action of this drug in the kidney?", "context": ["A 30-year-old woman is brought to the emergency department because of severe headache and vomiting that started after she was hiking in the mountains at high altitude.", "She normally lives in a city that is close to sea level.", "Therapy is initiated with a drug that alkalinizes the urine."], "context_len": 3, "options": {"A": "Proximal convoluted tubule", "B": "Ascending loop of Henle", "C": "Glomerulus", "D": "Early distal convoluted tubule"}, "answer": "Proximal convoluted tubule", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Emergency Medicine", "Family Medicine", "Internal Medicine"], "subspecialties": ["Neurocritical Care", "Pulmonary Disease", "Sports Medicine"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 30-year-old woman is brought to the emergency department.", "2. She has severe headache and vomiting.", "3. Her symptoms started after she was hiking in the mountains at high altitude.", "4. She normally lives in a city that is close to sea level.", "5. Therapy is initiated with a drug that alkalinizes the urine."], "atomic_facts": ["1. She normally lives in a city.", "2. The city is close to sea level.", "3. Therapy is initiated.", "4. The therapy involves a drug.", "5. The drug alkalinizes the urine."]}
{"id": 282, "question": "In addition to drawing her blood for viral serologies, which of the following is the most appropriate next step?", "context": ["A 35-year-old woman comes to employee health services 30 minutes after a work-related incident.", "She works as a phlebotomist and reports that blood splashed into her right eye when she was drawing blood from a 30-year-old male patient.", "Immediately following the incident, she flushed her eye with water for several minutes.", "The patient from whom she drew blood was admitted for hemoptysis, weight loss, and night sweats.", "He is an intravenous drug user and is sexually active with several male and female partners.", "The phlebotomist has no history of serious illness and takes no medications.", "Her immunizations are up-to-date.", "Physical examination shows no abnormalities."], "context_len": 8, "options": {"A": "Start raltegravir, tenofovir, and emtricitabine", "B": "Start zidovudine", "C": "Start tenofovir and emtricitabine", "D": "Administer hepatitis B immune globulin and vaccine"}, "answer": "Start raltegravir, tenofovir, and emtricitabine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "35 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 35-year-old woman came to employee health services 30 minutes after a work-related incident.", "2. She works as a phlebotomist.", "3. Blood splashed into her right eye when she was drawing blood from a 30-year-old male patient.", "4. Immediately following the incident, she flushed her eye with water for several minutes.", "5. The patient from whom she drew blood was admitted for hemoptysis, weight loss, and night sweats.", "6. He is an intravenous drug user.", "7. He is sexually active with several male and female partners.", "8. The phlebotomist has no history of serious illness.", "9. She takes no medications.", "10. Her immunizations are up-to-date.", "11. Physical examination shows no abnormalities."], "atomic_facts": ["1. She works as a phlebotomist.", "2. Blood splashed into her right eye when she was drawing blood from a 30-year-old male patient.", "3. She flushed her eye with water for several minutes immediately following the incident.", "4. The patient from whom she drew blood was admitted for hemoptysis, weight loss, and night sweats.", "5. The patient is an intravenous drug user and is sexually active with several male and female partners.", "6. The phlebotomist has no history of serious illness.", "7. The phlebotomist takes no medications.", "8. Her immunizations are up-to-date.", "9. Physical examination shows no abnormalities."]}
{"id": 283, "question": "Which of the following is the most likely diagnosis?", "context": ["A 65-year-old Asian woman comes to the physician for a routine health maintenance examination.", "On questioning, she has had occasional night sweats during the past 2 months.", "She has not had fevers or weight loss.", "Seven months ago, she had an acute myocardial infarction and was treated with percutaneous coronary intervention.", "She has hypertension, hyperlipidemia, and gastroesophageal reflux disease.", "She has smoked one pack of cigarettes daily for 37 years.", "Current medications include aspirin, atorvastatin, ramipril, metoprolol, and esomeprazole.", "She is 178 cm (5 ft 10 in) tall and weighs 89 kg (207 lbs); BMI is 29.7 kg/m2.", "Her temperature is 37.4\u00b0C (99.3\u00b0F), pulse is 84/min, respirations are 18/min, and blood pressure is 145/80 mm Hg.", "The lungs are clear to auscultation.", "Cardiac examination shows an S4.", "There is a nontender skin lesion near the right large toenail.", "A photograph of the lesion is shown.", "The remainder of the examination shows no abnormalities."], "context_len": 14, "options": {"A": "Traumatic subungual hemorrhage", "B": "Malignant melanoma", "C": "Onychomycosis", "D": "Squamous cell carcinoma"}, "answer": "Malignant melanoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "65 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 65-year-old Asian woman.", "2. Patient has had occasional night sweats during the past 2 months.", "3. Patient has not had fevers or weight loss.", "4. Patient had an acute myocardial infarction 7 months ago and was treated with percutaneous coronary intervention.", "5. Patient has hypertension, hyperlipidemia, and gastroesophageal reflux disease.", "6. Patient has smoked one pack of cigarettes daily for 37 years.", "7. Patient's current medications include aspirin, atorvastatin, ramipril, metoprolol, and esomeprazole.", "8. Patient is 178 cm (5 ft 10 in) tall and weighs 89 kg (207 lbs); BMI is 29.7 kg/m2.", "9. Patient's temperature is 37.4\u00b0C (99.3\u00b0F), pulse is 84/min, respirations are 18/min, and blood pressure is 145/80 mm Hg.", "10. Lungs are clear to auscultation.", "11. Cardiac examination shows an S4.", "12. Patient has a nontender skin lesion near the right large toenail.", "13. Photograph of the lesion is shown.", "14. No other abnormalities found on examination."], "atomic_facts": ["1. She has had occasional night sweats during the past 2 months.", "2. She has not had fevers or weight loss.", "3. Seven months ago, she had an acute myocardial infarction and was treated with percutaneous coronary intervention.", "4. She has hypertension, hyperlipidemia, and gastroesophageal reflux disease.", "5. She has smoked one pack of cigarettes daily for 37 years.", "6. Current medications include aspirin, atorvastatin, ramipril, metoprolol, and esomeprazole.", "7. She is 178 cm (5 ft 10 in) tall and weighs 89 kg (207 lbs); BMI is 29.7 kg/m2.", "8. Her temperature is 37.4\u00b0C (99.3\u00b0F), pulse is 84/min, respirations are 18/min, and blood pressure is 145/80 mm Hg.", "9. The lungs are clear to auscultation.", "10. Cardiac examination shows an S4.", "11. There is a nontender skin lesion near the right large toenail.", "12. A photograph of the lesion is shown.", "13. The remainder of the examination shows no abnormalities."]}
{"id": 284, "question": "Which of the following microorganisms is the most likely cause of this patient\u2019s symptoms?", "context": ["A 12-year-old girl brought to the clinic by her mother has a 3-day history of fever and sore throat and hematuria since this morning.", "The patient\u2019s mother says she had a fever up to 39.5\u2103 (103.1\u2109) for the last 3 days and a severe sore throat, which has improved slightly.", "The mother states that she noticed her daughter had red urine today.", "The patient\u2019s temperature is 39.3\u2103 (102.8\u2109), pulse is 89/min, respiratory rate is 25/min, and blood pressure is 109/69 mm Hg.", "On physical examination, her pharynx is erythematous.", "There is significant swelling of the tonsils bilaterally, and there is a white exudate covering them.", "Ophthalmologic examination reveals evidence of conjunctivitis bilaterally.", "Otoscopic examination is significant for gray-white tympanic membranes bilaterally.", "The remainder of the exam is unremarkable.", "A urine dipstick is performed and shows the following results: | Urine Dipstick | Specific Gravity 1.019 | Glucose None | Ketones None | Nitrites Negative | Leukocyte Esterase Negative | Protein None | Blood 3+ |  ."], "context_len": 10, "options": {"A": "Streptococcus pyogenes", "B": "Adenovirus", "C": "Escherichia coli O157:H7", "D": "Proteus mirabilis"}, "answer": "Adenovirus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "12 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology", "Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 12-year-old girl was brought to the clinic by her mother.", "2. The patient has a 3-day history of fever and sore throat.", "3. The patient has had hematuria since this morning.", "4. The patient's mother says the fever has been up to 39.5\u2103 (103.1\u2109) for the last 3 days.", "5. The patient's mother says the sore throat has improved slightly.", "6. The patient's mother noticed her daughter had red urine today.", "7. The patient's temperature is 39.3\u2103 (102.8\u2109).", "8. The patient's pulse is 89/min.", "9. The patient's respiratory rate is 25/min.", "10. The patient's blood pressure is 109/69 mm Hg.", "11. On physical examination, the patient's pharynx is erythematous.", "12. There is significant swelling of the tonsils bilaterally.", "13. There is a white exudate covering the tonsils bilaterally.", "14. Ophthalmologic examination reveals evidence of conjunctivitis bilaterally.", "15. Otoscopic examination is significant for gray-white tympanic membranes bilaterally.", "16. The remainder of the exam is unremarkable.", "17. A urine dipstick was performed.", "18. The urine dipstick showed a specific gravity of 1.019.", "19. The urine dipstick showed no glucose.", "20. The urine dipstick showed no ketones.", "21. The urine dipstick showed negative nitrites.", "22. The urine dipstick showed negative leukocyte esterase.", "23. The urine dipstick showed no protein.", "24. The urine dipstick showed 3+ blood."], "atomic_facts": ["1. The patient's mother reports a fever up to 39.5\u2103 (103.1\u2109) for the last 3 days and a severe sore throat.", "2. The patient's mother noticed her daughter had red urine today.", "3. The patient's temperature is 39.3\u2103 (102.8\u2109), pulse is 89/min, respiratory rate is 25/min, and blood pressure is 109/69 mm Hg.", "4. On physical examination, the patient's pharynx is erythematous.", "5. There is significant swelling of the tonsils bilaterally, and there is a white exudate covering them.", "6. Ophthalmologic examination reveals evidence of conjunctivitis bilaterally.", "7. Otoscopic examination is significant for gray-white tympanic membranes bilaterally.", "8. The remainder of the exam is unremarkable.", "9. A urine dipstick test shows the following results: Specific Gravity 1.019, Glucose None, Ketones None, Nitrites Negative, Leukocyte Esterase Negative, Protein None, Blood 3+."]}
{"id": 285, "question": "What physical finding would suggest involvement of the nerve in its course through the parotid gland?", "context": ["A 73-year-old woman with a past medical history of diabetes, hypertension, and hyperlipidemia presents to the emergency department with swelling in her left neck.", "The onset was a few months ago.", "She has lost 6.8 kg (15.0 lb) over the same duration.", "She denies any fever, night sweats or itching.", "Physical examination reveals a painless swelling in front of her left ear.", "There is painless lymphadenopathy below the ear.", "Biopsy of the lymph nodes reveals mucoepidermoid carcinoma of the parotid gland.", "Surgery is planned and the tumor is removed while trying to preserve a nerve that could be involved."], "context_len": 8, "options": {"A": "Loss of taste on the left anterior 2/3 of the tongue", "B": "Hypersensitivity to sound in the left ear", "C": "Inability to smile on the left side", "D": "Numbness of the left cheek"}, "answer": "Inability to smile on the left side", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "73", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 73-year-old woman presents to the emergency department with swelling in her left neck.", "2. The onset of the swelling was a few months ago.", "3. The woman has lost 6.8 kg (15.0 lb) over the same duration.", "4. The woman denies any fever, night sweats or itching.", "5. Physical examination reveals a painless swelling in front of her left ear.", "6. There is painless lymphadenopathy below the ear.", "7. Biopsy of the lymph nodes reveals mucoepidermoid carcinoma of the parotid gland.", "8. Surgery is planned to remove the tumor while trying to preserve a nerve that could be involved.", "9. The woman has a past medical history of diabetes, hypertension, and hyperlipidemia."], "atomic_facts": ["1. The onset of symptoms was a few months ago.", "2. She has lost 6.8 kg (15.0 lb) over the same duration.", "3. She denies any fever, night sweats, or itching.", "4. Physical examination reveals a painless swelling in front of her left ear.", "5. There is painless lymphadenopathy below the ear.", "6. Biopsy of the lymph nodes reveals mucoepidermoid carcinoma of the parotid gland.", "7. Surgery is planned.", "8. The tumor is removed while trying to preserve a nerve that could be involved."]}
{"id": 286, "question": "Concurrent treatment with which of the following agents most likely predisposed the patient to this episode?", "context": ["A 43-year-old man is brought to the emergency department by his wife after a near-syncopal episode.", "He was doing yard work when he began feeling dizzy and had to lie down.", "Earlier in the day, he was started on lisinopril.", "On arrival, he is fully oriented.", "His pulse is 100/min and blood pressure is 92/60 mm Hg.", "Serum electrolytes are within normal limits.", "An ECG shows no evidence of ischemia."], "context_len": 7, "options": {"A": "Ibuprofen", "B": "Hydrochlorothiazide", "C": "Lithium", "D": "Trimethoprim/sulfamethoxazole"}, "answer": "Hydrochlorothiazide", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "43 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 43-year-old man is brought to the emergency department by his wife.", "2. He had a near-syncopal episode.", "3. He was doing yard work when he began feeling dizzy and had to lie down.", "4. He was started on lisinopril earlier in the day.", "5. On arrival, he is fully oriented.", "6. His pulse is 100/min.", "7. His blood pressure is 92/60 mm Hg.", "8. His serum electrolytes are within normal limits.", "9. An ECG shows no evidence of ischemia."], "atomic_facts": ["1. He was doing yard work.", "2. He began feeling dizzy.", "3. He had to lie down.", "4. Earlier in the day, he was started on lisinopril.", "5. On arrival, he is fully oriented.", "6. His pulse is 100/min.", "7. His blood pressure is 92/60 mm Hg.", "8. Serum electrolytes are within normal limits.", "9. An ECG shows no evidence of ischemia."]}
{"id": 287, "question": "What additional diagnostic test would be helpful in establishing a diagnosis?", "context": ["A 4-year-old Caucasian girl previously diagnosed with asthma presents with recurrent sinusitis, otitis media, and clubbing of the nail bed.", "Family history is significant for a distant cousin with cystic fibrosis.", "A \"sweat test\" is performed and comes back normal."], "context_len": 3, "options": {"A": "Nasal transepithelial potential difference", "B": "Skeletal survey", "C": "Complete blood cell count", "D": "Urinalysis"}, "answer": "Nasal transepithelial potential difference", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 4-year-old Caucasian girl.", "2. Patient has a previous diagnosis of asthma.", "3. Patient presents with recurrent sinusitis.", "4. Patient presents with otitis media.", "5. Patient has clubbing of the nail bed.", "6. Patient has a family history of a distant cousin with cystic fibrosis.", "7. A \"sweat test\" was performed.", "8. The \"sweat test\" came back normal."], "atomic_facts": ["1. Family history is significant for a distant cousin with cystic fibrosis.", "2. A \"sweat test\" is performed.", "3. The sweat test comes back normal."]}
{"id": 288, "question": "Which of the following would most likely be positive in this patient?", "context": ["A 35-year-old woman presents with a complaint of oral ulcers.", "It is the third recurrence of ulcers in the last 8 months.", "She is sexually active and complains of dyspareunia.", "Examination shows the presence of a uveitis."], "context_len": 4, "options": {"A": "Anti-double stranded (Ds) DNA", "B": "HLA-B51", "C": "ANCA", "D": "HLA-B27"}, "answer": "HLA-B51", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "35 years old", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 35-year-old woman presents with a complaint of oral ulcers.", "2. It is the third recurrence of ulcers in the last 8 months.", "3. She is sexually active.", "4. She complains of dyspareunia.", "5. Examination shows the presence of a uveitis."], "atomic_facts": ["1. It is the third recurrence of ulcers", "2. The ulcers have recurred in the last 8 months", "3. She is sexually active", "4. She complains of dyspareunia", "5. Examination shows the presence of a uveitis"]}
{"id": 289, "question": "What is the most likely cause of this patient\u2019s symptoms?", "context": ["A 22-year-old female software analyst presents to a medical clinic for evaluation of tingling and numbness in both hands for the past 2 months.", "Her symptoms are usually aggravated by the end of the work day and absent on most off days.", "She has been a type I diabetic for 2 years and is currently on insulin.", "She admits to being sexually active but has had irregular periods for the past 3 months.", "A urine pregnancy test is negative."], "context_len": 5, "options": {"A": "Hypothyroidism", "B": "Acute intermittent porphyria", "C": "Amyotrophic lateral sclerosis", "D": "Multiple sclerosis"}, "answer": "Hypothyroidism", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "22", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 22-year-old female software analyst presents to a medical clinic.", "2. She has tingling and numbness in both hands for the past 2 months.", "3. Her symptoms are usually aggravated by the end of the work day.", "4. Her symptoms are absent on most off days.", "5. She has been a type I diabetic for 2 years.", "6. She is currently on insulin.", "7. She admits to being sexually active.", "8. She has had irregular periods for the past 3 months.", "9. A urine pregnancy test is negative."], "atomic_facts": ["1. Her symptoms are usually aggravated by the end of the work day.", "2. Her symptoms are absent on most off days.", "3. She has been a type I diabetic for 2 years.", "4. She is currently on insulin.", "5. She admits to being sexually active.", "6. She has had irregular periods for the past 3 months.", "7. A urine pregnancy test is negative."]}
{"id": 290, "question": "What is the normal function of the protein that is overexpressed due to the translocation seen in this patient?", "context": ["A 60-year-old male presents to his primary care physician complaining of fatigue.", "He reports a six-month history of gradually worsening tiredness.", "More recently, he has experienced intermittent fevers and night sweats.", "His temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 115/80 mmHg, pulse is 80/min, and respirations are 18/min.", "On examination, painless cervical lymphadenopathy is noted.", "A lymph node biopsy is performed and karyotypic analysis of the biopsy reveals an 11;14 translocation."], "context_len": 6, "options": {"A": "Promote cell growth", "B": "Mediate cell cycle transition to mitosis", "C": "Mediate cell cycle transition to G2 phase", "D": "Mediate cell cycle transition to S phase"}, "answer": "Mediate cell cycle transition to S phase", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "60", "specialties": ["Medical Genetics and Genomics", "Internal Medicine"], "subspecialties": ["Molecular Genetic Pathology", "Clinical Genetics and Genomics", "Hematology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 60-year-old male presents to his primary care physician.", "2. He complains of fatigue.", "3. He has a six-month history of gradually worsening tiredness.", "4. He has experienced intermittent fevers and night sweats.", "5. His temperature is 99.5\u00b0F (37.5\u00b0C).", "6. His blood pressure is 115/80 mmHg.", "7. His pulse is 80/min.", "8. His respirations are 18/min.", "9. On examination, painless cervical lymphadenopathy is noted.", "10. A lymph node biopsy is performed.", "11. Karyotypic analysis of the biopsy reveals an 11;14 translocation."], "atomic_facts": ["1. The patient reports a six-month history of gradually worsening tiredness.", "2. The patient has experienced intermittent fevers and night sweats.", "3. The patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "4. The patient's blood pressure is 115/80 mmHg.", "5. The patient's pulse is 80/min.", "6. The patient's respirations are 18/min.", "7. On examination, painless cervical lymphadenopathy is noted.", "8. A lymph node biopsy is performed.", "9. Karyotypic analysis of the biopsy reveals an 11;14 translocation."]}
{"id": 291, "question": "Which of the following is the most appropriate next step in the management of this patient?", "context": ["An 8-year-old boy presents with abdominal pain and constipation.", "The patient\u2019s mother says that the symptoms gradually onset 2 months ago.", "The patient describes the pain as moderate to severe, gnawing and diffusely localized.", "No significant past medical history and no current medications.", "The patient lives in a house built in the 1990s with his parents and has a sister who goes to daycare.", "His mother mentioned that he is a good student but has been irritable lately, and his homework has been full of careless mistakes.", "The vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 100/65 mm Hg, pulse 82/min, respiratory rate 19/min, and oxygen saturation 99% on room air.", "On physical examination, the patient is alert and cooperative.", "The abdomen is diffusely tender to palpation with no rebound or guarding.", "There is a left wrist drop.", "A nontender, flat bluish line above the gums is noted.", "Laboratory results are significant for the following: | Sodium 141 mEq/L | Potassium 4.1 mEq/L | Chloride 101 mEq/L | Bicarbonate 25 mEq/L | Blood urea nitrogen (BUN) 27 mg/dL | Creatinine 1.7 mg/dL | Glucose (fasting) 80 mg/dL | White blood cell (WBC) count 8,700/mm3 | Red blood cell (RBC) count 4.20 x 106/mm3 | Hematocrit 41.5% | Hemoglobin 10.3 g/dL | Platelet count 190,000/mm3 | Mean corpuscular volume (MCV) 65 mm3 | Lead 72 mcg/dL. "], "context_len": 12, "options": {"A": "Chelation therapy with dimercaptosuccinic acid (succimer)", "B": "Chelation therapy with dimercaprol", "C": "Chelation therapy with dimercaprol and calcium disodium edetate (EDTA)", "D": "Plain abdominal radiographs"}, "answer": "Chelation therapy with dimercaprol and calcium disodium edetate (EDTA)", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is 8 years old.", "2. Patient presents with abdominal pain and constipation.", "3. Symptoms gradually onset 2 months ago.", "4. Patient describes pain as moderate to severe, gnawing and diffusely localized.", "5. No significant past medical history and no current medications.", "6. Patient lives in a house built in the 1990s with his parents and has a sister who goes to daycare.", "7. Patient is a good student but has been irritable lately, and his homework has been full of careless mistakes.", "8. Vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 100/65 mm Hg, pulse 82/min, respiratory rate 19/min, and oxygen saturation 99% on room air.", "9. Patient is alert and cooperative on physical examination.", "10. Abdomen is diffusely tender to palpation with no rebound or guarding.", "11. Left wrist drop is present.", "12. Nontender, flat bluish line above the gums is noted.", "13. Laboratory results are significant for sodium 141 mEq/L, potassium 4.1 mEq/L, chloride 101 mEq/L, bicarbonate 25 mEq/L, BUN 27 mg/dL, creatinine 1.7 mg/dL, and glucose (fasting) 80 mg/dL, White blood cell (WBC) count 8,700/mm3, Red blood cell (RBC) count 4.20 x 106/mm3, Hematocrit 41.5%, Hemoglobin 10.3 g/dL, Platelet count 190,000/mm3, Mean corpuscular volume (MCV) 65 mm3, Lead 72 mcg/dL."], "atomic_facts": ["1. The patient's symptoms gradually onset 2 months ago.", "2. The patient describes the pain as moderate to severe, gnawing, and diffusely localized.", "3. The patient has no significant past medical history and is not taking any current medications.", "4. The patient lives in a house built in the 1990s with his parents and has a sister who goes to daycare.", "5. The patient's mother mentioned that he is a good student but has been irritable lately, and his homework has been full of careless mistakes.", "6. The patient's vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 100/65 mm Hg, pulse 82/min, respiratory rate 19/min, and oxygen saturation 99% on room air.", "7. On physical examination, the patient is alert and cooperative.", "8. The patient's abdomen is diffusely tender to palpation with no rebound or guarding.", "9. The patient has a left wrist drop.", "10. A nontender, flat bluish line above the gums is noted.", "11. Laboratory results show: Sodium 141 mEq/L, Potassium 4.1 mEq/L, Chloride 101 mEq/L, Bicarbonate 25 mEq/L, Blood urea nitrogen (BUN) 27 mg/dL, Creatinine 1.7 mg/dL, Glucose (fasting) 80 mg/dL, White blood cell (WBC) count 8,700/mm3, Red blood cell (RBC) count 4.20 x 106/mm3, Hematocrit 41.5%, Hemoglobin 10.3 g/dL, Platelet count 190,000/mm3, Mean corpuscular volume (MCV) 65 mm3, and Lead 72 mcg/dL."]}
{"id": 292, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["Two days after undergoing a left total hip replacement, a 68-year-old man has increasing shortness of breath and chest pain for 30 minutes.", "He has type 2 diabetes mellitus and bilateral osteoarthritis of the hips.", "Prior to admission to the hospital, his medications were metformin and naproxen.", "His temperature is 37.8\u00b0C (100\u00b0F), pulse is 110/min, respirations are 30/min, and blood pressure is 106/70 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 89%.", "The lungs are clear to auscultation.", "Cardiac examination shows no abnormalities.", "The right lower extremity is swollen.", "Right foot flexion in an upward direction causes pain in the right calf.", "Pedal pulses are palpable.", "Supplemental oxygen and intravenous fluid resuscitation are begun.", "His hematocrit is 30%.", "Arterial blood gas analysis on room air shows: | pH 7.48 | pCO2 27 mm Hg | pO2 68 mm Hg | HCO3- 23 mEq/L | An electrocardiogram shows sinus tachycardia and right axis deviation."], "context_len": 13, "options": {"A": "Administer alteplase", "B": "Obtain a spiral CT angiogram", "C": "Obtain an x-ray of the chest", "D": "Perfom an echocardiography"}, "answer": "Obtain a spiral CT angiogram", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "68", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 68 years old.", "2. Patient has type 2 diabetes mellitus and bilateral osteoarthritis of the hips.", "3. Patient's medications prior to admission were metformin and naproxen.", "4. Patient's temperature is 37.8\u00b0C (100\u00b0F).", "5. Patient's pulse is 110/min.", "6. Patient's respirations are 30/min.", "7. Patient's blood pressure is 106/70 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 89%.", "9. Lungs are clear to auscultation.", "10. Cardiac examination shows no abnormalities.", "11. Right lower extremity is swollen.", "12. Right foot flexion in an upward direction causes pain in the right calf.", "13. Pedal pulses are palpable.", "14. Supplemental oxygen and intravenous fluid resuscitation are begun.", "15. Patient's hematocrit is 30%.", "16. Arterial blood gas analysis on room air shows: pH 7.48, pCO2 27 mm Hg, pO2 68 mm Hg, HCO3- 23 mEq/L.", "17. An electrocardiogram shows sinus tachycardia and right axis deviation.", "18. Patient has increasing shortness of breath and chest pain for 30 minutes, two days after undergoing a left total hip replacement."], "atomic_facts": ["1. He has type 2 diabetes mellitus.", "2. He has bilateral osteoarthritis of the hips.", "3. Prior to admission to the hospital, his medications were metformin and naproxen.", "4. His temperature is 37.8\u00b0C (100\u00b0F).", "5. His pulse is 110/min.", "6. His respirations are 30/min.", "7. His blood pressure is 106/70 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 89%.", "9. The lungs are clear to auscultation.", "10. Cardiac examination shows no abnormalities.", "11. The right lower extremity is swollen.", "12. Right foot flexion in an upward direction causes pain in the right calf.", "13. Pedal pulses are palpable.", "14. Supplemental oxygen and intravenous fluid resuscitation are begun.", "15. His hematocrit is 30%.", "16. Arterial blood gas analysis on room air shows: pH 7.48, pCO2 27 mm Hg, pO2 68 mm Hg, HCO3- 23 mEq/L.", "17. An electrocardiogram shows sinus tachycardia and right axis deviation."]}
{"id": 293, "question": "Which of the following is the best next step in management?", "context": ["An 11-month-old male presents to the emergency department with his father after \u201cpassing out\u201d at home.", "His father reports that the patient started crying after his older brother took a toy away from him.", "The patient was difficult to soothe and then suddenly stopped breathing.", "His father reports that his lips turned slightly blue, and the patient\u2019s entire body became limp.", "The episode lasted a few seconds, and the patient seemed to act normally afterwards.", "The patient\u2019s father notes that the patient\u2019s older brother had similar episodes as a child.", "He denies any family history of neurological disease.", "The patient\u2019s temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 86/64 mmHg, pulse is 98/min, and respirations are 26/min.", "On physical exam, the patient is in no acute distress playing on his father\u2019s lap.", "The patient's neurological exam is unremarkable."], "context_len": 10, "options": {"A": "Arterial blood gas", "B": "Echocardiogram", "C": "Electrocardiogram (ECG)", "D": "Observation and reassurance"}, "answer": "Observation and reassurance", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "11 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 11-month-old male presents to the emergency department with his father.", "2. His father reports that the patient started crying after his older brother took a toy away from him.", "3. The patient was difficult to soothe and then suddenly stopped breathing.", "4. His father reports that his lips turned slightly blue, and the patient\u2019s entire body became limp.", "5. The episode lasted a few seconds, and the patient seemed to act normally afterwards.", "6. The patient\u2019s father notes that the patient\u2019s older brother had similar episodes as a child.", "7. He denies any family history of neurological disease.", "8. The patient\u2019s temperature is 98.5\u00b0F (36.9\u00b0C).", "9. The patient's blood pressure is 86/64 mmHg.", "10. The patient's pulse is 98/min.", "11. The patient's respirations are 26/min.", "12. On physical exam, the patient is in no acute distress playing on his father\u2019s lap.", "13. The patient's neurological exam is unremarkable."], "atomic_facts": ["1. The patient started crying after his older brother took a toy away from him.", "2. The patient was difficult to soothe.", "3. The patient suddenly stopped breathing.", "4. The patient's lips turned slightly blue.", "5. The patient's entire body became limp.", "6. The episode lasted a few seconds.", "7. The patient seemed to act normally afterwards.", "8. The patient's older brother had similar episodes as a child.", "9. There is no family history of neurological disease.", "10. The patient's temperature is 98.5\u00b0F (36.9\u00b0C).", "11. The patient's blood pressure is 86/64 mmHg.", "12. The patient's pulse is 98/min.", "13. The patient's respirations are 26/min.", "14. On physical exam, the patient is in no acute distress playing on his father\u2019s lap.", "15. The patient's neurological exam is unremarkable."]}
{"id": 294, "question": "Which of the following is the most likely diagnosis?", "context": ["A 27-year-old woman presents to the emergency department for pain in multiple joints.", "She states that she has had symmetric joint pain that started yesterday and has been worsening.", "It is affecting her wrists, elbows, and shoulders.", "She also endorses a subjective fever and some fatigue but denies any other symptoms.", "The patient works as a schoolteacher and is generally healthy.", "She is currently sexually active with 2 male partners and uses condoms occasionally.", "Her temperature is 100\u00b0F (37.8\u00b0C), blood pressure is 122/85 mmHg, pulse is 88/min, respirations are 14/min, and oxygen saturation is 99% on room air.", "Her laboratory values are within normal limits.", "Physical exam is notable for joint stiffness and pain in particular of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and the wrist.", "The patient is discharged with ibuprofen.", "Four weeks later, the patient follows up at her primary doctor and notes that her symptoms have improved and she is no longer taking any medications for symptom control."], "context_len": 11, "options": {"A": "Gonococcal arthritis", "B": "Parvovirus B19", "C": "Rheumatoid arthritis", "D": "Transient synovitis"}, "answer": "Parvovirus B19", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 27-year-old woman presents to the emergency department for pain in multiple joints.", "2. She states that she has had symmetric joint pain that started yesterday and has been worsening.", "3. It is affecting her wrists, elbows, and shoulders.", "4. She also endorses a subjective fever and some fatigue but denies any other symptoms.", "5. The patient works as a schoolteacher and is generally healthy.", "6. She is currently sexually active with 2 male partners and uses condoms occasionally.", "7. Her temperature is 100\u00b0F (37.8\u00b0C), blood pressure is 122/85 mmHg, pulse is 88/min, respirations are 14/min, and oxygen saturation is 99% on room air.", "8. Her laboratory values are within normal limits.", "9. Physical exam is notable for joint stiffness and pain in particular of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and the wrist.", "10. The patient is discharged with ibuprofen.", "11. Four weeks later, the patient follows up at her primary doctor and notes that her symptoms have improved and she is no longer taking any medications for symptom control."], "atomic_facts": ["1. The patient has symmetric joint pain affecting her wrists, elbows, and shoulders.", "2. The joint pain started yesterday and has been worsening.", "3. She endorses a subjective fever and some fatigue.", "4. The patient denies any other symptoms.", "5. She works as a schoolteacher and is generally healthy.", "6. The patient is currently sexually active with 2 male partners and uses condoms occasionally.", "7. Her temperature is 100\u00b0F (37.8\u00b0C).", "8. Her blood pressure is 122/85 mmHg.", "9. Her pulse is 88/min.", "10. Her respirations are 14/min.", "11. Her oxygen saturation is 99% on room air.", "12. Her laboratory values are within normal limits.", "13. Physical exam is notable for joint stiffness and pain in particular of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and the wrist.", "14. The patient is discharged with ibuprofen.", "15. Four weeks later, the patient follows up at her primary doctor and notes that her symptoms have improved and she is no longer taking any medications for symptom control."]}
{"id": 295, "question": "Which of the following is the most likely cause of this patient's symptoms?", "context": ["A 57-year-old man with HIV and GERD comes to the emergency department because of productive cough with malodorous phlegm and night sweats for the past week.", "He has smoked 1 pack of cigarettes daily for 30 years and he drinks 8\u201310 beers daily.", "His temperature is 38.9\u00b0C (102.0\u00b0F).", "Physical examination shows coarse crackles and dullness to percussion at the right lung base.", "Scattered expiratory wheezing is heard throughout both lung fields.", "The CD4+ T-lymphocyte count is 280/mm3 (N \u2265 500).", "An x-ray of the chest is shown."], "context_len": 7, "options": {"A": "Bronchiectasis", "B": "Adenocarcinoma in situ", "C": "Tuberculosis", "D": "Aspiration pneumonia"}, "answer": "Aspiration pneumonia", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Infectious Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 57-year-old man with HIV and GERD comes to the emergency department.", "2. He has had productive cough with malodorous phlegm and night sweats for the past week.", "3. He has smoked 1 pack of cigarettes daily for 30 years.", "4. He drinks 8\u201310 beers daily.", "5. His temperature is 38.9\u00b0C (102.0\u00b0F).", "6. Physical examination shows coarse crackles and dullness to percussion at the right lung base.", "7. Scattered expiratory wheezing is heard throughout both lung fields.", "8. The CD4+ T-lymphocyte count is 280/mm3 (N \u2265 500).", "9. An x-ray of the chest is shown."], "atomic_facts": ["1. He has smoked 1 pack of cigarettes daily for 30 years.", "2. He drinks 8\u201310 beers daily.", "3. His temperature is 38.9\u00b0C (102.0\u00b0F).", "4. Physical examination shows coarse crackles and dullness to percussion at the right lung base.", "5. Scattered expiratory wheezing is heard throughout both lung fields.", "6. The CD4+ T-lymphocyte count is 280/mm3 (N \u2265 500).", "7. An x-ray of the chest is shown."]}
{"id": 296, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 20-year-old woman is brought to the emergency department by her boyfriend for right arm and leg weakness, numbness, and tingling that has been resolving gradually.", "The symptoms started 4 hours ago after she had an argument with her boyfriend during which she slapped and kicked him.", "She says she has been limping and cannot use her right arm anymore.", "She has never had similar symptoms in the past.", "She has a history of genital herpes and trichotillomania.", "She is alert and oriented.", "Physical examination shows upper and lower face symmetry and normal speech.", "She has 5/5 strength in all extremities and 5/5 right ankle plantar flexion when lying down.", "She has 4/5 strength in the right arm and leg when ambulating.", "She cannot stand on her toes when asked.", "Her deep tendon reflexes are 2+ bilaterally.", "She has normal proprioception, light touch sensation, and two-point discrimination in all extremities.", "She has a negative Spurling test.", "CT of the head without contrast shows no abnormalities."], "context_len": 14, "options": {"A": "Administer alteplase", "B": "Provide patient education", "C": "Prescribe aspirin", "D": "Start biofeedback therapy\n\""}, "answer": "Provide patient education", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 20-year-old woman.", "2. Patient was brought to the emergency department by her boyfriend.", "3. Patient has right arm and leg weakness, numbness, and tingling.", "4. Symptoms have been resolving gradually.", "5. Symptoms started 4 hours ago after an argument with her boyfriend during which she slapped and kicked him.", "6. Patient has been limping and cannot use her right arm.", "7. Patient has never had similar symptoms in the past.", "8. Patient has a history of genital herpes and trichotillomania.", "9. Patient is alert and oriented.", "10. Physical examination shows upper and lower face symmetry and normal speech.", "11. Patient has 5/5 strength in all extremities and 5/5 right ankle plantar flexion when lying down.", "12. Patient has 4/5 strength in the right arm and leg when ambulating.", "13. Patient cannot stand on her toes when asked.", "14. Patient has 2+ deep tendon reflexes bilaterally.", "15. Patient has normal proprioception, light touch sensation, and two-point discrimination in all extremities.", "16. Patient has a negative Spurling test.", "17. CT of the head without contrast shows no abnormalities."], "atomic_facts": ["1. The symptoms started 4 hours ago after an argument with her boyfriend.", "2. During the argument, she slapped and kicked him.", "3. She says she has been limping and cannot use her right arm anymore.", "4. She has never had similar symptoms in the past.", "5. She has a history of genital herpes and trichotillomania.", "6. She is alert and oriented.", "7. Physical examination shows upper and lower face symmetry and normal speech.", "8. She has 5/5 strength in all extremities and 5/5 right ankle plantar flexion when lying down.", "9. She has 4/5 strength in the right arm and leg when ambulating.", "10. She cannot stand on her toes when asked.", "11. Her deep tendon reflexes are 2+ bilaterally.", "12. She has normal proprioception, light touch sensation, and two-point discrimination in all extremities.", "13. She has a negative Spurling test.", "14. CT of the head without contrast shows no abnormalities."]}
{"id": 297, "question": "Which of the following best describes the feelings that the psychiatrist has for the patient?", "context": ["A 14-year-old female presents to her psychiatrist in hopes that she can find help in dealing with the sexual abuse that occurred in her childhood.", "While retelling her story of the numerous encounters the patient had with her abuser, the psychiatrist begins to feel protective and parental towards the client, wishing that he could have somehow helped the young girl."], "context_len": 2, "options": {"A": "Countertransference", "B": "Identification", "C": "Sublimation", "D": "Projection"}, "answer": "Countertransference", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "14", "specialties": ["Psychiatry"], "subspecialties": ["Child and Adolescent Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 14-year-old female presents to her psychiatrist.", "2. The patient is seeking help in dealing with sexual abuse that occurred in her childhood.", "3. The patient is retelling her story of numerous encounters with her abuser.", "4. The psychiatrist begins to feel protective and parental towards the client.", "5. The psychiatrist wishes he could have somehow helped the young girl."], "atomic_facts": ["1. The patient had numerous encounters with her abuser.", "2. The psychiatrist feels protective and parental towards the client.", "3. The psychiatrist wishes he could have somehow helped the young girl."]}
{"id": 298, "question": "Which of the following trinucleotide DNA sequences would initiate protein translation when converted to mRNA? | Note: sequences are written 3'-->5'", "context": [], "context_len": 0, "options": {"A": "TAC", "B": "ATC", "C": "ATT", "D": "AAA"}, "answer": "TAC", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Medical Genetics and Genomics", "Pathology"], "subspecialties": ["General Medical Genetics and Genomics", "Molecular Genetic Pathology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": [], "atomic_facts": []}
{"id": 299, "question": "Which side-effect is associated with the drug of choice for the treatment of this patient\u2019s condition?", "context": ["A 47-year-old woman visits the emergency department due to painful, swollen fingers in both of her hands.", "She has worked as a bus driver for the county school system for the last 20 years.", "Her past medical history is significant for a transient ischemic attack 5 years ago.", "She reports that she has lost weight in the last 2 months although there have been no changes in her diet.", "She also says that she generally feels fatigued all day.", "On examination, nodules are seen over her Achilles tendon and both wrists are erythematous, swollen, and tender to touch.", "Laboratory tests are presented below: | Hemoglobin: 11.0 g/dL | Hematocrit: 40.5% | Leukocyte count: 7400/mm3 | Mean corpuscular volume: 80.1 \u03bcm3 | Platelet count: 210,000/mm3 | Erythrocyte sedimentation rate: 55 mm/h | Anti-cyclic citrullinated peptide antibody: 45 (Normal reference values: < 20) | ."], "context_len": 7, "options": {"A": "Retinopathy", "B": "Arterial hypertension", "C": "Pneumonitis", "D": "Reactivation of latent tuberculosis"}, "answer": "Pneumonitis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "47 years old", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 47-year-old woman visits the emergency department.", "2. She has painful, swollen fingers in both of her hands.", "3. She has worked as a bus driver for the county school system for the last 20 years.", "4. Her past medical history is significant for a transient ischemic attack 5 years ago.", "5. She reports that she has lost weight in the last 2 months.", "6. There have been no changes in her diet.", "7. She generally feels fatigued all day.", "8. On examination, nodules are seen over her Achilles tendon.", "9. Both wrists are erythematous, swollen, and tender to touch.", "10. Hemoglobin: 11.0 g/dL", "11. Hematocrit: 40.5%", "12. Leukocyte count: 7400/mm3", "13. Mean corpuscular volume: 80.1 \u03bcm3", "14. Platelet count: 210,000/mm3", "15. Erythrocyte sedimentation rate: 55 mm/h", "16. Anti-cyclic citrullinated peptide antibody: 45 (Normal reference values: < 20)"], "atomic_facts": ["1. She has worked as a bus driver for the county school system for the last 20 years.", "2. Her past medical history is significant for a transient ischemic attack 5 years ago.", "3. She reports that she has lost weight in the last 2 months although there have been no changes in her diet.", "4. She also says that she generally feels fatigued all day.", "5. On examination, nodules are seen over her Achilles tendon.", "6. Both wrists are erythematous, swollen, and tender to touch.", "7. Laboratory tests: Hemoglobin: 11.0 g/dL.", "8. Hematocrit: 40.5%.", "9. Leukocyte count: 7400/mm3.", "10. Mean corpuscular volume: 80.1 \u03bcm3.", "11. Platelet count: 210,000/mm3.", "12. Erythrocyte sedimentation rate: 55 mm/h.", "13. Anti-cyclic citrullinated peptide antibody: 45 (Normal reference values: < 20)."]}
{"id": 300, "question": "The patient was most likely treated with an antibiotic that binds to which of the following?", "context": ["A 37-year-old man comes to the emergency room with fever, chills, and left lower leg pain for 2 days.", "He was recently discharged from the hospital after arthroscopic knee surgery.", "Physical examination shows an erythematous lesion with poorly defined margins over the left shin but no fluctuance.", "Treatment with an intravenous antibiotic is begun.", "Shortly after starting the infusion, the patient develops flushing, erythema, and pruritus of the upper body.", "The symptoms resolve after discontinuation of the infusion.", "Before the next dose with the same agent, the patient is given diphenhydramine and ranitidine and the antibiotic is subsequently given at a slower infusion rate without complications."], "context_len": 7, "options": {"A": "Transpeptidase", "B": "Topoisomerase II", "C": "Dihydrofolate reductase", "D": "D-alanyl-D-alanine"}, "answer": "D-alanyl-D-alanine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "37", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 37-year-old man comes to the emergency room with fever, chills, and left lower leg pain for 2 days.", "2. He was recently discharged from the hospital after arthroscopic knee surgery.", "3. Physical examination shows an erythematous lesion with poorly defined margins over the left shin but no fluctuance.", "4. Treatment with an intravenous antibiotic is begun.", "5. Shortly after starting the infusion, the patient develops flushing, erythema, and pruritus of the upper body.", "6. The symptoms resolve after discontinuation of the infusion.", "7. Before the next dose with the same agent, the patient is given diphenhydramine and ranitidine.", "8. The antibiotic is subsequently given at a slower infusion rate without complications."], "atomic_facts": ["1. The patient recently had arthroscopic knee surgery.", "2. Physical examination shows an erythematous lesion with poorly defined margins over the left shin but no fluctuance.", "3. Treatment with an intravenous antibiotic is begun.", "4. Shortly after starting the infusion, the patient develops flushing, erythema, and pruritus of the upper body.", "5. The symptoms resolve after discontinuation of the infusion.", "6. Before the next dose with the same agent, the patient is given diphenhydramine and ranitidine.", "7. The antibiotic is subsequently given at a slower infusion rate without complications."]}
{"id": 301, "question": "Which of the following pathologies most likely underlies this patient\u2019s condition?", "context": ["A 55-year-old man presents with worsening weakness of the left hand and progressive difficulty in walking for the last 2 months.", "He says he was previously healthy and active, hiking every weekend, but because of his increasing weakness and incoordination while walking, he stopped his weekly hiking excursion.", "His past medical history is unremarkable.", "Current medications are a daily multivitamin and occasional acetaminophen for headaches.", "He has no significant family history.", "The patient denies smoking, recreational drug use, or drinking.", "His vitals include: pulse 70/min, respirations 14/min, temperature 37.0\u00b0C (98.6\u00b0F), and blood pressure 130/80 mm Hg.", "Physical examination reveals fasciculations in the tongue and distal extremities.", "The left forearm shows significant atrophy, and mild lower limb muscle atrophy is also seen bilaterally.", "Hyporeflexia (1+) is present in the left arm, while hyperreflexia (3+) is seen in the legs bilaterally.", "Babinski\u2019s sign is positive bilaterally.", "The patient's speech is notably slow but no evidence of productive or expressive aphasia is present.", "The cranial nerves are intact."], "context_len": 13, "options": {"A": "Demyelination of neurons in various parts of the brain", "B": "Degeneration of the dorsal columns of the spinal cord", "C": "Infarction of the posterior limb of the internal capsule", "D": "Loss of the pyramidal tract neurons and anterior horn cells of the spinal cord"}, "answer": "Loss of the pyramidal tract neurons and anterior horn cells of the spinal cord", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "55 years old", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine", "Degeneration of the dorsal columns of the spinal cord"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 55-year-old man.", "2. Patient has been experiencing worsening weakness of the left hand and progressive difficulty in walking for the last 2 months.", "3. Patient was previously healthy and active, hiking every weekend.", "4. Patient stopped his weekly hiking excursion due to increasing weakness and incoordination while walking.", "5. Patient's past medical history is unremarkable.", "6. Patient's current medications are a daily multivitamin and occasional acetaminophen for headaches.", "7. Patient has no significant family history.", "8. Patient denies smoking, recreational drug use, or drinking.", "9. Patient's vitals include: pulse 70/min, respirations 14/min, temperature 37.0\u00b0C (98.6\u00b0F), and blood pressure 130/80 mm Hg.", "10. Physical examination reveals fasciculations in the tongue and distal extremities.", "11. Left forearm shows significant atrophy.", "12. Mild lower limb muscle atrophy is seen bilaterally.", "13. Hyporeflexia (1+) is present in the left arm.", "14. Hyperreflexia (3+) is seen in the legs bilaterally.", "15. Babinski\u2019s sign is positive bilaterally.", "16. Patient's speech is notably slow.", "17. No evidence of productive or expressive aphasia is present.", "18. Cranial nerves are intact."], "atomic_facts": ["1. The patient was previously healthy and active, hiking every weekend.", "2. The patient stopped hiking due to increasing weakness and incoordination while walking.", "3. The patient's past medical history is unremarkable.", "4. The patient's current medications are a daily multivitamin and occasional acetaminophen for headaches.", "5. The patient has no significant family history.", "6. The patient denies smoking, recreational drug use, or drinking.", "7. The patient's vitals include: pulse 70/min, respirations 14/min, temperature 37.0\u00b0C (98.6\u00b0F), and blood pressure 130/80 mm Hg.", "8. Physical examination reveals fasciculations in the tongue and distal extremities.", "9. The left forearm shows significant atrophy.", "10. Mild lower limb muscle atrophy is seen bilaterally.", "11. Hyporeflexia (1+) is present in the left arm.", "12. Hyperreflexia (3+) is seen in the legs bilaterally.", "13. Babinski\u2019s sign is positive bilaterally.", "14. The patient's speech is notably slow.", "15. No evidence of productive or expressive aphasia is present.", "16. The cranial nerves are intact."]}
{"id": 302, "question": "Which of the following best describes the likely causal virus of this patient\u2019s symptoms?", "context": ["A 14-year-old male who is a recent immigrant from India visits your office complaining of difficulty walking.", "Physical examination reveals weakness upon right leg extension and absent right patellar tendon reflex.", "PCR of a stool sample and a swab of the pharynx both yield viral RNA."], "context_len": 3, "options": {"A": "Non-enveloped, positive stranded, icosahedral virus", "B": "Enveloped, positive stranded, icosahedral virus", "C": "Enveloped, negative stranded, helical virus", "D": "Non-enveloped, negative stranded, helical virus"}, "answer": "Non-enveloped, positive stranded, icosahedral virus", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "14", "specialties": ["Pediatrics", "Neurology"], "subspecialties": ["Neurodevelopmental Disabilities", "Neurology", "Neurology with Special Qualification in Child Neurology", "Pediatric Neurology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 14-year-old male.", "2. Patient is a recent immigrant from India.", "3. Patient is visiting office complaining of difficulty walking.", "4. Physical examination reveals weakness upon right leg extension.", "5. Physical examination reveals absent right patellar tendon reflex.", "6. PCR of a stool sample yields viral RNA.", "7. PCR of a swab of the pharynx yields viral RNA."], "atomic_facts": ["1. Physical examination reveals weakness upon right leg extension.", "2. Physical examination reveals absent right patellar tendon reflex.", "3. PCR of a stool sample yields viral RNA.", "4. PCR of a swab of the pharynx yields viral RNA."]}
{"id": 303, "question": "Further evaluation of this patient's urine is most likely to show which of the following?", "context": ["A 21-year-old woman is brought to the emergency department because of the sudden onset of left-sided back pain with radiation to the groin that began 2 hours ago.", "She has had similar episodes in the past.", "Her pulse is 103/min.", "Examination shows a soft and non-tender abdomen.", "Left costovertebral angle tenderness is present.", "Leukocyte count is 11,000/mm3.", "Urine dipstick is positive for blood and a urinary cyanide nitroprusside test is positive.", "An x-ray of the abdomen shows no abnormalities."], "context_len": 8, "options": {"A": "pH of 7.8", "B": "Urease-producing bacteria", "C": "High uric acid concentration", "D": "Hexagon-shaped crystals"}, "answer": "Hexagon-shaped crystals", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "21 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 21-year-old woman is brought to the emergency department.", "2. She has sudden onset of left-sided back pain with radiation to the groin that began 2 hours ago.", "3. She has had similar episodes in the past.", "4. Her pulse is 103/min.", "5. Examination shows a soft and non-tender abdomen.", "6. Left costovertebral angle tenderness is present.", "7. Leukocyte count is 11,000/mm3.", "8. Urine dipstick is positive for blood.", "9. Urinary cyanide nitroprusside test is positive.", "10. An x-ray of the abdomen shows no abnormalities."], "atomic_facts": ["1. She has had similar episodes in the past.", "2. Her pulse is 103/min.", "3. Examination shows a soft and non-tender abdomen.", "4. Left costovertebral angle tenderness is present.", "5. Leukocyte count is 11,000/mm3.", "6. Urine dipstick is positive for blood.", "7. Urinary cyanide nitroprusside test is positive.", "8. An x-ray of the abdomen shows no abnormalities."]}
{"id": 304, "question": "What will be most helpful in diagnosing sequelae resulting from the patient\u2019s underlying condition?", "context": ["A 45-year-old man presents to the emergency department with sudden left lower back pain and bloody urine.", "The pain is dull and constant.", "He can not localize exactly where it is.", "Over the past 2 weeks, he has also gained 3 kg (7 lb) and his shoes feel tight.", "He denies a history of any chronic medical conditions, recent abdominal trauma or illness, and has never noticed blood in his urine before.", "In the hospital, his temperature is 36.8\u00b0C (98.2\u00b0F), the heart rate is 98/min, the respiratory rate is 15/min, and the blood pressure is 135/85 mm Hg.", "A review of medical records shows that his blood pressure was 115/75 mm Hg 6 months ago.", "On physical exam, he appears distressed.", "There are bruises on his left upper arm, chest, and right thigh.", "The patient does not remember when he got them.", "His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally.", "He has 2+ pitting edema in both legs up to the knee and his hands appear edematous.", "A urine dipstick shows 3+ blood and 4+ protein.", "Additional specimens are sent to chemistry for analysis."], "context_len": 14, "options": {"A": "CT angiogram with contrast", "B": "Non-contrast CT", "C": "Cystoscopy", "D": "Renal biopsy"}, "answer": "CT angiogram with contrast", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "45", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 45-year-old man presents to the emergency department with sudden left lower back pain and bloody urine.", "2. The pain is dull and constant.", "3. He can not localize exactly where it is.", "4. Over the past 2 weeks, he has also gained 3 kg (7 lb).", "5. His shoes feel tight.", "6. He denies a history of any chronic medical conditions.", "7. He denies a history of recent abdominal trauma or illness.", "8. He has never noticed blood in his urine before.", "9. In the hospital, his temperature is 36.8\u00b0C (98.2\u00b0F).", "10. The heart rate is 98/min.", "11. The respiratory rate is 15/min.", "12. The blood pressure is 135/85 mm Hg.", "13. A review of medical records shows that his blood pressure was 115/75 mm Hg 6 months ago.", "14. On physical exam, he appears distressed.", "15. There are bruises on his left upper arm, chest, and right thigh.", "16. The patient does not remember when he got them.", "17. His heart has a regular rate and rhythm.", "18. His lungs are clear to auscultation bilaterally.", "19. He has 2+ pitting edema in both legs up to the knee.", "20. His hands appear edematous.", "21. A urine dipstick shows 3+ blood and 4+ protein.", "22. Additional specimens are sent to chemistry for analysis."], "atomic_facts": ["1. The pain is dull and constant.", "2. He cannot localize exactly where it is.", "3. Over the past 2 weeks, he has gained 3 kg (7 lb) and his shoes feel tight.", "4. He denies a history of any chronic medical conditions, recent abdominal trauma or illness, and has never noticed blood in his urine before.", "5. In the hospital, his temperature is 36.8\u00b0C (98.2\u00b0F), the heart rate is 98/min, the respiratory rate is 15/min, and the blood pressure is 135/85 mm Hg.", "6. A review of medical records shows that his blood pressure was 115/75 mm Hg 6 months ago.", "7. On physical exam, he appears distressed.", "8. There are bruises on his left upper arm, chest, and right thigh.", "9. The patient does not remember when he got them.", "10. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally.", "11. He has 2+ pitting edema in both legs up to the knee and his hands appear edematous.", "12. A urine dipstick shows 3+ blood and 4+ protein.", "13. Additional specimens are sent to chemistry for analysis."]}
{"id": 305, "question": "The difference in the level of severity of this disorder among family members in best explained by which of the following?", "context": ["A 21-year-old man visits his primary care provider complaining of visual disturbance in both eyes for a month and an episode of abnormal uncontrollable shaking that occurred twice last week.", "He was previously healthy and did not take any medication.", "His mother has intermittent muscle weakness and his maternal uncle developed hemiplegia at the age of 35.", "Neuroimaging shows bilateral occipital lobe infarcts and a skeletal muscle biopsy reveals atypical muscle fibers that stain positive for subsarcomelar structures.", "The physician suspects a maternally inherited genetic disorder."], "context_len": 5, "options": {"A": "Heteroplasmy", "B": "Mosaicism", "C": "Anticipation", "D": "Uniparental disomy"}, "answer": "Heteroplasmy", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "21 years old", "specialties": ["Neurology"], "subspecialties": ["Neurodevelopmental Disabilities", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 21-year-old man visits his primary care provider.", "2. He is complaining of visual disturbance in both eyes for a month.", "3. He also had an episode of abnormal uncontrollable shaking that occurred twice last week.", "4. He was previously healthy and did not take any medication.", "5. His mother has intermittent muscle weakness.", "6. His maternal uncle developed hemiplegia at the age of 35.", "7. Neuroimaging shows bilateral occipital lobe infarcts.", "8. A skeletal muscle biopsy reveals atypical muscle fibers that stain positive for subsarcomelar structures.", "9. The physician suspects a maternally inherited genetic disorder."], "atomic_facts": ["1. He was previously healthy.", "2. He did not take any medication.", "3. His mother has intermittent muscle weakness.", "4. His maternal uncle developed hemiplegia at the age of 35.", "5. Neuroimaging shows bilateral occipital lobe infarcts.", "6. A skeletal muscle biopsy reveals atypical muscle fibers.", "7. The atypical muscle fibers stain positive for subsarcomelar structures.", "8. The physician suspects a maternally inherited genetic disorder."]}
{"id": 306, "question": "How would you describe the data shown below?", "context": ["Your hospital administrators want to provide you with a tool to analyze the usage of emergency department visits by patients in your high-risk practice.", "The following graph is displayed on the dashboard of your electronic medical record to show you how often your patients utilize the ED so that you can provide higher quality and more cost-effective care.", "The X-axis indicates the number of times a patient has been to the ED in the last year.", "The Y-axis indicates the number of patients who fit into that category."], "context_len": 4, "options": {"A": "It is positively-skewed, with mean > median > mode.", "B": "It is positively-skewed, with mode > median > mean.", "C": "It is positively-skewed, with median > mode > mean.", "D": "It is negatively-skewed, with mode > median > mean."}, "answer": "It is positively-skewed, with mean > median > mode.", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Statistics", "Pathology", "Family Medicine"], "subspecialties": ["General Pathology", "General Statistics", "Health Care Administration, Leadership, and Management", "N/A"], "specialty_prob": [0.4, 0.4, 0.2], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Hospital administrators want to provide a tool to analyze emergency department visits by patients in a high-risk practice.", "2. The dashboard of the electronic medical record displays a graph to show how often patients utilize the ED.", "3. The X-axis of the graph indicates the number of times a patient has been to the ED in the last year.", "4. The Y-axis of the graph indicates the number of patients who fit into that category."], "atomic_facts": ["1. The graph is displayed on the dashboard of the electronic medical record.", "2. The graph shows how often patients utilize the ED.", "3. The purpose is to provide higher quality and more cost-effective care.", "4. The X-axis indicates the number of times a patient has been to the ED in the last year.", "5. The Y-axis indicates the number of patients who fit into that category."]}
{"id": 307, "question": "Which of the following findings would most likely be abnormal during pregnancy?", "context": ["A 27-year-old G1P0000 at 17 weeks of gestation is interested in participating in a clinical trial for nausea management during pregnancy.", "The trial will be evaluating the effects of moderate ginger consumption on nausea symptoms.", "Prior to enrolling in the trial, the investigators explain to the patient that they will be doing a full exam and some special testing to make sure she is experiencing a healthy pregnancy."], "context_len": 3, "options": {"A": "Hypertension", "B": "Increased cardiac output", "C": "Increase in factor VII", "D": "Respiratory alkalosis"}, "answer": "Hypertension", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "27 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 27-year-old G1P0000 is interested in participating in a clinical trial.", "2. The clinical trial is for nausea management during pregnancy.", "3. The trial will be evaluating the effects of moderate ginger consumption on nausea symptoms.", "4. The patient is 17 weeks of gestation.", "5. Prior to enrolling in the trial, the investigators explain to the patient that they will be doing a full exam.", "6. Prior to enrolling in the trial, the investigators explain to the patient that they will be doing some special testing.", "7. The special testing is to make sure the patient is experiencing a healthy pregnancy."], "atomic_facts": ["1. The trial will be evaluating the effects of moderate ginger consumption.", "2. The trial will be evaluating the effects on nausea symptoms.", "3. The investigators will explain the trial to the patient.", "4. The investigators will do a full exam on the patient.", "5. The investigators will do some special testing on the patient.", "6. The testing is to ensure the patient is experiencing a healthy pregnancy."]}
{"id": 308, "question": "Which of the following is most consistent with their son's symptoms?", "context": ["A 14-year-old Caucasian male of normal weight presents for a well-child checkup.", "During physical examination, his parents state that their son has been frequenting the bathroom more often than usual and his weight has decreased despite an increase in his caloric intake."], "context_len": 2, "options": {"A": "Self-reactive T-cells", "B": "Amyloid deposits in pancreatic islet cells", "C": "Absence of leukocytic infiltrates in the pancreas", "D": "Hypoglycemia"}, "answer": "Self-reactive T-cells", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "14", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology", "General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 14-year-old Caucasian male is presenting for a well-child checkup.", "2. His weight is normal.", "3. His parents state he has been frequenting the bathroom more often than usual.", "4. His weight has decreased.", "5. His caloric intake has increased."], "atomic_facts": ["1. During physical examination", "2. His parents state", "3. Their son has been frequenting the bathroom more often than usual", "4. His weight has decreased", "5. Increase in his caloric intake"]}
{"id": 309, "question": "Which of the following findings would you most likely expect to be reported in the ultrasound?", "context": ["A 56-year-old woman with a history of stage IIA cervical cancer presents to your office after her 5th episode of a complicated urinary tract infection.", "She complains of easy fatigability, weakness, and has noted that her shoes no longer fit.", "The physical examination is unremarkable, except for a blood pressure of 165/90 mm Hg and mild pitting lower extremity edema.", "The rectovaginal exam revealed no masses.", "Given the patient\u2019s medical history, the specialist makes a stage IIIB diagnosis; however, to confirm this, he orders abdominal and transvaginal ultrasounds and renal function tests."], "context_len": 5, "options": {"A": "Bladder or rectum mucosa invasion", "B": "Distant metastasis", "C": "Parametrial invasion by cancer", "D": "Hydronephrosis"}, "answer": "Hydronephrosis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "56", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Radiology"}, "facts_old": ["1. A 56-year-old woman presents to the office.", "2. She has a history of stage IIA cervical cancer.", "3. She has had 5 episodes of a complicated urinary tract infection.", "4. She complains of easy fatigability and weakness.", "5. Her shoes no longer fit.", "6. The physical examination is unremarkable, except for a blood pressure of 165/90 mm Hg and mild pitting lower extremity edema.", "7. The rectovaginal exam revealed no masses.", "8. The specialist makes a stage IIIB diagnosis.", "9. To confirm this, he orders abdominal and transvaginal ultrasounds.", "10. He also orders renal function tests."], "atomic_facts": ["1. The patient complains of easy fatigability.", "2. The patient complains of weakness.", "3. The patient has noted that her shoes no longer fit.", "4. The physical examination is unremarkable.", "5. The patient has a blood pressure of 165/90 mm Hg.", "6. The patient has mild pitting lower extremity edema.", "7. The rectovaginal exam revealed no masses.", "8. The specialist makes a stage IIIB diagnosis based on the patient's medical history.", "9. The specialist orders abdominal and transvaginal ultrasounds.", "10. The specialist orders renal function tests."]}
{"id": 310, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 77-year-old man is brought to the physician because of a 2-day history of increasing shortness of breath and ankle swelling.", "He has type 2 diabetes mellitus, hypertension, coronary artery disease, and congestive heart failure.", "Current medications include lisinopril, metformin, and aspirin.", "He has smoked half a pack of cigarettes daily for 50 years.", "His temperature is 37.2\u00b0C (98.9\u00b0F), pulse is 100/min and regular, respirations are 20/min, and blood pressure is 100/65 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 91%.", "There are jugular venous pulsations 5 cm above the sternal angle.", "Crackles are heard at both lung bases.", "Cardiac examination shows an S3 gallop.", "There is edema from the mid-tibia to the ankle bilaterally.", "Laboratory studies show: | Hemoglobin 14.1 g/dL | Leukocyte count 7100/mm3 | Serum | Na+ 129 mEq/L | Cl- 99 mEq/L | K+ 4.8 mEq/L | Urea nitrogen 48 mg/dL | Glucose 196 mg/dL | Creatinine 2.1 mg/dL | ."], "context_len": 11, "options": {"A": "Discontinue metformin therapy", "B": "Begin vancomycin therapy", "C": "Begin nitroprusside therapy", "D": "Begin hydrochlorothiazide therapy"}, "answer": "Discontinue metformin therapy", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "77 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 77 years old.", "2. Patient has 2-day history of increasing shortness of breath and ankle swelling.", "3. Patient has type 2 diabetes mellitus, hypertension, coronary artery disease, and congestive heart failure.", "4. Patient is taking lisinopril, metformin, and aspirin.", "5. Patient has smoked half a pack of cigarettes daily for 50 years.", "6. Patient's temperature is 37.2\u00b0C (98.9\u00b0F).", "7. Patient's pulse is 100/min and regular.", "8. Patient's respirations are 20/min.", "9. Patient's blood pressure is 100/65 mm Hg.", "10. Pulse oximetry on room air shows an oxygen saturation of 91%.", "11. Jugular venous pulsations 5 cm above the sternal angle.", "12. Crackles are heard at both lung bases.", "13. Cardiac examination shows an S3 gallop.", "14. Patient has edema from the mid-tibia to the ankle bilaterally.", "15. Laboratory studies show hemoglobin 14.1 g/dL.", "16. Laboratory studies show leukocyte count 7100/mm3.", "17. Laboratory studies show serum Na+ 129 mEq/L.", "18. Laboratory studies show Cl- 99 mEq/L.", "19. Laboratory studies show K+ 4.8 mEq/L.", "20. Laboratory studies show urea nitrogen 48 mg/dL.", "21. Laboratory studies show glucose 196 mg/dL.", "22. Laboratory studies show creatinine 2.1 mg/dL."], "atomic_facts": ["1. He has type 2 diabetes mellitus.", "2. He has hypertension.", "3. He has coronary artery disease.", "4. He has congestive heart failure.", "5. Current medications include lisinopril, metformin, and aspirin.", "6. He has smoked half a pack of cigarettes daily for 50 years.", "7. His temperature is 37.2\u00b0C (98.9\u00b0F).", "8. His pulse is 100/min and regular.", "9. His respirations are 20/min.", "10. His blood pressure is 100/65 mm Hg.", "11. Pulse oximetry on room air shows an oxygen saturation of 91%.", "12. There are jugular venous pulsations 5 cm above the sternal angle.", "13. Crackles are heard at both lung bases.", "14. Cardiac examination shows an S3 gallop.", "15. There is edema from the mid-tibia to the ankle bilaterally.", "16. Laboratory studies show: Hemoglobin 14.1 g/dL.", "17. Laboratory studies show: Leukocyte count 7100/mm3.", "18. Laboratory studies show: Serum Na+ 129 mEq/L.", "19. Laboratory studies show: Serum Cl- 99 mEq/L.", "20. Laboratory studies show: Serum K+ 4.8 mEq/L.", "21. Laboratory studies show: Urea nitrogen 48 mg/dL.", "22. Laboratory studies show: Glucose 196 mg/dL.", "23. Laboratory studies show: Creatinine 2.1 mg/dL."]}
{"id": 311, "question": "Which of the following is the most likely cause of the cardiotocography findings?", "context": ["A 32-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital 30 minutes after spontaneous rupture of membranes without labor pains.", "She delivered her first child vaginally at 38 weeks' gestation.", "Pregnancy was complicated by hypothyroidism.", "She has no other history of serious illness.", "Medications include levothyroxine and a multivitamin.", "Her pulse is 90/min, respirations are 16/min, and blood pressure is 134/76 mm Hg.", "Pelvic examination shows a uterus consistent in size with a 40 week gestation.", "A cardiotocography reading is shown."], "context_len": 8, "options": {"A": "Umbilical cord compression", "B": "Fetal head compression", "C": "Uteroplacental insufficiency", "D": "Fetal CNS depression"}, "answer": "Umbilical cord compression", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "32 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Uteroplacental insufficiency"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 32-year-old woman is admitted to the hospital.", "2. She is gravida 2, para 1.", "3. She is at 40 weeks' gestation.", "4. She experienced spontaneous rupture of membranes 30 minutes prior to admission.", "5. She had no labor pains.", "6. She delivered her first child vaginally at 38 weeks' gestation.", "7. Her pregnancy was complicated by hypothyroidism.", "8. She has no other history of serious illness.", "9. Her medications include levothyroxine and a multivitamin.", "10. Her pulse is 90/min.", "11. Her respirations are 16/min.", "12. Her blood pressure is 134/76 mm Hg.", "13. Pelvic examination shows a uterus consistent in size with a 40 week gestation.", "14. A cardiotocography reading is shown."], "atomic_facts": ["1. She delivered her first child vaginally at 38 weeks' gestation.", "2. Pregnancy was complicated by hypothyroidism.", "3. She has no other history of serious illness.", "4. Medications include levothyroxine and a multivitamin.", "5. Her pulse is 90/min.", "6. Her respirations are 16/min.", "7. Her blood pressure is 134/76 mm Hg.", "8. Pelvic examination shows a uterus consistent in size with a 40 week gestation.", "9. A cardiotocography reading is shown."]}
{"id": 312, "question": "WBC 38,000/mm3 | RBC 4.20 x 106/mm3 | Hematocrit 27.3% | Hemoglobin 8.3 g/dL | Platelet count 355,000/mm3 | A peripheral blood smear and differential shows 92% small normocytic lymphocytes. | Which of the following is the most likely diagnosis in this patient?", "context": ["A 55-year-old man presents for a routine check-up.", "He currently has no complaints, and his last physical and laboratory studies were unremarkable.", "His past medical history is significant for hypercholesterolemia, well managed with rosuvastatin, and hypertension, well managed with hydrochlorothiazide.", "His current medications also include aspirin.", "The patient is afebrile and his vital signs are within normal limits.", "Physical examination reveals some generalized lymphadenopathy.", "Laboratory findings are significant for the following: | ."], "context_len": 7, "options": {"A": "Acute myelogenous leukemia", "B": "Chronic myelogenous leukemia", "C": "Chronic lymphocytic leukemia", "D": "Asymptomatic multiple myeloma"}, "answer": "Chronic lymphocytic leukemia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Hematology", "Internal Medicine"], "subspecialties": ["General Hematology", "Hematology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 55-year-old man presents for a routine check-up.", "2. He currently has no complaints.", "3. His last physical and laboratory studies were unremarkable.", "4. His past medical history is significant for hypercholesterolemia.", "5. Hypercholesterolemia is well managed with rosuvastatin.", "6. His past medical history is also significant for hypertension.", "7. Hypertension is well managed with hydrochlorothiazide.", "8. His current medications also include aspirin.", "9. The patient is afebrile.", "10. His vital signs are within normal limits.", "11. Physical examination reveals some generalized lymphadenopathy.", "12. Laboratory findings are significant for the following."], "atomic_facts": ["1. The patient currently has no complaints.", "2. His last physical and laboratory studies were unremarkable.", "3. His past medical history includes hypercholesterolemia.", "4. His hypercholesterolemia is well managed with rosuvastatin.", "5. His past medical history also includes hypertension.", "6. His hypertension is well managed with hydrochlorothiazide.", "7. His current medications include aspirin.", "8. The patient is afebrile.", "9. His vital signs are within normal limits.", "10. Physical examination reveals some generalized lymphadenopathy.", "11. Laboratory findings are significant for certain results."]}
{"id": 313, "question": "What is the next step in management?", "context": ["A 72-year-old man with a history of diabetes, dyslipidemia, and hypertension presents to the emergency department with sudden-onset right-sided facial paresthesia, word-finding difficulty, and lightheadedness.", "He was at a restaurant, in general good health, enjoying a dinner with friends when the 1st symptoms started.", "He takes atorvastatin, lisinopril, hydrochlorothiazide, and a multivitamin every day.", "A review of symptoms was negative.", "His symptoms spontaneously resolved after 5 minutes.", "In the emergency department, the vital signs included: blood pressure of 132/80 mm Hg, heart rate of 86/min, respiratory rate of 20/min, and oxygen saturation of 99% on room air.", "The laboratory results included: | Hemoglobin 11.3 g/dL | Hematocrit 33% | WBC count 9,800/mm3 | Platelet count 247,000/mm3 | International normalized ratio (INR) 1.1 | Prothrombin time (PT) 11.5 seconds | Partial thromboplastin time (PTT) 32 seconds | His electrocardiogram (ECG) and his head computed tomography (CT) scan were normal.", "A duplex ultrasound scan shows 70\u201389% stenosis in the left carotid artery and 50% in the right.", "In the course of evaluation, his aphasia recurred for 3 minutes.", "A brain magnetic resonance imaging (MRI) scan was negative for areas of ischemia or intracranial hemorrhage.", "His symptom recurrence prompted his hospital admission for inpatient care."], "context_len": 11, "options": {"A": "Enoxaparin", "B": "Thrombolysis", "C": "Carotid endarterectomy", "D": "Carotid artery stenting"}, "answer": "Carotid endarterectomy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "72", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 72 years old.", "2. Patient has a history of diabetes, dyslipidemia, and hypertension.", "3. Patient presented to the emergency department with sudden-onset right-sided facial paresthesia, word-finding difficulty, and lightheadedness.", "4. Patient was at a restaurant, in general good health, enjoying a dinner with friends when the 1st symptoms started.", "5. Patient takes atorvastatin, lisinopril, hydrochlorothiazide, and a multivitamin every day.", "6. Review of symptoms was negative.", "7. Symptoms spontaneously resolved after 5 minutes.", "8. Vital signs included: blood pressure of 132/80 mm Hg, heart rate of 86/min, respiratory rate of 20/min, and oxygen saturation of 99% on room air.", "9. Laboratory results included: Hemoglobin 11.3 g/dL, Hematocrit 33%, WBC count 9,800/mm3, Platelet count 247,000/mm3, International normalized ratio (INR) 1.1, Prothrombin time (PT) 11.5 seconds, Partial thromboplastin time (PTT) 32 seconds.", "10. Electrocardiogram (ECG) and head computed tomography (CT) scan were normal.", "11. Duplex ultrasound scan shows 70\u201389% stenosis in the left carotid artery and 50% in the right.", "12. In the course of evaluation, his aphasia recurred for 3 minutes.", "13. Brain magnetic resonance imaging (MRI) scan was negative for areas of ischemia or intracranial hemorrhage.", "14. Symptom recurrence prompted his hospital admission for inpatient care."], "atomic_facts": ["1. The patient was at a restaurant when the first symptoms started.", "2. The patient takes atorvastatin, lisinopril, hydrochlorothiazide, and a multivitamin daily.", "3. A review of symptoms was negative.", "4. The symptoms spontaneously resolved after 5 minutes.", "5. In the emergency department, the patient's vital signs were: blood pressure 132/80 mm Hg, heart rate 86/min, respiratory rate 20/min, and oxygen saturation 99% on room air.", "6. Laboratory results showed: Hemoglobin 11.3 g/dL, Hematocrit 33%, WBC count 9,800/mm3, Platelet count 247,000/mm3, INR 1.1, PT 11.5 seconds, PTT 32 seconds.", "7. The patient's ECG and head CT scan were normal.", "8. A duplex ultrasound scan revealed 70\u201389% stenosis in the left carotid artery and 50% in the right.", "9. During evaluation, the patient's aphasia recurred for 3 minutes.", "10. A brain MRI scan showed no areas of ischemia or intracranial hemorrhage.", "11. The symptom recurrence prompted the patient's hospital admission for inpatient care."]}
{"id": 314, "question": "Which of the following is the best 1st step in this patient\u2019s management?", "context": ["A 70-year-old woman visits her physician complaining of dry mouth and dry eyes.", "She states that she has recently been having difficulty wearing her dentures on account of her dry mouth.", "She also says that her tongue sticks to the roof of her mouth, making it difficult to speak and swallow food.", "Her eyes have also been burning, and she has had to use over the counter eye drops much more often.", "These symptoms have persisted for several months.", "On physical exam, mild bilateral enlargement of the parotid glands was noted, and an intraoral examination revealed a red, dry, and smooth mucosal surface on the dorsum of the tongue and buccal mucosa.", "The patient has a history of hypertension, for which she takes lisinopril."], "context_len": 7, "options": {"A": "Administer prednisone", "B": "Obtain an electrocardiogram (ECG)", "C": "Perform a Schirmer test and obtain anti-Ro/anti-La titers", "D": "Perform a parotid gland biopsy"}, "answer": "Perform a Schirmer test and obtain anti-Ro/anti-La titers", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "70", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 70-year-old woman visits her physician.", "2. She is complaining of dry mouth and dry eyes.", "3. She has difficulty wearing her dentures due to her dry mouth.", "4. Her tongue sticks to the roof of her mouth, making it difficult to speak and swallow food.", "5. Her eyes have been burning and she has been using over the counter eye drops more often.", "6. These symptoms have persisted for several months.", "7. On physical exam, mild bilateral enlargement of the parotid glands was noted.", "8. An intraoral examination revealed a red, dry, and smooth mucosal surface on the dorsum of the tongue and buccal mucosa.", "9. The patient has a history of hypertension.", "10. She takes lisinopril for her hypertension."], "atomic_facts": ["1. The patient has been having difficulty wearing her dentures due to dry mouth.", "2. Her tongue sticks to the roof of her mouth, making it difficult to speak and swallow food.", "3. She has been experiencing burning eyes and has had to use over the counter eye drops more frequently.", "4. These symptoms have been present for several months.", "5. On physical exam, mild bilateral enlargement of the parotid glands was noted.", "6. An intraoral examination revealed a red, dry, and smooth mucosal surface on the dorsum of the tongue and buccal mucosa.", "7. The patient has a history of hypertension and takes lisinopril for it."]}
{"id": 315, "question": "This patient most likely has elevated levels of which of the following?", "context": ["A 61-year old obese nulliparous female presents to your office with right lower quadrant abdominal pain.", "Her medical history is significant for breast cancer and past use of postmenopausal estrogen replacement therapy."], "context_len": 2, "options": {"A": "hCG", "B": "AFP", "C": "CA 19-9", "D": "CA 125"}, "answer": "CA 125", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "61 years old", "specialties": ["Obstetrics and Gynecology", "General Surgery"], "subspecialties": ["General Obstetrics and Gynecology", "General Surgery"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 61-year old female presents to your office.", "2. The female is obese.", "3. The female is nulliparous.", "4. The female has right lower quadrant abdominal pain.", "5. The female has a medical history of breast cancer.", "6. The female has a history of past use of postmenopausal estrogen replacement therapy."], "atomic_facts": ["1. Medical history includes breast cancer.", "2. Past use of postmenopausal estrogen replacement therapy."]}
{"id": 316, "question": "Further evaluation of this patient is most likely to reveal which of the following?", "context": ["A 28-year-old man comes to the physician because of a swollen, tender left knee for the past 4 days.", "During this period, the patient has had pain with urination.", "The patient has no history of serious illness and takes no medications.", "He is sexually active with two male partners and they use condoms inconsistently.", "His older sister has systemic lupus erythematosus.", "He is 180 cm (5 ft 11 in) tall and weighs 98 kg (216 lb); BMI is 30.1 kg/m2.", "His temperature is 37\u00b0C (98.6\u00b0F), pulse is 83/min, and blood pressure is 140/75 mm Hg.", "Examination shows conjunctivitis bilaterally.", "The left knee is warm, erythematous, and tender to touch; range of motion is limited.", "Laboratory studies show an erythrocyte sedimentation rate of 62 mm/h.", "Urinanalysis shows WBCs."], "context_len": 11, "options": {"A": "HLA-B27 positive genotype", "B": "Hiking trip two months ago", "C": "Positive anti-dsDNA antibodies", "D": "Intravenous drug use"}, "answer": "HLA-B27 positive genotype", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "28 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 28 years old.", "2. Patient has had a swollen, tender left knee for the past 4 days.", "3. Patient has had pain with urination during this period.", "4. Patient has no history of serious illness and takes no medications.", "5. Patient is sexually active with two male partners and they use condoms inconsistently.", "6. Patient's older sister has systemic lupus erythematosus.", "7. Patient is 180 cm (5 ft 11 in) tall.", "8. Patient weighs 98 kg (216 lb); BMI is 30.1 kg/m2.", "9. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "10. Patient's pulse is 83/min.", "11. Patient's blood pressure is 140/75 mm Hg.", "12. Patient has conjunctivitis bilaterally.", "13. Patient's left knee is warm, erythematous, and tender to touch.", "14. Patient's range of motion is limited.", "15. Laboratory studies show an erythrocyte sedimentation rate of 62 mm/h.", "16. Urinanalysis shows WBCs."], "atomic_facts": ["1. The patient has had pain with urination.", "2. The patient has no history of serious illness and takes no medications.", "3. He is sexually active with two male partners and they use condoms inconsistently.", "4. His older sister has systemic lupus erythematosus.", "5. He is 180 cm (5 ft 11 in) tall and weighs 98 kg (216 lb); BMI is 30.1 kg/m2.", "6. His temperature is 37\u00b0C (98.6\u00b0F), pulse is 83/min, and blood pressure is 140/75 mm Hg.", "7. Examination shows conjunctivitis bilaterally.", "8. The left knee is warm, erythematous, and tender to touch; range of motion is limited.", "9. Laboratory studies show an erythrocyte sedimentation rate of 62 mm/h.", "10. Urinanalysis shows WBCs."]}
{"id": 317, "question": "Which of the following is the most likely diagnosis?", "context": ["A 21-year-old man comes to the physician because of nervousness and difficulty sleeping over the past 2 weeks.", "Three months ago, he started a new team project at his job.", "He says that he has trouble falling asleep at night because he thinks about the project.", "He insists on checking the work of his teammates and spends several hours each week making elaborate lists and schedules.", "He refuses to let others take on more tasks because he thinks that only he can complete them satisfactorily.", "The project deadline has already been postponed once.", "He says, \u201cMy teammates never understand how important it is to do things the right way.\u201d Ever since high school, he has used the majority of his time to plan out assignments and does not have time to regularly participate in social activities."], "context_len": 7, "options": {"A": "Obsessive-compulsive personality disorder", "B": "Obsessive-compulsive disorder", "C": "Schizoid personality disorder", "D": "Adjustment disorder with mixed anxiety and depressed mood\n\""}, "answer": "Obsessive-compulsive personality disorder", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "21 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 21-year-old man comes to the physician because of nervousness and difficulty sleeping over the past 2 weeks.", "2. Three months ago, he started a new team project at his job.", "3. He says that he has trouble falling asleep at night because he thinks about the project.", "4. He insists on checking the work of his teammates and spends several hours each week making elaborate lists and schedules.", "5. He refuses to let others take on more tasks because he thinks that only he can complete them satisfactorily.", "6. The project deadline has already been postponed once.", "7. He says, \u201cMy teammates never understand how important it is to do things the right way.\u201d", "8. Ever since high school, he has used the majority of his time to plan out assignments.", "9. He does not have time to regularly participate in social activities."], "atomic_facts": ["1. Three months ago, he started a new team project at his job.", "2. He says that he has trouble falling asleep at night because he thinks about the project.", "3. He insists on checking the work of his teammates and spends several hours each week making elaborate lists and schedules.", "4. He refuses to let others take on more tasks because he thinks that only he can complete them satisfactorily.", "5. The project deadline has already been postponed once.", "6. He says, \u201cMy teammates never understand how important it is to do things the right way.\u201d", "7. Ever since high school, he has used the majority of his time to plan out assignments and does not have time to regularly participate in social activities."]}
{"id": 318, "question": "Which of the following drugs is most likely to be effective as a preventive therapy in this patient?", "context": ["A 52-years-old man presents with a history of recurrent episodes of unilateral headaches.", "He says the episodes are short-lived (usually lasting for a few seconds to 3-4 minutes), and he describes them as a severe throbbing orbital headache, accompanied by ipsilateral conjunctival injection and lacrimation.", "He says that often the episodes seem to be triggered by a cutaneous stimulus touching the face or while chewing food.", "Sometimes, he says he experiences countless attacks during a single day.", "The headaches do not respond to indomethacin and any other non-steroidal anti-inflammatory drug (NSAID)."], "context_len": 5, "options": {"A": "Ibuprofen", "B": "Acetaminophen", "C": "Lamotrigine", "D": "Amitriptyline"}, "answer": "Lamotrigine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "52 years old", "specialties": ["Neurology"], "subspecialties": ["Headache Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 52-years-old man presents with a history of recurrent episodes of unilateral headaches.", "2. The episodes are short-lived, usually lasting for a few seconds to 3-4 minutes.", "3. He describes them as a severe throbbing orbital headache.", "4. The headaches are accompanied by ipsilateral conjunctival injection and lacrimation.", "5. The episodes seem to be triggered by a cutaneous stimulus touching the face or while chewing food.", "6. Sometimes, he experiences countless attacks during a single day.", "7. The headaches do not respond to indomethacin.", "8. The headaches do not respond to any other non-steroidal anti-inflammatory drug (NSAID)."], "atomic_facts": ["1. The episodes are short-lived, usually lasting for a few seconds to 3-4 minutes.", "2. The episodes are described as a severe throbbing orbital headache.", "3. The episodes are accompanied by ipsilateral conjunctival injection and lacrimation.", "4. The episodes seem to be triggered by a cutaneous stimulus touching the face or while chewing food.", "5. Sometimes, countless attacks are experienced during a single day.", "6. The headaches do not respond to indomethacin.", "7. The headaches do not respond to any other non-steroidal anti-inflammatory drug (NSAID)."]}
{"id": 319, "question": "Which of the following is appropriate treatment of this patient?", "context": ["A 55-year-old obese man presents to the emergency department with abdominal pain.", "His pain started 2 days ago and has been worsening steadily.", "His only current medication is allopurinol.", "His temperature is 101.0\u00b0F (38.3\u00b0C), blood pressure is 157/98 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for left lower quadrant abdominal tenderness and rectal exam is unremarkable.", "A CT scan is performed demonstrating inflamed outpouchings of the colonic mucosa with a 4-cm abscess."], "context_len": 6, "options": {"A": "Ciprofloxacin and gentamicin", "B": "CT-guided percutaneous drainage", "C": "Laparoscopy and drainage", "D": "Piperacillin-tazobactam and vancomycin"}, "answer": "CT-guided percutaneous drainage", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old man presents to the emergency department with abdominal pain.", "2. His pain started 2 days ago and has been worsening steadily.", "3. His only current medication is allopurinol.", "4. His temperature is 101.0\u00b0F (38.3\u00b0C).", "5. His blood pressure is 157/98 mmHg.", "6. His pulse is 120/min.", "7. His respirations are 17/min.", "8. His oxygen saturation is 98% on room air.", "9. Physical exam is notable for left lower quadrant abdominal tenderness.", "10. Rectal exam is unremarkable.", "11. A CT scan is performed.", "12. CT scan demonstrates inflamed outpouchings of the colonic mucosa.", "13. CT scan demonstrates a 4-cm abscess."], "atomic_facts": ["1. His pain started 2 days ago and has been worsening steadily.", "2. His only current medication is allopurinol.", "3. His temperature is 101.0\u00b0F (38.3\u00b0C).", "4. His blood pressure is 157/98 mmHg.", "5. His pulse is 120/min.", "6. His respirations are 17/min.", "7. His oxygen saturation is 98% on room air.", "8. Physical exam is notable for left lower quadrant abdominal tenderness.", "9. Rectal exam is unremarkable.", "10. A CT scan is performed demonstrating inflamed outpouchings of the colonic mucosa with a 4-cm abscess."]}
{"id": 320, "question": "Which of the following is the most appropriate treatment for this patient?", "context": ["A 32-year-old G2P2 woman gives birth to a boy at 39 weeks gestation.", "The mother recently immigrated from Somalia and had no prenatal care.", "She refused all intrapartum medications.", "The boy\u2019s Apgar scores were 7 and 9 at 1 and 5 minutes, respectively.", "His height and weight were in the 20th and 15th percentiles, respectively.", "Mother and child were discharged the day after birth.", "However, 7 days later, the mother presents to the pediatrician because she noticed redness and discharge in her baby's eyes.", "His temperature is 98.8\u00b0F (37.1\u00b0C), blood pressure is 105/65 mmHg, pulse is 120/min, and respirations are 22/min.", "On exam, the boy has scant non-purulent mucoid bilateral eye discharge and conjunctival hyperemia."], "context_len": 9, "options": {"A": "Intravenous acyclovir", "B": "Oral and topical erythromycin", "C": "Sterile lubricant with artificial tear preparation", "D": "Topical bacitracin"}, "answer": "Oral and topical erythromycin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "32 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology", "Maternal"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 32-year-old G2P2 woman gave birth to a boy.", "2. The gestation was 39 weeks.", "3. The mother recently immigrated from Somalia.", "4. The mother had no prenatal care.", "5. The mother refused all intrapartum medications.", "6. The boy's Apgar scores were 7 and 9 at 1 and 5 minutes, respectively.", "7. The boy's height was in the 20th percentile.", "8. The boy's weight was in the 15th percentile.", "9. Mother and child were discharged the day after birth.", "10. Seven days later, the mother presented to the pediatrician.", "11. The mother noticed redness and discharge in her baby's eyes.", "12. The boy's temperature was 98.8\u00b0F (37.1\u00b0C).", "13. The boy's blood pressure was 105/65 mmHg.", "14. The boy's pulse was 120/min.", "15. The boy's respirations were 22/min.", "16. On exam, the boy had scant non-purulent mucoid bilateral eye discharge and conjunctival hyperemia."], "atomic_facts": ["1. The mother recently immigrated from Somalia.", "2. The mother had no prenatal care.", "3. The mother refused all intrapartum medications.", "4. The boy\u2019s Apgar scores were 7 and 9 at 1 and 5 minutes, respectively.", "5. The boy\u2019s height was in the 20th percentile.", "6. The boy\u2019s weight was in the 15th percentile.", "7. Mother and child were discharged the day after birth.", "8. 7 days later, the mother presents to the pediatrician.", "9. The mother noticed redness and discharge in her baby's eyes.", "10. The boy's temperature is 98.8\u00b0F (37.1\u00b0C).", "11. The boy's blood pressure is 105/65 mmHg.", "12. The boy's pulse is 120/min.", "13. The boy's respirations are 22/min.", "14. On exam, the boy has scant non-purulent mucoid bilateral eye discharge.", "15. On exam, the boy has conjunctival hyperemia."]}
{"id": 321, "question": "Inhibition of which of the following processes is the best explanation for such adverse effects?", "context": ["A 21-year-old woman presents to her physician for a regular follow-up visit.", "She was diagnosed with relapsing-remitting multiple sclerosis 2 months ago when she suffered a second episode of optic neuritis.", "She was successfully treated with methylprednisolone pulse therapy and discharged.", "Today, she only complains of slight fatigue with upper and lower extremity weakness.", "Her blood pressure is 120/80 mm Hg, her heart rate is 63/min, her respiratory rate is 14/min, and her temperature is 36.7\u00b0C (98.0\u00b0F).", "Neurological examination reveals brisk deep reflexes (3+ equal) and decreased strength (4/4) in the upper limbs.", "The rest of the examination is unremarkable.", "The patient is prescribed a drug that is an inhibitor of \u02514-integrin (CD49d) for the prevention of relapses.", "She is concerned about the side effects of this drug, among which is increased susceptibility to the upper respiratory tract and urinary tract infections."], "context_len": 9, "options": {"A": "Tight adhesion of leukocytes to the endothelial cells", "B": "Expression of selectins on the surface of endothelial cells", "C": "Formation of tight bounds between leukocytes and endothelial selectins", "D": "Inhibition of interaction between platelet endothelial cell adhesion molecules (PECAMs) on the surfaces of leukocytes and endothelial cells"}, "answer": "Tight adhesion of leukocytes to the endothelial cells", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "21", "specialties": ["Internal Medicine"], "subspecialties": ["Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. Patient is 21 years old.", "2. Patient was diagnosed with relapsing-remitting multiple sclerosis 2 months ago.", "3. Patient suffered a second episode of optic neuritis.", "4. Patient was successfully treated with methylprednisolone pulse therapy and discharged.", "5. Patient only complains of slight fatigue with upper and lower extremity weakness.", "6. Patient's blood pressure is 120/80 mm Hg.", "7. Patient's heart rate is 63/min.", "8. Patient's respiratory rate is 14/min.", "9. Patient's temperature is 36.7\u00b0C (98.0\u00b0F).", "10. Neurological examination reveals brisk deep reflexes (3+ equal).", "11. Neurological examination reveals decreased strength (4/4) in the upper limbs.", "12. The rest of the examination is unremarkable.", "13. Patient is prescribed a drug that is an inhibitor of \u02514-integrin (CD49d) for the prevention of relapses.", "14. Patient is concerned about the side effects of this drug, among which is increased susceptibility to the upper respiratory tract and urinary tract infections."], "atomic_facts": ["1. The patient was diagnosed with relapsing-remitting multiple sclerosis 2 months ago.", "2. The diagnosis was made after she suffered a second episode of optic neuritis.", "3. She was treated with methylprednisolone pulse therapy and discharged.", "4. Currently, she complains of slight fatigue with upper and lower extremity weakness.", "5. Her blood pressure is 120/80 mm Hg.", "6. Her heart rate is 63/min.", "7. Her respiratory rate is 14/min.", "8. Her temperature is 36.7\u00b0C (98.0\u00b0F).", "9. Neurological examination reveals brisk deep reflexes (3+ equal) and decreased strength (4/4) in the upper limbs.", "10. The rest of the examination is unremarkable.", "11. The patient is prescribed a drug that is an inhibitor of \u02514-integrin (CD49d) for the prevention of relapses.", "12. The patient is concerned about the side effects of the drug, including increased susceptibility to upper respiratory tract and urinary tract infections."]}
{"id": 322, "question": "Which of the following is the best next step in management?", "context": ["A 64-year-old man presents to the clinic complaining of low back pain.", "He was diagnosed with benign prostatic hypertrophy several years ago, which worsened last year.", "A hard nodule was felt on a digital rectal exam, which led to a prostate biopsy that revealed high-grade adenocarcinoma.", "A bone scan at that time showed small, focal abnormalities in the lumbar spine.", "He subsequently underwent radiation therapy to his prostate and pelvic lymph nodes.", "He was then placed on leuprolide and an anti-androgen.", "He was doing well until 2 months ago when he developed low back pain, which has worsened since then.", "He reports that the pain is 8/10 and nearly constant.", "He states that the pain not only affects his ability to fall asleep but also wakes him up at night.", "The pain is mildly alleviated by ibuprofen.", "In addition to prostate cancer, his medical history is significant for hypertension, hyperlipidemia, recurrent nephrolithiasis, and gastroesophageal reflux disease.", "He takes aspirin, lisinopril, rosuvastatin, and pantoprazole.", "Upon physical examination, there is midline tenderness within the lumbar region.", "Magnetic resonance imaging of the spine is obtained, which shows bony metastasis to the L2 and L3 spine without evidence of fracture or spinal cord compression.", "His prostate-specific antigen is 17.5 ng/mL."], "context_len": 15, "options": {"A": "Calcium and vitamin D supplementation", "B": "External radiation therapy", "C": "Flutamide", "D": "Kyphoplasty"}, "answer": "External radiation therapy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "64", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 64 years old.", "2. Patient presents with low back pain.", "3. Patient was diagnosed with benign prostatic hypertrophy several years ago.", "4. Benign prostatic hypertrophy worsened last year.", "5. Digital rectal exam revealed a hard nodule.", "6. Prostate biopsy revealed high-grade adenocarcinoma.", "7. Bone scan showed small, focal abnormalities in the lumbar spine.", "8. Patient underwent radiation therapy to prostate and pelvic lymph nodes.", "9. Patient was placed on leuprolide and an anti-androgen.", "10. Patient was doing well until 2 months ago.", "11. Low back pain has worsened since then.", "12. Pain is 8/10 and nearly constant.", "13. Pain affects patient's ability to fall asleep and wakes him up at night.", "14. Pain is mildly alleviated by ibuprofen.", "15. Patient's medical history is significant for hypertension, hyperlipidemia, recurrent nephrolithiasis, and gastroesophageal reflux disease.", "16. Patient takes aspirin, lisinopril, rosuvastatin, and pantoprazole.", "17. Physical examination reveals midline tenderness within the lumbar region.", "18. Magnetic resonance imaging of the spine shows bony metastasis to the L2 and L3 spine without evidence of fracture or spinal cord compression.", "19. Patient's prostate-specific antigen is 17.5 ng/mL."], "atomic_facts": ["1. Diagnosed with benign prostatic hypertrophy several years ago", "2. Diagnosis worsened last year", "3. Hard nodule felt on digital rectal exam", "4. Prostate biopsy revealed high-grade adenocarcinoma", "5. Bone scan showed small, focal abnormalities in the lumbar spine", "6. Underwent radiation therapy to prostate and pelvic lymph nodes", "7. Placed on leuprolide and an anti-androgen", "8. Developed low back pain 2 months ago", "9. Pain is 8/10 and nearly constant", "10. Pain affects ability to fall asleep and wakes him up at night", "11. Pain mildly alleviated by ibuprofen", "12. Medical history significant for hypertension, hyperlipidemia, recurrent nephrolithiasis, and gastroesophageal reflux disease", "13. Takes aspirin, lisinopril, rosuvastatin, and pantoprazole", "14. Midline tenderness within the lumbar region upon physical examination", "15. Magnetic resonance imaging shows bony metastasis to the L2 and L3 spine without evidence of fracture or spinal cord compression", "16. Prostate-specific antigen is 17.5 ng/mL"]}
{"id": 323, "question": "Which of the following is the most likely cause of her current condition?", "context": ["Two days after undergoing internal fixation of a displaced right femoral fracture sustained during a motor vehicle accident, a 34-year-old woman develops sudden shortness of breath.", "On examination, she is oriented only to person.", "Her temperature is 38.3\u00b0C (100.9\u00b0F), pulse is 122/min, respiratory rate is 31/min, and blood pressure is 152/90 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 83%.", "There are several scattered petechiae on the anterior chest wall.", "Her hemoglobin concentration is 10.3 g/dL, leukocyte count is 9,500/mm3, and platelet count is 140,000/mm3."], "context_len": 6, "options": {"A": "Fat globules entering the circulation", "B": "Rupture of a coronary plaque", "C": "Damage to the alveolar capillary endothelium", "D": "Bacterial invasion of the pulmonary parenchyma"}, "answer": "Fat globules entering the circulation", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 34-year-old woman developed sudden shortness of breath two days after undergoing internal fixation of a displaced right femoral fracture sustained during a motor vehicle accident.", "2. On examination, she is oriented only to person.", "3. Her temperature is 38.3\u00b0C (100.9\u00b0F).", "4. Her pulse is 122/min.", "5. Her respiratory rate is 31/min.", "6. Her blood pressure is 152/90 mm Hg.", "7. Pulse oximetry on room air shows an oxygen saturation of 83%.", "8. There are several scattered petechiae on the anterior chest wall.", "9. Her hemoglobin concentration is 10.3 g/dL.", "10. Her leukocyte count is 9,500/mm3.", "11. Her platelet count is 140,000/mm3."], "atomic_facts": ["1. On examination, she is oriented only to person.", "2. Her temperature is 38.3\u00b0C (100.9\u00b0F).", "3. Her pulse is 122/min.", "4. Her respiratory rate is 31/min.", "5. Her blood pressure is 152/90 mm Hg.", "6. Pulse oximetry on room air shows an oxygen saturation of 83%.", "7. There are several scattered petechiae on the anterior chest wall.", "8. Her hemoglobin concentration is 10.3 g/dL.", "9. Her leukocyte count is 9,500/mm3.", "10. Her platelet count is 140,000/mm3."]}
{"id": 324, "question": "Which of the following is the most likely diagnosis?", "context": ["A 15-year-old girl comes to the physician for the evaluation of a painless swelling under the left lower jaw for 5 months.", "Her 18-year-old sister has a history of acute lymphoblastic leukemia that has been in remission for 11 years.", "The patient's temperature is 37\u00b0C (98.6\u00b0F) Physical examination shows a 3 \u00d7 2 cm swelling on the left side, 4 cm below the base of the mandible and anterior to the sternocleidomastoid muscle.", "The swelling is soft and fluctuant.", "It does not move with swallowing, and forced exhalation against a closed glottis does not increase the size of the swelling.", "Ultrasound shows a round mass with uniform low echogenicity and no internal septations."], "context_len": 6, "options": {"A": "Lymphadenopathy", "B": "Branchial cleft cyst", "C": "Laryngocele", "D": "Infantile hemangioma"}, "answer": "Branchial cleft cyst", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "15 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is a 15-year-old girl.", "2. Patient has a painless swelling under the left lower jaw for 5 months.", "3. Patient's 18-year-old sister has a history of acute lymphoblastic leukemia in remission for 11 years.", "4. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "5. Physical examination shows a 3 \u00d7 2 cm swelling on the left side, 4 cm below the base of the mandible and anterior to the sternocleidomastoid muscle.", "6. Swelling is soft and fluctuant.", "7. Swelling does not move with swallowing.", "8. Forced exhalation against a closed glottis does not increase the size of the swelling.", "9. Ultrasound shows a round mass with uniform low echogenicity and no internal septations."], "atomic_facts": ["1. Her 18-year-old sister has a history of acute lymphoblastic leukemia.", "2. The sister's leukemia has been in remission for 11 years.", "3. The patient's temperature is 37\u00b0C (98.6\u00b0F).", "4. Physical examination shows a 3 \u00d7 2 cm swelling on the left side, 4 cm below the base of the mandible and anterior to the sternocleidomastoid muscle.", "5. The swelling is soft and fluctuant.", "6. The swelling does not move with swallowing.", "7. Forced exhalation against a closed glottis does not increase the size of the swelling.", "8. Ultrasound shows a round mass with uniform low echogenicity and no internal septations."]}
{"id": 325, "question": "Which of the following is the most likely cause of this patient\u2019s current condition?", "context": ["A 70-year-old man is brought to the emergency department by staff of the group home where he resides because of fever, a productive cough, and blood-tinged sputum for 2 days.", "The staff report that he developed myalgia, headache, and rhinorrhea 7 days ago, which improved initially before worsening again.", "He has hypertension and Alzheimer disease.", "Current medications include enalapril and donepezil.", "On arrival, he is obtunded.", "His temperature is 39.8\u00b0C (103.6\u00b0F), pulse is 120/min, respirations are 22/min and shallow, and blood pressure is 100/60 mm Hg.", "Pulse oximetry on 10 L/min of oxygen via nasal cannula shows an oxygen saturation of 92%.", "Examination shows scattered crackles and rhonchi throughout both lung fields.", "An x-ray of the chest shows bilateral lung opacities and multiple small, thin-walled cystic spaces within the basal pulmonary parenchyma."], "context_len": 9, "options": {"A": "Infection with Staphylococcus aureus", "B": "Infection with Aspergillus fumigatus", "C": "Foreign body aspiration", "D": "Granulomatosis with polyangiitis"}, "answer": "Infection with Staphylococcus aureus", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 70-year-old man is brought to the emergency department.", "2. He resides in a group home.", "3. He has fever, a productive cough, and blood-tinged sputum for 2 days.", "4. He developed myalgia, headache, and rhinorrhea 7 days ago.", "5. His symptoms initially improved before worsening again.", "6. He has hypertension and Alzheimer disease.", "7. His current medications include enalapril and donepezil.", "8. On arrival, he is obtunded.", "9. His temperature is 39.8\u00b0C (103.6\u00b0F).", "10. His pulse is 120/min.", "11. His respirations are 22/min and shallow.", "12. His blood pressure is 100/60 mm Hg.", "13. Pulse oximetry on 10 L/min of oxygen via nasal cannula shows an oxygen saturation of 92%.", "14. Examination shows scattered crackles and rhonchi throughout both lung fields.", "15. An x-ray of the chest shows bilateral lung opacities.", "16. An x-ray of the chest shows multiple small, thin-walled cystic spaces within the basal pulmonary parenchyma."], "atomic_facts": ["1. He developed myalgia, headache, and rhinorrhea 7 days ago.", "2. His symptoms improved initially before worsening again.", "3. He has hypertension.", "4. He has Alzheimer's disease.", "5. His current medications include enalapril and donepezil.", "6. On arrival, he is obtunded.", "7. His temperature is 39.8\u00b0C (103.6\u00b0F).", "8. His pulse is 120/min.", "9. His respirations are 22/min and shallow.", "10. His blood pressure is 100/60 mm Hg.", "11. Pulse oximetry on 10 L/min of oxygen via nasal cannula shows an oxygen saturation of 92%.", "12. Examination shows scattered crackles and rhonchi throughout both lung fields.", "13. An x-ray of the chest shows bilateral lung opacities.", "14. An x-ray of the chest shows multiple small, thin-walled cystic spaces within the basal pulmonary parenchyma."]}
{"id": 326, "question": "Which of the following is the most likely infectious agent?", "context": ["A 55-year-old man presents to his primary care physician with ear pain.", "The patient states he has had worsening ear pain for the past 2 days.", "He describes his pain as 9/10.", "The patient has a past medical history of diabetes, obesity, and hypertension.", "His current medications include insulin, metformin, lisinopril, aspirin, and atorvastatin.", "His temperature is 100.5\u00b0F (38.1\u00b0C), blood pressure is 177/99 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 98% on room air.", "Physical exam reveals a purulent drainage from the ear canal.", "Manipulation of the ear causes severe pain."], "context_len": 8, "options": {"A": "Haemophilus influenzae", "B": "Moraxella catarrhalis", "C": "Pseudomonas aeruginosa", "D": "Staphylococcus aureus"}, "answer": "Pseudomonas aeruginosa", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 55 years old.", "2. Patient has ear pain for 2 days.", "3. Patient describes pain as 9/10.", "4. Patient has past medical history of diabetes, obesity, and hypertension.", "5. Patient is taking insulin, metformin, lisinopril, aspirin, and atorvastatin.", "6. Patient's temperature is 100.5\u00b0F (38.1\u00b0C).", "7. Patient's blood pressure is 177/99 mmHg.", "8. Patient's pulse is 100/min.", "9. Patient's respirations are 19/min.", "10. Patient's oxygen saturation is 98% on room air.", "11. Physical exam reveals purulent drainage from ear canal.", "12. Manipulation of ear causes severe pain."], "atomic_facts": ["1. The patient has had worsening ear pain for the past 2 days.", "2. The patient describes his pain as 9/10.", "3. The patient has a past medical history of diabetes, obesity, and hypertension.", "4. The patient's current medications include insulin, metformin, lisinopril, aspirin, and atorvastatin.", "5. The patient's temperature is 100.5\u00b0F (38.1\u00b0C).", "6. The patient's blood pressure is 177/99 mmHg.", "7. The patient's pulse is 100/min.", "8. The patient's respirations are 19/min.", "9. The patient's oxygen saturation is 98% on room air.", "10. Physical exam reveals a purulent drainage from the ear canal.", "11. Manipulation of the ear causes severe pain."]}
{"id": 327, "question": "How do you respond?", "context": ["A 19-year-old male college student with no significant medical history presents to the emergency department with altered mental status.", "His girlfriend said that he drank multiple shots of vodka and gin throughout the weekend and was found slumped on the couch with some vomit on his shirt.", "He is afebrile, with a blood pressure of 128/60 mmHg, pulse of 100/min, respirations at 25/min, and SpO2 of 95% on room air.", "His pupils are equal and reactive to light bilaterally.", "He exhibits no tremors or myoclonus.", "The remainder of the physical exam is unremarkable.", "His basic metabolic panel is displayed below: |  | Serum: | Na+: 138 mEq/L | Cl-: 90 mEq/L | K+: 4.0 mEq/L | HCO3-: 20 mEq/L | BUN: 30 mg/dL | Glucose: 100 mg/dL | Creatinine: 0.8 mg/dL |  | An arterial blood gas reveals the following: |  | pH: 7.32 | pCO2: 34 mmHg | pO2: 89 mmHg |  | The girlfriend is concerned that the patient's breathing appears uncomfortable."], "context_len": 7, "options": {"A": "His breathing is concerning for hepatic encephalopathy", "B": "His breathing suggests that he needs some fluids", "C": "His breathing suggests that he has major depression disorder", "D": "You are not his healthcare proxy and I cannot speak to you"}, "answer": "His breathing suggests that he needs some fluids", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "19", "specialties": ["Emergency Medicine", "Neurology"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 19-year-old male college student with no significant medical history presents to the emergency department with altered mental status.", "2. His girlfriend said that he drank multiple shots of vodka and gin throughout the weekend and was found slumped on the couch with some vomit on his shirt.", "3. He is afebrile.", "4. His blood pressure is 128/60 mmHg.", "5. His pulse is 100/min.", "6. His respirations are 25/min.", "7. His SpO2 is 95% on room air.", "8. His pupils are equal and reactive to light bilaterally.", "9. He exhibits no tremors or myoclonus.", "10. The remainder of the physical exam is unremarkable.", "11. His serum Na+ is 138 mEq/L.", "12. His serum Cl- is 90 mEq/L.", "13. His serum K+ is 4.0 mEq/L.", "14. His serum HCO3- is 20 mEq/L.", "15. His BUN is 30 mg/dL.", "16. His glucose is 100 mg/dL.", "17. His creatinine is 0.8 mg/dL.", "18. His pH is 7.32.", "19. His pCO2 is 34 mmHg.", "20. His pO2 is 89 mmHg.", "21. The girlfriend is concerned that the patient's breathing appears uncomfortable."], "atomic_facts": ["1. The patient drank multiple shots of vodka and gin throughout the weekend.", "2. The patient was found slumped on the couch with vomit on his shirt.", "3. The patient is afebrile.", "4. The patient's blood pressure is 128/60 mmHg.", "5. The patient's pulse is 100/min.", "6. The patient's respirations are at 25/min.", "7. The patient's SpO2 is 95% on room air.", "8. The patient's pupils are equal and reactive to light bilaterally.", "9. The patient exhibits no tremors or myoclonus.", "10. The remainder of the physical exam is unremarkable.", "11. The patient's basic metabolic panel shows: Na+: 138 mEq/L, Cl-: 90 mEq/L, K+: 4.0 mEq/L, HCO3-: 20 mEq/L, BUN: 30 mg/dL, Glucose: 100 mg/dL, Creatinine: 0.8 mg/dL.", "12. An arterial blood gas reveals: pH: 7.32, pCO2: 34 mmHg, pO2: 89 mmHg.", "13. The girlfriend is concerned that the patient's breathing appears uncomfortable."]}
{"id": 328, "question": "Which of the following explains these findings?", "context": ["A 56-year-old man presents to his primary care provider for a check-up.", "His past medical history is significant for type 2 diabetes mellitus for 20 years and insomnia.", " He takes metformin and insulin NPH.", "Both of his parents died in a car accident several years ago.", "He smokes a half of a pack of cigarettes every day and drinks 1-2 beers a day and more on the weekends.", "Today, his blood pressure is 130/80 mm Hg, pulse is 76/min, respiratory rate is 18/min, and temperature is 36.5\u00b0C (97.7\u00b0F).", "On physical exam, he appears obese.", "His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally.", "A foot exam is performed and is unremarkable.", "A urinalysis reveals  glucose (++), and protein (+++)."], "context_len": 10, "options": {"A": "Glomerular hyperfiltration", "B": "Renal artery stenosis", "C": "Subendothelial immune-complex deposits", "D": "Interstitial atrophy"}, "answer": "Glomerular hyperfiltration", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Nephrology"], "subspecialties": ["General Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 56-year-old man presents to his primary care provider for a check-up.", "2. His past medical history is significant for type 2 diabetes mellitus for 20 years and insomnia.", "3. He takes metformin and insulin NPH.", "4. Both of his parents died in a car accident several years ago.", "5. He smokes a half of a pack of cigarettes every day and drinks 1-2 beers a day and more on the weekends.", "6. Today, his blood pressure is 130/80 mm Hg.", "7. Today, his pulse is 76/min.", "8. Today, his respiratory rate is 18/min.", "9. Today, his temperature is 36.5\u00b0C (97.7\u00b0F).", "10. On physical exam, he appears obese.", "11. His heart has a regular rate and rhythm.", "12. His lungs are clear to auscultation bilaterally.", "13. A foot exam is performed and is unremarkable.", "14. A urinalysis reveals glucose (++).", "15. A urinalysis reveals protein (+++)."], "atomic_facts": ["1. His past medical history includes type 2 diabetes mellitus for 20 years.", "2. His past medical history includes insomnia.", "3. He takes metformin.", "4. He takes insulin NPH.", "5. Both of his parents died in a car accident several years ago.", "6. He smokes half a pack of cigarettes every day.", "7. He drinks 1-2 beers a day and more on the weekends.", "8. His blood pressure is 130/80 mm Hg.", "9. His pulse is 76/min.", "10. His respiratory rate is 18/min.", "11. His temperature is 36.5\u00b0C (97.7\u00b0F).", "12. On physical exam, he appears obese.", "13. His heart has a regular rate and rhythm.", "14. His lungs are clear to auscultation bilaterally.", "15. A foot exam is performed and is unremarkable.", "16. A urinalysis reveals glucose (++).", "17. A urinalysis reveals protein (+++)."]}
{"id": 329, "question": "Treatment with which of the following drugs was most likely initiated in this patient?", "context": ["A 64-year-old man comes to the physician because of a 1-month history of progressively worsening back pain that wakes him up at night.", "He also reports symptoms of urinary urgency and a weak urine stream.", "He has no history of serious illness and takes no medications.", "Rectal examination shows an enlarged and hardened prostate with a nodular surface.", "After further evaluation and confirmation of the diagnosis, he is started on a new drug.", "Initially, there is an increase in serum testosterone and dihydrotestosterone levels, followed by a sustained decrease in both serum hormone levels."], "context_len": 6, "options": {"A": "Leuprolide", "B": "Finasteride", "C": "Ketoconazole", "D": "Cyproterone acetate"}, "answer": "Leuprolide", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "64 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery", "Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 64-year-old man comes to the physician.", "2. He has a 1-month history of progressively worsening back pain that wakes him up at night.", "3. He also reports symptoms of urinary urgency and a weak urine stream.", "4. He has no history of serious illness and takes no medications.", "5. Rectal examination shows an enlarged and hardened prostate with a nodular surface.", "6. After further evaluation and confirmation of the diagnosis, he is started on a new drug.", "7. Initially, there is an increase in serum testosterone and dihydrotestosterone levels.", "8. This is followed by a sustained decrease in both serum hormone levels."], "atomic_facts": ["1. Patient reports symptoms of urinary urgency", "2. Patient reports symptoms of a weak urine stream", "3. Patient has no history of serious illness", "4. Patient takes no medications", "5. Rectal examination shows an enlarged prostate", "6. Rectal examination shows a hardened prostate", "7. Rectal examination shows a nodular surface of the prostate", "8. Patient is started on a new drug", "9. Initially, there is an increase in serum testosterone levels", "10. Initially, there is an increase in dihydrotestosterone levels", "11. There is a sustained decrease in serum testosterone levels", "12. There is a sustained decrease in dihydrotestosterone levels"]}
{"id": 330, "question": "The toxin responsible for this clinical presentation has a mechanism of action that is most similar to which other toxin?", "context": ["A 46-year-old man presents to a physician three days after arriving in Morocco.", "He endorses acute onset of painless, profuse watery diarrhea that appears white and cloudy.", "The patient denies bloody stool, vomiting, or subjective fevers.", "Vital signs are T 98.6, HR 120, RR 17, and BP 85/50.", "On physical exam, the patient has dry mouth, decreased skin turgor, and cold clammy skin.", "His peripheral pulse is rapid and thready."], "context_len": 6, "options": {"A": "Diphtheria toxin", "B": "Exotoxin A", "C": "Edema toxin", "D": "Shiga-like toxin"}, "answer": "Edema toxin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "46 years old", "specialties": ["Infectious Disease"], "subspecialties": ["General Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 46-year-old man presents to a physician.", "2. He arrived in Morocco three days ago.", "3. He has acute onset of painless, profuse watery diarrhea.", "4. The diarrhea appears white and cloudy.", "5. The patient denies bloody stool, vomiting, or subjective fevers.", "6. His temperature is 98.6.", "7. His heart rate is 120.", "8. His respiratory rate is 17.", "9. His blood pressure is 85/50.", "10. On physical exam, he has dry mouth.", "11. He has decreased skin turgor.", "12. His skin is cold and clammy.", "13. His peripheral pulse is rapid and thready."], "atomic_facts": ["1. The patient endorses acute onset of painless, profuse watery diarrhea.", "2. The diarrhea appears white and cloudy.", "3. The patient denies bloody stool, vomiting, or subjective fevers.", "4. Vital signs are T 98.6, HR 120, RR 17, and BP 85/50.", "5. On physical exam, the patient has dry mouth.", "6. The patient has decreased skin turgor.", "7. The patient has cold clammy skin.", "8. His peripheral pulse is rapid and thready."]}
{"id": 331, "question": "What test will most likely be positive?", "context": ["A 25-year-old woman presents to the urgent care center with a one month history of intermittent chest pain that occurs about 2-3 times per week in the early mornings.", "She does not smoke and has never suffered from chest pain before.", "She has no family history of early MI.", "A 12 lead ECG does not show any abnormalities.", "Creatine kinase and troponin I enzymes are within normal limits."], "context_len": 5, "options": {"A": "Ergonovine", "B": "Immediately repeat ECG", "C": "Exercise stress test", "D": "Kehr's sign"}, "answer": "Ergonovine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 25-year-old woman presents to the urgent care center.", "2. She has a one month history of intermittent chest pain.", "3. The chest pain occurs about 2-3 times per week in the early mornings.", "4. She does not smoke.", "5. She has never suffered from chest pain before.", "6. She has no family history of early MI.", "7. A 12 lead ECG does not show any abnormalities.", "8. Creatine kinase and troponin I enzymes are within normal limits."], "atomic_facts": ["1. She does not smoke.", "2. She has never suffered from chest pain before.", "3. She has no family history of early MI.", "4. A 12 lead ECG does not show any abnormalities.", "5. Creatine kinase enzymes are within normal limits.", "6. Troponin I enzymes are within normal limits."]}
{"id": 332, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?", "context": ["A 28-year-old man is scheduled for skin grafting of the right leg.", "Four weeks earlier, he underwent open reduction and internal fixation of an open right tibial fracture.", "The postoperative period at that time was complicated by necrosis of the overlying skin.", "In the operating room, he is placed on continuous hemodynamic monitoring and anesthetized with intrathecal bupivacaine injected into the L3\u2013L4 spinal interspace.", "Thirty minutes later, he has severe shortness of breath and lightheadedness and loses consciousness.", "His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 38/min, respirations are 24/min, and palpable systolic blood pressure is 58 mmHg.", "The skin is diaphoretic and flushed.", "He withdraws the upper extremities to painful stimuli above the navel.", "The lungs are clear to auscultation.", "Heart sounds are not audible."], "context_len": 10, "options": {"A": "Loss of sympathetic vascular tone", "B": "Obstructive thrombus in the pulmonary artery", "C": "Intravascular volume depletion", "D": "Type I hypersensitivity reaction"}, "answer": "Loss of sympathetic vascular tone", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "28 years old", "specialties": ["Plastic Surgery", "Dermatology"], "subspecialties": ["General Plastic Surgery", "Micrographic Dermatologic Surgery"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Plastic Surgery"}, "facts_old": ["1. A 28-year-old man is scheduled for skin grafting of the right leg.", "2. Four weeks earlier, he underwent open reduction and internal fixation of an open right tibial fracture.", "3. The postoperative period at that time was complicated by necrosis of the overlying skin.", "4. In the operating room, he is placed on continuous hemodynamic monitoring.", "5. Anesthetized with intrathecal bupivacaine injected into the L3\u2013L4 spinal interspace.", "6. Thirty minutes later, he has severe shortness of breath and lightheadedness and loses consciousness.", "7. His temperature is 37.1\u00b0C (98.8\u00b0F).", "8. Pulse is 38/min.", "9. Respirations are 24/min.", "10. Palpable systolic blood pressure is 58 mmHg.", "11. The skin is diaphoretic and flushed.", "12. He withdraws the upper extremities to painful stimuli above the navel.", "13. The lungs are clear to auscultation.", "14. Heart sounds are not audible."], "atomic_facts": ["1. Four weeks earlier, open reduction and internal fixation of an open right tibial fracture", "2. Postoperative period complicated by necrosis of the overlying skin", "3. Placed on continuous hemodynamic monitoring in the operating room", "4. Anesthetized with intrathecal bupivacaine injected into the L3\u2013L4 spinal interspace", "5. Thirty minutes later, severe shortness of breath and lightheadedness", "6. Loss of consciousness", "7. Temperature is 37.1\u00b0C (98.8\u00b0F)", "8. Pulse is 38/min", "9. Respirations are 24/min", "10. Palpable systolic blood pressure is 58 mmHg", "11. Skin is diaphoretic and flushed", "12. Withdraws upper extremities to painful stimuli above the navel", "13. Lungs are clear to auscultation", "14. Heart sounds are not audible"]}
{"id": 333, "question": "Which of the following is the best next step in management?", "context": ["A 42-year-old man with no significant medical history presents to the emergency department with complaints of headache, nausea, and dizziness.", "He states that he was at home working on his car when he started to feel dizzy and experienced a headache.", "This progressed to him feeling nauseous.", "The patient states he went inside and drank some water and felt better; however, when he started working on his car again his symptoms returned.", "Upon presentation, he states his symptoms have mostly improved except for a persistent headache.", "His temperature is 98.1\u00b0F (36.7\u00b0C), blood pressure is 125/84 mmHg, pulse is 87/min, respirations are 18/min, and oxygen saturation is 98% on room air.", "Neurologic exam is unremarkable."], "context_len": 7, "options": {"A": "100% oxygen", "B": "CT", "C": "Hydroxocobalamin", "D": "Ibuprofen and acetaminophen"}, "answer": "100% oxygen", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "42", "specialties": ["Emergency Medicine"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 42 years old.", "2. Patient has no significant medical history.", "3. Patient presented to the emergency department with complaints of headache, nausea, and dizziness.", "4. Patient was at home working on his car when he started to feel dizzy and experienced a headache.", "5. Symptoms progressed to feeling nauseous.", "6. Patient went inside and drank some water and felt better.", "7. Symptoms returned when patient started working on his car again.", "8. Upon presentation, patient states his symptoms have mostly improved except for a persistent headache.", "9. Patient's temperature is 98.1\u00b0F (36.7\u00b0C).", "10. Patient's blood pressure is 125/84 mmHg.", "11. Patient's pulse is 87/min.", "12. Patient's respirations are 18/min.", "13. Patient's oxygen saturation is 98% on room air.", "14. Neurologic exam is unremarkable."], "atomic_facts": ["1. The patient was at home working on his car when he started to feel dizzy and experienced a headache.", "2. His symptoms progressed to feeling nauseous.", "3. After drinking water, he felt better, but his symptoms returned when he resumed working on his car.", "4. Upon presentation, his symptoms had mostly improved except for a persistent headache.", "5. His temperature is 98.1\u00b0F (36.7\u00b0C).", "6. His blood pressure is 125/84 mmHg.", "7. His pulse is 87/min.", "8. His respirations are 18/min.", "9. His oxygen saturation is 98% on room air.", "10. His neurologic exam is unremarkable."]}
{"id": 334, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 19-year-old woman comes to the physician because of severe headaches for the past 3 months.", "The headaches are pulsating in nature and she describes the pain as 8 out of 10 in intensity.", "She has visited the emergency department for headaches twice in the past month; during both visits, her blood pressure was elevated.", "She has polycystic ovarian disease.", "Her medications include metformin and an oral contraceptive pill.", "She is 162 cm (5 ft 4 in) tall and weighs 86 kg (190 lb); BMI is 32.8 kg/m2.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 99/min, and blood pressure is 168/98 mm Hg.", "Examination shows hirsutism.", "Cardiopulmonary examination shows no abnormalities.", "The abdomen is soft and nontender.", "An abdominal bruit is heard on the left side.", "Neurologic examination shows no focal findings.", "A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "Plasma free metanephrines are within the reference range.", "An abdominal ultrasound shows an increased peak systolic velocity in the distal portion of the left renal artery.", "A contrast-enhanced CT scan of the abdomen shows alternating stenosis and dilation in an 8-mm distal segment of the left renal artery with approximately 75% reduction in the diameter of the vessel.", "A CT scan of the brain shows no abnormalities."], "context_len": 17, "options": {"A": "Combination therapy with captopril and valsartan", "B": "Percutaneous transluminal angioplasty without stent placement", "C": "Ramipril and percutaneous transluminal angioplasty without stent placement", "D": "Enalapril and aortorenal bypass with a vein graft"}, "answer": "Ramipril and percutaneous transluminal angioplasty without stent placement", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "19 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 19 years old.", "2. Patient has had severe headaches for 3 months.", "3. Headaches are pulsating in nature.", "4. Patient describes pain as 8 out of 10 in intensity.", "5. Patient has visited the emergency department twice in the past month.", "6. Both visits showed elevated blood pressure.", "7. Patient has polycystic ovarian disease.", "8. Medications include metformin and an oral contraceptive pill.", "9. Patient is 162 cm tall and weighs 86 kg.", "10. BMI is 32.8 kg/m2.", "11. Temperature is 37\u00b0C (98.6\u00b0F).", "12. Pulse is 99/min.", "13. Blood pressure is 168/98 mm Hg.", "14. Examination shows hirsutism.", "15. Cardiopulmonary examination shows no abnormalities.", "16. Abdomen is soft and nontender.", "17. Abdominal bruit is heard on the left side.", "18. Neurologic examination shows no focal findings.", "19. Complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "20. Plasma free metanephrines are within the reference range.", "21. Abdominal ultrasound shows increased peak systolic velocity in the distal portion of the left renal artery.", "22. Contrast-enhanced CT scan of the abdomen shows alternating stenosis and dilation in an 8-mm distal segment of the left renal artery with approximately 75% reduction in the diameter of the vessel.", "23. CT scan of the brain shows no abnormalities."], "atomic_facts": ["1. The headaches are pulsating in nature.", "2. She describes the pain as 8 out of 10 in intensity.", "3. She has visited the emergency department for headaches twice in the past month.", "4. During both visits, her blood pressure was elevated.", "5. She has polycystic ovarian disease.", "6. Her medications include metformin and an oral contraceptive pill.", "7. She is 162 cm (5 ft 4 in) tall and weighs 86 kg (190 lb).", "8. Her BMI is 32.8 kg/m2.", "9. Her temperature is 37\u00b0C (98.6\u00b0F).", "10. Her pulse is 99/min.", "11. Her blood pressure is 168/98 mm Hg.", "12. Examination shows hirsutism.", "13. Cardiopulmonary examination shows no abnormalities.", "14. The abdomen is soft and nontender.", "15. An abdominal bruit is heard on the left side.", "16. Neurologic examination shows no focal findings.", "17. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "18. Plasma free metanephrines are within the reference range.", "19. An abdominal ultrasound shows an increased peak systolic velocity in the distal portion of the left renal artery.", "20. A contrast-enhanced CT scan of the abdomen shows alternating stenosis and dilation in an 8-mm distal segment of the left renal artery with approximately 75% reduction in the diameter of the vessel.", "21. A CT scan of the brain shows no abnormalities."]}
{"id": 335, "question": "Which of the following is the most likely diagnosis?", "context": ["A 28-year-old male is found to have 93% HbA, 2% HbF, and 5% HbA2 on hemoglobin electrophoresis."], "context_len": 1, "options": {"A": "Alpha thalassemia major with Hb Bart's", "B": "Beta-thalassemia minor", "C": "Beta-thalassemia major", "D": "Diabetes mellitus"}, "answer": "Beta-thalassemia minor", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "28 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. Patient is 28 years old.", "2. Patient is male.", "3. Hemoglobin electrophoresis reveals 93% HbA.", "4. Hemoglobin electrophoresis reveals 2% HbF.", "5. Hemoglobin electrophoresis reveals 5% HbA2."], "atomic_facts": ["1. A 28-year-old male", "2. Found to have 93% HbA", "3. Found to have 2% HbF", "4. Found to have 5% HbA2", "5. On hemoglobin electrophoresis"]}
{"id": 336, "question": "Which of the following is the best assessment of the patient\u2019s capacity to make healthcare decisions?", "context": ["A 76-year-old female is brought to the emergency department for altered mental status.", "She is accompanied by a nurse from her nursing home.", "The nurse says that usually the patient is interactive even though she is sometimes forgetful.", "In the last two days, the patient has been increasingly lethargic and doesn\u2019t respond to the staff\u2019s questions.", "She also has not been able to get up and use the restroom so the staff has had to change multiple soiled sheets.", "Her temperature is 102.1\u00b0F (38.9\u00b0C), blood pressure is 100/74 mmHg, pulse is 120/min, and respirations are 24/min.", "The patient is combative on arrival but can be subdued with reorientation by the care team.", "She is not oriented to person, place, or time.", "Urinalysis shows positive leukocyte esterase and nitrites.", "Urine culture grows >100,000 CFU of E.", "coli.", "The physician team would like to consent this patient for a Foley catheter."], "context_len": 12, "options": {"A": "The patient does not have capacity to make decisions", "B": "The patient does have capacity to make decisions", "C": "The hospital ethics board should be consulted", "D": "Capacity cannot be determined at this time"}, "answer": "Capacity cannot be determined at this time", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "76", "specialties": ["Psychiatry"], "subspecialties": ["Geriatric Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is 76 years old.", "2. Patient is female.", "3. Patient is accompanied by a nurse from her nursing home.", "4. Patient is usually interactive, but sometimes forgetful.", "5. Patient has been increasingly lethargic in the last two days.", "6. Patient does not respond to staff's questions.", "7. Patient has not been able to get up and use the restroom.", "8. Staff has had to change multiple soiled sheets.", "9. Patient's temperature is 102.1\u00b0F (38.9\u00b0C).", "10. Patient's blood pressure is 100/74 mmHg.", "11. Patient's pulse is 120/min.", "12. Patient's respirations are 24/min.", "13. Patient is combative on arrival.", "14. Patient can be subdued with reorientation by the care team.", "15. Patient is not oriented to person, place, or time.", "16. Urinalysis shows positive leukocyte esterase and nitrites.", "17. Urine culture grows >100,000 CFU of E. coli.", "18. Physician team would like to consent this patient for a Foley catheter."], "atomic_facts": ["1. The patient is accompanied by a nurse from her nursing home.", "2. The nurse states that the patient is usually interactive but sometimes forgetful.", "3. In the last two days, the patient has been increasingly lethargic and unresponsive to staff questions.", "4. The patient has not been able to get up and use the restroom, requiring staff to change multiple soiled sheets.", "5. The patient's temperature is 102.1\u00b0F (38.9\u00b0C), blood pressure is 100/74 mmHg, pulse is 120/min, and respirations are 24/min.", "6. The patient is combative on arrival but can be subdued with reorientation by the care team.", "7. The patient is not oriented to person, place, or time.", "8. Urinalysis shows positive leukocyte esterase and nitrites.", "9. Urine culture grows >100,000 CFU of E. coli.", "10. The physician team would like to consent this patient for a Foley catheter."]}
{"id": 337, "question": "While the physician empathizes with the family, which of the following is the most appropriate response?", "context": ["A 19-year-old woman is brought to the emergency department by ambulance 1 hour after a motor vehicle accident.", "She has no history of serious illness.", "She is on mechanical ventilation without any sedation.", "Her vital signs are within a normal range.", "Her Glasgow Coma Scale (GCS) is 3.", "Examination by the attending trauma surgeon and neurologist shows brain death.", "Laboratory studies show no abnormalities.", "A search on the state donor registry shows that she has registered as an organ donor.", "Her father is shocked at the suggestion of organ donation and says that \u201clife is still circulating in her body because it is warm, and she has a normal heartbeat!\u201d ."], "context_len": 9, "options": {"A": "\u201cOnly after your consent will her organs be removed.\u201d", "B": "\u201cBrain death is considered legal death just as if her heart was not beating.\u201d", "C": "\u201cShe is very unlikely to recover.\u201d", "D": "\u201cShe will be dead once she is disconnected from advanced life-support.\u201d"}, "answer": "\u201cBrain death is considered legal death just as if her heart was not beating.\u201d", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "19 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 19-year-old woman is brought to the emergency department by ambulance 1 hour after a motor vehicle accident.", "2. She has no history of serious illness.", "3. She is on mechanical ventilation without any sedation.", "4. Her vital signs are within a normal range.", "5. Her Glasgow Coma Scale (GCS) is 3.", "6. Examination by the attending trauma surgeon and neurologist shows brain death.", "7. Laboratory studies show no abnormalities.", "8. A search on the state donor registry shows that she has registered as an organ donor.", "9. Her father is shocked at the suggestion of organ donation.", "10. He says that \u201clife is still circulating in her body because it is warm, and she has a normal heartbeat!\u201d"], "atomic_facts": ["1. She has no history of serious illness.", "2. She is on mechanical ventilation without any sedation.", "3. Her vital signs are within a normal range.", "4. Her Glasgow Coma Scale (GCS) is 3.", "5. Examination by the attending trauma surgeon and neurologist shows brain death.", "6. Laboratory studies show no abnormalities.", "7. A search on the state donor registry shows that she has registered as an organ donor.", "8. Her father is shocked at the suggestion of organ donation.", "9. Her father says that \"life is still circulating in her body because it is warm, and she has a normal heartbeat.\""]}
{"id": 338, "question": "Which of the following ego defenses best characterizes this gentleman's behavior?", "context": ["A 58-year-old male has had long-term involvement in the world of organized crime.", "He very recently retired from his post within this organization.", "This former mafia boss has now suddenly started making large contributions to several local charities."], "context_len": 3, "options": {"A": "Altruism", "B": "Displacement", "C": "Sublimation", "D": "Atonement"}, "answer": "Altruism", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "58", "specialties": ["Psychiatry"], "subspecialties": ["Forensic Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 58-year-old male has had long-term involvement in the world of organized crime.", "2. He very recently retired from his post within this organization.", "3. This former mafia boss has now suddenly started making large contributions to several local charities."], "atomic_facts": ["1. He very recently retired from his post within this organization.", "2. This former mafia boss has now suddenly started making large contributions to several local charities."]}
{"id": 339, "question": "The patient's pulmonary function tests would be similar to that seen in a patient with:", "context": ["A 45-year-old man presents with a chronic productive cough that he has had for the past few years.", "He admits to having smoked 1 pack of cigarettes a day for the past 25 years.", "A chest radiograph reveals an enlarged heart."], "context_len": 3, "options": {"A": "Asymptomatic asthma", "B": "Silicosis", "C": "Emphysema", "D": "Coal worker's pneumonitis"}, "answer": "Emphysema", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 45-year-old man presents with a chronic productive cough.", "2. The cough has been present for the past few years.", "3. The man has smoked 1 pack of cigarettes a day for the past 25 years.", "4. A chest radiograph reveals an enlarged heart."], "atomic_facts": ["1. He admits to smoking 1 pack of cigarettes a day for the past 25 years.", "2. A chest radiograph reveals an enlarged heart."]}
{"id": 340, "question": "Which of the following physiological changes is most likely in this patient?", "context": ["A 69-year-old gentleman presents to his primary care physician for a general checkup.", "He states that overall he is doing well.", "Ever since he retired, he has been working on projects at home, and taking time to exercise every day.", "He eats a balanced diet, and has been spending time with his wife every evening.", "Despite this, the patient claims that he feels less well rested when he awakes in the morning.", "The patient states that he used to sleep nine hours a night in his youth and felt excellent.", "Now he sleeps seven hours a night and doesn\u2019t feel as well rested as he used to.", "The patient\u2019s wife states that he seems to sleep peacefully.", "On physical exam the patient\u2019s neurological exam is within normal limits.", "The patient is muscular and has a healthy weight and has a pleasant demeanor.", "He denies feeling fatigued or tired currently."], "context_len": 11, "options": {"A": "Decreased orexin", "B": "Decreased melatonin", "C": "Increased dopamine", "D": "Increased acetylcholine"}, "answer": "Decreased melatonin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "69", "specialties": ["Neurology"], "subspecialties": ["Sleep Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Others"}, "facts_old": ["1. A 69-year-old gentleman presents to his primary care physician for a general checkup.", "2. He states that overall he is doing well.", "3. Ever since he retired, he has been working on projects at home, and taking time to exercise every day.", "4. He eats a balanced diet, and has been spending time with his wife every evening.", "5. Despite this, the patient claims that he feels less well rested when he awakes in the morning.", "6. The patient states that he used to sleep nine hours a night in his youth and felt excellent.", "7. Now he sleeps seven hours a night and doesn\u2019t feel as well rested as he used to.", "8. The patient\u2019s wife states that he seems to sleep peacefully.", "9. On physical exam the patient\u2019s neurological exam is within normal limits.", "10. The patient is muscular and has a healthy weight and has a pleasant demeanor.", "11. He denies feeling fatigued or tired currently."], "atomic_facts": ["1. The patient states that overall he is doing well.", "2. Ever since he retired, he has been working on projects at home.", "3. He takes time to exercise every day.", "4. He eats a balanced diet.", "5. He has been spending time with his wife every evening.", "6. The patient claims that he feels less well rested when he awakes in the morning.", "7. He used to sleep nine hours a night in his youth and felt excellent.", "8. Now he sleeps seven hours a night and doesn\u2019t feel as well rested as he used to.", "9. The patient\u2019s wife states that he seems to sleep peacefully.", "10. On physical exam, the patient\u2019s neurological exam is within normal limits.", "11. The patient is muscular and has a healthy weight.", "12. He has a pleasant demeanor.", "13. He denies feeling fatigued or tired currently."]}
{"id": 341, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 7-year-old boy with sickle cell disease is brought into the clinic by his mother for knee and hip pain.", "The child has been admitted several times in the past for pain crises managed with fluids and hydromorphone.", "He started complaining of worsening hip pain over the last several days and now walks with a limp.", "His temperature is 97.9\u00b0F (36.6\u00b0C), blood pressure is 84/54 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 99% on room air.", "On physical exam, the hip appears normal and is cool to the touch.", "There is decreased range of motion at the hip and pain with ambulation."], "context_len": 6, "options": {"A": "CT", "B": "Ibuprofen and acetaminophen", "C": "MRI", "D": "Radiograph"}, "answer": "Radiograph", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 7-year-old boy.", "2. Patient has sickle cell disease.", "3. Patient is brought into the clinic by his mother.", "4. Patient has knee and hip pain.", "5. Patient has been admitted several times in the past for pain crises.", "6. Patient's pain crises were managed with fluids and hydromorphone.", "7. Patient has been complaining of worsening hip pain over the last several days.", "8. Patient now walks with a limp.", "9. Patient's temperature is 97.9\u00b0F (36.6\u00b0C).", "10. Patient's blood pressure is 84/54 mmHg.", "11. Patient's pulse is 100/min.", "12. Patient's respirations are 19/min.", "13. Patient's oxygen saturation is 99% on room air.", "14. On physical exam, the hip appears normal.", "15. On physical exam, the hip is cool to the touch.", "16. On physical exam, there is decreased range of motion at the hip.", "17. On physical exam, there is pain with ambulation."], "atomic_facts": ["1. The child has been admitted several times in the past for pain crises managed with fluids and hydromorphone.", "2. He started complaining of worsening hip pain over the last several days and now walks with a limp.", "3. His temperature is 97.9\u00b0F (36.6\u00b0C).", "4. His blood pressure is 84/54 mmHg.", "5. His pulse is 100/min.", "6. His respirations are 19/min.", "7. His oxygen saturation is 99% on room air.", "8. On physical exam, the hip appears normal and is cool to the touch.", "9. There is decreased range of motion at the hip.", "10. There is pain with ambulation."]}
{"id": 342, "question": "Which of the following is a risk factor for this patient condition?", "context": ["A 65-year-old asian man presents to his primary care physician because of abdominal distension, right upper quadrant (RUQ) abdominal pain, decreased appetite, and weight loss for several weeks.", "He denies smoking or excess alcohol intake.", "His temperature is 37.1\u00b0C (98.7\u00b0F), blood pressure is 120/80 mm Hg, and pulse is 85/min.", "Physical examination reveals a cachectic man with jaundice, palmar erythema, ascites, and a palpable mass in the RUQ.", "Abdominal ultrasound shows a 3 cm hypoechoic mass in the right lobe of the liver.", "Alpha fetoprotein (AFP) is 500 \u03bcg/L."], "context_len": 6, "options": {"A": "Exposure to nitrosamines  ", "B": "Cyclophosphamide use", "C": "Clonorchis sinensis infection", "D": "Chronic hepatitis C infection"}, "answer": "Chronic hepatitis C infection", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old Asian man presents to his primary care physician.", "2. He has abdominal distension, right upper quadrant (RUQ) abdominal pain, decreased appetite, and weight loss for several weeks.", "3. He denies smoking or excess alcohol intake.", "4. His temperature is 37.1\u00b0C (98.7\u00b0F).", "5. His blood pressure is 120/80 mm Hg.", "6. His pulse is 85/min.", "7. Physical examination reveals a cachectic man with jaundice, palmar erythema, ascites, and a palpable mass in the RUQ.", "8. Abdominal ultrasound shows a 3 cm hypoechoic mass in the right lobe of the liver.", "9. Alpha fetoprotein (AFP) is 500 \u03bcg/L."], "atomic_facts": ["1. Patient denies smoking.", "2. Patient denies excess alcohol intake.", "3. Temperature is 37.1\u00b0C (98.7\u00b0F).", "4. Blood pressure is 120/80 mm Hg.", "5. Pulse is 85/min.", "6. Physical examination reveals a cachectic man.", "7. Physical examination reveals jaundice.", "8. Physical examination reveals palmar erythema.", "9. Physical examination reveals ascites.", "10. Physical examination reveals a palpable mass in the RUQ.", "11. Abdominal ultrasound shows a 3 cm hypoechoic mass in the right lobe of the liver.", "12. Alpha fetoprotein (AFP) is 500 \u03bcg/L."]}
{"id": 343, "question": "What should the physician do in this situation?", "context": ["A 71-year-old man from Puerto Rico presents to the emergency department with a 2-week history of abdominal pain.", "He does not speak much English so his family explains that he has been complaining of intermittent pain that is not associated with any particular actions.", "Furthermore, his family is concerned because he has been having weight loss and blood in his stool for 3 months.", "The physician explains that there is a concern for colon cancer and that a colonoscopy is required to evaluate his condition further.", "The family is afraid that the news will upset the patient so they ask that they be allowed to make healthcare decisions on the patient's behalf.", "They explain that this is the way that their culture handles medical decisions."], "context_len": 6, "options": {"A": "Ask the family to translate the plan for the patient and ask for questions", "B": "Call for a Spanish-speaking interpreter to speak with the patient", "C": "Respect the family's cultural wishes and not discuss the plan with the patient", "D": "Speak directly with the patient in English to ascertain their wishes"}, "answer": "Call for a Spanish-speaking interpreter to speak with the patient", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "71 years old", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 71-year-old man from Puerto Rico presents to the emergency department.", "2. He has a 2-week history of abdominal pain.", "3. He does not speak much English.", "4. His family explains that he has been complaining of intermittent pain that is not associated with any particular actions.", "5. His family is concerned because he has been having weight loss and blood in his stool for 3 months.", "6. The physician explains that there is a concern for colon cancer.", "7. A colonoscopy is required to evaluate his condition further.", "8. The family is afraid that the news will upset the patient.", "9. They ask that they be allowed to make healthcare decisions on the patient's behalf.", "10. They explain that this is the way that their culture handles medical decisions."], "atomic_facts": ["1. The patient does not speak much English.", "2. The patient has been complaining of intermittent pain.", "3. The pain is not associated with any particular actions.", "4. The patient has been experiencing weight loss for 3 months.", "5. The patient has been having blood in his stool for 3 months.", "6. The physician is concerned about colon cancer.", "7. A colonoscopy is required to evaluate the patient's condition further.", "8. The family is concerned about upsetting the patient with the news.", "9. The family wants to make healthcare decisions on the patient's behalf.", "10. The family's culture handles medical decisions in this way."]}
{"id": 344, "question": "Which of the following ion channels is dysfunctional in this patient?", "context": ["A 45-year-old man presents to a physician with recurrent episodes of palpitations over the last 3 months.", "The episodes are self-limiting but cause significant distress and discomfort to the patient.", "After a detailed electrophysiological workup, the physician concludes that the symptoms occur mainly due to abnormal function of the cardiac ion channels, which primarily produce the plateau phase of the action potential in cardiac myocytes in healthy patients."], "context_len": 3, "options": {"A": "Fast sodium channels", "B": "L-type voltage-gated calcium channels", "C": "T-type voltage-gated calcium channels", "D": "Inward rectifier IK1 channels"}, "answer": "L-type voltage-gated calcium channels", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 45-year-old man presents to a physician.", "2. The patient has had recurrent episodes of palpitations over the last 3 months.", "3. The episodes are self-limiting.", "4. The episodes cause significant distress and discomfort to the patient.", "5. The physician performs a detailed electrophysiological workup.", "6. The physician concludes that the symptoms occur mainly due to abnormal function of the cardiac ion channels.", "7. The cardiac ion channels primarily produce the plateau phase of the action potential in cardiac myocytes in healthy patients."], "atomic_facts": ["1. The episodes are self-limiting.", "2. The episodes cause significant distress and discomfort to the patient.", "3. A detailed electrophysiological workup was performed.", "4. The physician concludes that the symptoms occur mainly due to abnormal function of the cardiac ion channels.", "5. The abnormal function of the cardiac ion channels primarily produces the plateau phase of the action potential in cardiac myocytes in healthy patients."]}
{"id": 345, "question": "An analysis of this patient's cerebral spinal fluid is most likely to show which of the following findings?", "context": ["A 23-year-old man comes to the physician because of severe daytime sleepiness and random episodes of falling asleep during the day for short periods of time.", "When he wakes up from these episodes, he feels refreshed.", "He sleeps 6\u20137 hours at night.", "He reports that sometimes he is unable to move for a few minutes when he first wakes up in the morning.", "Last week, he suddenly \u201clost control\u201d of his legs and neck for about 30 seconds after his classmate had told him a joke."], "context_len": 5, "options": {"A": "Decreased orexin-A", "B": "Increased neuron-specific enolase", "C": "Increased 14-3-3 protein", "D": "Anti-ganglioside antibodies"}, "answer": "Decreased orexin-A", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "23 years old", "specialties": ["Neurology"], "subspecialties": ["Sleep Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 23-year-old man comes to the physician.", "2. He has severe daytime sleepiness.", "3. He has random episodes of falling asleep during the day for short periods of time.", "4. When he wakes up from these episodes, he feels refreshed.", "5. He sleeps 6\u20137 hours at night.", "6. He reports that sometimes he is unable to move for a few minutes when he first wakes up in the morning.", "7. Last week, he suddenly \u201clost control\u201d of his legs and neck for about 30 seconds.", "8. This happened after his classmate had told him a joke."], "atomic_facts": ["1. He feels refreshed when he wakes up from these episodes.", "2. He sleeps 6\u20137 hours at night.", "3. Sometimes he is unable to move for a few minutes when he first wakes up in the morning.", "4. Last week, he suddenly \u201clost control\u201d of his legs and neck for about 30 seconds.", "5. The loss of control occurred after his classmate had told him a joke."]}
{"id": 346, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?", "context": ["A 73-year-old man is brought to the emergency department 30 minutes after he lost consciousness for 5 minutes while watching a game of summer league football in a seat from the stands in the afternoon.", "On arrival, he is lethargic and oriented only to person.", "Three weeks ago, he was treated for hepatitis A.", "He has type 2 diabetes mellitus and hypothyroidism.", "Current medications include metformin and levothyroxine.", "His temperature is 41.5 \u00b0C (106.7 \u00b0F), pulse is 106/min, respirations are 26/min, and blood pressure is 128/70 mm Hg.", "Examination shows hot, dry skin.", "The pupils are equal and reactive to light.", "Neurologic examination shows no focal findings.", "Fundoscopy shows proliferative diabetic retinopathy.", "Cardiopulmonary examination shows no abnormalities.", "His abdomen is soft and nontender.", "There is no costovertebral angle tenderness.", "His serum glucose concentration is 160 mg/dL.", "An ECG shows a normal sinus rhythm."], "context_len": 15, "options": {"A": "Inadequate hypothalamic response", "B": "Metabolic acidosis with ketosis", "C": "Elevation of serum thyroxine levels", "D": "Central dopamine receptor blockade"}, "answer": "Inadequate hypothalamic response", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "73", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 73-year-old man was brought to the emergency department.", "2. He lost consciousness for 5 minutes while watching a game of summer league football in a seat from the stands in the afternoon.", "3. On arrival, he is lethargic and oriented only to person.", "4. Three weeks ago, he was treated for hepatitis A.", "5. He has type 2 diabetes mellitus and hypothyroidism.", "6. Current medications include metformin and levothyroxine.", "7. His temperature is 41.5 \u00b0C (106.7 \u00b0F).", "8. His pulse is 106/min.", "9. His respirations are 26/min.", "10. His blood pressure is 128/70 mm Hg.", "11. Examination shows hot, dry skin.", "12. The pupils are equal and reactive to light.", "13. Neurologic examination shows no focal findings.", "14. Fundoscopy shows proliferative diabetic retinopathy.", "15. Cardiopulmonary examination shows no abnormalities.", "16. His abdomen is soft and nontender.", "17. There is no costovertebral angle tenderness.", "18. His serum glucose concentration is 160 mg/dL.", "19. An ECG shows a normal sinus rhythm."], "atomic_facts": ["1. On arrival, he is lethargic and oriented only to person.", "2. Three weeks ago, he was treated for hepatitis A.", "3. He has type 2 diabetes mellitus and hypothyroidism.", "4. Current medications include metformin and levothyroxine.", "5. His temperature is 41.5 \u00b0C (106.7 \u00b0F), pulse is 106/min, respirations are 26/min, and blood pressure is 128/70 mm Hg.", "6. Examination shows hot, dry skin.", "7. The pupils are equal and reactive to light.", "8. Neurologic examination shows no focal findings.", "9. Fundoscopy shows proliferative diabetic retinopathy.", "10. Cardiopulmonary examination shows no abnormalities.", "11. His abdomen is soft and nontender.", "12. There is no costovertebral angle tenderness.", "13. His serum glucose concentration is 160 mg/dL.", "14. An ECG shows a normal sinus rhythm."]}
{"id": 347, "question": "Which of the following is the most likely diagnosis?", "context": ["A 3-year-old boy is brought to the physician for a well-child examination.", "He feels well.", "He was born at 38 weeks' gestation and weighed 2766 g (6 lb 2 oz).", "He now weighs 14 kg (31 lbs).", "There is no personal or family history of serious illness.", "His immunizations are up-to-date.", "He is at 60th percentile for height and 55th percentile for weight.", "Vital signs are within normal limits.", "The lungs are clear to auscultation.", "A grade 3/6 systolic ejection murmur is heard along the upper left sternal border.", "S2 is widely split and does not vary with respiration.", "There is a grade 2/6 mid-diastolic murmur along the lower left sternal border.", "The abdomen is soft and nontender; there is no organomegaly."], "context_len": 13, "options": {"A": "Patent ductus arteriosus", "B": "Benign heart murmur", "C": "Atrial septal defect", "D": "Pulmonary valve stenosis"}, "answer": "Atrial septal defect", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 3-year-old boy.", "2. Patient feels well.", "3. Patient was born at 38 weeks' gestation.", "4. Patient weighed 2766 g (6 lb 2 oz) at birth.", "5. Patient now weighs 14 kg (31 lbs).", "6. No personal or family history of serious illness.", "7. Immunizations are up-to-date.", "8. Patient is at 60th percentile for height.", "9. Patient is at 55th percentile for weight.", "10. Vital signs are within normal limits.", "11. Lungs are clear to auscultation.", "12. Grade 3/6 systolic ejection murmur heard along upper left sternal border.", "13. S2 is widely split and does not vary with respiration.", "14. Grade 2/6 mid-diastolic murmur heard along lower left sternal border.", "15. Abdomen is soft and nontender.", "16. No organomegaly."], "atomic_facts": ["1. He was born at 38 weeks' gestation", "2. He weighed 2766 g (6 lb 2 oz) at birth", "3. He now weighs 14 kg (31 lbs)", "4. There is no personal or family history of serious illness", "5. His immunizations are up-to-date", "6. He is at 60th percentile for height", "7. He is at 55th percentile for weight", "8. Vital signs are within normal limits", "9. The lungs are clear to auscultation", "10. A grade 3/6 systolic ejection murmur is heard along the upper left sternal border", "11. S2 is widely split and does not vary with respiration", "12. There is a grade 2/6 mid-diastolic murmur along the lower left sternal border", "13. The abdomen is soft and nontender", "14. There is no organomegaly"]}
{"id": 348, "question": "What is the next best step in the management of this patient?", "context": ["A 30-year-old man presents to the emergency department after being attacked by 2 men a few minutes ago.", "He was suddenly approached by 2 men holding knives while he was walking on the street nearby.", "While trying to escape, he was stabbed once in the neck.", "He is complaining of difficulty breathing and chest pain.", "He is in apparent distress.", "His temperature is 36.8\u00b0C (98.2\u00b0F), the blood pressure is 100/60 mm Hg, the pulse is 110/min, the respirations are 28/min, and the SaO2 is 85% on 4 L oxygen by nasal cannula.", "Examination of the neck reveals a deep penetrating injury on the right side and distended neck veins.", "The respiratory exam shows severe tenderness in the right chest, decreased inspiration in the right lung, and tracheal deviation to the left."], "context_len": 8, "options": {"A": "Pericardiocentesis", "B": "Intravenous fluids", "C": "Dobutamine", "D": "Needle thoracostomy"}, "answer": "Needle thoracostomy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "30 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 30-year-old man presents to the emergency department.", "2. He was attacked by 2 men a few minutes ago.", "3. He was suddenly approached by 2 men holding knives while he was walking on the street nearby.", "4. While trying to escape, he was stabbed once in the neck.", "5. He is complaining of difficulty breathing and chest pain.", "6. He is in apparent distress.", "7. His temperature is 36.8\u00b0C (98.2\u00b0F).", "8. The blood pressure is 100/60 mm Hg.", "9. The pulse is 110/min.", "10. The respirations are 28/min.", "11. The SaO2 is 85% on 4 L oxygen by nasal cannula.", "12. Examination of the neck reveals a deep penetrating injury on the right side and distended neck veins.", "13. The respiratory exam shows severe tenderness in the right chest.", "14. The respiratory exam shows decreased inspiration in the right lung.", "15. The respiratory exam shows tracheal deviation to the left."], "atomic_facts": ["1. He was suddenly approached by 2 men holding knives while walking on the street nearby.", "2. While trying to escape, he was stabbed once in the neck.", "3. He is complaining of difficulty breathing and chest pain.", "4. He is in apparent distress.", "5. His temperature is 36.8\u00b0C (98.2\u00b0F).", "6. The blood pressure is 100/60 mm Hg.", "7. The pulse is 110/min.", "8. The respirations are 28/min.", "9. The SaO2 is 85% on 4 L oxygen by nasal cannula.", "10. Examination of the neck reveals a deep penetrating injury on the right side and distended neck veins.", "11. The respiratory exam shows severe tenderness in the right chest, decreased inspiration in the right lung, and tracheal deviation to the left."]}
{"id": 349, "question": "Which of the following is characteristic of this patient\u2019s diagnosis?", "context": ["An 8-month-old male presents to your office with a 5-day history of blood in his stool.", "Abdominal pain is notably absent on history obtained from his parents.", "Past medical history and physical exam findings are not remarkable.", "Laboratory findings are significant for mild iron deficiency."], "context_len": 4, "options": {"A": "It may affect neonates but is more common in adolescents.", "B": "It is rare, affecting less than 1% of the population.", "C": "Both males and females are equally affected.", "D": "Diagnostic studies localize ectopic gastric tissue."}, "answer": "Diagnostic studies localize ectopic gastric tissue.", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "8 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 8-month-old male presents to your office.", "2. He has a 5-day history of blood in his stool.", "3. Abdominal pain is absent on history obtained from his parents.", "4. Past medical history and physical exam findings are not remarkable.", "5. Laboratory findings are significant for mild iron deficiency."], "atomic_facts": ["1. Abdominal pain is notably absent on history obtained from his parents.", "2. Past medical history is not remarkable.", "3. Physical exam findings are not remarkable.", "4. Laboratory findings are significant for mild iron deficiency."]}
{"id": 350, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 19-year-old man is brought to a psychiatrist by his mother.", "The patient\u2019s mother has become increasingly concerned about him since his high school graduation.", "Although she says that he had been an excellent student in high school, his grades have begun slipping in his second year in college, and he no longer socializes with friends.", "When she asked him why he no longer talks to his friends, she states that he told her, \u201cThey already know where I am.", "They can see me.", "They watch me from my bedroom window, so they already know what I\u2019m doing.", "We don\u2019t need to talk.\u201d She found this to be bizarre, as nearly all of his friends live hours away.", "The patient states that he feels fine and doesn\u2019t understand why everyone thinks he is crazy.", "The psychiatrist notices reduced spontaneous movements while the patient is speaking and that he speaks in a monotone with a voice that is soft in volume.", "He also appears suspicious and defensive, asking the psychiatrist \u201cwhy are you asking me that?\u201d after each evaluative question.", "His mood is generally flat with little reactivity or engagement during the course of his interview, but he denies any symptoms of depression or psychosis.", "No significant past medical history.", "Family history is not available as he was adopted."], "context_len": 13, "options": {"A": "Paranoid personality disorder", "B": "Schizophrenia", "C": "Drug abuse", "D": "Brain tumor"}, "answer": "Schizophrenia", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "19", "specialties": ["Psychiatry"], "subspecialties": ["Child and Adolescent Psychiatry", "Schizophrenia"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 19-year-old man is brought to a psychiatrist by his mother.", "2. His mother has become increasingly concerned about him since his high school graduation.", "3. He had been an excellent student in high school.", "4. His grades have begun slipping in his second year in college.", "5. He no longer socializes with friends.", "6. When she asked him why he no longer talks to his friends, he told her, \u201cThey already know where I am. They can see me. They watch me from my bedroom window, so they already know what I\u2019m doing. We don\u2019t need to talk.\u201d", "7. Nearly all of his friends live hours away.", "8. The patient states that he feels fine and doesn\u2019t understand why everyone thinks he is crazy.", "9. The psychiatrist notices reduced spontaneous movements while the patient is speaking.", "10. He speaks in a monotone with a voice that is soft in volume.", "11. He appears suspicious and defensive, asking the psychiatrist \u201cwhy are you asking me that?\u201d after each evaluative question.", "12. His mood is generally flat with little reactivity or engagement during the course of his interview.", "13. He denies any symptoms of depression or psychosis.", "14. No significant past medical history.", "15. Family history is not available as he was adopted."], "atomic_facts": ["1. The patient's mother is increasingly concerned about him since his high school graduation.", "2. The patient's grades have begun slipping in his second year of college.", "3. The patient no longer socializes with friends.", "4. The patient told his mother that his friends can see him from his bedroom window and don't need to talk to him.", "5. The patient's friends live hours away.", "6. The patient feels fine and doesn't understand why everyone thinks he is crazy.", "7. The psychiatrist notices reduced spontaneous movements while the patient is speaking.", "8. The patient speaks in a monotone with a soft voice.", "9. The patient appears suspicious and defensive during the evaluation.", "10. The patient's mood is generally flat with little reactivity or engagement.", "11. The patient denies any symptoms of depression or psychosis.", "12. The patient has no significant past medical history.", "13. The patient's family history is not available as he was adopted."]}
{"id": 351, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 26-year-old woman comes to the physician because of progressively worsening episodic pelvic pain for 2 years.", "The pain starts a few days before her menstrual period and lasts about 10 days.", "She has tried taking ibuprofen, but her symptoms do not improve.", "Menses have occurred at regular 29-day intervals since menarche at the age of 11 years and last for 5\u20137 days.", "The first day of her last menstrual period was 2 weeks ago.", "She is sexually active with her boyfriend and has noticed that intercourse is often painful; they use condoms inconsistently.", "Vital signs are within normal limits.", "Pelvic examination shows a normal vagina and cervix.", "Bimanual examination shows a normal-sized uterus and no palpable adnexal masses.", "Urine pregnancy test is negative."], "context_len": 10, "options": {"A": "Perform MRI of the pelvis", "B": "Prescribe gonadotropin-releasing hormone agonists", "C": "Prescribe androgenic steroids", "D": "Prescribe estrogen-progestin contraceptives"}, "answer": "Prescribe estrogen-progestin contraceptives", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "26 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Complex Family Planning", "General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 26-year-old woman.", "2. Patient has had progressively worsening episodic pelvic pain for 2 years.", "3. Pain starts a few days before her menstrual period and lasts about 10 days.", "4. Patient has tried taking ibuprofen, but her symptoms do not improve.", "5. Patient has had regular 29-day menstrual intervals since menarche at the age of 11 years.", "6. Menstrual periods last for 5\u20137 days.", "7. First day of patient's last menstrual period was 2 weeks ago.", "8. Patient is sexually active with her boyfriend.", "9. Patient has noticed that intercourse is often painful.", "10. Patient and her boyfriend use condoms inconsistently.", "11. Vital signs are within normal limits.", "12. Pelvic examination shows a normal vagina and cervix.", "13. Bimanual examination shows a normal-sized uterus and no palpable adnexal masses.", "14. Urine pregnancy test is negative."], "atomic_facts": ["1. The pain starts a few days before her menstrual period and lasts about 10 days.", "2. She has tried taking ibuprofen, but her symptoms do not improve.", "3. Menses have occurred at regular 29-day intervals since menarche at the age of 11 years and last for 5\u20137 days.", "4. The first day of her last menstrual period was 2 weeks ago.", "5. She is sexually active with her boyfriend and has noticed that intercourse is often painful; they use condoms inconsistently.", "6. Vital signs are within normal limits.", "7. Pelvic examination shows a normal vagina and cervix.", "8. Bimanual examination shows a normal-sized uterus and no palpable adnexal masses.", "9. Urine pregnancy test is negative."]}
{"id": 352, "question": "Which of the following will most likely reduce the type II error of this screening test?", "context": ["A research group has developed a new screening test for HIV that can detect infection 2 weeks earlier than the current gold standard.", "A rigorous clinical study of this new screening test involving n subjects yields a false-positive probability \u03b1, and a false-negative probability, \u03b2."], "context_len": 2, "options": {"A": "Decreasing n", "B": "Increasing \u03b1", "C": "Increasing the specificity of the test", "D": "Decreasing the sensitivity of the test"}, "answer": "Increasing \u03b1", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Clinical Biochemical Genetics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A research group has developed a new screening test for HIV.", "2. The new screening test can detect infection 2 weeks earlier than the current gold standard.", "3. A rigorous clinical study of the new screening test was conducted involving n subjects.", "4. The false-positive probability of the new screening test is \u03b1.", "5. The false-negative probability of the new screening test is \u03b2."], "atomic_facts": ["1. A rigorous clinical study was conducted on a new screening test.", "2. The study involved n subjects.", "3. The study yielded a false-positive probability \u03b1.", "4. The study yielded a false-negative probability \u03b2."]}
{"id": 353, "question": "Which of the following is the pathophysiology of this patient's presentation?", "context": ["A 70-year-old female underwent a right total knee arthroplasty without complication.", "She was discharged to a rehab facility on post-operative day 3.", "Two days after her discharge from the hospital, she began experiencing pain and swelling of the right leg.", "Doppler ultrasound imaging at this time revealed a deep venous thrombosis in the right popliteal and tibial veins.", "The patient was re-admitted and started on an unfractionated heparin infusion.", "Five days later, doppler ultrasonography of the lower extremities revealed extension of the clot in the right lower extremity to include the common femoral, superficial femoral, popliteal, tibial, and saphenous veins.", "In addition, a thrombus was noted in the left common femoral vein as well.", "CBC showed a decrease in platelet count from 195,000/uL on admission to 83,000/uL."], "context_len": 8, "options": {"A": "Excessive irreversible inactivation of the cyclo-oxygenase enzyme", "B": "Formation of antibodies to heparin-platelet factor-4 complex", "C": "Deposition of immune complex nuclear antigens in kidneys", "D": "Inherited mutation in clotting factor V, which cannot be degraded by activated protein C"}, "answer": "Formation of antibodies to heparin-platelet factor-4 complex", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "70", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 70-year-old female.", "2. Patient underwent right total knee arthroplasty without complication.", "3. Patient was discharged to rehab facility on post-operative day 3.", "4. Two days after discharge, patient began experiencing pain and swelling of right leg.", "5. Doppler ultrasound imaging revealed deep venous thrombosis in right popliteal and tibial veins.", "6. Patient was re-admitted and started on unfractionated heparin infusion.", "7. Five days later, doppler ultrasonography revealed extension of clot in right lower extremity to include common femoral, superficial femoral, popliteal, tibial, and saphenous veins.", "8. Doppler ultrasonography also revealed thrombus in left common femoral vein.", "9. CBC showed decrease in platelet count from 195,000/uL on admission to 83,000/uL."], "atomic_facts": ["1. The patient was discharged to a rehab facility on post-operative day 3.", "2. Two days after her discharge from the hospital, she began experiencing pain and swelling of the right leg.", "3. Doppler ultrasound imaging revealed a deep venous thrombosis in the right popliteal and tibial veins.", "4. The patient was re-admitted and started on an unfractionated heparin infusion.", "5. Five days later, doppler ultrasonography revealed extension of the clot in the right lower extremity to include the common femoral, superficial femoral, popliteal, tibial, and saphenous veins.", "6. A thrombus was noted in the left common femoral vein as well.", "7. CBC showed a decrease in platelet count from 195,000/uL on admission to 83,000/uL."]}
{"id": 354, "question": "Which of the following measures would be most effective?", "context": ["Three days after surgical repair of a distal right radius fracture, a 62-year-old man develops severe wound pain and fever.", "His temperature is 39.1\u00b0C (102.4\u00b0F).", "Physical examination shows erythema and edema of the right arm that extends up to the elbow.", "Yellow pus drains from the surgical wound.", "Cultures from the wound fluid grow gram-positive bacteria in grape-like clusters that are resistant to nafcillin.", "While treating the patient's condition, the hospital also wants to eradicate the causal pathogen in asymptomatic carriers."], "context_len": 6, "options": {"A": "Permethrin hair wash", "B": "Colistin nebulized aerosol", "C": "Chlorhexidine hand disinfection", "D": "Mupirocin nasal ointment"}, "answer": "Mupirocin nasal ointment", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "62", "specialties": ["Surgery"], "subspecialties": ["Surgical Critical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 62-year-old man developed severe wound pain and fever three days after surgical repair of a distal right radius fracture.", "2. His temperature was 39.1\u00b0C (102.4\u00b0F).", "3. Physical examination showed erythema and edema of the right arm that extended up to the elbow.", "4. Yellow pus drained from the surgical wound.", "5. Cultures from the wound fluid grew gram-positive bacteria in grape-like clusters.", "6. The bacteria were resistant to nafcillin.", "7. The hospital wanted to eradicate the causal pathogen in asymptomatic carriers."], "atomic_facts": ["1. His temperature is 39.1\u00b0C (102.4\u00b0F).", "2. Physical examination shows erythema and edema of the right arm that extends up to the elbow.", "3. Yellow pus drains from the surgical wound.", "4. Cultures from the wound fluid grow gram-positive bacteria in grape-like clusters that are resistant to nafcillin.", "5. The hospital wants to eradicate the causal pathogen in asymptomatic carriers while treating the patient's condition."]}
{"id": 355, "question": "For this reason (and to accurately answer the research question), the risk of the disease should be estimated in terms of which of the following?", "context": ["A research group from Europe is investigating a potential link between certain lifestyle risk factors and the development of potentially fatal renal disease.", "They designed a cohort study that included 68 individuals: 34 exposed and 34 unexposed to given risk factors, who were followed up for 4 years in total.", "During this time, the renal disease of interest was seen in 6 individuals among the exposed group and 6 individuals among the unexposed group; thus, the risk ratio (RR) of the disease development (exposed vs.", "unexposed) was 1.", "During the initial 2 years, there was 1 death in the exposed group, and another death in the unexposed group.", "A survey administered for the last 2 years of the study showed that the prevalence ratio of disease between exposed and unexposed individuals was in fact 0.5 (at 2 years of follow-up there was only 1 case of the disease in the 34 exposed individuals, with a resulting prevalence of 2.94%; and only 2 cases of the disease in the 34 unexposed individuals, with a resulting prevalence of 5.88%), a value that deviates from the true RR (i.e.", "1)."], "context_len": 7, "options": {"A": "Incidence", "B": "Prevalence", "C": "Mortality", "D": "Survival rates"}, "answer": "Incidence", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A research group from Europe is investigating a potential link between certain lifestyle risk factors and the development of potentially fatal renal disease.", "2. They designed a cohort study that included 68 individuals: 34 exposed and 34 unexposed to given risk factors.", "3. The study was followed up for 4 years in total.", "4. During this time, the renal disease of interest was seen in 6 individuals among the exposed group and 6 individuals among the unexposed group.", "5. The risk ratio (RR) of the disease development (exposed vs. unexposed) was 1.", "6. During the initial 2 years, there was 1 death in the exposed group, and another death in the unexposed group.", "7. A survey administered for the last 2 years of the study showed that the prevalence ratio of disease between exposed and unexposed individuals was 0.5.", "8. At 2 years of follow-up there was only 1 case of the disease in the 34 exposed individuals, with a resulting prevalence of 2.94%.", "9. There were only 2 cases of the disease in the 34 unexposed individuals, with a resulting prevalence of 5.88%.", "10. The prevalence ratio of 0.5 deviates from the true RR (i.e. 1)."], "atomic_facts": ["1. A cohort study was designed with 68 individuals: 34 exposed and 34 unexposed to given risk factors.", "2. The individuals were followed up for 4 years in total.", "3. During the study, the renal disease of interest was seen in 6 individuals among the exposed group and 6 individuals among the unexposed group.", "4. The risk ratio (RR) of the disease development (exposed vs. unexposed) was 1.", "5. During the initial 2 years, there was 1 death in the exposed group and another death in the unexposed group.", "6. A survey administered for the last 2 years of the study showed that the prevalence ratio of disease between exposed and unexposed individuals was 0.5.", "7. At 2 years of follow-up, there was only 1 case of the disease in the 34 exposed individuals, with a resulting prevalence of 2.94%.", "8. At 2 years of follow-up, there were only 2 cases of the disease in the 34 unexposed individuals, with a resulting prevalence of 5.88%.", "9. The prevalence ratio value deviates from the true RR, which is 1."]}
{"id": 356, "question": "What is the most likely chromosomal translocation that is responsible for this patient's clinical presentation and lab results?", "context": ["A 55-year-old male with fever, fatigue, generalized weakness, and bleeding gums for the past 3 weeks presents to his family physician.", "On exam, he has bilateral submandibular lymphadenopathy and hepatosplenomegaly.", "CBC demonstrates decreased RBCs and mature WBCs.", "The patient is referred to an oncologist, and a bone marrow aspiration is performed, demonstrating >20% myeloblasts with Auer rods that are myeloperoxidase positive."], "context_len": 4, "options": {"A": "15;17", "B": "14;18", "C": "11;14", "D": "8;14"}, "answer": "15;17", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Hematology", "Pathology"], "subspecialties": ["General Hematology", "Hematopathology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 55-year-old male presents to his family physician.", "2. He has had fever, fatigue, generalized weakness, and bleeding gums for the past 3 weeks.", "3. On exam, he has bilateral submandibular lymphadenopathy and hepatosplenomegaly.", "4. CBC demonstrates decreased RBCs and mature WBCs.", "5. The patient is referred to an oncologist.", "6. A bone marrow aspiration is performed.", "7. The bone marrow aspiration demonstrates >20% myeloblasts with Auer rods.", "8. The Auer rods are myeloperoxidase positive."], "atomic_facts": ["1. On exam, he has bilateral submandibular lymphadenopathy.", "2. On exam, he has hepatosplenomegaly.", "3. CBC demonstrates decreased RBCs.", "4. CBC demonstrates mature WBCs.", "5. The patient is referred to an oncologist.", "6. A bone marrow aspiration is performed.", "7. The bone marrow aspiration demonstrates >20% myeloblasts.", "8. The myeloblasts have Auer rods.", "9. The Auer rods are myeloperoxidase positive."]}
{"id": 357, "question": "The patient is most likely experiencing adverse effects caused by a drug that works through which of the following mechanisms of action?", "context": ["A 59-year-old man with Parkinson disease is brought to the emergency department 1 hour after he had a syncopal episode.", "Over the past two weeks, the patient has felt light-headed upon standing and has noticed that his legs have been swollen.", "He was started on a medication for early symptoms of Parkinson disease one month ago.", "Vital signs show blood pressure 114/70 mm Hg when supine and 92/38 mm Hg upon standing.", "Examination of the lower extremities shows a lacy, purple rash and 2+ pitting edema.", "Neurologic examination shows an ataxic gait.", "The physician decreases the dose of medication."], "context_len": 7, "options": {"A": "Increased dopamine release from central neurons", "B": "Inhibition of acetylcholine activity in the basal ganglia", "C": "Selective inhibition of monoamine oxidase type B", "D": "Inhibition of central methylation of dopamine"}, "answer": "Increased dopamine release from central neurons", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "59 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 59-year-old man with Parkinson disease is brought to the emergency department.", "2. He had a syncopal episode 1 hour prior.", "3. Over the past two weeks, the patient has felt light-headed upon standing.", "4. Over the past two weeks, the patient has noticed that his legs have been swollen.", "5. He was started on a medication for early symptoms of Parkinson disease one month ago.", "6. Vital signs show blood pressure 114/70 mm Hg when supine.", "7. Vital signs show blood pressure 92/38 mm Hg upon standing.", "8. Examination of the lower extremities shows a lacy, purple rash.", "9. Examination of the lower extremities shows 2+ pitting edema.", "10. Neurologic examination shows an ataxic gait.", "11. The physician decreases the dose of medication."], "atomic_facts": ["1. Over the past two weeks, the patient has felt light-headed upon standing.", "2. The patient has noticed that his legs have been swollen.", "3. The patient was started on a medication for early symptoms of Parkinson disease one month ago.", "4. Vital signs show blood pressure 114/70 mm Hg when supine.", "5. Vital signs show blood pressure 92/38 mm Hg upon standing.", "6. Examination of the lower extremities shows a lacy, purple rash.", "7. Examination of the lower extremities shows 2+ pitting edema.", "8. Neurologic examination shows an ataxic gait.", "9. The physician decreases the dose of medication."]}
{"id": 358, "question": "Which of the following is the best initial treatment for this patient?", "context": ["A 50-year-old woman presents to her primary care physician for muscle weakness.", "Her symptoms have progressively worsened over the course of several months, where she has experienced difficulty getting up from a chair, climbing the stairs, and placing her groceries on the top shelves of her kitchen.", "She also reports feeling tired lately and is unsure when this began.", "Physical examination is notable for muscle weakness in the deltoids and hip flexors with 2+ biceps, triceps, patellar, and ankle tendon reflexes.", "Laboratory testing demonstrates a creatine kinase level of 4,200 U/L (normal is 10-70 U/L), lactate dehydrogenase level of 150 U/L (normal is 45-90 U/L), and thyroid-stimulating hormone level of 1.5 \u00b5U/mL (normal is 0.5-5.0 \u00b5U/mL)."], "context_len": 5, "options": {"A": "Azathioprine", "B": "Intravenous immunoglobulin", "C": "Prednisone", "D": "Thyroxine"}, "answer": "Prednisone", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "50 years old", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 50-year-old woman presents to her primary care physician for muscle weakness.", "2. Her symptoms have progressively worsened over the course of several months.", "3. She has experienced difficulty getting up from a chair.", "4. She has experienced difficulty climbing the stairs.", "5. She has experienced difficulty placing her groceries on the top shelves of her kitchen.", "6. She reports feeling tired lately.", "7. She is unsure when this began.", "8. Physical examination is notable for muscle weakness in the deltoids and hip flexors.", "9. Biceps, triceps, patellar, and ankle tendon reflexes are 2+.", "10. Laboratory testing demonstrates a creatine kinase level of 4,200 U/L.", "11. Normal creatine kinase level is 10-70 U/L.", "12. Laboratory testing demonstrates a lactate dehydrogenase level of 150 U/L.", "13. Normal lactate dehydrogenase level is 45-90 U/L.", "14. Laboratory testing demonstrates a thyroid-stimulating hormone level of 1.5 \u00b5U/mL.", "15. Normal thyroid-stimulating hormone level is 0.5-5.0 \u00b5U/mL."], "atomic_facts": ["1. The patient's symptoms have progressively worsened over several months.", "2. The patient has difficulty getting up from a chair, climbing stairs, and placing groceries on high shelves.", "3. The patient reports feeling tired lately and is unsure when this began.", "4. Physical examination shows muscle weakness in the deltoids and hip flexors.", "5. The patient has 2+ biceps, triceps, patellar, and ankle tendon reflexes.", "6. Laboratory testing demonstrates a creatine kinase level of 4,200 U/L (normal is 10-70 U/L).", "7. Laboratory testing shows a lactate dehydrogenase level of 150 U/L (normal is 45-90 U/L).", "8. Laboratory testing reveals a thyroid-stimulating hormone level of 1.5 \u00b5U/mL (normal is 0.5-5.0 \u00b5U/mL)."]}
{"id": 359, "question": "The most likely cause of amenorrhea in this patient is an increase in production of which of the following hormones?\"", "context": ["A 22-year-old woman comes to the physician because of a 5-kg (11-lb) weight gain and hair loss over the past 4 months.", "Menarche occurred at the age of 12 years and menses occurred at irregular intervals until she stopped having periods 2 months ago.", "She is 165 cm (5 ft 5 in) tall and weighs 82 kg (180 lb); BMI is 30 kg/m2.", "Physical examination shows a receding hairline and hair loss over the vertex of the head.", "Serum studies show: | Thyroid-stimulating hormone 2 \u03bcU/mL | Luteinizing hormone 32 mIU/mL | Prolactin 11 ng/mL | Urine pregnancy test is negative.", "Withdrawal bleeding occurs after a progestin challenge test."], "context_len": 6, "options": {"A": "Progesterone in corpus luteum", "B": "Estrogen in adipose tissue", "C": "Follicle stimulating hormone in the adenohypophysis", "D": "Dopamine in the hypothalamus"}, "answer": "Estrogen in adipose tissue", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "22 years old", "specialties": ["Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 22-year-old woman comes to the physician.", "2. She has experienced a 5-kg (11-lb) weight gain and hair loss over the past 4 months.", "3. Menarche occurred at the age of 12 years.", "4. Menses occurred at irregular intervals until she stopped having periods 2 months ago.", "5. She is 165 cm (5 ft 5 in) tall.", "6. She weighs 82 kg (180 lb).", "7. Her BMI is 30 kg/m2.", "8. Physical examination shows a receding hairline and hair loss over the vertex of the head.", "9. Serum studies show: Thyroid-stimulating hormone 2 \u03bcU/mL.", "10. Serum studies show: Luteinizing hormone 32 mIU/mL.", "11. Serum studies show: Prolactin 11 ng/mL.", "12. Urine pregnancy test is negative.", "13. Withdrawal bleeding occurs after a progestin challenge test."], "atomic_facts": ["1. Menarche occurred at the age of 12 years.", "2. Menses occurred at irregular intervals until she stopped having periods 2 months ago.", "3. She is 165 cm (5 ft 5 in) tall.", "4. She weighs 82 kg (180 lb).", "5. Her BMI is 30 kg/m2.", "6. Physical examination shows a receding hairline.", "7. Hair loss is observed over the vertex of the head.", "8. Serum studies show: Thyroid-stimulating hormone 2 \u03bcU/mL.", "9. Serum studies show: Luteinizing hormone 32 mIU/mL.", "10. Serum studies show: Prolactin 11 ng/mL.", "11. Urine pregnancy test is negative.", "12. Withdrawal bleeding occurs after a progestin challenge test."]}
{"id": 360, "question": "Which of the following drugs was most likely prescribed?", "context": ["A 70-year-old man with chronic myopia comes to the physician because of a 4-month history of difficulty seeing distant objects, especially at night, despite wearing glasses.", "Examination shows bilateral narrowing of peripheral visual fields, cupping of the optic discs, and elevated intraocular pressure.", "Gonioscopy shows no abnormalities.", "He is prescribed a drug.", "At a follow-up examination several months later, intraocular pressure is normal, but darkening of the iris and an increase in the length of the eyelashes is observed."], "context_len": 5, "options": {"A": "Timolol", "B": "Acetazolamide", "C": "Apraclonidine", "D": "Latanoprost"}, "answer": "Latanoprost", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "70", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. A 70-year-old man has chronic myopia.", "2. He has had difficulty seeing distant objects for 4 months, especially at night, despite wearing glasses.", "3. Examination shows bilateral narrowing of peripheral visual fields, cupping of the optic discs, and elevated intraocular pressure.", "4. Gonioscopy shows no abnormalities.", "5. He is prescribed a drug.", "6. At a follow-up examination several months later, intraocular pressure is normal.", "7. At the follow-up examination, darkening of the iris is observed.", "8. At the follow-up examination, an increase in the length of the eyelashes is observed."], "atomic_facts": ["1. Examination shows bilateral narrowing of peripheral visual fields.", "2. Examination shows cupping of the optic discs.", "3. Examination shows elevated intraocular pressure.", "4. Gonioscopy shows no abnormalities.", "5. He is prescribed a drug.", "6. At a follow-up examination several months later, intraocular pressure is normal.", "7. At a follow-up examination several months later, darkening of the iris is observed.", "8. At a follow-up examination several months later, an increase in the length of the eyelashes is observed."]}
{"id": 361, "question": "Which of the following is the best next step in management?", "context": ["A 3-week-old female presents with her parents to her pediatrician for a routine visit.", "The parents report that the child is sleeping in regular two-hour intervals and feeding and stooling well.", "They are concerned because they have on occasion noticed a \u201cswelling of the belly button.\u201d Cord separation occurred at seven days of age.", "The parents report that the swelling seems to come and go but is never larger than the size of a blueberry.", "They deny any drainage from the swelling.", "On physical exam, the child is in no acute distress and appears developmentally appropriate for her age.", "Her abdomen is soft and non-tender with a soft, 1 cm bulge at the umbilicus.", "The bulge increases in size when the child cries and can be easily reduced inside the umbilical ring without apparent pain. |  | ."], "context_len": 8, "options": {"A": "Expectant management", "B": "Histopathologic evaluation", "C": "Elective surgical management", "D": "Immediate surgical management"}, "answer": "Expectant management", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "3 weeks", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 3-week-old female presents with her parents to her pediatrician for a routine visit.", "2. The parents report that the child is sleeping in regular two-hour intervals and feeding and stooling well.", "3. They are concerned because they have on occasion noticed a \u201cswelling of the belly button.\u201d", "4. Cord separation occurred at seven days of age.", "5. The parents report that the swelling seems to come and go but is never larger than the size of a blueberry.", "6. They deny any drainage from the swelling.", "7. On physical exam, the child is in no acute distress and appears developmentally appropriate for her age.", "8. Her abdomen is soft and non-tender with a soft, 1 cm bulge at the umbilicus.", "9. The bulge increases in size when the child cries and can be easily reduced inside the umbilical ring without apparent pain."], "atomic_facts": ["1. The child is sleeping in regular two-hour intervals.", "2. The child is feeding and stooling well.", "3. The parents have noticed a \"swelling of the belly button.\"", "4. Cord separation occurred at seven days of age.", "5. The swelling seems to come and go but is never larger than the size of a blueberry.", "6. There is no drainage from the swelling.", "7. On physical exam, the child is in no acute distress.", "8. The child appears developmentally appropriate for her age.", "9. The abdomen is soft and non-tender.", "10. There is a soft, 1 cm bulge at the umbilicus.", "11. The bulge increases in size when the child cries.", "12. The bulge can be easily reduced inside the umbilical ring without apparent pain."]}
{"id": 362, "question": "Which of the following is the best next intervention for this patient?", "context": ["A 25-year-old man presents to the emergency department after a motor vehicle collision.", "He is currently complaining of chest pain and shortness of breath and seems rather confused.", "His temperature is 97.7\u00b0F (36.5\u00b0C), blood pressure is 94/54 mmHg, pulse is 170/min, respirations are 12/min, and oxygen saturation is 90% on room air.", "A 14-gauge needle is placed in the 2nd intercostal space on the patient\u2019s left, and his blood pressure increases to 104/74 mmHg and his pulse decreases to 100/min."], "context_len": 4, "options": {"A": "Chest radiograph", "B": "Pericardiocentesis", "C": "Thoracotomy", "D": "Tube thoracostomy"}, "answer": "Tube thoracostomy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "25", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 25-year-old man presents to the emergency department after a motor vehicle collision.", "2. He is currently complaining of chest pain and shortness of breath and seems rather confused.", "3. His temperature is 97.7\u00b0F (36.5\u00b0C).", "4. His blood pressure is 94/54 mmHg.", "5. His pulse is 170/min.", "6. His respirations are 12/min.", "7. His oxygen saturation is 90% on room air.", "8. A 14-gauge needle is placed in the 2nd intercostal space on the patient\u2019s left.", "9. His blood pressure increases to 104/74 mmHg.", "10. His pulse decreases to 100/min."], "atomic_facts": ["1. The patient is complaining of chest pain and shortness of breath.", "2. The patient is confused.", "3. The patient's temperature is 97.7\u00b0F (36.5\u00b0C).", "4. The patient's blood pressure is 94/54 mmHg.", "5. The patient's pulse is 170/min.", "6. The patient's respirations are 12/min.", "7. The patient's oxygen saturation is 90% on room air.", "8. A 14-gauge needle is placed in the 2nd intercostal space on the patient\u2019s left.", "9. The patient's blood pressure increases to 104/74 mmHg after the needle placement.", "10. The patient's pulse decreases to 100/min after the needle placement."]}
{"id": 363, "question": "Which of the following is the best course of treatment for this patient?", "context": ["A 13-year-old girl presents with a rash on her left hand and forearm.", "She went hiking with friends the day before yesterday and awoke this morning to find her hand and forearm red and itchy.", "She denies any swelling of the face or throat, difficulty breathing, dizziness, or palpitations.", "She has no significant past medical history or known allergies.", "She is afebrile and her vital signs are within normal limits.", "On physical examination, there are multiple erythematous papules and fluid-filled vesicles in a linear pattern on her left hand and forearm as shown in the exhibit (see image)."], "context_len": 6, "options": {"A": "Oral prednisone", "B": "Topical clobetasol", "C": "Phototherapy", "D": "Azathioprine"}, "answer": "Topical clobetasol", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "13 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 13-year-old girl.", "2. Patient went hiking with friends two days ago.", "3. Patient awoke this morning with a rash on her left hand and forearm.", "4. Patient denies any swelling of the face or throat, difficulty breathing, dizziness, or palpitations.", "5. Patient has no significant past medical history or known allergies.", "6. Patient is afebrile.", "7. Patient's vital signs are within normal limits.", "8. On physical examination, there are multiple erythematous papules and fluid-filled vesicles in a linear pattern on her left hand and forearm.", "9. Exhibit (see image) shows the rash on the patient's left hand and forearm."], "atomic_facts": ["1. She went hiking with friends the day before yesterday.", "2. She awoke this morning to find her hand and forearm red and itchy.", "3. She denies any swelling of the face or throat, difficulty breathing, dizziness, or palpitations.", "4. She has no significant past medical history or known allergies.", "5. She is afebrile.", "6. Her vital signs are within normal limits.", "7. On physical examination, there are multiple erythematous papules and fluid-filled vesicles in a linear pattern on her left hand and forearm."]}
{"id": 364, "question": "This patient is most likely to die from which of the following complications?", "context": ["A 12-year-old boy is brought to the physician for multiple bruises.", "He has fallen multiple times over the past 4 months and has difficulty walking without assistance.", "His speech is slow and difficult to understand.", "Neurological examination shows bilateral nystagmus, decreased muscle strength, 1+ reflexes bilaterally, and a wide-based gait with irregular and uneven steps.", "His proprioception and vibration senses are absent.", "The remainder of the examination shows kyphoscoliosis and foot inversion with hammer toes."], "context_len": 6, "options": {"A": "Renal cell carcinoma", "B": "Heart failure", "C": "Posterior fossa tumors", "D": "Aspiration pneumonia\n\""}, "answer": "Heart failure", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "12 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 12-year-old boy is brought to the physician.", "2. He has fallen multiple times over the past 4 months.", "3. He has difficulty walking without assistance.", "4. His speech is slow and difficult to understand.", "5. Neurological examination shows bilateral nystagmus.", "6. Neurological examination shows decreased muscle strength.", "7. Neurological examination shows 1+ reflexes bilaterally.", "8. Neurological examination shows a wide-based gait with irregular and uneven steps.", "9. Neurological examination shows absent proprioception and vibration senses.", "10. The remainder of the examination shows kyphoscoliosis.", "11. The remainder of the examination shows foot inversion with hammer toes."], "atomic_facts": ["1. He has fallen multiple times over the past 4 months.", "2. He has difficulty walking without assistance.", "3. His speech is slow and difficult to understand.", "4. Neurological examination shows bilateral nystagmus.", "5. Neurological examination shows decreased muscle strength.", "6. Neurological examination shows 1+ reflexes bilaterally.", "7. Neurological examination shows a wide-based gait with irregular and uneven steps.", "8. His proprioception is absent.", "9. His vibration senses are absent.", "10. The remainder of the examination shows kyphoscoliosis.", "11. The remainder of the examination shows foot inversion with hammer toes."]}
{"id": 365, "question": "Further evaluation is most likely to show which of the following findings?", "context": ["A 28-year-old nulligravid woman comes to the physician for a routine health maintenance examination.", "Upon questioning, she reports that she and her husband have been trying to conceive for more than 1 year; they have unprotected sexual intercourse 3\u20134 times per week.", "Recently, she has not been enjoying sexual intercourse with her husband because of painful penetration.", "She also reports episodic back and pelvic pain over the past 6 months that lasts for 2\u20133 days; she has missed several days of work each month because of the pain.", "Menarche was at the age of 13 years, and menses occur at 26\u201328 day intervals.", "Pelvic examination shows a normal-appearing vulva and vagina.", "There is rectovaginal tenderness.", "Ultrasonography of the pelvis shows a retroverted normal-sized uterus."], "context_len": 8, "options": {"A": "Endometrial tisssue within the myometrium on biopsy", "B": "Multiple bilateral ovarian cysts on ultrasonography", "C": "Reddish-black peritoneal lesions on laparoscopy", "D": "Concentric, solid myometrial tumors on MRI"}, "answer": "Reddish-black peritoneal lesions on laparoscopy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is 28 years old.", "2. Patient is nulligravid.", "3. Patient and her husband have been trying to conceive for more than 1 year.", "4. Patient and her husband have unprotected sexual intercourse 3-4 times per week.", "5. Patient has not been enjoying sexual intercourse with her husband because of painful penetration.", "6. Patient has episodic back and pelvic pain over the past 6 months.", "7. Pain lasts for 2-3 days.", "8. Patient has missed several days of work each month because of the pain.", "9. Patient's menarche was at the age of 13 years.", "10. Patient's menses occur at 26-28 day intervals.", "11. Pelvic examination shows a normal-appearing vulva and vagina.", "12. Pelvic examination shows rectovaginal tenderness.", "13. Ultrasonography of the pelvis shows a retroverted normal-sized uterus."], "atomic_facts": ["1. She and her husband have been trying to conceive for more than 1 year.", "2. They have unprotected sexual intercourse 3\u20134 times per week.", "3. She has not been enjoying sexual intercourse with her husband because of painful penetration.", "4. She reports episodic back and pelvic pain over the past 6 months that lasts for 2\u20133 days.", "5. She has missed several days of work each month because of the pain.", "6. Menarche was at the age of 13 years.", "7. Menses occur at 26\u201328 day intervals.", "8. Pelvic examination shows a normal-appearing vulva and vagina.", "9. There is rectovaginal tenderness.", "10. Ultrasonography of the pelvis shows a retroverted normal-sized uterus."]}
{"id": 366, "question": "What disease is the child suffering from?", "context": ["A 2-year-old Caucasian male presents with recurrent diaper rash and oral thrush.", "He has also experienced recurrent episodes of otitis media from repeat Streptoccous pneumoniae.", "He notably has reduced T and B cell counts."], "context_len": 3, "options": {"A": "X-linked agammaglobulinemia", "B": "Isolated IgA deficiency", "C": "Severe combined immunodeficiency", "D": "DiGeorge syndrome"}, "answer": "Severe combined immunodeficiency", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Immunology", "Pediatric Immunology and Allergy", "Immunology and Allergy"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. Patient is 2-year-old Caucasian male.", "2. Patient presents with recurrent diaper rash and oral thrush.", "3. Patient has experienced recurrent episodes of otitis media.", "4. Patient has repeat Streptoccous pneumoniae.", "5. Patient has reduced T and B cell counts."], "atomic_facts": ["1. He has experienced recurrent episodes of otitis media.", "2. The otitis media is caused by repeat Streptococcus pneumoniae.", "3. He has reduced T cell counts.", "4. He has reduced B cell counts."]}
{"id": 367, "question": "If the pregnancy is continued to term, the child is at an increased risk of developing which of the following conditions?", "context": ["A 42-year-old primigravida woman presents to her gynecologist for a routine prenatal visit at 11 weeks of gestation.", "Her pregnancy has been uneventful so far.", "She denies smoking, using alcohol, or any illicit drugs.", "Past medical history is significant for Hashimoto\u2019s thyroiditis which is well-controlled with levothyroxine.", "Her blood pressure is 110/70 mm Hg, a heart rate of 95/min, a respiratory rate of 20/min, and a temperature of 36.4\u00b0C (97.5\u00b0F).", "Physical examination is unremarkable.", "A transvaginal ultrasound reveals increased nuchal translucency.", "Laboratory studies show decreased levels of PAPP-A and increased levels of \u03b2-hCG."], "context_len": 8, "options": {"A": "Vaginal adenosis", "B": "Huntington disease", "C": "Alzheimer\u2019s disease", "D": "Ebstein anomaly"}, "answer": "Alzheimer\u2019s disease", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Maternal", "Complex Family Planning"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 42-year-old primigravida woman presents to her gynecologist for a routine prenatal visit at 11 weeks of gestation.", "2. Her pregnancy has been uneventful so far.", "3. She denies smoking, using alcohol, or any illicit drugs.", "4. Past medical history is significant for Hashimoto\u2019s thyroiditis which is well-controlled with levothyroxine.", "5. Her blood pressure is 110/70 mm Hg.", "6. Her heart rate is 95/min.", "7. Her respiratory rate is 20/min.", "8. Her temperature is 36.4\u00b0C (97.5\u00b0F).", "9. Physical examination is unremarkable.", "10. A transvaginal ultrasound reveals increased nuchal translucency.", "11. Laboratory studies show decreased levels of PAPP-A.", "12. Laboratory studies show increased levels of \u03b2-hCG."], "atomic_facts": ["1. Her pregnancy has been uneventful so far.", "2. She denies smoking, using alcohol, or any illicit drugs.", "3. Past medical history is significant for Hashimoto\u2019s thyroiditis which is well-controlled with levothyroxine.", "4. Her blood pressure is 110/70 mm Hg.", "5. Her heart rate is 95/min.", "6. Her respiratory rate is 20/min.", "7. Her temperature is 36.4\u00b0C (97.5\u00b0F).", "8. Physical examination is unremarkable.", "9. A transvaginal ultrasound reveals increased nuchal translucency.", "10. Laboratory studies show decreased levels of PAPP-A.", "11. Laboratory studies show increased levels of \u03b2-hCG."]}
{"id": 368, "question": "Vaccination against the causal pathogen of this patient's current disease is most likely to also prevent which of the following conditions?", "context": ["An 18-month-old boy is brought to the emergency department by his babysitter because of lethargy and fever for 3 hours.", "He has not fully recovered from a middle ear infection that started a few days ago.", "The parents cannot be reached for further information.", "His temperature is 39.1\u00b0C (102.3\u00b0F).", "Physical examination shows nuchal rigidity.", "A pathogen is isolated from the patient's cerebrospinal fluid that does not grow on regular blood agar plate but produces colonies when cocultured with Staphylococcus aureus."], "context_len": 6, "options": {"A": "Bacterial rhinosinusitis", "B": "Epiglottitis", "C": "Chancroid", "D": "Impetigo"}, "answer": "Epiglottitis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "18 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 18-month-old boy is brought to the emergency department by his babysitter.", "2. The boy has been lethargic and has had a fever for 3 hours.", "3. The boy had a middle ear infection a few days ago.", "4. The parents cannot be reached for further information.", "5. The boy's temperature is 39.1\u00b0C (102.3\u00b0F).", "6. Physical examination shows nuchal rigidity.", "7. A pathogen is isolated from the patient's cerebrospinal fluid.", "8. The pathogen does not grow on regular blood agar plate.", "9. The pathogen produces colonies when cocultured with Staphylococcus aureus."], "atomic_facts": ["1. He has not fully recovered from a middle ear infection that started a few days ago.", "2. The parents cannot be reached for further information.", "3. His temperature is 39.1\u00b0C (102.3\u00b0F).", "4. Physical examination shows nuchal rigidity.", "5. A pathogen is isolated from the patient's cerebrospinal fluid.", "6. The pathogen does not grow on regular blood agar plate.", "7. The pathogen produces colonies when cocultured with Staphylococcus aureus."]}
{"id": 369, "question": "The serum concentration of which of the following substances is most likely to also be increased in this patient?", "context": ["A 20-month-old boy is brought to the physician for the evaluation of intellectual and behavioral abnormalities and abnormal movements of his extremities.", "His mother reports that he often hits his head and limbs against furniture.", "He is unable to walk without support and speaks in unclear 2-word phrases.", "Examination shows multiple bruises on the forehead and several healing wounds over the fingers.", "There is increased muscle tone in all extremities.", "Laboratory studies show an increased serum uric acid concentration."], "context_len": 6, "options": {"A": "Phenylalanine", "B": "Deoxyadenosine trisphosphate", "C": "Phosphoribosyl pyrophosphate", "D": "Cytosine monophosphate"}, "answer": "Phosphoribosyl pyrophosphate", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "20 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 20-month-old boy is brought to the physician for the evaluation of intellectual and behavioral abnormalities and abnormal movements of his extremities.", "2. His mother reports that he often hits his head and limbs against furniture.", "3. He is unable to walk without support.", "4. He speaks in unclear 2-word phrases.", "5. Examination shows multiple bruises on the forehead.", "6. Examination shows several healing wounds over the fingers.", "7. There is increased muscle tone in all extremities.", "8. Laboratory studies show an increased serum uric acid concentration."], "atomic_facts": ["1. His mother reports that he often hits his head and limbs against furniture.", "2. He is unable to walk without support.", "3. He speaks in unclear 2-word phrases.", "4. Examination shows multiple bruises on the forehead.", "5. Examination shows several healing wounds over the fingers.", "6. There is increased muscle tone in all extremities.", "7. Laboratory studies show an increased serum uric acid concentration."]}
{"id": 370, "question": "Which of the following is most likely this patient\u2019s diagnosis?", "context": ["A 24-year-old man presents to the office for a physical exam and drug screening requested by his parole officer.", "He has a history of multiple run-ins with the law, including theft, destruction of property, and assault and battery.", "Patient confesses that he has always been the 'problem child' in his home and always got into trouble with authority figures.", "Past medical records reveal testimonies from his mother describing episodes of physically aggressive behavior in school starting at before 12.", "Although a single parent, his mother states there were no stressful changes or issues at home.", "Today's urine toxicology screens are negative."], "context_len": 6, "options": {"A": "Substance use-related aggression", "B": "Conduct disorder", "C": "Antisocial personality disorder", "D": "Borderline personality disorder"}, "answer": "Antisocial personality disorder", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "24", "specialties": ["Psychiatry"], "subspecialties": ["Addiction Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 24-year-old man presents to the office for a physical exam and drug screening.", "2. The drug screening was requested by his parole officer.", "3. He has a history of multiple run-ins with the law, including theft, destruction of property, and assault and battery.", "4. Patient confesses that he has always been the 'problem child' in his home and always got into trouble with authority figures.", "5. Past medical records reveal testimonies from his mother describing episodes of physically aggressive behavior in school starting before 12.", "6. His mother is a single parent.", "7. His mother states there were no stressful changes or issues at home.", "8. Today's urine toxicology screens are negative."], "atomic_facts": ["1. He has a history of multiple run-ins with the law, including theft, destruction of property, and assault and battery.", "2. Patient confesses that he has always been the 'problem child' in his home and always got into trouble with authority figures.", "3. Past medical records reveal testimonies from his mother describing episodes of physically aggressive behavior in school starting at before 12.", "4. Although a single parent, his mother states there were no stressful changes or issues at home.", "5. Today's urine toxicology screens are negative."]}
{"id": 371, "question": "Which of the following is the best initial therapy for this patient?", "context": ["A 47-year old woman is referred to a nephrologist due to hematuria over the last week and lower extremity edema.", "She first noticed her feet and legs would swell in the mornings about 2 weeks ago.", "Her past medical history is significant for systemic lupus erythematosus for the past 24 years.", "This causes her mild joint and muscle pain on most day and she manages her symptoms with ibuprofen and acetaminophen.", "Today, her heart rate is 90/min, the respiratory rate is 17/min, the blood pressure is 140/90 mm Hg, and the temperature is 37.1\u00b0C (98.8\u00b0F).", "Urine analysis shows 6-10 dysmorphic RBCs per high powered field and occasional cellular casts.", "Serum creatinine is 2.4 mg/dL and a 24 hour urine collection reveals 550mg of excreted protein.", "A kidney biopsy shows findings consistent with diffuse proliferative glomerulonephritis."], "context_len": 8, "options": {"A": "Methotrexate and folic acid", "B": "Intravenous immunoglobulin", "C": "Plasmapheresis", "D": "Cyclophosphamide and prednisolone"}, "answer": "Cyclophosphamide and prednisolone", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "47 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 47-year old woman is referred to a nephrologist.", "2. She has had hematuria over the last week.", "3. She has lower extremity edema.", "4. She first noticed her feet and legs would swell in the mornings about 2 weeks ago.", "5. Her past medical history is significant for systemic lupus erythematosus for the past 24 years.", "6. This causes her mild joint and muscle pain on most days.", "7. She manages her symptoms with ibuprofen and acetaminophen.", "8. Today, her heart rate is 90/min.", "9. The respiratory rate is 17/min.", "10. The blood pressure is 140/90 mm Hg.", "11. The temperature is 37.1\u00b0C (98.8\u00b0F).", "12. Urine analysis shows 6-10 dysmorphic RBCs per high powered field.", "13. Urine analysis also shows occasional cellular casts.", "14. Serum creatinine is 2.4 mg/dL.", "15. A 24 hour urine collection reveals 550mg of excreted protein.", "16. A kidney biopsy shows findings consistent with diffuse proliferative glomerulonephritis."], "atomic_facts": ["1. Patient noticed swelling in feet and legs 2 weeks ago", "2. Past medical history includes systemic lupus erythematosus for 24 years", "3. SLE causes mild joint and muscle pain, managed with ibuprofen and acetaminophen", "4. Current vital signs: heart rate 90/min, respiratory rate 17/min, blood pressure 140/90 mm Hg, temperature 37.1\u00b0C (98.8\u00b0F)", "5. Urine analysis shows 6-10 dysmorphic RBCs per high powered field and occasional cellular casts", "6. Serum creatinine level is 2.4 mg/dL", "7. 24-hour urine collection reveals 550mg of excreted protein", "8. Kidney biopsy shows findings consistent with diffuse proliferative glomerulonephritis"]}
{"id": 372, "question": "Which pathological change would likely be seen on microscopy?", "context": ["A 6-year-old girl presents to your clinic two weeks after receiving a routine immunization in preparation for a trip overseas.", "Periorbital edema is present on exam, and 24 hour urine collection shows excretion of 4.3 grams of protein/day."], "context_len": 2, "options": {"A": "Linear IgG deposition on light microscopy", "B": "IgA-immune complexes in the mesangium on electron microscopy", "C": "Subepithelial deposits with \u201cspike and dome\u201d appearance on electron microscopy", "D": "Podocyte effacement on electron microscopy"}, "answer": "Podocyte effacement on electron microscopy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 6-year-old girl presents to a clinic.", "2. She received a routine immunization two weeks prior.", "3. The immunization was in preparation for a trip overseas.", "4. Periorbital edema is present on exam.", "5. A 24 hour urine collection was done.", "6. The urine collection showed excretion of 4.3 grams of protein/day."], "atomic_facts": ["1. Periorbital edema is present on exam.", "2. 24 hour urine collection shows excretion of 4.3 grams of protein/day."]}
{"id": 373, "question": "Which of the following sets of laboratory findings is most likely in this patient's serum? |  $$$ Calcium %%% Phosphorus %%% Parathyroid hormone %%% Calcitriol $$$", "context": ["A 9-year-old girl is brought to the physician by her father for evaluation of intermittent muscle cramps for the past year and short stature.", "She has had recurrent upper respiratory tract infections since infancy.", "She is at the 5th percentile for weight and 10th percentile for height.", "Physical examination shows nasal polyps and dry skin.", "An x-ray of the right wrist shows osteopenia with epiphyseal widening."], "context_len": 5, "options": {"A": "\u2193 \u2193 \u2191 \u2193", "B": "\u2193 \u2191 \u2191 \u2193", "C": "\u2191 \u2193 \u2191 \u2191", "D": "Normal \u2193 \u2191 \u2193"}, "answer": "\u2193 \u2193 \u2191 \u2193", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "9 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 9-year-old girl is brought to the physician by her father.", "2. She has had intermittent muscle cramps for the past year.", "3. She has had recurrent upper respiratory tract infections since infancy.", "4. She is at the 5th percentile for weight.", "5. She is at the 10th percentile for height.", "6. Physical examination shows nasal polyps.", "7. Physical examination shows dry skin.", "8. An x-ray of the right wrist shows osteopenia.", "9. An x-ray of the right wrist shows epiphyseal widening."], "atomic_facts": ["1. She has had recurrent upper respiratory tract infections since infancy.", "2. She is at the 5th percentile for weight.", "3. She is at the 10th percentile for height.", "4. Physical examination shows nasal polyps.", "5. Physical examination shows dry skin.", "6. An x-ray of the right wrist shows osteopenia.", "7. An x-ray of the right wrist shows epiphyseal widening."]}
{"id": 374, "question": "Which of the following is the most likely explanation for his positive Candida culture?", "context": ["A 24-year-old medical student presents to urgent care with cough and rhinorrhea.", "He has been learning about HIV and immunosuppression in medical school, and he is worried that he is seriously ill.", "He has no significant medical history, and he is sexually active with his girlfriend.", "He consumes alcohol on weekends but does not use tobacco or other recreational drugs.", "He candidly reports that, in microbiology lab, he cultured his own sputum on Sabouraud agar, and Candida grew on the agar.", "Examination of the oropharynx does not show any abnormalities.", "You perform a nasal viral swab, which confirms that he has a rhinovirus infection."], "context_len": 7, "options": {"A": "HIV virus infection", "B": "Xerostomia", "C": "Surreptitious drug use", "D": "Benign Candida colonization"}, "answer": "Benign Candida colonization", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "24 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 24 years old.", "2. Patient is a medical student.", "3. Patient presents to urgent care with cough and rhinorrhea.", "4. Patient has been learning about HIV and immunosuppression in medical school.", "5. Patient is worried that he is seriously ill.", "6. Patient has no significant medical history.", "7. Patient is sexually active with his girlfriend.", "8. Patient consumes alcohol on weekends.", "9. Patient does not use tobacco or other recreational drugs.", "10. Patient cultured his own sputum on Sabouraud agar, and Candida grew on the agar.", "11. Examination of the oropharynx does not show any abnormalities.", "12. Nasal viral swab confirms that patient has a rhinovirus infection."], "atomic_facts": ["1. He has been learning about HIV and immunosuppression in medical school.", "2. He is worried that he is seriously ill.", "3. He has no significant medical history.", "4. He is sexually active with his girlfriend.", "5. He consumes alcohol on weekends.", "6. He does not use tobacco or other recreational drugs.", "7. In microbiology lab, he cultured his own sputum on Sabouraud agar.", "8. Candida grew on the agar.", "9. Examination of the oropharynx does not show any abnormalities.", "10. A nasal viral swab confirms that he has a rhinovirus infection."]}
{"id": 375, "question": "Which of the following medications would be most appropriate to assist the patient with her symptoms at this time?", "context": ["A 57-year-old woman comes to her physician with a persistent cough.", "She has observed an increase in the frequency of her cough over the past few months and also the production of yellowish sputum on several occasions.", "She says that sputum production is greater in the morning compared to the rest of the day.", "She has been a chain smoker for about 35 years now, smoking close to 3 packs a day.", "She has never had the will to quit.", "Over the last 2 years, she has had this cough and doesn't recall being free of it for 3 months at a stretch.", "On examination, there is a slight expiratory wheeze in the lower lung fields.", "Her respiratory rate is 18/min, pulse is 85/min, and blood pressure is 110/70 mm Hg.", "Her forced expiratory volume in the first second is 83% at this time.", "Her FEV1/FVC post-bronchodilator ratio is 0.65.", "Based on these findings, her physician recommends that she quit smoking.", "She is also advised to take pneumococcal and influenza vaccinations over the next few months."], "context_len": 12, "options": {"A": "Albuterol", "B": "Fluticasone", "C": "Doxycycline", "D": "Prednisone"}, "answer": "Albuterol", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "57 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 57-year-old woman comes to her physician with a persistent cough.", "2. She has observed an increase in the frequency of her cough over the past few months.", "3. She has also observed the production of yellowish sputum on several occasions.", "4. She says that sputum production is greater in the morning compared to the rest of the day.", "5. She has been a chain smoker for about 35 years now, smoking close to 3 packs a day.", "6. She has never had the will to quit.", "7. Over the last 2 years, she has had this cough and doesn't recall being free of it for 3 months at a stretch.", "8. On examination, there is a slight expiratory wheeze in the lower lung fields.", "9. Her respiratory rate is 18/min.", "10. Her pulse is 85/min.", "11. Her blood pressure is 110/70 mm Hg.", "12. Her forced expiratory volume in the first second is 83% at this time.", "13. Her FEV1/FVC post-bronchodilator ratio is 0.65.", "14. Based on these findings, her physician recommends that she quit smoking.", "15. She is also advised to take pneumococcal and influenza vaccinations over the next few months."], "atomic_facts": ["1. She has observed an increase in the frequency of her cough over the past few months.", "2. She has observed the production of yellowish sputum on several occasions.", "3. Sputum production is greater in the morning compared to the rest of the day.", "4. She has been a chain smoker for about 35 years.", "5. She smokes close to 3 packs a day.", "6. She has never had the will to quit smoking.", "7. Over the last 2 years, she has had a cough and doesn't recall being free of it for 3 months at a stretch.", "8. On examination, there is a slight expiratory wheeze in the lower lung fields.", "9. Her respiratory rate is 18/min.", "10. Her pulse is 85/min.", "11. Her blood pressure is 110/70 mm Hg.", "12. Her forced expiratory volume in the first second is 83% at this time.", "13. Her FEV1/FVC post-bronchodilator ratio is 0.65.", "14. Her physician recommends that she quit smoking based on these findings.", "15. She is advised to take pneumococcal and influenza vaccinations over the next few months."]}
{"id": 376, "question": "Which of the following is most likely the diagnosis?", "context": ["A 56-year-old woman presents to her primary care physician for dizziness.", "She says that her symptoms began approximately 1 month prior to presentation and are associated with nausea and ringing of the ears.", "She describes her dizziness as a spinning sensation that has a start and end and lasts approximately 25 minutes.", "This dizziness is severe enough that she cannot walk or stand.", "Her symptoms are fluctuating, and she denies any tunnel vision or feelings of fainting.", "However, she has abruptly fallen to the ground in the past and denied losing consciousness.", "Medical history is significant for a migraine with aura treated with zolmitriptan, type 2 diabetes managed with metformin, and hypertension managed with lisinopril.", "Her blood pressure is 125/75 mmHg, pulse is 88/min, and respirations are 16/min.", "On physical exam, when words are whispered into her right ear, she is unable to repeat the whispered words aloud; however, this is normal in the left ear.", "Air conduction is greater than bone conduction with Rinne testing, and the sound of the tuning fork is loudest in the left ear on Weber testing."], "context_len": 10, "options": {"A": "Benign paroxysmal positional vertigo", "B": "Meniere disease", "C": "Migraine", "D": "Transient ischemic attack"}, "answer": "Meniere disease", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "56 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is a 56-year-old woman.", "2. Patient presents to primary care physician for dizziness.", "3. Symptoms began approximately 1 month prior to presentation.", "4. Symptoms associated with nausea and ringing of the ears.", "5. Dizziness described as a spinning sensation with a start and end, lasting approximately 25 minutes.", "6. Dizziness severe enough that patient cannot walk or stand.", "7. Symptoms fluctuating.", "8. Patient denies tunnel vision or feelings of fainting.", "9. Patient has abruptly fallen to the ground in the past and denied losing consciousness.", "10. Medical history significant for migraine with aura treated with zolmitriptan.", "11. Medical history significant for type 2 diabetes managed with metformin.", "12. Medical history significant for hypertension managed with lisinopril.", "13. Blood pressure is 125/75 mmHg.", "14. Pulse is 88/min.", "15. Respirations are 16/min.", "16. When words are whispered into right ear, patient is unable to repeat the whispered words aloud.", "17. When words are whispered into left ear, patient is able to repeat the whispered words aloud.", "18. Air conduction is greater than bone conduction with Rinne testing.", "19. Sound of tuning fork is loudest in left ear on Weber testing."], "atomic_facts": ["1. Symptoms began approximately 1 month prior to presentation", "2. Symptoms are associated with nausea and ringing of the ears", "3. Dizziness is described as a spinning sensation with a start and end", "4. Dizziness lasts approximately 25 minutes", "5. Dizziness is severe enough that the patient cannot walk or stand", "6. Symptoms are fluctuating", "7. Denies tunnel vision or feelings of fainting", "8. Has abruptly fallen to the ground in the past", "9. Denies losing consciousness", "10. Medical history includes migraine with aura treated with zolmitriptan", "11. Medical history includes type 2 diabetes managed with metformin", "12. Medical history includes hypertension managed with lisinopril", "13. Blood pressure is 125/75 mmHg", "14. Pulse is 88/min", "15. Respirations are 16/min", "16. Unable to repeat whispered words aloud when whispered into the right ear", "17. Normal response when whispered into the left ear", "18. Air conduction is greater than bone conduction with Rinne testing", "19. Sound of the tuning fork is loudest in the left ear on Weber testing"]}
{"id": 377, "question": "Which of the following is the most likely cause of this infant\u2019s symptoms?", "context": ["A 3086-g (6-lb) male newborn is delivered at 39 weeks' gestation to a 29-year-old woman.", "Initial examination shows micrognathia, a broad nasal bridge, short philtrum, and a cleft palate.", "Intermittent muscle spasms are seen predominantly in the hands and feet.", "A harsh systolic murmur is heard over the lower left sternal border."], "context_len": 4, "options": {"A": "Deletion in chromosome 7", "B": "Deletion in chromosome 22", "C": "Nondisjunction of chromosome 21", "D": "Nondisjunction of chromosome 13"}, "answer": "Deletion in chromosome 22", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "Newborn", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 3086-g (6-lb) male newborn is delivered.", "2. The newborn is delivered at 39 weeks' gestation.", "3. The mother is 29 years old.", "4. Initial examination shows micrognathia.", "5. Initial examination shows a broad nasal bridge.", "6. Initial examination shows a short philtrum.", "7. Initial examination shows a cleft palate.", "8. Intermittent muscle spasms are seen predominantly in the hands and feet.", "9. A harsh systolic murmur is heard over the lower left sternal border."], "atomic_facts": ["1. Initial examination shows micrognathia.", "2. Initial examination shows a broad nasal bridge.", "3. Initial examination shows a short philtrum.", "4. Initial examination shows a cleft palate.", "5. Intermittent muscle spasms are seen predominantly in the hands and feet.", "6. A harsh systolic murmur is heard over the lower left sternal border."]}
{"id": 378, "question": "Serum studies are most likely to show which of the following findings?\"", "context": ["A 37-year-old woman comes to the emergency department because her eyes have had a yellow discoloration and she has had dark urine for the past 3 days.", "She has also had fever, itching, and severe fatigue.", "She reports having symptoms of the stomach flu a week ago, which resolved with over-the-counter medication.", "She does not have diarrhea but says her stools are whitish in appearance.", "She has no personal history of serious illness.", "She does not smoke and drinks an average of 2 beers on weekends.", "She does not use illicit drugs.", "She has been sexually active with the same partner for 12 years and uses condoms consistently.", "She works as a flight attendant for an international airline.", "She appears ill.", "Her temperature is 39.3\u00b0C (102.7\u00b0F), pulse is 64/min, and blood pressure is 132/82 mm Hg.", "Examination shows scleral icterus, excoriation marks over her extremities, and parched lips.", "The liver is tender on palpation; there is no splenomegaly.", "Cardiopulmonary examination is normal.", "Laboratory studies show: | Hemoglobin 11.6 g/dL | Leukocyte count 10,300/mm3 | Platelet count 256,000/mm3 | ESR 19 mm/hr | Prothrombin time 13 seconds | Serum | Urea nitrogen 28 mg/dL | Glucose 89 mg/dL | Creatinine 0.7 mg/dL | Bilirubin | Total 8 mg/dL | Direct 4 mg/dL | ALP 80 U/L | AST 312 U/L | ALT 569 U/L | An ultrasound of the abdomen shows no abnormalities."], "context_len": 15, "options": {"A": "Anti-mitochondrial antibodies", "B": "Perinuclear anti-neutrophil cytoplasmic antibodies", "C": "Anti-HAV IgM", "D": "Anti-HEV IgG"}, "answer": "Anti-HAV IgM", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "37 years old", "specialties": ["Internal Medicine", "Gastroenterology"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 37-year-old woman comes to the emergency department.", "2. She has had a yellow discoloration in her eyes for the past 3 days.", "3. She has had dark urine for the past 3 days.", "4. She has had fever, itching, and severe fatigue.", "5. She had symptoms of the stomach flu a week ago, which resolved with over-the-counter medication.", "6. She does not have diarrhea but says her stools are whitish in appearance.", "7. She has no personal history of serious illness.", "8. She does not smoke.", "9. She drinks an average of 2 beers on weekends.", "10. She does not use illicit drugs.", "11. She has been sexually active with the same partner for 12 years and uses condoms consistently.", "12. She works as a flight attendant for an international airline.", "13. She appears ill.", "14. Her temperature is 39.3\u00b0C (102.7\u00b0F).", "15. Her pulse is 64/min.", "16. Her blood pressure is 132/82 mm Hg.", "17. Examination shows scleral icterus, excoriation marks over her extremities, and parched lips.", "18. The liver is tender on palpation; there is no splenomegaly.", "19. Cardiopulmonary examination is normal.", "20. Laboratory studies show: Hemoglobin 11.6 g/dL, Leukocyte count 10,300/mm3, Platelet count 256,000/mm3, ESR 19 mm/hr, Prothrombin time 13 seconds, Serum Urea nitrogen 28 mg/dL, Glucose 89 mg/dL, Creatinine 0.7 mg/dL, Bilirubin Total 8 mg/dL, Direct 4 mg/dL, ALP 80 U/L, AST 312 U/L, ALT 569 U/L.", "21. An ultrasound of the abdomen shows no abnormalities."], "atomic_facts": ["1. She has had fever, itching, and severe fatigue.", "2. She had symptoms of the stomach flu a week ago, which resolved with over-the-counter medication.", "3. She does not have diarrhea but says her stools are whitish in appearance.", "4. She has no personal history of serious illness.", "5. She does not smoke and drinks an average of 2 beers on weekends.", "6. She does not use illicit drugs.", "7. She has been sexually active with the same partner for 12 years and uses condoms consistently.", "8. She works as a flight attendant for an international airline.", "9. She appears ill.", "10. Her temperature is 39.3\u00b0C (102.7\u00b0F), pulse is 64/min, and blood pressure is 132/82 mm Hg.", "11. Examination shows scleral icterus, excoriation marks over her extremities, and parched lips.", "12. The liver is tender on palpation; there is no splenomegaly.", "13. Cardiopulmonary examination is normal.", "14. Laboratory studies show: Hemoglobin 11.6 g/dL, Leukocyte count 10,300/mm3, Platelet count 256,000/mm3, ESR 19 mm/hr, Prothrombin time 13 seconds, Serum Urea nitrogen 28 mg/dL, Glucose 89 mg/dL, Creatinine 0.7 mg/dL, Bilirubin Total 8 mg/dL, Direct 4 mg/dL, ALP 80 U/L, AST 312 U/L, ALT 569 U/L.", "15. An ultrasound of the abdomen shows no abnormalities."]}
{"id": 379, "question": "What is the mechanism of action of the drug which typically induces remission of this patient\u2019s most likely condition?", "context": ["A 27-year-old man presents with diarrhea, fatigue and weight loss.", "He says he has been having occasional loose stools and abdominal pain for the past month, but he did not seek any medical attention because of work deadlines.", "He says the diarrhea is associated with cramping lower abdominal pain and an urgency to defecate.", "His stool is loose, occasionally blood-tinged, and contains mucus.", "He also says he feels fatigued and has lost 11 kg (24 lb) over the last 2 months.", "The patient denies any fever, sick contacts, or a history of recent travel.", "No significant past medical history.", "Family history is significant for colon cancer in his father, who died at the age of 50.", "On physical examination, the patient has generalized pallor.", "Abdominal exam reveals mild tenderness to palpation in the left lower quadrant.", "Laboratory investigations reveal microcytic anemia with an elevated ESR.", "A colonoscopy with biopsy is performed, which shows inflammation of the sigmoid colon and rectum.", "Biopsy shows a predominantly lymphoid infiltration of the mucosa and submucosa with multiple crypt abscesses.", "No evidence of granulomatous disease."], "context_len": 14, "options": {"A": "Inhibition of prostaglandins and inflammatory cytokines", "B": "Antibody against tumor necrosis factor", "C": "Inhibition of cellular metabolism", "D": "Suppression of polymorphonuclear cell migration"}, "answer": "Inhibition of prostaglandins and inflammatory cytokines", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "27 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 27 years old.", "2. Patient has diarrhea, fatigue and weight loss.", "3. Patient has had occasional loose stools and abdominal pain for the past month.", "4. Patient did not seek medical attention due to work deadlines.", "5. Diarrhea is associated with cramping lower abdominal pain and an urgency to defecate.", "6. Stool is loose, occasionally blood-tinged, and contains mucus.", "7. Patient feels fatigued and has lost 11 kg (24 lb) over the last 2 months.", "8. Patient denies any fever, sick contacts, or a history of recent travel.", "9. No significant past medical history.", "10. Family history is significant for colon cancer in his father, who died at the age of 50.", "11. On physical examination, patient has generalized pallor.", "12. Abdominal exam reveals mild tenderness to palpation in the left lower quadrant.", "13. Laboratory investigations reveal microcytic anemia with an elevated ESR.", "14. Colonoscopy with biopsy is performed, which shows inflammation of the sigmoid colon and rectum.", "15. Biopsy shows a predominantly lymphoid infiltration of the mucosa and submucosa with multiple crypt abscesses.", "16. No evidence of granulomatous disease."], "atomic_facts": ["1. Patient has been having occasional loose stools and abdominal pain for the past month.", "2. Patient did not seek medical attention due to work deadlines.", "3. Diarrhea is associated with cramping lower abdominal pain and an urgency to defecate.", "4. Stool is loose, occasionally blood-tinged, and contains mucus.", "5. Patient feels fatigued and has lost 11 kg (24 lb) over the last 2 months.", "6. Patient denies fever, sick contacts, or a history of recent travel.", "7. No significant past medical history.", "8. Family history is significant for colon cancer in his father, who died at the age of 50.", "9. Patient has generalized pallor on physical examination.", "10. Abdominal exam reveals mild tenderness to palpation in the left lower quadrant.", "11. Laboratory investigations reveal microcytic anemia with an elevated ESR.", "12. Colonoscopy with biopsy shows inflammation of the sigmoid colon and rectum.", "13. Biopsy shows a predominantly lymphoid infiltration of the mucosa and submucosa with multiple crypt abscesses.", "14. No evidence of granulomatous disease."]}
{"id": 380, "question": "Which of the following translocations is likely to be seen in this patient?", "context": ["A 61-year-old woman presents to your office complaining of mild fatigue and weight loss over the past 6 months.", "She states she has felt generally unwell and has had decreased appetite during this time frame.", "Her temperature is 98.1\u00b0F (36.7\u00b0C), blood pressure is 122/80 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 98% on room air.", "Physical exam reveals splenomegaly and a nontender abdomen.", "A complete blood count with differential shows the following: |  | Hemoglobin: 10 g/dL | Hematocrit: 30% | Leukocyte count: 166,500/mm^3 | Segmented neutrophils 92% | Leukocyte alkaline phosphatase: Low | Platelet count: 92,000/mm^3 |  | A bone marrow biopsy is performed demonstrating infiltration with a large number of normal-appearing neutrophils."], "context_len": 5, "options": {"A": "t(8;14)", "B": "t(9;22)", "C": "t(12;21)", "D": "t(15;17)"}, "answer": "t(9;22)", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "61", "specialties": ["Hematology", "Pathology"], "subspecialties": ["General Hematology", "Hematopathology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 61-year-old woman presents to your office complaining of mild fatigue and weight loss over the past 6 months.", "2. She states she has felt generally unwell and has had decreased appetite during this time frame.", "3. Her temperature is 98.1\u00b0F (36.7\u00b0C).", "4. Blood pressure is 122/80 mmHg.", "5. Pulse is 88/min.", "6. Respirations are 16/min.", "7. Oxygen saturation is 98% on room air.", "8. Physical exam reveals splenomegaly and a nontender abdomen.", "9. Hemoglobin: 10 g/dL.", "10. Hematocrit: 30%.", "11. Leukocyte count: 166,500/mm^3.", "12. Segmented neutrophils 92%.", "13. Leukocyte alkaline phosphatase: Low.", "14. Platelet count: 92,000/mm^3.", "15. A bone marrow biopsy is performed demonstrating infiltration with a large number of normal-appearing neutrophils."], "atomic_facts": ["1. The patient has felt generally unwell.", "2. The patient has had decreased appetite.", "3. The patient's temperature is 98.1\u00b0F (36.7\u00b0C).", "4. The patient's blood pressure is 122/80 mmHg.", "5. The patient's pulse is 88/min.", "6. The patient's respirations are 16/min.", "7. The patient's oxygen saturation is 98% on room air.", "8. Physical exam reveals splenomegaly.", "9. Physical exam reveals a nontender abdomen.", "10. Hemoglobin: 10 g/dL.", "11. Hematocrit: 30%.", "12. Leukocyte count: 166,500/mm^3.", "13. Segmented neutrophils: 92%.", "14. Leukocyte alkaline phosphatase: Low.", "15. Platelet count: 92,000/mm^3.", "16. A bone marrow biopsy demonstrates infiltration with a large number of normal-appearing neutrophils."]}
{"id": 381, "question": "Which of the following is the most appropriate initial treatment of this patient?", "context": ["A 44-year-old homeless man is brought to the emergency department after he was arrested when found intoxicated in someone's garage.", "The patient is acutely altered and is covered in urine, stool, and vomit.", "His temperature is 97.6\u00b0F (36.4\u00b0C), blood pressure is 104/64 mmHg, pulse is 130/min, respirations are 19/min, and oxygen saturation is 98% on room air.", "The patient is aroused with pain and begins answering basic questions.", "He states his vision is blurry and he can't see anything.", "Laboratory values are ordered as seen below. |  | Serum: | Na+: 141 mEq/L | Cl-: 102 mEq/L | K+: 4.4 mEq/L | HCO3-: 14 mEq/L | BUN: 25 mg/dL | Glucose: 99 mg/dL | Creatinine: 1.4 mg/dL | Ca2+: 10.2 mg/dL |  | ."], "context_len": 6, "options": {"A": "Glutathione formation", "B": "Inhibition of alcohol dehydrogenase", "C": "Muscarinic antagonism", "D": "Removal via dialysis"}, "answer": "Inhibition of alcohol dehydrogenase", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "44", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 44-year-old homeless man is brought to the emergency department after he was arrested when found intoxicated in someone's garage.", "2. The patient is acutely altered and is covered in urine, stool, and vomit.", "3. His temperature is 97.6\u00b0F (36.4\u00b0C).", "4. His blood pressure is 104/64 mmHg.", "5. His pulse is 130/min.", "6. His respirations are 19/min.", "7. His oxygen saturation is 98% on room air.", "8. The patient is aroused with pain and begins answering basic questions.", "9. He states his vision is blurry and he can't see anything.", "10. Serum Na+ is 141 mEq/L.", "11. Serum Cl- is 102 mEq/L.", "12. Serum K+ is 4.4 mEq/L.", "13. Serum HCO3- is 14 mEq/L.", "14. Serum BUN is 25 mg/dL.", "15. Serum Glucose is 99 mg/dL.", "16. Serum Creatinine is 1.4 mg/dL.", "17. Serum Ca2+ is 10.2 mg/dL."], "atomic_facts": ["1. The patient is acutely altered.", "2. The patient is covered in urine, stool, and vomit.", "3. The patient's temperature is 97.6\u00b0F (36.4\u00b0C).", "4. The patient's blood pressure is 104/64 mmHg.", "5. The patient's pulse is 130/min.", "6. The patient's respirations are 19/min.", "7. The patient's oxygen saturation is 98% on room air.", "8. The patient is aroused with pain and begins answering basic questions.", "9. The patient states his vision is blurry and he can't see anything.", "10. Laboratory values are ordered as seen below.", "11. Serum Na+ level is 141 mEq/L.", "12. Serum Cl- level is 102 mEq/L.", "13. Serum K+ level is 4.4 mEq/L.", "14. Serum HCO3- level is 14 mEq/L.", "15. Serum BUN level is 25 mg/dL.", "16. Serum glucose level is 99 mg/dL.", "17. Serum creatinine level is 1.4 mg/dL.", "18. Serum Ca2+ level is 10.2 mg/dL."]}
{"id": 382, "question": "Which of the following laboratory abnormalities would you expect to find in this patient?", "context": ["A 32-year-old construction worker is brought to the Emergency Department after a block of concrete crushed his right leg.", "His coworkers tried to remove the block, but it was not possible until firemen arrived on the scene 30 minutes after the incident.", "His personal medical history is unremarkable.", "Upon admission his vitals were stable.", "On physical examination the man is unconscious.", "His right leg is deformed with lacerations and hematomas.", "There are at least two fractures and several areas of the muscle appear pulpified.", "Distal right pulses are absent.", "An X-ray of the right leg reveals several displaced fractures of the tibia and fibula.", "Blood samples and a urine specimens are sent to the lab for analysis."], "context_len": 10, "options": {"A": "Fractional excretion of sodium (FeNa+) > 2%", "B": "Urine osmolality > 500 mOsmol/kg", "C": "Red-tinted plasma", "D": "Elevated haptoglobin"}, "answer": "Fractional excretion of sodium (FeNa+) > 2%", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "32 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 32-year-old construction worker is brought to the Emergency Department.", "2. A block of concrete crushed his right leg.", "3. His coworkers tried to remove the block, but it was not possible until firemen arrived on the scene 30 minutes after the incident.", "4. His personal medical history is unremarkable.", "5. Upon admission his vitals were stable.", "6. On physical examination the man is unconscious.", "7. His right leg is deformed with lacerations and hematomas.", "8. There are at least two fractures and several areas of the muscle appear pulpified.", "9. Distal right pulses are absent.", "10. An X-ray of the right leg reveals several displaced fractures of the tibia and fibula.", "11. Blood samples and a urine specimens are sent to the lab for analysis."], "atomic_facts": ["1. His coworkers tried to remove the block", "2. It was not possible until firemen arrived on the scene 30 minutes after the incident", "3. His personal medical history is unremarkable", "4. Upon admission his vitals were stable", "5. On physical examination the man is unconscious", "6. His right leg is deformed with lacerations and hematomas", "7. There are at least two fractures and several areas of the muscle appear pulpified", "8. Distal right pulses are absent", "9. An X-ray of the right leg reveals several displaced fractures of the tibia and fibula", "10. Blood samples and a urine specimens are sent to the lab for analysis"]}
{"id": 383, "question": "Which of the following is the most likely cause of the patient\u2019s condition?", "context": ["A 42-year-old primigravida woman goes into labor at 37 weeks.", "After several hours of labor, a boy is born with multiple physical abnormalities including cleft palate, micrognathia, and low-set ears.", "Imaging reveals an absence of the thymic shadow."], "context_len": 3, "options": {"A": "Microdeletion of the long arm of chromosome 22", "B": "Microdeletion of the long arm of chromosome 7", "C": "Microdeletion of the short arm of chromosome 5", "D": "Adenosine deaminase deficiency"}, "answer": "Microdeletion of the long arm of chromosome 22", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 42-year-old primigravida woman goes into labor.", "2. The woman goes into labor at 37 weeks.", "3. After several hours of labor, a boy is born.", "4. The boy has multiple physical abnormalities including cleft palate, micrognathia, and low-set ears.", "5. Imaging reveals an absence of the thymic shadow."], "atomic_facts": ["1. A boy is born after several hours of labor.", "2. The boy has multiple physical abnormalities, including cleft palate, micrognathia, and low-set ears.", "3. Imaging reveals an absence of the thymic shadow."]}
{"id": 384, "question": "When this drug is used long-term, which of the following complications can develop?", "context": ["A 20-year-old woman presents following a seizure 2 hours ago.", "The patient's roommate describes seeing the patient suddenly 'freeze', collapse, and start having jerky movements involving her entire body.", "The patient says she can not recall the episode but does remember 'seeing stars' before losing consciousness.", "She remembers being confused about where she was soon after the seizure and had urinated in her clothes when she regained consciousness.", "A persistent headache has troubled her since the seizure for which she took acetaminophen before coming to the hospital.", "Her past medical history is unremarkable.", "She denies alcohol and drug use.", "The physician starts her on an antiepileptic drug that acts in the motor cortex by blocking repeated activation of voltage-gated sodium channels and is also used in status epilepticus."], "context_len": 8, "options": {"A": "Drug dependence", "B": "Drug-induced SLE", "C": "Renal failure", "D": "Liver failure"}, "answer": "Drug-induced SLE", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Neurology"], "subspecialties": ["Epilepsy"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 20-year-old woman.", "2. Patient presented 2 hours after a seizure.", "3. Roommate described patient suddenly 'freezing', collapsing, and having jerky movements involving her entire body.", "4. Patient cannot recall the episode but remembers 'seeing stars' before losing consciousness.", "5. Patient was confused about where she was soon after the seizure.", "6. Patient had urinated in her clothes when she regained consciousness.", "7. Patient has had a persistent headache since the seizure.", "8. Patient took acetaminophen before coming to the hospital.", "9. Patient's past medical history is unremarkable.", "10. Patient denies alcohol and drug use.", "11. Physician started patient on an antiepileptic drug that acts in the motor cortex by blocking repeated activation of voltage-gated sodium channels.", "12. Antiepileptic drug is also used in status epilepticus."], "atomic_facts": ["1. The patient's roommate describes seeing the patient suddenly 'freeze', collapse, and start having jerky movements involving her entire body.", "2. The patient says she can not recall the episode but does remember 'seeing stars' before losing consciousness.", "3. She remembers being confused about where she was soon after the seizure and had urinated in her clothes when she regained consciousness.", "4. A persistent headache has troubled her since the seizure for which she took acetaminophen before coming to the hospital.", "5. Her past medical history is unremarkable.", "6. She denies alcohol and drug use.", "7. The physician starts her on an antiepileptic drug that acts in the motor cortex by blocking repeated activation of voltage-gated sodium channels and is also used in status epilepticus."]}
{"id": 385, "question": "Which of the following findings is most likely to be found in this patient?", "context": ["A 68-year-old man presents to his primary care physician for pain in his feet.", "The patient states that it is very painful for him to walk around, and he has significant pain in his right and left toes.", "The patient has a past medical history of obesity, type II diabetes mellitus, anxiety, depression, COPD, and a 30 pack-year smoking history.", "The patient\u2019s current medications include lisinopril, hydrochlorothiazide, insulin, metformin, fluoxetine, clonazepam, albuterol, home oxygen, varenicline, and fish oil and he is compliant with all medications.", "On physical exam, the patient\u2019s toes appear pale and dirty.", "When inspecting his toes, shallow wounds with a pale base devoid of granulation tissue can be appreciated.", "The patient has decreased pinprick sensation in his lower extremities bilaterally.", "Pulmonary exam is notable for a prolonged expiratory phase."], "context_len": 8, "options": {"A": "Bipedal edema", "B": "Increased reflexes of the lower extremities", "C": "Loss of vibration sensation in the lower extremities", "D": "Calf pain after walking moderate distance"}, "answer": "Calf pain after walking moderate distance", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "68", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine", "Peripheral Neuropathy"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 68-year-old man presents to his primary care physician for pain in his feet.", "2. The patient states that it is very painful for him to walk around.", "3. The patient has significant pain in his right and left toes.", "4. The patient has a past medical history of obesity.", "5. The patient has a past medical history of type II diabetes mellitus.", "6. The patient has a past medical history of anxiety.", "7. The patient has a past medical history of depression.", "8. The patient has a past medical history of COPD.", "9. The patient has a 30 pack-year smoking history.", "10. The patient's current medications include lisinopril.", "11. The patient's current medications include hydrochlorothiazide.", "12. The patient's current medications include insulin.", "13. The patient's current medications include metformin.", "14. The patient's current medications include fluoxetine.", "15. The patient's current medications include clonazepam.", "16. The patient's current medications include albuterol.", "17. The patient's current medications include home oxygen.", "18. The patient's current medications include varenicline.", "19. The patient's current medications include fish oil.", "20. The patient is compliant with all medications.", "21. On physical exam, the patient's toes appear pale and dirty.", "22. When inspecting his toes, shallow wounds with a pale base devoid of granulation tissue can be appreciated.", "23. The patient has decreased pinprick sensation in his lower extremities bilaterally.", "24. Pulmonary exam is notable for a prolonged expiratory phase."], "atomic_facts": ["1. The patient experiences significant pain in his right and left toes.", "2. The patient has a past medical history of obesity, type II diabetes mellitus, anxiety, depression, COPD, and a 30 pack-year smoking history.", "3. The patient's current medications include lisinopril, hydrochlorothiazide, insulin, metformin, fluoxetine, clonazepam, albuterol, home oxygen, varenicline, and fish oil, and he is compliant with all medications.", "4. On physical exam, the patient's toes appear pale and dirty.", "5. Shallow wounds with a pale base devoid of granulation tissue can be appreciated when inspecting the patient's toes.", "6. The patient has decreased pinprick sensation in his lower extremities bilaterally.", "7. Pulmonary exam is notable for a prolonged expiratory phase."]}
{"id": 386, "question": "What additional finding would you expect from this patient?", "context": ["A 16-year-old man is brought to the emergency department for left arm pain.", "Per the patient, he was playing at his high-school football game when a member of the opposing team tackled him from behind, which resulted in him landing on his left arm.", "He felt a \u201cpopping\u201d sensation and immediate, sharp pain at his left shoulder.", "The patient is in mild distress and holds his arm against his abdomen.", "Physical examination demonstrates limited abduction secondary to pain and reduced muscle tone over the shoulder."], "context_len": 5, "options": {"A": "Loss of sensation over the dorsal hand", "B": "Loss of sensation over the lateral 3 1/2 fingers", "C": "Loss of sensation over the lateral arm", "D": "Loss of sensation over the lateral forearm"}, "answer": "Loss of sensation over the lateral arm", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "16 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery", "Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 16-year-old man is brought to the emergency department for left arm pain.", "2. The patient was playing at his high-school football game when a member of the opposing team tackled him from behind.", "3. The patient landed on his left arm.", "4. He felt a \u201cpopping\u201d sensation and immediate, sharp pain at his left shoulder.", "5. The patient is in mild distress and holds his arm against his abdomen.", "6. Physical examination demonstrates limited abduction secondary to pain.", "7. Physical examination demonstrates reduced muscle tone over the shoulder."], "atomic_facts": ["1. The patient was playing at his high-school football game.", "2. A member of the opposing team tackled him from behind.", "3. The tackle resulted in him landing on his left arm.", "4. He felt a \u201cpopping\u201d sensation in his left shoulder.", "5. He experienced immediate, sharp pain in his left shoulder.", "6. The patient is in mild distress.", "7. He holds his arm against his abdomen.", "8. Physical examination demonstrates limited abduction secondary to pain.", "9. Reduced muscle tone is observed over the shoulder."]}
{"id": 387, "question": "Which of the following movements is most likely to be impaired in this patient?", "context": ["A 68-year-old woman is brought to the emergency room because of pain in her right shoulder after falling down the stairs in her apartment.", "She has a history of postmenopausal osteoporosis.", "Her current medications are alendronate, vitamin D, and calcium supplementation.", "Physical examination shows shortening of the right arm as well as tenderness and swelling over the right shoulder.", "The range of motion of the right arm is limited by pain.", "An x-ray of the right shoulder shows a fracture of the surgical neck of the humerus."], "context_len": 6, "options": {"A": "Wrist extension", "B": "Elbow flexion", "C": "Arm abduction", "D": "Thumb adduction"}, "answer": "Arm abduction", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "68", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 68-year-old woman is brought to the emergency room.", "2. She fell down the stairs in her apartment.", "3. She has a history of postmenopausal osteoporosis.", "4. Her current medications are alendronate, vitamin D, and calcium supplementation.", "5. She has pain in her right shoulder.", "6. Physical examination shows shortening of the right arm.", "7. Physical examination shows tenderness and swelling over the right shoulder.", "8. The range of motion of the right arm is limited by pain.", "9. An x-ray of the right shoulder shows a fracture of the surgical neck of the humerus."], "atomic_facts": ["1. She has a history of postmenopausal osteoporosis.", "2. Her current medications are alendronate, vitamin D, and calcium supplementation.", "3. Physical examination shows shortening of the right arm.", "4. Physical examination shows tenderness and swelling over the right shoulder.", "5. The range of motion of the right arm is limited by pain.", "6. An x-ray of the right shoulder shows a fracture of the surgical neck of the humerus."]}
{"id": 388, "question": "The platelet counts of repeated measurements are shown in ascending order: | Historical hemocytometer 55,000 57,000 62,000 76,000 77,000 82,000 92,000 Mean: 72,000 | Modern automated CBC analyzer 71,000 71,000 72,000 72,000 73,000 74,000 74,000 Mean: 72,000 | If the measurements on a modern automated CBC analyzer are considered accurate, which of the following conclusions can be drawn about the historical hemocytometer?\"", "context": ["A hematologist has found a historical hemocytometer used during the 1960s.", "Out of curiosity, he decides to obtain platelet counts from his brother, who has idiopathic thrombocytopenic purpura (ITP), with both the historical hemocytometer and a modern automated CBC analyzer."], "context_len": 2, "options": {"A": "Test lacks accuracy", "B": "Test lacks validity", "C": "Test lacks specificity", "D": "Test lacks precision"}, "answer": "Test lacks precision", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Hematopathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A hematologist has found a historical hemocytometer.", "2. The historical hemocytometer was used during the 1960s.", "3. The hematologist decides to obtain platelet counts from his brother.", "4. His brother has idiopathic thrombocytopenic purpura (ITP).", "5. The platelet counts will be obtained with both the historical hemocytometer and a modern automated CBC analyzer."], "atomic_facts": ["1. The man is curious about platelet counts.", "2. The man's brother has idiopathic thrombocytopenic purpura (ITP).", "3. The platelet counts are obtained from the man's brother.", "4. The platelet counts are obtained using a historical hemocytometer.", "5. The platelet counts are obtained using a modern automated CBC analyzer."]}
{"id": 389, "question": "Which of the following is the mechanism of action of the toxin causing this child's symptoms?", "context": ["A 9-year-old female child whose family recently emigrated from Afghanistan presents to the county hospital with difficulty swallowing and generalized muscle rigidity.", "Her parents note that although she is in severe pain she always appears to be smiling.", "After getting a detailed history from the parents, the residents comes to the conclusion that the child's clinical presentation is due to a lack of immunizations and a deep wound on her knee resulting from a fall six days ago."], "context_len": 3, "options": {"A": "Inhibiting protein synthesis via ADP-ribosylation of elongation factor 2", "B": "Overactivating adenylate cyclase by ADP-ribosylation of the Gs alpha subunit", "C": "Overactivating adenylate cyclase by disabling the Gi subunit", "D": "Preventing release of GABA by cleaving of synaptobrevin 2"}, "answer": "Preventing release of GABA by cleaving of synaptobrevin 2", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "9 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 9-year-old female child presents to the county hospital.", "2. Her family recently emigrated from Afghanistan.", "3. She has difficulty swallowing and generalized muscle rigidity.", "4. Her parents note that she is in severe pain but always appears to be smiling.", "5. The residents get a detailed history from the parents.", "6. The residents come to the conclusion that the child's clinical presentation is due to a lack of immunizations.", "7. The child has a deep wound on her knee resulting from a fall six days ago."], "atomic_facts": ["1. The child is in severe pain.", "2. The child always appears to be smiling.", "3. The child has a lack of immunizations.", "4. The child has a deep wound on her knee.", "5. The wound resulted from a fall six days ago."]}
{"id": 390, "question": "The area of the lung most likely affected by this patient's condition has which of the following characteristics?", "context": ["A 49-year-old obese man presents to the emergency department with a fever and a cough productive of bloody sputum.", "He has also been waking up at night frequently, which he attributes to sweating while asleep.", "He is also proud of recently losing some weight but denies actively trying to do so.", "He says that he has had these symptoms intermittently for the last several years but has not consistently sought treatment because his housing has been transient with periods of homelessness.", "He is started on a course of therapy and leaves against medical advice before his physician is able to explain the medications.", "He returns two days later because he is concerned that his eyes are bleeding."], "context_len": 6, "options": {"A": "High perfusion, high ventilation, high V/Q ratio", "B": "High perfusion, high ventilation, low V/Q ratio", "C": "Low perfusion, low ventilation, high V/Q ratio", "D": "Low perfusion, low ventilation, low V/Q ratio"}, "answer": "Low perfusion, low ventilation, high V/Q ratio", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "49 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 49-year-old man presented to the emergency department.", "2. He was obese.", "3. He had a fever and a cough productive of bloody sputum.", "4. He was waking up at night frequently and attributed it to sweating while asleep.", "5. He was proud of recently losing some weight but denied actively trying to do so.", "6. He had these symptoms intermittently for the last several years.", "7. He had not consistently sought treatment due to periods of homelessness.", "8. He was started on a course of therapy.", "9. He left against medical advice before his physician was able to explain the medications.", "10. He returned two days later because he was concerned his eyes were bleeding."], "atomic_facts": ["1. He has been waking up at night frequently.", "2. He attributes the waking up at night to sweating while asleep.", "3. He is proud of recently losing some weight.", "4. He denies actively trying to lose weight.", "5. He has had symptoms intermittently for the last several years.", "6. He has not consistently sought treatment for his symptoms.", "7. His housing has been transient with periods of homelessness.", "8. He started on a course of therapy.", "9. He left against medical advice before his physician could explain the medications.", "10. He returned two days later.", "11. He was concerned that his eyes are bleeding."]}
{"id": 391, "question": "What is the next best step in management?", "context": ["A 66-year-old male presents to clinic for a blood glucose level of 169 mg/dL taken at a local pharmacy.", "He is a farmer in rural Alabama and has not seen a doctor for decades.", "He wants to be in excellent shape prior to his trip to visit his daughter at college.", "His past medical history and family history are unknown, and he does not take any medications.", "His diet consists of pork products and he does not smoke.", "His temperature is 99.5\u00b0F (37.5\u00b0C), pulse is 100/min, blood pressure is 169/90 mmHg, respirations are 18/min, and oxygen saturation is 97% on room air.", "The patient is started on metformin, lisinopril, and a guided exercise program.", "Lab results are below: |  | Serum: | Na+: 145 mEq/L | Cl-: 100 mEq/L | K+: 4.9 mEq/L | HCO3-: 24 mEq/L | BUN: 18 mg/dL | Glucose: 211 mg/dL | Creatinine: 1.0 mg/dL | Ca2+: 10.0 mg/dL |  | He returns from his trip, complaining of cough.", "He denies any other symptoms.", "His temperature is 99.5\u00b0F (37.5\u00b0C), pulse is 101/min, blood pressure is 160/85 mmHg, respirations are 18/min, and oxygen saturation is 98% on room air.", "Repeat lab results are below: |  | Serum: | Na+: 145 mEq/L | Cl-: 100 mEq/L | K+: 5.3 mEq/L | HCO3-: 24 mEq/L | BUN: 22 mg/dL | Glucose: 169 mg/dL | Creatinine: 1.2 mg/dL | Ca2+: 10.1 mg/dL |  | ."], "context_len": 11, "options": {"A": "Switch blood pressure medication to losartan", "B": "Switch blood pressure medication to hydrochlorothiazide", "C": "Azithromycin", "D": "Loratadine"}, "answer": "Switch blood pressure medication to losartan", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "66 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 66 years old.", "2. Blood glucose level is 169 mg/dL.", "3. Patient is a farmer in rural Alabama.", "4. Patient has not seen a doctor for decades.", "5. Patient wants to be in excellent shape prior to trip to visit daughter at college.", "6. Patient's past medical history and family history are unknown.", "7. Patient does not take any medications.", "8. Patient's diet consists of pork products.", "9. Patient does not smoke.", "10. Patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "11. Patient's pulse is 100/min.", "12. Patient's blood pressure is 169/90 mmHg.", "13. Patient's respirations are 18/min.", "14. Patient's oxygen saturation is 97% on room air.", "15. Patient is started on metformin, lisinopril, and a guided exercise program.", "16. Patient's serum Na+ is 145 mEq/L.", "17. Patient's serum Cl- is 100 mEq/L.", "18. Patient's serum K+ is 4.9 mEq/L.", "19. Patient's serum HCO3- is 24 mEq/L.", "20. Patient's serum BUN is 18 mg/dL.", "21. Patient's serum glucose is 211 mg/dL.", "22. Patient's serum creatinine is 1.0 mg/dL.", "23. Patient's serum Ca2+ is 10.0 mg/dL.", "24. Patient returns from trip complaining of cough.", "25. Patient denies any other symptoms.", "26. Patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "27. Patient's pulse is 101/min.", "28. Patient's blood pressure is 160/85 mmHg.", "29. Patient's respirations are 18/min.", "30. Patient's oxygen saturation is 98% on room air.", "31. Patient's serum Na+ is 145 mEq/L.", "32. Patient's serum Cl- is 100 mEq/L.", "33. Patient's serum K+ is 5.3 mEq/L.", "34. Patient's serum HCO3- is 24 mEq/L.", "35. Patient's serum BUN is 22 mg/"], "atomic_facts": ["1. The patient is a farmer in rural Alabama.", "2. The patient has not seen a doctor for decades.", "3. The patient wants to be in excellent shape prior to his trip to visit his daughter at college.", "4. The patient's past medical history and family history are unknown.", "5. The patient does not take any medications.", "6. The patient's diet consists of pork products and he does not smoke.", "7. The patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "8. The patient's pulse is 100/min.", "9. The patient's blood pressure is 169/90 mmHg.", "10. The patient's respirations are 18/min.", "11. The patient's oxygen saturation is 97% on room air.", "12. The patient is started on metformin, lisinopril, and a guided exercise program.", "13. Lab results show: Na+: 145 mEq/L, Cl-: 100 mEq/L, K+: 4.9 mEq/L, HCO3-: 24 mEq/L, BUN: 18 mg/dL, Glucose: 211 mg/dL, Creatinine: 1.0 mg/dL, Ca2+: 10.0 mg/dL.", "14. The patient returns from his trip, complaining of cough.", "15. The patient denies any other symptoms.", "16. The patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "17. The patient's pulse is 101/min.", "18. The patient's blood pressure is 160/85 mmHg.", "19. The patient's respirations are 18/min.", "20. The patient's oxygen saturation is 98% on room air.", "21. Repeat lab results show: Na+: 145 mEq/L, Cl-: 100 mEq/L, K+: 5.3 mEq/L, HCO3-: 24 mEq/L, BUN: 22 mg/dL, Glucose: 169 mg/dL, Creatinine: 1.2 mg/dL, Ca2+: 10.1 mg/dL."]}
{"id": 392, "question": "Which of the following is the most likely cause of this patient's disorder?", "context": ["A 25-year-old woman presents to her primary care physician for her annual physical exam.", "Her prior medical history is significant for seasonal allergies and a broken arm at age 12 that was treated in a long arm cast.", "She has not had any major illnesses in the previous year and does not currently have any major complaints.", "On physical exam her blood pressure is found to be 152/95 mmHg.", "Laboratory findings reveal elevated levels of renin and aldosterone.", "Given her elevated blood pressure, she is prescribed captopril; however, 1 week later she presents to the emergency department with hypertensive urgency.", "At that point captopril is immediately stopped."], "context_len": 7, "options": {"A": "Bilateral fibromuscular dysplasia", "B": "Conn syndrome", "C": "Renin secreting tumor", "D": "Unilateral fibromuscular dysplasia"}, "answer": "Bilateral fibromuscular dysplasia", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "25", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 25-year-old woman presents to her primary care physician for her annual physical exam.", "2. Her prior medical history is significant for seasonal allergies.", "3. She had a broken arm at age 12 that was treated in a long arm cast.", "4. She has not had any major illnesses in the previous year.", "5. She does not currently have any major complaints.", "6. On physical exam her blood pressure is found to be 152/95 mmHg.", "7. Laboratory findings reveal elevated levels of renin and aldosterone.", "8. Given her elevated blood pressure, she is prescribed captopril.", "9. 1 week later she presents to the emergency department with hypertensive urgency.", "10. At that point captopril is immediately stopped."], "atomic_facts": ["1. Prior medical history includes seasonal allergies and a broken arm at age 12.", "2. Broken arm at age 12 was treated in a long arm cast.", "3. No major illnesses in the previous year.", "4. No major complaints at present.", "5. Blood pressure on physical exam is 152/95 mmHg.", "6. Laboratory findings reveal elevated levels of renin.", "7. Laboratory findings reveal elevated levels of aldosterone.", "8. Prescribed captopril due to elevated blood pressure.", "9. Presented to the emergency department with hypertensive urgency 1 week after starting captopril.", "10. Captopril was immediately stopped at that point."]}
{"id": 393, "question": "Which of the following is a possible explanation for the group marked with the letter E?", "context": ["An investigator is analyzing the serum calcium and parathyroid hormone levels of 100 patients.", "A scatter plot of the findings is shown."], "context_len": 2, "options": {"A": "Lymphoma", "B": "End-stage kidney disease", "C": "Thyroidectomy", "D": "Multiple endocrine neoplasia"}, "answer": "Lymphoma", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An investigator is analyzing the serum calcium and parathyroid hormone levels of 100 patients.", "2. A scatter plot of the findings is shown."], "atomic_facts": ["1. A scatter plot", "2. The findings are shown"]}
{"id": 394, "question": "Which of the following tests should be performed to confirm the diagnosis in this patient?", "context": ["A 56-year-old male is admitted to the emergency department with sudden onset of pain, left-sided scrotal swelling, and nausea.", "The patient states that the symptoms started three hours ago after he lifted up a heavy pack.", "He says that the swelling had been intermittently present for several years already and was most prominent when physically straining or coughing, but it had never been painful.", "Past medical history is unremarkable.", "Patient reports a 26-pack-year history of smoking.", "Vital signs are as follows: blood pressure 150/90 mm Hg, heart rate 85/min, respiratory rate 14/min, and temperature 37.8\u2103 (100\u2109).", "BMI is 32.9 kg/m2.", "Patient\u2019s respiratory and cardiovascular exams are within normal limits.", "The abdomen is moderately distended.", "There is a tender erythematous scrotal swelling on the left, which cannot be manually reduced."], "context_len": 10, "options": {"A": "Ultrasonography", "B": "No further tests are needed", "C": "Fine needle biopsy", "D": "Laparoscopy"}, "answer": "No further tests are needed", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 56-year-old male is admitted to the emergency department.", "2. Patient has sudden onset of pain, left-sided scrotal swelling, and nausea.", "3. Symptoms started three hours ago after he lifted up a heavy pack.", "4. Swelling had been intermittently present for several years already.", "5. Swelling was most prominent when physically straining or coughing, but it had never been painful.", "6. Patient's past medical history is unremarkable.", "7. Patient has a 26-pack-year history of smoking.", "8. Blood pressure is 150/90 mm Hg.", "9. Heart rate is 85/min.", "10. Respiratory rate is 14/min.", "11. Temperature is 37.8\u2103 (100\u2109).", "12. BMI is 32.9 kg/m2.", "13. Patient's respiratory and cardiovascular exams are within normal limits.", "14. Abdomen is moderately distended.", "15. There is a tender erythematous scrotal swelling on the left.", "16. Swelling cannot be manually reduced."], "atomic_facts": ["1. The patient's symptoms started three hours ago after lifting a heavy pack.", "2. The swelling had been intermittently present for several years and was most prominent when physically straining or coughing, but it had never been painful.", "3. The patient's past medical history is unremarkable.", "4. The patient reports a 26-pack-year history of smoking.", "5. Vital signs: blood pressure 150/90 mm Hg, heart rate 85/min, respiratory rate 14/min, temperature 37.8\u2103 (100\u2109).", "6. BMI is 32.9 kg/m2.", "7. Patient's respiratory and cardiovascular exams are within normal limits.", "8. The abdomen is moderately distended.", "9. There is a tender erythematous scrotal swelling on the left, which cannot be manually reduced."]}
{"id": 395, "question": "Which of the following mechanisms is most likely associated with this patient's presentation?", "context": ["A 6-year-old boy presents to a pediatrician for initial evaluation.", "He was recently adopted from abroad and his parents want to establish care in the United States.", "His medical history is unclear and there are no records on any family history.", "On presentation, he is found to fall below the 5th percentile in height for his age with shortened 4th and 5th digits.", "Physical exam reveals wrist spasms when his blood pressure is taken.", "Radiographs reveal decreased bone mineral density and several healing fractures."], "context_len": 6, "options": {"A": "Decreased production of parathyroid hormone", "B": "Inadequate intake of vitamin D", "C": "Malabsorption of nutrients", "D": "Resistance to effects of parathyroid hormone"}, "answer": "Resistance to effects of parathyroid hormone", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-year-old boy presents to a pediatrician for initial evaluation.", "2. He was recently adopted from abroad.", "3. His parents want to establish care in the United States.", "4. His medical history is unclear.", "5. There are no records on any family history.", "6. On presentation, he is found to fall below the 5th percentile in height for his age.", "7. He has shortened 4th and 5th digits.", "8. Physical exam reveals wrist spasms when his blood pressure is taken.", "9. Radiographs reveal decreased bone mineral density.", "10. Radiographs reveal several healing fractures."], "atomic_facts": ["1. He was recently adopted from abroad.", "2. His parents want to establish care in the United States.", "3. His medical history is unclear.", "4. There are no records on any family history.", "5. On presentation, he is found to fall below the 5th percentile in height for his age.", "6. He has shortened 4th and 5th digits.", "7. Physical exam reveals wrist spasms when his blood pressure is taken.", "8. Radiographs reveal decreased bone mineral density.", "9. Radiographs also reveal several healing fractures."]}
{"id": 396, "question": "Which of the following physiologic mechanisms is primarily responsible for this patient's current presentation?", "context": ["A 12-year-old boy is brought to the emergency department with a 2-month history of increasing difficulty with physical activity.", "Specifically, he says that he gets short of breath quickly with exertion even though he used to participate in all activities without a problem.", "When asked, he endorses sometimes coughing up flecks of blood.", "His past medical history is unclear because he was recently adopted from abroad and has not yet established care.", "Physical exam reveals blue discoloration of his lips and fingernails as well as a holosystolic murmur best heard at the lower left sternal border."], "context_len": 5, "options": {"A": "Increasing size of ventricular septal defect", "B": "Left ventricular outflow tract obstruction", "C": "New atrial septal defect", "D": "Pulmonary artery hypertension"}, "answer": "Pulmonary artery hypertension", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "12 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 12-year-old boy is brought to the emergency department.", "2. He has a 2-month history of increasing difficulty with physical activity.", "3. He used to participate in all activities without a problem.", "4. He endorses sometimes coughing up flecks of blood.", "5. His past medical history is unclear.", "6. He was recently adopted from abroad and has not yet established care.", "7. Physical exam reveals blue discoloration of his lips and fingernails.", "8. Physical exam reveals a holosystolic murmur best heard at the lower left sternal border."], "atomic_facts": ["1. He gets short of breath quickly with exertion.", "2. He used to participate in all activities without a problem.", "3. He sometimes coughs up flecks of blood.", "4. His past medical history is unclear.", "5. He was recently adopted from abroad.", "6. He has not yet established care.", "7. Physical exam reveals blue discoloration of his lips and fingernails.", "8. Physical exam reveals a holosystolic murmur best heard at the lower left sternal border."]}
{"id": 397, "question": "Which of the following molecules make up part of the structure that was separated?", "context": ["A scientist isolates the rough endoplasmic reticulum from HeLa cells.", "He performs a northern blot to isolate nucleic acid sequences of interest."], "context_len": 2, "options": {"A": "RNA polymerase", "B": "Transfer RNA", "C": "Ribosomal RNA", "D": "Mitochondrial RNA"}, "answer": "Ribosomal RNA", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Molecular Genetic Pathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A scientist isolates the rough endoplasmic reticulum from HeLa cells.", "2. He performs a northern blot.", "3. He isolates nucleic acid sequences of interest."], "atomic_facts": ["1. A northern blot is performed.", "2. The purpose is to isolate nucleic acid sequences of interest."]}
{"id": 398, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 14-month-old girl is brought to the pediatrician after her parents noticed her being increasingly irritable with frequent vomiting for the past 2 weeks.", "Parents deny any history of fever.", "They recently immigrated to the country and, unfortunately, the mother did not receive prenatal care during pregnancy due to a lack of health insurance.", "Physical examination is unremarkable except for a head circumference over 2 standard deviations larger than the mean for her age, and delay in meeting motor developmental milestones.", "A magnetic resonance imaging (MRI) of her brain shows an enlargement of the posterior fossa, cystic dilation of the 4th ventricle, and hypoplasia of the cerebellar vermis (see image)."], "context_len": 5, "options": {"A": "Chiari II malformation", "B": "Chiari III malformation", "C": "Dandy-Walker malformation", "D": "Klippel Feil syndrome"}, "answer": "Dandy-Walker malformation", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "14 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 14-month-old girl.", "2. Parents noticed her being increasingly irritable with frequent vomiting for the past 2 weeks.", "3. Parents deny any history of fever.", "4. Parents recently immigrated to the country.", "5. Mother did not receive prenatal care during pregnancy due to a lack of health insurance.", "6. Physical examination is unremarkable except for a head circumference over 2 standard deviations larger than the mean for her age, and delay in meeting motor developmental milestones.", "7. MRI of her brain shows an enlargement of the posterior fossa.", "8. MRI of her brain shows cystic dilation of the 4th ventricle.", "9. MRI of her brain shows hypoplasia of the cerebellar vermis."], "atomic_facts": ["1. Parents deny any history of fever.", "2. They recently immigrated to the country.", "3. The mother did not receive prenatal care during pregnancy due to a lack of health insurance.", "4. Physical examination is unremarkable.", "5. Head circumference is over 2 standard deviations larger than the mean for her age.", "6. Delay in meeting motor developmental milestones.", "7. MRI of her brain shows an enlargement of the posterior fossa.", "8. MRI shows cystic dilation of the 4th ventricle.", "9. MRI shows hypoplasia of the cerebellar vermis."]}
{"id": 399, "question": "Which of the following brain regions, if lesioned, would most likely result in no change in this patient\u2019s symptoms?", "context": ["A 28-year-old woman presents with a 3-year history of recurrent headaches.", "She says the episodes are typically triggered by hunger, mental stress, physical exertion, and lack of sleep, although many times the trigger is not known.", "She describes her headaches as unilateral, severe, throbbing, and aggravated by movement.", "The patient says that each episode usually lasts for 6\u201324 hours and is often accompanied by nausea, vomiting, and intolerance to light."], "context_len": 4, "options": {"A": "Red nucleus", "B": "Locus coeruleus", "C": "Nucleus raphe magnus", "D": "Periaqueductal gray"}, "answer": "Red nucleus", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 28-year-old woman presents with a 3-year history of recurrent headaches.", "2. The episodes are typically triggered by hunger, mental stress, physical exertion, and lack of sleep.", "3. Many times the trigger is not known.", "4. She describes her headaches as unilateral, severe, throbbing, and aggravated by movement.", "5. Each episode usually lasts for 6\u201324 hours.", "6. The episodes are often accompanied by nausea, vomiting, and intolerance to light."], "atomic_facts": ["1. Episodes are typically triggered by hunger.", "2. Episodes are typically triggered by mental stress.", "3. Episodes are typically triggered by physical exertion.", "4. Episodes are typically triggered by lack of sleep.", "5. Many times the trigger is not known.", "6. Headaches are described as unilateral.", "7. Headaches are described as severe.", "8. Headaches are described as throbbing.", "9. Headaches are aggravated by movement.", "10. Each episode usually lasts for 6\u201324 hours.", "11. Episodes are often accompanied by nausea.", "12. Episodes are often accompanied by vomiting.", "13. Episodes are often accompanied by intolerance to light."]}
{"id": 400, "question": "Which of the following is the most likely cause of this patient's findings?", "context": ["A 68-year-old man comes to the physician for a routine health maintenance examination.", "He has had increasing shortness of breath and a productive cough for the past 1 year.", "He can walk up a flight of stairs without stopping.", "He has hypertension and his only medication is amlodipine.", "He has a history of asthma during childhood.", "He smoked 1 pack of cigarettes daily for 30 years but quit 16 years ago.", "He used to work at a shipyard and retired 5 years ago.", "His pulse is 98/min, respirations are 25/min and blood pressure is 134/88 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 93%.", "Scattered expiratory wheezing and rhonchi are heard throughout both lung fields.", "Cardiac examination shows no murmurs, rubs, or gallops.", "Spirometry shows an FEV1:FVC ratio of 63% and an FEV1 of 65% of predicted.", "His diffusing capacity for carbon monoxide (DLCO) is 40% of predicted."], "context_len": 13, "options": {"A": "Asthma", "B": "Congestive heart failure", "C": "Emphysema", "D": "Asbestosis\n\""}, "answer": "Emphysema", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "68 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine", "General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 68-year-old man comes to the physician for a routine health maintenance examination.", "2. He has had increasing shortness of breath and a productive cough for the past 1 year.", "3. He can walk up a flight of stairs without stopping.", "4. He has hypertension and his only medication is amlodipine.", "5. He has a history of asthma during childhood.", "6. He smoked 1 pack of cigarettes daily for 30 years but quit 16 years ago.", "7. He used to work at a shipyard and retired 5 years ago.", "8. His pulse is 98/min.", "9. Respirations are 25/min.", "10. Blood pressure is 134/88 mm Hg.", "11. Pulse oximetry on room air shows an oxygen saturation of 93%.", "12. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields.", "13. Cardiac examination shows no murmurs, rubs, or gallops.", "14. Spirometry shows an FEV1:FVC ratio of 63%.", "15. FEV1 is 65% of predicted.", "16. His diffusing capacity for carbon monoxide (DLCO) is 40% of predicted."], "atomic_facts": ["1. He has had increasing shortness of breath and a productive cough for the past 1 year.", "2. He can walk up a flight of stairs without stopping.", "3. He has hypertension and his only medication is amlodipine.", "4. He has a history of asthma during childhood.", "5. He smoked 1 pack of cigarettes daily for 30 years but quit 16 years ago.", "6. He used to work at a shipyard and retired 5 years ago.", "7. His pulse is 98/min, respirations are 25/min and blood pressure is 134/88 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 93%.", "9. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields.", "10. Cardiac examination shows no murmurs, rubs, or gallops.", "11. Spirometry shows an FEV1:FVC ratio of 63% and an FEV1 of 65% of predicted.", "12. His diffusing capacity for carbon monoxide (DLCO) is 40% of predicted."]}
{"id": 401, "question": "Which of the following substances was most likely elevated in his mother's serum during her pregnancy?", "context": ["A 9-year-old boy presents to his orthopedic surgeon for ongoing evaluation of his lower extremity deformities.", "Specifically, his hips have been dislocating over the last year despite bracing in hip-knee-ankle-foot orthoses.", "He is paralyzed from below the L2 nerve root and has difficulty with both bladder and bowel incontinence.", "He has had these abnormalities since birth due to a lower back lesion that required surgical closure during infancy."], "context_len": 4, "options": {"A": "Alpha-fetoprotein", "B": "Beta-human chorionic growth hormone", "C": "Estriol", "D": "Sphingomyelin"}, "answer": "Alpha-fetoprotein", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "9 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 9-year-old boy presents to his orthopedic surgeon.", "2. His hips have been dislocating over the last year.", "3. He has been wearing hip-knee-ankle-foot orthoses.", "4. He is paralyzed from below the L2 nerve root.", "5. He has difficulty with bladder and bowel incontinence.", "6. He has had these abnormalities since birth.", "7. He had a lower back lesion that required surgical closure during infancy."], "atomic_facts": ["1. His hips have been dislocating over the last year.", "2. Dislocation occurred despite bracing in hip-knee-ankle-foot orthoses.", "3. He is paralyzed from below the L2 nerve root.", "4. He has difficulty with both bladder incontinence.", "5. He has difficulty with bowel incontinence.", "6. He has had these abnormalities since birth.", "7. The abnormalities are due to a lower back lesion.", "8. The lower back lesion required surgical closure during infancy."]}
{"id": 402, "question": "Which of the following is NOT necessary for PCR?", "context": ["Polymerase chain reaction (PCR) has revolutionized the molecular biology field.", "PCR allows for amplification of a single piece of genetic material to produce trillions of idential copies."], "context_len": 2, "options": {"A": "Taq polymerase", "B": "Reverse transcriptase", "C": "Primers", "D": "Target DNA strand"}, "answer": "Reverse transcriptase", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Molecular Genetic Pathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. Polymerase chain reaction (PCR) has revolutionized the molecular biology field.", "2. PCR allows for amplification of a single piece of genetic material.", "3. Amplification of a single piece of genetic material produces trillions of identical copies."], "atomic_facts": ["1. PCR stands for polymerase chain reaction.", "2. PCR allows amplification of genetic material.", "3. PCR can produce trillions of identical copies of the genetic material.", "4. PCR can amplify a single piece of genetic material."]}
{"id": 403, "question": "Which of the following is the most likely mechanism for these findings?", "context": ["An investigator is studying the efficacy of antiviral drugs in infected human cells.", "Harvested human cells are inoculated onto four cell culture plates.", "Live varicella-zoster virus (VZV) is administered to cells on two of the culture plates.", "One healthy and one infected cell set are set aside as controls.", "In comparison with the control plates, the subsequent application of a guanosine analog to the experimental cell sets induces cell death in the virally infected cells but not in the healthy cells."], "context_len": 5, "options": {"A": "Secretion of interferons by virally infected cells", "B": "Mutation of viral DNA polymerase", "C": "Phosphorylation by virally-encoded thymidine kinase", "D": "Inhibition of RNA-dependent DNA polymerase"}, "answer": "Phosphorylation by virally-encoded thymidine kinase", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An investigator is studying the efficacy of antiviral drugs.", "2. Harvested human cells are inoculated onto four cell culture plates.", "3. Live varicella-zoster virus (VZV) is administered to cells on two of the culture plates.", "4. One healthy and one infected cell set are set aside as controls.", "5. In comparison with the control plates, the subsequent application of a guanosine analog induces cell death in the virally infected cells.", "6. The guanosine analog does not induce cell death in the healthy cells."], "atomic_facts": ["1. Harvested human cells are inoculated onto four cell culture plates.", "2. Live varicella-zoster virus (VZV) is administered to cells on two of the culture plates.", "3. One healthy and one infected cell set are set aside as controls.", "4. The subsequent application of a guanosine analog to the experimental cell sets induces cell death in the virally infected cells.", "5. The subsequent application of a guanosine analog to the experimental cell sets does not induce cell death in the healthy cells."]}
{"id": 404, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 13-year-old boy is brought to the physician because of pain and redness on his back for 2 days.", "He returned yesterday from a vacation to East Africa with his parents, where he took multiple rides on hot air balloons.", "His vital signs are within normal limits.", "Examination shows a tender, nonpruritic, erythematous rash with edema covering the extensor surface of both forearms, the shoulders, and the upper back, with small patches of skin exfoliation.", "The rash becomes pale when pressed and then rapidly regains color.", "The remainder of the examination shows no abnormalities."], "context_len": 6, "options": {"A": "Dress wound with wet gauze", "B": "Administer 2 liters of intravenous fluids", "C": "Apply topical mupirocin", "D": "Apply aloe vera-based moisturizer\n\""}, "answer": "Apply aloe vera-based moisturizer\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "13 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 13-year-old boy is brought to the physician.", "2. He has had pain and redness on his back for 2 days.", "3. He returned yesterday from a vacation to East Africa with his parents.", "4. He took multiple rides on hot air balloons.", "5. His vital signs are within normal limits.", "6. Examination shows a tender, nonpruritic, erythematous rash with edema.", "7. The rash covers the extensor surface of both forearms, the shoulders, and the upper back.", "8. There are small patches of skin exfoliation.", "9. The rash becomes pale when pressed and then rapidly regains color.", "10. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. He returned yesterday from a vacation to East Africa with his parents.", "2. He took multiple rides on hot air balloons during the vacation.", "3. His vital signs are within normal limits.", "4. Examination shows a tender, nonpruritic, erythematous rash with edema covering the extensor surface of both forearms, the shoulders, and the upper back.", "5. Small patches of skin exfoliation are present in the affected areas.", "6. The rash becomes pale when pressed and then rapidly regains color.", "7. The remainder of the examination shows no abnormalities."]}
{"id": 405, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 55-year-old man comes to the emergency department because of headache, fever, chills, shortness of breath, and abdominal pain for 1 week.", "He also feels tired and nauseous.", "He returned from a trip to Botswana 2 weeks ago.", "He has type 2 diabetes mellitus.", "He has smoked one pack of cigarettes daily for the past 30 years and drinks a glass of beer daily.", "His only current medication is metformin.", "His temperature is 39.3\u00b0C (102.8\u00b0F), pulse is 122/min, respirations are 28/min, and blood pressure is 109/84 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 94%.", "Examination shows jaundice.", "A few scattered inspiratory crackles are heard in the thorax.", "The liver is palpated 2 cm below the right costal margin.", "Laboratory studies show: | Hemoglobin 9.2 g/dL | Leukocyte count 9,400/mm3 | Platelet count 90,000/mm3 | Serum | Na+ 137 mEq/L | Cl- 102 mEq/L | K+ 5.2 mEq/L | HCO3- 13 mEq/L | Glucose 69 mg/dL | Lactate dehydrogenase 360 U/L | Creatinine 0.9 mg/dL | Bilirubin | _ Total 4.2 mg/dL | _ Direct 0.8 mg/dL | AST 79 U/L | ALT 90 U/L | Urine | Blood 3+ | Protein trace | RBC 0\u20131/hpf | WBC 1\u20132/hpf | Arterial blood gas analysis on room air shows a pH of 7.31."], "context_len": 12, "options": {"A": "Coombs test", "B": "Blood culture", "C": "Blood smear", "D": "Serology"}, "answer": "Blood smear", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 55-year-old man comes to the emergency department.", "2. He has been experiencing headache, fever, chills, shortness of breath, and abdominal pain for 1 week.", "3. He also feels tired and nauseous.", "4. He returned from a trip to Botswana 2 weeks ago.", "5. He has type 2 diabetes mellitus.", "6. He has smoked one pack of cigarettes daily for the past 30 years.", "7. He drinks a glass of beer daily.", "8. His only current medication is metformin.", "9. His temperature is 39.3\u00b0C (102.8\u00b0F).", "10. His pulse is 122/min.", "11. His respirations are 28/min.", "12. His blood pressure is 109/84 mm Hg.", "13. Pulse oximetry on room air shows an oxygen saturation of 94%.", "14. Examination shows jaundice.", "15. A few scattered inspiratory crackles are heard in the thorax.", "16. The liver is palpated 2 cm below the right costal margin.", "17. Laboratory studies show a hemoglobin of 9.2 g/dL.", "18. Laboratory studies show a leukocyte count of 9,400/mm3.", "19. Laboratory studies show a platelet count of 90,000/mm3.", "20. Laboratory studies show a serum Na+ of 137 mEq/L.", "21. Laboratory studies show a serum Cl- of 102 mEq/L.", "22. Laboratory studies show a serum K+ of 5.2 mEq/L.", "23. Laboratory studies show a serum HCO3- of 13 mEq/L.", "24. Laboratory studies show a glucose of 69 mg/dL.", "25. Laboratory studies show a lactate dehydrogenase of 360 U/L.", "26. Laboratory studies show a creatinine of 0.9 mg/dL.", "27. Laboratory studies show a total bilirubin of 4.2 mg/dL.", "28. Laboratory studies show a direct bilirubin of 0.8 mg/dL.", "29. Laboratory studies show an AST of 79 U/L.", "30. Laboratory studies show an ALT of 90 U/L.", "31. Laboratory studies show a urine blood of 3+.", "32. Laboratory studies show"], "atomic_facts": ["1. He feels tired and nauseous.", "2. He returned from a trip to Botswana 2 weeks ago.", "3. He has type 2 diabetes mellitus.", "4. He has smoked one pack of cigarettes daily for the past 30 years and drinks a glass of beer daily.", "5. His only current medication is metformin.", "6. His temperature is 39.3\u00b0C (102.8\u00b0F), pulse is 122/min, respirations are 28/min, and blood pressure is 109/84 mm Hg.", "7. Pulse oximetry on room air shows an oxygen saturation of 94%.", "8. Examination shows jaundice.", "9. A few scattered inspiratory crackles are heard in the thorax.", "10. The liver is palpated 2 cm below the right costal margin.", "11. Laboratory studies show: Hemoglobin 9.2 g/dL, Leukocyte count 9,400/mm3, Platelet count 90,000/mm3, Serum Na+ 137 mEq/L, Cl- 102 mEq/L, K+ 5.2 mEq/L, HCO3- 13 mEq/L, Glucose 69 mg/dL, Lactate dehydrogenase 360 U/L, Creatinine 0.9 mg/dL, Bilirubin Total 4.2 mg/dL, Bilirubin Direct 0.8 mg/dL, AST 79 U/L, ALT 90 U/L, Urine Blood 3+, Urine Protein trace, Urine RBC 0\u20131/hpf, Urine WBC 1\u20132/hpf.", "12. Arterial blood gas analysis on room air shows a pH of 7.31."]}
{"id": 406, "question": "Which of the following was the most common finding in this cohort?", "context": ["A population study was conducted to evaluate coronary artery disease in the general population.", "A cohort of 700 patients underwent coronary angiography to evaluate the geographic distribution of coronary arteries throughout the heart."], "context_len": 2, "options": {"A": "The SA node is supplied by a branch of the right coronary artery.", "B": "The AV node is supplied by a branch of the right coronary artery.", "C": "Right coronary artery dominance", "D": "A SA node is supplied by a branch of the left coronary artery."}, "answer": "Right coronary artery dominance", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A population study was conducted.", "2. The study was to evaluate coronary artery disease in the general population.", "3. A cohort of 700 patients was used.", "4. The patients underwent coronary angiography.", "5. The angiography was to evaluate the geographic distribution of coronary arteries throughout the heart."], "atomic_facts": ["1. A cohort of 700 patients underwent coronary angiography.", "2. The purpose was to evaluate the geographic distribution of coronary arteries.", "3. The evaluation was conducted throughout the heart."]}
{"id": 407, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 24-year-old woman comes to the physician because of intermittent episodes of stabbing facial pain for 4 months.", "The pain occurs over her left cheek, is 9 out of 10 in intensity, radiates towards her mouth, and lasts around half a minute before subsiding.", "These episodes commonly occur when she washes her face, brushes her teeth, or eats a meal.", "She does not have visual disturbances, weakness of her facial muscles, or hearing loss.", "She had a tooth extracted about 2 months ago, but the facial pain has persisted.", "She has hypothyroidism and vitiligo.", "Her mother has major depressive disorder.", "Current medications include levothyroxine and a herbal cream.", "She appears anxious.", "Vital signs are within normal limits.", "Cardiopulmonary examination shows no abnormalities.", "Neurologic examination shows no focal findings."], "context_len": 12, "options": {"A": "Microvascular decompression", "B": "Botulinum toxin injection", "C": "Radiofrequency rhizotomy", "D": "Carbamazepine"}, "answer": "Carbamazepine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "24 years old", "specialties": ["Neurology"], "subspecialties": ["Pain Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 24-year-old woman.", "2. Patient has intermittent episodes of stabbing facial pain for 4 months.", "3. Pain occurs over her left cheek.", "4. Pain is 9 out of 10 in intensity.", "5. Pain radiates towards her mouth.", "6. Pain lasts around half a minute before subsiding.", "7. Episodes commonly occur when she washes her face, brushes her teeth, or eats a meal.", "8. Patient does not have visual disturbances, weakness of her facial muscles, or hearing loss.", "9. Patient had a tooth extracted about 2 months ago.", "10. Facial pain has persisted.", "11. Patient has hypothyroidism and vitiligo.", "12. Patient's mother has major depressive disorder.", "13. Current medications include levothyroxine and a herbal cream.", "14. Patient appears anxious.", "15. Vital signs are within normal limits.", "16. Cardiopulmonary examination shows no abnormalities.", "17. Neurologic examination shows no focal findings."], "atomic_facts": ["1. The pain occurs over her left cheek.", "2. The pain is 9 out of 10 in intensity.", "3. The pain radiates towards her mouth.", "4. The pain lasts around half a minute before subsiding.", "5. The episodes commonly occur when she washes her face.", "6. The episodes commonly occur when she brushes her teeth.", "7. The episodes commonly occur when she eats a meal.", "8. She does not have visual disturbances.", "9. She does not have weakness of her facial muscles.", "10. She does not have hearing loss.", "11. She had a tooth extracted about 2 months ago.", "12. The facial pain has persisted after the tooth extraction.", "13. She has hypothyroidism.", "14. She has vitiligo.", "15. Her mother has major depressive disorder.", "16. Her current medications include levothyroxine and a herbal cream.", "17. She appears anxious.", "18. Vital signs are within normal limits.", "19. Cardiopulmonary examination shows no abnormalities.", "20. Neurologic examination shows no focal findings."]}
{"id": 408, "question": "Occlusion of which of the following arteries is the most likely cause of this patient's symptoms?", "context": ["A 67-year-old man is brought to the emergency department after the sudden onset of dizziness, blurry vision, and a raspy voice.", "He has type 2 diabetes mellitus, hypercholesterolemia, coronary artery disease, and hypertension.", "He has smoked two packs of cigarettes daily for 30 years.", "He drinks three to four beers daily.", "His current medications include metformin, atenolol, lisinopril, furosemide, and aspirin.", "His temperature is 36.6\u00b0C (98\u00b0F), pulse is 85/min, respirations are 18/min, and blood pressure is 142/90 mm Hg.", "He is alert and oriented to person, place, and time.", "The pupil on the left is pinpoint.", "There is ptosis of the left eye.", "Horizontal nystagmus is present.", "The gag reflex is diminished.", "When he stands without support, he falls towards his left side.", "There is loss of pain and temperature sensation over the left face and right trunk and limbs."], "context_len": 13, "options": {"A": "Right middle cerebral artery", "B": "Left posterior inferior cerebellar artery", "C": "Right internal carotid artery", "D": "Left posterior cerebral artery"}, "answer": "Left posterior inferior cerebellar artery", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "67 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 67 years old.", "2. Patient has sudden onset of dizziness, blurry vision, and raspy voice.", "3. Patient has type 2 diabetes mellitus, hypercholesterolemia, coronary artery disease, and hypertension.", "4. Patient has smoked two packs of cigarettes daily for 30 years.", "5. Patient drinks three to four beers daily.", "6. Patient's current medications include metformin, atenolol, lisinopril, furosemide, and aspirin.", "7. Patient's temperature is 36.6\u00b0C (98\u00b0F).", "8. Patient's pulse is 85/min.", "9. Patient's respirations are 18/min.", "10. Patient's blood pressure is 142/90 mm Hg.", "11. Patient is alert and oriented to person, place, and time.", "12. Patient's left pupil is pinpoint.", "13. Patient has ptosis of the left eye.", "14. Patient has horizontal nystagmus.", "15. Patient's gag reflex is diminished.", "16. Patient falls towards left side when standing without support.", "17. Patient has loss of pain and temperature sensation over left face and right trunk and limbs."], "atomic_facts": ["1. He has type 2 diabetes mellitus.", "2. He has hypercholesterolemia.", "3. He has coronary artery disease.", "4. He has hypertension.", "5. He has smoked two packs of cigarettes daily for 30 years.", "6. He drinks three to four beers daily.", "7. His current medications include metformin, atenolol, lisinopril, furosemide, and aspirin.", "8. His temperature is 36.6\u00b0C (98\u00b0F).", "9. His pulse is 85/min.", "10. His respirations are 18/min.", "11. His blood pressure is 142/90 mm Hg.", "12. He is alert and oriented to person, place, and time.", "13. The pupil on the left is pinpoint.", "14. There is ptosis of the left eye.", "15. Horizontal nystagmus is present.", "16. The gag reflex is diminished.", "17. When he stands without support, he falls towards his left side.", "18. There is loss of pain and temperature sensation over the left face and right trunk and limbs."]}
{"id": 409, "question": "What is the most likely cause of her recent mental impairment?", "context": ["A 67-year-old woman with a recently found hepatic carcinoma has been an inpatient for more than a week.", "During morning rounds, she was abnormally disoriented to time and place along with a shortened attention span.", "The overnight resident reports that she was coming in and out of this state for the past couple nights.", "The patient was known to drink often, but reported that she has not consumed alcohol in weeks leading up to her admission.", "She is not jaundiced and has no metabolic imbalance upon laboratory tests."], "context_len": 5, "options": {"A": "Delirium", "B": "Substance abuse", "C": "Brain metastasis", "D": "Delirium tremens"}, "answer": "Delirium", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "67", "specialties": ["Internal Medicine"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 67-year-old woman has been an inpatient for more than a week.", "2. She has a recently found hepatic carcinoma.", "3. During morning rounds, she was abnormally disoriented to time and place along with a shortened attention span.", "4. The overnight resident reports that she was coming in and out of this state for the past couple nights.", "5. The patient was known to drink often.", "6. She reported that she has not consumed alcohol in weeks leading up to her admission.", "7. She is not jaundiced.", "8. She has no metabolic imbalance upon laboratory tests."], "atomic_facts": ["1. During morning rounds, the patient was abnormally disoriented to time and place.", "2. The patient had a shortened attention span.", "3. The overnight resident reports that the patient was coming in and out of this state for the past couple nights.", "4. The patient was known to drink often.", "5. The patient reported that she has not consumed alcohol in weeks leading up to her admission.", "6. The patient is not jaundiced.", "7. The patient has no metabolic imbalance upon laboratory tests."]}
{"id": 410, "question": "Which of the following is the most likely cause of this patient's symptoms?", "context": ["A 51-year-old man comes to the physician because of recurrent episodes of dizziness, tinnitus, and hearing loss on the left side for 6 weeks.", "These episodes last for hours at a time and are associated with the sensation that the room is spinning.", "He has no history of major medical illness and takes no medications.", "Examination shows horizontal nystagmus to the left.", "Weber test shows lateralization to the right ear.", "The Rinne test is positive bilaterally."], "context_len": 6, "options": {"A": "Dislodged otoliths", "B": "Acoustic neuroma", "C": "Endolymphatic hydrops", "D": "Posterior inferior cerebellar artery infarction"}, "answer": "Endolymphatic hydrops", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "51 years old", "specialties": ["Otolaryngology"], "subspecialties": ["Neurotology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 51-year-old man comes to the physician.", "2. He has recurrent episodes of dizziness, tinnitus, and hearing loss on the left side for 6 weeks.", "3. The episodes last for hours at a time.", "4. He has the sensation that the room is spinning.", "5. He has no history of major medical illness.", "6. He takes no medications.", "7. Examination shows horizontal nystagmus to the left.", "8. Weber test shows lateralization to the right ear.", "9. The Rinne test is positive bilaterally."], "atomic_facts": ["1. The episodes last for hours at a time.", "2. The episodes are associated with the sensation that the room is spinning.", "3. He has no history of major medical illness.", "4. He takes no medications.", "5. Examination shows horizontal nystagmus to the left.", "6. Weber test shows lateralization to the right ear.", "7. The Rinne test is positive bilaterally."]}
{"id": 411, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 37-year-old farmer presents to the emergency department with acute onset of complaints of diarrhea, excessive tearing, and increased saliva production.", "He is concerned that he is dehydrated, as he has also been urinating with increased frequency over the past several hours.", "His temperature is 97.6\u00b0F (36.4\u00b0C), blood pressure is 111/64 mmHg, pulse is 60/min, respirations are 10/min, and oxygen saturation is 98% on room air.", "Physical exam is significant for a moderately agitated and diaphoretic man who demonstrates pinpoint pupils."], "context_len": 4, "options": {"A": "Atropine", "B": "Diphenhydramine", "C": "Naloxone", "D": "Physostigmine"}, "answer": "Atropine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "37 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 37-year-old farmer presents to the emergency department.", "2. Complaints of diarrhea, excessive tearing, and increased saliva production.", "3. He is concerned that he is dehydrated.", "4. He has been urinating with increased frequency over the past several hours.", "5. His temperature is 97.6\u00b0F (36.4\u00b0C).", "6. Blood pressure is 111/64 mmHg.", "7. Pulse is 60/min.", "8. Respirations are 10/min.", "9. Oxygen saturation is 98% on room air.", "10. Physical exam is significant for a moderately agitated and diaphoretic man.", "11. He demonstrates pinpoint pupils."], "atomic_facts": ["1. Concerned about dehydration", "2. Increased frequency of urination", "3. Temperature: 97.6\u00b0F (36.4\u00b0C)", "4. Blood pressure: 111/64 mmHg", "5. Pulse: 60/min", "6. Respirations: 10/min", "7. Oxygen saturation: 98% on room air", "8. Physical exam significant for agitation and diaphoresis", "9. Pinpoint pupils"]}
{"id": 412, "question": "Arterial blood gas analysis on room air shows: | pH 7.52 | PCO2 25 mm Hg | PO2 65 mm Hg | O2 saturation 92% | Physical examination is most likely to show which of the following findings?\"", "context": ["A 54-year-old woman comes to the emergency department because of sharp chest pain and shortness of breath for 1 day.", "She has been coughing intermittently, which worsens the pain.", "She has osteoporosis, for which she takes raloxifene."], "context_len": 3, "options": {"A": "Unilateral swelling of the leg", "B": "Increased anteroposterior diameter of the thorax", "C": "Grouped vesicles on the right hemithorax", "D": "Absent left radial pulse"}, "answer": "Unilateral swelling of the leg", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "54 years old", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 54-year-old woman comes to the emergency department.", "2. She has sharp chest pain and shortness of breath for 1 day.", "3. She has been coughing intermittently.", "4. The coughing worsens the pain.", "5. She has osteoporosis.", "6. She takes raloxifene for her osteoporosis."], "atomic_facts": ["1. She has been coughing intermittently.", "2. The coughing worsens the pain.", "3. She has osteoporosis.", "4. She takes raloxifene for osteoporosis."]}
{"id": 413, "question": "Which of the following is the most likely causal organism?", "context": ["A previously healthy 18-year-old woman comes to the emergency department because of diarrhea and abdominal cramps since the previous evening.", "She has had around 3\u20134 episodes of watery stools.", "She feels nauseous and has vomited twice.", "She recollects eating out 2 days ago.", "She has been on a vegan diet for 6 months.", "She takes no medications and has not traveled anywhere recently.", "Her temperature is 36.8\u00b0(98.2\u00b0F), pulse is 73/min, and blood pressure is 110/70 mm Hg.", "Examination shows dry mucous membranes.", "Abdominal examination is unremarkable."], "context_len": 9, "options": {"A": "Rotavirus", "B": "Norovirus", "C": "Vibrio vulnificus", "D": "Bacillus cereus"}, "answer": "Norovirus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "18 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A previously healthy 18-year-old woman comes to the emergency department.", "2. She has had diarrhea and abdominal cramps since the previous evening.", "3. She has had around 3\u20134 episodes of watery stools.", "4. She feels nauseous and has vomited twice.", "5. She recollects eating out 2 days ago.", "6. She has been on a vegan diet for 6 months.", "7. She takes no medications.", "8. She has not traveled anywhere recently.", "9. Her temperature is 36.8\u00b0(98.2\u00b0F).", "10. Her pulse is 73/min.", "11. Her blood pressure is 110/70 mm Hg.", "12. Examination shows dry mucous membranes.", "13. Abdominal examination is unremarkable."], "atomic_facts": ["1. She has had around 3\u20134 episodes of watery stools.", "2. She feels nauseous and has vomited twice.", "3. She recollects eating out 2 days ago.", "4. She has been on a vegan diet for 6 months.", "5. She takes no medications and has not traveled anywhere recently.", "6. Her temperature is 36.8\u00b0(98.2\u00b0F), pulse is 73/min, and blood pressure is 110/70 mm Hg.", "7. Examination shows dry mucous membranes.", "8. Abdominal examination is unremarkable."]}
{"id": 414, "question": "The patient\u2019s condition is most likely associated with impaired formation of which of the following?", "context": ["A 6-year-old boy is brought to the physician for a well-child examination.", "He has no history of major medical illness.", "His mother says, \u201cSometimes when my son forgets to flush, his urine leaves dark stains in the toilet.\u201d She is unconcerned because her son already had dark-colored urine as a baby and he has never had any health issues.", "His vital signs are within normal limits.", "Physical examination shows no abnormalities."], "context_len": 5, "options": {"A": "Cystathionine", "B": "Methylmalonate", "C": "Tyrosine", "D": "Maleylacetoacetate"}, "answer": "Maleylacetoacetate", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["General Medical Genetics and Genomics", "Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 6-year-old boy is brought to the physician for a well-child examination.", "2. He has no history of major medical illness.", "3. His mother says, \u201cSometimes when my son forgets to flush, his urine leaves dark stains in the toilet.\u201d", "4. She is unconcerned because her son already had dark-colored urine as a baby and he has never had any health issues.", "5. His vital signs are within normal limits.", "6. Physical examination shows no abnormalities."], "atomic_facts": ["1. He has no history of major medical illness.", "2. His mother says, \u201cSometimes when my son forgets to flush, his urine leaves dark stains in the toilet.\u201d", "3. She is unconcerned because her son already had dark-colored urine as a baby.", "4. He has never had any health issues.", "5. His vital signs are within normal limits.", "6. Physical examination shows no abnormalities."]}
{"id": 415, "question": "Which of the following is the next best step in the management of this patient?", "context": ["A 72-year-old man presents with a recent episode of slurred speech and numbness in his left arm and left leg 2 hours ago that resolved completely within 45 minutes.", "He says he was having breakfast when he noticed that he had difficulty talking and the left side of his body was numb.", "The patient denies any past similar symptoms.", "Past medical history is significant for type 2 diabetes mellitus, hypertension, and ischemic heart disease.", "He had a coronary artery bypass graft 12 years ago and a percutaneous intervention 3 years ago.", "Current medications are aspirin, metformin, nitrates, and rosuvastatin.", "His vital signs include: blood pressure 143/97 mm Hg, pulse 80/min, oxygen saturation 98% on room air.", "On physical examination, the patient is alert and oriented.", "Higher mental functions are intact.", "Muscle strength is 5 out of 5l in both upper and lower limbs bilaterally.", "The sensation is intact.", "Cerebellar signs are absent and his gait is normal."], "context_len": 12, "options": {"A": "Add clopidogrel and discharge the patient", "B": "Admit the patient for observation and workup", "C": "Discharge now and ask him to visit again when symptoms reoccur", "D": "Start antiepileptic drugs"}, "answer": "Admit the patient for observation and workup", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "72 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 72 years old.", "2. Patient had an episode of slurred speech and numbness in his left arm and left leg 2 hours ago that resolved completely within 45 minutes.", "3. Patient was having breakfast when he noticed difficulty talking and numbness on left side of body.", "4. Patient denies any past similar symptoms.", "5. Patient has past medical history of type 2 diabetes mellitus, hypertension, and ischemic heart disease.", "6. Patient had coronary artery bypass graft 12 years ago and percutaneous intervention 3 years ago.", "7. Patient is currently taking aspirin, metformin, nitrates, and rosuvastatin.", "8. Patient's blood pressure is 143/97 mm Hg, pulse 80/min, oxygen saturation 98% on room air.", "9. Patient is alert and oriented with higher mental functions intact.", "10. Muscle strength is 5 out of 5 in both upper and lower limbs bilaterally.", "11. Sensation is intact.", "12. Cerebellar signs are absent.", "13. Patient's gait is normal."], "atomic_facts": ["1. The patient was having breakfast when he noticed difficulty talking and numbness on the left side of his body.", "2. The patient denies any past similar symptoms.", "3. Past medical history includes type 2 diabetes mellitus, hypertension, and ischemic heart disease.", "4. The patient had a coronary artery bypass graft 12 years ago and a percutaneous intervention 3 years ago.", "5. Current medications are aspirin, metformin, nitrates, and rosuvastatin.", "6. Vital signs: blood pressure 143/97 mm Hg, pulse 80/min, oxygen saturation 98% on room air.", "7. On physical examination, the patient is alert and oriented.", "8. Higher mental functions are intact.", "9. Muscle strength is 5 out of 5 in both upper and lower limbs bilaterally.", "10. Sensation is intact.", "11. Cerebellar signs are absent and gait is normal."]}
{"id": 416, "question": "Which of the following is the most appropriate pharmacotherapy?\"", "context": ["A 29-year-old man is brought to the emergency department after being found unresponsive at home.", "The patient's roommate says that the patient had previously been feeling well.", "The patient and his roommate had a celebration the night before, where they drank homemade liquor.", "His temperature is 37\u00b0C (98.6\u00b0F), pulse is 126/min, respirations are 30/min and shallow, and blood pressure is 84/44 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 96%.", "He is unresponsive to painful stimuli.", "The pupils are 3 mm, equal, round, and reactive to light.", "The lungs are clear to auscultation.", "Cardiac examination shows a grade 2/6 systolic murmur along the left parasternal border.", "Laboratory studies show: | Serum | Na+ 146 mmol/L | K+ 7.7 mmol/L | Cl- 111 mmol/L | Urea nitrogen 5.8 mmol/L | Glucose 83 mg/dL | Lactate 11.2 mmol/L | Serum osmolality 379 mosm/kg | Arterial blood gas analysis shows: | pH 6.69 | pCO2 53 mm Hg | pO2 84 mm Hg | HCO3- 4.3 mmol/L | The patient is intubated and fluid resuscitation is begun."], "context_len": 10, "options": {"A": "N-acetylcysteine", "B": "Fomepizole", "C": "Naloxone", "D": "Flumazenil"}, "answer": "Fomepizole", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "29", "specialties": ["Emergency Medicine"], "subspecialties": ["Medical Toxicology", "General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 29-year-old man is brought to the emergency department after being found unresponsive at home.", "2. The patient's roommate says that the patient had previously been feeling well.", "3. The patient and his roommate had a celebration the night before, where they drank homemade liquor.", "4. His temperature is 37\u00b0C (98.6\u00b0F).", "5. Pulse is 126/min.", "6. Respirations are 30/min and shallow.", "7. Blood pressure is 84/44 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 96%.", "9. He is unresponsive to painful stimuli.", "10. The pupils are 3 mm, equal, round, and reactive to light.", "11. The lungs are clear to auscultation.", "12. Cardiac examination shows a grade 2/6 systolic murmur along the left parasternal border.", "13. Laboratory studies show: Na+ 146 mmol/L, K+ 7.7 mmol/L, Cl- 111 mmol/L, Urea nitrogen 5.8 mmol/L, Glucose 83 mg/dL, Lactate 11.2 mmol/L, Serum osmolality 379 mosm/kg.", "14. Arterial blood gas analysis shows: pH 6.69, pCO2 53 mm Hg, pO2 84 mm Hg, HCO3- 4.3 mmol/L.", "15. The patient is intubated.", "16. Fluid resuscitation is begun."], "atomic_facts": ["1. The patient's roommate says that the patient had previously been feeling well.", "2. The patient and his roommate had a celebration the night before, where they drank homemade liquor.", "3. His temperature is 37\u00b0C (98.6\u00b0F).", "4. His pulse is 126/min.", "5. His respirations are 30/min and shallow.", "6. His blood pressure is 84/44 mm Hg.", "7. Pulse oximetry on room air shows an oxygen saturation of 96%.", "8. He is unresponsive to painful stimuli.", "9. The pupils are 3 mm, equal, round, and reactive to light.", "10. The lungs are clear to auscultation.", "11. Cardiac examination shows a grade 2/6 systolic murmur along the left parasternal border.", "12. Laboratory studies show: Serum Na+ 146 mmol/L, K+ 7.7 mmol/L, Cl- 111 mmol/L, Urea nitrogen 5.8 mmol/L, Glucose 83 mg/dL, Lactate 11.2 mmol/L, Serum osmolality 379 mosm/kg.", "13. Arterial blood gas analysis shows: pH 6.69, pCO2 53 mm Hg, pO2 84 mm Hg, HCO3- 4.3 mmol/L.", "14. The patient is intubated and fluid resuscitation is begun."]}
{"id": 417, "question": "Which of the following is the most likely diagnosis for this patient?", "context": ["A 22-year-old woman presents with an episodic history of swelling of the face, hands, and neck and a single episode of difficulty swallowing.", "She also has a history of frequent, severe abdominal pain.", "At the time of her visit, her blood pressure is 126/84 mm Hg, heart rate is 82/min, and respiratory rate is 15/min.", "Physical examination is unremarkable except for a swollen right hand as shown in the image below.", "Imaging studies are normal and do not reveal any cause of her pain.", "Her C1 inhibitor level is less than 6% of the reference value."], "context_len": 6, "options": {"A": "DiGeorge syndrome", "B": "Hereditary angioedema", "C": "Paroxysmal nocturnal hemoglobinuria", "D": "Chediak-Higashi syndrome"}, "answer": "Hereditary angioedema", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "22 years old", "specialties": ["Allergy and Immunology"], "subspecialties": ["General Allergy and Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. Patient is a 22-year-old woman.", "2. Patient has episodic history of swelling of the face, hands, and neck.", "3. Patient has a single episode of difficulty swallowing.", "4. Patient has a history of frequent, severe abdominal pain.", "5. Patient's blood pressure is 126/84 mm Hg.", "6. Patient's heart rate is 82/min.", "7. Patient's respiratory rate is 15/min.", "8. Physical examination is unremarkable except for a swollen right hand.", "9. Imaging studies are normal and do not reveal any cause of her pain.", "10. Patient's C1 inhibitor level is less than 6% of the reference value."], "atomic_facts": ["1. She has a history of frequent, severe abdominal pain.", "2. At the time of her visit, her blood pressure is 126/84 mm Hg.", "3. At the time of her visit, her heart rate is 82/min.", "4. At the time of her visit, her respiratory rate is 15/min.", "5. Physical examination is unremarkable except for a swollen right hand as shown in the image below.", "6. Imaging studies are normal and do not reveal any cause of her pain.", "7. Her C1 inhibitor level is less than 6% of the reference value."]}
{"id": 418, "question": "Which of the following is the most appropriate statement by the physician at this time?", "context": ["A 60-year-old man calls his hospital and asks to speak to his physician about laboratory test reports ordered because of a 3-month history of abdominal fullness and generalized fatigue.", "The referral note shows that he was constipated for the previous week.", "His abdominal examination had shown distention, and a 7-cm, hard, irregular, nontender mass was palpable on rectal examination.", "His colonoscopy report reveals a low anterior circumferential rectal lesion.", "An MRI of the pelvis shows a rectal mass with involvement of the prostate and seminal vesicles.", "A brief review of the results shows that an endoscopic biopsy confirms the clinical diagnosis of advanced rectal adenocarcinoma.", "His serum carcinoembryonic antigen concentration is 21.0 ng/mL (N < 2.5).", "The physician is tasked with delivering the diagnosis to the patient."], "context_len": 8, "options": {"A": "\"\"\"Your lab reports show that you have a locally advanced rectal adenocarcinoma\"\"\"", "B": "\"\"\"Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?\"\"\"", "C": "\"\"\"I would like to meet later today at 4:00 PM so that we have enough time to discuss the lab results. If you'd like a friend or family member to accompany you, feel free to bring them along.\"\"\"", "D": "\"\"\"You must be be curious as to why all these tests were ordered, and you may even be anxious about the results.\"\"\""}, "answer": "\"\"\"I would like to meet later today at 4:00 PM so that we have enough time to discuss the lab results. If you'd like a friend or family member to accompany you, feel free to bring them along.\"\"\"", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "60 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 60-year-old man called his hospital.", "2. He asked to speak to his physician about laboratory test reports.", "3. The laboratory test reports were ordered because of a 3-month history of abdominal fullness and generalized fatigue.", "4. The referral note showed that he was constipated for the previous week.", "5. His abdominal examination had shown distention.", "6. A 7-cm, hard, irregular, nontender mass was palpable on rectal examination.", "7. His colonoscopy report revealed a low anterior circumferential rectal lesion.", "8. An MRI of the pelvis showed a rectal mass with involvement of the prostate and seminal vesicles.", "9. A brief review of the results showed that an endoscopic biopsy confirmed the clinical diagnosis of advanced rectal adenocarcinoma.", "10. His serum carcinoembryonic antigen concentration was 21.0 ng/mL (N < 2.5).", "11. The physician was tasked with delivering the diagnosis to the patient."], "atomic_facts": ["1. The referral note shows constipation for the previous week.", "2. Abdominal examination showed distention.", "3. A 7-cm, hard, irregular, nontender mass was palpable on rectal examination.", "4. Colonoscopy report reveals a low anterior circumferential rectal lesion.", "5. MRI of the pelvis shows a rectal mass with involvement of the prostate and seminal vesicles.", "6. Endoscopic biopsy confirms the clinical diagnosis of advanced rectal adenocarcinoma.", "7. Serum carcinoembryonic antigen concentration is 21.0 ng/mL (N < 2.5).", "8. The physician is tasked with delivering the diagnosis to the patient."]}
{"id": 419, "question": "Prior to discharge, administration of which of the following is most appropriate in this patient?", "context": ["A 50-year-old man has a kidney transplantation for end-stage renal disease in the setting of long-standing polycystic kidney disease.", "His postoperative course is uncomplicated.", "He had smoked one pack of cigarettes daily for 20 years but quit 5 years ago.", "He does not drink alcohol or use illicit drugs.", "Current medications include basiliximab, mycophenolate mofetil, and prednisone.", "His vital signs are within normal limits.", "On physical examination, the surgical incisions appear clean and intact."], "context_len": 7, "options": {"A": "Azithromycin", "B": "Trimethoprim-sulfamethoxazole", "C": "Acyclovir", "D": "Varicella vaccine"}, "answer": "Trimethoprim-sulfamethoxazole", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "50", "specialties": ["Nephrology", "Internal Medicine"], "subspecialties": ["General Nephrology", "Nephrology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 50-year-old man has a kidney transplantation.", "2. The transplantation is for end-stage renal disease.", "3. The end-stage renal disease is in the setting of long-standing polycystic kidney disease.", "4. His postoperative course is uncomplicated.", "5. He smoked one pack of cigarettes daily for 20 years.", "6. He quit smoking 5 years ago.", "7. He does not drink alcohol.", "8. He does not use illicit drugs.", "9. Current medications include basiliximab, mycophenolate mofetil, and prednisone.", "10. His vital signs are within normal limits.", "11. On physical examination, the surgical incisions appear clean and intact."], "atomic_facts": ["1. His postoperative course is uncomplicated.", "2. He had smoked one pack of cigarettes daily for 20 years but quit 5 years ago.", "3. He does not drink alcohol or use illicit drugs.", "4. Current medications include basiliximab, mycophenolate mofetil, and prednisone.", "5. His vital signs are within normal limits.", "6. On physical examination, the surgical incisions appear clean and intact."]}
{"id": 420, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation comes to the physician for a prenatal visit.", "She has had no prenatal care.", "She emigrated from China 5 years ago and cannot recall all of her vaccinations.", "She appears well.", "Physical examination shows a uterus consistent in size with a 32-week gestation.", "Serum studies show: | Anti-hepatitis A IgM antibody negative | Anti-hepatitis A IgG antibody positive | Hepatitis B surface antigen negative | Anti-hepatitis B surface antibody positive | Hepatitis B core antigen negative | Anti-hepatitis B core antibody negative | ."], "context_len": 6, "options": {"A": "Plan normal vaginal delivery at term", "B": "Determine hepatitis B e antigen serum level", "C": "Administer hepatitis B vaccine to mother", "D": "Perform liver biopsy of mother"}, "answer": "Plan normal vaginal delivery at term", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 28-year-old woman comes to the physician for a prenatal visit.", "2. She is gravida 1, para 0, at 32 weeks' gestation.", "3. She has had no prenatal care.", "4. She emigrated from China 5 years ago.", "5. She cannot recall all of her vaccinations.", "6. She appears well.", "7. Physical examination shows a uterus consistent in size with a 32-week gestation.", "8. Anti-hepatitis A IgM antibody is negative.", "9. Anti-hepatitis A IgG antibody is positive.", "10. Hepatitis B surface antigen is negative.", "11. Anti-hepatitis B surface antibody is positive.", "12. Hepatitis B core antigen is negative.", "13. Anti-hepatitis B core antibody is negative."], "atomic_facts": ["1. She has had no prenatal care.", "2. She emigrated from China 5 years ago.", "3. She cannot recall all of her vaccinations.", "4. She appears well.", "5. Physical examination shows a uterus consistent in size with a 32-week gestation.", "6. Serum studies show: Anti-hepatitis A IgM antibody negative.", "7. Serum studies show: Anti-hepatitis A IgG antibody positive.", "8. Serum studies show: Hepatitis B surface antigen negative.", "9. Serum studies show: Anti-hepatitis B surface antibody positive.", "10. Serum studies show: Hepatitis B core antigen negative.", "11. Serum studies show: Anti-hepatitis B core antibody negative."]}
{"id": 421, "question": "Which of the following is a potential side effect of this medication?", "context": ["A 58-year-old woman presents to her family physician for an annual checkup.", "During the visit, the patient asks her physician for help quitting smoking cigarettes.", "She has unsuccessfully tried quitting several times previously and has also failed prior attempts with meditation and exercise.", "The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation."], "context_len": 4, "options": {"A": "Seizure", "B": "Sexual dysfunction", "C": "Suicidal ideation", "D": "Tachycardia"}, "answer": "Suicidal ideation", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "58", "specialties": ["Internal Medicine", "Family Medicine"], "subspecialties": ["General Internal Medicine", "General Family Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 58-year-old woman presents to her family physician for an annual checkup.", "2. The patient asks her physician for help quitting smoking cigarettes.", "3. She has unsuccessfully tried quitting several times previously.", "4. She has also failed prior attempts with meditation and exercise.", "5. The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation."], "atomic_facts": ["1. The patient asks her physician for help quitting smoking cigarettes during the visit.", "2. She has unsuccessfully tried quitting several times previously.", "3. She has also failed prior attempts with meditation and exercise.", "4. The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation."]}
{"id": 422, "question": "Which of the following is the most likely underlying cause of this patient's condition?", "context": ["A 57-year-old man with chronic obstructive pulmonary disease comes to the emergency department because of leg swelling for 2 weeks.", "He has smoked 2 packs of cigarettes daily for the past twenty years.", "His vital signs are within normal limits.", "Physical examination shows jugular venous distention, hepatomegaly, and pitting edema of both lower extremities.", "Cardiac examination shows a regular heart rate and normal heart sounds.", "Auscultation of the lungs shows scattered wheezing without crackles.", "Left ventricular ejection fraction is 60%."], "context_len": 7, "options": {"A": "Left-sided systolic heart failure", "B": "Ventricular septal defect", "C": "Chronic occlusion of the pulmonary vessels", "D": "Chronic hypoxic vasoconstriction"}, "answer": "Chronic hypoxic vasoconstriction", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 57-year-old man with chronic obstructive pulmonary disease comes to the emergency department.", "2. He has smoked 2 packs of cigarettes daily for the past twenty years.", "3. His vital signs are within normal limits.", "4. Physical examination shows jugular venous distention.", "5. Physical examination shows hepatomegaly.", "6. Physical examination shows pitting edema of both lower extremities.", "7. Cardiac examination shows a regular heart rate.", "8. Cardiac examination shows normal heart sounds.", "9. Auscultation of the lungs shows scattered wheezing without crackles.", "10. Left ventricular ejection fraction is 60%."], "atomic_facts": ["1. He has smoked 2 packs of cigarettes daily for the past twenty years.", "2. His vital signs are within normal limits.", "3. Physical examination shows jugular venous distention, hepatomegaly, and pitting edema of both lower extremities.", "4. Cardiac examination shows a regular heart rate and normal heart sounds.", "5. Auscultation of the lungs shows scattered wheezing without crackles.", "6. Left ventricular ejection fraction is 60%."]}
{"id": 423, "question": "What is the most likely diagnosis?", "context": ["A young Mediterranean teen brings her 4-year-old little brother to the Emergency Room because of a high temperature.", "Their parents are on their way to the hospital, but, in the meantime, she provides some of the history.", "She explains that he has been running a fever and limping for the past week.", "This morning, she had trouble awakening him, and she noticed some swelling and redness around his right ankle.", "In terms of his past medical history, she knows he has something wrong with his blood.", "He had to receive extra vaccinations as an infant, and he takes an antibiotic everyday.", "On exam in the ED, his temperature is 102.4 deg F (39.1 deg C), blood pressure is 90/60 mmHg, pulse is 123/min, and respirations are 22/min.", "He is lethargic, and his exam is noteworthy for erythema and edema in an area surrounding his distal shin."], "context_len": 8, "options": {"A": "Dactylitis", "B": "Avascular necrosis", "C": "Osteomyelitis", "D": "Thrombophlebitis"}, "answer": "Osteomyelitis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "Teen", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A young Mediterranean teen brings her 4-year-old little brother to the Emergency Room.", "2. Their parents are on their way to the hospital.", "3. She explains that he has been running a fever and limping for the past week.", "4. This morning, she had trouble awakening him.", "5. She noticed some swelling and redness around his right ankle.", "6. In terms of his past medical history, she knows he has something wrong with his blood.", "7. He had to receive extra vaccinations as an infant.", "8. He takes an antibiotic everyday.", "9. On exam in the ED, his temperature is 102.4 deg F (39.1 deg C).", "10. His blood pressure is 90/60 mmHg.", "11. His pulse is 123/min.", "12. His respirations are 22/min.", "13. He is lethargic.", "14. His exam is noteworthy for erythema and edema in an area surrounding his distal shin."], "atomic_facts": ["1. Their parents are on their way to the hospital.", "2. She explains that he has been running a fever and limping for the past week.", "3. This morning, she had trouble awakening him.", "4. She noticed some swelling and redness around his right ankle.", "5. He has something wrong with his blood.", "6. He had to receive extra vaccinations as an infant.", "7. He takes an antibiotic everyday.", "8. On exam in the ED, his temperature is 102.4 deg F (39.1 deg C).", "9. His blood pressure is 90/60 mmHg.", "10. His pulse is 123/min.", "11. His respirations are 22/min.", "12. He is lethargic.", "13. His exam is noteworthy for erythema and edema in an area surrounding his distal shin."]}
{"id": 424, "question": "Which of the following is the next best step in management of the patient\u2019s condition?", "context": ["A 47-year-old man comes to the emergency department complaining of weight gain and abdominal discomfort.", "He states that over the past month he has gained 10 lbs.", "This week he began experiencing mild, diffuse abdominal discomfort.", "He denies nausea, vomiting, constipation, or diarrhea.", "The patient has not seen a physician in years and takes no medications.", "He is a truck driver.", "He states that he drinks a 6-pack of beer per night.", "On physical examination, there is jaundice, hepatomegaly, and a positive fluid wave.", "An abdominal ultrasound reveals cirrhosis, portal vein dilation, and moderate ascites.", "He undergoes a paracentesis that relieves his symptoms.", "Fluid analysis is shown below: |  | Serum: | Albumin: 4.0 g/dL |  | Ascitic fluid: | Color: Yellow | Leukocyte count: 100/mm^3 with 50% neutrophils | Protein: 2.3 g/dL | Albumin: 1.9 g/dL |  | A culture is pending.", "He is discharged and instructed to follow-up with a gastroenterologist for an upper endoscopy.", "Upper endoscopy reveals multiple, small non-bleeding esophageal varices."], "context_len": 13, "options": {"A": "Atenolol", "B": "Ceftriaxone", "C": "Propranolol", "D": "Transjugular intrahepatic portosystemic shunt"}, "answer": "Propranolol", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "47 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 47-year-old man comes to the emergency department complaining of weight gain and abdominal discomfort.", "2. He states that over the past month he has gained 10 lbs.", "3. This week he began experiencing mild, diffuse abdominal discomfort.", "4. He denies nausea, vomiting, constipation, or diarrhea.", "5. The patient has not seen a physician in years and takes no medications.", "6. He is a truck driver.", "7. He states that he drinks a 6-pack of beer per night.", "8. On physical examination, there is jaundice, hepatomegaly, and a positive fluid wave.", "9. An abdominal ultrasound reveals cirrhosis, portal vein dilation, and moderate ascites.", "10. He undergoes a paracentesis that relieves his symptoms.", "11. Fluid analysis of serum shows albumin of 4.0 g/dL.", "12. Fluid analysis of ascitic fluid shows color of yellow, leukocyte count of 100/mm^3 with 50% neutrophils, protein of 2.3 g/dL, and albumin of 1.9 g/dL.", "13. A culture is pending.", "14. He is discharged and instructed to follow-up with a gastroenterologist for an upper endoscopy.", "15. Upper endoscopy reveals multiple, small non-bleeding esophageal varices."], "atomic_facts": ["1. The patient has gained 10 lbs over the past month.", "2. The patient began experiencing mild, diffuse abdominal discomfort this week.", "3. The patient denies nausea, vomiting, constipation, or diarrhea.", "4. The patient has not seen a physician in years and takes no medications.", "5. The patient is a truck driver.", "6. The patient drinks a 6-pack of beer per night.", "7. On physical examination, there is jaundice, hepatomegaly, and a positive fluid wave.", "8. An abdominal ultrasound reveals cirrhosis, portal vein dilation, and moderate ascites.", "9. The patient undergoes a paracentesis that relieves his symptoms.", "10. Fluid analysis shows serum albumin at 4.0 g/dL, ascitic fluid color as yellow, leukocyte count at 100/mm^3 with 50% neutrophils, ascitic fluid protein at 2.3 g/dL, and ascitic fluid albumin at 1.9 g/dL.", "11. A culture is pending.", "12. The patient is discharged and instructed to follow-up with a gastroenterologist for an upper endoscopy.", "13. Upper endoscopy reveals multiple, small non-bleeding esophageal varices."]}
{"id": 425, "question": "What is the most likely cause of this patient\u2019s condition?", "context": ["An 8-month-old boy is brought to the office by his mother for recurrent infections.", "Over the past 2 months, the boy had multiple visits to the urgent care clinic for respiratory, ear, and skin infections.", "His mother is concerned about the health of her child.", "Currently, the child had a runny nose for the last 2 days.", "There is no fever but the mother adds that the boy is not eating very well.", "His mother denies any history of infection during her pregnancy and was tested negative for HIV.", "The patient\u2019s heart rate is 90/min, respiratory rate is 14/min, and temperature is 36.7\u00b0C (98.0\u00b0F).", "On physical exam, there are decreased lung sounds in the left lower lobe.", "A chest X-ray reveals an absent thymic shadow and fails to show any lung pathology.", "There is no history of similar symptoms in the families of either parent."], "context_len": 10, "options": {"A": "Adenosine deaminase deficiency", "B": "Hypoxanthine-guanine phosphoribosyl transferase (HGPRT) deficiency", "C": "HIV infection", "D": "Purine nucleoside phosphorylase deficiency"}, "answer": "Adenosine deaminase deficiency", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "8 months", "specialties": ["Pediatrics"], "subspecialties": ["Immunology and Allergy", "Immunology (Pediatric Immunology)", "Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An 8-month-old boy is brought to the office by his mother.", "2. Over the past 2 months, the boy had multiple visits to the urgent care clinic for respiratory, ear, and skin infections.", "3. His mother is concerned about the health of her child.", "4. Currently, the child had a runny nose for the last 2 days.", "5. There is no fever.", "6. The mother adds that the boy is not eating very well.", "7. His mother denies any history of infection during her pregnancy.", "8. His mother was tested negative for HIV.", "9. The patient\u2019s heart rate is 90/min.", "10. The patient\u2019s respiratory rate is 14/min.", "11. The patient\u2019s temperature is 36.7\u00b0C (98.0\u00b0F).", "12. On physical exam, there are decreased lung sounds in the left lower lobe.", "13. A chest X-ray reveals an absent thymic shadow.", "14. The chest X-ray fails to show any lung pathology.", "15. There is no history of similar symptoms in the families of either parent."], "atomic_facts": ["1. The boy had multiple visits to the urgent care clinic for respiratory, ear, and skin infections over the past 2 months.", "2. The mother is concerned about the health of her child.", "3. The child had a runny nose for the last 2 days.", "4. There is no fever, but the boy is not eating very well.", "5. The mother denies any history of infection during her pregnancy and was tested negative for HIV.", "6. The patient\u2019s heart rate is 90/min, respiratory rate is 14/min, and temperature is 36.7\u00b0C (98.0\u00b0F).", "7. On physical exam, there are decreased lung sounds in the left lower lobe.", "8. A chest X-ray reveals an absent thymic shadow and fails to show any lung pathology.", "9. There is no history of similar symptoms in the families of either parent."]}
{"id": 426, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 4-year-old girl is brought to the physician because of a nonpruritic, painless rash on her face for 5 days.", "She was born at term and has been healthy since.", "Her 62-year-old maternal grandmother has bullous pemphigoid.", "Her development is adequate for her age and immunizations are up-to-date.", "She appears healthy and well-nourished.", "Her temperature is 37\u00b0C (98.6\u00b0F) and pulse is 90/min.", "Examination shows a nontender rash on the right side of the patient's face.", "An image of the patient's lower face is shown.", "The remainder of the examination shows no abnormalities."], "context_len": 9, "options": {"A": "Potassium hydroxide preparation", "B": "Oral cephalexin therapy", "C": "Skin biopsy", "D": "Topical mupirocin therapy"}, "answer": "Topical mupirocin therapy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 4-year-old girl.", "2. Patient has a nonpruritic, painless rash on her face for 5 days.", "3. Patient was born at term.", "4. Patient has been healthy since birth.", "5. Patient's 62-year-old maternal grandmother has bullous pemphigoid.", "6. Patient's development is adequate for her age.", "7. Patient's immunizations are up-to-date.", "8. Patient appears healthy and well-nourished.", "9. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "10. Patient's pulse is 90/min.", "11. Examination shows a nontender rash on the right side of the patient's face.", "12. An image of the patient's lower face is shown.", "13. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. She was born at term.", "2. She has been healthy since birth.", "3. Her 62-year-old maternal grandmother has bullous pemphigoid.", "4. Her development is adequate for her age.", "5. Her immunizations are up-to-date.", "6. She appears healthy.", "7. She appears well-nourished.", "8. Her temperature is 37\u00b0C (98.6\u00b0F).", "9. Her pulse is 90/min.", "10. Examination shows a nontender rash on the right side of the patient's face.", "11. An image of the patient's lower face is shown.", "12. The remainder of the examination shows no abnormalities."]}
{"id": 427, "question": "Which of the following is the most likely diagnosis?", "context": ["A 56-year-old man comes to the physician for a routine health maintenance examination.", "He has had mild pain in his left groin for 2 weeks.", "He was admitted to the hospital 1 month ago for myocardial infarction.", "Cardiac catheterization and angiography showed occlusion of the left anterior descending artery and he underwent placement of 2 stents.", "He has hypertension and hypercholesterolemia.", "There is no family history of serious illness.", "He has smoked 2 packs of cigarettes daily for 30 years.", "Current medications include aspirin, clopidogrel, rosuvastatin, and enalapril.", "His temperature is 36.7\u00b0C (98\u00b0F), pulse is 88/min, and blood pressure is 130/84 mm Hg.", "Examination shows a 3-cm (1.2-in), tender, pulsatile mass in the left thigh, below the inguinal ligament.", "There is mild erythema of the overlying skin.", "A loud murmur is heard on auscultation of the mass.", "Cardiopulmonary examination shows no abnormalities.", "There is no edema in the lower limbs.", "Femoral and pedal pulses are palpable bilaterally.", "Neurologic examination shows no focal findings."], "context_len": 16, "options": {"A": "Femoral artery dissection", "B": "Femoral artery pseudoaneurysm", "C": "Femoral artery thrombosis", "D": "Femoral abscess"}, "answer": "Femoral artery pseudoaneurysm", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Internal Medicine", "Vascular Surgery"], "subspecialties": ["General Internal Medicine", "General Vascular Surgery"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 56-year-old man comes to the physician for a routine health maintenance examination.", "2. He has had mild pain in his left groin for 2 weeks.", "3. He was admitted to the hospital 1 month ago for myocardial infarction.", "4. Cardiac catheterization and angiography showed occlusion of the left anterior descending artery and he underwent placement of 2 stents.", "5. He has hypertension and hypercholesterolemia.", "6. There is no family history of serious illness.", "7. He has smoked 2 packs of cigarettes daily for 30 years.", "8. Current medications include aspirin, clopidogrel, rosuvastatin, and enalapril.", "9. His temperature is 36.7\u00b0C (98\u00b0F), pulse is 88/min, and blood pressure is 130/84 mm Hg.", "10. Examination shows a 3-cm (1.2-in), tender, pulsatile mass in the left thigh, below the inguinal ligament.", "11. There is mild erythema of the overlying skin.", "12. A loud murmur is heard on auscultation of the mass.", "13. Cardiopulmonary examination shows no abnormalities.", "14. There is no edema in the lower limbs.", "15. Femoral and pedal pulses are palpable bilaterally.", "16. Neurologic examination shows no focal findings."], "atomic_facts": ["1. He has had mild pain in his left groin for 2 weeks.", "2. He was admitted to the hospital 1 month ago for myocardial infarction.", "3. Cardiac catheterization and angiography showed occlusion of the left anterior descending artery and he underwent placement of 2 stents.", "4. He has hypertension and hypercholesterolemia.", "5. There is no family history of serious illness.", "6. He has smoked 2 packs of cigarettes daily for 30 years.", "7. Current medications include aspirin, clopidogrel, rosuvastatin, and enalapril.", "8. His temperature is 36.7\u00b0C (98\u00b0F), pulse is 88/min, and blood pressure is 130/84 mm Hg.", "9. Examination shows a 3-cm (1.2-in), tender, pulsatile mass in the left thigh, below the inguinal ligament.", "10. There is mild erythema of the overlying skin.", "11. A loud murmur is heard on auscultation of the mass.", "12. Cardiopulmonary examination shows no abnormalities.", "13. There is no edema in the lower limbs.", "14. Femoral and pedal pulses are palpable bilaterally.", "15. Neurologic examination shows no focal findings."]}
{"id": 428, "question": "Which of the following is the most appropriate next step in diagnosis?", "context": ["A 1-year-old girl is brought to the physician because of fever and crying while passing urine for 2 days.", "She was born at term and has been healthy since.", "Three months ago, she was treated for a urinary tract infection with oral cefixime.", "Her temperature is 39\u00b0C (102.2\u00b0F), pulse is 144/min, and blood pressure is 85/40 mm Hg.", "Physical examination shows no abnormalities.", "Her leukocyte count is 14,000/mm3.", "Urine dipstick shows leukocyte esterase and nitrites; urinalysis shows WBCs and gram-negative rods.", "Urine culture results are pending.", "Renal ultrasonography shows hydronephrosis of the left kidney.", "Empirical antimicrobial therapy is initiated, following which the patient's symptoms improve."], "context_len": 10, "options": {"A": "Intravenous pyelography", "B": "Dynamic renal scintigraphy", "C": "Urodynamic testing", "D": "Voiding cystourethrography"}, "answer": "Voiding cystourethrography", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "1 year old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 1-year-old girl is brought to the physician.", "2. She has been having fever and crying while passing urine for 2 days.", "3. She was born at term.", "4. She has been healthy since.", "5. Three months ago, she was treated for a urinary tract infection with oral cefixime.", "6. Her temperature is 39\u00b0C (102.2\u00b0F).", "7. Her pulse is 144/min.", "8. Her blood pressure is 85/40 mm Hg.", "9. Physical examination shows no abnormalities.", "10. Her leukocyte count is 14,000/mm3.", "11. Urine dipstick shows leukocyte esterase and nitrites.", "12. Urinalysis shows WBCs and gram-negative rods.", "13. Urine culture results are pending.", "14. Renal ultrasonography shows hydronephrosis of the left kidney.", "15. Empirical antimicrobial therapy is initiated.", "16. Following the therapy, the patient's symptoms improve."], "atomic_facts": ["1. She was born at term and has been healthy since.", "2. Three months ago, she was treated for a urinary tract infection with oral cefixime.", "3. Her temperature is 39\u00b0C (102.2\u00b0F).", "4. Her pulse is 144/min.", "5. Her blood pressure is 85/40 mm Hg.", "6. Physical examination shows no abnormalities.", "7. Her leukocyte count is 14,000/mm3.", "8. Urine dipstick shows leukocyte esterase and nitrites.", "9. Urinalysis shows WBCs and gram-negative rods.", "10. Urine culture results are pending.", "11. Renal ultrasonography shows hydronephrosis of the left kidney.", "12. Empirical antimicrobial therapy is initiated, following which the patient's symptoms improve."]}
{"id": 429, "question": "Which of the following is a complication of this condition if not treated promptly?", "context": ["A 69-year-old woman presents to her primary care physician complaining of a new-onset, left-sided, throbbing headache that has lasted for several days.", "She reports that the pain is worsened by eating."], "context_len": 2, "options": {"A": "Skin nodules", "B": "Intestinal ischemia", "C": "Monocular blindness", "D": "Ischemic stroke"}, "answer": "Monocular blindness", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "69", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 69-year-old woman presents to her primary care physician.", "2. She is complaining of a new-onset, left-sided, throbbing headache.", "3. The headache has lasted for several days.", "4. The pain is worsened by eating."], "atomic_facts": ["1. She reports", "2. The pain is worsened", "3. By eating"]}
{"id": 430, "question": "Which of the following best describes the pathogenesis of this patient's nail findings?", "context": ["A 32-year old woman presents to the office complaining of progressively worsening shortness of breath for 2 months.", "She was seen multiple times in the past for complications of systemic lupus erythematosus that include anemia, pericarditis, and chronic interstitial lung disease.", "As she does not have medical insurance, she does not regularly follow up with her physician and also is not compliant with her medications.", "She does not drink alcohol, smoke cigarettes, or take illicit drugs.", "Her family history is positive for colon cancer in her father.", "Her temperature is 36.5\u00b0C (97.8\u00b0F), the blood pressure is 106/70 mm Hg, the pulse is 84/min, and the respirations are 16/min.", "Severe clubbing of her fingernails is noted."], "context_len": 7, "options": {"A": "Septic emboli", "B": "Atherosclerotic emboli", "C": "Entrapment of megakaryocytes in the nail bed", "D": "Chronic hypoxemia"}, "answer": "Entrapment of megakaryocytes in the nail bed", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "32 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 32-year old woman.", "2. Patient has been experiencing progressively worsening shortness of breath for 2 months.", "3. Patient has a history of systemic lupus erythematosus with complications of anemia, pericarditis, and chronic interstitial lung disease.", "4. Patient does not have medical insurance.", "5. Patient is not compliant with her medications.", "6. Patient does not drink alcohol, smoke cigarettes, or take illicit drugs.", "7. Patient's family history is positive for colon cancer in her father.", "8. Patient's temperature is 36.5\u00b0C (97.8\u00b0F).", "9. Patient's blood pressure is 106/70 mm Hg.", "10. Patient's pulse is 84/min.", "11. Patient's respirations are 16/min.", "12. Patient has severe clubbing of her fingernails."], "atomic_facts": ["1. The patient has been seen multiple times in the past for complications of systemic lupus erythematosus including anemia, pericarditis, and chronic interstitial lung disease.", "2. The patient does not have medical insurance.", "3. The patient does not regularly follow up with her physician.", "4. The patient is not compliant with her medications.", "5. The patient does not drink alcohol.", "6. The patient does not smoke cigarettes.", "7. The patient does not take illicit drugs.", "8. The patient's family history is positive for colon cancer in her father.", "9. The patient's temperature is 36.5\u00b0C (97.8\u00b0F).", "10. The patient's blood pressure is 106/70 mm Hg.", "11. The patient's pulse is 84/min.", "12. The patient's respirations are 16/min.", "13. Severe clubbing of the patient's fingernails is noted."]}
{"id": 431, "question": "Which of the following is the most likely cause of this patient\u2019s condition?", "context": ["An otherwise healthy 27-year-old woman presents to the emergency department because of worsening headaches and nosebleeds.", "Her blood pressure is 185/115 mm Hg, pulse is 88/min and temperature is 36.9\u00b0C (98.4\u00b0F).", "She denies the use of nicotine, alcohol, or illicit drugs.", "Family history is irrelevant.", "Physical examination is only positive for abdominal bruits.", "She is given a calcium-channel blocker and a thiazide diuretic, but her blood pressure did not respond adequately.", "Aldosterone-to-renin ratio is < 20."], "context_len": 7, "options": {"A": "Renal artery stenosis", "B": "Essential hypertension", "C": "Coarctation of the aorta", "D": "Primary aldosteronism"}, "answer": "Renal artery stenosis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology", "Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 27-year-old woman.", "2. Patient presents to the emergency department due to worsening headaches and nosebleeds.", "3. Blood pressure is 185/115 mm Hg.", "4. Pulse is 88/min.", "5. Temperature is 36.9\u00b0C (98.4\u00b0F).", "6. Patient denies use of nicotine, alcohol, or illicit drugs.", "7. Family history is irrelevant.", "8. Physical examination is only positive for abdominal bruits.", "9. Patient is given a calcium-channel blocker and a thiazide diuretic.", "10. Blood pressure did not respond adequately.", "11. Aldosterone-to-renin ratio is < 20."], "atomic_facts": ["1. Blood pressure is 185/115 mm Hg.", "2. Pulse is 88/min.", "3. Temperature is 36.9\u00b0C (98.4\u00b0F).", "4. Denies the use of nicotine, alcohol, or illicit drugs.", "5. Family history is irrelevant.", "6. Physical examination is only positive for abdominal bruits.", "7. Given a calcium-channel blocker and a thiazide diuretic, but blood pressure did not respond adequately.", "8. Aldosterone-to-renin ratio is < 20."]}
{"id": 432, "question": "Which of the following is the most likely diagnosis?", "context": ["A 50-year-old farmer from Jamaica presents to his physician with a wart-like lesion on his left foot.", "He is a plantain farmer and often farms barefoot because of the pleasant climate.", "Physical examination reveals warty, cutaneous nodules that resemble the florets of cauliflower.", "On a KOH preparation, irregular, dark brown, yeast-like bodies with septae are noted.", "Culture on Sabouraud agar reveals sclerotic bodies."], "context_len": 5, "options": {"A": "Mycetoma", "B": "Sporotrichosis", "C": "Entomophthoromycoses", "D": "Chromoblastomycosis"}, "answer": "Chromoblastomycosis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "50 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 50-year-old farmer from Jamaica presents to his physician.", "2. He is a plantain farmer.", "3. He often farms barefoot because of the pleasant climate.", "4. Physical examination reveals warty, cutaneous nodules that resemble the florets of cauliflower.", "5. On a KOH preparation, irregular, dark brown, yeast-like bodies with septae are noted.", "6. Culture on Sabouraud agar reveals sclerotic bodies."], "atomic_facts": ["1. He is a plantain farmer.", "2. He often farms barefoot.", "3. He farms barefoot because of the pleasant climate.", "4. Physical examination reveals warty, cutaneous nodules.", "5. The nodules resemble the florets of cauliflower.", "6. On a KOH preparation, irregular, dark brown, yeast-like bodies with septae are noted.", "7. Culture on Sabouraud agar reveals sclerotic bodies."]}
{"id": 433, "question": "Which of the following findings is most likely in this patient?\"", "context": ["A 52-year-old man comes to the physician because of a 3.6-kg (8-lb) weight loss over the past 3 months and increasing fatigue.", "He was diagnosed with hepatitis C 6 years ago.", "His father died of colon cancer.", "He has smoked one pack of cigarettes daily for 35 years and drinks one beer daily.", "He used cocaine and heroin in the past but stopped 12 years ago.", "He is 176 cm (5 ft 8 in) tall and weighs 71 kg (156 lb); BMI is 22.9 kg/m2.", "His temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 79/min, and blood pressure is 115/75 mm Hg.", "He appears weak and lethargic.", "Examination shows scleral icterus and scars on both cubital fossae.", "There is reddening of the palms bilaterally.", "There are several telangiectasias over the chest and back.", "The abdomen is soft and nontender.", "The liver is firm and of nodular consistency.", "Laboratory studies show: | Hemoglobin 11.6 g/dL | Mean corpuscular volume 88 \u03bcm3 | Leukocyte count 9,600/mm3 | Platelet count 223,000/mm3 | Ultrasonography of the liver shows a solitary lesion."], "context_len": 14, "options": {"A": "Positive blood cultures", "B": "Elevated \u03b1-fetoprotein", "C": "Elevated carcinoembryonic antigen", "D": "Spiculated lesion on chest CT"}, "answer": "Elevated \u03b1-fetoprotein", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "52 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology", "Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 52-year-old man comes to the physician.", "2. He has experienced a 3.6-kg (8-lb) weight loss over the past 3 months and increasing fatigue.", "3. He was diagnosed with hepatitis C 6 years ago.", "4. His father died of colon cancer.", "5. He has smoked one pack of cigarettes daily for 35 years.", "6. He drinks one beer daily.", "7. He used cocaine and heroin in the past but stopped 12 years ago.", "8. He is 176 cm (5 ft 8 in) tall.", "9. He weighs 71 kg (156 lb); BMI is 22.9 kg/m2.", "10. His temperature is 37.0\u00b0C (98.6\u00b0F).", "11. His pulse is 79/min.", "12. His blood pressure is 115/75 mm Hg.", "13. He appears weak and lethargic.", "14. Examination shows scleral icterus and scars on both cubital fossae.", "15. There is reddening of the palms bilaterally.", "16. There are several telangiectasias over the chest and back.", "17. The abdomen is soft and nontender.", "18. The liver is firm and of nodular consistency.", "19. Laboratory studies show: Hemoglobin 11.6 g/dL.", "20. Laboratory studies show: Mean corpuscular volume 88 \u03bcm3.", "21. Laboratory studies show: Leukocyte count 9,600/mm3.", "22. Laboratory studies show: Platelet count 223,000/mm3.", "23. Ultrasonography of the liver shows a solitary lesion."], "atomic_facts": ["1. Diagnosed with hepatitis C 6 years ago", "2. Father died of colon cancer", "3. Smokes one pack of cigarettes daily for 35 years", "4. Drinks one beer daily", "5. Used cocaine and heroin in the past, stopped 12 years ago", "6. Height is 176 cm (5 ft 8 in)", "7. Weight is 71 kg (156 lb)", "8. BMI is 22.9 kg/m2", "9. Temperature is 37.0\u00b0C (98.6\u00b0F)", "10. Pulse is 79/min", "11. Blood pressure is 115/75 mm Hg", "12. Appears weak and lethargic", "13. Scleral icterus and scars on both cubital fossae", "14. Reddening of the palms bilaterally", "15. Several telangiectasias over the chest and back", "16. Abdomen is soft and nontender", "17. Liver is firm and of nodular consistency", "18. Laboratory studies show: Hemoglobin 11.6 g/dL, Mean corpuscular volume 88 \u03bcm3, Leukocyte count 9,600/mm3, Platelet count 223,000/mm3", "19. Ultrasonography of the liver shows a solitary lesion"]}
{"id": 434, "question": "Which of the following is most likely to confirm the diagnosis?", "context": ["A 63-year-old man comes to the physician for the evaluation of difficulty walking for the last 6 months.", "He reports weakness in his lower legs that improves with exercise and throughout the day.", "Three months ago, he started adding flax seeds to his breakfast because he is frequently constipated.", "He has hypertension and type 2 diabetes mellitus.", "He has smoked 2 packs of cigarettes daily for the last 45 years.", "His current medications include enalapril and metformin.", "Vital signs are within normal limits.", "Examination shows dry mucous membranes.", "Muscle strength in the lower extremities is decreased.", "Sensation to pinprick and light touch is normal.", "Deep tendon reflexes are 1+ bilaterally.", "Active muscle contraction or repeated muscle tapping increases reflex activity."], "context_len": 12, "options": {"A": "Demyelinating plaques on a brain MRI", "B": "Autoantibodies against voltage-gated calcium channels", "C": "Decremental response following repetitive nerve stimulation", "D": "Fasciculations and positive sharp waves on EMG"}, "answer": "Autoantibodies against voltage-gated calcium channels", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "63 years old", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 63-year-old man comes to the physician for the evaluation of difficulty walking for the last 6 months.", "2. He reports weakness in his lower legs that improves with exercise and throughout the day.", "3. Three months ago, he started adding flax seeds to his breakfast because he is frequently constipated.", "4. He has hypertension and type 2 diabetes mellitus.", "5. He has smoked 2 packs of cigarettes daily for the last 45 years.", "6. His current medications include enalapril and metformin.", "7. Vital signs are within normal limits.", "8. Examination shows dry mucous membranes.", "9. Muscle strength in the lower extremities is decreased.", "10. Sensation to pinprick and light touch is normal.", "11. Deep tendon reflexes are 1+ bilaterally.", "12. Active muscle contraction or repeated muscle tapping increases reflex activity."], "atomic_facts": ["1. Patient reports weakness in lower legs", "2. Weakness improves with exercise and throughout the day", "3. Started adding flax seeds to breakfast three months ago due to frequent constipation", "4. Patient has hypertension", "5. Patient has type 2 diabetes mellitus", "6. Patient has smoked 2 packs of cigarettes daily for the last 45 years", "7. Current medications include enalapril and metformin", "8. Vital signs are within normal limits", "9. Examination shows dry mucous membranes", "10. Muscle strength in lower extremities is decreased", "11. Sensation to pinprick and light touch is normal", "12. Deep tendon reflexes are 1+ bilaterally", "13. Active muscle contraction or repeated muscle tapping increases reflex activity"]}
{"id": 435, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 5-year-old boy is brought to the emergency department by his mother because of abdominal pain.", "His mother says that he has not had any fever, vomiting, diarrhea, or dysuria.", "His last bowel movement was 3 days ago and appeared normal.", "The boy is restless and clutches his abdomen.", "His temperature is 37.2\u00b0C (99\u00b0F), blood pressure is 108/76 mm Hg, pulse is 110/min, respirations are 20/min.", "The abdomen appears mildly distended.", "On auscultation, he has hyperactive bowel sounds.", "The remainder of the examination shows no abnormalities.", "An ultrasound of the abdomen shows no abnormalities."], "context_len": 9, "options": {"A": "Administer polyethyelene glycol", "B": "Reassurance and observation", "C": "Perform a barium enema", "D": "Start empirical antibiotic therapy"}, "answer": "Administer polyethyelene glycol", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "5 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 5-year-old boy is brought to the emergency department by his mother.", "2. His mother says he has not had any fever, vomiting, diarrhea, or dysuria.", "3. His last bowel movement was 3 days ago and appeared normal.", "4. The boy is restless and clutches his abdomen.", "5. His temperature is 37.2\u00b0C (99\u00b0F).", "6. His blood pressure is 108/76 mm Hg.", "7. His pulse is 110/min.", "8. His respirations are 20/min.", "9. The abdomen appears mildly distended.", "10. On auscultation, he has hyperactive bowel sounds.", "11. The remainder of the examination shows no abnormalities.", "12. An ultrasound of the abdomen shows no abnormalities."], "atomic_facts": ["1. His mother reports no fever, vomiting, diarrhea, or dysuria.", "2. His last bowel movement was 3 days ago and appeared normal.", "3. The boy is restless and clutches his abdomen.", "4. His temperature is 37.2\u00b0C (99\u00b0F).", "5. His blood pressure is 108/76 mm Hg.", "6. His pulse is 110/min.", "7. His respirations are 20/min.", "8. The abdomen appears mildly distended.", "9. On auscultation, he has hyperactive bowel sounds.", "10. The remainder of the examination shows no abnormalities.", "11. An ultrasound of the abdomen shows no abnormalities."]}
{"id": 436, "question": "Which of the following is the best initial step in management?", "context": ["A 30-year-old woman presents to the emergency department with chest pain.", "She states that she was making coffee this morning when she suddenly developed sharp, 8/10, mid-sternal chest pain.", "The pain does not radiate and is constant.", "She is worried because she has a marathon next week that she has been training for.", "Her medical history is significant for seasonal allergies.", "She takes no medications except a multivitamin.", "Her mother has asthma.", "She works as a lawyer.", "She denies sick contacts or recent travel.", "She has a glass of wine with dinner but denies tobacco or recreational drug use.", "The patient\u2019s initial temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 122/78 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air.", "A physical examination is within normal limits.", "Labs are pending."], "context_len": 13, "options": {"A": "Aspirin, oxygen, nitroglycerin, and morphine", "B": "Computerized tomography scan", "C": "Electrocardiogram", "D": "Heparin"}, "answer": "Electrocardiogram", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 30-year-old woman.", "2. Patient presents to the emergency department with chest pain.", "3. Patient states that she was making coffee this morning when she suddenly developed sharp, 8/10, mid-sternal chest pain.", "4. Pain does not radiate and is constant.", "5. Patient is worried because she has a marathon next week that she has been training for.", "6. Patient's medical history is significant for seasonal allergies.", "7. Patient takes no medications except a multivitamin.", "8. Patient's mother has asthma.", "9. Patient works as a lawyer.", "10. Patient denies sick contacts or recent travel.", "11. Patient has a glass of wine with dinner but denies tobacco or recreational drug use.", "12. Patient's initial temperature is 98\u00b0F (36.7\u00b0C).", "13. Patient's blood pressure is 122/78 mmHg.", "14. Patient's pulse is 89/min.", "15. Patient's respirations are 14/min with an oxygen saturation of 98% on room air.", "16. Physical examination is within normal limits.", "17. Labs are pending."], "atomic_facts": ["1. The patient was making coffee this morning when she suddenly developed sharp, 8/10, mid-sternal chest pain.", "2. The pain does not radiate and is constant.", "3. The patient is worried because she has a marathon next week that she has been training for.", "4. The patient's medical history is significant for seasonal allergies.", "5. The patient takes no medications except a multivitamin.", "6. The patient's mother has asthma.", "7. The patient works as a lawyer.", "8. The patient denies sick contacts or recent travel.", "9. The patient has a glass of wine with dinner but denies tobacco or recreational drug use.", "10. The patient's initial temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 122/78 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air.", "11. A physical examination is within normal limits.", "12. Labs are pending."]}
{"id": 437, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 34-year-old woman, gravida 2, para 1, at 34 weeks' gestation comes to the physician because of a 10-day history of generalized pruritus and a 2-day history of jaundice, dark urine, and pale stools.", "She had developed pruritus at the end of her previous pregnancy, which disappeared after delivery.", "She has had standard prenatal care.", "Medications include folic acid and a multivitamin.", "Her blood pressure is 108/60 mm Hg.", "Examination shows scleral icterus, jaundice, and scratch marks on her upper and lower limbs.", "Pelvic examination shows a uterus consistent in size with a 30-week gestation. | Hemoglobin 11.5 g/dl | Platelet 350,000/mm3 | Prothrombin time 11 seconds (INR=1) | Serum | Total bilirubin 5 mg/dl | Direct bilirubin 4.2 mg/dl | Bile acid | 25 \u03bcmol/l (N= 0.3 to 10 \u03bcmol/l) | Aspartate aminotransferase 55 U/L | Alanine aminotransferase 45 U/L | There are no abnormalities on abdominopelvic ultrasonography."], "context_len": 7, "options": {"A": "24-hour urine protein", "B": "Emergency endoscopic retrograde cholangiopancreatography and sphincterotomy", "C": "Immediate induction of labor", "D": "Ursodeoxycholic acid"}, "answer": "Ursodeoxycholic acid", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "34 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Maternal", "Maternal\u2013Fetal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 34-year-old woman.", "2. Gravida 2, para 1.", "3. 34 weeks' gestation.", "4. 10-day history of generalized pruritus.", "5. 2-day history of jaundice, dark urine, and pale stools.", "6. Developed pruritus at the end of previous pregnancy, which disappeared after delivery.", "7. Had standard prenatal care.", "8. Medications include folic acid and a multivitamin.", "9. Blood pressure is 108/60 mm Hg.", "10. Examination shows scleral icterus, jaundice, and scratch marks on upper and lower limbs.", "11. Pelvic examination shows uterus consistent in size with 30-week gestation.", "12. Hemoglobin 11.5 g/dl.", "13. Platelet 350,000/mm3.", "14. Prothrombin time 11 seconds (INR=1).", "15. Serum total bilirubin 5 mg/dl.", "16. Direct bilirubin 4.2 mg/dl.", "17. Bile acid 25 \u03bcmol/l (N= 0.3 to 10 \u03bcmol/l).", "18. Aspartate aminotransferase 55 U/L.", "19. Alanine aminotransferase 45 U/L.", "20. Abdominopelvic ultrasonography shows no abnormalities."], "atomic_facts": ["1. She developed pruritus at the end of her previous pregnancy.", "2. The pruritus disappeared after delivery.", "3. She has had standard prenatal care.", "4. Her medications include folic acid and a multivitamin.", "5. Her blood pressure is 108/60 mm Hg.", "6. Examination shows scleral icterus, jaundice, and scratch marks on her upper and lower limbs.", "7. Pelvic examination shows a uterus consistent in size with a 30-week gestation.", "8. Hemoglobin is 11.5 g/dl.", "9. Platelet count is 350,000/mm3.", "10. Prothrombin time is 11 seconds (INR=1).", "11. Serum total bilirubin is 5 mg/dl.", "12. Direct bilirubin is 4.2 mg/dl.", "13. Bile acid level is 25 \u03bcmol/l (N= 0.3 to 10 \u03bcmol/l).", "14. Aspartate aminotransferase level is 55 U/L.", "15. Alanine aminotransferase level is 45 U/L.", "16. There are no abnormalities on abdominopelvic ultrasonography."]}
{"id": 438, "question": "What was the most likely diagnosis of this patient?", "context": ["A mother brings her 17-year-old daughter to your office because of a recent onset dull unilateral pelvic pain that started last week.", "In addition, the daughter also complains of constipation for which she increased her fiber intake, but the dietary changes are not helping her.", "She began menstruating at the age of 13, and her menstrual cycles are regular (about 28 days).", "On physical examination, the patient has a large, non-tender, mobile adnexal mass in the left lower quadrant.", "The pelvic examination is normal except for the presence of the adnexal mass.", "The patient is advised to have an outpatient ultrasound, and then return to the clinic next week.", "After 2 weeks, you learned that the patient visited the emergency department for a sudden onset of abdominal pain that required observation after an abdominal ultrasound was performed.", "The ultrasound showed a large simple cystic mass with increased internal echoes, having a diameter of 10 cm and hyperechogenic vascular walls on the left ovary with a small intraperitoneal collection in the pouch of Douglas."], "context_len": 8, "options": {"A": "Follicular cyst", "B": "Endometrioma", "C": "Corpus luteum cyst", "D": "Dermoid cyst"}, "answer": "Corpus luteum cyst", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "17", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A mother brings her 17-year-old daughter to the office.", "2. The daughter has a recent onset of dull unilateral pelvic pain that started last week.", "3. The daughter also complains of constipation.", "4. The daughter increased her fiber intake, but the dietary changes are not helping her.", "5. The daughter began menstruating at the age of 13.", "6. The daughter's menstrual cycles are regular (about 28 days).", "7. On physical examination, the patient has a large, non-tender, mobile adnexal mass in the left lower quadrant.", "8. The pelvic examination is normal except for the presence of the adnexal mass.", "9. The patient is advised to have an outpatient ultrasound.", "10. The patient is to return to the clinic next week.", "11. After 2 weeks, the patient visited the emergency department for a sudden onset of abdominal pain.", "12. An abdominal ultrasound was performed.", "13. The ultrasound showed a large simple cystic mass with increased internal echoes.", "14. The cystic mass has a diameter of 10 cm.", "15. The cystic mass has hyperechogenic vascular walls on the left ovary.", "16. There is a small intraperitoneal collection in the pouch of Douglas."], "atomic_facts": ["1. The daughter complains of constipation and increased her fiber intake.", "2. The dietary changes are not helping her constipation.", "3. The patient began menstruating at the age of 13.", "4. Her menstrual cycles are regular, about 28 days.", "5. On physical examination, the patient has a large, non-tender, mobile adnexal mass in the left lower quadrant.", "6. The pelvic examination is normal except for the presence of the adnexal mass.", "7. The patient is advised to have an outpatient ultrasound.", "8. The patient is advised to return to the clinic next week.", "9. The patient visited the emergency department for a sudden onset of abdominal pain.", "10. Observation was required after an abdominal ultrasound was performed.", "11. The ultrasound showed a large simple cystic mass with increased internal echoes on the left ovary.", "12. The cystic mass has a diameter of 10 cm.", "13. The cystic mass has hyperechogenic vascular walls.", "14. There is a small intraperitoneal collection in the pouch of Douglas."]}
{"id": 439, "question": "Which of the following is the most appropriate management of the patient\u2019s symptoms?", "context": ["A 22-year-old woman comes to the clinic complaining of right anterior knee pain.", "She reports that the pain has been present for 3 months and has gradually worsened.", "She says the pain is exacerbated when climbing or descending the stairs.", "She also states the pain is sometimes worse with prolonged periods of sitting.", "She has tried over-the-counter aspirin and ibuprofen without relief.", "She is a soccer player and is worried that the pain is starting to affect her ability to play.", "She reports multiple minor lower extremity injuries due to soccer but denies significant trauma such as known fractures or torn ligaments.", "Her past medical history is unremarkable.", "She had a myringotomy in her left ear as a child.", "On examination, there is pain and crepitus on extension of the right knee with anterior patellar compression."], "context_len": 10, "options": {"A": "Aspiration", "B": "Orthopedic surgery", "C": "Ossicle resection", "D": "Quadriceps exercises"}, "answer": "Quadriceps exercises", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "22 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 22-year-old woman comes to the clinic complaining of right anterior knee pain.", "2. She reports that the pain has been present for 3 months and has gradually worsened.", "3. She says the pain is exacerbated when climbing or descending the stairs.", "4. She also states the pain is sometimes worse with prolonged periods of sitting.", "5. She has tried over-the-counter aspirin and ibuprofen without relief.", "6. She is a soccer player and is worried that the pain is starting to affect her ability to play.", "7. She reports multiple minor lower extremity injuries due to soccer but denies significant trauma such as known fractures or torn ligaments.", "8. Her past medical history is unremarkable.", "9. She had a myringotomy in her left ear as a child.", "10. On examination, there is pain and crepitus on extension of the right knee with anterior patellar compression."], "atomic_facts": ["1. The pain has been present for 3 months.", "2. The pain has gradually worsened.", "3. The pain is exacerbated when climbing or descending the stairs.", "4. The pain is sometimes worse with prolonged periods of sitting.", "5. Over-the-counter aspirin and ibuprofen have been tried without relief.", "6. She is a soccer player.", "7. She is worried that the pain is affecting her ability to play.", "8. She reports multiple minor lower extremity injuries due to soccer.", "9. She denies significant trauma such as known fractures or torn ligaments.", "10. Her past medical history is unremarkable.", "11. She had a myringotomy in her left ear as a child.", "12. On examination, there is pain and crepitus on extension of the right knee with anterior patellar compression."]}
{"id": 440, "question": "Which of the following immediate responses by the physician is most appropriate?", "context": ["A 25-year-old woman is brought to the emergency department by her husband for abdominal pain.", "The husband answers all questions posed to the patient by the physician.", "Throughout the interview, the patient makes very little eye contact with the physician.", "Her husband asks the physician to prescribe \u201csomething for her abdominal pain\u201d so that they can return home.", "Examination of the patient shows mild bruising in the left infraorbital area and a right periorbital hematoma.", "When asked about her injuries, she quietly states that she fell while walking down the stairwell of her apartment complex.", "The husband reluctantly leaves the examination room when asked to by the physician.", "While alone with the physician, the patient admits that her husband is responsible for her injuries."], "context_len": 8, "options": {"A": "\"\"\"May I add some information about local domestic violence agencies to your discharge records?\"\"\"", "B": "\"\"\"Do you feel safe leaving the emergency department?\"\"\"", "C": "\"\"\"How often has your husband physically hurt you in the past?\"\"\"", "D": "\u201cMay I ask your husband to join us so we can talk about this matter together?\u201d"}, "answer": "\"\"\"Do you feel safe leaving the emergency department?\"\"\"", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 25-year-old woman is brought to the emergency department by her husband.", "2. The husband answers all questions posed to the patient by the physician.", "3. The patient makes very little eye contact with the physician.", "4. Her husband asks the physician to prescribe \u201csomething for her abdominal pain\u201d.", "5. Examination of the patient shows mild bruising in the left infraorbital area.", "6. Examination of the patient shows a right periorbital hematoma.", "7. When asked about her injuries, she quietly states that she fell while walking down the stairwell of her apartment complex.", "8. The husband reluctantly leaves the examination room when asked to by the physician.", "9. While alone with the physician, the patient admits that her husband is responsible for her injuries."], "atomic_facts": ["1. The husband answers all questions posed to the patient by the physician.", "2. Throughout the interview, the patient makes very little eye contact with the physician.", "3. Her husband asks the physician to prescribe \u201csomething for her abdominal pain\u201d so that they can return home.", "4. Examination of the patient shows mild bruising in the left infraorbital area and a right periorbital hematoma.", "5. When asked about her injuries, she quietly states that she fell while walking down the stairwell of her apartment complex.", "6. The husband reluctantly leaves the examination room when asked to by the physician.", "7. While alone with the physician, the patient admits that her husband is responsible for her injuries."]}
{"id": 441, "question": "Further evaluation is most likely to show which of the following?", "context": ["A 15-year-old girl comes to the physician because of a 2-month history of progressive fatigue and weakness.", "She also reports recurrent headaches for 2 years, which have increased in severity and frequency.", "Her blood pressure is 185/95 mm Hg.", "Serum studies show a morning renin activity of 130 ng/mL per hour (N=1\u20134), a morning aldosterone concentration of 60 ng/dL (N=5-30), and a potassium concentration of 2.9 mEq/L."], "context_len": 4, "options": {"A": "ACTH-producing growth in the pituitary gland", "B": "Increased 17-hydroxyprogesterone levels", "C": "Pleomorphic modified smooth muscle cells in the renal cortex", "D": "Involution of zona glomerulosa of the adrenal gland"}, "answer": "Pleomorphic modified smooth muscle cells in the renal cortex", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "15", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 15-year-old girl comes to the physician.", "2. She has a 2-month history of progressive fatigue and weakness.", "3. She has had recurrent headaches for 2 years.", "4. The headaches have increased in severity and frequency.", "5. Her blood pressure is 185/95 mm Hg.", "6. Serum studies show a morning renin activity of 130 ng/mL per hour (N=1\u20134).", "7. Serum studies show a morning aldosterone concentration of 60 ng/dL (N=5-30).", "8. Serum studies show a potassium concentration of 2.9 mEq/L."], "atomic_facts": ["1. Recurrent headaches for 2 years", "2. Increased severity and frequency of headaches", "3. Blood pressure: 185/95 mm Hg", "4. Morning renin activity: 130 ng/mL per hour (N=1\u20134)", "5. Morning aldosterone concentration: 60 ng/dL (N=5-30)", "6. Potassium concentration: 2.9 mEq/L"]}
{"id": 442, "question": "Further evaluation of this patient is most likely to show which of the following findings?", "context": ["A 15-year-old boy is brought to the emergency department by his mother because of severe left testicular pain for 1 hour.", "For the past week, he has also had mild testicular pain and pain on urination.", "He has not had nausea or vomiting.", "He is otherwise healthy.", "His temperature is 39.1\u00b0C (102.3\u00b0F), pulse is 114/min, and blood pressure is 120/76 mm Hg.", "Examination shows a high-riding, swollen, erythematous tender left testis; lifting the left testis relieves his pain.", "His hemoglobin concentration is 15.6 g/dL, leukocyte count is 14,600/mm3, and platelet count is 290,000/mm3.", "Testicular ultrasound shows increased blood flow to the left testicle when compared to the right and an enlarged left epididymis with decreased echogenicity."], "context_len": 8, "options": {"A": "Reducible scrotal mass", "B": "Gram-negative rods in urethral swab", "C": "Positive nucleic acid amplification testing", "D": "Absent cremasteric reflex"}, "answer": "Positive nucleic acid amplification testing", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "15 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 15-year-old boy.", "2. Patient has had severe left testicular pain for 1 hour.", "3. Patient has had mild testicular pain and pain on urination for the past week.", "4. Patient has not had nausea or vomiting.", "5. Patient is otherwise healthy.", "6. Patient's temperature is 39.1\u00b0C (102.3\u00b0F).", "7. Patient's pulse is 114/min.", "8. Patient's blood pressure is 120/76 mm Hg.", "9. Examination shows a high-riding, swollen, erythematous tender left testis.", "10. Lifting the left testis relieves his pain.", "11. Patient's hemoglobin concentration is 15.6 g/dL.", "12. Patient's leukocyte count is 14,600/mm3.", "13. Patient's platelet count is 290,000/mm3.", "14. Testicular ultrasound shows increased blood flow to the left testicle when compared to the right.", "15. Testicular ultrasound shows an enlarged left epididymis with decreased echogenicity."], "atomic_facts": ["1. He has had mild testicular pain for the past week.", "2. He has had pain on urination for the past week.", "3. He has not had nausea.", "4. He has not had vomiting.", "5. He is otherwise healthy.", "6. His temperature is 39.1\u00b0C (102.3\u00b0F).", "7. His pulse is 114/min.", "8. His blood pressure is 120/76 mm Hg.", "9. Examination shows a high-riding, swollen, erythematous tender left testis.", "10. Lifting the left testis relieves his pain.", "11. His hemoglobin concentration is 15.6 g/dL.", "12. His leukocyte count is 14,600/mm3.", "13. His platelet count is 290,000/mm3.", "14. Testicular ultrasound shows increased blood flow to the left testicle when compared to the right.", "15. Testicular ultrasound shows an enlarged left epididymis with decreased echogenicity."]}
{"id": 443, "question": "Which of the following would be expected on a peripheral blood smear from this patient?", "context": ["A 27-year-old female presents to the emergency department with complaints of acute-onset fatigue, blurred vision, and rash earlier today.", "Her husband rushed her to emergency department when he noted that she was exhibiting changes in her mental status and had trouble speaking.", "Her vital signs are as follows: T 38.4, HR 87, BP 110/85, RR 14, and SpO2 96%.", "Physical examination reveals petechiae, pallor, and left upper extremity weakness.", "Work-up reveals Hgb 8.5 g/dL, platelets 22,000 cells/uL, normal PT/INR and PTT, absent fibrin split products, elevated fibrinogen, a negative Coombs test, 3.7 mg/dL creatinine, 3.8 mg/dL indirect bilirubin, and LDH 1000 IU/L."], "context_len": 5, "options": {"A": "Spherocytes", "B": "Atypical lymphocytes", "C": "Schistocytes", "D": "Rouleaux formation"}, "answer": "Schistocytes", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Hematology"], "subspecialties": ["General Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 27-year-old female.", "2. Patient presented to the emergency department with acute-onset fatigue, blurred vision, and rash earlier today.", "3. Patient's husband noted changes in her mental status and difficulty speaking.", "4. Patient's vital signs are T 38.4, HR 87, BP 110/85, RR 14, and SpO2 96%.", "5. Physical examination reveals petechiae, pallor, and left upper extremity weakness.", "6. Work-up reveals Hgb 8.5 g/dL, platelets 22,000 cells/uL, normal PT/INR and PTT.", "7. Work-up reveals absent fibrin split products, elevated fibrinogen, a negative Coombs test.", "8. Work-up reveals 3.7 mg/dL creatinine, 3.8 mg/dL indirect bilirubin, and LDH 1000 IU/L."], "atomic_facts": ["1. Patient was rushed to the emergency department due to changes in mental status and trouble speaking.", "2. Vital signs: T 38.4, HR 87, BP 110/85, RR 14, SpO2 96%.", "3. Physical examination revealed petechiae, pallor, and left upper extremity weakness.", "4. Hgb level is 8.5 g/dL.", "5. Platelet count is 22,000 cells/uL.", "6. PT/INR and PTT are normal.", "7. Fibrin split products are absent.", "8. Fibrinogen level is elevated.", "9. Coombs test is negative.", "10. Creatinine level is 3.7 mg/dL.", "11. Indirect bilirubin level is 3.8 mg/dL.", "12. LDH level is 1000 IU/L."]}
{"id": 444, "question": "What is the mechanism of action of methyldopa?", "context": ["A 67-year-old African American male presents to his primary care physician for routine follow-up.", "He has a history of poorly controlled hypertension, despite being on lisinopril, hydrochlorothiazide, amlodipine and metoprolol, which he takes regularly.", "His blood pressure during the visit is 170/80.", "He does not have kidney disease.", "His primary care physician decides to start him on methyldopa."], "context_len": 5, "options": {"A": "Direct vascular smooth muscle relaxation", "B": "Dopamine receptor agonist", "C": "Centrally acting alpha2 adrenergic receptor agonist", "D": "Inhibition of alpha1 adrenergic receptors"}, "answer": "Centrally acting alpha2 adrenergic receptor agonist", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "67", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 67-year-old African American male presents to his primary care physician for routine follow-up.", "2. He has a history of poorly controlled hypertension.", "3. He is taking lisinopril, hydrochlorothiazide, amlodipine and metoprolol regularly.", "4. His blood pressure during the visit is 170/80.", "5. He does not have kidney disease.", "6. His primary care physician decides to start him on methyldopa."], "atomic_facts": ["1. The patient has a history of poorly controlled hypertension.", "2. The patient is taking lisinopril, hydrochlorothiazide, amlodipine, and metoprolol regularly.", "3. The patient's blood pressure during the visit is 170/80.", "4. The patient does not have kidney disease.", "5. The primary care physician decides to start the patient on methyldopa."]}
{"id": 445, "question": "Which of the following would most likely have prevented this complication?", "context": ["A 2800-g (6-lb 3-oz), 3-day-old newborn is in the intensive care unit for fever, vomiting, tremors, cyanotic episodes, and seizures.", "She was born at 36 weeks to a 25-year-old primigravid woman.", "Spontaneous vaginal delivery was complicated by maternal fever and chorioamnionitis.", "Apgar scores were 6 at 1 minute and 7 at 5 minutes, respectively.", "Shortly after delivery, the child had seizures and high-grade fever with poor feeding and hypotonia.", "She was intubated for respiratory distress.", "Her temperature is 39\u00b0C (102.3\u00b0F), pulse is 180/min, and respirations are 60/min.", "Physical exam shows grunting breath sounds, an enlarged liver palpable 3 cm below the right costal margin, and lethargy.", "A CT scan of the chest, abdomen, and pelvis shows multiple pulmonary and hepatic granulomas."], "context_len": 9, "options": {"A": "Avoiding unpasteurized milk products", "B": "Measles, mumps, rubella vaccination before pregnancy", "C": "Prophylactic penicillin", "D": "Delivery via cesarean section"}, "answer": "Avoiding unpasteurized milk products", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "3-day-old newborn", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2800-g (6-lb 3-oz) newborn is in the intensive care unit.", "2. The newborn is 3 days old.", "3. The newborn has fever, vomiting, tremors, cyanotic episodes, and seizures.", "4. The mother is 25 years old and this is her first pregnancy.", "5. Delivery was spontaneous vaginal delivery.", "6. Delivery was complicated by maternal fever and chorioamnionitis.", "7. Apgar scores were 6 at 1 minute and 7 at 5 minutes, respectively.", "8. Shortly after delivery, the child had seizures and high-grade fever with poor feeding and hypotonia.", "9. The child was intubated for respiratory distress.", "10. The child's temperature is 39\u00b0C (102.3\u00b0F).", "11. The child's pulse is 180/min.", "12. The child's respirations are 60/min.", "13. Physical exam shows grunting breath sounds.", "14. Physical exam shows an enlarged liver palpable 3 cm below the right costal margin.", "15. Physical exam shows lethargy.", "16. A CT scan of the chest, abdomen, and pelvis shows multiple pulmonary and hepatic granulomas."], "atomic_facts": ["1. The baby was born at 36 weeks gestation.", "2. The mother was 25 years old at the time of birth.", "3. It was the mother's first pregnancy.", "4. The delivery was through spontaneous vaginal delivery.", "5. The mother had a fever during delivery.", "6. The mother had chorioamnionitis during delivery.", "7. The baby's Apgar score at 1 minute was 6.", "8. The baby's Apgar score at 5 minutes was 7.", "9. The baby experienced seizures shortly after birth.", "10. The baby had a high-grade fever shortly after birth.", "11. The baby had poor feeding shortly after birth.", "12. The baby had hypotonia shortly after birth.", "13. The baby was intubated due to respiratory distress.", "14. The baby's temperature was 39\u00b0C (102.3\u00b0F).", "15. The baby's pulse was 180/min.", "16. The baby's respirations were 60/min.", "17. The baby had grunting breath sounds during the physical exam.", "18. The baby had an enlarged liver palpable 3 cm below the right costal margin.", "19. The baby was lethargic during the physical exam.", "20. A CT scan showed multiple pulmonary and hepatic granulomas."]}
{"id": 446, "question": "With a surgical pathology report that describes vascular invasion, which of the following additional features would you expect to find for this thyroid nodule?", "context": ["A 45-year-old woman presents to her primary care practitioner requesting a routine checkup for a job application.", "Her family history is negative for malignancies and inheritable diseases.", "She has been married for 15 years and has 2 healthy children.", "Her past medical history is negative for surgical procedures and cardiovascular disease; however, she used to work as a radiology technician.", "Her only complaints at the moment are neck pain and hoarseness.", "Physical examination is unremarkable except for a painless nodule in the right lobe of the thyroid gland with no inflammatory signs.", "In a follow-up appointment, the patient brings the results of her thyroid function tests, which are normal.", "She also brings the results of a fine-needle aspiration biopsy that report the pathology of the nodule as follicular neoplasia.", "After some discussion, the patient opts for surgical treatment."], "context_len": 9, "options": {"A": "Capsular invasion", "B": "Cystic nature", "C": "Psammoma bodies", "D": "Pleomorphic cells without follicle development"}, "answer": "Capsular invasion", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Pathology"], "subspecialties": ["General Pathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 45-year-old woman presents to her primary care practitioner requesting a routine checkup for a job application.", "2. Her family history is negative for malignancies and inheritable diseases.", "3. She has been married for 15 years and has 2 healthy children.", "4. Her past medical history is negative for surgical procedures and cardiovascular disease.", "5. She used to work as a radiology technician.", "6. Her only complaints at the moment are neck pain and hoarseness.", "7. Physical examination is unremarkable except for a painless nodule in the right lobe of the thyroid gland with no inflammatory signs.", "8. In a follow-up appointment, the patient brings the results of her thyroid function tests, which are normal.", "9. She also brings the results of a fine-needle aspiration biopsy that report the pathology of the nodule as follicular neoplasia.", "10. After some discussion, the patient opts for surgical treatment."], "atomic_facts": ["1. Her family history is negative for malignancies and inheritable diseases.", "2. She has been married for 15 years and has 2 healthy children.", "3. Her past medical history is negative for surgical procedures and cardiovascular disease.", "4. She used to work as a radiology technician.", "5. Her only complaints at the moment are neck pain and hoarseness.", "6. Physical examination is unremarkable except for a painless nodule in the right lobe of the thyroid gland with no inflammatory signs.", "7. In a follow-up appointment, the patient brings the results of her thyroid function tests, which are normal.", "8. She also brings the results of a fine-needle aspiration biopsy that report the pathology of the nodule as follicular neoplasia.", "9. After some discussion, the patient opts for surgical treatment."]}
{"id": 447, "question": "Which of the following is the most likely cause of the patient's symptoms?", "context": ["A 65-year-old man comes to the physician because of progressive shortness of breath and a worsening cough for the past month.", "He also reports occasional bloody sputum.", "He has lost about 7 kg (15.4 lb) of weight over the past 4 months despite having no change in appetite.", "He has smoked 2 packs of cigarettes daily for 15 years but stopped smoking at the age of 55.", "Physical examination shows reduced breath sounds throughout both lungs.", "An x-ray of the chest is shown."], "context_len": 6, "options": {"A": "Squamous cell lung carcinoma", "B": "Small cell lung cancer", "C": "Lung adenocarcinoma", "D": "Pulmonary metastases"}, "answer": "Pulmonary metastases", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease", "General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old man comes to the physician.", "2. He has progressive shortness of breath and a worsening cough for the past month.", "3. He reports occasional bloody sputum.", "4. He has lost 7 kg (15.4 lb) of weight over the past 4 months.", "5. He has no change in appetite.", "6. He smoked 2 packs of cigarettes daily for 15 years.", "7. He stopped smoking at the age of 55.", "8. Physical examination shows reduced breath sounds throughout both lungs.", "9. An x-ray of the chest is shown."], "atomic_facts": ["1. He reports occasional bloody sputum.", "2. He has lost about 7 kg (15.4 lb) of weight over the past 4 months.", "3. He has had no change in appetite.", "4. He has smoked 2 packs of cigarettes daily for 15 years.", "5. He stopped smoking at the age of 55.", "6. Physical examination shows reduced breath sounds throughout both lungs.", "7. An x-ray of the chest is shown."]}
{"id": 448, "question": "Which of the following is the gold standard test for diagnosing this patient\u2019s condition?", "context": ["A 67-year-old man comes to the physician due to exertional dyspnea and lower extremity swelling for the last 4 weeks.", "The patient has been a smoker for the last 45 years and has been diagnosed with COPD.", "He has no history of diabetes mellitus or ischemic heart disease.", "He is non-compliant with his medications for COPD.", "The patient is a retired social worker and spends most of his time at home.", "His temperature is 37.2\u00b0C (98.9\u00b0F), blood pressure is 135/115 mm Hg, pulse is 90/min, and respirations are 22/min.", "Oxygen saturation on room air is 92%.", "Physical examination reveals a barrel-shaped chest, distension of neck veins, and 3+ bilateral pitting edema of his lower extremities.", "The liver is palpated 6 cm below the costal margin and is tender to palpation.", "Application of pressure on the upper abdomen causes persistent distension of jugular veins.", "Lungs are clear to auscultation.", "Chest X-ray shows enlarged main pulmonary arteries.", "ECG shows right bundle branch block and right ventricular hypertrophy."], "context_len": 13, "options": {"A": "Right heart catheterization", "B": "Coronary angiography", "C": "Abdominal paracentesis", "D": "Ultrasound of liver"}, "answer": "Right heart catheterization", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "67 years old", "specialties": ["Internal Medicine", "Cardiology"], "subspecialties": ["Cardiovascular Disease", "Echocardiography", "General Cardiology"], "specialty_prob": [0.5, 0.5], "subspecialty_prob": [0.5, 0.25, 0.25], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 67-year-old man comes to the physician due to exertional dyspnea and lower extremity swelling for the last 4 weeks.", "2. The patient has been a smoker for the last 45 years and has been diagnosed with COPD.", "3. He has no history of diabetes mellitus or ischemic heart disease.", "4. He is non-compliant with his medications for COPD.", "5. The patient is a retired social worker and spends most of his time at home.", "6. His temperature is 37.2\u00b0C (98.9\u00b0F).", "7. Blood pressure is 135/115 mm Hg.", "8. Pulse is 90/min.", "9. Respirations are 22/min.", "10. Oxygen saturation on room air is 92%.", "11. Physical examination reveals a barrel-shaped chest.", "12. Distension of neck veins is present.", "13. 3+ bilateral pitting edema of his lower extremities is present.", "14. The liver is palpated 6 cm below the costal margin and is tender to palpation.", "15. Application of pressure on the upper abdomen causes persistent distension of jugular veins.", "16. Lungs are clear to auscultation.", "17. Chest X-ray shows enlarged main pulmonary arteries.", "18. ECG shows right bundle branch block and right ventricular hypertrophy."], "atomic_facts": ["1. The patient has been a smoker for the last 45 years.", "2. The patient has been diagnosed with COPD.", "3. The patient has no history of diabetes mellitus.", "4. The patient has no history of ischemic heart disease.", "5. The patient is non-compliant with his medications for COPD.", "6. The patient is a retired social worker.", "7. The patient spends most of his time at home.", "8. The patient's temperature is 37.2\u00b0C (98.9\u00b0F).", "9. The patient's blood pressure is 135/115 mm Hg.", "10. The patient's pulse is 90/min.", "11. The patient's respirations are 22/min.", "12. The patient's oxygen saturation on room air is 92%.", "13. Physical examination reveals a barrel-shaped chest.", "14. Physical examination reveals distension of neck veins.", "15. Physical examination reveals 3+ bilateral pitting edema of the lower extremities.", "16. The liver is palpated 6 cm below the costal margin.", "17. The liver is tender to palpation.", "18. Application of pressure on the upper abdomen causes persistent distension of jugular veins.", "19. Lungs are clear to auscultation.", "20. Chest X-ray shows enlarged main pulmonary arteries.", "21. ECG shows right bundle branch block.", "22. ECG shows right ventricular hypertrophy."]}
{"id": 449, "question": "Which of the following is the most likely underlying cause of this patient's shoulder pain?", "context": ["A 13-year-old African-American girl is brought to the physician for right shoulder pain that has worsened over the past month.", "She has had many episodes of joint and bone pain and recurrent painful swelling in her hands and feet.", "Physical examination shows tenderness of the right anterior humerus without swelling or skin changes.", "Active and passive range of motion of the right shoulder is decreased and there is pain with movement.", "The leukocyte count is 4600/mm3.", "An x-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing."], "context_len": 6, "options": {"A": "Infection of the joint space", "B": "Crystal deposition within the joint", "C": "Infarction of the bone trabeculae", "D": "Infection of the bone"}, "answer": "Infarction of the bone trabeculae", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "13 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is a 13-year-old African-American girl.", "2. Patient has right shoulder pain that has worsened over the past month.", "3. Patient has had many episodes of joint and bone pain.", "4. Patient has had recurrent painful swelling in her hands and feet.", "5. Physical examination shows tenderness of the right anterior humerus without swelling or skin changes.", "6. Active and passive range of motion of the right shoulder is decreased and there is pain with movement.", "7. Leukocyte count is 4600/mm3.", "8. X-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing."], "atomic_facts": ["1. She has had many episodes of joint and bone pain.", "2. She has had recurrent painful swelling in her hands and feet.", "3. Physical examination shows tenderness of the right anterior humerus.", "4. There is no swelling or skin changes in the right anterior humerus.", "5. Active range of motion of the right shoulder is decreased.", "6. Passive range of motion of the right shoulder is decreased.", "7. There is pain with movement of the right shoulder.", "8. The leukocyte count is 4600/mm3.", "9. An x-ray of the right shoulder shows subchondral lucency of the humeral head.", "10. An x-ray of the right shoulder shows sclerosis of the humeral head.", "11. An x-ray of the right shoulder shows joint space narrowing."]}
{"id": 450, "question": "This drug is often used to treat which one of these other infections?", "context": ["A 4-month-old male presents to the emergency department with severe cough, wheezing, and cyanosis.", "You suspect bronchiolitis of viral etiology and you administer an anti-viral medication."], "context_len": 2, "options": {"A": "Hepatitis B", "B": "Hepatitis C", "C": "Rhinovirus", "D": "HSV"}, "answer": "Hepatitis C", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "4 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-month-old male presents to the emergency department.", "2. The patient has severe cough.", "3. The patient has wheezing.", "4. The patient has cyanosis.", "5. The diagnosis is suspected to be bronchiolitis of viral etiology.", "6. An anti-viral medication is administered."], "atomic_facts": ["1. Bronchiolitis is suspected.", "2. The suspected bronchiolitis is of viral etiology.", "3. An anti-viral medication is administered."]}
{"id": 451, "question": "Which of the following is the most likely diagnosis?", "context": ["A 43-year-old woman presents to the clinic complaining of \u201cspotting.\u201d She states that over the past 5 months she has had intermenstrual bleeding.", "Additionally, her menses last more than a week with the first 4 days consisting of heavy bleeding.", "She denies abdominal pain but reports feeling an increasing \u201cpressure-like\" discomfort.", "She denies dysuria, dyspareunia, or dyschezia.", "Prior to 5 months ago, her menstrual periods were only 4 days long and consisted of moderate bleeding.", "Her periods normally occur every 28 days.", "She is frustrated because she feels like she needs to wear a pad all the time.", "The patient delivered 3 healthy children vaginally without complications, followed by a tubal ligation.", "Her last menstrual period was 1 week ago.", "She is sexually active with her husband and denies a history of sexually transmitted diseases.", "She has never had an abnormal pap smear.", "Her last pap smear and test for human papillomavirus was 4 years ago.", "The patient has hypothyroidism treated with levothyroxine.", "On physical examination, the thyroid is normal in size without masses or tenderness.", "Pelvic examination reveals a firm, mobile, enlarged, irregularly-shaped uterus without adnexal tenderness.", "Speculum exam is unremarkable."], "context_len": 16, "options": {"A": "Adenomyosis", "B": "Cervical cancer", "C": "Endometriosis", "D": "Leiomyoma"}, "answer": "Leiomyoma", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "43 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is 43 years old.", "2. Patient presents to clinic complaining of \u201cspotting.\u201d", "3. Patient has had intermenstrual bleeding for the past 5 months.", "4. Patient's menses last more than a week with the first 4 days consisting of heavy bleeding.", "5. Patient denies abdominal pain but reports feeling an increasing \u201cpressure-like\" discomfort.", "6. Patient denies dysuria, dyspareunia, or dyschezia.", "7. Prior to 5 months ago, patient's menstrual periods were only 4 days long and consisted of moderate bleeding.", "8. Patient's periods normally occur every 28 days.", "9. Patient feels like she needs to wear a pad all the time.", "10. Patient delivered 3 healthy children vaginally without complications, followed by a tubal ligation.", "11. Patient's last menstrual period was 1 week ago.", "12. Patient is sexually active with her husband.", "13. Patient denies a history of sexually transmitted diseases.", "14. Patient has never had an abnormal pap smear.", "15. Patient's last pap smear and test for human papillomavirus was 4 years ago.", "16. Patient has hypothyroidism treated with levothyroxine.", "17. On physical examination, thyroid is normal in size without masses or tenderness.", "18. Pelvic examination reveals a firm, mobile, enlarged, irregularly-shaped uterus without adnexal tenderness.", "19. Speculum exam is unremarkable."], "atomic_facts": ["1. Her menses last more than a week with the first 4 days consisting of heavy bleeding.", "2. She denies abdominal pain but reports feeling an increasing \u201cpressure-like\" discomfort.", "3. She denies dysuria, dyspareunia, or dyschezia.", "4. Prior to 5 months ago, her menstrual periods were only 4 days long and consisted of moderate bleeding.", "5. Her periods normally occur every 28 days.", "6. She is frustrated because she feels like she needs to wear a pad all the time.", "7. The patient delivered 3 healthy children vaginally without complications, followed by a tubal ligation.", "8. Her last menstrual period was 1 week ago.", "9. She is sexually active with her husband and denies a history of sexually transmitted diseases.", "10. She has never had an abnormal pap smear.", "11. Her last pap smear and test for human papillomavirus was 4 years ago.", "12. The patient has hypothyroidism treated with levothyroxine.", "13. On physical examination, the thyroid is normal in size without masses or tenderness.", "14. Pelvic examination reveals a firm, mobile, enlarged, irregularly-shaped uterus without adnexal tenderness.", "15. Speculum exam is unremarkable."]}
{"id": 452, "question": "Which of the following additional laboratory findings is most likely in this case?", "context": ["A 19-year-old woman comes to the physician because of a 1-week history of fatigue and yellow discoloration of her eyes.", "Four weeks ago, she had a sore throat and was diagnosed with a viral infection that self-resolved.", "She has no history of serious medical illness.", "Her only medication is an oral contraceptive.", "She appears tired.", "Her pulse is 94/min, and blood pressure is 125/75 mm Hg.", "Physical examination shows scleral icterus.", "The liver edge is palpable 2 cm below the right costal margin and the spleen tip is palpable 4 cm below the left costal margin.", "Skin examination shows no rashes.", "Her hemoglobin concentration is 9.5 g/dL, and the direct antiglobulin test is positive."], "context_len": 10, "options": {"A": "Increased serum C3 complement concentration", "B": "Increased direct bilirubin level", "C": "Decreased haptoglobin level", "D": "Decreased mean corpuscular volume"}, "answer": "Decreased haptoglobin level", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "19 years old", "specialties": ["Internal Medicine", "Gastroenterology"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 19-year-old woman comes to the physician.", "2. She has a 1-week history of fatigue.", "3. She has yellow discoloration of her eyes.", "4. Four weeks ago, she had a sore throat.", "5. She was diagnosed with a viral infection that self-resolved.", "6. She has no history of serious medical illness.", "7. Her only medication is an oral contraceptive.", "8. She appears tired.", "9. Her pulse is 94/min.", "10. Her blood pressure is 125/75 mm Hg.", "11. Physical examination shows scleral icterus.", "12. The liver edge is palpable 2 cm below the right costal margin.", "13. The spleen tip is palpable 4 cm below the left costal margin.", "14. Skin examination shows no rashes.", "15. Her hemoglobin concentration is 9.5 g/dL.", "16. The direct antiglobulin test is positive."], "atomic_facts": ["1. Four weeks ago, she had a sore throat and was diagnosed with a viral infection that self-resolved.", "2. She has no history of serious medical illness.", "3. Her only medication is an oral contraceptive.", "4. She appears tired.", "5. Her pulse is 94/min, and blood pressure is 125/75 mm Hg.", "6. Physical examination shows scleral icterus.", "7. The liver edge is palpable 2 cm below the right costal margin and the spleen tip is palpable 4 cm below the left costal margin.", "8. Skin examination shows no rashes.", "9. Her hemoglobin concentration is 9.5 g/dL, and the direct antiglobulin test is positive."]}
{"id": 453, "question": "This patient is most likely to experience which of the following adverse reactions to her current pharmacological treatment:", "context": ["A 67-year-old female is admitted to the hospital with enterococcus endocarditis and is treated with penicillin and gentamicin.", "During her admission, she develops worsening pulmonary edema secondary to valvular insufficiency and requires therapy with IV furosemide."], "context_len": 2, "options": {"A": "Ringing in the ears and impaired hearing", "B": "Hyperkalemia leading to possible cardiac arrhythmia", "C": "Diffuse flushing and redness over body surface", "D": "Pseudomembranous colitis and diarrhea"}, "answer": "Ringing in the ears and impaired hearing", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "67 years old", "specialties": ["Internal Medicine", "Infectious Disease"], "subspecialties": ["Infectious Disease", "General Infectious Disease"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 67-year-old female is admitted to the hospital.", "2. She has enterococcus endocarditis.", "3. She is treated with penicillin and gentamicin.", "4. During her admission, she develops worsening pulmonary edema.", "5. The pulmonary edema is secondary to valvular insufficiency.", "6. She requires therapy with IV furosemide."], "atomic_facts": ["1. During her admission, the patient develops worsening pulmonary edema.", "2. The pulmonary edema is secondary to valvular insufficiency.", "3. The patient requires therapy with IV furosemide."]}
{"id": 454, "question": "Where is the lesion responsible for his symptoms most likely located?", "context": ["A 75-year-old male is brought to the emergency room by his daughter due to slurred speech and a drooping eyelid on the right side.", "This morning, he had difficulty eating his breakfast and immediately called his daughter for help.", "She says that his voice also seems different.", "His temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 120/78 mmHg, pulse is 90/min, respirations are 21/min, and pulse oximetry is 98% on room air.", "On physical exam, he is oriented to time and place.", "There is right-sided nystagmus and he has difficulty with point-to-point movement."], "context_len": 6, "options": {"A": "Posterior inferior cerebellar artery", "B": "Anterior cerebral artery", "C": "Anterior inferior cerebellar artery", "D": "Basilar artery"}, "answer": "Posterior inferior cerebellar artery", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "75 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 75-year-old male is brought to the emergency room by his daughter.", "2. He has slurred speech and a drooping eyelid on the right side.", "3. This morning, he had difficulty eating his breakfast.", "4. He called his daughter for help.", "5. His daughter says his voice also seems different.", "6. His temperature is 99\u00b0F (37.2\u00b0C).", "7. His blood pressure is 120/78 mmHg.", "8. His pulse is 90/min.", "9. His respirations are 21/min.", "10. His pulse oximetry is 98% on room air.", "11. On physical exam, he is oriented to time and place.", "12. There is right-sided nystagmus.", "13. He has difficulty with point-to-point movement."], "atomic_facts": ["1. He had difficulty eating his breakfast this morning.", "2. He immediately called his daughter for help.", "3. His daughter says that his voice seems different.", "4. His temperature is 99\u00b0F (37.2\u00b0C).", "5. His blood pressure is 120/78 mmHg.", "6. His pulse is 90/min.", "7. His respirations are 21/min.", "8. His pulse oximetry is 98% on room air.", "9. On physical exam, he is oriented to time and place.", "10. There is right-sided nystagmus.", "11. He has difficulty with point-to-point movement."]}
{"id": 455, "question": "What was the molecule that you introduced into the culture?", "context": ["You are conducting an experiment on a cell line in your laboratory.", "You introduce a molecule into the tissue culture dish containing the cell line that binds to a transmembrane protein.", "As a result, the affected cell initiates a process characterized by karyorrhexis, membrane blebbing, and pyknosis."], "context_len": 3, "options": {"A": "Perforin", "B": "Granzyme B", "C": "FAS-ligand", "D": "BCL-2"}, "answer": "FAS-ligand", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Medical Microbiology Pathology", "Molecular Genetic Pathology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pathology"}, "facts_old": ["1. You are conducting an experiment on a cell line in your laboratory.", "2. You introduce a molecule into the tissue culture dish containing the cell line.", "3. The molecule binds to a transmembrane protein.", "4. As a result, the affected cell initiates a process.", "5. The process is characterized by karyorrhexis.", "6. The process is characterized by membrane blebbing.", "7. The process is characterized by pyknosis."], "atomic_facts": ["1. A molecule was introduced into a tissue culture dish.", "2. The tissue culture dish contains a cell line.", "3. The molecule binds to a transmembrane protein.", "4. The affected cell initiates a process.", "5. The process is characterized by karyorrhexis.", "6. The process is characterized by membrane blebbing.", "7. The process is characterized by pyknosis."]}
{"id": 456, "question": "This patient is at greatest risk for which of the following complications?", "context": ["A 45-year-old woman comes to the physician because of a 6-month history of progressive irritability, palpitations, heat intolerance, frequent bowel movements, and a 6.8-kg (15-lb) weight loss.", "She also has a smooth, uniformly enlarged mass at the front of her neck and protuberant eyes with lid retraction.", "Laboratory investigations show undetectable levels of thyroid stimulating hormone, elevated levels of free T3 and T4, and a raised titer of TSH receptor autoantibodies (TRAbs).", "Therapy is initiated with radioactive iodine-131."], "context_len": 4, "options": {"A": "Worsening exophthalomos", "B": "Agranulocytosis", "C": "Vocal cord paralysis", "D": "Thyroid carcinoma\n\""}, "answer": "Worsening exophthalomos", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 45-year-old woman comes to the physician.", "2. She has a 6-month history of progressive irritability, palpitations, heat intolerance, frequent bowel movements, and a 6.8-kg (15-lb) weight loss.", "3. She has a smooth, uniformly enlarged mass at the front of her neck and protuberant eyes with lid retraction.", "4. Laboratory investigations show undetectable levels of thyroid stimulating hormone.", "5. Laboratory investigations show elevated levels of free T3 and T4.", "6. Laboratory investigations show a raised titer of TSH receptor autoantibodies (TRAbs).", "7. Therapy is initiated with radioactive iodine-131."], "atomic_facts": ["1. The patient has a smooth, uniformly enlarged mass at the front of her neck.", "2. The patient has protuberant eyes with lid retraction.", "3. Laboratory investigations show undetectable levels of thyroid stimulating hormone.", "4. Laboratory investigations show elevated levels of free T3.", "5. Laboratory investigations show elevated levels of free T4.", "6. Laboratory investigations show a raised titer of TSH receptor autoantibodies (TRAbs).", "7. Therapy is initiated with radioactive iodine-131."]}
{"id": 457, "question": "Which of the following is the most likely underlying condition?", "context": ["A 56-year-old woman comes to the emergency department because of severe abdominal pain associated with nausea and vomiting for 12 hours.", "The pain extends from the epigastrium to the right upper quadrant and radiates to the right scapula.", "The patient has gastroesophageal reflux disease.", "She underwent total thyroidectomy for papillary thyroid carcinoma 3 years ago.", "She has smoked one pack of cigarettes daily for 35 years.", "Current medications include levothyroxine, omeprazole, and a multivitamin.", "The patient appears uncomfortable.", "Her temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 93/min, and blood pressure is 140/85 mm Hg.", "Abdominal examination shows tenderness to deep palpation in the right upper quadrant.", "The patient's leukocyte count is 10,300/mm3.", "Abdominal ultrasonography shows thickening of the gallbladder wall, without dilatation of the intra- and extrahepatic bile ducts.", "Laparoscopic cholecystectomy is performed.", "Pathological examination shows acute cholecystitis.", "There is an ulcerated 1 x 1.5-cm mass in the fundus of the gallbladder with invasion of the gallbladder wall and lymphatic vessels."], "context_len": 14, "options": {"A": "Adenocarcinoma of the sigmoid colon", "B": "Cutaneous malignant melanoma", "C": "Multiple endocrine neoplasia", "D": "Squamous cell carcinoma of the esophagus\n\""}, "answer": "Cutaneous malignant melanoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "56 years old", "specialties": ["General Surgery", "Gastroenterology", "Surgery"], "subspecialties": ["General Surgery", "General Gastroenterology"], "specialty_prob": [0.5, 0.25, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 56-year-old woman comes to the emergency department because of severe abdominal pain associated with nausea and vomiting for 12 hours.", "2. The pain extends from the epigastrium to the right upper quadrant and radiates to the right scapula.", "3. The patient has gastroesophageal reflux disease.", "4. She underwent total thyroidectomy for papillary thyroid carcinoma 3 years ago.", "5. She has smoked one pack of cigarettes daily for 35 years.", "6. Current medications include levothyroxine, omeprazole, and a multivitamin.", "7. The patient appears uncomfortable.", "8. Her temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 93/min, and blood pressure is 140/85 mm Hg.", "9. Abdominal examination shows tenderness to deep palpation in the right upper quadrant.", "10. The patient's leukocyte count is 10,300/mm3.", "11. Abdominal ultrasonography shows thickening of the gallbladder wall, without dilatation of the intra- and extrahepatic bile ducts.", "12. Laparoscopic cholecystectomy is performed.", "13. Pathological examination shows acute cholecystitis.", "14. There is an ulcerated 1 x 1.5-cm mass in the fundus of the gallbladder with invasion of the gallbladder wall and lymphatic vessels."], "atomic_facts": ["1. The pain extends from the epigastrium to the right upper quadrant and radiates to the right scapula.", "2. The patient has gastroesophageal reflux disease.", "3. She underwent total thyroidectomy for papillary thyroid carcinoma 3 years ago.", "4. She has smoked one pack of cigarettes daily for 35 years.", "5. Current medications include levothyroxine, omeprazole, and a multivitamin.", "6. The patient appears uncomfortable.", "7. Her temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 93/min, and blood pressure is 140/85 mm Hg.", "8. Abdominal examination shows tenderness to deep palpation in the right upper quadrant.", "9. The patient's leukocyte count is 10,300/mm3.", "10. Abdominal ultrasonography shows thickening of the gallbladder wall, without dilatation of the intra- and extrahepatic bile ducts.", "11. Laparoscopic cholecystectomy is performed.", "12. Pathological examination shows acute cholecystitis.", "13. There is an ulcerated 1 x 1.5-cm mass in the fundus of the gallbladder with invasion of the gallbladder wall and lymphatic vessels."]}
{"id": 458, "question": "What are the most likely histologic findings in this biopsy specimen?", "context": ["You are on your first day of a pathology rotation and the attending pathologist gives you a biopsy specimen to examine.", "She says it is from the antrum of the stomach of a 32-year-old man who has been complaining of abdominal pain for the past 6 months.", "The patient states the pain gets worse when eating.", "On endoscopy, there was a single ulcerated lesion with a 'punched out' appearance."], "context_len": 4, "options": {"A": "Signet ring cells", "B": "An abundance of self reactive T cells", "C": "A urease-positive organism", "D": "Absence or evidence of destruction of parietal cells"}, "answer": "A urease-positive organism", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["General Pathology", "Gastrointestinal Pathology"], "specialty_prob": [1.0], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Pathology"}, "facts_old": ["1. You are on your first day of a pathology rotation.", "2. The attending pathologist gives you a biopsy specimen to examine.", "3. The biopsy specimen is from the antrum of the stomach.", "4. The patient is a 32-year-old man.", "5. The patient has been complaining of abdominal pain for the past 6 months.", "6. The patient states the pain gets worse when eating.", "7. On endoscopy, there was a single ulcerated lesion.", "8. The lesion had a 'punched out' appearance."], "atomic_facts": ["1. The sample is from the antrum of the stomach.", "2. The patient is a 32-year-old man.", "3. The patient has been complaining of abdominal pain for the past 6 months.", "4. The pain worsens when eating.", "5. Endoscopy revealed a single ulcerated lesion with a 'punched out' appearance."]}
{"id": 459, "question": "Which type of hallucination is this patient likely to experience?", "context": ["A 40-year-old man is brought into the emergency department by his wife complaining of intense lower right abdominal pain.", "An abdominal CT scan was performed which noted a dilated appendix with a thickened wall and the accumulation of extraluminal fluid.", "A quick history is taken while the OR is prepped for surgery.", "Past medical history is noncontributory and the patient takes no medications.", "Social history reveals a sedentary lifestyle.", "The patient admits to regularly drinking several beers and several shots of vodka every night.", "He had to stop drinking 2 days ago due to the intense abdominal pain.", "The patient is brought into the OR and the inflamed and necrotic appendix is removed.", "He is admitted to the hospital for overnight monitoring.", "Later that night, the patient begins to hallucinate."], "context_len": 10, "options": {"A": "Proprioceptive hallucinations", "B": "Olfactory hallucination", "C": "Gustatory hallucination", "D": "Tactile hallucination"}, "answer": "Tactile hallucination", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "40 years old", "specialties": ["General Surgery", "Emergency Medicine"], "subspecialties": ["General Surgery", "General Emergency Medicine"], "specialty_prob": [0.5, 0.5], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 40-year-old man is brought into the emergency department by his wife.", "2. The patient is complaining of intense lower right abdominal pain.", "3. An abdominal CT scan was performed.", "4. The CT scan noted a dilated appendix with a thickened wall and the accumulation of extraluminal fluid.", "5. A quick history is taken while the OR is prepped for surgery.", "6. Past medical history is noncontributory.", "7. The patient takes no medications.", "8. Social history reveals a sedentary lifestyle.", "9. The patient admits to regularly drinking several beers and several shots of vodka every night.", "10. The patient had to stop drinking 2 days ago due to the intense abdominal pain.", "11. The patient is brought into the OR.", "12. The inflamed and necrotic appendix is removed.", "13. The patient is admitted to the hospital for overnight monitoring.", "14. Later that night, the patient begins to hallucinate."], "atomic_facts": ["1. An abdominal CT scan was performed", "2. The CT scan noted a dilated appendix with a thickened wall", "3. The CT scan noted the accumulation of extraluminal fluid", "4. A quick history is taken while the OR is prepped for surgery", "5. Past medical history is noncontributory", "6. The patient takes no medications", "7. Social history reveals a sedentary lifestyle", "8. The patient admits to regularly drinking several beers and several shots of vodka every night", "9. The patient had to stop drinking 2 days ago due to intense abdominal pain", "10. The patient is brought into the OR", "11. The inflamed and necrotic appendix is removed", "12. The patient is admitted to the hospital for overnight monitoring", "13. Later that night, the patient begins to hallucinate"]}
{"id": 460, "question": "Which of the following mutated gene products is most likely causing this patient\u2019s symptoms?", "context": ["A 34-year-old woman presents with sudden onset flank pain for the past day.", "She describes the pain as intermittent and radiating to her groin.", "She denies any similar symptoms in the past.", "No significant past medical history.", "The patient currently does not take any medications.", "Family history is significant for her mother who died of a pancreatic tumor at the age of 53.", "Laboratory analysis reveals: | Serum calcium 12 mg/dL | Serum phosphorus 2.2 mg/dL | Serum parathyroid hormone 105 pg/mL | ."], "context_len": 7, "options": {"A": "Receptor tyrosine kinase", "B": "Cytokine receptor", "C": "Threonine kinase", "D": "Menin"}, "answer": "Menin", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 34-year-old woman presents with sudden onset flank pain for the past day.", "2. She describes the pain as intermittent and radiating to her groin.", "3. She denies any similar symptoms in the past.", "4. No significant past medical history.", "5. The patient currently does not take any medications.", "6. Family history is significant for her mother who died of a pancreatic tumor at the age of 53.", "7. Laboratory analysis reveals serum calcium 12 mg/dL.", "8. Laboratory analysis reveals serum phosphorus 2.2 mg/dL.", "9. Laboratory analysis reveals serum parathyroid hormone 105 pg/mL."], "atomic_facts": ["1. The patient describes the pain as intermittent.", "2. The pain is radiating to her groin.", "3. The patient denies any similar symptoms in the past.", "4. There is no significant past medical history.", "5. The patient currently does not take any medications.", "6. Family history is significant for her mother who died of a pancreatic tumor at the age of 53.", "7. Laboratory analysis reveals: Serum calcium 12 mg/dL.", "8. Laboratory analysis reveals: Serum phosphorus 2.2 mg/dL.", "9. Laboratory analysis reveals: Serum parathyroid hormone 105 pg/mL."]}
{"id": 461, "question": "Which of the following is the highest priority characteristic of this new test?", "context": ["As a public health practitioner, you are charged with choosing which blood test to use for the screening of a new infectious disease.", "You want to ensure that as many cases of this disease as possible are picked up by this initial screening test."], "context_len": 2, "options": {"A": "Highly sensitive test", "B": "Low false positive rate", "C": "High true positive rate", "D": "Low negative predictive value"}, "answer": "Highly sensitive test", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Clinical Informatics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. As a public health practitioner, you are charged with choosing which blood test to use.", "2. The blood test is for the screening of a new infectious disease.", "3. You want to ensure that as many cases of this disease as possible are picked up by this initial screening test."], "atomic_facts": ["1. The goal is to detect as many cases of the disease as possible.", "2. The focus is on the initial screening test.", "3. The emphasis is on maximizing the number of cases detected."]}
{"id": 462, "question": "Which of the following findings is most important in correctly diagnosing this patient\u2019s condition?", "context": ["A 25-year-old man is brought into the hospital by his family because they are concerned that he has post-traumatic stress disorder.", "The patient is a marine and was deployed to Afghanistan 2 years ago.", "He was able to successfully reintegrate with society upon his return; however, for the last 2 weeks, he has been having recurrent nightmares and avoiding news coverage on the war.", "He has become more and more detached from his family and friends and, on the few times he does interact with them, he has angry outbursts.", "The patient is afebrile, and his vital signs are within normal limits.", "Physical examination is unremarkable."], "context_len": 6, "options": {"A": "Duration of symptoms", "B": "State of hyperarousal", "C": "Avoidance of triggers", "D": "Negative Mood"}, "answer": "Duration of symptoms", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Psychiatry"], "subspecialties": ["Post", "Posttraumatic Stress Disorder (PTSD)"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 25-year-old man is brought into the hospital by his family.", "2. The family is concerned that he has post-traumatic stress disorder.", "3. The patient is a marine.", "4. The patient was deployed to Afghanistan 2 years ago.", "5. The patient was able to successfully reintegrate with society upon his return.", "6. For the last 2 weeks, the patient has been having recurrent nightmares.", "7. The patient has been avoiding news coverage on the war.", "8. The patient has become more and more detached from his family and friends.", "9. On the few times the patient does interact with them, he has angry outbursts.", "10. The patient is afebrile.", "11. The patient's vital signs are within normal limits.", "12. Physical examination is unremarkable."], "atomic_facts": ["1. The patient is a marine.", "2. The patient was deployed to Afghanistan 2 years ago.", "3. The patient was able to successfully reintegrate with society upon his return.", "4. For the last 2 weeks, the patient has been having recurrent nightmares.", "5. For the last 2 weeks, the patient has been avoiding news coverage on the war.", "6. The patient has become more and more detached from his family and friends.", "7. The patient has angry outbursts when interacting with family and friends.", "8. The patient is afebrile.", "9. The patient's vital signs are within normal limits.", "10. Physical examination is unremarkable."]}
{"id": 463, "question": "A deficiency in which of the following enzymes is the most likely cause of this patient's recurrent infections?", "context": ["A 4-year-old girl is brought to the pediatrician because of throat pain for 2 days.", "She had frequent episodes of oral thrush as a baby and has been treated for vaginal yeast infection twice in the past year.", "Physical examination shows white patches on the tongue and palate.", "Scraping off the patches reveals erythematous oral mucosa with pinpoint bleeding.", "Leukocyte count is within normal range.", "Exposure to nitroblue tetrazolium turns the patient's neutrophils dark blue."], "context_len": 6, "options": {"A": "Adenosine deaminase", "B": "Pyruvate kinase", "C": "Glucose-6-phosphate dehydrogenase", "D": "Myeloperoxidase"}, "answer": "Myeloperoxidase", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases", "Pediatric Immunology and Allergy"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A 4-year-old girl is brought to the pediatrician because of throat pain for 2 days.", "2. She had frequent episodes of oral thrush as a baby.", "3. She has been treated for vaginal yeast infection twice in the past year.", "4. Physical examination shows white patches on the tongue and palate.", "5. Scraping off the patches reveals erythematous oral mucosa with pinpoint bleeding.", "6. Leukocyte count is within normal range.", "7. Exposure to nitroblue tetrazolium turns the patient's neutrophils dark blue."], "atomic_facts": ["1. She had frequent episodes of oral thrush as a baby.", "2. She has been treated for vaginal yeast infection twice in the past year.", "3. Physical examination shows white patches on the tongue and palate.", "4. Scraping off the patches reveals erythematous oral mucosa with pinpoint bleeding.", "5. Leukocyte count is within normal range.", "6. Exposure to nitroblue tetrazolium turns the patient's neutrophils dark blue."]}
{"id": 464, "question": "Of the following options, which is the most likely cause of his respiratory failure?", "context": ["A 55-year-old male with chronic dyspnea is intubated and started on mechanical ventilation for respiratory failure.", "Pressure-volume scalars on the ventilator show decreased change in volume for each unit change in pressure as compared to normal values."], "context_len": 2, "options": {"A": "Asthma", "B": "Centriacinar emphysema", "C": "Pulmonary fibrosis", "D": "Alpha-1-antitrypsin deficiency"}, "answer": "Pulmonary fibrosis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 55 years old.", "2. Patient is male.", "3. Patient has chronic dyspnea.", "4. Patient is intubated.", "5. Patient is on mechanical ventilation for respiratory failure.", "6. Pressure-volume scalars on the ventilator show decreased change in volume for each unit change in pressure.", "7. Decreased change in volume for each unit change in pressure is compared to normal values."], "atomic_facts": ["1. Pressure-volume scalars are used on the ventilator.", "2. The pressure-volume scalars show decreased change in volume for each unit change in pressure.", "3. The decreased change in volume is compared to normal values."]}
{"id": 465, "question": "Which of the following mutations is most consistent with this patient\u2019s clinical condition?", "context": ["A 6-year-old African-American boy presents with severe pain and swelling of both his hands and wrists.", "His symptoms onset 2 days ago and have not improved.", "He also has had diarrhea for the last 2 days and looks dehydrated.", "This patient has had two similar episodes of severe pain in the past.", "Physical examination reveals pallor, jaundice, dry mucous membranes, and sunken eyes."], "context_len": 5, "options": {"A": "Chromosomal deletion", "B": "Nonsense", "C": "Missense", "D": "Frame shift"}, "answer": "Missense", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics", "Rheumatology"], "subspecialties": ["Pediatric Rheumatology", "General Rheumatology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. Patient is a 6-year-old African-American boy.", "2. Patient has severe pain and swelling of both hands and wrists.", "3. Symptoms onset 2 days ago and have not improved.", "4. Patient has had diarrhea for the last 2 days.", "5. Patient looks dehydrated.", "6. Patient has had two similar episodes of severe pain in the past.", "7. Physical examination reveals pallor.", "8. Physical examination reveals jaundice.", "9. Physical examination reveals dry mucous membranes.", "10. Physical examination reveals sunken eyes."], "atomic_facts": ["1. Symptoms onset 2 days ago", "2. Symptoms have not improved", "3. Diarrhea for the last 2 days", "4. Patient looks dehydrated", "5. Patient has had two similar episodes of severe pain in the past", "6. Physical examination reveals pallor", "7. Physical examination reveals jaundice", "8. Physical examination reveals dry mucous membranes", "9. Physical examination reveals sunken eyes"]}
{"id": 466, "question": "Which of the following is the best initial therapy for the patient's condition?", "context": ["A 45-year-old woman presents to her primary care physician with complaints of weight loss and anxiety.", "She says that over the past 6 months she has lost 10 pounds even though she has had an increased appetite.", "In addition, she describes 3 episodes where it felt like her heart was \"pounding out of her chest.\" Her temperature is 99.3\u00b0F (37.4\u00b0C), pulse is 106/min and regular, blood pressure is 141/80 mmHg, and respirations are 18/min.", "Physical exam is significant for mild bilateral proptosis and 3+ deep tendon reflexes bilaterally."], "context_len": 4, "options": {"A": "Adenosine", "B": "Potassium iodide", "C": "Propranolol", "D": "Thyroidectomy"}, "answer": "Propranolol", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 45-year-old woman presents to her primary care physician.", "2. She has complaints of weight loss and anxiety.", "3. She has lost 10 pounds over the past 6 months.", "4. She has had an increased appetite.", "5. She has had 3 episodes where it felt like her heart was \"pounding out of her chest.\"", "6. Her temperature is 99.3\u00b0F (37.4\u00b0C).", "7. Her pulse is 106/min and regular.", "8. Her blood pressure is 141/80 mmHg.", "9. Her respirations are 18/min.", "10. Physical exam is significant for mild bilateral proptosis.", "11. Physical exam is significant for 3+ deep tendon reflexes bilaterally."], "atomic_facts": ["1. The patient has lost 10 pounds over the past 6 months.", "2. The patient has had an increased appetite.", "3. The patient has experienced 3 episodes of feeling like her heart was \"pounding out of her chest.\"", "4. The patient's temperature is 99.3\u00b0F (37.4\u00b0C).", "5. The patient's pulse is 106/min and regular.", "6. The patient's blood pressure is 141/80 mmHg.", "7. The patient's respirations are 18/min.", "8. The patient has mild bilateral proptosis.", "9. The patient has 3+ deep tendon reflexes bilaterally."]}
{"id": 467, "question": "Which of the following is the most likely cause of this patient's symptoms?\"", "context": ["A 58-year-old woman is brought to the emergency department by her husband because of increasing confusion and generalized fatigue over the past week.", "During this period, she has had muscle cramps, headaches, nausea, and vomiting.", "Six days ago, she underwent resection of a parasagittal meningioma.", "She tolerated the procedure well without complications and was discharged two days ago.", "She has hypercholesterolemia and hypertension.", "Current medications include oxycodone, acetaminophen, atorvastatin, and hydrochlorothiazide.", "She is oriented only to person and place.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 89/min, respiratory rate is 14/min, and blood pressure is 142/88 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 97%.", "The remainder of the examination shows no abnormalities.", "Serum studies show: | Serum | Na+ 126 mEq/L | K+ 3.6 mEq/L | Cl- 107 mEq/L | Urea nitrogen 16 mg/dL | Glucose 87 mg/dL | Creatinine 0.9 mg/dL | Osmolality 255 mOsmol/kg H2O | Urine | Osmolality 523 mOsmol/kg H2O | Sodium 44 mEq/L | ."], "context_len": 11, "options": {"A": "Cerebral salt wasting syndrome", "B": "Syndrome of inappropriate antidiuretic hormone", "C": "Primary polydipsia", "D": "Mineralocorticoid deficiency"}, "answer": "Syndrome of inappropriate antidiuretic hormone", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "58 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Neurology", "Geriatric Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 58-year-old woman is brought to the emergency department by her husband.", "2. She has increasing confusion and generalized fatigue over the past week.", "3. She has had muscle cramps, headaches, nausea, and vomiting.", "4. Six days ago, she underwent resection of a parasagittal meningioma.", "5. She tolerated the procedure well without complications and was discharged two days ago.", "6. She has hypercholesterolemia and hypertension.", "7. Current medications include oxycodone, acetaminophen, atorvastatin, and hydrochlorothiazide.", "8. She is oriented only to person and place.", "9. Her temperature is 37\u00b0C (98.6\u00b0F).", "10. Her pulse is 89/min.", "11. Her respiratory rate is 14/min.", "12. Her blood pressure is 142/88 mm Hg.", "13. Pulse oximetry on room air shows an oxygen saturation of 97%.", "14. The remainder of the examination shows no abnormalities.", "15. Serum Na+ is 126 mEq/L.", "16. Serum K+ is 3.6 mEq/L.", "17. Serum Cl- is 107 mEq/L.", "18. Serum urea nitrogen is 16 mg/dL.", "19. Serum glucose is 87 mg/dL.", "20. Serum creatinine is 0.9 mg/dL.", "21. Serum osmolality is 255 mOsmol/kg H2O.", "22. Urine osmolality is 523 mOsmol/kg H2O.", "23. Urine sodium is 44 mEq/L."], "atomic_facts": ["1. The patient has had muscle cramps, headaches, nausea, and vomiting.", "2. Six days ago, the patient underwent resection of a parasagittal meningioma.", "3. The patient tolerated the procedure well without complications and was discharged two days ago.", "4. The patient has hypercholesterolemia and hypertension.", "5. The patient's current medications include oxycodone, acetaminophen, atorvastatin, and hydrochlorothiazide.", "6. The patient is oriented only to person and place.", "7. The patient's temperature is 37\u00b0C (98.6\u00b0F), pulse is 89/min, respiratory rate is 14/min, and blood pressure is 142/88 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 97%.", "9. The remainder of the examination shows no abnormalities.", "10. Serum studies show: Serum Na+ 126 mEq/L, K+ 3.6 mEq/L, Cl- 107 mEq/L, Urea nitrogen 16 mg/dL, Glucose 87 mg/dL, Creatinine 0.9 mg/dL, Osmolality 255 mOsmol/kg H2O.", "11. Urine Osmolality is 523 mOsmol/kg H2O and Sodium is 44 mEq/L."]}
{"id": 468, "question": "Which of the following cytokines is most likely to be involved in normal bone healing in this patient?", "context": ["A 55-year-old man comes to the emergency department because of left arm pain after falling from a ladder.", "Physical examination shows tenderness along the proximal left humerus.", "An x-ray of the left arm and shoulder shows a nondisplaced proximal humerus fracture."], "context_len": 3, "options": {"A": "Interleukin-4", "B": "Interferon-\u03b1", "C": "Granulocyte colony-stimulating factor", "D": "Macrophage colony-stimulating factor"}, "answer": "Macrophage colony-stimulating factor", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 55-year-old man comes to the emergency department.", "2. The man has left arm pain after falling from a ladder.", "3. Physical examination shows tenderness along the proximal left humerus.", "4. An x-ray of the left arm and shoulder is performed.", "5. The x-ray shows a nondisplaced proximal humerus fracture."], "atomic_facts": ["1. Physical examination shows tenderness along the proximal left humerus.", "2. An x-ray of the left arm shows a nondisplaced proximal humerus fracture.", "3. An x-ray of the shoulder shows a nondisplaced proximal humerus fracture."]}
{"id": 469, "question": "Which of the following is the most likely responsible for this patient\u2019s condition?", "context": ["A 62-year-old African American man is admitted to the emergency department with a 24-hour history of intense epigastric pain that radiates to the back with nausea and vomiting.", "His medical history is relevant for hypertension, heart failure (HF), chronic obstructive pulmonary disease (COPD), and radicular pain, all under control with amlodipine, furosemide, ipratropium, and gabapentin.", "He drinks occasionally at family gatherings and has never smoked cigarettes.", "His vital signs are recorded as follows: blood pressure of 130/80 mm Hg, a heart rate of 78/min, a respiratory rate of 18/min, and a body temperature of 36.6\u00b0C (97.9\u00b0F).", "Abdominal examination shows edema and bruising of periumbilical subcutaneous tissue and intense pain to touch but no signs of peritoneal irritation."], "context_len": 5, "options": {"A": "Furosemide", "B": "Ipratropium", "C": "Gabapentin", "D": "Alcohol consumption"}, "answer": "Furosemide", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "62 years old", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.5, 0.5], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 62-year-old African American man.", "2. Patient has a 24-hour history of intense epigastric pain radiating to the back with nausea and vomiting.", "3. Patient's medical history is relevant for hypertension, HF, COPD, and radicular pain.", "4. Patient is taking amlodipine, furosemide, ipratropium, and gabapentin.", "5. Patient drinks occasionally at family gatherings and has never smoked cigarettes.", "6. Patient's blood pressure is 130/80 mm Hg.", "7. Patient's heart rate is 78/min.", "8. Patient's respiratory rate is 18/min.", "9. Patient's body temperature is 36.6\u00b0C (97.9\u00b0F).", "10. Abdominal examination shows edema and bruising of periumbilical subcutaneous tissue and intense pain to touch.", "11. Abdominal examination shows no signs of peritoneal irritation."], "atomic_facts": ["1. His medical history includes hypertension, heart failure (HF), chronic obstructive pulmonary disease (COPD), and radicular pain.", "2. His conditions are under control with amlodipine, furosemide, ipratropium, and gabapentin.", "3. He drinks occasionally at family gatherings.", "4. He has never smoked cigarettes.", "5. His blood pressure is 130/80 mm Hg.", "6. His heart rate is 78/min.", "7. His respiratory rate is 18/min.", "8. His body temperature is 36.6\u00b0C (97.9\u00b0F).", "9. Abdominal examination shows edema and bruising of periumbilical subcutaneous tissue.", "10. He experiences intense pain to touch but no signs of peritoneal irritation."]}
{"id": 470, "question": "Which of the following additional findings would you also expect to observe in this patient?", "context": ["A 62-year-old woman presents to the emergency department complaining of intense pain in her right knee that started 12 hours ago.", "Her past medical history is significant for hemochromatosis, managed with biweekly phlebotomy.", "Her vitals include: blood pressure of 130/70 mm Hg, pulse of 82/min, respiratory rate of 18/min, and temperature of 36.5\u00b0C (97.7\u00b0F).", "Physical examination reveals an erythematous, warm, and severely tender right knee with a restricted range of motion.", "An arthrocentesis is performed, and synovial fluid analysis is significant for a neutrophil count of 3,200 cells/\u03bcL, a negative Gram stain, and the following result under polarized light microscopy (see image)."], "context_len": 5, "options": {"A": "Chondrocalcinosis", "B": "Urate tophi", "C": "Heberden's nodes", "D": "Rheumatoid nodules"}, "answer": "Chondrocalcinosis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "62", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 62-year-old woman presents to the emergency department.", "2. She is complaining of intense pain in her right knee that started 12 hours ago.", "3. Her past medical history is significant for hemochromatosis, managed with biweekly phlebotomy.", "4. Her vitals include: blood pressure of 130/70 mm Hg, pulse of 82/min, respiratory rate of 18/min, and temperature of 36.5\u00b0C (97.7\u00b0F).", "5. Physical examination reveals an erythematous, warm, and severely tender right knee with a restricted range of motion.", "6. An arthrocentesis is performed.", "7. Synovial fluid analysis is significant for a neutrophil count of 3,200 cells/\u03bcL.", "8. Synovial fluid analysis is also significant for a negative Gram stain.", "9. Synovial fluid analysis is also significant for the following result under polarized light microscopy (see image)."], "atomic_facts": ["1. Past medical history includes hemochromatosis managed with biweekly phlebotomy.", "2. Vitals: blood pressure 130/70 mm Hg, pulse 82/min, respiratory rate 18/min, temperature 36.5\u00b0C (97.7\u00b0F).", "3. Physical examination reveals erythematous, warm, and severely tender right knee with restricted range of motion.", "4. Arthrocentesis performed.", "5. Synovial fluid analysis shows neutrophil count of 3,200 cells/\u03bcL.", "6. Synovial fluid analysis shows negative Gram stain.", "7. Synovial fluid analysis shows result under polarized light microscopy."]}
{"id": 471, "question": "What is the next best step for the management of his COPD?", "context": ["A 52-year-old man with a history of mild chronic obstructive pulmonary disease (COPD) has been using albuterol as needed to manage his COPD without any other maintenance medications.", "Recently, he has been experiencing a greater degree of shortness of breath, wheezing, and a productive cough.", "He denies any recent changes to his activities of daily living, exercise, or recent upper respiratory illnesses.", "The vital signs include: temperature 36.7\u00b0C (98.0\u00b0F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min.", "His physical examination shows decreased breath sounds bilateral, and expiratory wheezes, a barrel-shaped chest, and a holosystolic murmur heard best at the 2nd intercostal space on the left.", "Pulmonary function tests demonstrate a forced expiratory volume-1 (FEV-1) which is 60% of the predicted value."], "context_len": 6, "options": {"A": "Add rofilumast to treatment regimen", "B": "Add tiotropium to treatment regimen", "C": "Add tiotropium plus fluticasone to treatment regimen", "D": "Add carbocysteine to treatment regimen"}, "answer": "Add tiotropium to treatment regimen", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 52-year-old man.", "2. Patient has a history of mild chronic obstructive pulmonary disease (COPD).", "3. Patient has been using albuterol as needed to manage his COPD without any other maintenance medications.", "4. Patient has been experiencing a greater degree of shortness of breath, wheezing, and a productive cough.", "5. Patient denies any recent changes to his activities of daily living, exercise, or recent upper respiratory illnesses.", "6. Temperature is 36.7\u00b0C (98.0\u00b0F).", "7. Blood pressure is 126/74 mm Hg.", "8. Heart rate is 74/min.", "9. Respiratory rate is 14/min.", "10. Physical examination shows decreased breath sounds bilateral, and expiratory wheezes, a barrel-shaped chest, and a holosystolic murmur heard best at the 2nd intercostal space on the left.", "11. Pulmonary function tests demonstrate a forced expiratory volume-1 (FEV-1) which is 60% of the predicted value."], "atomic_facts": ["1. He has been experiencing a greater degree of shortness of breath, wheezing, and a productive cough.", "2. He denies any recent changes to his activities of daily living, exercise, or recent upper respiratory illnesses.", "3. Vital signs: temperature 36.7\u00b0C (98.0\u00b0F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min.", "4. Physical examination shows decreased breath sounds bilateral, and expiratory wheezes, a barrel-shaped chest, and a holosystolic murmur heard best at the 2nd intercostal space on the left.", "5. Pulmonary function tests demonstrate a forced expiratory volume-1 (FEV-1) which is 60% of the predicted value."]}
{"id": 472, "question": "Which of the following would you expect to see in a tissue sample from the patient\u2019s orchiectomy?", "context": ["A 24 year-old male presented to his physician with a homogenous, painless testicular swelling that he noticed for the past two weeks.", "After ultrasound and blood tests, he subsequently underwent a radical inguinal orchiectomy and pathology was consistent with seminoma."], "context_len": 2, "options": {"A": "Lobules of large cells with prominent nuclei and watery cytoplasm", "B": "Schiller-Duval bodies", "C": "Tubular papillary architecture with necrosis", "D": "Mature derivatives of endoderm, mesoderm, and ectoderm"}, "answer": "Lobules of large cells with prominent nuclei and watery cytoplasm", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "24", "specialties": ["Pathology"], "subspecialties": ["Pediatric Pathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 24 year-old male presented to his physician.", "2. He had a homogenous, painless testicular swelling.", "3. He noticed the swelling for the past two weeks.", "4. He underwent an ultrasound and blood tests.", "5. He subsequently underwent a radical inguinal orchiectomy.", "6. Pathology was consistent with seminoma."], "atomic_facts": ["1. Ultrasound was performed.", "2. Blood tests were conducted.", "3. A radical inguinal orchiectomy was performed.", "4. Pathology results were consistent with seminoma."]}
{"id": 473, "question": "Which of the following is the most appropriate treatment?", "context": ["A 31-year-old man comes to the physician because of diarrhea, bloating, nausea, and vomiting for the past week.", "He describes his stool as greasy, frothy, and soft; it is not red or darkened.", "The patient went on a hiking trip in Brazil 3 weeks ago.", "He has no history of serious illness and takes no medications.", "The patient appears dehydrated.", "His vital signs are normal.", "Examination shows dry mucous membranes and diffuse abdominal tenderness.", "Microscopy of the stool reveals egg-shaped cysts with prominent two-layered cell wall and multiple nuclei."], "context_len": 8, "options": {"A": "Supportive treatment only", "B": "Trimethoprim-sulfamethoxazole therapy", "C": "Metronidazole therapy", "D": "Octreotide therapy"}, "answer": "Metronidazole therapy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "31 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 31-year-old man comes to the physician.", "2. He has had diarrhea, bloating, nausea, and vomiting for the past week.", "3. He describes his stool as greasy, frothy, and soft.", "4. His stool is not red or darkened.", "5. He went on a hiking trip in Brazil 3 weeks ago.", "6. He has no history of serious illness.", "7. He takes no medications.", "8. The patient appears dehydrated.", "9. His vital signs are normal.", "10. Examination shows dry mucous membranes.", "11. Examination shows diffuse abdominal tenderness.", "12. Microscopy of the stool reveals egg-shaped cysts.", "13. The egg-shaped cysts have a prominent two-layered cell wall.", "14. The egg-shaped cysts have multiple nuclei."], "atomic_facts": ["1. The patient describes his stool as greasy, frothy, and soft.", "2. The patient's stool is not red or darkened.", "3. The patient went on a hiking trip in Brazil 3 weeks ago.", "4. The patient has no history of serious illness.", "5. The patient takes no medications.", "6. The patient appears dehydrated.", "7. The patient's vital signs are normal.", "8. Examination shows dry mucous membranes.", "9. Examination shows diffuse abdominal tenderness.", "10. Microscopy of the stool reveals egg-shaped cysts.", "11. The egg-shaped cysts have a prominent two-layered cell wall.", "12. The egg-shaped cysts have multiple nuclei."]}
{"id": 474, "question": "The alteration in the normal functioning of which of the following is the mechanism of action for this therapy?", "context": ["A 48-year-old man presents to the clinic feeling depressed after a string of failed business projects.", "His team noticed that he seems less engaged than he once used to be and this is reflecting in his work.", "He has no previous psychiatric history and symptoms of depressed mood have been ongoing for the past 6 months.", "A patient health questionnaire 9 (PHQ-9) was administered and the patient scored 10.", "The patient is started on venlafaxine."], "context_len": 5, "options": {"A": "Serotonin, norepinephrine, and dopamine", "B": "Norepinephrine and dopamine", "C": "Serotonin receptor antagonism", "D": "Alpha-2 receptor antagonism"}, "answer": "Serotonin, norepinephrine, and dopamine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "48 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 48-year-old man presents to the clinic feeling depressed.", "2. His team noticed that he seems less engaged than he once used to be.", "3. This is reflecting in his work.", "4. He has no previous psychiatric history.", "5. Symptoms of depressed mood have been ongoing for the past 6 months.", "6. A patient health questionnaire 9 (PHQ-9) was administered.", "7. The patient scored 10.", "8. The patient is started on venlafaxine."], "atomic_facts": ["1. His team noticed that he seems less engaged than he once used to be.", "2. This is reflecting in his work.", "3. He has no previous psychiatric history.", "4. Symptoms of depressed mood have been ongoing for the past 6 months.", "5. A patient health questionnaire 9 (PHQ-9) was administered.", "6. The patient scored 10 on the PHQ-9.", "7. The patient is started on venlafaxine."]}
{"id": 475, "question": "Which of the following processes was necessary in order for the bacteria to survive on the plate and contain copies of the gene of interest?", "context": ["A researcher is performing an experiment where she is using bacteria to clone copies of a mutated gene that she plans on introducing to cells.", "In order to perform this, she has created a small, circular segment of double-stranded DNA that includes the gene of interest as well as a gene for antibiotic resistance.", "After introducing this segment of DNA to competent bacteria, she plates the bacteria on media containing the antibiotic."], "context_len": 3, "options": {"A": "Conjugation", "B": "Transduction", "C": "Transfection", "D": "Transformation"}, "answer": "Transformation", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Microbiology", "Pathology", "Microbiology Pathology"], "subspecialties": ["Molecular Genetic Pathology", "General Microbiology", "General Pathology"], "specialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Others"}, "facts_old": ["1. A researcher is performing an experiment.", "2. The researcher is using bacteria to clone copies of a mutated gene.", "3. The researcher plans on introducing the mutated gene to cells.", "4. The researcher has created a small, circular segment of double-stranded DNA.", "5. The segment of DNA includes the gene of interest and a gene for antibiotic resistance.", "6. The researcher has introduced the segment of DNA to competent bacteria.", "7. The researcher has plated the bacteria on media containing the antibiotic."], "atomic_facts": ["1. She has created a small, circular segment of double-stranded DNA.", "2. The segment of DNA includes the gene of interest.", "3. The segment of DNA includes a gene for antibiotic resistance.", "4. She introduces the segment of DNA to competent bacteria.", "5. She plates the bacteria on media containing the antibiotic."]}
{"id": 476, "question": "Which of the following is the most likely intoxication in this patient?", "context": ["A 27-year-old woman presents to the emergency department with altered mental status.", "Her parents found her in her room surrounded by pill bottles, alcohol, and illicit drugs 10 minutes ago and promptly brought her in.", "She was unconscious with lacerations on her wrists.", "The patient has a past medical history of depression, fibromyalgia, and multiple suicide attempts.", "Physical exam is notable for a somnolent young woman who responds to questions but is non-compliant in describing the history.", "She is currently vomiting and her gait seems ataxic.", "Initial laboratory values are unremarkable.", "An arterial blood gas analysis reveals the following findings. |  | Arterial blood gas | pH: 7.50 | pO2: 105 mmHg | pCO2: 20 mmHg | Bicarbonate: 24 mEq/L |  | ."], "context_len": 8, "options": {"A": "Acetaminophen", "B": "Amitriptyline", "C": "Aspirin", "D": "Ethylene glycol"}, "answer": "Aspirin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 27-year-old woman presents to the emergency department with altered mental status.", "2. Her parents found her in her room surrounded by pill bottles, alcohol, and illicit drugs 10 minutes ago and promptly brought her in.", "3. She was unconscious with lacerations on her wrists.", "4. The patient has a past medical history of depression, fibromyalgia, and multiple suicide attempts.", "5. Physical exam is notable for a somnolent young woman who responds to questions but is non-compliant in describing the history.", "6. She is currently vomiting and her gait seems ataxic.", "7. Initial laboratory values are unremarkable.", "8. An arterial blood gas analysis reveals a pH of 7.50.", "9. An arterial blood gas analysis reveals a pO2 of 105 mmHg.", "10. An arterial blood gas analysis reveals a pCO2 of 20 mmHg.", "11. An arterial blood gas analysis reveals a bicarbonate of 24 mEq/L."], "atomic_facts": ["1. Her parents found her in her room surrounded by pill bottles, alcohol, and illicit drugs 10 minutes ago.", "2. She was unconscious with lacerations on her wrists.", "3. The patient has a past medical history of depression, fibromyalgia, and multiple suicide attempts.", "4. Physical exam is notable for a somnolent young woman who responds to questions but is non-compliant in describing the history.", "5. She is currently vomiting and her gait seems ataxic.", "6. Initial laboratory values are unremarkable.", "7. Arterial blood gas analysis reveals the following findings: pH: 7.50, pO2: 105 mmHg, pCO2: 20 mmHg, Bicarbonate: 24 mEq/L."]}
{"id": 477, "question": "Which of the following medications is most appropriate to address this patient's concerns?", "context": ["A 33-year-old Asian American man presents to his primary care provider in February with pain in his fingers.", "His symptoms started 2 years ago and have gradually progressed.", "He initially attributed his symptoms to stress at work as a social worker.", "He has tried using ibuprofen, acetaminophen, and naproxen, but these medications did not improve his pain.", "He also reports that there have been at least 3 instances in the past 2 months in which his fingers became extremely painful and turned white before turning pale blue.", "These instances occurred when the patient was walking outside.", "His past medical history is notable for gastroesophageal reflux disease and gout.", "He takes omeprazole and allopurinol.", "His temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 120/78 mmHg, pulse is 90/min, and respirations are 18/min.", "Physical examination reveals loss of skin fold wrinkles and indurated skin on the palmar side of the digits.", "Finger range of motion is limited."], "context_len": 11, "options": {"A": "Ambrisentan", "B": "Amlodipine", "C": "Cilostazol", "D": "Lisinopril"}, "answer": "Amlodipine", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "33", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 33-year-old Asian American man.", "2. Patient presents to primary care provider in February with pain in fingers.", "3. Symptoms started 2 years ago and have gradually progressed.", "4. Patient initially attributed symptoms to stress at work as a social worker.", "5. Patient has tried ibuprofen, acetaminophen, and naproxen, but these medications did not improve pain.", "6. At least 3 instances in past 2 months in which fingers became extremely painful and turned white before turning pale blue.", "7. These instances occurred when patient was walking outside.", "8. Patient's past medical history is notable for gastroesophageal reflux disease and gout.", "9. Patient takes omeprazole and allopurinol.", "10. Patient's temperature is 99\u00b0F (37.2\u00b0C).", "11. Patient's blood pressure is 120/78 mmHg.", "12. Patient's pulse is 90/min.", "13. Patient's respirations are 18/min.", "14. Physical examination reveals loss of skin fold wrinkles and indurated skin on palmar side of digits.", "15. Finger range of motion is limited."], "atomic_facts": ["1. Symptoms started 2 years ago", "2. Symptoms have gradually progressed", "3. Initially attributed symptoms to stress at work as a social worker", "4. Tried using ibuprofen, acetaminophen, and naproxen", "5. Medications did not improve his pain", "6. At least 3 instances in the past 2 months of extremely painful and white fingers turning pale blue", "7. Instances occurred when walking outside", "8. Past medical history includes gastroesophageal reflux disease and gout", "9. Takes omeprazole and allopurinol", "10. Temperature is 99\u00b0F (37.2\u00b0C)", "11. Blood pressure is 120/78 mmHg", "12. Pulse is 90/min", "13. Respirations are 18/min", "14. Physical examination reveals loss of skin fold wrinkles and indurated skin on the palmar side of the digits", "15. Finger range of motion is limited"]}
{"id": 478, "question": "Which of the following is the most likely predisposing factor for this patient's condition?", "context": ["A 3-year-old boy is brought to the physician because of a 1-day history of abdominal pain and frequent urination.", "His mother reports that the patient has wet his bed overnight and that his urine smelled odd this morning.", "He has been toilet trained for 4 months and has had very few accidents since then.", "His last bowel movement was 3 days ago.", "He was born at term after a normal gestation and has reached all developmental milestones.", "His parents divorced 4 months ago and the patient's father has moved away.", "The patient began preschool 6 weeks ago.", "During this period, he has had two upper respiratory infections that resolved without treatment.", "His 12-year-old brother has type 1 diabetes mellitus.", "Vital signs are within normal limits.", "Physical examination of the abdomen shows mild suprapubic tenderness.", "Urine dipstick is positive for leukocyte esterase, nitrite, and blood; urinalysis shows white blood cells and gram-negative rods."], "context_len": 12, "options": {"A": "Social stressors", "B": "Constipation", "C": "Posterior urethral valves", "D": "Respiratory tract infection"}, "answer": "Constipation", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 3-year-old boy.", "2. Patient has a 1-day history of abdominal pain and frequent urination.", "3. Patient's mother reports he wet his bed overnight and his urine smelled odd this morning.", "4. Patient has been toilet trained for 4 months and has had very few accidents since then.", "5. Patient's last bowel movement was 3 days ago.", "6. Patient was born at term after a normal gestation and has reached all developmental milestones.", "7. Patient's parents divorced 4 months ago and the patient's father has moved away.", "8. Patient began preschool 6 weeks ago.", "9. Patient has had two upper respiratory infections that resolved without treatment.", "10. Patient's 12-year-old brother has type 1 diabetes mellitus.", "11. Vital signs are within normal limits.", "12. Physical examination of the abdomen shows mild suprapubic tenderness.", "13. Urine dipstick is positive for leukocyte esterase, nitrite, and blood.", "14. Urinalysis shows white blood cells and gram-negative rods."], "atomic_facts": ["1. The patient has wet his bed overnight.", "2. His urine smelled odd this morning.", "3. He has been toilet trained for 4 months.", "4. He has had very few accidents since then.", "5. His last bowel movement was 3 days ago.", "6. He was born at term after a normal gestation.", "7. He has reached all developmental milestones.", "8. His parents divorced 4 months ago.", "9. The patient's father has moved away.", "10. The patient began preschool 6 weeks ago.", "11. During this period, he has had two upper respiratory infections that resolved without treatment.", "12. His 12-year-old brother has type 1 diabetes mellitus.", "13. Vital signs are within normal limits.", "14. Physical examination of the abdomen shows mild suprapubic tenderness.", "15. Urine dipstick is positive for leukocyte esterase, nitrite, and blood.", "16. Urinalysis shows white blood cells and gram-negative rods."]}
{"id": 479, "question": "If esophageal manometry is performed, which of the following will most likely be present in this patient?", "context": ["A 37-year-old male presents with difficulty eating solids and drinking water; which has been progressively worse over the past year.", "He has noticed that he is regurgitating food that appears undigested and has also been having difficulty belching.", "He said that lifting his neck seems to help him keep his food down.", "He is currently on omeprazole for his acid reflux; however, his heartburn still persists.", "An esophagogastroduodenoscopy (EGD) is performed that shows no evidence of mechanical obstruction or esophageal inflammation."], "context_len": 5, "options": {"A": "Aperistalsis in the distal two-thirds of the esophagus with incomplete lower esophageal relaxation", "B": "Normal amplitude, uncoordiated, simultaneous esophageal contractions", "C": "Excessive amplitude or duration of coordinated esophageal contractions", "D": "Hypotensive peristaltic contractions"}, "answer": "Aperistalsis in the distal two-thirds of the esophagus with incomplete lower esophageal relaxation", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "37", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 37 years old.", "2. Patient has difficulty eating solids and drinking water.", "3. Symptoms have been progressively worse over the past year.", "4. Patient regurgitates food that appears undigested.", "5. Patient has difficulty belching.", "6. Lifting neck helps patient keep food down.", "7. Patient is currently on omeprazole for acid reflux.", "8. Heartburn still persists.", "9. An EGD is performed.", "10. EGD shows no evidence of mechanical obstruction.", "11. EGD shows no evidence of esophageal inflammation."], "atomic_facts": ["1. He is regurgitating undigested food.", "2. He is having difficulty belching.", "3. Lifting his neck seems to help him keep his food down.", "4. He is currently on omeprazole for acid reflux.", "5. His heartburn still persists despite omeprazole.", "6. An esophagogastroduodenoscopy (EGD) shows no evidence of mechanical obstruction or esophageal inflammation."]}
{"id": 480, "question": "Which of the following is the most likely trigger of this patient's ventricular contractions?", "context": ["A 56-year-old man comes to the emergency department for chest pain that started 1 hour ago.", "He has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus.", "He appears diaphoretic and distressed.", "An ECG shows P waves independent of QRS complexes.", "The QRS interval is 0.11 seconds with normal morphology."], "context_len": 5, "options": {"A": "Sinoatrial node", "B": "Bachmann bundle", "C": "Bundle of His", "D": "Purkinje fibers"}, "answer": "Bundle of His", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 56-year-old man comes to the emergency department for chest pain.", "2. The chest pain started 1 hour ago.", "3. He has a history of hypertension.", "4. He has a history of hyperlipidemia.", "5. He has a history of type 2 diabetes mellitus.", "6. He appears diaphoretic and distressed.", "7. An ECG shows P waves independent of QRS complexes.", "8. The QRS interval is 0.11 seconds.", "9. The QRS morphology is normal."], "atomic_facts": ["1. He has a history of hypertension.", "2. He has a history of hyperlipidemia.", "3. He has a history of type 2 diabetes mellitus.", "4. He appears diaphoretic.", "5. He appears distressed.", "6. An ECG shows P waves independent of QRS complexes.", "7. The QRS interval is 0.11 seconds.", "8. The QRS interval has normal morphology."]}
{"id": 481, "question": "Which of the following is the most appropriate definitive step in the management of this patient?", "context": ["A 29-year-old pregnant woman is brought to the emergency department complaining of the sudden onset of severe, sharp pelvic pain.", "She is at 6 weeks\u2019 gestation.", "The patient is bleeding heavily from the vagina and feels very dizzy.", "Substantial pain is noted in the lower right quadrant, which intensified towards the end of the physical exam.", "On examination, there is evidence of abdominal and cervical motion tenderness.", "Her blood pressure is 71/37 mm Hg, respiratory rate is 21/min, pulse is 117/min, and temperature is 38.4\u00b0C (101.1\u00b0F)."], "context_len": 6, "options": {"A": "Surgery", "B": "Methotrexate", "C": "Transvaginal ultrasound", "D": "Serial hCG"}, "answer": "Surgery", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "29 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 29-year-old pregnant woman is brought to the emergency department.", "2. She is complaining of the sudden onset of severe, sharp pelvic pain.", "3. She is at 6 weeks\u2019 gestation.", "4. The patient is bleeding heavily from the vagina.", "5. She feels very dizzy.", "6. Substantial pain is noted in the lower right quadrant.", "7. The pain intensified towards the end of the physical exam.", "8. On examination, there is evidence of abdominal and cervical motion tenderness.", "9. Her blood pressure is 71/37 mm Hg.", "10. Her respiratory rate is 21/min.", "11. Her pulse is 117/min.", "12. Her temperature is 38.4\u00b0C (101.1\u00b0F)."], "atomic_facts": ["1. The patient is at 6 weeks\u2019 gestation.", "2. The patient is bleeding heavily from the vagina.", "3. The patient feels very dizzy.", "4. Substantial pain is noted in the lower right quadrant.", "5. The pain intensified towards the end of the physical exam.", "6. On examination, there is evidence of abdominal and cervical motion tenderness.", "7. The patient's blood pressure is 71/37 mm Hg.", "8. The patient's respiratory rate is 21/min.", "9. The patient's pulse is 117/min.", "10. The patient's temperature is 38.4\u00b0C (101.1\u00b0F)."]}
{"id": 482, "question": "This patient most likely presents with clinical features of which disease?", "context": ["A 24-year-old man presents to his primary care physician with heel pain that has been persistent for 3 weeks now.", "He is bothered by the feeling of significant pressure and swelling in his ankle.", "He is also having difficulty walking due to pain in his hip.", "Upon physical examination, there is evidence of swelling and warmth over his Achilles tendon.", "Imaging of his sacroiliac joint reveals soft tissue involvement and narrowing of the joint spaces.", "This patient also appears to have a low to moderate kyphosis of his spine.", "He has no family history of any bone or rheumatological diseases."], "context_len": 7, "options": {"A": "Ankylosing spondylitis", "B": "Reactive arthritis", "C": "Osteoma", "D": "Fibromyalgia"}, "answer": "Ankylosing spondylitis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "24", "specialties": ["Orthopaedic Surgery", "Rheumatology"], "subspecialties": ["Orthopaedic Sports Medicine", "General Rheumatology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 24-year-old man presents to his primary care physician.", "2. He has heel pain that has been persistent for 3 weeks.", "3. He is bothered by the feeling of significant pressure and swelling in his ankle.", "4. He is having difficulty walking due to pain in his hip.", "5. Upon physical examination, there is evidence of swelling and warmth over his Achilles tendon.", "6. Imaging of his sacroiliac joint reveals soft tissue involvement and narrowing of the joint spaces.", "7. This patient also appears to have a low to moderate kyphosis of his spine.", "8. He has no family history of any bone or rheumatological diseases."], "atomic_facts": ["1. He is bothered by the feeling of significant pressure and swelling in his ankle.", "2. He is also having difficulty walking due to pain in his hip.", "3. Upon physical examination, there is evidence of swelling and warmth over his Achilles tendon.", "4. Imaging of his sacroiliac joint reveals soft tissue involvement and narrowing of the joint spaces.", "5. This patient also appears to have a low to moderate kyphosis of his spine.", "6. He has no family history of any bone or rheumatological diseases."]}
{"id": 483, "question": "Which of the following should also be added to this patient\u2019s therapeutic regimen?", "context": ["A 51-year-old man comes to his physician with chronic sinusitis and rhinorrhea for which he uses mometasone nasal spray.", "He is seeking a refill on this prescription, noting that, although it has not fully relieved his nasal symptoms over the past 2 years, it has helped minimize the severity of those symptoms.", "On auscultation, there are faint crackles in the bilateral lung fields and an indentation at the nasal bridge.", "The patient also notes occasional hemoptysis and hematuria.", "He has no significant medical history and takes no other medications.", "Family history is significant for rheumatoid arthritis.", "The physician is suspicious for granulomatosis with polyangiitis and a nasal mucosal biopsy is obtained which confirms the diagnosis.", "The patient is started immediately on prednisone and cyclophosphamide."], "context_len": 8, "options": {"A": "Azithromycin", "B": "Ganciclovir", "C": "Doxycycline", "D": "Trimethoprim/sulfamethoxazole"}, "answer": "Trimethoprim/sulfamethoxazole", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "51 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 51 years old.", "2. Patient has chronic sinusitis and rhinorrhea.", "3. Patient uses mometasone nasal spray.", "4. Patient is seeking a refill on the prescription.", "5. Prescription has not fully relieved nasal symptoms over the past 2 years, but has helped minimize severity.", "6. On auscultation, faint crackles in bilateral lung fields and indentation at nasal bridge.", "7. Patient notes occasional hemoptysis and hematuria.", "8. Patient has no significant medical history.", "9. Patient takes no other medications.", "10. Family history is significant for rheumatoid arthritis.", "11. Physician is suspicious for granulomatosis with polyangiitis.", "12. Nasal mucosal biopsy is obtained which confirms diagnosis.", "13. Patient is started immediately on prednisone and cyclophosphamide."], "atomic_facts": ["1. The patient is seeking a refill on a prescription.", "2. The prescription has not fully relieved his nasal symptoms over the past 2 years.", "3. The prescription has helped minimize the severity of those symptoms.", "4. Faint crackles are heard in the bilateral lung fields on auscultation.", "5. There is an indentation at the nasal bridge.", "6. The patient experiences occasional hemoptysis.", "7. The patient experiences occasional hematuria.", "8. The patient has no significant medical history.", "9. The patient takes no other medications.", "10. Family history is significant for rheumatoid arthritis.", "11. The physician is suspicious for granulomatosis with polyangiitis.", "12. A nasal mucosal biopsy is obtained.", "13. The nasal mucosal biopsy confirms the diagnosis of granulomatosis with polyangiitis.", "14. The patient is started immediately on prednisone and cyclophosphamide."]}
{"id": 484, "question": "Laboratory testing shows the following: | Serum Glucose (fasting) 100 mg/dL |   Sodium 142 mEq/L |   Potassium 3.9 mEq/L |   Chloride 101 mEq/L | Serum Creatinine 0.8 mg/dL | Blood Urea Nitrogen 10 mg/dL | Cholesterol, total 250 mg/dL |   HDL-cholesterol 34 mg/dL |   LDL-cholesterol 210 mg/dL | Triglycerides 160 mg/dL | The patient is most likely started on a medication which acts by which of the following mechanism?", "context": ["A 28-year-old man presents to a clinic for a health check-up.", "He says that he feels great and has not seen a physician for approximately 10 years.", "He is concerned about his health because his 3 older brothers have recently developed cardiac problems.", "His medical history is significant for an appendectomy 16 years ago.", "He works out twice a week and eats a low-salt, well-balanced diet.", "He drinks alcohol socially on the weekend, but does not use tobacco or drugs.", "The pulse is 80/min, respirations are 14/min, and the blood pressure is 129/80 mm Hg.", "The physical examination is unremarkable."], "context_len": 8, "options": {"A": "Blockage of beta-adrenergic receptors", "B": "Blockage of the angiotensin receptors", "C": "Increase loss of bile acids in the feces", "D": "Inhibition of HMG-CoA reductase"}, "answer": "Inhibition of HMG-CoA reductase", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "28", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 28-year-old man presents to a clinic for a health check-up.", "2. He says that he feels great and has not seen a physician for approximately 10 years.", "3. His 3 older brothers have recently developed cardiac problems.", "4. His medical history is significant for an appendectomy 16 years ago.", "5. He works out twice a week.", "6. He eats a low-salt, well-balanced diet.", "7. He drinks alcohol socially on the weekend.", "8. He does not use tobacco or drugs.", "9. The pulse is 80/min.", "10. Respirations are 14/min.", "11. The blood pressure is 129/80 mm Hg.", "12. The physical examination is unremarkable."], "atomic_facts": ["1. He feels great and has not seen a physician for approximately 10 years.", "2. He is concerned about his health because his 3 older brothers have recently developed cardiac problems.", "3. His medical history is significant for an appendectomy 16 years ago.", "4. He works out twice a week and eats a low-salt, well-balanced diet.", "5. He drinks alcohol socially on the weekend, but does not use tobacco or drugs.", "6. The pulse is 80/min, respirations are 14/min, and the blood pressure is 129/80 mm Hg.", "7. The physical examination is unremarkable."]}
{"id": 485, "question": "Which of the following potential actions by this patient would be an example of sublimation?", "context": ["A 17-year-old boy presents for a psychotherapy session after finding out that his girlfriend has been carrying on another relationship with someone else.", "He expresses rage and complains of difficulty focusing on his upcoming high school comedy club routines and upcoming track meet.", "His therapist, while explaining the concept of defense mechanisms, describes some hypothetical examples related to the situation."], "context_len": 3, "options": {"A": "Channeling his anger about the situation into training for his track meet", "B": "Instigating a physical fight with his girlfriend\u2019s other partner", "C": "Making jokes about the situation and incorporating them into his comedy routine", "D": "Not thinking about the upsetting situation until after his track meet, then confronting and processing his feelings about it"}, "answer": "Channeling his anger about the situation into training for his track meet", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "17", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 17-year-old boy presents for a psychotherapy session.", "2. He found out that his girlfriend has been carrying on another relationship with someone else.", "3. He expresses rage.", "4. He complains of difficulty focusing on his upcoming high school comedy club routines.", "5. He complains of difficulty focusing on his upcoming track meet.", "6. His therapist explains the concept of defense mechanisms.", "7. His therapist describes some hypothetical examples related to the situation."], "atomic_facts": ["1. He expresses rage.", "2. He complains of difficulty focusing on his upcoming high school comedy club routines.", "3. He complains of difficulty focusing on his upcoming track meet.", "4. His therapist explains the concept of defense mechanisms.", "5. The therapist describes some hypothetical examples related to the situation."]}
{"id": 486, "question": "What is the best next step in the workup of this patient?", "context": ["A 39-year-old woman is brought to the emergency room by her fianc\u00e9 for severe abdominal pain for the past 5 hours.", "She was watching TV after dinner when she felt a sudden, sharp, 10/10 pain at the epigastric region that did not go away.", "Ibuprofen also did not help.", "She reports recurrent abdominal pain that would self-resolve in the past but states that \u201cthis one is way worse.\u201d Her past medical history is significant for diabetes and an appendectomy 2 years ago.", "The patient endorses nausea and 1 episode of emesis, but denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness.", "She used to smoke marijuana in college and drinks about 2 beers a week.", "A physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness.", "Her vitals are within normal limits.", "Laboratory values are shown below: |  | Hemoglobin: 12 g/dL | Hematocrit: 34% | Leukocyte count: 4,900/mm^3 with normal differential | Platelet count: 160,000/mm^3 |  | Serum: | Na+: 138 mEq/L | Cl-: 98 mEq/L | K+: 4.8 mEq/L | HCO3-: 25 mEq/L  | Glucose: 123 mg/dL | Ca2+:  6.9 mg/dL | AST: 387 U/L | ALT: 297 U/L | ALP: 168 U/L | Lipase: 650 U/L (Normal 0 \u2013 160 U/L) |  | ."], "context_len": 9, "options": {"A": "Abdominal computed tomography without IV contrast", "B": "Abdominal magnetic resonance imaging", "C": "Abdominal ultrasound", "D": "Upright chest and abdominal radiograph"}, "answer": "Abdominal ultrasound", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "39 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 39-year-old woman.", "2. She was brought to the emergency room by her fianc\u00e9.", "3. She has been experiencing severe abdominal pain for the past 5 hours.", "4. She was watching TV after dinner when she felt a sudden, sharp, 10/10 pain at the epigastric region that did not go away.", "5. Ibuprofen did not help.", "6. She has had recurrent abdominal pain in the past that would self-resolve.", "7. She states that \u201cthis one is way worse.\u201d", "8. Her past medical history is significant for diabetes and an appendectomy 2 years ago.", "9. She endorses nausea and 1 episode of emesis.", "10. She denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness.", "11. She used to smoke marijuana in college.", "12. She drinks about 2 beers a week.", "13. Physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness.", "14. Her vitals are within normal limits.", "15. Hemoglobin: 12 g/dL", "16. Hematocrit: 34%", "17. Leukocyte count: 4,900/mm^3 with normal differential", "18. Platelet count: 160,000/mm^3", "19. Serum Na+: 138 mEq/L", "20. Serum Cl-: 98 mEq/L", "21. Serum K+: 4.8 mEq/L", "22. Serum HCO3-: 25 mEq/L", "23. Serum Glucose: 123 mg/dL", "24. Serum Ca2+: 6.9 mg/dL", "25. AST: 387 U/L", "26. ALT: 297 U/L", "27. ALP: 168 U/L", "28. Lipase: 650 U/L (Normal 0 \u2013 160 U/L)"], "atomic_facts": ["1. The patient felt sudden, sharp, 10/10 pain at the epigastric region after watching TV after dinner.", "2. Ibuprofen did not help with the pain.", "3. The patient has a history of recurrent abdominal pain that would self-resolve in the past.", "4. The patient's past medical history includes diabetes and an appendectomy 2 years ago.", "5. The patient endorses nausea and 1 episode of emesis.", "6. The patient denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness.", "7. The patient used to smoke marijuana in college and drinks about 2 beers a week.", "8. A physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness.", "9. Laboratory values show: Hemoglobin: 12 g/dL, Hematocrit: 34%, Leukocyte count: 4,900/mm^3 with normal differential, Platelet count: 160,000/mm^3, Serum: Na+: 138 mEq/L, Cl-: 98 mEq/L, K+: 4.8 mEq/L, HCO3-: 25 mEq/L, Glucose: 123 mg/dL, Ca2+: 6.9 mg/dL, AST: 387 U/L, ALT: 297 U/L, ALP: 168 U/L, Lipase: 650 U/L (Normal 0 \u2013 160 U/L)."]}
{"id": 487, "question": "Which of the following is most likely to confirm the diagnosis for this patient?", "context": ["A 50-year-old man is evaluated for a 2-year history of intermittent, nonproductive, chronic cough, as well as mild dyspnea with exertion.", "He has a 20-pack-year history of smoking and is a current smoker.", "His medical history is significant for hypertension and type 2 diabetes mellitus, which he has controlled with diet and exercise.", "He also takes lisinopril.", "On physical examination, blood pressure is 125/76 mm Hg, pulse rate is 78/min, respiratory rate is 15/min, oxygen saturation is 98% (breathing room air), and his BMI is 25 kg/m2.", "There is no jugular venous distention.", "Heart sounds are normal, and there is no murmur.", "Auscultation of the lungs reveals faint, bilateral wheezing.", "No peripheral edema is noted.", "The remainder of the examination is normal."], "context_len": 10, "options": {"A": "Chest CT scan", "B": "Measurement of protease inhibitor", "C": "Spirometry", "D": "Cardiac catheterization"}, "answer": "Spirometry", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "50 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 50-year-old man.", "2. Patient has a 2-year history of intermittent, nonproductive, chronic cough.", "3. Patient has mild dyspnea with exertion.", "4. Patient has a 20-pack-year history of smoking.", "5. Patient is a current smoker.", "6. Patient has a medical history of hypertension.", "7. Patient has a medical history of type 2 diabetes mellitus.", "8. Patient has controlled diabetes mellitus with diet and exercise.", "9. Patient takes lisinopril.", "10. Patient's blood pressure is 125/76 mm Hg.", "11. Patient's pulse rate is 78/min.", "12. Patient's respiratory rate is 15/min.", "13. Patient's oxygen saturation is 98% (breathing room air).", "14. Patient's BMI is 25 kg/m2.", "15. Patient has no jugular venous distention.", "16. Patient's heart sounds are normal.", "17. Patient has no murmur.", "18. Auscultation of the lungs reveals faint, bilateral wheezing.", "19. Patient has no peripheral edema.", "20. The remainder of the examination is normal."], "atomic_facts": ["1. He has a 20-pack-year history of smoking", "2. He is a current smoker", "3. His medical history is significant for hypertension", "4. His medical history is significant for type 2 diabetes mellitus", "5. He has controlled his diabetes with diet and exercise", "6. He takes lisinopril", "7. His blood pressure is 125/76 mm Hg", "8. His pulse rate is 78/min", "9. His respiratory rate is 15/min", "10. His oxygen saturation is 98% (breathing room air)", "11. His BMI is 25 kg/m2", "12. There is no jugular venous distention", "13. Heart sounds are normal", "14. There is no murmur", "15. Auscultation of the lungs reveals faint, bilateral wheezing", "16. No peripheral edema is noted", "17. The remainder of the examination is normal"]}
{"id": 488, "question": "Which of the following is the best course of treatment for this patient?", "context": ["A 51-year-old woman presents with bilateral hand tremors.", "She has had these tremors for several years, and her symptoms have gradually worsened over time.", "The tremors are restricted to her hands and are most prominent when she is holding a cup of tea or a pen.", "The tremors get worse when she is under stress or exhausted, and they are starting to disrupt her work routine.", "She denies walking difficulties, speech problems, and weakness.", "Her past medical history is significant for a recent hospitalization for an asthma exacerbation.", "Current medications include salmeterol, medium-dose fluticasone, and a daily multivitamin.", "The patient denies smoking but drinks alcohol socially.", "The patient is afebrile and her vital signs are within normal limits.", "On physical examination, her hands have a noticeable tremor when in use and remain still while resting in her lap."], "context_len": 10, "options": {"A": "Baclofen", "B": "Primidone", "C": "Propranolol", "D": "Sodium valproate"}, "answer": "Primidone", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "51 years old", "specialties": ["Neurology"], "subspecialties": ["Movement Disorders"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 51 years old.", "2. Patient has bilateral hand tremors.", "3. Patient has had tremors for several years.", "4. Symptoms have gradually worsened over time.", "5. Tremors are restricted to hands.", "6. Tremors are most prominent when holding a cup of tea or a pen.", "7. Tremors get worse when under stress or exhausted.", "8. Tremors are starting to disrupt work routine.", "9. Patient denies walking difficulties, speech problems, and weakness.", "10. Patient has past medical history of recent hospitalization for asthma exacerbation.", "11. Current medications include salmeterol, medium-dose fluticasone, and daily multivitamin.", "12. Patient denies smoking.", "13. Patient drinks alcohol socially.", "14. Patient is afebrile.", "15. Vital signs are within normal limits.", "16. Hands have noticeable tremor when in use.", "17. Hands remain still when resting in lap."], "atomic_facts": ["1. The patient has had tremors for several years.", "2. Her symptoms have gradually worsened over time.", "3. The tremors are restricted to her hands.", "4. The tremors are most prominent when she is holding a cup of tea or a pen.", "5. The tremors worsen when she is under stress or exhausted.", "6. The tremors are starting to disrupt her work routine.", "7. She denies walking difficulties, speech problems, and weakness.", "8. Her past medical history includes a recent hospitalization for an asthma exacerbation.", "9. Her current medications include salmeterol, medium-dose fluticasone, and a daily multivitamin.", "10. The patient denies smoking but drinks alcohol socially.", "11. The patient is afebrile.", "12. Her vital signs are within normal limits.", "13. On physical examination, her hands have a noticeable tremor when in use and remain still while resting in her lap."]}
{"id": 489, "question": "If she was found to have a traumatic rupture of the aorta, where along the path of the aorta is the most common site of injury?", "context": ["A 39-year-old female was involved in a head-on collision motor vehicle accident."], "context_len": 1, "options": {"A": "Ascending aorta", "B": "Site of attachment of ligamentum arteriosum", "C": "Aortic isthmus", "D": "Descending aorta - Thoracic aorta"}, "answer": "Aortic isthmus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "39", "specialties": ["Cardiothoracic Surgery", "Cardiovascular Disease"], "subspecialties": ["Congenital Cardiac Surgery", "General Internal Medicine", "Thoracic and Cardiac Surgery", "General Thoracic Surgery"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 39-year-old female was involved.", "2. Head-on collision motor vehicle accident."], "atomic_facts": ["1. Age of the patient: 39 years old", "2. Gender of the patient: female", "3. Involvement in a motor vehicle accident", "4. Type of motor vehicle accident: head-on collision"]}
{"id": 490, "question": "Which of the following is the most likely explanation for the direction of flow of blood across this shunt?", "context": ["A previously healthy 2-month-old boy is brought to the physician because of a 10-day history of poor feeding.", "He used to feed for 20 minutes but now needs 40 minutes.", "He struggles to breathe and sweats while feeding.", "He was born at 38 weeks' gestation.", "He is at the 20th percentile for length and 10th percentile for weight.", "His vital signs are within normal limits.", "Pulse oximetry on room air shows an oxygen saturation of 98%.", "A grade 3/6 holosystolic murmur is heard at the left lower sternal border.", "An ECG shows left-axis deviation.", "An x-ray of the chest shows an enlarged left atrium and ventricle and increased pulmonary vascular markings.", "Doppler echocardiography confirms the presence of an intracardiac shunt."], "context_len": 11, "options": {"A": "Communication between the right and left atria", "B": "Right ventricular outflow tract obstruction", "C": "Increase in pulmonary vascular resistance", "D": "Decrease in pulmonary vascular resistance"}, "answer": "Decrease in pulmonary vascular resistance", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "2 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 2-month-old boy.", "2. Patient has a 10-day history of poor feeding.", "3. Patient used to feed for 20 minutes, but now needs 40 minutes.", "4. Patient struggles to breathe and sweats while feeding.", "5. Patient was born at 38 weeks' gestation.", "6. Patient is at the 20th percentile for length.", "7. Patient is at the 10th percentile for weight.", "8. Patient's vital signs are within normal limits.", "9. Pulse oximetry on room air shows an oxygen saturation of 98%.", "10. Grade 3/6 holosystolic murmur is heard at the left lower sternal border.", "11. ECG shows left-axis deviation.", "12. X-ray of the chest shows an enlarged left atrium and ventricle and increased pulmonary vascular markings.", "13. Doppler echocardiography confirms the presence of an intracardiac shunt."], "atomic_facts": ["1. He used to feed for 20 minutes but now needs 40 minutes.", "2. He struggles to breathe and sweats while feeding.", "3. He was born at 38 weeks' gestation.", "4. He is at the 20th percentile for length and 10th percentile for weight.", "5. His vital signs are within normal limits.", "6. Pulse oximetry on room air shows an oxygen saturation of 98%.", "7. A grade 3/6 holosystolic murmur is heard at the left lower sternal border.", "8. An ECG shows left-axis deviation.", "9. An x-ray of the chest shows an enlarged left atrium and ventricle and increased pulmonary vascular markings.", "10. Doppler echocardiography confirms the presence of an intracardiac shunt."]}
{"id": 491, "question": "Which of the following is the most likely cause of this patient's findings?", "context": ["A 14-year-old boy is brought to the physician for a follow-up examination.", "He has allergic rhinitis and his only medication is cetirizine.", "He is at the 60th percentile for height and above the 95th percentile for weight and BMI.", "Vital signs are within the normal limits.", "Examination shows a slightly tender, firm, 1-cm subareolar mass in the left breast.", "There are no changes in the skin or nipple.", "The right breast is unremarkable.", "There is no palpable axillary lymphadenopathy.", "Axillary and pubic hair is present.", "Examination of the penis and testis shows no abnormalities.", "Neurologic examination shows no focal findings."], "context_len": 11, "options": {"A": "Adverse drug reaction", "B": "Leydig cell tumor", "C": "Ductal ectasia", "D": "Physiological development"}, "answer": "Physiological development", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "14 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is 14 years old.", "2. Patient has allergic rhinitis.", "3. Patient's only medication is cetirizine.", "4. Patient is at the 60th percentile for height.", "5. Patient is above the 95th percentile for weight and BMI.", "6. Vital signs are within the normal limits.", "7. Examination shows a slightly tender, firm, 1-cm subareolar mass in the left breast.", "8. There are no changes in the skin or nipple.", "9. The right breast is unremarkable.", "10. There is no palpable axillary lymphadenopathy.", "11. Axillary and pubic hair is present.", "12. Examination of the penis and testis shows no abnormalities.", "13. Neurologic examination shows no focal findings."], "atomic_facts": ["1. He has allergic rhinitis.", "2. His only medication is cetirizine.", "3. He is at the 60th percentile for height.", "4. He is above the 95th percentile for weight and BMI.", "5. Vital signs are within the normal limits.", "6. Examination shows a slightly tender, firm, 1-cm subareolar mass in the left breast.", "7. There are no changes in the skin or nipple.", "8. The right breast is unremarkable.", "9. There is no palpable axillary lymphadenopathy.", "10. Axillary and pubic hair is present.", "11. Examination of the penis and testis shows no abnormalities.", "12. Neurologic examination shows no focal findings."]}
{"id": 492, "question": "Which of the following should be started post-mastectomy to improve the patient\u2019s prognosis?", "context": ["A 54-year-old woman presents to her primary care physician complaining of a lump in her right breast.", "She first noticed it 1 month ago.", "Now she is worried that it may have grown.", "She claims that the lump is not painful or itchy, and she denies any abnormal nipple bleeding or discharge.", "She has a family history of breast cancer, including both her mother and older sister.", "Physical examination reveals a firm, immobile lump in the upper right breast.", "A mammogram is performed, which identifies an irregular mass with a fibrotically stranded border.", "A biopsy is performed that is positive for invasive ductal carcinoma.", "The patient is started on radiation induction therapy and scheduled for a modified radical mastectomy.", "Following tumor gene testing, the patient is found to be positive or the HER-2/neu oncogene."], "context_len": 10, "options": {"A": "Anastrozole", "B": "Corticosteroids", "C": "Leuprolide", "D": "Trastuzumab"}, "answer": "Trastuzumab", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "54", "specialties": ["Oncology"], "subspecialties": ["Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 54-year-old woman presents to her primary care physician.", "2. She is complaining of a lump in her right breast.", "3. She first noticed it 1 month ago.", "4. Now she is worried that it may have grown.", "5. She claims that the lump is not painful or itchy.", "6. She denies any abnormal nipple bleeding or discharge.", "7. She has a family history of breast cancer.", "8. Her mother and older sister both have breast cancer.", "9. Physical examination reveals a firm, immobile lump in the upper right breast.", "10. A mammogram is performed.", "11. The mammogram identifies an irregular mass with a fibrotically stranded border.", "12. A biopsy is performed.", "13. The biopsy is positive for invasive ductal carcinoma.", "14. The patient is started on radiation induction therapy.", "15. The patient is scheduled for a modified radical mastectomy.", "16. Following tumor gene testing, the patient is found to be positive for the HER-2/neu oncogene."], "atomic_facts": ["1. She first noticed the lump 1 month ago.", "2. She is worried that the lump may have grown.", "3. The lump is not painful or itchy.", "4. She denies abnormal nipple bleeding or discharge.", "5. She has a family history of breast cancer.", "6. Her mother and older sister had breast cancer.", "7. Physical examination reveals a firm, immobile lump in the upper right breast.", "8. A mammogram identifies an irregular mass with a fibrotically stranded border.", "9. A biopsy is positive for invasive ductal carcinoma.", "10. The patient is started on radiation induction therapy.", "11. The patient is scheduled for a modified radical mastectomy.", "12. Tumor gene testing shows the patient is positive for the HER-2/neu oncogene."]}
{"id": 493, "question": "Which of the following is associated with the most likely diagnosis?", "context": ["A 48-year-old man presents to his primary care physician concerned about his weight.", "He states he has been gaining weight though does not feel he has changed his diet.", "The patient also states he has felt fatigued lately and not himself.", "He denies taking any medications or using any illicit substances at baseline.", "His temperature is 99.2\u00b0F (37.3\u00b0C), blood pressure is 177/108 mmHg, pulse is 100/min, respirations are 18/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for an obese man with striae on his abdomen.", "A 24-hour urine free cortisol is collected and demonstrates an elevated cortisol level; however, a high dose of dexamethasone when administered results in no attenuation of cortisol release.", "A CT scan of the abdomen is within normal limits."], "context_len": 8, "options": {"A": "Adrenal adenoma", "B": "Decreased ACTH level", "C": "Enlargement of the facial bones", "D": "History of smoking"}, "answer": "History of smoking", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "48", "specialties": ["Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 48-year-old man presents to his primary care physician concerned about his weight.", "2. He states he has been gaining weight though does not feel he has changed his diet.", "3. The patient also states he has felt fatigued lately and not himself.", "4. He denies taking any medications or using any illicit substances at baseline.", "5. His temperature is 99.2\u00b0F (37.3\u00b0C).", "6. Blood pressure is 177/108 mmHg.", "7. Pulse is 100/min.", "8. Respirations are 18/min.", "9. Oxygen saturation is 98% on room air.", "10. Physical exam is notable for an obese man with striae on his abdomen.", "11. A 24-hour urine free cortisol is collected and demonstrates an elevated cortisol level.", "12. A high dose of dexamethasone when administered results in no attenuation of cortisol release.", "13. A CT scan of the abdomen is within normal limits."], "atomic_facts": ["1. The patient has been gaining weight.", "2. The patient does not feel he has changed his diet.", "3. The patient has been feeling fatigued lately.", "4. The patient denies taking any medications or using any illicit substances at baseline.", "5. The patient's temperature is 99.2\u00b0F (37.3\u00b0C).", "6. The patient's blood pressure is 177/108 mmHg.", "7. The patient's pulse is 100/min.", "8. The patient's respirations are 18/min.", "9. The patient's oxygen saturation is 98% on room air.", "10. Physical exam is notable for an obese man with striae on his abdomen.", "11. A 24-hour urine free cortisol is collected and demonstrates an elevated cortisol level.", "12. A high dose of dexamethasone when administered results in no attenuation of cortisol release.", "13. A CT scan of the abdomen is within normal limits."]}
{"id": 494, "question": "What is the Kozak consensus sequence?", "context": ["Advances in molecular biology have identified important factors and sequences required for transcription and translation of mRNA as well as multiple diseases associated with mutations.", "The Kozak sequence is one such finding from this research."], "context_len": 2, "options": {"A": "A sequence box that binds to NF-1", "B": "An untranslated region downstream of the the stop codon", "C": "An initiator of translation proximal to the start codon", "D": "A site to which the 50S ribosome binds"}, "answer": "An initiator of translation proximal to the start codon", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Medical Genetics and Genomics", "Pathology"], "subspecialties": ["Molecular Genetic Pathology", "Clinical Genetics and Genomics"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. Advances in molecular biology have identified important factors and sequences required for transcription and translation of mRNA.", "2. Advances in molecular biology have identified multiple diseases associated with mutations.", "3. The Kozak sequence is one finding from this research."], "atomic_facts": ["1. The Kozak sequence is a finding from research."]}
{"id": 495, "question": "Which of the following is the strongest predisposing factor for this patient's condition?", "context": ["A 3-week-old male infant is brought to the physician by his parents because they noticed that his head has been tilted to the left since birth.", "Physical examination shows the head turned toward the left side and the chin rotated toward the right.", "He cries during an attempt to rotate the head to the right.", "There is a firm, well-circumscribed mass on the left lower side of the neck."], "context_len": 4, "options": {"A": "Fetal macrosomia", "B": "Cesarean delivery", "C": "Intrauterine exposure to haloperidol", "D": "Preterm birth"}, "answer": "Fetal macrosomia", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "3 weeks old", "specialties": ["Orthopaedic Surgery", "Pediatrics"], "subspecialties": ["General Orthopaedic Surgery", "Pediatric Neurology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Physical Medicine and Rehabilitation"}, "facts_old": ["1. A 3-week-old male infant is brought to the physician by his parents.", "2. His parents noticed that his head has been tilted to the left since birth.", "3. Physical examination shows the head turned toward the left side.", "4. The chin is rotated toward the right.", "5. He cries during an attempt to rotate the head to the right.", "6. There is a firm, well-circumscribed mass on the left lower side of the neck."], "atomic_facts": ["1. Physical examination shows the head turned toward the left side.", "2. Physical examination shows the chin rotated toward the right.", "3. He cries during an attempt to rotate the head to the right.", "4. There is a firm, well-circumscribed mass on the left lower side of the neck."]}
{"id": 496, "question": "What is the most likely cause for the underlying abnormalities?", "context": ["A 13-month-old boy was brought to the clinic due to failure-to-thrive and mental impairment.", "Retinal findings are shown in the picture.", "The parents are healthy, but they previously had a child who died at 14 months of age."], "context_len": 3, "options": {"A": "Structural protein mutation", "B": "Genomic imprinting", "C": "Lysosomal enzyme mutation", "D": "Mitochondrial gene mutation"}, "answer": "Lysosomal enzyme mutation", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "13 months", "specialties": ["Medical Genetics and Genomics", "Pediatrics"], "subspecialties": ["General Medical Genetics and Genomics", "Metabolic Genetics", "General Pediatrics", "Clinical Genetics and Genomics"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 13-month-old boy was brought to the clinic.", "2. The reason for the visit was failure-to-thrive and mental impairment.", "3. Retinal findings are shown in the picture.", "4. The parents are healthy.", "5. The parents previously had a child who died at 14 months of age."], "atomic_facts": ["1. Retinal findings are shown in the picture.", "2. The parents are healthy.", "3. The parents previously had a child who died at 14 months of age."]}
{"id": 497, "question": "What is the most likely cause of this lab abnormality in this patient?", "context": ["A 24-year-old woman who is 16 weeks pregnant comes to your office requesting a referral for an abortion.", "Upon questioning she states that she is scared that her baby will be \"deformed\" because on routine screening she was found to have an elevated level of alpha-fetoprotein."], "context_len": 2, "options": {"A": "Trisomy 13", "B": "Trisomy 18", "C": "Trisomy 21", "D": "Inaccurate gestational age"}, "answer": "Inaccurate gestational age", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "24 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Complex Family Planning"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 24-year-old woman has come to the office.", "2. She is 16 weeks pregnant.", "3. She is requesting a referral for an abortion.", "4. She is scared that her baby will be \"deformed\".", "5. She had a routine screening which showed an elevated level of alpha-fetoprotein."], "atomic_facts": ["1. The patient is scared about her baby being \"deformed.\"", "2. The patient had routine screening.", "3. The routine screening showed an elevated level of alpha-fetoprotein."]}
{"id": 498, "question": "Evaluation of this patient's urine before treatment is initiated is most likely to show which of the following?", "context": ["A previously healthy 45-year-old man is brought to the emergency department after being found by a search and rescue team in the mountains.", "He has been without food or water for 30 hours.", "His temperature is 37\u00b0C (98.6\u00b0F), pulse is 123/min, respirations are 20/min, and blood pressure is 90/55 mm Hg.", "Physical examination shows decreased skin turgor and dry mucous membranes."], "context_len": 4, "options": {"A": "Low urine sodium and low urine osmolality", "B": "Low urine sodium with hyaline casts", "C": "High urine protein with fatty casts", "D": "Low urine osmolality with RBC casts"}, "answer": "Low urine sodium with hyaline casts", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "45", "specialties": ["Nephrology", "Internal Medicine"], "subspecialties": ["General Nephrology", "Nephrology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 45-year-old man was brought to the emergency department.", "2. He was found by a search and rescue team in the mountains.", "3. He had been without food or water for 30 hours.", "4. His temperature was 37\u00b0C (98.6\u00b0F).", "5. His pulse was 123/min.", "6. His respirations were 20/min.", "7. His blood pressure was 90/55 mm Hg.", "8. Physical examination showed decreased skin turgor.", "9. Physical examination showed dry mucous membranes."], "atomic_facts": ["1. He has been without food for 30 hours.", "2. He has been without water for 30 hours.", "3. His temperature is 37\u00b0C (98.6\u00b0F).", "4. His pulse is 123/min.", "5. His respirations are 20/min.", "6. His blood pressure is 90/55 mm Hg.", "7. Physical examination shows decreased skin turgor.", "8. Physical examination shows dry mucous membranes."]}
{"id": 499, "question": "Which of the following helps the bacterium in this infection bind to immunoglobulin and prevent phagocytosis when invading its host?", "context": ["A 14-year-old Caucasian male presents with painful erythematous and honey-colored crusted lesions around his mouth.", "Culture of the lesions reveals gram-positive cocci in clusters.", "Further analysis reveals bacteria that are beta-hemolytic, coagulase positive, catalase positive, and appear golden on the blood agar plate."], "context_len": 3, "options": {"A": "Protein A", "B": "Staphylokinase", "C": "Exfoliatin A", "D": "Neurotoxin"}, "answer": "Protein A", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "14", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 14-year-old Caucasian male.", "2. Patient has painful erythematous and honey-colored crusted lesions around his mouth.", "3. Culture of the lesions reveals gram-positive cocci in clusters.", "4. Further analysis reveals bacteria that are beta-hemolytic.", "5. Further analysis reveals bacteria that are coagulase positive.", "6. Further analysis reveals bacteria that are catalase positive.", "7. Further analysis reveals bacteria that appear golden on the blood agar plate."], "atomic_facts": ["1. Culture of the lesions reveals gram-positive cocci in clusters.", "2. Further analysis reveals bacteria that are beta-hemolytic.", "3. Further analysis reveals bacteria that are coagulase positive.", "4. Further analysis reveals bacteria that are catalase positive.", "5. Further analysis reveals bacteria that appear golden on the blood agar plate."]}
{"id": 500, "question": "Which of the following is most likely to have contributed to this patient's condition?", "context": ["A 70-year-old man comes to the physician for the evaluation of abdominal pain over the past month.", "The patient describes epigastric pain that radiates to the back.", "He also reports a 10-kg (22-lb) weight loss over the past 6 months.", "He has a history of untreated type 2 diabetes mellitus.", "He has not seen a doctor in 15 years.", "He is retired and spends most of his time at home watching TV.", "He rarely cooks and mainly eats fast food.", "He has smoked one pack of cigarettes daily for the past 50 years.", "He drinks 2\u20133 cans of beer per day.", "He appears pale.", "His temperature is 37\u00b0C (98.6\u00b0F), pulse is 80/min, and blood pressure is 150/90 mm Hg.", "Physical examination shows jaundice of the conjunctivae and the skin.", "The abdomen is soft, with no rebound or guarding.", "Laboratory studies show a serum glucose concentration of 260 mg/dL.", "Abdominal sonography shows enlargement of the gallbladder."], "context_len": 15, "options": {"A": "Smoking history", "B": "Poor dietary habits", "C": "History of alcohol use", "D": "Diabetes mellitus"}, "answer": "Smoking history", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "70", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 70 years old.", "2. Patient has abdominal pain for the past month.", "3. Patient describes epigastric pain that radiates to the back.", "4. Patient has lost 10 kg (22 lbs) in the past 6 months.", "5. Patient has a history of untreated type 2 diabetes mellitus.", "6. Patient has not seen a doctor in 15 years.", "7. Patient is retired and spends most of his time at home watching TV.", "8. Patient rarely cooks and mainly eats fast food.", "9. Patient has smoked one pack of cigarettes daily for the past 50 years.", "10. Patient drinks 2-3 cans of beer per day.", "11. Patient appears pale.", "12. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "13. Patient's pulse is 80/min.", "14. Patient's blood pressure is 150/90 mm Hg.", "15. Physical examination shows jaundice of the conjunctivae and the skin.", "16. Abdomen is soft, with no rebound or guarding.", "17. Laboratory studies show a serum glucose concentration of 260 mg/dL.", "18. Abdominal sonography shows enlargement of the gallbladder."], "atomic_facts": ["1. The patient describes epigastric pain that radiates to the back.", "2. He also reports a 10-kg (22-lb) weight loss over the past 6 months.", "3. He has a history of untreated type 2 diabetes mellitus.", "4. He has not seen a doctor in 15 years.", "5. He is retired and spends most of his time at home watching TV.", "6. He rarely cooks and mainly eats fast food.", "7. He has smoked one pack of cigarettes daily for the past 50 years.", "8. He drinks 2\u20133 cans of beer per day.", "9. He appears pale.", "10. His temperature is 37\u00b0C (98.6\u00b0F), pulse is 80/min, and blood pressure is 150/90 mm Hg.", "11. Physical examination shows jaundice of the conjunctivae and the skin.", "12. The abdomen is soft, with no rebound or guarding.", "13. Laboratory studies show a serum glucose concentration of 260 mg/dL.", "14. Abdominal sonography shows enlargement of the gallbladder."]}
{"id": 501, "question": "Of the following options, which is the most likely diagnosis?", "context": ["A 63-year-old African American man with a history of hypertension and dyslipidemia presents to the emergency department with facial swelling and difficulty breathing.", "Symptoms began suddenly that morning and continued to worsen.", "He started taking lisinopril several weeks ago.", "His blood pressure is 110/74 mm Hg, heart rate is 94/min, and respiratory rate is 20/min.", "Physical examination is notable for swelling of his lips and inspiratory stridor.", "Clinical lab results suggest a normal C1 esterase inhibitor level."], "context_len": 6, "options": {"A": "Erysipelas", "B": "Facial lymphedema", "C": "Drug-induced angioedema", "D": "Contact dermatitis"}, "answer": "Drug-induced angioedema", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "63", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 63-year-old African American man presented to the emergency department.", "2. He has a history of hypertension and dyslipidemia.", "3. Symptoms began suddenly that morning and continued to worsen.", "4. He started taking lisinopril several weeks ago.", "5. His blood pressure is 110/74 mm Hg.", "6. His heart rate is 94/min.", "7. His respiratory rate is 20/min.", "8. Physical examination is notable for swelling of his lips and inspiratory stridor.", "9. Clinical lab results suggest a normal C1 esterase inhibitor level."], "atomic_facts": ["1. Symptoms began suddenly that morning.", "2. Symptoms continued to worsen.", "3. He started taking lisinopril several weeks ago.", "4. His blood pressure is 110/74 mm Hg.", "5. His heart rate is 94/min.", "6. His respiratory rate is 20/min.", "7. Physical examination is notable for swelling of his lips.", "8. Physical examination is notable for inspiratory stridor.", "9. Clinical lab results suggest a normal C1 esterase inhibitor level."]}
{"id": 502, "question": "Which of the following is the greatest predisposing factor for this patient's condition?\"", "context": ["A 21-year-old female college student comes to the physician because of a two-week history of vaginal itching and burning.", "She also noticed white vaginal discharge despite cleaning her genital area daily using a \"\"soap-free, natural\"\" vaginal douche.", "She is worried that she might have contracted a sexually transmitted disease after meeting her new boyfriend around one month ago.", "She has type 1 diabetes mellitus.", "The patient swims for the college swimming team.", "She had an intrauterine device implanted 3 months ago and does not use barrier protection.", "She smokes one pack of cigarettes per day and does not drink alcohol.", "Speculum examination shows an erythematous vagina covered in copious white discharge.", "Her vaginal pH is 4.4 and the microscopic image of a KOH preparation shows multiple pseudohyphae."], "context_len": 9, "options": {"A": "Frequent vaginal douching", "B": "Unprotected sexual intercourse", "C": "Intrauterine device", "D": "Diabetes mellitus"}, "answer": "Diabetes mellitus", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "21 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 21-year-old female college student.", "2. Patient has a two-week history of vaginal itching and burning.", "3. Patient has noticed white vaginal discharge despite cleaning her genital area daily using a \"soap-free, natural\" vaginal douche.", "4. Patient is worried that she might have contracted a sexually transmitted disease after meeting her new boyfriend around one month ago.", "5. Patient has type 1 diabetes mellitus.", "6. Patient swims for the college swimming team.", "7. Patient had an intrauterine device implanted 3 months ago and does not use barrier protection.", "8. Patient smokes one pack of cigarettes per day and does not drink alcohol.", "9. Speculum examination shows an erythematous vagina covered in copious white discharge.", "10. Patient's vaginal pH is 4.4.", "11. Microscopic image of a KOH preparation shows multiple pseudohyphae."], "atomic_facts": ["1. The patient noticed white vaginal discharge despite cleaning her genital area daily using a \"soap-free, natural\" vaginal douche.", "2. She is worried that she might have contracted a sexually transmitted disease after meeting her new boyfriend around one month ago.", "3. She has type 1 diabetes mellitus.", "4. The patient swims for the college swimming team.", "5. She had an intrauterine device implanted 3 months ago and does not use barrier protection.", "6. She smokes one pack of cigarettes per day and does not drink alcohol.", "7. Speculum examination shows an erythematous vagina covered in copious white discharge.", "8. Her vaginal pH is 4.4.", "9. The microscopic image of a KOH preparation shows multiple pseudohyphae."]}
{"id": 503, "question": "Which of the following likely contributes to her orthopedic problems?", "context": ["A 72-year-old female recently fractured her hip in a fall.", "She suffers from regular joint pain in her fingers, and hip X-rays reveal low bone mineral density.", "She has a history of diabetes mellitus and was diagnosed 2 years ago with end-stage renal disease.", "Serum phosphate levels are markedly elevated."], "context_len": 4, "options": {"A": "Decreased serum aldosterone", "B": "Increased serum parathyroid hormone", "C": "Increased serum glucose", "D": "Chronic hypertension"}, "answer": "Increased serum parathyroid hormone", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "72", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 72-year-old female recently fractured her hip in a fall.", "2. She suffers from regular joint pain in her fingers.", "3. Hip X-rays reveal low bone mineral density.", "4. She has a history of diabetes mellitus.", "5. She was diagnosed 2 years ago with end-stage renal disease.", "6. Serum phosphate levels are markedly elevated."], "atomic_facts": ["1. She suffers from regular joint pain in her fingers.", "2. Hip X-rays reveal low bone mineral density.", "3. She has a history of diabetes mellitus.", "4. She was diagnosed 2 years ago with end-stage renal disease.", "5. Serum phosphate levels are markedly elevated."]}
{"id": 504, "question": "Which of the following chromosomes contain genes that may be mutated in this patient's disease?", "context": ["A 52-year-old man presents to his primary care physician for his annual check-up.", "He says that he has no health concerns; however, his wife is concerned that he has become increasingly forgetful.", "For example, he has become forgetful during his daily activities and recently has been getting lost during errands like shopping.", "She says that these symptoms have been occurring for about a year.", "She says that she became alarmed when he started forgetting the names of their children.", "Finally, over the last month he has become more irritable, which has led to several confrontations at work.", "Based on the age of onset for his disease, the patient is referred for genetic testing."], "context_len": 7, "options": {"A": "1", "B": "4", "C": "18", "D": "20"}, "answer": "1", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["General Medical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 52-year-old man presents to his primary care physician for his annual check-up.", "2. He says that he has no health concerns.", "3. His wife is concerned that he has become increasingly forgetful.", "4. He has become forgetful during his daily activities.", "5. He has been getting lost during errands like shopping.", "6. His wife says that these symptoms have been occurring for about a year.", "7. He has started forgetting the names of their children.", "8. Over the last month he has become more irritable.", "9. This has led to several confrontations at work.", "10. Based on the age of onset for his disease, the patient is referred for genetic testing."], "atomic_facts": ["1. The patient says he has no health concerns.", "2. The patient's wife is concerned about his increasing forgetfulness.", "3. The patient has been forgetful during daily activities.", "4. The patient has been getting lost during errands like shopping.", "5. The symptoms have been occurring for about a year.", "6. The wife became alarmed when the patient started forgetting the names of their children.", "7. Over the last month, the patient has become more irritable.", "8. The patient has had several confrontations at work due to irritability.", "9. The patient is referred for genetic testing based on the age of onset for his disease."]}
{"id": 505, "question": "Which of the following is the most appropriate treatment?", "context": ["A 23-year-old woman, gravida 2, para 1, at 13 weeks gestation, comes to the physician because of a 2-day history of burning pain during urination.", "She has been sexually active with different male partners during the pregnancy and did not use condoms.", "She has not had any fever, chills, or pelvic pain.", "Physical examination shows thick, purulent discharge from the urethra.", "Urine dipstick shows leukocyte esterase, urinalysis shows 10 WBCs/hpf, and Gram stain of the urethral swab shows polymorphonuclear leukocytes with intracellular gram-negative diplococci.", "Pelvic ultrasound shows a viable intrauterine pregnancy."], "context_len": 6, "options": {"A": "Oral levofloxacin", "B": "Intramuscular ceftriaxone", "C": "Oral erythromycin", "D": "Intramuscular ceftriaxone and oral azithromycin\n\""}, "answer": "Intramuscular ceftriaxone and oral azithromycin\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "23 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 23-year-old woman.", "2. Patient is gravida 2, para 1.", "3. Patient is 13 weeks gestation.", "4. Patient has a 2-day history of burning pain during urination.", "5. Patient has been sexually active with different male partners during the pregnancy.", "6. Patient did not use condoms.", "7. Patient has not had any fever, chills, or pelvic pain.", "8. Physical examination shows thick, purulent discharge from the urethra.", "9. Urine dipstick shows leukocyte esterase.", "10. Urinalysis shows 10 WBCs/hpf.", "11. Gram stain of the urethral swab shows polymorphonuclear leukocytes with intracellular gram-negative diplococci.", "12. Pelvic ultrasound shows a viable intrauterine pregnancy."], "atomic_facts": ["1. She has been sexually active with different male partners during the pregnancy and did not use condoms.", "2. She has not had any fever, chills, or pelvic pain.", "3. Physical examination shows thick, purulent discharge from the urethra.", "4. Urine dipstick shows leukocyte esterase.", "5. Urinalysis shows 10 WBCs/hpf.", "6. Gram stain of the urethral swab shows polymorphonuclear leukocytes with intracellular gram-negative diplococci.", "7. Pelvic ultrasound shows a viable intrauterine pregnancy."]}
{"id": 506, "question": "What is the most likely diagnosis?", "context": ["A 20-year-old college student is brought to his primary care physician by his parents over the New Years holiday because they are concerned about his behavior since right after high school graduation in May the spring before.", "Prior to this year, he was generally an outgoing and social young man, who now reportedly has been spending the majority of his time alone in his dorm room and room at home, where his mother and father have overheard him talking to other people when he has no guests.", "When asked if anything was bothering him at school, he reports that at night the voice of the school's mascot encourages him to save the school from the large oak grove that will soon takeover the student union building by setting the trees on fire for all to see.", "On exam, his appears to be otherwise healthy and his urine toxicology screen is negative."], "context_len": 4, "options": {"A": "Schizoaffective disorder", "B": "Major depression", "C": "Schizophrenia", "D": "Schizophreniform disorder"}, "answer": "Schizophrenia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Not specified", "age": "20 years old", "specialties": ["Psychiatry"], "subspecialties": ["Child and Adolescent Psychiatry", "Schizophrenia"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 20-year-old college student is brought to his primary care physician by his parents. ", "2. The visit is over the New Years holiday. ", "3. The parents are concerned about his behavior since right after high school graduation in May the spring before. ", "4. Prior to this year, he was generally an outgoing and social young man. ", "5. He has been spending the majority of his time alone in his dorm room and room at home. ", "6. His mother and father have overheard him talking to other people when he has no guests. ", "7. When asked if anything was bothering him at school, he reports that at night the voice of the school's mascot encourages him to save the school from the large oak grove. ", "8. The oak grove will soon takeover the student union building. ", "9. The voice encourages him to set the trees on fire for all to see. ", "10. On exam, his appears to be otherwise healthy. ", "11. His urine toxicology screen is negative."], "atomic_facts": ["1. Prior to this year, he was generally an outgoing and social young man.", "2. He has reportedly been spending the majority of his time alone in his dorm room and room at home.", "3. His mother and father have overheard him talking to other people when he has no guests.", "4. When asked if anything was bothering him at school, he reports that at night the voice of the school's mascot encourages him to save the school from the large oak grove that will soon takeover the student union building by setting the trees on fire for all to see.", "5. On exam, he appears to be otherwise healthy.", "6. His urine toxicology screen is negative."]}
{"id": 507, "question": "This patient is at greatest risk for which of the following complications?", "context": ["A 58-year-old man comes to the physician for evaluation of an increasing left-sided cheek swelling and recurrent oral ulcers for 1 year.", "He has smoked a pack of cigarettes daily for 25 years.", "Examination shows a mild, nontender swelling above the angle of the left jaw.", "An ultrasound-guided biopsy of the mass confirms the diagnosis of parotid adenoid cystic carcinoma.", "A left-sided total parotidectomy is performed."], "context_len": 5, "options": {"A": "Hyperesthesia of the left ear lobe", "B": "Impaired taste of the posterior 1/3 of the tongue", "C": "Flushing of the right cheek while eating", "D": "Inability to wrinkle the left side of the forehead"}, "answer": "Inability to wrinkle the left side of the forehead", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "58 years old", "specialties": ["Dermatology", "Otolaryngology"], "subspecialties": ["General Dermatology", "General Otolaryngology"], "specialty_prob": [0.5, 0.5], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 58-year-old man comes to the physician for evaluation of an increasing left-sided cheek swelling and recurrent oral ulcers for 1 year.", "2. He has smoked a pack of cigarettes daily for 25 years.", "3. Examination shows a mild, nontender swelling above the angle of the left jaw.", "4. An ultrasound-guided biopsy of the mass confirms the diagnosis of parotid adenoid cystic carcinoma.", "5. A left-sided total parotidectomy is performed."], "atomic_facts": ["1. He has smoked a pack of cigarettes daily for 25 years.", "2. Examination shows a mild, nontender swelling above the angle of the left jaw.", "3. An ultrasound-guided biopsy of the mass confirms the diagnosis of parotid adenoid cystic carcinoma.", "4. A left-sided total parotidectomy is performed."]}
{"id": 508, "question": "Which of the following responses by the physician is the most appropriate?", "context": ["A 34-year-old man comes to the physician for a routine health maintenance examination required for his occupation as a school bus driver.", "He feels well and healthy.", "Upon questioning, he reports that he has smoked 2 joints of marijuana every night after work for the past year for recreational purposes.", "He typically smokes 5 joints or more on weekends."], "context_len": 4, "options": {"A": "\"\"\"Let me know when you are ready to stop smoking marijuana. We can talk about specific strategies to help you quit at that time.\"\"\"", "B": "\"\"\"Have you ever experienced a situation in which you wished you smoked less marijuana?\"\"\"", "C": "\"\"\"We have a great program to help patients with substance use disorder issues. Let me give you more information about specific details.\"\"\"", "D": "\"\"\"You should stop smoking marijuana because it is not good for your health.\"\"\""}, "answer": "\"\"\"Have you ever experienced a situation in which you wished you smoked less marijuana?\"\"\"", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "34", "specialties": ["Psychiatry"], "subspecialties": ["Addiction Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Preventive Medicine"}, "facts_old": ["1. A 34-year-old man comes to the physician for a routine health maintenance examination.", "2. The man's occupation is a school bus driver.", "3. The man feels well and healthy.", "4. The man has smoked 2 joints of marijuana every night after work for the past year.", "5. The man smokes marijuana for recreational purposes.", "6. The man typically smokes 5 joints or more on weekends."], "atomic_facts": ["1. The patient feels well and healthy.", "2. The patient has smoked 2 joints of marijuana every night after work for the past year for recreational purposes.", "3. The patient typically smokes 5 joints or more on weekends."]}
{"id": 509, "question": "Which of the following metabolites is most likely elevated in this patient?", "context": ["A 6-year-old girl of Moroccan descent is brought to the pediatrician by her father who is concerned about the child developing a body odor.", "He reports that she has started to smell \u201clike a teenage boy\u201d especially after physical activity.", "The child has had limited medical follow-up since being born in Morocco and immigrating to the United States at 3 years of age.", "Her temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 150/90 mmHg, pulse is 85/min, and respirations are 18/min.", "On exam, she has hair in her axillary and pubic regions.", "Genital examination demonstrates clitoral enlargement and labioscrotal fusion."], "context_len": 6, "options": {"A": "Aldosterone", "B": "Cortisol", "C": "11-deoxycorticosterone", "D": "Leutenizing hormone"}, "answer": "11-deoxycorticosterone", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 6-year-old girl of Moroccan descent is brought to the pediatrician by her father. ", "2. The father is concerned about the child developing a body odor. ", "3. He reports that she has started to smell \u201clike a teenage boy\u201d especially after physical activity. ", "4. The child has had limited medical follow-up since being born in Morocco and immigrating to the United States at 3 years of age. ", "5. Her temperature is 99\u00b0F (37.2\u00b0C). ", "6. Her blood pressure is 150/90 mmHg. ", "7. Her pulse is 85/min. ", "8. Her respirations are 18/min. ", "9. On exam, she has hair in her axillary and pubic regions. ", "10. Genital examination demonstrates clitoral enlargement and labioscrotal fusion."], "atomic_facts": ["1. The patient reports that she has started to smell \"like a teenage boy\" especially after physical activity.", "2. The child has had limited medical follow-up since being born in Morocco and immigrating to the United States at 3 years of age.", "3. Her temperature is 99\u00b0F (37.2\u00b0C).", "4. Her blood pressure is 150/90 mmHg.", "5. Her pulse is 85/min.", "6. Her respirations are 18/min.", "7. On exam, she has hair in her axillary and pubic regions.", "8. Genital examination demonstrates clitoral enlargement and labioscrotal fusion."]}
{"id": 510, "question": "While getting up to leave, the patient asks \u201cwhy is it that I always get these symptoms but my husband is fine?\u201d What is the most appropriate answer to this patient\u2019s question?", "context": ["A 25-year-old woman presents to the clinic for burning with urination.", "She is a newlywed and reports 3 similar episodes within the past 4 months.", "She claims that since yesterday she has noticed a burning sensation whenever she urinates, an increase in urinary frequency, and some clear vaginal discharge.", "She denies fever, chills, back pain, or chest pain.", "Her past medical history is significant for chlamydia that was adequately treated 3 years ago.", "She is currently sexually active with her husband and has an IUD.", "She is subsequently prescribed a course of nitrofurantoin for her symptoms."], "context_len": 7, "options": {"A": "Her partner is an asymptomatic carrier", "B": "Inadequate treatment of her prior episodes", "C": "The female urethra is shorter", "D": "The patient is experiencing recurrence of her past chlamydial infection"}, "answer": "The female urethra is shorter", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Family Medicine"}, "facts_old": ["1. A 25-year-old woman presents to the clinic for burning with urination.", "2. She reports 3 similar episodes within the past 4 months.", "3. She claims that since yesterday she has noticed a burning sensation whenever she urinates, an increase in urinary frequency, and some clear vaginal discharge.", "4. She denies fever, chills, back pain, or chest pain.", "5. Her past medical history is significant for chlamydia that was adequately treated 3 years ago.", "6. She is a newlywed.", "7. She is currently sexually active with her husband.", "8. She has an IUD.", "9. She is subsequently prescribed a course of nitrofurantoin for her symptoms."], "atomic_facts": ["1. She is a newlywed.", "2. She reports 3 similar episodes within the past 4 months.", "3. Since yesterday, she has noticed a burning sensation whenever she urinates.", "4. She has noticed an increase in urinary frequency since yesterday.", "5. She has noticed some clear vaginal discharge since yesterday.", "6. She denies fever.", "7. She denies chills.", "8. She denies back pain.", "9. She denies chest pain.", "10. Her past medical history is significant for chlamydia.", "11. The chlamydia was adequately treated 3 years ago.", "12. She is currently sexually active with her husband.", "13. She has an IUD.", "14. She is subsequently prescribed a course of nitrofurantoin for her symptoms."]}
{"id": 511, "question": "Which of the following is the most likely pathogen?", "context": ["A 17-year-old boy comes to the physician 1 week after noticing a lesion on his penis.", "There is no history of itching or pain associated with the lesion.", "He is sexually active with two female partners and uses condoms inconsistently.", "Five weeks ago, he returned from a trip to the Caribbean with some of his football teammates.", "He takes no medications.", "He has recently started an intense exercise program.", "His vital signs are within normal limits.", "Physical examination shows multiple enlarged, nontender lymph nodes in the inguinal area bilaterally.", "A photograph of the lesion is shown."], "context_len": 9, "options": {"A": "Mycoplasma genitalium", "B": "Human papillomavirus", "C": "Treponema pallidum", "D": "Herpes simplex virus type 2"}, "answer": "Treponema pallidum", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "17 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 17-year-old boy comes to the physician.", "2. He noticed a lesion on his penis 1 week ago.", "3. There is no history of itching or pain associated with the lesion.", "4. He is sexually active with two female partners.", "5. He uses condoms inconsistently.", "6. He returned from a trip to the Caribbean with some of his football teammates 5 weeks ago.", "7. He takes no medications.", "8. He has recently started an intense exercise program.", "9. His vital signs are within normal limits.", "10. Physical examination shows multiple enlarged, nontender lymph nodes in the inguinal area bilaterally.", "11. A photograph of the lesion is shown."], "atomic_facts": ["1. No history of itching or pain associated with the lesion.", "2. He is sexually active with two female partners and uses condoms inconsistently.", "3. Five weeks ago, he returned from a trip to the Caribbean with some of his football teammates.", "4. He takes no medications.", "5. He has recently started an intense exercise program.", "6. His vital signs are within normal limits.", "7. Physical examination shows multiple enlarged, nontender lymph nodes in the inguinal area bilaterally.", "8. A photograph of the lesion is shown."]}
{"id": 512, "question": "Which of the following constitutes the first-line therapy in this patient?", "context": ["A 36-year-old man presents to a physician for a post-transplant medical evaluation.", "He has been taking prednisone and azathioprine for the last 6 months after receiving a cadaveric renal transplant.", "He complains of fever, cough, and anorexia for the last 6-7 days.", "His cough is productive of thick sputum.", "His temperature is 38.5\u00b0C (101.5\u00b0F).", "The physical examination is significant for diminished breath sounds over the left lower lung with dullness on percussion and increased vocal resonance.", "A left lower lobe nodule, 5 cm (2 in) in diameter with eccentric central cavitation, is visible on the chest X-ray.", "A sputum analysis reveals branched, irregular, gram-positive filamentous rods."], "context_len": 8, "options": {"A": "Erythromycin", "B": "Ceftazidime", "C": "Penicillin", "D": "Sulfisoxazole"}, "answer": "Sulfisoxazole", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "36", "specialties": ["Internal Medicine"], "subspecialties": ["Transplant Hepatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 36-year-old man presents to a physician for a post-transplant medical evaluation.", "2. He has been taking prednisone and azathioprine for the last 6 months after receiving a cadaveric renal transplant.", "3. He complains of fever, cough, and anorexia for the last 6-7 days.", "4. His cough is productive of thick sputum.", "5. His temperature is 38.5\u00b0C (101.5\u00b0F).", "6. The physical examination is significant for diminished breath sounds over the left lower lung with dullness on percussion and increased vocal resonance.", "7. A left lower lobe nodule, 5 cm (2 in) in diameter with eccentric central cavitation, is visible on the chest X-ray.", "8. A sputum analysis reveals branched, irregular, gram-positive filamentous rods."], "atomic_facts": ["1. He has been taking prednisone and azathioprine for the last 6 months after receiving a cadaveric renal transplant.", "2. He complains of fever, cough, and anorexia for the last 6-7 days.", "3. His cough is productive of thick sputum.", "4. His temperature is 38.5\u00b0C (101.5\u00b0F).", "5. The physical examination is significant for diminished breath sounds over the left lower lung with dullness on percussion and increased vocal resonance.", "6. A left lower lobe nodule, 5 cm (2 in) in diameter with eccentric central cavitation, is visible on the chest X-ray.", "7. A sputum analysis reveals branched, irregular, gram-positive filamentous rods."]}
{"id": 513, "question": "Which of the following is a reasonable first step in the management of this patient's condition?", "context": ["A 54-year-old woman presents to her gynecologist complaining of incontinence.", "She reports leakage of a small amount of urine when she coughs or laughs as well as occasionally when she is exercising.", "She denies any pain with urination.", "She underwent menopause 2 years ago and noted that this problem has increased in frequency since that time.", "Her history is significant only for three uncomplicated pregnancies with vaginal births.", "Urinalysis, post-void residual, and cystometrogram are conducted and all show normal results.", "The patient's vital signs are as follows: T 37.5 C, HR 80, BP 128/67, RR 12, and SpO2 99%.", "Physical examination is significant for pelvic organ prolapse on pelvic exam."], "context_len": 8, "options": {"A": "Kegel exercises", "B": "Bethanechol", "C": "Urethropexy", "D": "Tension-free vaginal tape"}, "answer": "Kegel exercises", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "54 years old", "specialties": ["Urology"], "subspecialties": ["Female Pelvic Medicine and Reconstructive Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is 54 years old.", "2. Patient is complaining of incontinence.", "3. Patient reports leakage of small amount of urine when coughing, laughing, and exercising.", "4. Patient denies any pain with urination.", "5. Patient underwent menopause 2 years ago.", "6. Problem has increased in frequency since menopause.", "7. Patient has had three uncomplicated pregnancies with vaginal births.", "8. Urinalysis, post-void residual, and cystometrogram show normal results.", "9. Patient's temperature is 37.5 C.", "10. Patient's heart rate is 80.", "11. Patient's blood pressure is 128/67.", "12. Patient's respiratory rate is 12.", "13. Patient's SpO2 is 99%.", "14. Pelvic organ prolapse is present on pelvic exam."], "atomic_facts": ["1. The patient reports leakage of a small amount of urine when she coughs or laughs.", "2. The patient reports leakage of urine occasionally when she is exercising.", "3. The patient denies any pain with urination.", "4. The patient underwent menopause 2 years ago.", "5. The patient noted that the urinary leakage problem has increased in frequency since menopause.", "6. The patient has a history of three uncomplicated pregnancies with vaginal births.", "7. Urinalysis shows normal results.", "8. Post-void residual test shows normal results.", "9. Cystometrogram shows normal results.", "10. The patient's vital signs are: T 37.5 C, HR 80, BP 128/67, RR 12, and SpO2 99%.", "11. Physical examination shows pelvic organ prolapse on pelvic exam."]}
{"id": 514, "question": "What is this metric also known as?", "context": ["Researchers from a public health institute located in the United States conducted a multicenter cohort study on a large number of elderly individuals in order to evaluate the protective effect of the new vaccine for herpes zoster (commonly known as shingles) reactivation.", "After a long follow-up period, the data shows that shingles developed in 15% of study participants who received the new vaccine compared to 20% of diseased study participants in the control group that did not receive the vaccine.", "If the new vaccine showed identical efficacy in groups with higher and lower risks of herpes zoster reactivation (e.g., 40% and 10% risk), the calculated protective proportion of 25% would be maintained, regardless of the different baseline risk for shingles development."], "context_len": 3, "options": {"A": "Event rate", "B": "Risk difference", "C": "Relative risk reduction", "D": "Absolute risk reduction"}, "answer": "Relative risk reduction", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine", "Preventive Medicine"], "subspecialties": ["Geriatric Medicine", "Public Health and General Preventive Medicine"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Researchers from a public health institute located in the United States conducted a multicenter cohort study. ", "2. The study was conducted on a large number of elderly individuals. ", "3. The purpose of the study was to evaluate the protective effect of the new vaccine for herpes zoster (commonly known as shingles) reactivation. ", "4. After a long follow-up period, the data shows that shingles developed in 15% of study participants who received the new vaccine. ", "5. 20% of diseased study participants in the control group that did not receive the vaccine developed shingles. ", "6. If the new vaccine showed identical efficacy in groups with higher and lower risks of herpes zoster reactivation (e.g., 40% and 10% risk), the calculated protective proportion of 25% would be maintained. ", "7. This would be true regardless of the different baseline risk for shingles development."], "atomic_facts": ["1. After a long follow-up period, the data shows that shingles developed in 15% of study participants who received the new vaccine.", "2. Shingles developed in 20% of diseased study participants in the control group that did not receive the vaccine.", "3. The new vaccine showed identical efficacy in groups with higher and lower risks of herpes zoster reactivation.", "4. For example, 40% and 10% risk.", "5. The calculated protective proportion of 25% would be maintained, regardless of the different baseline risk for shingles development."]}
{"id": 515, "question": "Which of the following has most likely been the long-term mechanism of his disease development?", "context": ["A 55-year-old gentleman has been working in a sand blasting factory for over 25 years.", "He presents to his primary care physician with what he describes as increasing shortness of breath.", "PFTs are performed describing a restrictive lung process."], "context_len": 3, "options": {"A": "Eosinophilic reaction", "B": "Phagocytosis of silica", "C": "Tuberculosis", "D": "Defective mucociliary transport"}, "answer": "Phagocytosis of silica", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 55-year-old gentleman has been working in a sand blasting factory for over 25 years.", "2. He presents to his primary care physician with what he describes as increasing shortness of breath.", "3. PFTs are performed.", "4. PFTs describe a restrictive lung process."], "atomic_facts": ["1. The patient presents to his primary care physician.", "2. He describes increasing shortness of breath.", "3. Pulmonary function tests (PFTs) are performed.", "4. The PFTs describe a restrictive lung process."]}
{"id": 516, "question": "Which of the following pathogens is most likely responsible for this patient\u2019s opportunistic infection?", "context": ["A 37-year-old man presents to the emergency department with acute loss of vision, slurred speech, and agitation.", "Past medical history is significant for HIV and hepatitis C, diagnosed 10 years ago for which he is non-compliant with medication.", "A T1 MRI of the brain shows asymmetric, hypointense white matter lesions."], "context_len": 3, "options": {"A": "Herpes virus 8", "B": "Candida albicans", "C": "JC virus", "D": "Pneumocystis jirovecii"}, "answer": "JC virus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "37 years old", "specialties": ["Neurology"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 37-year-old man presents to the emergency department.", "2. Symptoms include acute loss of vision, slurred speech, and agitation.", "3. Patient has a past medical history of HIV and hepatitis C.", "4. HIV and hepatitis C were diagnosed 10 years ago.", "5. Patient is non-compliant with medication.", "6. A T1 MRI of the brain was performed.", "7. MRI shows asymmetric, hypointense white matter lesions."], "atomic_facts": ["1. Past medical history includes HIV and hepatitis C.", "2. HIV and hepatitis C were diagnosed 10 years ago.", "3. The patient is non-compliant with medication for HIV and hepatitis C.", "4. A T1 MRI of the brain shows asymmetric, hypointense white matter lesions."]}
{"id": 517, "question": "Which of the following infectious agents is the most likely cause of this patient's skin condition?", "context": ["A 4-year-old girl is brought to the physician for evaluation of a rash that her mother noticed 5 months ago.", "The rash is not painful or itchy but she notices that her daughter sometimes picks at the \u201cspots.\u201d The girl's 2-year-old brother has also started developing similar skin lesions over the past month.", "The patient has no history of serious illness and takes no medications.", "She is in the 75th percentile for height and 50th percentile for weight.", "A photograph of the patient's rash is shown."], "context_len": 5, "options": {"A": "Human herpesvirus 8", "B": "Human papillomavirus", "C": "Poxvirus", "D": "Varicella-zoster virus"}, "answer": "Poxvirus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Dermatology"], "subspecialties": ["Pediatric Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 4-year-old girl is brought to the physician for evaluation of a rash.", "2. The rash was noticed by the mother 5 months ago.", "3. The rash is not painful or itchy.", "4. The girl sometimes picks at the \u201cspots.\u201d", "5. The girl's 2-year-old brother has also started developing similar skin lesions over the past month.", "6. The patient has no history of serious illness.", "7. The patient takes no medications.", "8. The patient is in the 75th percentile for height.", "9. The patient is in the 50th percentile for weight.", "10. A photograph of the patient's rash is shown."], "atomic_facts": ["1. The rash is not painful or itchy.", "2. The patient's daughter sometimes picks at the \"spots.\"", "3. The girl's 2-year-old brother has started developing similar skin lesions over the past month.", "4. The patient has no history of serious illness.", "5. The patient takes no medications.", "6. The patient is in the 75th percentile for height.", "7. The patient is in the 50th percentile for weight.", "8. A photograph of the patient's rash is shown."]}
{"id": 518, "question": "This patient's symptoms are most likely due to taking an antibiotic that inhibits which of the following enzymes?", "context": ["A 51-year-old police officer is brought to the emergency room after being shot in the abdomen.", "His wound was packed and bandaged by emergency medical services before he was transported to the hospital.", "His past medical history is notable for hypertension and diabetes.", "He takes metformin and lisinopril.", "He has a 20-pack-year smoking history and does not drink alcohol.", "His temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 142/86 mmHg, pulse is 120/min, and respirations are 24/min.", "On exam, he appears uncomfortable but is able to answer questions appropriately.", "He has a 1 cm x 1 cm wound in the left upper quadrant.", "There is an exit wound in the left lower back.", "After undergoing the appropriate laboratory and imaging tests, he undergoes a diagnostic laparotomy.", "No involvement of the colon or small intestine is noted intraoperatively.", "He is placed on the appropriate antibiotic and pain control regimens.", "Three days later, he experiences several episodes of non-bloody diarrhea.", "His temperature is 101\u00b0F (38.3\u00b0C).", "Sigmoidoscopy reveals multiple pseudomembranous plaques in the sigmoid and descending colon."], "context_len": 15, "options": {"A": "30S ribosomal subunit", "B": "50S ribosomal subunit", "C": "Dihydropteroate synthetase", "D": "DNA-dependent RNA polymerase"}, "answer": "50S ribosomal subunit", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "51 years old", "specialties": ["Emergency Medicine", "Surgery"], "subspecialties": ["General Emergency Medicine", "General Surgery"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 51-year-old police officer is brought to the emergency room after being shot in the abdomen.", "2. His wound was packed and bandaged by emergency medical services before he was transported to the hospital.", "3. His past medical history is notable for hypertension and diabetes.", "4. He takes metformin and lisinopril.", "5. He has a 20-pack-year smoking history and does not drink alcohol.", "6. His temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 142/86 mmHg, pulse is 120/min, and respirations are 24/min.", "7. On exam, he appears uncomfortable but is able to answer questions appropriately.", "8. He has a 1 cm x 1 cm wound in the left upper quadrant.", "9. There is an exit wound in the left lower back.", "10. After undergoing the appropriate laboratory and imaging tests, he undergoes a diagnostic laparotomy.", "11. No involvement of the colon or small intestine is noted intraoperatively.", "12. He is placed on the appropriate antibiotic and pain control regimens.", "13. Three days later, he experiences several episodes of non-bloody diarrhea.", "14. His temperature is 101\u00b0F (38.3\u00b0C).", "15. Sigmoidoscopy reveals multiple pseudomembranous plaques in the sigmoid and descending colon."], "atomic_facts": ["1. His wound was packed and bandaged by emergency medical services before he was transported to the hospital.", "2. His past medical history is notable for hypertension and diabetes.", "3. He takes metformin and lisinopril.", "4. He has a 20-pack-year smoking history and does not drink alcohol.", "5. His temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 142/86 mmHg, pulse is 120/min, and respirations are 24/min.", "6. On exam, he appears uncomfortable but is able to answer questions appropriately.", "7. He has a 1 cm x 1 cm wound in the left upper quadrant.", "8. There is an exit wound in the left lower back.", "9. After undergoing the appropriate laboratory and imaging tests, he undergoes a diagnostic laparotomy.", "10. No involvement of the colon or small intestine is noted intraoperatively.", "11. He is placed on the appropriate antibiotic and pain control regimens.", "12. Three days later, he experiences several episodes of non-bloody diarrhea.", "13. His temperature is 101\u00b0F (38.3\u00b0C).", "14. Sigmoidoscopy reveals multiple pseudomembranous plaques in the sigmoid and descending colon."]}
{"id": 519, "question": "Which of the following is the most appropriate next step in the management of this patient?", "context": ["A 3-year-old girl is brought to the physician by her parents for the evaluation of vaginal discharge for one month.", "The discharge is foul-smelling and contains some blood.", "The patient sometimes has pain with urination.", "She has not had increased urinary frequency or abdominal pain.", "Topical vaginal cream application did not improve the patient's symptoms.", "There is no personal or family history of serious illness.", "She lives with her parents and attends a local daycare center.", "Vital signs are within normal limits.", "Examination of the vulva and vaginal entrance shows an intact hymen, vaginal erythema with blood-tinged, foul-smelling discharge, and the tip of a white object.", "The remainder of the examination shows no abnormalities."], "context_len": 10, "options": {"A": "Vaginal irrigation with warm saline", "B": "Vacuum suction", "C": "Alert Child Protective Services", "D": "Administration of oral metronidazole"}, "answer": "Vaginal irrigation with warm saline", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases", "Pediatric Gastroenterology", "Pediatric Urology"], "specialty_prob": [1.0], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 3-year-old girl is brought to the physician by her parents.", "2. The patient has had vaginal discharge for one month.", "3. The discharge is foul-smelling and contains some blood.", "4. The patient sometimes has pain with urination.", "5. She has not had increased urinary frequency or abdominal pain.", "6. Topical vaginal cream application did not improve the patient's symptoms.", "7. There is no personal or family history of serious illness.", "8. She lives with her parents and attends a local daycare center.", "9. Vital signs are within normal limits.", "10. Examination of the vulva and vaginal entrance shows an intact hymen.", "11. Examination of the vulva and vaginal entrance shows vaginal erythema with blood-tinged, foul-smelling discharge.", "12. Examination of the vulva and vaginal entrance shows the tip of a white object.", "13. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. The discharge is foul-smelling and contains some blood.", "2. The patient sometimes has pain with urination.", "3. She has not had increased urinary frequency or abdominal pain.", "4. Topical vaginal cream application did not improve the patient's symptoms.", "5. There is no personal or family history of serious illness.", "6. She lives with her parents and attends a local daycare center.", "7. Vital signs are within normal limits.", "8. Examination of the vulva and vaginal entrance shows an intact hymen, vaginal erythema with blood-tinged, foul-smelling discharge, and the tip of a white object.", "9. The remainder of the examination shows no abnormalities."]}
{"id": 520, "question": "Which of the following is the most likely diagnosis?", "context": ["A 60-year-old man comes to the physician because of a 3-month history of a slowly enlarging painless ulcer on his lower lip.", "One year ago he had a painful rash near his upper lip that resolved completely with acyclovir therapy.", "He has a 10-year history of type 2 diabetes mellitus treated with metformin.", "He has worked in construction for the past 33 years.", "He has smoked one pack of cigarettes daily for 35 years.", "Examination shows a 0.5 x 0.5 cm nontender ulcer with everted edges on the midline of his lower lip.", "The erythematous ulcer bleeds upon palpation.", "He has numerous moles of varying sizes all over his body.", "There are no palpable cervical lymph nodes."], "context_len": 9, "options": {"A": "Squamous cell carcinoma", "B": "Aphthous stomatitis", "C": "Psoriasis", "D": "Seborrheic keratosis"}, "answer": "Squamous cell carcinoma", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "60 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 60-year-old man comes to the physician.", "2. He has a 3-month history of a slowly enlarging painless ulcer on his lower lip.", "3. One year ago he had a painful rash near his upper lip.", "4. The rash resolved completely with acyclovir therapy.", "5. He has a 10-year history of type 2 diabetes mellitus.", "6. He is treated with metformin.", "7. He has worked in construction for the past 33 years.", "8. He has smoked one pack of cigarettes daily for 35 years.", "9. Examination shows a 0.5 x 0.5 cm nontender ulcer with everted edges on the midline of his lower lip.", "10. The erythematous ulcer bleeds upon palpation.", "11. He has numerous moles of varying sizes all over his body.", "12. There are no palpable cervical lymph nodes."], "atomic_facts": ["1. One year ago, he had a painful rash near his upper lip that resolved completely with acyclovir therapy.", "2. He has a 10-year history of type 2 diabetes mellitus treated with metformin.", "3. He has worked in construction for the past 33 years.", "4. He has smoked one pack of cigarettes daily for 35 years.", "5. Examination shows a 0.5 x 0.5 cm nontender ulcer with everted edges on the midline of his lower lip.", "6. The erythematous ulcer bleeds upon palpation.", "7. He has numerous moles of varying sizes all over his body.", "8. There are no palpable cervical lymph nodes."]}
{"id": 521, "question": "Which of the following is the patient most at risk for developing?", "context": ["A 3-year-old girl is brought to the pediatrician by her father for fever and cough.", "The patient\u2019s father states that she had a sore throat and runny nose 2 weeks ago.", "Then last night she developed a productive cough and a fever.", "The father is worried that this is pneumonia again, and reports that she has been hospitalized 5 times already with pneumonia.", "Her medical history is also significant for chronic diarrhea.", "The father reports that the patient has 2 older brothers who are both healthy.", "The patient\u2019s temperature is 102\u00b0F (38.9\u00b0C), blood pressure is 102/60 mmHg, pulse is 110/min, and respirations are 28/min with an oxygen saturation of 94% on room air.", "On physical examination, decreased breath sounds are appreciated on the right.", "A chest radiography shows consolidation in the right upper lobe, consistent with pneumonia.", "An antibody panel and flow cytometry are obtained in the setting of the patient\u2019s recurrent infections.", "The results show a normal lymphocyte count with low levels of IgA, IgG, and IgE and elevated levels of IgM."], "context_len": 11, "options": {"A": "Ataxia", "B": "Atopic dermatitis", "C": "Blurry vision", "D": "Scant tonsils"}, "answer": "Blurry vision", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 3-year-old girl is brought to the pediatrician by her father.", "2. The patient had a sore throat and runny nose 2 weeks ago.", "3. Last night she developed a productive cough and a fever.", "4. The father is worried that this is pneumonia again.", "5. The patient has been hospitalized 5 times already with pneumonia.", "6. The patient has a medical history of chronic diarrhea.", "7. The patient has 2 older brothers who are both healthy.", "8. The patient's temperature is 102\u00b0F (38.9\u00b0C).", "9. The patient's blood pressure is 102/60 mmHg.", "10. The patient's pulse is 110/min.", "11. The patient's respirations are 28/min with an oxygen saturation of 94% on room air.", "12. On physical examination, decreased breath sounds are appreciated on the right.", "13. A chest radiography shows consolidation in the right upper lobe, consistent with pneumonia.", "14. An antibody panel and flow cytometry are obtained in the setting of the patient's recurrent infections.", "15. The results show a normal lymphocyte count.", "16. The results show low levels of IgA, IgG, and IgE.", "17. The results show elevated levels of IgM."], "atomic_facts": ["1. The patient had a sore throat and runny nose 2 weeks ago.", "2. Last night, the patient developed a productive cough and a fever.", "3. The patient has been hospitalized 5 times already with pneumonia.", "4. The patient's medical history is significant for chronic diarrhea.", "5. The patient has 2 older brothers who are both healthy.", "6. The patient's temperature is 102\u00b0F (38.9\u00b0C), blood pressure is 102/60 mmHg, pulse is 110/min, and respirations are 28/min with an oxygen saturation of 94% on room air.", "7. On physical examination, decreased breath sounds are appreciated on the right.", "8. A chest radiography shows consolidation in the right upper lobe, consistent with pneumonia.", "9. An antibody panel and flow cytometry are obtained in the setting of the patient's recurrent infections.", "10. The results show a normal lymphocyte count with low levels of IgA, IgG, and IgE and elevated levels of IgM."]}
{"id": 522, "question": "Which type of patient would least likely have these same diagnostic findings?", "context": ["A 72-year-old man presents with urinary frequency resulting in frequent awakening to urinate at night.", "He is a retired elite runner and does not have a history of any chronic medical conditions.", "The patient denies weight loss, bone pain, or pain with urination.", "The patient is not in distress.", "Vitals show: temperature 36.8\u00b0C (98.2\u00b0F), heart rate 98/min, respiratory rate 15/min, and blood pressure 100/75 mm Hg.", "Physical exam is significant for a smooth, non-tender, uniformly enlarged prostate on digital rectal exam.", "There is no CVA tenderness.", "CBC, CMP, urinalysis, and abdominal ultrasound are ordered.", "Significant findings include: bilateral hydronephrosis on ultrasound, BUN/creatinine > 20:1, specific gravity > 1,020, FENa < 1%, urine Na < 20, and urine osmolality > 450 mOsm/kg.", "Furthermore, post-void residual volume is > 100 mL."], "context_len": 10, "options": {"A": "A 55-year-old Egyptian man with painless hematuria, 18.1 kg (40 lb) incidental weight loss and confirmed Schistosoma hematobium infection", "B": "A 27-year-old woman with waxing and waning internuclear ophthalmoplegia, scanning speech, and optic neuritis", "C": "An ICU patient with a kinked Foley catheter", "D": "A 35-year-old woman with severe colicky pain radiating to the left flank"}, "answer": "A 35-year-old woman with severe colicky pain radiating to the left flank", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "72 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is 72 years old.", "2. Patient is a retired elite runner.", "3. Patient has urinary frequency resulting in frequent awakening to urinate at night.", "4. Patient does not have a history of any chronic medical conditions.", "5. Patient denies weight loss, bone pain, or pain with urination.", "6. Patient is not in distress.", "7. Temperature is 36.8\u00b0C (98.2\u00b0F).", "8. Heart rate is 98/min.", "9. Respiratory rate is 15/min.", "10. Blood pressure is 100/75 mm Hg.", "11. Digital rectal exam reveals a smooth, non-tender, uniformly enlarged prostate.", "12. No CVA tenderness.", "13. Bilateral hydronephrosis on ultrasound.", "14. BUN/creatinine > 20:1.", "15. Specific gravity > 1,020.", "16. FENa < 1%.", "17. Urine Na < 20.", "18. Urine osmolality > 450 mOsm/kg.", "19. Post-void residual volume is > 100 mL."], "atomic_facts": ["1. The patient is a retired elite runner.", "2. The patient does not have a history of any chronic medical conditions.", "3. The patient denies weight loss, bone pain, or pain with urination.", "4. The patient is not in distress.", "5. Vitals show: temperature 36.8\u00b0C (98.2\u00b0F), heart rate 98/min, respiratory rate 15/min, and blood pressure 100/75 mm Hg.", "6. Physical exam is significant for a smooth, non-tender, uniformly enlarged prostate on digital rectal exam.", "7. There is no CVA tenderness.", "8. CBC, CMP, urinalysis, and abdominal ultrasound are ordered.", "9. Significant findings include: bilateral hydronephrosis on ultrasound, BUN/creatinine > 20:1, specific gravity > 1,020, FENa < 1%, urine Na < 20, and urine osmolality > 450 mOsm/kg.", "10. Post-void residual volume is > 100 mL."]}
{"id": 523, "question": "Which of the following is the most likely etiology of his bruises?", "context": ["An 82-year-old man with Alzheimer disease is brought to the physician by his daughter because of extensive bruising on his arms.", "He lives in an assisted living facility.", "Physical examination shows large ecchymoses across both forearms and upper arms in varied stages of healing.", "His hemoglobin concentration is 11.7 g/dL, mean corpuscular volume is 78 \u03bcm3, and platelet count is 180,000/mm3.", "Coagulation studies are within normal limits."], "context_len": 5, "options": {"A": "Platelet aggregation inhibition", "B": "Intravascular coagulation with fibrinolysis", "C": "Nonaccidental trauma", "D": "Vitamin K deficiency"}, "answer": "Nonaccidental trauma", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "82 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An 82-year-old man has Alzheimer disease.", "2. He was brought to the physician by his daughter.", "3. He has extensive bruising on his arms.", "4. He lives in an assisted living facility.", "5. Physical examination shows large ecchymoses across both forearms and upper arms in varied stages of healing.", "6. His hemoglobin concentration is 11.7 g/dL.", "7. His mean corpuscular volume is 78 \u03bcm3.", "8. His platelet count is 180,000/mm3.", "9. Coagulation studies are within normal limits."], "atomic_facts": ["1. He lives in an assisted living facility.", "2. Physical examination shows large ecchymoses across both forearms and upper arms in varied stages of healing.", "3. His hemoglobin concentration is 11.7 g/dL.", "4. Mean corpuscular volume is 78 \u03bcm3.", "5. Platelet count is 180,000/mm3.", "6. Coagulation studies are within normal limits."]}
{"id": 524, "question": "On bimanual examination, the uterus is normal size, non-tender, and mobile adnexa is non-palpable. | The pap smear result is as follows: | The pap smear result is as follows: | Specimen adequacy: satisfactory for evaluation | Interpretation: negative for intraepithelial lesion or malignancy | Notes: absent transformation zone component | How should we proceed with the management of this patient?", "context": ["A 23-year-old woman presents to her gynecologist for a routine visit.", "She is nulliparous, does not report any gynecologic or systemic diseases, and has no complaints.", "She is sexually active with one partner and uses oral contraceptive pills.", "Her vital signs are as follows: blood pressure 125/70 mm Hg, heart rate 81/min, respiratory rate 12/min, and temperature 36.6\u2103 (97.9\u2109).", "The physical examination is within normal limits.", "The breast examination is normal.", "No pathology is noted in the external genitalia and a speculum examination reveals a normal cervix with a closed external os and no discharge.", "A specimen is obtained from the cervical portion for a Pap smear."], "context_len": 8, "options": {"A": "Repeat Pap test in 3 years as a usual screening schedule suggests", "B": "Repeat Pap test within 2 weeks and ensure proper sampling from the transformation zone", "C": "Perform a screening test for high-risk human papillomavirus (HPV)", "D": "Perform a HPV testing and Pap smear in one year"}, "answer": "Repeat Pap test in 3 years as a usual screening schedule suggests", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "23", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 23-year-old woman presents to her gynecologist for a routine visit.", "2. She is nulliparous.", "3. She does not report any gynecologic or systemic diseases.", "4. She has no complaints.", "5. She is sexually active with one partner.", "6. She uses oral contraceptive pills.", "7. Her blood pressure is 125/70 mm Hg.", "8. Her heart rate is 81/min.", "9. Her respiratory rate is 12/min.", "10. Her temperature is 36.6\u2103 (97.9\u2109).", "11. The physical examination is within normal limits.", "12. The breast examination is normal.", "13. No pathology is noted in the external genitalia.", "14. A speculum examination reveals a normal cervix with a closed external os and no discharge.", "15. A specimen is obtained from the cervical portion for a Pap smear."], "atomic_facts": ["1. She is nulliparous.", "2. She does not report any gynecologic or systemic diseases.", "3. She has no complaints.", "4. She is sexually active with one partner.", "5. She uses oral contraceptive pills.", "6. Her blood pressure is 125/70 mm Hg.", "7. Her heart rate is 81/min.", "8. Her respiratory rate is 12/min.", "9. Her temperature is 36.6\u2103 (97.9\u2109).", "10. The physical examination is within normal limits.", "11. The breast examination is normal.", "12. No pathology is noted in the external genitalia.", "13. A speculum examination reveals a normal cervix with a closed external os and no discharge.", "14. A specimen is obtained from the cervical portion for a Pap smear."]}
{"id": 525, "question": "Which of the following best describe the primary disorder in this patient?", "context": ["A 57-year-old woman presents to the emergency department with acute pain in the left lower abdomen associated with nausea and vomiting for the past 24 hours.", "Prior to this episode, the patient did not have any significant gastrointestinal (GI) problems except for occasional constipation and indigestion after heavy meals.", "She has had hypertension and hypercholesterolemia for the past 7 years.", "Her family history is negative for GI disorders.", "Vital signs include a temperature of 38.0\u00b0C (100.4\u00b0F), blood pressure of 120/80 mm Hg, and pulse of 85/min.", "On physical examination, there is tenderness in the left lower abdominal quadrant.", "Abdominal CT scan shows thickening of the bowel wall and streaky mesenteric fat."], "context_len": 7, "options": {"A": "Obstruction of the lumen of the appendix", "B": "Inflammation of the renal parenchyma, calyces and pelvis", "C": "Herniation of mucosa and submucosa through the muscular layer of the colon", "D": "Inflammation of the upper genital tract"}, "answer": "Herniation of mucosa and submucosa through the muscular layer of the colon", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "57 years old", "specialties": ["Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 57-year-old woman presents to the emergency department with acute pain in the left lower abdomen associated with nausea and vomiting for the past 24 hours.", "2. Prior to this episode, the patient did not have any significant gastrointestinal (GI) problems except for occasional constipation and indigestion after heavy meals.", "3. She has had hypertension and hypercholesterolemia for the past 7 years.", "4. Her family history is negative for GI disorders.", "5. Vital signs include a temperature of 38.0\u00b0C (100.4\u00b0F), blood pressure of 120/80 mm Hg, and pulse of 85/min.", "6. On physical examination, there is tenderness in the left lower abdominal quadrant.", "7. Abdominal CT scan shows thickening of the bowel wall and streaky mesenteric fat."], "atomic_facts": ["1. The patient had occasional constipation and indigestion after heavy meals prior to the current episode.", "2. The patient has had hypertension and hypercholesterolemia for the past 7 years.", "3. The patient's family history is negative for GI disorders.", "4. Vital signs include a temperature of 38.0\u00b0C (100.4\u00b0F), blood pressure of 120/80 mm Hg, and pulse of 85/min.", "5. On physical examination, there is tenderness in the left lower abdominal quadrant.", "6. Abdominal CT scan shows thickening of the bowel wall and streaky mesenteric fat."]}
{"id": 526, "question": "Which of the following is the most likely diagnosis?", "context": ["A 35-year-old woman comes to the emergency department because of a 3-day history of pain in the left cheek.", "The pain occurs every few hours, lasts 30\u201360 seconds, and is aggravated by chewing and brushing.", "She has a history of pain with a vesicular rash in the right axillary area one year ago.", "She had an upper respiratory infection 2 weeks ago.", "Physical examination shows no abnormalities."], "context_len": 5, "options": {"A": "Cluster headache", "B": "Trigeminal neuralgia", "C": "Postherpetic neuralgia", "D": "Temporal arteritis"}, "answer": "Trigeminal neuralgia", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "35 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology", "Pain Medicine", "Headache Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.25, 0.25], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 35-year-old woman comes to the emergency department.", "2. She has a 3-day history of pain in the left cheek.", "3. The pain occurs every few hours.", "4. The pain lasts 30\u201360 seconds.", "5. The pain is aggravated by chewing and brushing.", "6. She has a history of pain with a vesicular rash in the right axillary area one year ago.", "7. She had an upper respiratory infection 2 weeks ago.", "8. Physical examination shows no abnormalities."], "atomic_facts": ["1. The pain occurs every few hours.", "2. The pain lasts 30\u201360 seconds.", "3. The pain is aggravated by chewing and brushing.", "4. She has a history of pain with a vesicular rash in the right axillary area one year ago.", "5. She had an upper respiratory infection 2 weeks ago.", "6. Physical examination shows no abnormalities."]}
{"id": 527, "question": "Which of the following chromosomes is most likely mutated in association with this patient's condition?", "context": ["A 45 year old male presents to clinic complaining of a ringing in his ears.", "The patient's vitals are: BP 120/65, RR 16, 100% on room air, HR 78 bpm and he appears to be in no acute distress.", "Upon obtaining a history you learn that this patient also complains that at times the \"room feels like it's spinning.\" You also notice throughout the interview that you have to speak loudly as the patient has difficulty hearing.", "The patient is then lost to follow up for his current condition.", "The patient returns several years later with worsening symptoms and as part of this patient's workup a MRI is obtained (Image A)."], "context_len": 5, "options": {"A": "Chromosome 13", "B": "Chromosome 17", "C": "Chromosome 22", "D": "The X chromosome"}, "answer": "Chromosome 22", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 45 year old male presents to clinic complaining of a ringing in his ears.", "2. BP 120/65, RR 16, 100% on room air, HR 78 bpm.", "3. Patient appears to be in no acute distress.", "4. Patient also complains that at times the \"room feels like it's spinning.\"", "5. Patient has difficulty hearing.", "6. Patient is then lost to follow up for his current condition.", "7. Patient returns several years later with worsening symptoms.", "8. MRI is obtained (Image A)."], "atomic_facts": ["1. The patient's vitals are: BP 120/65, RR 16, 100% on room air, HR 78 bpm.", "2. The patient appears to be in no acute distress.", "3. The patient complains of feeling like the \"room feels like it's spinning.\"", "4. The patient has difficulty hearing.", "5. The patient is lost to follow up for his current condition.", "6. The patient returns several years later with worsening symptoms.", "7. A MRI is obtained as part of the patient's workup (Image A)."]}
{"id": 528, "question": "What is the most likely diagnosis?", "context": ["A 35-year-old is brought into the emergency room after a bicycle vs motored vehicle accident.", "He was unconscious after hitting the side of his head on the road, but recovered consciousness after a few minutes.", "He started to ride his bicycle again, but then developed a severe headache with nausea and vomiting, at which time he called EMS.", "While in the hospital, the patient is confused and cannot provide a history.", "He quickly loses consciousness and his CT scan is displayed in Figure 1."], "context_len": 5, "options": {"A": "Subdural hematoma", "B": "Epidural hematoma", "C": "Subgaleal hematoma", "D": "Caput succedaneum"}, "answer": "Epidural hematoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "35 years old", "specialties": ["Neurological Surgery"], "subspecialties": ["General Neurological Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 35-year-old was brought into the emergency room.", "2. The patient was involved in a bicycle vs motored vehicle accident.", "3. He was unconscious after hitting the side of his head on the road.", "4. He recovered consciousness after a few minutes.", "5. He started to ride his bicycle again.", "6. He then developed a severe headache with nausea and vomiting.", "7. He called EMS at this time.", "8. While in the hospital, the patient was confused and could not provide a history.", "9. He quickly lost consciousness.", "10. His CT scan is displayed in Figure 1."], "atomic_facts": ["1. He was unconscious after hitting the side of his head on the road.", "2. He recovered consciousness after a few minutes.", "3. He started to ride his bicycle again.", "4. He developed a severe headache with nausea and vomiting.", "5. He called EMS at the time of developing severe symptoms.", "6. While in the hospital, the patient is confused.", "7. He cannot provide a history.", "8. He quickly loses consciousness.", "9. His CT scan is displayed in Figure 1."]}
{"id": 529, "question": "Which of the following auscultation findings is most likely to correlate with the severity of this patient's valvular disease?", "context": ["A 39-year-old man comes to the physician because of a 2-month history of shortness of breath with exertion.", "He immigrated to the United States from Ghana 20 years ago.", "His pulse is 88/min, respirations are 18/min, and blood pressure is 120/80 mm Hg.", "Echocardiography shows thickened mitral valve leaflets with reduced motion and a narrowed mitral valve orifice diameter."], "context_len": 4, "options": {"A": "Decreased time between S2 and opening snap", "B": "Radiation of murmur to the axilla", "C": "Increased intensity of the murmur", "D": "Absence of A2 heart sound"}, "answer": "Decreased time between S2 and opening snap", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "39 years old", "specialties": ["Cardiology"], "subspecialties": ["Cardiovascular Disease", "Valvular Heart Disease", "General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 39-year-old man comes to the physician.", "2. He has a 2-month history of shortness of breath with exertion.", "3. He immigrated to the United States from Ghana 20 years ago.", "4. His pulse is 88/min.", "5. His respirations are 18/min.", "6. His blood pressure is 120/80 mm Hg.", "7. Echocardiography shows thickened mitral valve leaflets.", "8. Echocardiography shows reduced motion of the mitral valve leaflets.", "9. Echocardiography shows a narrowed mitral valve orifice diameter."], "atomic_facts": ["1. He immigrated to the United States from Ghana 20 years ago.", "2. His pulse is 88/min.", "3. His respirations are 18/min.", "4. His blood pressure is 120/80 mm Hg.", "5. Echocardiography shows thickened mitral valve leaflets.", "6. Echocardiography shows reduced motion of the mitral valve.", "7. Echocardiography shows a narrowed mitral valve orifice diameter."]}
{"id": 530, "question": "Analysis of the bone marrow aspirate of this patient is most likely to show which of the following findings?", "context": ["A 6-year-old boy is brought to the physician because of worsening fatigue for the past 4 weeks.", "Examination of the head and neck shows conjunctival pallor, grayish-brown spots on the irises, prominent epicanthal folds, and a broad nasal bridge.", "He has a single transverse palmar crease, and there are scattered petechiae over the chest.", "An ultrasound of the abdomen shows enlargement of the liver and spleen."], "context_len": 4, "options": {"A": "Translocation t(15;17)", "B": "Ringed sideroblasts", "C": "CD10 positive cells", "D": "Hypocellular bone marrow"}, "answer": "CD10 positive cells", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-year-old boy is brought to the physician.", "2. The boy has been experiencing worsening fatigue for the past 4 weeks.", "3. Examination of the head and neck shows conjunctival pallor.", "4. Examination of the head and neck shows grayish-brown spots on the irises.", "5. Examination of the head and neck shows prominent epicanthal folds.", "6. Examination of the head and neck shows a broad nasal bridge.", "7. The boy has a single transverse palmar crease.", "8. There are scattered petechiae over the chest.", "9. An ultrasound of the abdomen shows enlargement of the liver.", "10. An ultrasound of the abdomen shows enlargement of the spleen."], "atomic_facts": ["1. Examination of the head and neck shows conjunctival pallor.", "2. Examination of the head and neck shows grayish-brown spots on the irises.", "3. Examination of the head and neck shows prominent epicanthal folds.", "4. Examination of the head and neck shows a broad nasal bridge.", "5. He has a single transverse palmar crease.", "6. There are scattered petechiae over the chest.", "7. An ultrasound of the abdomen shows enlargement of the liver and spleen."]}
{"id": 531, "question": "What is the diagnosis in this patient?", "context": ["A 42-year-old female presents to the emergency department with two days of severe abdominal pain and fever.", "The patient has a history of gallstones, for which she was scheduled to have a cholecystectomy in two weeks.", "On physical exam, her abdomen is tender to palpation over the epigastrium, without rebound or guarding.", "The patient is noticeably jaundiced.", "Laboratory evaluation is notable for a leukocytosis and a total bilirubin of 6.4 mg/dL."], "context_len": 5, "options": {"A": "Acute pancreatitis", "B": "Chronic pancreatitis", "C": "Acute cholangitis", "D": "Primary sclerosing cholangitis"}, "answer": "Acute cholangitis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "42", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 42-year-old female presents to the emergency department.", "2. She has two days of severe abdominal pain and fever.", "3. She has a history of gallstones.", "4. She was scheduled to have a cholecystectomy in two weeks.", "5. On physical exam, her abdomen is tender to palpation over the epigastrium, without rebound or guarding.", "6. The patient is noticeably jaundiced.", "7. Laboratory evaluation is notable for a leukocytosis.", "8. Laboratory evaluation is notable for a total bilirubin of 6.4 mg/dL."], "atomic_facts": ["1. The patient has a history of gallstones.", "2. The patient was scheduled to have a cholecystectomy in two weeks.", "3. On physical exam, the patient's abdomen is tender to palpation over the epigastrium.", "4. There is no rebound or guarding on physical exam.", "5. The patient is noticeably jaundiced.", "6. Laboratory evaluation shows leukocytosis.", "7. Laboratory evaluation shows a total bilirubin of 6.4 mg/dL."]}
{"id": 532, "question": "Which of the following characteristics of this patient most likely increased her risk for this disorder?", "context": ["A 52-year-old woman presents to her primary care physician because she has been feeling pain in her right leg.", "Specifically, she says that an area on her right thigh has been feeling tender and swollen over the past few weeks.", "Her past medical history is significant for obesity, poorly controlled diabetes, and hypertension.", "She also has been taking estrogen replacement therapy and drinking alcohol to cope with her symptoms of menopause.", "Her family history is significant for cardiomyopathy.", "On physical exam, there is erythema and edema along a cord-like lesion in her thigh.", "This lesion feels thick and hardened on palpation and is tender to the touch.", "She is started on compression therapy as well as NSAIDs for pain management."], "context_len": 8, "options": {"A": "Alcohol use", "B": "Diabetes", "C": "Estrogen therapy", "D": "Hypertension"}, "answer": "Estrogen therapy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "52 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 52-year-old woman presents to her primary care physician.", "2. She has been feeling pain in her right leg.", "3. Specifically, she says that an area on her right thigh has been feeling tender and swollen over the past few weeks.", "4. Her past medical history is significant for obesity, poorly controlled diabetes, and hypertension.", "5. She has been taking estrogen replacement therapy.", "6. She has been drinking alcohol to cope with her symptoms of menopause.", "7. Her family history is significant for cardiomyopathy.", "8. On physical exam, there is erythema and edema along a cord-like lesion in her thigh.", "9. This lesion feels thick and hardened on palpation.", "10. This lesion is tender to the touch.", "11. She is started on compression therapy.", "12. She is started on NSAIDs for pain management."], "atomic_facts": ["1. The patient reports tenderness and swelling in an area on her right thigh.", "2. The patient has a past medical history of obesity, poorly controlled diabetes, and hypertension.", "3. The patient has been taking estrogen replacement therapy and drinking alcohol to cope with menopausal symptoms.", "4. The patient's family history includes cardiomyopathy.", "5. On physical exam, there is erythema and edema along a cord-like lesion in her thigh.", "6. The lesion feels thick and hardened on palpation and is tender to the touch.", "7. The patient is started on compression therapy and NSAIDs for pain management."]}
{"id": 533, "question": "What medication did the patient take?", "context": ["A 34-year-old woman presents to the clinic complaining of constipation and dry mouth.", "She had uncontrollable diarrhea for 1 day and took some medications afterwards.", "Patient denies any recent hospitalizations or antibiotic use.", "She also denies melena, hematochezia, nausea, or vomiting.", "Vitals are within normal limits."], "context_len": 5, "options": {"A": "Loperamide", "B": "Oral vancomycin", "C": "Sulfasalazine", "D": "Setraline"}, "answer": "Loperamide", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 34-year-old woman presents to the clinic.", "2. She is complaining of constipation and dry mouth.", "3. She had uncontrollable diarrhea for 1 day.", "4. She took some medications afterwards.", "5. Patient denies any recent hospitalizations or antibiotic use.", "6. Patient denies melena, hematochezia, nausea, or vomiting.", "7. Vitals are within normal limits."], "atomic_facts": ["1. The patient had uncontrollable diarrhea for 1 day.", "2. The patient took some medications afterwards.", "3. The patient denies any recent hospitalizations.", "4. The patient denies any recent antibiotic use.", "5. The patient denies melena.", "6. The patient denies hematochezia.", "7. The patient denies nausea.", "8. The patient denies vomiting.", "9. The patient's vitals are within normal limits."]}
{"id": 534, "question": "What is the most likely cause of this patient\u2019s high blood pressure?", "context": ["A 25-year-old arrives at a gynecology clinic for a consult as she and her husband plan to conceive a baby soon.", "She is currently taking no medications, doesn\u2019t smoke, and drinks alcohol socially.", "Her father passed away at the age of 51 due to heart failure.", "Her vital signs include blood pressure 150/100 mm Hg, heart rate 67/min, respiratory rate 16/min, and temperature 36.7\u00b0C (98.0\u00b0F).", "Physical examination is unremarkable.", "When asked about her high blood pressure, the patient says that her primary care physician once told her that her blood pressure was elevated on most of her visits; the physician emphasized that she should exercise and control her diet, but she never followed up with him as she always felt good.", "A number of tests are run to find out the etiology of her elevated blood pressure.", "Everything is within the normal range except for a renal angiogram shown in the picture."], "context_len": 8, "options": {"A": "Atherosclerosis", "B": "Adult polycystic kidney disease", "C": "Fibromuscular hyperplasia", "D": "Pheochromocytoma"}, "answer": "Fibromuscular hyperplasia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "25", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 25-year-old is at a gynecology clinic for a consult.", "2. The patient and her husband plan to conceive a baby soon.", "3. The patient is not taking any medications.", "4. The patient does not smoke.", "5. The patient drinks alcohol socially.", "6. The patient's father passed away at the age of 51 due to heart failure.", "7. The patient's blood pressure is 150/100 mm Hg.", "8. The patient's heart rate is 67/min.", "9. The patient's respiratory rate is 16/min.", "10. The patient's temperature is 36.7\u00b0C (98.0\u00b0F).", "11. The physical examination is unremarkable.", "12. The patient's primary care physician told her that her blood pressure was elevated on most of her visits.", "13. The primary care physician emphasized that the patient should exercise and control her diet.", "14. The patient never followed up with her primary care physician as she always felt good.", "15. Tests are run to find out the etiology of the patient's elevated blood pressure.", "16. Everything is within the normal range except for a renal angiogram shown in the picture."], "atomic_facts": ["1. She is currently taking no medications.", "2. She doesn\u2019t smoke.", "3. She drinks alcohol socially.", "4. Her father passed away at the age of 51 due to heart failure.", "5. Her vital signs include blood pressure 150/100 mm Hg.", "6. Her heart rate is 67/min.", "7. Her respiratory rate is 16/min.", "8. Her temperature is 36.7\u00b0C (98.0\u00b0F).", "9. Physical examination is unremarkable.", "10. The patient's primary care physician once told her that her blood pressure was elevated on most of her visits.", "11. The physician emphasized that she should exercise and control her diet.", "12. She never followed up with her physician as she always felt good.", "13. A number of tests are run to find out the etiology of her elevated blood pressure.", "14. Everything is within the normal range except for a renal angiogram shown in the picture."]}
{"id": 535, "question": "Which of the following embryonic structures most likely gave rise to the thickening described here?", "context": ["A 73-year-old man is found to have an early stage hepatocellular carcinoma in the left lobe of his liver.", "He decides to undergo surgery to remove the tumor through partial liver resection.", "During the procedure, a ligament is found that attaches the liver to the anterior abdominal wall.", "Since part of this ligament lies over the part of the liver that needs to be resected, the ligament is incised to allow for removal of the tumor.", "The free edge of the ligament is found to have a thickening with small remnant blood vessels."], "context_len": 5, "options": {"A": "Ductus venosus", "B": "Left umbilical vein", "C": "Right umbilical artery", "D": "Ductus arteriosus"}, "answer": "Left umbilical vein", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "73", "specialties": ["Pediatrics", "Internal Medicine"], "subspecialties": ["Pediatric Surgery", "Gastroenterology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 73-year-old man is found to have an early stage hepatocellular carcinoma in the left lobe of his liver.", "2. He decides to undergo surgery to remove the tumor through partial liver resection.", "3. During the procedure, a ligament is found that attaches the liver to the anterior abdominal wall.", "4. Part of this ligament lies over the part of the liver that needs to be resected.", "5. The ligament is incised to allow for removal of the tumor.", "6. The free edge of the ligament is found to have a thickening.", "7. The thickening has small remnant blood vessels."], "atomic_facts": ["1. He decides to undergo surgery to remove the tumor through partial liver resection.", "2. During the procedure, a ligament is found that attaches the liver to the anterior abdominal wall.", "3. Part of the ligament lies over the part of the liver that needs to be resected.", "4. The ligament is incised to allow for removal of the tumor.", "5. The free edge of the ligament is found to have a thickening with small remnant blood vessels."]}
{"id": 536, "question": "Which of the following parameters are most likely to affect the x-axis in the diagram?", "context": ["A researcher is conducting an experiment on the physiology of body fluids.", "He documents specific observations and plots some of them as a Darrow-Yannet diagram.", "In his study, some diagrams are normal, while most are abnormal.", "The abnormalities in the diagram are mostly in the form of changes in the x-axis, changes in the y-axis or changes in both axes of the diagram."], "context_len": 4, "options": {"A": "Fluid osmolality", "B": "Fluid surface tension", "C": "Fluid viscosity", "D": "Fluid volume"}, "answer": "Fluid volume", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Clinical Chemistry", "Clinical Informatics"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pathology"}, "facts_old": ["1. A researcher is conducting an experiment on the physiology of body fluids.", "2. He documents specific observations.", "3. He plots some of the observations as a Darrow-Yannet diagram.", "4. Some diagrams are normal.", "5. Most diagrams are abnormal.", "6. The abnormalities in the diagram are mostly in the form of changes in the x-axis.", "7. The abnormalities in the diagram are mostly in the form of changes in the y-axis.", "8. The abnormalities in the diagram are mostly in the form of changes in both axes of the diagram."], "atomic_facts": ["1. He documents specific observations.", "2. He plots some observations as a Darrow-Yannet diagram.", "3. In his study, some diagrams are normal.", "4. Most diagrams in his study are abnormal.", "5. The abnormalities in the diagram are mostly in the form of changes in the x-axis.", "6. The abnormalities in the diagram are mostly in the form of changes in the y-axis.", "7. The abnormalities in the diagram are mostly in the form of changes in both axes of the diagram."]}
{"id": 537, "question": "Which of the following drugs is most likely suggested by the pediatrician?", "context": ["An 11-year-old girl is brought to a pediatrician by her parents with recurrent wheezing for the last 3 years.", "After a detailed history, complete physical examination, and thorough diagnostic evaluation, the pediatrician informs the parents that the girl has mild persistent asthma, which will be most effectively treated with inhaled corticosteroids (ICS).", "However, her parents firmly object to the use of corticosteroids in any form, despite being told that the side effects associated with ICS are negligible.", "Therefore, the pediatrician suggests the regular use of a drug that does not contain a corticosteroid.", "The pediatrician mentions that the drug is used as prophylaxis only and will not be useful to treat acute bronchospasm."], "context_len": 5, "options": {"A": "Subcutaneous terbutaline", "B": "Inhaled ipratropium bromide", "C": "Inhaled cromolyn sodium", "D": "Oral roflumilast"}, "answer": "Inhaled cromolyn sodium", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "11 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. An 11-year-old girl is brought to a pediatrician by her parents.", "2. The girl has had recurrent wheezing for the last 3 years.", "3. The pediatrician has conducted a detailed history, complete physical examination, and thorough diagnostic evaluation.", "4. The pediatrician has informed the parents that the girl has mild persistent asthma.", "5. The most effective treatment for the girl's asthma is inhaled corticosteroids (ICS).", "6. The parents object to the use of corticosteroids in any form.", "7. The pediatrician has informed the parents that the side effects associated with ICS are negligible.", "8. The pediatrician has suggested the regular use of a drug that does not contain a corticosteroid.", "9. The drug is used as prophylaxis only and will not be useful to treat acute bronchospasm."], "atomic_facts": ["1. The girl has mild persistent asthma.", "2. The most effective treatment for her asthma is inhaled corticosteroids (ICS).", "3. The parents object to the use of corticosteroids in any form.", "4. The side effects associated with ICS are negligible.", "5. The pediatrician suggests the regular use of a drug that does not contain a corticosteroid.", "6. The drug is used as prophylaxis only.", "7. The drug will not be useful to treat acute bronchospasm."]}
{"id": 538, "question": "Based on this knowledge, provided the concentration and actions of reactant B and enzyme E are same in both normal hepatocytes and hepatocytes of fatty liver patients, which of the following is the most likely possibility if drug A is administered to hypertensive patients with fatty liver?", "context": ["A team of scientists is researching the synthesis of a drug that would potentially reduce blood pressure in hypertensive patients by a novel mechanism of action.", "The drug A is an inactive prodrug and enters hepatocytes, reacts with reactant B, a native material in the cell, and creates products C and D.", "D has a blood pressure lowering effects.", "The reaction requires the presence of enzyme E.", "The researcher observes that, for the above chemical reaction, Gibbs free energy change (\u0394G) is less than zero in normal hepatocytes whereas, in hepatocytes of patients with fatty liver, \u0394G is more than 0 due to some unknown reason."], "context_len": 5, "options": {"A": "Drug A will decrease blood pressure only if reactant B is also supplemented in necessary dose", "B": "Drug A will decrease blood pressure only if enzyme E is also supplemented in necessary dose", "C": "Drug A will not decrease blood pressure, regardless of its dose or supplementation of B or E", "D": "Drug A will decrease blood pressure in same dose as required for patients with a healthy liver"}, "answer": "Drug A will not decrease blood pressure, regardless of its dose or supplementation of B or E", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A team of scientists is researching the synthesis of a drug that would potentially reduce blood pressure in hypertensive patients.", "2. The drug A is an inactive prodrug and enters hepatocytes.", "3. The drug A reacts with reactant B, a native material in the cell.", "4. The reaction creates products C and D.", "5. Product D has a blood pressure lowering effect.", "6. The reaction requires the presence of enzyme E.", "7. The researcher observes that, for the above chemical reaction, Gibbs free energy change (\u0394G) is less than zero in normal hepatocytes.", "8. In hepatocytes of patients with fatty liver, \u0394G is more than 0 due to some unknown reason."], "atomic_facts": ["1. Drug A is an inactive prodrug.", "2. Drug A enters hepatocytes.", "3. Drug A reacts with reactant B.", "4. Reactant B is a native material in the cell.", "5. The reaction of A and B creates products C and D.", "6. Product D has blood pressure lowering effects.", "7. The reaction requires the presence of enzyme E.", "8. In normal hepatocytes, the Gibbs free energy change (\u0394G) for the reaction is less than zero.", "9. In hepatocytes of patients with fatty liver, \u0394G for the reaction is more than 0.", "10. The reason for the change in \u0394G in fatty liver patients is unknown."]}
{"id": 539, "question": "In addition to analgesia, which of the following is the most appropriate next step in management?", "context": ["A 70-year-old man comes to the physician because of a 4-month history of progressively worsening lower back pain.", "He describes the pain as a constant, dull ache that interferes with his sleep and is only partially relieved with ibuprofen.", "Two years ago, he was diagnosed with advanced prostate cancer, for which he underwent radiation therapy of the prostate and bilateral orchiectomy.", "One year postoperatively, serum prostate-specific antigen (PSA) was undetectable.", "He missed his previous follow-up visit.", "Current medications include over-the-counter ibuprofen.", "Vital signs are within normal limits.", "Physical examination shows tenderness of the spinous process of the third lumbar vertebra.", "Digital rectal examination shows a hard, nontender prostate.", "The remainder of the examination shows no abnormalities.", "The serum PSA concentration is 16 ng/mL (N<4).", "A technetium-99m bone scan shows increased uptake at the second and third lumbar vertebral bodies."], "context_len": 12, "options": {"A": "External beam radiotherapy to the lumbar vertebrae", "B": "Leuprolide therapy", "C": "Finasteride therapy", "D": "Observation with no further treatment"}, "answer": "External beam radiotherapy to the lumbar vertebrae", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 70 years old.", "2. Patient has 4-month history of progressively worsening lower back pain.", "3. Patient describes pain as constant, dull ache.", "4. Pain interferes with sleep and is only partially relieved with ibuprofen.", "5. Two years ago, patient was diagnosed with advanced prostate cancer.", "6. Patient underwent radiation therapy of the prostate and bilateral orchiectomy.", "7. One year postoperatively, serum prostate-specific antigen (PSA) was undetectable.", "8. Patient missed previous follow-up visit.", "9. Current medications include over-the-counter ibuprofen.", "10. Vital signs are within normal limits.", "11. Physical examination shows tenderness of the spinous process of the third lumbar vertebra.", "12. Digital rectal examination shows a hard, nontender prostate.", "13. The remainder of the examination shows no abnormalities.", "14. Serum PSA concentration is 16 ng/mL (N<4).", "15. Technetium-99m bone scan shows increased uptake at the second and third lumbar vertebral bodies."], "atomic_facts": ["1. Patient describes pain as constant, dull ache interfering with sleep", "2. Pain partially relieved with ibuprofen", "3. Diagnosed with advanced prostate cancer two years ago", "4. Underwent radiation therapy of the prostate and bilateral orchiectomy", "5. One year postoperatively, serum PSA was undetectable", "6. Missed previous follow-up visit", "7. Current medications include over-the-counter ibuprofen", "8. Vital signs are within normal limits", "9. Physical examination shows tenderness of the spinous process of the third lumbar vertebra", "10. Digital rectal examination shows hard, nontender prostate", "11. Remainder of the examination shows no abnormalities", "12. Serum PSA concentration is 16 ng/mL (N<4)", "13. Technetium-99m bone scan shows increased uptake at the second and third lumbar vertebral bodies"]}
{"id": 540, "question": "What is the most likely causative organism?", "context": ["A 24-year-old woman presents complaining of a new onset vaginal odor.", "She reports that she is sexually active in a monogamous relationship with the same partner for two years.", "You perform a KOH prep, and notice an abnormal smell.", "On microscopy in your office, you observe the findings in figure A. |  | ."], "context_len": 4, "options": {"A": "Trichomonas vaginalis", "B": "Candida albicans", "C": "Escherichia coli", "D": "Gardnerella vaginalis"}, "answer": "Gardnerella vaginalis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "24 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 24-year-old woman presents complaining of a new onset vaginal odor.", "2. She reports that she is sexually active in a monogamous relationship with the same partner for two years.", "3. You perform a KOH prep.", "4. You notice an abnormal smell.", "5. On microscopy in your office, you observe the findings in figure A."], "atomic_facts": ["1. The patient reports being sexually active.", "2. The patient is in a monogamous relationship.", "3. The relationship has lasted for two years.", "4. A KOH prep was performed.", "5. An abnormal smell was noticed during the KOH prep.", "6. Microscopy was performed in the office.", "7. Abnormal findings were observed in figure A."]}
{"id": 541, "question": "In addition to securing the airway, which of the following is the most appropriate next step in management?", "context": ["A 22-year-old woman is brought to the emergency department 4 hours after the ingestion of 25 tablets of an unknown drug in an attempt to commit suicide.", "Her temperature is 36.7\u00b0C (98\u00b0F), pulse is 41/min, respirations are 14/min, and blood pressure is 88/55 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 93%.", "She is confused and oriented only to person.", "The pupils are equal and reactive to light.", "Examination shows cold, clammy extremities.", "Scattered expiratory wheezing and rhonchi are heard throughout both lung fields.", "The abdomen is soft.", "Fingerstick blood glucose concentration is 65 mg/dL.", "ECG shows prolonged PR intervals and narrow QRS complexes.", "Two large bore cannulas are inserted and intravenous normal saline, dextrose, and atropine are administered.", "Five minutes later, pulse is 51/min and blood pressure is 95/61 mm Hg."], "context_len": 12, "options": {"A": "Glucagon", "B": "Activated charcoal", "C": "Sodium bicarbonate", "D": "Hemodialysis"}, "answer": "Glucagon", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "22 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 22-year-old woman was brought to the emergency department.", "2. She had ingested 25 tablets of an unknown drug 4 hours prior.", "3. The attempt was in an attempt to commit suicide.", "4. Her temperature was 36.7\u00b0C (98\u00b0F).", "5. Her pulse was 41/min.", "6. Her respirations were 14/min.", "7. Her blood pressure was 88/55 mm Hg.", "8. Pulse oximetry on room air showed an oxygen saturation of 93%.", "9. She was confused and oriented only to person.", "10. Her pupils were equal and reactive to light.", "11. Examination showed cold, clammy extremities.", "12. Scattered expiratory wheezing and rhonchi were heard throughout both lung fields.", "13. Her abdomen was soft.", "14. Fingerstick blood glucose concentration was 65 mg/dL.", "15. ECG showed prolonged PR intervals and narrow QRS complexes.", "16. Two large bore cannulas were inserted.", "17. Intravenous normal saline, dextrose, and atropine were administered.", "18. Five minutes later, pulse was 51/min.", "19. Five minutes later, blood pressure was 95/61 mm Hg."], "atomic_facts": ["1. Her temperature is 36.7\u00b0C (98\u00b0F).", "2. Pulse is 41/min.", "3. Respirations are 14/min.", "4. Blood pressure is 88/55 mm Hg.", "5. Pulse oximetry on room air shows an oxygen saturation of 93%.", "6. She is confused and oriented only to person.", "7. The pupils are equal and reactive to light.", "8. Examination shows cold, clammy extremities.", "9. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields.", "10. The abdomen is soft.", "11. Fingerstick blood glucose concentration is 65 mg/dL.", "12. ECG shows prolonged PR intervals and narrow QRS complexes.", "13. Two large bore cannulas are inserted and intravenous normal saline, dextrose, and atropine are administered.", "14. Five minutes later, pulse is 51/min and blood pressure is 95/61 mm Hg."]}
{"id": 542, "question": "The bacteria causing this patient's dental problems most likely exhibits which of the following properties?", "context": ["A 56-year-old patient reports a history of recurrent dental caries."], "context_len": 1, "options": {"A": "Inhibition of growth on optochin sensitivity test", "B": "Production of dextrans from glucose", "C": "Presence of catalase enzyme", "D": "Soluble in bile"}, "answer": "Production of dextrans from glucose", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "56 years old", "specialties": ["Pediatrics", "Dermatology"], "subspecialties": ["Pediatric Infectious Diseases", "General Dermatology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Others"}, "facts_old": ["1. Patient is 56 years old.", "2. Patient has a history of recurrent dental caries."], "atomic_facts": ["1. The patient is 56 years old.", "2. The patient has a history of recurrent dental caries."]}
{"id": 543, "question": "Which of the following autoantibodies is most likely to be present in this patient?\"", "context": ["A 40-year-old woman comes to the physician for a follow-up examination.", "She says she has felt fatigued for about 3 months.", "She does not have enough energy for her job as a physician's assistant and often has to lie down and rest during shifts.", "She no longer adheres to her usual exercise routine because of exhaustion.", "During this time, she has noticed that her stools are sometimes pale and foul smelling.", "She also has generalized itching.", "The patient does not have abdominal pain, fever, or weight loss.", "She takes levothyroxine for hypothyroidism.", "She has smoked one pack of cigarettes weekly for 20 years.", "Physical examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 14.1 g/dL | Leukocyte count 7,200/mm3 | Erythrocyte sedimentation rate 26 mm/h | Serum | Thyroid-stimulating hormone 4.2 \u03bcU/ml | Bilirubin | Total 1.7 mg/dL | Direct 1.0 mg/dL | Alkaline phosphatase 370 U/L | Aspartate aminotransferase 80 U/L | Alanine aminotransferase 46 U/L | Cholesterol 320 mg/dL | Gamma-glutamyl transferase 98 U/L (N = 5\u201350) | Magnetic resonance cholangiopancreatography shows no gallstones and no evidence of extrahepatic biliary obstruction.", "Liver biopsy shows nonsuppurative destructive cholangitis with lymphocytic infiltration of portal areas and periductal granulomas."], "context_len": 12, "options": {"A": "Anti-liver-kidney microsomal-1 antibodies", "B": "Anti-mitochondrial antibodies", "C": "Anti-smooth muscle antibodies", "D": "Perinuclear anti-neutrophil cytoplasmic antibodies"}, "answer": "Anti-mitochondrial antibodies", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "40", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 40-year-old woman comes to the physician for a follow-up examination.", "2. She says she has felt fatigued for about 3 months.", "3. She does not have enough energy for her job as a physician's assistant and often has to lie down and rest during shifts.", "4. She no longer adheres to her usual exercise routine because of exhaustion.", "5. During this time, she has noticed that her stools are sometimes pale and foul smelling.", "6. She also has generalized itching.", "7. The patient does not have abdominal pain, fever, or weight loss.", "8. She takes levothyroxine for hypothyroidism.", "9. She has smoked one pack of cigarettes weekly for 20 years.", "10. Physical examination shows no abnormalities.", "11. Laboratory studies show: Hemoglobin 14.1 g/dL, Leukocyte count 7,200/mm3, Erythrocyte sedimentation rate 26 mm/h, Serum Thyroid-stimulating hormone 4.2 \u03bcU/ml, Bilirubin Total 1.7 mg/dL, Direct 1.0 mg/dL, Alkaline phosphatase 370 U/L, Aspartate aminotransferase 80 U/L, Alanine aminotransferase 46 U/L, Cholesterol 320 mg/dL, Gamma-glutamyl transferase 98 U/L (N = 5\u201350).", "12. Magnetic resonance cholangiopancreatography shows no gallstones and no evidence of extrahepatic biliary obstruction.", "13. Liver biopsy shows nonsuppurative destructive cholangitis with lymphocytic infiltration of portal areas and periductal granulomas."], "atomic_facts": ["1. The patient has felt fatigued for about 3 months.", "2. She does not have enough energy for her job as a physician's assistant and often has to lie down and rest during shifts.", "3. She no longer adheres to her usual exercise routine because of exhaustion.", "4. The patient has noticed that her stools are sometimes pale and foul smelling.", "5. She also has generalized itching.", "6. The patient does not have abdominal pain, fever, or weight loss.", "7. She takes levothyroxine for hypothyroidism.", "8. She has smoked one pack of cigarettes weekly for 20 years.", "9. Physical examination shows no abnormalities.", "10. Laboratory studies show: Hemoglobin 14.1 g/dL, Leukocyte count 7,200/mm3, Erythrocyte sedimentation rate 26 mm/h, Serum Thyroid-stimulating hormone 4.2 \u03bcU/ml, Bilirubin Total 1.7 mg/dL, Direct 1.0 mg/dL, Alkaline phosphatase 370 U/L, Aspartate aminotransferase 80 U/L, Alanine aminotransferase 46 U/L, Cholesterol 320 mg/dL, Gamma-glutamyl transferase 98 U/L (N = 5\u201350).", "11. Magnetic resonance cholangiopancreatography shows no gallstones and no evidence of extrahepatic biliary obstruction.", "12. Liver biopsy shows nonsuppurative destructive cholangitis with lymphocytic infiltration of portal areas and periductal granulomas."]}
{"id": 544, "question": "Inhibition of which of the following best describes this drug\u2019s mechanism of action?", "context": ["A 73-year-old man seeks evaluation for difficulty developing and maintaining erections.", "He has recently made lifestyle modifications, such as losing 4.5 kg (10 lb) but his erectile symptoms have not improved.", "He was prescribed a drug by his physician."], "context_len": 3, "options": {"A": "5-alpha reductase", "B": "cGMP phosphodiesterase", "C": "Estrogen receptors", "D": "Testosterone receptors"}, "answer": "cGMP phosphodiesterase", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "73 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 73-year-old man seeks evaluation for difficulty developing and maintaining erections.", "2. He has recently made lifestyle modifications, such as losing 4.5 kg (10 lb).", "3. His erectile symptoms have not improved.", "4. He was prescribed a drug by his physician."], "atomic_facts": ["1. He has recently made lifestyle modifications.", "2. He has lost 4.5 kg (10 lb).", "3. His erectile symptoms have not improved.", "4. He was prescribed a drug by his physician."]}
{"id": 545, "question": "Which of the following regions of the brain is most likely affected?", "context": ["A 65-year-old woman with hypertension comes to the emergency department because of sudden onset of a severe headache 2 hours ago.", "Her temperature is 35\u00b0C (95\u00b0F) and blood pressure is 189/115 mm Hg.", "A CT scan of the head shows a subarachnoid hemorrhage and she is started on appropriate pharmacotherapy."], "context_len": 3, "options": {"A": "Ventral lateral thalamic nucleus", "B": "Pineal gland", "C": "Preoptic nucleus", "D": "Caudate nucleus"}, "answer": "Preoptic nucleus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "65 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 65-year-old woman comes to the emergency department.", "2. She has hypertension.", "3. She has sudden onset of a severe headache 2 hours ago.", "4. Her temperature is 35\u00b0C (95\u00b0F).", "5. Her blood pressure is 189/115 mm Hg.", "6. A CT scan of the head shows a subarachnoid hemorrhage.", "7. She is started on appropriate pharmacotherapy."], "atomic_facts": ["1. Her temperature is 35\u00b0C (95\u00b0F).", "2. Her blood pressure is 189/115 mm Hg.", "3. A CT scan of the head shows a subarachnoid hemorrhage.", "4. She is started on appropriate pharmacotherapy."]}
{"id": 546, "question": "Which of the following should be tested weekly?", "context": ["A 35-year-old woman with a one-year history of auditory hallucinations and periods of anhedonia and amotivation is being seen by her psychiatrist.", "She was started on haloperidol at her last visit, but she was told to stop taking the medication since she developed muscle stiffness and spasms soon after taking the drug.", "Today, her temperature is 97.7\u00b0F (36.5\u00b0C), blood pressure is 132/76 mmHg, pulse is 98/min, and respirations are 12/min.", "The patient is now started on a new medication that will seek to avoid the same side effects as her previous one; however, she will need to come in for weekly testing."], "context_len": 4, "options": {"A": "Electrocardiogram", "B": "Electrolytes", "C": "Gonadotropin releasing hormone", "D": "White blood cell count"}, "answer": "White blood cell count", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "35 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 35-year-old woman has a one-year history of auditory hallucinations and periods of anhedonia and amotivation.", "2. She was started on haloperidol at her last visit.", "3. She was told to stop taking the medication since she developed muscle stiffness and spasms soon after taking the drug.", "4. Today, her temperature is 97.7\u00b0F (36.5\u00b0C).", "5. Her blood pressure is 132/76 mmHg.", "6. Her pulse is 98/min.", "7. Her respirations are 12/min.", "8. She is now started on a new medication that will seek to avoid the same side effects as her previous one.", "9. She will need to come in for weekly testing."], "atomic_facts": ["1. The patient was started on haloperidol at her last visit.", "2. She was told to stop taking the medication due to developing muscle stiffness and spasms soon after taking the drug.", "3. Her temperature is 97.7\u00b0F (36.5\u00b0C).", "4. Her blood pressure is 132/76 mmHg.", "5. Her pulse is 98/min.", "6. Her respirations are 12/min.", "7. The patient is now started on a new medication.", "8. The new medication aims to avoid the same side effects as her previous one.", "9. The patient will need to come in for weekly testing."]}
{"id": 547, "question": "Which of the following is the most common viral cause of this child's condition?", "context": ["A 9-year-old boy is brought to the emergency room by his concerned mother after he \"urinated blood.\" The boy reports that, starting this morning, he experienced significant pain with urination and his urine appeared a bright red color.", "These symptoms were not present before today; however, he reports a cough, runny nose, and sore throat that started approximately 3 days ago.", "Vital signs are as follows: T 38.4 deg C, HR 101, BP 110/65, RR 14, SpO2 99%.", "Physical examination is significant for bilateral conjunctivitis, tenderness to suprapubic palpation, and a small amount of clotted blood is noted surrounding the urethral meatus.", "A urine sample is obtained, and urinalysis shows 3+ blood, and urine microscopy demonstrates gross blood with too many cells to count per high powered field."], "context_len": 5, "options": {"A": "Parvovirus B19", "B": "Coronavirus", "C": "Adenovirus", "D": "Coxsackie A virus"}, "answer": "Adenovirus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "9 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 9-year-old boy.", "2. Patient was brought to the emergency room by his concerned mother.", "3. Patient urinated blood.", "4. Patient experienced significant pain with urination.", "5. Patient's urine appeared a bright red color.", "6. Symptoms were not present before today.", "7. Patient reports a cough, runny nose, and sore throat that started approximately 3 days ago.", "8. Vital signs: T 38.4 deg C, HR 101, BP 110/65, RR 14, SpO2 99%.", "9. Physical examination is significant for bilateral conjunctivitis.", "10. Physical examination is significant for tenderness to suprapubic palpation.", "11. A small amount of clotted blood is noted surrounding the urethral meatus.", "12. Urine sample obtained, and urinalysis shows 3+ blood.", "13. Urine microscopy demonstrates gross blood with too many cells to count per high powered field."], "atomic_facts": ["1. Symptoms include cough, runny nose, and sore throat that started approximately 3 days ago.", "2. Vital signs: T 38.4 deg C, HR 101, BP 110/65, RR 14, SpO2 99%.", "3. Physical examination shows bilateral conjunctivitis, tenderness to suprapubic palpation, and clotted blood surrounding the urethral meatus.", "4. Urinalysis shows 3+ blood.", "5. Urine microscopy demonstrates gross blood with too many cells to count per high powered field."]}
{"id": 548, "question": "Of the following proposed mechanisms, which one would best serve the researcher's purpose?", "context": ["A young researcher wants to develop a method of increasing oxygen delivery to the peripheral tissues.", "He brainstorms several ideas but is informed by his mentor that only one of his ideas will most likely help him achieve the desired result."], "context_len": 2, "options": {"A": "Decrease lactic acid production by skeletal muscle", "B": "Increase fetal hemoglobin concentration in circulation", "C": "Increase relaxed form hemoglobin in muscle capillaries", "D": "Increase taut form hemoglobin in muscle capillaries"}, "answer": "Increase taut form hemoglobin in muscle capillaries", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Anesthesiology"}, "facts_old": ["1. A young researcher wants to develop a method of increasing oxygen delivery to the peripheral tissues.", "2. He brainstorms several ideas.", "3. His mentor informs him that only one of his ideas will most likely help him achieve the desired result."], "atomic_facts": ["1. He brainstorms several ideas.", "2. His mentor informs him.", "3. Only one of his ideas will most likely help him achieve the desired result."]}
{"id": 549, "question": "Administration of which of the following is most likely to have prevented this patient's current symptoms?", "context": ["A 29-year-old man comes to the physician for a follow-up examination.", "He has had numbness and tingling of his legs for the past 10 days.", "Three months ago, he was diagnosed with pulmonary tuberculosis and started on antituberculosis therapy.", "Examination shows dry scaly lips and cracks at the corner of the mouth.", "Sensation to pinprick and light touch is decreased over the lower extremities.", "His hemoglobin concentration is 10.4 g/dL and mean corpuscular volume is 76 \u03bcm3."], "context_len": 6, "options": {"A": "Iron", "B": "Vitamin E", "C": "Folic acid", "D": "Pyridoxine"}, "answer": "Pyridoxine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "29", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 29-year-old man comes to the physician for a follow-up examination.", "2. He has had numbness and tingling of his legs for the past 10 days.", "3. Three months ago, he was diagnosed with pulmonary tuberculosis.", "4. He started on antituberculosis therapy three months ago.", "5. Examination shows dry scaly lips and cracks at the corner of the mouth.", "6. Sensation to pinprick and light touch is decreased over the lower extremities.", "7. His hemoglobin concentration is 10.4 g/dL.", "8. His mean corpuscular volume is 76 \u03bcm3."], "atomic_facts": ["1. He has had numbness and tingling of his legs for the past 10 days.", "2. Three months ago, he was diagnosed with pulmonary tuberculosis.", "3. He started on antituberculosis therapy.", "4. Examination shows dry scaly lips and cracks at the corner of the mouth.", "5. Sensation to pinprick is decreased over the lower extremities.", "6. Sensation to light touch is decreased over the lower extremities.", "7. His hemoglobin concentration is 10.4 g/dL.", "8. His mean corpuscular volume is 76 \u03bcm3."]}
{"id": 550, "question": "Which investigation should be performed next in this patient?", "context": ["A 36-year-old woman presents with a 2-month history of urinary incontinence, accompanied by urgency, nocturia, and occasional hematuria.", "Her symptoms are present day and night and have no known triggers.", "She was diagnosed with grade 2 pelvic organ prolapse (cystocele) 1 year ago, which is managed with pelvic floor training exercises and a vaginal pessary.", "She is otherwise healthy and does not take any medications.", "The blood pressure is 120/80 mm Hg, the heart rate is 67/min, the respiratory rate is 14/min, and the temperature is 36.8\u2103 (98.2\u2109).", "The physical examination is significant for suprapubic tenderness.", "No costovertebral angle tenderness is present.", "There are no signs of vulvar inflammation, and no urethral or vaginal discharge.", "The vaginal mucosa is normal and there is no cervical discharge.", "A vaginal pessary is placed.", "The cervix is non-tender and mobile, the uterus is not enlarged, and the adnexa have no masses. | The urinalysis shows the following findings: |  Color:  Pale yellow |  Clarity:  Clear |  pH:  6.2 |  Specific gravity:  1.023 |  Glucose:  Negative |  Ketones:  Negative |  Nitrites:  Positive |  Leukocyte esterase:  Positive |  Bilirubin:  Negative |  Urinary bilirubin:  Negative |  Protein: Negative |  RBCs:  47 RBCs/hpf |  WBCs:  21 WBCs/hpf |  Epithelial cells:  27 squamous epithelial cells/hpf |  Casts:  5 hyaline casts/lpf |  Crystals:  Occasional urates |  Bacteria:  None noted |  Yeast:  None noted | The urinary culture is negative."], "context_len": 11, "options": {"A": "Cystoscopy", "B": "Ultrasound examination", "C": "Cystometry", "D": "Pelvic CT scan"}, "answer": "Ultrasound examination", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "36 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is a 36-year-old woman.", "2. Patient has a 2-month history of urinary incontinence, accompanied by urgency, nocturia, and occasional hematuria.", "3. Symptoms are present day and night and have no known triggers.", "4. Patient was diagnosed with grade 2 pelvic organ prolapse (cystocele) 1 year ago.", "5. Patient is managed with pelvic floor training exercises and a vaginal pessary.", "6. Patient is otherwise healthy and does not take any medications.", "7. Blood pressure is 120/80 mm Hg.", "8. Heart rate is 67/min.", "9. Respiratory rate is 14/min.", "10. Temperature is 36.8\u2103 (98.2\u2109).", "11. Physical examination is significant for suprapubic tenderness.", "12. No costovertebral angle tenderness is present.", "13. No signs of vulvar inflammation.", "14. No urethral or vaginal discharge.", "15. Vaginal mucosa is normal.", "16. No cervical discharge.", "17. A vaginal pessary is placed.", "18. Cervix is non-tender and mobile.", "19. Uterus is not enlarged.", "20. Adnexa have no masses.", "21. Urinalysis shows pale yellow color, clear clarity, pH 6.2, specific gravity 1.023, negative glucose, negative ketones, positive nitrites, positive leukocyte esterase, negative bilirubin, negative urinary bilirubin, negative protein, 47 RBCs/hpf, 21 WBCs/hpf, 27 squamous epithelial cells/hpf, 5 hyaline casts/lpf, occasional urates, no bacteria, and no yeast.", "22. Urinary culture is negative."], "atomic_facts": ["1. The patient's symptoms are present day and night and have no known triggers.", "2. She was diagnosed with grade 2 pelvic organ prolapse (cystocele) 1 year ago, which is managed with pelvic floor training exercises and a vaginal pessary.", "3. She is otherwise healthy and does not take any medications.", "4. The blood pressure is 120/80 mm Hg, the heart rate is 67/min, the respiratory rate is 14/min, and the temperature is 36.8\u2103 (98.2\u2109).", "5. The physical examination is significant for suprapubic tenderness.", "6. No costovertebral angle tenderness is present.", "7. There are no signs of vulvar inflammation, and no urethral or vaginal discharge.", "8. The vaginal mucosa is normal and there is no cervical discharge.", "9. A vaginal pessary is placed.", "10. The cervix is non-tender and mobile, the uterus is not enlarged, and the adnexa have no masses.", "11. The urinalysis shows the following findings: ", "12. Color: Pale yellow", "13. Clarity: Clear", "14. pH: 6.2", "15. Specific gravity: 1.023", "16. Glucose: Negative", "17. Ketones: Negative", "18. Nitrites: Positive", "19. Leukocyte esterase: Positive", "20. Bilirubin: Negative", "21. Urinary bilirubin: Negative", "22. Protein: Negative", "23. RBCs: 47 RBCs/hpf", "24. WBCs: 21 WBCs/hpf", "25. Epithelial cells: 27 squamous epithelial cells/hpf", "26. Casts: 5 hyaline casts/lpf", "27. Crystals: Occasional urates", "28. Bacteria: None noted", "29. Yeast: None noted", "30. The urinary culture is negative."]}
{"id": 551, "question": "Which of the following is closest to the probability of a female and a male with normal vision having a daughter with red-green color blindness?", "context": ["The incidence of red-green color blindness in males in a certain population is 1/100."], "context_len": 1, "options": {"A": "1/100", "B": "1/50", "C": "98/100", "D": "0"}, "answer": "0", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. The incidence of red-green color blindness is 1/100.", "2. The population is a certain population.", "3. The incidence is in males."], "atomic_facts": ["1. The incidence of red-green color blindness in males is 1/100.", "2. The incidence is in a certain population."]}
{"id": 552, "question": "The most likely cause of this patient's condition is a defect in which of the following molecular structures?", "context": ["A 31-year-old man comes to the physician for evaluation of chronic cough, sinus pain, and nasal discharge.", "He has a history of frequent upper respiratory infections and recurrent sinusitis since childhood.", "He is also concerned about fertility, as he and his wife have been trying to conceive for 5 years unsuccessfully.", "Pulmonary examination shows crackles and wheezing throughout both lung fields.", "A CT scan of the chest is shown."], "context_len": 5, "options": {"A": "IL-2R gamma chain", "B": "NADPH oxidase", "C": "CFTR protein", "D": "Dynein arm"}, "answer": "Dynein arm", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "31 years old", "specialties": ["Allergy and Immunology", "Pediatrics"], "subspecialties": ["General Allergy and Immunology", "Pediatric Pulmonology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A 31-year-old man comes to the physician for evaluation of chronic cough, sinus pain, and nasal discharge.", "2. He has a history of frequent upper respiratory infections and recurrent sinusitis since childhood.", "3. He and his wife have been trying to conceive for 5 years unsuccessfully.", "4. Pulmonary examination shows crackles and wheezing throughout both lung fields.", "5. A CT scan of the chest is shown."], "atomic_facts": ["1. He has a history of frequent upper respiratory infections since childhood.", "2. He has a history of recurrent sinusitis since childhood.", "3. He and his wife have been trying to conceive for 5 years unsuccessfully.", "4. Pulmonary examination shows crackles throughout both lung fields.", "5. Pulmonary examination shows wheezing throughout both lung fields.", "6. A CT scan of the chest is shown."]}
{"id": 553, "question": "Which of the following is most likely to have prevented this patient's condition?", "context": ["A 3-year-old boy is brought to the emergency department because of abdominal pain and watery diarrhea for the past 3 days.", "This morning he also had nausea and his stool had a red tint.", "Four days ago, he and his parents returned home from a vacation, during which they visited a petting zoo and consumed many new foods.", "He lives with his family and they have cats and dogs at home.", "The patient attends daycare.", "His immunizations are up-to-date.", "His temperature is 38\u00b0C (100.4\u00b0F), pulse is 140/min, and blood pressure is 80/45 mm Hg.", "Examination shows dry mucus membranes.", "The abdomen is soft, and there is tenderness to palpation of the right lower quadrant with rebound.", "Stool culture grows Yersinia enterocolitica."], "context_len": 10, "options": {"A": "Hand-washing at daycare", "B": "Avoiding the consumption of undercooked pork", "C": "Avoiding the consumption of deli meats", "D": "Avoiding the consumption of unwashed vegetables"}, "answer": "Avoiding the consumption of undercooked pork", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 3-year-old boy.", "2. Patient has had abdominal pain and watery diarrhea for the past 3 days.", "3. Patient had nausea this morning.", "4. Patient's stool had a red tint.", "5. Patient and his parents returned home from a vacation 4 days ago.", "6. Patient and his family visited a petting zoo during the vacation.", "7. Patient and his family consumed many new foods during the vacation.", "8. Patient lives with his family.", "9. Patient's family has cats and dogs at home.", "10. Patient attends daycare.", "11. Patient's immunizations are up-to-date.", "12. Patient's temperature is 38\u00b0C (100.4\u00b0F).", "13. Patient's pulse is 140/min.", "14. Patient's blood pressure is 80/45 mm Hg.", "15. Patient's mucus membranes are dry.", "16. Patient's abdomen is soft.", "17. Patient has tenderness to palpation of the right lower quadrant with rebound.", "18. Stool culture grows Yersinia enterocolitica."], "atomic_facts": ["1. This morning he had nausea.", "2. His stool had a red tint.", "3. Four days ago, he and his parents returned home from a vacation.", "4. During the vacation, they visited a petting zoo.", "5. During the vacation, they consumed many new foods.", "6. He lives with his family.", "7. They have cats and dogs at home.", "8. The patient attends daycare.", "9. His immunizations are up-to-date.", "10. His temperature is 38\u00b0C (100.4\u00b0F).", "11. His pulse is 140/min.", "12. His blood pressure is 80/45 mm Hg.", "13. Examination shows dry mucus membranes.", "14. The abdomen is soft.", "15. There is tenderness to palpation of the right lower quadrant with rebound.", "16. Stool culture grows Yersinia enterocolitica."]}
{"id": 554, "question": "Which of the following is the most likely underlying cause of these findings?", "context": ["A 61-year-old woman dies unexpectedly.", "She had not seen a physician in 10 years.", "Examination of the heart during autopsy shows hypertrophy of the left ventricular wall and enlargement of the left ventricular chamber.", "Microscopic examination shows lengthening of individual muscle fibers due to duplication of sarcomeres in series."], "context_len": 4, "options": {"A": "Increased pulmonary arterial pressure", "B": "Decreased left ventricular contractility", "C": "Decreased left ventricular compliance", "D": "Increased left ventricular end diastolic volume"}, "answer": "Increased left ventricular end diastolic volume", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "61 years old", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["General Cardiology", "Cardiovascular Disease"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 61-year-old woman dies unexpectedly.", "2. She had not seen a physician in 10 years.", "3. Examination of the heart during autopsy shows hypertrophy of the left ventricular wall.", "4. Examination of the heart during autopsy shows enlargement of the left ventricular chamber.", "5. Microscopic examination shows lengthening of individual muscle fibers.", "6. Microscopic examination shows duplication of sarcomeres in series."], "atomic_facts": ["1. She had not seen a physician in 10 years.", "2. Examination of the heart during autopsy shows hypertrophy of the left ventricular wall.", "3. Examination of the heart during autopsy shows enlargement of the left ventricular chamber.", "4. Microscopic examination shows lengthening of individual muscle fibers.", "5. Microscopic examination shows duplication of sarcomeres in series."]}
{"id": 555, "question": "What is the mechanism of action of this drug?", "context": ["A 57-year-old man with a history of hypertension, hyperlipidemia, type 2 diabetes mellitus, and obstructive sleep apnea presents to your office for routine screening.", "He reports compliance with his medications but admits to difficulty maintaining the diet and exercise routines discussed during his last visit.", "He does not have any other complaints.", "He drinks 3-4 beers on the weekends and does not smoke cigarettes.", "His current medications include metformin, atorvastatin, and hydrochlorothiazide.", "On physical examination, his temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 130/85 mmHg, pulse is 85/min, and respirations are 18/min.", "Laboratory results are shown below: |  | Serum: | Na+: 138 mEq/L | Cl-: 100 mEq/L | K+: 3.9 mEq/L | HCO3-: 23 mEq/L | BUN: 13 mg/dL | Glucose: 160 mg/dL |  | You decide to start the patient on a medication that triggers insulin release."], "context_len": 7, "options": {"A": "Close potassium channels", "B": "Increase insulin sensitivity", "C": "Delay gastric emptying", "D": "Increase ATP generation"}, "answer": "Close potassium channels", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "57", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 57 years old.", "2. Patient has a history of hypertension, hyperlipidemia, type 2 diabetes mellitus, and obstructive sleep apnea.", "3. Patient reports compliance with medications.", "4. Patient has difficulty maintaining diet and exercise routines.", "5. Patient does not have any other complaints.", "6. Patient drinks 3-4 beers on the weekends.", "7. Patient does not smoke cigarettes.", "8. Patient's current medications include metformin, atorvastatin, and hydrochlorothiazide.", "9. Patient's temperature is 99\u00b0F (37.2\u00b0C).", "10. Patient's blood pressure is 130/85 mmHg.", "11. Patient's pulse is 85/min.", "12. Patient's respirations are 18/min.", "13. Patient's serum Na+ is 138 mEq/L.", "14. Patient's serum Cl- is 100 mEq/L.", "15. Patient's serum K+ is 3.9 mEq/L.", "16. Patient's serum HCO3- is 23 mEq/L.", "17. Patient's BUN is 13 mg/dL.", "18. Patient's glucose is 160 mg/dL.", "19. Patient is to be started on a medication that triggers insulin release."], "atomic_facts": ["1. Patient reports compliance with medications", "2. Patient admits difficulty maintaining diet and exercise routines", "3. Patient does not have any other complaints", "4. Patient drinks 3-4 beers on weekends", "5. Patient does not smoke cigarettes", "6. Patient's current medications: metformin, atorvastatin, hydrochlorothiazide", "7. Physical examination: temperature 99\u00b0F, blood pressure 130/85 mmHg, pulse 85/min, respirations 18/min", "8. Laboratory results: Na+ 138 mEq/L, Cl- 100 mEq/L, K+ 3.9 mEq/L, HCO3- 23 mEq/L, BUN 13 mg/dL, Glucose 160 mg/dL", "9. Decision to start patient on a medication that triggers insulin release"]}
{"id": 556, "question": "Which of the following is the most likely organism responsible for the patient's condition?", "context": ["A 28-year-old woman presents to the emergency department with fever and abdominal pain for the past several days.", "She says she feels like she has a slight fever.", "She denies nausea or vomiting.", "Physical examination shows pain in the right upper quadrant to deep palpation with rebound tenderness and guarding.", "A laparoscopy is performed which shows string-like, fibrous scar tissue in the perihepatic recesses."], "context_len": 5, "options": {"A": "Giardia lamblia", "B": "Gardnerella vaginalis", "C": "Trichomonas vaginalis", "D": "Neisseria gonorrhoeae"}, "answer": "Neisseria gonorrhoeae", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "28", "specialties": ["Infectious Disease", "Internal Medicine"], "subspecialties": ["General Infectious Disease", "Infectious Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 28-year-old woman presents to the emergency department.", "2. She has had fever and abdominal pain for several days.", "3. She feels like she has a slight fever.", "4. She denies nausea or vomiting.", "5. Physical examination shows pain in the right upper quadrant to deep palpation.", "6. Physical examination also shows rebound tenderness and guarding.", "7. A laparoscopy is performed.", "8. The laparoscopy shows string-like, fibrous scar tissue in the perihepatic recesses."], "atomic_facts": ["1. The patient feels like she has a slight fever.", "2. The patient denies nausea or vomiting.", "3. Physical examination shows pain in the right upper quadrant to deep palpation.", "4. Physical examination shows rebound tenderness and guarding.", "5. Laparoscopy reveals string-like, fibrous scar tissue in the perihepatic recesses."]}
{"id": 557, "question": "Cardiovascular evaluation of this patient is most likely to show which of the following findings?", "context": ["A 30-year-old woman comes to the emergency department because of a 1-day history of sharp chest pain radiating to the left shoulder.", "The pain worsens when she coughs, breathes deeply, or lies down.", "She has had a mild fever and a cough for the past 2 days.", "She takes ibuprofen for hip and knee pain, which started 4 months ago.", "Examination shows a symmetric, erythematous rash on her nose and cheeks, and erythematous patches with scaling and plugged follicles over her hands."], "context_len": 5, "options": {"A": "Increased distension of jugular veins during inspiration", "B": "18 mm Hg decrease in systolic blood pressure during inspiration", "C": "Triphasic scratchy heart sound of varying intensity", "D": "Holosystolic blowing murmur heard best at the apex"}, "answer": "Triphasic scratchy heart sound of varying intensity", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 30-year-old woman comes to the emergency department.", "2. She has a 1-day history of sharp chest pain radiating to the left shoulder.", "3. The pain worsens when she coughs, breathes deeply, or lies down.", "4. She has had a mild fever and a cough for the past 2 days.", "5. She takes ibuprofen for hip and knee pain, which started 4 months ago.", "6. Examination shows a symmetric, erythematous rash on her nose and cheeks.", "7. Examination shows erythematous patches with scaling and plugged follicles over her hands."], "atomic_facts": ["1. The pain worsens when she coughs, breathes deeply, or lies down.", "2. She has had a mild fever and a cough for the past 2 days.", "3. She takes ibuprofen for hip and knee pain, which started 4 months ago.", "4. Examination shows a symmetric, erythematous rash on her nose and cheeks.", "5. Examination shows erythematous patches with scaling and plugged follicles over her hands."]}
{"id": 558, "question": "Which of the following is the most appropriate next step in management of this patient's symptoms?", "context": ["A 22-year-old man comes to the physician because he has been increasingly worried and stressed in recent weeks.", "He started a marketing job three months ago, which involves traveling between Washington and California several times a year.", "Two months ago, he was supposed to fly to Seattle, but he experienced nausea, palpitations, sweating, and shortness of breath and was unable to board the plane, causing him great embarrassment.", "He had never been on a plane before; his parents died in a plane crash when he was younger.", "A week ago, he called in sick when he was supposed to go on a business trip.", "He worries that he will lose his job.", "He is otherwise well and has no history of serious illness.", "He takes no medications.", "His temperature is 37.2\u00b0C (99\u00b0F), pulse is 85/min, respirations are 12/min, and blood pressure is 130/80 mm Hg.", "Physical examination shows no abnormalities.", "On mental status examination, he is alert and cooperative.", "His speech is normal and his thought process is organized.", "His memory, attention, and concentration are intact."], "context_len": 13, "options": {"A": "Oral paroxetine", "B": "Oral alprazolam", "C": "Observation", "D": "Cognitive behavioral therapy"}, "answer": "Cognitive behavioral therapy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "22", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is a 22-year-old male.", "2. Patient has been increasingly worried and stressed in recent weeks.", "3. Patient started a marketing job three months ago.", "4. Job involves traveling between Washington and California several times a year.", "5. Two months ago, patient experienced nausea, palpitations, sweating, and shortness of breath and was unable to board the plane.", "6. Patient had never been on a plane before.", "7. Patient's parents died in a plane crash when he was younger.", "8. A week ago, patient called in sick when he was supposed to go on a business trip.", "9. Patient worries that he will lose his job.", "10. Patient is otherwise well and has no history of serious illness.", "11. Patient takes no medications.", "12. Patient's temperature is 37.2\u00b0C (99\u00b0F).", "13. Patient's pulse is 85/min.", "14. Patient's respirations are 12/min.", "15. Patient's blood pressure is 130/80 mm Hg.", "16. Physical examination shows no abnormalities.", "17. On mental status examination, patient is alert and cooperative.", "18. Patient's speech is normal.", "19. Patient's thought process is organized.", "20. Patient's memory, attention, and concentration are intact."], "atomic_facts": ["1. He started a marketing job three months ago.", "2. The job involves traveling between Washington and California several times a year.", "3. Two months ago, he was supposed to fly to Seattle.", "4. He experienced nausea, palpitations, sweating, and shortness of breath and was unable to board the plane.", "5. This caused him great embarrassment.", "6. He had never been on a plane before.", "7. His parents died in a plane crash when he was younger.", "8. A week ago, he called in sick when he was supposed to go on a business trip.", "9. He worries that he will lose his job.", "10. He is otherwise well and has no history of serious illness.", "11. He takes no medications.", "12. His temperature is 37.2\u00b0C (99\u00b0F).", "13. His pulse is 85/min.", "14. His respirations are 12/min.", "15. His blood pressure is 130/80 mm Hg.", "16. Physical examination shows no abnormalities.", "17. On mental status examination, he is alert and cooperative.", "18. His speech is normal.", "19. His thought process is organized.", "20. His memory, attention, and concentration are intact."]}
{"id": 559, "question": "What is the appropriate medication for this patient\u2019s condition?", "context": ["A 52-year-old man presents to the office complaining of a 2-week history of fatigue, progressively worsening shortness of breath, and swelling of his lower legs and feet.", "His past medical history is only significant for slightly elevated blood pressure.", "The patient denies tobacco use although he does admit to drinking 8-10 beers, daily, for the past 10 years.", "He takes a low dose of aspirin daily, ever since he had an anterior myocardial infarction 2 years ago.", "The patient works as a financial consultant and frequently travels for work.", "The current temperature is 36.8\u00b0C (98.3\u00b0F), the pulse rate is 68/min, the blood pressure is 152/84 mm Hg, and the respiratory rate is 16/min.", "His weight is 102 kg (224 lb) and height 180 cm (5 ft 9 in).", "Echocardiography demonstrates an ejection fraction of 35% and a thin left ventricular wall."], "context_len": 8, "options": {"A": "Nifedipine", "B": "Procainamide", "C": "Ibuprofen", "D": "Spironolactone"}, "answer": "Spironolactone", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine", "Cardiovascular Disease", "Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 52-year-old man.", "2. Patient has a 2-week history of fatigue, progressively worsening shortness of breath, and swelling of his lower legs and feet.", "3. Patient's past medical history is only significant for slightly elevated blood pressure.", "4. Patient denies tobacco use.", "5. Patient admits to drinking 8-10 beers daily for the past 10 years.", "6. Patient takes a low dose of aspirin daily since he had an anterior myocardial infarction 2 years ago.", "7. Patient works as a financial consultant and frequently travels for work.", "8. Current temperature is 36.8\u00b0C (98.3\u00b0F).", "9. Pulse rate is 68/min.", "10. Blood pressure is 152/84 mm Hg.", "11. Respiratory rate is 16/min.", "12. Weight is 102 kg (224 lb).", "13. Height is 180 cm (5 ft 9 in).", "14. Echocardiography demonstrates an ejection fraction of 35% and a thin left ventricular wall."], "atomic_facts": ["1. His past medical history is only significant for slightly elevated blood pressure.", "2. The patient denies tobacco use.", "3. He admits to drinking 8-10 beers daily for the past 10 years.", "4. He takes a low dose of aspirin daily.", "5. He had an anterior myocardial infarction 2 years ago.", "6. The patient works as a financial consultant.", "7. He frequently travels for work.", "8. The current temperature is 36.8\u00b0C (98.3\u00b0F).", "9. The pulse rate is 68/min.", "10. The blood pressure is 152/84 mm Hg.", "11. The respiratory rate is 16/min.", "12. His weight is 102 kg (224 lb).", "13. His height is 180 cm (5 ft 9 in).", "14. Echocardiography demonstrates an ejection fraction of 35%.", "15. Echocardiography demonstrates a thin left ventricular wall."]}
{"id": 560, "question": "Which of the following medications was most likely used to treat this patient's symptoms?", "context": ["A 70-year-old man comes to the physician for a follow-up evaluation.", "Eight months ago, he presented with a 6-month history of increased urinary frequency, difficulty to initiate urination, and straining to maintain the urinary stream.", "Digital rectal examination showed symmetrically enlarged, nontender prostate with rubbery texture.", "Laboratory studies showed a prostate-specific antigen (PSA) level of 2 ng/mL.", "Abdominal ultrasound showed a post-void residual urine volume of 250 ml and bladder wall thickening.", "The patient received appropriate treatment.", "His vital signs are within normal limits.", "Laboratory studies now show a PSA level of 1 ng/mL."], "context_len": 8, "options": {"A": "Oxybutynin", "B": "Dutasteride", "C": "Terazosin", "D": "Tadalafil"}, "answer": "Dutasteride", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "70", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 70-year-old man comes to the physician for a follow-up evaluation.", "2. Eight months ago, he presented with a 6-month history of increased urinary frequency, difficulty to initiate urination, and straining to maintain the urinary stream.", "3. Digital rectal examination showed symmetrically enlarged, nontender prostate with rubbery texture.", "4. Laboratory studies showed a prostate-specific antigen (PSA) level of 2 ng/mL.", "5. Abdominal ultrasound showed a post-void residual urine volume of 250 ml and bladder wall thickening.", "6. The patient received appropriate treatment.", "7. His vital signs are within normal limits.", "8. Laboratory studies now show a PSA level of 1 ng/mL."], "atomic_facts": ["1. Eight months ago, he presented with a 6-month history of increased urinary frequency, difficulty to initiate urination, and straining to maintain the urinary stream.", "2. Digital rectal examination showed symmetrically enlarged, nontender prostate with rubbery texture.", "3. Laboratory studies showed a prostate-specific antigen (PSA) level of 2 ng/mL.", "4. Abdominal ultrasound showed a post-void residual urine volume of 250 ml and bladder wall thickening.", "5. The patient received appropriate treatment.", "6. His vital signs are within normal limits.", "7. Laboratory studies now show a PSA level of 1 ng/mL."]}
{"id": 561, "question": "Which of the following is the most likely diagnosis?", "context": ["A 53-year-old man presents to the office complaining of persistent abdominal pain.", "He states that he has gained 4.5 kg (10.0 lb) because the pain is only relieved by eating.", "The patient also admits that he has had numerous loose, foul-smelling stools over the last few weeks with associated nausea.", "He has taken some over the counter antacids without relief or change in symptoms.", "His blood pressure is 132/76 mm Hg, respiratory rate is 14/min, and heart rate is 75/min.", "Physical examination reveals mild tenderness to palpation of the upper abdomen."], "context_len": 6, "options": {"A": "H. pylori infection", "B": "Intestinal type gastric adenocarcinoma", "C": "NSAID induced peptic ulcer disease", "D": "Zollinger-Ellison syndrome"}, "answer": "Zollinger-Ellison syndrome", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "53 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 53-year-old man presents to the office complaining of persistent abdominal pain.", "2. He states that he has gained 4.5 kg (10.0 lb) because the pain is only relieved by eating.", "3. The patient has had numerous loose, foul-smelling stools over the last few weeks with associated nausea.", "4. He has taken some over the counter antacids without relief or change in symptoms.", "5. His blood pressure is 132/76 mm Hg.", "6. His respiratory rate is 14/min.", "7. His heart rate is 75/min.", "8. Physical examination reveals mild tenderness to palpation of the upper abdomen."], "atomic_facts": ["1. The patient has gained 4.5 kg (10.0 lb) due to pain relief from eating.", "2. The patient has experienced numerous loose, foul-smelling stools over the last few weeks with associated nausea.", "3. The patient has taken over the counter antacids without relief or change in symptoms.", "4. The patient's blood pressure is 132/76 mm Hg.", "5. The patient's respiratory rate is 14/min.", "6. The patient's heart rate is 75/min.", "7. Physical examination reveals mild tenderness to palpation of the upper abdomen."]}
{"id": 562, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 68-year-old man with advanced dementia is brought to the preoperative unit prior to an elective cholecystectomy for biliary colic.", "He says he does not want the surgery anymore.", "He begins yelling at unit staff and requests to leave.", "His designated medical power of attorney, who had previously signed the surgery consent forms, is present."], "context_len": 4, "options": {"A": "Cancel the surgery and allow the patient to leave", "B": "Ask the patient about his concerns and try to address them", "C": "Call family members and schedule a family meeting", "D": "Perform cognitive screening evaluation"}, "answer": "Ask the patient about his concerns and try to address them", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "68 years old", "specialties": ["Geriatric Medicine", "Geriatrics", "Anesthesiology", "Internal Medicine"], "subspecialties": ["Geriatric Medicine", "General Geriatric Medicine", "General Geriatrics"], "specialty_prob": [0.4, 0.2, 0.2, 0.2], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 68-year-old man has advanced dementia.", "2. He was brought to the preoperative unit prior to an elective cholecystectomy for biliary colic.", "3. He says he does not want the surgery anymore.", "4. He begins yelling at unit staff.", "5. He requests to leave.", "6. His designated medical power of attorney is present.", "7. The medical power of attorney had previously signed the surgery consent forms."], "atomic_facts": ["1. He does not want the surgery anymore.", "2. He begins yelling at unit staff.", "3. He requests to leave.", "4. His designated medical power of attorney is present.", "5. The medical power of attorney had previously signed the surgery consent forms."]}
{"id": 563, "question": "Which of the following pathogens should be considered before initiating treatment for the current episode?", "context": ["A 67-year-old man presents to his physician\u2019s office with a progressive cough.", "It has been increasing in intensity over the past week.", "He has also been noticing an increase in the amount of sputum he usually produces, which is thick and yellow.", "He also complains of increased difficulty in breathing, more so than he previously experienced.", "He was diagnosed with chronic obstructive lung disease (COPD) about 3 years ago and has been on treatment for it since then.", "He doesn\u2019t report any fever, chills, or night sweats.", "He has observed a foul smell to his sputum.", "His blood pressure is 100/65 mm Hg, the respirations are 23/min and the pulse is about 110/min.", "Currently, his FEV1 is around 48% of the normal predicted value.", "He is currently receiving a yearly influenza shot and has taken the pneumococcal vaccination at the time of his diagnosis.", "In spite of this, he has had acute exacerbations of his symptoms 4 times over the last year.", "His last episode was 2 months ago, for which he was treated with a short course of antibiotics.", "He is also currently receiving treatment for diabetes."], "context_len": 13, "options": {"A": "S. pneumonia", "B": "H. influenzae", "C": "P. aeruginosa", "D": "Syncytial virus"}, "answer": "P. aeruginosa", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "67 years old", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 67 years old.", "2. Patient has a progressive cough for the past week.", "3. Patient has increased sputum production, which is thick and yellow.", "4. Patient has increased difficulty in breathing.", "5. Patient was diagnosed with COPD 3 years ago and has been on treatment since then.", "6. Patient does not report fever, chills, or night sweats.", "7. Patient's sputum has a foul smell.", "8. Patient's blood pressure is 100/65 mm Hg.", "9. Patient's respirations are 23/min.", "10. Patient's pulse is 110/min.", "11. Patient's FEV1 is 48% of the normal predicted value.", "12. Patient receives a yearly influenza shot.", "13. Patient has taken the pneumococcal vaccination at the time of diagnosis.", "14. Patient has had 4 acute exacerbations of symptoms in the last year.", "15. Patient's last episode was 2 months ago and was treated with a short course of antibiotics.", "16. Patient is currently receiving treatment for diabetes."], "atomic_facts": ["1. The patient's symptoms have been increasing in intensity over the past week.", "2. The patient has noticed an increase in the amount of sputum he usually produces, which is thick and yellow.", "3. The patient complains of increased difficulty in breathing, more so than he previously experienced.", "4. The patient was diagnosed with chronic obstructive lung disease (COPD) about 3 years ago and has been on treatment for it since then.", "5. The patient doesn\u2019t report any fever, chills, or night sweats.", "6. The patient has observed a foul smell to his sputum.", "7. The patient's blood pressure is 100/65 mm Hg, the respirations are 23/min, and the pulse is about 110/min.", "8. Currently, the patient's FEV1 is around 48% of the normal predicted value.", "9. The patient is currently receiving a yearly influenza shot and has taken the pneumococcal vaccination at the time of his diagnosis.", "10. The patient has had acute exacerbations of his symptoms 4 times over the last year.", "11. The patient's last episode was 2 months ago, for which he was treated with a short course of antibiotics.", "12. The patient is also currently receiving treatment for diabetes."]}
{"id": 564, "question": "Which of the following structures is involved in the development of an epidural hematoma?", "context": ["A 27-year-old man who was involved in a motor vehicle collision is brought into the emergency room with a fractured skull.", "The paramedics report that the patient was conscious and lucid on the way to the hospital but now is unresponsive.", "His vitals are a blood pressure of 122/78 mm Hg, temperature of 37.0\u00b0C (98.6\u00b0F), pulse rate of 88/min, and respiratory rate of 14/min.", "A noncontrast CT scan of the head shows an epidural hematoma."], "context_len": 4, "options": {"A": "Middle meningeal artery", "B": "Bridging cortical veins", "C": "Arteriovenous malformation", "D": "Lenticulostriate vessels"}, "answer": "Middle meningeal artery", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "27 years old", "specialties": ["Neurological Surgery"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurological Surgery"}, "facts_old": ["1. A 27-year-old man was involved in a motor vehicle collision.", "2. The patient was conscious and lucid on the way to the hospital.", "3. The patient is now unresponsive.", "4. The patient's blood pressure is 122/78 mm Hg.", "5. The patient's temperature is 37.0\u00b0C (98.6\u00b0F).", "6. The patient's pulse rate is 88/min.", "7. The patient's respiratory rate is 14/min.", "8. A noncontrast CT scan of the head shows an epidural hematoma.", "9. The patient has a fractured skull."], "atomic_facts": ["1. The paramedics reported the patient was conscious and lucid on the way to the hospital.", "2. The patient is now unresponsive.", "3. The patient's blood pressure is 122/78 mm Hg.", "4. The patient's temperature is 37.0\u00b0C (98.6\u00b0F).", "5. The patient's pulse rate is 88/min.", "6. The patient's respiratory rate is 14/min.", "7. A noncontrast CT scan of the head shows an epidural hematoma."]}
{"id": 565, "question": "Which of the following characteristics is true of the most likely cause of this patient's disorder?", "context": ["A 54-year-old woman presents to the emergency department due to recent onset of a high fever, accompanied by severe headache and neck stiffness.", "Her past medical history is significant for rapidly progressive glomerulonephritis.", "She is currently on immunosuppressants after a kidney transplant performed 6 months ago.", "On presentation, her temperature is 102.2\u00b0F (39\u00b0C), blood pressure is 112/71 mmHg, pulse is 107/min, and respirations are 22/min.", "Physical exam reveals severe pain with neck flexion and reciprocal knee flexion.", "Laboratory tests reveal a gram-positive organism with endotoxin."], "context_len": 6, "options": {"A": "Anaerobic spore forming rods", "B": "Catalase-negative", "C": "Coagulase-positive", "D": "Tumbling motility in broth"}, "answer": "Tumbling motility in broth", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "54 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 54-year-old woman presents to the emergency department.", "2. She has a high fever, severe headache, and neck stiffness.", "3. Her past medical history is significant for rapidly progressive glomerulonephritis.", "4. She is currently on immunosuppressants after a kidney transplant 6 months ago.", "5. Her temperature is 102.2\u00b0F (39\u00b0C).", "6. Her blood pressure is 112/71 mmHg.", "7. Her pulse is 107/min.", "8. Her respirations are 22/min.", "9. Physical exam reveals severe pain with neck flexion and reciprocal knee flexion.", "10. Laboratory tests reveal a gram-positive organism with endotoxin."], "atomic_facts": ["1. Past medical history includes rapidly progressive glomerulonephritis.", "2. Currently on immunosuppressants after a kidney transplant performed 6 months ago.", "3. On presentation, temperature is 102.2\u00b0F (39\u00b0C).", "4. On presentation, blood pressure is 112/71 mmHg.", "5. On presentation, pulse is 107/min.", "6. On presentation, respirations are 22/min.", "7. Physical exam reveals severe pain with neck flexion and reciprocal knee flexion.", "8. Laboratory tests reveal a gram-positive organism with endotoxin."]}
{"id": 566, "question": "Which of the following antibiotics is recommended for this patient?", "context": ["A 2-year-old boy is brought to see the pediatrician by his mother due to a \u201cbad\u201d cough.", "The mother reports that he has been coughing so hard that he threw up on several occasions.", "He is adopted and the mother does not know his vaccination history.", "He has no known allergies.", "His temperature is 38.5\u00b0C (100.5\u00b0F), pulse is 120/min, respirations are 33/min, blood pressure is 101/54 mm Hg, and oxygen saturation is 96% on room air.", "The boy looks unwell with mild difficulty breathing and a nonproductive cough multiple times followed by a \u201cwhoop\u201d sound during the inhalation.", "He has scattered petechiae on his face.", "A nasopharyngeal swab is sent for culture and PCR."], "context_len": 8, "options": {"A": "Ceftriaxone", "B": "Cefotaxime", "C": "Erythromycin", "D": "Ampicillin"}, "answer": "Erythromycin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2-year-old boy is brought to see the pediatrician by his mother.", "2. The mother reports that he has been coughing so hard that he threw up on several occasions.", "3. He is adopted and the mother does not know his vaccination history.", "4. He has no known allergies.", "5. His temperature is 38.5\u00b0C (100.5\u00b0F).", "6. His pulse is 120/min.", "7. His respirations are 33/min.", "8. His blood pressure is 101/54 mm Hg.", "9. His oxygen saturation is 96% on room air.", "10. The boy looks unwell with mild difficulty breathing.", "11. He has a nonproductive cough multiple times followed by a \u201cwhoop\u201d sound during the inhalation.", "12. He has scattered petechiae on his face.", "13. A nasopharyngeal swab is sent for culture and PCR."], "atomic_facts": ["1. The mother reports that he has been coughing so hard that he threw up on several occasions.", "2. He is adopted and the mother does not know his vaccination history.", "3. He has no known allergies.", "4. His temperature is 38.5\u00b0C (100.5\u00b0F).", "5. His pulse is 120/min.", "6. His respirations are 33/min.", "7. His blood pressure is 101/54 mm Hg.", "8. His oxygen saturation is 96% on room air.", "9. The boy looks unwell with mild difficulty breathing and a nonproductive cough multiple times followed by a \u201cwhoop\u201d sound during the inhalation.", "10. He has scattered petechiae on his face.", "11. A nasopharyngeal swab is sent for culture and PCR."]}
{"id": 567, "question": "What is the mechanism by which this organism causes diarrhea?", "context": ["A 19-year-old man returns from travel in South America.", "He presents complaining of profuse, watery diarrhea.", "You suspect the causative organism to be Enterotoxigenic E.coli."], "context_len": 4, "options": {"A": "Blocks the release of inhibitory neurotransmitters GABA and glycine", "B": "Blocks the presynaptic release of acetylcholine at the neuromuscular junction", "C": "Stimulates release of cytokines", "D": "Stimulates adenylate cyclase (increasing cAMP)"}, "answer": "Stimulates adenylate cyclase (increasing cAMP)", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "19", "specialties": ["Infectious Disease"], "subspecialties": ["General Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 19-year-old man returns from travel.", "2. He presents complaining of profuse, watery diarrhea.", "3. You suspect the causative organism to be Enterotoxigenic E. coli."], "atomic_facts": ["1. Patient presents with profuse, watery diarrhea.", "2. Suspected causative organism is Enterotoxigenic E.coli."]}
{"id": 568, "question": "What histopathological findings would you expect to find in this patient?", "context": ["A 38-year-old man presents to the clinic for complaints of abdominal pain and diarrhea.", "He reports a long-standing history of the symptoms except for the time when he attempted a carbohydrate-free diet 5 years ago.", "The pain is described as stabbing, diffuse, 8/10, and is especially worse following food intake.", "Recently, he noticed some numbness and tingling of his feet but denies any bloody stool, nausea, vomiting, fevers, weight loss, or focal neurological deficits."], "context_len": 4, "options": {"A": "Blunting of the intestinal villi at the ileum", "B": "Crypt abscesses at the descending colon", "C": "Noncaseating granulomas at the ileum", "D": "Normal gastric mucosa at the jejunum"}, "answer": "Blunting of the intestinal villi at the ileum", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "38", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 38-year-old man presents to the clinic.", "2. He has abdominal pain and diarrhea.", "3. He has had these symptoms for a long time.", "4. Five years ago, he attempted a carbohydrate-free diet.", "5. The pain is described as stabbing, diffuse, 8/10.", "6. The pain is worse following food intake.", "7. He has noticed some numbness and tingling of his feet.", "8. He denies any bloody stool.", "9. He denies any nausea.", "10. He denies any vomiting.", "11. He denies any fevers.", "12. He denies any weight loss.", "13. He denies any focal neurological deficits."], "atomic_facts": ["1. Patient reports long-standing history of symptoms", "2. Symptoms improved when attempted carbohydrate-free diet 5 years ago", "3. Pain is stabbing, diffuse, 8/10", "4. Pain worsens following food intake", "5. Patient noticed numbness and tingling in feet", "6. Denies bloody stool", "7. Denies nausea", "8. Denies vomiting", "9. Denies fevers", "10. Denies weight loss", "11. Denies focal neurological deficits"]}
{"id": 569, "question": "What is the histopathology of the most common large-artery complication of this disease?", "context": ["A 25-year-old male presents for a new primary-care visit.", "He has never been seen by a physician and reports that he has been in good health.", "You note a very tall, very thin male whose arm span is greater than his height.", "The patient reports that his father had a similar build but passed away suddenly in his 40s.", "You suspect a genetic disorder characterized by a defect in fibrillin-1."], "context_len": 5, "options": {"A": "Focal granulomatous inflammation with mural lymphocytes, macrophages, giant cells", "B": "Predominant neutrophilic infiltration with fibrinoid necrosis", "C": "Fibrinoid necrosis of blood vessel walls, endothelial swelling, and neutrophilic infiltrate in skin lesions", "D": "Cystic medial degeneration"}, "answer": "Cystic medial degeneration", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "25", "specialties": ["Pathology"], "subspecialties": ["Hematopathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 25-year-old male presents for a new primary-care visit.", "2. He has never been seen by a physician.", "3. He reports that he has been in good health.", "4. The patient is very tall and very thin.", "5. His arm span is greater than his height.", "6. The patient's father had a similar build.", "7. The patient's father passed away suddenly in his 40s.", "8. You suspect a genetic disorder characterized by a defect in fibrillin-1."], "atomic_facts": ["1. The patient has never been seen by a physician.", "2. The patient reports being in good health.", "3. The patient is very tall and very thin.", "4. The patient's arm span is greater than his height.", "5. The patient's father had a similar build.", "6. The patient's father passed away suddenly in his 40s.", "7. The medical assistant suspects a genetic disorder.", "8. The genetic disorder is characterized by a defect in fibrillin-1."]}
{"id": 570, "question": "Assuming the investigators intend to keep the level of significance at 5%, which of the following changes would be most effective to increase the statistical power?", "context": ["A group of investigators is evaluating the efficacy of intranasal ketamine in decreasing acute suicidality in teenagers admitted to inpatient psychiatric units.", "They conducted a pilot study in which 15 participants were randomized to receive intranasal ketamine while 15 participants were randomized to receive placebo.", "The investigators ultimately found no statistically significant difference in suicidality after 30 days of follow up with the level of significance fixed at 5%.", "They suspect inadequate statistical power."], "context_len": 4, "options": {"A": "Decrease the sample size", "B": "Decrease the type II error rate", "C": "Increase beta", "D": "Increase the type I error rate"}, "answer": "Decrease the type II error rate", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Psychiatry"], "subspecialties": ["Child and Adolescent Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A group of investigators is evaluating the efficacy of intranasal ketamine in decreasing acute suicidality in teenagers admitted to inpatient psychiatric units.", "2. They conducted a pilot study in which 15 participants were randomized to receive intranasal ketamine.", "3. 15 participants were randomized to receive placebo.", "4. The investigators ultimately found no statistically significant difference in suicidality after 30 days of follow up.", "5. The level of significance was fixed at 5%.", "6. They suspect inadequate statistical power."], "atomic_facts": ["1. A pilot study was conducted.", "2. 15 participants received intranasal ketamine.", "3. 15 participants received placebo.", "4. No statistically significant difference in suicidality was found after 30 days of follow-up.", "5. The level of significance was fixed at 5%.", "6. The investigators suspect inadequate statistical power."]}
{"id": 571, "question": "Which of the following etiologies is the most likely cause of this patient\u2019s neurologic findings?", "context": ["A 56-year-old man presents with severe back pain for the past hour.", "He says the pain started about 1 hour ago and has not improved.", "The patient describes the pain as sharp, 10/10, and located between his scapula.", "Past medical history is significant for hypertension, which he is noncompliant with medication.", "His vital signs are a blood pressure of 180/95 mm Hg and a pulse of 108/min.", "On physical examination, there is a loss of pain and temperature sensation in the lower trunk and extremities bilaterally.", "Strength is 4 out of 5 in all muscle groups in the lower extremities bilaterally.", "A contrast CT of the chest reveals findings consistent with a type B aortic dissection."], "context_len": 8, "options": {"A": "Brown-S\u00e9quard syndrome", "B": "Spinal cord compression", "C": "Anterior cord syndrome", "D": "Spinal epidural hematoma"}, "answer": "Anterior cord syndrome", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Neurological Surgery", "Neurology"], "subspecialties": ["General Neurological Surgery", "Spinal Cord Compression"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 56 years old.", "2. Patient has severe back pain for the past hour.", "3. Patient says pain started 1 hour ago and has not improved.", "4. Patient describes pain as sharp, 10/10, and located between scapula.", "5. Patient has past medical history of hypertension.", "6. Patient is noncompliant with medication.", "7. Patient's blood pressure is 180/95 mm Hg.", "8. Patient's pulse is 108/min.", "9. Patient has loss of pain and temperature sensation in lower trunk and extremities bilaterally.", "10. Patient has strength of 4 out of 5 in all muscle groups in lower extremities bilaterally.", "11. Contrast CT of chest reveals findings consistent with type B aortic dissection."], "atomic_facts": ["1. The patient reports that the pain started about 1 hour ago and has not improved.", "2. The patient describes the pain as sharp and rates it as 10/10.", "3. The pain is located between the patient's scapula.", "4. The patient has a past medical history significant for hypertension.", "5. The patient is noncompliant with medication for hypertension.", "6. The patient's blood pressure is 180/95 mm Hg.", "7. The patient's pulse is 108/min.", "8. On physical examination, there is a loss of pain and temperature sensation in the lower trunk and extremities bilaterally.", "9. Strength is 4 out of 5 in all muscle groups in the lower extremities bilaterally.", "10. A contrast CT of the chest reveals findings consistent with a type B aortic dissection."]}
{"id": 572, "question": "This patient's condition is most likely caused by a defect in a gene encoding a protein that is normally involved in which of the following processes?", "context": ["A 7-year-old girl is brought to the physician by her mother because of a 6-month history of worsening fatigue and frequent upper respiratory tract infections.", "She is at the 2nd percentile for height and 10th percentile for weight.", "Physical examination shows pallor, diffuse hyperpigmented macules, absence of the radial bones, and hypoplastic thumbs.", "Her hemoglobin concentration of 8.7 g/dL, leukocyte count is 2,500/mm3, and platelet count is 30,000/mm3."], "context_len": 4, "options": {"A": "Hydrolysis of glucocerebroside", "B": "DNA interstrand crosslink repair", "C": "Maturation of erythroid progenitor cells", "D": "Ras signal transduction pathway"}, "answer": "DNA interstrand crosslink repair", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology", "Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 7-year-old girl is brought to the physician by her mother.", "2. She has a 6-month history of worsening fatigue and frequent upper respiratory tract infections.", "3. She is at the 2nd percentile for height.", "4. She is at the 10th percentile for weight.", "5. Physical examination shows pallor.", "6. Physical examination shows diffuse hyperpigmented macules.", "7. Physical examination shows absence of the radial bones.", "8. Physical examination shows hypoplastic thumbs.", "9. Her hemoglobin concentration is 8.7 g/dL.", "10. Her leukocyte count is 2,500/mm3.", "11. Her platelet count is 30,000/mm3."], "atomic_facts": ["1. She is at the 2nd percentile for height.", "2. She is at the 10th percentile for weight.", "3. Physical examination shows pallor.", "4. Physical examination shows diffuse hyperpigmented macules.", "5. Physical examination shows absence of the radial bones.", "6. Physical examination shows hypoplastic thumbs.", "7. Her hemoglobin concentration is 8.7 g/dL.", "8. Her leukocyte count is 2,500/mm3.", "9. Her platelet count is 30,000/mm3."]}
{"id": 573, "question": "Which of the following is the best next step in the management of this patient condition?", "context": ["A 36-year-old woman is brought to the emergency department because of loss of consciousness.", "Her husband says that she complained of vomiting and dizziness for 2 days, but did not seek medical care.", "She has a history of acral vitiligo.", "Her blood pressure is 90/60 mm Hg, temperature is 35.9\u00b0C (96.6\u00b0F), and pulse is 90/min.", "On physical examination, she is obtunded, skin turgor is reduced, and her oral mucosa is dry with hyperpigmented spots on the inner side of both cheeks.", "Lab results are shown: | Random plasma glucose 40 mg/dL | Serum osmolarity 275 mOsm/kg H\u2082O | Serum sodium 130 mEq/L | Serum potassium 6 mEq/L | Urine sodium level 30 mEq/L | ECG shows normal sinus rhythm without ST-T wave changes.", "Dextrose 5% is given and random plasma glucose becomes 60 mg/dL, but her blood pressure is still the same."], "context_len": 7, "options": {"A": "Intravenous calcium gluconate", "B": "ACTH stimulation test", "C": "Oral dehydroepiandrosterone (DHEA)", "D": "Normal saline and intravenous dexamethasone"}, "answer": "Normal saline and intravenous dexamethasone", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "36 years old", "specialties": ["Emergency Medicine", "Internal Medicine"], "subspecialties": ["General Emergency Medicine", "Neurology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 36-year-old woman is brought to the emergency department because of loss of consciousness.", "2. Her husband says that she complained of vomiting and dizziness for 2 days, but did not seek medical care.", "3. She has a history of acral vitiligo.", "4. Her blood pressure is 90/60 mm Hg.", "5. Her temperature is 35.9\u00b0C (96.6\u00b0F).", "6. Her pulse is 90/min.", "7. On physical examination, she is obtunded.", "8. Skin turgor is reduced.", "9. Her oral mucosa is dry with hyperpigmented spots on the inner side of both cheeks.", "10. Random plasma glucose is 40 mg/dL.", "11. Serum osmolarity is 275 mOsm/kg H\u2082O.", "12. Serum sodium is 130 mEq/L.", "13. Serum potassium is 6 mEq/L.", "14. Urine sodium level is 30 mEq/L.", "15. ECG shows normal sinus rhythm without ST-T wave changes.", "16. Dextrose 5% is given.", "17. Random plasma glucose becomes 60 mg/dL.", "18. Her blood pressure is still the same."], "atomic_facts": ["1. Her husband says she complained of vomiting and dizziness for 2 days but did not seek medical care.", "2. She has a history of acral vitiligo.", "3. Her blood pressure is 90/60 mm Hg.", "4. Her temperature is 35.9\u00b0C (96.6\u00b0F).", "5. Her pulse is 90/min.", "6. On physical examination, she is obtunded.", "7. Her skin turgor is reduced.", "8. Her oral mucosa is dry with hyperpigmented spots on the inner side of both cheeks.", "9. Lab results: Random plasma glucose 40 mg/dL.", "10. Lab results: Serum osmolarity 275 mOsm/kg H\u2082O.", "11. Lab results: Serum sodium 130 mEq/L.", "12. Lab results: Serum potassium 6 mEq/L.", "13. Lab results: Urine sodium level 30 mEq/L.", "14. ECG shows normal sinus rhythm without ST-T wave changes.", "15. Dextrose 5% is given and random plasma glucose becomes 60 mg/dL.", "16. Her blood pressure is still the same."]}
{"id": 574, "question": "What is the most likely diagnosis?", "context": ["A 4-year-old girl is seen by her pediatrician for developmental delay.", "One year prior, the patient was able to ride a tricycle, stack 3 blocks, and speak in short sentences.", "Now, she is unable to feed herself and has recently started to point to objects she wants rather than asking.", "Physical exam reveals a well nourished child sitting in a stroller wringing her hands.", "Vital signs are normal.", "The patient's mother reports that her 7-year-old son is doing well, and that they have no family history of mental retardation or other cognitive disorders."], "context_len": 6, "options": {"A": "Angelman syndrome", "B": "Rett syndrome", "C": "Prader-Willi syndrome", "D": "McCune-Albright syndrome"}, "answer": "Rett syndrome", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Developmental"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 4-year-old girl is seen by her pediatrician for developmental delay.", "2. One year prior, the patient was able to ride a tricycle.", "3. One year prior, the patient was able to stack 3 blocks.", "4. One year prior, the patient was able to speak in short sentences.", "5. Now, she is unable to feed herself.", "6. Now, she has recently started to point to objects she wants rather than asking.", "7. Physical exam reveals a well nourished child sitting in a stroller wringing her hands.", "8. Vital signs are normal.", "9. The patient's mother reports that her 7-year-old son is doing well.", "10. The patient's mother reports that they have no family history of mental retardation.", "11. The patient's mother reports that they have no family history of other cognitive disorders."], "atomic_facts": ["1. One year prior, the patient was able to ride a tricycle, stack 3 blocks, and speak in short sentences.", "2. Now, she is unable to feed herself.", "3. She has recently started to point to objects she wants rather than asking.", "4. Physical exam reveals a well nourished child sitting in a stroller wringing her hands.", "5. Vital signs are normal.", "6. The patient's mother reports that her 7-year-old son is doing well.", "7. They have no family history of mental retardation or other cognitive disorders."]}
{"id": 575, "question": "Which of the following is the most appropriate next step in the management of this patient?", "context": ["A 49-year-old woman visits the emergency department with the acute onset of severe shortness of breath.", "She also reports right-sided calf pain that developed after a 22-hour flight from Beijing to Los Angeles, and that, several hours after she felt pain in her calf, she began to have trouble breathing.", "Currently, her shortness of breath is so severe that she is unable to speak clearly or quickly, but she manages to deny any recent surgery or history of recent bleeding.", "The vital signs include: blood pressure 111/69 mm Hg, pulse 142/min, and respiratory rate 33/min.", "On observation, she is using accessory muscles to breathe.", "On auscultation, her lungs are clear and her heart rate is rapid but regular.", "Her right calf is swollen, warm, and tender.", "The arterial blood gas test result reveals a pH of 7.5, partial pressure of carbon dioxide (PCO2) 22 mm Hg, and a partial pressure of oxygen (PaO2) 47 mm Hg on 6 L of oxygen by nasal cannula."], "context_len": 8, "options": {"A": "Unfractionated heparin", "B": "Streptokinase", "C": "Low molecular-weight heparin", "D": "Embolectomy"}, "answer": "Streptokinase", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "49", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 49-year-old woman.", "2. Patient has acute onset of severe shortness of breath.", "3. Patient has right-sided calf pain that developed after a 22-hour flight from Beijing to Los Angeles.", "4. Patient felt pain in her calf several hours before having trouble breathing.", "5. Patient denies any recent surgery or history of recent bleeding.", "6. Patient's blood pressure is 111/69 mm Hg.", "7. Patient's pulse is 142/min.", "8. Patient's respiratory rate is 33/min.", "9. Patient is using accessory muscles to breathe.", "10. Patient's lungs are clear on auscultation.", "11. Patient's heart rate is rapid but regular.", "12. Patient's right calf is swollen, warm, and tender.", "13. Arterial blood gas test result reveals a pH of 7.5.", "14. Arterial blood gas test result reveals a PCO2 of 22 mm Hg.", "15. Arterial blood gas test result reveals a PaO2 of 47 mm Hg on 6 L of oxygen by nasal cannula."], "atomic_facts": ["1. Patient reports right-sided calf pain after a 22-hour flight from Beijing to Los Angeles.", "2. Patient developed trouble breathing several hours after feeling pain in her calf.", "3. Patient's shortness of breath is severe, making it difficult for her to speak clearly or quickly.", "4. Patient denies any recent surgery or history of recent bleeding.", "5. Vital signs: blood pressure 111/69 mm Hg, pulse 142/min, respiratory rate 33/min.", "6. Patient is using accessory muscles to breathe.", "7. On auscultation, lungs are clear and heart rate is rapid but regular.", "8. Patient's right calf is swollen, warm, and tender.", "9. Arterial blood gas test result: pH 7.5, PCO2 22 mm Hg, PaO2 47 mm Hg on 6 L of oxygen by nasal cannula."]}
{"id": 576, "question": "Which of the following is the most likely diagnosis?", "context": ["A 37-year-old woman, gravida 4, para 3, at 35 weeks' gestation is admitted to the hospital in active labor.", "She has had no prenatal care.", "Her three children were delivered by lower segment transverse cesarean section.", "The patient appears in acute distress.", "Her pulse is 98/min, respirations are 15/min, and blood pressure is 130/80 mm Hg.", "The abdomen is nontender and contractions are felt.", "The fetus is in a cephalic presentation.", "The fetal heart rate is reactive with no decelerations.", "One hour following vaginal delivery, the placenta is not delivered.", "Manual separation of the placenta leads to profuse vaginal bleeding.", "A firm, nontender uterine fundus is palpated at the level of the umbilicus."], "context_len": 11, "options": {"A": "Uterine rupture", "B": "Placenta previa", "C": "Placenta accreta", "D": "Abruptio placentae\n\""}, "answer": "Placenta accreta", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "37 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology", "Placenta accreta", "Placenta previa"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 37-year-old woman is admitted to the hospital in active labor.", "2. She has had no prenatal care.", "3. Her gravida is 4.", "4. Her para is 3.", "5. She is at 35 weeks' gestation.", "6. Her three children were delivered by lower segment transverse cesarean section.", "7. The patient appears in acute distress.", "8. Her pulse is 98/min.", "9. Her respirations are 15/min.", "10. Her blood pressure is 130/80 mm Hg.", "11. The abdomen is nontender.", "12. Contractions are felt.", "13. The fetus is in a cephalic presentation.", "14. The fetal heart rate is reactive with no decelerations.", "15. One hour following vaginal delivery, the placenta is not delivered.", "16. Manual separation of the placenta leads to profuse vaginal bleeding.", "17. A firm, nontender uterine fundus is palpated at the level of the umbilicus."], "atomic_facts": ["1. She has had no prenatal care.", "2. Her three children were delivered by lower segment transverse cesarean section.", "3. The patient appears in acute distress.", "4. Her pulse is 98/min.", "5. Her respirations are 15/min.", "6. Her blood pressure is 130/80 mm Hg.", "7. The abdomen is nontender.", "8. Contractions are felt.", "9. The fetus is in a cephalic presentation.", "10. The fetal heart rate is reactive with no decelerations.", "11. One hour following vaginal delivery, the placenta is not delivered.", "12. Manual separation of the placenta leads to profuse vaginal bleeding.", "13. A firm, nontender uterine fundus is palpated at the level of the umbilicus."]}
{"id": 577, "question": "An MRI of the brain will reveal an atrophy of which of the following structure?", "context": ["A 40-year-old man is brought to the clinic by his wife with a complaint of behavioral changes for the past few months.", "He is irritable and gets angry with trivial matters.", "He sometimes screams in the middle of the night and remains restless.", "His wife has recently noticed that he is forgetting things and repeats the same question multiple times.", "For the past few weeks, he is also having abnormal movements of his body, more prominent in the arms and hands.", "The past medical history is unremarkable.", "His father died at the age of 28 years old in a road traffic accident.", "His grandmother had similar symptoms after her retirement.", "He does not smoke, drinks alcohol, or uses illicit drugs.", "The physical examination reveals a restless ill-groomed man.", "He is having intermittent involuntary dance-like movements.", "The slit-lamp ophthalmic examination is normal.", "His mini-mental state examination (MMSE) score is 22/30.", "The complete blood count, basic metabolic profile, thyroid profile, liver profile, serum vitamin B12, and ceruloplasmin levels are within normal range."], "context_len": 14, "options": {"A": "Caudate nucleus", "B": "Cerebellum", "C": "Diffuse cortex", "D": "Frontal and temporal lobes"}, "answer": "Caudate nucleus", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "40 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 40-year-old man is brought to the clinic by his wife.", "2. He has been exhibiting behavioral changes for the past few months.", "3. He is irritable and gets angry with trivial matters.", "4. He sometimes screams in the middle of the night and remains restless.", "5. His wife has recently noticed that he is forgetting things and repeats the same question multiple times.", "6. For the past few weeks, he is also having abnormal movements of his body, more prominent in the arms and hands.", "7. His past medical history is unremarkable.", "8. His father died at the age of 28 years old in a road traffic accident.", "9. His grandmother had similar symptoms after her retirement.", "10. He does not smoke, drink alcohol, or use illicit drugs.", "11. The physical examination reveals a restless ill-groomed man.", "12. He is having intermittent involuntary dance-like movements.", "13. The slit-lamp ophthalmic examination is normal.", "14. His mini-mental state examination (MMSE) score is 22/30.", "15. The complete blood count, basic metabolic profile, thyroid profile, liver profile, serum vitamin B12, and ceruloplasmin levels are within normal range."], "atomic_facts": ["1. He is irritable and gets angry with trivial matters.", "2. He sometimes screams in the middle of the night and remains restless.", "3. His wife has recently noticed that he is forgetting things and repeats the same question multiple times.", "4. For the past few weeks, he is also having abnormal movements of his body, more prominent in the arms and hands.", "5. The past medical history is unremarkable.", "6. His father died at the age of 28 years old in a road traffic accident.", "7. His grandmother had similar symptoms after her retirement.", "8. He does not smoke, drinks alcohol, or uses illicit drugs.", "9. The physical examination reveals a restless ill-groomed man.", "10. He is having intermittent involuntary dance-like movements.", "11. The slit-lamp ophthalmic examination is normal.", "12. His mini-mental state examination (MMSE) score is 22/30.", "13. The complete blood count, basic metabolic profile, thyroid profile, liver profile, serum vitamin B12, and ceruloplasmin levels are within normal range."]}
{"id": 578, "question": "Which of the following statements best describes the study?", "context": ["A researcher is studying the association between hemoglobin levels and BMI.", "He divides volunteers who wish to participate into 2 groups based on their BMI, a normal weight group and an overweight group.", "He then measures the hemoglobin level of all of the volunteers.", "His null hypothesis is that there is no association between hemoglobin levels and body weight.", "The mean hemoglobin level for the normal weight group is 13.4 g/dL and 13.8 g/dL for the overweight group.", "He obtains a mean difference of 0.4 g/dL between the 2 groups.", "He does an unpaired t-test and gets a p-value of 0.10."], "context_len": 7, "options": {"A": "If the null hypothesis is not true, 10% or more of the volunteers would not show any association between hemoglobin level and weight.", "B": "If the null hypothesis is not true, there is still a 10% probability to not get this difference of 0.4 g/dL or higher due to chance.", "C": "If the null hypothesis is true, there is still a 10% probability of not getting this difference of 0.4 g/dL or higher due to chance.", "D": "If the null hypothesis is true, there is a 10% probability to get this difference of 0.4 g/dL or higher due to chance."}, "answer": "If the null hypothesis is true, there is a 10% probability to get this difference of 0.4 g/dL or higher due to chance.", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A researcher is studying the association between hemoglobin levels and BMI.", "2. He divides volunteers who wish to participate into 2 groups based on their BMI, a normal weight group and an overweight group.", "3. He then measures the hemoglobin level of all of the volunteers.", "4. His null hypothesis is that there is no association between hemoglobin levels and body weight.", "5. The mean hemoglobin level for the normal weight group is 13.4 g/dL.", "6. The mean hemoglobin level for the overweight group is 13.8 g/dL.", "7. He obtains a mean difference of 0.4 g/dL between the 2 groups.", "8. He does an unpaired t-test and gets a p-value of 0.10."], "atomic_facts": ["1. Volunteers are divided into 2 groups based on their BMI: normal weight and overweight.", "2. Hemoglobin levels of all volunteers are measured.", "3. The null hypothesis is that there is no association between hemoglobin levels and body weight.", "4. The mean hemoglobin level for the normal weight group is 13.4 g/dL.", "5. The mean hemoglobin level for the overweight group is 13.8 g/dL.", "6. The mean difference in hemoglobin levels between the 2 groups is 0.4 g/dL.", "7. An unpaired t-test is conducted.", "8. The p-value obtained from the t-test is 0.10."]}
{"id": 579, "question": "Which of the following embryologic structures most likely gave rise to the structure that was damaged in this patient?", "context": ["A 51-year-old female with a history of papillary thyroid carcinoma who is two weeks status-post thyroidectomy presents to her surgeon complaining of difficulty with her voice.", "Following the operation, she developed immediate hoarseness and difficulty speaking.", "The hoarseness has not improved since the operation.", "Her past medical history is notable for hypertension and obesity.", "Her temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 120/80 mmHg, pulse is 90/min, and respirations are 16/min.", "Physical examination reveals a healing surgical scar without evidence of infection or dehiscence."], "context_len": 6, "options": {"A": "First branchial arch", "B": "Second branchial arch", "C": "Fourth branchial arch", "D": "Sixth branchial arch"}, "answer": "Sixth branchial arch", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "51", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is a 51-year-old female.", "2. Patient has a history of papillary thyroid carcinoma.", "3. Patient is two weeks status-post thyroidectomy.", "4. Patient presents to her surgeon complaining of difficulty with her voice.", "5. Patient developed immediate hoarseness and difficulty speaking following the operation.", "6. Hoarseness has not improved since the operation.", "7. Patient's past medical history is notable for hypertension and obesity.", "8. Patient's temperature is 99\u00b0F (37.2\u00b0C).", "9. Patient's blood pressure is 120/80 mmHg.", "10. Patient's pulse is 90/min.", "11. Patient's respirations are 16/min.", "12. Physical examination reveals a healing surgical scar without evidence of infection or dehiscence."], "atomic_facts": ["1. Following the operation, she developed immediate hoarseness and difficulty speaking.", "2. The hoarseness has not improved since the operation.", "3. Her past medical history is notable for hypertension and obesity.", "4. Her temperature is 99\u00b0F (37.2\u00b0C).", "5. Her blood pressure is 120/80 mmHg.", "6. Her pulse is 90/min.", "7. Her respirations are 16/min.", "8. Physical examination reveals a healing surgical scar without evidence of infection or dehiscence."]}
{"id": 580, "question": "Which of the following is the most likely cause of this patient's current symptoms?", "context": ["Six days after admission to the hospital for treatment of infective endocarditis, a 64-year-old woman develops persistent ringing in both ears, lightheadedness, and nausea.", "When she turns her head, she sees the light on the ceiling swinging from side to side.", "She has congestive heart disease, hypertension, and coronary artery disease.", "She was treated for a cerebrovascular accident 7 years ago and has no residual deficits.", "Current medications include intravenous vancomycin and gentamicin, as well as oral aspirin, atenolol, furosemide, and lisinopril.", "Her vital signs are within normal limits.", "Cardiac examination shows a grade 3/6 holosystolic murmur along the left lower sternal border.", "While the patient fixates on a target, administration of brisk, horizontal head rotations to both sides results in corrective saccades to refixate back to the target.", "She has an unsteady gait.", "Muscle strength and sensation are normal."], "context_len": 10, "options": {"A": "Decreased endolymph resorption", "B": "Suppurative labyrinthitis", "C": "Medication toxicity", "D": "Delirium"}, "answer": "Medication toxicity", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "64", "specialties": ["Otolaryngology"], "subspecialties": ["Neurotology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 64 years old.", "2. Patient has been admitted to the hospital for 6 days for treatment of infective endocarditis.", "3. Patient has persistent ringing in both ears, lightheadedness, and nausea.", "4. When patient turns her head, she sees the light on the ceiling swinging from side to side.", "5. Patient has congestive heart disease, hypertension, and coronary artery disease.", "6. Patient was treated for a cerebrovascular accident 7 years ago and has no residual deficits.", "7. Patient is currently taking intravenous vancomycin and gentamicin, as well as oral aspirin, atenolol, furosemide, and lisinopril.", "8. Patient's vital signs are within normal limits.", "9. Cardiac examination shows a grade 3/6 holosystolic murmur along the left lower sternal border.", "10. When patient fixates on a target, administration of brisk, horizontal head rotations to both sides results in corrective saccades to refixate back to the target.", "11. Patient has an unsteady gait.", "12. Patient's muscle strength and sensation are normal."], "atomic_facts": ["1. She sees the light on the ceiling swinging from side to side when she turns her head.", "2. She has congestive heart disease.", "3. She has hypertension.", "4. She has coronary artery disease.", "5. She was treated for a cerebrovascular accident 7 years ago.", "6. She has no residual deficits from the cerebrovascular accident.", "7. Her current medications include intravenous vancomycin.", "8. Her current medications include intravenous gentamicin.", "9. Her current medications include oral aspirin.", "10. Her current medications include oral atenolol.", "11. Her current medications include oral furosemide.", "12. Her current medications include oral lisinopril.", "13. Her vital signs are within normal limits.", "14. Cardiac examination shows a grade 3/6 holosystolic murmur along the left lower sternal border.", "15. Administration of brisk, horizontal head rotations to both sides results in corrective saccades while the patient fixates on a target.", "16. She has an unsteady gait.", "17. Her muscle strength is normal.", "18. Her sensation is normal."]}
{"id": 581, "question": "Which of the following cardiac conditions are the most likely long-term consequence of the patient\u2019s clinical presentation and hospitalization?", "context": ["A patient with congestive heart failure with viral myocarditis due to coxsackievirus infection presents to a local hospital for treatment and then returns home."], "context_len": 1, "options": {"A": "Concentric hypertrophy", "B": "Dilated cardiomyopathy", "C": "Endarteritis obliterans", "D": "Hypertrophic cardiomyopathy"}, "answer": "Dilated cardiomyopathy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "Not specified", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Dilated Cardiomyopathy", "Cardiology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A patient presents to a local hospital.", "2. The patient has congestive heart failure.", "3. The patient has viral myocarditis.", "4. The cause of the viral myocarditis is coxsackievirus infection.", "5. The patient returns home."], "atomic_facts": ["1. The patient has congestive heart failure.", "2. The patient has viral myocarditis.", "3. The viral myocarditis is due to coxsackievirus infection.", "4. The patient presents to a local hospital for treatment.", "5. The patient returns home after treatment."]}
{"id": 582, "question": "This patient should be screened for abnormalities in which of the following organs?", "context": ["A 5-year-old male presents to the pediatrician with his mother for a well child visit.", "His mother has no complaints.", "The patient is doing well in preschool and appears to be ready for kindergarten.", "He can begin to sound out letters and write out his first name.", "He has many friends at school and enjoys playing with his older siblings.", "The patient\u2019s past medical history is notable for birth weight in the 99th percentile and unexplained hypoglycemia in the first week of life.", "The patient\u2019s mother denies any family history of genetic syndromes or malignancy.", "The patient\u2019s height and weight are in the 99th percentile.", "On physical exam, the patient has an enlarged tongue with no other dysmorphic features.", "He also has the physical exam findings seen in Figures A and B."], "context_len": 10, "options": {"A": "Adrenal glands", "B": "Bone", "C": "Eyes", "D": "Kidneys"}, "answer": "Kidneys", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "5 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 5-year-old male presents to the pediatrician with his mother for a well child visit.", "2. His mother has no complaints.", "3. The patient is doing well in preschool and appears to be ready for kindergarten.", "4. He can begin to sound out letters and write out his first name.", "5. He has many friends at school and enjoys playing with his older siblings.", "6. The patient\u2019s past medical history is notable for birth weight in the 99th percentile and unexplained hypoglycemia in the first week of life.", "7. The patient\u2019s mother denies any family history of genetic syndromes or malignancy.", "8. The patient\u2019s height and weight are in the 99th percentile.", "9. On physical exam, the patient has an enlarged tongue with no other dysmorphic features.", "10. He also has the physical exam findings seen in Figures A and B."], "atomic_facts": ["1. His mother has no complaints.", "2. The patient is doing well in preschool and appears to be ready for kindergarten.", "3. He can begin to sound out letters and write out his first name.", "4. He has many friends at school and enjoys playing with his older siblings.", "5. The patient\u2019s past medical history is notable for birth weight in the 99th percentile and unexplained hypoglycemia in the first week of life.", "6. The patient\u2019s mother denies any family history of genetic syndromes or malignancy.", "7. The patient\u2019s height and weight are in the 99th percentile.", "8. On physical exam, the patient has an enlarged tongue with no other dysmorphic features.", "9. He also has the physical exam findings seen in Figures A and B."]}
{"id": 583, "question": "What type of tissue is causing the scar to form on my abdomen?\" The physician promptly answers:", "context": ["A first-year medical student undergoes a surgical procedure involving a midline laporotomy incision.", "The patient presents back to the surgeon approximately 3 months later and asks the surgeon: \"."], "context_len": 2, "options": {"A": "Keratin", "B": "Type 1 collagen", "C": "Type 2 collagen", "D": "Type 4 collagen"}, "answer": "Type 1 collagen", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "Not specified", "specialties": ["Pathology"], "subspecialties": ["Dermatopathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A first-year medical student underwent a surgical procedure.", "2. The surgical procedure involved a midline laporotomy incision.", "3. The patient presented back to the surgeon approximately 3 months later.", "4. The patient asked the surgeon a question."], "atomic_facts": ["1. The patient presents back to the surgeon.", "2. The patient presents approximately 3 months later.", "3. The patient asks the surgeon a question."]}
{"id": 584, "question": "The patient\u2019s lesion is likely composed of functional cells from which of the following regions:", "context": ["A 40-year-old female complains of muscle weakness.", "Her blood pressure is 180/140 mm Hg, and serum potassium is 3.2 mEq/L.", "Plasma renin levels are abnormally low.", "A CT scan of her abdomen reveals a 3 cm lesion in her right adrenal gland."], "context_len": 4, "options": {"A": "Zona glomerulosa", "B": "Zona fasciculata", "C": "Adrenal medulla", "D": "Posterior pituitary"}, "answer": "Zona glomerulosa", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "40", "specialties": ["Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 40-year-old female complains of muscle weakness.", "2. Her blood pressure is 180/140 mm Hg.", "3. Her serum potassium is 3.2 mEq/L.", "4. Her plasma renin levels are abnormally low.", "5. A CT scan of her abdomen reveals a 3 cm lesion in her right adrenal gland."], "atomic_facts": ["1. Her blood pressure is 180/140 mm Hg.", "2. Her serum potassium is 3.2 mEq/L.", "3. Plasma renin levels are abnormally low.", "4. A CT scan of her abdomen reveals a 3 cm lesion in her right adrenal gland."]}
{"id": 585, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?", "context": ["A 75-year-old woman is brought to the physician by her daughter because of a 1-month history of fatigue and a 3.5-kg (7-lb) weight loss.", "The patient has a history of hypertension, hyperlipidemia, and Alzheimer's dementia.", "She lives with her daughter and requires assistance with all of her banking and meal preparation.", "Her daughter has hypothyroidism but there is no other history of serious illness in the family.", "She does not remember the names of her medications but says she takes them every day.", "Her pulse is 114/min and blood pressure is 148/101 mm Hg.", "Physical examination shows warm skin and a tremor.", "The thyroid gland is not palpable.", "The serum thyroid stimulating hormone level is undetectable.", "Histological examination of a thyroid biopsy shows follicular atrophy."], "context_len": 10, "options": {"A": "Graves disease", "B": "Exogenous levothyroxine use", "C": "Granulomatous thyroiditis", "D": "Iodine exposure"}, "answer": "Exogenous levothyroxine use", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "75 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 75-year-old woman is brought to the physician by her daughter.", "2. She has a 1-month history of fatigue and a 3.5-kg (7-lb) weight loss.", "3. She has a history of hypertension, hyperlipidemia, and Alzheimer's dementia.", "4. She lives with her daughter and requires assistance with all of her banking and meal preparation.", "5. Her daughter has hypothyroidism.", "6. There is no other history of serious illness in the family.", "7. She does not remember the names of her medications but says she takes them every day.", "8. Her pulse is 114/min and blood pressure is 148/101 mm Hg.", "9. Physical examination shows warm skin and a tremor.", "10. The thyroid gland is not palpable.", "11. The serum thyroid stimulating hormone level is undetectable.", "12. Histological examination of a thyroid biopsy shows follicular atrophy."], "atomic_facts": ["1. The patient has a history of hypertension, hyperlipidemia, and Alzheimer's dementia.", "2. She lives with her daughter and requires assistance with all of her banking and meal preparation.", "3. Her daughter has hypothyroidism but there is no other history of serious illness in the family.", "4. She does not remember the names of her medications but says she takes them every day.", "5. Her pulse is 114/min and blood pressure is 148/101 mm Hg.", "6. Physical examination shows warm skin and a tremor.", "7. The thyroid gland is not palpable.", "8. The serum thyroid stimulating hormone level is undetectable.", "9. Histological examination of a thyroid biopsy shows follicular atrophy."]}
{"id": 586, "question": "Which of the following types of shock best describes this patient's condition?", "context": ["A 42-year-old man is brought to the emergency department by EMS from the scene of an automobile accident, where he appeared to be an unrestrained passenger.", "The patient is confused and unable to answer questions.", "His temperature is 98.6\u00b0F (37\u00b0C), pulse is 120/min, blood pressure is 75/44 mmHg, and respiratory rate is 22/min.", "On physical exam, there is bruising over his sternum and left chest, with tenderness to palpation.", "Cardiac auscultation reveals normal heart sounds with no murmurs, rubs, or gallops.", "He has marked jugular venous distention and bibasilar crackles on pulmonary auscultation with equal air entry bilaterally.", "Abdominal and cranial nerve exams are within normal limits.", "His extremities are cool with prolonged capillary refill, and he is diaphoretic.", "The patient is admitted to the intensive care unit and hemodynamic monitoring is established, which reveals a pulmonary capillary wedge pressure (PCWP) of 22 mmHg (normal range 8-12 mmHg), central venous pressure (CVP) of 12 cmH2O (normal range 4-12 cmH2O), cardiac output (CO) of 2.2 L/min (normal range 4-8 L/min), and systemic vascular resistance (SVR) of 1800 dynes/seconds/cm^-5 (normal range 700\u20131600 dynes/seconds/cm^-5)."], "context_len": 9, "options": {"A": "Cardiogenic", "B": "Anaphylactic", "C": "Neurogenic", "D": "Obstructive"}, "answer": "Cardiogenic", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "42 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 42 years old.", "2. Patient was brought to the emergency department by EMS from the scene of an automobile accident.", "3. Patient appeared to be an unrestrained passenger.", "4. Patient is confused and unable to answer questions.", "5. Patient's temperature is 98.6\u00b0F (37\u00b0C).", "6. Patient's pulse is 120/min.", "7. Patient's blood pressure is 75/44 mmHg.", "8. Patient's respiratory rate is 22/min.", "9. Patient has bruising over his sternum and left chest, with tenderness to palpation.", "10. Cardiac auscultation reveals normal heart sounds with no murmurs, rubs, or gallops.", "11. Patient has marked jugular venous distention.", "12. Patient has bibasilar crackles on pulmonary auscultation with equal air entry bilaterally.", "13. Abdominal and cranial nerve exams are within normal limits.", "14. Patient's extremities are cool with prolonged capillary refill.", "15. Patient is diaphoretic.", "16. Patient is admitted to the intensive care unit.", "17. Hemodynamic monitoring is established.", "18. Pulmonary capillary wedge pressure (PCWP) is 22 mmHg (normal range 8-12 mmHg).", "19. Central venous pressure (CVP) is 12 cmH2O (normal range 4-12 cmH2O).", "20. Cardiac output (CO) is 2.2 L/min (normal range 4-8 L/min).", "21. Systemic vascular resistance (SVR) is 1800 dynes/seconds/cm^-5 (normal range 700\u20131600 dynes/seconds/cm^-5)."], "atomic_facts": ["1. The patient is confused and unable to answer questions.", "2. His temperature is 98.6\u00b0F (37\u00b0C).", "3. His pulse is 120/min.", "4. His blood pressure is 75/44 mmHg.", "5. His respiratory rate is 22/min.", "6. On physical exam, there is bruising over his sternum and left chest, with tenderness to palpation.", "7. Cardiac auscultation reveals normal heart sounds with no murmurs, rubs, or gallops.", "8. He has marked jugular venous distention.", "9. He has bibasilar crackles on pulmonary auscultation with equal air entry bilaterally.", "10. Abdominal and cranial nerve exams are within normal limits.", "11. His extremities are cool with prolonged capillary refill, and he is diaphoretic.", "12. The patient is admitted to the intensive care unit.", "13. Hemodynamic monitoring is established.", "14. The pulmonary capillary wedge pressure (PCWP) is 22 mmHg (normal range 8-12 mmHg).", "15. The central venous pressure (CVP) is 12 cmH2O (normal range 4-12 cmH2O).", "16. The cardiac output (CO) is 2.2 L/min (normal range 4-8 L/min).", "17. The systemic vascular resistance (SVR) is 1800 dynes/seconds/cm^-5 (normal range 700\u20131600 dynes/seconds/cm^-5)."]}
{"id": 587, "question": "What is the most likely explanation for this patient\u2019s presentation?", "context": ["A 23-year-old man comes to the emergency department complaining of 10/10 abdominal pain.", "He describes the pain as sharp, stabbing, intermittent, and concentrated at the left lower quadrant.", "It started about 3 hours ago with no obvious precipitating factor.", "He reports multiple similar episodes in the past but they have all resolved within 1 hour or so.", "He denies fever, weight changes, headaches, nausea/vomiting, or gastrointestinal changes but endorses \u201cred-colored urine\u201d for the past day.", "He just returned from an extensive hiking trip in Colorado.", "A radiograph of the abdomen was unremarkable."], "context_len": 7, "options": {"A": "Hereditary defect of amino acid transporter in the kidney", "B": "Infection with urease positive bacteria", "C": "Presence of antibodies to the glomerular basement membrane", "D": "Thinning and splitting of the glomerular basement membrane"}, "answer": "Hereditary defect of amino acid transporter in the kidney", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "23 years old", "specialties": ["Internal Medicine", "Gastroenterology"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 23-year-old man comes to the emergency department.", "2. He is complaining of 10/10 abdominal pain.", "3. He describes the pain as sharp, stabbing, intermittent, and concentrated at the left lower quadrant.", "4. The pain started about 3 hours ago with no obvious precipitating factor.", "5. He reports multiple similar episodes in the past but they have all resolved within 1 hour or so.", "6. He denies fever, weight changes, headaches, nausea/vomiting, or gastrointestinal changes.", "7. He endorses \u201cred-colored urine\u201d for the past day.", "8. He just returned from an extensive hiking trip in Colorado.", "9. A radiograph of the abdomen was unremarkable."], "atomic_facts": ["1. The patient describes the pain as sharp, stabbing, intermittent, and concentrated at the left lower quadrant.", "2. The pain started about 3 hours ago with no obvious precipitating factor.", "3. The patient reports multiple similar episodes in the past, but they have all resolved within 1 hour or so.", "4. The patient denies fever, weight changes, headaches, nausea/vomiting, or gastrointestinal changes but endorses \u201cred-colored urine\u201d for the past day.", "5. The patient just returned from an extensive hiking trip in Colorado.", "6. A radiograph of the abdomen was unremarkable."]}
{"id": 588, "question": "Which of the following is a side-effect of definitive treatment for this patient?", "context": ["A 33-year-old African American woman presents to the emergency department due to diffuse pain and fatigue.", "The woman states that she feels like her bones and muscles diffusely hurt.", "She also has experienced some abdominal pain as well and states that she has trouble focusing.", "The patient has a past medical history of sickle cell disease for which she takes hydroxyurea.", "Her temperature is 98.1\u00b0F (36.7\u00b0C), blood pressure is 119/59 mmHg, pulse is 130/min, respirations are 16/min, and oxygen saturation is 98% on room air.", "Laboratory values are ordered and are currently pending."], "context_len": 6, "options": {"A": "Dilute urine", "B": "Peaked T-waves on ECG", "C": "QT shortening on ECG", "D": "Tetany"}, "answer": "Tetany", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "33", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Internal Medicine", "Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 33-year-old African American woman presents to the emergency department.", "2. The woman states that she has diffuse pain and fatigue.", "3. She also has experienced some abdominal pain.", "4. The patient has difficulty focusing.", "5. The patient has a past medical history of sickle cell disease.", "6. The patient takes hydroxyurea for her sickle cell disease.", "7. The patient's temperature is 98.1\u00b0F (36.7\u00b0C).", "8. The patient's blood pressure is 119/59 mmHg.", "9. The patient's pulse is 130/min.", "10. The patient's respirations are 16/min.", "11. The patient's oxygen saturation is 98% on room air.", "12. Laboratory values are ordered and are currently pending."], "atomic_facts": ["1. The woman feels diffuse bone and muscle pain.", "2. She has experienced abdominal pain.", "3. She has trouble focusing.", "4. The patient has a past medical history of sickle cell disease.", "5. She takes hydroxyurea for sickle cell disease.", "6. Her temperature is 98.1\u00b0F (36.7\u00b0C).", "7. Her blood pressure is 119/59 mmHg.", "8. Her pulse is 130/min.", "9. Her respirations are 16/min.", "10. Her oxygen saturation is 98% on room air.", "11. Laboratory values are ordered and pending."]}
{"id": 589, "question": "Which of the following is the most likely underlying mechanism of the recurrence of this patient's symptoms?", "context": ["A 40-year-old man with psoriatic arthritis comes to the physician because of progressively worsening pain and stiffness in both of his hands and feet for the past 3 weeks.", "His psoriatic arthritis had been well-controlled with adalimumab for several years prior to this.", "His only other medication is omeprazole.", "Physical examination shows scaly plaques on both elbows and limited range of motion of most of the larger joints."], "context_len": 4, "options": {"A": "Suppression of the bone marrow", "B": "Decreased ionization by the glomeruli", "C": "Formation of antidrug antibodies", "D": "Increased acetylation by the liver"}, "answer": "Formation of antidrug antibodies", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "40", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 40-year-old man has psoriatic arthritis.", "2. He has been experiencing progressively worsening pain and stiffness in both of his hands and feet for the past 3 weeks.", "3. His psoriatic arthritis had been well-controlled with adalimumab for several years prior to this.", "4. His only other medication is omeprazole.", "5. Physical examination shows scaly plaques on both elbows.", "6. Physical examination shows limited range of motion of most of the larger joints."], "atomic_facts": ["1. His psoriatic arthritis had been well-controlled with adalimumab for several years.", "2. His only other medication is omeprazole.", "3. Physical examination shows scaly plaques on both elbows.", "4. Physical examination shows limited range of motion of most of the larger joints."]}
{"id": 590, "question": "This abnormal lab finding was most likely caused by increased activity of which of the following mediators?", "context": ["A 35-year-old African American female presents to the emergency department with a three day history of cough, chest pain, and fever.", "Upon presenting to the emergency department, her temperature is 101.4 \u00b0F (38.5 \u00b0C), blood pressure is 110/80 mmHg, pulse is 95/min, and respirations are 24/min.", "Lung auscultation reveals crackles over the left lung base.", "Chest radiograph reveals a dense consolidation in the left lower lung.", "The patient undergoes lab tests in the emergency department that demonstrate an elevated level of C-reactive protein."], "context_len": 5, "options": {"A": "IL-12", "B": "IL-8", "C": "IL-6", "D": "IL-2"}, "answer": "IL-6", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "35", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 35-year-old African American female presents to the emergency department.", "2. She has a three day history of cough, chest pain, and fever.", "3. Her temperature is 101.4 \u00b0F (38.5 \u00b0C).", "4. Her blood pressure is 110/80 mmHg.", "5. Her pulse is 95/min.", "6. Her respirations are 24/min.", "7. Lung auscultation reveals crackles over the left lung base.", "8. Chest radiograph reveals a dense consolidation in the left lower lung.", "9. The patient undergoes lab tests in the emergency department.", "10. The lab tests demonstrate an elevated level of C-reactive protein."], "atomic_facts": ["1. Upon presenting to the emergency department, her temperature is 101.4 \u00b0F (38.5 \u00b0C).", "2. Her blood pressure is 110/80 mmHg.", "3. Her pulse is 95/min.", "4. Her respirations are 24/min.", "5. Lung auscultation reveals crackles over the left lung base.", "6. Chest radiograph reveals a dense consolidation in the left lower lung.", "7. The patient undergoes lab tests in the emergency department.", "8. The lab tests demonstrate an elevated level of C-reactive protein."]}
{"id": 591, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 50-year-old man comes to the physician after a fall on a flight of stairs earlier that day.", "He slipped, causing him to fall and hit the handrail with the lateral part of his chest.", "He has no shortness of breath.", "He returned from a 10-day trip to South Africa 4 weeks ago.", "He smoked one pack of cigarettes daily for 10 years but stopped 18 years ago.", "He drinks 1\u20132 beers a week.", "His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 78/min, and blood pressure is 126/72 mm Hg.", "Examination shows normal breath sounds bilaterally.", "The left lateral chest wall is tender to palpation.", "An x-ray of the chest shows no fracture; there is a 5-mm lesion in the right upper lung field.", "There are no previous x-rays of the patient available."], "context_len": 11, "options": {"A": "Follow-up x-ray of the chest in 12 months", "B": "Positron emission tomography", "C": "CT scan of the chest", "D": "Reassurance"}, "answer": "CT scan of the chest", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "50", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery", "Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 50-year-old man comes to the physician after a fall on a flight of stairs earlier that day.", "2. He slipped, causing him to fall and hit the handrail with the lateral part of his chest.", "3. He has no shortness of breath.", "4. He returned from a 10-day trip to South Africa 4 weeks ago.", "5. He smoked one pack of cigarettes daily for 10 years but stopped 18 years ago.", "6. He drinks 1\u20132 beers a week.", "7. His temperature is 37.1\u00b0C (98.8\u00b0F).", "8. His pulse is 78/min.", "9. His blood pressure is 126/72 mm Hg.", "10. Examination shows normal breath sounds bilaterally.", "11. The left lateral chest wall is tender to palpation.", "12. An x-ray of the chest shows no fracture.", "13. There is a 5-mm lesion in the right upper lung field.", "14. There are no previous x-rays of the patient available."], "atomic_facts": ["1. He slipped, causing him to fall and hit the handrail with the lateral part of his chest.", "2. He has no shortness of breath.", "3. He returned from a 10-day trip to South Africa 4 weeks ago.", "4. He smoked one pack of cigarettes daily for 10 years but stopped 18 years ago.", "5. He drinks 1\u20132 beers a week.", "6. His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 78/min, and blood pressure is 126/72 mm Hg.", "7. Examination shows normal breath sounds bilaterally.", "8. The left lateral chest wall is tender to palpation.", "9. An x-ray of the chest shows no fracture; there is a 5-mm lesion in the right upper lung field.", "10. There are no previous x-rays of the patient available."]}
{"id": 592, "question": "White blood cell (WBC) count  1,500/mm3 | Platelets 300,000/mm3 | Which of the following organisms is most likely responsible for this patient\u2019s condition?", "context": ["A 62-year-old woman presents to a clinic with complaints of a worsening rash on her back, fevers with chills, and rigor for 2 days.", "She denies any headaches, nausea, or vomiting.", "She is currently on chemotherapy for multiple myeloma, which was diagnosed last year.", "On examination, there were multiple punched-out ulcers covered in crusts surrounded by raised, violaceous margins on her back.", "Some of the lesions have black necrotic centers.", "The vital signs include: temperature 38.8\u00b0C (102.0\u00b0F), respirations 24/min, pulse 110/min, and blood pressure 100/90 mm Hg.", "Laboratory studies show: | Hemoglobin 8.4 g/dL | ."], "context_len": 7, "options": {"A": "Pseudomonas aeruginosa", "B": "Streptococcus pneumoniae", "C": "Haemophilus influenzae", "D": "Streptococcus pyogenes"}, "answer": "Pseudomonas aeruginosa", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "62 years old", "specialties": ["Dermatology", "Internal Medicine"], "subspecialties": ["General Dermatology", "Infectious Disease"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 62-year-old woman.", "2. Patient has a worsening rash on her back, fevers with chills, and rigor for 2 days.", "3. Patient denies any headaches, nausea, or vomiting.", "4. Patient is currently on chemotherapy for multiple myeloma, which was diagnosed last year.", "5. On examination, there were multiple punched-out ulcers covered in crusts surrounded by raised, violaceous margins on her back. Some of the lesions have black necrotic centers.", "6. Vital signs include: temperature 38.8\u00b0C (102.0\u00b0F), respirations 24/min, pulse 110/min, and blood pressure 100/90 mm Hg.", "7. Laboratory studies show: Hemoglobin 8.4 g/dL."], "atomic_facts": ["1. The patient denies any headaches, nausea, or vomiting.", "2. She is currently on chemotherapy for multiple myeloma, which was diagnosed last year.", "3. On examination, there were multiple punched-out ulcers covered in crusts surrounded by raised, violaceous margins on her back.", "4. Some of the lesions have black necrotic centers.", "5. The vital signs include: temperature 38.8\u00b0C (102.0\u00b0F), respirations 24/min, pulse 110/min, and blood pressure 100/90 mm Hg.", "6. Laboratory studies show: Hemoglobin 8.4 g/dL."]}
{"id": 593, "question": "Which of the following enzymes is most likely inhibited by this toxin?", "context": ["An 8-year-old boy developed nausea, abdominal pain, and watery diarrhea 6 hours after consuming homemade mushroom soup.", "The boy is rushed to the emergency department.", "He is severely dehydrated and his blood pressure is 60/40 mm Hg.", "He is managed with intravenous fluids and other supportive treatment.", "The mushrooms in the soup had been picked from his family's backyard, and samples of mushrooms were sent to the lab for analysis.", "The lab reports confirmed that the mushrooms contained some kind of toxin."], "context_len": 6, "options": {"A": "DNA gyrase", "B": "RNA polymerase II", "C": "RNA polymerase I", "D": "RNA polymerase III"}, "answer": "RNA polymerase II", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. An 8-year-old boy developed nausea, abdominal pain, and watery diarrhea 6 hours after consuming homemade mushroom soup.", "2. The boy is rushed to the emergency department.", "3. He is severely dehydrated and his blood pressure is 60/40 mm Hg.", "4. He is managed with intravenous fluids and other supportive treatment.", "5. The mushrooms in the soup had been picked from his family's backyard.", "6. Samples of mushrooms were sent to the lab for analysis.", "7. The lab reports confirmed that the mushrooms contained some kind of toxin."], "atomic_facts": ["1. The boy is rushed to the emergency department.", "2. He is severely dehydrated.", "3. His blood pressure is 60/40 mm Hg.", "4. He is managed with intravenous fluids and other supportive treatment.", "5. The mushrooms in the soup had been picked from his family's backyard.", "6. Samples of mushrooms were sent to the lab for analysis.", "7. The lab reports confirmed that the mushrooms contained some kind of toxin."]}
{"id": 594, "question": "Which of the following is the most likely cause of these findings?\"", "context": ["A 6-year-old girl is brought to the physician because of generalized fatigue and dark urine for 4 days.", "Four weeks ago, she was treated with cephalexin for a skin infection.", "Her temperature is 37\u00b0C (98.6\u00b0F) and blood pressure is 132/89 mm Hg.", "Physical examination shows 1+ pretibial edema bilaterally.", "Her serum creatinine is 1.7 mg/dL.", "Urine studies show: | Blood 2+ | Protein 2+ | RBC 12\u201314/hpf with dysmorphic features | RBC casts numerous | ."], "context_len": 6, "options": {"A": "Granular subepithelial immune complex deposition", "B": "Systemic amyloid protein aggregation", "C": "Anti-type IV collagen antibody formation", "D": "DNA-anti-DNA antibody immune complex formation"}, "answer": "Granular subepithelial immune complex deposition", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-year-old girl is brought to the physician.", "2. She has had generalized fatigue and dark urine for 4 days.", "3. Four weeks ago, she was treated with cephalexin for a skin infection.", "4. Her temperature is 37\u00b0C (98.6\u00b0F).", "5. Her blood pressure is 132/89 mm Hg.", "6. Physical examination shows 1+ pretibial edema bilaterally.", "7. Her serum creatinine is 1.7 mg/dL.", "8. Urine studies show: Blood 2+.", "9. Urine studies show: Protein 2+.", "10. Urine studies show: RBC 12\u201314/hpf with dysmorphic features.", "11. Urine studies show: RBC casts numerous."], "atomic_facts": ["1. Four weeks ago, she was treated with cephalexin for a skin infection.", "2. Her temperature is 37\u00b0C (98.6\u00b0F).", "3. Her blood pressure is 132/89 mm Hg.", "4. Physical examination shows 1+ pretibial edema bilaterally.", "5. Her serum creatinine is 1.7 mg/dL.", "6. Urine studies show: Blood 2+.", "7. Urine studies show: Protein 2+.", "8. Urine studies show: RBC 12\u201314/hpf with dysmorphic features.", "9. Urine studies show: RBC casts numerous."]}
{"id": 595, "question": "Which of the following infectious agents is the most likely cause of these findings?", "context": ["A 7-year-old girl is brought to the physician by her mother for a 6-month history of irritability.", "She has no history of significant illness and is up-to-date on her immunizations.", "She appears markedly lethargic.", "Her vital signs are within normal limits.", "Physical examination shows subconjunctival pallor.", "Her hemoglobin concentration is 9.2 g/dL and mean corpuscular volume is 76 \u03bcm3.", "A photomicrograph of a wet stool mount is shown."], "context_len": 7, "options": {"A": "Necator americanus", "B": "Enterobius vermicularis", "C": "Trichuris trichiura", "D": "Taenia solium"}, "answer": "Necator americanus", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 7-year-old girl is brought to the physician by her mother.", "2. She has a 6-month history of irritability.", "3. She has no history of significant illness.", "4. She is up-to-date on her immunizations.", "5. She appears markedly lethargic.", "6. Her vital signs are within normal limits.", "7. Physical examination shows subconjunctival pallor.", "8. Her hemoglobin concentration is 9.2 g/dL.", "9. Her mean corpuscular volume is 76 \u03bcm3.", "10. A photomicrograph of a wet stool mount is shown."], "atomic_facts": ["1. She has no history of significant illness.", "2. She is up-to-date on her immunizations.", "3. She appears markedly lethargic.", "4. Her vital signs are within normal limits.", "5. Physical examination shows subconjunctival pallor.", "6. Her hemoglobin concentration is 9.2 g/dL.", "7. Her mean corpuscular volume is 76 \u03bcm3.", "8. A photomicrograph of a wet stool mount is shown."]}
{"id": 596, "question": "Which of the following is the most likely diagnosis?", "context": ["A 15-year-old girl is brought to the physician by her mother because of a 3-day history of lower abdominal pain.", "Over the past 9 months, she has had multiple similar episodes of abdominal pain, each lasting for 4\u20135 days.", "Menarche has not yet occurred.", "Examination shows suprapubic tenderness to palpation.", "Pubic hair and breast development are Tanner stage 4.", "Pelvic examination shows bulging, bluish tissue 1 cm inside the vaginal introitus."], "context_len": 6, "options": {"A": "Labial adhesions", "B": "Androgen insensitivity", "C": "Endometriosis", "D": "Imperforate hymen"}, "answer": "Imperforate hymen", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "15 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 15-year-old girl.", "2. Patient was brought to the physician by her mother.", "3. Patient has a 3-day history of lower abdominal pain.", "4. Patient has had multiple similar episodes of abdominal pain over the past 9 months.", "5. Each episode of abdominal pain has lasted for 4\u20135 days.", "6. Patient has not yet experienced menarche.", "7. Examination shows suprapubic tenderness to palpation.", "8. Pubic hair and breast development are Tanner stage 4.", "9. Pelvic examination shows bulging, bluish tissue 1 cm inside the vaginal introitus."], "atomic_facts": ["1. Over the past 9 months, she has had multiple similar episodes of abdominal pain, each lasting for 4\u20135 days.", "2. Menarche has not yet occurred.", "3. Examination shows suprapubic tenderness to palpation.", "4. Pubic hair and breast development are Tanner stage 4.", "5. Pelvic examination shows bulging, bluish tissue 1 cm inside the vaginal introitus."]}
{"id": 597, "question": "In addition to symptomatic treatment, which of the following antiviral drugs would most likely benefit this patient?", "context": ["A 6-year-old boy presents with high fever, sore throat, and cough for the past day.", "The patient\u2019s mother also says he is complaining of generalized muscle aches and chills.", "Past medical history is significant for childhood asthma, managed with inhaled mometasone furoate.", "The patient\u2019s temperature is 39.1\u00b0C (102.3\u00b0F), pulse is 120/min, and respiratory rate is 20/min.", "On physical examination, his oropharynx is erythematous with mild swelling of the pharyngeal tonsils.", "Chest auscultation reveals crepitus over the lung bases bilaterally.", "There are no signs of respiratory distress.", "Rapid diagnostic testing for influenza B infection in this patient is positive."], "context_len": 8, "options": {"A": "Amantadine", "B": "Ribavirin", "C": "Rimantadine", "D": "Oseltamivir"}, "answer": "Oseltamivir", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 6-year-old boy.", "2. Patient has high fever, sore throat, and cough for the past day.", "3. Patient is complaining of generalized muscle aches and chills.", "4. Patient has past medical history of childhood asthma, managed with inhaled mometasone furoate.", "5. Patient's temperature is 39.1\u00b0C (102.3\u00b0F).", "6. Patient's pulse is 120/min.", "7. Patient's respiratory rate is 20/min.", "8. Patient's oropharynx is erythematous with mild swelling of the pharyngeal tonsils.", "9. Chest auscultation reveals crepitus over the lung bases bilaterally.", "10. Patient has no signs of respiratory distress.", "11. Rapid diagnostic testing for influenza B infection in this patient is positive."], "atomic_facts": ["1. The patient's mother reports that he is complaining of generalized muscle aches and chills.", "2. The patient has a past medical history significant for childhood asthma, managed with inhaled mometasone furoate.", "3. The patient's temperature is 39.1\u00b0C (102.3\u00b0F).", "4. The patient's pulse is 120/min.", "5. The patient's respiratory rate is 20/min.", "6. On physical examination, the patient's oropharynx is erythematous with mild swelling of the pharyngeal tonsils.", "7. Chest auscultation reveals crepitus over the lung bases bilaterally.", "8. There are no signs of respiratory distress.", "9. Rapid diagnostic testing for influenza B infection in this patient is positive."]}
{"id": 598, "question": "Which of the following is most likely to be below the normal range in her blood due to her current condition?", "context": ["A 38-year-old woman presents to the emergency department with nausea and progressive right upper quadrant abdominal pain for the past day.", "For the past year, she has had occasional pain in her right upper quadrant which is often relieved on its own after a few hours.", "She was recently diagnosed with multiple gallstones for which she underwent an elective uncomplicated endoscopic retrograde cholangiopancreatography (ERCP) 3 days ago.", "Past medical history is otherwise unremarkable.", "On physical examination, there is tenderness over the epigastrium with no guarding or rebound.", "Vital signs include blood pressure 110/68 mm Hg, pulse 98/min, temperature 36.2\u00b0C (97.2\u00b0F), and respiratory rate 11/min.", "Laboratory tests are pending.", "An imaging study of the abdomen confirms the most likely diagnosis."], "context_len": 8, "options": {"A": "Trypsinogen", "B": "C-reactive protein", "C": "Glucose", "D": "Calcium"}, "answer": "Calcium", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "38 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 38-year-old woman.", "2. Patient presents with nausea and progressive right upper quadrant abdominal pain for the past day.", "3. Patient has had occasional pain in her right upper quadrant for the past year, which is often relieved on its own after a few hours.", "4. Patient was recently diagnosed with multiple gallstones.", "5. Patient underwent an elective uncomplicated endoscopic retrograde cholangiopancreatography (ERCP) 3 days ago.", "6. Patient's past medical history is otherwise unremarkable.", "7. On physical examination, there is tenderness over the epigastrium with no guarding or rebound.", "8. Patient's vital signs include blood pressure 110/68 mm Hg, pulse 98/min, temperature 36.2\u00b0C (97.2\u00b0F), and respiratory rate 11/min.", "9. Laboratory tests are pending.", "10. Imaging study of the abdomen confirms the most likely diagnosis."], "atomic_facts": ["1. She has had occasional pain in her right upper quadrant for the past year.", "2. The pain is often relieved on its own after a few hours.", "3. She was recently diagnosed with multiple gallstones.", "4. She underwent an elective uncomplicated endoscopic retrograde cholangiopancreatography (ERCP) 3 days ago.", "5. Her past medical history is otherwise unremarkable.", "6. On physical examination, there is tenderness over the epigastrium.", "7. There is no guarding or rebound on physical examination.", "8. Her blood pressure is 110/68 mm Hg.", "9. Her pulse is 98/min.", "10. Her temperature is 36.2\u00b0C (97.2\u00b0F).", "11. Her respiratory rate is 11/min.", "12. Laboratory tests are pending.", "13. An imaging study of the abdomen confirms the most likely diagnosis."]}
{"id": 599, "question": "Which of the following additional findings is most likely to be seen in this patient?", "context": ["A 42-year-old woman comes to the emergency department because of hematuria and pain in both flanks.", "She has a history of recurrent urinary tract infections.", "She also complains of swelling of both feet and facial puffiness.", "She has passed urinary stones twice before.", "Her mother also has a history of urinary stone and underwent a kidney transplant.", "Her temperature is 38.0\u00b0C (100.4\u00b0F), pulse is 110/min, and blood pressure is 150/98 mm Hg.", "Abdominal examination shows palpable, bilateral flank masses.", "Results of a complete blood count are within the reference range.", "Her serum creatinine concentration is 2.7 mg/dL."], "context_len": 9, "options": {"A": "Osteolytic bone lesions", "B": "Multiple hepatic cysts", "C": "Mitral valve stenosis", "D": "Popliteal aneurysm"}, "answer": "Multiple hepatic cysts", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 42-year-old woman comes to the emergency department.", "2. She has hematuria and pain in both flanks.", "3. She has a history of recurrent urinary tract infections.", "4. She complains of swelling of both feet and facial puffiness.", "5. She has passed urinary stones twice before.", "6. Her mother has a history of urinary stone and underwent a kidney transplant.", "7. Her temperature is 38.0\u00b0C (100.4\u00b0F).", "8. Her pulse is 110/min.", "9. Her blood pressure is 150/98 mm Hg.", "10. Abdominal examination shows palpable, bilateral flank masses.", "11. Results of a complete blood count are within the reference range.", "12. Her serum creatinine concentration is 2.7 mg/dL."], "atomic_facts": ["1. She has a history of recurrent urinary tract infections.", "2. She complains of swelling of both feet and facial puffiness.", "3. She has passed urinary stones twice before.", "4. Her mother has a history of urinary stone and underwent a kidney transplant.", "5. Her temperature is 38.0\u00b0C (100.4\u00b0F).", "6. Her pulse is 110/min.", "7. Her blood pressure is 150/98 mm Hg.", "8. Abdominal examination shows palpable, bilateral flank masses.", "9. Results of a complete blood count are within the reference range.", "10. Her serum creatinine concentration is 2.7 mg/dL."]}
{"id": 600, "question": "Given the following options, what is the next best step in patient management?", "context": ["A 51-year-old man with a past medical history of peptic ulcer disease currently treated via outpatient triple therapy presents to the urgent care center complaining of acute abdominal pain which began suddenly less than 2 hours ago.", "The physical examination shows his abdomen to be mildly distended, diffusely tender to palpation, and positive for rebound tenderness.", "Physical exam is unremarkable.", "The vital signs include: temperature 36.7\u00b0C (98.0\u00b0F), blood pressure 96/54 mm Hg, heart rate 112/min, and respiratory rate 19/min."], "context_len": 4, "options": {"A": "Abdominal radiographs", "B": "CT abdomen and pelvis", "C": "H. pylori testing", "D": "Serum gastrin level"}, "answer": "CT abdomen and pelvis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "51 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 51-year-old man has a past medical history of peptic ulcer disease.", "2. He is currently treated via outpatient triple therapy.", "3. He presents to the urgent care center complaining of acute abdominal pain.", "4. The pain began suddenly less than 2 hours ago.", "5. The physical examination shows his abdomen to be mildly distended.", "6. His abdomen is diffusely tender to palpation.", "7. His abdomen is positive for rebound tenderness.", "8. His physical exam is otherwise unremarkable.", "9. His temperature is 36.7\u00b0C (98.0\u00b0F).", "10. His blood pressure is 96/54 mm Hg.", "11. His heart rate is 112/min.", "12. His respiratory rate is 19/min."], "atomic_facts": ["1. The physical examination shows his abdomen to be mildly distended.", "2. The physical examination shows his abdomen to be diffusely tender to palpation.", "3. The physical examination shows his abdomen to be positive for rebound tenderness.", "4. The physical exam is unremarkable.", "5. Vital signs include: temperature 36.7\u00b0C (98.0\u00b0F).", "6. Vital signs include: blood pressure 96/54 mm Hg.", "7. Vital signs include: heart rate 112/min.", "8. Vital signs include: respiratory rate 19/min."]}
{"id": 601, "question": "Which of the following is mostly responsible for this patient's late onset of symptoms?", "context": ["A 10-month-old boy is brought to the physician because of fever and a cough for 3 days.", "He was treated for otitis media 3 and 4 months ago.", "He was also treated for pneumococcal pneumonia and H.", "influenzae meningitis this past month.", "He was delivered at term.", "Pregnancy and neonatal period were uncomplicated.", "He was breast-fed until 6 months of age.", "He has a maternal uncle who died of recurrent respiratory tract infections at 28 years of age.", "He is at the 20th percentile for height and the 10th percentile for weight.", "His temperature is 39\u00b0C (102.2\u00b0F), pulse is 122/min, and respirations are 44/min.", "Examination shows crackles at the left lung base.", "Palatine tonsils are absent.", "An x-ray shows an infiltrate in the left lower lung lobe.", "Flow cytometry shows absence of B-cells."], "context_len": 14, "options": {"A": "Reduced T-cell receptor excision circles by 6 months", "B": "Involution of the thymus begins at 6 months", "C": "Splenic dysfunction occurs by 6 months", "D": "Maternal IgG decreases by 6 months"}, "answer": "Maternal IgG decreases by 6 months", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "10 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 10-month-old boy is brought to the physician.", "2. He has had a fever and a cough for 3 days.", "3. He was treated for otitis media 3 and 4 months ago.", "4. He was treated for pneumococcal pneumonia and H. influenzae meningitis this past month.", "5. He was delivered at term.", "6. Pregnancy and neonatal period were uncomplicated.", "7. He was breast-fed until 6 months of age.", "8. He has a maternal uncle who died of recurrent respiratory tract infections at 28 years of age.", "9. He is at the 20th percentile for height.", "10. He is at the 10th percentile for weight.", "11. His temperature is 39\u00b0C (102.2\u00b0F).", "12. His pulse is 122/min.", "13. His respirations are 44/min.", "14. Examination shows crackles at the left lung base.", "15. Palatine tonsils are absent.", "16. An x-ray shows an infiltrate in the left lower lung lobe.", "17. Flow cytometry shows absence of B-cells."], "atomic_facts": ["1. Treated for otitis media 3 and 4 months ago", "2. Treated for pneumococcal pneumonia and H. influenzae meningitis this past month", "3. Delivered at term", "4. Pregnancy and neonatal period were uncomplicated", "5. Breast-fed until 6 months of age", "6. Maternal uncle died of recurrent respiratory tract infections at 28 years of age", "7. At the 20th percentile for height and the 10th percentile for weight", "8. Temperature is 39\u00b0C (102.2\u00b0F), pulse is 122/min, and respirations are 44/min", "9. Examination shows crackles at the left lung base", "10. Palatine tonsils are absent", "11. An x-ray shows an infiltrate in the left lower lung lobe", "12. Flow cytometry shows absence of B-cells"]}
{"id": 602, "question": "Which of the following is the most inclusive list of spinal roots that contribute to the affected nerve in this patient?", "context": ["A 55-year-old right-handed woman is being evaluated for a long history of numbness and tingling in both of her hands, particularly in the third digits, that is worse at night.", "She works as a medical office assistant in a local travel medicine clinic.", "Her past medical history is significant for hypothyroidism, managed medically with thyroxine.", "Physical examination showed thenar eminence atrophy, decreased sensation in the 3 first digits of both hands that extends proximally, and weakness on thumb abduction and thumb opposition; deep tendon reflexes are normal.", "Phalen and Tinel tests are positive."], "context_len": 5, "options": {"A": "C4, C5", "B": "C6, C7, C8", "C": "C3, C4, C5", "D": "C5, C6, C7, C8, T1"}, "answer": "C5, C6, C7, C8, T1", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "55", "specialties": ["Neurology"], "subspecialties": ["General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 55-year-old right-handed woman.", "2. Patient has a long history of numbness and tingling in both hands, particularly in the third digits, that is worse at night.", "3. Patient works as a medical office assistant in a local travel medicine clinic.", "4. Patient has a past medical history of hypothyroidism, managed medically with thyroxine.", "5. Physical examination showed thenar eminence atrophy.", "6. Physical examination showed decreased sensation in the 3 first digits of both hands that extends proximally.", "7. Physical examination showed weakness on thumb abduction and thumb opposition.", "8. Physical examination showed normal deep tendon reflexes.", "9. Phalen and Tinel tests are positive."], "atomic_facts": ["1. She works as a medical office assistant in a local travel medicine clinic.", "2. Her past medical history is significant for hypothyroidism, managed medically with thyroxine.", "3. Physical examination showed thenar eminence atrophy.", "4. Physical examination showed decreased sensation in the 3 first digits of both hands that extends proximally.", "5. Physical examination showed weakness on thumb abduction and thumb opposition.", "6. Physical examination showed normal deep tendon reflexes.", "7. Phalen test is positive.", "8. Tinel test is positive."]}
{"id": 603, "question": "Surgical correction of this patient's condition will most likely prevent which of the following from developing later in life?", "context": ["A 7-year-old girl is referred to a pediatric cardiologist after a heart murmur was auscultated during a routine school health examination.", "The patient has not experienced any symptoms of shortness of breath, fatigue, chest pain, or palpitations.", "She is healthy, does not have any significant medical history, and had an uneventful birth without any complications.", "Her vital signs are as follows: T 37.2 C, HR 92, BP 104/62, RR 24, SpO2 99%.", "Physical examination is significant for a midsystolic ejection murmur heard best at the 2nd intercostal space near the left sternal border, a loud S1 heart sound, a widely fixed split S2 heart sound, and no evidence of cyanosis or clubbing.", "An echocardiogram is conducted and reveals a left-to-right shunt across the interatrial septum."], "context_len": 6, "options": {"A": "Arteriovenous fistula", "B": "Pulmonary stenosis", "C": "Pulmonary hypertension", "D": "Aortic root dilation"}, "answer": "Pulmonary hypertension", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 7-year-old girl is referred to a pediatric cardiologist.", "2. The referral is due to a heart murmur auscultated during a routine school health examination.", "3. The patient has not experienced any symptoms of shortness of breath, fatigue, chest pain, or palpitations.", "4. The patient is healthy and does not have any significant medical history.", "5. The patient had an uneventful birth without any complications.", "6. The patient's temperature is 37.2 C.", "7. The patient's heart rate is 92.", "8. The patient's blood pressure is 104/62.", "9. The patient's respiratory rate is 24.", "10. The patient's SpO2 is 99%.", "11. Physical examination is significant for a midsystolic ejection murmur heard best at the 2nd intercostal space near the left sternal border.", "12. Physical examination is also significant for a loud S1 heart sound.", "13. Physical examination is also significant for a widely fixed split S2 heart sound.", "14. Physical examination is also significant for no evidence of cyanosis or clubbing.", "15. An echocardiogram is conducted.", "16. The echocardiogram reveals a left-to-right shunt across the interatrial septum."], "atomic_facts": ["1. The patient has not experienced symptoms of shortness of breath, fatigue, chest pain, or palpitations.", "2. The patient is healthy and does not have any significant medical history.", "3. The patient had an uneventful birth without any complications.", "4. Vital signs: T 37.2 C, HR 92, BP 104/62, RR 24, SpO2 99%.", "5. Physical examination reveals a midsystolic ejection murmur heard best at the 2nd intercostal space near the left sternal border.", "6. Physical examination reveals a loud S1 heart sound.", "7. Physical examination reveals a widely fixed split S2 heart sound.", "8. Physical examination reveals no evidence of cyanosis or clubbing.", "9. An echocardiogram reveals a left-to-right shunt across the interatrial septum."]}
{"id": 604, "question": "Which of the following is the most likely explanation of the patient's laboratory findings?\"", "context": ["A 21-year-old man is brought to the emergency department by the police because of altered mental status.", "The police found him covering his ears and shouting near a highway rest area.", "Upon questioning, he was unable to look directly at the police and answer coherently.", "On the way to the hospital, he reported feeling nauseous and vomited twice.", "His temperature is 38.2\u00b0C (100.8\u00b0F), pulse is 100/min, respirations are 28/min, and blood pressure is 110/77 mm Hg.", "He is admitted to the hospital for evaluation.", "Three hours after admission, he has a tonic-clonic seizure.", "Laboratory studies show: | Serum | Na+ 140 mEq/L | Cl- 102 mEq/L | Arterial blood gas analysis on room air: | On admission Three hours later | pH 7.47 7.39 | PaCO2 24 mm Hg 31 mm Hg | PO2 84 mm Hg 82 mm Hg | HCO3- 20 mEq/L 18 mEq/L | ."], "context_len": 8, "options": {"A": "Salicylate toxicity", "B": "Diabetic ketoacidosis", "C": "Recurrent vomiting", "D": "Adrenal insufficiency"}, "answer": "Salicylate toxicity", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "21 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 21-year-old man is brought to the emergency department by the police.", "2. The police found him covering his ears and shouting near a highway rest area.", "3. Upon questioning, he was unable to look directly at the police and answer coherently.", "4. On the way to the hospital, he reported feeling nauseous and vomited twice.", "5. His temperature is 38.2\u00b0C (100.8\u00b0F).", "6. His pulse is 100/min.", "7. His respirations are 28/min.", "8. His blood pressure is 110/77 mm Hg.", "9. He is admitted to the hospital for evaluation.", "10. Three hours after admission, he has a tonic-clonic seizure.", "11. Serum Na+ is 140 mEq/L.", "12. Serum Cl- is 102 mEq/L.", "13. Arterial blood gas analysis on room air pH on admission is 7.47.", "14. Arterial blood gas analysis on room air PaCO2 on admission is 24 mm Hg.", "15. Arterial blood gas analysis on room air PO2 on admission is 84 mm Hg.", "16. Arterial blood gas analysis on room air HCO3- on admission is 20 mEq/L.", "17. Arterial blood gas analysis on room air pH three hours later is 7.39.", "18. Arterial blood gas analysis on room air PaCO2 three hours later is 31 mm Hg.", "19. Arterial blood gas analysis on room air PO2 three hours later is 82 mm Hg.", "20. Arterial blood gas analysis on room air HCO3- three hours later is 18 mEq/L."], "atomic_facts": ["1. The police found him covering his ears and shouting near a highway rest area.", "2. Upon questioning, he was unable to look directly at the police and answer coherently.", "3. On the way to the hospital, he reported feeling nauseous and vomited twice.", "4. His temperature is 38.2\u00b0C (100.8\u00b0F), pulse is 100/min, respirations are 28/min, and blood pressure is 110/77 mm Hg.", "5. He is admitted to the hospital for evaluation.", "6. Three hours after admission, he has a tonic-clonic seizure.", "7. Laboratory studies show: Serum Na+ 140 mEq/L, Cl- 102 mEq/L, Arterial blood gas analysis on room air: On admission - pH 7.47, PaCO2 24 mm Hg, PO2 84 mm Hg, HCO3- 20 mEq/L. Three hours later - pH 7.39, PaCO2 31 mm Hg, PO2 82 mm Hg, HCO3- 18 mEq/L."]}
{"id": 605, "question": "Which of the following is the most likely mechanism of action for this treatment?", "context": ["A 58-year-old man makes an appointment with his nephrologist because he has been feeling weak and increasingly fatigued over the last month.", "Specifically, he has not been able to do activities of daily living independently because he feels short of breath after several minutes of activity.", "His past medical history is significant for rapidly progressive glomerulonephritis that led to kidney failure.", "He has been on hemodialysis for the last 6 months and has been compliant with attending every dialysis session.", "Physical exam reveals conjunctival pallor.", "Laboratory tests are obtained and results are shown below: |  | Hemoglobin: 8.9 g/dL (normal: 13.5-17.5 g/dL) | Platelet count: 198,000/mm^3 (normal: 150,000-400,000/mm^3) | Mean corpuscular volume: 87 \u00b5m^3 (normal: 80-100 \u00b5m^3) | Reticulocyte count: 0.1% (normal: 0.5-1.5%) |  | Based on these findings, the patient is given appropriate treatment to address his symptoms."], "context_len": 6, "options": {"A": "Activation of receptors on erythroid progenitor cells", "B": "Chelation of heavy metals", "C": "Provision of finished blood products", "D": "Removal of red blood cell clearing organ"}, "answer": "Activation of receptors on erythroid progenitor cells", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "58", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology", "Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 58-year-old man makes an appointment with his nephrologist.", "2. He has been feeling weak and increasingly fatigued over the last month.", "3. He has not been able to do activities of daily living independently because he feels short of breath after several minutes of activity.", "4. His past medical history is significant for rapidly progressive glomerulonephritis that led to kidney failure.", "5. He has been on hemodialysis for the last 6 months and has been compliant with attending every dialysis session.", "6. Physical exam reveals conjunctival pallor.", "7. Laboratory tests are obtained and results are shown below:", "8. Hemoglobin: 8.9 g/dL (normal: 13.5-17.5 g/dL)", "9. Platelet count: 198,000/mm^3 (normal: 150,000-400,000/mm^3)", "10. Mean corpuscular volume: 87 \u00b5m^3 (normal: 80-100 \u00b5m^3)", "11. Reticulocyte count: 0.1% (normal: 0.5-1.5%)", "12. Based on these findings, the patient is given appropriate treatment to address his symptoms."], "atomic_facts": ["1. The patient is unable to perform activities of daily living independently due to shortness of breath after several minutes of activity.", "2. The patient has a history of rapidly progressive glomerulonephritis leading to kidney failure.", "3. The patient has been undergoing hemodialysis for the past 6 months and has been compliant with attending every dialysis session.", "4. Physical exam reveals conjunctival pallor.", "5. Laboratory tests show: Hemoglobin: 8.9 g/dL (normal: 13.5-17.5 g/dL), Platelet count: 198,000/mm^3 (normal: 150,000-400,000/mm^3), Mean corpuscular volume: 87 \u00b5m^3 (normal: 80-100 \u00b5m^3), Reticulocyte count: 0.1% (normal: 0.5-1.5%).", "6. Based on these findings, the patient is given appropriate treatment to address his symptoms."]}
{"id": 606, "question": "Which of the following best describes the pathogenesis of this patient's histopathological findings?", "context": ["A 33-year-old African American woman comes to the physician because of a 4-month history of progressive fatigue, shortness of breath, constipation, and a nonproductive cough.", "She returned from a trip to Nigeria 6 months ago.", "Physical examination is unremarkable.", "Serum calcium concentration is 11.7 mg/dL.", "An x-ray of the chest shows bilateral hilar lymphadenopathy with coarse, nodular opacities in both lower lobes.", "A photomicrograph of a biopsy specimen of the affected area of the lungs is shown."], "context_len": 6, "options": {"A": "MHC I binding to CD8+ T cells", "B": "Antigen binding to IgM", "C": "TNF-\u03b1 secretion by CD4+ T cells", "D": "IL-5 secretion by Th2 cells"}, "answer": "TNF-\u03b1 secretion by CD4+ T cells", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "33", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology", "Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 33-year-old African American woman comes to the physician.", "2. She has a 4-month history of progressive fatigue, shortness of breath, constipation, and a nonproductive cough.", "3. She returned from a trip to Nigeria 6 months ago.", "4. Physical examination is unremarkable.", "5. Serum calcium concentration is 11.7 mg/dL.", "6. An x-ray of the chest shows bilateral hilar lymphadenopathy with coarse, nodular opacities in both lower lobes.", "7. A photomicrograph of a biopsy specimen of the affected area of the lungs is shown."], "atomic_facts": ["1. She returned from a trip to Nigeria 6 months ago.", "2. Physical examination is unremarkable.", "3. Serum calcium concentration is 11.7 mg/dL.", "4. An x-ray of the chest shows bilateral hilar lymphadenopathy with coarse, nodular opacities in both lower lobes.", "5. A photomicrograph of a biopsy specimen of the affected area of the lungs is shown."]}
{"id": 607, "question": "Which of the following is the most likely cause of this patient's presentation?", "context": ["A 15-day-old female newborn is brought to the physician for evaluation of red eyes with discharge for 3 days.", "She was born at 37 weeks' gestation to a 26-year-old woman.", "Pregnancy and delivery were uncomplicated.", "The mother received irregular prenatal care during the 3rd trimester of pregnancy.", "Examination of the newborn shows watery discharge in both eyes and mild eyelid swelling."], "context_len": 5, "options": {"A": "Staphylococcus aureus", "B": "Chlamydia trachomatis", "C": "Neisseria gonorrhoeae", "D": "Herpes simplex virus 2"}, "answer": "Chlamydia trachomatis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "15 days old", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 15-day-old female newborn was brought to the physician for evaluation of red eyes with discharge for 3 days.", "2. The newborn was born at 37 weeks' gestation.", "3. The mother was 26 years old.", "4. Pregnancy and delivery were uncomplicated.", "5. The mother received irregular prenatal care during the 3rd trimester of pregnancy.", "6. Examination of the newborn showed watery discharge in both eyes.", "7. Examination of the newborn showed mild eyelid swelling."], "atomic_facts": ["1. The baby was born at 37 weeks' gestation.", "2. The mother is 26 years old.", "3. The pregnancy and delivery were uncomplicated.", "4. The mother received irregular prenatal care during the 3rd trimester of pregnancy.", "5. Examination of the newborn shows watery discharge in both eyes.", "6. Examination of the newborn shows mild eyelid swelling."]}
{"id": 608, "question": "Which of the following consequences would be expected?", "context": ["An investigator is studying central nervous system neurotransmitters in mice.", "He injects the spinal cord with a protease that cleaves SNARE proteins, thereby blocking the release of neurotransmitters from the Renshaw cells in the spinal cord."], "context_len": 2, "options": {"A": "Disinhibited behavior", "B": "Hydrophobia", "C": "Positive Kernig sign", "D": "Spastic paralysis"}, "answer": "Spastic paralysis", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Neurology"], "subspecialties": ["Neurodevelopmental Disabilities"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. An investigator is studying central nervous system neurotransmitters in mice.", "2. He injects the spinal cord with a protease.", "3. The protease cleaves SNARE proteins.", "4. The cleaving of SNARE proteins blocks the release of neurotransmitters from the Renshaw cells in the spinal cord."], "atomic_facts": ["1. He injects the spinal cord.", "2. The injection contains a protease.", "3. The protease cleaves SNARE proteins.", "4. Cleaving SNARE proteins blocks the release of neurotransmitters.", "5. The release of neurotransmitters is blocked from the Renshaw cells in the spinal cord."]}
{"id": 609, "question": "Her present condition places her at increased risk for which of the following:", "context": ["A 32-year-old G2P2 at 33 weeks and 4 days of gestation presents to the emergency room with low-grade fever, mild low back pain, and dysuria for 1 day.", "She has a history of urinary tract infections, including one during this current pregnancy that was treated successfully with cephalexin.", "On examination, she is nontoxic but mildly uncomfortable; she has CVA tenderness on her right side.", "Her urinalysis is positive for leukocyte esterase and nitrites, and she is admitted to the hospital for IV antibiotics with ceftriaxone."], "context_len": 4, "options": {"A": "Low birth weight", "B": "Pre-eclampsia", "C": "Postpartum hemorrhage", "D": "Preterm labor"}, "answer": "Preterm labor", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "32 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology", "General Obstetrics and Gynecology."], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 32-year-old G2P2 is presenting to the emergency room.", "2. She is 33 weeks and 4 days of gestation.", "3. She has low-grade fever, mild low back pain, and dysuria for 1 day.", "4. She has a history of urinary tract infections.", "5. She had a UTI during this current pregnancy.", "6. The UTI was treated successfully with cephalexin.", "7. On examination, she is nontoxic but mildly uncomfortable.", "8. She has CVA tenderness on her right side.", "9. Her urinalysis is positive for leukocyte esterase and nitrites.", "10. She is admitted to the hospital for IV antibiotics with ceftriaxone."], "atomic_facts": ["1. She has a history of urinary tract infections.", "2. She had a urinary tract infection during her current pregnancy.", "3. The infection was successfully treated with cephalexin.", "4. On examination, she is nontoxic.", "5. She is mildly uncomfortable.", "6. She has CVA tenderness on her right side.", "7. Her urinalysis is positive for leukocyte esterase.", "8. Her urinalysis is positive for nitrites.", "9. She is admitted to the hospital.", "10. She is admitted for IV antibiotics.", "11. The IV antibiotics are with ceftriaxone."]}
{"id": 610, "question": "Which of the following is the most likely explanation for this patient's symptoms?", "context": ["A 16-year-old African-American boy is brought to the physician because of a 2-month history of progressive right shoulder pain.", "He has had many episodes of joint and bone pain in the past, and as a child, had recurrent painful swelling of his hands and feet.", "His brother had a stroke at 6 years of age and now has an intellectual disability.", "The patient is at the 60th percentile for height and 55th percentile for weight.", "His vital signs are within normal limits.", "Physical examination shows tenderness of the right anterior humerus without noticeable swelling or skin changes.", "Active and passive range of motion of the right shoulder is decreased and there is pain with movement.", "The leukocyte count is 4600/mm3.", "An x-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing."], "context_len": 9, "options": {"A": "Infection of the dermis and subcutaneous tissue", "B": "Infection of the bone", "C": "Infarction of the bone trabeculae", "D": "Loss of bone mineral density"}, "answer": "Infarction of the bone trabeculae", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "16 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 16 years old.", "2. Patient is African-American.", "3. Patient has had 2 months of progressive right shoulder pain.", "4. Patient has had many episodes of joint and bone pain in the past.", "5. Patient had recurrent painful swelling of hands and feet as a child.", "6. Patient's brother had a stroke at 6 years of age.", "7. Patient's brother has an intellectual disability.", "8. Patient is at 60th percentile for height.", "9. Patient is at 55th percentile for weight.", "10. Patient's vital signs are within normal limits.", "11. Physical examination shows tenderness of right anterior humerus without noticeable swelling or skin changes.", "12. Active and passive range of motion of right shoulder is decreased.", "13. Patient has pain with movement of right shoulder.", "14. Leukocyte count is 4600/mm3.", "15. X-ray of right shoulder shows subchondral lucency of humeral head with sclerosis and joint space narrowing."], "atomic_facts": ["1. He has had many episodes of joint and bone pain in the past.", "2. As a child, he had recurrent painful swelling of his hands and feet.", "3. His brother had a stroke at 6 years of age and now has an intellectual disability.", "4. The patient is at the 60th percentile for height.", "5. The patient is at the 55th percentile for weight.", "6. His vital signs are within normal limits.", "7. Physical examination shows tenderness of the right anterior humerus without noticeable swelling or skin changes.", "8. Active and passive range of motion of the right shoulder is decreased.", "9. There is pain with movement in the right shoulder.", "10. The leukocyte count is 4600/mm3.", "11. An x-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing."]}
{"id": 611, "question": "Which of the following is the most likely cause of this patient's symptoms?", "context": ["A 50-year-old woman comes to the emergency department after waking up with facial swelling and with difficulties swallowing.", "She was recently diagnosed with hypertension and started on an antihypertensive drug.", "She follows a strict vegetarian diet.", "Her pulse is 110/min and blood pressure is 135/85 mm Hg.", "Physical examination shows marked edematous swelling of the face, lips, and tongue.", "There is no rash.", "Serum C4 levels are within the reference range."], "context_len": 7, "options": {"A": "Deficiency of C1 esterase inhibitor", "B": "Scombroid poisoning", "C": "Nonimmunologic release of histamine", "D": "Impaired breakdown of kinins"}, "answer": "Impaired breakdown of kinins", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "50", "specialties": ["Allergy and Immunology"], "subspecialties": ["General Allergy and Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A 50-year-old woman comes to the emergency department.", "2. She woke up with facial swelling and difficulties swallowing.", "3. She was recently diagnosed with hypertension.", "4. She started on an antihypertensive drug.", "5. She follows a strict vegetarian diet.", "6. Her pulse is 110/min.", "7. Her blood pressure is 135/85 mm Hg.", "8. Physical examination shows marked edematous swelling of the face, lips, and tongue.", "9. There is no rash.", "10. Serum C4 levels are within the reference range."], "atomic_facts": ["1. She was recently diagnosed with hypertension.", "2. She started on an antihypertensive drug.", "3. She follows a strict vegetarian diet.", "4. Her pulse is 110/min.", "5. Her blood pressure is 135/85 mm Hg.", "6. Physical examination shows marked edematous swelling of the face, lips, and tongue.", "7. There is no rash.", "8. Serum C4 levels are within the reference range."]}
{"id": 612, "question": "Which of the following is the best initial management for this patient?", "context": ["An 82-year-old man presents to the primary care physician with complaints of urinary leakage over the last 2 months.", "The leakage occurred without any additional symptoms.", "He has a history of prostatic hyperplasia.", "The vital signs include: blood pressure 140/90 mm Hg, heart rate 84/min, respiratory rate 18/min, and temperature 36.6\u00b0C (98.0\u00b0F).", "Physical examination reveals a palpable and distended bladder.", "Urinalysis reveals: | Color Yellow | Clarity/turbidity Clear | pH 5.5 | Specific gravity 1.015 | Nitrites Negative | Leukocyte esterase Negative | ."], "context_len": 6, "options": {"A": "Anticholinergics", "B": "Surgery", "C": "Bladder catheterization", "D": "Pelvic floor muscle training"}, "answer": "Bladder catheterization", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "82 years old", "specialties": ["Urology"], "subspecialties": ["General Urology", "Female Pelvic Medicine and Reconstructive Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Urology"}, "facts_old": ["1. An 82-year-old man presents to the primary care physician with complaints of urinary leakage over the last 2 months.", "2. The leakage occurred without any additional symptoms.", "3. He has a history of prostatic hyperplasia.", "4. Blood pressure is 140/90 mm Hg.", "5. Heart rate is 84/min.", "6. Respiratory rate is 18/min.", "7. Temperature is 36.6\u00b0C (98.0\u00b0F).", "8. Physical examination reveals a palpable and distended bladder.", "9. Urinalysis color is Yellow.", "10. Urinalysis clarity/turbidity is Clear.", "11. Urinalysis pH is 5.5.", "12. Urinalysis specific gravity is 1.015.", "13. Urinalysis nitrites are Negative.", "14. Urinalysis leukocyte esterase is Negative."], "atomic_facts": ["1. The leakage occurred without any additional symptoms.", "2. He has a history of prostatic hyperplasia.", "3. The vital signs include: blood pressure 140/90 mm Hg, heart rate 84/min, respiratory rate 18/min, and temperature 36.6\u00b0C (98.0\u00b0F).", "4. Physical examination reveals a palpable and distended bladder.", "5. Urinalysis reveals: Color Yellow.", "6. Urinalysis reveals: Clarity/turbidity Clear.", "7. Urinalysis reveals: pH 5.5.", "8. Urinalysis reveals: Specific gravity 1.015.", "9. Urinalysis reveals: Nitrites Negative.", "10. Urinalysis reveals: Leukocyte esterase Negative."]}
{"id": 613, "question": "What phenomenon describes this?", "context": ["A 25-year-old female presents to her geneticist due to the fear that she may have inherited her father's disease.", "He was diagnosed at the age of 41 when his symptoms of chorea, coordination problems, and cognitive decline begin to occur.", "He was diagnosed with a disease resulting from the expansion of CAG repeats on chromosome 4 and later developed severe dementia and died at the age of 56.", "The daughter was found to have double the amount of CAG repeats and was told by the geneticist that she may have an earlier onset with increased severity of disease."], "context_len": 4, "options": {"A": "Variable expression", "B": "Incomplete penetrance", "C": "Anticipation", "D": "Heteroplasmy"}, "answer": "Anticipation", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 25-year-old female presents to her geneticist.", "2. Her father was diagnosed with a disease at the age of 41.", "3. His symptoms were chorea, coordination problems, and cognitive decline.", "4. The disease was caused by the expansion of CAG repeats on chromosome 4.", "5. Her father developed severe dementia and died at the age of 56.", "6. The daughter was found to have double the amount of CAG repeats.", "7. The geneticist told her she may have an earlier onset with increased severity of disease."], "atomic_facts": ["1. The patient was diagnosed at the age of 41.", "2. His symptoms included chorea, coordination problems, and cognitive decline.", "3. The disease resulted from the expansion of CAG repeats on chromosome 4.", "4. He later developed severe dementia.", "5. He died at the age of 56.", "6. The daughter was found to have double the amount of CAG repeats.", "7. The geneticist told the daughter that she may have an earlier onset with increased severity of the disease."]}
{"id": 614, "question": "Which of the following antibiotics will be most effective in treating this patient\u2019s condition?", "context": ["A 25-year-old man presents to the emergency department after being rescued from a house fire 30 minutes ago.", "He is conscious and in distress.", "On examination, he is noted to have 1st-degree burns involving 54% of his total body surface area.", "He has type 1 diabetes and takes insulin every day.", "He is admitted to the burn unit and treated appropriately.", "Ten days after admission, the physician notices blue-green pus oozing from the burn wounds.", "He is afebrile with a pulse of 90/min and a blood pressure of 130/80 mm Hg.", "A sample exudate is collected with a sterile swab and sent to the laboratory for culture, which yields the growth of aerobic gram-negative rods."], "context_len": 8, "options": {"A": "Azithromycin with rifampin", "B": "Piperacillin with gentamicin", "C": "Piperacillin", "D": "Ticarcillin"}, "answer": "Piperacillin with gentamicin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 25-year-old man presents to the emergency department after being rescued from a house fire 30 minutes ago.", "2. He is conscious and in distress.", "3. On examination, he is noted to have 1st-degree burns involving 54% of his total body surface area.", "4. He has type 1 diabetes and takes insulin every day.", "5. He is admitted to the burn unit and treated appropriately.", "6. Ten days after admission, the physician notices blue-green pus oozing from the burn wounds.", "7. He is afebrile with a pulse of 90/min and a blood pressure of 130/80 mm Hg.", "8. A sample exudate is collected with a sterile swab and sent to the laboratory for culture.", "9. The laboratory culture yields the growth of aerobic gram-negative rods."], "atomic_facts": ["1. He is conscious and in distress.", "2. On examination, he is noted to have 1st-degree burns involving 54% of his total body surface area.", "3. He has type 1 diabetes and takes insulin every day.", "4. He is admitted to the burn unit and treated appropriately.", "5. Ten days after admission, the physician notices blue-green pus oozing from the burn wounds.", "6. He is afebrile with a pulse of 90/min and a blood pressure of 130/80 mm Hg.", "7. A sample exudate is collected with a sterile swab and sent to the laboratory for culture.", "8. The culture yields the growth of aerobic gram-negative rods."]}
{"id": 615, "question": "Which of the following is also likely to be found in this patient?", "context": ["A 67-year-old man with a past medical history of obesity and diabetes presents to the emergency department with fatigue.", "The patient has become more confused over the past several days and has been urinating profusely.", "His temperature is 99.0\u00b0F (37.2\u00b0C), blood pressure is 120/68 mmHg, pulse is 160/min, respirations are 19/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for a confused man with dry mucous membranes.", "He is unable to answer simple questions and is moving all extremities spontaneously."], "context_len": 5, "options": {"A": "Blurred vision", "B": "Meningeal symptoms", "C": "Seizures", "D": "Tremulousness"}, "answer": "Blurred vision", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "67 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 67-year-old man presents to the emergency department.", "2. The patient has a past medical history of obesity and diabetes.", "3. The patient has become more confused over the past several days.", "4. The patient has been urinating profusely.", "5. The patient's temperature is 99.0\u00b0F (37.2\u00b0C).", "6. The patient's blood pressure is 120/68 mmHg.", "7. The patient's pulse is 160/min.", "8. The patient's respirations are 19/min.", "9. The patient's oxygen saturation is 98% on room air.", "10. The patient is confused and has dry mucous membranes.", "11. The patient is unable to answer simple questions.", "12. The patient is moving all extremities spontaneously."], "atomic_facts": ["1. The patient has become more confused over the past several days.", "2. The patient has been urinating profusely.", "3. The patient's temperature is 99.0\u00b0F (37.2\u00b0C).", "4. The patient's blood pressure is 120/68 mmHg.", "5. The patient's pulse is 160/min.", "6. The patient's respirations are 19/min.", "7. The patient's oxygen saturation is 98% on room air.", "8. Physical exam is notable for a confused man with dry mucous membranes.", "9. The patient is unable to answer simple questions.", "10. The patient is moving all extremities spontaneously."]}
{"id": 616, "question": "Which of the following is the most likely etiology of liver damage in this patient?", "context": ["A 42-year-old man presents with acute onset jaundice.", "Past medical history is significant for COPD diagnosed 4 years ago, managed medically, and admission for acute pancreatitis 6 months ago.", "The patient denies any history of smoking, alcohol use or recreational drugs."], "context_len": 3, "options": {"A": "\u03b11-antitrypsin (AAT) deficiency", "B": "Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)", "C": "Dubin\u2013Johnson syndrome", "D": "Hepatitis C"}, "answer": "\u03b11-antitrypsin (AAT) deficiency", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "42 years old", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["Gastroenterology", "General Gastroenterology", "Hepatology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 42-year-old man presents with acute onset jaundice.", "2. Past medical history is significant for COPD diagnosed 4 years ago.", "3. COPD is managed medically.", "4. Patient had an admission for acute pancreatitis 6 months ago.", "5. Patient denies any history of smoking.", "6. Patient denies any history of alcohol use.", "7. Patient denies any history of recreational drugs."], "atomic_facts": ["1. Past medical history includes COPD diagnosed 4 years ago.", "2. COPD is managed medically.", "3. The patient had an admission for acute pancreatitis 6 months ago.", "4. The patient denies any history of smoking.", "5. The patient denies any history of alcohol use.", "6. The patient denies any history of recreational drugs."]}
{"id": 617, "question": "Of the following options, which is the most appropriate next step in the management of this patient?", "context": ["An 8-year-old girl presents to the emergency department with respiratory distress, facial edema, and a skin rash after eating a buffet dinner with her family.", "Her parents say they were eating at a seafood buffet when, all of a sudden, the patient began to cough and feel short of breath.", "They say nothing like this has ever happened before.", "The patient has a history of seasonal allergies for which she occasionally takes cetirizine.", "Her blood pressure is 80/52 mm Hg; heart rate, 122/min; and respiratory rate, 22/min.", "On physical examination, the patient has severe edema over her face and audible stridor."], "context_len": 6, "options": {"A": "Intramuscular epinephrine", "B": "Intravenous epinephrine", "C": "Extra-strength topical diphenhydramine", "D": "Inhaled sodium cromolyn"}, "answer": "Intramuscular epinephrine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. Patient is an 8-year-old girl.", "2. Patient presented to the emergency department with respiratory distress, facial edema, and a skin rash.", "3. Patient was eating at a seafood buffet with her family when she began to cough and feel short of breath.", "4. Patient's parents say nothing like this has ever happened before.", "5. Patient has a history of seasonal allergies for which she occasionally takes cetirizine.", "6. Patient's blood pressure is 80/52 mm Hg.", "7. Patient's heart rate is 122/min.", "8. Patient's respiratory rate is 22/min.", "9. Patient has severe edema over her face.", "10. Patient has audible stridor."], "atomic_facts": ["1. The patient's parents were eating at a seafood buffet.", "2. The patient began to cough and feel short of breath suddenly.", "3. The patient has no history of similar incidents.", "4. The patient has a history of seasonal allergies.", "5. The patient occasionally takes cetirizine for her allergies.", "6. The patient's blood pressure is 80/52 mm Hg.", "7. The patient's heart rate is 122/min.", "8. The patient's respiratory rate is 22/min.", "9. The patient has severe edema over her face.", "10. The patient has audible stridor on physical examination."]}
{"id": 618, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 33-year-old man presents to his physician complaining of a small mass he noticed in his scrotum about 1 month ago.", "The mass feels loosely attached to the right testicle and is firm, and not painful.", "He has no history of a serious illness and takes no medications.", "He is married with 2 children.", "His vital signs are within normal limits.", "Examination shows a 1-cm spherical mass in the superior part of the right testis that has a smooth border.", "It transilluminates with a flashlight.", "The mass does not enlarge when the patient coughs or bears down.", "Scrotal ultrasonography shows an extratesticular hypoechoic mass near the epididymal head of the right testicle with posterior acoustic enhancement and without internal shadows."], "context_len": 9, "options": {"A": "Ligation of processus vaginalis", "B": "Microsurgical varicocelectomy", "C": "Orchiectomy", "D": "No therapy at this time"}, "answer": "No therapy at this time", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "33 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 33-year-old man presents to his physician.", "2. He noticed a small mass in his scrotum about 1 month ago.", "3. The mass feels loosely attached to the right testicle and is firm, and not painful.", "4. He has no history of a serious illness and takes no medications.", "5. He is married with 2 children.", "6. His vital signs are within normal limits.", "7. Examination shows a 1-cm spherical mass in the superior part of the right testis.", "8. The mass has a smooth border.", "9. It transilluminates with a flashlight.", "10. The mass does not enlarge when the patient coughs or bears down.", "11. Scrotal ultrasonography shows an extratesticular hypoechoic mass near the epididymal head of the right testicle.", "12. The mass has posterior acoustic enhancement and without internal shadows."], "atomic_facts": ["1. The mass feels loosely attached to the right testicle", "2. The mass is firm", "3. The mass is not painful", "4. The patient has no history of a serious illness", "5. The patient takes no medications", "6. The patient is married", "7. The patient has 2 children", "8. The patient's vital signs are within normal limits", "9. Examination shows a 1-cm spherical mass in the superior part of the right testis", "10. The mass has a smooth border", "11. The mass transilluminates with a flashlight", "12. The mass does not enlarge when the patient coughs or bears down", "13. Scrotal ultrasonography shows an extratesticular hypoechoic mass near the epididymal head of the right testicle", "14. The mass has posterior acoustic enhancement", "15. The mass does not have internal shadows"]}
{"id": 619, "question": "Which of the following interventions is a proper management strategy for the presented patient?", "context": ["A 51-year-old asymptomatic woman undergoes colposcopy due to a high-grade intraepithelial lesion based on a Pap smear.", "Colposcopy shows a visible lesion 2 cm in diameter located on the posterior cervical lip and confined to the cervix with sharp borders, a coarse mosaic pattern after application of acetic acid, and contact bleeding.", "The histologic evaluation of the biopsy shows glandular epithelial cells with nuclear hyperchromasia and enlargement, increased mitoses, a fusion of glands, and stromal infiltration to 8 mm.", "The chest X-ray and abdominal ultrasound are negative for any additional findings."], "context_len": 4, "options": {"A": "Loop electrosurgical excision procedure (LEEP)", "B": "Modified radical (Wertheim) hysterectomy", "C": "Platinum-based chemotherapy", "D": "Simple hysterectomy with bilateral salpingo-oophorectomy"}, "answer": "Modified radical (Wertheim) hysterectomy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "51 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Complex Family Planning"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 51-year-old asymptomatic woman underwent colposcopy.", "2. The colposcopy was due to a high-grade intraepithelial lesion based on a Pap smear.", "3. Colposcopy showed a visible lesion 2 cm in diameter located on the posterior cervical lip and confined to the cervix with sharp borders.", "4. Colposcopy showed a coarse mosaic pattern after application of acetic acid.", "5. Colposcopy showed contact bleeding.", "6. The histologic evaluation of the biopsy showed glandular epithelial cells with nuclear hyperchromasia and enlargement.", "7. The histologic evaluation of the biopsy showed increased mitoses.", "8. The histologic evaluation of the biopsy showed a fusion of glands.", "9. The histologic evaluation of the biopsy showed stromal infiltration to 8 mm.", "10. The chest X-ray was negative for any additional findings.", "11. The abdominal ultrasound was negative for any additional findings."], "atomic_facts": ["1. Colposcopy shows a visible lesion 2 cm in diameter located on the posterior cervical lip and confined to the cervix with sharp borders.", "2. The lesion has a coarse mosaic pattern after application of acetic acid.", "3. The lesion shows contact bleeding.", "4. The histologic evaluation of the biopsy shows glandular epithelial cells with nuclear hyperchromasia and enlargement.", "5. The biopsy shows increased mitoses.", "6. The biopsy shows a fusion of glands.", "7. The biopsy shows stromal infiltration to 8 mm.", "8. The chest X-ray is negative for any additional findings.", "9. The abdominal ultrasound is negative for any additional findings."]}
{"id": 620, "question": "In the formation of an atherosclerotic plaque, which of the following pairings is correct?", "context": ["A 65-year-old man presents to the Emergency Department complaining of substernal chest pain.", "An acute coronary event is suspected and a coronary catheterization procedure reveals an atherosclerotic plaque in the patient's left anterior descending artery."], "context_len": 2, "options": {"A": "Fibroblasts -- foam cells", "B": "Smooth muscle cells (SMC) -- extracellular matrix (ECM) deposition", "C": "Endothelial cells -- downregulation of VCAM-1", "D": "LDL chemical reduction -- endothelial dysfunction"}, "answer": "Smooth muscle cells (SMC) -- extracellular matrix (ECM) deposition", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology", "Interventional Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old man presents to the Emergency Department.", "2. He is complaining of substernal chest pain.", "3. An acute coronary event is suspected.", "4. A coronary catheterization procedure is performed.", "5. An atherosclerotic plaque is found in the patient's left anterior descending artery."], "atomic_facts": ["1. An acute coronary event is suspected.", "2. A coronary catheterization procedure is performed.", "3. The procedure reveals an atherosclerotic plaque.", "4. The plaque is located in the patient's left anterior descending artery."]}
{"id": 621, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 15-year-old boy is brought to the physician by his mother because of a 2-month history of pain in his left hip.", "The pain started suddenly and has worsened over the past 2 weeks.", "The pain radiates down the thigh and is aggravated by movement.", "He had a fall while cycling around a month ago.", "He had a urinary tract infection 3 months ago that resolved with trimethoprim/sulfamethoxazole.", "There is no family history of serious illness.", "His immunizations are up-to-date.", "He is 165 cm (5 ft 5 in) tall and weighs 85 kg (187 lb); BMI is 31.2 kg/m2.", "His temperature is 37.5\u00b0C (99.5\u00b0F), pulse is 65/min, and blood pressure is 104/70 mm Hg.", "Examination shows an antalgic gait.", "The left groin is tender to palpation and internal rotation is limited due to pain.", "Flexing the hip causes external rotation and abduction.", "His leukocyte count is 9,800/mm3 and erythrocyte sedimentation rate is 12 mm/h.", "An x-ray of the pelvis is shown."], "context_len": 14, "options": {"A": "Long leg cast", "B": "Surgical pinning of femoral head", "C": "Intra-articular lidocaine", "D": "Proximal femoral osteotomy"}, "answer": "Surgical pinning of femoral head", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "15 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is a 15-year-old boy.", "2. Patient has had pain in his left hip for 2 months.", "3. Pain started suddenly and has worsened over the past 2 weeks.", "4. Pain radiates down the thigh and is aggravated by movement.", "5. Patient had a fall while cycling around a month ago.", "6. Patient had a urinary tract infection 3 months ago that resolved with trimethoprim/sulfamethoxazole.", "7. No family history of serious illness.", "8. Immunizations are up-to-date.", "9. Patient is 165 cm (5 ft 5 in) tall and weighs 85 kg (187 lb); BMI is 31.2 kg/m2.", "10. Temperature is 37.5\u00b0C (99.5\u00b0F), pulse is 65/min, and blood pressure is 104/70 mm Hg.", "11. Examination shows an antalgic gait.", "12. Left groin is tender to palpation and internal rotation is limited due to pain.", "13. Flexing the hip causes external rotation and abduction.", "14. Leukocyte count is 9,800/mm3 and erythrocyte sedimentation rate is 12 mm/h.", "15. X-ray of the pelvis is shown."], "atomic_facts": ["1. The pain started suddenly", "2. The pain has worsened over the past 2 weeks", "3. The pain radiates down the thigh", "4. The pain is aggravated by movement", "5. He had a fall while cycling around a month ago", "6. He had a urinary tract infection 3 months ago", "7. The urinary tract infection resolved with trimethoprim/sulfamethoxazole", "8. There is no family history of serious illness", "9. His immunizations are up-to-date", "10. He is 165 cm (5 ft 5 in) tall", "11. He weighs 85 kg (187 lb)", "12. His BMI is 31.2 kg/m2", "13. His temperature is 37.5\u00b0C (99.5\u00b0F)", "14. His pulse is 65/min", "15. His blood pressure is 104/70 mm Hg", "16. Examination shows an antalgic gait", "17. The left groin is tender to palpation", "18. Internal rotation is limited due to pain", "19. Flexing the hip causes external rotation and abduction", "20. His leukocyte count is 9,800/mm3", "21. His erythrocyte sedimentation rate is 12 mm/h", "22. An x-ray of the pelvis is shown"]}
{"id": 622, "question": "What is the preferred treatment for this condition?", "context": ["A 58-year-old man is hospitalized and treated with clindamycin for a pulmonary abscess.", "During his hospital stay he develops abdominal pain and bloody diarrhea, and has a WBC of 14,000; serum creatinine is 0.9 mg/dL.", "On teaching rounds, you learn that the responsible pathogen produces a multi-unit toxin that binds to the colonic mucosa, causing actin depolymerization that results in cell death and mucosal necrosis."], "context_len": 3, "options": {"A": "Metronidazole", "B": "Penicillin G", "C": "Tetracycline", "D": "Erythromycin"}, "answer": "Metronidazole", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "58 years old", "specialties": ["Infectious Disease", "Internal Medicine"], "subspecialties": ["General Infectious Disease", "Infectious Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 58-year-old man is hospitalized.", "2. He is treated with clindamycin for a pulmonary abscess.", "3. During his hospital stay he develops abdominal pain and bloody diarrhea.", "4. His WBC is 14,000.", "5. His serum creatinine is 0.9 mg/dL.", "6. The responsible pathogen produces a multi-unit toxin.", "7. The toxin binds to the colonic mucosa.", "8. This causes actin depolymerization.", "9. Actin depolymerization results in cell death and mucosal necrosis."], "atomic_facts": ["1. Patient develops abdominal pain during hospital stay.", "2. Patient develops bloody diarrhea during hospital stay.", "3. Patient has a WBC count of 14,000.", "4. Patient's serum creatinine level is 0.9 mg/dL.", "5. Responsible pathogen produces a multi-unit toxin.", "6. Toxin binds to the colonic mucosa.", "7. Toxin causes actin depolymerization.", "8. Actin depolymerization results in cell death.", "9. Toxin causes mucosal necrosis."]}
{"id": 623, "question": "Which result would you expect to find on her screening tests?", "context": ["A 61-year-old Caucasian woman presents to her physician for a routine checkup.", "She has primary hypertension and rheumatoid arthritis.", "She currently does not report any relevant symptoms, such as weight change, increased or decreased appetite, sleep or mood problems, gastrointestinal symptoms, fever, or night sweats.", "Her medications include valsartan 160 mg, hydrochlorothiazide 25 mg daily, and methylprednisolone 28 mg every other day.", "According to her diary, her blood pressure varies from 130/80 to 120/60 mm Hg.", "In the past year, she had humeral and tibial fractures from a self-height fall and stepping over a fence, respectively, that occurred 6 months apart.", "She is in menopause and is not on hormone replacement therapy.", "Currently, she does not smoke but has a 10-pack-year history of smoking.", "She consumes alcohol occasionally.", "She weighs 56 kg (123.5 lb), and her height is 169 cm (5 ft 7 in).", "She does not report a family history of any cancer.", "Her father died after a myocardial infarction at the age of 63.", "She performs daily household activities but is not engaged in either aerobic or strength training.", "She mainly consumes vegetables, cereals, and dairy products.", "Her blood pressure is 125/80 mm Hg, heart rate is 67/min, respiratory rate is 14/min, and temperature is 36.5\u00b0C (97.7\u00b0F).", "Her physical examination is unremarkable."], "context_len": 16, "options": {"A": "A score of 17 on PHQ-9 test", "B": "T score \u20132.01 on DEXA scan", "C": "Dilation of the abdominal aorta on ultrasound examination", "D": "Presence of focal hyperintensities on mammography"}, "answer": "T score \u20132.01 on DEXA scan", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "61", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Preventive Medicine"}, "facts_old": ["1. Patient is a 61-year-old Caucasian woman.", "2. Patient has primary hypertension and rheumatoid arthritis.", "3. Patient does not report any relevant symptoms.", "4. Patient's medications include valsartan 160 mg, hydrochlorothiazide 25 mg daily, and methylprednisolone 28 mg every other day.", "5. Patient's blood pressure varies from 130/80 to 120/60 mm Hg.", "6. Patient had humeral and tibial fractures from a self-height fall and stepping over a fence, respectively, that occurred 6 months apart.", "7. Patient is in menopause and is not on hormone replacement therapy.", "8. Patient currently does not smoke but has a 10-pack-year history of smoking.", "9. Patient consumes alcohol occasionally.", "10. Patient weighs 56 kg (123.5 lb) and her height is 169 cm (5 ft 7 in).", "11. Patient does not report a family history of any cancer.", "12. Patient's father died after a myocardial infarction at the age of 63.", "13. Patient performs daily household activities but is not engaged in either aerobic or strength training.", "14. Patient mainly consumes vegetables, cereals, and dairy products.", "15. Patient's blood pressure is 125/80 mm Hg, heart rate is 67/min, respiratory rate is 14/min, and temperature is 36.5\u00b0C (97.7\u00b0F).", "16. Patient's physical examination is unremarkable."], "atomic_facts": ["1. She has primary hypertension and rheumatoid arthritis.", "2. She currently does not report any relevant symptoms, such as weight change, increased or decreased appetite, sleep or mood problems, gastrointestinal symptoms, fever, or night sweats.", "3. Her medications include valsartan 160 mg, hydrochlorothiazide 25 mg daily, and methylprednisolone 28 mg every other day.", "4. According to her diary, her blood pressure varies from 130/80 to 120/60 mm Hg.", "5. In the past year, she had humeral and tibial fractures from a self-height fall and stepping over a fence, respectively, that occurred 6 months apart.", "6. She is in menopause and is not on hormone replacement therapy.", "7. Currently, she does not smoke but has a 10-pack-year history of smoking.", "8. She consumes alcohol occasionally.", "9. She weighs 56 kg (123.5 lb), and her height is 169 cm (5 ft 7 in).", "10. She does not report a family history of any cancer.", "11. Her father died after a myocardial infarction at the age of 63.", "12. She performs daily household activities but is not engaged in either aerobic or strength training.", "13. She mainly consumes vegetables, cereals, and dairy products.", "14. Her blood pressure is 125/80 mm Hg, heart rate is 67/min, respiratory rate is 14/min, and temperature is 36.5\u00b0C (97.7\u00b0F).", "15. Her physical examination is unremarkable."]}
{"id": 624, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 24-year-old man is brought to the emergency department by his sister because she has noticed that he has been behaving differently over the past 4 weeks.", "Today, the patient attempted to set their house on fire while yelling that he was trying to \u201csave us all.\u201d The patient has a history of psychotic symptoms treated with aripiprazole.", "His sister states that he stopped taking his medications about 3 weeks ago.", "He works as a dishwasher but has not been to work for several days.", "His vital signs are within normal limits.", "Mental status examination shows a blunted affect.", "Throughout the interview, the patient continuously stares at the ceiling and makes little eye contact with the physician.", "When asked about the incident today, he states that he has been hearing the voice of \u201cthe great one\u201d who has informed him that aliens are in his neighborhood in the form of rats and cockroaches that need to be \u201ctorched to prevent the alien invasion.\u201d He is refusing treatment and insists on going home."], "context_len": 8, "options": {"A": "Administer aripiprazole and follow-up after 24 hours", "B": "Refer the patient to a psychologist for cognitive behavioral therapy", "C": "Involuntarily hospitalize the patient", "D": "Ask the patient's sister to convince him to stay overnight"}, "answer": "Involuntarily hospitalize the patient", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "24 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is 24 years old.", "2. Patient was brought to the emergency department by his sister.", "3. Sister noticed patient behaving differently over the past 4 weeks.", "4. Patient attempted to set their house on fire while yelling.", "5. Patient has a history of psychotic symptoms treated with aripiprazole.", "6. Sister states patient stopped taking medications 3 weeks ago.", "7. Patient works as a dishwasher.", "8. Patient has not been to work for several days.", "9. Patient's vital signs are within normal limits.", "10. Mental status examination shows blunted affect.", "11. Patient continuously stares at the ceiling and makes little eye contact with the physician.", "12. Patient has been hearing the voice of \u201cthe great one\u201d.", "13. Voice has informed patient that aliens are in his neighborhood in the form of rats and cockroaches.", "14. Patient believes aliens need to be \u201ctorched to prevent the alien invasion.\u201d", "15. Patient is refusing treatment and insists on going home."], "atomic_facts": ["1. The patient attempted to set their house on fire.", "2. The patient was yelling that he was trying to \"save us all.\"", "3. The patient has a history of psychotic symptoms.", "4. The psychotic symptoms were treated with aripiprazole.", "5. The patient's sister states that he stopped taking his medications about 3 weeks ago.", "6. The patient works as a dishwasher.", "7. The patient has not been to work for several days.", "8. The patient's vital signs are within normal limits.", "9. Mental status examination shows a blunted affect.", "10. Throughout the interview, the patient continuously stares at the ceiling.", "11. The patient makes little eye contact with the physician.", "12. The patient states that he has been hearing the voice of \"the great one.\"", "13. The voice has informed him that aliens are in his neighborhood.", "14. The aliens are in the form of rats and cockroaches.", "15. The patient believes they need to be \"torched to prevent the alien invasion.\"", "16. The patient is refusing treatment.", "17. The patient insists on going home."]}
{"id": 625, "question": "Which of the following is the most appropriate pharmacotherapy?\"", "context": ["A 13-year-old girl is brought to the emergency department by her father because of a severe nosebleed.", "She takes no medications and has no history of serious medical illness but has had frequent nosebleeds in the past.", "Physical examination shows brisk bleeding from the right nare and pooled blood in the posterior pharynx.", "Laboratory studies show: | Hemoglobin 8 g/dL | Platelet count 195,000/mm3 | Prothrombin time 12 sec | Partial thromboplastin time 49 sec | Fibrin split products negative | The bleeding time is 11 minutes."], "context_len": 4, "options": {"A": "Prothrombin complex concentrate", "B": "Rituximab", "C": "Desmopressin", "D": "Intravenous immunoglobulin"}, "answer": "Desmopressin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "13 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 13-year-old girl is brought to the emergency department by her father.", "2. She takes no medications.", "3. She has no history of serious medical illness.", "4. She has had frequent nosebleeds in the past.", "5. Physical examination shows brisk bleeding from the right nare and pooled blood in the posterior pharynx.", "6. Laboratory studies show Hemoglobin 8 g/dL.", "7. Laboratory studies show Platelet count 195,000/mm3.", "8. Laboratory studies show Prothrombin time 12 sec.", "9. Laboratory studies show Partial thromboplastin time 49 sec.", "10. Laboratory studies show Fibrin split products negative.", "11. The bleeding time is 11 minutes."], "atomic_facts": ["1. Patient takes no medications.", "2. Patient has no history of serious medical illness.", "3. Patient has had frequent nosebleeds in the past.", "4. Physical examination shows brisk bleeding from the right nare.", "5. Physical examination shows pooled blood in the posterior pharynx.", "6. Hemoglobin level is 8 g/dL.", "7. Platelet count is 195,000/mm3.", "8. Prothrombin time is 12 sec.", "9. Partial thromboplastin time is 49 sec.", "10. Fibrin split products are negative.", "11. Bleeding time is 11 minutes."]}
{"id": 626, "question": "Which of the following is the most appropriate treatment for the most likely diagnosis?", "context": ["A 33-year-old man presents to the emergency department with joint pain.", "He states that since yesterday he has had joint pain, and today he noticed a rash.", "The patient does not have a significant past medical history.", "The patient smokes cigars, drinks 1 to 4 drinks per day, is sexually active, and uses cocaine occasionally.", "His temperature is 101\u00b0F (38.3\u00b0C), blood pressure is 125/65 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air.", "Physical exam reveals pustular skin lesions and an inflamed and painful right knee that is warm to the touch."], "context_len": 6, "options": {"A": "Cefixime and azithromycin", "B": "Ceftriaxone", "C": "Ceftriaxone and vancomycin", "D": "Piperacillin and tazobactam"}, "answer": "Cefixime and azithromycin", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "33", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 33-year-old man presents to the emergency department with joint pain.", "2. He states that since yesterday he has had joint pain.", "3. Today he noticed a rash.", "4. The patient does not have a significant past medical history.", "5. The patient smokes cigars.", "6. The patient drinks 1 to 4 drinks per day.", "7. The patient is sexually active.", "8. The patient uses cocaine occasionally.", "9. His temperature is 101\u00b0F (38.3\u00b0C).", "10. His blood pressure is 125/65 mmHg.", "11. His pulse is 80/min.", "12. His respirations are 14/min.", "13. His oxygen saturation is 98% on room air.", "14. Physical exam reveals pustular skin lesions.", "15. Physical exam reveals an inflamed and painful right knee that is warm to the touch."], "atomic_facts": ["1. The patient has had joint pain since yesterday.", "2. The patient noticed a rash today.", "3. The patient does not have a significant past medical history.", "4. The patient smokes cigars.", "5. The patient drinks 1 to 4 drinks per day.", "6. The patient is sexually active.", "7. The patient uses cocaine occasionally.", "8. The patient's temperature is 101\u00b0F (38.3\u00b0C).", "9. The patient's blood pressure is 125/65 mmHg.", "10. The patient's pulse is 80/min.", "11. The patient's respirations are 14/min.", "12. The patient's oxygen saturation is 98% on room air.", "13. Physical exam reveals pustular skin lesions.", "14. Physical exam reveals an inflamed and painful right knee that is warm to the touch."]}
{"id": 627, "question": "Which of the following is the primary mechanism of action of levonorgestrel?", "context": ["A 20-year-old woman presents to a physician following unprotected coitus with her boyfriend about 10 hours ago.", "She tells the physician that although they usually use a barrier method of contraception, but this time they did not.", "She does not want to become pregnant.", "She also mentions that she has been diagnosed with major depression and does not want to take an estrogen-containing oral contraceptive pill.", "After counseling, the physician prescribes an enteric-coated pill containing 1.5 mg of levonorgestrel."], "context_len": 5, "options": {"A": "Delayed ovulation through inhibition of follicular development", "B": "Thickening of cervical mucus", "C": "Atrophy of endometrium", "D": "Reduction in motility of cilia in fallopian tubes"}, "answer": "Delayed ovulation through inhibition of follicular development", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 20-year-old woman presented to a physician.", "2. The woman had unprotected coitus with her boyfriend about 10 hours ago.", "3. The woman and her boyfriend usually use a barrier method of contraception.", "4. This time they did not use a barrier method of contraception.", "5. The woman does not want to become pregnant.", "6. The woman has been diagnosed with major depression.", "7. The woman does not want to take an estrogen-containing oral contraceptive pill.", "8. The physician prescribed an enteric-coated pill containing 1.5 mg of levonorgestrel."], "atomic_facts": ["1. The patient usually uses a barrier method of contraception.", "2. This time, the patient did not use a barrier method of contraception.", "3. The patient does not want to become pregnant.", "4. The patient has been diagnosed with major depression.", "5. The patient does not want to take an estrogen-containing oral contraceptive pill.", "6. The physician prescribes an enteric-coated pill containing 1.5 mg of levonorgestrel after counseling."]}
{"id": 628, "question": "Further evaluation of this patient is most likely to show which of the following findings?", "context": ["A 4-year-old girl is brought to the emergency department because of colicky abdominal pain for 1 day.", "She has had two similar episodes in the past.", "Urinalysis shows red blood cells and hexagonal-shaped crystals.", "Urine sodium cyanide nitroprusside test is positive."], "context_len": 4, "options": {"A": "Increased stool fat content", "B": "Inability of intercalated cells to secrete H+", "C": "Impaired intestinal ornithine reabsorption", "D": "Urease-positive bacteria in the renal pelvis"}, "answer": "Impaired intestinal ornithine reabsorption", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old girl is brought to the emergency department.", "2. She has colicky abdominal pain for 1 day.", "3. She has had two similar episodes in the past.", "4. Urinalysis shows red blood cells.", "5. Urinalysis shows hexagonal-shaped crystals.", "6. Urine sodium cyanide nitroprusside test is positive."], "atomic_facts": ["1. She has had two similar episodes in the past.", "2. Urinalysis shows red blood cells.", "3. Urinalysis shows hexagonal-shaped crystals.", "4. Urine sodium cyanide nitroprusside test is positive."]}
{"id": 629, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 49-year-old woman, gravida 1, para 1, comes to the physician because of shorter and less frequent menstrual periods over the past year.", "During this time, she has also had frequent mood swings and a 2.5-kg (5-lb) weight loss.", "She occasionally wakes up at night because she is too warm and sweating profusely.", "These episodes are followed by chills and anxiety that subside within minutes.", "She has no history of abnormal Pap smears.", "She is sexually active with her husband, who had a vasectomy 10 years prior.", "She is 163 cm (5 ft 3 in) tall and weighs 70 kg (154 lb); BMI is 26 kg/m2.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 103/min, respirations are 16/min, and blood pressure is 129/84 mm Hg.", "Abdominal and genitourinary examination shows no abnormalities."], "context_len": 9, "options": {"A": "Perform transvaginal ultrasound", "B": "Measure serum \u03b2-hCG concentration", "C": "Obtain endometrial biopsy", "D": "Measure serum TSH concentration"}, "answer": "Measure serum TSH concentration", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "49 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 49-year-old woman.", "2. Patient is gravida 1, para 1.", "3. Patient has had shorter and less frequent menstrual periods over the past year.", "4. Patient has had frequent mood swings over the past year.", "5. Patient has had a 2.5-kg (5-lb) weight loss over the past year.", "6. Patient occasionally wakes up at night because she is too warm and sweating profusely.", "7. Patient experiences chills and anxiety after waking up at night, which subside within minutes.", "8. Patient has no history of abnormal Pap smears.", "9. Patient is sexually active with her husband, who had a vasectomy 10 years prior.", "10. Patient is 163 cm (5 ft 3 in) tall.", "11. Patient weighs 70 kg (154 lb).", "12. Patient's BMI is 26 kg/m2.", "13. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "14. Patient's pulse is 103/min.", "15. Patient's respirations are 16/min.", "16. Patient's blood pressure is 129/84 mm Hg.", "17. Abdominal and genitourinary examination shows no abnormalities."], "atomic_facts": ["1. Frequent mood swings", "2. 2.5-kg (5-lb) weight loss", "3. Occasional night sweats", "4. Followed by chills and anxiety", "5. No history of abnormal Pap smears", "6. Sexually active with husband who had a vasectomy 10 years prior", "7. 163 cm (5 ft 3 in) tall", "8. Weighs 70 kg (154 lb)", "9. BMI is 26 kg/m2", "10. Temperature is 37\u00b0C (98.6\u00b0F)", "11. Pulse is 103/min", "12. Respirations are 16/min", "13. Blood pressure is 129/84 mm Hg", "14. Abdominal and genitourinary examination shows no abnormalities"]}
{"id": 630, "question": "Which of the following findings is most likely to be detected in a skeletal survey?", "context": ["An 8-year-old boy is brought by his parents to the emergency department with a tender and swollen right leg.", "The boy said that he was playing soccer when he accidentally kicked a metal goal post.", "The boy was born at 39 weeks gestation via spontaneous vaginal delivery.", "He is up to date on all vaccines and is meeting all developmental milestones.", "A review of his medical history reveals that he had a fracture of the left tibia at 4-years-old and a fracture of the right radius 6 months ago.", "Neither of the two was associated with major trauma and both healed well.", "At the hospital, his vital signs are stable and his sclerae are white-blue.", "There is no muscular hypotonia.", "His height and weight are normal for his age and sex and the skin is normal.", "A tender swelling is present over his right leg and he can not put weight on that leg.", "The radiograph of his right leg confirms a fracture of the shaft of the tibia at the junction of its upper one-third and lower two-thirds.", "The clinician suspects physical abuse and orders a skeletal survey."], "context_len": 12, "options": {"A": "A healed right scapular fracture", "B": "Ground-glass appearance of the cortices of the long bones", "C": "Widening and cupping of the metaphyses of the long bones", "D": "Wormian bones in the skull"}, "answer": "Wormian bones in the skull", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Orthopedics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 8-year-old boy is brought by his parents to the emergency department.", "2. The boy said he was playing soccer when he accidentally kicked a metal goal post.", "3. The boy was born at 39 weeks gestation via spontaneous vaginal delivery.", "4. He is up to date on all vaccines and is meeting all developmental milestones.", "5. A review of his medical history reveals a fracture of the left tibia at 4-years-old.", "6. A review of his medical history reveals a fracture of the right radius 6 months ago.", "7. Neither of the two fractures was associated with major trauma and both healed well.", "8. At the hospital, his vital signs are stable and his sclerae are white-blue.", "9. There is no muscular hypotonia.", "10. His height and weight are normal for his age and sex.", "11. The skin is normal.", "12. A tender swelling is present over his right leg and he can not put weight on that leg.", "13. The radiograph of his right leg confirms a fracture of the shaft of the tibia at the junction of its upper one-third and lower two-thirds.", "14. The clinician suspects physical abuse and orders a skeletal survey."], "atomic_facts": ["1. The boy said he was playing soccer when he accidentally kicked a metal goal post.", "2. The boy was born at 39 weeks gestation via spontaneous vaginal delivery.", "3. He is up to date on all vaccines.", "4. He is meeting all developmental milestones.", "5. A review of his medical history reveals a left tibia fracture at 4-years-old.", "6. A review of his medical history reveals a right radius fracture 6 months ago.", "7. Neither fracture was associated with major trauma.", "8. Both fractures healed well.", "9. At the hospital, his vital signs are stable.", "10. His sclerae are white-blue.", "11. There is no muscular hypotonia.", "12. His height and weight are normal for his age and sex.", "13. The skin is normal.", "14. A tender swelling is present over his right leg.", "15. He cannot put weight on that leg.", "16. The radiograph of his right leg confirms a fracture of the shaft of the tibia at the junction of its upper one-third and lower two-thirds.", "17. The clinician suspects physical abuse.", "18. The clinician orders a skeletal survey."]}
{"id": 631, "question": "Which of the following is the most appropriate initial recommendation?", "context": ["A previously healthy 34-year-old man comes to the physician because of loose stools for the past 4 months.", "On average, he has 1 episode of loose non-bloody bowel movement with abdominal cramps each day around noon.", "He has no diarrhea when he does not have breakfast in the morning.", "He also complains of excess flatus but no bowel incontinence or urgency.", "He has had no fever or weight loss.", "His symptoms are not associated with stress.", "He has had no overseas or mountainous trips over the past year.", "He takes no medications.", "His vital signs are within normal limits.", "Physical examination shows no abnormalities."], "context_len": 10, "options": {"A": "Cholestyramine", "B": "Elimination of all dairy products", "C": "Empirical therapy with metronidazole", "D": "Loperamide"}, "answer": "Elimination of all dairy products", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "34", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 34 years old.", "2. Patient has had loose stools for 4 months.", "3. Patient has 1 episode of loose non-bloody bowel movement with abdominal cramps each day around noon.", "4. Patient has no diarrhea when he does not have breakfast in the morning.", "5. Patient complains of excess flatus but no bowel incontinence or urgency.", "6. Patient has had no fever or weight loss.", "7. Patient's symptoms are not associated with stress.", "8. Patient has had no overseas or mountainous trips over the past year.", "9. Patient takes no medications.", "10. Patient's vital signs are within normal limits.", "11. Physical examination shows no abnormalities."], "atomic_facts": ["1. He has 1 episode of loose non-bloody bowel movement with abdominal cramps each day around noon.", "2. He has no diarrhea when he does not have breakfast in the morning.", "3. He complains of excess flatus but no bowel incontinence or urgency.", "4. He has had no fever or weight loss.", "5. His symptoms are not associated with stress.", "6. He has had no overseas or mountainous trips over the past year.", "7. He takes no medications.", "8. His vital signs are within normal limits.", "9. Physical examination shows no abnormalities."]}
{"id": 632, "question": "Which of the following physiologic changes is most likely expected after being prescribed that medication?", "context": ["A 37-year-old male with a history of diabetes is prescribed a drug that would decrease the risk of the patient developing glomerular renal capillary damage, nodular glomerular sclerosis, and eventual nephrotic syndrome.", "After some time being on this medication, the patient complains of a bad cough."], "context_len": 2, "options": {"A": "Decreased aldosterone, decreased GFR, decreased renal plasma flow, increased bradykinin", "B": "Increased aldosterone, increased GFR, decreased renal plasma flow, increased bradykinin", "C": "Decreased aldosterone, decreased GFR, increased renal plasma flow, increased bradykinin", "D": "Increased aldosterone, increased GFR, increased renal plasma flow, increased bradykinin"}, "answer": "Decreased aldosterone, decreased GFR, increased renal plasma flow, increased bradykinin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "37", "specialties": ["Nephrology"], "subspecialties": ["General Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 37-year-old male has a history of diabetes.", "2. The patient was prescribed a drug to decrease the risk of developing glomerular renal capillary damage, nodular glomerular sclerosis, and eventual nephrotic syndrome.", "3. After some time being on this medication, the patient complained of a bad cough."], "atomic_facts": ["1. The patient is on a medication.", "2. The patient has been on the medication for some time.", "3. The patient complains of a bad cough."]}
{"id": 633, "question": "Which of the following would be the best treatment for this patient\u2019s change in mental status?", "context": ["A 69-year-old woman presents with insomnia and altered mental status.", "The patient is accompanied by her husband who says her symptoms began acutely 4 days ago with no obvious trigger and have not improved.", "Before this point, she had been living independently with no signs of cognitive impairment.", "The patient\u2019s husband says that the patient is often non-compliant with medication and eats and drinks little unless prompted.", "Past medical history is significant for hypertension, diabetes mellitus type 2, chronic pyelonephritis, and depression.", "Current medications are aspirin, metoprolol, hydrochlorothiazide, losartan, metformin, and trazodone.", "Vitals include: temperature 38.1\u2103 (100.6\u2109), blood pressure 130/70 mm Hg, pulse 91/min, respiratory rate 17/min, and oxygen saturation 99% on room air.", "On physical examination, the patient is agitated and easily distracted.", "Oriented x 1.", "She believes it is 1967, and she is at the bookstore.", "She talks to non-existent people and uses words inappropriately.", "Cardiac sounds are muffled but otherwise normal.", "Lungs are clear to auscultation.", "On abdominal examination, the tip of the urinary bladder can be palpated.", "Costovertebral angle tenderness is present bilaterally.", "Catheterization of the bladder yields cloudy, foul-smelling urine.", "Urinalysis is pending."], "context_len": 17, "options": {"A": "Changing trazodone to amitriptyline", "B": "Antibiotic therapy", "C": "Discontinuation of metoprolol", "D": "Lifelong administration of memantine"}, "answer": "Antibiotic therapy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "69", "specialties": ["Neurology"], "subspecialties": ["Sleep Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is 69 years old.", "2. Patient presents with insomnia and altered mental status.", "3. Patient's husband says symptoms began acutely 4 days ago with no obvious trigger and have not improved.", "4. Patient had been living independently with no signs of cognitive impairment.", "5. Patient's husband says patient is often non-compliant with medication and eats and drinks little unless prompted.", "6. Patient has past medical history of hypertension, diabetes mellitus type 2, chronic pyelonephritis, and depression.", "7. Patient is currently taking aspirin, metoprolol, hydrochlorothiazide, losartan, metformin, and trazodone.", "8. Patient's vitals include temperature 38.1\u2103 (100.6\u2109), blood pressure 130/70 mm Hg, pulse 91/min, respiratory rate 17/min, and oxygen saturation 99% on room air.", "9. Patient is agitated and easily distracted on physical examination.", "10. Patient is oriented x 1.", "11. Patient believes it is 1967 and she is at the bookstore.", "12. Patient talks to non-existent people and uses words inappropriately.", "13. Cardiac sounds are muffled but otherwise normal.", "14. Lungs are clear to auscultation.", "15. On abdominal examination, the tip of the urinary bladder can be palpated.", "16. Costovertebral angle tenderness is present bilaterally.", "17. Catheterization of the bladder yields cloudy, foul-smelling urine.", "18. Urinalysis is pending."], "atomic_facts": ["1. The patient is accompanied by her husband.", "2. The symptoms began acutely 4 days ago with no obvious trigger.", "3. The symptoms have not improved.", "4. Before this point, the patient had been living independently with no signs of cognitive impairment.", "5. The patient is often non-compliant with medication.", "6. The patient eats and drinks little unless prompted.", "7. Past medical history includes hypertension, diabetes mellitus type 2, chronic pyelonephritis, and depression.", "8. Current medications are aspirin, metoprolol, hydrochlorothiazide, losartan, metformin, and trazodone.", "9. Vitals include: temperature 38.1\u2103 (100.6\u2109), blood pressure 130/70 mm Hg, pulse 91/min, respiratory rate 17/min, and oxygen saturation 99% on room air.", "10. On physical examination, the patient is agitated and easily distracted.", "11. The patient is oriented x 1.", "12. The patient believes it is 1967 and she is at the bookstore.", "13. The patient talks to non-existent people and uses words inappropriately.", "14. Cardiac sounds are muffled but otherwise normal.", "15. Lungs are clear to auscultation.", "16. On abdominal examination, the tip of the urinary bladder can be palpated.", "17. Costovertebral angle tenderness is present bilaterally.", "18. Catheterization of the bladder yields cloudy, foul-smelling urine.", "19. Urinalysis is pending."]}
{"id": 634, "question": "Which of the following medical treatments is indicated for this patient\u2019s condition?", "context": ["A 65-year-old man presents to the physician with a concern for several lumps on his jaw.", "He has a history of dental caries and admits to maintaining poor oral hygiene.", "On physical examination, he has 3 nontender and indurated masses at the angle of his jaw that are draining thick yellow pus.", "Microscopy of the drained pus reveals yellow granules filled with bacteria."], "context_len": 4, "options": {"A": "Amoxicillin-clavulanate", "B": "Dapsone and rifampin", "C": "Penicillin", "D": "Trimethoprim-sulfamethoxazole"}, "answer": "Penicillin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 65-year-old man presents to the physician.", "2. He has a history of dental caries.", "3. He admits to maintaining poor oral hygiene.", "4. On physical examination, he has 3 nontender and indurated masses at the angle of his jaw.", "5. The masses are draining thick yellow pus.", "6. Microscopy of the drained pus reveals yellow granules filled with bacteria."], "atomic_facts": ["1. He has a history of dental caries.", "2. He admits to maintaining poor oral hygiene.", "3. On physical examination, he has 3 nontender and indurated masses at the angle of his jaw.", "4. The masses are draining thick yellow pus.", "5. Microscopy of the drained pus reveals yellow granules.", "6. The yellow granules are filled with bacteria."]}
{"id": 635, "question": "Which of the following was most likely the second compound administered to this patient?", "context": ["A 23-year-old man presents with severe right lower quadrant abdominal pain for the past 2 hours.", "He says the pain started in the periumbilical region and has now shifted to the lower right quadrant.", "He describes the pain as spasmodic.", "Past medical history is insignificant, and the patient denies any history of smoking, alcohol, or drug use.", "The patient\u2019s vital signs show: pulse 88/min, respiratory rate 18/min, blood pressure 126/84 mm Hg, and temperature 38.4\u00b0C (101.0\u00b0F).", "On physical examination, there is severe tenderness to palpation in the right lower quadrant with rebound and guarding.", "The patient is rushed to the operating room for a laparoscopic appendectomy.", "The following preoperative laboratory tests are obtained: | Serum glucose (random) 123 mg/dL |   Serum electrolytes | Sodium 143 mEq/L | Potassium 4.7 mEq/L | Chloride 102 mEq/L |     Serum creatinine 1.7 mg/dL | Blood urea nitrogen 32 mg/dL |     Hemoglobin (Hb%) 12.5 g/dL | Mean corpuscular volume (MCV)  80 fl | Reticulocyte count 1% | Erythrocyte count 5.1 million/mm\u00b3 | Leukocyte count 14,000/mm\u00b3 | Neutrophils 80% | During the induction of anesthesia, isoflurane and a second compound are administered.", "About 25 minutes after induction, the patient develops significant muscle rigidity and his temperature increases to 40.8\u00b0C (105.4\u00b0F).", "The patient\u2019s blood pressure is now 158/94 mm Hg."], "context_len": 10, "options": {"A": "Atracurium", "B": "Nitrous oxide", "C": "Neostigmine", "D": "Succinylcholine"}, "answer": "Succinylcholine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "23", "specialties": ["General Surgery", "Emergency Medicine", "Surgery"], "subspecialties": ["General Surgery", "General Emergency Medicine"], "specialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Surgery"}, "facts_old": ["1. Patient is a 23-year-old male.", "2. Patient has had severe right lower quadrant abdominal pain for the past 2 hours.", "3. Pain started in the periumbilical region and has shifted to the lower right quadrant.", "4. Pain is described as spasmodic.", "5. Patient denies any history of smoking, alcohol, or drug use.", "6. Patient's vital signs: pulse 88/min, respiratory rate 18/min, blood pressure 126/84 mm Hg, temperature 38.4\u00b0C (101.0\u00b0F).", "7. Physical examination reveals severe tenderness to palpation in the right lower quadrant with rebound and guarding.", "8. Patient is rushed to the operating room for a laparoscopic appendectomy.", "9. Preoperative laboratory tests: serum glucose (random) 123 mg/dL, serum electrolytes (sodium 143 mEq/L, potassium 4.7 mEq/L, chloride 102 mEq/L), serum creatinine 1.7 mg/dL, blood urea nitrogen 32 mg/dL, hemoglobin (Hb%) 12.5 g/dL, mean corpuscular volume (MCV) 80 fl, reticulocyte count 1%, erythrocyte count 5.1 million/mm\u00b3, leukocyte count 14,000/mm\u00b3, neutrophils 80%.", "10. During induction of anesthesia, isoflurane and a second compound are administered.", "11. 25 minutes after induction, patient develops significant muscle rigidity and temperature increases to 40.8\u00b0C (105.4\u00b0F).", "12. Patient's blood pressure is now 158/94 mm Hg."], "atomic_facts": ["1. The patient reports pain starting in the periumbilical region and shifting to the lower right quadrant.", "2. The patient describes the pain as spasmodic.", "3. The patient has no significant past medical history and denies smoking, alcohol, or drug use.", "4. Vital signs: pulse 88/min, respiratory rate 18/min, blood pressure 126/84 mm Hg, temperature 38.4\u00b0C (101.0\u00b0F).", "5. Physical examination reveals severe tenderness to palpation in the right lower quadrant with rebound and guarding.", "6. The patient undergoes a laparoscopic appendectomy.", "7. Preoperative laboratory tests: Serum glucose (random) 123 mg/dL, Serum electrolytes - Sodium 143 mEq/L, Potassium 4.7 mEq/L, Chloride 102 mEq/L, Serum creatinine 1.7 mg/dL, Blood urea nitrogen 32 mg/dL, Hemoglobin (Hb%) 12.5 g/dL, Mean corpuscular volume (MCV) 80 fl, Reticulocyte count 1%, Erythrocyte count 5.1 million/mm\u00b3, Leukocyte count 14,000/mm\u00b3, Neutrophils 80%.", "8. Isoflurane and a second compound are administered during the induction of anesthesia.", "9. About 25 minutes after induction, the patient develops significant muscle rigidity and his temperature increases to 40.8\u00b0C (105.4\u00b0F).", "10. The patient's blood pressure is now 158/94 mm Hg."]}
{"id": 636, "question": "Which of the following is the most appropriate therapy for this patient?", "context": ["A 16-year-old boy is brought to the physician because of a 3-week history of loose stools.", "He has 2\u20133 episodes of loose stools a day that are occasionally bloody.", "During this period, he has also had crampy abdominal pain, generalized fatigue, and a 2-kg (5-lb) weight loss.", "His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 82/min, and blood pressure is 106/68 mm Hg.", "Examination shows mild lower abdominal tenderness to palpation.", "Test of the stool for ova and parasites is negative.", "His hemoglobin concentration is 11.8 g/dL, leukocyte count is 12,400/mm3, and erythrocyte sedimentation rate is 14 mm/h.", "A colonoscopy shows inflamed, friable mucosa extending just beyond the rectum that bleeds on contact with the endoscope.", "A biopsy confirms the diagnosis."], "context_len": 9, "options": {"A": "Gluten-free diet", "B": "Proctocolectomy", "C": "Mesalamine therapy", "D": "Cyclosporine therapy\n\""}, "answer": "Mesalamine therapy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "16 years old", "specialties": ["Gastroenterology", "Pediatrics"], "subspecialties": ["General Gastroenterology", "Pediatric Gastroenterology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 16-year-old boy.", "2. Patient has had loose stools for 3 weeks.", "3. Patient has 2-3 episodes of loose stools per day.", "4. Loose stools are occasionally bloody.", "5. Patient has had crampy abdominal pain, generalized fatigue, and a 2-kg (5-lb) weight loss.", "6. Patient's temperature is 37.1\u00b0C (98.8\u00b0F).", "7. Patient's pulse is 82/min.", "8. Patient's blood pressure is 106/68 mm Hg.", "9. Examination shows mild lower abdominal tenderness to palpation.", "10. Test of the stool for ova and parasites is negative.", "11. Patient's hemoglobin concentration is 11.8 g/dL.", "12. Patient's leukocyte count is 12,400/mm3.", "13. Patient's erythrocyte sedimentation rate is 14 mm/h.", "14. Colonoscopy shows inflamed, friable mucosa extending just beyond the rectum that bleeds on contact with the endoscope.", "15. Biopsy confirms diagnosis."], "atomic_facts": ["1. He has 2\u20133 episodes of loose stools a day that are occasionally bloody.", "2. During this period, he has also had crampy abdominal pain, generalized fatigue, and a 2-kg (5-lb) weight loss.", "3. His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 82/min, and blood pressure is 106/68 mm Hg.", "4. Examination shows mild lower abdominal tenderness to palpation.", "5. Test of the stool for ova and parasites is negative.", "6. His hemoglobin concentration is 11.8 g/dL, leukocyte count is 12,400/mm3, and erythrocyte sedimentation rate is 14 mm/h.", "7. A colonoscopy shows inflamed, friable mucosa extending just beyond the rectum that bleeds on contact with the endoscope.", "8. A biopsy confirms the diagnosis."]}
{"id": 637, "question": "Which of the following is the next best step in the management of this patient?", "context": ["A 26-year-old man presents with a 6-month history of headaches.", "Over the past 6 months, he has developed headaches that are 4/10 in intensity and occur every other day for 1\u20132 hours.", "The headaches are bilateral and feel like a \u2018band is squeezing his head\u2019.", "He denies photophobia, phonophobia, nausea, and vomiting.", "He has had no visual loss or photopsia.", "No significant past medical history.", "He is an avid weightlifter and works at a moving company, where he is constantly lifting heavy items.", "Additionally, he recently got his 21-year-old girlfriend and his other 23-year-old girlfriend pregnant, which he says is causing a lot of stress.", "Physical examination is unremarkable."], "context_len": 9, "options": {"A": "Amitriptyline", "B": "Magnetic resonance image (MRI) of the head", "C": "Ophthalmologic evaluation", "D": "Ibuprofen"}, "answer": "Ibuprofen", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "26 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 26-year-old male.", "2. Patient has had headaches for 6 months.", "3. Headaches are 4/10 in intensity.", "4. Headaches occur every other day for 1-2 hours.", "5. Headaches are bilateral and feel like a \u2018band is squeezing his head\u2019.", "6. Patient denies photophobia, phonophobia, nausea, and vomiting.", "7. Patient has had no visual loss or photopsia.", "8. Patient has no significant past medical history.", "9. Patient is an avid weightlifter.", "10. Patient works at a moving company, where he is constantly lifting heavy items.", "11. Patient recently got his 21-year-old girlfriend and his other 23-year-old girlfriend pregnant.", "12. Patient states this is causing a lot of stress.", "13. Physical examination is unremarkable."], "atomic_facts": ["1. Over the past 6 months, he has developed headaches that are 4/10 in intensity and occur every other day for 1\u20132 hours.", "2. The headaches are bilateral and feel like a \u2018band is squeezing his head\u2019.", "3. He denies photophobia, phonophobia, nausea, and vomiting.", "4. He has had no visual loss or photopsia.", "5. No significant past medical history.", "6. He is an avid weightlifter and works at a moving company, where he is constantly lifting heavy items.", "7. Additionally, he recently got his 21-year-old girlfriend and his other 23-year-old girlfriend pregnant, which he says is causing a lot of stress.", "8. Physical examination is unremarkable."]}
{"id": 638, "question": "Which of the following best describes the primary function that the cells highlighted in blue serve?", "context": ["A histologic section is obtained from the central canal of the spinal cord.", "A special stain is used to identify a specific glial cell that makes up the lining of the central canal and ventricles in the central nervous system."], "context_len": 2, "options": {"A": "Production and circulation of CSF", "B": "Protective membrane surrounding spinal cord", "C": "Conduct voluntary muscle action potentials", "D": "Increasing action potential conduction velocity"}, "answer": "Production and circulation of CSF", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology", "Neurology"], "subspecialties": ["Neuropathology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Pathology"}, "facts_old": ["1. A histologic section is obtained from the central canal of the spinal cord.", "2. A special stain is used.", "3. The special stain is used to identify a specific glial cell.", "4. The glial cell makes up the lining of the central canal and ventricles in the central nervous system."], "atomic_facts": ["1. A special stain is used.", "2. The stain is used to identify a specific glial cell.", "3. The glial cell makes up the lining of the central canal.", "4. The glial cell makes up the lining of the ventricles.", "5. The central canal and ventricles are in the central nervous system."]}
{"id": 639, "question": "Which of the following is the best next step in the management of this patient?", "context": ["A 58-year-old man presents to the emergency department with a 4-hour history of severe abdominal pain.", "He has noted brief episodes of postprandial abdominal pain for the last 2 months, but this pain is much more severe and diffuse.", "He also reports nausea and has had several episodes of non-bloody, non-bilious emesis since the pain started.", "Past medical history is notable for hyperlipidemia diagnosed 10 years ago and managed with lifestyle modifications; he has never been hospitalized.", "Vital signs are unremarkable.", "Physical examination shows dry mucous membranes and a soft, non-distended abdomen that is diffusely tender.", "Laboratory tests are notable for a lipase level of 3,125 U/L.", "CT of the abdomen shows an enlarged gallbladder and peripancreatic fluid with dilation of the pancreatic and common bile ducts."], "context_len": 8, "options": {"A": "Cholecystectomy", "B": "Colonoscopy", "C": "Endoscopic retrograde cholangiopancreatography (ERCP)", "D": "Esophagogastroduodenoscopy (EGD)"}, "answer": "Endoscopic retrograde cholangiopancreatography (ERCP)", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "58", "specialties": ["General Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 58 years old.", "2. Patient has 4-hour history of severe abdominal pain.", "3. Patient has had brief episodes of postprandial abdominal pain for the last 2 months.", "4. Patient has nausea and several episodes of non-bloody, non-bilious emesis since the pain started.", "5. Patient has past medical history of hyperlipidemia diagnosed 10 years ago and managed with lifestyle modifications.", "6. Patient has never been hospitalized.", "7. Vital signs are unremarkable.", "8. Physical examination shows dry mucous membranes and a soft, non-distended abdomen that is diffusely tender.", "9. Laboratory tests are notable for a lipase level of 3,125 U/L.", "10. CT of the abdomen shows an enlarged gallbladder and peripancreatic fluid with dilation of the pancreatic and common bile ducts."], "atomic_facts": ["1. He has noted brief episodes of postprandial abdominal pain for the last 2 months.", "2. The pain is much more severe and diffuse.", "3. He also reports nausea.", "4. He has had several episodes of non-bloody, non-bilious emesis since the pain started.", "5. Past medical history is notable for hyperlipidemia diagnosed 10 years ago.", "6. Hyperlipidemia has been managed with lifestyle modifications.", "7. He has never been hospitalized.", "8. Vital signs are unremarkable.", "9. Physical examination shows dry mucous membranes.", "10. Physical examination shows a soft, non-distended abdomen that is diffusely tender.", "11. Laboratory tests are notable for a lipase level of 3,125 U/L.", "12. CT of the abdomen shows an enlarged gallbladder.", "13. CT of the abdomen shows peripancreatic fluid.", "14. CT of the abdomen shows dilation of the pancreatic and common bile ducts."]}
{"id": 640, "question": "Which of the following would most likely be observed in cells with this genetic change?", "context": ["A 55-year-old man presents to his primary care physician for his annual check-up.", "He says that he has generally been feeling well; however, he has noticed that he has had some intermittent very low grade fevers of unknown etiology.", "His past medical history is significant for well-controlled hypertension and diabetes.", "On physical exam he is found to have painless enlargement of a number of cervical and axillary lymph nodes.", "A biopsy of the enlarged nodes is obtained and genetic testing shows that part of chromosomes 14 and 18 are joined together."], "context_len": 5, "options": {"A": "Decreased activation of CD95", "B": "Decreased activity of p53", "C": "Decreased release of cytochrome c", "D": "Increased activation of Apaf-1"}, "answer": "Decreased release of cytochrome c", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["Molecular Genetic Pathology", "Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 55-year-old man presents to his primary care physician for his annual check-up.", "2. He says that he has generally been feeling well.", "3. He has noticed that he has had some intermittent very low grade fevers of unknown etiology.", "4. His past medical history is significant for well-controlled hypertension and diabetes.", "5. On physical exam he is found to have painless enlargement of a number of cervical and axillary lymph nodes.", "6. A biopsy of the enlarged nodes is obtained.", "7. Genetic testing shows that part of chromosomes 14 and 18 are joined together."], "atomic_facts": ["1. He has generally been feeling well.", "2. He has noticed intermittent very low grade fevers of unknown etiology.", "3. His past medical history includes well-controlled hypertension and diabetes.", "4. On physical exam, he has painless enlargement of cervical and axillary lymph nodes.", "5. A biopsy of the enlarged nodes is obtained.", "6. Genetic testing shows part of chromosomes 14 and 18 are joined together."]}
{"id": 641, "question": "Which of the following adverse effects is most likely to occur?", "context": ["A 75-year-old man is brought to the emergency room because of dizziness and palpitations for the past hour.", "His pulse is 185/min and blood pressure is 100/52 mm Hg.", "An ECG shows a narrow-complex, regular tachycardia without P waves.", "A drug is administered that activates cardiac potassium channels and causes transient atrioventricular block."], "context_len": 4, "options": {"A": "Chest pain", "B": "Dry cough", "C": "Perioral paresthesia", "D": "Yellow vision"}, "answer": "Chest pain", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "75", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 75-year-old man is brought to the emergency room.", "2. He has been experiencing dizziness and palpitations for the past hour.", "3. His pulse is 185/min.", "4. His blood pressure is 100/52 mm Hg.", "5. An ECG shows a narrow-complex, regular tachycardia without P waves.", "6. A drug is administered that activates cardiac potassium channels.", "7. The drug causes transient atrioventricular block."], "atomic_facts": ["1. Pulse rate is 185/min.", "2. Blood pressure is 100/52 mm Hg.", "3. ECG shows narrow-complex, regular tachycardia without P waves.", "4. A drug is administered.", "5. The drug activates cardiac potassium channels.", "6. The drug causes transient atrioventricular block."]}
{"id": 642, "question": "Which of the following is most likely associated with this patient's condition?", "context": ["A 70-year-old man is brought to the emergency department with painful discharge from his right ear with difficulty hearing for 3 days.", "His temperature is 39.5\u00b0C (103.1\u00b0F) and pulse is 120/minute.", "Physical examination shows mild facial asymmetry with the right corner of his mouth lagging behind the left when the patient smiles.", "There is severe ear pain when the right auricle is pulled superiorly.", "Otoscopic examination shows granulation tissue at the transition between the cartilaginous and the osseous part of the ear canal."], "context_len": 5, "options": {"A": "Decreased intracranial perfusion", "B": "Glucose intolerance", "C": "Pus-filled mastoid air cells", "D": "Positive streptococcal culture"}, "answer": "Glucose intolerance", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 70-year-old man is brought to the emergency department.", "2. He has painful discharge from his right ear.", "3. He has difficulty hearing for 3 days.", "4. His temperature is 39.5\u00b0C (103.1\u00b0F).", "5. His pulse is 120/minute.", "6. Physical examination shows mild facial asymmetry.", "7. The right corner of his mouth lags behind the left when the patient smiles.", "8. There is severe ear pain when the right auricle is pulled superiorly.", "9. Otoscopic examination shows granulation tissue at the transition between the cartilaginous and the osseous part of the ear canal."], "atomic_facts": ["1. His temperature is 39.5\u00b0C (103.1\u00b0F).", "2. His pulse is 120/minute.", "3. Physical examination shows mild facial asymmetry with the right corner of his mouth lagging behind the left when the patient smiles.", "4. There is severe ear pain when the right auricle is pulled superiorly.", "5. Otoscopic examination shows granulation tissue at the transition between the cartilaginous and the osseous part of the ear canal."]}
{"id": 643, "question": "Which of the following drugs was this mother most likely taking during pregnancy?", "context": ["A 24-year-old female with a history of recurrent infections, bipolar disorder, and no prenatal care gives birth to a male infant.", "On physical exam in the delivery room, you observe a tuft of hair over the infant's lumbosacral region."], "context_len": 2, "options": {"A": "Gentamicin", "B": "Lithium", "C": "Valproate", "D": "Folic acid"}, "answer": "Valproate", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "24", "specialties": ["Pediatrics"], "subspecialties": ["Maternal", "Pediatric Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 24-year-old female gave birth to a male infant.", "2. The female has a history of recurrent infections.", "3. The female has a history of bipolar disorder.", "4. The female had no prenatal care.", "5. On physical exam in the delivery room, a tuft of hair was observed over the infant's lumbosacral region."], "atomic_facts": ["1. Physical exam", "2. Delivery room", "3. Observation of tuft of hair", "4. Location: infant's lumbosacral region"]}
{"id": 644, "question": "What structure is most likely to be affected by this patient's condition?", "context": ["A 25-year-old woman presents to the physician with the complaint of several episodes of headache in the past 4 weeks that are affecting her school performance.", "The episodes are getting progressively worse, and over-the-counter headache and migraine medication do not seem to help.", "She also mentions having to raise her head each time to look at the board when taking notes; she cannot simply glance up with just her eyes while facing her notes.", "She has no significant past medical or family history and was otherwise well prior to this visit.", "Ophthalmic examination shows an upward gaze palsy, convergence-retraction nystagmus, and papilledema."], "context_len": 5, "options": {"A": "Third ventricle", "B": "Aqueduct of Sylvius", "C": "Tegmentum", "D": "Inferior colliculi"}, "answer": "Aqueduct of Sylvius", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology", "Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 25-year-old woman presents to the physician with the complaint of several episodes of headache in the past 4 weeks.", "2. The episodes are affecting her school performance.", "3. The episodes are getting progressively worse.", "4. Over-the-counter headache and migraine medication do not seem to help.", "5. She has to raise her head each time to look at the board when taking notes.", "6. She cannot simply glance up with just her eyes while facing her notes.", "7. She has no significant past medical or family history.", "8. She was otherwise well prior to this visit.", "9. Ophthalmic examination shows an upward gaze palsy.", "10. Ophthalmic examination shows convergence-retraction nystagmus.", "11. Ophthalmic examination shows papilledema."], "atomic_facts": ["1. The episodes are getting progressively worse.", "2. Over-the-counter headache and migraine medication do not seem to help.", "3. She mentions having to raise her head each time to look at the board when taking notes.", "4. She cannot simply glance up with just her eyes while facing her notes.", "5. She has no significant past medical or family history.", "6. She was otherwise well prior to this visit.", "7. Ophthalmic examination shows an upward gaze palsy.", "8. Ophthalmic examination shows convergence-retraction nystagmus.", "9. Ophthalmic examination shows papilledema."]}
{"id": 645, "question": "The patient is at greatest risk of which of the following adverse effects?", "context": ["A 75-year-old woman is brought to the emergency department because of a 6-hour history of severe headache, nausea, and 1 episode of vomiting.", "On arrival, she is lethargic and oriented only to self.", "Her pulse is 50/min, respirations are 8/min and shallow, and blood pressure is 150/96 mm Hg.", "Examination shows medial deviation of the left globe and ecchymoses of the upper eyelids.", "Appropriate pharmacotherapy with an intravenous drug is initiated, and the patient's urine output subsequently increases."], "context_len": 5, "options": {"A": "Drug-induced hypersensitivity syndrome", "B": "Hyperuricemia", "C": "Tinnitus", "D": "Pulmonary edema"}, "answer": "Pulmonary edema", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "75 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 75-year-old woman is brought to the emergency department.", "2. She has a 6-hour history of severe headache, nausea, and 1 episode of vomiting.", "3. On arrival, she is lethargic and oriented only to self.", "4. Her pulse is 50/min.", "5. Her respirations are 8/min and shallow.", "6. Her blood pressure is 150/96 mm Hg.", "7. Examination shows medial deviation of the left globe and ecchymoses of the upper eyelids.", "8. Appropriate pharmacotherapy with an intravenous drug is initiated.", "9. The patient's urine output subsequently increases."], "atomic_facts": ["1. On arrival, she is lethargic and oriented only to self.", "2. Her pulse is 50/min.", "3. Her respirations are 8/min and shallow.", "4. Her blood pressure is 150/96 mm Hg.", "5. Examination shows medial deviation of the left globe.", "6. Examination shows ecchymoses of the upper eyelids.", "7. Appropriate pharmacotherapy with an intravenous drug is initiated.", "8. The patient's urine output subsequently increases."]}
{"id": 646, "question": "Which of the following is the most likely diagnosis?", "context": ["A 31-year-old gravida 2 para 2 woman presents to her primary care physician for follow up.", "Two weeks ago, she gave birth via vaginal delivery to a 9.5 lb (4.3 kg) male infant.", "The delivery was complicated by a vaginal laceration that required extensive suturing once the infant was delivered.", "Immediately after delivery of the placenta she experienced intense shaking and chills that resolved within 1 hour.", "She has felt well since the delivery but admits to 6 days of malodorous smelling vaginal discharge that is tan in color.", "She has a history of vaginal candidiasis and is worried that it may be recurring.", "Her temperature is 98.8\u00b0F (37.1\u00b0C), blood pressure is 122/73 mmHg, pulse is 88/min, respirations are 16/min, and BMI is 33 kg/m^2.", "Speculum exam reveals a 1.5 cm dark red, velvety lesion on the posterior vaginal wall with a tan discharge.", "The pH of the discharge is 6.4."], "context_len": 9, "options": {"A": "Bacterial vaginosis", "B": "Rectovaginal fistula", "C": "Vaginal melanoma", "D": "Vesicovaginal fistula"}, "answer": "Rectovaginal fistula", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "31 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 31-year-old gravida 2 para 2 woman.", "2. Two weeks ago, she gave birth via vaginal delivery to a 9.5 lb (4.3 kg) male infant.", "3. Delivery was complicated by a vaginal laceration that required extensive suturing once the infant was delivered.", "4. Immediately after delivery of the placenta she experienced intense shaking and chills that resolved within 1 hour.", "5. She has felt well since the delivery but admits to 6 days of malodorous smelling vaginal discharge that is tan in color.", "6. She has a history of vaginal candidiasis.", "7. Temperature is 98.8\u00b0F (37.1\u00b0C), blood pressure is 122/73 mmHg, pulse is 88/min, respirations are 16/min, and BMI is 33 kg/m^2.", "8. Speculum exam reveals a 1.5 cm dark red, velvety lesion on the posterior vaginal wall with a tan discharge.", "9. The pH of the discharge is 6.4."], "atomic_facts": ["1. Two weeks ago, she gave birth via vaginal delivery to a 9.5 lb (4.3 kg) male infant.", "2. The delivery was complicated by a vaginal laceration that required extensive suturing once the infant was delivered.", "3. Immediately after delivery of the placenta she experienced intense shaking and chills that resolved within 1 hour.", "4. She has felt well since the delivery but admits to 6 days of malodorous smelling vaginal discharge that is tan in color.", "5. She has a history of vaginal candidiasis and is worried that it may be recurring.", "6. Her temperature is 98.8\u00b0F (37.1\u00b0C), blood pressure is 122/73 mmHg, pulse is 88/min, respirations are 16/min, and BMI is 33 kg/m^2.", "7. Speculum exam reveals a 1.5 cm dark red, velvety lesion on the posterior vaginal wall with a tan discharge.", "8. The pH of the discharge is 6.4."]}
{"id": 647, "question": "Which of the following is the most likely cause of this patient\u2019s respiratory symptoms?", "context": ["A 50-year-old male presents to the emergency room after getting hit by a car while biking.", "He complains of severe pain in both thighs.", "His thighs appear swollen, bruised, and angulated.", "Radiographic imaging demonstrates bilateral femoral shaft fractures.", "He subsequently undergoes surgical fixation of his fractures.", "Initially he has an uneventful post-operative course; however, on post-op day 4 he becomes confused and develops chest pain, tachypnea, and dyspnea.", "A new petechial rash is seen over his chest and neck.", "Electrocardiogram reveals normal sinus rhythm."], "context_len": 8, "options": {"A": "Lobar lung consolidation", "B": "Aspiration of stomach contents", "C": "Occlusion of the pulmonary vessels by fat globules", "D": "Spontaneous pneumothorax"}, "answer": "Occlusion of the pulmonary vessels by fat globules", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "50", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 50-year-old male presents to the emergency room.", "2. He was hit by a car while biking.", "3. He complains of severe pain in both thighs.", "4. His thighs appear swollen, bruised, and angulated.", "5. Radiographic imaging demonstrates bilateral femoral shaft fractures.", "6. He subsequently undergoes surgical fixation of his fractures.", "7. Initially he has an uneventful post-operative course.", "8. On post-op day 4 he becomes confused.", "9. He develops chest pain, tachypnea, and dyspnea.", "10. A new petechial rash is seen over his chest and neck.", "11. Electrocardiogram reveals normal sinus rhythm."], "atomic_facts": ["1. Patient complains of severe pain in both thighs.", "2. Thighs appear swollen, bruised, and angulated.", "3. Radiographic imaging demonstrates bilateral femoral shaft fractures.", "4. Patient undergoes surgical fixation of his fractures.", "5. Patient has an uneventful post-operative course.", "6. On post-op day 4, patient becomes confused and develops chest pain, tachypnea, and dyspnea.", "7. A new petechial rash is seen over patient's chest and neck.", "8. Electrocardiogram reveals normal sinus rhythm."]}
{"id": 648, "question": "Which of the following statements regarding this results of this study is true?", "context": ["A group of researchers is conducting a study to assess the validity and reliability of patient history in determining the amount and duration of drug abuse.", "In this study, 60 subjects with hepatitis were asked details of their history of drug abuse, such as the duration of drug abstinence, the amount and duration of drug abuse, and the treatment history.", "Additionally, a source close to or related to each of the study subjects (most often a spouse) was asked similar questions about the subject by a second researcher who was blinded to the subject\u2019s drug abuse history.", "Results revealed that the duration of drug abstinence correlated highly between subjects and the source (Spearman\u2019s r = 0.94, p-value < 0.001), as did the individual's score on the stimulant relapse risk scale (SRRS, Spearman\u2019s r = 0.74, p-value < 0.001), a ranked metric of relapse risk."], "context_len": 4, "options": {"A": "If the authors had conducted a study on larger sample size, Pearson\u2019s correlation coefficient for these data would have been calculated.", "B": "There is a linear relationship between the duration of drug abstinence as assessed by the subject and their close/related source.", "C": "Spearman\u2019s correlation coefficient reveals a strong association between the SRRS scores, as assessed by the study subject and their related source.", "D": "We can conclude that 88.4% (= 0.94 x 0.94) of the variability in the duration of drug abstinence (as assessed by the study subjects) can be 'explained' by the variability in the duration of drug abstinence as assessed by their sources."}, "answer": "Spearman\u2019s correlation coefficient reveals a strong association between the SRRS scores, as assessed by the study subject and their related source.", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Psychiatry"], "subspecialties": ["Addiction Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A group of researchers is conducting a study to assess the validity and reliability of patient history in determining the amount and duration of drug abuse. ", "2. 60 subjects with hepatitis were asked details of their history of drug abuse, such as the duration of drug abstinence, the amount and duration of drug abuse, and the treatment history. ", "3. A source close to or related to each of the study subjects (most often a spouse) was asked similar questions about the subject by a second researcher who was blinded to the subject\u2019s drug abuse history. ", "4. Results revealed that the duration of drug abstinence correlated highly between subjects and the source (Spearman\u2019s r = 0.94, p-value < 0.001). ", "5. Results also revealed that the individual's score on the stimulant relapse risk scale (SRRS, Spearman\u2019s r = 0.74, p-value < 0.001), a ranked metric of relapse risk correlated highly between subjects and the source."], "atomic_facts": ["1. 60 subjects with hepatitis were included in the study.", "2. Subjects were asked about their history of drug abuse, including duration of drug abstinence, amount and duration of drug abuse, and treatment history.", "3. A source close to each subject was asked similar questions about the subject's drug abuse history.", "4. The second researcher who asked the questions was blinded to the subject's drug abuse history.", "5. Results revealed a high correlation (Spearman\u2019s r = 0.94, p-value < 0.001) between the duration of drug abstinence reported by subjects and their sources.", "6. Results also showed a high correlation (Spearman\u2019s r = 0.74, p-value < 0.001) between the individual's score on the stimulant relapse risk scale (SRRS) and the source's report."]}
{"id": 649, "question": "Which of the following structures is most likely affected in this patient?", "context": ["A 27-year-old man comes to the emergency department for progressive weakness and numbness in his legs for 5 days.", "Symptoms originally started with tingling in both feet and have progressed to involve the knees and hips; he is currently unable to walk without assistance.", "Two weeks ago, the patient had diarrhea that subsided without antibiotics.", "Neurologic examination shows weakness, decreased sensation, and absent patellar reflexes in both lower extremities.", "Lumbar puncture shows elevated CSF protein and no white blood cells."], "context_len": 5, "options": {"A": "Postsynaptic acetylcholine receptors", "B": "Muscle endomysium", "C": "Schwann cells", "D": "Cerebral white matter"}, "answer": "Schwann cells", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "27 years old", "specialties": ["Neurology"], "subspecialties": ["Neuromuscular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 27-year-old man comes to the emergency department.", "2. He has progressive weakness and numbness in his legs for 5 days.", "3. Symptoms originally started with tingling in both feet.", "4. Symptoms have progressed to involve the knees and hips.", "5. He is currently unable to walk without assistance.", "6. Two weeks ago, the patient had diarrhea that subsided without antibiotics.", "7. Neurologic examination shows weakness, decreased sensation, and absent patellar reflexes in both lower extremities.", "8. Lumbar puncture shows elevated CSF protein.", "9. Lumbar puncture shows no white blood cells."], "atomic_facts": ["1. Symptoms started with tingling in both feet", "2. Symptoms progressed to involve the knees and hips", "3. Patient is currently unable to walk without assistance", "4. Two weeks ago, the patient had diarrhea", "5. Diarrhea subsided without antibiotics", "6. Neurologic examination shows weakness in both lower extremities", "7. Neurologic examination shows decreased sensation in both lower extremities", "8. Neurologic examination shows absent patellar reflexes in both lower extremities", "9. Lumbar puncture shows elevated CSF protein", "10. Lumbar puncture shows no white blood cells"]}
{"id": 650, "question": "Which of the following is the most appropriate further management of this patient?", "context": ["A 23-year-old man presents to the emergency department presenting with sudden-onset dyspnea and left-sided chest pain over the last hour.", "This event started when he was in class sitting for an exam.", "He reports that the pain is worse with inspiration and does not radiate.", "He says he has anxiety and takes alprazolam as needed.", "He smokes half a pack of cigarettes a day and drinks alcohol socially.", "The temperature is 36.7\u00b0C (98.0\u00b0F), the blood pressure is 130/80 mm Hg, the pulse is 82/min, and the respiratory rate is 14/min.", "Pulse oximetry shows 97% on room air.", "The patient\u2019s weight is 63.5 kg (140 lb), height is 185 cm (6 ft 1 in), and he has a BMI of 18.5 kg/m2.", "A chest X-ray is taken (see exhibit).", "After an hour of supplemental oxygen, rest, and careful monitoring his dyspnea improves and chest pain resolves without medication."], "context_len": 10, "options": {"A": "Needle thoracostomy", "B": "IV antibiotics", "C": "Supplemental oxygen", "D": "CT angiogram of chest"}, "answer": "Supplemental oxygen", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "23 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 23-year-old man.", "2. Patient presents with sudden-onset dyspnea and left-sided chest pain over the last hour.", "3. Event started when patient was in class sitting for an exam.", "4. Pain is worse with inspiration and does not radiate.", "5. Patient has anxiety and takes alprazolam as needed.", "6. Patient smokes half a pack of cigarettes a day.", "7. Patient drinks alcohol socially.", "8. Temperature is 36.7\u00b0C (98.0\u00b0F).", "9. Blood pressure is 130/80 mm Hg.", "10. Pulse is 82/min.", "11. Respiratory rate is 14/min.", "12. Pulse oximetry shows 97% on room air.", "13. Patient's weight is 63.5 kg (140 lb).", "14. Patient's height is 185 cm (6 ft 1 in).", "15. Patient has a BMI of 18.5 kg/m2.", "16. Chest X-ray is taken (see exhibit).", "17. After an hour of supplemental oxygen, rest, and careful monitoring, patient's dyspnea improves and chest pain resolves without medication."], "atomic_facts": ["1. The event started when he was in class sitting for an exam.", "2. He reports that the pain is worse with inspiration and does not radiate.", "3. He says he has anxiety and takes alprazolam as needed.", "4. He smokes half a pack of cigarettes a day and drinks alcohol socially.", "5. The temperature is 36.7\u00b0C (98.0\u00b0F), the blood pressure is 130/80 mm Hg, the pulse is 82/min, and the respiratory rate is 14/min.", "6. Pulse oximetry shows 97% on room air.", "7. The patient\u2019s weight is 63.5 kg (140 lb), height is 185 cm (6 ft 1 in), and he has a BMI of 18.5 kg/m2.", "8. A chest X-ray is taken (see exhibit).", "9. After an hour of supplemental oxygen, rest, and careful monitoring his dyspnea improves and chest pain resolves without medication."]}
{"id": 651, "question": "Which of the following is the most likely etiology of this patient\u2019s presentation?", "context": ["A 36-year-old male is brought to the emergency department by fire and rescue after being found down in his apartment by his wife.", "His wife reports that the patient had been complaining of chest pain for the last few hours but refused to go to the hospital.", "She went to the grocery store for about half an hour and found her husband unresponsive on the ground when she returned home.", "The patient\u2019s wife reports that his past medical history is significant for a \u201cheart murmur\u201d and that the patient\u2019s father died at age 32 for unknown reasons.", "In the trauma bay, the patient\u2019s temperature is 98.8\u00b0F (37.1\u00b0C), blood pressure is 88/41 mmHg, pulse is 116/min, and respirations are 12/min.", "On physical exam, the patient has a Glascow Coma Score (GCS) of 7.", "He has a tall stature with long limbs and long, slender fingers.", "He is also noted to have a pectus deformity.", "On cardiac exam, the patient has a diastolic decrescendo murmur at the left third intercostal space.", "He has weak brachial and femoral pulses. |  | ."], "context_len": 10, "options": {"A": "Coronary atherosclerosis", "B": "Spontaneous rupture of the aorta", "C": "Spontaneous rupture of the mitral chordae tendinae", "D": "Spontaneous separation in the arterial wall"}, "answer": "Spontaneous separation in the arterial wall", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "36", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 36 years old.", "2. Patient was brought to the emergency department by fire and rescue.", "3. Patient's wife found him unresponsive in his apartment.", "4. Patient had been complaining of chest pain for the last few hours.", "5. Patient's wife went to the grocery store for about half an hour.", "6. Patient's past medical history is significant for a \"heart murmur\".", "7. Patient's father died at age 32 for unknown reasons.", "8. Patient's temperature is 98.8\u00b0F (37.1\u00b0C).", "9. Patient's blood pressure is 88/41 mmHg.", "10. Patient's pulse is 116/min.", "11. Patient's respirations are 12/min.", "12. Patient has a Glascow Coma Score (GCS) of 7.", "13. Patient has a tall stature with long limbs and long, slender fingers.", "14. Patient has a pectus deformity.", "15. Patient has a diastolic decrescendo murmur at the left third intercostal space.", "16. Patient has weak brachial and femoral pulses."], "atomic_facts": ["1. The patient had been complaining of chest pain for the last few hours.", "2. The patient refused to go to the hospital.", "3. The patient's wife went to the grocery store for about half an hour.", "4. The patient's wife found her husband unresponsive on the ground when she returned home.", "5. The patient's past medical history is significant for a \"heart murmur.\"", "6. The patient's father died at age 32 for unknown reasons.", "7. In the trauma bay, the patient's temperature is 98.8\u00b0F (37.1\u00b0C).", "8. The patient's blood pressure is 88/41 mmHg.", "9. The patient's pulse is 116/min.", "10. The patient's respirations are 12/min.", "11. On physical exam, the patient has a Glascow Coma Score (GCS) of 7.", "12. The patient has a tall stature with long limbs and long, slender fingers.", "13. The patient is noted to have a pectus deformity.", "14. On cardiac exam, the patient has a diastolic decrescendo murmur at the left third intercostal space.", "15. The patient has weak brachial and femoral pulses."]}
{"id": 652, "question": "Further evaluation of this patient is most likely to show which of the following findings?", "context": ["A 44-year-old man comes to the physician because of severe lower back pain for 1 week.", "He has also had fatigue, weight gain, and episodic headaches during the past 3 months.", "He has no history of serious illness and takes no medications.", "His pulse is 88/min and blood pressure is 155/102 mm Hg.", "Physical examination shows facial plethora and truncal obesity.", "The skin appears stretched, with multiple ecchymotic patches over the upper and lower extremities bilaterally.", "Cardiopulmonary examination shows no abnormalities.", "There are bilateral paravertebral muscle spasms and severe tenderness over the second lumbar vertebra.", "An x-ray of the lumbar spine shows decreased bone density and a compression fracture of the L2 vertebra."], "context_len": 9, "options": {"A": "Low serum glucose levels", "B": "Suprasellar mass on cranial MRI", "C": "T-wave flattening on ECG", "D": "Positive Chvostek sign"}, "answer": "T-wave flattening on ECG", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "44", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 44-year-old man comes to the physician because of severe lower back pain for 1 week.", "2. He has also had fatigue, weight gain, and episodic headaches during the past 3 months.", "3. He has no history of serious illness and takes no medications.", "4. His pulse is 88/min and blood pressure is 155/102 mm Hg.", "5. Physical examination shows facial plethora and truncal obesity.", "6. The skin appears stretched, with multiple ecchymotic patches over the upper and lower extremities bilaterally.", "7. Cardiopulmonary examination shows no abnormalities.", "8. There are bilateral paravertebral muscle spasms and severe tenderness over the second lumbar vertebra.", "9. An x-ray of the lumbar spine shows decreased bone density.", "10. An x-ray of the lumbar spine shows a compression fracture of the L2 vertebra."], "atomic_facts": ["1. He has had fatigue during the past 3 months.", "2. He has had weight gain during the past 3 months.", "3. He has had episodic headaches during the past 3 months.", "4. He has no history of serious illness.", "5. He takes no medications.", "6. His pulse is 88/min.", "7. His blood pressure is 155/102 mm Hg.", "8. Physical examination shows facial plethora.", "9. Physical examination shows truncal obesity.", "10. The skin appears stretched.", "11. The skin has multiple ecchymotic patches over the upper and lower extremities bilaterally.", "12. Cardiopulmonary examination shows no abnormalities.", "13. There are bilateral paravertebral muscle spasms.", "14. There is severe tenderness over the second lumbar vertebra.", "15. An x-ray of the lumbar spine shows decreased bone density.", "16. An x-ray of the lumbar spine shows a compression fracture of the L2 vertebra."]}
{"id": 653, "question": "Which of the following is the most likely cause of this patient's symptoms?", "context": ["Two weeks after undergoing coronary artery bypass surgery for acute myocardial infarction, a 62-year-old man comes to the physician because of a 4-day history of fever, stabbing chest pain, and fatigue.", "Initially the pain was only present when he was lying supine, but now it is present all the time and only subsides when he is leaning forward.", "He has hypertension and mild mitral regurgitation.", "He has smoked one pack of cigarettes daily for 44 years but quit prior to surgery.", "Current medications include aspirin, clopidogrel, metoprolol, captopril, and atorvastatin.", "His temperature is 38.3\u00b0C (102\u00b0F), pulse is 84/min and regular, respirations are 16/min, and blood pressure is 132/86 mm Hg.", "During inspiration the blood pressure drops to 117/80 mm Hg.", "On physical examination there are jugular venous pulsations 4 cm above the sternal angle.", "Heart sounds are faint.", "There is 2+ edema in the lower extremities."], "context_len": 10, "options": {"A": "Increase in mean aortic pressure", "B": "Decreased left ventricular diastolic filling", "C": "Supraventricular arrhythmia", "D": "Decreased right ventricular contractility\n\""}, "answer": "Decreased left ventricular diastolic filling", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "62 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 62 years old.", "2. Patient has a 4-day history of fever, stabbing chest pain, and fatigue.", "3. Initially the pain was only present when he was lying supine.", "4. Now the pain is present all the time and only subsides when he is leaning forward.", "5. Patient has hypertension and mild mitral regurgitation.", "6. Patient smoked one pack of cigarettes daily for 44 years but quit prior to surgery.", "7. Current medications include aspirin, clopidogrel, metoprolol, captopril, and atorvastatin.", "8. Patient's temperature is 38.3\u00b0C (102\u00b0F).", "9. Patient's pulse is 84/min and regular.", "10. Patient's respirations are 16/min.", "11. Patient's blood pressure is 132/86 mm Hg.", "12. During inspiration the blood pressure drops to 117/80 mm Hg.", "13. On physical examination there are jugular venous pulsations 4 cm above the sternal angle.", "14. Heart sounds are faint.", "15. There is 2+ edema in the lower extremities.", "16. Patient underwent coronary artery bypass surgery for acute myocardial infarction two weeks prior."], "atomic_facts": ["1. The patient initially experienced pain only when lying supine.", "2. The pain is now present all the time and subsides only when leaning forward.", "3. The patient has hypertension.", "4. The patient has mild mitral regurgitation.", "5. The patient smoked one pack of cigarettes daily for 44 years but quit prior to surgery.", "6. Current medications include aspirin, clopidogrel, metoprolol, captopril, and atorvastatin.", "7. The patient's temperature is 38.3\u00b0C (102\u00b0F).", "8. The patient's pulse is 84/min and regular.", "9. The patient's respirations are 16/min.", "10. The patient's blood pressure is 132/86 mm Hg.", "11. During inspiration, the patient's blood pressure drops to 117/80 mm Hg.", "12. On physical examination, there are jugular venous pulsations 4 cm above the sternal angle.", "13. The patient's heart sounds are faint.", "14. There is 2+ edema in the lower extremities."]}
{"id": 654, "question": "Which of the following is the most likely diagnosis?", "context": ["A 28-year-old woman comes to the physician with her mother because of a 1-week history of feeling unusually energetic.", "The mother describes her state as \u201chyper\u201d and reports that she often paces around her room.", "During this period, the patient has not slept.", "She had similar episodes 2 months and 5 months ago.", "The mother also states that, for the past 8 months, the patient has believed she is a famous singer and is going on a world tour next year.", "The patient does not have a partner and has only a few friends.", "She was working as a dental technician until 6 months ago, when she started to hear voices telling her to quit.", "She has not held a job since then.", "She does not use illicit drugs.", "Vital signs are within normal limits.", "Physical and neurological examinations show no abnormalities.", "On mental status examination, her speech is pressured, but she suddenly stops talking in the middle of sentences and does not finish them.", "She occasionally directs her attention to empty corners in the room, as if she were listening to someone."], "context_len": 13, "options": {"A": "Schizoaffective disorder", "B": "Schizotypal personality disorder", "C": "Delusional disorder", "D": "Mood disorder with psychotic features"}, "answer": "Schizoaffective disorder", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Psychiatry"], "subspecialties": ["Mood Disorder with Psychotic Features"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 28-year-old woman comes to the physician with her mother.", "2. She has a 1-week history of feeling unusually energetic.", "3. The mother describes her state as \u201chyper\u201d.", "4. She often paces around her room.", "5. She has not slept during this period.", "6. She had similar episodes 2 months and 5 months ago.", "7. For the past 8 months, she has believed she is a famous singer.", "8. She believes she is going on a world tour next year.", "9. She does not have a partner and has only a few friends.", "10. She was working as a dental technician until 6 months ago.", "11. She started to hear voices telling her to quit 6 months ago.", "12. She has not held a job since then.", "13. She does not use illicit drugs.", "14. Vital signs are within normal limits.", "15. Physical and neurological examinations show no abnormalities.", "16. On mental status examination, her speech is pressured.", "17. She suddenly stops talking in the middle of sentences and does not finish them.", "18. She occasionally directs her attention to empty corners in the room, as if she were listening to someone."], "atomic_facts": ["1. The mother describes her state as \"hyper\" and reports that she often paces around her room.", "2. During this period, the patient has not slept.", "3. She had similar episodes 2 months and 5 months ago.", "4. The mother also states that, for the past 8 months, the patient has believed she is a famous singer and is going on a world tour next year.", "5. The patient does not have a partner and has only a few friends.", "6. She was working as a dental technician until 6 months ago, when she started to hear voices telling her to quit.", "7. She has not held a job since then.", "8. She does not use illicit drugs.", "9. Vital signs are within normal limits.", "10. Physical and neurological examinations show no abnormalities.", "11. On mental status examination, her speech is pressured, but she suddenly stops talking in the middle of sentences and does not finish them.", "12. She occasionally directs her attention to empty corners in the room, as if she were listening to someone."]}
{"id": 655, "question": "Which of the following investigations is indicated as part of his diagnostic evaluation at present?", "context": ["A 4-year-old boy presents the pediatrician with his parents for a consultation after his school teacher complained about his abnormal behavior and his inability to make friends in school.", "They mention that the boy does not interact well with others at home, school, or daycare.", "On physical examination, his vital signs are stable with normal weight, height, and head circumference for his age and sex.", "His general examination and systemic examination, including neurologic examination, are completely normal.", "His recent audiologic evaluation shows normal hearing, and intellectual disability has been ruled out by a clinical psychologist."], "context_len": 5, "options": {"A": "Magnetic Resonance Imaging (MRI) of brain", "B": "Positron Emission Tomography (SPECT) Scanning of head", "C": "Electroencephalography", "D": "No further testing is needed"}, "answer": "No further testing is needed", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics", "Psychiatry"], "subspecialties": ["Developmental", "Child and Adolescent Psychiatry"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 4-year-old boy presents the pediatrician with his parents for a consultation.", "2. His school teacher complained about his abnormal behavior and his inability to make friends in school.", "3. His parents mention that the boy does not interact well with others at home, school, or daycare.", "4. On physical examination, his vital signs are stable.", "5. His weight, height, and head circumference are normal for his age and sex.", "6. His general examination and systemic examination, including neurologic examination, are completely normal.", "7. His recent audiologic evaluation shows normal hearing.", "8. Intellectual disability has been ruled out by a clinical psychologist."], "atomic_facts": ["1. The boy does not interact well with others at home, school, or daycare.", "2. His vital signs are stable.", "3. His weight, height, and head circumference are normal for his age and sex.", "4. His general examination and systemic examination are normal.", "5. His neurologic examination is normal.", "6. His recent audiologic evaluation shows normal hearing.", "7. Intellectual disability has been ruled out by a clinical psychologist."]}
{"id": 656, "question": "Which of the following is the most likely explanation for this patient's current condition?", "context": ["A 57-year-old man comes to the physician because of a 5-day history of fever, joint pain, malaise, and a diffuse rash.", "Two months ago, he was diagnosed with latent tuberculosis and the appropriate treatment was administered.", "Examination shows a scaly, maculopapular rash over the chest, arms, and back."], "context_len": 3, "options": {"A": "Decreased acetaldehyde dehydrogenase activity", "B": "Decreased acetyltransferase activity", "C": "Decreased cytochrome p450 activity", "D": "Decreased glucose-6-phosphate dehydrogenase activity"}, "answer": "Decreased acetyltransferase activity", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 57-year-old man comes to the physician.", "2. He has a 5-day history of fever, joint pain, malaise, and a diffuse rash.", "3. Two months ago, he was diagnosed with latent tuberculosis.", "4. The appropriate treatment for latent tuberculosis was administered.", "5. Examination shows a scaly, maculopapular rash over the chest, arms, and back."], "atomic_facts": ["1. Two months ago, he was diagnosed with latent tuberculosis.", "2. The appropriate treatment was administered for latent tuberculosis.", "3. Examination shows a scaly rash over the chest, arms, and back.", "4. Examination shows a maculopapular rash over the chest, arms, and back."]}
{"id": 657, "question": "What is the most likely additional finding?", "context": ["A 40-hour-old baby girl is being evaluated for failure to pass meconium.", "She is the product of a full-term vaginal delivery to a G2P2 36-year-old mother.", "The pregnancy was uncomplicated, and the only medication that the mother took was a prenatal vitamin.", "The baby has been exclusively breastfed, and she has an adequate latch.", "On physical examination, the newborn\u2019s abdomen is distended and on digital rectal examination, reveals that the rectum is empty."], "context_len": 5, "options": {"A": "Absence of ganglion cells in the submucosal plexus on suction biopsy of the rectum", "B": "Acid-producing mucosa visualized in a technetium scan", "C": "Abdominal ultrasound showing bowel-within-bowel", "D": "Inability to pass a 10-French catheter from the mouth into the stomach"}, "answer": "Absence of ganglion cells in the submucosal plexus on suction biopsy of the rectum", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "40 hours old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 40-hour-old baby girl is being evaluated for failure to pass meconium.", "2. The baby is the product of a full-term vaginal delivery.", "3. The mother is a G2P2 36-year-old.", "4. The pregnancy was uncomplicated.", "5. The mother only took a prenatal vitamin.", "6. The baby has been exclusively breastfed.", "7. The baby has an adequate latch.", "8. On physical examination, the newborn's abdomen is distended.", "9. On digital rectal examination, the rectum is empty."], "atomic_facts": ["1. The baby is the product of a full-term vaginal delivery.", "2. The mother is 36 years old and has a G2P2 history.", "3. The pregnancy was uncomplicated.", "4. The mother only took a prenatal vitamin during pregnancy.", "5. The baby has been exclusively breastfed.", "6. The baby has an adequate latch.", "7. On physical examination, the newborn's abdomen is distended.", "8. Digital rectal examination reveals that the rectum is empty."]}
{"id": 658, "question": "Which of the following is the best next step in diagnosing this patient\u2019s condition?", "context": ["A 65-year-old man presents to the physician with a low-grade fever, fatigue, and anorexia for the past 10 days.", "The patient denies any chest pain, cough, or shortness of breath.", "He has been a smoker for the last 10 years and consumes alcohol occasionally.", "His past medical history is significant for colorectal carcinoma.", "His temperature is 38.3\u00b0C (101.0\u00b0F), the blood pressure is 130/90 mm Hg, and the pulse is 100/min.", "Physical examination shows reddish-brown spots under his nail bed (as shown in the exhibit) and tender erythematous fingers tips.", "Cardiac auscultation reveals a new holosystolic murmur best heard at the apex with no radiation.", "Chest X-ray, electrocardiogram, and urinalysis are normal."], "context_len": 8, "options": {"A": "Obtain anti-CCP antibody titers", "B": "Echocardiography", "C": "Obtain blood samples for blood culture", "D": "Reassurance and symptomatic management"}, "answer": "Obtain blood samples for blood culture", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 65 years old.", "2. Patient has low-grade fever, fatigue, and anorexia for 10 days.", "3. Patient denies chest pain, cough, or shortness of breath.", "4. Patient has been a smoker for 10 years and consumes alcohol occasionally.", "5. Patient has past medical history of colorectal carcinoma.", "6. Patient's temperature is 38.3\u00b0C (101.0\u00b0F).", "7. Patient's blood pressure is 130/90 mm Hg.", "8. Patient's pulse is 100/min.", "9. Physical examination shows reddish-brown spots under nail bed.", "10. Physical examination shows tender erythematous fingers tips.", "11. Cardiac auscultation reveals new holosystolic murmur best heard at apex with no radiation.", "12. Chest X-ray is normal.", "13. Electrocardiogram is normal.", "14. Urinalysis is normal."], "atomic_facts": ["1. The patient denies chest pain, cough, or shortness of breath.", "2. He has been a smoker for the last 10 years.", "3. He consumes alcohol occasionally.", "4. His past medical history is significant for colorectal carcinoma.", "5. His temperature is 38.3\u00b0C (101.0\u00b0F).", "6. His blood pressure is 130/90 mm Hg.", "7. His pulse is 100/min.", "8. Physical examination shows reddish-brown spots under his nail bed.", "9. Physical examination shows tender erythematous fingertips.", "10. Cardiac auscultation reveals a new holosystolic murmur best heard at the apex with no radiation.", "11. Chest X-ray, electrocardiogram, and urinalysis are normal."]}
{"id": 659, "question": "Which of the following treatment regimens should be recommended for this patient given the fully suppressed viral load?", "context": ["A 27-year-old man presents for followup 3 months after starting an antiretroviral regimen consisting of efavirenz, tenofovir, and emtricitabine.", "Labs drawn just prior to presentation reveal an undetectable viral load and a T-lymphocyte count of 317/mm^3.", "By comparison, his viral load was 6100/mL and his T-lymphocyte count was 146/mm^3 at the time of treatment initiation.", "He reports that he is tolerating the medications well and is not experiencing any major side effects."], "context_len": 4, "options": {"A": "Continue current regimen of efavirenz, tenofovir, and emtricitabine", "B": "Continue efavirenz and emtricitabine but discontinue tenofovir", "C": "Continue efavirenz and tenofovir but discontinue emtricitabine", "D": "Continue tenofovir and emtricitabine but discontinue efavirenz"}, "answer": "Continue current regimen of efavirenz, tenofovir, and emtricitabine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "27 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 27 years old.", "2. Patient is 3 months into antiretroviral regimen.", "3. Regimen consists of efavirenz, tenofovir, and emtricitabine.", "4. Labs drawn prior to presentation reveal undetectable viral load.", "5. Labs drawn prior to presentation reveal T-lymphocyte count of 317/mm^3.", "6. At time of treatment initiation, viral load was 6100/mL.", "7. At time of treatment initiation, T-lymphocyte count was 146/mm^3.", "8. Patient is tolerating medications well.", "9. Patient is not experiencing any major side effects."], "atomic_facts": ["1. Labs drawn just prior to presentation reveal an undetectable viral load.", "2. Labs drawn just prior to presentation reveal a T-lymphocyte count of 317/mm^3.", "3. His viral load was 6100/mL at the time of treatment initiation.", "4. His T-lymphocyte count was 146/mm^3 at the time of treatment initiation.", "5. He reports that he is tolerating the medications well.", "6. He reports that he is not experiencing any major side effects."]}
{"id": 660, "question": "What type of cells were most likely injured in the initial stage of his disease?", "context": ["A 60-year-old male painter with severe chest pain is found to have atherosclerosis of his coronary arteries."], "context_len": 1, "options": {"A": "Myocytes", "B": "Neutrophils", "C": "Endothelial cells", "D": "Smooth muscle cells"}, "answer": "Endothelial cells", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "60", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology", "Interventional Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 60 years old.", "2. Patient is male.", "3. Patient is a painter.", "4. Patient has severe chest pain.", "5. Patient has atherosclerosis of his coronary arteries."], "atomic_facts": ["1. The patient is a 60-year-old male.", "2. The patient is a painter.", "3. The patient is experiencing severe chest pain.", "4. The patient has atherosclerosis.", "5. The atherosclerosis is located in the coronary arteries."]}
{"id": 661, "question": "Regarding Rh D immunoglobulin (RhoGam) administration, the most appropriate next step is which of the following?", "context": ["A 27-year-old woman, gravida 1, at 26 weeks gestation presents to the physician during a prenatal visit.", "She feels well.", "Her pregnancy has been uncomplicated.", "Her initial laboratory tests at 8 weeks confirmed her blood type as B-.", "Her partner is blood type A+.", "At the clinic, her temperature is 37.2\u00b0C (99.0\u00b0F), and blood pressure is 108/60 mm Hg.", "Pelvic examination shows a uterus consistent in size with a 24-week gestation.", "Fetal heartbeats are normal.", "A sample of blood is collected for blood type screening and verification."], "context_len": 9, "options": {"A": "At 28 weeks gestation if anti-D screen is negative", "B": "At 28 weeks gestation if anti-D screen is positive", "C": "Within 72 hours after birth if anti-D screen is negative", "D": "Rh D immunoglobulin (RhoGam) is not required in this patient regardless of test results"}, "answer": "At 28 weeks gestation if anti-D screen is negative", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Maternal", "Maternal\u2013Fetal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 27-year-old woman is presenting to the physician during a prenatal visit.", "2. She is gravida 1.", "3. She is at 26 weeks gestation.", "4. She feels well.", "5. Her pregnancy has been uncomplicated.", "6. Her initial laboratory tests at 8 weeks confirmed her blood type as B-.", "7. Her partner is blood type A+.", "8. At the clinic, her temperature is 37.2\u00b0C (99.0\u00b0F).", "9. Her blood pressure is 108/60 mm Hg.", "10. Pelvic examination shows a uterus consistent in size with a 24-week gestation.", "11. Fetal heartbeats are normal.", "12. A sample of blood is collected for blood type screening and verification."], "atomic_facts": ["1. She feels well.", "2. Her pregnancy has been uncomplicated.", "3. Her initial laboratory tests at 8 weeks confirmed her blood type as B-.", "4. Her partner is blood type A+.", "5. At the clinic, her temperature is 37.2\u00b0C (99.0\u00b0F), and blood pressure is 108/60 mm Hg.", "6. Pelvic examination shows a uterus consistent in size with a 24-week gestation.", "7. Fetal heartbeats are normal.", "8. A sample of blood is collected for blood type screening and verification."]}
{"id": 662, "question": "What could be causing this patient\u2019s newly-discovered dermatologic change?", "context": ["A 32-year-old obese man visits your dermatology clinic after his barber saw a darkened area on the back of his neck.", "He has not seen his primary care physician in many years and does not know if he has diabetes.", "A rapid blood glucose test showed a normal glucose level.", "Otherwise, he reports recent loss of appetite with slight weight loss."], "context_len": 4, "options": {"A": "Gastric adenocarcinoma", "B": "Diabetes insipidus", "C": "Diabetes mellitus", "D": "Barrett\u2019s esophagus"}, "answer": "Gastric adenocarcinoma", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "32", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 32-year-old man visited a dermatology clinic.", "2. His barber noticed a darkened area on the back of his neck.", "3. He has not seen his primary care physician in many years.", "4. He does not know if he has diabetes.", "5. A rapid blood glucose test showed a normal glucose level.", "6. He reported recent loss of appetite.", "7. He reported slight weight loss."], "atomic_facts": ["1. He has not seen his primary care physician in many years.", "2. He does not know if he has diabetes.", "3. A rapid blood glucose test showed a normal glucose level.", "4. He reports recent loss of appetite.", "5. He reports slight weight loss."]}
{"id": 663, "question": "Which of the following is the most likely cause of this patient's symptoms?", "context": ["A 59-year-old man comes to the physician because of a 6-month history of progressive blurry vision in both eyes.", "His vision has not improved with the use of reading glasses.", "His blood pressure is 155/98 mm Hg.", "Physical examination shows his visual acuity to be 20/80 in the right eye and 20/60 in the left eye.", "A photograph of the fundoscopic examination of the right eye is shown."], "context_len": 5, "options": {"A": "Idiopathic intracranial hypertension", "B": "Open-angle glaucoma", "C": "Central retinal artery occlusion", "D": "Diabetic retinopathy\n\""}, "answer": "Diabetic retinopathy\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "59 years old", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. A 59-year-old man comes to the physician.", "2. He has a 6-month history of progressive blurry vision in both eyes.", "3. His vision has not improved with the use of reading glasses.", "4. His blood pressure is 155/98 mm Hg.", "5. Physical examination shows his visual acuity to be 20/80 in the right eye.", "6. Physical examination shows his visual acuity to be 20/60 in the left eye.", "7. A photograph of the fundoscopic examination of the right eye is shown."], "atomic_facts": ["1. His vision has not improved with the use of reading glasses.", "2. His blood pressure is 155/98 mm Hg.", "3. Physical examination shows his visual acuity to be 20/80 in the right eye and 20/60 in the left eye.", "4. A photograph of the fundoscopic examination of the right eye is shown."]}
{"id": 664, "question": "What is the most appropriate next step in the management of this patient\u2019s symptoms?", "context": ["A 16-year-old high school cheerleader is brought by her mother to the emergency department after falling on her back during a stunt.", "She strongly believes that the accident happened because the team couldn\u2019t catch her \u2018enormous and bloated\u2019 body.", "Lately, she has been in a lot of stress as dance regionals are coming up soon and she wants to lose 6.8 kg (15 lb).", "She is also experiencing intermittent palpitations and dizziness, even during rest.", "The physical examination reveals a slender girl with bilateral swelling on her cheeks and abrasions on the dorsum of her right hand.", "When her mother left the room, she admitted to taking furosemide that she found in the medicine cabinet.", "The vital signs include: temperature 36.2\u00b0C (97.2\u00b0F), blood pressure 90/60 mm Hg, pulse rate 50/min, respiratory rate 12/min, height 162 cm (5 ft 4 in), and weight 40.9 kg (90 lb).", "A magnetic resonance image (MRI) of the thoracic spine shows a vertebral compression fracture.", "She is refusing to eat anything but ice."], "context_len": 9, "options": {"A": "Admit and start parenteral nutrition", "B": "Stabilize the fracture with a brace and discharge patient", "C": "Switch furosemide to hydrochlorothiazide", "D": "Refer to psychiatrist for outpatient cognitive behavioral therapy"}, "answer": "Admit and start parenteral nutrition", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "16", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is a 16-year-old high school cheerleader.", "2. Patient fell on her back during a stunt.", "3. Patient believes the accident happened because the team couldn\u2019t catch her \u2018enormous and bloated\u2019 body.", "4. Patient is under a lot of stress due to upcoming dance regionals.", "5. Patient wants to lose 6.8 kg (15 lb).", "6. Patient is experiencing intermittent palpitations and dizziness, even during rest.", "7. Physical examination reveals a slender girl with bilateral swelling on her cheeks and abrasions on the dorsum of her right hand.", "8. Patient admitted to taking furosemide that she found in the medicine cabinet when her mother left the room.", "9. Vital signs include: temperature 36.2\u00b0C (97.2\u00b0F), blood pressure 90/60 mm Hg, pulse rate 50/min, respiratory rate 12/min, height 162 cm (5 ft 4 in), and weight 40.9 kg (90 lb).", "10. MRI of the thoracic spine shows a vertebral compression fracture.", "11. Patient is refusing to eat anything but ice."], "atomic_facts": ["1. She strongly believes that the accident happened because the team couldn\u2019t catch her \u2018enormous and bloated\u2019 body.", "2. She has been in a lot of stress as dance regionals are coming up soon and she wants to lose 6.8 kg (15 lb).", "3. She is experiencing intermittent palpitations and dizziness, even during rest.", "4. The physical examination reveals a slender girl with bilateral swelling on her cheeks and abrasions on the dorsum of her right hand.", "5. When her mother left the room, she admitted to taking furosemide that she found in the medicine cabinet.", "6. The vital signs include: temperature 36.2\u00b0C (97.2\u00b0F), blood pressure 90/60 mm Hg, pulse rate 50/min, respiratory rate 12/min, height 162 cm (5 ft 4 in), and weight 40.9 kg (90 lb).", "7. A magnetic resonance image (MRI) of the thoracic spine shows a vertebral compression fracture.", "8. She is refusing to eat anything but ice."]}
{"id": 665, "question": "Which of the following enzymes is primarily inhibited at the biochemical level by the chemical agent responsible for this patient\u2019s condition?", "context": ["A 44-year-old man presents to an oncologist after being diagnosed with small cell lung carcinoma confirmed with a biopsy last week.", "He worked as a plant technician in the metal processing unit at a factory for the last 14 years.", "Family history is unremarkable.", "It is concluded that this cancer is most likely mediated by mutations triggered by chronic chemical exposure at his work."], "context_len": 4, "options": {"A": "Pyruvate dehydrogenase", "B": "Phosphofructokinase", "C": "Dihydrofolate reductase", "D": "Glucose-6-phosphate dehydrogenase"}, "answer": "Pyruvate dehydrogenase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "44", "specialties": ["Internal Medicine", "Medical Genetics and Genomics"], "subspecialties": ["Medical Oncology", "Clinical Biochemical Genetics"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 44-year-old man presents to an oncologist.", "2. He was diagnosed with small cell lung carcinoma.", "3. The diagnosis was confirmed with a biopsy last week.", "4. He worked as a plant technician in the metal processing unit at a factory for the last 14 years.", "5. Family history is unremarkable.", "6. It is concluded that this cancer is most likely mediated by mutations triggered by chronic chemical exposure at his work."], "atomic_facts": ["1. He worked as a plant technician in the metal processing unit at a factory for the last 14 years.", "2. Family history is unremarkable.", "3. It is concluded that this cancer is most likely mediated by mutations triggered by chronic chemical exposure at his work."]}
{"id": 666, "question": "Which of the following is associated with the most likely cause of this patient's symptoms?", "context": ["A 41-year-old woman presents to the emergency room with a 2-day history of flank pain, nausea, and vomiting.", "She denies any urinary frequency or urgency and denies any recent changes in her diet.", "Her temperature is 100.4\u00b0F (38\u00b0C), blood pressure is 152/96 mmHg, and pulse is 104/min.", "On physical exam, there is bilateral flank tenderness to palpation.", "In addition, neurologic testing reveals decreased strength in her left upper extremity and an inability to sustain lateral gaze with her right eye.", "An electrocardiogram reveals an irregularly irregular heart rhythm."], "context_len": 6, "options": {"A": "Drug allergy", "B": "Hereditary thrombophilia", "C": "Hypertension", "D": "Streptococcus infection"}, "answer": "Hereditary thrombophilia", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "41", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 41-year-old woman presents to the emergency room.", "2. She has a 2-day history of flank pain, nausea, and vomiting.", "3. She denies any urinary frequency or urgency.", "4. She denies any recent changes in her diet.", "5. Her temperature is 100.4\u00b0F (38\u00b0C).", "6. Her blood pressure is 152/96 mmHg.", "7. Her pulse is 104/min.", "8. On physical exam, there is bilateral flank tenderness to palpation.", "9. Neurologic testing reveals decreased strength in her left upper extremity.", "10. Neurologic testing reveals an inability to sustain lateral gaze with her right eye.", "11. An electrocardiogram reveals an irregularly irregular heart rhythm."], "atomic_facts": ["1. She denies urinary frequency or urgency.", "2. She denies recent changes in her diet.", "3. Her temperature is 100.4\u00b0F (38\u00b0C).", "4. Her blood pressure is 152/96 mmHg.", "5. Her pulse is 104/min.", "6. On physical exam, there is bilateral flank tenderness to palpation.", "7. Neurologic testing reveals decreased strength in her left upper extremity.", "8. Neurologic testing reveals an inability to sustain lateral gaze with her right eye.", "9. An electrocardiogram reveals an irregularly irregular heart rhythm."]}
{"id": 667, "question": "Which of the following is the best initial step in her management?", "context": ["A 20-year-old African American woman comes to the clinic after missing her last two periods.", "Her cycles are usually regular, occurring at 28-32 day intervals with moderate bleeding and some abdominal discomfort.", "She also complains of occasional diffuse and generalized headaches.", "She is a college student and works part-time as a bartender.", "Past medical history is insignificant.", "Blood pressure is 110/70 mm Hg, pulse rate is 80 /min, respiratory rate is 14 /min, and temperature is 36.5\u00b0C (97.7\u00b0F).", "Physical examination is significant for mild breast tenderness and some secretions from the nipple area.", "Urine pregnancy test is negative."], "context_len": 8, "options": {"A": "Serum prolactin levels", "B": "LH/FSH ratio", "C": "Ultrasound of abdomen and pelvis", "D": "Dopamine agonists"}, "answer": "Serum prolactin levels", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 20-year-old African American woman comes to the clinic.", "2. She has missed her last two periods.", "3. Her cycles usually occur at 28-32 day intervals.", "4. She experiences moderate bleeding and some abdominal discomfort.", "5. She also complains of occasional diffuse and generalized headaches.", "6. She is a college student and works part-time as a bartender.", "7. Her past medical history is insignificant.", "8. Her blood pressure is 110/70 mm Hg.", "9. Her pulse rate is 80 /min.", "10. Her respiratory rate is 14 /min.", "11. Her temperature is 36.5\u00b0C (97.7\u00b0F).", "12. Physical examination is significant for mild breast tenderness.", "13. Physical examination is significant for some secretions from the nipple area.", "14. Urine pregnancy test is negative."], "atomic_facts": ["1. Her cycles are usually regular, occurring at 28-32 day intervals with moderate bleeding and some abdominal discomfort.", "2. She complains of occasional diffuse and generalized headaches.", "3. She is a college student and works part-time as a bartender.", "4. Past medical history is insignificant.", "5. Blood pressure is 110/70 mm Hg.", "6. Pulse rate is 80 /min.", "7. Respiratory rate is 14 /min.", "8. Temperature is 36.5\u00b0C (97.7\u00b0F).", "9. Physical examination is significant for mild breast tenderness and some secretions from the nipple area.", "10. Urine pregnancy test is negative."]}
{"id": 668, "question": "Which of the following is the most likely explanation for the finding on this patient's peripheral blood smear?", "context": ["A 25-year-old man comes to the physician because he and his wife have been unable to conceive a child despite having regular unprotected sexual intercourse.", "He is 187 cm (6 ft 1 in) tall and weighs 79 kg (174 lb).", "Examination shows long extremities, bilateral gynecomastia, and small, firm testes.", "A peripheral blood smear shows a dense, dark-staining spot at the periphery of the nucleus of a cell."], "context_len": 4, "options": {"A": "Acetylation of histone lysine residues", "B": "Methylation of cytosine nucleotides", "C": "Aggregation of ribosomes", "D": "Precipitation of oxidized hemoglobin"}, "answer": "Methylation of cytosine nucleotides", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Reproductive Endocrinology and Infertility"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 25-year-old man comes to the physician.", "2. He and his wife have been unable to conceive a child despite having regular unprotected sexual intercourse.", "3. He is 187 cm (6 ft 1 in) tall.", "4. He weighs 79 kg (174 lb).", "5. Examination shows long extremities.", "6. Examination shows bilateral gynecomastia.", "7. Examination shows small, firm testes.", "8. A peripheral blood smear shows a dense, dark-staining spot at the periphery of the nucleus of a cell."], "atomic_facts": ["1. He is 187 cm (6 ft 1 in) tall.", "2. He weighs 79 kg (174 lb).", "3. Examination shows long extremities.", "4. Examination shows bilateral gynecomastia.", "5. Examination shows small, firm testes.", "6. A peripheral blood smear shows a dense, dark-staining spot at the periphery of the nucleus of a cell."]}
{"id": 669, "question": "Which of the following is a diagnostic criteria for the disorder that is most likely responsible for the patient\u2019s presentation?", "context": ["A 22-year-old woman college student presents with diarrhea and crampy abdominal pain that is relieved by defecation.", "She states that she has had a lot of \u2018stomach issues\u2019 in the past, especially during exam weeks.", "The past medical history is significant for major depressive disorder diagnosed 2 years ago that has been managed with Prozac.", "She does not have a family history of irritable bowel disease, autoimmune disease, or cancer.", "The symptoms do not seem to be worse with any particular food, though she admits to eating a lot of pizza and deli sandwiches with minimal fruits and vegetables.", "She denies recent travel and has not experienced fever, weight loss, nausea, or vomiting.", "She has not noticed blood in her stool.", "The physical exam and laboratory findings are unremarkable."], "context_len": 8, "options": {"A": "Symptoms present at least 6 months", "B": "Symptoms not relieved with defecation", "C": "Symptoms present at least 1 day per week for 3 consecutive months with symptom onset at least 6 months before diagnosis", "D": "No change in stool consistency"}, "answer": "Symptoms present at least 1 day per week for 3 consecutive months with symptom onset at least 6 months before diagnosis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "22 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 22-year-old female college student.", "2. Patient presents with diarrhea and crampy abdominal pain that is relieved by defecation.", "3. Patient states she has had a lot of \u2018stomach issues\u2019 in the past, especially during exam weeks.", "4. Patient has a past medical history of major depressive disorder diagnosed 2 years ago that has been managed with Prozac.", "5. Patient does not have a family history of irritable bowel disease, autoimmune disease, or cancer.", "6. Patient's symptoms do not seem to be worse with any particular food, though she admits to eating a lot of pizza and deli sandwiches with minimal fruits and vegetables.", "7. Patient denies recent travel.", "8. Patient has not experienced fever, weight loss, nausea, or vomiting.", "9. Patient has not noticed blood in her stool.", "10. Physical exam and laboratory findings are unremarkable."], "atomic_facts": ["1. Patient reports having had a lot of 'stomach issues' in the past, especially during exam weeks.", "2. Past medical history includes major depressive disorder diagnosed 2 years ago, managed with Prozac.", "3. No family history of irritable bowel disease, autoimmune disease, or cancer.", "4. Symptoms not worsened by any particular food, but patient admits to eating a lot of pizza and deli sandwiches with minimal fruits and vegetables.", "5. Denies recent travel and has not experienced fever, weight loss, nausea, or vomiting.", "6. No blood noticed in stool.", "7. Physical exam and laboratory findings are unremarkable."]}
{"id": 670, "question": "Which of the following findings are most likely on radiograph?", "context": ["A 69-year-old female presents to the emergency department with crampy abdominal pain.", "She has a past medical history of hypertension, dyslipidemia, and cholelithiasis status post cholecystectomy.", "The patient states she has not passed stool or gas for 48 hrs.", "On physical exam vitals are T 98.4 F HR 105 bpm BP 155/101 mmHg RR 16 SpO2 96%, abdominal exam is notable for distension, tympany to percussion, and tenderness to palpation without rebound or guarding."], "context_len": 4, "options": {"A": "Apple core defect after lower GI series", "B": "Multiple punctate mucosal outpouchings through the serosa on lower GI series", "C": "Ladder-like series of distended bowel loops with air-fluid levels on abdominal radiograph", "D": "Loss of haustral markings and \"lead pipe\" appearance to the descending colon on lower GI series"}, "answer": "Ladder-like series of distended bowel loops with air-fluid levels on abdominal radiograph", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "69 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Radiology"}, "facts_old": ["1. A 69-year-old female presents to the emergency department with crampy abdominal pain.", "2. She has a past medical history of hypertension, dyslipidemia, and cholelithiasis status post cholecystectomy.", "3. The patient states she has not passed stool or gas for 48 hrs.", "4. On physical exam, her temperature is 98.4 F.", "5. Her heart rate is 105 bpm.", "6. Her blood pressure is 155/101 mmHg.", "7. Her respiratory rate is 16.", "8. Her SpO2 is 96%.", "9. Abdominal exam is notable for distension.", "10. Abdominal exam is notable for tympany to percussion.", "11. Abdominal exam is notable for tenderness to palpation without rebound or guarding."], "atomic_facts": ["1. Past medical history of hypertension", "2. Past medical history of dyslipidemia", "3. Past medical history of cholelithiasis", "4. Status post cholecystectomy", "5. Patient has not passed stool for 48 hrs", "6. Patient has not passed gas for 48 hrs", "7. Vitals: T 98.4 F", "8. Vitals: HR 105 bpm", "9. Vitals: BP 155/101 mmHg", "10. Vitals: RR 16", "11. Vitals: SpO2 96%", "12. Abdominal exam notable for distension", "13. Abdominal exam notable for tympany to percussion", "14. Abdominal exam notable for tenderness to palpation without rebound or guarding"]}
{"id": 671, "question": "Which of the following is the most likely diagnosis?", "context": ["A 56-year-old man comes to the physician because of a 2-month history of worsening pain in his left buttock.", "The pain is described as a deep, dull ache that is worse at night.", "He does not report any recent trauma.", "He has hyperlipidemia.", "He has smoked one pack of cigarettes daily for the past 30 years and drinks one beer every night.", "He does not use illicit drugs.", "His only medication is simvastatin.", "Physical examination shows tenderness over the left gluteal region.", "Neurologic examination shows no focal findings.", "An x-ray of the pelvis shows a 4-cm, poorly defined, osteolytic lesion in the left ilium with a moth-eaten pattern of bone destruction, multiple well-defined sclerotic lesions, and an aggressive periosteal reaction.", "The remainder of the physical examination, including rectal examination, shows no abnormalities.", "Chest x-ray and abdominal ultrasonography show no abnormalities."], "context_len": 12, "options": {"A": "Giant cell tumor", "B": "Fibrosarcoma", "C": "Plasmacytoma", "D": "Chondrosarcoma"}, "answer": "Chondrosarcoma", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 56-year-old man comes to the physician.", "2. He has a 2-month history of worsening pain in his left buttock.", "3. The pain is described as a deep, dull ache that is worse at night.", "4. He does not report any recent trauma.", "5. He has hyperlipidemia.", "6. He has smoked one pack of cigarettes daily for the past 30 years.", "7. He drinks one beer every night.", "8. He does not use illicit drugs.", "9. His only medication is simvastatin.", "10. Physical examination shows tenderness over the left gluteal region.", "11. Neurologic examination shows no focal findings.", "12. An x-ray of the pelvis shows a 4-cm, poorly defined, osteolytic lesion in the left ilium with a moth-eaten pattern of bone destruction, multiple well-defined sclerotic lesions, and an aggressive periosteal reaction.", "13. The remainder of the physical examination, including rectal examination, shows no abnormalities.", "14. Chest x-ray shows no abnormalities.", "15. Abdominal ultrasonography shows no abnormalities."], "atomic_facts": ["1. The pain is described as a deep, dull ache that is worse at night.", "2. He does not report any recent trauma.", "3. He has hyperlipidemia.", "4. He has smoked one pack of cigarettes daily for the past 30 years and drinks one beer every night.", "5. He does not use illicit drugs.", "6. His only medication is simvastatin.", "7. Physical examination shows tenderness over the left gluteal region.", "8. Neurologic examination shows no focal findings.", "9. An x-ray of the pelvis shows a 4-cm, poorly defined, osteolytic lesion in the left ilium with a moth-eaten pattern of bone destruction, multiple well-defined sclerotic lesions, and an aggressive periosteal reaction.", "10. The remainder of the physical examination, including rectal examination, shows no abnormalities.", "11. Chest x-ray and abdominal ultrasonography show no abnormalities."]}
{"id": 672, "question": "Microscopic examination of the mass will most likely show which of the following?", "context": ["An otherwise healthy 49-year-old man comes to the physician because of a 1-month history of worsening headaches and increasing irritability.", "Examination shows bilateral papilledema.", "An MRI of the brain shows a mass in the right temporal lobe with heterogeneous peripheral rim enhancement that crosses the midline.", "He undergoes surgical resection of the mass.", "Gross examination shows a poorly-demarcated mass with areas of hemorrhage and necrosis."], "context_len": 5, "options": {"A": "Closely-packed capillaries and foamy stromal cells", "B": "Pleomorphic cells forming pseudopalisades", "C": "Cells with clear cytoplasm and central round nuclei", "D": "Areas of lamellated calcification"}, "answer": "Pleomorphic cells forming pseudopalisades", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "49", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. An otherwise healthy 49-year-old man comes to the physician.", "2. He has a 1-month history of worsening headaches and increasing irritability.", "3. Examination shows bilateral papilledema.", "4. An MRI of the brain shows a mass in the right temporal lobe.", "5. The mass has heterogeneous peripheral rim enhancement that crosses the midline.", "6. He undergoes surgical resection of the mass.", "7. Gross examination shows a poorly-demarcated mass.", "8. The mass has areas of hemorrhage and necrosis."], "atomic_facts": ["1. Examination shows bilateral papilledema.", "2. An MRI of the brain shows a mass in the right temporal lobe.", "3. The mass has heterogeneous peripheral rim enhancement.", "4. The mass crosses the midline.", "5. Surgical resection of the mass is performed.", "6. Gross examination shows a poorly-demarcated mass.", "7. The mass has areas of hemorrhage.", "8. The mass has areas of necrosis."]}
{"id": 673, "question": "What enzyme is most likely deficient in this patient\u2019s case?", "context": ["A male newborn develops hyperammonemia, encephalopathy, and respiratory alkalosis 3 days after a normal delivery.", "He enters into a coma the next day and dies a week later.", "Family history is positive for parental consanguinity.", "Histopathologic examination of the liver shows diffuse microvesicular steatosis, distinct focal hepatocellular fibrosis, and Kupffer cell glycogenosis.", "Citrulline levels are low."], "context_len": 5, "options": {"A": "Carbamoyl phosphate synthetase I", "B": "Homogentisic acid dioxygenase", "C": "Ornithine transcarbamylase", "D": "Propionyl-CoA carboxylase"}, "answer": "Carbamoyl phosphate synthetase I", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "Newborn", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal", "Metabolic Genetics"], "specialty_prob": [1.0], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A male newborn develops hyperammonemia, encephalopathy, and respiratory alkalosis 3 days after a normal delivery.", "2. He enters into a coma the next day.", "3. He dies a week later.", "4. Family history is positive for parental consanguinity.", "5. Histopathologic examination of the liver shows diffuse microvesicular steatosis.", "6. Histopathologic examination of the liver shows distinct focal hepatocellular fibrosis.", "7. Histopathologic examination of the liver shows Kupffer cell glycogenosis.", "8. Citrulline levels are low."], "atomic_facts": ["1. He enters into a coma the next day.", "2. He dies a week later.", "3. Family history is positive for parental consanguinity.", "4. Histopathologic examination of the liver shows diffuse microvesicular steatosis.", "5. Histopathologic examination of the liver shows distinct focal hepatocellular fibrosis.", "6. Histopathologic examination of the liver shows Kupffer cell glycogenosis.", "7. Citrulline levels are low."]}
{"id": 674, "question": "Which of the following signs is most likely to be present in her chest radiogram?", "context": ["A 48-year-old woman is brought to the emergency department immediately following a motor vehicle accident in an unconscious state.", "She is managed as per emergency treatment protocols with the airway, breathing, and circulation being appropriately managed by mechanical ventilation, intravenous fluids, and other supportive drugs.", "A complete diagnostic evaluation suggests a diagnosis of traumatic brain injury and rules out the presence of fractures and other visceral injuries.", "About 36 hours after the accident, pulse oximetry shows deteriorating oxygen saturation.", "Chest auscultation reveals widespread rales over bilateral lung fields.", "Her arterial blood gas analysis shows a PaO2 of 100 mm Hg at FiO2 of 60%.", "Her bedside echocardiogram is normal and suggests a pulmonary capillary wedge pressure of 11 mm Hg."], "context_len": 7, "options": {"A": "Deep sulcus sign with radiolucency along the costophrenic sulcus", "B": "Lung collapse at the hilum on one side and shift of the mediastinum to the opposite side", "C": "Bilateral asymmetric pulmonary infiltrates with peripheral distribution", "D": "Abrupt tapering of a pulmonary artery"}, "answer": "Bilateral asymmetric pulmonary infiltrates with peripheral distribution", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "48 years old", "specialties": ["Radiology"], "subspecialties": ["General Radiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 48-year-old woman is brought to the emergency department immediately following a motor vehicle accident in an unconscious state.", "2. She is managed as per emergency treatment protocols with the airway, breathing, and circulation being appropriately managed by mechanical ventilation, intravenous fluids, and other supportive drugs.", "3. A complete diagnostic evaluation suggests a diagnosis of traumatic brain injury and rules out the presence of fractures and other visceral injuries.", "4. About 36 hours after the accident, pulse oximetry shows deteriorating oxygen saturation.", "5. Chest auscultation reveals widespread rales over bilateral lung fields.", "6. Her arterial blood gas analysis shows a PaO2 of 100 mm Hg at FiO2 of 60%.", "7. Her bedside echocardiogram is normal and suggests a pulmonary capillary wedge pressure of 11 mm Hg."], "atomic_facts": ["1. She is managed as per emergency treatment protocols with the airway, breathing, and circulation being appropriately managed by mechanical ventilation, intravenous fluids, and other supportive drugs.", "2. A complete diagnostic evaluation suggests a diagnosis of traumatic brain injury and rules out the presence of fractures and other visceral injuries.", "3. About 36 hours after the accident, pulse oximetry shows deteriorating oxygen saturation.", "4. Chest auscultation reveals widespread rales over bilateral lung fields.", "5. Her arterial blood gas analysis shows a PaO2 of 100 mm Hg at FiO2 of 60%.", "6. Her bedside echocardiogram is normal and suggests a pulmonary capillary wedge pressure of 11 mm Hg."]}
{"id": 675, "question": "What is true about the medication prescribed to this patient?", "context": ["A 58-year-old man with a history of heart failure is admitted to the hospital for a cardiac transplantation.", "Five years ago, the patient had a mitral valve replacement with a porcine valve, but since then his heart failure symptoms have not improved.", "He developed persistent New York Heart Association class IV symptoms and was placed on the transplant waiting list.", "The heart to be transplanted originated from a deceased donor and the family has given consent for the transplantation.", "The patient is subsequently started on cyclosporine, and the postoperative period is unremarkable.", "He is readmitted to the emergency department 10 months later due to chest pain and severe shortness of breath."], "context_len": 6, "options": {"A": "Inhibits IMP dehydrogenase", "B": "Binds FK506 binding protein", "C": "Inhibits calcineurin", "D": "Is a precursor of 6-mercaptopurine"}, "answer": "Inhibits calcineurin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "58", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Advanced Heart Failure and Transplant Cardiology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 58-year-old man with a history of heart failure is admitted to the hospital for a cardiac transplantation.", "2. Five years ago, the patient had a mitral valve replacement with a porcine valve.", "3. Since then his heart failure symptoms have not improved.", "4. He developed persistent New York Heart Association class IV symptoms.", "5. He was placed on the transplant waiting list.", "6. The heart to be transplanted originated from a deceased donor.", "7. The family has given consent for the transplantation.", "8. The patient is subsequently started on cyclosporine.", "9. The postoperative period is unremarkable.", "10. He is readmitted to the emergency department 10 months later due to chest pain and severe shortness of breath."], "atomic_facts": ["1. Five years ago, the patient had a mitral valve replacement with a porcine valve.", "2. Since the valve replacement, the patient's heart failure symptoms have not improved.", "3. The patient developed persistent New York Heart Association class IV symptoms.", "4. The patient was placed on the transplant waiting list.", "5. The heart to be transplanted originated from a deceased donor.", "6. The family has given consent for the transplantation.", "7. The patient is subsequently started on cyclosporine.", "8. The postoperative period is unremarkable.", "9. The patient is readmitted to the emergency department 10 months later.", "10. The reason for readmission is chest pain and severe shortness of breath."]}
{"id": 676, "question": "Which of the following explains the measured decline in the calculated effective renal plasma flow?", "context": ["An investigator studying renal physiology uses para-aminohippuric acid (PAH) to estimate the renal plasma flow in a human volunteer.", "An intravenous infusion of 400 mg of PAH solution is administered to the subject; effective renal plasma flow is calculated to be 600 ml/min.", "Next, an intravenous infusion of 1000 mg of PAH solution is administered to the subject; effective renal plasma flow is calculated to be 400 mL/min."], "context_len": 3, "options": {"A": "Decreased serum protein binding", "B": "Efferent arteriole dilation", "C": "Afferent arteriole dilation", "D": "Decreased PAH clearance"}, "answer": "Decreased PAH clearance", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Nephrology"], "subspecialties": ["General Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An investigator is studying renal physiology.", "2. Para-aminohippuric acid (PAH) is used to estimate the renal plasma flow in a human volunteer.", "3. An intravenous infusion of 400 mg of PAH solution is administered to the subject.", "4. Effective renal plasma flow is calculated to be 600 ml/min.", "5. An intravenous infusion of 1000 mg of PAH solution is administered to the subject.", "6. Effective renal plasma flow is calculated to be 400 mL/min."], "atomic_facts": ["1. An intravenous infusion of 400 mg of PAH solution is administered to the subject.", "2. Effective renal plasma flow is calculated to be 600 ml/min.", "3. An intravenous infusion of 1000 mg of PAH solution is administered to the subject.", "4. Effective renal plasma flow is calculated to be 400 mL/min."]}
{"id": 677, "question": "Which of the following findings would most likely also be seen in this patient?", "context": ["A 55-year-old man presents to his primary care physician with a 2-month history of fatigue.", "He says that he has been feeling tired, even after mild exertion, and decided to be evaluated because it has begun interfering with his job as a construction worker.", "He reports that he has been feeling numbness and tingling in his feet and has been tripping more frequently.", "His past medical history is significant for hypertension and type 2 diabetes well-controlled on metformin.", "His surgical history is significant for weight-loss surgery 2 years ago.", "Physical exam reveals bilateral vibration sensory deficits as well as conjunctival pallor.", "Selected lab results are presented as follows: |  | Hemoglobin: 9.1 g/dL | Hematocrit: 27% | Platelet count: 265,000/mm^3 | Mean corpuscular volume: 112 \u00b5m^3 | Reticulocyte count: 0.19% |  | ."], "context_len": 7, "options": {"A": "Elevated bilirubin levels", "B": "High methylmalonic acid and high homocysteine levels", "C": "High transferrin levels", "D": "Low haptoglobin levels"}, "answer": "High methylmalonic acid and high homocysteine levels", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 55-year-old man presents to his primary care physician with a 2-month history of fatigue.", "2. He says that he has been feeling tired, even after mild exertion, and decided to be evaluated because it has begun interfering with his job as a construction worker.", "3. He reports that he has been feeling numbness and tingling in his feet and has been tripping more frequently.", "4. His past medical history is significant for hypertension and type 2 diabetes well-controlled on metformin.", "5. His surgical history is significant for weight-loss surgery 2 years ago.", "6. Physical exam reveals bilateral vibration sensory deficits as well as conjunctival pallor.", "7. Selected lab results are presented as follows: Hemoglobin: 9.1 g/dL.", "8. Selected lab results are presented as follows: Hematocrit: 27%.", "9. Selected lab results are presented as follows: Platelet count: 265,000/mm^3.", "10. Selected lab results are presented as follows: Mean corpuscular volume: 112 \u00b5m^3.", "11. Selected lab results are presented as follows: Reticulocyte count: 0.19%."], "atomic_facts": ["1. The patient has been feeling tired, even after mild exertion.", "2. The tiredness has begun interfering with his job as a construction worker.", "3. He has been feeling numbness and tingling in his feet.", "4. He has been tripping more frequently.", "5. His past medical history includes hypertension and type 2 diabetes.", "6. His hypertension and type 2 diabetes are well-controlled on metformin.", "7. He had weight-loss surgery 2 years ago.", "8. Physical exam reveals bilateral vibration sensory deficits.", "9. Physical exam reveals conjunctival pallor.", "10. Hemoglobin level is 9.1 g/dL.", "11. Hematocrit level is 27%.", "12. Platelet count is 265,000/mm^3.", "13. Mean corpuscular volume is 112 \u00b5m^3.", "14. Reticulocyte count is 0.19%."]}
{"id": 678, "question": "Which of the following is the most appropriate initial pharmacotherapy?", "context": ["A 27-year-old woman is brought to the emergency department by her coworker after having a generalized seizure at work.", "Her coworker reports that she is at 30 weeks' gestation and has mentioned headache and right upper quadrant pain earlier that day.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 91/min, and blood pressure is 170/102 mm Hg.", "Pulmonary examination shows bilateral rales.", "There is diffuse edema in the lower extremities.", "Deep tendon reflexes are increased bilaterally.", "She is not oriented to person, place, and time."], "context_len": 7, "options": {"A": "Calcium gluconate", "B": "Aspirin", "C": "Phenytoin", "D": "Magnesium sulfate"}, "answer": "Magnesium sulfate", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology", "Epilepsy"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 27-year-old woman is brought to the emergency department.", "2. Her coworker reports she is at 30 weeks' gestation.", "3. She mentioned headache and right upper quadrant pain earlier that day.", "4. Her temperature is 37\u00b0C (98.6\u00b0F).", "5. Her pulse is 91/min.", "6. Her blood pressure is 170/102 mm Hg.", "7. Pulmonary examination shows bilateral rales.", "8. There is diffuse edema in the lower extremities.", "9. Deep tendon reflexes are increased bilaterally.", "10. She is not oriented to person, place, and time."], "atomic_facts": ["1. The patient is at 30 weeks' gestation.", "2. She has mentioned headache and right upper quadrant pain earlier that day.", "3. Her temperature is 37\u00b0C (98.6\u00b0F).", "4. Her pulse is 91/min.", "5. Her blood pressure is 170/102 mm Hg.", "6. Pulmonary examination shows bilateral rales.", "7. There is diffuse edema in the lower extremities.", "8. Deep tendon reflexes are increased bilaterally.", "9. She is not oriented to person, place, and time."]}
{"id": 679, "question": "Which of the following disorders is most consistent with this patient's presentation?", "context": ["A 23-year-old woman presents to the emergency department because of nausea.", "She has been experiencing severe intermittent nausea and diarrhea for the last year and refuses to leave the emergency department until she is told what is causing her symptoms.", "She hates hospitals but has reluctantly undergone numerous workups and imaging studies in order to discern what is wrong.", "All of the studies have been normal.", "She says that these symptoms have been causing her severe distress and is impairing her ability to perform her job.", "She says that she feels as if the nausea is worse when she is trying to work but says that she will continue to work as an insurance agent despite the physical discomfort.", "She has started restricting her diet to only graham crackers because she thinks that helps her symptoms.", "She has also started avoiding eating lunch because of the nausea."], "context_len": 8, "options": {"A": "Conversion disorder", "B": "Factitious disorder", "C": "Malingering", "D": "Somatic symptom disorder"}, "answer": "Somatic symptom disorder", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "23 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 23-year-old woman.", "2. Patient presents to the emergency department due to nausea.", "3. Patient has been experiencing severe intermittent nausea and diarrhea for the last year.", "4. Patient refuses to leave the emergency department until she is told what is causing her symptoms.", "5. Patient hates hospitals.", "6. Patient has reluctantly undergone numerous workups and imaging studies in order to discern what is wrong.", "7. All of the studies have been normal.", "8. Symptoms have been causing her severe distress.", "9. Symptoms are impairing her ability to perform her job.", "10. Patient feels as if the nausea is worse when she is trying to work.", "11. Patient will continue to work as an insurance agent despite the physical discomfort.", "12. Patient has started restricting her diet to only graham crackers.", "13. Patient has also started avoiding eating lunch because of the nausea."], "atomic_facts": ["1. She has been experiencing severe intermittent nausea for the last year.", "2. She has been experiencing severe intermittent diarrhea for the last year.", "3. She refuses to leave the emergency department until she is told what is causing her symptoms.", "4. She hates hospitals.", "5. She has reluctantly undergone numerous workups and imaging studies.", "6. All of the studies have been normal.", "7. These symptoms have been causing her severe distress.", "8. The symptoms are impairing her ability to perform her job.", "9. She feels as if the nausea is worse when she is trying to work.", "10. She will continue to work as an insurance agent despite the physical discomfort.", "11. She has started restricting her diet to only graham crackers.", "12. She thinks that restricting her diet helps her symptoms.", "13. She has started avoiding eating lunch because of the nausea."]}
{"id": 680, "question": "Which of the laboratory findings will be found in this patient?", "context": ["A 37-year-old homeless man is brought in by ambulance to the emergency department after being found unresponsive.", "He was found in an area of IV drug use with drug paraphernalia including glassine envelopes with a white powder residue.", "There is no past medical history available.", "He is treated with intranasal naloxone and stabilized in the field.", "Upon arrival to the hospital, his blood pressure is 100/70 mm Hg, pulse rate is 90/min, respiratory rate is 18/min, and temperature is 38.9\u00b0C (102.0\u00b0F).", "On physical examination, the patient is jaundiced with white scrapable exudates on the oral mucosa.", "His arms are covered with stigmata of IV drug use.", "Heart auscultation reveals a holosystolic murmur that is loudest at the left sternal border.", "The lungs are clear to auscultation bilaterally.", "Laboratory work is performed which shows: | Hemoglobin 10.9 g/dL | Hematocrit 37.7% | Leukocyte count 1,500/mm3 | Neutrophils 65% | Lymphocytes 30% | Monocytes 5% | Mean corpuscular volume 82.2 \u03bcm3 | Platelet count 190,000/mm3 | Erythrocyte sedimentation rate 35 mm/h | Aspartate aminotransferase 2,400 U/L | Alanine aminotransferase 3,200 U/L | CD4 count 27 cells/mm3 | HIV-1 antibody positive | Hepatitis C virus antibody positive | Quantiferon-gold test negative | ."], "context_len": 10, "options": {"A": "Atypical lymphocytes on blood smear", "B": "Positive blood culture", "C": "Elevated levels of cardiac troponin I and T", "D": "Positive sputum culture"}, "answer": "Positive blood culture", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "37 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 37-year-old homeless man is brought in by ambulance to the emergency department after being found unresponsive. ", "2. He was found in an area of IV drug use with drug paraphernalia including glassine envelopes with a white powder residue. ", "3. There is no past medical history available. ", "4. He is treated with intranasal naloxone and stabilized in the field. ", "5. Upon arrival to the hospital, his blood pressure is 100/70 mm Hg. ", "6. Pulse rate is 90/min. ", "7. Respiratory rate is 18/min. ", "8. Temperature is 38.9\u00b0C (102.0\u00b0F). ", "9. On physical examination, the patient is jaundiced with white scrapable exudates on the oral mucosa. ", "10. His arms are covered with stigmata of IV drug use. ", "11. Heart auscultation reveals a holosystolic murmur that is loudest at the left sternal border. ", "12. The lungs are clear to auscultation bilaterally. ", "13. Laboratory work shows hemoglobin 10.9 g/dL. ", "14. Hematocrit 37.7%. ", "15. Leukocyte count 1,500/mm3. ", "16. Neutrophils 65%. ", "17. Lymphocytes 30%. ", "18. Monocytes 5%. ", "19. Mean corpuscular volume 82.2 \u03bcm3. ", "20. Platelet count 190,000/mm3. ", "21. Erythrocyte sedimentation rate 35 mm/h. ", "22. Aspartate aminotransferase 2,400 U/L. ", "23. Alanine aminotransferase 3,200 U/L. ", "24. CD4 count 27 cells/mm3. ", "25. HIV-1 antibody positive. ", "26. Hepatitis C virus antibody positive. ", "27. Quantiferon-gold test negative."], "atomic_facts": ["1. The patient was found in an area of IV drug use with drug paraphernalia.", "2. The drug paraphernalia included glassine envelopes with a white powder residue.", "3. There is no past medical history available for the patient.", "4. The patient was treated with intranasal naloxone and stabilized in the field.", "5. Upon arrival to the hospital, the patient's blood pressure is 100/70 mm Hg.", "6. The patient's pulse rate is 90/min.", "7. The patient's respiratory rate is 18/min.", "8. The patient's temperature is 38.9\u00b0C (102.0\u00b0F).", "9. On physical examination, the patient is jaundiced with white scrapable exudates on the oral mucosa.", "10. The patient's arms are covered with stigmata of IV drug use.", "11. Heart auscultation reveals a holosystolic murmur that is loudest at the left sternal border.", "12. The lungs are clear to auscultation bilaterally.", "13. Laboratory work shows: Hemoglobin 10.9 g/dL.", "14. Laboratory work shows: Hematocrit 37.7%.", "15. Laboratory work shows: Leukocyte count 1,500/mm3.", "16. Laboratory work shows: Neutrophils 65%.", "17. Laboratory work shows: Lymphocytes 30%.", "18. Laboratory work shows: Monocytes 5%.", "19. Laboratory work shows: Mean corpuscular volume 82.2 \u03bcm3.", "20. Laboratory work shows: Platelet count 190,000/mm3.", "21. Laboratory work shows: Erythrocyte sedimentation rate 35 mm/h.", "22. Laboratory work shows: Aspartate aminotransferase 2,400 U/L.", "23. Laboratory work shows: Alanine aminotransferase 3,200 U/L.", "24. Laboratory work shows: CD4 count 27 cells/mm3.", "25. Laboratory work shows: HIV-1 antibody positive.", "26. Laboratory work shows: Hepatitis C virus antibody positive.", "27. Laboratory work shows: Quantiferon-gold test negative."]}
{"id": 681, "question": "Which of the following is the most appropriate step in management?", "context": ["A 35-year-old woman, gravida 6, para 5, at 35 weeks' gestation comes to the emergency department because of vaginal bleeding for 2 hours.", "This is her second episode in the past 2 days.", "She has had no prenatal care.", "Her children were delivered vaginally.", "Her pulse is 122/min, respirations are 20/min, and blood pressure is 88/59 mm Hg.", "The abdomen is nontender, and no contractions are felt.", "There is active bright red vaginal bleeding.", "The fetal heart rate is 110/min.", "Two large-bore peripheral intravenous cannulas are inserted and intravenous fluids are administered.", "Three units of blood are typed and cross-matched."], "context_len": 10, "options": {"A": "Perform cesarean delivery", "B": "Hospitalization and observation", "C": "Administer magnesium sulfate", "D": "Perform cervical cerclage"}, "answer": "Perform cesarean delivery", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "35 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Maternal", "General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 35-year-old woman comes to the emergency department.", "2. She is gravida 6, para 5, at 35 weeks' gestation.", "3. She has had vaginal bleeding for 2 hours.", "4. This is her second episode in the past 2 days.", "5. She has had no prenatal care.", "6. Her children were delivered vaginally.", "7. Her pulse is 122/min.", "8. Her respirations are 20/min.", "9. Her blood pressure is 88/59 mm Hg.", "10. The abdomen is nontender.", "11. No contractions are felt.", "12. There is active bright red vaginal bleeding.", "13. The fetal heart rate is 110/min.", "14. Two large-bore peripheral intravenous cannulas are inserted.", "15. Intravenous fluids are administered.", "16. Three units of blood are typed and cross-matched."], "atomic_facts": ["1. This is her second episode in the past 2 days.", "2. She has had no prenatal care.", "3. Her children were delivered vaginally.", "4. Her pulse is 122/min.", "5. Her respirations are 20/min.", "6. Her blood pressure is 88/59 mm Hg.", "7. The abdomen is nontender.", "8. No contractions are felt.", "9. There is active bright red vaginal bleeding.", "10. The fetal heart rate is 110/min.", "11. Two large-bore peripheral intravenous cannulas are inserted and intravenous fluids are administered.", "12. Three units of blood are typed and cross-matched."]}
{"id": 682, "question": "Which of the following supplements is most important to prevent a potentially life-threatening condition in this newborn?", "context": ["A 2710-g (6-lb) male newborn is delivered at 38 weeks of gestation to a 26-year-old woman, gravida 2, para 2.", "The pregnancy, labor, and delivery were uncomplicated.", "Breastfeeding is initiated."], "context_len": 3, "options": {"A": "Vitamin B1", "B": "Vitamin K", "C": "Folic acid", "D": "Iron"}, "answer": "Vitamin K", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "Newborn", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2710-g (6-lb) male newborn is delivered.", "2. The newborn is delivered at 38 weeks of gestation.", "3. The mother is 26 years old.", "4. The mother is gravida 2, para 2.", "5. The pregnancy, labor, and delivery were uncomplicated.", "6. Breastfeeding is initiated."], "atomic_facts": ["1. The pregnancy was uncomplicated.", "2. The labor was uncomplicated.", "3. The delivery was uncomplicated.", "4. Breastfeeding is initiated."]}
{"id": 683, "question": "These findings support a diagnosis of which of the following?", "context": ["A 4-month-old adopted infant is brought to the pediatrician because of feeding problems and recurrent fungal and bacterial infections.", "Her family has almost no background information about the infant.", "They report that she is a little fragile and looks different compared to other infants her age.", "Physical evaluation reveals a cleft lip with intact hard and soft palate and mild jaw malformation.", "An echocardiogram reveals an interrupted aortic arch.", "Further investigation reveals leukopenia and mild hypocalcemia."], "context_len": 6, "options": {"A": "Chediak-Higashi syndrome", "B": "DiGeorge syndrome", "C": "Severe combined immunodeficiency (SCID)", "D": "Wiskott-Aidrich syndrome"}, "answer": "DiGeorge syndrome", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "4 months", "specialties": ["Pediatrics"], "subspecialties": ["Immunodeficiency", "Immunology and Allergy", "Pediatric Immunology and Allergy"], "specialty_prob": [1.0], "subspecialty_prob": [0.3333333333333333, 0.3333333333333333, 0.3333333333333333], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 4-month-old adopted infant is brought to the pediatrician.", "2. The infant has feeding problems and recurrent fungal and bacterial infections.", "3. The family has almost no background information about the infant.", "4. The family reports that the infant is a little fragile and looks different compared to other infants her age.", "5. Physical evaluation reveals a cleft lip with intact hard and soft palate and mild jaw malformation.", "6. An echocardiogram reveals an interrupted aortic arch.", "7. Further investigation reveals leukopenia.", "8. Further investigation reveals mild hypocalcemia."], "atomic_facts": ["1. Her family has almost no background information about the infant.", "2. They report that she is a little fragile and looks different compared to other infants her age.", "3. Physical evaluation reveals a cleft lip with intact hard and soft palate and mild jaw malformation.", "4. An echocardiogram reveals an interrupted aortic arch.", "5. Further investigation reveals leukopenia and mild hypocalcemia."]}
{"id": 684, "question": "This presentation is consistent with which defect?", "context": ["A 48-year-old homeless man presents to clinic complaining of fatigue and fevers that \"began recently.\" Cardiac exam reveals a holosystolic murmur, heard best over the left lower sternal border.", "The murmur increases on inspiration.", "He also has track marks on his arms bilaterally."], "context_len": 3, "options": {"A": "Ventricular septal defect", "B": "Tricuspid regurgitation", "C": "Mitral regurgitation", "D": "Pulmonary stenosis"}, "answer": "Tricuspid regurgitation", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "48 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease", "Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 48-year-old homeless man presents to clinic.", "2. He is complaining of fatigue and fevers.", "3. The fatigue and fevers began recently.", "4. Cardiac exam reveals a holosystolic murmur.", "5. The murmur is heard best over the left lower sternal border.", "6. The murmur increases on inspiration.", "7. He has track marks on his arms bilaterally."], "atomic_facts": ["1. The murmur increases on inspiration.", "2. He has track marks on his arms bilaterally."]}
{"id": 685, "question": "Which of the following management steps is most likely to decrease the risk for development of acute renal failure in this patient?", "context": ["A 65-year-old diabetic man presents to the emergency department with severe retrosternal chest pain, vomiting, and diaphoresis for the last half hour.", "He has a history of diabetic chronic kidney disease.", "He is on insulin therapy.", "Oral medications include aspirin, losartan, and metformin.", "The vital signs include: temperature 36.8\u00b0C (98.2\u00b0F), pulse 88/min, respiration rate 14/min, and blood pressure 120/65 mm Hg.", "The weight is 78 kg (172.0 lb).", "The lungs are clear to auscultation.", "Cardiac examination shows no abnormalities.", "The electrocardiogram (ECG) shows ST-segment elevation in the precordial leads V-1\u2013V-4.", "Left ventricular ejection fraction is estimated at 55%.", "The laboratory test results are as follows: | Laboratory test | Hemoglobin 15 g/dL | Leukocyte count 9,500/mm3 | Serum | Glucose 215 mg/dL | Na+ 140 mEq/L | Cl\u2212 102 mEq/L | K+ 4.1 mEq/L | Urea nitrogen 22 mg/dL | Creatinine 1.4 mg/dL | Cardiac troponin I 0.8 ng/mL | The patient is being considered for primary percutaneous coronary intervention."], "context_len": 11, "options": {"A": "Intravenous normal saline", "B": "Reduced intravenous contrast dose", "C": "Preemptive hemodialysis", "D": "Withholding losartan"}, "answer": "Intravenous normal saline", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 65-year-old man presents to the emergency department with severe retrosternal chest pain, vomiting, and diaphoresis for the last half hour.", "2. He has a history of diabetic chronic kidney disease.", "3. He is on insulin therapy.", "4. Oral medications include aspirin, losartan, and metformin.", "5. The vital signs include: temperature 36.8\u00b0C (98.2\u00b0F), pulse 88/min, respiration rate 14/min, and blood pressure 120/65 mm Hg.", "6. The weight is 78 kg (172.0 lb).", "7. The lungs are clear to auscultation.", "8. Cardiac examination shows no abnormalities.", "9. The electrocardiogram (ECG) shows ST-segment elevation in the precordial leads V-1\u2013V-4.", "10. Left ventricular ejection fraction is estimated at 55%.", "11. Laboratory test results include hemoglobin 15 g/dL, leukocyte count 9,500/mm3, serum glucose 215 mg/dL, Na+ 140 mEq/L, Cl\u2212 102 mEq/L, K+ 4.1 mEq/L, urea nitrogen 22 mg/dL, creatinine 1.4 mg/dL, and cardiac troponin I 0.8 ng/mL.", "12. The patient is being considered for primary percutaneous coronary intervention."], "atomic_facts": ["1. The patient has a history of diabetic chronic kidney disease.", "2. The patient is on insulin therapy.", "3. The patient's oral medications include aspirin, losartan, and metformin.", "4. The patient's vital signs are: temperature 36.8\u00b0C (98.2\u00b0F), pulse 88/min, respiration rate 14/min, and blood pressure 120/65 mm Hg.", "5. The patient's weight is 78 kg (172.0 lb).", "6. The patient's lungs are clear to auscultation.", "7. Cardiac examination shows no abnormalities.", "8. The electrocardiogram (ECG) shows ST-segment elevation in the precordial leads V-1\u2013V-4.", "9. Left ventricular ejection fraction is estimated at 55%.", "10. Laboratory test results: Hemoglobin 15 g/dL, Leukocyte count 9,500/mm3, Serum Glucose 215 mg/dL, Na+ 140 mEq/L, Cl\u2212 102 mEq/L, K+ 4.1 mEq/L, Urea nitrogen 22 mg/dL, Creatinine 1.4 mg/dL, Cardiac troponin I 0.8 ng/mL.", "11. The patient is being considered for primary percutaneous coronary intervention."]}
{"id": 686, "question": "Which of the following is the most likely diagnosis?", "context": ["A 7-year-old boy is brought in to your clinic by his mother, who is complaining of her son\u2019s \u201cdry scalp and hair loss.\u201d She reports a scaling spot on his scalp developed around 2 months ago, soon after moving to a new school, which then became a larger bald spot.", "She denies that anyone in the household is exhibiting similar symptoms, but does recall a note that came home from school warning of a lice outbreak.", "Thus far, she has only tried daily baths with little improvement.", "The patient denies pain or itchiness, but the mother reports she does notice him scratching his scalp.", "The mother also reports that since her son has started at the new school, she has noticed an increase in his tics including excessive blinking and clearing of his throat.", "The patient's medical history is significant for asthma, allergic rhinitis, and attention deficient hyperactivity disorder.", "His current medications include fluticasone, salmeterol, loratadine, and methylphenidate.", "Family history includes obsessive compulsive disorder in his older sister.", "The mother also reports her father had a debilitating skin and joint disorder.", "On examination, you note swollen lymph glands at the back of the patient's ears and neck, and there are residual black dots within a patch of alopecia."], "context_len": 10, "options": {"A": "Nummular dermatitis", "B": "Psoriasis", "C": "Tinea capitis", "D": "Trichotillomania"}, "answer": "Tinea capitis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Dermatology"], "subspecialties": ["Pediatric Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 7-year-old boy.", "2. Mother brought him to the clinic.", "3. Complaint is dry scalp and hair loss.", "4. Scaling spot on scalp developed around 2 months ago.", "5. Spot became a larger bald spot.", "6. No one in household exhibiting similar symptoms.", "7. Note came home from school warning of lice outbreak.", "8. Mother has only tried daily baths with little improvement.", "9. Patient denies pain or itchiness.", "10. Mother reports patient scratches scalp.", "11. Since new school, increase in patient's tics including excessive blinking and clearing of throat.", "12. Patient's medical history is significant for asthma, allergic rhinitis, and attention deficient hyperactivity disorder.", "13. Current medications include fluticasone, salmeterol, loratadine, and methylphenidate.", "14. Family history includes obsessive compulsive disorder in older sister.", "15. Mother's father had a debilitating skin and joint disorder.", "16. On examination, swollen lymph glands at back of patient's ears and neck.", "17. Residual black dots within patch of alopecia."], "atomic_facts": ["1. The patient denies pain or itchiness.", "2. The mother reports she does notice him scratching his scalp.", "3. The patient has only tried daily baths with little improvement.", "4. The patient's medical history is significant for asthma, allergic rhinitis, and attention deficient hyperactivity disorder.", "5. His current medications include fluticasone, salmeterol, loratadine, and methylphenidate.", "6. Family history includes obsessive compulsive disorder in his older sister.", "7. The mother also reports her father had a debilitating skin and joint disorder.", "8. Since her son has started at the new school, the mother has noticed an increase in his tics including excessive blinking and clearing of his throat.", "9. She denies that anyone in the household is exhibiting similar symptoms.", "10. She does recall a note that came home from school warning of a lice outbreak.", "11. On examination, swollen lymph glands at the back of the patient's ears and neck are noted.", "12. There are residual black dots within a patch of alopecia."]}
{"id": 687, "question": "In addition to discontinuation of his current medication, administration of which of the following drugs is most appropriate in this patient?", "context": ["A 68-year-old man is brought to the emergency department because of a 1-day history of fever and cloudy urine.", "He lives in a group home and has a chronic indwelling urinary catheter for benign prostatic hyperplasia.", "He has depression, for which he takes vilazodone.", "His temperature is 38.3\u00b0C (100.9\u00b0F), pulse is 89/min, and blood pressure is 110/74 mm Hg.", "Urine cultures grow Enterococcus faecium resistant to vancomycin, and therapy with intravenous linezolid is initiated.", "Eight hours later, he becomes agitated and starts to sweat profusely.", "His temperature is 39.6\u00b0C (103.3\u00b0F), pulse is 120/min, and blood pressure is 184/105 mm Hg.", "Neurologic examination shows increased deep tendon reflexes and clonus of the arms and legs."], "context_len": 8, "options": {"A": "Flumazenil", "B": "Dantrolene", "C": "Octreotide", "D": "Cyproheptadine"}, "answer": "Cyproheptadine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "68 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 68-year-old man is brought to the emergency department.", "2. He has a 1-day history of fever and cloudy urine.", "3. He lives in a group home.", "4. He has a chronic indwelling urinary catheter for benign prostatic hyperplasia.", "5. He has depression and takes vilazodone.", "6. His temperature is 38.3\u00b0C (100.9\u00b0F).", "7. His pulse is 89/min.", "8. His blood pressure is 110/74 mm Hg.", "9. Urine cultures grow Enterococcus faecium resistant to vancomycin.", "10. Therapy with intravenous linezolid is initiated.", "11. Eight hours later, he becomes agitated and starts to sweat profusely.", "12. His temperature is 39.6\u00b0C (103.3\u00b0F).", "13. His pulse is 120/min.", "14. His blood pressure is 184/105 mm Hg.", "15. Neurologic examination shows increased deep tendon reflexes.", "16. Neurologic examination shows clonus of the arms and legs."], "atomic_facts": ["1. He lives in a group home.", "2. He has a chronic indwelling urinary catheter for benign prostatic hyperplasia.", "3. He has depression and takes vilazodone.", "4. His temperature is 38.3\u00b0C (100.9\u00b0F).", "5. His pulse is 89/min.", "6. His blood pressure is 110/74 mm Hg.", "7. Urine cultures grow Enterococcus faecium resistant to vancomycin.", "8. Therapy with intravenous linezolid is initiated.", "9. Eight hours later, he becomes agitated and starts to sweat profusely.", "10. His temperature is 39.6\u00b0C (103.3\u00b0F).", "11. His pulse is 120/min.", "12. His blood pressure is 184/105 mm Hg.", "13. Neurologic examination shows increased deep tendon reflexes and clonus of the arms and legs."]}
{"id": 688, "question": "Aside from size of the 2 molecules, which of the following features of the glomerular basement membrane accounts for this additional finding?", "context": ["A 54-year-old man is newly diagnosed with diabetes.", "As part of his clinical care, he undergoes testing to determine his kidney function.", "His glomerular filtration rate is found to be 80 mL/min.", "He is curious about how glomerular filtration occurs and which molecules are filtered the fastest and slowest.", "He is told that albumin is filtered less readily than sodium."], "context_len": 5, "options": {"A": "Thickness", "B": "Positive charge", "C": "Negative charge", "D": "Presence of podocytes"}, "answer": "Negative charge", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "54", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 54-year-old man is newly diagnosed with diabetes.", "2. As part of his clinical care, he undergoes testing to determine his kidney function.", "3. His glomerular filtration rate is found to be 80 mL/min.", "4. He is curious about how glomerular filtration occurs.", "5. He is curious about which molecules are filtered the fastest and slowest.", "6. He is told that albumin is filtered less readily than sodium."], "atomic_facts": ["1. The patient undergoes testing to determine his kidney function.", "2. His glomerular filtration rate is found to be 80 mL/min.", "3. He is curious about how glomerular filtration occurs.", "4. He is curious about which molecules are filtered the fastest and slowest.", "5. He is told that albumin is filtered less readily than sodium."]}
{"id": 689, "question": "Which of the following additional findings is most likely in this patient?", "context": ["A 2-year-old boy with recurrent ear infections is brought to the pediatrician for a follow-up examination.", "He can walk with support and his vocabulary consists of approximately 50 words.", "His maternal uncle died in childhood from an unknown disease.", "Physical examination shows coarse facial features with an enlarged tongue.", "The abdomen is distended and both the liver and spleen tip are palpable.", "Laboratory studies show elevated total urinary glycosaminoglycan levels and an absence of plasma iduronate-2-sulfatase."], "context_len": 6, "options": {"A": "Optic atrophy", "B": "Cherry-red macula", "C": "Corneal clouding", "D": "Aggressive behavior"}, "answer": "Aggressive behavior", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Ophthalmology", "Pediatric Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 2-year-old boy is brought to the pediatrician for a follow-up examination.", "2. He has recurrent ear infections.", "3. He can walk with support.", "4. His vocabulary consists of approximately 50 words.", "5. His maternal uncle died in childhood from an unknown disease.", "6. Physical examination shows coarse facial features with an enlarged tongue.", "7. The abdomen is distended.", "8. Both the liver and spleen tip are palpable.", "9. Laboratory studies show elevated total urinary glycosaminoglycan levels.", "10. Laboratory studies show an absence of plasma iduronate-2-sulfatase."], "atomic_facts": ["1. He can walk with support.", "2. His vocabulary consists of approximately 50 words.", "3. His maternal uncle died in childhood from an unknown disease.", "4. Physical examination shows coarse facial features with an enlarged tongue.", "5. The abdomen is distended.", "6. Both the liver and spleen tip are palpable.", "7. Laboratory studies show elevated total urinary glycosaminoglycan levels.", "8. Laboratory studies show an absence of plasma iduronate-2-sulfatase."]}
{"id": 690, "question": "Which of the following medical conditions is the physician referring to?", "context": ["A 29-year-old woman presents to a physician at 16 weeks gestation with fevers and a cough for 2 days.", "The cough is productive and occurs more often in the morning.", "Her medical history is not significant.", "Physical and laboratory evaluations suggest a diagnosis of community-acquired pneumonia.", "The physician explains to her that she needs to be treated with antibiotic therapy.", "She asks the physician if she can take levofloxacin because she tolerates levofloxacin.", "The physician explains that levofloxacin should be avoided during pregnancy because fetal exposure may increase the risk of a specific medical condition."], "context_len": 7, "options": {"A": "Arthropathy", "B": "Congenital heart defect", "C": "Deafness", "D": "Neural tube defect"}, "answer": "Arthropathy", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "29 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 29-year-old woman presents to a physician at 16 weeks gestation.", "2. She has fevers and a cough for 2 days.", "3. The cough is productive and occurs more often in the morning.", "4. Her medical history is not significant.", "5. Physical and laboratory evaluations suggest a diagnosis of community-acquired pneumonia.", "6. The physician explains to her that she needs to be treated with antibiotic therapy.", "7. She asks the physician if she can take levofloxacin because she tolerates levofloxacin.", "8. The physician explains that levofloxacin should be avoided during pregnancy.", "9. Fetal exposure to levofloxacin may increase the risk of a specific medical condition."], "atomic_facts": ["1. The cough is productive and occurs more often in the morning.", "2. Her medical history is not significant.", "3. Physical and laboratory evaluations suggest a diagnosis of community-acquired pneumonia.", "4. The physician explains to her that she needs to be treated with antibiotic therapy.", "5. She asks the physician if she can take levofloxacin because she tolerates levofloxacin.", "6. The physician explains that levofloxacin should be avoided during pregnancy because fetal exposure may increase the risk of a specific medical condition."]}
{"id": 691, "question": "Based on the study results, which of the following responses by the investigator is most accurate?\"", "context": ["A large, multicenter study is conducted to assess the prevalence and mortality rate of pneumonia requiring hospitalization caused by various pathogens in 3 states over the past year.", "The study encompassed 250,000 adults between 45\u201379 years of age.", "The results for five different pathogens are shown: | All cases Fatal cases | Pathogen Number Percentage Number Percentage | S.", "aureus 460 34.8 69 50.3 | Influenza virus 288 21.8 12 8.8 | P.", "aeruginosa 136 10.3 17 12.4 | S.", "pneumoniae 338 25.5 27 19.7 | Klebsiella spp.", "101 7.6 12 8.8 | Total 1323 100 137 100 | A journalist would like to report the yearly case fatality rate of the pneumonia pathogen responsible for most hospitalizations in these states."], "context_len": 7, "options": {"A": "10.4%", "B": "34.8%", "C": "15.0%", "D": "12.5%"}, "answer": "15.0%", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease", "Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A large, multicenter study was conducted to assess the prevalence and mortality rate of pneumonia requiring hospitalization caused by various pathogens in 3 states over the past year.", "2. The study encompassed 250,000 adults between 45\u201379 years of age.", "3. The results for five different pathogens are shown: S. aureus, Influenza virus, P. aeruginosa, S. pneumoniae, and Klebsiella spp.", "4. The total number of cases was 1323.", "5. The total number of fatal cases was 137.", "6. The percentage of cases caused by S. aureus was 34.8%.", "7. The percentage of fatal cases caused by S. aureus was 50.3%.", "8. The percentage of cases caused by Influenza virus was 21.8%.", "9. The percentage of fatal cases caused by Influenza virus was 8.8%.", "10. The percentage of cases caused by P. aeruginosa was 10.3%.", "11. The percentage of fatal cases caused by P. aeruginosa was 12.4%.", "12. The percentage of cases caused by S. pneumoniae was 25.5%.", "13. The percentage of fatal cases caused by S. pneumoniae was 19.7%.", "14. The percentage of cases caused by Klebsiella spp. was 7.6%.", "15. The percentage of fatal cases caused by Klebsiella spp. was 8.8%.", "16. The yearly case fatality rate of the pneumonia pathogen responsible for most hospitalizations in these states is 50.3%."], "atomic_facts": ["1. The study encompassed 250,000 adults between 45\u201379 years of age.", "2. Results for five different pathogens are shown.", "3. S. aureus had 460 cases, accounting for 34.8% of the total.", "4. S. aureus had 69 fatal cases, accounting for 50.3% of the total fatal cases.", "5. Influenza virus had 288 cases, accounting for 21.8% of the total.", "6. Influenza virus had 12 fatal cases, accounting for 8.8% of the total fatal cases.", "7. P. aeruginosa had 136 cases, accounting for 10.3% of the total.", "8. P. aeruginosa had 17 fatal cases, accounting for 12.4% of the total fatal cases.", "9. S. pneumoniae had 338 cases, accounting for 25.5% of the total.", "10. S. pneumoniae had 27 fatal cases, accounting for 19.7% of the total fatal cases.", "11. Klebsiella spp. had 101 cases, accounting for 7.6% of the total.", "12. Klebsiella spp. had 12 fatal cases, accounting for 8.8% of the total fatal cases.", "13. The total number of cases was 1323.", "14. The total number of fatal cases was 137.", "15. A journalist would like to report the yearly case fatality rate of the pneumonia pathogen responsible for most hospitalizations in these states."]}
{"id": 692, "question": "Which of the following is the best next step in management?", "context": ["A 52-year-old woman is admitted to the surgical unit after a laparoscopic hysterectomy for uterine leiomyomas performed 2 days ago.", "The surgery was performed under general anesthesia, blood loss was minimal, and there were no intraoperative complications.", "The patient reports lower abdominal pain and discomfort.", "Medical history is significant for multiple sclerosis that is well-controlled with ocrelizumab.", "Her last multiple sclerosis flare was approximately 7 years ago and presented with paresthesias and weakness of the upper extremities.", "Her temperature is 99\u00b0F (37.2 \u00b0C), blood pressure is 125/85 mmHg, pulse is 99/min, and respirations are 19/min.", "On physical exam, the patient appears restless and uncomfortable.", "The surgical incision sites are mildly erythematous and without discharge.", "There is tenderness with deep suprapubic palpation.", "Neurologic exam is unremarkable.", "Laboratory studies show: |  | Serum: | Na+: 144 mEq/L | Cl-: 100 mEq/L | K+: 4.3 mEq/L | HCO3-: 26 mEq/L | Glucose: 105 mg/dL | Creatinine: 3.1 mg/dL |  | ."], "context_len": 11, "options": {"A": "Bethanechol administration", "B": "Bladder scan", "C": "Intravenous fluids", "D": "Urodynamic studies"}, "answer": "Bladder scan", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "52 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 52-year-old woman is admitted to the surgical unit.", "2. She had a laparoscopic hysterectomy for uterine leiomyomas 2 days ago.", "3. The surgery was performed under general anesthesia.", "4. Blood loss was minimal and there were no intraoperative complications.", "5. The patient reports lower abdominal pain and discomfort.", "6. Her medical history is significant for multiple sclerosis that is well-controlled with ocrelizumab.", "7. Her last multiple sclerosis flare was approximately 7 years ago and presented with paresthesias and weakness of the upper extremities.", "8. Her temperature is 99\u00b0F (37.2 \u00b0C).", "9. Her blood pressure is 125/85 mmHg.", "10. Her pulse is 99/min.", "11. Her respirations are 19/min.", "12. On physical exam, the patient appears restless and uncomfortable.", "13. The surgical incision sites are mildly erythematous and without discharge.", "14. There is tenderness with deep suprapubic palpation.", "15. Neurologic exam is unremarkable.", "16. Serum Na+ is 144 mEq/L.", "17. Serum Cl- is 100 mEq/L.", "18. Serum K+ is 4.3 mEq/L.", "19. Serum HCO3- is 26 mEq/L.", "20. Serum glucose is 105 mg/dL.", "21. Serum creatinine is 3.1 mg/dL."], "atomic_facts": ["1. The surgery was performed under general anesthesia.", "2. Blood loss was minimal during the surgery.", "3. There were no intraoperative complications during the surgery.", "4. The patient reports lower abdominal pain and discomfort.", "5. Medical history is significant for multiple sclerosis.", "6. The multiple sclerosis is well-controlled with ocrelizumab.", "7. The last multiple sclerosis flare was approximately 7 years ago.", "8. The last multiple sclerosis flare presented with paresthesias and weakness of the upper extremities.", "9. The patient's temperature is 99\u00b0F (37.2 \u00b0C).", "10. The patient's blood pressure is 125/85 mmHg.", "11. The patient's pulse is 99/min.", "12. The patient's respirations are 19/min.", "13. On physical exam, the patient appears restless and uncomfortable.", "14. The surgical incision sites are mildly erythematous and without discharge.", "15. There is tenderness with deep suprapubic palpation.", "16. Neurologic exam is unremarkable.", "17. Laboratory studies show: Serum: Na+: 144 mEq/L, Cl-: 100 mEq/L, K+: 4.3 mEq/L, HCO3-: 26 mEq/L, Glucose: 105 mg/dL, Creatinine: 3.1 mg/dL."]}
{"id": 693, "question": "The presence of which of the following in this patient\u2019s serum would most help 'rule in' a diagnosis of rheumatoid arthritis:", "context": ["A 38-year-old female visits your office complaining of several years of joint swelling and stiffness that is worse in the morning and improves throughout the day.", "Physical examination reveals bilateral deformities at her proximal interphalangeal and metacarpophalangeal joints."], "context_len": 2, "options": {"A": "Anti-nuclear antibody", "B": "Anti-citrullinated protein antibody", "C": "Anti-centromere antibody", "D": "Anti-smooth muscle antibody"}, "answer": "Anti-citrullinated protein antibody", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "38", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 38-year-old female visits your office.", "2. She is complaining of several years of joint swelling and stiffness.", "3. The joint swelling and stiffness is worse in the morning.", "4. The joint swelling and stiffness improves throughout the day.", "5. Physical examination reveals bilateral deformities at her proximal interphalangeal joints.", "6. Physical examination reveals bilateral deformities at her metacarpophalangeal joints."], "atomic_facts": ["1. Physical examination reveals bilateral deformities.", "2. The deformities are located at her proximal interphalangeal joints.", "3. The deformities are also located at her metacarpophalangeal joints."]}
{"id": 694, "question": "Which of the following is a complication associated with the best treatment for this patient?", "context": ["A 3-week-old infant presents to the emergency department with thick white discharge from his eyes that has persisted for the past 24 hours.", "The patient's birth was not complicated, and he was born at home vaginally with a mid-wife supervising the birth.", "The patient has a documented allergy to penicillin which caused anaphylaxis after it was given secondary to a maternal syphilis infection.", "His temperature is 97.6\u00b0F (36.4\u00b0C), blood pressure is 75/40 mm Hg, pulse is 130/min, respiratory rate is 24/min, and oxygen saturation is 98% on room air.", "The patient is currently sleeping.", "Physical exam is notable for bilateral purulent drainage from the eyes."], "context_len": 6, "options": {"A": "Damage to the lacrimal ducts", "B": "Non-bilious projectile vomiting", "C": "Possible anaphylaxis and urticaria", "D": "Sedation and increased sleepiness"}, "answer": "Non-bilious projectile vomiting", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "3 weeks old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. Patient is 3-week-old infant.", "2. Patient has thick white discharge from eyes for past 24 hours.", "3. Patient's birth was not complicated.", "4. Patient was born at home vaginally with mid-wife supervising.", "5. Patient has documented allergy to penicillin.", "6. Patient had anaphylaxis after penicillin given secondary to maternal syphilis infection.", "7. Patient's temperature is 97.6\u00b0F (36.4\u00b0C).", "8. Patient's blood pressure is 75/40 mm Hg.", "9. Patient's pulse is 130/min.", "10. Patient's respiratory rate is 24/min.", "11. Patient's oxygen saturation is 98% on room air.", "12. Patient is currently sleeping.", "13. Physical exam is notable for bilateral purulent drainage from eyes."], "atomic_facts": ["1. The patient's birth was not complicated.", "2. He was born at home vaginally.", "3. A mid-wife supervised the birth.", "4. The patient has a documented allergy to penicillin.", "5. The allergy caused anaphylaxis after it was given.", "6. The anaphylaxis was secondary to a maternal syphilis infection.", "7. His temperature is 97.6\u00b0F (36.4\u00b0C).", "8. Blood pressure is 75/40 mm Hg.", "9. Pulse is 130/min.", "10. Respiratory rate is 24/min.", "11. Oxygen saturation is 98% on room air.", "12. The patient is currently sleeping.", "13. Physical exam is notable for bilateral purulent drainage from the eyes."]}
{"id": 695, "question": "Which of the following histopathological findings will most likely be seen on the liver biopsy in this patient?", "context": ["A 10-year-old boy initially presented with a runny nose, fever, and watery eyes.", "His parents gave him aspirin.", "Over the next few days, the boy developed jaundice, became irritable, lethargic, and had seizures.", "The hepatic transaminases were significantly raised.", "The blood ammonia levels were also increased.", "A liver biopsy is performed."], "context_len": 6, "options": {"A": "Hepatic granulomas", "B": "Iron accumulation and proliferation of smooth endoplasmic reticulum", "C": "Hepatocytes proliferation", "D": "Cytoplasmic fatty vacuolization in hepatocytes and swollen mitochondria"}, "answer": "Cytoplasmic fatty vacuolization in hepatocytes and swollen mitochondria", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "10 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases", "General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 10-year-old boy initially presented with a runny nose, fever, and watery eyes.", "2. His parents gave him aspirin.", "3. Over the next few days, the boy developed jaundice.", "4. The boy became irritable and lethargic.", "5. The boy had seizures.", "6. The hepatic transaminases were significantly raised.", "7. The blood ammonia levels were also increased.", "8. A liver biopsy was performed."], "atomic_facts": ["1. His parents gave him aspirin.", "2. Over the next few days, the boy developed jaundice.", "3. The boy became irritable.", "4. The boy became lethargic.", "5. The boy had seizures.", "6. The hepatic transaminases were significantly raised.", "7. The blood ammonia levels were also increased.", "8. A liver biopsy is performed."]}
{"id": 696, "question": "Which of the following antibiotics would be best to administer to this patient?", "context": ["An 18-year-old woman presents with a dry cough for the past 2 weeks.", "She also says that she is tired all the time and feels feverish and chilly at times.", "She is a college student and lives in a dormitory and says that her roommate has a similar cough.", "Past medical history is unremarkable.", "The patient denies any smoking history, alcohol or recreational drug use.", "Her vitals signs include: temperature 36.8\u00b0C (98.2\u00b0F), pulse 72/min, blood pressure 118/63 mm Hg, and respiratory rate 15/min.", "Physical examination is unremarkable.", "A chest radiograph reveals interstitial infiltrates that look worse than her symptoms.", "A nasopharyngeal swab is sent to the lab for a bacterial culture which shows colonies having fried-egg appearance on Eaton\u2019s agar.", "Cold agglutinins are positive."], "context_len": 10, "options": {"A": "Penicillin", "B": "Ceftriaxone", "C": "Erythromycin", "D": "Aztreonam"}, "answer": "Erythromycin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "18", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is an 18-year-old woman.", "2. Patient has had a dry cough for 2 weeks.", "3. Patient is tired all the time and feels feverish and chilly at times.", "4. Patient is a college student and lives in a dormitory.", "5. Patient's roommate has a similar cough.", "6. Patient's past medical history is unremarkable.", "7. Patient denies any smoking history, alcohol or recreational drug use.", "8. Patient's temperature is 36.8\u00b0C (98.2\u00b0F).", "9. Patient's pulse is 72/min.", "10. Patient's blood pressure is 118/63 mm Hg.", "11. Patient's respiratory rate is 15/min.", "12. Patient's physical examination is unremarkable.", "13. Chest radiograph reveals interstitial infiltrates that look worse than her symptoms.", "14. Nasopharyngeal swab is sent to the lab for a bacterial culture.", "15. Bacterial culture shows colonies having fried-egg appearance on Eaton\u2019s agar.", "16. Cold agglutinins are positive."], "atomic_facts": ["1. The patient complains of feeling tired all the time and experiencing feverish and chilly sensations.", "2. The patient is a college student who lives in a dormitory.", "3. The patient's roommate has a similar cough.", "4. The patient's past medical history is unremarkable.", "5. The patient denies any history of smoking, alcohol, or recreational drug use.", "6. The patient's vital signs are: temperature 36.8\u00b0C (98.2\u00b0F), pulse 72/min, blood pressure 118/63 mm Hg, and respiratory rate 15/min.", "7. The patient's physical examination is unremarkable.", "8. A chest radiograph reveals interstitial infiltrates that look worse than the patient's symptoms.", "9. A nasopharyngeal swab is sent to the lab for a bacterial culture, which shows colonies having a fried-egg appearance on Eaton\u2019s agar.", "10. Cold agglutinins are positive."]}
{"id": 697, "question": "Which of the following could have prevented this patient's chief complaints?", "context": ["A 9-year-old boy comes to the physician because of pain with swallowing and a burning sensation in his mouth for the past 10 days.", "Over the past 3 weeks, he has had increasing fatigue and runs out of breath easily.", "His father had gallstones, for which he underwent a cholecystectomy at the age of 30 years.", "The boy appears weak and lethargic.", "His temperature is 37.7\u00b0C (99.8\u00b0F), blood pressure is 110/68 mm Hg, pulse is 105/min, and respirations are 28/min.", "Examination shows pallor of the mucosal membranes, mild scleral icterus, and a swollen, red tongue.", "His spleen is enlarged and palpable 2\u20133 cm below the left costal margin.", "A complete blood cell count shows a hemoglobin concentration of 9.8 g/dL, mean corpuscular volume of 102 \u03bcm3, and a reticulocyte count of 0.4%.", "His peripheral blood smear shows erythrocytes without central pallor."], "context_len": 9, "options": {"A": "Folic acid supplementation", "B": "Cholecystectomy", "C": "Gluten-free diet", "D": "Vitamin B12 injections"}, "answer": "Folic acid supplementation", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "9 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 9-year-old boy comes to the physician.", "2. He has had pain with swallowing and a burning sensation in his mouth for the past 10 days.", "3. He has had increasing fatigue and runs out of breath easily for the past 3 weeks.", "4. His father had gallstones and underwent a cholecystectomy at the age of 30 years.", "5. The boy appears weak and lethargic.", "6. His temperature is 37.7\u00b0C (99.8\u00b0F).", "7. His blood pressure is 110/68 mm Hg.", "8. His pulse is 105/min.", "9. His respirations are 28/min.", "10. Examination shows pallor of the mucosal membranes, mild scleral icterus, and a swollen, red tongue.", "11. His spleen is enlarged and palpable 2\u20133 cm below the left costal margin.", "12. A complete blood cell count shows a hemoglobin concentration of 9.8 g/dL.", "13. His mean corpuscular volume is 102 \u03bcm3.", "14. His reticulocyte count is 0.4%.", "15. His peripheral blood smear shows erythrocytes without central pallor."], "atomic_facts": ["1. Over the past 3 weeks, he has had increasing fatigue and runs out of breath easily.", "2. His father had gallstones, for which he underwent a cholecystectomy at the age of 30 years.", "3. The boy appears weak and lethargic.", "4. His temperature is 37.7\u00b0C (99.8\u00b0F), blood pressure is 110/68 mm Hg, pulse is 105/min, and respirations are 28/min.", "5. Examination shows pallor of the mucosal membranes, mild scleral icterus, and a swollen, red tongue.", "6. His spleen is enlarged and palpable 2\u20133 cm below the left costal margin.", "7. A complete blood cell count shows a hemoglobin concentration of 9.8 g/dL, mean corpuscular volume of 102 \u03bcm3, and a reticulocyte count of 0.4%.", "8. His peripheral blood smear shows erythrocytes without central pallor."]}
{"id": 698, "question": "In addition to discontinuation of spironolactone, which of the following is the most appropriate next step in management of this patient's hyperkalemia?\"", "context": ["A 62-year-old man is brought to the hospital because of a 6-hour history of worsening upper abdominal pain, nausea, and vomiting.", "He is diagnosed with acute calculous cholecystitis and scheduled for cholecystectomy the next day.", "He has congestive heart failure, hyperlipidemia, and hypertension.", "Physical examination shows no abnormalities.", "Current medications include metoprolol and simvastatin.", "One month ago, spironolactone was added to his medication regimen.", "Preoperative serum studies show: | Na+ 138 mEq/L | K+ 6.1 mEq/L | Cl- 100 mEq/L | HCO3- 22 mEq/L | Urea nitrogen 13 mg/dL | Creatinine 1.0 mg/dL | An ECG shows normal sinus rhythm."], "context_len": 7, "options": {"A": "Administer intravenous saline with furosemide", "B": "Administer intravenous sodium bicarbonate", "C": "Order dietary modification", "D": "Administer intravenous calcium gluconate"}, "answer": "Administer intravenous saline with furosemide", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "62 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 62-year-old man is brought to the hospital.", "2. He has a 6-hour history of worsening upper abdominal pain, nausea, and vomiting.", "3. He is diagnosed with acute calculous cholecystitis.", "4. He is scheduled for cholecystectomy the next day.", "5. He has congestive heart failure, hyperlipidemia, and hypertension.", "6. Physical examination shows no abnormalities.", "7. His current medications include metoprolol and simvastatin.", "8. One month ago, spironolactone was added to his medication regimen.", "9. Preoperative serum studies show Na+ 138 mEq/L, K+ 6.1 mEq/L, Cl- 100 mEq/L, HCO3- 22 mEq/L, Urea nitrogen 13 mg/dL, and Creatinine 1.0 mg/dL.", "10. An ECG shows normal sinus rhythm."], "atomic_facts": ["1. Diagnosis: Acute calculous cholecystitis", "2. Scheduled procedure: Cholecystectomy the next day", "3. Medical history: Congestive heart failure, hyperlipidemia, and hypertension", "4. Physical examination: No abnormalities", "5. Current medications: Metoprolol and simvastatin", "6. Medication change: Spironolactone added one month ago", "7. Preoperative serum studies: ", "   - Na+ 138 mEq/L", "   - K+ 6.1 mEq/L", "   - Cl- 100 mEq/L", "   - HCO3- 22 mEq/L", "   - Urea nitrogen 13 mg/dL", "   - Creatinine 1.0 mg/dL", "8. ECG findings: Normal sinus rhythm"]}
{"id": 699, "question": "This patient is at greatest risk for which of the following adverse effects of this new drug?", "context": ["A 48-year-old woman comes to the physician for a follow-up examination.", "She has a history of type 2 diabetes mellitus and coronary artery disease.", "Current medications include metformin, aspirin, pravastatin, and losartan.", "Her body mass index is 30 kg/m2.", "Physical examination shows no abnormalities.", "Her hemoglobin A1c concentration is 8%.", "She does not want to start insulin injection therapy and is afraid that a new medication is going to cause weight gain.", "Empagliflozin is added to her diabetes regimen."], "context_len": 8, "options": {"A": "Localized lipodystrophy", "B": "Vaginal candidiasis", "C": "Hypoglycemia", "D": "Lactic acidosis"}, "answer": "Vaginal candidiasis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "48", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 48-year-old woman comes to the physician for a follow-up examination.", "2. She has a history of type 2 diabetes mellitus.", "3. She has a history of coronary artery disease.", "4. Current medications include metformin, aspirin, pravastatin, and losartan.", "5. Her body mass index is 30 kg/m2.", "6. Physical examination shows no abnormalities.", "7. Her hemoglobin A1c concentration is 8%.", "8. She does not want to start insulin injection therapy.", "9. She is afraid that a new medication is going to cause weight gain.", "10. Empagliflozin is added to her diabetes regimen."], "atomic_facts": ["1. She has a history of type 2 diabetes mellitus.", "2. She has a history of coronary artery disease.", "3. Current medications include metformin.", "4. Current medications include aspirin.", "5. Current medications include pravastatin.", "6. Current medications include losartan.", "7. Her body mass index is 30 kg/m2.", "8. Physical examination shows no abnormalities.", "9. Her hemoglobin A1c concentration is 8%.", "10. She does not want to start insulin injection therapy.", "11. She is afraid that a new medication is going to cause weight gain.", "12. Empagliflozin is added to her diabetes regimen."]}
{"id": 700, "question": "Which of the following adverse effects is most commonly associated with long-term use of this medication?", "context": ["A 62-year-old man with coronary artery disease and type 2 diabetes mellitus comes to the emergency department because of frequent episodes of palpitations for 4 days.", "His pulse is 165/min and blood pressure is 98/70 mm Hg.", "An ECG shows monomorphic ventricular tachycardia.", "Intravenous pharmacotherapy is begun with a highly lipophilic drug that prolongs the duration of the myocardial action potential and refractory period and inhibits adrenergic stimulation of the myocardium.", "The patient's ventricular tachycardia converts to normal sinus rhythm.", "He is discharged home with an oral formulation of the same drug."], "context_len": 6, "options": {"A": "Priapism", "B": "Angle-closure glaucoma", "C": "Hyperthyroidism", "D": "Hepatic adenoma"}, "answer": "Hyperthyroidism", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "62 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 62-year-old man has coronary artery disease and type 2 diabetes mellitus.", "2. He comes to the emergency department because of frequent episodes of palpitations for 4 days.", "3. His pulse is 165/min and blood pressure is 98/70 mm Hg.", "4. An ECG shows monomorphic ventricular tachycardia.", "5. Intravenous pharmacotherapy is begun with a highly lipophilic drug.", "6. The drug prolongs the duration of the myocardial action potential and refractory period and inhibits adrenergic stimulation of the myocardium.", "7. The patient's ventricular tachycardia converts to normal sinus rhythm.", "8. He is discharged home with an oral formulation of the same drug."], "atomic_facts": ["1. His pulse is 165/min.", "2. His blood pressure is 98/70 mm Hg.", "3. An ECG shows monomorphic ventricular tachycardia.", "4. Intravenous pharmacotherapy is begun with a highly lipophilic drug.", "5. The drug prolongs the duration of the myocardial action potential and refractory period.", "6. The drug inhibits adrenergic stimulation of the myocardium.", "7. The patient's ventricular tachycardia converts to normal sinus rhythm.", "8. He is discharged home with an oral formulation of the same drug."]}
{"id": 701, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 45-year-old woman presents to her primary care physician complaining of weight gain.", "She states that for the past few months she has gained 10 pounds, especially around her abdomen.", "She says that this is despite going to kickboxing classes 5 days a week.", "She reports mild fatigue and muscle soreness, which she attributes to her exercise classes.", "She also complains of dry skin and hair, but feels that this might be due to showering twice a day.", "Her medical history is significant for major depressive disorder.", "She takes citalopram and a multivitamin.", "She smokes a half pack of cigarettes a day.", "She drinks 1 glass of red wine every night after dinner, and 3-4 drinks mixed with hard liquor on the weekend with friends.", "Her temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 122/75, and pulse is 65/min.", "Her physical examination is unremarkable, except for xerosis.", "Labs are obtained, as shown below: |  | Serum: | Na+: 130 mEq/L | K+: 4.1 mEq/L | Cl-: 101 mEq/L | BUN: 16 mg/dL | Glucose: 125 mg/dL | Creatinine: 0.9 mg/dL | Aspartate aminotransferase (AST): 56 U/L | Alanine aminotransferase (ALT): 70 U/L | Creatine kinase (CK): 223 U/L (normal 22 to 198 U/L) |  | Hemoglobin A1c: 5.3 | Total cholesterol: 264 mg/dL (normal < 200 mg/dL) | Low-density lipoprotein (LDL) cholesterol: 117 mg/dL (normal < 100 mg/dL) | High-density lipoprotein (HDL) cholesterol: 48 (normal > 50 mg/dL) | Triglycerides: 163 mg/dL (normal < 150 mg/dL) |  | ."], "context_len": 12, "options": {"A": "Fludrocortisone", "B": "Liver biopsy", "C": "Muscle biopsy", "D": "Thyroxine"}, "answer": "Thyroxine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 45-year-old woman presents to her primary care physician complaining of weight gain.", "2. She states that for the past few months she has gained 10 pounds, especially around her abdomen.", "3. She says that this is despite going to kickboxing classes 5 days a week.", "4. She reports mild fatigue and muscle soreness, which she attributes to her exercise classes.", "5. She also complains of dry skin and hair, but feels that this might be due to showering twice a day.", "6. Her medical history is significant for major depressive disorder.", "7. She takes citalopram and a multivitamin.", "8. She smokes a half pack of cigarettes a day.", "9. She drinks 1 glass of red wine every night after dinner, and 3-4 drinks mixed with hard liquor on the weekend with friends.", "10. Her temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 122/75, and pulse is 65/min.", "11. Her physical examination is unremarkable, except for xerosis.", "12. Labs are obtained, with serum Na+ of 130 mEq/L, K+ of 4.1 mEq/L, Cl- of 101 mEq/L, BUN of 16 mg/dL, glucose of 125 mg/dL, creatinine of 0.9 mg/dL, AST of 56 U/L, ALT of 70 U/L, CK of 223 U/L, hemoglobin A1c of 5.3, total cholesterol of 264 mg/dL, LDL cholesterol of 117 mg/dL, HDL cholesterol of 48 mg/dL, and triglycerides of 163 mg/dL."], "atomic_facts": ["1. The patient has gained 10 pounds in the past few months, especially around her abdomen.", "2. Despite attending kickboxing classes 5 days a week, she has still gained weight.", "3. She experiences mild fatigue and muscle soreness, which she attributes to her exercise classes.", "4. She complains of dry skin and hair, possibly due to showering twice a day.", "5. Her medical history includes major depressive disorder.", "6. She takes citalopram and a multivitamin.", "7. She smokes half a pack of cigarettes daily.", "8. She drinks 1 glass of red wine every night and 3-4 drinks mixed with hard liquor on the weekend.", "9. Her temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 122/75, and pulse is 65/min.", "10. Her physical examination is unremarkable, except for xerosis.", "11. Lab results show: Na+: 130 mEq/L, K+: 4.1 mEq/L, Cl-: 101 mEq/L, BUN: 16 mg/dL, Glucose: 125 mg/dL, Creatinine: 0.9 mg/dL, AST: 56 U/L, ALT: 70 U/L, CK: 223 U/L, Hemoglobin A1c: 5.3, Total cholesterol: 264 mg/dL, LDL cholesterol: 117 mg/dL, HDL cholesterol: 48 mg/dL, Triglycerides: 163 mg/dL."]}
{"id": 702, "question": "Which of the following is the most appropriate next step in the management of this patient?", "context": ["A 31-year-old woman comes to the physician because of white lesions in her mouth that she first noticed 5 days ago.", "The lesions are not painful or itchy.", "She has asthma treated with theophylline, inhaled \u03b2-adrenergic agonists, and corticosteroids.", "She smokes half a pack of cigarettes daily.", "She appears healthy.", "Vital signs are within normal limits.", "Oral examination shows white plaques on the buccal mucosa and hard palate that are firmly adherent and cannot be scraped off.", "She has no cervical or axillary lymphadenopathy."], "context_len": 8, "options": {"A": "Topical nystatin", "B": "Biopsy of the lesions", "C": "Smoking cessation", "D": "Culture of the lesions"}, "answer": "Biopsy of the lesions", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "31 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 31-year-old woman comes to the physician.", "2. She first noticed white lesions in her mouth 5 days ago.", "3. The lesions are not painful or itchy.", "4. She has asthma treated with theophylline, inhaled \u03b2-adrenergic agonists, and corticosteroids.", "5. She smokes half a pack of cigarettes daily.", "6. She appears healthy.", "7. Vital signs are within normal limits.", "8. Oral examination shows white plaques on the buccal mucosa and hard palate.", "9. The plaques are firmly adherent and cannot be scraped off.", "10. She has no cervical or axillary lymphadenopathy."], "atomic_facts": ["1. The lesions are not painful or itchy.", "2. She has asthma treated with theophylline, inhaled \u03b2-adrenergic agonists, and corticosteroids.", "3. She smokes half a pack of cigarettes daily.", "4. She appears healthy.", "5. Vital signs are within normal limits.", "6. Oral examination shows white plaques on the buccal mucosa and hard palate that are firmly adherent and cannot be scraped off.", "7. She has no cervical or axillary lymphadenopathy."]}
{"id": 703, "question": "Which of the following chromosomes most likely contains the gene mutation responsible for this patient's symptoms?", "context": ["An 11-year-old male is brought to his pediatrician for continuing management of a chronic lung infection.", "He has had many lung infections throughout childhood, and current sputum samples show oxidase positive, non-lactose fermenting gram-negative rods that produce a blue-green pigment.", "Physical exam shows nasal polyps and nail clubbing.", "He has also recently been experiencing floating foul smelling diarrhea, so he is prescribed enzymes and vitamin supplementation tablets."], "context_len": 4, "options": {"A": "7", "B": "17", "C": "22", "D": "X"}, "answer": "7", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "11 years old", "specialties": ["Medical Genetics and Genomics", "Pediatrics"], "subspecialties": ["Pediatric Pulmonology", "Clinical Genetics and Genomics", "General Medical Genetics and Genomics"], "specialty_prob": [0.5, 0.5], "subspecialty_prob": [0.5, 0.25, 0.25], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An 11-year-old male is brought to his pediatrician.", "2. He has had many lung infections throughout childhood.", "3. Current sputum samples show oxidase positive, non-lactose fermenting gram-negative rods.", "4. These rods produce a blue-green pigment.", "5. Physical exam shows nasal polyps and nail clubbing.", "6. He has recently been experiencing floating foul smelling diarrhea.", "7. He is prescribed enzymes and vitamin supplementation tablets."], "atomic_facts": ["1. He has had many lung infections throughout childhood.", "2. Current sputum samples show oxidase positive, non-lactose fermenting gram-negative rods.", "3. The gram-negative rods produce a blue-green pigment.", "4. Physical exam shows nasal polyps.", "5. Physical exam shows nail clubbing.", "6. He has been experiencing floating foul smelling diarrhea.", "7. He is prescribed enzymes.", "8. He is prescribed vitamin supplementation tablets."]}
{"id": 704, "question": "The patient is most likely to develop which of the following complications?", "context": ["A 16-year-old girl is brought to the physician for a routine health maintenance examination.", "Her last visit was over a year ago.", "Menarche was at the age of 12 years; her last menstrual period was 4 months ago.", "She is on the school's gymnastics team and is currently preparing for an important competition.", "She is 165 cm (5 ft 5 in) tall and weighs 45 kg (99 lbs); BMI is 16.5 kg/m2.", "Her temperature is 36.8\u00b0C (98.2\u00b0F), pulse is 53/min, and blood pressure is 98/64 mm Hg.", "Examination shows yellowish discoloration of the skin.", "There are bilateral soft symmetric masses below her mandible.", "The skin over the dorsal side of her right hand is thickened."], "context_len": 9, "options": {"A": "Recurrent infections", "B": "Ovarian cancer", "C": "Fractures", "D": "Hyperthyroidism"}, "answer": "Fractures", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "16 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is 16 years old.", "2. Last visit was over a year ago.", "3. Menarche was at age 12.", "4. Last menstrual period was 4 months ago.", "5. Patient is on school's gymnastics team.", "6. Patient is preparing for an important competition.", "7. Patient is 165 cm tall.", "8. Patient weighs 45 kg.", "9. BMI is 16.5 kg/m2.", "10. Temperature is 36.8\u00b0C.", "11. Pulse is 53/min.", "12. Blood pressure is 98/64 mm Hg.", "13. Examination shows yellowish discoloration of the skin.", "14. Bilateral soft symmetric masses below mandible.", "15. Skin over dorsal side of right hand is thickened."], "atomic_facts": ["1. Her last visit was over a year ago.", "2. Menarche was at the age of 12 years.", "3. Her last menstrual period was 4 months ago.", "4. She is on the school's gymnastics team.", "5. She is currently preparing for an important competition.", "6. She is 165 cm (5 ft 5 in) tall.", "7. She weighs 45 kg (99 lbs).", "8. Her BMI is 16.5 kg/m2.", "9. Her temperature is 36.8\u00b0C (98.2\u00b0F).", "10. Her pulse is 53/min.", "11. Her blood pressure is 98/64 mm Hg.", "12. Examination shows yellowish discoloration of the skin.", "13. There are bilateral soft symmetric masses below her mandible.", "14. The skin over the dorsal side of her right hand is thickened."]}
{"id": 705, "question": "Which of the following activities is inhibited by this medication?", "context": ["A 32-year-old female is seeing an endocrinologist for the first time after a recently-diagnosed illness by her primary care physician.", "Her temperature is 99.7 \u00b0F (37.6 \u00b0C), blood pressure is 110/65 mmHg, pulse is 89/min, and respirations are 11/min.", "Prior to starting medical management, the patient is cautioned to alert her providers if she becomes pregnant, as this medication crosses the placenta and is known to cause aplasia cutis."], "context_len": 3, "options": {"A": "Coupling of iodine with tyrosine residues", "B": "Production of TRH", "C": "Response of peripheral tissues to thyroid hormone", "D": "Sensitivity of anterior pituitary to TRH"}, "answer": "Coupling of iodine with tyrosine residues", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "32", "specialties": ["Endocrinology"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 32-year-old female is seeing an endocrinologist for the first time.", "2. She was recently diagnosed with an illness by her primary care physician.", "3. Her temperature is 99.7 \u00b0F (37.6 \u00b0C).", "4. Her blood pressure is 110/65 mmHg.", "5. Her pulse is 89/min.", "6. Her respirations are 11/min.", "7. Prior to starting medical management, the patient is cautioned to alert her providers if she becomes pregnant.", "8. This medication crosses the placenta.", "9. This medication is known to cause aplasia cutis."], "atomic_facts": ["1. Her temperature is 99.7 \u00b0F (37.6 \u00b0C).", "2. Her blood pressure is 110/65 mmHg.", "3. Her pulse is 89/min.", "4. Her respirations are 11/min.", "5. Prior to starting medical management, the patient is cautioned to alert her providers if she becomes pregnant.", "6. This medication crosses the placenta.", "7. This medication is known to cause aplasia cutis."]}
{"id": 706, "question": "What vitamin deficiency is this woman most likely suffering from?", "context": ["A 62 year old woman presents to her doctor complaining of painful tingling and burning in her feet for the past year.", "Careful physical exam demonstrates that she has poor position sense in her bilateral lower extremities.", "Lab results reveal elevated urine and plasma methylmalonic acid concentrations."], "context_len": 3, "options": {"A": "Vitamin C", "B": "Vitamin B1", "C": "Vitamin B12", "D": "Biotin"}, "answer": "Vitamin B12", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "62 years old", "specialties": ["Neurology", "Internal Medicine"], "subspecialties": ["Neuromuscular Medicine", "Neurology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 62 year old woman presents to her doctor.", "2. She is complaining of painful tingling and burning in her feet for the past year.", "3. Careful physical exam demonstrates that she has poor position sense in her bilateral lower extremities.", "4. Lab results reveal elevated urine methylmalonic acid concentrations.", "5. Lab results reveal elevated plasma methylmalonic acid concentrations."], "atomic_facts": ["1. Careful physical exam demonstrates poor position sense in bilateral lower extremities.", "2. Lab results reveal elevated urine methylmalonic acid concentrations.", "3. Lab results reveal elevated plasma methylmalonic acid concentrations."]}
{"id": 707, "question": "Which of the following best describes the symptoms this patient is expressing?", "context": ["A 52-year-old man visits his psychiatrist saying he feels sad most of the time.", "5 months ago, he lost his daughter in a motor vehicle accident and since then has been unable to cope with this loss.", "He spends most of his day thinking about her and this often distracts him from his daily activities.", "He also admits to hearing his daughter\u2019s voice in his sleep and sometimes has dreams about her.", "During the day, he sometimes gets brief glimpses of her.", "He believes this is because he was not able to do anything to help her during the last moments of her life.", "Other than this, he is able to get along his daily life and has never contemplated suicide.", "But he often wishes he could be close to his daughter again."], "context_len": 8, "options": {"A": "Brief psychotic disorder", "B": "Major depressive disorder", "C": "Normal grief reaction", "D": "Post-traumatic stress disorder"}, "answer": "Normal grief reaction", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 52-year-old man visits his psychiatrist.", "2. He feels sad most of the time.", "3. 5 months ago, he lost his daughter in a motor vehicle accident.", "4. Since then, he has been unable to cope with this loss.", "5. He spends most of his day thinking about her.", "6. This often distracts him from his daily activities.", "7. He admits to hearing his daughter\u2019s voice in his sleep.", "8. He sometimes has dreams about her.", "9. During the day, he sometimes gets brief glimpses of her.", "10. He believes this is because he was not able to do anything to help her during the last moments of her life.", "11. Other than this, he is able to get along his daily life.", "12. He has never contemplated suicide.", "13. But he often wishes he could be close to his daughter again."], "atomic_facts": ["1. 5 months ago, he lost his daughter in a motor vehicle accident.", "2. Since then, he has been unable to cope with this loss.", "3. He spends most of his day thinking about her.", "4. This often distracts him from his daily activities.", "5. He admits to hearing his daughter\u2019s voice in his sleep.", "6. He sometimes has dreams about her.", "7. During the day, he sometimes gets brief glimpses of her.", "8. He believes this is because he was not able to do anything to help her during the last moments of her life.", "9. Other than this, he is able to get along with his daily life.", "10. He has never contemplated suicide.", "11. But he often wishes he could be close to his daughter again."]}
{"id": 708, "question": "Which of the following is the primary mechanism of action of this drug?", "context": ["A 68-year-old woman with hypertension and congestive heart failure is brought to the emergency department because of a 2-day history of shortness of breath and confusion.", "Her pulse is 112/min, respirations are 22/min, and blood pressure is 73/45 mm Hg.", "Examination shows cool extremities, jugular venous distention, and diffuse crackles in the lungs.", "Treatment with intravenous dobutamine is begun."], "context_len": 4, "options": {"A": "\u03b12-adrenergic agonism", "B": "\u03b22-adrenergic antagonism", "C": "\u03b21-adrenergic agonism", "D": "\u03b11-adrenergic antagonism"}, "answer": "\u03b21-adrenergic agonism", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "68", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 68-year-old woman is brought to the emergency department.", "2. She has hypertension and congestive heart failure.", "3. She has a 2-day history of shortness of breath and confusion.", "4. Her pulse is 112/min.", "5. Her respirations are 22/min.", "6. Her blood pressure is 73/45 mm Hg.", "7. Examination shows cool extremities.", "8. Examination shows jugular venous distention.", "9. Examination shows diffuse crackles in the lungs.", "10. Treatment with intravenous dobutamine is begun."], "atomic_facts": ["1. Pulse: 112/min", "2. Respirations: 22/min", "3. Blood pressure: 73/45 mm Hg", "4. Examination findings: cool extremities, jugular venous distention, diffuse crackles in the lungs", "5. Treatment: intravenous dobutamine started"]}
{"id": 709, "question": "Which of the following health maintenance recommendations is most appropriate at this time?", "context": ["A 58-year-old man comes to the physician for a follow-up examination dressed in a vampire costume.", "He is on his way to a Halloween party at an assisted-living facility, where he works as a patient care attendant.", "He feels well.", "He has a history of hypertension that is well controlled.", "He was also diagnosed with type 2 diabetes two months ago during a routine check up.", "His current medications include lisinopril and metformin.", "His father died of colon cancer at 52 years of age.", "His screening colonoscopy at age 55 was normal.", "He used to smoke half a pack of cigarettes daily for 10 years but quit 15 years ago.", "His temperature is 37\u00b0C (98.6\u00b0F), pulse is 90/min, respirations are 14/min, and blood pressure is 138/90 mm Hg.", "Physical examination shows no abnormalities.", "His hemoglobin A1c two months ago was 7.6%."], "context_len": 12, "options": {"A": "Hemoglobin A1c measurement", "B": "Influenza vaccine", "C": "Prostate-specific antigen measurement", "D": "Colonoscopy"}, "answer": "Influenza vaccine", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "58 years old", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine", "Geriatric Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 58-year-old man comes to the physician for a follow-up examination.", "2. He is dressed in a vampire costume.", "3. He is on his way to a Halloween party at an assisted-living facility.", "4. He works as a patient care attendant at the assisted-living facility.", "5. He feels well.", "6. He has a history of hypertension that is well controlled.", "7. He was diagnosed with type 2 diabetes two months ago during a routine check up.", "8. His current medications include lisinopril and metformin.", "9. His father died of colon cancer at 52 years of age.", "10. His screening colonoscopy at age 55 was normal.", "11. He used to smoke half a pack of cigarettes daily for 10 years.", "12. He quit smoking 15 years ago.", "13. His temperature is 37\u00b0C (98.6\u00b0F).", "14. His pulse is 90/min.", "15. His respirations are 14/min.", "16. His blood pressure is 138/90 mm Hg.", "17. Physical examination shows no abnormalities.", "18. His hemoglobin A1c two months ago was 7.6%."], "atomic_facts": ["1. He is on his way to a Halloween party at an assisted-living facility.", "2. He works as a patient care attendant.", "3. He feels well.", "4. He has a history of hypertension.", "5. His hypertension is well controlled.", "6. He was diagnosed with type 2 diabetes two months ago.", "7. The diagnosis was made during a routine check up.", "8. His current medications include lisinopril and metformin.", "9. His father died of colon cancer at 52 years of age.", "10. His screening colonoscopy at age 55 was normal.", "11. He used to smoke half a pack of cigarettes daily for 10 years.", "12. He quit smoking 15 years ago.", "13. His temperature is 37\u00b0C (98.6\u00b0F).", "14. His pulse is 90/min.", "15. His respirations are 14/min.", "16. His blood pressure is 138/90 mm Hg.", "17. Physical examination shows no abnormalities.", "18. His hemoglobin A1c two months ago was 7.6%."]}
{"id": 710, "question": "Which of the following is the best treatment for this patient?", "context": ["A 33-year-old homeless man presents to the emergency department with an altered mental status.", "The patient was found minimally responsive at a local mall and was brought in by police.", "The patient has a past medical history of polysubstance abuse, anxiety, depression, and panic disorder.", "His current medications include sertraline, clonazepam, and amitriptyline.", "His temperature is 98.7\u00b0F (37.1\u00b0C), blood pressure is 117/68 mmHg, pulse is 80/min, respirations are 10/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for a somnolent man.", "Neurological exam reveals 4 mm pupils, which are equal and reactive to light, and a patient who responds incoherently to questions when stimulated.", "The patient has normoactive bowel sounds and is non-tender in all 4 quadrants.", "Laboratory values are ordered as seen below. |  | Serum: | Na+: 139 mEq/L | Cl-: 100 mEq/L | K+: 4.3 mEq/L | HCO3-: 25 mEq/L | BUN: 20 mg/dL | Glucose: 99 mg/dL | Creatinine: 1.1 mg/dL | Ca2+: 10.2 mg/dL | Ethanol: negative |  | An initial ECG is unremarkable."], "context_len": 9, "options": {"A": "Flumazenil", "B": "Fomepizole", "C": "Observation", "D": "Sodium bicarbonate"}, "answer": "Observation", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "33", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine", "Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 33-year-old homeless man presents to the emergency department with an altered mental status.", "2. The patient was found minimally responsive at a local mall and was brought in by police.", "3. The patient has a past medical history of polysubstance abuse, anxiety, depression, and panic disorder.", "4. His current medications include sertraline, clonazepam, and amitriptyline.", "5. His temperature is 98.7\u00b0F (37.1\u00b0C).", "6. His blood pressure is 117/68 mmHg.", "7. His pulse is 80/min.", "8. His respirations are 10/min.", "9. His oxygen saturation is 98% on room air.", "10. Physical exam is notable for a somnolent man.", "11. Neurological exam reveals 4 mm pupils, which are equal and reactive to light.", "12. The patient responds incoherently to questions when stimulated.", "13. The patient has normoactive bowel sounds.", "14. The patient is non-tender in all 4 quadrants.", "15. Serum Na+ is 139 mEq/L.", "16. Serum Cl- is 100 mEq/L.", "17. Serum K+ is 4.3 mEq/L.", "18. Serum HCO3- is 25 mEq/L.", "19. Serum BUN is 20 mg/dL.", "20. Serum Glucose is 99 mg/dL.", "21. Serum Creatinine is 1.1 mg/dL.", "22. Serum Ca2+ is 10.2 mg/dL.", "23. Serum Ethanol is negative.", "24. An initial ECG is unremarkable."], "atomic_facts": ["1. The patient was found minimally responsive at a local mall and was brought in by police.", "2. The patient has a past medical history of polysubstance abuse, anxiety, depression, and panic disorder.", "3. His current medications include sertraline, clonazepam, and amitriptyline.", "4. His temperature is 98.7\u00b0F (37.1\u00b0C), blood pressure is 117/68 mmHg, pulse is 80/min, respirations are 10/min, and oxygen saturation is 98% on room air.", "5. Physical exam is notable for a somnolent man.", "6. Neurological exam reveals 4 mm pupils, which are equal and reactive to light, and a patient who responds incoherently to questions when stimulated.", "7. The patient has normoactive bowel sounds and is non-tender in all 4 quadrants.", "8. Laboratory values are ordered as seen below: Serum: Na+: 139 mEq/L, Cl-: 100 mEq/L, K+: 4.3 mEq/L, HCO3-: 25 mEq/L, BUN: 20 mg/dL, Glucose: 99 mg/dL, Creatinine: 1.1 mg/dL, Ca2+: 10.2 mg/dL, Ethanol: negative.", "9. An initial ECG is unremarkable."]}
{"id": 711, "question": "Which of the following vaccines should be administered for this patient at this visit?", "context": ["A 6-month-old boy is brought to her pediatrician for a checkup and vaccines.", "He was born at 39 weeks gestation via spontaneous vaginal delivery.", "He is meeting all the developmental milestones.", "His prenatal history was complicated with maternal diabetes.", "He is being breastfed exclusively and has 3\u20134 wet diapers a day.", "On physical exam, the vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 85/45 mm Hg, pulse 140/min, and respiratory rate is 31/min.", "On physical examination, the patient is alert and responsive.", "Height, weight, and head circumference are above the 90th percentile."], "context_len": 8, "options": {"A": "RV, Tdap, PCV, Hib", "B": "RV, DTaP, PCV, Hib, IPV", "C": "Hep B, DTaP, Influenza", "D": "RV, Hep B, Hep A"}, "answer": "RV, DTaP, PCV, Hib, IPV", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "6 months", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-month-old boy is brought to her pediatrician for a checkup and vaccines.", "2. He was born at 39 weeks gestation via spontaneous vaginal delivery.", "3. He is meeting all the developmental milestones.", "4. His prenatal history was complicated with maternal diabetes.", "5. He is being breastfed exclusively.", "6. He has 3\u20134 wet diapers a day.", "7. On physical exam, the vital signs include: temperature 37.0\u00b0C (98.6\u00b0F).", "8. On physical exam, the vital signs include: blood pressure 85/45 mm Hg.", "9. On physical exam, the vital signs include: pulse 140/min.", "10. On physical exam, the vital signs include: respiratory rate is 31/min.", "11. On physical examination, the patient is alert and responsive.", "12. Height, weight, and head circumference are above the 90th percentile."], "atomic_facts": ["1. The patient was born at 39 weeks gestation via spontaneous vaginal delivery.", "2. The patient is meeting all the developmental milestones.", "3. The prenatal history was complicated with maternal diabetes.", "4. The patient is being breastfed exclusively and has 3\u20134 wet diapers a day.", "5. On physical exam, the vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 85/45 mm Hg, pulse 140/min, and respiratory rate is 31/min.", "6. On physical examination, the patient is alert and responsive.", "7. Height, weight, and head circumference are above the 90th percentile."]}
{"id": 712, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 23-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision where she was the unrestrained driver.", "She was found thrown across the dashboard of the car.", "On arrival, she appears lethargic.", "She is unable to provide a history.", "Her pulse is 133/min, respirations are 23/min, and blood pressure is 90/60 mm Hg.", "Examination shows a 2-cm laceration over the right upper extremity.", "The pupils are equal and reactive to light.", "There are multiple bruises over the chest and abdomen.", "The lungs are clear to auscultation.", "Cardiac examination shows no abnormalities.", "The abdomen is soft and not distended.", "Neurologic examination shows no focal findings.", "0.9% saline infusion is begun."], "context_len": 13, "options": {"A": "Observation", "B": "Exploratory laparotomy", "C": "CT scan of the abdomen", "D": "Ultrasonography"}, "answer": "Ultrasonography", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "23 years old", "specialties": ["Surgery", "Emergency Medicine"], "subspecialties": ["General Surgery", "General Emergency Medicine"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 23-year-old woman was brought to the emergency department.", "2. She was involved in a high-speed motor vehicle collision.", "3. She was the unrestrained driver.", "4. She was found thrown across the dashboard of the car.", "5. On arrival, she appeared lethargic.", "6. She was unable to provide a history.", "7. Her pulse was 133/min.", "8. Her respirations were 23/min.", "9. Her blood pressure was 90/60 mm Hg.", "10. Examination showed a 2-cm laceration over the right upper extremity.", "11. The pupils were equal and reactive to light.", "12. There were multiple bruises over the chest and abdomen.", "13. The lungs were clear to auscultation.", "14. Cardiac examination showed no abnormalities.", "15. The abdomen was soft and not distended.", "16. Neurologic examination showed no focal findings.", "17. 0.9% saline infusion was begun."], "atomic_facts": ["1. She was found thrown across the dashboard of the car.", "2. On arrival, she appears lethargic.", "3. She is unable to provide a history.", "4. Her pulse is 133/min.", "5. Her respirations are 23/min.", "6. Her blood pressure is 90/60 mm Hg.", "7. Examination shows a 2-cm laceration over the right upper extremity.", "8. The pupils are equal and reactive to light.", "9. There are multiple bruises over the chest and abdomen.", "10. The lungs are clear to auscultation.", "11. Cardiac examination shows no abnormalities.", "12. The abdomen is soft and not distended.", "13. Neurologic examination shows no focal findings.", "14. 0.9% saline infusion is begun."]}
{"id": 713, "question": "Which of the following drugs is the most likely cause of this patient's worsening renal function?", "context": ["Three days after starting a new medication, a 66-year-old woman with resistant hypertension and hyperlipidemia comes to the doctor because of decreased urination.", "She denies dysuria, fevers, or chills.", "Blood pressure is 133/67 mm Hg.", "Physical examination shows no abnormalities.", "Compared to measurements from one week ago, the glomerular filtration rate is markedly decreased and plasma renin activity is elevated.", "A duplex ultrasound of the kidneys shows increased systolic flow velocity in both renal arteries when compared to the aorta."], "context_len": 6, "options": {"A": "Furosemide", "B": "Spironolactone", "C": "Enalapril", "D": "Atenolol"}, "answer": "Enalapril", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "66 years old", "specialties": ["Nephrology"], "subspecialties": ["General Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 66-year-old woman with resistant hypertension and hyperlipidemia comes to the doctor three days after starting a new medication.", "2. She denies dysuria, fevers, or chills.", "3. Blood pressure is 133/67 mm Hg.", "4. Physical examination shows no abnormalities.", "5. Glomerular filtration rate is markedly decreased compared to measurements from one week ago.", "6. Plasma renin activity is elevated compared to measurements from one week ago.", "7. Duplex ultrasound of the kidneys shows increased systolic flow velocity in both renal arteries when compared to the aorta."], "atomic_facts": ["1. She denies dysuria, fevers, or chills.", "2. Blood pressure is 133/67 mm Hg.", "3. Physical examination shows no abnormalities.", "4. Glomerular filtration rate is markedly decreased compared to measurements from one week ago.", "5. Plasma renin activity is elevated compared to measurements from one week ago.", "6. Duplex ultrasound of the kidneys shows increased systolic flow velocity in both renal arteries when compared to the aorta."]}
{"id": 714, "question": "Inhibition of which of the following steps of HIV infection is the most likely therapeutic effect of this experimental drug?", "context": ["An investigator is conducting an experiment to develop a new drug against HIV infection.", "HIV-infected and uninfected CD4 T-cell lines are mixed in-vitro with a chemically modified synthetic peptide triazole complex.", "The complex is found to have a high binding affinity to the gp120 protein, irreversibly inhibiting its function and reducing CD4 T cell infection."], "context_len": 3, "options": {"A": "Incorporation of viral genome into host cell DNA", "B": "Transcription of the viral genome", "C": "Fusion and entry into CD4 T-cells", "D": "Attachment to host CD4 T-cells"}, "answer": "Attachment to host CD4 T-cells", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine", "Infectious Disease"], "subspecialties": ["Infectious Disease", "General Infectious Disease"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An investigator is conducting an experiment.", "2. The experiment is to develop a new drug against HIV infection.", "3. HIV-infected and uninfected CD4 T-cell lines are mixed in-vitro.", "4. The mixture contains a chemically modified synthetic peptide triazole complex.", "5. The complex has a high binding affinity to the gp120 protein.", "6. The complex irreversibly inhibits the function of the gp120 protein.", "7. The complex reduces CD4 T cell infection."], "atomic_facts": ["1. HIV-infected and uninfected CD4 T-cell lines are mixed in-vitro.", "2. A chemically modified synthetic peptide triazole complex is used in the mixture.", "3. The complex has a high binding affinity to the gp120 protein.", "4. The complex irreversibly inhibits the function of the gp120 protein.", "5. The complex reduces CD4 T cell infection."]}
{"id": 715, "question": "Which of the following is the next best step in his evaluation?", "context": ["A 35-year-old man presents to the physician for a medical evaluation necessary before joining the armed force services.", "He is a healthy man with no history of smoking or substance abuse.", "His past medical history is not significant.", "His vital signs are stable and his systemic examination is within normal limits.", "Examination of his respiratory system, including auscultation of his chest, does not reveal any abnormality.", "His laboratory investigations are within normal limits but his chest radiogram shows a solitary pulmonary nodule (SPN), size 9 mm (0.35 in) in diameter, in the middle zone of his right lung.", "The physician compares the radiogram with a radiogram obtained 3 years back for pre-employment medical evaluation.", "The physician notes that a similar SPN with the same size was present in the previous radiogram at the same location."], "context_len": 8, "options": {"A": "No further workup", "B": "Thin-section computed tomography (CT) scan", "C": "Positron emission tomography (PET) scan", "D": "Follow-up after 12 months; if unchanged, no further follow-up"}, "answer": "No further workup", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "35 years old", "specialties": ["Radiology"], "subspecialties": ["Thin", "Diagnostic Radiology", "Neuroradiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.25, 0.25], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 35-year-old man presents to the physician for a medical evaluation.", "2. He is a healthy man with no history of smoking or substance abuse.", "3. His past medical history is not significant.", "4. His vital signs are stable.", "5. His systemic examination is within normal limits.", "6. Examination of his respiratory system, including auscultation of his chest, does not reveal any abnormality.", "7. His laboratory investigations are within normal limits.", "8. His chest radiogram shows a solitary pulmonary nodule (SPN), size 9 mm (0.35 in) in diameter, in the middle zone of his right lung.", "9. The physician compares the radiogram with a radiogram obtained 3 years back for pre-employment medical evaluation.", "10. The physician notes that a similar SPN with the same size was present in the previous radiogram at the same location."], "atomic_facts": ["1. The man is healthy.", "2. He has no history of smoking or substance abuse.", "3. His past medical history is not significant.", "4. His vital signs are stable.", "5. His systemic examination is within normal limits.", "6. Examination of his respiratory system does not reveal any abnormality.", "7. Auscultation of his chest does not reveal any abnormality.", "8. His laboratory investigations are within normal limits.", "9. His chest radiogram shows a solitary pulmonary nodule (SPN) in the middle zone of his right lung, size 9 mm (0.35 in) in diameter.", "10. A radiogram obtained 3 years back for pre-employment medical evaluation shows a similar SPN with the same size at the same location."]}
{"id": 716, "question": "Which of the following would most likely be seen on a peripheral blood smear in this patient?", "context": ["A 32-year-old man presents to his primary care physician because he has been experiencing fatigue and back pain over the last 2 days.", "He suffered from malaria after going on vacation 5 years ago and recently started taking a medication to deal with a latent form of this infection.", "He started developing these symptoms 36 hours after taking the first dose and noticed his urine became progressively darker during that time.", "On physical exam he is found to have scleral icterus and skin jaundice.", "Labs are obtained with the following results: |  | Hematocrit: 32% (Normal: 41%-53%) | Hemoglobin: 10.6 g/dL (Normal: 13.5-17.5 g/dL) | Leukocyte count: 8500/mm3 (Normal: 4500-11,000/mm3) | Platelet count: 273,000/mm3 (Normal: 150,000-400,000/mm3) |  | ."], "context_len": 5, "options": {"A": "Helmet-shaped red blood cells", "B": "Small round inclusions of denatured hemoglobin", "C": "Small round inclusions of nuclear remnants", "D": "Target-shaped red blood cells"}, "answer": "Small round inclusions of denatured hemoglobin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "32", "specialties": ["Hematology", "Internal Medicine"], "subspecialties": ["General Hematology", "Hematology"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 32-year-old man presents to his primary care physician.", "2. He has been experiencing fatigue and back pain over the last 2 days.", "3. He suffered from malaria after going on vacation 5 years ago.", "4. He recently started taking a medication to deal with a latent form of this infection.", "5. He started developing these symptoms 36 hours after taking the first dose.", "6. He noticed his urine became progressively darker during that time.", "7. On physical exam he is found to have scleral icterus and skin jaundice.", "8. Labs are obtained with the following results: Hematocrit: 32% (Normal: 41%-53%).", "9. Labs are obtained with the following results: Hemoglobin: 10.6 g/dL (Normal: 13.5-17.5 g/dL).", "10. Labs are obtained with the following results: Leukocyte count: 8500/mm3 (Normal: 4500-11,000/mm3).", "11. Labs are obtained with the following results: Platelet count: 273,000/mm3 (Normal: 150,000-400,000/mm3)."], "atomic_facts": ["1. The patient suffered from malaria 5 years ago.", "2. The patient recently started taking medication for a latent form of the infection.", "3. The patient developed symptoms 36 hours after taking the first dose of medication.", "4. The patient noticed his urine became progressively darker during that time.", "5. On physical exam, the patient was found to have scleral icterus and skin jaundice.", "6. The patient's hematocrit is 32% (Normal: 41%-53%).", "7. The patient's hemoglobin is 10.6 g/dL (Normal: 13.5-17.5 g/dL).", "8. The patient's leukocyte count is 8500/mm3 (Normal: 4500-11,000/mm3).", "9. The patient's platelet count is 273,000/mm3 (Normal: 150,000-400,000/mm3)."]}
{"id": 717, "question": "Which of the following abnormalities would most likely be seen in this patient?", "context": ["A 30-year-old woman presents to the office for routine examination.", "She has no medical complaints except for mild burning sensation in her eyes and an occasional dry cough.", "She denies fever, headache, or any recent illnesses.", "Past medical history is unremarkable and she takes no medications.", "She does not smoke cigarettes or drinks alcohol.", "Her temperature is 37.0\u00b0C (98.6\u00b0F), the blood pressure is 110/70 mm Hg, the pulse is 78/min, and the respirations are 12/min.", "Physical examination is normal except for bilateral conjunctival injection.", "Laboratory results and chest X-ray is shown below: | Serum chemistry |   Sodium 145 mEq/L |   Potassium 4.1 mEq/L |   Chloride 98 mEq/L |   Calcium 13 mEq/L |   Bicarbonate 20 mEq/L |   Blood urea nitrogen 8 mEq/L |   Creatinine 0.7 mEq/L |   Glucose 96 mEq/L | Urine toxicology Negative | ."], "context_len": 8, "options": {"A": "Increased ACE levels", "B": "Increased ADH levels", "C": "Presence of anti-dsDNA antibodies", "D": "Caseating granulomas in lung tissue biopsy"}, "answer": "Increased ACE levels", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 30-year-old woman presents to the office for routine examination.", "2. She has no medical complaints except for mild burning sensation in her eyes and an occasional dry cough.", "3. She denies fever, headache, or any recent illnesses.", "4. Past medical history is unremarkable and she takes no medications.", "5. She does not smoke cigarettes or drinks alcohol.", "6. Her temperature is 37.0\u00b0C (98.6\u00b0F).", "7. The blood pressure is 110/70 mm Hg.", "8. The pulse is 78/min.", "9. The respirations are 12/min.", "10. Physical examination is normal except for bilateral conjunctival injection.", "11. Laboratory results show serum sodium 145 mEq/L.", "12. Laboratory results show serum potassium 4.1 mEq/L.", "13. Laboratory results show serum chloride 98 mEq/L.", "14. Laboratory results show serum calcium 13 mEq/L.", "15. Laboratory results show serum bicarbonate 20 mEq/L.", "16. Laboratory results show serum blood urea nitrogen 8 mEq/L.", "17. Laboratory results show serum creatinine 0.7 mEq/L.", "18. Laboratory results show serum glucose 96 mEq/L.", "19. Urine toxicology is negative.", "20. Chest X-ray is normal."], "atomic_facts": ["1. Patient has mild burning sensation in her eyes.", "2. Patient has an occasional dry cough.", "3. Patient denies fever, headache, or recent illnesses.", "4. Patient's past medical history is unremarkable.", "5. Patient takes no medications.", "6. Patient does not smoke cigarettes.", "7. Patient does not drink alcohol.", "8. Patient's temperature is 37.0\u00b0C (98.6\u00b0F).", "9. Patient's blood pressure is 110/70 mm Hg.", "10. Patient's pulse is 78/min.", "11. Patient's respirations are 12/min.", "12. Patient has bilateral conjunctival injection.", "13. Serum chemistry results: Sodium 145 mEq/L, Potassium 4.1 mEq/L, Chloride 98 mEq/L, Calcium 13 mEq/L, Bicarbonate 20 mEq/L, Blood urea nitrogen 8 mEq/L, Creatinine 0.7 mEq/L, Glucose 96 mEq/L.", "14. Urine toxicology is negative."]}
{"id": 718, "question": "Which of the following is the initial treatment of choice for the patient?", "context": ["A 60-year-old man presents to a physician with the complaint of a persistent cough for a year.", "He has visited multiple physicians to date, but there has been no conclusive diagnosis.", "He has been a smoker since the age of 30.", "There is no history of significant expectoration, blood in sputum, wheezing, or breathing difficulty, but he has lost approx.", "6.35 kg (14 lb) of weight over the last 9 months.", "On physical examination, his vital signs are stable, and examination of the chest reveals decreased breath sounds over the left infrascapular region.", "His chest radiogram suggests atelectasis in the left lower lobe.", "A detailed evaluation confirms a diagnosis of non-small cell lung carcinoma involving the left main bronchus, which is 4 cm in size and is located 3.8 cm (1.5 in) from the carina.", "Ipsilateral hilar lymph nodes, ipsilateral subcarinal lymph nodes, and ipsilateral scalene lymph nodes are involved in metastasis with no distant metastasis.", "Investigations also suggest that the patient does not have any comorbidity that contraindicates any anti-cancer treatment modality and that his performance status is good."], "context_len": 10, "options": {"A": "Surgery followed by adjuvant chemotherapy", "B": "Chemotherapy only", "C": "Concurrent chemoradiotherapy", "D": "Radiation therapy only"}, "answer": "Concurrent chemoradiotherapy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "60 years old", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.6666666666666666, 0.3333333333333333], "subspecialty_prob": [0.6666666666666666, 0.3333333333333333], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 60-year-old man.", "2. Patient has had a persistent cough for one year.", "3. Patient has visited multiple physicians with no conclusive diagnosis.", "4. Patient has been a smoker since the age of 30.", "5. Patient has no history of significant expectoration, blood in sputum, wheezing, or breathing difficulty.", "6. Patient has lost approx. 6.35 kg (14 lb) of weight over the last 9 months.", "7. Patient's vital signs are stable on physical examination.", "8. Examination of the chest reveals decreased breath sounds over the left infrascapular region.", "9. Chest radiogram suggests atelectasis in the left lower lobe.", "10. Detailed evaluation confirms a diagnosis of non-small cell lung carcinoma involving the left main bronchus.", "11. Carcinoma is 4 cm in size and is located 3.8 cm (1.5 in) from the carina.", "12. Ipsilateral hilar lymph nodes, ipsilateral subcarinal lymph nodes, and ipsilateral scalene lymph nodes are involved in metastasis.", "13. No distant metastasis.", "14. Patient does not have any comorbidity that contraindicates any anti-cancer treatment modality.", "15. Patient's performance status is good."], "atomic_facts": ["1. He has visited multiple physicians to date with no conclusive diagnosis.", "2. He has been a smoker since the age of 30.", "3. There is no history of significant expectoration, blood in sputum, wheezing, or breathing difficulty.", "4. He has lost approximately 6.35 kg (14 lb) of weight over the last 9 months.", "5. On physical examination, his vital signs are stable.", "6. Examination of the chest reveals decreased breath sounds over the left infrascapular region.", "7. His chest radiogram suggests atelectasis in the left lower lobe.", "8. A detailed evaluation confirms a diagnosis of non-small cell lung carcinoma involving the left main bronchus, which is 4 cm in size and is located 3.8 cm (1.5 in) from the carina.", "9. Ipsilateral hilar lymph nodes, ipsilateral subcarinal lymph nodes, and ipsilateral scalene lymph nodes are involved in metastasis with no distant metastasis.", "10. Investigations suggest that the patient does not have any comorbidity that contraindicates any anti-cancer treatment modality and that his performance status is good."]}
{"id": 719, "question": "Processing of the sample with which of the following methods is most likely to confirm the diagnosis?", "context": ["A previously healthy 25-year-old woman comes to the physician because of a 3-week history of fever, recurrent headaches, and anorexia.", "One month ago, she returned from a camping trip in Chile.", "Her temperature is 39.3\u00b0C (102.8\u00b0F).", "Examination shows a swelling in the left periorbital region and axillary, cervical, and inguinal lymphadenopathy.", "A blood sample is obtained."], "context_len": 5, "options": {"A": "Staining with India ink", "B": "Staining with Giemsa dye", "C": "Staining of glycogen", "D": "Staining with silver"}, "answer": "Staining with Giemsa dye", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 25-year-old woman came to the physician.", "2. She had a 3-week history of fever, recurrent headaches, and anorexia.", "3. One month ago, she returned from a camping trip in Chile.", "4. Her temperature is 39.3\u00b0C (102.8\u00b0F).", "5. Examination showed a swelling in the left periorbital region.", "6. Examination also showed axillary, cervical, and inguinal lymphadenopathy.", "7. A blood sample was obtained."], "atomic_facts": ["1. One month ago, she returned from a camping trip in Chile.", "2. Her temperature is 39.3\u00b0C (102.8\u00b0F).", "3. Examination shows a swelling in the left periorbital region.", "4. Examination shows axillary, cervical, and inguinal lymphadenopathy.", "5. A blood sample is obtained."]}
{"id": 720, "question": "Which of the following is the best next step in management?", "context": ["A 57-year-old man presents to the emergency department with chest and back pain.", "He states that his symptoms started suddenly 1 hour ago and have persisted.", "He has a past medical history of hypertension and diabetes.", "His temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 168/111 mmHg, pulse is 95/min, respirations are 14/min, and oxygen saturation is 99% on room air.", "Physical exam is notable for an uncomfortable man but is otherwise within normal limits.", "An initial ECG is unremarkable.", "Laboratory values are ordered as seen below. |  | Hemoglobin: 15 g/dL | Hematocrit: 45% | Leukocyte count: 6,300/mm^3 with normal differential | Platelet count: 222,000/mm^3 |  | Serum: | Na+: 141 mEq/L | Cl-: 103 mEq/L | K+: 4.5 mEq/L | HCO3-: 24 mEq/L | BUN: 42 mg/dL | Glucose: 129 mg/dL | Creatinine: 1.9 mg/dL | Ca2+: 10.2 mg/dL |  | ."], "context_len": 7, "options": {"A": "CT angiogram of the chest", "B": "D-dimer", "C": "Esmolol", "D": "Transesophageal echocardiography"}, "answer": "Transesophageal echocardiography", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "57", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 57-year-old man presents to the emergency department with chest and back pain.", "2. He states that his symptoms started suddenly 1 hour ago and have persisted.", "3. He has a past medical history of hypertension and diabetes.", "4. His temperature is 98.5\u00b0F (36.9\u00b0C).", "5. His blood pressure is 168/111 mmHg.", "6. His pulse is 95/min.", "7. His respirations are 14/min.", "8. His oxygen saturation is 99% on room air.", "9. Physical exam is notable for an uncomfortable man but is otherwise within normal limits.", "10. An initial ECG is unremarkable.", "11. His hemoglobin is 15 g/dL.", "12. His hematocrit is 45%.", "13. His leukocyte count is 6,300/mm^3 with normal differential.", "14. His platelet count is 222,000/mm^3.", "15. His serum sodium is 141 mEq/L.", "16. His serum chloride is 103 mEq/L.", "17. His serum potassium is 4.5 mEq/L.", "18. His serum bicarbonate is 24 mEq/L.", "19. His BUN is 42 mg/dL.", "20. His glucose is 129 mg/dL.", "21. His creatinine is 1.9 mg/dL.", "22. His calcium is 10.2 mg/dL."], "atomic_facts": ["1. Symptoms started suddenly 1 hour ago and have persisted.", "2. Past medical history of hypertension and diabetes.", "3. Temperature is 98.5\u00b0F (36.9\u00b0C).", "4. Blood pressure is 168/111 mmHg.", "5. Pulse is 95/min.", "6. Respirations are 14/min.", "7. Oxygen saturation is 99% on room air.", "8. Physical exam is notable for an uncomfortable man but is otherwise within normal limits.", "9. Initial ECG is unremarkable.", "10. Hemoglobin: 15 g/dL.", "11. Hematocrit: 45%.", "12. Leukocyte count: 6,300/mm^3 with normal differential.", "13. Platelet count: 222,000/mm^3.", "14. Serum: Na+: 141 mEq/L.", "15. Serum: Cl-: 103 mEq/L.", "16. Serum: K+: 4.5 mEq/L.", "17. Serum: HCO3-: 24 mEq/L.", "18. Serum: BUN: 42 mg/dL.", "19. Serum: Glucose: 129 mg/dL.", "20. Serum: Creatinine: 1.9 mg/dL.", "21. Serum: Ca2+: 10.2 mg/dL."]}
{"id": 721, "question": "Which of the following is the most appropriate course of action?", "context": ["A 2-week-old infant is brought to the pediatrician for the first time by his parents.", "His mother received regular prenatal care and the child was born at home under the guidance of a midwife and a doula.", "The child appears well.", "The parents tell you they do not plan to have their child receive any vaccines.", "After a discussion regarding the risks and benefits of vaccines, the parents are still adamant in their wishes to forgo."], "context_len": 5, "options": {"A": "Call child protective services", "B": "Refuse to continue to care for the child", "C": "Give any scheduled vaccines during that visit against the will of the parents", "D": "Document the visit, specifically the detailing of risks and benefits and the parents' refusal of treatment"}, "answer": "Document the visit, specifically the detailing of risks and benefits and the parents' refusal of treatment", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "2 weeks old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2-week-old infant is brought to the pediatrician for the first time by his parents.", "2. His mother received regular prenatal care.", "3. The child was born at home under the guidance of a midwife and a doula.", "4. The child appears well.", "5. The parents tell the pediatrician they do not plan to have their child receive any vaccines.", "6. After a discussion regarding the risks and benefits of vaccines, the parents are still adamant in their wishes to forgo."], "atomic_facts": ["1. His mother received regular prenatal care.", "2. The child was born at home.", "3. The birth was under the guidance of a midwife and a doula.", "4. The child appears well.", "5. The parents do not plan to have their child receive any vaccines.", "6. After a discussion regarding the risks and benefits of vaccines, the parents are still adamant in their wishes to forgo."]}
{"id": 722, "question": "Which of the following is the patient\u2019s most likely diagnosis?", "context": ["A 15-year-old boy is brought in to his pediatrician's office by his step-mother for uncontrollable behavior.", "She reports he has an extensive history of detention for outbursts in class.", "He recently got expelled from school for fist fighting.", "At home, he punches his younger brother when he\u2019s angry.", "The family had to give their cat away to a neighbor because the patient tried to set it on fire.", "The patient\u2019s medical history is significant for bed-wetting until he was 11.", "His father has adult attention deficit disorder.", "The patient states that he thinks school is a \u201cjoke.\u201d He denies having close friends and says \u201cthe kids in my town are stupid anyway.\u201d He calmly describes how he would like to burn down all their houses.", "He admits to trying alcohol and cocaine but denies any other illicit drugs."], "context_len": 9, "options": {"A": "Antisocial personality disorder", "B": "Attention deficient hyperactivity disorder", "C": "Conduct disorder", "D": "Substance abuse"}, "answer": "Conduct disorder", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "15 years old", "specialties": ["Psychiatry"], "subspecialties": ["Child and Adolescent Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is 15 years old.", "2. Patient is brought in by step-mother.", "3. Patient has history of detention for outbursts in class.", "4. Patient recently expelled from school for fist fighting.", "5. Patient punches younger brother when angry.", "6. Family had to give cat away to neighbor because patient tried to set it on fire.", "7. Patient had bed-wetting until age 11.", "8. Patient's father has adult attention deficit disorder.", "9. Patient states school is a \"joke\".", "10. Patient denies having close friends.", "11. Patient says \"the kids in my town are stupid anyway\".", "12. Patient calmly describes wanting to burn down all their houses.", "13. Patient admits to trying alcohol and cocaine.", "14. Patient denies any other illicit drugs."], "atomic_facts": ["1. She reports he has an extensive history of detention for outbursts in class.", "2. He recently got expelled from school for fist fighting.", "3. At home, he punches his younger brother when he\u2019s angry.", "4. The family had to give their cat away to a neighbor because the patient tried to set it on fire.", "5. The patient\u2019s medical history is significant for bed-wetting until he was 11.", "6. His father has adult attention deficit disorder.", "7. The patient states that he thinks school is a \u201cjoke.\u201d", "8. He denies having close friends and says \u201cthe kids in my town are stupid anyway.\u201d", "9. He calmly describes how he would like to burn down all their houses.", "10. He admits to trying alcohol and cocaine but denies any other illicit drugs."]}
{"id": 723, "question": "Methimazole interferes with the function of which of the following proteins?", "context": ["A 30-year-old female complains of heat intolerance, excessive sweating, and recent unintentional weight loss.", "She denies alcohol, tobacco, and other drug use and does not take any medications.", "Laboratory analysis reveals elevated serum T4 and decreased serum TSH.", "You elect to manage the patient\u2019s condition pharmacologically with methimazole."], "context_len": 4, "options": {"A": "Sex-hormone binding globulin", "B": "Thyroid peroxidase", "C": "5\u2019-deiodinase", "D": "Sodium/iodide symporter"}, "answer": "Thyroid peroxidase", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 30-year-old female.", "2. Patient complains of heat intolerance, excessive sweating, and recent unintentional weight loss.", "3. Patient denies alcohol, tobacco, and other drug use.", "4. Patient does not take any medications.", "5. Laboratory analysis reveals elevated serum T4 and decreased serum TSH.", "6. Management plan is to use methimazole pharmacologically."], "atomic_facts": ["1. The patient denies alcohol use.", "2. The patient denies tobacco use.", "3. The patient denies other drug use.", "4. The patient does not take any medications.", "5. Laboratory analysis reveals elevated serum T4.", "6. Laboratory analysis reveals decreased serum TSH.", "7. The patient's condition will be managed pharmacologically with methimazole."]}
{"id": 724, "question": "Which of the following is the most appropriate treatment for this patient?", "context": ["A 40-year-old woman presents to her primary care physician with complaints of worsening muscle aches and diffuse weakness over the past several months.", "She states that she now has difficulty climbing stairs and extending her neck.", "Ultimately, she became more concerned when she began having trouble swallowing and experienced shortness of breath last night which has resolved.", "Her temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 120/84 mmHg, pulse is 70/min, respirations are 12/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for 2/5 strength of the proximal muscles of the upper and lower extremities.", "Dermatologic, cardiac, and pulmonary exam are unremarkable.", "The patient is tolerating oral secretions and has no difficulty swallowing or protecting her airway currently.", "Laboratory studies are notable for an elevated CRP and aldolase."], "context_len": 8, "options": {"A": "Intravenous immunoglobulin", "B": "Methotrexate", "C": "Naproxen", "D": "Prednisone"}, "answer": "Prednisone", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "40", "specialties": ["Rheumatology", "Neurology"], "subspecialties": ["General Rheumatology", "Neuromuscular Medicine"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 40-years-old.", "2. Patient has worsening muscle aches and diffuse weakness over the past several months.", "3. Patient has difficulty climbing stairs and extending her neck.", "4. Patient had trouble swallowing and experienced shortness of breath last night which has resolved.", "5. Temperature is 98.5\u00b0F (36.9\u00b0C).", "6. Blood pressure is 120/84 mmHg.", "7. Pulse is 70/min.", "8. Respirations are 12/min.", "9. Oxygen saturation is 98% on room air.", "10. Physical exam is notable for 2/5 strength of the proximal muscles of the upper and lower extremities.", "11. Dermatologic, cardiac, and pulmonary exam are unremarkable.", "12. Patient is tolerating oral secretions and has no difficulty swallowing or protecting her airway currently.", "13. Laboratory studies are notable for an elevated CRP and aldolase."], "atomic_facts": ["1. She has difficulty climbing stairs.", "2. She has difficulty extending her neck.", "3. She began having trouble swallowing.", "4. She experienced shortness of breath last night.", "5. Her temperature is 98.5\u00b0F (36.9\u00b0C).", "6. Her blood pressure is 120/84 mmHg.", "7. Her pulse is 70/min.", "8. Her respirations are 12/min.", "9. Her oxygen saturation is 98% on room air.", "10. Physical exam shows 2/5 strength of the proximal muscles of the upper and lower extremities.", "11. Dermatologic exam is unremarkable.", "12. Cardiac exam is unremarkable.", "13. Pulmonary exam is unremarkable.", "14. The patient is tolerating oral secretions.", "15. The patient has no difficulty swallowing.", "16. The patient has no difficulty protecting her airway currently.", "17. Laboratory studies show an elevated CRP.", "18. Laboratory studies show an elevated aldolase."]}
{"id": 725, "question": "Which of the following is the next best step in the management of this patient?", "context": ["A 50-year-old woman visits her primary care practitioner with the complaints of generalized weakness, lightheadedness, and fatigability for the past month.", "She also claims to have epigastric pain, heartburn, and a sensation of a lump in her throat.", "Her family history is irrelevant, but her medical history is significant for a Pap smear that reported atypical squamous cells of undetermined significance (ASCUS), which was followed up with a cervical biopsy negative for malignancy.", "She occasionally takes over-the-counter medicines to cope with the heartburn, and recently her hemoglobin was found to be 11 g/dL, for which she received iron and vitamin B12 supplementation.", "Physical examination is unremarkable, except for pale skin, and a pulse of 120/min."], "context_len": 5, "options": {"A": "Proton pump inhibitor", "B": "Anti-H2 agent", "C": "Endoscopy", "D": "Diet and lifestyle recommendations"}, "answer": "Endoscopy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "50", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Internal Medicine", "Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.25, 0.25], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 50-year-old woman visited her primary care practitioner.", "2. She had generalized weakness, lightheadedness, and fatigability for the past month.", "3. She also had epigastric pain, heartburn, and a sensation of a lump in her throat.", "4. Her family history is irrelevant.", "5. Her medical history is significant for a Pap smear that reported ASCUS.", "6. This was followed up with a cervical biopsy negative for malignancy.", "7. She occasionally takes over-the-counter medicines to cope with the heartburn.", "8. Her hemoglobin was found to be 11 g/dL.", "9. She received iron and vitamin B12 supplementation.", "10. Physical examination is unremarkable, except for pale skin.", "11. Her pulse was 120/min."], "atomic_facts": ["1. Patient claims to have epigastric pain, heartburn, and a sensation of a lump in her throat.", "2. Family history is irrelevant.", "3. Medical history is significant for a Pap smear that reported atypical squamous cells of undetermined significance (ASCUS).", "4. Cervical biopsy was negative for malignancy.", "5. Patient occasionally takes over-the-counter medicines to cope with heartburn.", "6. Recent hemoglobin level was found to be 11 g/dL.", "7. Patient received iron and vitamin B12 supplementation for low hemoglobin.", "8. Physical examination is unremarkable, except for pale skin.", "9. Patient has a pulse of 120/min."]}
{"id": 726, "question": "Which of the following tests is indicated at this time?", "context": ["A 67-year-old man presents to a primary care clinic to establish care after moving from another state.", "According to his prior medical records, he last saw a physician 4 years ago and had no significant medical problems at that time.", "Records also show a normal EKG and normal colonoscopy results at that time.", "The patient reports feeling well overall, but review of systems is positive for 1 year of mild cough productive of clear sputum and 2 years of increased urinary frequency.", "He denies fever, chills, dyspnea, dysuria or hematuria.", "He denies illicit drug use but has been drinking approximately 1-2 beers per night and smoking 1 pack of cigarettes per day since age 20.", "Physical exam is unremarkable."], "context_len": 7, "options": {"A": "Abdominal ultrasound", "B": "Bladder ultrasound", "C": "Serum prostate specific antigen (PSA) testing", "D": "Sputum culture"}, "answer": "Abdominal ultrasound", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "67 years old", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 67-year-old man presents to a primary care clinic to establish care after moving from another state.", "2. He last saw a physician 4 years ago and had no significant medical problems at that time.", "3. Records show a normal EKG and normal colonoscopy results at that time.", "4. The patient reports feeling well overall.", "5. Review of systems is positive for 1 year of mild cough productive of clear sputum.", "6. Review of systems is positive for 2 years of increased urinary frequency.", "7. He denies fever, chills, dyspnea, dysuria or hematuria.", "8. He denies illicit drug use.", "9. He has been drinking approximately 1-2 beers per night since age 20.", "10. He has been smoking 1 pack of cigarettes per day since age 20.", "11. Physical exam is unremarkable."], "atomic_facts": ["1. Last physician visit was 4 years ago", "2. No significant medical problems at last visit", "3. Normal EKG at last visit", "4. Normal colonoscopy results at last visit", "5. 1 year of mild cough productive of clear sputum", "6. 2 years of increased urinary frequency", "7. Denies fever", "8. Denies chills", "9. Denies dyspnea", "10. Denies dysuria", "11. Denies hematuria", "12. Denies illicit drug use", "13. Drinks 1-2 beers per night", "14. Smokes 1 pack of cigarettes per day since age 20", "15. Physical exam is unremarkable"]}
{"id": 727, "question": "This drug is most likely to result in which of the following?", "context": ["An 8-year-old boy is brought to the physician for evaluation of an excessive bleeding after undergoing a dental procedure.", "Laboratory studies show a platelet count of 195,000/mm3, a partial thromboplastin time of 44 sec, and a prothrombin time of 12 sec.", "A one-stage clotting assay shows a decreased factor VIII.", "Therapy with a drug that acts on endothelial cells is initiated."], "context_len": 4, "options": {"A": "Decreased cAMP in renal tubular cells", "B": "Increased tubular fluid osmolarity in the loop of Henle", "C": "Increased permeability to urea in the collecting duct", "D": "Increased bleeding time"}, "answer": "Increased permeability to urea in the collecting duct", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An 8-year-old boy is brought to the physician for evaluation of an excessive bleeding after undergoing a dental procedure.", "2. Laboratory studies show a platelet count of 195,000/mm3.", "3. Laboratory studies show a partial thromboplastin time of 44 sec.", "4. Laboratory studies show a prothrombin time of 12 sec.", "5. A one-stage clotting assay shows a decreased factor VIII.", "6. Therapy with a drug that acts on endothelial cells is initiated."], "atomic_facts": ["1. Platelet count: 195,000/mm3", "2. Partial thromboplastin time: 44 sec", "3. Prothrombin time: 12 sec", "4. Factor VIII: decreased in one-stage clotting assay", "5. Therapy initiated with a drug that acts on endothelial cells"]}
{"id": 728, "question": "Assuming normal development, which of the following milestones would be expected in a patient this age?", "context": ["A young girl is brought to the physician by her mother for a well-child examination.", "She is at the 55th percentile for height and at the 40th percentile for weight.", "Vital signs are within normal limits.", "Physical examination shows no abnormalities.", "She is able to follow simple commands, such as \u201cclose your eyes, then stick out your tongue,\u201d but she is unable to follow 3-step commands.", "She knows approximately 75 words, and half of her speech is understandable.", "She can say 2-word phrases, and she is able to name many parts of the body."], "context_len": 7, "options": {"A": "Separates easily from parents", "B": "Kicks a ball", "C": "Pedals a tricycle", "D": "Hops on one foot"}, "answer": "Kicks a ball", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "Young girl", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A young girl is brought to the physician by her mother for a well-child examination.", "2. She is at the 55th percentile for height.", "3. She is at the 40th percentile for weight.", "4. Vital signs are within normal limits.", "5. Physical examination shows no abnormalities.", "6. She is able to follow simple commands.", "7. She is unable to follow 3-step commands.", "8. She knows approximately 75 words.", "9. Half of her speech is understandable.", "10. She can say 2-word phrases.", "11. She is able to name many parts of the body."], "atomic_facts": ["1. She is at the 55th percentile for height.", "2. She is at the 40th percentile for weight.", "3. Vital signs are within normal limits.", "4. Physical examination shows no abnormalities.", "5. She is able to follow simple commands, such as \u201cclose your eyes, then stick out your tongue.\u201d", "6. She is unable to follow 3-step commands.", "7. She knows approximately 75 words.", "8. Half of her speech is understandable.", "9. She can say 2-word phrases.", "10. She is able to name many parts of the body."]}
{"id": 729, "question": "Which of the following characteristics is generally true about this measurement?\"", "context": ["An investigator is studying the association between exclusive breastfeeding and body weight in infants.", "The body weights of 15 exclusively breastfed infants at the age of 6 months are measured.", "Results are shown: | Patient Body weight (kg) | 1 7.0 | 2 6.0 | 3 6.1 | 4 6.8 | 5 7.2 | 6 6.4 | 7 6.2 | 8 6.8 | 9 6.5 | 10 7.3 | 11 6.3 | 12 8.5 | 13 6.9 | 14 6.6 | 15 5.2 | One of the computed measures of central tendency is 6.8 kg."], "context_len": 3, "options": {"A": "It is not applicable for qualitative data analysis.", "B": "It is resistant to outliers.", "C": "Its value only occurs once in a data set.", "D": "It is useful to assess the extent of data variability."}, "answer": "It is resistant to outliers.", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An investigator is studying the association between exclusive breastfeeding and body weight in infants.", "2. The body weights of 15 exclusively breastfed infants at the age of 6 months are measured.", "3. Patient 1 has a body weight of 7.0 kg.", "4. Patient 2 has a body weight of 6.0 kg.", "5. Patient 3 has a body weight of 6.1 kg.", "6. Patient 4 has a body weight of 6.8 kg.", "7. Patient 5 has a body weight of 7.2 kg.", "8. Patient 6 has a body weight of 6.4 kg.", "9. Patient 7 has a body weight of 6.2 kg.", "10. Patient 8 has a body weight of 6.8 kg.", "11. Patient 9 has a body weight of 6.5 kg.", "12. Patient 10 has a body weight of 7.3 kg.", "13. Patient 11 has a body weight of 6.3 kg.", "14. Patient 12 has a body weight of 8.5 kg.", "15. Patient 13 has a body weight of 6.9 kg.", "16. Patient 14 has a body weight of 6.6 kg.", "17. Patient 15 has a body weight of 5.2 kg.", "18. One of the computed measures of central tendency is 6.8 kg."], "atomic_facts": ["1. The body weights of 15 exclusively breastfed infants at the age of 6 months are measured.", "2. Patient Body weight (kg): 1 - 7.0, 2 - 6.0, 3 - 6.1, 4 - 6.8, 5 - 7.2, 6 - 6.4, 7 - 6.2, 8 - 6.8, 9 - 6.5, 10 - 7.3, 11 - 6.3, 12 - 8.5, 13 - 6.9, 14 - 6.6, 15 - 5.2.", "3. One of the computed measures of central tendency is 6.8 kg."]}
{"id": 730, "question": "Additional questioning would most likely reveal which of the following additional features about this patient\u2019s current symptoms?", "context": ["A 32-year-old man presents to his primary care provider with right leg weakness and numbness.", "He reports a 2-day history of \u201cclumsiness\u201d in his right lower extremity after playing in his company\u2019s annual weekend-long charity baseball tournament.", "He says a similar episode happened 1 year ago during the same tournament.", "He has a history of major depressive disorder and right distal radius fracture status post-closed reduction and casting after falling 2 years ago.", "He takes fluoxetine.", "He also reports that he several years ago he had an isolated episode of decreased vision and inability to move his right eye that resolved on its own.", "He has a 15-pack-year smoking history and drinks 3-4 beers per week.", "His temperature is 98.4\u00b0F (36.9\u00b0C), blood pressure is 115/65 mmHg, pulse is 85/min, and respirations are 18/min.", "On exam, hip flexion, knee extension, and ankle dorsiflexion are all 3/5 on his right and 5/5 on his left.", "Right Achilles and patellar reflexes are 1+ on the right and 2+ on the left.", "He has decreased sensation to light touch throughout the right leg especially below the knee."], "context_len": 11, "options": {"A": "Concomitant hyperreflexia", "B": "Symptom improvement in the heat", "C": "Symptom exacerbation in the heat", "D": "Symptom exacerbation with repetitive muscle contractions"}, "answer": "Symptom exacerbation in the heat", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "32", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.5, 0.5], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 32 years old.", "2. Patient presents with right leg weakness and numbness.", "3. Patient has a 2-day history of \u201cclumsiness\u201d in his right lower extremity after playing in his company\u2019s annual weekend-long charity baseball tournament.", "4. Patient had a similar episode 1 year ago during the same tournament.", "5. Patient has a history of major depressive disorder.", "6. Patient has a history of right distal radius fracture status post-closed reduction and casting after falling 2 years ago.", "7. Patient takes fluoxetine.", "8. Patient had an isolated episode of decreased vision and inability to move his right eye several years ago that resolved on its own.", "9. Patient has a 15-pack-year smoking history.", "10. Patient drinks 3-4 beers per week.", "11. Patient's temperature is 98.4\u00b0F (36.9\u00b0C).", "12. Patient's blood pressure is 115/65 mmHg.", "13. Patient's pulse is 85/min.", "14. Patient's respirations are 18/min.", "15. Patient's hip flexion, knee extension, and ankle dorsiflexion are all 3/5 on his right and 5/5 on his left.", "16. Patient's right Achilles and patellar reflexes are 1+ on the right and 2+ on the left.", "17. Patient has decreased sensation to light touch throughout the right leg especially below the knee."], "atomic_facts": ["1. The patient reports a 2-day history of \"clumsiness\" in his right lower extremity after playing in his company\u2019s annual weekend-long charity baseball tournament.", "2. He experienced a similar episode 1 year ago during the same tournament.", "3. The patient has a history of major depressive disorder.", "4. He also has a history of right distal radius fracture status post-closed reduction and casting after falling 2 years ago.", "5. The patient takes fluoxetine.", "6. Several years ago, he had an isolated episode of decreased vision and inability to move his right eye that resolved on its own.", "7. He has a 15-pack-year smoking history and drinks 3-4 beers per week.", "8. His temperature is 98.4\u00b0F (36.9\u00b0C), blood pressure is 115/65 mmHg, pulse is 85/min, and respirations are 18/min.", "9. On exam, hip flexion, knee extension, and ankle dorsiflexion are all 3/5 on his right and 5/5 on his left.", "10. Right Achilles and patellar reflexes are 1+ on the right and 2+ on the left.", "11. He has decreased sensation to light touch throughout the right leg, especially below the knee."]}
{"id": 731, "question": "Which of the following is the most appropriate initial step in management?", "context": ["A 56-year-old man comes to the physician because of throat pain and increasing difficulty swallowing food for the past 5 months.", "He has also had episodic left ear pain for the past 3 months.", "He has hypertension.", "His only medication is amlodipine.", "His father died of laryngeal cancer at the age of 55 years.", "He has smoked one pack of cigarettes daily for 36 years.", "He drinks 2\u20133 beers daily.", "Vital signs are within normal limits.", "Examination shows left cervical lymphadenopathy.", "Oropharyngeal examination shows a 3-cm ulcerating left tonsillar mass.", "Examination of both auditory canals is unremarkable."], "context_len": 11, "options": {"A": "Nasopharyngoscopy", "B": "Panendoscopy", "C": "Barium swallow", "D": "Laryngoscopy\n\""}, "answer": "Panendoscopy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 56 years old.", "2. Patient has had throat pain and difficulty swallowing food for the past 5 months.", "3. Patient has had episodic left ear pain for the past 3 months.", "4. Patient has hypertension.", "5. Patient's only medication is amlodipine.", "6. Patient's father died of laryngeal cancer at the age of 55 years.", "7. Patient has smoked one pack of cigarettes daily for 36 years.", "8. Patient drinks 2\u20133 beers daily.", "9. Vital signs are within normal limits.", "10. Examination shows left cervical lymphadenopathy.", "11. Oropharyngeal examination shows a 3-cm ulcerating left tonsillar mass.", "12. Examination of both auditory canals is unremarkable."], "atomic_facts": ["1. He has episodic left ear pain for the past 3 months.", "2. He has hypertension.", "3. His only medication is amlodipine.", "4. His father died of laryngeal cancer at the age of 55 years.", "5. He has smoked one pack of cigarettes daily for 36 years.", "6. He drinks 2\u20133 beers daily.", "7. Vital signs are within normal limits.", "8. Examination shows left cervical lymphadenopathy.", "9. Oropharyngeal examination shows a 3-cm ulcerating left tonsillar mass.", "10. Examination of both auditory canals is unremarkable."]}
{"id": 732, "question": "Which of the following is the best test for this patient's most likely diagnosis?", "context": ["A 23-year-old woman presents to the emergency department with abdominal pain.", "The patient states that she has pain in her back that radiates to her abdomen.", "The pain started yesterday and is episodic.", "She describes the pain as a 10/10 when it occurs.", "The patient has a past medical history of asthma, anxiety, and chlamydia that was appropriately treated.", "Her current medications include fluoxetine.", "The patient's lab values are ordered as seen below. |  | Hemoglobin: 14 g/dL | Hematocrit: 40% | Leukocyte count: 8,500 cells/mm^3 with normal differential | Platelet count: 225,000/mm^3 |  | Serum: | Na+: 140 mEq/L | Cl-: 100 mEq/L | K+: 4.9 mEq/L | HCO3-: 24 mEq/L | BUN: 22 mg/dL | Glucose: 89 mg/dL | Creatinine: 1.2 mg/dL | Ca2+: 10.0 mg/dL | AST: 11 U/L | ALT: 11 U/L |  | Urine: | Color: amber | Nitrites: negative | Na+: 12 mmol/24 hours | Beta-hCG: positive | Red blood cells: 11/hpf |  | ."], "context_len": 7, "options": {"A": "Abdominal CT", "B": "Transvaginal ultrasound", "C": "Abdominal ultrasound", "D": "Renal ultrasound"}, "answer": "Renal ultrasound", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "23 years old", "specialties": ["Gynecology", "Emergency Medicine", "Gastroenterology"], "subspecialties": ["General Emergency Medicine", "General Obstetrics and Gynecology", "General Gastroenterology"], "specialty_prob": [0.4, 0.4, 0.2], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 23-year-old woman.", "2. Patient presents to the emergency department with abdominal pain.", "3. Patient states that she has pain in her back that radiates to her abdomen.", "4. Pain started yesterday and is episodic.", "5. Patient describes the pain as a 10/10 when it occurs.", "6. Patient has a past medical history of asthma, anxiety, and chlamydia that was appropriately treated.", "7. Patient's current medications include fluoxetine.", "8. Hemoglobin: 14 g/dL", "9. Hematocrit: 40%", "10. Leukocyte count: 8,500 cells/mm^3 with normal differential", "11. Platelet count: 225,000/mm^3", "12. Serum Na+: 140 mEq/L", "13. Serum Cl-: 100 mEq/L", "14. Serum K+: 4.9 mEq/L", "15. Serum HCO3-: 24 mEq/L", "16. Serum BUN: 22 mg/dL", "17. Serum Glucose: 89 mg/dL", "18. Serum Creatinine: 1.2 mg/dL", "19. Serum Ca2+: 10.0 mg/dL", "20. Serum AST: 11 U/L", "21. Serum ALT: 11 U/L", "22. Urine Color: amber", "23. Urine Nitrites: negative", "24. Urine Na+: 12 mmol/24 hours", "25. Urine Beta-hCG: positive", "26. Urine Red blood cells: 11/hpf"], "atomic_facts": ["1. The patient has pain in her back that radiates to her abdomen.", "2. The pain started yesterday and is episodic.", "3. The patient describes the pain as a 10/10 when it occurs.", "4. The patient has a past medical history of asthma, anxiety, and chlamydia that was appropriately treated.", "5. The patient's current medications include fluoxetine.", "6. The patient's lab values are as follows:", "7. Hemoglobin: 14 g/dL", "8. Hematocrit: 40%", "9. Leukocyte count: 8,500 cells/mm^3 with normal differential", "10. Platelet count: 225,000/mm^3", "11. Serum:", "12. Na+: 140 mEq/L", "13. Cl-: 100 mEq/L", "14. K+: 4.9 mEq/L", "15. HCO3-: 24 mEq/L", "16. BUN: 22 mg/dL", "17. Glucose: 89 mg/dL", "18. Creatinine: 1.2 mg/dL", "19. Ca2+: 10.0 mg/dL", "20. AST: 11 U/L", "21. ALT: 11 U/L", "22. Urine:", "23. Color: amber", "24. Nitrites: negative", "25. Na+: 12 mmol/24 hours", "26. Beta-hCG: positive", "27. Red blood cells: 11/hpf"]}
{"id": 733, "question": "What is the best treatment plan in the present case?", "context": ["A baby is delivered via cesarean section on the 31st gestational week.", "The child has tachypnea, nasal flaring, and subcostal, and intercostal retraction.", "Nasogastric tube was positioned without problems.", "Chest radiography shows bilateral, diffuse, ground-glass appearance, air bronchograms, and poor lung expansion."], "context_len": 4, "options": {"A": "No therapy right away, only observation", "B": "Surfactant administration and oxygen therapy", "C": "Antibiotics", "D": "Emergency surgical repair of tracheoesophageal fistula"}, "answer": "Surfactant administration and oxygen therapy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "Baby (gestational age of 31 weeks)", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A baby was delivered via cesarean section on the 31st gestational week.", "2. The child has tachypnea, nasal flaring, and subcostal and intercostal retraction.", "3. Nasogastric tube was positioned without problems.", "4. Chest radiography shows bilateral, diffuse, ground-glass appearance.", "5. Chest radiography shows air bronchograms.", "6. Chest radiography shows poor lung expansion."], "atomic_facts": ["1. The child has tachypnea.", "2. The child has nasal flaring.", "3. The child has subcostal retraction.", "4. The child has intercostal retraction.", "5. A nasogastric tube was positioned without problems.", "6. Chest radiography shows bilateral ground-glass appearance.", "7. Chest radiography shows diffuse ground-glass appearance.", "8. Chest radiography shows air bronchograms.", "9. Chest radiography shows poor lung expansion."]}
{"id": 734, "question": "Which of the following is most likely to prevent future episodes of flank pain?", "context": ["A previously healthy 38-year-old man comes to the emergency department for evaluation of several hours of severe, right-sided, colicky flank pain that radiates to the groin.", "He drinks 2\u20133 energy drinks daily.", "An x-ray of the abdomen shows a 4-mm radiopaque mass in the right ureter.", "Microscopic examination of the urine shows biconcave, dumbbell-shaped crystals."], "context_len": 4, "options": {"A": "Begin loop diuretic", "B": "Maintain acidic urine", "C": "Maintain adequate hydration", "D": "Start high-dose vitamin C"}, "answer": "Maintain adequate hydration", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "38 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 38-year-old man comes to the emergency department.", "2. He has severe, right-sided, colicky flank pain that radiates to the groin.", "3. He drinks 2-3 energy drinks daily.", "4. An x-ray of the abdomen shows a 4-mm radiopaque mass in the right ureter.", "5. Microscopic examination of the urine shows biconcave, dumbbell-shaped crystals."], "atomic_facts": ["1. He drinks 2\u20133 energy drinks daily.", "2. An x-ray of the abdomen shows a 4-mm radiopaque mass in the right ureter.", "3. Microscopic examination of the urine shows biconcave, dumbbell-shaped crystals."]}
{"id": 735, "question": "Which of the following investigations is the main method for staging the patient\u2019s condition?", "context": ["A 45-year-old woman presents for evaluation of mild painless postcoital bleeding for the past 6 months.", "Recently, she started to note irregular intermenstrual bleeding.", "She has a regular menstrual cycle that lasts 30 days.", "She has no history of genital infections or any other major gynecologic diseases.", "She has 1 sexual partner and uses barrier contraception for birth control.", "The pelvic examination shows an erosive necrotizing lesion (6 cm in diameter) that involves the posterior lip of the cervix and extends to the cervical canal and posterior vaginal apex.", "Cervical mobility is decreased.", "The uterus is not enlarged and the ovaries are non-palpable.", "A colposcopy is performed and a biopsy is obtained.", "The histologic evaluation shows irregularly-shaped nests of squamous epithelium cells with large pleomorphic nuclei, inconspicuous nucleoli, a clear cytoplasm, and increased mitoses that infiltrate the stroma for greater than 10 mm."], "context_len": 10, "options": {"A": "Pelvic MRI", "B": "Clinical examination", "C": "Pelvic CT", "D": "PET-CT"}, "answer": "Clinical examination", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Gynecologic Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 45-year-old woman presents for evaluation of mild painless postcoital bleeding for the past 6 months.", "2. Recently, she started to note irregular intermenstrual bleeding.", "3. She has a regular menstrual cycle that lasts 30 days.", "4. She has no history of genital infections or any other major gynecologic diseases.", "5. She has 1 sexual partner and uses barrier contraception for birth control.", "6. The pelvic examination shows an erosive necrotizing lesion (6 cm in diameter) that involves the posterior lip of the cervix and extends to the cervical canal and posterior vaginal apex.", "7. Cervical mobility is decreased.", "8. The uterus is not enlarged and the ovaries are non-palpable.", "9. A colposcopy is performed and a biopsy is obtained.", "10. The histologic evaluation shows irregularly-shaped nests of squamous epithelium cells with large pleomorphic nuclei, inconspicuous nucleoli, a clear cytoplasm, and increased mitoses that infiltrate the stroma for greater than 10 mm."], "atomic_facts": ["1. She started to note irregular intermenstrual bleeding.", "2. She has a regular menstrual cycle that lasts 30 days.", "3. She has no history of genital infections or any other major gynecologic diseases.", "4. She has 1 sexual partner.", "5. She uses barrier contraception for birth control.", "6. The pelvic examination shows an erosive necrotizing lesion (6 cm in diameter) involving the posterior lip of the cervix, cervical canal, and posterior vaginal apex.", "7. Cervical mobility is decreased.", "8. The uterus is not enlarged.", "9. The ovaries are non-palpable.", "10. A colposcopy is performed.", "11. A biopsy is obtained.", "12. The histologic evaluation shows irregularly-shaped nests of squamous epithelium cells.", "13. The cells have large pleomorphic nuclei.", "14. The cells have inconspicuous nucleoli.", "15. The cells have a clear cytoplasm.", "16. The cells have increased mitoses.", "17. The cells infiltrate the stroma for greater than 10 mm."]}
{"id": 736, "question": "Which artery should be briefly clamped to prevent bleeding during the partial sigmoidectomy?", "context": ["A 69-year-old man presents for surgery due to chronic painful diverticula in the sigmoid colon.", "The patient is a Jehovah's witness and refuses a transfusion of blood products even in an emergency."], "context_len": 2, "options": {"A": "Superior mesenteric artery", "B": "Inferior mesenteric artery", "C": "Celiac trunk", "D": "Inferior rectal artery"}, "answer": "Inferior mesenteric artery", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "69", "specialties": ["General Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Colon and Rectal Surgery"}, "facts_old": ["1. A 69-year-old man presents for surgery.", "2. The surgery is due to chronic painful diverticula in the sigmoid colon.", "3. The patient is a Jehovah's Witness.", "4. The patient refuses a transfusion of blood products even in an emergency."], "atomic_facts": ["1. The patient is a Jehovah's witness.", "2. The patient refuses a transfusion of blood products.", "3. The patient refuses a transfusion of blood products even in an emergency."]}
{"id": 737, "question": "What is the identity of these double-positive cells?", "context": ["A thymic sample from a fetus is examined.", "One cell type found was double-positive for the CD4 and CD8 receptors."], "context_len": 2, "options": {"A": "B-cells", "B": "Immature T-cells of the thymic cortex", "C": "Immature T-cells of the thymic medulla", "D": "Macrophages"}, "answer": "Immature T-cells of the thymic cortex", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Pediatric Pathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A thymic sample was taken from a fetus.", "2. The sample was examined.", "3. One cell type was found.", "4. The cell type was double-positive for the CD4 receptor.", "5. The cell type was double-positive for the CD8 receptor."], "atomic_facts": ["1. One cell type was found.", "2. The cell type was double-positive for the CD4 receptor.", "3. The cell type was double-positive for the CD8 receptor."]}
{"id": 738, "question": "Which of the following is most likely the organism being studied?\"", "context": ["An investigator is studying the antimicrobial resistance profile of a bacterial pathogen using disk diffusion testing.", "The pathogen is isolated onto agar plates and antibiotic wafers are added to the plates.", "The inhibitory zone diameters are then recorded and used to define susceptibility thresholds.", "The results of the testing for the pathogen shown: | Drug Susceptibility | Penicillin G Resistant | Cefazolin Resistant | Doxycycline Susceptible | Imipenem Resistant | Azithromycin Susceptible | Vancomycin Resistant | ."], "context_len": 4, "options": {"A": "Staphylococcus aureus", "B": "Clostridioides difficile", "C": "Borrelia burgdorferi", "D": "Ureaplasma urealyticum"}, "answer": "Ureaplasma urealyticum", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology", "Clinical Microbiology"], "subspecialties": ["Medical Microbiology Pathology", "General Microbiology Pathology", "General Pathology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Others"}, "facts_old": ["1. An investigator is studying the antimicrobial resistance profile of a bacterial pathogen.", "2. The pathogen is isolated onto agar plates.", "3. Antibiotic wafers are added to the plates.", "4. The inhibitory zone diameters are then recorded.", "5. The results of the testing for the pathogen show Penicillin G resistance.", "6. The results of the testing for the pathogen show Cefazolin resistance.", "7. The results of the testing for the pathogen show Doxycycline susceptibility.", "8. The results of the testing for the pathogen show Imipenem resistance.", "9. The results of the testing for the pathogen show Azithromycin susceptibility.", "10. The results of the testing for the pathogen show Vancomycin resistance."], "atomic_facts": ["1. The pathogen is isolated onto agar plates.", "2. Antibiotic wafers are added to the plates.", "3. Inhibitory zone diameters are recorded.", "4. The recorded diameters are used to define susceptibility thresholds.", "5. The pathogen is Penicillin G resistant.", "6. The pathogen is Cefazolin resistant.", "7. The pathogen is Doxycycline susceptible.", "8. The pathogen is Imipenem resistant.", "9. The pathogen is Azithromycin susceptible.", "10. The pathogen is Vancomycin resistant."]}
{"id": 739, "question": "What is the most likely cause of this patient's serum finding?", "context": ["A 30-year-old man comes to the physician for evaluation of infertility.", "He does not smoke, drink, or take any medications.", "Physical examination shows no abnormalities.", "Serum analysis shows anti-sperm antibodies."], "context_len": 4, "options": {"A": "Increase in testicular temperature", "B": "Dysgenesis of vas deferens", "C": "Defect in Sertoli cell function", "D": "Defect in GnRH production\n\""}, "answer": "Defect in Sertoli cell function", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "30", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 30-year-old man comes to the physician for evaluation of infertility.", "2. He does not smoke.", "3. He does not drink.", "4. He does not take any medications.", "5. Physical examination shows no abnormalities.", "6. Serum analysis shows anti-sperm antibodies."], "atomic_facts": ["1. He does not smoke.", "2. He does not drink.", "3. He does not take any medications.", "4. Physical examination shows no abnormalities.", "5. Serum analysis shows anti-sperm antibodies."]}
{"id": 740, "question": "Which of the following is a risk of the drug that the son is most likely using?", "context": ["A mother calls the psychiatrist, saying that she is concerned about her 18-year-old son who has become quite emaciated over the past several months.", "She has noticed that his pupils are enlarged, he has frequent nose bleeds, and he wears long sleeve shirts even in warm weather.", "His personality has changed quite dramatically as well, as he repeatedly steals from her and sells anything valuable in the house.", "He also has become overconfident, aggressive, and paranoid."], "context_len": 4, "options": {"A": "Serotonin syndrome", "B": "Sudden cardiac arrest", "C": "CNS white matter lesions", "D": "Increased risk of schizophrenia in predisposed patients"}, "answer": "Sudden cardiac arrest", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "18", "specialties": ["Psychiatry", "Pediatrics"], "subspecialties": ["Addiction Psychiatry", "Adolescent Medicine"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A mother calls a psychiatrist.", "2. The mother is concerned about her 18-year-old son.", "3. The son has become quite emaciated over the past several months.", "4. The son's pupils are enlarged.", "5. The son has frequent nose bleeds.", "6. The son wears long sleeve shirts even in warm weather.", "7. The son's personality has changed dramatically.", "8. The son repeatedly steals from his mother.", "9. The son sells anything valuable in the house.", "10. The son has become overconfident.", "11. The son has become aggressive.", "12. The son has become paranoid."], "atomic_facts": ["1. She has noticed that his pupils are enlarged.", "2. He has frequent nose bleeds.", "3. He wears long sleeve shirts even in warm weather.", "4. His personality has changed quite dramatically.", "5. He repeatedly steals from her.", "6. He sells anything valuable in the house.", "7. He has become overconfident.", "8. He has become aggressive.", "9. He has become paranoid."]}
{"id": 741, "question": "Which of the following is the most likely diagnosis?", "context": ["A 48-year-old man is brought to the physician by his wife because he has become increasingly restless and anxious.", "His wife says that he has seemed sad and irritable for the past 4 months.", "He lost his job as a store clerk because he often lied to avoid work, and spent most of his days on the phone placing bets on football games.", "He avoids all family-related events because he has borrowed money from most of his relatives.", "He is hopeful that his symptoms will improve once he is able to win some of his money back.", "He previously smoked 8\u201310 cigarettes daily but quit 1 month ago.", "He drinks beer on the weekends.", "On examination, he is uncooperative and dismissive.", "He is mildly tremulous.", "Neurologic examination is normal.", "He is oriented to person, place, and time."], "context_len": 11, "options": {"A": "Gambling disorder", "B": "Alcohol withdrawal", "C": "Bipolar II disorder", "D": "Adjustment disorder"}, "answer": "Gambling disorder", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "48 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 48-year-old man is brought to the physician by his wife.", "2. His wife says he has been sad and irritable for the past 4 months.", "3. He lost his job as a store clerk.", "4. He often lied to avoid work.", "5. He spent most of his days on the phone placing bets on football games.", "6. He avoids all family-related events.", "7. He has borrowed money from most of his relatives.", "8. He is hopeful that his symptoms will improve once he is able to win some of his money back.", "9. He previously smoked 8\u201310 cigarettes daily.", "10. He quit smoking 1 month ago.", "11. He drinks beer on the weekends.", "12. On examination, he is uncooperative and dismissive.", "13. He is mildly tremulous.", "14. Neurologic examination is normal.", "15. He is oriented to person, place, and time."], "atomic_facts": ["1. His wife reports that he has seemed sad and irritable for the past 4 months.", "2. He lost his job as a store clerk because he often lied to avoid work and spent most of his days on the phone placing bets on football games.", "3. He avoids all family-related events because he has borrowed money from most of his relatives.", "4. He is hopeful that his symptoms will improve once he is able to win some of his money back.", "5. He previously smoked 8\u201310 cigarettes daily but quit 1 month ago.", "6. He drinks beer on the weekends.", "7. On examination, he is uncooperative and dismissive.", "8. He is mildly tremulous.", "9. Neurologic examination is normal.", "10. He is oriented to person, place, and time."]}
{"id": 742, "question": "In addition to supplemental oxygen therapy, administration of which of the following drugs is most likely to provide acute relief in this patient?", "context": ["A 28-year-old man comes to the emergency department because of an excruciating headache that started 30 minutes ago.", "The pain is located around the right eye and it awoke him from sleep.", "Over the past two weeks, he has had similar headaches around the same time of the day, and he reports pacing around restlessly during these episodes.", "Physical examination shows conjunctival injection and tearing of the right eye."], "context_len": 4, "options": {"A": "Sumatriptan", "B": "Amitriptyline", "C": "Prednisone", "D": "Oxycodone"}, "answer": "Sumatriptan", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "28 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 28-year-old man comes to the emergency department.", "2. He has an excruciating headache that started 30 minutes ago.", "3. The pain is located around the right eye.", "4. The headache awoke him from sleep.", "5. He has had similar headaches around the same time of the day over the past two weeks.", "6. He reports pacing around restlessly during these episodes.", "7. Physical examination shows conjunctival injection and tearing of the right eye."], "atomic_facts": ["1. The pain is located around the right eye.", "2. The pain awoke him from sleep.", "3. Over the past two weeks, he has had similar headaches around the same time of the day.", "4. He reports pacing around restlessly during these episodes.", "5. Physical examination shows conjunctival injection of the right eye.", "6. Physical examination shows tearing of the right eye."]}
{"id": 743, "question": "Which of the following diabetic complications is most likely the cause of this patient\u2019s presenting symptoms?", "context": ["A 27-year-old woman presents with loss of consciousness at work.", "The patient\u2019s colleagues say that she had been complaining of a headache all day.", "Her past medical history is significant for diabetes mellitus type 1.", "Her blood pressure is 70/60 mm Hg, pulse is 105/min, temperature is 37.2\u00b0C (99.0\u00b0F), and her respiratory rate is 28/min and shallow.", "On physical examination, there is a black eschar formation on her nose and her breath has a fruity odor.", "Laboratory findings are significant for serum glucose of 750 mg/dL, potassium of 3.3 mmol/L, and blood pH of 7.1."], "context_len": 6, "options": {"A": "Diabetic ketoacidosis", "B": "Hyperosmolar coma", "C": "Lactic acidosis", "D": "Hypoglycemic coma"}, "answer": "Diabetic ketoacidosis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 27-year-old woman.", "2. Patient presented with loss of consciousness at work.", "3. Patient's colleagues reported she had been complaining of a headache all day.", "4. Patient has a past medical history of diabetes mellitus type 1.", "5. Patient's blood pressure is 70/60 mm Hg.", "6. Patient's pulse is 105/min.", "7. Patient's temperature is 37.2\u00b0C (99.0\u00b0F).", "8. Patient's respiratory rate is 28/min and shallow.", "9. Physical examination revealed a black eschar formation on patient's nose.", "10. Patient's breath has a fruity odor.", "11. Laboratory findings revealed serum glucose of 750 mg/dL.", "12. Laboratory findings revealed potassium of 3.3 mmol/L.", "13. Laboratory findings revealed blood pH of 7.1."], "atomic_facts": ["1. The patient's colleagues say she had been complaining of a headache all day.", "2. The patient's past medical history is significant for diabetes mellitus type 1.", "3. The patient's blood pressure is 70/60 mm Hg.", "4. The patient's pulse is 105/min.", "5. The patient's temperature is 37.2\u00b0C (99.0\u00b0F).", "6. The patient's respiratory rate is 28/min and shallow.", "7. On physical examination, there is a black eschar formation on her nose.", "8. The patient's breath has a fruity odor.", "9. Laboratory findings are significant for serum glucose of 750 mg/dL.", "10. Laboratory findings are significant for potassium of 3.3 mmol/L.", "11. Laboratory findings are significant for blood pH of 7.1."]}
{"id": 744, "question": "Which of the following is most likely true about this patient?", "context": ["A 61-year-old male presents to his primary care doctor with a six-month history of progressively worsening cough, shortness of breath, and 15-pound weight loss.", "Over the same time period, he has also started to notice occasional weakness in his legs that has made it difficult for him to stand up from his chair and climb stairs.", "The weakness appears to improve when he exercises at his local aerobics class.", "His past medical history is notable for hypertension and hyperlipidemia.", "He has smoked 2 packs of cigarettes per day for 35 years.", "Chest radiographs demonstrate a perihilar mass in his right lung.", "A biopsy of the lung lesion is shown."], "context_len": 7, "options": {"A": "His weakness is due to a type III hypersensitivity reaction", "B": "He is at high risk of developing extraocular weakness", "C": "His weakness is due to antibodies directed against post-synaptic, voltage-gated ion channels", "D": "His weakness improves when calcium builds up in the presynaptic nerve terminal"}, "answer": "His weakness improves when calcium builds up in the presynaptic nerve terminal", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "61", "specialties": ["Pulmonary Disease", "Internal Medicine"], "subspecialties": ["General Pulmonary Disease", "Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 61 years old.", "2. Patient has had a progressively worsening cough and shortness of breath for 6 months.", "3. Patient has lost 15 pounds over the same time period.", "4. Patient has noticed occasional weakness in his legs that makes it difficult to stand up from his chair and climb stairs.", "5. Weakness improves with exercise at local aerobics class.", "6. Patient has hypertension and hyperlipidemia in his past medical history.", "7. Patient has smoked 2 packs of cigarettes per day for 35 years.", "8. Chest radiographs demonstrate a perihilar mass in his right lung.", "9. Biopsy of lung lesion is shown."], "atomic_facts": ["1. Over the same time period, he has also started to notice occasional weakness in his legs.", "2. The weakness has made it difficult for him to stand up from his chair and climb stairs.", "3. The weakness appears to improve when he exercises at his local aerobics class.", "4. His past medical history is notable for hypertension and hyperlipidemia.", "5. He has smoked 2 packs of cigarettes per day for 35 years.", "6. Chest radiographs demonstrate a perihilar mass in his right lung.", "7. A biopsy of the lung lesion is shown."]}
{"id": 745, "question": "Which of the following findings would you also expect to see in this patient?", "context": ["A 45-year-old man with a history of hypertension, IV drug use, and type 1 diabetes is brought to the emergency room due to nausea, vomiting, and altered consciousness.", "He was brought in by his sister who found him asleep on her couch.", "He is difficult to arouse and does not respond to questions.", "His sister does not know his medications; however, he has a known history of medication noncompliance.", "On physical exam his temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 100/70 mmHg, pulse is 112/min, respirations are 26/min, and pulse oximetry is 99% on room air.", "He is arousable but is not cooperative with the exam.", "His breaths are deep and you notice a fruity-smell coming from his mouth.", "Exam is otherwise unremarkable."], "context_len": 8, "options": {"A": "Decreased total body potassium", "B": "Increased bicarbonate concentration", "C": "Decreased hydrogen ion concentration", "D": "Decreased free fatty acid concentration"}, "answer": "Decreased total body potassium", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 45 years old.", "2. Patient has a history of hypertension, IV drug use, and type 1 diabetes.", "3. Patient was brought to the emergency room due to nausea, vomiting, and altered consciousness.", "4. Patient was brought in by his sister.", "5. Patient was found asleep on his sister's couch.", "6. Patient is difficult to arouse and does not respond to questions.", "7. Patient's sister does not know his medications.", "8. Patient has a known history of medication noncompliance.", "9. Patient's temperature is 99\u00b0F (37.2\u00b0C).", "10. Patient's blood pressure is 100/70 mmHg.", "11. Patient's pulse is 112/min.", "12. Patient's respirations are 26/min.", "13. Patient's pulse oximetry is 99% on room air.", "14. Patient is arousable but is not cooperative with the exam.", "15. Patient's breaths are deep.", "16. Fruity-smell is coming from patient's mouth.", "17. Exam is otherwise unremarkable."], "atomic_facts": ["1. Patient was brought in by his sister", "2. Sister found him asleep on her couch", "3. Patient is difficult to arouse", "4. Patient does not respond to questions", "5. Sister does not know his medications", "6. Patient has a known history of medication noncompliance", "7. Patient's temperature is 99\u00b0F (37.2\u00b0C)", "8. Patient's blood pressure is 100/70 mmHg", "9. Patient's pulse is 112/min", "10. Patient's respirations are 26/min", "11. Patient's pulse oximetry is 99% on room air", "12. Patient is arousable but not cooperative with the exam", "13. Patient's breaths are deep", "14. Fruity-smell coming from his mouth", "15. Exam is otherwise unremarkable"]}
{"id": 746, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 31-year-old woman and her 32-year-old husband come to the physician because they have not been able to conceive since they married 1.5 years ago.", "They are sexually active and have not used any form of contraception during this period.", "She was diagnosed with cervicitis due to Chlamydia trachomatis infection 4 years ago, which was treated with oral azithromycin.", "The wife reports that she has regular menses and is otherwise healthy.", "Her last menstrual bleeding was 2 weeks ago.", "Neither partner shows abnormalities on physical examination."], "context_len": 6, "options": {"A": "Chromosomal karyotyping", "B": "Postcoital testing", "C": "Post-ejaculatory urinalysis", "D": "Semen analysis"}, "answer": "Semen analysis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "31 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Reproductive Endocrinology and Infertility"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 31-year-old woman and her 32-year-old husband come to the physician.", "2. They have not been able to conceive since they married 1.5 years ago.", "3. They are sexually active and have not used any form of contraception during this period.", "4. She was diagnosed with cervicitis due to Chlamydia trachomatis infection 4 years ago.", "5. She was treated with oral azithromycin.", "6. The wife reports that she has regular menses.", "7. She is otherwise healthy.", "8. Her last menstrual bleeding was 2 weeks ago.", "9. Neither partner shows abnormalities on physical examination."], "atomic_facts": ["1. The patient is sexually active.", "2. The patient has not used any form of contraception during this period.", "3. The patient was diagnosed with cervicitis due to Chlamydia trachomatis infection 4 years ago.", "4. The cervicitis was treated with oral azithromycin.", "5. The patient's wife reports having regular menses.", "6. The patient's wife is otherwise healthy.", "7. The patient's wife's last menstrual bleeding was 2 weeks ago.", "8. Neither partner shows abnormalities on physical examination."]}
{"id": 747, "question": "Which of the following is the most likely diagnosis?", "context": ["A 66-year-old man comes to the physician with a 4-month history of recurrent crusty lesions on the dorsal surface of his hands.", "When he scrapes off the crusts, they reappear after a few days.", "The lesions are mildly pruritic and occasionally burn.", "He works as a landscaper.", "A photograph of his right hand is shown."], "context_len": 5, "options": {"A": "Sporotrichosis", "B": "Basal cell carcinoma", "C": "Actinic keratosis", "D": "Seborrheic keratosis\n\""}, "answer": "Actinic keratosis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "66 years old", "specialties": ["Dermatology"], "subspecialties": ["Micrographic Dermatologic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 66-year-old man comes to the physician.", "2. He has a 4-month history of recurrent crusty lesions on the dorsal surface of his hands.", "3. When he scrapes off the crusts, they reappear after a few days.", "4. The lesions are mildly pruritic and occasionally burn.", "5. He works as a landscaper.", "6. A photograph of his right hand is shown."], "atomic_facts": ["1. The crusts reappear after being scraped off.", "2. The lesions are mildly pruritic.", "3. The lesions occasionally burn.", "4. He works as a landscaper.", "5. A photograph of his right hand is shown."]}
{"id": 748, "question": "Treatment of which of the following conditions most likely led to this patient's current condition?", "context": ["A 50-year-old woman presents to the emergency department with severe abdominal pain and discomfort for several hours.", "She says that the pain started suddenly and rates it as an 8/10 pain.", "There are no exacerbating factors but the pain gets relieved by leaning forward.", "She also complains of nausea and vomiting.", "She has vomited 4 times in the last 2 hours.", "Her past medical history is significant for HIV, diabetes, asthma, depression, and acute angle glaucoma.", "She states that she is very diligent with her medications and has never missed a pill.", "She says that she does not smoke or drink alcohol.", "Her temperature is 37\u00b0C (98.6\u00b0F), respirations are 15/min, pulse is 97/min, and blood pressure is 102/98 mm Hg.", "On examination, she is pale, diaphoretic, and in extreme discomfort.", "She does not allow an abdominal exam.", "Laboratory results show a serum amylase of 456 U/L and a serum lipase of 562 U/L."], "context_len": 12, "options": {"A": "Asthma", "B": "Acquired immunodeficiency syndrome", "C": "Depression", "D": "Diabetes"}, "answer": "Acquired immunodeficiency syndrome", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "50", "specialties": ["General Surgery", "Gastroenterology", "Emergency Medicine"], "subspecialties": ["General Surgery", "General Gastroenterology", "General Emergency Medicine"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 50-year-old woman presents to the emergency department with severe abdominal pain and discomfort for several hours.", "2. The pain started suddenly and rates it as an 8/10 pain.", "3. There are no exacerbating factors but the pain gets relieved by leaning forward.", "4. She also complains of nausea and vomiting.", "5. She has vomited 4 times in the last 2 hours.", "6. Her past medical history is significant for HIV, diabetes, asthma, depression, and acute angle glaucoma.", "7. She states that she is very diligent with her medications and has never missed a pill.", "8. She says that she does not smoke or drink alcohol.", "9. Her temperature is 37\u00b0C (98.6\u00b0F), respirations are 15/min, pulse is 97/min, and blood pressure is 102/98 mm Hg.", "10. On examination, she is pale, diaphoretic, and in extreme discomfort.", "11. She does not allow an abdominal exam.", "12. Laboratory results show a serum amylase of 456 U/L and a serum lipase of 562 U/L."], "atomic_facts": ["1. The patient rates her pain as 8/10.", "2. The pain started suddenly.", "3. Leaning forward relieves the pain.", "4. The patient has experienced nausea and vomiting.", "5. She has vomited 4 times in the last 2 hours.", "6. The patient has a past medical history significant for HIV, diabetes, asthma, depression, and acute angle glaucoma.", "7. She is diligent with her medications and has never missed a pill.", "8. The patient does not smoke or drink alcohol.", "9. Her temperature is 37\u00b0C (98.6\u00b0F).", "10. Respirations are 15/min.", "11. Pulse is 97/min.", "12. Blood pressure is 102/98 mm Hg.", "13. On examination, she is pale, diaphoretic, and in extreme discomfort.", "14. She does not allow an abdominal exam.", "15. Laboratory results show a serum amylase of 456 U/L.", "16. Laboratory results show a serum lipase of 562 U/L."]}
{"id": 749, "question": "Which of the following is the most likely cause of this patient\u2019s acid-base abnormality?", "context": ["A 66-year-old man is brought to the emergency department after 3 consecutive days of nausea and multiple episodes of vomiting every day.", "He has been receiving cisplatin as part of treatment for small cell lung carcinoma diagnosed about a year ago.", "Upon admission, he is found to be drowsy with muscle weakness.", "The patient\u2019s vital signs are as follows: blood pressure is 98/60 mm Hg, heart rate is 120/min, respiratory rate is 14/min, and body temperature is 36.5\u00b0C (97.7\u00b0F).", "Physical examination reveals a mildly cachectic male with mild abdominal tenderness to palpation.", "The following tests are performed: | Laboratory test | Serum Na+ 136 mEq/L | Serum Cl- 78 mEq/L | Serum K+ 3.0 mEq/L | Serum creatinine (SCr)  1.0 mg/dL |     Arterial blood gas | pH 7.58 | PO2 95 mm Hg | PCO2 49 mm Hg | SO2% 98% | HCO3- 44.4 mEq/L | ."], "context_len": 6, "options": {"A": "Increased potassium secretion", "B": "Excessive hydrogen ion loss", "C": "Carbon dioxide retention", "D": "Decreased bicarbonate excretion"}, "answer": "Excessive hydrogen ion loss", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "66", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 66-year-old man is brought to the emergency department.", "2. He has been experiencing nausea and vomiting for 3 consecutive days.", "3. He has been receiving cisplatin as part of treatment for small cell lung carcinoma diagnosed about a year ago.", "4. Upon admission, he is found to be drowsy with muscle weakness.", "5. His blood pressure is 98/60 mm Hg.", "6. His heart rate is 120/min.", "7. His respiratory rate is 14/min.", "8. His body temperature is 36.5\u00b0C (97.7\u00b0F).", "9. Physical examination reveals a mildly cachectic male with mild abdominal tenderness to palpation.", "10. His serum Na+ is 136 mEq/L.", "11. His serum Cl- is 78 mEq/L.", "12. His serum K+ is 3.0 mEq/L.", "13. His serum creatinine (SCr) is 1.0 mg/dL.", "14. His arterial blood gas pH is 7.58.", "15. His PO2 is 95 mm Hg.", "16. His PCO2 is 49 mm Hg.", "17. His SO2% is 98%.", "18. His HCO3- is 44.4 mEq/L."], "atomic_facts": ["1. The patient has been receiving cisplatin as part of treatment for small cell lung carcinoma diagnosed about a year ago.", "2. Upon admission, the patient is found to be drowsy with muscle weakness.", "3. The patient\u2019s blood pressure is 98/60 mm Hg.", "4. The patient\u2019s heart rate is 120/min.", "5. The patient\u2019s respiratory rate is 14/min.", "6. The patient\u2019s body temperature is 36.5\u00b0C (97.7\u00b0F).", "7. Physical examination reveals a mildly cachectic male with mild abdominal tenderness to palpation.", "8. Laboratory test shows serum Na+ 136 mEq/L, serum Cl- 78 mEq/L, serum K+ 3.0 mEq/L, and serum creatinine (SCr) 1.0 mg/dL.", "9. Arterial blood gas test shows pH 7.58, PO2 95 mm Hg, PCO2 49 mm Hg, SO2% 98%, and HCO3- 44.4 mEq/L."]}
{"id": 750, "question": "Which of the following best describes the mechanism of action of this drug?", "context": ["A 30-year-old woman presents with a white patch on her tongue that she noticed a few weeks ago.", "She denies any changes in taste sensation or pain, weight loss, or night sweats.", "Past medical history is significant for a 10-year history of type 1 diabetes mellitus, managed currently on insulin therapy.", "Her last HbA1c a month ago was 9%.", "On physical examination, there are white patches present over the dorsum of her tongue (as seen in the image) that can easily be scraped off.", "Microscopic examination of KOH treated scrapings shows pseudohyphae.", "The patient is advised to have better blood glucose control and is prescribed a drug for these oral patches, which she is instructed to swish in her mouth for several minutes and then swallow."], "context_len": 7, "options": {"A": "Inhibition of synthesis of lanosterol", "B": "Inhibit of synthesis of ergosterol", "C": "Disruption of cell membrane integrity", "D": "Inhibition of nucleic acid synthesis"}, "answer": "Disruption of cell membrane integrity", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology", "Dermatopathology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is a 30-year-old woman.", "2. Patient noticed a white patch on her tongue a few weeks ago.", "3. Patient denies any changes in taste sensation, pain, weight loss, or night sweats.", "4. Patient has a 10-year history of type 1 diabetes mellitus, managed currently on insulin therapy.", "5. Patient's last HbA1c a month ago was 9%.", "6. Physical examination reveals white patches present over the dorsum of her tongue.", "7. White patches can easily be scraped off.", "8. Microscopic examination of KOH treated scrapings shows pseudohyphae.", "9. Patient is advised to have better blood glucose control.", "10. Patient is prescribed a drug for these oral patches.", "11. Patient is instructed to swish the drug in her mouth for several minutes and then swallow."], "atomic_facts": ["1. Patient denies changes in taste sensation or pain, weight loss, or night sweats.", "2. Past medical history includes a 10-year history of type 1 diabetes mellitus.", "3. Diabetes is managed currently on insulin therapy.", "4. Last HbA1c a month ago was 9%.", "5. Physical examination shows white patches on the dorsum of the tongue.", "6. Patches can be easily scraped off.", "7. Microscopic examination of KOH treated scrapings shows pseudohyphae.", "8. Patient is advised to have better blood glucose control.", "9. Prescribed a drug for the oral patches, instructed to swish in her mouth for several minutes and then swallow."]}
{"id": 751, "question": "Which of the following is the most likely cause of this patient's hypercalcemia?", "context": ["A 34-year-old African-American woman comes to the physician because of a 6-month history of fatigue, increasing shortness of breath on exertion, and a dry cough.", "She also has chronic constipation with bowel movements once every two to three days.", "She has not had fevers, night sweats, or weight loss.", "She has a history of hypertension and arthritis of both ankle joints.", "Current medications include hydrochlorothiazide and daily multivitamins.", "Her vital signs are within normal limits.", "Her serum sodium is 138 mEq/L, potassium is 3.9 mEq/L, and calcium is 11.5 mg/dL.", "An x-ray of the chest shows bilateral hilar lymphadenopathy and normal lung parenchyma."], "context_len": 8, "options": {"A": "Elevated 1,25-dihydroxyvitamin D3 levels", "B": "PTH-related protein production", "C": "Thiazide-induced renal calcium reabsorption", "D": "Chronic kidney disease"}, "answer": "Elevated 1,25-dihydroxyvitamin D3 levels", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 34-year-old African-American woman comes to the physician.", "2. She has a 6-month history of fatigue, increasing shortness of breath on exertion, and a dry cough.", "3. She has chronic constipation with bowel movements once every two to three days.", "4. She has not had fevers, night sweats, or weight loss.", "5. She has a history of hypertension and arthritis of both ankle joints.", "6. Current medications include hydrochlorothiazide and daily multivitamins.", "7. Her vital signs are within normal limits.", "8. Her serum sodium is 138 mEq/L.", "9. Her serum potassium is 3.9 mEq/L.", "10. Her serum calcium is 11.5 mg/dL.", "11. An x-ray of the chest shows bilateral hilar lymphadenopathy.", "12. An x-ray of the chest shows normal lung parenchyma."], "atomic_facts": ["1. She has chronic constipation with bowel movements once every two to three days.", "2. She has not had fevers, night sweats, or weight loss.", "3. She has a history of hypertension and arthritis of both ankle joints.", "4. Current medications include hydrochlorothiazide and daily multivitamins.", "5. Her vital signs are within normal limits.", "6. Her serum sodium is 138 mEq/L.", "7. Her potassium is 3.9 mEq/L.", "8. Her calcium is 11.5 mg/dL.", "9. An x-ray of the chest shows bilateral hilar lymphadenopathy and normal lung parenchyma."]}
{"id": 752, "question": "The nerve responsible for motor innervation of the affected muscle is also responsible for which of the following functions?", "context": ["A 78-year-old man comes to the physician because of difficulty swallowing and regurgitation of undigested food for the past several months.", "The patient reports that his symptoms have gotten progressively worse.", "Physical examination shows severe halitosis and a gurgling sound after he swallows a small amount of water.", "Results of fluoroscopic barium esophagography are shown."], "context_len": 4, "options": {"A": "Parasympathetic innervation of the AV node", "B": "Sensory innervation of the posterior tongue", "C": "Visceral sensory innervation of the carotid sinus", "D": "Motor innervation of the ventral tongue"}, "answer": "Parasympathetic innervation of the AV node", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "78 years old", "specialties": ["Gastroenterology", "Otolaryngology"], "subspecialties": ["General Gastroenterology", "General Otolaryngology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 78-year-old man comes to the physician.", "2. The patient has difficulty swallowing and regurgitation of undigested food for the past several months.", "3. The patient's symptoms have gotten progressively worse.", "4. Physical examination shows severe halitosis.", "5. Physical examination shows a gurgling sound after the patient swallows a small amount of water.", "6. Results of fluoroscopic barium esophagography are shown."], "atomic_facts": ["1. The patient reports worsening symptoms.", "2. Physical examination reveals severe halitosis.", "3. Physical examination shows a gurgling sound after swallowing water.", "4. Results of fluoroscopic barium esophagography are available."]}
{"id": 753, "question": "Which of the following findings would most likely also be seen in this patient?", "context": ["A 1-day-old boy is brought to the emergency department by ambulance after his parents found him to be increasingly lethargic.", "He was born at home with inconsistent prenatal care.", "Since then, his parents report that his head appears to be getting bigger over the past few hours.", "He also feeds poorly and has had a few episodes of vomiting.", "On presentation, he is found to have limb spasticity with adducted thumbs.", "His head circumference is bigger than expected and he appears to be unable to look up when following objects."], "context_len": 6, "options": {"A": "Abnormally large posterior fossa", "B": "Downwardly displaced cerebellum", "C": "Obstruction of the cerebral aqueduct", "D": "Tuft of hair on the spine"}, "answer": "Obstruction of the cerebral aqueduct", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "1 day old", "specialties": ["Neurology", "Pediatrics", "Neurosurgery"], "subspecialties": ["Neurodevelopmental Disabilities", "Neurology with Special Qualification in Child Neurology", "Neurosurgery (General Neurological Surgery)", "Neonatal"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 1-day-old boy is brought to the emergency department by ambulance.", "2. He was born at home with inconsistent prenatal care.", "3. His parents report that his head appears to be getting bigger over the past few hours.", "4. He feeds poorly and has had a few episodes of vomiting.", "5. On presentation, he has limb spasticity with adducted thumbs.", "6. His head circumference is bigger than expected.", "7. He appears to be unable to look up when following objects."], "atomic_facts": ["1. He was born at home.", "2. He had inconsistent prenatal care.", "3. His head appears to be getting bigger over the past few hours.", "4. He feeds poorly.", "5. He has had a few episodes of vomiting.", "6. On presentation, he is found to have limb spasticity with adducted thumbs.", "7. His head circumference is bigger than expected.", "8. He appears to be unable to look up when following objects."]}
{"id": 754, "question": "Which of the following is the most appropriate initial step in the management of this patient?", "context": ["A 48-year-old woman presents to the emergency department with a 2-day history of chest pain.", "The patient\u2019s symptoms started gradually after moving heavy objects during packing.", "The pain is constant and nagging but intensifies with lateral movement.", "The patient has no history of serious illness and takes no medications, currently.", "She does not smoke.", "Her vitals are as follows: blood pressure 125/75 mm Hg; pulse 75/min; respiratory rate 14/min; and temperature 36.9\u2103 (98.4\u2109).", "Examination of the anterior chest wall shows the absence of swelling, erythema, or warmth.", "The 3rd and 4th left rib bones are tender anteriorly near the sternum.", "An electrocardiogram is shown.", "The test for cardiac troponin I is negative."], "context_len": 10, "options": {"A": "Ibuprofen", "B": "Intercostal nerve block", "C": "Serial ECG for 12 hours", "D": "Sublingual nitroglycerin"}, "answer": "Ibuprofen", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "48 years old", "specialties": ["Internal Medicine", "Cardiology"], "subspecialties": ["Cardiovascular Disease", "General Cardiology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 48-year-old woman presents to the emergency department with a 2-day history of chest pain.", "2. The patient's symptoms started gradually after moving heavy objects during packing.", "3. The pain is constant and nagging but intensifies with lateral movement.", "4. The patient has no history of serious illness and takes no medications, currently.", "5. She does not smoke.", "6. Her blood pressure is 125/75 mm Hg.", "7. Her pulse is 75/min.", "8. Her respiratory rate is 14/min.", "9. Her temperature is 36.9\u2103 (98.4\u2109).", "10. Examination of the anterior chest wall shows the absence of swelling, erythema, or warmth.", "11. The 3rd and 4th left rib bones are tender anteriorly near the sternum.", "12. An electrocardiogram is shown.", "13. The test for cardiac troponin I is negative."], "atomic_facts": ["1. The patient's symptoms started gradually after moving heavy objects during packing.", "2. The pain is constant and nagging but intensifies with lateral movement.", "3. The patient has no history of serious illness and takes no medications, currently.", "4. She does not smoke.", "5. Her vitals are as follows: blood pressure 125/75 mm Hg; pulse 75/min; respiratory rate 14/min; and temperature 36.9\u2103 (98.4\u2109).", "6. Examination of the anterior chest wall shows the absence of swelling, erythema, or warmth.", "7. The 3rd and 4th left rib bones are tender anteriorly near the sternum.", "8. An electrocardiogram is shown.", "9. The test for cardiac troponin I is negative."]}
{"id": 755, "question": "Which of the following organs is most likely to be spared in this patient?", "context": ["A 28-year-old woman who recently immigrated from Kenya presents with fatigue, shortness of breath, and palpitations for a few weeks.", "Review of systems is significant for a painful swollen knee.", "The patient is afebrile, and her vital signs are within normal limits.", "On physical examination, her voice seems hoarse, although her pharynx does not show signs of an inflammatory process.", "Cardiopulmonary auscultation is significant for a loud first heart sound with a split second heart sound and a mid-diastolic rumbling murmur with an opening snap best heard over the cardiac apex.", "Transthoracic echocardiography shows a calcified mitral valve with an opening area of 1.5 cm2 (normal: 3.0\u20133.5 cm2).", "The patient is recommended to have her mitral valve replaced because of the risk for complications such as atrial fibrillation which may lead to the formation of a life-threatening blood clot that can travel to other parts of the body."], "context_len": 7, "options": {"A": "Lungs", "B": "Spleen", "C": "Brain", "D": "Small bowel"}, "answer": "Lungs", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "28", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 28-year-old woman who recently immigrated from Kenya.", "2. Patient presents with fatigue, shortness of breath, and palpitations for a few weeks.", "3. Review of systems is significant for a painful swollen knee.", "4. Patient is afebrile.", "5. Vital signs are within normal limits.", "6. On physical examination, patient's voice seems hoarse.", "7. Pharynx does not show signs of an inflammatory process.", "8. Cardiopulmonary auscultation is significant for a loud first heart sound with a split second heart sound and a mid-diastolic rumbling murmur with an opening snap best heard over the cardiac apex.", "9. Transthoracic echocardiography shows a calcified mitral valve with an opening area of 1.5 cm2 (normal: 3.0\u20133.5 cm2).", "10. Patient is recommended to have her mitral valve replaced due to risk for complications such as atrial fibrillation.", "11. Atrial fibrillation may lead to the formation of a life-threatening blood clot that can travel to other parts of the body."], "atomic_facts": ["1. Review of systems is significant for a painful swollen knee.", "2. The patient is afebrile.", "3. Her vital signs are within normal limits.", "4. On physical examination, her voice seems hoarse.", "5. Her pharynx does not show signs of an inflammatory process.", "6. Cardiopulmonary auscultation is significant for a loud first heart sound with a split second heart sound.", "7. Cardiopulmonary auscultation is significant for a mid-diastolic rumbling murmur with an opening snap best heard over the cardiac apex.", "8. Transthoracic echocardiography shows a calcified mitral valve.", "9. The opening area of the mitral valve is 1.5 cm2 (normal: 3.0\u20133.5 cm2).", "10. The patient is recommended to have her mitral valve replaced.", "11. The replacement is recommended because of the risk for complications such as atrial fibrillation.", "12. Atrial fibrillation may lead to the formation of a life-threatening blood clot that can travel to other parts of the body."]}
{"id": 756, "question": "Which of the following is a property of the hormone that is deficient in this patient?", "context": ["A 14-year-old girl with a BMI of 17 complains of frequent urination, excessive thirst, and abdominal pain.", "Her parents have noticed that she appears to have lost some weight.", "Her past medical history is significant for celiac disease.", "A random plasma blood glucose is 267 mg/dL."], "context_len": 4, "options": {"A": "Up-regulates glycogen phosphorylase activity", "B": "Enhances potassium uptake", "C": "Downregulates HMG-CoA reductase", "D": "Crosses the placenta to affect the fetus"}, "answer": "Enhances potassium uptake", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "14", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 14-year-old girl.", "2. Patient has a BMI of 17.", "3. Patient complains of frequent urination.", "4. Patient complains of excessive thirst.", "5. Patient complains of abdominal pain.", "6. Patient's parents have noticed weight loss.", "7. Patient has a past medical history of celiac disease.", "8. Patient's random plasma blood glucose is 267 mg/dL."], "atomic_facts": ["1. Her parents have noticed that she appears to have lost some weight.", "2. Her past medical history is significant for celiac disease.", "3. A random plasma blood glucose is 267 mg/dL."]}
{"id": 757, "question": "Which of the following is a likely cause of this patient's iron studies findings?", "context": ["A 37-year-old woman presents to her primary care physician with a 6-month history of fatigue.", "She denies any recent history of fevers, chills or headaches.", "She does not smoke or drink alcohol.", "A CBC demonstrates a microcytic anemia.", "Iron studies are ordered and demonstrate the following: | Serum iron: 40 \u00b5g/dL (normal 50\u2013170 \u00b5g/dL); | TIBC: 230 \u00b5g/dL (normal 250\u2013370 \u00b5g/dL); | Transferrin saturation: 10% (normal 15\u201350%); | Serum ferritin: 180 \u00b5g/L (normal 15-150 \u00b5g/L); | ."], "context_len": 5, "options": {"A": "Lead poisoning", "B": "Dysfunctional uterine bleeding", "C": "Splenic sequestration of RBCs", "D": "Rheumatoid arthritis"}, "answer": "Rheumatoid arthritis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "37 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 37-year-old woman presents to her primary care physician with a 6-month history of fatigue.", "2. She denies any recent history of fevers, chills or headaches.", "3. She does not smoke or drink alcohol.", "4. A CBC demonstrates a microcytic anemia.", "5. Iron studies are ordered.", "6. Serum iron is 40 \u00b5g/dL (normal 50\u2013170 \u00b5g/dL).", "7. TIBC is 230 \u00b5g/dL (normal 250\u2013370 \u00b5g/dL).", "8. Transferrin saturation is 10% (normal 15\u201350%).", "9. Serum ferritin is 180 \u00b5g/L (normal 15-150 \u00b5g/L)."], "atomic_facts": ["1. The patient denies recent history of fevers, chills, or headaches.", "2. The patient does not smoke or drink alcohol.", "3. A CBC demonstrates a microcytic anemia.", "4. Iron studies show: Serum iron: 40 \u00b5g/dL (normal 50\u2013170 \u00b5g/dL).", "5. Iron studies show: TIBC: 230 \u00b5g/dL (normal 250\u2013370 \u00b5g/dL).", "6. Iron studies show: Transferrin saturation: 10% (normal 15\u201350%).", "7. Iron studies show: Serum ferritin: 180 \u00b5g/L (normal 15-150 \u00b5g/L)."]}
{"id": 758, "question": "Which of the following statements regarding the test results in this patient is true?", "context": ["A 32-year-old man presents with epigastric gnawing pain occurring after meals.", "Occasionally, dull pain awakens him at night.", "He also complains of bloating and occasional constipation.", "He has been having these symptoms for almost 2 years and uses antacids and castor oil for relief.", "Recently, he began to note that these remedies provide less relief than in the past.", "He reports no significant weight loss, night sweats, or a change in stool color.", "He has no family history of peptic ulcer disease or gastrointestinal malignancies.", "The patient does not smoke cigarettes but drinks alcohol occasionally.", "He rarely uses NSAIDs for symptomatic treatment.", "His blood pressure is 120/80 mm Hg, heart rate is 85/min, respiratory rate is 14/min, and temperature is 36.6\u00b0C (97.9\u00b0F).", "A physical examination revealed epigastric tenderness on palpation and the abdomen was distended.", "A urea breath test was performed, which was positive."], "context_len": 12, "options": {"A": "The test detected products of increased cellular breakdown by the causative agent induced by urea ingestion.", "B": "The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urease with labeled N-14 orally and then measuring the ammonia content in the exhaled breath.", "C": "The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urea with labeled C-14 orally and then measuring the carbon dioxide content in the exhaled breath.", "D": "The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urease and then measuring the pH of the exhaled breath to determine whether or not there was an increased breakdown of ammonia."}, "answer": "The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urea with labeled C-14 orally and then measuring the carbon dioxide content in the exhaled breath.", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "32 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 32 years old.", "2. Patient presents with epigastric gnawing pain occurring after meals.", "3. Patient occasionally experiences dull pain that awakens him at night.", "4. Patient also complains of bloating and occasional constipation.", "5. Patient has been having these symptoms for almost 2 years.", "6. Patient uses antacids and castor oil for relief.", "7. Patient reports that these remedies provide less relief than in the past.", "8. Patient reports no significant weight loss, night sweats, or a change in stool color.", "9. Patient has no family history of peptic ulcer disease or gastrointestinal malignancies.", "10. Patient does not smoke cigarettes.", "11. Patient drinks alcohol occasionally.", "12. Patient rarely uses NSAIDs for symptomatic treatment.", "13. Patient's blood pressure is 120/80 mm Hg.", "14. Patient's heart rate is 85/min.", "15. Patient's respiratory rate is 14/min.", "16. Patient's temperature is 36.6\u00b0C (97.9\u00b0F).", "17. Physical examination revealed epigastric tenderness on palpation.", "18. Abdomen was distended.", "19. Urea breath test was performed and was positive."], "atomic_facts": ["1. The patient experiences dull pain at night.", "2. The patient complains of bloating and occasional constipation.", "3. These symptoms have been present for almost 2 years.", "4. The patient uses antacids and castor oil for relief.", "5. The remedies provide less relief than in the past.", "6. There is no significant weight loss, night sweats, or change in stool color.", "7. There is no family history of peptic ulcer disease or gastrointestinal malignancies.", "8. The patient does not smoke cigarettes but drinks alcohol occasionally.", "9. The patient rarely uses NSAIDs for symptomatic treatment.", "10. Blood pressure is 120/80 mm Hg.", "11. Heart rate is 85/min.", "12. Respiratory rate is 14/min.", "13. Temperature is 36.6\u00b0C (97.9\u00b0F).", "14. Physical examination revealed epigastric tenderness on palpation.", "15. The abdomen was distended.", "16. A urea breath test was performed, which was positive."]}
{"id": 759, "question": "Which of the following findings would be most likely seen in this patient as a result of administering  this reversal agent?", "context": ["A 45-year-old man is brought into the emergency department after he was found collapsed in a housing development stairwell.", "He was found in a pool of vomit, barely breathing.", "Used syringes and a tourniquet were found near the patient.", "His blood pressure is 100/70 mm Hg, pulse is 65/min, and respiratory rate is 6/min.", "Physical examination reveals a thin and disheveled man with track marks on both arms.", "The appropriate reversal agent is administered."], "context_len": 6, "options": {"A": "Yawning", "B": "Miosis", "C": "Smooth skin", "D": "Tremulousness"}, "answer": "Yawning", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 45-year-old man was brought into the emergency department.", "2. He was found collapsed in a housing development stairwell.", "3. He was found in a pool of vomit, barely breathing.", "4. Used syringes and a tourniquet were found near the patient.", "5. His blood pressure is 100/70 mm Hg.", "6. His pulse is 65/min.", "7. His respiratory rate is 6/min.", "8. Physical examination reveals a thin and disheveled man with track marks on both arms.", "9. The appropriate reversal agent is administered."], "atomic_facts": ["1. The patient was found in a pool of vomit.", "2. The patient was barely breathing.", "3. Used syringes were found near the patient.", "4. A tourniquet was found near the patient.", "5. The patient's blood pressure is 100/70 mm Hg.", "6. The patient's pulse is 65/min.", "7. The patient's respiratory rate is 6/min.", "8. Physical examination reveals a thin and disheveled man.", "9. The man has track marks on both arms.", "10. The appropriate reversal agent is administered."]}
{"id": 760, "question": "This patient most likely received which of the following drugs?", "context": ["A 33-year-old woman comes to the physician because of a 1-year history of irregular menses and infertility.", "She has a history of an eating disorder and has received dietary and behavioral therapy over the past 6 months with minimal improvement in her symptoms.", "She is 170 cm (5 ft 7 in) tall and weighs 49 kg (104 lb); her BMI is 17 kg/m2.", "Physical examination is significant for pallor and thin, soft, depigmented hair on the arms and back.", "After an extensive workup, the physician recommends pulsatile GnRH therapy.", "One week after initiating therapy, a pelvic ultrasound shows a 24-mm hypoechogenic cavity in the right ovary.", "The patient subsequently receives a drug that results in the resumption of meiosis and the loss of gap junctions between the cumulus granulosa cells and the oocyte."], "context_len": 7, "options": {"A": "Follicle-stimulating hormone", "B": "Mifepristone", "C": "Human chorionic gonadotropin", "D": "Cyproterone citrate"}, "answer": "Human chorionic gonadotropin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "33 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Reproductive Endocrinology and Infertility"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 33-year-old woman comes to the physician because of a 1-year history of irregular menses and infertility.", "2. She has a history of an eating disorder and has received dietary and behavioral therapy over the past 6 months with minimal improvement in her symptoms.", "3. She is 170 cm (5 ft 7 in) tall and weighs 49 kg (104 lb); her BMI is 17 kg/m2.", "4. Physical examination is significant for pallor and thin, soft, depigmented hair on the arms and back.", "5. After an extensive workup, the physician recommends pulsatile GnRH therapy.", "6. One week after initiating therapy, a pelvic ultrasound shows a 24-mm hypoechogenic cavity in the right ovary.", "7. The patient subsequently receives a drug that results in the resumption of meiosis and the loss of gap junctions between the cumulus granulosa cells and the oocyte."], "atomic_facts": ["1. She has a history of an eating disorder.", "2. She has received dietary and behavioral therapy over the past 6 months.", "3. There has been minimal improvement in her symptoms.", "4. She is 170 cm (5 ft 7 in) tall.", "5. She weighs 49 kg (104 lb).", "6. Her BMI is 17 kg/m2.", "7. Physical examination is significant for pallor.", "8. Physical examination is significant for thin, soft, depigmented hair on the arms and back.", "9. After an extensive workup, the physician recommends pulsatile GnRH therapy.", "10. One week after initiating therapy, a pelvic ultrasound shows a 24-mm hypoechogenic cavity in the right ovary.", "11. The patient subsequently receives a drug.", "12. The drug results in the resumption of meiosis.", "13. The drug results in the loss of gap junctions between the cumulus granulosa cells and the oocyte."]}
{"id": 761, "question": "In addition to a protein pump inhibitor (PPI), which of the following should be added to the treatment regime of this patient?", "context": ["A 52-year-old woman visits her primary care practitioner, who has been following her closely after she was diagnosed with peptic ulcer disease.", "She tested positive for H.", "pylori in a urea breath test, which was later confirmed by an endoscopic biopsy.", "Her family history is significant for colorectal carcinoma, as well as ovarian cancer.", "Her past medical history is relevant for cigarette smoking and peptic ulcer disease, which has been under treatment twice, initially with a clarithromycin-containing regime.", "This was followed by a bismuth-containing regime after a fecal antigen test was positive 4 weeks later.", "A recent endoscopy and fecal antigen test detected H.", "pylori in her stomach mucosa."], "context_len": 8, "options": {"A": "Bismuth subsalicylate, metronidazole, tetracycline", "B": "Levofloxacin, amoxicillin", "C": "Clarithromycin, amoxicillin", "D": "Rifabutin, amoxicillin"}, "answer": "Levofloxacin, amoxicillin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "52 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 52-year-old woman visits her primary care practitioner.", "2. She was diagnosed with peptic ulcer disease.", "3. She tested positive for H. pylori in a urea breath test.", "4. This was later confirmed by an endoscopic biopsy.", "5. Her family history is significant for colorectal carcinoma.", "6. Her family history is also significant for ovarian cancer.", "7. Her past medical history is relevant for cigarette smoking.", "8. Her past medical history is also relevant for peptic ulcer disease.", "9. She has been under treatment twice for peptic ulcer disease.", "10. Initially, she was treated with a clarithromycin-containing regime.", "11. This was followed by a bismuth-containing regime.", "12. A fecal antigen test was positive 4 weeks later.", "13. A recent endoscopy and fecal antigen test detected H. pylori in her stomach mucosa."], "atomic_facts": ["1. She tested positive for H. pylori in a urea breath test.", "2. The H. pylori infection was later confirmed by an endoscopic biopsy.", "3. Her family history is significant for colorectal carcinoma and ovarian cancer.", "4. Her past medical history includes cigarette smoking and peptic ulcer disease.", "5. The peptic ulcer disease has been under treatment twice.", "6. The initial treatment regime contained clarithromycin.", "7. The treatment was followed by a bismuth-containing regime after a positive fecal antigen test.", "8. A recent endoscopy and fecal antigen test detected H. pylori in her stomach mucosa."]}
{"id": 762, "question": "Which of the following techniques would most likely identify the cause of this patient\u2019s presentation?", "context": ["An 8-year-old boy is brought to the pediatrician\u2019s office with his mother for a routine check-up.", "Although her son is doing well, the mother has some concerns with regards to his overall health.", "He was born at 39 weeks gestation via spontaneous vaginal birth.", "He is up to date on all vaccines and has met most of developmental milestones.", "She reports that he is shorter than his classmates and seems less developed physically than his older brother and sister when they were his age.", "Additionally, the boy\u2019s teacher has some concerns regarding his learning capability not being at the level of his peers.", "His height and weight are at the 10th and 15th percentile respectively.", "He has a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0\u00b0C (98.6\u00b0F).", "At physical exam the child appears cheerful, well developed, and well nourished.", "He is small for his age.", "with upslanting palpebral fissures, flat occiput, low set ears, and a flat nose."], "context_len": 11, "options": {"A": "Punnett square", "B": "Karyotype", "C": "Polymerase chain reaction", "D": "Gene mapping"}, "answer": "Karyotype", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "8 years old", "specialties": ["Medical Genetics and Genomics", "Pediatrics"], "subspecialties": ["Clinical Genetics and Genomics", "General Pediatrics"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An 8-year-old boy is brought to the pediatrician\u2019s office with his mother for a routine check-up.", "2. He was born at 39 weeks gestation via spontaneous vaginal birth.", "3. He is up to date on all vaccines and has met most of developmental milestones.", "4. The mother has some concerns with regards to his overall health.", "5. He is shorter than his classmates.", "6. He seems less developed physically than his older brother and sister when they were his age.", "7. The boy\u2019s teacher has some concerns regarding his learning capability not being at the level of his peers.", "8. His height and weight are at the 10th and 15th percentile respectively.", "9. He has a heart rate of 90/min.", "10. He has a respiratory rate of 22/min.", "11. He has a blood pressure of 110/65 mm Hg.", "12. He has a temperature of 37.0\u00b0C (98.6\u00b0F).", "13. At physical exam the child appears cheerful, well developed, and well nourished.", "14. He is small for his age.", "15. He has upslanting palpebral fissures.", "16. He has a flat occiput.", "17. He has low set ears.", "18. He has a flat nose."], "atomic_facts": ["1. The mother has concerns about her son's overall health.", "2. The son was born at 39 weeks gestation via spontaneous vaginal birth.", "3. The son is up to date on all vaccines and has met most of developmental milestones.", "4. The mother reports that the son is shorter than his classmates and seems less developed physically than his older brother and sister at the same age.", "5. The boy\u2019s teacher has concerns about his learning capability not being at the level of his peers.", "6. The son's height and weight are at the 10th and 15th percentile respectively.", "7. The son has a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0\u00b0C (98.6\u00b0F).", "8. At physical exam the child appears cheerful, well developed, and well nourished.", "9. The son is small for his age.", "10. The son has upslanting palpebral fissures, flat occiput, low set ears, and a flat nose."]}
{"id": 763, "question": "Which of the symptoms below is most commonly associated with the patient\u2019s condition?", "context": ["A 55-year-old woman visits her primary care provider for concerns of frequent headaches.", "She complains of recurrent headaches and involuntary weight loss, which she attributes to a constant pain along the right side of her jaw that occasionally radiates to her right eye.", "Her past medical history includes diabetes mellitus type 2 and chronic glomerulonephritis resulting in stage II chronic kidney disease.", "Her mother passed away in her 70s and had been diagnosed with multiple sclerosis at the age of 50.", "Today, her blood pressure is 135/90 mm Hg, heart rate is 88/min, respiratory rate is 15/min, and temperature is 36.6\u00b0C (97.9\u00b0F).", "The right side of her face is painful to palpation from her jaw to the right side of her scalp."], "context_len": 6, "options": {"A": "Limb muscle weakness", "B": "Neck stiffness", "C": "Diplopia", "D": "Shock-like pain in face"}, "answer": "Neck stiffness", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "55", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 55-year-old woman visits her primary care provider for concerns of frequent headaches.", "2. She complains of recurrent headaches and involuntary weight loss.", "3. She attributes the headaches and weight loss to a constant pain along the right side of her jaw that occasionally radiates to her right eye.", "4. Her past medical history includes diabetes mellitus type 2 and chronic glomerulonephritis resulting in stage II chronic kidney disease.", "5. Her mother passed away in her 70s and had been diagnosed with multiple sclerosis at the age of 50.", "6. Her blood pressure is 135/90 mm Hg.", "7. Her heart rate is 88/min.", "8. Her respiratory rate is 15/min.", "9. Her temperature is 36.6\u00b0C (97.9\u00b0F).", "10. The right side of her face is painful to palpation from her jaw to the right side of her scalp."], "atomic_facts": ["1. She complains of recurrent headaches.", "2. She complains of involuntary weight loss.", "3. She attributes her symptoms to a constant pain along the right side of her jaw.", "4. The pain occasionally radiates to her right eye.", "5. Her past medical history includes diabetes mellitus type 2.", "6. Her past medical history includes chronic glomerulonephritis resulting in stage II chronic kidney disease.", "7. Her mother passed away in her 70s.", "8. Her mother had been diagnosed with multiple sclerosis at the age of 50.", "9. Her blood pressure is 135/90 mm Hg.", "10. Her heart rate is 88/min.", "11. Her respiratory rate is 15/min.", "12. Her temperature is 36.6\u00b0C (97.9\u00b0F).", "13. The right side of her face is painful to palpation from her jaw to the right side of her scalp."]}
{"id": 764, "question": "Which of the following additional findings is most strongly associated with this patient\u2019s condition?", "context": ["A 66-year-old man presents to his primary care provider for a routine checkup.", "He says that he feels well overall but has experienced some intermittent back pain and vague epigastric pain over the past 6 months.", "He also has experienced cramping in both legs that is worse whenever he walks for long periods of time.", "He has a history of poorly controlled hypertension, diabetes mellitus, recurrent renal stones, and major depressive disorder.", "He takes lisinopril, nifedipine, metformin, glyburide, and fluoxetine.", "He has a 55-pack-year smoking history and drinks alcohol socially.", "His temperature is 98.4\u00b0F (36.9\u00b0C), blood pressure is 155/85 mmHg, pulse is 92/min, and respirations are 16/min.", "On exam, he is well-appearing and in no acute distress.", "A normal S1 and S2 are heard on auscultation.", "He has no abdominal tenderness to palpation.", "A light pulsatile mass is felt in the mid-epigastrium.", "Achilles and patellar reflexes are 2+ bilaterally.", "His gait is normal."], "context_len": 13, "options": {"A": "Abdominal bruit", "B": "Asymmetric upper extremity pulses", "C": "Continuous machine-like murmur", "D": "Costovertebral tenderness"}, "answer": "Abdominal bruit", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "66 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease", "Vascular Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 66-year-old man presents to his primary care provider for a routine checkup.", "2. He says that he feels well overall but has experienced some intermittent back pain and vague epigastric pain over the past 6 months.", "3. He also has experienced cramping in both legs that is worse whenever he walks for long periods of time.", "4. He has a history of poorly controlled hypertension, diabetes mellitus, recurrent renal stones, and major depressive disorder.", "5. He takes lisinopril, nifedipine, metformin, glyburide, and fluoxetine.", "6. He has a 55-pack-year smoking history and drinks alcohol socially.", "7. His temperature is 98.4\u00b0F (36.9\u00b0C), blood pressure is 155/85 mmHg, pulse is 92/min, and respirations are 16/min.", "8. On exam, he is well-appearing and in no acute distress.", "9. A normal S1 and S2 are heard on auscultation.", "10. He has no abdominal tenderness to palpation.", "11. A light pulsatile mass is felt in the mid-epigastrium.", "12. Achilles and patellar reflexes are 2+ bilaterally.", "13. His gait is normal."], "atomic_facts": ["1. He feels well overall", "2. He has experienced intermittent back pain over the past 6 months", "3. He has experienced vague epigastric pain over the past 6 months", "4. He has experienced cramping in both legs", "5. Cramping is worse whenever he walks for long periods of time", "6. He has a history of poorly controlled hypertension", "7. He has a history of diabetes mellitus", "8. He has a history of recurrent renal stones", "9. He has a history of major depressive disorder", "10. He takes lisinopril", "11. He takes nifedipine", "12. He takes metformin", "13. He takes glyburide", "14. He takes fluoxetine", "15. He has a 55-pack-year smoking history", "16. He drinks alcohol socially", "17. His temperature is 98.4\u00b0F (36.9\u00b0C)", "18. His blood pressure is 155/85 mmHg", "19. His pulse is 92/min", "20. His respirations are 16/min", "21. On exam, he is well-appearing", "22. On exam, he is in no acute distress", "23. A normal S1 is heard on auscultation", "24. A normal S2 is heard on auscultation", "25. He has no abdominal tenderness to palpation", "26. A light pulsatile mass is felt in the mid-epigastrium", "27. Achilles reflexes are 2+ bilaterally", "28. Patellar reflexes are 2+ bilaterally", "29. His gait is normal"]}
{"id": 765, "question": "A mutation in which of the following proteins most likely contributed to this patient\u2019s condition?", "context": ["A 17-year-old male collapses 25 minutes into a soccer game.", "He is unresponsive and pulseless.", "Despite adequate resuscitation by a bystander, the patient is pronounced dead when the ambulance arrives.", "The patient had no past medical history other than a heart murmur as a child and he took no medications.", "His family history is notable for an uncle who died suddenly of unknown causes at the age of 25."], "context_len": 5, "options": {"A": "Myosin heavy chain", "B": "Dystrophin", "C": "Fibrilin", "D": "Elastin"}, "answer": "Myosin heavy chain", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "17", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 17-year-old male collapses 25 minutes into a soccer game.", "2. He is unresponsive and pulseless.", "3. Despite adequate resuscitation by a bystander, the patient is pronounced dead when the ambulance arrives.", "4. The patient had no past medical history other than a heart murmur as a child.", "5. The patient took no medications.", "6. His family history is notable for an uncle who died suddenly of unknown causes at the age of 25."], "atomic_facts": ["1. The patient is unresponsive.", "2. The patient is pulseless.", "3. The patient was resuscitated by a bystander.", "4. The patient was pronounced dead when the ambulance arrived.", "5. The patient had a heart murmur as a child.", "6. The patient had no past medical history other than a heart murmur.", "7. The patient took no medications.", "8. The patient's family history includes an uncle who died suddenly at the age of 25.", "9. The cause of the uncle's death is unknown."]}
{"id": 766, "question": "Which of the following findings is most likely on ultrasound?", "context": ["A 36-year-old woman, gravida 3, para 2, at 31 weeks' gestation comes to the emergency department because of painless, bright red vaginal bleeding for one day.", "She has not felt any contractions.", "Her other children were delivered by Cesarean section because of breech position.", "Fetal heart rate is reactive with no decelerations."], "context_len": 4, "options": {"A": "Retroplacental hematoma", "B": "Adnexal bleeding", "C": "Placenta over the cervical os", "D": "Gestational sac in a dilated cervix"}, "answer": "Placenta over the cervical os", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "36 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Placenta over the cervical os"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 36-year-old woman comes to the emergency department.", "2. She is gravida 3, para 2.", "3. She is at 31 weeks' gestation.", "4. She has painless, bright red vaginal bleeding for one day.", "5. She has not felt any contractions.", "6. Her other children were delivered by Cesarean section.", "7. The Cesarean section was due to breech position.", "8. Fetal heart rate is reactive with no decelerations."], "atomic_facts": ["1. She has not felt any contractions.", "2. Her other children were delivered by Cesarean section because of breech position.", "3. Fetal heart rate is reactive with no decelerations."]}
{"id": 767, "question": "Which of the following best describes the most likely diagnosis?", "context": ["A 24-year-old man is brought to the emergency department for bowling at a local bowling alley while inappropriately dressed.", "The patient refused to speak with police and was seen conversing with inanimate objects in the back of the police car.", "The patient states that his clothes were contaminated by assassins who have been tracking him for years.", "The patient refuses to answer any further questions, and continues to whisper toward someone else.", "The patient has a past medical history of homelessness, alcohol abuse, marijuana use, and cocaine abuse.", "Physical exam is notable for a healthy young man who seems mistrustful of all hospital personnel.", "The patient is started on a medication and is transferred to the psychiatric inpatient unit.", "The patient\u2019s condition improves, but he still often speaks of a contamination that is on his clothes and skin that is coming from external parties.", "The patient is started on a new medication.", "He is then sent to group therapy, followed by physical activity in the yard.", "The physician is called over when the patient is found down in the recreation yard while he was exercising.", "The patient is not responsive, and his limbs seem to resist passive force.", "His temperature is 104\u00b0F (40\u00b0C), pulse is 112/min, blood pressure is 140/90 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air."], "context_len": 13, "options": {"A": "Dehydration", "B": "Dopamine blockade", "C": "Inadequate evaporative cooling", "D": "Infection"}, "answer": "Dopamine blockade", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "24 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 24-year-old man is brought to the emergency department.", "2. The patient was bowling at a local bowling alley while inappropriately dressed.", "3. The patient refused to speak with police.", "4. The patient was seen conversing with inanimate objects in the back of the police car.", "5. The patient states that his clothes were contaminated by assassins who have been tracking him for years.", "6. The patient refuses to answer any further questions, and continues to whisper toward someone else.", "7. The patient has a past medical history of homelessness, alcohol abuse, marijuana use, and cocaine abuse.", "8. Physical exam is notable for a healthy young man who seems mistrustful of all hospital personnel.", "9. The patient is started on a medication and is transferred to the psychiatric inpatient unit.", "10. The patient\u2019s condition improves, but he still often speaks of a contamination that is on his clothes and skin that is coming from external parties.", "11. The patient is started on a new medication.", "12. He is then sent to group therapy, followed by physical activity in the yard.", "13. The physician is called over when the patient is found down in the recreation yard while he was exercising.", "14. The patient is not responsive, and his limbs seem to resist passive force.", "15. His temperature is 104\u00b0F (40\u00b0C), pulse is 112/min, blood pressure is 140/90 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air."], "atomic_facts": ["1. The patient refused to speak with police.", "2. The patient was seen conversing with inanimate objects in the back of the police car.", "3. The patient states that his clothes were contaminated by assassins who have been tracking him for years.", "4. The patient refuses to answer any further questions.", "5. The patient continues to whisper toward someone else.", "6. The patient has a past medical history of homelessness, alcohol abuse, marijuana use, and cocaine abuse.", "7. Physical exam is notable for a healthy young man who seems mistrustful of all hospital personnel.", "8. The patient is started on a medication and is transferred to the psychiatric inpatient unit.", "9. The patient\u2019s condition improves, but he still often speaks of a contamination that is on his clothes and skin that is coming from external parties.", "10. The patient is started on a new medication.", "11. The patient is sent to group therapy, followed by physical activity in the yard.", "12. The physician is called over when the patient is found down in the recreation yard while he was exercising.", "13. The patient is not responsive.", "14. The patient's limbs seem to resist passive force.", "15. The patient's temperature is 104\u00b0F (40\u00b0C).", "16. The patient's pulse is 112/min.", "17. The patient's blood pressure is 140/90 mmHg.", "18. The patient's respirations are 18/min.", "19. The patient's oxygen saturation is 95% on room air."]}
{"id": 768, "question": "Which of the following is the best next step in management?", "context": ["A 23-year-old male presents to the emergency department after he was found naked wandering his neighborhood.", "The patient is disheveled and has not bathed in months.", "The patient has a past medical history of alcohol abuse and schizophrenia that is well controlled with haloperidol.", "The patient is started on haloperidol and most of his symptoms improve dramatically; however, he continues to refuse to eat food from the hospital as he believes it to be contaminated.", "The patient stays on the inpatient psychiatric unit and lab values are drawn and return as follows: |  | Serum: | Na+: 135 mEq/L | K+: 3.0 mEq/L | Cl-: 92 mEq/L | HCO3-: 22 mEq/L | BUN: 7 mg/dL | Ca2+: 8.4 mg/dL | Creatinine: 0.6 mg/dL | Glucose: 70 mg/dL |  | That patient is started on an intravenous solution containing potassium chloride and is closely monitored.", "His oral intake also seems to be improving.", "Lab values are ordered again the following day and return as follows: |  | Serum: | Na+: 137 mEq/L | K+: 2.9 mEq/L | Cl-: 95 mEq/L | HCO3-: 22 mEq/L | BUN: 8 mg/dL | Ca2+: 9.0 mg/dL | Creatinine: 1.0 mg/dL | Glucose: 77 mg/dL |  | The patient is continued on IV fluids and his clinical symptoms seem to further improve.", "Repeat labs the following three days remains largely unchanged.", "The patient's symptoms improve and he is determined to be at his baseline in terms of functioning."], "context_len": 9, "options": {"A": "Discharge the patient on IM haloperidol", "B": "IV fluids containing potassium", "C": "IV fluids containing magnesium", "D": "Increase oral intake"}, "answer": "IV fluids containing magnesium", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "23", "specialties": ["Psychiatry", "Emergency Medicine"], "subspecialties": ["General Psychiatry", "General Emergency Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 23-year-old male presents to the emergency department after he was found naked wandering his neighborhood.", "2. The patient is disheveled and has not bathed in months.", "3. The patient has a past medical history of alcohol abuse and schizophrenia that is well controlled with haloperidol.", "4. The patient is started on haloperidol and most of his symptoms improve dramatically.", "5. The patient continues to refuse to eat food from the hospital as he believes it to be contaminated.", "6. The patient stays on the inpatient psychiatric unit.", "7. Lab values are drawn and return as follows: Serum Na+: 135 mEq/L, K+: 3.0 mEq/L, Cl-: 92 mEq/L, HCO3-: 22 mEq/L, BUN: 7 mg/dL, Ca2+: 8.4 mg/dL, Creatinine: 0.6 mg/dL, Glucose: 70 mg/dL.", "8. The patient is started on an intravenous solution containing potassium chloride and is closely monitored.", "9. His oral intake also seems to be improving.", "10. Lab values are ordered again the following day and return as follows: Serum Na+: 137 mEq/L, K+: 2.9 mEq/L, Cl-: 95 mEq/L, HCO3-: 22 mEq/L, BUN: 8 mg/dL, Ca2+: 9.0 mg/dL, Creatinine: 1.0 mg/dL, Glucose: 77 mg/dL.", "11. The patient is continued on IV fluids and his clinical symptoms seem to further improve.", "12. Repeat labs the following three days remains largely unchanged.", "13. The patient's symptoms improve and he is determined to be at his baseline in terms of functioning."], "atomic_facts": ["1. The patient is disheveled and has not bathed in months.", "2. The patient has a past medical history of alcohol abuse.", "3. The patient has a past medical history of schizophrenia.", "4. The patient's schizophrenia is well controlled with haloperidol.", "5. The patient is started on haloperidol and most of his symptoms improve dramatically.", "6. The patient continues to refuse to eat food from the hospital as he believes it to be contaminated.", "7. The patient stays on the inpatient psychiatric unit.", "8. Lab values are drawn and return as follows: Serum: Na+: 135 mEq/L, K+: 3.0 mEq/L, Cl-: 92 mEq/L, HCO3-: 22 mEq/L, BUN: 7 mg/dL, Ca2+: 8.4 mg/dL, Creatinine: 0.6 mg/dL, Glucose: 70 mg/dL.", "9. The patient is started on an intravenous solution containing potassium chloride and is closely monitored.", "10. The patient's oral intake seems to be improving.", "11. Lab values are ordered again the following day and return as follows: Serum: Na+: 137 mEq/L, K+: 2.9 mEq/L, Cl-: 95 mEq/L, HCO3-: 22 mEq/L, BUN: 8 mg/dL, Ca2+: 9.0 mg/dL, Creatinine: 1.0 mg/dL, Glucose: 77 mg/dL.", "12. The patient is continued on IV fluids and his clinical symptoms seem to further improve.", "13. Repeat labs the following three days remains largely unchanged.", "14. The patient's symptoms improve and he is determined to be at his baseline in terms of functioning."]}
{"id": 769, "question": "Without treatment, which of the following is this patient most likely to develop?", "context": ["A 2-year-old girl is brought to the physician because of high-grade fever and crying while passing urine.", "Four months ago, she was treated for a febrile urinary tract infection with cefixime.", "There is no family history of serious illness.", "Her temperature is 39.2\u00b0C (102.6\u00b0F) and pulse is 123/min.", "Physical examination shows no abnormalities.", "Urine dipstick shows leukocyte esterase; urinalysis shows WBCs.", "Urine culture shows Escherichia coli sensitive to cefixime.", "A voiding cystourethrogram is shown."], "context_len": 8, "options": {"A": "Renal cell carcinoma", "B": "Hypotension", "C": "Renal scarring", "D": "Nephrotic syndrome"}, "answer": "Renal scarring", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2-year-old girl is brought to the physician.", "2. Four months ago, she was treated for a febrile urinary tract infection with cefixime.", "3. There is no family history of serious illness.", "4. Her temperature is 39.2\u00b0C (102.6\u00b0F).", "5. Her pulse is 123/min.", "6. Physical examination shows no abnormalities.", "7. Urine dipstick shows leukocyte esterase.", "8. Urinalysis shows WBCs.", "9. Urine culture shows Escherichia coli.", "10. Escherichia coli is sensitive to cefixime.", "11. A voiding cystourethrogram is shown.", "12. The girl is crying while passing urine.", "13. The girl has high-grade fever."], "atomic_facts": ["1. Four months ago, she was treated for a febrile urinary tract infection with cefixime.", "2. There is no family history of serious illness.", "3. Her temperature is 39.2\u00b0C (102.6\u00b0F) and pulse is 123/min.", "4. Physical examination shows no abnormalities.", "5. Urine dipstick shows leukocyte esterase.", "6. Urinalysis shows WBCs.", "7. Urine culture shows Escherichia coli sensitive to cefixime.", "8. A voiding cystourethrogram is shown."]}
{"id": 770, "question": "What is the most likely diagnosis?", "context": ["A 37-year-old man presents to his primary care physician with a chief complaint of diarrhea.", "The patient states that his symptoms have worsened recently.", "He works as a farmer and is dressed in tattered and old denim.", "He lives alone, and this is the first time he has come to town in years.", "The patient\u2019s diet is mostly dairy products and some meat products.", "He denies any systemic symptoms and states that diarrhea tends to occur right after a meal.", "He also claims that at times he struggles to fall asleep, and sometimes he feels he lacks energy.", "The patient is instructed to avoid consuming dairy products for a week and to return with a report of his symptoms.", "As you set up the return appointment with this patient you notice that he is rather emotionless.", "He also states that he lacks anybody that he can list as an emergency contact so he leaves that section of his medical forms blank."], "context_len": 10, "options": {"A": "Avoidant personality disorder", "B": "Major depressive disorder", "C": "Schizoid personality disorder", "D": "Schizotypal personality disorder"}, "answer": "Schizoid personality disorder", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "37 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 37-year-old man presents to his primary care physician with a chief complaint of diarrhea.", "2. The patient states that his symptoms have worsened recently.", "3. He works as a farmer and is dressed in tattered and old denim.", "4. He lives alone, and this is the first time he has come to town in years.", "5. The patient\u2019s diet is mostly dairy products and some meat products.", "6. He denies any systemic symptoms and states that diarrhea tends to occur right after a meal.", "7. He also claims that at times he struggles to fall asleep, and sometimes he feels he lacks energy.", "8. The patient is instructed to avoid consuming dairy products for a week and to return with a report of his symptoms.", "9. As you set up the return appointment with this patient you notice that he is rather emotionless.", "10. He also states that he lacks anybody that he can list as an emergency contact so he leaves that section of his medical forms blank."], "atomic_facts": ["1. The patient's symptoms have worsened recently.", "2. The patient works as a farmer and is dressed in tattered and old denim.", "3. The patient lives alone and has not come to town in years.", "4. The patient's diet is mostly dairy products and some meat products.", "5. The patient denies any systemic symptoms and states that diarrhea tends to occur right after a meal.", "6. The patient struggles to fall asleep at times and feels he lacks energy.", "7. The patient is instructed to avoid consuming dairy products for a week and to return with a report of his symptoms.", "8. The patient appears rather emotionless during the appointment.", "9. The patient lacks anybody that he can list as an emergency contact and leaves that section of his medical forms blank."]}
{"id": 771, "question": "Which of the following is the most likely diagnosis?", "context": ["A 77-year-old man presents to the emergency department with a change in his mental status.", "The patient\u2019s daughter states that he can cook and clean up after himself and only needs help paying bills.", "Yesterday the patient seemed fine; however, this morning she noticed that he struggled to perform simple tasks and was forgetful while cooking, leaving the stove on.", "They recently returned from a trip to Mexico and admit to drinking unfiltered water and eating local cuisines while abroad.", "The patient has a past medical history of hypertension and diabetes.", "His temperature is 97.5\u00b0F (36.4\u00b0C), blood pressure is 187/118 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 100% on room air."], "context_len": 6, "options": {"A": "Alzheimer dementia", "B": "Lewy body dementia", "C": "Normal pressure hydrocephalus", "D": "Vascular dementia"}, "answer": "Vascular dementia", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "77 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 77-year-old man presents to the emergency department with a change in his mental status.", "2. The patient's daughter states that he can cook and clean up after himself and only needs help paying bills.", "3. Yesterday the patient seemed fine.", "4. This morning she noticed that he struggled to perform simple tasks and was forgetful while cooking, leaving the stove on.", "5. They recently returned from a trip to Mexico.", "6. They admit to drinking unfiltered water and eating local cuisines while abroad.", "7. The patient has a past medical history of hypertension and diabetes.", "8. His temperature is 97.5\u00b0F (36.4\u00b0C).", "9. His blood pressure is 187/118 mmHg.", "10. His pulse is 90/min.", "11. His respirations are 16/min.", "12. His oxygen saturation is 100% on room air."], "atomic_facts": ["1. The patient's daughter states that he can cook and clean up after himself and only needs help paying bills.", "2. Yesterday the patient seemed fine.", "3. This morning she noticed that he struggled to perform simple tasks and was forgetful while cooking, leaving the stove on.", "4. They recently returned from a trip to Mexico.", "5. They admit to drinking unfiltered water and eating local cuisines while abroad.", "6. The patient has a past medical history of hypertension and diabetes.", "7. His temperature is 97.5\u00b0F (36.4\u00b0C).", "8. His blood pressure is 187/118 mmHg.", "9. His pulse is 90/min.", "10. His respirations are 16/min.", "11. His oxygen saturation is 100% on room air."]}
{"id": 772, "question": "Which of the following most likely accounts for this patient\u2019s dyspnea?", "context": ["A 65-year-old male with a past medical history of left ventricular hypertrophy presents to the emergency room because of a history of progressive shortness of breath and a cough productive of frothy pink sputum.", "Physical examination reveals crackles at the lung bases bilaterally.", "The patient denies fever, chills, or any recent infection.", "A radiograph of the chest shows septal lines and areas of opacification in both lung fields (see image). | ."], "context_len": 4, "options": {"A": "Destruction of interalveolar septa", "B": "Excess mucous production in bronchiolar epithelium", "C": "A collection of air in the pleural space", "D": "Alveolar and interstitial fluid accumulation"}, "answer": "Alveolar and interstitial fluid accumulation", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease", "Cardiovascular Disease", "Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 65-years-old.", "2. Patient has a past medical history of left ventricular hypertrophy.", "3. Patient presents to the emergency room due to progressive shortness of breath and a cough productive of frothy pink sputum.", "4. Physical examination reveals crackles at the lung bases bilaterally.", "5. Patient denies fever, chills, or any recent infection.", "6. Radiograph of the chest shows septal lines and areas of opacification in both lung fields."], "atomic_facts": ["1. Physical examination reveals crackles at the lung bases bilaterally.", "2. The patient denies fever.", "3. The patient denies chills.", "4. The patient denies any recent infection.", "5. A radiograph of the chest shows septal lines.", "6. A radiograph of the chest shows areas of opacification in both lung fields."]}
{"id": 773, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 42-year-old man is brought to the emergency department because of several episodes of black, tarlike stool and lightheadedness over the past couple of days.", "He underwent an appendectomy at the age of 16.", "He has hypertension and tension headaches.", "He drinks 4 beers daily.", "Current medications include amlodipine and naproxen.", "His temperature is 36.7\u00b0C (98\u00b0F), pulse is 100/min, and his blood pressure is 100/70 mm Hg.", "The lungs are clear to auscultation bilaterally.", "The abdomen is soft, nondistended, and nontender.", "The liver is palpated 3 cm below the right costal margin.", "His hemoglobin concentration is 10 g/dL.", "Intravenous fluid resuscitation is begun.", "An esophagogastroduodenoscopy is performed, which does not show bleeding."], "context_len": 12, "options": {"A": "Double-balloon enteroscopy", "B": "Colonoscopy", "C": "Laparotomy", "D": "Angiography\n\""}, "answer": "Colonoscopy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "42 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 42 years old.", "2. Patient has had several episodes of black, tarlike stool and lightheadedness over the past couple of days.", "3. Patient had an appendectomy at the age of 16.", "4. Patient has hypertension and tension headaches.", "5. Patient drinks 4 beers daily.", "6. Patient is currently taking amlodipine and naproxen.", "7. Patient's temperature is 36.7\u00b0C (98\u00b0F).", "8. Patient's pulse is 100/min.", "9. Patient's blood pressure is 100/70 mm Hg.", "10. Lungs are clear to auscultation bilaterally.", "11. Abdomen is soft, nondistended, and nontender.", "12. Liver is palpated 3 cm below the right costal margin.", "13. Patient's hemoglobin concentration is 10 g/dL.", "14. Intravenous fluid resuscitation is begun.", "15. Esophagogastroduodenoscopy is performed, which does not show bleeding."], "atomic_facts": ["1. He underwent an appendectomy at the age of 16.", "2. He has hypertension and tension headaches.", "3. He drinks 4 beers daily.", "4. Current medications include amlodipine and naproxen.", "5. His temperature is 36.7\u00b0C (98\u00b0F), pulse is 100/min, and his blood pressure is 100/70 mm Hg.", "6. The lungs are clear to auscultation bilaterally.", "7. The abdomen is soft, nondistended, and nontender.", "8. The liver is palpated 3 cm below the right costal margin.", "9. His hemoglobin concentration is 10 g/dL.", "10. Intravenous fluid resuscitation is begun.", "11. An esophagogastroduodenoscopy is performed, which does not show bleeding."]}
{"id": 774, "question": "Which of the following is the most appropriate next step in diagnosis?\"", "context": ["A 68-year-old man comes to the physician because of constipation and decreased appetite during the past several months.", "In the past 2 weeks, he has also noticed an increasing frequency of urination.", "He has not had any dysuria or flank pain.", "He has a history of hypertension, calcium pyrophosphate crystal arthritis, and alcoholic cirrhosis.", "Current medications include hydrochlorothiazide, rifaximin, lactulose, and naproxen as needed for the joint pain.", "He quit drinking 5 years ago.", "He does not smoke cigarettes.", "His vital signs are within normal limits.", "Physical examination shows decreased bowel sounds but is otherwise unremarkable.", "Serum studies show: | Creatinine 1.1 mg/dL | Calcium 11.8 mg/dL | Phosphorus 2.1 mg/dL | Magnesium 1.6 mg/dL | Total protein 6 g/dL | Albumin 3.1 g/dL | AST 53 U/L | ALT 43 U/L | ."], "context_len": 10, "options": {"A": "Serum parathyroid-related protein level", "B": "Urine and serum protein electrophoresis", "C": "Serum parathyroid hormone level", "D": "X-ray of the chest"}, "answer": "Serum parathyroid hormone level", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "68 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 68-year-old man comes to the physician because of constipation and decreased appetite during the past several months.", "2. In the past 2 weeks, he has also noticed an increasing frequency of urination.", "3. He has not had any dysuria or flank pain.", "4. He has a history of hypertension.", "5. He has a history of calcium pyrophosphate crystal arthritis.", "6. He has a history of alcoholic cirrhosis.", "7. Current medications include hydrochlorothiazide.", "8. Current medications include rifaximin.", "9. Current medications include lactulose.", "10. Current medications include naproxen as needed for the joint pain.", "11. He quit drinking 5 years ago.", "12. He does not smoke cigarettes.", "13. His vital signs are within normal limits.", "14. Physical examination shows decreased bowel sounds but is otherwise unremarkable.", "15. Serum studies show creatinine 1.1 mg/dL.", "16. Serum studies show calcium 11.8 mg/dL.", "17. Serum studies show phosphorus 2.1 mg/dL.", "18. Serum studies show magnesium 1.6 mg/dL.", "19. Serum studies show total protein 6 g/dL.", "20. Serum studies show albumin 3.1 g/dL.", "21. Serum studies show AST 53 U/L.", "22. Serum studies show ALT 43 U/L."], "atomic_facts": ["1. In the past 2 weeks, he has noticed an increasing frequency of urination.", "2. He has not had any dysuria or flank pain.", "3. He has a history of hypertension, calcium pyrophosphate crystal arthritis, and alcoholic cirrhosis.", "4. Current medications include hydrochlorothiazide, rifaximin, lactulose, and naproxen as needed for the joint pain.", "5. He quit drinking 5 years ago.", "6. He does not smoke cigarettes.", "7. His vital signs are within normal limits.", "8. Physical examination shows decreased bowel sounds but is otherwise unremarkable.", "9. Serum studies show: Creatinine 1.1 mg/dL, Calcium 11.8 mg/dL, Phosphorus 2.1 mg/dL, Magnesium 1.6 mg/dL, Total protein 6 g/dL, Albumin 3.1 g/dL, AST 53 U/L, ALT 43 U/L."]}
{"id": 775, "question": "Which of the following tests would most likely confirm the diagnosis in this patient?", "context": ["A 68-year-old African American male presents to his primary care provider complaining of progressively worsening back pain.", "The pain is localized to the lower back and sometimes wakes him up from sleep.", "He has a history of hypertension and admits to a 50 pack-year smoking history.", "Further questioning reveals that he has also experienced fatigue and an unintentional weight loss of 18 pounds over the past year.", "Laboratory analysis is notable for an elevated alkaline phosphatase.", "A radiograph of the patient\u2019s spine demonstrates multiple sclerotic lesions in the lumbar vertebral bodies."], "context_len": 6, "options": {"A": "Renal biopsy", "B": "Fine needle aspiration of the thyroid", "C": "Transrectal ultrasound-guided prostate biopsy", "D": "Chest radiograph"}, "answer": "Transrectal ultrasound-guided prostate biopsy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "68", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery", "Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 68-year-old African American male presents to his primary care provider.", "2. He is complaining of progressively worsening back pain.", "3. The pain is localized to the lower back.", "4. The pain sometimes wakes him up from sleep.", "5. He has a history of hypertension.", "6. He admits to a 50 pack-year smoking history.", "7. He has also experienced fatigue.", "8. He has experienced an unintentional weight loss of 18 pounds over the past year.", "9. Laboratory analysis is notable for an elevated alkaline phosphatase.", "10. A radiograph of the patient\u2019s spine demonstrates multiple sclerotic lesions in the lumbar vertebral bodies."], "atomic_facts": ["1. The pain is localized to the lower back.", "2. The pain sometimes wakes him up from sleep.", "3. He has a history of hypertension.", "4. He admits to a 50 pack-year smoking history.", "5. He has experienced fatigue.", "6. He has experienced unintentional weight loss of 18 pounds over the past year.", "7. Laboratory analysis is notable for an elevated alkaline phosphatase.", "8. A radiograph of the patient\u2019s spine demonstrates multiple sclerotic lesions in the lumbar vertebral bodies."]}
{"id": 776, "question": "The most likely cause of this patient's symptoms is associated with which of the following structures?", "context": ["A 75-year-old man presents to his primary care physician because he has been experiencing increasing muscle and joint pain over the last 3 months.", "He says that he also feels increasingly fatigued and weak despite no change to his daily routine.", "His past medical history is significant for an infection when he was 12 years of age that led to 2 months of paralysis and mechanical ventilation through a tracheostomy tube.", "At the time, he developed the paralysis after 3 days of fever and sore throat.", "He recalls that he was still able to feel everything and was embarrassed that his daily activities had to be performed for him by caregivers."], "context_len": 5, "options": {"A": "DNA virus", "B": "Enveloped (-) stranded RNA virus", "C": "Naked (+) stranded RNA virus", "D": "Naked (-) stranded RNA virus"}, "answer": "Naked (+) stranded RNA virus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "75", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 75-year-old man presents to his primary care physician.", "2. He has been experiencing increasing muscle and joint pain over the last 3 months.", "3. He also feels increasingly fatigued and weak despite no change to his daily routine.", "4. His past medical history is significant for an infection when he was 12 years of age.", "5. The infection led to 2 months of paralysis and mechanical ventilation through a tracheostomy tube.", "6. He developed the paralysis after 3 days of fever and sore throat.", "7. He recalls that he was still able to feel everything.", "8. He was embarrassed that his daily activities had to be performed for him by caregivers."], "atomic_facts": ["1. He feels increasingly fatigued and weak.", "2. There has been no change to his daily routine.", "3. His past medical history includes an infection at 12 years old.", "4. The infection led to 2 months of paralysis.", "5. Mechanical ventilation was required through a tracheostomy tube.", "6. The paralysis developed after 3 days of fever and sore throat.", "7. He was still able to feel everything during the paralysis.", "8. Caregivers had to perform his daily activities for him."]}
{"id": 777, "question": "Which of the following is the most likely etiology of this patient\u2019s symptoms?", "context": ["A 2-year-old boy was rushed to the emergency department in the early morning by his mother because he was unresponsive to deep pain stimuli.", "The patient\u2019s mother said that he has been suffering from a fever, cough and runny nose for the last 10 days.", "2 days ago, they visited a free clinic and received medication.", "When she gave him the medication yesterday, the patient had 3 episodes of vomiting and his condition rapidly worsened.", "This morning, the patient did not wake up, even after multiple attempts.", "On physical examination, the patient is febrile, hypotensive, and tachycardic.", "Peripheral pulses are 1+, and his extremities are pale and cool to touch.", "Pupils are equal and slowly reactive to light.", "Significant hepatomegaly is noted."], "context_len": 9, "options": {"A": "Decrease in beta-oxidation", "B": "Increase in gluconeogenesis", "C": "Increase in beta-oxidation", "D": "Increase in glycolysis"}, "answer": "Decrease in beta-oxidation", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Emergency Medicine", "Neurology with Special Qualification in Child Neurology", "Pediatric Neurology", "Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2-year-old boy was rushed to the emergency department in the early morning by his mother.", "2. The patient's mother said he has been suffering from a fever, cough and runny nose for the last 10 days.", "3. 2 days ago, they visited a free clinic and received medication.", "4. When she gave him the medication yesterday, the patient had 3 episodes of vomiting.", "5. His condition rapidly worsened this morning, and he did not wake up, even after multiple attempts.", "6. On physical examination, the patient is febrile, hypotensive, and tachycardic.", "7. Peripheral pulses are 1+, and his extremities are pale and cool to touch.", "8. Pupils are equal and slowly reactive to light.", "9. Significant hepatomegaly is noted."], "atomic_facts": ["1. The patient has been suffering from a fever, cough, and runny nose for the last 10 days.", "2. Two days ago, they visited a free clinic and received medication.", "3. When the patient was given the medication yesterday, he had 3 episodes of vomiting and his condition rapidly worsened.", "4. This morning, the patient did not wake up, even after multiple attempts.", "5. On physical examination, the patient is febrile, hypotensive, and tachycardic.", "6. Peripheral pulses are 1+ and his extremities are pale and cool to touch.", "7. Pupils are equal and slowly reactive to light.", "8. Significant hepatomegaly is noted."]}
{"id": 778, "question": "Which of the following drugs has a mechanism of action that is similar to the pathophysiology of this patient's disease?", "context": ["A 24-year-old patient presents to your gastroenterology practice on a referral from her primary care provider.", "The patient has been experiencing postprandial bloating and abdominal pain for one year.", "Symptoms occur following the ingestion of milk products."], "context_len": 3, "options": {"A": "Omeprazole", "B": "Bismuth", "C": "Octreotide", "D": "Magnesium hydroxide"}, "answer": "Magnesium hydroxide", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "24", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 24-year-old patient presents to a gastroenterology practice.", "2. The patient was referred by her primary care provider.", "3. The patient has been experiencing postprandial bloating and abdominal pain for one year.", "4. Symptoms occur following the ingestion of milk products."], "atomic_facts": ["1. The patient has been experiencing postprandial bloating for one year.", "2. The patient has been experiencing abdominal pain for one year.", "3. The symptoms occur following the ingestion of milk products."]}
{"id": 779, "question": "In which location is dimeric IgA most likely to be found in highest concentrations?", "context": [], "context_len": 0, "options": {"A": "Colostrum", "B": "Blood from the fetus", "C": "Blood from the mother", "D": "Fetal bone marrow"}, "answer": "Colostrum", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Allergy and Immunology"], "subspecialties": ["General Allergy and Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": [], "atomic_facts": []}
{"id": 780, "question": "If this patient's symptoms are allowed to progress without intervention, which of the following would be expected to occur?", "context": ["A 25-year-old man presents to the ER after a street fight.", "His girlfriend reports that he was struck with a bat in the head.", "After the initial hit, she reported that he briefly lost consciousness but then was normal for several hours.", "Since then, he has been rapidly decompensating.", "He is grabbing his head in pain and his mental status is altered.", "Vital signs are stable.", "Neurological exam reveals that his right pupil is dilated and his right lid is drooping."], "context_len": 7, "options": {"A": "Right sided hemiparesis", "B": "Down and in gaze of the right pupil", "C": "Right sided homonymous hemianopsia.", "D": "Right eye with an inability to abduct"}, "answer": "Right sided hemiparesis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 25-year-old man presents to the ER after a street fight.", "2. His girlfriend reports that he was struck with a bat in the head.", "3. After the initial hit, she reported that he briefly lost consciousness but then was normal for several hours.", "4. Since then, he has been rapidly decompensating.", "5. He is grabbing his head in pain and his mental status is altered.", "6. Vital signs are stable.", "7. Neurological exam reveals that his right pupil is dilated.", "8. Neurological exam reveals that his right lid is drooping."], "atomic_facts": ["1. His girlfriend reports that he was struck with a bat in the head.", "2. After the initial hit, she reported that he briefly lost consciousness but then was normal for several hours.", "3. Since then, he has been rapidly decompensating.", "4. He is grabbing his head in pain.", "5. His mental status is altered.", "6. Vital signs are stable.", "7. Neurological exam reveals that his right pupil is dilated.", "8. Neurological exam reveals that his right lid is drooping."]}
{"id": 781, "question": "Which of the following was the portal of entry for the most likely causal organism?", "context": ["A 7-year-old girl is brought to the emergency department because of diffuse abdominal pain and multiple episodes of vomiting for 2 hours.", "She started developing fever, headache, and neck pain 3 days ago.", "On arrival, she is unresponsive.", "Her temperature is 40.3\u00b0C (104.5\u00b0F) and palpable blood pressure is 45 mm Hg.", "Physical examination shows diffuse purpuric skin lesions.", "In spite of all appropriate therapy, she dies shortly thereafter.", "Autopsy shows massive parenchymal hemorrhage of the adrenal glands."], "context_len": 7, "options": {"A": "Nasopharynx", "B": "Genital mucosa", "C": "Choroid plexus", "D": "Gastrointestinal tract"}, "answer": "Nasopharynx", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 7-year-old girl is brought to the emergency department.", "2. She has diffuse abdominal pain and multiple episodes of vomiting for 2 hours.", "3. She started developing fever, headache, and neck pain 3 days ago.", "4. On arrival, she is unresponsive.", "5. Her temperature is 40.3\u00b0C (104.5\u00b0F).", "6. Palpable blood pressure is 45 mm Hg.", "7. Physical examination shows diffuse purpuric skin lesions.", "8. In spite of all appropriate therapy, she dies shortly thereafter.", "9. Autopsy shows massive parenchymal hemorrhage of the adrenal glands."], "atomic_facts": ["1. She started developing fever, headache, and neck pain 3 days ago.", "2. On arrival, she is unresponsive.", "3. Her temperature is 40.3\u00b0C (104.5\u00b0F).", "4. Palpable blood pressure is 45 mm Hg.", "5. Physical examination shows diffuse purpuric skin lesions.", "6. In spite of all appropriate therapy, she dies shortly thereafter.", "7. Autopsy shows massive parenchymal hemorrhage of the adrenal glands."]}
{"id": 782, "question": "Which of the following, if seen microscopically, would indicate that her calf myocytes are more likely to recover without permanent damage?", "context": ["A 50-year-old female comes to the emergency department with sudden onset left-sided calf pain starting 20 minutes ago.", "Her past medical history is notable for diabetes, hypertension, and chronic atrial fibrillation controlled on an anti-arrhythmic.", "Upon arrival to the emergency department, her blood pressure is 150/91 mmHg, pulse is 100/min, and respirations of 22/min.", "Examination of the leg reveals a pale left calf with diminished dorsalis pedis and posterior tibial pulses.", "Prompt intervention relieves the patient\u2019s symptoms."], "context_len": 5, "options": {"A": "Cellular swelling", "B": "Mitochondrial vacuolization", "C": "Nuclear pyknosis", "D": "Fragmented cells and debris"}, "answer": "Cellular swelling", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "50", "specialties": ["Internal Medicine", "Pathology"], "subspecialties": ["Cardiology", "General Pathology", "Cardiovascular Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 50-year-old female comes to the emergency department.", "2. She has sudden onset left-sided calf pain starting 20 minutes ago.", "3. Her past medical history is notable for diabetes, hypertension, and chronic atrial fibrillation controlled on an anti-arrhythmic.", "4. Upon arrival to the emergency department, her blood pressure is 150/91 mmHg.", "5. Her pulse is 100/min.", "6. Her respirations are 22/min.", "7. Examination of the leg reveals a pale left calf with diminished dorsalis pedis and posterior tibial pulses.", "8. Prompt intervention relieves the patient\u2019s symptoms."], "atomic_facts": ["1. Her past medical history includes diabetes, hypertension, and chronic atrial fibrillation.", "2. Her chronic atrial fibrillation is controlled on an anti-arrhythmic.", "3. Upon arrival to the emergency department, her blood pressure is 150/91 mmHg.", "4. Upon arrival to the emergency department, her pulse is 100/min.", "5. Upon arrival to the emergency department, her respirations are 22/min.", "6. Examination of the leg reveals a pale left calf.", "7. Examination of the leg reveals diminished dorsalis pedis pulses.", "8. Examination of the leg reveals diminished posterior tibial pulses.", "9. Prompt intervention relieves the patient\u2019s symptoms."]}
{"id": 783, "question": "Damage to which of the following structures is most likely responsible for this patient's current symptoms?", "context": ["A 56-year-old man comes to the physician because of progressive worsening of vision in both his eyes over the past 6 months.", "He reports that he first noticed some blurring of his vision and glare in the evenings, which have both gotten worse in this period.", "He works as a tower crane operator and spends most of his day outdoors.", "Ophthalmologic examination shows visual acuity of 20/100 in both eyes.", "A photograph of the eye is shown."], "context_len": 5, "options": {"A": "Aqueous humor", "B": "Vitreous body", "C": "Lens", "D": "Retina"}, "answer": "Lens", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "56 years old", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. A 56-year-old man comes to the physician.", "2. His vision has been progressively worsening over the past 6 months.", "3. He first noticed blurring of his vision and glare in the evenings.", "4. His vision has gotten worse in this period.", "5. He works as a tower crane operator.", "6. He spends most of his day outdoors.", "7. Ophthalmologic examination shows visual acuity of 20/100 in both eyes.", "8. A photograph of the eye is shown."], "atomic_facts": ["1. He first noticed blurring of his vision and glare in the evenings.", "2. The symptoms have worsened over time.", "3. He works as a tower crane operator.", "4. He spends most of his day outdoors.", "5. Ophthalmologic examination shows visual acuity of 20/100 in both eyes.", "6. A photograph of the eye is shown."]}
{"id": 784, "question": "What is the most likely pathology giving rise to this patient\u2019s condition?", "context": ["A 25-year-old man presents to the clinic with the complaint of yellow discoloration of his skin.", "He reports that the discoloration appeared gradually over the past 5 days.", "He does not have any other complaints.", "He never had similar symptoms before.", "Past medical history is only significant for a recent flu infection that was so bad that he missed work for a week.", "Physical exam is significant for yellow sclera and slight yellowish discoloration of the skin over the face and neck.", "Liver function tests reveal: | Total bilirubin level 5 mg/dL | Direct bilirubin level 0.4 mg/dL | Aspartate aminotransferase (AST) 25 U/L | Alanine aminotransferase (ALT) 15 U/L | ."], "context_len": 7, "options": {"A": "Decreased conjugation of bilirubin by uridine-diphosphate glucuronyltransferase", "B": "Bile duct obstruction", "C": "Hemolysis", "D": "Decreased transport of bile into the bile canaliculi"}, "answer": "Decreased conjugation of bilirubin by uridine-diphosphate glucuronyltransferase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Internal Medicine", "Gastroenterology"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 25-year-old male.", "2. Patient has yellow discoloration of skin.", "3. Discoloration appeared gradually over the past 5 days.", "4. Patient has no other complaints.", "5. Patient never had similar symptoms before.", "6. Patient's past medical history is significant for a recent flu infection.", "7. Patient missed work for a week due to the flu infection.", "8. Physical exam is significant for yellow sclera and slight yellowish discoloration of the skin over the face and neck.", "9. Total bilirubin level is 5 mg/dL.", "10. Direct bilirubin level is 0.4 mg/dL.", "11. Aspartate aminotransferase (AST) is 25 U/L.", "12. Alanine aminotransferase (ALT) is 15 U/L."], "atomic_facts": ["1. The discoloration appeared gradually over the past 5 days.", "2. He does not have any other complaints.", "3. He never had similar symptoms before.", "4. Past medical history is only significant for a recent flu infection that was so bad that he missed work for a week.", "5. Physical exam is significant for yellow sclera and slight yellowish discoloration of the skin over the face and neck.", "6. Liver function tests reveal: Total bilirubin level 5 mg/dL.", "7. Liver function tests reveal: Direct bilirubin level 0.4 mg/dL.", "8. Liver function tests reveal: Aspartate aminotransferase (AST) 25 U/L.", "9. Liver function tests reveal: Alanine aminotransferase (ALT) 15 U/L."]}
{"id": 785, "question": "Further evaluation of this patient is most likely to show which of the following findings?", "context": ["A 17-year-old girl is brought to the physician by her father because of concerns about her behavior.", "She worries excessively about her weight and body image, and has frequent diarrhea.", "She is 170 cm (5 ft 7 in) tall and weighs 63.5 kg (140 lb); BMI is 22 kg/m2.", "She appears anxious but well.", "Vital signs are within normal limits.", "Physical examination shows calluses on the knuckles of her right hand."], "context_len": 6, "options": {"A": "Parotid gland swelling", "B": "Elevated blood pressure", "C": "Right upper quadrant tenderness", "D": "Jugular venous distention"}, "answer": "Parotid gland swelling", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "17 years old", "specialties": ["Psychiatry"], "subspecialties": ["Child and Adolescent Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 17-year-old girl is brought to the physician by her father.", "2. She worries excessively about her weight and body image.", "3. She has frequent diarrhea.", "4. She is 170 cm (5 ft 7 in) tall.", "5. She weighs 63.5 kg (140 lb).", "6. Her BMI is 22 kg/m2.", "7. She appears anxious but well.", "8. Vital signs are within normal limits.", "9. Physical examination shows calluses on the knuckles of her right hand."], "atomic_facts": ["1. She worries excessively about her weight and body image.", "2. She has frequent diarrhea.", "3. She is 170 cm (5 ft 7 in) tall.", "4. She weighs 63.5 kg (140 lb).", "5. Her BMI is 22 kg/m2.", "6. She appears anxious.", "7. She appears well.", "8. Vital signs are within normal limits.", "9. Physical examination shows calluses on the knuckles of her right hand."]}
{"id": 786, "question": "The most likely cause of these findings is a fracture of which of the following bones?", "context": ["A 36-year-old woman comes to the emergency department because of left wrist pain and swelling that started immediately after a fall.", "She was walking her dog when the dog abruptly pulled away, causing her to fall forward onto both hands.", "Physical examination shows left wrist pain with pinching and grasping, moderate swelling, and mild tenderness.", "Her left thumb is placed in a thumb immobilization splint.", "An x-ray of the wrist 2 days later is shown."], "context_len": 5, "options": {"A": "Scaphoid", "B": "Ulna", "C": "Lunate", "D": "Hamate"}, "answer": "Scaphoid", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "36 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Surgery of the Hand", "General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 36-year-old woman comes to the emergency department.", "2. She has left wrist pain and swelling.", "3. The pain and swelling started immediately after a fall.", "4. She was walking her dog when the dog abruptly pulled away, causing her to fall forward onto both hands.", "5. Physical examination shows left wrist pain with pinching and grasping, moderate swelling, and mild tenderness.", "6. Her left thumb is placed in a thumb immobilization splint.", "7. An x-ray of the wrist was taken 2 days later."], "atomic_facts": ["1. She was walking her dog.", "2. The dog abruptly pulled away.", "3. This caused her to fall forward onto both hands.", "4. Physical examination shows left wrist pain.", "5. Left wrist pain is associated with pinching and grasping.", "6. There is moderate swelling in the left wrist.", "7. There is mild tenderness in the left wrist.", "8. Her left thumb is placed in a thumb immobilization splint.", "9. An x-ray of the wrist was taken 2 days later."]}
{"id": 787, "question": "Which of the following is the most likely cause of these findings?", "context": ["A 2200-g (4-lb 14-oz) newborn is delivered at term to a 37-year-old primigravid woman.", "Apgar scores are 6 and 8 at 1 and 5 minutes, respectively.", "Examination in the delivery room shows that he is at the 2nd percentile for head circumference and at the 10th percentile for length.", "He has a small jaw, small eyes, and low-set ears.", "There is a keyhole-shaped defect in the iris of the left eye.", "He has seven fingers on each hand.", "There is an opening in the roof of the mouth extending into the soft and hard palate bilaterally.", "Cleft lip and cleft palate are present.", "A 3/6 holosystolic murmur is heard at the left lower sternal border.", "The heels are prominent, with convex-shaped deformity of the plantar surface of the feet."], "context_len": 10, "options": {"A": "Fragile X syndrome", "B": "Trisomy 18", "C": "Fetal alcohol syndrome", "D": "Trisomy 13"}, "answer": "Trisomy 13", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "37 years old", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 2200-g (4-lb 14-oz) newborn is delivered at term.", "2. The mother is a 37-year-old primigravid woman.", "3. Apgar scores are 6 and 8 at 1 and 5 minutes, respectively.", "4. Examination in the delivery room shows the newborn is at the 2nd percentile for head circumference.", "5. Examination in the delivery room shows the newborn is at the 10th percentile for length.", "6. The newborn has a small jaw.", "7. The newborn has small eyes.", "8. The newborn has low-set ears.", "9. There is a keyhole-shaped defect in the iris of the left eye.", "10. The newborn has seven fingers on each hand.", "11. There is an opening in the roof of the mouth extending into the soft and hard palate bilaterally.", "12. Cleft lip and cleft palate are present.", "13. A 3/6 holosystolic murmur is heard at the left lower sternal border.", "14. The heels are prominent.", "15. There is a convex-shaped deformity of the plantar surface of the feet."], "atomic_facts": ["1. Apgar score at 1 minute is 6.", "2. Apgar score at 5 minutes is 8.", "3. The baby is at the 2nd percentile for head circumference.", "4. The baby is at the 10th percentile for length.", "5. The baby has a small jaw.", "6. The baby has small eyes.", "7. The baby has low-set ears.", "8. There is a keyhole-shaped defect in the iris of the left eye.", "9. The baby has seven fingers on each hand.", "10. There is an opening in the roof of the mouth extending into the soft and hard palate bilaterally.", "11. Cleft lip and cleft palate are present.", "12. A 3/6 holosystolic murmur is heard at the left lower sternal border.", "13. The heels are prominent, with convex-shaped deformity of the plantar surface of the feet."]}
{"id": 788, "question": "Which of the following changes in the oxygen-hemoglobin curve would most likely be expected in this patient?", "context": ["A 55-year-old woman is rushed to the emergency department after being found lying unconscious in a burning house by a firefighter.", "No history can be obtained.", "Her vital signs include pulse 130/min and respirations 16/min.", "Physical examination reveals soot all over her face.", "Scattered wheezes can be heard on auscultation of the chest.", "A thorough survey of the body shows no evidence of any burn injuries."], "context_len": 6, "options": {"A": "The curve would be shifted left due to an increased oxygen binding affinity by hemoglobin.", "B": "The curve would be shifted left due to metabolic acidosis in peripheral tissues.", "C": "The curve would be unchanged because the partial pressure of oxygen is unchanged.", "D": "The curve would be shifted right due to decreased hemoglobin affinity for oxygen."}, "answer": "The curve would be shifted left due to an increased oxygen binding affinity by hemoglobin.", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "55 years old", "specialties": ["Internal Medicine", "Emergency Medicine"], "subspecialties": ["General Emergency Medicine", "Critical Care Medicine", "Pulmonary Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old woman is rushed to the emergency department.", "2. She was found lying unconscious in a burning house by a firefighter.", "3. No history can be obtained.", "4. Her pulse is 130/min.", "5. Her respirations are 16/min.", "6. Physical examination reveals soot all over her face.", "7. Scattered wheezes can be heard on auscultation of the chest.", "8. A thorough survey of the body shows no evidence of any burn injuries."], "atomic_facts": ["1. No history can be obtained.", "2. Her vital signs include pulse 130/min and respirations 16/min.", "3. Physical examination reveals soot all over her face.", "4. Scattered wheezes can be heard on auscultation of the chest.", "5. A thorough survey of the body shows no evidence of any burn injuries."]}
{"id": 789, "question": "Of the following, which medication is most likely responsible for his presentation?", "context": ["A 73-year-old man with a past medical history significant for high blood pressure, hypothyroidism, and diabetes presents to the outpatient clinic.", "He complains of joint pain, muscle pain, and fatigue that has been present for the last several weeks.", "On examination, you notice a butterfly-shaped rash across the bridge of his nose and cheeks.", "He has a blood pressure of 124/72 mm Hg and heart rate of 64/min."], "context_len": 4, "options": {"A": "Verapamil", "B": "Clonidine", "C": "Hydralazine", "D": "Terazosin"}, "answer": "Hydralazine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "73", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine", "Hypertension Specialist"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 73-year-old man presents to the outpatient clinic.", "2. His past medical history is significant for high blood pressure, hypothyroidism, and diabetes.", "3. He complains of joint pain, muscle pain, and fatigue for the last several weeks.", "4. On examination, there is a butterfly-shaped rash across the bridge of his nose and cheeks.", "5. His blood pressure is 124/72 mm Hg.", "6. His heart rate is 64/min."], "atomic_facts": ["1. The patient complains of joint pain, muscle pain, and fatigue.", "2. The symptoms have been present for the last several weeks.", "3. On examination, a butterfly-shaped rash is noticed across the bridge of the nose and cheeks.", "4. The patient has a blood pressure of 124/72 mm Hg.", "5. The patient has a heart rate of 64/min."]}
{"id": 790, "question": "Which of the following set of laboratory findings would most likely be seen in this patient?", "context": ["A 65-year-old woman with a 6-month history of acute promyelocytic leukemia managed with all-trans-retinoic acid presents with severe abdominal pain, nausea, vomiting, and bloody urine.", "The patient states her symptoms onset acutely a few hours ago and has not improved.", "She describes the pain as severe, sharp and stabbing in character, and diffusely localized to the umbilical region, accompanied by nausea and vomiting.", "The patient also states that she noticed blood in her urine last time she urinated.", "No additional significant past medical history.", "Her vitals signs include: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 95/75 mm Hg, pulse 115/min, respiratory rate 23/min, and oxygen saturation 99% on room air.", "On physical examination, the patient is ill-appearing and in severe distress.", "The cardiac exam is normal.", "Lungs are clear to auscultation.", "The abdomen is severely tender and out of proportion with physical exam findings.", "There are diffuse petechiae present over the entire body.", "Laboratory results are pending.", "A peripheral blood smear is shown in the exhibit.", "A contrast CT of the abdomen shows findings consistent with acute mesenteric ischemia."], "context_len": 14, "options": {"A": "PT: \u2191 | PTT \u2191 | Bleeding time: \u2191 | Fibrin split products: \u2191 | D-dimer: \u2191| Fibrinogen: \u2191 | Platelet count: \u2193", "B": "PT: \u2193 | PTT \u2193 | Bleeding time: \u2191 | Fibrin split products: \u2191 | D-dimer: \u2191| Fibrinogen: \u2193 | Platelet count: \u2193", "C": "PT: \u2191 | PTT \u2191 | Bleeding time: \u2191 | Fibrin split products: \u2191 | D-dimer: \u2191| Fibrinogen: \u2193 | Platelet count: \u2193", "D": "PT: \u2193 | PTT \u2193 | Bleeding time: \u2193 | Fibrin split products: \u2193 | D-dimer: \u2193| Fibrinogen: \u2193 | Platelet count: \u2193"}, "answer": "PT: \u2191 | PTT \u2191 | Bleeding time: \u2191 | Fibrin split products: \u2191 | D-dimer: \u2191| Fibrinogen: \u2193 | Platelet count: \u2193", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "65 years old", "specialties": ["Hematology"], "subspecialties": ["Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 65-years-old.", "2. Patient has a 6-month history of acute promyelocytic leukemia managed with all-trans-retinoic acid.", "3. Patient presents with severe abdominal pain, nausea, vomiting, and bloody urine.", "4. Symptoms onset acutely a few hours ago and have not improved.", "5. Pain is severe, sharp and stabbing in character, and diffusely localized to the umbilical region, accompanied by nausea and vomiting.", "6. Patient noticed blood in her urine last time she urinated.", "7. No additional significant past medical history.", "8. Temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 95/75 mm Hg, pulse 115/min, respiratory rate 23/min, and oxygen saturation 99% on room air.", "9. Patient is ill-appearing and in severe distress.", "10. Cardiac exam is normal.", "11. Lungs are clear to auscultation.", "12. Abdomen is severely tender and out of proportion with physical exam findings.", "13. Diffuse petechiae present over the entire body.", "14. Laboratory results are pending.", "15. Peripheral blood smear is shown in the exhibit.", "16. Contrast CT of the abdomen shows findings consistent with acute mesenteric ischemia."], "atomic_facts": ["1. The patient's symptoms onset acutely a few hours ago and has not improved.", "2. The pain is severe, sharp, and stabbing in character, and diffusely localized to the umbilical region.", "3. The pain is accompanied by nausea and vomiting.", "4. The patient noticed blood in her urine last time she urinated.", "5. No additional significant past medical history.", "6. Vitals signs: temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 95/75 mm Hg, pulse 115/min, respiratory rate 23/min, and oxygen saturation 99% on room air.", "7. On physical examination, the patient is ill-appearing and in severe distress.", "8. The cardiac exam is normal.", "9. Lungs are clear to auscultation.", "10. The abdomen is severely tender and out of proportion with physical exam findings.", "11. There are diffuse petechiae present over the entire body.", "12. Laboratory results are pending.", "13. A contrast CT of the abdomen shows findings consistent with acute mesenteric ischemia."]}
{"id": 791, "question": "Which of the following is the most appropriate initial pharmacotherapy in this patient?", "context": ["A 32-year-old woman comes to the physician because of a throbbing left-sided headache that started 3 hours ago.", "Two hours ago, she took ibuprofen with no relief.", "She has been vomiting every 20 minutes since the start of the headache.", "She reports that she could not see very well for a few minutes this morning.", "A similar episode occurred last week.", "She is otherwise healthy and has recently started taking an oral contraceptive.", "Her vital signs are within normal limits.", "Physical examination shows no abnormalities except mild sensitivity to light.", "Visual acuity is 20/20."], "context_len": 9, "options": {"A": "Intranasal dihydroergotamine and subcutaneous sumatriptan", "B": "Oral tramadol", "C": "Intravenous prochlorperazine", "D": "Oral ketorolac and oral ergotamine\n\""}, "answer": "Intravenous prochlorperazine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "32", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 32-year-old woman comes to the physician.", "2. She has a throbbing left-sided headache that started 3 hours ago.", "3. Two hours ago, she took ibuprofen with no relief.", "4. She has been vomiting every 20 minutes since the start of the headache.", "5. She reports that she could not see very well for a few minutes this morning.", "6. A similar episode occurred last week.", "7. She is otherwise healthy.", "8. She has recently started taking an oral contraceptive.", "9. Her vital signs are within normal limits.", "10. Physical examination shows no abnormalities except mild sensitivity to light.", "11. Visual acuity is 20/20."], "atomic_facts": ["1. Two hours ago, she took ibuprofen with no relief.", "2. She has been vomiting every 20 minutes since the start of the headache.", "3. She reports that she could not see very well for a few minutes this morning.", "4. A similar episode occurred last week.", "5. She is otherwise healthy and has recently started taking an oral contraceptive.", "6. Her vital signs are within normal limits.", "7. Physical examination shows no abnormalities except mild sensitivity to light.", "8. Visual acuity is 20/20."]}
{"id": 792, "question": "Which of the following mechanisms best explains the effect of amiodarone on the coagulation profile of this patient?", "context": ["A 66-year-old man presents with palpitation, syncope, and difficulty breathing.", "He has a past medical history of stroke and his current medications include warfarin.", "Physical examination is unremarkable.", "An ECG is performed and shows ventricular tachycardia.", "The patient is treated successfully with amiodarone.", "At the time of discharge, his medications include warfarin and amiodarone, and he is cautioned that his PT might be prolonged."], "context_len": 6, "options": {"A": "Amiodarone induces CYP3A4 leading to a decreased effectiveness of warfarin", "B": "Amiodarone inhibits CYP2C9 leading to an increased risk of bleeding", "C": "Amiodarone causes hepatotoxicity which requires monitoring of the prothrombin time", "D": "Inorganic iodine from amiodarone decreases the effectiveness of warfarin"}, "answer": "Amiodarone inhibits CYP2C9 leading to an increased risk of bleeding", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "66 years old", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["General Cardiology", "Cardiovascular Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 66-year-old man presents with palpitation, syncope, and difficulty breathing.", "2. He has a past medical history of stroke.", "3. His current medications include warfarin.", "4. Physical examination is unremarkable.", "5. An ECG is performed and shows ventricular tachycardia.", "6. The patient is treated successfully with amiodarone.", "7. At the time of discharge, his medications include warfarin and amiodarone.", "8. He is cautioned that his PT might be prolonged."], "atomic_facts": ["1. The patient has a past medical history of stroke.", "2. The patient's current medications include warfarin.", "3. Physical examination is unremarkable.", "4. An ECG is performed and shows ventricular tachycardia.", "5. The patient is treated successfully with amiodarone.", "6. At the time of discharge, the patient's medications include warfarin and amiodarone.", "7. The patient is cautioned that his PT might be prolonged."]}
{"id": 793, "question": "What is the most appropriate initial treatment for this patient?", "context": ["A 55-year-old woman presents to the emergency department with recent onset confusion and photophobia.", "Upon questioning her husband, you discover the patient has been sick over the past week with fevers and productive sputum.", "Her vital signs are Temperature 102.6 Pulse 80 Respirations 18 Blood Pressure 110/70.", "The physical exam is significant for lethargy and nuchal rigidity.", "A lumbar puncture is performed and demonstrates cloudy fluid with an opening pressure of 35 cm H20, cell count of 1500 cells/uL (neutrophil predominant), protein level of 50 mg/dL and glucose of 30 mg/dL.", "Computed tomography scan demonstrates no space-occupying lesions."], "context_len": 6, "options": {"A": "Acyclovir", "B": "Ceftriaxone and dexamethasone", "C": "Vancomycin, ceftriaxone, ampicillin and dexamethasone", "D": "Vancomycin, ceftriaxone and ampicillin"}, "answer": "Vancomycin, ceftriaxone, ampicillin and dexamethasone", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "55 years old", "specialties": ["Neurology"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 55 years old.", "2. Patient presents to the emergency department with recent onset confusion and photophobia.", "3. Patient has been sick over the past week with fevers and productive sputum.", "4. Patient's temperature is 102.6.", "5. Patient's pulse is 80.", "6. Patient's respirations are 18.", "7. Patient's blood pressure is 110/70.", "8. Patient's physical exam is significant for lethargy and nuchal rigidity.", "9. Lumbar puncture is performed.", "10. Lumbar puncture fluid is cloudy.", "11. Lumbar puncture opening pressure is 35 cm H20.", "12. Lumbar puncture cell count is 1500 cells/uL (neutrophil predominant).", "13. Lumbar puncture protein level is 50 mg/dL.", "14. Lumbar puncture glucose is 30 mg/dL.", "15. Computed tomography scan demonstrates no space-occupying lesions."], "atomic_facts": ["1. The patient has been sick over the past week with fevers and productive sputum.", "2. Vital signs: Temperature 102.6, Pulse 80, Respirations 18, Blood Pressure 110/70.", "3. Physical exam shows lethargy and nuchal rigidity.", "4. Lumbar puncture demonstrates cloudy fluid with an opening pressure of 35 cm H20.", "5. Lumbar puncture shows cell count of 1500 cells/uL (neutrophil predominant).", "6. Lumbar puncture reveals protein level of 50 mg/dL and glucose of 30 mg/dL.", "7. Computed tomography scan demonstrates no space-occupying lesions."]}
{"id": 794, "question": "Which of the following pathological findings is most likely to be seen on the biopsy specimen?", "context": ["A 58-year-old male presents to his primary care physician complaining of a painless bump on his penis.", "He first noticed the lesion 1 year ago but was too embarrassed to mention the issue at his last annual physical exam.", "The lesion has since grown in size and has recently become more erythematous.", "He has hypertension treated with lisinopril.", "At age 45, he was successfully treated for phimosis with a steroid cream.", "He first engaged in sexual intercourse at age 14 and has had \u201ctoo many sexual partners to count\u201d in his lifetime.", "He smoked one pack of cigarettes daily for 30 years but quit 10 years ago.", "He drinks one alcoholic beverage daily.", "Physical examination shows a nontender 5 mm x 5 mm ulcerated lesion with an erythematous base on the dorsum of the glans.", "There is no inguinal lymphadenopathy.", "Excisional biopsy of the lesion is performed."], "context_len": 11, "options": {"A": "Atypical squamous cells with varying degrees of mitotic activity", "B": "Spirochetes on dark-field microscopy", "C": "Nonspecific inflammatory features with C. trachomatis amplification on PCR", "D": "Safety pin-shaped intracellular inclusions that appear purple on Giemsa stain"}, "answer": "Atypical squamous cells with varying degrees of mitotic activity", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "58", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is 58 years old.", "2. Patient complains of a painless bump on his penis.", "3. Patient first noticed the lesion 1 year ago.", "4. Patient was too embarrassed to mention the issue at his last annual physical exam.", "5. Lesion has grown in size and become more erythematous.", "6. Patient has hypertension treated with lisinopril.", "7. Patient was successfully treated for phimosis with a steroid cream at age 45.", "8. Patient first engaged in sexual intercourse at age 14.", "9. Patient has had \"too many sexual partners to count\" in his lifetime.", "10. Patient smoked one pack of cigarettes daily for 30 years.", "11. Patient quit smoking 10 years ago.", "12. Patient drinks one alcoholic beverage daily.", "13. Physical examination shows a nontender 5 mm x 5 mm ulcerated lesion with an erythematous base on the dorsum of the glans.", "14. No inguinal lymphadenopathy.", "15. Excisional biopsy of the lesion is performed."], "atomic_facts": ["1. The patient first noticed the lesion 1 year ago.", "2. The patient was too embarrassed to mention the issue at his last annual physical exam.", "3. The lesion has grown in size.", "4. The lesion has recently become more erythematous.", "5. The patient has hypertension treated with lisinopril.", "6. At age 45, the patient was successfully treated for phimosis with a steroid cream.", "7. The patient first engaged in sexual intercourse at age 14.", "8. The patient has had \u201ctoo many sexual partners to count\u201d in his lifetime.", "9. The patient smoked one pack of cigarettes daily for 30 years but quit 10 years ago.", "10. The patient drinks one alcoholic beverage daily.", "11. Physical examination shows a nontender 5 mm x 5 mm ulcerated lesion with an erythematous base on the dorsum of the glans.", "12. There is no inguinal lymphadenopathy.", "13. Excisional biopsy of the lesion is performed."]}
{"id": 795, "question": "His serum creatinine concentration is 1.6 mg/dL and blood urea nitrogen concentration is 20 mg/dL.This patient is at increased risk for which of the following complications?", "context": ["A 54-year-old man comes to the physician for a follow-up appointment.", "Three weeks ago he underwent emergent cardiac catheterization because of a myocardial infarction and had to stay at the hospital longer than expected because of decreased kidney function.", "He says his symptoms have since improved greatly and he now produces even more urine than before the procedure."], "context_len": 3, "options": {"A": "Hypermagnesemia", "B": "Metabolic alkalosis", "C": "Hypernatremia", "D": "Hypokalemia"}, "answer": "Hypokalemia", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "54", "specialties": ["Nephrology", "Internal Medicine"], "subspecialties": ["General Nephrology", "Nephrology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 54-year-old man comes to the physician for a follow-up appointment.", "2. Three weeks ago he underwent emergent cardiac catheterization because of a myocardial infarction.", "3. He had to stay at the hospital longer than expected because of decreased kidney function.", "4. He says his symptoms have since improved greatly.", "5. He now produces even more urine than before the procedure."], "atomic_facts": ["1. Three weeks ago, he underwent emergent cardiac catheterization.", "2. The reason for the cardiac catheterization was a myocardial infarction.", "3. He had to stay at the hospital longer than expected.", "4. The extended stay was due to decreased kidney function.", "5. His symptoms have improved greatly since the procedure.", "6. He now produces even more urine than before the procedure."]}
{"id": 796, "question": "WBC 2,500/mm3 | Platelets 95,000/mm3 | What is the most likely diagnosis?", "context": ["A 35-year-old woman visits her primary care provider with complaints of easy fatigability, breathlessness on exertion, and altered sensations in her lower limbs.", "Past medical history is positive for hypertension.", "She takes hydrochlorothiazide and lisinopril, ethinyl estradiol-progestin, and a multivitamin every day.", "Family history is noncontributory.", "She drinks alcohol almost every day and smokes cigarettes when she drinks.", "Today her heart rate is 95/min, respiratory rate is 17/min, blood pressure is 130/92 mm Hg, and temperature of 37.0\u00b0C (98.6\u00b0F).", "Overall, she has marked pallor with slight bluing of her lips and distal fingertips.", "Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally.", "Additionally, she has loss of touch, and vibration sense in both of her lower limbs.", "Her CBC is as follows: | Hemoglobin 8.0 g/dL | MCV 112 fL | ."], "context_len": 10, "options": {"A": "Vitamin B12 deficiency", "B": "Folic acid deficiency", "C": "Vitamin C deficiency", "D": "Vitamin A deficiency"}, "answer": "Vitamin B12 deficiency", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "35", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 35-year-old woman.", "2. Patient has complaints of easy fatigability, breathlessness on exertion, and altered sensations in her lower limbs.", "3. Patient has a past medical history of hypertension.", "4. Patient takes hydrochlorothiazide and lisinopril, ethinyl estradiol-progestin, and a multivitamin every day.", "5. Patient's family history is noncontributory.", "6. Patient drinks alcohol almost every day and smokes cigarettes when she drinks.", "7. Patient's heart rate is 95/min.", "8. Patient's respiratory rate is 17/min.", "9. Patient's blood pressure is 130/92 mm Hg.", "10. Patient's temperature is 37.0\u00b0C (98.6\u00b0F).", "11. Patient has marked pallor with slight bluing of her lips and distal fingertips.", "12. Patient's heart has a regular rate and rhythm.", "13. Patient's lungs are clear to auscultation bilaterally.", "14. Patient has loss of touch, and vibration sense in both of her lower limbs.", "15. Patient's CBC hemoglobin is 8.0 g/dL.", "16. Patient's CBC MCV is 112 fL."], "atomic_facts": ["1. Past medical history is positive for hypertension.", "2. She takes hydrochlorothiazide and lisinopril, ethinyl estradiol-progestin, and a multivitamin every day.", "3. Family history is noncontributory.", "4. She drinks alcohol almost every day and smokes cigarettes when she drinks.", "5. Today her heart rate is 95/min, respiratory rate is 17/min, blood pressure is 130/92 mm Hg, and temperature of 37.0\u00b0C (98.6\u00b0F).", "6. Overall, she has marked pallor with slight bluing of her lips and distal fingertips.", "7. Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally.", "8. Additionally, she has loss of touch, and vibration sense in both of her lower limbs.", "9. Her CBC is as follows: Hemoglobin 8.0 g/dL, MCV 112 fL."]}
{"id": 797, "question": "The compound responsible for this patient\u2019s clinical presentation has what mechanism of action?", "context": ["A 40-year-old man is brought by his wife with nausea and vomiting.", "He had been working for four hours on repairing his car with the garage shutter closed and the car running but did not lose consciousness.", "The patient\u2019s blood pressure is 120/70 mmHg, respirations are 28/min, pulse is 120/min, and SaO2 is 98% on room air.", "The patient has no medical history and is not taking any medications.", "The patient has 1 alcoholic drink/week and does not use any other illicit drugs.", "Ophthalmologic exam reveals bilateral retinal hemorrhages."], "context_len": 6, "options": {"A": "Inhibits the electron transport chain", "B": "Inhibits acetylcholine esterase", "C": "Prevents acetylcholine release", "D": "DNA alkylation"}, "answer": "Inhibits the electron transport chain", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "40 years old", "specialties": ["Emergency Medicine", "Gastroenterology"], "subspecialties": ["General Emergency Medicine", "General Gastroenterology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 40-year-old man is brought by his wife with nausea and vomiting.", "2. He had been working for four hours on repairing his car with the garage shutter closed and the car running but did not lose consciousness.", "3. The patient\u2019s blood pressure is 120/70 mmHg.", "4. The patient\u2019s respirations are 28/min.", "5. The patient\u2019s pulse is 120/min.", "6. The patient\u2019s SaO2 is 98% on room air.", "7. The patient has no medical history.", "8. The patient is not taking any medications.", "9. The patient has 1 alcoholic drink/week.", "10. The patient does not use any other illicit drugs.", "11. Ophthalmologic exam reveals bilateral retinal hemorrhages."], "atomic_facts": ["1. He had been working for four hours on repairing his car with the garage shutter closed and the car running but did not lose consciousness.", "2. The patient\u2019s blood pressure is 120/70 mmHg.", "3. The patient\u2019s respirations are 28/min.", "4. The patient\u2019s pulse is 120/min.", "5. The patient\u2019s SaO2 is 98% on room air.", "6. The patient has no medical history.", "7. The patient is not taking any medications.", "8. The patient has 1 alcoholic drink/week.", "9. The patient does not use any other illicit drugs.", "10. Ophthalmologic exam reveals bilateral retinal hemorrhages."]}
{"id": 798, "question": "Which of these findings is most concerning regarding the severity of his hypovolemia?", "context": ["A 54-year-old man is hospitalized after a left hemicolectomy for colon cancer.", "On postoperative day 1, his hemoglobin is noted on routine labs to have dropped overnight from 7.1 g/dL to 5.3 g/dL.", "The patient does not report feeling any differently.", "On exam, his temperature is 100.4\u00b0F (38.0\u00b0C), blood pressure is 102/80 mmHg, pulse is 95/min, and respirations are 14/min.", "The patient\u2019s urine output in his Foley bag has been 1.0 cc/kg/hr for the last 8 hours.", "Prior to the operation, the patient had a temperature of 98.8\u00b0F (37.1\u00b0C), blood pressure of 122/70 mmHg, and a pulse of 65/min."], "context_len": 6, "options": {"A": "Decreased pulse pressure", "B": "Decreased systolic blood pressure", "C": "Increased heart rate", "D": "Increased temperature"}, "answer": "Decreased systolic blood pressure", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "54 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Critical Care Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 54-year-old man is hospitalized after a left hemicolectomy for colon cancer.", "2. On postoperative day 1, his hemoglobin is noted on routine labs to have dropped overnight from 7.1 g/dL to 5.3 g/dL.", "3. The patient does not report feeling any differently.", "4. On exam, his temperature is 100.4\u00b0F (38.0\u00b0C).", "5. On exam, his blood pressure is 102/80 mmHg.", "6. On exam, his pulse is 95/min.", "7. On exam, his respirations are 14/min.", "8. The patient\u2019s urine output in his Foley bag has been 1.0 cc/kg/hr for the last 8 hours.", "9. Prior to the operation, the patient had a temperature of 98.8\u00b0F (37.1\u00b0C).", "10. Prior to the operation, the patient had a blood pressure of 122/70 mmHg.", "11. Prior to the operation, the patient had a pulse of 65/min."], "atomic_facts": ["1. On postoperative day 1, the patient's hemoglobin dropped from 7.1 g/dL to 5.3 g/dL overnight.", "2. The patient does not report feeling any differently.", "3. On exam, the patient's temperature is 100.4\u00b0F (38.0\u00b0C).", "4. On exam, the patient's blood pressure is 102/80 mmHg.", "5. On exam, the patient's pulse is 95/min.", "6. On exam, the patient's respirations are 14/min.", "7. The patient's urine output in his Foley bag has been 1.0 cc/kg/hr for the last 8 hours.", "8. Prior to the operation, the patient had a temperature of 98.8\u00b0F (37.1\u00b0C).", "9. Prior to the operation, the patient had a blood pressure of 122/70 mmHg.", "10. Prior to the operation, the patient had a pulse of 65/min."]}
{"id": 799, "question": "Which of the following embryologic structures eventually ends up within the visualized structure?", "context": ["An obese 45-year-old female presents to the emergency room complaining of abdominal pain.", "She reports a 4-hour history of severe right upper quadrant pain following a fatty meal.", "She has a history of multiple similar episodes over the past year.", "An ultrasound of the right upper quadrant reveals gallstones.", "Due to the recurrent nature of her disease, she undergoes an elective laparoscopic cholecystectomy.", "While in the operating room, the surgeons use the laparoscope to visualize a structure connecting the liver to the anterior wall of the abdominal wall."], "context_len": 6, "options": {"A": "Ductus venosus", "B": "Umbilical artery", "C": "Umbilical vein", "D": "Vitelline duct"}, "answer": "Umbilical vein", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "45", "specialties": ["Obstetrics and Gynecology", "General Surgery"], "subspecialties": ["General Obstetrics and Gynecology", "General Surgery"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Surgery"}, "facts_old": ["1. An obese 45-year-old female presents to the emergency room complaining of abdominal pain.", "2. She reports a 4-hour history of severe right upper quadrant pain following a fatty meal.", "3. She has a history of multiple similar episodes over the past year.", "4. An ultrasound of the right upper quadrant reveals gallstones.", "5. Due to the recurrent nature of her disease, she undergoes an elective laparoscopic cholecystectomy.", "6. While in the operating room, the surgeons use the laparoscope to visualize a structure connecting the liver to the anterior wall of the abdominal wall."], "atomic_facts": ["1. The patient reports a 4-hour history of severe right upper quadrant pain following a fatty meal.", "2. The patient has a history of multiple similar episodes over the past year.", "3. An ultrasound of the right upper quadrant reveals gallstones.", "4. Due to the recurrent nature of her disease, the patient undergoes an elective laparoscopic cholecystectomy.", "5. While in the operating room, the surgeons use the laparoscope to visualize a structure connecting the liver to the anterior wall of the abdominal wall."]}
{"id": 800, "question": "Which of the following is the most likely cause of the headaches in this patient?", "context": ["A 28-year-old woman presents with a recent history of severe headaches.", "The patient states that the headaches came on gradually about 1 week ago and have steadily worsened.", "She describes the headaches as severe, diffuse, and frequently causing nausea and vomiting, especially in the mornings.", "Past medical history is significant for bacterial meningitis, approx.", "one month ago, that was successfully treated.", "Current medications are combined oral contraceptives and fluoxetine.", "A review of systems is significant for fatigue and daytime sleepiness.", "Family history is significant for her mother and aunt who suffer from migraines with aura.", "Her temperature is 37.0\u00b0C (98.6\u00b0F), the blood pressure is 110/70 mm Hg, the pulse is 70/min, the respiratory rate is 16/min, and the oxygen saturation is 99% on room air.", "The cardiac exam is normal.", "Lungs are clear to auscultation.", "The neurological exam is normal.", "The ophthalmic exam reveals the indistinct margins of the optic disc, bilaterally."], "context_len": 13, "options": {"A": "Genetics", "B": "Hydrocephalus", "C": "Intracranial mass", "D": "Infection"}, "answer": "Hydrocephalus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 28-year-old woman.", "2. Patient has a recent history of severe headaches.", "3. Headaches came on gradually about 1 week ago.", "4. Headaches have steadily worsened.", "5. Headaches are severe, diffuse, and frequently causing nausea and vomiting, especially in the mornings.", "6. Past medical history is significant for bacterial meningitis, approx. one month ago, that was successfully treated.", "7. Current medications are combined oral contraceptives and fluoxetine.", "8. Review of systems is significant for fatigue and daytime sleepiness.", "9. Family history is significant for her mother and aunt who suffer from migraines with aura.", "10. Temperature is 37.0\u00b0C (98.6\u00b0F).", "11. Blood pressure is 110/70 mm Hg.", "12. Pulse is 70/min.", "13. Respiratory rate is 16/min.", "14. Oxygen saturation is 99% on room air.", "15. Cardiac exam is normal.", "16. Lungs are clear to auscultation.", "17. Neurological exam is normal.", "18. Ophthalmic exam reveals the indistinct margins of the optic disc, bilaterally."], "atomic_facts": ["1. The patient's headaches started gradually about 1 week ago and have worsened.", "2. The patient describes the headaches as severe, diffuse, and causing nausea and vomiting, especially in the mornings.", "3. The patient had bacterial meningitis approximately one month ago, which was successfully treated.", "4. The patient's current medications are combined oral contraceptives and fluoxetine.", "5. The patient experiences fatigue and daytime sleepiness.", "6. The patient's mother and aunt suffer from migraines with aura.", "7. The patient's temperature is 37.0\u00b0C (98.6\u00b0F), blood pressure is 110/70 mm Hg, pulse is 70/min, respiratory rate is 16/min, and oxygen saturation is 99% on room air.", "8. The patient's cardiac exam is normal.", "9. The patient's lungs are clear to auscultation.", "10. The patient's neurological exam is normal.", "11. The patient's ophthalmic exam reveals indistinct margins of the optic disc bilaterally."]}
{"id": 801, "question": "Of the following, which is the most likely cause of the patient\u2019s symptoms:", "context": ["A 72-year-old presents to the Emergency Room with hemoptysis.", "He has smoked 1 pack of cigarettes a day for the past 30 years.", "Physical examination of the face is shown in Image A and is accompanied by left upper extremity edema."], "context_len": 3, "options": {"A": "Pleural effusion", "B": "Superior sulcus tumor", "C": "Pulmonary embolus", "D": "Mass in the thoracic region of the spinal cord"}, "answer": "Superior sulcus tumor", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "72 years old", "specialties": ["Pulmonary Disease", "Pulmonology"], "subspecialties": ["General Pulmonary Disease", "General Pulmonology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 72-year-old presents to the Emergency Room.", "2. The patient has a history of smoking 1 pack of cigarettes a day for the past 30 years.", "3. The patient has hemoptysis.", "4. Physical examination of the face is shown in Image A.", "5. The patient has left upper extremity edema."], "atomic_facts": ["1. He has smoked 1 pack of cigarettes a day for the past 30 years.", "2. Physical examination of the face is shown in Image A.", "3. The physical examination is accompanied by left upper extremity edema."]}
{"id": 802, "question": "A recent history of which of the following conditions would discourage the use of this drug?", "context": ["A 59-year-old man who was recently diagnosed with renal cell carcinoma comes to the physician for a follow-up evaluation.", "The physician recommends starting treatment with a chemotherapeutic agent that is also used to treat neovascular age-related macular degeneration."], "context_len": 2, "options": {"A": "Interstitial lung disease", "B": "Chronic kidney disease", "C": "Platinum allergy", "D": "Gastrointestinal bleeding"}, "answer": "Gastrointestinal bleeding", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "59", "specialties": ["Internal Medicine"], "subspecialties": ["Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 59-year-old man has been diagnosed with renal cell carcinoma.", "2. The man is coming to the physician for a follow-up evaluation.", "3. The physician is recommending starting treatment with a chemotherapeutic agent.", "4. The chemotherapeutic agent is also used to treat neovascular age-related macular degeneration."], "atomic_facts": ["1. The physician recommends starting treatment.", "2. The treatment involves a chemotherapeutic agent.", "3. The chemotherapeutic agent is used to treat neovascular age-related macular degeneration."]}
{"id": 803, "question": "Which of the following statements is correct?", "context": ["A 36-year-old woman presents with a persistent cough productive of blood-streaked sputum, night sweats, and weight loss.", "No significant past medical history.", "She denies any history of smoking, alcohol consumption, or recreational drug use.", "She works as a nurse at a local hospital and lives in an apartment with her extended family.", "Her vital signs are a blood pressure of 100/80 mm Hg, heart rate of 94/min, respiratory rate of 17/min, and temperature of 35.9\u2103 (96.6\u2109).", "Physical examination reveals dullness to percussion and diminished breath sounds over the upper lobe of the left lung.", "During the discussion regarding the required workup, the patient tells the physician about recent contact with a patient with tuberculosis.", "She asks the physician not to report her case because she is concerned she will lose her job."], "context_len": 8, "options": {"A": "If this patient is diagnosed with active pulmonary tuberculosis, it should be reported even without the patient\u2019s consent, and the patient should receive isolation and treatment.", "B": "The patient has a right to privacy, so, without her consent, the physician can not report her case even if she is diagnosed with active pulmonary tuberculosis.", "C": "If this patient turns out to have active pulmonary tuberculosis, her case can stay unreported only if she agrees to stay home from work and remain isolated at home for her entire treatment period.", "D": "Only active pulmonary tuberculosis is a reportable disease."}, "answer": "If this patient is diagnosed with active pulmonary tuberculosis, it should be reported even without the patient\u2019s consent, and the patient should receive isolation and treatment.", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "36", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease", "Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 36-year-old woman.", "2. Patient has a persistent cough productive of blood-streaked sputum, night sweats, and weight loss.", "3. Patient has no significant past medical history.", "4. Patient denies any history of smoking, alcohol consumption, or recreational drug use.", "5. Patient works as a nurse at a local hospital.", "6. Patient lives in an apartment with her extended family.", "7. Patient's blood pressure is 100/80 mm Hg.", "8. Patient's heart rate is 94/min.", "9. Patient's respiratory rate is 17/min.", "10. Patient's temperature is 35.9\u2103 (96.6\u2109).", "11. Physical examination reveals dullness to percussion and diminished breath sounds over the upper lobe of the left lung.", "12. Patient recently had contact with a patient with tuberculosis.", "13. Patient is concerned she will lose her job if her case is reported."], "atomic_facts": ["1. No significant past medical history.", "2. She denies any history of smoking, alcohol consumption, or recreational drug use.", "3. She works as a nurse at a local hospital and lives in an apartment with her extended family.", "4. Her vital signs are a blood pressure of 100/80 mm Hg, heart rate of 94/min, respiratory rate of 17/min, and temperature of 35.9\u2103 (96.6\u2109).", "5. Physical examination reveals dullness to percussion and diminished breath sounds over the upper lobe of the left lung.", "6. During the discussion regarding the required workup, the patient tells the physician about recent contact with a patient with tuberculosis.", "7. She asks the physician not to report her case because she is concerned she will lose her job."]}
{"id": 804, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 33-year-old woman gravida 2, para 1, at 35 weeks gestation is admitted to the hospital with fever and active labor.", "She reports a 2-day history of fluid leakage from the vagina without pain or vaginal bleeding.", "Her pregnancy has otherwise been uncomplicated.", "She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise.", "Her previous pregnancy was complicated by a preterm delivery at 34 weeks gestation.", "The patient reports a 10-pack-year history of smoking before pregnancy and smoked 4 cigarettes daily during pregnancy.", "At the hospital, her temperature is 39.6\u00b0C (103.3\u00b0F), blood pressure is 108/60 mm Hg, and pulse is 125/min.", "Her BMI is 18.2 kg/m2.", "Uterine palpation reveals tenderness.", "Cervical examination indicates 100% effacement and 10 cm dilation.", "Her lungs are clear to auscultation.", "The baseline fetal heart rate is 180/min."], "context_len": 12, "options": {"A": "Amnioinfusion", "B": "Ampicillin and gentamicin", "C": "Intravenous betamethasone", "D": "Ritodrine hydrochloride"}, "answer": "Ampicillin and gentamicin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "33 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Maternal", "General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 33-year-old woman is admitted to the hospital.", "2. She is gravida 2, para 1, at 35 weeks gestation.", "3. She has a 2-day history of fluid leakage from the vagina without pain or vaginal bleeding.", "4. Her pregnancy has otherwise been uncomplicated.", "5. She has attended many prenatal appointments.", "6. She followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise.", "7. Her previous pregnancy was complicated by a preterm delivery at 34 weeks gestation.", "8. She has a 10-pack-year history of smoking before pregnancy.", "9. She smoked 4 cigarettes daily during pregnancy.", "10. Her temperature is 39.6\u00b0C (103.3\u00b0F).", "11. Her blood pressure is 108/60 mm Hg.", "12. Her pulse is 125/min.", "13. Her BMI is 18.2 kg/m2.", "14. Uterine palpation reveals tenderness.", "15. Cervical examination indicates 100% effacement and 10 cm dilation.", "16. Her lungs are clear to auscultation.", "17. The baseline fetal heart rate is 180/min."], "atomic_facts": ["1. The patient reports a 2-day history of fluid leakage from the vagina without pain or vaginal bleeding.", "2. Her pregnancy has otherwise been uncomplicated.", "3. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise.", "4. Her previous pregnancy was complicated by a preterm delivery at 34 weeks gestation.", "5. The patient reports a 10-pack-year history of smoking before pregnancy and smoked 4 cigarettes daily during pregnancy.", "6. At the hospital, her temperature is 39.6\u00b0C (103.3\u00b0F), blood pressure is 108/60 mm Hg, and pulse is 125/min.", "7. Her BMI is 18.2 kg/m2.", "8. Uterine palpation reveals tenderness.", "9. Cervical examination indicates 100% effacement and 10 cm dilation.", "10. Her lungs are clear to auscultation.", "11. The baseline fetal heart rate is 180/min."]}
{"id": 805, "question": "Which of the following tests is comparatively less useful in assessing the function of the organ involved in this condition?", "context": ["A 49-year-old man, with a history of alcohol abuse over the last 2 decades, presents with a complaint of epigastric pain for about a year.", "He previously had one episode of acute pancreatitis for which he was hospitalized.", "He continued to drink 4\u20135 beers/day after he was discharged.", "His appetite is good, but he has a history of weight loss.", "He also complains of oily and bulky stools.", "He takes aluminum hydroxide gel and ranitidine for partial pain relief.", "Vital signs are stable.", "Routine physical exam and blood work are normal except for mild hypocalcemia.", "Abdominal CT scan is shown below."], "context_len": 9, "options": {"A": "Secretin stimulation test", "B": "Serum amylase and lipase levels", "C": "Fecal elastase level", "D": "Magnetic resonance cholangiopancreatography (MRCP)"}, "answer": "Serum amylase and lipase levels", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "49 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 49-year-old man.", "2. Patient has a history of alcohol abuse for the last 2 decades.", "3. Patient presents with a complaint of epigastric pain for about a year.", "4. Patient had one episode of acute pancreatitis for which he was hospitalized.", "5. Patient continued to drink 4\u20135 beers/day after he was discharged.", "6. Patient's appetite is good.", "7. Patient has a history of weight loss.", "8. Patient complains of oily and bulky stools.", "9. Patient takes aluminum hydroxide gel and ranitidine for partial pain relief.", "10. Vital signs are stable.", "11. Routine physical exam and blood work are normal except for mild hypocalcemia.", "12. Abdominal CT scan is shown below."], "atomic_facts": ["1. He previously had one episode of acute pancreatitis.", "2. He was hospitalized for the acute pancreatitis.", "3. He continued to drink 4\u20135 beers/day after he was discharged.", "4. His appetite is good.", "5. He has a history of weight loss.", "6. He complains of oily and bulky stools.", "7. He takes aluminum hydroxide gel for partial pain relief.", "8. He takes ranitidine for partial pain relief.", "9. Vital signs are stable.", "10. Routine physical exam is normal.", "11. Blood work is normal except for mild hypocalcemia.", "12. Abdominal CT scan is shown below."]}
{"id": 806, "question": "Which of the following diagnostic tests would be the most appropriate?", "context": ["A 34-year-old woman presents to the office due to a pulmonary embolism confirmed by computed tomography (CT) chest angiogram, which she was recently hospitalized for.", "She does not have any recent surgical trauma or travel history.", "She complains of having episodes where her fingers become white and then blue, and they are usually accompanied by pain in the same region.", "These episodes tend to happen more frequently during winter and have been ongoing for about 2 years now.", "She also had a spontaneous abortion at 12 weeks of gestation last year.", "She does not have a family history of venous thromboembolic disease.", "The vital signs include heart rate 76/min, respiratory rate 18/min, temperature 37.2\u00b0C (99.0\u00b0F), and blood pressure 120/80 mm Hg.", "Physical examination is non-contributory.", "The complete blood count (CBC) results are as follows: | Hemoglobin 14.2 g/dL | Hematocrit 39% | Leukocyte count 4,950/mm3 | Neutrophils 59% | Bands 3% | Eosinophils 1% | Basophils 0% | Lymphocytes 31% | Monocytes 4% | Platelet count 120,000/mm3 | The coagulation test results are as follows: | Partial thromboplastin time (activated) 56 seconds | Prothrombin time 15 seconds | Reticulocyte count 1.0% | Thrombin time < 2 seconds deviation from control | ."], "context_len": 9, "options": {"A": "Protein C", "B": "Factor-V-Leiden", "C": "Lupus anticoagulant", "D": "Protein S"}, "answer": "Lupus anticoagulant", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology", "Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. Patient is a 34-year-old woman.", "2. Patient was recently hospitalized for a pulmonary embolism confirmed by CT chest angiogram.", "3. Patient does not have any recent surgical trauma or travel history.", "4. Patient complains of episodes where her fingers become white and then blue, accompanied by pain in the same region.", "5. Episodes tend to happen more frequently during winter and have been ongoing for about 2 years.", "6. Patient had a spontaneous abortion at 12 weeks of gestation last year.", "7. Patient does not have a family history of venous thromboembolic disease.", "8. Vital signs include heart rate 76/min, respiratory rate 18/min, temperature 37.2\u00b0C (99.0\u00b0F), and blood pressure 120/80 mm Hg.", "9. Physical examination is non-contributory.", "10. CBC results: Hemoglobin 14.2 g/dL, Hematocrit 39%, Leukocyte count 4,950/mm3, Neutrophils 59%, Bands 3%, Eosinophils 1%, Basophils 0%, Lymphocytes 31%, Monocytes 4%, Platelet count 120,000/mm3.", "11. Coagulation test results: Partial thromboplastin time (activated) 56 seconds, Prothrombin time 15 seconds, Reticulocyte count 1.0%, Thrombin time < 2 seconds deviation from control."], "atomic_facts": ["1. The patient does not have recent surgical trauma or travel history.", "2. She experiences episodes where her fingers become white and then blue, accompanied by pain in the same region.", "3. These episodes occur more frequently during winter and have been ongoing for about 2 years.", "4. The patient had a spontaneous abortion at 12 weeks of gestation last year.", "5. There is no family history of venous thromboembolic disease.", "6. Vital signs include heart rate 76/min, respiratory rate 18/min, temperature 37.2\u00b0C (99.0\u00b0F), and blood pressure 120/80 mm Hg.", "7. Physical examination is non-contributory.", "8. Complete blood count (CBC) results: Hemoglobin 14.2 g/dL, Hematocrit 39%, Leukocyte count 4,950/mm3, Neutrophils 59%, Bands 3%, Eosinophils 1%, Basophils 0%, Lymphocytes 31%, Monocytes 4%, Platelet count 120,000/mm3.", "9. Coagulation test results: Partial thromboplastin time (activated) 56 seconds, Prothrombin time 15 seconds, Reticulocyte count 1.0%, Thrombin time < 2 seconds deviation from control."]}
{"id": 807, "question": "Which of the following is the most appropriate next step in the management of this patient?", "context": ["A 36-year-old woman, gravida 3, para 2, at 34 weeks' gestation is brought to the emergency department for the evaluation of continuous, dark, vaginal bleeding that started one hour ago.", "She also reports severe lower abdominal pain.", "Her current pregnancy was complicated by preeclampsia.", "Her first two children were delivered vaginally.", "Current medications include methyldopa and a multivitamin.", "Her pulse is 100/min, respirations are 16/min, and blood pressure is 90/60 mm Hg.", "The abdomen is tender, and hypertonic contractions are felt.", "There is blood on the vulva and on the medial aspect of both thighs bilaterally.", "The fetus is in a cephalic presentation.", "The fetal heart rate is 170/min with several decelerations."], "context_len": 10, "options": {"A": "Emergency cesarean delivery", "B": "Elective cesarean delivery", "C": "Administration of terbutaline", "D": "Administration of oxytocin and normal vaginal birth"}, "answer": "Emergency cesarean delivery", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "36 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology", "Maternal"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 36-year-old woman.", "2. Gravida 3, para 2.", "3. 34 weeks' gestation.", "4. Brought to the emergency department for evaluation of continuous, dark, vaginal bleeding that started one hour ago.", "5. Severe lower abdominal pain.", "6. Pregnancy complicated by preeclampsia.", "7. First two children delivered vaginally.", "8. Current medications include methyldopa and a multivitamin.", "9. Pulse is 100/min.", "10. Respirations are 16/min.", "11. Blood pressure is 90/60 mm Hg.", "12. Abdomen is tender.", "13. Hypertonic contractions are felt.", "14. Blood on the vulva and on the medial aspect of both thighs bilaterally.", "15. Fetus in cephalic presentation.", "16. Fetal heart rate is 170/min with several decelerations."], "atomic_facts": ["1. She reports severe lower abdominal pain.", "2. Her current pregnancy was complicated by preeclampsia.", "3. Her first two children were delivered vaginally.", "4. Current medications include methyldopa and a multivitamin.", "5. Her pulse is 100/min.", "6. Her respirations are 16/min.", "7. Her blood pressure is 90/60 mm Hg.", "8. The abdomen is tender.", "9. Hypertonic contractions are felt.", "10. There is blood on the vulva and on the medial aspect of both thighs bilaterally.", "11. The fetus is in a cephalic presentation.", "12. The fetal heart rate is 170/min with several decelerations."]}
{"id": 808, "question": "Further evaluation of this patient is most likely to show which of the following?", "context": ["A 16-year-old boy is brought to the emergency department because of severe left flank pain and nausea for 3 hours.", "The pain is colicky and radiates towards his groin.", "He drinks multiple glasses of iced tea every day.", "He has had similar episodes of abdominal pain in the past.", "His maternal uncle has a similar history of abdominal pain.", "His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 103/min, and blood pressure is 108/72 mm Hg.", "Examination shows a soft and nontender abdomen.", "Left costovertebral angle tenderness is present.", "An x-ray of the abdomen shows no abnormalities.", "A urinary cyanide nitroprusside test is positive."], "context_len": 10, "options": {"A": "Rhomboid crystals on urinalysis", "B": "Urinary pH of 7.8", "C": "Serum anti-Saccharomyces cerevisiae antibodies", "D": "Hexagon-shaped crystals on urinalysis"}, "answer": "Hexagon-shaped crystals on urinalysis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "16 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 16-year-old boy is brought to the emergency department.", "2. He has severe left flank pain and nausea for 3 hours.", "3. The pain is colicky and radiates towards his groin.", "4. He drinks multiple glasses of iced tea every day.", "5. He has had similar episodes of abdominal pain in the past.", "6. His maternal uncle has a similar history of abdominal pain.", "7. His temperature is 37.1\u00b0C (98.8\u00b0F).", "8. His pulse is 103/min.", "9. His blood pressure is 108/72 mm Hg.", "10. Examination shows a soft and nontender abdomen.", "11. Left costovertebral angle tenderness is present.", "12. An x-ray of the abdomen shows no abnormalities.", "13. A urinary cyanide nitroprusside test is positive."], "atomic_facts": ["1. The pain is colicky and radiates towards his groin.", "2. He drinks multiple glasses of iced tea every day.", "3. He has had similar episodes of abdominal pain in the past.", "4. His maternal uncle has a similar history of abdominal pain.", "5. His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 103/min, and blood pressure is 108/72 mm Hg.", "6. Examination shows a soft and nontender abdomen.", "7. Left costovertebral angle tenderness is present.", "8. An x-ray of the abdomen shows no abnormalities.", "9. A urinary cyanide nitroprusside test is positive."]}
{"id": 809, "question": "Which of the following is the most appropriate treatment for this patient's condition?", "context": ["A 57-year-old woman comes to the emergency department because of severe dyspnea, cough, and pleuritic chest pain for 20 minutes.", "Three weeks ago, she underwent surgery for a total right knee replacement.", "The patient appears distressed.", "Her pulse is 112/min, respirations are 24/min, and blood pressure is 88/55 mm Hg.", "Examination shows jugular venous distention.", "There is a mildly tender surgical scar on her right knee.", "A CT scan of the chest is shown."], "context_len": 7, "options": {"A": "Endovascular stent-grafting", "B": "Alteplase", "C": "Coronary angioplasty", "D": "Pericardiocentesis"}, "answer": "Alteplase", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "57 years old", "specialties": ["Internal Medicine", "Emergency Medicine"], "subspecialties": ["Pulmonary Disease", "General Emergency Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 57-year-old woman comes to the emergency department.", "2. She has severe dyspnea, cough, and pleuritic chest pain for 20 minutes.", "3. Three weeks ago, she underwent surgery for a total right knee replacement.", "4. The patient appears distressed.", "5. Her pulse is 112/min.", "6. Her respirations are 24/min.", "7. Her blood pressure is 88/55 mm Hg.", "8. Examination shows jugular venous distention.", "9. There is a mildly tender surgical scar on her right knee.", "10. A CT scan of the chest is shown."], "atomic_facts": ["1. Three weeks ago, she underwent surgery for a total right knee replacement.", "2. The patient appears distressed.", "3. Her pulse is 112/min.", "4. Her respirations are 24/min.", "5. Her blood pressure is 88/55 mm Hg.", "6. Examination shows jugular venous distention.", "7. There is a mildly tender surgical scar on her right knee.", "8. A CT scan of the chest is shown."]}
{"id": 810, "question": "What type of study has been used by the researchers in this example?", "context": ["A group of multidisciplinary researchers from a tertiary hospital decides to investigate whether there is an association between splenectomy and pulmonary tuberculosis.", "From the hospital database, they identify 19,000 patients over the age of 20 with newly diagnosed pulmonary tuberculosis, as well as 72,000 patients without pulmonary tuberculosis for comparison purposes.", "Both of these groups are matched for age, gender, and an index year when the condition was initially diagnosed.", "The odds of pulmonary tuberculosis development associated with splenectomy and other comorbidities is estimated.", "After controlling for all relevant confounders, the results show that splenectomy is associated with a two-fold higher incidence of pulmonary tuberculosis development.", "There is also a synergistic effect between splenectomy and other comorbid conditions in the development of pulmonary tuberculosis."], "context_len": 6, "options": {"A": "Cohort study", "B": "Case-control study", "C": "Ecological study", "D": "Intervention study"}, "answer": "Case-control study", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A group of multidisciplinary researchers from a tertiary hospital decides to investigate whether there is an association between splenectomy and pulmonary tuberculosis. ", "2. From the hospital database, they identify 19,000 patients over the age of 20 with newly diagnosed pulmonary tuberculosis. ", "3. From the hospital database, they identify 72,000 patients without pulmonary tuberculosis for comparison purposes. ", "4. Both of these groups are matched for age, gender, and an index year when the condition was initially diagnosed. ", "5. The odds of pulmonary tuberculosis development associated with splenectomy and other comorbidities is estimated. ", "6. After controlling for all relevant confounders, the results show that splenectomy is associated with a two-fold higher incidence of pulmonary tuberculosis development. ", "7. There is also a synergistic effect between splenectomy and other comorbid conditions in the development of pulmonary tuberculosis."], "atomic_facts": ["1. 19,000 patients over the age of 20 have newly diagnosed pulmonary tuberculosis.", "2. 72,000 patients without pulmonary tuberculosis are identified for comparison.", "3. Both groups are matched for age, gender, and an index year of diagnosis.", "4. The odds of pulmonary tuberculosis development associated with splenectomy and other comorbidities are estimated.", "5. After controlling for relevant confounders, splenectomy is associated with a two-fold higher incidence of pulmonary tuberculosis development.", "6. There is a synergistic effect between splenectomy and other comorbid conditions in the development of pulmonary tuberculosis."]}
{"id": 811, "question": "What is the best next step in evaluating this patient?", "context": ["A 53-year-old woman presents to the clinic with complaints of fatigue.", "She reports that over the past several months she has been lethargic and tired.", "She has gained 10 pounds over the past month but attributes it to her menopause.", "Her last menstrual period (LMP) was 1 year ago.", "Past medical history is significant for asthma and seasonal allergies, and medications include a rescue inhaler and cetirizine as need.", "Review of systems is negative except for cold intolerance and constipation."], "context_len": 6, "options": {"A": "Beta-hCG levels", "B": "FSH levels", "C": "Thyroid peroxidase antibody titer", "D": "TSH levels"}, "answer": "TSH levels", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "53", "specialties": ["Internal Medicine", "Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Endocrinology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 53-year-old woman presents to the clinic with complaints of fatigue.", "2. She reports that over the past several months she has been lethargic and tired.", "3. She has gained 10 pounds over the past month.", "4. She attributes her weight gain to her menopause.", "5. Her last menstrual period (LMP) was 1 year ago.", "6. Past medical history is significant for asthma.", "7. Past medical history is significant for seasonal allergies.", "8. Medications include a rescue inhaler.", "9. Medications include cetirizine as needed.", "10. Review of systems is negative except for cold intolerance.", "11. Review of systems is negative except for constipation."], "atomic_facts": ["1. The patient reports feeling lethargic and tired over the past several months.", "2. She has gained 10 pounds in the past month and attributes it to her menopause.", "3. Her last menstrual period (LMP) was 1 year ago.", "4. Her past medical history includes asthma and seasonal allergies.", "5. Her medications include a rescue inhaler and cetirizine as needed.", "6. Review of systems is negative except for cold intolerance and constipation."]}
{"id": 812, "question": "Which of the following is the most likely underlying diagnosis?", "context": ["A 33-year-old man presents to his primary care physician for fatigue, weight loss, and diffuse pruritus.", "The patient has a past medical history of multiple admissions for severe abdominal pain and bloody diarrhea as well as several episodes of ascending cholangitis which were successfully treated.", "He is currently a member of Alcoholics Anonymous.", "His temperature is 98.2\u00b0F (36.8\u00b0C), blood pressure is 124/75 mmHg, pulse is 100/min, respirations are 13/min, and oxygen saturation is 99% on room air.", "Urinalysis is notable only for a dark urine sample with no red blood cells present.", "A rectal exam reveals pale stool and grossly visible blood.", "Physical exam is otherwise notable for pruritis, jaundice, and scleral icterus."], "context_len": 7, "options": {"A": "Ascending cholangitis", "B": "Cholangiocarcinoma", "C": "Cirrhosis", "D": "Colon cancer"}, "answer": "Cholangiocarcinoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "33", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 33 years old.", "2. Patient presents with fatigue, weight loss, and diffuse pruritus.", "3. Patient has past medical history of multiple admissions for severe abdominal pain and bloody diarrhea.", "4. Patient has past medical history of several episodes of ascending cholangitis.", "5. Patient is currently a member of Alcoholics Anonymous.", "6. Patient's temperature is 98.2\u00b0F (36.8\u00b0C).", "7. Patient's blood pressure is 124/75 mmHg.", "8. Patient's pulse is 100/min.", "9. Patient's respirations are 13/min.", "10. Patient's oxygen saturation is 99% on room air.", "11. Urinalysis is notable only for a dark urine sample with no red blood cells present.", "12. Rectal exam reveals pale stool and grossly visible blood.", "13. Physical exam is notable for pruritis, jaundice, and scleral icterus."], "atomic_facts": ["1. The patient has a past medical history of multiple admissions for severe abdominal pain and bloody diarrhea.", "2. The patient has a past medical history of several episodes of ascending cholangitis which were successfully treated.", "3. The patient is currently a member of Alcoholics Anonymous.", "4. The patient's temperature is 98.2\u00b0F (36.8\u00b0C).", "5. The patient's blood pressure is 124/75 mmHg.", "6. The patient's pulse is 100/min.", "7. The patient's respirations are 13/min.", "8. The patient's oxygen saturation is 99% on room air.", "9. Urinalysis is notable only for a dark urine sample with no red blood cells present.", "10. A rectal exam reveals pale stool and grossly visible blood.", "11. Physical exam is notable for pruritis, jaundice, and scleral icterus."]}
{"id": 813, "question": "Which of the following must be done before beginning treatment with a TNF inhibitor?", "context": ["A 43-year-old female presents with several years of pain and stiffness in her wrists and hands.", "Her symptoms have been getting progressively worse.", "She reports that her hands feel stiff for an hour or more after awaking in the morning.", "She undergoes subsequent testing, and is found to have anti-citrullinated protein antibodies.", "Her physician is concerned for rheumatoid arthritis, and discusses treatment with a biologic disease-modifying anti-rheumatic agent. |  | ."], "context_len": 5, "options": {"A": "Confirm diagnosis with a test for rheumatoid factor", "B": "Confirm diagnosis with elevated ESR and CRP", "C": "Test for latent mycobacterial infection", "D": "Obtain a radiograph demonstrating osteophytes"}, "answer": "Test for latent mycobacterial infection", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "43", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 43-year-old female presents with several years of pain and stiffness in her wrists and hands.", "2. Her symptoms have been getting progressively worse.", "3. She reports that her hands feel stiff for an hour or more after awaking in the morning.", "4. She undergoes subsequent testing.", "5. She is found to have anti-citrullinated protein antibodies.", "6. Her physician is concerned for rheumatoid arthritis.", "7. Her physician discusses treatment with a biologic disease-modifying anti-rheumatic agent."], "atomic_facts": ["1. Her symptoms have been getting progressively worse.", "2. She reports that her hands feel stiff for an hour or more after awaking in the morning.", "3. She undergoes subsequent testing.", "4. She is found to have anti-citrullinated protein antibodies.", "5. Her physician is concerned for rheumatoid arthritis.", "6. Her physician discusses treatment with a biologic disease-modifying anti-rheumatic agent."]}
{"id": 814, "question": "Which of the following is the most crucial in the development of this patient\u2019s condition?", "context": ["A 65-year-old man is brought to the emergency department with a complaint of right-sided numbness for 5 hours.", "The numbness started in the right-side of the face and has progressed to the same side arm and leg within 30 minutes.", "He denies limb weakness, walking difficulty, vision problem, or vertigo.", "He had similar symptoms 5 months ago that were resolved within 10 minutes.", "The past medical history includes type 2 diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia.", "The medication list includes allopurinol, amlodipine, aspirin, glimepiride, lisinopril, and rosuvastatin.", "The blood pressure is 165/102 mm Hg, and the rest of the vital signs are within normal limits.", "On examination, there are no facial droop and slurring of the speech noted.", "The muscle strength is normal in all 4 limbs with a normal tone and deep tendon reflexes.", "There is a decreased pinprick sensation and proprioception on the right arm and leg.", "The gait is normal.", "The blood sugar is 221 mg/dL.", "The CT scan of the head is normal.", "The MRI of the head with diffusion-weighted imaging reveals a 15 mm diffusion restriction in the left thalamus."], "context_len": 14, "options": {"A": "Emboli from deep leg veins with a patent foramen ovale", "B": "Leakage of blood from intracranial vessel due to uncontrolled hypertension", "C": "Lipohyalinosis of small penetrating arteries due to chronic hypertension", "D": "Significant stenosis of the left carotid artery"}, "answer": "Lipohyalinosis of small penetrating arteries due to chronic hypertension", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 65 years old.", "2. Patient has right-sided numbness for 5 hours.", "3. Numbness started in right-side of face and progressed to same side arm and leg within 30 minutes.", "4. Patient denies limb weakness, walking difficulty, vision problem, or vertigo.", "5. Patient had similar symptoms 5 months ago that were resolved within 10 minutes.", "6. Past medical history includes type 2 diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia.", "7. Medication list includes allopurinol, amlodipine, aspirin, glimepiride, lisinopril, and rosuvastatin.", "8. Blood pressure is 165/102 mm Hg.", "9. Other vital signs are within normal limits.", "10. No facial droop or slurring of speech noted on examination.", "11. Muscle strength is normal in all 4 limbs with normal tone and deep tendon reflexes.", "12. Decreased pinprick sensation and proprioception on right arm and leg.", "13. Gait is normal.", "14. Blood sugar is 221 mg/dL.", "15. CT scan of head is normal.", "16. MRI of head with diffusion-weighted imaging reveals 15 mm diffusion restriction in left thalamus."], "atomic_facts": ["1. The numbness started in the right-side of the face and has progressed to the same side arm and leg within 30 minutes.", "2. He denies limb weakness, walking difficulty, vision problem, or vertigo.", "3. He had similar symptoms 5 months ago that were resolved within 10 minutes.", "4. The past medical history includes type 2 diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia.", "5. The medication list includes allopurinol, amlodipine, aspirin, glimepiride, lisinopril, and rosuvastatin.", "6. The blood pressure is 165/102 mm Hg, and the rest of the vital signs are within normal limits.", "7. On examination, there are no facial droop and slurring of the speech noted.", "8. The muscle strength is normal in all 4 limbs with a normal tone and deep tendon reflexes.", "9. There is a decreased pinprick sensation and proprioception on the right arm and leg.", "10. The gait is normal.", "11. The blood sugar is 221 mg/dL.", "12. The CT scan of the head is normal.", "13. The MRI of the head with diffusion-weighted imaging reveals a 15 mm diffusion restriction in the left thalamus."]}
{"id": 815, "question": "Which of the following physiologic changes will occur when the patient takes this medication?", "context": ["A 23-year-old man presents to a psychiatrist for evaluation of situational anxiety.", "He reports that he recently started a new job that involves regular public speaking and is very stressed before every public speaking event.", "He describes developing a rapid heart rate and diaphoresis that interferes with his ability to speak well.", "He has no past medical history and takes no medications.", "He does not smoke or drink alcohol.", "His temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 110/65 mmHg, pulse is 85/min, and respirations are 17/min.", "On exam, he is well-appearing and appropriately conversational.", "He is alert and fully oriented.", "The patient is prescribed propranolol to take before major public speaking events."], "context_len": 9, "options": {"A": "Decreased cardiac output and decreased peripheral resistance", "B": "Decreased cardiac output and increased peripheral resistance", "C": "Increased cardiac output and decreased peripheral resistance", "D": "Increased cardiac output and increased peripheral resistance"}, "answer": "Decreased cardiac output and increased peripheral resistance", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "23", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 23-year-old man presents to a psychiatrist for evaluation of situational anxiety.", "2. He reports that he recently started a new job that involves regular public speaking.", "3. He is very stressed before every public speaking event.", "4. He describes developing a rapid heart rate and diaphoresis that interferes with his ability to speak well.", "5. He has no past medical history and takes no medications.", "6. He does not smoke or drink alcohol.", "7. His temperature is 98.6\u00b0F (37\u00b0C).", "8. His blood pressure is 110/65 mmHg.", "9. His pulse is 85/min.", "10. His respirations are 17/min.", "11. On exam, he is well-appearing and appropriately conversational.", "12. He is alert and fully oriented.", "13. The patient is prescribed propranolol to take before major public speaking events."], "atomic_facts": ["1. The patient recently started a new job involving regular public speaking.", "2. The patient experiences stress before every public speaking event.", "3. The patient reports developing a rapid heart rate and diaphoresis during public speaking.", "4. The patient has no past medical history.", "5. The patient takes no medications.", "6. The patient does not smoke or drink alcohol.", "7. The patient's temperature is 98.6\u00b0F (37\u00b0C).", "8. The patient's blood pressure is 110/65 mmHg.", "9. The patient's pulse is 85/min.", "10. The patient's respirations are 17/min.", "11. On exam, the patient is well-appearing and appropriately conversational.", "12. The patient is alert and fully oriented.", "13. The patient is prescribed propranolol to take before major public speaking events."]}
{"id": 816, "question": "Which of the following is the best initial step in the management of this patient's condition?", "context": ["A 69-year-old woman is brought into the emergency room by family members after they noted that she had become increasingly lethargic over the past 3 days.", "Her temperature is 39.5\u00b0C (103.1\u00b0F), the blood pressure is 75/40 mm Hg, the heart rate 130/min, the respiratory rate 24/min, and the oxygen saturation is 89% on room air.", "On examination, she is severely ill, drowsy, and unable to speak.", "Her skin is warm to the touch.", "White blood cell count is 15,000/mm3 and her urinalysis is positive for nitrites and leukocyte esterase."], "context_len": 5, "options": {"A": "Intramuscular adrenaline", "B": "Intravenous hydrocortisone", "C": "Assessment of airway, breathing, and circulation", "D": "Intravenous noradrenaline"}, "answer": "Assessment of airway, breathing, and circulation", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "69 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 69-year-old woman is brought into the emergency room by family members.", "2. She had become increasingly lethargic over the past 3 days.", "3. Her temperature is 39.5\u00b0C (103.1\u00b0F).", "4. Her blood pressure is 75/40 mm Hg.", "5. Her heart rate is 130/min.", "6. Her respiratory rate is 24/min.", "7. Her oxygen saturation is 89% on room air.", "8. On examination, she is severely ill, drowsy, and unable to speak.", "9. Her skin is warm to the touch.", "10. Her white blood cell count is 15,000/mm3.", "11. Her urinalysis is positive for nitrites and leukocyte esterase."], "atomic_facts": ["1. Her temperature is 39.5\u00b0C (103.1\u00b0F).", "2. The blood pressure is 75/40 mm Hg.", "3. The heart rate is 130/min.", "4. The respiratory rate is 24/min.", "5. The oxygen saturation is 89% on room air.", "6. On examination, she is severely ill.", "7. On examination, she is drowsy.", "8. On examination, she is unable to speak.", "9. Her skin is warm to the touch.", "10. White blood cell count is 15,000/mm3.", "11. Her urinalysis is positive for nitrites.", "12. Her urinalysis is positive for leukocyte esterase."]}
{"id": 817, "question": "Which of the following is the most likely diagnosis?", "context": ["A 28-year-old G2P1 woman at 29 weeks gestation presents to the obstetrician after noticing red spots on her undergarments over the past week.", "Her vaginal bleeding has not been painful; however, she is concerned that it has persisted.", "Her previous child was born by cesarean section and she is currently taking folate and a multivitamin.", "She endorses feeling fetal movements.", "Her temperature is 98.9\u00b0F (37.2\u00b0C), blood pressure is 120/84 mmHg, pulse is 88/min, respirations are 17/min, and oxygen saturation is 99% on room air.", "Physical exam is notable for a gravid uterus and non-tender abdomen.", "Speculum exam reveals a closed cervical os and a small amount of blood."], "context_len": 7, "options": {"A": "Placenta percreta", "B": "Placenta previa", "C": "Placental abruption", "D": "Uterine rupture"}, "answer": "Placenta previa", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 28-year-old G2P1 woman.", "2. Patient is at 29 weeks gestation.", "3. Patient has noticed red spots on her undergarments over the past week.", "4. Patient's vaginal bleeding has not been painful.", "5. Patient's previous child was born by cesarean section.", "6. Patient is currently taking folate and a multivitamin.", "7. Patient endorses feeling fetal movements.", "8. Patient's temperature is 98.9\u00b0F (37.2\u00b0C).", "9. Patient's blood pressure is 120/84 mmHg.", "10. Patient's pulse is 88/min.", "11. Patient's respirations are 17/min.", "12. Patient's oxygen saturation is 99% on room air.", "13. Physical exam is notable for a gravid uterus and non-tender abdomen.", "14. Speculum exam reveals a closed cervical os and a small amount of blood."], "atomic_facts": ["1. Her vaginal bleeding has not been painful.", "2. She is concerned that the bleeding has persisted.", "3. Her previous child was born by cesarean section.", "4. She is currently taking folate and a multivitamin.", "5. She endorses feeling fetal movements.", "6. Her temperature is 98.9\u00b0F (37.2\u00b0C).", "7. Her blood pressure is 120/84 mmHg.", "8. Her pulse is 88/min.", "9. Her respirations are 17/min.", "10. Her oxygen saturation is 99% on room air.", "11. Physical exam is notable for a gravid uterus.", "12. Physical exam is notable for a non-tender abdomen.", "13. Speculum exam reveals a closed cervical os.", "14. Speculum exam reveals a small amount of blood."]}
{"id": 818, "question": "Which of the following is the most likely cause of this patient's physical findings?", "context": ["A 57-year-old woman comes to the emergency department 1 hour after experiencing a distressing 10-minute episode of stuttering during a business meeting.", "She has hypertension.", "She has smoked 2 packs of cigarettes daily for 30 years.", "Current medications include fosinopril and hydrochlorothiazide.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 90/min, respirations are 16/min, and blood pressure is 134/88 mm Hg.", "She is oriented to person, place, and time.", "Her speech is clear.", "When she is asked to hold both arms fully extended at shoulder level with palms upwards and eyes closed, her right palm turns inwards and downwards."], "context_len": 8, "options": {"A": "Cerebellar lesion", "B": "Inferior frontal gyrus lesion", "C": "Upper motor neuron lesion", "D": "Thalamus lesion"}, "answer": "Upper motor neuron lesion", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "57 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 57-year-old woman comes to the emergency department 1 hour after experiencing a distressing 10-minute episode of stuttering during a business meeting.", "2. She has hypertension.", "3. She has smoked 2 packs of cigarettes daily for 30 years.", "4. Current medications include fosinopril and hydrochlorothiazide.", "5. Her temperature is 37\u00b0C (98.6\u00b0F).", "6. Pulse is 90/min.", "7. Respirations are 16/min.", "8. Blood pressure is 134/88 mm Hg.", "9. She is oriented to person, place, and time.", "10. Her speech is clear.", "11. When she is asked to hold both arms fully extended at shoulder level with palms upwards and eyes closed, her right palm turns inwards and downwards."], "atomic_facts": ["1. She has hypertension.", "2. She has smoked 2 packs of cigarettes daily for 30 years.", "3. Current medications include fosinopril and hydrochlorothiazide.", "4. Her temperature is 37\u00b0C (98.6\u00b0F).", "5. Her pulse is 90/min.", "6. Her respirations are 16/min.", "7. Her blood pressure is 134/88 mm Hg.", "8. She is oriented to person, place, and time.", "9. Her speech is clear.", "10. When asked to hold both arms fully extended at shoulder level with palms upwards and eyes closed, her right palm turns inwards and downwards."]}
{"id": 819, "question": "Which of the following is the most appropriate treatment for this patient at this time?\"", "context": ["A 40-year-old man comes to the physician because of a 5-kg (11-lb) weight loss over the past month and easy bruising.", "He has not changed his diet significantly.", "He also noticed that his arms now bruise more easily.", "He appears pale.", "His pulse is 70/min, his blood pressure is 125/75 mm Hg, and his temperature is 38\u00b0C (100.4\u00b0F).", "Examination shows a palm-sized hematoma on his right arm.", "His spleen is palpable 5 cm below the costal margin.", "His liver is enlarged.", "Laboratory results show: | Leukocytes 10,500/mm3 | Hemoglobin 10.2 g/dL | Platelets 52,000/mm3 | Fibrinogen 110 mg/dL (Reference: 150-400 mg/dL) | Cytogenetic analysis shows leukocytes with a reciprocal translocation of chromosomes 15 and 17."], "context_len": 9, "options": {"A": "Cyclophosphamide", "B": "All-trans retinoic acid", "C": "Cryoprecipitate transfusion", "D": "Imatinib"}, "answer": "All-trans retinoic acid", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "40 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 40-year-old man comes to the physician.", "2. He has experienced a 5-kg (11-lb) weight loss over the past month.", "3. He has experienced easy bruising.", "4. He has not changed his diet significantly.", "5. He has noticed that his arms now bruise more easily.", "6. He appears pale.", "7. His pulse is 70/min.", "8. His blood pressure is 125/75 mm Hg.", "9. His temperature is 38\u00b0C (100.4\u00b0F).", "10. Examination shows a palm-sized hematoma on his right arm.", "11. His spleen is palpable 5 cm below the costal margin.", "12. His liver is enlarged.", "13. Laboratory results show leukocytes 10,500/mm3.", "14. Laboratory results show hemoglobin 10.2 g/dL.", "15. Laboratory results show platelets 52,000/mm3.", "16. Laboratory results show fibrinogen 110 mg/dL (Reference: 150-400 mg/dL).", "17. Laboratory results show cytogenetic analysis with leukocytes with a reciprocal translocation of chromosomes 15 and 17."], "atomic_facts": ["1. He has not changed his diet significantly.", "2. He also noticed that his arms now bruise more easily.", "3. He appears pale.", "4. His pulse is 70/min.", "5. His blood pressure is 125/75 mm Hg.", "6. His temperature is 38\u00b0C (100.4\u00b0F).", "7. Examination shows a palm-sized hematoma on his right arm.", "8. His spleen is palpable 5 cm below the costal margin.", "9. His liver is enlarged.", "10. Laboratory results show: Leukocytes 10,500/mm3.", "11. Hemoglobin 10.2 g/dL.", "12. Platelets 52,000/mm3.", "13. Fibrinogen 110 mg/dL (Reference: 150-400 mg/dL).", "14. Cytogenetic analysis shows leukocytes with a reciprocal translocation of chromosomes 15 and 17."]}
{"id": 820, "question": "Which of the following is the most likely etiology of this patient's condition?", "context": ["At a routine exam, a 68-year-old female patient is discovered to have a serum calcium level of 11.5 mg/dL.", "Follow-up laboratory tests show a high parathyroid hormone with low phosphorus and mildly elevated alkaline phosphatase.", "24-hour urine calcium level is elevated.", "Review of symptoms includes complaints of fatigue, constipation, and diffuse bone pain for which she takes vitamin D.", "Past medical history is significant for type 2 diabetes mellitus for 25 years and essential hypertension for 15 years.", "The patient has a history of kidney stones.", "Family history is irrelevant."], "context_len": 7, "options": {"A": "Vitamin D intoxication", "B": "Familial hypocalciuric hypercalcaemia", "C": "Solitary parathyroid adenoma", "D": "Thyrotoxicosis"}, "answer": "Solitary parathyroid adenoma", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "68 years old", "specialties": ["Endocrinology, Diabetes, and Metabolism", "Internal Medicine"], "subspecialties": ["General Endocrinology", "Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 68-year-old female.", "2. Serum calcium level is 11.5 mg/dL.", "3. Follow-up laboratory tests show high parathyroid hormone with low phosphorus and mildly elevated alkaline phosphatase.", "4. 24-hour urine calcium level is elevated.", "5. Patient has complaints of fatigue, constipation, and diffuse bone pain.", "6. Patient takes vitamin D.", "7. Patient has past medical history of type 2 diabetes mellitus for 25 years and essential hypertension for 15 years.", "8. Patient has history of kidney stones.", "9. Family history is irrelevant."], "atomic_facts": ["1. Follow-up laboratory tests show high parathyroid hormone.", "2. Follow-up laboratory tests show low phosphorus.", "3. Follow-up laboratory tests show mildly elevated alkaline phosphatase.", "4. 24-hour urine calcium level is elevated.", "5. Review of symptoms includes complaints of fatigue.", "6. Review of symptoms includes complaints of constipation.", "7. Review of symptoms includes complaints of diffuse bone pain.", "8. The patient takes vitamin D for diffuse bone pain.", "9. Past medical history is significant for type 2 diabetes mellitus for 25 years.", "10. Past medical history is significant for essential hypertension for 15 years.", "11. The patient has a history of kidney stones.", "12. Family history is irrelevant."]}
{"id": 821, "question": "Which of the following is associated with the pathophysiology underlying this patient's disorder?", "context": ["A 27-year-old man and his wife present to an infertility clinic for evaluation after they tried unsuccessfully to conceive for 2 years.", "He has no prior medical history and does not currently take any medications.", "On evaluation, he is found to have long extremities and gynecomastia.", "In addition, he has testicular atrophy and very little body hair, which is distributed primarily in the pubic region.", "Further analysis reveals azoospermia, and appropriate tests confirming the diagnosis are performed.", "The couple is told about the cause of their inability to conceive and given further options to pursue."], "context_len": 6, "options": {"A": "Abnormal signaling through androgen receptors", "B": "Abnormal conversion of testosterone", "C": "Increased aromatase activity", "D": "Increased production of prolactin"}, "answer": "Increased aromatase activity", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "27", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Reproductive Endocrinology and Infertility"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 27-year-old man and his wife present to an infertility clinic for evaluation.", "2. They have been trying unsuccessfully to conceive for 2 years.", "3. He has no prior medical history and does not currently take any medications.", "4. On evaluation, he is found to have long extremities and gynecomastia.", "5. He also has testicular atrophy and very little body hair, which is distributed primarily in the pubic region.", "6. Further analysis reveals azoospermia.", "7. Appropriate tests confirming the diagnosis are performed.", "8. The couple is told about the cause of their inability to conceive.", "9. The couple is given further options to pursue."], "atomic_facts": ["1. He has no prior medical history.", "2. He does not currently take any medications.", "3. On evaluation, he is found to have long extremities.", "4. On evaluation, he is found to have gynecomastia.", "5. He has testicular atrophy.", "6. He has very little body hair.", "7. The body hair is distributed primarily in the pubic region.", "8. Further analysis reveals azoospermia.", "9. Appropriate tests confirming the diagnosis are performed.", "10. The couple is told about the cause of their inability to conceive.", "11. The couple is given further options to pursue."]}
{"id": 822, "question": "Which of the following is the next best step in management?", "context": ["A 32-year-old GP2 presents to an outpatient clinic for a routine gynecologic examination.", "The patient appears well, although she mentions that during the past 6 months she has noticed small amounts of vaginal bleeding in the middle of her menstrual cycles.", "Her last pregnancy was 3 years ago.", "Her subsequent menstrual cycles have been regular, lasting about 2\u20133 days.", "She mentions that she is up to date with her Pap smear; all of her Pap smears have been normal.", "She denies any recent travel or history of trauma.", "The patient is sexually active with her husband and they use condoms consistently.", "She does not smoke, drinks alcohol occasionally, and has never used illicit drugs.", "The physical examination is essentially normal.", "An ultrasound reveals a fleshy mass with a pedunculated stalk deep in the cervical canal.", "The uterine lining measures 5 mm in thickness and is homogeneous.", "Multiple small leiomyomas are also observed.", "The patient is otherwise asymptomatic and has no other complaints.", "The rest of the physical examination is unremarkable."], "context_len": 14, "options": {"A": "No further intervention with follow-up in 6 months", "B": "Electrocautery and cryofreezing", "C": "Cervical brush biopsy", "D": "Removal of the lesion with a ring forceps"}, "answer": "Removal of the lesion with a ring forceps", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "32", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is 32 years old.", "2. Patient is a GP2.", "3. Patient is presenting to an outpatient clinic for a routine gynecologic examination.", "4. Patient has noticed small amounts of vaginal bleeding in the middle of her menstrual cycles for the past 6 months.", "5. Patient's last pregnancy was 3 years ago.", "6. Patient's menstrual cycles have been regular, lasting about 2\u20133 days.", "7. Patient is up to date with her Pap smear.", "8. All of patient's Pap smears have been normal.", "9. Patient denies any recent travel or history of trauma.", "10. Patient is sexually active with her husband and they use condoms consistently.", "11. Patient does not smoke.", "12. Patient drinks alcohol occasionally.", "13. Patient has never used illicit drugs.", "14. Physical examination is essentially normal.", "15. Ultrasound reveals a fleshy mass with a pedunculated stalk deep in the cervical canal.", "16. Uterine lining measures 5 mm in thickness and is homogeneous.", "17. Multiple small leiomyomas are also observed.", "18. Patient is otherwise asymptomatic and has no other complaints.", "19. Rest of the physical examination is unremarkable."], "atomic_facts": ["1. The patient has noticed small amounts of vaginal bleeding in the middle of her menstrual cycles over the past 6 months.", "2. Her last pregnancy was 3 years ago.", "3. Her subsequent menstrual cycles have been regular, lasting about 2\u20133 days.", "4. She is up to date with her Pap smear and all of her Pap smears have been normal.", "5. She denies any recent travel or history of trauma.", "6. The patient is sexually active with her husband and they use condoms consistently.", "7. She does not smoke, drinks alcohol occasionally, and has never used illicit drugs.", "8. An ultrasound reveals a fleshy mass with a pedunculated stalk deep in the cervical canal.", "9. The uterine lining measures 5 mm in thickness and is homogeneous.", "10. Multiple small leiomyomas are also observed.", "11. The patient is otherwise asymptomatic and has no other complaints.", "12. The rest of the physical examination is unremarkable."]}
{"id": 823, "question": "Which of the following is the most likely underlying pathology?", "context": ["An 11-year-old girl presents to her pediatrician with complaints of headache and rapid leg fatigue with exercise.", "Her vital signs are: HR 77, BP in left arm 155/100, RR 14, SpO2 100%, T 37.0 C.", "On palpation, her left dorsalis pedis pulse is delayed as compared to her left radial pulse.", "Her lower extremities feel slightly cool.", "Blood pressure obtained on the left lower extremity is 120/80."], "context_len": 5, "options": {"A": "Peripheral arterial disease", "B": "Vasospasm", "C": "Coarctation of the aorta", "D": "Tetralogy of Fallot"}, "answer": "Coarctation of the aorta", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "11 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 11-year-old girl presents to her pediatrician.", "2. She has complaints of headache and rapid leg fatigue with exercise.", "3. Her HR is 77.", "4. Her BP in left arm is 155/100.", "5. Her RR is 14.", "6. Her SpO2 is 100%.", "7. Her T is 37.0 C.", "8. On palpation, her left dorsalis pedis pulse is delayed as compared to her left radial pulse.", "9. Her lower extremities feel slightly cool.", "10. Blood pressure obtained on the left lower extremity is 120/80."], "atomic_facts": ["1. Her vital signs: HR 77", "2. Her vital signs: BP in left arm 155/100", "3. Her vital signs: RR 14", "4. Her vital signs: SpO2 100%", "5. Her vital signs: T 37.0 C", "6. On palpation, her left dorsalis pedis pulse is delayed as compared to her left radial pulse", "7. Her lower extremities feel slightly cool", "8. Blood pressure obtained on the left lower extremity is 120/80"]}
{"id": 824, "question": "Which of the following is the most likely diagnosis?", "context": ["A 34-year-old woman comes to the gynecologist complaining of vaginal swelling and discomfort.", "She states that over the past 2 weeks she has noticed swelling of her right labia.", "The swelling continued to grow in size and now causes her discomfort when walking.", "She denies abnormal discharge or bleeding from the swelling or from the vulva.", "She normally shaves the area, but with the recent pain, she has been unable to.", "She denies any history of known trauma.", "The patient is relatively healthy and takes only a multivitamin.", "She never received the vaccine for human papillomavirus (HPV).", "On physical exam, there is a fluctuant, swelling of the right labia, most prominently at the posterior vestibule."], "context_len": 9, "options": {"A": "Bartholin gland cyst", "B": "Folliculitis", "C": "Granuloma inguinale", "D": "Vulvar cancer"}, "answer": "Bartholin gland cyst", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 34-year-old woman comes to the gynecologist.", "2. She is complaining of vaginal swelling and discomfort.", "3. She has noticed swelling of her right labia over the past 2 weeks.", "4. The swelling has continued to grow in size.", "5. The swelling causes her discomfort when walking.", "6. She denies abnormal discharge or bleeding from the swelling or from the vulva.", "7. She normally shaves the area, but with the recent pain, she has been unable to.", "8. She denies any history of known trauma.", "9. The patient is relatively healthy and takes only a multivitamin.", "10. She never received the vaccine for human papillomavirus (HPV).", "11. On physical exam, there is a fluctuant, swelling of the right labia.", "12. The swelling is most prominently at the posterior vestibule."], "atomic_facts": ["1. The patient has noticed swelling of her right labia over the past 2 weeks.", "2. The swelling causes discomfort when walking.", "3. There is no abnormal discharge or bleeding from the swelling or from the vulva.", "4. The patient normally shaves the area but has been unable to due to recent pain.", "5. There is no history of known trauma.", "6. The patient is relatively healthy and takes only a multivitamin.", "7. The patient has not received the vaccine for human papillomavirus (HPV).", "8. On physical exam, there is a fluctuant swelling of the right labia, most prominently at the posterior vestibule."]}
{"id": 825, "question": "Which of the following is the most appropriate treatment?", "context": ["A 4-month-old boy is brought to the physician because of noisy breathing for 2 months that has progressively become louder.", "The noisy breathing improves when he is in the prone position.", "It is worse when he is agitated, feeding, or lying on his back.", "He was born at term and has been healthy since.", "His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 120/min, and respirations are 50/min.", "Pulse oximetry on room air shows an oxygen saturation of 98%.", "Examination shows inspiratory stridor."], "context_len": 7, "options": {"A": "Observation", "B": "Surgical division", "C": "Ceftriaxone therapy", "D": "Supraglottoplasty"}, "answer": "Observation", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "4 months", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 4-month-old boy is brought to the physician.", "2. Noisy breathing has been present for 2 months and has progressively become louder.", "3. Noisy breathing improves when he is in the prone position.", "4. Noisy breathing is worse when he is agitated, feeding, or lying on his back.", "5. He was born at term and has been healthy since.", "6. His temperature is 37.1\u00b0C (98.8\u00b0F).", "7. His pulse is 120/min.", "8. His respirations are 50/min.", "9. Pulse oximetry on room air shows an oxygen saturation of 98%.", "10. Examination shows inspiratory stridor."], "atomic_facts": ["1. The noisy breathing improves in the prone position.", "2. Noisy breathing is worse when he is agitated, feeding, or lying on his back.", "3. He was born at term and has been healthy since.", "4. His temperature is 37.1\u00b0C (98.8\u00b0F).", "5. His pulse is 120/min.", "6. His respirations are 50/min.", "7. Pulse oximetry on room air shows an oxygen saturation of 98%.", "8. Examination shows inspiratory stridor."]}
{"id": 826, "question": "Which of the following is the most appropriate treatment for this patient's condition?", "context": ["A 16-year-old girl comes to the physician with a 4-day history of painful vulvar lesions, generalized fatigue, and malaise.", "During this period, she has also had dysuria.", "She is sexually active with 2 male partners and uses condoms inconsistently.", "Her immunizations are up-to-date; she completed the vaccination course for human papilloma virus 2 months ago.", "Her temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 100/min, respirations are 12/min, and blood pressure is 110/70 mm Hg.", "Pelvic examination shows several shallow ulcers on an erythematous base over the labia majora and minora.", "There is bilateral, tender inguinal lymphadenopathy."], "context_len": 7, "options": {"A": "Acyclovir therapy", "B": "Azithromycin therapy", "C": "Doxycycline therapy", "D": "Penicillin therapy"}, "answer": "Acyclovir therapy", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "16", "specialties": ["Pediatrics", "Obstetrics and Gynecology", "Dermatology"], "subspecialties": ["Pediatric Infectious Diseases", "General Obstetrics and Gynecology", "General Dermatology"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is 16 years old.", "2. Patient has a 4-day history of painful vulvar lesions, generalized fatigue, and malaise.", "3. Patient has had dysuria during this period.", "4. Patient is sexually active with 2 male partners.", "5. Patient uses condoms inconsistently.", "6. Patient's immunizations are up-to-date.", "7. Patient completed the vaccination course for human papilloma virus 2 months ago.", "8. Patient's temperature is 38.1\u00b0C (100.6\u00b0F).", "9. Patient's pulse is 100/min.", "10. Patient's respirations are 12/min.", "11. Patient's blood pressure is 110/70 mm Hg.", "12. Pelvic examination shows several shallow ulcers on an erythematous base over the labia majora and minora.", "13. Patient has bilateral, tender inguinal lymphadenopathy."], "atomic_facts": ["1. She has dysuria.", "2. She is sexually active with 2 male partners.", "3. She uses condoms inconsistently.", "4. Her immunizations are up-to-date.", "5. She completed the vaccination course for human papilloma virus 2 months ago.", "6. Her temperature is 38.1\u00b0C (100.6\u00b0F).", "7. Her pulse is 100/min.", "8. Her respirations are 12/min.", "9. Her blood pressure is 110/70 mm Hg.", "10. Pelvic examination shows several shallow ulcers on an erythematous base over the labia majora and minora.", "11. There is bilateral, tender inguinal lymphadenopathy."]}
{"id": 827, "question": "These cells most likely originated from which of the following structures?", "context": ["A 57-year-old man comes to the physician because of progressively worsening epigastric pain and 6.8-kg (15-lb) weight loss for the past 2 months.", "Two weeks ago, he noticed painful, red blotches on the medial aspect of his right calf.", "He has smoked one pack of cigarettes daily for the last 35 years.", "He appears thin.", "Physical examination shows tender erythematous nodules on the right ankle and left antecubital fossa.", "Endoscopy shows a large mass in the antrum of the stomach.", "A biopsy specimen of the gastric mass shows disorganized mucin-secreting cells with surrounding fibrosis."], "context_len": 7, "options": {"A": "Lymphoid tissue in the terminal ileum", "B": "Mature hepatocytes in the liver", "C": "Exocrine ducts in the body of the pancreas", "D": "Squamous epithelium in the proximal esophagus"}, "answer": "Exocrine ducts in the body of the pancreas", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 57-year-old man comes to the physician.", "2. He has experienced progressively worsening epigastric pain for the past 2 months.", "3. He has lost 6.8 kg (15 lb) in the past 2 months.", "4. Two weeks ago, he noticed painful, red blotches on the medial aspect of his right calf.", "5. He has smoked one pack of cigarettes daily for the last 35 years.", "6. He appears thin.", "7. Physical examination shows tender erythematous nodules on the right ankle and left antecubital fossa.", "8. Endoscopy shows a large mass in the antrum of the stomach.", "9. A biopsy specimen of the gastric mass shows disorganized mucin-secreting cells with surrounding fibrosis."], "atomic_facts": ["1. Two weeks ago, he noticed painful, red blotches on the medial aspect of his right calf.", "2. He has smoked one pack of cigarettes daily for the last 35 years.", "3. He appears thin.", "4. Physical examination shows tender erythematous nodules on the right ankle and left antecubital fossa.", "5. Endoscopy shows a large mass in the antrum of the stomach.", "6. A biopsy specimen of the gastric mass shows disorganized mucin-secreting cells with surrounding fibrosis."]}
{"id": 828, "question": "Which of the following is the most likely cause of this patient's presentation?", "context": ["A 62-year-old woman comes to the emergency department because of painful and difficult swallowing.", "Her voice has also become muffled.", "She has been well until last night and reports having intermittent fevers at home.", "The patient has smoked a pack of cigarettes a day since age 19 but is otherwise healthy.", "Her temperature is 39\u00b0C (102.2\u00b0F), blood pressure is 142/93 Hg/mm, heart rate is 109/min, and respiratory rate is 18/min.", "On examination, the patient's head is extended and she appears anxious.", "Her voice is muffled and there is inspiratory stridor.", "There is tender bilateral cervical lymphadenopathy and pain upon palpation of the hyoid.", "The remainder of the examination shows no abnormalities.", "Laboratory studies show a leukocyte count of 18,000/mm3 with 83% neutrophils."], "context_len": 10, "options": {"A": "Pseudomonas aeruginosa", "B": "Corynebacterium diphtheriae", "C": "Parainfluenza virus", "D": "Haemophilus influenzae type b"}, "answer": "Haemophilus influenzae type b", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "62 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 62-year-old woman comes to the emergency department.", "2. She has painful and difficult swallowing.", "3. Her voice has become muffled.", "4. She has been well until last night.", "5. She reports having intermittent fevers at home.", "6. She has smoked a pack of cigarettes a day since age 19.", "7. She is otherwise healthy.", "8. Her temperature is 39\u00b0C (102.2\u00b0F).", "9. Her blood pressure is 142/93 Hg/mm.", "10. Her heart rate is 109/min.", "11. Her respiratory rate is 18/min.", "12. On examination, her head is extended.", "13. She appears anxious.", "14. Her voice is muffled.", "15. There is inspiratory stridor.", "16. There is tender bilateral cervical lymphadenopathy.", "17. There is pain upon palpation of the hyoid.", "18. The remainder of the examination shows no abnormalities.", "19. Laboratory studies show a leukocyte count of 18,000/mm3.", "20. 83% of the leukocytes are neutrophils."], "atomic_facts": ["1. The patient's voice has become muffled.", "2. The patient has been well until last night.", "3. The patient reports having intermittent fevers at home.", "4. The patient has smoked a pack of cigarettes a day since age 19.", "5. The patient's temperature is 39\u00b0C (102.2\u00b0F).", "6. The patient's blood pressure is 142/93 Hg/mm.", "7. The patient's heart rate is 109/min.", "8. The patient's respiratory rate is 18/min.", "9. On examination, the patient's head is extended and she appears anxious.", "10. The patient's voice is muffled.", "11. The patient has inspiratory stridor.", "12. The patient has tender bilateral cervical lymphadenopathy.", "13. The patient has pain upon palpation of the hyoid.", "14. The remainder of the examination shows no abnormalities.", "15. Laboratory studies show a leukocyte count of 18,000/mm3 with 83% neutrophils."]}
{"id": 829, "question": "Which of the following was the most likely cause of this patient's symptoms?", "context": ["A 56-year-old woman is brought to the emergency department by her husband 30 minutes after a generalized tonic-clonic seizure.", "Over the past 3 months, she has had recurrent headaches and worsening early-morning vomiting.", "She has no personal or family history of a seizure disorder.", "An MRI of the brain shows a central mass; surgical resection is planned.", "One day before the surgery, the patient has another generalized seizure and, despite resuscitative efforts, she dies.", "Gross examination of the brain at autopsy is shown."], "context_len": 6, "options": {"A": "Oligodendroglioma", "B": "Glioblastoma", "C": "Schwannoma", "D": "Meningioma"}, "answer": "Glioblastoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "56 years old", "specialties": ["Neurology"], "subspecialties": ["Epilepsy", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 56-year-old woman is brought to the emergency department by her husband 30 minutes after a generalized tonic-clonic seizure.", "2. Over the past 3 months, she has had recurrent headaches and worsening early-morning vomiting.", "3. She has no personal or family history of a seizure disorder.", "4. An MRI of the brain shows a central mass.", "5. Surgical resection is planned.", "6. One day before the surgery, the patient has another generalized seizure.", "7. Despite resuscitative efforts, she dies.", "8. Gross examination of the brain at autopsy is shown."], "atomic_facts": ["1. Over the past 3 months, she has had recurrent headaches and worsening early-morning vomiting.", "2. She has no personal or family history of a seizure disorder.", "3. An MRI of the brain shows a central mass; surgical resection is planned.", "4. One day before the surgery, the patient has another generalized seizure and, despite resuscitative efforts, she dies.", "5. Gross examination of the brain at autopsy is shown."]}
{"id": 830, "question": "Which of the following laboratory values should be assessed next in this patient?", "context": ["A 29-year-old woman (gravida 2, para 1) presents at 32 weeks gestation for routine follow-up care.", "Her previous pregnancy was complicated with preeclampsia, and she delivered at 35 weeks via cesarean delivery.", "Four years ago, she was diagnosed with arterial hypertension.", "Prior to pregnancy, she took amlodipine and hydrochlorothiazide; after she found out she was pregnant, she switched to methyldopa.", "The course of her current pregnancy has been unremarkable with normal laboratory values at each checkup.", "According to her blood pressure diary, her systolic blood pressure varies between 120 and 130 mm Hg, and her diastolic blood pressure is usually normal.", "At presentation, the blood pressure is 140/80 mm Hg, heart rate is 76/min, respiratory rate is 15/min, and temperature is 36.9\u00b0C (98.4\u00b0F).", "The fetal heart rate is 143/min.", "Examination shows a 1+ pitting lower leg edema.", "Dipstick test shows 2+ protein.", "24-hour urine assessment demonstrates urinary protein excretion of 1 g/L."], "context_len": 11, "options": {"A": "Coagulogram", "B": "Liver transaminases", "C": "Total bilirubin", "D": "Urinalysis"}, "answer": "Liver transaminases", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "29 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 29-year-old woman.", "2. Patient is gravida 2, para 1.", "3. Patient is 32 weeks gestation.", "4. Patient's previous pregnancy was complicated with preeclampsia.", "5. Patient delivered at 35 weeks via cesarean delivery.", "6. Patient was diagnosed with arterial hypertension four years ago.", "7. Patient took amlodipine and hydrochlorothiazide prior to pregnancy.", "8. Patient switched to methyldopa after finding out she was pregnant.", "9. Course of current pregnancy has been unremarkable.", "10. Normal laboratory values at each checkup.", "11. Systolic blood pressure varies between 120 and 130 mm Hg.", "12. Diastolic blood pressure is usually normal.", "13. Blood pressure at presentation is 140/80 mm Hg.", "14. Heart rate at presentation is 76/min.", "15. Respiratory rate at presentation is 15/min.", "16. Temperature at presentation is 36.9\u00b0C (98.4\u00b0F).", "17. Fetal heart rate is 143/min.", "18. Examination shows 1+ pitting lower leg edema.", "19. Dipstick test shows 2+ protein.", "20. 24-hour urine assessment demonstrates urinary protein excretion of 1 g/L."], "atomic_facts": ["1. Her previous pregnancy was complicated with preeclampsia.", "2. She delivered at 35 weeks via cesarean delivery.", "3. Four years ago, she was diagnosed with arterial hypertension.", "4. Prior to pregnancy, she took amlodipine and hydrochlorothiazide.", "5. After she found out she was pregnant, she switched to methyldopa.", "6. The course of her current pregnancy has been unremarkable with normal laboratory values at each checkup.", "7. According to her blood pressure diary, her systolic blood pressure varies between 120 and 130 mm Hg.", "8. Her diastolic blood pressure is usually normal.", "9. At presentation, the blood pressure is 140/80 mm Hg.", "10. Heart rate is 76/min.", "11. Respiratory rate is 15/min.", "12. Temperature is 36.9\u00b0C (98.4\u00b0F).", "13. The fetal heart rate is 143/min.", "14. Examination shows a 1+ pitting lower leg edema.", "15. Dipstick test shows 2+ protein.", "16. 24-hour urine assessment demonstrates urinary protein excretion of 1 g/L."]}
{"id": 831, "question": "Which of the following best describes this approach to the prevention of medical errors?", "context": ["Following a colonoscopy performed on a 63-year-old man, the gastroenterologist identifies a firm tumor approx.", "80 cm (31.4 in) from the entry site.", "He also performs an endoscopic polypectomy and tattooing at 50 cm (19.6 in) from the entry site.", "A pathologic report shows a benign polyp.", "One week later, the surgeon in the operating room is erroneously preparing to perform partial colectomy of the tattooed site.", "After confirming the patient\u2019s name and before surgery, the surgical team reviews the patient\u2019s history and medical documents orally based on institutional protocols.", "The surgery resident points out that the resected polyp is benign and the tumor lies 30 cm (11.8 in) distal to the tattooed area.", "The attending surgeon performs a partial colectomy on the correct site."], "context_len": 8, "options": {"A": "Closed-loop communication", "B": "Preoperative time-out", "C": "Primordial prevention", "D": "Sentinel event"}, "answer": "Preoperative time-out", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "63 years old", "specialties": ["Internal Medicine", "Surgery", "General Surgery"], "subspecialties": ["General Surgery", "Gastroenterology"], "specialty_prob": [0.4, 0.4, 0.2], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Colon and Rectal Surgery"}, "facts_old": ["1. A colonoscopy was performed on a 63-year-old man.", "2. An endoscopic polypectomy and tattooing was performed at 50 cm (19.6 in) from the entry site.", "3. A pathologic report showed a benign polyp.", "4. One week later, the surgeon was erroneously preparing to perform partial colectomy of the tattooed site.", "5. The surgical team reviewed the patient\u2019s history and medical documents orally based on institutional protocols.", "6. The surgery resident pointed out that the resected polyp was benign and the tumor lies 30 cm (11.8 in) distal to the tattooed area.", "7. The attending surgeon performed a partial colectomy on the correct site."], "atomic_facts": ["1. The distance from the entry site for endoscopic polypectomy and tattooing is 80 cm (31.4 in).", "2. A pathologic report shows a benign polyp.", "3. The surgeon erroneously prepares to perform partial colectomy of the tattooed site.", "4. The surgical team reviews the patient\u2019s history and medical documents orally before surgery.", "5. The resected polyp is benign.", "6. The tumor lies 30 cm (11.8 in) distal to the tattooed area.", "7. The attending surgeon performs a partial colectomy on the correct site."]}
{"id": 832, "question": "Which of the following is the best next step in management?", "context": ["A 28-year-old G2P1001 presents for a routine obstetric visit in her 36th week of pregnancy.", "She has a history of type I diabetes controlled by insulin and delivered 1 child by normal spontaneous vaginal delivery 2 years ago.", "Earlier in this pregnancy, she had 2 episodes of burning with urination and frequent urination.", "Urinalysis each time confirmed a urinary tract infection, and both urine cultures isolated organisms sensitive to nitrofurantoin.", "Her symptoms resolved with 10-day courses of nitrofurantoin.", "She has no complaints today.", "Urinalysis is positive for leukocyte esterase and nitrites."], "context_len": 7, "options": {"A": "Admit to the hospital and treat with intravenous ceftriaxone", "B": "Treat with oral trimethroprim-sulfamethoxazole for 10 days then continue for prophylaxis until delivery", "C": "Treat with oral nitrofurantion for 10 days", "D": "Treat with oral nitrofurantion for 10 days then continue for prophylaxis until delivery"}, "answer": "Treat with oral nitrofurantion for 10 days then continue for prophylaxis until delivery", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 28-year-old G2P1001 presents for a routine obstetric visit in her 36th week of pregnancy.", "2. She has a history of type I diabetes controlled by insulin.", "3. She delivered 1 child by normal spontaneous vaginal delivery 2 years ago.", "4. Earlier in this pregnancy, she had 2 episodes of burning with urination and frequent urination.", "5. Urinalysis each time confirmed a urinary tract infection.", "6. Both urine cultures isolated organisms sensitive to nitrofurantoin.", "7. Her symptoms resolved with 10-day courses of nitrofurantoin.", "8. She has no complaints today.", "9. Urinalysis is positive for leukocyte esterase and nitrites."], "atomic_facts": ["1. She has a history of type I diabetes controlled by insulin.", "2. She delivered 1 child by normal spontaneous vaginal delivery 2 years ago.", "3. Earlier in this pregnancy, she had 2 episodes of burning with urination and frequent urination.", "4. Urinalysis each time confirmed a urinary tract infection.", "5. Both urine cultures isolated organisms sensitive to nitrofurantoin.", "6. Her symptoms resolved with 10-day courses of nitrofurantoin.", "7. She has no complaints today.", "8. Urinalysis is positive for leukocyte esterase and nitrites."]}
{"id": 833, "question": "Analysis of a left calf biopsy specimen from this patient is most likely to show which of the following?", "context": ["A 3-year-old boy is brought to the physician by his parents because of clumsiness and multiple falls over the past 4 months.", "He started walking at the age of 18 months and could walk up steps by the time he was 27 months old but now struggles to walk at all without assistance.", "When standing up from a lying position, he crawls onto his knees and slowly walks himself up with his hands.", "There is bilateral calf enlargement."], "context_len": 4, "options": {"A": "Proliferation of mitochondria within muscle fibers", "B": "Degeneration of muscle fibers with fibrofatty replacement", "C": "Atrophic muscle fibers interspersed among hypertrophic muscle fibers", "D": "Necrotic muscle fibers with lymphocytic infiltrate"}, "answer": "Degeneration of muscle fibers with fibrofatty replacement", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 3-year-old boy is brought to the physician by his parents.", "2. The boy has experienced clumsiness and multiple falls over the past 4 months.", "3. The boy started walking at the age of 18 months.", "4. The boy could walk up steps by the time he was 27 months old.", "5. The boy now struggles to walk at all without assistance.", "6. When standing up from a lying position, he crawls onto his knees and slowly walks himself up with his hands.", "7. There is bilateral calf enlargement."], "atomic_facts": ["1. He started walking at the age of 18 months.", "2. He could walk up steps by the time he was 27 months old.", "3. He now struggles to walk at all without assistance.", "4. When standing up from a lying position, he crawls onto his knees.", "5. He slowly walks himself up with his hands.", "6. There is bilateral calf enlargement."]}
{"id": 834, "question": "What is the most likely diagnosis for the lesions seen in endoscopy?", "context": ["A 60-year-old man presented to the hospital with right upper quadrant abdominal pain.", "He has a history of hepatitis B.", "He underwent a CT of his abdomen which revealed a large mass (11.3 cm x 7.2 cm in diameter) with a metastatic retroperitoneal lymph node.", "He was diagnosed with hepatocellular carcinoma and initially received radiotherapy while on the transplant list to prevent local expansion of his malignancy.", "3 months after radiotherapy, the patient experienced hematemesis and melena.", "He was admitted to the emergency department for evaluation.", "His vitals were: blood pressure 84/56 mmHg, heart rate 92/min, and respiratory rate 20/min.", "Laboratory evaluation revealed severe anemia with a hemoglobin level of 5.7 g/dL, INR 1.8 and platelets of 68,000 cells/mm3.", "He received a blood transfusion.", "An endoscopic examination demonstrated diffuse edematous hyperemic mucosa and multiple hemorrhagic patches with active oozing in the antrum."], "context_len": 10, "options": {"A": "Intrinsic apoptotic pathway", "B": "Coagulative necrosis", "C": "Overexpression of BcL-2 gene", "D": "Cytotoxic CD8 T cells pathway"}, "answer": "Intrinsic apoptotic pathway", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "60 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 60-year-old man presented to the hospital with right upper quadrant abdominal pain.", "2. He has a history of hepatitis B.", "3. He underwent a CT of his abdomen which revealed a large mass (11.3 cm x 7.2 cm in diameter) with a metastatic retroperitoneal lymph node.", "4. He was diagnosed with hepatocellular carcinoma.", "5. He initially received radiotherapy while on the transplant list to prevent local expansion of his malignancy.", "6. 3 months after radiotherapy, the patient experienced hematemesis and melena.", "7. He was admitted to the emergency department for evaluation.", "8. His vitals were: blood pressure 84/56 mmHg, heart rate 92/min, and respiratory rate 20/min.", "9. Laboratory evaluation revealed severe anemia with a hemoglobin level of 5.7 g/dL, INR 1.8 and platelets of 68,000 cells/mm3.", "10. He received a blood transfusion.", "11. An endoscopic examination demonstrated diffuse edematous hyperemic mucosa and multiple hemorrhagic patches with active oozing in the antrum."], "atomic_facts": ["1. He has a history of hepatitis B.", "2. He underwent a CT of his abdomen which revealed a large mass (11.3 cm x 7.2 cm in diameter) with a metastatic retroperitoneal lymph node.", "3. He was diagnosed with hepatocellular carcinoma.", "4. He initially received radiotherapy while on the transplant list to prevent local expansion of his malignancy.", "5. 3 months after radiotherapy, the patient experienced hematemesis and melena.", "6. He was admitted to the emergency department for evaluation.", "7. His vitals were: blood pressure 84/56 mmHg, heart rate 92/min, and respiratory rate 20/min.", "8. Laboratory evaluation revealed severe anemia with a hemoglobin level of 5.7 g/dL, INR 1.8 and platelets of 68,000 cells/mm3.", "9. He received a blood transfusion.", "10. An endoscopic examination demonstrated diffuse edematous hyperemic mucosa and multiple hemorrhagic patches with active oozing in the antrum."]}
{"id": 835, "question": "Which of the following is the best next step in management?", "context": ["A 49-year-old Caucasian woman presents to your office for elevated blood pressure.", "She is a nurse and checks her blood pressure regularly while working in the wards.", "She presents with readings ranging between 163/101 and 156/94 mm Hg.", "After some research she conducted on her own, she has been exercising and following a low-fat, low-salt diet for the past 3 months.", "Her past medical history includes laparoscopic cholecystectomy for acute cholecystitis 2 years previously.", "Her mother and father have hypertension and her father had myocardial infarction at the age of 68 years.", "She takes no medications and denies smoking.", "She drinks 3 glasses of wine a week.", "Her blood pressure in the office after more than 10 minutes of rest was 153/89 mm Hg in her left arm and 145/90 mm Hg in her right arm.", "A review of her medical record reveals that her blood pressure was 142/92 mm Hg at her visit 1 year ago."], "context_len": 10, "options": {"A": "Liver function tests", "B": "Urine microalbumin", "C": "Hemoglobin A1C", "D": "Blood glucose"}, "answer": "Blood glucose", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "49", "specialties": ["Internal Medicine"], "subspecialties": ["Hypertension Specialist", "Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 49-year-old Caucasian woman presents to your office for elevated blood pressure.", "2. She is a nurse and checks her blood pressure regularly while working in the wards.", "3. She presents with readings ranging between 163/101 and 156/94 mm Hg.", "4. After some research she conducted on her own, she has been exercising and following a low-fat, low-salt diet for the past 3 months.", "5. Her past medical history includes laparoscopic cholecystectomy for acute cholecystitis 2 years previously.", "6. Her mother and father have hypertension.", "7. Her father had myocardial infarction at the age of 68 years.", "8. She takes no medications and denies smoking.", "9. She drinks 3 glasses of wine a week.", "10. Her blood pressure in the office after more than 10 minutes of rest was 153/89 mm Hg in her left arm and 145/90 mm Hg in her right arm.", "11. A review of her medical record reveals that her blood pressure was 142/92 mm Hg at her visit 1 year ago."], "atomic_facts": ["1. She is a nurse.", "2. She checks her blood pressure regularly while working in the wards.", "3. Her blood pressure readings range between 163/101 and 156/94 mm Hg.", "4. She has been exercising and following a low-fat, low-salt diet for the past 3 months.", "5. Her past medical history includes laparoscopic cholecystectomy for acute cholecystitis 2 years previously.", "6. Her mother and father have hypertension.", "7. Her father had a myocardial infarction at the age of 68 years.", "8. She takes no medications.", "9. She denies smoking.", "10. She drinks 3 glasses of wine a week.", "11. Her blood pressure in the office after more than 10 minutes of rest was 153/89 mm Hg in her left arm and 145/90 mm Hg in her right arm.", "12. Her blood pressure was 142/92 mm Hg at her visit 1 year ago."]}
{"id": 836, "question": "Which of the following is most likely to be seen in this patient?", "context": ["A 55-year-old man presents to his primary care physician for back pain.", "The patient states that his back pain is worse in the morning and improves with certain activities.", "He does not experience pain when cycling but notices the pain when standing or walking.", "2 months prior to presentation he was lifting heavy boxes and furniture into his daughter's new home.", "He is requesting pain medication and a doctor's note to take off work for the week as his symptoms are disrupting his life."], "context_len": 5, "options": {"A": "Bamboo appearance of the spine on radiography", "B": "Muscular tenderness with perispinal palpation", "C": "Multiple doctors visits for other unrelated problems", "D": "Narrowing of the lumbar spinal canal on MRI"}, "answer": "Narrowing of the lumbar spinal canal on MRI", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine", "General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 55-year-old man presents to his primary care physician for back pain.", "2. The patient states that his back pain is worse in the morning and improves with certain activities.", "3. He does not experience pain when cycling.", "4. He notices the pain when standing or walking.", "5. 2 months prior to presentation he was lifting heavy boxes and furniture into his daughter's new home.", "6. He is requesting pain medication.", "7. He is requesting a doctor's note to take off work for the week.", "8. His symptoms are disrupting his life."], "atomic_facts": ["1. The patient's back pain is worse in the morning.", "2. The patient's back pain improves with certain activities.", "3. The patient does not experience pain when cycling.", "4. The patient notices the pain when standing or walking.", "5. Two months prior to presentation, the patient was lifting heavy boxes and furniture.", "6. The patient is requesting pain medication.", "7. The patient is requesting a doctor's note to take off work for the week."]}
{"id": 837, "question": "WBC 15.2 x  10\u00b0/L | Hemoglobin 13.4 g/dL | Platelets 185 x 109/L | Prostate-specific antigen (PSA) 10 ng/mL | What is the most likely cause of the patient\u2019s symptoms?", "context": ["A 75-year-old man presents to the emergency department from his doctor\u2019s office with a 2-day history of urinary hesitancy, fever, and chills.", "He additionally notes that he has been getting up frequently during the night to urinate.", "For the last 2 years, it has taken him longer than usual to initiate urination and his stream has gotten weaker.", "He has a history of hypertension for which he takes losartan.", "His blood pressure is 128/84 mm Hg, heart rate is 84/min, respiratory rate is 14/min, and temperature is 38.2\u00b0C (100.8\u00b0F).", "No costovertebral angle tenderness is present on physical examination.", "The patient declines rectal examination.", "Significant laboratory results are as follows: | ."], "context_len": 8, "options": {"A": "Prostate cancer", "B": "Pyelonephritis", "C": "Nephrolithiasis", "D": "Prostatitis"}, "answer": "Prostatitis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "75", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is 75 years old.", "2. Patient has a 2-day history of urinary hesitancy, fever, and chills.", "3. Patient has been getting up frequently during the night to urinate.", "4. Patient has a history of hypertension for which he takes losartan.", "5. Patient's blood pressure is 128/84 mm Hg.", "6. Patient's heart rate is 84/min.", "7. Patient's respiratory rate is 14/min.", "8. Patient's temperature is 38.2\u00b0C (100.8\u00b0F).", "9. No costovertebral angle tenderness is present on physical examination.", "10. Patient declines rectal examination.", "11. Significant laboratory results are present."], "atomic_facts": ["1. He has been getting up frequently during the night to urinate.", "2. For the last 2 years, it has taken him longer than usual to initiate urination.", "3. His stream has gotten weaker.", "4. He has a history of hypertension.", "5. He takes losartan for hypertension.", "6. His blood pressure is 128/84 mm Hg.", "7. His heart rate is 84/min.", "8. His respiratory rate is 14/min.", "9. His temperature is 38.2\u00b0C (100.8\u00b0F).", "10. No costovertebral angle tenderness is present on physical examination.", "11. The patient declines rectal examination.", "12. Significant laboratory results are present."]}
{"id": 838, "question": "This patient's skin lesions are most likely associated with which of the following?", "context": ["A 6-year-old boy is brought to the physician for evaluation of bilateral erythematous skin lesions on the flexures of the elbows and knees.", "He has been scratching the areas frequently.", "He has had similar lesions intermittently for the last 2 years.", "A photograph of the lesions on the back of the knees is shown."], "context_len": 4, "options": {"A": "Reversible decrease in FEV1/FVC ratio", "B": "IgA anti-tissue transglutaminase antibodies", "C": "Hepatocyte infection with hepatitis C virus", "D": "Pencil-in-cup deformity of the fingers"}, "answer": "Reversible decrease in FEV1/FVC ratio", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology", "Pediatric Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 6-year-old boy is brought to the physician for evaluation.", "2. The evaluation is for bilateral erythematous skin lesions on the flexures of the elbows and knees.", "3. The boy has been scratching the areas frequently.", "4. The boy has had similar lesions intermittently for the last 2 years.", "5. A photograph of the lesions on the back of the knees is shown."], "atomic_facts": ["1. The patient has been scratching the areas frequently.", "2. The patient has had similar lesions intermittently for the last 2 years.", "3. A photograph of the lesions on the back of the knees is shown."]}
{"id": 839, "question": "Which of the following molecules is responsible for this reaction?", "context": ["An important step in the formation of thyroid hormones is the formation of I2 via oxidation of I-."], "context_len": 1, "options": {"A": "Thyroid deiodinase", "B": "Thyroid peroxidase", "C": "Perchlorate", "D": "Propylthiouracil"}, "answer": "Thyroid peroxidase", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["General Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An important step in the formation of thyroid hormones.", "2. Formation of I2.", "3. Oxidation of I-."], "atomic_facts": ["1. An important step in the formation of thyroid hormones is the formation of I2.", "2. The formation of I2 occurs via oxidation of I-."]}
{"id": 840, "question": "This patient\u2019s history is most consistent with which of the following conditions?", "context": ["A 29-year-old woman presents to her primary care provider for a normal check-up at the prompting of her mother.", "When asked how she is doing, she replies that she feels depressed.", "Upon further questioning, she states that she feels \u201cworthless\u201d now that her ex-boyfriend left her 2 days ago.", "She has been sitting in his bed all day trying to call him but he is not answering her calls.", "She says that she will never find another man like him and feels like she should just \u201cdisappear\u201d rather than continue living without him.", "She also reports that she can hear his voice when he\u2019s not around, especially at night before she goes to bed.", "She denies having any other friends and has some social anxiety, particularly in large groups of people.", "A review of her medical record indicates that she has endured several episodes of verbal and physical abuse from her prior relationships which she suggested \u201cwere all her fault.\u201d She has had 4 prior serious relationships and reports that she has not been single for more than a few days in the last 10 years.", "On exam, she is unkempt with poor self-care."], "context_len": 9, "options": {"A": "Avoidant personality disorder", "B": "Dependent personality disorder", "C": "Histrionic personality disorder", "D": "Paranoid personality disorder"}, "answer": "Dependent personality disorder", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "29", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 29-year-old woman presents to her primary care provider for a normal check-up. ", "2. Her mother prompted her to go for the check-up. ", "3. When asked how she is doing, she replies that she feels depressed. ", "4. Upon further questioning, she states that she feels \u201cworthless\u201d now that her ex-boyfriend left her 2 days ago. ", "5. She has been sitting in his bed all day trying to call him but he is not answering her calls. ", "6. She says that she will never find another man like him and feels like she should just \u201cdisappear\u201d rather than continue living without him. ", "7. She also reports that she can hear his voice when he\u2019s not around, especially at night before she goes to bed. ", "8. She denies having any other friends and has some social anxiety, particularly in large groups of people. ", "9. A review of her medical record indicates that she has endured several episodes of verbal and physical abuse from her prior relationships. ", "10. She suggested that the abuse was \u201call her fault.\u201d ", "11. She has had 4 prior serious relationships. ", "12. She reports that she has not been single for more than a few days in the last 10 years. ", "13. On exam, she is unkempt with poor self-care."], "atomic_facts": ["1. She feels depressed.", "2. She feels \"worthless\" after her ex-boyfriend left her 2 days ago.", "3. She has been sitting in his bed all day trying to call him but he is not answering her calls.", "4. She feels like she should just \"disappear\" rather than continue living without him.", "5. She can hear his voice when he's not around, especially at night before she goes to bed.", "6. She denies having any other friends and has social anxiety, particularly in large groups of people.", "7. She has endured several episodes of verbal and physical abuse from her prior relationships.", "8. She suggested that the abuse \"were all her fault.\"", "9. She has had 4 prior serious relationships.", "10. She has not been single for more than a few days in the last 10 years.", "11. On exam, she is unkempt with poor self-care."]}
{"id": 841, "question": "Which of the following is the best next step in management?", "context": ["A 65-year-old man presents to the emergency department with confusion and chest pain.", "He states his symptoms started after he landed on a return flight from Brazil.", "Since then, the patient states that he feels anxious, short of breath, and has pleuritic chest pain.", "The patient has a past medical history of diabetes and chronic kidney disease.", "His medications include insulin, lisinopril, aspirin, and atorvastatin.", "His temperature is 101\u00b0F (38.3\u00b0C), blood pressure is 154/94 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 96% on room air.", "Physical exam is notable for a confused man.", "The patient\u2019s laboratory studies are ordered as seen below. |  | Serum: | Na+: 140 mEq/L | Cl-: 103 mEq/L | K+: 5.3 mEq/L | HCO3-: 25 mEq/L | BUN: 33 mg/dL | Glucose: 168 mg/dL | Creatinine: 1.8 mg/dL | Ca2+: 10.0 mg/dL | Troponin: < 0.05 mcg/L |  | A chest CT angiogram, an echocardiogram (ECG), and a second troponin are ordered and are all unremarkable.", "The patient\u2019s chest pain resolves with diazepam.", "A lumbar puncture is performed and based on the results the patient is subsequently started on acyclovir."], "context_len": 10, "options": {"A": "Bolus of IV fluids", "B": "Calcium gluconate", "C": "Hemodialysis", "D": "No further interventions needed"}, "answer": "Bolus of IV fluids", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Internal Medicine", "Emergency Medicine"], "subspecialties": ["Neurocritical Care", "General Emergency Medicine", "Neurology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old man presents to the emergency department with confusion and chest pain.", "2. He states his symptoms started after he landed on a return flight from Brazil.", "3. Since then, the patient states that he feels anxious, short of breath, and has pleuritic chest pain.", "4. The patient has a past medical history of diabetes and chronic kidney disease.", "5. His medications include insulin, lisinopril, aspirin, and atorvastatin.", "6. His temperature is 101\u00b0F (38.3\u00b0C), blood pressure is 154/94 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 96% on room air.", "7. Physical exam is notable for a confused man.", "8. Serum Na+: 140 mEq/L", "9. Serum Cl-: 103 mEq/L", "10. Serum K+: 5.3 mEq/L", "11. Serum HCO3-: 25 mEq/L", "12. Serum BUN: 33 mg/dL", "13. Serum Glucose: 168 mg/dL", "14. Serum Creatinine: 1.8 mg/dL", "15. Serum Ca2+: 10.0 mg/dL", "16. Serum Troponin: < 0.05 mcg/L", "17. A chest CT angiogram, an echocardiogram (ECG), and a second troponin are ordered and are all unremarkable.", "18. The patient\u2019s chest pain resolves with diazepam.", "19. A lumbar puncture is performed.", "20. Based on the results of the lumbar puncture, the patient is subsequently started on acyclovir."], "atomic_facts": ["1. Symptoms started after returning from Brazil", "2. Feels anxious, short of breath, and has pleuritic chest pain", "3. Past medical history of diabetes and chronic kidney disease", "4. Medications include insulin, lisinopril, aspirin, and atorvastatin", "5. Temperature is 101\u00b0F (38.3\u00b0C), blood pressure is 154/94 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 96% on room air", "6. Physical exam is notable for a confused man", "7. Laboratory studies show: Na+: 140 mEq/L, Cl-: 103 mEq/L, K+: 5.3 mEq/L, HCO3-: 25 mEq/L, BUN: 33 mg/dL, Glucose: 168 mg/dL, Creatinine: 1.8 mg/dL, Ca2+: 10.0 mg/dL, Troponin: < 0.05 mcg/L", "8. Chest CT angiogram, echocardiogram (ECG), and second troponin are all unremarkable", "9. Chest pain resolves with diazepam", "10. Lumbar puncture is performed and patient is subsequently started on acyclovir"]}
{"id": 842, "question": "Which of the following is the most likely underlying etiology of this patient's condition?", "context": ["A 52-year-old homosexual man presents to the emergency department because of sudden right loin pain accompanied by nausea and vomiting.", "He has essential hypertension for 3 years for which he takes bisoprolol.", "He has a remote history of intravenous drug use.", "His temperature is 36.9\u00b0C (98.4\u00b0F), the blood pressure is 137/92 mm Hg, and the pulse is 95/min.", "Physical examination reveals right flank tenderness and 2+ edema of both legs up to the knees.", "Doppler ultrasonography shows an enlarged, echogenic right kidney with the absent venous signal.", "Laboratory results are shown: | Serum creatinine 2.2 mg/dL | Urine dipstick 4+ protein | Urine analysis 20\u201325 red cells/high power field | ."], "context_len": 7, "options": {"A": "Acute pyelonephritis", "B": "Hypertensive kidney disease", "C": "Membranous nephropathy", "D": "Penile cancer"}, "answer": "Membranous nephropathy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "52 years old", "specialties": ["Urology", "Internal Medicine"], "subspecialties": ["General Urology", "Nephrology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 52-year-old homosexual man presents to the emergency department.", "2. He has sudden right loin pain accompanied by nausea and vomiting.", "3. He has essential hypertension for 3 years for which he takes bisoprolol.", "4. He has a remote history of intravenous drug use.", "5. His temperature is 36.9\u00b0C (98.4\u00b0F).", "6. His blood pressure is 137/92 mm Hg.", "7. His pulse is 95/min.", "8. Physical examination reveals right flank tenderness.", "9. Physical examination reveals 2+ edema of both legs up to the knees.", "10. Doppler ultrasonography shows an enlarged, echogenic right kidney with the absent venous signal.", "11. Serum creatinine is 2.2 mg/dL.", "12. Urine dipstick is 4+ protein.", "13. Urine analysis shows 20\u201325 red cells/high power field."], "atomic_facts": ["1. He has essential hypertension for 3 years.", "2. He takes bisoprolol for his essential hypertension.", "3. He has a remote history of intravenous drug use.", "4. His temperature is 36.9\u00b0C (98.4\u00b0F).", "5. His blood pressure is 137/92 mm Hg.", "6. His pulse is 95/min.", "7. Physical examination reveals right flank tenderness.", "8. Physical examination reveals 2+ edema of both legs up to the knees.", "9. Doppler ultrasonography shows an enlarged, echogenic right kidney.", "10. Doppler ultrasonography shows the absent venous signal in the right kidney.", "11. Laboratory results show serum creatinine 2.2 mg/dL.", "12. Laboratory results show urine dipstick 4+ protein.", "13. Laboratory results show urine analysis 20\u201325 red cells/high power field."]}
{"id": 843, "question": "Angiography would most likely show a dissection in which of the following vessels?", "context": ["A 53-year-old woman is brought to the emergency department for a 2-hour history of balance problems.", "She was gardening when she suddenly felt very dizzy and she quickly called for her husband.", "When he arrived, she was sitting on the ground, swaying back and forth but overall leaning to the right.", "When she tried to stand up they found she was very unsteady and unbalanced, so her husband carried her to the car.", "In the emergency department, while lying in bed, she complains of a room-spinning sensation; when she sits up, she sways to the right.", "She is unable to walk more than 3 steps without falling.", "Finger-nose-finger and heel-knee-shin testing are abnormal.", "She has a past medical history of hypertension, polycystic ovarian syndrome, and type 2 diabetes mellitus.", "All of her vital signs are all within normal limits."], "context_len": 9, "options": {"A": "Anterior cerebral artery", "B": "Middle cerebral artery", "C": "Vertebral artery", "D": "Anterior spinal artery"}, "answer": "Vertebral artery", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "53 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 53-year-old woman is brought to the emergency department.", "2. She has a 2-hour history of balance problems.", "3. She was gardening when she suddenly felt very dizzy.", "4. She quickly called for her husband.", "5. When he arrived, she was sitting on the ground, swaying back and forth but overall leaning to the right.", "6. When she tried to stand up they found she was very unsteady and unbalanced.", "7. Her husband carried her to the car.", "8. In the emergency department, while lying in bed, she complains of a room-spinning sensation.", "9. When she sits up, she sways to the right.", "10. She is unable to walk more than 3 steps without falling.", "11. Finger-nose-finger and heel-knee-shin testing are abnormal.", "12. She has a past medical history of hypertension.", "13. She has a past medical history of polycystic ovarian syndrome.", "14. She has a past medical history of type 2 diabetes mellitus.", "15. All of her vital signs are all within normal limits."], "atomic_facts": ["1. She was gardening when she suddenly felt very dizzy.", "2. She quickly called for her husband.", "3. When he arrived, she was sitting on the ground, swaying back and forth.", "4. She was overall leaning to the right.", "5. When she tried to stand up, they found she was very unsteady and unbalanced.", "6. Her husband carried her to the car.", "7. In the emergency department, while lying in bed, she complains of a room-spinning sensation.", "8. When she sits up, she sways to the right.", "9. She is unable to walk more than 3 steps without falling.", "10. Finger-nose-finger testing is abnormal.", "11. Heel-knee-shin testing is abnormal.", "12. She has a past medical history of hypertension.", "13. She has a past medical history of polycystic ovarian syndrome.", "14. She has a past medical history of type 2 diabetes mellitus.", "15. All of her vital signs are within normal limits."]}
{"id": 844, "question": "Which of the following best describes this cause of the patients symptoms after treatment?", "context": ["A 65-year-old man with squamous cell carcinoma of the lung presents with a sodium of 118 and an altered mental status.", "He is started on 3% normal saline over the next several hours.", "The patient\u2019s mental status improves and and a repeat sodium six hours later is 129.", "Three days after treatment he demonstrates quadriparesis and dysarthria."], "context_len": 4, "options": {"A": "Lateral medullary syndrome", "B": "Medial medullary syndrome", "C": "Osmotic demyelination syndrome", "D": "Hypercalcemia"}, "answer": "Osmotic demyelination syndrome", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "65", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old man has squamous cell carcinoma of the lung.", "2. His sodium level is 118.", "3. His mental status is altered.", "4. He is started on 3% normal saline.", "5. His mental status improves.", "6. His sodium level is 129 six hours later.", "7. Three days after treatment he has quadriparesis and dysarthria."], "atomic_facts": ["1. The patient is started on 3% normal saline over the next several hours.", "2. The patient's mental status improves.", "3. A repeat sodium six hours later is 129.", "4. Three days after treatment, the patient demonstrates quadriparesis and dysarthria."]}
{"id": 845, "question": "Which of the following is the most likely trigger for her current episode?", "context": ["A 27-year-old woman presents to the emergency department with severe wheezing, which started an hour ago.", "She informs the doctor that she has had mild persistent asthma for the last 2 years and is on inhaled corticosteroids, and uses them regularly.", "She has not experienced asthma symptoms for the last 2 months and there is no history of non-compliance.", "She mentions that her present symptoms came on about 20 minutes after her last meal.", "When the doctor makes specific inquiries, she recollects items in her lunch, which included canned milk product, commercially available roasted peanuts, homemade celery salad, and wine.", "She also mentions that she took a tablet of acetaminophen immediately after the meal because her legs were aching since morning, which she attributes to her morning walk at 6 am the same day.", "She has never developed respiratory symptoms in response to milk protein, peanuts, or acetaminophen until now.", "Skin prick testing for food allergens, performed a month back, was negative for all the common food allergens, including milk and peanuts."], "context_len": 8, "options": {"A": "Ara-h-1 protein", "B": "Food additive", "C": "Acetaminophen", "D": "Exercise"}, "answer": "Food additive", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Allergy and Immunology"], "subspecialties": ["General Allergy and Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 27 years old.", "2. Patient presents to the emergency department with severe wheezing.", "3. Wheezing started an hour ago.", "4. Patient has had mild persistent asthma for the last 2 years.", "5. Patient is on inhaled corticosteroids.", "6. Patient uses inhaled corticosteroids regularly.", "7. Patient has not experienced asthma symptoms for the last 2 months.", "8. No history of non-compliance.", "9. Symptoms came on about 20 minutes after last meal.", "10. Last meal included canned milk product, commercially available roasted peanuts, homemade celery salad, and wine.", "11. Patient took a tablet of acetaminophen immediately after the meal.", "12. Patient's legs were aching since morning.", "13. Patient attributes aching legs to morning walk at 6 am the same day.", "14. Patient has never developed respiratory symptoms in response to milk protein, peanuts, or acetaminophen until now.", "15. Skin prick testing for food allergens, performed a month back, was negative for all the common food allergens, including milk and peanuts."], "atomic_facts": ["1. She has had mild persistent asthma for the last 2 years.", "2. She is on inhaled corticosteroids and uses them regularly.", "3. She has not experienced asthma symptoms for the last 2 months.", "4. There is no history of non-compliance with her medication.", "5. Her present symptoms came on about 20 minutes after her last meal.", "6. Her lunch included canned milk product, commercially available roasted peanuts, homemade celery salad, and wine.", "7. She took a tablet of acetaminophen immediately after the meal.", "8. She attributes her leg ache to her morning walk at 6 am the same day.", "9. She has never developed respiratory symptoms in response to milk protein, peanuts, or acetaminophen until now.", "10. Skin prick testing for food allergens performed a month back was negative for all common food allergens, including milk and peanuts."]}
{"id": 846, "question": "What is the chance the offspring will be a child WITHOUT sickle cell anemia?", "context": ["A 30-year old African-American woman comes into your office for pregnancy counseling with her husband.", "She states that both she and her husband have family histories of sickle cell disease.", "Based on previous genetic testing, they both also have a copy of the sickle cell gene from their parents, but neither of them has ever manifested symptoms associated with the disease.", "They want to conceive and are concerned about the chances that their child might have the disease."], "context_len": 4, "options": {"A": "1/2", "B": "3/4", "C": "1/4", "D": "2/3"}, "answer": "3/4", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "30", "specialties": ["Pediatrics", "Medical Genetics and Genomics"], "subspecialties": ["Clinical Genetics and Genomics", "Pediatric Genetics and Genomics", "Pediatric Genetics"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 30-year old African-American woman comes into your office for pregnancy counseling with her husband.", "2. She has a family history of sickle cell disease.", "3. Her husband has a family history of sickle cell disease.", "4. She has a copy of the sickle cell gene from her parents.", "5. Her husband has a copy of the sickle cell gene from his parents.", "6. Neither of them has ever manifested symptoms associated with the disease.", "7. They want to conceive.", "8. They are concerned about the chances that their child might have the disease."], "atomic_facts": ["1. The patient and her husband have family histories of sickle cell disease.", "2. Both the patient and her husband have a copy of the sickle cell gene from their parents.", "3. Neither the patient nor her husband has ever manifested symptoms associated with sickle cell disease.", "4. The patient and her husband want to conceive.", "5. They are concerned about the chances that their child might have sickle cell disease."]}
{"id": 847, "question": "Which of the following would be the closest match?", "context": ["A 52-year-old man presents to the clinic complaining of blood in his urine.", "He had a mild respiratory illness 3 weeks ago.", "Urinalysis reveals a high red blood cell count and casts in the urine.", "A diagnosis of post-streptococcal glomerulonephritis is made.", "The physician explains that the treatment is supportive and that the patient needs to follow up with him every two weeks.", "Six weeks later, the patient returns to the clinic because he does not feel well; he has been experiencing malaise and fatigue.", "On examination, his pulse is 98/min, blood pressure is 135/85 mm Hg, temperature is 36.6\u00b0C (98.0\u00b0F), and respiratory rate is 16/min.", "He has a mildly distended abdomen.", "Blood tests reveal that the patient\u2019s creatinine level has increased from 1.2 mg/dL to 3.0 mg/dL over the last month.", "He is referred to a nephrologist who diagnoses him with rapidly progressive glomerulonephritis (RPGN) and starts him on hemodialysis, as his potassium level has risen to 7 mEq/dL.", "The patient is advised to undergo renal transplantation.", "His human leukocyte antigen (HLA) genotype is A7/A5, B2/B9, C8/C3.", "The first allele in each locus is the maternal form; the second is paternal.", "Several potential donors are available for the renal graft."], "context_len": 14, "options": {"A": "Donor B: tA5/A12, tB22/9, ttC4/C3", "B": "Donor A: tA7/A5, ttB8/B2, ttC3/C8", "C": "Donor E: tA7/A8, ttB9/B27, tC3/C4", "D": "Donor D: tA4/A7, ttB1/B8, ttC8/C3"}, "answer": "Donor A: tA7/A5, ttB8/B2, ttC3/C8", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 52-year-old man presents to the clinic complaining of blood in his urine.", "2. He had a mild respiratory illness 3 weeks ago.", "3. Urinalysis reveals a high red blood cell count and casts in the urine.", "4. A diagnosis of post-streptococcal glomerulonephritis is made.", "5. The physician explains that the treatment is supportive and that the patient needs to follow up with him every two weeks.", "6. Six weeks later, the patient returns to the clinic because he does not feel well; he has been experiencing malaise and fatigue.", "7. On examination, his pulse is 98/min, blood pressure is 135/85 mm Hg, temperature is 36.6\u00b0C (98.0\u00b0F), and respiratory rate is 16/min.", "8. He has a mildly distended abdomen.", "9. Blood tests reveal that the patient\u2019s creatinine level has increased from 1.2 mg/dL to 3.0 mg/dL over the last month.", "10. He is referred to a nephrologist who diagnoses him with rapidly progressive glomerulonephritis (RPGN) and starts him on hemodialysis, as his potassium level has risen to 7 mEq/dL.", "11. The patient is advised to undergo renal transplantation.", "12. His human leukocyte antigen (HLA) genotype is A7/A5, B2/B9, C8/C3.", "13. The first allele in each locus is the maternal form; the second is paternal.", "14. Several potential donors are available for the renal graft."], "atomic_facts": ["1. He had a mild respiratory illness 3 weeks ago.", "2. Urinalysis reveals a high red blood cell count and casts in the urine.", "3. A diagnosis of post-streptococcal glomerulonephritis is made.", "4. The physician explains that the treatment is supportive and that the patient needs to follow up with him every two weeks.", "5. Six weeks later, the patient returns to the clinic because he does not feel well; he has been experiencing malaise and fatigue.", "6. On examination, his pulse is 98/min, blood pressure is 135/85 mm Hg, temperature is 36.6\u00b0C (98.0\u00b0F), and respiratory rate is 16/min.", "7. He has a mildly distended abdomen.", "8. Blood tests reveal that the patient\u2019s creatinine level has increased from 1.2 mg/dL to 3.0 mg/dL over the last month.", "9. He is referred to a nephrologist who diagnoses him with rapidly progressive glomerulonephritis (RPGN) and starts him on hemodialysis, as his potassium level has risen to 7 mEq/dL.", "10. The patient is advised to undergo renal transplantation.", "11. His human leukocyte antigen (HLA) genotype is A7/A5, B2/B9, C8/C3.", "12. The first allele in each locus is the maternal form; the second is paternal.", "13. Several potential donors are available for the renal graft."]}
{"id": 848, "question": "Based on these findings, which of the following is the most likely correlation coefficient?", "context": ["An investigator is studying determinants of childhood obesity by observing a cohort of pregnant women with obesity.", "After delivery, he regularly records the height and weight of the cohort's children.", "The results of the correlation analysis between mean childhood BMI at 4 years of age and mean maternal BMI before pregnancy are shown."], "context_len": 3, "options": {"A": "-0.45", "B": "0.45", "C": "0", "D": "-1.80"}, "answer": "0.45", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pediatrics", "Obstetrics and Gynecology"], "subspecialties": ["Pediatric Endocrinology", "Maternal", "Neonatal"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An investigator is studying determinants of childhood obesity.", "2. The investigator is observing a cohort of pregnant women with obesity.", "3. The investigator regularly records the height and weight of the cohort's children after delivery.", "4. The investigator is conducting a correlation analysis between mean childhood BMI at 4 years of age and mean maternal BMI before pregnancy.", "5. The results of the correlation analysis are shown."], "atomic_facts": ["1. After delivery, he records the height and weight of the cohort's children.", "2. The results of the correlation analysis are between mean childhood BMI at 4 years of age and mean maternal BMI before pregnancy."]}
{"id": 849, "question": "Which of the following is the most likely cause of this patient's anemia?\"", "context": ["A 25-year-old woman comes to the physician for a routine examination.", "She is a recreational runner and for the past 3 months she has been training for a marathon.", "Yesterday she ran 17 km (10.5 mile).", "Menses occur at regular 28-day intervals and last 6 days.", "She drinks three to five beers when going out with friends.", "She follows a vegan diet.", "She appears well.", "Her temperature is 36.6\u00b0C (98.0\u00b0F), blood pressure is 110/72 mm Hg, pulse is 70/min, and respirations are 14/min.", "Physical examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 9.8 g/dL | Mean corpuscular volume 91 fL | Lactate dehydrogenase 400 U/L | Platelet count 250,000/mm3 | Reticulocyte count 3% | Haptoglobin 23 mg/dL (N=41\u2013165 mg/dL) | Serum | Iron 90 \u03bcg/dL | Ferritin 170 ng/mL | Total iron binding capacity (TIBC) 220 \u03bcg/dL (N=251\u2013406 \u03bcg/dL) | Urinalysis shows trace blood but no RBCs."], "context_len": 10, "options": {"A": "Extravascular hemolysis", "B": "Vitamin B12 deficiency", "C": "Intravascular hemolysis", "D": "Impaired heme synthesis"}, "answer": "Intravascular hemolysis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "25", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 25-year-old woman comes to the physician for a routine examination.", "2. She is a recreational runner and for the past 3 months she has been training for a marathon.", "3. Yesterday she ran 17 km (10.5 mile).", "4. Menses occur at regular 28-day intervals and last 6 days.", "5. She drinks three to five beers when going out with friends.", "6. She follows a vegan diet.", "7. She appears well.", "8. Her temperature is 36.6\u00b0C (98.0\u00b0F).", "9. Blood pressure is 110/72 mm Hg.", "10. Pulse is 70/min.", "11. Respirations are 14/min.", "12. Physical examination shows no abnormalities.", "13. Laboratory studies show hemoglobin 9.8 g/dL.", "14. Mean corpuscular volume 91 fL.", "15. Lactate dehydrogenase 400 U/L.", "16. Platelet count 250,000/mm3.", "17. Reticulocyte count 3%.", "18. Haptoglobin 23 mg/dL (N=41\u2013165 mg/dL).", "19. Serum iron 90 \u03bcg/dL.", "20. Ferritin 170 ng/mL.", "21. Total iron binding capacity (TIBC) 220 \u03bcg/dL (N=251\u2013406 \u03bcg/dL).", "22. Urinalysis shows trace blood but no RBCs."], "atomic_facts": ["1. She is a recreational runner.", "2. She has been training for a marathon for the past 3 months.", "3. Yesterday she ran 17 km (10.5 miles).", "4. Her menses occur at regular 28-day intervals and last 6 days.", "5. She drinks three to five beers when going out with friends.", "6. She follows a vegan diet.", "7. She appears well.", "8. Her temperature is 36.6\u00b0C (98.0\u00b0F).", "9. Her blood pressure is 110/72 mm Hg.", "10. Her pulse is 70/min.", "11. Her respirations are 14/min.", "12. Physical examination shows no abnormalities.", "13. Laboratory studies show: Hemoglobin 9.8 g/dL.", "14. Laboratory studies show: Mean corpuscular volume 91 fL.", "15. Laboratory studies show: Lactate dehydrogenase 400 U/L.", "16. Laboratory studies show: Platelet count 250,000/mm3.", "17. Laboratory studies show: Reticulocyte count 3%.", "18. Laboratory studies show: Haptoglobin 23 mg/dL (N=41\u2013165 mg/dL).", "19. Laboratory studies show: Serum Iron 90 \u03bcg/dL.", "20. Laboratory studies show: Ferritin 170 ng/mL.", "21. Laboratory studies show: Total iron binding capacity (TIBC) 220 \u03bcg/dL (N=251\u2013406 \u03bcg/dL).", "22. Urinalysis shows trace blood but no RBCs."]}
{"id": 850, "question": "Which personality disorder is most likely?", "context": ["A 45-year-old man comes into the ED after a car accident.", "After waiting an hour in the waiting room, he begins to berate the receptionist and demands to be seen by a doctor.", "During the exam, the patient brags that he recently had to quit his job because they did not appreciate his talent and drive.", "After a medical student declines his invitation for a date, he becomes very angry and throws supplies across the room.", "The physician manages the patient's physical injuries and begins to suspect the patient has a personality disorder."], "context_len": 5, "options": {"A": "Narcissistic personality disorder", "B": "Avoidant personality disorder", "C": "Histrionic personality disorder", "D": "Obsessive-compulsive personality disorder"}, "answer": "Narcissistic personality disorder", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "45", "specialties": ["Psychiatry", "Emergency Medicine"], "subspecialties": ["General Psychiatry", "General Emergency Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 45-year-old man comes into the ED after a car accident.", "2. He waits an hour in the waiting room.", "3. He berates the receptionist and demands to be seen by a doctor.", "4. He brags that he recently had to quit his job because they did not appreciate his talent and drive.", "5. A medical student declines his invitation for a date.", "6. He becomes very angry and throws supplies across the room.", "7. The physician manages the patient's physical injuries.", "8. The physician begins to suspect the patient has a personality disorder."], "atomic_facts": ["1. The patient waits for an hour in the waiting room.", "2. The patient berates the receptionist.", "3. The patient demands to be seen by a doctor.", "4. The patient brags about recently quitting his job.", "5. The patient claims his job did not appreciate his talent and drive.", "6. The patient becomes angry after a medical student declines his date invitation.", "7. The patient throws supplies across the room.", "8. The physician manages the patient's physical injuries.", "9. The physician suspects the patient has a personality disorder."]}
{"id": 851, "question": "The beneficial effect of this drug is most likely due to arrest in which of the following phases of the cell cycle?", "context": ["A 61-year-old man comes to the physician because of weight loss and a non-productive cough for 4 months.", "He has smoked 2 packs of cigarettes daily for 42 years.", "A CT scan of the chest shows an irregular mass at the right hilum and axillary lymphadenopathy.", "A biopsy of the mass obtained on bronchoscopy confirms the diagnosis of metastatic non-small cell lung cancer.", "Results of a molecular diagnostic test show a microdeletion on the short arm of chromosome 7.", "The physician recommends chemotherapy with erlotinib."], "context_len": 6, "options": {"A": "G2 phase", "B": "G1 phase", "C": "G0 phase", "D": "S phase"}, "answer": "G1 phase", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "61 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 61-year-old man comes to the physician.", "2. He has a non-productive cough for 4 months.", "3. He has smoked 2 packs of cigarettes daily for 42 years.", "4. A CT scan of the chest shows an irregular mass at the right hilum and axillary lymphadenopathy.", "5. A biopsy of the mass obtained on bronchoscopy confirms the diagnosis of metastatic non-small cell lung cancer.", "6. Results of a molecular diagnostic test show a microdeletion on the short arm of chromosome 7.", "7. The physician recommends chemotherapy with erlotinib."], "atomic_facts": ["1. He has smoked 2 packs of cigarettes daily for 42 years.", "2. A CT scan of the chest shows an irregular mass at the right hilum and axillary lymphadenopathy.", "3. A biopsy of the mass obtained on bronchoscopy confirms the diagnosis of metastatic non-small cell lung cancer.", "4. Results of a molecular diagnostic test show a microdeletion on the short arm of chromosome 7.", "5. The physician recommends chemotherapy with erlotinib."]}
{"id": 852, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?", "context": ["A 52-year-old woman comes to the physician because of a 4-day history of painful swallowing and retrosternal pain.", "She was diagnosed with HIV infection 2 months ago; her medications include tenofovir, emtricitabine, and raltegravir.", "Vital signs are within normal limits.", "Physical examination of the oral cavity shows no abnormalities.", "The patient's CD4+ T-lymphocyte count is 70/mm3 (N \u2265 500).", "Empiric treatment is started.", "Two weeks later, she reports no improvement in symptoms.", "Esophagogastroduodenoscopy is performed and shows multiple round superficial ulcers in the distal esophagus."], "context_len": 8, "options": {"A": "Adverse effect of medication", "B": "Degeneration of ganglion cells within the myenteric plexuses", "C": "Infection with herpes simplex virus", "D": "Infection with Candida species"}, "answer": "Infection with herpes simplex virus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "52 years old", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 52-year-old woman comes to the physician.", "2. She has a 4-day history of painful swallowing and retrosternal pain.", "3. She was diagnosed with HIV infection 2 months ago.", "4. Her medications include tenofovir, emtricitabine, and raltegravir.", "5. Vital signs are within normal limits.", "6. Physical examination of the oral cavity shows no abnormalities.", "7. The patient's CD4+ T-lymphocyte count is 70/mm3 (N \u2265 500).", "8. Empiric treatment is started.", "9. Two weeks later, she reports no improvement in symptoms.", "10. Esophagogastroduodenoscopy is performed.", "11. Esophagogastroduodenoscopy shows multiple round superficial ulcers in the distal esophagus."], "atomic_facts": ["1. The patient was diagnosed with HIV infection 2 months ago.", "2. The patient's medications include tenofovir, emtricitabine, and raltegravir.", "3. Vital signs are within normal limits.", "4. Physical examination of the oral cavity shows no abnormalities.", "5. The patient's CD4+ T-lymphocyte count is 70/mm3 (N \u2265 500).", "6. Empiric treatment is started.", "7. Two weeks later, the patient reports no improvement in symptoms.", "8. Esophagogastroduodenoscopy is performed.", "9. The esophagogastroduodenoscopy shows multiple round superficial ulcers in the distal esophagus."]}
{"id": 853, "question": "Which of the following is the most likely diagnosis?", "context": ["An 18-year-old girl comes to the emergency room with abdominal pain.", "She states that the pain started 6 hours ago, is 8/10, and localizes to the right lower abdomen.", "She recalls a similar episode last month.", "Her older brother was hospitalized 2 years ago for perforated appendicitis.", "Her mother has diverticulitis.", "The patient got her first menstrual period at age 14.", "Her periods occur regularly every 28 days.", "Her last menstrual period was 2 weeks ago.", "She is sexually active with multiple partners and uses condoms inconsistently.", "The patient\u2019s temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 110/74 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air.", "On physical exam, the patient is in moderate distress.", "There is lower abdominal tenderness with guarding.", "A pelvic examination reveals clear mucous in the vaginal introitus, a mobile uterus, and tenderness of the right adnexa.", "Labs are obtained, as shown below: |  | Leukocyte count: 10,000/mm^3 with normal differential | Hemoglobin: 13.5 g/dL | Platelet count: 200,000/mm^3 | Beta-human chorionic gonadotropin: Pending |  | A pelvic ultrasound demonstrates a small fluid collection in the cul-de-sac posterior to the uterus."], "context_len": 14, "options": {"A": "Appendicitis", "B": "Endometriosis", "C": "Midcycle pain", "D": "Ruptured ectopic pregnancy"}, "answer": "Midcycle pain", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "18", "specialties": ["Emergency Medicine", "Pediatrics", "Obstetrics and Gynecology", "General Surgery"], "subspecialties": ["General Emergency Medicine", "General Pediatrics", "General Surgery", "General Obstetrics and Gynecology"], "specialty_prob": [0.4, 0.2, 0.2, 0.2], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. An 18-year-old girl comes to the emergency room with abdominal pain.", "2. She states that the pain started 6 hours ago, is 8/10, and localizes to the right lower abdomen.", "3. She recalls a similar episode last month.", "4. Her older brother was hospitalized 2 years ago for perforated appendicitis.", "5. Her mother has diverticulitis.", "6. The patient got her first menstrual period at age 14.", "7. Her periods occur regularly every 28 days.", "8. Her last menstrual period was 2 weeks ago.", "9. She is sexually active with multiple partners and uses condoms inconsistently.", "10. The patient\u2019s temperature is 99\u00b0F (37.2\u00b0C).", "11. The patient\u2019s blood pressure is 110/74 mmHg.", "12. The patient\u2019s pulse is 89/min.", "13. The patient\u2019s respirations are 14/min with an oxygen saturation of 98% on room air.", "14. On physical exam, the patient is in moderate distress.", "15. There is lower abdominal tenderness with guarding.", "16. A pelvic examination reveals clear mucous in the vaginal introitus, a mobile uterus, and tenderness of the right adnexa.", "17. Labs are obtained, as shown below: Leukocyte count: 10,000/mm^3 with normal differential.", "18. Labs are obtained, as shown below: Hemoglobin: 13.5 g/dL.", "19. Labs are obtained, as shown below: Platelet count: 200,000/mm^3.", "20. Labs are obtained, as shown below: Beta-human chorionic gonadotropin: Pending.", "21. A pelvic ultrasound demonstrates a small fluid collection in the cul-de-sac posterior to the uterus."], "atomic_facts": ["1. The patient's pain started 6 hours ago and is 8/10.", "2. The pain localizes to the right lower abdomen.", "3. The patient had a similar episode last month.", "4. The patient's older brother was hospitalized 2 years ago for perforated appendicitis.", "5. The patient's mother has diverticulitis.", "6. The patient got her first menstrual period at age 14.", "7. Her periods occur regularly every 28 days.", "8. Her last menstrual period was 2 weeks ago.", "9. The patient is sexually active with multiple partners and uses condoms inconsistently.", "10. The patient's temperature is 99\u00b0F (37.2\u00b0C).", "11. Her blood pressure is 110/74 mmHg.", "12. Her pulse is 89/min.", "13. Her respirations are 14/min with an oxygen saturation of 98% on room air.", "14. On physical exam, the patient is in moderate distress.", "15. There is lower abdominal tenderness with guarding.", "16. A pelvic examination reveals clear mucous in the vaginal introitus, a mobile uterus, and tenderness of the right adnexa.", "17. Labs: Leukocyte count is 10,000/mm^3 with normal differential.", "18. Hemoglobin is 13.5 g/dL.", "19. Platelet count is 200,000/mm^3.", "20. Beta-human chorionic gonadotropin is pending.", "21. A pelvic ultrasound demonstrates a small fluid collection in the cul-de-sac posterior to the uterus."]}
{"id": 854, "question": "Which of the following cluster of differentiation markers will he need to use to identify these cells in the resected specimens?", "context": ["In a suburban town in Virginia, epidemiologists are alarmed by the increasing number of squamous cell lung cancer cases.", "Further investigation reveals that most people in the area work in a glass factory, the region\u2019s main source of employment.", "A researcher is interested in studying the role of immunosurveillance in the pathogenesis of this lung cancer.", "He postulates that tumor infiltration by natural killer (NK) cells has a better prognosis since they play a major role in immunosurveillance.", "NK cells also kill tumor cells by the perforin-mediated destruction of cancerous cells.", "The researcher is interested in studying tumor infiltration by NK cells in the resected specimen from patients within the cohort who have been diagnosed with stage 1 lung cancer."], "context_len": 6, "options": {"A": "CD20", "B": "CD3", "C": "CD34", "D": "CD56"}, "answer": "CD56", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["General Pathology", "Dermatopathology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pathology"}, "facts_old": ["1. In a suburban town in Virginia, epidemiologists are alarmed by the increasing number of squamous cell lung cancer cases.", "2. Most people in the area work in a glass factory, the region\u2019s main source of employment.", "3. A researcher is interested in studying the role of immunosurveillance in the pathogenesis of this lung cancer.", "4. He postulates that tumor infiltration by natural killer (NK) cells has a better prognosis since they play a major role in immunosurveillance.", "5. NK cells also kill tumor cells by the perforin-mediated destruction of cancerous cells.", "6. The researcher is interested in studying tumor infiltration by NK cells in the resected specimen from patients within the cohort who have been diagnosed with stage 1 lung cancer."], "atomic_facts": ["1. Most people in the area work in a glass factory, the region\u2019s main source of employment.", "2. A researcher is interested in studying the role of immunosurveillance in the pathogenesis of lung cancer.", "3. The researcher postulates that tumor infiltration by natural killer (NK) cells has a better prognosis.", "4. NK cells play a major role in immunosurveillance.", "5. NK cells kill tumor cells by the perforin-mediated destruction of cancerous cells.", "6. The researcher is interested in studying tumor infiltration by NK cells in the resected specimen from patients within the cohort diagnosed with stage 1 lung cancer."]}
{"id": 855, "question": "What is the most likely diagnosis?", "context": ["A 26-year-old man presents to the office complaining of persistent back pain for the past 3 months.", "You saw the patient previously and prescribed NSAIDs and rest, but he has not improved.", "The patient states that his maternal grandfather had \u2018back problems his whole life\u2019, and he worries that he might have the same issues.", "An X-ray is performed and shows squaring of the vertebrae with longitudinal fibrous bands."], "context_len": 4, "options": {"A": "Ehlers-Danlos syndrome", "B": "Osteosarcoma", "C": "Ankylosing spondylitis", "D": "Osteopetrosis"}, "answer": "Ankylosing spondylitis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "26 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Physical Medicine and Rehabilitation"}, "facts_old": ["1. A 26-year-old man presents to the office.", "2. He has been complaining of persistent back pain for the past 3 months.", "3. The patient was previously prescribed NSAIDs and rest, but has not improved.", "4. The patient's maternal grandfather had \"back problems his whole life\".", "5. The patient worries that he might have the same issues.", "6. An X-ray is performed.", "7. The X-ray shows squaring of the vertebrae with longitudinal fibrous bands."], "atomic_facts": ["1. The patient was previously prescribed NSAIDs and rest.", "2. The patient has not improved.", "3. The patient's maternal grandfather had back problems his whole life.", "4. The patient worries that he might have the same issues.", "5. An X-ray was performed.", "6. The X-ray shows squaring of the vertebrae.", "7. The X-ray shows longitudinal fibrous bands."]}
{"id": 856, "question": "Which of the following interventions would be most successful at achieving the task group\u2019s mission?", "context": ["A regional hospital system has decided to institute a new task group for quality improvement and patient safety.", "The task group would like to begin by decreasing the number of days given for narcotic pain medication prescriptions in the emergency department to at most 7 days instead of the hospital average of 21 days per prescription."], "context_len": 2, "options": {"A": "Educating patients about appropriate narcotics dosing", "B": "Printing out and posting handouts detailing the dangers of narcotics", "C": "Sending an email to all providers notifying them of narcotics prescribing best practices", "D": "Changing the electronic medical record to only allow a maximum of 7 days per prescription"}, "answer": "Changing the electronic medical record to only allow a maximum of 7 days per prescription", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Family Medicine", "Preventive Medicine"], "subspecialties": ["Health Care Administration, Leadership, and Management", "Clinical Informatics"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Preventive Medicine"}, "facts_old": ["1. A regional hospital system has decided to institute a new task group for quality improvement and patient safety.", "2. The task group would like to begin by decreasing the number of days given for narcotic pain medication prescriptions in the emergency department.", "3. The number of days given for narcotic pain medication prescriptions in the emergency department should be at most 7 days.", "4. The hospital average for narcotic pain medication prescriptions is 21 days per prescription."], "atomic_facts": ["1. The task group wants to decrease the number of days for narcotic pain medication prescriptions in the emergency department.", "2. The current hospital average for narcotic pain medication prescriptions is 21 days.", "3. The task group aims to limit narcotic pain medication prescriptions to a maximum of 7 days in the emergency department."]}
{"id": 857, "question": "What is the most likely explanation for this patient\u2019s symptoms?", "context": ["A 57-year-old man comes to the clinic complaining of nausea and 1 episode of vomiting during the past day.", "He denies any precipitating event except for a headache for which he took some acetaminophen yesterday.", "The headache is described as bilateral, dull, and 8/10 in severity.", "He has never had such symptoms before.", "His past medical history is significant for hypertension, biliary colic, and a past hospitalization for delirium tremens when he \u201ctried to quit alcohol cold turkey.\u201d When asked about his current alcohol intake, the patient looks away and mutters \u201cjust a couple of drinks here and there.\u201d The patient reports mild abdominal pain that began this morning but denies vision changes, bowel changes, fever, or weight loss.", "Physical examination demonstrates tenderness at the right upper quadrant (RUQ) that does not worsens with inhalation."], "context_len": 6, "options": {"A": "Accumulation of N-acetyl-p-benzoquinone imine in the liver", "B": "Impaction of a gallstone in the ileus", "C": "Malignant overgrowth of glial cells in the brain", "D": "Obstruction of the cystic duct by gallstone"}, "answer": "Accumulation of N-acetyl-p-benzoquinone imine in the liver", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Internal Medicine", "Gastroenterology"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 57-year-old man comes to the clinic.", "2. He complains of nausea and 1 episode of vomiting during the past day.", "3. He denies any precipitating event except for a headache.", "4. The headache is described as bilateral, dull, and 8/10 in severity.", "5. He has never had such symptoms before.", "6. His past medical history is significant for hypertension, biliary colic, and a past hospitalization for delirium tremens.", "7. He \"tried to quit alcohol cold turkey\" in the past.", "8. When asked about his current alcohol intake, the patient looks away and mutters \u201cjust a couple of drinks here and there.\u201d", "9. The patient reports mild abdominal pain that began this morning.", "10. He denies vision changes, bowel changes, fever, or weight loss.", "11. Physical examination demonstrates tenderness at the right upper quadrant (RUQ) that does not worsens with inhalation."], "atomic_facts": ["1. Patient denies any precipitating event except for a headache for which he took acetaminophen yesterday.", "2. The headache is described as bilateral, dull, and 8/10 in severity.", "3. Patient has never had such symptoms before.", "4. Past medical history includes hypertension, biliary colic, and a past hospitalization for delirium tremens.", "5. Patient \"tried to quit alcohol cold turkey.\"", "6. Patient looks away and mutters \"just a couple of drinks here and there\" when asked about current alcohol intake.", "7. Patient reports mild abdominal pain that began this morning.", "8. Patient denies vision changes, bowel changes, fever, or weight loss.", "9. Physical examination demonstrates tenderness at the right upper quadrant (RUQ) that does not worsen with inhalation."]}
{"id": 858, "question": "The patient's condition was most likely transmitted by which of the following vectors?\"", "context": ["A 48-year-old patient comes to the physician because of a 4-day history fever, headaches, loss of appetite, and myalgia.", "Two weeks ago, the patient went on a camping trip to Wisconsin.", "His temperature is 39.5\u00b0C (103.1\u00b0F).", "Physical examination shows no rash or joint swelling.", "Laboratory studies show: | Hemoglobin 14.1 g/dL | Leukocyte count 3,800/mm3 | Platelet count 85,000/mm3 | Serum | AST 48 U/L | ALT 52 U/L | Treatment with doxycycline is begun and the patient recovers.", "A paired acute and convalescent indirect fluorescent antibody test confirms that the patient had anaplasmosis."], "context_len": 6, "options": {"A": "Lone star tick", "B": "Ixodes tick", "C": "Dog tick", "D": "Flea"}, "answer": "Ixodes tick", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "48 years old", "specialties": ["Infectious Disease"], "subspecialties": ["General Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 48-year-old patient comes to the physician.", "2. The patient has a 4-day history of fever, headaches, loss of appetite, and myalgia.", "3. Two weeks ago, the patient went on a camping trip to Wisconsin.", "4. The patient's temperature is 39.5\u00b0C (103.1\u00b0F).", "5. Physical examination shows no rash or joint swelling.", "6. Laboratory studies show a hemoglobin level of 14.1 g/dL.", "7. Laboratory studies show a leukocyte count of 3,800/mm3.", "8. Laboratory studies show a platelet count of 85,000/mm3.", "9. Laboratory studies show an AST level of 48 U/L.", "10. Laboratory studies show an ALT level of 52 U/L.", "11. Treatment with doxycycline is begun.", "12. The patient recovers.", "13. A paired acute and convalescent indirect fluorescent antibody test confirms that the patient had anaplasmosis."], "atomic_facts": ["1. Two weeks ago, the patient went on a camping trip to Wisconsin.", "2. His temperature is 39.5\u00b0C (103.1\u00b0F).", "3. Physical examination shows no rash or joint swelling.", "4. Laboratory studies show: Hemoglobin 14.1 g/dL.", "5. Laboratory studies show: Leukocyte count 3,800/mm3.", "6. Laboratory studies show: Platelet count 85,000/mm3.", "7. Laboratory studies show: Serum AST 48 U/L.", "8. Laboratory studies show: Serum ALT 52 U/L.", "9. Treatment with doxycycline is begun and the patient recovers.", "10. A paired acute and convalescent indirect fluorescent antibody test confirms that the patient had anaplasmosis."]}
{"id": 859, "question": "Which of the following is the next best step in management?", "context": ["A 42-year-old woman comes to the clinic complaining of upper abdominal pain.", "Her symptoms started 1 month ago with vague abdominal discomfort following a meal at a steakhouse.", "Since then the pain has progressed to the point that she has more than 5 episodes a week.", "The pain is worse with eating but has not affected her appetite.", "She also reports a burning sensation in her chest when she lies down at night after dinner.", "She denies weight loss or dysphagia.", "She takes no medications except daily calcium supplements.", "She drinks 2 glasses of wine per week and denies tobacco use.", "Her blood pressure is 110/78, pulse is 72/min, and respirations are 13/min.", "On physical examination, the patient\u2019s abdomen is soft and non-distended.", "Normal bowel sounds are appreciation.", "There is mild epigastric tenderness but no guarding and no rebound.", "Fecal occult blood is negative."], "context_len": 13, "options": {"A": "Start antibiotic therapy", "B": "Start omeprazole", "C": "Surgical fundiplication", "D": "Upper gastrointestinal endoscopy"}, "answer": "Start omeprazole", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 42-year-old woman comes to the clinic complaining of upper abdominal pain.", "2. Her symptoms started 1 month ago with vague abdominal discomfort following a meal at a steakhouse.", "3. Since then the pain has progressed to the point that she has more than 5 episodes a week.", "4. The pain is worse with eating but has not affected her appetite.", "5. She also reports a burning sensation in her chest when she lies down at night after dinner.", "6. She denies weight loss or dysphagia.", "7. She takes no medications except daily calcium supplements.", "8. She drinks 2 glasses of wine per week and denies tobacco use.", "9. Her blood pressure is 110/78, pulse is 72/min, and respirations are 13/min.", "10. On physical examination, the patient\u2019s abdomen is soft and non-distended.", "11. Normal bowel sounds are appreciation.", "12. There is mild epigastric tenderness but no guarding and no rebound.", "13. Fecal occult blood is negative."], "atomic_facts": ["1. Symptoms started 1 month ago with vague abdominal discomfort after a meal at a steakhouse.", "2. Experiences more than 5 episodes of pain per week.", "3. Pain worsens with eating but does not affect appetite.", "4. Reports a burning sensation in the chest when lying down at night after dinner.", "5. Denies weight loss or dysphagia.", "6. Takes daily calcium supplements.", "7. Drinks 2 glasses of wine per week and denies tobacco use.", "8. Blood pressure is 110/78, pulse is 72/min, and respirations are 13/min.", "9. On physical examination, the abdomen is soft and non-distended.", "10. Normal bowel sounds are appreciated.", "11. Mild epigastric tenderness but no guarding and no rebound.", "12. Fecal occult blood is negative."]}
{"id": 860, "question": "Which of the following is the best next step in management?", "context": ["A 3-year-old boy presents to the pediatrician crying with ear pain and his temperature has been 101\u00b0F (38.3\u00b0C) for several days.", "His mother states that other children at his daycare center have been having similar symptoms.", "She further describes that he was fed formula and was not breastfed.", "The mother admits that she smokes cigarettes daily.", "On exam, the boy is irritable and crying, and frequently tugs on his left ear.", "Both tympanic membranes appear erythematous, and the left appears opaque and bulging with decreased mobility on pneumatic otoscopy."], "context_len": 6, "options": {"A": "Amoxicillin", "B": "TMP-SMX", "C": "Tympanocentesis", "D": "Supportive therapy"}, "answer": "Amoxicillin", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 3-year-old boy.", "2. Patient has been crying with ear pain.", "3. Patient's temperature has been 101\u00b0F (38.3\u00b0C) for several days.", "4. Patient's mother states other children at his daycare center have been having similar symptoms.", "5. Patient was fed formula and was not breastfed.", "6. Patient's mother smokes cigarettes daily.", "7. On exam, patient is irritable and crying.", "8. Patient frequently tugs on his left ear.", "9. Both tympanic membranes appear erythematous.", "10. Left tympanic membrane appears opaque and bulging.", "11. Left tympanic membrane has decreased mobility on pneumatic otoscopy."], "atomic_facts": ["1. His mother states that other children at his daycare center have been having similar symptoms.", "2. She further describes that he was fed formula and was not breastfed.", "3. The mother admits that she smokes cigarettes daily.", "4. On exam, the boy is irritable and crying, and frequently tugs on his left ear.", "5. Both tympanic membranes appear erythematous.", "6. The left tympanic membrane appears opaque and bulging.", "7. Decreased mobility is observed on pneumatic otoscopy."]}
{"id": 861, "question": "Which of the following pathologic findings is she most likely to have?", "context": ["A 47-year-old G3P2 woman presents to her endocrinologist for a follow-up appointment.", "Her last menstrual period was at the age of 35 years.", "She now feels fatigued and cannot concentrate on her work or type properly on the keyboard because of an onset of tremor in her hands.", "Her symptoms are taking a toll on her quality of life.", "The patient\u2019s blood pressure is 124/83 mm Hg, pulse is 91/min, respirations are 17/min, and temperature is 36.7\u00b0C (98.1\u00b0F).", "On physical examination, there is a mild enlargement of the thyroid; the gland is minimally firm in texture and is nontender."], "context_len": 6, "options": {"A": "Follicular thyroid neoplasia  ", "B": "Silent thyroiditis", "C": "Chronic lymphocytic thyroiditis", "D": "Fibrous thyroiditis"}, "answer": "Silent thyroiditis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "47 years old", "specialties": ["Endocrinology, Diabetes, and Metabolism", "Endocrinology"], "subspecialties": ["General Endocrinology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 47-year-old G3P2 woman presents to her endocrinologist for a follow-up appointment.", "2. Her last menstrual period was at the age of 35 years.", "3. She now feels fatigued.", "4. She cannot concentrate on her work or type properly on the keyboard because of an onset of tremor in her hands.", "5. Her symptoms are taking a toll on her quality of life.", "6. The patient\u2019s blood pressure is 124/83 mm Hg.", "7. The patient\u2019s pulse is 91/min.", "8. The patient\u2019s respirations are 17/min.", "9. The patient\u2019s temperature is 36.7\u00b0C (98.1\u00b0F).", "10. On physical examination, there is a mild enlargement of the thyroid.", "11. The gland is minimally firm in texture.", "12. The gland is nontender."], "atomic_facts": ["1. Her last menstrual period was at the age of 35 years.", "2. She now feels fatigued and cannot concentrate on her work or type properly on the keyboard because of an onset of tremor in her hands.", "3. Her symptoms are taking a toll on her quality of life.", "4. The patient\u2019s blood pressure is 124/83 mm Hg, pulse is 91/min, respirations are 17/min, and temperature is 36.7\u00b0C (98.1\u00b0F).", "5. On physical examination, there is a mild enlargement of the thyroid; the gland is minimally firm in texture and is nontender."]}
{"id": 862, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 44-year-old woman is brought to the emergency department after she was found lying in the park mumbling to herself.", "She is lethargic and disoriented.", "She has a 2-week history of increasing weakness, nausea, and vomiting.", "She denies any recent alcohol or drug use.", "She has a history of systemic lupus erythematosus but stopped taking methotrexate many years ago.", "Her temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 89/min, and blood pressure is 154/91 mm Hg.", "On mental status examination, she is confused and only oriented to person, but not to place or time.", "She is unable to name the days of the week backwards.", "She exhibits moderate generalized weakness.", "Physical exam shows jugular venous distention and pitting edema in the lower extremities.", "Laboratory studies show: | Serum | Na+ 137 mEq/L | K+ 5.5 mEq/L | Cl- 120 mEq/L | Bicarbonate 15 mEq/L | Urea nitrogen 94 mg/dL | Creatinine 5.5 mg/dL | Glucose 92 mg/dL | ."], "context_len": 11, "options": {"A": "Administer lactulose", "B": "Hemodialysis", "C": "Restart methotrexate", "D": "Fluid restriction"}, "answer": "Hemodialysis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "44 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry", "Geriatric Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 44-year-old woman is brought to the emergency department.", "2. She was found lying in the park mumbling to herself.", "3. She is lethargic and disoriented.", "4. She has a 2-week history of increasing weakness, nausea, and vomiting.", "5. She denies any recent alcohol or drug use.", "6. She has a history of systemic lupus erythematosus.", "7. She stopped taking methotrexate many years ago.", "8. Her temperature is 37.3\u00b0C (99.1\u00b0F).", "9. Her pulse is 89/min.", "10. Her blood pressure is 154/91 mm Hg.", "11. On mental status examination, she is confused and only oriented to person.", "12. She is not oriented to place or time.", "13. She is unable to name the days of the week backwards.", "14. She exhibits moderate generalized weakness.", "15. Physical exam shows jugular venous distention.", "16. Physical exam shows pitting edema in the lower extremities.", "17. Laboratory studies show serum Na+ 137 mEq/L.", "18. Laboratory studies show serum K+ 5.5 mEq/L.", "19. Laboratory studies show serum Cl- 120 mEq/L.", "20. Laboratory studies show serum bicarbonate 15 mEq/L.", "21. Laboratory studies show serum urea nitrogen 94 mg/dL.", "22. Laboratory studies show serum creatinine 5.5 mg/dL.", "23. Laboratory studies show serum glucose 92 mg/dL."], "atomic_facts": ["1. She is lethargic and disoriented.", "2. She has a 2-week history of increasing weakness, nausea, and vomiting.", "3. She denies any recent alcohol or drug use.", "4. She has a history of systemic lupus erythematosus but stopped taking methotrexate many years ago.", "5. Her temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 89/min, and blood pressure is 154/91 mm Hg.", "6. On mental status examination, she is confused and only oriented to person, but not to place or time.", "7. She is unable to name the days of the week backwards.", "8. She exhibits moderate generalized weakness.", "9. Physical exam shows jugular venous distention and pitting edema in the lower extremities.", "10. Laboratory studies show: Serum Na+ 137 mEq/L, K+ 5.5 mEq/L, Cl- 120 mEq/L, Bicarbonate 15 mEq/L, Urea nitrogen 94 mg/dL, Creatinine 5.5 mg/dL, Glucose 92 mg/dL."]}
{"id": 863, "question": "The isolated hormone is most likely which of the following?", "context": ["An investigator is studying the secretion of gastrointestinal hormones before and after food intake.", "She isolates a hormone that accelerates the emptying of gastric contents into the duodenal bulb."], "context_len": 2, "options": {"A": "Glucagon-like peptide", "B": "Gastrin", "C": "Cholecystokinin", "D": "Vasoactive intestinal peptide"}, "answer": "Gastrin", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An investigator is studying the secretion of gastrointestinal hormones.", "2. The study is conducted before and after food intake.", "3. The investigator isolates a hormone.", "4. The hormone accelerates the emptying of gastric contents.", "5. The gastric contents are emptied into the duodenal bulb."], "atomic_facts": ["1. She isolates a hormone.", "2. The hormone accelerates the emptying of gastric contents.", "3. The acceleration occurs into the duodenal bulb."]}
{"id": 864, "question": "What is the most likely cause of her presentation?", "context": ["A 45-year-old woman presents to the office with a chief complaint of a cough that has persisted for a month and a half.", "She also has night fevers and has lost 5 kg (11 lb) in the last 2 months.", "She recently returned from a 6-month trip to Peru.", "Her vitals include: heart rate 82/min, respiratory rate 17/min, temperature 38.0\u00b0C (100.4\u00b0F), and blood pressure 107/80 mm Hg.", "On auscultation, she has diminished respiratory sounds at the base of the right lung.", "Chest radiography shows an opacity in the right apex."], "context_len": 6, "options": {"A": "Echinococcosis", "B": "Tuberculosis", "C": "Pulmonary thromboembolism", "D": "Heart failure"}, "answer": "Tuberculosis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 45-year-old woman presents to the office.", "2. Her chief complaint is a cough that has persisted for a month and a half.", "3. She also has night fevers.", "4. She has lost 5 kg (11 lb) in the last 2 months.", "5. She recently returned from a 6-month trip to Peru.", "6. Her heart rate is 82/min.", "7. Her respiratory rate is 17/min.", "8. Her temperature is 38.0\u00b0C (100.4\u00b0F).", "9. Her blood pressure is 107/80 mm Hg.", "10. On auscultation, she has diminished respiratory sounds at the base of the right lung.", "11. Chest radiography shows an opacity in the right apex."], "atomic_facts": ["1. She has night fevers.", "2. She has lost 5 kg (11 lb) in the last 2 months.", "3. She recently returned from a 6-month trip to Peru.", "4. Her heart rate is 82/min.", "5. Her respiratory rate is 17/min.", "6. Her temperature is 38.0\u00b0C (100.4\u00b0F).", "7. Her blood pressure is 107/80 mm Hg.", "8. On auscultation, she has diminished respiratory sounds at the base of the right lung.", "9. Chest radiography shows an opacity in the right apex."]}
{"id": 865, "question": "What is the most likely diagnosis?", "context": ["A 52-year-old homeless man is brought to the urgent care clinic with altered mental status and disorientation for the last day.", "Past medical records are unavailable.", "His temperature is 37\u00b0C (98.6\u00b0F), the respiratory rate is 15/min, the pulse is 107/min, and the blood pressure is 92/67 mm Hg.", "He has a flapping tremor of the wrists during attempted extension.", "He is started on intravenous D5 1/2NS and blood is drawn for further testing.", "His condition deteriorates overnight.", "On re-examination the next morning, he has developed visual disturbances with a new horizontal nystagmus and a staggering gait.", "His blood tests show:  | Serum | Albumin 3.2 gm/dL | Alkaline phosphatase 150 U/L | Alanine aminotransferase 76 U/L | Aspartate aminotransferase 155 U/L | Gamma-glutamyl transpeptidase 202 U/L | ."], "context_len": 8, "options": {"A": "Alcohol-related dementia", "B": "Hepatic encephalopathy", "C": "Delirium", "D": "Wernicke's encephalopathy"}, "answer": "Wernicke's encephalopathy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "52 years old", "specialties": ["Emergency Medicine", "Internal Medicine"], "subspecialties": ["General Emergency Medicine", "Neurocritical Care"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 52-year-old homeless man is brought to the urgent care clinic with altered mental status and disorientation for the last day.", "2. Past medical records are unavailable.", "3. His temperature is 37\u00b0C (98.6\u00b0F).", "4. The respiratory rate is 15/min.", "5. The pulse is 107/min.", "6. The blood pressure is 92/67 mm Hg.", "7. He has a flapping tremor of the wrists during attempted extension.", "8. He is started on intravenous D5 1/2NS and blood is drawn for further testing.", "9. His condition deteriorates overnight.", "10. On re-examination the next morning, he has developed visual disturbances with a new horizontal nystagmus and a staggering gait.", "11. His blood tests show: Serum Albumin 3.2 gm/dL.", "12. His blood tests show: Alkaline phosphatase 150 U/L.", "13. His blood tests show: Alanine aminotransferase 76 U/L.", "14. His blood tests show: Aspartate aminotransferase 155 U/L.", "15. His blood tests show: Gamma-glutamyl transpeptidase 202 U/L."], "atomic_facts": ["1. Past medical records are unavailable.", "2. His temperature is 37\u00b0C (98.6\u00b0F).", "3. The respiratory rate is 15/min.", "4. The pulse is 107/min.", "5. The blood pressure is 92/67 mm Hg.", "6. He has a flapping tremor of the wrists during attempted extension.", "7. He is started on intravenous D5 1/2NS.", "8. Blood is drawn for further testing.", "9. His condition deteriorates overnight.", "10. On re-examination the next morning, he has developed visual disturbances with a new horizontal nystagmus and a staggering gait.", "11. His blood tests show: Serum Albumin 3.2 gm/dL.", "12. Alkaline phosphatase 150 U/L.", "13. Alanine aminotransferase 76 U/L.", "14. Aspartate aminotransferase 155 U/L.", "15. Gamma-glutamyl transpeptidase 202 U/L."]}
{"id": 866, "question": "Which of the following is the best next step in management?", "context": ["A 27-year-old woman comes to the emergency department at 14 weeks gestation with abdominal pain.", "She states she has passed a large amount of blood from her vagina in the past 2 hours.", "Her vitals are within normal limits and she describes her abdominal pain as a 4/10.", "Physical exam is notable for a dilated cervix.", "The patient states she does not want any invasive procedures in her workup but is accepting to necessary medical interventions."], "context_len": 5, "options": {"A": "Admission and external fetal monitoring", "B": "Dilation and curettage", "C": "Expectant management", "D": "Transvaginal ultrasound"}, "answer": "Expectant management", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology", "Maternal"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 27-year-old woman comes to the emergency department.", "2. She is 14 weeks gestation.", "3. She has passed a large amount of blood from her vagina in the past 2 hours.", "4. Her vitals are within normal limits.", "5. She describes her abdominal pain as a 4/10.", "6. Physical exam is notable for a dilated cervix.", "7. The patient states she does not want any invasive procedures in her workup.", "8. She is accepting to necessary medical interventions."], "atomic_facts": ["1. The patient has passed a large amount of blood from her vagina in the past 2 hours.", "2. Her vitals are within normal limits.", "3. She describes her abdominal pain as a 4/10.", "4. Physical exam is notable for a dilated cervix.", "5. The patient does not want any invasive procedures in her workup.", "6. The patient is accepting to necessary medical interventions."]}
{"id": 867, "question": "Which of the following genes was most likely mutated in this fetus?", "context": ["A 25-year-old female is admitted to the hospital for an intrauterine fetal demise (IUFD) during her 30th gestational week.", "The patient did not receive any prenatal care or screenings.", "The baby is delivered via C-section and the family wishes to conduct an autopsy to understand the reason for the IUFD and to better prepare for future pregnancies.", "On autopsy, the fetus is discovered to have severe facial abnormalities as well as a brain lacking the normal sagittal fissure."], "context_len": 4, "options": {"A": "Hox", "B": "Wnt-7", "C": "Sonic hedgehog", "D": "BMP"}, "answer": "Sonic hedgehog", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 25-year-old female is admitted to the hospital.", "2. The patient is admitted for an intrauterine fetal demise (IUFD).", "3. The patient is in her 30th gestational week.", "4. The patient did not receive any prenatal care or screenings.", "5. The baby is delivered via C-section.", "6. The family wishes to conduct an autopsy.", "7. The purpose of the autopsy is to understand the reason for the IUFD and to better prepare for future pregnancies.", "8. On autopsy, the fetus is discovered to have severe facial abnormalities.", "9. On autopsy, the fetus is discovered to have a brain lacking the normal sagittal fissure."], "atomic_facts": ["1. The patient did not receive any prenatal care.", "2. The patient did not receive any prenatal screenings.", "3. The baby was delivered via C-section.", "4. The family wishes to conduct an autopsy.", "5. The reason for the IUFD is to be understood.", "6. The autopsy is to better prepare for future pregnancies.", "7. On autopsy, the fetus is discovered to have severe facial abnormalities.", "8. On autopsy, the fetus is discovered to have a brain lacking the normal sagittal fissure."]}
{"id": 868, "question": "The following sets of measurements are taken every 10 minutes: | Plasma concentration of substance Excretion rate of substance | Set 1 0.1 mg/mL 60 mg/min | Set 2 0.15 mg/mL 90 mg/min | Set 3 0.2 mg/mL 104 mg/min | Set 4 0.25 mg/mL 110 mg/min | Set 5 0.3 mg/mL 116 mg/min | This patient was most likely administered which of the following substances?\"", "context": ["A healthy 32-year-old woman enrolls in a study investigating kidney function.", "Her renal plasma flow (RPF) is 600 mL/min.", "She is administered an intravenous substance that does not undergo tubular reabsorption."], "context_len": 3, "options": {"A": "Cystatin C", "B": "Glucose", "C": "Para-aminohippurate", "D": "Iohexol"}, "answer": "Para-aminohippurate", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "32", "specialties": ["Nephrology"], "subspecialties": ["General Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A healthy 32-year-old woman enrolls in a study investigating kidney function.", "2. Her renal plasma flow (RPF) is 600 mL/min.", "3. She is administered an intravenous substance.", "4. The intravenous substance does not undergo tubular reabsorption."], "atomic_facts": ["1. Renal plasma flow (RPF) is 600 mL/min.", "2. She is administered an intravenous substance.", "3. The substance does not undergo tubular reabsorption."]}
{"id": 869, "question": "Which of the following is the most likely diagnosis?", "context": ["A 6-year-old girl is brought to the physician for a well-child examination.", "She has no history of serious illness.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 95/min, and blood pressure is 96/52 mm Hg.", "Examination shows a 2/6 continuous, low-pitched murmur over the left upper sternal border that radiates towards the neck.", "The murmur disappears when she flexes her neck.", "The remainder of the examination shows no abnormalities."], "context_len": 6, "options": {"A": "Patent ductus arteriosus", "B": "Venous hum", "C": "Coronary artery fistula", "D": "Aortic stenosis"}, "answer": "Venous hum", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-year-old girl is brought to the physician for a well-child examination.", "2. She has no history of serious illness.", "3. Her temperature is 37\u00b0C (98.6\u00b0F).", "4. Her pulse is 95/min.", "5. Her blood pressure is 96/52 mm Hg.", "6. Examination shows a 2/6 continuous, low-pitched murmur over the left upper sternal border.", "7. The murmur radiates towards the neck.", "8. The murmur disappears when she flexes her neck.", "9. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. She has no history of serious illness.", "2. Her temperature is 37\u00b0C (98.6\u00b0F).", "3. Her pulse is 95/min.", "4. Her blood pressure is 96/52 mm Hg.", "5. Examination shows a 2/6 continuous, low-pitched murmur over the left upper sternal border.", "6. The murmur radiates towards the neck.", "7. The murmur disappears when she flexes her neck.", "8. The remainder of the examination shows no abnormalities."]}
{"id": 870, "question": "What is the most appropriate management of this patient\u2019s hyponatremia?", "context": ["A 72-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department with three-days of fever, cough, and shortness of breath.", "On physical exam, temperature is 101.3 deg F (38.5 deg C), pulse is 106/min, blood pressure is 148/92 mmHg, and respiratory rate is 24/min.", "Crackles are auscultated on the right lower lobe.", "Chest radiograph demonstrates right lower lobe opacities concerning for consolidation.", "Sodium level is 118 mEq/L.", "He is admitted to the hospital on empiric antibiotics."], "context_len": 6, "options": {"A": "Hypertonic saline", "B": "Fluid restriction", "C": "Salt tablets", "D": "Demeclocycline"}, "answer": "Fluid restriction", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "72 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 72-year-old man presents to the emergency department.", "2. He has a history of hypertension and hyperlipidemia.", "3. He has three days of fever, cough, and shortness of breath.", "4. His temperature is 101.3 deg F (38.5 deg C).", "5. His pulse is 106/min.", "6. His blood pressure is 148/92 mmHg.", "7. His respiratory rate is 24/min.", "8. Crackles are auscultated on the right lower lobe.", "9. Chest radiograph demonstrates right lower lobe opacities concerning for consolidation.", "10. His sodium level is 118 mEq/L.", "11. He is admitted to the hospital on empiric antibiotics."], "atomic_facts": ["1. Temperature is 101.3 deg F (38.5 deg C)", "2. Pulse is 106/min", "3. Blood pressure is 148/92 mmHg", "4. Respiratory rate is 24/min", "5. Crackles are auscultated on the right lower lobe", "6. Chest radiograph demonstrates right lower lobe opacities concerning for consolidation", "7. Sodium level is 118 mEq/L", "8. Admitted to the hospital on empiric antibiotics"]}
{"id": 871, "question": "Which of the following best explains these findings?", "context": ["A 75-year-old man presents to the physician for a follow-up examination.", "Over the last several months, he reports dyspnea when walking during his daily exercise routine.", "He feels tired most of the time.", "He has no fever or weight loss.", "He has no history of severe illness and takes no medications.", "He does not smoke, drinks alcohol, or follow a particular diet.", "The vital signs are within normal limits.", "The physical examination reveals pale conjunctiva.", "The examination of the heart, lungs, abdomen, and extremities shows no abnormalities.", "No lymphadenopathy is palpated.", "The laboratory studies show the following: | Hemoglobin 8.5 g/dL | Mean corpuscular volume 105 \u03bcm3 | Leukocyte count 4,500/mm3 | Platelet 160,000/mm3 | Abdominal ultrasonography shows no organomegaly or other pathologic findings.", "The peripheral blood smear shows large and hypogranular platelets and neutrophils with hypo-segmented or ringed nuclei.", "No blasts are seen.", "Bone marrow aspiration shows hypercellularity.", "In addition, ring sideroblasts, hypogranulation, and hyposegmentation of granulocyte precursors, and megakaryocytes with disorganized nuclei are present.", "Marrow myeloblasts are 4% in volume."], "context_len": 16, "options": {"A": "Acute myeloid leukemia", "B": "Aplastic anemia", "C": "Myelodysplastic syndrome", "D": "Primary myelofibrosis"}, "answer": "Myelodysplastic syndrome", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "75", "specialties": ["Internal Medicine", "Hematology"], "subspecialties": ["Hematology", "General Hematology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 75-year-old man presents to the physician for a follow-up examination.", "2. Over the last several months, he reports dyspnea when walking during his daily exercise routine.", "3. He feels tired most of the time.", "4. He has no fever or weight loss.", "5. He has no history of severe illness and takes no medications.", "6. He does not smoke, drinks alcohol, or follow a particular diet.", "7. The vital signs are within normal limits.", "8. The physical examination reveals pale conjunctiva.", "9. The examination of the heart, lungs, abdomen, and extremities shows no abnormalities.", "10. No lymphadenopathy is palpated.", "11. The laboratory studies show the following: Hemoglobin 8.5 g/dL, Mean corpuscular volume 105 \u03bcm3, Leukocyte count 4,500/mm3, Platelet 160,000/mm3.", "12. Abdominal ultrasonography shows no organomegaly or other pathologic findings.", "13. The peripheral blood smear shows large and hypogranular platelets and neutrophils with hypo-segmented or ringed nuclei.", "14. No blasts are seen.", "15. Bone marrow aspiration shows hypercellularity.", "16. In addition, ring sideroblasts, hypogranulation, and hyposegmentation of granulocyte precursors, and megakaryocytes with disorganized nuclei are present.", "17. Marrow myeloblasts are 4% in volume."], "atomic_facts": ["1. He reports dyspnea when walking during his daily exercise routine.", "2. He feels tired most of the time.", "3. He has no fever.", "4. He has no weight loss.", "5. He has no history of severe illness.", "6. He takes no medications.", "7. He does not smoke.", "8. He does not drink alcohol.", "9. He does not follow a particular diet.", "10. The vital signs are within normal limits.", "11. The physical examination reveals pale conjunctiva.", "12. The examination of the heart, lungs, abdomen, and extremities shows no abnormalities.", "13. No lymphadenopathy is palpated.", "14. Hemoglobin is 8.5 g/dL.", "15. Mean corpuscular volume is 105 \u03bcm3.", "16. Leukocyte count is 4,500/mm3.", "17. Platelet count is 160,000/mm3.", "18. Abdominal ultrasonography shows no organomegaly or other pathologic findings.", "19. The peripheral blood smear shows large and hypogranular platelets and neutrophils with hypo-segmented or ringed nuclei.", "20. No blasts are seen.", "21. Bone marrow aspiration shows hypercellularity.", "22. Ring sideroblasts, hypogranulation, and hyposegmentation of granulocyte precursors, and megakaryocytes with disorganized nuclei are present.", "23. Marrow myeloblasts are 4% in volume."]}
{"id": 872, "question": "Which of the following is the next best step in management?", "context": ["A 37-year-old man comes to the physician because of a 1-month history of a burning sensation in his chest.", "The sensation is most prominent when he is lying in bed, but it is also present after eating heavy meals.", "He also states his breath has an unpleasant odor in the morning.", "He has not lost any weight during this period.", "He has hypothyroidism.", "His father died of colon cancer and his mother has hypertension.", "He has smoked one pack of cigarettes daily for 15 years and drinks 2\u20133 beers on weekends.", "His medications include levothyroxine and an over-the-counter multivitamin.", "He is 170 cm (5 ft 7 in) tall and weighs 95 kg (210 lb); BMI is 32.9 kg/m2.", "Vital signs are within normal limits.", "Physical examination shows no abnormalities."], "context_len": 11, "options": {"A": "Urea breath test", "B": "Proton-pump inhibitor", "C": "H2 receptor blocker", "D": "Barium swallow"}, "answer": "Proton-pump inhibitor", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "37 years old", "specialties": ["Internal Medicine", "Gastroenterology"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 37-year-old man comes to the physician.", "2. He has a 1-month history of a burning sensation in his chest.", "3. The sensation is most prominent when he is lying in bed.", "4. The sensation is also present after eating heavy meals.", "5. He states his breath has an unpleasant odor in the morning.", "6. He has not lost any weight during this period.", "7. He has hypothyroidism.", "8. His father died of colon cancer.", "9. His mother has hypertension.", "10. He has smoked one pack of cigarettes daily for 15 years.", "11. He drinks 2\u20133 beers on weekends.", "12. His medications include levothyroxine and an over-the-counter multivitamin.", "13. He is 170 cm (5 ft 7 in) tall.", "14. He weighs 95 kg (210 lb).", "15. His BMI is 32.9 kg/m2.", "16. Vital signs are within normal limits.", "17. Physical examination shows no abnormalities."], "atomic_facts": ["1. The sensation is most prominent when he is lying in bed.", "2. The sensation is also present after eating heavy meals.", "3. He states his breath has an unpleasant odor in the morning.", "4. He has not lost any weight during this period.", "5. He has hypothyroidism.", "6. His father died of colon cancer.", "7. His mother has hypertension.", "8. He has smoked one pack of cigarettes daily for 15 years.", "9. He drinks 2\u20133 beers on weekends.", "10. His medications include levothyroxine and an over-the-counter multivitamin.", "11. He is 170 cm (5 ft 7 in) tall.", "12. He weighs 95 kg (210 lb).", "13. His BMI is 32.9 kg/m2.", "14. Vital signs are within normal limits.", "15. Physical examination shows no abnormalities."]}
{"id": 873, "question": "Which of the following histopathologic findings would most likely be seen on the liver biopsy of this patient?", "context": ["A 36-year-old man presents with right upper quadrant pain, fatigue, and pruritus.", "His past medical history is significant for ulcerative colitis diagnosed 5 years ago, which is well-managed medically.", "He is vaccinated against hepatitis A and B and denies any recent travel abroad.", "On physical examination, mild jaundice of the skin is present.", "An abdominal examination reveals significant hepatosplenomegaly.", "A percutaneous liver biopsy is performed."], "context_len": 6, "options": {"A": "Small drops of fat throughout the liver parenchyma", "B": "Normal histologic findings", "C": "Mononuclear cell infiltrate and apoptotic hepatocytes", "D": "Onion skin fibrosis (concentric periductal fibrosis)"}, "answer": "Onion skin fibrosis (concentric periductal fibrosis)", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "36 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 36-year-old man presents with right upper quadrant pain, fatigue, and pruritus.", "2. His past medical history is significant for ulcerative colitis diagnosed 5 years ago, which is well-managed medically.", "3. He is vaccinated against hepatitis A and B.", "4. He denies any recent travel abroad.", "5. On physical examination, mild jaundice of the skin is present.", "6. An abdominal examination reveals significant hepatosplenomegaly.", "7. A percutaneous liver biopsy is performed."], "atomic_facts": ["1. Past medical history includes ulcerative colitis diagnosed 5 years ago.", "2. Ulcerative colitis is well-managed medically.", "3. Vaccinated against hepatitis A and B.", "4. Denies recent travel abroad.", "5. Mild jaundice of the skin is present on physical examination.", "6. Significant hepatosplenomegaly is revealed on abdominal examination.", "7. A percutaneous liver biopsy is performed."]}
{"id": 874, "question": "Which of the following is the most likely causal organism?", "context": ["A 26-year-old man is brought to the emergency department because he has had abdominal pain, nausea, and vomiting for the past 2 hours.", "He ate a sandwich and coleslaw from a deli about 1 hour before the symptoms began.", "He has no history of serious illness and takes no medications.", "His temperature is 99.6\u00b0F (37.6\u00b0C), pulse is 80/min, respirations are 18/min, and blood pressure is 122/68 mm Hg.", "The lungs are clear to auscultation.", "Cardiac examination shows no abnormalities.", "Abdominal examination shows diffuse mild tenderness with no rigidity, rebound, or guarding.", "The remainder of the examination shows no abnormalities."], "context_len": 8, "options": {"A": "Shigella dysenteriae", "B": "Staphylococcus aureus", "C": "Enterotoxigenic Escherichia coli", "D": "Bacillus cereus"}, "answer": "Staphylococcus aureus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "26 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 26-year-old man is brought to the emergency department.", "2. He has had abdominal pain, nausea, and vomiting for the past 2 hours.", "3. He ate a sandwich and coleslaw from a deli about 1 hour before the symptoms began.", "4. He has no history of serious illness and takes no medications.", "5. His temperature is 99.6\u00b0F (37.6\u00b0C).", "6. His pulse is 80/min.", "7. His respirations are 18/min.", "8. His blood pressure is 122/68 mm Hg.", "9. The lungs are clear to auscultation.", "10. Cardiac examination shows no abnormalities.", "11. Abdominal examination shows diffuse mild tenderness with no rigidity, rebound, or guarding.", "12. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. He ate a sandwich and coleslaw from a deli about 1 hour before the symptoms began.", "2. He has no history of serious illness and takes no medications.", "3. His temperature is 99.6\u00b0F (37.6\u00b0C).", "4. His pulse is 80/min.", "5. His respirations are 18/min.", "6. His blood pressure is 122/68 mm Hg.", "7. The lungs are clear to auscultation.", "8. Cardiac examination shows no abnormalities.", "9. Abdominal examination shows diffuse mild tenderness with no rigidity, rebound, or guarding.", "10. The remainder of the examination shows no abnormalities."]}
{"id": 875, "question": "Which of the following is the most likely cause of the patient's symptoms?", "context": ["A 12-year-old girl is brought to the emergency department because of severe pain and swelling of her right eye for 3 days.", "Over the past two weeks, she had nasal congestion and a constant, mild headache.", "She did not visit a doctor and instead took over-the-counter naproxen and phenylephrine.", "Her nasal congestion has since improved, but the headache persists.", "She underwent a dental procedure for caries about ten days ago.", "She does not recollect any recent insect bites or trauma.", "Her immunizations are up-to-date.", "She appears ill and reports occasional chills.", "Her temperature is 38.3\u00b0C (101\u00b0F), pulse is 89/min, and blood pressure is 110/70 mm Hg.", "Examination shows proptosis of the right eye.", "Vision is impaired in the affected eye.", "Her right upper and lower eyelid are erythematous, swollen, and tender to touch.", "Ocular movements cause severe pain.", "Her headache is worsened by leaning forward and improves when the patient is lying on her back."], "context_len": 14, "options": {"A": "Cavernous sinus thrombosis", "B": "Suppurative spread of dacrocystitis", "C": "Bacterial infection from sphenoid sinus", "D": "Bacterial infection from ethmoidal sinus"}, "answer": "Bacterial infection from ethmoidal sinus", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "12 years old", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. Patient is a 12-year-old girl.", "2. Patient has had severe pain and swelling of her right eye for 3 days.", "3. Patient had nasal congestion and a constant, mild headache for two weeks.", "4. Patient took over-the-counter naproxen and phenylephrine for her symptoms.", "5. Nasal congestion has improved, but headache persists.", "6. Patient underwent a dental procedure for caries about ten days ago.", "7. Patient does not recollect any recent insect bites or trauma.", "8. Patient's immunizations are up-to-date.", "9. Patient appears ill and reports occasional chills.", "10. Patient's temperature is 38.3\u00b0C (101\u00b0F).", "11. Patient's pulse is 89/min.", "12. Patient's blood pressure is 110/70 mm Hg.", "13. Examination shows proptosis of the right eye.", "14. Vision is impaired in the affected eye.", "15. Right upper and lower eyelid are erythematous, swollen, and tender to touch.", "16. Ocular movements cause severe pain.", "17. Patient's headache is worsened by leaning forward and improves when the patient is lying on her back."], "atomic_facts": ["1. Over the past two weeks, she had nasal congestion and a constant, mild headache.", "2. She did not visit a doctor and instead took over-the-counter naproxen and phenylephrine.", "3. Her nasal congestion has since improved, but the headache persists.", "4. She underwent a dental procedure for caries about ten days ago.", "5. She does not recollect any recent insect bites or trauma.", "6. Her immunizations are up-to-date.", "7. She appears ill and reports occasional chills.", "8. Her temperature is 38.3\u00b0C (101\u00b0F), pulse is 89/min, and blood pressure is 110/70 mm Hg.", "9. Examination shows proptosis of the right eye.", "10. Vision is impaired in the affected eye.", "11. Her right upper and lower eyelid are erythematous, swollen, and tender to touch.", "12. Ocular movements cause severe pain.", "13. Her headache is worsened by leaning forward and improves when the patient is lying on her back."]}
{"id": 876, "question": "Which of the following laboratory findings would best represent your suspected diagnosis?", "context": ["A 45-year-old man presents to the emergency room with fever and headache.", "He recently had a middle ear infection.", "On physical examination, when the head is passively flexed towards the chest, then flexion of the knee is observed.", "In addition, he reports that his headache increases after rotating his head horizontally.", "Lumbar puncture and CSF analysis were done."], "context_len": 5, "options": {"A": "Glucose: \u2191, Proteins: \u2191, Cells: 10% lymphocytes, Lactic Acid (mmol/l): 3.0", "B": "Glucose: \u2193, Proteins: normal, Cells: 10% lymphocytes, Lactic Acid (mmol/l): 2.8", "C": "Glucose: \u2191, Proteins: \u2193, Cells: 90% neutrophils , Lactic Acid (mmol/l): 4.3", "D": "Glucose: \u2193, Proteins: \u2191, Cells: 90% neutrophils, Lactic Acid (mmol/l): 4.5"}, "answer": "Glucose: \u2193, Proteins: \u2191, Cells: 90% neutrophils, Lactic Acid (mmol/l): 4.5", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "45", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 45-year-old man presents to the emergency room with fever and headache.", "2. He recently had a middle ear infection.", "3. On physical examination, when the head is passively flexed towards the chest, then flexion of the knee is observed.", "4. He reports that his headache increases after rotating his head horizontally.", "5. Lumbar puncture and CSF analysis were done."], "atomic_facts": ["1. He recently had a middle ear infection.", "2. On physical examination, when the head is passively flexed towards the chest, flexion of the knee is observed.", "3. He reports that his headache increases after rotating his head horizontally.", "4. Lumbar puncture and CSF analysis were done."]}
{"id": 877, "question": "Infection of a healthy adult with the pathogen affecting this infant would most likely present with which of the following clinical conditions?", "context": ["A 6-day-old female infant is brought to the emergency department because of poor feeding and irritability for two days.", "She was born at 39 weeks' gestation, and the pregnancy and delivery were uncomplicated.", "Her temperature is 39.2\u00b0C (102.6\u00b0F).", "She appears lethargic and makes occasional twitching movements in both upper extremities.", "The anterior fontanelle is soft and full.", "A lumbar puncture is performed and analysis of the cerebrospinal fluid shows increased protein and decreased glucose.", "Cerebrospinal fluid culture shows gram-positive, intracellular rods with tumbling motility."], "context_len": 7, "options": {"A": "Cystitis", "B": "Pelvic inflammatory disease", "C": "Meningitis", "D": "Gastroenteritis"}, "answer": "Gastroenteritis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "6 days old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-day-old female infant is brought to the emergency department.", "2. The infant has been poor feeding and irritable for two days.", "3. The infant was born at 39 weeks' gestation.", "4. The pregnancy and delivery were uncomplicated.", "5. The infant's temperature is 39.2\u00b0C (102.6\u00b0F).", "6. The infant appears lethargic and makes occasional twitching movements in both upper extremities.", "7. The anterior fontanelle is soft and full.", "8. A lumbar puncture is performed.", "9. Analysis of the cerebrospinal fluid shows increased protein and decreased glucose.", "10. Cerebrospinal fluid culture shows gram-positive, intracellular rods with tumbling motility."], "atomic_facts": ["1. She was born at 39 weeks' gestation", "2. The pregnancy and delivery were uncomplicated", "3. Her temperature is 39.2\u00b0C (102.6\u00b0F)", "4. She appears lethargic", "5. She makes occasional twitching movements in both upper extremities", "6. The anterior fontanelle is soft and full", "7. A lumbar puncture is performed", "8. Analysis of the cerebrospinal fluid shows increased protein", "9. Analysis of the cerebrospinal fluid shows decreased glucose", "10. Cerebrospinal fluid culture shows gram-positive, intracellular rods", "11. Cerebrospinal fluid culture shows tumbling motility"]}
{"id": 878, "question": "What is the most likely infectious agent responsible for this patient\u2019s condition?", "context": ["A 64-year-old man has complaints of scrotal pain and swelling for the past 2 weeks.", "The pain is so severe that he is now unable to even sit comfortably for more than 5 minutes.", "Additionally, he complains of an inability to hold urine when he has an urge to urinate and of mild discomfort during urination.", "His medical history is significant for hypertension that is well-controlled with losartan.", "He smokes 1 pack of cigarettes every day and has been doing so for the past 25 years.", "On physical examination, swelling and erythema of the right hemiscrotal sac are evident, accompanied by intense tenderness with palpation of an indurated epididymis."], "context_len": 6, "options": {"A": "Chlamydia trachomatis", "B": "Neisseria gonorrhoeae", "C": "Mumps virus", "D": "Escherichia coli"}, "answer": "Escherichia coli", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "64", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is 64 years old.", "2. Patient has had scrotal pain and swelling for 2 weeks.", "3. Patient has severe pain that prevents him from sitting for more than 5 minutes.", "4. Patient has difficulty holding urine when he has an urge to urinate.", "5. Patient has mild discomfort during urination.", "6. Patient has a history of hypertension, which is well-controlled with losartan.", "7. Patient smokes 1 pack of cigarettes every day for the past 25 years.", "8. On physical examination, swelling and erythema of the right hemiscrotal sac are evident.", "9. On physical examination, intense tenderness is present with palpation of an indurated epididymis."], "atomic_facts": ["1. The pain is severe", "2. He is unable to sit comfortably for more than 5 minutes", "3. He complains of an inability to hold urine when he has an urge to urinate", "4. He complains of mild discomfort during urination", "5. His medical history includes hypertension", "6. His hypertension is well-controlled with losartan", "7. He smokes 1 pack of cigarettes every day", "8. He has been smoking for the past 25 years", "9. On physical examination, swelling and erythema of the right hemiscrotal sac are evident", "10. Intense tenderness with palpation of an indurated epididymis is present"]}
{"id": 879, "question": "Which of the following is an expected side effect of this medication?", "context": ["A 65-year-old female is diagnosed with invasive ductal carcinoma of the breast.", "After a lumpectomy with a negative axillary lymph node dissection and subsequent radiation therapy, the patient is started on adjuvant chemotherapy with anastrozole."], "context_len": 2, "options": {"A": "Increased risk for endometrial carcinoma", "B": "Decreased LDL and increased HDL levels", "C": "Increased risk for osteoporosis", "D": "Excessive weight loss"}, "answer": "Increased risk for osteoporosis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "65", "specialties": ["Oncology"], "subspecialties": ["Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old female is diagnosed with invasive ductal carcinoma of the breast.", "2. A lumpectomy is performed.", "3. Axillary lymph node dissection is negative.", "4. The patient receives radiation therapy.", "5. The patient is started on adjuvant chemotherapy with anastrozole."], "atomic_facts": ["1. The patient had a lumpectomy.", "2. The lumpectomy had a negative axillary lymph node dissection.", "3. The patient received subsequent radiation therapy.", "4. The patient is started on adjuvant chemotherapy.", "5. The adjuvant chemotherapy includes anastrozole."]}
{"id": 880, "question": "Which of the following is the most likely mode of inheritance for this patient's condition?", "context": ["An 18-year-old man comes to the physician because of fatigue, back pain, and dark-colored urine for two days.", "He has no history of serious illness.", "He recently sprained his ankle playing basketball and has been taking ibuprofen as needed for pain.", "Physical examination shows scleral icterus.", "Laboratory studies show a hemoglobin concentration of 9.2 g/dL and serum lactate dehydrogenase concentration of 254 U/L.", "A photomicrograph of a peripheral blood smear with Wright's stain is shown."], "context_len": 6, "options": {"A": "Autosomal recessive", "B": "X-linked dominant", "C": "Autosomal dominant", "D": "X-linked recessive\n\""}, "answer": "X-linked recessive\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "18", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An 18-year-old man comes to the physician.", "2. He has fatigue, back pain, and dark-colored urine for two days.", "3. He has no history of serious illness.", "4. He recently sprained his ankle playing basketball.", "5. He has been taking ibuprofen as needed for pain.", "6. Physical examination shows scleral icterus.", "7. Laboratory studies show a hemoglobin concentration of 9.2 g/dL.", "8. Laboratory studies show a serum lactate dehydrogenase concentration of 254 U/L.", "9. A photomicrograph of a peripheral blood smear with Wright's stain is shown."], "atomic_facts": ["1. No history of serious illness", "2. Recently sprained his ankle playing basketball", "3. Taking ibuprofen as needed for pain", "4. Physical examination shows scleral icterus", "5. Laboratory studies show hemoglobin concentration of 9.2 g/dL", "6. Laboratory studies show serum lactate dehydrogenase concentration of 254 U/L", "7. A photomicrograph of a peripheral blood smear with Wright's stain is shown"]}
{"id": 881, "question": "Which of the following tests is most likely to yield an accurate diagnosis?", "context": ["A 32-day-old boy is brought to the pediatrician with complaints of purulent discharge from the umbilicus and perianal ulceration for the past few days.", "A detailed developmental history reveals that he was born to a couple who had a non-consanguineous marriage.", "He was born by normal delivery at 39 weeks of gestation and his neonatal period was uneventful.", "His birth weight was 2.9 kg (6.3 lb) and he is exclusively breastfed.", "His parents also report that he has had 25\u201330 episodes of loose stools per day since his seventh day of life.", "His umbilical cord fell off on the 25th day of life.", "His temperature is 38.6\u00baC (101.4\u00b0F), pulse is 110/min, and respiratory rate is 35/min.", "On physical examination, erythema and induration are noted around the umbilicus and mild hepatosplenomegaly is present.", "His laboratory studies show: | Hemoglobin 12.9 gm/dL | Leukocyte count 73,000/mm3 | Platelet count 170,000/mm3 | Peripheral smear Hypersegmented polymorphs, toxic granules | Stool pH 6 | ."], "context_len": 9, "options": {"A": "Ultrasonography of the abdomen and pelvis", "B": "Flow cytometry", "C": "Magnetic resonance imaging", "D": "Complete blood count"}, "answer": "Flow cytometry", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "32 days", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 32-day-old boy is brought to the pediatrician with complaints of purulent discharge from the umbilicus and perianal ulceration for the past few days.", "2. The boy's parents had a non-consanguineous marriage.", "3. He was born by normal delivery at 39 weeks of gestation.", "4. His neonatal period was uneventful.", "5. His birth weight was 2.9 kg (6.3 lb).", "6. He is exclusively breastfed.", "7. His parents report that he has had 25\u201330 episodes of loose stools per day since his seventh day of life.", "8. His umbilical cord fell off on the 25th day of life.", "9. His temperature is 38.6\u00baC (101.4\u00b0F).", "10. His pulse is 110/min.", "11. His respiratory rate is 35/min.", "12. On physical examination, erythema and induration are noted around the umbilicus.", "13. Mild hepatosplenomegaly is present.", "14. His hemoglobin is 12.9 gm/dL.", "15. His leukocyte count is 73,000/mm3.", "16. His platelet count is 170,000/mm3.", "17. His peripheral smear shows hypersegmented polymorphs and toxic granules.", "18. His stool pH is 6."], "atomic_facts": ["1. Detailed developmental history reveals non-consanguineous marriage of parents.", "2. Born by normal delivery at 39 weeks of gestation.", "3. Neonatal period was uneventful.", "4. Birth weight was 2.9 kg (6.3 lb).", "5. Exclusively breastfed.", "6. Experienced 25\u201330 episodes of loose stools per day since seventh day of life.", "7. Umbilical cord fell off on the 25th day of life.", "8. Temperature is 38.6\u00baC (101.4\u00b0F).", "9. Pulse is 110/min.", "10. Respiratory rate is 35/min.", "11. Physical examination shows erythema and induration around the umbilicus.", "12. Mild hepatosplenomegaly is present.", "13. Laboratory studies show: Hemoglobin 12.9 gm/dL.", "14. Leukocyte count 73,000/mm3.", "15. Platelet count 170,000/mm3.", "16. Peripheral smear shows hypersegmented polymorphs and toxic granules.", "17. Stool pH is 6."]}
{"id": 882, "question": "The abdominal defect is immediately covered in sterile saline dressings, and an orogastric tube and two peripheral intravenous lines are placed. |  | This condition is associated with which of the following additional cardiac defects?", "context": ["A 1-hour-old newborn male is evaluated in the delivery room.", "The infant was born at 37 weeks gestation to a 39-year-old G3.", "The mother initially labored at home with a midwife but was transferred to the hospital for failure to progress.", "The infant was eventually delivered via Caesarean section.", "The mother declined all prenatal screening during this pregnancy.", "Upon delivery, the infant is found to have a 3 cm full-thickness defect in the abdominal wall to the right of the umbilicus with evisceration of a loop of bowel.", "His Apgar scores were 7 and 8 at 1 and 5 minutes, respectively.", "His weight is 3.0 kg (6.6 lb), and his height and head circumference are in the 30th and 40th percentiles, respectively."], "context_len": 8, "options": {"A": "No cardiac defects", "B": "Bicuspid aortic valve", "C": "Tetralogy of Fallot", "D": "Ventricular septal defect"}, "answer": "No cardiac defects", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "1 hour old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Infant is 1-hour-old.", "2. Infant is male.", "3. Infant was born at 37 weeks gestation.", "4. Mother is 39-years-old.", "5. Mother is G3.", "6. Mother initially labored at home with a midwife.", "7. Mother was transferred to the hospital for failure to progress.", "8. Infant was delivered via Caesarean section.", "9. Mother declined all prenatal screening during this pregnancy.", "10. Infant has a 3 cm full-thickness defect in the abdominal wall to the right of the umbilicus with evisceration of a loop of bowel.", "11. Infant's Apgar scores were 7 and 8 at 1 and 5 minutes, respectively.", "12. Infant's weight is 3.0 kg (6.6 lb).", "13. Infant's height is in the 30th percentile.", "14. Infant's head circumference is in the 40th percentile."], "atomic_facts": ["1. The infant was born at 37 weeks gestation.", "2. The mother is 39 years old and has had 3 pregnancies.", "3. The mother initially labored at home with a midwife.", "4. The mother was transferred to the hospital for failure to progress.", "5. The infant was delivered via Caesarean section.", "6. The mother declined all prenatal screening during this pregnancy.", "7. Upon delivery, the infant is found to have a 3 cm full-thickness defect in the abdominal wall to the right of the umbilicus with evisceration of a loop of bowel.", "8. The infant's Apgar scores were 7 and 8 at 1 and 5 minutes, respectively.", "9. The infant's weight is 3.0 kg (6.6 lb).", "10. The infant's height and head circumference are in the 30th and 40th percentiles, respectively."]}
{"id": 883, "question": "Which of the following is the most likely diagnosis?", "context": ["A 17-year-old girl is brought to the physician for a well-child examination.", "She is worried about gaining weight.", "She frequents buffet restaurants but feels guilty soon after.", "She has a history of burning her extremities with cigarettes.", "Her last menstrual period was 3 weeks ago.", "She attends high school and plays field hockey on the school team.", "She is at the 25th percentile for height, 12th percentile for weight, and 17th percentile for BMI.", "Examination shows bilateral parotid gland enlargement.", "Oropharyngeal examination shows perimolysis.", "The remainder of the examination shows no abnormalities."], "context_len": 10, "options": {"A": "Major depressive disorder", "B": "Bulimia nervosa", "C": "Body dysmorphic disorder", "D": "Anorexia nervosa\n\""}, "answer": "Bulimia nervosa", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "17 years old", "specialties": ["Pediatrics"], "subspecialties": ["Adolescent Medicine", "General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 17-year-old girl is brought to the physician for a well-child examination.", "2. She is worried about gaining weight.", "3. She frequents buffet restaurants but feels guilty soon after.", "4. She has a history of burning her extremities with cigarettes.", "5. Her last menstrual period was 3 weeks ago.", "6. She attends high school.", "7. She plays field hockey on the school team.", "8. She is at the 25th percentile for height.", "9. She is at the 12th percentile for weight.", "10. She is at the 17th percentile for BMI.", "11. Examination shows bilateral parotid gland enlargement.", "12. Oropharyngeal examination shows perimolysis.", "13. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. She is worried about gaining weight.", "2. She frequents buffet restaurants.", "3. She feels guilty soon after eating at buffet restaurants.", "4. She has a history of burning her extremities with cigarettes.", "5. Her last menstrual period was 3 weeks ago.", "6. She attends high school.", "7. She plays field hockey on the school team.", "8. She is at the 25th percentile for height.", "9. She is at the 12th percentile for weight.", "10. She is at the 17th percentile for BMI.", "11. Examination shows bilateral parotid gland enlargement.", "12. Oropharyngeal examination shows perimolysis.", "13. The remainder of the examination shows no abnormalities."]}
{"id": 884, "question": "What would be the expected findings on brain MRI?", "context": ["A 37-year-old man with a history of depression has a two-year history of slowly worsening movement abnormalities characterized by rapid, involuntary, nonrepetitive movements involving his face, trunk, and limbs presents to clinic.", "He has also noted worsening of his depression, along with symptoms of increased anxiety and irritability.", "During the interview, his wife explains that he has suffered cognitive decline, most notably in the realm of executive function.", "On family history, you discover that his father suffered from a similar illness before dying at the age of 44."], "context_len": 4, "options": {"A": "Normal brain MRI", "B": "Atrophy of the caudate nucleus", "C": "Periventricular high-signal intensity lesions on FLAIR sequence", "D": "Atrophy of the hippocampi"}, "answer": "Atrophy of the caudate nucleus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "37", "specialties": ["Neurology"], "subspecialties": ["Movement Disorders", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 37-year-old man has a two-year history of slowly worsening movement abnormalities.", "2. The movement abnormalities involve his face, trunk, and limbs.", "3. The man has a history of depression.", "4. The man has worsening of his depression, along with symptoms of increased anxiety and irritability.", "5. The man's wife explains that he has suffered cognitive decline, most notably in the realm of executive function.", "6. The man's father suffered from a similar illness.", "7. The man's father died at the age of 44."], "atomic_facts": ["1. The patient has noted worsening of his depression.", "2. The patient has symptoms of increased anxiety.", "3. The patient has symptoms of irritability.", "4. The patient has suffered cognitive decline.", "5. The cognitive decline is most notable in the realm of executive function.", "6. The patient's father suffered from a similar illness.", "7. The patient's father died at the age of 44."]}
{"id": 885, "question": "Which of the following is the next best step in management for the most likely diagnosis?", "context": ["A 55-year-old man with a history of diabetes and hypertension presents to the emergency department when he found half of his face paralyzed this morning.", "The patient was last seen normal the night before by his wife and woke up with these symptoms.", "He has a past medical history of diabetes and hypertension and is not currently taking any medications for these conditions.", "His temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 177/118 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air.", "Physical exam is notable for an inability for the patient to move any part of his face on the right side.", "The rest of his neurological exam is within normal limits."], "context_len": 6, "options": {"A": "Elevation of the head of the bed and intubation", "B": "MRI of the head", "C": "Tissue plasminogen activator", "D": "Topical lubricants and discharge"}, "answer": "Topical lubricants and discharge", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "55 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 55 years old.", "2. Patient has a history of diabetes and hypertension.", "3. Patient was last seen normal the night before by his wife.", "4. Patient woke up with half of his face paralyzed.", "5. Patient is not currently taking any medications for diabetes or hypertension.", "6. Patient's temperature is 98.5\u00b0F (36.9\u00b0C).", "7. Patient's blood pressure is 177/118 mmHg.", "8. Patient's pulse is 90/min.", "9. Patient's respirations are 15/min.", "10. Patient's oxygen saturation is 99% on room air.", "11. Patient is unable to move any part of his face on the right side.", "12. Patient's neurological exam is within normal limits."], "atomic_facts": ["1. The patient was last seen normal the night before by his wife.", "2. The patient woke up with symptoms.", "3. The patient has a past medical history of diabetes and hypertension.", "4. The patient is not currently taking any medications for diabetes and hypertension.", "5. The patient's temperature is 98.5\u00b0F (36.9\u00b0C).", "6. The patient's blood pressure is 177/118 mmHg.", "7. The patient's pulse is 90/min.", "8. The patient's respirations are 15/min.", "9. The patient's oxygen saturation is 99% on room air.", "10. The patient has an inability to move any part of his face on the right side.", "11. The rest of the patient's neurological exam is within normal limits."]}
{"id": 886, "question": "What is the most probable site of obstruction?", "context": ["A newborn boy develops excessive bilious vomiting 4 hours after delivery.", "The infant was born vaginally to a 29-year-old mother (gravida 2, para 1) at 38 weeks gestation.", "History was significant for polyhydramnios detected at 32 weeks and monitored for the duration of gestation.", "He was put to the breast right after birth and sucked actively.", "He still has not passed meconium.", "The patient\u2019s vital signs include: blood pressure 77/50 mm Hg, heart rate 128/min, respiratory rate 37/min, and temperature 36.4\u2103 (97.5\u2109).", "On physical examination, the newborn appears fussy and mildly dehydrated.", "His abdomen appears rounded, soft and nontender on palpation, with no palpable organomegaly or masses."], "context_len": 8, "options": {"A": "Esophagus", "B": "Gastric pylorus", "C": "Duodenum, distal to Vater\u2019s papilla", "D": "Sigmoid colon"}, "answer": "Duodenum, distal to Vater\u2019s papilla", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "Newborn", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Surgery", "Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Surgery"}, "facts_old": ["1. A newborn boy was born vaginally.", "2. The mother was 29 years old.", "3. This was her second pregnancy.", "4. She had one prior delivery.", "5. The infant was born at 38 weeks gestation.", "6. Polyhydramnios was detected at 32 weeks gestation.", "7. The infant was put to the breast right after birth.", "8. He sucked actively.", "9. He has not passed meconium.", "10. The infant developed excessive bilious vomiting 4 hours after delivery.", "11. His blood pressure is 77/50 mm Hg.", "12. His heart rate is 128/min.", "13. His respiratory rate is 37/min.", "14. His temperature is 36.4\u2103 (97.5\u2109).", "15. On physical examination, the newborn appears fussy and mildly dehydrated.", "16. His abdomen appears rounded, soft and nontender on palpation.", "17. There is no palpable organomegaly or masses."], "atomic_facts": ["1. The infant was born vaginally.", "2. The mother is 29 years old.", "3. The mother is gravida 2, para 1.", "4. The infant was born at 38 weeks gestation.", "5. History was significant for polyhydramnios detected at 32 weeks.", "6. Polyhydramnios was monitored for the duration of gestation.", "7. The infant was put to the breast right after birth.", "8. The infant sucked actively.", "9. The infant has not passed meconium.", "10. The patient\u2019s blood pressure is 77/50 mm Hg.", "11. The patient\u2019s heart rate is 128/min.", "12. The patient\u2019s respiratory rate is 37/min.", "13. The patient\u2019s temperature is 36.4\u2103 (97.5\u2109).", "14. On physical examination, the newborn appears fussy.", "15. On physical examination, the newborn appears mildly dehydrated.", "16. The infant's abdomen appears rounded.", "17. The infant's abdomen is soft and nontender on palpation.", "18. There is no palpable organomegaly or masses in the infant's abdomen."]}
{"id": 887, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["The patient is counselled about her risk of thyroid malignancy.", "Serum studies show: | Na+ 138 mEq/L | K+ 4.1 mEq/L | Cl- 101 mEq/L | TSH 0.03 \u03bcU/mL | Calcium 9 mg/dL | ."], "context_len": 2, "options": {"A": "Free T4 and T3 levels", "B": "Fine-needle aspiration biopsy", "C": "Open biopsy", "D": "Thyroid scintigraphy scan"}, "answer": "Thyroid scintigraphy scan", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "Not provided", "specialties": ["Endocrinology, Diabetes, and Metabolism", "Internal Medicine"], "subspecialties": ["General Endocrinology", "Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. The patient is counselled about her risk of thyroid malignancy.", "2. Serum studies show Na+ 138 mEq/L.", "3. Serum studies show K+ 4.1 mEq/L.", "4. Serum studies show Cl- 101 mEq/L.", "5. Serum studies show TSH 0.03 \u03bcU/mL.", "6. Serum studies show Calcium 9 mg/dL."], "atomic_facts": ["1. Serum Na+ level is 138 mEq/L.", "2. Serum K+ level is 4.1 mEq/L.", "3. Serum Cl- level is 101 mEq/L.", "4. Serum TSH level is 0.03 \u03bcU/mL.", "5. Serum calcium level is 9 mg/dL."]}
{"id": 888, "question": "Which of the following best represents the etiology of this infant condition?", "context": ["An 18-month-old girl is brought to her pediatrician because of swelling in her hands and feet.", "Her mother is concerned because she has been inconsolable for the last 8 hours.", "The mother adds that the girl has been getting tired easily recently.", "The vital signs include: temperature 38.0\u00b0C (100.4\u00b0F), blood pressure 90/55 mm Hg, and pulse 122/min.", "Gentle palpation of the metacarpal and metatarsal bones causes the infant to scream.", "The laboratory evaluation is remarkable for mild anemia, leukocytosis, and increased reticulocyte count.", "Her peripheral blood smear is shown in the picture."], "context_len": 7, "options": {"A": "Red cell enzymatic deficiency", "B": "Abnormal heme synthesis", "C": "Abnormal globin chain structure", "D": "Abnormal globin chain synthesis"}, "answer": "Abnormal globin chain structure", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "18 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 18-month-old girl is brought to her pediatrician.", "2. The girl has swelling in her hands and feet.", "3. The girl has been inconsolable for the last 8 hours.", "4. The girl has been getting tired easily recently.", "5. The girl's temperature is 38.0\u00b0C (100.4\u00b0F).", "6. The girl's blood pressure is 90/55 mm Hg.", "7. The girl's pulse is 122/min.", "8. Gentle palpation of the metacarpal and metatarsal bones causes the infant to scream.", "9. The laboratory evaluation is remarkable for mild anemia.", "10. The laboratory evaluation is remarkable for leukocytosis.", "11. The laboratory evaluation is remarkable for increased reticulocyte count.", "12. The peripheral blood smear is shown in the picture."], "atomic_facts": ["1. The girl has been inconsolable for the last 8 hours.", "2. The girl has been getting tired easily recently.", "3. Vital signs: temperature 38.0\u00b0C (100.4\u00b0F), blood pressure 90/55 mm Hg, and pulse 122/min.", "4. Gentle palpation of the metacarpal and metatarsal bones causes the infant to scream.", "5. Laboratory evaluation shows mild anemia, leukocytosis, and increased reticulocyte count.", "6. Peripheral blood smear is shown in the picture."]}
{"id": 889, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 34-year-old gravida-1 at 8 weeks gestation seeks evaluation for a fever and sore throat for 3 days.", "She also reports generalized body pain and fatigue over this period.", "She was diagnosed with Graves\u2019 disease 6 months ago.", "Before conception, methimazole was switched to propylthiouracil.", "She appears ill.", "The vital signs include: axillary temperature 38.0\u2103 (100.4\u2109), pulse 88/min, respiratory rate 12/min, and blood pressure 120/80 mm Hg.", "A 1 \u00d7 1 cm ulcer is seen on the side of the tongue.", "The ulcer is tender with surrounding erythema.", "Examination of the neck, lungs, heart, and abdomen shows no abnormalities.", "The laboratory studies show the following: | Hemoglobin 13.5 g/dL | Mean corpuscular volume 90 \u03bcm3 | Leukocyte count 2,500/mm3 | Segmented neutrophils 5% | Lymphocytes 88% | Platelet count 240,000/mm3 | Alanine aminotransferase 18 U/L | Aspartate transaminase 16 U/L | ."], "context_len": 10, "options": {"A": "Acetaminophen for fever control", "B": "Discontinuation of propylthiouracil", "C": "Oral ampicillin", "D": "Rectal temperature measurement"}, "answer": "Discontinuation of propylthiouracil", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "34", "specialties": ["Pediatrics", "Internal Medicine"], "subspecialties": ["Infectious Disease", "General Pediatrics", "Pediatric Infectious Diseases"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 34-year-old gravida-1 at 8 weeks gestation.", "2. Patient has had a fever and sore throat for 3 days.", "3. Patient also reports generalized body pain and fatigue over this period.", "4. Patient was diagnosed with Graves\u2019 disease 6 months ago.", "5. Before conception, methimazole was switched to propylthiouracil.", "6. Patient appears ill.", "7. Vital signs include axillary temperature 38.0\u2103 (100.4\u2109), pulse 88/min, respiratory rate 12/min, and blood pressure 120/80 mm Hg.", "8. Examination of the neck, lungs, heart, and abdomen shows no abnormalities.", "9. A 1 \u00d7 1 cm ulcer is seen on the side of the tongue.", "10. The ulcer is tender with surrounding erythema.", "11. Laboratory studies show hemoglobin 13.5 g/dL.", "12. Laboratory studies show mean corpuscular volume 90 \u03bcm3.", "13. Laboratory studies show leukocyte count 2,500/mm3.", "14. Laboratory studies show segmented neutrophils 5%.", "15. Laboratory studies show lymphocytes 88%.", "16. Laboratory studies show platelet count 240,000/mm3.", "17. Laboratory studies show alanine aminotransferase 18 U/L.", "18. Laboratory studies show aspartate transaminase 16 U/L."], "atomic_facts": ["1. The patient reports generalized body pain and fatigue over a period of time.", "2. The patient was diagnosed with Graves\u2019 disease 6 months ago.", "3. Methimazole was switched to propylthiouracil before conception.", "4. The patient appears ill.", "5. Vital signs include: axillary temperature 38.0\u2103 (100.4\u2109), pulse 88/min, respiratory rate 12/min, and blood pressure 120/80 mm Hg.", "6. A 1 \u00d7 1 cm ulcer is seen on the side of the tongue.", "7. The ulcer is tender with surrounding erythema.", "8. Examination of the neck, lungs, heart, and abdomen shows no abnormalities.", "9. Laboratory studies show: Hemoglobin 13.5 g/dL, Mean corpuscular volume 90 \u03bcm3, Leukocyte count 2,500/mm3, Segmented neutrophils 5%, Lymphocytes 88%, Platelet count 240,000/mm3, Alanine aminotransferase 18 U/L, Aspartate transaminase 16 U/L."]}
{"id": 890, "question": "This patient's findings indicate damage to which of the following structures?", "context": ["A 27-year-old man comes to the physician because of a 1-week history of fever and pain with urination.", "His temperature is 39\u00b0C (102.2\u00b0F).", "Physical examination shows no abnormalities.", "A photomicrograph of a urine sample is shown."], "context_len": 4, "options": {"A": "Urethra", "B": "Ureter", "C": "Renal interstitium", "D": "Glomerulus"}, "answer": "Renal interstitium", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "27 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 27-year-old man comes to the physician.", "2. He has a 1-week history of fever and pain with urination.", "3. His temperature is 39\u00b0C (102.2\u00b0F).", "4. Physical examination shows no abnormalities.", "5. A photomicrograph of a urine sample is shown."], "atomic_facts": ["1. His temperature is 39\u00b0C (102.2\u00b0F).", "2. Physical examination shows no abnormalities.", "3. A photomicrograph of a urine sample is shown."]}
{"id": 891, "question": "Administration of which of the following drugs is the most appropriate next step in management?", "context": ["Twelve hours after undergoing uncomplicated total knee replacement, a 55-year-old man develops increasing anxiety, agitation, hand tremor, and nausea.", "He told the nurse he saw a bear in his room.", "His pain has been controlled with intravenous morphine.", "He has a history of advanced liver disease.", "He drinks 7 cans of beer daily.", "He is diaphoretic.", "His temperature is 37.6\u00b0C (99.7\u00b0F), pulse is 118/min, respirations are 18/min, and blood pressure is 146/92 mm Hg."], "context_len": 7, "options": {"A": "Chlordiazepoxide", "B": "Lorazepam", "C": "Dantrolene", "D": "Carbamazepine"}, "answer": "Lorazepam", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Anesthesiology"], "subspecialties": ["General Anesthesiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Anesthesiology"}, "facts_old": ["1. A 55-year-old man underwent uncomplicated total knee replacement 12 hours ago.", "2. He has developed increasing anxiety, agitation, hand tremor, and nausea.", "3. He told the nurse he saw a bear in his room.", "4. His pain has been controlled with intravenous morphine.", "5. He has a history of advanced liver disease.", "6. He drinks 7 cans of beer daily.", "7. He is diaphoretic.", "8. His temperature is 37.6\u00b0C (99.7\u00b0F).", "9. His pulse is 118/min.", "10. His respirations are 18/min.", "11. His blood pressure is 146/92 mm Hg."], "atomic_facts": ["1. He told the nurse he saw a bear in his room.", "2. His pain has been controlled with intravenous morphine.", "3. He has a history of advanced liver disease.", "4. He drinks 7 cans of beer daily.", "5. He is diaphoretic.", "6. His temperature is 37.6\u00b0C (99.7\u00b0F).", "7. His pulse is 118/min.", "8. His respirations are 18/min.", "9. His blood pressure is 146/92 mm Hg."]}
{"id": 892, "question": "The nerve involved in this patient\u2019s clinical presentation exits the skull through which of the following brain structures?", "context": ["A 45-year-old woman comes to the physician\u2019s office with complaints of jaw pain.", "When she eats, yawns, or rubs her jaw, she gets intense, shooting pains down the left side of her jaw, including her lower lip and chin.", "These episodes last about 30 seconds and have recurred about 10 times per day for the last month.", "She finds these episodes extremely distressing and comes to the physician\u2019s office in hope of finding a treatment.", "The patient denies any locking of her jaw.", "Physical exam is not notable for any tenderness to palpation over the jaw.", "She has no crepitus in her temporomandibular joint.", "The patient is able to open and close her jaw without pain."], "context_len": 8, "options": {"A": "Superior orbital fissure", "B": "Foramen ovale", "C": "Foramen spinosum", "D": "Jugular foramen"}, "answer": "Foramen ovale", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "45", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 45-year-old woman comes to the physician's office with complaints of jaw pain.", "2. When she eats, yawns, or rubs her jaw, she gets intense, shooting pains down the left side of her jaw, including her lower lip and chin.", "3. These episodes last about 30 seconds.", "4. These episodes have recurred about 10 times per day for the last month.", "5. She finds these episodes extremely distressing and comes to the physician's office in hope of finding a treatment.", "6. The patient denies any locking of her jaw.", "7. Physical exam is not notable for any tenderness to palpation over the jaw.", "8. She has no crepitus in her temporomandibular joint.", "9. The patient is able to open and close her jaw without pain."], "atomic_facts": ["1. When she eats, yawns, or rubs her jaw, she gets intense, shooting pains down the left side of her jaw, including her lower lip and chin.", "2. These episodes last about 30 seconds and have recurred about 10 times per day for the last month.", "3. She finds these episodes extremely distressing and comes to the physician\u2019s office in hope of finding a treatment.", "4. The patient denies any locking of her jaw.", "5. Physical exam is not notable for any tenderness to palpation over the jaw.", "6. She has no crepitus in her temporomandibular joint.", "7. The patient is able to open and close her jaw without pain."]}
{"id": 893, "question": "In addition to adequate intravenous hydration, which of the following if given would have most likely prevented the patient\u2019s symptoms?", "context": ["A 64-year-old woman presents to the hospital for chemotherapy.", "She has newly diagnosed acute myeloid leukemia.", "She is due to receive treatment with bendamustine for 2 days.", "On day 2 of her treatment, the patient complains of intense pain in her right great toe.", "On physical exam, the metatarsophalangeal joint of the 1st toe is warm, erythematous, swollen, and tender to both movement and palpation.", "An arthrocentesis is performed that reveals negatively birefringent needle-shaped crystals under polarized light.", "A Gram stain of the synovial fluid is negative."], "context_len": 7, "options": {"A": "Acetazolamide", "B": "Allopurinol", "C": "Colchicine", "D": "Corticosteroids"}, "answer": "Allopurinol", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "64 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 64-year-old woman presents to the hospital for chemotherapy.", "2. She has newly diagnosed acute myeloid leukemia.", "3. She is due to receive treatment with bendamustine for 2 days.", "4. On day 2 of her treatment, the patient complains of intense pain in her right great toe.", "5. On physical exam, the metatarsophalangeal joint of the 1st toe is warm, erythematous, swollen, and tender to both movement and palpation.", "6. An arthrocentesis is performed.", "7. Negatively birefringent needle-shaped crystals are seen under polarized light.", "8. A Gram stain of the synovial fluid is negative."], "atomic_facts": ["1. She has newly diagnosed acute myeloid leukemia.", "2. She is due to receive treatment with bendamustine for 2 days.", "3. On day 2 of her treatment, the patient complains of intense pain in her right great toe.", "4. On physical exam, the metatarsophalangeal joint of the 1st toe is warm, erythematous, swollen, and tender to both movement and palpation.", "5. An arthrocentesis is performed that reveals negatively birefringent needle-shaped crystals under polarized light.", "6. A Gram stain of the synovial fluid is negative."]}
{"id": 894, "question": "Which of the following is the most likely diagnosis?", "context": ["A 29-year-old woman comes to the physician with complaints of fever, headache, and rash, which have gradually worsened over the past 6 days.", "The patient informs the physician that the rash appeared after 2 days of fever.", "The rash started at the wrists and ankles and then gradually spread to the trunk, palms, and soles.", "On examination, the physician notes a maculopapular rash as shown in the image below.", "Vital signs show a temperature of 39.4\u00b0C (103.0\u00b0F), a blood pressure of 110/70 mm Hg, and a pulse rate of 86/min."], "context_len": 5, "options": {"A": "Endemic typhus", "B": "Lyme disease", "C": "Rocky Mountain spotted fever", "D": "Q fever"}, "answer": "Rocky Mountain spotted fever", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "29 years old", "specialties": ["Internal Medicine", "Pediatrics", "Infectious Disease"], "subspecialties": ["Infectious Disease", "Pediatric Infectious Diseases", "General Infectious Disease"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 29-year-old woman comes to the physician.", "2. She has complaints of fever, headache, and rash.", "3. The symptoms have gradually worsened over the past 6 days.", "4. The patient informs the physician that the rash appeared after 2 days of fever.", "5. The rash started at the wrists and ankles.", "6. The rash then gradually spread to the trunk, palms, and soles.", "7. On examination, the physician notes a maculopapular rash.", "8. Vital signs show a temperature of 39.4\u00b0C (103.0\u00b0F).", "9. Vital signs show a blood pressure of 110/70 mm Hg.", "10. Vital signs show a pulse rate of 86/min."], "atomic_facts": ["1. The patient reports that the rash appeared after 2 days of fever.", "2. The rash began at the wrists and ankles and then spread to the trunk, palms, and soles.", "3. The physician observes a maculopapular rash during the examination.", "4. Vital signs show a temperature of 39.4\u00b0C (103.0\u00b0F).", "5. The patient's blood pressure is 110/70 mm Hg.", "6. The patient's pulse rate is 86/min."]}
{"id": 895, "question": "Which of the following was most likely ingested by the patient?", "context": ["A 25-year-old man presents to the emergency department after paramedics picked him up from an electronic music festival.", "His temperature is 103\u00b0F (39.4\u00b0C), blood pressure is 167/105 mmHg, and pulse is 122/min.", "On physical exam, the patient is highly alert, agitated, and diaphoretic.", "Laboratory testing is significant for a serum sodium concentration of 130 mEq/L."], "context_len": 4, "options": {"A": "Heroin", "B": "Ketamine", "C": "3,4-methylenedioxymethamphetamine", "D": "Lysergic acid diethylamide"}, "answer": "3,4-methylenedioxymethamphetamine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "25", "specialties": ["Emergency Medicine"], "subspecialties": ["Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 25-year-old man presented to the emergency department. ", "2. Paramedics picked him up from an electronic music festival. ", "3. His temperature was 103\u00b0F (39.4\u00b0C). ", "4. His blood pressure was 167/105 mmHg. ", "5. His pulse was 122/min. ", "6. On physical exam, the patient was highly alert, agitated, and diaphoretic. ", "7. Laboratory testing was significant for a serum sodium concentration of 130 mEq/L."], "atomic_facts": ["1. Temperature: 103\u00b0F (39.4\u00b0C)", "2. Blood pressure: 167/105 mmHg", "3. Pulse: 122/min", "4. Patient is highly alert", "5. Patient is agitated", "6. Patient is diaphoretic", "7. Serum sodium concentration: 130 mEq/L"]}
{"id": 896, "question": "What is the most likely diagnosis?", "context": ["A 1-day-old male is seen in the neonatal intensive care unit for respiratory distress.", "He was born at 37 weeks to a 24-year-old G3P11011 Rh- mother who had no prenatal care.", "On physical examination, temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 120/85 mmHg, pulse is 120/min, respirations are 26/min, and pulse oximetry is 92% on room air.", "There is abdominal distention with a positive fluid wave.", "Laboratory results are as follows: |  | Serum: | Alkaline phosphatase: 80 U/L | ALT: 33 U/L | AST: 32 U/L | Bilirubin (total): 10 mg/dL | Bilirubin (conjugated): 0.2 mg/dL | Amylase: 76 U/L |  | Leukocyte count: 5,000/mm^3 with normal differential | Hemoglobin: 8 g/dL | Platelet count: 200,000/mm^3 | Mean corpuscular volume: 80 \u00b5m^3 | Reticulocyte count: 3% |  | ."], "context_len": 5, "options": {"A": "Dubin-Johnson syndrome", "B": "Gilbert syndrome", "C": "Breast feeding jaundice", "D": "Erythroblastosis fetalis"}, "answer": "Erythroblastosis fetalis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "1 day old", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 1-day-old male.", "2. Patient is in the neonatal intensive care unit for respiratory distress.", "3. Patient was born at 37 weeks.", "4. Patient's mother is 24-years-old.", "5. Patient's mother is G3P11011 Rh-.", "6. Patient's mother had no prenatal care.", "7. Patient's temperature is 99\u00b0F (37.2\u00b0C).", "8. Patient's blood pressure is 120/85 mmHg.", "9. Patient's pulse is 120/min.", "10. Patient's respirations are 26/min.", "11. Patient's pulse oximetry is 92% on room air.", "12. Patient has abdominal distention with a positive fluid wave.", "13. Patient's serum alkaline phosphatase is 80 U/L.", "14. Patient's serum ALT is 33 U/L.", "15. Patient's serum AST is 32 U/L.", "16. Patient's total bilirubin is 10 mg/dL.", "17. Patient's conjugated bilirubin is 0.2 mg/dL.", "18. Patient's amylase is 76 U/L.", "19. Patient's leukocyte count is 5,000/mm^3 with normal differential.", "20. Patient's hemoglobin is 8 g/dL.", "21. Patient's platelet count is 200,000/mm^3.", "22. Patient's mean corpuscular volume is 80 \u00b5m^3.", "23. Patient's reticulocyte count is 3%."], "atomic_facts": ["1. The patient was born at 37 weeks.", "2. The mother is 24 years old.", "3. The mother is G3P11011.", "4. The mother is Rh-.", "5. The mother had no prenatal care.", "6. The patient's temperature is 99\u00b0F (37.2\u00b0C).", "7. The patient's blood pressure is 120/85 mmHg.", "8. The patient's pulse is 120/min.", "9. The patient's respirations are 26/min.", "10. The patient's pulse oximetry is 92% on room air.", "11. There is abdominal distention with a positive fluid wave.", "12. Serum alkaline phosphatase is 80 U/L.", "13. Serum ALT is 33 U/L.", "14. Serum AST is 32 U/L.", "15. Serum total bilirubin is 10 mg/dL.", "16. Serum conjugated bilirubin is 0.2 mg/dL.", "17. Serum amylase is 76 U/L.", "18. Leukocyte count is 5,000/mm^3 with normal differential.", "19. Hemoglobin is 8 g/dL.", "20. Platelet count is 200,000/mm^3.", "21. Mean corpuscular volume is 80 \u00b5m^3.", "22. Reticulocyte count is 3%."]}
{"id": 897, "question": "Which of the following most likely explains the difference between these 2 studies?", "context": ["Study X examined the relationship between coffee consumption and lung cancer.", "The authors of Study X retrospectively reviewed patients' reported coffee consumption and found that drinking greater than 6 cups of coffee per day was associated with an increased risk of developing lung cancer.", "The same study in lab mice; however, did not come to a similar conclusion."], "context_len": 3, "options": {"A": "Confounding", "B": "Lead time bias", "C": "Observer bias", "D": "Selection bias"}, "answer": "Confounding", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Others"}, "facts_old": ["1. Study X examined the relationship between coffee consumption and lung cancer.", "2. The authors of Study X retrospectively reviewed patients' reported coffee consumption.", "3. Drinking greater than 6 cups of coffee per day was associated with an increased risk of developing lung cancer.", "4. The same study in lab mice did not come to a similar conclusion."], "atomic_facts": ["1. The authors of Study X retrospectively reviewed patients' reported coffee consumption.", "2. Drinking greater than 6 cups of coffee per day was associated with an increased risk of developing lung cancer.", "3. The same study in lab mice did not come to a similar conclusion."]}
{"id": 898, "question": "What is the most likely mechanism underlying this patient\u2019s findings?", "context": ["A 2-day-old boy was born at 38 weeks gestation to a 37-year-old woman by vaginal delivery.", "Since birth, the boy has had difficulty latching onto the breast but has not vomited or passed meconium.", "Examination reveals a flat facial profile with epicanthal eyelids, low-set earlobes, and a transverse crease on each palm.", "The abdomen is distended with absent breath sounds in the hypogastric region.", "A digital rectal examination shows a patent anal canal and is followed by a projected expulsion of gas and stool."], "context_len": 5, "options": {"A": "Hypertrophic pylorus causing retrograde flow of gastric contents", "B": "Inspissated meconium causing intestinal obstruction", "C": "Failure of neural crest cell migration during embryologic development", "D": "Telescoping of 2 parts of the intestine into each other"}, "answer": "Failure of neural crest cell migration during embryologic development", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "2 days old", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal", "Pediatric Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2-day-old boy was born at 38 weeks gestation.", "2. The mother is 37 years old.", "3. The delivery was vaginal.", "4. The boy has difficulty latching onto the breast.", "5. The boy has not vomited or passed meconium.", "6. Examination reveals a flat facial profile with epicanthal eyelids.", "7. Examination reveals low-set earlobes.", "8. Examination reveals a transverse crease on each palm.", "9. The abdomen is distended.", "10. Breath sounds are absent in the hypogastric region.", "11. A digital rectal examination shows a patent anal canal.", "12. Gas and stool are projected after the digital rectal examination."], "atomic_facts": ["1. The boy has had difficulty latching onto the breast since birth.", "2. The boy has not vomited or passed meconium.", "3. Examination reveals a flat facial profile.", "4. Examination reveals epicanthal eyelids.", "5. Examination reveals low-set earlobes.", "6. Examination reveals a transverse crease on each palm.", "7. The abdomen is distended.", "8. Absent breath sounds in the hypogastric region.", "9. A digital rectal examination shows a patent anal canal.", "10. A digital rectal examination is followed by a projected expulsion of gas and stool."]}
{"id": 899, "question": "Which of the following is the most likely cause of these findings?", "context": ["An otherwise healthy 23-year-old newly-married woman comes to the physician because of a 6-day history of discomfort in her vaginal area during and after sexual intercourse.", "Her last menstrual period was 3 weeks ago.", "Two years ago, she was diagnosed with genital herpes which was treated with acyclovir.", "She has been in a monogamous relationship for the past year and has been using an intrauterine device for contraception for the past month.", "Examination shows a 4-cm, mildly tender mass in the inferior aspect of the left labium minus with no signs of inflammation.", "Speculum examination causes her discomfort but shows no abnormalities."], "context_len": 6, "options": {"A": "Obstructed orifice of the Bartholin duct", "B": "Reactivation of the genital herpes", "C": "Squamous cell carcinoma of the vulva", "D": "Allergic reaction to the intrauterine device"}, "answer": "Obstructed orifice of the Bartholin duct", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "23", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 23-year-old newly-married woman.", "2. Patient has a 6-day history of discomfort in her vaginal area during and after sexual intercourse.", "3. Patient's last menstrual period was 3 weeks ago.", "4. Patient was diagnosed with genital herpes two years ago and was treated with acyclovir.", "5. Patient has been in a monogamous relationship for the past year.", "6. Patient has been using an intrauterine device for contraception for the past month.", "7. Examination shows a 4-cm, mildly tender mass in the inferior aspect of the left labium minus with no signs of inflammation.", "8. Speculum examination causes her discomfort but shows no abnormalities."], "atomic_facts": ["1. Her last menstrual period was 3 weeks ago.", "2. Two years ago, she was diagnosed with genital herpes.", "3. The genital herpes was treated with acyclovir.", "4. She has been in a monogamous relationship for the past year.", "5. She has been using an intrauterine device for contraception for the past month.", "6. Examination shows a 4-cm, mildly tender mass in the inferior aspect of the left labium minus.", "7. There are no signs of inflammation in the mass.", "8. Speculum examination causes her discomfort.", "9. The speculum examination shows no abnormalities."]}
{"id": 900, "question": "Which biopsy findings are most likely to be present in this patient?", "context": ["A 22-year-old professional softball player is undergoing an annual check-up.", "Her medical history is significant for hallux valgus and scoliosis.", "She additionally notes that she frequently has bumps and bruises from playing softball, but she has no injuries today.", "Her family history is significant for heart disease.", "The patient's blood pressure is 110/70 mm Hg, heart rate is 78/min, and respiratory rate is 15/min.", "A physical examination is unremarkable except for an indurated palpable mass on her left breast.", "A biopsy of the mass is performed."], "context_len": 7, "options": {"A": "Chronic inflammation with plasma cells", "B": "Necrotic fat with calcifications and giant cells", "C": "Leaf-like projections", "D": "Abundant extracellular mucin"}, "answer": "Necrotic fat with calcifications and giant cells", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "22 years old", "specialties": ["Pathology"], "subspecialties": ["Dermatopathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 22-year-old professional softball player is undergoing an annual check-up.", "2. Her medical history is significant for hallux valgus and scoliosis.", "3. She additionally notes that she frequently has bumps and bruises from playing softball.", "4. She has no injuries today.", "5. Her family history is significant for heart disease.", "6. The patient's blood pressure is 110/70 mm Hg.", "7. The patient's heart rate is 78/min.", "8. The patient's respiratory rate is 15/min.", "9. A physical examination is unremarkable except for an indurated palpable mass on her left breast.", "10. A biopsy of the mass is performed."], "atomic_facts": ["1. Her medical history includes hallux valgus and scoliosis.", "2. She frequently has bumps and bruises from playing softball.", "3. She has no injuries today.", "4. Her family history includes heart disease.", "5. Her blood pressure is 110/70 mm Hg.", "6. Her heart rate is 78/min.", "7. Her respiratory rate is 15/min.", "8. A physical examination is unremarkable except for an indurated palpable mass on her left breast.", "9. A biopsy of the mass is performed."]}
{"id": 901, "question": "Which of the following is the most appropriate next step in the management of this patient?", "context": ["A 5-month-old male infant is brought to the physician by his parents for the evaluation of a progressive enlargement of his head circumference.", "His parents report that he has been healthy except for an episode of tonsillitis 3 months ago treated with penicillin.", "The patient was born at term by a lower segment transverse cesarean section because of a transverse lie.", "He has met all developmental milestones.", "His immunizations are up-to-date.", "The patient is at the 50th percentile for length, 50th percentile for weight, and 95th percentile for head circumference.", "He appears well-nourished.", "His temperature is 37\u00b0C (98.6\u00b0F), pulse is 120/min, and blood pressure is 90/60 mm Hg.", "Physical examination shows a tense anterior fontanelle.", "The eyes deviate inferiorly and the eyelids are retracted."], "context_len": 10, "options": {"A": "Serial lumbar punctures", "B": "CT scan of the head", "C": "Place a CSF shunt", "D": "Ultrasound of the head"}, "answer": "Ultrasound of the head", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "5 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 5-month-old male infant.", "2. Parents brought him to the physician for evaluation of progressive enlargement of head circumference.", "3. Patient had an episode of tonsillitis 3 months ago, treated with penicillin.", "4. Patient was born at term by lower segment transverse cesarean section because of transverse lie.", "5. Patient has met all developmental milestones.", "6. Patient's immunizations are up-to-date.", "7. Patient is at 50th percentile for length.", "8. Patient is at 50th percentile for weight.", "9. Patient is at 95th percentile for head circumference.", "10. Patient appears well-nourished.", "11. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "12. Patient's pulse is 120/min.", "13. Patient's blood pressure is 90/60 mm Hg.", "14. Physical examination shows a tense anterior fontanelle.", "15. Patient's eyes deviate inferiorly.", "16. Patient's eyelids are retracted."], "atomic_facts": ["1. The patient had an episode of tonsillitis 3 months ago.", "2. The tonsillitis was treated with penicillin.", "3. The patient was born at term.", "4. The patient was born by a lower segment transverse cesarean section.", "5. The cesarean section was due to a transverse lie.", "6. The patient has met all developmental milestones.", "7. The patient's immunizations are up-to-date.", "8. The patient is at the 50th percentile for length.", "9. The patient is at the 50th percentile for weight.", "10. The patient is at the 95th percentile for head circumference.", "11. The patient appears well-nourished.", "12. The patient's temperature is 37\u00b0C (98.6\u00b0F).", "13. The patient's pulse is 120/min.", "14. The patient's blood pressure is 90/60 mm Hg.", "15. Physical examination shows a tense anterior fontanelle.", "16. The patient's eyes deviate inferiorly.", "17. The patient's eyelids are retracted."]}
{"id": 902, "question": "Which of the following is the most likely cause of this infant\u2019s presentation?", "context": ["A 37-year-old G1P1001 delivers a male infant at 9 pounds 6 ounces after a C-section for preeclampsia with severe features.", "The mother has a history of type II diabetes with a hemoglobin A1c of 12.8% at her first obstetric visit.", "Before this pregnancy, she was taking metformin, and during this pregnancy, she was started on insulin.", "At her routine visits, her glucose logs frequently showed fasting fingerstick glucoses above 120 mg/dL and postprandial values above 180 mg/dL.", "In addition, her routine third trimester culture for group B Streptococcus was positive.", "At 38 weeks and 4 days gestation, she was found to have a blood pressure of 176/103 mmHg and reported a severe headache during a routine obstetric visit.", "She denied rupture of membranes or vaginal bleeding.", "Her physician sent her to the obstetric triage unit, and after failure of several intravenous doses of labetalol to lower her blood pressure and relieve her headache, a C-section was performed without complication.", "Fetal heart rate tracing had been reassuring throughout her admission.", "Apgar scores at 1 and 5 minutes were 7 and 10.", "After one hour, the infant is found to be jittery; the infant's temperature is 96.1\u00b0F (35.6\u00b0C), blood pressure is 80/50 mmHg, pulse is 110/min, and respirations are 60/min.", "When the first feeding is attempted, he does not latch and begins to shake his arms and legs.", "After 20 seconds, the episode ends and the infant becomes lethargic."], "context_len": 13, "options": {"A": "\u00df-cell hyperplasia", "B": "Neonatal sepsis", "C": "Inborn error of metabolism", "D": "Neonatal encephalopathy"}, "answer": "\u00df-cell hyperplasia", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "37 years old", "specialties": ["Obstetrics and Gynecology", "Pediatrics"], "subspecialties": ["Maternal", "Neonatal"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 37-year-old G1P1001.", "2. Patient delivers a male infant at 9 pounds 6 ounces.", "3. Delivery is via C-section for preeclampsia with severe features.", "4. Patient has a history of type II diabetes.", "5. Patient's hemoglobin A1c at first obstetric visit is 12.8%.", "6. Patient was taking metformin before this pregnancy.", "7. Patient was started on insulin during this pregnancy.", "8. Patient's glucose logs frequently showed fasting fingerstick glucoses above 120 mg/dL and postprandial values above 180 mg/dL.", "9. Patient's routine third trimester culture for group B Streptococcus was positive.", "10. Patient's blood pressure at 38 weeks and 4 days gestation is 176/103 mmHg.", "11. Patient reported a severe headache during a routine obstetric visit.", "12. Patient denied rupture of membranes or vaginal bleeding.", "13. Patient's physician sent her to the obstetric triage unit.", "14. After failure of several intravenous doses of labetalol to lower her blood pressure and relieve her headache, a C-section was performed without complication.", "15. Fetal heart rate tracing had been reassuring throughout her admission.", "16. Apgar scores at 1 and 5 minutes were 7 and 10.", "17. After one hour, the infant is found to be jittery.", "18. Infant's temperature is 96.1\u00b0F (35.6\u00b0C).", "19. Infant's blood pressure is 80/50 mmHg.", "20. Infant's pulse is 110/min.", "21. Infant's respirations are 60/min.", "22. When the first feeding is attempted, he does not latch and begins to shake his arms and legs.", "23. After 20 seconds, the episode ends and the infant becomes lethargic."], "atomic_facts": ["1. The mother has a history of type II diabetes.", "2. The mother's hemoglobin A1c was 12.8% at her first obstetric visit.", "3. Before this pregnancy, the mother was taking metformin.", "4. During this pregnancy, the mother was started on insulin.", "5. The mother's glucose logs frequently showed fasting fingerstick glucoses above 120 mg/dL and postprandial values above 180 mg/dL.", "6. The routine third trimester culture for group B Streptococcus was positive.", "7. At 38 weeks and 4 days gestation, the mother had a blood pressure of 176/103 mmHg.", "8. The mother reported a severe headache during a routine obstetric visit.", "9. The mother denied rupture of membranes or vaginal bleeding.", "10. The physician sent the mother to the obstetric triage unit.", "11. Several intravenous doses of labetalol failed to lower the mother's blood pressure and relieve her headache.", "12. A C-section was performed without complication.", "13. The fetal heart rate tracing had been reassuring throughout the mother's admission.", "14. The infant's Apgar scores at 1 and 5 minutes were 7 and 10.", "15. After one hour, the infant was found to be jittery.", "16. The infant's temperature was 96.1\u00b0F (35.6\u00b0C).", "17. The infant's blood pressure was 80/50 mmHg.", "18. The infant's pulse was 110/min.", "19. The infant's respirations were 60/min.", "20. When the first feeding was attempted, the infant did not latch and began to shake his arms and legs.", "21. After 20 seconds, the episode ended and the infant became lethargic."]}
{"id": 903, "question": "What is the most likely diagnosis?", "context": ["A 65-year-old male presents to his cardiologist to discuss increasing episodes of dyspnea after climbing stairs.", "He also now needs three pillows at night to sleep.", "Physical examination reveals an early diastolic murmur best appreciated at the left sternal border with bounding peripheral pulses.", "The cardiologist is very concerned and immediately refers the patient for a surgical workup."], "context_len": 4, "options": {"A": "Mitral valve insufficiency", "B": "Aortic regurgitation", "C": "Mitral stenosis", "D": "Aortic stenosis"}, "answer": "Aortic regurgitation", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "65", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old male presents to his cardiologist.", "2. The patient has increasing episodes of dyspnea after climbing stairs.", "3. The patient now needs three pillows at night to sleep.", "4. Physical examination reveals an early diastolic murmur.", "5. The murmur is best appreciated at the left sternal border.", "6. The patient has bounding peripheral pulses.", "7. The cardiologist is very concerned.", "8. The cardiologist immediately refers the patient for a surgical workup."], "atomic_facts": ["1. The patient now needs three pillows at night to sleep.", "2. Physical examination reveals an early diastolic murmur.", "3. The murmur is best appreciated at the left sternal border.", "4. The patient has bounding peripheral pulses.", "5. The cardiologist is very concerned.", "6. The cardiologist immediately refers the patient for a surgical workup."]}
{"id": 904, "question": "Which of the following is most accurate?", "context": ["A 42-year-old overweight restaurant waiter develops excruciating pain in the heel of his right foot.", "Symptoms are most intense after getting out of bed but get better after walking.", "On physical examination, both feet have a flat medial arch.", "There is tenderness to palpation along the inner aspect of the right heel bone, minimal active dorsiflexion, and pain at passive dorsiflexion.", "X-ray films reveal a bone spur at the level of the attachment of the right plantar fascia.", "The spur is also present in the comparison film of the left foot.", "He is diagnosed with plantar fasciitis and is told to lose weight, rest, use ice, and take anti-inflammatory medications."], "context_len": 7, "options": {"A": "The central fascicle is the thinnest and the most likely to rupture.", "B": "The patient's windlass mechanism remains intact.", "C": "This was caused by excessive strain on the medial fascicle.", "D": "The pain in the right foot is caused by the bone spur."}, "answer": "This was caused by excessive strain on the medial fascicle.", "answer_idx": "C", "explanation": "", "patient": {"gender": "Not specified", "age": "42 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 42-year-old restaurant waiter is overweight.", "2. He has excruciating pain in the heel of his right foot.", "3. Symptoms are most intense after getting out of bed but get better after walking.", "4. On physical examination, both feet have a flat medial arch.", "5. There is tenderness to palpation along the inner aspect of the right heel bone.", "6. There is minimal active dorsiflexion and pain at passive dorsiflexion.", "7. X-ray films reveal a bone spur at the level of the attachment of the right plantar fascia.", "8. The spur is also present in the comparison film of the left foot.", "9. He is diagnosed with plantar fasciitis.", "10. He is told to lose weight, rest, use ice, and take anti-inflammatory medications."], "atomic_facts": ["1. Symptoms are most intense after getting out of bed but get better after walking.", "2. On physical examination, both feet have a flat medial arch.", "3. There is tenderness to palpation along the inner aspect of the right heel bone.", "4. Minimal active dorsiflexion is observed.", "5. Pain at passive dorsiflexion is present.", "6. X-ray films reveal a bone spur at the level of the attachment of the right plantar fascia.", "7. The spur is also present in the comparison film of the left foot.", "8. The patient is diagnosed with plantar fasciitis.", "9. The patient is advised to lose weight.", "10. The patient is advised to rest.", "11. The patient is advised to use ice.", "12. The patient is advised to take anti-inflammatory medications."]}
{"id": 905, "question": "Which of the following is the most likely cause of this patient's symptoms?", "context": ["A 7-year-old boy is brought to the physician because of decreased vision, hearing, and speaking over the past 3 months.", "During this time, he has also had difficulty walking, concentrating, drawing, and feeding himself.", "His maternal male cousin had similar complaints and died at the age of 5 years.", "Examination shows hyperpigmented skin and nails.", "His speech is dysarthric.", "Neurologic examination shows an ataxic gait, spasticity, and decreased muscle strength in all extremities.", "Fundoscopy shows optic atrophy."], "context_len": 7, "options": {"A": "Deficiency of \u03b2-glucocerebrosidase", "B": "Dysfunction of ATP-binding cassette transporter", "C": "Deficiency of arylsulfatase A", "D": "Deficiency of lysosomal galactocerebrosidase"}, "answer": "Dysfunction of ATP-binding cassette transporter", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Pediatrics", "Neurology"], "subspecialties": ["Pediatric Neurology", "Neurodevelopmental Disabilities"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 7-year-old boy is brought to the physician.", "2. The boy has had decreased vision, hearing, and speaking over the past 3 months.", "3. The boy has also had difficulty walking, concentrating, drawing, and feeding himself.", "4. His maternal male cousin had similar complaints and died at the age of 5 years.", "5. Examination shows hyperpigmented skin and nails.", "6. His speech is dysarthric.", "7. Neurologic examination shows an ataxic gait, spasticity, and decreased muscle strength in all extremities.", "8. Fundoscopy shows optic atrophy."], "atomic_facts": ["1. Patient has difficulty walking, concentrating, drawing, and feeding himself.", "2. Maternal male cousin had similar complaints and died at the age of 5 years.", "3. Examination shows hyperpigmented skin and nails.", "4. Patient's speech is dysarthric.", "5. Neurologic examination shows an ataxic gait, spasticity, and decreased muscle strength in all extremities.", "6. Fundoscopy shows optic atrophy."]}
{"id": 906, "question": "Based on this information, what is the probability that this patient does not have prostate cancer if his PSA is 4.3 ng/mL?", "context": ["A 55-year-old man comes to the physician because of a 4-month history of nocturia.", "He wakes up twice each night to urinate.", "He has no history of serious illness.", "He takes no medication.", "His younger brother was diagnosed with testicular cancer at the age of 35 years.", "Rectal examination shows a smooth, symmetrical prostate without nodules.", "The physician offers to discuss the advantages and limitations of the prostate specific antigen (PSA) test in diagnosing prostate cancer.", "He mentions that a a serum PSA of 4 ng/mL is generally used as a cutoff value.", "At this cutoff, the test has a sensitivity of 21% for detecting any prostate cancer and 51% for detecting high-risk prostate cancer, with a specificity of 91%.", "In patients without urinary retention, hematuria, back pain, or incontinence, the positive predictive value for PSA > 4 ng/mL is estimated at 30% and the negative predictive value for PSA \u2264 4 ng/mL at 85%."], "context_len": 10, "options": {"A": "79%", "B": "15%", "C": "70%", "D": "9%"}, "answer": "70%", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 55-year-old man comes to the physician because of a 4-month history of nocturia.", "2. He wakes up twice each night to urinate.", "3. He has no history of serious illness.", "4. He takes no medication.", "5. His younger brother was diagnosed with testicular cancer at the age of 35 years.", "6. Rectal examination shows a smooth, symmetrical prostate without nodules.", "7. The physician offers to discuss the advantages and limitations of the prostate specific antigen (PSA) test in diagnosing prostate cancer.", "8. He mentions that a a serum PSA of 4 ng/mL is generally used as a cutoff value.", "9. At this cutoff, the test has a sensitivity of 21% for detecting any prostate cancer and 51% for detecting high-risk prostate cancer, with a specificity of 91%.", "10. In patients without urinary retention, hematuria, back pain, or incontinence, the positive predictive value for PSA > 4 ng/mL is estimated at 30%.", "11. The negative predictive value for PSA \u2264 4 ng/mL at 85%."], "atomic_facts": ["1. He wakes up twice each night to urinate.", "2. He has no history of serious illness.", "3. He takes no medication.", "4. His younger brother was diagnosed with testicular cancer at the age of 35 years.", "5. Rectal examination shows a smooth, symmetrical prostate without nodules.", "6. The physician offers to discuss the advantages and limitations of the prostate specific antigen (PSA) test in diagnosing prostate cancer.", "7. He mentions that a serum PSA of 4 ng/mL is generally used as a cutoff value.", "8. At this cutoff, the test has a sensitivity of 21% for detecting any prostate cancer and 51% for detecting high-risk prostate cancer, with a specificity of 91%.", "9. In patients without urinary retention, hematuria, back pain, or incontinence, the positive predictive value for PSA > 4 ng/mL is estimated at 30% and the negative predictive value for PSA \u2264 4 ng/mL at 85%."]}
{"id": 907, "question": "Which of the following is the next best step in management?", "context": ["A 23-year-old woman presents to the emergency department for vomiting and abdominal pain.", "The patient states that she has been unable to eat or drink for the past 24 hours without vomiting.", "She also complains of worsening abdominal pain that started 3 days ago.", "The patient has a past medical history of IV drug abuse and alcohol abuse.", "She is not on any current medications.", "Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air.", "On physical exam, tenderness is elicited when the right lower quadrant of her abdomen is palpated.", "Deep palpation and release of the left lower quadrant of her abdomen also causes severe pain.", "Rectal exam reveals normal tone and stool is Guiac negative.", "Laboratory studies are ordered as seen below. |  | Hemoglobin: 12 g/dL | Hematocrit: 36% | Leukocyte count: 11,500/mm^3 with normal differential | Platelet count: 197,000/mm^3 |  | Serum: | Na+: 139 mEq/L | Cl-: 100 mEq/L | K+: 4.3 mEq/L | HCO3-: 27 mEq/L | BUN: 20 mg/dL | Glucose: 67 mg/dL | Creatinine: 1.1 mg/dL | Ca2+: 10.2 mg/dL | AST: 12 U/L | ALT: 15 U/L |  | Urine: | Cocaine: positive | Amphetamines: positive | \u00df-hCG: positive | Marijuana: positive | Heroin: negative | PCP: negative | MDMA: positive | Glucose: negative | Ketones: negative |  | ."], "context_len": 10, "options": {"A": "Chest radiograph", "B": "Abdominal CT", "C": "Ultrasound", "D": "Colonoscopy"}, "answer": "Ultrasound", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "23", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 23-year-old woman.", "2. Patient presents to the emergency department for vomiting and abdominal pain.", "3. Patient states she has been unable to eat or drink for the past 24 hours without vomiting.", "4. Patient complains of worsening abdominal pain that started 3 days ago.", "5. Patient has a past medical history of IV drug abuse and alcohol abuse.", "6. Patient is not on any current medications.", "7. Patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "8. Patient's blood pressure is 127/68 mmHg.", "9. Patient's pulse is 120/min.", "10. Patient's respirations are 17/min.", "11. Patient's oxygen saturation is 98% on room air.", "12. Tenderness is elicited when the right lower quadrant of her abdomen is palpated.", "13. Deep palpation and release of the left lower quadrant of her abdomen also causes severe pain.", "14. Rectal exam reveals normal tone and stool is Guiac negative.", "15. Laboratory studies show hemoglobin of 12 g/dL, hematocrit of 36%, leukocyte count of 11,500/mm^3 with normal differential, and platelet count of 197,000/mm^3.", "16. Serum Na+ is 139 mEq/L, Cl- is 100 mEq/L, K+ is 4.3 mEq/L, HCO3- is 27 mEq/L, BUN is 20 mg/dL, glucose is 67 mg/dL, creatinine is 1.1 mg/dL, and Ca2+ is 10.2 mg/dL.", "17. Serum AST is 12 U/L and ALT is 15 U/L.", "18. Urine cocaine is positive, amphetamines is positive, \u00df-hCG is positive, marijuana is positive, heroin is negative, PCP is negative, MDMA is positive, glucose is negative, and ketones are negative."], "atomic_facts": ["1. The patient has been unable to eat or drink for the past 24 hours without vomiting.", "2. The patient complains of worsening abdominal pain that started 3 days ago.", "3. The patient has a past medical history of IV drug abuse and alcohol abuse.", "4. The patient is not on any current medications.", "5. The patient's temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air.", "6. Tenderness is elicited when the right lower quadrant of her abdomen is palpated.", "7. Deep palpation and release of the left lower quadrant of her abdomen also causes severe pain.", "8. Rectal exam reveals normal tone and stool is Guiac negative.", "9. Laboratory studies show: Hemoglobin: 12 g/dL, Hematocrit: 36%, Leukocyte count: 11,500/mm^3 with normal differential, Platelet count: 197,000/mm^3, Serum: Na+: 139 mEq/L, Cl-: 100 mEq/L, K+: 4.3 mEq/L, HCO3-: 27 mEq/L, BUN: 20 mg/dL, Glucose: 67 mg/dL, Creatinine: 1.1 mg/dL, Ca2+: 10.2 mg/dL, AST: 12 U/L, ALT: 15 U/L, Urine: Cocaine: positive, Amphetamines: positive, \u00df-hCG: positive, Marijuana: positive, Heroin: negative, PCP: negative, MDMA: positive, Glucose: negative, Ketones: negative."]}
{"id": 908, "question": "Which of the following is the most likely pathology for this presentation?", "context": ["A 75-year-old man was brought in by his daughter since he was having increased incidences of forgetting things.", "His daughter said that he becomes increasingly frustrated searching for his glasses and keys most of the time.", "He was helped out a couple of times in the supermarket for forgetting the way out.", "He recently lost his driving license when he was spotted by the cops driving in the wrong direction on the interstate."], "context_len": 4, "options": {"A": "Prion infection", "B": "\u03b1-synuclein defect", "C": "Depigmented substantia nigra and locus cerulus", "D": "Abnormal cleavage of amyloid precursor protein"}, "answer": "Abnormal cleavage of amyloid precursor protein", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "75 years old", "specialties": ["Neurology"], "subspecialties": ["Neurodevelopmental Disabilities", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 75-year-old man was brought in by his daughter.", "2. He was having increased incidences of forgetting things.", "3. His daughter said he becomes increasingly frustrated searching for his glasses and keys most of the time.", "4. He was helped out a couple of times in the supermarket for forgetting the way out.", "5. He recently lost his driving license.", "6. He was spotted by the cops driving in the wrong direction on the interstate."], "atomic_facts": ["1. His daughter said he becomes increasingly frustrated searching for his glasses and keys most of the time.", "2. He was helped out a couple of times in the supermarket for forgetting the way out.", "3. He recently lost his driving license when he was spotted by the cops driving in the wrong direction on the interstate."]}
{"id": 909, "question": "What is the most likely organism responsible?", "context": ["A 7-month-old male child is brought into your office for recent rhinorrhea and cough.", "The mother states that the child has had mild fevers of up to 100.7 F over the last three days along with clear nasal discharge, and a nonproductive cough, but the child has been working harder to breathe over the last day.", "The mother states the child was vaccinated for the flu one month ago.", "His vitals are significant for a temperature of 100.9F and his physical exam is significant for intercostal retractions along with expiratory wheezing."], "context_len": 4, "options": {"A": "Parainfluenza virus", "B": "Adenovirus", "C": "Respiratory syncytial virus", "D": "Echovirus"}, "answer": "Respiratory syncytial virus", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "7 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases", "General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 7-month-old male child is brought into your office.", "2. The mother states the child has had mild fevers of up to 100.7 F over the last three days.", "3. The child has clear nasal discharge and a nonproductive cough.", "4. The child has been working harder to breathe over the last day.", "5. The mother states the child was vaccinated for the flu one month ago.", "6. The child's vitals are significant for a temperature of 100.9F.", "7. The child's physical exam is significant for intercostal retractions.", "8. The child's physical exam is significant for expiratory wheezing."], "atomic_facts": ["1. The child has had mild fevers of up to 100.7 F over the last three days.", "2. The child has clear nasal discharge.", "3. The child has a nonproductive cough.", "4. The child has been working harder to breathe over the last day.", "5. The child was vaccinated for the flu one month ago.", "6. The child's temperature is 100.9F.", "7. The child's physical exam shows intercostal retractions.", "8. The child's physical exam shows expiratory wheezing."]}
{"id": 910, "question": "Which of the following interventions most likely would have prevented this patient's condition?\"", "context": ["A 56-year-old man comes to the physician because of increasing generalized fatigue for 1 month.", "He also has had a 5.4 kg (12 lb) weight loss over the past 6 months.", "He has hypertension and type 1 diabetes mellitus.", "His father died of colon cancer at the age of 65 years.", "He has smoked one pack of cigarettes daily for 32 years and drinks one alcoholic beverage per week.", "He has numerous tattoos, several of which were acquired when he went backpacking through Southeast Asia as a young man.", "Current medications include enalapril and insulin.", "He is 180 cm (5 ft 11 in) tall and weighs 78 kg (172 lb); BMI is 24.1 kg/m2.", "His temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 86/min, and blood pressure is 140/90 mm Hg.", "The abdomen is soft and nontender.", "The liver is palpated 3 cm below the right costal margin.", "Laboratory studies show: | Hemoglobin 12.6 g/dL | Mean corpuscular volume 86 \u03bcm3 | Leukocyte count 8800/mm3 | Platelet count 282,000/mm3 | Hemoglobin A1C 6.3 % | Serum | Glucose 113 mg/dL | Creatinine 1.1 mg/dL | Albumin 4.1 mg/dL | Total bilirubin 1.1 mg/dL | Alkaline phosphatase 66 U/L | AST 100 U/L | ALT 69 U/L | Ferritin 180 ng/mL | \u03b1-fetoprotein | 410 ng/mL (N < 10 ng/mL) | CT scan of the abdomen shows a 3.5 x 2 x 1.5 cm mass in segment 6 of the liver."], "context_len": 12, "options": {"A": "Regular phlebotomies", "B": "Hepatitis B vaccination", "C": "Penicillamine therapy", "D": "Antitrypsin replacement therapy"}, "answer": "Hepatitis B vaccination", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "56 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 56-year-old man comes to the physician because of increasing generalized fatigue for 1 month.", "2. He has had a 5.4 kg (12 lb) weight loss over the past 6 months.", "3. He has hypertension and type 1 diabetes mellitus.", "4. His father died of colon cancer at the age of 65 years.", "5. He has smoked one pack of cigarettes daily for 32 years.", "6. He drinks one alcoholic beverage per week.", "7. He has numerous tattoos, several of which were acquired when he went backpacking through Southeast Asia as a young man.", "8. Current medications include enalapril and insulin.", "9. He is 180 cm (5 ft 11 in) tall and weighs 78 kg (172 lb); BMI is 24.1 kg/m2.", "10. His temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 86/min, and blood pressure is 140/90 mm Hg.", "11. The abdomen is soft and nontender.", "12. The liver is palpated 3 cm below the right costal margin.", "13. Laboratory studies show: Hemoglobin 12.6 g/dL, Mean corpuscular volume 86 \u03bcm3, Leukocyte count 8800/mm3, Platelet count 282,000/mm3, Hemoglobin A1C 6.3 %, Serum Glucose 113 mg/dL, Creatinine 1.1 mg/dL, Albumin 4.1 mg/dL, Total bilirubin 1.1 mg/dL, Alkaline phosphatase 66 U/L, AST 100 U/L, ALT 69 U/L, Ferritin 180 ng/mL, \u03b1-fetoprotein 410 ng/mL (N < 10 ng/mL).", "14. CT scan of the abdomen shows a 3.5 x 2 x 1.5 cm mass in segment 6 of the liver."], "atomic_facts": ["1. 5.4 kg (12 lb) weight loss over the past 6 months", "2. Hypertension and type 1 diabetes mellitus", "3. Father died of colon cancer at the age of 65 years", "4. Smoked one pack of cigarettes daily for 32 years and drinks one alcoholic beverage per week", "5. Numerous tattoos, several acquired when backpacking through Southeast Asia", "6. Current medications include enalapril and insulin", "7. Height: 180 cm (5 ft 11 in), weight: 78 kg (172 lb), BMI: 24.1 kg/m2", "8. Temperature: 37.0\u00b0C (98.6\u00b0F), pulse: 86/min, blood pressure: 140/90 mm Hg", "9. Abdomen is soft and nontender", "10. Liver is palpated 3 cm below the right costal margin", "11. Laboratory studies show: Hemoglobin 12.6 g/dL, Mean corpuscular volume 86 \u03bcm3, Leukocyte count 8800/mm3, Platelet count 282,000/mm3, Hemoglobin A1C 6.3 %, Serum Glucose 113 mg/dL, Creatinine 1.1 mg/dL, Albumin 4.1 mg/dL, Total bilirubin 1.1 mg/dL, Alkaline phosphatase 66 U/L, AST 100 U/L, ALT 69 U/L, Ferritin 180 ng/mL, \u03b1-fetoprotein 410 ng/mL (N < 10 ng/mL)", "12. CT scan of the abdomen shows a 3.5 x 2 x 1.5 cm mass in segment 6 of the liver"]}
{"id": 911, "question": "Which of the following drugs is the most likely cause of these laboratory findings?", "context": ["A 6-year-old girl with polycystic kidney disease is started on a new medication after receiving a kidney transplant from a matched, unrelated donor.", "Two days after starting the medication, laboratory studies show a leukocyte count of 17,500/mm3 (90% segmented neutrophils, 4% bands, 1% eosinophils, 3% lymphocytes, and 1% monocytes)."], "context_len": 2, "options": {"A": "Methylprednisolone", "B": "Abciximab", "C": "Erythropoietin", "D": "Tacrolimus"}, "answer": "Methylprednisolone", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 6-year-old girl has polycystic kidney disease.", "2. She received a kidney transplant from a matched, unrelated donor.", "3. She was started on a new medication.", "4. Two days after starting the medication, laboratory studies showed a leukocyte count of 17,500/mm3.", "5. 90% of the leukocytes were segmented neutrophils.", "6. 4% of the leukocytes were bands.", "7. 1% of the leukocytes were eosinophils.", "8. 3% of the leukocytes were lymphocytes.", "9. 1% of the leukocytes were monocytes."], "atomic_facts": ["1. The medication was started two days ago.", "2. The leukocyte count is 17,500/mm3.", "3. 90% of the leukocytes are segmented neutrophils.", "4. 4% of the leukocytes are bands.", "5. 1% of the leukocytes are eosinophils.", "6. 3% of the leukocytes are lymphocytes.", "7. 1% of the leukocytes are monocytes."]}
{"id": 912, "question": "The activity of which of the following cellular enzymes is most likely to be decreased in response to treatment with this drug?", "context": ["A clinical trial is conducted to investigate the efficiency of a new glucagon receptor antagonist in the treatment of type 2 diabetes mellitus.", "After 12 weeks of treatment with this drug, all participants in the study achieved statistically significant reductions in fasting and postprandial serum glucose.", "Three individuals reported symptoms of hypoglycemia while exercising."], "context_len": 3, "options": {"A": "Mitogen-activated protein kinase", "B": "Guanylate cyclase", "C": "Protein kinase A", "D": "Phospholipase C"}, "answer": "Protein kinase A", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine", "Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Endocrinology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A clinical trial is conducted to investigate the efficiency of a new glucagon receptor antagonist in the treatment of type 2 diabetes mellitus.", "2. After 12 weeks of treatment with this drug, all participants in the study achieved statistically significant reductions in fasting and postprandial serum glucose.", "3. Three individuals reported symptoms of hypoglycemia while exercising."], "atomic_facts": ["1. After 12 weeks of treatment with this drug, all participants in the study achieved statistically significant reductions in fasting serum glucose.", "2. After 12 weeks of treatment with this drug, all participants in the study achieved statistically significant reductions in postprandial serum glucose.", "3. Three individuals reported symptoms of hypoglycemia while exercising."]}
{"id": 913, "question": "Which of the following would you expect to find on a detailed history and physical examination of this patient?", "context": ["A 19-year-old man is admitted to the medical intensive care unit with suspected sepsis.", "Blood cultures grow Gram-negative cocci containing lipooligosaccharide in their cell wall."], "context_len": 2, "options": {"A": "Petechial rash", "B": "Ascending paralysis", "C": "History of exposure to rabbit hides", "D": "Rice water stools"}, "answer": "Petechial rash", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "19", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 19-year-old man is admitted to the medical intensive care unit.", "2. The man is suspected of having sepsis.", "3. Blood cultures grow Gram-negative cocci.", "4. The Gram-negative cocci contain lipooligosaccharide in their cell wall."], "atomic_facts": ["1. Blood cultures grow Gram-negative cocci.", "2. The cocci contain lipooligosaccharide in their cell wall."]}
{"id": 914, "question": "The affected vessel in this patient directly branches from which of the following vessels?", "context": ["A 25-year-old male rugby player presents to the emergency room complaining of a severe headache.", "He is accompanied by his teammate who reports that he had a head-to-head collision with another player and briefly passed out before regaining consciousness.", "His past medical history is significant for a pilocytic astrocytoma as a child treated successfully with surgery.", "His family history is notable for stroke in his father.", "His temperature is 98.9\u00b0F (37.2\u00b0C), blood pressure is 160/90 mmHg, pulse is 60/min, and respirations are 20/min.", "On examination, he is lethargic but oriented to person, place, and time."], "context_len": 6, "options": {"A": "Maxillary artery", "B": "Internal carotid artery", "C": "Superficial temporal artery", "D": "Anterior cerebral artery"}, "answer": "Maxillary artery", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "25", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 25-year-old male rugby player.", "2. Patient presents to the emergency room complaining of a severe headache.", "3. Patient is accompanied by his teammate.", "4. Patient had a head-to-head collision with another player and briefly passed out before regaining consciousness.", "5. Patient's past medical history is significant for a pilocytic astrocytoma as a child treated successfully with surgery.", "6. Patient's family history is notable for stroke in his father.", "7. Patient's temperature is 98.9\u00b0F (37.2\u00b0C).", "8. Patient's blood pressure is 160/90 mmHg.", "9. Patient's pulse is 60/min.", "10. Patient's respirations are 20/min.", "11. On examination, patient is lethargic but oriented to person, place, and time."], "atomic_facts": ["1. He is accompanied by his teammate.", "2. His teammate reports a head-to-head collision with another player.", "3. He briefly passed out before regaining consciousness.", "4. His past medical history includes a pilocytic astrocytoma as a child.", "5. The pilocytic astrocytoma was successfully treated with surgery.", "6. His family history includes a stroke in his father.", "7. His temperature is 98.9\u00b0F (37.2\u00b0C).", "8. His blood pressure is 160/90 mmHg.", "9. His pulse is 60/min.", "10. His respirations are 20/min.", "11. On examination, he is lethargic.", "12. He is oriented to person, place, and time."]}
{"id": 915, "question": "Which of the following is characteristic of the most likely microorganism responsible for this patient\u2019s symptoms?", "context": ["A 4-year-old boy presents with 3 days of fever, crampy abdominal pain, vomiting, and loose, bloody bowel movements containing mucus.", "The patient\u2019s mother says that other children from his daycare class have also developed similar symptoms.", "The patient\u2019s temperature is 39.0\u00b0C (102.2\u00b0F).", "On physical examination, the patient is irritable and inconsolable, and his abdomen is distended.", "Intravenous fluid resuscitation is initiated.", "Histopathologic analysis of his stool reveals numerous red and white blood cells."], "context_len": 6, "options": {"A": "Inactivation of the 60S ribosome subunit", "B": "Permanent activation of Gs alpha subunit", "C": "Overactivation of guanylate cyclase", "D": "Disabling Gi alpha subunit"}, "answer": "Inactivation of the 60S ribosome subunit", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old boy presents with 3 days of fever, crampy abdominal pain, vomiting, and loose, bloody bowel movements containing mucus.", "2. The patient's mother says that other children from his daycare class have also developed similar symptoms.", "3. The patient's temperature is 39.0\u00b0C (102.2\u00b0F).", "4. On physical examination, the patient is irritable and inconsolable, and his abdomen is distended.", "5. Intravenous fluid resuscitation is initiated.", "6. Histopathologic analysis of his stool reveals numerous red and white blood cells."], "atomic_facts": ["1. The patient's mother reports other children from his daycare class have similar symptoms.", "2. The patient's temperature is 39.0\u00b0C (102.2\u00b0F).", "3. On physical examination, the patient is irritable and inconsolable.", "4. On physical examination, the patient's abdomen is distended.", "5. Intravenous fluid resuscitation is initiated.", "6. Histopathologic analysis of the patient's stool reveals numerous red and white blood cells."]}
{"id": 916, "question": "Which of the following is the most likely cause of his abnormal radiologic findings?", "context": ["A 23-year-old man develops a seizure on the medical floor.", "He was admitted 2 days ago with high-grade fever and severe headache.", "At the time of admission, he had photophobia, neck rigidity, and the following vital signs: temperature 39.5\u00b0C (103.1\u00b0F), blood pressure 130/70 mm Hg, and heart rate 120/min.", "A cerebral spinal fluid analysis was ordered, and he was started on intravenous antibiotics.", "The patient\u2019s seizure terminates without any medication or intervention.", "An MRI is performed which reveals dilation of all the ventricles of the brain."], "context_len": 6, "options": {"A": "Blood clot in the foramen of 3rd ventricle", "B": "Aqueductal stenosis", "C": "Arachnoid granulation adhesions", "D": "Mega cisterna magna"}, "answer": "Arachnoid granulation adhesions", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "23", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 23-year-old man develops a seizure on the medical floor.", "2. He was admitted 2 days ago with high-grade fever and severe headache.", "3. At the time of admission, he had photophobia, neck rigidity.", "4. Temperature at admission was 39.5\u00b0C (103.1\u00b0F).", "5. Blood pressure at admission was 130/70 mm Hg.", "6. Heart rate at admission was 120/min.", "7. A cerebral spinal fluid analysis was ordered.", "8. He was started on intravenous antibiotics.", "9. The patient\u2019s seizure terminates without any medication or intervention.", "10. An MRI is performed.", "11. MRI reveals dilation of all the ventricles of the brain."], "atomic_facts": ["1. He was admitted 2 days ago with high-grade fever and severe headache.", "2. At the time of admission, he had photophobia, neck rigidity, and the following vital signs: temperature 39.5\u00b0C (103.1\u00b0F), blood pressure 130/70 mm Hg, and heart rate 120/min.", "3. A cerebral spinal fluid analysis was ordered, and he was started on intravenous antibiotics.", "4. The patient\u2019s seizure terminates without any medication or intervention.", "5. An MRI is performed which reveals dilation of all the ventricles of the brain."]}
{"id": 917, "question": "Following initial stabilization and respiratory support, what is the best next step for this patient?", "context": ["A 27-year-old unconscious man is brought to the ED by EMS.", "He was found face down in the middle of the sidewalk at 2AM.", "The patient is disheveled and smells of alcohol.", "Physical exam reveals bruising and ecchymosis at the right temple and 1-mm pupils bilaterally.", "His temperature 97.1\u00b0F (36.3\u00b0C), blood pressure is 84/58 mmHg, pulse is 71/min, respirations are 8/min."], "context_len": 5, "options": {"A": "Flumazenil", "B": "Glucose", "C": "Naloxone", "D": "Warming blankets"}, "answer": "Naloxone", "answer_idx": "C", "explanation": "", "patient": {"gender": "Not specified", "age": "27 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 27-year-old man was brought to the ED by EMS.", "2. He was found face down in the middle of the sidewalk at 2AM.", "3. The patient is disheveled and smells of alcohol.", "4. Physical exam reveals bruising and ecchymosis at the right temple.", "5. Pupils are 1-mm bilaterally.", "6. His temperature is 97.1\u00b0F (36.3\u00b0C).", "7. Blood pressure is 84/58 mmHg.", "8. Pulse is 71/min.", "9. Respirations are 8/min."], "atomic_facts": ["1. The patient was found face down in the middle of the sidewalk at 2AM.", "2. The patient is disheveled and smells of alcohol.", "3. Physical exam reveals bruising and ecchymosis at the right temple.", "4. Physical exam reveals 1-mm pupils bilaterally.", "5. The patient's temperature is 97.1\u00b0F (36.3\u00b0C).", "6. The patient's blood pressure is 84/58 mmHg.", "7. The patient's pulse is 71/min.", "8. The patient's respirations are 8/min."]}
{"id": 918, "question": "WBC): 2,400 /mm3 | Differential count: | Neutrophils: 70% | Lymphocytes: 25% | Monocytes: 5% | CD4+ cell count: 51/mm3 | What is the best pharmacotherapy for this patient's current symptom?", "context": ["A 43-year-old man presents to the clinic for pain with swallowing for a month.", "He says that the pain has gotten worse over the past few weeks.", "His past medical history is significant for AIDS.", "He states that he has not been able to afford his highly active antiretroviral therapy, so he is not currently taking any medications.", "His temperature is 98.6\u00b0F (37\u00b0C), respirations are 15/min, pulse is 70/min, and blood pressure is 100/84 mm Hg.", "Physical examination reveals no mucosal lesions.", "Evaluation of the blood reveals: | Hb%: 11 gm/dL | Total count (."], "context_len": 7, "options": {"A": "Oral fluconazole", "B": "Oral nystatin liquid suspension", "C": "Intravenous amphotericin B", "D": "Oral acyclovir"}, "answer": "Oral fluconazole", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "43 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 43 years old.", "2. Patient presents to clinic with pain with swallowing for one month.", "3. Pain has gotten worse over past few weeks.", "4. Patient has past medical history of AIDS.", "5. Patient is not currently taking any medications due to inability to afford highly active antiretroviral therapy.", "6. Patient's temperature is 98.6\u00b0F (37\u00b0C).", "7. Patient's respirations are 15/min.", "8. Patient's pulse is 70/min.", "9. Patient's blood pressure is 100/84 mm Hg.", "10. Physical examination reveals no mucosal lesions.", "11. Evaluation of blood reveals Hb%: 11 gm/dL.", "12. Evaluation of blood reveals total count."], "atomic_facts": ["1. The patient reports worsening pain over the past few weeks.", "2. The patient has a past medical history significant for AIDS.", "3. The patient cannot afford highly active antiretroviral therapy and is not currently taking any medications.", "4. The patient's temperature is 98.6\u00b0F (37\u00b0C), respirations are 15/min, pulse is 70/min, and blood pressure is 100/84 mm Hg.", "5. Physical examination reveals no mucosal lesions.", "6. Evaluation of the blood reveals: Hb%: 11 gm/dL, Total count (unspecified)."]}
{"id": 919, "question": "The most appropriate next step in management is administration of which of the following?", "context": ["A 25-year-old man is brought by his roommate to the emergency department with chest pain, which began 90 minutes ago.", "His roommate says that he has not slept within the past 24 hours and has been taking pills to help him study longer for his upcoming national dental board exam.", "On examination, he is diaphoretic, extremely agitated, and attempts to remove his IV lines and ECG leads.", "His temperature is 38.9\u00b0C (102.2\u00b0F), pulse is 115/min, and blood pressure is 160/102 mmHg.", "His pupil size is 7 mm bilaterally.", "The lungs are clear to auscultation."], "context_len": 6, "options": {"A": "Lorazepam", "B": "Dantrolene", "C": "Ketamine", "D": "Haloperidol\n\""}, "answer": "Lorazepam", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 25-year-old man is brought to the emergency department with chest pain.", "2. The chest pain began 90 minutes ago.", "3. His roommate says he has not slept within the past 24 hours.", "4. He has been taking pills to help him study longer for his upcoming national dental board exam.", "5. On examination, he is diaphoretic, extremely agitated, and attempts to remove his IV lines and ECG leads.", "6. His temperature is 38.9\u00b0C (102.2\u00b0F).", "7. His pulse is 115/min.", "8. His blood pressure is 160/102 mmHg.", "9. His pupil size is 7 mm bilaterally.", "10. The lungs are clear to auscultation."], "atomic_facts": ["1. His roommate reports that he has not slept within the past 24 hours.", "2. He has been taking pills to help him study longer for his upcoming national dental board exam.", "3. On examination, he is diaphoretic.", "4. On examination, he is extremely agitated.", "5. On examination, he attempts to remove his IV lines and ECG leads.", "6. His temperature is 38.9\u00b0C (102.2\u00b0F).", "7. His pulse is 115/min.", "8. His blood pressure is 160/102 mmHg.", "9. His pupil size is 7 mm bilaterally.", "10. The lungs are clear to auscultation."]}
{"id": 920, "question": "Which of the following mechanisms is most likely involved in this patient\u2019s symptoms?", "context": ["A 65-year-old female presents to her primary care physician for a routine check-up.", "She reports feeling well but has noticed occasional weakness and constipation over the past few months.", "A complete blood count is within normal limits.", "Serum calcium is 11.9 mg/dL and serum phosphate is 2.4 mg/dL.", "Urine calcium output is 400 mg/24 h.", "A sestamibi scan demonstrates increased uptake near the inferior left pole of the thyroid gland."], "context_len": 6, "options": {"A": "Increased osteoprotegerin expression", "B": "Decreased RANK-L expression", "C": "Increased RANK-L expression", "D": "Increased \u00df-adrenergic receptor synthesis"}, "answer": "Increased RANK-L expression", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "65", "specialties": ["Internal Medicine"], "subspecialties": ["Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old female presents to her primary care physician for a routine check-up.", "2. She reports feeling well but has noticed occasional weakness and constipation over the past few months.", "3. A complete blood count is within normal limits.", "4. Serum calcium is 11.9 mg/dL.", "5. Serum phosphate is 2.4 mg/dL.", "6. Urine calcium output is 400 mg/24 h.", "7. A sestamibi scan demonstrates increased uptake near the inferior left pole of the thyroid gland."], "atomic_facts": ["1. The patient reports feeling well.", "2. The patient has noticed occasional weakness and constipation over the past few months.", "3. The complete blood count is within normal limits.", "4. Serum calcium level is 11.9 mg/dL.", "5. Serum phosphate level is 2.4 mg/dL.", "6. Urine calcium output is 400 mg/24 h.", "7. A sestamibi scan demonstrates increased uptake near the inferior left pole of the thyroid gland."]}
{"id": 921, "question": "Which of the following factors will most likely make the prognosis worse in this patient?", "context": ["A 35-year-old male presents to his physician with a small mass that he found in the anterior of his neck a few days ago.", "The mass is not painful and does not affect his swallowing.", "He noticed no change in his weight.", "His history is significant for radiation exposure for treating his neuroblastoma at the age of 15.", "On examination, a nodule around the size of 2.2 cm is palpated in the right thyroid lobule; the nodule is firm and non-tender.", "There is cervical lymphadenopathy.", "His blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 67/min, and temperature is 37.5\u00b0C (99.5\u00b0F).", "Laboratory findings include serum Na+ of 136 mmol/L, K+ of 4.2 mmol/L, Cl\u2013 of 90 mmol/L, and bicarbonate of 24 mmol/L."], "context_len": 8, "options": {"A": "Age", "B": "Bone metastases", "C": "Follicular histological variant", "D": "Hurthle cell variant"}, "answer": "Bone metastases", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "35", "specialties": ["Internal Medicine", "Otolaryngology", "Endocrinology"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Endocrinology", "General Otolaryngology"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is a 35-year-old male.", "2. Patient found a small mass in the anterior of his neck a few days ago.", "3. Mass is not painful and does not affect his swallowing.", "4. Patient noticed no change in his weight.", "5. Patient has a history of radiation exposure for treating his neuroblastoma at the age of 15.", "6. On examination, a nodule around the size of 2.2 cm is palpated in the right thyroid lobule.", "7. Nodule is firm and non-tender.", "8. Cervical lymphadenopathy is present.", "9. Blood pressure is 118/75 mm Hg.", "10. Respirations are 17/min.", "11. Pulse is 67/min.", "12. Temperature is 37.5\u00b0C (99.5\u00b0F).", "13. Serum Na+ is 136 mmol/L.", "14. Serum K+ is 4.2 mmol/L.", "15. Serum Cl\u2013 is 90 mmol/L.", "16. Serum bicarbonate is 24 mmol/L."], "atomic_facts": ["1. The mass is not painful and does not affect his swallowing.", "2. He noticed no change in his weight.", "3. His history is significant for radiation exposure for treating his neuroblastoma at the age of 15.", "4. On examination, a nodule around the size of 2.2 cm is palpated in the right thyroid lobule; the nodule is firm and non-tender.", "5. There is cervical lymphadenopathy.", "6. His blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 67/min, and temperature is 37.5\u00b0C (99.5\u00b0F).", "7. Laboratory findings include serum Na+ of 136 mmol/L, K+ of 4.2 mmol/L, Cl\u2013 of 90 mmol/L, and bicarbonate of 24 mmol/L."]}
{"id": 922, "question": "Which of the following patterns of abnormal brain activity would most likely be present in this patient?", "context": ["An 18-year-old man is referred to a psychiatrist for evaluation after a recent suicide attempt.", "On questioning him, he says that he did it because he got fed up with life and feels that he is worthless.", "The patient\u2019s father informs the doctor that his son has been gloomy most of the time over the last 2 months, and his academic performance has declined significantly.", "His father further adds that his son\u2019s appetite has decreased significantly over the last 3 months, leading to a 5.0 kg (11.0 lb) weight loss.", " The patient denies any history of manic or hypomanic episodes.", "Physical examination is unremarkable.", "Routine laboratory tests, including thyroid hormone and cortisol levels, are within normal limits."], "context_len": 7, "options": {"A": "Increased dopaminergic activity in the limbic system", "B": "Increased glutamatergic activity in the subthalamic nucleus", "C": "Decreased norepinephrine levels in the cortical and limbic areas", "D": "Decreased cholinergic activity in the hippocampus and amygdala"}, "answer": "Decreased norepinephrine levels in the cortical and limbic areas", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "18", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. An 18-year-old man is referred to a psychiatrist for evaluation after a recent suicide attempt. ", "2. On questioning him, he says that he did it because he got fed up with life and feels that he is worthless. ", "3. The patient's father informs the doctor that his son has been gloomy most of the time over the last 2 months. ", "4. The patient's father further adds that his son's academic performance has declined significantly. ", "5. The patient's father further adds that his son's appetite has decreased significantly over the last 3 months. ", "6. The patient's father further adds that his son has experienced a 5.0 kg (11.0 lb) weight loss. ", "7. The patient denies any history of manic or hypomanic episodes. ", "8. Physical examination is unremarkable. ", "9. Routine laboratory tests, including thyroid hormone and cortisol levels, are within normal limits."], "atomic_facts": ["1. The patient states that he did it because he got fed up with life and feels worthless.", "2. The patient has been gloomy most of the time over the last 2 months.", "3. The patient's academic performance has declined significantly.", "4. The patient's appetite has decreased significantly over the last 3 months.", "5. The patient has experienced a 5.0 kg (11.0 lb) weight loss.", "6. The patient denies any history of manic or hypomanic episodes.", "7. Physical examination is unremarkable.", "8. Routine laboratory tests, including thyroid hormone and cortisol levels, are within normal limits."]}
{"id": 923, "question": "Which of the following proteins is heavily involved with this pathogenesis?", "context": ["A 10-year-old girl is evaluated for a suspected primary deficiency.", "She is the first child in a consanguineous marriage.", "She was born vaginally at full term after an uncomplicated pregnancy and was breastfed for 9 months.", "The patient has had an episode of meningococcal meningitis, recurrent bronchiolitis, and multiple bouts of pneumococcal pneumonia over the past 5 years.", "She has also suffered from chronic otitis media since the age of 5.", "After a thorough examination, the child is found to have a partial CD19 deficiency."], "context_len": 6, "options": {"A": "CD8", "B": "CD16", "C": "CD21", "D": "CD25"}, "answer": "CD21", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "10 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 10-year-old girl is evaluated for a suspected primary deficiency.", "2. She is the first child in a consanguineous marriage.", "3. She was born vaginally at full term after an uncomplicated pregnancy.", "4. She was breastfed for 9 months.", "5. The patient has had an episode of meningococcal meningitis.", "6. The patient has had recurrent bronchiolitis.", "7. The patient has had multiple bouts of pneumococcal pneumonia over the past 5 years.", "8. The patient has suffered from chronic otitis media since the age of 5.", "9. After a thorough examination, the child is found to have a partial CD19 deficiency."], "atomic_facts": ["1. She is the first child in a consanguineous marriage.", "2. She was born vaginally at full term after an uncomplicated pregnancy.", "3. She was breastfed for 9 months.", "4. The patient has had an episode of meningococcal meningitis.", "5. The patient has had recurrent bronchiolitis.", "6. The patient has had multiple bouts of pneumococcal pneumonia over the past 5 years.", "7. She has suffered from chronic otitis media since the age of 5.", "8. After a thorough examination, the child is found to have a partial CD19 deficiency."]}
{"id": 924, "question": "Based on the patient\u2019s current presentation, which organ is most likely affected?", "context": ["A 24-year old woman is brought to the emergency department after a motor vehicle collision.", "She was a restrained passenger at the time of impact.", "On examination, the patient is pale and in moderate distress.", "She complains of a sharp pain in the posterior aspect of the left shoulder.", "Vitals include temperature is 37.0\u00b0C (98.6\u00b0F), right arm blood pressure is 94/63 mm Hg, left arm blood pressure is 90/61 mm Hg, pulse is 122/min, and respirations are 24/min.", "Cardiopulmonary auscultation reveals normal heart sounds and clear lungs.", "Neck veins are not distended.", "Several, large ecchymoses are visible over the chest and abdomen in a seatbelt pattern.", "Her abdomen is tender on superficial palpation with mild rebound tenderness and rigidity.", "Her range of motion is normal with 5/5 motor strength in all extremities.", "Wrist drop is absent.", "A FAST scan is pending."], "context_len": 12, "options": {"A": "Pancreas", "B": "Heart", "C": "Spleen", "D": "Appendix"}, "answer": "Spleen", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "24 years old", "specialties": ["Emergency Medicine", "Surgery", "General Surgery"], "subspecialties": ["General Emergency Medicine", "Surgical Critical Care"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 24-year old woman is brought to the emergency department after a motor vehicle collision. ", "2. She was a restrained passenger at the time of impact. ", "3. On examination, the patient is pale and in moderate distress. ", "4. She complains of a sharp pain in the posterior aspect of the left shoulder. ", "5. Temperature is 37.0\u00b0C (98.6\u00b0F). ", "6. Right arm blood pressure is 94/63 mm Hg. ", "7. Left arm blood pressure is 90/61 mm Hg. ", "8. Pulse is 122/min. ", "9. Respirations are 24/min. ", "10. Cardiopulmonary auscultation reveals normal heart sounds and clear lungs. ", "11. Neck veins are not distended. ", "12. Several, large ecchymoses are visible over the chest and abdomen in a seatbelt pattern. ", "13. Abdomen is tender on superficial palpation with mild rebound tenderness and rigidity. ", "14. Range of motion is normal with 5/5 motor strength in all extremities. ", "15. Wrist drop is absent. ", "16. A FAST scan is pending."], "atomic_facts": ["1. She was a restrained passenger at the time of impact.", "2. On examination, the patient is pale and in moderate distress.", "3. She complains of a sharp pain in the posterior aspect of the left shoulder.", "4. Vitals include temperature is 37.0\u00b0C (98.6\u00b0F), right arm blood pressure is 94/63 mm Hg, left arm blood pressure is 90/61 mm Hg, pulse is 122/min, and respirations are 24/min.", "5. Cardiopulmonary auscultation reveals normal heart sounds and clear lungs.", "6. Neck veins are not distended.", "7. Several, large ecchymoses are visible over the chest and abdomen in a seatbelt pattern.", "8. Her abdomen is tender on superficial palpation with mild rebound tenderness and rigidity.", "9. Her range of motion is normal with 5/5 motor strength in all extremities.", "10. Wrist drop is absent.", "11. A FAST scan is pending."]}
{"id": 925, "question": "Which of the following tests can be used for postoperative follow up of this patient?", "context": ["A 68-year-old woman presents to her primary care physician with complaints of fatigue, difficulty breathing upon exertion, and crampy lower abdominal pain.", "She also notices that her stools are dark.", "She has had essential hypertension for 20 years for which she takes bisoprolol.", "Her family history is positive for type 2 diabetes mellitus.", "On physical examination, she looks pale.", "Complete blood count shows the following: | Hemoglobin 10 g/dL | Mean corpuscular volume (MCV) 70 fL | Mean corpuscular hemoglobin (MCH) 25 pg/cell | Mean corpuscular hemoglobin concentration (MCHC) 27 g/dL | Red cell distribution width 16% | Platelet count 350,000/mm3 | Serum ferritin is 9 ng/mL.", "The patient is referred to a gastroenterologist and conventional colonoscopy reveals a polypoid mass in the ascending colon.", "Biopsy shows poorly differentiated adenocarcinoma.", "A preoperative staging is performed and a laparoscopic cancer resection with postoperative chemotherapy are planned."], "context_len": 9, "options": {"A": "Carcinoembryonic antigen (CEA)", "B": "Pelvic magnetic resonance imaging (MRI)", "C": "Transrectal endoscopic ultrasound (TRUS)", "D": "Cancer antigen 125 (CA 125)"}, "answer": "Carcinoembryonic antigen (CEA)", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "68", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Thoracic Surgery"}, "facts_old": ["1. A 68-year-old woman presents to her primary care physician with complaints of fatigue, difficulty breathing upon exertion, and crampy lower abdominal pain.", "2. She also notices that her stools are dark.", "3. She has had essential hypertension for 20 years for which she takes bisoprolol.", "4. Her family history is positive for type 2 diabetes mellitus.", "5. On physical examination, she looks pale.", "6. Complete blood count shows a hemoglobin of 10 g/dL.", "7. Complete blood count shows a mean corpuscular volume (MCV) of 70 fL.", "8. Complete blood count shows a mean corpuscular hemoglobin (MCH) of 25 pg/cell.", "9. Complete blood count shows a mean corpuscular hemoglobin concentration (MCHC) of 27 g/dL.", "10. Complete blood count shows a red cell distribution width of 16%.", "11. Complete blood count shows a platelet count of 350,000/mm3.", "12. Serum ferritin is 9 ng/mL.", "13. The patient is referred to a gastroenterologist.", "14. Conventional colonoscopy reveals a polypoid mass in the ascending colon.", "15. Biopsy shows poorly differentiated adenocarcinoma.", "16. A preoperative staging is performed.", "17. A laparoscopic cancer resection with postoperative chemotherapy are planned."], "atomic_facts": ["1. The patient has had essential hypertension for 20 years.", "2. The patient takes bisoprolol for essential hypertension.", "3. The patient's family history is positive for type 2 diabetes mellitus.", "4. On physical examination, the patient looks pale.", "5. Hemoglobin level is 10 g/dL.", "6. Mean corpuscular volume (MCV) is 70 fL.", "7. Mean corpuscular hemoglobin (MCH) is 25 pg/cell.", "8. Mean corpuscular hemoglobin concentration (MCHC) is 27 g/dL.", "9. Red cell distribution width is 16%.", "10. Platelet count is 350,000/mm3.", "11. Serum ferritin level is 9 ng/mL.", "12. Conventional colonoscopy reveals a polypoid mass in the ascending colon.", "13. Biopsy shows poorly differentiated adenocarcinoma.", "14. A preoperative staging is performed.", "15. A laparoscopic cancer resection with postoperative chemotherapy is planned."]}
{"id": 926, "question": "Which of the following is the most appropriate pharmacotherapy for this patient's eye condition?", "context": ["A 34-year-old man comes to the physician because of a 2-day history of progressively blurred vision.", "He also reports seeing flashing lights in his visual field.", "He does not have any pain.", "The patient has not been examined by a physician in several years.", "He appears emaciated.", "Examination shows right conjunctival injection.", "Visual acuity is 20/20 in the left eye and 20/100 in the right eye.", "Fundoscopic examination of the right eye is shown.", "His CD4+ T-lymphocyte count is 46/mm3."], "context_len": 9, "options": {"A": "Valganciclovir", "B": "Penicillin G", "C": "Sulfadiazine and pyrimethamine", "D": "Trimethoprim-sulfamethoxazole"}, "answer": "Valganciclovir", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "34 years old", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. A 34-year-old man comes to the physician.", "2. He has a 2-day history of progressively blurred vision.", "3. He reports seeing flashing lights in his visual field.", "4. He does not have any pain.", "5. He has not been examined by a physician in several years.", "6. He appears emaciated.", "7. Examination shows right conjunctival injection.", "8. Visual acuity is 20/20 in the left eye and 20/100 in the right eye.", "9. Fundoscopic examination of the right eye is shown.", "10. His CD4+ T-lymphocyte count is 46/mm3."], "atomic_facts": ["1. He reports seeing flashing lights in his visual field.", "2. He does not have any pain.", "3. The patient has not been examined by a physician in several years.", "4. He appears emaciated.", "5. Examination shows right conjunctival injection.", "6. Visual acuity is 20/20 in the left eye and 20/100 in the right eye.", "7. Fundoscopic examination of the right eye is shown.", "8. His CD4+ T-lymphocyte count is 46/mm3."]}
{"id": 927, "question": "This patient is most likely to benefit from which of the following interventions?", "context": ["A 42-year-old man comes to the physician because of several episodes of rectal bleeding over 2 weeks.", "He has had pain around the anal area for the past month.", "Six months ago, he was diagnosed with esophageal candidiasis and was treated with oral fluconazole.", "He is HIV-positive.", "He has had 9 male sexual partners over his lifetime and uses condoms inconsistently.", "The patient's current medications include dolutegravir, tenofovir, and emtricitabine.", "He is 179 cm (5 ft 10 in) and weighs 66 kg (146 lb); BMI is 20.9 kg/m2.", "Vital signs are within normal limits.", "Digital rectal examination and anoscopy show a hard 2-cm mass palpable 0.5 cm above the anal verge that bleeds on contact.", "There is no inguinal lymphadenopathy.", "The abdomen is soft and nontender.", "The CD4+ T-lymphocyte count is 95/mm3(N \u2265 500/mm3).", "A biopsy confirms the diagnosis."], "context_len": 13, "options": {"A": "Radiochemotherapy", "B": "Local 5-fluorouracil therapy", "C": "Injection sclerotherapy", "D": "Submucosal hemorrhoidectomy\n\""}, "answer": "Radiochemotherapy", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "42 years old", "specialties": ["Colon and Rectal Surgery"], "subspecialties": ["General Colon and Rectal Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Colon and Rectal Surgery"}, "facts_old": ["1. A 42-year-old man comes to the physician because of several episodes of rectal bleeding over 2 weeks.", "2. He has had pain around the anal area for the past month.", "3. Six months ago, he was diagnosed with esophageal candidiasis and was treated with oral fluconazole.", "4. He is HIV-positive.", "5. He has had 9 male sexual partners over his lifetime and uses condoms inconsistently.", "6. The patient's current medications include dolutegravir, tenofovir, and emtricitabine.", "7. He is 179 cm (5 ft 10 in) and weighs 66 kg (146 lb); BMI is 20.9 kg/m2.", "8. Vital signs are within normal limits.", "9. Digital rectal examination and anoscopy show a hard 2-cm mass palpable 0.5 cm above the anal verge that bleeds on contact.", "10. There is no inguinal lymphadenopathy.", "11. The abdomen is soft and nontender.", "12. The CD4+ T-lymphocyte count is 95/mm3(N \u2265 500/mm3).", "13. A biopsy confirms the diagnosis."], "atomic_facts": ["1. He has had pain around the anal area for the past month.", "2. Six months ago, he was diagnosed with esophageal candidiasis and was treated with oral fluconazole.", "3. He is HIV-positive.", "4. He has had 9 male sexual partners over his lifetime and uses condoms inconsistently.", "5. The patient's current medications include dolutegravir, tenofovir, and emtricitabine.", "6. He is 179 cm (5 ft 10 in) and weighs 66 kg (146 lb); BMI is 20.9 kg/m2.", "7. Vital signs are within normal limits.", "8. Digital rectal examination and anoscopy show a hard 2-cm mass palpable 0.5 cm above the anal verge that bleeds on contact.", "9. There is no inguinal lymphadenopathy.", "10. The abdomen is soft and nontender.", "11. The CD4+ T-lymphocyte count is 95/mm3(N \u2265 500/mm3).", "12. A biopsy confirms the diagnosis."]}
{"id": 928, "question": "Which of the following burn patterns would be most indicative of child abuse in this patient?", "context": ["A 19-month-old boy comes into the emergency department with his parents.", "He has burns on his buttocks and perineal area.", "The patient\u2019s mother says she was at home with the patient when she heard him screaming from the kitchen.", "She says she ran to the room to find that the patient had pulled down a container of hot water on himself."], "context_len": 4, "options": {"A": "Burns to flexor and anterior surfaces", "B": "Burns with irregular borders, uneven depth of burns, and splash pattern", "C": "Burns with some areas blistering but with others not blistering", "D": "Circular burns of equal depth restricted to the buttocks, with sparing of the hands and feet"}, "answer": "Circular burns of equal depth restricted to the buttocks, with sparing of the hands and feet", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "19 months", "specialties": ["Pediatrics"], "subspecialties": ["Child Abuse Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 19-month-old boy comes into the emergency department with his parents.", "2. He has burns on his buttocks and perineal area.", "3. The patient's mother was at home with the patient when she heard him screaming from the kitchen.", "4. She ran to the room to find that the patient had pulled down a container of hot water on himself."], "atomic_facts": ["1. The patient has burns on his buttocks.", "2. The patient has burns on his perineal area.", "3. The patient's mother was at home with the patient.", "4. The mother heard the patient screaming from the kitchen.", "5. The mother ran to the room.", "6. The patient had pulled down a container of hot water on himself."]}
{"id": 929, "question": "What is the most appropriate initial management for this patient?", "context": ["A 44-year-old woman presents to the physician for evaluation of recurrent episodes of pounding headache, palpitations, excessive sweating, anxiety, tremors, and pallor, with occasional vomiting for the last 2 weeks.", "She has presented to the same physician with similar complaints in the past; however, she is frustrated with the lack of proper diagnosis and now insists on a detailed workup.", "She does not take any medications.", "She has a history of progressively increasing thyroid swelling as well as multiple bone pain for the past 2 months.", "On physical examination, she is very lean and appears anxious and apprehensive.", "She has clammy and moist hands.", "Her temperature is 37.1\u00b0C (98.9\u00b0F), the pulse is 110/min, the blood pressure is 176/94 mm Hg, and the respiratory rate is 27/min.", "Her weight is 43 kg (94.8 lb), height is 145 cm (4 ft 7 in), and body mass index (BMI) is 20.4 kg/m2.", "A firm thyroid nodule is palpable in the right lobe.", "Physical examination is otherwise normal."], "context_len": 10, "options": {"A": "Serum epinephrine and norepinephrine", "B": "Clonidine test", "C": "24-h urine catecholamine by-products (vanillylmandelic acid (VMA), metanephrine, and normetanephrine)", "D": "Serum calcium and PTH"}, "answer": "24-h urine catecholamine by-products (vanillylmandelic acid (VMA), metanephrine, and normetanephrine)", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "44 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 44 years old.", "2. Patient has recurrent episodes of pounding headache, palpitations, excessive sweating, anxiety, tremors, and pallor, with occasional vomiting for the last 2 weeks.", "3. Patient has presented to the same physician with similar complaints in the past.", "4. Patient is frustrated with the lack of proper diagnosis and now insists on a detailed workup.", "5. Patient does not take any medications.", "6. Patient has a history of progressively increasing thyroid swelling for the past 2 months.", "7. Patient has multiple bone pain for the past 2 months.", "8. Patient appears anxious and apprehensive.", "9. Patient has clammy and moist hands.", "10. Patient's temperature is 37.1\u00b0C (98.9\u00b0F).", "11. Patient's pulse is 110/min.", "12. Patient's blood pressure is 176/94 mm Hg.", "13. Patient's respiratory rate is 27/min.", "14. Patient's weight is 43 kg (94.8 lb).", "15. Patient's height is 145 cm (4 ft 7 in).", "16. Patient's body mass index (BMI) is 20.4 kg/m2.", "17. A firm thyroid nodule is palpable in the right lobe.", "18. Physical examination is otherwise normal."], "atomic_facts": ["1. She has presented to the same physician with similar complaints in the past.", "2. She is frustrated with the lack of proper diagnosis and now insists on a detailed workup.", "3. She does not take any medications.", "4. She has a history of progressively increasing thyroid swelling.", "5. She has a history of multiple bone pain for the past 2 months.", "6. On physical examination, she is very lean.", "7. On physical examination, she appears anxious and apprehensive.", "8. She has clammy and moist hands.", "9. Her temperature is 37.1\u00b0C (98.9\u00b0F).", "10. Her pulse is 110/min.", "11. Her blood pressure is 176/94 mm Hg.", "12. Her respiratory rate is 27/min.", "13. Her weight is 43 kg (94.8 lb).", "14. Her height is 145 cm (4 ft 7 in).", "15. Her body mass index (BMI) is 20.4 kg/m2.", "16. A firm thyroid nodule is palpable in the right lobe.", "17. Physical examination is otherwise normal."]}
{"id": 930, "question": "Which medication is most likely responsible for this complication?", "context": ["A 54-year-old male is involved in a high speed motor vehicle collision and is brought to the emergency department.", "On arrival, his vitals are temperature 98.6 \u00b0F (37 \u00b0C), blood pressure 110/70 mmHg, pulse 100/min, and respirations are 20/min.", "His Glasgow Coma Score (GCS) is 13 (eye opening 3, verbal response 5, and motor response 5).", "Physical exam is notable for a rapid and thready pulse, and a rigid and distended abdomen with positive rebound tenderness.", "FAST exam reveals a large hypoechoic stripe in the hepatorenal recess.", "Two large bore IV's are started and the patient is given a 1L bolus of normal saline.", "The patient\u2019s mental status rapidly deteriorates and he becomes unresponsive.", "His pulse is 149/min and blood pressure is 70/40 mmHg.", "The patient is started on a medication while additional fluids are administered.", "Subsequently his vitals, his pulse is 80/minute and blood pressure is 120/80 mmHg.", "While the patient is being taken to the operating room, he develops pain in all four distal extremities.", "His digits appear blue and are cool to the touch."], "context_len": 12, "options": {"A": "Epinephrine", "B": "Norepinephrine", "C": "Vasopressin", "D": "Ephedrine"}, "answer": "Norepinephrine", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "54", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 54-year-old male is involved in a high speed motor vehicle collision.", "2. He is brought to the emergency department.", "3. On arrival, his temperature is 98.6 \u00b0F (37 \u00b0C).", "4. His blood pressure is 110/70 mmHg.", "5. His pulse is 100/min.", "6. His respirations are 20/min.", "7. His Glasgow Coma Score (GCS) is 13 (eye opening 3, verbal response 5, and motor response 5).", "8. Physical exam is notable for a rapid and thready pulse.", "9. His abdomen is rigid and distended with positive rebound tenderness.", "10. FAST exam reveals a large hypoechoic stripe in the hepatorenal recess.", "11. Two large bore IV's are started.", "12. He is given a 1L bolus of normal saline.", "13. His mental status rapidly deteriorates and he becomes unresponsive.", "14. His pulse is 149/min and blood pressure is 70/40 mmHg.", "15. He is started on a medication.", "16. Additional fluids are administered.", "17. His pulse is 80/minute and blood pressure is 120/80 mmHg.", "18. While being taken to the operating room, he develops pain in all four distal extremities.", "19. His digits appear blue and are cool to the touch."], "atomic_facts": ["1. On arrival, temperature is 98.6 \u00b0F (37 \u00b0C)", "2. On arrival, blood pressure is 110/70 mmHg", "3. On arrival, pulse is 100/min", "4. On arrival, respirations are 20/min", "5. Glasgow Coma Score (GCS) is 13", "6. Glasgow Coma Score (GCS) components: eye opening 3, verbal response 5, motor response 5", "7. Physical exam shows rapid and thready pulse", "8. Physical exam shows rigid and distended abdomen with positive rebound tenderness", "9. FAST exam reveals a large hypoechoic stripe in the hepatorenal recess", "10. Two large bore IV's are started", "11. Patient is given a 1L bolus of normal saline", "12. Patient\u2019s mental status rapidly deteriorates and becomes unresponsive", "13. Pulse is 149/min", "14. Blood pressure is 70/40 mmHg", "15. Patient is started on a medication", "16. Additional fluids are administered", "17. Subsequently, pulse is 80/minute", "18. Blood pressure is 120/80 mmHg", "19. Patient develops pain in all four distal extremities while being taken to the operating room", "20. Patient's digits appear blue and are cool to the touch"]}
{"id": 931, "question": "Serum level of which of the following coagulation factors is likely abnormal in this patient?", "context": ["A 20-year-old man with a history of cystic fibrosis presents to his pulmonologist for a regular checkup.", "He generally feels well but noticed that he has had an increase in stool frequency.", "He describes his stools as loose and \u201cgreasy\u201d, often staining the toilet bowl.", "He regularly uses albuterol and budesonide inhalers and has chest physical therapy several times a month.", "Physical exam is unremarkable."], "context_len": 5, "options": {"A": "II", "B": "V", "C": "VIII", "D": "XI"}, "answer": "II", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "20", "specialties": ["Hematology"], "subspecialties": ["General Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 20-year-old man presents to his pulmonologist for a regular checkup.", "2. He has a history of cystic fibrosis.", "3. He generally feels well.", "4. He has had an increase in stool frequency.", "5. He describes his stools as loose and \u201cgreasy\u201d.", "6. His stools often stain the toilet bowl.", "7. He regularly uses albuterol and budesonide inhalers.", "8. He has chest physical therapy several times a month.", "9. Physical exam is unremarkable."], "atomic_facts": ["1. The patient generally feels well.", "2. The patient has noticed an increase in stool frequency.", "3. The patient describes his stools as loose and \"greasy\".", "4. The patient's stools often stain the toilet bowl.", "5. The patient regularly uses albuterol and budesonide inhalers.", "6. The patient has chest physical therapy several times a month.", "7. The patient's physical exam is unremarkable."]}
{"id": 932, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 6-year-old boy is brought to the physician by his father for an annual health maintenance examination.", "His father notes that he has several pigmented areas on his skin and a few fleshy bumps.", "He has also had some blurred vision in his left eye.", "He has no history of serious medical illness.", "He lives at home with both parents and is up-to-date on all his immunizations.", "His father has similar skin findings.", "His mother has epilepsy and glaucoma.", "Vital signs are within normal limits.", "Visual acuity testing shows 20/50 in the left eye and 20/20 in the right eye.", "Slit-lamp examination shows pigmented iris nodules.", "Examination of his skin shows eight brownish macules and numerous soft, non-tender, pedunculated lesions on the back, chest, and abdomen."], "context_len": 11, "options": {"A": "MRI of the brain", "B": "Electroencephalogram", "C": "B-scan ultrasound", "D": "Gonioscopy"}, "answer": "MRI of the brain", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Neurodevelopmental Disabilities"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-year-old boy is brought to the physician by his father for an annual health maintenance examination.", "2. His father notes that he has several pigmented areas on his skin and a few fleshy bumps.", "3. He has also had some blurred vision in his left eye.", "4. He has no history of serious medical illness.", "5. He lives at home with both parents and is up-to-date on all his immunizations.", "6. His father has similar skin findings.", "7. His mother has epilepsy and glaucoma.", "8. Vital signs are within normal limits.", "9. Visual acuity testing shows 20/50 in the left eye and 20/20 in the right eye.", "10. Slit-lamp examination shows pigmented iris nodules.", "11. Examination of his skin shows eight brownish macules.", "12. Examination of his skin shows numerous soft, non-tender, pedunculated lesions on the back, chest, and abdomen."], "atomic_facts": ["1. His father notes pigmented areas on his skin.", "2. His father notes fleshy bumps on his skin.", "3. He has blurred vision in his left eye.", "4. He has no history of serious medical illness.", "5. He lives at home with both parents.", "6. He is up-to-date on all his immunizations.", "7. His father has similar skin findings.", "8. His mother has epilepsy.", "9. His mother has glaucoma.", "10. Vital signs are within normal limits.", "11. Visual acuity testing shows 20/50 in the left eye.", "12. Visual acuity testing shows 20/20 in the right eye.", "13. Slit-lamp examination shows pigmented iris nodules.", "14. Examination of his skin shows eight brownish macules.", "15. Examination of his skin shows numerous soft, non-tender, pedunculated lesions on the back, chest, and abdomen."]}
{"id": 933, "question": "This patient is most likely to experience which of the following adverse effects?", "context": ["A 43-year-old man is brought to the emergency department because of a fever, cough, pleuritic chest pain, and dyspnea.", "Two days ago, he returned from a construction site along the Mississippi River.", "Abdominal examination shows a palpable spleen.", "An x-ray of the chest shows diffuse reticulonodular infiltrates.", "Therapy with a drug that binds ergosterol is initiated."], "context_len": 5, "options": {"A": "Hypomagnesemia", "B": "Histamine release", "C": "Leukopenia", "D": "Cytochrome P450 induction"}, "answer": "Hypomagnesemia", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "43 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 43-year-old man is brought to the emergency department.", "2. He has a fever, cough, pleuritic chest pain, and dyspnea.", "3. Two days ago, he returned from a construction site along the Mississippi River.", "4. Abdominal examination shows a palpable spleen.", "5. An x-ray of the chest shows diffuse reticulonodular infiltrates.", "6. Therapy with a drug that binds ergosterol is initiated."], "atomic_facts": ["1. Two days ago, he returned from a construction site along the Mississippi River.", "2. Abdominal examination shows a palpable spleen.", "3. An x-ray of the chest shows diffuse reticulonodular infiltrates.", "4. Therapy with a drug that binds ergosterol is initiated."]}
{"id": 934, "question": "Which of the following is the primary underlying cause of this patient\u2019s presentation?", "context": ["A 49-year-old African man presents to the physician with a 3-month history of fatigue, shortness of breath, and abdominal distention.", "He immigrated to the US approximately 6 months ago.", "He has no other medical problems and is currently not on medication.", "He previously worked as a farmer but stopped due to his inability to keep up with the work.", "His blood pressure is 112/58 mm Hg, pulse is 90/min, respiratory rate is 19/min, and temperature is 37.8\u00b0C (100.0\u00b0F).", "Physical examination reveals bilateral pedal edema up to the knees, jugular venous distention, and abdominal distention with free fluid.", "Chest auscultation reveals the following sound.", "Jugular venous pressure tracing reveals prominent \u2018x\u2019 and \u2018y\u2019 descents.", "Radial pulse is absent during inspiration bilaterally."], "context_len": 9, "options": {"A": "Coxsackie A virus", "B": "Tuberculosis", "C": "Protozoan infection", "D": "Tricuspid endocarditis"}, "answer": "Tuberculosis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "49", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology", "Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 49-year-old African man.", "2. Patient has a 3-month history of fatigue, shortness of breath, and abdominal distention.", "3. Patient immigrated to the US approximately 6 months ago.", "4. Patient has no other medical problems and is currently not on medication.", "5. Patient previously worked as a farmer but stopped due to his inability to keep up with the work.", "6. Patient's blood pressure is 112/58 mm Hg.", "7. Patient's pulse is 90/min.", "8. Patient's respiratory rate is 19/min.", "9. Patient's temperature is 37.8\u00b0C (100.0\u00b0F).", "10. Physical examination reveals bilateral pedal edema up to the knees.", "11. Physical examination reveals jugular venous distention.", "12. Physical examination reveals abdominal distention with free fluid.", "13. Chest auscultation reveals a specific sound.", "14. Jugular venous pressure tracing reveals prominent \u2018x\u2019 and \u2018y\u2019 descents.", "15. Radial pulse is absent during inspiration bilaterally."], "atomic_facts": ["1. He immigrated to the US approximately 6 months ago.", "2. He has no other medical problems.", "3. He is currently not on medication.", "4. He previously worked as a farmer.", "5. He stopped working as a farmer due to his inability to keep up with the work.", "6. His blood pressure is 112/58 mm Hg.", "7. His pulse is 90/min.", "8. His respiratory rate is 19/min.", "9. His temperature is 37.8\u00b0C (100.0\u00b0F).", "10. Physical examination reveals bilateral pedal edema up to the knees.", "11. Physical examination reveals jugular venous distention.", "12. Physical examination reveals abdominal distention with free fluid.", "13. Chest auscultation reveals specific sounds.", "14. Jugular venous pressure tracing reveals prominent \u2018x\u2019 and \u2018y\u2019 descents.", "15. Radial pulse is absent during inspiration bilaterally."]}
{"id": 935, "question": "Which of the following options describes the  proper management in this patient assuming that no deterioration occurs up to the time of delivery?", "context": ["A 25-year-old primigravida is admitted to the hospital at 35 weeks gestation with lower leg edema.", "She denies any other symptoms.", "Prior to admission, the antepartum course was unremarkable and she was compliant with recommended  prenatal care.", "The vital signs were as follows: blood pressure, 155/90 mm Hg; heart rate, 84/min; respiratory rate, 16/min; and temperature, 36.6\u2103 (97.9\u2109).", "The fetal heart rate was 142/min.", "The physical examination shows 2+ pitting edema.", "A 24-hour urine assessment showed proteinuria (1.2 g).", "An ultrasound examination showed a normally developing fetus without structural abnormalities.", "The placental margin was located 3 cm away from the internal os."], "context_len": 9, "options": {"A": "Induction of vaginal delivery at 37 weeks\u2019 pregnancy if not begin spontaneously earlier", "B": "Cesarean delivery after a course of a corticosteroid treatment", "C": "Vaginal delivery induction after a course of corticosteroid treatment", "D": "Watch for a spontaneous vaginal delivery at any term from the moment of presentation"}, "answer": "Induction of vaginal delivery at 37 weeks\u2019 pregnancy if not begin spontaneously earlier", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "25 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 25-year-old primigravida.", "2. Patient is admitted to the hospital at 35 weeks gestation.", "3. Patient has lower leg edema.", "4. Patient denies any other symptoms.", "5. Antepartum course was unremarkable.", "6. Patient was compliant with recommended prenatal care.", "7. Blood pressure is 155/90 mm Hg.", "8. Heart rate is 84/min.", "9. Respiratory rate is 16/min.", "10. Temperature is 36.6\u2103 (97.9\u2109).", "11. Fetal heart rate is 142/min.", "12. Physical examination shows 2+ pitting edema.", "13. 24-hour urine assessment showed proteinuria (1.2 g).", "14. Ultrasound examination showed a normally developing fetus without structural abnormalities.", "15. Placental margin is located 3 cm away from the internal os."], "atomic_facts": ["1. She denies any other symptoms.", "2. Prior to admission, the antepartum course was unremarkable and she was compliant with recommended prenatal care.", "3. The vital signs were as follows: blood pressure, 155/90 mm Hg; heart rate, 84/min; respiratory rate, 16/min; and temperature, 36.6\u2103 (97.9\u2109).", "4. The fetal heart rate was 142/min.", "5. The physical examination shows 2+ pitting edema.", "6. A 24-hour urine assessment showed proteinuria (1.2 g).", "7. An ultrasound examination showed a normally developing fetus without structural abnormalities.", "8. The placental margin was located 3 cm away from the internal os."]}
{"id": 936, "question": "What is the most likely primary metabolic disturbance?", "context": ["A 12-year-old female presents to the emergency room difficult to arouse and occasionally vomiting.", "On physical exam, her oral mucosa looks dry, her breath has a fruity odor, and her breathing is slow, deep and labored."], "context_len": 2, "options": {"A": "Anion gap metabolic acidosis", "B": "Non-anion gap metabolic acidosis", "C": "Metabolic alkalosis", "D": "Respiratory alkalosis"}, "answer": "Anion gap metabolic acidosis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "12 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 12-year-old female presents to the emergency room.", "2. She is difficult to arouse.", "3. She is occasionally vomiting.", "4. On physical exam, her oral mucosa looks dry.", "5. Her breath has a fruity odor.", "6. Her breathing is slow, deep and labored."], "atomic_facts": ["1. On physical exam, her oral mucosa looks dry.", "2. Her breath has a fruity odor.", "3. Her breathing is slow.", "4. Her breathing is deep.", "5. Her breathing is labored."]}
{"id": 937, "question": "Which of the following is the most likely diagnosis?", "context": ["A 36-year-old man presents to the emergency room with subacute worsening of chronic chest pain and shortness of breath with exertion.", "The patient is generally healthy, lifts weights regularly, and does not smoke.", "His temperature is 97.8\u00b0F (36.6\u00b0C), blood pressure is 122/83 mm Hg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air.", "Cardiac auscultation reveals a crescendo-decrescendo murmur heard right of the upper sternal border with radiation into the carotids.", "An ECG shows left axis deviation and meets criteria for left ventricular hypertrophy.", "An initial troponin is < 0.01 ng/mL."], "context_len": 6, "options": {"A": "Bacterial endocarditis", "B": "Bicuspid aortic valve", "C": "Cardiac myxoma", "D": "Senile calcific changes"}, "answer": "Bicuspid aortic valve", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "36", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 36-year-old man presents to the emergency room.", "2. Patient has subacute worsening of chronic chest pain and shortness of breath with exertion.", "3. Patient is generally healthy and lifts weights regularly.", "4. Patient does not smoke.", "5. Patient's temperature is 97.8\u00b0F (36.6\u00b0C).", "6. Patient's blood pressure is 122/83 mm Hg.", "7. Patient's pulse is 80/min.", "8. Patient's respirations are 13/min.", "9. Patient's oxygen saturation is 98% on room air.", "10. Cardiac auscultation reveals a crescendo-decrescendo murmur heard right of the upper sternal border with radiation into the carotids.", "11. ECG shows left axis deviation and meets criteria for left ventricular hypertrophy.", "12. Initial troponin is < 0.01 ng/mL."], "atomic_facts": ["1. The patient is generally healthy.", "2. The patient lifts weights regularly.", "3. The patient does not smoke.", "4. The patient's temperature is 97.8\u00b0F (36.6\u00b0C).", "5. The patient's blood pressure is 122/83 mm Hg.", "6. The patient's pulse is 80/min.", "7. The patient's respirations are 13/min.", "8. The patient's oxygen saturation is 98% on room air.", "9. Cardiac auscultation reveals a crescendo-decrescendo murmur heard right of the upper sternal border with radiation into the carotids.", "10. An ECG shows left axis deviation.", "11. An ECG meets criteria for left ventricular hypertrophy.", "12. An initial troponin is < 0.01 ng/mL."]}
{"id": 938, "question": "Which of the following characteristics of norepinephrine best explains this choice in this patient?", "context": ["A 66-year-old man is admitted to the intensive care unit for management of laboratory-confirmed septic shock.", "His current plan includes appropriate management of airway and breathing, intravenous antibiotics, fluid resuscitation, and supportive care.", "After the administration of adequate intravenous isotonic fluids, his temperature is 37.2\u00b0C (99.0\u00b0F), the pulse rate is 120/min, the blood pressure is 90/50 mm Hg, and the respiratory rate is 22/min.", "His extremities are warm and capillary refill time is normal.", "The patient is started on vasopressor therapy, and norepinephrine is chosen over epinephrine."], "context_len": 5, "options": {"A": "Norepinephrine has less \u03b11-adrenergic effects compared to epinephrine", "B": "Norepinephrine has more \u03b22-adrenergic activity compared to epinephrine", "C": "Norepinephrine has similar \u03b11-adrenergic effects compared to epinephrine", "D": "Norepinephrine has more \u03b11-adrenergic effects compared to epinephrine"}, "answer": "Norepinephrine has more \u03b11-adrenergic effects compared to epinephrine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "66", "specialties": ["Critical Care Medicine"], "subspecialties": ["General Critical Care Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Anesthesiology"}, "facts_old": ["1. A 66-year-old man is admitted to the intensive care unit.", "2. He has laboratory-confirmed septic shock.", "3. His current plan includes appropriate management of airway and breathing, intravenous antibiotics, fluid resuscitation, and supportive care.", "4. After the administration of adequate intravenous isotonic fluids, his temperature is 37.2\u00b0C (99.0\u00b0F).", "5. His pulse rate is 120/min.", "6. His blood pressure is 90/50 mm Hg.", "7. His respiratory rate is 22/min.", "8. His extremities are warm.", "9. His capillary refill time is normal.", "10. He is started on vasopressor therapy.", "11. Norepinephrine is chosen over epinephrine."], "atomic_facts": ["1. His current plan includes appropriate management of airway and breathing, intravenous antibiotics, fluid resuscitation, and supportive care.", "2. After the administration of adequate intravenous isotonic fluids, his temperature is 37.2\u00b0C (99.0\u00b0F), the pulse rate is 120/min, the blood pressure is 90/50 mm Hg, and the respiratory rate is 22/min.", "3. His extremities are warm and capillary refill time is normal.", "4. The patient is started on vasopressor therapy.", "5. Norepinephrine is chosen over epinephrine."]}
{"id": 939, "question": "Further evaluation is most likely to show which of the following?", "context": ["A 67-year-old man comes to the physician because of a worsening tremor that began one year ago.", "The tremor affects his left hand and improves when he uses his hand to complete a task.", "He also reports feeling stiffer throughout the day, and he has fallen twice in the past year.", "He has not noticed any changes in his cognition or mood.", "He has not had difficulty sleeping, but his wife says that he would kick and punch while dreaming for almost a decade.", "He drinks two cans of beer daily.", "He takes no medications.", "He appears healthy and well nourished.", "His vital signs are within normal limits.", "He maintains a blank stare throughout the visit."], "context_len": 10, "options": {"A": "Reduced amplitude on foot tapping", "B": "Extensor plantar response", "C": "Choreiform movements", "D": "No abnormalities\n\""}, "answer": "Reduced amplitude on foot tapping", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "67 years old", "specialties": ["Neurology"], "subspecialties": ["General Neurology", "Neurology with Special Qualification in Child Neurology", "Movement Disorders"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 67 years old.", "2. Patient has worsening tremor that began one year ago.", "3. Tremor affects left hand.", "4. Tremor improves when patient uses hand to complete a task.", "5. Patient reports feeling stiffer throughout the day.", "6. Patient has fallen twice in the past year.", "7. Patient has not noticed any changes in cognition or mood.", "8. Patient has not had difficulty sleeping.", "9. Patient's wife says he has been kicking and punching while dreaming for almost a decade.", "10. Patient drinks two cans of beer daily.", "11. Patient takes no medications.", "12. Patient appears healthy and well nourished.", "13. Patient's vital signs are within normal limits.", "14. Patient maintains a blank stare throughout the visit."], "atomic_facts": ["1. The tremor affects his left hand.", "2. The tremor improves when he uses his hand to complete a task.", "3. He reports feeling stiffer throughout the day.", "4. He has fallen twice in the past year.", "5. He has not noticed any changes in his cognition or mood.", "6. He has not had difficulty sleeping.", "7. His wife says that he would kick and punch while dreaming for almost a decade.", "8. He drinks two cans of beer daily.", "9. He takes no medications.", "10. He appears healthy and well nourished.", "11. His vital signs are within normal limits.", "12. He maintains a blank stare throughout the visit."]}
{"id": 940, "question": "Which finding would you most likely expect with this patient?", "context": ["A 25-year-old African American man comes to the emergency department for \u201cred urine.\u201d Patient reports that he just returned from a skiing trip in the Rocky Mountains and developed the reddish urine today.", "He denies upper respiratory infection symptoms, chest pain, fever, or chills but does endorse some right flank pain that developed 3 days ago.", "Physical examination was unremarkable except for some tenderness upon palpation at the right flank.", "Laboratory findings are as follows: |  | Serum: | Na+: 137 mEq/L | K+: 4.9 mEq/L | Cl-: 100 mEq/L | HCO3-: 25 mEq/L | Osmolality: 275 Osm/kg |  | Urine: | Color: Red | Protein: 3+ | RBC: 4 cells/hpf | Osmolality: 214 Osm/kg | Specific gravity: 1.004 |  | ."], "context_len": 4, "options": {"A": "Cystic mass of the right kidney on CT abdomen/pelvis", "B": "HbS on hemoglobin electrophoresis", "C": "Renal stones on CT abdomen/pelvis", "D": "Segmental sclerosis and hyalinosis of renal glomeruli on light microscopy"}, "answer": "HbS on hemoglobin electrophoresis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "25", "specialties": ["Nephrology"], "subspecialties": ["General Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 25-year-old African American man comes to the emergency department for \u201cred urine.\u201d", "2. Patient reports that he just returned from a skiing trip in the Rocky Mountains and developed the reddish urine today.", "3. He denies upper respiratory infection symptoms, chest pain, fever, or chills.", "4. He endorses some right flank pain that developed 3 days ago.", "5. Physical examination was unremarkable except for some tenderness upon palpation at the right flank.", "6. Serum Na+: 137 mEq/L", "7. Serum K+: 4.9 mEq/L", "8. Serum Cl-: 100 mEq/L", "9. Serum HCO3-: 25 mEq/L", "10. Serum Osmolality: 275 Osm/kg", "11. Urine Color: Red", "12. Urine Protein: 3+", "13. Urine RBC: 4 cells/hpf", "14. Urine Osmolality: 214 Osm/kg", "15. Urine Specific gravity: 1.004"], "atomic_facts": ["1. Patient denies upper respiratory infection symptoms, chest pain, fever, or chills.", "2. Patient endorses right flank pain that developed 3 days ago.", "3. Physical examination was unremarkable except for tenderness upon palpation at the right flank.", "4. Serum sodium level: 137 mEq/L.", "5. Serum potassium level: 4.9 mEq/L.", "6. Serum chloride level: 100 mEq/L.", "7. Serum bicarbonate level: 25 mEq/L.", "8. Serum osmolality: 275 Osm/kg.", "9. Urine color: Red.", "10. Urine protein: 3+.", "11. Urine RBC: 4 cells/hpf.", "12. Urine osmolality: 214 Osm/kg.", "13. Urine specific gravity: 1.004."]}
{"id": 941, "question": "Which of the following sets of findings would most likely be seen in this patient?", "context": ["A 62-year-old man presents to his primary care physician because of lower back pain and radiating leg pain.", "He says that the pain is searing and goes from the buttock into the posterior thigh and lateral leg.", "It is moderate in intensity and he has noticed that it worsens with sitting and improves with standing.", "His past medical history is significant for well controlled hypertension, but he has otherwise been healthy.", "He works as a laborer loading packages in a warehouse and is concerned because the pain does not allow him to work.", "On physical exam, he is found to have pain and paresthesia while performing a straight leg raise.", "Radiographs show loss of disk height and MRI shows significant degeneration and posterolateral herniation of the disk in between the L5 and S1 vertebrae.", "Adjacent disks appear to be relatively normal without notable herniation."], "context_len": 8, "options": {"A": "Weak ankle dorsiflexion and diminished Achilles reflex", "B": "Weak ankle dorsiflexion and hallucis extension", "C": "Weak ankle plantarflexion and diminished Achilles reflex", "D": "Weak ankle plantarflexion and diminished patellar reflex"}, "answer": "Weak ankle plantarflexion and diminished Achilles reflex", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "62", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Physical Medicine and Rehabilitation"}, "facts_old": ["1. A 62-year-old man presents to his primary care physician.", "2. He has lower back pain and radiating leg pain.", "3. The pain is searing and goes from the buttock into the posterior thigh and lateral leg.", "4. The pain is moderate in intensity.", "5. The pain worsens with sitting and improves with standing.", "6. His past medical history is significant for well controlled hypertension.", "7. He works as a laborer loading packages in a warehouse.", "8. He is concerned because the pain does not allow him to work.", "9. On physical exam, he has pain and paresthesia while performing a straight leg raise.", "10. Radiographs show loss of disk height.", "11. MRI shows significant degeneration and posterolateral herniation of the disk in between the L5 and S1 vertebrae.", "12. Adjacent disks appear to be relatively normal without notable herniation."], "atomic_facts": ["1. The patient reports searing pain that goes from the buttock into the posterior thigh and lateral leg.", "2. The pain is moderate in intensity.", "3. The pain worsens with sitting and improves with standing.", "4. The patient has well controlled hypertension.", "5. The patient works as a laborer loading packages in a warehouse.", "6. The pain is preventing the patient from working.", "7. On physical exam, the patient experiences pain and paresthesia while performing a straight leg raise.", "8. Radiographs show loss of disk height.", "9. MRI shows significant degeneration and posterolateral herniation of the disk between the L5 and S1 vertebrae.", "10. Adjacent disks appear to be relatively normal without notable herniation."]}
{"id": 942, "question": "Which of the following medications is first-line therapy to slow disease progression?", "context": ["A 46-year-old woman presents to her primary care provider with pain in both of his hands and wrists.", "She notes that it is hard for her to prepare breakfast or wash dishes in the morning due to stiffness.", "It seems to subsides later in the day.", "She also complains of a constant fatigue and unintentional weight loss during the last few months.", "The past medical history is significant for hypertension.", "She takes captopril and aspirin daily, and occasional ibuprofen for the pain in her hands.", "Her mother developed similar symptoms in her hands resulting in hand deformity.", "The blood pressure is 140/90 mm Hg, heart rate is 67/min, respiratory rate is 13/min, and temperature is 37.0\u00b0C (98.6\u00b0F).", "Physical examination shows redness, edema, and tenderness on palpation at the metacarpophalangeal and proximal interphalangeal joints of both hands.", "The blood tests show the following findings: | Red blood cell count 3.3 million/mm3 | Hb 12.1 mg/dL | Leukocyte count 10,101/mm3 | ESR 48 mm/h | C-reactive protein 3.9 mg/L | Anti-cyclic citrullinated peptide 45 \u03bc/mL | ."], "context_len": 10, "options": {"A": "Intra-articular corticosteroid injections", "B": "Methotrexate", "C": "Meloxicam", "D": "Etanercept"}, "answer": "Methotrexate", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "46", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 46-year-old woman presents to her primary care provider with pain in both of his hands and wrists.", "2. She notes that it is hard for her to prepare breakfast or wash dishes in the morning due to stiffness.", "3. It seems to subsides later in the day.", "4. She also complains of a constant fatigue and unintentional weight loss during the last few months.", "5. The past medical history is significant for hypertension.", "6. She takes captopril and aspirin daily, and occasional ibuprofen for the pain in her hands.", "7. Her mother developed similar symptoms in her hands resulting in hand deformity.", "8. The blood pressure is 140/90 mm Hg, heart rate is 67/min, respiratory rate is 13/min, and temperature is 37.0\u00b0C (98.6\u00b0F).", "9. Physical examination shows redness, edema, and tenderness on palpation at the metacarpophalangeal and proximal interphalangeal joints of both hands.", "10. The blood tests show the following findings:", "11. Red blood cell count 3.3 million/mm3", "12. Hb 12.1 mg/dL", "13. Leukocyte count 10,101/mm3", "14. ESR 48 mm/h", "15. C-reactive protein 3.9 mg/L", "16. Anti-cyclic citrullinated peptide 45 \u03bc/mL."], "atomic_facts": ["1. The patient has difficulty preparing breakfast and washing dishes in the morning due to stiffness.", "2. The stiffness seems to subside later in the day.", "3. The patient complains of constant fatigue and unintentional weight loss over the last few months.", "4. The patient has a past medical history significant for hypertension.", "5. The patient takes captopril and aspirin daily, and occasional ibuprofen for hand pain.", "6. The patient's mother developed similar symptoms in her hands resulting in hand deformity.", "7. The patient's blood pressure is 140/90 mm Hg, heart rate is 67/min, respiratory rate is 13/min, and temperature is 37.0\u00b0C (98.6\u00b0F).", "8. Physical examination shows redness, edema, and tenderness on palpation at the metacarpophalangeal and proximal interphalangeal joints of both hands.", "9. Blood tests show the following findings: Red blood cell count 3.3 million/mm3, Hb 12.1 mg/dL, Leukocyte count 10,101/mm3, ESR 48 mm/h, C-reactive protein 3.9 mg/L, Anti-cyclic citrullinated peptide 45 \u03bc/mL."]}
{"id": 943, "question": "Which of the following neurotransmitters is most likely decreased in this patient?", "context": ["A 27-year-old woman presents to her primary care physician\u2019s office complaining of trouble sleeping.", "She reports that for the past 10 months she has experienced difficulty falling asleep due constant worrying.", "The content of her worry include items such as whether or not her child will feel lonely in day care and the health of her parents.", "These worrying episodes typically begin toward the end of the day and last for several hours.", "She states that she has trouble concentrating at work as well and describes her heart as \"racing\" during these episodes.", "She denies any alcohol or illicit drug use."], "context_len": 6, "options": {"A": "Acetylcholine", "B": "Dopamine", "C": "GABA", "D": "Norepinephrine"}, "answer": "GABA", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Psychiatry"], "subspecialties": ["Sleep Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 27-year-old woman presents to her primary care physician's office.", "2. She is complaining of trouble sleeping.", "3. She has experienced difficulty falling asleep for the past 10 months.", "4. The content of her worry includes items such as whether or not her child will feel lonely in day care and the health of her parents.", "5. These worrying episodes typically begin toward the end of the day and last for several hours.", "6. She has trouble concentrating at work.", "7. She describes her heart as \"racing\" during these episodes.", "8. She denies any alcohol or illicit drug use."], "atomic_facts": ["1. The patient has experienced difficulty falling asleep for the past 10 months.", "2. The difficulty falling asleep is due to constant worrying.", "3. The content of her worry includes her child feeling lonely in day care and the health of her parents.", "4. The worrying episodes typically begin toward the end of the day and last for several hours.", "5. She has trouble concentrating at work.", "6. She describes her heart as \"racing\" during these episodes.", "7. The patient denies any alcohol or illicit drug use."]}
{"id": 944, "question": "Which of the following is the most likely diagnosis?", "context": ["A 10-year-old boy is brought to the physician because of fever and bloody diarrhea for the past few days.", "His parents report that he has become increasingly lethargic and irritable.", "His temperature is 38.6\u00b0C (101.4\u00b0F), pulse is 102/min, and respirations are 22/min.", "He has no significant past medical history.", "His parents say that he mostly only eats a diet of chicken, hamburgers, fries, cheese, and milk.", "On physical examination, pallor and edema in both legs are present.", "His laboratory studies show: | Hemoglobin 8.9 gm/dL | Leukocyte count 9,300/mm3 | Platelet count 67,000/mm3 | Blood urea nitrogen 43 mg/dL | Serum creatinine 2.46 mg/dL | Coombs test Negative | ."], "context_len": 7, "options": {"A": "Thrombotic thrombocytopenic purpura", "B": "Genetic form of hemolytic uremic syndrome", "C": "Hemolytic uremic syndrome associated with systemic disease", "D": "Escherichia-induced hemolytic uremic syndrome"}, "answer": "Escherichia-induced hemolytic uremic syndrome", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "10 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 10-year-old boy.", "2. Patient has had fever and bloody diarrhea for the past few days.", "3. Patient has become increasingly lethargic and irritable.", "4. Patient's temperature is 38.6\u00b0C (101.4\u00b0F).", "5. Patient's pulse is 102/min.", "6. Patient's respirations are 22/min.", "7. Patient has no significant past medical history.", "8. Patient's diet consists mostly of chicken, hamburgers, fries, cheese, and milk.", "9. On physical examination, pallor and edema in both legs are present.", "10. Patient's hemoglobin is 8.9 gm/dL.", "11. Patient's leukocyte count is 9,300/mm3.", "12. Patient's platelet count is 67,000/mm3.", "13. Patient's blood urea nitrogen is 43 mg/dL.", "14. Patient's serum creatinine is 2.46 mg/dL.", "15. Patient's Coombs test is Negative."], "atomic_facts": ["1. The patient is increasingly lethargic and irritable according to his parents.", "2. The patient's temperature is 38.6\u00b0C (101.4\u00b0F).", "3. The patient's pulse is 102/min.", "4. The patient's respirations are 22/min.", "5. The patient has no significant past medical history.", "6. The patient's diet mainly consists of chicken, hamburgers, fries, cheese, and milk.", "7. On physical examination, pallor and edema in both legs are present.", "8. The patient's hemoglobin level is 8.9 gm/dL.", "9. The patient's leukocyte count is 9,300/mm3.", "10. The patient's platelet count is 67,000/mm3.", "11. The patient's blood urea nitrogen level is 43 mg/dL.", "12. The patient's serum creatinine level is 2.46 mg/dL.", "13. The Coombs test is negative."]}
{"id": 945, "question": "Which structure has he most likely injured?", "context": ["A 50-year-old white male who works in construction comes to your office because of pain in his upper arm.", "He states that over the last few months, he has been having pain in his upper arm that worsens with raising objects overhead.", "He states that he also recently fell on his outstretched hand and that seemed to worsen his pain.", "His vital signs are within normal limits.", "He has no pain on internal or external rotation.", "He also had no pain with the lift off test, but does have significant pain with the empty can test and the arm drop test."], "context_len": 6, "options": {"A": "Pectoralis major tendon", "B": "Deltoid muscle", "C": "Supraspinatus tendon", "D": "Subscapularis tendon"}, "answer": "Supraspinatus tendon", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "50", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 50-year-old white male comes to the office.", "2. He works in construction.", "3. He has pain in his upper arm.", "4. The pain has been worsening over the last few months.", "5. He recently fell on his outstretched hand.", "6. His vital signs are within normal limits.", "7. He has no pain on internal or external rotation.", "8. He has no pain with the lift off test.", "9. He has significant pain with the empty can test.", "10. He has significant pain with the arm drop test."], "atomic_facts": ["1. He has been having pain in his upper arm over the last few months.", "2. The pain worsens with raising objects overhead.", "3. He recently fell on his outstretched hand.", "4. The fall seemed to worsen his pain.", "5. His vital signs are within normal limits.", "6. He has no pain on internal or external rotation.", "7. He had no pain with the lift off test.", "8. He has significant pain with the empty can test.", "9. He has significant pain with the arm drop test."]}
{"id": 946, "question": "Which of the following pathogens is the most likely cause of this patient\u2019s condition?", "context": ["A 76-year-old man presents to the physician with a severe, pruritic rash as shown in the image.", "He has lost sleep over the past week because of itchiness and discomfort.", "He has not noticed any insect bites.", "He is not experiencing any pain.", "He currently lives in an elderly home where several other residents are experiencing a similar problem.", "He has no history of a serious illness and does not take any medications.", "His vital signs are within normal limits.", "A similar rash is seen on his face and below the knees on both sides.", "The skin of the groin, genital and perianal area, buttocks, and thighs show no abnormalities.", "The remainder of the physical examination is unremarkable."], "context_len": 10, "options": {"A": "Cimex lectularius", "B": "Dermatobia hominis", "C": "Varicella zoster", "D": "Sarcoptes scabiei"}, "answer": "Cimex lectularius", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "76 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 76-year-old man presents to the physician with a severe, pruritic rash.", "2. He has lost sleep over the past week because of itchiness and discomfort.", "3. He has not noticed any insect bites.", "4. He is not experiencing any pain.", "5. He currently lives in an elderly home where several other residents are experiencing a similar problem.", "6. He has no history of a serious illness and does not take any medications.", "7. His vital signs are within normal limits.", "8. A similar rash is seen on his face and below the knees on both sides.", "9. The skin of the groin, genital and perianal area, buttocks, and thighs show no abnormalities.", "10. The remainder of the physical examination is unremarkable."], "atomic_facts": ["1. He has lost sleep over the past week due to itchiness and discomfort.", "2. He has not noticed any insect bites.", "3. He is not experiencing any pain.", "4. He currently lives in an elderly home where several other residents are experiencing a similar problem.", "5. He has no history of a serious illness and does not take any medications.", "6. His vital signs are within normal limits.", "7. A similar rash is seen on his face and below the knees on both sides.", "8. The skin of the groin, genital and perianal area, buttocks, and thighs show no abnormalities.", "9. The remainder of the physical examination is unremarkable."]}
{"id": 947, "question": "Which of the following enzymes is deficient in this patient?", "context": ["A 6-month-old girl is brought to the hospital by her parents for evaluation due to poor feeding for the last month.", "Her parents say that she has not been eating well over the last two months, yet her abdomen has grown larger.", "Physical exam shows a thin female infant with an enlarged liver and palpable spleen.", "Eye exam reveals a red spot on the retina.", "She has an intact muscle tone and reflexes."], "context_len": 5, "options": {"A": "Hexosaminidase A", "B": "\u03b1-galactosidase A", "C": "Sphingomyelinase", "D": "Galactocerebrosidase"}, "answer": "Sphingomyelinase", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "6 months", "specialties": ["Pediatrics", "Medical Genetics and Genomics"], "subspecialties": ["Pediatric Neurology", "Pediatric Hematology", "General Medical Genetics and Genomics"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 6-month-old girl is brought to the hospital by her parents.", "2. Her parents say that she has not been eating well over the last two months.", "3. Her abdomen has grown larger.", "4. Physical exam shows a thin female infant.", "5. Physical exam reveals an enlarged liver.", "6. Physical exam reveals a palpable spleen.", "7. Eye exam reveals a red spot on the retina.", "8. She has an intact muscle tone.", "9. She has intact reflexes."], "atomic_facts": ["1. Her parents report poor eating over the last two months.", "2. Her abdomen has grown larger.", "3. Physical exam shows a thin female infant.", "4. She has an enlarged liver.", "5. She has a palpable spleen.", "6. Eye exam reveals a red spot on the retina.", "7. She has intact muscle tone.", "8. She has intact reflexes."]}
{"id": 948, "question": "This patient's presentation can be best explained by intoxication with a substance that acts at which of the following receptors?", "context": ["A 24-year-old female is brought to the ED from a nearby nightclub by the local police due to aggressive and violent behavior over the past hour.", "A friend accompanying the patient reports that the patient smoked marijuana that \"seemed different\" approximately one hour ago.", "The patient has never had this kind of reaction to marijuana use in the past.", "On examination, the patient is combative with slurred speech and active visual hallucinations; eye examination shows prominent vertical nystagmus."], "context_len": 4, "options": {"A": "Serotonin", "B": "Cannabinoid", "C": "NMDA", "D": "Norepinephrine"}, "answer": "NMDA", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "24 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 24-year-old female was brought to the ED from a nearby nightclub by the local police.", "2. The patient had been exhibiting aggressive and violent behavior for the past hour.", "3. A friend accompanying the patient reported that the patient had smoked marijuana approximately one hour ago.", "4. The friend reported that the marijuana \"seemed different\".", "5. The patient had never had this kind of reaction to marijuana use in the past.", "6. On examination, the patient was combative with slurred speech and active visual hallucinations.", "7. Eye examination showed prominent vertical nystagmus."], "atomic_facts": ["1. A friend accompanying the patient reports that the patient smoked marijuana approximately one hour ago.", "2. The marijuana \"seemed different\" to the patient's friend.", "3. The patient has never had this kind of reaction to marijuana use in the past.", "4. On examination, the patient is combative.", "5. The patient has slurred speech.", "6. The patient has active visual hallucinations.", "7. Eye examination shows prominent vertical nystagmus."]}
{"id": 949, "question": "Which of the following enzymes is most likely deficient in this patient?", "context": ["A 2-month-old infant comes to the clinic because of progressive weakness and fatigue over the past 4 weeks.", "He is his mother\u2019s first-born boy.", "She was in Mexico during the delivery and says that she had a regular 39-week gestation.", "She took folic acid during her pregnancy.", "The infant was born through vaginal delivery with no complications.", "Apgar scores were 10 and 9 at 1 and 5 minutes, respectively.", "The neonate did not go through a newborn screening process.", "His pulse is 130/min, respiratory rate is 43/min, temperature is 37.2\u00b0C (99.0\u00b0F), and blood pressure is 90/60 mm Hg.", "Physical examination shows lethargy, hypotonia, and a weak response to primitive reflexes.", "There is a \u201choney-like\u201d odor around his diaper which the mother says has been present since birth."], "context_len": 10, "options": {"A": "Branched-chain alpha-ketoacid dehydrogenase", "B": "Cystathionine synthase deficiency", "C": "Phenylalanine hydroxylase", "D": "Propionyl-CoA carboxylase"}, "answer": "Branched-chain alpha-ketoacid dehydrogenase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "2 months", "specialties": ["Pediatrics"], "subspecialties": ["Metabolic Genetics", "Pediatric Metabolic Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 2-month-old infant comes to the clinic because of progressive weakness and fatigue over the past 4 weeks.", "2. He is his mother\u2019s first-born boy.", "3. She was in Mexico during the delivery.", "4. She says that she had a regular 39-week gestation.", "5. She took folic acid during her pregnancy.", "6. The infant was born through vaginal delivery with no complications.", "7. Apgar scores were 10 and 9 at 1 and 5 minutes, respectively.", "8. The neonate did not go through a newborn screening process.", "9. His pulse is 130/min.", "10. Respiratory rate is 43/min.", "11. Temperature is 37.2\u00b0C (99.0\u00b0F).", "12. Blood pressure is 90/60 mm Hg.", "13. Physical examination shows lethargy, hypotonia, and a weak response to primitive reflexes.", "14. There is a \u201choney-like\u201d odor around his diaper which the mother says has been present since birth."], "atomic_facts": ["1. He is his mother\u2019s first-born boy.", "2. She was in Mexico during the delivery and says that she had a regular 39-week gestation.", "3. She took folic acid during her pregnancy.", "4. The infant was born through vaginal delivery with no complications.", "5. Apgar scores were 10 and 9 at 1 and 5 minutes, respectively.", "6. The neonate did not go through a newborn screening process.", "7. His pulse is 130/min, respiratory rate is 43/min, temperature is 37.2\u00b0C (99.0\u00b0F), and blood pressure is 90/60 mm Hg.", "8. Physical examination shows lethargy, hypotonia, and a weak response to primitive reflexes.", "9. There is a \u201choney-like\u201d odor around his diaper which the mother says has been present since birth."]}
{"id": 950, "question": "Which of the following psychological defense mechanisms is this individual demonstrating?", "context": ["A 35-year-old engineer is told by his boss that his team will need to work extra evening hours in the coming week in order to meet a project deadline.", "This frustrates the engineer, who already feels he is working too many hours.", "Instead of discussing this directly with his boss, the engineer calls in sick and leaves his work for his boss to finish."], "context_len": 3, "options": {"A": "Displacement", "B": "Acting out", "C": "Passive aggression", "D": "Blocking"}, "answer": "Passive aggression", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "35", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 35-year-old engineer is told by his boss that his team will need to work extra evening hours in the coming week.", "2. The extra evening hours are in order to meet a project deadline.", "3. The engineer already feels he is working too many hours.", "4. The engineer does not discuss this directly with his boss.", "5. The engineer calls in sick and leaves his work for his boss to finish."], "atomic_facts": ["1. The engineer is frustrated.", "2. The engineer feels he is working too many hours.", "3. The engineer does not directly discuss the issue with his boss.", "4. The engineer calls in sick.", "5. The engineer leaves his work for his boss to finish."]}
{"id": 951, "question": "Which of the following is the most likely underlying mechanism of this condition?", "context": ["A 29-year-old woman comes to the physician because of a 4-month history of fever, progressive shortness of breath, and a dry cough.", "During this time, she has also had a 5-kg (11-lb) weight loss.", "Two months ago, she was in Kenya for several weeks to visit her family.", "Physical examination shows fine crackles and wheezing over both lung fields.", "Her serum calcium concentration is 11.8 mg/dL.", "An x-ray of the chest shows reticular opacities in both lungs and bilateral hilar lymphadenopathy."], "context_len": 6, "options": {"A": "Necrotizing inflammation", "B": "Granulomatous inflammation", "C": "Monoclonal plasma cell production", "D": "Neoplastic transformation\n\""}, "answer": "Granulomatous inflammation", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "29", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease", "Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 29-year-old woman comes to the physician.", "2. She has had a 4-month history of fever, progressive shortness of breath, and a dry cough.", "3. She has had a 5-kg (11-lb) weight loss.", "4. Two months ago, she was in Kenya for several weeks to visit her family.", "5. Physical examination shows fine crackles and wheezing over both lung fields.", "6. Her serum calcium concentration is 11.8 mg/dL.", "7. An x-ray of the chest shows reticular opacities in both lungs and bilateral hilar lymphadenopathy."], "atomic_facts": ["1. She has had a 5-kg (11-lb) weight loss.", "2. Two months ago, she was in Kenya for several weeks to visit her family.", "3. Physical examination shows fine crackles and wheezing over both lung fields.", "4. Her serum calcium concentration is 11.8 mg/dL.", "5. An x-ray of the chest shows reticular opacities in both lungs and bilateral hilar lymphadenopathy."]}
{"id": 952, "question": "Which of the following agents is most strongly associated with this phenomenon described above?", "context": ["A 58-year-old man undergoes coronary angiography that demonstrates a 90% stenosis of the left anterior descending coronary artery.", "The circumflex branch of the left coronary artery is not significantly obstructed.", "Prior to the angiogram, he underwent a pharmacologic cardiac stress test.", "When administered, the pharmacologic agent caused the left circumflex artery to vasodilate, with resulting increased blood supply to its supplied myocardium that was already well-perfused at baseline.", "This increased flow through the circumflex artery shunted blood flow away from the myocardium supplied by the stenosed left anterior descending artery, resulting in ischemia that manifested as a perfusion defect on radionuclide imaging."], "context_len": 5, "options": {"A": "Metoprolol", "B": "Verapamil", "C": "Diltiazem", "D": "Dipyridamole"}, "answer": "Dipyridamole", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "58 years old", "specialties": ["Cardiology"], "subspecialties": ["Interventional Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 58-year-old man underwent coronary angiography.", "2. The angiography demonstrated a 90% stenosis of the left anterior descending coronary artery.", "3. The circumflex branch of the left coronary artery was not significantly obstructed.", "4. The man underwent a pharmacologic cardiac stress test prior to the angiogram.", "5. The pharmacologic agent caused the left circumflex artery to vasodilate.", "6. This increased blood supply to its supplied myocardium that was already well-perfused at baseline.", "7. This increased flow through the circumflex artery shunted blood flow away from the myocardium supplied by the stenosed left anterior descending artery.", "8. This resulted in ischemia that manifested as a perfusion defect on radionuclide imaging."], "atomic_facts": ["1. The circumflex branch of the left coronary artery is not significantly obstructed.", "2. Prior to the angiogram, the patient underwent a pharmacologic cardiac stress test.", "3. The pharmacologic agent caused the left circumflex artery to vasodilate when administered.", "4. The vasodilation resulted in increased blood supply to the supplied myocardium, which was already well-perfused at baseline.", "5. The increased flow through the circumflex artery shunted blood flow away from the myocardium supplied by the stenosed left anterior descending artery.", "6. This resulted in ischemia that manifested as a perfusion defect on radionuclide imaging."]}
{"id": 953, "question": "Maintaining the patient on this medication to prevent recurrence of her current illness will also prevent infection with which of the following pathogens?", "context": ["A 51-year-old woman comes to the physician because of a 3-week history of fatigue, non-productive cough, and worsening shortness of breath while walking.", "She was diagnosed with HIV 11 years ago.", "Two years ago, she was treated for esophageal thrush with fluconazole.", "She takes no medications because she does not feel like she needs them.", "She occasionally uses intravenous illicit drugs and has smoked a pack of cigarettes daily for 35 years.", "She appears ill.", "Her temperature is 38.4\u00b0C (101.1\u00b0F), respiratory rate is 25/min, pulse is 116/min, and blood pressure is 115/70 mm Hg.", "Pulse oximetry shows an oxygen saturation of 89% on room air.", "Inspiratory crackles are heard over bilateral lung fields.", "Cardiac examination shows no abnormalities.", "Laboratory studies show a CD4 count of 67/mm3 (N \u2265 500/mm3) and an elevated HIV viral load.", "An x-ray of the chest shows diffuse interstitial infiltrates bilaterally.", "In addition to starting antiretroviral therapy, the appropriate treatment for her current illness is initiated."], "context_len": 13, "options": {"A": "Varicella zoster virus", "B": "Toxoplasmosa gondii", "C": "Cryptococcus neoformans", "D": "Candida albicans"}, "answer": "Toxoplasmosa gondii", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "51", "specialties": ["Pulmonary Disease", "Internal Medicine"], "subspecialties": ["General Pulmonary Disease", "Pulmonary Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 51-year-old woman comes to the physician.", "2. She has a 3-week history of fatigue, non-productive cough, and worsening shortness of breath while walking.", "3. She was diagnosed with HIV 11 years ago.", "4. Two years ago, she was treated for esophageal thrush with fluconazole.", "5. She takes no medications.", "6. She occasionally uses intravenous illicit drugs.", "7. She has smoked a pack of cigarettes daily for 35 years.", "8. She appears ill.", "9. Her temperature is 38.4\u00b0C (101.1\u00b0F).", "10. Her respiratory rate is 25/min.", "11. Her pulse is 116/min.", "12. Her blood pressure is 115/70 mm Hg.", "13. Pulse oximetry shows an oxygen saturation of 89% on room air.", "14. Inspiratory crackles are heard over bilateral lung fields.", "15. Cardiac examination shows no abnormalities.", "16. Laboratory studies show a CD4 count of 67/mm3 (N \u2265 500/mm3).", "17. Laboratory studies show an elevated HIV viral load.", "18. An x-ray of the chest shows diffuse interstitial infiltrates bilaterally.", "19. The appropriate treatment for her current illness is initiated in addition to starting antiretroviral therapy."], "atomic_facts": ["1. She was diagnosed with HIV 11 years ago.", "2. Two years ago, she was treated for esophageal thrush with fluconazole.", "3. She takes no medications because she does not feel like she needs them.", "4. She occasionally uses intravenous illicit drugs.", "5. She has smoked a pack of cigarettes daily for 35 years.", "6. She appears ill.", "7. Her temperature is 38.4\u00b0C (101.1\u00b0F).", "8. Her respiratory rate is 25/min.", "9. Her pulse is 116/min.", "10. Her blood pressure is 115/70 mm Hg.", "11. Pulse oximetry shows an oxygen saturation of 89% on room air.", "12. Inspiratory crackles are heard over bilateral lung fields.", "13. Cardiac examination shows no abnormalities.", "14. Laboratory studies show a CD4 count of 67/mm3 (N \u2265 500/mm3).", "15. Laboratory studies show an elevated HIV viral load.", "16. An x-ray of the chest shows diffuse interstitial infiltrates bilaterally.", "17. In addition to starting antiretroviral therapy, the appropriate treatment for her current illness is initiated."]}
{"id": 954, "question": "Which of the following is the most likely mechanism giving rise to this patient\u2019s condition?", "context": ["A 37-year-old man presents with right lower extremity weakness and low back pain.", "The patient states that he has had chronic mild to moderate low back pain for several years, but, 3 days ago after lifting a box, the pain increased in intensity and spread to his right leg.", "He describes the pain as severe, electrical in character, and descending from his right gluteal region along his right posterior thigh and leg to his right lateral ankle and foot.", "The patient also says that he has been having difficulty walking due to stumbling over his right foot.", "His temperature is 37.0\u2103 (98.6\u2109), the blood pressure is 125/80 mm Hg, the pulse is 72/min, the respiratory rate is 16/min, and the oxygen saturation is 98% on room air.", "On physical examination, the patient is alert and cooperative.", "Musculoskeletal examination of the lower extremities shows the following results: | Functional Muscle Group/DTR Tested Right Side Left Side |                Strength | Hip extension 5/5 5/5 | Hip abduction 4/5  5/5 | Hip adduction  5/5  5/5 | Hip flexion 5/5 5/5 | Knee flexion 5/5 5/5 | Knee extension 5/5 5/5 | Foot plantar flexion 5/5 5/5 | Foot dorsiflexion 4/5 5/5 | Foot inversion 4/5 5/5 | Foot eversion 4/5 5/5 | Toe extension 3/5 5/5 |               Reflexes | Knee 3+ 3+ | Achilles 1+ 3+ | Plantar 2+ 3+ |                Sensory | Sensation Decreased on the lateral aspect of the lower leg and dorsum of the foot Normal over all the surface | Lassegue test Positive at 30 deg.", "Negative | ."], "context_len": 8, "options": {"A": "Protrusion of the L4/L5 intervertebral disk", "B": "Entrapment of the femoral nerve in the femoral canal", "C": "Inflammation of the S2-3 spinal roots", "D": "Herniation of the L2/3 intervertebral disk"}, "answer": "Protrusion of the L4/L5 intervertebral disk", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "37", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 37-years-old.", "2. Patient presents with right lower extremity weakness and low back pain.", "3. Patient has had chronic mild to moderate low back pain for several years.", "4. Pain increased in intensity and spread to right leg 3 days ago after lifting a box.", "5. Patient describes pain as severe, electrical in character, and descending from right gluteal region along right posterior thigh and leg to right lateral ankle and foot.", "6. Patient has been having difficulty walking due to stumbling over right foot.", "7. Temperature is 37.0\u2103 (98.6\u2109).", "8. Blood pressure is 125/80 mm Hg.", "9. Pulse is 72/min.", "10. Respiratory rate is 16/min.", "11. Oxygen saturation is 98% on room air.", "12. Patient is alert and cooperative on physical examination.", "13. Strength of hip extension is 5/5 on right side and 5/5 on left side.", "14. Strength of hip abduction is 4/5 on right side and 5/5 on left side.", "15. Strength of hip adduction is 5/5 on right side and 5/5 on left side.", "16. Strength of hip flexion is 5/5 on right side and 5/5 on left side.", "17. Strength of knee flexion is 5/5 on right side and 5/5 on left side.", "18. Strength of knee extension is 5/5 on right side and 5/5 on left side.", "19. Strength of foot plantar flexion is 5/5 on right side and 5/5 on left side.", "20. Strength of foot dorsiflexion is 4/5 on right side and 5/5 on left side.", "21. Strength of foot inversion is 4/5 on right side and 5/5 on left side.", "22. Strength of foot eversion is 4/5 on right side and 5/5 on left side.", "23. Strength of toe extension is 3/5 on right side and 5/5 on left side.", "24. Knee reflex is 3+ on right side and 3+ on left side.", "25. Achilles reflex is 1+ on right side and 3+ on left side.", "26. Plantar reflex is 2+ on right side and 3+ on left"], "atomic_facts": ["1. The patient has chronic mild to moderate low back pain for several years.", "2. The pain increased in intensity and spread to his right leg after lifting a box 3 days ago.", "3. The pain is described as severe, electrical in character, and descending from his right gluteal region along his right posterior thigh and leg to his right lateral ankle and foot.", "4. The patient has been having difficulty walking due to stumbling over his right foot.", "5. The patient's temperature is 37.0\u2103 (98.6\u2109).", "6. The blood pressure is 125/80 mm Hg.", "7. The pulse is 72/min.", "8. The respiratory rate is 16/min.", "9. The oxygen saturation is 98% on room air.", "10. On physical examination, the patient is alert and cooperative.", "11. Musculoskeletal examination of the lower extremities shows various strength and reflex test results, as well as sensory and Lassegue test results."]}
{"id": 955, "question": "Which of the following is the most likely causal organism?", "context": ["A 21-year-old woman comes to the physician because of a 5-day history of pain with urination and vaginal itching.", "She is sexually active with multiple partners and uses condoms inconsistently.", "Pelvic examination shows erythema of the vulva and vaginal mucosa, punctate hemorrhages on the cervix, and green-yellow, malodorous discharge.", "A photomicrograph of the discharge is shown."], "context_len": 4, "options": {"A": "Neisseria gonorrhoeae", "B": "Treponema pallidum", "C": "Candida albicans", "D": "Trichomonas vaginalis"}, "answer": "Trichomonas vaginalis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "21 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 21-year-old woman comes to the physician.", "2. She has a 5-day history of pain with urination and vaginal itching.", "3. She is sexually active with multiple partners.", "4. She uses condoms inconsistently.", "5. Pelvic examination shows erythema of the vulva and vaginal mucosa.", "6. Pelvic examination shows punctate hemorrhages on the cervix.", "7. Pelvic examination shows green-yellow, malodorous discharge.", "8. A photomicrograph of the discharge is shown."], "atomic_facts": ["1. She is sexually active with multiple partners.", "2. She uses condoms inconsistently.", "3. Pelvic examination shows erythema of the vulva.", "4. Pelvic examination shows erythema of the vaginal mucosa.", "5. Pelvic examination shows punctate hemorrhages on the cervix.", "6. Pelvic examination shows green-yellow, malodorous discharge.", "7. A photomicrograph of the discharge is shown."]}
{"id": 956, "question": "Which of the following is the most appropriate next step?", "context": ["A 9-year-old girl has recently begun having daily staring-spells in which she becomes unresponsive for several seconds.", "Following these episodes, she rapidly returns to normal with no recollection of the event.", "Her performance in school has begun to deteriorate.", "The child's pediatrician refers her to a pediatric neurologist, and, after an appropriate neurological work-up, the child is diagnosed with absence seizures.", "Her neurologist recommends initiating an anti-seizure medication, but the patient adamantly refuses due to fear of side effects and her belief that the condition is not affecting her quality of life."], "context_len": 5, "options": {"A": "Prescribe a long acting depot medication", "B": "Discuss the patient's school performance with her teachers", "C": "Obtain consent from one parent before initiating therapy", "D": "Obtain consent from both parents before initiating therapy"}, "answer": "Obtain consent from one parent before initiating therapy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "9 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 9-year-old girl has recently begun having daily staring-spells.", "2. During these episodes, she becomes unresponsive for several seconds.", "3. Following the episodes, she rapidly returns to normal with no recollection of the event.", "4. Her performance in school has begun to deteriorate.", "5. The child's pediatrician refers her to a pediatric neurologist.", "6. After an appropriate neurological work-up, the child is diagnosed with absence seizures.", "7. Her neurologist recommends initiating an anti-seizure medication.", "8. The patient adamantly refuses due to fear of side effects.", "9. The patient also refuses due to her belief that the condition is not affecting her quality of life."], "atomic_facts": ["1. Following episodes, the patient rapidly returns to normal with no recollection of the event.", "2. The patient's performance in school has begun to deteriorate.", "3. The child's pediatrician refers her to a pediatric neurologist.", "4. After an appropriate neurological work-up, the child is diagnosed with absence seizures.", "5. Her neurologist recommends initiating an anti-seizure medication.", "6. The patient adamantly refuses the medication due to fear of side effects and her belief that the condition is not affecting her quality of life."]}
{"id": 957, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 44-year-old woman comes to the physician because of pain and swelling below her left eye for 3 days.", "She has also had excessive watering from her eyes during this period.", "She has no history of serious illness and takes no medications.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 90/min, and blood pressure is 110/70 mm Hg.", "Examination shows erythema, tenderness, warmth, and swelling below the medial canthus of the left eye.", "There is purulent discharge from the lower lacrimal punctum on palpation of the swelling.", "The remainder of the examination shows no abnormalities.", "The discharge is sent for cultures."], "context_len": 8, "options": {"A": "Topical ciprofloxacin", "B": "Irrigation of lacrimal cannaliculi", "C": "Oral amoxicillin-clavulanate therapy", "D": "CT scan of the orbit\n\""}, "answer": "Oral amoxicillin-clavulanate therapy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "44", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. A 44-year-old woman comes to the physician.", "2. She has pain and swelling below her left eye for 3 days.", "3. She has had excessive watering from her eyes during this period.", "4. She has no history of serious illness.", "5. She takes no medications.", "6. Her temperature is 37\u00b0C (98.6\u00b0F).", "7. Her pulse is 90/min.", "8. Her blood pressure is 110/70 mm Hg.", "9. Examination shows erythema, tenderness, warmth, and swelling below the medial canthus of the left eye.", "10. There is purulent discharge from the lower lacrimal punctum on palpation of the swelling.", "11. The remainder of the examination shows no abnormalities.", "12. The discharge is sent for cultures."], "atomic_facts": ["1. Excessive watering from her eyes", "2. No history of serious illness", "3. Takes no medications", "4. Temperature is 37\u00b0C (98.6\u00b0F)", "5. Pulse is 90/min", "6. Blood pressure is 110/70 mm Hg", "7. Examination shows erythema, tenderness, warmth, and swelling below the medial canthus of the left eye", "8. Purulent discharge from the lower lacrimal punctum on palpation of the swelling", "9. The remainder of the examination shows no abnormalities", "10. The discharge is sent for cultures"]}
{"id": 958, "question": "Which of the following is the most likely cause of these findings?\"", "context": ["A 40-year-old man comes to the physician because of decreased sexual arousal and erectile dysfunction that has put strain on his marriage for the last year.", "He has also had fatigue and generalized weakness for the past 9 months.", "He has noticed his bowel movements have not been as frequent as usual.", "He has occasional dry coughing and back pain.", "He has not had fever, headache, or changes in vision.", "One year ago, he traveled to South Africa with his wife.", "He looks fatigued.", "He is 168 cm (5 ft 6 in) tall and weighs 89 kg (196 lb); BMI is 31.6 kg/m2.", "His temperature is 36.5\u00b0C (97.7\u00b0F), pulse is 50/min, and blood pressure is 125/90 mm Hg.", "Physical examination shows dry skin and a distended abdomen.", "Neurological examination reveals delayed deep tendon reflexes.", "Laboratory studies show: | Hemoglobin 11.0 g/dL | Platelet count 380,000/mm3 | Serum | Na+ 130 mEq/L | Cl- 97 mEq/L | K+ 4.5 mEq/L | HCO3- 25 mEq/L | Glucose 95 mg/dL | TSH 0.2 \u03bcU/mL | ."], "context_len": 12, "options": {"A": "Hemochromatosis", "B": "Pituitary adenoma", "C": "Graves disease", "D": "Hashimoto thyroiditis"}, "answer": "Pituitary adenoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "40 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 40-year-old man comes to the physician.", "2. He has decreased sexual arousal and erectile dysfunction.", "3. This has put strain on his marriage for the last year.", "4. He has had fatigue and generalized weakness for the past 9 months.", "5. He has noticed his bowel movements have not been as frequent as usual.", "6. He has occasional dry coughing and back pain.", "7. He has not had fever, headache, or changes in vision.", "8. One year ago, he traveled to South Africa with his wife.", "9. He looks fatigued.", "10. He is 168 cm (5 ft 6 in) tall.", "11. He weighs 89 kg (196 lb).", "12. His BMI is 31.6 kg/m2.", "13. His temperature is 36.5\u00b0C (97.7\u00b0F).", "14. His pulse is 50/min.", "15. His blood pressure is 125/90 mm Hg.", "16. Physical examination shows dry skin and a distended abdomen.", "17. Neurological examination reveals delayed deep tendon reflexes.", "18. Laboratory studies show: Hemoglobin 11.0 g/dL.", "19. Laboratory studies show: Platelet count 380,000/mm3.", "20. Laboratory studies show: Serum Na+ 130 mEq/L.", "21. Laboratory studies show: Cl- 97 mEq/L.", "22. Laboratory studies show: K+ 4.5 mEq/L.", "23. Laboratory studies show: HCO3- 25 mEq/L.", "24. Laboratory studies show: Glucose 95 mg/dL.", "25. Laboratory studies show: TSH 0.2 \u03bcU/mL."], "atomic_facts": ["1. He has had fatigue and generalized weakness for the past 9 months.", "2. His bowel movements have not been as frequent as usual.", "3. He has occasional dry coughing and back pain.", "4. He has not had fever, headache, or changes in vision.", "5. One year ago, he traveled to South Africa with his wife.", "6. He looks fatigued.", "7. He is 168 cm (5 ft 6 in) tall and weighs 89 kg (196 lb); BMI is 31.6 kg/m2.", "8. His temperature is 36.5\u00b0C (97.7\u00b0F), pulse is 50/min, and blood pressure is 125/90 mm Hg.", "9. Physical examination shows dry skin and a distended abdomen.", "10. Neurological examination reveals delayed deep tendon reflexes.", "11. Laboratory studies show: Hemoglobin 11.0 g/dL, Platelet count 380,000/mm3, Serum Na+ 130 mEq/L, Cl- 97 mEq/L, K+ 4.5 mEq/L, HCO3- 25 mEq/L, Glucose 95 mg/dL, TSH 0.2 \u03bcU/mL."]}
{"id": 959, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 52-year-old man with limited, unresectable small cell lung cancer comes to the emergency department because of fever for the past 2 days.", "He has been on numerous chemotherapy regimens.", "His last round of treatment was with cisplatin and etoposide and ended 10 days ago.", "He feels fatigued but has not had nausea or vomiting.", "His temperature is 38.5\u00b0C (101.3\u00b0F), blood pressure is 100/60 mm Hg, and pulse is 115/min.", "The lungs are clear to auscultation.", "Examination shows a soft, nontender abdomen.", "Laboratory studies show: | Hemoglobin 10.2 g/dL | Leukocyte count 4,000/mm3 | Total neutrophils 8% | Eosinophils 2% | Lymphocytes 80% | Monocytes 10% | Urinalysis shows no abnormalities.", "Blood culture samples are obtained."], "context_len": 9, "options": {"A": "Cefepime", "B": "Piperacillin", "C": "Clindamycin", "D": "High-resolution chest CT"}, "answer": "Cefepime", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "52 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 52-year-old man has limited, unresectable small cell lung cancer.", "2. He has been on numerous chemotherapy regimens.", "3. His last round of treatment was with cisplatin and etoposide and ended 10 days ago.", "4. He has had fever for the past 2 days.", "5. He feels fatigued but has not had nausea or vomiting.", "6. His temperature is 38.5\u00b0C (101.3\u00b0F).", "7. His blood pressure is 100/60 mm Hg.", "8. His pulse is 115/min.", "9. The lungs are clear to auscultation.", "10. His hemoglobin is 10.2 g/dL.", "11. His leukocyte count is 4,000/mm3.", "12. His total neutrophils are 8%.", "13. His eosinophils are 2%.", "14. His lymphocytes are 80%.", "15. His monocytes are 10%.", "16. His urinalysis shows no abnormalities.", "17. Blood culture samples are obtained."], "atomic_facts": ["1. He has been on numerous chemotherapy regimens.", "2. His last round of treatment was with cisplatin and etoposide and ended 10 days ago.", "3. He feels fatigued but has not had nausea or vomiting.", "4. His temperature is 38.5\u00b0C (101.3\u00b0F), blood pressure is 100/60 mm Hg, and pulse is 115/min.", "5. The lungs are clear to auscultation.", "6. Examination shows a soft, nontender abdomen.", "7. Laboratory studies show: Hemoglobin 10.2 g/dL, Leukocyte count 4,000/mm3, Total neutrophils 8%, Eosinophils 2%, Lymphocytes 80%, Monocytes 10%.", "8. Urinalysis shows no abnormalities.", "9. Blood culture samples are obtained."]}
{"id": 960, "question": "Which of the following findings are most likely?", "context": ["A 28-year-old woman presents in respiratory distress.", "Auscultation of the lungs reveals bilateral crepitations and a friction rub.", "Lab findings show pancytopenia, proteinuria, and a false-positive test for syphilis.", "A chest X-ray shows bilateral pleural effusions."], "context_len": 4, "options": {"A": "Photosensitivity", "B": "Urethritis", "C": "Xerostomia", "D": "Esophageal dysmotility"}, "answer": "Photosensitivity", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 28-year-old woman presents in respiratory distress.", "2. Auscultation of the lungs reveals bilateral crepitations.", "3. Auscultation of the lungs reveals a friction rub.", "4. Lab findings show pancytopenia.", "5. Lab findings show proteinuria.", "6. Lab findings show a false-positive test for syphilis.", "7. A chest X-ray shows bilateral pleural effusions."], "atomic_facts": ["1. Auscultation of the lungs reveals bilateral crepitations.", "2. Auscultation of the lungs reveals a friction rub.", "3. Lab findings show pancytopenia.", "4. Lab findings show proteinuria.", "5. Lab findings show a false-positive test for syphilis.", "6. A chest X-ray shows bilateral pleural effusions."]}
{"id": 961, "question": "Which of the following is the most likely cause of this patient\u2019s presentation?", "context": ["A 2-month-old infant is brought in by his mother for runny nose and cough.", "She reports he had an ear infection 2 weeks ago, and since then he has had a productive cough and nasal congestion.", "His medical history is significant for multiple ear infections and eczematous dermatitis.", "He has also been hospitalized for 2 episodes of severe viral bronchiolitis.", "The mother reports that the infant has a good appetite but has had intermittent, non-bloody diarrhea.", "The patient is at the 20th percentile for weight.", "On physical examination, the patient has widespread, dry, erythematous patches, mucopurulent nasal drip, and crusting of the nares.", "His tongue is coated by a thick white film which is easily scraped off.", "Crackles are heard at the left lung base.", "Labs are drawn, as shown below: |  | Hemoglobin: 12.8 g/dL | Platelets: 280,000/mm^3 | Leukocytes: 7,500/mm^3 | Neutrophils: 5,500/mm^3 | Lymphocytes: 2,000/mm^3 |  | Serum: | Na+: 138 mEq/L | Cl-: 96 mEq/L | K+: 4.3 mEq/L | HCO3-: 23 mEq/L | Urea nitrogen: 18 mg/dL | Glucose: 90 mg/dL | Creatinine: 1.0 mg/dL | Ca2+: : 9.2 mg/dL |  | ."], "context_len": 10, "options": {"A": "22q11.2 deletion", "B": "Adenosine deaminase deficiency", "C": "Defective leukocyte adhesion", "D": "WAS gene mutation"}, "answer": "Adenosine deaminase deficiency", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "2 months", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2-month-old infant is brought in by his mother.", "2. The infant has a runny nose and cough.", "3. The mother reports he had an ear infection 2 weeks ago.", "4. Since then he has had a productive cough and nasal congestion.", "5. His medical history is significant for multiple ear infections and eczematous dermatitis.", "6. He has also been hospitalized for 2 episodes of severe viral bronchiolitis.", "7. The mother reports that the infant has a good appetite.", "8. The infant has intermittent, non-bloody diarrhea.", "9. The patient is at the 20th percentile for weight.", "10. On physical examination, the patient has widespread, dry, erythematous patches.", "11. The patient has mucopurulent nasal drip and crusting of the nares.", "12. His tongue is coated by a thick white film which is easily scraped off.", "13. Crackles are heard at the left lung base.", "14. Hemoglobin: 12.8 g/dL", "15. Platelets: 280,000/mm^3", "16. Leukocytes: 7,500/mm^3", "17. Neutrophils: 5,500/mm^3", "18. Lymphocytes: 2,000/mm^3", "19. Serum Na+: 138 mEq/L", "20. Serum Cl-: 96 mEq/L", "21. Serum K+: 4.3 mEq/L", "22. Serum HCO3-: 23 mEq/L", "23. Serum Urea nitrogen: 18 mg/dL", "24. Serum Glucose: 90 mg/dL", "25. Serum Creatinine: 1.0 mg/dL", "26. Serum Ca2+: 9.2 mg/dL"], "atomic_facts": ["1. She reports he had an ear infection 2 weeks ago", "2. Since then he has had a productive cough and nasal congestion", "3. His medical history is significant for multiple ear infections and eczematous dermatitis", "4. He has been hospitalized for 2 episodes of severe viral bronchiolitis", "5. The mother reports that the infant has a good appetite but has had intermittent, non-bloody diarrhea", "6. The patient is at the 20th percentile for weight", "7. On physical examination, the patient has widespread, dry, erythematous patches, mucopurulent nasal drip, and crusting of the nares", "8. His tongue is coated by a thick white film which is easily scraped off", "9. Crackles are heard at the left lung base", "10. Labs are drawn, as shown below:", "11. Hemoglobin: 12.8 g/dL", "12. Platelets: 280,000/mm^3", "13. Leukocytes: 7,500/mm^3", "14. Neutrophils: 5,500/mm^3", "15. Lymphocytes: 2,000/mm^3", "16. Serum: Na+: 138 mEq/L", "17. Cl-: 96 mEq/L", "18. K+: 4.3 mEq/L", "19. HCO3-: 23 mEq/L", "20. Urea nitrogen: 18 mg/dL", "21. Glucose: 90 mg/dL", "22. Creatinine: 1.0 mg/dL", "23. Ca2+: : 9.2 mg/dL"]}
{"id": 962, "question": "Which of the following is the most appropriate response in this patient\u2019s case?", "context": ["A 51-year-old inmate was released from prison 1 month ago and visits his general practitioner for evaluation of a positive HIV diagnosis he received from a local free clinic a week ago.", "The patient states that he had spent the last 2 years in prison and that, during that time, he had engaged in multiple unprotected sexual acts with fellow male inmates.", "When he was released from prison recently, he decided to get tested for HIV and was diagnosed positive.", "He is currently married with 2 children and has been paroled back to the home he shares with them.", "He has not told either his wife or his children of his diagnosis.", "He adamantly states that he is not homosexual, but that his wife would assume that he is if she found out he had contracted HIV while in prison.", "He states that he is terrified his wife will leave him or possibly keep his children from seeing him if she finds out about his HIV status.", " He wants to be treated without the threat of his wife finding out.", "He insists that he will use the proper precautions to ensure his wife and children don\u2019t contract HIV from him and reiterates the importance of keeping his diagnosis a secret.", "He continues and states that \u201cthey are all I have.", "If they leave me, I have no one.\u201d ."], "context_len": 11, "options": {"A": "Honor the patient\u2019s wishes and treat him without telling his wife or reporting him to the Department of Health", "B": "Tell the patient you will honor his wishes, but report him to the Department of Health so they can tell his wife", "C": "Consult an ethics committee to determine whether or not to report him to the Department of Health", "D": "Advise the patient the positive diagnosis will be reported to the public health office, but you would also encourage him to have a discussion with his family."}, "answer": "Advise the patient the positive diagnosis will be reported to the public health office, but you would also encourage him to have a discussion with his family.", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "51 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 51-year-old inmate was released from prison 1 month ago.", "2. He visits his general practitioner for evaluation of a positive HIV diagnosis he received from a local free clinic a week ago.", "3. He had spent the last 2 years in prison.", "4. During that time, he had engaged in multiple unprotected sexual acts with fellow male inmates.", "5. He is currently married with 2 children.", "6. He has been paroled back to the home he shares with them.", "7. He has not told either his wife or his children of his HIV diagnosis.", "8. He adamantly states that he is not homosexual.", "9. He is terrified his wife will leave him or possibly keep his children from seeing him if she finds out about his HIV status.", "10. He wants to be treated without the threat of his wife finding out.", "11. He insists that he will use the proper precautions to ensure his wife and children don\u2019t contract HIV from him.", "12. He reiterates the importance of keeping his diagnosis a secret.", "13. He states that \u201cthey are all I have. If they leave me, I have no one.\u201d"], "atomic_facts": ["1. The patient spent the last 2 years in prison.", "2. During his time in prison, he engaged in multiple unprotected sexual acts with fellow male inmates.", "3. He was diagnosed positive for HIV after getting tested upon release from prison.", "4. He is currently married with 2 children.", "5. He has been paroled back to the home he shares with his wife and children.", "6. He has not told his wife or children about his HIV diagnosis.", "7. He adamantly states that he is not homosexual.", "8. He fears his wife will assume he is homosexual if she finds out about his HIV status.", "9. He is terrified his wife will leave him or keep his children from seeing him if she finds out about his HIV status.", "10. He wants to be treated without his wife finding out.", "11. He insists on using proper precautions to ensure his wife and children don\u2019t contract HIV from him.", "12. He emphasizes the importance of keeping his diagnosis a secret.", "13. He states that his family is all he has and fears losing them."]}
{"id": 963, "question": "Which of the following adverse events is associated with the use of this agent?", "context": ["A 62-year-old man with end-stage renal disease is brought to the emergency department because of fever, severe abdominal pain, and shaking chills for 4 hours.", "His last hemodialysis was 2 days ago.", "On arrival, he appears ill and is poorly responsive.", "Blood cultures grow gram-positive, catalase-positive cocci that express mecA.", "Intravenous antibiotic therapy is begun with an agent that disrupts cell membranes by creating transmembrane channels."], "context_len": 5, "options": {"A": "Photosensitivity", "B": "Rhabdomyolysis", "C": "Ototoxicity", "D": "QT prolongation"}, "answer": "Rhabdomyolysis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "62 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 62-year-old man with end-stage renal disease is brought to the emergency department.", "2. He has fever, severe abdominal pain, and shaking chills for 4 hours.", "3. His last hemodialysis was 2 days ago.", "4. On arrival, he appears ill and is poorly responsive.", "5. Blood cultures grow gram-positive, catalase-positive cocci that express mecA.", "6. Intravenous antibiotic therapy is begun with an agent that disrupts cell membranes by creating transmembrane channels."], "atomic_facts": ["1. His last hemodialysis was 2 days ago.", "2. On arrival, he appears ill.", "3. On arrival, he is poorly responsive.", "4. Blood cultures grow gram-positive, catalase-positive cocci.", "5. The cocci express mecA.", "6. Intravenous antibiotic therapy is begun.", "7. The antibiotic disrupts cell membranes.", "8. The antibiotic creates transmembrane channels."]}
{"id": 964, "question": "Which of the following is the most likely origin of the injured muscles?", "context": ["A 25-year-old woman comes to the physician because of pain and weakness in her left leg that started 2 days ago while running a marathon.", "Physical examination shows impaired flexion of the left knee joint and impaired extension of the left hip joint.", "An MRI of the left lower extremity shows injury to the long head of the biceps femoris muscle and the semitendinosus muscle."], "context_len": 3, "options": {"A": "Ischial tuberosity", "B": "Anterior superior iliac spine", "C": "Greater trochanter", "D": "Linea aspera"}, "answer": "Ischial tuberosity", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 25-year-old woman comes to the physician.", "2. She has pain and weakness in her left leg.", "3. The pain and weakness started 2 days ago.", "4. She was running a marathon when the pain and weakness started.", "5. Physical examination shows impaired flexion of the left knee joint.", "6. Physical examination shows impaired extension of the left hip joint.", "7. An MRI of the left lower extremity shows injury to the long head of the biceps femoris muscle.", "8. An MRI of the left lower extremity shows injury to the semitendinosus muscle."], "atomic_facts": ["1. Physical examination shows impaired flexion of the left knee joint.", "2. Physical examination shows impaired extension of the left hip joint.", "3. MRI of the left lower extremity shows injury to the long head of the biceps femoris muscle.", "4. MRI of the left lower extremity shows injury to the semitendinosus muscle."]}
{"id": 965, "question": "Which of the following is most likely to improve the patient's ability to conceive?", "context": ["A 32-year-old man and his 29-year-old wife come to the physician because they have been unable to conceive despite regular unprotected sexual intercourse for 13 months.", "The woman reports regular menstrual cycles since the age of 13.", "Menses occur at regular 28-day intervals and last 5\u20137 days.", "Ovulation predictor kits consistently turn positive around day 14.", "The man has a negative history of mumps.", "They each smoked one pack of cigarettes per day until one year ago.", "The man works in construction and his wife is a secretary for a law firm.", "Examination of the scrotum in a standing position shows soft bands palpated in the upper pole of the left scrotum with an intact left testicle.", "Following Valsalva maneuver, the patient reports a dull, aching pain in his left hemiscrotum.", "A light held behind the scrotum does not shine through.", "The right scrotum appears normal.", "Semen studies show normal sperm count with moderately decreased motility and abnormal morphology."], "context_len": 12, "options": {"A": "Ligation of dilated pampiniform venous plexus", "B": "Conservative management with scrotal support", "C": "Surgical excision of the hydrocele sac", "D": "Administration of ceftriaxone and doxycycline"}, "answer": "Ligation of dilated pampiniform venous plexus", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "32", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Reproductive Endocrinology and Infertility"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 32-year-old man and a 29-year-old wife come to the physician.", "2. They have been unable to conceive despite regular unprotected sexual intercourse for 13 months.", "3. The woman reports regular menstrual cycles since the age of 13.", "4. Menses occur at regular 28-day intervals and last 5\u20137 days.", "5. Ovulation predictor kits consistently turn positive around day 14.", "6. The man has a negative history of mumps.", "7. They each smoked one pack of cigarettes per day until one year ago.", "8. The man works in construction.", "9. The wife is a secretary for a law firm.", "10. Examination of the scrotum in a standing position shows soft bands palpated in the upper pole of the left scrotum with an intact left testicle.", "11. Following Valsalva maneuver, the patient reports a dull, aching pain in his left hemiscrotum.", "12. A light held behind the scrotum does not shine through.", "13. The right scrotum appears normal.", "14. Semen studies show normal sperm count with moderately decreased motility and abnormal morphology."], "atomic_facts": ["1. The woman reports regular menstrual cycles since the age of 13.", "2. Menses occur at regular 28-day intervals and last 5\u20137 days.", "3. Ovulation predictor kits consistently turn positive around day 14.", "4. The man has a negative history of mumps.", "5. They each smoked one pack of cigarettes per day until one year ago.", "6. The man works in construction and his wife is a secretary for a law firm.", "7. Examination of the scrotum in a standing position shows soft bands palpated in the upper pole of the left scrotum with an intact left testicle.", "8. Following Valsalva maneuver, the patient reports a dull, aching pain in his left hemiscrotum.", "9. A light held behind the scrotum does not shine through.", "10. The right scrotum appears normal.", "11. Semen studies show normal sperm count with moderately decreased motility and abnormal morphology."]}
{"id": 966, "question": "Which of the following personality disorders best characterizes this patient?", "context": ["A 29-year-old man comes into his primary care physician's office with a chief complaint of a cough.", "The patient states that the cough started yesterday and he is asking if he needs antibiotics.", "While conversing with the patient, you note that he seems cold, mistrustful, and does not display much emotion.", "The patient worked for a software company but recently took a different position that allows him to work from home.", "The patient states that he switched positions because while at the office he made a mistake during a presentation.", "He felt that afterwards, his fellow workers thought less of him and he was embarrassed to show his face around the office.", "The patient wishes he could have related better to his coworkers.", "He currently lives in a barn on the outskirts of town with his many cats.", "On physical exam you note a healthy young man, adorned in overalls and denim shoes.", "His physical exam is notable for erythema of the posterior pharynx.", "The patient is informed that he has a viral upper respiratory infection and is sent home with instructions to rest and hydrate himself."], "context_len": 11, "options": {"A": "Avoidant", "B": "Schizoid", "C": "Schizotypal", "D": "Paranoid"}, "answer": "Avoidant", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "29", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is 29 years old.", "2. Chief complaint is a cough.", "3. Cough started yesterday.", "4. Patient is cold, mistrustful, and does not display much emotion.", "5. Patient worked for a software company.", "6. Patient recently took a different position that allows him to work from home.", "7. Patient switched positions because of a mistake during a presentation.", "8. Patient felt his coworkers thought less of him after the mistake.", "9. Patient wishes he could have related better to his coworkers.", "10. Patient currently lives in a barn on the outskirts of town with his many cats.", "11. On physical exam patient is healthy and adorned in overalls and denim shoes.", "12. Physical exam is notable for erythema of the posterior pharynx.", "13. Patient has a viral upper respiratory infection.", "14. Patient is sent home with instructions to rest and hydrate himself."], "atomic_facts": ["1. The patient states that the cough started yesterday.", "2. The patient is asking if he needs antibiotics.", "3. The patient seems cold, mistrustful, and does not display much emotion.", "4. The patient worked for a software company.", "5. The patient recently took a different position that allows him to work from home.", "6. The patient switched positions because he made a mistake during a presentation at the office.", "7. The patient felt embarrassed to show his face around the office.", "8. The patient wishes he could have related better to his coworkers.", "9. The patient currently lives in a barn on the outskirts of town with his many cats.", "10. On physical exam, a healthy young man is noted, adorned in overalls and denim shoes.", "11. The physical exam is notable for erythema of the posterior pharynx.", "12. The patient is informed that he has a viral upper respiratory infection.", "13. The patient is sent home with instructions to rest and hydrate himself."]}
{"id": 967, "question": "Which of the following is true about informed consent in this case?", "context": ["A 49-year-old man is undergoing an elective hernia repair.", "No significant past medical history or current medications.", "The patient has been working as a cardiovascular surgeon in the same hospital for the past 15 years.", "In obtaining informed consent, the patient\u2019s doctor has described all the available options for the procedure with their pros and cons, has offered different materials for the hernioplasty, and described the exact procedure.", "He has not focused too much on the possible complications and the risks and benefits of not performing the operation, because the patient insists he already knows everything that can happen since he is a surgeon himself.", "The patient has given his consent, but on the day of the operation, he changes his mind regarding the material of the synthetic mesh to be used for the hernioplasty."], "context_len": 6, "options": {"A": "The informed consent obtained from this patient in this hospital is invalid because he works in the hospital.", "B": "There is no need to receive an informed consent from a patient who is a doctor himself.", "C": "The patient\u2019s doctor should have included possible complications of the given operation and risks and benefits of not performing it, regardless of the patient\u2019s education or prior experience.", "D": "Even though the patient has changed his mind about the type of mesh material, since the basic procedure is still the same, informed consent does not need to be obtained from the patient again."}, "answer": "The patient\u2019s doctor should have included possible complications of the given operation and risks and benefits of not performing it, regardless of the patient\u2019s education or prior experience.", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "49", "specialties": ["Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. Patient is 49 years old.", "2. Patient has no significant past medical history or current medications.", "3. Patient has been working as a cardiovascular surgeon in the same hospital for the past 15 years.", "4. Doctor has described all the available options for the procedure with their pros and cons.", "5. Doctor has offered different materials for the hernioplasty.", "6. Doctor has described the exact procedure.", "7. Doctor has not focused too much on the possible complications and the risks and benefits of not performing the operation.", "8. Patient has given his consent.", "9. On the day of the operation, patient changes his mind regarding the material of the synthetic mesh to be used for the hernioplasty."], "atomic_facts": ["1. No significant past medical history", "2. No current medications", "3. The patient has been working as a cardiovascular surgeon in the same hospital for the past 15 years", "4. The patient's doctor has described all the available options for the procedure with their pros and cons", "5. The doctor has offered different materials for the hernioplasty", "6. The doctor has described the exact procedure", "7. The doctor has not focused too much on the possible complications and the risks and benefits of not performing the operation", "8. The patient insists he already knows everything that can happen since he is a surgeon himself", "9. The patient has given his consent", "10. On the day of the operation, the patient changes his mind regarding the material of the synthetic mesh to be used for the hernioplasty"]}
{"id": 968, "question": "What is the mechanism of action of the drug most likely responsible for the patient\u2019s complaints?", "context": ["A 55-year-old man presents to his primary care provider complaining of blood clots in his urine.", "On further questioning, he also reports suprapubic discomfort and a feeling of bladder fullness with difficulty voiding.", "The patient reports recently starting treatment for a newly diagnosed non-Hodgkin lymphoma.", "Vital signs are within normal limits.", "Physical exam reveals pain on palpation of the suprapubic region."], "context_len": 5, "options": {"A": "Alkylating agent", "B": "Intercalating agent", "C": "Reverse transcriptase inhibitor", "D": "Microtubule inhibitor"}, "answer": "Alkylating agent", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 55-year-old man presents to his primary care provider.", "2. He is complaining of blood clots in his urine.", "3. On further questioning, he also reports suprapubic discomfort.", "4. He also reports a feeling of bladder fullness with difficulty voiding.", "5. The patient reports recently starting treatment for a newly diagnosed non-Hodgkin lymphoma.", "6. Vital signs are within normal limits.", "7. Physical exam reveals pain on palpation of the suprapubic region."], "atomic_facts": ["1. The patient reports suprapubic discomfort.", "2. The patient reports a feeling of bladder fullness.", "3. The patient reports difficulty voiding.", "4. The patient has been recently diagnosed with non-Hodgkin lymphoma.", "5. Vital signs are within normal limits.", "6. Physical exam reveals pain on palpation of the suprapubic region."]}
{"id": 969, "question": "Which of the following is most likely to confirm the most likely diagnosis in this patient?", "context": ["A 25-year-old man presents to his primary care physician with lower back pain.", "He states that he has had the pain for the past two years.", "The patient works as a butcher, and recently was moving heavy meat carcasses.", "The patient states that his pain is worse in the morning and that nothing improves it aside from swimming.", "The patient has a past medical history of anabolic steroid abuse, acne, hypertension and obesity.", "His current medications are hydrochlorothiazide, ibuprofen, topical benzoyl peroxide, and acetaminophen.", "On physical exam there is no tenderness upon palpation of the spine.", "There is limited range of motion of the spine in all 4 directions."], "context_len": 8, "options": {"A": "Radiograph of the spine", "B": "The straight leg test and the clinical presentation", "C": "MRI of the sacroiliac joint", "D": "HLA typing"}, "answer": "MRI of the sacroiliac joint", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "25", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Physical Medicine and Rehabilitation"}, "facts_old": ["1. Patient is 25 years old.", "2. Patient has lower back pain for two years.", "3. Patient works as a butcher.", "4. Patient recently moved heavy meat carcasses.", "5. Patient's pain is worse in the morning.", "6. Nothing improves patient's pain aside from swimming.", "7. Patient has past medical history of anabolic steroid abuse, acne, hypertension, and obesity.", "8. Patient's current medications are hydrochlorothiazide, ibuprofen, topical benzoyl peroxide, and acetaminophen.", "9. On physical exam, there is no tenderness upon palpation of the spine.", "10. On physical exam, there is limited range of motion of the spine in all 4 directions."], "atomic_facts": ["1. The patient has had pain for the past two years.", "2. The patient works as a butcher and recently moved heavy meat carcasses.", "3. The patient's pain is worse in the morning and only improves with swimming.", "4. The patient has a past medical history of anabolic steroid abuse, acne, hypertension, and obesity.", "5. The patient's current medications are hydrochlorothiazide, ibuprofen, topical benzoyl peroxide, and acetaminophen.", "6. On physical exam, there is no tenderness upon palpation of the spine.", "7. There is limited range of motion of the spine in all 4 directions."]}
{"id": 970, "question": "Which of the following may be associated with this patient\u2019s condition?", "context": ["A 42-year-old African American female presents to your clinic complaining of excessive thirst and urination.", "She reports that these symptoms began one week ago, and they have been affecting her ability to work as a schoolteacher.", "Labs are drawn and are listed below. |  | Serum: | Na+: 145 mEq/L | Cl-: 101 mEq/L | K+: 4.4 mEq/L | HCO3-: 25 mEq/L | Urea nitrogen: 24 mg/dL | Glucose: 115 mg/dL | Creatinine: 0.7 mg/dL | Hemoglobin: 10.5 g/dL | Hematocrit: 25% | Leukocyte count: 11,000/mm^3 | Platelets: 200,000/mm^3 |  | Urine: | Specific gravity: 1.006 | Epithelial cells: 5/hpf | Glucose: negative | Protein: 20 mg/dL | RBC: 6/hpf | WBC: 1/hpf | Leukocyte esterase: negative | Nitrites: negative | Bacterial: none |  | A water deprivation test is performed with the following results: |  | Serum osmolality: 305 mOsm/kg | Urine osmolality: 400 mOsm/kg | Urine specific gravity: 1.007 |  | Desmopressin is administered, and the patient's urine osmolality increases to 490 mOsm/kg.", "The patient's antidiuretic hormone is measured and is within normal limits."], "context_len": 4, "options": {"A": "Coarse tremor", "B": "Auditory hallucinations", "C": "Amenorrhea", "D": "Dactylitis"}, "answer": "Dactylitis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "42", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 42-year-old African American female.", "2. Patient is complaining of excessive thirst and urination.", "3. Symptoms began one week ago.", "4. Symptoms are affecting patient's ability to work as a schoolteacher.", "5. Serum Na+: 145 mEq/L", "6. Serum Cl-: 101 mEq/L", "7. Serum K+: 4.4 mEq/L", "8. Serum HCO3-: 25 mEq/L", "9. Serum Urea nitrogen: 24 mg/dL", "10. Serum Glucose: 115 mg/dL", "11. Serum Creatinine: 0.7 mg/dL", "12. Serum Hemoglobin: 10.5 g/dL", "13. Serum Hematocrit: 25%", "14. Serum Leukocyte count: 11,000/mm^3", "15. Serum Platelets: 200,000/mm^3", "16. Urine Specific gravity: 1.006", "17. Urine Epithelial cells: 5/hpf", "18. Urine Glucose: negative", "19. Urine Protein: 20 mg/dL", "20. Urine RBC: 6/hpf", "21. Urine WBC: 1/hpf", "22. Urine Leukocyte esterase: negative", "23. Urine Nitrites: negative", "24. Urine Bacterial: none", "25. Serum osmolality after water deprivation test: 305 mOsm/kg", "26. Urine osmolality after water deprivation test: 400 mOsm/kg", "27. Urine specific gravity after water deprivation test: 1.007", "28. Urine osmolality after desmopressin administration: 490 mOsm/kg", "29. Patient's antidiuretic hormone is within normal limits."], "atomic_facts": ["1. Symptoms began one week ago", "2. Symptoms affecting ability to work as a schoolteacher", "3. Serum sodium level: 145 mEq/L", "4. Serum chloride level: 101 mEq/L", "5. Serum potassium level: 4.4 mEq/L", "6. Serum bicarbonate level: 25 mEq/L", "7. Serum urea nitrogen level: 24 mg/dL", "8. Serum glucose level: 115 mg/dL", "9. Serum creatinine level: 0.7 mg/dL", "10. Serum hemoglobin level: 10.5 g/dL", "11. Serum hematocrit level: 25%", "12. Serum leukocyte count: 11,000/mm^3", "13. Serum platelet count: 200,000/mm^3", "14. Urine specific gravity: 1.006", "15. Urine epithelial cells: 5/hpf", "16. Urine glucose: negative", "17. Urine protein: 20 mg/dL", "18. Urine RBC: 6/hpf", "19. Urine WBC: 1/hpf", "20. Urine leukocyte esterase: negative", "21. Urine nitrites: negative", "22. Urine bacteria: none", "23. Serum osmolality: 305 mOsm/kg", "24. Urine osmolality: 400 mOsm/kg", "25. Urine specific gravity: 1.007", "26. Desmopressin administered", "27. Patient's urine osmolality increases to 490 mOsm/kg", "28. Patient's antidiuretic hormone within normal limits"]}
{"id": 971, "question": "This patient has most likely been treated with which of the following medications?", "context": ["A 42-year-old male with a history of schizophrenia presents to his psychiatrist for a normal follow-up visit.", "He is accompanied by his case manager.", "The patient was diagnosed with schizophrenia at the age of 27.", "After being trialed on two different medications, he was deemed to be stable on a third medication which he has been taking for the past 10 years.", "He reports that he occasionally hears voices.", "He lives in supportive housing, and his caretakers report that he prefers to be alone but is not disruptive.", "His temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 130/90 mmHg, pulse is 105/min, and respirations are 18/min.", "On exam, he demonstrates a flattened affect and disorganized speech.", "A funduscopic examination reveals pigmented plaques at the retinal periphery.", "No deposits are seen in the cornea or anterior lens."], "context_len": 10, "options": {"A": "Fluphenazine", "B": "Olanzapine", "C": "Chlorpromazine", "D": "Thioridazine"}, "answer": "Thioridazine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "42", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is 42 years old.", "2. Patient has a history of schizophrenia.", "3. Patient was diagnosed with schizophrenia at age 27.", "4. Patient was trialed on two different medications.", "5. Patient is stable on third medication for 10 years.", "6. Patient occasionally hears voices.", "7. Patient lives in supportive housing.", "8. Caretakers report patient prefers to be alone.", "9. Patient's temperature is 99\u00b0F (37.2\u00b0C).", "10. Patient's blood pressure is 130/90 mmHg.", "11. Patient's pulse is 105/min.", "12. Patient's respirations are 18/min.", "13. Patient demonstrates flattened affect and disorganized speech.", "14. Funduscopic examination reveals pigmented plaques at retinal periphery.", "15. No deposits seen in cornea or anterior lens."], "atomic_facts": ["1. He is accompanied by his case manager.", "2. The patient was diagnosed with schizophrenia at the age of 27.", "3. After being trialed on two different medications, he was deemed to be stable on a third medication which he has been taking for the past 10 years.", "4. He reports that he occasionally hears voices.", "5. He lives in supportive housing, and his caretakers report that he prefers to be alone but is not disruptive.", "6. His temperature is 99\u00b0F (37.2\u00b0C), blood pressure is 130/90 mmHg, pulse is 105/min, and respirations are 18/min.", "7. On exam, he demonstrates a flattened affect and disorganized speech.", "8. A funduscopic examination reveals pigmented plaques at the retinal periphery.", "9. No deposits are seen in the cornea or anterior lens."]}
{"id": 972, "question": "Further evaluation of this patient is most likely to show which of the following?", "context": ["A 6-month-old girl is brought to the emergency department because her lips turned blue for several minutes earlier during feeding.", "Her father reports that the patient had similar episodes while playing that resolved quickly.", "During the examination, she sits calmly in her father's lap.", "When her ears are examined, the patient begins to cry and her lips and fingers begin to turn blue."], "context_len": 4, "options": {"A": "Diminutive left ventricle on echocardiogram", "B": "Decreased blood pressure in both lower extremities", "C": "Pulmonary vascular congestion on chest x-ray", "D": "Right axis deviation on ECG"}, "answer": "Right axis deviation on ECG", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "6 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-month-old girl was brought to the emergency department.", "2. Her lips had turned blue for several minutes earlier during feeding.", "3. Her father reported similar episodes while playing that resolved quickly.", "4. During the examination, she was sitting calmly in her father's lap.", "5. When her ears were examined, the patient began to cry.", "6. Her lips and fingers began to turn blue."], "atomic_facts": ["1. The patient had similar episodes while playing.", "2. The episodes resolved quickly.", "3. The patient sits calmly in her father's lap during the examination.", "4. The patient begins to cry when her ears are examined.", "5. The patient's lips and fingers begin to turn blue during the examination."]}
{"id": 973, "question": "Which of the following mechanisms is responsible for the patient\u2019s current condition?", "context": ["A 52-year-old female presents to clinic complaining of sudden onset of flank tenderness that was fluctuating and radiating into her groin.", "Laboratory analysis reveals a serum calcium of 12.4 (normal 8.4-10.2) and a serum phosphorous of 2.5 (normal 2.7-4.5) and a chloride:phosphorous ratio >33.", "You suspect primary hyperparathyroidism."], "context_len": 3, "options": {"A": "PTH binding to receptors on osteoclasts", "B": "Parafollicular, or C-cell, synthesis of calcitonin", "C": "Increased RANK-L production", "D": "Decreased M-CSF production"}, "answer": "Increased RANK-L production", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "52", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 52-year-old female presents to clinic.", "2. Complaining of sudden onset of flank tenderness.", "3. Flank tenderness was fluctuating and radiating into her groin.", "4. Laboratory analysis reveals a serum calcium of 12.4.", "5. Normal range for serum calcium is 8.4-10.2.", "6. Laboratory analysis reveals a serum phosphorous of 2.5.", "7. Normal range for serum phosphorous is 2.7-4.5.", "8. Laboratory analysis reveals a chloride:phosphorous ratio >33.", "9. You suspect primary hyperparathyroidism."], "atomic_facts": ["1. Laboratory analysis reveals a serum calcium of 12.4 (normal 8.4-10.2).", "2. Laboratory analysis reveals a serum phosphorous of 2.5 (normal 2.7-4.5).", "3. Laboratory analysis reveals a chloride:phosphorous ratio >33.", "4. Suspected diagnosis: primary hyperparathyroidism."]}
{"id": 974, "question": "Further histological examination of the liver biopsy specimen is most likely to show which of the following findings?", "context": ["A 53-year-old man comes to the physician because of a 2-week history of fatigue, generalized itching, and yellowing of the eyes and skin.", "He underwent a liver transplantation because of acute liver failure following \u03b1-amanitin poisoning 1 year ago.", "Physical examination shows scleral icterus and abdominal distention with shifting dullness.", "A liver biopsy specimen shows decreased hepatic duct density."], "context_len": 4, "options": {"A": "Graft vessel vasculitis", "B": "Fibrinoid necrosis", "C": "Interstitial fibrosis", "D": "Viral inclusions\n\""}, "answer": "Interstitial fibrosis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "53 years old", "specialties": ["Gastroenterology", "Hepatology"], "subspecialties": ["General Gastroenterology", "General Hepatology", "Hepatology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 53-year-old man comes to the physician.", "2. He has a 2-week history of fatigue, generalized itching, and yellowing of the eyes and skin.", "3. He underwent a liver transplantation 1 year ago due to acute liver failure following \u03b1-amanitin poisoning.", "4. Physical examination shows scleral icterus and abdominal distention with shifting dullness.", "5. A liver biopsy specimen shows decreased hepatic duct density."], "atomic_facts": ["1. The patient underwent a liver transplantation.", "2. The reason for the transplantation was acute liver failure.", "3. The cause of the acute liver failure was \u03b1-amanitin poisoning.", "4. The poisoning occurred 1 year ago.", "5. Physical examination shows scleral icterus.", "6. Physical examination shows abdominal distention.", "7. Abdominal distention exhibits shifting dullness.", "8. A liver biopsy specimen was taken.", "9. The biopsy specimen shows decreased hepatic duct density."]}
{"id": 975, "question": "Which of the following echocardiographic findings is most likely in this patient?\"", "context": ["A 23-year-old man comes to the emergency department because of a 5-day history of progressively worsening dyspnea.", "He has had intermittent episodes of chest pain, which was 4/10 in intensity and increased on inspiration.", "He does triathlons and has not been able to train because of the discomfort.", "He has had no fever or syncopal episodes.", "He had an upper respiratory tract infection 3 weeks ago.", "His father died of heart disease at the age of 55 years.", "His temperature is 36.8\u00b0C (98.2\u00b0F), pulse is 113/min, and blood pressure is 100/70 mm Hg.", "Examination shows jugular venous distention.", "Inspiratory crackles are heard throughout the thorax.", "Cardiac examination shows an S3 gallop.", "Laboratory studies show: | Hemoglobin 14.8 g/dL | Leukocyte count 9200/mm3 | Platelet count 230,000/mm3 | ESR 41 mm/hr | Serum | Creatinine 1.1 mg/dL | Glucose 92 mg/dL | LDH 120 U/L | Troponin I 0.204 ng/mL (N< 0.1 ng/mL) | An x-ray of the chest shows an enlarged cardiac silhouette and prominent vascular markings in both lung fields.", "An ECG shows diffuse T-wave inversions."], "context_len": 12, "options": {"A": "Swinging heart with compression of the left heart chambers", "B": "Mitral valve stenosis with left atrial enlargement", "C": "Left ventricular dilation and global hypokinesis", "D": "Vegetations on the mitral valve"}, "answer": "Left ventricular dilation and global hypokinesis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "23 years old", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Echocardiography", "Cardiovascular Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 23-year-old man comes to the emergency department.", "2. He has had a 5-day history of progressively worsening dyspnea.", "3. He has had intermittent episodes of chest pain, which was 4/10 in intensity and increased on inspiration.", "4. He does triathlons and has not been able to train because of the discomfort.", "5. He has had no fever or syncopal episodes.", "6. He had an upper respiratory tract infection 3 weeks ago.", "7. His father died of heart disease at the age of 55 years.", "8. His temperature is 36.8\u00b0C (98.2\u00b0F).", "9. His pulse is 113/min.", "10. His blood pressure is 100/70 mm Hg.", "11. Examination shows jugular venous distention.", "12. Inspiratory crackles are heard throughout the thorax.", "13. Cardiac examination shows an S3 gallop.", "14. Laboratory studies show: Hemoglobin 14.8 g/dL.", "15. Laboratory studies show: Leukocyte count 9200/mm3.", "16. Laboratory studies show: Platelet count 230,000/mm3.", "17. Laboratory studies show: ESR 41 mm/hr.", "18. Laboratory studies show: Serum Creatinine 1.1 mg/dL.", "19. Laboratory studies show: Glucose 92 mg/dL.", "20. Laboratory studies show: LDH 120 U/L.", "21. Laboratory studies show: Troponin I 0.204 ng/mL (N< 0.1 ng/mL).", "22. An x-ray of the chest shows an enlarged cardiac silhouette and prominent vascular markings in both lung fields.", "23. An ECG shows diffuse T-wave inversions."], "atomic_facts": ["1. He has had intermittent episodes of chest pain, which was 4/10 in intensity and increased on inspiration.", "2. He does triathlons and has not been able to train because of the discomfort.", "3. He has had no fever or syncopal episodes.", "4. He had an upper respiratory tract infection 3 weeks ago.", "5. His father died of heart disease at the age of 55 years.", "6. His temperature is 36.8\u00b0C (98.2\u00b0F), pulse is 113/min, and blood pressure is 100/70 mm Hg.", "7. Examination shows jugular venous distention.", "8. Inspiratory crackles are heard throughout the thorax.", "9. Cardiac examination shows an S3 gallop.", "10. Laboratory studies show: Hemoglobin 14.8 g/dL, Leukocyte count 9200/mm3, Platelet count 230,000/mm3, ESR 41 mm/hr, Serum Creatinine 1.1 mg/dL, Glucose 92 mg/dL, LDH 120 U/L, Troponin I 0.204 ng/mL (N< 0.1 ng/mL).", "11. An x-ray of the chest shows an enlarged cardiac silhouette and prominent vascular markings in both lung fields.", "12. An ECG shows diffuse T-wave inversions."]}
{"id": 976, "question": "The obstruction in this patient is most likely caused by which of the following structures?", "context": ["Two days after undergoing abdominal surgery for lysis of adhesions, a 52-year-old man has nausea and one episode of bilious vomiting.", "The patient's nausea is somewhat alleviated in the prone position.", "The patient has had a 70-kg (154-lb) weight loss since undergoing bariatric surgery 1 year ago.", "Physical examination shows abdominal distention.", "Sudden movement of the patient elicits a sloshing sound on auscultation of the abdomen.", "An upper gastrointestinal series of the abdomen with oral contrast shows no passage of contrast past the third segment of the duodenum."], "context_len": 6, "options": {"A": "Superior mesenteric artery", "B": "Common bile duct", "C": "Portal vein", "D": "Inferior vena cava"}, "answer": "Superior mesenteric artery", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "52 years old", "specialties": ["General Surgery", "Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 52-year-old man underwent abdominal surgery for lysis of adhesions two days ago.", "2. The patient has nausea and one episode of bilious vomiting.", "3. The patient's nausea is somewhat alleviated in the prone position.", "4. The patient has had a 70-kg (154-lb) weight loss since undergoing bariatric surgery 1 year ago.", "5. Physical examination shows abdominal distention.", "6. Sudden movement of the patient elicits a sloshing sound on auscultation of the abdomen.", "7. An upper gastrointestinal series of the abdomen with oral contrast shows no passage of contrast past the third segment of the duodenum."], "atomic_facts": ["1. The patient's nausea is somewhat alleviated in the prone position.", "2. The patient has had a 70-kg (154-lb) weight loss since undergoing bariatric surgery 1 year ago.", "3. Physical examination shows abdominal distention.", "4. Sudden movement of the patient elicits a sloshing sound on auscultation of the abdomen.", "5. An upper gastrointestinal series of the abdomen with oral contrast shows no passage of contrast past the third segment of the duodenum."]}
{"id": 977, "question": "Which of the following is the most likely diagnosis?", "context": ["A 16-year-old girl is brought to the physician because her mother is concerned about her lack of appetite and poor weight gain.", "She has had a 7-kg (15-lb) weight loss over the past 3 months.", "The patient states that she should try to lose more weight because she does not want to be overweight anymore.", "She maintains a diary of her daily calorie intake.", "Menarche was at the age of 13 years, and her last menstrual period was 3 months ago.", "She is on the high school track team.", "She is sexually active with 2 male partners and uses condoms inconsistently.", "She is at 50th percentile for height and below the 5th percentile for weight and BMI.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 58/min and blood pressure is 96/60 mm Hg.", "Examination shows fine hair over the trunk and extremities."], "context_len": 10, "options": {"A": "HIV infection", "B": "Type 1 diabetes mellitus", "C": "Hyperthyroidism", "D": "Anorexia nervosa"}, "answer": "Anorexia nervosa", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "16 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology", "Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is 16 years old.", "2. Patient has had a 7-kg (15-lb) weight loss over the past 3 months.", "3. Patient states she should try to lose more weight.", "4. Patient maintains a diary of her daily calorie intake.", "5. Patient's menarche was at the age of 13 years.", "6. Patient's last menstrual period was 3 months ago.", "7. Patient is on the high school track team.", "8. Patient is sexually active with 2 male partners.", "9. Patient uses condoms inconsistently.", "10. Patient is at 50th percentile for height.", "11. Patient is below the 5th percentile for weight and BMI.", "12. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "13. Patient's pulse is 58/min.", "14. Patient's blood pressure is 96/60 mm Hg.", "15. Examination shows fine hair over the trunk and extremities."], "atomic_facts": ["1. She has had a 7-kg (15-lb) weight loss over the past 3 months.", "2. The patient states that she should try to lose more weight because she does not want to be overweight anymore.", "3. She maintains a diary of her daily calorie intake.", "4. Menarche was at the age of 13 years, and her last menstrual period was 3 months ago.", "5. She is on the high school track team.", "6. She is sexually active with 2 male partners and uses condoms inconsistently.", "7. She is at 50th percentile for height and below the 5th percentile for weight and BMI.", "8. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 58/min and blood pressure is 96/60 mm Hg.", "9. Examination shows fine hair over the trunk and extremities."]}
{"id": 978, "question": "What is the most likely diagnosis in this patient?", "context": ["A 25-year-old male presents with progressively worsening headaches over the past two months.", "He also feels that he has been losing his balance more often over the past week, but he denies any motor weakness or sensory impairment.", "His neurological exam reveals impaired upward gaze, pupils that constrict poorly to light but react to accommodation, and bilateral upper eyelid retraction.", "On tandem walking, he tends to fall on both sides.", "The remainder of the physical examination is unremarkable."], "context_len": 5, "options": {"A": "Multiple sclerosis", "B": "Pituitary mass", "C": "Pineal tumor", "D": "Craniopharyngioma"}, "answer": "Pineal tumor", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "25", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "Vascular Neurology", "Headache Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 25 years old.", "2. Patient is male.", "3. Patient has had progressively worsening headaches for two months.", "4. Patient has been losing balance more often over the past week.", "5. Patient denies motor weakness or sensory impairment.", "6. Neurological exam reveals impaired upward gaze.", "7. Neurological exam reveals pupils constrict poorly to light but react to accommodation.", "8. Neurological exam reveals bilateral upper eyelid retraction.", "9. Patient tends to fall on both sides when tandem walking.", "10. Remainder of physical examination is unremarkable."], "atomic_facts": ["1. He feels that he has been losing his balance more often over the past week.", "2. He denies any motor weakness.", "3. He denies any sensory impairment.", "4. His neurological exam reveals impaired upward gaze.", "5. His pupils constrict poorly to light.", "6. His pupils react to accommodation.", "7. He has bilateral upper eyelid retraction.", "8. On tandem walking, he tends to fall on both sides.", "9. The remainder of the physical examination is unremarkable."]}
{"id": 979, "question": "What is the next best step in management?", "context": ["A 32-year-old woman presents to an urgent care facility after having sustained a deep cut 8 hours ago while hiking in the Appalachian mountains.", "Immediately after she sustained the injury she rinsed out the dirt with a bottle of saline from her first aid kit.", "She immigrated to the United States at age 20 and was unvaccinated upon arrival.", "Her medical records indicate that she has since received one dose of Tdap and one Td booster 3 years ago.", "She is afebrile, well appearing, and her wound appears clean without signs of infection at this time."], "context_len": 5, "options": {"A": "Tetanus immunoglobulin only", "B": "Tetanus titers and if negative, tetanus toxoid and immunoglobulin within 48 hours", "C": "Tetanus toxoid and tetanus immunoglobulin", "D": "Tetanus toxoid and tetanus immunoglobulin today; tetanus toxoid again on days 3, 7, and 14 after exposure"}, "answer": "Tetanus toxoid and tetanus immunoglobulin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "32", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 32-year-old woman presented to an urgent care facility.", "2. She sustained a deep cut 8 hours ago while hiking in the Appalachian mountains.", "3. Immediately after she sustained the injury she rinsed out the dirt with a bottle of saline from her first aid kit.", "4. She immigrated to the United States at age 20.", "5. She was unvaccinated upon arrival.", "6. Her medical records indicate that she has since received one dose of Tdap.", "7. She has also received one Td booster 3 years ago.", "8. She is afebrile.", "9. She is well appearing.", "10. Her wound appears clean without signs of infection at this time."], "atomic_facts": ["1. She sustained an injury.", "2. She rinsed out the dirt with a bottle of saline from her first aid kit.", "3. She immigrated to the United States at age 20.", "4. She was unvaccinated upon arrival in the United States.", "5. Her medical records indicate that she has received one dose of Tdap.", "6. Her medical records indicate that she has received one Td booster 3 years ago.", "7. She is afebrile.", "8. She is well appearing.", "9. Her wound appears clean without signs of infection at this time."]}
{"id": 980, "question": "Which of the following is associated with this patient's most likely diagnosis?", "context": ["A 39-year-old woman presents to the emergency department with a chief concern of abdominal pain.", "She states that her symptoms occurred shortly after she began eating dinner that evening.", "She states that the pain is in the right side of her abdomen and travels to her right shoulder.", "She has a past medical history of polycystic ovarian syndrome, obesity, type II diabetes mellitus, and hypertension.", "Her current medications include metformin, insulin, atorvastatin, aspirin, and lisinopril.", "Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 110/75 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 99% on room air.", "On abdominal exam, the patient demonstrates tenderness in the right upper quadrant.", "The patient is started on IV fluids and morphine.", "Four hours later, she states that the pain has abated."], "context_len": 9, "options": {"A": "Acetylcholine", "B": "Cholecystokinin", "C": "Gastrin", "D": "Secretin"}, "answer": "Cholecystokinin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "39 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 39 years old.", "2. Patient presents to the emergency department with abdominal pain.", "3. Symptoms began shortly after eating dinner.", "4. Pain is in the right side of the abdomen and travels to the right shoulder.", "5. Patient has a past medical history of polycystic ovarian syndrome, obesity, type II diabetes mellitus, and hypertension.", "6. Patient's current medications include metformin, insulin, atorvastatin, aspirin, and lisinopril.", "7. Patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "8. Patient's blood pressure is 110/75 mmHg.", "9. Patient's pulse is 90/min.", "10. Patient's respirations are 13/min.", "11. Patient's oxygen saturation is 99% on room air.", "12. Abdominal exam demonstrates tenderness in the right upper quadrant.", "13. Patient is started on IV fluids and morphine.", "14. Four hours later, patient states that the pain has abated."], "atomic_facts": ["1. The patient's symptoms occurred shortly after she began eating dinner that evening.", "2. The pain is in the right side of her abdomen and travels to her right shoulder.", "3. The patient has a past medical history of polycystic ovarian syndrome, obesity, type II diabetes mellitus, and hypertension.", "4. Her current medications include metformin, insulin, atorvastatin, aspirin, and lisinopril.", "5. Her temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 110/75 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 99% on room air.", "6. On abdominal exam, the patient demonstrates tenderness in the right upper quadrant.", "7. The patient is started on IV fluids and morphine.", "8. Four hours later, she states that the pain has abated."]}
{"id": 981, "question": "Which of the following is the most likely cause of the patient's symptoms?", "context": ["A 12-year-old girl is brought to the primary physician because of severe ear pain and yellow discharge from her left ear for the past 2 days.", "It is also mildly pruritic.", "The pain started during her last day of summer camp, where she spent a lot of time outdoors hiking, horseback riding, and swimming.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 76/min, and blood pressure is 110/75 mm Hg.", "Examination shows tragal tenderness and a red and edematous external auditory canal.", "A diagnostic tuning fork is placed in the middle of the patient's forehead.", "The patient reports hearing the sound more loudly in the left ear.", "To complete the workup, the tuning fork is placed on the mastoid process of the left ear.", "Once she can no longer hear the sound, the tuning fork is placed in front of the auricle, and she reports no longer hearing the sound.", "On the right side, once the sound from the mastoid process subsides and the tuning fork is placed in front of the right ear, she reports hearing the sound again."], "context_len": 10, "options": {"A": "Infection with Aspergillus species", "B": "Abnormal squamous epithelial growth", "C": "Infection with Pseudomonas aeruginosa", "D": "Pleomorphic replacement of normal bone\n\""}, "answer": "Infection with Pseudomonas aeruginosa", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "12 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 12 years old.", "2. Patient has severe ear pain and yellow discharge from left ear for 2 days.", "3. Patient's ear is mildly pruritic.", "4. Patient's pain started during last day of summer camp.", "5. Patient spent time outdoors hiking, horseback riding, and swimming.", "6. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "7. Patient's pulse is 76/min.", "8. Patient's blood pressure is 110/75 mm Hg.", "9. Examination shows tragal tenderness and red and edematous external auditory canal.", "10. Diagnostic tuning fork is placed in middle of patient's forehead.", "11. Patient reports hearing sound more loudly in left ear.", "12. Tuning fork is placed on mastoid process of left ear.", "13. Patient can no longer hear sound when tuning fork is placed in front of auricle.", "14. On right side, sound from mastoid process subsides and patient reports no longer hearing sound when tuning fork is placed in front of right ear."], "atomic_facts": ["1. The patient is experiencing mild pruritus.", "2. The pain started during the patient's last day of summer camp.", "3. The patient spent a lot of time outdoors hiking, horseback riding, and swimming.", "4. The patient's temperature is 37\u00b0C (98.6\u00b0F).", "5. The patient's pulse is 76/min.", "6. The patient's blood pressure is 110/75 mm Hg.", "7. Examination shows tragal tenderness.", "8. Examination shows a red and edematous external auditory canal.", "9. A diagnostic tuning fork is placed in the middle of the patient's forehead.", "10. The patient reports hearing the sound more loudly in the left ear.", "11. The tuning fork is placed on the mastoid process of the left ear.", "12. Once the patient can no longer hear the sound, the tuning fork is placed in front of the auricle, and she reports no longer hearing the sound.", "13. On the right side, once the sound from the mastoid process subsides and the tuning fork is placed in front of the right ear, she reports hearing the sound again."]}
{"id": 982, "question": "Which of the following is the most likely diagnosis?\"", "context": ["A 50-year-old man comes to the emergency department because of severe lower chest pain for the past hour.", "The pain radiates to the back and is associated with nausea.", "He has had two episodes of non-bloody vomiting since the pain started.", "He has a history of hypertension and type 2 diabetes mellitus.", "He has smoked one pack of cigarettes daily for 30 years.", "He drinks five to six beers per day.", "His medications include enalapril and metformin.", "His temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 110/min, and blood pressure is 90/60 mm Hg.", "The lungs are clear to auscultation.", "Examination shows a distended abdomen with epigastric tenderness and guarding but no rebound; bowel sounds are decreased.", "Laboratory studies show: | Hemoglobin 14.5 g/dL | Leukocyte count 5,100/mm3 | Platelet count 280,000/mm3 | Serum | Na+ 133 mEq/L | K+ 3.5 mEq/L | Cl- 98 mEq/L | Total bilirubin 1.0 mg/dL | Amylase 160 U/L | Lipase 880 U/L (N = 14\u2013280) | An ECG shows sinus tachycardia."], "context_len": 11, "options": {"A": "Acute mesenteric ischemia", "B": "Peptic ulcer disease", "C": "Myocardial infarction", "D": "Acute pancreatitis"}, "answer": "Acute pancreatitis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "50 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 50-year-old man.", "2. Patient has severe lower chest pain for the past hour that radiates to the back and is associated with nausea.", "3. Patient has had two episodes of non-bloody vomiting since the pain started.", "4. Patient has a history of hypertension and type 2 diabetes mellitus.", "5. Patient smokes one pack of cigarettes daily for 30 years.", "6. Patient drinks five to six beers per day.", "7. Patient's medications include enalapril and metformin.", "8. Patient's temperature is 38.5\u00b0C (101.3\u00b0F).", "9. Patient's pulse is 110/min.", "10. Patient's blood pressure is 90/60 mm Hg.", "11. Patient's lungs are clear to auscultation.", "12. Patient's abdomen is distended with epigastric tenderness and guarding but no rebound; bowel sounds are decreased.", "13. Patient's hemoglobin is 14.5 g/dL.", "14. Patient's leukocyte count is 5,100/mm3.", "15. Patient's platelet count is 280,000/mm3.", "16. Patient's serum Na+ is 133 mEq/L.", "17. Patient's serum K+ is 3.5 mEq/L.", "18. Patient's serum Cl- is 98 mEq/L.", "19. Patient's total bilirubin is 1.0 mg/dL.", "20. Patient's amylase is 160 U/L.", "21. Patient's lipase is 880 U/L (N = 14\u2013280).", "22. An ECG shows sinus tachycardia."], "atomic_facts": ["1. The pain radiates to the back and is associated with nausea.", "2. He has had two episodes of non-bloody vomiting since the pain started.", "3. He has a history of hypertension and type 2 diabetes mellitus.", "4. He has smoked one pack of cigarettes daily for 30 years.", "5. He drinks five to six beers per day.", "6. His medications include enalapril and metformin.", "7. His temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 110/min, and blood pressure is 90/60 mm Hg.", "8. The lungs are clear to auscultation.", "9. Examination shows a distended abdomen with epigastric tenderness and guarding but no rebound; bowel sounds are decreased.", "10. Laboratory studies show: Hemoglobin 14.5 g/dL, Leukocyte count 5,100/mm3, Platelet count 280,000/mm3, Serum Na+ 133 mEq/L, K+ 3.5 mEq/L, Cl- 98 mEq/L, Total bilirubin 1.0 mg/dL, Amylase 160 U/L, Lipase 880 U/L (N = 14\u2013280).", "11. An ECG shows sinus tachycardia."]}
{"id": 983, "question": "Which of the following tests is the best next step in evaluating this patient?", "context": ["A 29-year-old woman presents to the physician\u2019s office complaining of swollen hands for the past 3 weeks.", "It is associated with stiffness in the morning, which lasts about 10 minutes.", "The patient\u2019s medical history is significant for hypothyroidism that is managed with levothyroxine.", "She has no recent travel history.", "Vital signs are normal.", "On examination, the patient has a butterfly-shaped, non-blanching rash on her face with mild cervical lymphadenopathy.", "The metacarpophalangeal and proximal interphalangeal joints are tender and appear swollen.", "Cardiopulmonary examination reveals a grade 2/6 holosystolic murmur heard best at the apex."], "context_len": 8, "options": {"A": "Anti-double-stranded-DNA antibody", "B": "Anti-U1 ribonucleoprotein antibody", "C": "Antinuclear antibody", "D": "Anti-histone antibody"}, "answer": "Antinuclear antibody", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "29", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 29-year-old woman presents to the physician's office.", "2. She is complaining of swollen hands for the past 3 weeks.", "3. It is associated with stiffness in the morning, which lasts about 10 minutes.", "4. The patient's medical history is significant for hypothyroidism.", "5. She is managed with levothyroxine.", "6. She has no recent travel history.", "7. Vital signs are normal.", "8. On examination, the patient has a butterfly-shaped, non-blanching rash on her face.", "9. She has mild cervical lymphadenopathy.", "10. The metacarpophalangeal and proximal interphalangeal joints are tender and appear swollen.", "11. Cardiopulmonary examination reveals a grade 2/6 holosystolic murmur heard best at the apex."], "atomic_facts": ["1. Associated with stiffness in the morning", "2. Stiffness lasts about 10 minutes", "3. Patient's medical history includes hypothyroidism", "4. Hypothyroidism is managed with levothyroxine", "5. No recent travel history", "6. Vital signs are normal", "7. Patient has a butterfly-shaped, non-blanching rash on her face", "8. Patient has mild cervical lymphadenopathy", "9. Metacarpophalangeal joints are tender", "10. Proximal interphalangeal joints appear swollen", "11. Cardiopulmonary examination reveals a grade 2/6 holosystolic murmur", "12. Murmur is heard best at the apex"]}
{"id": 984, "question": "The structural changes in this patient's heart are most likely associated with which of the following?", "context": ["A 61-year-old male dies in a motor vehicle accident.", "Autopsy of the heart reveals dilatation of the left atrium and expansion of the left ventricular cavity with associated eccentric hypertrophy."], "context_len": 2, "options": {"A": "Pulmonic stenosis", "B": "Mitral insufficiency", "C": "Chronic hypertension", "D": "Congenital atrial septal defect"}, "answer": "Mitral insufficiency", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "61", "specialties": ["Cardiology", "Cardiovascular Disease"], "subspecialties": ["Adult Congenital Heart Disease", "Congenital Cardiac Surgery", "General Internal Medicine", "General Cardiology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 61-year-old male died.", "2. The cause of death was a motor vehicle accident.", "3. An autopsy of the heart was performed.", "4. The left atrium was dilated.", "5. The left ventricular cavity was expanded.", "6. Eccentric hypertrophy was associated with the expansion."], "atomic_facts": ["1. Autopsy of the heart was performed.", "2. Dilatation of the left atrium was observed.", "3. Expansion of the left ventricular cavity was observed.", "4. Eccentric hypertrophy was associated with the left ventricular cavity expansion."]}
{"id": 985, "question": "Which of the following changes best describes the direct effect of the prescribed medication on his cardiovascular physiology in the cardiac output/venous return versus right atrial pressure graph?", "context": ["A 52-year-old business executive presents to his physician with complaints of intermittent chest pain which started 2 months ago.", "He describes his pain as crushing, centrally located, and typically lasting about 5 minutes but never more than 10 minutes.", "The pain radiates to his left arm and jaw, occurs only when he climbs the stairs or runs on a treadmill, and is relieved by rest.", "He has been hypertensive and diabetic for the last 10 years and has been compliant with his medications.", "His physical exam findings are within normal limits.", "Lab tests are normal except for a significantly elevated LDL-cholesterol level.", "A stress ECG shows ST-segment depression in the anterior chest leads when his heart rate and blood pressure increase to over 40% from their baseline values.", "The physician decides to initiate a medication to relieve his symptoms."], "context_len": 8, "options": {"A": "i", "B": "iii", "C": "iv", "D": "vi"}, "answer": "iv", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 52-year-old business executive presents to his physician.", "2. He has intermittent chest pain which started 2 months ago.", "3. He describes his pain as crushing, centrally located, and typically lasting about 5 minutes but never more than 10 minutes.", "4. The pain radiates to his left arm and jaw.", "5. The pain occurs only when he climbs the stairs or runs on a treadmill.", "6. The pain is relieved by rest.", "7. He has been hypertensive and diabetic for the last 10 years.", "8. He has been compliant with his medications.", "9. His physical exam findings are within normal limits.", "10. Lab tests are normal except for a significantly elevated LDL-cholesterol level.", "11. A stress ECG shows ST-segment depression in the anterior chest leads when his heart rate and blood pressure increase to over 40% from their baseline values.", "12. The physician decides to initiate a medication to relieve his symptoms."], "atomic_facts": ["1. Patient describes pain as crushing, centrally located, and lasting about 5 minutes but never more than 10 minutes.", "2. Pain radiates to left arm and jaw, occurs only when climbing stairs or running on a treadmill, and is relieved by rest.", "3. Patient has been hypertensive and diabetic for the last 10 years and has been compliant with medications.", "4. Physical exam findings are within normal limits.", "5. Lab tests are normal except for significantly elevated LDL-cholesterol level.", "6. Stress ECG shows ST-segment depression in the anterior chest leads when heart rate and blood pressure increase to over 40% from baseline values.", "7. Physician decides to initiate a medication to relieve symptoms."]}
{"id": 986, "question": "Mutations in which of the following genes are most likely responsible for these findings?", "context": ["A 34-year-old man comes to the physician for a follow-up appointment.", "He was diagnosed with HIV 6 years ago and has been on highly active antiretroviral therapy with emtricitabine, tenofovir, and darunavir.", "He reports that he has been compliant with his medication regimen.", "His last CD4+ T-lymphocyte count was 520/mm3 (N > 500) and HIV viral load was undetectable.", "Today, his CD4+ T-lymphocyte count is 410/mm3 and his HIV viral load is 240 copies/mL.", "Further evaluation shows resistance to emtricitabine and tenofovir."], "context_len": 6, "options": {"A": "tat", "B": "pol", "C": "rev", "D": "env"}, "answer": "pol", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "34", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["General Medical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 34-year-old man comes to the physician for a follow-up appointment.", "2. He was diagnosed with HIV 6 years ago.", "3. He has been on highly active antiretroviral therapy with emtricitabine, tenofovir, and darunavir.", "4. He reports that he has been compliant with his medication regimen.", "5. His last CD4+ T-lymphocyte count was 520/mm3 (N > 500).", "6. His last HIV viral load was undetectable.", "7. Today, his CD4+ T-lymphocyte count is 410/mm3.", "8. Today, his HIV viral load is 240 copies/mL.", "9. Further evaluation shows resistance to emtricitabine and tenofovir."], "atomic_facts": ["1. Diagnosed with HIV 6 years ago", "2. On highly active antiretroviral therapy", "3. Medication regimen includes emtricitabine, tenofovir, and darunavir", "4. Reports compliance with medication regimen", "5. Last CD4+ T-lymphocyte count was 520/mm3 (N > 500)", "6. Last HIV viral load was undetectable", "7. Today's CD4+ T-lymphocyte count is 410/mm3", "8. Today's HIV viral load is 240 copies/mL", "9. Shows resistance to emtricitabine and tenofovir"]}
{"id": 987, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 61-year-old woman with a history of stage IV pancreatic cancer comes to the emergency department with insomnia due to intractable midepigastric pain.", "The pain had been constant for months but has worsened over the past few weeks despite the fact that she is already taking hydrocodone 10 mg and ibuprofen 400 mg.", "She has a past medical history of chronic pain and major depressive disorder.", "In the past month, she has been taking her pain medications with increasing frequency, going from twice a day to four times a day.", "Her other medications include venlafaxine and eszopiclone.", "She describes her mood as low, but states she does not have any suicidal thoughts.", "She appears fatigued and slightly cachectic.", "Her temperature is 36\u00b0C (96.8\u00b0F), pulse is 100/min, and blood pressure is 128/65 mm Hg.", "Physical examination shows a mass in the midepigastric region."], "context_len": 9, "options": {"A": "Discontinue hydrocodone and ibuprofen, and start IV ketorolac", "B": "Switch from hydrocodone to hydromorphone", "C": "Switch from eszopiclone to zolpidem", "D": "Allow the patient to take hydrocodone and ibuprofen up to every four hours\n\""}, "answer": "Switch from hydrocodone to hydromorphone", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "61 years old", "specialties": ["Pain Medicine", "Anesthesiology"], "subspecialties": ["General Pain Medicine", "Pain Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 61-year-old woman.", "2. Patient has a history of stage IV pancreatic cancer.", "3. Patient presents to the emergency department with insomnia due to intractable midepigastric pain.", "4. Pain has been constant for months but has worsened over the past few weeks.", "5. Patient is already taking hydrocodone 10 mg and ibuprofen 400 mg.", "6. Patient has a past medical history of chronic pain and major depressive disorder.", "7. Patient has been taking her pain medications with increasing frequency, going from twice a day to four times a day.", "8. Patient's other medications include venlafaxine and eszopiclone.", "9. Patient describes her mood as low, but states she does not have any suicidal thoughts.", "10. Patient appears fatigued and slightly cachectic.", "11. Patient's temperature is 36\u00b0C (96.8\u00b0F).", "12. Patient's pulse is 100/min.", "13. Patient's blood pressure is 128/65 mm Hg.", "14. Physical examination shows a mass in the midepigastric region."], "atomic_facts": ["1. The pain had been constant for months", "2. The pain has worsened over the past few weeks", "3. She is already taking hydrocodone 10 mg", "4. She is already taking ibuprofen 400 mg", "5. She has a past medical history of chronic pain", "6. She has a past medical history of major depressive disorder", "7. In the past month, she has been taking her pain medications with increasing frequency", "8. She has increased her pain medication frequency from twice a day to four times a day", "9. Her other medications include venlafaxine", "10. Her other medications include eszopiclone", "11. She describes her mood as low", "12. She states she does not have any suicidal thoughts", "13. She appears fatigued", "14. She appears slightly cachectic", "15. Her temperature is 36\u00b0C (96.8\u00b0F)", "16. Her pulse is 100/min", "17. Her blood pressure is 128/65 mm Hg", "18. Physical examination shows a mass in the midepigastric region"]}
{"id": 988, "question": "Which of the following is the most appropriate next step in management?", "context": ["Two days into hospitalization for pyelonephritis and sepsis, a 48-year-old woman develops severe sudden-onset dyspnea.", "She has no history of serious cardiopulmonary disease.", "She is fatigued and pale.", "Her blood pressure is 115/65 mm Hg, the pulse is 120/min, the respiratory rate is 36/min, and the temperature is 39.7\u00b0C (103.5\u00b0F).", "Her oxygen saturation is 80% on 60% FiO2.", "She has severe nasal flaring, supraclavicular and intercostal respiratory retractions, and paradoxical abdominal movements.", "Inspiratory crackles are heard over both lung fields.", "Cardiac examination shows no murmurs.", "A chest X-ray, taken before orotracheal intubation, is shown."], "context_len": 9, "options": {"A": "Broad-spectrum antibiotics", "B": "High-dose glucocorticoids", "C": "Intravenous fluids", "D": "Low tidal volume ventilation"}, "answer": "Low tidal volume ventilation", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "48 years old", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 48-year-old woman is hospitalized for pyelonephritis and sepsis. ", "2. Two days into hospitalization, she develops severe sudden-onset dyspnea. ", "3. She has no history of serious cardiopulmonary disease. ", "4. She is fatigued and pale. ", "5. Her blood pressure is 115/65 mm Hg. ", "6. Her pulse is 120/min. ", "7. Her respiratory rate is 36/min. ", "8. Her temperature is 39.7\u00b0C (103.5\u00b0F). ", "9. Her oxygen saturation is 80% on 60% FiO2. ", "10. She has severe nasal flaring, supraclavicular and intercostal respiratory retractions, and paradoxical abdominal movements. ", "11. Inspiratory crackles are heard over both lung fields. ", "12. Cardiac examination shows no murmurs. ", "13. A chest X-ray is taken before orotracheal intubation."], "atomic_facts": ["1. She has no history of serious cardiopulmonary disease.", "2. She is fatigued and pale.", "3. Her blood pressure is 115/65 mm Hg.", "4. Her pulse is 120/min.", "5. Her respiratory rate is 36/min.", "6. Her temperature is 39.7\u00b0C (103.5\u00b0F).", "7. Her oxygen saturation is 80% on 60% FiO2.", "8. She has severe nasal flaring.", "9. She has supraclavicular and intercostal respiratory retractions.", "10. She has paradoxical abdominal movements.", "11. Inspiratory crackles are heard over both lung fields.", "12. Cardiac examination shows no murmurs.", "13. A chest X-ray, taken before orotracheal intubation, is shown."]}
{"id": 989, "question": "In such a situation, which of the following vaccines should definitely be recommended to this patient?", "context": ["A 48-year-old man presents to the physician with a cough with expectoration and breathlessness on exertion for the last 4 years.", "There is no history of any other medical conditions.", "He has been a smoker for the last 10 years.", "He recently immigrated from a developing country and his immunization status is unknown.", "After a complete physical examination of the patient, the physician orders a chest radiogram which shows increased bronchovascular markings and flattening of the diaphragm.", "His spirometry findings include an FEV1 of 82% of predicted, which increases to 88% of predicted at 15 minutes after the administration of inhaled albuterol.", "The FEV1/FVC ratio is 0.66.", "The physician explains the diagnosis to the patient and emphasizes the importance of smoking cessation.", "He also offers him specific vaccinations.", "However, the patient mentions that he does not have medical insurance and due to his poor financial situation, he can afford only 1 of the suggested vaccines."], "context_len": 10, "options": {"A": "23-valent pneumococcal polysaccharide vaccine", "B": "Haemophilus influenzae type b vaccine", "C": "Influenza vaccine", "D": "Pertussis vaccine"}, "answer": "Influenza vaccine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "48 years old", "specialties": ["Pulmonary Disease", "Internal Medicine"], "subspecialties": ["General Pulmonary Disease", "Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 48-year-old man presents to the physician with a cough with expectoration and breathlessness on exertion for the last 4 years.", "2. There is no history of any other medical conditions.", "3. He has been a smoker for the last 10 years.", "4. He recently immigrated from a developing country and his immunization status is unknown.", "5. After a complete physical examination of the patient, the physician orders a chest radiogram which shows increased bronchovascular markings and flattening of the diaphragm.", "6. His spirometry findings include an FEV1 of 82% of predicted, which increases to 88% of predicted at 15 minutes after the administration of inhaled albuterol.", "7. The FEV1/FVC ratio is 0.66.", "8. The physician explains the diagnosis to the patient and emphasizes the importance of smoking cessation.", "9. He also offers him specific vaccinations.", "10. However, the patient mentions that he does not have medical insurance and due to his poor financial situation, he can afford only 1 of the suggested vaccines."], "atomic_facts": ["1. No history of any other medical conditions.", "2. He has been a smoker for the last 10 years.", "3. Recently immigrated from a developing country.", "4. Immunization status is unknown.", "5. Chest radiogram shows increased bronchovascular markings and flattening of the diaphragm.", "6. Spirometry findings include an FEV1 of 82% of predicted.", "7. FEV1 increases to 88% of predicted at 15 minutes after the administration of inhaled albuterol.", "8. FEV1/FVC ratio is 0.66.", "9. Physician emphasizes the importance of smoking cessation.", "10. Specific vaccinations offered.", "11. Patient does not have medical insurance.", "12. Can afford only 1 of the suggested vaccines."]}
{"id": 990, "question": "Which of the following cardiac abnormalities is associated with this condition?", "context": ["A five-year-old female presents to the pediatrician for a well visit.", "The patient\u2019s parents report that she recently entered kindergarten and her teacher expressed concern that the patient is not meeting developmental milestones.", "She struggles to name colors and has not expressed any interest in learning to read.", "The patient\u2019s parents have also noticed that the patient is not completing tasks that her older siblings were doing by this age, including dressing herself independently and going to the bathroom by herself.", "The patient rolled over at 9 months, sat without support at 12 months, and walked at 20 months.", "Her parents also report that the patient is very social, and that adults frequently comment on her friendly personality.", "The patient is in the 15th percentile for weight and 5th percentile for height.", "On physical exam, the patient has a broad forehead, flat nasal bridge, long philtrum, and a wide mouth.", "She has a strabismus on neurological exam, and her cardiac exam is significant for a heart murmur.", "Laboratory testing is below: |  | Serum: | Na+: 145 mEq/L | K+: 3.9 mEq/L | Cl-: 100 mEq/L | HCO3-: 24 mEq/ | Urea nitrogen: 11 mg/dL | Glucose: 76 mg/dL | Creatinine: 0.9 mg/dL | Ca2+: 11.9 mg/dL |  | ."], "context_len": 10, "options": {"A": "Bicuspid aortic valve", "B": "Coarctation of the aorta", "C": "Supravalvular aortic stenosis", "D": "Tetralogy of Fallot"}, "answer": "Supravalvular aortic stenosis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "5 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a five-year-old female.", "2. Patient recently entered kindergarten.", "3. Teacher expressed concern that patient is not meeting developmental milestones.", "4. Patient struggles to name colors.", "5. Patient has not expressed any interest in learning to read.", "6. Patient is not completing tasks that her older siblings were doing by this age.", "7. Patient rolled over at 9 months.", "8. Patient sat without support at 12 months.", "9. Patient walked at 20 months.", "10. Patient is very social.", "11. Adults frequently comment on patient's friendly personality.", "12. Patient is in the 15th percentile for weight.", "13. Patient is in the 5th percentile for height.", "14. Patient has a broad forehead.", "15. Patient has a flat nasal bridge.", "16. Patient has a long philtrum.", "17. Patient has a wide mouth.", "18. Patient has a strabismus on neurological exam.", "19. Patient has a heart murmur on cardiac exam.", "20. Serum Na+ is 145 mEq/L.", "21. Serum K+ is 3.9 mEq/L.", "22. Serum Cl- is 100 mEq/L.", "23. Serum HCO3- is 24 mEq/L.", "24. Serum urea nitrogen is 11 mg/dL.", "25. Serum glucose is 76 mg/dL.", "26. Serum creatinine is 0.9 mg/dL.", "27. Serum Ca2+ is 11.9 mg/dL."], "atomic_facts": ["1. The patient recently entered kindergarten.", "2. The patient's teacher expressed concern about her not meeting developmental milestones.", "3. The patient struggles to name colors.", "4. The patient has not expressed any interest in learning to read.", "5. The patient is not completing tasks her older siblings were doing at her age.", "6. The patient rolled over at 9 months.", "7. The patient sat without support at 12 months.", "8. The patient walked at 20 months.", "9. The patient is very social.", "10. Adults frequently comment on the patient's friendly personality.", "11. The patient is in the 15th percentile for weight.", "12. The patient is in the 5th percentile for height.", "13. On physical exam, the patient has a broad forehead.", "14. On physical exam, the patient has a flat nasal bridge.", "15. On physical exam, the patient has a long philtrum.", "16. On physical exam, the patient has a wide mouth.", "17. On neurological exam, the patient has a strabismus.", "18. On cardiac exam, the patient has a heart murmur.", "19. Serum Na+: 145 mEq/L", "20. Serum K+: 3.9 mEq/L", "21. Serum Cl-: 100 mEq/L", "22. Serum HCO3-: 24 mEq/", "23. Serum Urea nitrogen: 11 mg/dL", "24. Serum Glucose: 76 mg/dL", "25. Serum Creatinine: 0.9 mg/dL", "26. Serum Ca2+: 11.9 mg/dL"]}
{"id": 991, "question": "Which of the following is most likely to confirm the diagnosis in this patient?", "context": ["A 20-year-old male comes to the physician because of a 1-week-history of a painless ulceration on his penis.", "The patient is sexually active with multiple partners and does not use barrier protection.", "Physical examination shows a shallow, firm ulcer with a smooth base along the shaft of the penis and nontender bilateral inguinal adenopathy."], "context_len": 3, "options": {"A": "Tzanck preparation", "B": "Culture swab", "C": "Dark field microscopy", "D": "Serologic detection of antibodies"}, "answer": "Dark field microscopy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "20", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 20-year-old male comes to the physician.", "2. The patient has a 1-week-history of a painless ulceration on his penis.", "3. The patient is sexually active with multiple partners.", "4. The patient does not use barrier protection.", "5. Physical examination shows a shallow, firm ulcer with a smooth base along the shaft of the penis.", "6. Physical examination shows nontender bilateral inguinal adenopathy."], "atomic_facts": ["1. The patient is sexually active.", "2. The patient has multiple partners.", "3. The patient does not use barrier protection.", "4. Physical examination shows a shallow, firm ulcer.", "5. The ulcer has a smooth base.", "6. The ulcer is along the shaft of the penis.", "7. The ulcer is nontender.", "8. The patient has bilateral inguinal adenopathy."]}
{"id": 992, "question": "What additional finding is most likely to be present in this patient on physical examination?", "context": ["A 31-year-old man presents to the clinic as a follow-up visit after recently being diagnosed with medullary thyroid cancer.", "Last year, he was diagnosed with a pheochromocytoma that was successfully resected.", "His family history is positive for medullary thyroid cancer in his father and paternal grandmother with a mucosal neuroma in his brother."], "context_len": 3, "options": {"A": "Ash leaf spot", "B": "Pituitary adenoma", "C": "Neurofibromas", "D": "Marfanoid habitus"}, "answer": "Marfanoid habitus", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "31 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 31-year-old man presents to the clinic as a follow-up visit.", "2. He was recently diagnosed with medullary thyroid cancer.", "3. Last year, he was diagnosed with a pheochromocytoma.", "4. The pheochromocytoma was successfully resected.", "5. His family history is positive for medullary thyroid cancer in his father.", "6. His family history is positive for medullary thyroid cancer in his paternal grandmother.", "7. His brother has a mucosal neuroma."], "atomic_facts": ["1. Last year, he was diagnosed with a pheochromocytoma.", "2. The pheochromocytoma was successfully resected.", "3. His family history is positive for medullary thyroid cancer in his father.", "4. His family history is positive for medullary thyroid cancer in his paternal grandmother.", "5. His family history is positive for a mucosal neuroma in his brother."]}
{"id": 993, "question": "Resection of which of the following segments of the gastrointestinal tract would prevent the absorption of these digested lipids?", "context": ["Digestion begins in the mouth by breaking food up into smaller particles through mastication and mixing it with saliva containing amylase.", "Food then enters the stomach, where gastric acid and pepsin initiate protein digestion.", "The resulting chyme is then expelled into the duodenum where pancreatic enzymes, such as lipase and phospholipase-A2, digest lipids.", "These digested lipids are then ready for absorption across the gastrointestinal mucosa."], "context_len": 4, "options": {"A": "Jejunum", "B": "Ileum", "C": "Descending colon", "D": "Rectum"}, "answer": "Jejunum", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Digestion begins in the mouth.", "2. Food is broken up into smaller particles through mastication.", "3. Food is mixed with saliva containing amylase.", "4. Food then enters the stomach.", "5. Gastric acid and pepsin initiate protein digestion in the stomach.", "6. The resulting chyme is expelled into the duodenum.", "7. Pancreatic enzymes, such as lipase and phospholipase-A2, digest lipids in the duodenum.", "8. Digested lipids are ready for absorption across the gastrointestinal mucosa."], "atomic_facts": ["1. Food enters the stomach.", "2. Gastric acid and pepsin initiate protein digestion in the stomach.", "3. The resulting chyme is expelled into the duodenum.", "4. Pancreatic enzymes, such as lipase and phospholipase-A2, digest lipids in the duodenum.", "5. Digested lipids are ready for absorption across the gastrointestinal mucosa."]}
{"id": 994, "question": "Increased atrial stretch would most likely lead to which of the following changes?", "context": ["A group of investigators is studying hemodynamic regulatory mechanisms in a human volunteer subject.", "The volunteer is administered a stimulant drug, and a sudden increase in blood pressure is observed.", "It is hypothesized that the increase in blood pressure causes stretching of the atria."], "context_len": 3, "options": {"A": "Vasodilation and decreased platelet aggregation", "B": "Decreased reabsorption of sodium", "C": "Increased reabsorption of solute-free water", "D": "Vasoconstriction and stimulation of thirst"}, "answer": "Decreased reabsorption of sodium", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology", "Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A group of investigators is studying hemodynamic regulatory mechanisms.", "2. The study involves a human volunteer subject.", "3. The volunteer is administered a stimulant drug.", "4. A sudden increase in blood pressure is observed.", "5. It is hypothesized that the increase in blood pressure causes stretching of the atria."], "atomic_facts": ["1. The volunteer is administered a stimulant drug.", "2. A sudden increase in blood pressure is observed.", "3. It is hypothesized that the increase in blood pressure causes stretching of the atria."]}
{"id": 995, "question": "Which of the following would be the definitive treatment of this patient\u2019s condition?", "context": ["A 26-month-old boy is presented to the outpatient clinic by his parents complaining of a productive cough for the last 5 days.", "His mother reports a history of recurrent chest infections during the past year.", "He also has a history of chronic bloody diarrhea and pronounced bleeding after his circumcision.", "The vital signs are as follows: blood pressure 100/60 mm Hg, pulse 100/min, temperature 38.0\u00b0C (100.4\u00b0F), and respiratory rate 27/min.", "On examination, there are purpuric eruptions over the extremities as well as eczematous patches on the flexural surfaces of his elbows and knees.", "Chest auscultation reveals crepitus over the base of the right lung.", "Chest radiography is suggestive of consolidation in the right lower lobe.", "Blood test results show anemia, thrombocytopenia with small platelets, and leukopenia.", "With a suspicion of a congenital immunodeficiency, flow cytometry is ordered which reveals a Wiskott-Aldrich syndrome protein (WASP) mutation."], "context_len": 9, "options": {"A": "Early hematopoietic stem cell transplantation (HSCT)", "B": "Intravenous immunoglobulin (IVIG)", "C": "Rituximab", "D": "Chemotherapy"}, "answer": "Early hematopoietic stem cell transplantation (HSCT)", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "26 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 26-month-old boy is presented to the outpatient clinic by his parents.", "2. His parents are complaining of a productive cough for the last 5 days.", "3. His mother reports a history of recurrent chest infections during the past year.", "4. He also has a history of chronic bloody diarrhea and pronounced bleeding after his circumcision.", "5. The vital signs are as follows: blood pressure 100/60 mm Hg, pulse 100/min, temperature 38.0\u00b0C (100.4\u00b0F), and respiratory rate 27/min.", "6. On examination, there are purpuric eruptions over the extremities.", "7. On examination, there are also eczematous patches on the flexural surfaces of his elbows and knees.", "8. Chest auscultation reveals crepitus over the base of the right lung.", "9. Chest radiography is suggestive of consolidation in the right lower lobe.", "10. Blood test results show anemia, thrombocytopenia with small platelets, and leukopenia.", "11. With a suspicion of a congenital immunodeficiency, flow cytometry is ordered.", "12. Flow cytometry reveals a Wiskott-Aldrich syndrome protein (WASP) mutation."], "atomic_facts": ["1. His mother reports a history of recurrent chest infections during the past year.", "2. He has a history of chronic bloody diarrhea.", "3. He has a history of pronounced bleeding after his circumcision.", "4. The vital signs are: blood pressure 100/60 mm Hg.", "5. The vital signs are: pulse 100/min.", "6. The vital signs are: temperature 38.0\u00b0C (100.4\u00b0F).", "7. The vital signs are: respiratory rate 27/min.", "8. On examination, there are purpuric eruptions over the extremities.", "9. On examination, there are eczematous patches on the flexural surfaces of his elbows and knees.", "10. Chest auscultation reveals crepitus over the base of the right lung.", "11. Chest radiography is suggestive of consolidation in the right lower lobe.", "12. Blood test results show anemia.", "13. Blood test results show thrombocytopenia with small platelets.", "14. Blood test results show leukopenia.", "15. Flow cytometry is ordered.", "16. Flow cytometry reveals a Wiskott-Aldrich syndrome protein (WASP) mutation."]}
{"id": 996, "question": "Further evaluation of this patient is most likely to show which of the following?", "context": ["Four hours after undergoing an open emergency surgery under general anesthesia for a bleeding abdominal aortic aneurysm, a 55-year-old man is unable to move both his legs.", "During the surgery, he had prolonged hypotension, which was corrected with IV fluids and vasopressors.", "He has a history of hypertension and hyperlipidemia.", "He has smoked one pack of cigarettes daily for 35 years.", "Prior to admission, his medications were hydrochlorothiazide and atorvastatin.", "The patient is conscious and oriented to place and person.", "His temperature is 37.7\u00b0C (99\u00b0F), pulse is 74/min, and blood pressure is 100/70 mm Hg.", "Examination shows muscle strength of 1/5 in the lower extremities."], "context_len": 8, "options": {"A": "Babinski's sign present bilaterally", "B": "Normal bulbocavernosus reflex", "C": "Bilaterally increased knee and ankle jerk", "D": "Normal proprioception in the extremities\n\""}, "answer": "Normal proprioception in the extremities\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "55 years old", "specialties": ["Neurology"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurological Surgery"}, "facts_old": ["1. Patient is 55 years old.", "2. Patient underwent open emergency surgery under general anesthesia for a bleeding abdominal aortic aneurysm four hours ago.", "3. Patient is unable to move both his legs.", "4. Patient had prolonged hypotension during surgery, which was corrected with IV fluids and vasopressors.", "5. Patient has a history of hypertension and hyperlipidemia.", "6. Patient has smoked one pack of cigarettes daily for 35 years.", "7. Patient's medications prior to admission were hydrochlorothiazide and atorvastatin.", "8. Patient is conscious and oriented to place and person.", "9. Patient's temperature is 37.7\u00b0C (99\u00b0F).", "10. Patient's pulse is 74/min.", "11. Patient's blood pressure is 100/70 mm Hg.", "12. Patient's muscle strength in lower extremities is 1/5."], "atomic_facts": ["1. During the surgery, he had prolonged hypotension.", "2. The prolonged hypotension was corrected with IV fluids and vasopressors.", "3. He has a history of hypertension.", "4. He has a history of hyperlipidemia.", "5. He has smoked one pack of cigarettes daily for 35 years.", "6. Prior to admission, his medications were hydrochlorothiazide and atorvastatin.", "7. The patient is conscious.", "8. The patient is oriented to place and person.", "9. His temperature is 37.7\u00b0C (99\u00b0F).", "10. His pulse is 74/min.", "11. His blood pressure is 100/70 mm Hg.", "12. Examination shows muscle strength of 1/5 in the lower extremities."]}
{"id": 997, "question": "Based on these findings, which of the following is the most likely diagnosis?", "context": ["A 30-year-old woman seeks evaluation at a local walk-in clinic with a week-long history of lightheadedness and palpitations.", "She also complains of fatigability and shortness of breath of the same duration.", "The past medical history is significant for menarche at 9 years of age, heavy menstrual bleeding for the past several years and abdominal pain that worsens during menses.", "She stopped trying to conceive a child after 2 spontaneous abortions in the past 4 years and has been on iron oral supplementation for the last 2 years.", "She adds that she feels a dull pressure-like discomfort in her pelvis and constipation.", "The physical examination is significant for pale mucous membranes and a grade 2/6 ejection systolic murmur in the area of the pulmonic valve.", "Pelvic examination reveals an enlarged, mobile uterus with an irregular contour.", "The hemoglobin level is 10 g/dL and the hematocrit is 27%."], "context_len": 8, "options": {"A": "Uterine leiomyoma", "B": "Endometrial hyperplasia", "C": "Endometrial carcinoma", "D": "Endometrial polyp"}, "answer": "Uterine leiomyoma", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "30", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 30-year-old woman.", "2. Patient has a week-long history of lightheadedness and palpitations.", "3. Patient has a week-long history of fatigability and shortness of breath.", "4. Patient had menarche at 9 years of age.", "5. Patient has had heavy menstrual bleeding for several years.", "6. Patient has abdominal pain that worsens during menses.", "7. Patient has had 2 spontaneous abortions in the past 4 years.", "8. Patient has been on iron oral supplementation for the last 2 years.", "9. Patient feels a dull pressure-like discomfort in her pelvis.", "10. Patient has constipation.", "11. Physical examination is significant for pale mucous membranes.", "12. Physical examination is significant for a grade 2/6 ejection systolic murmur in the area of the pulmonic valve.", "13. Pelvic examination reveals an enlarged, mobile uterus with an irregular contour.", "14. Hemoglobin level is 10 g/dL.", "15. Hematocrit is 27%."], "atomic_facts": ["1. She complains of fatigability and shortness of breath.", "2. Her past medical history includes menarche at 9 years of age.", "3. She has heavy menstrual bleeding for the past several years.", "4. She experiences abdominal pain that worsens during menses.", "5. She had 2 spontaneous abortions in the past 4 years.", "6. She has been on iron oral supplementation for the last 2 years.", "7. She feels a dull pressure-like discomfort in her pelvis.", "8. She experiences constipation.", "9. Physical examination shows pale mucous membranes.", "10. Physical examination reveals a grade 2/6 ejection systolic murmur in the area of the pulmonic valve.", "11. Pelvic examination shows an enlarged, mobile uterus with an irregular contour.", "12. Her hemoglobin level is 10 g/dL.", "13. Her hematocrit is 27%."]}
{"id": 998, "question": "What percentage of the risk of developing emphysema can be attributed to smoking?", "context": ["A study is conducted in a town with a population of 225,000, where the people are followed-up for the development of emphysema.", "A total of 1,000 smokers are selected and followed-up, out of which 200 actually develop the disease.", "A control group of 1,000 non-smokers is formed, out of which 20 develop emphysema.", "The prevalence of smoking in the general population is 40%.", "The researcher calculates all possible risk estimates, including the odds ratio."], "context_len": 5, "options": {"A": "40%", "B": "20%", "C": "10%", "D": "18%"}, "answer": "18%", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A study is conducted in a town with a population of 225,000.", "2. The people are followed-up for the development of emphysema.", "3. A total of 1,000 smokers are selected and followed-up.", "4. Out of the 1,000 smokers, 200 actually develop the disease.", "5. A control group of 1,000 non-smokers is formed.", "6. Out of the 1,000 non-smokers, 20 develop emphysema.", "7. The prevalence of smoking in the general population is 40%.", "8. The researcher calculates all possible risk estimates, including the odds ratio."], "atomic_facts": ["1. A total of 1,000 smokers are selected and followed-up.", "2. 200 of the selected smokers develop the disease.", "3. A control group of 1,000 non-smokers is formed.", "4. 20 of the non-smokers in the control group develop emphysema.", "5. The prevalence of smoking in the general population is 40%.", "6. The researcher calculates all possible risk estimates, including the odds ratio."]}
{"id": 999, "question": "Which of the following faults to this study most likely explains why the result was considered meaningless?", "context": ["A medical student is performing clinical research by analyzing the aggregated data of all patients from a national database.", "In performing the study, she uses all the data collected from patients who had an appendectomy and analyzes the risk factors that are associated with readmission after discharge.", "She first excludes some of the data based on previously determined exclusion criteria and then performs analysis on the rest.", "She performs a multiple regression on all variables and finds that one of the risk factors demonstrates a < 5% probability of being the same between groups.", "She takes this result and presents it to faculty; however, they respond that the finding is meaningless."], "context_len": 5, "options": {"A": "Data should not have been aggregated", "B": "Failure to consider clinical significance versus statistical significance", "C": "Single rather than multiple regression should have been performed", "D": "Usage of the wrong threshold for significance"}, "answer": "Failure to consider clinical significance versus statistical significance", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology", "Preventive Medicine"], "subspecialties": ["Clinical Informatics"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Others"}, "facts_old": ["1. A medical student is performing clinical research.", "2. The research involves analyzing aggregated data from a national database.", "3. The data is from patients who had an appendectomy.", "4. The research is analyzing risk factors associated with readmission after discharge.", "5. The medical student excludes some of the data based on previously determined exclusion criteria.", "6. The medical student performs a multiple regression on all variables.", "7. The multiple regression finds that one of the risk factors has a < 5% probability of being the same between groups.", "8. The medical student presents the finding to faculty.", "9. The faculty respond that the finding is meaningless."], "atomic_facts": ["1. She uses all the data collected from patients who had an appendectomy.", "2. She analyzes the risk factors associated with readmission after discharge.", "3. She excludes some of the data based on previously determined exclusion criteria.", "4. She performs analysis on the rest of the data.", "5. She performs a multiple regression on all variables.", "6. She finds that one of the risk factors demonstrates a < 5% probability of being the same between groups.", "7. She presents the result to faculty.", "8. The faculty responds that the finding is meaningless."]}
{"id": 1000, "question": "Which of the following features is a contraindication for thrombolytic therapy in this patient?", "context": ["A 60-year-old man presents to the emergency department with \u2018discomfort\u2019 in his chest and a \u2018squeezing\u2019 sensation in his neck.", "The symptoms started 45 minutes ago while he was washing the dishes.", "He also complains of nausea.", "He has been a regular smoker for 45 years, averaging a pack of cigarettes each day.", "He also drinks heavily on weekends.", "His medical history is significant for a stroke 3 months ago, but the patient admits he has not been taking his medications.", "Vital signs show: pulse 62/min, respiratory rate 20/min, blood pressure 176/94 mm Hg, and temperature 36.9\u00b0C (98.4\u00b0F).", "Physical examination reveals a visibly distressed man who is sweating profusely.", "The chest is clear to auscultation and a 4th heart sound can be heard.", "Aspirin was administered upon arrival.", "His ECG is shown in the picture."], "context_len": 11, "options": {"A": "Aspirin administration", "B": "Elevated blood pressure", "C": "History of smoking", "D": "Stroke 3 months ago"}, "answer": "Stroke 3 months ago", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "60 years old", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["General Cardiology", "Interventional Cardiology", "Cardiovascular Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is a 60-year-old man.", "2. Patient presents to the emergency department with \u2018discomfort\u2019 in his chest and a \u2018squeezing\u2019 sensation in his neck.", "3. Symptoms started 45 minutes ago while he was washing the dishes.", "4. Patient also complains of nausea.", "5. Patient has been a regular smoker for 45 years, averaging a pack of cigarettes each day.", "6. Patient also drinks heavily on weekends.", "7. Patient's medical history is significant for a stroke 3 months ago.", "8. Patient admits he has not been taking his medications.", "9. Vital signs show: pulse 62/min, respiratory rate 20/min, blood pressure 176/94 mm Hg, and temperature 36.9\u00b0C (98.4\u00b0F).", "10. Physical examination reveals a visibly distressed man who is sweating profusely.", "11. Chest is clear to auscultation and a 4th heart sound can be heard.", "12. Aspirin was administered upon arrival.", "13. Patient's ECG is shown in the picture."], "atomic_facts": ["1. The symptoms started 45 minutes ago while he was washing the dishes.", "2. He complains of nausea.", "3. He has been a regular smoker for 45 years, averaging a pack of cigarettes each day.", "4. He also drinks heavily on weekends.", "5. His medical history is significant for a stroke 3 months ago, but the patient admits he has not been taking his medications.", "6. Vital signs show: pulse 62/min, respiratory rate 20/min, blood pressure 176/94 mm Hg, and temperature 36.9\u00b0C (98.4\u00b0F).", "7. Physical examination reveals a visibly distressed man who is sweating profusely.", "8. The chest is clear to auscultation and a 4th heart sound can be heard.", "9. Aspirin was administered upon arrival.", "10. His ECG is shown in the picture."]}
{"id": 1001, "question": "What is the most likely diagnosis?", "context": ["A 3-year-old girl is brought by her parents to the office for bloody diarrhea and a seizure.", "The parents say she started having fever, abdominal pain, and diarrhea about 3 days ago, but the bloody diarrhea started 12 hours ago.", "The seizure was the last symptom to appear 3 hours ago, and it consisted of repetitive movement of arms and legs with loss of consciousness.", "Her 4-year-old brother had a similar case with bloody diarrhea 2 weeks ago.", "Her vital signs include: blood pressure is 130/85 mm Hg, her respiratory rate is 25/min, her heart rate is 120/min, and her temperature is 39.2\u00b0C (102.6\u00b0F).", "On physical examination, she looks pale and sleepy, the cardiopulmonary auscultation is normal, the abdomen is painful on palpation, and the skin assessment reveals the presence of disseminated pinpoint petechiae.", "The urinalysis show hematuria.", "The Coombs test is negative.", "The complete blood count results are as follows: | Hemoglobin 7 g/dL | Hematocrit 25 % | Leukocyte count 17,000/mm3 | Neutrophils 70% | Bands 2% | Eosinophils 1% | Basophils 0% | Lymphocytes 22% | Monocytes 5% | Platelet count 7,000/mm3 | Her coagulation tests are as follows: | Partial thromboplastin time (activated) 30 seconds | Prothrombin time 12 seconds | Reticulocyte count 1 % | Thrombin time < 2 seconds deviation from control | ."], "context_len": 9, "options": {"A": "Disseminated intravascular coagulation", "B": "Henoch-Schonlein purpura", "C": "Systemic vasculitis", "D": "Hemolytic-uremic syndrome"}, "answer": "Hemolytic-uremic syndrome", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology", "Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 3-year-old girl is brought by her parents to the office.", "2. The parents say she started having fever, abdominal pain, and diarrhea about 3 days ago.", "3. The bloody diarrhea started 12 hours ago.", "4. The seizure was the last symptom to appear 3 hours ago.", "5. The seizure consisted of repetitive movement of arms and legs with loss of consciousness.", "6. Her 4-year-old brother had a similar case with bloody diarrhea 2 weeks ago.", "7. Her blood pressure is 130/85 mm Hg.", "8. Her respiratory rate is 25/min.", "9. Her heart rate is 120/min.", "10. Her temperature is 39.2\u00b0C (102.6\u00b0F).", "11. On physical examination, she looks pale and sleepy.", "12. The cardiopulmonary auscultation is normal.", "13. The abdomen is painful on palpation.", "14. The skin assessment reveals the presence of disseminated pinpoint petechiae.", "15. The urinalysis show hematuria.", "16. The Coombs test is negative.", "17. The Hemoglobin is 7 g/dL.", "18. The Hematocrit is 25 %.", "19. The Leukocyte count is 17,000/mm3.", "20. The Neutrophils are 70%.", "21. The Bands are 2%.", "22. The Eosinophils are 1%.", "23. The Basophils are 0%.", "24. The Lymphocytes are 22%.", "25. The Monocytes are 5%.", "26. The Platelet count is 7,000/mm3.", "27. The Partial thromboplastin time (activated) is 30 seconds.", "28. The Prothrombin time is 12 seconds.", "29. The Reticulocyte count is 1 %.", "30. The Thrombin time is < 2 seconds deviation from control."], "atomic_facts": ["1. The patient started having fever, abdominal pain, and diarrhea about 3 days ago.", "2. The bloody diarrhea started 12 hours ago.", "3. The seizure was the last symptom to appear 3 hours ago, and it consisted of repetitive movement of arms and legs with loss of consciousness.", "4. The patient's 4-year-old brother had a similar case with bloody diarrhea 2 weeks ago.", "5. The patient's blood pressure is 130/85 mm Hg.", "6. The patient's respiratory rate is 25/min.", "7. The patient's heart rate is 120/min.", "8. The patient's temperature is 39.2\u00b0C (102.6\u00b0F).", "9. On physical examination, the patient looks pale and sleepy.", "10. The cardiopulmonary auscultation is normal.", "11. The abdomen is painful on palpation.", "12. The skin assessment reveals the presence of disseminated pinpoint petechiae.", "13. The urinalysis shows hematuria.", "14. The Coombs test is negative.", "15. The complete blood count results are as follows: Hemoglobin 7 g/dL, Hematocrit 25%, Leukocyte count 17,000/mm3, Neutrophils 70%, Bands 2%, Eosinophils 1%, Basophils 0%, Lymphocytes 22%, Monocytes 5%, Platelet count 7,000/mm3.", "16. The patient's coagulation tests are as follows: Partial thromboplastin time (activated) 30 seconds, Prothrombin time 12 seconds, Reticulocyte count 1%, Thrombin time < 2 seconds deviation from control."]}
{"id": 1002, "question": "Which of the following organisms is the most likely cause of this patient's symptoms?", "context": ["A 68-year-old woman presents to the emergency room with productive cough and fever.", "She has a chronic cough that has been getting progressively worse over the last 2 weeks.", "Last night she developed a fever and vomited.", "She smoked one pack of cigarettes per day for 40 years and recently quit.", "Her past medical history includes COPD and her medications include ipratropium and fluticasone.", "On physical exam her temperature is 102.2\u00b0F (39\u00b0C), blood pressure is 131/78 mmHg, pulse is 110/min, respirations are 22/min, and oxygen saturation is 95% on room air.", "She has decreased breath sounds bilaterally with diffuse crackles.", "You obtain a sputum sample and identify an organism that grows selectively on medium containing factors V and X."], "context_len": 8, "options": {"A": "Haemophilus influenzae", "B": "Streptococcus pneumoniae", "C": "Mycoplasma pneumoniae", "D": "Fusobacterium species"}, "answer": "Haemophilus influenzae", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "68 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease", "Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 68-year-old woman presents to the emergency room.", "2. She has a productive cough and fever.", "3. She has a chronic cough that has been getting progressively worse over the last 2 weeks.", "4. Last night she developed a fever and vomited.", "5. She smoked one pack of cigarettes per day for 40 years and recently quit.", "6. Her past medical history includes COPD.", "7. Her medications include ipratropium and fluticasone.", "8. On physical exam her temperature is 102.2\u00b0F (39\u00b0C).", "9. Her blood pressure is 131/78 mmHg.", "10. Her pulse is 110/min.", "11. Her respirations are 22/min.", "12. Her oxygen saturation is 95% on room air.", "13. She has decreased breath sounds bilaterally with diffuse crackles.", "14. You obtain a sputum sample.", "15. An organism is identified that grows selectively on medium containing factors V and X."], "atomic_facts": ["1. She has a chronic cough.", "2. The chronic cough has been getting progressively worse over the last 2 weeks.", "3. Last night she developed a fever.", "4. Last night she vomited.", "5. She smoked one pack of cigarettes per day for 40 years.", "6. She recently quit smoking.", "7. Her past medical history includes COPD.", "8. Her medications include ipratropium and fluticasone.", "9. On physical exam her temperature is 102.2\u00b0F (39\u00b0C).", "10. Her blood pressure is 131/78 mmHg.", "11. Her pulse is 110/min.", "12. Her respirations are 22/min.", "13. Her oxygen saturation is 95% on room air.", "14. She has decreased breath sounds bilaterally.", "15. She has diffuse crackles.", "16. An organism was identified in a sputum sample.", "17. The organism grows selectively on medium containing factors V and X."]}
{"id": 1003, "question": "The mechanism of action of this drug is most similar to that of which of the following?", "context": ["A 36-year-old man comes to the physician because of progressive fatigue and night sweats for 2 months.", "During this time, he has also had a 10-kg (22-lb) weight loss.", "Physical examination shows painless swelling of the cervical, axillary, and inguinal lymph nodes.", "Examination of the abdomen shows hepatosplenomegaly.", "Histologic examination of a lymph node biopsy specimen shows Reed-Sternberg cells.", "A diagnosis of Hodgkin lymphoma is made.", "The patient is started on a chemotherapeutic regimen that includes bleomycin."], "context_len": 7, "options": {"A": "Trimethoprim", "B": "Sulfamethoxazole", "C": "Metronidazole", "D": "Chloramphenicol"}, "answer": "Metronidazole", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "36 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 36-year-old man comes to the physician.", "2. He has progressive fatigue and night sweats for 2 months.", "3. He has had a 10-kg (22-lb) weight loss.", "4. Physical examination shows painless swelling of the cervical, axillary, and inguinal lymph nodes.", "5. Examination of the abdomen shows hepatosplenomegaly.", "6. Histologic examination of a lymph node biopsy specimen shows Reed-Sternberg cells.", "7. A diagnosis of Hodgkin lymphoma is made.", "8. The patient is started on a chemotherapeutic regimen that includes bleomycin."], "atomic_facts": ["1. The patient has had a 10-kg (22-lb) weight loss.", "2. Physical examination shows painless swelling of the cervical, axillary, and inguinal lymph nodes.", "3. Examination of the abdomen shows hepatosplenomegaly.", "4. Histologic examination of a lymph node biopsy specimen shows Reed-Sternberg cells.", "5. A diagnosis of Hodgkin lymphoma is made.", "6. The patient is started on a chemotherapeutic regimen that includes bleomycin."]}
{"id": 1004, "question": "Which of the following is the most appropriate treatment for this condition?", "context": ["An 7-year-old girl is brought to the pediatrician by her concerned mother, because she is \"more physically matured\" than the rest of the girls in her class.", "On physical exam, she is noted to have breast development and pubic hair.", "On gonadotropin reseasing hormone (GnRH) stimulation, she has an increase in leutienizing hormone (LH) levels.", "Thyroid function tests and an MRI of the head are both within normal limits."], "context_len": 4, "options": {"A": "Leuprolide", "B": "Finasteride", "C": "Octreotide", "D": "Anastrozole"}, "answer": "Leuprolide", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 7-year-old girl is brought to the pediatrician by her concerned mother.", "2. The girl is \"more physically matured\" than the rest of the girls in her class.", "3. On physical exam, she is noted to have breast development and pubic hair.", "4. On gonadotropin reseasing hormone (GnRH) stimulation, she has an increase in leutienizing hormone (LH) levels.", "5. Thyroid function tests are within normal limits.", "6. An MRI of the head is within normal limits."], "atomic_facts": ["1. On physical exam, she is noted to have breast development.", "2. On physical exam, she is noted to have pubic hair.", "3. On gonadotropin releasing hormone (GnRH) stimulation, she has an increase in leutienizing hormone (LH) levels.", "4. Thyroid function tests are within normal limits.", "5. An MRI of the head is within normal limits."]}
{"id": 1005, "question": "What is the most likely diagnosis?", "context": ["A 45-year-old woman presents to the emergency department with hematemesis.", "Her son said that the patient had complained of gnawing abdominal pain that worsened before and improved after meals for the past 3 weeks.", "She frequently travels for work and is often stressed.", "She drinks alcohol socially and does not smoke tobacco or marijuana.", "She has not had anything to eat or drink for the past 24 hours due to the pain, but coughed up \"several cup of\" frank red blood before arrival.", "Her temperature is 98\u00b0F (37\u00b0C), blood pressure is 80/50 mmHg, pulse is 140/min, respirations are 23/min, and oxygen saturation is 96% on room air.", "Gastric ultrasound reveals high gastric residual volume.", "The patient is empirically started on 3 units of uncrossmatched O-negative blood transfusion and pantoprazole.", "The patient's initial laboratory data return in the meantime: |  | Hemoglobin: 5 g/dL | Hematocrit: 18 % | Leukocyte count: 8,000/mm^3 with normal differential | Platelet count: 400,000/mm^3 |  | Serum: | Na+: 140 mEq/L | Cl-: 115 mEq/L | K+: 3.2 mEq/L | HCO3-: 26 mEq/L | BUN: 60 mg/dL | Glucose: 104 mg/dL | Creatinine: 1.1 mg/dL |  | Blood type: AB | Rhesus status: negative |  | After bedside esophageogastroduodenoscopy with stapling of several peptic ulcers, repeat labs are obtained in 2 hours.", "The patient now complains of feeling hot with intermittent shivering.", "She denies any other symptoms.", "Her temperature is 101\u00b0F (38.3\u00b0C), blood pressure is 100/55 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air.", "Her lungs are clear to auscultation bilaterally, and no accessory respiratory muscle use is observed.", "No rash is seen."], "context_len": 14, "options": {"A": "Febrile hemolytic reaction", "B": "Febrile nonhemolytic reaction", "C": "Transfusion related bacterial contamination", "D": "Transfusion related acute lung injury"}, "answer": "Febrile nonhemolytic reaction", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 45-year-old woman presents to the emergency department with hematemesis.", "2. Her son said that the patient had complained of gnawing abdominal pain that worsened before and improved after meals for the past 3 weeks.", "3. She frequently travels for work and is often stressed.", "4. She drinks alcohol socially and does not smoke tobacco or marijuana.", "5. She has not had anything to eat or drink for the past 24 hours due to the pain, but coughed up \"several cup of\" frank red blood before arrival.", "6. Her temperature is 98\u00b0F (37\u00b0C), blood pressure is 80/50 mmHg, pulse is 140/min, respirations are 23/min, and oxygen saturation is 96% on room air.", "7. Gastric ultrasound reveals high gastric residual volume.", "8. The patient is empirically started on 3 units of uncrossmatched O-negative blood transfusion and pantoprazole.", "9. The patient's initial laboratory data return: Hemoglobin: 5 g/dL, Hematocrit: 18 %, Leukocyte count: 8,000/mm^3 with normal differential, Platelet count: 400,000/mm^3, Serum: Na+: 140 mEq/L, Cl-: 115 mEq/L, K+: 3.2 mEq/L, HCO3-: 26 mEq/L, BUN: 60 mg/dL, Glucose: 104 mg/dL, Creatinine: 1.1 mg/dL, Blood type: AB, Rhesus status: negative.", "10. After bedside esophageogastroduodenoscopy with stapling of several peptic ulcers, repeat labs are obtained in 2 hours.", "11. The patient now complains of feeling hot with intermittent shivering.", "12. She denies any other symptoms.", "13. Her temperature is 101\u00b0F (38.3\u00b0C), blood pressure is 100/55 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air.", "14. Her lungs are clear to auscultation bilaterally, and no accessory respiratory muscle use is observed.", "15. No rash is seen."], "atomic_facts": ["1. The patient complained of gnawing abdominal pain that worsened before and improved after meals for the past 3 weeks.", "2. The patient frequently travels for work and is often stressed.", "3. The patient drinks alcohol socially and does not smoke tobacco or marijuana.", "4. The patient has not had anything to eat or drink for the past 24 hours due to the pain, but coughed up \"several cup of\" frank red blood before arrival.", "5. The patient's temperature is 98\u00b0F (37\u00b0C), blood pressure is 80/50 mmHg, pulse is 140/min, respirations are 23/min, and oxygen saturation is 96% on room air.", "6. Gastric ultrasound reveals high gastric residual volume.", "7. The patient is empirically started on 3 units of uncrossmatched O-negative blood transfusion and pantoprazole.", "8. The patient's initial laboratory data return: Hemoglobin: 5 g/dL, Hematocrit: 18 %, Leukocyte count: 8,000/mm^3 with normal differential, Platelet count: 400,000/mm^3, Serum: Na+: 140 mEq/L, Cl-: 115 mEq/L, K+: 3.2 mEq/L, HCO3-: 26 mEq/L, BUN: 60 mg/dL, Glucose: 104 mg/dL, Creatinine: 1.1 mg/dL, Blood type: AB, Rhesus status: negative.", "9. After bedside esophageogastroduodenoscopy with stapling of several peptic ulcers, repeat labs are obtained in 2 hours.", "10. The patient now complains of feeling hot with intermittent shivering.", "11. The patient's temperature is 101\u00b0F (38.3\u00b0C), blood pressure is 100/55 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air.", "12. Her lungs are clear to auscultation bilaterally, and no accessory respiratory muscle use is observed. No rash is seen."]}
{"id": 1006, "question": "Further evaluation of this patient is most likely to show which of the following?", "context": ["A 66-year-old man comes to the physician because of a 3-week history of shortness of breath with exertion.", "He has hypertension, hyperlipidemia, and type 2 diabetes mellitus.", "Current medications include aspirin, losartan, simvastatin, and insulin.", "His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 74/min, and blood pressure is 150/84 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 96%.", "Cardiac examination is shown."], "context_len": 6, "options": {"A": "Earlier onset of abnormal cardiac sound with standing", "B": "Elevated serum brain natriuretic peptide levels", "C": "Left-to-right shunt through the atrial septum", "D": "Bounding pulses of peripheral arteries"}, "answer": "Elevated serum brain natriuretic peptide levels", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "66 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 66-year-old man comes to the physician.", "2. He has a 3-week history of shortness of breath with exertion.", "3. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus.", "4. His current medications include aspirin, losartan, simvastatin, and insulin.", "5. His temperature is 37.1\u00b0C (98.8\u00b0F).", "6. His pulse is 74/min.", "7. His blood pressure is 150/84 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 96%.", "9. Cardiac examination is shown."], "atomic_facts": ["1. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus.", "2. Current medications include aspirin, losartan, simvastatin, and insulin.", "3. His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 74/min, and blood pressure is 150/84 mm Hg.", "4. Pulse oximetry on room air shows an oxygen saturation of 96%.", "5. Cardiac examination is shown."]}
{"id": 1007, "question": "Which of the following would be the most appropriate recommendation for this patient?", "context": ["A 27-year-old gravida 2, para 2 woman presents to her OB/GYN\u2019s office concerned that she may be pregnant.", "She and her husband use condoms for contraception.", "The night before, the condom broke during intercourse.", "She has 2 children under the age of 3 and does not want another child at this time.", "She says she cannot take \u201cthe pill\u201d because she had a blood clot in her leg after her last cesarean section successfully treated with 6 months of anticoagulation.", "She smokes cigarettes and drinks alcohol regularly."], "context_len": 6, "options": {"A": "Reassure her that she is likely not pregnant", "B": "Refer her to an abortion clinic", "C": "Recommend etonogestrel implant", "D": "Recommend copper IUD"}, "answer": "Recommend copper IUD", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 27-year-old woman presents to her OB/GYN's office.", "2. She is gravida 2, para 2.", "3. She and her husband use condoms for contraception.", "4. The night before, the condom broke during intercourse.", "5. She has 2 children under the age of 3.", "6. She does not want another child at this time.", "7. She cannot take \"the pill\" because she had a blood clot in her leg after her last cesarean section.", "8. The blood clot was successfully treated with 6 months of anticoagulation.", "9. She smokes cigarettes regularly.", "10. She drinks alcohol regularly."], "atomic_facts": ["1. She and her husband use condoms for contraception.", "2. The condom broke during intercourse the night before.", "3. She has 2 children under the age of 3.", "4. She does not want another child at this time.", "5. She cannot take \"the pill\" because she had a blood clot in her leg after her last cesarean section.", "6. The blood clot was successfully treated with 6 months of anticoagulation.", "7. She smokes cigarettes regularly.", "8. She drinks alcohol regularly."]}
{"id": 1008, "question": "Bloodwork is drawn and is shown below. |  | Serum: | Na+: 139 mEq/L | K+: 3.7 mEq/L | Cl-: 100 mEq/L | HCO3-: 28 mEq/L | Urea nitrogen: 9 mg/dL | Glucose: 122 mg/dL | Creatinine: 1.0 mg/dL | Ca2+: 9.8 mg/dL | Mg2+: 1.7 mg/dL |  | After a physical exam is performed, which of the following is the best initial step in management for this patient's underlying condition?", "context": ["A 25-year-old Ashkenazi Jewish man presents to his primary care physician for a follow-up visit.", "One week ago, he presented with a chief complaint of priapism while engaging in intercourse with two of his partners.", "During that visit, it was determined that his blood pressure was 175/100 mmHg.", "He returns this week to have his vitals rechecked.", "His temperature is 99.5\u00b0F (37.5\u00b0C), pulse is 80/min, blood pressure is 182/100 mmHg, respirations are 10/min, and oxygen saturation is 98% on room air."], "context_len": 5, "options": {"A": "Begin lifestyle modification and weight loss program", "B": "Begin lifestyle modification, weight loss program, and hydrochlorothiazide", "C": "24-hour urinary cortisol", "D": "Duplex ultrasound"}, "answer": "Duplex ultrasound", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 25-year-old Ashkenazi Jewish man presented to his primary care physician for a follow-up visit.", "2. One week ago, he presented with a chief complaint of priapism while engaging in intercourse with two of his partners.", "3. During that visit, it was determined that his blood pressure was 175/100 mmHg.", "4. He returns this week to have his vitals rechecked.", "5. His temperature is 99.5\u00b0F (37.5\u00b0C).", "6. His pulse is 80/min.", "7. His blood pressure is 182/100 mmHg.", "8. His respirations are 10/min.", "9. His oxygen saturation is 98% on room air."], "atomic_facts": ["1. One week ago, he presented with a chief complaint of priapism while engaging in intercourse with two of his partners.", "2. During that visit, it was determined that his blood pressure was 175/100 mmHg.", "3. He returns this week to have his vitals rechecked.", "4. His temperature is 99.5\u00b0F (37.5\u00b0C).", "5. His pulse is 80/min.", "6. His blood pressure is 182/100 mmHg.", "7. His respirations are 10/min.", "8. His oxygen saturation is 98% on room air."]}
{"id": 1009, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 63-year-old man is brought to the emergency department after having 8\u20139 episodes of red watery stool.", "He has no abdominal pain or fever.", "He underwent an angioplasty 4 years ago and received 2 stents in his left main coronary artery.", "He has hypertension, hypercholesterolemia, coronary artery disease, and chronic constipation.", "Current medications include aspirin, metoprolol, and simvastatin.", "He drinks one beer daily.", "He is in distress.", "His temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 110/min, respirations are 14/min, and blood pressure is 86/58 mm Hg.", "Examination shows pale conjunctivae.", "The abdomen is soft and nontender.", "Bowel sounds are increased.", "The lungs are clear to auscultation.", "Cardiac examination shows an S4 gallop.", "Rectal examination shows frank blood.", "Laboratory studies show: | Hemoglobin 9.8 g/dL | Leukocyte count 7,800/mm3 | Platelet count 280,000/mm3 | Prothrombin time 14 seconds (INR=0.9) | Serum | Na+ 135 mEq/L | K+ 4.1 mEq/L | Cl- 101 mEq/L | Urea nitrogen 16 mg/dL | Glucose 96 mg/dL | Creatinine 0.7 mg/dL | Two large bore intravenous catheters are inserted and 0.9% saline infusions are administered.", "A nasogastric tube is inserted.", "Aspiration shows clear gastric content containing bile.", "Directly afterwards, his pulse is 133/min and blood pressure is 80/54 mm Hg."], "context_len": 18, "options": {"A": "Angiography", "B": "Laparotomy", "C": "Esophagogastroduodenoscopy", "D": "Enteroscopy"}, "answer": "Angiography", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "63 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 63 years old.", "2. Patient has had 8-9 episodes of red watery stool.", "3. Patient has no abdominal pain or fever.", "4. Patient underwent an angioplasty 4 years ago and received 2 stents in his left main coronary artery.", "5. Patient has hypertension, hypercholesterolemia, coronary artery disease, and chronic constipation.", "6. Patient's current medications include aspirin, metoprolol, and simvastatin.", "7. Patient drinks one beer daily.", "8. Patient is in distress.", "9. Patient's temperature is 37.3\u00b0C (99.1\u00b0F).", "10. Patient's pulse is 110/min.", "11. Patient's respirations are 14/min.", "12. Patient's blood pressure is 86/58 mm Hg.", "13. Patient's conjunctivae are pale.", "14. Patient's abdomen is soft and nontender.", "15. Patient's bowel sounds are increased.", "16. Patient's lungs are clear to auscultation.", "17. Patient's cardiac examination shows an S4 gallop.", "18. Patient's rectal examination shows frank blood.", "19. Patient's hemoglobin is 9.8 g/dL.", "20. Patient's leukocyte count is 7,800/mm3.", "21. Patient's platelet count is 280,000/mm3.", "22. Patient's prothrombin time is 14 seconds (INR=0.9).", "23. Patient's serum Na+ is 135 mEq/L.", "24. Patient's serum K+ is 4.1 mEq/L.", "25. Patient's serum Cl- is 101 mEq/L.", "26. Patient's urea nitrogen is 16 mg/dL.", "27. Patient's glucose is 96 mg/dL.", "28. Patient's creatinine is 0.7 mg/dL.", "29. Two large bore intravenous catheters are inserted and 0.9% saline infusions are administered.", "30. A nasogastric tube is inserted.", "31. Aspiration shows clear gastric content containing bile.", "32. Patient's pulse is 133/min directly afterwards.", "33. Patient's blood pressure is 80/54 mm Hg directly afterwards."], "atomic_facts": ["1. He has no abdominal pain or fever.", "2. He underwent an angioplasty 4 years ago and received 2 stents in his left main coronary artery.", "3. He has hypertension, hypercholesterolemia, coronary artery disease, and chronic constipation.", "4. Current medications include aspirin, metoprolol, and simvastatin.", "5. He drinks one beer daily.", "6. He is in distress.", "7. His temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 110/min, respirations are 14/min, and blood pressure is 86/58 mm Hg.", "8. Examination shows pale conjunctivae.", "9. The abdomen is soft and nontender.", "10. Bowel sounds are increased.", "11. The lungs are clear to auscultation.", "12. Cardiac examination shows an S4 gallop.", "13. Rectal examination shows frank blood.", "14. Laboratory studies show: Hemoglobin 9.8 g/dL, Leukocyte count 7,800/mm3, Platelet count 280,000/mm3, Prothrombin time 14 seconds (INR=0.9), Serum Na+ 135 mEq/L, K+ 4.1 mEq/L, Cl- 101 mEq/L, Urea nitrogen 16 mg/dL, Glucose 96 mg/dL, Creatinine 0.7 mg/dL.", "15. Two large bore intravenous catheters are inserted and 0.9% saline infusions are administered.", "16. A nasogastric tube is inserted.", "17. Aspiration shows clear gastric content containing bile.", "18. Directly afterwards, his pulse is 133/min and blood pressure is 80/54 mm Hg."]}
{"id": 1010, "question": "Which of the following is a relative contraindication for administering one or more routine vaccinations in this patient at this time?", "context": ["A 15-month-old boy with Down syndrome is brought to the physician for a well-child examination.", "The mother is concerned about giving the child any more vaccinations, as she reports he had a fever of 38.7\u00b0C (101.7\u00b0F) soon after his vaccinations at 12-months of age.", "He has had a runny nose for 2 days.", "He has a seizure disorder with a seizure lasting 1\u20132 minutes a few times a week that has not been controlled by medications.", "He was treated for intussusception at 6 months of age.", "His father was diagnosed with HIV 2 years ago.", "His medications include phenytoin, levetiracetam, and vitamin supplements.", "He is allergic to amoxicillin and has previously developed localized urticaria after consumption of eggs.", "His immunizations are up-to-date.", "Vital signs are within normal limits.", "Examination shows low-set ears, hypertelorism, and a flat head.", "The remainder of the examination shows no abnormalities."], "context_len": 12, "options": {"A": "Egg protein allergy", "B": "Fever of 38.7\u00b0C (101.7\u00b0F) after previous vaccination", "C": "Current upper respiratory tract infection", "D": "Uncontrolled seizure disorder\n\""}, "answer": "Uncontrolled seizure disorder\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "15 months", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 15-month-old boy with Down syndrome.", "2. Mother is concerned about giving the child any more vaccinations.", "3. Patient had a fever of 38.7\u00b0C (101.7\u00b0F) soon after his vaccinations at 12-months of age.", "4. Patient has had a runny nose for 2 days.", "5. Patient has a seizure disorder with a seizure lasting 1\u20132 minutes a few times a week that has not been controlled by medications.", "6. Patient was treated for intussusception at 6 months of age.", "7. Patient's father was diagnosed with HIV 2 years ago.", "8. Patient's medications include phenytoin, levetiracetam, and vitamin supplements.", "9. Patient is allergic to amoxicillin.", "10. Patient has previously developed localized urticaria after consumption of eggs.", "11. Patient's immunizations are up-to-date.", "12. Patient's vital signs are within normal limits.", "13. Examination shows low-set ears, hypertelorism, and a flat head.", "14. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. The child had a fever of 38.7\u00b0C (101.7\u00b0F) soon after his vaccinations at 12 months of age.", "2. The child has had a runny nose for 2 days.", "3. The child has a seizure disorder with seizures lasting 1\u20132 minutes a few times a week that has not been controlled by medications.", "4. The child was treated for intussusception at 6 months of age.", "5. The child's father was diagnosed with HIV 2 years ago.", "6. The child's medications include phenytoin, levetiracetam, and vitamin supplements.", "7. The child is allergic to amoxicillin and has previously developed localized urticaria after consumption of eggs.", "8. The child's immunizations are up-to-date.", "9. Examination shows low-set ears, hypertelorism, and a flat head.", "10. The remainder of the examination shows no abnormalities."]}
{"id": 1011, "question": "Which of the following genetic conditions is most likely related to these clinical features?", "context": ["A 1-year-old boy is brought to his pediatrician\u2019s office due to regression of development.", "She has observed that he is not progressing as he did during the 1st year of his life.", "There seems to be a regression in some behavioral and other milestones.", "She is also concerned about his facial development.", "On examination, the vital signs are normal.", "He has coarse facial features with a bulging frontal bone.", "Additionally, his lips are enlarged and corneal clouding is observed.", "Urine studies show an increase in dermatan sulfate."], "context_len": 8, "options": {"A": "Morquio syndrome", "B": "Tay-Sachs disease", "C": "Hurler syndrome", "D": "Fabry disease"}, "answer": "Hurler syndrome", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "1 year old", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 1-year-old boy is brought to his pediatrician's office.", "2. The pediatrician has observed regression in some behavioral and other milestones.", "3. The pediatrician is also concerned about his facial development.", "4. On examination, the vital signs are normal.", "5. He has coarse facial features with a bulging frontal bone.", "6. His lips are enlarged.", "7. Corneal clouding is observed.", "8. Urine studies show an increase in dermatan sulfate."], "atomic_facts": ["1. She has observed that he is not progressing as he did during the 1st year of his life.", "2. There seems to be a regression in some behavioral and other milestones.", "3. She is also concerned about his facial development.", "4. On examination, the vital signs are normal.", "5. He has coarse facial features with a bulging frontal bone.", "6. Additionally, his lips are enlarged and corneal clouding is observed.", "7. Urine studies show an increase in dermatan sulfate."]}
{"id": 1012, "question": "Which of the following is the most likely explanation for this patient's examination findings?", "context": ["A 6-year-old African American girl is brought to the physician by her mother because she has recently developed axillary and pubic hair.", "She also has multiple pustules on her forehead and has had oily skin for 3 months.", "Her mother reports that she recently bought some deodorant for the girl because of her body odor.", "Her mother has hypothyroidism.", "She is at the 95th percentile for height and the 99th percentile for weight and BMI.", "Her vital signs are within normal limits.", "She has no palpable glandular breast tissue.", "There is coarse hair under both axilla and sparse dark hair on the mons pubis and along the labia majora."], "context_len": 8, "options": {"A": "High levels of insulin", "B": "Adrenal enzyme deficiency", "C": "Pituitary tumor", "D": "Ovarian cyst"}, "answer": "High levels of insulin", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 6-year-old African American girl.", "2. Patient was brought to the physician by her mother.", "3. Patient has recently developed axillary and pubic hair.", "4. Patient has multiple pustules on her forehead.", "5. Patient has had oily skin for 3 months.", "6. Patient's mother recently bought deodorant for her due to body odor.", "7. Patient's mother has hypothyroidism.", "8. Patient is at the 95th percentile for height.", "9. Patient is at the 99th percentile for weight and BMI.", "10. Patient's vital signs are within normal limits.", "11. Patient has no palpable glandular breast tissue.", "12. Patient has coarse hair under both axilla.", "13. Patient has sparse dark hair on the mons pubis and along the labia majora."], "atomic_facts": ["1. She has multiple pustules on her forehead.", "2. She has had oily skin for 3 months.", "3. Her mother recently bought deodorant for her because of her body odor.", "4. Her mother has hypothyroidism.", "5. She is at the 95th percentile for height.", "6. She is at the 99th percentile for weight and BMI.", "7. Her vital signs are within normal limits.", "8. She has no palpable glandular breast tissue.", "9. There is coarse hair under both axilla.", "10. There is sparse dark hair on the mons pubis and along the labia majora."]}
{"id": 1013, "question": "Which of the following factors is most likely involved in the pathogenesis of this patient's condition?", "context": ["A 45-year-old woman comes to the physician for a health maintenance examination.", "Her father has a history of type 2 diabetes mellitus.", "She has gained 18-kg (40-lb) since the birth of her son 6 years ago.", "Her BMI is 31 kg/m2.", "Physical examination shows hyperpigmented plaques in the axillae and posterior neck.", "Laboratory studies show a hemoglobin A1c of 6.4% and an elevated serum insulin level."], "context_len": 6, "options": {"A": "Increased serum levels of glucagon-like peptide-1", "B": "Increased levels of serum fatty acids", "C": "Decreased levels of serum cortisol", "D": "Positive HLA-DR4 serotype"}, "answer": "Increased levels of serum fatty acids", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "45", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Family Medicine"}, "facts_old": ["1. A 45-year-old woman comes to the physician for a health maintenance examination.", "2. Her father has a history of type 2 diabetes mellitus.", "3. She has gained 18-kg (40-lb) since the birth of her son 6 years ago.", "4. Her BMI is 31 kg/m2.", "5. Physical examination shows hyperpigmented plaques in the axillae and posterior neck.", "6. Laboratory studies show a hemoglobin A1c of 6.4%.", "7. Laboratory studies show an elevated serum insulin level."], "atomic_facts": ["1. Her father has a history of type 2 diabetes mellitus.", "2. She has gained 18-kg (40-lb) since the birth of her son 6 years ago.", "3. Her BMI is 31 kg/m2.", "4. Physical examination shows hyperpigmented plaques in the axillae and posterior neck.", "5. Laboratory studies show a hemoglobin A1c of 6.4%.", "6. Laboratory studies show an elevated serum insulin level."]}
{"id": 1014, "question": "What pathological step preceded calcification in her condition?", "context": ["An 89-year-old woman presents with worsening dyspnea on exertion and generalized fatigue.", "She has fainted once.", "Exam reveals a crescendo-decrescendo systolic ejection murmur that radiates to the carotids."], "context_len": 3, "options": {"A": "Commissural fibrosis", "B": "Congenital bicuspid valve", "C": "Fibrillin-1 deficiency", "D": "Cellular injury and necrosis"}, "answer": "Cellular injury and necrosis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "89 years old", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["General Cardiology", "Cardiology", "Pulmonary Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 89 years old.", "2. Patient presents with worsening dyspnea on exertion and generalized fatigue.", "3. Patient has fainted once.", "4. Exam reveals a crescendo-decrescendo systolic ejection murmur.", "5. Murmur radiates to the carotids."], "atomic_facts": ["1. She has fainted once.", "2. Exam reveals a crescendo-decrescendo systolic ejection murmur.", "3. The murmur radiates to the carotids."]}
{"id": 1015, "question": "Which of the following is most likely the diagnosis?", "context": ["A 22-year-old man presents to the emergency department for chest pain.", "He says that the chest pain began a few hours prior to presentation and is associated with nausea, abdominal discomfort, and sweating.", "He has experienced similar symptoms multiple times in the past, which brings him great concern because he believes he may be having a heart attack.", "This concern has persisted for 2 months.", "This has caused him to avoid taking long train rides or driving on divided highways.", "Approximately 7 months ago his parents divorced.", "Medical history is significant for obesity.", "He denies any medications or illicit drug use.", "Physical examination is unremarkable.", "An electrocardiogram demonstrates sinus tachycardia with a pulse of 110/min."], "context_len": 10, "options": {"A": "Adjustment disorder", "B": "Illness anxiety disorder", "C": "Panic disorder", "D": "Specific phobia"}, "answer": "Panic disorder", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "22", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 22-year-old man presents to the emergency department for chest pain.", "2. The chest pain began a few hours prior to presentation.", "3. The chest pain is associated with nausea, abdominal discomfort, and sweating.", "4. He has experienced similar symptoms multiple times in the past.", "5. He believes he may be having a heart attack.", "6. His concern has persisted for 2 months.", "7. He has avoided taking long train rides or driving on divided highways.", "8. Approximately 7 months ago his parents divorced.", "9. Medical history is significant for obesity.", "10. He denies any medications or illicit drug use.", "11. Physical examination is unremarkable.", "12. An electrocardiogram demonstrates sinus tachycardia with a pulse of 110/min."], "atomic_facts": ["1. The patient reports that the chest pain started a few hours before seeking medical attention.", "2. The chest pain is accompanied by nausea, abdominal discomfort, and sweating.", "3. The patient has had similar symptoms on multiple occasions in the past.", "4. The patient is concerned that he may be having a heart attack due to the recurring symptoms.", "5. The patient has been worried about this for 2 months.", "6. His concern has led him to avoid long train rides and driving on divided highways.", "7. The patient's parents divorced approximately 7 months ago.", "8. The patient has a significant medical history of obesity.", "9. The patient denies using any medications or illicit drugs.", "10. The physical examination did not reveal any remarkable findings.", "11. An electrocardiogram shows sinus tachycardia with a pulse of 110/min."]}
{"id": 1016, "question": "After the aminoacyl-tRNA binds to the A site, which of the following is the next step in protein formation?", "context": ["An investigator is developing a new vaccine.", "Eukaryote ribosomes are utilized to create a novel protein."], "context_len": 2, "options": {"A": "Catalysis of peptide bond", "B": "Recognition of UAG codon by release factor", "C": "Assembly of 40s subunit with tRNA", "D": "Advancement of ribosome in 3' direction"}, "answer": "Catalysis of peptide bond", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology", "Internal Medicine"], "subspecialties": ["Molecular Genetic Pathology", "Rheumatology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An investigator is developing a new vaccine.", "2. Eukaryote ribosomes are utilized.", "3. A novel protein is being created."], "atomic_facts": ["1. Eukaryote ribosomes are present in eukaryotic cells.", "2. Ribosomes are used to synthesize proteins.", "3. The process of using ribosomes to create a new protein is called translation."]}
{"id": 1017, "question": "Which of the following is the most significant risk factor for this patient\u2019s most likely diagnosis?", "context": ["A 70-year-old Caucasian woman presents with a 2-week history of blood-tinged sputum.", "Her past medical history is significant for peptic ulcer disease for which she underwent triple-drug therapy.", "She is a lifetime non-smoker and worked as a teacher before retiring at the age of 60 years.", "A review of systems is significant for a weight loss of 6.8 kg (15 lb) over the last 5 months.", "Her vitals include: blood pressure 135/85 mm Hg, temperature 37.7\u00b0C (99.9\u00b0F), pulse 95/min, and respiratory rate 18/min.", "Physical examination is unremarkable.", "A contrast CT scan of the chest shows an irregular mass in the peripheral region of the inferior lobe of the right lung.", "A CT-guided biopsy is performed and reveals malignant tissue architecture and gland formation with a significant amount of mucus."], "context_len": 8, "options": {"A": "Medications", "B": "Occupational history", "C": "Race", "D": "Sex"}, "answer": "Sex", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "70 years old", "specialties": ["Pulmonary Disease", "Internal Medicine"], "subspecialties": ["General Pulmonary Disease", "Pulmonary Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 70-year-old Caucasian woman.", "2. Patient has a 2-week history of blood-tinged sputum.", "3. Patient has a past medical history of peptic ulcer disease.", "4. Patient underwent triple-drug therapy for peptic ulcer disease.", "5. Patient is a lifetime non-smoker.", "6. Patient worked as a teacher before retiring at the age of 60 years.", "7. Patient has had a weight loss of 6.8 kg (15 lb) over the last 5 months.", "8. Patient's blood pressure is 135/85 mm Hg.", "9. Patient's temperature is 37.7\u00b0C (99.9\u00b0F).", "10. Patient's pulse is 95/min.", "11. Patient's respiratory rate is 18/min.", "12. Physical examination is unremarkable.", "13. Contrast CT scan of the chest shows an irregular mass in the peripheral region of the inferior lobe of the right lung.", "14. CT-guided biopsy reveals malignant tissue architecture and gland formation with a significant amount of mucus."], "atomic_facts": ["1. Past medical history includes peptic ulcer disease", "2. Underwent triple-drug therapy for peptic ulcer disease", "3. Lifetime non-smoker", "4. Worked as a teacher before retiring at age 60", "5. Review of systems shows weight loss of 6.8 kg (15 lb) over last 5 months", "6. Vitals: blood pressure 135/85 mm Hg", "7. Vitals: temperature 37.7\u00b0C (99.9\u00b0F)", "8. Vitals: pulse 95/min", "9. Vitals: respiratory rate 18/min", "10. Physical examination is unremarkable", "11. Contrast CT scan of the chest shows irregular mass in peripheral region of inferior lobe of right lung", "12. CT-guided biopsy reveals malignant tissue architecture and gland formation with significant amount of mucus"]}
{"id": 1018, "question": "Which of the following is the most appropriate next step in management?", "context": ["Four days after admission to the hospital for community-acquired pneumonia, a 68-year-old woman has abdominal pain and multiple episodes of loose stools.", "They are watery, foul-smelling, and occasionally streaked with blood.", "She has approximately 6 episodes daily.", "She feels tired.", "She is currently being treated with intravenous ceftriaxone and oral azithromycin.", "She underwent a laparoscopic cholecystectomy 5 years ago.", "She returned from a trip to Bolivia 4 weeks ago.", "Her temperature is 37.5\u00b0C (99.5\u00b0F), pulse is 98/min, and blood pressure is 138/80 mm Hg.", "Bronchial breath sounds are heard over her right lung.", "Abdominal examination shows mild diffuse tenderness throughout the lower quadrants.", "The abdomen is not distended.", "The remainder of her examination shows no abnormalities.", "Her hemoglobin concentration is 12 g/dL, leukocyte count is 14,100/mm3, and erythrocyte sedimentation rate is 37 mm/h."], "context_len": 13, "options": {"A": "Stool for ova and parasites", "B": "Fecal lactoferrin", "C": "Enzyme immunoassay for glutamate dehydrogenase antigen", "D": "Stool acidity test"}, "answer": "Enzyme immunoassay for glutamate dehydrogenase antigen", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "68", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 68-year-old woman.", "2. Patient was admitted to the hospital four days ago for community-acquired pneumonia.", "3. Patient has abdominal pain and multiple episodes of loose stools.", "4. Loose stools are watery, foul-smelling, and occasionally streaked with blood.", "5. Patient has approximately 6 episodes of loose stools daily.", "6. Patient feels tired.", "7. Patient is currently being treated with intravenous ceftriaxone and oral azithromycin.", "8. Patient underwent a laparoscopic cholecystectomy 5 years ago.", "9. Patient returned from a trip to Bolivia 4 weeks ago.", "10. Patient's temperature is 37.5\u00b0C (99.5\u00b0F).", "11. Patient's pulse is 98/min.", "12. Patient's blood pressure is 138/80 mm Hg.", "13. Bronchial breath sounds are heard over patient's right lung.", "14. Abdominal examination shows mild diffuse tenderness throughout the lower quadrants.", "15. Abdomen is not distended.", "16. Remainder of patient's examination shows no abnormalities.", "17. Patient's hemoglobin concentration is 12 g/dL.", "18. Patient's leukocyte count is 14,100/mm3.", "19. Patient's erythrocyte sedimentation rate is 37 mm/h."], "atomic_facts": ["1. The patient's stool is watery, foul-smelling, and occasionally streaked with blood.", "2. The patient has approximately 6 episodes of stool daily.", "3. The patient feels tired.", "4. The patient is currently being treated with intravenous ceftriaxone and oral azithromycin.", "5. The patient underwent a laparoscopic cholecystectomy 5 years ago.", "6. The patient returned from a trip to Bolivia 4 weeks ago.", "7. The patient's temperature is 37.5\u00b0C (99.5\u00b0F), pulse is 98/min, and blood pressure is 138/80 mm Hg.", "8. Bronchial breath sounds are heard over the patient's right lung.", "9. Abdominal examination shows mild diffuse tenderness throughout the lower quadrants.", "10. The patient's abdomen is not distended.", "11. The remainder of the patient's examination shows no abnormalities.", "12. The patient's hemoglobin concentration is 12 g/dL, leukocyte count is 14,100/mm3, and erythrocyte sedimentation rate is 37 mm/h."]}
{"id": 1019, "question": "Which of the following is the most likely diagnosis?", "context": ["An otherwise healthy 52-year-old man comes to the physician because of a 2-month history of palpitations.", "He says that he can feel his heart beat in his chest all the time.", "For the past 3 weeks, he has shortness of breath on exertion.", "He has not had chest pain, orthopnea, or nocturnal dyspnea.", "He emigrated from Nepal at the age of 25 years.", "He does not take any medications.", "His temperature is 36.5\u00b0C (97.7\u00b0F), pulse is 103/min, and blood pressure is 138/56 mm Hg.", "The lungs are clear to auscultation.", "Cardiac examination is shown."], "context_len": 9, "options": {"A": "Pulmonary valve stenosis", "B": "Aortic valve regurgitation", "C": "Tricuspid valve regurgitation", "D": "Mitral valve prolapse"}, "answer": "Aortic valve regurgitation", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Cardiovascular Disease", "Cardiology", "General Cardiology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 52-year-old man.", "2. Patient has a 2-month history of palpitations.", "3. Patient feels his heart beat in his chest all the time.", "4. Patient has shortness of breath on exertion for the past 3 weeks.", "5. Patient has no chest pain, orthopnea, or nocturnal dyspnea.", "6. Patient emigrated from Nepal at the age of 25 years.", "7. Patient does not take any medications.", "8. Patient's temperature is 36.5\u00b0C (97.7\u00b0F).", "9. Patient's pulse is 103/min.", "10. Patient's blood pressure is 138/56 mm Hg.", "11. Lungs are clear to auscultation.", "12. Cardiac examination is shown."], "atomic_facts": ["1. He can feel his heart beat in his chest all the time.", "2. For the past 3 weeks, he has shortness of breath on exertion.", "3. He has not had chest pain, orthopnea, or nocturnal dyspnea.", "4. He emigrated from Nepal at the age of 25 years.", "5. He does not take any medications.", "6. His temperature is 36.5\u00b0C (97.7\u00b0F), pulse is 103/min, and blood pressure is 138/56 mm Hg.", "7. The lungs are clear to auscultation.", "8. Cardiac examination is shown."]}
{"id": 1020, "question": "Which of the following activities was most likely inhibited by the cause of this patient's presentation?", "context": ["A 55-year-old male presents to the emergency department after he was seen having a seizure.", "On presentation he is comatose and very jaundiced despite having no previous medical history and dies shortly thereafter.", "Over the next several hours 5 more patients present to the ER with severe diarrhea, abdominal pain, and bleeding abnormalities.", "They all recently returned from a several day camping trip where they slept in the woods and cooked with ingredients they were able to find in the wild.", "The original patient was also part of this camping trip.", "Postmortem analysis reveals massive hepatic necrosis."], "context_len": 6, "options": {"A": "Transcription of mRNA", "B": "Transcription of rRNA", "C": "Transcription of tRNA", "D": "Translation of mRNA"}, "answer": "Transcription of mRNA", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Neurology"], "subspecialties": ["Clinical Neurophysiology", "Epilepsy", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 55-year-old male presents to the emergency department after he was seen having a seizure.", "2. On presentation he is comatose and very jaundiced.", "3. He had no previous medical history.", "4. He dies shortly thereafter.", "5. Over the next several hours 5 more patients present to the ER with severe diarrhea, abdominal pain, and bleeding abnormalities.", "6. They all recently returned from a several day camping trip.", "7. They slept in the woods and cooked with ingredients they were able to find in the wild.", "8. The original patient was also part of this camping trip.", "9. Postmortem analysis reveals massive hepatic necrosis."], "atomic_facts": ["1. A patient presented comatose and jaundiced.", "2. The patient had no previous medical history.", "3. The patient died shortly after presentation.", "4. Five more patients presented to the ER with severe diarrhea, abdominal pain, and bleeding abnormalities.", "5. The patients had recently returned from a camping trip.", "6. During the camping trip, they slept in the woods and cooked with wild ingredients.", "7. The original patient was part of the camping trip.", "8. Postmortem analysis revealed massive hepatic necrosis."]}
{"id": 1021, "question": "Which of the following is the most likely cause of this patient's seizure?", "context": ["A 46-year-old woman is brought to the emergency department for respiratory depression.", "Routine urine toxicology screening is positive for alcohol, fentanyl, and benzodiazepines.", "Blood glucose is 80 mg/dL.", "Naloxone, flumazenil, and lactated Ringer's solution are administered intravenously.", "Two hours later, the woman has a tonic-clonic seizure lasting for one minute.", "Her pulse is 100/min, blood pressure is 145/90 mm Hg, and respiratory rate is 24/min.", "Pulse oximetry on room air shows an oxygen saturation of 98%.", "The patient appears drowsy and diaphoretic.", "She is not oriented to place or time but responds to her name.", "Examination shows a hematoma on her left temple.", "Neurological examination shows stiff extremities and a tremor in both hands.", "The remainder of the examination shows no abnormalities."], "context_len": 12, "options": {"A": "Hypoglycemia", "B": "Benzodiazepine withdrawal", "C": "Alcohol withdrawal", "D": "Subdural hemorrhage"}, "answer": "Benzodiazepine withdrawal", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "46 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine", "Neurocritical Care", "Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 46-year-old woman is brought to the emergency department for respiratory depression.", "2. Routine urine toxicology screening is positive for alcohol, fentanyl, and benzodiazepines.", "3. Blood glucose is 80 mg/dL.", "4. Naloxone, flumazenil, and lactated Ringer's solution are administered intravenously.", "5. Two hours later, the woman has a tonic-clonic seizure lasting for one minute.", "6. Her pulse is 100/min.", "7. Blood pressure is 145/90 mm Hg.", "8. Respiratory rate is 24/min.", "9. Pulse oximetry on room air shows an oxygen saturation of 98%.", "10. The patient appears drowsy and diaphoretic.", "11. She is not oriented to place or time but responds to her name.", "12. Examination shows a hematoma on her left temple.", "13. Neurological examination shows stiff extremities and a tremor in both hands.", "14. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. Routine urine toxicology screening is positive for alcohol, fentanyl, and benzodiazepines.", "2. Blood glucose is 80 mg/dL.", "3. Naloxone, flumazenil, and lactated Ringer's solution are administered intravenously.", "4. Two hours later, the woman has a tonic-clonic seizure lasting for one minute.", "5. Her pulse is 100/min, blood pressure is 145/90 mm Hg, and respiratory rate is 24/min.", "6. Pulse oximetry on room air shows an oxygen saturation of 98%.", "7. The patient appears drowsy and diaphoretic.", "8. She is not oriented to place or time but responds to her name.", "9. Examination shows a hematoma on her left temple.", "10. Neurological examination shows stiff extremities and a tremor in both hands.", "11. The remainder of the examination shows no abnormalities."]}
{"id": 1022, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 22-year-old man comes to the emergency department because of sudden onset of facial swelling, abdominal pain, and nausea 1 hour after eating some trail mix.", "He does not have shortness of breath or hoarseness.", "He has never had a similar episode before.", "He has asthma treated with an albuterol inhaler, which he uses less than once a month.", "His pulse is 90/min, respirations are 25/min, and blood pressure is 125/80 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 99%.", "Physical examination shows perioral swelling and scattered urticaria over the face and the fingers of his right hand.", "There is no swelling of the oropharynx and no audible stridor.", "The lungs are clear to auscultation bilaterally.", "Treatment with intravenous diphenhydramine is begun.", "Shortly after, the abdominal pain and nausea have resolved, the swelling has improved, and the rash has started to fade."], "context_len": 11, "options": {"A": "Recommend avoidance of peanuts", "B": "Perform patch test", "C": "Prescribe epinephrine autoinjector", "D": "Administer oral prednisone"}, "answer": "Prescribe epinephrine autoinjector", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "22 years old", "specialties": ["Allergy and Immunology"], "subspecialties": ["General Allergy and Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A 22-year-old man comes to the emergency department.", "2. He has sudden onset of facial swelling, abdominal pain, and nausea 1 hour after eating some trail mix.", "3. He does not have shortness of breath or hoarseness.", "4. He has never had a similar episode before.", "5. He has asthma treated with an albuterol inhaler, which he uses less than once a month.", "6. His pulse is 90/min.", "7. His respirations are 25/min.", "8. His blood pressure is 125/80 mm Hg.", "9. Pulse oximetry on room air shows an oxygen saturation of 99%.", "10. Physical examination shows perioral swelling and scattered urticaria over the face and the fingers of his right hand.", "11. There is no swelling of the oropharynx and no audible stridor.", "12. The lungs are clear to auscultation bilaterally.", "13. Treatment with intravenous diphenhydramine is begun.", "14. Shortly after, the abdominal pain and nausea have resolved.", "15. The swelling has improved.", "16. The rash has started to fade."], "atomic_facts": ["1. He does not have shortness of breath or hoarseness.", "2. He has never had a similar episode before.", "3. He has asthma treated with an albuterol inhaler, which he uses less than once a month.", "4. His pulse is 90/min, respirations are 25/min, and blood pressure is 125/80 mm Hg.", "5. Pulse oximetry on room air shows an oxygen saturation of 99%.", "6. Physical examination shows perioral swelling and scattered urticaria over the face and the fingers of his right hand.", "7. There is no swelling of the oropharynx and no audible stridor.", "8. The lungs are clear to auscultation bilaterally.", "9. Treatment with intravenous diphenhydramine is begun.", "10. Shortly after, the abdominal pain and nausea have resolved, the swelling has improved, and the rash has started to fade."]}
{"id": 1023, "question": "The regions of this patient's lymph nodes that is likely abnormal also contains which of the following?", "context": ["A 2-year-old boy is referred by his primary care physician to a geneticist because of prolonged and recurrent infections.", "Specifically, he has had an abnormally large number of upper respiratory and gastrointestinal infections over the last year.", "He was born with a defect in the cardiac septum that was repaired right after birth and has remained asymptomatic since then.", "On evaluation, the patient appears to have hyperactive reflexes and his arm twitches upon blood pressure measurement."], "context_len": 4, "options": {"A": "Efferent sinuses", "B": "High endothelial venules", "C": "Plasma cell cords", "D": "Primary follicles"}, "answer": "High endothelial venules", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Immunology and Allergy", "Pediatric Immunology and Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A 2-year-old boy is referred by his primary care physician to a geneticist.", "2. The referral is due to prolonged and recurrent infections.", "3. The patient has had an abnormally large number of upper respiratory and gastrointestinal infections over the last year.", "4. The patient was born with a defect in the cardiac septum.", "5. The defect was repaired right after birth.", "6. The defect has remained asymptomatic since then.", "7. On evaluation, the patient appears to have hyperactive reflexes.", "8. The patient's arm twitches upon blood pressure measurement."], "atomic_facts": ["1. The patient has had an abnormally large number of upper respiratory infections over the last year.", "2. The patient has had an abnormally large number of gastrointestinal infections over the last year.", "3. The patient was born with a defect in the cardiac septum.", "4. The defect in the cardiac septum was repaired right after birth.", "5. The patient has remained asymptomatic since the repair of the cardiac septum.", "6. On evaluation, the patient appears to have hyperactive reflexes.", "7. The patient's arm twitches upon blood pressure measurement."]}
{"id": 1024, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 45-year-old woman presents with a 2-year history of fatigue, paresthesia, diarrhea, and abdominal pain.", "She says she experiences 2\u20133 episodes of non-bloody diarrhea per month associated with crampy abdominal pain.", "She also has the bilateral tingling sensation of her upper and lower limbs in a glove and stocking pattern which is sometimes associated with the burning sensation of her hands and legs.", "Past medical history is unremarkable.", "The patient denies smoking, alcohol consumption, illicit drug use.", "Her vital signs include: blood pressure 100/60 mm Hg without postural changes, heart rate 92/min, respiratory rate 16/min, temperature 37.0\u2103 (98.6\u2109).", "Laboratory findings are significant for the following: | Hgb 7.2 gm/dL | MCV 110 fL | RBC 3.6 X109/L | Platelets 10,000/mm3 | Total count  4,200/mm3 | Reticulocyte 0.8% | A peripheral blood smear demonstrates hypersegmented neutrophils.", "Anti-intrinsic factor and anti-tissue transglutaminase antibodies were negative.", "An upper GI series with small bowel follow-through is performed which shows a narrowing of the barium contrast in the lumen of the terminal ileum to the width of a string."], "context_len": 9, "options": {"A": "Celiac disease", "B": "Crohn's disease", "C": "Bacterial overgrowth", "D": "Hypothyroidism"}, "answer": "Crohn's disease", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 45-year-old woman.", "2. Patient has a 2-year history of fatigue, paresthesia, diarrhea, and abdominal pain.", "3. Patient experiences 2\u20133 episodes of non-bloody diarrhea per month associated with crampy abdominal pain.", "4. Patient has bilateral tingling sensation of her upper and lower limbs in a glove and stocking pattern which is sometimes associated with the burning sensation of her hands and legs.", "5. Patient's past medical history is unremarkable.", "6. Patient denies smoking, alcohol consumption, and illicit drug use.", "7. Patient's vital signs include: blood pressure 100/60 mm Hg without postural changes, heart rate 92/min, respiratory rate 16/min, temperature 37.0\u2103 (98.6\u2109).", "8. Laboratory findings are significant for Hgb 7.2 gm/dL, MCV 110 fL, RBC 3.6 X109/L, Platelets 10,000/mm3, Total count 4,200/mm3, Reticulocyte 0.8%.", "9. Peripheral blood smear demonstrates hypersegmented neutrophils.", "10. Anti-intrinsic factor and anti-tissue transglutaminase antibodies were negative.", "11. Upper GI series with small bowel follow-through shows a narrowing of the barium contrast in the lumen of the terminal ileum to the width of a string."], "atomic_facts": ["1. The patient experiences 2\u20133 episodes of non-bloody diarrhea per month.", "2. The diarrhea is associated with crampy abdominal pain.", "3. The patient has bilateral tingling sensation in a glove and stocking pattern in her upper and lower limbs.", "4. The tingling sensation is sometimes associated with a burning sensation in her hands and legs.", "5. The patient has an unremarkable past medical history.", "6. The patient denies smoking, alcohol consumption, and illicit drug use.", "7. The patient's blood pressure is 100/60 mm Hg without postural changes.", "8. The patient's heart rate is 92/min.", "9. The patient's respiratory rate is 16/min.", "10. The patient's temperature is 37.0\u2103 (98.6\u2109).", "11. Laboratory findings show: Hgb 7.2 gm/dL, MCV 110 fL, RBC 3.6 X109/L, Platelets 10,000/mm3, Total count 4,200/mm3, Reticulocyte 0.8%.", "12. A peripheral blood smear demonstrates hypersegmented neutrophils.", "13. Anti-intrinsic factor and anti-tissue transglutaminase antibodies were negative.", "14. An upper GI series with small bowel follow-through shows a narrowing of the barium contrast in the lumen of the terminal ileum to the width of a string."]}
{"id": 1025, "question": "Which of the following should be included in the work-up of this patient?", "context": ["A 15-month-old boy is brought to his pediatrician by his mother with a swollen and painful right elbow.", "She reports that he stumbled and fell on the carpeted floor of their living room, hitting his right elbow on the ground.", "The mother reports that he did not appear to be in a great deal of pain after the fall, and that she noted the swelling of the joint a few hours after the fall.", "He recently started walking approximately 2 weeks ago.", "He does not have any known medical issues, and he is not currently on medication.", "The mother's pregnancy was without complications and the boy was delivered vaginally without complications at 40 weeks.", "Aspiration of the right elbow joint reveals frank blood."], "context_len": 7, "options": {"A": "Peripheral blood smear", "B": "Creatinine level and percutaneous kidney biopsy", "C": "Prothrombin time/partial thromboplastin time", "D": "24 hour urine collection for porphyrin levels"}, "answer": "Prothrombin time/partial thromboplastin time", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "15 months", "specialties": ["Pediatrics", "Orthopaedic Surgery"], "subspecialties": ["Pediatric Rheumatology", "General Orthopaedic Surgery"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 15-month-old boy is brought to his pediatrician by his mother.", "2. The boy has a swollen and painful right elbow.", "3. The mother reports that he stumbled and fell on the carpeted floor of their living room, hitting his right elbow on the ground.", "4. The mother reports that he did not appear to be in a great deal of pain after the fall.", "5. The mother noted the swelling of the joint a few hours after the fall.", "6. He recently started walking approximately 2 weeks ago.", "7. He does not have any known medical issues.", "8. He is not currently on medication.", "9. The mother's pregnancy was without complications.", "10. The boy was delivered vaginally without complications at 40 weeks.", "11. Aspiration of the right elbow joint reveals frank blood."], "atomic_facts": ["1. The boy stumbled and fell on the carpeted floor of their living room, hitting his right elbow on the ground.", "2. The mother reports that he did not appear to be in a great deal of pain after the fall.", "3. The mother noted the swelling of the joint a few hours after the fall.", "4. He recently started walking approximately 2 weeks ago.", "5. He does not have any known medical issues.", "6. He is not currently on medication.", "7. The mother's pregnancy was without complications.", "8. The boy was delivered vaginally without complications at 40 weeks.", "9. Aspiration of the right elbow joint reveals frank blood."]}
{"id": 1026, "question": "Which of the following structures has this patient injured in addition to the meniscus?", "context": ["A 45-year-old male comes into your office one week after he was tackled playing football with his friends.", "The patient states that the medial aspect of his knee collided with another player's knee.", "Since then, he has been taking ibuprofen for knee pain.", "On exam, the patient's right knee appears larger than his left knee with a small effusion.", "The patient has intact sensation and strength in both lower extremities.", "The patient's right knee has no laxity on valgus stress test, but is very lax on varus stress test.", "Lachman's test and posterior drawer test both have firm endpoints without laxity.", "McMurray's test is positive and the patient states he feels catching and locking during the test."], "context_len": 8, "options": {"A": "Anterior cruciate ligament", "B": "Posterior cruciate ligament", "C": "Medial collateral ligament", "D": "Lateral collateral ligament"}, "answer": "Lateral collateral ligament", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "45", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 45 years old.", "2. Patient was tackled playing football one week prior.", "3. Patient's medial knee collided with another player's knee.", "4. Patient has been taking ibuprofen for knee pain.", "5. Patient's right knee appears larger than left knee with a small effusion.", "6. Patient has intact sensation and strength in both lower extremities.", "7. Patient's right knee has no laxity on valgus stress test.", "8. Patient's right knee is very lax on varus stress test.", "9. Lachman's test and posterior drawer test have firm endpoints without laxity.", "10. McMurray's test is positive.", "11. Patient states he feels catching and locking during McMurray's test."], "atomic_facts": ["1. The patient reports a collision between the medial aspect of his knee and another player's knee.", "2. The patient has been taking ibuprofen for knee pain since the collision.", "3. On exam, the patient's right knee appears larger than his left knee with a small effusion.", "4. The patient has intact sensation and strength in both lower extremities.", "5. The patient's right knee has no laxity on valgus stress test, but is very lax on varus stress test.", "6. Lachman's test and posterior drawer test both have firm endpoints without laxity.", "7. McMurray's test is positive and the patient experiences catching and locking during the test."]}
{"id": 1027, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 19-month-old girl is brought for a well-child examination.", "She was born at term and has been healthy.", "On physical examination, the child is alert and active.", "Her temperature is 37.3 \u00b0C (99.1 \u00b0F), pulse is 102/min, respirations are 24/min, and blood pressure is 102/54 mm Hg.", "She is at the 75th percentile for height and 80th percentile for weight.", "Cardiac examination shows a normal S1 and a split S2 during inspiration.", "A grade 2/6 soft mid-systolic murmur is heard maximally at the lower left sternal border.", "A contrast echocardiogram is performed and reveals a mild transient right-to-left interatrial shunt that becomes apparent when the child coughs."], "context_len": 8, "options": {"A": "No intervention", "B": "Aspirin therapy", "C": "Surgical closure", "D": "Regular echocardiographies"}, "answer": "No intervention", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "19 months", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 19-month-old girl is brought for a well-child examination.", "2. She was born at term.", "3. She has been healthy.", "4. On physical examination, the child is alert and active.", "5. Her temperature is 37.3 \u00b0C (99.1 \u00b0F).", "6. Her pulse is 102/min.", "7. Her respirations are 24/min.", "8. Her blood pressure is 102/54 mm Hg.", "9. She is at the 75th percentile for height.", "10. She is at the 80th percentile for weight.", "11. Cardiac examination shows a normal S1.", "12. Cardiac examination shows a split S2 during inspiration.", "13. A grade 2/6 soft mid-systolic murmur is heard maximally at the lower left sternal border.", "14. A contrast echocardiogram is performed.", "15. The contrast echocardiogram reveals a mild transient right-to-left interatrial shunt.", "16. The shunt becomes apparent when the child coughs."], "atomic_facts": ["1. She was born at term", "2. She has been healthy", "3. The child is alert and active", "4. Her temperature is 37.3 \u00b0C (99.1 \u00b0F)", "5. Her pulse is 102/min", "6. Her respirations are 24/min", "7. Her blood pressure is 102/54 mm Hg", "8. She is at the 75th percentile for height", "9. She is at the 80th percentile for weight", "10. Cardiac examination shows a normal S1", "11. Cardiac examination shows a split S2 during inspiration", "12. A grade 2/6 soft mid-systolic murmur is heard maximally at the lower left sternal border", "13. A contrast echocardiogram is performed", "14. The echocardiogram reveals a mild transient right-to-left interatrial shunt", "15. The shunt becomes apparent when the child coughs"]}
{"id": 1028, "question": "Further evaluation of this patient is likely to show which of the following findings?", "context": ["A 6-year-old girl is brought to the emergency department because of right knee pain for the past 3 days.", "During this period, the girl has refused to walk.", "Her mother reports that her symptoms began after she fell down while playing.", "Three weeks ago, the patient had a sore throat and was treated with penicillin V.", "Her father has hemophilia A and has had repeated episodes of joint pain and swelling following minor injury.", "The patient's immunizations are up-to-date.", "Her temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 120/min, and respirations are 21/min.", "The right knee joint is warm and erythematous.", "The girl starts to cry as soon as the physician tries to flex the knee joint."], "context_len": 9, "options": {"A": "Gram-positive cocci in synovial fluid", "B": "Prolonged prothrombin time", "C": "Increased antistreptolysin O titers", "D": "Rhomboid crystals in synovial fluid"}, "answer": "Gram-positive cocci in synovial fluid", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 6-year-old girl is brought to the emergency department.", "2. The girl has right knee pain for the past 3 days.", "3. The girl has refused to walk.", "4. Her symptoms began after she fell down while playing.", "5. Three weeks ago, the patient had a sore throat and was treated with penicillin V.", "6. Her father has hemophilia A.", "7. Her father has had repeated episodes of joint pain and swelling following minor injury.", "8. The patient's immunizations are up-to-date.", "9. Her temperature is 38.1\u00b0C (100.6\u00b0F).", "10. Her pulse is 120/min.", "11. Her respirations are 21/min.", "12. The right knee joint is warm and erythematous.", "13. The girl starts to cry as soon as the physician tries to flex the knee joint."], "atomic_facts": ["1. The girl has refused to walk.", "2. Her symptoms began after she fell down while playing.", "3. Three weeks ago, the patient had a sore throat and was treated with penicillin V.", "4. Her father has hemophilia A and has had repeated episodes of joint pain and swelling following minor injury.", "5. The patient's immunizations are up-to-date.", "6. Her temperature is 38.1\u00b0C (100.6\u00b0F), pulse is 120/min, and respirations are 21/min.", "7. The right knee joint is warm and erythematous.", "8. The girl starts to cry as soon as the physician tries to flex the knee joint."]}
{"id": 1029, "question": "What is the most likely cause of this patient\u2019s condition?", "context": ["A 35-year-old man attempted to climb Mount Everest.", "At an altitude of 7,000 meters, he became short of breath and developed a dusky blue tinge around his face and lips.", "A physician in the climbing party performs a rudimentary physical exam which reveals a respiratory rate of 30/min, blood pressure of 130/90 mm Hg, heart rate of 108/min, and temperature of 36.4\u00b0C (97.5\u00b0F), with few basal crackles on the right side of chest.", "No jugular venous distension or dependent edema is noted.", "With this information, the mountain climber is sent down the mountain for further evaluation.", "Investigation reveals a normal chest X-ray with a normal heart size."], "context_len": 6, "options": {"A": "Diffusion defect", "B": "Anemic hypoxia", "C": "Ischemic hypoxia", "D": "Hypoxemic hypoxia"}, "answer": "Hypoxemic hypoxia", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "35", "specialties": ["Internal Medicine", "Pulmonary Disease"], "subspecialties": ["Pulmonary Disease", "General Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 35-year-old man attempted to climb Mount Everest.", "2. At an altitude of 7,000 meters, he became short of breath and developed a dusky blue tinge around his face and lips.", "3. A physician in the climbing party performed a rudimentary physical exam.", "4. The physical exam revealed a respiratory rate of 30/min.", "5. The physical exam revealed a blood pressure of 130/90 mm Hg.", "6. The physical exam revealed a heart rate of 108/min.", "7. The physical exam revealed a temperature of 36.4\u00b0C (97.5\u00b0F).", "8. The physical exam revealed few basal crackles on the right side of chest.", "9. The physical exam revealed no jugular venous distension.", "10. The physical exam revealed no dependent edema.", "11. The mountain climber was sent down the mountain for further evaluation.", "12. Investigation revealed a normal chest X-ray.", "13. Investigation revealed a normal heart size."], "atomic_facts": ["1. Altitude of 7,000 meters", "2. Shortness of breath", "3. Dusky blue tinge around face and lips", "4. Respiratory rate of 30/min", "5. Blood pressure of 130/90 mm Hg", "6. Heart rate of 108/min", "7. Temperature of 36.4\u00b0C (97.5\u00b0F)", "8. Few basal crackles on the right side of chest", "9. No jugular venous distension", "10. No dependent edema", "11. Mountain climber sent down the mountain for further evaluation", "12. Normal chest X-ray", "13. Normal heart size"]}
{"id": 1030, "question": "Which of the following clinical features can be seen as a long-term complication of posterior pituitary dysfunction?", "context": ["A 28-year-old man who was involved in a motorcycle accident presents to the nearest trauma center to get his wounds treated.", "After the initial evaluation and resuscitation by the emergency trauma team, a CT scan shows a skull base fracture."], "context_len": 2, "options": {"A": "Erectile dysfunction", "B": "Decreased lean body mass", "C": "Polydipsia", "D": "Cold intolerance"}, "answer": "Polydipsia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "28 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 28-year-old man was involved in a motorcycle accident.", "2. He presents to the nearest trauma center to get his wounds treated.", "3. The emergency trauma team performs an initial evaluation and resuscitation.", "4. A CT scan shows a skull base fracture."], "atomic_facts": ["1. Initial evaluation and resuscitation performed by emergency trauma team", "2. CT scan conducted", "3. CT scan shows a skull base fracture"]}
{"id": 1031, "question": "The dosage of which of the following types of insulin was most likely changed in this patient's medication regimen?", "context": ["A 19-year-old woman comes to the physician for a follow-up examination.", "She has a history of type 1 diabetes mellitus and is compliant with her medications.", "After reviewing the patient's recent blood sugar levels, the physician changes the patient's antidiabetic regimen by changing the dosage of an insulin that does not produce an observable peak in serum insulin concentration."], "context_len": 3, "options": {"A": "Insulin glargine", "B": "Insulin glulisine", "C": "Regular insulin", "D": "Insulin lispro"}, "answer": "Insulin glargine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "19", "specialties": ["Internal Medicine", "Endocrinology, Diabetes, and Metabolism"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Endocrinology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 19-year-old woman comes to the physician for a follow-up examination.", "2. She has a history of type 1 diabetes mellitus.", "3. She is compliant with her medications.", "4. The physician reviews the patient's recent blood sugar levels.", "5. The physician changes the patient's antidiabetic regimen.", "6. The dosage of an insulin is changed.", "7. The insulin does not produce an observable peak in serum insulin concentration."], "atomic_facts": ["1. The patient has a history of type 1 diabetes mellitus.", "2. The patient is compliant with her medications.", "3. The physician reviewed the patient's recent blood sugar levels.", "4. The physician changed the patient's antidiabetic regimen.", "5. The change involved adjusting the dosage of an insulin.", "6. The insulin does not produce an observable peak in serum insulin concentration."]}
{"id": 1032, "question": "Which of the following organisms would be most likely isolated in this patient?", "context": ["A 31-year-old woman visits her local walk-in clinic for 2 days of dysuria, increased voiding frequency, urgency, and intense suprapubic pain.", "She just came back a day ago from a short honeymoon trip to Prague.", "On physical examination, the patient is found with exquisite suprapubic pain.", "Costovertebral tenderness is absent and pelvic examination is normal.", "Her vital signs are: temperature 36.5\u00b0C (97.7\u00b0F), heart rate 78/min, respiratory rate 15/min."], "context_len": 5, "options": {"A": "Streptococcus agalactiae", "B": "Enterococcus faecalis", "C": "Klebsiella pneumoniae", "D": "Staphylococcus saprophyticus"}, "answer": "Staphylococcus saprophyticus", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "31 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Family Medicine"}, "facts_old": ["1. A 31-year-old woman visited her local walk-in clinic.", "2. She had dysuria, increased voiding frequency, urgency, and intense suprapubic pain.", "3. She had recently returned from a honeymoon trip to Prague.", "4. On physical examination, the patient had exquisite suprapubic pain.", "5. Costovertebral tenderness was absent.", "6. Pelvic examination was normal.", "7. Her temperature was 36.5\u00b0C (97.7\u00b0F).", "8. Her heart rate was 78/min.", "9. Her respiratory rate was 15/min."], "atomic_facts": ["1. The patient just came back from a short honeymoon trip to Prague a day ago.", "2. On physical examination, the patient has exquisite suprapubic pain.", "3. Costovertebral tenderness is absent.", "4. Pelvic examination is normal.", "5. Vital signs: temperature 36.5\u00b0C (97.7\u00b0F), heart rate 78/min, respiratory rate 15/min."]}
{"id": 1033, "question": "Which of the following is the most appropriate recommendation by the physician?", "context": ["A 14-year-old boy is brought to the physician by his mother because of a 1-week history of fever, fatigue, and throat pain.", "He appears lethargic.", "His temperature is 38.5\u00b0C (101.3\u00b0F).", "Physical examination shows bilateral cervical lymphadenopathy.", "Oral examination shows the findings in the photograph.", "A peripheral blood smear shows lymphocytosis with atypical lymphocytes.", "A heterophile antibody test is positive."], "context_len": 7, "options": {"A": "Start antiretroviral therapy", "B": "Schedule bone marrow biopsy", "C": "Avoid contact sports", "D": "Avoid crowded places"}, "answer": "Avoid contact sports", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "14 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 14-year-old boy is brought to the physician by his mother.", "2. He has a 1-week history of fever, fatigue, and throat pain.", "3. He appears lethargic.", "4. His temperature is 38.5\u00b0C (101.3\u00b0F).", "5. Physical examination shows bilateral cervical lymphadenopathy.", "6. Oral examination shows the findings in the photograph.", "7. A peripheral blood smear shows lymphocytosis with atypical lymphocytes.", "8. A heterophile antibody test is positive."], "atomic_facts": ["1. He appears lethargic.", "2. His temperature is 38.5\u00b0C (101.3\u00b0F).", "3. Physical examination shows bilateral cervical lymphadenopathy.", "4. Oral examination shows the findings in the photograph.", "5. A peripheral blood smear shows lymphocytosis with atypical lymphocytes.", "6. A heterophile antibody test is positive."]}
{"id": 1034, "question": "What is the most likely pathogenesis leading to the X-ray findings?", "context": ["A 62-year-old carpenter presents to your clinic complaining of worsening joint pain in her hands.", "She states that the pain is present in all of her fingers, but is worse in the right hand and that it gets better when she has a few days off from work.", "She notes no paresthesias, fever, or fatigue.", "On examination, the patient is afebrile and all vital signs are stable.", "She has hard, non-tender lesions overlying the proximal interphalangeal joints of the 2nd and 3rd fingers on the right hand and all 5 digits on this hand have a decreased range of motion.", "An X-ray of her hands is shown."], "context_len": 6, "options": {"A": "Repetitive movement injury", "B": "Overgrowth of a gram-positive bacteria", "C": "Deposition of monosodium urate crystals", "D": "Production of rheumatoid factor and other autoantibodies"}, "answer": "Repetitive movement injury", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "62", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 62-year-old carpenter presents to your clinic.", "2. She is complaining of worsening joint pain in her hands.", "3. The pain is present in all of her fingers.", "4. The pain is worse in the right hand.", "5. The pain gets better when she has a few days off from work.", "6. She notes no paresthesias, fever, or fatigue.", "7. On examination, the patient is afebrile.", "8. All vital signs are stable.", "9. She has hard, non-tender lesions overlying the proximal interphalangeal joints of the 2nd and 3rd fingers on the right hand.", "10. All 5 digits on the right hand have a decreased range of motion.", "11. An X-ray of her hands is shown."], "atomic_facts": ["1. The patient reports pain in all fingers, worse in the right hand, and improved with time off work.", "2. The patient denies experiencing paresthesias, fever, or fatigue.", "3. On examination, the patient is afebrile and has stable vital signs.", "4. The patient has hard, non-tender lesions over the proximal interphalangeal joints of the 2nd and 3rd fingers on the right hand.", "5. All 5 digits on the right hand have a decreased range of motion.", "6. An X-ray of the patient's hands is available."]}
{"id": 1035, "question": "Which of the following is the next best step?", "context": ["A 7-year-old girl presents to the emergency department with a bloody nose that spontaneously started bleeding 20 minutes ago.", "On physical examination, she appears well and has no lymphadenopathy.", "Her heart has a regular rate and rhythm, her lungs are clear to auscultation bilaterally, and her abdomen is soft without hepatosplenomegaly, but she does have petechiae over her lower extremities.", "A complete blood count is obtained and reveals a leukocyte count of 11,300 cells/mcL, hemoglobin 12.1 g/dL, hematocrit 36%, and platelets 15,000/mcL.", "A peripheral smear shows a few morphologically normal platelets.", "Her mother reports that she had a viral infection 2 weeks ago but has been otherwise healthy."], "context_len": 6, "options": {"A": "Start intravenous immunoglobulin", "B": "Perform a splenectomy", "C": "Perform a bone marrow aspiration", "D": "Observation"}, "answer": "Start intravenous immunoglobulin", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 7-year-old girl presents to the emergency department with a bloody nose.", "2. The nose spontaneously started bleeding 20 minutes ago.", "3. On physical examination, she appears well and has no lymphadenopathy.", "4. Her heart has a regular rate and rhythm.", "5. Her lungs are clear to auscultation bilaterally.", "6. Her abdomen is soft without hepatosplenomegaly.", "7. She has petechiae over her lower extremities.", "8. A complete blood count is obtained.", "9. Leukocyte count is 11,300 cells/mcL.", "10. Hemoglobin is 12.1 g/dL.", "11. Hematocrit is 36%.", "12. Platelets are 15,000/mcL.", "13. A peripheral smear shows a few morphologically normal platelets.", "14. Her mother reports she had a viral infection 2 weeks ago.", "15. She has been otherwise healthy."], "atomic_facts": ["1. On physical examination, she appears well", "2. She has no lymphadenopathy", "3. Her heart has a regular rate and rhythm", "4. Her lungs are clear to auscultation bilaterally", "5. Her abdomen is soft without hepatosplenomegaly", "6. She has petechiae over her lower extremities", "7. A complete blood count reveals a leukocyte count of 11,300 cells/mcL", "8. Hemoglobin is 12.1 g/dL", "9. Hematocrit is 36%", "10. Platelets are 15,000/mcL", "11. A peripheral smear shows a few morphologically normal platelets", "12. Her mother reports that she had a viral infection 2 weeks ago"]}
{"id": 1036, "question": "Which of the following is the most likely cause of this patient's presentation?", "context": ["A 2-year-old boy is brought to the physician by his parents because their son frequently avoids eye contact and has no friends in daycare.", "He was born at term and has been healthy except for an episode of otitis media 6 months ago.", "His immunizations are up-to-date.", "He is at the 95th percentile for height, 20th percentile for weight, and 95th percentile for head circumference.", "Vital signs are within normal limits.", "Examination shows elongated facial features and large ears.", "The patient is shy and does not speak or follow instructions.", "He continually opens and closes his mother's purse and does not maintain eye contact."], "context_len": 8, "options": {"A": "CGG trinucleotide repeat expansion on X-chromosome", "B": "Deletion of the long arm on chromosome 7", "C": "Genomic imprinting on chromosome 15", "D": "An additional X chromosome"}, "answer": "CGG trinucleotide repeat expansion on X-chromosome", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Developmental"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2-year-old boy is brought to the physician by his parents.", "2. The boy frequently avoids eye contact and has no friends in daycare.", "3. He was born at term.", "4. He has been healthy except for an episode of otitis media 6 months ago.", "5. His immunizations are up-to-date.", "6. He is at the 95th percentile for height.", "7. He is at the 20th percentile for weight.", "8. He is at the 95th percentile for head circumference.", "9. Vital signs are within normal limits.", "10. Examination shows elongated facial features and large ears.", "11. The patient is shy and does not speak or follow instructions.", "12. He continually opens and closes his mother's purse.", "13. He does not maintain eye contact."], "atomic_facts": ["1. He was born at term.", "2. He has been healthy except for an episode of otitis media 6 months ago.", "3. His immunizations are up-to-date.", "4. He is at the 95th percentile for height.", "5. He is at the 20th percentile for weight.", "6. He is at the 95th percentile for head circumference.", "7. Vital signs are within normal limits.", "8. Examination shows elongated facial features and large ears.", "9. The patient is shy.", "10. The patient does not speak or follow instructions.", "11. He continually opens and closes his mother's purse.", "12. He does not maintain eye contact."]}
{"id": 1037, "question": "What best explains the change in this patient\u2019s lipid profile over this time period?", "context": ["A 78-year-old man is admitted to hospital for treatment of a severe attack of pneumonia he has been experiencing for the past three days.", "A week earlier, he had been feeling well until he developed what he describes as a mild cold.", "Over the next few days, he began to have difficulty breathing and developed a productive cough and fever.", "As his condition worsened despite antibiotic therapy at home, he was admitted for intravenous antibiotics and observation.", "He has a 50-pack-year history of smoking and has been diagnosed with chronic obstructive pulmonary disease (COPD).", "Prior to admission, the man was taking inhaled formoterol, budesonide, and oxygen at home.", "He has been drinking 3 alcoholic drinks daily for the last 60 years and smoked marijuana during his 20s.", "His lab results from 1 week ago and from his day of admission to hospital are as follows: | 7 days ago | On admission to hospital | Serum glucose (random)  130 mg/dL | Serum electrolytes | Sodium 142 mEq/L | Potassium 3.9 mEq/L | Chloride 101 mEq/L | Serum creatinine 0.8 mg/dL | Blood urea nitrogen 9 mg/dL | Cholesterol, total 170 mg/dL | HDL-cholesterol 42 mg/dL | LDL-cholesterol 110 mg/dL | Triglycerides 130 mg/dL | Serum glucose (random)  100 mg/dL | Serum electrolytes | Sodium 140 mEq/L | Potassium 4.0 mEq/L | Chloride 100 mEq/L | Serum creatinine 0.9 mg/dL | Blood urea nitrogen 11 mg/dL | Cholesterol, total 130 mg/dL | HDL-cholesterol 30 mg/dL | LDL-cholesterol 80 mg/dL | Triglycerides 180 mg/dL | ."], "context_len": 8, "options": {"A": "COPD exacerbation", "B": "Drug side effect", "C": "Physiological response", "D": "Undiagnosed dyslipidemia"}, "answer": "Physiological response", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "78 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 78-year-old man is admitted to hospital for treatment of a severe attack of pneumonia he has been experiencing for the past three days.", "2. A week earlier, he had been feeling well until he developed what he describes as a mild cold.", "3. Over the next few days, he began to have difficulty breathing and developed a productive cough and fever.", "4. As his condition worsened despite antibiotic therapy at home, he was admitted for intravenous antibiotics and observation.", "5. He has a 50-pack-year history of smoking and has been diagnosed with chronic obstructive pulmonary disease (COPD).", "6. Prior to admission, the man was taking inhaled formoterol, budesonide, and oxygen at home.", "7. He has been drinking 3 alcoholic drinks daily for the last 60 years and smoked marijuana during his 20s.", "8. His lab results from 1 week ago show a serum glucose (random) of 130 mg/dL, sodium of 142 mEq/L, potassium of 3.9 mEq/L, chloride of 101 mEq/L, serum creatinine of 0.8 mg/dL, and blood urea nitrogen of 9 mg/dL.", "9. His lab results from his day of admission to hospital show a serum glucose (random) of 100 mg/dL, sodium of 140 mEq/L, potassium of 4.0 mEq/L, chloride of 100 mEq/L, serum creatinine of 0.9 mg/dL, and blood urea nitrogen of 11 mg/dL.", "10. His lab results from 1 week ago show a cholesterol, total of 170 mg/dL, HDL-cholesterol of 42 mg/dL, LDL-cholesterol of 110 mg/dL, and triglycerides of 130 mg/dL.", "11. His lab results from his day of admission to hospital show a cholesterol, total of 130 mg/dL, HDL-cholesterol of 30 mg/dL, LDL-cholesterol of 80 mg/dL, and triglycerides of 180 mg/dL."], "atomic_facts": ["1. The patient had been feeling well a week earlier.", "2. He developed what he describes as a mild cold.", "3. He began to have difficulty breathing over the next few days.", "4. He developed a productive cough and fever.", "5. His condition worsened despite antibiotic therapy at home.", "6. He was admitted for intravenous antibiotics and observation.", "7. The patient has a 50-pack-year history of smoking.", "8. He has been diagnosed with chronic obstructive pulmonary disease (COPD).", "9. Prior to admission, the man was taking inhaled formoterol, budesonide, and oxygen at home.", "10. He has been drinking 3 alcoholic drinks daily for the last 60 years.", "11. He smoked marijuana during his 20s.", "12. His lab results from 1 week ago and from his day of admission to hospital are as follows:", "13. Serum glucose (random) 130 mg/dL 7 days ago.", "14. Serum electrolytes: Sodium 142 mEq/L, Potassium 3.9 mEq/L, Chloride 101 mEq/L, Serum creatinine 0.8 mg/dL, Blood urea nitrogen 9 mg/dL, Cholesterol, total 170 mg/dL, HDL-cholesterol 42 mg/dL, LDL-cholesterol 110 mg/dL, Triglycerides 130 mg/dL 7 days ago.", "15. Serum glucose (random) 100 mg/dL on admission to hospital.", "16. Serum electrolytes: Sodium 140 mEq/L, Potassium 4.0 mEq/L, Chloride 100 mEq/L, Serum creatinine 0.9 mg/dL, Blood urea nitrogen 11 mg/dL, Cholesterol, total 130 mg/dL, HDL-cholesterol 30 mg/dL, LDL-cholesterol 80 mg/dL, Triglycerides 180 mg/dL on admission to hospital."]}
{"id": 1038, "question": "Further evaluation of the patient is most likely to show which of the following?", "context": ["A 42-year-old woman comes to the physician because of a 4-week history of progressive difficulty swallowing solid foods.", "The patient reports feeling like food gets stuck in her throat, and that she has to drink a lot of water to swallow her meals.", "Over the past 3 months, she has had progressive fatigue and occasional dyspnea while performing her daily activities.", "Her pulse is 104/min, respirations are 19/min, and blood pressure is 110/70 mm Hg.", "Physical examination shows conjunctival pallor, erythema around the corners of the mouth, and dry, scaly lips.", "Her fingernails appear spoon-shaped and brittle.", "Auscultation of the heart shows a grade 1/6 systolic murmur best heard at the second left intercostal space.", "Esophagogastroduodenoscopy shows thin membranes that are protruding into the upper third of the esophagus."], "context_len": 8, "options": {"A": "Altered sense of smell", "B": "Intolerance to cold temperatures", "C": "Thickening of the skin", "D": "Craving for non-nutritive substances"}, "answer": "Craving for non-nutritive substances", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 42 years old.", "2. Patient has had difficulty swallowing solid foods for 4 weeks.", "3. Patient feels like food gets stuck in her throat.", "4. Patient has to drink a lot of water to swallow meals.", "5. Patient has had progressive fatigue for 3 months.", "6. Patient has occasional dyspnea while performing daily activities.", "7. Patient's pulse is 104/min.", "8. Patient's respirations are 19/min.", "9. Patient's blood pressure is 110/70 mm Hg.", "10. Physical examination shows conjunctival pallor.", "11. Physical examination shows erythema around the corners of the mouth.", "12. Physical examination shows dry, scaly lips.", "13. Patient's fingernails appear spoon-shaped and brittle.", "14. Auscultation of the heart shows a grade 1/6 systolic murmur best heard at the second left intercostal space.", "15. Esophagogastroduodenoscopy shows thin membranes that are protruding into the upper third of the esophagus."], "atomic_facts": ["1. The patient reports feeling like food gets stuck in her throat.", "2. The patient reports having to drink a lot of water to swallow her meals.", "3. Over the past 3 months, the patient has had progressive fatigue.", "4. Over the past 3 months, the patient has had occasional dyspnea while performing her daily activities.", "5. The patient's pulse is 104/min.", "6. The patient's respirations are 19/min.", "7. The patient's blood pressure is 110/70 mm Hg.", "8. Physical examination shows conjunctival pallor.", "9. Physical examination shows erythema around the corners of the mouth.", "10. Physical examination shows dry, scaly lips.", "11. The patient's fingernails appear spoon-shaped.", "12. The patient's fingernails appear brittle.", "13. Auscultation of the heart shows a grade 1/6 systolic murmur best heard at the second left intercostal space.", "14. Esophagogastroduodenoscopy shows thin membranes protruding into the upper third of the esophagus."]}
{"id": 1039, "question": "Which of the following statements regarding the management of this patient is correct?", "context": ["A 27-year-old nullipara makes an appointment with her gynecologist to discuss the results of her cervical cancer screening.", "She is not vaccinated against HPV and has a single sexual partner.", "She and her partner are planning pregnancy, so she recently discontinued oral contraception and began to take folate and iron supplements.", "She has no history of gynecologic diseases.", "Her first Pap smear showed atypical squamous cells of undetermined significance, but 2 subsequent Pap smears had normal results.", "The most recent Pap smear was reported as a high-grade squamous intraepithelial lesion.", "Colposcopy was performed at the next visit and a biopsy was obtained from a small patch of the acetowhite epithelium at the cervical transformation zone.", "The pathologic assessment shows CIN 3."], "context_len": 8, "options": {"A": "The annual rate of progression of CIN 3 to cancer is > 10%, so the patient should be treated as soon as possible.", "B": "Close follow-up with cytology and colposcopy may be considered in this patient.", "C": "Additional HPV testing would be useful to guide the therapy.", "D": "Pregnancy is not recommended in women with high-grade cervical lesions, so treatment is reasonable."}, "answer": "Close follow-up with cytology and colposcopy may be considered in this patient.", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "27", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Gynecologic Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 27-year-old nullipara makes an appointment with her gynecologist.", "2. She is not vaccinated against HPV.", "3. She has a single sexual partner.", "4. She and her partner are planning pregnancy.", "5. She recently discontinued oral contraception.", "6. She began to take folate and iron supplements.", "7. She has no history of gynecologic diseases.", "8. Her first Pap smear showed atypical squamous cells of undetermined significance.", "9. Two subsequent Pap smears had normal results.", "10. The most recent Pap smear was reported as a high-grade squamous intraepithelial lesion.", "11. Colposcopy was performed at the next visit.", "12. A biopsy was obtained from a small patch of the acetowhite epithelium at the cervical transformation zone.", "13. The pathologic assessment shows CIN 3."], "atomic_facts": ["1. She is not vaccinated against HPV.", "2. She has a single sexual partner.", "3. She recently discontinued oral contraception.", "4. She began to take folate and iron supplements.", "5. She has no history of gynecologic diseases.", "6. Her first Pap smear showed atypical squamous cells of undetermined significance.", "7. 2 subsequent Pap smears had normal results.", "8. The most recent Pap smear was reported as a high-grade squamous intraepithelial lesion.", "9. Colposcopy was performed at the next visit.", "10. A biopsy was obtained from a small patch of the acetowhite epithelium at the cervical transformation zone.", "11. The pathologic assessment shows CIN 3."]}
{"id": 1040, "question": "Which of the following findings most closely correlates with this patient's symptoms?", "context": ["A 47-year-old woman comes to the physician because of a 3-month history of recurrent episodes of nausea and feeling like the room is spinning.", "Each episode lasts less than a minute and usually occurs when she gets out of bed in the morning or suddenly turns her head.", "She has not vomited and does not have headaches.", "She is asymptomatic between episodes."], "context_len": 4, "options": {"A": "Intention tremor", "B": "Nystagmus", "C": "Abnormal Rinne test", "D": "Orthostatic hypotension"}, "answer": "Nystagmus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "47 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 47-year-old woman comes to the physician.", "2. She has a 3-month history of recurrent episodes of nausea.", "3. She also has a feeling like the room is spinning.", "4. Each episode lasts less than a minute.", "5. The episodes usually occur when she gets out of bed in the morning or suddenly turns her head.", "6. She has not vomited.", "7. She does not have headaches.", "8. She is asymptomatic between episodes."], "atomic_facts": ["1. Each episode lasts less than a minute.", "2. Episodes usually occur when she gets out of bed in the morning.", "3. Episodes also occur when she suddenly turns her head.", "4. She has not vomited.", "5. She does not have headaches.", "6. She is asymptomatic between episodes."]}
{"id": 1041, "question": "Which of the following is the most likely precipitating factor for this patient's symptoms?", "context": ["A 56-year-old man is brought to the emergency department by his wife because of increasing confusion and lethargy for the past 12 hours.", "He is oriented only to person.", "His temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 109/min, respirations are 18/min, and blood pressure is 108/67 mm Hg.", "Examination shows abdominal distention and several erythematous, lacy lesions on the chest that blanch with pressure.", "His hands make a flapping motion when they are dorsiflexed."], "context_len": 5, "options": {"A": "Elevated systemic vascular resistance", "B": "Destruction of gut anaerobes", "C": "Presence of hemoglobin in the intestine", "D": "Low protein consumption"}, "answer": "Presence of hemoglobin in the intestine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "56 years old", "specialties": ["Neurology", "Internal Medicine"], "subspecialties": ["Neurocritical Care", "Neurology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 56-year-old man is brought to the emergency department by his wife.", "2. He has been experiencing increasing confusion and lethargy for the past 12 hours.", "3. He is oriented only to person.", "4. His temperature is 37.3\u00b0C (99.1\u00b0F).", "5. His pulse is 109/min.", "6. His respirations are 18/min.", "7. His blood pressure is 108/67 mm Hg.", "8. Examination shows abdominal distention.", "9. Examination shows several erythematous, lacy lesions on the chest.", "10. The lesions on the chest blanch with pressure.", "11. His hands make a flapping motion when they are dorsiflexed."], "atomic_facts": ["1. He is oriented only to person.", "2. His temperature is 37.3\u00b0C (99.1\u00b0F).", "3. His pulse is 109/min.", "4. His respirations are 18/min.", "5. His blood pressure is 108/67 mm Hg.", "6. Examination shows abdominal distention.", "7. Examination shows several erythematous, lacy lesions on the chest that blanch with pressure.", "8. His hands make a flapping motion when they are dorsiflexed."]}
{"id": 1042, "question": "The patient was most likely treated with a drug that predominantly acts on which of the following parts of the cell?", "context": ["A 63-year-old man comes to the physician because of a 4-hour history of severe pain in the right knee.", "His temperature is 38.0\u00b0C (100.1\u00b0F).", "Examination shows erythema, edema, and warmth of the right knee; range of motion is limited by pain.", "Arthrocentesis of the knee joint yields cloudy fluid with a leukocyte count of 24,000/mm3 (74% segmented neutrophils).", "Polarized light microscopy shows needle-shaped, negatively birefringent crystals.", "Five hours after treatment with a drug is begun, he develops abdominal cramp, diarrhea, and vomiting."], "context_len": 6, "options": {"A": "Cell wall", "B": "Cytosolic enzyme", "C": "Nucleus", "D": "Cytoskeleton"}, "answer": "Cytoskeleton", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "63 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 63-year-old man comes to the physician.", "2. He has a 4-hour history of severe pain in the right knee.", "3. His temperature is 38.0\u00b0C (100.1\u00b0F).", "4. Examination shows erythema, edema, and warmth of the right knee.", "5. Range of motion is limited by pain.", "6. Arthrocentesis of the knee joint yields cloudy fluid.", "7. Leukocyte count of the fluid is 24,000/mm3 (74% segmented neutrophils).", "8. Polarized light microscopy shows needle-shaped, negatively birefringent crystals.", "9. Five hours after treatment with a drug is begun, he develops abdominal cramp.", "10. He develops diarrhea.", "11. He develops vomiting."], "atomic_facts": ["1. His temperature is 38.0\u00b0C (100.1\u00b0F).", "2. Examination shows erythema, edema, and warmth of the right knee.", "3. Range of motion is limited by pain.", "4. Arthrocentesis of the knee joint yields cloudy fluid.", "5. The leukocyte count of the fluid is 24,000/mm3.", "6. 74% of the leukocytes are segmented neutrophils.", "7. Polarized light microscopy shows needle-shaped, negatively birefringent crystals.", "8. Five hours after treatment with a drug is begun, he develops abdominal cramp, diarrhea, and vomiting."]}
{"id": 1043, "question": "Which of the following is the next best step in management?", "context": ["A 1-year-old boy presents to the emergency department for several days of irritability and poor feeding.", "His parents are very concerned that he has been acting differently.", "The patient has an unremarkable past medical history and has been followed by a pediatrician.", "His temperature is 102\u00b0F (38.9\u00b0C), blood pressure is 57/38 mmHg, pulse is 170/min, respirations are 35/min, and oxygen saturation is 99% on room air.", "During the exam the infant is irritable and is crying.", "Musculoskeletal exam reveals that the patient's knee can not be extended while the patient's hip is in a flexed position without significant patient irritation.", "Fundoscopy is within normal limits.", "Abdominal, cardiac, and pulmonary exam are within normal limits."], "context_len": 8, "options": {"A": "Blood and urine cultures", "B": "Lumbar puncture", "C": "Vancomycin and ceftriaxone", "D": "Vancomycin, ceftriaxone, and prednisone"}, "answer": "Lumbar puncture", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "1 year old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases", "General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 1-year-old boy presents to the emergency department.", "2. The parents are concerned that he has been acting differently.", "3. The patient has an unremarkable past medical history.", "4. The patient has been followed by a pediatrician.", "5. The patient's temperature is 102\u00b0F (38.9\u00b0C).", "6. The patient's blood pressure is 57/38 mmHg.", "7. The patient's pulse is 170/min.", "8. The patient's respirations are 35/min.", "9. The patient's oxygen saturation is 99% on room air.", "10. During the exam the infant is irritable and is crying.", "11. Musculoskeletal exam reveals that the patient's knee can not be extended while the patient's hip is in a flexed position without significant patient irritation.", "12. Fundoscopy is within normal limits.", "13. Abdominal, cardiac, and pulmonary exam are within normal limits."], "atomic_facts": ["1. The patient's parents are very concerned about his change in behavior.", "2. The patient has an unremarkable past medical history.", "3. The patient has been followed by a pediatrician.", "4. The patient's temperature is 102\u00b0F (38.9\u00b0C).", "5. The patient's blood pressure is 57/38 mmHg.", "6. The patient's pulse is 170/min.", "7. The patient's respirations are 35/min.", "8. The patient's oxygen saturation is 99% on room air.", "9. During the exam, the infant is irritable and crying.", "10. The patient's knee cannot be extended while the hip is in a flexed position without significant irritation.", "11. Fundoscopy is within normal limits.", "12. Abdominal exam is within normal limits.", "13. Cardiac exam is within normal limits.", "14. Pulmonary exam is within normal limits."]}
{"id": 1044, "question": "Which of the following is the most likely underlying mechanism of this patient's cardiomyopathy?", "context": ["A 74-year-old man comes to the physician because of a 2-month history of shortness of breath and leg swelling.", "He has trouble climbing one flight of stairs due to dyspnea.", "He has hypertension and was diagnosed with multiple myeloma 6 months ago.", "Current medications include hydrochlorothiazide.", "Cardiopulmonary examination shows jugular venous distention, bibasilar crackles, and pitting edema in the lower extremities.", "Transthoracic echocardiography shows a thickened myocardium with elevated diastolic filling pressures."], "context_len": 6, "options": {"A": "Chronic vasoconstriction", "B": "Myosin gene mutation", "C": "Amyloid deposition", "D": "Chronic hypercalcemia"}, "answer": "Amyloid deposition", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "74", "specialties": ["Internal Medicine", "Cardiology"], "subspecialties": ["Cardiovascular Disease", "Cardiology", "General Cardiology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 74-year-old man comes to the physician.", "2. He has a 2-month history of shortness of breath and leg swelling.", "3. He has trouble climbing one flight of stairs due to dyspnea.", "4. He has hypertension.", "5. He was diagnosed with multiple myeloma 6 months ago.", "6. His current medications include hydrochlorothiazide.", "7. Cardiopulmonary examination shows jugular venous distention.", "8. Cardiopulmonary examination shows bibasilar crackles.", "9. Cardiopulmonary examination shows pitting edema in the lower extremities.", "10. Transthoracic echocardiography shows a thickened myocardium.", "11. Transthoracic echocardiography shows elevated diastolic filling pressures."], "atomic_facts": ["1. He has trouble climbing one flight of stairs due to dyspnea.", "2. He has hypertension.", "3. He was diagnosed with multiple myeloma 6 months ago.", "4. Current medications include hydrochlorothiazide.", "5. Cardiopulmonary examination shows jugular venous distention.", "6. Cardiopulmonary examination shows bibasilar crackles.", "7. Cardiopulmonary examination shows pitting edema in the lower extremities.", "8. Transthoracic echocardiography shows a thickened myocardium.", "9. Transthoracic echocardiography shows elevated diastolic filling pressures."]}
{"id": 1045, "question": "The next appropriate step in the management of this patient involves passing a tube through an incision through which of the following structures?", "context": ["A 47-year-old man is brought to the emergency department 30 minutes after he was involved in a motor vehicle collision.", "On arrival, he is unconscious and unresponsive to painful stimuli.", "His pulse is 120/min, respirations are 10/min, and his blood pressure is 88/60 mm Hg.", "Infusion of 0.9% saline is begun, and intubation is attempted without success.", "Pulse oximetry on 20 L/min of oxygen via bag mask shows an oxygen saturation of 78%."], "context_len": 5, "options": {"A": "Investing layer of deep cervical fascia", "B": "Annular ligament", "C": "Cricotracheal ligament", "D": "Prevertebral layer of deep cervical fascia"}, "answer": "Investing layer of deep cervical fascia", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "47 years old", "specialties": ["Surgery", "Emergency Medicine"], "subspecialties": ["General Surgery", "General Emergency Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 47-year-old man was brought to the emergency department 30 minutes after a motor vehicle collision.", "2. On arrival, he was unconscious and unresponsive to painful stimuli.", "3. His pulse was 120/min.", "4. His respirations were 10/min.", "5. His blood pressure was 88/60 mm Hg.", "6. 0.9% saline was infused.", "7. Intubation was attempted without success.", "8. Pulse oximetry on 20 L/min of oxygen via bag mask showed an oxygen saturation of 78%."], "atomic_facts": ["1. On arrival, the patient is unconscious.", "2. On arrival, the patient is unresponsive to painful stimuli.", "3. The patient's pulse is 120/min.", "4. The patient's respirations are 10/min.", "5. The patient's blood pressure is 88/60 mm Hg.", "6. Infusion of 0.9% saline is begun.", "7. Intubation is attempted without success.", "8. Pulse oximetry on 20 L/min of oxygen via bag mask shows an oxygen saturation of 78%."]}
{"id": 1046, "question": "What is the most likely diagnosis?", "context": ["Parents bring an 11-month-old baby to the clinic because the baby has a fever of 39.0\u00b0C (102.2\u00b0F).", "The baby is irritated and crying constantly.", "She is up to date on immunizations.", "A complete physical examination reveals no significant findings, and all laboratory tests are negative.", "Five days after resolution of her fever, she develops a transient maculopapular rash."], "context_len": 5, "options": {"A": "Roseola", "B": "Erythema infectiosum", "C": "Rubella", "D": "Kawasaki disease"}, "answer": "Roseola", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "11 months", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Parents bring an 11-month-old baby to the clinic.", "2. The baby has a fever of 39.0\u00b0C (102.2\u00b0F).", "3. The baby is irritated and crying constantly.", "4. The baby is up to date on immunizations.", "5. A complete physical examination reveals no significant findings.", "6. All laboratory tests are negative.", "7. Five days after resolution of her fever, she develops a transient maculopapular rash."], "atomic_facts": ["1. The baby is irritated.", "2. The baby is crying constantly.", "3. She is up to date on immunizations.", "4. A complete physical examination reveals no significant findings.", "5. All laboratory tests are negative.", "6. Five days after resolution of her fever, she develops a transient maculopapular rash."]}
{"id": 1047, "question": "Which of the following statements would best explain the mechanism of action of these drugs?", "context": ["A 67-year-old man is brought to his primary care practitioner by his daughter who has noticed a \u2018pill-rolling\u2019 tremor in his right hand, along with a progressively slow, shuffling gait.", "The patient\u2019s daughter says that these symptoms gradually started 2 weeks ago and have progressively worsened.", "His past medical history is significant for hypertension, which is well-controlled with losartan.", "He does not take any other medications.", "Physical examination reveals a slow shuffling gait, difficulty initiating movements, a resting tremor in his right hand that decreases in intensity with voluntary movement, and cogwheel-like rigidity in the right arm.", "The primary care practitioner decides to prescribe levodopa and carbidopa."], "context_len": 6, "options": {"A": "Inhibition of the enzyme monoamine oxidase (MAO) B", "B": "Blockade of muscarinic receptors", "C": "Inhibition of dopamine reuptake", "D": "Increased dopamine synthesis"}, "answer": "Increased dopamine synthesis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "67 years old", "specialties": ["Neurology"], "subspecialties": ["Movement Disorders", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 67 years old.", "2. Patient's daughter noticed a \"pill-rolling\" tremor in his right hand.", "3. Patient's daughter noticed a progressively slow, shuffling gait.", "4. Symptoms gradually started 2 weeks ago and have progressively worsened.", "5. Patient has a past medical history of hypertension.", "6. Hypertension is well-controlled with losartan.", "7. Patient does not take any other medications.", "8. Physical examination reveals a slow shuffling gait.", "9. Physical examination reveals difficulty initiating movements.", "10. Physical examination reveals a resting tremor in his right hand that decreases in intensity with voluntary movement.", "11. Physical examination reveals cogwheel-like rigidity in the right arm.", "12. Primary care practitioner decides to prescribe levodopa and carbidopa."], "atomic_facts": ["1. The patient's daughter reports that symptoms started 2 weeks ago and have worsened.", "2. The patient has a past medical history of hypertension.", "3. The hypertension is well-controlled with losartan.", "4. The patient does not take any other medications.", "5. Physical examination reveals a slow shuffling gait.", "6. Physical examination reveals difficulty initiating movements.", "7. Physical examination reveals a resting tremor in the right hand.", "8. The tremor decreases in intensity with voluntary movement.", "9. Physical examination reveals cogwheel-like rigidity in the right arm.", "10. The primary care practitioner decides to prescribe levodopa and carbidopa."]}
{"id": 1048, "question": "Which of the following is the most likely underlying pathogenesis?", "context": ["A 79-year-old man with a long-standing history of hypertension and diabetes presents to the emergency department with sudden-onset of loss of motor function on the left side of his body.", "Neurologic exam shows normal sensation throughout the body.", "MRI of the brain is obtained and shows a small sub-cortical infarct involving a perforating vessel."], "context_len": 3, "options": {"A": "Embolism originating from the left atrium", "B": "Berry aneurysm", "C": "Lipohyalinosis of small vessels", "D": "Fibromuscular dysplasia"}, "answer": "Lipohyalinosis of small vessels", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "79 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 79 years old.", "2. Patient has a long-standing history of hypertension and diabetes.", "3. Patient presents to the emergency department with sudden-onset of loss of motor function on the left side of his body.", "4. Neurologic exam shows normal sensation throughout the body.", "5. MRI of the brain is obtained.", "6. MRI of the brain shows a small sub-cortical infarct involving a perforating vessel."], "atomic_facts": ["1. Neurologic exam shows normal sensation throughout the body.", "2. MRI of the brain is obtained.", "3. MRI shows a small sub-cortical infarct.", "4. The infarct involves a perforating vessel."]}
{"id": 1049, "question": "If the cardiologist was aware of Berkson\u2019s bias (also known as the admission rate bias), he could minimize it by which of the following?", "context": ["A cardiology specialist working in the university hospital center noticed that a large number of his patients who had myocardial infarctions also had some sort of malignancy in their medical history.", "In order to determine whether a relationship existed between myocardial infarction and malignant processes, he decided to pursue a case-control study.", "His selected cases consisted of a sample of patients hospitalized in an internal ward with a history of a myocardial infarction, while control cases were patients on the same ward without a history of a myocardial infarction.", "Their charts and medical documentation were then reviewed for a history of any type of malignancy.", "The results of the study led the cardiologist to conclude that, for patients with malignancy, the odds of having a myocardial infarction were 3.2 times higher when compared to patients without malignancy."], "context_len": 5, "options": {"A": "Including the diagnoses negatively related to the risk factor being studied", "B": "Excluding controls that present a probability of hospital admission similar to cases", "C": "Recruiting the controls from different wards to increase disease variability", "D": "Excluding those patients with preferential recollection of exposures"}, "answer": "Recruiting the controls from different wards to increase disease variability", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Medical Oncology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A cardiology specialist was working in the university hospital center.", "2. A large number of his patients who had myocardial infarctions also had some sort of malignancy in their medical history.", "3. He decided to pursue a case-control study to determine whether a relationship existed between myocardial infarction and malignant processes.", "4. The selected cases consisted of a sample of patients hospitalized in an internal ward with a history of a myocardial infarction.", "5. The control cases were patients on the same ward without a history of a myocardial infarction.", "6. Their charts and medical documentation were then reviewed for a history of any type of malignancy.", "7. The results of the study led the cardiologist to conclude that, for patients with malignancy, the odds of having a myocardial infarction were 3.2 times higher when compared to patients without malignancy."], "atomic_facts": ["1. The cardiologist pursued a case-control study to determine the relationship between myocardial infarction and malignant processes.", "2. The selected cases for the study were patients hospitalized in an internal ward with a history of myocardial infarction.", "3. The control cases for the study were patients on the same ward without a history of myocardial infarction.", "4. Charts and medical documentation of the patients were reviewed for a history of any type of malignancy.", "5. The study results showed that the odds of having a myocardial infarction were 3.2 times higher for patients with malignancy compared to patients without malignancy."]}
{"id": 1050, "question": "Which of the following is the most appropriate pharmacologic treatment for this patient?", "context": ["A 27-year-old woman presents to her primary care physician\u2019s office with fatigue, headaches, and concentration difficulties.", "Her symptoms began approximately 7 months prior to presentation.", "Throughout this time, she reports problems with initiating and remaining asleep, has noticed periods of muscle soreness, and has feelings of restlessness.", "She states that she is very concerned about whether she will be able to pay her monthly expenses and if her parents are satisfied with her career choices.", "She is also worried about how her colleagues and supervisor think of her performance at work.", "She denies any significant past medical history besides occasional palpitations.", "She takes a daily multivitamin.", "Family history is significant for panic disorder in her mother.", "She currently lives alone and at times socializes with friends.", "She occasionally drinks alcohol during social gatherings, does not smoke, and denies any illicit drug use.", "Her temperature is 99\u00b0F (37.2 \u00b0C), blood pressure is 110/75, pulse is 101/min, and respirations are 18/min.", "Physical examination is unremarkable."], "context_len": 12, "options": {"A": "Buspirone", "B": "Mirtazapine", "C": "Olanzapine", "D": "Trazodone"}, "answer": "Buspirone", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "27", "specialties": ["Psychiatry", "Internal Medicine"], "subspecialties": ["General Psychiatry", "General Internal Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 27-year-old woman presents to her primary care physician's office.", "2. She has fatigue, headaches, and concentration difficulties.", "3. Her symptoms began approximately 7 months prior to presentation.", "4. She reports problems with initiating and remaining asleep.", "5. She has noticed periods of muscle soreness and has feelings of restlessness.", "6. She is very concerned about whether she will be able to pay her monthly expenses and if her parents are satisfied with her career choices.", "7. She is also worried about how her colleagues and supervisor think of her performance at work.", "8. She denies any significant past medical history besides occasional palpitations.", "9. She takes a daily multivitamin.", "10. Family history is significant for panic disorder in her mother.", "11. She currently lives alone and at times socializes with friends.", "12. She occasionally drinks alcohol during social gatherings.", "13. She does not smoke and denies any illicit drug use.", "14. Her temperature is 99\u00b0F (37.2 \u00b0C).", "15. Her blood pressure is 110/75.", "16. Her pulse is 101/min.", "17. Her respirations are 18/min.", "18. Physical examination is unremarkable."], "atomic_facts": ["1. Her symptoms began approximately 7 months prior to presentation.", "2. She reports problems with initiating and remaining asleep.", "3. She has noticed periods of muscle soreness.", "4. She has feelings of restlessness.", "5. She is very concerned about whether she will be able to pay her monthly expenses.", "6. She is concerned about if her parents are satisfied with her career choices.", "7. She is worried about how her colleagues and supervisor think of her performance at work.", "8. She denies any significant past medical history besides occasional palpitations.", "9. She takes a daily multivitamin.", "10. Family history is significant for panic disorder in her mother.", "11. She currently lives alone and at times socializes with friends.", "12. She occasionally drinks alcohol during social gatherings.", "13. She does not smoke.", "14. She denies any illicit drug use.", "15. Her temperature is 99\u00b0F (37.2 \u00b0C).", "16. Her blood pressure is 110/75.", "17. Her pulse is 101/min.", "18. Her respirations are 18/min.", "19. Physical examination is unremarkable."]}
{"id": 1051, "question": "Which of the following is the most likely diagnosis?\"", "context": ["A 73-year-old man comes in to the emergency department because of nausea and severe pain in his upper abdomen and right shoulder blade for the past day.", "He was able to eat a little for breakfast but vomited up the meal a couple of hours later.", "He has type 2 diabetes mellitus treated with metformin.", "He has smoked half a pack of cigarettes daily for 40 years and drinks 4 beers every week.", "He appears acutely distressed.", "His temperature is 38.8\u00b0C (102\u00b0F), pulse is 124/min, and blood pressure is 92/68 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 95%.", "The abdomen is soft and there is tenderness to palpation of the right upper quadrant with soft crepitus.", "The remainder of the examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 14.3 g/dL | Leukocyte count 18,100/mm3 | Platelet count 216,000/mm3 | Serum | Aspartate aminotransferase (AST, SGOT) 41 U/L | Alanine aminotransferase (ALT, SGPT) 19 U/L | Alkaline phosphatase 110 U/L | Total bilirubin 0.9 mg/dL | Direct bilirubin 0.2 mg/dL | Albumin 4.1 g/dL | Ultrasonography of the right upper quadrant shows a gallbladder with an air-filled, thickened wall and no stones in the lumen."], "context_len": 10, "options": {"A": "Chronic pancreatitis with pseudocyst rupture", "B": "Emphysematous cholecystitis", "C": "Gallstone ileus", "D": "Primary sclerosing cholangitis"}, "answer": "Emphysematous cholecystitis", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "73 years old", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 73-year-old man comes in to the emergency department.", "2. He has nausea and severe pain in his upper abdomen and right shoulder blade for the past day.", "3. He was able to eat a little for breakfast but vomited up the meal a couple of hours later.", "4. He has type 2 diabetes mellitus treated with metformin.", "5. He has smoked half a pack of cigarettes daily for 40 years.", "6. He drinks 4 beers every week.", "7. He appears acutely distressed.", "8. His temperature is 38.8\u00b0C (102\u00b0F).", "9. His pulse is 124/min.", "10. His blood pressure is 92/68 mm Hg.", "11. Pulse oximetry on room air shows an oxygen saturation of 95%.", "12. The abdomen is soft.", "13. There is tenderness to palpation of the right upper quadrant with soft crepitus.", "14. The remainder of the examination shows no abnormalities.", "15. Laboratory studies show a hemoglobin of 14.3 g/dL.", "16. Laboratory studies show a leukocyte count of 18,100/mm3.", "17. Laboratory studies show a platelet count of 216,000/mm3.", "18. Laboratory studies show an aspartate aminotransferase (AST, SGOT) of 41 U/L.", "19. Laboratory studies show an alanine aminotransferase (ALT, SGPT) of 19 U/L.", "20. Laboratory studies show an alkaline phosphatase of 110 U/L.", "21. Laboratory studies show a total bilirubin of 0.9 mg/dL.", "22. Laboratory studies show a direct bilirubin of 0.2 mg/dL.", "23. Laboratory studies show an albumin of 4.1 g/dL.", "24. Ultrasonography of the right upper quadrant shows a gallbladder with an air-filled, thickened wall and no stones in the lumen."], "atomic_facts": ["1. He was able to eat a little for breakfast but vomited up the meal a couple of hours later.", "2. He has type 2 diabetes mellitus treated with metformin.", "3. He has smoked half a pack of cigarettes daily for 40 years and drinks 4 beers every week.", "4. He appears acutely distressed.", "5. His temperature is 38.8\u00b0C (102\u00b0F), pulse is 124/min, and blood pressure is 92/68 mm Hg.", "6. Pulse oximetry on room air shows an oxygen saturation of 95%.", "7. The abdomen is soft and there is tenderness to palpation of the right upper quadrant with soft crepitus.", "8. The remainder of the examination shows no abnormalities.", "9. Laboratory studies show: Hemoglobin 14.3 g/dL, Leukocyte count 18,100/mm3, Platelet count 216,000/mm3, Serum Aspartate aminotransferase (AST, SGOT) 41 U/L, Alanine aminotransferase (ALT, SGPT) 19 U/L, Alkaline phosphatase 110 U/L, Total bilirubin 0.9 mg/dL, Direct bilirubin 0.2 mg/dL, Albumin 4.1 g/dL.", "10. Ultrasonography of the right upper quadrant shows a gallbladder with an air-filled, thickened wall and no stones in the lumen."]}
{"id": 1052, "question": "Which of the following is associated with his condition?", "context": ["A 26-year-old man presented with a headache and fatigue for the past few months.", "On presentation to the clinic, the blood pressure is 190/110 mm Hg; the femoral pulse is reduced compared to the radial pulse, and an ejection click is heard.", "There was no murmur."], "context_len": 3, "options": {"A": "Ventricular septal defect (VSD)", "B": "Wolff-Parkinson-White syndrome", "C": "Coarctation of the aorta", "D": "Atrial septal defect (ASD)"}, "answer": "Coarctation of the aorta", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "26", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine", "Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 26-year-old man presented with a headache and fatigue for the past few months.", "2. On presentation to the clinic, the blood pressure is 190/110 mm Hg.", "3. The femoral pulse is reduced compared to the radial pulse.", "4. An ejection click is heard.", "5. There was no murmur."], "atomic_facts": ["1. Blood pressure on presentation to the clinic is 190/110 mm Hg.", "2. The femoral pulse is reduced compared to the radial pulse.", "3. An ejection click is heard.", "4. There was no murmur."]}
{"id": 1053, "question": "Which of the following strategies is most likely to decrease the likelihood that the procedure will exacerbate the patient\u2019s renal failure?", "context": ["A 57-year-old man with a history of diabetes and stage 3 chronic kidney disease is admitted to the hospital for elective coronary angiography.", "The senior resident admitting the patient to the ward is concerned about his chronic renal impairment and the scheduled angiography, which will require the use of intravenous contrast."], "context_len": 2, "options": {"A": "Intravenous mannitol before and during the procedure", "B": "Intravenous N-acetyl cysteine before and during the procedure", "C": "Use non-iodinated contrast medium", "D": "Forced diuresis with furosemide"}, "answer": "Use non-iodinated contrast medium", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 57-year-old man has a history of diabetes.", "2. The man has stage 3 chronic kidney disease.", "3. The man is admitted to the hospital for elective coronary angiography.", "4. The senior resident admitting the patient is concerned about the man's chronic renal impairment.", "5. The scheduled angiography will require the use of intravenous contrast."], "atomic_facts": ["1. The senior resident is admitting the patient to the ward.", "2. The patient has chronic renal impairment.", "3. The patient is scheduled for an angiography.", "4. The angiography will require the use of intravenous contrast."]}
{"id": 1054, "question": "Presuming it is an inherited condition, what is the most likely genetic pathophysiology of this disorder?", "context": ["A 17-year-old girl is brought in a wheelchair because of gradually progressive difficulty in walking, incoordination, and frequent falls.", "Her symptoms started at 9 years old with clumsiness while walking.", "She later experienced difficulties with coordination, which later involved her arms and trunk.", "She was born at term with normal developmental milestones.", "The physical examination reveals severely ataxic gait, nystagmus, absent deep tendon reflexes, and loss of vibration and proprioception."], "context_len": 5, "options": {"A": "GAA trinucleotide repeats", "B": "Mitochondrial DNA mutation", "C": "NOTCH3 mutation", "D": "PMP22 gene duplication"}, "answer": "GAA trinucleotide repeats", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "17 years old", "specialties": ["Neurology"], "subspecialties": ["Neurodevelopmental Disabilities", "Neuromuscular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 17-year-old girl is brought in a wheelchair.", "2. She has gradually progressive difficulty in walking, incoordination, and frequent falls.", "3. Her symptoms started at 9 years old with clumsiness while walking.", "4. Her difficulties with coordination later involved her arms and trunk.", "5. She was born at term with normal developmental milestones.", "6. The physical examination reveals severely ataxic gait.", "7. The physical examination reveals nystagmus.", "8. The physical examination reveals absent deep tendon reflexes.", "9. The physical examination reveals loss of vibration and proprioception."], "atomic_facts": ["1. Her symptoms started at 9 years old with clumsiness while walking.", "2. She later experienced difficulties with coordination.", "3. The difficulties with coordination later involved her arms and trunk.", "4. She was born at term.", "5. She had normal developmental milestones.", "6. The physical examination reveals severely ataxic gait.", "7. The physical examination reveals nystagmus.", "8. The physical examination reveals absent deep tendon reflexes.", "9. The physical examination reveals loss of vibration and proprioception."]}
{"id": 1055, "question": "Which of the following is the most likely additional finding in this patient?", "context": ["A previously healthy 51-year-old man is brought to the emergency department because of confusion for 2 hours.", "His wife reports that he fell and hit his head while changing a ceiling light the previous evening.", "On arrival, he is unconscious.", "His temperature is 37.1\u00b0C (98.8\u00b0F), pulse is 54/min, respirations are 8/min and irregular, and blood pressure is 198/106 mm Hg.", "The right pupil is dilated and fixed; the left pupil is round and reactive to light.", "There is extension of the extremities to painful stimuli.", "He is intubated and mechanically ventilated.", "A mannitol infusion is begun.", "A noncontrast CT scan of the brain shows herniation of the right medial temporal lobe."], "context_len": 9, "options": {"A": "Right-sided hemiplegia", "B": "Left-side facial nerve palsy", "C": "Bilateral spasticity", "D": "Multifocal myoclonus"}, "answer": "Right-sided hemiplegia", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "51 years old", "specialties": ["Neurology"], "subspecialties": ["Neurocritical Care", "Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 51-year-old man is brought to the emergency department because of confusion for 2 hours.", "2. His wife reports that he fell and hit his head while changing a ceiling light the previous evening.", "3. On arrival, he is unconscious.", "4. His temperature is 37.1\u00b0C (98.8\u00b0F).", "5. His pulse is 54/min.", "6. His respirations are 8/min and irregular.", "7. His blood pressure is 198/106 mm Hg.", "8. The right pupil is dilated and fixed.", "9. The left pupil is round and reactive to light.", "10. There is extension of the extremities to painful stimuli.", "11. He is intubated and mechanically ventilated.", "12. A mannitol infusion is begun.", "13. A noncontrast CT scan of the brain shows herniation of the right medial temporal lobe."], "atomic_facts": ["1. His wife reports that he fell and hit his head while changing a ceiling light the previous evening.", "2. On arrival, he is unconscious.", "3. His temperature is 37.1\u00b0C (98.8\u00b0F).", "4. His pulse is 54/min.", "5. His respirations are 8/min and irregular.", "6. His blood pressure is 198/106 mm Hg.", "7. The right pupil is dilated and fixed.", "8. The left pupil is round and reactive to light.", "9. There is extension of the extremities to painful stimuli.", "10. He is intubated and mechanically ventilated.", "11. A mannitol infusion is begun.", "12. A noncontrast CT scan of the brain shows herniation of the right medial temporal lobe."]}
{"id": 1056, "question": "In addition to her current therapy, what additional steps should be taken during the management of this child's UTI?", "context": ["A 1-year-old female presents to the emergency department with 2 days of fever up to 103\u00baF.", "During the course of her work-up, a urine culture reveals gram negative rods and a urinary tract infection (UTI) is diagnosed.", "She is placed on ceftriaxone and quickly defervesces.", "Follow-up of the urine culture reveals the causal bacteria was E.", "coli, without any concerning resistance patterns and was susceptible to ceftriaxone.", "This is her first UTI and there is no family history of renal abnormalities or vesicourethral reflux."], "context_len": 6, "options": {"A": "Prophylactic antibiotic therapy to prevent future UTIs", "B": "Voiding cystourethrogram", "C": "Renal bladder ultrasound", "D": "Repeat urine culture"}, "answer": "Renal bladder ultrasound", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "1 year old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 1-year-old female presents to the emergency department.", "2. She has 2 days of fever up to 103\u00baF.", "3. A urine culture reveals gram negative rods.", "4. A UTI is diagnosed.", "5. She is placed on ceftriaxone.", "6. She quickly defervesces.", "7. Follow-up of the urine culture reveals the causal bacteria was E. coli.", "8. There are no concerning resistance patterns.", "9. The bacteria is susceptible to ceftriaxone.", "10. This is her first UTI.", "11. There is no family history of renal abnormalities.", "12. There is no family history of vesicourethral reflux."], "atomic_facts": ["1. Urine culture reveals gram negative rods", "2. Urinary tract infection (UTI) is diagnosed", "3. Patient is placed on ceftriaxone", "4. Patient quickly defervesces", "5. Causal bacteria in urine culture was E. coli", "6. No concerning resistance patterns found in bacteria", "7. Bacteria was susceptible to ceftriaxone", "8. Patient's first UTI", "9. No family history of renal abnormalities", "10. No family history of vesicourethral reflux"]}
{"id": 1057, "question": "Which of the following mechanisms was most likely involved in the development of this patient's symptoms?", "context": ["A 22-year-old woman presents to her primary care physician because she has been having severe pruritus on her left leg.", "She says the symptoms started 1 week ago after she went on a hiking trip with her friends.", "She wore shorts during the hike and felt as if something brushed her skin on the front of her leg just below the knee.", "She has no past medical history and no family history of autoimmune diseases.", "On physical exam, she has red pruritic papules and vesicles on her left leg."], "context_len": 5, "options": {"A": "Activation of cell surface receptors by antibodies", "B": "Cross-linking of IgE antibodies", "C": "Cytotoxicity due to T-cells", "D": "Immune complex deposition"}, "answer": "Cytotoxicity due to T-cells", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "22 years old", "specialties": ["Allergy and Immunology"], "subspecialties": ["General Allergy and Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 22-year-old woman presents to her primary care physician.", "2. She has been having severe pruritus on her left leg.", "3. The symptoms started 1 week ago.", "4. She went on a hiking trip with her friends.", "5. She wore shorts during the hike.", "6. She felt as if something brushed her skin on the front of her leg just below the knee.", "7. She has no past medical history.", "8. She has no family history of autoimmune diseases.", "9. On physical exam, she has red pruritic papules and vesicles on her left leg."], "atomic_facts": ["1. The symptoms started 1 week ago.", "2. The symptoms started after a hiking trip with friends.", "3. She wore shorts during the hike.", "4. She felt something brush her skin on the front of her leg just below the knee.", "5. She has no past medical history.", "6. She has no family history of autoimmune diseases.", "7. On physical exam, she has red pruritic papules and vesicles on her left leg."]}
{"id": 1058, "question": "Which of the following is the trinucleotide repeat linked to this patient\u2019s most likely condition?", "context": ["An adopted 7-year-old boy is brought to a pediatrician with a history of progressive muscular weakness, intellectual impairment, and speech problems.", "The adoptive parents say that the patient was normal at birth, but as he grew older, his muscular weakness increased.", "Physical examination reveals the wasting of muscles of the dorsal forearm and the anterior compartment of the lower legs.", "Thenar and hypothenar eminences are also flattened.", "However, deep tendon reflexes are 2+ bilaterally.", "His face has an atypical appearance with thin cheeks and temporal wasting.", "When he was asked to make a tight fist and open his hands quickly, he could not open them immediately, and relaxation of the contracted muscles was very slow.", "The pediatrician suspects genetic muscular dystrophy."], "context_len": 8, "options": {"A": "CTG", "B": "CGG", "C": "GAA", "D": "CGT"}, "answer": "CTG", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Neurodevelopmental Disabilities", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An adopted 7-year-old boy is brought to a pediatrician.", "2. The patient has a history of progressive muscular weakness, intellectual impairment, and speech problems.", "3. The adoptive parents say the patient was normal at birth.", "4. As the patient grew older, his muscular weakness increased.", "5. Physical examination reveals wasting of muscles of the dorsal forearm and the anterior compartment of the lower legs.", "6. Thenar and hypothenar eminences are flattened.", "7. Deep tendon reflexes are 2+ bilaterally.", "8. The patient's face has an atypical appearance with thin cheeks and temporal wasting.", "9. When asked to make a tight fist and open his hands quickly, the patient could not open them immediately.", "10. Relaxation of the contracted muscles was very slow.", "11. The pediatrician suspects genetic muscular dystrophy."], "atomic_facts": ["1. The adoptive parents say the patient was normal at birth.", "2. The patient's muscular weakness increased as he grew older.", "3. Physical examination reveals wasting of muscles in the dorsal forearm and anterior compartment of the lower legs.", "4. The thenar and hypothenar eminences are flattened.", "5. Deep tendon reflexes are 2+ bilaterally.", "6. The patient's face has an atypical appearance with thin cheeks and temporal wasting.", "7. When asked to make a tight fist and open his hands quickly, the patient could not open them immediately, and relaxation of the contracted muscles was very slow.", "8. The pediatrician suspects genetic muscular dystrophy."]}
{"id": 1059, "question": "Which of the following is most consistent with this physical exam finding?", "context": ["A 36-year-old woman presents to her primary care physician for her yearly physical exam.", "She says that she has been experiencing some mild shortness of breath, but otherwise has no medical complaints.", "Her past medical history is significant for allergies and asthma as a child, but she is not currently taking any medications or supplements.", "She does not smoke and drinks about 2 glasses of wine per week as a social activity.", "On physical exam she is asked to take deep breaths during cardiac auscultation.", "The physician notices that the splitting of S2 decreases during inspiration."], "context_len": 6, "options": {"A": "Asthma recurrence", "B": "Atrial septal defect", "C": "Left bundle branch block", "D": "Pulmonary stenosis"}, "answer": "Left bundle branch block", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "36", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 36-year-old woman presents to her primary care physician for her yearly physical exam.", "2. She says that she has been experiencing some mild shortness of breath.", "3. She has no other medical complaints.", "4. Her past medical history is significant for allergies and asthma as a child.", "5. She is not currently taking any medications or supplements.", "6. She does not smoke.", "7. She drinks about 2 glasses of wine per week as a social activity.", "8. On physical exam she is asked to take deep breaths during cardiac auscultation.", "9. The physician notices that the splitting of S2 decreases during inspiration."], "atomic_facts": ["1. The patient has been experiencing mild shortness of breath.", "2. The patient has no other medical complaints.", "3. The patient had allergies and asthma as a child.", "4. The patient is not currently taking any medications or supplements.", "5. The patient does not smoke.", "6. The patient drinks about 2 glasses of wine per week as a social activity.", "7. During the physical exam, the patient is asked to take deep breaths during cardiac auscultation.", "8. The physician notices that the splitting of S2 decreases during inspiration."]}
{"id": 1060, "question": "Which of the following is appropriate initial management of this patient?", "context": ["A 47-year-old woman presents to the emergency department with calf pain and swelling that has persisted for the past 24 hours.", "She recently had an elective cholecystectomy performed 3 days ago that was complicated intraoperatively by bleeding requiring a transfusion of 1 unit of packed red blood cells.", "The patient is otherwise healthy, and her vitals are within normal limits.", "Physical exam is notable for an enlarged and tender right calf.", "Ultrasound with doppler reveals non-compressible veins of the affected leg."], "context_len": 5, "options": {"A": "CT angiogram of the chest", "B": "Heparin", "C": "Inferior vena cava filter", "D": "Warfarin"}, "answer": "Heparin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "47", "specialties": ["Internal Medicine"], "subspecialties": ["Vascular Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 47-year-old woman presents to the emergency department.", "2. She has calf pain and swelling that has persisted for the past 24 hours.", "3. She recently had an elective cholecystectomy performed 3 days ago.", "4. The cholecystectomy was complicated intraoperatively by bleeding.", "5. The bleeding required a transfusion of 1 unit of packed red blood cells.", "6. The patient is otherwise healthy.", "7. Her vitals are within normal limits.", "8. Physical exam is notable for an enlarged and tender right calf.", "9. Ultrasound with doppler reveals non-compressible veins of the affected leg."], "atomic_facts": ["1. Elective cholecystectomy performed 3 days ago", "2. Complicated intraoperatively by bleeding", "3. Required transfusion of 1 unit of packed red blood cells", "4. Patient is otherwise healthy", "5. Vitals are within normal limits", "6. Physical exam notable for an enlarged and tender right calf", "7. Ultrasound with doppler reveals non-compressible veins of the affected leg"]}
{"id": 1061, "question": "Which of the following options describe the most likely mechanism underlying the patient\u2019s seizure?", "context": ["A 24-year-old primigravida is admitted to the hospital at 36 weeks gestation with a headache and blurred vision.", "The vital signs are as follows: blood pressure, 170/95 mm Hg; heart rate, 88/min; respiratory rate, 15/min; and temperature, 36.6\u2103 (97.9\u2109).", "The physical examination is significant for pitting edema of the lower extremity.", "Meningeal signs are negative.", "The ophthalmoscopic exam shows vascular narrowing and a cotton-like fundal exudate.", "The dipstick test shows 1+ proteinuria.", "While the blood is being drawn, the patient has a generalized tonic-clonic seizure."], "context_len": 7, "options": {"A": "Increase in the extracellular sodium concentration", "B": "Failure of cerebral vasoregulation", "C": "Inhibition of brain GABA-signaling", "D": "Increased activation of NMDA receptors"}, "answer": "Failure of cerebral vasoregulation", "answer_idx": "B", "explanation": "", "patient": {"gender": "Not specified", "age": "24 years old", "specialties": ["Obstetrics and Gynecology", "Neurology"], "subspecialties": ["Maternal", "Vascular Neurology", "Maternal\u2013Fetal Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 24-year-old primigravida is admitted to the hospital at 36 weeks gestation.", "2. The patient has a headache and blurred vision.", "3. The patient's blood pressure is 170/95 mm Hg.", "4. The patient's heart rate is 88/min.", "5. The patient's respiratory rate is 15/min.", "6. The patient's temperature is 36.6\u2103 (97.9\u2109).", "7. The physical examination is significant for pitting edema of the lower extremity.", "8. Meningeal signs are negative.", "9. The ophthalmoscopic exam shows vascular narrowing and a cotton-like fundal exudate.", "10. The dipstick test shows 1+ proteinuria.", "11. The patient has a generalized tonic-clonic seizure while the blood is being drawn."], "atomic_facts": ["1. Blood pressure: 170/95 mm Hg", "2. Heart rate: 88/min", "3. Respiratory rate: 15/min", "4. Temperature: 36.6\u2103 (97.9\u2109)", "5. Physical examination significant for pitting edema of the lower extremity", "6. Meningeal signs are negative", "7. Ophthalmoscopic exam shows vascular narrowing and a cotton-like fundal exudate", "8. Dipstick test shows 1+ proteinuria", "9. Patient has a generalized tonic-clonic seizure while blood is being drawn"]}
{"id": 1062, "question": "Which of the following is the most likely diagnosis?", "context": ["A 12-month-old girl is brought in by her mother to the pediatrician for the first time since her 6-month checkup.", "The mother states that her daughter had been doing fine, but the parents are now concerned that their daughter is still not able to stand up or speak.", "On exam, the patient has a temperature of 98.5\u00b0F (36.9\u00b0C), pulse is 96/min, respirations are 20/min, and blood pressure is 100/80 mmHg.", "The child appears to have difficulty supporting herself while sitting.", "The patient has no other abnormal physical findings.", "She plays by herself and is making babbling noises but does not respond to her own name.", "She appears to have some purposeless motions.", "A previous clinic note documents typical development at her 6-month visit and mentioned that the patient was sitting unsupported at that time."], "context_len": 8, "options": {"A": "Language disorder", "B": "Rett syndrome", "C": "Fragile X syndrome", "D": "Trisomy 21"}, "answer": "Rett syndrome", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "12 months", "specialties": ["Pediatrics"], "subspecialties": ["Developmental"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 12-month-old girl is brought in by her mother to the pediatrician.", "2. The mother states that her daughter had been doing fine.", "3. The parents are now concerned that their daughter is still not able to stand up or speak.", "4. The patient has a temperature of 98.5\u00b0F (36.9\u00b0C).", "5. The patient's pulse is 96/min.", "6. The patient's respirations are 20/min.", "7. The patient's blood pressure is 100/80 mmHg.", "8. The child appears to have difficulty supporting herself while sitting.", "9. The patient has no other abnormal physical findings.", "10. She plays by herself and is making babbling noises.", "11. The patient does not respond to her own name.", "12. She appears to have some purposeless motions.", "13. A previous clinic note documents typical development at her 6-month visit.", "14. The patient was sitting unsupported at her 6-month visit."], "atomic_facts": ["1. The mother states that her daughter had been doing fine.", "2. The parents are concerned that their daughter is still not able to stand up or speak.", "3. On exam, the patient has a temperature of 98.5\u00b0F (36.9\u00b0C).", "4. The patient's pulse is 96/min.", "5. The patient's respirations are 20/min.", "6. The patient's blood pressure is 100/80 mmHg.", "7. The child appears to have difficulty supporting herself while sitting.", "8. The patient has no other abnormal physical findings.", "9. She plays by herself and is making babbling noises but does not respond to her own name.", "10. She appears to have some purposeless motions.", "11. A previous clinic note documents typical development at her 6-month visit.", "12. The patient was sitting unsupported at that time."]}
{"id": 1063, "question": "In addition to adequate hydration, the patient is most likely to benefit from which of the following?", "context": ["A 55-year-old man comes to the emergency department because of cramps and left-sided flank pain, nausea, and urinary frequency for 3 hours.", "He has no history of serious illness and takes no medications.", "He drinks 2\u20133 alcoholic beverages daily.", "His temperature is 37.2\u00b0C (99.0\u00b0F), pulse is 107/min, and blood pressure is 145/80 mm Hg.", "Examination of the back shows left costovertebral angle tenderness.", "An x-ray of the abdomen shows no abnormalities.", "Abdominal ultrasound shows a 4-mm stone in the distal left ureter and a scatter of small stones in the left renal pelvis.", "Urinalysis shows RBCs and needle-shaped crystals, but no WBCs.", "Pain medication and intravenous fluids are administered."], "context_len": 9, "options": {"A": "Probenecid", "B": "Potassium citrate", "C": "High-protein diet", "D": "Hydrochlorothiazide"}, "answer": "Potassium citrate", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 55-year-old man comes to the emergency department.", "2. He has cramps and left-sided flank pain, nausea, and urinary frequency for 3 hours.", "3. He has no history of serious illness and takes no medications.", "4. He drinks 2\u20133 alcoholic beverages daily.", "5. His temperature is 37.2\u00b0C (99.0\u00b0F).", "6. His pulse is 107/min.", "7. His blood pressure is 145/80 mm Hg.", "8. Examination of the back shows left costovertebral angle tenderness.", "9. An x-ray of the abdomen shows no abnormalities.", "10. Abdominal ultrasound shows a 4-mm stone in the distal left ureter.", "11. Abdominal ultrasound shows a scatter of small stones in the left renal pelvis.", "12. Urinalysis shows RBCs and needle-shaped crystals, but no WBCs.", "13. Pain medication and intravenous fluids are administered."], "atomic_facts": ["1. He has no history of serious illness and takes no medications.", "2. He drinks 2\u20133 alcoholic beverages daily.", "3. His temperature is 37.2\u00b0C (99.0\u00b0F).", "4. His pulse is 107/min.", "5. His blood pressure is 145/80 mm Hg.", "6. Examination of the back shows left costovertebral angle tenderness.", "7. An x-ray of the abdomen shows no abnormalities.", "8. Abdominal ultrasound shows a 4-mm stone in the distal left ureter and a scatter of small stones in the left renal pelvis.", "9. Urinalysis shows RBCs and needle-shaped crystals, but no WBCs.", "10. Pain medication and intravenous fluids are administered."]}
{"id": 1064, "question": "Which of the following is the most likely diagnosis?", "context": ["A 4-year-old boy is brought to the physician because of a 1-month history of generalized fatigue.", "During the past week, he has also had fever and severe leg pain that keeps him awake at night.", "Examination shows cervical and axillary lymphadenopathy.", "His liver is palpated 4 cm below the right costal margin and the spleen is palpated 3 cm below the left costal margin.", "His hemoglobin concentration is 10.2 g/dL, leukocyte count is 64,500/mm3, and platelet count is 29,000/mm3.", "A bone marrow aspirate predominantly shows immature cells that stain positive for CD10, CD19, and TdT."], "context_len": 6, "options": {"A": "Idiopathic thrombocytopenic purpura", "B": "Acute myeloid leukemia", "C": "Acute lymphoblastic leukemia", "D": "Hodgkin lymphoma"}, "answer": "Acute lymphoblastic leukemia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old boy is brought to the physician.", "2. He has a 1-month history of generalized fatigue.", "3. During the past week, he has had fever and severe leg pain.", "4. The leg pain keeps him awake at night.", "5. Examination shows cervical and axillary lymphadenopathy.", "6. His liver is palpated 4 cm below the right costal margin.", "7. His spleen is palpated 3 cm below the left costal margin.", "8. His hemoglobin concentration is 10.2 g/dL.", "9. His leukocyte count is 64,500/mm3.", "10. His platelet count is 29,000/mm3.", "11. A bone marrow aspirate predominantly shows immature cells.", "12. The immature cells stain positive for CD10.", "13. The immature cells stain positive for CD19.", "14. The immature cells stain positive for TdT."], "atomic_facts": ["1. He has had fever during the past week.", "2. He has had severe leg pain that keeps him awake at night.", "3. Examination shows cervical lymphadenopathy.", "4. Examination shows axillary lymphadenopathy.", "5. His liver is palpated 4 cm below the right costal margin.", "6. His spleen is palpated 3 cm below the left costal margin.", "7. His hemoglobin concentration is 10.2 g/dL.", "8. His leukocyte count is 64,500/mm3.", "9. His platelet count is 29,000/mm3.", "10. A bone marrow aspirate predominantly shows immature cells.", "11. The immature cells stain positive for CD10.", "12. The immature cells stain positive for CD19.", "13. The immature cells stain positive for TdT."]}
{"id": 1065, "question": "Which of the following is the most likely consequence of this patient's condition?", "context": ["A 41-year-old man comes to the physician because of a 10-day history of generalized weakness.", "He has also had headaches and night sweats and is a known user of illicit intravenous drugs.", "His temperature is 39.1\u00b0C (102.4\u00b0F), pulse is 110/min, respirations are 17/min, and blood pressure is 127/78 mm Hg.", "There are several track marks on his forearms.", "A holosystolic murmur that increases on inspiration is heard along the left sternal border.", "Laboratory studies show a leukocyte count of 13,900/mm3 and an erythrocyte sedimentation rate of 58 mm/h."], "context_len": 6, "options": {"A": "Hematuria", "B": "Rupture of nail-bed capillaries", "C": "Pulmonary embolism", "D": "Painful nodules on pads of the fingers"}, "answer": "Pulmonary embolism", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "41 years old", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 41-year-old man comes to the physician.", "2. He has a 10-day history of generalized weakness.", "3. He has also had headaches and night sweats.", "4. He is a known user of illicit intravenous drugs.", "5. His temperature is 39.1\u00b0C (102.4\u00b0F).", "6. His pulse is 110/min.", "7. His respirations are 17/min.", "8. His blood pressure is 127/78 mm Hg.", "9. There are several track marks on his forearms.", "10. A holosystolic murmur that increases on inspiration is heard along the left sternal border.", "11. Laboratory studies show a leukocyte count of 13,900/mm3.", "12. Laboratory studies show an erythrocyte sedimentation rate of 58 mm/h."], "atomic_facts": ["1. He has had headaches.", "2. He has had night sweats.", "3. He is a known user of illicit intravenous drugs.", "4. His temperature is 39.1\u00b0C (102.4\u00b0F).", "5. His pulse is 110/min.", "6. His respirations are 17/min.", "7. His blood pressure is 127/78 mm Hg.", "8. There are several track marks on his forearms.", "9. A holosystolic murmur is heard along the left sternal border.", "10. The murmur increases on inspiration.", "11. Laboratory studies show a leukocyte count of 13,900/mm3.", "12. Laboratory studies show an erythrocyte sedimentation rate of 58 mm/h."]}
{"id": 1066, "question": "Further examination and testing would most likely reveal which of the following findings in this patient?", "context": ["A 17-year-old girl presents to the emergency department with a painful rash on her head.", "She says that she started noticing a rash 2 weeks ago that has gotten worse over time.", "In addition, she says that she has been very thirsty over the same time period and often needs to urgently use the restroom during the day, which has been disrupting her ability to pay attention in school.", "Otherwise she says that she has some headaches, but attributes this to migraines that run in her family.", "She does not take any medications, doesn't smoke, and drinks socially with her friends.", "On physical exam, a disfiguring red scalp rash is observed and radiographs reveal lytic appearing skull lesions."], "context_len": 6, "options": {"A": "Anti-nuclear antibodies on serology", "B": "Granules with tennis racket shape on electron microscopy", "C": "HLA-B27 gene variant on genetic testing", "D": "Noncaseating granulomas with multinucleated giant cells on histology"}, "answer": "Granules with tennis racket shape on electron microscopy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "17", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 17-year-old female.", "2. Patient presents to the emergency department with a painful rash on her head.", "3. Patient started noticing the rash 2 weeks ago.", "4. Rash has gotten worse over time.", "5. Patient has been very thirsty over the same time period.", "6. Patient often needs to urgently use the restroom during the day.", "7. Patient's need to use the restroom has been disrupting her ability to pay attention in school.", "8. Patient has some headaches, which she attributes to migraines that run in her family.", "9. Patient does not take any medications.", "10. Patient does not smoke.", "11. Patient drinks socially with her friends.", "12. On physical exam, a disfiguring red scalp rash is observed.", "13. Radiographs reveal lytic appearing skull lesions."], "atomic_facts": ["1. The patient started noticing a rash 2 weeks ago.", "2. The rash has gotten worse over time.", "3. The patient has been very thirsty over the same time period.", "4. The patient often needs to urgently use the restroom during the day.", "5. The restroom urgency has been disrupting her ability to pay attention in school.", "6. The patient has some headaches.", "7. The patient attributes the headaches to migraines that run in her family.", "8. The patient does not take any medications.", "9. The patient doesn't smoke.", "10. The patient drinks socially with her friends.", "11. On physical exam, a disfiguring red scalp rash is observed.", "12. Radiographs reveal lytic appearing skull lesions."]}
{"id": 1067, "question": "Which of the following is the best treatment for this patient?", "context": ["A 57-year-old man presents to the emergency department with a change in his mental status.", "His wife noticed he was particularly somnolent this evening which prompted her to bring him in.", "The patient has a past medical history of congestive heart failure, diabetes, and hypertension.", "His temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 97/58 mmHg, pulse is 40/min, respirations are 17/min, and oxygen saturation is 95% on room air.", "A fingerstick blood glucose is notable for a value of 47 mg/dL."], "context_len": 5, "options": {"A": "Calcium chloride", "B": "Dextrose", "C": "Glucagon", "D": "Transcutaneous pacing"}, "answer": "Glucagon", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Neurocritical Care"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 57-year-old man presents to the emergency department.", "2. His wife noticed he was particularly somnolent this evening.", "3. His past medical history includes congestive heart failure, diabetes, and hypertension.", "4. His temperature is 99.5\u00b0F (37.5\u00b0C).", "5. His blood pressure is 97/58 mmHg.", "6. His pulse is 40/min.", "7. His respirations are 17/min.", "8. His oxygen saturation is 95% on room air.", "9. A fingerstick blood glucose is notable for a value of 47 mg/dL."], "atomic_facts": ["1. The patient's wife noticed he was particularly somnolent this evening.", "2. The patient has a past medical history of congestive heart failure, diabetes, and hypertension.", "3. The patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "4. The patient's blood pressure is 97/58 mmHg.", "5. The patient's pulse is 40/min.", "6. The patient's respirations are 17/min.", "7. The patient's oxygen saturation is 95% on room air.", "8. A fingerstick blood glucose is notable for a value of 47 mg/dL."]}
{"id": 1068, "question": "Which of the following is the next best diagnostic step?", "context": ["A 16-year-old boy comes to his primary care clinic for a sports physical.", "He states that he wants to try out for his high school\u2019s football team this year.", "He's \"trying to get in better shape.\u201d The patient has no complaints except for occasional headaches when he is stressed about exams.", "The patient also mentions that he is embarrassed of his \u201csmall penis\u201d and asks if there is something he can take for that.", "The patient\u2019s temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 118/76 mmHg, and pulse is 79/min.", "On physical examination, the patient is obese and has no visible facial hair.", "His testes are less than 20 mL in volume, and his phallus measures less than 8 cm.", "Initial labs show testosterone levels of 95 ng/dL and a low follicle stimulating hormone/luteinizing hormone ratio."], "context_len": 8, "options": {"A": "Adrenocorticotrophic hormone stimulation test", "B": "Semen analysis", "C": "Spectral karyotype", "D": "Thyroid-stimulating hormone and prolactin levels"}, "answer": "Thyroid-stimulating hormone and prolactin levels", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "16", "specialties": ["Pediatrics"], "subspecialties": ["Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 16-year-old boy comes to his primary care clinic for a sports physical.", "2. He states that he wants to try out for his high school\u2019s football team this year.", "3. He's \"trying to get in better shape.\u201d", "4. The patient has no complaints except for occasional headaches when he is stressed about exams.", "5. The patient also mentions that he is embarrassed of his \u201csmall penis\u201d and asks if there is something he can take for that.", "6. The patient\u2019s temperature is 98\u00b0F (36.7\u00b0C).", "7. The patient\u2019s blood pressure is 118/76 mmHg.", "8. The patient\u2019s pulse is 79/min.", "9. On physical examination, the patient is obese and has no visible facial hair.", "10. His testes are less than 20 mL in volume.", "11. His phallus measures less than 8 cm.", "12. Initial labs show testosterone levels of 95 ng/dL.", "13. Initial labs show a low follicle stimulating hormone/luteinizing hormone ratio."], "atomic_facts": ["1. The patient wants to try out for his high school\u2019s football team this year.", "2. He is \"trying to get in better shape.\u201d", "3. The patient has occasional headaches when stressed about exams.", "4. The patient is embarrassed about his \u201csmall penis\u201d and asks if there is something he can take for that.", "5. The patient\u2019s temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 118/76 mmHg, and pulse is 79/min.", "6. On physical examination, the patient is obese and has no visible facial hair.", "7. His testes are less than 20 mL in volume.", "8. His phallus measures less than 8 cm.", "9. Initial labs show testosterone levels of 95 ng/dL.", "10. The patient has a low follicle stimulating hormone/luteinizing hormone ratio."]}
{"id": 1069, "question": "Which of the following statements regarding this patient\u2019s myocardial tissue is true?", "context": ["A 72-year-old man presents to the hospital with retrosternal chest pain and shortness of breath.", "The pain started 5 hours prior to arrival and has not changed after sublingual nitroglycerin intake.", "The patient has a history of long-standing persistent atrial fibrillation but had not been taking anticoagulants at the time of presentation.", "He had also been diagnosed with iron-deficiency anemia 3 months before admission and is taking 120 mg of elemental iron daily.", "He has no history of ischemic heart disease.", "Clinical investigation confirms inferior ST-elevation myocardial infarction with occlusion of the right coronary artery.", "The patient is managed with percutaneous coronary intervention (PCI).", "Six hours after the PCI, the patient develops cardiogenic shock; 8 hours after presentation, he dies, despite intensive care management.", "The autopsy reveals widespread inferior-posterior myocardial infarction and thrombotic occlusion of the left circumflex artery.", "The microscopic image depicts a macroscopically intact myocardium."], "context_len": 10, "options": {"A": "This slide shows changes in the myocardial tissue that result from lipid peroxidation during the patient's lifetime.", "B": "The changes shown on this slide are a result of iron overload.", "C": "The slide shows cardiac steatosis.", "D": "The microscopic image reveals cardiac tissue hypertrophy."}, "answer": "This slide shows changes in the myocardial tissue that result from lipid peroxidation during the patient's lifetime.", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "72", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 72 years old.", "2. Patient presents with retrosternal chest pain and shortness of breath.", "3. Pain started 5 hours prior to arrival.", "4. Pain has not changed after sublingual nitroglycerin intake.", "5. Patient has a history of long-standing persistent atrial fibrillation.", "6. Patient was not taking anticoagulants at the time of presentation.", "7. Patient had been diagnosed with iron-deficiency anemia 3 months before admission.", "8. Patient is taking 120 mg of elemental iron daily.", "9. Patient has no history of ischemic heart disease.", "10. Clinical investigation confirms inferior ST-elevation myocardial infarction with occlusion of the right coronary artery.", "11. Patient is managed with percutaneous coronary intervention (PCI).", "12. Six hours after the PCI, the patient develops cardiogenic shock.", "13. 8 hours after presentation, patient dies despite intensive care management.", "14. Autopsy reveals widespread inferior-posterior myocardial infarction and thrombotic occlusion of the left circumflex artery.", "15. Microscopic image depicts macroscopically intact myocardium."], "atomic_facts": ["1. The pain started 5 hours prior to arrival and has not changed after sublingual nitroglycerin intake.", "2. The patient has a history of long-standing persistent atrial fibrillation but had not been taking anticoagulants at the time of presentation.", "3. He had also been diagnosed with iron-deficiency anemia 3 months before admission and is taking 120 mg of elemental iron daily.", "4. He has no history of ischemic heart disease.", "5. Clinical investigation confirms inferior ST-elevation myocardial infarction with occlusion of the right coronary artery.", "6. The patient is managed with percutaneous coronary intervention (PCI).", "7. Six hours after the PCI, the patient develops cardiogenic shock; 8 hours after presentation, he dies, despite intensive care management.", "8. The autopsy reveals widespread inferior-posterior myocardial infarction and thrombotic occlusion of the left circumflex artery.", "9. The microscopic image depicts a macroscopically intact myocardium."]}
{"id": 1070, "question": "Which of the following forms of inheritance is associated with the most likely cause of this patient's disorder?", "context": ["A 3-year-old boy is brought in by his parents for placement of a tracheostomy tube in order to allow for better ventilator support of his breathing.", "At birth, he was flaccid with a poor sucking reflex.", "Since then, his weakness has progressively worsened such that he is unable to sit, eat, or breathe independently.", "Family history reveals that his grandfather was affected by a degenerative disorder at age 50, and his father had the same degenerative disorder at age 30.", "Examination is significant for tongue fasciculations and absent deep tendon reflexes."], "context_len": 5, "options": {"A": "Autosomal dominant on chromosome 19", "B": "Autosomal recessive on chromosome 5", "C": "Autosomal recessive on chromosome 9", "D": "X-linked dominant"}, "answer": "Autosomal recessive on chromosome 5", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology", "Pediatric Critical Care Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 3-year-old boy is brought in by his parents for placement of a tracheostomy tube.", "2. At birth, he was flaccid with a poor sucking reflex.", "3. His weakness has progressively worsened such that he is unable to sit, eat, or breathe independently.", "4. Family history reveals his grandfather was affected by a degenerative disorder at age 50.", "5. His father had the same degenerative disorder at age 30.", "6. Examination is significant for tongue fasciculations.", "7. Examination is significant for absent deep tendon reflexes."], "atomic_facts": ["1. At birth, he was flaccid with a poor sucking reflex.", "2. His weakness has progressively worsened.", "3. He is unable to sit, eat, or breathe independently.", "4. Family history reveals that his grandfather was affected by a degenerative disorder at age 50.", "5. His father had the same degenerative disorder at age 30.", "6. Examination is significant for tongue fasciculations.", "7. Examination is significant for absent deep tendon reflexes."]}
{"id": 1071, "question": "Which of the following is the most likely diagnosis?", "context": ["A 73-year-old man is brought to the emergency department 30 minutes after the sudden onset of right-sided body weakness.", "His wife reports that he does not seem to understand simple questions.", "He has type 2 diabetes mellitus and has smoked 1 pack of cigarettes daily for 45 years.", "The patient speaks fluently, but he answers questions with nonsensical phrases and cannot repeat single words."], "context_len": 4, "options": {"A": "Conduction aphasia", "B": "Global aphasia", "C": "Wernicke aphasia", "D": "Transcortical sensory aphasia"}, "answer": "Wernicke aphasia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "73 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 73-year-old man is brought to the emergency department.", "2. The onset of symptoms was sudden.", "3. The symptoms are right-sided body weakness.", "4. His wife reports that he does not seem to understand simple questions.", "5. He has type 2 diabetes mellitus.", "6. He has smoked 1 pack of cigarettes daily for 45 years.", "7. The patient speaks fluently.", "8. He answers questions with nonsensical phrases.", "9. He cannot repeat single words."], "atomic_facts": ["1. The patient's wife reports that he does not seem to understand simple questions.", "2. He has type 2 diabetes mellitus.", "3. He has smoked 1 pack of cigarettes daily for 45 years.", "4. The patient speaks fluently.", "5. He answers questions with nonsensical phrases.", "6. He cannot repeat single words."]}
{"id": 1072, "question": "This patient's skin finding is most likely associated with which of the following conditions?", "context": ["A 23-year-old woman comes to physician for an annual health maintenance examination.", "She feels well.", "She is 155 cm (5 ft 1 in) tall and weighs 79 kg (174 lb); BMI is 33 kg/m2.", "Examination shows a skin rash over both axillae.", "A photograph of her left axilla is shown."], "context_len": 5, "options": {"A": "Niacin deficiency", "B": "Primary adrenal insufficiency", "C": "Polycystic ovarian syndrome", "D": "Hashimoto thyroiditis"}, "answer": "Polycystic ovarian syndrome", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "23", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 23-year-old woman comes to physician for an annual health maintenance examination.", "2. She feels well.", "3. She is 155 cm (5 ft 1 in) tall.", "4. She weighs 79 kg (174 lb).", "5. BMI is 33 kg/m2.", "6. Examination shows a skin rash over both axillae.", "7. A photograph of her left axilla is shown."], "atomic_facts": ["1. She feels well.", "2. She is 155 cm (5 ft 1 in) tall.", "3. She weighs 79 kg (174 lb).", "4. Her BMI is 33 kg/m2.", "5. Examination shows a skin rash over both axillae.", "6. A photograph of her left axilla is shown."]}
{"id": 1073, "question": "Damage to which of the following structures is most likely to be responsible for her language deficits?", "context": ["A 72-year-old female is brought in by ambulance after being found down in her home.", "Her daughter discovered her after returning from work and does not know how long she has been down.", "Physical exam reveals right sided paralysis with a positive babinski sign.", "She is also found to produce strained stuttering speech with no perceivable meaning.", "She is unable to follow any instructions and cannot repeat speech.", "An MRI is obtained showing a left MCA infarct."], "context_len": 6, "options": {"A": "Arcuate fasciculus", "B": "Inferior frontal gyrus", "C": "Inferior frontal gyrus + superior temporal gyrus", "D": "Arcuate fasciculus + Inferior frontal gyrus + superior temporal gyrus"}, "answer": "Arcuate fasciculus + Inferior frontal gyrus + superior temporal gyrus", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "72", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 72-year-old female is brought in by ambulance. ", "2. Her daughter discovered her after returning from work and does not know how long she has been down. ", "3. Physical exam reveals right sided paralysis with a positive babinski sign. ", "4. She is also found to produce strained stuttering speech with no perceivable meaning. ", "5. She is unable to follow any instructions and cannot repeat speech. ", "6. An MRI is obtained showing a left MCA infarct."], "atomic_facts": ["1. Her daughter discovered her after returning from work.", "2. Her daughter does not know how long she has been down.", "3. Physical exam reveals right sided paralysis.", "4. Physical exam reveals a positive babinski sign.", "5. She is found to produce strained stuttering speech.", "6. The speech has no perceivable meaning.", "7. She is unable to follow any instructions.", "8. She cannot repeat speech.", "9. An MRI is obtained.", "10. The MRI shows a left MCA infarct."]}
{"id": 1074, "question": "At steady state, which of the following sets of findings is most likely in this patient?", "context": ["A 66-year-old male with a history of diabetes and knee osteoarthritis presents to his primary care provider in July complaining of headaches and blurry vision.", "He reports a 6-month history of occasional dull diffuse headaches and blurry vision.", "He notes that the episodes have increased in severity since the weather got warmer and that he occasionally feels extremely itchy when he spends time outdoors.", "The patient lives in southern Arizona.", "Moreover, he has felt chronically fatigued and has lost 10 pounds without dieting or changing his appetite.", "He currently takes metformin and his most recent hemoglobin A1c was 6.5%.", "Physical examination reveals multiple bruises on the bilateral upper and lower extremities and hepatosplenomegaly.", "Fundoscopic examination demonstrates enlarged retinal veins.", "Multiple laboratory tests are pending."], "context_len": 9, "options": {"A": "Increased plasma volume, increased RBC mass, decreased EPO, normal SaO2", "B": "Normal plasma volume, increased RBC mass, increased EPO, normal SaO2", "C": "Decreased plasma volume, normal RBC mass, normal EPO, normal SaO2", "D": "Increased plasma volume, decreased RBC mass, decreased EPO, normal SaO2"}, "answer": "Increased plasma volume, increased RBC mass, decreased EPO, normal SaO2", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "66", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. A 66-year-old male presents to his primary care provider in July.", "2. He has a history of diabetes and knee osteoarthritis.", "3. He complains of headaches and blurry vision.", "4. He has a 6-month history of occasional dull diffuse headaches and blurry vision.", "5. The episodes have increased in severity since the weather got warmer.", "6. He occasionally feels extremely itchy when he spends time outdoors.", "7. He lives in southern Arizona.", "8. He has felt chronically fatigued.", "9. He has lost 10 pounds without dieting or changing his appetite.", "10. He currently takes metformin.", "11. His most recent hemoglobin A1c was 6.5%.", "12. Physical examination reveals multiple bruises on the bilateral upper and lower extremities and hepatosplenomegaly.", "13. Fundoscopic examination demonstrates enlarged retinal veins.", "14. Multiple laboratory tests are pending."], "atomic_facts": ["1. The patient reports a 6-month history of occasional dull diffuse headaches and blurry vision.", "2. The episodes have increased in severity since the weather got warmer.", "3. He occasionally feels extremely itchy when he spends time outdoors.", "4. The patient lives in southern Arizona.", "5. He has felt chronically fatigued.", "6. He has lost 10 pounds without dieting or changing his appetite.", "7. He currently takes metformin.", "8. His most recent hemoglobin A1c was 6.5%.", "9. Physical examination reveals multiple bruises on the bilateral upper and lower extremities.", "10. Physical examination reveals hepatosplenomegaly.", "11. Fundoscopic examination demonstrates enlarged retinal veins.", "12. Multiple laboratory tests are pending."]}
{"id": 1075, "question": "This patient's behavior is characteristic of a condition that is most typically associated with which of the following?", "context": ["A 25-year-old woman is brought to the emergency department for the evaluation of severe abdominal pain for the last hour.", "Abdominal ultrasound shows a non-compressible and enlarged appendix.", "The patient is diagnosed with acute appendicitis.", "While obtaining informed consent from the patient for appendectomy, the patient reports that she does not want to undergo surgery because she does not trust doctors.", "She states that all doctors are \u201cbad\u201d and all they think about is money.", "She adds that she thinks that nurses are \u201cangels\u201d and that they should take care of her instead of the \u201carrogant\u201d doctors."], "context_len": 6, "options": {"A": "Repeated performance of certain routines", "B": "Substance use disorder", "C": "Fear of social situations", "D": "Self-injurious behavior"}, "answer": "Self-injurious behavior", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "25 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 25-year-old woman is brought to the emergency department for the evaluation of severe abdominal pain for the last hour.", "2. Abdominal ultrasound shows a non-compressible and enlarged appendix.", "3. The patient is diagnosed with acute appendicitis.", "4. While obtaining informed consent from the patient for appendectomy, the patient reports that she does not want to undergo surgery.", "5. The patient states that all doctors are \u201cbad\u201d.", "6. The patient states that all doctors think about is money.", "7. The patient states that nurses are \u201cangels\u201d.", "8. The patient states that nurses should take care of her instead of the \u201carrogant\u201d doctors."], "atomic_facts": ["1. Abdominal ultrasound shows a non-compressible and enlarged appendix.", "2. The patient is diagnosed with acute appendicitis.", "3. The patient reports that she does not want to undergo surgery because she does not trust doctors.", "4. She states that all doctors are \u201cbad\u201d and all they think about is money.", "5. She adds that she thinks that nurses are \u201cangels\u201d and that they should take care of her instead of the \u201carrogant\u201d doctors."]}
{"id": 1076, "question": "Which of the following medications is the best course of treatment in this patient?", "context": ["A 20-year-old woman presents with persistent sadness for the last 2 months.", "She says that she is always feeling tired and nothing seems to cheer her up.", "Although previously a top student at her college, she did not register for classes this term, because she does not feel like going to school anymore.", "She says her friends complain that she does not want to \u2018hang out\u2019 with them anymore.", "She is sleeping more than usual and often does not want to leave the bed in the morning.", "The patient denies any suicidal ideation or preoccupation with death.", "Her past medical history is unremarkable.", "She currently takes a daily multivitamin.", "The vital signs include pulse 64/min, respiratory rate 12/min, blood pressure 110/70 mm Hg, and temperature 36.9\u00b0C (98.5\u00b0F).", "Her body mass index (BMI) is 17.5 kg/m2.", "On physical examination, the patient is pale.", "Mucous membranes and oral cavity are dry with poor dentition.", "Multiple calluses are present on the knuckles of her left hand."], "context_len": 13, "options": {"A": "Mirtazapine", "B": "Lorazepam", "C": "Bupropion", "D": "Amitriptyline"}, "answer": "Mirtazapine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is a 20-year-old woman.", "2. Patient has persistent sadness for the last 2 months.", "3. Patient is always feeling tired and nothing seems to cheer her up.", "4. Patient was previously a top student at her college.", "5. Patient did not register for classes this term.", "6. Patient's friends complain that she does not want to 'hang out' with them anymore.", "7. Patient is sleeping more than usual.", "8. Patient often does not want to leave the bed in the morning.", "9. Patient denies any suicidal ideation or preoccupation with death.", "10. Patient's past medical history is unremarkable.", "11. Patient currently takes a daily multivitamin.", "12. Patient's vital signs include pulse 64/min, respiratory rate 12/min, blood pressure 110/70 mm Hg, and temperature 36.9\u00b0C (98.5\u00b0F).", "13. Patient's body mass index (BMI) is 17.5 kg/m2.", "14. On physical examination, patient is pale.", "15. Mucous membranes and oral cavity are dry with poor dentition.", "16. Multiple calluses are present on the knuckles of her left hand."], "atomic_facts": ["1. The patient reports feeling constantly tired and unable to find joy in anything.", "2. She was a top student at her college but did not register for classes this term due to lack of motivation.", "3. Her friends have noticed that she no longer wants to spend time with them.", "4. She is sleeping more than usual and struggles to get out of bed in the morning.", "5. The patient denies having any thoughts of suicide or preoccupation with death.", "6. Her past medical history is unremarkable.", "7. She takes a daily multivitamin.", "8. Vital signs: pulse 64/min, respiratory rate 12/min, blood pressure 110/70 mm Hg, temperature 36.9\u00b0C (98.5\u00b0F).", "9. Her BMI is 17.5 kg/m2.", "10. On physical examination, the patient appears pale.", "11. Her mucous membranes and oral cavity are dry with poor dentition.", "12. Multiple calluses are present on the knuckles of her left hand."]}
{"id": 1077, "question": "Which of the following was the most likely vector that transmitted the disease to this for patient?", "context": ["A 31-year-old man presents to the clinic with complaints of sudden onset of fever, headache, chills, and a painful \u201cbump\u201d in his right groin.", "He recently spent three months working as a park ranger in New Mexico.", "His physical exam is notable for an enlarged lymph node in the inguinal region that is extremely tender to palpation.", "The patient is promptly treated with antibiotics, and his case is reported to the Centers for Disease Control and Prevention."], "context_len": 4, "options": {"A": "Armadillo", "B": "Flea", "C": "Rat", "D": "Tick"}, "answer": "Flea", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "31 years old", "specialties": ["Infectious Disease"], "subspecialties": ["General Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 31-year-old man presents to the clinic.", "2. He has sudden onset of fever, headache, chills, and a painful \u201cbump\u201d in his right groin.", "3. He recently spent three months working as a park ranger in New Mexico.", "4. His physical exam is notable for an enlarged lymph node in the inguinal region.", "5. The lymph node is extremely tender to palpation.", "6. The patient is promptly treated with antibiotics.", "7. His case is reported to the Centers for Disease Control and Prevention."], "atomic_facts": ["1. He recently spent three months working as a park ranger in New Mexico.", "2. His physical exam is notable for an enlarged lymph node in the inguinal region.", "3. The enlarged lymph node is extremely tender to palpation.", "4. The patient is promptly treated with antibiotics.", "5. His case is reported to the Centers for Disease Control and Prevention."]}
{"id": 1078, "question": "Which of the devices has the best precision?", "context": ["As the only full-time inpatient endocrinologist at your hospital, you have been tasked with deciding which blood glucose measuring device to use on the wards.", "A medical device representative presents you with the data in Image A.", "All readings were performed on the same individual whose blood glucose was known to be 125 mg/dL at the time."], "context_len": 3, "options": {"A": "Device B", "B": "Device C", "C": "Device D", "D": "Not enough information provided"}, "answer": "Device D", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine", "Pathology"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "Chemical Pathology", "Clinical Chemistry"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Pathology"}, "facts_old": ["1. The speaker is an inpatient endocrinologist.", "2. The speaker works full-time at a hospital.", "3. The speaker has been tasked with deciding which blood glucose measuring device to use on the wards.", "4. A medical device representative presented the speaker with data in Image A.", "5. All readings in Image A were performed on the same individual.", "6. The individual's blood glucose was known to be 125 mg/dL at the time of the readings."], "atomic_facts": ["1. A medical device representative presents data in Image A.", "2. All readings were performed on the same individual.", "3. The individual's blood glucose was known to be 125 mg/dL at the time."]}
{"id": 1079, "question": "Which of the following enzymes is most likely defective in this patient?", "context": ["A 21-year-old male comes to the physician\u2019s office with complaints of fatigue.", "The patient is a college intramural athlete and has noticed that during hard workouts with his team, he gets severe muscle pain and weakness to the point where he has to stop and rest.", "Usually he is able to recover and the cramps subside after rest.", "After strenuous workouts he has also noticed that his urine is dark.", "On exam, the patient has no acute symptoms and appears to be sitting comfortably with a completely normal exam.", "The patient does not have any tenderness to palpation of his muscles."], "context_len": 6, "options": {"A": "Glucose-6-phosphatase", "B": "Debranching enzyme", "C": "Glycogen phosphorylase", "D": "Acid maltase"}, "answer": "Glycogen phosphorylase", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "21", "specialties": ["Pediatrics", "Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Pediatrics", "Metabolic Genetics"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 21-year-old male comes to the physician's office with complaints of fatigue.", "2. The patient is a college intramural athlete.", "3. During hard workouts with his team, he gets severe muscle pain and weakness to the point where he has to stop and rest.", "4. Usually he is able to recover and the cramps subside after rest.", "5. After strenuous workouts he has also noticed that his urine is dark.", "6. On exam, the patient has no acute symptoms.", "7. The patient appears to be sitting comfortably with a completely normal exam.", "8. The patient does not have any tenderness to palpation of his muscles."], "atomic_facts": ["1. The patient is a college intramural athlete.", "2. During hard workouts with his team, he gets severe muscle pain and weakness.", "3. He has to stop and rest during hard workouts.", "4. He is able to recover and the cramps subside after rest.", "5. After strenuous workouts, his urine is dark.", "6. On exam, the patient has no acute symptoms.", "7. The patient appears to be sitting comfortably with a completely normal exam.", "8. The patient does not have any tenderness to palpation of his muscles."]}
{"id": 1080, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?", "context": ["A 78-year-old man comes to the physician because of a 3-week history of dyspnea, chest pain, dry cough, painful swallowing, and a feeling of fullness in his head.", "The symptoms were initially mild but have progressively worsened.", "He has a history of gastroesophageal reflux disease treated with esomeprazole.", "He does not smoke cigarettes.", "His pulse is 99/min and blood pressure is 95/66 mm Hg.", "Examination shows swelling and redness of the face and neck.", "There is distention of the superficial veins of his neck and upper thorax.", "Plain radiographs of the chest show a widened mediastinum and unremarkable lung fields."], "context_len": 8, "options": {"A": "Pancoast tumor", "B": "Constrictive pericarditis", "C": "Descending aortic aneurysm", "D": "Mediastinal lymphoma"}, "answer": "Mediastinal lymphoma", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "78 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 78 years old.", "2. Patient has 3-week history of dyspnea, chest pain, dry cough, painful swallowing, and feeling of fullness in head.", "3. Symptoms initially mild but have progressively worsened.", "4. Patient has history of gastroesophageal reflux disease treated with esomeprazole.", "5. Patient does not smoke cigarettes.", "6. Pulse is 99/min.", "7. Blood pressure is 95/66 mm Hg.", "8. Examination shows swelling and redness of face and neck.", "9. Distention of superficial veins of neck and upper thorax.", "10. Plain radiographs of chest show widened mediastinum and unremarkable lung fields."], "atomic_facts": ["1. The symptoms were initially mild but have progressively worsened.", "2. He has a history of gastroesophageal reflux disease treated with esomeprazole.", "3. He does not smoke cigarettes.", "4. His pulse is 99/min and blood pressure is 95/66 mm Hg.", "5. Examination shows swelling and redness of the face and neck.", "6. There is distention of the superficial veins of his neck and upper thorax.", "7. Plain radiographs of the chest show a widened mediastinum and unremarkable lung fields."]}
{"id": 1081, "question": "A drug with which of the following mechanisms of action is most appropriate for this patient?", "context": ["A 52-year-old man is brought to the emergency department 30 minutes after his farmhand found him on the ground sweating profusely.", "On arrival, he is lethargic and unable to provide any history.", "His temperature is 37.5\u00b0C (99.5\u00b0F), pulse is 42/min, and blood pressure is 95/60 mm Hg.", "Physical examination shows diaphoresis and excessive salivation.", "The pupils are constricted.", "There is scattered expiratory wheezing throughout both lung fields.", "His clothes are soaked with vomit, urine, and feces."], "context_len": 7, "options": {"A": "Non-selective \u03b1 adrenergic receptor antagonism", "B": "\u03b22 adrenergic receptor agonism", "C": "Muscarinic acetylcholine receptor antagonism", "D": "Nicotinic acetylcholine receptor agonism"}, "answer": "Muscarinic acetylcholine receptor antagonism", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "52 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 52-year-old man was brought to the emergency department.", "2. His farmhand found him on the ground sweating profusely 30 minutes prior.", "3. He is lethargic and unable to provide any history.", "4. His temperature is 37.5\u00b0C (99.5\u00b0F).", "5. His pulse is 42/min.", "6. His blood pressure is 95/60 mm Hg.", "7. Physical examination shows diaphoresis and excessive salivation.", "8. His pupils are constricted.", "9. There is scattered expiratory wheezing throughout both lung fields.", "10. His clothes are soaked with vomit, urine, and feces."], "atomic_facts": ["1. On arrival, the patient is lethargic and unable to provide any history.", "2. The patient's temperature is 37.5\u00b0C (99.5\u00b0F).", "3. The patient's pulse is 42/min.", "4. The patient's blood pressure is 95/60 mm Hg.", "5. Physical examination shows diaphoresis and excessive salivation.", "6. The patient's pupils are constricted.", "7. There is scattered expiratory wheezing throughout both lung fields.", "8. The patient's clothes are soaked with vomit, urine, and feces."]}
{"id": 1082, "question": "What is the best next step in management?", "context": ["A 40-year-old woman is admitted to the hospital about four hours after her husband discovered that she ingested a bottle of acetaminophen in an attempted suicide.", "The patient denies any symptoms at this time.", "Vital signs include a blood pressure of 115/80 mmHg and pulse of 85/min.", "Physical exam is unremarkable.", "AST and ALT levels are approximately 2500 U/L.", "APAP level is 160 mcg/mL, and INR is 1.7.", "The patient refuses N-acetyl-cysteine (NAC) treatment."], "context_len": 7, "options": {"A": "Administer NAC", "B": "Cancel the NAC order", "C": "Involve the patient's husband to guide medical care", "D": "Force the patient to accept NAC"}, "answer": "Involve the patient's husband to guide medical care", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "40 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Medical Toxicology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 40-year-old woman is admitted to the hospital.", "2. Her husband discovered that she ingested a bottle of acetaminophen four hours prior.", "3. The patient denies any symptoms at this time.", "4. Blood pressure is 115/80 mmHg and pulse is 85/min.", "5. Physical exam is unremarkable.", "6. AST and ALT levels are approximately 2500 U/L.", "7. APAP level is 160 mcg/mL.", "8. INR is 1.7.", "9. The patient refuses N-acetyl-cysteine (NAC) treatment."], "atomic_facts": ["1. The patient denies any symptoms at this time.", "2. Vital signs include a blood pressure of 115/80 mmHg and pulse of 85/min.", "3. Physical exam is unremarkable.", "4. AST and ALT levels are approximately 2500 U/L.", "5. APAP level is 160 mcg/mL, and INR is 1.7.", "6. The patient refuses N-acetyl-cysteine (NAC) treatment."]}
{"id": 1083, "question": "What is the pathophysiology of this patient\u2019s condition?", "context": ["An 11-month-old baby boy is brought to the emergency room by his parents for vomiting.", "His mom reports that he has had a cold for the past week with a runny nose and low-grade fevers.", "However, his condition worsened today when he began coughing and struggling to breathe.", "During one of his coughing spells he threw up his milk as well.", "The parents deny any sick contacts, changes in diet, or bowel changes but endorse fatigue and decreased appetite.", "A physical examination demonstrates a healthy-looking baby with an intense cough and significant inspiratory stridor."], "context_len": 6, "options": {"A": "Generation of reactive oxygen species", "B": "Production of IgA proteases", "C": "Toxin that inactivates Gi protein", "D": "Toxin that permanently activates Gs protein"}, "answer": "Toxin that inactivates Gi protein", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "11 months", "specialties": ["Pediatrics"], "subspecialties": ["Gastroenterology", "General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 11-month-old baby boy is brought to the emergency room by his parents.", "2. His mom reports he has had a cold for the past week with a runny nose and low-grade fevers.", "3. His condition worsened today when he began coughing and struggling to breathe.", "4. During one of his coughing spells he threw up his milk.", "5. The parents deny any sick contacts, changes in diet, or bowel changes.", "6. The parents endorse fatigue and decreased appetite.", "7. A physical examination demonstrates a healthy-looking baby with an intense cough.", "8. A physical examination demonstrates a healthy-looking baby with significant inspiratory stridor."], "atomic_facts": ["1. His mom reports that he has had a cold for the past week with a runny nose and low-grade fevers.", "2. His condition worsened today when he began coughing and struggling to breathe.", "3. During one of his coughing spells he threw up his milk.", "4. The parents deny any sick contacts, changes in diet, or bowel changes but endorse fatigue and decreased appetite.", "5. A physical examination demonstrates a healthy-looking baby with an intense cough and significant inspiratory stridor."]}
{"id": 1084, "question": "Which of the following underlying conditions most likely predisposed this patient to develop this reaction?", "context": ["A 56-year-old male undergoes a pancreaticoduodenectomy for resection of a tumor of the head of the pancreas.", "His medical history is otherwise insignificant except for a series of minor respiratory and gastrointestinal infections since childhood that were effectively treated with antibiotics.", "Before today, he has not had any prior surgeries or required a blood transfusion.", "In the post anesthesia care unit, his hemoglobin is measured and found to be 5.2 g/dL.", "A transfusion of 2 units of packed red blood cells is ordered.", "Minutes after the transfusion is initiated, the patient reports severe itching, nausea, and shortness of breath.", "His vital signs show a drop in blood pressure from 138/88 to 92/47 and an increase in heart rate from 94 to 118.", "The patient's nurse stops the transfusion immediately."], "context_len": 8, "options": {"A": "Severe combined immunodeficiency disorder", "B": "Bruton's agammaglobulilnemia", "C": "Wiskott-Aldrich syndrome", "D": "Selective IgA deficiency"}, "answer": "Selective IgA deficiency", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "56", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. Patient is 56-years-old.", "2. Patient underwent pancreaticoduodenectomy.", "3. Reason for surgery was resection of a tumor of the head of the pancreas.", "4. Patient's medical history includes minor respiratory and gastrointestinal infections since childhood.", "5. Patient has not had any prior surgeries or required a blood transfusion.", "6. Hemoglobin measured in post anesthesia care unit was 5.2 g/dL.", "7. 2 units of packed red blood cells were ordered for transfusion.", "8. Minutes after transfusion was initiated, patient reported severe itching, nausea, and shortness of breath.", "9. Patient's vital signs showed a drop in blood pressure from 138/88 to 92/47 and an increase in heart rate from 94 to 118.", "10. Transfusion was stopped immediately by the patient's nurse."], "atomic_facts": ["1. His medical history is otherwise insignificant except for a series of minor respiratory and gastrointestinal infections since childhood.", "2. The infections were effectively treated with antibiotics.", "3. Before today, he has not had any prior surgeries.", "4. Before today, he has not required a blood transfusion.", "5. In the post anesthesia care unit, his hemoglobin is measured and found to be 5.2 g/dL.", "6. A transfusion of 2 units of packed red blood cells is ordered.", "7. Minutes after the transfusion is initiated, the patient reports severe itching, nausea, and shortness of breath.", "8. His vital signs show a drop in blood pressure from 138/88 to 92/47.", "9. His vital signs show an increase in heart rate from 94 to 118.", "10. The patient's nurse stops the transfusion immediately."]}
{"id": 1085, "question": "Which of the inheritance patterns can be attributed to the girl\u2019s condition?", "context": ["A 5-year-old girl is brought to the emergency department after sustaining an atraumatic tibial fracture while playing with her friends.", "This patient has a history of fractures in her upper and lower extremities.", "Children's services have investigated the family several times in the past and found no abuse.", "She was born at 39 weeks gestation via spontaneous vaginal delivery which resulted in several mild fractures.", "She is up to date on all vaccines and is meeting all developmental milestones.", "The mother has a brother with a similar history that is still living.", "Her vital signs show a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0\u00b0C (98.6\u00b0F).", "Physical exam reveals a regular heart rate, and her lungs are clear to auscultation bilaterally.", "The sclera of both eyes are blue.", "Additionally, her teeth are brown and distorted.", "Her leg is swollen, erythematous, and tender to palpation.", "An X-ray reveals a tibia fracture, while multiple fractures at various stages of healing are also seen on her arms.", "The physician suspects this is a genetic condition."], "context_len": 13, "options": {"A": "Pleiotropy", "B": "Anticipation", "C": "Locus heterogeneity", "D": "De novo mutation"}, "answer": "Locus heterogeneity", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "5 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Orthopedics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 5-year-old girl is brought to the emergency department after sustaining an atraumatic tibial fracture while playing with her friends.", "2. This patient has a history of fractures in her upper and lower extremities.", "3. Children's services have investigated the family several times in the past and found no abuse.", "4. She was born at 39 weeks gestation via spontaneous vaginal delivery which resulted in several mild fractures.", "5. She is up to date on all vaccines and is meeting all developmental milestones.", "6. The mother has a brother with a similar history that is still living.", "7. Her vital signs show a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0\u00b0C (98.6\u00b0F).", "8. Physical exam reveals a regular heart rate, and her lungs are clear to auscultation bilaterally.", "9. The sclera of both eyes are blue.", "10. Additionally, her teeth are brown and distorted.", "11. Her leg is swollen, erythematous, and tender to palpation.", "12. An X-ray reveals a tibia fracture, while multiple fractures at various stages of healing are also seen on her arms.", "13. The physician suspects this is a genetic condition."], "atomic_facts": ["1. The patient has a history of fractures in her upper and lower extremities.", "2. Children's services have investigated the family several times in the past and found no abuse.", "3. She was born at 39 weeks gestation via spontaneous vaginal delivery which resulted in several mild fractures.", "4. She is up to date on all vaccines and is meeting all developmental milestones.", "5. The mother has a brother with a similar history that is still living.", "6. Her vital signs show a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0\u00b0C (98.6\u00b0F).", "7. Physical exam reveals a regular heart rate, and her lungs are clear to auscultation bilaterally.", "8. The sclera of both eyes are blue.", "9. Additionally, her teeth are brown and distorted.", "10. Her leg is swollen, erythematous, and tender to palpation.", "11. An X-ray reveals a tibia fracture, while multiple fractures at various stages of healing are also seen on her arms.", "12. The physician suspects this is a genetic condition."]}
{"id": 1086, "question": "Which of the following is the most likely mechanism of action for the medication that was started in this patient?", "context": ["A 72-year-old woman presents to her primary care physician because she is coughing pink sputum and has difficulty breathing.", "She says that she was feeling pretty good until she traveled to her grandson's wedding last week.", "Since then she has had increasing difficulty sleeping and walking due to her shortness of breath.", "Physical exam reveals swollen ankles, basilar crackles bilaterally, and a murmur best heard in the left lateral decubitus position.", "She is already taking several medications for this condition; however, given the recent worsening of symptoms she is started on an additional medication."], "context_len": 5, "options": {"A": "Competitive inhibition of hormonal signaling", "B": "Decrease in adenylyl cyclase activity", "C": "Inhibition of Na-Cl symporter", "D": "Inhibition of Na-K-Cl cotransporter"}, "answer": "Inhibition of Na-K-Cl cotransporter", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "72 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 72-year-old woman presents to her primary care physician.", "2. She is coughing pink sputum and has difficulty breathing.", "3. She was feeling pretty good until she traveled to her grandson's wedding last week.", "4. Since then she has had increasing difficulty sleeping and walking due to her shortness of breath.", "5. Physical exam reveals swollen ankles.", "6. Physical exam reveals basilar crackles bilaterally.", "7. Physical exam reveals a murmur best heard in the left lateral decubitus position.", "8. She is already taking several medications for this condition.", "9. Given the recent worsening of symptoms she is started on an additional medication."], "atomic_facts": ["1. The patient was feeling pretty good until she traveled to her grandson's wedding last week.", "2. Since then, she has had increasing difficulty sleeping and walking due to her shortness of breath.", "3. Physical exam reveals swollen ankles.", "4. Physical exam reveals basilar crackles bilaterally.", "5. Physical exam reveals a murmur best heard in the left lateral decubitus position.", "6. The patient is already taking several medications for this condition.", "7. Given the recent worsening of symptoms, she is started on an additional medication."]}
{"id": 1087, "question": "What is the most likely explanation for this patient\u2019s symptoms?", "context": ["A 37-year-old woman is brought to the emergency department for acute abdominal pain for the past 2 hours.", "She reports that the pain is constant, 10/10, and is diffusely spread across her stomach.", "She reports nausea and 1 episode of vomiting 1 hour ago, painless bloody urine, and paresthesias in her hands bilaterally.", "The patient claims similar episodes in the past following the use of alcohol, though with milder pain.", "Her past medical history is significant for pelvic inflammatory disease that was adequately treated 5 years ago.", "She is currently sexually active with her husband without contraceptive use.", "Her temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 148/98 mmHg, pulse is 103/min, respirations are 18/min, and oxygen saturation is 99% on room air.", "A physical examination demonstrates a patient in acute distress with diffuse abdominal tenderness and decreased sensation of the hands bilaterally."], "context_len": 8, "options": {"A": "Implantation of the embryo outside of the uterus", "B": "Inflammation of the appendix", "C": "Mutation of the porphobilinogen deaminase enzyme", "D": "Obstruction of the cystic duct and subsequent inflammation of the gallbladder"}, "answer": "Mutation of the porphobilinogen deaminase enzyme", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "37 years old", "specialties": ["Surgery", "General Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 37-year-old woman is brought to the emergency department for acute abdominal pain for the past 2 hours.", "2. The pain is constant, 10/10, and is diffusely spread across her stomach.", "3. She reports nausea and 1 episode of vomiting 1 hour ago.", "4. She reports painless bloody urine and paresthesias in her hands bilaterally.", "5. The patient claims similar episodes in the past following the use of alcohol, though with milder pain.", "6. Her past medical history is significant for pelvic inflammatory disease that was adequately treated 5 years ago.", "7. She is currently sexually active with her husband without contraceptive use.", "8. Her temperature is 98.6\u00b0F (37\u00b0C).", "9. Her blood pressure is 148/98 mmHg.", "10. Her pulse is 103/min.", "11. Her respirations are 18/min.", "12. Her oxygen saturation is 99% on room air.", "13. A physical examination demonstrates a patient in acute distress with diffuse abdominal tenderness.", "14. A physical examination demonstrates decreased sensation of the hands bilaterally."], "atomic_facts": ["1. The patient reports constant, 10/10 pain diffusely spread across her stomach.", "2. The patient reports nausea and 1 episode of vomiting 1 hour ago.", "3. The patient reports painless bloody urine and paresthesias in her hands bilaterally.", "4. The patient claims similar episodes in the past following the use of alcohol, though with milder pain.", "5. The patient's past medical history includes adequately treated pelvic inflammatory disease 5 years ago.", "6. The patient is currently sexually active with her husband without contraceptive use.", "7. The patient's temperature is 98.6\u00b0F (37\u00b0C).", "8. The patient's blood pressure is 148/98 mmHg.", "9. The patient's pulse is 103/min.", "10. The patient's respirations are 18/min.", "11. The patient's oxygen saturation is 99% on room air.", "12. A physical examination demonstrates a patient in acute distress with diffuse abdominal tenderness and decreased sensation of the hands bilaterally."]}
{"id": 1088, "question": "Which of the following represents the overall specificity of this novel test?", "context": ["A medical research study is being conducted to evaluate the specificity of a novel blood test for rheumatoid arthritis.", "Of the 300 patients enrolled, half are diagnosed with RA.", "The remaining patients are age-matched controls.", "In the subgroup of patients with RA, 125 are found positive for the novel blood test.", "In the control group, 45 are found positive."], "context_len": 5, "options": {"A": "105 / (105 + 25)", "B": "125 / (125 + 105)", "C": "105 / (105 + 45)", "D": "125 / (125 + 25)"}, "answer": "105 / (105 + 45)", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology"], "subspecialties": ["Rheumatology", "Clinical Biochemical Genetics"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A medical research study is being conducted to evaluate the specificity of a novel blood test for rheumatoid arthritis.", "2. 300 patients are enrolled in the study.", "3. Half of the patients enrolled are diagnosed with RA.", "4. The remaining patients are age-matched controls.", "5. 125 patients with RA are found positive for the novel blood test.", "6. 45 patients in the control group are found positive for the novel blood test."], "atomic_facts": ["1. 300 patients are enrolled in the study.", "2. Half of the patients are diagnosed with RA.", "3. The remaining patients are age-matched controls.", "4. In the subgroup of patients with RA, 125 are found positive for the novel blood test.", "5. In the control group, 45 are found positive."]}
{"id": 1089, "question": "In addition to placing the patient in the right lateral decubitus position, which of the following is the most appropriate next step in management?", "context": ["A 58-year-old man comes to the emergency department because of multiple episodes of coughing up blood over the past 2 hours.", "He says that he has coughed up approximately half a cup of bright-red blood each time.", "He has had progressively worsening shortness of breath on exertion and a productive cough with occasionally blood-tinged sputum for the past 6 months.", "He has a history of hypertension and chronic obstructive pulmonary disease.", "He has worked in a car manufacturing company for over 20 years.", "He drinks 2 to 3 beers every evening.", "He has smoked 1 pack of cigarettes daily for the past 30 years.", "His medications include amlodipine, tiotropium, and an albuterol inhaler as needed.", "His temperature is 37.2 \u00b0C (99.0 \u00b0F), blood pressure is 102/68 mm Hg, pulse is 108/min, and respirations are 22/min.", "Pulse oximetry on room air shows an oxygen saturation of 89%.", "He appears anxious and cachectic.", "Examination of the lung shows decreased breath sounds bilaterally.", "There is no cervical or axillary lymphadenopathy.", "His hemoglobin is 11.5 g/dL, leukocyte count is 8,800/mm3, and a platelet count is 160,000/mm3.", "His coagulation parameters are within normal limits.", "Serum studies and urine analysis show no abnormalities.", "He is intubated and mechanically ventilated, and infusion of 0.9% saline is begun.", "An x-ray of the chest shows hyperinflation of the lung fields and a 2-cm nodule in the right lower lobe."], "context_len": 18, "options": {"A": "Radionuclide scan", "B": "Upper endoscopy", "C": "Arteriography", "D": "Bronchoscopy"}, "answer": "Bronchoscopy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "58 years old", "specialties": ["Pulmonary Disease", "Internal Medicine"], "subspecialties": ["General Pulmonary Disease", "Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 58 years old.", "2. Patient has had multiple episodes of coughing up blood over the past 2 hours.", "3. Patient has coughed up approximately half a cup of bright-red blood each time.", "4. Patient has had progressively worsening shortness of breath on exertion and a productive cough with occasionally blood-tinged sputum for the past 6 months.", "5. Patient has a history of hypertension and chronic obstructive pulmonary disease.", "6. Patient has worked in a car manufacturing company for over 20 years.", "7. Patient drinks 2 to 3 beers every evening.", "8. Patient has smoked 1 pack of cigarettes daily for the past 30 years.", "9. Patient's medications include amlodipine, tiotropium, and an albuterol inhaler as needed.", "10. Patient's temperature is 37.2 \u00b0C (99.0 \u00b0F).", "11. Patient's blood pressure is 102/68 mm Hg.", "12. Patient's pulse is 108/min.", "13. Patient's respirations are 22/min.", "14. Pulse oximetry on room air shows an oxygen saturation of 89%.", "15. Patient appears anxious and cachectic.", "16. Examination of the lung shows decreased breath sounds bilaterally.", "17. There is no cervical or axillary lymphadenopathy.", "18. Patient's hemoglobin is 11.5 g/dL.", "19. Patient's leukocyte count is 8,800/mm3.", "20. Patient's platelet count is 160,000/mm3.", "21. Patient's coagulation parameters are within normal limits.", "22. Serum studies and urine analysis show no abnormalities.", "23. Patient is intubated and mechanically ventilated.", "24. Infusion of 0.9% saline is begun.", "25. X-ray of the chest shows hyperinflation of the lung fields.", "26. X-ray of the chest shows a 2-cm nodule in the right lower lobe."], "atomic_facts": ["1. The patient has coughed up approximately half a cup of bright-red blood each time.", "2. He has had progressively worsening shortness of breath on exertion and a productive cough with occasionally blood-tinged sputum for the past 6 months.", "3. The patient has a history of hypertension and chronic obstructive pulmonary disease.", "4. He has worked in a car manufacturing company for over 20 years.", "5. The patient drinks 2 to 3 beers every evening.", "6. He has smoked 1 pack of cigarettes daily for the past 30 years.", "7. His medications include amlodipine, tiotropium, and an albuterol inhaler as needed.", "8. His temperature is 37.2 \u00b0C (99.0 \u00b0F), blood pressure is 102/68 mm Hg, pulse is 108/min, and respirations are 22/min.", "9. Pulse oximetry on room air shows an oxygen saturation of 89%.", "10. The patient appears anxious and cachectic.", "11. Examination of the lung shows decreased breath sounds bilaterally.", "12. There is no cervical or axillary lymphadenopathy.", "13. His hemoglobin is 11.5 g/dL, leukocyte count is 8,800/mm3, and a platelet count is 160,000/mm3.", "14. His coagulation parameters are within normal limits.", "15. Serum studies and urine analysis show no abnormalities.", "16. He is intubated and mechanically ventilated, and infusion of 0.9% saline is begun.", "17. An x-ray of the chest shows hyperinflation of the lung fields and a 2-cm nodule in the right lower lobe."]}
{"id": 1090, "question": "Which of the following is the most appropriate next step for the physician?", "context": ["A previously healthy 3-year-old girl is brought to the physician because she refuses to use her left arm after \u201ctripping over a stone\u201d that morning on the way to the supermarket while holding her mother's hand.", "She did not hit the ground.", "Development has been normal for her age.", "She appears anxious.", "Her vital signs are within normal limits.", "The left forearm is held close to her body in partial extension and pronation.", "There is no swelling or bruising of the elbow or the forearm.", "Palpation of the proximal radius produces pain.", "The child cries on attempting to passively supinate the forearm."], "context_len": 9, "options": {"A": "Administer ibuprofen and ice packs", "B": "Forced hyperpronation of the arm", "C": "Notify child protective services", "D": "Perform nerve conduction studies and electromyography\n\""}, "answer": "Forced hyperpronation of the arm", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "3 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 3-year-old girl was brought to the physician.", "2. She refused to use her left arm.", "3. She tripped over a stone that morning while holding her mother's hand.", "4. She did not hit the ground.", "5. Development has been normal for her age.", "6. She appears anxious.", "7. Her vital signs are within normal limits.", "8. The left forearm is held close to her body in partial extension and pronation.", "9. There is no swelling or bruising of the elbow or the forearm.", "10. Palpation of the proximal radius produces pain.", "11. The child cries on attempting to passively supinate the forearm."], "atomic_facts": ["1. She did not hit the ground.", "2. Development has been normal for her age.", "3. She appears anxious.", "4. Her vital signs are within normal limits.", "5. The left forearm is held close to her body in partial extension and pronation.", "6. There is no swelling or bruising of the elbow or the forearm.", "7. Palpation of the proximal radius produces pain.", "8. The child cries on attempting to passively supinate the forearm."]}
{"id": 1091, "question": "Which of the following is the most appropriate next step in management?", "context": ["A previously healthy 29-year-old woman comes to the physician because of a 3-day history of low-grade fever, muscle aches, and a rash.", "She has had 4 male sexual partners over the past year and uses condoms inconsistently.", "Examination shows a diffuse maculopapular rash that includes the palms and soles.", "Testing for nonspecific anticardiolipin antibodies is positive."], "context_len": 4, "options": {"A": "Assess for double-stranded DNA antibodies", "B": "Administer penicillin G", "C": "Analyze rash with darkfield microscopy", "D": "Test for fluorescent treponemal antibody absorption"}, "answer": "Test for fluorescent treponemal antibody absorption", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "29", "specialties": ["Internal Medicine", "Dermatology"], "subspecialties": ["Infectious Disease", "General Dermatology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 29-year-old woman came to the physician.", "2. She had a 3-day history of low-grade fever, muscle aches, and a rash.", "3. She had 4 male sexual partners over the past year.", "4. She uses condoms inconsistently.", "5. Examination showed a diffuse maculopapular rash that included the palms and soles.", "6. Testing for nonspecific anticardiolipin antibodies was positive."], "atomic_facts": ["1. She has had 4 male sexual partners over the past year.", "2. She uses condoms inconsistently.", "3. Examination shows a diffuse maculopapular rash.", "4. The rash includes the palms and soles.", "5. Testing for nonspecific anticardiolipin antibodies is positive."]}
{"id": 1092, "question": "Of the following, which is true regarding aldosterone antagonists in patients with heart failure?", "context": ["A 59-year-old man with New York Heart Association Class II heart failure presents to your outpatient clinic for routine follow-up.", "His blood pressure is 134/89 mm Hg and heart rate is 75/min.", "Physical examination reveals clear lung sounds bilaterally with normal S1 and S2 heart sounds.", "He currently takes captopril, bisoprolol, and furosemide.", "You would like to add on spironolactone."], "context_len": 5, "options": {"A": "Aldosterone antagonists do not require renal dosing", "B": " Aldosterone antagonists are indicated for patients in all stages of heart failure", "C": "Aldosterone antagonists decrease morbidity and mortality in heart failure patients", "D": "Aldosterone antagonists can cause visual disturbances"}, "answer": "Aldosterone antagonists decrease morbidity and mortality in heart failure patients", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "59", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 59-year-old man presents to an outpatient clinic for routine follow-up.", "2. The man has New York Heart Association Class II heart failure.", "3. His blood pressure is 134/89 mm Hg.", "4. His heart rate is 75/min.", "5. Physical examination reveals clear lung sounds bilaterally with normal S1 and S2 heart sounds.", "6. He currently takes captopril, bisoprolol, and furosemide.", "7. The doctor would like to add on spironolactone."], "atomic_facts": ["1. Blood pressure is 134/89 mm Hg.", "2. Heart rate is 75/min.", "3. Physical examination reveals clear lung sounds bilaterally.", "4. Physical examination reveals normal S1 and S2 heart sounds.", "5. Current medications include captopril, bisoprolol, and furosemide.", "6. Considering adding on spironolactone."]}
{"id": 1093, "question": "The cells most likely affected in this patient\u2019s current condition are analogous to which of the following cell types?", "context": ["A 32-year-old man comes to the physician because of a 1-week history of fever, nausea, headache, and confusion.", "Three weeks ago, he had an episode of a sore throat, diarrhea, and generalized lymphadenopathy.", "He is sexually active with a new partner that he met 2 months ago and they use condoms inconsistently.", "He appears ill.", "Physical examination shows nuchal rigidity.", "Further evaluation shows infection with a single-stranded, positive-sense RNA virus."], "context_len": 6, "options": {"A": "Osteoblasts", "B": "Mast cells", "C": "Schwann cells", "D": "Langerhans cells"}, "answer": "Langerhans cells", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "32 years old", "specialties": ["Neurology", "Internal Medicine"], "subspecialties": ["Neurocritical Care", "Infectious Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 32-year-old man comes to the physician.", "2. He has a 1-week history of fever, nausea, headache, and confusion.", "3. Three weeks ago, he had an episode of a sore throat, diarrhea, and generalized lymphadenopathy.", "4. He is sexually active with a new partner he met 2 months ago.", "5. They use condoms inconsistently.", "6. He appears ill.", "7. Physical examination shows nuchal rigidity.", "8. Further evaluation shows infection with a single-stranded, positive-sense RNA virus."], "atomic_facts": ["1. Three weeks ago, he had an episode of a sore throat, diarrhea, and generalized lymphadenopathy.", "2. He is sexually active with a new partner that he met 2 months ago.", "3. They use condoms inconsistently.", "4. He appears ill.", "5. Physical examination shows nuchal rigidity.", "6. Further evaluation shows infection with a single-stranded, positive-sense RNA virus."]}
{"id": 1094, "question": "Which of the following tests is most likely abnormal in this patient?", "context": ["A 64-year-old man presents for a routine physical.", "He states that he has felt abnormally weak during this time and has had trouble focusing in the setting of losing 5 pounds.", "The patient states he has a decreased appetite and also has not had a bowel movement in the past 5 days and feels uncomfortable.", "On review of system, he endorses abdominal pain.", "His temperature is 97.5\u00b0F (36.4\u00b0C), blood pressure is 132/83 mmHg, pulse is 115/min, respirations are 15/min, and oxygen saturation is 98% on room air.", "Physical exam is notable only for the patient being able to recall 1 of 3 objects.", "His cranial nerve exam is unremarkable and his gait is stable.", "Urinalysis is initially notable for a clear and voluminous sample with a low specific gravity."], "context_len": 8, "options": {"A": "Calcium level", "B": "Lead level", "C": "Potassium level", "D": "TSH level"}, "answer": "Calcium level", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "64 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine", "General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 64-year-old man presents for a routine physical.", "2. He states that he has felt abnormally weak during this time.", "3. He has had trouble focusing in the setting of losing 5 pounds.", "4. The patient states he has a decreased appetite.", "5. He has not had a bowel movement in the past 5 days and feels uncomfortable.", "6. On review of system, he endorses abdominal pain.", "7. His temperature is 97.5\u00b0F (36.4\u00b0C).", "8. His blood pressure is 132/83 mmHg.", "9. His pulse is 115/min.", "10. His respirations are 15/min.", "11. His oxygen saturation is 98% on room air.", "12. Physical exam is notable only for the patient being able to recall 1 of 3 objects.", "13. His cranial nerve exam is unremarkable.", "14. His gait is stable.", "15. Urinalysis is initially notable for a clear and voluminous sample with a low specific gravity."], "atomic_facts": ["1. The patient has felt abnormally weak.", "2. The patient has had trouble focusing.", "3. The patient has lost 5 pounds.", "4. The patient has a decreased appetite.", "5. The patient has not had a bowel movement in the past 5 days.", "6. The patient feels uncomfortable.", "7. The patient endorses abdominal pain.", "8. The patient's temperature is 97.5\u00b0F (36.4\u00b0C).", "9. The patient's blood pressure is 132/83 mmHg.", "10. The patient's pulse is 115/min.", "11. The patient's respirations are 15/min.", "12. The patient's oxygen saturation is 98% on room air.", "13. The patient is able to recall 1 of 3 objects.", "14. The patient's cranial nerve exam is unremarkable.", "15. The patient's gait is stable.", "16. The urinalysis is initially notable for a clear and voluminous sample.", "17. The urinalysis has a low specific gravity."]}
{"id": 1095, "question": "Which of the following is the most likely cause of this patient's jaundice?\"", "context": ["Ten days after a motor vehicle collision, a 28-year-old man develops jaundiced skin.", "Upon initial presentation for his injuries, the patient was taken for an emergency laparotomy, which revealed significant internal hemorrhage from blunt abdominal trauma to the spleen.", "He required rapid transfusion with a total of 7 units of packed red blood cells.", "He has recovered well from the procedure until this morning, when he began to develop jaundiced skin and sclerae.", "He does not have pruritus.", "He has had no prior surgeries and takes no other medications.", "He is sexually active with one female partner.", "Prior to the accident, he drank 4 beers per day.", "His vital signs are within normal limits.", "Abdominal examination is limited due to pain.", "There are no palpable abdominal masses.", "There is a midline surgical scar with no erythema, purulence, or drainage.", "He has healing abrasions on the upper left side of his face and bruises over the anterior abdomen.", "CT scans show a resolving hematoma in the peritoneal cavity.", "Laboratory studies show: | Hemoglobin 9.7 g/dL | Hematocrit 30% | Leukocyte count 7,000/mm3 | Platelet count 135,000/mm3 | Serum | Total bilirubin 3.9 mg/dL | Indirect bilirubin 3.7 mg/dL | Direct bilirubin 0.2 mg/dL | Aspartate aminotransferase (AST) 60 U/L | Alanine aminotransferase (ALT) 92 U/L | ."], "context_len": 15, "options": {"A": "Biliary obstruction", "B": "Hepatocellular injury", "C": "Increased formation of bilirubin", "D": "Decreased hepatic uptake of unconjugated bilirubin\n\""}, "answer": "Increased formation of bilirubin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "28 years old", "specialties": ["Internal Medicine", "Gastroenterology"], "subspecialties": ["Gastroenterology", "General Gastroenterology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 28 years old.", "2. Patient presented 10 days after motor vehicle collision.", "3. Patient underwent emergency laparotomy due to blunt abdominal trauma to the spleen.", "4. Patient required rapid transfusion with a total of 7 units of packed red blood cells.", "5. Patient had no prior surgeries and takes no other medications.", "6. Patient is sexually active with one female partner.", "7. Prior to the accident, patient drank 4 beers per day.", "8. Patient's vital signs are within normal limits.", "9. Abdominal examination is limited due to pain.", "10. No palpable abdominal masses.", "11. Midline surgical scar with no erythema, purulence, or drainage.", "12. Patient has healing abrasions on the upper left side of his face and bruises over the anterior abdomen.", "13. CT scans show a resolving hematoma in the peritoneal cavity.", "14. Patient has jaundiced skin and sclerae.", "15. Patient does not have pruritus.", "16. Laboratory studies show: Hemoglobin 9.7 g/dL, Hematocrit 30%, Leukocyte count 7,000/mm3, Platelet count 135,000/mm3, Total bilirubin 3.9 mg/dL, Indirect bilirubin 3.7 mg/dL, Direct bilirubin 0.2 mg/dL, Aspartate aminotransferase (AST) 60 U/L, Alanine aminotransferase (ALT) 92 U/L."], "atomic_facts": ["1. The patient had emergency laparotomy for significant internal hemorrhage from blunt abdominal trauma to the spleen.", "2. The patient received a total of 7 units of packed red blood cells.", "3. The patient developed jaundiced skin and sclerae.", "4. The patient does not have pruritus.", "5. The patient had no prior surgeries and takes no other medications.", "6. The patient is sexually active with one female partner.", "7. Prior to the accident, the patient drank 4 beers per day.", "8. The patient's vital signs are within normal limits.", "9. Abdominal examination is limited due to pain.", "10. There are no palpable abdominal masses.", "11. The patient has a midline surgical scar with no erythema, purulence, or drainage.", "12. The patient has healing abrasions on the upper left side of his face and bruises over the anterior abdomen.", "13. CT scans show a resolving hematoma in the peritoneal cavity.", "14. Laboratory studies show: Hemoglobin 9.7 g/dL, Hematocrit 30%, Leukocyte count 7,000/mm3, Platelet count 135,000/mm3, Total bilirubin 3.9 mg/dL, Indirect bilirubin 3.7 mg/dL, Direct bilirubin 0.2 mg/dL, Aspartate aminotransferase (AST) 60 U/L, Alanine aminotransferase (ALT) 92 U/L."]}
{"id": 1096, "question": "Which of the following is the most likely diagnosis?", "context": ["A 69-year-old man comes to the physician because of a cough for the past 3 months.", "The cough is mostly dry, but the patient recalls a recent episode in which he coughed up mucus with dark red streaks.", "He has felt tired for the past few months.", "Over the past month, he has had poor appetite and a 5-kg (11-lb) weight loss.", "He also has occasional back pain, which has worsened in recent weeks.", "He has no recent travel history.", "He has smoked a pack of cigarettes daily for 30 years.", "He does not drink alcohol.", "His vitals are within normal limits.", "Auscultation of the lungs reveals wheezing in the lower right lung field.", "There is no peripheral lymphadenopathy.", "The liver is of normal size, and the spleen is not palpable.", "Laboratory studies show a hemoglobin concentration of 13.5 g/dL, serum calcium concentration of 12.3 mg/dL, and a total serum protein of 7.0 g/dL.", "X-rays of the chest are shown."], "context_len": 14, "options": {"A": "Tuberculosis", "B": "Lobar pneumonia", "C": "Small cell lung carcinoma", "D": "Squamous cell lung carcinoma\n\""}, "answer": "Squamous cell lung carcinoma\n\"", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "69 years old", "specialties": ["Pulmonary Disease", "Internal Medicine"], "subspecialties": ["General Pulmonary Disease", "Pulmonary Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 69 years old.", "2. Patient has had a cough for 3 months.", "3. Cough is mostly dry.", "4. Patient recently coughed up mucus with dark red streaks.", "5. Patient has felt tired for the past few months.", "6. Patient has had poor appetite and a 5-kg (11-lb) weight loss over the past month.", "7. Patient has occasional back pain, which has worsened in recent weeks.", "8. Patient has no recent travel history.", "9. Patient has smoked a pack of cigarettes daily for 30 years.", "10. Patient does not drink alcohol.", "11. Patient's vitals are within normal limits.", "12. Auscultation of the lungs reveals wheezing in the lower right lung field.", "13. No peripheral lymphadenopathy.", "14. Liver is of normal size.", "15. Spleen is not palpable.", "16. Laboratory studies show a hemoglobin concentration of 13.5 g/dL.", "17. Laboratory studies show a serum calcium concentration of 12.3 mg/dL.", "18. Laboratory studies show a total serum protein of 7.0 g/dL.", "19. X-rays of the chest are shown."], "atomic_facts": ["1. The cough is mostly dry.", "2. The patient recalls a recent episode in which he coughed up mucus with dark red streaks.", "3. He has felt tired for the past few months.", "4. Over the past month, he has had poor appetite.", "5. He has experienced a 5-kg (11-lb) weight loss.", "6. He has occasional back pain, which has worsened in recent weeks.", "7. He has no recent travel history.", "8. He has smoked a pack of cigarettes daily for 30 years.", "9. He does not drink alcohol.", "10. His vitals are within normal limits.", "11. Auscultation of the lungs reveals wheezing in the lower right lung field.", "12. There is no peripheral lymphadenopathy.", "13. The liver is of normal size, and the spleen is not palpable.", "14. Laboratory studies show a hemoglobin concentration of 13.5 g/dL.", "15. Laboratory studies show a serum calcium concentration of 12.3 mg/dL.", "16. Laboratory studies show a total serum protein of 7.0 g/dL.", "17. X-rays of the chest are shown."]}
{"id": 1097, "question": "This neoplasm most likely derived from which of the following types of epithelial tissue?", "context": ["A 37-year-old man comes to the physician because of a 3-month history of worsening painful swallowing, hoarseness, and bilateral otalgia.", "He has had a 10-kg (22-lb) weight loss during this period.", "He does not smoke or drink alcohol.", "Laryngoscopic examination shows an abnormal mass located on the right true vocal cord.", "Immunohistochemistry of the mass shows expression of HPV-16 DNA."], "context_len": 5, "options": {"A": "Stratified squamous epithelium with submucosal glands", "B": "Simple columnar epithelium with cilia", "C": "Pseudostratified columnar epithelium with cilia", "D": "Pseudostratified columnar epithelium with cartilage"}, "answer": "Stratified squamous epithelium with submucosal glands", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "37 years old", "specialties": ["Otolaryngology"], "subspecialties": ["General Otolaryngology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 37-year-old man comes to the physician.", "2. He has a 3-month history of worsening painful swallowing, hoarseness, and bilateral otalgia.", "3. He has had a 10-kg (22-lb) weight loss during this period.", "4. He does not smoke or drink alcohol.", "5. Laryngoscopic examination shows an abnormal mass located on the right true vocal cord.", "6. Immunohistochemistry of the mass shows expression of HPV-16 DNA."], "atomic_facts": ["1. He has had a 10-kg (22-lb) weight loss during this period.", "2. He does not smoke or drink alcohol.", "3. Laryngoscopic examination shows an abnormal mass located on the right true vocal cord.", "4. Immunohistochemistry of the mass shows expression of HPV-16 DNA."]}
{"id": 1098, "question": "These patients are at greatest risk for which of the following complications?", "context": ["An investigator is studying patients with an autosomal dominant mutation in the long arm of chromosome 10.", "This mutation alters the structure of CD95 receptors and impairs the binding of a ligand to this receptor."], "context_len": 2, "options": {"A": "Partial albinism", "B": "Autoimmune cytopenia", "C": "Acute myeloid leukemia", "D": "Diabetes mellitus"}, "answer": "Autoimmune cytopenia", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An investigator is studying patients.", "2. The patients have an autosomal dominant mutation.", "3. The mutation is in the long arm of chromosome 10.", "4. The mutation alters the structure of CD95 receptors.", "5. The mutation impairs the binding of a ligand to this receptor."], "atomic_facts": ["1. Mutation alters the structure of CD95 receptors.", "2. Mutation impairs the binding of a ligand to the CD95 receptor."]}
{"id": 1099, "question": "Which of the following is most likely a direct effect of these metabolites?", "context": ["An investigator is studying cardiovascular changes during exercise.", "He is following a 25-year-old female volunteer who is training for a marathon.", "Her training consists of running on a treadmill for increasing amounts of time.", "During her training sessions, laboratory studies show increased concentrations of adenosine and lactate in the active muscles."], "context_len": 4, "options": {"A": "Decreased capillary pressure", "B": "Decreased systemic vascular resistance", "C": "Increased venous return", "D": "Increased mixed venous oxygen saturation"}, "answer": "Decreased systemic vascular resistance", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine", "Cardiology"], "subspecialties": ["Cardiovascular Disease", "Cardiology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An investigator is studying cardiovascular changes during exercise.", "2. The investigator is following a 25-year-old female volunteer.", "3. The volunteer is training for a marathon.", "4. The training consists of running on a treadmill for increasing amounts of time.", "5. During her training sessions, laboratory studies show increased concentrations of adenosine in the active muscles.", "6. During her training sessions, laboratory studies show increased concentrations of lactate in the active muscles."], "atomic_facts": ["1. He is following a 25-year-old female volunteer.", "2. The female volunteer is training for a marathon.", "3. Her training consists of running on a treadmill for increasing amounts of time.", "4. Laboratory studies show increased concentrations of adenosine in the active muscles during her training sessions.", "5. Laboratory studies show increased concentrations of lactate in the active muscles during her training sessions."]}
{"id": 1100, "question": "The patient's symptoms are most likely caused by antibodies against which of the following?", "context": ["A previously healthy 16-year-old girl is brought to the physician by her parents because of behavior changes and involuntary limb movements over the past 2 days.", "She also has a 2-week history of fever, headache, and fatigue.", "Her temperature is 38\u00b0C (100.4\u00b0F), pulse is 110/min, respirations are 20/min, and blood pressure is 102/72 mm Hg.", "Mental status examination shows impaired speech and a disorganized thought process.", "Muscle strength is 5/5 in all extremities.", "Urine toxicology screening is negative.", "Cerebrospinal fluid analysis shows a leukocyte count of 70 cells/mm3 (90% lymphocytes) and a protein concentration of 51 mg/dL.", "Abdominal ultrasound shows a large right adnexal mass."], "context_len": 8, "options": {"A": "Purkinje cell Yo antigens", "B": "GM1 ganglioside", "C": "Neuronal Hu antigens", "D": "Glutamate receptors"}, "answer": "Glutamate receptors", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "16 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 16-year-old girl.", "2. Parents brought her to the physician due to behavior changes and involuntary limb movements over the past 2 days.", "3. Patient has a 2-week history of fever, headache, and fatigue.", "4. Temperature is 38\u00b0C (100.4\u00b0F).", "5. Pulse is 110/min.", "6. Respirations are 20/min.", "7. Blood pressure is 102/72 mm Hg.", "8. Mental status examination shows impaired speech and a disorganized thought process.", "9. Muscle strength is 5/5 in all extremities.", "10. Urine toxicology screening is negative.", "11. Cerebrospinal fluid analysis shows a leukocyte count of 70 cells/mm3 (90% lymphocytes).", "12. Cerebrospinal fluid analysis shows a protein concentration of 51 mg/dL.", "13. Abdominal ultrasound shows a large right adnexal mass."], "atomic_facts": ["1. 2-week history of fever, headache, and fatigue", "2. Temperature is 38\u00b0C (100.4\u00b0F)", "3. Pulse is 110/min", "4. Respirations are 20/min", "5. Blood pressure is 102/72 mm Hg", "6. Impaired speech and a disorganized thought process", "7. Muscle strength is 5/5 in all extremities", "8. Urine toxicology screening is negative", "9. Cerebrospinal fluid analysis shows a leukocyte count of 70 cells/mm3 (90% lymphocytes) and a protein concentration of 51 mg/dL", "10. Abdominal ultrasound shows a large right adnexal mass"]}
{"id": 1101, "question": "The pathogen most likely responsible for this patient's presentation contains a toxin that acts by which of the following mechanisms?", "context": ["A 7-year-old boy is brought to the physician by his mother because of low-grade fevers and a cough lasting for 2 weeks.", "He has vomited several times after fits of coughing.", "He has no history of serious illness and has not received any routine childhood vaccinations.", "His temperature is 38.3\u00b0C (101\u00b0F).", "Physical examination shows erythema of the nasal and oral mucosa.", "While in the exam room, he has a long series of consecutive coughs, during which he appears diaphoretic.", "The coughing is followed by a loud inspiratory gasp.", "Laboratory studies show a leukocyte count of 16,300/mm3 (67% lymphocytes)."], "context_len": 8, "options": {"A": "Increases intracellular cAMP", "B": "Increases intracellular cGMP", "C": "Inactivates host elongation factor", "D": "Inactivates host 60S ribosome"}, "answer": "Increases intracellular cAMP", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 7-year-old boy.", "2. Patient's mother brought him to the physician.", "3. Patient has low-grade fevers and a cough lasting for 2 weeks.", "4. Patient has vomited several times after fits of coughing.", "5. Patient has no history of serious illness.", "6. Patient has not received any routine childhood vaccinations.", "7. Patient's temperature is 38.3\u00b0C (101\u00b0F).", "8. Physical examination shows erythema of the nasal and oral mucosa.", "9. Patient has a long series of consecutive coughs, during which he appears diaphoretic.", "10. Coughing is followed by a loud inspiratory gasp.", "11. Laboratory studies show a leukocyte count of 16,300/mm3 (67% lymphocytes)."], "atomic_facts": ["1. He has vomited several times after fits of coughing.", "2. He has no history of serious illness.", "3. He has not received any routine childhood vaccinations.", "4. His temperature is 38.3\u00b0C (101\u00b0F).", "5. Physical examination shows erythema of the nasal and oral mucosa.", "6. While in the exam room, he has a long series of consecutive coughs, during which he appears diaphoretic.", "7. The coughing is followed by a loud inspiratory gasp.", "8. Laboratory studies show a leukocyte count of 16,300/mm3 (67% lymphocytes)."]}
{"id": 1102, "question": "The CSF analysis will most likely reveal which of the following?", "context": ["A 21-year-old college student is rushed to the ER because of a high-grade fever that started this morning.", "She vomited several times last night.", "She is complaining of a severe, unremitting headache.", "Her temperature is 38.9\u00b0C (102.0\u00b0F), respiratory rate is 20/min, pulse is 112/min, and blood pressure is 105/78 mm Hg.", "She is highly sensitive to light.", "Her neck feels stiff on passive flexion, with positive Kernig\u2019s and Brudzinski\u2019s signs.", "There is a non-blanching maculopapular rash all over the body.", "Cerebrospinal fluid (CSF) samples are sent to the lab for analysis and she is started on intravenous fluids and antibiotics."], "context_len": 8, "options": {"A": "Eosinophils", "B": "Decreased protein concentration", "C": "Lymphocytosis", "D": "Polymorphonuclear leukocytosis"}, "answer": "Polymorphonuclear leukocytosis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "21 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 21-year-old college student is rushed to the ER.", "2. The student has a high-grade fever that started this morning.", "3. The student vomited several times last night.", "4. The student is complaining of a severe, unremitting headache.", "5. The student's temperature is 38.9\u00b0C (102.0\u00b0F).", "6. The student's respiratory rate is 20/min.", "7. The student's pulse is 112/min.", "8. The student's blood pressure is 105/78 mm Hg.", "9. The student is highly sensitive to light.", "10. The student's neck feels stiff on passive flexion.", "11. The student has positive Kernig\u2019s and Brudzinski\u2019s signs.", "12. The student has a non-blanching maculopapular rash all over the body.", "13. Cerebrospinal fluid (CSF) samples are sent to the lab for analysis.", "14. The student is started on intravenous fluids and antibiotics."], "atomic_facts": ["1. She vomited several times last night.", "2. She is complaining of a severe, unremitting headache.", "3. Her temperature is 38.9\u00b0C (102.0\u00b0F).", "4. Her respiratory rate is 20/min.", "5. Her pulse is 112/min.", "6. Her blood pressure is 105/78 mm Hg.", "7. She is highly sensitive to light.", "8. Her neck feels stiff on passive flexion.", "9. She has positive Kernig\u2019s and Brudzinski\u2019s signs.", "10. There is a non-blanching maculopapular rash all over the body.", "11. Cerebrospinal fluid (CSF) samples are sent to the lab for analysis.", "12. She is started on intravenous fluids and antibiotics."]}
{"id": 1103, "question": "In addition to discontinuing the propranolol, which of the following drugs should be administered?", "context": ["A 58-year-old man with chronic obstructive pulmonary disease and hypertension comes to the physician because of shortness of breath 3 days after starting propranolol.", "His temperature is 36.7\u00b0C (98.1\u00b0F), pulse is 64/min, respirations are 20/min, and blood pressure is 138/88 mm Hg.", "Auscultation of the lungs shows diffuse expiratory wheezes."], "context_len": 3, "options": {"A": "Albuterol", "B": "Prednisone", "C": "Tiotropium bromide", "D": "Theophylline"}, "answer": "Albuterol", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "58 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 58-year-old man has chronic obstructive pulmonary disease and hypertension.", "2. He came to the physician because of shortness of breath 3 days after starting propranolol.", "3. His temperature is 36.7\u00b0C (98.1\u00b0F).", "4. His pulse is 64/min.", "5. His respirations are 20/min.", "6. His blood pressure is 138/88 mm Hg.", "7. Auscultation of the lungs shows diffuse expiratory wheezes."], "atomic_facts": ["1. Temperature: 36.7\u00b0C (98.1\u00b0F)", "2. Pulse: 64/min", "3. Respirations: 20/min", "4. Blood pressure: 138/88 mm Hg", "5. Auscultation of the lungs shows diffuse expiratory wheezes"]}
{"id": 1104, "question": "Which of the following would be expected on a peripheral blood smear?", "context": ["A 6-year-old boy is admitted with a one-week history of diarrhea, which was sometimes bloody and originally began after a birthday party.", "He has become lethargic and has not been eating or drinking.", "His vital signs are as follows: T 38.5 C, HR 135, BP 82/54.", "Physical examination is significant for petechiae on his legs and diffuse abdominal tenderness to palpation.", "Lab-work shows BUN 72 mg/dL, creatinine 8.1 mg/dL, and platelet count < 10,000.", "PT and PTT are within normal limits."], "context_len": 6, "options": {"A": "Rouleaux formation", "B": "Fragmented red blood cells", "C": "Spur cells", "D": "Giant platelets"}, "answer": "Fragmented red blood cells", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-year-old boy is admitted.", "2. He has a one-week history of diarrhea.", "3. The diarrhea was sometimes bloody.", "4. The diarrhea originally began after a birthday party.", "5. He has become lethargic.", "6. He has not been eating or drinking.", "7. His temperature is 38.5 C.", "8. His heart rate is 135.", "9. His blood pressure is 82/54.", "10. Physical examination is significant for petechiae on his legs.", "11. Physical examination is significant for diffuse abdominal tenderness to palpation.", "12. Lab-work shows BUN 72 mg/dL.", "13. Lab-work shows creatinine 8.1 mg/dL.", "14. Lab-work shows platelet count < 10,000.", "15. PT and PTT are within normal limits."], "atomic_facts": ["1. He has become lethargic.", "2. He has not been eating.", "3. He has not been drinking.", "4. His vital signs are: T 38.5 C, HR 135, BP 82/54.", "5. Physical examination shows petechiae on his legs.", "6. Physical examination shows diffuse abdominal tenderness to palpation.", "7. Lab-work shows BUN 72 mg/dL.", "8. Lab-work shows creatinine 8.1 mg/dL.", "9. Lab-work shows platelet count < 10,000.", "10. PT and PTT are within normal limits."]}
{"id": 1105, "question": "Which of the following cells express molecules encoded by these genes?", "context": ["A microbiology student is studying the different types of cell surface markers on immune cells.", "He is interested in the human major histocompatibility complex (MHC) and human leukocyte antigens (HLAs).", "While studying, he learns that both class I and class II MHC molecules are expressed on specific types of cells.", "Currently, he is studying the HLA-DP, HLA-DQ, HLA-DR\u03b1, and HLA-DR\u03b2 genes."], "context_len": 4, "options": {"A": "Eosinophils", "B": "Mesenchymal cells", "C": "Platelets", "D": "Thymic epithelial cells"}, "answer": "Thymic epithelial cells", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Allergy and Immunology"], "subspecialties": ["General Allergy and Immunology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A microbiology student is studying the different types of cell surface markers on immune cells.", "2. He is interested in the human major histocompatibility complex (MHC).", "3. He is interested in human leukocyte antigens (HLAs).", "4. Both class I and class II MHC molecules are expressed on specific types of cells.", "5. He is currently studying the HLA-DP gene.", "6. He is currently studying the HLA-DQ gene.", "7. He is currently studying the HLA-DR\u03b1 gene.", "8. He is currently studying the HLA-DR\u03b2 gene."], "atomic_facts": ["1. He is interested in the human major histocompatibility complex (MHC) and human leukocyte antigens (HLAs).", "2. Both class I and class II MHC molecules are expressed on specific types of cells.", "3. He is studying the HLA-DP, HLA-DQ, HLA-DR\u03b1, and HLA-DR\u03b2 genes."]}
{"id": 1106, "question": "Which of the following is the incidence of lung cancer per 1,000 people per year?", "context": ["A 10-year study of 1,000 residents in a small US town is conducted to determine the risk of developing lung cancer.", "The study assesses each subject with a comprehensive physical exam and chest X-ray at 3-time points: at baseline, at the 5-year point, and at the conclusion of the study.", "At each time point, the total number of cases of lung cancer in the population is recorded.", "The data gathered from the study are given in the table below: | Time point Total cases of lung cancer | t = 0 years 100 | t = 5 years 500 | t = 10 years 600 | ."], "context_len": 4, "options": {"A": "104", "B": "0.6", "C": "87", "D": "125"}, "answer": "87", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 10-year study of 1,000 residents in a small US town is conducted to determine the risk of developing lung cancer.", "2. The study assesses each subject with a comprehensive physical exam and chest X-ray at 3-time points: at baseline, at the 5-year point, and at the conclusion of the study.", "3. At each time point, the total number of cases of lung cancer in the population is recorded.", "4. The data gathered from the study is given in the table below.", "5. At time point t = 0 years, there are 100 total cases of lung cancer.", "6. At time point t = 5 years, there are 500 total cases of lung cancer.", "7. At time point t = 10 years, there are 600 total cases of lung cancer."], "atomic_facts": ["1. The study assesses each subject with a comprehensive physical exam and chest X-ray at 3-time points: at baseline, at the 5-year point, and at the conclusion of the study.", "2. At each time point, the total number of cases of lung cancer in the population is recorded.", "3. The data gathered from the study are given in the table below:", "4. Time point t = 0 years, Total cases of lung cancer: 100", "5. Time point t = 5 years, Total cases of lung cancer: 500", "6. Time point t = 10 years, Total cases of lung cancer: 600"]}
{"id": 1107, "question": "If a kidney biopsy had been performed while the patient\u2019s condition was pathologic, which of the following would you expect to find upon glomerular electron microscopy?", "context": ["A 7-year-old boy suffers from generalized edema.", "Urine protein excretion is 5.2 g over 24 hours, and serum analysis reveals hyperlipidemia.", "The patient responds to treatment with prednisone, and, 8 weeks later, his urine does not contain measurable protein."], "context_len": 3, "options": {"A": "Effacement of podocyte foot processes", "B": "Subepithelial \u2018spike and dome\u2019 deposits", "C": "Subepithelial humps", "D": "Subendothelial thickening"}, "answer": "Effacement of podocyte foot processes", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 7-year-old boy suffers from generalized edema.", "2. Urine protein excretion is 5.2 g over 24 hours.", "3. Serum analysis reveals hyperlipidemia.", "4. The patient responds to treatment with prednisone.", "5. 8 weeks later, his urine does not contain measurable protein."], "atomic_facts": ["1. Urine protein excretion is 5.2 g over 24 hours.", "2. Serum analysis reveals hyperlipidemia.", "3. The patient responds to treatment with prednisone.", "4. Eight weeks later, his urine does not contain measurable protein."]}
{"id": 1108, "question": "Which of the following would most likely improve this patient's symptoms?", "context": ["A previously healthy 3-month-old girl is brought to the emergency department because her lips turned blue while passing stools 20 minutes ago.", "She has not stopped crying since then.", "She was born at 38 weeks' gestation.", "She is at the 50th percentile for length and below the 30th percentile for weight.", "She is alert and agitated.", "Her temperature is 36.6\u00b0C (98\u00b0F), pulse is 180/min, respirations are 50/min, and blood pressure is 70/50 mm\u2009Hg.", "Pulse oximetry on room air shows an oxygen saturation of 70%, which increases to 81% on administration of 100% oxygen.", "Physical examination shows perioral cyanosis and retractions of the lower ribs with respiration.", "Cardiac examination shows a harsh grade 2/6 systolic crescendo-decrescendo murmur at the left upper sternal border."], "context_len": 9, "options": {"A": "Knee-chest positioning", "B": "Supine positioning", "C": "Lower limb elevation", "D": "Prone positioning"}, "answer": "Knee-chest positioning", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "3 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology", "General Pediatrics", "Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 3-month-old girl was brought to the emergency department.", "2. Her lips turned blue 20 minutes ago.", "3. She has not stopped crying since then.", "4. She was born at 38 weeks' gestation.", "5. She is at the 50th percentile for length.", "6. She is below the 30th percentile for weight.", "7. She is alert and agitated.", "8. Her temperature is 36.6\u00b0C (98\u00b0F).", "9. Her pulse is 180/min.", "10. Her respirations are 50/min.", "11. Her blood pressure is 70/50 mm\u2009Hg.", "12. Pulse oximetry on room air shows an oxygen saturation of 70%.", "13. Oxygen saturation increases to 81% on administration of 100% oxygen.", "14. Physical examination shows perioral cyanosis and retractions of the lower ribs with respiration.", "15. Cardiac examination shows a harsh grade 2/6 systolic crescendo-decrescendo murmur at the left upper sternal border."], "atomic_facts": ["1. She has not stopped crying since then.", "2. She was born at 38 weeks' gestation.", "3. She is at the 50th percentile for length and below the 30th percentile for weight.", "4. She is alert and agitated.", "5. Her temperature is 36.6\u00b0C (98\u00b0F), pulse is 180/min, respirations are 50/min, and blood pressure is 70/50 mm\u2009Hg.", "6. Pulse oximetry on room air shows an oxygen saturation of 70%, which increases to 81% on administration of 100% oxygen.", "7. Physical examination shows perioral cyanosis and retractions of the lower ribs with respiration.", "8. Cardiac examination shows a harsh grade 2/6 systolic crescendo-decrescendo murmur at the left upper sternal border."]}
{"id": 1109, "question": "Which of the following best describes the pathogenesis of the disease process in this patient?\"", "context": ["An 8-year-old girl of Asian descent is brought to the physician because of fatigue.", "She is not able to keep up with the rest of her classmates in gym class because she tires easily.", "Physical examination shows pale conjunctivae.", "Laboratory studies show: | Hemoglobin 11.0 g/dL | Mean corpuscular volume 74 \u03bcm3 | Red cell distribution width 14 (N=13-15) | Serum ferritin 77 ng/mL | Peripheral blood smear shows small, pale red blood cells.", "Hemoglobin electrophoresis is normal."], "context_len": 5, "options": {"A": "Decreased production of \u03b2-globin proteins", "B": "Amino acid substitution in the \u03b2-globin protein", "C": "Cis deletion of \u03b1-globin genes", "D": "Acquired inhibition of heme synthesis"}, "answer": "Cis deletion of \u03b1-globin genes", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An 8-year-old girl of Asian descent is brought to the physician because of fatigue.", "2. She is not able to keep up with the rest of her classmates in gym class because she tires easily.", "3. Physical examination shows pale conjunctivae.", "4. Laboratory studies show Hemoglobin 11.0 g/dL.", "5. Laboratory studies show Mean corpuscular volume 74 \u03bcm3.", "6. Laboratory studies show Red cell distribution width 14 (N=13-15).", "7. Laboratory studies show Serum ferritin 77 ng/mL.", "8. Peripheral blood smear shows small, pale red blood cells.", "9. Hemoglobin electrophoresis is normal."], "atomic_facts": ["1. She is not able to keep up with the rest of her classmates in gym class because she tires easily.", "2. Physical examination shows pale conjunctivae.", "3. Laboratory studies show: Hemoglobin 11.0 g/dL.", "4. Laboratory studies show: Mean corpuscular volume 74 \u03bcm3.", "5. Laboratory studies show: Red cell distribution width 14 (N=13-15).", "6. Laboratory studies show: Serum ferritin 77 ng/mL.", "7. Peripheral blood smear shows small, pale red blood cells.", "8. Hemoglobin electrophoresis is normal."]}
{"id": 1110, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 52-year-old postmenopausal woman comes to the physician with a 6-month history of difficulty biting down and chewing that is becoming progressively worse.", "She has been taking acetaminophen for headaches and nonspecific pain in her hips and back.", "She also complains that her hearing has been deteriorating as she gets older.", "Vital signs are within normal limits.", "Examination shows a mildly tender, 1-cm, bony, immobile swelling in the left side of her forehead.", "Intraoral examination shows bilateral expansion of the maxillary alveolus and malocclusion.", "Audiometry shows bilateral mixed conductive and sensorineural hearing loss.", "Laboratory studies show: | Hemoglobin 14.6 g/dL | Leukocyte count 9,000/mm3 | Platelet count 256,000/mm3 | Serum | Alkaline phosphatase 1100 U/L | Vitamin D 40 ng/ml (N = 20\u2013100 ng/mL) | Calcium 9.5 mg/dL | Parathyroid hormone 300 pg/mL | A plain x-ray of the skull is shown."], "context_len": 8, "options": {"A": "Hematopoietic cell transplantation", "B": "Transsphenoidal hypophysectomy", "C": "Intravenous zoledronate", "D": "Estrogen replacement therapy"}, "answer": "Intravenous zoledronate", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "52 years old", "specialties": ["Neurology", "Dermatology", "Orthopaedic Surgery", "Otolaryngology"], "subspecialties": ["Neuromuscular Medicine", "General Otolaryngology", "General Orthopaedic Surgery", "General Dermatology"], "specialty_prob": [0.4, 0.2, 0.2, 0.2], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 52-year-old postmenopausal woman.", "2. Patient has a 6-month history of difficulty biting down and chewing that is becoming progressively worse.", "3. Patient has been taking acetaminophen for headaches and nonspecific pain in her hips and back.", "4. Patient complains that her hearing has been deteriorating as she gets older.", "5. Vital signs are within normal limits.", "6. Examination shows a mildly tender, 1-cm, bony, immobile swelling in the left side of her forehead.", "7. Intraoral examination shows bilateral expansion of the maxillary alveolus and malocclusion.", "8. Audiometry shows bilateral mixed conductive and sensorineural hearing loss.", "9. Laboratory studies show: Hemoglobin 14.6 g/dL, Leukocyte count 9,000/mm3, Platelet count 256,000/mm3, Serum Alkaline phosphatase 1100 U/L, Vitamin D 40 ng/ml (N = 20\u2013100 ng/mL), Calcium 9.5 mg/dL, Parathyroid hormone 300 pg/mL.", "10. A plain x-ray of the skull is shown."], "atomic_facts": ["1. She has been taking acetaminophen for headaches and nonspecific pain in her hips and back.", "2. She also complains that her hearing has been deteriorating as she gets older.", "3. Vital signs are within normal limits.", "4. Examination shows a mildly tender, 1-cm, bony, immobile swelling in the left side of her forehead.", "5. Intraoral examination shows bilateral expansion of the maxillary alveolus and malocclusion.", "6. Audiometry shows bilateral mixed conductive and sensorineural hearing loss.", "7. Laboratory studies show: Hemoglobin 14.6 g/dL, Leukocyte count 9,000/mm3, Platelet count 256,000/mm3, Serum Alkaline phosphatase 1100 U/L, Vitamin D 40 ng/ml (N = 20\u2013100 ng/mL), Calcium 9.5 mg/dL, Parathyroid hormone 300 pg/mL.", "8. A plain x-ray of the skull is shown."]}
{"id": 1111, "question": "Serum studies obtained 5 days after admission show: | Na+ 138 mEq/L | Cl\u2212 101 mEq/L | Mg2+ 1.3 mEq/L | Urea nitrogen 42 mg/dL | Creatinine 1.8 mg/dL | Arterial blood gas analysis on room air: | pH 7.51 | PCO2 52 mm Hg | PO2 60 mm Hg | HCO3- 33 mmol/L | Further evaluation of this patient is most likely to show which of the following findings?\"", "context": ["A 66-year-old man is brought to the emergency department because of worsening shortness of breath and progressive swelling of his legs for 1 week.", "He has hypertension and hyperlipidemia.", "Current medications include amlodipine and pravastatin.", "His temperature is 37.5\u00b0C (99\u00b0F), pulse is 95/min, respirations are 12/min, and blood pressure is 113/70 mm Hg.", "Pulmonary examination shows bilateral coarse crackles.", "An S3 gallop is heard on auscultation.", "There is jugular venous distension and pitting edema of both ankles.", "He is admitted to the hospital and treatment with intravenous bumetanide is initiated."], "context_len": 8, "options": {"A": "Elevated serum aldosterone", "B": "Decreased urine chloride", "C": "Decreased serum renin", "D": "Elevated serum potassium"}, "answer": "Elevated serum aldosterone", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "66 years old", "specialties": ["Internal Medicine", "Nephrology"], "subspecialties": ["Nephrology", "General Nephrology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 66-year-old man is brought to the emergency department.", "2. He has worsening shortness of breath and progressive swelling of his legs for 1 week.", "3. He has hypertension and hyperlipidemia.", "4. His current medications include amlodipine and pravastatin.", "5. His temperature is 37.5\u00b0C (99\u00b0F).", "6. His pulse is 95/min.", "7. His respirations are 12/min.", "8. His blood pressure is 113/70 mm Hg.", "9. Pulmonary examination shows bilateral coarse crackles.", "10. An S3 gallop is heard on auscultation.", "11. There is jugular venous distension.", "12. There is pitting edema of both ankles.", "13. He is admitted to the hospital.", "14. Treatment with intravenous bumetanide is initiated."], "atomic_facts": ["1. He has hypertension and hyperlipidemia.", "2. Current medications include amlodipine and pravastatin.", "3. His temperature is 37.5\u00b0C (99\u00b0F).", "4. His pulse is 95/min.", "5. His respirations are 12/min.", "6. His blood pressure is 113/70 mm Hg.", "7. Pulmonary examination shows bilateral coarse crackles.", "8. An S3 gallop is heard on auscultation.", "9. There is jugular venous distension.", "10. There is pitting edema of both ankles.", "11. He is admitted to the hospital.", "12. Treatment with intravenous bumetanide is initiated."]}
{"id": 1112, "question": "What is the most likely cause of this patient\u2019s condition?", "context": ["A 16-year-old boy is brought to the emergency department by his parents after collapsing at home.", "He was resting at home after an uneventful dental procedure that involved the extraction of several teeth.", "He became drowsy and then unconscious and was unrousable.", "At the hospital, his temperature is 37.0\u00b0 C (98.6\u00b0 F), respiratory rate is 15/min, pulse rate is 67/min, and blood pressure is 122/98 mm Hg.", "Oxygen saturation is 85% on room air.", "The patient is deeply cyanosed despite a good respiratory effort and a clear airway.", "His lungs are clear to auscultation, bilaterally.", "Even though an endotracheal tube is introduced and assisted ventilation is induced, his condition does not improve.", "A review of dental records reveals the details of the procedure where the local anesthetic pilocarpine was administered."], "context_len": 9, "options": {"A": "Cyanide poisoning", "B": "Methemoglobinemia", "C": "Sulfhemoglobinemia", "D": "Carbon monoxide poisoning"}, "answer": "Methemoglobinemia", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "16 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 16-years-old.", "2. Patient was brought to the emergency department by his parents.", "3. Patient collapsed at home.", "4. Patient had an uneventful dental procedure involving the extraction of several teeth.", "5. Patient became drowsy and then unconscious and was unrousable.", "6. Patient's temperature is 37.0\u00b0 C (98.6\u00b0 F).", "7. Patient's respiratory rate is 15/min.", "8. Patient's pulse rate is 67/min.", "9. Patient's blood pressure is 122/98 mm Hg.", "10. Patient's oxygen saturation is 85% on room air.", "11. Patient is deeply cyanosed despite a good respiratory effort and a clear airway.", "12. Patient's lungs are clear to auscultation, bilaterally.", "13. An endotracheal tube was introduced and assisted ventilation was induced, but patient's condition did not improve.", "14. Dental records reveal the details of the procedure where the local anesthetic pilocarpine was administered."], "atomic_facts": ["1. The patient was resting at home after a dental procedure involving the extraction of several teeth.", "2. He became drowsy and then unconscious and was unrousable.", "3. At the hospital, his temperature is 37.0\u00b0 C (98.6\u00b0 F).", "4. His respiratory rate is 15/min.", "5. His pulse rate is 67/min.", "6. His blood pressure is 122/98 mm Hg.", "7. Oxygen saturation is 85% on room air.", "8. The patient is deeply cyanosed despite a good respiratory effort and a clear airway.", "9. His lungs are clear to auscultation, bilaterally.", "10. Even though an endotracheal tube is introduced and assisted ventilation is induced, his condition does not improve.", "11. A review of dental records reveals the details of the procedure where the local anesthetic pilocarpine was administered."]}
{"id": 1113, "question": "Which of the following is the most likely underlying cause of this patient's upper extremity symptoms?", "context": ["Patient Information.", "Age: 1 day.", "Sex: F.", "Ethnicity: Hispanic.", "Site of Care: office.", "History.", "Reason for Visit/Chief Concern: brought in by her parents because \u201cher arm looks funny\u201d.", "History of Present Illness: mother had no prenatal care.", "labor was spontaneous with rupture of membranes yielding fluid with dark green streaks.", "the infant was delivered vaginally 1 day ago at home at approximately 39 weeks' gestation.", "the delivery was complicated by shoulder dystocia, which was managed with suprapubic pressure and the McRoberts maneuver.", "father reports that the infant's right arm \u201cjust hangs by the side\u201d and that she never bends her right elbow.", "the infant is breastfeeding, stooling, and voiding without complication.", "Past Medical History: none.", "Family History: mother has type 2 diabetes mellitus.", "Medications: none.", "Immunizations: has not received any routine vaccinations.", "Allergies: no known drug allergies.", "Social History: the infant lives with her mother, father, and paternal grandmother.", "no one in the residence smokes.", "Physical Examination.", "Temp Pulse Resp BP O2 Sat Ht Wt Head circumference.", "37.1\u00b0C.", "(98.8\u00b0F).", "154/min 45/min 87/49 mm Hg.", "99%.", "50 cm.", "(20 in; 69th percentile).", "4,400 g.", "(9 lb 11 oz; 99th percentile).", "35 cm.", "(13.8 in; 82nd percentile).", "Appearance: well-appearing; crying during the examination.", "HEENT: red reflex is seen bilaterally; there is a fluctuant area over the left parietal bone that crosses suture lines.", "Pulmonary: clear to auscultation.", "Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops.", "Abdominal: no tenderness, masses, or hepatosplenomegaly; bowel sounds normal; umbilical stump is intact and clamped.", "Extremities: hips are stable bilaterally.", "Musculoskeletal: clavicles are intact bilaterally; the right upper extremity hangs limply from the shoulder in full extension, adduction, and fixed internal rotation; the hand is pronated, and the wrist and fingers are flexed.", "Skin: dry, warm; no jaundice.", "Neurologic: normal suck and grasp reflexes; the Moro reflex is normal in the left upper extremity and absent in the right upper extremity; deep tendon reflexes are 2+ bilaterally. Please refer to the summary above to answer this question."], "context_len": 41, "options": {"A": "Injury to the median nerve", "B": "Damage to the upper trunk of the brachial plexus", "C": "Damage to the lower trunk of the brachial plexus", "D": "Aspiration of meconium"}, "answer": "Damage to the upper trunk of the brachial plexus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "1 day", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery", "Surgery of the Hand"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["- Age: 1 day", "- Sex: F", "- Ethnicity: Hispanic", "- Site of Care: office", "- Reason for Visit/Chief Concern: brought in by her parents because \u201cher arm looks funny\u201d", "- History of Present Illness: mother had no prenatal care", "- Labor was spontaneous with rupture of membranes yielding fluid with dark green streaks", "- The infant was delivered vaginally 1 day ago at home at approximately 39 weeks' gestation", "- The delivery was complicated by shoulder dystocia, which was managed with suprapubic pressure and the McRoberts maneuver", "- Father reports that the infant's right arm \u201cjust hangs by the side\u201d and that she never bends her right elbow", "- The infant is breastfeeding, stooling, and voiding without complication", "- Past Medical History: none", "- Family History: mother has type 2 diabetes mellitus", "- Medications: none", "- Immunizations: has not received any routine vaccinations", "- Allergies: no known drug allergies", "- Social History: the infant lives with her mother, father, and paternal grandmother; no one in the residence smokes", "- Physical Examination:", "  -Temp: 37.1\u00b0C (98.8\u00b0F)", "  - Pulse: 154/min", "  - Resp: 45/min", "  - BP: 87/49 mm Hg", "  - O2 Sat: 99%", "  - Ht: 50 cm (20 in; 69th percentile)", "  - Wt: 4,400 g (9 lb 11 oz; 99th percentile)", "  - Head circumference: 35 cm (13.8 in; 82nd percentile)", "- Appearance: well-appearing; crying during the examination", "- HEENT: red reflex is seen bilaterally; there is a fluctuant area over the left parietal bone that crosses suture lines", "- Pulmonary: clear to auscultation", "- Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops", "- Abdominal: no tenderness, masses, or hepatosplenomegaly; bowel sounds normal; umbilical stump is intact and clamped", "- Extremities: hips are stable bilaterally", "- Musculoskeletal: clavicles are intact bilaterally; the right upper extremity hangs limply from the shoulder in full extension, adduction, and fixed internal rotation; the hand is pronated, and the wrist and fingers are flexed", "- Skin: dry, warm; no jaundice", "- Neurologic: normal suck and grasp reflexes; the Moro reflex is normal in the left upper extremity and absent in the right upper extremity; deep tendon reflexes are 2+ bilaterally."], "atomic_facts": ["1. Age: 1 day", "2. Sex: F", "3. Ethnicity: Hispanic", "4. Site of Care: office", "5. Reason for Visit/Chief Concern: brought in by her parents because \u201cher arm looks funny\u201d", "6. History of Present Illness: mother had no prenatal care", "7. Labor was spontaneous with rupture of membranes yielding fluid with dark green streaks", "8. The infant was delivered vaginally 1 day ago at home at approximately 39 weeks' gestation", "9. The delivery was complicated by shoulder dystocia, which was managed with suprapubic pressure and the McRoberts maneuver", "10. Father reports that the infant's right arm \u201cjust hangs by the side\u201d and that she never bends her right elbow", "11. The infant is breastfeeding, stooling, and voiding without complication", "12. Past Medical History: none", "13. Family History: mother has type 2 diabetes mellitus", "14. Medications: none", "15. Immunizations: has not received any routine vaccinations", "16. Allergies: no known drug allergies", "17. Social History: the infant lives with her mother, father, and paternal grandmother", "18. No one in the residence smokes", "19. Temp: 37.1\u00b0C (98.8\u00b0F)", "20. Pulse: 154/min", "21. Resp: 45/min", "22. BP: 87/49 mm Hg", "23. O2 Sat: 99%", "24. Ht: 50 cm (20 in; 69th percentile)", "25. Wt: 4,400 g (9 lb 11 oz; 99th percentile)", "26. Head circumference: 35 cm (13.8 in; 82nd percentile)", "27. Appearance: well-appearing; crying during the examination", "28. HEENT: red reflex is seen bilaterally; there is a fluctuant area over the left parietal bone that crosses suture lines", "29. Pulmonary: clear to auscultation", "30. Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops", "31. Abdominal: no tenderness, masses, or hepatosplenomegaly; bowel sounds normal; umbilical stump is intact and clamped", "32. Extremities: hips are stable bilaterally", "33. Musculoskeletal: clavicles are intact bilaterally; the right upper extremity hangs limply from the shoulder in full extension, adduction, and fixed internal rotation; the hand is pronated, and the wrist and fingers are flexed", "34. Skin: dry, warm; no jaundice", "35. Neurologic: normal suck and grasp reflexes; the Moro reflex is normal in the left upper extremity and absent in the right upper extremity; deep tendon reflexes are 2+ bilaterally"]}
{"id": 1114, "question": "Which of the following pathogens is the most likely cause of this patient\u2019s condition?", "context": ["A 34-year-old man presents with severe left inguinal pain and swelling since last night.", "He has just returned from a summer trip to the southwestern United States where he spent most of his time working with homeless and unemployed people in an area that straddles New Mexico and Utah.", "Upon further inquiry, he denies any contact with wild or domestic animals including pets, but he does remember occasionally seeing mice in his motel room and found their droppings on the floor.", "On physical exam his temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 95/min, respiration rate is 18/min, and blood pressure is 130/85 mm Hg.", "The left inguinal area is swollen.", "There is no skin erythema and it is not warm to palpation.", "There are several enlarged and soft lymph nodes with a hard underlying core.", "The area is very tender and surrounded by edema.", "A localized rash is found in the ipsilateral inner thigh above the knee (see image).", "Examination of the heart, lungs, abdomen, and other limbs shows no abnormalities."], "context_len": 10, "options": {"A": "Hantavirus", "B": "Rhabdovirus", "C": "Borrelia burgdorferi", "D": "Yersinia pestis"}, "answer": "Yersinia pestis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "34", "specialties": ["Surgery", "General Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 34 years old.", "2. Patient has severe left inguinal pain and swelling since last night.", "3. Patient recently returned from a summer trip to the southwestern United States.", "4. Patient spent most of his time working with homeless and unemployed people in an area that straddles New Mexico and Utah.", "5. Patient denies any contact with wild or domestic animals including pets.", "6. Patient remembers occasionally seeing mice in his motel room and found their droppings on the floor.", "7. Patient's temperature is 38.5\u00b0C (101.3\u00b0F).", "8. Patient's pulse is 95/min.", "9. Patient's respiration rate is 18/min.", "10. Patient's blood pressure is 130/85 mm Hg.", "11. Left inguinal area is swollen.", "12. No skin erythema and not warm to palpation.", "13. Several enlarged and soft lymph nodes with a hard underlying core.", "14. Area is very tender and surrounded by edema.", "15. Localized rash found in ipsilateral inner thigh above the knee.", "16. Examination of heart, lungs, abdomen, and other limbs shows no abnormalities."], "atomic_facts": ["1. The patient has just returned from a summer trip to the southwestern United States.", "2. He spent most of his time working with homeless and unemployed people in an area that straddles New Mexico and Utah.", "3. He denies any contact with wild or domestic animals including pets.", "4. He occasionally saw mice in his motel room and found their droppings on the floor.", "5. On physical exam, his temperature is 38.5\u00b0C (101.3\u00b0F).", "6. His pulse is 95/min.", "7. His respiration rate is 18/min.", "8. His blood pressure is 130/85 mm Hg.", "9. The left inguinal area is swollen.", "10. There is no skin erythema and it is not warm to palpation.", "11. There are several enlarged and soft lymph nodes with a hard underlying core.", "12. The area is very tender and surrounded by edema.", "13. A localized rash is found in the ipsilateral inner thigh above the knee.", "14. Examination of the heart, lungs, abdomen, and other limbs shows no abnormalities."]}
{"id": 1115, "question": "Which of the following is the most appropriate advice for this patient\u2019s mother?", "context": ["A 10-year-old unvaccinated girl presents to her pediatrician with a rash.", "Her mother reports that she has had a fever, \u201cred eyes,\u201d sore throat, and rash on her face for the last day.", "On physical examination, the girl appears sick but not toxic, and has nonpurulent conjunctivitis and an erythematous posterior pharynx without exudate or tonsillar hypertrophy.", "She has lymphadenopathy bilaterally.", "Her heart has a regular rate without murmurs, her lungs are clear to auscultation bilaterally, and her abdomen is soft without hepatosplenomegaly.", "She has red cheeks with circumoral pallor and no other skin findings."], "context_len": 6, "options": {"A": "This infection could have been prevented with a vaccine.", "B": "Her symptoms were caused by human herpesvirus type 6 (HHV-6) or human herpesvirus type 7 (HHV-7).", "C": "She will likely develop a maculopapular truncal rash in a few days that will fade to become a lacy rash.", "D": "She should be started on oral valacyclovir."}, "answer": "She will likely develop a maculopapular truncal rash in a few days that will fade to become a lacy rash.", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "10 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 10-year-old unvaccinated girl presents to her pediatrician.", "2. Her mother reports that she has had a fever.", "3. Her mother reports that she has had \"red eyes\".", "4. Her mother reports that she has had a sore throat.", "5. Her mother reports that she has had a rash on her face for the last day.", "6. On physical examination, the girl appears sick but not toxic.", "7. On physical examination, the girl has nonpurulent conjunctivitis.", "8. On physical examination, the girl has an erythematous posterior pharynx without exudate or tonsillar hypertrophy.", "9. On physical examination, the girl has lymphadenopathy bilaterally.", "10. On physical examination, the girl's heart has a regular rate without murmurs.", "11. On physical examination, the girl's lungs are clear to auscultation bilaterally.", "12. On physical examination, the girl's abdomen is soft without hepatosplenomegaly.", "13. On physical examination, the girl has red cheeks with circumoral pallor.", "14. On physical examination, the girl has no other skin findings."], "atomic_facts": ["1. Her mother reports that she has had a fever for the last day.", "2. Her mother reports that she has had \"red eyes\" for the last day.", "3. Her mother reports that she has had a sore throat for the last day.", "4. Her mother reports that she has had a rash on her face for the last day.", "5. On physical examination, the girl appears sick but not toxic.", "6. On physical examination, the girl has nonpurulent conjunctivitis.", "7. On physical examination, the girl has an erythematous posterior pharynx without exudate.", "8. On physical examination, the girl has an erythematous posterior pharynx without tonsillar hypertrophy.", "9. On physical examination, the girl has lymphadenopathy bilaterally.", "10. On physical examination, her heart has a regular rate without murmurs.", "11. On physical examination, her lungs are clear to auscultation bilaterally.", "12. On physical examination, her abdomen is soft without hepatosplenomegaly.", "13. On physical examination, she has red cheeks with circumoral pallor.", "14. On physical examination, she has no other skin findings."]}
{"id": 1116, "question": "Which of the following changes in forced expiratory volume (FEV1) and forced vital capacity (FVC) are expected if she takes a pulmonary function test?", "context": ["A 42-year-old woman presents to the clinic for worsening fatigue and difficulty breathing for the last 6 months.", "Previously, she could routinely walk 3 miles after dinner, but now she can no longer walk more than 2 blocks without being short of breath.", "She also reports being tired soon after starting any type of physical activity.", "On further questioning, she recalls having on and off fevers, occasional night sweats, and losing 5 kg (11 lb) over the last 6 months.", "Her past medical history reveals 2 cesarean deliveries in her twenties and a hospitalization for acute appendicitis in her teens.", "She currently takes no medications and also denies smoking and recreational drug use.", "She drinks half a glass of wine with her evening meals.", "Her vitals include a respiratory rate of 14/min, a pulse rate of 87/min, a blood pressure of 110/89 mm Hg, and a temperature of 36.7\u00b0C (98.0\u00b0F).", "Physical examination is normal.", "A chest X-ray shows bilateral hilar lymphadenopathy."], "context_len": 10, "options": {"A": "FEV1: decrease and FVC: decreased", "B": "FEV1: decreased and FVC: no change", "C": "FEV1: decreased and FVC: increased", "D": "FEV1: no change and FVC: no change"}, "answer": "FEV1: decrease and FVC: decreased", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Pulmonary Disease", "Pulmonology"], "subspecialties": ["General Pulmonary Disease", "General Pulmonology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 42-year-old woman.", "2. Patient has been experiencing worsening fatigue and difficulty breathing for the last 6 months.", "3. Patient used to be able to walk 3 miles after dinner, but now can only walk 2 blocks without being short of breath.", "4. Patient reports being tired soon after starting any type of physical activity.", "5. Patient has had on and off fevers, occasional night sweats, and has lost 5 kg (11 lb) over the last 6 months.", "6. Patient's past medical history includes 2 cesarean deliveries in her twenties and a hospitalization for acute appendicitis in her teens.", "7. Patient takes no medications.", "8. Patient denies smoking and recreational drug use.", "9. Patient drinks half a glass of wine with her evening meals.", "10. Patient's vitals include a respiratory rate of 14/min, a pulse rate of 87/min, a blood pressure of 110/89 mm Hg, and a temperature of 36.7\u00b0C (98.0\u00b0F).", "11. Physical examination is normal.", "12. Chest X-ray shows bilateral hilar lymphadenopathy."], "atomic_facts": ["1. Previously, she could routinely walk 3 miles after dinner", "2. Now she can no longer walk more than 2 blocks without being short of breath", "3. She reports being tired soon after starting any type of physical activity", "4. On further questioning, she recalls having on and off fevers", "5. She also recalls occasional night sweats", "6. She has lost 5 kg (11 lb) over the last 6 months", "7. Her past medical history reveals 2 cesarean deliveries in her twenties", "8. Her past medical history reveals a hospitalization for acute appendicitis in her teens", "9. She currently takes no medications", "10. She denies smoking and recreational drug use", "11. She drinks half a glass of wine with her evening meals", "12. Her vitals include a respiratory rate of 14/min", "13. Her vitals include a pulse rate of 87/min", "14. Her vitals include a blood pressure of 110/89 mm Hg", "15. Her vitals include a temperature of 36.7\u00b0C (98.0\u00b0F)", "16. Physical examination is normal", "17. A chest X-ray shows bilateral hilar lymphadenopathy"]}
{"id": 1117, "question": "This patient's symptoms are most likely caused by a side effect of which of the following medications?", "context": ["A 42-year-old woman is brought to the emergency department because of a severe, throbbing, occipital headache for 2 hours.", "She also reports nausea, photophobia, and chest tightness.", "The symptoms developed shortly after she had a snack consisting of salami and some dried fruits at a wine tasting event.", "The patient has recurrent migraine headaches and depression, for which she takes medication daily.", "She is mildly distressed, diaphoretic, and her face is flushed.", "Her temperature is 37.2\u00b0C (98.9 F), pulse is 88/min, respirations are 19/min, and blood pressure is 190/128 mmHg.", "Deep-tendon reflexes are 2+ bilaterally."], "context_len": 7, "options": {"A": "Tranylcypromine", "B": "Almotriptan", "C": "Topiramate", "D": "Doxepin"}, "answer": "Tranylcypromine", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 42-year-old woman is brought to the emergency department.", "2. She has a severe, throbbing, occipital headache for 2 hours.", "3. She also reports nausea, photophobia, and chest tightness.", "4. The symptoms developed shortly after she had a snack consisting of salami and some dried fruits at a wine tasting event.", "5. The patient has recurrent migraine headaches and depression.", "6. She takes medication daily for her migraine headaches and depression.", "7. She is mildly distressed, diaphoretic, and her face is flushed.", "8. Her temperature is 37.2\u00b0C (98.9 F).", "9. Her pulse is 88/min.", "10. Her respirations are 19/min.", "11. Her blood pressure is 190/128 mmHg.", "12. Deep-tendon reflexes are 2+ bilaterally."], "atomic_facts": ["1. The patient reports nausea.", "2. The patient reports photophobia.", "3. The patient reports chest tightness.", "4. The symptoms developed after having a snack of salami and dried fruits at a wine tasting event.", "5. The patient has recurrent migraine headaches.", "6. The patient has depression.", "7. The patient takes medication daily for migraine headaches and depression.", "8. The patient is mildly distressed.", "9. The patient is diaphoretic.", "10. The patient's face is flushed.", "11. The patient's temperature is 37.2\u00b0C (98.9 F).", "12. The patient's pulse is 88/min.", "13. The patient's respirations are 19/min.", "14. The patient's blood pressure is 190/128 mmHg.", "15. Deep-tendon reflexes are 2+ bilaterally."]}
{"id": 1118, "question": "Which of the following is the most likely diagnosis?", "context": ["A 70-year-old man is brought to the emergency department because of severe back pain that began when he was lifting a box 1 hour ago.", "He also has a 2-year history of increasingly severe right hip pain.", "Physical examination shows tenderness to palpation of the lower spine as well as erythema of the skin over the right hip.", "Neurologic examination shows decreased hearing in the left ear; the Weber test localizes to the left side.", "Serum studies show an alkaline phosphatase concentration of 410 U/L, calcium concentration of 9.5 mg/dL, and parathyroid hormone level of 322 pg/mL.", "An x-ray of the spine shows a fracture of the L4 vertebra."], "context_len": 6, "options": {"A": "Osteoporosis", "B": "Osteomalacia", "C": "Osteitis deformans", "D": "Osteonecrosis"}, "answer": "Osteitis deformans", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine", "General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 70-year-old man is brought to the emergency department.", "2. The man has severe back pain that began 1 hour ago.", "3. The man has a 2-year history of increasingly severe right hip pain.", "4. Physical examination shows tenderness to palpation of the lower spine.", "5. Physical examination also shows erythema of the skin over the right hip.", "6. Neurologic examination shows decreased hearing in the left ear.", "7. The Weber test localizes to the left side.", "8. Serum studies show an alkaline phosphatase concentration of 410 U/L.", "9. Serum studies show a calcium concentration of 9.5 mg/dL.", "10. Serum studies show a parathyroid hormone level of 322 pg/mL.", "11. An x-ray of the spine shows a fracture of the L4 vertebra."], "atomic_facts": ["1. 2-year history of increasingly severe right hip pain", "2. Physical examination shows tenderness to palpation of the lower spine", "3. Physical examination shows erythema of the skin over the right hip", "4. Neurologic examination shows decreased hearing in the left ear", "5. Weber test localizes to the left side", "6. Serum studies show alkaline phosphatase concentration of 410 U/L", "7. Serum studies show calcium concentration of 9.5 mg/dL", "8. Serum studies show parathyroid hormone level of 322 pg/mL", "9. X-ray of the spine shows a fracture of the L4 vertebra"]}
{"id": 1119, "question": "Which of the following is true about cross-over study designs?", "context": ["A study investigating the use of adalimumab for the relief of peripheral arthropathy in patients with psoriatic arthritis was conducted.", "The study utilizes a crossover design in which half of the study participants are given adalimumab for a month while the other half takes placebo.", "After a 2 week washout period in which no one takes any adalimumab, the group that was originally on adalimumab is given placebo for a month while the group that was originally taking placebo is given adalimumab for a month.", "Pain in all affected joints is assessed clinically by follow-up visits every two weeks for the duration of the study."], "context_len": 4, "options": {"A": "Crossover studies avoid the ethical issue of not giving all participants access to a novel therapeutic agent", "B": "Crossover studies minimize the effects of differences between participants", "C": "The purpose of the washout period is to increase the length of the study to gather more data", "D": "1 and 2"}, "answer": "1 and 2", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine", "Rheumatology"], "subspecialties": ["Rheumatology", "General Rheumatology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A study was conducted investigating the use of adalimumab for the relief of peripheral arthropathy in patients with psoriatic arthritis.", "2. The study utilizes a crossover design.", "3. Half of the study participants are given adalimumab for a month.", "4. The other half takes placebo.", "5. After a 2 week washout period, the group that was originally on adalimumab is given placebo for a month.", "6. The group that was originally taking placebo is given adalimumab for a month.", "7. Pain in all affected joints is assessed clinically by follow-up visits every two weeks for the duration of the study."], "atomic_facts": ["1. The study utilizes a crossover design.", "2. Half of the study participants are given adalimumab for a month.", "3. The other half takes placebo for a month.", "4. After a 2 week washout period, no one takes any adalimumab.", "5. The group originally on adalimumab is given placebo for a month.", "6. The group originally taking placebo is given adalimumab for a month.", "7. Pain in all affected joints is assessed clinically.", "8. Follow-up visits occur every two weeks for the duration of the study."]}
{"id": 1120, "question": "Which medication is likely responsible for these symptoms?", "context": ["A 64-year-old woman presented to the community health clinic complaining of nausea, bloating, pain in both knees, and a burning sensation in her feet.", "She has recently immigrated to the United States and was previously diagnosed with diabetes mellitus, hypertension, and osteoarthritis but no medical records are currently available.", "She has stopped taking her medication since immigrating; however, she does recall being on insulin but cannot recall the dosage or the specific type.", "She has a blood pressure of 172/120 mm Hg, heart rate of 95/min, respiratory rate of 15/min, and temperature of 37.0\u00b0C (98.6\u00b0F).", "Her random serum glucose is 364 mg/dL.", "She is started on atorvastatin, amlodipine, ramipril, aspirin, duloxetine, metoclopramide, acetaminophen, and insulin detemir.", "Three weeks later, she presents with generalized weakness, walking difficulty, and hand tremors.", "Physical examination reveals bilateral hand tremors, cogwheel rigidity, and bradykinesia.", "She is walking with small narrow steps and reduced arm swing.", "Today her random serum glucose is 150 mg/dL.", "Her symptoms are presumed to be caused by a drug."], "context_len": 11, "options": {"A": "Atorvastatin", "B": "Metoclopramide", "C": "Ramipril", "D": "Acetaminophen"}, "answer": "Metoclopramide", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "64", "specialties": ["Internal Medicine", "Rheumatology"], "subspecialties": ["Rheumatology", "General Rheumatology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 64-year-old woman presented to the community health clinic.", "2. She was complaining of nausea, bloating, pain in both knees, and a burning sensation in her feet.", "3. She has recently immigrated to the United States.", "4. She was previously diagnosed with diabetes mellitus, hypertension, and osteoarthritis.", "5. No medical records are currently available.", "6. She has stopped taking her medication since immigrating.", "7. She recalls being on insulin but cannot recall the dosage or the specific type.", "8. Her blood pressure is 172/120 mm Hg.", "9. Her heart rate is 95/min.", "10. Her respiratory rate is 15/min.", "11. Her temperature is 37.0\u00b0C (98.6\u00b0F).", "12. Her random serum glucose is 364 mg/dL.", "13. She is started on atorvastatin, amlodipine, ramipril, aspirin, duloxetine, metoclopramide, acetaminophen, and insulin detemir.", "14. Three weeks later, she presents with generalized weakness, walking difficulty, and hand tremors.", "15. Physical examination reveals bilateral hand tremors, cogwheel rigidity, and bradykinesia.", "16. She is walking with small narrow steps and reduced arm swing.", "17. Today her random serum glucose is 150 mg/dL.", "18. Her symptoms are presumed to be caused by a drug."], "atomic_facts": ["1. She has recently immigrated to the United States.", "2. She was previously diagnosed with diabetes mellitus, hypertension, and osteoarthritis.", "3. No medical records are currently available.", "4. She has stopped taking her medication since immigrating.", "5. She recalls being on insulin but cannot recall the dosage or the specific type.", "6. She has a blood pressure of 172/120 mm Hg.", "7. Her heart rate is 95/min.", "8. Her respiratory rate is 15/min.", "9. Her temperature is 37.0\u00b0C (98.6\u00b0F).", "10. Her random serum glucose is 364 mg/dL.", "11. She is started on atorvastatin, amlodipine, ramipril, aspirin, duloxetine, metoclopramide, acetaminophen, and insulin detemir.", "12. Three weeks later, she presents with generalized weakness, walking difficulty, and hand tremors.", "13. Physical examination reveals bilateral hand tremors, cogwheel rigidity, and bradykinesia.", "14. She is walking with small narrow steps and reduced arm swing.", "15. Today her random serum glucose is 150 mg/dL.", "16. Her symptoms are presumed to be caused by a drug."]}
{"id": 1121, "question": "This patient most likely has an injury to which of the following muscle tendons?", "context": ["A 51-year-old man presents to the emergency room after being the victim of a robbery and assault.", "He was walking down an alley when he was approached by a stranger with a knife.", "Upon resisting, the stranger stabbed the patient\u2019s right distal forearm before stealing his wallet and evading the scene.", "The patient was able to call an ambulance and has remained conscious despite mild bleeding from the injury site.", "He reports severe pain in his forearm and an inability to move his 2nd and 3rd fingers.", "He has no medical conditions and takes no medications.", "He is allergic to penicillin and ibuprofen.", "On exam, the patient is able to flex the proximal interphalangeal (PIP) joints of his 2nd through 5th fingers.", "When the PIP joints of his 2nd through 5th fingers are restrained by the examiner, flexion is noted at the DIP joints of the 4th and 5th fingers but not the 2nd and 3rd digits.", "Thumb flexion at the metacarpophalangeal (MCP) joint and interphalangeal (IP) joint is preserved.", "Sensation is intact over the palmar and dorsal aspects of the radial and ulnar hand."], "context_len": 11, "options": {"A": "Flexor digitorum longus", "B": "Flexor digitorum profundus", "C": "Flexor digitorum superficialis", "D": "Flexor pollicis longus"}, "answer": "Flexor digitorum profundus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "51 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 51-year-old man presents to the emergency room.", "2. He was the victim of a robbery and assault.", "3. He was walking down an alley when he was approached by a stranger with a knife.", "4. Upon resisting, the stranger stabbed the patient\u2019s right distal forearm.", "5. The stranger stole the patient's wallet and evaded the scene.", "6. The patient was able to call an ambulance.", "7. The patient has remained conscious.", "8. The patient has mild bleeding from the injury site.", "9. The patient reports severe pain in his forearm.", "10. The patient reports an inability to move his 2nd and 3rd fingers.", "11. The patient has no medical conditions.", "12. The patient takes no medications.", "13. The patient is allergic to penicillin.", "14. The patient is allergic to ibuprofen.", "15. On exam, the patient is able to flex the proximal interphalangeal (PIP) joints of his 2nd through 5th fingers.", "16. When the PIP joints of his 2nd through 5th fingers are restrained by the examiner, flexion is noted at the DIP joints of the 4th and 5th fingers but not the 2nd and 3rd digits.", "17. Thumb flexion at the metacarpophalangeal (MCP) joint and interphalangeal (IP) joint is preserved.", "18. Sensation is intact over the palmar and dorsal aspects of the radial and ulnar hand."], "atomic_facts": ["1. Patient was walking down an alley.", "2. Patient was approached by a stranger with a knife.", "3. Stranger stabbed the patient\u2019s right distal forearm.", "4. Stranger stole the patient's wallet and evaded the scene.", "5. Patient was able to call an ambulance.", "6. Patient has remained conscious despite mild bleeding from the injury site.", "7. Patient reports severe pain in his forearm.", "8. Patient reports an inability to move his 2nd and 3rd fingers.", "9. Patient has no medical conditions.", "10. Patient takes no medications.", "11. Patient is allergic to penicillin and ibuprofen.", "12. On exam, the patient is able to flex the PIP joints of his 2nd through 5th fingers.", "13. When the PIP joints of his 2nd through 5th fingers are restrained by the examiner, flexion is noted at the DIP joints of the 4th and 5th fingers but not the 2nd and 3rd digits.", "14. Thumb flexion at the MCP joint and IP joint is preserved.", "15. Sensation is intact over the palmar and dorsal aspects of the radial and ulnar hand."]}
{"id": 1122, "question": "Which of the following natural substances are most similar to the concentration profiles of drug X and drug Y in the proximal tubule?", "context": ["Researchers develop a drug X that acts on the loop of Henle but discover that it does not reach its intended site of action within the nephron.", "It is freely filtered but rapidly disappears from the proximal tubule.", "They modify several of the chemical properties of drug X to produce drug Y, which cannot be reabsorbed from the proximal tubule."], "context_len": 3, "options": {"A": "Drug X: creatinine; Drug Y: glucose", "B": "Drug X: glucose; Drug Y: creatinine", "C": "Drug X: glucose; Drug Y: potassium", "D": "Drug X: potassium; Drug Y: creatinine"}, "answer": "Drug X: glucose; Drug Y: creatinine", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Nephrology"], "subspecialties": ["General Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Researchers develop a drug X.", "2. Drug X acts on the loop of Henle.", "3. Drug X does not reach its intended site of action within the nephron.", "4. Drug X is freely filtered.", "5. Drug X rapidly disappears from the proximal tubule.", "6. Researchers modify several of the chemical properties of drug X.", "7. Drug X is modified to produce drug Y.", "8. Drug Y cannot be reabsorbed from the proximal tubule."], "atomic_facts": ["1. Drug X is modified by a process to produce drug Y.", "2. Drug Y cannot be reabsorbed from the proximal tubule.", "3. Drug X is freely filtered.", "4. Drug X rapidly disappears from the proximal tubule."]}
{"id": 1123, "question": "Which of the following is the most likely causal organism?", "context": ["A 66-year-old woman comes to the emergency department because of fever and difficulty swallowing for 5 hours.", "She appears anxious.", "Her temperature is 39.1\u00b0C (102.4\u00b0F).", "Physical examination shows an extended neck and excessive drooling.", "Her voice is muffled and there is inspiratory stridor.", "There is tender bilateral cervical lymphadenopathy and pain upon palpation of the hyoid.", "Laboratory studies show a leukocyte count of 18,800/mm3 with 85% neutrophils."], "context_len": 7, "options": {"A": "Haemophilus influenzae type b", "B": "Streptococcus pyogenes", "C": "Corynebacterium diphtheriae", "D": "Parainfluenza virus\n\""}, "answer": "Haemophilus influenzae type b", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "66 years old", "specialties": ["Otolaryngology", "Internal Medicine", "Pediatrics"], "subspecialties": ["General Otolaryngology", "Pediatric Infectious Diseases", "Infectious Disease"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 66-year-old woman comes to the emergency department.", "2. She has had fever and difficulty swallowing for 5 hours.", "3. She appears anxious.", "4. Her temperature is 39.1\u00b0C (102.4\u00b0F).", "5. Physical examination shows an extended neck and excessive drooling.", "6. Her voice is muffled.", "7. There is inspiratory stridor.", "8. There is tender bilateral cervical lymphadenopathy.", "9. There is pain upon palpation of the hyoid.", "10. Laboratory studies show a leukocyte count of 18,800/mm3.", "11. Laboratory studies show 85% neutrophils."], "atomic_facts": ["1. She appears anxious.", "2. Her temperature is 39.1\u00b0C (102.4\u00b0F).", "3. Physical examination shows an extended neck and excessive drooling.", "4. Her voice is muffled and there is inspiratory stridor.", "5. There is tender bilateral cervical lymphadenopathy.", "6. There is pain upon palpation of the hyoid.", "7. Laboratory studies show a leukocyte count of 18,800/mm3.", "8. The leukocyte count shows 85% neutrophils."]}
{"id": 1124, "question": "What is the cause of the persistent symptoms?", "context": ["A 65-year-old man with a history of coronary artery disease presents to your office complaining of ongoing chest pain with exertion.", "The patient has had a recent cardiac work-up that showed no areas of acute ischemia.", "At the last visit, the patient was prescribed sublingual nitroglycerin for symptom relief of stable angina.", "On further questioning, the patient states that he has been swallowing the tablet whole instead of allowing it to dissolve because he \u201cdoes not like the taste\u201d."], "context_len": 4, "options": {"A": "Nitroglycerin tolerance", "B": "Unstable angina", "C": "First pass metabolism of nitroglycerin", "D": "Concomitant use of sildenafil"}, "answer": "First pass metabolism of nitroglycerin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Cardiology"], "subspecialties": ["Interventional Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old man presents to the office.", "2. The patient has a history of coronary artery disease.", "3. The patient is complaining of chest pain with exertion.", "4. The patient had a recent cardiac work-up that showed no areas of acute ischemia.", "5. At the last visit, the patient was prescribed sublingual nitroglycerin.", "6. The patient has been swallowing the tablet whole instead of allowing it to dissolve.", "7. The patient does not like the taste of the nitroglycerin."], "atomic_facts": ["1. The patient had a recent cardiac work-up.", "2. The cardiac work-up showed no areas of acute ischemia.", "3. At the last visit, the patient was prescribed sublingual nitroglycerin.", "4. The nitroglycerin was prescribed for symptom relief of stable angina.", "5. The patient has been swallowing the nitroglycerin tablet whole.", "6. The patient has not been allowing the tablet to dissolve.", "7. The reason for not allowing the tablet to dissolve is that the patient does not like the taste."]}
{"id": 1125, "question": "Which of the following is the most likely pathogen?", "context": ["A 5-year-old boy is brought to the physician by his mother because of a 3-day history of low-grade fever and sore throat.", "This morning, she noticed a rash on his buttocks, hands, and feet.", "He does not have pruritus.", "His temperature is 38.3\u00b0C (100.9\u00b0F), pulse is 99/min, and blood pressure is 123/78 mm Hg.", "Physical examination shows oral vesicles.", "A photograph of the rash on the feet is shown."], "context_len": 6, "options": {"A": "Herpes simplex virus 1", "B": "Coxsackie A virus", "C": "Parvovirus B19", "D": "Epstein-Barr virus"}, "answer": "Coxsackie A virus", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "5 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 5-year-old boy is brought to the physician by his mother.", "2. He has a 3-day history of low-grade fever and sore throat.", "3. This morning, his mother noticed a rash on his buttocks, hands, and feet.", "4. He does not have pruritus.", "5. His temperature is 38.3\u00b0C (100.9\u00b0F).", "6. His pulse is 99/min.", "7. His blood pressure is 123/78 mm Hg.", "8. Physical examination shows oral vesicles.", "9. A photograph of the rash on the feet is shown."], "atomic_facts": ["1. She noticed a rash on his buttocks, hands, and feet.", "2. He does not have pruritus.", "3. His temperature is 38.3\u00b0C (100.9\u00b0F).", "4. His pulse is 99/min.", "5. His blood pressure is 123/78 mm Hg.", "6. Physical examination shows oral vesicles.", "7. A photograph of the rash on the feet is shown."]}
{"id": 1126, "question": "Which of the following is the most likely diagnosis?", "context": ["An 8-year-old African-American male is found to have a holosystolic, harsh-sounding murmur upon physical examination.", "The murmur is best appreciated at the left sternal border, and is found to be louder when the patient squats."], "context_len": 2, "options": {"A": "Ventricular septal defect", "B": "Patent ductus arteriosus", "C": "Atrial septal defect", "D": "Tricuspid atresia"}, "answer": "Ventricular septal defect", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 8-year-old African-American male is found to have a holosystolic, harsh-sounding murmur.", "2. The murmur is best appreciated at the left sternal border.", "3. The murmur is louder when the patient squats."], "atomic_facts": ["1. The murmur is best appreciated at the left sternal border.", "2. The murmur is found to be louder when the patient squats."]}
{"id": 1127, "question": "What is the most likely explanation for this patient\u2019s presentation?", "context": ["A 29-year-old G1P0 woman at 32 weeks of gestation comes to the emergency department complaining of vaginal bleeding for the past hour.", "She noticed some blood on the toilet paper when she went to the bathroom an hour ago, but now she is bleeding through her underwear.", "She denies any trauma, pain, abnormal discharge or odor, fever, or recent infections.", "The patient mentioned that that during her last ultrasound, the doctor told her that, \u201cthere\u2019s an abnormality but not to worry,\u201d but she can\u2019t remember the name of the condition.", "Her temperature is 100.1\u00b0F (37.8\u00b0C), blood pressure is 120/70 mmHg, pulse is 86/min, and respirations are 15/min .", "A fetal heart tracing is obtained and shows a fetal heart rate of 130-140, long-term variability, and appropriate accelerations."], "context_len": 6, "options": {"A": "Abnormal placental spiral artery development", "B": "Attachment of the placenta to the lower placental segment over the internal os", "C": "Cystic swelling of chorionic villi and trophoblast proliferation", "D": "Fetal vessels in close proximity to the cervical os"}, "answer": "Attachment of the placenta to the lower placental segment over the internal os", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "29 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Placenta Previa", "General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 29-year-old G1P0 woman.", "2. Patient is 32 weeks of gestation.", "3. Patient is complaining of vaginal bleeding for the past hour.", "4. Patient noticed some blood on the toilet paper an hour ago.", "5. Patient is now bleeding through her underwear.", "6. Patient denies any trauma, pain, abnormal discharge or odor, fever, or recent infections.", "7. Patient mentioned that during her last ultrasound, the doctor told her that \u201cthere\u2019s an abnormality but not to worry,\u201d but she can\u2019t remember the name of the condition.", "8. Patient's temperature is 100.1\u00b0F (37.8\u00b0C).", "9. Patient's blood pressure is 120/70 mmHg.", "10. Patient's pulse is 86/min.", "11. Patient's respirations are 15/min.", "12. Fetal heart tracing shows a fetal heart rate of 130-140.", "13. Fetal heart tracing shows long-term variability.", "14. Fetal heart tracing shows appropriate accelerations."], "atomic_facts": ["1. She noticed blood on the toilet paper an hour ago.", "2. She is bleeding through her underwear.", "3. She denies trauma, pain, abnormal discharge, odor, fever, or recent infections.", "4. During her last ultrasound, the doctor mentioned an abnormality but told her not to worry.", "5. She can't remember the name of the condition mentioned during the ultrasound.", "6. Her temperature is 100.1\u00b0F (37.8\u00b0C).", "7. Her blood pressure is 120/70 mmHg.", "8. Her pulse is 86/min.", "9. Her respirations are 15/min.", "10. A fetal heart tracing shows a fetal heart rate of 130-140, long-term variability, and appropriate accelerations."]}
{"id": 1128, "question": "Which of the following is the most likely diagnosis?", "context": ["A 55-year-old woman comes to the office complaining of a dry mouth for the past few months.", "She has to drink water more frequently, as she finds it difficult to chew and swallow solid foods.", "She has to wake up 3\u20135 times each night to drink due to intense thirst.", "She also complains of a foreign body sensation in both the eyes for the past month.", "She has had no joint pain, fever, weight loss, or urinary or bowel changes.", "She does not smoke cigarettes but drinks alcohol socially.", "Her mother has rheumatoid arthritis for which she takes methotrexate, and her father died of prostatic carcinoma 7 years ago.", "Her temperature is 36.7\u00b0C (98\u00b0F), blood pressure is 130/75 mm Hg, pulse is 80/min, respirations are 14/min, and BMI is 28 kg/m2.", "On examination, the eyes and oral cavity appear dry, and dental caries are present.", "No lymphadenopathy is noted.", "Cardiopulmonary and abdominal examinations are negative.", "Laboratory results are shown below: | Complete blood count: | Hemoglobin 10 g/dL | Leukocytes   13,500/mm3 | Platelets 170,000/mm3 | ESR 65 mm/hr |    Antinuclear antibody Positive | Rheumatoid factor Positive | Anti dsDNA Negative | Anti Ro Positive | Anti-CCP Negative | Anti Jo 1   Negative | ."], "context_len": 12, "options": {"A": "Rheumatoid arthritis", "B": "Systemic lupus erythematosus", "C": "Primary Sjogren\u2019s syndrome", "D": "Polymyositis"}, "answer": "Primary Sjogren\u2019s syndrome", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "55", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 55-year-old woman comes to the office complaining of a dry mouth for the past few months.", "2. She has to drink water more frequently, as she finds it difficult to chew and swallow solid foods.", "3. She has to wake up 3\u20135 times each night to drink due to intense thirst.", "4. She also complains of a foreign body sensation in both the eyes for the past month.", "5. She has had no joint pain, fever, weight loss, or urinary or bowel changes.", "6. She does not smoke cigarettes but drinks alcohol socially.", "7. Her mother has rheumatoid arthritis for which she takes methotrexate.", "8. Her father died of prostatic carcinoma 7 years ago.", "9. Her temperature is 36.7\u00b0C (98\u00b0F), blood pressure is 130/75 mm Hg, pulse is 80/min, respirations are 14/min, and BMI is 28 kg/m2.", "10. On examination, the eyes and oral cavity appear dry, and dental caries are present.", "11. No lymphadenopathy is noted.", "12. Cardiopulmonary and abdominal examinations are negative.", "13. Laboratory results show a hemoglobin of 10 g/dL, leukocytes of 13,500/mm3, platelets of 170,000/mm3, and ESR of 65 mm/hr.", "14. Antinuclear antibody is positive.", "15. Rheumatoid factor is positive.", "16. Anti dsDNA is negative.", "17. Anti Ro is positive.", "18. Anti-CCP is negative.", "19. Anti Jo 1 is negative."], "atomic_facts": ["1. She has to drink water more frequently due to difficulty chewing and swallowing solid foods.", "2. She wakes up 3\u20135 times each night to drink due to intense thirst.", "3. She complains of a foreign body sensation in both eyes for the past month.", "4. She has had no joint pain, fever, weight loss, or urinary or bowel changes.", "5. She does not smoke cigarettes but drinks alcohol socially.", "6. Her mother has rheumatoid arthritis and takes methotrexate, and her father died of prostatic carcinoma 7 years ago.", "7. Her temperature is 36.7\u00b0C (98\u00b0F), blood pressure is 130/75 mm Hg, pulse is 80/min, respirations are 14/min, and BMI is 28 kg/m2.", "8. On examination, the eyes and oral cavity appear dry, and dental caries are present.", "9. No lymphadenopathy is noted.", "10. Cardiopulmonary and abdominal examinations are negative.", "11. Laboratory results: Hemoglobin 10 g/dL, Leukocytes 13,500/mm3, Platelets 170,000/mm3, ESR 65 mm/hr, Antinuclear antibody Positive, Rheumatoid factor Positive, Anti dsDNA Negative, Anti Ro Positive, Anti-CCP Negative, Anti Jo 1 Negative."]}
{"id": 1129, "question": "Which of the following is the most likely underlying cause of this patient\u2019s condition?", "context": ["A 42-year-old woman presents to the physician with chronic abdominal pain.", "She was initially diagnosed with an ulcer in the 2nd part of the duodenum and severe esophagitis 6 years ago.", "Despite confirmed H.", "pylori eradication and long-term therapy with pantoprazole, she has had frequent recurrences of duodenal and gastric ulcers.", "The medical history is otherwise unremarkable.", "She is a 10 pack-year smoker and consumes alcohol regularly.", "Her father had severe gastric ulcer disease.", "The vital signs are within normal limits.", "The body mass index is 19 kg/m2.", "Mild epigastric tenderness is noted on deep palpation of the epigastrium.", "The laboratory studies show the following: | Laboratory test | Hemoglobin 10 g/dL | Mean corpuscular volume 75 \u03bcm3 | Leukocyte count 7500/mm3 with a normal differential | Serum   | Na+ 145 mEq/L | K+ 4.5 mEq/L | Ca+ 9.5 mg/dL | Phosphorus 4 mg/dL | Urea nitrogen 18 mg/dL | Creatinine 1.0 mg/dL | ."], "context_len": 11, "options": {"A": "Chronic alcohol consumption", "B": "Gastrin-secreting tumor", "C": "Primary hyperparathyroidism", "D": "Tobacco use"}, "answer": "Gastrin-secreting tumor", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 42-year-old woman presents to the physician with chronic abdominal pain.", "2. She was initially diagnosed with an ulcer in the 2nd part of the duodenum and severe esophagitis 6 years ago.", "3. Despite confirmed H. pylori eradication and long-term therapy with pantoprazole, she has had frequent recurrences of duodenal and gastric ulcers.", "4. The medical history is otherwise unremarkable.", "5. She is a 10 pack-year smoker and consumes alcohol regularly.", "6. Her father had severe gastric ulcer disease.", "7. The vital signs are within normal limits.", "8. The body mass index is 19 kg/m2.", "9. Mild epigastric tenderness is noted on deep palpation of the epigastrium.", "10. The laboratory studies show the following: Hemoglobin 10 g/dL.", "11. The laboratory studies show the following: Mean corpuscular volume 75 \u03bcm3.", "12. The laboratory studies show the following: Leukocyte count 7500/mm3 with a normal differential.", "13. The laboratory studies show the following: Serum Na+ 145 mEq/L.", "14. The laboratory studies show the following: Serum K+ 4.5 mEq/L.", "15. The laboratory studies show the following: Serum Ca+ 9.5 mg/dL.", "16. The laboratory studies show the following: Serum Phosphorus 4 mg/dL.", "17. The laboratory studies show the following: Serum Urea nitrogen 18 mg/dL.", "18. The laboratory studies show the following: Serum Creatinine 1.0 mg/dL."], "atomic_facts": ["1. The patient was initially diagnosed with an ulcer in the 2nd part of the duodenum and severe esophagitis 6 years ago.", "2. Despite confirmed H. pylori eradication and long-term therapy with pantoprazole, she has had frequent recurrences of duodenal and gastric ulcers.", "3. The medical history is otherwise unremarkable.", "4. She is a 10 pack-year smoker and consumes alcohol regularly.", "5. Her father had severe gastric ulcer disease.", "6. The vital signs are within normal limits.", "7. The body mass index is 19 kg/m2.", "8. Mild epigastric tenderness is noted on deep palpation of the epigastrium.", "9. Laboratory test results: Hemoglobin 10 g/dL, Mean corpuscular volume 75 \u03bcm3, Leukocyte count 7500/mm3 with a normal differential, Serum Na+ 145 mEq/L, K+ 4.5 mEq/L, Ca+ 9.5 mg/dL, Phosphorus 4 mg/dL, Urea nitrogen 18 mg/dL, Creatinine 1.0 mg/dL."]}
{"id": 1130, "question": "What imaging finding would you expect in this patient?", "context": ["A 33-year-old woman comes to the emergency department for severe abdominal pain for the past hour.", "The pain is 10/10, stabbing, and concentrated around the epigastric region with radiation to the back.", "She had 2 episodes of emesis and complains of nausea.", "She has had multiple similar episodes over the past 3 months which are not correlated with oral intake.", "She denies fever, weight changes, headaches, palpitations, bowel changes, or chest pain, but endorses nausea and stool that is hard to flush.", "Her medical history is significant for diabetes that is controlled with metformin.", "Her surgical history is significant for an elective cesarean section 5 years ago.", "She is currently sexually active with contraceptive use."], "context_len": 8, "options": {"A": "Gallbladder thickening and presence of cholelithiasis on ultrasound", "B": "Increase in appendicular diameter and fat stranding on computer tomography (CT)", "C": "Lack of an intrauterine pregnancy on ultrasound", "D": "Multiple pancreatic calcifications on CT"}, "answer": "Multiple pancreatic calcifications on CT", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "33 years old", "specialties": ["Radiology"], "subspecialties": ["General Radiology", "Abdominal Radiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 33-year-old woman comes to the emergency department for severe abdominal pain.", "2. The pain is 10/10, stabbing, and concentrated around the epigastric region with radiation to the back.", "3. She had 2 episodes of emesis and complains of nausea.", "4. She has had multiple similar episodes over the past 3 months which are not correlated with oral intake.", "5. She denies fever, weight changes, headaches, palpitations, bowel changes, or chest pain.", "6. She endorses nausea and stool that is hard to flush.", "7. Her medical history is significant for diabetes that is controlled with metformin.", "8. Her surgical history is significant for an elective cesarean section 5 years ago.", "9. She is currently sexually active with contraceptive use."], "atomic_facts": ["1. The pain is 10/10, stabbing, and concentrated around the epigastric region with radiation to the back.", "2. She had 2 episodes of emesis and complains of nausea.", "3. She has had multiple similar episodes over the past 3 months which are not correlated with oral intake.", "4. She denies fever, weight changes, headaches, palpitations, bowel changes, or chest pain, but endorses nausea and stool that is hard to flush.", "5. Her medical history is significant for diabetes that is controlled with metformin.", "6. Her surgical history is significant for an elective cesarean section 5 years ago.", "7. She is currently sexually active with contraceptive use."]}
{"id": 1131, "question": "This patient\u2019s symptoms are most likely attributable to which of the following medications?", "context": ["A 37-year-old female presents to her primary care provider for a normal follow-up visit.", "Her past medical history is notable for poorly controlled type II diabetes mellitus despite good treatment adherence to oral medications.", "She has been trialed on metformin and glyburide but stopped them due to rapid weight gain, respectively.", "She was started on a new oral diabetes medication three months ago.", "Since starting the new medication, she has noticed slowly progressive swelling in her lower extremities.", "Her temperature is 99.2\u00b0F (37.3\u00b0C), blood pressure is 120/75 mmHg, pulse is 105/min, and respirations are 22/min.", "She has gained 10 pounds since her last visit.", "Physical examination reveals 1+ pitting edema in the bilateral legs.", "A hemoglobin A1c lab test is drawn."], "context_len": 9, "options": {"A": "Glipizide", "B": "Exenatide", "C": "Pioglitazone", "D": "Acarbose"}, "answer": "Pioglitazone", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "37", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 37-year-old female.", "2. Patient is presenting for a normal follow-up visit.", "3. Patient has a past medical history of poorly controlled type II diabetes mellitus.", "4. Patient has been adherent to oral medications.", "5. Patient was trialed on metformin and glyburide but stopped due to rapid weight gain.", "6. Patient was started on a new oral diabetes medication three months ago.", "7. Patient has noticed slowly progressive swelling in her lower extremities since starting the new medication.", "8. Patient's temperature is 99.2\u00b0F (37.3\u00b0C).", "9. Patient's blood pressure is 120/75 mmHg.", "10. Patient's pulse is 105/min.", "11. Patient's respirations are 22/min.", "12. Patient has gained 10 pounds since her last visit.", "13. Physical examination reveals 1+ pitting edema in the bilateral legs.", "14. A hemoglobin A1c lab test is drawn."], "atomic_facts": ["1. Her past medical history includes poorly controlled type II diabetes mellitus.", "2. Despite good treatment adherence to oral medications, her diabetes is poorly controlled.", "3. She has been trialed on metformin.", "4. She has been trialed on glyburide.", "5. She stopped metformin due to rapid weight gain.", "6. She stopped glyburide due to rapid weight gain.", "7. She was started on a new oral diabetes medication three months ago.", "8. Since starting the new medication, she has noticed slowly progressive swelling in her lower extremities.", "9. Her temperature is 99.2\u00b0F (37.3\u00b0C).", "10. Her blood pressure is 120/75 mmHg.", "11. Her pulse is 105/min.", "12. Her respirations are 22/min.", "13. She has gained 10 pounds since her last visit.", "14. Physical examination reveals 1+ pitting edema in the bilateral legs.", "15. A hemoglobin A1c lab test is drawn."]}
{"id": 1132, "question": "The nerve that was most likely injured in the surgery originates from which of the following spinal roots?", "context": ["A 21-year-old woman comes to the physician for a follow-up examination.", "Four months ago, she underwent posterior arthrodesis for thoracolumbar scoliosis.", "She has recovered well from the surgery but noticed difficulties combing her hair with her right hand.", "A photograph of the patient's back is shown."], "context_len": 4, "options": {"A": "C6-C8", "B": "C1-C3", "C": "T2-T5", "D": "C5\u2013C7"}, "answer": "C5\u2013C7", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "21", "specialties": ["Neurological Surgery", "Neurology"], "subspecialties": ["General Neurological Surgery", "General Neurology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 21-year-old woman comes to the physician for a follow-up examination.", "2. Four months ago, she underwent posterior arthrodesis for thoracolumbar scoliosis.", "3. She has recovered well from the surgery.", "4. She noticed difficulties combing her hair with her right hand.", "5. A photograph of the patient's back is shown."], "atomic_facts": ["1. Four months ago, she underwent posterior arthrodesis.", "2. The surgery was for thoracolumbar scoliosis.", "3. She has recovered well from the surgery.", "4. She noticed difficulties combing her hair with her right hand.", "5. A photograph of the patient's back is shown."]}
{"id": 1133, "question": "What must she have been exposed to at the party that led to such a dramatic side effect?", "context": ["A 45-year-old female is brought by ambulance to your emergency room after complaining of shortness of breath along with profuse sweating at a company social function.", "Her vitals were notable for elevated blood pressure with a normal exam and a stable electrocardiogram.", "She has been seeing a psychiatrist recently for her depression and was prescribed phenelzine after failing treatment with a first-line antidepressant therapy."], "context_len": 3, "options": {"A": "Norepinephrine", "B": "Tyramine", "C": "Gluten", "D": "Dopamine"}, "answer": "Tyramine", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "45", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine", "Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 45-year-old female was brought to the emergency room by ambulance.", "2. She was complaining of shortness of breath and profuse sweating at a company social function.", "3. Her vitals showed elevated blood pressure.", "4. Her physical exam was normal.", "5. Her electrocardiogram was stable.", "6. She has been seeing a psychiatrist recently for depression.", "7. She was prescribed phenelzine after failing treatment with a first-line antidepressant therapy."], "atomic_facts": ["1. Her vitals were notable for elevated blood pressure.", "2. Her exam was normal.", "3. Her electrocardiogram was stable.", "4. She has been seeing a psychiatrist recently for her depression.", "5. She was prescribed phenelzine.", "6. She failed treatment with a first-line antidepressant therapy."]}
{"id": 1134, "question": "Which of the following would most likely be expected for this patient's prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time?", "context": ["A 3-day-old female infant is brought by her mother to the pediatrician\u2019s office.", "The patient\u2019s mother says she has been noticing bruising on her child\u2019s arms and some blood in her diapers.", "The infant was born at home after the mother received normal prenatal care.", "The patient has been exclusively breastfed since birth and is gaining weight appropriately.", "On exam, multiple ecchymoses are noted throughout the patient\u2019s torso and extremities.", "The patient is lethargic with a large, full anterior fontanelle.", "On examination of the diaper, some dried blood mixed with a small amount of stool is noted."], "context_len": 7, "options": {"A": "PT normal, aPTT normal, bleeding time normal", "B": "PT increased, aPTT normal, bleeding time normal", "C": "PT normal, aPTT normal, bleeding time increased", "D": "PT normal, aPTT increased, bleeding time normal"}, "answer": "PT increased, aPTT normal, bleeding time normal", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "3 days old", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 3-day-old female infant is brought by her mother to the pediatrician\u2019s office.", "2. The patient\u2019s mother says she has been noticing bruising on her child\u2019s arms.", "3. The patient\u2019s mother says she has been noticing some blood in her diapers.", "4. The infant was born at home.", "5. The mother received normal prenatal care.", "6. The patient has been exclusively breastfed since birth.", "7. The patient is gaining weight appropriately.", "8. On exam, multiple ecchymoses are noted throughout the patient\u2019s torso and extremities.", "9. The patient is lethargic.", "10. The patient has a large, full anterior fontanelle.", "11. On examination of the diaper, some dried blood mixed with a small amount of stool is noted."], "atomic_facts": ["1. The patient's mother has been noticing bruising on her child's arms.", "2. The patient's mother has been noticing some blood in her child's diapers.", "3. The infant was born at home.", "4. The mother received normal prenatal care.", "5. The patient has been exclusively breastfed since birth.", "6. The patient is gaining weight appropriately.", "7. On exam, multiple ecchymoses are noted throughout the patient's torso and extremities.", "8. The patient is lethargic.", "9. The patient has a large, full anterior fontanelle.", "10. On examination of the diaper, dried blood mixed with a small amount of stool is noted."]}
{"id": 1135, "question": "The signal responsible for the elevated levels of these proteins was most likely secreted by which of the following cells?", "context": ["A 53-year-old woman comes to see her primary care physician because she has had fever and malaise for two days.", "She was in her usual state of health until three days ago when she began to feel tired in the evening and decided to go to bed early.", "The next day she developed a fever, productive cough, chills, and malaise.", "She is otherwise healthy with no chronic conditions and lives by herself with two cats.", "She smokes one pack of cigarettes per day and drinks alcohol socially.", "On physical exam, she is found to have increased dullness to percussion at the lung bases and blood work is obtained showing elevated levels of C-reactive protein and hepcidin."], "context_len": 6, "options": {"A": "Macrophages", "B": "Neutrophils", "C": "Regulatory T-cells", "D": "Type 2 helper T-cells"}, "answer": "Macrophages", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "53", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 53-year-old woman comes to see her primary care physician.", "2. She has had fever and malaise for two days.", "3. She was in her usual state of health until three days ago.", "4. She began to feel tired in the evening and decided to go to bed early.", "5. The next day she developed a fever, productive cough, chills, and malaise.", "6. She is otherwise healthy with no chronic conditions.", "7. She lives by herself with two cats.", "8. She smokes one pack of cigarettes per day.", "9. She drinks alcohol socially.", "10. On physical exam, she is found to have increased dullness to percussion at the lung bases.", "11. Blood work is obtained showing elevated levels of C-reactive protein and hepcidin."], "atomic_facts": ["1. She was in her usual state of health until three days ago", "2. Three days ago she began to feel tired in the evening", "3. She decided to go to bed early", "4. The next day she developed a fever", "5. The next day she developed a productive cough", "6. The next day she developed chills", "7. The next day she developed malaise", "8. She is otherwise healthy", "9. She has no chronic conditions", "10. She lives by herself", "11. She lives with two cats", "12. She smokes one pack of cigarettes per day", "13. She drinks alcohol socially", "14. On physical exam, she is found to have increased dullness to percussion at the lung bases", "15. Blood work is obtained showing elevated levels of C-reactive protein", "16. Blood work is obtained showing elevated levels of hepcidin"]}
{"id": 1136, "question": "Which of the following is the most likely causal organism?", "context": ["Three weeks after undergoing transurethral prostate resection for benign prostatic hyperplasia, a 70-year-old man has fever, malaise, and pain in his extremities.", "Physical examination shows subungal petechiae and tender red papules on his fingers and toes.", "A new holosystolic murmur is heard on chest auscultation.", "A photomicrograph of a Gram stain of an isolate from blood culture is shown.", "The organism does not cause hemolysis on blood agar.", "Addition of pyrrolidonyl-\u03b2-naphthylamide gives the bacterial colonies a cherry red color."], "context_len": 6, "options": {"A": "Enterococcus faecalis", "B": "Streptococcus gallolyticus", "C": "Cardiobacterium hominis", "D": "Staphylococcus epidermidis"}, "answer": "Enterococcus faecalis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Infectious Disease", "In this case, the most relevant specialty would be Infectious Disease", "Internal Medicine"], "subspecialties": ["General Infectious Disease", "Infectious Disease", "General Infectious Disease."], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 70-year-old man underwent transurethral prostate resection for benign prostatic hyperplasia three weeks ago.", "2. The man has fever, malaise, and pain in his extremities.", "3. Physical examination shows subungal petechiae and tender red papules on his fingers and toes.", "4. A new holosystolic murmur is heard on chest auscultation.", "5. A photomicrograph of a Gram stain of an isolate from blood culture is shown.", "6. The organism does not cause hemolysis on blood agar.", "7. Addition of pyrrolidonyl-\u03b2-naphthylamide gives the bacterial colonies a cherry red color."], "atomic_facts": ["1. Physical examination shows subungal petechiae.", "2. Physical examination shows tender red papules on fingers and toes.", "3. A new holosystolic murmur is heard on chest auscultation.", "4. A photomicrograph of a Gram stain of an isolate from blood culture is shown.", "5. The organism does not cause hemolysis on blood agar.", "6. Addition of pyrrolidonyl-\u03b2-naphthylamide gives the bacterial colonies a cherry red color."]}
{"id": 1137, "question": "What is the mechanism of action of the medication received by the patient?", "context": ["An 85-year-old woman is brought to her primary care provider by her son for a checkup.", "She is feeling well with no major complaints.", "Her son is concerned that she has been bruising much more easily over the last week or two.", "Past medical history is significant for hypertension, hyperlipidemia, and a urinary tract infection that was successfully treated with an extended course of oral cephalexin 3 weeks ago.", "Family history is noncontributory.", "Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 125/85 mm Hg, and temperature is 36.7\u00b0C (98.1\u00b0F).", "On physical exam, her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally.", "She has some poorly demarcated purple-yellow bruising and areas of dark purple bruising as well.", "Further analysis reveals a prolonged PT that corrects with mixing, normal liver function tests, and a stool test that is guaiac positive.", "The physician administers an injection that should improve her condition and recommends further testing and a follow-up exam."], "context_len": 10, "options": {"A": "\u03b3-carboxylation of pancreatic enzymes", "B": "Protein C deficiency", "C": "Activation of 7-dehydrocholesterol by UV light", "D": "\u03b3-carboxylation of liver enzymes"}, "answer": "\u03b3-carboxylation of liver enzymes", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "85 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An 85-year-old woman is brought to her primary care provider by her son.", "2. She is feeling well with no major complaints.", "3. Her son is concerned that she has been bruising much more easily over the last week or two.", "4. Past medical history is significant for hypertension, hyperlipidemia, and a urinary tract infection.", "5. The urinary tract infection was successfully treated with an extended course of oral cephalexin 3 weeks ago.", "6. Family history is noncontributory.", "7. Today, her heart rate is 90/min.", "8. Today, her respiratory rate is 17/min.", "9. Today, her blood pressure is 125/85 mm Hg.", "10. Today, her temperature is 36.7\u00b0C (98.1\u00b0F).", "11. On physical exam, her heart has a regular rate and rhythm.", "12. On physical exam, her lungs are clear to auscultation bilaterally.", "13. She has some poorly demarcated purple-yellow bruising and areas of dark purple bruising as well.", "14. Further analysis reveals a prolonged PT that corrects with mixing.", "15. Further analysis reveals normal liver function tests.", "16. Further analysis reveals a stool test that is guaiac positive.", "17. The physician administers an injection that should improve her condition.", "18. The physician recommends further testing and a follow-up exam."], "atomic_facts": ["1. The patient is feeling well with no major complaints.", "2. Her son is concerned that she has been bruising much more easily over the last week or two.", "3. Past medical history includes hypertension, hyperlipidemia, and a urinary tract infection that was successfully treated with an extended course of oral cephalexin 3 weeks ago.", "4. Family history is noncontributory.", "5. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 125/85 mm Hg, and temperature is 36.7\u00b0C (98.1\u00b0F).", "6. On physical exam, her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally.", "7. She has some poorly demarcated purple-yellow bruising and areas of dark purple bruising as well.", "8. Further analysis reveals a prolonged PT that corrects with mixing, normal liver function tests, and a stool test that is guaiac positive.", "9. The physician administers an injection that should improve her condition and recommends further testing and a follow-up exam."]}
{"id": 1138, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 35-year-old man presents with loose stools and left lower quadrant abdominal pain.", "He says he passes 8\u201310 loose stools per day.", "The volume of each bowel movement is small and appears mucoid with occasional blood.", "The patient reports a 20-pack-year smoking history.", "He also says he recently traveled abroad about 3 weeks ago to Egypt.", "The vital signs include: blood pressure 120/76 mm Hg, pulse 74/min, and temperature 36.5\u00b0C (97.8\u00b0F).", "On physical examination, mild to moderate tenderness to palpation in the left lower quadrant with no rebound or guarding is present.", "Rectal examination shows the presence of perianal skin ulcers."], "context_len": 8, "options": {"A": "Amebiasis", "B": "Crohn\u2019s disease", "C": "Salmonellosis", "D": "Diverticulosis"}, "answer": "Amebiasis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "35", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 35-year-old man.", "2. Patient has loose stools and left lower quadrant abdominal pain.", "3. Patient passes 8-10 loose stools per day.", "4. Volume of each bowel movement is small and appears mucoid with occasional blood.", "5. Patient has a 20-pack-year smoking history.", "6. Patient recently traveled abroad to Egypt about 3 weeks ago.", "7. Blood pressure is 120/76 mm Hg.", "8. Pulse is 74/min.", "9. Temperature is 36.5\u00b0C (97.8\u00b0F).", "10. Physical examination shows mild to moderate tenderness to palpation in the left lower quadrant with no rebound or guarding.", "11. Rectal examination shows presence of perianal skin ulcers."], "atomic_facts": ["1. The patient reports passing 8\u201310 loose stools per day.", "2. The volume of each bowel movement is small and appears mucoid with occasional blood.", "3. The patient has a 20-pack-year smoking history.", "4. The patient recently traveled abroad about 3 weeks ago to Egypt.", "5. Vital signs: blood pressure 120/76 mm Hg, pulse 74/min, and temperature 36.5\u00b0C (97.8\u00b0F).", "6. On physical examination, mild to moderate tenderness to palpation in the left lower quadrant with no rebound or guarding is present.", "7. Rectal examination shows the presence of perianal skin ulcers."]}
{"id": 1139, "question": "Which of the following is responsible for producing the different isoforms of HNF4a?", "context": ["Hepatocyte nuclear factor 4 alpha (HNF4a) is a transcription factor that is found in the liver, pancreas, kidney, and intestines.", "The gene is composed of 11 exons and depending on the tissue there are different isoforms of the protein being expressed."], "context_len": 2, "options": {"A": "Addition of 7-methylguanosine cap", "B": "Addition of polyadenylated (poly-A) tail", "C": "Alternative splicing", "D": "DNA methylation"}, "answer": "Alternative splicing", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Medical Genetics and Genomics"], "subspecialties": ["General Medical Genetics and Genomics", "Clinical Genetics and Genomics"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. Hepatocyte nuclear factor 4 alpha (HNF4a) is a transcription factor.", "2. HNF4a is found in the liver, pancreas, kidney, and intestines.", "3. The gene for HNF4a is composed of 11 exons.", "4. Different isoforms of the HNF4a protein are expressed in different tissues."], "atomic_facts": ["1. The gene is composed of 11 exons.", "2. Depending on the tissue, there are different isoforms of the protein being expressed."]}
{"id": 1140, "question": "Which of the following is the most likely etiology of this patient\u2019s condition?", "context": ["A 50-year-old man presents for a routine examination.", "Past medical history is significant for cirrhosis secondary to hepatitis C virus (HCV) infection diagnosed 4 years ago and complicated by ascites.", "Current medications include furosemide 40 mg orally daily.", "Physical examination is unremarkable.", "Laboratory findings are significant for the following: | Laboratory test | Aspartate Aminotransferase (AST) 80 U/L | Alanine Aminotransferase (ALT) 50 U/L | Total bilirubin 2.5 mg/dL | Direct bilirubin 1.8 mg/dL | Alkaline phosphatase (ALP) 140 U/L | International normalized ratido (INR) 1.9 | Serum creatinine 1 mg/dL | Urinalysis | Sodium 200 mmol/24h | Potassium 60 mmol/24h | Protein Nil | RBCs Nil | RBC casts Nil | WBCs Nil | Urea 13 g/24h | Creatinine 6 mmol/24h |   Abdominal and renal ultrasound reveals no interval change over the past 6 months.", "Moderate ascites is present.", "Upper GI endoscopy reveals esophageal varices with a hepatic venous pressure gradient measuring 14 mm Hg.", "Diagnostic paracentesis is performed and yields a clear liquid with an absolute polymorphonuclear neutrophil (PMN) count of 75 cells/mm3."], "context_len": 8, "options": {"A": "Hepatocellular carcinoma", "B": "Portal hypertension", "C": "Spontaneous bacterial peritonitis", "D": "Hepatorenal syndrome"}, "answer": "Portal hypertension", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "50", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 50-year-old man.", "2. Patient has a past medical history of cirrhosis secondary to HCV infection diagnosed 4 years ago.", "3. Patient has ascites as a complication of cirrhosis.", "4. Patient is currently taking furosemide 40 mg orally daily.", "5. Physical examination is unremarkable.", "6. Laboratory findings are significant for AST 80 U/L, ALT 50 U/L, total bilirubin 2.5 mg/dL, direct bilirubin 1.8 mg/dL, ALP 140 U/L, INR 1.9, and serum creatinine 1 mg/dL.", "7. Urinalysis reveals sodium 200 mmol/24h, potassium 60 mmol/24h, protein nil, RBCs nil, RBC casts nil, WBCs nil, urea 13 g/24h, and creatinine 6 mmol/24h.", "8. Abdominal and renal ultrasound reveals no interval change over the past 6 months and moderate ascites.", "9. Upper GI endoscopy reveals esophageal varices with a hepatic venous pressure gradient measuring 14 mm Hg.", "10. Diagnostic paracentesis is performed and yields a clear liquid with an absolute PMN count of 75 cells/mm3."], "atomic_facts": ["1. Past medical history includes cirrhosis secondary to hepatitis C virus (HCV) infection diagnosed 4 years ago.", "2. Past medical history includes complications of cirrhosis with ascites.", "3. Current medications include furosemide 40 mg orally daily.", "4. Physical examination is unremarkable.", "5. Laboratory findings show Aspartate Aminotransferase (AST) at 80 U/L.", "6. Laboratory findings show Alanine Aminotransferase (ALT) at 50 U/L.", "7. Laboratory findings show Total bilirubin at 2.5 mg/dL.", "8. Laboratory findings show Direct bilirubin at 1.8 mg/dL.", "9. Laboratory findings show Alkaline phosphatase (ALP) at 140 U/L.", "10. Laboratory findings show International normalized ratio (INR) at 1.9.", "11. Laboratory findings show Serum creatinine at 1 mg/dL.", "12. Laboratory findings from urinalysis show Sodium at 200 mmol/24h.", "13. Laboratory findings from urinalysis show Potassium at 60 mmol/24h.", "14. Laboratory findings from urinalysis show no protein, RBCs, RBC casts, or WBCs.", "15. Laboratory findings from urinalysis show Urea at 13 g/24h.", "16. Laboratory findings from urinalysis show Creatinine at 6 mmol/24h.", "17. Abdominal and renal ultrasound reveals no interval change over the past 6 months.", "18. Abdominal and renal ultrasound shows moderate ascites.", "19. Upper GI endoscopy reveals esophageal varices.", "20. Upper GI endoscopy reveals hepatic venous pressure gradient measuring 14 mm Hg.", "21. Diagnostic paracentesis yields a clear liquid.", "22. Diagnostic paracentesis shows an absolute polymorphonuclear neutrophil (PMN) count of 75 cells/mm3."]}
{"id": 1141, "question": "Which of the following is the most likely causal organism?", "context": ["A 45-year-old man with HIV comes to the physician because of multiple lesions on his lower extremity.", "The lesions are increasing in size and are not painful or pruritic.", "He does not have lymphadenopathy.", "He works at a garden center.", "He lives in Mississippi.", "Medications include abacavir, dolutegravir, and lamivudine.", "His temperature is 37.7\u00b0C (98.8\u00b0F), pulse is 75/min, and blood pressure is 125/80 mm Hg.", "Examination shows multiple lesions on both heels; some are elevated.", "There are two similar lesions on the chest.", "An image of the patient's right heel is shown.", "His CD4+ T-lymphocyte count is 450/mm3 (normal \u2265 500/mm3).", "A skin biopsy shows multiple spindle-shaped cells and leukocyte infiltration."], "context_len": 12, "options": {"A": "Mycobacterium avium complex", "B": "Human herpesvirus 8", "C": "Coccidioides immitis", "D": "Epstein-Barr virus"}, "answer": "Human herpesvirus 8", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "45", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is 45 years old.", "2. Patient has HIV.", "3. Patient has multiple lesions on lower extremity.", "4. Lesions are increasing in size.", "5. Lesions are not painful or pruritic.", "6. Patient does not have lymphadenopathy.", "7. Patient works at a garden center.", "8. Patient lives in Mississippi.", "9. Patient is taking abacavir, dolutegravir, and lamivudine.", "10. Patient's temperature is 37.7\u00b0C (98.8\u00b0F).", "11. Patient's pulse is 75/min.", "12. Patient's blood pressure is 125/80 mm Hg.", "13. Examination shows multiple lesions on both heels, some are elevated.", "14. Examination shows two similar lesions on the chest.", "15. Image of patient's right heel is shown.", "16. Patient's CD4+ T-lymphocyte count is 450/mm3 (normal \u2265 500/mm3).", "17. Skin biopsy shows multiple spindle-shaped cells and leukocyte infiltration."], "atomic_facts": ["1. The lesions are increasing in size.", "2. The lesions are not painful or pruritic.", "3. He does not have lymphadenopathy.", "4. He works at a garden center.", "5. He lives in Mississippi.", "6. Medications include abacavir, dolutegravir, and lamivudine.", "7. His temperature is 37.7\u00b0C (98.8\u00b0F).", "8. His pulse is 75/min.", "9. His blood pressure is 125/80 mm Hg.", "10. Examination shows multiple lesions on both heels; some are elevated.", "11. There are two similar lesions on the chest.", "12. An image of the patient's right heel is shown.", "13. His CD4+ T-lymphocyte count is 450/mm3 (normal \u2265 500/mm3).", "14. A skin biopsy shows multiple spindle-shaped cells and leukocyte infiltration."]}
{"id": 1142, "question": "What is the next best step in management?", "context": ["A 32-year-old woman presents to the office complaining of pain, numbness, and discoloration of her fingers over the past 6 months.", "She notices that cold temperatures worsen these symptoms, turning the tip of her fingers white and sometimes blue.", "Her vital signs show her temperature is 37.5\u00b0C (99.5\u00b0F), blood pressure is 124/86 mm Hg, pulse is 80/min, and respirations are 10/min.", "On physical examination, the patient has a pale malar rash spread across her face with tender cervical and axillary lymphadenopathy.", "Examination of her hands reveal tenderness and shiny sclerodactyly.", "Antinuclear and anti-U1 ribonucleoprotein antibodies are positive.", "A diagnosis of mixed connective tissue disease is confirmed."], "context_len": 7, "options": {"A": "Echocardiogram", "B": "Arthrocentesis", "C": "Bone marrow transplant", "D": "Upper GI series"}, "answer": "Echocardiogram", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "32 years old", "specialties": ["Rheumatology", "Internal Medicine"], "subspecialties": ["General Rheumatology", "Rheumatology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 32-year-old woman.", "2. Patient has been experiencing pain, numbness, and discoloration of her fingers for the past 6 months.", "3. Patient's symptoms worsen in cold temperatures, turning the tip of her fingers white and sometimes blue.", "4. Patient's temperature is 37.5\u00b0C (99.5\u00b0F).", "5. Patient's blood pressure is 124/86 mm Hg.", "6. Patient's pulse is 80/min.", "7. Patient's respirations are 10/min.", "8. Patient has a pale malar rash spread across her face.", "9. Patient has tender cervical and axillary lymphadenopathy.", "10. Patient has tenderness and shiny sclerodactyly on examination of her hands.", "11. Patient's antinuclear and anti-U1 ribonucleoprotein antibodies are positive.", "12. Patient is diagnosed with mixed connective tissue disease."], "atomic_facts": ["1. Cold temperatures worsen the symptoms, turning the tip of her fingers white and sometimes blue.", "2. Vital signs: temperature is 37.5\u00b0C (99.5\u00b0F), blood pressure is 124/86 mm Hg, pulse is 80/min, and respirations are 10/min.", "3. Physical examination shows a pale malar rash spread across her face with tender cervical and axillary lymphadenopathy.", "4. Examination of her hands reveals tenderness and shiny sclerodactyly.", "5. Antinuclear and anti-U1 ribonucleoprotein antibodies are positive.", "6. Diagnosis of mixed connective tissue disease is confirmed."]}
{"id": 1143, "question": "Which of the following nerves is most likely injured in this patient?", "context": ["A 58-year-old woman presents with difficulty moving her right shoulder.", "She underwent a right radical mastectomy with lymph node dissection 3 weeks ago.", "Her surgery went well with no complications.", "She has undergone some physical therapy which has not been effective.", "A few days ago, she started to notice brief periods of painful shoulder instability, especially while opening or closing doors.", "On physical examination, there is normal active and passive range of motion in the right shoulder.", "Strength is 5 out of 5 in all muscles of the right shoulder and upper extremity.", "Sensation is intact.", "When the patient is asked to push against the wall, her right shoulder blade moves backward (see image)."], "context_len": 9, "options": {"A": "Axillary nerve", "B": "Suprascapular nerve", "C": "Long thoracic nerve", "D": "Ulnar nerve"}, "answer": "Long thoracic nerve", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "58 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 58 years old.", "2. Patient underwent right radical mastectomy with lymph node dissection 3 weeks ago.", "3. Surgery went well with no complications.", "4. Patient has undergone physical therapy which has not been effective.", "5. Patient started to notice brief periods of painful shoulder instability, especially while opening or closing doors.", "6. On physical examination, normal active and passive range of motion in the right shoulder.", "7. Strength is 5 out of 5 in all muscles of the right shoulder and upper extremity.", "8. Sensation is intact.", "9. When patient is asked to push against the wall, right shoulder blade moves backward (see image)."], "atomic_facts": ["1. She underwent a right radical mastectomy with lymph node dissection 3 weeks ago.", "2. Her surgery went well with no complications.", "3. She has undergone some physical therapy which has not been effective.", "4. A few days ago, she started to notice brief periods of painful shoulder instability, especially while opening or closing doors.", "5. On physical examination, there is normal active and passive range of motion in the right shoulder.", "6. Strength is 5 out of 5 in all muscles of the right shoulder and upper extremity.", "7. Sensation is intact.", "8. When the patient is asked to push against the wall, her right shoulder blade moves backward."]}
{"id": 1144, "question": "Which of the following is the most likely cause of his symptoms?\"", "context": ["A 40-year-old man comes to the physician because he is concerned about the amount of breast tissue he has recently developed.", "His wife has noticed that he has been irritable for the past month.", "He was recently treated for tinea capitis.", "In preparation for an upcoming bodybuilding competition, he has been eating a lot of chicken breast.", "He drinks 2 beers everyday.", "He smokes marijuana 3\u20134 times a week but does not smoke cigarettes.", "He weighs 90 kg (198 lb) and is 175 cm (5 ft 8 in) tall; BMI is 30.1 kg/m2.", "Physical examination shows bilateral gynecomastia and small, firm testes.", "There is no hepatosplenomegaly or abdominal tenderness.", "Laboratory studies show: | Hematocrit 60% | Platelet count 400,000/mm3 | Serum | Na+ 135 mEq/L | Cl- 97 mEq/L | K+ 4.5 mEq/L | HCO3- 25 mEq/L | Glucose 100 mg/dL | ."], "context_len": 10, "options": {"A": "Anabolic steroid use", "B": "Normal aging", "C": "Erythropoietin use", "D": "Marijuana use"}, "answer": "Anabolic steroid use", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "40", "specialties": ["Plastic Surgery", "Internal Medicine"], "subspecialties": ["General Plastic Surgery", "Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 40-year-old man comes to the physician.", "2. He is concerned about the amount of breast tissue he has recently developed.", "3. His wife has noticed that he has been irritable for the past month.", "4. He was recently treated for tinea capitis.", "5. In preparation for an upcoming bodybuilding competition, he has been eating a lot of chicken breast.", "6. He drinks 2 beers everyday.", "7. He smokes marijuana 3\u20134 times a week but does not smoke cigarettes.", "8. He weighs 90 kg (198 lb).", "9. He is 175 cm (5 ft 8 in) tall.", "10. BMI is 30.1 kg/m2.", "11. Physical examination shows bilateral gynecomastia and small, firm testes.", "12. There is no hepatosplenomegaly or abdominal tenderness.", "13. Laboratory studies show hematocrit 60%.", "14. Platelet count 400,000/mm3.", "15. Serum Na+ 135 mEq/L.", "16. Serum Cl- 97 mEq/L.", "17. Serum K+ 4.5 mEq/L.", "18. Serum HCO3- 25 mEq/L.", "19. Glucose 100 mg/dL."], "atomic_facts": ["1. His wife has noticed that he has been irritable for the past month.", "2. He was recently treated for tinea capitis.", "3. In preparation for an upcoming bodybuilding competition, he has been eating a lot of chicken breast.", "4. He drinks 2 beers everyday.", "5. He smokes marijuana 3\u20134 times a week but does not smoke cigarettes.", "6. He weighs 90 kg (198 lb) and is 175 cm (5 ft 8 in) tall; BMI is 30.1 kg/m2.", "7. Physical examination shows bilateral gynecomastia and small, firm testes.", "8. There is no hepatosplenomegaly or abdominal tenderness.", "9. Laboratory studies show: Hematocrit 60%, Platelet count 400,000/mm3, Serum Na+ 135 mEq/L, Cl- 97 mEq/L, K+ 4.5 mEq/L, HCO3- 25 mEq/L, Glucose 100 mg/dL."]}
{"id": 1145, "question": "Which of the following statements is correct?", "context": ["A 35-year-old woodsman from local forestry presents to a clinic for counseling regarding his contact with a wild fox that occurred 5 days ago.", "He says that the fox was not aggressive, allowed him to caress it, and even licked his forearm where he had an open wound.", "Two days ago, in the same forest, foresters shot a group of foxes who had attacked them, and the fox corpses were handed over to a local veterinary laboratory for testing.", "Two locals also reported they were attacked by foxes, so the patient became concerned about his exposure.", "At the time of presentation, the patient had no complaints.", "His vital signs are as follows: the blood pressure is 125/80 mmHg, the heart rate is 81/min, the respiratory rate is 14/min, and the temperature is 36.8\u00b0C (98.2\u00b0F).", "Physical examination reveals 2 healing lacerations, 2 \u00d7 3 cm, with a depth of 1 mm each, and multiple scratches on the flexor surface of his right arm.", "The patient is unaware of his immunization status."], "context_len": 8, "options": {"A": "The patient does not need immunoglobulin to be administered since he was not bitten by the animal.", "B": "Before initiating post-exposure prophylaxis, results of laboratory testing of the fox's corpses should be obtained.", "C": "There is no need to treat the patient\u2019s wounds before administering post-exposure prophylaxis because the wounds are already healing; thus, they do not pose a threat to the patient\u2019s health.", "D": "If rabies immunoglobulin is not available immediately, it can be administered within 7 days of the first vaccine dose."}, "answer": "If rabies immunoglobulin is not available immediately, it can be administered within 7 days of the first vaccine dose.", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "35 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 35-year-old woodsman from local forestry presents to a clinic for counseling.", "2. He had contact with a wild fox 5 days ago.", "3. The fox was not aggressive and allowed him to caress it.", "4. The fox even licked his forearm where he had an open wound.", "5. Two days ago, in the same forest, foresters shot a group of foxes who had attacked them.", "6. The fox corpses were handed over to a local veterinary laboratory for testing.", "7. Two locals also reported they were attacked by foxes.", "8. The patient became concerned about his exposure.", "9. At the time of presentation, the patient had no complaints.", "10. His blood pressure is 125/80 mmHg.", "11. His heart rate is 81/min.", "12. His respiratory rate is 14/min.", "13. His temperature is 36.8\u00b0C (98.2\u00b0F).", "14. Physical examination reveals 2 healing lacerations, 2 \u00d7 3 cm, with a depth of 1 mm each.", "15. Physical examination also reveals multiple scratches on the flexor surface of his right arm.", "16. The patient is unaware of his immunization status."], "atomic_facts": ["1. The patient was allowed to caress the fox and it even licked his forearm where he had an open wound.", "2. Two days ago, foresters shot a group of foxes in the same forest who had attacked them.", "3. The fox corpses were handed over to a local veterinary laboratory for testing.", "4. Two locals reported they were attacked by foxes, causing the patient to become concerned about his exposure.", "5. At the time of presentation, the patient had no complaints.", "6. The patient's blood pressure is 125/80 mmHg.", "7. The patient's heart rate is 81/min.", "8. The patient's respiratory rate is 14/min.", "9. The patient's temperature is 36.8\u00b0C (98.2\u00b0F).", "10. Physical examination reveals 2 healing lacerations, 2 \u00d7 3 cm, with a depth of 1 mm each, and multiple scratches on the flexor surface of his right arm.", "11. The patient is unaware of his immunization status."]}
{"id": 1146, "question": "Which of the following is appropriate management in this patient?", "context": ["A 14-year-old boy presents to his primary care physician for a general check up.", "The patient's parents refuse to allow the boy to join the school basketball team.", "The patient has attended two practices, and both times during conditioning, he has fainted.", "Otherwise, the child is performing well in school.", "The patient has a past medical history of obesity, elevated fasting blood glucose, and high blood pressure.", "He is not currently taking any medications.", "The patient's parents want the patient to be cleared medically before he goes back to playing basketball again.", "His temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 130/87 mmHg, pulse is 81/min, and respirations are 11/min.", "Physical exam is notable for an obese child who is pleasant and conversational.", "Pulmonary exam reveals lungs that are clear to auscultation bilaterally.", "Cardiovascular exam reveals a murmur heard loudest along the left sternal border.", "Neurological exam reveals 5/5 strength in the upper and lower extremities with 2+ reflexes.", "Further diagnostic exams are ordered."], "context_len": 13, "options": {"A": "Metformin", "B": "Metoprolol", "C": "Suggest the patient exercise more before joining a competitive team", "D": "Clear the patient to participate in sports"}, "answer": "Metoprolol", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "14", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is 14 years old.", "2. Parents refuse to allow the boy to join the school basketball team.", "3. Patient has attended two practices.", "4. Patient has fainted twice during conditioning.", "5. Patient is performing well in school.", "6. Patient has a past medical history of obesity, elevated fasting blood glucose, and high blood pressure.", "7. Patient is not currently taking any medications.", "8. Parents want patient to be cleared medically before returning to playing basketball.", "9. Patient's temperature is 99.5\u00b0F (37.5\u00b0C).", "10. Patient's blood pressure is 130/87 mmHg.", "11. Patient's pulse is 81/min.", "12. Patient's respirations are 11/min.", "13. Patient is obese.", "14. Patient is pleasant and conversational.", "15. Pulmonary exam reveals lungs that are clear to auscultation bilaterally.", "16. Cardiovascular exam reveals a murmur heard loudest along the left sternal border.", "17. Neurological exam reveals 5/5 strength in the upper and lower extremities with 2+ reflexes.", "18. Further diagnostic exams are ordered."], "atomic_facts": ["1. The patient's parents refuse to allow the boy to join the school basketball team.", "2. The patient has attended two practices, and both times during conditioning, he has fainted.", "3. The child is performing well in school.", "4. The patient has a past medical history of obesity, elevated fasting blood glucose, and high blood pressure.", "5. He is not currently taking any medications.", "6. The patient's parents want the patient to be cleared medically before he goes back to playing basketball again.", "7. His temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 130/87 mmHg, pulse is 81/min, and respirations are 11/min.", "8. Physical exam is notable for an obese child who is pleasant and conversational.", "9. Pulmonary exam reveals lungs that are clear to auscultation bilaterally.", "10. Cardiovascular exam reveals a murmur heard loudest along the left sternal border.", "11. Neurological exam reveals 5/5 strength in the upper and lower extremities with 2+ reflexes.", "12. Further diagnostic exams are ordered."]}
{"id": 1147, "question": "The drug that is most likely responsible for this patient's muscle weakness inhibits which of the following?", "context": ["A 65-year-old man with chronic obstructive pulmonary disease is admitted to the hospital for the treatment of worsening shortness of breath and productive cough.", "Three days later, he complains of weakness in the lower limbs.", "His muscle strength is 4/5 at both hips but normal elsewhere."], "context_len": 3, "options": {"A": "Adenosine receptor", "B": "5-lipoxygenase", "C": "Myosin light-chain kinase", "D": "Nuclear factor-\u03baB"}, "answer": "Nuclear factor-\u03baB", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "65 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 65-year-old man has chronic obstructive pulmonary disease.", "2. He is admitted to the hospital for the treatment of worsening shortness of breath and productive cough.", "3. Three days later, he complains of weakness in the lower limbs.", "4. His muscle strength is 4/5 at both hips.", "5. His muscle strength is normal elsewhere."], "atomic_facts": ["1. Three days later, he complains of weakness in the lower limbs.", "2. His muscle strength is 4/5 at both hips.", "3. His muscle strength is normal elsewhere."]}
{"id": 1148, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 64-year-old woman is brought to the emergency department after a syncopal episode 2 hours ago while grocery shopping.", "She has been feeling fatigued and lightheaded for the past couple of days.", "She has hypertension.", "Current medications include carvedilol.", "She appears diaphoretic.", "She is oriented to person but not to place or time.", "Her blood pressure is 102/65 mm Hg.", "An ECG is shown."], "context_len": 8, "options": {"A": "Observation", "B": "Administration of dopamine", "C": "Placement of transcutaneous pacemaker", "D": "Administration of amiodarone\n\""}, "answer": "Placement of transcutaneous pacemaker", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "64 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 64-year-old woman is brought to the emergency department.", "2. She had a syncopal episode 2 hours ago while grocery shopping.", "3. She has been feeling fatigued and lightheaded for the past couple of days.", "4. She has hypertension.", "5. Her current medications include carvedilol.", "6. She appears diaphoretic.", "7. She is oriented to person but not to place or time.", "8. Her blood pressure is 102/65 mm Hg.", "9. An ECG is shown."], "atomic_facts": ["1. She has been feeling fatigued and lightheaded for the past couple of days.", "2. She has hypertension.", "3. Current medications include carvedilol.", "4. She appears diaphoretic.", "5. She is oriented to person but not to place or time.", "6. Her blood pressure is 102/65 mm Hg.", "7. An ECG is shown."]}
{"id": 1149, "question": "What is the most likely causative agent of this rash?", "context": ["A 42-year-old morbidly obese woman presents to the emergency room for evaluation of a rash that started 3 days ago.", "The rash appeared under the patient\u2019s breasts as well as in the abdominal folds, and the patient describes it as being very itchy.", "The rash is bright red with scaling and a few scattered purulent areas of skin breakdown.", "The patient is afebrile and is in no apparent distress, besides being uncomfortable from the itching."], "context_len": 4, "options": {"A": "A heavily encapsulated, urease-positive yeast", "B": "A gram-negative rod that produces pyocyanin", "C": "An acid-fast bacillus", "D": "A commensal yeast that is catalase-positive"}, "answer": "A commensal yeast that is catalase-positive", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "42", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 42-year-old morbidly obese woman presents to the emergency room.", "2. The rash started 3 days ago.", "3. The rash appeared under the patient's breasts and in the abdominal folds.", "4. The patient describes the rash as being very itchy.", "5. The rash is bright red with scaling.", "6. There are a few scattered purulent areas of skin breakdown.", "7. The patient is afebrile.", "8. The patient is in no apparent distress, besides being uncomfortable from the itching."], "atomic_facts": ["1. The rash appeared under the patient\u2019s breasts.", "2. The rash appeared in the abdominal folds.", "3. The patient describes the rash as being very itchy.", "4. The rash is bright red.", "5. The rash has scaling.", "6. The rash has a few scattered purulent areas of skin breakdown.", "7. The patient is afebrile.", "8. The patient is in no apparent distress.", "9. The patient is uncomfortable from the itching."]}
{"id": 1150, "question": "Which of the following is the most likely cause of death in this patient?", "context": ["A 47-year-old man comes to the physician because of severe retrosternal chest pain and shortness of breath for 45 minutes.", "He has dyslipidemia, hypertension, and type 2 diabetes mellitus.", "Current medications include hydrochlorothiazide, lisinopril, metformin, and atorvastatin.", "He has smoked 1 pack of cigarettes daily for 20 years.", "He appears pale and diaphoretic.", "His temperature is 37\u00b0C (98.6\u00b0F), pulse is 115/min, and blood pressure is 140/70 mm Hg.", "Breath sounds are normal.", "The remainder of the examination shows no abnormalities.", "An ECG shows left ventricular hypertrophy with ST-segment elevation in leads I, aVL, and V1\u2013V6.", "High-dose aspirin, clopidogrel, metoprolol, sublingual nitroglycerin, and unfractionated heparin are administered.", "As the patient awaits transport to the nearest emergency room, he collapses and becomes unresponsive.", "His pulse and blood pressure cannot be detected.", "Despite resuscitative efforts, the patient dies."], "context_len": 13, "options": {"A": "Papillary muscle rupture", "B": "Ventricular fibrillation", "C": "Septal wall rupture", "D": "Pulmonary embolism\n\""}, "answer": "Ventricular fibrillation", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "47 years old", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Interventional Cardiology", "General Cardiology", "Cardiovascular Disease"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 47-year-old man comes to the physician because of severe retrosternal chest pain and shortness of breath for 45 minutes.", "2. He has dyslipidemia, hypertension, and type 2 diabetes mellitus.", "3. Current medications include hydrochlorothiazide, lisinopril, metformin, and atorvastatin.", "4. He has smoked 1 pack of cigarettes daily for 20 years.", "5. He appears pale and diaphoretic.", "6. His temperature is 37\u00b0C (98.6\u00b0F), pulse is 115/min, and blood pressure is 140/70 mm Hg.", "7. Breath sounds are normal.", "8. The remainder of the examination shows no abnormalities.", "9. An ECG shows left ventricular hypertrophy with ST-segment elevation in leads I, aVL, and V1\u2013V6.", "10. High-dose aspirin, clopidogrel, metoprolol, sublingual nitroglycerin, and unfractionated heparin are administered.", "11. As the patient awaits transport to the nearest emergency room, he collapses and becomes unresponsive.", "12. His pulse and blood pressure cannot be detected.", "13. Despite resuscitative efforts, the patient dies."], "atomic_facts": ["1. He has dyslipidemia, hypertension, and type 2 diabetes mellitus.", "2. Current medications include hydrochlorothiazide, lisinopril, metformin, and atorvastatin.", "3. He has smoked 1 pack of cigarettes daily for 20 years.", "4. He appears pale and diaphoretic.", "5. His temperature is 37\u00b0C (98.6\u00b0F), pulse is 115/min, and blood pressure is 140/70 mm Hg.", "6. Breath sounds are normal.", "7. The remainder of the examination shows no abnormalities.", "8. An ECG shows left ventricular hypertrophy with ST-segment elevation in leads I, aVL, and V1\u2013V6.", "9. High-dose aspirin, clopidogrel, metoprolol, sublingual nitroglycerin, and unfractionated heparin are administered.", "10. As the patient awaits transport to the nearest emergency room, he collapses and becomes unresponsive.", "11. His pulse and blood pressure cannot be detected.", "12. Despite resuscitative efforts, the patient dies."]}
{"id": 1151, "question": "Immunoglobulin M (IgM) antibody detection by the enzyme-linked immunoassay (ELISA) will most likely detect antibodies against which of the following pathogens?", "context": ["A 4-year-old boy presents to a clinic with intermittent fevers and a rash for 6 days.", "According to his mother, he is also complaining of pain all over his body.", "She adds that the rash 1st appeared on his face within 12 hours of the onset of fever, and later spread to his trunks and limbs.", "The patient denies any itchiness over the rash.", "There is no history of a sore throat or recent use of medication for symptom relief.", "The temperature is 37.2\u00b0C (99.9\u00b0F) and the pulse is 88/min.", "On examination, there is a maculopapular rash on the face and the trunk, including the limbs, but sparing the palms and soles.", "The pediatrician reassures the mother that this is most likely a viral infection and will resolve spontaneously.", "After 7\u201310 days, the boy is brought back to the clinic for a follow-up visit.", "The areas affected by the rash appear to have a central clearing giving a lacy or reticular appearance, especially on the cheeks and it looks like someone slapped him on the cheeks."], "context_len": 10, "options": {"A": "Measles virus", "B": "Human herpesvirus 6", "C": "Rubella virus", "D": "Parvovirus B19"}, "answer": "Parvovirus B19", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old boy presents to a clinic with intermittent fevers and a rash for 6 days.", "2. According to his mother, he is also complaining of pain all over his body.", "3. She adds that the rash 1st appeared on his face within 12 hours of the onset of fever, and later spread to his trunks and limbs.", "4. The patient denies any itchiness over the rash.", "5. There is no history of a sore throat or recent use of medication for symptom relief.", "6. The temperature is 37.2\u00b0C (99.9\u00b0F) and the pulse is 88/min.", "7. On examination, there is a maculopapular rash on the face and the trunk, including the limbs, but sparing the palms and soles.", "8. The pediatrician reassures the mother that this is most likely a viral infection and will resolve spontaneously.", "9. After 7\u201310 days, the boy is brought back to the clinic for a follow-up visit.", "10. The areas affected by the rash appear to have a central clearing giving a lacy or reticular appearance, especially on the cheeks and it looks like someone slapped him on the cheeks."], "atomic_facts": ["1. The patient is complaining of pain all over his body.", "2. The rash first appeared on his face within 12 hours of the onset of fever.", "3. The rash later spread to his trunks and limbs.", "4. The patient denies any itchiness over the rash.", "5. There is no history of a sore throat or recent use of medication for symptom relief.", "6. The temperature is 37.2\u00b0C (99.9\u00b0F) and the pulse is 88/min.", "7. On examination, there is a maculopapular rash on the face and the trunk, including the limbs, but sparing the palms and soles.", "8. The pediatrician reassures the mother that this is most likely a viral infection and will resolve spontaneously.", "9. After 7\u201310 days, the boy is brought back to the clinic for a follow-up visit.", "10. The areas affected by the rash appear to have a central clearing giving a lacy or reticular appearance, especially on the cheeks."]}
{"id": 1152, "question": "What is the most likely cause of this patient's menorrhagia?", "context": ["A 25-year-old woman comes into your office with complaints of heavy bleeding.", "She states that her mother also has heavy bleeding during her menstrual cycle.", "She has had a heavy flow as long as she can remember and had her first menstrual cycle at age 12.", "She states during her cycle, she has to change pads every 2 hours for at least 3 days.", "She also states that she gets bruised easily just like her mother.", "She denies any past medical history other than her heavy menstrual flow and denies taking any medications.", "She also denies any medical history in her father and says he is \"perfectly healthy.\" Her vitals are HR 85, T 98.8 F, RR 13, BP 125/75.", "Her CBC is significant for Hgb 10.5, WBC 5.8, Plts 250, Hct 33.", "On coagulation studies, her PT is 14 seconds and her PTT is 43 seconds.", "Her INR is 1.1."], "context_len": 10, "options": {"A": "Factor V Leiden", "B": "Von Willebrand's disease", "C": "Hemophilia B", "D": "Antiphospholipid antibody syndrome"}, "answer": "Von Willebrand's disease", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "25", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 25-year-old woman.", "2. Patient has complaints of heavy bleeding.", "3. Patient's mother also has heavy bleeding during her menstrual cycle.", "4. Patient has had a heavy flow as long as she can remember.", "5. Patient had her first menstrual cycle at age 12.", "6. Patient has to change pads every 2 hours for at least 3 days during her cycle.", "7. Patient gets bruised easily, like her mother.", "8. Patient denies any past medical history other than her heavy menstrual flow.", "9. Patient denies taking any medications.", "10. Patient denies any medical history in her father and says he is \"perfectly healthy.\"", "11. Patient's vitals are HR 85, T 98.8 F, RR 13, BP 125/75.", "12. Patient's CBC is significant for Hgb 10.5, WBC 5.8, Plts 250, Hct 33.", "13. Patient's PT is 14 seconds.", "14. Patient's PTT is 43 seconds.", "15. Patient's INR is 1.1."], "atomic_facts": ["1. The patient's mother also experiences heavy bleeding during her menstrual cycle.", "2. The patient has had a heavy flow for as long as she can remember and had her first menstrual cycle at age 12.", "3. During her cycle, the patient has to change pads every 2 hours for at least 3 days.", "4. The patient gets bruised easily, similar to her mother.", "5. The patient denies any past medical history other than her heavy menstrual flow and denies taking any medications.", "6. The patient denies any medical history in her father and states he is \"perfectly healthy.\"", "7. The patient's vitals are HR 85, T 98.8 F, RR 13, BP 125/75.", "8. The patient's CBC shows Hgb 10.5, WBC 5.8, Plts 250, Hct 33.", "9. On coagulation studies, the patient's PT is 14 seconds and her PTT is 43 seconds.", "10. The patient's INR is 1.1."]}
{"id": 1153, "question": "Which of the following best describes the pathogenesis of the disease process in this patient?", "context": ["A 30-year-old woman comes to the physician because of numbness, fatigue, and blurry vision for 1 week.", "The symptoms are worse after a hot shower or bath.", "She had an episode of right arm weakness 2 years ago that resolved without intervention.", "She recently returned from a hiking trip in upstate New York.", "Her temperature is 37.1\u00b0C (100\u00b0F) and blood pressure is 100/66 mm Hg.", "Physical examination shows decreased sensation to light touch in the left hand, right thigh, and right flank.", "Strength is normal.", "There is left-sided photophobia and pupillary constriction in the left eye is decreased compared to the right eye."], "context_len": 8, "options": {"A": "Spirochete protein cross-reactivity in the meninges", "B": "Osmotically-mediated Schwann cell damage", "C": "Th1 cell-mediated nerve sheath damage", "D": "Lymphocytic infiltrate of the endoneurium"}, "answer": "Th1 cell-mediated nerve sheath damage", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "Multiple Sclerosis (MS) Specialist", "Multiple Sclerosis"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 30-year-old woman comes to the physician.", "2. She has had numbness, fatigue, and blurry vision for 1 week.", "3. Symptoms are worse after a hot shower or bath.", "4. She had an episode of right arm weakness 2 years ago.", "5. The episode resolved without intervention.", "6. She recently returned from a hiking trip in upstate New York.", "7. Her temperature is 37.1\u00b0C (100\u00b0F).", "8. Her blood pressure is 100/66 mm Hg.", "9. Physical examination shows decreased sensation to light touch in the left hand, right thigh, and right flank.", "10. Strength is normal.", "11. There is left-sided photophobia.", "12. Pupillary constriction in the left eye is decreased compared to the right eye."], "atomic_facts": ["1. The symptoms worsen after a hot shower or bath.", "2. She had an episode of right arm weakness 2 years ago that resolved without intervention.", "3. She recently returned from a hiking trip in upstate New York.", "4. Her temperature is 37.1\u00b0C (100\u00b0F) and blood pressure is 100/66 mm Hg.", "5. Physical examination shows decreased sensation to light touch in the left hand, right thigh, and right flank.", "6. Strength is normal.", "7. There is left-sided photophobia.", "8. Pupillary constriction in the left eye is decreased compared to the right eye."]}
{"id": 1154, "question": "Which of the following would be the best course of treatment for this patient?", "context": ["A 30-year-old man visits his physician with thoughts that he \u2018is not real\u2019 which occurred suddenly and have persisted for weeks.", "The patient states that, 3 weeks ago, he witnessed an armed robbery in which he saw a person get shot in the chest.", "The patient states that at the time the shot was fired, he felt as though he \u2018wasn\u2019t in the room\u2019 and as if he was \u2018floating above watching it all happen\u2019 below him.", "Ever since the event, he has been having similar experiences without provocation.", "He states that now, seemingly out of nowhere, he will have a sudden feeling that he is \u2018perceiving life as a dream\u2019.", "He now seeks help to control these feelings of depersonalization."], "context_len": 6, "options": {"A": "Amantadine", "B": "Butorphanol", "C": "Dextromethorphan", "D": "Psychotherapy"}, "answer": "Psychotherapy", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "30", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 30-year-old man visits his physician.", "2. He has thoughts that he \u2018is not real\u2019.", "3. These thoughts occurred suddenly.", "4. The thoughts have persisted for weeks.", "5. Three weeks ago, he witnessed an armed robbery.", "6. He saw a person get shot in the chest.", "7. At the time the shot was fired, he felt as though he \u2018wasn\u2019t in the room\u2019.", "8. He felt as if he was \u2018floating above watching it all happen\u2019 below him.", "9. Ever since the event, he has been having similar experiences without provocation.", "10. Seemingly out of nowhere, he will have a sudden feeling that he is \u2018perceiving life as a dream\u2019.", "11. He now seeks help to control these feelings of depersonalization."], "atomic_facts": ["1. The patient witnessed an armed robbery 3 weeks ago.", "2. He saw a person get shot in the chest during the robbery.", "3. At the time of the shooting, he felt as though he 'wasn't in the room' and was 'floating above watching it all happen' below him.", "4. Since the event, he has been having similar experiences without provocation.", "5. He now experiences sudden feelings of perceiving life as a dream.", "6. He seeks help to control these feelings of depersonalization."]}
{"id": 1155, "question": "Which of the following genes is most likely impaired in this patient?", "context": ["A 9-year-old boy presents with recent onset worsening performance in school and facial lesions that look like acne.", "Past medical history is significant for developmental delays and infantile spasm.", "No current medications.", "On physical examination, there are facial papulonodular lesions (as shown in the image), pitting of dental enamel, and multiple hypomelanotic oval macules over the torso."], "context_len": 4, "options": {"A": "VHL", "B": "TSC", "C": "NF1", "D": "GNAQ"}, "answer": "TSC", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "9 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 9-year-old boy.", "2. Patient has recent onset worsening performance in school.", "3. Patient has facial lesions that look like acne.", "4. Patient has past medical history of developmental delays and infantile spasm.", "5. Patient is not currently taking any medications.", "6. On physical examination, patient has facial papulonodular lesions.", "7. On physical examination, patient has pitting of dental enamel.", "8. On physical examination, patient has multiple hypomelanotic oval macules over the torso."], "atomic_facts": ["1. Past medical history includes developmental delays", "2. Past medical history includes infantile spasm", "3. No current medications", "4. Physical examination shows facial papulonodular lesions", "5. Physical examination shows pitting of dental enamel", "6. Physical examination shows multiple hypomelanotic oval macules over the torso"]}
{"id": 1156, "question": "Which of the following is the most likely underlying cause of this patient\u2019s current condition?", "context": ["A 14-year-old girl is brought to the emergency department because of occipital headache, nausea, and vomiting for the last 2 hours.", "She has a multi-year history of frequent left ear infections and discharge, with poor response to antimicrobial therapy.", "She has muffled hearing in the left ear.", "Her blood pressure is 134/78 mm Hg, the pulse is 83/min, the respiratory rate is 16/min, and the temperature is 36.5\u00b0C (97.7\u00b0F).", "She is alert and oriented.", "Physical examination of the left ear shows perforation of the tympanic membrane, granulation tissue, and white keratinaceous debris in the posterosuperior quadrant of the tympanic membrane.", "An MRI shows evidence of sigmoid sinus thrombosis on the left side and a hyperintense area in the middle ear on."], "context_len": 7, "options": {"A": "Acoustic neuroma", "B": "Cholesteatoma", "C": "Chronic serous otitis media", "D": "Chronic suppurative otitis media"}, "answer": "Cholesteatoma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "14 years old", "specialties": ["Neurology", "Otolaryngology"], "subspecialties": ["Vascular Neurology", "Neurotology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 14-year-old girl is brought to the emergency department.", "2. She has been experiencing occipital headache, nausea, and vomiting for the last 2 hours.", "3. She has a multi-year history of frequent left ear infections and discharge.", "4. She has poor response to antimicrobial therapy.", "5. She has muffled hearing in the left ear.", "6. Her blood pressure is 134/78 mm Hg.", "7. Her pulse is 83/min.", "8. Her respiratory rate is 16/min.", "9. Her temperature is 36.5\u00b0C (97.7\u00b0F).", "10. She is alert and oriented.", "11. Physical examination of the left ear shows perforation of the tympanic membrane.", "12. Physical examination of the left ear shows granulation tissue.", "13. Physical examination of the left ear shows white keratinaceous debris in the posterosuperior quadrant of the tympanic membrane.", "14. An MRI shows evidence of sigmoid sinus thrombosis on the left side.", "15. An MRI shows a hyperintense area in the middle ear on."], "atomic_facts": ["1. She has a multi-year history of frequent left ear infections and discharge.", "2. She has poor response to antimicrobial therapy.", "3. She has muffled hearing in the left ear.", "4. Her blood pressure is 134/78 mm Hg.", "5. Her pulse is 83/min.", "6. Her respiratory rate is 16/min.", "7. Her temperature is 36.5\u00b0C (97.7\u00b0F).", "8. She is alert and oriented.", "9. Physical examination of the left ear shows perforation of the tympanic membrane.", "10. Physical examination shows granulation tissue in the left ear.", "11. Physical examination shows white keratinaceous debris in the posterosuperior quadrant of the tympanic membrane.", "12. An MRI shows evidence of sigmoid sinus thrombosis on the left side.", "13. An MRI shows a hyperintense area in the middle ear."]}
{"id": 1157, "question": "In the process of embryologic development, this nodule forms as a result of the activity of which of the following?", "context": ["An otherwise healthy 8-year-old boy is brought to the emergency department by his mother 2 hours after the sudden onset of scrotal pain.", "Physical examination shows nontender testes and a tender, 5-mm, bluish nodule at the superior pole of the left testis.", "The patient undergoes urgent surgical exploration of the scrotum.", "During the operation, the nodule on the superior pole of the testis is found to be necrotic."], "context_len": 4, "options": {"A": "Leydig cells", "B": "Estradiol", "C": "Luteinizing hormone", "D": "Sertoli cells"}, "answer": "Sertoli cells", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "8 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Emergency Medicine", "Pediatric Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 8-year-old boy is brought to the emergency department.", "2. His mother brought him 2 hours after the sudden onset of scrotal pain.", "3. Physical examination shows nontender testes.", "4. Physical examination shows a tender, 5-mm, bluish nodule at the superior pole of the left testis.", "5. The patient undergoes urgent surgical exploration of the scrotum.", "6. During the operation, the nodule on the superior pole of the testis is found to be necrotic."], "atomic_facts": ["1. Physical examination shows nontender testes.", "2. Physical examination shows a tender, 5-mm, bluish nodule at the superior pole of the left testis.", "3. The patient undergoes urgent surgical exploration of the scrotum.", "4. During the operation, the nodule on the superior pole of the testis is found to be necrotic."]}
{"id": 1158, "question": "Which of the following is the most likely diagnosis?", "context": ["A 23-year-old woman comes to the physician for a 6-month history of dry cough, hoarseness, and chest pain.", "She does not smoke and has not lost weight.", "Laboratory studies show no abnormalities.", "An x-ray of the chest shows a mass that projects across the right hilum.", "A CT scan of the chest is shown."], "context_len": 5, "options": {"A": "Rhabdomyosarcoma", "B": "Neurofibroma", "C": "Sarcoma", "D": "Aortic aneurysm"}, "answer": "Neurofibroma", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "23", "specialties": ["Pulmonary Disease", "Internal Medicine"], "subspecialties": ["General Pulmonary Disease", "Pulmonary Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. A 23-year-old woman comes to the physician.", "2. She has a 6-month history of dry cough, hoarseness, and chest pain.", "3. She does not smoke.", "4. She has not lost weight.", "5. Laboratory studies show no abnormalities.", "6. An x-ray of the chest shows a mass that projects across the right hilum.", "7. A CT scan of the chest is shown."], "atomic_facts": ["1. She does not smoke.", "2. She has not lost weight.", "3. Laboratory studies show no abnormalities.", "4. An x-ray of the chest shows a mass.", "5. The mass projects across the right hilum.", "6. A CT scan of the chest is shown."]}
{"id": 1159, "question": "What is the most likely organism responsible?", "context": ["A 4-year-old is brought into the emeregency room by his mother.", "The mother states that the child had a slight cough one week ago that has since worsened.", "The mother states the child's cough sounds like someone barking and states that he has also had mild fevers along with rhinorrhea.", "The patient's vitals are significant for a fever of 100.8 F, and his physical exam reveals inspiratory stridor."], "context_len": 4, "options": {"A": "Parainfluenza virus", "B": "Respiratory syncytial virus", "C": "Adenovirus", "D": "Ebstein barr virus"}, "answer": "Parainfluenza virus", "answer_idx": "A", "explanation": "", "patient": {"gender": "Not specified", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 4-year-old is brought into the emergency room by his mother.", "2. The mother states that the child had a slight cough one week ago that has since worsened.", "3. The mother states the child's cough sounds like someone barking.", "4. The mother states the child has had mild fevers along with rhinorrhea.", "5. The patient's vitals are significant for a fever of 100.8 F.", "6. The patient's physical exam reveals inspiratory stridor."], "atomic_facts": ["1. The mother states that the child had a slight cough one week ago.", "2. The child's cough has since worsened.", "3. The mother states the child's cough sounds like someone barking.", "4. The mother states that he has also had mild fevers along with rhinorrhea.", "5. The patient's vitals are significant for a fever of 100.8 F.", "6. His physical exam reveals inspiratory stridor."]}
{"id": 1160, "question": "Which of the following correctly identifies the study design used by the researcher?", "context": ["A researcher interested in the relationship between vaccination and autism sends a survey to parents of children who are active patients at a large primary care practice.", "The survey asks several questions, including whether their children received their childhood vaccines on-time, and whether their children currently have a diagnosis of an autism spectrum disorder."], "context_len": 2, "options": {"A": "Cross-sectional", "B": "Cohort", "C": "Randomized controlled trial", "D": "Case-control"}, "answer": "Cross-sectional", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A researcher is interested in the relationship between vaccination and autism.", "2. The researcher sends a survey to parents of children who are active patients at a large primary care practice.", "3. The survey asks several questions.", "4. One of the questions is whether their children received their childhood vaccines on-time.", "5. Another question is whether their children currently have a diagnosis of an autism spectrum disorder."], "atomic_facts": ["1. The survey asks several questions.", "2. The questions include whether their children received their childhood vaccines on-time.", "3. The questions also include whether their children currently have a diagnosis of an autism spectrum disorder."]}
{"id": 1161, "question": "Which of the following developmental milestones is delayed in this infant?", "context": ["A 6-month-old boy is brought to the physician for a well-child examination.", "He was born at term, and pregnancy was complicated by prolonged labor.", "There is no family history of serious illness.", "He can sit upright without support and can roll over from the prone to the supine position.", "He cannot pull himself to stand.", "He can grasp his rattle and cannot transfer it from one hand to the other.", "He babbles.", "He cries if anyone apart from his parents holds him or plays with him.", "He touches his own reflection in the mirror.", "Vital signs are within normal limits.", "He is at 40th percentile for head circumference, 30th percentile for length and at 40th percentile for weight.", "Physical examination shows no abnormalities."], "context_len": 12, "options": {"A": "Fine motor", "B": "Social", "C": "Gross motor", "D": "Cognitive"}, "answer": "Fine motor", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "6 months", "specialties": ["Pediatrics"], "subspecialties": ["Developmental"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-month-old boy is brought to the physician for a well-child examination.", "2. He was born at term.", "3. Pregnancy was complicated by prolonged labor.", "4. There is no family history of serious illness.", "5. He can sit upright without support.", "6. He can roll over from the prone to the supine position.", "7. He cannot pull himself to stand.", "8. He can grasp his rattle.", "9. He cannot transfer it from one hand to the other.", "10. He babbles.", "11. He cries if anyone apart from his parents holds him or plays with him.", "12. He touches his own reflection in the mirror.", "13. Vital signs are within normal limits.", "14. He is at 40th percentile for head circumference.", "15. He is at 30th percentile for length.", "16. He is at 40th percentile for weight.", "17. Physical examination shows no abnormalities."], "atomic_facts": ["1. He was born at term", "2. Pregnancy was complicated by prolonged labor", "3. There is no family history of serious illness", "4. He can sit upright without support", "5. He can roll over from the prone to the supine position", "6. He cannot pull himself to stand", "7. He can grasp his rattle", "8. He cannot transfer it from one hand to the other", "9. He babbles", "10. He cries if anyone apart from his parents holds him or plays with him", "11. He touches his own reflection in the mirror", "12. Vital signs are within normal limits", "13. He is at 40th percentile for head circumference", "14. He is at 30th percentile for length", "15. He is at 40th percentile for weight", "16. Physical examination shows no abnormalities"]}
{"id": 1162, "question": "Which of the following is the most likely effect of this drug?", "context": ["A 28-year-old woman is admitted to the hospital for treatment of a displaced fracture of the femoral neck following a high-speed motor vehicle collision.", "She is given pentazocine for pain relief.", "This drug binds to heptahelical transmembrane receptors."], "context_len": 3, "options": {"A": "Release of presynaptic acetylcholine", "B": "Release of presynaptic norepinephrine", "C": "Opening of postsynaptic Na+ channels", "D": "Opening of postsynaptic K+ channels"}, "answer": "Opening of postsynaptic K+ channels", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery", "Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 28-year-old woman is admitted to the hospital.", "2. The woman has a displaced fracture of the femoral neck.", "3. The woman's injury was caused by a high-speed motor vehicle collision.", "4. The woman is given pentazocine for pain relief.", "5. Pentazocine binds to heptahelical transmembrane receptors."], "atomic_facts": ["1. She is given pentazocine for pain relief.", "2. Pentazocine binds to heptahelical transmembrane receptors."]}
{"id": 1163, "question": "Which of the following is the most appropriate therapy with curative intent at this time?", "context": ["A 70-year-old man comes to the physician because of fatigue and intermittent epigastric pain.", "The symptoms began about one year ago.", "He describes the pain as diffuse and 3 out of 10 in intensity.", "Recently, he has had unusually large black stools.", "He appears pale.", "His pulse is 72/min and his blood pressure is 110/70 mm Hg.", "Physical examination shows epigastric tenderness.", "A urea breath test is positive.", "Upper gastrointestinal endoscopy reveals an ulcerating mass in the gastric antrum.", "Biopsies of the mass show diffuse infiltrates of small lymphoid cells that are positive for CD20 antigen.", "A CT scan of the chest and abdomen shows normal regional lymph nodes."], "context_len": 11, "options": {"A": "Rituximab, cyclophosphamide, adriamycin, and vincristine", "B": "Imatinib", "C": "External beam radiation therapy", "D": "Amoxicillin, clarithromycin, and omeprazole"}, "answer": "Amoxicillin, clarithromycin, and omeprazole", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 70-year-old man comes to the physician.", "2. He has fatigue and intermittent epigastric pain.", "3. The symptoms began about one year ago.", "4. He describes the pain as diffuse and 3 out of 10 in intensity.", "5. Recently, he has had unusually large black stools.", "6. He appears pale.", "7. His pulse is 72/min.", "8. His blood pressure is 110/70 mm Hg.", "9. Physical examination shows epigastric tenderness.", "10. A urea breath test is positive.", "11. Upper gastrointestinal endoscopy reveals an ulcerating mass in the gastric antrum.", "12. Biopsies of the mass show diffuse infiltrates of small lymphoid cells.", "13. The lymphoid cells are positive for CD20 antigen.", "14. A CT scan of the chest and abdomen shows normal regional lymph nodes."], "atomic_facts": ["1. The symptoms began about one year ago.", "2. He describes the pain as diffuse.", "3. The pain is 3 out of 10 in intensity.", "4. Recently, he has had unusually large black stools.", "5. He appears pale.", "6. His pulse is 72/min.", "7. His blood pressure is 110/70 mm Hg.", "8. Physical examination shows epigastric tenderness.", "9. A urea breath test is positive.", "10. Upper gastrointestinal endoscopy reveals an ulcerating mass in the gastric antrum.", "11. Biopsies of the mass show diffuse infiltrates of small lymphoid cells.", "12. The cells are positive for CD20 antigen.", "13. A CT scan of the chest and abdomen shows normal regional lymph nodes."]}
{"id": 1164, "question": "What is the most appropriate step in this case?", "context": ["A 42-year-old woman approaches your office complaining of a 1-year long persistent dysuria, increasing discomfort with bladder filling and voiding, and suprapubic pain.", "She further comments that she has been presenting with abdominal cramps, and alternating periods of diarrhea and constipation for the past 4 months.", "Her family medical history is negative for malignancies and hereditary disorders.", "Her personal history is relevant for various visits to the general practitioners for similar complaints that resulted in multiple antimicrobial treatments for urinary tract infection.", "At the moment, she is not taking any medication.", "Physical examination shows suprapubic tenderness as well as tender areas in the pelvic floor.", "The vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), heart rate 68/min, blood pressure 120/58 mm Hg, and respiratory rate 13/min.", "Vaginal examination is normal.", "No adnexal masses are detected and no vaginal secretions are noticed. | She brings a urinalysis and a urine culture from 1 week ago that show the following: | Test Result Normal Range | Urine culture Negative < 100,000 CFU/mL to no bacterial growth in asymptomatic patients | Urinalysis Density: 1.030; Leukocyte esterase (-); Nitrites (-); pH: 6.0, Presence of 4 RBCs per high power field.", "Density: 1.030 - 1.060; Leukocyte esterase (-), Nitrites (-), pH: 4.5 - 8.0 | ."], "context_len": 10, "options": {"A": "Self-care and behavior modification", "B": "Admission to the ER for intravenous antibiotic administration", "C": "Urinary analgesia with phenazopyridine", "D": "Conjugated estrogens"}, "answer": "Self-care and behavior modification", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is a 42-year-old woman.", "2. Patient has been experiencing dysuria for 1 year.", "3. Patient has increasing discomfort with bladder filling and voiding.", "4. Patient has suprapubic pain.", "5. Patient has had abdominal cramps for 4 months.", "6. Patient has had alternating periods of diarrhea and constipation for 4 months.", "7. Patient's family medical history is negative for malignancies and hereditary disorders.", "8. Patient has had multiple visits to the general practitioner for similar complaints.", "9. Patient has had multiple antimicrobial treatments for urinary tract infection.", "10. Patient is not taking any medication.", "11. Physical examination shows suprapubic tenderness and tender areas in the pelvic floor.", "12. Patient's vital signs include temperature 37.0\u00b0C (98.6\u00b0F), heart rate 68/min, blood pressure 120/58 mm Hg, and respiratory rate 13/min.", "13. Vaginal examination is normal.", "14. No adnexal masses are detected.", "15. No vaginal secretions are noticed.", "16. Urine culture from 1 week ago was negative < 100,000 CFU/mL to no bacterial growth in asymptomatic patients.", "17. Urinalysis from 1 week ago showed density 1.030, leukocyte esterase (-), nitrites (-), pH 6.0, and 4 RBCs per high power field."], "atomic_facts": ["1. The patient has been experiencing abdominal cramps, alternating periods of diarrhea and constipation for the past 4 months.", "2. Her family medical history is negative for malignancies and hereditary disorders.", "3. She has a personal history of multiple visits to general practitioners for similar complaints, resulting in multiple antimicrobial treatments for urinary tract infection.", "4. She is not currently taking any medication.", "5. Physical examination shows suprapubic tenderness and tender areas in the pelvic floor.", "6. Vital signs include: temperature 37.0\u00b0C (98.6\u00b0F), heart rate 68/min, blood pressure 120/58 mm Hg, and respiratory rate 13/min.", "7. Vaginal examination is normal.", "8. No adnexal masses are detected and no vaginal secretions are noticed.", "9. Urinalysis from 1 week ago shows density: 1.030; leukocyte esterase (-); nitrites (-); pH: 6.0, presence of 4 RBCs per high power field.", "10. Urine culture from 1 week ago is negative for bacterial growth."]}
{"id": 1165, "question": "Which of the following is the most appropriate next step in management?\"", "context": ["A 27-year-old man comes to the physician for a routine health maintenance examination.", "He says he feels well, but is worried because his 32-year-old brother recently had to start hemodialysis because of kidney disease.", "He reports that his grandfather had \"\"bad kidneys\u201d as well.", "The patient does not have dysuria, hematuria, or flank pain.", "He has no history of serious illness.", "His vital signs are within normal limits.", "Physical examination shows no abnormalities.", "An ultrasound of his right kidney is shown."], "context_len": 8, "options": {"A": "Percutaneous aspiration", "B": "Reassurance", "C": "Abdominal CT scan", "D": "Partial nephrectomy"}, "answer": "Reassurance", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "27", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Family Medicine"}, "facts_old": ["1. A 27-year-old man comes to the physician for a routine health maintenance examination.", "2. He says he feels well.", "3. His 32-year-old brother recently had to start hemodialysis because of kidney disease.", "4. He reports that his grandfather had \"bad kidneys\" as well.", "5. The patient does not have dysuria, hematuria, or flank pain.", "6. He has no history of serious illness.", "7. His vital signs are within normal limits.", "8. Physical examination shows no abnormalities.", "9. An ultrasound of his right kidney is shown."], "atomic_facts": ["1. The patient feels well.", "2. The patient's 32-year-old brother recently started hemodialysis due to kidney disease.", "3. The patient's grandfather had \"bad kidneys.\"", "4. The patient does not have dysuria.", "5. The patient does not have hematuria.", "6. The patient does not have flank pain.", "7. The patient has no history of serious illness.", "8. The patient's vital signs are within normal limits.", "9. Physical examination shows no abnormalities.", "10. An ultrasound of the patient's right kidney is shown."]}
{"id": 1166, "question": "Which of the following best describes the mechanism of action for his blood pressure medication?", "context": ["A 45-year-old man is following up with his primary care doctor for follow up of his essential hypertension.", "This is his annual check-up, and he reports that he has been doing well since his appointment last year.", "He denies any negative side effects from his amlodipine or metformin.", "His physical examination is within normal limits, and his vital signs are all within normal limits, other than his blood pressure being 142/84 mm Hg."], "context_len": 4, "options": {"A": "Dihydropyridine calcium channel blockers preferentially bind to a vascular smooth muscle", "B": "Calcium channel blockers only bind to channels on cardiac muscles", "C": "Non-dihydropyridine calcium channel blockers preferentially bind to a vascular smooth muscle", "D": "Calcium channel blockers only bind to channels on the sarcoplasmic reticulum"}, "answer": "Dihydropyridine calcium channel blockers preferentially bind to a vascular smooth muscle", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "45", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine", "Cardiovascular Disease", "Hypertension Specialist"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 45-year-old man is following up with his primary care doctor.", "2. This is his annual check-up.", "3. He reports that he has been doing well since his appointment last year.", "4. He denies any negative side effects from his amlodipine or metformin.", "5. His physical examination is within normal limits.", "6. His vital signs are all within normal limits.", "7. His blood pressure is 142/84 mm Hg."], "atomic_facts": ["1. This is his annual check-up.", "2. He reports that he has been doing well since his appointment last year.", "3. He denies any negative side effects from his amlodipine.", "4. He denies any negative side effects from his metformin.", "5. His physical examination is within normal limits.", "6. His vital signs are all within normal limits.", "7. His blood pressure is 142/84 mm Hg."]}
{"id": 1167, "question": "Which of the following pairs of adjectives most likely characterize the patient\u2019s skin lesions:", "context": ["A 50-year-old male visits his primary care physician with skin lesions on his knees and elbows.", "He reports joint pain, and physical examination reveals severe swelling of the fingers on both hands.", "Tests for serum rheumatoid factor are negative."], "context_len": 3, "options": {"A": "Honey-colored, crusting", "B": "Irregular, depigmented", "C": "Silver, scaly", "D": "Non-blanching, hemorrhagic"}, "answer": "Silver, scaly", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "50", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 50-year-old male visits his primary care physician.", "2. He has skin lesions on his knees and elbows.", "3. He reports joint pain.", "4. Physical examination reveals severe swelling of the fingers on both hands.", "5. Tests for serum rheumatoid factor are negative."], "atomic_facts": ["1. The patient reports joint pain.", "2. Physical examination reveals severe swelling of the fingers on both hands.", "3. Tests for serum rheumatoid factor are negative."]}
{"id": 1168, "question": "Which of the following is the most appropriate next step in the management of this patient?\"", "context": ["A 42-year-old woman comes to the physician because of a low-grade fever and generalized fatigue for a week.", "During this period, she has passed decreased amounts of urine.", "Two months ago, she underwent a renal allograft transplant because of reflux nephropathy.", "There is no family history of serious illness.", "Her current medications include prednisone, cyclosporine, and azathioprine.", "Her temperature is 37.8\u00b0C (100\u00b0F), pulse is 99/min, and blood pressure is 160/94 mm Hg.", "Examination shows several white patches within the oral cavity.", "There is a well-healed surgical incision over the right lower abdomen.", "The remainder of the examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 12.1 g/dL | Leukocyte count 6,000/mm3 | Platelet count 156,000/mm3 | Serum | Urea nitrogen 89 mg/dL | Glucose 76 mg/dL | Creatinine 3.9 mg/dL | Donor-specific antibodies negative | A biopsy of the allograft shows mononuclear infiltrates with tubulitis and arteritis.", "C4d staining is negative.", "Oral fluconazole is administered."], "context_len": 12, "options": {"A": "Intravenous immunoglobulin therapy", "B": "Methylprednisolone therapy", "C": "Removal of graft", "D": "Plasmapheresis"}, "answer": "Methylprednisolone therapy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "42 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 42-year-old woman comes to the physician.", "2. She has a low-grade fever and generalized fatigue for a week.", "3. She has passed decreased amounts of urine.", "4. Two months ago, she underwent a renal allograft transplant because of reflux nephropathy.", "5. There is no family history of serious illness.", "6. Her current medications include prednisone, cyclosporine, and azathioprine.", "7. Her temperature is 37.8\u00b0C (100\u00b0F).", "8. Her pulse is 99/min.", "9. Her blood pressure is 160/94 mm Hg.", "10. Examination shows several white patches within the oral cavity.", "11. There is a well-healed surgical incision over the right lower abdomen.", "12. The remainder of the examination shows no abnormalities.", "13. Laboratory studies show: Hemoglobin 12.1 g/dL.", "14. Laboratory studies show: Leukocyte count 6,000/mm3.", "15. Laboratory studies show: Platelet count 156,000/mm3.", "16. Laboratory studies show: Serum urea nitrogen 89 mg/dL.", "17. Laboratory studies show: Glucose 76 mg/dL.", "18. Laboratory studies show: Creatinine 3.9 mg/dL.", "19. Laboratory studies show: Donor-specific antibodies negative.", "20. A biopsy of the allograft shows mononuclear infiltrates with tubulitis and arteritis.", "21. C4d staining is negative.", "22. Oral fluconazole is administered."], "atomic_facts": ["1. She has passed decreased amounts of urine.", "2. Two months ago, she underwent a renal allograft transplant because of reflux nephropathy.", "3. There is no family history of serious illness.", "4. Her current medications include prednisone, cyclosporine, and azathioprine.", "5. Her temperature is 37.8\u00b0C (100\u00b0F), pulse is 99/min, and blood pressure is 160/94 mm Hg.", "6. Examination shows several white patches within the oral cavity.", "7. There is a well-healed surgical incision over the right lower abdomen.", "8. The remainder of the examination shows no abnormalities.", "9. Laboratory studies show: Hemoglobin 12.1 g/dL, Leukocyte count 6,000/mm3, Platelet count 156,000/mm3, Serum Urea nitrogen 89 mg/dL, Glucose 76 mg/dL, Creatinine 3.9 mg/dL, Donor-specific antibodies negative.", "10. A biopsy of the allograft shows mononuclear infiltrates with tubulitis and arteritis.", "11. C4d staining is negative.", "12. Oral fluconazole is administered."]}
{"id": 1169, "question": "Which of the following lesions is the patient at risk to develop?", "context": ["A 55-year-old woman is brought to your office for evaluation of 6 months of anal discomfort, vaginal pruritus, and soreness that worsened in the last several months.", "The past medical history is significant for hypertension and smoking.", "The family history is negative for malignancies.", "The physical examination is unremarkable, except for the presence of white, atrophic papules merging into an ulcerated plaque, with some of the white lesions extending and surrounding the anus (see image).", "You order biopsies of the lesions and a follow-up appointment.", "2 weeks later, the histology evaluation reports hyperkeratosis, significant epidermal thinning, and plugging of infundibular follicles."], "context_len": 6, "options": {"A": "Basal cell carcinoma (BCC)", "B": "Vulvar low-grade squamous intraepithelial lesion (LSIL)", "C": "Differentiated squamous cell carcinoma (SCC)", "D": "Vulvar high-grade squamous intraepithelial lesion (HSIL)"}, "answer": "Differentiated squamous cell carcinoma (SCC)", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "55 years old", "specialties": ["Dermatology", "Obstetrics and Gynecology"], "subspecialties": ["General Dermatology", "Gynecologic Oncology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 55-year-old woman is brought to the office for evaluation.", "2. The symptoms are 6 months of anal discomfort, vaginal pruritus, and soreness that worsened in the last several months.", "3. The past medical history is significant for hypertension and smoking.", "4. The family history is negative for malignancies.", "5. The physical examination is unremarkable, except for the presence of white, atrophic papules merging into an ulcerated plaque.", "6. Some of the white lesions extend and surround the anus.", "7. Biopsies of the lesions and a follow-up appointment are ordered.", "8. 2 weeks later, the histology evaluation reports hyperkeratosis.", "9. The histology evaluation also reports significant epidermal thinning.", "10. The histology evaluation also reports plugging of infundibular follicles."], "atomic_facts": ["1. Past medical history includes hypertension and smoking.", "2. Family history is negative for malignancies.", "3. Physical examination shows white, atrophic papules merging into an ulcerated plaque, with some of the white lesions extending and surrounding the anus.", "4. Biopsies of the lesions are ordered.", "5. A follow-up appointment is scheduled.", "6. Histology evaluation 2 weeks later reports hyperkeratosis, significant epidermal thinning, and plugging of infundibular follicles."]}
{"id": 1170, "question": "Which of the following is the most likely diagnosis in this patient?", "context": ["A 32-year-old male presents to his primary care physician with complaints of chronic headaches that have developed and increased in frequency and severity over the last several months.", "Additionally, the patient has noted he has been less coordinated over the last few weeks, stumbling and tripping often when he is walking.", "Physical examination is significant for notably reduced hand grip strength bilaterally as well as decreased pain and temperature sensation along the upper back and down both arms to the hands.", "A referral to the appropriate specialist is made, and an MRI of the brain and neck is obtained.", "Results of the MRI are show in Figures A and B."], "context_len": 5, "options": {"A": "Arnold-Chiari malformation type 1", "B": "Arnold-Chiari malformation type 2", "C": "Arnold-Chiari malformation type 3", "D": "Arnold-Chiari malformation type 4"}, "answer": "Arnold-Chiari malformation type 1", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "32", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 32-year-old male presents to his primary care physician.", "2. The patient has been experiencing chronic headaches for several months.", "3. The headaches have been increasing in frequency and severity.", "4. The patient has been less coordinated over the last few weeks, stumbling and tripping often when he is walking.", "5. Physical examination is significant for notably reduced hand grip strength bilaterally.", "6. Physical examination is also significant for decreased pain and temperature sensation along the upper back and down both arms to the hands.", "7. A referral to the appropriate specialist is made.", "8. An MRI of the brain and neck is obtained.", "9. Results of the MRI are shown in Figures A and B."], "atomic_facts": ["1. The patient has noted he has been less coordinated over the last few weeks, stumbling and tripping often when he is walking.", "2. Physical examination is significant for notably reduced hand grip strength bilaterally.", "3. Physical examination is significant for decreased pain and temperature sensation along the upper back and down both arms to the hands.", "4. A referral to the appropriate specialist is made.", "5. An MRI of the brain and neck is obtained.", "6. Results of the MRI are shown in Figures A and B."]}
{"id": 1171, "question": "Which of the following is the most appropriate next step in management?", "context": ["After hospitalization for urgent chemotherapy to treat Burkitt\u2019s lymphoma, a 7-year-old boy develops paresthesias of the fingers, toes, and face.", "Blood pressure is 100/65 mm Hg, respirations are 28/min, pulse is 100/min, and temperature is 36.2\u00b0C (97.2\u00b0F).", "Inflating a blood pressure cuff on the boy\u2019s arm produces carpal spasm.", "He has excreted 20 mL urine in the past 6 hours.", "Laboratory studies show the following: | Hemoglobin 15 g/dL | Leukocyte count 6,000/mm3 with a normal differential serum | K+ 6.5 mEq/L | Ca+ 6.6 mg/dL | Phosphorus 5.4 mg/dL | HCO3\u2212 15 mEq/L | Uric acid 12 mg/dL | Urea nitrogen 54 mg/dL | Creatinine 3.4 mg/dL | Arterial blood gas analysis on room air: | pH 7.30 | PCO2 30 mm Hg | O2 saturation 95% | Febuxostat is initiated."], "context_len": 5, "options": {"A": "Hemodialysis", "B": "Intravenous 0.9% saline", "C": "Sodium bicarbonate", "D": "Orotracheal intubation"}, "answer": "Hemodialysis", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "7 years old", "specialties": ["Pediatrics", "Neurology"], "subspecialties": ["Pediatric Hematology", "Neuromuscular Medicine", "Pediatric Neurology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 7-year-old boy develops paresthesias of the fingers, toes, and face after hospitalization for urgent chemotherapy to treat Burkitt\u2019s lymphoma. ", "2. Blood pressure is 100/65 mm Hg, respirations are 28/min, pulse is 100/min, and temperature is 36.2\u00b0C (97.2\u00b0F). ", "3. Inflating a blood pressure cuff on the boy\u2019s arm produces carpal spasm. ", "4. He has excreted 20 mL urine in the past 6 hours. ", "5. Laboratory studies show hemoglobin 15 g/dL. ", "6. Laboratory studies show leukocyte count 6,000/mm3 with a normal differential serum. ", "7. Laboratory studies show K+ 6.5 mEq/L. ", "8. Laboratory studies show Ca+ 6.6 mg/dL. ", "9. Laboratory studies show phosphorus 5.4 mg/dL. ", "10. Laboratory studies show HCO3\u2212 15 mEq/L. ", "11. Laboratory studies show uric acid 12 mg/dL. ", "12. Laboratory studies show urea nitrogen 54 mg/dL. ", "13. Laboratory studies show creatinine 3.4 mg/dL. ", "14. Arterial blood gas analysis on room air shows pH 7.30. ", "15. Arterial blood gas analysis on room air shows PCO2 30 mm Hg. ", "16. Arterial blood gas analysis on room air shows O2 saturation 95%. ", "17. Febuxostat is initiated."], "atomic_facts": ["1. Blood pressure is 100/65 mm Hg.", "2. Respirations are 28/min.", "3. Pulse is 100/min.", "4. Temperature is 36.2\u00b0C (97.2\u00b0F).", "5. Inflating a blood pressure cuff on the boy\u2019s arm produces carpal spasm.", "6. He has excreted 20 mL urine in the past 6 hours.", "7. Hemoglobin is 15 g/dL.", "8. Leukocyte count is 6,000/mm3 with a normal differential serum.", "9. Serum K+ is 6.5 mEq/L.", "10. Serum Ca+ is 6.6 mg/dL.", "11. Serum phosphorus is 5.4 mg/dL.", "12. Serum HCO3\u2212 is 15 mEq/L.", "13. Uric acid is 12 mg/dL.", "14. Urea nitrogen is 54 mg/dL.", "15. Creatinine is 3.4 mg/dL.", "16. Arterial blood gas analysis on room air shows: pH 7.30, PCO2 30 mm Hg, O2 saturation 95%.", "17. Febuxostat is initiated."]}
{"id": 1172, "question": "Which of the following is most likely to be present on this patient's urine culture?\"", "context": ["An 84-year-old woman with an indwelling urinary catheter and a history of recurrent nephrolithiasis is brought to the emergency department from her nursing home because of increasing confusion over the past day.", "On arrival, she is oriented only to person.", "Her temperature is 38.3\u00b0C (100.9\u00b0F).", "Examination shows dry mucous membranes.", "Urine studies show: | pH 8.3 | WBC 40/hpf | Bacteria moderate | Nitrites positive | The urine has an ammonia odor."], "context_len": 5, "options": {"A": "Gram-negative, oxidase-positive rods", "B": "Gram-positive, novobiocin-resistant cocci", "C": "Gram-positive, gamma-hemolytic cocci", "D": "Gram-negative, oxidase-negative rods"}, "answer": "Gram-negative, oxidase-negative rods", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "84 years old", "specialties": ["Internal Medicine", "Urology"], "subspecialties": ["Infectious Disease", "General Urology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. An 84-year-old woman has an indwelling urinary catheter and a history of recurrent nephrolithiasis.", "2. She was brought to the emergency department from her nursing home because of increasing confusion over the past day.", "3. On arrival, she is oriented only to person.", "4. Her temperature is 38.3\u00b0C (100.9\u00b0F).", "5. Examination shows dry mucous membranes.", "6. Urine studies show a pH of 8.3.", "7. Urine studies show WBC of 40/hpf.", "8. Urine studies show bacteria present in moderate amounts.", "9. Urine studies show nitrites are positive.", "10. The urine has an ammonia odor."], "atomic_facts": ["1. On arrival, she is oriented only to person.", "2. Her temperature is 38.3\u00b0C (100.9\u00b0F).", "3. Examination shows dry mucous membranes.", "4. Urine studies show: pH 8.3.", "5. Urine studies show: WBC 40/hpf.", "6. Urine studies show: Bacteria moderate.", "7. Urine studies show: Nitrites positive.", "8. The urine has an ammonia odor."]}
{"id": 1173, "question": "Which of the following ego defenses is this patient most closely exhibiting?", "context": ["A 28-year-old woman who was recently hired at a new company feels intense physical attraction towards her supervisor.", "She feels he is exceptionally kind to her and finds herself fantasizing about him during work.", "While talking to her co-workers, she ardently raises complaints about her supervisor and declares that she finds him to be extremely repulsive, rude, and arrogant."], "context_len": 3, "options": {"A": "Denial", "B": "Isolation of affect", "C": "Reaction formation", "D": "Repression"}, "answer": "Reaction formation", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "28", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry", "C: \"Reaction formation\"", "Clinical Neurophysiology", "Reaction Formation"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 28-year-old woman was recently hired at a new company.", "2. She feels intense physical attraction towards her supervisor.", "3. She feels he is exceptionally kind to her.", "4. She finds herself fantasizing about him during work.", "5. She ardently raises complaints about her supervisor while talking to her co-workers.", "6. She declares that she finds her supervisor to be extremely repulsive, rude, and arrogant."], "atomic_facts": ["1. She feels he is exceptionally kind to her.", "2. She finds herself fantasizing about him during work.", "3. She ardently raises complaints about her supervisor.", "4. She declares that she finds him to be extremely repulsive.", "5. She declares that she finds him to be rude.", "6. She declares that she finds him to be arrogant."]}
{"id": 1174, "question": "Which of the following is the best next step in management?", "context": ["An 11-year-old boy presents to his pediatrician with his mother for a sore throat.", "His symptoms began approximately a few days ago after attending a birthday party with his friends.", "His symptoms are accompanied by nausea, vomiting, and a mild headache.", "He also has mild discomfort in his throat when eating food or drinking water.", "The patient denies rhinorrhea, conjunctivitis, cough, myalgias, or a rash.", "His mother said his temperature last night was 101\u00b0F (38.3\u00b0C).", "On physical exam, the patient has tender and enlarged anterior cervical lymph nodes.", "Upon oral inspection, there is pharyngeal inflammation and exudates with petechial lesions on the soft palate."], "context_len": 8, "options": {"A": "Azithromycin", "B": "Observation", "C": "Penicillin V", "D": "Rapid antigen detection test"}, "answer": "Rapid antigen detection test", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "11 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Infectious Diseases"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is an 11-year-old boy.", "2. Patient is presenting to his pediatrician with his mother.", "3. Patient has a sore throat.", "4. Symptoms began a few days ago after attending a birthday party with friends.", "5. Symptoms include nausea, vomiting, and a mild headache.", "6. Patient has mild discomfort in throat when eating food or drinking water.", "7. Patient denies rhinorrhea, conjunctivitis, cough, myalgias, or a rash.", "8. Mother reported patient's temperature last night was 101\u00b0F (38.3\u00b0C).", "9. On physical exam, patient has tender and enlarged anterior cervical lymph nodes.", "10. Upon oral inspection, there is pharyngeal inflammation and exudates with petechial lesions on the soft palate."], "atomic_facts": ["1. Symptoms began a few days ago after attending a birthday party with friends.", "2. Symptoms include nausea, vomiting, and a mild headache.", "3. Patient has mild discomfort in the throat when eating or drinking.", "4. Patient denies rhinorrhea, conjunctivitis, cough, myalgias, or a rash.", "5. Patient's temperature last night was 101\u00b0F (38.3\u00b0C).", "6. On physical exam, the patient has tender and enlarged anterior cervical lymph nodes.", "7. Upon oral inspection, there is pharyngeal inflammation and exudates with petechial lesions on the soft palate."]}
{"id": 1175, "question": "Which of the following compounds is most likely responsible for this patient's symptoms?", "context": ["A 52-year-old male with follicular non-Hodgkin lymphoma undergoes chemotherapy.", "He develops suprapubic pain and hematuria."], "context_len": 2, "options": {"A": "Cyclophosphamide", "B": "Mesna", "C": "Bleomycin", "D": "Carmustine"}, "answer": "Cyclophosphamide", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "52", "specialties": ["Internal Medicine", "Medical Oncology"], "subspecialties": ["Medical Oncology", "General Medical Oncology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 52-year-old male has follicular non-Hodgkin lymphoma.", "2. He undergoes chemotherapy.", "3. He develops suprapubic pain.", "4. He develops hematuria."], "atomic_facts": ["1. The patient develops suprapubic pain.", "2. The patient develops hematuria."]}
{"id": 1176, "question": "Which of the following is the most appropriate pharmacotherapy for this patient?", "context": ["A 68-year-old man comes to the physician because of a 1-week history of difficulty with urination.", "Two weeks ago, he was hospitalized for treatment of a cerebrovascular accident; his symptoms began after he was discharged.", "His vital signs are within normal limits.", "Neurologic examination shows mild dysarthria, right facial droop, and right hemiparesis.", "Rectal examination shows a normal prostate.", "The patient produces 70 mL of urine for a sample.", "Placement of a Foley catheter yields an additional 500 mL of urine."], "context_len": 7, "options": {"A": "Muscarinic agonist", "B": "Muscarinic antagonist", "C": "Alpha-1 receptor agonist", "D": "5-alpha-reductase inhibitor"}, "answer": "Muscarinic agonist", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "68 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 68-year-old man comes to the physician.", "2. He has a 1-week history of difficulty with urination.", "3. Two weeks ago, he was hospitalized for treatment of a cerebrovascular accident.", "4. His symptoms began after he was discharged.", "5. His vital signs are within normal limits.", "6. Neurologic examination shows mild dysarthria, right facial droop, and right hemiparesis.", "7. Rectal examination shows a normal prostate.", "8. The patient produces 70 mL of urine for a sample.", "9. Placement of a Foley catheter yields an additional 500 mL of urine."], "atomic_facts": ["1. Two weeks ago, he was hospitalized for treatment of a cerebrovascular accident", "2. His symptoms began after he was discharged", "3. His vital signs are within normal limits", "4. Neurologic examination shows mild dysarthria", "5. Neurologic examination shows right facial droop", "6. Neurologic examination shows right hemiparesis", "7. Rectal examination shows a normal prostate", "8. The patient produces 70 mL of urine for a sample", "9. Placement of a Foley catheter yields an additional 500 mL of urine"]}
{"id": 1177, "question": "Which of the following is the next best diagnostic step in this patient?", "context": ["A 61-year-old woman presents with painless vaginal bleeding.", "Patient says the bleeding has been occurring occasionally for the past 3 years.", "Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically.", "Current medications are atorvastatin, lisinopril, hydrochlorothiazide, and metformin.", "Patient has not been sexually active since the death of her husband 9 years ago.", "Menopause occurred 8 years ago, and she denies taking hormone replacement therapy or estrogen-containing oral contraceptives.", "Her last Pap smear 1 year ago was normal.", "Vital signs are temperature 37.0\u2103 (98.6\u2109), blood pressure 130/85 mm Hg, pulse 82/min, respiratory rate 13/min, and oxygen saturation 99% on room air.", "BMI is 33.8 kg/m2.", "On physical examination, patient is alert and cooperative.", "Cardiac exam is normal.", "Lungs are clear to auscultation.", "Abdomen is soft and non-tender with no masses or hepatosplenomegaly.", "Examination of the perineum shows pale, atrophic vaginal mucosa.", "Speculum examination shows no vaginal or cervical lesions.", "The cervix is movable and non-tender.", "There is trace blood in the vaginal vault and mild bleeding from the cervical os.", "The uterus is not enlarged but softened on palpation.", "Adnexa is non-palpable."], "context_len": 19, "options": {"A": "Hysteroscopy", "B": "Pap test", "C": "Endometrial biopsy", "D": "Pelvic MRI"}, "answer": "Endometrial biopsy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "61 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is 61 years old.", "2. Patient presents with painless vaginal bleeding.", "3. Patient says the bleeding has been occurring occasionally for the past 3 years.", "4. Patient has a past medical history of diabetes mellitus type 2 and hypertension, both managed medically.", "5. Patient's current medications are atorvastatin, lisinopril, hydrochlorothiazide, and metformin.", "6. Patient has not been sexually active since the death of her husband 9 years ago.", "7. Patient's menopause occurred 8 years ago.", "8. Patient denies taking hormone replacement therapy or estrogen-containing oral contraceptives.", "9. Patient's last Pap smear 1 year ago was normal.", "10. Patient's vital signs are temperature 37.0\u2103 (98.6\u2109), blood pressure 130/85 mm Hg, pulse 82/min, respiratory rate 13/min, and oxygen saturation 99% on room air.", "11. Patient's BMI is 33.8 kg/m2.", "12. On physical examination, patient is alert and cooperative.", "13. Cardiac exam is normal.", "14. Lungs are clear to auscultation.", "15. Abdomen is soft and non-tender with no masses or hepatosplenomegaly.", "16. Examination of the perineum shows pale, atrophic vaginal mucosa.", "17. Speculum examination shows no vaginal or cervical lesions.", "18. Cervix is movable and non-tender.", "19. There is trace blood in the vaginal vault and mild bleeding from the cervical os.", "20. Uterus is not enlarged but softened on palpation.", "21. Adnexa is non-palpable."], "atomic_facts": ["1. Patient reports bleeding occurring occasionally for the past 3 years.", "2. Past medical history includes diabetes mellitus type 2 and hypertension, both managed medically.", "3. Current medications are atorvastatin, lisinopril, hydrochlorothiazide, and metformin.", "4. Patient has not been sexually active since the death of her husband 9 years ago.", "5. Menopause occurred 8 years ago, and she denies taking hormone replacement therapy or estrogen-containing oral contraceptives.", "6. Last Pap smear 1 year ago was normal.", "7. Vital signs: temperature 37.0\u2103 (98.6\u2109), blood pressure 130/85 mm Hg, pulse 82/min, respiratory rate 13/min, and oxygen saturation 99% on room air.", "8. BMI is 33.8 kg/m2.", "9. On physical examination, patient is alert and cooperative.", "10. Cardiac exam is normal.", "11. Lungs are clear to auscultation.", "12. Abdomen is soft and non-tender with no masses or hepatosplenomegaly.", "13. Examination of the perineum shows pale, atrophic vaginal mucosa.", "14. Speculum examination shows no vaginal or cervical lesions.", "15. The cervix is movable and non-tender.", "16. There is trace blood in the vaginal vault and mild bleeding from the cervical os.", "17. The uterus is not enlarged but softened on palpation.", "18. Adnexa is non-palpable."]}
{"id": 1178, "question": "Which of the following is the best initial step in her management?", "context": ["A 20-year-old African American woman presents to the clinic after missing her last 2 periods.", "Her cycles are usually regular, occurring at 28\u201332 day intervals with moderate bleeding and some abdominal discomfort.", "She also complains of occasional diffuse and generalized headaches.", "She is a college student and works part-time as a bartender.", "The past medical history is benign.", "The blood pressure is 110/70 mm Hg, the pulse is 80/min, the respiratory rate is 14/min, and the temperature is 36.5\u00b0C (97.7\u00b0F).", "The physical examination is significant for mild breast tenderness and secretions from the nipple area.", "A urine pregnancy test is negative."], "context_len": 8, "options": {"A": "MRI of the brain", "B": "Serum prolactin levels", "C": "LH:FSH ratio", "D": "Dopamine agonists"}, "answer": "Serum prolactin levels", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Reproductive Endocrinology and Infertility"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 20-year-old African American woman.", "2. Patient has missed her last 2 periods.", "3. Patient's cycles are usually regular, occurring at 28\u201332 day intervals with moderate bleeding and some abdominal discomfort.", "4. Patient complains of occasional diffuse and generalized headaches.", "5. Patient is a college student and works part-time as a bartender.", "6. Patient's past medical history is benign.", "7. Patient's blood pressure is 110/70 mm Hg.", "8. Patient's pulse is 80/min.", "9. Patient's respiratory rate is 14/min.", "10. Patient's temperature is 36.5\u00b0C (97.7\u00b0F).", "11. Physical examination is significant for mild breast tenderness and secretions from the nipple area.", "12. Urine pregnancy test is negative."], "atomic_facts": ["1. Her cycles are usually regular, occurring at 28\u201332 day intervals with moderate bleeding and some abdominal discomfort.", "2. She complains of occasional diffuse and generalized headaches.", "3. She is a college student and works part-time as a bartender.", "4. The past medical history is benign.", "5. The blood pressure is 110/70 mm Hg.", "6. The pulse is 80/min.", "7. The respiratory rate is 14/min.", "8. The temperature is 36.5\u00b0C (97.7\u00b0F).", "9. The physical examination is significant for mild breast tenderness and secretions from the nipple area.", "10. A urine pregnancy test is negative."]}
{"id": 1179, "question": "Further evaluation is most likely to show which of the following?", "context": ["A 50-year-old man comes to the physician because of an 8-month history of intermittent watery diarrhea and abdominal pain.", "He has had a 12-kg (26-lb) weight loss during this period.", "He has also had episodic pain of the ankle, wrist, and knee joints during the past 5 years.", "An endoscopy with small bowel biopsy is performed.", "Histopathologic examination of a tissue specimen shows foamy macrophages in the lamina propria with periodic acid-Schiff (PAS)-positive inclusions."], "context_len": 5, "options": {"A": "Anti-tissue transglutaminase antibodies", "B": "Anti-cyclic citrullinated peptide antibody", "C": "Intracellular, gram-positive bacilli", "D": "Low serum TSH and high free T4 concentrations"}, "answer": "Intracellular, gram-positive bacilli", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "50", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 50-year-old man comes to the physician.", "2. He has had an 8-month history of intermittent watery diarrhea and abdominal pain.", "3. He has had a 12-kg (26-lb) weight loss during this period.", "4. He has had episodic pain of the ankle, wrist, and knee joints during the past 5 years.", "5. An endoscopy with small bowel biopsy is performed.", "6. Histopathologic examination of a tissue specimen shows foamy macrophages in the lamina propria.", "7. The foamy macrophages are periodic acid-Schiff (PAS)-positive inclusions."], "atomic_facts": ["1. He has had a 12-kg (26-lb) weight loss during this period.", "2. He has also had episodic pain of the ankle, wrist, and knee joints during the past 5 years.", "3. An endoscopy with small bowel biopsy is performed.", "4. Histopathologic examination of a tissue specimen shows foamy macrophages in the lamina propria.", "5. The tissue specimen shows periodic acid-Schiff (PAS)-positive inclusions."]}
{"id": 1180, "question": "The drug that most specifically targets this patient's tumor is also used in the treatment of which of the following conditions?", "context": ["A 49-year-old woman comes to the physician because of a growing lump in the right breast that she first noticed 1 month ago.", "Physical examination of the right breast shows a 3.5-cm firm, fixed mass in the right upper quadrant.", "There is dimpling of the overlying skin.", "A mammogram shows a mass with poorly-defined margins and microcalcifications.", "Immunohistochemical analysis of a biopsy specimen from the mass shows malignant cells that stain negative for estrogen and progesterone receptors and positive for human epidermal growth factor receptor 2."], "context_len": 5, "options": {"A": "Multiple sclerosis", "B": "Gastric cancer", "C": "Osteoporosis", "D": "Rheumatoid arthritis"}, "answer": "Gastric cancer", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "49", "specialties": ["Oncology", "Internal Medicine"], "subspecialties": ["Medical Oncology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 49-year-old woman comes to the physician.", "2. She noticed a growing lump in the right breast 1 month ago.", "3. Physical examination of the right breast shows a 3.5-cm firm, fixed mass in the right upper quadrant.", "4. There is dimpling of the overlying skin.", "5. A mammogram shows a mass with poorly-defined margins and microcalcifications.", "6. Immunohistochemical analysis of a biopsy specimen from the mass shows malignant cells.", "7. The malignant cells stain negative for estrogen and progesterone receptors.", "8. The malignant cells stain positive for human epidermal growth factor receptor 2."], "atomic_facts": ["1. Physical examination of the right breast shows a 3.5-cm firm, fixed mass in the right upper quadrant.", "2. There is dimpling of the overlying skin.", "3. A mammogram shows a mass with poorly-defined margins and microcalcifications.", "4. Immunohistochemical analysis of a biopsy specimen from the mass shows malignant cells.", "5. The malignant cells stain negative for estrogen and progesterone receptors.", "6. The malignant cells stain positive for human epidermal growth factor receptor 2."]}
{"id": 1181, "question": "Which of the following is the most appropriate next step in diagnosis?", "context": ["A 17-year-old girl is brought to the physician because her mother is concerned about her lack of appetite.", "She has had a 4-kg (8.8-lb) weight loss over the past 4 months.", "The patient states that she does not \u201cfeel like eating so much\u201d.", "Over the last year her academic performance in school has decreased and she has had a lot of disputes with her parents concerning her future.", "Her mother says that she has also become more nervous and restless.", "Her grandmother had a problem with her thyroid.", "She is sexually active with two male partners and uses condoms inconsistently.", "She is at 60th percentile for height and at 15th percentile for weight.", "She appears thin.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 104/min, and blood pressure is 135/80 mm Hg.", "The pupils are 9 mm large, round and minimally reactive to light.", "Deep tendon reflexes are 2+ bilaterally.", "There is fine tremor of her hands.", "The remainder of the examination shows no abnormalities."], "context_len": 14, "options": {"A": "Measure serum electrolytes", "B": "Perform abdominal ultrasound", "C": "Obtain toxicology screening", "D": "Obtain HIV screening test"}, "answer": "Obtain toxicology screening", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "17 years old", "specialties": ["Pediatrics"], "subspecialties": ["Adolescent Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 17-year-old girl.", "2. Patient has had a 4-kg (8.8-lb) weight loss over the past 4 months.", "3. Patient states that she does not \u201cfeel like eating so much\u201d.", "4. Patient's academic performance in school has decreased over the last year.", "5. Patient has had a lot of disputes with her parents concerning her future.", "6. Patient's mother says that she has also become more nervous and restless.", "7. Patient's grandmother had a problem with her thyroid.", "8. Patient is sexually active with two male partners and uses condoms inconsistently.", "9. Patient is at 60th percentile for height and at 15th percentile for weight.", "10. Patient appears thin.", "11. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "12. Patient's pulse is 104/min.", "13. Patient's blood pressure is 135/80 mm Hg.", "14. Patient's pupils are 9 mm large, round and minimally reactive to light.", "15. Patient's deep tendon reflexes are 2+ bilaterally.", "16. Patient has fine tremor of her hands.", "17. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. She has had a 4-kg (8.8-lb) weight loss over the past 4 months.", "2. The patient states that she does not \u201cfeel like eating so much\u201d.", "3. Over the last year her academic performance in school has decreased and she has had a lot of disputes with her parents concerning her future.", "4. Her mother says that she has also become more nervous and restless.", "5. Her grandmother had a problem with her thyroid.", "6. She is sexually active with two male partners and uses condoms inconsistently.", "7. She is at 60th percentile for height and at 15th percentile for weight.", "8. She appears thin.", "9. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 104/min, and blood pressure is 135/80 mm Hg.", "10. The pupils are 9 mm large, round and minimally reactive to light.", "11. Deep tendon reflexes are 2+ bilaterally.", "12. There is fine tremor of her hands.", "13. The remainder of the examination shows no abnormalities."]}
{"id": 1182, "question": "Which of the following additional findings is most likely to be found in this patient\u2019s history?", "context": ["An 11-year-old male presents to the pediatrician to be evaluated for learning difficulties.", "His parents report that the patient\u2019s grades have been falling since he started middle school this year.", "The patient previously attended a smaller elementary school that focused more on the arts and creative play.", "His parents report that at home the patient bathes and dresses himself independently but requires help with more difficult tasks, such as packing his backpack and making a schedule for homework.", "He enjoys reading comic books and playing video games.", "The patient\u2019s parents report that he said his first word at 19 months and walked at 21 months.", "His mother notes that she herself struggled to pay attention in her classes and completed college in six years after taking a reduced course load.", "On physical exam, the patient has a long, narrow face with large ears.", "His testicles are larger than expected for his age."], "context_len": 9, "options": {"A": "Compulsive completion of rituals", "B": "Cruelty to animals or fire-setting", "C": "Difficulty seeing the board at school", "D": "Poor reciprocal emotional behavior"}, "answer": "Poor reciprocal emotional behavior", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "11 years old", "specialties": ["Pediatrics", "Psychiatry"], "subspecialties": ["Developmental", "Child and Adolescent Psychiatry"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is 11-year-old male.", "2. Patient presents to pediatrician to be evaluated for learning difficulties.", "3. Patient's grades have been falling since he started middle school this year.", "4. Patient previously attended a smaller elementary school that focused more on the arts and creative play.", "5. Patient bathes and dresses himself independently.", "6. Patient requires help with more difficult tasks, such as packing his backpack and making a schedule for homework.", "7. Patient enjoys reading comic books and playing video games.", "8. Patient said his first word at 19 months.", "9. Patient walked at 21 months.", "10. Patient's mother struggled to pay attention in her classes and completed college in six years after taking a reduced course load.", "11. On physical exam, patient has a long, narrow face with large ears.", "12. Patient's testicles are larger than expected for his age."], "atomic_facts": ["1. The patient's grades have been falling since he started middle school this year.", "2. The patient previously attended a smaller elementary school that focused more on the arts and creative play.", "3. At home, the patient bathes and dresses himself independently but requires help with more difficult tasks, such as packing his backpack and making a schedule for homework.", "4. He enjoys reading comic books and playing video games.", "5. The patient said his first word at 19 months and walked at 21 months.", "6. His mother struggled to pay attention in her classes and completed college in six years after taking a reduced course load.", "7. On physical exam, the patient has a long, narrow face with large ears.", "8. His testicles are larger than expected for his age."]}
{"id": 1183, "question": "Which of the following is the most likely diagnosis?", "context": ["A 17-year-old girl comes to the primary care clinic with her father complaining of right knee pain.", "She reports that the pain started about a month ago, and since then it has gotten progressively worse.", "The knee pain is not constant but becomes most noticeable when going up or down the stairs.", "She also endorses that her knee becomes uncomfortable towards the end of class.", "Her father is worried because the pain is affecting her ability to play basketball, and she has college scouts coming to watch her play.", "The patient has no chronic medical conditions.", "She had a tonsillectomy as a child.", "She takes a multivitamin and uses ibuprofen as needed for the pain.", "On physical examination, there is tenderness at the inferior pole of the patella, without swelling or overlying skin changes."], "context_len": 9, "options": {"A": "Osgood-Schlatter disease", "B": "Patellar stress fracture", "C": "Patellar tendonitis", "D": "Patellofemoral syndrome"}, "answer": "Patellar tendonitis", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "17 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is a 17-year-old female. ", "2. Patient is accompanied by her father. ", "3. Patient complains of right knee pain. ", "4. Pain started about a month ago. ", "5. Pain has gotten progressively worse. ", "6. Pain is not constant. ", "7. Pain is most noticeable when going up or down stairs. ", "8. Pain becomes uncomfortable towards the end of class. ", "9. Father is worried because pain is affecting her ability to play basketball. ", "10. College scouts are coming to watch her play. ", "11. Patient has no chronic medical conditions. ", "12. Patient had a tonsillectomy as a child. ", "13. Patient takes a multivitamin. ", "14. Patient uses ibuprofen as needed for the pain. ", "15. Physical examination reveals tenderness at the inferior pole of the patella. ", "16. No swelling or overlying skin changes noted."], "atomic_facts": ["1. The patient reports that the knee pain started about a month ago.", "2. The knee pain has gotten progressively worse since it started.", "3. The knee pain is most noticeable when going up or down the stairs.", "4. The patient's knee becomes uncomfortable towards the end of class.", "5. The patient's father is worried because the pain is affecting her ability to play basketball.", "6. The patient has college scouts coming to watch her play basketball.", "7. The patient has no chronic medical conditions.", "8. The patient had a tonsillectomy as a child.", "9. The patient takes a multivitamin.", "10. The patient uses ibuprofen as needed for the pain.", "11. On physical examination, there is tenderness at the inferior pole of the patella.", "12. There is no swelling or overlying skin changes at the site of tenderness."]}
{"id": 1184, "question": "Which of the following pathological type of polyp does this patient most likely have that also puts him at higher risk of malignancy?", "context": ["A 60-year-old man presents to the physician for his 10-year colonoscopy screening.", "He has no complaints except for occasional diarrhea and dribbling of urine.", "He says that he is on a healthy diet and exercises 3 days a week.", "He quit smoking 5 years ago after smoking 1 pack of cigarettes per day for 20 years.", "He has hypertension and dyslipidemia.", "He has benign prostatic hyperplasia that was diagnosed last year.", "On physical examination, his abdomen is lax with no tenderness or rigidity.", "Rectal examination reveals no blood in the rectal vault.", "Colonoscopy reveals a 4 x 3 cm polyp in the sigmoid colon.", "Multiple biopsies are obtained and sent for pathologic examination.", "Genetic testing reveals a mutation in the KRAS gene."], "context_len": 11, "options": {"A": "Hamartomatous polyps", "B": "Villous adenomatous polyps", "C": "Tubular adenomatous polyps", "D": "Hyperplastic polyps"}, "answer": "Villous adenomatous polyps", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "60", "specialties": ["Gastroenterology"], "subspecialties": ["General Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Colon and Rectal Surgery"}, "facts_old": ["1. A 60-year-old man presents to the physician for his 10-year colonoscopy screening.", "2. He has no complaints except for occasional diarrhea and dribbling of urine.", "3. He says that he is on a healthy diet and exercises 3 days a week.", "4. He quit smoking 5 years ago after smoking 1 pack of cigarettes per day for 20 years.", "5. He has hypertension and dyslipidemia.", "6. He has benign prostatic hyperplasia that was diagnosed last year.", "7. On physical examination, his abdomen is lax with no tenderness or rigidity.", "8. Rectal examination reveals no blood in the rectal vault.", "9. Colonoscopy reveals a 4 x 3 cm polyp in the sigmoid colon.", "10. Multiple biopsies are obtained and sent for pathologic examination.", "11. Genetic testing reveals a mutation in the KRAS gene."], "atomic_facts": ["1. He has occasional diarrhea.", "2. He has dribbling of urine.", "3. He is on a healthy diet.", "4. He exercises 3 days a week.", "5. He quit smoking 5 years ago.", "6. He smoked 1 pack of cigarettes per day for 20 years.", "7. He has hypertension.", "8. He has dyslipidemia.", "9. He has benign prostatic hyperplasia.", "10. It was diagnosed last year.", "11. His abdomen is lax on physical examination.", "12. There is no tenderness or rigidity in his abdomen.", "13. Rectal examination reveals no blood in the rectal vault.", "14. Colonoscopy reveals a 4 x 3 cm polyp in the sigmoid colon.", "15. Multiple biopsies are obtained.", "16. They are sent for pathologic examination.", "17. Genetic testing reveals a mutation in the KRAS gene."]}
{"id": 1185, "question": "Which of the following could be the mechanism of action of the administered drug?", "context": ["A 20-year-old healthy female volunteer is enrolled in a study involving renal perfusion.", "The medical history is unremarkable and she takes no medications.", "She denies smoking, drinking, and drug use.", "The family history is unremarkable.", "The physical examination reveals no abnormal findings.", "A drug which is known to selectively act on a segment of the renal vasculature is administered and the glomerular filtration rate (GFR) and filtration fraction (FF) both increase."], "context_len": 6, "options": {"A": "Efferent arteriole constriction", "B": "Renal artery constriction", "C": "Increased peritubular capillary permeability", "D": "Afferent arteriole constriction"}, "answer": "Efferent arteriole constriction", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Internal Medicine", "Nephrology"], "subspecialties": ["Nephrology", "General Nephrology"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Nuclear Medicine"}, "facts_old": ["1. A 20-year-old healthy female volunteer is enrolled in a study involving renal perfusion.", "2. The medical history is unremarkable.", "3. She takes no medications.", "4. She denies smoking.", "5. She denies drinking.", "6. She denies drug use.", "7. The family history is unremarkable.", "8. The physical examination reveals no abnormal findings.", "9. A drug is administered.", "10. The drug is known to selectively act on a segment of the renal vasculature.", "11. The glomerular filtration rate (GFR) increases.", "12. The filtration fraction (FF) increases."], "atomic_facts": ["1. The medical history is unremarkable.", "2. She takes no medications.", "3. She denies smoking.", "4. She denies drinking.", "5. She denies drug use.", "6. The family history is unremarkable.", "7. The physical examination reveals no abnormal findings.", "8. A drug is administered.", "9. The drug selectively acts on a segment of the renal vasculature.", "10. The glomerular filtration rate (GFR) increases.", "11. The filtration fraction (FF) increases."]}
{"id": 1186, "question": "This patient most likely has a deficiency in which of the following factors?", "context": ["A 3-year-old male is brought to the emergency room by his mother for a rash and fever.", "The mother reports that the child first developed a cough and malaise three days ago.", "Over the last 24 hours, a rash developed and the patient had a temperature up to 101.4\u00b0F (38.6\u00b0C) the night prior to presentation.", "The child\u2019s medical history is notable for a prior hospitalization at the age of 2 for fever, vomiting, and lethargy.", "During that hospitalization, a cerebrospinal fluid sample demonstrated gram-negative diplococci.", "His current temperature is 100.9\u00b0F (38.3\u00b0C), blood pressure is 130/85 mmHg, pulse is 115/min, and respirations are 22/min.", "Physical examination reveals a lethargic male child with a diffuse petechial skin rash that is most prominent on the trunk and legs."], "context_len": 7, "options": {"A": "C1q", "B": "C3", "C": "C4", "D": "C5"}, "answer": "C5", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases", "Pediatric Rheumatology", "General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 3-year-old male.", "2. Patient was brought to the emergency room by his mother.", "3. Patient has a rash and fever.", "4. Patient had a cough and malaise three days ago.", "5. Patient had a temperature up to 101.4\u00b0F (38.6\u00b0C) the night prior to presentation.", "6. Patient had a prior hospitalization at the age of 2 for fever, vomiting, and lethargy.", "7. During prior hospitalization, a cerebrospinal fluid sample demonstrated gram-negative diplococci.", "8. Patient's current temperature is 100.9\u00b0F (38.3\u00b0C).", "9. Patient's blood pressure is 130/85 mmHg.", "10. Patient's pulse is 115/min.", "11. Patient's respirations are 22/min.", "12. Physical examination reveals a lethargic male child with a diffuse petechial skin rash that is most prominent on the trunk and legs."], "atomic_facts": ["1. The child first developed a cough and malaise three days ago.", "2. Over the last 24 hours, a rash developed.", "3. The patient had a temperature up to 101.4\u00b0F (38.6\u00b0C) the night prior to presentation.", "4. The child\u2019s medical history is notable for a prior hospitalization at the age of 2 for fever, vomiting, and lethargy.", "5. During that hospitalization, a cerebrospinal fluid sample demonstrated gram-negative diplococci.", "6. His current temperature is 100.9\u00b0F (38.3\u00b0C).", "7. Blood pressure is 130/85 mmHg.", "8. Pulse is 115/min.", "9. Respirations are 22/min.", "10. Physical examination reveals a lethargic male child.", "11. The child has a diffuse petechial skin rash that is most prominent on the trunk and legs."]}
{"id": 1187, "question": "Which of the following is the most likely diagnosis?\"", "context": ["A 13-month-old boy is brought to the physician for the evaluation of rectal bleeding that occurred earlier that morning.", "The patient has also had several itchy and red skin lesions that started on his scalp and spread downwards.", "The parents report that their son has had six episodes of bilateral otitis media since birth.", "His immunizations are up-to-date.", "He is at the 3rd percentile for height and weight.", "His vital signs are within normal limits.", "Examination shows several eczematous lesions over the scalp, neck, and upper and lower extremities, as well as multiple red spots that do not blanch on pressure.", "The remainder of the physical examination shows no abnormalities.", "Laboratory studies show: | Hemoglobin 9.4 g/dL | Leukocyte count 11,500/mm3 | Platelet count 30,000/mm3 | Prothrombin time 14 sec | Partial thromboplastin time 33 sec | ."], "context_len": 9, "options": {"A": "Chronic granulomatous disease", "B": "DiGeorge syndrome", "C": "Chediak-Higashi syndrome", "D": "Wiskott-Aldrich syndrome"}, "answer": "Wiskott-Aldrich syndrome", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "13 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Gastroenterology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 13-month-old boy is brought to the physician for the evaluation of rectal bleeding that occurred earlier that morning.", "2. The patient has also had several itchy and red skin lesions that started on his scalp and spread downwards.", "3. The parents report that their son has had six episodes of bilateral otitis media since birth.", "4. His immunizations are up-to-date.", "5. He is at the 3rd percentile for height and weight.", "6. His vital signs are within normal limits.", "7. Examination shows several eczematous lesions over the scalp, neck, and upper and lower extremities, as well as multiple red spots that do not blanch on pressure.", "8. The remainder of the physical examination shows no abnormalities.", "9. Laboratory studies show: Hemoglobin 9.4 g/dL", "10. Laboratory studies show: Leukocyte count 11,500/mm3", "11. Laboratory studies show: Platelet count 30,000/mm3", "12. Laboratory studies show: Prothrombin time 14 sec", "13. Laboratory studies show: Partial thromboplastin time 33 sec."], "atomic_facts": ["1. The patient has itchy and red skin lesions that started on his scalp and spread downwards.", "2. The parents report their son has had six episodes of bilateral otitis media since birth.", "3. His immunizations are up-to-date.", "4. He is at the 3rd percentile for height and weight.", "5. His vital signs are within normal limits.", "6. Examination shows eczematous lesions over the scalp, neck, and upper and lower extremities, as well as multiple red spots that do not blanch on pressure.", "7. The remainder of the physical examination shows no abnormalities.", "8. Laboratory studies show: Hemoglobin 9.4 g/dL, Leukocyte count 11,500/mm3, Platelet count 30,000/mm3, Prothrombin time 14 sec, Partial thromboplastin time 33 sec."]}
{"id": 1188, "question": "Which of the following is the most likely diagnosis?", "context": ["A 28-year-old woman, gravida 3, para 2, at 34 weeks' gestation comes to the physician because of a 1-day history of dyspnea, dry cough, and chest pain.", "Her pulse is 112/min, respirations are 24/min, and blood pressure is 108/78 mm Hg.", "Pulse oximetry on room air shows an oxygen saturation of 90%.", "Examination shows jugular venous distention and bilateral pitting edema below the knees that is worse on the right side.", "There is dullness to percussion over the right lung base."], "context_len": 5, "options": {"A": "Pulmonary embolism", "B": "Panic attack", "C": "Bacterial pneumonia", "D": "Acute pericarditis"}, "answer": "Pulmonary embolism", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 28-year-old woman comes to the physician.", "2. She is gravida 3, para 2.", "3. She is at 34 weeks' gestation.", "4. She has a 1-day history of dyspnea, dry cough, and chest pain.", "5. Her pulse is 112/min.", "6. Her respirations are 24/min.", "7. Her blood pressure is 108/78 mm Hg.", "8. Pulse oximetry on room air shows an oxygen saturation of 90%.", "9. Examination shows jugular venous distention.", "10. Examination shows bilateral pitting edema below the knees.", "11. The edema is worse on the right side.", "12. There is dullness to percussion over the right lung base."], "atomic_facts": ["1. Pulse: 112/min", "2. Respirations: 24/min", "3. Blood pressure: 108/78 mm Hg", "4. Oxygen saturation on room air: 90%", "5. Jugular venous distention present", "6. Bilateral pitting edema below the knees, worse on the right side", "7. Dullness to percussion over the right lung base"]}
{"id": 1189, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?\"", "context": ["A 55-year-old man comes to the physician for a follow-up examination.", "One month ago, he underwent a right-sided kidney transplantation due to severe polycystic kidney disease.", "Following the procedure, he was started on transplant rejection prophylaxis.", "He has had some chest and back pain as well as frequent coughing.", "He has also had 5\u20136 bowel movements per day of loose stool and occasional vomiting.", "He appears pale.", "Temperature is 37\u00b0C (98.6\u00b0F), pulse is 80/min, and blood pressure is 155/90 mm Hg.", "Physical examination shows lower extremity pitting edema.", "Laboratory studies show: | Hemoglobin 10 g/dL | Leukocyte count 2,500/mm3 | Platelet count 80,000/mm3 | Serum | Urea nitrogen 30 mg/dL | Glucose 150 mg/dL | ."], "context_len": 9, "options": {"A": "Tacrolimus", "B": "Daclizumab", "C": "Mycophenolate mofetil", "D": "Azathioprine"}, "answer": "Mycophenolate mofetil", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology", "Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 55-year-old man comes to the physician for a follow-up examination.", "2. One month ago, he underwent a right-sided kidney transplantation due to severe polycystic kidney disease.", "3. Following the procedure, he was started on transplant rejection prophylaxis.", "4. He has had some chest and back pain as well as frequent coughing.", "5. He has also had 5\u20136 bowel movements per day of loose stool and occasional vomiting.", "6. He appears pale.", "7. Temperature is 37\u00b0C (98.6\u00b0F).", "8. Pulse is 80/min.", "9. Blood pressure is 155/90 mm Hg.", "10. Physical examination shows lower extremity pitting edema.", "11. Laboratory studies show hemoglobin 10 g/dL.", "12. Leukocyte count 2,500/mm3.", "13. Platelet count 80,000/mm3.", "14. Serum urea nitrogen 30 mg/dL.", "15. Glucose 150 mg/dL."], "atomic_facts": ["1. One month ago, he underwent a right-sided kidney transplantation due to severe polycystic kidney disease.", "2. Following the procedure, he was started on transplant rejection prophylaxis.", "3. He has had some chest and back pain as well as frequent coughing.", "4. He has also had 5\u20136 bowel movements per day of loose stool and occasional vomiting.", "5. He appears pale.", "6. Temperature is 37\u00b0C (98.6\u00b0F), pulse is 80/min, and blood pressure is 155/90 mm Hg.", "7. Physical examination shows lower extremity pitting edema.", "8. Laboratory studies show: Hemoglobin 10 g/dL, Leukocyte count 2,500/mm3, Platelet count 80,000/mm3, Serum Urea nitrogen 30 mg/dL, Glucose 150 mg/dL."]}
{"id": 1190, "question": "This patient is at increased risk for recurrent infections with which of the following pathogens?", "context": ["A 2-year-old boy with a history of multiple hospitalizations for fever and infection undergoes immunologic evaluation.", "Serum CH50 assay shows inappropriately low erythrocyte lysis and further workup confirms C8 deficiency."], "context_len": 2, "options": {"A": "Neisseria species", "B": "Giardia species", "C": "Pneumocystis species", "D": "Mycobacterium species\n\""}, "answer": "Neisseria species", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Infectious Diseases", "Immunology and Allergy"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A 2-year-old boy has a history of multiple hospitalizations for fever and infection.", "2. Serum CH50 assay shows inappropriately low erythrocyte lysis.", "3. Further workup confirms C8 deficiency."], "atomic_facts": ["1. Serum CH50 assay shows inappropriately low erythrocyte lysis.", "2. Further workup confirms C8 deficiency."]}
{"id": 1191, "question": "Which of the following is the most likely cause of this patient's symptoms?", "context": ["A 55-year-old man is brought to the emergency department because of cough and poor appetite for the past week.", "Since it began, he has been coughing up small amounts of malodorous phlegm.", "During the past two nights, he has also had night sweats.", "He was diagnosed with HIV infection 5 years ago.", "He has hypertension, type 2 diabetes mellitus, and severe heartburn.", "The patient is homeless and does not take any medication.", "He has smoked a pack of cigarettes daily for 30 years.", "He drinks 8\u201310 beers daily.", "His temperature is 38.9\u00b0C (102.0\u00b0F), pulse is 101/min, respirations are 25/min and blood pressure is 145/92 mm Hg.", "The patient appears intoxicated.", "Physical examination shows crackles and dullness to percussion at the right lung base.", "Scattered expiratory wheezing is heard throughout both lung fields.", "A grade 2/6 mid-systolic ejection murmur is heard along the upper right sternal border.", "His CD4+T-lymphocyte count is 280/mm3 (Normal \u2265 500).", "An x-ray of the chest shows a hazy infiltrate in the right lower lung field."], "context_len": 15, "options": {"A": "Pneumocystis pneumonia", "B": "Aspiration pneumonia", "C": "Mitral valve regurgitation", "D": "Pharyngoesophageal diverticulum\n\""}, "answer": "Aspiration pneumonia", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old man is brought to the emergency department.", "2. He has had a cough and poor appetite for the past week.", "3. He has been coughing up small amounts of malodorous phlegm.", "4. He has had night sweats for the past two nights.", "5. He was diagnosed with HIV infection 5 years ago.", "6. He has hypertension, type 2 diabetes mellitus, and severe heartburn.", "7. The patient is homeless and does not take any medication.", "8. He has smoked a pack of cigarettes daily for 30 years.", "9. He drinks 8\u201310 beers daily.", "10. His temperature is 38.9\u00b0C (102.0\u00b0F).", "11. His pulse is 101/min.", "12. His respirations are 25/min.", "13. His blood pressure is 145/92 mm Hg.", "14. The patient appears intoxicated.", "15. Physical examination shows crackles and dullness to percussion at the right lung base.", "16. Scattered expiratory wheezing is heard throughout both lung fields.", "17. A grade 2/6 mid-systolic ejection murmur is heard along the upper right sternal border.", "18. His CD4+T-lymphocyte count is 280/mm3 (Normal \u2265 500).", "19. An x-ray of the chest shows a hazy infiltrate in the right lower lung field."], "atomic_facts": ["1. The patient has been coughing up small amounts of malodorous phlegm.", "2. The patient has had night sweats during the past two nights.", "3. The patient was diagnosed with HIV infection 5 years ago.", "4. The patient has hypertension, type 2 diabetes mellitus, and severe heartburn.", "5. The patient is homeless and does not take any medication.", "6. The patient has smoked a pack of cigarettes daily for 30 years.", "7. The patient drinks 8\u201310 beers daily.", "8. The patient's temperature is 38.9\u00b0C (102.0\u00b0F), pulse is 101/min, respirations are 25/min, and blood pressure is 145/92 mm Hg.", "9. The patient appears intoxicated.", "10. Physical examination shows crackles and dullness to percussion at the right lung base.", "11. Scattered expiratory wheezing is heard throughout both lung fields.", "12. A grade 2/6 mid-systolic ejection murmur is heard along the upper right sternal border.", "13. The patient's CD4+T-lymphocyte count is 280/mm3 (Normal \u2265 500).", "14. An x-ray of the chest shows a hazy infiltrate in the right lower lung field."]}
{"id": 1192, "question": "Which of the following is the next best step in the management of the child?", "context": ["A 2-year-old boy is brought in to his pediatrician for his annual exam, flu vaccination, and to evaluate a diaper rash.", "The itchy pink rash has been bothering the boy for about 1 week and over the counter, remedies are not helping.", "He was born at 39 weeks gestation via spontaneous vaginal delivery.", "He is up to date on all vaccines and is meeting all developmental milestones.", "During the discussion, his parents are frustrated by his behavior and inability to follow directions.", "Today, his vital signs are stable and normal for his age.", "On physical examination, the boy appears uncomfortable.", "His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally.", "There is a pink-red, raised rash in the anogenital region and medial thighs.", "Additionally, there are multiple bruises on the boy\u2019s buttocks and the back of his thighs.", "Some are healing and some are fresh.", "When questioned about the bruising, the parents become evasive and end the discussion."], "context_len": 12, "options": {"A": "To report to Child Protective Services", "B": "To order patch testing for allergic contact dermatitis", "C": "To obtain skin scrapings for examination by light microscopy", "D": "Mupirocin cream"}, "answer": "To report to Child Protective Services", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 2-year-old boy is brought in to his pediatrician for his annual exam, flu vaccination, and to evaluate a diaper rash.", "2. The itchy pink rash has been bothering the boy for about 1 week and over the counter, remedies are not helping.", "3. He was born at 39 weeks gestation via spontaneous vaginal delivery.", "4. He is up to date on all vaccines and is meeting all developmental milestones.", "5. During the discussion, his parents are frustrated by his behavior and inability to follow directions.", "6. Today, his vital signs are stable and normal for his age.", "7. On physical examination, the boy appears uncomfortable.", "8. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally.", "9. There is a pink-red, raised rash in the anogenital region and medial thighs.", "10. Additionally, there are multiple bruises on the boy\u2019s buttocks and the back of his thighs.", "11. Some are healing and some are fresh.", "12. When questioned about the bruising, the parents become evasive and end the discussion."], "atomic_facts": ["1. The boy has been bothered by an itchy pink rash for about 1 week.", "2. Over the counter remedies are not helping the boy's rash.", "3. The boy was born at 39 weeks gestation via spontaneous vaginal delivery.", "4. The boy is up to date on all vaccines.", "5. The boy is meeting all developmental milestones.", "6. The boy's parents are frustrated by his behavior and inability to follow directions.", "7. The boy's vital signs are stable and normal for his age.", "8. On physical examination, the boy appears uncomfortable.", "9. The boy's heart has a regular rate and rhythm.", "10. The boy's lungs are clear to auscultation bilaterally.", "11. There is a pink-red, raised rash in the anogenital region and medial thighs.", "12. There are multiple bruises on the boy\u2019s buttocks and the back of his thighs.", "13. Some bruises are healing and some are fresh.", "14. When questioned about the bruising, the parents become evasive and end the discussion."]}
{"id": 1193, "question": "The patient's therapy increases her risk of which of the following conditions?", "context": ["A 62-year-old woman comes to the physician for the evaluation of a palpable mass in the left breast that she noticed 3 weeks ago.", "During this period, she has also had some left-sided blood-tinged discharge.", "She has hypertension, type 2 diabetes mellitus, and hypercholesterolemia.", "She has no children.", "The patient's menopause occurred at 57 years of age.", "Her mother died of colon cancer at the age of 65 years.", "The patient had smoked one pack of cigarettes daily for 30 years but quit 15 years ago.", "She does not drink alcohol.", "Her current medications include enalapril, metformin, atorvastatin, and a multivitamin.", "She is 165 cm (5 ft 5 in) tall and weighs 84 kg (187 lb); BMI is 30.9 kg/m2.", "She appears well.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 78/min, and blood pressure is 135/80 mm Hg.", "Examination of the breasts shows a left-sided single, nontender, firm mass with poorly defined margins in the upper outer quadrant.", "Biopsy of the mass confirms the diagnosis of pleomorphic lobular carcinoma in situ (LCIS) that is estrogen-receptor (ER) positive.", "The patient undergoes lumpectomy of the left breast and treatment with tamoxifen is started."], "context_len": 15, "options": {"A": "Myelosuppression", "B": "Osteoporosis", "C": "Endometrial cancer", "D": "Ovarian cancer"}, "answer": "Endometrial cancer", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "62 years old", "specialties": ["Internal Medicine", "General Surgery"], "subspecialties": ["Medical Oncology", "General Surgery"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 62-year-old woman comes to the physician for the evaluation of a palpable mass in the left breast.", "2. She noticed the mass 3 weeks ago.", "3. During this period, she has also had some left-sided blood-tinged discharge.", "4. She has hypertension, type 2 diabetes mellitus, and hypercholesterolemia.", "5. She has no children.", "6. Her menopause occurred at 57 years of age.", "7. Her mother died of colon cancer at the age of 65 years.", "8. She smoked one pack of cigarettes daily for 30 years.", "9. She quit smoking 15 years ago.", "10. She does not drink alcohol.", "11. Her current medications include enalapril, metformin, atorvastatin, and a multivitamin.", "12. She is 165 cm (5 ft 5 in) tall and weighs 84 kg (187 lb); BMI is 30.9 kg/m2.", "13. She appears well.", "14. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 78/min, and blood pressure is 135/80 mm Hg.", "15. Examination of the breasts shows a left-sided single, nontender, firm mass with poorly defined margins in the upper outer quadrant.", "16. Biopsy of the mass confirms the diagnosis of pleomorphic lobular carcinoma in situ (LCIS) that is estrogen-receptor (ER) positive.", "17. The patient undergoes lumpectomy of the left breast.", "18. Treatment with tamoxifen is started."], "atomic_facts": ["1. The patient has left-sided blood-tinged discharge.", "2. The patient has hypertension, type 2 diabetes mellitus, and hypercholesterolemia.", "3. The patient has no children.", "4. The patient's menopause occurred at 57 years of age.", "5. The patient's mother died of colon cancer at the age of 65 years.", "6. The patient smoked one pack of cigarettes daily for 30 years but quit 15 years ago.", "7. The patient does not drink alcohol.", "8. The patient's current medications include enalapril, metformin, atorvastatin, and a multivitamin.", "9. The patient is 165 cm (5 ft 5 in) tall and weighs 84 kg (187 lb); BMI is 30.9 kg/m2.", "10. The patient appears well.", "11. The patient's temperature is 37\u00b0C (98.6\u00b0F), pulse is 78/min, and blood pressure is 135/80 mm Hg.", "12. Examination of the breasts shows a left-sided single, nontender, firm mass with poorly defined margins in the upper outer quadrant.", "13. Biopsy of the mass confirms the diagnosis of pleomorphic lobular carcinoma in situ (LCIS) that is estrogen-receptor (ER) positive.", "14. The patient undergoes lumpectomy of the left breast and treatment with tamoxifen is started."]}
{"id": 1194, "question": "Which of the following is the most likely risk factor contributing to this patient's underlying diagnosis?", "context": ["A confused and disoriented 32-year-old man is brought to the emergency department by his wife.", "He was in his usual state of health until yesterday, when he started complaining of fever and headache.", "This morning he was complaining of worsened headache and was acting odd, prompting his wife to bring him to the hospital.", "His past medical history is unremarkable.", "At the hospital, his temperature is 39.2\u00b0C (102.5\u00b0F), pulse is 116/min, and blood pressure is 96/64 mm Hg.", "Physical examination is notable for neck stiffness and a large scar across his abdomen that his wife says is from a splenectomy operation following a car accident a few years ago.", "He has not seen a doctor since that time.", "A lumbar puncture shows elevated protein, low glucose, and 1,200 WBCs with 95% polymorphonuclear cells; gram staining shows gram-positive diplococci."], "context_len": 8, "options": {"A": "Congenital humoral immunodeficiency", "B": "Dysfunction of a single organ", "C": "Dysfunction of multiple organs", "D": "Undiagnosed viral infection"}, "answer": "Dysfunction of a single organ", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "32", "specialties": ["Internal Medicine", "Neurology"], "subspecialties": ["Neurology", "Neurocritical Care"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 32-year-old man is brought to the emergency department by his wife.", "2. He was in his usual state of health until yesterday.", "3. Yesterday he started complaining of fever and headache.", "4. This morning he was complaining of worsened headache and was acting odd.", "5. His past medical history is unremarkable.", "6. At the hospital, his temperature is 39.2\u00b0C (102.5\u00b0F).", "7. His pulse is 116/min.", "8. His blood pressure is 96/64 mm Hg.", "9. Physical examination is notable for neck stiffness.", "10. He has a large scar across his abdomen from a splenectomy operation following a car accident a few years ago.", "11. He has not seen a doctor since that time.", "12. A lumbar puncture shows elevated protein.", "13. A lumbar puncture shows low glucose.", "14. A lumbar puncture shows 1,200 WBCs with 95% polymorphonuclear cells.", "15. Gram staining shows gram-positive diplococci."], "atomic_facts": ["1. He was in his usual state of health until yesterday.", "2. Yesterday, he started complaining of fever and headache.", "3. This morning, he was complaining of worsened headache.", "4. He was acting odd this morning.", "5. His wife brought him to the hospital.", "6. His past medical history is unremarkable.", "7. At the hospital, his temperature is 39.2\u00b0C (102.5\u00b0F).", "8. At the hospital, his pulse is 116/min.", "9. At the hospital, his blood pressure is 96/64 mm Hg.", "10. Physical examination is notable for neck stiffness.", "11. Physical examination is notable for a large scar across his abdomen.", "12. The scar is from a splenectomy operation following a car accident a few years ago.", "13. He has not seen a doctor since the time of the car accident.", "14. A lumbar puncture shows elevated protein.", "15. A lumbar puncture shows low glucose.", "16. A lumbar puncture shows 1,200 WBCs with 95% polymorphonuclear cells.", "17. Gram staining shows gram-positive diplococci."]}
{"id": 1195, "question": "What does the letter \u2018a\u2019 represent in this process?", "context": ["A group of scientists is verifying previous research on DNA replication.", "The diagram illustrates the theoretical DNA replication process in bacteria such as Escherichia coli."], "context_len": 2, "options": {"A": "RNA Primers", "B": "Okazaki fragments", "C": "The leading strand", "D": "Replication fork"}, "answer": "Okazaki fragments", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Pathology", "Medical Genetics and Genomics"], "subspecialties": ["Molecular Genetic Pathology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A group of scientists is verifying previous research.", "2. The research is on DNA replication.", "3. A diagram illustrates the theoretical DNA replication process.", "4. The DNA replication process is in bacteria such as Escherichia coli."], "atomic_facts": ["1. The diagram illustrates the theoretical DNA replication process.", "2. The process occurs in bacteria.", "3. The bacteria mentioned is Escherichia coli."]}
{"id": 1196, "question": "Which of the following is acceptable for the physician to accept?: | A) Compensation for travel expenses | B) An honorarium for speaking | C) Assistance with preparing her presentations", "context": ["A physician is involved in a research collaboration with a pharmaceutical company.", "The company invites her to give a lecture series for other physicians on new therapies in her field of expertise at a retreat center in the Caribbean."], "context_len": 2, "options": {"A": "A only", "B": "B only", "C": "C only", "D": "A and B"}, "answer": "A and B", "answer_idx": "D", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Preventive Medicine", "Family Medicine"], "subspecialties": ["Health Care Administration, Leadership, and Management"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A physician is involved in a research collaboration with a pharmaceutical company.", "2. The pharmaceutical company invites the physician to give a lecture series.", "3. The lecture series is for other physicians.", "4. The lecture series is about new therapies in the physician's field of expertise.", "5. The lecture series will be held at a retreat center in the Caribbean."], "atomic_facts": ["1. The company invites her", "2. To give a lecture series", "3. For other physicians", "4. On new therapies", "5. In her field of expertise", "6. At a retreat center", "7. In the Caribbean."]}
{"id": 1197, "question": "Which of the following set of findings were most likely found during the physical exam?", "context": ["A 15-year-old teenager is brought to a pediatrician by his parents.", "They are concerned about his performance at school and have received several letters from his school noting that the adolescent has difficulty with reading and writing compared to his classmates and often misbehaves during class.", "A physical exam reveals some atypical findings.", "A Wechsler Intelligence Scale for Children (WISC) shows that the boy has a mild intellectual disability with an IQ of 84.", "Complete blood count and serum TSH levels are normal.", "After a careful review of all findings the pediatrician suspects the teenager may have a numerical chromosomal disorder and orders karyotype (see image)."], "context_len": 6, "options": {"A": "Arachnodactyly, scoliosis and aortic root dilation", "B": "Short stature, broad chest and thick skin folds in neck", "C": "Short stature, hypotonia and obesity", "D": "Tall Stature and gynecomastia"}, "answer": "Tall Stature and gynecomastia", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "15 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology", "Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. A 15-year-old teenager is brought to a pediatrician by his parents.", "2. His parents are concerned about his performance at school.", "3. The adolescent has difficulty with reading and writing compared to his classmates.", "4. He often misbehaves during class.", "5. A physical exam reveals some atypical findings.", "6. A Wechsler Intelligence Scale for Children (WISC) shows that the boy has a mild intellectual disability with an IQ of 84.", "7. Complete blood count and serum TSH levels are normal.", "8. The pediatrician suspects the teenager may have a numerical chromosomal disorder.", "9. The pediatrician orders karyotype (see image)."], "atomic_facts": ["1. Concern about the adolescent's performance at school", "2. Received several letters from the school noting difficulty with reading and writing", "3. Difficulty compared to classmates", "4. Misbehaves during class", "5. Atypical findings on physical exam", "6. Wechsler Intelligence Scale for Children (WISC) shows mild intellectual disability", "7. IQ of 84", "8. Complete blood count is normal", "9. Serum TSH levels are normal", "10. Suspected numerical chromosomal disorder", "11. Karyotype ordered by pediatrician"]}
{"id": 1198, "question": "Which of the following is the most appropriate treatment?\"", "context": ["Ten days after delivery, a 1500-g (3.3-lb) male newborn is feeding poorly.", "He was born at 32 weeks' gestation.", "He has had frequent episodes of vomiting for the past 2 days.", "He has no fever, diarrhea, or hematemesis.", "He appears lethargic and is difficult to arouse.", "His temperature is 37\u00b0C (98.6\u00b0F), pulse is 145/min, respirations are 65/min, and blood pressure is 78/55 mm Hg.", "The lungs are clear to auscultation.", "The abdomen is hard with rebound tenderness.", "The patient is responsive only to painful stimuli.", "His hemoglobin concentration is 13.0 g/dL, leukocyte count is 10,900/mm3, and platelet count is 90,000/mm3.", "Arterial blood gas analysis on room air shows: | pH 7.31 | PCO2 30 mm Hg | PO2 80 mm Hg | O2 saturation 98% | An x-ray of the abdomen is shown."], "context_len": 11, "options": {"A": "Nasogastric tube gut decompression", "B": "Exploratory laparotomy", "C": "Administration of ampicillin, gentamicin, and metronidazole", "D": "Barium enema\n\""}, "answer": "Exploratory laparotomy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "Newborn", "specialties": ["Pediatrics"], "subspecialties": ["Neonatal"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Ten days after delivery, a 1500-g (3.3-lb) male newborn is feeding poorly.", "2. He was born at 32 weeks' gestation.", "3. He has had frequent episodes of vomiting for the past 2 days.", "4. He has no fever, diarrhea, or hematemesis.", "5. He appears lethargic and is difficult to arouse.", "6. His temperature is 37\u00b0C (98.6\u00b0F).", "7. His pulse is 145/min.", "8. His respirations are 65/min.", "9. His blood pressure is 78/55 mm Hg.", "10. The lungs are clear to auscultation.", "11. The abdomen is hard with rebound tenderness.", "12. The patient is responsive only to painful stimuli.", "13. His hemoglobin concentration is 13.0 g/dL.", "14. His leukocyte count is 10,900/mm3.", "15. His platelet count is 90,000/mm3.", "16. Arterial blood gas analysis on room air shows pH 7.31, PCO2 30 mm Hg, PO2 80 mm Hg, and O2 saturation 98%.", "17. An x-ray of the abdomen is shown."], "atomic_facts": ["1. The patient was born at 32 weeks' gestation.", "2. He has had frequent episodes of vomiting for the past 2 days.", "3. He has no fever, diarrhea, or hematemesis.", "4. He appears lethargic and is difficult to arouse.", "5. His temperature is 37\u00b0C (98.6\u00b0F), pulse is 145/min, respirations are 65/min, and blood pressure is 78/55 mm Hg.", "6. The lungs are clear to auscultation.", "7. The abdomen is hard with rebound tenderness.", "8. The patient is responsive only to painful stimuli.", "9. His hemoglobin concentration is 13.0 g/dL, leukocyte count is 10,900/mm3, and platelet count is 90,000/mm3.", "10. Arterial blood gas analysis on room air shows: pH 7.31, PCO2 30 mm Hg, PO2 80 mm Hg, O2 saturation 98%.", "11. An x-ray of the abdomen is shown."]}
{"id": 1199, "question": "What is the most likely diagnosis?", "context": ["A 45-year-old man who underwent liver transplantation 3 months ago for chronic liver failure presents to the physician because of a backache following a fall from sitting.", "He is currently on immunosuppressive therapy with glucocorticoids and cyclosporine.", "He has no comorbidities.", "On physical examination, his vitals are within normal limits.", "He has tenderness over his lumbar spine.", "An X-ray of the lumbar spine shows a wedge compression fracture of the L1 vertebra.", "His serum testosterone and serum creatinine levels are normal.", "Bone mineral densitometry shows a T-score of \u20133.0."], "context_len": 8, "options": {"A": "Renal osteodystrophy", "B": "Osteopenia", "C": "Osteomalacia", "D": "Transplantation-related osteoporosis"}, "answer": "Transplantation-related osteoporosis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["General Orthopaedic Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. Patient is 45 years old.", "2. Patient underwent liver transplantation 3 months ago for chronic liver failure.", "3. Patient presents to physician due to backache following a fall from sitting.", "4. Patient is on immunosuppressive therapy with glucocorticoids and cyclosporine.", "5. Patient has no comorbidities.", "6. Patient's vitals are within normal limits.", "7. Patient has tenderness over lumbar spine.", "8. X-ray of lumbar spine shows wedge compression fracture of L1 vertebra.", "9. Patient's serum testosterone level is normal.", "10. Patient's serum creatinine level is normal.", "11. Bone mineral densitometry shows T-score of -3.0."], "atomic_facts": ["1. He is currently on immunosuppressive therapy with glucocorticoids and cyclosporine.", "2. He has no comorbidities.", "3. On physical examination, his vitals are within normal limits.", "4. He has tenderness over his lumbar spine.", "5. An X-ray of the lumbar spine shows a wedge compression fracture of the L1 vertebra.", "6. His serum testosterone levels are normal.", "7. His serum creatinine levels are normal.", "8. Bone mineral densitometry shows a T-score of \u20133.0."]}
{"id": 1200, "question": "Which of the following is the best initial diagnostic test for her current complaint?", "context": ["A 56-year-old woman presents to the emergency department with acute onset of pain and redness of the skin of her right arm for the past 3 days.", "She has had type 2 diabetes mellitus for the past 22 years, but she is not compliant with her medications.", "Her temperature is 38.0\u00b0C (100.4\u00b0F), pulse is 105/min, and blood pressure is 116/74 mm Hg.", "On physical examination, her forearm is tender and erythematous.", "She is diagnosed with acute cellulitis, and intravenous clindamycin is started.", "On the 6th day of antibiotic therapy, the patient complains of severe watery diarrhea, fever, and abdominal tenderness without rigidity."], "context_len": 6, "options": {"A": "Complete blood count with differential", "B": "Sigmoidoscopy or colonoscopy", "C": "Fecal occult blood test", "D": "Polymerase chain reaction"}, "answer": "Polymerase chain reaction", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "56 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 56-year-old woman presents to the emergency department.", "2. She has had type 2 diabetes mellitus for the past 22 years.", "3. She is not compliant with her medications.", "4. Her temperature is 38.0\u00b0C (100.4\u00b0F).", "5. Her pulse is 105/min.", "6. Her blood pressure is 116/74 mm Hg.", "7. On physical examination, her forearm is tender and erythematous.", "8. She is diagnosed with acute cellulitis.", "9. Intravenous clindamycin is started.", "10. On the 6th day of antibiotic therapy, the patient complains of severe watery diarrhea.", "11. She also complains of fever.", "12. She also complains of abdominal tenderness without rigidity."], "atomic_facts": ["1. She has had type 2 diabetes mellitus for the past 22 years.", "2. She is not compliant with her medications.", "3. Her temperature is 38.0\u00b0C (100.4\u00b0F).", "4. Her pulse is 105/min.", "5. Her blood pressure is 116/74 mm Hg.", "6. On physical examination, her forearm is tender and erythematous.", "7. She is diagnosed with acute cellulitis.", "8. Intravenous clindamycin is started.", "9. On the 6th day of antibiotic therapy, the patient complains of severe watery diarrhea.", "10. The patient complains of fever.", "11. The patient complains of abdominal tenderness without rigidity."]}
{"id": 1201, "question": "Which of the following correlates with the estimated standard error of the mean for this population?", "context": ["A group of researchers attempts to determine the mean fasting triglyceride levels in patients between the ages of 30 and 60 in a suburb of Tampa, FL.", "Over the course of several years, the team manages to obtain the blood levels of a random sample of 10,000 volunteers who fit their inclusion criteria.", "The blood levels are measured and demonstrate a standard deviation of 5."], "context_len": 3, "options": {"A": "0.02", "B": "0.05", "C": "0.10", "D": "0.15"}, "answer": "0.05", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Preventive Medicine"}, "facts_old": ["1. A group of researchers attempts to determine the mean fasting triglyceride levels in patients.", "2. The patients are between the ages of 30 and 60.", "3. The research is conducted in a suburb of Tampa, FL.", "4. The team manages to obtain the blood levels of a random sample of 10,000 volunteers.", "5. The volunteers fit the inclusion criteria.", "6. The blood levels are measured.", "7. The blood levels demonstrate a standard deviation of 5."], "atomic_facts": ["1. The team obtained the blood levels of a random sample of 10,000 volunteers.", "2. The volunteers fit the team's inclusion criteria.", "3. The blood levels were measured.", "4. The blood levels demonstrated a standard deviation of 5."]}
{"id": 1202, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?", "context": ["A 14-year-old girl is brought to the physician by her mother for evaluation of several bruises on her lower extremities.", "She has had these bruises for about 6 weeks, and the mother is concerned that she might be bullied at school.", "The patient has had increasing fatigue and paleness over the past several days.", "She has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine.", "She appears pale and ill.", "Her temperature is 37.8\u00b0C (100.1\u00b0F), pulse is 115/min, and blood pressure is 100/60 mm Hg.", "The lungs are clear to auscultation.", "Examination shows a soft, nontender abdomen with no organomegaly.", "There are several subcutaneous purple spots on her legs bilaterally.", "Her hemoglobin concentration is 8.4 g/dL, leukocyte count is 2,600/mm3, platelet count is 18,000/mm3, and reticulocyte count is 0.3%.", "Serum electrolyte concentrations are within normal limits."], "context_len": 11, "options": {"A": "Immune thrombocytopenic purpura", "B": "Sickle cell disease", "C": "Systemic lupus erythematosus", "D": "Adverse effect of medication"}, "answer": "Adverse effect of medication", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "14 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 14-year-old girl.", "2. Patient has several bruises on her lower extremities for 6 weeks.", "3. Mother is concerned that patient might be bullied at school.", "4. Patient has increasing fatigue and paleness over the past several days.", "5. Patient has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine.", "6. Patient appears pale and ill.", "7. Patient's temperature is 37.8\u00b0C (100.1\u00b0F).", "8. Patient's pulse is 115/min.", "9. Patient's blood pressure is 100/60 mm Hg.", "10. Lungs are clear to auscultation.", "11. Examination shows a soft, nontender abdomen with no organomegaly.", "12. Patient has several subcutaneous purple spots on her legs bilaterally.", "13. Patient's hemoglobin concentration is 8.4 g/dL.", "14. Patient's leukocyte count is 2,600/mm3.", "15. Patient's platelet count is 18,000/mm3.", "16. Patient's reticulocyte count is 0.3%.", "17. Serum electrolyte concentrations are within normal limits."], "atomic_facts": ["1. She has had bruises for about 6 weeks.", "2. The mother is concerned that she might be bullied at school.", "3. The patient has had increasing fatigue and paleness over the past several days.", "4. She has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine.", "5. She appears pale and ill.", "6. Her temperature is 37.8\u00b0C (100.1\u00b0F), pulse is 115/min, and blood pressure is 100/60 mm Hg.", "7. The lungs are clear to auscultation.", "8. Examination shows a soft, nontender abdomen with no organomegaly.", "9. There are several subcutaneous purple spots on her legs bilaterally.", "10. Her hemoglobin concentration is 8.4 g/dL.", "11. Leukocyte count is 2,600/mm3.", "12. Platelet count is 18,000/mm3.", "13. Reticulocyte count is 0.3%.", "14. Serum electrolyte concentrations are within normal limits."]}
{"id": 1203, "question": "Histopathologic examination of these macules is most likely to show which of the following?", "context": ["A 51-year-old man comes to the emergency department because of a 3-day history of shortness of breath, fever, and chills.", "He has no history of serious illness.", "His temperature is 39.5\u00b0C (103.1\u00b0F).", "Physical examination shows a grade 4/6, holosystolic, blowing murmur over the apex that radiates to the axilla.", "Crackles are heard in both lower lung fields.", "Examination of the extremities shows several non-tender, non-blanching, erythematous macules on the palms and soles."], "context_len": 6, "options": {"A": "Microabscesses with neutrophil infiltration of capillaries", "B": "Epithelioid cells with surrounding multinucleated giant cells", "C": "Cleft-like vacuoles within the arterioles", "D": "Spiral-shaped bacteria with axial filaments in the epidermis"}, "answer": "Microabscesses with neutrophil infiltration of capillaries", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "51", "specialties": ["Dermatology"], "subspecialties": ["Dermatopathology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pathology"}, "facts_old": ["1. A 51-year-old man comes to the emergency department.", "2. He has a 3-day history of shortness of breath, fever, and chills.", "3. He has no history of serious illness.", "4. His temperature is 39.5\u00b0C (103.1\u00b0F).", "5. Physical examination shows a grade 4/6, holosystolic, blowing murmur over the apex.", "6. The murmur radiates to the axilla.", "7. Crackles are heard in both lower lung fields.", "8. Examination of the extremities shows several non-tender, non-blanching, erythematous macules on the palms and soles."], "atomic_facts": ["1. He has no history of serious illness.", "2. His temperature is 39.5\u00b0C (103.1\u00b0F).", "3. Physical examination shows a grade 4/6, holosystolic, blowing murmur over the apex that radiates to the axilla.", "4. Crackles are heard in both lower lung fields.", "5. Examination of the extremities shows several non-tender, non-blanching, erythematous macules on the palms and soles."]}
{"id": 1204, "question": "Which of the following terms describes the investigator's statistical measure of interest?", "context": ["An investigator is studying the maternal and fetal consequences of a recent spike in benzodiazepine addiction in Ireland.", "She is particularly interested in whether benzodiazepine use contributes to oral cleft deformities in newborns exposed to alprazolam, clonazepam, or lorazepam during the first trimester.", "The investigator uses statistical data from the local demographic institute to calculate the number of newly diagnosed cases of oral cleft deformities in Ireland over the past 5 years."], "context_len": 3, "options": {"A": "Mortality rate", "B": "Relative risk", "C": "Cumulative incidence", "D": "Attributable risk"}, "answer": "Cumulative incidence", "answer_idx": "C", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Psychiatry", "Internal Medicine"], "subspecialties": ["Addiction Psychiatry", "Addiction Medicine"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. An investigator is studying the maternal and fetal consequences of a recent spike in benzodiazepine addiction in Ireland.", "2. She is particularly interested in whether benzodiazepine use contributes to oral cleft deformities in newborns exposed to alprazolam, clonazepam, or lorazepam during the first trimester.", "3. The investigator uses statistical data from the local demographic institute.", "4. The investigator is calculating the number of newly diagnosed cases of oral cleft deformities in Ireland over the past 5 years."], "atomic_facts": ["1. The investigator is interested in benzodiazepine use and oral cleft deformities in newborns.", "2. The focus is on alprazolam, clonazepam, and lorazepam use during the first trimester.", "3. Statistical data from the local demographic institute is used.", "4. The data is used to calculate the number of newly diagnosed cases of oral cleft deformities in Ireland.", "5. The data covers the past 5 years."]}
{"id": 1205, "question": "What is the next best step in management of this patient?", "context": ["A 55-year-old woman comes to the office for preventive health care.", "She has recently migrated to the United States from Hong Kong.", "Her past medical history is noncontributory.", "She denies smoking cigarettes or drinking alcohol.", "She last saw a doctor at the age of 14 when she was diagnosed with appendicitis and underwent an appendectomy.", "Her father died of a stroke at 59 years old and her mother died of a heart attack at 66 years old.", "She has 2 daughters who are in good health.", "Temperature is 37\u00b0C (98.7\u00b0F), blood pressure is 113/85 mm Hg, pulse is 69/min, respiratory rate is 14/min, and BMI is 24 kg/m2.", "Cardiopulmonary and abdominal examinations are negative. | Laboratory test | Complete blood count | Hemoglobin 12.5 g/dL | MCV 88 fl | Leukocytes 5,500/mm3 | Platelets 155,000/mm3 | Basic metabolic panel | Serum Na+ 135 mEq/L | Serum K+ 3.7 mEq/L | Serum Cl- 106 mEq/L | Serum HCO3- 25 mEq/L | BUN 10 mg/dL | Serum creatinine 0.8 mg/dL | Liver function test | Serum bilirubin 0.8 mg/dL | AST 30 U/L | ALT 35 U/L | ALP 130 U/L (20\u201370 U/L) | ."], "context_len": 9, "options": {"A": "Bone scan", "B": "Ultrasonography of the abdomen", "C": "Gamma glutamyl transferase", "D": "Anti mitochondrial antibody"}, "answer": "Gamma glutamyl transferase", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "55", "specialties": ["Internal Medicine"], "subspecialties": ["General Internal Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Preventive Medicine"}, "facts_old": ["1. A 55-year-old woman comes to the office for preventive health care.", "2. She has recently migrated to the United States from Hong Kong.", "3. Her past medical history is noncontributory.", "4. She denies smoking cigarettes or drinking alcohol.", "5. She last saw a doctor at the age of 14 when she was diagnosed with appendicitis and underwent an appendectomy.", "6. Her father died of a stroke at 59 years old.", "7. Her mother died of a heart attack at 66 years old.", "8. She has 2 daughters who are in good health.", "9. Temperature is 37\u00b0C (98.7\u00b0F).", "10. Blood pressure is 113/85 mm Hg.", "11. Pulse is 69/min.", "12. Respiratory rate is 14/min.", "13. BMI is 24 kg/m2.", "14. Cardiopulmonary and abdominal examinations are negative.", "15. Laboratory test: Complete blood count.", "16. Hemoglobin 12.5 g/dL.", "17. MCV 88 fl.", "18. Leukocytes 5,500/mm3.", "19. Platelets 155,000/mm3.", "20. Laboratory test: Basic metabolic panel.", "21. Serum Na+ 135 mEq/L.", "22. Serum K+ 3.7 mEq/L.", "23. Serum Cl- 106 mEq/L.", "24. Serum HCO3- 25 mEq/L.", "25. BUN 10 mg/dL.", "26. Serum creatinine 0.8 mg/dL.", "27. Laboratory test: Liver function test.", "28. Serum bilirubin 0.8 mg/dL.", "29. AST 30 U/L.", "30. ALT 35 U/L.", "31. ALP 130 U/L (20\u201370 U/L)."], "atomic_facts": ["1. She has recently migrated to the United States from Hong Kong.", "2. Her past medical history is noncontributory.", "3. She denies smoking cigarettes or drinking alcohol.", "4. She last saw a doctor at the age of 14 when she was diagnosed with appendicitis and underwent an appendectomy.", "5. Her father died of a stroke at 59 years old and her mother died of a heart attack at 66 years old.", "6. She has 2 daughters who are in good health.", "7. Temperature is 37\u00b0C (98.7\u00b0F), blood pressure is 113/85 mm Hg, pulse is 69/min, respiratory rate is 14/min, and BMI is 24 kg/m2.", "8. Cardiopulmonary and abdominal examinations are negative.", "9. Laboratory test: Complete blood count: Hemoglobin 12.5 g/dL, MCV 88 fl, Leukocytes 5,500/mm3, Platelets 155,000/mm3.", "10. Basic metabolic panel: Serum Na+ 135 mEq/L, Serum K+ 3.7 mEq/L, Serum Cl- 106 mEq/L, Serum HCO3- 25 mEq/L, BUN 10 mg/dL, Serum creatinine 0.8 mg/dL.", "11. Liver function test: Serum bilirubin 0.8 mg/dL, AST 30 U/L, ALT 35 U/L, ALP 130 U/L (20\u201370 U/L)."]}
{"id": 1206, "question": "Which is the most likely diagnosis of this condition?", "context": ["A 33-year-old man presents to his primary care practitioner, complaining about the presence of white spots in both of his hands.", "He states that the white spots have expanded in the last few months; they are not tender nor ulcerated.", "His past medical history is relevant for hypothyroidism.", "Upon physical examination, the patient shows hypopigmented macules on both hands and on the back and shoulders adjacent to a patch of skin, with signs of excoriation and scratching.", "Under the Wood\u2019s lamp, the skin lesions on the hands, back, and shoulders show fluorescence.", "There are no signs of inflammation in any of the skin lesions.", "The vital signs of the patient are within normal limits."], "context_len": 7, "options": {"A": "Vitiligo", "B": "Tinea versicolor", "C": "Pityriasis alba", "D": "Halo nevus"}, "answer": "Vitiligo", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "33 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is 33 years old.", "2. Patient complains of white spots in both hands.", "3. White spots have expanded in last few months.", "4. White spots are not tender nor ulcerated.", "5. Patient has past medical history of hypothyroidism.", "6. Physical examination shows hypopigmented macules on both hands, back, and shoulders.", "7. Skin lesions show signs of excoriation and scratching.", "8. Skin lesions show fluorescence under Wood's lamp.", "9. No signs of inflammation in any of the skin lesions.", "10. Patient's vital signs are within normal limits."], "atomic_facts": ["1. The patient reports that the white spots have expanded in the last few months.", "2. The white spots are not tender nor ulcerated.", "3. The patient has a past medical history of hypothyroidism.", "4. Upon physical examination, the patient shows hypopigmented macules on both hands and on the back and shoulders adjacent to a patch of skin, with signs of excoriation and scratching.", "5. Under the Wood\u2019s lamp, the skin lesions on the hands, back, and shoulders show fluorescence.", "6. There are no signs of inflammation in any of the skin lesions.", "7. The vital signs of the patient are within normal limits."]}
{"id": 1207, "question": "Which of the following is the most likely site where the aspirated foreign body is lodged?", "context": ["A 3-year-old boy is brought to the emergency department by his mother.", "He started violently coughing, wheezing, and having difficulty breathing about 10 minutes ago.", "She had briefly left him lying on his back playing with toys and when she returned he was choking.", "She attempted the Heimlich maneuver with no improvement.", "He has a heart rate is 120/min, respiratory rate is difficult to evaluate, blood pressure of 110/65 mm Hg, and temperature of 37.0\u00b0C (98.6\u00b0F).", "A respiratory exam reveals wheezing and decreased breath sounds on the right side.", "A stat chest X-ray is ordered."], "context_len": 7, "options": {"A": "Basilar segment of the right upper lobe", "B": "Posterior segment of the right upper lobe", "C": "Basilar segment of the left lower lobe", "D": "Basilar segment of the right lower lobe"}, "answer": "Posterior segment of the right upper lobe", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "3 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 3-year-old boy is brought to the emergency department by his mother.", "2. He started violently coughing, wheezing, and having difficulty breathing about 10 minutes ago.", "3. She had briefly left him lying on his back playing with toys and when she returned he was choking.", "4. She attempted the Heimlich maneuver with no improvement.", "5. He has a heart rate of 120/min.", "6. He has a blood pressure of 110/65 mm Hg.", "7. He has a temperature of 37.0\u00b0C (98.6\u00b0F).", "8. His respiratory rate is difficult to evaluate.", "9. A respiratory exam reveals wheezing and decreased breath sounds on the right side.", "10. A stat chest X-ray is ordered."], "atomic_facts": ["1. He started violently coughing, wheezing, and having difficulty breathing about 10 minutes ago.", "2. She had briefly left him lying on his back playing with toys and when she returned he was choking.", "3. She attempted the Heimlich maneuver with no improvement.", "4. His heart rate is 120/min.", "5. His respiratory rate is difficult to evaluate.", "6. His blood pressure is 110/65 mm Hg.", "7. His temperature is 37.0\u00b0C (98.6\u00b0F).", "8. A respiratory exam reveals wheezing and decreased breath sounds on the right side.", "9. A stat chest X-ray is ordered."]}
{"id": 1208, "question": "Which of the following drugs should be prescribed to this patient?", "context": ["A 38-year-old man presents with weakness, loss of appetite, headaches, and irritability.", "He developed these symptoms gradually over the past 4 months.", "He was diagnosed with Crohn\u2019s disease, which was moderate at the time of diagnosis 6 months ago.", "He takes methotrexate 15 mg, which effectively controls his symptoms.", "The patient\u2019s vital signs include: blood pressure 105/70 mm Hg, heart rate 102/min, respiratory rate 16/min, and temperature 36.4\u2103 (97.5\u2109).", "On physical examination, the patient is pale.", "His lungs are clear to auscultation.", "His heart sounds are rhythmic; a short early systolic murmur can be heard over the apex of the heart.", "The rest of the exam is unremarkable.", "The patient\u2019s blood test shows the following findings: | Erythrocytes 2.7 x 109/mm3 | Hb 9.3 g/dL | Hct 37% | Mean corpuscular hemoglobin  45.2 pg/cell (2.8 fmol/cell) | Mean corpuscular volume 122 \u00b5m3 (122 fL) | Reticulocyte count 0.4% | Total leukocyte count 3050/mm3 | Neutrophils 62% | Lymphocytes 32% | Eosinophils 1% | Monocytes 5% | Basophils 0% | Platelet count 199,000/mm3 | ."], "context_len": 10, "options": {"A": "Riboflavin", "B": "Niacin", "C": "Pyridoxine", "D": "Folic acid"}, "answer": "Folic acid", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "38", "specialties": ["Neurology", "Internal Medicine"], "subspecialties": ["General Neurology", "General Internal Medicine"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 38 years old.", "2. Patient has weakness, loss of appetite, headaches, and irritability.", "3. Symptoms developed gradually over the past 4 months.", "4. Patient was diagnosed with Crohn's disease 6 months ago.", "5. Disease was moderate at time of diagnosis.", "6. Patient takes methotrexate 15 mg, which effectively controls symptoms.", "7. Blood pressure is 105/70 mm Hg.", "8. Heart rate is 102/min.", "9. Respiratory rate is 16/min.", "10. Temperature is 36.4\u2103 (97.5\u2109).", "11. Patient is pale on physical examination.", "12. Lungs are clear to auscultation.", "13. Heart sounds are rhythmic.", "14. Short early systolic murmur can be heard over the apex of the heart.", "15. Rest of exam is unremarkable.", "16. Erythrocytes count is 2.7 x 109/mm3.", "17. Hb is 9.3 g/dL.", "18. Hct is 37%.", "19. Mean corpuscular hemoglobin is 45.2 pg/cell (2.8 fmol/cell).", "20. Mean corpuscular volume is 122 \u00b5m3 (122 fL).", "21. Reticulocyte count is 0.4%.", "22. Total leukocyte count is 3050/mm3.", "23. Neutrophils are 62%.", "24. Lymphocytes are 32%.", "25. Eosinophils are 1%.", "26. Monocytes are 5%.", "27. Basophils are 0%.", "28. Platelet count is 199,000/mm3."], "atomic_facts": ["1. Symptoms developed gradually over the past 4 months.", "2. Diagnosed with Crohn\u2019s disease 6 months ago.", "3. Crohn\u2019s disease was moderate at the time of diagnosis.", "4. Takes methotrexate 15 mg.", "5. Methotrexate effectively controls his symptoms.", "6. Vital signs: blood pressure 105/70 mm Hg, heart rate 102/min, respiratory rate 16/min, temperature 36.4\u2103 (97.5\u2109).", "7. Patient is pale on physical examination.", "8. Lungs are clear to auscultation.", "9. Rhythmic heart sounds; a short early systolic murmur can be heard over the apex of the heart.", "10. Rest of the exam is unremarkable.", "11. Blood test findings: Erythrocytes 2.7 x 109/mm3, Hb 9.3 g/dL, Hct 37%, Mean corpuscular hemoglobin 45.2 pg/cell (2.8 fmol/cell), Mean corpuscular volume 122 \u00b5m3 (122 fL), Reticulocyte count 0.4%, Total leukocyte count 3050/mm3, Neutrophils 62%, Lymphocytes 32%, Eosinophils 1%, Monocytes 5%, Basophils 0%, Platelet count 199,000/mm3."]}
{"id": 1209, "question": "What is the most likely cause of his hypercalcemia?", "context": ["A 75-year-old man with coronary artery disease and mitral valve stenosis status-post coronary artery bypass graft and mitral bioprosthetic valve replacement is evaluated in the intensive care unit.", "His postsurgical course was complicated by ventilator-associated pneumonia and bilateral postoperative pleural effusions requiring chest tubes.", "He has been weaned from the ventilator and has had his chest tubes removed but has required frequent suctioning to minimize aspirations.", "He has been dependent on a percutaneous gastrostomy tube for enteral nutrition for the past four weeks.", "He is currently on aspirin, carvedilol, atorvastatin, ceftazidime, and pantoprazole.", "He has a history of prostate cancer status post radical prostatectomy.", "His temperature is 96\u00b0F (35.6\u00b0C), blood pressure is 95/55 mmHg, pulse is 50/min, and respirations are 20/min.", "On physical exam, he is not alert and oriented but responds with moans when stimulated.", "His laboratory data are listed below: |  | Serum: | Na+: 145 mEq/L | Cl-: 110 mEq/L | K+: 3.4 mEq/L | HCO3-: 26 mEq/L | BUN: 10 mg/dL | Glucose: 112 mg/dL | Creatinine: 1.4 mg/dL | Thyroid-stimulating hormone: 10 \u00b5U/mL | Ca2+: 11.1 mg/dL | PO4-: 1.0 mg/dL | AST: 6 U/L | ALT: 10 U/L | Albumin: 2.5 mg/dL | Lactate dehydrogenase: 200 U/L (140-280 U/L) | Haptoglobin: 150 mg/dL (30-200 mg/dL) | 1,25-(OH)2 D3: 10 pg/mL (15-75 pg/mL) | Parathyroid hormone: 9 pg/mL (10-60 pg/mL) |  | Leukocyte count: 10,000 cells/mm^3 with normal differential | Hemoglobin: 9 g/dL | Hematocrit: 30 % | Platelet count: 165,000 /mm^3 |  | His electrocardiogram and chest radiograph are shown in Figures A and B."], "context_len": 9, "options": {"A": "Euthyroid sick syndrome", "B": "Immobilization", "C": "Malignancy", "D": "Primary hyperparathyroidism"}, "answer": "Immobilization", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "75", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 75-year-old man with coronary artery disease and mitral valve stenosis.", "2. Patient has had coronary artery bypass graft and mitral bioprosthetic valve replacement.", "3. Patient's postsurgical course was complicated by ventilator-associated pneumonia and bilateral postoperative pleural effusions requiring chest tubes.", "4. Patient has been weaned from the ventilator and has had his chest tubes removed but has required frequent suctioning to minimize aspirations.", "5. Patient has been dependent on a percutaneous gastrostomy tube for enteral nutrition for the past four weeks.", "6. Patient is currently on aspirin, carvedilol, atorvastatin, ceftazidime, and pantoprazole.", "7. Patient has a history of prostate cancer status post radical prostatectomy.", "8. Patient's temperature is 96\u00b0F (35.6\u00b0C).", "9. Patient's blood pressure is 95/55 mmHg.", "10. Patient's pulse is 50/min.", "11. Patient's respirations are 20/min.", "12. Patient is not alert and oriented but responds with moans when stimulated.", "13. Patient's serum Na+ is 145 mEq/L.", "14. Patient's serum Cl- is 110 mEq/L.", "15. Patient's serum K+ is 3.4 mEq/L.", "16. Patient's serum HCO3- is 26 mEq/L.", "17. Patient's serum BUN is 10 mg/dL.", "18. Patient's serum glucose is 112 mg/dL.", "19. Patient's serum creatinine is 1.4 mg/dL.", "20. Patient's serum thyroid-stimulating hormone is 10 \u00b5U/mL.", "21. Patient's serum Ca2+ is 11.1 mg/dL.", "22. Patient's serum PO4- is 1.0 mg/dL.", "23. Patient's serum AST is 6 U/L.", "24. Patient's serum ALT is 10 U/L.", "25. Patient's serum albumin is 2.5 mg/dL.", "26. Patient's serum lactate dehydrogenase is 200 U/L (140-280 U/L).", "27. Patient's serum haptoglobin is 150 mg/dL (30-200 mg"], "atomic_facts": ["1. His postsurgical course was complicated by ventilator-associated pneumonia.", "2. His postsurgical course was complicated by bilateral postoperative pleural effusions requiring chest tubes.", "3. He has been weaned from the ventilator.", "4. He has had his chest tubes removed.", "5. He has required frequent suctioning to minimize aspirations.", "6. He has been dependent on a percutaneous gastrostomy tube for enteral nutrition for the past four weeks.", "7. He is currently on aspirin, carvedilol, atorvastatin, ceftazidime, and pantoprazole.", "8. He has a history of prostate cancer status post radical prostatectomy.", "9. His temperature is 96\u00b0F (35.6\u00b0C).", "10. His blood pressure is 95/55 mmHg.", "11. His pulse is 50/min.", "12. His respirations are 20/min.", "13. On physical exam, he is not alert and oriented but responds with moans when stimulated.", "14. Serum: Na+: 145 mEq/L.", "15. Serum: Cl-: 110 mEq/L.", "16. Serum: K+: 3.4 mEq/L.", "17. Serum: HCO3-: 26 mEq/L.", "18. Serum: BUN: 10 mg/dL.", "19. Serum: Glucose: 112 mg/dL.", "20. Serum: Creatinine: 1.4 mg/dL.", "21. Serum: Thyroid-stimulating hormone: 10 \u00b5U/mL.", "22. Serum: Ca2+: 11.1 mg/dL.", "23. Serum: PO4-: 1.0 mg/dL.", "24. Serum: AST: 6 U/L.", "25. Serum: ALT: 10 U/L.", "26. Serum: Albumin: 2.5 mg/dL.", "27. Serum: Lactate dehydrogenase: 200 U/L (140-280 U/L).", "28. Serum: Haptoglobin: 150 mg/dL (30-200 mg/dL).", "29. Serum: 1,25-(OH)2 D3: 10 pg/mL (15-75 pg/mL).", "30. Serum: Parathyroid hormone: 9 pg/mL (10-60 pg/mL).", "31. Leukocyte count: 10,000 cells/mm^3 with normal differential.", "32. Hemoglobin: 9 g/dL.", "33. Hematocrit: 30 %.", "34. Platelet count: 165,000 /mm^3.", "35. His electrocardiogram and chest radiograph are shown in Figures A and B."]}
{"id": 1210, "question": "Which of the following would be the next best step in the treatment of this patient\u2019s depression?", "context": ["A 35-year-old woman presents for a follow-up.", "The patient was diagnosed with major depressive disorder 16 months ago and has tried multiple medications with no improvement, namely bupropion, fluoxetine, sertraline, and imipramine.", "Upon inquiry, she assures the psychiatrist that she has been fully compliant with her medications so far but stopped her current medications a few weeks back as they did not help either.", "Her husband suggested her to try a herbal preparation for improving her mood.", "She also noted that she felt temporarily better while attending her sister\u2019s wedding last weekend, but she still remains depressed most of the times."], "context_len": 5, "options": {"A": "St John\u2019s Wort", "B": "Selegiline", "C": "Phenelzine", "D": "Electroconvulsive therapy"}, "answer": "Phenelzine", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "35", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 35-year-old woman presents for a follow-up.", "2. The patient was diagnosed with major depressive disorder 16 months ago.", "3. The patient has tried multiple medications with no improvement.", "4. The medications tried were bupropion, fluoxetine, sertraline, and imipramine.", "5. The patient has been fully compliant with her medications so far.", "6. The patient stopped her current medications a few weeks back.", "7. The patient's husband suggested her to try a herbal preparation for improving her mood.", "8. The patient felt temporarily better while attending her sister\u2019s wedding last weekend.", "9. The patient still remains depressed most of the times."], "atomic_facts": ["1. The patient was diagnosed with major depressive disorder 16 months ago.", "2. The patient has tried multiple medications with no improvement, including bupropion, fluoxetine, sertraline, and imipramine.", "3. The patient has been fully compliant with her medications so far.", "4. The patient stopped her current medications a few weeks back as they did not help.", "5. The patient's husband suggested her to try a herbal preparation for improving her mood.", "6. The patient felt temporarily better while attending her sister\u2019s wedding last weekend.", "7. The patient still remains depressed most of the times."]}
{"id": 1211, "question": "Which of the following best describes an effect of the next best step in management?", "context": ["A 17-year-old boy is brought in by paramedics to the emergency department.", "He was found down at a family picnic.", "The boy's parents state that he tried many new foods at the picnic.", "Additionally, because it is springtime, many insects were out while he was playing football.", "His temperature is 99.5\u00b0F (37.5\u00b0C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 33/min, and oxygen saturation is 84% on room air.", "Physical exam is notable for tachycardia and very minimal breath sounds bilaterally.", "No jugular venous distention is noted and an abdominal exam is within normal limits."], "context_len": 7, "options": {"A": "Decreased serum potassium", "B": "Equilibration of environmental and chest cavity pressure", "C": "Hypoglycemia", "D": "Increased systemic vascular resistance"}, "answer": "Decreased serum potassium", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "17", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 17-year-old boy was brought in by paramedics to the emergency department.", "2. He was found down at a family picnic.", "3. The boy's parents state that he tried many new foods at the picnic.", "4. It is springtime.", "5. Many insects were out while he was playing football.", "6. His temperature is 99.5\u00b0F (37.5\u00b0C).", "7. His blood pressure is 127/68 mmHg.", "8. His pulse is 120/min.", "9. His respirations are 33/min.", "10. His oxygen saturation is 84% on room air.", "11. Physical exam is notable for tachycardia.", "12. Very minimal breath sounds bilaterally.", "13. No jugular venous distention is noted.", "14. Abdominal exam is within normal limits."], "atomic_facts": ["1. He was found down at a family picnic.", "2. The boy's parents state that he tried many new foods at the picnic.", "3. Many insects were out while he was playing football due to springtime.", "4. His temperature is 99.5\u00b0F (37.5\u00b0C).", "5. His blood pressure is 127/68 mmHg.", "6. His pulse is 120/min.", "7. His respirations are 33/min.", "8. His oxygen saturation is 84% on room air.", "9. Physical exam is notable for tachycardia.", "10. Physical exam is notable for very minimal breath sounds bilaterally.", "11. No jugular venous distention is noted.", "12. An abdominal exam is within normal limits."]}
{"id": 1212, "question": "Which of the following is the best initial step in management?", "context": ["A 45-year-old woman comes to the emergency department with her 17-year-old son because she believes she has been poisoned by her ex-husband.", "She reports that her coffee tasted \u201cstrange\u201d this morning.", "After breakfast, she then saw a black car drive by the house, which she concludes must have been her ex-husband, who also drives a black car.", "She says that since the divorce 3 years ago, her ex-husband has been seeking revenge and thinks that he has installed cameras in her apartment to spy on her and their son.", "She has never seen any of these cameras but when she is alone in the apartment, she can sometimes hear them beeping and feel them recording her.", "The son also reports his mother's coffee mug smelled of bitter almonds, which he suspects was cyanide.", "He agrees with the mother's distrust towards his father and reports that he has also occasionally heard a camera beeping but has not been able to find any cameras yet.", "The mother's vital signs are within normal limits.", "Physical examination shows no abnormalities.", "Arterial blood gas analysis on room air shows a pH of 7.4.", "Toxicology screening is negative."], "context_len": 11, "options": {"A": "Ziprasidone therapy", "B": "Repetitive transcranial magnetic stimulation", "C": "Examine mother and son separately", "D": "Report the case to the authorities"}, "answer": "Examine mother and son separately", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "45 years old", "specialties": ["Psychiatry"], "subspecialties": ["Forensic Psychiatry", "Consultation"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. Patient is a 45-year-old woman.", "2. Patient is accompanied by her 17-year-old son.", "3. Patient believes she has been poisoned by her ex-husband.", "4. Patient reports her coffee tasted \u201cstrange\u201d this morning.", "5. Patient saw a black car drive by the house.", "6. Patient's ex-husband drives a black car.", "7. Patient and her ex-husband divorced 3 years ago.", "8. Patient's ex-husband has been seeking revenge.", "9. Patient believes her ex-husband has installed cameras in her apartment to spy on her and their son.", "10. Patient has never seen any of these cameras.", "11. Patient can sometimes hear cameras beeping and feel them recording her when she is alone in the apartment.", "12. Patient's son reports her coffee mug smelled of bitter almonds.", "13. Patient's son suspects the smell was cyanide.", "14. Patient's son agrees with the mother's distrust towards his father.", "15. Patient's son has occasionally heard a camera beeping but has not been able to find any cameras yet.", "16. Patient's vital signs are within normal limits.", "17. Physical examination shows no abnormalities.", "18. Arterial blood gas analysis on room air shows a pH of 7.4.", "19. Toxicology screening is negative."], "atomic_facts": ["1. She reports that her coffee tasted \u201cstrange\u201d this morning.", "2. After breakfast, she saw a black car drive by the house, which she concludes must have been her ex-husband, who also drives a black car.", "3. Since the divorce 3 years ago, her ex-husband has been seeking revenge and thinks that he has installed cameras in her apartment to spy on her and their son.", "4. She has never seen any of these cameras but when she is alone in the apartment, she can sometimes hear them beeping and feel them recording her.", "5. The son reports his mother's coffee mug smelled of bitter almonds, which he suspects was cyanide.", "6. He agrees with the mother's distrust towards his father and reports that he has also occasionally heard a camera beeping but has not been able to find any cameras yet.", "7. The mother's vital signs are within normal limits.", "8. Physical examination shows no abnormalities.", "9. Arterial blood gas analysis on room air shows a pH of 7.4.", "10. Toxicology screening is negative."]}
{"id": 1213, "question": "This patient is most likely deficient in which of the following enzymes?", "context": ["A 2-year-old boy is brought to the physician after his adoptive mother observed jerking movements of his arms and legs earlier that morning.", "He was adopted from an orphanage in Albania at 4 months of age.", "He has a history of intellectual disability.", "Examination shows pale skin and light blue eyes.", "There is a dry, eczematous, scaly rash on the extensor surfaces of the extremities."], "context_len": 5, "options": {"A": "Phenylalanine hydroxylase", "B": "\u03b1-ketoacid dehydrogenase", "C": "Cystathionine synthase", "D": "Homogentisate oxidase"}, "answer": "Phenylalanine hydroxylase", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "Child Neurology", "Pediatric Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.6, 0.2, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 2-year-old boy was brought to the physician.", "2. His adoptive mother observed jerking movements of his arms and legs earlier that morning.", "3. He was adopted from an orphanage in Albania at 4 months of age.", "4. He has a history of intellectual disability.", "5. Examination shows pale skin and light blue eyes.", "6. There is a dry, eczematous, scaly rash on the extensor surfaces of the extremities."], "atomic_facts": ["1. He was adopted from an orphanage in Albania at 4 months of age.", "2. He has a history of intellectual disability.", "3. Examination shows pale skin.", "4. Examination shows light blue eyes.", "5. There is a dry rash on the extensor surfaces of the extremities.", "6. There is an eczematous rash on the extensor surfaces of the extremities.", "7. There is a scaly rash on the extensor surfaces of the extremities."]}
{"id": 1214, "question": "Laboratory evaluation in this patient is most likely to show which of the following?", "context": ["A 45-year-old man comes to the physician because of a 4-month history of increased frequency of urination.", "He wakes up several times a night to urinate and feels fatigued during the day.", "He also complains of increased thirst; he drinks multiple liters of water and soda daily and still feels thirsty.", "Vital signs are within normal limits.", "Physical examination shows patches of velvety hyperpigmentation in the axilla and on the posterior neck."], "context_len": 5, "options": {"A": "Elevated serum thyroxine concentration", "B": "Elevated glycated hemoglobin concentration", "C": "Positive urinary leukocyte esterase", "D": "Low urine osmolality"}, "answer": "Elevated glycated hemoglobin concentration", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 45-year-old man comes to the physician.", "2. He has a 4-month history of increased frequency of urination.", "3. He wakes up several times a night to urinate.", "4. He feels fatigued during the day.", "5. He complains of increased thirst.", "6. He drinks multiple liters of water and soda daily.", "7. He still feels thirsty.", "8. Vital signs are within normal limits.", "9. Physical examination shows patches of velvety hyperpigmentation in the axilla.", "10. Physical examination shows patches of velvety hyperpigmentation on the posterior neck."], "atomic_facts": ["1. He wakes up several times a night to urinate.", "2. He feels fatigued during the day.", "3. He complains of increased thirst.", "4. He drinks multiple liters of water and soda daily.", "5. He still feels thirsty.", "6. Vital signs are within normal limits.", "7. Physical examination shows patches of velvety hyperpigmentation in the axilla.", "8. Physical examination shows patches of velvety hyperpigmentation on the posterior neck."]}
{"id": 1215, "question": "Which of the following agents is most likely to improve the patient's long-term survival?", "context": ["A 69-year-old man comes to the physician with a 9-month history of worsening shortness of breath on exertion and need to urinate at night.", "He occasionally has palpitations but does not have chest pain.", "The patient had a transient ischemic attack 5 years ago for which he underwent right-sided carotid endarterectomy.", "He has hypertension and type 2 diabetes mellitus.", "Current medications include metformin, lisinopril, aspirin, and simvastatin.", "He appears fatigued.", "His pulse is 61/min, blood pressure is 120/75 mmHg, and respirations are 25/min.", "Pulse oximetry shows an oxygen saturation of 96%.", "Examination shows cold extremities.", "There are no murmurs or rubs on cardiac auscultation.", "Fine, bilateral crackles are heard at the lung bases.", "There is 2+ lower extremity edema.", "An ECG shows sinus rhythm and known T wave inversions in leads V1 to V4."], "context_len": 13, "options": {"A": "Eplerenone", "B": "Ivabradine", "C": "Verapamil", "D": "Digoxin"}, "answer": "Eplerenone", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "69 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Cardiovascular Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 69 years old.", "2. Patient has 9-month history of worsening shortness of breath on exertion and need to urinate at night.", "3. Patient occasionally has palpitations but does not have chest pain.", "4. Patient had transient ischemic attack 5 years ago and underwent right-sided carotid endarterectomy.", "5. Patient has hypertension and type 2 diabetes mellitus.", "6. Patient is currently taking metformin, lisinopril, aspirin, and simvastatin.", "7. Patient appears fatigued.", "8. Patient's pulse is 61/min.", "9. Patient's blood pressure is 120/75 mmHg.", "10. Patient's respirations are 25/min.", "11. Pulse oximetry shows oxygen saturation of 96%.", "12. Examination shows cold extremities.", "13. No murmurs or rubs on cardiac auscultation.", "14. Fine, bilateral crackles heard at lung bases.", "15. 2+ lower extremity edema.", "16. ECG shows sinus rhythm and known T wave inversions in leads V1 to V4."], "atomic_facts": ["1. The patient occasionally has palpitations.", "2. The patient does not have chest pain.", "3. The patient had a transient ischemic attack 5 years ago.", "4. The patient underwent right-sided carotid endarterectomy for the transient ischemic attack.", "5. The patient has hypertension.", "6. The patient has type 2 diabetes mellitus.", "7. The patient's current medications include metformin.", "8. The patient's current medications include lisinopril.", "9. The patient's current medications include aspirin.", "10. The patient's current medications include simvastatin.", "11. The patient appears fatigued.", "12. The patient's pulse is 61/min.", "13. The patient's blood pressure is 120/75 mmHg.", "14. The patient's respirations are 25/min.", "15. Pulse oximetry shows an oxygen saturation of 96%.", "16. Examination shows cold extremities.", "17. There are no murmurs on cardiac auscultation.", "18. There are no rubs on cardiac auscultation.", "19. Fine, bilateral crackles are heard at the lung bases.", "20. There is 2+ lower extremity edema.", "21. An ECG shows sinus rhythm.", "22. An ECG shows known T wave inversions in leads V1 to V4."]}
{"id": 1216, "question": "Which of the following is the next best step in diagnosis?", "context": ["A 22-year-old woman presents to her primary care provider complaining of a facial rash.", "She says the rash began 3 weeks ago after hiking in the White Mountains of New Hampshire this summer.", "Since that time she has also experienced pain in her hands and wrists that is worse in the morning and accompanied by subjective fevers.", "She denies chest pain, shortness of breath, nausea, or vomiting.", "Vital signs are 99.6\u00b0F (37.6\u00b0F), blood pressure is 134/82 mmHg, pulse is 88/min, and respirations are 18/min.", "Examination demonstrates a rash on the patient's face that spares the nasolabial folds along with oral ulcers.", "The metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain.", "Complete blood count demonstrates normocytic anemia with thrombocytopenia."], "context_len": 8, "options": {"A": "Anti-cardiolipin antibodies", "B": "Anti-dsDNA antibodies", "C": "Anti-nuclear antibodies", "D": "Anti-Smith antibodies"}, "answer": "Anti-nuclear antibodies", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "22 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. Patient is a 22-year-old woman.", "2. Patient presents to primary care provider complaining of facial rash.", "3. Patient says rash began 3 weeks ago after hiking in White Mountains of New Hampshire.", "4. Patient has experienced pain in hands and wrists that is worse in the morning and accompanied by subjective fevers.", "5. Patient denies chest pain, shortness of breath, nausea, or vomiting.", "6. Vital signs are 99.6\u00b0F (37.6\u00b0C), blood pressure is 134/82 mmHg, pulse is 88/min, and respirations are 18/min.", "7. Examination demonstrates rash on patient's face that spares the nasolabial folds along with oral ulcers.", "8. Metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain.", "9. Complete blood count demonstrates normocytic anemia with thrombocytopenia."], "atomic_facts": ["1. The rash began 3 weeks ago after hiking in the White Mountains of New Hampshire this summer.", "2. She has experienced pain in her hands and wrists that is worse in the morning and accompanied by subjective fevers.", "3. She denies chest pain, shortness of breath, nausea, or vomiting.", "4. Vital signs: 99.6\u00b0F (37.6\u00b0C) temperature, blood pressure 134/82 mmHg, pulse 88/min, and respirations 18/min.", "5. Examination demonstrates a rash on the patient's face that spares the nasolabial folds along with oral ulcers.", "6. The metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain.", "7. Complete blood count demonstrates normocytic anemia with thrombocytopenia."]}
{"id": 1217, "question": "Which of the following organisms is the most likely cause of this patient\u2019s condition?", "context": ["A 54-year-old man presents with fever and a painful jaw mass with a yellowish discharge.", "He says that he first noticed the jaw mass 6 weeks ago and that the mass has been progressively increasing in size.", "He reports a history of chronic alcoholism and currently takes more than 6 drinks daily.", "His temperature is 37.9\u00b0C (100.2\u00b0F).", "On physical examination, there is a 7 \u00d7 7 cm mass at the tip of the jaw bone with significant surrounding edema and sclerosis The mass is severely tender on light palpation and has a yellowish malodorous discharge.", "The oral cavity shows signs of very poor dentition.", "Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria."], "context_len": 7, "options": {"A": "Peptostreptococcus magnus", "B": "Actinomyces israelii", "C": "Nocardia asteroides", "D": "Eikenella corrodens"}, "answer": "Actinomyces israelii", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "54 years old", "specialties": ["Otolaryngology", "Pathology"], "subspecialties": ["General Otolaryngology", "Medical Microbiology Pathology"], "specialty_prob": [0.75, 0.25], "subspecialty_prob": [0.75, 0.25], "gpt_specialty": "Otolaryngology"}, "facts_old": ["1. Patient is 54 years old.", "2. Patient has fever.", "3. Patient has a painful jaw mass with a yellowish discharge.", "4. Patient first noticed the jaw mass 6 weeks ago.", "5. Mass has been progressively increasing in size.", "6. Patient has a history of chronic alcoholism.", "7. Patient currently takes more than 6 drinks daily.", "8. Patient's temperature is 37.9\u00b0C (100.2\u00b0F).", "9. Physical examination reveals a 7 \u00d7 7 cm mass at the tip of the jaw bone with significant surrounding edema and sclerosis.", "10. Mass is severely tender on light palpation.", "11. Mass has a yellowish malodorous discharge.", "12. Oral cavity shows signs of very poor dentition.", "13. Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria."], "atomic_facts": ["1. He first noticed the jaw mass 6 weeks ago.", "2. The mass has been progressively increasing in size.", "3. He has a history of chronic alcoholism.", "4. He currently takes more than 6 drinks daily.", "5. His temperature is 37.9\u00b0C (100.2\u00b0F).", "6. On physical examination, there is a 7 \u00d7 7 cm mass at the tip of the jaw bone.", "7. Significant surrounding edema and sclerosis are present.", "8. The mass is severely tender on light palpation.", "9. The mass has a yellowish malodorous discharge.", "10. The oral cavity shows signs of very poor dentition.", "11. Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria."]}
{"id": 1218, "question": "Which of the following is the best initial diagnostic test for this patient\u2019s condition?", "context": ["A 57-year-old homosexual man presents to the emergency department with epigastric pain.", "He has presented multiple times for the same complaint in the past.", "The patient has a past medical history of alcoholism and is homeless.", "He states that his symptoms at this time are constant and occur at all times of the day and are near his baseline.", "He also endorses fatty and foul smelling diarrhea during this time frame."], "context_len": 5, "options": {"A": "CT scan", "B": "Lipase", "C": "Secretin stimulation test", "D": "Stool ova and parasite analysis"}, "answer": "CT scan", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "57 years old", "specialties": ["Gastroenterology", "Internal Medicine"], "subspecialties": ["General Gastroenterology", "Gastroenterology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 57-year-old man presents to the emergency department with epigastric pain.", "2. He has presented multiple times for the same complaint in the past.", "3. The patient has a past medical history of alcoholism.", "4. The patient is homeless.", "5. He states that his symptoms at this time are constant.", "6. His symptoms occur at all times of the day.", "7. His symptoms are near his baseline.", "8. He endorses fatty and foul smelling diarrhea during this time frame."], "atomic_facts": ["1. The patient has presented multiple times for the same complaint in the past.", "2. The patient has a past medical history of alcoholism.", "3. The patient is homeless.", "4. The patient states that his symptoms at this time are constant.", "5. The patient's symptoms occur at all times of the day.", "6. The patient's symptoms are near his baseline.", "7. The patient endorses fatty and foul smelling diarrhea during this time frame."]}
{"id": 1219, "question": "Which of the following cells is responsible for the initial cascade by the release of TGF-\u03b2 and PDGF?", "context": ["A 6-year-old boy is rushed to the emergency department after being involved in a motor vehicle accident.", "He has abrasions on his left knee and left elbow.", "His wounds are cleaned and a pressure bandage is applied.", "Typically, neutrophils and macrophages are attracted toward the site of injury by various chemical mediators."], "context_len": 4, "options": {"A": "Mast cells", "B": "Fibroblasts", "C": "Platelets", "D": "Basophils"}, "answer": "Platelets", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 6-year-old boy is rushed to the emergency department.", "2. He has abrasions on his left knee and left elbow.", "3. His wounds are cleaned.", "4. A pressure bandage is applied.", "5. Neutrophils and macrophages are typically attracted toward the site of injury.", "6. Various chemical mediators attract neutrophils and macrophages."], "atomic_facts": ["1. He has abrasions on his left knee.", "2. He has abrasions on his left elbow.", "3. His wounds are cleaned.", "4. A pressure bandage is applied.", "5. Neutrophils are attracted toward the site of injury.", "6. Macrophages are attracted toward the site of injury.", "7. They are attracted by various chemical mediators."]}
{"id": 1220, "question": "Which of the following is the most likely cause of this patient's presentation?", "context": ["A 70-year-old man comes to the emergency department after briefly losing consciousness and collapsing when rising from a chair.", "He did not sustain any injuries from his collapse.", "He has had a two-week history of dizziness upon standing.", "He has smoked one pack of cigarettes daily for 55 years.", "He drinks three beers and two glasses of whiskey daily.", "He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia.", "His blood pressure is 120/80 mm Hg supine and 100/70 mm Hg one minute after standing with no change in pulse rate.", "Physical examination shows conjunctival pallor.", "On cardiac auscultation, there is a plopping sound followed by a low-pitched, rumbling mid-diastolic murmur heard best at the apex."], "context_len": 9, "options": {"A": "Stokes-Adams attack", "B": "Constricted aortic valve orifice", "C": "Cardiac tumor", "D": "Left ventricular dilation"}, "answer": "Cardiac tumor", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "70 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 70-year-old man comes to the emergency department.", "2. He briefly lost consciousness and collapsed when rising from a chair.", "3. He did not sustain any injuries from his collapse.", "4. He has had a two-week history of dizziness upon standing.", "5. He has smoked one pack of cigarettes daily for 55 years.", "6. He drinks three beers and two glasses of whiskey daily.", "7. He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia.", "8. His blood pressure is 120/80 mm Hg supine.", "9. His blood pressure is 100/70 mm Hg one minute after standing with no change in pulse rate.", "10. Physical examination shows conjunctival pallor.", "11. On cardiac auscultation, there is a plopping sound.", "12. On cardiac auscultation, there is a low-pitched, rumbling mid-diastolic murmur heard best at the apex."], "atomic_facts": ["1. He did not sustain any injuries from his collapse.", "2. He has had a two-week history of dizziness upon standing.", "3. He has smoked one pack of cigarettes daily for 55 years.", "4. He drinks three beers and two glasses of whiskey daily.", "5. He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia.", "6. His blood pressure is 120/80 mm Hg supine and 100/70 mm Hg one minute after standing with no change in pulse rate.", "7. Physical examination shows conjunctival pallor.", "8. On cardiac auscultation, there is a plopping sound followed by a low-pitched, rumbling mid-diastolic murmur heard best at the apex."]}
{"id": 1221, "question": "Which of the following congenital heart diseases does this infant most likely present with?", "context": ["A 6-month-old infant is brought to a pediatrician for his scheduled immunizations.", "The parents deny any specific current complaints, but his facial features differ from those of other children in the family.", "During the physical examination, the pediatrician notes that the infant\u2019s vital signs are stable.", "His facial features include a medial epicanthic fold, a face that appears flat, and a flat occiput with low-set ears.", "The pediatrician also notes a single transverse palmar crease on both hands.", "An echocardiogram is performed which suggests that the infant has a congenital heart disease which is the most common form of congenital heart disease seen in children with this particular genetic disorder."], "context_len": 6, "options": {"A": "Supravalvar aortic stenosis", "B": "Tetralogy of Fallot", "C": "Atrial septal defect", "D": "Atrioventricular septal defect"}, "answer": "Atrioventricular septal defect", "answer_idx": "D", "explanation": "", "patient": {"gender": "Not specified", "age": "6 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 6-month-old infant is brought to a pediatrician for his scheduled immunizations.", "2. The parents deny any specific current complaints.", "3. His facial features differ from those of other children in the family.", "4. During the physical examination, the pediatrician notes that the infant\u2019s vital signs are stable.", "5. His facial features include a medial epicanthic fold, a face that appears flat, and a flat occiput with low-set ears.", "6. The pediatrician also notes a single transverse palmar crease on both hands.", "7. An echocardiogram is performed.", "8. The echocardiogram suggests that the infant has a congenital heart disease.", "9. The congenital heart disease is the most common form of congenital heart disease seen in children with this particular genetic disorder."], "atomic_facts": ["1. The parents deny any specific current complaints.", "2. His facial features differ from those of other children in the family.", "3. The pediatrician notes that the infant\u2019s vital signs are stable.", "4. His facial features include a medial epicanthic fold.", "5. His facial features include a face that appears flat.", "6. His facial features include a flat occiput with low-set ears.", "7. The pediatrician notes a single transverse palmar crease on both hands.", "8. An echocardiogram suggests that the infant has a congenital heart disease.", "9. The congenital heart disease is the most common form seen in children with this particular genetic disorder."]}
{"id": 1222, "question": "WBC 0\u20131/hpf | Fatty casts numerous | A renal biopsy specimen is most likely to show which of the following?\"", "context": ["A 32-year-old white woman comes to the physician because of fatigue, lethargy, and swelling of the lower legs for 2 months.", "She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year.", "She has had skin problems that are aggravated by exposure to sunlight for the past 18 months.", "She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily.", "Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 92/min, and blood pressure is 115/75 mm Hg.", "Examination shows 2+ pretibial edema bilaterally and periorbital edema.", "There are erythematous patches with scaling on both cheeks.", "Laboratory studies show: | Hemoglobin 11.2 g/dL | Leukocyte count 8500/mm3 | Platelet count 130,000/mm3 | Serum | Urea nitrogen 36 mg/dL | Glucose 77 mg/dL | Creatinine 0.9 mg/dL | Albumin 2.6 mg/dL | Total cholesterol 275 mg/dL | Triglycerides 180 mg/dL | Urine | Blood negative | Glucose negative | Protein 4+ | ."], "context_len": 8, "options": {"A": "Thickened capillary loops", "B": "Segmental sclerosis", "C": "Crescent formation", "D": "Hypercellular glomeruli"}, "answer": "Thickened capillary loops", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "32 years old", "specialties": ["Nephrology", "Internal Medicine"], "subspecialties": ["General Nephrology", "Nephrology"], "specialty_prob": [0.8, 0.2], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 32-year-old white woman.", "2. Patient has been experiencing fatigue, lethargy, and swelling of the lower legs for 2 months.", "3. Patient has had recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year.", "4. Patient has had skin problems that are aggravated by exposure to sunlight for the past 18 months.", "5. Patient has smoked one pack of cigarettes daily for 13 years.", "6. Patient drinks one alcoholic beverage daily.", "7. Patient's temperature is 37\u00b0C (98.6\u00b0F).", "8. Patient's pulse is 92/min.", "9. Patient's blood pressure is 115/75 mm Hg.", "10. Examination shows 2+ pretibial edema bilaterally and periorbital edema.", "11. Examination shows erythematous patches with scaling on both cheeks.", "12. Laboratory studies show hemoglobin 11.2 g/dL.", "13. Laboratory studies show leukocyte count 8500/mm3.", "14. Laboratory studies show platelet count 130,000/mm3.", "15. Laboratory studies show serum urea nitrogen 36 mg/dL.", "16. Laboratory studies show serum glucose 77 mg/dL.", "17. Laboratory studies show serum creatinine 0.9 mg/dL.", "18. Laboratory studies show serum albumin 2.6 mg/dL.", "19. Laboratory studies show total cholesterol 275 mg/dL.", "20. Laboratory studies show triglycerides 180 mg/dL.", "21. Laboratory studies show urine blood negative.", "22. Laboratory studies show urine glucose negative.", "23. Laboratory studies show urine protein 4+."], "atomic_facts": ["1. She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year.", "2. She has had skin problems that are aggravated by exposure to sunlight for the past 18 months.", "3. She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily.", "4. Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 92/min, and blood pressure is 115/75 mm Hg.", "5. Examination shows 2+ pretibial edema bilaterally and periorbital edema.", "6. There are erythematous patches with scaling on both cheeks.", "7. Laboratory studies show: Hemoglobin 11.2 g/dL, Leukocyte count 8500/mm3, Platelet count 130,000/mm3, Serum Urea nitrogen 36 mg/dL, Glucose 77 mg/dL, Creatinine 0.9 mg/dL, Albumin 2.6 mg/dL, Total cholesterol 275 mg/dL, Triglycerides 180 mg/dL, Urine Blood negative, Glucose negative, Protein 4+."]}
{"id": 1223, "question": "Which of the following is most likely responsible for this patient\u2019s breathing pattern?", "context": ["A 60-year-old man presents to the clinic with his wife for \u201cweird breathing\u201d during the night.", "The patient\u2019s wife says that his breathing pattern is irregular but he does not snore.", "The patient says he is not aware of these symptoms.", "Past medical history is remarkable for an NSTEMI when he was 50 years old.", "He spends a night at the sleep lab where his tidal volume is monitored overnight and a tracing is shown in the image below."], "context_len": 5, "options": {"A": "Diabetic ketoacidosis", "B": "Hypothyroidism", "C": "Left ventricular heart failure", "D": "Obesity"}, "answer": "Left ventricular heart failure", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "60 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 60-year-old man presents to the clinic with his wife.", "2. The patient's wife reports that his breathing pattern is irregular.", "3. The patient does not snore.", "4. The patient is not aware of these symptoms.", "5. The patient's past medical history is remarkable for an NSTEMI when he was 50 years old.", "6. The patient spends a night at the sleep lab.", "7. The patient's tidal volume is monitored overnight.", "8. An image of the tracing is shown below."], "atomic_facts": ["1. The patient's wife reports irregular breathing pattern.", "2. The patient does not snore.", "3. The patient denies awareness of the reported symptoms.", "4. Past medical history includes an NSTEMI at age 50.", "5. The patient spent a night at a sleep lab.", "6. Tidal volume was monitored overnight.", "7. A tracing was shown in an image."]}
{"id": 1224, "question": "Which of the following is the most likely diagnosis?", "context": ["A 72-year-old man with a history of chronic kidney disease presents to his primary care physician complaining of recurrent chest pain with activity.", "The patient used to have chest pain when he mowed his lawn.", "Now he gets chest pain whenever he walks short distances such as to get his mail.", "The pain resolves on its own when the patient sits and rests.", "His temperature is 98.2\u00b0F (36.8\u00b0C), blood pressure is 157/98 mm Hg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air.", "Physical exam is notable for an obese man who is in no distress.", "An initial ECG is unchanged from a previous ECG.", "The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins."], "context_len": 8, "options": {"A": "NSTEMI", "B": "Stable angina", "C": "Unstable angina", "D": "Variant angina"}, "answer": "Unstable angina", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "72 years old", "specialties": ["Internal Medicine", "Cardiovascular Disease", "Cardiology"], "subspecialties": ["Cardiovascular Disease", "Cardiology", "General Cardiology", "General Internal Medicine"], "specialty_prob": [0.6, 0.2, 0.2], "subspecialty_prob": [0.4, 0.2, 0.2, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is 72 years old.", "2. Patient has a history of chronic kidney disease.", "3. Patient presents to primary care physician with recurrent chest pain with activity.", "4. Patient used to have chest pain when mowing lawn.", "5. Patient now gets chest pain when walking short distances such as to get mail.", "6. Pain resolves on its own when patient sits and rests.", "7. Patient's temperature is 98.2\u00b0F (36.8\u00b0C).", "8. Patient's blood pressure is 157/98 mm Hg.", "9. Patient's pulse is 80/min.", "10. Patient's respirations are 15/min.", "11. Patient's oxygen saturation is 98% on room air.", "12. Patient is obese and in no distress.", "13. Initial ECG is unchanged from previous ECG.", "14. Patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins."], "atomic_facts": ["1. The patient used to have chest pain when he mowed his lawn.", "2. Now he gets chest pain whenever he walks short distances such as to get his mail.", "3. The pain resolves on its own when the patient sits and rests.", "4. His temperature is 98.2\u00b0F (36.8\u00b0C).", "5. Blood pressure is 157/98 mm Hg.", "6. Pulse is 80/min.", "7. Respirations are 15/min.", "8. Oxygen saturation is 98% on room air.", "9. Physical exam is notable for an obese man who is in no distress.", "10. An initial ECG is unchanged from a previous ECG.", "11. The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins."]}
{"id": 1225, "question": "Which of the following procedures involves the removal of an entire breast?", "context": ["A 55-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer.", "She has a medical history of hypertension for which she takes lisinopril.", "She denies any surgical history.", "Her family history is notable for breast cancer in her maternal grandmother.", "She is visibly anxious during the encounter, but physical examination is otherwise unremarkable.", "Her primary concern today is which surgical approach will be chosen to remove her breast cancer."], "context_len": 6, "options": {"A": "Vasectomy", "B": "Mastectomy", "C": "Lumpectomy", "D": "Arthroplasty"}, "answer": "Mastectomy", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "55 years old", "specialties": ["Surgery"], "subspecialties": ["General Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Surgery"}, "facts_old": ["1. A 55-year-old woman presents to the surgical oncology clinic as a new patient.", "2. She has a medical history of hypertension.", "3. She takes lisinopril for her hypertension.", "4. She denies any surgical history.", "5. Her family history is notable for breast cancer in her maternal grandmother.", "6. She is visibly anxious during the encounter.", "7. Physical examination is otherwise unremarkable.", "8. Her primary concern today is which surgical approach will be chosen to remove her breast cancer."], "atomic_facts": ["1. She has a medical history of hypertension.", "2. She takes lisinopril for her hypertension.", "3. She denies any surgical history.", "4. Her family history includes breast cancer in her maternal grandmother.", "5. She is visibly anxious during the encounter.", "6. Physical examination is otherwise unremarkable.", "7. Her primary concern today is which surgical approach will be chosen to remove her breast cancer."]}
{"id": 1226, "question": "Which of the following did the physician add?", "context": ["A 14-year-old female is seeing her pulmonologist in clinic after a recent asthma exacerbation.", "She has been adherent to her original controller medication so the physician prescribes an additional new drug which prevents IgE binding to mast cells."], "context_len": 2, "options": {"A": "Theophylline", "B": "Albuterol", "C": "Omalizumab", "D": "Beclamethasone"}, "answer": "Omalizumab", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "14", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Pulmonology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A 14-year-old female is seeing her pulmonologist in clinic.", "2. The visit is due to a recent asthma exacerbation.", "3. She has been adherent to her original controller medication.", "4. The physician prescribes an additional new drug.", "5. The new drug prevents IgE binding to mast cells."], "atomic_facts": ["1. The patient has been adherent to her original controller medication.", "2. The physician prescribes an additional new drug.", "3. The new drug prevents IgE binding to mast cells."]}
{"id": 1227, "question": "Which of the following is the best next step in management for this patient?", "context": ["A 24-year-old man is brought in to the emergency room after being retrieved by firefighters from a burning building.", "The patient is responding coherently to questions but reports pain secondary to a burn on his leg.", "He states he also has a headache and feels dizzy.", "His temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 129/66 mmHg, pulse is 126/min, respirations are 14/min, and oxygen saturation is 99% on room air.", "Physical exam is notable for a confused young man with dry and flushed skin.", "Cardiopulmonary exam reveals a normal S1 and S2 as well as clear breath sounds bilaterally.", "The patient\u2019s neurological exam is within normal limits.", "Towards the end of his exam, the patient begins vomiting.", "Dermatologic exam reveals a superficial burn covering 1% of the patient\u2019s body over his right leg."], "context_len": 9, "options": {"A": "100% oxygen", "B": "Hydroxocobalamin", "C": "Normal saline", "D": "Ondansetron"}, "answer": "100% oxygen", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "24 years old", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 24-year-old man is brought in to the emergency room. ", "2. He was retrieved by firefighters from a burning building. ", "3. He is responding coherently to questions. ", "4. He reports pain secondary to a burn on his leg. ", "5. He also has a headache and feels dizzy. ", "6. His temperature is 98.5\u00b0F (36.9\u00b0C). ", "7. His blood pressure is 129/66 mmHg. ", "8. His pulse is 126/min. ", "9. His respirations are 14/min. ", "10. His oxygen saturation is 99% on room air. ", "11. He is a confused young man with dry and flushed skin. ", "12. Cardiopulmonary exam reveals a normal S1 and S2. ", "13. Breath sounds are clear bilaterally. ", "14. His neurological exam is within normal limits. ", "15. Towards the end of his exam, he begins vomiting. ", "16. Dermatologic exam reveals a superficial burn covering 1% of his body over his right leg."], "atomic_facts": ["1. The patient is responding coherently to questions.", "2. The patient reports pain secondary to a burn on his leg.", "3. The patient states he also has a headache and feels dizzy.", "4. The patient's temperature is 98.5\u00b0F (36.9\u00b0C).", "5. The patient's blood pressure is 129/66 mmHg.", "6. The patient's pulse is 126/min.", "7. The patient's respirations are 14/min.", "8. The patient's oxygen saturation is 99% on room air.", "9. Physical exam is notable for a confused young man with dry and flushed skin.", "10. Cardiopulmonary exam reveals a normal S1 and S2.", "11. Cardiopulmonary exam reveals clear breath sounds bilaterally.", "12. The patient's neurological exam is within normal limits.", "13. Towards the end of his exam, the patient begins vomiting.", "14. Dermatologic exam reveals a superficial burn covering 1% of the patient\u2019s body over his right leg."]}
{"id": 1228, "question": "Which of the following vitamin deficiencies is she most likely to develop?", "context": ["A 29-year-old female presents to her psychiatrist with concerns that she may be \"OCD.\" She explains that she has become extremely obsessed with making sure that her fruits and vegetables are completely sanitized by first rinsing with water for exactly 60 seconds and then boiling for exactly 60 minutes.", "She refuses to eat any fruits or vegetables that did not undergo this process, which she began doing about 3 months ago."], "context_len": 2, "options": {"A": "Vitamin A", "B": "Vitamin K", "C": "Vitamin C", "D": "Vitamin E"}, "answer": "Vitamin C", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "29", "specialties": ["Psychiatry"], "subspecialties": ["General Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Others"}, "facts_old": ["1. A 29-year-old female presents to her psychiatrist.", "2. She has concerns that she may be \"OCD.\"", "3. She rinses fruits and vegetables with water for exactly 60 seconds.", "4. She boils fruits and vegetables for exactly 60 minutes.", "5. She refuses to eat any fruits or vegetables that did not undergo this process.", "6. She began this process about 3 months ago."], "atomic_facts": ["1. She refuses to eat fruits or vegetables.", "2. The fruits or vegetables must undergo a specific process.", "3. She began this process about 3 months ago."]}
{"id": 1229, "question": "What is the most likely diagnosis?", "context": ["A 73-year-old male is brought to his family practitioner by his daughter with the complaints of a spinning sensation for the past 4 weeks.", "He says that the room appears to be continuously spinning.", "This has progressively worsened over the last 4 weeks to the point that he has become bed bound and cannot walk without support.", "These spinning sensations are present throughout the day and do not change with position.", "They are associated with nausea and vomiting.", "He denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness.", "He has a blood pressure of 133/80 mm Hg, heart rate of 80/min, respiratory rate of 12/min, and temperature of 36.7\u00b0C (98.2\u00b0F).", "His extraocular eye movements are normal in all directions, but a vertical nystagmus is present that does not disappear despite repetitive testing.", "Hearing tests are within normal limits."], "context_len": 9, "options": {"A": "Acute labyrinthitis", "B": "Benign paroxysmal positional vertigo", "C": "Cerebellar tumor", "D": "Meniere's disease"}, "answer": "Cerebellar tumor", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "73 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 73 years old.", "2. Patient was brought to family practitioner by daughter.", "3. Patient has been experiencing a spinning sensation for 4 weeks.", "4. Spinning sensation has progressively worsened over 4 weeks.", "5. Patient has become bed bound and cannot walk without support.", "6. Spinning sensation is present throughout the day and does not change with position.", "7. Spinning sensation is associated with nausea and vomiting.", "8. Patient denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness.", "9. Patient's blood pressure is 133/80 mm Hg.", "10. Patient's heart rate is 80/min.", "11. Patient's respiratory rate is 12/min.", "12. Patient's temperature is 36.7\u00b0C (98.2\u00b0F).", "13. Patient's extraocular eye movements are normal in all directions.", "14. Patient has vertical nystagmus that does not disappear despite repetitive testing.", "15. Patient's hearing tests are within normal limits."], "atomic_facts": ["1. The patient experiences continuous spinning sensations in the room.", "2. The spinning sensations have worsened progressively over the last 4 weeks.", "3. The patient has become bed bound due to the spinning sensations and cannot walk without support.", "4. The spinning sensations are present throughout the day and do not change with position.", "5. The spinning sensations are associated with nausea and vomiting.", "6. The patient denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness.", "7. The patient's blood pressure is 133/80 mm Hg.", "8. The patient's heart rate is 80/min.", "9. The patient's respiratory rate is 12/min.", "10. The patient's temperature is 36.7\u00b0C (98.2\u00b0F).", "11. The patient's extraocular eye movements are normal in all directions.", "12. A vertical nystagmus is present in the patient and does not disappear despite repetitive testing.", "13. Hearing tests for the patient are within normal limits."]}
{"id": 1230, "question": "On physical exam, one would also expect:", "context": ["A 79-year-old man presents to the emergency room after a syncopal event.", "The patient has a history of hyperlipidemia for which he is taking atorvastatin.", "On physical examination, his vital signs are stable, but on cardiac auscultation, you detect a crescendo-decrescendo systolic murmur loudest on the right upper sternal border radiating to the neck."], "context_len": 3, "options": {"A": "That the murmur would best be heard in the lateral left decubitus position", "B": "The character of the murmur would be machine-like", "C": "The murmur would also have a mid-systolic click loudest before S2", "D": "Palpation of the carotid pulse would be weak and late relative to the patient\u2019s heart sounds"}, "answer": "Palpation of the carotid pulse would be weak and late relative to the patient\u2019s heart sounds", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "79 years old", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 79-year-old man presents to the emergency room.", "2. The patient has a history of hyperlipidemia.", "3. The patient is taking atorvastatin.", "4. Vital signs are stable.", "5. Cardiac auscultation reveals a crescendo-decrescendo systolic murmur.", "6. The murmur is loudest on the right upper sternal border.", "7. The murmur radiates to the neck."], "atomic_facts": ["1. The patient has a history of hyperlipidemia.", "2. The patient is taking atorvastatin for hyperlipidemia.", "3. The patient's vital signs are stable on physical examination.", "4. A crescendo-decrescendo systolic murmur is detected on cardiac auscultation.", "5. The murmur is loudest on the right upper sternal border.", "6. The murmur radiates to the neck."]}
{"id": 1231, "question": "Which of the following best describes this type of study design?", "context": ["A researcher is designing a study to examine a possible correlation between exposure to a particular pesticide and chronic bronchitis.", "The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital and contacts the qualifying subjects to ask them about exposure to the particular pesticide.", "Using the data he compiles, he is able to calculate an estimate for the relative and absolute risk for developing chronic bronchitis in people who have been exposed to that pesticide."], "context_len": 3, "options": {"A": "Case-control study", "B": "Cross-sectional study", "C": "Cohort study", "D": "Double-blind, randomized, placebo-controlled clinical trial"}, "answer": "Cross-sectional study", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A researcher is designing a study to examine a possible correlation between exposure to a particular pesticide and chronic bronchitis.", "2. The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital.", "3. The researcher contacts the qualifying subjects to ask them about exposure to the particular pesticide.", "4. The researcher compiles data from the records and the subjects' responses.", "5. The researcher is able to calculate an estimate for the relative and absolute risk for developing chronic bronchitis in people who have been exposed to that pesticide."], "atomic_facts": ["1. The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital.", "2. The researcher contacts the qualifying subjects to ask them about exposure to the particular pesticide.", "3. The researcher uses the data to calculate an estimate for the relative and absolute risk for developing chronic bronchitis.", "4. The study focuses on people who have been exposed to a particular pesticide."]}
{"id": 1232, "question": "Which of the following will most likely be found on cardiac auscultation?", "context": ["A 49-year-old woman presents to her primary care physician due to fatigue and shortness of breath.", "She finds herself being short of breath when climbing the stairs or walking uphill.", "Approximately 1 year ago, she was able to partake in long-distance running and weightlifting.", "Two weeks ago she noticed blood-tinged sputum after severely coughing during sleep.", "She emigrated from Mexico to the United States 3 years ago.", "Her temperature is 98\u00b0F (36.7\u00b0C), blood pressure is 100/62 mmHg, pulse is 135/min and irregularly irregular, and respirations are 21/min.", "On physical exam her speech is hoarse.", "She has bilateral crackles heard in the lung bases."], "context_len": 8, "options": {"A": "Crescendo-decrescendo systolic ejection murmur", "B": "High-pitched, early diastolic decrescendo murmur", "C": "Holosystolic, high-pitched murmur loudest at the left lower sternal border", "D": "Opening snap with a mid-to-late diastolic murmur"}, "answer": "Opening snap with a mid-to-late diastolic murmur", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "49", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 49-year-old woman.", "2. Patient presents to primary care physician due to fatigue and shortness of breath.", "3. Patient finds herself being short of breath when climbing stairs or walking uphill.", "4. Approximately 1 year ago, patient was able to partake in long-distance running and weightlifting.", "5. Two weeks ago, patient noticed blood-tinged sputum after severely coughing during sleep.", "6. Patient emigrated from Mexico to the United States 3 years ago.", "7. Patient's temperature is 98\u00b0F (36.7\u00b0C).", "8. Patient's blood pressure is 100/62 mmHg.", "9. Patient's pulse is 135/min and irregularly irregular.", "10. Patient's respirations are 21/min.", "11. On physical exam, patient's speech is hoarse.", "12. Patient has bilateral crackles heard in the lung bases."], "atomic_facts": ["1. She finds herself being short of breath when climbing the stairs or walking uphill.", "2. Approximately 1 year ago, she was able to partake in long-distance running and weightlifting.", "3. Two weeks ago she noticed blood-tinged sputum after severely coughing during sleep.", "4. She emigrated from Mexico to the United States 3 years ago.", "5. Her temperature is 98\u00b0F (36.7\u00b0C).", "6. Her blood pressure is 100/62 mmHg.", "7. Her pulse is 135/min and irregularly irregular.", "8. Her respirations are 21/min.", "9. On physical exam her speech is hoarse.", "10. She has bilateral crackles heard in the lung bases."]}
{"id": 1233, "question": "Which of the following is the most appropriate pharmacotherapy at this time?", "context": ["A 60-year-old man presents to the physician for a follow-up examination.", "During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound.", "He has no complaints other than fatigue for several months.", "He has no history of serious illness and takes no medications.", "The vital signs are within the normal range.", "On percussion, spleen size is 15 cm (5.9 in).", "Otherwise, the physical examination shows no abnormalities.", "The laboratory test results are as follows: | Hemoglobin 10 g/dL | Mean corpuscular volume 88 \u03bcm3 | Leukocyte count 65,000/mm3 | Platelet count 500,000/mm3 | The peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "The molecular studies document the BCR-ABL1 rearrangement."], "context_len": 9, "options": {"A": "All-trans retinoic acid", "B": "Aspirin", "C": "Imatinib", "D": "Hydroxyurea"}, "answer": "Imatinib", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "60 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Geriatric Medicine", "Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 60-year-old man presents to the physician for a follow-up examination.", "2. During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound.", "3. He has no complaints other than fatigue for several months.", "4. He has no history of serious illness and takes no medications.", "5. The vital signs are within the normal range.", "6. On percussion, spleen size is 15 cm (5.9 in).", "7. Otherwise, the physical examination shows no abnormalities.", "8. The laboratory test results are as follows: Hemoglobin 10 g/dL.", "9. The laboratory test results are as follows: Mean corpuscular volume 88 \u03bcm3.", "10. The laboratory test results are as follows: Leukocyte count 65,000/mm3.", "11. The laboratory test results are as follows: Platelet count 500,000/mm3.", "12. The peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "13. The molecular studies document the BCR-ABL1 rearrangement."], "atomic_facts": ["1. Splenomegaly was detected on the abdominal exam during the previous visit.", "2. The splenomegaly has been confirmed by abdominal ultrasound.", "3. The patient has been experiencing fatigue for several months.", "4. The patient has no complaints other than fatigue.", "5. The patient has no history of serious illness.", "6. The patient takes no medications.", "7. The vital signs are within the normal range.", "8. Spleen size on percussion is 15 cm (5.9 in).", "9. Otherwise, the physical examination shows no abnormalities.", "10. Laboratory test results: Hemoglobin 10 g/dL.", "11. Laboratory test results: Mean corpuscular volume 88 \u03bcm3.", "12. Laboratory test results: Leukocyte count 65,000/mm3.", "13. Laboratory test results: Platelet count 500,000/mm3.", "14. Peripheral blood smear shows a predominance of neutrophils.", "15. Peripheral blood smear shows the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%).", "16. Molecular studies document the BCR-ABL1 rearrangement."]}
{"id": 1234, "question": "What is the most likely cause of the following findings?", "context": ["A 45-year-old man presents to the outpatient unit with a complaint of lower extremity edema for the past few weeks.", "He has also been observing puffiness of the face lately.", "The urinalysis shows 4+ proteinuria.", "The serum creatinine is 3.5 mg/dL, and antinuclear antibodies are absent.", "The biopsy findings are given in the picture."], "context_len": 5, "options": {"A": "Membranoproliferative glomerulonephritis", "B": "Rapidly progressive glomerlonephritis", "C": "Postinfectious glomerulonephritis", "D": "Membranous glomerulonephritis"}, "answer": "Membranous glomerulonephritis", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "45 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 45-year-old man presents to the outpatient unit.", "2. Complaint is lower extremity edema for the past few weeks.", "3. Puffiness of the face has been observed lately.", "4. Urinalysis shows 4+ proteinuria.", "5. Serum creatinine is 3.5 mg/dL.", "6. Antinuclear antibodies are absent.", "7. Biopsy findings are given in the picture."], "atomic_facts": ["1. He has been observing puffiness of the face lately.", "2. The urinalysis shows 4+ proteinuria.", "3. The serum creatinine is 3.5 mg/dL.", "4. Antinuclear antibodies are absent.", "5. The biopsy findings are given in the picture."]}
{"id": 1235, "question": "If the child\u2019s condition is left untreated, levels of which of the following hormones is most likely to be decreased most when the child reaches sexual maturity?", "context": ["A 2-year-old male is brought to his pediatrician by his parents because of a lack of testes in his scrotum.", "Physical examination confirms that testes are absent from the scrotal sac and palpable masses are found bilaterally around the inguinal canal."], "context_len": 2, "options": {"A": "FSH", "B": "LH", "C": "Inhibin", "D": "Prolactin"}, "answer": "Inhibin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "2 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Endocrinology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 2-year-old male is brought to his pediatrician by his parents.", "2. The reason for the visit is a lack of testes in his scrotum.", "3. Physical examination confirms that testes are absent from the scrotal sac.", "4. Palpable masses are found bilaterally around the inguinal canal."], "atomic_facts": ["1. Physical examination confirms testes are absent from the scrotal sac.", "2. Palpable masses are found bilaterally around the inguinal canal."]}
{"id": 1236, "question": "Which of the following is the volume of isotonic fluid that should be given to this patient over the next 24 hours?", "context": ["A 23-year-old man presents to the emergency department by ambulance after being rescued from a burning house.", "The patient was intubated in the field and is maintaining his oxygen saturation above 98%.", "Physical exam reveals partial or full-thickness burns across an estimated 30% of his total body surface area.", "His weight is 70 kg."], "context_len": 4, "options": {"A": "1,100 mL", "B": "4,200 mL", "C": "8,400 mL", "D": "16,800 mL"}, "answer": "8,400 mL", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "23", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 23-year-old man presents to the emergency department by ambulance.", "2. The patient was intubated in the field.", "3. The patient is maintaining his oxygen saturation above 98%.", "4. Physical exam reveals partial or full-thickness burns across an estimated 30% of his total body surface area.", "5. His weight is 70 kg."], "atomic_facts": ["1. The patient was intubated in the field.", "2. The patient is maintaining his oxygen saturation above 98%.", "3. Physical exam reveals partial or full-thickness burns.", "4. The burns are across an estimated 30% of his total body surface area.", "5. The patient's weight is 70 kg."]}
{"id": 1237, "question": "Which of the following statements best describes the rationale for administering RhO(D) immunoglobulins (RhoGAM) in this patient?", "context": ["A 28-year-old G1P0 primigravida woman at 28 weeks estimated gestational age presents for routine prenatal care.", "She has no complaints and says she can feel her baby move and respond to outside sounds.", "The patient has no significant past medical or family history.", "Currently, she is taking a prenatal multivitamin which contains iron and folic acid.", "Her blood type is A (-) negative, and her husband is A (+) positive.", "The patient says she stopped drinking alcohol 2 years ago and denies any history of smoking or recreational drug use.", "Her pulse is 90/min, blood pressure is 114/68 mm Hg, and respiratory rate is 18/min.", "She has gained 9.0 kg (19.8 lb) over the course of the pregnancy.", "Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis.", "Occasional movements are observed in the abdomen.", "There is no guarding or tenderness to palpation.", "Fetal heart sounds can be auscultated.", "The remainder of the examination is unremarkable.", "The patient is administered an injection of RhO(D) immunoglobulin (RhoGAM)."], "context_len": 14, "options": {"A": "RhO(D) immunoglobulin will prevent hemolytic disease in this pregnancy.", "B": "The father requires RhO(D) immunoglobulin administration rather than the patient.", "C": "RhO(D) immunoglobulins will prevent anti-D antibody formation in the mother.", "D": "RhO(D) immunoglobulins will prevent anti-D antibody formation in the fetus."}, "answer": "RhO(D) immunoglobulins will prevent anti-D antibody formation in the mother.", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "28 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["General Obstetrics and Gynecology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. Patient is a 28-year-old G1P0 primigravida woman.", "2. Patient is at 28 weeks estimated gestational age.", "3. Patient has no complaints.", "4. Patient can feel her baby move and respond to outside sounds.", "5. Patient has no significant past medical or family history.", "6. Patient is taking a prenatal multivitamin which contains iron and folic acid.", "7. Patient's blood type is A (-) negative.", "8. Patient's husband's blood type is A (+) positive.", "9. Patient stopped drinking alcohol 2 years ago.", "10. Patient denies any history of smoking or recreational drug use.", "11. Patient's pulse is 90/min.", "12. Patient's blood pressure is 114/68 mm Hg.", "13. Patient's respiratory rate is 18/min.", "14. Patient has gained 9.0 kg (19.8 lb) over the course of the pregnancy.", "15. Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis.", "16. Occasional movements are observed in the abdomen.", "17. There is no guarding or tenderness to palpation.", "18. Fetal heart sounds can be auscultated.", "19. The remainder of the examination is unremarkable.", "20. Patient is administered an injection of RhO(D) immunoglobulin (RhoGAM)."], "atomic_facts": ["1. The patient has no complaints.", "2. The patient can feel her baby move and respond to outside sounds.", "3. The patient has no significant past medical history.", "4. The patient has no significant family history.", "5. The patient is taking a prenatal multivitamin containing iron and folic acid.", "6. The patient's blood type is A (-) negative.", "7. The patient's husband's blood type is A (+) positive.", "8. The patient stopped drinking alcohol 2 years ago.", "9. The patient denies any history of smoking or recreational drug use.", "10. The patient's pulse is 90/min.", "11. The patient's blood pressure is 114/68 mm Hg.", "12. The patient's respiratory rate is 18/min.", "13. The patient has gained 9.0 kg (19.8 lb) over the course of the pregnancy.", "14. Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis.", "15. Occasional movements are observed in the abdomen.", "16. There is no guarding or tenderness to palpation.", "17. Fetal heart sounds can be auscultated.", "18. The remainder of the examination is unremarkable.", "19. The patient is administered an injection of RhO(D) immunoglobulin (RhoGAM)."]}
{"id": 1238, "question": "The underlying cause of this patient's condition is best classified as which of the following?", "context": ["A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months.", "He has had an active sexual life in the past.", "He reports that early morning erections are present every other day.", "He has a history of hypertension and diabetes mellitus.", "His wife recently filed for divorce.", "He has smoked one pack of cigarettes daily for 25 years.", "His only medications are enalapril and metformin.", "Physical examination shows no abnormalities."], "context_len": 8, "options": {"A": "Hormonal", "B": "Neurogenic", "C": "Psychogenic", "D": "Vascular"}, "answer": "Psychogenic", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "51 years old", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months.", "2. He has had an active sexual life in the past.", "3. He reports that early morning erections are present every other day.", "4. He has a history of hypertension.", "5. He has a history of diabetes mellitus.", "6. His wife recently filed for divorce.", "7. He has smoked one pack of cigarettes daily for 25 years.", "8. His only medications are enalapril and metformin.", "9. Physical examination shows no abnormalities."], "atomic_facts": ["1. He has had an active sexual life in the past.", "2. He reports that early morning erections are present every other day.", "3. He has a history of hypertension and diabetes mellitus.", "4. His wife recently filed for divorce.", "5. He has smoked one pack of cigarettes daily for 25 years.", "6. His only medications are enalapril and metformin.", "7. Physical examination shows no abnormalities."]}
{"id": 1239, "question": "What is the most likely explanation for this patient\u2019s symptoms?", "context": ["A 49-year-old G4P4 woman comes to the clinic complaining of repeated leakage of fluid from her vagina for the past 5 months.", "She noticed an increase in episodes following her cold last week when she was coughing and sneezing a lot.", "Her past medical history is significant for Crohn disease, which is well controlled with sulfasalazine.", "Her last menstrual period was 1 year ago.", "She is currently sexually active with multiple partners with inconsistent condom use.", "She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors.", "Physical examination is significant for a bulge at the anterior vaginal wall."], "context_len": 7, "options": {"A": "Prolapse of the bladder", "B": "Detrusor muscle overactivity", "C": "Genitourinary syndrome of menopause", "D": "Rectovaginal fistula"}, "answer": "Prolapse of the bladder", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "49 years old", "specialties": ["Obstetrics and Gynecology"], "subspecialties": ["Female Pelvic Medicine and Reconstructive Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Obstetrics and Gynecology"}, "facts_old": ["1. A 49-year-old G4P4 woman comes to the clinic.", "2. She has been experiencing repeated leakage of fluid from her vagina for the past 5 months.", "3. She noticed an increase in episodes following her cold last week.", "4. She was coughing and sneezing a lot during her cold.", "5. Her past medical history is significant for Crohn disease.", "6. Her Crohn disease is well controlled with sulfasalazine.", "7. Her last menstrual period was 1 year ago.", "8. She is currently sexually active with multiple partners.", "9. Her condom use is inconsistent.", "10. She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors.", "11. Physical examination is significant for a bulge at the anterior vaginal wall."], "atomic_facts": ["1. She noticed an increase in episodes following her cold last week when she was coughing and sneezing a lot.", "2. Her past medical history is significant for Crohn disease, which is well controlled with sulfasalazine.", "3. Her last menstrual period was 1 year ago.", "4. She is currently sexually active with multiple partners with inconsistent condom use.", "5. She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors.", "6. Physical examination is significant for a bulge at the anterior vaginal wall."]}
{"id": 1240, "question": "Which of the following cellular mechanisms best explains the effects of stimulation of sympathetic cardiac nerves on the pacemaker cells in the sinoatrial node?", "context": ["A 24-year-old woman presents to a physician with recurrent episodes of palpitations, shortness of breath, and perspiration.", "The episodes are self-limited and are usually preceded by specific social circumstances that she does not enjoy.", "There is no significant past medical history.", "After a complete history and physical examination, the physician diagnoses an anxiety disorder.", "He explains that anxiety is associated with the stimulation of the sympathetic nervous system which produces several symptoms related to anxiety such as tachycardia."], "context_len": 5, "options": {"A": "Decreased intracellular cyclic adenosine monophosphate (cAMP) level in the sinoatrial node", "B": "Inactivation of L-type voltage-gated calcium channels", "C": "Facilitation of If currents through HCN channels", "D": "Opening of G-protein activated potassium channels"}, "answer": "Facilitation of If currents through HCN channels", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "24", "specialties": ["Cardiology"], "subspecialties": ["General Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 24-year-old woman presents to a physician.", "2. She has recurrent episodes of palpitations, shortness of breath, and perspiration.", "3. The episodes are self-limited.", "4. The episodes are usually preceded by specific social circumstances that she does not enjoy.", "5. There is no significant past medical history.", "6. The physician diagnoses an anxiety disorder.", "7. Anxiety is associated with the stimulation of the sympathetic nervous system.", "8. The sympathetic nervous system produces several symptoms related to anxiety such as tachycardia."], "atomic_facts": ["1. The episodes are self-limited.", "2. The episodes are usually preceded by specific social circumstances that she does not enjoy.", "3. There is no significant past medical history.", "4. After a complete history and physical examination, the physician diagnoses an anxiety disorder.", "5. Anxiety is associated with the stimulation of the sympathetic nervous system.", "6. Stimulation of the sympathetic nervous system produces several symptoms related to anxiety.", "7. Symptoms related to anxiety include tachycardia."]}
{"id": 1241, "question": "What is the most likely etiology of this patient\u2019s diagnosis?", "context": ["A 14-year-old boy is brought to the office by his parents because he states that for the past 2 months he has been feeling constantly tired, and also noticed a dull pain in the pit of his stomach.", "The patient has no relevant family history.", "The vital signs include a heart rate of 105/min, a respiratory rate of 16/min, a temperature of 37.0\u00b0C (98.6\u00b0F), and a blood pressure of 111/66 mm Hg.", "On physical exam, the abdomen is distended with hepatomegaly 5 cm underneath the xiphoid process.", "The complete blood count results are as follows: | Hemoglobin 17.6 g/dL | Hematocrit 64% | RBC 6.02 x 1012/L | Leukocyte count | 26,300/mm3 | Neutrophils 55% | Bands 2% | Eosinophils 1% | Basophils 0% | Lymphocytes 29% | Monocytes 2% | Platelet count 480,000/mm\u00b3 | Erythropoietin < 1.0 mU/mL | The coagulation test results are as follows: | Partial thromboplastin time (activated) 30.9 s | Prothrombin time 14.0 s | The abdominal Doppler ultrasound imaging is shown in the picture."], "context_len": 5, "options": {"A": "Beh\u00e7et's syndrome", "B": "Protein C deficiency", "C": "Factor V Leiden mutation", "D": "Polycythemia vera"}, "answer": "Polycythemia vera", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "14 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 14-year-old boy.", "2. Patient has been feeling constantly tired for the past 2 months.", "3. Patient has noticed a dull pain in the pit of his stomach.", "4. Patient has no relevant family history.", "5. Heart rate is 105/min.", "6. Respiratory rate is 16/min.", "7. Temperature is 37.0\u00b0C (98.6\u00b0F).", "8. Blood pressure is 111/66 mm Hg.", "9. Abdomen is distended with hepatomegaly 5 cm underneath the xiphoid process.", "10. Hemoglobin is 17.6 g/dL.", "11. Hematocrit is 64%.", "12. RBC is 6.02 x 1012/L.", "13. Leukocyte count is 26,300/mm3.", "14. Neutrophils are 55%.", "15. Bands are 2%.", "16. Eosinophils are 1%.", "17. Basophils are 0%.", "18. Lymphocytes are 29%.", "19. Monocytes are 2%.", "20. Platelet count is 480,000/mm\u00b3.", "21. Erythropoietin is < 1.0 mU/mL.", "22. Partial thromboplastin time (activated) is 30.9 s.", "23. Prothrombin time is 14.0 s.", "24. Abdominal Doppler ultrasound imaging is shown in the picture."], "atomic_facts": ["1. The patient has no relevant family history.", "2. Vital signs: heart rate 105/min, respiratory rate 16/min, temperature 37.0\u00b0C (98.6\u00b0F), blood pressure 111/66 mm Hg.", "3. Physical exam findings: distended abdomen with hepatomegaly 5 cm underneath the xiphoid process.", "4. Complete blood count results: Hemoglobin 17.6 g/dL, Hematocrit 64%, RBC 6.02 x 1012/L, Leukocyte count 26,300/mm3, Neutrophils 55%, Bands 2%, Eosinophils 1%, Basophils 0%, Lymphocytes 29%, Monocytes 2%, Platelet count 480,000/mm\u00b3, Erythropoietin < 1.0 mU/mL.", "5. Coagulation test results: Partial thromboplastin time (activated) 30.9 s, Prothrombin time 14.0 s.", "6. The abdominal Doppler ultrasound imaging is shown in the picture."]}
{"id": 1242, "question": "Which of the following is the best treatment for this patient?", "context": ["A 17-year-old girl is presented to the clinic by her mom for hair loss.", "Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes, 1st appearing several months ago.", "The girl has noticed no other symptoms, though the spots of hair loss are sometimes sore.", "On further questioning, the girl shares that she has been very stressed lately about getting good grades and applying to colleges.", "She knows she needs to do well on all of her homework in order to get into a good college, so she has sometimes had to stay up late into the night to rewrite her homework over and over again so that they are 'absolutely perfect'.", "The physical exam shows an anxious-appearing, somewhat quiet girl.", "There is diffuse hair loss and thinning across her scalp, with many different hair shafts of different lengths.", "There is no discernible pattern to the hair loss."], "context_len": 8, "options": {"A": "Cognitive-behavioral therapy", "B": "Intralesional steroids", "C": "Oral griseofulvin", "D": "Systemic steroids"}, "answer": "Cognitive-behavioral therapy", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "17 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 17-year-old girl is presented to the clinic by her mom.", "2. Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes.", "3. The hair loss 1st appeared several months ago.", "4. The girl has noticed no other symptoms.", "5. The spots of hair loss are sometimes sore.", "6. The girl has been very stressed lately about getting good grades and applying to colleges.", "7. She knows she needs to do well on all of her homework in order to get into a good college.", "8. She has sometimes had to stay up late into the night to rewrite her homework over and over again so that they are 'absolutely perfect'.", "9. The physical exam shows an anxious-appearing, somewhat quiet girl.", "10. There is diffuse hair loss and thinning across her scalp.", "11. There are many different hair shafts of different lengths.", "12. There is no discernible pattern to the hair loss."], "atomic_facts": ["1. Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes.", "2. The hair loss first appeared several months ago.", "3. The girl has noticed no other symptoms.", "4. The spots of hair loss are sometimes sore.", "5. The girl has been very stressed lately about getting good grades and applying to colleges.", "6. She has sometimes had to stay up late into the night to rewrite her homework over and over again.", "7. The physical exam shows an anxious-appearing, somewhat quiet girl.", "8. There is diffuse hair loss and thinning across her scalp, with many different hair shafts of different lengths.", "9. There is no discernible pattern to the hair loss."]}
{"id": 1243, "question": "Which of the following best describes the findings obtained from the study?", "context": ["In a town with a hepatitis B prevalence of 4%, a new screening test is introduced as part of a study.", "The first round of the study detects cases of hepatitis B using the new test, which has a sensitivity of 99% and a specificity of 77%.", "In the second round of the study, the same test is used again in a different population with a hepatitis B prevalence of 29%."], "context_len": 3, "options": {"A": "The positive predictive value would increase in the second round.", "B": "The sensitivity would decrease in the second round.", "C": "The negative predictive value would increase in the second round.", "D": "The positive likelihood ratio would increase in the second round."}, "answer": "The positive predictive value would increase in the second round.", "answer_idx": "A", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Infectious Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Medical Genetics and Genomics"}, "facts_old": ["1. In a town, the hepatitis B prevalence is 4%.", "2. A new screening test is introduced as part of a study.", "3. The first round of the study uses the new test.", "4. The new test has a sensitivity of 99%.", "5. The new test has a specificity of 77%.", "6. The second round of the study uses the same test.", "7. The second round of the study is in a different population.", "8. The hepatitis B prevalence in the second population is 29%."], "atomic_facts": ["1. The first round of the study detects cases of hepatitis B.", "2. The new test has a sensitivity of 99%.", "3. The new test has a specificity of 77%.", "4. The same test is used again in a different population in the second round of the study.", "5. The hepatitis B prevalence in the second round of the study is 29%."]}
{"id": 1244, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 5-year-old girl is brought to the physician for a well-child examination.", "Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area.", "The girl has otherwise been feeling well.", "She is at the 45th percentile for height and 51st percentile for weight.", "Vital signs are within normal limits.", "Pelvic examination shows erythema of the vulva and perianal region.", "There is no vaginal discharge."], "context_len": 7, "options": {"A": "Potassium hydroxide preparation", "B": "Perianal cellophane-tape examination", "C": "Cultures for chlamydia and gonorrhea", "D": "Stool microscopy"}, "answer": "Perianal cellophane-tape examination", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "5 years old", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 5-year-old girl is brought to the physician for a well-child examination.", "2. Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area.", "3. The girl has otherwise been feeling well.", "4. She is at the 45th percentile for height.", "5. She is at the 51st percentile for weight.", "6. Vital signs are within normal limits.", "7. Pelvic examination shows erythema of the vulva and perianal region.", "8. There is no vaginal discharge."], "atomic_facts": ["1. Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area.", "2. The girl has otherwise been feeling well.", "3. She is at the 45th percentile for height.", "4. She is at the 51st percentile for weight.", "5. Vital signs are within normal limits.", "6. Pelvic examination shows erythema of the vulva and perianal region.", "7. There is no vaginal discharge."]}
{"id": 1245, "question": "Which of the following is the most likely underlying cause of this patient's symptoms?", "context": ["A 25-year-old man comes to the emergency department because of left flank pain for 2 hours.", "The pain is colicky in nature and he describes it as 8 out of 10 in intensity.", "He has nausea and has vomited once.", "He had a similar episode 6 months ago for which he took naproxen.", "There is no personal or family history of serious illness.", "He is a second-year medical student and has been consuming more coffee and energy drinks than normal to stay awake and study for the past 2 days.", "He does not smoke or drink alcohol.", "He takes no medications.", "His temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 98/min, and blood pressure is 124/78 mm Hg.", "The abdomen is soft and nontender.", "Examination of the back shows no costovertebral angle tenderness.", "The remainder of the examination shows no abnormalities.", "Urinalysis is unremarkable."], "context_len": 13, "options": {"A": "Bilateral renal cysts", "B": "Glomerular IgA deposits", "C": "Ureteropelvic junction obstruction", "D": "Ascending urinary tract infection\n\""}, "answer": "Ureteropelvic junction obstruction", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "25 years old", "specialties": ["Urology"], "subspecialties": ["General Urology", "Urology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Urology"}, "facts_old": ["1. A 25-year-old man comes to the emergency department.", "2. He has left flank pain for 2 hours.", "3. The pain is colicky in nature.", "4. He describes the pain as 8 out of 10 in intensity.", "5. He has nausea and has vomited once.", "6. He had a similar episode 6 months ago for which he took naproxen.", "7. There is no personal or family history of serious illness.", "8. He is a second-year medical student.", "9. He has been consuming more coffee and energy drinks than normal to stay awake and study for the past 2 days.", "10. He does not smoke or drink alcohol.", "11. He takes no medications.", "12. His temperature is 37.3\u00b0C (99.1\u00b0F).", "13. His pulse is 98/min.", "14. His blood pressure is 124/78 mm Hg.", "15. The abdomen is soft and nontender.", "16. Examination of the back shows no costovertebral angle tenderness.", "17. The remainder of the examination shows no abnormalities.", "18. Urinalysis is unremarkable."], "atomic_facts": ["1. The pain is colicky in nature.", "2. He describes the pain as 8 out of 10 in intensity.", "3. He has nausea.", "4. He has vomited once.", "5. He had a similar episode 6 months ago for which he took naproxen.", "6. There is no personal history of serious illness.", "7. There is no family history of serious illness.", "8. He is a second-year medical student.", "9. He has been consuming more coffee and energy drinks than normal for the past 2 days.", "10. He does not smoke.", "11. He does not drink alcohol.", "12. He takes no medications.", "13. His temperature is 37.3\u00b0C (99.1\u00b0F).", "14. His pulse is 98/min.", "15. His blood pressure is 124/78 mm Hg.", "16. The abdomen is soft and nontender.", "17. Examination of the back shows no costovertebral angle tenderness.", "18. The remainder of the examination shows no abnormalities.", "19. Urinalysis is unremarkable."]}
{"id": 1246, "question": "What is the next best step in management?", "context": ["An otherwise healthy 6-year-old boy presents for a follow-up visit to his pediatrician's office for persistent nocturnal enuresis.", "He has never been dry at night and throughout the last year the pediatrician has seen him multiple times for this issue.", "He and his family have tried not drinking liquids 2 hours before bed, bed wetting alarms, and a reward sticker chart with limited success.", "His 2 older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age, but the patient often sleeps over at a friend's house and is very bothered by this problem.", "He has 1 soft stool a day, denies abdominal pain, dysuria, or frequency, and has been continent during the day since 3 years of age.", "He has a completely normal physical exam, urinalysis, and basic metabolic panel."], "context_len": 6, "options": {"A": "Cognitive behavioral therapy", "B": "Desmopressin", "C": "Imipramine", "D": "Oxybutynin"}, "answer": "Desmopressin", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "6 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Urology", "Pediatric Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 6-year-old boy.", "2. Patient presents for follow-up visit for persistent nocturnal enuresis.", "3. Patient has never been dry at night.", "4. Pediatrician has seen patient multiple times for this issue in the last year.", "5. Patient and family have tried not drinking liquids 2 hours before bed, bed wetting alarms, and a reward sticker chart with limited success.", "6. Patient's two older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age.", "7. Patient often sleeps over at a friend's house and is very bothered by this problem.", "8. Patient has 1 soft stool a day.", "9. Patient denies abdominal pain, dysuria, or frequency.", "10. Patient has been continent during the day since 3 years of age.", "11. Patient has a completely normal physical exam.", "12. Patient has a completely normal urinalysis.", "13. Patient has a completely normal basic metabolic panel."], "atomic_facts": ["1. He has never been dry at night.", "2. Throughout the last year, the pediatrician has seen him multiple times for this issue.", "3. He and his family have tried not drinking liquids 2 hours before bed.", "4. They have tried bed wetting alarms.", "5. They have tried a reward sticker chart with limited success.", "6. His 2 older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age.", "7. The patient often sleeps over at a friend's house.", "8. He is very bothered by this problem.", "9. He has 1 soft stool a day.", "10. He denies abdominal pain, dysuria, or frequency.", "11. He has been continent during the day since 3 years of age.", "12. He has a completely normal physical exam.", "13. He has a completely normal urinalysis.", "14. He has a completely normal basic metabolic panel."]}
{"id": 1247, "question": "Which of the following is the next best step in the management of this patient?", "context": ["A 41-year-old woman presents with acute right flank pain for the past 6 hours.", "She says the pain is severe, colicky, \u2018comes in waves\u2019, and is localized to the right flank.", "She also has associated nausea and vomiting.", "The patient is afebrile, and her vital signs are within normal limits.", "On physical examination, she is writhing in pain and moaning.", "There is severe right costovertebral angle tenderness.", "Gross hematuria is present on urinalysis.", "A noncontrast CT of the abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction.", "Aggressive IV fluid hydration is started, and ondansetron is administered."], "context_len": 9, "options": {"A": "Renal ultrasound", "B": "24-hour urine chemistry", "C": "Potassium citrate", "D": "Hydrocodone/acetaminophen"}, "answer": "Hydrocodone/acetaminophen", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "41", "specialties": ["Urology"], "subspecialties": ["General Urology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Urology"}, "facts_old": ["1. Patient is a 41-year-old woman.", "2. Patient has had acute right flank pain for the past 6 hours.", "3. Patient describes the pain as severe, colicky, and \u2018coming in waves\u2019.", "4. Pain is localized to the right flank.", "5. Patient has associated nausea and vomiting.", "6. Patient is afebrile.", "7. Vital signs are within normal limits.", "8. On physical examination, patient is writhing in pain and moaning.", "9. Severe right costovertebral angle tenderness is present.", "10. Urinalysis reveals gross hematuria.", "11. Noncontrast CT of abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction.", "12. Aggressive IV fluid hydration is started.", "13. Ondansetron is administered."], "atomic_facts": ["1. The patient reports severe, colicky pain localized to the right flank.", "2. The pain comes in waves.", "3. The patient experiences associated nausea and vomiting.", "4. The patient is afebrile.", "5. Vital signs are within normal limits.", "6. On physical examination, the patient is writhing in pain and moaning.", "7. Severe right costovertebral angle tenderness is present.", "8. Gross hematuria is present on urinalysis.", "9. A noncontrast CT of the abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction.", "10. Aggressive IV fluid hydration is started.", "11. Ondansetron is administered."]}
{"id": 1248, "question": "Which of the following drugs has the most similar mechanism to inflixmab?", "context": ["A 36-year-old female presents with a 6-month history of stiffness in her joints.", "She reports bilateral knee pain that is worse in the morning prior to activity and stiffness of the fingers in both hands.", "Anti-CCP antibody tests are positive.", "Over several months, the patient's symptoms prove unresponsive to NSAIDs and methotrexate, and the decision is made to begin infliximab."], "context_len": 4, "options": {"A": "Imatinib", "B": "Cyclophosphamide", "C": "Trastuzumab", "D": "Allopurinol"}, "answer": "Trastuzumab", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "36", "specialties": ["Rheumatology"], "subspecialties": ["General Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 36-year-old female presents.", "2. She has a 6-month history of stiffness in her joints.", "3. She reports bilateral knee pain.", "4. The knee pain is worse in the morning prior to activity.", "5. She has stiffness of the fingers in both hands.", "6. Anti-CCP antibody tests are positive.", "7. The patient's symptoms are unresponsive to NSAIDs and methotrexate.", "8. The decision is made to begin infliximab."], "atomic_facts": ["1. The patient reports bilateral knee pain.", "2. The knee pain is worse in the morning prior to activity.", "3. The patient experiences stiffness of the fingers in both hands.", "4. Anti-CCP antibody tests are positive.", "5. The patient's symptoms are unresponsive to NSAIDs.", "6. The patient's symptoms are unresponsive to methotrexate.", "7. The decision is made to begin infliximab."]}
{"id": 1249, "question": "Which of the following is the best explanation for this patient\u2019s improvement in symptoms?", "context": ["A 55-year-old man presents to the emergency department with chest pain that started 1 hour ago and has not been improving.", "He has a past medical history of diabetes, hypertension, and obesity.", "His temperature is 98.5\u00b0F (36.9\u00b0C), blood pressure is 147/68 mmHg, pulse is 130/min, respirations are 13/min, and oxygen saturation is 100% on room air.", "Physical exam is notable for jugular venous distension and bilateral lower extremity pitting edema.", "The patient is given nitroglycerin, and his chest pain improves."], "context_len": 5, "options": {"A": "Coronary artery vasodilation", "B": "Decreased adrenergic tone", "C": "Mu receptor agonism", "D": "Preload reduction"}, "answer": "Preload reduction", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "55", "specialties": ["Cardiology", "Internal Medicine"], "subspecialties": ["Interventional Cardiology", "Cardiovascular Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 55-year-old man presents to the emergency department with chest pain.", "2. The chest pain started 1 hour ago and has not been improving.", "3. The patient has a past medical history of diabetes, hypertension, and obesity.", "4. His temperature is 98.5\u00b0F (36.9\u00b0C).", "5. His blood pressure is 147/68 mmHg.", "6. His pulse is 130/min.", "7. His respirations are 13/min.", "8. His oxygen saturation is 100% on room air.", "9. Physical exam is notable for jugular venous distension and bilateral lower extremity pitting edema.", "10. The patient is given nitroglycerin.", "11. His chest pain improves."], "atomic_facts": ["1. Past medical history of diabetes", "2. Past medical history of hypertension", "3. Past medical history of obesity", "4. Temperature: 98.5\u00b0F (36.9\u00b0C)", "5. Blood pressure: 147/68 mmHg", "6. Pulse: 130/min", "7. Respirations: 13/min", "8. Oxygen saturation: 100% on room air", "9. Physical exam notable for jugular venous distension", "10. Physical exam notable for bilateral lower extremity pitting edema", "11. Patient given nitroglycerin", "12. Patient's chest pain improves"]}
{"id": 1250, "question": "This increase in serum lactate is necessary to regenerate an essential cofactor for which of the following enzymes?", "context": ["An investigator is studying energy metabolism in athletes.", "Baseline serum lactate levels at rest are recorded and repeat levels are obtained directly after a 1000-meter sprint.", "Compared to the baseline measurements, the serum lactate levels are significantly increased after the sprint."], "context_len": 3, "options": {"A": "Glycogen phosphorylase", "B": "Glyceraldehyde-3 phosphate dehydrogenase", "C": "Phosphofructokinase-1", "D": "Pyruvate carboxylase"}, "answer": "Glyceraldehyde-3 phosphate dehydrogenase", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Endocrinology, Diabetes, and Metabolism", "Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Others"}, "facts_old": ["1. An investigator is studying energy metabolism in athletes.", "2. Baseline serum lactate levels at rest are recorded.", "3. Repeat levels are obtained directly after a 1000-meter sprint.", "4. Compared to the baseline measurements, the serum lactate levels are significantly increased after the sprint."], "atomic_facts": ["1. Baseline serum lactate levels are recorded at rest.", "2. Repeat serum lactate levels are obtained directly after a 1000-meter sprint.", "3. Serum lactate levels are significantly increased after the sprint compared to the baseline measurements."]}
{"id": 1251, "question": "Which of the following processes is responsible for the loss of these marked CD8+ cells?", "context": ["A scientist is studying the development of CD8+ T cells.", "In his experiments, he uses a radioactive isotope to mark a population of T cells.", "Once injected into the thymus, these cells bind tightly to MHC I self-antigen complexes.", "Later in the experiment, the scientist cannot find any marked cells in the peripheral blood."], "context_len": 4, "options": {"A": "Positive selection", "B": "Negative selection", "C": "APC antigen presentation", "D": "IL-2 stimulation"}, "answer": "Negative selection", "answer_idx": "B", "explanation": "", "patient": {"gender": "study", "age": "study", "specialties": ["Internal Medicine"], "subspecialties": ["Rheumatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Allergy and Immunology"}, "facts_old": ["1. A scientist is studying the development of CD8+ T cells.", "2. In his experiments, he uses a radioactive isotope to mark a population of T cells.", "3. The marked cells are injected into the thymus.", "4. The marked cells bind tightly to MHC I self-antigen complexes.", "5. Later in the experiment, the scientist cannot find any marked cells in the peripheral blood."], "atomic_facts": ["1. In his experiments, he uses a radioactive isotope to mark a population of T cells.", "2. The radioactive isotope is injected into the thymus.", "3. The marked cells bind tightly to MHC I self-antigen complexes.", "4. The scientist cannot find any marked cells in the peripheral blood later in the experiment."]}
{"id": 1252, "question": "Based on CXR and biopsy slides shown, you feel that all of the following would be consistent with her diagnosis EXCEPT?", "context": ["A 65-year-old woman who has smoked 2 packs per day for forty years comes to your practice complaining of a chronic cough, dyspnea, hemoptysis, and difficulty rising from a chair."], "context_len": 1, "options": {"A": "Decreasing muscle strength with repetitive stimulation", "B": "Antibodies to presynaptic calcium channels", "C": "Dry mouth", "D": "Orthostatic hypotension"}, "answer": "Decreasing muscle strength with repetitive stimulation", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "65 years old", "specialties": ["Pulmonary Disease"], "subspecialties": ["General Pulmonary Disease"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is 65 years old.", "2. Patient has smoked 2 packs per day for 40 years.", "3. Patient is complaining of a chronic cough.", "4. Patient is complaining of dyspnea.", "5. Patient is complaining of hemoptysis.", "6. Patient is complaining of difficulty rising from a chair."], "atomic_facts": ["1. The patient is a 65-year-old woman.", "2. She has smoked 2 packs per day for forty years.", "3. She complains of a chronic cough.", "4. She complains of dyspnea.", "5. She complains of hemoptysis.", "6. She complains of difficulty rising from a chair."]}
{"id": 1253, "question": "What is the most likely diagnosis?", "context": ["A 16-month-old boy is brought to the pediatrician after his parents noticed the appearance of a rash on his face, torso, and limbs.", "The boy has been ill for almost 2 weeks, initiating with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks.", "Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities with a reticular pattern (as shown in the photograph)."], "context_len": 3, "options": {"A": "Measles", "B": "Chickenpox", "C": "Erythema infectiosum", "D": "Roseola infantum"}, "answer": "Erythema infectiosum", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "16 months", "specialties": ["Pediatrics"], "subspecialties": ["General Pediatrics", "Pediatric Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. A 16-month-old boy is brought to the pediatrician.", "2. His parents noticed the appearance of a rash on his face, torso, and limbs.", "3. The boy has been ill for almost 2 weeks.", "4. The illness initiated with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks.", "5. Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities.", "6. The rash has a reticular pattern (as shown in the photograph)."], "atomic_facts": ["1. The boy has been ill for almost 2 weeks.", "2. The illness initiated with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks.", "3. Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities.", "4. The rash has a reticular pattern."]}
{"id": 1254, "question": "This patient\u2019s symptoms are likely due to irritation of a nerve that passes through which of the following foramina?", "context": ["A 27-year-old woman presents to a neurologist complaining of facial pain.", "She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain that happens over 10 seconds to 3 minutes.", "The pain is severe enough to completely stop her from her activities.", "She is worried whenever she goes out that another attack will happen and she is sad that this has limited her ability to work as a lawyer.", "Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome.", "She takes an oral contraceptive pill.", "Her temperature is 98.6\u00b0F (37\u00b0C), blood pressure is 130/75 mmHg, pulse is 75/min, and respirations are 18/min.", "On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive.", "Her pupils are 2 mm and reactive to light bilaterally.", "Fundoscopic examination is unremarkable.", "Her strength and range of motion are full and symmetric in her upper and lower extremities."], "context_len": 11, "options": {"A": "Foramen rotundum", "B": "Inferior orbital fissure", "C": "Jugular foramen", "D": "Superior orbital fissure"}, "answer": "Foramen rotundum", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "27 years old", "specialties": ["Neurology"], "subspecialties": ["Pain Medicine", "Neurology with Special Qualification in Child Neurology", "General Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.4, 0.4, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 27-year-old woman presents to a neurologist.", "2. She complains of facial pain.", "3. She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain.", "4. The pain happens over 10 seconds to 3 minutes.", "5. The pain is severe enough to completely stop her from her activities.", "6. She is worried whenever she goes out that another attack will happen.", "7. She is sad that this has limited her ability to work as a lawyer.", "8. Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome.", "9. She takes an oral contraceptive pill.", "10. Her temperature is 98.6\u00b0F (37\u00b0C).", "11. Her blood pressure is 130/75 mmHg.", "12. Her pulse is 75/min.", "13. Her respirations are 18/min.", "14. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive.", "15. Her pupils are 2 mm and reactive to light bilaterally.", "16. Fundoscopic examination is unremarkable.", "17. Her strength and range of motion are full and symmetric in her upper and lower extremities."], "atomic_facts": ["1. She reports developing intermittent burning unilateral facial pain over the past 6 months.", "2. The pain lasts for 10 seconds to 3 minutes.", "3. The pain is severe enough to completely stop her from her activities.", "4. She is worried about another attack happening whenever she goes out.", "5. She is sad that the pain has limited her ability to work as a lawyer.", "6. Her past medical history includes irritable bowel syndrome and polycystic ovarian syndrome.", "7. She takes an oral contraceptive pill.", "8. Her temperature is 98.6\u00b0F (37\u00b0C).", "9. Her blood pressure is 130/75 mmHg.", "10. Her pulse is 75/min.", "11. Her respirations are 18/min.", "12. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive.", "13. Her pupils are 2 mm and reactive to light bilaterally.", "14. Fundoscopic examination is unremarkable.", "15. Her strength and range of motion are full and symmetric in her upper and lower extremities."]}
{"id": 1255, "question": "Which of the following is the most likely causal organism?", "context": ["A 26-year-old man comes to the physician because of high-grade fever, fatigue, nausea, and headache for 4 days.", "The headache is constant and feels like a tight band around his head.", "He also reports that his eyes hurt while looking at bright lights.", "He has been taking acetaminophen and using cold towels to help relieve his symptoms.", "He works as an assistant for a nature camp organization but has been unable to go to work for 3 days.", "His immunization records are unavailable.", "His temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 92/min, and blood pressure is 108/74 mm Hg.", "He is oriented to time, place, and person.", "There is no rash or lymphadenopathy.", "Flexion of the neck results in flexion of the knee and hip.", "A lumbar puncture is done; cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O, leukocyte count of 93/mm3 (78% lymphocytes), a glucose concentration of 64 mg/dL, and a protein concentration of 50 mg/dL."], "context_len": 11, "options": {"A": "Borrelia burgdorferi", "B": "Mycobacterium tuberculosis", "C": "Herpes simplex virus 1", "D": "Coxsackievirus"}, "answer": "Coxsackievirus", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "26 years old", "specialties": ["Infectious Disease", "Internal Medicine"], "subspecialties": ["General Infectious Disease", "Infectious Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. Patient is a 26-year-old male.", "2. Patient has high-grade fever, fatigue, nausea, and headache for 4 days.", "3. Headache is constant and feels like a tight band around his head.", "4. Eyes hurt while looking at bright lights.", "5. Patient has been taking acetaminophen and using cold towels to help relieve his symptoms.", "6. Patient works as an assistant for a nature camp organization.", "7. Patient has been unable to go to work for 3 days.", "8. Patient's immunization records are unavailable.", "9. Patient's temperature is 38.5\u00b0C (101.3\u00b0F).", "10. Patient's pulse is 92/min.", "11. Patient's blood pressure is 108/74 mm Hg.", "12. Patient is oriented to time, place, and person.", "13. No rash or lymphadenopathy present.", "14. Flexion of the neck results in flexion of the knee and hip.", "15. Lumbar puncture done; cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O.", "16. Leukocyte count of 93/mm3 (78% lymphocytes).", "17. Glucose concentration of 64 mg/dL.", "18. Protein concentration of 50 mg/dL."], "atomic_facts": ["1. The patient reports a constant headache that feels like a tight band around his head.", "2. The patient's eyes hurt when looking at bright lights.", "3. The patient has been taking acetaminophen and using cold towels to relieve his symptoms.", "4. The patient has been unable to go to work for 3 days.", "5. The patient's immunization records are unavailable.", "6. The patient's temperature is 38.5\u00b0C (101.3\u00b0F).", "7. The patient's pulse is 92/min.", "8. The patient's blood pressure is 108/74 mm Hg.", "9. The patient is oriented to time, place, and person.", "10. There is no rash or lymphadenopathy.", "11. Flexion of the neck results in flexion of the knee and hip.", "12. A lumbar puncture is done.", "13. Cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O.", "14. Cerebrospinal fluid analysis shows a leukocyte count of 93/mm3 (78% lymphocytes).", "15. Cerebrospinal fluid analysis shows a glucose concentration of 64 mg/dL.", "16. Cerebrospinal fluid analysis shows a protein concentration of 50 mg/dL."]}
{"id": 1256, "question": "Which of the following congenital defects is the most likely cause of these findings?", "context": ["A 4-year-old girl presents to the pediatrician\u2019s office for a physical examination prior to starting preschool.", "She was born at 39 weeks gestation via spontaneous vaginal delivery.", "She is up to date on all vaccines and is meeting all developmental milestones.", "Past medical history is noncontributory.", "She takes no medications but does take a chewable vitamin daily.", "She lives with her parents and older brother in a house.", "Today, her blood pressure is 110/65 mm Hg, heart rate is 90/min, respiratory rate is 22/min, and temperature of 37.0\u00b0C (98.6\u00b0F).", "On physical exam, she appears well developed and pleasant.", "She sits listening to the conversation and follows directions.", "Palpation of the heart reveals a mild parasternal heave.", "Auscultation reveals a normal S1 but the S2 is split and remains split during inhalation and exhalation.", "Additionally, there is a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side and a very soft diastolic rumble."], "context_len": 12, "options": {"A": "Atrial septal defect", "B": "Coarctation of the aorta", "C": "Patent ductus arteriosus", "D": "Tetralogy of Fallot"}, "answer": "Atrial septal defect", "answer_idx": "A", "explanation": "", "patient": {"gender": "Female", "age": "4 years old", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. Patient is a 4-year-old girl.", "2. Patient was born at 39 weeks gestation via spontaneous vaginal delivery.", "3. Patient is up to date on all vaccines and is meeting all developmental milestones.", "4. Patient's past medical history is noncontributory.", "5. Patient takes no medications but does take a chewable vitamin daily.", "6. Patient lives with her parents and older brother in a house.", "7. Patient's blood pressure is 110/65 mm Hg.", "8. Patient's heart rate is 90/min.", "9. Patient's respiratory rate is 22/min.", "10. Patient's temperature is 37.0\u00b0C (98.6\u00b0F).", "11. On physical exam, patient appears well developed and pleasant.", "12. Patient sits listening to the conversation and follows directions.", "13. Palpation of the heart reveals a mild parasternal heave.", "14. Auscultation reveals a normal S1.", "15. Auscultation reveals S2 is split and remains split during inhalation and exhalation.", "16. Auscultation reveals a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side.", "17. Auscultation reveals a very soft diastolic rumble."], "atomic_facts": ["1. She was born at 39 weeks gestation", "2. She was born via spontaneous vaginal delivery", "3. She is up to date on all vaccines", "4. She is meeting all developmental milestones", "5. Past medical history is noncontributory", "6. She takes no medications", "7. She takes a chewable vitamin daily", "8. She lives with her parents and older brother in a house", "9. Today, her blood pressure is 110/65 mm Hg", "10. Her heart rate is 90/min", "11. Her respiratory rate is 22/min", "12. Her temperature is 37.0\u00b0C (98.6\u00b0F)", "13. On physical exam, she appears well developed and pleasant", "14. She sits listening to the conversation", "15. She follows directions", "16. Palpation of the heart reveals a mild parasternal heave", "17. Auscultation reveals a normal S1", "18. The S2 is split and remains split during inhalation and exhalation", "19. There is a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side", "20. There is a very soft diastolic rumble"]}
{"id": 1257, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 24-year-old man is brought to the emergency department after his head was hit with a bat during a baseball game.", "His teammates state that he was unresponsive after the incident but regained consciousness after 15 minutes.", "The patient initially refused to go to the hospital and sat on the bench for the remainder of the game.", "He initially appeared fine but became increasingly confused.", "He appears lethargic but opens his eyes to loud verbal commands.", "He is oriented to person and place.", "His temperature is 37.1 (98.8\u00b0F), pulse is 78/min, respiratory rate is 16/min, and blood pressure is 148/87 mm Hg.", "Examination shows an area of soft-tissue swelling over the left temporal region.", "A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "A CT scan of the head is shown.", "After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds.", "He withdraws from painful stimuli.", "On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light.", "The right pupil is 3 mm in diameter and reacts normally to light.", "His respiratory rate is 10/min and he is intubated in the emergency department."], "context_len": 15, "options": {"A": "Adminster hypotonic saline", "B": "Administer dexamethasone", "C": "Perform craniotomy", "D": "Perform brain MRI"}, "answer": "Perform craniotomy", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "24 years old", "specialties": ["Neurological Surgery"], "subspecialties": ["General Neurological Surgery"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 24-year-old man was brought to the emergency department.", "2. His head was hit with a bat during a baseball game.", "3. His teammates state he was unresponsive after the incident but regained consciousness after 15 minutes.", "4. The patient initially refused to go to the hospital and sat on the bench for the remainder of the game.", "5. He initially appeared fine but became increasingly confused.", "6. He appears lethargic but opens his eyes to loud verbal commands.", "7. He is oriented to person and place.", "8. His temperature is 37.1 (98.8\u00b0F).", "9. His pulse is 78/min.", "10. His respiratory rate is 16/min.", "11. His blood pressure is 148/87 mm Hg.", "12. Examination shows an area of soft-tissue swelling over the left temporal region.", "13. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "14. A CT scan of the head is shown.", "15. After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds.", "16. He withdraws from painful stimuli.", "17. On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light.", "18. The right pupil is 3 mm in diameter and reacts normally to light.", "19. His respiratory rate is 10/min.", "20. He is intubated in the emergency department."], "atomic_facts": ["1. His teammates state that he was unresponsive after the incident but regained consciousness after 15 minutes.", "2. The patient initially refused to go to the hospital and sat on the bench for the remainder of the game.", "3. He initially appeared fine but became increasingly confused.", "4. He appears lethargic but opens his eyes to loud verbal commands.", "5. He is oriented to person and place.", "6. His temperature is 37.1 (98.8\u00b0F), pulse is 78/min, respiratory rate is 16/min, and blood pressure is 148/87 mm Hg.", "7. Examination shows an area of soft-tissue swelling over the left temporal region.", "8. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range.", "9. A CT scan of the head is shown.", "10. After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds.", "11. He withdraws from painful stimuli.", "12. On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light.", "13. The right pupil is 3 mm in diameter and reacts normally to light.", "14. His respiratory rate is 10/min and he is intubated in the emergency department."]}
{"id": 1258, "question": "Laboratory studies show: | Today 6 months ago | Hemoglobin A1c 6.2% 6.4% | Serum | Creatinine 1.3 mg/dL 1.1 mg/dL | Urine | Albumin:creatinine ratio (N < 30) 470 mg/g 260 mg/g | The addition of which of the following medications is most likely to have prevented this patient's progressively worsening renal function?\"", "context": ["A 58-year-old woman comes to the physician for a routine follow-up examination.", "She has a history of type 2 diabetes mellitus, hypertension, and asthma.", "Last year, she received laser photocoagulation for proliferative retinopathy.", "Her current medications include metformin, lisinopril, and an albuterol inhaler.", "Her mother died of complications from diabetes.", "She drinks 1 glass of wine daily with dinner and does not smoke.", "Her temperature is 37.2\u00b0C (99\u00b0F), pulse is 92/min, respirations are 14/min, and blood pressure is 152/98 mm Hg.", "Cardiopulmonary examination is unremarkable.", "There is decreased sensation to monofilament testing of the plantar surfaces of both feet."], "context_len": 9, "options": {"A": "Losartan", "B": "Aspirin", "C": "Atorvastatin", "D": "Amlodipine"}, "answer": "Amlodipine", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "58", "specialties": ["Internal Medicine"], "subspecialties": ["Nephrology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 58-year-old woman comes to the physician for a routine follow-up examination.", "2. She has a history of type 2 diabetes mellitus, hypertension, and asthma.", "3. Last year, she received laser photocoagulation for proliferative retinopathy.", "4. Her current medications include metformin, lisinopril, and an albuterol inhaler.", "5. Her mother died of complications from diabetes.", "6. She drinks 1 glass of wine daily with dinner and does not smoke.", "7. Her temperature is 37.2\u00b0C (99\u00b0F).", "8. Her pulse is 92/min.", "9. Her respirations are 14/min.", "10. Her blood pressure is 152/98 mm Hg.", "11. Cardiopulmonary examination is unremarkable.", "12. There is decreased sensation to monofilament testing of the plantar surfaces of both feet."], "atomic_facts": ["1. She has a history of type 2 diabetes mellitus, hypertension, and asthma.", "2. Last year, she received laser photocoagulation for proliferative retinopathy.", "3. Her current medications include metformin, lisinopril, and an albuterol inhaler.", "4. Her mother died of complications from diabetes.", "5. She drinks 1 glass of wine daily with dinner and does not smoke.", "6. Her temperature is 37.2\u00b0C (99\u00b0F), pulse is 92/min, respirations are 14/min, and blood pressure is 152/98 mm Hg.", "7. Cardiopulmonary examination is unremarkable.", "8. There is decreased sensation to monofilament testing of the plantar surfaces of both feet."]}
{"id": 1259, "question": "Which of the following is the most effective intervention for this patient's skin lesion?", "context": ["A 4-year-old boy is brought to the physician by his mother because of a rash on his hands and feet for the past two weeks.", "It is intensely pruritic, especially at night.", "He has not had fever, headache, or diarrhea.", "His mother has a history of eczema.", "The child was due for an appointment later in the week to follow up on any potentially missing vaccinations.", "His temperature is 37.8\u00b0C (100.1\u00b0F).", "Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes.", "The remainder of the examination shows no abnormalities."], "context_len": 8, "options": {"A": "Oral acyclovir", "B": "Supportive care", "C": "Topical permethrin", "D": "Topical clotrimazole"}, "answer": "Topical permethrin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "4 years old", "specialties": ["Dermatology"], "subspecialties": ["Pediatric Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 4-year-old boy is brought to the physician by his mother.", "2. The boy has had a rash on his hands and feet for the past two weeks.", "3. The rash is intensely pruritic, especially at night.", "4. The boy has not had fever, headache, or diarrhea.", "5. The boy's mother has a history of eczema.", "6. The boy was due for an appointment later in the week to follow up on any potentially missing vaccinations.", "7. The boy's temperature is 37.8\u00b0C (100.1\u00b0F).", "8. Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes.", "9. The remainder of the examination shows no abnormalities."], "atomic_facts": ["1. It is intensely pruritic, especially at night.", "2. He has not had fever, headache, or diarrhea.", "3. His mother has a history of eczema.", "4. The child was due for an appointment later in the week to follow up on any potentially missing vaccinations.", "5. His temperature is 37.8\u00b0C (100.1\u00b0F).", "6. Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes.", "7. The remainder of the examination shows no abnormalities."]}
{"id": 1260, "question": "Which of the following stages does this patient's behavior most likely represent?", "context": ["A 32-year-old man comes with his wife to the primary care physician because she is concerned about his drinking behavior.", "Specifically, he drinks 7 drinks every day and has abandoned many social activities that he previously enjoyed.", "In addition, he starts drinking in the morning because he feels shaky when he does not have a drink.", "When asked about his behavior, the man says that he knows that he probably should drink less but feels that he is not motivated enough to change.", "He says that perhaps the topic should be addressed again next year."], "context_len": 5, "options": {"A": "Contemplation", "B": "Precontemplation", "C": "Preparation", "D": "Relapse"}, "answer": "Contemplation", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "32 years old", "specialties": ["Psychiatry"], "subspecialties": ["Addiction Psychiatry"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 32-year-old man comes with his wife to the primary care physician.", "2. His wife is concerned about his drinking behavior.", "3. He drinks 7 drinks every day.", "4. He has abandoned many social activities that he previously enjoyed.", "5. He starts drinking in the morning.", "6. He feels shaky when he does not have a drink.", "7. When asked about his behavior, he says he knows he should drink less.", "8. He feels he is not motivated enough to change.", "9. He suggests the topic should be addressed again next year."], "atomic_facts": ["1. He drinks 7 drinks every day.", "2. He has abandoned many social activities.", "3. He starts drinking in the morning because he feels shaky without a drink.", "4. He knows he should drink less but feels unmotivated to change.", "5. He suggests addressing the topic again next year."]}
{"id": 1261, "question": "Which of the following is the most appropriate next step in management?", "context": ["An 18-month-old boy is brought to the emergency department 25 minutes after an episode of loss of consciousness.", "The child began crying after his 4-year-old brother snatched a toy from him.", "The brief shrill cry was followed by a period of expiration; he then turned blue, became unconscious, and briefly lost his muscle tone, before he stiffened and had jerky movements of his arms and legs for 15 seconds.", "After this episode, he immediately regained consciousness.", "He had a similar episode 2 weeks ago when his father refused to give him a juice box.", "He has been healthy and has met all his developmental milestones.", "Vital signs are within normal limits.", "He is alert and active.", "Cardiopulmonary examination shows no abnormalities.", "Neurologic examination shows no focal findings."], "context_len": 10, "options": {"A": "CT scan of the head", "B": "Echocardiography", "C": "Reassurance", "D": "Tilt table test"}, "answer": "Reassurance", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "18 months", "specialties": ["Pediatrics"], "subspecialties": ["Pediatric Cardiology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Pediatrics"}, "facts_old": ["1. An 18-month-old boy was brought to the emergency department 25 minutes after an episode of loss of consciousness.", "2. The episode began when the child's 4-year-old brother snatched a toy from him.", "3. The child had a brief shrill cry, followed by a period of expiration.", "4. He then turned blue, became unconscious, and briefly lost his muscle tone.", "5. He then had jerky movements of his arms and legs for 15 seconds.", "6. After this episode, he immediately regained consciousness.", "7. Two weeks ago, he had a similar episode when his father refused to give him a juice box.", "8. He has been healthy and has met all his developmental milestones.", "9. His vital signs are within normal limits.", "10. He is alert and active.", "11. Cardiopulmonary examination shows no abnormalities.", "12. Neurologic examination shows no focal findings."], "atomic_facts": ["1. The child began crying after his 4-year-old brother snatched a toy from him.", "2. The brief shrill cry was followed by a period of expiration.", "3. He then turned blue, became unconscious, and briefly lost his muscle tone.", "4. He stiffened and had jerky movements of his arms and legs for 15 seconds.", "5. After this episode, he immediately regained consciousness.", "6. He had a similar episode 2 weeks ago when his father refused to give him a juice box.", "7. He has been healthy and has met all his developmental milestones.", "8. Vital signs are within normal limits.", "9. He is alert and active.", "10. Cardiopulmonary examination shows no abnormalities.", "11. Neurologic examination shows no focal findings."]}
{"id": 1262, "question": "What is the most likely cause of this patient\u2019s visual loss?", "context": ["A 67-year-old woman presents to the ophthalmologist with complaints of worsening visual loss.", "She states that her vision is blurry.", "Driving has become difficult, particularly at night, as she experiences substantial glare and sees halos around lights.", "On physical examination, there is absence of a red reflex."], "context_len": 4, "options": {"A": "Age-related macular degeneration", "B": "Cataracts", "C": "Open-angle glaucoma", "D": "Refractive error"}, "answer": "Cataracts", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "67 years old", "specialties": ["Ophthalmology"], "subspecialties": ["General Ophthalmology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Ophthalmology"}, "facts_old": ["1. A 67-year-old woman presents to the ophthalmologist.", "2. She has complaints of worsening visual loss.", "3. She states that her vision is blurry.", "4. Driving has become difficult, particularly at night.", "5. She experiences substantial glare.", "6. She sees halos around lights.", "7. On physical examination, there is absence of a red reflex."], "atomic_facts": ["1. The patient states that her vision is blurry.", "2. Driving has become difficult for the patient, particularly at night.", "3. The patient experiences substantial glare and sees halos around lights.", "4. On physical examination, there is absence of a red reflex."]}
{"id": 1263, "question": "Further evaluation of this patient is most likely to show which of the following findings?", "context": ["A 30-year-old woman comes to the physician because of headaches and nausea for the past 3 weeks.", "The headaches are holocranial and last up to several hours.", "During this period, she has also had a swishing sound in both ears, which decreases when she turns her head to either side.", "She has had multiple episodes of blurring of vision and double vision for the past 2 weeks.", "She has vomited twice in the past week.", "She has nodular cystic acne and polycystic ovarian disease.", "Current medications include an oral contraceptive, metformin, and isotretinoin.", "She is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2.", "Her temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 70/min, and blood pressure is 128/82 mm Hg.", "She is oriented to time, place, and person.", "Examination shows acne over her cheeks and back.", "Hirsutism is present.", "Visual acuity is 20/20 in both eyes.", "There is esotropia of the left eye."], "context_len": 14, "options": {"A": "Hyperpigmentation of palmar creases", "B": "Bilateral optic disc swelling", "C": "Raised intra-ocular pressure", "D": "Weakness of left upper and lower extremities"}, "answer": "Bilateral optic disc swelling", "answer_idx": "B", "explanation": "", "patient": {"gender": "Female", "age": "30 years old", "specialties": ["Neurology"], "subspecialties": ["Neurology with Special Qualification in Child Neurology", "Vascular Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. Patient is a 30-year-old woman.", "2. Patient has had headaches and nausea for the past 3 weeks.", "3. Headaches are holocranial and last up to several hours.", "4. Patient has had a swishing sound in both ears, which decreases when she turns her head to either side.", "5. Patient has had multiple episodes of blurring of vision and double vision for the past 2 weeks.", "6. Patient has vomited twice in the past week.", "7. Patient has nodular cystic acne and polycystic ovarian disease.", "8. Current medications include an oral contraceptive, metformin, and isotretinoin.", "9. Patient is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2.", "10. Patient's temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 70/min, and blood pressure is 128/82 mm Hg.", "11. Patient is oriented to time, place, and person.", "12. Examination shows acne over her cheeks and back.", "13. Hirsutism is present.", "14. Visual acuity is 20/20 in both eyes.", "15. There is esotropia of the left eye."], "atomic_facts": ["1. The headaches are holocranial and last up to several hours.", "2. She has a swishing sound in both ears, which decreases when she turns her head to either side.", "3. She has had multiple episodes of blurring of vision and double vision for the past 2 weeks.", "4. She has vomited twice in the past week.", "5. She has nodular cystic acne and polycystic ovarian disease.", "6. Current medications include an oral contraceptive, metformin, and isotretinoin.", "7. She is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2.", "8. Her temperature is 37.3\u00b0C (99.1\u00b0F), pulse is 70/min, and blood pressure is 128/82 mm Hg.", "9. She is oriented to time, place, and person.", "10. Examination shows acne over her cheeks and back.", "11. Hirsutism is present.", "12. Visual acuity is 20/20 in both eyes.", "13. There is esotropia of the left eye."]}
{"id": 1264, "question": "A history involving which of the following conditions is most likely to explain the administration of this drug instead of another nonsteroidal anti-inflammatory drug?", "context": ["A 64-year-old woman with knee osteoarthritis comes to the physician for a follow-up examination.", "She reports significantly improved pain control since starting celecoxib 1 month ago."], "context_len": 2, "options": {"A": "Reye syndrome", "B": "Sulfa drug allergy", "C": "Glanzmann thrombasthenia", "D": "Gout"}, "answer": "Glanzmann thrombasthenia", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "64", "specialties": ["Orthopaedic Surgery"], "subspecialties": ["Orthopaedic Sports Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Orthopaedic Surgery"}, "facts_old": ["1. A 64-year-old woman comes to the physician for a follow-up examination.", "2. She has knee osteoarthritis.", "3. She has been taking celecoxib for 1 month.", "4. She reports significantly improved pain control since starting celecoxib."], "atomic_facts": ["1. Patient started taking celecoxib 1 month ago.", "2. Patient reports significantly improved pain control since starting celecoxib."]}
{"id": 1265, "question": "Which of the following drugs was administered?", "context": ["A 48-year-old woman is admitted to the hospital and requires anticoagulation.", "She is administered a drug that binds tightly to antithrombin III."], "context_len": 2, "options": {"A": "Aspirin", "B": "Warfarin", "C": "Dabigatran", "D": "Enoxaparin"}, "answer": "Enoxaparin", "answer_idx": "D", "explanation": "", "patient": {"gender": "Female", "age": "48 years old", "specialties": ["Internal Medicine"], "subspecialties": ["Hematology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Internal Medicine"}, "facts_old": ["1. A 48-year-old woman is admitted to the hospital.", "2. The woman requires anticoagulation.", "3. She is administered a drug.", "4. The drug binds tightly to antithrombin III."], "atomic_facts": ["1. A drug is administered to her.", "2. The drug binds tightly to antithrombin III."]}
{"id": 1266, "question": "Which of the following best describes the properties of the most likely virus involved?", "context": ["A 20-year-old woman comes to the physician because of a 2-day history of low-grade fever and painful lesions on her left index finger.", "Two weeks ago, she had a painful rash on the right labia majora that resolved without treatment.", "Physical examination shows tender lymphadenopathy of the left epitrochlear and right inguinal region.", "A photograph of the left index finger is shown."], "context_len": 4, "options": {"A": "Naked virus with a double-stranded, circular DNA structure", "B": "Naked virus with a single-stranded, positive sense, linear RNA structure", "C": "Enveloped virus with a double-stranded, linear DNA structure", "D": "Enveloped virus with a partially double-stranded, circular DNA structure"}, "answer": "Enveloped virus with a double-stranded, linear DNA structure", "answer_idx": "C", "explanation": "", "patient": {"gender": "Female", "age": "20 years old", "specialties": ["Dermatology"], "subspecialties": ["General Dermatology"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Dermatology"}, "facts_old": ["1. A 20-year-old woman comes to the physician.", "2. She has a 2-day history of low-grade fever.", "3. She has painful lesions on her left index finger.", "4. Two weeks ago, she had a painful rash on the right labia majora.", "5. The rash resolved without treatment.", "6. Physical examination shows tender lymphadenopathy of the left epitrochlear region.", "7. Physical examination shows tender lymphadenopathy of the right inguinal region.", "8. A photograph of the left index finger is shown."], "atomic_facts": ["1. Two weeks ago, she had a painful rash on the right labia majora.", "2. The painful rash resolved without treatment.", "3. Physical examination shows tender lymphadenopathy of the left epitrochlear region.", "4. Physical examination shows tender lymphadenopathy of the right inguinal region.", "5. A photograph of the left index finger is shown."]}
{"id": 1267, "question": "Which of the following is the most appropriate next step in management?", "context": ["A 37-year-old man comes to the emergency department because of unsteady gait that started after waking up that morning.", "He has no fever, chills, headache, or myalgia.", "He works as a logger in Washington.", "His younger sister has multiple sclerosis.", "The patient appears pale.", "He is alert and responsive.", "His temperature is 37\u00b0C (98.9\u00b0F), pulse is 100/min, respirations are 11/min, and blood pressure is 136/86 mm Hg.", "Examinations shows intact cranial nerves.", "There is bilateral flaccid paralysis of his lower extremities.", "Lower extremity deep tendon reflexes are absent.", "The patient develops tachypnea and is admitted to the intensive care unit.", "Assisted breathing is started because of respiratory weakness."], "context_len": 12, "options": {"A": "Perform enzyme\u2011linked immunosorbent assay", "B": "Administer doxycycline", "C": "Administer botulism antitoxin", "D": "Locate and remove tick"}, "answer": "Locate and remove tick", "answer_idx": "D", "explanation": "", "patient": {"gender": "Male", "age": "37 years old", "specialties": ["Neurology"], "subspecialties": ["Vascular Neurology", "Neurology with Special Qualification in Child Neurology"], "specialty_prob": [1.0], "subspecialty_prob": [0.8, 0.2], "gpt_specialty": "Neurology"}, "facts_old": ["1. A 37-year-old man comes to the emergency department.", "2. His gait became unsteady after waking up that morning.", "3. He has no fever, chills, headache, or myalgia.", "4. He works as a logger in Washington.", "5. His younger sister has multiple sclerosis.", "6. The patient appears pale.", "7. He is alert and responsive.", "8. His temperature is 37\u00b0C (98.9\u00b0F).", "9. His pulse is 100/min.", "10. His respirations are 11/min.", "11. His blood pressure is 136/86 mm Hg.", "12. Examinations shows intact cranial nerves.", "13. There is bilateral flaccid paralysis of his lower extremities.", "14. Lower extremity deep tendon reflexes are absent.", "15. The patient develops tachypnea.", "16. He is admitted to the intensive care unit.", "17. Assisted breathing is started because of respiratory weakness."], "atomic_facts": ["1. He has no fever, chills, headache, or myalgia.", "2. He works as a logger in Washington.", "3. His younger sister has multiple sclerosis.", "4. The patient appears pale.", "5. He is alert and responsive.", "6. His temperature is 37\u00b0C (98.9\u00b0F), pulse is 100/min, respirations are 11/min, and blood pressure is 136/86 mm Hg.", "7. Examinations shows intact cranial nerves.", "8. There is bilateral flaccid paralysis of his lower extremities.", "9. Lower extremity deep tendon reflexes are absent.", "10. The patient develops tachypnea and is admitted to the intensive care unit.", "11. Assisted breathing is started because of respiratory weakness."]}
{"id": 1268, "question": "What is the next best step in the management of this patient?", "context": ["A 43-year-old man presents requesting a sleep aid for long-standing insomnia.", "He says he has been having trouble falling asleep for as long as he can remember, but it has become increasingly worse after he and his wife moved to their new house.", "He claims that his new neighbors are jealous of his huge swimming pool and are trying to sabotage it while he sleeps.", "His wife even had to cancel the housewarming party that was planned for the neighbors because of her husband\u2019s behavior.", "When probed further on this topic, the patient accuses the physician of being angry and hostile."], "context_len": 5, "options": {"A": "Respond in a straightforward manner, be honest and non-threatening", "B": "Encourage the patient to inform the police", "C": "Set rules and be firm with adhering to them", "D": "Refer this patient to another physician"}, "answer": "Respond in a straightforward manner, be honest and non-threatening", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "43", "specialties": ["Psychiatry"], "subspecialties": ["Sleep Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Psychiatry"}, "facts_old": ["1. A 43-year-old man presents requesting a sleep aid for long-standing insomnia.", "2. He has been having trouble falling asleep for as long as he can remember.", "3. His insomnia has become increasingly worse after he and his wife moved to their new house.", "4. He claims that his new neighbors are jealous of his huge swimming pool and are trying to sabotage it while he sleeps.", "5. His wife had to cancel the housewarming party that was planned for the neighbors.", "6. When probed further on this topic, the patient accuses the physician of being angry and hostile."], "atomic_facts": ["1. The patient has been having trouble falling asleep for as long as he can remember.", "2. The sleep troubles have become worse after the patient and his wife moved to their new house.", "3. The patient claims that his new neighbors are jealous of his huge swimming pool.", "4. The patient believes that his neighbors are trying to sabotage his swimming pool while he sleeps.", "5. The patient's wife had to cancel the housewarming party planned for the neighbors due to her husband's behavior.", "6. When probed further on this topic, the patient accuses the physician of being angry and hostile."]}
{"id": 1269, "question": "Which of the following medications was most likely given to this patient?", "context": ["A 22-year-old man presents to the emergency room after an altercation with the police.", "The police were called because the man was acting erratically in public.", "On physical examination, the patient is disoriented, does not respond to questioning, and appears to be reacting to internal stimuli.", "Laboratory tests are performed, which are all within normal limits, including a toxicology screen.", "The patient becomes aggressive and is given a medication to address his acute psychotic episode.", "An hour later, he is found in a sustained rigid posture in his bed, with his eyes in a fixed upward gaze."], "context_len": 6, "options": {"A": "Citalopram", "B": "Haloperidol", "C": "Phenelzine", "D": "Alprazolam"}, "answer": "Haloperidol", "answer_idx": "B", "explanation": "", "patient": {"gender": "Male", "age": "22", "specialties": ["Emergency Medicine"], "subspecialties": ["General Emergency Medicine"], "specialty_prob": [1.0], "subspecialty_prob": [1.0], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. A 22-year-old man presents to the emergency room.", "2. The police were called because the man was acting erratically in public.", "3. On physical examination, the patient is disoriented.", "4. The patient does not respond to questioning.", "5. The patient appears to be reacting to internal stimuli.", "6. Laboratory tests are performed.", "7. The laboratory tests are all within normal limits.", "8. A toxicology screen is performed.", "9. The patient becomes aggressive.", "10. The patient is given a medication to address his acute psychotic episode.", "11. An hour later, the patient is found in a sustained rigid posture in his bed.", "12. The patient's eyes are in a fixed upward gaze."], "atomic_facts": ["1. The police were called because the man was acting erratically in public.", "2. On physical examination, the patient is disoriented.", "3. The patient does not respond to questioning.", "4. The patient appears to be reacting to internal stimuli.", "5. Laboratory tests are performed.", "6. The laboratory tests are all within normal limits.", "7. The laboratory tests include a toxicology screen.", "8. The patient becomes aggressive.", "9. The patient is given a medication to address his acute psychotic episode.", "10. An hour later, the patient is found in a sustained rigid posture in his bed.", "11. The patient's eyes are in a fixed upward gaze."]}
{"id": 1270, "question": "Which of the following antibiotic therapies would be most suitable for this patient?", "context": ["A 42-year-old man is brought to the emergency department by his wife with chills and a temperature of 38.5\u00b0C (101.3\u00b0F) for the past 2 days.", "The patient\u2019s wife mentions that he recently injured his leg 5 days ago, after which she noticed that his calf was swollen, red, and painful.", "She says there was no pus, but that her husband was in excruciating pain.", "His vital signs include: temperature 38.9\u00b0C (102.1\u00b0F), blood pressure 110/75 mm Hg, and  respiratory rate 18/min.", "On physical examination, there is a tender mass over the left calf which is red and inflamed.", "Blood and wound cultures are taken.", "The patient is started on empiric antibiotics with vancomycin, but shows no improvement.", "Culture results reveal that the causative organism is resistant to the current antibiotic as well as penicillin."], "context_len": 8, "options": {"A": "IV nafcillin", "B": "Dicloxacillin", "C": "IV daptomycin", "D": "Doxycycline"}, "answer": "IV daptomycin", "answer_idx": "C", "explanation": "", "patient": {"gender": "Male", "age": "42 years old", "specialties": ["Infectious Disease", "Internal Medicine"], "subspecialties": ["General Infectious Disease", "Infectious Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Emergency Medicine"}, "facts_old": ["1. Patient is 42 years old.", "2. Patient has had chills and a temperature of 38.5\u00b0C (101.3\u00b0F) for the past 2 days.", "3. Patient injured his leg 5 days ago.", "4. Patient's calf was swollen, red, and painful.", "5. Patient was in excruciating pain.", "6. Patient's vital signs include temperature 38.9\u00b0C (102.1\u00b0F), blood pressure 110/75 mm Hg, and respiratory rate 18/min.", "7. Physical examination reveals a tender mass over the left calf which is red and inflamed.", "8. Blood and wound cultures are taken.", "9. Patient is started on empiric antibiotics with vancomycin.", "10. Patient shows no improvement.", "11. Culture results reveal that the causative organism is resistant to the current antibiotic as well as penicillin."], "atomic_facts": ["1. The patient injured his leg 5 days ago.", "2. The patient's wife noticed swelling, redness, and pain in his calf after the injury.", "3. There was no pus present in the calf.", "4. The patient was in excruciating pain.", "5. The patient's temperature is 38.9\u00b0C (102.1\u00b0F).", "6. The patient's blood pressure is 110/75 mm Hg.", "7. The patient's respiratory rate is 18/min.", "8. A tender mass is found over the left calf during physical examination.", "9. The mass is red and inflamed.", "10. Blood and wound cultures are taken.", "11. The patient is started on empiric antibiotics with vancomycin.", "12. The patient shows no improvement with the antibiotics.", "13. Culture results reveal that the causative organism is resistant to the current antibiotic as well as penicillin."]}
{"id": 1271, "question": "Which of the following is the next best step?", "context": ["A 63-year-old man presents to the emergency department with the sudden onset of excruciating chest pain, which he describes as a tearing sensation", "He was diagnosed with essential hypertension 20 years ago, but he is not compliant with his medications", "On physical examination, the temperature is 37.1\u00b0C (98.8\u00b0F), heart rate is 95/min, and blood pressure is 195/90 mm Hg in the right arm and 160/80 mm Hg in the left arm", "The pulses are absent in his right leg and diminished in his left leg", "A chest X-ray shows a widened mediastinum."], "context_len": 5, "options": {"A": "CT scan", "B": "Surgery", "C": "D-dimer", "D": "Intravenous ultrasound"}, "answer": "CT scan", "answer_idx": "A", "explanation": "", "patient": {"gender": "Male", "age": "63 years old", "specialties": ["Internal Medicine", "Cardiology"], "subspecialties": ["General Cardiology", "Cardiovascular Disease"], "specialty_prob": [0.6, 0.4], "subspecialty_prob": [0.6, 0.4], "gpt_specialty": "Thoracic Surgery"}, "facts_old": ["A 63-year-old man presents to the emergency department.", "He is experiencing sudden, excruciating chest pain.", "He describes the pain as a tearing sensation.", "He was diagnosed with essential hypertension 20 years ago.", "He is not compliant with his hypertension medications.", "His physical examination reveals a temperature of 37.1\u00b0C (98.8\u00b0F).", "His heart rate is 95 beats per minute.", "His blood pressure is 195/90 mm Hg in the right arm.", "His blood pressure is 160/80 mm Hg in the left arm.", "The blood pressure difference between his arms is 35/10 mm Hg.", "His right leg pulses are absent.", "His left leg pulses are diminished.", "A chest X-ray shows a widened mediastinum."], "atomic_facts": ["1. Diagnosed with essential hypertension 20 years ago", "2. Non-compliant with medications", "3. Temperature is 37.1\u00b0C (98.8\u00b0F)", "4. Heart rate is 95/min", "5. Blood pressure is 195/90 mm Hg in the right arm", "6. Blood pressure is 160/80 mm Hg in the left arm", "7. Absent pulses in right leg", "8. Diminished pulses in left leg", "9. Chest X-ray shows widened mediastinum"]}