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[['QUESTION', 'TYPE:', 'PRIMARY', 'CARE', 'AND', 'SOCIAL', 'NETWORKS'], ['CLINICAL', 'CASE:'], ['Juan,', 'a', 'second', 'year', 'resident,', 'attends', 'Sofia,', 'a', '15', 'year', 'old', 'girl', 'in', 'the', 'emergency', 'room,', 'who', 'apparently', 'fainted', 'at', 'school', 'without', 'losing', 'consciousness.'], ['The', 'patient', 'says', 'that', 'she', 'was', 'due', 'to', 'take', 'an', 'exam,', 'which', 'caused', 'her', 'a', 'lot', 'of', 'anxiety.'], ['From', 'the', 'interrogation,', 'it', 'appears', 'that', 'she', 'was', 'being', 'bullied', 'by', 'her', 'classmates', 'and', 'that', 'she', 'may', 'have', 'an', 'eating', 'disorder.'], ['Vital', 'signs', 'and', 'neurological', 'examination', 'are', 'normal.'], ['Juan', 'keeps', 'Sofia', 'under', 'observation', 'while', 'waiting', 'for', 'her', 'parents', 'to', 'come', 'to', 'the', 'service,', 'periodically', 'taking', 'a', 'look', 'at', 'how', 'the', 'patient', 'is', 'doing.'], ['After', 'the', 'initial', 'scare,', 'the', 'patient', 'seems', 'to', 'be', 'increasingly', 'animated', 'and', 'is', 'very', 'friendly.'], ['On', 'one', 'occasion,', 'Juan', 'finds', 'her', 'actively', 'chatting', 'on', 'her', 'cell', 'phone.'], ['Juan', 'tells', 'her', 'that', 'it', 'would', 'be', 'better', 'for', 'her', 'to', 'put', 'the', 'cell', 'phone', 'down', 'and', 'rest', 'and', 'to', 'reassure', 'her,', 'he', 'tells', 'her', 'that', 'he', 'also', 'uses', 'social', 'networks', 'a', 'lot', 'since', 'college.'], ['Sofia', 'apologizes', 'for', 'not', 'knowing', 'that', 'she', 'should', 'have', 'her', 'cell', 'phone', 'turned', 'off,', 'and', 'after', 'turning', 'it', 'off,', 'asks', 'if', 'she', 'can', 'make', 'a', 'friend', 'request', 'on', 'Facebook.'], ['What', 'do', 'you', 'think', 'is', "Juan's", 'best', 'response?'], ['1-', 'Tell', 'him', 'to', 'make', 'the', 'friend', 'request', 'and', 'that', 'he', 'will', 'accept', 'it,', 'as', 'he', 'is', 'sure', 'that', 'there', 'are', 'no', 'inappropriate', 'items', 'on', 'his', 'page', 'for', 'a', 'girl', 'of', "Sofia's", 'age.'], ['2-', 'Because', 'you', 'consider', 'Sofia', 'a', 'vulnerable', 'patient', 'and', 'are', 'concerned', 'that', 'she', 'may', 'misinterpret', 'a', 'rejection,', 'agree', 'to', 'let', 'her', 'make', 'the', 'request', 'but', 'only', 'allow', 'her', 'access', 'to', 'certain', 'content', 'on', 'your', 'page.'], ['3-', 'Answer', 'that', 'it', 'is', 'important', 'to', 'maintain', 'certain', 'professional', 'boundaries', 'between', 'patients', 'and', 'physicians', 'and', 'that,', 'unfortunately,', 'if', 'you', 'make', 'the', 'request', 'you', 'will', 'not', 'be', 'able', 'to', 'accept', 'it,', 'so', 'it', 'is', 'better', 'not', 'to', 'do', 'so.'], ['4-', 'Tell', 'him', 'to', 'make', 'the', 'request', 'but', 'without', 'any', 'intention', 'of', 'accepting', 'it.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['There', 'is', 'no', 'doubt', 'that', 'the', 'doctor-patient', 'relationship', 'today', 'transcends', 'the', 'physical', 'environment', 'of', 'the', 'consultation', 'room.'], ['But', 'we', 'must', 'not', 'forget', 'that', 'we', 'must', 'maintain', 'the', 'same', 'ethical', 'and', 'professional', 'codes', 'as', 'in', 'the', 'real', 'environment.'], ['The', 'code', 'of', 'ethics', 'Article', '26-3.'], ['The', 'clinical', 'practice', 'of', 'medicine', 'by', 'means', 'of', 'consultations', 'exclusively', 'by', 'letter,', 'telephone,', 'radio,', 'press', 'or', 'internet,', 'is', 'contrary', 'to', 'the', 'deontological', 'norms.'], ['The', 'correct', 'action', 'implies', 'inescapably', 'the', 'personal', 'and', 'direct', 'contact', 'between', 'the', 'doctor', 'and', 'the', 'patient.']]

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[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['After', 'a', 'traffic', 'accident', 'a', '38-year-old', 'patient', 'is', 'admitted', 'to', 'the', 'ICU', 'in', 'coma.'], ['After', 'several', 'days', 'the', 'patient', 'does', 'not', 'improve', 'neurologically', 'and', 'a', 'CT', 'scan', 'shows', 'hemorrhagic', 'punctate', 'lesions', 'in', 'the', 'corpus', 'callosum', 'and', 'cortico-subcortical', 'junction.'], ['What', 'is', 'the', 'diagnosis?'], ['1-', 'Acute', 'subdural', 'hematoma.'], ['2-', 'Trobocytopenic', 'purpura.'], ['3-', 'Cerebral', 'hemorrhagic', 'contusion.'], ['4-', 'Severe', 'diffuse', 'axonal', 'injury.'], ['5-', 'Hypoxic-ischemic', 'encephalopathy.'], ['CORRECT', 'ANSWER:', '4'], ['Diffuse', 'axonal', 'injury', 'produces', 'an', 'early', 'and', 'sustained', 'deterioration', 'of', 'the', 'level', 'of', 'consciousness', '(as', 'mentioned', 'in', 'the', 'case', 'statement)', 'without', 'a', 'lesion', 'on', 'CT', 'scan', 'to', 'justify', 'the', 'picture.'], ['Sometimes,', 'punctate', 'hemorrhages', 'at', 'the', 'level', 'of', 'the', 'corpus', 'callosum,', 'corticosubcortical', 'junction', 'and', 'dorsolateral', 'portion', 'of', 'the', 'brainstem', 'are', 'evidenced', 'in', 'this', 'imaging', 'test.']]

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[['QUESTION', 'TYPE:', 'DIGESTIVE', 'TRACT'], ['CLINICAL', 'CASE:'], ['A', '37-year-old', 'woman', 'with', 'extensive', 'ulcerative', 'colitis', 'presents', 'a', 'severe', 'flare-up', 'for', 'which', 'treatment', 'with', 'prednisone', 'at', 'a', 'dose', 'of', '1', 'mg/kg', 'is', 'started.'], ['After', 'one', 'week', 'of', 'treatment,', 'the', 'patient', 'shows', 'no', 'improvement.'], ['What', 'is', 'the', 'next', 'therapeutic', 'measure', 'to', 'be', 'taken?'], ['1-', 'Emergency', 'subtotal', 'colectomy', 'and', 'in', 'a', 'second', 'time', 'prostectomy', 'and', 'ileoanal', 'reservoir.'], ['2-', 'Associate', 'an', 'immunosuppressant', 'such', 'as', 'azathioprine.'], ['3-', 'Associate', 'mesalazine', 'in', 'doses', 'of', '4g', 'per', 'day', 'orally', 'and', 'rectal', 'triamcinolone', '1', 'application', 'every', '12', 'hours.'], ['4-', 'Intravenous', 'cyclosporine', '2mg/kg.'], ['5-', 'Treatment', 'with', 'etanercept', '(an', 'anti-TNFa', 'antibody)', 'should', 'be', 'considered.'], ['CORRECT', 'ANSWER:', '4'], ['When', 'a', 'severe', 'flare', 'does', 'not', 'respond', 'to', 'iv', 'corticosteroid', 'therapy', 'at', 'full', 'doses', '(1mg/kg', 'body', 'weight),', 'it', 'is', 'necessary', 'to', 'switch', 'to', 'cyclosporine', 'or', 'infliximab.'], ['Etanercept', 'is', 'not', 'approved', 'in', 'Europe', 'for', 'inflammatory', 'bowel', 'disease', '(for', 'the', 'time', 'being).']]

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224_63

[['QUESTION', 'TYPE:', 'CARDIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'patient', 'who', 'has', 'been', 'complaining', 'of', 'dyspnea', 'on', 'medium', 'exertion', 'for', '6', 'months.'], ['He', 'has', 'not', 'presented', 'angina', 'or', 'syncope.'], ['Physical', 'examination', 'and', 'diagnostic', 'tests', 'show', 'a', 'mean', 'aortic', 'transvalvular', 'gradient', 'of', '55', 'mmHg', 'and', 'a', 'calculated', 'area', 'of', '0.7', 'cm².'], ['Ejection', 'fraction', 'of', '65%.'], ['The', 'treatment', 'to', 'be', 'indicated', 'for', 'this', 'patient', 'is:'], ['1-', 'Diuretics', 'and', 'more', 'frequent', 'check-ups', 'by', 'a', 'specialist.'], ['2-', 'In', 'case', 'of', 'increasing', 'dyspnea', 'on', 'exertion,', 'percutaneous', 'dilatation', 'of', 'the', 'aortic', 'valve', 'with', 'a', 'balloon', 'catheter', 'should', 'be', 'performed.'], ['3-', 'Replacement', 'of', 'the', 'aortic', 'valve', 'with', 'a', 'prosthesis/bioprosthesis.'], ['4-', 'Replacement', 'of', 'the', 'aortic', 'valve', 'with', 'a', 'homograft.'], ['5-', 'Implantation', 'of', 'a', 'percutaneous', 'valve.'], ['CORRECT', 'ANSWER:', '3'], ['Something', 'aortic.'], ['They', 'give', 'me', 'a', 'gradient,', 'which', 'without', 'knowing', 'the', 'values', 'seems', 'somewhat', 'high', '(55', 'mmHg!)', 'and', 'the', 'area,', 'which', 'looks', 'tiny', 'to', 'the', 'naked', 'eye:', 'this', 'is', 'going', 'to', 'be', 'aortic', 'stenosis...'], ['And', 'he', 'has', 'dyspnea.'], ['Symptomatic', 'aortic', 'stenosis,', 'will', 'the', 'examiner', 'want', 'me', 'to', 'send', 'him', 'for', 'surgery?'], ['With', 'the', 'guidelines', 'in', 'hand,', "that's", 'right:', 'this', 'is', 'a', 'severe', 'stenosis', 'both', 'in', 'terms', 'of', 'area', '(<1', 'cm²)', 'and', 'mean', 'gradient', '(>40', 'mmHg),', 'with', 'a', 'preserved', 'ejection', 'fraction,', 'and', 'symptomatic.'], ['Surgical', 'indication.'], ['If', 'we', 'do', '1', 'we', 'take', 'away', 'life', 'expectancy,', 'because', 'we', 'allow', 'the', 'ventricle', 'to', 'claudicate.'], ['2', 'is', 'outdated:', 'balloon', 'valvuloplasty?'], ['Only', 'if', 'the', 'surgical', 'risk', 'is', 'unaffordable,', 'and', 'in', 'that', 'case', 'we', 'would', 'do', '5,', 'TAVI', 'implantation', '(see', '[1]).'], ['But', 'this', 'is', 'a', '52-year-old', 'man,', 'who', 'we', 'assume', 'has', 'good', 'bodywork', 'because', 'he', 'walks', 'to', 'have', 'dyspnea,', 'so', 'to', 'the', 'operating', 'room.'], ['So', 'to', 'the', 'operating', 'room.'], ['A', 'homograft?', "That's", 'the', 'Ross', 'technique,', 'I', 'take', 'the', 'pulmonary', 'and', 'put', 'it', 'where', 'the', 'aortic.'], ['But', "it's", 'rare,', 'complex', 'and', 'only', 'done', 'in', 'pediatrics.'], ['The', 'correct', 'thing', 'to', 'do', 'is', '3,', 'without', 'a', 'doubt:', 'replace', 'with', 'a', 'prosthesis,', 'preferably', 'mechanical', 'unless', 'the', 'patient', 'has', 'a', 'contraindication', 'for', 'anticoagulation.']]

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430_115

[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES', 'AND', 'MICROBIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '65-year-old', 'woman', 'who', 'underwent', 'hematopoietic', 'precursor', 'transplantation', '30', 'days', 'ago', 'and', 'has', 'severe', 'neutropenia.'], ['She', 'starts', 'with', 'cough', 'and', 'hemoptotic', 'expectoration', 'in', 'addition', 'to', 'fever', 'and', 'moderate', 'exertional', 'dyspnea', 'that', 'does', 'not', 'improve', 'despite', 'five', 'days', 'of', 'treatment', 'with', 'amoxicillin-clavulanic', 'acid', '(875/125', 'mg/8', 'h)', 'and', 'levofloxacin', '(500', 'mg/12', 'h).'], ['Chest', 'X-ray', 'shows', 'multiple', 'ill-defined', 'pulmonary', 'nodules,', 'some', 'of', 'them', 'cavitated.'], ['Among', 'the', 'following,', 'which', 'is', 'the', 'most', 'probable', 'diagnosis', 'of', 'suspicion?'], ['1-', 'Septic', 'embolisms.'], ['2-', 'Invasive', 'pulmonary', 'aspergillosis.'], ['3-', 'Pneumonia', 'due', 'to', 'Staphylococcus', 'aureus.'], ['4-', 'Systemic', 'candidiasis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Patient', 'on', 'her', '30th', 'post-transplant', 'day', 'of', 'hematopoietic', 'precursor', 'transplantation,', 'in', 'severe', 'neutropenia', 'who', 'presents', 'with', 'cough', 'with', 'hemoptotic', 'expectoration.'], ['This', 'picture', 'is', 'usually', 'seen', 'in', 'infection', 'by', 'Aspergillus', 'spp.'], ['We', 'can', 'rule', 'out', 'infection', 'by', 'Staphylococcus', 'aureus', 'because', 'of', 'previous', 'treatment,', 'although', 'we', 'do', 'not', 'know', 'if', 'it', 'raises', 'the', 'response', 'also', 'a', 'possible', 'MRSA.']]

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588_63

11_74

[['QUESTION', 'TYPE:', 'SURGERY'], ['CLINICAL', 'CASE:'], ['Ten', 'days', 'after', 'performing', 'a', 'hemithyroidectomy', 'on', 'a', 'patient', 'with', 'a', '1.5', 'cm', 'thyroid', 'nodule', 'you', 'receive', 'the', 'following', 'anatomopathologic', 'report:', '"very', 'cellular', 'follicular', 'pattern', 'without', 'capsular', 'invasion', 'and', 'infiltrating', 'adjacent', 'blood', 'vessels', 'and', 'nerves".'], ['Point', 'out', 'the', 'correct', 'answer:'], ['1-', 'As', 'there', 'is', 'no', 'capsular', 'invasion,', 'no', 'further', 'surgery', 'is', 'necessary.'], ['2-', 'Follicular', 'pattern', 'is', 'an', 'indication', 'for', 'prophylactic', 'cervical', 'lymph', 'node', 'emptying.'], ['3-', 'This', 'is', 'a', 'follicular', 'carcinoma', 'and', 'requires', 'completion', 'of', 'thyroidectomy.'], ['4-', 'The', 'report', 'allows', 'us', 'to', 'rule', 'out', 'with', 'total', 'certainty', 'a', 'papillary', 'carcinoma', 'in', 'the', 'remaining', 'thyroid.'], ['5-', 'Measurement', 'of', 'plasma', 'calcitonin', 'will', 'allow', 'us', 'to', 'distinguish', 'between', 'papillary', 'and', 'follicular', 'carcinoma.'], ['CORRECT', 'ANSWER:', '3'], ['I', 'think', 'the', 'correct', 'answer', 'is', '3', 'answers', '2,4', 'and', '5', 'are', 'clearly', 'false.'], ['The', 'doubt', 'is', 'between', '1', 'and', '2.'], ['The', 'statement', 'of', '1', 'is', 'correct', 'in', 'cases', 'of', 'follicular', 'carcinoma', 'without', 'capsular', 'invasion', 'a', 'total', 'thyroidectomy', 'can', 'be', 'performed.'], ['But', 'if', 'there', 'are', 'data', 'of', 'poor', 'prognosis', 'and', 'the', 'possibility', 'of', 'metastases', '-', 'as', 'in', 'this', 'case', '-', 'it', 'is', 'best', 'to', 'complete', 'the', 'thyroidectomy', 'and', 'perform', 'a', 'radioactive', 'iodine', 'scan', 'to', 'rule', 'out', 'metastases', 'or', 'treat', 'them', 'if', 'they', 'are', 'present.']]

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535_121

[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'black', 'woman', 'consults', 'for', 'the', 'appearance', 'of', 'edema', 'in', 'the', 'lower', 'limbs,', 'decreased', 'diuresis,', 'fever', 'and', 'a', 'malar', 'rash', 'in', 'butterfly', 'wings', 'of', '20', 'days', 'of', 'evolution.'], ['Laboratory', 'tests', 'showed', 'creatinine', '3', 'mg/dl,', 'leukopenia,', 'hemoglobin', '10.5', 'g/dl', '(normochromic', 'normocytic),', 'CRP', '9', 'mg/dl', 'and', 'ESR', '60', 'mm.'], ['Regarding', 'the', 'pathology', 'presented', 'by', 'this', 'patient,', 'point', 'out', 'the', 'correct', 'answer:'], ['1-', 'The', 'anti-Sm', 'antibodies', 'are', 'not', 'specific', 'for', 'this', 'pathology.'], ['2-', 'Anti-centromere', 'antibodies', 'are', 'detected', 'in', '90%', 'of', 'cases.'], ['3-', 'ANA', '(antinuclear', 'antibodies)', 'are', 'detected', 'in', '50%', 'of', 'cases.'], ['4-', 'Anti-two-stranded', 'or', 'native', 'anti-DNA', 'correlates', 'with', 'the', 'risk', 'of', 'nephritis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Another', 'question', 'about', 'SLE', 'antibodies.'], ['Clinical', 'case', 'of', 'SLE', 'with', 'renal', 'involvement,', 'in', 'which', 'positive', 'double-stranded', 'anti-DNA', 'increases', 'the', 'risk', 'of', 'nephritis.'], ['As', 'for', 'the', 'rest,', 'anti-Sm', 'are', 'specific', 'to', 'SLE,', 'ANA', 'are', 'detected', 'in', 'more', 'than', '90%', 'of', 'cases,', 'and', 'anti-centromere', 'are', 'typical', 'of', 'scleroderma.']]

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452_149

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'woman', 'with', 'an', 'epileptic', 'seizure', 'presenting', 'with', 'the', 'following', 'clinical', 'features:', 'epigastric', 'aura,', 'unpleasant', 'odor,', 'disconnection', 'from', 'the', 'environment,', 'motor', 'automatisms', '(sucking,', 'swallowing,', 'opening', 'and', 'closing', 'of', 'one', 'hand)', 'and', 'postcritical', 'amnesia,', 'what', 'is', 'your', 'diagnostic', 'suspicion?'], ['1-', 'Generalized', 'non-convulsive', 'seizure', 'or', 'typical', 'absence.'], ['2-', 'Continuous', 'partial', 'epilepsy.'], ['3-', 'Amyotonic', 'crisis.'], ['4-', 'Complex', 'partial', 'temporal', 'lobe', 'seizure.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Clearly', 'the', 'answer', 'is', '4,', 'with', 'a', 'very', 'characteristic', 'clinic', 'of', 'temporary', 'seizures.']]

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

55_74

[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['Ten', 'days', 'after', 'performing', 'a', 'hemithyroidectomy', 'on', 'a', 'patient', 'with', 'a', '1.5', 'cm', 'thyroid', 'nodule', 'you', 'receive', 'the', 'following', 'definitive', 'report', 'from', 'the', 'pathologist:', '"very', 'cellular', 'follicular', 'pattern', 'without', 'capsular', 'invasion', 'invading', 'adjacent', 'blood', 'vessels', 'and', 'nerves".'], ['Point', 'out', 'the', 'correct', 'answer:'], ['1-', 'As', 'there', 'is', 'no', 'capsular', 'invasion', 'it', 'is', 'not', 'convenient', 'to', 'perform', 'further', 'surgery.'], ['2-', 'The', 'follicular', 'pattern', 'is', 'an', 'indication', 'for', 'prophylactic', 'cervical', 'lymph', 'node', 'emptying.'], ['3-', 'It', 'is', 'a', 'follicular', 'carcinoma', 'and', 'requires', 'completion', 'of', 'thyroidectomy.'], ['4-', 'The', 'report', 'allows', 'to', 'rule', 'out', 'papillary', 'carcinoma', 'with', 'total', 'certainty', 'in', 'the', 'remaining', 'thyroid.'], ['5-', 'Measurement', 'of', 'plasma', 'calcitonin', 'will', 'allow', 'us', 'to', 'differentiate', 'between', 'papillary', 'and', 'follicular', 'carcinoma.'], ['CORRECT', 'ANSWER:', '3'], ['I', 'find', 'this', 'question', 'a', 'bit', 'more', 'difficult', 'since', 'you', 'have', 'to', 'have', 'clear', 'concepts', 'of', 'pathologic', 'anatomy.'], ['In', 'any', 'case,', 'it', 'is', 'possible', 'to', 'exclude', 'by', 'exclusion', 'and', 'by', 'the', 'way', 'the', 'answers', 'are', 'expressed:', 'Answer', '2:', 'prophylactic', 'emptying', 'is', 'indicated', 'in', 'the', 'medullary.'], ['Answer', '4:', 'simply', 'by', 'the', 'way', 'of', 'expressing', 'it,', 'it', 'should', 'already', 'have', 'been', 'ruled', 'out.'], ['Answer', '5:', 'you', 'already', 'know', 'that', 'calcitonin', 'is', 'used', 'in', 'medullary', 'carcinoma', 'and', 'not', 'in', 'differentiated', 'carcinoma.'], ['Answers', '1', 'and', '3', 'are', 'contrary,', 'one', 'recommends', 'completing', 'thyroidectomy', 'and', 'the', 'other', 'does', 'not.'], ['The', 'only', 'ones', 'in', 'which', 'complete', 'thyroidectomy', 'is', 'not', 'recommended', 'are', 'microcarcinomas', 'measuring', 'less', 'than', '1', 'cm.']]

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281_33

[['QUESTION', 'TYPE:', 'PATHOLOGICAL', 'ANATOMY'], ['CLINICAL', 'CASE:'], ['A', '67-year-old', 'woman', 'diagnosed', 'with', 'an', 'infiltrating', 'ductal', 'carcinoma', 'of', 'the', 'breast', 'and', 'no', 'family', 'history', 'of', 'neoplasia.'], ['What', 'additional', 'studies', 'should', 'be', 'performed', 'on', 'the', 'tumor', 'for', 'its', 'clinical-therapeutic', 'implications?'], ['1-', 'Complete', 'phenotypic', 'study', 'by', 'flow', 'cytometry.'], ['2-', 'Study', 'of', 'hormone', 'receptors', 'and', 'HER2.'], ['3-', 'Study', 'of', 'hormone', 'receptors,', 'e-cadherin', 'and', 'study', 'of', 'first', 'degree', 'relatives.'], ['4-', 'Study', 'of', 'BRCA', '1-2', 'and', 'study', 'of', 'first-degree', 'relatives.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'would', 'be', '2,', 'HORMONE', 'AND', 'HER2', 'RECEPTOR', 'STUDY,', 'since', 'positive', 'HER2', 'receptors', 'imply', 'greater', 'aggressiveness', 'of', 'the', 'tumor', 'but', 'treatment', 'with', 'trastuzumab', 'and', 'positive', 'hormone', 'receptors', 'would', 'imply', 'the', 'use', 'of', 'hormone', 'therapy.'], ['Answer', '1', 'can', 'be', 'ruled', 'out', 'visu', 'visu,', 'while', 'answers', '3', 'and', '4', 'should', 'be', 'ruled', 'out', 'since,', 'being', 'the', 'first', 'woman', 'in', 'the', 'family', 'with', 'breast', 'carcinoma,', 'the', 'study', 'of', 'the', "patient's", 'relatives', 'would', 'not', 'be', 'obligatory.'], ['Likewise,', 'e-cadherin', 'is', 'important', 'for', 'the', 'differential', 'diagnosis', 'of', 'a', 'lobular', 'breast', 'carcinoma,', 'not', 'a', 'ductal', 'one.']]

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310_216

[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', 'parent', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'his', '2-year-old', 'son', 'because', 'he', 'reports', 'that', 'he', 'has', 'hit', 'his', 'right', 'eye', 'while', 'playing.'], ['Indeed,', 'a', 'hematoma', 'is', 'observed', 'on', 'the', 'right', 'eyelid,', 'apparently', 'of', 'no', 'importance.'], ['The', 'fundus', 'examination', 'showed', 'intraretinal', 'hemorrhages', 'not', 'only', 'in', 'the', 'eye', 'referred', 'by', 'the', 'parents', 'but', 'also', 'in', 'the', 'other', 'eye.'], ['It', 'is', 'noteworthy', 'that', 'the', 'child', 'appears', 'drowsy', 'and', 'with', 'little', 'tone.'], ['Which', 'of', 'the', 'following', 'statements', 'should', 'you', 'consider', 'regarding', 'this', 'clinical', 'picture?'], ['1-', 'It', 'is', 'a', 'highly', 'suggestive', 'history', 'of', 'child', 'abuse.'], ['2-', 'It', 'is', 'the', 'normal', 'evolution', 'of', 'a', 'non-perforating', 'intraocular', 'trauma.'], ['3-', 'The', 'most', 'likely', 'diagnosis', 'is', 'Berlin', 'edema.'], ['4-', 'It', 'is', 'the', 'characteristic', 'picture', 'of', "Purstcher's", 'traumatic', 'retinal', 'angiopathy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Easy', 'question', 'in', 'principle,', 'but', 'with', 'a', 'bit', 'of', 'a', 'catch.'], ['If', 'you', 'have', 'the', 'right', 'intuition', 'when', 'you', 'read', 'it', 'and', 'go', 'straight', 'to', 'what', 'you', 'think,', 'you', 'will', 'probably', 'get', 'it', 'right.'], ['The', 'problem', 'is', 'option', '4,', 'which', 'can', 'confuse', 'us.'], ["Let's", 'see:', 'we', 'have', 'a', 'blow', 'to', 'the', 'right', 'eye', 'area,', 'with', 'a', 'hematoma', 'on', 'the', 'eyelid.'], ['So', 'far', 'so', 'normal.'], ['The', 'problem', 'is', 'that', 'retinal', 'hemorrhages', 'appear', 'not', 'only', 'in', 'that', 'eye', '(which', 'in', 'itself', 'is', 'rare,', 'because', 'an', 'external', 'blow', 'to', 'the', 'eye', 'in', 'a', 'child', 'rarely', 'causes', 'bleeding', 'in', 'the', 'retina),', 'but', 'also', 'in', 'the', 'other', 'eye.'], ['Therefore,', 'something', 'other', 'than', 'the', 'blow', 'has', 'caused', 'hemorrhages', 'in', 'both', 'retinas.'], ['Then', 'we', 'are', 'told', 'that', 'the', 'child', 'seems', 'drowsy', 'and', 'with', 'little', 'tone.'], ['Here', 'we', 'already', 'have', 'the', 'two', 'keys;', 'we', 'have', 'to', 'suspect', 'what', 'is', 'not', 'mentioned', 'in', 'the', 'answers,', 'but', 'which', 'is', 'what', 'the', 'child', 'has:', 'the', 'shaken', 'baby', 'syndrome', '(shaken', 'baby', 'syndrome).'], ['Characteristic', 'of', 'this', 'syndrome', 'are', 'bilateral', 'retinal', 'hemorrhages,', 'cerebral', 'edema', 'and', 'subdural', 'hematoma.'], ['There', 'may', 'also', 'be', 'fracture', 'of', 'long', 'bones', 'and', 'other', 'problems.'], ['Numbness', 'and', 'hypotonia', 'allow', 'us', 'to', 'suspect', 'intracranial', 'complications.'], ['The', 'cause', 'of', 'shaken', 'baby', 'syndrome', 'is', 'almost', 'always', 'abuse,', 'so', 'the', 'answer', 'is', '1.'], ['Options', '2', 'and', '3', 'are', 'easy', 'to', 'rule', 'out:', 'nothing', 'indicates', 'perforating', 'trauma,', 'and', 'it', 'does', 'not', 'explain', 'the', 'hemorrhages', 'in', 'the', 'other', 'eye.'], ['And', 'the', 'berlin', 'edema', 'is', 'an', 'edema', 'of', 'the', 'macula', 'and', 'appears', 'as', 'a', 'whitish', 'lesion,', 'which', 'is', 'not', 'described', 'in', 'the', 'statement.'], ['The', 'catch', 'is', 'option', '4.'], ["Purstcher's", 'retinopathy', 'can', 'also', 'appear', 'in', 'the', 'context', 'of', 'the', 'child', 'of', 'the', 'shaken', 'child,', 'and', 'therefore', 'occur', 'in', 'the', 'case', 'of', 'child', 'abuse.'], ['Seeing', 'these', 'two', 'partly', 'related', 'questions,', 'we', 'may', 'hesitate.'], ['However,', 'if', 'we', 'read', 'answer', '4', 'carefully,', 'it', 'does', 'not', 'tell', 'us', 'that', 'if', 'there', 'is', 'child', 'maltreatment', 'Purstcher', 'can', 'occur.'], ['It', 'states', 'that', 'the', 'picture', 'described', 'above', '(intraretinal', 'hemorrhages,', 'without', 'other', 'findings)', 'is', 'characteristic', 'of', "Purstcher's", 'angiopathy.', 'It', 'is', 'not.'], ['In', "Purstcher's", 'there', 'are', 'hemorrhages,', 'but', 'also', 'cottony', 'exudates', 'and', 'edema.'], ['If', 'there', 'are', 'only', 'hemorrhages,', "it's", 'not', "Purstcher's."], ["Here's", 'the', 'messy', 'bit,', 'but', "it's", 'really', 'well', 'worded.'], ['If', 'he', 'had', 'a', 'Purstcher', 'it', 'could', 'also', 'be', 'for', 'child', 'abuse,', 'but', 'he', "doesn't."]]

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

293_214

[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'erythroderma', 'with', 'fever', 'and', 'general', 'malaise.'], ['On', 'examination,', 'the', 'nails', 'show', 'the', 'presence', 'of', 'nail', 'pitting', 'and', 'distal', 'yellowish', 'areas', 'in', 'an', 'oil', 'stain.'], ['What', 'is', 'the', 'primary', 'disease', 'that', 'caused', 'the', 'condition?'], ['1-', 'Cutaneous', 'lymphoma.'], ['2-', 'Atopic', 'dermatitis.'], ['3-', 'Psoriasis.'], ['4-', 'Ichthyosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Any', 'of', 'the', '4', 'options', 'can', 'be', 'the', 'cause', 'of', 'erythroderma,', 'although', 'the', 'description', 'of', 'nail', 'lesions', 'highly', 'suggestive', 'of', 'psoriasis', 'makes', 'this', 'diagnosis', 'the', 'most', 'likely.']]

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132_229

[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['A', '54-year-old', 'man,', 'with', 'a', 'personal', 'history', 'of', 'DM,', 'hypertension', 'and', 'mild', 'chronic', 'renal', 'insufficiency,', 'presented', 'with', 'somnolence', 'and', 'right', 'hemiparesis.'], ['Laboratory', 'tests:', 'creatinine', '2.3', 'mg/dl,', 'Hb', '10.3', 'g/dl', 'and', 'platelets', '20000', 'mm3,', 'with', 'normal', 'coagulation.'], ['Cranial', 'CT:', 'ischemic', 'lesions', 'with', 'microhemorrhagic', 'necrosis.'], ['Subsequently,', 'he', 'began', 'with', 'progressive', 'deterioration', 'of', 'the', 'level', 'of', 'consciousness', 'and', 'increase', 'of', 'Cr,', 'LDH', 'and', 'unconjugated', 'bilirubin.'], ['Direct', "Coombs'", 'test', 'was', 'negative.'], ['Schistocytes', 'in', 'smear.'], ['In', 'view', 'of', 'the', 'diagnostic', 'suspicion,', 'the', 'following', 'conduct', 'is', 'to', 'be', 'followed:'], ['1-', 'New', 'cranial', 'CT', 'in', 'the', 'presence', 'of', 'suspected', 'hemorrhagic', 'transformation', 'of', 'ischemic', 'stroke.'], ['2-', 'Initiate', 'urgent', 'plasmapheresis.'], ['3-', 'Beginning', 'of', 'treatment', 'with', 'glucocorticoids', 'at', 'a', 'dose', 'of', '1', 'mg/kg/day.'], ['4-', 'Search', 'for', 'triggering', 'cause', 'of', 'DIC.'], ['5-', 'Suspected', 'multiple', 'myeloma:', 'bone', 'marrow', 'aspirate.'], ['CORRECT', 'ANSWER:', '2'], ["Let's", 'see:', 'a', 'patient', 'with', 'certain', 'history', 'who', 'has:', '-', 'Schistocytes', 'in', 'smear:', 'indicates', 'microangiopathic', 'anemia,', 'red', 'cell', 'rupture', 'of', 'mechanical', 'cause,', 'which', 'can', 'be', 'seen', 'mainly', 'in', 'PTT,', 'autoimmune', 'hemolytic', 'anemia', 'and', 'DIC.'], ['-', 'Bicytopenia:', 'here', 'the', 'causes', 'can', 'be', 'very,', 'very', 'varied.'], ['-', 'Elevation', 'of', 'LDH', 'and', 'Bilirubin,', 'which', 'indicates', 'a', 'massive', 'rupture', 'of', 'red', 'blood', 'cells.'], ['-', 'Negative', 'direct', "Coombs'", 'test:', 'essential', 'data,', 'indicating', 'that', 'there', 'is', 'no', 'antibody', 'that', 'sticks', 'to', 'the', 'red', 'blood', 'cells.'], ['With', 'these', 'wickers', 'we', 'are', 'going', 'to', 'weave', 'the', 'basket:', 'Answer', '1:', 'it', 'cannot', 'be', 'because', 'a', 'hemorrhagic', 'transformation', 'does', 'not', 'give', 'such', 'a', 'brutal', 'elevation', 'of', 'LDH', 'and', 'Cr,', 'in', 'addition', 'to', 'not', 'explaining', 'schistocytosis.'], ['Answer', '2:', 'urgent', 'plasmapheresis...', 'in', 'case', 'of', 'thrombotic', 'thrombocytopenic', 'purpura,', 'yes;', 'I', 'like', 'this', 'answer', 'because', 'it', 'justifies', 'bicytopenia,', 'since', 'microangiopathic', 'hemolytic', 'anemia', 'is', 'produced', 'by', 'rupture', 'of', 'red', 'blood', 'cells', 'when', 'they', 'are', 'fragmented', 'by', 'ultralong', 'von', 'Willebrand', 'factor', 'multimers', 'in', 'case', 'of', 'deficiency', 'of', 'the', 'ADAMST13', 'enzyme,', 'resulting', 'in', 'brutal', 'platelet', 'aggregates', 'and', 'the', 'flow', 'cytometer', 'does', 'not', 'count', '400', 'platelets,', 'but', 'a', 'molondron', 'of', 'platelets', 'that', 'form', 'a', 'mass,', 'hence', 'the', 'thrombocytopenia.'], ['It', 'also', 'explains', 'the', 'negative', 'direct', 'Coombs,', 'elevated', 'LDH', 'and', 'Cr.'], ['Answer', '3:', 'a', 'situation', 'as', 'critical', 'as', 'that', "patient's", 'indicates', 'that', 'something', 'big', 'is', 'going', 'on', 'and', 'I', 'would', 'not', 'sit', 'and', 'wait', 'for', 'glucocorticoids', 'to', 'take', 'effect...and', 'I', 'do', 'not', 'know', 'right', 'now', 'what', 'pathology', 'gives', 'that', 'symptomatology', 'and', 'has', 'that', 'treatment', 'as', 'standard.'], ['Answer', '4:', 'looking', 'for', 'a', 'trigger', 'for', 'DIC...it', 'would', 'make', 'sense', 'if', 'it', 'were', 'not', 'for', 'the', 'fact', 'that', 'in', 'DIC', 'it', 'is', 'VERY', 'characteristic', 'the', 'consumption', 'of', 'coagulation', 'factors,', 'which', 'is', 'not', 'present', 'in', 'this', 'case.'], ['Answer', '5:', 'a', 'myeloma', 'does', 'not', 'give', 'schistocytosis', 'nor', 'does', 'it', 'have', 'this', 'symptomatology,', 'they', 'would', 'have', 'to', 'give', 'other', 'data', 'that', 'would', 'support', 'this', 'pathology,', 'such', 'as', 'bone', 'pain', 'and', 'hypercalcemia...']]

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49_159

120_192

[['QUESTION', 'TYPE:', 'PREVENTIVE', 'MEDICINE', 'AND', 'EPIDEMIOLOGY'], ['CLINICAL', 'CASE:'], ['A', '40-year-old', 'orthopedic', 'surgeon', 'who', 'in', 'a', 'routine', 'serology', 'was', 'found', 'to', 'have', 'anti-HBs', 'levels', 'of', '30', 'IU/l.'], ['He', 'refers', 'complete', 'vaccination', 'according', 'to', 'the', 'standard', 'hepatitis', 'B', 'vaccination', 'schedule', '4', 'years', 'ago.'], ['It', 'would', 'be', 'advisable:'], ['1-', 'Restart', 'vaccination', 'schedule', '(0-1-6', 'months).'], ['2-', 'Restart', 'vaccination', 'schedule', '(0-1-2-12', 'months).'], ['3-', 'Do', 'not', 'revaccinate.'], ['4-', 'Give', 'a', 'booster', 'dose.'], ['5-', 'Give', 'anti-hepatitis', 'B', 'immunoglobulin', 'and', 'restart', 'vaccination', 'schedule', '(0-1-2-12', 'months).'], ['CORRECT', 'ANSWER:', '3'], ['As', 'long', 'as', 'the', 'serological', 'levels', 'of', 'anti-HBs', 'are', 'above', '10', 'IU/l', 'it', 'is', 'not', 'necessary', 'to', 'revaccinate.']]

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304_174

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['87-year-old', 'man', 'with', 'a', 'history', 'of', 'hypertension', 'and', 'gonarthrosis.'], ['Baseline', 'situation', 'with', 'full', 'functional', 'and', 'cognitive', 'autonomy', 'that', 'allows', 'him', 'to', 'continue', 'living', 'alone', 'in', 'the', 'community.'], ['He', 'is', 'receiving', 'regular', 'treatment', 'with', 'perindopril', 'and', 'thiazide', 'diuretic', 'for', 'blood', 'pressure', 'control', 'and', 'routinely', 'takes', 'ibuprofen', '1800', 'mg/day', 'to', 'control', 'the', 'symptoms', 'derived', 'from', 'his', 'gonarthrosis.'], ['After', 'routine', 'control,', 'a', 'persistent', 'blood', 'pressure', 'of', '190', 'and', 'TAD', '80', 'mmHg', 'was', 'observed.'], ['What', 'would', 'be', 'the', 'most', 'reasonable', 'therapeutic', 'modification', 'to', 'achieve', 'blood', 'pressure', 'control?'], ['1-', 'I', 'would', 'add', 'a', 'calcium', 'channel', 'blocker.'], ['2-', 'I', 'would', 'increase', 'the', 'dose', 'of', 'hydrochlorothiazide', 'to', '25', 'mg/day.'], ['3-', 'I', 'would', 'change', 'ibuprofen', 'for', 'paracetamol', 'to', 'avoid', 'the', 'possible', 'influence', 'of', 'paracetamol', 'on', 'the', 'effect', 'of', 'hypotensives.'], ['4-', 'I', 'would', 'add', 'an', 'alpha', 'blocker', 'because', 'of', 'the', 'high', 'prevalence', 'of', 'prostatic', 'syndrome', 'in', 'males', 'of', 'this', 'age.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Before', 'intensifying', 'antihypertensive', 'treatment,', 'the', 'potential', 'causes', 'should', 'be', 'resolved.'], ['In', 'this', 'case', 'we', 'are', 'dealing', 'with', 'an', 'elderly', 'patient', 'with', 'chronic', 'treatment', 'with', 'NSAIDs', 'that', 'produces', 'arterial', 'hypertension', 'secondary', 'to', 'renal', 'hypoperfusion.'], ['The', 'most', 'reasonable', 'option', 'would', 'be', 'to', 'withdraw', 'ibuprofen', 'and', 'replace', 'it', 'with', 'an', 'analgesic', 'from', 'a', 'group', 'other', 'than', 'NSAIDs', '(paracetamol,', 'opiates),', 'subsequently', 'monitoring', 'the', 'evolution', 'of', 'blood', 'pressure.']]

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

214_228

[['QUESTION', 'TYPE:', 'RHEUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '19-year-old', 'man', 'consults', 'for', 'a', '24-hour', 'history', 'of', 'pain,', 'swelling', 'and', 'functional', 'impotence', 'of', 'the', 'right', 'knee', 'accompanied', 'by', 'a', 'fever', 'of', '38°C.'], ['Physical', 'examination', 'reveals', 'inflammatory', 'signs', 'and', 'joint', 'effusion', 'in', 'the', 'right', 'knee.'], ['Laboratory', 'tests', 'showed', 'leukocytosis', 'with', 'neutrophilia', 'and', 'elevated', 'C-reactive', 'protein.'], ['The', 'syndromic', 'diagnosis', 'of', 'acute', 'monoarthritis', 'is', 'made.'], ['What', 'is', 'the', 'most', 'likely', 'etiologic', 'diagnosis?'], ['1-', 'Arthritis', 'due', 'to', 'microcrystals.'], ['2-', 'Reactive', 'arthritis.'], ['3-', 'Bacterial', 'infectious', 'arthritis.'], ['4-', 'Mycobacterial', 'infectious', 'arthritis.'], ['5-', 'Rheumatoid', 'arthritis.'], ['CORRECT', 'ANSWER:', '3'], ['Acute', 'monoarthritis', 'associated', 'with', 'fever,', 'leukocytosis', 'with', 'neutrophilia', 'and', 'increased', 'acute', 'phase', 'reactants', 'does', 'not', 'always', 'have', 'a', 'septic', 'origin.'], ['In', 'the', 'absence', 'of', 'further', 'information', '(more', 'complete', 'anamnesis', 'on', 'the', 'current', 'disease,', 'risk', 'factors,', 'personal', 'and', 'family', 'history,', 'extra-articular', 'symptoms', 'or', 'signs,', 'etc.)', 'it', 'can', 'be', 'said', 'that', 'also', '1', 'and', '2', '(and', 'very', 'exceptionally', '5)', 'could', 'debut', 'with', 'a', 'similar', 'clinical', 'and', 'biological', 'picture.'], ['With', 'the', 'data', 'provided', 'and', 'taking', 'into', 'account', 'that', 'this', 'is', 'a', 'young', 'male,', 'the', 'most', 'likely', 'option', 'would', 'be', 'bacterial', 'infectious', 'arthritis', '(that', 'caused', 'by', 'mycobacteria', 'usually', 'have', 'a', 'chronic', 'course).'], ['And', 'above', 'all,', 'because', 'of', 'its', 'implications,', 'the', 'first', 'one', 'to', 'always', 'rule', 'out.']]

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249_120

[['QUESTION', 'TYPE:', 'INFECTIOUS', 'DISEASES'], ['CLINICAL', 'CASE:'], ['A', '53-year-old', 'woman', 'consults', 'for', 'a', 'fever', 'of', '15', 'days', 'of', 'evolution,', 'without', 'symptoms', 'of', 'infectious', 'focality.'], ['On', 'examination,', 'a', 'painful', 'hepatomegaly', 'is', 'detected', 'at', '5', 'cm', 'from', 'the', 'costal', 'margin', 'and', 'the', 'spleen', 'is', 'palpated', 'at', '14', 'cm', 'from', 'the', 'left', 'costal', 'margin.'], ['The', 'blood', 'count', 'showed', 'Hb', '8.5', 'g/dL,', 'leukocytes', '630/ml', '(lymphocytes', '63%,', 'monocytes', '20%,', 'neutrophils', '17%)', 'and', 'platelets', '35,000/ml.'], ['Biochemistry', 'shows', 'moderate', 'elevation', 'of', 'liver', 'biochemistry,', 'LDH', 'is', 'normal', 'and', 'polyclonal', 'hypergammaglobulinemia', '(3.5', 'g/dL)', 'is', 'observed', 'in', 'the', 'proteinogram.'], ['He', 'has', 'a', 'history', 'of', 'known', 'HIV', 'infection', 'for', '10', 'years', 'and', 'irregular', 'adherence', 'to', 'antiretroviral', 'treatment,', 'with', 'recent', 'determinations', 'of', 'CD4', 'lymphocytes', '350', 'cells/mL', 'and', 'HIV', 'viral', 'load', 'of', '154', 'copies/mL.'], ['For', 'the', 'past', '3', 'months', 'she', 'has', 'been', 'treated', 'for', 'seronegative', 'symmetrical', 'polyarthritis', 'with', '10-20', 'mg/day', 'of', 'prednisone.'], ['Which', 'of', 'the', 'following', 'statements', 'is', 'correct?'], ['1-', 'I', 'would', 'perform', 'a', 'bone', 'marrow', 'biopsy,', 'since', 'the', 'most', 'probable', 'diagnosis', 'is', 'visceral', 'leishmaniasis.'], ['2-', 'Pancytopenia', 'is', 'justified', 'by', 'C', 'virus-associated', 'cirrhosis', 'and', 'I', 'would', 'not', 'perform', 'further', 'testing.'], ['3-', 'Probably', 'a', 'medullary', 'toxicity', 'due', 'to', 'prednisone', 'that', 'would', 'be', 'treated', 'with', 'drug', 'withdrawal', 'and', 'filgastrim.'], ['4-', 'I', 'would', 'request', 'an', 'ANAs', 'determination', 'to', 'rule', 'out', 'disseminated', 'systemic', 'lupus.'], ['5-', 'I', 'would', 'intensify', 'antiretroviral', 'therapy,', 'as', 'it', 'is', 'likely', 'that', 'all', 'manifestations', 'are', 'due', 'to', 'HIV.'], ['CORRECT', 'ANSWER:', '1'], ['Easy', 'and', 'quite', 'typical', 'question.'], ['We', 'are', 'told', 'about', 'an', 'HIV', 'patient', 'with', 'irregular', 'follow-up', 'of', 'antiretroviral', 'treatment,', 'presenting', 'fever,', 'hepatosplenomegaly,', 'pancytopenia', 'and', 'polyclonal', 'hypergammaglobulinemia.'], ['All', 'these', 'data', 'are', 'suggestive', 'of', 'visceral', 'Leishmaniasis,', 'so', 'an', 'OM', 'biopsy', 'should', 'be', 'performed', 'to', 'look', 'for', 'amastigotes', 'and', 'confirm', 'the', 'diagnosis.']]

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53_146

[['QUESTION', 'TYPE:', 'PSYCHIATRY'], ['CLINICAL', 'CASE:'], ['A', '31-year-old', 'man', 'with', 'no', 'psychiatric', 'history', 'comes', 'to', 'the', 'emergency', 'room', 'complaining...¨', 'symptoms', 'of', 'anxiety.'], ['Two', 'days', 'ago', 'he', 'experienced', 'another', 'episode', 'of', 'the', 'same', 'symptoms...', '....'], ['1', 'week', 'ago', 'he', 'broke', 'up', 'with', 'his', 'partner...', 'ruled', 'out', 'any', 'organic', 'pathology....:'], ['1-', 'Post-traumatic', 'stress', 'reaction.'], ['2-', 'Acute"', 'dependent', 'personality', 'disorder.'], ['3-', 'Depressive', 'disorder.'], ['4-', 'Agoraphobia.'], ['5-', 'Anguish', 'crisis.'], ['CORRECT', 'ANSWER:', '5'], ['Here', 'it', 'is', 'good', 'that', 'they', 'tell', 'you', 'their', 'antecedents', '(we', 'all', 'have', 'antecedents', 'because', 'we', 'all', 'have', 'a', 'life)', 'and', 'that', 'they', 'rule', 'out', 'organic', 'pathology.'], ['That', 'is', 'fundamental.'], ['Let', 'us', 'not', 'forget', 'that', 'also', 'the', 'hypochondriacs', 'have', 'body.'], ['We', 'first', 'eliminate', 'the', 'most', 'striking', '"acute"', 'personality', 'disorder.'], ['Personality', 'accompanies', 'us', 'all', 'our', 'lives.'], ['There', 'are', 'no', '"acute"', 'characteristics', 'in', 'our', 'personality.'], ['Depressive', 'disorder?', 'There', 'is', 'a', 'time', 'criterion', 'that', 'is', 'not', 'met,', 'it', 'may', 'be', 'sad,', 'but', 'sad', 'is', 'not', 'depression', '(1).'], ['agoraphobia?', 'if', 'it', 'was', 'something', 'like', 'that', 'we', 'would', 'have', 'been', 'told', 'the', 'context', 'post-traumatic', 'stress', 'reaction?'], ["That's", 'a', 'good', 'one.'], ['The', 'correct', 'term', 'would', 'be', 'post-traumatic', 'stress', 'disorder', 'or', 'acute', 'stress', 'reaction,', 'and', 'according', 'to', 'ICD', '10:', '"The', 'stressor', 'may', 'be', 'a', 'devastating', 'traumatic', 'experience', 'involving', 'a', 'serious', 'threat', 'to', 'the', 'safety', 'or', 'physical', 'integrity', 'of', 'the', 'patient', 'or', 'loved', 'one(s)', '(e.g.,', 'natural', 'catastrophes,', 'accidents,', 'battles,', 'muggings,', 'rapes)', 'or', 'an', 'abrupt', 'and', 'threatening', 'change', 'in', 'the', "individual's", 'rank', 'or', 'social', 'environment', '(e.g.,', 'loss', 'of', 'several', 'loved', 'ones,', 'house', 'fire,', 'etc.).', ')"', 'or', 'more', 'briefly:', '"exceptionally', 'threatening', 'or', 'catastrophic', 'nature"', 'Breaking', 'up', 'with', 'a', 'partner', 'I', 'understand', 'is', 'hard,', 'but', 'not', 'exceptional.'], ['So', 'by', 'elimination', '5.', 'Crisis', 'of', 'distress.'], ['This', 'is', 'a', 'useful', 'question,', 'common', 'in', 'daily', 'practice,', 'and', 'so', 'we', 'see', 'that', 'we', 'must', 'avoid', 'giving', 'a', 'diagnosis', 'of', 'long', 'evolution', 'for', 'a', 'natural', 'reaction.'], ['Diagnoses', '1', 'to', '4', 'would', 'be', 'like', 'calling', 'diabetic', 'the', 'one', 'who', 'has', 'hyperglycemia', 'after', 'eating', 'three', 'muffins.'], ['Useful', 'and', 'realistic', 'question.']]

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

48_158

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', '10-year-old', 'boy', 'is', 'brought', 'to', 'the', 'Emergency', 'Department', 'because', 'for', 'the', 'last', '2', 'hours', 'he', 'has', 'been', 'involuntarily', 'turning', 'his', 'neck', 'to', 'the', 'right', 'associated', 'with', 'marked', 'cervical', 'pain', 'at', 'each', 'turn.'], ['The', 'grandmother', 'subsequently', 'tells', 'us', 'that', 'he', 'has', 'been', 'vomiting', 'since', 'yesterday,', 'so', 'she', 'gave', 'him', 'a', 'syrup;', 'what', 'would', 'be', 'the', 'most', 'appropriate', 'therapeutic', 'approach?'], ['1-', 'Inject', 'an', 'intravenous', 'anticholinergic.'], ['2-', 'Do', 'not', 'treat', 'until', 'an', 'electroencephalogram', 'is', 'performed', 'in', 'the', 'following', 'days.'], ['3-', 'Do', 'not', 'treat', 'until', 'the', 'result', 'of', 'the', 'cerebrospinal', 'fluid', 'culture', 'is', 'known', 'in', 'the', 'next', 'few', 'days.'], ['4-', 'Call', 'the', 'on-call', 'psychiatrist.'], ['5-', 'Start', 'an', 'intravenous', 'antibiotic', 'after', 'obtaining', 'a', 'pharyngeal', 'swab.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'correct', 'answer', 'is', '1.'], ['The', 'anticholinergic', 'can', 'be', 'administered', 'intravenously', 'and', 'also', 'intramuscularly', 'if', 'I', 'am', 'not', 'mistaken.'], ['The', 'occurrence', 'of', 'dystonia', 'as', 'a', 'side', 'effect', 'is', 'common', 'in', 'children', 'and', 'is', 'one', 'of', 'the', 'main', 'reasons', 'why', 'pediatricians', 'do', 'not', 'usually', 'prescribe', 'some', 'antiemetics', 'in', 'children.']]

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

490_106

[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '65-year-old', 'woman', 'referred', 'to', 'the', 'emergency', 'department', 'for', 'fever', 'and', 'alterations', 'in', 'the', 'laboratory', 'tests:', 'hemoglobin', '11.4', 'g/dL,', 'leukocytes', '0.86', 'x103/μL,(neutrophils', '41.9%,', 'lymphocytes', '55.8%),platelets', '48.0', 'x103/μL,', 'fibrinogen', '118', 'mg/dL,D-dimer', '20.2', 'μg/mL.'], ['Bone', 'marrow', 'examination', 'was', 'performed', 'and', 'she', 'was', 'diagnosed', 'with', 'acute', 'leukemia', 'with', 't(15;17)', 'in', '60%', 'of', 'the', 'cells.'], ['Which', 'of', 'the', 'following', 'answers', 'is', 'correct?'], ['1-', 'If', 'asymptomatic,', 'transretinoic', 'acid', '(ATRA)', 'will', 'be', 'started', 'and', 'day', 'hospital', 'controls', 'will', 'be', 'recommended.'], ['2-', 'Start', 'treatment', 'with', 'arsenic', 'trioxide,', 'ATRA', 'and', 'supportive', 'therapy.'], ['3-', 'It', 'is', 'a', 'myeloblastic', 'leukemia', 'type', 'M3,', 'so', 'chemotherapy', 'and', 'heparin', 'will', 'be', 'started', 'to', 'control', 'disseminated', 'intravascular', 'coagulation.'], ['4-', 'Antibiotic', 'treatment', 'should', 'be', 'started.', 'When', 'the', 'fever', 'disappears,', 'leukemia', 'treatment', 'should', 'be', 'started.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['It', 'is', 'a', 'definitive', 'promyelocytic', 'leukemia', 'with', 't(15;17),', 'and', 'as', 'it', 'is', 'well', 'known', 'by', 'all', 'of', 'you', 'the', 'treatment', 'is', 'with', 'arsenic', 'trioxide', '+', 'ATRA.'], ['Option', '1', 'leaves', 'the', 'treatment', 'incomplete,', 'there', 'is', 'only', 'ATRA', 'and', 'it', 'must', 'be', 'treated', 'as', 'long', 'as', 'the', "patient's", 'condition', 'allows', 'it,', 'whether', 'or', 'not', 'there', 'are', 'symptoms.'], ['Option', '3', '3', 'years', 'ago', 'would', 'have', 'been', 'the', 'correct', 'option', 'but', 'nowadays', 'neither', 'chemotherapy', 'nor', 'heparin', 'is', 'used.'], ['And', 'option', '4', 'is', 'false', 'because', 'that', 'fever', 'is', 'due', 'to', 'the', 'leukemia', 'itself', 'and', 'the', 'priority', 'is', 'to', 'start', 'specific', 'treatment', 'for', 'leukemia.']]

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416_76

[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '78-year-old', 'woman', 'with', 'dementia', 'and', 'institutionalized', 'is', 'brought', 'in', 'by', 'her', 'caregivers', 'for', 'significant', 'abdominal', 'pain', 'with', 'deterioration', 'of', 'general', 'condition', 'and', 'abdominal', 'distension.'], ['CBC', 'shows', 'leukocytosis,', 'elevated', 'hematocrit,', 'renal', 'failure', 'and', 'metabolic', 'acidosis.'], ['ECG', 'shows', 'atrial', 'fibrillation.'], ['Abdominal', 'tomography', 'shows', 'edematous', 'small', 'bowel', 'loops,', 'with', 'intestinal', 'and', 'portal', 'accumulation.'], ['The', 'most', 'probable', 'diagnosis', 'is:'], ['1-', 'Perforation', 'of', 'gastric', 'or', 'duodenal', 'ulcus.'], ['2-', 'Biliary', 'leak.'], ['3-', 'Obstructive', 'neoplasm', 'of', 'the', 'sigma', 'with', 'perforation.'], ['4-', 'Mesenteric', 'ischemia.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['This', 'is', 'a', 'classic', 'picture', 'and', 'the', 'author', 'of', 'the', 'question', 'has', 'taken', 'care', 'to', 'give', 'us', 'enough', 'clues', 'so', 'that', 'we', 'do', 'not', 'miss', 'it.'], ['When', 'reading', 'this', 'statement,', 'multiple', 'alarms', 'go', 'off:', '-', 'Atrial', 'Fibrillation:', 'at', 'the', 'mir', 'and', 'at', 'the', 'ED', 'door,', 'any', 'elderly', 'person', 'with', 'AF', 'and', 'abdominal', 'pain', 'is', 'emboligenic', 'mesenteric', 'ischemia', 'until', 'proven', 'otherwise.'], ['-', 'Acute', 'abdominal', 'pain,', 'SIRS,', 'renal', 'failure,', 'metabolic', 'acidosis', '(ischemia!),', 'probably', 'an', 'elevated', 'lactic...'], ['-', 'CT:', 'The', 'finding', 'of', 'portal', 'gas', 'is', 'also', 'highly', 'indicative', 'of', 'mesenteric', 'ischemia,', 'we', 'could', 'also', 'have', 'been', 'told', 'of', 'intestinal', 'pneumatosis.'], ['Why', 'are', 'not', 'the', 'other', 'pictures?'], ['-', 'Perforated', 'ulcus:', 'We', 'would', 'have', 'been', 'told', 'of', 'a', 'history', 'of', 'NSAID', 'use,', 'or', 'a', 'history', 'of', 'pain', 'that', 'improves', 'with', 'ingestion,', 'of', 'pneumoperitoneum', 'on', 'chest', 'X-ray.'], ['-', 'Biliary', 'ileus:', 'There', 'would', 'be', 'a', 'history', 'of', 'biliary', 'colic', 'or', 'pain', 'in', 'the', 'right', 'hypochondrium,', 'they', 'would', 'also', 'speak', 'of', 'aerobilia', 'in', 'the', 'imaging', 'test', 'and', 'dilatation', 'of', 'the', 'small', 'loops', 'with', 'image', '(or', 'not)', 'of', 'biliary', 'lithiasis', 'in', 'the', 'terminal', 'ileum.'], ['-', 'Neo', 'sigmoidoscopy:', 'In', 'the', 'myocardial', 'imaging', 'they', 'would', 'speak', 'of', 'weight', 'loss,', 'change', 'of', 'stool', 'habit,', 'pneumoperitoneum', 'in', 'Rx', 'or', 'CT', 'and', 'peritonitic', 'abdominal', 'exploration', 'and', 'may', 'even', 'be', 'able', 'to', 'palpate', 'the', 'mass.']]

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45_154

336_31

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '20-year-old', 'woman', 'with', 'a', '15-cm', 'solid-cystic', 'ovarian', 'tumor', 'detected', 'by', 'ultrasound', 'after', 'presenting', 'with', 'nonspecific', 'abdominal', 'symptoms.'], ['In', 'the', 'histopathological', 'study', 'of', 'the', 'corresponding', 'specimen,', 'teeth,', 'hairs,', 'areas', 'of', 'intestinal', 'epithelium,', 'areas', 'of', 'squamous', 'epithelium', '(15%)', 'and', 'bronchial', 'epithelium,', 'as', 'well', 'as', 'neuroectodermal', 'and', 'embryonal', 'elements', 'are', 'found', 'in', 'several', 'of', 'the', 'histological', 'preparations.'], ['In', 'reference', 'to', 'this', 'case,', 'point', 'out', 'the', 'correct', 'diagnosis:'], ['1-', 'Teratocarcinoma.'], ['2-', 'Immature', 'teratoma.'], ['3-', 'Mature', 'cystic', 'teratoma.'], ['4-', 'Dysgerminoma.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Mature', 'cystic', 'teratoma', 'is', 'a', 'common', 'benign', 'tumor', 'of', 'the', 'ovary', 'in', 'adult', 'women.'], ['The', 'tissues', 'that', 'make', 'up', 'the', 'tumor', 'are', 'well', 'differentiated', '(mature', 'or', 'adult-type);', 'apart', 'from', 'cutaneous', 'structures', 'many', 'other', 'tissues', 'can', 'be', 'seen,', 'particularly', 'in', 'a', 'thickening', 'or', 'spur', 'that', 'eminences', 'into', 'the', 'cavity,', 'in', 'which', 'there', 'are', 'often', 'teeth,', 'cartilage', 'and', 'bone.']]

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609_115

[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'male,', 'a', 'regular', 'athlete,', 'refers', 'pain', 'in', 'the', 'right', 'leg', 'after', 'continuous', 'running.'], ['He', 'has', 'visited', 'a', 'physiotherapist', 'on', 'several', 'occasions', 'and', 'has', 'been', 'diagnosed', 'with', 'calf', 'overload.'], ['Several', 'months', 'have', 'passed,', 'she', 'has', 'not', 'improved', 'and', 'refers', 'intense', 'pain', 'after', 'physical', 'activity', 'that', 'subsides', 'with', 'rest', 'in', 'the', 'hours', 'following', 'exercise.'], ['What', 'test', 'can', 'help', 'in', 'the', 'diagnosis?'], ['1-', 'Positron', 'emission', 'tomography', 'with', '18', 'FDG.'], ['2-', 'Determination', 'of', 'posterior', 'compartment', 'pressure', 'immediately', 'after', 'activity.'], ['3-', 'Doppler', 'ultrasound', 'to', 'rule', 'out', 'a', 'circulatory', 'disorder', 'of', 'the', 'lower', 'extremity.'], ['4-', 'Magnetic', 'resonance', 'spectroscopy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Exercise-induced', 'compartment', 'syndrome', 'is', 'an', 'exercise-induced', 'condition', 'of', 'the', 'leg.'], ['It', 'is', 'characterized', 'by', 'reversible', 'ischemia', 'of', 'the', 'muscles', 'of', 'a', 'muscle', 'compartment.'], ['Diagnosis', 'is', 'made', 'by', 'measuring', 'compartment', 'pressures', 'at', 'rest,', 'during', 'exercise', 'and', 'after', 'exercise', '(answer', '2', 'correct).'], ['Treatment', 'usually', 'consists', 'of', 'fasciotomies', 'of', 'the', 'affected', 'compartments.'], ['Although', 'MRI', 'is', 'not', 'very', 'useful', 'in', 'establishing', 'the', 'diagnosis,', 'it', 'can', 'help', 'in', 'the', 'differential', 'diagnosis.']]

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389_235

201_76

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'who', 'presents', 'with', 'problems', 'in', 'understanding', 'spoken', 'and', 'written', 'language,', 'inability', 'to', 'name', 'objects', 'and', 'repeat', 'words', 'that', 'are', 'said', 'to', 'him,', 'incomprehensible', 'fluent', 'speech', 'with', 'semantic', 'and', 'phonemic', 'paraphasias.'], ['This', 'is', 'a:'], ['1-', 'Global', 'aphasia.'], ['2-', "Wernicke's", 'aphasia.'], ['3-', "Broca's", 'aphasia.'], ['4-', 'Sensitive', 'transcortical', 'aphasia.'], ['5-', 'Transcortical', 'motor', 'aphasia.'], ['CORRECT', 'ANSWER:', '2'], ['Transcortical', 'have', 'preserved', 'repetition.'], ["Broca's", 'aphasia', 'has', 'preserved', 'comprehension', 'and', 'absence', 'of', 'fluent', 'speech.'], ["Wernicke's", 'aphasia', 'is', 'characterized', 'by', 'fluent', 'speech', '(even', 'in', 'excess)', 'with', 'paraphasias', 'and', 'problems', 'with', 'comprehension,', 'nomination', 'and', 'repetition.']]

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345_159

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '69-year-old', 'woman', 'comes', 'to', 'your', 'office', 'reporting', 'genital', 'bleeding', 'of', 'several', "months'", 'evolution.'], ['She', 'denies', 'hormone', 'replacement', 'therapy', 'and', 'anticoagulation.'], ['She', 'provides', 'normal', 'cervicovaginal', 'cytology.'], ['General', 'and', 'genital', 'physical', 'examination', 'without', 'findings', 'of', 'interest.'], ['BMI', 'of', '38kg/m2.'], ['Indicate', 'the', 'most', 'correct', 'attitude:'], ['1-', 'Prescribe', 'cyclic', 'progesterone.'], ['2-', 'Endometrial', 'biopsy.'], ['3-', 'Random', 'cervical', 'biopsies.'], ['4-', 'Hormonal', 'evaluation', 'with', 'FSH,', 'LH', 'and', 'estradiol.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['We', 'are', 'being', 'presented', 'with', 'a', 'case', 'of', 'postmenopausal', 'metrorrhagia.'], ['In', 'a', 'case', 'like', 'this', 'we', 'must', 'rule', 'out', 'endometrial', 'neoplasia,', 'so', 'an', 'endometrial', 'biopsy', 'would', 'be', 'indicated,', 'either', 'by', 'Cornier', 'cannula', 'if', 'possible,', 'or', 'by', 'hysteroscopy.'], ['A', 'cervical', 'biopsy', 'is', 'not', 'of', 'interest', 'in', 'this', 'case', 'since', 'the', 'cytology', 'is', 'normal', 'and', 'hormonal', 'assessment', 'is', 'not', 'going', 'to', 'be', 'useful', 'in', 'the', 'diagnosis', 'of', 'endometrial', 'neoplasia.'], ['Finally,', 'prescribing', 'cyclic', 'progesterone', 'is', 'not', 'indicated', 'in', 'a', 'postmenopausal', 'woman.']]

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166_82

[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'CARDIOVASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman', 'presents', 'arterial', 'hypertension', '(190/120', 'mmHg)', 'accompanied', 'by', 'K', '2.5', 'mEq/l.'], ['An', 'abdominal', 'ultrasound', 'shows', 'stenosis', 'of', 'both', 'renal', 'arteries.'], ['Indicate', 'which', 'treatment', 'is', 'contraindicated:'], ['1-', 'Enalapril.'], ['2-', 'Propanolol.'], ['3-', 'Amiloride.'], ['4-', 'Prazosin.'], ['5-', 'Amlodipine.'], ['CORRECT', 'ANSWER:', '1'], ['If', 'the', 'renal', 'arteries', 'are', 'stenosed,', 'blood', 'has', 'difficulty', 'reaching', 'the', 'kidneys.'], ['That', 'is,', 'both', 'are', 'poorly', 'perfused', 'and', 'can', 'only', 'create', 'the', 'pressure', 'gradient', 'necessary', 'for', 'filtration', 'by', 'contraction', 'of', 'the', 'efferent', 'arteriole.'], ['If', 'we', 'administer', 'an', 'ACEI,', 'we', 'will', 'provoke', 'the', 'relaxation', 'of', 'this', 'arteriole', 'and', 'the', 'fall', 'of', 'the', 'glomerular', 'filtration', 'rate.'], ['And', 'if', 'neither', 'kidney', 'filters,', 'because', 'both', 'have', 'arterial', 'stenosis,', 'we', 'have', 'a', 'problem....']]

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481_171

612_116

[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['95-year-old', 'woman', 'living', 'in', 'a', 'nursing', 'home,', 'independent', 'for', 'her', 'basic', 'activities', 'of', 'daily', 'living,', 'goes', 'out', 'to', 'the', 'garden', 'for', 'walks.'], ['She', 'has', 'a', 'history', 'of', 'hypertension,', 'dyslipidemia,', 'osteoporosis', 'and', 'mild', 'cognitive', 'impairment.'], ['She', 'suffers', 'a', 'fall', 'when', 'getting', 'up', 'at', 'night', 'to', 'go', 'to', 'the', 'bathroom.'], ['X-ray', 'shows', 'a', 'displaced', 'subcapital', 'fracture', 'of', 'the', 'right', 'hip.'], ['What', 'is', 'the', 'recommended', 'treatment?'], ['1-', 'Hip', 'hemiarthroplasty.'], ['2-', 'Trochanteric', 'nail', 'fixation.'], ['3-', 'Fixation', 'with', 'cannulated', 'screws.'], ['4-', 'Conservative:', 'bed-chair', 'life.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Correct', 'Answer', '1:', 'Given', 'that', 'this', 'is', 'a', 'displaced', 'subcapital', 'hip', 'fracture,', 'the', 'surgical', 'treatment', 'we', 'should', 'consider', 'is', 'hip', 'joint', 'replacement,', 'given', 'that', 'the', 'injury', 'described', 'presents', 'a', 'high', 'probability', 'of', 'necrosis', 'of', 'the', 'femoral', 'head.'], ['The', 'options', 'would', 'be', 'total', 'or', 'partial', 'arthroplasty:', 'in', 'elderly', 'patients,', 'partial', 'arthroplasty', 'is', 'preferred', 'because', 'it', 'is', 'a', 'shorter', 'and', 'less', 'aggressive', 'surgery', 'than', 'total', 'hip', 'arthroplasty.'], ['Answer', '2', 'incorrect:', 'We', 'would', 'consider', 'this', 'technique', 'in', 'basicervical', 'fractures', 'and', 'trochanteric', 'mass', 'lesions,', 'not', 'in', 'subcapital', 'fractures.'], ['Incorrect', 'Answer', '3:', 'We', 'would', 'consider', 'this', 'technique', 'in', 'nondisplaced', 'subcapital', 'fractures', 'in', 'young', 'patients.'], ['Incorrect', 'answer', '4:', 'We', 'would', 'only', 'consider', 'non-surgical', 'treatment', 'in', 'a', 'patient', 'with', 'a', 'very', 'poor', 'baseline', 'general', 'condition:', 'bedridden', 'patients', 'with', 'low', 'life', 'expectancy.']]

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585_74

[['QUESTION', 'TYPE:', 'OBSTETRICS', 'AND', 'GYNECOLOGY'], ['CLINICAL', 'CASE:'], ['34-week', 'primigravida', 'with', 'blood', 'pressure', 'of', '165/95', 'and', 'headache', 'of', 'two', 'days', 'of', 'evolution.'], ['Laboratory', 'tests:', 'hemoglobin', '10.5', 'g/dL,', 'platelets', '98,000/mm3,', 'AST', '356', 'IU/L', '(0-31),', 'ALT', '234', 'IU/L', '(0-31),', 'LDH', '878', 'IU/L', '(125-243).'], ['The', 'laboratory', 'is', 'called', 'because', 'of', 'the', 'presence', 'of', 'schistocytes', 'in', 'the', 'peripheral', 'blood', 'smear.'], ['She', 'received', 'the', 'second', 'dose', 'of', 'corticosteroids', 'for', 'fetal', 'maturation', '24', 'hours', 'ago.'], ['On', 'obstetric', 'ultrasound', 'the', 'estimated', 'fetal', 'weight', 'is', 'in', 'the', '1st', 'percentile', 'for', 'gestational', 'age', 'and', 'the', 'umbilical', 'artery', 'Doppler', 'shows', 'absence', 'of', 'end-diastolic', 'flow.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'indicated', 'clinical', 'approach?'], ['1-', 'Expectant', 'management', 'with', 'antihypertensive', 'drugs', 'and', 'magnesium', 'sulfate', 'until', 'the', 'maternal', 'platelets', 'improve.'], ['2-', 'Expectant', 'attitude', 'with', 'antihypertensive', 'treatment', 'at', 'home', 'and', 'controls', 'every', '48', 'hours.'], ['3-', 'Termination', 'of', 'gestation', 'when', 'she', 'completes', 'fetal', 'lung', 'maturation.'], ['4-', 'Immediate', 'termination', 'of', 'pregnancy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['They', 'are', 'describing', 'HELLP', 'syndrome.'], ['With', 'these', 'weeks', 'of', 'gestation', 'and', 'with', 'the', 'fetus', 'recently', 'matured', '(she', 'has', 'already', 'been', 'given', 'two', 'doses', 'of', 'corticosteroids),', 'the', 'attitude', 'is', 'immediate', 'termination.']]

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3_37

[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['A', '76-year-old', 'woman', 'with', 'no', 'history', 'other', 'than', 'hypertension', 'consults', 'for', 'painless', 'jaundice', 'and', 'pruritus', 'with', 'anorexia.'], ['Laboratory', 'tests', 'show', 'bilirubin', 'of', '12', 'mg/dl', '(9.5', 'direct).'], ['Ultrasound', 'shows', 'intrahepatic', 'and', 'extrahepatic', 'biliary', 'dilatation', 'together', 'with', 'a', 'single', 'hepatic', 'nodule', 'smaller', 'than', '2', 'cm', 'located', 'peripherally', 'on', 'the', 'anterior', 'aspect', 'of', 'the', 'left', 'lobe.'], ['The', 'CT', 'scan', 'confirms', 'these', 'findings', 'also', 'demonstrating', 'the', 'presence', 'of', 'a', 'pancreatic', 'mass', 'of', '3.5', 'cm.', 'In', 'the', 'pancreatic', 'head.'], ['The', 'aspiration', 'puncture', 'of', 'the', 'hepatic', 'nodule', 'is', 'conclusive', 'for', 'adenocarcinoma.'], ['Indicate', 'the', 'best', 'therapeutic', 'option:'], ['1-', 'Neoadjuvant', 'chemo/radiotherapy,', 'conditioning', 'the', 'option', 'of', 'radical', 'surgery', 'on', 'initial', 'response.'], ['2-', 'Percutaneous', 'external', 'biliary', 'drainage', 'with', 'palliative', 'character', 'with', 'eventual', 'reconversion', 'to', 'internal', 'drainage', 'in', 'case', 'of', 'intolerance', 'or', 'complications.'], ['3-', 'Palliative', 'surgical', 'biliary', 'bypass', 'with', 'or', 'without', 'prophylactic', 'gastrojejunostomy', 'depending', 'on', 'intraoperative', 'findings.'], ['4-', 'Metallic', 'biliary', 'prosthesis', 'by', 'endoscopic', 'retrograde', 'cholangiopancreatography', 'with', 'the', 'option', 'of', 'palliative', 'chemotherapy.'], ['5-', 'Cephalic', 'duodenopancreatectomy,', 'with', 'percutaneous', 'ablation', 'by', 'radiofrequency', 'or', 'alcoholization', 'of', 'the', 'hepatic', 'lesion.'], ['CORRECT', 'ANSWER:', '4'], ['This', 'case', 'does', 'not', 'seem', 'so', 'easy', 'to', 'me.'], ['It', 'is', 'a', 'pancreatic', 'adenocarcinoma', 'with', 'metastasis,', 'so', 'the', 'treatment', 'should', 'be', 'palliative,', 'so', 'we', 'remove', 'options', '1', 'and', '5.'], ['In', 'principle', 'she', 'is', 'a', 'patient', 'in', 'moderately', 'good', 'general', 'condition,', 'so', 'the', 'ideal', 'would', 'be', 'to', 'perform', 'a', 'permanent', 'biliary', 'diversion', 'and', 'chemotherapy,', 'option', '4', 'being', 'the', 'one', 'I', 'consider', 'most', 'correct.']]

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439_96

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'woman.'], ['Menopause', 'at', '54', 'years', 'of', 'age.'], ['Two', 'pregnancies', 'and', 'eutocic', 'deliveries.'], ['She', 'does', 'not', 'take', 'any', 'medication.'], ['She', 'comes', 'to', 'the', 'emergency', 'department', 'reporting', 'two', 'days', 'of', 'vaginal', 'bleeding', 'with', 'discomfort', 'in', 'the', 'hypogastrium.'], ['The', 'clinical', 'examination', 'performed', 'by', 'the', 'gynecologist', 'does', 'not', 'show', 'any', 'lesions', 'in', 'the', 'external', 'genitalia,', 'vagina', 'or', 'cervix.'], ['Vaginal', 'examination', 'is', 'inconclusive.'], ['Which', 'of', 'the', 'following', 'seems', 'to', 'you', 'to', 'be', 'the', 'most', 'appropriate', 'first', 'diagnostic', 'approach?'], ['1-', 'Transvaginal', 'ultrasound', 'and', 'measurement', 'of', 'endometrial', 'thickness.', 'Depending', 'on', 'this,', 'an', 'endometrial', 'biopsy', 'should', 'be', 'taken', 'or', 'not.'], ['2-', 'Endometrial', 'biopsy', 'by', 'aspiration', 'in', 'consultation.', 'With', 'it', 'I', 'can', 'get', 'the', 'diagnosis', 'very', 'reliably', 'and', 'it', 'is', 'inexpensive.'], ['3-', 'Hysteroscopy', 'with', 'sedation', 'and', 'directed', 'biopsy', 'if', 'a', 'lesion', 'is', 'seen.'], ['4-', 'I', 'would', 'perform', 'a', 'microbleed,', 'since', 'it', 'is', 'the', 'test', 'that', 'would', 'provide', 'me', 'with', 'the', 'definitive', 'diagnosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Since', 'the', 'most', 'frequent', 'cause', 'of', 'vaginal', 'bleeding', 'in', 'postmenopausal', 'women', 'is', 'urogenital', 'atrophy,', 'the', 'existence', 'of', 'an', 'endometrial', 'pathology', 'cannot', 'be', 'ruled', 'out.'], ['According', 'to', 'the', 'SEGO:', '"Abnormal', 'genital', 'bleeding', 'is', 'the', 'main', 'sign', 'of', 'suspicion', 'that', 'should', 'lead', 'us', 'to', 'rule', 'out', 'an', 'endometrial', 'neoplastic', 'pathology,', 'particularly', 'in', 'postmenopausal', 'patients,', 'or', 'those', 'with', 'associated', 'risk', 'factors', '(...)', 'Given', 'the', 'sign', 'of', 'suspicion,', 'the', 'performance', 'of', 'a', 'transvaginal', 'ultrasound,', 'or', 'in', 'its', 'absence', 'transrectal,', 'allows', 'us', 'to:', 'rule', 'out', 'organic', 'pathology', '(fibroids,', 'polyps);', 'measurement', 'of', 'endometrial', 'thickness', 'in', 'a', 'longitudinal', 'cut.'], ['It', 'is', 'recommended', 'to', 'use', 'a', 'cut-off', 'point', 'of', '3mm', 'for', 'endometrial', 'biopsy', 'in', 'the', 'symptomatic', 'patient".']]

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192_160

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['The', 'parents', 'of', 'a', '5-month-old', 'infant', 'come', 'because', 'their', 'child,', 'who', 'attends', 'day', 'care,', 'has', 'been', 'presenting', 'for', '3', 'days,', 'coinciding', 'with', 'an', 'upper', 'respiratory', 'tract', 'infection,', 'liquid', 'stools', 'numbering', '4', 'per', 'day,', 'occasional', 'alimentary', 'vomiting,', 'and', 'axillary', 'temperature', 'of', '38.3°C.'], ['He', 'is', 'being', 'fed', 'with', 'mixed', 'breastfeeding.'], ['On', 'examination', 'the', 'infant', 'is', 'in', 'good', 'general', 'condition,', 'is', 'well', 'nourished', 'and', 'hydrated', 'and', 'his', 'breathing', 'is', 'eupneic;', 'his', 'weight', 'is', '4,730g', 'and', 'has', 'decreased', 'by', '70g', 'with', 'respect', 'to', 'the', 'previous', 'week.'], ['The', 'abdomen', 'is', 'soft', 'and', 'depressible,', 'without', 'masses', 'or', 'megaliths,', 'and', 'the', 'fontanel', 'is', 'normotensive.'], ['Except', 'for', 'the', 'presence', 'of', 'watery', 'rhinorrhea,', 'the', 'rest', 'of', 'the', 'examination', 'by', 'organs', 'and', 'devices', 'is', 'normal.'], ['Of', 'the', 'following', 'statements,', 'indicate', 'the', 'answer', 'that', 'you', 'consider', 'CORRECT:'], ['1-', 'An', 'estimation', 'of', 'losses', 'should', 'be', 'made,', 'recommend', 'a', '4-hour', 'fast', 'and', 'rehydrate', 'during', 'this', 'time', 'with', 'oral', 'rehydration', 'solution.'], ['2-', 'It', 'is', 'advisable', 'to', 'introduce', 'rice', 'cereals', 'for', 'their', 'astringent', 'effect.'], ['3-', 'A', 'stool', 'culture', 'should', 'be', 'performed', 'as', 'soon', 'as', 'possible', 'to', 'exclude', 'a', 'bacterial', 'origin.'], ['4-', 'The', 'use', 'of', 'lactose-free', 'formula', 'should', 'be', 'recommended.'], ['5-', 'It', 'is', 'advisable', 'to', 'replace', 'losses', 'after', 'each', 'bowel', 'movement', 'with', 'oral', 'rehydration', 'solution', 'and', 'continue', 'with', 'the', "patient's", 'usual', 'diet.'], ['CORRECT', 'ANSWER:', '5'], ['The', 'baby', 'is', 'not', 'dehydrated', 'and', 'is', 'in', 'good', 'general', 'condition.'], ['Try', 'to', 'avoid', 'dehydration', 'by', 'replenishing', 'what', 'is', 'being', 'lost,', 'avoiding', 'drastic', 'changes', 'in', 'feeding', 'habits', 'as', 'much', 'as', 'possible.'], ['The', 'rest', 'of', 'the', 'answers', 'touch', 'on', 'many', 'of', 'the', '"myths"', 'and', 'customs', 'surrounding', 'gastroenteritis.'], ['There', 'is', 'also', 'no', 'evidence', 'of', 'lactose', 'intolerance', '(perianal', 'irritation,', 'frothy', 'and', 'acid', 'stools,', 'etc.)', 'that', 'would', 'advise', 'lactose-free', 'milk.']]

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261_100

289_65

[['QUESTION', 'TYPE:', 'GENERAL', 'SURGERY'], ['CLINICAL', 'CASE:'], ['Point', 'out', 'from', 'among', 'the', 'following', 'the', 'most', 'likely', 'complication', 'presented', 'by', 'a', 'patient', 'operated,', '20', 'years', 'ago,', 'of', 'gastric', 'ulcer', 'by', 'antrectomy', 'and', 'gastrojejunostomy', '(Billroth', 'II)', 'who', 'comes', 'to', 'your', 'office', 'referring', 'postpradial', 'abdominal', 'pain,', 'abdominal', 'distension,', 'diarrhea', 'and', 'analytical', 'data', 'of', 'malabsorption', 'of', 'fats', 'and', 'vitamin', 'B12:'], ['1-', 'Biliary', 'reflux', 'gastropathy.'], ['2-', 'Gastric', 'adenocarcinoma.'], ['3-', 'Rapid', 'gastric', 'emptying', 'syndrome', '(dumping).'], ['4-', 'Afferent', 'loop', 'syndrome', 'with', 'bacterial', 'overgrowth.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['The', 'statement', 'has', 'described', 'the', 'clinical', 'features', 'of', 'this', 'syndrome.'], ['It', 'is', 'usually', 'a', 'late', 'complication', '(the', 'patient', 'was', 'operated', '20', 'years', 'ago', 'for', 'a', 'Bilroth', 'II,', 'remember', 'that', 'it', 'is', 'a', 'partial', 'gastrectomy,', 'closure', 'of', 'the', 'gastric', 'stump', 'and', 'anastomosis', 'of', 'the', 'first', 'jejunal', 'loop', 'to', 'the', 'stump),', 'it', 'is', 'accompanied', 'by', 'postprandial', 'pain,', 'abdominal', 'distension.'], ['What', 'has', 'occurred', 'is', 'a', 'stenosis', 'of', 'the', 'afferent', 'loop,', 'so', 'that', 'biliary', 'and', 'pancreatic', 'secretions', 'do', 'not', 'mix', 'with', 'the', 'bolus,', 'they', 'accumulate,', 'produce', 'pain', 'that', 'is', 'relieved', 'by', 'vomiting,', 'fat', 'absorption', 'is', 'not', 'possible', '(lack', 'of', 'pancreatic', 'lipase),', 'so', 'there', 'is', 'diarrhea,', 'and', 'if', 'associated', 'with', 'bacterial', 'overgrowth,', 'there', 'is', 'malabsorption', 'of', 'vitamin', 'B12.'], ['If', 'it', 'were', 'gastric', 'adenocarcinoma,', 'they', 'would', 'have', 'spoken', 'of', 'constitutional', 'syndrome,', 'extradigestive', 'manifestations', '(sister', 'Maria', 'Jose', 'node,', 'Krukenberg', 'tumor,', 'Virchow', 'node).'], ['It', 'is', 'not', 'dumping', 'because', 'it', 'does', 'not', 'speak', 'of', 'vegetative', 'symptoms', '(palpitations,', 'facial', 'flushing,', 'etc...).'], ['Biliary', 'reflux', 'gastropathy', 'is', 'an', 'endoscopic', 'diagnosis,', 'moreover', 'it', 'is', 'not', 'associated', 'with', 'diarrhea', 'or', 'malabsorption.']]

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366_106

[['QUESTION', 'TYPE:', 'PNEUMOLOGY', 'AND', 'THORACIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '32-year-old', 'man', 'from', 'Cameroon', 'consults', 'for', 'fever', 'cough', 'and', 'left', 'hemithorax', 'pain', 'of', '1', 'month', 'of', 'evolution.'], ['He', 'took', 'amoxicillin-clavulanic', 'acid', 'for', '1', 'week', 'without', 'improvement', 'of', 'symptoms.'], ['A', 'blood', 'test', 'showed', 'a', 'white', 'blood', 'cell', 'count', 'of', '8000/microL', 'and', 'a', 'hemoglobin', 'of', '12.8', 'g/dL.'], ['Chest', 'X-ray', 'shows', 'a', 'loculated', 'left', 'pleural', 'effusion', 'occupying', 'one', 'third', 'of', 'the', 'hemithorax.'], ['A', 'thoracentesis', 'shows', 'a', 'yellowish', 'fluid', 'with', 'the', 'following', 'features:', 'red', 'blood', 'cells', '2000/µL,', 'leukocytes', '2500/µL', 'with', '90%', 'lymphocytes,', 'protein', '4.9', 'g/dL,', 'lactate', 'dehydrogenase', '550', 'VIL,', 'glucose', '67', 'mg/dL,', 'and', 'absence', 'of', 'malignant', 'cells', 'on', 'cytologic', 'study.'], ['Which', 'of', 'the', 'following', 'tests', 'would', 'be', 'most', 'useful', 'in', 'diagnosing', 'the', 'cause', 'of', 'the', 'pleural', 'effusion?'], ['1-', 'A', 'thoracic', 'computed', 'tomography', '(CT)', 'scan.'], ['2-', 'Pleural', 'fluid', 'pH', 'measurement.'], ['3-', 'Measurement', 'of', 'pleural', 'fluid', 'adenosine', 'deaminase.'], ['4-', 'Tuberculin', 'test.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Suspicion', 'is', 'very', 'high', 'for', 'tuberculous', 'pleural', 'effusion,', 'in', 'a', 'young', 'patient', 'from', 'an', 'area', 'with', 'a', 'high', 'rate', 'of', 'TB,', 'a', 'lymphocytic', 'exudate', 'pointing', 'to', 'TB,', 'lymphoma', 'or', 'tumor.'], ['Tumor', 'unlikely', 'due', 'to', 'age,', 'negative', 'cytology.'], ['Lymphoma', 'could', 'be', 'but', 'no', 'evidence', 'of', 'associated', 'nodal', 'pathology.'], ['High', 'adenosine', 'deaminase', 'in', 'LP', 'would', 'point', 'with', 'great', 'certainty', 'to', 'a', 'pleural', 'TB', 'although', 'it', 'would', 'be', 'advisable', 'to', 'confirm', 'the', 'diagnosis', 'with', 'a', 'pleural', 'biopsy', 'since', 'it', 'can', 'also', 'occur', 'in', 'lymphomas', 'and', 'empyemas', 'of', 'other', 'origin.']]

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544_40

[['QUESTION', 'TYPE:', 'ALLERGOLOGY'], ['CLINICAL', 'CASE:'], ['16-year-old', 'woman', 'diagnosed', 'with', 'allergic', 'rhinoconjunctivitis', 'due', 'to', 'sensitization', 'to', 'grass', 'pollens', 'since', 'she', 'was', '10', 'years', 'old,', 'who', 'does', 'not', 'fully', 'control', 'the', 'symptomatology', 'during', 'the', 'pollination', 'season', 'with', 'oral', 'antihistamines', 'and', 'nasal', 'topical', 'corticosteroids.'], ['Which', 'etiologic', 'therapeutic', 'option', 'would', 'be', 'indicated:'], ['1-', 'Specific', 'immunotherapy', 'by', 'sublingual', 'or', 'subcutaneous', 'route', 'for', 'a', 'minimum', 'period', 'of', '3', 'years.'], ['2-', 'Specific', 'immunotherapy', 'by', 'sublingual', 'or', 'subcutaneous', 'route', 'for', 'a', 'maximum', 'period', 'of', '1', 'year.'], ['3-', 'Omalizumab', 'subcutaneously', 'every', '4', 'weeks', 'for', 'up', 'to', '1', 'year.'], ['4-', 'Omalizumab', 'subcutaneously', 'every', '4', 'weeks', 'for', 'a', 'minimum', 'period', 'of', '6', 'months.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Currently', 'the', 'only', 'effective', 'treatment', 'capable', 'of', 'modifying', 'the', 'natural', 'course', 'of', 'respiratory', 'allergy', 'is', 'specific', 'allergen', 'immunotherapy', 'for', 'a', 'minimum', 'of', '3', 'consecutive', 'years.'], ['In', 'this', 'patient', 'the', 'conventional', 'treatment', 'has', 'not', 'worked,', 'so', 'it', 'is', 'possible', 'to', 'escalate', 'to', 'specific', 'allergen', 'immunotherapy.'], ['It', 'is', 'true', 'that', 'it', 'is', 'not', 'necessary', 'to', 'wait', '10', 'years', 'to', 'start', 'it', 'since', 'it', 'is', 'indicated', 'and', 'its', 'use', 'is', 'allowed', 'if', 'there', 'is', 'clinical', 'relevance', 'in', 'patients', 'older', 'than', '5', 'years.'], ['Omalizumab', 'is', 'a', 'biological', 'treatment', 'that', 'would', 'only', 'be', 'indicated', 'in', 'cases', 'of', 'severe', 'moderate', 'bronchial', 'asthma', 'secondary', 'to', 'respiratory', 'allergy.']]

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533_179

[['QUESTION', 'TYPE:', 'ONCOLOGY'], ['CLINICAL', 'CASE:'], ['A', '32-year-old', 'woman', 'with', 'multiple', 'endocrine', 'neoplasia', 'syndrome', 'type', '2A', '(MEN-2A)', 'and', 'carrier', 'of', 'a', 'mutation', 'in', 'RET.'], ['In', 'a', 'neck', 'ultrasound', 'a', '6', 'mm', 'hypoechogenic', 'nodule', 'with', 'calcifications', 'inside', 'is', 'identified.'], ['It', 'was', 'decided', 'to', 'perform', 'a', 'total', 'thyroidectomy', 'and', 'cervical', 'lymph', 'node', 'removal.'], ['In', 'the', 'macroscopic', 'study', 'a', 'total', 'of', 'three', 'nodules', 'were', 'identified,', 'two', 'in', 'the', 'right', 'lobe', 'of', '5', 'and', '6', 'mm,', 'and', 'one', 'in', 'the', 'left', 'lobe', 'of', '4', 'mm.'], ['In', 'the', 'microscopic', 'study', 'the', 'three', 'lesions', 'are', 'constituted', 'by', 'a', 'uniform', 'proliferation', 'of', 'rounded', 'cells', 'arranged', 'in', 'a', 'solid', 'pattern', 'and', 'accompanied', 'by', 'calcifications', 'and', 'amyloid', 'deposits.'], ['The', 'nuclei', 'are', 'not', 'clear,', 'nor', 'do', 'they', 'show', 'clefts', 'or', 'pseudoinclusions.'], ['Immunohistochemical', 'staining', 'for', 'synaptophysin', 'is', 'positive.'], ['In', 'the', 'cervical', 'lymph', 'node', 'clearance', 'metastases', 'are', 'identified.'], ['What', 'is', 'the', 'pathologic', 'diagnosis', 'of', 'the', 'lesions', 'identified', 'in', 'the', 'total', 'thyroidectomy?'], ['1-', 'Multifocal', 'medullary', 'carcinoma.'], ['2-', 'Multifocal', 'papillary', 'carcinoma.'], ['3-', 'Follicular', 'carcinoma.'], ['4-', 'Hyperplasia', 'of', 'parafollicular', 'cells.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Typical', 'medullary', 'thyroid', 'RET', '(C', 'cells,', 'elevated', 'calcitonin,', 'inherited', 'MEN-2nd,', 'typical', 'MIR', 'question).']]

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80_37

[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'man', 'who', 'consults', 'for', 'a', 'second', 'opinion', 'on', 'the', 'need', 'to', 'perform', 'a', 'liver', 'biopsy', 'for', 'the', 'study', 'of', 'hypertransaminasemia', 'detected', 'two', 'years', 'ago', 'in', 'routine', 'company', 'analyses.'], ['His', 'family', 'history', 'includes', 'the', 'death', 'of', 'his', 'father', 'of', 'an', 'unidentified', 'etiology', 'of', 'epatic', 'cirrhosis.'], ['Asymptomatic', 'and', 'performing', 'social', 'and', 'work', 'life', 'without', 'limits.'], ['He', 'denies', 'alcohol', 'consumption.'], ['Physical', 'examination', 'shows', 'metallic', 'skin', 'pigmentation', 'and', 'minimal', 'non-painful', 'hepatomegaly.'], ['The', 'rest', 'of', 'the', 'physical', 'examination', 'was', 'normal,', 'body', 'mass', 'index', '23.'], ['Laboratory', 'tests', 'showed', 'the', 'following', 'results:', 'billirubin,', 'albumin,', 'transaminases', 'AST', 'and', 'ALT,', 'normal', 'blood', 'count', 'and', 'prothrombin', 'time:', 'glycemia', '150', 'mg/dl;', 'serum', 'ferritin', '950;', 'transferrin', 'saturation', '>45%,', 'negative', 'for', 'hepatotropic', 'virus.'], ['Normal', 'abdominal', 'ultrasound.'], ['He', 'has', 'undergone', 'HFE', 'genetic', 'study', 'being', 'homozygous', 'for', 'the', 'C282Y', 'mutation.'], ['What', 'would', 'be', 'the', 'best', 'recommendation', 'with', 'the', 'available', 'information?'], ['1-', 'Perform', 'liver', 'biopsy.'], ['2-', 'Perform', 'hepatic', 'MRI.'], ['3-', 'Initiate', 'treatment', 'with', 'phlebotomies.'], ['4-', 'Start', 'treatment', 'with', 'desferroxamine.'], ['5-', 'Start', 'treatment', 'with', 'Vitamin', 'E.'], ['CORRECT', 'ANSWER:', '3'], ['This', 'is', 'a', 'patient', 'who', 'already', 'has', 'a', 'diagnosis', 'of', 'hemochromatosis,', 'due', 'to', 'a', 'positive', 'genetic', 'study', 'and', 'data', 'of', 'iron', 'overload', '(IST', '>45%', 'and', 'elevated', 'ferritin).'], ['Biopsy', 'would', 'be', 'useful', 'if', 'the', 'diagnosis', 'is', 'uncertain', 'or', 'if', 'we', 'would', 'like', 'to', 'assess', 'liver', 'involvement', 'that', 'is', 'not', 'suspected', 'with', 'this', 'analysis.'], ['The', 'treatment', 'of', 'choice', 'is', 'phlebotomy.']]

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394_225

[['QUESTION', 'TYPE:', 'PSYCHIATRY'], ['CLINICAL', 'CASE:'], ['Mariano', 'is', 'a', '53-year-old', 'man', 'who', 'comes', 'to', 'your', 'office', 'reporting', 'that', 'he', 'has', 'been', 'feeling', 'very', 'unwell', 'for', 'several', 'years.'], ['He', 'relates', 'his', 'discomfort', 'to', 'a', 'behavior', 'that', 'he', 'finds', 'absurd', 'but', 'that', 'he', 'is', 'unable', 'to', 'avoid.'], ['This', 'behavior,', 'which', 'she', 'always', 'does', 'when', 'she', 'comes', 'home', 'from', 'work,', 'consists', 'of', 'turning', 'the', 'doorknob', 'of', 'the', 'bathroom', 'on', 'the', 'upper', 'floor', 'of', 'the', 'house', 'before', 'doing', 'anything', 'else,', 'even', 'before', 'greeting', 'her', 'family.'], ['Sometimes', 'he', 'has', 'tried', 'to', 'resist', 'doing', 'this', 'but', 'has', 'only', 'succeeded', 'in', 'distressing', 'himself', 'and', 'delaying', 'the', 'behavior', 'for', 'a', 'few', 'minutes.'], ['This', 'behavior', 'that', 'Mariano', 'performs', 'in', 'an', 'incoercible', 'and', 'automatic', 'way', 'is', 'what', 'is', 'called:'], ['1-', 'Obsessive-compulsive', 'disorder.'], ['2-', 'Obsession.'], ['3-', 'Impulsion.'], ['4-', 'Compulsion.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['In', 'this', 'question', 'they', 'ask', 'for', 'the', 'name', 'of', 'the', 'symptom,', 'not', 'the', 'disease,', 'so', 'therefore', 'the', 'correct', 'answer', 'is', 'compulsion.'], ['According', 'to', 'the', 'DSM-5,', 'a', 'compulsion', 'is', 'a', 'repetitive', 'behavior', '(e.g.,', 'washing', 'hands,', 'tidying', 'up,', 'checking', 'things)', 'or', 'mental', 'act', '(e.g.,', 'praying,', 'counting,', 'repeating', 'words', 'silently)', 'that', 'the', 'subject', 'performs', 'in', 'response', 'to', 'an', 'obsession', 'or', 'in', 'accordance', 'with', 'rules', 'that', 'must', 'be', 'rigidly', 'enforced.'], ['The', 'goal', 'of', 'the', 'behaviors', 'or', 'mental', 'acts', 'is', 'to', 'prevent', 'or', 'decrease', 'anxiety', 'or', 'discomfort,', 'or', 'to', 'avoid', 'some', 'feared', 'event', 'or', 'situation;', 'however,', 'these', 'behaviors', 'or', 'mental', 'acts', 'are', 'not', 'realistically', 'connected', 'with', 'those', 'intended', 'to', 'neutralize', 'or', 'prevent', 'or', 'are', 'clearly', 'excessive.']]

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229_178

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['Previously', 'healthy', '10-month-old', 'infant', 'with', 'acute', 'gastroenteritis', 'of', 'one', "day's", 'evolution', 'and', 'signs', 'of', 'mild', 'dehydration,', 'without', 'blood', 'or', 'mucus', 'in', 'the', 'stool', 'and', 'without', 'oral', 'tolerance.'], ['What', 'is', 'the', 'initial', 'treatment', 'of', 'choice', 'in', 'our', 'environment?'], ['1-', 'Intravenous', 'rehydration,', 'absolute', 'diet', '8', 'hours', 'and', 'start', 'feeding', 'with', 'astringent', 'diet.'], ['2-', 'Rehydration', 'with', 'low', 'osmolality', 'oral', 'rehydration', 'solution', '(sodium', '60-75', 'mEq/L)', 'and', 'continue', 'with', 'his', 'usual', 'diet.'], ['3-', 'Rehydration', 'with', 'low', 'osmolality', 'oral', 'rehydration', 'solution', '(sodium', '60-75', 'mEq/L)', 'maintain', 'usual', 'feeding', 'and', 'oral', 'amoxicillin', '10', 'days.'], ['4-', 'Rehydration', 'with', 'low', 'osmolality', 'oral', 'rehydration', 'solution', '(sodium', '60-75', 'mEq/L)', 'and', 'start', 'feeding', 'with', 'lactose-free', 'formulas.'], ['5-', 'Rehydration', 'with', 'low', 'osmolality', 'oral', 'rehydration', 'solution', '(sodium', '60-75', 'mEq/L)', 'maintain', 'usual', 'feeding', 'and', 'loperamide', '7', 'days.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'infant', 'presents', 'with', 'acute', 'GEA', 'without', 'signs', 'of', 'alarm', 'or', 'severe', 'dehydration.'], ['The', 'first', 'step', 'would', 'be', 'to', 'try', 'oral', 'tolerance', 'with', 'oral', 'rehydration', 'saline', 'and', 'continue', 'with', 'normal', 'feeding', 'if', 'well', 'tolerated.'], ['Answer', '1', 'may', 'give', 'rise', 'to', 'doubts,', 'due', 'to', 'the', 'fact', 'that', 'the', 'statement', 'says', 'that', 'the', 'patient', '"does', 'not', 'tolerate', 'the', 'oral', 'route".'], ['In', 'this', 'case,', 'intravenous', 'rehydration', 'could', 'be', 'started...', 'but', 'it', 'would', 'not', 'be', 'advisable', 'to', 'leave', 'the', 'patient', 'on', 'an', 'absolute', 'diet', 'for', '8', 'hours,', 'nor', 'a', 'subsequent', 'astringent', 'diet,', 'so', 'I', 'prefer', 'answer', '2.'], ['The', 'rest', 'of', 'the', 'treatments', 'do', 'not', 'provide', 'any', 'benefit.']]

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198_73

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '77-year-old', 'man', 'with', 'a', 'history', 'of', 'type', '2', 'Diabetes', 'Mellitus', 'was', 'diagnosed', '2', 'years', 'ago', 'with', 'mild', 'cognitive', 'impairment.'], ['At', 'that', 'time', 'a', 'Minimental', '(Folstein)', '28/30,', 'abbreviated', 'Yesavage', 'Test', '14/15,', 'a', 'CBC', 'with', 'normal', 'TSH', 'and', 'maturation', 'factors', 'along', 'with', 'negative', 'LUES', 'and', 'HIV', 'serologies', 'and', 'a', 'magnetic', 'resonance', 'imaging', '(MRI)', 'showing', 'diffuse', 'cortical', 'atrophy', 'predominantly', 'in', 'the', 'posterior', 'area.'], ['The', 'patient', 'was', 'accompanied', 'by', 'his', 'wife,', 'who', 'reported', 'a', 'slow', 'progressive', 'evolution', 'of', 'memory', 'impairment', '(e.g.,', 'sometimes', 'confused', 'with', 'insulin', 'doses).'], ['There', 'are', 'no', 'hallucinations', 'or', 'behavioral', 'disorder.'], ['Current', 'Minimental', 'is', '24/30', 'and', 'Yesavage', 'test', '14/15,', 'there', 'is', 'no', 'neurological', 'focality,', 'tremor', 'or', 'tone', 'or', 'gait', 'disorders', 'on', 'physical', 'examination.'], ['Two', 'months', 'ago', 'he', 'came', 'to', 'the', 'emergency', 'department', 'after', 'a', 'mild', 'traumatic', 'brain', 'injury', 'due', 'to', 'an', 'accidental', 'fall', '(the', 'only', 'one', 'in', '2', 'years)', 'and', 'a', 'CT', 'scan', 'was', 'performed', 'which', 'did', 'not', 'provide', 'new', 'information', 'compared', 'to', 'the', 'previous', 'MRI.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis', 'in', 'this', 'patient?'], ['1-', 'Frontotemporal', 'dementia.'], ['2-', "Alzheimer's", 'disease.'], ['3-', 'Vascular', 'dementia.'], ['4-', 'Lewy', 'body', 'disease.'], ['5-', 'Creutzfeldt-Jakob', 'disease.'], ['CORRECT', 'ANSWER:', '2'], ['This', 'case', 'describes', 'an', "Alzheimer's", 'disease', 'with', 'insidious', 'onset', 'of', 'short-term', 'memory', 'problems.'], ['Clinically', 'it', 'can', 'be', 'distinguished', 'from', 'other', 'options', 'by', 'the', 'absence', 'of', 'behavioral', 'problems', '(typical', 'of', 'frontotemporal', 'dementia)', 'and', 'hallucinations', '(early', 'in', 'Lewy', 'body', 'disease).'], ['Vascular', 'dementia', 'is', 'diagnosed', 'by', 'criteria', 'that', 'include', 'deficits', 'in', 'memory', 'and', 'two', 'other', 'cognitive', 'areas', 'with', 'consequent', 'functional', 'impairment,', 'but', 'cerebral', 'vascular', 'disease', 'based', 'on', 'history,', 'examination', 'and/or', 'neuroimaging', 'tests,', 'which', 'are', 'not', 'indicated', 'in', 'the', 'case.'], ['Creutzfeldt-Jacob', 'disease', 'is', 'mostly', 'rapidly', 'progressive', 'and', 'usually', 'presents', 'with', 'other', 'clinical,', 'abnormal', 'neurological', 'examination', 'and', 'MRI', 'alterations.']]

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351_161

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'woman', 'referred', 'to', 'a', 'gynecology', 'office', 'for', 'evaluation,', 'reporting', 'dyspareunia', 'for', 'about', '8', 'months,', 'along', 'with', 'dyschezia', 'and', 'occasional', 'rectorrhagia', 'coinciding', 'with', 'menstruation', 'for', '3-4', 'months.'], ['She', 'also', 'reports', 'dysmenorrhea', 'for', 'years,', 'which', 'she', 'controls', 'well', 'with', 'ibuprofen.'], ['She', 'has', 'been', 'trying', 'to', 'get', 'pregnant', 'for', '16', 'months', 'without', 'success.'], ['In', 'the', 'gynecological', 'examination', 'she', 'only', 'shows', 'pain', 'when', 'pressing', 'on', 'the', 'posterior', 'vaginal', 'fornix.'], ['Which', 'test', 'do', 'you', 'consider', 'would', 'allow', 'you', 'to', 'reach', 'a', 'diagnosis', 'of', 'certainty', 'of', 'her', 'pathology?'], ['1-', 'Transvaginal', 'ultrasound.'], ['2-', 'Diagnostic', 'laparoscopy.'], ['3-', 'Magnetic', 'resonance', 'imaging.'], ['4-', 'Colonoscopy.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'clinical', 'case', 'presented', 'is', 'a', 'woman', 'of', 'childbearing', 'age', '(27', 'years)', 'presenting', 'dyspareunia', '+', 'dysmenorrhea', '+', 'infertility,', 'which', 'should', 'lead', 'us', 'to', 'think', 'of', 'endometriosis.'], ['The', 'clinical', 'history', 'and', 'ultrasound', 'give', 'a', 'diagnosis', 'of', 'suspicion,', 'but', 'the', 'diagnosis', 'of', 'certainty', 'is', 'given', 'by', 'direct', 'observation', '(with', 'or', 'without', 'associated', 'biopsy)', 'of', 'ectopic', 'endometrial', 'tissue', 'implants,', 'either', 'by', 'laparotomy', 'or', 'laparoscopy.']]

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69_124

[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY,', 'CRITICAL', 'CARE', 'AND', 'EMERGENCY', 'MEDICINE'], ['CLINICAL', 'CASE:'], ['The', 'daughter', 'of', 'an', '82-year-old', 'woman', 'consults', 'us', 'because', 'she', 'has', 'found', 'her', 'mother', 'more', 'confused', 'than', 'usual.'], ['The', 'patient', 'is', 'diagnosed', 'with', 'moderate', "Alzheimer's", 'disease.'], ['She', 'also', 'has', 'AF,', 'depression', 'and', 'osteoarthritis.'], ['She', 'has', 'been', 'receiving', 'stable', 'treatment', 'for', '3', 'years,', 'including', 'digoxin,', 'acenocoumarol,', 'fluoxetine', 'for', 'the', 'last', '4', 'months', 'and', 'ibuprofen', 'for', 'the', 'last', 'month', 'for', 'joint', 'pain.'], ['On', 'examination,', 'her', 'blood', 'pressure', 'is', '130/80,', 'heart', 'rate', '48', 'bpm', 'and', 'respiratory', 'rate', '10', 'rpm.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'likely', 'cause', 'of', 'the', 'increased', 'confusion?'], ['1-', 'Progression', 'of', "Alzheimer's", 'disease.'], ['2-', 'Worsening', 'depression.'], ['3-', 'Digitalis', 'intoxication.'], ['4-', 'Dementia', 'due', 'to', 'Lewy', 'bodies.'], ['5-', 'Ibuprofen', 'toxicity.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'most', 'likely', 'cause', 'is', 'a', 'digitalis', 'intoxication,', 'which', 'would', 'produce', 'this', 'slowing', 'of', 'conduction,', 'which', 'is', 'seen', 'in', 'the', 'heart', 'rate.'], ['Probably', 'secondary', 'to', 'renal', 'failure', 'due', 'to', 'ibuprofen', 'toxicity', '(but', 'this', 'is', 'a', 'bit', 'of', 'a', 'stretch).']]

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140_134

[['QUESTION', 'TYPE:', 'PEDIATRICS'], ['CLINICAL', 'CASE:'], ['A', 'newborn', 'of', '37', 'weeks', 'gestational', 'age,', 'with', 'no', 'pathological', 'findings', 'in', 'the', 'prenatal', 'ultrasound,', 'presents', 'in', 'the', 'examination', 'performed', 'in', 'the', 'delivery', 'room', 'a', '"stop"', 'to', 'the', 'passage', 'of', 'the', 'nasogastric', 'tube.'], ['Chest', 'and', 'abdominal', 'X-ray', 'showed', 'an', 'atresic', 'esophageal', 'pouch,', 'with', 'normal', 'gastrointestinal', 'pneumatization.'], ['After', 'a', 'diagnostic', 'evaluation', 'that', 'ruled', 'out', 'other', 'anomalies', 'and', 'being', 'in', 'a', 'stable', 'respiratory', 'condition,', 'surgical', 'intervention', 'was', 'decided.'], ['On', 'what', 'basis', 'was', 'the', 'priority', 'to', 'intervene', 'in', 'this', 'patient', 'based?'], ['1-', 'Due', 'to', 'the', 'impossibility', 'of', 'swallowing', 'saliva.'], ['2-', 'Because', 'of', 'frequently', 'associated', 'cardiac', 'malformations.'], ['3-', 'Because', 'of', 'the', 'risk', 'of', 'aspiration', 'pneumonitis.'], ['4-', 'Due', 'to', 'the', 'impossibility', 'of', 'enteral', 'feeding.'], ['5-', 'Associated', 'tracheomalacia.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is', '3.'], ['The', 'fact', 'that', 'there', 'is', 'intestinal', 'aeration', 'points', 'to', 'the', 'existence', 'of', 'a', 'fistula', 'of', 'the', 'lower', 'esophageal', 'segment', 'with', 'the', 'trachea', 'or', 'with', 'a', 'bronchus.'], ['In', 'this', 'case,', 'pulmonary', 'complications', 'are', 'frequent', 'due', 'to', 'the', 'passage', 'of', 'gastric', 'contents', 'into', 'the', 'airway.']]

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

475_89

[['QUESTION', 'TYPE:', 'CRITICAL', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '46-year-old', 'man', 'with', 'bipolar', 'disorder', 'is', 'brought', 'to', 'the', 'emergency', 'department', 'after', 'an', 'over-ingestion', 'of', 'lithium', 'carbonate.'], ['Examination', 'reveals', 'severe', 'tremor,', 'ataxia,', 'dysarthria,', 'myoclonus', 'and', 'fasciculations.'], ['Lithemia', 'is', '4.1', 'mEq/L', '(toxicity', '>', '1.6', 'mEq/L).'], ['Which', 'of', 'the', 'following', 'therapeutic', 'options', 'would', 'be', 'most', 'indicated?'], ['1-', 'Aminophylline', 'associated', 'with', 'a', 'cathartic.'], ['2-', 'Activated', 'charcoal.'], ['3-', 'Hemodialysis.'], ['4-', 'Forced', 'diuresis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['We', 'are', 'dealing', 'with', 'a', 'case', 'of', 'severe', 'lithium', 'intoxication', '(lithemia', '>', '3.5', 'mEq/L', 'is', 'life', 'threatening),', 'therefore,', 'the', 'therapeutic', 'option', 'of', 'choice', 'is', 'to', 'start', 'hemodialysis', 'urgently.'], ['Remember', 'that', 'activated', 'charcoal', 'is', 'NOT', 'indicated', 'in', 'lithium', 'intoxication.']]

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85_50

[['QUESTION', 'TYPE:', 'CARDIOLOGY', 'AND', 'VASCULAR', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', 'patient', 'with', 'a', 'history', 'of', 'febrile', 'illness', 'and', 'chest', 'pain', 'comes', 'to', 'the', 'hospital', 'with', 'dyspnea', 'and', 'tachypnea.'], ['On', 'physical', 'examination', 'his', 'blood', 'pressure', 'is', 'low,', 'jugular', 'venous', 'pressure', 'is', 'elevated', 'with', 'a', 'deep', 'descending', 'sinus', '"X"', 'and', 'he', 'has', 'a', 'paradoxical', 'pulse.'], ['What', 'pathology', 'should', 'you', 'suspect?'], ['1-', 'Ischemic', 'heart', 'disease.'], ['2-', 'Dilated', 'cardiomyopathy.'], ['3-', 'Severe', 'aortic', 'stenosis.'], ['4-', 'Constrictive', 'pericarditis.'], ['5-', 'Pericardial', 'effusion', 'with', 'cardiac', 'tamponade.'], ['CORRECT', 'ANSWER:', '5'], ['Paradoxical', 'pulse', 'is', 'a', 'drop', 'in', 'blood', 'pressure', '>', '10', 'mmHg', 'during', 'inspiration;', 'it', 'represents', 'an', 'exaggeration', 'of', 'the', 'physiological', 'phenomenon', 'consisting', 'of', 'inspiratory', 'lowering', 'of', 'BP', '(normal', 'up', 'to', '10', 'mmHg).'], ['In', 'cardiac', 'tamponade,', 'inspiration,', 'which', 'causes', 'an', 'increase', 'in', 'blood', 'flow', 'to', 'the', 'right', 'chambers,', 'increasing', 'their', 'volume,', 'secondarily', 'causes', 'a', 'displacement', 'of', 'the', 'interventricular', 'septum', 'to', 'the', 'left,', 'so', 'that', 'the', 'left', 'heart', 'lodges', 'and', 'expels', 'less', 'blood', 'during', 'systole', 'and', 'the', 'pulse,', 'therefore,', 'decreases.'], ['In', 'a', 'normal', 'heart', 'this', 'exaggerated', 'displacement,', 'caused', 'by', 'the', 'pressure', 'exerted', 'by', 'the', 'tamponade', 'on', 'the', 'RV', 'free', 'wall,', 'does', 'not', 'occur.'], ['Sinus', 'X', 'represents', 'the', 'systolic', 'collapse', 'of', 'the', 'venous', 'pulse,', 'i.e.,', 'the', 'pressure', 'drop', 'due', 'to', 'atrial', 'relaxation', '(also', 'partly', 'due', 'to', 'a', 'downward', 'displacement', 'of', 'the', 'RV', 'base', 'during', 'systole).'], ['Sinus', 'Y', 'represents', 'the', 'diastolic', 'collapse', 'of', 'the', 'venous', 'pulse,', 'i.e.,', 'the', 'pressure', 'drop', 'that', 'occurs', 'from', 'the', 'moment', 'blood', 'enters', 'the', 'tricuspid', 'valve', 'into', 'the', 'ventricle.'], ['In', 'cardiac', 'tamponade,', 'the', 'deep', 'sinus', 'X', 'is', 'characteristic.'], ['In', 'constrictive', 'pericarditis,', 'the', 'deep', 'Y', 'sinus.'], ['For', 'all', 'these', 'reasons,', 'the', 'correct', 'answer', 'is', '5.']]

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527_31

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', "patient's", 'arterial', 'blood', 'gas', 'result', 'is:', 'pH:', '7.40,', 'PaCO2', '60', 'mmHg;', 'bicarbonate', '36', 'mM/L.'], ['What', 'is', 'the', 'presenting', 'disturbance:'], ['1-', 'None,', 'pH', 'is', 'normal.'], ['2-', 'Respiratory', 'acidosis.'], ['3-', 'Respiratory', 'acidosis', 'and', 'metabolic', 'alkalosis.'], ['4-', 'Metabolic', 'alkalosis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Blood', 'gases', 'can', 'be', 'misleading', 'since', 'a', 'normal', 'pH', 'may', 'suggest', 'that', 'there', 'is', 'no', 'disturbance', 'of', 'acid-base', 'balance,', 'instead', 'it', 'is', 'masking', 'a', 'double', 'disturbance', 'in', 'opposite', 'directions', 'as', 'in', 'this', 'case.'], ['The', 'patient', 'presents', 'with', 'respiratory', 'acidosis', '(PaCO2', '60', 'mmHg;', 'normal', 'to', '50)', 'and', 'compensatory', 'metabolic', 'alkalosis', '(bicarbonate', '36', 'mmol/l;', 'normal', 'to', '28).'], ['This', 'is', 'the', 'typical', 'blood', 'gas', 'of', 'the', 'patient', 'with', 'COPD', 'and', 'compensated', 'chronic', 'respiratory', 'failure.']]

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

407_81

[['QUESTION', 'TYPE:', 'ONCOLOGY', '(ECTOPIC)'], ['CLINICAL', 'CASE:'], ['A', '30-year-old', 'woman', 'comes', 'to', 'the', 'clinic', 'reporting', 'anxiety,', 'weight', 'loss', 'of', 'about', '6', 'kgs', 'and', 'a', 'feeling', 'of', '"nervousness"', 'in', 'the', 'last', 'three', 'months.'], ['Physical', 'examination', 'showed', 'tachycardia,', 'hyperreflexia', 'and', 'absence', 'of', 'goiter.'], ['TSH', 'values', 'are', '<', '0.01', 'microU/mL,', 'T4', 'is', 'elevated', 'and', 'thyroglobulin', 'levels', 'are', 'decreased.'], ['A', 'scan', 'reveals', 'an', 'absence', 'of', 'uptake', 'in', 'the', 'thyroid', 'region.'], ['What', 'seems', 'to', 'you', 'the', 'most', 'likely', 'diagnosis?'], ['1-', 'Factitious', 'thyrotoxicosis.'], ['2-', 'Hyperthyroidism', 'due', 'to', "Graves'", 'disease.'], ['3-', 'Ovarian', 'teratoma', '(ovarian', 'stromal).'], ['4-', 'Subacute', 'thyroiditis.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Patients', 'with', 'this', 'disorder', 'voluntarily', 'or', 'accidentally', 'ingest', 'excessive', 'amounts', 'of', 'thyroid', 'hormone,', 'resulting', 'in', 'hyperthyroidism', 'in', 'the', 'absence', 'of', 'goiter.'], ['In', 'contrast', 'to', 'all', 'other', 'causes', 'of', 'hyperthyroidism,', 'serum', 'thyroglobulin', 'is', 'not', 'elevated', 'and', 'is', 'almost', 'always', 'low', 'or', 'at', 'the', 'lower', 'limit', 'of', 'normal.'], ['The', 'fundamental', 'doubt', 'we', 'had', 'with', 'ovarian', 'teratoma', '(ovarian', 'struma)', 'which', 'is', 'a', 'rare', 'variant', 'of', 'mature', 'monodermal', 'teratoma', 'composed', 'of', 'thyroid', 'tissue', 'described', 'at', 'the', 'beginning', 'of', 'the', '20th', 'century.'], ['It', 'is', 'so', 'named', 'when', 'the', 'teratoma', 'is', 'predominantly', 'composed', 'of', 'mature', 'thyroid', 'tissue', '(at', 'least', '50%,', 'in', 'order', 'to', 'be', 'classified', 'as', 'struma', 'ovarii).'], ['It', 'represents', 'between', '2.5', 'and', '5%', 'of', 'ovarian', 'teratomas.'], ['In', 'itself,', 'it', 'is', 'a', 'benign', 'tumor,', 'but', 'in', 'up', 'to', '5%', 'of', 'cases', 'it', 'can', 'develop', 'a', 'malignant', 'transformation', 'of', 'its', 'elements,', 'classically', 'referred', 'to', 'as', 'malignant', 'struma', 'ovarii.'], ['Mostly,', 'the', 'neoplastic', 'tissue', 'developed', 'is', 'a', 'papillary', 'carcinoma,', 'less', 'frequently', 'it', 'corresponds', 'to', 'follicular', 'carcinoma.'], ['This', 'malignant', 'transformation', 'arises', 'mostly', 'from', 'classical', 'forms', 'of', 'struma,', 'but', 'is', 'extremely', 'rare', 'in', 'cases', 'of', 'mature', 'cystic', 'teratomas.'], ['Its', 'behavior', 'is', 'similar', 'to', 'that', 'of', 'other', 'primary', 'ovarian', 'tumors,', 'tending', 'to', 'metastasize', 'to', 'the', 'peritoneal', 'cavity', 'and', 'hematogenously', 'to', 'bone,', 'liver', 'and', 'brain.'], ['The', 'mean', 'age', 'of', 'presentation', 'of', 'thyroid', 'carcinoma', 'on', 'struma', 'ovarii', 'is', 'between', '42.9-44', 'years', 'and', 'between', '21', 'and', '63', 'for', 'the', 'papillary', 'carcinoma', 'variant.'], ['Clinically,', 'the', 'predominant', 'form', 'of', 'presentation', 'is', 'as', 'a', 'pelvic', 'mass', 'or', 'abdominal', 'pain', '(45%),', 'less', 'frequently', 'hyperthyroidism', '(5-8%)', 'or', 'ascites', '(17%).'], ['It', 'is', 'postulated', 'that', 'the', 'ovarian', 'thyroid', 'tissue', 'in', 'the', 'struma', 'is', 'autonomous', 'in', 'the', 'production', 'of', 'thyroid', 'hormones,', 'so', 'it', 'is', 'essential', 'to', 'measure', 'serum', 'thyroglobulin', 'levels', 'in', 'patients', 'affected', 'by', 'hyperthyroidism,', 'as', 'they', 'point', 'to', 'the', 'extrathyroid', 'production', 'of', 'thyroid', 'hormone.']]

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15_126

[['QUESTION', 'TYPE:', 'PALLIATIVE', 'CARE'], ['CLINICAL', 'CASE:'], ['For', 'the', 'third', 'time', 'in', 'the', 'last', '6', 'months', 'an', '84-year-old', 'man', 'with', 'advanced', 'dementia', 'is', 'admitted', 'to', 'a', 'hospital', 'for', 'aspiration', 'pneumonia.'], ['He', 'has', 'lost', '9.5', 'kg', 'in', 'the', 'last', '10', 'months.'], ['He', 'has', 'a', 'pressure', 'ulcer', 'in', 'the', 'sacrum.'], ['He', 'does', 'not', 'communicate', 'verbally,', 'does', 'not', 'ambulate', 'and', 'is', 'dependent', 'for', 'all', 'activities', 'of', 'daily', 'living.'], ['His', 'wife', 'cares', 'for', 'him', 'at', 'home', 'and', 'does', 'not', 'want', 'to', 'place', 'him', 'in', 'a', 'nursing', 'home.'], ['A', 'swallowing', 'study', 'indicates', 'that', 'he', 'chokes', 'on', 'all', 'types', 'of', 'food', 'consistencies.'], ['The', 'hospital', 'physician', 'suggests', 'tube', 'feeding.'], ['The', "patient's", '"Advance', 'Living', 'Will"', 'states', 'that', 'his', 'wife', 'is', 'the', 'representative', 'decision', 'maker', 'regarding', 'his', 'medical', 'care', 'and', 'that', 'he', 'does', 'not', 'want', 'extraordinary', 'measures', 'to', 'prolong', 'his', 'life', 'including', 'artificial', 'nutrition.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'appropriate', 'recommendation', 'for', 'this', 'patient:'], ['1-', 'Place', 'an', 'indwelling', 'SNG', 'and', 'discharge', 'to', 'a', 'skilled', 'nursing', 'home.'], ['2-', 'Place', 'a', 'mid-term', 'NGUS', 'and', 'discharge', 'to', 'a', 'nursing', 'home', 'with', 'specialized', 'care', 'until', 'bedsores', 'heal.'], ['3-', 'Discharge', 'to', 'a', 'nursing', 'home', 'with', 'specialized', 'care', 'until', 'pressure', 'ulcers', 'heal.'], ['4-', 'Place', 'a', 'gastrostomy', 'tube', 'and', 'discharge', 'home.'], ['5-', 'Discharge', 'home', 'with', 'palliative', 'care', 'from', 'the', 'health', 'area.'], ['CORRECT', 'ANSWER:', '5'], ['This', 'is', 'perhaps', 'the', 'least', 'scientific', 'of', 'this', "year's", 'MIR', 'questions,', 'since', 'its', 'answer', 'is', 'based', 'on', 'the', 'interpretation', 'of', 'a', 'law,', 'which', 'is', 'also', 'of', 'an', 'autonomous', 'nature.'], ['Probably', 'the', 'spirit', 'of', 'the', 'examiner', 'wants', 'to', 'reflect', 'this', 'law,', 'in', 'an', 'extreme', 'case.'], ["Let's", 'see,', 'starting', 'from', 'article', '11', 'of', 'Law', '41', '/2002,', 'of', 'November', '14', '(1),', 'basic', 'law', 'regulating', 'patient', 'autonomy', 'and', 'the', 'rights', 'and', 'obligations', 'regarding', 'information', 'and', 'clinical', 'documentation', '(B.O.E.', 'No.', '274,', 'of', 'November', '15)', 'of', 'a', 'national', 'nature,', 'in', 'Castilla-La', 'Mancha', 'there', 'is', 'Law', '6/2005,', 'of', 'July', '7', '(2),', 'of', 'Castilla-La', 'Mancha,', 'on', 'the', 'Declaration', 'of', 'Advance', 'Directives', 'in', 'matters', 'of', "one's", 'own', 'health.'], ['(D.O.C.M.', 'No.', '141,', 'of', 'July', '15)', 'and', 'Decree', '15/2006,', 'of', 'February', '21', '(3),', 'of', 'the', 'Registry', 'of', 'Advance', 'Directives', 'of', 'Castilla-La', 'Mancha', '(D.O.C.M.', 'No.', '42,', 'of', 'February', '24).'], ['In', 'the', 'summary', 'published', 'by', 'the', 'JCCM', '(4)', 'it', 'says:', '"The', 'declaration', 'of', 'advance', 'directives', '(also', 'known', 'as', 'advance', 'directives', 'or', 'living', 'will)', 'is', 'the', 'written', 'manifestation', 'of', 'a', 'capable', 'person', 'who,', 'acting', 'freely,', 'expresses', 'the', 'instructions', 'to', 'be', 'taken', 'into', 'account', 'regarding', 'the', 'health', 'care', 'he/she', 'wishes', 'to', 'receive', 'in', 'situations', 'that', 'prevent', 'him/her', 'from', 'communicating', 'his/her', 'will', 'personally,', 'or', 'regarding', 'the', 'destination', 'of', 'his/her', 'body', 'or', 'organs', 'once', 'death', 'has', 'occurred.'], ['In', 'our', 'declaration', 'of', 'advance', 'directives,', 'we', 'can', 'refer', 'to:', '1.', 'The', 'expression', 'of', 'personal', 'values,', 'in', 'order', 'to', 'help', 'in', 'the', 'interpretation', 'of', 'the', 'document', 'itself', 'and', 'to', 'guide', 'physicians', 'in', 'making', 'clinical', 'decisions.'], ['2.'], ['Instructions', 'about', 'the', 'care', 'and', 'treatment', 'related', 'to', 'our', 'health', 'that', 'we', 'may', 'or', 'may', 'not', 'wish', 'to', 'receive.'], ['3.'], ['We', 'may', 'appoint', 'a', 'representative', 'to', 'act', 'as', 'an', 'interlocutor', 'with', 'the', 'responsible', 'physician', 'or', 'health', 'care', 'team', 'to', 'ensure', 'that', 'the', 'instructions', 'contained', 'in', 'the', 'declaration', 'are', 'carried', 'out.'], ['4.'], ['We', 'may', 'also', 'include', 'our', 'decision', 'regarding', 'organ', 'donation.'], ['In', 'these', 'cases,', 'the', 'authorization', 'of', 'the', 'family', 'will', 'not', 'be', 'required', 'for', 'the', 'removal', 'or', 'use', 'of', 'the', 'donated', 'organs".'], ['It', 'thus', 'seems', 'clear', 'that', 'the', 'intended', 'response', 'is', '5.']]

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322_85

[['QUESTION', 'TYPE:', 'UROLOGY'], ['CLINICAL', 'CASE:'], ['A', '22-year-old', 'boy', 'with', 'hyposmia', 'presents', 'lack', 'of', 'development', 'of', 'secondary', 'sexual', 'characteristics', 'and', 'infertility.'], ['Bilateral', 'testicular', 'volume', 'of', '4', 'mL.'], ['Analytically,', 'EST-I', '1.2', 'U/L', '(vn', '5-15);', 'LH', '0.6', 'U/L', '(vn', '3-15);', 'testosterone', '100', 'ng/dL', '(vn', '300-1200),', 'prolactin', 'normal.'], ['State', 'your', 'proposed', 'treatment', 'to', 'achieve', 'fertility:'], ['1-', 'GnRH', 'infusion', 'pump.'], ['2-', 'Monthly', 'intramuscular', 'administration', 'of', 'triptorelin.'], ['3-', 'Intramuscular', 'administration', 'of', 'FSH', 'and', 'LH', 'once', 'a', 'week.'], ['4-', 'Treatment', 'with', 'bromocriptine.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['This', 'is', 'a', 'Kallman', 'syndrome', '(hypogonadotropic', 'hypogonadism', '+', 'olfactory', 'disturbance).'], ['Triptorelin', 'is', 'a', 'GnRH', 'agonist,', 'which', 'by', 'continuous', 'action', 'reduces', 'FSH', 'and', 'LH,', 'and', 'is', 'used', 'in', 'sex', 'hormone-dependent', 'cancers,', 'as', 'well', 'as', 'precocious', 'puberty.'], ['Bromocriptine', 'is', 'a', 'dopaminergic', 'agonist', 'used', 'in', 'hyperPRL', '(he', 'has', 'normal', 'PRL),', 'pituitary', 'tumors...'], ['We', 'stay', 'between', '1', 'and', '3.'], ['To', 'induce', 'testicular', 'maturation,', 'pulsatile', 'GnRH', 'with', 'pump,', 'hCG', 'or', 'FSH+hCG', 'can', 'be', 'used.'], ['LH', 'is', 'not', 'used', 'as', 'a', 'treatment,', 'it', 'would', 'be', 'stimulated', 'by', 'intermittent', 'GnRH.']]

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

610_116

391_222

[['QUESTION', 'TYPE:', 'PSYCHIATRY'], ['CLINICAL', 'CASE:'], ['A', '26-year-old', 'single', 'man', 'is', 'brought', 'in', 'by', 'his', 'family', 'because', 'he', 'has', 'been', 'refusing', 'to', 'leave', 'his', 'home', 'for', '3', 'months.'], ['The', 'reason', 'given', 'by', 'the', 'patient', 'is', 'the', 'belief', 'that', 'he', 'has', 'an', 'asymmetrical', 'jaw', 'and', 'a', 'crooked', 'face.'], ['According', 'to', 'the', 'patient,', 'this', 'situation', 'is', 'progressive', 'and', 'he', 'looks', 'more', 'and', 'more', 'deformed', 'when', 'he', 'looks', 'in', 'the', 'mirror.'], ['He', 'is', 'ashamed', 'of', 'his', 'appearance,', 'so', 'he', 'does', 'not', 'want', 'to', 'go', 'out,', 'he', 'gets', 'very', 'anxious', 'when', 'he', 'sees', 'his', 'image', 'and', 'he', 'cannot', 'stop', 'thinking', 'about', 'his', 'deformity', 'all', 'day', 'long.'], ['He', 'has', 'consulted', 'several', 'maxillofacial', 'surgeons', 'but', 'they', 'tell', 'him', 'that', 'he', 'does', 'not', 'have', 'facial', 'asymmetry', 'and', 'refer', 'him', 'to', 'a', 'psychiatrist.'], ['The', "patient's", 'diagnosis', 'is:'], ['1-', 'Major', 'depressive', 'disorder', 'with', 'delusional', 'ideas', 'incongruent', 'with', 'mood.'], ['2-', 'Obsessive-compulsive', 'disorder.'], ['3-', 'Paranoid', 'schizophrenia.'], ['4-', 'Body', 'dysmorphic', 'disorder.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Another', 'simple', 'question', 'with', 'an', 'immediate', 'answer,', 'which', 'offers', 'no', 'doubt.'], ['It', 'describes', 'a', 'patient', 'worried', 'about', 'a', 'non-existent', 'physical', 'defect,', 'whose', 'concern', 'distresses', 'him', 'and', 'prevents', 'him', 'from', 'leaving', 'the', 'house.'], ['As', 'a', 'psychiatry', 'resident,', 'I', 'wish', 'the', 'MIR', 'questions', 'in', 'my', 'specialty', 'were', 'a', 'bit', 'more', 'thought-provoking', 'and', 'in-depth,', 'although', 'I', 'know', 'that', 'the', 'seconds', 'you', 'will', 'have', 'saved', 'by', 'marking', 'the', 'fourth', 'one', 'directly', 'are', 'very', 'valuable.']]

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324_55

[['QUESTION', 'TYPE:', 'CRITICAL,', 'PALLIATIVE', 'AND', 'EMERGENCY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '70-year-old', 'female', 'patient', 'is', 'admitted', 'to', 'the', 'ICU', 'after', 'suffering', 'anterior', 'AMI', 'treated', 'by', 'coronary', 'angioplasty', 'and', 'stent', 'placement', 'in', 'the', 'anterior', 'descending', 'artery.'], ['Four', 'days', 'later,', 'she', 'suddenly', 'presents', 'hypotension', 'that', 'requires', 'vigorous', 'volume', 'support,', 'initiation', 'of', 'vasoactive', 'drugs,', 'orotracheal', 'intubation', 'and', 'connection', 'to', 'mechanical', 'ventilation.'], ['Physical', 'examination', 'revealed', 'a', 'murmur', 'not', 'previously', 'present.'], ['Suspecting', 'a', 'mechanical', 'complication', 'of', 'the', 'infarction,', 'transthoracic', 'echocardiography', 'showed', 'pericardial', 'effusion.'], ['Mark', 'the', 'CORRECT', 'answer:'], ['1-', 'Mortality', 'with', 'medical', 'treatment', 'is', '20%.'], ['2-', 'In', 'case', 'of', 'free', 'wall', 'rupture,', 'there', 'is', 'an', 'oxymetric', 'jump', 'in', 'the', 'right', 'ventricle', 'in', 'the', 'Swan-Ganz', 'catheterization.'], ['3-', 'In', 'case', 'of', 'free', 'wall', 'rupture,', 'there', 'is', 'no', 'palpable', 'frémito.'], ['4-', 'Mechanical', 'complications', 'usually', 'appear', 'on', 'the', 'first', 'post-infarction', 'day.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Mortality', 'is', 'not', 'so', 'low,', 'the', 'oximetric', 'jump', 'occurs', 'in', 'the', 'case', 'of', 'septum', 'rupture,', 'as', 'well', 'as', 'fremitus', '(hence', 'the', 'correct', 'answer', 'is', '3)', 'and', 'complications', 'can', 'occur', 'up', 'to', 'the', 'first', 'week.']]

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240_150

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '76-year-old', 'man', 'consults', 'for', 'cognitive', 'impairment,', 'slowness', 'and', 'clumsiness', 'of', 'movements,', 'of', 'eight', 'months', 'of', 'evolution.'], ['The', 'family', 'reports', 'that', 'the', 'patient', 'had', 'visual', 'hallucinations,', 'so', 'his', 'primary', 'care', 'physician', 'prescribed', 'low', 'doses', 'of', 'risperidone,', 'with', 'a', 'significant', 'worsening', 'of', 'motor', 'status.'], ['In', 'view', 'of', 'these', 'data,', 'what', 'is', 'the', 'most', 'likely', 'diagnosis?'], ['1-', "Alzheimer's", 'disease.'], ['2-', 'Dementia', 'due', 'to', 'Lewy', 'bodies.'], ['3-', 'Frontotemporal', 'dementia.'], ['4-', 'Vascular', 'dementia.'], ['5-', 'Sporadic', 'Creutzfeldt-Jakob', 'disease.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'is', '2', 'because', 'it', 'presents', 'the', 'case', 'with', 'the', 'typical', 'symptoms', 'of', 'dementia', 'due', 'to', 'Lewy', 'bodies,', 'being', 'the', 'guiding', 'symptom', 'visual', 'hallucinations.'], ['Progressive', 'cognitive', 'impairment,', 'parkinsonian', 'motor', 'signs', '(inferred', 'from', 'clumsiness', 'of', 'movements)', 'and', 'hypersensitivity', 'to', 'neuroleptics', 'even', 'in', 'small', 'doses', 'are', 'also', 'mentioned.']]

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68_123

[['QUESTION', 'TYPE:', 'ANESTHESIOLOGY,', 'CRITICAL', 'CARE', 'AND', 'EMERGENCY', 'MEDICINE'], ['CLINICAL', 'CASE:'], ['A', '64-year-old', 'man', 'with', 'a', 'history', 'of', 'hypertension', 'and', 'ischemic', 'heart', 'disease', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'oppressive', 'chest', 'pain', 'while', 'watching', 'television.'], ['In', 'the', 'ED', 'triage', 'consultation,', 'T.', 'art', 'values', 'of', '155/95', 'mmHg', 'and', 'a', 'capillary', 'O2', 'saturation', 'of', '95%', 'are', 'detected.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'correct', 'course', 'of', 'action?'], ['1-', 'Instruct', 'her', 'to', 'go', 'to', 'the', 'waiting', 'room.', 'You', 'will', 'be', 'notified', 'for', 'tests.'], ['2-', 'This', 'patient', 'should', 'be', 'treated', 'in', 'the', 'vital', 'emergency', 'room', '(shock', 'room).'], ['3-', 'We', 'will', 'notify', 'the', 'cardiologist', 'on', 'duty', 'to', 'evaluate', 'the', 'patient.'], ['4-', 'From', 'the', 'Triage', 'consultation,', 'the', 'patient', 'will', 'be', 'referred', 'to', 'the', 'Coronary', 'Unit.'], ['5-', 'We', 'will', 'do', 'an', 'ECG', 'in', 'less', 'than', '10', 'minutes.'], ['CORRECT', 'ANSWER:', '5'], ['If', 'the', 'ECG', 'shows', 'ischemic', 'changes,', 'we', 'will', 'obviously', 'treat', 'the', 'patient', 'in', 'the', 'emergency', 'room', 'and', 'notify', 'the', 'cardiologist.'], ['If', 'not,', 'you', 'will', 'be', 'treated', 'as', 'if', 'it', 'were', 'angina', 'and', 'observed,', 'with', 'serial', 'enzymes', 'and', 'treatment', 'in', 'the', 'observation', 'area.']]

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206_125

[['QUESTION', 'TYPE:', 'UROLOGY'], ['CLINICAL', 'CASE:'], ['Faced', 'with', 'a', '49-year-old', 'man,', 'asymptomatic,', 'with', 'a', 'family', 'history', 'of', 'a', 'father', 'who', 'died', 'of', 'prostate', 'cancer,', 'who', 'in', 'a', 'routine', 'company', 'control', 'is', 'identified', 'a', 'PSA', '(Prostate', 'Specific', 'Antigen)', 'of', '5.9', 'ng', '/', 'ml,', 'with', 'a', 'ratio', 'of', 'free', 'PSA', '/', 'total', 'PSA', 'of', '11%', 'and', 'that', 'a', 'rectal', 'examination', 'shows', 'increased', 'consistency', 'in', 'the', 'right', 'prostatic', 'lobe,', 'what', 'is', 'the', 'following', 'clinical', 'indication?'], ['1-', 'Suggest', 'to', 'the', 'patient', 'the', 'performance', 'of', 'a', 'transrectal', 'ultrasound', 'and', 'prostate', 'biopsy.'], ['2-', 'Perform', 'an', 'abdominopelvic', 'CT', 'scan.'], ['3-', 'Initiate', 'treatment', 'with', '5', 'alpha', 'Reductase', 'Inhibitors', 'to', 'reduce', 'PSA', 'levels', 'by', 'half.'], ['4-', 'Initiate', 'combined', 'treatment', 'of', 'LHRH', 'analogues', 'and', 'antiandrogens.'], ['5-', 'Perform', 'a', 'bone', 'scan.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'patient', 'has', 'a', 'PSA', '>4', 'and', 'a', 'palpation', 'with', 'increased', 'consistency,', 'which', 'implies', 'the', 'need', 'for', 'a', 'transrectal', 'ultrasound-guided', 'biopsy', 'to', 'diagnose', 'whether', 'it', 'is', 'Benign', 'Prostatic', 'Hyperplasia', 'or', 'Prostate', 'Cancer.']]

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570_153

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '19-year-old', 'male', 'with', 'no', 'past', 'history', 'of', 'interest', 'comes', 'to', 'the', 'emergency', 'department', 'because', 'after', 'a', 'respiratory', 'infection', 'he', 'presents', 'with', 'asthenia,', 'malaise,', 'oliguria', 'and', 'headache.'], ['Physical', 'examination:', 'BP', '210/120', 'mmHg,', 'fundus', 'with', 'hypertensive', 'retinopathy', 'grade', 'III.'], ['Laboratory', 'tests:', 'Hb', '7.4', 'g/dl,', 'platelets', '85,000/mm3,', '2-3', 'schistocytes', 'in', 'the', 'peripheral', 'blood', 'smear,', 'LDH', '950', 'IU/ml,', 'serum', 'creatinine', '8.75', 'mg/dl.'], ['Urine', 'system:', 'proteinuria', '300', 'mg/dl,', 'sediment', '15', 'red', 'blood', 'cells', 'per', 'field.'], ['ADAMTS-13', 'levels', 'are', 'normal.'], ['Given', 'these', 'findings,', 'what', 'would', 'be', 'your', 'main', 'diagnostic', 'suspicion?'], ['1-', 'Thrombotic', 'thrombocytopenic', 'purpura.'], ['2-', 'Atypical', 'hemolytic', 'uremic', 'syndrome.'], ['3-', 'Disseminated', 'intravascular', 'coagulation.'], ['4-', 'Typical', 'hemolytic', 'uremic', 'syndrome.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['Difficult', 'question.'], ['The', 'patient', 'presents', 'with', 'thrombotic', 'microangiopathy', '(TMA)', 'with', 'acute', 'renal', 'failure.'], ['This', 'points', 'to', 'HUS,', 'TTP,', 'drug-induced', 'TMA,', 'or', 'TMA', 'mediated', 'by', 'complement,', 'coagulation,', 'or', 'metabolism.'], ['Normal', 'ADAMTS-13', 'levels', 'rule', 'out', 'TTP', '(incorrect', 'choice', '1).'], ['The', 'absence', 'of', 'gastrointestinal', 'symptoms', 'rules', 'out', 'typical', 'Shiga', 'toxin', 'HUS', '(incorrect', 'choice', '4).'], ['Pneumococcal', 'infections', 'can', 'also', 'cause', 'HUS,', 'although', 'it', 'is', 'rare', 'and', 'more', 'so', 'in', 'adults.'], ['The', 'history', 'of', 'respiratory', 'infection', '(not', 'specified,', 'it', 'could', 'be', 'pneumococcal', 'pneumonia)', 'together', 'with', 'the', 'absence', 'of', 'DIC', 'data', '(no', 'mention', 'of', 'bleeding', 'or', 'altered', 'coagulation', 'tests)', 'makes', 'me', 'think', 'of', 'atypical', 'HUS', '(option', '2', 'correct).']]

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506_87

[['QUESTION', 'TYPE:', 'PSYCHIATRY'], ['CLINICAL', 'CASE:'], ['Faced', 'with', 'sudden-onset', 'obsessive-compulsive', 'disorder', '(OCD)', 'in', 'a', '9-year-old', 'boy', 'who', 'also', 'presents', 'with', 'tics', 'and', 'chorea', 'as', 'neurological', 'manifestations,', 'infection', 'by:'], ['1-', 'Streptococcus', 'viridans.'], ['2-', 'Alpha-hemolytic', 'streptococcus.'], ['3-', 'Beta-hemolytic', 'streptococcus,', 'group', 'A.'], ['4-', 'Enterococcus.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['There', 'is', 'a', 'large', 'literature', 'on', 'this', 'subject.'], ['It', 'never', 'ceases', 'to', 'amaze', 'us', 'the', 'strange', 'ways', 'of', 'biology', 'and', 'that', 'the', 'axiom', '"the', 'longest', 'is', 'the', 'right', 'one"', 'is', 'fulfilled', 'in', 'this', 'case.']]

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619_121

161_118

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '60-year-old', 'woman', 'diagnosed', 'with', 'chronic', 'bronchopathy,', 'diabetes', 'mellitus,', 'hypertension', 'and', 'treated', 'for', '4', 'months', 'with', 'Omeprazole,', 'Metformin,', 'Salbutamol,', 'Ipratropium', 'Bromide', 'and', 'Enalapril', '20', 'mg', '+', 'Hydrochlorothiazide', '25', 'mg', 'comes', 'to', 'your', 'office', 'for', 'fatigue,', 'decreased', 'appetite,', 'with', 'slight', 'dyspnea', 'and', 'occasional', 'cough,', 'variable', 'stools,', 'sometimes', 'soft', 'and', 'without', 'urinary', 'symptoms.'], ['Blood', 'tests', 'show', 'leukocytes', '10,000/mm³,', 'Ht', '35%,', 'MCV', '80,', 'Glucose', '150', 'mg/dl,', 'Urea', '80', 'mg/dl,', 'Creatinine', '1.6', 'mg/dl,', 'Sodium', '133', 'mEq/l', 'and', 'Potassium', '2.9', 'mEq/l.'], ['What', 'is', 'the', 'most', 'likely', 'cause', 'of', 'hypokalemia?'], ['1-', 'Renal', 'insufficiency.'], ['2-', 'Hyponatremia.'], ['3-', 'Potassium', 'deficiency.'], ['4-', 'Antihypertensive.'], ['5-', 'Metformin.'], ['CORRECT', 'ANSWER:', '4'], ['The', 'correct', 'answer', 'is:', '4.'], ['Antihypertensive.'], ['In', 'particular,', 'hydrochlorothiazide,', 'as', 'a', 'thiazide,', 'is', 'primarily', 'responsible', 'for', 'this', "patient's", 'hypokalemia.']]

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269_141

18_138

[['QUESTION', 'TYPE:', 'DERMATOLOGY'], ['CLINICAL', 'CASE:'], ['If', 'a', 'patient', 'reports', 'having', 'for', 'months', 'now', 'enlargement', 'of', 'the', 'tongue,', 'with', 'no', 'other', 'alterations', 'of', 'the', 'tongue', 'causing', 'constant', 'biting,', 'which', 'disease', 'would', 'you', 'think', 'of', 'the', 'following:'], ['1-', 'Hypoglossal', 'paralysis.'], ['2-', 'Hyperthyroidism.'], ['3-', 'Mastocytosis.'], ['4-', 'Amyloidosis.'], ['5-', 'Facial', 'granuloma.'], ['CORRECT', 'ANSWER:', '4'], ['Question', 'shared', 'with', 'ENT.'], ['Amyloidosis', 'is', 'a', 'localized', 'or', 'systemic', 'deposition', 'of', 'fibrillar', 'proteins.'], ['It', 'can', 'be', 'primary', 'or', 'secondary.'], ['The', 'most', 'frequently', 'affected', 'organs', 'are', 'the', 'kidneys', 'and', 'the', 'heart.'], ['Sometimes', 'amyloid', 'deposits', 'appear', 'on', 'the', 'tongue', 'which', 'can', 'produce', 'macroglossia.']]

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250_78

[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['A', '55-year-old', 'man,', 'father', 'of', 'a', 'celiac', 'child,', 'with', 'iron-deficiency', 'anemia', 'and', 'a', 'recent', 'increase', 'in', 'the', 'stool', 'rhythm,', 'has', 'been', 'tested', 'negative', 'for', 'HLA-DQ2', 'and', 'HLA-DQ8', 'alleles.'], ['Which', 'diagnostic', 'test', 'is', 'the', 'most', 'appropriate', 'in', 'this', 'case?'], ['1-', 'Determination', 'of', 'anti-transglutaminase', 'IgA', 'antibodies.'], ['2-', 'Upper', 'endoscopy', 'with', 'duodenal', 'biopsies.'], ['3-', 'D-xylose', 'test.'], ['4-', 'Evaluate', 'response', 'to', 'gluten-free', 'diet.'], ['5-', 'Colonoscopy.'], ['CORRECT', 'ANSWER:', '5'], ['Middle-aged', 'male', 'with', 'iron', 'deficiency', 'anemia', 'and', 'increased', 'number', 'of', 'stools,', 'a', 'colonoscopy', 'should', 'be', 'done', 'to', 'rule', 'out', 'colorectal', 'cancer!!!'], ['If', 'the', 'HLA', 'is', 'negative', 'it', 'is', 'very', 'unlikely', 'to', 'be', 'celiac', 'disease', '(high', 'negative', 'predictive', 'value).']]

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5_44

[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['A', '66-year-old', 'man', 'reports', 'daily', 'heartburn', 'since', 'youth,', 'which', 'he', 'treats', 'with', 'alkalis.'], ['An', 'upper', 'endoscopy', 'shows', 'mild', 'erosive', 'esophagitis', 'and', 'displaced', 'squamous', 'columnar', 'junction', 'approximately', '7', 'cm.'], ['The', 'esophageal', 'biopsies', 'showed', 'mild', 'erosive', 'esophagitis', 'and', 'a', 'columnar', 'squamous', 'junction', 'displaced', 'approximately', '7', 'cm', 'from', 'the', 'most', 'proximal', 'portion', 'of', 'the', 'gastric', 'folds.'], ['Biopsies', 'of', 'the', 'distal', 'esophagus', 'reveal', 'that', 'the', 'normal', 'squamous', 'epithelium', 'has', 'been', 'replaced', 'by', 'intestinal-type', 'columnar', 'epithelium', 'with', 'low-grade', 'dysplasia', 'What', 'is', 'the', 'most', 'appropriate', 'management', 'option', 'for', 'this', 'patient?'], ['1-', 'Given', 'that', 'the', 'esophagitis', 'is', 'mild', 'and', 'the', 'dysplasia', 'is', 'low', 'grade,', 'it', 'is', 'advisable', 'to', 'continue', 'treatment', 'with', 'alkalines.'], ['2-', 'Indefinite', 'treatment', 'with', 'high', 'doses', 'of', 'PPI', 'since', 'it', 'has', 'been', 'demonstrated', 'that', 'this', 'prevents', 'the', 'progression', 'of', "Barrett's", 'esophagus', 'to', 'adenocarcinoma,', 'making', 'endoscopic', 'surveillance', 'unnecessary.'], ['3-', 'Periodic', 'surveillance', 'endoscopies', 'and', 'treatment', 'with', 'PPIs', 'for', 'less', 'than', '12', 'weeks,', 'since', 'prolonged', 'treatment', 'is', 'associated', 'with', 'a', 'high', 'risk', 'of', 'gastrinoma', 'development.'], ['4-', 'Periodic', 'surveillance', 'endoscopies', 'and', 'indefinite', 'treatment', 'with', 'PPI.'], ['5-', 'Esophagectomy.'], ['CORRECT', 'ANSWER:', '4'], ['This', 'patient', 'presents', "Barrett's", 'esophagus', 'with', 'low', 'grade', 'dysplasia.'], ['I', 'do', 'not', 'like', 'the', 'question,', 'since', 'not', 'being', 'with', 'acid', 'production', 'inhibition', 'the', 'dysplasia', 'may', 'be', 'conditioned', 'by', 'inflammation', 'and', 'not', 'be', 'real.'], ['In', 'any', 'case,', "Barrett's", 'esophagus', 'should', 'follow', 'endoscopic', 'surveillance', 'and', 'lifelong', 'PPI', 'treatment', 'or', 'antireflux', 'surgery', 'to', 'prevent', 'progression.'], ['The', 'correct', 'answer', 'is', '4.']]

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359_91

[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['The', 'determination', 'in', 'a', '70-year-old', 'woman', 'of', 'hematocrit', '32%,', 'Hb', '9.6', 'g/dL,', 'MCV', '85', 'fL', '(70-99),', 'Fe', '25', 'ug/dL', '(37-145)', 'and', 'ferritin', '350', 'ng/mL', '(15-150),', 'is', 'more', 'suggestive', 'of:'], ['1-', 'Recent', 'blood', 'loss', 'through', 'the', 'digestive', 'tract.'], ['2-', 'Intestinal', 'malabsorption.'], ['3-', 'Polymyalgia', 'rheumatica.'], ['4-', 'Thalassemia', 'minor.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['Polymyalgia', 'rheumatica.'], ['Classic', 'example', 'I', 'suppose,', 'and', 'it', 'is', 'seen', 'in', 'the', 'clinic', 'in', 'droves.'], ['Older', 'woman', 'with', 'normocitic', 'anemia', 'and', 'clear', 'ferrokinetic', 'pattern', 'of', 'chronic', 'disorder', '(hyposideremia', 'but', 'hyperferritinemia).'], ['The', 'only', 'one', 'that', 'fits,', 'and', 'it', 'fits', 'perfectly,', 'is', 'number', '3;', 'they', 'only', 'needed', 'to', 'give', 'us', 'a', 'high', 'ESR.'], ['1:', 'if', 'it', 'is', 'a', 'recent', 'loss,', 'the', 'MCV', 'could', 'remain', 'normal,', 'but', 'the', 'ferritin', 'should', 'be', 'affected,', 'and', 'certainly', 'not', 'elevated.'], ['2:', 'the', 'same.', 'If', 'it', 'is', 'due', 'to', 'Fe', 'malabsorption,', 'ferritin', 'should', 'be', 'low.'], ['And', 'if', 'it', 'were', 'due', 'to', 'B12', 'malabsorption,', 'the', 'MCV', 'would', 'be', 'clearly', 'higher.'], ['4:', '70', 'tachycardia', 'and', 'normal', 'MCV.', 'This', 'one', 'is', 'too', 'much.']]

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108_219

[['QUESTION', 'TYPE:', 'GENETICS', 'AND', 'IMMUNOLOGY'], ['CLINICAL', 'CASE:'], ['A', 'man', 'has', 'a', 'partial', 'deletion', 'in', 'the', 'dystrophin', 'gene', '(chromosome', 'Xp21)', 'which', 'causes', 'the', 'semiology', 'of', 'Becker', 'muscular', 'dystrophy.'], ['He', 'goes', 'to', 'the', 'genetic', 'consultation', 'with', 'his', 'wife,', 'to', 'assess', 'the', 'risks', 'of', 'transmission', 'of', 'the', 'disease.'], ['What', 'correct', 'information', 'will', 'be', 'provided', 'in', 'the', 'course', 'of', 'the', 'genetic', 'counseling?'], ['1-', 'According', 'to', 'autosomal', 'dominant', 'inheritance,', 'half', 'of', 'her', 'children', 'will', 'inherit', 'the', 'disease', 'and', 'without', 'distinction', 'of', 'sexes.'], ['2-', 'Their', 'daughters', 'will', 'not', 'inherit', 'the', 'disease,', 'but', 'all', 'their', 'future', 'sons', 'will', 'be', 'carriers', 'and', 'can', 'transmit', 'the', 'mutation', 'to', '50%.'], ['3-', 'Their', 'sons', 'will', 'not', 'inherit', 'the', 'disease,', 'but', 'all', 'their', 'future', 'daughters', 'will', 'be', 'carriers', 'and', 'can', 'transmit', 'the', 'mutation', 'to', '50%.'], ['4-', 'There', 'is', 'no', 'risk:', 'the', 'inheritance', 'of', 'the', 'disease', 'is', 'of', 'the', 'mitochondrial', 'type,', 'never', 'transmitted', 'by', 'males.'], ['5-', 'According', 'to', 'autosomal', 'recessive', 'inheritance,', '25%', 'of', 'their', 'children', 'will', 'manifest', 'the', 'disease', 'in', 'childhood,', 'regardless', 'of', 'sex.'], ['CORRECT', 'ANSWER:', '3'], ['It', 'is', 'the', 'male', 'who', 'presents', 'the', 'disease,', 'which', 'we', 'are', 'told', 'is', 'X-linked,', 'so', 'there', 'are', 'only', 'two', 'options', 'left:', '2', 'and', '3.'], ['2', 'is', 'not', 'because', 'the', 'males', 'will', 'receive', 'the', 'Y', 'chromosome', 'from', 'the', 'father', 'and', 'the', 'X', 'from', 'the', 'mother,', 'who', 'is', 'healthy,', 'so', 'the', 'daughters', 'will', 'be', 'able', 'to', 'carry', 'the', 'disease', '(correct', 'option', '3).']]

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255_94

[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['A', '65-year-old', 'woman', 'with', 'a', 'history', 'of', 'joint', 'pain', 'and', 'under', 'treatment', 'with', 'anti-inflammatory', 'drugs', 'is', 'referred', 'for', 'anemia.'], ['In', 'the', 'complementary', 'studies', 'she', 'presented', 'red', 'blood', 'cells', '3,164,000,', 'Hto.', '32%,', 'Hb', '11g/dl,', 'MCV', '69', 'fl,', 'Leukocytes', '7800,', 'Platelets', '370,000,', 'CRP', '0.29', 'mg/dl,', 'Fe', '20ng/ml,', 'Ferritin', '18', 'ng/ml,', 'Glucose', '105', 'mg/dl,', 'GOT,', 'GPT,', 'GGT,', 'Alkaline', 'F,', 'total', 'Bilirubin,', 'Cholesterol,', 'Creatinine,', 'Calcium', 'and', 'Phosphorus', 'normal.'], ['Negative', 'antitransglutaminase', 'and', 'antigliadin', 'antibodies.'], ['Gastroscopy:', 'hiatus', 'hernia', 'of', '3', 'cm,', 'the', 'rest', 'without', 'alterations.'], ['Colonoscopy:', 'up', 'to', 'cecum,', 'isolated', 'diverticula', 'in', 'sigma.'], ['Intestinal', 'transit', 'without', 'alterations.'], ['Ultrasound', 'of', 'the', 'abdomen', 'without', 'alterations.'], ['Which', 'of', 'the', 'following', 'examinations', 'do', 'you', 'consider', 'most', 'appropriate', 'to', 'complete', 'the', 'study?'], ['1-', 'Jejunum', 'biopsy.'], ['2-', 'Arteriography.'], ['3-', 'Endoscopic', 'capsule.'], ['4-', 'Radioisotopes.'], ['5-', 'Pelvic', 'MRI.'], ['CORRECT', 'ANSWER:', '3'], ['It', 'is', 'a', 'study', 'of', 'iron', 'deficiency', 'anemia', 'with', 'normal', 'gastroscopy', 'and', 'colonoscopy,', 'having', 'ruled', 'out', 'possible', 'celiac', 'disease.'], ['We', 'have', 'yet', 'to', 'see', 'jejunum', 'and', 'ileum,', 'so', 'we', 'will', 'have', 'to', 'perform', 'a', 'capsule', 'endoscopy.'], ['In', 'iron', 'deficiency', 'anemia,', 'a', 'digestive', 'cause', 'must', 'always', 'be', 'ruled', 'out.']]

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303_111

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['In', 'a', 'patient', 'with', 'rheumatoid', 'arthritis', 'on', 'methotrexate,', 'prednisone', 'and', 'indomethacin', 'who', 'acutely', 'presents', 'with', 'edema', 'and', 'increased', 'plasma', 'creatinine', 'with', 'poorly', 'expressive', 'urine', 'sediment', 'and', 'proteinuria', 'less', 'than', '100', 'mg/24', 'h', 'the', 'most', 'likely', 'cause', 'is:'], ['1-', 'Renal', 'amyloidosis.'], ['2-', 'Glomerulonephritis', 'secondary', 'to', 'rheumatoid', 'arthritis.'], ['3-', 'Renal', 'failure', 'due', 'to', 'nonsteroidal', 'anti-inflammatory', 'drugs.'], ['4-', 'Interstitial', 'nephritis', 'due', 'to', 'methotrexate.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['Amyloidosis', 'presents', 'with', 'proteinuria', 'usually', 'in', 'the', 'nephrotic', 'range,', 'and', 'has', 'a', 'more', 'chronic', 'course.'], ['GMN', 'associated', 'with', 'rheumatoid', 'arthritis', 'characteristically', 'alters', 'the', 'sediment,', 'and', 'renal', 'failure', 'due', 'to', 'NSAIDs', 'has', 'a', 'more', 'chronic', 'course,', 'with', 'papillary', 'necrosis.'], ['Thus,', 'given', 'the', 'course', 'and', 'the', 'alterations', 'described,', 'interstitial', 'nephritis', 'due', 'to', 'methotrexate', 'is', 'more', 'likely,', 'which', 'is', 'more', 'directly', 'toxic', 'than', 'allergic,', 'hence', 'the', 'absence', 'of', 'pyuria,', 'eosinophilia,', 'fever', 'or', 'other', 'hypersensitivity', 'data.']]

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539_3

408_190

[['QUESTION', 'TYPE:', 'PRIMARY', 'CARE'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman', 'diagnosed', 'with', 'stage', 'IV', 'breast', 'cancer', 'with', 'multiple', 'bone', 'metastases', 'on', 'hormonal', 'treatment', 'and', 'iv', 'bisphosphonates.'], ['She', 'comes', 'to', 'your', 'office', 'referring', 'intense', 'bone', 'pain', '(VAS=7),', 'in', 'several', 'locations', 'without', 'associated', 'neurological', 'symptoms', 'and', 'exarcerbations', 'of', 'pain', '(VAS=9)', 'several', 'times', 'a', 'day', 'that', 'force', 'her', 'to', 'remain', 'at', 'rest.'], ['In', 'the', 'treatment', 'with', 'ibuprofen', '(600', 'mg', 'every', '8', 'h)', 'and', 'tramadol', '(150', 'mg', 'per', 'day),', 'what', 'treatment', 'would', 'you', 'consider', 'most', 'appropriate', 'in', 'this', 'patient', 'to', 'improve', 'the', 'pain?'], ['1-', 'Suspend', 'ibuprofen', 'and', 'tramadol', 'and', 'start', 'a', 'major', 'opioid', 'such', 'as', 'morphine', 'or', 'oxycodone.'], ['2-', 'Suspend', 'tramadol,', 'maintain', 'ibuprofen', 'and', 'initiate', 'a', 'major', 'opioid', 'such', 'as', 'morphine', 'and', 'oxycodone.'], ['3-', 'Discontinue', 'ibuprofen', 'and', 'tramadol', 'and', 'start', 'a', 'major', 'opioid', 'such', 'as', 'morphine', 'or', 'oxycodone', 'and', 'at', 'the', 'same', 'time', 'start', 'treatment', 'of', 'breakthrough', 'pain', 'with', 'sublingual', 'fentanyl.'], ['4-', 'Suspend', 'tramadol,', 'maintain', 'ibuprofen', 'and', 'initiate', 'a', 'major', 'opioid', 'such', 'as', 'morphine', 'and', 'oxycodone', 'and', 'at', 'the', 'same', 'time', 'treatment', 'for', 'breakthrough', 'pain', 'with', 'sublingual', 'fentanyl.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '4'], ['The', 'correct', 'answer', 'is', '4', 'because', 'if', 'the', 'patient', 'has', 'bone', 'metastases', 'and', 'may', 'suffer', 'fractures', 'we', 'can', 'control', 'inflammatory', 'pain', 'with', 'ibuprofen', 'and', 'it', 'will', 'also', 'help', 'us', 'to', 'use', 'the', 'antalgic', 'synergy.'], ['We', 'should', 'change', 'the', 'treatment', 'to', 'a', 'major', 'opioid', 'and', 'treat', 'the', 'disrruptive', 'pain', 'vigorously', 'since', 'she', 'is', 'at', 'almost', 'the', 'maximum', 'pain', 'she', 'can', 'bear.']]

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29_60

[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'THORACIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '71-year-old', 'patient,', 'smoker', 'of', '2', 'packs', 'of', 'cigarettes/day', 'for', '50', 'years,', 'with', 'good', 'quality', 'of', 'life', 'and', 'no', 'other', 'pathologic', 'history', 'of', 'interest,', 'consults', 'for', 'cough', 'and', 'hemoptotic', 'expectoration.'], ['Physical', 'examination', 'revealed', 'no', 'significant', 'pathological', 'findings.'], ['Chest', 'X-ray', 'showed', 'a', 'mass', 'of', '4x3.4', 'cm', 'lower', 'right,', 'a', 'finding', 'that', 'was', 'confirmed', 'in', 'the', 'thoracoabdominal', 'CT', 'scan,', 'which', 'located', 'the', 'lesion', 'in', 'the', 'lower', 'lobe', 'and', 'found', 'no', 'adenopathy', 'or', 'metastasis.'], ['Bronchoscopy', 'showed', 'an', 'infiltrating', 'lesion', 'in', 'the', 'right', 'basal', 'pyramid,', 'biopsied', 'as', 'a', 'well-differentiated', 'squamous', 'cell', 'carcinoma.'], ['As', 'for', 'respiratory', 'function', 'tests,', 'the', 'FVC', 'is', '3,300', 'cc', '(84%)', 'and', 'the', 'FEV', '1', 'is', '2,240', 'cc', '(80%).'], ['What', 'should', 'be', 'the', 'next', 'step', 'to', 'follow', 'in', 'this', 'patient?'], ['1-', 'Perform', 'mediastinoscopy.'], ['2-', 'Surgical', 'intervention', 'with', 'curative', 'intent', 'should', 'be', 'contraindicated', 'due', 'to', 'the', 'advanced', 'age', 'of', 'the', 'patient.'], ['3-', 'An', 'oxygen', 'consumption', 'test', 'should', 'be', 'performed,', 'given', 'the', 'respiratory', 'limitation', 'he', 'presents.'], ['4-', 'Surgical', 'resection', '(lobectomy', 'of', 'the', 'lower', 'lobe', 'of', 'the', 'right', 'lung)', 'should', 'be', 'indicated', 'directly.'], ['5-', 'A', 'trantoracic', 'puncture', 'should', 'be', 'performed.'], ['CORRECT', 'ANSWER:', '4'], ['1', 'and', '5:', 'These', 'are', 'diagnostic', 'tests,', 'they', 'are', 'meaningless', 'since', 'you', 'have', 'already', 'made', 'the', 'diagnosis.'], ['2:', 'Age', 'should', 'not', 'be', 'a', 'limiting', 'factor,', 'especially', 'considering', 'that', 'it', 'is', 'only', '71', 'years', 'old,', 'but', 'especially', 'because', 'the', "patient's", '"quality', 'of', 'life"', 'is', 'good', '(and', 'I', 'put', '"quality', 'of', 'life"', 'because', 'it', 'is', 'a', 'term', 'used', 'erroneously,', 'it', 'is', 'supposed', 'to', 'mean', 'that', 'he', 'maintains', 'a', 'good', 'functional', 'level).'], ['3:', 'Presents', 'a', 'very', 'mild', 'respiratory', 'limitation,', 'does', 'not', 'require', 'such', 'a', 'test.'], ['4:', 'Is', 'the', 'correct', 'one.']]

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10_37

[['QUESTION', 'TYPE:', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '76-year-old', 'woman', 'with', 'no', 'history', 'other', 'than', 'hypertension', 'consults', 'for', 'painless', 'jaundice', 'and', 'pruritus', 'with', 'anorexia.'], ['Laboratory', 'tests', 'show', 'a', 'bilirubin', 'level', 'of', '12', 'mg/dl', '(with', '9.5', 'direct', 'bilirubin).'], ['Abdominal', 'ultrasound', 'shows', 'dilatation', 'of', 'the', 'intrahepatic', 'and', 'extrahepatic', 'biliary', 'tract,', 'together', 'with', 'a', 'single', '2', 'cm', 'nodule', 'located', 'peripherally', 'in', 'the', 'anterior', 'aspect', 'of', 'the', 'left', 'lobe.'], ['CT', 'scan', 'confirms', 'the', 'findings,', 'also', 'demonstrating', 'the', 'presence', 'of', 'a', '3.5', 'cm', 'mass', 'in', 'the', 'head', 'of', 'the', 'pancreas.'], ['Fine', 'needle', 'aspiration', 'confirms', 'the', 'diagnosis', 'of', 'adenocarcinoma.'], ['Indicate', 'the', 'best', 'therapeutic', 'option:'], ['1-', 'Adjuvant', 'chemo/radiotherapy,', 'conditioning', 'radical', 'surgery', 'to', 'the', 'initial', 'response.'], ['2-', 'Percutaneous', 'external', 'drainage', 'is', 'palliative,', 'with', 'eventual', 'conversion', 'to', 'internal', 'drainage', 'in', 'case', 'of', 'intolerance', 'or', 'complications.'], ['3-', 'Surgical', 'biliary', 'bypass,', 'with', 'or', 'without', 'prophylactic', 'gastrojejunostomy', 'depending', 'on', 'intraoperative', 'findings.'], ['4-', 'Metallic', 'biliary', 'prosthesis', 'by', 'endoscopic', 'retrograde', 'cholangiography,', 'with', 'the', 'option', 'of', 'palliative', 'chemotherapy.'], ['5-', 'Cephalic', 'duodenopancreatectomy', 'with', 'radiofrequency', 'ablation', 'or', 'alcoholization', 'of', 'the', 'liver', 'lesion.'], ['CORRECT', 'ANSWER:', '4'], ['I', 'think', 'the', 'correct', 'answer', 'is', '4,', 'although', 'both', 'lesions', 'are', 'resectable,', 'pancreatic', 'adenocarcinoma', 'with', 'synchronous', 'hepatic', 'metastases', 'has', 'no', 'surgical', 'indication', 'because', 'it', 'does', 'not', 'prolong', 'survival', 'and', 'has', 'a', 'high', 'morbidity.'], ['Surgical', 'bypass', 'has', 'more', 'complications', 'than', 'placing', 'a', 'self-expanding', 'metallic', 'prosthesis', 'that', 'has', 'a', 'median', 'patency', 'of', '6', 'months', 'which', 'is', 'similar', 'to', 'the', 'median', 'survival', 'of', 'a', 'patient', 'with', 'hepatic', 'metastases', 'of', 'pancreatic', 'adenocarcinoma.']]

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284_57

188_230

[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '57-year-old', 'patient', 'had', 'an', 'acute', 'myocardial', 'infarction', 'and', 'has', 'a', 'blood', 'test', 'with', 'cholesterol', '312', 'mg/dl,', 'LDL', '241', 'mg/dl,', 'HDL', '29', 'and', 'normal', 'TG.'], ['He', 'smoked', '30', 'cig/day,', 'was', 'not', 'obese,', 'his', 'blood', 'pressure', 'was', '145/90', 'mm', 'Hg', 'and', 'he', 'did', 'not', 'have', 'diabetes.'], ['When', 'asked', 'about', 'family', 'history,', 'he', 'mentioned', 'that', 'an', 'uncle', 'on', 'his', "mother's", 'side', 'died', 'suddenly', 'at', '53', 'years', 'of', 'age.'], ['Which', 'answer', 'do', 'you', 'agree', 'with', 'the', 'most?'], ['1-', 'Treat', 'with', 'statins', 'until', 'cholesterol', 'is', 'normalized', 'and', 'recommend', 'healthy', 'lifestyle', '(diet,', 'exercise', 'and', 'no', 'smoking).'], ['2-', 'Rule', 'out', 'hypothyroidism', 'or', 'other', 'systemic', 'disease,', 'recommend', 'a', 'healthy', 'lifestyle', 'and', 'treat', 'with', 'fibrates', 'to', 'normalize', 'cholesterol.'], ['3-', 'It', 'is', 'not', 'necessary', 'to', 'rule', 'out', 'secondary', 'dyslipidemia', 'because', 'it', 'is', 'infrequent.', 'A', 'family', 'lipid', 'profile', 'should', 'be', 'performed.'], ['4-', 'Rule', 'out', 'secondary', 'dyslipidemia,', 'treat', 'with', 'resins', '(resincholestyramine)', 'and', 'fibrates', 'and', 're-commend', 'a', 'healthy', 'lifestyle.', 'Prohibit', 'alcohol.'], ['5-', 'Rule', 'out', 'secondary', 'dyslipidemia,', 'request', 'a', 'family', 'study', 'and', 'treat', 'with', 'statins', 'to', 'maintain', 'a', 'good', 'lipid', 'profile.', 'Control', 'of', 'other', 'risk', 'factors.'], ['CORRECT', 'ANSWER:', '5'], ['Question', 'on', 'a', 'fashionable', 'topic', 'in', 'recent', 'years:', 'dyslipidemia;', 'I', 'would', 'answer', 'it', 'by', 'rule', 'out.'], ['The', 'treatment', 'for', 'hypercholesterolemia', 'is', 'statins', 'so', 'we', 'rule', 'out', 'answers', '2', 'and', '4.'], ['The', 'statin', 'in', 'a', 'patient', 'with', 'cardiovascular', 'disease', '(such', 'as', 'an', 'AMI)', 'is', 'a', 'lifelong', 'treatment', '(we', 'discard', '1)', 'since', 'it', 'is', 'not', 'taken', 'until', 'LDL', 'levels', 'are', 'normalized.'], ['Between', '3', 'and', '5,', '5', 'is', 'more', 'complete', 'as', 'it', 'includes', 'treatment', 'and', 'control', 'of', 'other', 'risk', 'factors.'], ['Ruling', 'out', 'secondary', 'dyslipidemia', 'is', 'easy', 'with', 'the', "patient's", 'clinical', 'history', 'and', 'a', 'blood', 'test', 'with', 'thyroid', 'function.']]

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349_160

[['QUESTION', 'TYPE:', 'GYNECOLOGY', 'AND', 'OBSTETRICS'], ['CLINICAL', 'CASE:'], ['A', '45-year-old', 'woman,', 'mother', 'of', '3', 'children,', 'attends', 'an', 'early', 'diagnosis', 'consultation.'], ['Cervicovaginal', 'cytology', 'is', 'compatible', 'with', 'a', 'high-grade', 'squamous', 'intraepithelial', 'lesion.'], ['Which', 'of', 'the', 'following', 'options', 'would', 'you', 'choose?'], ['1-', 'Repeat', 'cytology', 'in', '1', 'month.'], ['2-', 'Colposcopy', 'with', 'possible', 'biopsy.'], ['3-', 'Hysterectomy', 'with', 'bilateral', 'salpinguectomy', 'and', 'ovarian', 'conservation.'], ['4-', 'Fractionated', 'uterine', 'curettage.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['The', 'correct', 'answer', 'is', '2.'], ['According', 'to', 'the', '2014', 'SEGO', 'Oncoguide', 'on', 'cervical', 'cancer', 'prevention,', 'when', 'a', 'cytology', 'shows', 'a', 'high-grade', 'squamous', 'intraepithelial', 'lesion,', 'the', 'action', 'to', 'be', 'taken', 'is', 'a', 'colposcopy,', 'with', 'or', 'without', 'biopsy', 'depending', 'on', 'the', 'findings', '(regardless', 'of', 'the', "patient's", 'age', 'and', 'parity).']]

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290_50

[['QUESTION', 'TYPE:', 'DERMATOLOGY,', 'VENEREOLOGY', 'AND', 'PLASTIC', 'SURGERY'], ['CLINICAL', 'CASE:'], ['A', '58-year-old', 'man', 'referred', 'a', '3-week', 'history', 'of', 'progressive,', 'mildly', 'painful', 'skin', 'lesions', 'on', 'his', 'left', 'arm.'], ['It', 'had', 'started', 'as', 'an', 'erythematous', 'lesion', 'on', 'his', 'left', 'thumb.'], ['He', 'had', 'visible', 'reddish', 'striae', 'as', 'connecting', 'lines', 'between', 'the', 'lesions.'], ['The', 'patient', 'had', 'no', 'fever', 'or', 'other', 'general', 'symptoms.'], ['He', 'had', 'been', 'working', 'in', 'his', 'garden', 'but', 'did', 'not', 'remember', 'any', 'injuries.'], ['The', 'etiologic', 'diagnosis', 'was', 'made', 'by', 'culture', 'of', 'a', 'skin', 'biopsy.'], ['What', 'is', 'the', 'most', 'likely', 'causative', 'agent', 'of', 'this', 'process?'], ['1-', 'Dermatophytosis', 'due', 'to', 'Microsporum', 'gypseum.'], ['2-', 'Cutaneous', 'infection', 'by', 'Staphylococcus', 'aureus.'], ['3-', 'Sporotrichosis.'], ['4-', 'Cutaneous', 'infection', 'by', 'Mycobacterium', 'marinum.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['The', 'lesions', 'with', 'sporotrichoid', 'or', 'lymphocutaneous', 'pattern', 'described', 'may', 'correspond', 'to', 'sporotrichosis', 'or', 'aquarium', 'granuloma,', 'so', 'the', 'first', 'two', 'would', 'be', 'ruled', 'out.'], ['The', 'history', 'of', 'having', 'been', 'working', 'in', 'the', 'garden', 'points', 'more', 'to', 'a', 'sporotrichosis,', 'although', 'the', 'fact', 'that', 'the', 'question', 'asks', 'for', 'the', '"causative', 'agent"', 'and', 'not', 'the', 'name', 'of', 'the', 'disease', 'misleads', 'a', 'little,', 'so', 'that', 'if', 'we', 'consider', 'sporotrichosis', 'in', 'reality', 'the', 'answer', 'should', 'be', 'Sporothrix', 'schenckii', 'Despite', 'this,', 'knowing', 'that', 'this', 'question', 'will', 'be', 'correct', 'for', 'many', 'examinees', 'although', 'it', 'is', 'poorly', 'worded', '-which', 'cancels', 'it', 'directly-', 'the', 'challenge', 'will', 'not', 'be', 'promoted.']]

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

305_174

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['An', '87-year-old', 'man', 'with', 'a', 'history', 'of', 'hypertension', 'and', 'gonarthrosis.'], ['Baseline', 'situation', 'with', 'full', 'functional', 'and', 'cognitive', 'autonomy', 'that', 'allows', 'him', 'to', 'continue', 'living', 'alone', 'in', 'the', 'community.'], ['He', 'is', 'receiving', 'regular', 'treatment', 'with', 'perindopril', 'and', 'thiazide', 'diuretic', 'for', 'blood', 'pressure', 'control', 'and', 'routinely', 'takes', 'ibuprofen', '1800', 'mg/day', 'to', 'control', 'the', 'symptoms', 'derived', 'from', 'his', 'gonarthrosis.'], ['After', 'routine', 'control,', 'a', 'persistent', 'blood', 'pressure', 'of', '190', 'and', 'TAD', '80', 'mmHg', 'was', 'observed.'], ['What', 'would', 'be', 'the', 'most', 'reasonable', 'therapeutic', 'modification', 'to', 'achieve', 'blood', 'pressure', 'control?'], ['1-', 'I', 'would', 'add', 'a', 'calcium', 'channel', 'blocker.'], ['2-', 'I', 'would', 'increase', 'the', 'dose', 'of', 'hydrochlorothiazide', 'to', '25', 'mg/day.'], ['3-', 'I', 'would', 'change', 'ibuprofen', 'to', 'paracetamol', 'to', 'avoid', 'the', 'possible', 'influence', 'of', 'paracetamol', 'on', 'the', 'effect', 'of', 'hypotensives.'], ['4-', 'I', 'would', 'add', 'an', 'alpha-blocker', 'because', 'of', 'the', 'high', 'prevalence', 'of', 'prostatic', 'syndrome', 'in', 'males', 'of', 'this', 'age.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['One', 'of', 'the', 'mechanisms', 'that', 'produce', 'the', 'hypotensive', 'effect', 'of', 'ACE', 'inhibitors', 'such', 'as', 'perindopril', 'is', 'the', 'increased', 'action', 'of', 'vasodilator', 'prostaglan-dins', 'on', 'the', 'kidney,', 'which', 'decreases', 'hydrosaline', 'retention', 'and', 'therefore', 'increases', 'diuresis', 'and', 'lowers', 'blood', 'pressure.'], ['NSAIDs', 'inhibit', 'prostaglandin', 'synthesis', 'and', 'decrease', 'renal', 'perfusion,', 'thus', 'antagonizing', 'the', 'hypotensive', 'effect', 'of', 'many', 'antihypertensives,', 'including', 'ACE', 'inhibitors.'], ['Therefore,', 'the', 'preferable', 'thing', 'to', 'do', 'in', 'this', 'patient,', 'before', 'increasing', 'the', 'medication,', 'is', 'to', 'change', 'the', 'ibuprofen', 'for', 'paracetamol,', 'which', 'does', 'not', 'have', 'this', 'effect,', 'and', 'to', 're-evaluate', 'it', 'later.']]

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104_91

38_232

[['QUESTION', 'TYPE:', 'OPHTHALMOLOGY'], ['CLINICAL', 'CASE:'], ['A', '52-year-old', 'woman', 'consults', 'for', 'having', 'noticed', 'during', 'the', 'previous', 'week', 'a', 'yellowish', 'discoloration', 'of', 'the', 'conjunctivae.'], ['She', 'does', 'not', 'refer', 'to', 'risky', 'sexual', 'behavior', 'or', 'epidemiological', 'history', 'of', 'risk', 'of', 'viral', 'hepatitis.'], ['She', 'does', 'not', 'consume', 'alcohol', 'or', 'hepatotoxic', 'drugs.'], ['She', 'reports', 'a', 'one-year', 'history', 'of', 'generalized', 'pruritus,', 'asthenia,', 'dry', 'mouth', 'and', 'absence', 'of', 'lacrimation', 'with', 'no', 'known', 'cause.'], ['Rest', 'of', 'the', 'anamnesis', 'without', 'pathological', 'data.'], ['Physical', 'examination', 'showed', 'scratching', 'lesions', 'conjunctival', 'jaundice', 'and', 'non-painful', 'hepatomegaly.'], ['The', 'patient', 'brings', 'a', 'blood', 'test', 'carried', 'out', 'in', 'his', 'company', 'with', 'the', 'following', 'pathological', 'results:', 'total', 'bilirubin', '3', 'mg/dl', 'alkaline', 'phosphatase', '400', 'UI', 'sedimentation', 'rate', '40', 'mm', 'at', 'the', 'first', 'hour.'], ['Indicate', 'which', 'would', 'be', 'the', 'best', 'recommendation', 'to', 'establish', 'the', 'etiological', 'diagnosis', 'of', 'the', "patient's", 'condition:'], ['1-', 'Anti-mitochondrial', 'antibodies.'], ['2-', 'Study', 'of', 'iron', 'metabolism.'], ['3-', 'Study', 'of', 'copper', 'metabolism.'], ['4-', 'Hepatic', 'MRI.'], ['5-', 'Serology', 'of', 'virus', 'B', 'and', 'virus', 'C.'], ['CORRECT', 'ANSWER:', '1'], ['A', 'middle-aged', 'woman', 'with', "Sjögren's-like", 'symptoms', '(absence', 'of', 'lacrimation,', 'dry', 'mouth),', 'with', 'hyperbilirubinemia,', 'jaundice', 'and', 'hepatomegaly,', 'makes', 'us', 'think', 'of', 'primary', 'biliary', 'cirrhosis.'], ['To', 'diagnose', 'it', 'we', 'will', 'use', 'antimitochondrial', 'antibodies', '(AMA', 'IgG).'], ['Therefore,', 'it', 'would', 'be', 'answer', '1.']]

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

376_130

[['QUESTION', 'TYPE:', 'NEUROLOGY'], ['CLINICAL', 'CASE:'], ['A', '39-year-old', 'man', 'who', 'in', 'the', 'last', '3', 'months', 'has', 'had', 'two', 'episodes', 'of', 'wide', 'and', 'involuntary', 'jumping', 'movements', 'of', 'the', 'left', 'limbs,', 'which', 'in', 'about', 'two', 'minutes', 'lead', 'to', 'loss', 'of', 'consciousness.'], ['In', 'the', 'neuroradiological', 'study', 'a', 'right', 'frontal', 'expansive', 'lesion', 'suggestive', 'of', 'cerebral', 'glioma', 'was', 'found.How', 'would', 'you', 'classify', 'this', "patient's", 'epilepsy?'], ['1-', 'Generalized', 'symptomatic.'], ['2-', 'Partially', 'symptomatic.'], ['3-', 'Partial', 'cryptogenic.'], ['4-', 'Partial', 'secondarily', 'generalized', 'symptomatic.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '2'], ['They', 'refer', 'to', 'a', 'partial', 'seizure', 'that', 'is', 'followed', 'by', 'loss', 'of', 'level', 'of', 'consciousness,', 'so', 'strictly', 'speaking', 'it', 'would', 'be', 'a', 'symptomatic', 'complex', 'partial', 'seizure,', 'not', 'a', 'secondarily', 'generalized', 'partial', 'seizure', '(which', 'occurs', 'when', 'tonic-clonic', 'movements', 'extend', 'to', 'the', 'rest', 'of', 'the', 'extremities).'], ['For', 'this', 'reason', 'the', 'most', 'correct', 'option', 'would', 'be', 'two', 'because', 'it', 'does', 'not', 'specify', 'that', 'it', 'is', 'a', 'simple', 'symptomatic', 'partial', 'seizure,', 'but', 'leaves', 'open', 'the', 'possibility', 'that', 'it', 'is', 'a', 'simple', 'or', 'complex', 'symptomatic', 'partial', 'seizure.']]

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

163_122

[['QUESTION', 'TYPE:', 'NEPHROLOGY'], ['CLINICAL', 'CASE:'], ['A', '66-year-old', 'man', 'with', 'a', 'history', 'of', 'ankylosing', 'spondylitis', 'of', 'long', 'evolution.'], ['He', 'presents', 'proteinuria', 'of', '6', 'grams', 'per', 'day', 'with', 'hypoalbuminemia', 'and', 'edema.'], ['In', 'the', 'urinary', 'sediment', 'no', 'hematuria', 'is', 'detected.'], ['His', 'plasma', 'creatinine', 'is', '1.6', 'mg/dL', 'and', 'his', 'glomerular', 'filtration', 'rate', 'is', '45', 'mL/min.'], ['Glycemia', '110', 'mg/dL.'], ['His', 'severe', 'spinal', 'deformity', 'makes', 'it', 'difficult', 'to', 'perform', 'percutaneous', 'renal', 'biopsy.'], ['What', 'is', 'the', 'correct', 'initial', 'approach?'], ['1-', 'To', 'initiate', 'corticoids', 'for', 'suspicion', 'of', 'minimal', 'change', 'glomerular', 'disease.'], ['2-', 'Treat', 'with', 'cyclophosphamide', 'for', 'suspected', 'membranous', 'glomerulopathy.'], ['3-', 'Subcutaneous', 'fat', 'biopsy.'], ['4-', 'Initiate', 'dialysis.'], ['5-', 'Glucose', 'overload', 'test', 'to', 'rule', 'out', 'diabetic', 'nephropathy.'], ['CORRECT', 'ANSWER:', '3'], ['The', 'correct', 'answer', 'is:', '3.'], ['Subcutaneous', 'fat', 'biopsy.'], ['Lupus', 'erythematosus,', 'some', 'vasculitides,', "Goodpasture's", 'disease', 'and', 'other', 'systemic', 'diseases', '(ankylosing', 'spondylitis', 'is', 'one', 'of', 'them)', 'affect', 'the', 'kidney', 'and', 'condition', 'its', 'prognosis.'], ['The', 'appearance', 'of', 'urinary', 'abnormalities', 'or', 'renal', 'impairment', 'of', 'parenchymal', 'cause', 'are', 'indications', 'for', 'renal', 'biopsy,', 'even', 'with', 'proteinuria', 'ranges', 'lower', 'than', 'those', 'accepted', 'in', 'primary', 'nephropathies.'], ['The', 'determination', 'of', 'anti-GBM', 'antibodies', 'and', 'ANCAS', 'are', 'helpful', 'for', 'diagnosis,', 'but', 'they', 'do', 'not', 'replace', 'renal', 'biopsy,', 'since', 'they', 'lack', 'prognostic', 'value', 'and', 'do', 'not', 'help', 'to', 'plan', 'treatment.'], ['In', 'this', 'case,', 'in', 'which', 'we', 'are', 'led', 'to', 'think', 'that', 'renal', 'biopsy', 'is', 'not', 'possible,', 'we', 'must', 'relate', 'AE', 'to', 'renal', 'failure.'], ['In', 'most', 'cases,', 'the', 'relationship', 'is', 'established', 'by', 'an', 'IgA', 'nephropathy,', 'which', 'presents', 'with', 'hematuria,', 'a', 'symptom', 'that', 'claims', 'not', 'to', 'exist', 'in', 'this', 'case.'], ['A', 'non-negligible', 'number', 'of', 'patients', 'with', 'evolved', 'AD', 'is', 'amyloidosis,', 'which', 'also', 'matches', 'the', "patient's", 'symptomatology.'], ['Therefore,', 'and', 'given', 'that', 'amyloidosis', 'can', 'be', 'diagnosed', 'with', 'a', 'subcutaneous', 'fat', 'biopsy,', 'it', 'is', 'answer', '3', 'that', 'should', 'be', 'considered', 'valid.']]

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148_158

[['QUESTION', 'TYPE:', 'PSYCHIATRY'], ['CLINICAL', 'CASE:'], ['A', '23-year-old', 'woman', 'comes', 'to', 'the', 'emergency', 'department', 'because', 'she', 'is', 'very', 'nervous', 'after', 'an', 'argument', 'with', 'her', 'partner.'], ['Her', 'medical', 'history', 'shows', 'several', 'similar', 'complaints', 'in', 'the', 'previous', 'year,', 'two', 'of', 'them', 'after', 'a', 'self-injurious', 'gesture.'], ['Frequent', 'conflicts', 'in', 'the', "couple's", 'relationship,', 'job', 'changes', 'and', 'family', 'arguments', 'are', 'also', 'noted.'], ['She', 'says', 'she', 'feels', 'misunderstood', 'by', 'everyone,', 'including', 'the', 'psychiatrists', 'attending', 'her.'], ['The', 'diagnosis', 'is:'], ['1-', 'Borderline', 'personality', 'disorder.'], ['2-', 'Histrionic', 'personality', 'disorder.'], ['3-', 'Dysthymia.'], ['4-', 'Dissociative', 'disorder.'], ['5-', 'Depersonalization', 'disorder.'], ['CORRECT', 'ANSWER:', '1'], ['The', 'woman', 'is', '23', 'years', 'old', 'and', 'is', 'pissed', 'off.'], ['She', 'needs', 'support', 'and', 'a', 'lot', 'of', 'emotional', 'education', 'to', 'curb', 'her', 'impulsivity...', 'she', 'feels', 'misunderstood...', 'maybe', 'she', 'is', 'right...'], ['The', 'issue', 'is', 'that', 'she', 'cannot', 'stand', 'rejection', 'and', 'has', 'self-injurious', 'gestures.'], ['The', 'diagnosis', 'is', '1.'], ['3,', '4', 'and', '5', 'are', 'not', 'even', 'close,', 'there', 'is', 'no', 'clinical', 'picture', 'described', 'in', 'the', 'question.'], ['Then', 'in', 'real', 'life', 'exploring', 'well', 'almost', 'certainly', 'there', 'would', 'be', 'dissociative', 'and', 'depersonalization', 'symptoms,', 'as', 'well', 'as', 'depressive', 'symptoms...', 'but', 'symptom', 'is', 'not', 'disorder.'], ['Why', 'not', '2?'], ['It', 'could', 'also', 'be', 'very', 'punctilious', 'and', 'spinning', 'very', 'fine...', 'here', 'the', 'discussion', 'is', 'served.'], ['I', 'put', 'the', 'criteria', 'of', 'each', 'one', 'and', 'we', 'talk', 'about', 'it,...', 'but', 'the', 'intention', 'of', 'the', 'examiner', 'was', 'the', '1', 'and', 'I', 'see', 'it', 'well', 'defended.'], ['It', 'cannot', 'be', 'challenged.'], ['-', 'The', 'limit:', 'A', 'general', 'pattern', 'of', 'instability', 'in', 'interpersonal', 'relationships,', 'self-image', 'and', 'self-efficacy,', 'and', 'notable', 'impulsivity,', 'beginning', 'in', 'early', 'adulthood', 'and', 'occurring', 'in', 'a', 'variety', 'of', 'contexts,', 'as', 'indicated', 'by', 'five', '(or', 'more)', 'of', 'the', 'following', 'items:', '1.'], ['Frantic', 'efforts', 'to', 'avoid', 'real', 'or', 'imagined', 'abandonment.'], ['Note:', 'Do', 'not', 'include', 'suicidal', 'or', 'self-mutilating', 'behaviors', 'covered', 'in', 'Criterion', '5.'], ['2.'], ['A', 'pattern', 'of', 'unstable', 'and', 'intense', 'interpersonal', 'relationships', 'characterized', 'by', 'alternating', 'between', 'extremes', 'of', 'idealization', 'and', 'devaluation.'], ['3.'], ['Identity', 'disturbance:', 'marked', 'and', 'persistently', 'unstable', 'self-image', 'or', 'sense', 'of', 'self.'], ['Impulsivity', 'in', 'at', 'least', 'two', 'areas,', 'which', 'is', 'potentially', 'self-harming', '(e.g.,', 'spending,', 'sex,', 'substance', 'abuse,', 'reckless', 'driving,', 'binge', 'eating).'], ['Note:', 'Do', 'not', 'include', 'suicidal', 'or', 'self-mutilating', 'behaviors', 'listed', 'in', 'Criterion', '5.'], ['5.'], ['Recurrent', 'suicidal', 'behaviors,', 'attempts', 'or', 'threats,', 'or', 'self-mutilating', 'behavior.'], ['Affective', 'instability', 'due', 'to', 'marked', 'mood', 'reactivity', '(e.g.,', 'episodes', 'of', 'intense', 'dysphoria,', 'irritability,', 'or', 'anxiety,', 'usually', 'lasting', 'a', 'few', 'hours', 'and', 'rarely', 'a', 'few', 'days).'], ['7.'], ['Chronic', 'feelings', 'of', 'emptiness.'], ['8.'], ['Inappropriate', 'and', 'intense', 'anger', 'or', 'difficulties', 'in', 'controlling', 'anger', '(e.g.,', 'frequent', 'displays', 'of', 'temper,', 'constant', 'anger,', 'recurrent', 'physical', 'fights).'], ['9.'], ['Transient', 'stress-related', 'paranoid', 'ideation', 'or', 'severe', 'dissociative', 'symptoms.'], ['-', 'The', 'histrionic:', 'A', 'general', 'pattern', 'of', 'excessive', 'emotionality', 'and', 'attention-seeking,', 'beginning', 'in', 'early', 'adulthood', 'and', 'occurring', 'in', 'a', 'variety', 'of', 'contexts,', 'as', 'indicated', 'by', 'five', '(or', 'more)', 'of', 'the', 'following', 'items:', '1.'], ['Not', 'comfortable', 'in', 'situations', 'where', 'he/she', 'is', 'not', 'the', 'center', 'of', 'attention.'], ['Interaction', 'with', 'others', 'is', 'often', 'characterized', 'by', 'sexually', 'seductive', 'or', 'provocative', 'behavior.'], ['3.'], ['3.'], ['Displays', 'a', 'superficial', 'and', 'rapidly', 'changing', 'emotional', 'expression.'], ['4.'], ['Constantly', 'uses', 'physical', 'appearance', 'to', 'draw', 'attention', 'to', 'him/herself.'], ['5.'], ['Has', 'a', 'way', 'of', 'speaking', 'that', 'is', 'excessively', 'subjective', 'and', 'lacking', 'in', 'nuance.'], ['6.'], ['Shows', 'self-dramatization,', 'theatricality', 'and', 'exaggerated', 'emotional', 'expression.'], ['7.'], ['Is', 'suggestible,', 'e.g.,', 'easily', 'influenced', 'by', 'others', 'or', 'by', 'circumstances.'], ['8.', 'considers', 'his', 'relationships', 'more', 'intimate', 'than', 'they', 'really', 'are.']]

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

178_94

[['QUESTION', 'TYPE:', 'HEMATOLOGY'], ['CLINICAL', 'CASE:'], ['18-month-old', 'boy,', 'with', 'complete', 'vaccination', 'schedule', 'to', 'date,', 'who', 'consults', 'the', 'Emergency', 'Department', 'for', 'swelling', 'of', 'the', 'right', 'knee', 'after', 'playing', 'in', 'the', 'park,', 'without', 'obvious', 'trauma.'], ['In', 'the', 'directed', 'anamnesis,', 'the', 'mother', 'refers', 'that', 'an', 'uncle', 'of', 'hers', 'had', 'similar', 'problems.'], ['The', 'ultrasound', 'examination', 'is', 'compatible', 'with', 'hemarthrosis', 'and', 'in', 'the', 'analysis', 'performed', 'only', 'an', 'APTT', 'lengthening', 'of', '52″', '(normal', '25-35″)', 'stands', 'out.'], ['What', 'is', 'the', 'most', 'likely', 'diagnostic', 'hypothesis?'], ['1-', 'Marfan', 'syndrome.'], ['2-', 'Von', "Willebrand's", 'disease.'], ['3-', 'Ehlers-Danlos', 'disease.'], ['4-', 'Hemophilia', 'A.'], ['5-', 'Bemard-Soulier', 'disease.'], ['CORRECT', 'ANSWER:', '4'], ['In', 'this', 'question', 'they', 'also', 'do', 'not', 'stop', 'dropping', 'clues', 'to', 'throw', 'us', 'headlong', 'into', 'the', 'correct', 'diagnosis.'], ["Let's", 'review:', 'a', 'small', 'child', 'who', 'suffers', 'a', 'hemarthrosis', 'without', 'clear', 'trauma.'], ['An', 'uncle', 'of', 'his', 'had', 'similar', 'problems,', 'so', 'we', 'suspect', 'hereditary', 'disease.'], ['The', 'APTT,', 'which', 'evaluates', 'the', 'intrinsic', 'coagulation', 'pathway', '(involving', 'factors', 'V,', 'VIII,', 'IX,', 'X,', 'XI', 'and', 'XII)', 'is', 'elongated.'], ['Hereditary', 'coagulation', 'problem.'], ['We', 'thus', 'discard', 'answers', '1,', '2', 'and', '5.'], ['We', 'are', 'left', 'with', 'von', "Willebrand's", 'disease', 'and', 'hemophilia', 'A.'], ['I', 'consider', 'that', 'the', 'correct', 'answer', 'is', '4,', 'hemophilia', 'A,', 'since', 'the', 'inheritance', 'pattern', 'is', 'X-linked', 'and', 'its', 'main', 'clinical', 'manifestation', 'is', 'soft', 'tissue', 'bruising', 'and', 'spontaneous', 'hemarthrosis,', 'without', 'apparent', 'trauma,', 'while', 'von', 'Willebrand', 'disease', 'is', 'characterized', 'by', 'bleeding', 'after', 'surgery', 'or', 'trauma', 'and', 'a', 'prolonged', 'bleeding', 'time', 'with', 'a', 'normal', 'platelet', 'count', 'is', 'characteristic', '(data', 'not', 'mentioned', 'in', 'the', 'statement).']]

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100_85

[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '24-year-old', 'man', 'reports', 'progressive', 'asthenia', 'for', 'at', 'least', '6', 'months,', 'hoarse', 'voice,', 'slow', 'speech,', 'drowsiness', 'and', 'swelling', 'of', 'the', 'hands,', 'feet', 'and', 'face.'], ['Examination:', 'pulse', 'at', '52', 'beats', 'per', 'minute,', 'abotarada', 'face', 'and', 'dry', 'and', 'pale', 'skin.'], ['CBC:', 'mild', 'anemia,', 'cholesterol', '385', 'mg/dL', '(normal', '<220),', 'creatinine', '1.3', 'mg/dL', '(normal:', '0.5-1.1),', 'negative', 'proteinuria,', 'TSH', '187μIU/mL', '(normal', '0.35-5.5)', 'and', 'Free', 'T4', '0.2', 'ng/dL', '(normal', '0.85-1.86).'], ['What', 'strategy', 'do', 'you', 'think', 'is', 'most', 'appropriate?'], ['1-', 'Perform', 'a', 'thyroid', 'ultrasound', 'before', 'starting', 'treatment.'], ['2-', 'Determine', 'free', 'T3', 'and', 'perform', 'a', 'pituitary', 'MRI.'], ['3-', 'Treat', 'with', 'L-triiodothyronine', 'and', 'a', 'statin.'], ['4-', 'Treat', 'with', 'L-Tyroxine', 'and', 'determine', 'antithyroid', 'antibodies.'], ['5-', 'Perform', 'thyroid', 'cytology', 'prior', 'to', 'treatment.'], ['CORRECT', 'ANSWER:', '4'], ['This', 'is', 'severe', 'primary', 'hypothyroidism.'], ['Treatment', 'is', 'with', 'thyroxine.'], ['If', 'there', 'is', 'no', 'nodule,', 'neither', 'echo', 'nor', 'FNA', 'is', 'indicated.']]

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

398_140

[['QUESTION', 'TYPE:', 'TRAUMATOLOGY', 'AND', 'ORTHOPEDICS'], ['CLINICAL', 'CASE:'], ['You', 'evaluate', 'a', '66-year-old', 'patient', 'with', 'groin', 'pain', 'accentuated', 'by', 'prolonged', 'standing', 'a', 'few', 'days', 'a', 'month.'], ['A', 'plain', 'radiograph', 'of', 'the', 'hips', 'shows', 'narrowing', 'of', 'the', 'femoroacetabular', 'joint', 'space,', 'sclerosis', 'and', 'osteophytes.'], ['What', 'is', 'your', 'approach?'], ['1-', 'I', 'make', 'the', 'diagnosis', 'of', 'coxarthrosis', 'and', 'send', 'to', 'the', 'traumatologist', 'to', 'place', 'a', 'hip', 'prosthesis.'], ['2-', 'Start', 'treatment', 'with', 'weak', 'opioids', 'that', 'have', 'shown', 'evidence', 'in', 'stopping', 'the', 'progression', 'of', 'the', 'disease.'], ['3-', 'I', 'insist', 'treatment', 'with', 'paracetamol,', 'explain', 'that', 'the', 'evolution', 'is', 'very', 'variable', 'and', 'the', 'surgical', 'indication', 'depends', 'on', 'the', 'functionality', 'and', 'pain', 'control.'], ['4-', 'Because', 'of', 'the', 'radiological', 'features', 'described,', 'I', 'need', 'a', 'hip', 'MRI', 'before', 'making', 'a', 'therapeutic', 'decision.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '3'], ['We', 'are', 'talking', 'about', 'a', '66-year-old', 'patient', 'with', 'pain', 'on', 'some', 'days,', 'pain', 'of', 'an', 'occasional', 'nature.'], ['Although', 'the', 'diagnosis', 'is', 'clearly', 'osteoarthritis,', 'it', 'does', 'not', 'lead', 'directly', 'to', 'a', 'surgical', 'indication.'], ['The', 'first', 'step', 'is', 'to', 'try', 'conservative', 'treatment', '(we', 'ruled', 'out', 'the', 'first', 'option).'], ['Osteoarthritis', 'is', 'a', 'degenerative', 'process', 'that', 'opioids', 'certainly', 'do', 'not', 'stop,', 'so', 'we', 'rule', 'out', 'option', 'two.'], ['Option', 'four', 'can', 'also', 'be', 'quickly', 'discarded:', 'the', 'statement', 'makes', 'the', 'diagnosis', 'and', 'treatment', 'to', 'follow', 'clear:', 'in', 'this', 'case', 'the', 'MRI', 'will', 'not', 'provide', 'us', 'with', 'any', 'information', 'of', 'interest.']]

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28_58

587_76

554_50

[['QUESTION', 'TYPE:', 'ENDOCRINOLOGY'], ['CLINICAL', 'CASE:'], ['A', '58-year-old', 'man', 'comes', 'for', 'a', 'scheduled', 'check-up', 'for', 'type', '2', 'diabetes', 'mellitus', 'diagnosed', '6', 'years', 'ago.'], ['He', 'has', 'a', 'personal', 'history', 'of', 'hypertension,', 'dyslipidemia,', 'ischemic', 'heart', 'disease', 'and', 'pancreatitis', 'of', 'biliary', 'origin.'], ['His', 'medication', 'includes', 'lisinopril,', 'metoprolol,', 'metformin,', 'ASA', 'and', 'atorvastatin.'], ['Physical', 'examination', 'showed', 'blood', 'pressure', '151/93', 'mmHg,', 'BMI', '27.1', 'kg/m2.'], ['Glycated', 'hemoglobin', 'is', '8.3%.'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'appropriate', 'treatment', 'for', 'this', 'patient?'], ['1-', 'Empaglifozin.'], ['2-', 'Glipizide.'], ['3-', 'Acarbose.'], ['4-', 'Sitagliptin.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Patient', 'with', 'obesity,', 'hypertension', 'and', 'increased', 'HbA1C.'], ['In', 'recent', 'studies,', 'Empaglifozin,', 'a', 'highly', 'selective', 'inhibitor', 'of', 'SGLT210,', 'significantly', 'reduces', 'AT,', 'HbA1C', 'and', 'BMI.'], ['Glipizide', 'is', 'of', 'the', 'sulfonylurea', 'group.'], ['Its', 'use', 'should', 'be', 'avoided', 'in', 'patients', 'with', 'heart', 'disease.'], ['Acarbose', 'can', 'interact', 'with', 'beta-blockers,', 'such', 'as', 'those', 'taken', 'by', 'our', 'patient.'], ['Sitagliptin', 'has', 'been', 'shown', 'to', 'decrease', 'HbA1C', 'but', 'not', 'HT', 'or', 'BMI.']]

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251_81

[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['A', '50-year-old', 'woman', 'comes', 'to', 'the', 'emergency', 'department', 'with', 'asthenia,', 'anorexia,', 'weight', 'loss,', 'jaundice,', 'fever', 'and', 'abdominal', 'pain.'], ['She', 'has', 'no', 'recent', 'history', 'of', 'blood', 'transfusion,', 'risky', 'sexual', 'contacts', 'or', 'addiction', 'to', 'parenteral', 'drugs.'], ['Habitual', 'consumption', 'of', '60', 'grams', 'of', 'alcohol', 'per', 'day', 'during', 'the', 'last', 'five', 'years,', 'consumption', 'that', 'has', 'increased', 'during', 'the', 'previous', 'month', 'due', 'to', 'family', 'problems.'], ['Temperature', '38.5ºC,', 'blood', 'pressure', '100/60', 'mmHg.'], ['Physical', 'examination', 'showed', 'temporal', 'and', 'spatial', 'disorientation,', 'malnutrition,', 'asterixis,', 'jaundice', 'and', 'painful', 'hepatomegaly.'], ['No', 'ascites', 'or', 'evidence', 'of', 'peritoneal', 'irritation.'], ['Laboratory', 'tests', 'include', 'leukocytes', '15,000/microliter', 'with', '90%', 'polymorphonuclear,', 'red', 'blood', 'cells', '3', 'million/mm3,', 'hemoglobin', '10g/dl,', 'mean', 'corpuscular', 'volume', '115', 'fl,', 'bilirubin', '15', 'mg/dl', 'direct', 'predominance,', 'AST', '(GOT)', '300', 'IU/L,', 'ALT', '(GPT)', '120', 'IU/L,', 'GGT', '635', 'IU/L,', 'prothrombin', 'time', 'prolongation', 'greater', 'than', '50%.'], ['What', 'is', 'the', 'most', 'likely', 'diagnosis', 'of', 'the', "patient's", 'condition?'], ['1-', 'Hepatic', 'abscess.'], ['2-', 'Acute', 'cholecystitis.'], ['3-', 'Acute', 'cholangitis.'], ['4-', 'Alcoholic', 'hepatitis.'], ['5-', 'Acute', 'pancreatitis.'], ['CORRECT', 'ANSWER:', '4'], ['Patient', 'with', 'harmful', 'alcohol', 'consumption', '(60g', 'and', 'female),', 'high', 'fever,', 'hepatic', 'encephalopathy', '(disorientation,', 'asterixis),', 'very', 'high', 'direct', 'bilirubin,', 'jaundice,', 'painful', 'hepatomegaly,', 'coagulopathy', '(elevated', 'prothrombin', 'time)', 'and', 'mild', 'elevation', 'of', 'transaminases', '(less', 'than', '5', 'times', 'the', 'upper', 'limit', 'of', 'normal)', 'suggest', 'acute', 'alcohol', 'hepatitis.']]

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128_79

[['QUESTION', 'TYPE:', 'NEUROLOGY', 'AND', 'NEUROSURGERY'], ['CLINICAL', 'CASE:'], ['A', '42-year-old', 'married', 'woman', 'with', '2', 'school-age', 'children', 'consults', 'her', 'family', 'physician', 'for', 'a', 'severe', 'headache', 'of', 'about', '7', "days'", 'evolution.'], ['Although', 'she', 'has', 'been', 'having', 'similar', 'episodes', 'for', 'more', 'than', 'a', 'year,', 'in', 'the', 'last', '2', 'months', 'they', 'have', 'worsened', 'considerably.'], ['The', 'pain', 'is', 'like', 'a', 'weight', 'that', 'starts', 'in', 'the', 'occipital', 'area,', 'spreads', 'to', 'both', 'temporal', 'regions', 'and', 'is', 'barely', 'relieved', 'by', 'taking', '650', 'mg', 'paracetamol', 'tablets,', 'so', 'she', 'requests', 'a', 'CT', 'scan', '(she', 'is', 'convinced', 'that', '"something', 'must', 'be', 'wrong', 'with', 'her', 'head").'], ['Which', 'of', 'the', 'following', 'is', 'the', 'most', 'plausible', 'cause', 'of', 'her', 'headache?'], ['1-', 'Migraine.'], ['2-', 'Vascular', 'disorders.'], ['3-', 'Temporal', 'artery', 'arteritis.'], ['4-', 'Tension.'], ['5-', 'Oncologic.'], ['CORRECT', 'ANSWER:', '4'], ['Just', 'as', 'last', 'year', 'they', 'wanted', 'to', 'paint', 'a', 'nurse', 'as', 'bad', 'for', 'waking', 'us', 'up', 'for', 'a', 'patient', 'with', 'myasthenia,', 'this', 'year', 'they', 'entertain', 'us', 'by', 'presenting', 'a', 'patient', 'asking', 'for', 'a', 'CT', 'scan.'], ['I', 'interpret', 'that', 'they', 'show', 'a', 'patient', 'stressed', 'by', 'her', 'children', 'with', 'recurrent', 'headaches', 'of', 'occipital', 'location', 'that', 'she', 'previously', 'relieved', 'with', 'a', 'low', 'dose', 'of', 'paracetamol', 'and', 'now', 'she', 'does', 'not.'], ['Both', 'the', 'initially', 'occipital', 'location,', 'the', '2-year', 'evolution', 'time,', 'and', 'the', 'sensation', 'of', 'weight', 'lead', 'to', 'answer', '4,', 'a', 'tension', 'headache.'], ['Migraine', 'and', 'vascular', 'disorders,', 'accompanied', 'by', 'other', 'neurological', 'symptoms', 'or', 'nausea,', 'photophobia,', 'etc.,', 'are', 'quickly', 'ruled', 'out,', 'as', 'well', 'as', 'the', 'rare', 'temporal', 'arteritis', 'before', 'the', 'age', 'of', '50', 'years.'], ['Tumor', 'headache', 'is', 'usually', '"in', 'crescendo",', 'not', 'recurrent', 'as', 'the', 'case', 'suggests,', 'and', 'is', 'accompanied', 'by', 'other', 'neurological', 'symptoms', 'or', 'intracranial', 'hypertension.']]

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0_34

[['QUESTION', 'TYPE:', 'DIGESTIVE'], ['CLINICAL', 'CASE:'], ['A', '27-year-old', 'woman', 'under', 'study', 'in', 'the', 'dermatology', 'department', 'for', 'recurrent', 'episodes', 'of', 'oral', 'aphthous', 'ulcers.'], ['She', 'was', 'referred', 'to', 'the', 'gastrointestinal', 'department', 'for', 'a', 'blood', 'test', 'showing', 'Hb', '11.5', 'gr/dl', 'Fe', '38', 'AST', '52', 'ALT', '64', 'Ac', 'antitrasglutaminase', 'IgA', '177.'], ['The', 'patient', 'reported', 'only', 'occasional', 'diffuse', 'abdominal', 'discomfort.'], ['She', 'reports', 'no', 'signs', 'of', 'hemorrhage', 'or', 'jaundice.'], ['The', 'physical', 'examination', 'is', 'normal.'], ['Which', 'of', 'the', 'following', 'tests', 'do', 'you', 'consider', 'to', 'be', 'the', 'most', 'appropriate', 'to', 'make', 'the', 'diagnosis?'], ['1-', 'Capsule', 'endoscopy.'], ['2-', 'Colonoscopy.'], ['3-', 'Serology', 'for', 'hepatitis', 'b', 'and', 'c', 'virus.'], ['4-', 'Intestinal', 'biopsy.'], ['5-', 'Abdominal', 'ultrasound.'], ['CORRECT', 'ANSWER:', '4'], ['In', 'this', 'question,', 'they', 'give', 'an', 'important', 'piece', 'of', 'information', 'when', 'it', 'comes', 'to', 'suspecting', 'a', 'diagnosis,', 'which', 'is', 'the', 'antitransglutaminase', 'antibodies', 'that', 'must', 'lead', 'you', 'to', 'suspect', 'celiac', 'disease.'], ['The', 'rest', 'of', 'the', 'symptoms', 'fall', 'perfectly', 'within', 'the', 'picture', 'and', 'although', 'probably', 'several', 'of', 'the', 'tests', 'that', 'it', 'says', 'will', 'be', 'done,', 'the', 'answer', 'that', 'will', 'give', 'us', 'the', 'diagnosis', 'is', '4', '(intestinal', 'biopsy).']]

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256_162

[['QUESTION', 'TYPE:', 'DIGESTIVE', 'SYSTEM'], ['CLINICAL', 'CASE:'], ['An', '80-year-old', 'woman', 'consults', 'for', 'presenting,', 'since', '1', 'month', 'ago,', 'a', 'progressive', 'increase', 'in', 'abdominal', 'perimeter.'], ['During', 'the', 'previous', '4-5', 'months', 'she', 'noted', 'asthenia,', 'anorexia', 'and', 'unspecified', 'weight', 'loss.'], ['Physical', 'examination', 'revealed', 'tension', 'ascites', 'and', 'malleolar', 'edema,', 'with', 'no', 'other', 'relevant', 'signs.'], ['An', 'ultrasound', 'and', 'CT', 'scan', 'of', 'the', 'abdomen', 'showed', 'the', 'presence', 'of', 'ascites,', 'of', 'homogeneous', 'density,', 'without', 'peritoneal', 'implants', 'or', 'abdominal', 'or', 'pelvic', 'masses.'], ['Liver,', 'pancreas,', 'adrenal,', 'spleen', 'and', 'kidneys', 'without', 'significant', 'findings.'], ['Paracentesis', 'is', 'performed', 'through', 'a', 'thick', 'needle,', 'obtaining', 'with', 'difficulty', 'a', 'somewhat', 'yellowish,', 'dense', 'and', 'gelatinous', 'fluid.'], ['What', 'is', 'the', 'most', 'probable', 'etiology?'], ['1-', 'Hydropic', 'decompensation', 'secondary', 'to', 'liver', 'cirrhosis.'], ['2-', 'Chylous', 'ascites', 'due', 'to', "non-Hodgkin's", 'lymphoma.'], ['3-', 'Peritoneal', 'tuberculosis.'], ['4-', 'Peritoneal', 'metastasis', 'of', 'adenocarcinoma.'], ['5-', 'Ascites', 'secondary', 'to', 'constrictive', 'pericarditis.'], ['CORRECT', 'ANSWER:', '2'], ['The', 'characteristics', 'of', 'the', 'fluid', 'described', 'are', 'milky,', 'i.e.,', 'chylous', 'ascitic', 'fluid.'], ['Taking', 'into', 'account', 'the', 'age', 'of', 'the', 'patient', 'and', 'the', 'constitutional', 'syndrome', 'described,', 'it', 'is', 'most', 'likely', 'to', 'be', 'a', "non-Hodgkin's", 'lymphoma', 'and', 'not', 'tuberculosis,', 'which', 'also', 'presents', 'with', 'chylous', 'ascitic', 'fluid,', 'since', 'there', 'is', 'no', 'mention', 'of', 'infectious', 'symptoms.'], ['The', 'rest', 'of', 'the', 'entities', 'offered', 'do', 'not', 'present', 'with', 'chylous', 'ascitic', 'fluid.']]

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604_113

[['QUESTION', 'TYPE:', 'TRAUMATOLOGY'], ['CLINICAL', 'CASE:'], ['A', '35-year-old', 'man,', 'a', 'letter', 'carrier,', 'with', 'no', 'history', 'of', 'interest,', 'who', 'comes', 'to', 'the', 'emergency', 'department', 'for', 'acute', 'cervical', 'pain', 'of', '24', 'hours', 'of', 'evolution,', 'without', 'previous', 'trauma,', 'which', 'radiates', 'to', 'the', 'left', 'arm', 'up', 'to', 'the', 'hand', 'and', 'is', 'accompanied', 'by', 'paresthesia', 'in', 'the', 'radial', 'border', 'of', 'the', 'forearm.'], ['She', 'presents', 'no', 'objectifiable', 'loss', 'of', 'strength,', 'preserves', 'neck', 'mobility', 'although', 'it', 'is', 'painful', 'and', 'contracture', 'of', 'the', 'paravertebral', 'musculature', 'is', 'appreciated.'], ['The', 'first', 'attitude', 'will', 'be:'], ['1-', 'Conservative', 'treatment', 'with', 'nonsteroidal', 'anti-inflammatory', 'drugs,', 'local', 'heat', 'and', 'relative', 'rest.'], ['2-', 'Urgent', 'call', 'to', 'the', 'neurosurgeon', 'for', 'surgical', 'evaluation.'], ['3-', 'Preferential', 'request', 'for', 'MRI', 'and', 'electromyogram.'], ['4-', 'Preferential', 'referral', 'to', 'outpatient', 'traumatology', 'consultations.'], ['5-', 'nan'], ['CORRECT', 'ANSWER:', '1'], ['Cervicalgia', 'without', 'alarm', 'signs.'], ['Conservative', 'treatment', 'with', 'a', 'success', 'rate', 'of', '75%-90%.']]

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362_96