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stellalisy

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[ "A 64-year-old woman comes to the physician because of several episodes of dizziness during the last month.", "The episodes last between 30–40 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." ]

[ "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 30–40 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." ]

[ "1. The episodes last between 30–40 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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 = 45–90 U/L)." ]

[ "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 45–90 U/L." ]

[ "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 = 45–90 U/L)." ]

[ "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’s 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 α1 adrenergic agonist drug.", "He examines the patient’s 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." ]

[ "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’s 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 α1 adrenergic agonist drug.", "6. He examines the patient’s 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." ]

[ "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 α1 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." ]

[ "A 21-year-old female comes to the physician’s office because of insomnia.", "For the past 9 months, the patient has been having a hard time falling asleep because she “can’t turn her mind off.” 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’t 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’t had the energy to go the gym as she usually does." ]

[ "1. A 21-year-old female comes to the physician’s office because of insomnia.", "2. For the past 9 months, the patient has been having a hard time falling asleep because she “can’t turn her mind off.”", "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." ]

[ "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." ]

[ "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°C (102.2°F).", "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." ]

[ "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°C (102.2°F).", "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." ]

[ "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°C (102.2°F).", "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." ]

[ "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 ‘okay.’ ." ]

[ "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 ‘okay.’" ]

[ "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 ‘okay.’" ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°F (36.6°C), 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." ]

[ "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°F (36.6°C).", "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." ]

[ "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°F (36.6°C).", "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°C (98.9°F), 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 | ." ]

[ "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°C (98.9°F), 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." ]

[ "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°C (98.9°F), 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°F (36.8°C), 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." ]

[ "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°F (36.8°C).", "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." ]

[ "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°F (36.8°C).", "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." ]

[ "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°C (98.6°F), 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." ]

[ "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°C (98.6°F), 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." ]

[ "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°C (98.6°F), 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" ]

[ "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°C (99.8°F), 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." ]

[ "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°C (99.8°F), 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." ]

[ "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°C (99.8°F), 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." ]

[ "An 8-year-old girl is brought by her mother to her pediatrician’s 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’s 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 β-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 β-agonist inhaler.", "She has some improvement in her symptoms.", "On physical examination, she doesn’t 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." ]

[ "1. An 8-year-old girl is brought by her mother to her pediatrician’s 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’s 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 β-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 β-agonist inhaler.", "9. She has some improvement in her symptoms.", "10. On physical examination, she doesn’t 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." ]

[ "1. She was diagnosed with asthma about 4 years ago.", "2. She has been on medications ever since.", "3. She came into the doctor’s 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 β-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 β-agonist inhaler.", "9. She has some improvement in her symptoms.", "10. On physical examination, she doesn’t 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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 “working on a project at home to save the earth from an evil alien power.” 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." ]

[ "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 “working on a project at home to save the earth from an evil alien power.” ", "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." ]

[ "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 “working on a project at home to save the earth from an evil alien power.”", "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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 96–100% 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°C (101.5°F), 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." ]

[ "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 96–100% 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°C (101.5°F), 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." ]

[ "1. The surgery was under general anesthesia with sevoflurane.", "2. The surgery lasted 98 minutes.", "3. The patient maintained oxygen saturation readings of 96–100% 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°C (101.5°F).", "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." ]

[ "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°F (36.7°C) 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." ]

[ "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°F (36.7°C).", "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." ]

[ "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°F (36.7°C).", "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°C (98.6°F).", "The physical exam is significant for preauricular adenopathy." ]

[ "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°C (98.6°F).", "10. Physical exam is significant for preauricular adenopathy." ]

[ "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°C (98.6°F).", "8. The physical exam is significant for preauricular adenopathy." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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 1–2 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°C (101°F).", "On physical examination, the skin above her right elbow is erythematous and severely tender to palpation." ]

[ "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 1–2 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°C (101°F).", "20. On physical examination, the skin above patient's right elbow is erythematous and severely tender to palpation." ]

[ "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 1–2 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°C (101°F).", "12. On physical examination, the skin above her right elbow is erythematous and severely tender to palpation." ]

[ "A 64-year-old man is brought to his primary care physician by his daughter for forgetfulness.", "The patient’s 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’s birthday party.", "When she went over to the patient’s house to check on him, she noticed the mailbox was stuffed with unopened letters.", "The patient says “I’m fine.", "I just have a headache.” The patient’s daughter adds, “I just hope you’re 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.” The patient’s 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’s temperature is 97°F (36.1°C), 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’s INR is 2.5.", "Imaging is pending." ]

[ "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’s 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°F (36.1°C). ", "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." ]

[ "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°F (36.1°C), 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." ]

[ "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℃ (98.1℉), 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 μm3 | 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)." ]

[ "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℃ (98.1℉).", "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 μm3.", "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)." ]

[ "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℃ (98.1℉).", "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 μm3.", "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)." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°F (37.5°C), 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 µm^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 | | ." ]

[ "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°F (37.5°C), 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 µm^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" ]

[ "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°F (37.5°C), 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 µm^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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°F (37.5°C), 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’s 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." ]

[ "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°F (37.5°C), 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’s 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." ]

[ "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°F (37.5°C).", "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°C (98.6°F), 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-γ release assay positive | An x-ray of the chest shows no abnormalities." ]

[ "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°C (98.6°F).", "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-γ release assay is positive.", "17. X-ray of the chest shows no abnormalities." ]

[ "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°C (98.6°F), 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-γ release assay positive.", "9. An x-ray of the chest shows no abnormalities." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°C (99.1°F), 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." ]

[ "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°C (99.1°F).", "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." ]

[ "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°C (99.1°F)", "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" ]

[ "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’s 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." ]

[ "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’s 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°C (98.8°F).", "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." ]

[ "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°C (98.8°F).", "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." ]

[ "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°C (98.8°F).", "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." ]

[ "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°C (101°F).", "Examination shows a black eschar with edematous borders on the left upper arm.", "There is axillary lymphadenopathy." ]

[ "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°C (101°F).", "8. Examination shows a black eschar with edematous borders on the left upper arm.", "9. There is axillary lymphadenopathy." ]

[ "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°C (101°F).", "5. Examination shows a black eschar on the left upper arm.", "6. The eschar has edematous borders.", "7. There is axillary lymphadenopathy." ]

[ "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)." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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 “common cold” 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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’s 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." ]

[ "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." ]

[ "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’s 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°C (98.6°F), 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, “I just want to know what happened.", "I'm her neighbor and childhood friend, and I'm worried about her.” ." ]

[ "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°C (98.6°F). ", "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." ]

[ "1. She appears lethargic.", "2. Her temperature is 37°C (98.6°F).", "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, “I just want to know what happened. I'm her neighbor and childhood friend, and I'm worried about her.”" ]

[ "A 40-year-old man presents to a clinic for a regular follow-up.", "He was diagnosed with Wilson’s disease 20 years ago and underwent a human leukocyte antigen–matched 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." ]

[ "1. A 40-year-old man presents to a clinic for a regular follow-up.", "2. He was diagnosed with Wilson’s disease 20 years ago.", "3. He underwent a human leukocyte antigen–matched 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." ]

[ "1. Diagnosed with Wilson’s disease 20 years ago", "2. Underwent a human leukocyte antigen–matched 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" ]

[ "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’s symptoms and make it difficult for him to breathe.", "Three months later, the mother is back with her son at the same pediatrician’s 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." ]

[ "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’s symptoms and make it difficult for him to breathe.", "11. Three months later, the mother is back with her son at the same pediatrician’s 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." ]

[ "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’s symptoms.", "10. Three months later, the mother is back with her son at the same pediatrician’s 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°F (36.9°C), 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." ]

[ "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°F (36.9°C).", "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." ]

[ "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°F (36.9°C), 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "1. The fetus lacks proper ureters.", "2. The fetus lacks major calyces.", "3. The fetus lacks minor calyces.", "4. The fetus lacks renal pelvises." ]

[ "An investigator is studying the effects of tissue hypoxia on skeletal muscles.", "Skeletal muscle hypoxia is induced by decreasing oxygen delivery to peripheral tissues." ]

[ "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." ]

[ "1. Skeletal muscle hypoxia", "2. Induced by decreasing oxygen delivery", "3. To peripheral tissues" ]

[ "A 48-year-old woman presents to the doctor’s 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." ]

[ "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." ]

[ "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." ]

[ "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°C (102.2°F).", "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." ]

[ "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°C (102.2°F).", "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." ]

[ "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°C (102.2°F).", "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." ]

[ "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." ]

[ "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." ]

[ "1. Blood pressure is measured to be 168/95.", "2. Prazosin is prescribed." ]

[ "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’s 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’s HIV status is negative and his complete blood count, T cell and B cell counts, immunoglobulin profile, and complement tests are within normal limits." ]

[ "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’s 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’s HIV status is negative.", "13. His complete blood count, T cell and B cell counts, immunoglobulin profile, and complement tests are within normal limits." ]

[ "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’s medical history is significant for neonatal sepsis.", "11. The boy’s medical history is significant for recurrent episodes of pyoderma.", "12. The boy’s 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’s HIV status is negative.", "17. The patient’s complete blood count is within normal limits.", "18. The patient’s T cell and B cell counts are within normal limits.", "19. The patient’s immunoglobulin profile is within normal limits.", "20. The patient’s complement tests are within normal limits." ]

[ "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°F (37.2°C), 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." ]

[ "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°F (37.2°C).", "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." ]

[ "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°F (37.2°C).", "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." ]

[ "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°F (37.3°C), 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." ]

[ "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°F (37.3°C).", "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." ]

[ "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°F (37.3°C).", "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°C (100.6°F), 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." ]

[ "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°C (100.6°F).", "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." ]

[ "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°C (100.6°F).", "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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%." ]

[ "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%." ]

[ "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%." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°F (37.4°C), 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’s clinical worsening that requires regular monitoring of liver function tests." ]

[ "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°F (37.4°C).", "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." ]

[ "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°F (37.4°C), 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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’s heart rate is 122/min, the respiratory rate is 31/min, and the temperature 36.4℃ (97.5℉).", "On examination, the newborn is pale, lethargic, diaphoretic, and has poor muscular tone.", "The liver is 2 cm below the right costal margin." ]

[ "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℃ (97.5℉). ", "11. On examination, newborn is pale, lethargic, diaphoretic, and has poor muscular tone. ", "12. Liver is 2 cm below the right costal margin." ]

[ "1. The current pregnancy was complicated by gestational diabetes with poor glycemic control.", "2. The newborn’s heart rate is 122/min.", "3. The newborn’s respiratory rate is 31/min.", "4. The newborn’s temperature is 36.4℃ (97.5℉).", "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." ]

[ "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’s 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’s 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." ]

[ "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’s 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’s 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." ]

[ "1. She was preparing for an exam at her college’s 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’s 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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’s 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°C (98.6°F).", "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." ]

[ "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’s 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°C (98.6°F).", "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." ]

[ "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’s 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°C (98.6°F).", "14. The patient has severe facial edema.", "15. The patient has severe stridor.", "16. The patient's complete blood count is normal." ]

[ "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°C (97.9°F).", "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." ]

[ "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°C (97.9°F).", "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." ]

[ "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°C (97.9°F).", "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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 | ." ]

[ "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" ]

[ "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" ]

[ "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°F (39°C), 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 | | ." ]

[ "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°F (39°C).", "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" ]

[ "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°F (39°C), 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" ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°F (37.3°C), 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." ]

[ "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°F (37.3°C).", "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." ]

[ "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°F (37.3°C).", "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." ]

[ "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% | ." ]

[ "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%." ]

[ "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%." ]

[ "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 2–4 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." ]

[ "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 2–4 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." ]

[ "1. He drinks about 2–4 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." ]

[ "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°C (97.7°F), 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." ]

[ "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°C (97.7°F), 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." ]

[ "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°C (97.7°F).", "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." ]

[ "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°C (100.8°F).", "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." ]

[ "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°C (100.8°F).", "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." ]

[ "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°C (100.8°F).", "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." ]

[ "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 | | ." ]

[ "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." ]

[ "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." ]

[ "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°C (98.4°F), 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." ]

[ "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°C (98.4°F).", "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." ]

[ "1. No history of hematuria", "2. No history of decreased urine output", "3. Temperature is 36.9°C (98.4°F)", "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" ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "During an emergency room shift, you encounter a disheveled looking man claiming that he is President Kennedy’s 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." ]

[ "1. During an emergency room shift, you encounter a disheveled looking man.", "2. The man claims that he is President Kennedy’s 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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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°C (101.8°F).", "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." ]

[ "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°C (101.8°F).", "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." ]

[ "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°C (101.8°F).", "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." ]

[ "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." ]

[ "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." ]

[ "1. Blood work shows mild anemia.", "2. Urinalysis detects proteinuria at a level of 670 mg/24 h.", "3. A kidney biopsy is performed." ]

[ "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°C (100.2°F).", "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." ]

[ "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°C (100.2°F).", "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." ]

[ "1. Her temperature is 37.9°C (100.2°F).", "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." ]

[ "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." ]

[ "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." ]

[ "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." ]

[ "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’s jaw seems rigid, and his temperature is 38.3°C (100.9°F).", "The puncture on the sole of his foot is 2 cm deep and 0.5 cm long.", "The patient is immediately given tetanus immunoglobulin." ]

[ "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°C (100.9°F).", "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." ]

[ "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°C (100.9°F).", "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." ]